[boiler1993]

Hi,

I have posted before about my symptoms of heart racing, painful sensations in my legs and arms (and sometimes trunk) (especially in the heat), and a few others (these are the main ones). Anyway I had a skin biopsy done and here were my results:

ENFD
Thigh -9.7 (cutoff 5% = 6.8 at thigh, 10% = 8)
Calf - 8 (cutoff 5% = 5.4, 10% = 5.7)

SGNFD
Thigh - 29.2 (below 5th % - cutoff = 37.8 )
Calf - 44.5 (cutoff 5% = 36.5)

I know the other values are considered normal but I have a few concerns:

1. I am only 19 and they said in the report that they dont have data for someone of my age but that my densties should be higher.

2. What percentile would these probably be considered? Are they still low?

3. The thigh is more reduced for its percentile than the calf and the report said "a greater reduction of the ENFD at the thigh than claf may indicate the presence of a multifocal sensory neuropathy or sensory neuronopathy" thoughts?

4. Any idea what percentile the calf SGNFD is?

THANK YOU SO MUCH!

[glenntaj]

--but that is not a very helpful criterion in these cases, as we don't know what your nerve fiber densities were you had symptoms--in other words, there is no 'normal, healthy baseline' to compare these to.

This is one of the big problems with the rather arbitrary cut-off of below 5th percentile and above 95th percentile for diagnosis of small-fiber neuropathy (I've written about this a number of times here); it's also why they are supposed to report the condition of the fibers they see under electron microscopy.

And, yes, the normed standards that originally came from Johns Hopkins were for the most part determined from people older than you, so that is another interpretive problem. It is know that normal nerve fiber density does decrease with age in general, but there is great individual variation.

It is interesting, though that the sweat gland nerve fiber density was apparently of lower percentile (if I'm reading this correctly). Small, unmyelinated fibers in the skin subsume the sensations of pain and temperature, but they also control the expression of many autonomic functions, such as sweating and blood pressure. These results would be consistent with some degree of small-fiber autonomic neuropathy.

Take a look at:

https://www.therapath.com/ENFD.php

[boiler1993]

On the website it says : "in sensory neuronopathies or multifocal neuropathies, it (ENFD) may be preferentially reduced proximally at the thigh ". Does this match my results (the thigh number is higher but more reduced based on the norms). Also I sent some questions to the lab about y age and the affects on the results including a question about the morphology of the fibers because it was not included in teh report.

Glenntaj - you said that my values were still low...do you have any idea what a normal range for these areas (thigh and calf) are? also when you say that the SGNFD could "indicate small-fiber autonomic neuropathy" do you think that it could also indicate purely SFN?
thank you so much

[mg neck prob]

[Boiler Im sorry I havent got back with you--- I know Glenn is much more versed then me ---all i know I was postive and since that time I have had -- my neck and cancer-- this issues took a back seat and so did my memory(lol) about what the % mean. I hope Glenn or someone here can get you the info u need . I tried to find my orginal path report this weekend so far cant locate it to compare.

[boiler1993]

mg - any thoughts on the numbers?

[mg neck prob]

Originally Posted by boiler1993

mg - any thoughts on the numbers?

Here is just my thought and I could be wrong but I have a little more background of you-- then others -- now your qsart test for sweat came back abnormal and with your previous symptoms like heart racing and you rest pulse being high to me indicates a form of neuropathy even if its not sfn its does seem automonic neuropathy ---example damage to the nerve that supply the blood would effect blood pressure and body temp...i forgot does ur blood pressure change via sitting or standing?--- I also remember u had a problem at movies --with your resting heart rate 2. I know u execise do u get any unusal shortness of breath when you do ? You heart rythms can be faster or slower with this too. Hopefully --Glenn chimes into to help me here a bit. Have u been lossing any weight without trying. What does you DR say??