I was initially referred to a neurologist because it was suspected that I may have small fibre neuropathy. I've had nerve conduction studies and EMG and a brain MRI (the latter of which I've not had results for but I expect them to be normal).

I've not yet seen the neuro for a follow up but I did get the letter from the dr who did the nerve tests. He said "no evidence of small fibre neuropathy" which confused me as neuro said a skin biopsy is the only way to draw a formal conclusion. The letter said I have peroneal nerve damage, likely from my mechanical ankle problems that I've had since childhood. It is possible to conclude the cause of my nerve problems based on my history? The dr is a renowned neurophysiologist who is very experienced and he talked to me in depth before and during the nerve tests, wanting to know my medical history and current symptoms.

On a positive note, I've been slowly increasing my gabapentin (it was giving me headaches and blurred vision when I first tried to increase it) and I've had a considerable improvement in my nerve symptoms. I assume this ties in with neuropathy that was caused by a nerve injury?

Thanks in advance.

--improvement in symptoms with increasing gabapentin dose wouldn't indicate a possible cause or location of the neuropathy; gabapentin is not only used for peripheral symptoms but for spinal nerve root (radiculopathy) pain/parastheses, as well as for treatment of seizures, its original indication. And certainly it is a good thing if it helps keep your symptoms in check.

And, yes, the gold standard for determination of small fiber neuropathy, at least currently, is a skin biopsy to evaluate and enumerate small, unmyelinated fibers that subsume the sensations of pain and temperature.

The fact that the report says you have peroneal nerve damage must mean that some disruption of signal was found in that nerve distribution, but that is a large, myelinated fiber finding, as EMG and nerve conduction studies cannot measure the very tiny unmyelinated nerves. It's certainly possible that is a symptom cause--although no one is exempted from being co-morbid--having more than one cause contributing to symptoms. I, for example, have both small-fiber problems and cervical spine nerve root compression that I am trying to avoid surgery for, and both contribute to my upper body symptoms, particularly in my right hand.

I have severe small fiber neuropathy finally confirmed through skin punch biopsy above my right ankle.

When this pain in my feet started I went to my PCP and she ran the 'regular' tests for neuropathy which are the tests u have had run.

When they were all normal I asked my foot and ankle Dr to do a skin biopsy which came back positive and severe. Thank goodness this only took me 4 months to get a DX.

Mine was from chemotherapy and being prediabetic during chemo.

Not sure this will help u but the more people comment the better I say. Lol

Debi From Georgia.

PS. Working on my tablet vs my laptop. Please excuse any errors.