Skin biopsy
 

Scheduled for a skin biopsy on 7/26. Just wondering what to expect during the procedure and what happens afterwards. Can anyone share their experiences? Thanks

Skin biopsy--
 

--is, fortunately, one of the most benign procedures you'll probably ever experience.

At each location from which a sample is to be taken, you will be given a shot of a local anesthetic, such as xylocaine--which will probably be the only discomfort you will experience (it sometimes burns a bit going in). Then, after a few minutes to give that time to numb the areas, small, 3mm diameter circles of skin will be carved out (usually to a depth of 1 mm) of each. Normally, samples are taken at the ankle and thigh, and sometimes the lower and upper arms (this is to check for the nerve fiber "length-dependency" of many suspected neuropathies).

You will bleed a little from each sample, but since the smaples are small this will stop quickly with some pressure and gauze. Normally, a band-aid on each spot is all that is needed--the samples are too small to require stitches. You'll probably be given instructions to keep the bandages on for a while and some care instructions that may include a topical admnistration of local antibiotic ointment once they come off, just as precuation.

It normally takes a while before you get results; what is looked for is intraepidermal nerve fiber density and the condition of those nerves (compared with "normal" controls). Significantly reduced density, or abnormal swelling/branching of fibers, often points to a small-fiber neuropathy, though cause is rarely revealed by skin biopsy.

I've had this done four times--I'm followed for research purposes--and my skin biopsies (after the first one, which showed major reduction in density and abnormal branching/swelling) have shown slow re-enervation over the years. The procedure is so ho-hum I'd let them do it every month if they felt it necessary.

I thought it was a simple procedure compared to everything else! Very easy. I am glad you are getting it.

Glenn, I have only had it once. I would love to get it again and also have proximal sites done. I want to see how things are affected proximally. I wonder if my deltoid sample would show the 'fibro' type pattern.

glenntaj,
What are you doing to cause the re-enervation (healing).

FYI--When I went to Mayo Clinic in Rochester in 2007 they told me that they normally don't do the skin biopsy anymore because they can obtain the same info from other tests that indicate small fiber neuropathy. I believe this would be the vibration, cold sensation, and heat-pain sensation. My cold and heat-pain were abnormal so they concluded probably small fiber neuropathy.
Electron

Well, Mayo--
 

--has never been a fan of skin biopsy--I suspect it's at least partly becasue they didn't come up with it or play a big role in its development. (Mayo tends to be very competitive with Hopkins, Cleveland Clinic, Columbia Presbyterian, etc., and skin biopsy was developed at Hopkins with assistance from Columbia and Mass General).

There are other tests, as you've mentioned, that can reveal small-fiber neuropathy, but the skin biopsy has come to be the current "gold standard" as presence of reduced intraepidermal nerve fiber density rather definitively points to neuropathy. The other tests rely more on patient self-reporting, and while sensitive are not as specific--abnormal results on many of them can be from small-fiber neuropathy but also from other syndromes.

As far as what I'm doing to get re-enervation--supplements, exercise, and time. Nerve fibers can regenerate given the proper conditions, especially when the neuropathy is acute onset, as mine was. No cause has ever been found for mine, though an autoimmune molecular mimicry process is suspected. In many such acute neuropathies, the process is monophasic--the theory is that once the immune system wipes out all the targets, the process stops. Still, that's no to say I'm asymptomatic (though better than at the height of this in 2003)--I'm still prone to "flares" and the regrwoth of nerve fibers in new patterns means I'm prone to parastheses and other weird symptoms by any number of compressive forces--even muscle-building from weightlifting!

I'm not sure, but I don't think that Mayo does the testing for the skin biopsies anymore. They don't do it in their labs, I mean.
From many posts I've read over the last 12 or so years, Mayo is on the list of the good places to go for PN evaluation & testing, but...... it seems to be on the bottom of the list. Preferences for other centers seem to be higher and experiences at Mayo seem to be left wanting, in many posts.
Cornell-Weill, Cleveland Clinic, Johns Hopkins, Jack miller Center to name a few, seem to get a higher experience and test rating than Mayo.

Cleveland Clinic....a good place to go.
 

Cleveland Clinic seems to be a good place to go for folks like us. I researched their physicians and found one that is a neurologist and a specialist in neuromuscular disorders. He actually specializes in autoimmune/ inflammatory polyneuropathies so hopefully I am in good hands. My neuro at IU wouldn't even consider a skin biopsy, this doc at CC actually suggested it. The problem is that I am a "get er done" kind of person and waiting 6 weeks for appointments is driving me nuts!!:Doh:

One of the neurologists I saw dissuaded me from getting this because he said it wouldn't tell us what the cause is and wouldn't affect my treatment. It made sense to me at the time. I'm confused now...what is the point to doing it?

From reading posts, I am NOT that impressed with Mayo. I do know of one center not far from Mayo from those in the Midwest, Great Lakes area that does do skin biopsy and also has an autonomic center. I have gotten care there for 6 years and am pretty satisfied. If any one needs a center in the western Great Lakes area, you can PM me.

The point of doing it for many people seems to be for confirmation that they have small fiber neuropathy. Many people with small fiber neuropathy have been told by doctors along the way that it is all in their head or from stress. Also people may need the confirmation of the small fiber neuropathy for use in disability cases, ssdi or ltd. You can also keep track over time with additional biopsies as to the direction you are going. getting better or getting worse or staying the same. It would seem to be useful for peace of mind as to finally know what is going on with yourself.

EEG's & MRI's will only show large fiber disturbances in the tissues.
If these are 'normal' and show no problems, the gold standard for small fiber
damage confirmation is the skin punch biopsy. I have one done every 3-4 years to check on the level of damage.
I've been able to keep it in check without significant additional damage for the last 6-8 years.

My neuro first diagnosed me by saying:
I've good news & bad news.......
the good is that you are continuing to grow new small fibers.
The bad is that your neuropathy/fiber destruction is faster than the new growth.
If we can halt progression, the new may just catch up, someday.

Knowing what type of neuropathy (mine is sensory, length dependent, axonal, small fiber, polyneuropathy) does affect the type of treatment, to some extent.

My diagnosis is pretty much the same as yours, Bob, except I have not heard "length dependent" but I have heard "demyelinating." What type of treatments have been tried for you? I am hoping that there is something that will come from my next visit at CC as I am not ready to throw in the towel on my career. I spent too many years in college to give up on something I am so passionate about :-(

New member seeking advice
 

I am new to this site. I have posted a thread asking for advice about the next step to take in my treatment. The local neurologist I visited only did a very simple sensory test - I would like to find someone with more resources and suggestions for treatment. I live in the Southeast - do you have any knowledge of local centers - Vanderbilt in TN or the New Orleans center? I would like to get the best answer possible - my neuropathy is due to a single event not due to diabetes. I would appreciate any info you could give. Thank you for sharing your journeys.

I don't know the proper terms, but the length dependant has something to do with the distance from the CNS. Feet & hands are at the greatest length or distance.
Demyleinating is when the myelin sheath is deteriorating. Many small fibers don't have a sheath, just an axon- so.... 'axonal' rather than "demyelinating".

Treatment?
Just meds and supplements is all they (at Hopkins) seem to be able to do for my problems. I sometimes think that I've been more instrumental in my aggressiveness to my treatment, than they have.

Skin Biopsy
 

Hi, kpRN -

The skin biopsy procedure is really rather benign. It is done by the punch method, same leg, either two or three sites starting just above the ankle and ending at the upper thigh. Really doesn't hurt, but the instructions for aftercare done by you is at home is important to prevent infection.

Mine was positive for non-length dependent small fiber neuropathy, and I have Sjogren's Syndrome where this type of neuropathy can occur.

Good luck,

Sheltiemom

lip and leg biopsy
 

I had 3 done- lip, foot and upper leg. upper leg now numb. n6 to 8 inches around site. foot dead around site. do pain. BUT the lip bio, they go deep. aIt broke open 3rd day and they told that it would not pay to sew it up.
So now I have a big scar on inside of lip and at times it hurts like hell

I also had 2 operations for my sleep apnea---UPPP- most painful.
upper and lower jaws broken ans extended10cm out I breath a weeeeeebit betteer but my face hurts as much as my feet. Which caused me to try all the drusg on the market. I always stay with methdone 60 to 120 mg per day and 40 mg 0f hydrocodo and what ever is hot6 at the time But you got to try
good Luck hm

Your effects--
 

--sound very unusual--first time I've ver heard of that much spreading numbness--was it a SKIN biopsy?

Skin biopsies for small-fiber neuropathies involve very shallow samples--generally only about 1mm deep and 3mm in diameter (smaller than a pencil eraser). The biopsy sites are small enough to be covered by a little round band-aid.

Cowboy is confused
 

[QUOTE=glenntaj;670094]--has never been a fan of skin biopsy--I suspect i

In many such acute neuropathies, the process is monophasic--the theory is that once the immune system wipes out all the targets, the process stops.

*** Can you describe what you mean by an "acute" neuropathy? I've always thought "acute" meant sudden. Mine developed slowly (maybe 4 years of the tingling before I got around to investigating). And I know my condition is now "chronic". [But perhaps was triggered by acute potassium and B12 deficiencies.]

CB:confused::confused::confused:[/I][/I]

Is the lip biopsy a labial salivary gland biopsy? Is that possibly what they did? That doesn't sound like a biopsy for nerve density.

I had a muscle biopsy, that was deep....

Skin biopsy for nerve fiber density, which I also had, was done at 4 sites and was superficial, a punch biopsy similar to a mole removal. It was very easy compared to most of my procedures. They just clean the area, numb it and they do a punch. Mine was done at the medial area of the ankle, medially, just behind the knee, inner thigh and fore arm, near the elbow-medially. It is not anything to even worry about. My results took 6 weeks.

Lip biopsy for a salivary gland IS painful and does take a few weeks to heal. I had that done to. They look at those for Sjogren's and for Amyloidosis.