Please help...biopsy nerve count is normal!
 

Hi again. Please can someone help me. I have had burning/tingling, etc. on the soles of my feet for years. I have a ton of other sfn symptoms. I just called the lab, and the lady said that my nerve count looks great. She said to call back on Wednesday and they will have the full pathologist report and he will go into detail and my see something abnormal but my nerve count looked perfect. I don't know what to think.

After years of being in pain and finally coming so close to finding out why, now it looks like I have no reason. Not that I wanted SFN. I'd just like to know what's going on. Can someone give me some input? Thank you.

When you call back, inquire about the morphology...the condition of the fibers. They should be checking for segmented, swollen, and/or tortuous fibers, etc, etc. Also ask for the actual numbers and percentile.

Did they do more then one site? Ask for detail on EACH site as they number may be different at the more distal location.

Thank you. The final path report will tell all of that. My neuro said he switched labs because this one actually looks at the condition of the nerves not just the count and the lady said that the report will be very detailed. I just did not think there would be any way my count would be normal since I've been dealing with the pain for so many years.

And I finally had hope for some kind of treatment and now I feel like I'm back to square one...not knowing.

Is there any way that I could have SFN with a normal nerve count ? if nerve conditions are normal, will the condition be ruled out ? thank you. I appreciate your help more than words can say!

In my opinion, yes you can have SFN with a normal nerve count and quality. I fall into this camp. My neurologists found damage to my arms during their physical exam. But when I had my punch biopsy on my legs, my results were normal (and I do have symptoms in my legs). There are a few others on this message board who are in this similar situation.

In my other online group, there are many people who fall into this camp as well. There was one individual today who posted about their punch biopsy results - the report stated they had SFN on a portion of their leg that didn't hurt, yet had a normal punch biopsy from a part of their leg that was burning and was tremendously painful. Other people had their 1st punch biopsy turn out normal and when they had it repeated one or two years later, it showed SFN.

It seems that punch biopsy results can be discordant with levels of pain and burning. At least that is what I'm observing from the message boards that I pay attention to.

Just wondering, maybe the structure of the nerves is normal but the problems is in their functionality ?

Did you have both sweat gland and Epidermal fiber tested with the skin biopsy?

The lab work should reflect the following procedures:

Epidermal Nerve Fiber Density (ENFD)
Sweat Gland Nerve Fiber Density (SGNFD)

Best to wait and see what the pathologist says before we try to speculate what/ifs.

Let us know when you get the detailed report.

I obviously have a problem with my nerves. I have crps2 and turn blue, chronic swelling etc...but my nerve test came back normal. So it does happen.:grouphug:

Hi Dreamer,

I am sure you had this looked at already but just in case...

Did anyone ever look at what was going on in your spine? Compression there can cause all kinds of crazy sensations in the sole of the foot. I'm also assuming they did NCS at some point?

:hug:

Yep...nothing that would cause this though. I do just have to wait for the rest of the results I guess:( what is the sweat test? I just had the biopsy. The lady just said the nerve count is normal. Thanks everyone.

Wow! Thanks. Hugs. Will update on Wednesday.

_dreamer_ : My neuro diagnosed me with SFN and a normal ENFD. I had greatly reduced SGNFD in my thigh and also an abnormal QSART test which he seemed to think was enough to make the judgement call.

Could the oral progesterone that I take affect the nerve biopsy results? thanks.

The nursing staff went through all my medications with me prior to the punch biopsy. I think they are concerned with any medication of an anti-inflammatory nature because it might change the way the sample looks under the microscope. Perhaps others could chime in...

Progesterone is a neuroprotective agent according to a quick search online. I just don't know whether it would affect small unmyelinated fibers. But when you talk to the lab tomorrow, you should ask them...this is a very good question for the pathologist.