Small Fiber Neuropathy Symptoms Diagnosis and Treatment
Small fiber neuropathy is really an interestingcondition because it consists typically of just burning, numbness, pain of the feet,sometimes the hands later on without necessarily having any abnormalities on your EMG or nerveconduction study. So what I tell patients and actually residents or students who trainunder us is that a normal nerve conduction study does not exclude a neuropathy. And wewill confirm this by doing additional testing, specifically the nervous the the examinationat the bedside asking patients about their symptoms, for example, loss of sensation tocool or or hot temperatures, loss of pain sensation and also doing skin biopsies wherewe look at nerve densities in the skin both
from the calf and the thigh as well as doinga special test that looks at sweat function both in your foot in in the legs as well asthe feet to gauge the level of small fiber nerve damage. Small fiber neuropathy typicallywill progress unless the underlying cause is identified and reversed. Diabetes of coursebeing the most common cause is always screened for. But once the more common causes are excludedand the focus becomes on excluding any underlying secondary disease process but also controllingpain because if patients' symptoms of pain are generally controlled they tend to do prettywell and really have no other major functional deficits. I've really become interested overthe years is how interconnected neurology
and rheumatology are and one thing I oftendo on patients who have unexplained small fiber even autonomic neuropathy is have themsee rheumatology or get evaluated for connective tissue disorders like lupus or Sjogren's orsarcoid and sometimes even if we are not directly involved in treating the patients, this canbe the first sign of an underlying connective tissue disorder that can then be brought tothe attention of rheumatology and addressed from their standpoint.
Fluoroquinolones and Peripheral Neuropathy
Peripheral neuropathy, this is an often devastatingcondition in which people develop pain and numbness in their hands and feet. Basicallythey're told on the evening news that they should be taking this or that medication sothat they can get through life. That's treating the smoke and ignoring thefire. Those medicines that you're seeing advertised don't treat the neuropathy, they only treatthe symptoms. But what's causing peripheral neuropathy? Well we know that in America,one of the biggest causes of peripheral neuropathy is being diabetic, which is clearly relatedto the foods that you eat by and large. Becoming a type 2 diabetic dramatically increases yourrisk for having peripheral neuropathy and
in fact being devastated by it. This is adisease that effects 1 in 15 Americans. Let's take a look. So again this is 1 in 15 Americansâ€”thisis 20 million Americans afflicted by this disease, that aside from diabetes, we're toldthe cause is unknown. Well maybe that's not exactly true. Last month, in the journal Neurology,an incredible study was published describing a relationship between what are called fluoroquinolones,and the risk of developing a peripheral neuropathy. You may not know what fluoroquinolones are,but chances are you may have actually been exposed to fluoroquinolone. These are antibioticsused for treating things like upper respiratory
infections and even urinary tract infections.Things like Levaquin and Cipro are commonly used in walk in s. If you have a urinarytract infection, you may have received these mediations. Well, here's what the study showedus: So this is a study published in September2014 that looked at men between age 45 to 80 years of age followed for a 10 year periodand in this group there were over 6,000 cases of peripheral neuropathy. And they comparedthese individuals to about 25,000 aged match controls, and what they found was that riskfor developing this devastating condition called peripheral neuropathy was doubled inthose individuals exposed to this class of
antibiotics called fluoroquinolones. And whatthe researchers also told us is that, and I quote, quot;Fluoroquinolones have been shownto neurotoxic. Oral fluoroquinolones have also been associated with reported cases ofpsychosis and seizures, which similar to peripheral neuropathy have been shown to be acute eventsoccurring within days of fluoroquinolone use. In light of strong evidence of unnecessaryprescribing of oral fluoroquinolones in the United States, ians must weigh the riskof PN against the benefits of prescribing FQ when prescribing these drugs to their patients.quot; We've got to practice medicine under the dictumof quot;above all do no harm.quot; One of our most
well respected peer review journals is nowtelling us that the use of these medicationsâ€”these fluoroquinolone antibiotics is associatedwith doubling of the risk of peripheral neuropathy. A disease which often is not treatable. Sokeep that in mind the next time you think you need an antibiotic for this or that problem,discuss this study with your treating physician. I'm David Perlmutter.