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.
Helping the body regrow nerves Science Nation
â™«MUSICâ™« MILES O'BRIEN: Combat, cancer and accidents all can cause devastating nerve injuries. Sometimes, the body heals on its own. CHRISTINE SCHMIDT: Your peripheral nerves are the ones in the arms and the face, have an inherent ability to regenerate but only under ideal circumstances. MILES O'BRIEN: With support from the National Science
Foundation, University of Florida Biomedical Engineer Christine Schmidt is working to restore nerve function when injuries are more complicated. SURGEON: Took that muscle and rotated it, took it over the back of his elbow to cover â€“ MILES O'BRIEN: Surgeons can sometimes move a nerve from one part of a patient's body to another. Schmidt has developed a method that grafts cadaver tissue onto the damaged area to
act as a scaffold for nerves to regrow themselves. CHRISTINE SCHMIDT: Basically what we're doing is removing all the cellular material that would cause rejection but leave behind the native architectures. You're putting this graft into the site of injury. And now, that graft is providing a scaffold for your blood vessels to grow in. And then once you have that recellerization your nerve fibers can then regrow, so then, ultimately regain that muscle function.
MILES O'BRIEN: Navy Veteran Edward Bonfiglio, wounded in Afghanistan, faced the prospect of an amputation. A graft was a welcome option. The company, AxoGen, distributes the grafts, which were developed based on work done in Schmidt's lab. JILL SCHIAPARELLI: And his family pressed the s to say, quot;Are there any alternatives?quot; He was a young, healthy, vibrant guy. And they had a great surgeon at Walter Reed who was willing to work with them to find those options.
CHRISTINE SCHMIDT: This is some of the micronized nerve that you're working with. MILES O'BRIEN: Schmidt and her team are also looking at other approaches to directly stimulate nerve growth using natural sugar molecules found in the body as building blocks, eliminating the need to transplant tissue. CHRISTINE SCHMIDT: So you don't have to actually take it from somebody's body. You can grow it.
MILES O'BRIEN: While the ultimate goal in nerve regeneration is reversing paralysis, Schmidt says intermediate successes, like improving lung or bladder function, can be invaluable to patients and their families. CHRISTINE SCHMIDT: So rather than saying we're going to try to tackle this humongously complex beast and try to get the patient to necessarily be exactly like they were before, why not provide some function that will have merit
Peripheral Nervous System Disorders Diagnosis and Treatment
The peripheral nervous system is the partof the nervous system that excludes or is outside of the brain and the spinal cord.We take care of patients that have disorders that affect the motor neurons, which livein the spinal cord â€“ the peripheral nerves that extend out into the arms and legs aswell as the muscles and the connection between the nerves and the muscles. Some of the disordersthat a nerve and muscle a disease specialist will evaluate and develop care plans for includemuscle disorders such as muscular dystrophy, polymyositis, dermatomyositis, peripheralneuropathies such as Charcot Marie Tooth disease or hereditary neuropathy and as well as theneuromuscular junction disorders such as myasthenia
gravis. Some symptoms that can be associatedwith the peripheral nervous system include generalized weakness, fatigue, numbness, tingling,sometimes pain can be caused by disorders of the peripheral nerve. The evaluation ofa patient with a possible peripheral nervous system disorder first begins with the verycareful history to understand how the symptoms started and how they affect the patient. Fromthe history we extend to the physical exam, which helps us determine what sort of deficitsmay be impacting the patient's function. From there we design a targeted testing strategyto to try to pinpoint exactly what's causing the symptoms. It's a very exciting time inneuromuscular medicine because the more we
understand about how these diseases occur,the more that we can develop very targeted, personalized treatments to help either stopor reverse the disease. In many cases there may not be a specific cure but we can reducethe symptoms through a comprehensive treatment plan.