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Neurophysiological studies of thin myelinated (A delta) and unmyelinated (C) fibers: application to peripheral neuropathies.
Neurophysiol Clin. 2000 Feb; 30(1):27-42.NC

Abstract

Dysfunction of small fibers may appear in isolation or associated with large fiber lesions. In some acute neuropathies, such as pandysautonomia, small-fiber impairment is relatively pure but it may also appear in disorders with prominent somatic damage, such as Guillain-Barré syndrome, in which autonomic failure worsens the prognosis. At the present time, chronic idiopathic distal small-fiber neuropathy is diagnosed more frequently, and in some prevalent disorders, such as diabetic or amyloidotic polyneuropathies, small-fiber dysfunction is very noticeable. In pure autonomic failure, a peripheral autonomic failure exists, distinguishing it from multiple-system atrophy. Complex regional pain syndrome is a severe condition in which small fibers are responsible for disabling signs and symptoms, and only instrumental recordings lead to the proper treatment. Standard neurophysiological techniques evaluate large myelinated fibers exclusively. Small-fiber polyneuropathy has been considered as a type of somatic neuropathy, but thin myelinated and unmyelinated fibers are responsible not only for temperature and pain perception but also autonomic function. For instance, full autonomic evaluation is needed in some clinical situations such as autonomic failure in the elderly or orthostatic intolerance syndrome. To evaluate small-fiber impairment we need a battery of sensitive, reproducible, specific and noninvasive tests covering somatic and autonomic systems. In this review, we describe and analyze a number of neurophysiological techniques used to diagnose and characterize small-fiber dysfunction in humans. These include cardiovascular monitoring, sudomotor testing, pupillary responses and quantitative sensory tests, and also to some extent thermography and laser evoked potentials. The use of such techniques has proven useful not only for diagnosis, but also to guide adequate therapy and optimize follow-up.

Authors+Show Affiliations

Department of Neurophysiology, La Paz General Hospital, Madrid, Spain.No affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

10740794

Citation

Santiago, S, et al. "Neurophysiological Studies of Thin Myelinated (A Delta) and Unmyelinated (C) Fibers: Application to Peripheral Neuropathies." Neurophysiologie Clinique = Clinical Neurophysiology, vol. 30, no. 1, 2000, pp. 27-42.
Santiago S, Ferrer T, Espinosa ML. Neurophysiological studies of thin myelinated (A delta) and unmyelinated (C) fibers: application to peripheral neuropathies. Neurophysiol Clin. 2000;30(1):27-42.
Santiago, S., Ferrer, T., & Espinosa, M. L. (2000). Neurophysiological studies of thin myelinated (A delta) and unmyelinated (C) fibers: application to peripheral neuropathies. Neurophysiologie Clinique = Clinical Neurophysiology, 30(1), 27-42.
Santiago S, Ferrer T, Espinosa ML. Neurophysiological Studies of Thin Myelinated (A Delta) and Unmyelinated (C) Fibers: Application to Peripheral Neuropathies. Neurophysiol Clin. 2000;30(1):27-42. PubMed PMID: 10740794.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Neurophysiological studies of thin myelinated (A delta) and unmyelinated (C) fibers: application to peripheral neuropathies. AU - Santiago,S, AU - Ferrer,T, AU - Espinosa,M L, PY - 2000/3/31/pubmed PY - 2000/5/8/medline PY - 2000/3/31/entrez SP - 27 EP - 42 JF - Neurophysiologie clinique = Clinical neurophysiology JO - Neurophysiol Clin VL - 30 IS - 1 N2 - Dysfunction of small fibers may appear in isolation or associated with large fiber lesions. In some acute neuropathies, such as pandysautonomia, small-fiber impairment is relatively pure but it may also appear in disorders with prominent somatic damage, such as Guillain-Barré syndrome, in which autonomic failure worsens the prognosis. At the present time, chronic idiopathic distal small-fiber neuropathy is diagnosed more frequently, and in some prevalent disorders, such as diabetic or amyloidotic polyneuropathies, small-fiber dysfunction is very noticeable. In pure autonomic failure, a peripheral autonomic failure exists, distinguishing it from multiple-system atrophy. Complex regional pain syndrome is a severe condition in which small fibers are responsible for disabling signs and symptoms, and only instrumental recordings lead to the proper treatment. Standard neurophysiological techniques evaluate large myelinated fibers exclusively. Small-fiber polyneuropathy has been considered as a type of somatic neuropathy, but thin myelinated and unmyelinated fibers are responsible not only for temperature and pain perception but also autonomic function. For instance, full autonomic evaluation is needed in some clinical situations such as autonomic failure in the elderly or orthostatic intolerance syndrome. To evaluate small-fiber impairment we need a battery of sensitive, reproducible, specific and noninvasive tests covering somatic and autonomic systems. In this review, we describe and analyze a number of neurophysiological techniques used to diagnose and characterize small-fiber dysfunction in humans. These include cardiovascular monitoring, sudomotor testing, pupillary responses and quantitative sensory tests, and also to some extent thermography and laser evoked potentials. The use of such techniques has proven useful not only for diagnosis, but also to guide adequate therapy and optimize follow-up. SN - 0987-7053 UR - https://www.unboundmedicine.com/medline/citation/10740794/Neurophysiological_studies_of_thin_myelinated__A_delta__and_unmyelinated__C__fibers:_application_to_peripheral_neuropathies_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0987-7053(00)88865-6 DB - PRIME DP - Unbound Medicine ER -