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Plantar nerve AP and skin biopsy in sensory neuropathies with normal routine conduction studies.
Neurology. 2004 Sep 14; 63(5):879-85.Neur

Abstract

OBJECTIVE

To assess the medial plantar nerve action potential (NAP) and skin biopsy in the evaluation of suspected distal sensory neuropathies (SN) with normal routine nerve conduction studies (NCS).

METHODS

A total of 110 consecutive patients with suspected distal SN and normal routine NCS underwent medial plantar NAP testing and punch skin biopsy. Patients were clinically stratified as having pure small fiber sensory neuropathy (SFSN), or distal SN with large fiber involvement (SN-LFI).

RESULTS

A total of 56 patients were classified as SN-LFI and 54 SFSN. The medial plantar NAP, a measure of large fiber function, was abnormal in 31.8% of patients, more frequently in SN-LFI than SFSN. Distal leg epidermal nerve fiber (ENF) density, a measure of small fibers, was reduced in 47.3% of biopsies, with isolated ENF morphologic changes in 29.1% and normal findings in 23.6%. Biopsy abnormalities were more severe and prevalent in SN-LFI than in SFSN. In patients with a normal medial plantar NAP, distal leg biopsy showed reduced ENF density in 34.7%, and isolated morphologic changes in a further 37% of cases.

CONCLUSIONS

The medial plantar nerve action potential and skin biopsy are complementary in evaluation of distal SN with normal routine NCS. Small sensory nerve fibers are affected early in SN, and more severely so when large fiber involvement is apparent clinically.

Authors+Show Affiliations

Department of Neurology, University of Rochester, NY, USA. david_herrmann@urmc.rochester.eduNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Evaluation Study
Journal Article

Language

eng

PubMed ID

15365140

Citation

Herrmann, D N., et al. "Plantar Nerve AP and Skin Biopsy in Sensory Neuropathies With Normal Routine Conduction Studies." Neurology, vol. 63, no. 5, 2004, pp. 879-85.
Herrmann DN, Ferguson ML, Pannoni V, et al. Plantar nerve AP and skin biopsy in sensory neuropathies with normal routine conduction studies. Neurology. 2004;63(5):879-85.
Herrmann, D. N., Ferguson, M. L., Pannoni, V., Barbano, R. L., Stanton, M., & Logigian, E. L. (2004). Plantar nerve AP and skin biopsy in sensory neuropathies with normal routine conduction studies. Neurology, 63(5), 879-85.
Herrmann DN, et al. Plantar Nerve AP and Skin Biopsy in Sensory Neuropathies With Normal Routine Conduction Studies. Neurology. 2004 Sep 14;63(5):879-85. PubMed PMID: 15365140.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Plantar nerve AP and skin biopsy in sensory neuropathies with normal routine conduction studies. AU - Herrmann,D N, AU - Ferguson,M L, AU - Pannoni,V, AU - Barbano,R L, AU - Stanton,M, AU - Logigian,E L, PY - 2004/9/15/pubmed PY - 2005/4/9/medline PY - 2004/9/15/entrez SP - 879 EP - 85 JF - Neurology JO - Neurology VL - 63 IS - 5 N2 - OBJECTIVE: To assess the medial plantar nerve action potential (NAP) and skin biopsy in the evaluation of suspected distal sensory neuropathies (SN) with normal routine nerve conduction studies (NCS). METHODS: A total of 110 consecutive patients with suspected distal SN and normal routine NCS underwent medial plantar NAP testing and punch skin biopsy. Patients were clinically stratified as having pure small fiber sensory neuropathy (SFSN), or distal SN with large fiber involvement (SN-LFI). RESULTS: A total of 56 patients were classified as SN-LFI and 54 SFSN. The medial plantar NAP, a measure of large fiber function, was abnormal in 31.8% of patients, more frequently in SN-LFI than SFSN. Distal leg epidermal nerve fiber (ENF) density, a measure of small fibers, was reduced in 47.3% of biopsies, with isolated ENF morphologic changes in 29.1% and normal findings in 23.6%. Biopsy abnormalities were more severe and prevalent in SN-LFI than in SFSN. In patients with a normal medial plantar NAP, distal leg biopsy showed reduced ENF density in 34.7%, and isolated morphologic changes in a further 37% of cases. CONCLUSIONS: The medial plantar nerve action potential and skin biopsy are complementary in evaluation of distal SN with normal routine NCS. Small sensory nerve fibers are affected early in SN, and more severely so when large fiber involvement is apparent clinically. SN - 1526-632X UR - https://www.unboundmedicine.com/medline/citation/15365140/Plantar_nerve_AP_and_skin_biopsy_in_sensory_neuropathies_with_normal_routine_conduction_studies_ L2 - http://www.neurology.org/cgi/pmidlookup?view=long&pmid=15365140 DB - PRIME DP - Unbound Medicine ER -