Small fiber neuropathy is really an interesting condition 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 nerve conduction study. So what I tell patients and actually residents or students who train under us is that a normal nerve conduction study does not exclude a neuropathy. And we will confirm this by doing additional testing, specifically the nervous the the examination at the bedside asking patients about their.
Symptoms, for example, loss of sensation to cool or or hot temperatures, loss of pain sensation and also doing skin biopsies where we look at nerve densities in the skin both from the calf and the thigh as well as doing a special test that looks at sweat function both in your foot in in the legs as well as the feet to gauge the level of small fiber nerve damage. Small fiber neuropathy typically will progress unless the underlying cause is identified and reversed. Diabetes of course being the most common cause is always screened.
For. but once the more common causes are excluded and the focus becomes on excluding any underlying secondary disease process but also controlling pain because if patients’ symptoms of pain are generally controlled they tend to do pretty well and really have no other major functional deficits. I’ve really become interested over the years is how interconnected neurology and rheumatology are and one thing I often do on patients who have unexplained small fiber even autonomic neuropathy is have them see rheumatology or get evaluated for connective.
Peripheral Nervous System Disorders Diagnosis and Treatment
The peripheral nervous system is the part of 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 live in the spinal cord the peripheral nerves that extend out into the arms and legs as well as the muscles and the connection between the nerves and the muscles. Some of the disorders that a nerve and muscle a disease specialist will evaluate and develop care plans for include muscle disorders such as muscular dystrophy,.
Polymyositis, dermatomyositis, peripheral neuropathies such as charcot marie tooth disease or hereditary neuropathy and as well as the neuromuscular junction disorders such as myasthenia gravis. Some symptoms that can be associated with the peripheral nervous system include generalized weakness, fatigue, numbness, tingling, sometimes pain can be caused by disorders of the peripheral nerve. The evaluation of a patient with a possible peripheral nervous system disorder first begins with the very careful history to understand how the symptoms.
Started and how they affect the patient. from the history we extend to the physical exam, which helps us determine what sort of deficits may be impacting the patient’s function. From there we design a targeted testing strategy to to try to pinpoint exactly what’s causing the symptoms. It’s a very exciting time in neuromuscular medicine because the more we understand about how these diseases occur, the more that we can develop very targeted, personalized treatments to help either stop or reverse the disease. In many cases there.