Inflammation

[fakiren]

Hi. I

[Cat2]

CCF Neuro writes:

"New test such as epidermal skin biopsies can shed new light on sensory peripheral neuropathies, and can be used for diagnosis and to assess treatment."

Isn't it true that the tests cannot provide any insight into causation, but merely show whether someone has small fiber caliber nerve loss and or pathology like axonal nerve swellings, signs of regeneration etc..Cannot distinguish between small fiber neuropathy and Neuronopathies.

Also may provide length dependent versus non length dependent info.. However if someone only has distal biopsy but has symptoms in upper body how can that determination be made without both areas proximal and distal being biopsied?

How is the test used to assess treatment when all it can do is identify PN when causation has not been established, which are all treated with trial and error meds for PN only.
Thank You.

[CCF-Neuro-M.D.-PW]

These type of diagnosis are often difficult, and even more difficult to interpret over the internet. Up to 30% of peripheral neuropathies remain undiagnosed.

CIDP often has more motor than sensory signs - there is more weakness than sensory disturbances. If you do not have weak muscles, it may be unlikely to be CIDP. Obviously a correct diagnosis is important, as steroids have serious side effects such as stomach ulcers,osteoporosis,hypertension,adrenal insufficiency, weight gain, among others.
Nonetheless, if there is no diagnosis after all appropriate tests, there could be an argument for a short term trial of steroids to assess response.

Treatment options for neuropathy are limited and depend on the underlying cause. If it is though to be an immune mediated cause, there are some newer treatments such as mycophenolate and cyclosporin which can be benefiical in place of steroids, and there are trials of the new monocloncal antibody drugs used for arthritis in some immune mediated neuropathies/myopathies. Imuran is another drug used to 'spare' steroids, but has its own hematological toxicities.


New test such as epidermal skin biopsies can shed new light on sensory peripheral neuropathies, and can be used for diagnosis and to assess treatment. These are becoming more availabel at specialized neuromuscular centers such as at the Cleveland Clinic. A second opinion before embarking on immune suppression might not be a bad idea.