Diabetic small fiber neuropathy (SFN) is a debilitating disease that can lead to the development of ulceration and amputation. Diabetic SFN research has been limited by the absence of reliable and reproducible tests of small fiber nerve structure and function. Skin biopsy intra-epidermal nerve fiber (IENF) density has become a potential measure of small nerve fiber structure, but does not provide information on nerve fiber function. The functional measures of small nerve fibers include quantitative sensory testing, sudomotor function and, more recently, the axon reflex mediated cutaneous vasodilation response. Impairment of this reflex, which plays a critical role in the generation of neurogenic inflammation and wound repair, is central to the development of neuropathic ulceration and amputation. To date, no investigation has examined the relationship between this important measure of small fiber function and IENF density. Nor are there many studies assessing the relationship between other small fiber functional measures and IENF density or the relationships among various small fiber functional measures in patients with diabetic peripheral neuropathy. The proposed studies will elucidate these structure-function relationships in patients with diabetic SFN. ? ?
| Gibbons, C H; Griffin, J W; Polydefkis, M et al. (2006) The utility of skin biopsy for prediction of progression in suspected small fiber neuropathy. Neurology 66:256-8 |
