Correlation of epidermal nerve fiber density with pain-related evoked potentials in HIV neuropathy.
HIV associated sensory neuropathy is a common neurological disorder with reported prevalence of 53%. When only small fibers are involved, the diagnosis of neuropathy remains difficult since standard nerve conduction studies generally are unremarkable. We assessed a method to identify small-fiber neuropathy using electrically evoked pain-related potentials and correlated the electrophysiological results with intraepidermal nerve fiber density in patients with HIV associated sensory neuropathy. Nineteen HIV positive patients were investigated for clinically diagnosed peripheral neuropathy with Neuropathy Symptoms Score (NSS)3 and Neuropathy Disability Score (NDS)5. Nine healthy HIV negative control subjects were recruited. We performed standard nerve conduction testing, electrically evoked pain-related potentials and skin biopsy in all participants. Pain-related evoked potentials revealed abnormalities in all HIV positive neuropathy patients, while standard nerve conduction testing was abnormal in eight patients only. Pain-related evoked potential latencies and amplitudes strongly correlated with intraepidermal nerve fiber density. The method of pain-related evoked potential conduction appears to be a sensitive, fast, non-invasive technique for the detection of small-fiber neuropathy and may prove to become a valuable diagnostic asset.
Obermann
Mark
M
Department of Neurology, University of Duisburg-Essen, Hufelandstr. 55, 45122 Essen, Germany Department of Dermatology, University of Duisburg-Essen, Germany Department of Neurology, Julius-Maximilians-University, Wuerzburg, Germany Department of Pain and Headache Research, University of Freiburg, Germany Department of Neurology and Neurophysiology, Bruederkrankenhaus Trier, Germany.
Katsarava
Zaza
Z
Esser
Stefan
S
Sommer
Claudia
C
He
Lan
L
Selter
Laura
L
Yoon
Min-Suk
MS
Kaube
Holger
H
Diener
Hans-Christoph
HC
Maschke
Matthias
M
D000328:Adult; D000344:Afferent Pathways / Q000473:pathology / Q000503:physiopathology; D000368:Aged; D005073:Evoked Potentials, Somatosensory; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009412:Nerve Fibers / Q000473:pathology*; D009437:Neuralgia / Q000473:pathology* / Q000503:physiopathology*; D010523:Peripheral Nervous System Diseases / Q000209:etiology / Q000473:pathology* / Q000503:physiopathology*; D012867:Skin / Q000294:innervation* / Q000473:pathology; D013223:Statistics as Topic