Corneal confocal microscopy: a novel means to detect nerve fibre damage in idiopathic small fibre neuropathy.
Patients with idiopathic small fibre neuropathy (ISFN) have been shown to have significant intraepidermal nerve fibre loss and an increased prevalence of impaired glucose tolerance (IGT). It has been suggested that the dysglycemia of IGT and additional metabolic risk factors may contribute to small nerve fibre damage in these patients. Twenty-five patients with ISFN and 12 aged-matched control subjects underwent a detailed evaluation of neuropathic symptoms, neurological deficits (Neuropathy deficit score (NDS); Nerve Conduction Studies (NCS); Quantitative Sensory Testing (QST) and Corneal Confocal Microscopy (CCM)) to quantify small nerve fibre pathology. Eight (32%) patients had IGT. Whilst all patients with ISFN had significant neuropathic symptoms, NDS, NCS and QST except for warm thresholds were normal. Corneal sensitivity was reduced and CCM demonstrated a significant reduction in corneal nerve fibre density (NFD) (P<0.0001), nerve branch density (NBD) (P<0.0001), nerve fibre length (NFL) (P<0.0001) and an increase in nerve fibre tortuosity (NFT) (P<0.0001). However these parameters did not differ between ISFN patients with and without IGT, nor did they correlate with BMI, lipids and blood pressure. Corneal confocal microscopy provides a sensitive non-invasive means to detect small nerve fibre damage in patients with ISFN and metabolic abnormalities do not relate to nerve damage.
Tavakoli
Mitra
M
Division of Cardiovascular Medicine, Central Manchester Foundation Trust and University of Manchester, Manchester, M13 9NT, UK.
Marshall
Andrew
A
Pitceathly
Robert
R
Fadavi
Hassan
H
Gow
David
D
Roberts
Mark E
ME
Efron
Nathan
N
Boulton
Andrew Jm
AJ
Malik
Rayaz A
RA
D000368:Aged; D000704:Analysis of Variance; D016022:Case-Control Studies; D003315:Cornea / Q000294:innervation* / Q000473:pathology*; D004558:Electric Stimulation / Q000379:methods; D005260:Female; D005951:Glucose Tolerance Test / Q000379:methods; D006801:Humans; D006930:Hyperalgesia / Q000503:physiopathology; D008297:Male; D018613:Microscopy, Confocal / Q000379:methods*; D008875:Middle Aged; D009412:Nerve Fibers / Q000473:pathology*; D009460:Neurologic Examination / Q000379:methods; D010523:Peripheral Nervous System Diseases / Q000175:diagnosis*; D012684:Sensory Thresholds / Q000502:physiology; D014953:Wrist / Q000294:innervation