title: Small fiber neuropathy: Getting bigger!
abstract: Etiological and clinical heterogeneity of small fiber neuropathy (SFN) precludes a unifying approach and necessitates reliance on recognizable clinical syndromes. Symptoms of SFN arise from dysfunction in nociception, temperature, and autonomic modalities. This review focuses on SFN involving nociception and temperature, examining epidemiology, etiology, clinical presentation, diagnosis, pathophysiology, and management. Prevalence of SFN is 52.95 per 100,000 population, and diabetes and idiopathic are the most common etiologies. Dysesthesia, allodynia, pain, burning, and coldness sensations frequently present in a length-dependent pattern. Additional autonomic features in gastrointestinal, urinary, or cardiovascular systems are frequent but poorly objectified. SFN is diagnosed by intraepidermal nerve fiber density and quantitative sensory and autonomic tests in combination with normal nerve conduction. Pathophysiological understanding centers on sodium channel dysfunction, and genetic forms are beginning to be understood. Treatment is directed at the underlying etiology supported by symptomatic treatment using antidepressants and anticonvulsants. Little is known about long-term outcomes, and systematic cohort studies are needed.
authors.affiliation: Division of Neurology, National University Hospital, Level 10 Tower Block, University Medicine Cluster, 1E Kent Ridge Road, 119228, Singapore.
authors.forename: Amanda C Y
authors.initials: AC
authors.lastname: Chan
authors.affiliation: Division of Neurology, National University Hospital, Level 10 Tower Block, University Medicine Cluster, 1E Kent Ridge Road, 119228, Singapore.|Neurology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
authors.forename: Einar P
authors.initials: EP
authors.lastname: Wilder-Smith
mesh_terms: D000927:Anticonvulsants / Q000627:therapeutic use; D000928:Antidepressive Agents / Q000627:therapeutic use; D001342:Autonomic Nervous System Diseases / Q000209:etiology / Q000503:physiopathology*; D003929:Diabetic Neuropathies / Q000453:epidemiology / Q000503:physiopathology* / Q000628:therapy; D019468:Disease Management; D004916:Erythromelalgia / Q000150:complications / Q000453:epidemiology / Q000503:physiopathology* / Q000628:therapy; D006801:Humans; D006930:Hyperalgesia / Q000209:etiology / Q000503:physiopathology*; D009431:Neural Conduction; D059225:Nociception / Q000502:physiology; D010292:Paresthesia / Q000209:etiology / Q000503:physiopathology*; D015222:Sodium Channels; D013696:Temperature
chemical_list: D000927:Anticonvulsants; D000928:Antidepressive Agents; D015222:Sodium Channels
keywords: autonomic test; intraepidermal nerve fiber density; skin biopsy; small fiber neuropathy; sodium channelopathy