title: Quantitative sensory testing and structural assessment of sensory nerve fibres in amyotrophic lateral sclerosis.
abstract: OBJECTIVE
  In this prospective study, involvement of sensory nerve fibres in ALS patients was assessed using functional and structural measures in the form of quantitative sensory testing (QST) and skin and nerve biopsies.
  
  
  METHODS
  Thirty-two ALS patients and 32 healthy subjects were evaluated with a QST battery comprising thresholds of mechanical detection, mechanical pain, vibration detection, cold detection, warm detection, heat pain, and pinprick sensation. Skin biopsies were evaluated in 31 ALS patients by intraepidermal nerve fibre density (IENFD) and axonal swelling ratios, and growth-associated protein 43 (GAP-43) antibody staining. Sural nerve biopsies were evaluated using teased fibre analysis in eight patients.
  
  
  RESULTS
  Mean values for QST parameters and IENFD in ALS patients were within normal range. However, the patients had increased axonal swelling ratios and GAP-43 antibody staining was negative in all patients.
  
  
  CONCLUSIONS
  Although QST and IENFD were affected in only a small subset of ALS patients, the axonal swellings observed in all patients indicate that the affection is more frequent, and suggests that IENFD count may not be sufficient. The negative GAP-43 staining suggested an insufficiency of regeneration in small sensory nerve fibres.
authors.affiliation: Department of Clinical Neurophysiology, Aarhus University Hospital, Aarhus, Denmark. Electronic address: barisisak@gmail.com.
authors.forename: Baris
authors.initials: B
authors.lastname: Isak
authors.affiliation: Department of Clinical Neurophysiology, Aarhus University Hospital, Aarhus, Denmark. Electronic address: pugdahl@aarhus.rm.dk.
authors.forename: Kirsten
authors.initials: K
authors.lastname: Pugdahl
authors.affiliation: Danish Pain Research Centre, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark. Electronic address: pall@clin.au.dk.
authors.forename: Páll
authors.initials: P
authors.lastname: Karlsson
authors.affiliation: Department of Clinical Neurophysiology, Aarhus University Hospital, Aarhus, Denmark. Electronic address: hatitank@rm.dk.
authors.forename: Hatice
authors.initials: H
authors.lastname: Tankisi
authors.affiliation: Danish Pain Research Centre, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark. Electronic address: finnerup@clin.au.dk.
authors.forename: Nanna Brix
authors.initials: NB
authors.lastname: Finnerup
authors.affiliation: Department of Clinical Neurophysiology, Aarhus University Hospital, Aarhus, Denmark. Electronic address: furtula@gmail.com.
authors.forename: Jasna
authors.initials: J
authors.lastname: Furtula
authors.affiliation: Department of Clinical Neurophysiology, Aarhus University Hospital, Aarhus, Denmark. Electronic address: birgjohn@rm.dk.
authors.forename: Birger
authors.initials: B
authors.lastname: Johnsen
authors.affiliation: Department of Neurosurgery, Aarhus University Hospital, Aarhus, Denmark. Electronic address: Niels.Sunde@aarhus.rm.dk.
authors.forename: Niels
authors.initials: N
authors.lastname: Sunde
authors.affiliation: Department of Neurology, Aarhus University Hospital, Aarhus, Denmark. Electronic address: johannes.klitgaard.jakobsen@regionh.dk.
authors.forename: Johannes
authors.initials: J
authors.lastname: Jakobsen
authors.affiliation: Department of Clinical Neurophysiology, Aarhus University Hospital, Aarhus, Denmark. Electronic address: anders.fuglsang@aarhus.rm.dk.
authors.forename: Anders
authors.initials: A
authors.lastname: Fuglsang-Frederiksen
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000690:Amyotrophic Lateral Sclerosis / Q000175:diagnosis / Q000473:pathology* / Q000503:physiopathology*; D001369:Axons / Q000473:pathology / Q000502:physiology; D001706:Biopsy; D003080:Cold Temperature; D005260:Female; D019922:GAP-43 Protein / Q000378:metabolism; D006358:Hot Temperature; D006801:Humans; D008297:Male; D008875:Middle Aged; D009460:Neurologic Examination / Q000379:methods; D010146:Pain / Q000473:pathology / Q000503:physiopathology; D017288:Pain Threshold / Q000502:physiology; D011446:Prospective Studies; D011984:Sensory Receptor Cells / Q000473:pathology* / Q000502:physiology*; D012684:Sensory Thresholds / Q000502:physiology*; D012867:Skin / Q000294:innervation / Q000473:pathology / Q000503:physiopathology; D013497:Sural Nerve / Q000473:pathology / Q000503:physiopathology; D014732:Vibration
chemical_list: D019922:GAP-43 Protein
keywords: Amyotrophic lateral sclerosis (ALS); Axonal swelling; Nerve biopsy; Quantitative sensory testing (QST); Skin biopsy