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Tekatas A, Tekatas DD, Solmaz V, Karaca T, Pamuk ON. Small fiber neuropathy and related factors in patients with systemic lupus erythematosus; the results of cutaneous silent period and skin biopsy. Adv Rheumatol 2020; 60:31. [PMID: 32503623 DOI: 10.1186/s42358-020-00133-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2020] [Accepted: 05/27/2020] [Indexed: 12/17/2022] Open
Abstract
INTRODUCTION Evaluating small nerve fibers in patients with systemic lupus erythematosus (SLE) using cutaneous silent period (CSP) and skin biopsy and assesssing the relationship between clinical signs, autoantibodies and neuropathic pain score. OBJECTIVE - METHODS Fifty one SLE patients and 46 healthy volunteers were included in this study. Nerve conduction studies and CSP were performed both on upper and lower limbs in subjects. Skin biopsy was performed and the number of epidermal nerve density and IL-6 staining were evaluated. RESULTS In SLE patients, CSP latencies were significantly prolonged both in lower and upper limbs and lower and upper extremity CSP durations were significantly shorter when compared to controls (p < 0.001). The number of epidermal nerve was significantly lower in SLE patients when compared to healthy controls (p < 0.001). CONCLUSION We detected marked small nerve fiber damage in both lower and upper limbs in SLE patients using CSP. Decreased epidermal nerve density also supports this finding.
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Affiliation(s)
- Aslan Tekatas
- Department of Neurology, Medikent Hospital, Kırklareli, Turkey
| | | | - Volkan Solmaz
- Department of Neurology, Memorial Hizmet hospital, 34100, İstanbul, Turkey.
| | - Turan Karaca
- Department of Histology, Trakya University Medical Faculty, Edirne, Turkey
| | - Omer Nuri Pamuk
- Department of Internal Medicine, Division of Rheumatology, Trakya University Medical Faculty, Edirne, Turkey
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Gündüz A, Aydın Ş, Kızıltan M. Cutaneous silent period: A literature review. NEUROL SCI NEUROPHYS 2020. [DOI: 10.4103/nsn.nsn_38_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Kofler M, Leis A, Valls-Solé J. Cutaneous silent periods – Part 1: Update on physiological mechanisms. Clin Neurophysiol 2019; 130:588-603. [DOI: 10.1016/j.clinph.2019.01.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Revised: 12/28/2018] [Accepted: 01/08/2019] [Indexed: 12/14/2022]
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Cutaneous silent periods – Part 2: Update on pathophysiology and clinical utility. Clin Neurophysiol 2019; 130:604-615. [DOI: 10.1016/j.clinph.2019.01.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Revised: 12/28/2018] [Accepted: 01/08/2019] [Indexed: 02/08/2023]
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Baek SH, Seok HY, Koo YS, Kim BJ. Lengthened Cutaneous Silent Period in Fibromyalgia Suggesting Central Sensitization as a Pathogenesis. PLoS One 2016; 11:e0149248. [PMID: 26871583 PMCID: PMC4752484 DOI: 10.1371/journal.pone.0149248] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Accepted: 01/28/2016] [Indexed: 11/18/2022] Open
Abstract
The pathogenesis of fibromyalgia (FM) has not been clearly elucidated, but central sensitization, which plays an important role in the development of neuropathic pain, is considered to be the main mechanism. The cutaneous silent period (CSP), which is a spinal reflex mediated by A-delta cutaneous afferents, is useful for the evaluation of sensorimotor integration at the spinal and supraspinal levels. To understand the pathophysiology of FM, we compared CSP patterns between patients with FM and normal healthy subjects. Twenty-four patients with FM diagnosed in accordance with the 1990 American College of Rheumatology classification system and 24 age- and sex-matched healthy volunteers were recruited. The CSP was measured from the abductor pollicis brevis muscle. Demographic data, number of tender points, and visual analog scale and FM impact questionnaire scores were collected. The measured CSP and clinical parameters of the patient and control groups were compared. In addition, possible correlations between the CSP parameters and the other clinical characteristics were analyzed. Mean CSP latencies did not differ between patients (55.50 ± 10.97 ms) and healthy controls (60.23 ± 11.87 ms; p = 0.158), although the mean CSP duration was significantly longer in patients (73.75 ± 15.67 ms) than in controls (63.50 ± 14.05 ms; p = 0.021). CSP variables did not correlate with any clinical variables. The significantly longer CSP duration in FM patients suggests central dysregulation at the spinal and supraspinal levels, rather than peripheral small fiber dysfunction.
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Affiliation(s)
- Seol-Hee Baek
- Department of Neurology, Korea University Medical Center, Korea University College of Medicine, Seoul, Korea
| | - Hung Youl Seok
- Department of Neurology, Korea University Medical Center, Korea University College of Medicine, Seoul, Korea
| | - Yong Seo Koo
- Department of Neurology, Korea University Medical Center, Korea University College of Medicine, Seoul, Korea
| | - Byung-Jo Kim
- Department of Neurology, Korea University Medical Center, Korea University College of Medicine, Seoul, Korea
- * E-mail:
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Lopergolo D, Isak B, Gabriele M, Onesti E, Ceccanti M, Capua G, Fionda L, Biasiotta A, Di Stefano G, La Cesa S, Frasca V, Inghilleri M. Cutaneous silent period recordings in demyelinating and axonal polyneuropathies. Clin Neurophysiol 2014; 126:1780-9. [PMID: 25497713 DOI: 10.1016/j.clinph.2014.11.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2014] [Revised: 11/11/2014] [Accepted: 11/15/2014] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To investigate the cutaneous silent period (CSP), a spinal inhibitory reflex mainly mediated by A-delta fibres, in demyelinating and axonal polyneuropathy (PNP) and evaluate whether CSP parameters differ between patients with and without neuropathic pain. METHODS Eighty-four patients with demyelinating PNP, 178 patients with axonal PNP and 265 controls underwent clinical examination, DN4 questionnaire, standard nerve conduction study, motor-root stimulation and CSP recordings from abductor digiti minimi. We calculated the afferent conduction time of CSP (a-CSP time) with the formula: CSP latency-root motor evoked potential latency. RESULTS In the demyelinating PNP group the a-CSP time was significantly longer; in the axonal PNP group, CSP duration was shorter than the demyelinating group (p=0.010) and controls (p=0.001). CSP parameters were not different between patients with and without neuropathic pain. CONCLUSIONS The abnormality of a-CSP time in the demyelinating PNP group suggests the crucial role of A-delta fibres in the mechanism of CSP; the shorter CSP duration in the axonal PNP group supports the strong influence of the number of axons on this parameter. Our study suggests that neuropathic pain could be related to pathophysiological mechanisms differing from mere A-delta fibre loss. SIGNIFICANCE CSP evaluation is effective in detecting A-delta fibre dysfunction in axonal as well as demyelinating PNP.
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Affiliation(s)
- Diego Lopergolo
- Department of Neurology and Psychiatry, University "Sapienza", Viale dell'Università 30, 00185 Rome, Italy
| | - Baris Isak
- Marmara University Hospital School of Medicine, Department of Neurology, Fevzi Cakmak Mah. Mimar Sinan Cad. No: 41, 34899 Ust Kaynarca/Pendik, Istanbul, Turkey; Department of Clinical Neurophysiology, Aarhus Universitets hospital, Nørrebrogade 44, 8000 Aarhus C, Denmark
| | - Maria Gabriele
- Department of Neurology and Psychiatry, University "Sapienza", Viale dell'Università 30, 00185 Rome, Italy
| | - Emanuela Onesti
- Department of Neurology and Psychiatry, University "Sapienza", Viale dell'Università 30, 00185 Rome, Italy
| | - Marco Ceccanti
- Department of Neurology and Psychiatry, University "Sapienza", Viale dell'Università 30, 00185 Rome, Italy
| | - Gelsomina Capua
- Department of Neurology and Psychiatry, University "Sapienza", Viale dell'Università 30, 00185 Rome, Italy
| | - Laura Fionda
- Department of Neurology and Psychiatry, University "Sapienza", Viale dell'Università 30, 00185 Rome, Italy
| | - Antonella Biasiotta
- Department of Neurology and Psychiatry, University "Sapienza", Viale dell'Università 30, 00185 Rome, Italy
| | - Giulia Di Stefano
- Department of Neurology and Psychiatry, University "Sapienza", Viale dell'Università 30, 00185 Rome, Italy
| | - Silvia La Cesa
- Department of Neurology and Psychiatry, University "Sapienza", Viale dell'Università 30, 00185 Rome, Italy
| | - Vittorio Frasca
- Department of Neurology and Psychiatry, University "Sapienza", Viale dell'Università 30, 00185 Rome, Italy
| | - Maurizio Inghilleri
- Department of Neurology and Psychiatry, University "Sapienza", Viale dell'Università 30, 00185 Rome, Italy.
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Koytak PK, Isak B, Borucu D, Uluc K, Tanridag T, Us O. Assessment of symptomatic diabetic patients with normal nerve conduction studies: utility of cutaneous silent periods and autonomic tests. Muscle Nerve 2011; 43:317-23. [PMID: 21321948 DOI: 10.1002/mus.21877] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Established electrophysiological methods have limited clinical utility in the diagnosis of small-fiber neuropathy (SFN). In this study, diabetic patients with clinically diagnosed SFN were evaluated with autonomic tests and cutaneous silent periods (CSPs). Thirty-one diabetic patients with clinically suspected SFN and normal nerve conduction studies were compared with 30 controls. In the upper extremities (UE), the CSP parameters did not differ statistically between the patient and control groups, whereas, in the lower extremities (LE), patients had prolonged CSP latencies (P = 0.018) and shortened CSP durations (P < 0.001). The sensitivity of the CSP duration was 32.6%, and the specificity was 96.7%. The expiration-to-inspiration ratios and amplitudes of the sympathetic skin responses in the lower extremities were also reduced. Our findings indicate that the diagnostic utility of CSPs was higher than that of the autonomic tests to support the clinically suspected diagnosis of SFN.
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Affiliation(s)
- Pinar Kahraman Koytak
- Department of Neurology, Marmara University Hospital, Tophanelioglu Cad. 13/15, Istanbul, Turkey.
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Utility of the cutaneous silent period in the evaluation of carpal tunnel syndrome. Clin Neurophysiol 2010; 121:1584-1588. [DOI: 10.1016/j.clinph.2010.03.012] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2009] [Revised: 03/09/2010] [Accepted: 03/11/2010] [Indexed: 11/19/2022]
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Otsuru N, Inui K, Yamashiro K, Miyazaki T, Takeshima Y, Kakigi R. Assessing Aδ Fiber Function With Lidocaine Using Intraepidermal Electrical Stimulation. THE JOURNAL OF PAIN 2010; 11:621-7. [DOI: 10.1016/j.jpain.2009.10.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/01/2009] [Revised: 07/09/2009] [Accepted: 10/02/2009] [Indexed: 10/20/2022]
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Kim BJ, Kim NH, Kim SG, Roh H, Park HR, Park MH, Park KW, Cho SC, So YT. Utility of the cutaneous silent period in patients with diabetes mellitus. J Neurol Sci 2010; 293:1-5. [PMID: 20417526 DOI: 10.1016/j.jns.2010.03.032] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2009] [Revised: 02/09/2010] [Accepted: 03/31/2010] [Indexed: 11/26/2022]
Abstract
We performed this study to evaluate whether or not the cutaneous silent period (CSP) is a useful metric to identify small-fiber neuropathy in diabetic patients. The CSP was measured from the abductor pollicis brevis muscle in 30 healthy controls and 110 diabetic patients, who in turn were divided into 3 subgroups (patients with large-fiber neuropathy, patients with small-fiber neuropathy, and asymptomatic patients). The measured CSP and clinical characteristics were compared among the groups. The power of the CSP in discriminating patients from controls and any correlation with other clinical variables were analyzed. Each patient subgroup had a significantly delayed CSP latency compared to the controls. The latency of patients with large-fiber neuropathy was also significantly prolonged compared to the other subgroups of patients. The CSP latency was the only variable to discriminate patients. The latency showed a significant correlation with the late responses in nerve conduction studies. Thus, the CSP latency may be a useful tool in evaluating small neural fiber function in diabetic patients.
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Affiliation(s)
- Byung-Jo Kim
- Department of Neurology, Korea University College of Medicine, Seoul, Korea
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Devigili G, Tugnoli V, Penza P, Camozzi F, Lombardi R, Melli G, Broglio L, Granieri E, Lauria G. The diagnostic criteria for small fibre neuropathy: from symptoms to neuropathology. Brain 2008; 131:1912-25. [PMID: 18524793 PMCID: PMC2442424 DOI: 10.1093/brain/awn093] [Citation(s) in RCA: 535] [Impact Index Per Article: 33.4] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Small fibre neuropathy (SFN), a condition dominated by neuropathic pain, is frequently encountered in clinical practise either as prevalent manifestation of more diffuse neuropathy or distinct nosologic entity. Aetiology of SFN includes pre-diabetes status and immune-mediated diseases, though it remains frequently unknown. Due to their physiologic characteristics, small nerve fibres cannot be investigated by routine electrophysiological tests, making the diagnosis particularly difficult. Quantitative sensory testing (QST) to assess the psychophysical thresholds for cold and warm sensations and skin biopsy with quantification of somatic intraepidermal nerve fibres (IENF) have been used to determine the damage to small nerve fibres. Nevertheless, the diagnostic criteria for SFN have not been defined yet and a 'gold standard' for clinical practise and research is not available. We screened 486 patients referred to our institutions and collected 124 patients with sensory neuropathy. Among them, we identified 67 patients with pure SFN using a new diagnostic 'gold standard', based on the presence of at least two abnormal results at clinical, QST and skin biopsy examination. The diagnosis of SFN was achieved by abnormal clinical and skin biopsy findings in 43.3% of patients, abnormal skin biopsy and QST findings in 37.3% of patients, abnormal clinical and QST findings in 11.9% of patients, whereas 7.5% patients had abnormal results at all the examinations. Skin biopsy showed a diagnostic efficiency of 88.4%, clinical examination of 54.6% and QST of 46.9%. Receiver operating characteristic curve analysis confirmed the significantly higher performance of skin biopsy comparing with QST. However, we found a significant inverse correlation between IENF density and both cold and warm thresholds at the leg. Clinical examination revealed pinprick and thermal hypoesthesia in about 50% patients, and signs of peripheral vascular autonomic dysfunction in about 70% of patients. Spontaneous pain dominated the clinical picture in most SFN patients. Neuropathic pain intensity was more severe in patients with SFN than in patients with large or mixed fibre neuropathy, but there was no significant correlation with IENF density. The aetiology of SFN was initially unknown in 41.8% of patients and at 2-year follow-up a potential cause could be determined in 25% of them. Over the same period, 13% of SFN patients showed the involvement of large nerve fibres, whereas in 45.6% of them the clinical picture did not change. Spontaneous remission of neuropathic pain occurred in 10.9% of SFN patients, while it worsened in 30.4% of them.
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Sensory modulation of voluntary and TMS-induced activation in hand muscles. Exp Brain Res 2008; 188:399-409. [DOI: 10.1007/s00221-008-1372-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2007] [Accepted: 04/02/2008] [Indexed: 11/26/2022]
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Nicholas PK, Mauceri L, Slate Ciampa A, Corless IB, Raymond N, Barry DJ, Viamonte Ros A. Distal sensory polyneuropathy in the context of HIV/AIDS. J Assoc Nurses AIDS Care 2007; 18:32-40. [PMID: 17662922 DOI: 10.1016/j.jana.2007.05.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2006] [Indexed: 10/23/2022]
Abstract
Peripheral neuropathy, or distal sensory polyneuropathy (DSPN), is the most common neurological problem in HIV disease. DSPN also represents a complex symptom that occurs because of peripheral nerve damage related to advanced HIV disease and in association with the use of antiretroviral therapy-particularly in individuals treated with dideoxynucleosides. Although DSPN is a frequent symptom, the specific pathophysiology is not well understood. The HIV-related neuropathies are commonly categorized as distal sensory polyneuropathies, although antiretroviral toxic neuropathies are described in the literature. Recently, mitochondrial toxicity has been identified as a possible etiology of DSPN. As individuals with HIV/AIDS survive longer, often living for decades with the disease, chronic symptoms like DSPN must be addressed. Pharmacologic approaches, complementary therapies, and self-care behaviors that may improve quality of life and limit symptoms of DSPN are important interventions for clinicians and those living with HIV/AIDS to consider in the management of peripheral neuropathy.
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Affiliation(s)
- Patrice K Nicholas
- Global Health and Academic Partnerships, Brigham and Women's Hospital, Division of Social Medicine and Health Inequalities and Center for Nursing Excellence, USA
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Abstract
PURPOSE OF REVIEW To summarize the recent advances in aetiology, diagnostic assessment, and treatment of small fibre neuropathies. RECENT FINDINGS New causes of small fibre neuropathy have been recognized and advances in neurophysiologic and neuropathologic techniques for investigating small fibres have been made, increasing the interest in this field. In particular, skin biopsy proved to be a sensitive method to diagnose small fibre neuropathy. It allows the detection of subclinical abnormalities of peripheral nerve function in patients with diabetes and tongue denervation in patients with burning mouth syndrome. This technique has also been used to demonstrate the neuroprotective effect of erythropoietin in experimental models of neuropathy. Among nonconventional neurophysiologic techniques for investigating small fibres, laser-evoked potential and contact heat-evoked potential stimulators have been developed and deserve particular interest. Several trials on neuropathic pain that is a typical feature of small fibre neuropathies have been performed and guidelines have recently been published. SUMMARY Detection of small fibre impairment allows earlier diagnosis of neuropathy and could be used as an outcome measure in future regenerative neuropathy trials. Standardization of skin biopsy can have an important impact on clinical practice and research. Further studies are needed to assess the reliability of current neurophysiologic techniques for testing small fibre function in peripheral neuropathies and the correlation with well established neuropathologic examination.
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Affiliation(s)
- Giuseppe Lauria
- Immunology and Muscular Pathology Unit, National Neurological Institute Carlo Besta, Milan, Italy.
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