• Title/Summary/Keyword: Intraepidermal nerve fiber

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Usefulness of Skin Biopsy as a Diagnostic Tool of Peripheral Neuropathy (말초신경질환의 진단검사로서 피부 생검의 유용성)

  • Oh, Jeeyoung
    • Annals of Clinical Neurophysiology
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    • v.9 no.2
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    • pp.43-50
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    • 2007
  • Analysis of intraepidermal nerve fibers using skin biopsy is a recently developed technique, providing diagnostic information on small fiber neuropathies. The specimens are obtained by 3 mm punch biopsy, which is safe and minimally invasive. Immunohistochemical staining by Protein gene product (PGP) 9.5 demonstrate not only intraepidermal nerve fibers but dermal structures, such as sweat gland and erector papillae. Up to now, many studies agree that intraepidermal nerve fiber density is dramatically reduced in various sensory neuropathies. The utility of density measure was confirmed with high sensitivity in the diagnosis of sensory neuropathy, comparable to sural nerve biopsy or quantitative sensory testing. Besides quantitative methods, morphological changes like axonal swelling and fragmentation can be used as predegenerative markers. This article reviews the technique of skin biopsy and clinical and experimental usefulness of skin biopsy in diagnosing and monitoring peripheral neuropathies.

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Skin Biopsy: Emerging Method for Small Nerve Fiber Evaluation (피부조직검사: 소신경섬유 평가의 유용한 방법)

  • Sohn, Eun Hee
    • Annals of Clinical Neurophysiology
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    • v.17 no.2
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    • pp.53-60
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    • 2015
  • Skin biopsy with investigation of small nerve fiber in human epidermis and dermis has been proven to be a useful method for demonstration of small fiber neuropathy. Quantification of intraepidermal nerve fiber density using anti-Protein Gene Product 9.5 (PGP 9.5) antibody is standardized method to diagnose the small fiber neuropathy. Skin biopsy method also makes it possible to differentiate the type of nerve fibers by using different antibodies. Quantification of dermal structures with different type of nerve fibers could be used to invest pathophysiologic mechanism of diseased state.

Skin biopsy: an emerging method for small nerve fiber evaluation

  • Sohn, Eun Hee
    • Annals of Clinical Neurophysiology
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    • v.20 no.1
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    • pp.3-11
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    • 2018
  • Skin biopsy and staining the specimens with immuno-reactive markers has been proven to be a useful method to demonstrate the pathologic status of small nerve fibers. Quantification of intraepidermal nerve fiber density using anti-protein gene product 9.5 antibody is a standard method to diagnose small fiber neuropathy. Skin biopsy also makes it possible to differentiate the nerve fibers according to their function by using different markers. Quantification of dermal structures with different types of nerve fibers could reveal the pathophysiologic mechanism of the disease state.

Controversies on the Usefulness of Nerve Conduction Study in the Early Diagnosis of Diabetic Polyneuropathy: Cons (당뇨병성 다발신경병증의 조기 진단에 있어서 신경전도검사의 유용성에 관한 논란: 부정적인 관점에서)

  • Sohn, Eun Hee
    • Annals of Clinical Neurophysiology
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    • v.10 no.1
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    • pp.33-37
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    • 2008
  • Diabetic polyneuropathy (DPN) is the most common form of diabetic neuropathy, and causes a significant morbidity with an impact on the quality of life in the patients with diabetes. Since DPN frequently induces foot deformity and ulceration, which finally leads to foot amputation, the early detection and treatment is very important for the prevention of a permanent structural change. In the early stage of DPN, the diagnostic methods which can evaluate the function or structure of small nerve fibers should be employed because small nerve fibers are first involved in the course of DPN. However, the nerve conduction study cannot reflect the function of the small nerve fibers, and thus, has a definite limitation in the early diagnosis of DPN. For the early detection of DPN, electrodiagnostic data should be interpreted on a clinical context, along with the careful evaluation of the small nerve fiber functions using the tests such as the analysis of intraepidermal nerve fiber density.

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Diagnosis of Small Fiber Neuropathy: Usefulness of Skin Biopsy (소섬유신경병증의 진단: 피부생검의 유용성)

  • Kim, Sooyoung;Sohn, Eun Hee
    • Journal of Electrodiagnosis and Neuromuscular Diseases
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    • v.20 no.2
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    • pp.77-83
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    • 2018
  • Small fiber neuropathy (SFN) mainly affects thinly myelinated $A{\delta}$-fibers and unmyelinated C-fibers presented with neuropathic pain like burning feet or numbness. Many conditions are known as a causes of SFN, metabolic derangement, especially glucose intolerance, is the most frequent cause of SFN. It has been hard to diagnose SFN because there has been lack of specialized test for small nerve fiber. Quantification of intraepidermal nerve fiber density using skin biopsy is promising method to diagnose SFN. A skin biopsy also could give helps to research pathophysiology of SFN by specialized stain method.

Controversies on the Usefulness of Nerve Conduction Study in the Early Diagnosis of Diabetic Polyneuropathy: Pros (당뇨병성 다발신경병증의 조기 진단에서 신경전도검사의 유용성에 관한 논란: 긍정적인 관점에서)

  • Kwon, Ohyun
    • Annals of Clinical Neurophysiology
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    • v.10 no.1
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    • pp.29-32
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    • 2008
  • Although various criteria on the diagnosis of diabetic neuropathy are applied from trial to trial, being tailored in concert with its purpose, the utmost evidences of the diagnosis are subjective symptoms and objective signs of neurologic deficit. The application and interpretation of auxiliary electrophysiological test including nerve conduction study (NCS) should be made on the context of clinical pictures. The evaluation of the functions of small, thinly myelinated or unmyelinated nerve fibers has been increasingly stressed recently with the advent of newer techniques, e.g., measurement of intraepidermal fiber density, quantitative sensory testing, and autonomic function test. And the studies with those techniques have shed light to the nature of the evolution of diabetic neuropathy. The practical application of these techniques to the diagnosis of diabetic neuropathy in the individual patients, however, should be made cautiously due to several shortcomings: limited accessibility, wide overlapping zone between norm and abnormality with resultant unsatisfactory sensitivity and specificity, difficulty in performing subsequent tests, unproven quantitative correlation with clinical deficit, and invasiveness of some technique. NCS, as an extension of clinical examination, is still the most reliable electrophysiological test in evaluating neuropathy and gives the invaluable information about the nature of neuropathy, whereas the newer techniques need more refinement of the procedure and interpretation, and the accumulation of large scaled data of application to be considered as established diagnostic tools of peripheral neuropathy.

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