Structural and functional characterization of nerve fibres in polyneuropathy and healthy subjects

Páll Karlsson, Simon Haroutounian, Michael J Polydefkis, Jens R. Nyengaard, Troels S. Jensen

Research output: Contribution to journalArticle

Abstract

Objectives: Quantification of intraepidermal nerve fibre density (IENFD) is an important small fibre measure in distal symmetric polyneuropathies (DSP), but quantitative evaluation of additional structural and functional factors may help in elucidating the underlying mechanisms, and in improving the diagnostic accuracy in DSP. The literature reports a weak or moderate relationship between IENFD and spontaneous and evoked pain in neuropathies, but the relationship between functional and structural small fibre parameters in patients with DSP is unclear. The objectives of the current study, therefore, were to determine morphological and functional parameters related to small nerve fibres in subjects with distal symmetric polyneuropathy (DSP) and healthy controls, and to characterize the interplay among these parameters in these two groups. Materials and Methods: 17 patients with painful DSP (≥4 on 0-10 numerical rating scale) and with symptoms and signs of small fibre abnormality (with or without large fibre involvement) and 19 healthy control subjects underwent comprehensive functional and structural small fibre assessments that included quantitative sensory testing, response to 30. min topical application of 10% capsaicin and analysis of skin biopsy samples taken from the distal leg (IENFD, epidermal and dermal nerve fibre length densities (eNFLD, dNFLD) using global spatial sampling and axonal swelling ratios (swellings/IENFD and swellings/NFLD)). Results: DSP patients had reduced sensitivity to cold (median -11.07. °C vs. -2.60, P≤. 0.001) and heat (median 46.7 vs. 37.70, P≤. 0.001), diminished neurovascular (median 184 vs. 278 mean flux on laser Doppler, P=. 0.0003) and pain response to topical capsaicin (median 10 vs. 35 on 0-100 VAS, P=. 0.0002), and lower IENFD, eNFLD and dNFLD values combined with increased swelling ratios (all P

Original languageEnglish (US)
Pages (from-to)28-35
Number of pages8
JournalScandinavian Journal of Pain
Volume10
DOIs
StatePublished - Jan 1 2016

Fingerprint

Polyneuropathies
Nerve Fibers
Healthy Volunteers
Capsaicin
Pain
Skin
Signs and Symptoms
Leg
Lasers
Hot Temperature
Biopsy

Keywords

  • Global spatial sampling
  • IENFD
  • Nerve fibre length density
  • Polyneuropathy
  • Skin biopsy

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine
  • Clinical Neurology

Cite this

Structural and functional characterization of nerve fibres in polyneuropathy and healthy subjects. / Karlsson, Páll; Haroutounian, Simon; Polydefkis, Michael J; Nyengaard, Jens R.; Jensen, Troels S.

In: Scandinavian Journal of Pain, Vol. 10, 01.01.2016, p. 28-35.

Research output: Contribution to journalArticle

Karlsson, Páll ; Haroutounian, Simon ; Polydefkis, Michael J ; Nyengaard, Jens R. ; Jensen, Troels S. / Structural and functional characterization of nerve fibres in polyneuropathy and healthy subjects. In: Scandinavian Journal of Pain. 2016 ; Vol. 10. pp. 28-35.
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abstract = "Objectives: Quantification of intraepidermal nerve fibre density (IENFD) is an important small fibre measure in distal symmetric polyneuropathies (DSP), but quantitative evaluation of additional structural and functional factors may help in elucidating the underlying mechanisms, and in improving the diagnostic accuracy in DSP. The literature reports a weak or moderate relationship between IENFD and spontaneous and evoked pain in neuropathies, but the relationship between functional and structural small fibre parameters in patients with DSP is unclear. The objectives of the current study, therefore, were to determine morphological and functional parameters related to small nerve fibres in subjects with distal symmetric polyneuropathy (DSP) and healthy controls, and to characterize the interplay among these parameters in these two groups. Materials and Methods: 17 patients with painful DSP (≥4 on 0-10 numerical rating scale) and with symptoms and signs of small fibre abnormality (with or without large fibre involvement) and 19 healthy control subjects underwent comprehensive functional and structural small fibre assessments that included quantitative sensory testing, response to 30. min topical application of 10{\%} capsaicin and analysis of skin biopsy samples taken from the distal leg (IENFD, epidermal and dermal nerve fibre length densities (eNFLD, dNFLD) using global spatial sampling and axonal swelling ratios (swellings/IENFD and swellings/NFLD)). Results: DSP patients had reduced sensitivity to cold (median -11.07. °C vs. -2.60, P≤. 0.001) and heat (median 46.7 vs. 37.70, P≤. 0.001), diminished neurovascular (median 184 vs. 278 mean flux on laser Doppler, P=. 0.0003) and pain response to topical capsaicin (median 10 vs. 35 on 0-100 VAS, P=. 0.0002), and lower IENFD, eNFLD and dNFLD values combined with increased swelling ratios (all P",
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