A reappraisal of the presence of small or large fiber neuropathy in patients with erythromelalgia - 20/04/21
Cet article a été publié dans un numéro de la revue, cliquez ici pour y accéder
Abstract |
Objective |
To assess the contribution of large and small nerve fiber alteration in erythromelalgia (EM).
Methods |
Thirty-three EM patients were included and underwent clinical evaluation based on EM severity score, DN4, and Utah Early Neuropathy Scale (UENS) score. Neurophysiological evaluation consisted in nerve conduction studies (NCS) for large nerve fibers and specific tests for small nerve fibers: electrochemical skin conductance, cold and warm detection thresholds, and laser evoked potentials. Finally, the evaluation of vascular changes was based on the presence of clinical feature of microvascular disorders and the measurement of the Toe Pressure Index (TPI).
Results |
While 28 patients (85%) had vascular alteration on TPI or clinical features, 23 patients (70%) had small-fiber neuropathy on neurophysiological tests, and only 10 patients (30%) had large fiber neuropathy on NCS. Regarding clinical scores, there was no difference between groups (presence or absence of large- or small-fiber neuropathy or microvascular disorder) except for a higher UENS score in patients with large fiber neuropathy.
Conclusion |
Peripheral neuropathy, mostly involving small nerve fibers, is almost as common as microvascular changes in EM, but remains inconstant and not related to a specific neuropathic pattern or higher clinical severity.
Significance |
The association of neuropathic and vascular factors is not systematic in EM, this syndrome being characterized by different pathophysiological mechanisms leading to a common clinical phenotype.
Le texte complet de cet article est disponible en PDF.Keywords : Erythermalgia, Erythromelalgia, Nd:YAP laser, Peripheral nervous system, Small-fiber neuropathy, Sudomotor function, Sudoscan, Thermotest
Plan
Bienvenue sur EM-consulte, la référence des professionnels de santé.
L’accès au texte intégral de cet article nécessite un abonnement.
Déjà abonné à cette revue ?