• N Collongues, F Blanc, A Echaniz-Laguna, N Boehm, and J de Seze.
• Département de neurologie, CHU de Strasbourg, hôpital civil, 1, place de l'Hôpital, 67091 Strasbourg cedex, France. collonguesnicolas@yahoo.fr
• Rev Neurol France. 2009 Mar 1;165(3):249-55.

IntroductionIn small-fiber neuropathy, skin biopsy reveals a reduction of intraepidermal nerve fiber density (IENFD), a feature often necessary for diagnosis. In France, this technique has not been widely used for this purpose.Patient And MethodTo validate this method, we studied 13 patients with suspected small-fiber neuropathy, analyzed their nervous intra- and subepidermal network with a punch skin biopsy and compared our data with those of literature.ResultsTen patients had pure small-fiber neuropathy and three an axonal polyneuropathy involving large-caliber nerve fibers. In the group of patients with pure small-fiber neuropathy, we found medium IENFD (11.6 +/- 4.46 fibers per millimeter in the proximal thigh and 7.15 +/- 3.59 fibers per millimeter in distal leg), well correlated with the electron microscopy quantitative and qualitative analysis of the unmyelinated subepidermal fibers.ConclusionThis work demonstrated the good reproducibility of skin biopsy for analyzing the small-fibers in our cohort. These results require further confirmation in a larger cohort and validation in comparison with controls analyzed on a local level. Nevertheless, these techniques seem to be useful to assess the difficult diagnosis of small-fiber neuropathy.

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