Can Nerve Fiber Density Testing Facilitate Earlier Treatment Of Diabetic Neuropathy?
Intraepidermal nerve fiber density testing is gaining enthusiastic acceptance for the diagnosis as well as the staging of diabetic neuropathy. Studies have demonstrated reduced intraepidermal nerve fiber density in patients with diabetes type 1 and type 2.1 One major advantage of intraepidermal nerve fiber density testing is the ability to detect the presence of evolving peripheral neuropathy in the presence of normal neurophysiologic studies. 2 Electrodiagnostic studies are reflective of large fiber disease, which is frequently preceded by the presence of small fiber neuropathy between 2 and 10 years. 3 In addition, small fiber neuropathy frequently presents with symptoms such as pain or numbness in the absence of any clinically definable signs. Using an epidermal nerve fiber density study enables the clinician to diagnose peripheral neuropathy in its earliest stages prior to otherwise demonstrable objective evidence of disease. This provides the opportunity to employ therapy aimed at
