Diagnostic confirmation allows for the most effective treatment 

BakoDx’s epidermal nerve fiber density (ENFD) analysis is an objective diagnostic tool used to monitor and manage patients with small fiber peripheral neuropathy (SFPN).

The analysis not only provides definitive confirmation of SFPN, but also enables better assessment of the severity of the neuropathic process, which may have treatment implications. ENFD analysis may also reveal degenerative changes in those patients with normal densities, which may predict the future onset of SFPN.

SFPN may present with varying symptoms, however, most commonly presents with burning/shooting pains, pins and needle sensation or numbness and coldness over the extremity. The neuropathic process typically progresses in a distal to proximal fashion, or in other words, in a “stocking and glove” type distribution. These symptoms are in contrast to those seen in large fiber peripheral neuropathy (LFPN) in that tendon reflexes and muscle strength are typically normal, as well as NCV/EMG are also within normal limits. While there are “textbook” symptoms one would look for in SFPN, this is often not as specific as one would like. Due to the varying presentations associated with SFPN, as well as cross over symptoms with large fiber peripheral neuropathy, diagnostic confirmation is essential. Once diagnostic confirmation is acquired, clinical identification of the underlying etiology, if possible, will allow for the most effective treatment. In many cases an etiology can be determined, with Diabetes (type I and II) being the most common and others including autoimmune disorders, inherited, or infectious causes. However, up to 40 percent of SFPN cases are idiopathic in nature.

The sample submitted for ENFD analysis is a simple, quick, minimally-invasive, 3mm punch biopsy procedure of the distal leg (10cm proximal to the lateral malleolus). The procedure is performed in an office setting, limiting outside referral. The biopsy itself requires approximately five minutes, with little to no post-procedure care and both the procedure and the test are reimbursable by nearly all payers.

The ENFD analysis requires a specially trained pathologist to count and calculate the nerve fiber density of the myelinated A-delta and unmyelinated C fibers within the epidermis. The direct observation of these small intra-epidermal nerve fibers makes ENFD the most objective method for diagnosing SFPN.

The therapy for SFPN is usually directed towards the underlying disease process or symptom relief. Therapies could include diet/lifestyle modifications, NeuRx-TF or other medical food products, topical anesthetics, and central acting agents to alleviate symptoms.

For more information, including procedural videos, ordering a complimentary ENFD kit, or request an in-service, visit bakodx.com/enfd.