Abstract Details

Title Corneal Confocal Microscopy (CCM) and Contact Heat-Evoked Potential Stimulator (CHEPS) Are Useful and Complementary Tools for Neuropathic Pain/Small-Fiber Neuropathy Diagnosis

Topic Peripheral Nerve

Presentation(s) P02 - (-)

Poster/Presentation
Number 180

Objective

Background BACKGROUND: SFPN are frequent conditions observed in clinical practice. Usually these neuropathies are painful. Neurological examination almost always shows a decreased thermo-algesic hypo or anesthesia in the involved areas, reflecting the compromise of afferent small nerve fibers. The best tools to assess SFPN/NP, comprising the state of the art for most clinicians, are a precise history and a well-performed neurological examination. Secondly, appear the neurophysiological methods, and thirdly the imaging and the morphological ones. CHEPS and CCM have been recently introduced in this armamentarium. CHEPS assessment of Adelta fibers is performed by applying limited numbers of fixed-intensity thermal stimuli resulting in a consistent waveform of CHEPS with negative-positive peaks by averaging the respective tracings. In neuropathic patients with skin denervation, amplitudes of CHEPS were reduced. CCM is a growing technique for the study of the cornea at the cellular level, providing images comparable to ex vivo histochemical methods. Small-fibers are respectively easily assessed and visualized by these methods. The possibility to perform both methods in our Center brought to us the opportunity to consider how these methods can offer a good substrate for SFPN/NP diagnosis.

Design/Methods DESIGN/METHODS: A series of 25 patients presenting symptoms and signs of SFPN/NP were examined by two neurologists and submitted to CHEPS (Medoc) and CCM (HRT 3 Hildelberg) tests to evaluate the accuracy of these methods in support clinical diagnosis. The disclosures of each method were blindly considered by each neurologist as positive or negative taking into account the abnormal findings.

Results RESULTS: The concordance with neurological examination pointing to SFPN/NP with both methods was respectively observed in 21 (84%), and 22 (88%) patients.

Conclusions CONCLUSIONS: CHEPS and CCM are non-invasive, easily reproducible, giving a good laboratorial support for SFPN/NP.

Authors/Disclosures
Osvaldo J. Nascimento, MD, PhD, FAAN (Fluminense Federal University) PRESENTER	Dr. Nascimento has nothing to disclose.
Edward J. Fine, MD, FAAN (University Neurology, Northtowns)	Dr. Fine has received personal compensation in the range of $500-$4,999 for serving as a Speaker with Friends of PALS (People with ALS.
Edward J. Fine, MD, FAAN (University Neurology, Northtowns)	Dr. Fine has received personal compensation in the range of $500-$4,999 for serving as a Speaker with Friends of PALS (People with ALS.
Camila Pupe, MD	Dr. Pupe has nothing to disclose.
Eduardo R. Davidovich	Dr. Davidovich has nothing to disclose.
	No disclosure on file
Bruno Coutinho, MD (InNeuro)	No disclosure on file
Eduardo B. Uchoa Cavalcanti, MD, PhD, MSc, FAAN (Hospital Sarah - Lago Norte - Brasília)	Dr. Uchoa Cavalcanti has nothing to disclose.
	No disclosure on file
Joseph J. Higgins, MD, FAAN (AEGRIS LLC)	No disclosure on file

��ɫ��

��ɫ��