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Abstract Details

Small Fiber Neuropathy in Multiple Sclerosis: A Case Series
Multiple Sclerosis
P3 - Poster Session 3 (5:30 PM-6:30 PM)
12-002
We present a series of five MS patients with intractable neuropathic pain and biopsy confirmed small fiber neuropathy.

Chronic neuropathic pain is a common and difficult to treat symptom in patients with MS. The etiology of pain is poorly understood and often thought to be centrally mediated. The response to treatment is suboptimal often resulting in poor quality of life.
A total of eight patients with severe intractable neuropathic pain unresponsive to treatment underwent a skin biopsy and measurement of intraepidermal nerve fiber density from two locations (thigh and calf). Five had pathological findings consistent with small fiber neuropathy, with nerve conduction studies revealing no large fiber abnormalities. All skin biopsies and exams were performed by a trained neurologist at our institution (Brown Neurology). Specimens were processed and studied at Therapath Neuropathology (545 West 45th street New York NY 10036). Comorbid conditions included hypothyroidism in three patients and diabetes in one patient.
NA
Neuropathic pain in MS patients contributes to disability and lower quality of life. The relationship between the pathogenesis of SFN and MS, if any, has yet to be determined. We recommend that SFN be considered in MS patients with chronic neuropathic pain as it may be underdiagnosed. A large controlled trial may provide more insight regarding prevalence of SFN in MS patients and response to treatment with IVIG.
Authors/Disclosures
Natalie K. Erlich-Malona, MD (Neurology Department, UMass Memorial Medical Center)
PRESENTER 		Dr. Erlich-Malona has nothing to disclose.
Syed Rizvi, MD (Neurology Foundation) Dr. Rizvi has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Serono Roche Bristol Myers . Dr. Rizvi has received personal compensation in the range of $5,000-$9,999 for serving as an Expert Witness for Na.
Todd Nguyen, MD (University of California, San Francisco) Mr. Nguyen has nothing to disclose.
Saima Chaudhry, MD Dr. Chaudhry has nothing to disclose.
Kara Stavros, MD, FAAN Dr. Stavros has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Springer Healthcare LLC. Dr. Stavros has received personal compensation in the range of $500-$4,999 for serving as an officer or member of the Board of Directors for Rhode Island Medical Society.
Jonathan Cahill, MD, FAAN (Brown Neurology) The institution of Dr. Cahill has received research support from Roche / Genentech. Dr. Cahill has received publishing royalties from a publication relating to health care.