Abstract Details

Title Small Fiber Neuropathy in People with MS with Neuropathic Pain and Dysautonomia: A Case Series

Topic Multiple Sclerosis

Presentation(s) P9 - Poster Session 9 (5:30 PM-6:30 PM)

Poster/Presentation
Number 12-005

Objective

Background The prevalence of neuropathic pain in Multiple Sclerosis (MS) has been reported to be 20-86% and often presents as extremity pain. Furthermore, patients with MS have been found to have evidence of sudomotor dysfunction and elevated vibration perception. Collectively these findings have been associated with increased neurological disability. These symptoms are suggestive of a peripheral neuropathy, specifically a small fiber neuropathy involving A-delta and C fiber dysfunction. However, it is often thought that these symptoms are the result of a central process and thus little investigation is put into the potential for a peripheral cause.

Design/Methods Five patients with diagnosis of MS meeting McDonald criteria whom were experiencing neuropathic pain and dysautonomia not explained by the location of their CNS lesions on MRI were evaluated for small fiber neuropathy. Patients completed MGH small fiber symptom survey along with COMPASS-31 and underwent skin punch biopsy at two sites, one distal and one proximal on their lower extremity. Biopsies were sent to a CLIA certified laboratory and stained with PGP9.5, and intraepidermal nerve fiber density was measured.

Results All patients were found to have reduced IENFD, four of which had significantly decreased IENFD meeting criteria for a diagnosis of small fiber neuropathy and one had borderline low IENFD with history suggestive of mild small fiber neuropathy. Four of these patients were being treated with immunotherapy for their MS at the time of biopsy.

Conclusions Damage to peripheral A-delta and C fibers may account for symptoms of neuropathic pain and autonomic abnormalities in patients diagnosed with MS. The small fiber neuropathy found in some patients with MS may not be responsive to immunotherapy for MS and may exist and contribute to overall disability in patients despite having stable MRI findings. This is an important point to consider when evaluating and treating people with MS.

Authors/Disclosures
Mary Kelley, DO PRESENTER	Dr. Kelley has nothing to disclose.
Leorah A. Freeman, MD, PhD (Dell Medical School, The University of Texas at Austin)	Dr. Freeman has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Novartis. Dr. Freeman has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Hoffman La-Roche. Dr. Freeman has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Genentech, Inc. Dr. Freeman has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for EMD Serono. Dr. Freeman has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Horizon. Dr. Freeman has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Sanofi. Dr. Freeman has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for TG Therapeutics. Dr. Freeman has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for Sanofi-Genzyme. Dr. Freeman has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Texas Neurological Society. Dr. Freeman has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for EMD Serono/ Merck. The institution of Dr. Freeman has received research support from Genentech. The institution of Dr. Freeman has received research support from PCORI. The institution of Dr. Freeman has received research support from EMD Serono. The institution of Dr. Freeman has received research support from Sanofi. The institution of Dr. Freeman has received research support from MSAA. The institution of Dr. Freeman has received research support from National Multiple Sclerosis Society.
Ethan I. Meltzer, MD (Dell Medical School, The University of Texas at Austin)	Dr. Meltzer has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Horizon therapeutics. Dr. Meltzer has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for TG Therapeutics. Dr. Meltzer has received personal compensation in the range of $0-$499 for serving as a Consultant for Novartis. Dr. Meltzer has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Genentech. The institution of Dr. Meltzer has received research support from Genentech. Dr. Meltzer has received publishing royalties from a publication relating to health care.
Ashlea Lucas, PA	Ms. Lucas has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Viela Bio. Ms. Lucas has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Bristol Meyers Squibb.
Helen Onuorah, Other (Dell Medical School - The University of Texas at Austin)	Ms. Onuorah has nothing to disclose.

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