Abstract Details

Title Characteristics of Small Fiber Neuropathy in a Cohort of Multiple Sclerosis Patients with Neuropathic Pain and/or Autonomic Dysfunction

Topic Multiple Sclerosis

Presentation(s) S7 - Multiple Sclerosis: Special Populations and Non-MS CNS Neuroinflammatory Disease (5:18 PM-5:30 PM)

Poster/Presentation
Number 010

Objective To characterize the presentation of small fiber neuropathy (SFN) in people with multiple sclerosis (pwMS) who suffer from neuropathic pain and/or dysautonomia.

Background Pain and sensory symptoms are reported in up to 80% of pwMS, with prevalence of neuropathic pain at approximately 26%. Historically, pain in MS has been mostly attributed to central lesions. Some recent studies have begun to emerge investigating demyelinating, large fiber peripheral neuropathies in pwMS, however little has been done to investigate whether small, non-myelinated fibers are also affected in pwMS with neuropathic pain and autonomic symptoms.

Design/Methods A total of 28 pwMS and neuropathic pain and/or autonomic symptoms underwent skin punch biopsies for evaluation of SFN at a single center. Samples were collected from a proximal and distal site in the lower extremity and sent for evaluation of intra-epidermal and sweat gland nerve fiber density. Symptoms and severity were characterized through collection of responses to the MGH Small-Fiber Symptom Survey.

Results Of 28 pwMS tested, 18 had significantly reduced intra-epidermal or sweat gland nerve fiber density in at least one of the biopsied sites. 2 patients had low-normal values in at least one of the collected sites. 8 patients had normal nerve fiber densities. Of those who tested positive, 90% were female with a mean disease duration of 5 years. MGH SSS results showed total symptom severity scores ranging from 17 to 85.

Conclusions This small case series indicates small fiber neuropathy as a potential cause of neuropathic pain and dysautonomia in pwMS. Symptoms of SFN and dysautonomia have a wide range of manifestations in this population. A larger study population is needed to further characterize the true prevalence of SFN in pwMS with neuropathic pain and dysautonomia, and to investigate potential mechanisms.

Authors/Disclosures
Kassandra Reyes, DO (Kassandra Reyes) PRESENTER	Dr. Reyes has nothing to disclose.
Mary Kelley, DO	Dr. Kelley has nothing to disclose.
Syed Ahmed, DO	Dr. Ahmed 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.

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