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Home : Services : Epidermal Nerve Fiber Density (ENFD) testing

EPIDERMAL NERVE FIBER DENSITY (ENFD) TESTING


Small Fiber Sensory and Autonomic Neuropathies

Small fiber neuropathy (SFN) is caused by damage to the small, unmyelinated nerve fibers that innverate the skin and internal organs. These fibers transmit pain and temperature senations from the skin and control autonomic functions like sweating. Dysfunction of the small nerve fibers can cause sensory or autonomic symptoms. SFN or automatic neuropathy can result from underlying disorders such as:

  • Diabetes/ Pre-Diabetes
  • Immune medicated disease
  • Amyloidosis
  • Drug toxins
  • Infections- Lyme, HCV, HIV-1
  • Hereditary/ genetic- Fabry’s disease
  • Nutritional- B1, B12
  • Tumor related- paraneoplastic, infilitrative

Therapath Advantages

  • Convenient biopsy process, no solution transfer needed
  • Single sample can be tested for Epidermal Nerve Fiber Density (ENFD), Sweat Gland Nerve Fiber Density
  • -10 day turnaround time
  • Board certified Neuropathologists

Reason to do a Skin Test

  • Early Screening tool for diabetic patients to detect neuropathy
  • Early detection for Small Fiber Neuropathy helps to determine the underlying cause
  • Diagnosis of Small Fiber Neuropathy will confirm that the patient’s pain is real
  • To follow the progression of the neuropathy response to therapy.

Testing Sites The 2 standard sites are:

  • D= Distel Leg, 10 cm above the lateral malleolus
  • F= Dorsum of the Foot, over the extensor digitorum brevis muscle
  • Small fiber neuropathy is most easily and reliably diagnosed by skin biopsy, demonstrating a reduction in the epidermal nerve fiber density.

Epidermal & Sweat Gland Nerve Fiber Density

SFN is the most easily and reliably diagnosed by skin biopsy. Two standardized tests are available: the Epidermal Nerve Fiber Density (ENFD) tests measures the density of small sensory nerve fibers in the skin epidermis, and the Sweat Gland Nerve Fiber Density (SGNFD) teat measures the density of small autonomic nerve fibers in the sweat glands. Both ENFD and SGNFD can be reduced in SFN, although to different extents, depending on the type of neuropathy. The SGNFD may also be decreased in some patients with SFN whose ENFD test is normal and the two tests together may, in some cases increase the sensitivity of either alone in detecting SFN.

Other Available Tests

  • Muscle biopsies
  • Nerve biopsies
  • Neuropathology consultations for surgical and autopsy specimens

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