Pain-related nociceptive evoked potential and skin wrinkle test in small fiber neuropathy

A 58-year-old woman with clinically probable small fiber neuropathy (SFN)[1], with normal electroneuromyography, was evaluated with pain-related nociceptive evoked potential (PREP) with a concentric planar electrode stimulation on the dorsum of the hands and feet[2] and skin wrinkle test (SWT)[3]. The PREP showed N1 latency delay ([Figure 1]), compatible with the change in SWT induced by water, which indicated a Grade 0 pattern ([Figure 2]), as can be seen in sympathetic autonomic small fiber dysfunction.

Figure 1 Pain-related nociceptive evoked potential.

Figure 2 Skin wrinkle test. Patient (C and D). Normal test (A and B).

New electrophysiological tools, combined with SWT and specific neurological examination, contribute to the diagnosis of SFN.

Multiple-choice questions with related answers are given in Supplementary Material. The following material is available online for this article: https://www.arquivosdeneuropsiquiatria.org/wp-content/uploads/2022/02/ANP_2021327_material-suplementar_16-02.pdf

Conflict of interest:

There is no conflict of interest to declare.

Authors’ contributions:

All authors worked extensively on the manuscript and approved this submitted version; OJHF: conceived the idea for the article, which was written and critically reviewed by all authors.

• References

• 1 Cazzato D, Lauria G. Small fibre neuropathy. Curr Opin Neurol 2017; Oct; 30 (05) 490-499 https://doi.org/10.1097/WCO.20210327202103270472
• 2 Hernandez Fustes OJ, Kay CSK, Lorenzoni PJ, Ducci RDP, Werneck LC, Scola RH. Somatosensory evoked potentials in clinical practice: a review. Arq Neuro-Psiquiatr 2021; Sep; 79 (09) 824-831 https://doi.org/10.1590/0004-282X-ANP-2020-0427
• 3 O’Riain S. New and simple test of nerve function in hand. Br Med J 1973; Sep; 3(5881) 615-616 https://doi.org/1010.1136/bmj.3.5881.615

Publication History

Received: 11 August 2021

Accepted: 27 October 2021

Article published online:
06 February 2023