PDF(Pubmed)
Abstract：
Background: The investigation of C-fiber-evoked ultralow-level responses (ULEPs) at somatic sites is difficult in clinical practice but may be useful in patients with small fiber neuropathy. Aim: The aim of the study was to investigate changes in LEPs and ULEPs in patients with fibromyalgia affected or not by abnormal intraepidermal innervation. Methods: We recorded LEPs and ULEPs of the hand, thigh and foot in 13 FM patients with a normal skin biopsy (NFM), 13 patients with a reduced intraepidermal nerve fiber density (IENFD) (AFM) and 13 age-matched controls. We used a YAP laser, changing the energy and spot size at the pain threshold for LEPs and at the heat threshold for ULEPs. Results: ULEPs occurred at a small number of sites in both the NFM and AFM groups compared to control subjects. The absence of ULEPs during foot stimulation was characteristic of AFM patients. The amplitude of LEPs and ULEPs was reduced in patients with AFM at the three stimulation sites, and a slight reduction was also observed in the NFM group. Conclusions: The present preliminary results confirmed the reliability of LEPs in detecting small fiber impairments. The complete absence of ULEPs in the upper and lower limbs, including the distal areas, could confirm the results of LEPs in patients with small fiber impairments. Further prospective studies in larger case series could confirm the present findings on the sensitivity of LEP amplitude and ULEP imaging in detecting small fiber impairments and the development of IENFD in FM patients.
摘要：
背景：在临床实践中，难以对躯体部位的C纤维诱发的超低水平反应（ULEP）进行研究，但可能对小纤维神经病变患者有用。目的：该研究的目的是研究受表皮内神经支配异常影响或不受影响的纤维肌痛患者LEP和ULEP的变化。方法：我们记录手的LEP和ULEP，13例皮肤活检（NFM）正常的FM患者的大腿和足部，13例表皮内神经纤维密度（IENFD）（AFM）降低的患者和13例年龄匹配的对照。我们用了YAP激光,改变LEP疼痛阈值和ULEP热阈值的能量和斑点大小。结果：与对照组相比，NFM和AFM组的ULEP发生在少量部位。在足部刺激期间没有ULEP是AFM患者的特征。AFM患者在三个刺激部位的LEP和ULEP的振幅均降低，在NFM组中也观察到轻微的减少。结论：本初步结果证实了LEP检测小纤维损伤的可靠性。上肢和下肢完全没有ULEP，包括远端区域，可以证实小纤维损伤患者LEP的结果。在更大的病例系列中进行的进一步前瞻性研究可以证实有关LEP振幅和ULEP成像在检测FM患者的小纤维损伤和IENFD发展中的敏感性的当前发现。
