Small fi ber neuropathy – how to start , where to go ?

Small fi ber neuropathy (SFN) is a type of sensory neuropathy which selectively aff ects small diameter somatic and autonomic nerve fi bers. Diagnosis is challenging, given that clinical picture can be diffi cult to interpret. Patients typically present with painful paresthesias and/or signs of autonomic dysfunction. In SFN, neuropathic pain was shown to be a frequent and early symptom, so it is considered as a reliable marker of this neuropathy. Th e diagnosis of SFN relies on clinical features combined with abnormal quantifi cation of intraepidermal nerve fi ber density (IENFD) and/or defi cit in temperature threshold on quantitative sensory testing (QST). SFN is associated with various systemic diseases, among which diabetes was found to be the most common one. Th is knowledge urges a detailed diagnostic work-up of every patient presenting with SFN because new understanding of the SFN etiology could help narrow the proportion of idiopathic SFN patients, which is still large. Most recent discoveries of several novel mutations to sodium channels in patients with idiopathic SFN could help in this area, as well as in the development of specifi c treatment options. For now, the treatment of SFN is very complex. Causative therapy is advised whenever possible and symptomatic treatment should follow newest guidelines on the management of neuropathic