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The histopathological evaluation of small fiber neuropathy in patients with vitamin B12 deficiency

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Abstract

Small fiber neuropathy (SFN), due to loss of A-delta and unmyelinated C fibers, is a cause of neuropathic pain. Although the patients with vitamin B12 deficiency are included in SFN studies in the literature, there is no histopathological study investigating the small fiber loss solely in patients with vitamin B12 deficiency. In this pilot study, we aim to demonstrate the intraepidermal nerve fiber density (IENFD) in skin punch biopsy of patients with vitamin B12 deficiency. Ten patients with vitamin B12 deficiency suffering from neuropathic pain and as control group ten patients with vitamin B12 deficiency without neuropathic pain were included. Neurological examination, electrophysiological evaluation, and DN4 questionnaire were performed. Subsequently, skin punch biopsy 10 cm above the lateral malleolus was done. The biopsy samples were stained with PGP9.5 antibody, and IENFD was determined. IENFD was low in two groups compared to their age normative values. The median of IENFD was 3.345 (1.12–5.32) in patients with neuropathic pain and 6. 20 (4.6–9.8) in controls (p < 0.001). Our pilot study showed that vitamin B12 deficiency causes symptomatic as well as asymptomatic small fiber loss like diabetes mellitus.

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Acknowledgements

The authors would like to thank Bülent Çakır for his technical support and Dr. Gürsel Güneş for statistical analysis.

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Authors and Affiliations

  1. Neurology Department, Ankara Training and Research Hospital, Ankara, Turkey

    Hafize Nalan Güneş

  2. Neurology Department, School of Medicine, Hacettepe University, Ankara, Turkey

    Can Ebru Bekircan-Kurt, Ersin Tan & Sevim Erdem-Özdamar

  3. Neuromuscular Diseases Research Laboratory, School of Medicine, Hacettepe University, Ankara, Turkey

    Can Ebru Bekircan-Kurt, Ersin Tan & Sevim Erdem-Özdamar

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  1. Hafize Nalan Güneş
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  2. Can Ebru Bekircan-Kurt
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  3. Ersin Tan
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  4. Sevim Erdem-Özdamar
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Correspondence to Can Ebru Bekircan-Kurt.

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The author declares that they have no conflict of interest.

Ethical approval

The patients have given their informed consent, and the study was approved by the local ethics committee (GO 14/626).

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Güneş, H.N., Bekircan-Kurt, C.E., Tan, E. et al. The histopathological evaluation of small fiber neuropathy in patients with vitamin B12 deficiency. Acta Neurol Belg 118, 405–410 (2018). https://doi.org/10.1007/s13760-017-0847-y

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  • DOI: https://doi.org/10.1007/s13760-017-0847-y

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