We've detected that Javascript is not enabled. It is required for an optimal survey taking experience.
Please check your browser's settings and make sure Javascript is turned on. Learn how to enable Javascript.

Skip survey header

Practice Current: How Do You Diagnose Small Fiber Neuropathy?

Introduction

Practice Current features anonymous surveys intended to assess real-life practice patterns in scenarios where uncertainty exists. There are no right or wrong answers and we understand that extra-medical factors affect neurologic practice.

Please answer each question based on your REGULAR practice, and not your IDEAL practice. For example, if “option A” would be your ideal choice but you regularly do “option B” due to encountered barriers, then choose “option B”.

Estimated Time: 4 Minutes

Case 1. A 62-year-old man with hyperlipidemia, central obesity, and well-controlled diabetes presents with bothersome dysesthesias and pain on the bottom of his feet for the last two years. Neurologic examination shows normal reflexes and vibratory sensation throughout, with some hypersensitivity when lightly brushing the feet.

1. Small fiber neuropathy can be confidently diagnosed through history and physical exam. *This question is required.

2. Which of the following tests would you typically order at the first visit? [Select all that apply.] *This question is required.

Electrodiagnostic studies including electromyography and nerve conduction studies (EMG/NCS)
Skin biopsy for quantification of epidermal nerve fiber density (ENFD)
Autonomic testing including quantitative sweat testing
Other tests
None of the above

Which additional tests would you order? [Select all that apply.] *This question is required.

Electrodiagnostic evaluation including nerve conduction studies and electromyography is normal. A skin punch biopsy is ordered to evaluate epidermal nerve fiber density.

3. How often do you order skin biopsy for the diagnosis of small fiber neuropathy? [Choose one.] *This question is required.

What are the reasons you never order a skin biopsy? [Select all that apply.] *This question is required.

It is not available/difficult to access in my practice.
I do not think this test is necessary.
I do not know how to interpret this test.
I do not trust the results of this test.
I usually refer to a different neurologist/specialist to order this test.
I was not aware of this test.

How commonly do you order a skin biopsy in patients with high suspicion of small fiber neuropathy? *This question is required.

How commonly do you order a skin biopsy in a patient with low suspicion of small fiber neuropathy? *This question is required.

In your opinion, what is the highest diagnostic value of skin biopsy? [Rank 1-4, with 1 being the most useful indication] *This question is required. Note: for the following table each column is restricted to a single answer across all rows.

	1	2	3	4
To rule-in small fiber neuropathy in cases for which there is high suspicion.	Rank To rule-in small fiber neuropathy in cases for which there is high suspicion. as 1 out of 4	Rank To rule-in small fiber neuropathy in cases for which there is high suspicion. as 2 out of 4	Rank To rule-in small fiber neuropathy in cases for which there is high suspicion. as 3 out of 4	Rank To rule-in small fiber neuropathy in cases for which there is high suspicion. as 4 out of 4
To rule-out small fiber neuropathy in cases for which there is high suspicion.	Rank To rule-out small fiber neuropathy in cases for which there is high suspicion. as 1 out of 4	Rank To rule-out small fiber neuropathy in cases for which there is high suspicion. as 2 out of 4	Rank To rule-out small fiber neuropathy in cases for which there is high suspicion. as 3 out of 4	Rank To rule-out small fiber neuropathy in cases for which there is high suspicion. as 4 out of 4
To rule-in small fiber neuropathy in cases for which there is low suspicion.	Rank To rule-in small fiber neuropathy in cases for which there is low suspicion. as 1 out of 4	Rank To rule-in small fiber neuropathy in cases for which there is low suspicion. as 2 out of 4	Rank To rule-in small fiber neuropathy in cases for which there is low suspicion. as 3 out of 4	Rank To rule-in small fiber neuropathy in cases for which there is low suspicion. as 4 out of 4
To rule-out small fiber neuropathy in cases for which there is low suspicion.	Rank To rule-out small fiber neuropathy in cases for which there is low suspicion. as 1 out of 4	Rank To rule-out small fiber neuropathy in cases for which there is low suspicion. as 2 out of 4	Rank To rule-out small fiber neuropathy in cases for which there is low suspicion. as 3 out of 4	Rank To rule-out small fiber neuropathy in cases for which there is low suspicion. as 4 out of 4

How confident are you in the accuracy of the results of a positive skin biopsy? [Select one.] *This question is required.

How confident are you in the accuracy of the results of a negative skin biopsy? [Select one.] *This question is required.

Do you perform or interpret skin biopsies for small fiber neuropathy diagnosis? *This question is required.