This plenary session will focus on small fiber neuropathy. The clinical picture of SFN is characterized by positive and negative symptoms and/or signs related to pain, temperature, and autonomic functions. Patients usually describe their symptoms as burning, stabbing, and/or shooting pain, and they may have a decreased pain-, temperature- and pinprick sensation. Autonomic symptoms frequently occur. Quality of life (QoL) is negatively impacted. Epidemiology costs of disease will be presented.
Based on diagnostic criteria, SFN can be graded into possible, probable, or definite SFN. Skin biopsies determining the intra-epidermal nerve fiber density (IENFD) and quantitative sensory testing (QST) for testing small nerve fiber function are the universally recommended tests for SFN. Typical symptoms and signs of small nerve fiber damage and absence of large nerve fiber involvement are required for the diagnosis SFN. SFN is associated with various underlying conditions. A genetic substrate for neuropathic pain is an accepted hypothesis. In the previous decade, novel pathogenic mutations have been identified in SCN9A, SCN10A, and SCN11A genes encoding for three sodium channels (Nav1.7, Nav1.8 and Nav1.9 respectively), known to play a critical role in the generation and conduction of action potentials in nociceptors and their terminal axons. Previous findings suggest that sodium channel mutations can change the physiological properties of nociceptors and also impair the integrity of their neurites, eventually leading to the degeneration of small nerve fibers.
Finally, the results of recent trials in SFN will be presented.


Learning Objectives
1: Upon completion, the participant will be better able to recognize the clinical picture of small fiber neuropathy.
2: Upon completion, the participant will be better able to define underlying conditions related to small fiber neuropathy.
3: Upon completion, the participant will be better able to describe current knowledge of recent trials in SFN with its practical implications.