Therapath LLC (www.Therapath.com),a leader in neuropathology laboratory services, has established normative values for two upper limb body sites that can now be used to evaluate 3mm punch skin biopsy specimens for Epidermal Nerve Fiber Density (ENFD) and Sweat Gland Nerve Fiber Density (SGNFD). The additional body sites were determined in an IRB approved clinical study of normal adult subjects. The new biopsy sites are defined as the Proximal Arm (Lateral surface midway between the shoulder (acromion) and the elbow) and the Distal Arm (Upper (hairy or dorsal) surface of the forearm, 5 cm above the wrist). These new sites complement the existing standardized biopsy sites at the proximal thigh, distal leg (calf) and dorsal foot. The punch skin biopsy with enumeration of the epidermal nerve fiber density is a reliable and efficient technique to assess the diagnosis of small fiber neuropathy (Joint Task Force or EFNS and PNS, J Periph Nerv Syst 2010).
Several studies have recently reported a decrease in epidermal nerve fiber density in a subset of patients with fibromyalgia (Oaklander et al, Pain 2013; Caro and Winter, Arthritis Rheumatol 2014; Giannoccaro, et all, Muscle Nerve 2014) concluding that skin biopsy should be considered in the diagnostic work-up of Fibromyalgia to search for Small Fiber Neuropathy. The availability of the new standard biopsy sites will enable physicians diagnose small fiber neuropathy in patients whose symptoms are confined to the upper extremities.
Additionally, Therapath completed analysis on the effect of age and gender on normative values for ENFD and SGNFD at all standardized biopsy sites. Therapath will use these values for diagnosis of small fiber neuropathy.
About Therapath Neuropathology:
Therapath Neuropathology, founded in 2004, is a College of American Pathology accredited (CAP) and CLIA licensed specialized laboratory. The medical team are board certified in neuropathology, academically trained and extensively published. Therapath’s focus is on research and development in the testing services for muscle biopsy, nerve biopsy with teased fiber analysis, ocular (including optic neurotis), skin epidermal nerve fiber density, sweat gland nerve fiber density, skin biopsy for CADASIL and other storage disorders as well as brain/spinal cord specimens. Therapath serves hospitals, private practitioners, reference laboratories, pharmaceutical industry, and researchers throughout all 50 states and worldwide including; Australia, Brazil, Canada, China, England, Germany, Greece, Hong Kong, Israel, Italy, Japan, Mexico, the Netherlands, and Saudi Arabia.
