| Title |
Immunotherapy Prospects for Painful Small-fiber Sensory Neuropathies and Ganglionopathies
|
|---|---|
| Published in |
Neurotherapeutics, January 2016
|
| DOI | 10.1007/s13311-015-0395-1 |
| Pubmed ID | |
| Authors |
Anne Louise Oaklander |
| Abstract |
The best-known peripheral neuropathies are those affecting the large, myelinated motor and sensory fibers. These have well-established immunological causes and therapies. Far less is known about the somatic and autonomic "small fibers"; the unmyelinated C-fibers, thinly myelinated A-deltas, and postganglionic sympathetics. The small fibers sense pain and itch, innervate internal organs and tissues, and modulate the inflammatory and immune responses. Symptoms of small-fiber neuropathy include chronic pain and itch, sensory impairment, edema, and skin color, temperature, and sweating changes. Small-fiber polyneuropathy (SFPN) also causes cardiovascular, gastrointestinal, and urological symptoms, the neurologic origin of which often remains unrecognized. Routine electrodiagnostic study does not detect SFPN, so skin biopsies immunolabeled to reveal axons are recommended for diagnostic confirmation. Preliminary evidence suggests that dysimmunity causes some cases of small-fiber neuropathy. Several autoimmune diseases, including Sjögren and celiac, are associated with painful small-fiber ganglionopathy and distal axonopathy, and some patients with "idiopathic" SFPN have evidence of organ-specific dysimmunity, including serological markers. Dysimmune SFPN first came into focus in children and teenagers as they lack other risk factors, for example diabetes or toxic exposures. In them, the rudimentary evidence suggests humoral rather than cellular mechanisms and complement consumption. Preliminary evidence supports efficacy of corticosteroids and immunoglobulins in carefully selected children and adult patients. This paper reviews the evidence of immune causality and the limited data regarding immunotherapy for small-fiber-predominant ganglionitis, regional neuropathy (complex regional pain syndrome), and distal SFPN. These demonstrate the need to develop case definitions and outcome metrics to improve diagnosis, enable prospective trials, and dissect the mechanisms of small-fiber neuropathy. |
X Demographics
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Geographical breakdown
| Country | Count | As % |
|---|---|---|
| Ireland | 1 | 20% |
| Germany | 1 | 20% |
| United Kingdom | 1 | 20% |
| United States | 1 | 20% |
| Unknown | 1 | 20% |
Demographic breakdown
| Type | Count | As % |
|---|---|---|
| Members of the public | 3 | 60% |
| Scientists | 1 | 20% |
| Science communicators (journalists, bloggers, editors) | 1 | 20% |
Mendeley readers
The data shown below were compiled from readership statistics for 113 Mendeley readers of this research output. Click here to see the associated Mendeley record.
Geographical breakdown
| Country | Count | As % |
|---|---|---|
| Spain | 1 | <1% |
| Unknown | 112 | 99% |
Demographic breakdown
| Readers by professional status | Count | As % |
|---|---|---|
| Researcher | 21 | 19% |
| Other | 13 | 12% |
| Student > Ph. D. Student | 11 | 10% |
| Student > Master | 9 | 8% |
| Student > Doctoral Student | 8 | 7% |
| Other | 28 | 25% |
| Unknown | 23 | 20% |
| Readers by discipline | Count | As % |
|---|---|---|
| Medicine and Dentistry | 52 | 46% |
| Nursing and Health Professions | 6 | 5% |
| Biochemistry, Genetics and Molecular Biology | 6 | 5% |
| Neuroscience | 6 | 5% |
| Pharmacology, Toxicology and Pharmaceutical Science | 4 | 4% |
| Other | 14 | 12% |
| Unknown | 25 | 22% |
Attention Score in Context
This research output has an Altmetric Attention Score of 4. This is our high-level measure of the quality and quantity of online attention that it has received. This Attention Score, as well as the ranking and number of research outputs shown below, was calculated when the research output was last mentioned on 26 March 2024.
All research outputs
#7,960,693
of 25,374,917 outputs
Outputs from Neurotherapeutics
#734
of 1,307 outputs
Outputs of similar age
#116,504
of 399,677 outputs
Outputs of similar age from Neurotherapeutics
#9
of 18 outputs
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