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Journal Review: Non-length-dependent small fiber neuropathy: Not a matter of stockings and gloves
Journal Review: Non-length-dependent small fiber neuropathy: Not a matter of stockings and gloves

The clinical spectrum of small fiber neuropathy (SFN) encompasses manifestations related to the involvement of thinly myelinated A-delta and unmyelinated C fibers, including not only the classical distal phenotype, but also a non–length-dependent (NLD) presentation that can be patchy, asymmetrical, upper limb-predominant, or dif-fuse. This narrative review is focused on NLD-SFN. The diagnosis of NLD-SFN can be problematic, due to its varied and often atypical presentation, and diagnostic criteria developed for distal SFN are not suitable for NLD-SFN. The topographic pat-tern of NLD-SFN is likely related to ganglionopathy restricted to the small neurons of dorsal root ganglia. It is often associated with systemic diseases, but about half the time is idiopathic. In comparison with distal SFN, immune-mediated diseases are more common than dysmetabolic conditions. Treatment is usually based on the man-agement of neuropathic pain. Disease-modifying therapy, including immunotherapy, may be effective in patients with identified causes. Future research on NLD-SFN is expected to further clarify the interconnected aspects of phenotypic characteriza-tion, diagnostic criteria, and pathophysiology.

1) Understand and apply the appropriate tests for the assessment and diagnosis of non-length dependent small fiber neuropathy;
2) Recognize the clinical features of non-length-dependent small fiber neuropathy and incorporate them into the evaluation of patients; 
3) Know the most common conditions associated with non-length-dependent small fiber neuropathy, and incorporate this knowledge into assessments of appropriate patients. 

The AANEM is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

The AANEM designates this enduring material for a maximum of 1 AMA PRA Category 1 Credits TM.  Physicians should claim only the credit commensurate with the extent of their participation in the activity. Credit expires 12/15/2024.

No one involved in the planning of this CME activity had any relevant financial relationships to disclose. 

Franco Gemignani, MD; Maria F. Bellanova, BSc; Elena Saccani, MD; Giovanni Pavesi, MD
Availability: On-Demand
Expires on Dec 15, 2024
Cost: Member: $0.00
Non-Member: $25.00
Credit Offered:
1 CME Credit
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