Definição e diagnóstico de neuropatia de fibras finas: consenso do Departamento Científico de Neuropatias Periféricas da Academia Brasileira de Neurologia.

Gondim, Francisco de Assis Aquino; Barreira, Amilton Antunes; Claudino, Rinaldo; Cruz, Márcia Waddington; Cunha, Francisco Marcos Bezerra da; Freitas, Marcos Raimundo Gomes de; França Jr, Marcondes Cavalcante; Gonçalves, Marcus Vinícius Magno; Marques Jr, Wilson; Nascimento, Osvaldo José Moreira; Oliveira, Acary Souza Bulle; Pereira, Raquel Campos; Pupe, Camila; Rotta, Francisco Tellechea; Schestatsky, Pedro

doi:10.1590/0004-282X20180015

Accessibility / Report Error

Brazil

Arquivos de Neuro-Psiquiatria

Português Español

Brazil

Português Español

table of contents « previous current next »

Table of contents

Brazilian Academy of Neurology • Arq. Neuro-Psiquiatr. 76 (3) • Mar 2018 • https://doi.org/10.1590/0004-282X20180015 copiar

Definição e diagnóstico de neuropatia de fibras finas: consenso do Departamento Científico de Neuropatias Periféricas da Academia Brasileira de Neurologia.

Autoria SCIMAGO INSTITUTIONS RANKINGS

RESUMO

O objetivo deste estudo é descrever os resultados de um Consenso Brasileiro sobre Neuropatia de Fibras Finas (NFF). Quinze neurologistas (membros da Academia Brasileira de Neurologia) revisaram uma versão preliminar do artigo. Onze panelistas se reuniram na cidade de Fortaleza para discutir e terminar o texto para a submissão do manuscrito. NFF pode ser definida como um subtipo de neuropatia caracterizada pelo envolvimento seletivo de fibras sensitivas amielínicas ou pouco mielinizadas. Seu quadro clínico inclui manifestações negativas e positivas: sensitivas (dor/disestesias/prurido) ou queixas sensitivas e autonômicas combinadas, associadas a exame neurológico quase totalmente normal. A eletromiografia convencional é normal. Uma lista crescente de condições médicas causa NFF. NFF também pode servir como uma terminologia útil para referenciar pequenas discrepâncias nos valores normais de diferentes laboratórios de neurofisiologia. Diferentes técnicas podem evidenciar anormalidades sensitivas e/ou autonômicas. São necessários mais estudos para refiná-las e para o desenvolvimento de terapias específicas.

Palavras-chave
neuropatia de pequenas fibras; fibras nervosas amielínicas

Academia Brasileira de Neurologia - ABNEURO R. Vergueiro, 1353 sl.1404 - Ed. Top Towers Offices Torre Norte, 04101-000 São Paulo SP Brazil, Tel.: +55 11 5084-9463 | +55 11 5083-3876 - São Paulo - SP - Brazil
E-mail: revista.arquivos@abneuro.org

Stay informed of issues for this journal through your RSS reader

[1] Correspondence: Francisco de Assis Aquino Gondim; Serviço de Neurologia, Departamento de Medicina Clínica da UFCE; Rua Capitão Francisco Pedro, 1290; 60430-372 Fortaleza CE, Brasil; E-mail: gondimfranc@gmail.com

Metabolic and/or nutritional
	Diabetes mellitus, metabolic syndrome/glucose intolerance, insulin neuritis¹¹11. Gibbons CH. Small fiber neuropathies. In: Levin KH, editor. Peripheral nervous system disorders. Riverwoods: Wolters Kluwer Health; 2014. p. 1398-1412.^,¹⁷17. Gibbons CH, Freeman R. Treatment-induced diabetic neuropathy: a reversible painful autonomic neuropathy. Ann Neurol. 2010 Apr;67(4):534-41. https://doi.org/10.1002/ana.21952 https://doi.org/10.1002/ana.21952...
	Chronic renal insufficiency¹⁸18. Chao CC, Wu VC, Tan CH, Wang YM, Tseng MT, Wu PC et al. Skin denervation and its clinical significance in late-stage chronic kidney disease. Arch Neurol. 2011 Feb;68(2):200-6. https://doi.org/10.1001/archneurol.2010.372 https://doi.org/10.1001/archneurol.2010....
	Thiamine or B12 deficiency (myeloneuropathy spectrum)¹¹11. Gibbons CH. Small fiber neuropathies. In: Levin KH, editor. Peripheral nervous system disorders. Riverwoods: Wolters Kluwer Health; 2014. p. 1398-1412.^,¹⁹19. Oliveira GR, Teles BC, Brasil EF, Souza MH, Furtado LE, de Castro-Costa CM et al. Peripheral neuropathy and neurological disorders in an unselected Brazilian population-based cohort of IBD patients. Inflamm Bowel Dis. 2008 Mar;14(3):389-95. https://doi.org/10.1002/ibd.20304 https://doi.org/10.1002/ibd.20304...
	Hyper- or hypothyroidism¹¹11. Gibbons CH. Small fiber neuropathies. In: Levin KH, editor. Peripheral nervous system disorders. Riverwoods: Wolters Kluwer Health; 2014. p. 1398-1412.^,²⁰20. Ørstavik K, Norheim I, Jørum E. Pain and small-fiber neuropathy in patients with hypothyroidism. Neurology. 2006 Sep;67(5):786-91. https://doi.org/10.1212/01.wnl.0000234035.13779.4a https://doi.org/10.1212/01.wnl.000023403...
	Hyperlipidemia²¹21. McManis PG, Windebank AJ, Kiziltan M. Neuropathy associated with hyperlipidemia. Neurology. 1994 Nov;44(11):2185-6. https://doi.org/10.1212/WNL.44.11.2185 https://doi.org/10.1212/WNL.44.11.2185...
Infectious
	Leprosy²²22. Nascimento OJ. Leprosy neuropathy: clinical presentations. Arq Neuropsiquiatr. 2013 Sep;71 9B:661-6. https://doi.org/10.1590/0004-282X20130146 https://doi.org/10.1590/0004-282X2013014...
	HIV²³23. Polydefkis M, Yiannoutsos CT, Cohen BA, Hollander H, Schifitto G, Clifford DB et al. Reduced intraepidermal nerve fiber density in HIV-associated sensory neuropathy. Neurology. 2002 Jan;58(1):115-9. https://doi.org/10.1212/WNL.58.1.115 https://doi.org/10.1212/WNL.58.1.115... , HTLV²⁴24. Nascimento OJ, Marques W Jr. Human T-cell leukemia virus (HTLV)-associated neuropathy. Handb Clin Neurol. 2013;115:531-41. https://doi.org/10.1016/B978-0-444-52902-2.00030-8 https://doi.org/10.1016/B978-0-444-52902...
	Hepatitis C²⁵25. Tembl JI, Ferrer JM, Sevilla MT, Lago A, Mayordomo F, Vilchez JJ. Neurologic complications associated with hepatitis C virus infection. Neurology. 1999 Sep;53(4):861-4. https://doi.org/10.1212/WNL.53.4.861 https://doi.org/10.1212/WNL.53.4.861...
	Chagas disease²⁶26. Nolano M, Provitera V, Manganelli F, Pagano A, Perretti A, Santoro L. Small fiber neuropathy in the chronic phase of Chagas disease: a case report. Clin Auton Res. 2013 Jun;23(3):149-53. https://doi.org/10.1007/s10286-013-0189-7 https://doi.org/10.1007/s10286-013-0189-...
Amyloidosis
	Systemic²⁷27. Kissel JT, Mendell JR. Neuropathies associated with monoclonal gammopathies. Neuromuscul Disord. 1996 Jan;6(1):3-18. https://doi.org/10.1016/0960-8966(95)00021-6 https://doi.org/10.1016/0960-8966(95)000...
	Familial (familial amyloid polyneuropathy)²⁸28. Conceição I, González-Duarte A, Obici L, Schmidt HH, Simoneau D, Ong ML et al. “Red-flag” symptom clusters in transthyretin familial amyloid polyneuropathy. J Peripher Nerv Syst. 2016 Mar;21(1):5-9. https://doi.org/10.1111/jns.12153 https://doi.org/10.1111/jns.12153...
Autoimmune
	Celiac disease¹⁵15. Thawani SP, Brannagan TH 3rd, Lebwohl B, Green PH, Ludvigsson JF. Risk of Neuropathy Among 28,232 Patients With Biopsy-Verified Celiac Disease. JAMA Neurol. 2015 Jul;72(7):806-11. https://doi.org/10.1001/jamaneurol.2015.0475 https://doi.org/10.1001/jamaneurol.2015....
	Sjögren's disease²⁹29. Indart S, Hugon J, Guillausseau PJ, Gilbert A, Dumurgier J, Paquet C et al. Impact of pain on cognitive functions in primary Sjögren syndrome with small fiber neuropathy: 10 cases and a literature review. Medicine (Baltimore). 2017 Apr;96(16):e6384. https://doi.org/10.1097/MD.0000000000006384 https://doi.org/10.1097/MD.0000000000006...
	Inflammatory bowel disease¹³13. Gondim FA, Brannagan TH 3rd, Sander HW, Chin RL, Latov N. Peripheral neuropathy in patients with inflammatory bowel disease. Brain. 2005 Apr;128(Pt 4):867-79. https://doi.org/10.1093/brain/awh429 https://doi.org/10.1093/brain/awh429... ^,¹⁴14. Gondim FA, de Oliveira GR, Teles BC, Aquino PS, Brasil EF, Carvalho AM et al. Clinical and Electrodiagnostic Findings in Patients with Peripheral Neuropathy and Inflammatory Bowel Disease. Inflamm Bowel Dis. 2015 Sep;21(9):2123-9. https://doi.org/10.1097/MIB.0000000000000459 https://doi.org/10.1097/MIB.000000000000...
	Systemic lupus erythematosus³⁰30. Gøransson LG, Tjensvoll AB, Herigstad A, Mellgren SI, Omdal R. Small-diameter nerve fiber neuropathy in systemic lupus erythematosus. Arch Neurol. 2006 Mar;63(3):401-4. https://doi.org/10.1001/archneur.63.3.401 https://doi.org/10.1001/archneur.63.3.40...
	Rheumatoid arthritis³¹31. Gøransson LG, Brun JG, Harboe E, Mellgren SI, Omdal R. Intraepidermal nerve fiber densities in chronic inflammatory autoimmune diseases. Arch Neurol. 2006 Oct;63(10):1410-3. https://doi.org/10.1001/archneur.63.10.1410 https://doi.org/10.1001/archneur.63.10.1...
	Sarcoidosis³²32. Bakkers M, Merkies IS, Lauria G, Devigili G, Penza P, Lombardi R et al. Intraepidermal nerve fiber density and its application in sarcoidosis. Neurology. 2009 Oct;73(14):1142-8. https://doi.org/10.1212/WNL.0b013e3181bacf05 https://doi.org/10.1212/WNL.0b013e3181ba...
	Guillain-Barré syndrome variants³³33. Makonahalli R, Seneviratne J, Seneviratne U. Acute small fiber neuropathy following Mycoplasma infection: a rare variant of Guillain-Barré syndrome. J Clin Neuromuscul Dis. 2014 Jun;15(4):147-51. https://doi.org/10.1097/CND.0000000000000031 https://doi.org/10.1097/CND.000000000000...
Drugs
	Extensive list, chronic metronidazole, statins, anti-TNF inhibitor, bortezomib¹¹11. Gibbons CH. Small fiber neuropathies. In: Levin KH, editor. Peripheral nervous system disorders. Riverwoods: Wolters Kluwer Health; 2014. p. 1398-1412.^,³⁴34. Zeng L, Alongkronrusmee D, van Rijn RM. An integrated perspective on diabetic, alcoholic, and drug-induced neuropathy, etiology, and treatment in the US. J Pain Res. 2017 Jan;10:219-28. https://doi.org/10.2147/JPR.S125987 https://doi.org/10.2147/JPR.S125987...
Toxins
	Thallium, arsenic, alcohol³⁵35. Koike H, Iijima M, Sugiura M, Mori K, Hattori N, Ito H et al. Alcoholic neuropathy is clinicopathologically distinct from thiamine-deficiency neuropathy. Ann Neurol. 2003 Jul;54(1):19-29. https://doi.org/10.1002/ana.10550 https://doi.org/10.1002/ana.10550... ^,³⁶36. Latov N, Vo ML, Chin RL, Carey BT, Langsdorf JA, Feuer NT. Abnormal Nutritional Factors in Patients Evaluated at a Neuropathy Center. J Clin Neuromuscul Dis. 2016 Jun;17(4):212-4. https://doi.org/10.1097/CND.0000000000000128 https://doi.org/10.1097/CND.000000000000...
Vaccinations³⁷37. Kafaie J, Kim M, Krause E. Small fiber neuropathy following vaccination. J Clin Neuromuscul Dis. 2016 Sep;18(1):37-40. https://doi.org/10.1097/CND.0000000000000130 https://doi.org/10.1097/CND.000000000000...
Hereditary forms
	Hereditary sensory and autonomic neuropathy, Fabry disease, sodium channelopathies, Wilson's disease, Pompe disease, Fragile X-associated tremor/ataxia syndrome, Ehlers-Danlos syndrome
Neurodegenerative
	Parkinson's disease, Amyotrophic lateral sclerosis ⁴²42. Cazzato D, Castori M, Lombardi R, Caravello F, Bella ED, Petrucci A et al. Small fiber neuropathy is a common feature of Ehlers-Danlos syndromes. Neurology. 2016 Jul;87(2):155-9. https://doi.org/10.1212/WNL.0000000000002847 https://doi.org/10.1212/WNL.000000000000... ^,⁴³43. de Araújo DF, de Melo Neto AP, Oliveira ÍS, Brito BS, de Araújo IT, Barros IS et al. Small (autonomic) and large fiber neuropathy in Parkinson disease and parkinsonism. BMC Neurol. 2016 Aug;16(1):139. https://doi.org/10.1186/s12883-016-0667-3 https://doi.org/10.1186/s12883-016-0667-...
	Cryptogenic