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Pain-related nociceptive evoked potential and skin wrinkle test in small fiber neuropathy

Potencial evocado nociceptivo relacionado à dor e teste de enrugamento cutâneo na neuropatia de fibras finas

A 58-year-old woman with clinically probable small fiber neuropathy (SFN)11. Cazzato D, Lauria G. Small fibre neuropathy. Curr Opin Neurol. 2017 Oct;30(5):490-9.
, with normal electroneuromyography, was evaluated with pain-related nociceptive evoked potential (PREP) with a concentric planar electrode stimulation on the dorsum of the hands and feet22. Hernandez Fustes OJ, Kay CSK, Lorenzoni PJ, Ducci RDP, Werneck LC, Scola RH. Somatosensory evoked potentials in clinical practice: a review. Arq Neuro-Psiquiatr. 2021 Sep;79(9):824-31.
and skin wrinkle test (SWT)33. O’Riain S. New and simple test of nerve function in hand. Br Med J. 1973 Sep;3(5881):615-6.
. The PREP showed N1 latency delay (Figure 1), compatible with the change in SWT induced by water, which indicated a Grade 0 pattern (Figure 2), as can be seen in sympathetic autonomic small fiber dysfunction.

Figure 1.
Pain-related nociceptive evoked potential.

Figure 2.
Skin wrinkle test. Patient (C and D). Normal test (A and B).

New electrophysiological tools, combined with SWT and specific neurological examination, contribute to the diagnosis of SFN.

Multiple-choice questions with related answers are given in Supplementary Material. The following material is available online for this article:


Publication Dates

  • Publication in this collection
    20 Apr 2022
  • Date of issue
    May 2022


  • Received
    11 Aug 2021
  • Reviewed
    18 Oct 2021
  • Accepted
    27 Oct 2021
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