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Intraepidermal nerve fiber density at the distal leg: a worldwide normative reference study
Author(s) -
Lauria Giuseppe,
Bakkers Mayienne,
Schmitz Christoph,
Lombardi Raffaella,
Penza Paola,
Devigili Grazia,
Smith A. Gordon,
Hsieh SungTsieh,
Mellgren Svein I.,
Umapathi Thirugnanam,
Ziegler Dan,
Faber Catharina G.,
Merkies Ingemar S. J.
Publication year - 2010
Publication title -
journal of the peripheral nervous system
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1
H-Index - 67
eISSN - 1529-8027
pISSN - 1085-9489
DOI - 10.1111/j.1529-8027.2010.00271.x
Subject(s) - medicine , percentile , nerve fiber , body mass index , biopsy , normative , statistics , anatomy , philosophy , mathematics , epistemology
The diagnostic reliability of skin biopsy in small fiber neuropathy depends on the availability of normative reference values. We performed a multicenter study to assess the normative values of intraepidermal nerve fiber (IENF) density at distal leg stratified by age deciles. Eight skin biopsy laboratories from Europe, USA, and Asia submitted eligible data. Inclusion criteria of raw data were healthy subjects 18 years or older; known age and gender; 3‐mm skin biopsy performed 10‐cm above the lateral malleolus; bright‐field immunohistochemistry protocol, and quantification of linear IENF density in three 50‐µm sections according to published guidelines. Data on height and weight were recorded, and body mass index (BMI) was calculated in subjects with both available data. Normative IENF density reference values were calculated through quantile regression analysis; influence of height, weight, or BMI was determined by regression analyses. IENF densities from 550 participants (285 women, 265 men) were pooled. We found a significant age‐dependent decrease of IENF density in both genders (women p < 0.001; men p = 0.002). Height, weight, or BMI did not influence the calculated 5th percentile IENF normative densities in both genders. Our study provides IENF density normative reference values at the distal leg to be used in clinical practice.