Successful Use of Flupirtine in Refractory Neuropathic Pain Due to Small Fiber Neuropathy

2012 ◽  
Vol 30 (1) ◽  
pp. 91-93 ◽  
Author(s):  
Seema Mishra ◽  
Prakash Choudhary ◽  
Saurabh Joshi ◽  
Sushma Bhatnagar
Keyword(s):  
Neuropathic Pain ◽  
Small Diameter ◽  
Nerve Fibers ◽  
Small Fiber Neuropathy ◽  
First Line ◽  
Small Fiber ◽  
Peripheral Pain ◽  
Multiple Drugs

Small fiber neuropathy typically involves the small diameter nerve fibers, is usually idiopathic, and presents with peripheral pain. It can be excruciatingly painful at times despite the best of treatments. We present the case of a 22-year-old postoperative case of right frontoparietal oligodendroglioma who received multiple drugs for his severe neuropathic pain without significant relief. However, the pain almost completely subsided once flupirtine was added and substituted for some of the currently recommended first-line drugs.

Neuropathic pain and symptoms of potential small-fiber neuropathy in fibromyalgic patients: A national on-line survey

2021 ◽  
Vol 88 (4) ◽  
pp. 105153 ◽  
Author(s):  
Antonello Viceconti ◽  
Tommaso Geri ◽  
Simone De Luca ◽  
Filippo Maselli ◽  
Giacomo Rossettini ◽  
...  
Keyword(s):  
Neuropathic Pain ◽  
Small Fiber Neuropathy ◽  
Small Fiber ◽  
On Line ◽  
Line Survey

scholarly journals Intraepidermal Nerve Fibers Are Indicators of Small-Fiber Neuropathy in Both Diabetic and Nondiabetic Patients

Diabetes Care ◽  
2004 ◽  
Vol 27 (8) ◽  
pp. 1974-1979 ◽  
Author(s):  
G. L. Pittenger ◽  
M. Ray ◽  
N. I. Burcus ◽  
P. McNulty ◽  
B. Basta ◽  
...  
Keyword(s):  
Nerve Fibers ◽  
Small Fiber Neuropathy ◽  
Small Fiber

scholarly journals Ca2+ toxicity due to reverse Na+/Ca2+ exchange contributes to degeneration of neurites of DRG neurons induced by a neuropathy-associated Nav1.7 mutation

2015 ◽  
Vol 114 (3) ◽  
pp. 1554-1564 ◽  
Author(s):  
M. Estacion ◽  
B. P. S Vohra ◽  
S. Liu ◽  
J. Hoeijmakers ◽  
C. G. Faber ◽  
...  
Keyword(s):  
Nerve Fibers ◽  
Small Fiber Neuropathy ◽  
Missense Mutations ◽  
Sodium Calcium Exchanger ◽  
Drg Neurons ◽  
Persistent Currents ◽  
Burning Pain ◽  
Reverse Mode ◽  
Small Fiber ◽  
High K

Gain-of-function missense mutations in voltage-gated sodium channel Nav1.7 have been linked to small-fiber neuropathy, which is characterized by burning pain, dysautonomia and a loss of intraepidermal nerve fibers. However, the mechanistic cascades linking Nav1.7 mutations to axonal degeneration are incompletely understood. The G856D mutation in Nav1.7 produces robust changes in channel biophysical properties, including hyperpolarized activation, depolarized inactivation, and enhanced ramp and persistent currents, which contribute to the hyperexcitability exhibited by neurons containing Nav1.8. We report here that cell bodies and neurites of dorsal root ganglion (DRG) neurons transfected with G856D display increased levels of intracellular Na+ concentration ([Na+]) and intracellular [Ca2+] following stimulation with high [K+] compared with wild-type (WT) Nav1.7-expressing neurons. Blockade of reverse mode of the sodium/calcium exchanger (NCX) or of sodium channels attenuates [Ca2+] transients evoked by high [K+] in G856D-expressing DRG cell bodies and neurites. We also show that treatment of WT or G856D-expressing neurites with high [K+] or 2-deoxyglucose (2-DG) does not elicit degeneration of these neurites, but that high [K+] and 2-DG in combination evokes degeneration of G856D neurites but not WT neurites. Our results also demonstrate that 0 Ca2+ or blockade of reverse mode of NCX protects G856D-expressing neurites from degeneration when exposed to high [K+] and 2-DG. These results point to [Na+] overload in DRG neurons expressing mutant G856D Nav1.7, which triggers reverse mode of NCX and contributes to Ca2+ toxicity, and suggest subtype-specific blockade of Nav1.7 or inhibition of reverse NCX as strategies that might slow or prevent axon degeneration in small-fiber neuropathy.

Numbness

2018 ◽  
Author(s):  
Aziz Shaibani
Keyword(s):  
Neuropathic Pain ◽  
Severe Pain ◽  
Specific Pattern ◽  
Small Fiber Neuropathy ◽  
Sensory Loss ◽  
Corneal Sensation ◽  
Small Fiber ◽  
Intercostal Pain

Sensory symptoms are the most common symptoms in neuromuscular clinics, yet it is hard to capture them via video unless they have a very specific pattern and they are associated with objective loss of sensation. Distal sensory loss is a common neuropathic finding. It follows gloves and stocks distribution. Sensory neuropathies may present with ataxia which results in falls, or severe pain. Neuropathic pain with normal ankle reflexes and sural responses suggest small fiber neuropathy. Multifocal sensory loss is usually vascular. It can also be infectious (leprosy). Migratory neuritis is a poorly understood condition. Intercostal pain and numbness is usually due to radiculopathy (diabetic, zoster, or compressive radiculopathy). Foots ulcers and unfelt mosquito bites are markers for sensory loss. Loss of corneal sensation may led to keratitis and blindness.

scholarly journals Evidence for Dietary Agmatine Sulfate Effectiveness in Neuropathies Associated with Painful Small Fiber Neuropathy. A Pilot Open-Label Consecutive Case Series Study

Nutrients ◽  
2020 ◽  
Vol 12 (2) ◽  
pp. 576 ◽  
Author(s):  
Michael L. Rosenberg ◽  
Vahid Tohidi ◽  
Karna Sherwood ◽  
Sujoy Gayen ◽  
Rosina Medel ◽  
...  
Keyword(s):  
Neuropathic Pain ◽  
Pain Intensity ◽  
Treatment Options ◽  
Case Series ◽  
Small Fiber Neuropathy ◽  
Consecutive Case ◽  
Open Label ◽  
Small Fiber ◽  
Case Series Study ◽  
Series Study

Peripheral neuropathies associated with painful small fiber neuropathy (SFN) are complex conditions, resistant to treatment with conventional medications. Previous clinical studies strongly support the use of dietary agmatine as a safe and effective treatment for neuropathic pain. Based on this evidence, we conducted an open-label consecutive case series study to evaluate the effectiveness of agmatine in neuropathies associated with painful SFN (Study Registry: ClinicalTrials.gov, System Identifier: NCT01524666). Participants diagnosed with painful SFN and autonomic dysfunctions were treated with 2.67 g/day agmatine sulfate (AgmaSet® capsules containing G-Agmatine® brand of agmatine sulfate) for a period of 2 months. Before the beginning (baseline) and at the end of the treatment period, participants answered the established 12-item neuropathic pain questionnaire specifically developed to distinguish symptoms associated with neuropathy and to quantify their severity. Secondary outcomes included other treatment options and a safety assessment. Twelve patients were recruited, and 11 patients—8 diagnosed with diabetic neuropathy, two with idiopathic neuropathy and one with inflammatory neuropathy—completed the study. All patients showed improvement in neuropathic pain to a varied extent. The average decrease in pain intensity was 26.0 rating points, corresponding to a 46.4% reduction in overall pain (p < 0.00001). The results suggest that dietary agmatine sulfate has a significant effect in reducing neuropathic pain intensity associated with painful SFN resistant to treatment with conventional neuropathic pain medications. Larger randomized placebo-controlled studies are expected to establish agmatine sulfate as a preferred treatment.

A quantitative method for the assessment of intraepidermal nerve fibers in small–fiber neuropathy

2005 ◽  
Vol 252 (7) ◽  
pp. 789-794 ◽  
Author(s):  
M. Koskinen ◽  
A. Hietaharju ◽  
M. Kyläniemi ◽  
J. Peltola ◽  
I. Rantala ◽  
...  
Keyword(s):  
Quantitative Method ◽  
Nerve Fibers ◽  
Small Fiber Neuropathy ◽  
Small Fiber
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