I have mixed feelings about the regenerative capacity. I've had full body neuropathy recede back to my legs and even that improves somewhat with treatment though I haven't been far enough in for full remission. I remember reading somewhere that rats regenerate nerves far better than humans and that one of the limiting factors is impaired macrophage clearance of cellular debris. Makes me think that lifestyle and immunity has a lot to do with it. But that's just me, I tend to give the body a lot more credit and ask what might be preventing it from doing its thing. A lot of the prevailing dogma in medicine stems from studying fundamentally sick populations as well as many times lacking a clear understanding of the etiology (i.e. Persistent infection)
One thing I'm a little confused on is the connection between small fiber neuropathy and demyelination disorders. As I understand it small fiber nerves are unmyelinated? Yet pathologies are associated with many of the same antibodies as many demyelinating diseases? Anyways I didn't get any of the conduction studies or biopsies. Seemed like a whole lot of pain simply for some doctor to nerd out and reductively classify my disorder with no added benefit to me as a human. But I had high titers of anti-GM1's, can't remember which isotype, and enough burning pain to connect the dots.
Yes small fibers are mostly unmylelinated. All the top LLMDs say that small fiber is immune mediated in the context of Lyme and requires IVIG......which most of us will never qualify for or be able to afford.
You are correct that you do see both small and large fiber pathologies together. I think we just don't understand what is going on. And I really don't see anyone doing much research on this. There is not much research on small fiber in general, let alone in the context of Lyme. If you are not diabetic, neuros shrug their shoulder and send you to pain mgnt with your "idiopathic neuropathy".
You only need to worry about
a punch biopsy if you are lucky enough to have a secondary condition that will qualify you for IVIG or have it as "proof" of your condition so you can get a pain mgnt doc to treat you. Many neuros won't even bother with the punch biopsy because SFN remains a clinical diagnosis. It can be patchy and the biopsy will miss it. It's kind of a crap shoot. If you have severe skin burning, then it's safe to say you have SFN.
Post Edited (madisongrrl) : 1/26/2017 11:16:22 AM (GMT-7)