I never had a biopsy but based on the symptoms I'm pretty sure I had horrific small fiber neuropathy. It started in my feet and rapidly climbed to my face. It was so bad I couldn't wear socks and touching a bed sheet would jolt me awake in agony. I also have musculoskeletal pains, joint pains, and carditis. I had a positive Lyme ELISA but negative western blot. So I'm not positive it's Lyme disease, but it responds to antibiotics nonetheless.
Honestly doesn't really matter if it's Lyme disease. If it is that's great because you can get treated pretty easily. But I would throw antibiotics at it regardless because a lot of these "autoimmune" diseases are thought to be infections anyways. That's what I did and I'm doing fantastic. Of course, it's still a battle. I often relapse if i stop. A word of caution though, treating can make it instantly worse due to the die-off. It will resolve so don't get scared if you take abx and think it's worsening (unless you are taking an abx known to cause neuropathy. You don't want to confuse toxic side effects with die-off). Just lower the dose if you need to. Also stopping for me can lead to horrific relapses.
I had similar thing - numbness started in longest toe on right foot then to tops of feet then rapidly all way to face. I have burning and buzzing at times. If it’s not lyme then it’s bart, mold or some other toxin.
Wpack - i’m surprised your neuro did the biopsy. They never even suggested it for me - they were mostly focused on MS.