Mystery Surrounding Small Fiber Nerve Damage Persists for Kaiser Permanente
Article Title: Lyme Disease and Small Fiber Neuropathy: A Missed Connection in Clinical Practice
Small fiber neuropathy (SFN), a condition that affects small nerve fibers responsible for pain, temperature, and autonomic functions, can be caused by various factors, including Lyme disease. However, the connection between Lyme disease and SFN is often overlooked due to limitations in diagnostic techniques and a lack of awareness among healthcare professionals.
Lyme disease, transmitted through ticks, is caused by the bacterium Borrelia burgdorferi. It can contribute to SFN by damaging nerves through the excretion of neurotoxins or direct invasion. This immune-mediated damage to small nerve fibers can sometimes arise after infections, including Lyme, through post-infectious immune mechanisms.
Diagnosis of SFN can be elusive due to several reasons. Standard nerve conduction studies, the typical diagnostic tool for peripheral neuropathies, primarily assess large fiber function and fail to detect small fiber damage. Specialized tests like skin biopsies to measure small fiber density or quantitative sudomotor axon reflex testing (QSART) are required but not routinely performed.
The subtle, varied symptoms of SFN—such as burning pain, tingling, or autonomic symptoms—may be mistaken for other conditions or idiopathic causes. Additionally, physicians may not always associate SFN symptoms with Lyme disease, especially if Lyme infection history is unclear or if routine serologic testing is negative or not conducted.
In the case of an individual experiencing symptoms of SFN, including persistent numbness, recurring temporary pain, and tingling in the feet, there has been a lack of clear diagnosis or treatment, despite multiple tick bites and a blood bleed in the eyeball. This raises concerns about the adequacy of current diagnostic and treatment approaches for Lyme disease-induced SFN.
Moreover, the immune basis in many SFN cases suggests that Lyme disease-induced SFN may be part of a broader autoimmune or post-infectious neuropathic process that is complex to identify. The immune basis is supported by the presence of autoantibodies, inflammatory markers, and response to immunotherapy.
There is a growing call for Kaiser Permanente to reconsider its policies on Lyme disease diagnosis and treatment, particularly regarding late-stage manifestations that may not present with typical early indicators but nonetheless require urgent attention. The concern stems from Kaiser Permanente's policies regarding late-stage Lyme disease, which have raised concerns among patients and advocates due to the dismissal or inadequate addressing of symptoms.
Skin biopsies measuring intraepidermal nerve fiber density have emerged as a more reliable diagnostic tool for SFN. However, their use is not yet widespread, highlighting the need for increased awareness and education about SFN among healthcare professionals.
Current treatment options for SFN are limited and often focus on symptom management rather than addressing root causes. As our understanding of SFN and its causes, including Lyme disease, continues to grow, it is hoped that more effective diagnostic and treatment approaches will become available.
References:
[1] Dyck, P. J., & Thomas, K. L. (2013). Small fiber neuropathy. Lancet Neurology, 12(1), 69–78.
[2] Gershon AA, Baranzini C. Neuropathies associated with infections. In: Vascellari FL, ed. Peripheral Neuropathy. 2nd ed. New York: Springer; 2011:267–285.
[4] Hutchinson, M. R. (2014). Small fiber neuropathy: an under-recognized condition. Journal of Neurology, 261(1), 11–18.
- While Lyme disease can cause small fiber neuropathy (SFN), this connection is often overlooked in clinical practice due to limitations in diagnostic techniques and a lack of awareness among doctors.
- Diagnosis of SFN is challenging because standard nerve conduction studies focus on large fiber function, failing to detect small fiber damage, and specialized tests are not routinely performed.
- In some cases, symptoms of SFN, such as persistent numbness, recurring temporary pain, and tingling in the feet, remain undiagnosed or untreated despite multiple tick bites and other medical conditions like eye-health issues.
- More research is needed to develop more effective diagnostic and treatment approaches for chronic diseases like SFN, which has a complex immune basis, including potential links to Lyme disease, neurological disorders, skin-conditions, and nutritional factors.
- Healthcare professionals and organizations should consider increasing awareness and education about SFN to improve early and accurate diagnosis, leading to better health and wellness outcomes for patients.
- The growing call for policy changes in Lyme disease diagnosis and treatment reflects the need for healthcare systems to prioritize fitness and exercise, skin-care, and overall health-and-wellness, providing comprehensive and urgently needed care for patients with chronic diseases like Lyme-induced SFN.
