Saturday, December 16, 2017

IVIG and small fiber neuropathy

Small fiber neuropathy (unmyelinated fibers in the skin and the autonomic nervous system) can account for the bulk of the pain and autonomic symptoms in Lyme patients. Until now there have not been any treatments for this other than symptomatic.

However, for large, myelinated fibers that become demyelinated, these lesions can be reversed with IVIG treatment.

Interestingly, lots of Lyme patients have both.

IVIG can get approved by insurance as a treatment for demyelination (as initially diagnosed with EMG-NCV studies) but so far insurance will not approve IVIG for biopsy proven (simple punch skin biopsy) small fiber neuropathy.

Because Lyme patients usually have both, treatment gets approved to treat the large fiber neuropathy but lo and behold, the small fiber stuff (pain and dysautonomia) can also clear.
So finally the attached article demonstrates this. Note that it comes from Harvard and does not mention Lyme disease- that is what got it published.

This is especially important as the EMG-NCV studies will not detect small fiber problems at all, and more importantly, will miss possibly half the cases of large fiber neuropathy, thus preventing insurance coverage and needed treatment. In contrast, skin biopsies specifically stained to see small fibers picks up a much higher percentage of cases, offering hope for a more sensitive way to get diagnosed and treated.

Whether this will be enough to get insurance to cover IVIG for small fiber neuropathy is yet to be seen.
Please share this with all the docs (Barbara- can you send this out to the ILADS group? Put it on the website?) and especially the neurologists you may know.

Dr. B

Joseph J. Burrascano Jr. M.D.
Water Mill, NY, USA
Sent from my LapTop

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