Rethinking How We Evaluate Small Fiber Neuropathy
Neurology Minute
Dr. Aaron Zelikovich discusses recent survey findings highlighting the wide variability in how clinicians evaluate and diagnose small fiber neuropathy. Fill out the Neurology® Clinical . Show citation: Thawani S, Chan M, Ostendorf T, et al. How Well do We Evaluate Small Fiber Neuropathy?: A Survey of American Academy of Neurology Members. J Clin Neuromuscul Dis. 2025;26(4):184-195. Published 2025 Jun 2. doi: Show transcript: Dr. Aaron Zelikovich: Welcome to today's Neurology Minute. My name is Aaron Zelikovich, a neuromuscular specialist at Lenox Hill Hospital in New...
info_outline
Understanding Physical Exam Findings Associated With FND - Part 3
Neurology Minute
In part three of this four-part series, Casey Kozak discusses the hip abductor sign as an option for assessing weakness in the lower extremities. Show citation: Sonoo M. Abductor sign: a reliable new sign to detect unilateral non-organic paresis of the lower limb. J Neurol Neurosurg Psychiatry. . Show transcript: Casey Kozak: Hello, this is Casey Kozak with Neurology Minute, and today we're returning to physical exam tests for functional neurological disorder. This episode will piggyback off our last focusing on Hoover's sign, now focusing on other signs of functional...
info_outline
US Burden of Disorders Affecting the Nervous System - Part 2
Neurology Minute
In the second episode of this two-part series, Dr. Stacey Clardy and Dr. John Ney discuss why deaths from neurologic conditions are decreasing, but disability is rising, and what this shift means for future care. Show citation: Ney JP, Steinmetz JD, Anderson-Benge E, et al. US Burden of Disorders Affecting the Nervous System: From the Global Burden of Disease 2021 Study. JAMA Neurol. 2026;83(1):20-34. doi: Show transcript: Dr. Stacey Clardy: Hi, this is Stacey Clardy from the Salt Lake City VA and the University of Utah. I've been talking with John Ney from...
info_outline
CGRP-Targeted Migraine Therapies in Patients With Vascular Risk Factors or Stroke
Neurology Minute
Dr. Tesha Monteith and Dr. Michael Eller discuss the implications of CGRP therapies in migraine treatment, particularly for patients with vascular risk factors or a history of stroke. Show citation: Eller MT, Schwarzová K, Gufler L, et al. CGRP-Targeted Migraine Therapies in Patients With Vascular Risk Factors or Stroke: A Review. Neurology. 2025;105(2):e213852. doi: Show transcript: Dr. Tesha Monteith: Hi, this is Tesha Monteith with the Neurology Minute. I've just been speaking with Michael Eller from the Department of Neurology Medical University of Innsbruck, Austria on...
info_outline
US Burden of Disorders Affecting the Nervous System - Part 1
Neurology Minute
In part one of this two-part series, Dr. Stacey Clardy and Dr. John Ney break down the key message neurologists need to understand from this update and offer guidance on how to clearly convey it to patients. Show citation: Ney JP, Steinmetz JD, Anderson-Benge E, et al. US Burden of Disorders Affecting the Nervous System: From the Global Burden of Disease 2021 Study. JAMA Neurol. 2026;83(1):20-34. doi: Show transcript: Dr. Stacey Clardy: Hi, this is Stacey Clardy from the Salt Lake City VA in the University of Utah. I've been talking with John Ney from Yale about a global...
info_outline
Understanding Physical Exam Findings Associated With FND - Part 2
Neurology Minute
In part two of this four-part series, Casey Kozak discusses Hover's sign, the most well-known test for FND. Show transcript: Casey Kozak: Welcome back to Neurology Minute. My name is Casey Kozak with Rutgers, and today we're continuing our examination of functional neurological disorder. That is physical examination. This episode is dedicated to Hoover's sign, probably the most well-known test for FND, and in my humble opinion, one of the most confusing maneuvers to learn. So today, we're going back to the origin using Dr. Charles Franklin Hoover's original description. Maybe...
info_outline
Understanding Physical Exam Findings Associated With FND - Part 1
Neurology Minute
In part one of this four-part series, Casey Kozak breaks down tremors observed during the physical examination of FND. Show transcript: Casey Kozak: Welcome back to Neurology Minute. This is Casey Kozak with Rutgers, and today we'll be discussing a very important and evolving topic, that is Functional Neurological Disorder, or FND. If you're a regular fan of the Minute, you'll have already heard a great miniseries on FND by Jon Stone and Gabriela Gilmour, which focuses on diagnosis and treatment. If you haven't listened yet, I encourage you to check it out. In this series, we're...
info_outline
Environmental Toxicants and Parkinson Disease
Neurology Minute
Dr. Margarita Fedorova discusses possible environmental exposures and their risk of Parkinson disease. Show citation: Dorsey ER, De Miranda BR, Hussain S, et al. Environmental toxicants and Parkinson's disease: recent evidence, risks, and prevention opportunities. Lancet Neurol. 2025;24(11):976-986. doi: Show transcript: Dr. Margarita Fedorova: Welcome to Neurology Minute. My name is Margarita Fedorova and I'm a neurology resident at the Cleveland Clinic. Today, we're reviewing some information about possible environmental exposures and their risk of Parkinson disease....
info_outline
Updates in Non-Arteritic Ischemic Optic Neuropathy - Part 2
Neurology Minute
In the second episode of this two-part series, Drs. Justin Abbatemarco, Valérie Biousse, and Nancy J. Newman discuss the risk of non-arteritic ischemic optic neuropathy and how to counsel patients around GLP-1 medications. Show transcript: Dr. Justin Abbatemarco: Hello and welcome back. This is Justin Abbatemarco again with Valarie Biousse and Nancy Newman talking about non-arteritic ischemic optic neuropathy. I think the other major point that we had a discussion in the podcast was around the GLP-1 medications, which you mentioned have been truly life-changing for diabetes...
info_outline
Updates in Non-Arteritic Ischemic Optic Neuropathy - Part 1
Neurology Minute
In part one of this two-part series, Drs. Justin Abbatemarco, Valérie Biousse, and Nancy J. Newman discuss common myths around non-arteritic ischemic optic neuropathy (NAION). Show transcript: Dr. Justin Abbatemarco: Hello and welcome. This is Justin Abbatemarco, and I just got done interviewing Valérie Biousse and Nancy Newman on all things around non-arteritic anterior ischemic optic neuropathy. I think one of my favorite takeaways from our interview were breaking some common myths around this disorder. Valérie and Nancy, could you maybe talk about one or two that you think are...
info_outlineDr. Aaron Zelikovich discusses recent survey findings highlighting the wide variability in how clinicians evaluate and diagnose small fiber neuropathy.
Fill out the Neurology® Clinical Practice Current survey.
Show citation:
Thawani S, Chan M, Ostendorf T, et al. How Well do We Evaluate Small Fiber Neuropathy?: A Survey of American Academy of Neurology Members. J Clin Neuromuscul Dis. 2025;26(4):184-195. Published 2025 Jun 2. doi:10.1097/CND.0000000000000502
Show transcript:
Dr. Aaron Zelikovich:
Welcome to today's Neurology Minute. My name is Aaron Zelikovich, a neuromuscular specialist at Lenox Hill Hospital in New York City. Today, we will discuss a recent article, How Well Do We Evaluate Small Fiber Neuropathy? A survey of The American Academy of Neurology members, which evaluates small fiber neuropathy in clinical practice.
The current landscape of evaluating and testing for small fiber neuropathy remains highly variable in regards to serum testing, skin biopsy, and nerve conduction studies. In this survey study, 800 members of The American Academy of Neurology were randomly selected and emailed a survey. 400 neuromuscular physicians and 400 non-neuromuscular physicians were selected. The overall response rate was 30% with half of the completed surveys coming from neuromuscular physicians. The most common overall initial blood work for this patient population was a CBC, vitamin B12, basic metabolic profile, TSH, and hemoglobin A1C. Other high yield blood tests included ESR, SPEP, immunofixation, and ANA. 70% of responders would also order a nerve conduction study as part of the initial workup. Second line evaluation had less consensus and included skin biopsies for intraepidermal nerve fiber density, hepatitis panel, HIV, and paraneoplastic testing. Responders noted that if the patient had acute onset of symptoms, had symptoms that were asymmetric, or being under 30 years old, they would order a more extensive workup.
The authors discussed the importance of both clinical exam, history, and diagnostic workup in patients with symptoms compatible with small fiber neuropathy. They highlight that there is no current objective gold standard for a diagnosis of small fiber neuropathy. The current diagnostic recommendation by the AAN for distal symmetric polyneuropathy includes serum blood sampling for glucose, vitamin B12, SPEP, and immunofixation. Clinical practice in the diagnosis of small fiber neuropathy remains highly variable based on the provider and clinical context of the patient.
Neurology Practice Current is currently accepting surveys on clinical practice patterns for patients with small fiber neuropathy. Please check out the link in today's Neurology Minute to complete the survey. Thank you and have a wonderful day.