NEUROLOGISTS ARE frequently asked to evaluate patients with numb, tingling, or painful feet thought to be caused by peripheral neuropathy. The 3 challenges that the neurologist faces in this situation are (1) to objectively determine whether there is a peripheral neuropathy, (2) to determine the cause of the peripheral neuropathy, and (3) to treat and monitor the peripheral neuropathy. In most instances, the diagnosis of a peripheral neuropathy can be easily established by careful neurologic examination, which is often supplemented by an electrophysiologic assessment with nerve conduction studies (NCS) and needle electromyography (EMG). The biopsy of a sensory peripheral nerve, such as a sural or superficial peroneal nerve, is not necessary in most cases of neuropathy. A nerve biopsy is seldom done to determine whether a peripheral neuropathy is present, but is usually done for the purpose of establishing the cause of a neuropathy resulting from vasculitis, sarcoidosis, or acquired amyloidosis, all unusual causes of neuropathy. The use of peripheral nerve biopsy is limited because the pathological findings are rarely diagnostic and the morbidity that can accompany the procedure includes permanent sensory loss, pain, and infection.
Barohn RJ. Intraepidermal Nerve Fiber AssessmentA New Window on Peripheral Neuropathy. Arch Neurol. 1998;55(12):1505-1506. doi:10.1001/archneur.55.12.1505