Small Fibre Neuropathy Tests. An information guide

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1 TO PROVIDE THE VERY BEST CARE FOR EACH PATIENT ON EVERY OCCASION Small Fibre Neuropathy Tests An information guide

2 Small Fibre Neuropathy Tests What is Small Fibre Neuropathy? Within the nerves there are small fibres and large fibres. A patient with neuropathy can have either both small and large fibres affected or just the small fibres or just the large fibres. Although there are differences between the symptoms of small and large fibre neuropathy, there is also an overlap of symptoms between the two therefore, various tests are carried out to diagnose them. In this department we, carry out Thermal Thresholds Test (TTT) or Autonomic Function Test (AFT). It will state on your appointment letter which test you will be having. What preparation is needed? No special preparation is needed before the test and you should take any medication as prescribed. It is helpful, however, if you can come wearing loose clothing as we may need to test above your knee or above your elbow. Please avoid using lotions or creams on your hands and feet when you come for the test. Please note that children/babies will not be allowed in the room where the test is being carried out therefore, if you need to bring a child with you, you must ensure that someone is with you that can supervise them. Before the tests The tests will be carried out by a fully trained and experienced Clinical Physiologist who will explain the procedures to you. You will be asked some questions about your symptoms and the medications that you take. Please do not hesitate to ask any questions that you may have. 2

3 During the tests The various tests that will be carried out are as follows. They are all simple and safe to perform. Autonomic Function Test This entails the R-R Interval and the Sympathetic Skin Response (SSR) R-R Interval R-R Interval is the time between successive heart beats which varies as we breathe in and out; this is normal. In some types of small fibre neuropathies, the time between successive heart beats does not vary as much as it should. Sticky-backed electrodes will be attached to your arms whilst you are sitting comfortably in a chair. You will then be asked to take five or six deep breaths over a 60 second period whilst we monitor your heart rate. Sympathetic Skin Response (SSR) Electrodes will be attached via sticky tape to one hand and one foot on the same side of the body whilst sitting in a chair. A small electrical impulse is delivered to the opposite wrist by a probe which will make your thumb twitch once and lasts for only a second. This may be uncomfortable but not painful. 3

4 Thermal Thresholds Test (TTT) In small fibre neuropathy, the ability to perceive warmth and cold may be affected which is what the thermal thresholds test will measure. A probe will be attached to your hand and later to your foot or leg whilst you are sitting in a chair. The probe is held in place via a velcro strap. You will be given a button to hold in your other hand. The temperature of the probe on your hand, foot or leg will slowly increase or decrease and you will be asked to press that button as soon as you feel it change. Any further change in temperature stops as soon as you press the button. After the tests The AFT takes about 30 minutes to perform and the TTTs take about 60 minutes. There are no side effects and you can go home straight away. Why do I have to come to North Manchester General Hospital? Small fibre neuropathy tests are not available at the other hospital sites within Pennine Acute Hospitals NHS Trust therefore, although you may have originally seen a doctor at another hospital, you have been referred to North Manchester General Hospital for this test. 4

5 Directions to the Neurophysiology Department From Entrance 1 walk to the end of the corridor and turn right. We are situated further down the corridor on the right. From Entrance 2 walk through the waiting area and use the lifts or stairs to the first floor. Turn right. We are situated further down the corridor on the right, directly opposite wards J3 and J4. Contacting us If you have any questions about the issues raised above, or have any other concerns, please contact the department on

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8 If English is not your frst language and you need help, please contact the Ethnic Health Team on Jeżeli angielski nie jest twoim pierwszym językiem i potrzebujesz pomocy proszę skontaktować się z załogą Ethnic Health pod numerem telefonu For general enquiries please contact the Patient Advice and Liaison Service (PALS) on For enquiries regarding clinic appointments, clinical care and treatment please contact and the Switchboard Operator will put you through to the correct department / service Date of publication: September 2017 Date of review: September 2019 Ref: PI (SS) 1053 The Pennine Acute Hospitals NHS Trust Wood pulp sourced from sustainable forests