Small fiber neuropathy is most easily and reliably diagnosed by skin biopsy, demonstrating a reduction in the epidermal nerve fiber density (ENFD). Determination of epidermal nerve fiber density by skin biopsy is the most sensitive and specific test for small fiber neuropathy, with a sensitivity of 88.4% compared to 54.6% for the clinical examination (Devigili et al, Brain 2008; 131:1912-25).
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