Nerve Biopsy For Neuropathy

Today's post from foundationforpn.org (see link below) appears here because two readers have recently asked me what a nerve biopsy involves and whether it's necessary or not. Neurologists will generally perform a nerve biopsy if they are running a very thorough series of diagnostic tests for neuropathy. However, it's expensive and slightly invasive, so many doctors will avoid it unless they feel it's completely necessary. The patient's own story, symptoms and medical history, plus a number of other tests will often be enough to reach a conclusion about neuropathy - a nerve biopsy will only confirm if the nerve damage is based on demyelation (damage to the protective layer surround the nerve) or axonal damage (damage to the axon in the nerve cell). Nevertheless nerve biopsies are quite frequently carried out and it's helpful to know what that involves - this short article does just that.

Nerve / Skin / Muscle / Tissue Biopsy  
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Biopsies are small samples of nerves, skin, muscle or other tissues that are removed from the body. The samples are examined to identify and diagnose various disorders.
What is it?

A biopsy is a minor surgical procedure which involves making a small incision to remove a sample of nerve, skin, muscle or tissue for examination.
Why should I do it?

A nerve biopsy may help distinguish between demyelination (damage to the myelin sheath covering the nerve) and axon degeneration (destruction of the axonal portion of the nerve cell). It may also help identify an inflammatory neuropathy or confirm specific diagnoses.

A nerve biopsy is invasive and is useful only in certain circumstances.

A skin biopsy is helpful to distinguish certain disorders that might affect the small nerve fibers, as may be the case with painful sensory axonal neuropathies.

A muscle or other tissue biopsy is used to diagnose and identify damage caused to muscles and organs as a result of various disorders such as Charcot-Marie-Tooth disease, sarcoidosis and amyloidosis.
How is a nerve biopsy performed?

A nerve, skin, muscle or other tissue biopsy usually is a simple outpatient procedure. For a nerve biopsy, a local anesthetic is used to numb the area. The surgeon makes a small incision and removes a portion of the nerve, usually from the ankle or the calf. The sample is then examined for abnormalities under a microscope.

A skin, muscle or other tissue biopsy is performed much the same way, except that the surgeon removes skin, muscle, or other tissue instead of nerve.
How will it feel?

Because a local anesthetic is used, discomfort during the procedure is usually minimal. The anesthetic may burn or sting when first injected. After the procedure, the area may feel tender or sore for a few days. An area of the skin may remain permanently numb after the biopsy.

https://www.foundationforpn.org/livingwithperipheralneuropathy/evaluation/neurologicaltests/index.cfm