TY  - THES
A1  - Frank, Johanna
T1  - Untersuchung der Kleinfaserpathologie beim Fibromyalgie-Syndrom
T1  - Examination of small fiber pathology in fibromyalgia syndrome
N2  - Die Studienergebnisse stützen das Konzept, dass das periphere Nervensystem zu Schmerzen beim Fibromyalgie-Syndrom (FMS) beiträgt. An der Neurologischen Universitätsklinik Würzburg wurden 53 FMS Patientinnen und 35 gesunde Kontrollen rekrutiert, ausführlich anamnestiziert inklusive spezieller Schmerzfragebögen, neurologisch und mittels spezieller Tests auf eine Störung der kleinkalibrigen A-delta- und C-Nervenfasern untersucht. Hierzu gehörte eine quantitative sensorische Testung mit Pleasant touch Untersuchung und die schmerz-assoziierten elektrisch-evoziierten Potentiale für die Kleinfaserfunktion und die corneale confocale Mikroskopie, sowie die Analyse von Hautstanbiopsien für die Kleinfasermorphologie.

Im Unterschied zu gesunden Kontrollen wiesen die FMS Patientinnen eine Reduktion, als auch eine Funktionsänderung der kleinkalibrigen Nervenfasern auf. Des Weiteren konnten wir aus der heterogenen Patientenpopulation anhand von unterschiedlichen Nervenfaserdichten der Haut eine Subgruppe mit generalisierter Reduktion der Hautinnervation identifizieren, die besonders schwer betroffen ist.
Diese Subgruppenanalysen können künftig von großer Bedeutung für die
Therapiewahl sein.
N2  - The results of this study support the concept of an involvement of the peripheral nervous system in the development of pain in fibromyalgia sydrome (FMS). At the Department of Neurology, University of Würzburg, Germany, we recruted 53 FMS patients and 35 healty controls, who filled in pain questionnaires and underwent thorough history taking, neurologic examination and special small fiber tests, which tested the function and morphology of the A-delta and C-fibers. In detail, tests consisted of quantitative sensory testing with pleasant touch examination and pain-related evoked potentials for small fiber function, and corneal confocal microscopy and skin punch biopsy for fiber morphology.

In contrast to healthy controls, FMS patients showed a reduction and change in morphology of the small fibers. Further, we identified a subgroup of patients with generalized reduction of skin innervation, who showed higher disease burden than FMS patients with normal skin innervation.
The identification of FMS subgroups may be of great relevance for future treatment stratification.
KW  - Fibromyalgie
KW  - Kleinfaseruntersuchungen
KW  - small fiber pathology
KW  - kleinkalibrige Nervenfasern
KW  - corneale confocale Mikroskopie
KW  - Hautstanzbiopsie
KW  - schmerz-assoziierte elektrisch-evozierte Potenziale
KW  - Quantitative sensorische Testung
KW  - pleasant touch
KW  - small fiber tests
KW  - skin punch biopsy
KW  - corneal confocal microscopy
KW  - quantitative sensory testing
KW  - pain-related evoked potentials
Y1  - 2019
U6  - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-192653
PB  - Annals of Neurology, The Journal of Rheumatology
ER  - 
TY  - JOUR
A1  - Klitsch, Alexander
A1  - Evdokimov, Dimitar
A1  - Frank, Johanna
A1  - Thomas, Dominique
A1  - Saffer, Nadine
A1  - Meyer zu Altenschildesche, Caren
A1  - Sisignano, Marco
A1  - Kampik, Daniel
A1  - Malik, Rayaz A.
A1  - Sommer, Claudia
A1  - Üçeyler, Nurcan
T1  - Reduced association between dendritic cells and corneal sub‐basal nerve fibers in patients with fibromyalgia syndrome
JF  - Journal of the Peripheral Nervous System
N2  - In our study, we aimed at investigating corneal langerhans cells (LC) in patients with fibromyalgia syndrome (FMS) and small fiber neuropathy (SFN) as potential contributors to corneal small fiber pathology. We enrolled women with FMS (n = 134) and SFN (n = 41) who underwent neurological examination, neurophysiology, prostaglandin analysis in tear fluid, and corneal confocal microscopy (CCM). Data were compared with those of 60 age‐matched female controls. After screening for dry eye disease, corneal LC were counted and sub‐classified as dendritic (dLC) and non‐dendritic (ndLC) cells with or without nerve fiber association. We further analyzed corneal nerve fiber density (CNFD), length (CNFL), and branch density (CNBD). Neurological examination indicated deficits of small fiber function in patients with SFN. Nerve conduction studies were normal in all participants. Dry eye disease was more prevalent in FMS (17%) and SFN (28%) patients than in controls (5%). Tear fluid prostaglandin levels did not differ between FMS patients and controls. While corneal LC density in FMS and SFN patients was not different from controls, there were fewer dLC in association with nerve fibers in FMS and SFN patients than in controls (P < .01 each). Compared to controls, CNFL was lower in FMS and SFN patients (P < .05 each), CNFD was lower only in FMS patients (P < .05), and CNBD was lower only in SFN patients (P < .001). There was no difference in any CCM parameter between patients with and without dry eyes. Our data indicate changes in corneal innervation and LC distribution in FMS and SFN, potentially based on altered LC signaling.
KW  - corneal confocal microscopy
KW  - fibromyalgia syndrome
KW  - Langerhans cells
KW  - pain
KW  - small fiber neuropathy
Y1  - 2020
U6  - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-214150
VL  - 25
IS  - 1
ER  -