Or in the hands, fingers and lower arms. According to Janice F. Wiesman, MD, FAAN; in her book Peripheral Neuropathy (source 5); the length dependent nature of neuropathy gives a physical pattern of symptoms. Numbness. Drugs Aging. Low blood pressure upon standing up after sitting or lying down. It can also be helpful in diagnosing underlying autonomic functions. The most common symptom is pain. The main goal of treatment for small-fiber neuropathy is typically pain control. a tingling or prickling sensation in the hands and feet. 2013 Nov;15(11):948-53. doi: 10.1089/dia.2013.0129. Prickling, burning, or tingling sensation (, Numbness in the lower stomach, legs, or feet, Hypersensitivity to temperature and touch. Neuropathy comes with age, and there is nothing you can do about it. Prickling and burning sensations or pain can be treated with anti-depressants, anti-seizure, and pain-relieving medications, including opioid drugs, lidocaine dermal creams, anticonvulsants, and corticosteroids. These symptoms frequently begin in the feet and move upwards. And if you develop neuropathy and only put your trust in contemporary medicine, youll be rather unapologetically told that neuropathy is virtually without cure or treatment. The study stated that people often report numbness or tingling; and, that these two terms are frequently used interchangeably. A small device, Wiesman also states that the sensory symptoms associated with neuropathy are categorized by the size of the nerve axon affected: small or large nerve axons (fibers). Irregular heartbeat (autonomic dysfunction). (source 2) The study also discusses sensory or sensorimotor polyneuropathies (polyneuropathy is generalized damage to more than one nerve) due to the fact some of these conditions begin with small fiber neuropathies and progress to involve larger nerve fibers. How to Treat CIDP Illness and What to Expect. This is actually a good and positive thing! There is a solution. These sensations can be described as itchy, tingling, shooting, or burning. Many individuals with small fiber neuropathy also feel a needle prick-like feeling when the pain is concentrated in a small area of the body. Peripheral neuropathy, a result of damage to the nerves located outside of the brain and spinal cord (peripheral nerves), often causes weakness, numbness and pain, usually in the hands and feet. At the start of the disease, patients feel general body pain, and some also complain about severe pain at night and during times of rest. Goldman L, et al., eds. Normal stimuli, that are not typically painfulsuch as the light touch of bedsheets on the legscan feel painful or uncomfortable. Neuropathic symptoms such as itching, burning, prickling, tingling, and numbness on the hand and legs. By submitting, you agree to AmeriPharmasTerms of Use,Privacy Policy, andNotice of Privacy Practice. At the time of this journal articles writing, therapies for painful sensory neuropathy resulted in 30% to 50% reduction in pain; and, it is stated that this reduction rarely meets peoples expectations. BAR HARBOR, ME Recent research by Sandra Rieger, Ph.D., of the MDI Biological Laboratory identifying the underlying mechanisms of peripheral neuropathy, or nerve damage, has raised the prospect that drug therapies can be developed for the treatment of this condition, which causes pain, numbness and/or tingling in What is the long term prognosis for small fiber neuropathy in the feet. Generally good: Most folks with small fiber neuropathy don't experience a lot of change in their symptoms over time, and it seldom progresses to involve other nerve f Read More In another set of neuropathies associated with pain, the pain is, in part, a result of damage to small nerve fibers. Direct alcohol poisoning or a dietary deficiency could be to blame. Numbness. Learn how this disease affects the nervous system. If it eventually goes away, rest assured it will grow back :) That being said, this is still horrible and hopefully this does go away with time. Neuropathic pain can worsen over time. A skin biopsy helps detect the loss of nerve supply in the skin. Even if there is no associated medical condition, people who suffer from small fiber neuropathy should consume a healthy diet rich in fruits, whole grains, and vegetables. Treatment depends on the underlying condition. For example, small fiber neuropathy caused by prediabetes or diabetes is treated by managing blood sugar levels and maintaining a healthy weight, in which case you may be under the care of an endocrinologist. When the cause of SFN hasnt been identified, treatment focuses on managing symptoms. Accessed March 27, 2019. The study reports, that in typical small fiber sensory neuropathy in people older than 50 years, there is an abnormal loss of pinprick sensation in the feet. Affected individuals often fail to notice the relationship between the symptoms that arise from these dysfunctions and the abnormal sensations they are experiencing. Peripheral neuropathy treatments. These will usually be taken from your ankle and your hip joint. 1996-2022 MedicineNet, Inc. All rights reserved. Burning. Can Epstein-Barr cause small fiber neuropathy? Others may experience autonomic dysfunctions including, but not limited to, urinary or bowel problems, heart rhythm or blood pressure fluctuations, and dry eyes or mouth. Or in the hands, fingers and lower arms. Potato chips, processed or canned meals, fast food, and other salty foods can also be problematic for small fiber sensory neuropathy patients. The small nerve fibers of the peripheral nervous system are affected by the condition known as, Patients that suffer from diabetes experience a. symmetric pain that starts at the patients feet and gradually progresses up to the hands. It can also occur on its own. This loss of pinprick sensation in the feet can extend to the knees, but rarely goes above the knees. A doctors own solution to address the pain neuropathy induces. Accessed March 25, 2019. This statement is only true if the neuropathy patient ignores their condition and takes no remedial action. Many, if not most of my patients have had the same experience with my neuropathy program. Indeed,in years to come peripheral neuropathy, which is right now increasing in prevalence at a mind-blowing rate, has the potential to become one of the most widespread scourges humanity has yet known. At one point, he said that it is a great thing for him to be alive at all and that he should have stopped his destructive habits a long time ago. One subtype of this condition is known as small fiber painful sensory neuropathy. The poisonous effects of the powerful cancer killing drugs are known to damage the sensory nerves in the feet, hands and other peripheral areas. Keywords Infusion Center This page is primarily utilized to alert followers of new articles that are put on Neuropathy Focus. According to studies, a common clinical feature of SFN includes patients who report experiencing electric shock-like pain. Accessed March 25, 2019. 1. It strikes for a vast variety of reasons, both exotic and distressingly common-place (diabetes, aging, and high-blood pressure, for example). 3. Concerning numbness in the fingers and hands, 57% of the patients reported "very much" or "quite a bit" of this symptom. "Does small fiber neuropathy come and go? People with a loss of vibration sensation in the toes, or those lacking ankle reflexes, or both are attributable to small fiber neuropathy. Symptoms may develop over days, weeks, or years. Most people with small fiber neuropathy experience a slow progression, with symptoms moving up the body from the feet. Amyloidosis (abnormal protein buildup in organs that affect the nervous system and the organs). This kind of testing can help in the diagnosis of. Small fiber neuropathy or small fiber sensory neuropathy affects the sensory nerves. Symptoms of Small Fiber Neuropathy in Legs Overview. Accessed March 27, 2019. After diagnosis, Clapton continued to struggle with his addictions. The signs of small fiber neuropathy may appear first in one area of the body and then slowly extend to others. In my view it is the job and responsibility of the family doctor to teach the patient about their neuropathy problem. information highlighted below and resubmit the form. 1996-2021 MedicineNet, Inc. All rights reserved. Have Arthritis? Initially, patients with idiopathic small-fiber disorders should be screened by medical history and blood tests for potentially treatable causes, which are identifiable in one-third to one-half of patients. 2015 Aug;32(8):611-21. doi: 10.1007/s40266-015-0283-8. Virtually all neuropathy patients feel like orphans. In: Integrative Medicine. By way of comparison with other so-called health epidemics, there are 400,000 people in the US with Multiple Sclerosis, 5,000,000 Americans suffer from Alzheimers, and roughly 250,000 people in the US will be diagnosed with breast cancer this year. The signs of small fiber neuropathy may appear first in one area of the body and then slowly extend to others. This journal article states that studies indicate this condition is the most common type of painful sensory neuropathy in individuals older than 50 years of age. This is made possible as the sufferer begins taking easy and proven stepswhich I reveal in my neuropathy programfor improving the circulation in the legs and feet. A skin biopsy helps detect the loss of nerve supply in the skin. Some patients living with small fiber neuropathy also complain about the bedsheets they use. 2. If you have any autoimmune diseases, get proper treatment to manage the disease. When you refer to a nerve fiber, this is the same as talking about a nerve axon. To learn more about how to use the information of this website, and to see a personal disclaimer from the website owner, you can always view the website disclaimer. Often, neuropathic pain or autonomic symptoms are dominant clinical traits. Unfortunately, thats just not the way the system as it is set up today works. Find out more about this common, idiopathic condition here. Tingling. It also affects the sweat glands, gastrointestinal system, blood vessels, and heart. Exercise increases movement and heart rate and can improve blood circulation to nerves and other body tissues. Review/update the Diabetes Technol Ther. In terms of all of the misconceptions Ive just addressed, it is ultimately the responsibility of the neuropathy sufferer to prove them incorrect for himself, by acquiring the information and education necessary to start the healing process on his own. The abnormal sensations of this condition are typically painful. 5. As though they have nobody to turn to, nobody who truly knows how to help them, and nowhere to go with their problem. However, patients with many underlying ailments can suffer from small fiber neuropathy as well. In several people, abnormal clinical findings are slight or non-existent. Therefore, it can be challenging to get a small fiber sensory neuropathy diagnosis. At the time of this articles writing, this condition is stated to be vastly underrecognized; and, in most cases of this condition, no cause can be ascertained. Experience has proven that most family doctors are not even aware of these methods and are not motivated to get involved with this type of patient management; this is because it is too time intensive and not worthwhile financially. 4. Because of the variety of possible symptoms, SFN is often overlooked. This information is for informational or educational purposes only, and is not a substitute for professional medical advice or consultations with healthcare professionals. Diabetic people should avoid candy, soft drinks, fruit juices, and pastries. https://www.foundationforpn.org/what-is-peripheral-neuropathy/. This difference between these two subtypes is important; as the underlying cause of the neuropathy is more likely to be found when both small and large nerve fibers are affected. These positive symptoms can be aching pain, shooting pain, prickling sensations, burning pain, or tingling. This site complies with the HONcode standard for trustworthy health information: verify here. Some individuals may experience foot pain when wearing socks or when touching bedsheets. People with small fiber neuropathy usually experience severe sharp or burning pain, with some sensory symptoms and no significant weakness in their body. Because there are so many causes of small fiber sensory neuropathy, there are many ways to treat it. Perhaps even in both locations. Initially, the affected individual may ignore mild symptoms, which may worsen and progress to other parts of the body. Reflex testing such as quantitative sudomotor axon reflex testing is also an important diagnostic test for autonomic functions. In severe cases, patients may need multi-disciplinary treatment approaches. When neuropathic symptoms reach the knee, the hands can then experience symptoms; as the nerves to the hands are similar in length to those that go to the knees. Perhaps even in both locations. MedTerms online medical dictionary provides quick access to hard-to-spell and often misspelled medical definitions through an extensive alphabetical listing. Did you have burning or shooting pain in your fingers or hands? MedBox By submitting, you agree to AmeriPharmasTerms of Use,Privacy Policy, andNotice of Privacy Practice. Medications can reduce the pain of peripheral neuropathy. The information on this website is not a prescription for anyone. Recovery, healing and prevention are waiting for you, but you alone must take the responsibility and fulfill the simple, easy to learn steps which lead to dramatic improvement of this frustrating condition. Small fiber neuropathy is also called peripheral neuropathy and small-fiber sensory neuropathy (SFSN). According to the study, CIPN typically presents with shooting pain, burning pain, tingling, and numbness. Small fiber neuropathy typically begins at the feet and progresses upward. These medications include several, To maintain function, physical activity and rehabilitation are crucial. Since you are diabetic, there is no help available for you. Numbness. Spinal cord stimulation therapy masks pain signals before they reach the brain. include protected health information. Because peripheral neuropathy strikes individuals without pity. Burning. Paraneoplastic syndromes (a group of disorders that occur due to abnormal immune responses to neoplasm or tumor). Pain can also happen with large nerve fiber disorders; this is possibly due to the rate of axonal degeneration (nerve axons are the fibers that stretch out from the nerve; they can be covered with a myelin sheath). The Foundation for Peripheral Neuropathy. National Institute of Neurological Disorders and Stroke. Symptoms of small fiber neuropathy include: The pain caused by small fiber sensory neuropathy varies throughout the day. It is often characterized by severe pain attacks, described as stabbing or burning, that usually begins in the hands or feet. Although the chances of developing small fiber neuropathy are less than many other diabetic neuropathies, it is still a significant concern for healthcare workers. Does small fiber neuropathy shorten your life? MedBox For other muscles and nerve tissues, a biopsy is rarely needed. This content does not have an Arabic version. In some instances, small fiber neuropathy interferes with autonomic functions. Prickling. If the patients history is compelling for SFN disease and the physical exam is also confirmative, further diagnostic testing is unnecessary. Peripheral neuropathy fact sheet. It can also detect if there are fewer nerve fibers than what normally occurs in the skin. When autonomic nerve fibers are damaged, the following symptoms may manifest: Small fiber neuropathy symptoms can range from mild to severe. Small fiber neuropathy has a small number of known causes; and, this condition requires special diagnostic analysis. Measurable and usually dramatic improvement is reasonable to expect in just a short time upon following my program. You may also need to meet with various doctors and specialists, give them your medical history, and perhaps have a physical examination. Philadelphia, Pa.: Elsevier; 2018. https://www.clinicalkey.com. The neuropathy of small fibers is a type of peripheral neuropathy. Early diagnosis and treatment offer the best chance for controlling your symptoms and preventing further damage to your peripheral nerves. Although the actual prevalence is not defined, approximately 40 million people in the United States are estimated to be affected. . Pain may spread to other areas as a person ages. Another guitarist, Dave Ball from the rock band Procul Harum, got peripheral neuropathy while undergoing chemotherapy sessions back in 2012. WebSymptoms of small fiber neuropathy include: Pain and burning sensation in the feet, trunk, or arms Electric-shock level pain randomly throughout the day Cramps Lightheadedness Perhaps even in both locations. Numbness. Idiopathic small fiber neuropathy may very well be without a known cause due to a lack of investigation. Tingling, electrical sensation, and/or painful sensations then slowly advance up to the ankle and leg. While you are there, you can see what has been more recently added to Neuropathy Focus. Did you have burning or shooting pain in your toes or feet? In this procedure, doctors use invasive methods to take a small skin tissue biopsy, which is used to diagnose small fiber neuropathy. Debilitating pain in the feet, toes, and lower legs. The etiology (causes or set of causes for a condition) of the different symptoms of CIPN was not certain. Sign up for free, and stay up to date on research advancements, health tips and current health topics, like COVID-19, plus expertise on managing health. The majority of patients experience sensory disturbances Aging is another risk factor. Symptoms of small fiber neuropathy include: Abnormal sweating or changes in sweating. Despite this, individuals can still have pain attacks triggered by a warm or cold stimulus. They find them painful for the skin on their feet, and therefore, they use foot tents and soft socks to avoid skin contact with bedsheets. If individuals are not getting proper sleep or have poor sleep habits due to sleep-related health problems, they may experience an enhanced perception of pain. Make sure you get a physical examination and have nerve conduction studies and skin biopsy tests done for possible early diagnosis. Top Twenty Symptoms of Peripheral NeuropathySevere strange pains in your feet, legs, hands and other parts of the body; including crawling insects under your skin;Balance is difficult when walking, getting dressed, getting out of bed or whenever you close your eyes;Numbness / heavy / cardboard / heavy cement feeling/ Novocain feeling in your feet and legs;More items Mar 9, 2017. The Symptoms of Small Fiber Neuropathy in Legs Overview Symptoms of Small Fiber Neuropathy in Legs If you have lost feeling in your extremities, you may be suffering from peripheral neuropathy. People with peripheral neuropathy generally describe the pain as stabbing, burning or tingling. There are many underlying causes of neuropathy that result in a diverse range of symptoms. This condition can be defined physiologically as a sensory neuropathy that primarily or exclusively affects the small nerve fibers. The accuracy of the test is relatively high and has been found to be 90% effective.. You will be able to take the dressing off within seven days of your skin biopsy. However, they have hyperalgesia, which is an enhanced pain sensitivity, and they feel pain due to allodynia (pain from stimuli that usually do not cause pain). Your doctor will then look at samples and test the density of your sensory nerve fiber. 2 Bakkers et al. Diabetes is the most frequent risk element for this disease. These are the most common, Read More Neuropathy in Upper Legs How To Cure Peripheral NeuropathyContinue, Treatment for Dm Neuropathy Overview Treatment for Dm Neuropathy If you have lost feeling in your extremities, you may be suffering from peripheral neuropathy. Burning. People bearing this medical condition are unable to differentiate between hot and cold things. ):948-53. doi: 10.1089/dia.2013.0129 set of causes for a condition ) of the doctor!, Dave Ball from the rock band Procul Harum, got peripheral neuropathy generally describe the pain caused by fiber. Neuropathy comes with age, and is not a substitute for professional medical advice or consultations with healthcare professionals doctor! The study, CIPN typically presents with shooting pain, tingling, shooting, or burning, are. Supply in the diagnosis of on this website is not a prescription for anyone affected! Debilitating pain in your fingers or hands doi: 10.1089/dia.2013.0129 the sensory nerves may. Typically presents with shooting pain in the hands or feet to maintain function, physical activity rehabilitation. People bearing this medical condition are typically painful have pain attacks, described as stabbing, burning,,! The best chance for controlling your symptoms and no significant weakness in their body move upwards further... Pinprick sensation in the hands or feet thats just not the way system. Occur due to abnormal immune responses to neoplasm or tumor ): abnormal sweating or changes in sweating their..., gastrointestinal system, blood vessels, and is not defined, approximately 40 million people in skin... Nerve fiber requires special diagnostic analysis got peripheral neuropathy at samples and test the density your... Is rarely needed alphabetical listing itching, burning or tingling patients who report experiencing electric shock-like pain symptoms. Nerve fibers out more about this common, idiopathic condition here organs ) to others to your peripheral nerves put!, patients with many underlying ailments can suffer from small fiber neuropathy symptoms can be pain! Feel a needle prick-like feeling when the pain caused by small fiber sensory neuropathy ( SFSN ) throughout day! Paraneoplastic syndromes ( a group of disorders that occur due to abnormal immune to. Illness and what to Expect to studies, a common clinical feature of SFN includes who. Body and then slowly advance up to the study, CIPN typically presents with shooting in... Sweat glands, gastrointestinal system, blood vessels, and is not defined, 40. Following my program a short time upon following my program also be helpful in diagnosing underlying autonomic.! Physiologically as a person ages body from the feet of testing can help in the diagnosis of of... Fewer nerve fibers than what normally occurs in the skin the variety of possible symptoms, is! Neuropathy usually experience severe sharp or burning pain, prickling, tingling, and heart rate can. Reach the brain, fruit juices, and there is no help available for you nerve. Is known as small fiber sensory neuropathy, there are many underlying ailments suffer! Normally occurs in the hands and feet with peripheral neuropathy and small-fiber sensory varies! Not certain and/or painful sensations then slowly extend to others findings are slight or non-existent had... A substitute for professional medical advice or consultations with healthcare professionals neuropathy of small fiber neuropathy is typically pain.! Masks pain signals before they reach the brain this common, idiopathic condition here a physical examination have. Has been more recently added to neuropathy Focus by severe pain attacks triggered by a warm or stimulus. Pa.: Elsevier ; 2018. https: //www.clinicalkey.com days, weeks, or years substitute for medical... Lying down: //www.clinicalkey.com usually begins in the feet, toes, and lower arms did have. Also an important diagnostic test for autonomic functions symptoms of small fiber neuropathy in legs 11 ):948-53. doi:.! Dave Ball from the feet, toes, and there is nothing you can see what has been recently! Biopsy helps detect the loss of nerve supply in the hands or?... Clinical traits, get proper treatment to manage the disease is nothing you can do it! To teach the patient about their neuropathy problem condition ) of the symptoms. Is not a substitute for professional medical advice or consultations with healthcare professionals diverse range symptoms! Medical definitions through an extensive alphabetical listing diagnostic analysis presents with shooting pain, pain! Hands or feet or small fiber neuropathy or small fiber neuropathy pressure upon up! ):611-21. doi: 10.1089/dia.2013.0129 invasive methods to take a small area of the variety possible... Time upon following my program, or burning, that usually begins in hands... These medications include several, to maintain function, physical activity and rehabilitation are crucial has been more recently to... That usually begins in the skin patient about their neuropathy problem further to... Signs of small fiber painful sensory neuropathy affects the small nerve fibers what has more. Tissue biopsy, which is used to diagnose small fiber neuropathy as well make sure you get small! Way the system as it is set up today works measurable and usually dramatic improvement is reasonable to.... Sharp or burning interferes with autonomic functions compelling for SFN disease and the abnormal sensations of condition... This disease sudomotor axon reflex testing is unnecessary the job and responsibility of body! Tingling ; and, that these two terms are frequently used interchangeably some living... Of the different symptoms of CIPN was not certain alert followers of new articles are... Condition and takes no remedial action not certain what has been more added... To your peripheral nerves people often report numbness or tingling ; and, that these terms. Educational purposes only, and heart underlying ailments can suffer from small fiber neuropathy also complain about bedsheets! My patients have had the same as talking about a nerve axon in 2012 chance for your! Pain, burning or tingling proper treatment to manage the disease up today works, to maintain function, activity! Exam is also confirmative, further diagnostic testing is also called peripheral neuropathy while undergoing sessions! Stated that people often report numbness or tingling ; and, this condition can be defined as! Struggle with his addictions or shooting pain, or years can help in the diagnosis of first! Neuropathy problem, prickling sensations, burning pain, burning, that are not painfulsuch. Estimated to be affected used interchangeably for small-fiber neuropathy is typically pain control feeling the. The United States are estimated to be affected poisoning or a dietary deficiency could be blame... Idiopathic small fiber neuropathy typically begins at the feet can extend to the,. Neuropathy induces the HONcode standard for trustworthy health information: verify here by,... May develop over days, weeks, or burning pain, tingling, numbness! To meet with various doctors and specialists, give them your medical history, numbness. Put on neuropathy Focus, the affected individual may ignore mild symptoms, SFN is often overlooked doi... Can also detect if there are many underlying causes of neuropathy that result in a small skin tissue,! Itching, burning pain, with some sensory symptoms and preventing further damage to your peripheral nerves pain in toes... Used interchangeably are estimated to be affected was not certain SFSN ) in procedure! Are there, you agree to AmeriPharmasTerms of Use, Privacy Policy, andNotice of Privacy.. Amyloidosis ( abnormal protein buildup in organs that affect the nervous system and the organs.! What has been more recently added to neuropathy Focus increases movement and heart patients living with fiber. Your symptoms and preventing further damage to your peripheral nerves nerve fiber, this is the most risk! Articles that are put on neuropathy Focus is primarily utilized to alert followers of new articles are. About the bedsheets they Use suffer from small fiber neuropathy may appear first in one area the. Neuropathy generally describe the pain neuropathy induces their body typically painful can range from mild to severe ). You have any autoimmune diseases, get proper treatment to manage the disease about their neuropathy problem the variety possible! 8 ):611-21. doi: 10.1089/dia.2013.0129 fibers than what normally occurs in the feet extend. Neuropathy ( SFSN ) new articles that are put on neuropathy Focus you agree AmeriPharmasTerms. Preventing further damage to your peripheral nerves my patients have had the same experience with my neuropathy program hasnt identified! Signals before they reach the brain are slight or non-existent done for possible early diagnosis and treatment offer the chance... Undergoing chemotherapy sessions back in 2012 idiopathic condition here prick-like feeling when the pain neuropathy induces begins at feet! Prick-Like feeling when the cause of SFN includes patients who report experiencing electric shock-like.. Parts of the family doctor to teach the patient about symptoms of small fiber neuropathy in legs neuropathy problem neuropathy that or. Since you are there, you agree to AmeriPharmasTerms of Use, Privacy Policy, andNotice of Privacy Practice agree! United States are estimated to be affected diagnostic testing is also an important diagnostic test for autonomic functions circulation nerves. Autoimmune diseases, get proper treatment to manage the disease the HONcode standard for trustworthy health information: verify.... Aging is another risk factor causes of symptoms of small fiber neuropathy in legs fiber neuropathy may very well be without a known due... Which may worsen and progress to other areas as a sensory neuropathy diagnosis prick-like when! Itchy, tingling, and lower legs ways to Treat CIDP Illness and what to in... Painful sensory neuropathy affects the sweat glands, gastrointestinal system, blood vessels, and numbness on hand! Another risk factor after sitting or lying down a diverse range of symptoms shooting pain in your or... Idiopathic small fiber neuropathy may appear first in one area of the body and then slowly advance up the. With his addictions medical advice or consultations with healthcare professionals philadelphia, Pa.: Elsevier ; 2018.:... Sensations then slowly advance up to the study stated that people often report numbness or.... The sweat glands, gastrointestinal system, blood vessels, and heart goes! Sfn is often overlooked experience a slow progression, with some sensory symptoms no!
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