Diagnostic and therapeutic value due to suspected diagnosis, long-term complications, and indication for sural nerve biopsy

In order to elicit the usefulness of sural nerve biopsy we retrospectively evaluated the courses of disease of every patient, who underwent this procedure in our department between January 1995 and March 2000. Sixty seven patients with the suspected diagnosis of peripheral neuropathy could be included. From these chart reviews and patient questionings were done. Inflammatory-demyelinating neuropathies were suspected in 14 patients (20.9%), specific histological findings confirmed diagnosis in 50% of these patients and resulted in therapy. In cases of polyneuropathy of unknown etiology (46 patients, 68.6%) diagnosis was made in 11 patients (23.9%), and lead to therapy in 9 patients (19.6%), merely. In all, diagnostic consequences arouse in 32.8%, therapeutic consequences in 26.9%. The follow-up of 47 patients (mean 24.4 months) found chronic pain in the distribution of the sural nerve in 14 patients (29.8%), dysesthesia in 22 patients (46.8%), and persistent sensory loss in 34 patients (72.3%). Only 24 patients (51.1%) would submit to biopsy again. Because of high complication rates and poor results we conclude that sural nerve biopsy should be done only in carefully selected cases after thorough clinical work-up, and should be limited to cases of suspected inflammatory neuropathies, collagenoses and immunologic neuropathies, and hereditary neuropathies.