Often it progresses slowly, and in a proportion of people it stays much the same for years. What most influences which of those happens is whether an underlying cause is found and controlled. In some people the damage later extends to the large nerve fibres as well.
Often it progresses slowly, and in a proportion of people it stays much the same for years. What most influences which of those happens is whether an underlying cause is found and controlled. In some people the damage later extends to the large nerve fibres as well.
Small fibre neuropathy typically starts in the feet with burning, prickling or a raw sensitivity, worse at night, and creeps upwards over years. Progression is generally slow. A minority follow a different pattern in which symptoms are patchy or non-length-dependent from the outset, affecting the face, trunk or arms as well, and that pattern is more often associated with an immune-mediated cause. Autonomic symptoms may appear alongside: altered sweating, dry eyes and mouth, lightheadedness on standing, or bowel and bladder change.
In some people the process later involves the larger myelinated fibres, and the picture changes accordingly: reduced vibration sense, absent ankle reflexes, unsteadiness in the dark, and eventually some weakness. That transition is worth detecting because it changes both the differential and the falls risk. It is also the point at which nerve conduction studies become abnormal, having often been normal earlier, since those studies assess large fibres. Both offices have an AANEM-accredited electrodiagnostic laboratory for that comparison.
Glucose is the most common lever, and impaired glucose tolerance short of diabetes is enough to matter, so a normal fasting glucose does not close the question. Correcting vitamin B12 deficiency, treating thyroid disease or coeliac disease, stopping alcohol, and reviewing a neurotoxic medication all alter the trajectory where they apply. Where an immune cause is identified, treatment is directed at that. In genuinely idiopathic cases progression tends to be slow and treatment addresses symptoms.
Follow-up tracks the extent of the sensory change, whether any large-fibre or autonomic features have appeared, pain control, and foot integrity. Repeat electrodiagnostic testing is done when the clinical picture shifts. Skin biopsy for intraepidermal nerve fibre density and formal autonomic testing are not performed at these offices; where they are needed they are arranged elsewhere. Adults 18 and older are seen at both the Las Vegas and Henderson locations.
Clinical Neurology Specialists has been physician-owned since 1998, when Leo Germin, M.D., FAANEM founded it. Five board-certified neurologists and four advanced practice providers see patients at the Las Vegas and Henderson offices, each with its own AANEM-accredited electrodiagnostic laboratory.
Clinical Neurology Specialists is an adult outpatient neurology practice for patients 18 and older. The practice performs no surgery and operates no imaging suite, infusion suite or interventional pain programme, and provides no emergency or inpatient care.
Physician-reviewed. Reviewed by the physicians of Clinical Neurology Specialists — board-certified neurologists, AANEM-accredited electrodiagnostic laboratories, physician-owned since 1998. Reviewed 1 August 2026. This article is general education for adults 18 and older and is not a substitute for a consultation.
Sources and further reading: MedlinePlus: peripheral nerve disorders; MedlinePlus: numbness and tingling; National Institute of Neurological Disorders and Stroke.
Adults 18 and older, at the Las Vegas and Henderson offices. Call 702-804-1212 or request an appointment online.