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Twenty-eight patients with B12 deficiency, nonspecific complaints, DN4 \u003C4, and normal nerve conduction studies were compared with 25 healthy controls. Sympathetic skin response (SSR) and cutaneous silent period (CSP) were recorded. CSP durations and SSR latencies differed, indicating combined somatic and autonomic involvement, supporting diagnostic utility of SSR plus CSP.",{"@graph":69,"@context":122},[70,84,105],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/assessment-of-possible-small-fiber-neuropathy-in-early-stage-vitamin-b12-deficiency-using-electrophysiological-methods/435894/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/assessment-of-possible-small-fiber-neuropathy-in-early-stage-vitamin-b12-deficiency-using-electrophysiological-methods/435894.png","ImageObject",300,407,{"name":92,"@type":93},"Finn","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-10-30","2026-09-29",true,{"@type":102,"interactionType":103,"userInteractionCount":44},"InteractionCounter",{"@type":104},"ViewAction",{"@type":106,"mainEntity":107},"FAQPage",[108,114,118],{"name":109,"@type":110,"acceptedAnswer":111},"Why are routine nerve conduction studies insufficient for early small fiber neuropathy?","Question",{"text":112,"@type":113},"Small fiber neuropathy affects thinly myelinated and unmyelinated fibers, which often produce subtle signs that routine nerve conduction studies may not detect.","Answer",{"name":115,"@type":110,"acceptedAnswer":116},"Which electrophysiological methods were evaluated in the study?",{"text":117,"@type":113},"The study assessed sympathetic skin response (SSR) and cutaneous silent period (CSP), including CSP recordings from the right median and sural nerves.",{"name":119,"@type":110,"acceptedAnswer":120},"What were the main diagnostic findings for patients with early-stage vitamin B12 deficiency?",{"text":121,"@type":113},"Median and tibialis anterior–sural CSP durations were shorter, CSP latencies differed versus controls, and SSR latencies were prolonged, while SSR amplitudes did not differ significantly.","https://schema.org",{"og:url":83,"og:type":124,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":126,"canonical":83},"index,follow",{"doc_id":128,"site_id":62},435894,1790956376,{"code":4,"msg":5,"data":131},{"doc_id":128,"user_id":132,"nickname":92,"user_avatar":133,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":44,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":34,"language":139,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":140,"faqs":141,"seo_title":142,"seo_description":67,"update_tm":143,"read_time":144,"preview_page_count":4},34359740700684,"https://ap-avatar.wpscdn.com/avatar/1f400023980c374ae676?_k=1777273430885731487","Article published online: 2025-09-19  \nOriginal Article 1  \nAssessment of possible small fiber Neuropathyin early-stage vitamin B12 deficiency using electrophysiological methods  \nElif Simin Issi 1,2  \n1 Eskişehir City Hospital, Neurology Department, Eskişehir, Turkey.  \n2 Afyonkarahisar Health Sciences University, Faculty of Medicine, Department of Neurology, Afyonkarahisar, Turkey.  \nArq. Neuro-Psiquiatr. 2025;83(9):s00451811722 .  \nAddress for correspondence Elif Simin Issi (email: [elifsiminissi@hotmail.com](elifsiminissi@hotmail.com))  \nAbstract  \nKeywords  \n► Vitamin  \nB 12 Deficiency  \n► Small Fiber Neuropathy  \n► Galvanic Skin Response  \n► Reflex, Abnormal  \n► Electrodiagnosis  \nBackground Small fiber neuropathy (SFN) affects thinly myelinated and unmyelinated fibers, often presenting with subtle clinical signs that are undetectable in routine nerve conduction studies. Vitamin B12 deficiency is a known risk factor for SFN, yet early-stage cases frequently remain undiagnosed. Sympathetic skin response (SSR) and cutaneous silent period (CSP) are noninvasive electrophysiological techniques used to assess autonomic and somatic small fiber function.  \nObjective The present study aimed to evaluate the diagnostic utility of SSR and CSP in detecting possible subclinical small-fiber neuropathy (pSFN) in individuals with earlystage vitamin B12 deficiency.  \nMethods The present observational study included 28 patients with vitamin B12 deficiency who had nonspecific complaints, Douleur Neuropathique en 4 Questions (DN4) scores \u003C4, and normal nerve conduction studies, along with 25 healthy controls. Electrophysiological testing involved SSR recordings from all extremities and CSP measurements from the right median and sural nerves.  \nResults In the patient group, Median Nerve Cutaneous Silent Period (MN-CSP) and Tibialis Anterior -Sural Cutaneous Silent Period (TA-sural CSP) durations were significantly shorter, while termination and onset latencies were prolonged compared with controls. MN-CSP and TA-sural CSP durations demonstrated high diagnostic accuracy. Sympathetic skin response latencies were significantly prolonged in both hands and feet, indicating autonomic dysfunction. No significant differences were observed in SSR amplitudes.  \nConclusion Sympathetic skin response and CSP are valuable tools for detecting possible subclinical SFN in vitamin B12 deficiency. Sympathetic skin response effectively identified autonomic dysfunction, while CSP provided additional diagnostic value for somatic small fiber impairment. Combining SSR and CSP may enhance early detection of pSFN in vitamin B12 deficiency and allow timely intervention.  \nreceived  \nApril 21, 2025  \nreceived in its final form June 18, 2025  \naccepted July 7, 2025  \nDOI [https://doi.org/](https://doi.org/)[ ](https://doi.org/)10.1055/s-0045-1811722 . ISSN 0004-282X.  \nEditor-in-Chief: Hélio A. G. Teive.  \nAssociate Editor: Carlos Otto Heise.   \n© 2025 . The Author(s) .  \nThis is an open access article published by Thieme under the terms of the Creative Commons Attribution 4.0 International License, permitting copying and reproduction so long as the original work is given appropriate credit ([https://creativecommons.org/licenses/by/4.0/](https://creativecommons.org/licenses/by/4.0/))  \nThieme Revinter Publicações Ltda. , Rua Rego Freitas, 175, loja 1, República, São Paulo, SP, CEP 01220-010, Brazil  \n2 Small fiber neuropathy and vitamin B-12 Issi  \nINTRODUCTION  \nVitamin B12 deficiency is a prevalent condition with signifi cant neurological consequences worldwide. It can lead to various disorders affecting both the central and peripheral nervous systems. The most well-known neurological manifestations include sensory-motor axonal polyneuropathy and subacute combined degeneration, which may present symptoms such as muscle weakness, numbness, paresthesia, balance impairment, and gait disturbances.1  \nSmall fiber neuropathy (SFN), primarily affecting thinly myelinated A-delta and unmyelinated C","cbCairJ5JAp69KCE","https://ap.wps.com/l/cbCairJ5JAp69KCE","pdf",779453,"English","# Abstract\n## Background\n## Objective\n## Methods\n## Results\n## Conclusion\n# Introduction\n## Rationale for early diagnosis","[{\"question\":\"Why are routine nerve conduction studies insufficient for early small fiber neuropathy?\",\"answer\":\"Small fiber neuropathy affects thinly myelinated and unmyelinated fibers, which often produce subtle signs that routine nerve conduction studies may not detect.\"},{\"question\":\"Which electrophysiological methods were evaluated in the study?\",\"answer\":\"The study assessed sympathetic skin response (SSR) and cutaneous silent period (CSP), including CSP recordings from the right median and sural nerves.\"},{\"question\":\"What were the main diagnostic findings for patients with early-stage vitamin B12 deficiency?\",\"answer\":\"Median and tibialis anterior–sural CSP durations were shorter, CSP latencies differed versus controls, and SSR latencies were prolonged, while SSR amplitudes did not differ significantly.\"}]","Assessment of possible small fiber Neuropathy in early-stage vitamin B12 deficiency using electrophysiological methods | PDF",1790675852,18]