Name: corneal confocal microscopy: a novel non-invasive technique to quantify small fibre pathology in peripheral neuropathies
Uploaded: 2011-01-03T17:30:00
Description: Watch this Scientific Journal Video about Corneal Confocal Microscopy: A Novel Non-invasive Technique to Quantify Small Fibre Pathology in Peripheral Neuropathies at JoVE.com

<p class="jove_content">This work was supported by the Juvenile Diabetes Research Foundation International (grant 17-2008-1031) and the National Institutes of Health (grant 1R01DK077903-01A1).</p>

<p class="jove_title">Introduction: </p>
<p class="jove_content">The accurate quantification of peripheral neuropathy is important to define at risk patients, anticipate deterioration, and assess new therapies. Conventional methods assess neurological deficits and electrophysiology and quantitative sensory testing quantifies functional alterations to detect neuropathy. However, the earliest damage appears to be to the small fibres and yet these tests primarily assess large fibre dysfunction and have a limited ability to demonstrate regeneratio...

<ol>
	<li>Abbott, C. A., Kallinikos, P., Marshall, A., Finnigan, J., Morgan, P., Efron, N., Boulton, A. J. M., Malik, R. A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Corneal+Confocal+Microscopy:+A+Novel+Non-invasive+Test+to+Diagnose+and+Assess+Progression+of+Human+Diabetic+Neuropathy.">Corneal Confocal Microscopy: A Novel Non-invasive Test to Diagnose and Assess Progression of Human Diabetic Neuropathy.</a> <em style='font-style: italic'>Diabetes Care</em>. <b>33</b>, 1792-1797 (2010).</li><li>Quattrini, C., Tavakoli, M., Jeziorska, M., Kallinikos, P., Tesfaye, S., Marshall, A., Finnigan, J., Boulton, A. J. M., Efron, N., Malik, R. A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Surrogate+Markers+of+Small+Fiber+Damage+in+Human+Diabetic+Neuropathy.">Surrogate Markers of Small Fiber Damage in Human Diabetic Neuropathy.</a> <em style='font-style: italic'>Diabetes</em>. <b>56</b>, 2148-2154 (2007).</li><li>Mehra, S., Tavakoli, M., Efron, N., Boulton, A. J. M., Augustine, T., Malik, R. A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Corneal+Confocal+Microscopy+Detects+Early+Nerve+Regeneration+After+Pancreas+Transplantation+in+Patients+with+Type+1+Diabetes.">Corneal Confocal Microscopy Detects Early Nerve Regeneration After Pancreas Transplantation in Patients with Type 1 Diabetes.</a> <em style='font-style: italic'>Diabetes Care</em>. <b>30</b>, 2608-2612 (2007).</li><li>Tavakoli, M., Marshall, A., Pitceathly, R., Fadavi, H., Gow, D., Roberts, M. E., Efron, N., Boulton, A. J. M., Malik, R. A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Corneal+confocal+microscopy:+A+novel+means+to+detect+nerve+fibre+damage+in+patients+with+impaired+glucose+tolerance+and+idiopathic+small+fibre+neuropathy.">Corneal confocal microscopy: A novel means to detect nerve fibre damage in patients with impaired glucose tolerance and idiopathic small fibre neuropathy.</a> <em style='font-style: italic'>Experimental Neurology</em>. <b>223</b>, 245-250 (2010).</li><li>Tavakoli, M., Marshall, A., Thompson, L., Kenny, M., Waldek, S., Efron, N., Malik, R. A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Corneal+confocal+microscopy:+A+novel+technique+to+detect+small-fibre+neuropathy+in+patients+with+Fabry+disease.">Corneal confocal microscopy: A novel technique to detect small-fibre neuropathy in patients with Fabry disease.</a> <em style='font-style: italic'>Muscle &#38; Nerve</em>. <b>40</b>, 976-984 (2009).</li></ol>

<p class="jove_content">Corneal confocal microscopy (CCM) is a noninvasive clinical technique that may be used to detect early nerve damage and quantify small fibre pathology in peripheral neuropathies including diabetes, Fabry disease and idiopathic small fibre neuropathies (ISFN). The immediate clinical impact of this technique represents a huge leap forward in terms of our ability to diagnose, follow progression and assess therapeutic response in patients with diabetic neuropathy and other peripheral neuropathies and will have an immediate i...

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<td>HRT III CCM Machine - The Rostock Cornea Module</td>
<td>&nbsp;</td>
<td>&nbsp;</td>
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<td> Heidelberg Engineering</td>
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<td>CCM image analysis software v0.6 </td>
<td>&nbsp;</td>
<td>&nbsp;</td>
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<td>University of Manchester</td>
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corneal confocal microscopy: a novel non-invasive technique to quantify small fibre pathology in peripheral neuropathies

<p class="jove_content">The accurate quantification of peripheral neuropathy is important to define at risk patients, anticipate deterioration, and assess new therapies. Conventional methods assess neurological deficits and electrophysiology and quantitative sensory testing quantifies functional alterations to detect neuropathy. However, the earliest damage appears to be to the small fibres and yet these tests primarily assess large fibre dysfunction and have a limited ability to demonstrate regeneration and repair. The only techniques which allow a direct examination of unmyelinated nerve fibre damage and repair are sural nerve biopsy with electron microscopy and skin-punch biopsy. However, both are invasive procedures and require lengthy laboratory procedures and considerable expertise. Corneal Confocal microscopy is a non-invasive clinical technique which provides <em>in-vivo</em> imaging of corneal nerve fibres. We have demonstrated early nerve damage, which precedes loss of intraepidermal nerve fibres in skin biopsies together with stratification of neuropathic severity and repair following pancreas transplantation in diabetic patients. We have also demonstrated nerve damage in idiopathic small fibre neuropathy and Fabry's disease.</p>

Watch this Scientific Journal Video about Corneal Confocal Microscopy: A Novel Non-invasive Technique to Quantify Small Fibre Pathology in Peripheral Neuropathies at JoVE.com

Corneal Confocal Microscopy: A Novel Non-invasive Technique to Quantify Small Fibre Pathology in Peripheral Neuropathies

<p class="jove_content">Corneal Confocal microscopy is a non-invasive clinical technique which may be used to quantify C fibre damage to diagnose and stratify patients with increasing neuropathic severity.</p>

The accurate quantification of peripheral neuropathy is important to define at risk patients, anticipate deterioration, and assess new therapies. ...

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