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    Cramps and small-fiber neuropathy.
    Muscle Nerve 2013 Aug 28;48(2):252-5. Epub 2013 Jun 28.
    Department of Neurology, Division of Neuromuscular Disease, Washington University School of Medicine, Campus Box 8111, 660 South Euclid Avenue, St. Louis, Missouri 63110, USA.
    Introduction: Muscle cramps are a common complaint and are thought to arise from spontaneous discharges of the motor nerve terminal. Polyneuropathy is often causative, but small-fiber neuropathy (SFN) has not been assessed.

    Methods: We performed skin biopsies on consecutive patients with cramps but without neuropathic complaints. Twelve patients were biopsied, 8 with normal small-fiber sensation.

    Results: Seven patients had decreased intraepidermal nerve fiber density (IENFD), 2 with non-length-dependent loss. A cause for neuropathy was found in 1 patient with cramp-fasciculation syndrome. Creatine kinase was elevated in 8 patients, 4 with decreased IENFD. Muscle biopsy, performed in 8 patients, but was diagnostic in only 1, with McArdle disease.

    Conclusions: Our data show that 60% of patients with muscle cramps who lack neuropathic complaints have SFN, as documented by decreased IENFD. Cramps may originate as local mediators of inflammation released by damaged small nerve that excite intramuscular nerves.

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    Zhonghua Yi Xue Za Zhi 2014 Nov;94(43):3397-401
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    Rev Neurol (Paris) 2009 Mar 3;165(3):249-55. Epub 2008 Dec 3.
    Département de neurologie, CHU de Strasbourg, hôpital civil, 1, place de l'Hôpital, 67091 Strasbourg cedex, France.
    Introduction: In small-fiber neuropathy, skin biopsy reveals a reduction of intraepidermal nerve fiber density (IENFD), a feature often necessary for diagnosis. In France, this technique has not been widely used for this purpose.

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