14642 Newport Ave. Ste 450       Tustin, CA 92780  (714) 709-4944

4100 Central Ave. Ste 101  Riverside, CA 92506  (951) 642-1059




Epidermal Nerve Fiber Density (ENFD) is a technology used by neurologists for over 15 years. This diagnostic modality takes advantage of the fact that most forms of peripheraly neuropathy progress in a distal to proximal fashion, beginning with the body's smallest and most distal (foot) nerve twigs (C fibers and A delta fibers), and then progressing proximally. This is why our diabetic patients so often present with peripheral neuropathy in a "stocking-like" distribution, i.e. in the feet. Those patients that exhibit this form of neuropathy, without involvement of larger and more proximal nerves, are said to have small fiber peripheral neuropathy. If the pathological process moves to the larger nerves, the neuropathy becomes mixed.

In short, ENFD testing measures the amount of C-fibers and A-delta fibers via a 3mm punch biopsy of the skin. With this testing, the physicians at OCFA can determine the amount of damage present as well as determine the degenerative changes present which may be predicative of impending neuropathy even before symptoms begin. The main advantages of our technique over others is:

1. It is the only test to directly measure small fiber neuropathy

2. It may predict the onset of neuropathy even before symptoms begin

3. It is purely objective and measures the quanitity of fibers present

4. It is performed in our office setting

5. It provides a baseline so that the benefits of therapeutic agents may be measured. The physicans repeat the test in 6 months to measure how well medication/treatment is affecting the nerves.