OBJECTIVE: To study the utility of nerve biopsy in providing diagnostic, therapeutic or prognostic information that aid in clinical management in elderly subjects with peripheral neuropathy.
METHODS: Clinico-pathological data of 100 elderly subjects aged 65 and above with peripheral neuropathy who underwent nerve biopsy in the last decade (2002-2011) was reviewed.
RESULTS: The study included 100 subjects (M : F 78 : 22). Mean age at biopsy and symptom duration was 69.62 {\textpm} 4.8 years and 24.17 {\textpm} 40.4 months, respectively. The most common pattern of was distal symmetric sensorimotor polyneuropathy (35\%), followed by multiple mononeuropathy (29\%) and asymmetric sensorimotor neuropathy (15\%). The nerve biopsy was {\textquoteright}diagnostic{\textquoteright} in 24\%, (definite vasculitis in 12, leprosy in 10 and acute inflammatory demyelinating polyradiculoneuropathy in 2) and proved {\textquoteright}essential{\textquoteright} or {\textquoteright}helpful{\textquoteright} in therapeutic management in 81\% subjects. In 60 (60\%) patients, where a pre-biopsy aetiological diagnosis could be arrived at based on the available data, nerve biopsy confirmed the diagnosis in 29 of 60 (48.3\%), and offered a new diagnosis in 25 (41.7\%). A higher yield of biopsy was noted in subjects with asymmetric/multiple mononeuropathy compared with symmetric neuropathies (32.7\% versus 17.7\%). In 40 (40\%) patients without a pre-biopsy aetiological diagnosis, nerve biopsy was {\textquoteright}essential{\textquoteright} in 7 of 40 (17.5\%) as it provided a definitive diagnosis (definite vasculitis: 5, leprosy: 2), and {\textquoteright}helpful{\textquoteright} in 21 of 40 (52.5\%) (ischaemic neuropathy: 10, possible vasculitis: 9, probable vasculitis: 2).
CONCLUSION: Nerve biopsy aided in the detection of potentially treatable disorders and influenced patient management in a significant proportion of elderly subjects with peripheral neuropathy (81\%), particularly in subset with undiagnosed neuropathies confirming that it{\textquoteright}s a useful tool in diagnosis of neuropathy in the elderly. With minor differences, the aetiological profile in our biopsied neuropathic elderly subjects may reflect the findings in other similar cohorts.
}, year = {2014}, journal = {Age and ageing}, issn = {1468-2834}, doi = {10.1093/ageing/afu171}, language = {eng}, }