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Length-dependent sensorimotor polyneuropathy is a common pattern of polyneuropathy. However, setting minimal criteria for its diagnosis remains problematic. In the recently published case definition of this polyneuropathy, the panel suggested three criteria: distal sensation loss, decreased or absent ankle reflexes, and typical symptoms.1 Accepting these criteria, the question remains whether physicians, even neurologists, can actually sensitively and consistently discriminate patients with and without polyneuropathy using these criteria. The question seems impertinent but must be asked because many neurologists, even highly regarded ones, examine lower limbs only perfunctorily and do not evaluate sensation taking age, gender, ethnicity, and anthropomorphic variables into account. To diagnose small fiber sensory polyneuropathy quantitatively and accurately some investigators have turned to counts of epidermal nerve fibers.2 Decreased counts have been observed especially in HIV and diabetic and chronic idiopathic sensorimotor polyneuropathy.2
In this issue, Herrmann et al.3 report on in vivo counting of Meissner corpuscles (MCs) as a marker of large fiber sensory polyneuropathy. Can this technique serve as the gold standard for the detection of large fiber sensorimotor polyneuropathy? To consider their suggestion we first consider the role of MCs in sensation.
Mammals sense conditions of their environment by olfactory, visual, auditory, vestibular, and somatosensory receptors and neural systems. Information about touch pressure, movement and its direction, size, shape, texture, warming, cooling, or tissue destructive stimuli are transduced by formed receptors or naked nerve …
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