Small fibre neuropathy: Understanding the vast spectrum of medical conditions

Andreas completed his undergraduate medical training, PhD and internal medicine training at the University of the Witwatersrand in Johannesburg, South Africa. He moved to the University of Oxford in 2013 to work as a Clinical Research Fellow in Professor David Bennett’s lab and pursued his research interests in neuropathic pain.

Since 2018 he has worked as a clinical lecturer and specialist registrar in clinical neurophysiology. His main research interest is how nerve injury changes nociceptive fibres and how these changes contribute to neuropathic pain.

Dr Nicholas Gall qualified in 1993 from Guy’s and St Thomas’ Hospitals medical school. He subsequently trained in General Internal Medicine and then in Cardiology in the South East Thames region. He was appointed a Consultant Cardiologist in 2004, initially between King’s College Hospital and Guy’s and St Thomas’ Hospitals and then in 2008, solely at King’s College Hospital. He is also an Honorary Senior Lecturer at King’s College, London.

Dr Gall is a Cardiologist with a special interest in the investigation and treatment of arrhythmia (cardiac electrophysiology), including inherited syndromes. He developed a particular interest in dizzy spells, blackouts and collapses of uncertain cause, which led to the development of the Neuro-cardiology service at King’s. Working closely with colleagues in neurology, neuro-otology and psychiatry, the clinics now see patients from around the UK with this problem. All forms of transient loss of consciousness are managed in the service with patients sign-posted to other experts as required. PoTS, inappropriate sinus tachycardia, orthostatic intolerance and other autonomic conditions are a particular focus with the clinic now being one of the largest in the UK.

Dr Gall has published in many areas of cardiology and in particular on arrhythmia subjects and more latterly in PoTS. He has been involved in many research studies, particularly in syncope. A research program particularly focussing on PoTS is ongoing with a number of recent publications. He has spoken at numerous conferences, both in the UK and abroad, on arrhythmia and syncope subjects. With Prof Kavi, he developed the PoTS masterclass, the first PoTS-focussed medical conference in the UK. He has run the highly successful London Syncope conference since 2010, focussing on the management of patients suffering transient loss of consciousness. Dr Gall is a Patron to PoTS-UK, the national PoTS charity and is a medical adviser to STARS, the national blackout charity.

Dr Jordi Serra has been a Consultant in Clinical Neurophysiology at King’s College Hospital since 2014. Dr Serra received his medical degree in 1988 from the University of Barcelona and completed his Neurology specialty in 1992 in Barcelona. He spent the following years as a Neuromuscular Fellow at Good Samaritan Hospital and Oregon Health Sciences University in Portland, Oregon, USA, where he specialized in the study, diagnosis, and treatment of neuropathic pain patients.

During this period, he was trained in the technique of microneurography. Microneurography offers an unrivalled tool to study spontaneous pain in humans by producing objective records of the abnormal nerve impulse activity responsible for paresthesia (myelinated fibers) and spontaneous pain (unmyelinated fibers). This is the only available technique to detect and quantify positive sensory phenomena of peripheral nerve origin in humans by recording individual action potentials from single sensory fibers. Dr Serra’s pioneering work on the recording of abnormal spontaneous activity in C-nociceptors from patients and animal models of neuropathic pain is widely cited in the medical literature.

Dr Serra’s expertise also lies in the areas of electromyography, nerve conduction studies, evoked potentials, quantitative sensory testing, thermography, and intraoperative electrophysiological monitoring.

He co-founded both the Pain section of the American Academy of Neurology and the Neuropathic Pain Group of the Spanish Society of Neurology, where he served as the first Chairman. He is a member of the International Association for the Study of Pain (IASP), the British Society of Clinical Neurophysiology, the Spanish Society of Neurology, and the Spanish Pain Society.

Dr Serra has authored many scientific journal articles and book chapters. He is a frequently invited speaker and organizes courses on neuropathic pain. He also serves as a reviewer for several scientific journals.