Since 2014, Dr. Serra has been a Consultant in Clinical Neurophysiology at King’s College Hospital, London. Jordi 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 (1992 – 1995) as a Neuromuscular Fellow at the Neuromuscular Unit, 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 unrivaled 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 expertise also lies in the areas of electromyography, nerve conduction studies, evoked potentials, quantitative sensory testing, thermography, and intraoperative electrophysiological monitoring.

Small Fibre neuropathy diagnostic techniques and microneurography
Jordi Serra
Dept. of Clinical Neurophysiology, King’s College Hospital, London
Patients with small fibre neuropathy represent a diagnostic challenge. They commonly express a variety of symptoms and signs that most likely reflect different pathophysiological mechanisms. Some of them escape conventional medical examination, particularly the mapping and quantification of positive sensory dysfunction. As opposed to negative sensory phenomena whose electrophysiological correlate can be readily measured through conventional laboratory methods, the study of positive sensory phenomena relies largely on neurological interrogation sensory examination. Sensory examination is time consuming and requires special training and facilities that are often not available. Beyond the history and physical examination, special studies may be performed to aid the clinician in further clarifying the nature of insult to the nervous system. Skin biopsy with quantification on intraepithelial nerve fibre density has emerged as the current gold-standard, although it is often normal in patients with the suspicion of small nerve fibre neuropathy. Electromyography and nerve conduction studies are among the most standard and widely available techniques for neurophysiological quantification of peripheral neuropathy, although they only assess large fibre function and are mildly invasive and sometimes uncomfortable. Other studies, like Quantitative Sensory Tests are more specialized, but they are only available at selected centres. They permit precise quantification of the sensory abnormality and allow comparison over time. Other more specialized tests, like microneurography, are only available at highly specialized centres. However, they provide crucial information on the possible pathophysiological mechanisms beyond neuropathic pain symptoms. A summary of different techniques for the diagnosis of small fibre neuropathy and interpretation of results will be presented.