Autonomic evaluation is independent of somatic evaluation for small fiber neuropathy

Thaisetthawatkul, Pariwat; Filho, J. Americo Fernandes; Herrmann, David N.

doi:10.1016/j.jns.2014.06.017

Cited by 36 publications

(30 citation statements)

References 17 publications

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“…These criteria use only sensory markers and SFN also affects autonomic fibers (Novak et al, 2001; Devigili et al, 2008; Hovaguimian and Gibbons, 2011). The diagnostic yield of Devigili's criteria can be increased by adding sudomotor evaluation (Low et al, 2006; Thaisetthawatkul et al, 2013, 2014). Therefore SFN was defined by the presence of all of the following: (1) clinical signs suggestive of SFN and (2) at least one abnormal test out of the following objective tests: ENFD, SGNFD, QSART, or sympathetic adrenergic evaluation.…”

Section: Methodsmentioning

confidence: 99%

Electrochemical Skin Conductance Correlates with Skin Nerve Fiber Density

Novák

2016

Front. Aging Neurosci.

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Purpose: Electrochemical skin conductance (ESC) using reverse iontophoresis and chronoamperometry has been used to evaluate abnormal function of small fibers. How ESC correlates with loss of small fibers in skin is unclear.Methods: This was a prospective, blinded study. The primary outcome measure was the correlation between ESC at the feet and results of skin biopsies including epidermal nerve fiber density (ENFD) and sweat gland nerve fiber density (SGNFD) at the distal leg. ESC, ENFD, and SGNFD data were normalized by adjusting for weight. The secondary outcome measures were the correlation between ESC and the following variables: quantitative sudomotor axon reflex test (QSART) and symptom scales (neuropathy, pain and autonomic).Results: Eighty-one patients (mean ± sd): age = 53.3 ± 17.3, men/women = 25/56 were enrolled in the study. ESC was reduced in subjects with abnormally low ENFD (ENFD normal/abnormal, ESC = 1.17 ± 0.27/0.87 ± 0.34 μSiemens/kg, p < 0.0008) and abnormally low SGNFD (SGNFD normal/abnormal ESC = 1.09 ± 0.34/0.78 ± 0.3 μSiemens/kg, p < 0.0003). ESC correlated with ENFD (ρ = 0.73, p = 0.0001) and SGNFD (ρ = 0.64, p = 0.0001). ESC did not correlate with symptom scales.Conclusion: ESC is diminished in subjects who have a reduced number of small fibers in the skin and the ESC reduction is proportional to ENFD and SGNFD. ESC can be useful in detecting loss of small nerve fibers.

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Section: Methodsmentioning

confidence: 99%

Electrochemical Skin Conductance Correlates with Skin Nerve Fiber Density

Novák

2016

Front. Aging Neurosci.

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“…SFN and FM symptoms do intertwine, since SFN also includes allodynia, hyperesthesia, paresthesia, severe fatigue, concentration disorders, burning, and pain sensation . Another complexity arises from dysautonomia that has been described in FM, but autonomic features do not always parallel the somatic features of the neuropathy, and the degree of dysautonomia may vary in patients with FM . Autonomic dysfunction could even be the common clustering of FM, chronic fatigue syndrome, irritable bowel syndrome, and interstitial cystitis, and underlie their pathogenesis .…”

Section: Introductionmentioning

confidence: 99%

Electrochemical Skin Conductance and Quantitative Sensory Testing on Fibromyalgia

et al. 2019

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Background An impairment of the peripheral nervous system has been suggested in fibromyalgia (FM). Noninvasive distal electrochemical skin conductance (ESC) has been studied little so far when combined with quantitative sensory testing (QST) in patients with FM. Methods This study (clinicaltrials.gov NCT03347669) included 50 female patients with FM and 50 matched healthy volunteers (HVs). ESC (measured in microsiemens [µS] with Sudoscan), as well as psychological, quality of life, sleep, and social characteristics, were assessed in both groups. In a subgroup of 24 patients with FM and 24 HVs, QST of cold and warm detection and pain thresholds and diffuse noxious inhibitory controls (DNICs) were explored. Statistical analysis was performed for a 2‐sided type I error at 5%. Results Between patients with FM and HVs, ESC values differed (71.4 ± 11.2 µS vs. 74.4 ± 10.3 µS, respectively; P = 0.003), especially on the dominant hand (P = 0.03), where more patients with FM had ESC values < 66 µS than did HVs (P = 0.046). No difference was observed on feet. In patients with FM, all collected characteristics were impaired (P < 0.001), DNICs were less functional, detection thresholds occurred later, and pain thresholds occurred earlier. No correlation was observed between ESC and DNICs or with any parameter. Conclusion This study shows that the sudomotor function is significantly impaired in patients with FM, especially on the dominant hand. This occurs in parallel with adjustments of detection and pain thresholds in the context of deficient spinal pain modulation. ESC values combined with QST values are relevant in the context of patients with FM and need to be explored further in this nociception‐autonomic system intertwining.

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“…All patients had normal routine electrophysiological studies and underwent blinded QST, QSART, and skin biopsy to assess IENFD. Methods and criteria for abnormality of electrophysiological studies, QST, QSART, and skin biopsy (IEFND) have been described elsewhere . In brief, QST of vibration detection threshold (VDT), cooling detection threshold (CDT), and heat‐pain (HP 0.5, minimal pain; HP 5.0, intermediate pain; and HP 5.0–0.5) was conducted with a CASE IV device (WR Medical, Maplewood, MN).…”

Section: Methodsmentioning

confidence: 99%

“…Methods and criteria for abnormality of electrophysiological studies, QST, QSART, and skin biopsy (IEFND) have been described elsewhere. 1,12 In brief, QST of vibration detection threshold (VDT), cooling detection threshold (CDT), and heat-pain (HP 0.5, minimal pain; Sweat production was collected and quantified in a sudorometer. Two 3-mm punch biopsies were obtained in each patient for IENFD analysis, one 10 cm above the lateral malleolus and the other 20 cm below the greater trochanter over the lateral thigh.…”

Section: Methodsmentioning

confidence: 99%

Prediabetes, diabetes, metabolic syndrome, and small fiber neuropathy

et al. 2020

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Introduction This study was conducted to evaluate the association between prediabetes (PD), elements of the metabolic syndrome (MetS), and small fiber neuropathy (SFN). Methods A total of 268 patients with SFN symptoms and normal electrophysiology underwent tests to assess small fibers. SFN was diagnosed based on abnormality of at least two among intraepidermal nerve fiber density (IEFND), quantitative sensory testing, and quantitative sudomotor axon reflex testing. Results There was no difference in IENFD or abnormal skin biopsy frequency between PD and normoglycemia (NG). However, IENFD was lower in people with diabetes mellitus (DM) than in those with NG. An association between HbA1C and IENFD was observed only if DM patients were included. Attributes of the MetS were more common in those with an abnormal skin biopsy but not among those with autonomic dysfunction or meeting SFN criteria. Discussion DM, but not PD alone, is associated with SFN. Other MetS elements appear to preferentially impact small fiber structure over function.

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Autonomic evaluation is independent of somatic evaluation for small fiber neuropathy

Cited by 36 publications

References 17 publications

Electrochemical Skin Conductance Correlates with Skin Nerve Fiber Density

Electrochemical Skin Conductance Correlates with Skin Nerve Fiber Density

Electrochemical Skin Conductance and Quantitative Sensory Testing on Fibromyalgia

Prediabetes, diabetes, metabolic syndrome, and small fiber neuropathy

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