Contact Heat-Evoked Potential Stimulation for the Evaluation of Small Nerve Fiber Function

Parson, Henri K.; Nguyen, Van Tuyen; Orciga, Michael-Angelo; Boyd, Amanda; Casellini, Carolina; Vinik, Aaron I.

doi:10.1089/dia.2012.0202

Cited by 27 publications

(18 citation statements)

References 40 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In addition, CHEP N 2 –P 2 amplitudes at the ankle, more than at the wrist, showed acceptable diagnostic accuracy in differentiating between our controls and SFN patients, with reasonable sensitivity and specificity scores. Several studies have demonstrated increased CHEP latencies and reduced amplitudes in various forms of peripheral neuropathies that involve small nerve fibers . Our ROC findings (Fig.…”

Section: Discussionsupporting

confidence: 56%

Contact heat evoked potentials: Normal values and use in small‐fiber neuropathy

Lagerburg

Bakkers

Bouwhuis³

et al. 2015

Muscle and Nerve

View full text Add to dashboard Cite

show abstract

Section: Discussionsupporting

confidence: 56%

Contact heat evoked potentials: Normal values and use in small‐fiber neuropathy

Lagerburg

Bakkers

Bouwhuis³

et al. 2015

Muscle and Nerve

View full text Add to dashboard Cite

show abstract

“…They are thin, poorly myelinated, or unmyelinated, and therefore prone to destruction early in many pathological processes and often symptomatically debilitating. Indeed, the earliest changes appear to occur in the lower back, forearm, and thenar eminence as shown using Contact Heat Evoked Potential (CHEPS) (64), challenging the dogma that neuropathy is a distal to proximal disorder. Small nerves can be assessed objectively, and recognition of early dysfunction can allow intervention, treatment, and potentially cure.…”

Section: Resultsmentioning

confidence: 99%

The New Age of Sudomotor Function Testing: A Sensitive and Specific Biomarker for Diagnosis, Estimation of Severity, Monitoring Progression, and Regression in Response to Intervention

Névoret²,

2015

Self Cite

View full text Add to dashboard Cite

Sudorimetry technology has evolved dramatically, as a rapid, non-invasive, robust, and accurate biomarker for small fibers that can easily be integrated into clinical practice. Though skin biopsy with quantitation of intraepidermal nerve fiber density is still currently recognized as the gold standard, sudorimetry may yield diagnostic information not only on autonomic dysfunction but also enhance the assessment of the small somatosensory nerves, disease detection, progression, and response to therapy. Sudorimetry can be assessed using Sudoscan™, which measures electrochemical skin conductance (ESC) of hands and feet. It is based on different electrochemical principles (reverse iontophoresis and chronoamperometry) to measure sudomotor function than prior technologies, affording it a much more practical and precise performance profile for routine clinical use with potential as a research tool. Small nerve fiber dysfunction has been found to occur early in metabolic syndrome and diabetes and may also be the only neurological manifestation in small fiber neuropathies, beneath the detection limits of traditional nerve function tests. Test results are robust, accomplished within minutes, require little technical training and no calculations, since established norms have been provided for the effects of age, gender, and ethnicity. Sudomotor testing has been greatly under-utilized in the past, restricted to specialized centers capable of handling the technically demanding and expensive technology. Yet, evaluation of autonomic and somatic nerve function has been shown to be one of the best estimates of cardiovascular risk. Evaluation of sweating has the appeal of quantifiable non-invasive determination of the integrity of the peripheral autonomic nervous system, and can now be accomplished rapidly at point of care clinics with the determination of ESC, allowing intervention for morbid complications prior to permanent structural nerve damage. We review here sudomotor function testing technology, the research evidence accumulated supporting the clinical utility of measuring ESC, the medical applications of sudorimetry now available to physicians with this device, and clinical vignettes illustrating its use in the clinical decision-making process.

show abstract

“…An explanation for lower ESC values in the hands of T2DM females versus males found in the current study is not readily apparent, nor is the higher prevalence of moderate to severe sudomotor dysfunction in the hands versus feet. It should be noted that Parson et al [29] recently showed in a study of individuals with T2DM that the expected distal to proximal gradient usually seen in diabetic peripheral neuropathy was not observed in their evaluation of small fiber function measured using contact heat-evoked potential stimulation. The observations with regard to ESC of the hands shown in our study warrant additional investigation, with larger studies being required to completely address these findings.…”

Section: Discussionmentioning

confidence: 99%

Osteopontin and clusterin levels in type 2 diabetes mellitus: differential association with peripheral autonomic nerve function

et al. 2017

View full text Add to dashboard Cite

Osteopontin (OPN) and clusterin are secreted glycoproteins potentially associated with nerve function. Sudomotor dysfunction is associated with the development of foot ulcerations. The purpose of this study was to investigate the potential relationship of OPN and clusterin with sudomotor function (i.e., autonomic nerves that control sweating) in participants with type 2 diabetes mellitus (T2DM). Sudomotor function was assessed using SUDOSCAN® which measures electrochemical skin conductance (ESC) of the hands and feet. Demographics (e.g., age, gender, race, body mass index (BMI)), HbA1c, 25-hydroxyvitamin D, creatinine, OPN, and clusterin were also determined for the participants. Fifty individuals with T2DM (age = 59±11 years; 23/27 male/female; 13 African Americans) participated in this study. Lower ESC for the hands and feet were observed in African Americans versus Caucasians/Asians (p < 0.05). No significant ESC differences were observed for good [HbA1c <7%] versus poor [HbA1c ≥7%] glycemic control. With regard to gender, ESC values were lower for the hands for females (p < 0.05). In linear regression with ESC for the hands or feet as the dependent variable, increased OPN levels, but not clusterin, were independently associated with reduced sudomotor function while adjusting for age, gender, race, BMI, and glycemic control (ESC hands model R2 = 0.504, p < 0.001; ESC feet model R2 = 0.534, p < 0.001). The association between OPN and reduced sudomotor function found in our study warrants further investigation to delineate the underlying mechanisms and determine if OPN is neuroprotective, involved in the pathogenesis of sudomotor dysfunction, or simply a bystander.

show abstract

Contact Heat-Evoked Potential Stimulation for the Evaluation of Small Nerve Fiber Function

Abstract: This study suggests that CHEPS is a novel, noninvasive technique able to detect impairment of small nerve fiber function from skin to cerebral cortex, providing an objective measure of C and Aδ nerve dysfunction.

Cited by 27 publications

References 40 publications

Contact heat evoked potentials: Normal values and use in small‐fiber neuropathy

Contact heat evoked potentials: Normal values and use in small‐fiber neuropathy

The New Age of Sudomotor Function Testing: A Sensitive and Specific Biomarker for Diagnosis, Estimation of Severity, Monitoring Progression, and Regression in Response to Intervention

Osteopontin and clusterin levels in type 2 diabetes mellitus: differential association with peripheral autonomic nerve function

Contact Info

Product

Resources

About