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Tentolouris A, Stergioti A, Eleftheriadou I, Siafarikas C, Tsilingiris D. Screening tools for diabetic foot ulcers: a narrative review. Hormones (Athens) 2024:10.1007/s42000-024-00598-z. [PMID: 39227550 DOI: 10.1007/s42000-024-00598-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Accepted: 08/26/2024] [Indexed: 09/05/2024]
Abstract
The prevalence of diabetic foot ulcers (DFUs) is 4 to 10% among people with diabetes mellitus. DFUs are associated with increased morbidity and mortality as well as reduced quality of life and have a significant impact on overall healthcare expenditure. The main predisposing factors for DFU are diabetic neuropathy, peripheral arterial disease, and trauma. The fact that a range of tests can be used to identify patients at risk for DFU often causes confusion among practitioners regarding which screening tests should be implemented in clinical practice. Herein we sought to determine whether tests of somatic nerve function, such as pinprick sensation, thermal (cold/hot) test, ankle reflexes, vibration perception, 10-g monofilament, Ipswich touch test, neuropathy disability score, and nerve conduction studies, predict the development of DFUs. In addition, we examined whether sudomotor function screening tests, such as Neuropad, sympathetic skin response, and other tests, such as elevated plantar pressure or temperature measurements, can be used for DFU screening. If not treated properly, DFUs can have serious consequences, including amputation, early detection and treatment are vital for patient outcomes.
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Affiliation(s)
- Anastasios Tentolouris
- First Department of Propaedeutic Internal Medicine and Diabetes Center, School of Medicine, National and Kapodistrian University of Athens, Laiko General Hospital, 17 Agiou Thoma Street, Athens, 11527, Greece.
| | - Anastasia Stergioti
- First Department of Propaedeutic Internal Medicine and Diabetes Center, School of Medicine, National and Kapodistrian University of Athens, Laiko General Hospital, 17 Agiou Thoma Street, Athens, 11527, Greece
| | - Ioanna Eleftheriadou
- First Department of Propaedeutic Internal Medicine and Diabetes Center, School of Medicine, National and Kapodistrian University of Athens, Laiko General Hospital, 17 Agiou Thoma Street, Athens, 11527, Greece
| | - Christos Siafarikas
- First Department of Propaedeutic Internal Medicine and Diabetes Center, School of Medicine, National and Kapodistrian University of Athens, Laiko General Hospital, 17 Agiou Thoma Street, Athens, 11527, Greece
| | - Dimitrios Tsilingiris
- First Department of Internal Medicine, University Hospital of Alexandroupolis, Democritus University of Thracae, Dragana, Alexandroupolis, 68100, Greece
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Delon-Martin C, Lefaucheur JP, Hodaj E, Sorel M, Dumolard A, Payen JF, Hodaj H. Neural Correlates of Pain-Autonomic Coupling in Patients With Complex Regional Pain Syndrome Treated by Repetitive Transcranial Magnetic Stimulation of the Motor Cortex. Neuromodulation 2024; 27:188-199. [PMID: 37589642 DOI: 10.1016/j.neurom.2023.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 05/26/2023] [Accepted: 05/30/2023] [Indexed: 08/18/2023]
Abstract
OBJECTIVES Complex regional pain syndrome (CRPS) is a chronic pain condition involving autonomic dysregulation. In this study, we report the results of an ancillary study to a larger clinical trial investigating the treatment of CRPS by neuromodulation. This ancillary study, based on functional magnetic resonance imaging (fMRI), evaluated the neural correlates of pain in patients with CRPS in relation to the sympathetic nervous system and for its potential relief after repetitive transcranial magnetic stimulation of the motor cortex. MATERIALS AND METHODS Eleven patients with CRPS at one limb (six women, five men, aged 52.0 ± 9.6 years) were assessed before and one month after the end of a five-month repetitive transcranial magnetic stimulation (rTMS) therapy targeting the motor cortex contralateral to the painful limb, by means of electrochemical skin conductance (ESC) measurement, daily pain intensity scores on a visual numerical scale (VNS), and fMRI with motor tasks (alternation of finger movements and rest). The fMRI scans were analyzed voxelwise using ESC and VNS pain score as regressors to derive their neural correlates. The criterion of response to rTMS therapy was defined as ≥30% reduction in VNS pain score one month after treatment compared with baseline. RESULTS At baseline, ESC values were reduced in the affected limb vs the nonaffected limb. There was a covariance of VNS with brain activation in a small region of the primary somatosensory cortex (S1) contralateral to the painful side on fMRI investigation. After rTMS therapy on motor cortex related to the painful limb, the VNS pain scores significantly decreased by 22% on average. The criterion of response was met in six of 11 patients (55%). In these responders, at one month after treatment, ESC value increased and returned to normal in the CRPS-affected limb, and overall, the increase in ESC correlated with the decrease in VNS after motor cortex rTMS therapy. At one month after treatment, there also was a covariance of both variables (ESC and VNS) with fMRI activation of the S1 region previously mentioned. The fMRI activation of other brain regions (middle frontal gyrus and temporo-parietal junction) showed correlation with ESC values before and after treatment. Finally, we found a positive correlation at one month after treatment (not at baseline) between VNS pain score and fMRI activation in the temporo-parietal junction contralateral to painful side. CONCLUSIONS This study first shows a functional pain-autonomic coupling in patients with CRPS, which could involve a specific S1 region. However, the modulation of sympathetic sudomotor activities expressed by ESC changes was rather correlated with functional changes in other brain regions. Finally, the pain relief observed at one month after rTMS treatment was associated with a reduced activation of the temporo-parietal junction on the side in which rTMS was performed. These findings open perspectives to define new targets or biomarkers for using rTMS to treat CRPS-associated pain. CLINICAL TRIAL REGISTRATION The Clinicaltrials.gov registration number for the study is NCT02817880.
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Affiliation(s)
- Chantal Delon-Martin
- University of Grenoble Alpes, Inserm, U1216, Grenoble Institut Neurosciences, Grenoble, France.
| | - Jean-Pascal Lefaucheur
- EA University Paris Est Créteil, Health Faculty, Créteil, France; AP-HP, Clinical Neurophysiology Unit, Henri Mondor Hospital, Créteil, France
| | - Enkeledja Hodaj
- CHU Grenoble Alpes, Clinical Investigation Center, Grenoble, France
| | - Marc Sorel
- Sud-Seine-et-Marne Hospital, Center for Pain Evaluation and Treatment, Nemours, France
| | | | - Jean-François Payen
- University of Grenoble Alpes, Inserm, U1216, Grenoble Institut Neurosciences, Grenoble, France; CHU Grenoble Alpes, Pain Center, Grenoble, France
| | - Hasan Hodaj
- University of Grenoble Alpes, Inserm, U1216, Grenoble Institut Neurosciences, Grenoble, France; CHU Grenoble Alpes, Pain Center, Grenoble, France
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Riveline JP, Mallone R, Tiercelin C, Yaker F, Alexandre-Heymann L, Khelifaoui L, Travert F, Fertichon C, Julla JB, Vidal-Trecan T, Potier L, Gautier JF, Larger E, Lefaucheur JP. Validation of the Body Scan ®, a new device to detect small fiber neuropathy by assessment of the sudomotor function: agreement with the Sudoscan ®. Front Neurol 2023; 14:1256984. [PMID: 38020587 PMCID: PMC10644320 DOI: 10.3389/fneur.2023.1256984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 10/10/2023] [Indexed: 12/01/2023] Open
Abstract
Background Sudomotor dysfunction is one of the earliest manifestations of small fiber neuropathy (SFN), reflecting the alteration of sympathetic C fiber innervation of the sweat glands. Among other techniques, such innervation can be assessed by measuring electrochemical skin conductance (ESC) in microsiemens (μS). In this study, ESC was measured at the feet to detect distal SFN. For this objective, the performance of a new device, the Body Scan® (Withings, France), intended for home use, was compared with that of a reference device, the Sudoscan® (Impeto Medical, France), which requires a hospital setting. Methods In patients with diabetes with or without neuropathy or non-diabetic patients with lower-limb neuropathy, the diagnostic performance of the Body Scan® measurement was assessed by calculating its sensitivity (Se) and specificity (Sp) to detect at least moderate SFN (Se70 and Sp70), defined by a value of feet ESC ≤ 70 μS and > 50 μS on the Sudoscan® measure, or severe SFN (Se50 and Sp50), defined by a value of feet ESC ≤ 50 μS on the Sudoscan® measure. The agreement between the two devices was assessed with the analysis of Bland-Altman plots, mean absolute error (MAE), and root mean squared error (RMSE) calculations. The repeatability of the measurements was also compared between the two devices. Results A total of 147 patients (52% men, mean age 59 years old, 76% diabetic) were included in the analysis. The sensitivity and specificity to detect at least moderate or severe SFN were: Se70 = 0.91 ([0.83, 0.96]), Sp70 = 0.97 ([0.88, 0.99]), Se50 = 0.91 ([0.80, 0.98]), and Sp50 = 0.99 ([0.94, 1]), respectively. The bias and 95% limits of agreement were 1.5 [-5.4, 8.4]. The MAE was 2.9 and the RMSE 3.8. The intra-sample variability was 2.0 for the Body Scan® and 2.3 for the Sudoscan®. Conclusion The ESC measurements provided by the Body Scan® were in almost perfect agreement with those provided by the reference device, the Sudoscan®, which validates the accuracy of the Body Scan® for the detection of SFN. By enabling simple, rapid, and autonomous use by the patient at home, this new technique will facilitate screening and monitoring of SFN in daily practice. Clinical trial registration ClinicalTrials.gov, identifier NCT05178459.
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Affiliation(s)
| | | | | | - Fetta Yaker
- Diabetology Department, Cochin Hospital, Paris, France
| | | | - Lysa Khelifaoui
- Diabetology – Endocrinology and Nutrition Department, Bichat-Claude-Bernard Hospital, Paris, France
| | - Florence Travert
- Diabetology – Endocrinology and Nutrition Department, Bichat-Claude-Bernard Hospital, Paris, France
| | - Claire Fertichon
- Diabetology – Endocrinology and Nutrition Department, Bichat-Claude-Bernard Hospital, Paris, France
| | - Jean-Baptiste Julla
- Diabetology and Endocrinology Department, Lariboisière Hospital, Paris, France
| | | | - Louis Potier
- Diabetology – Endocrinology and Nutrition Department, Bichat-Claude-Bernard Hospital, Paris, France
| | | | | | - Jean-Pascal Lefaucheur
- Unité de Neurophysiologie Clinique, Hôpital Henri Mondor, AP-HP, Créteil, France
- EA4391 (ENT), Faculté de Santé, Université Paris Est Créteil, Créteil, France
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Akbar M, Wandy A, Soraya GV, Goysal Y, Lotisna M, Basri MI. Sudomotor dysfunction in diabetic peripheral neuropathy (DPN) and its testing modalities: A literature review. Heliyon 2023; 9:e18184. [PMID: 37539131 PMCID: PMC10393629 DOI: 10.1016/j.heliyon.2023.e18184] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Revised: 06/04/2023] [Accepted: 07/11/2023] [Indexed: 08/05/2023] Open
Abstract
Long term consequences of diabetes mellitus (DM) may include multi-organ complications such as retinopathy, cardiovascular disease, neuronal, and kidney damage. One of the most prevalent complication is diabetic peripheral neuropathy (DPN), occurring in half of all diabetics, and is the main cause of disability globally with profound impact on a patient's quality of life. Small fiber neuropathy (SFN) can develop in the pre-diabetes stage preceding large fiber damage in DPN. Asymptomatic SFN is difficult to diagnose in early stages, with sudomotor dysfunction considered one of the earliest manifestations of autonomic neuropathy. Early detection is crucial as it can prevent potential cardiovascular events. Although punch skin biopsy is the gold-standard method for SFN diagnosis, implementation as routine screening is hindered due to its invasive, impractical, and time-consuming nature. Other sudomotor testing modalities, most of which evaluate the postganglionic cholinergic sympathetic nervous system, have been developed with varying sensitivity and specificity for SFN diagnosis. Here, we provide an overview on the general mechanism of DPN, the importance of sudomotor assessment for early detection of autonomic dysfunction in DPN, the benefits and disadvantages of current testing modalities, factors that may affect testing, and the importance of future discoveries on sudomotor testing for successful DPN diagnosis.
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Affiliation(s)
- Muhammad Akbar
- Department of Neurology, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia
| | - Alvian Wandy
- Department of Neurology, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia
| | - Gita Vita Soraya
- Department of Neurology, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia
- Department of Biochemistry, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia
| | - Yudy Goysal
- Department of Neurology, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia
| | - Mimi Lotisna
- Department of Neurology, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia
| | - Muhammad Iqbal Basri
- Department of Neurology, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia
- Department of Anatomy, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia
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Lefaucheur JP. Assessment of autonomic nervous system dysfunction associated with peripheral neuropathies in the context of clinical neurophysiology practice. Neurophysiol Clin 2023; 53:102858. [PMID: 36966708 DOI: 10.1016/j.neucli.2023.102858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 03/07/2023] [Accepted: 03/08/2023] [Indexed: 03/29/2023] Open
Abstract
Peripheral neuropathies may involve the small diameter nerve fibers of the autonomic nervous system. In the presence of clinical signs compatible with dysautonomia, it is very difficult to affirm that these signs are really linked to an alteration in postganglionic autonomic innervation, and not to a lesion of the central nervous system or to a direct damage to the tissues and innervated organs. Also, in the context of the investigation of peripheral neuropathies, there is an interest in performing objective and quantitative assessment of distal autonomic innervation. The corresponding autonomic tests are mainly based on the exploration of sudomotor or vasomotor disorders of the limb extremities. In this article, we provide an overview of the various tests available for the study of the autonomic nervous system in clinical practice, including vasomotor reactivity tests, in particular based on laser Doppler techniques, and sudomotor tests, based on axon-reflexes produced by iontophoresis of cholinergic drugs or on the simpler measurement of electrochemical skin conductance by the Sudoscan® device.
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Crnošija L, Adamec I, Krbot Skorić M, Habek M. How to explore and explain autonomic changes in multiple sclerosis. Neurophysiol Clin 2023; 53:102854. [PMID: 36966707 DOI: 10.1016/j.neucli.2023.102854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 02/27/2023] [Accepted: 03/01/2023] [Indexed: 03/29/2023] Open
Abstract
Autonomic dysfunction (AD) in people with MS (pwMS) is a frequent finding. This narrative review will present an overview of central neural mechanisms involved in the control of cardiovascular and thermoregulatory systems, and methods of autonomic nervous system testing will be discussed thereafter. Since the need for standardization of autonomic nervous system (ANS) testing, we will focus on the standard battery of tests (blood pressure and heart rate response to Valsalva maneuver and head-up tilt, and heart rate response to deep breathing test plus one of the tests for sudomotor function), which can detect ANS pathology in the majority of pwMS. The review will briefly discuss the other types of AD in pwMS and the use of appropriate tests. While performing ANS testing in pwMS one has to consider the multiple sclerosis phenotypes, disease duration, and its activity, the degree of clinical disability of patients included in the study, and the disease-modifying therapies taken, as these factors may have a great influence on the results of ANS testing. In other words, detailed patient characteristics presentation and patient stratification are beneficial when reporting results of ANS testing in pwMS.
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Mayes HS, Navarro M, Satchell LP, Tipton MJ, Ando S, Costello JT. The effects of manipulating the visual environment on thermal perception: A structured narrative review. J Therm Biol 2023; 112:103488. [PMID: 36796929 DOI: 10.1016/j.jtherbio.2023.103488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Revised: 01/14/2023] [Accepted: 01/15/2023] [Indexed: 01/26/2023]
Abstract
When exposed to ambient temperatures that cause thermal discomfort, a human's behavioral responses are more effective than autonomic ones at compensating for thermal imbalance. These behavioral thermal responses are typically directed by an individual's perception of the thermal environment. Perception of the environment is a holistic amalgamation of human senses, and in some circumstances, humans prioritize visual information. Existing research has considered this in the specific case of thermal perception, and this review investigates the state of the literature examining this effect. We identify the frameworks, research rationales, and potential mechanisms that underpin the evidence base in this area. Our review identified 31 experiments, comprising 1392 participants that met the inclusion criteria. Methodological heterogeneity was observed in the assessment of thermal perception, and a variety of methods were employed to manipulate the visual environment. However, the majority of the included experiments (80%) reported a difference in thermal perception after the visual environment was manipulated. There was limited research exploring any effects on physiological variables (e.g. skin and core temperature). This review has wide-ranging implications for the broad discipline of (thermo)physiology, psychology, psychophysiology, neuroscience, ergonomics, and behavior.
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Affiliation(s)
- Harry S Mayes
- School of Sport, Health and Exercise Science, University of Portsmouth, Portsmouth, England, UK
| | - Martina Navarro
- School of Sport, Health and Exercise Science, University of Portsmouth, Portsmouth, England, UK
| | - Liam P Satchell
- Department of Psychology, University of Winchester, Winchester, UK
| | - Michael J Tipton
- School of Sport, Health and Exercise Science, University of Portsmouth, Portsmouth, England, UK
| | - Soichi Ando
- Graduate School of Informatics and Engineering, The University of Electro-Communications, Tokyo, Japan
| | - Joseph T Costello
- School of Sport, Health and Exercise Science, University of Portsmouth, Portsmouth, England, UK.
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Idiaquez J, Casar JC, Arnardottir ES, August E, Santin J, Iturriaga R. Hyperhidrosis in sleep disorders - A narrative review of mechanisms and clinical significance. J Sleep Res 2023; 32:e13660. [PMID: 35706374 DOI: 10.1111/jsr.13660] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 05/10/2022] [Accepted: 05/13/2022] [Indexed: 02/03/2023]
Abstract
Hyperhidrosis is characterized by excessive sweating beyond thermoregulatory needs that affects patients' quality of life. It results from an excessive stimulation of eccrine sweat glands in the skin by the sympathetic nervous system. Hyperhidrosis may be primary or secondary to an underlying cause. Nocturnal hyperhidrosis is associated with different sleep disorders, such as obstructive sleep apnea, insomnia, restless legs syndrome/periodic limb movement during sleep and narcolepsy. The major cause of the hyperhidrosis is sympathetic overactivity and, in the case of narcolepsy type 1, orexin deficiency may also contribute. In this narrative review, we will provide an outline of the possible mechanisms underlying sudomotor dysfunction and the resulting nocturnal hyperhidrosis in these different sleep disorders and explore its clinical relevance.
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Affiliation(s)
- Juan Idiaquez
- Departamento de Neurología, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Juan Carlos Casar
- Departamento de Neurología, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Erna S Arnardottir
- Reykjavik University Sleep Institute, School of Technology, Reykjavik University, Reykjavik, Iceland.,Internal Medicine Services, Landspitali, The National University Hospital of Iceland, Reykjavik, Iceland
| | - Elias August
- Reykjavik University Sleep Institute, School of Technology, Reykjavik University, Reykjavik, Iceland.,Department of Engineering, School of Technology, Reykjavik University, Reykjavik, Iceland
| | - Julia Santin
- Departamento de Neurología, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Rodrigo Iturriaga
- Laboratorio de Neurobiología, Facultad de Ciencias Biológicas, Pontificia Universidad Católica de Chile, Santiago, Chile
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Sympathetic and electrochemical skin responses in the assessment of sudomotor function: a comparative study. Neurophysiol Clin 2023; 53:102840. [PMID: 36716506 DOI: 10.1016/j.neucli.2022.102840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Revised: 11/13/2022] [Accepted: 12/17/2022] [Indexed: 01/30/2023] Open
Abstract
OBJECTIVES The sympathetic skin response (SSR) is a well-established test, whereas the electrochemical skin conductance (ESC) is still under evaluation. Our aim was therefore to assess the diagnostic accuracy of ESC to detect abnormal sudomotor function, using SSR as a reference test. METHODS A cross sectional observational study was performed of 61 neurological patients assessed for possible sudomotor dysfunction and 50 age-matched healthy controls (HC). Patients with diagnoses of vasovagal syncope (VVS, n=25), Parkinson's disease (PD, n=15), multiple system atrophy (MSA, n=11) and peripheral neuropathies (PN, n=10) were included. Sudomotor function was assessed with SSR and ESC tests in all participants. The absence of SSR in the palms or soles indicates abnormal sudomotor function. Receiver operating characteristic (ROC) analysis was used to assess the diagnostic value of the ESC. Cardiovascular autonomic (CV-Aut) function was evaluated through the Ewing score, based on the following tests: Heart rate change with deep breathing, Valsalva ratio, 30:15 ratio, blood pressure changes on standing and during isometric exercise. A Ewing score ≥ 2 indicates the presence of CV-Aut dysfunction. RESULTS Mean SSR amplitudes and ESC values showed differences between HC and patients with MSA or PN (p < 0.05), but not in patients with VVS or PD. Absence of SSR was associated with abnormal ESC (p < 0.05). Patients with abnormal CV-Aut dysfunction had lower ESC (p< 0.05). Palm ESC (P-ESC) and sole ESC (S-ESC) assessment had a sensitivity of 0.91 and 0.95 to predict sudomotor dysfunction, with a specificity of 0.78 and 0.85, respectively. The area under ROC curve was 0.905 and 0.98, respectively. CONCLUSIONS ESC in palms and soles has a high diagnostic accuracy for sudomotor dysfunction as detected by absent SSR in patients with MSA and PN.
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The Role of Sympathetic Nerves in Osteoporosis: A Narrative Review. Biomedicines 2022; 11:biomedicines11010033. [PMID: 36672541 PMCID: PMC9855775 DOI: 10.3390/biomedicines11010033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 12/09/2022] [Accepted: 12/14/2022] [Indexed: 12/25/2022] Open
Abstract
Osteoporosis, a systemic bone disease, is characterized by decreased bone density due to various reasons, destructed bone microstructure, and increased bone fragility. The incidence of osteoporosis is very high among the elderly, and patients with osteoporosis are prone to suffer from spine fractures and hip fractures, which cause great harm to patients. Meanwhile, osteoporosis is mainly treated with anti-osteoporosis drugs that have side effects. Therefore, the development of new treatment modalities has a significant clinical impact. Sympathetic nerves play an important role in various physiological activities and the regulation of osteoporosis as well. Therefore, the role of sympathetic nerves in osteoporosis was reviewed, aiming to provide information for future targeting of sympathetic nerves in osteoporosis.
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Kwon RW, Park JS, Lee HG, Park JI, Choo EA, Lee SJ, Lee JB. Coffee intake may promote sudomotor function activation via the contribution of caffeine. Front Nutr 2022; 9:1051828. [PMID: 36570158 PMCID: PMC9774485 DOI: 10.3389/fnut.2022.1051828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 11/21/2022] [Indexed: 12/13/2022] Open
Abstract
Objectives To determine whether drinking coffee with caffeine accelerates the sympathetic response to acetylcholine (ACh). Methods Tests were performed twice at 1-week intervals following the intake of coffee. Subjects were randomly divided into two groups: Group A was administered 16 fluid oz of water (CON), while Group B was given 16 fluid oz of coffee (Coffee). After 1 week, Group A was administered 16 fluid oz of coffee (Coffee), while Group B was given 16 fluid oz of water (CON). The quantitative sudomotor axon reflex test (QSART) was performed after intake of coffee and water and a 40 min break. QSART with iontophoresis and 10% ACh was performed to determine axon reflex (AXR) mediated with and without iontophoresis [AXR (1) and AXR (2), respectively], and directly activated sweating (DIR). Results The sweat onset time of the AXR was shorter in the Coffee compared with the CON (p < 0.05). The sweat rates in AXR (1) AXR (2) and DIR were significantly higher in the Coffee than in the CON (p < 0.05, p < 0.05, p < 0.01, respectively). In addition, the Coffee showed significantly higher density of activated sweat glands and activated sweat gland output than the CON (p < 0.05, p < 0.01, respectively). The overall results of this study showed that coffee intake could stimulate higher activation in both AXR and DIR sweat responses. Conclusion Coffee intake can improve sweating sensitivity in both the AXR and DIR by the contribution of caffeine contained in coffee. This suggests that other compounds in coffee may not inhibit the sympathetic response to ACh. Therefore, coffee may be clinically worth considering as a supplement for the activation of the cholinergic and sudomotor function.
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Affiliation(s)
- Ryeo-Won Kwon
- Department of Physiology, College of Medicine, Soonchunhyang University, Cheonan, Republic of Korea,Department of Medical Sciences, Soonchunhyang University, Asan, Republic of Korea
| | - Jin-Sun Park
- Department of Physiology, College of Medicine, Soonchunhyang University, Cheonan, Republic of Korea
| | - Ha-Gyoung Lee
- Department of Physiology, College of Medicine, Soonchunhyang University, Cheonan, Republic of Korea
| | - Jong-In Park
- Department of Physiology, College of Medicine, Soonchunhyang University, Cheonan, Republic of Korea
| | - Eon-Ah Choo
- Department of Physiology, College of Medicine, Soonchunhyang University, Cheonan, Republic of Korea
| | - Seung-Jea Lee
- Department of Medical Sciences, Soonchunhyang University, Asan, Republic of Korea
| | - Jeong-Beom Lee
- Department of Physiology, College of Medicine, Soonchunhyang University, Cheonan, Republic of Korea,Department of Medical Sciences, Soonchunhyang University, Asan, Republic of Korea,*Correspondence: Jeong-Beom Lee,
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Omran AA, Nageeb RS, Waley AB, Nageeb GS, Eisa M. Serum sclerostin and sympathetic skin response: relationship with myeloma bone disease. THE EGYPTIAN JOURNAL OF NEUROLOGY, PSYCHIATRY AND NEUROSURGERY 2022. [DOI: 10.1186/s41983-022-00509-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Myeloma bone disease (MBD) is a common complication that significantly contributes to morbidity and mortality in multiple myeloma (MM). Serum sclerostin level and sympathetic activity can affect MBD. The purpose of this study is evaluation of serum sclerostin level and sympathetic activity (using sympathetic skin response “SSR”) in MM patients, and studying the relationship between both of them as well as their relationship with MBD. 35 smoldering myeloma patients (group I) and 35 newly diagnosed MM (group II) and 35 controls (group III) were included in the study. All the participants were subjected to complete history taking, and clinical examination. Assessment of serum sclerostin level, SSR, MM stages [by the international staging system (ISS)], MBD grading (according to the Durie–Salmon staging system) were done for all patients within 7 days from the diagnosis.
Results
Undetectable and decreased SSR amplitude are significantly more detected in group I and II (compared with group III). Autonomic manifestations, and loss of SSR is significantly more detected in group II than group I. Autonomic manifestations were absent in group III. SSR amplitude of median and tibial nerves is significantly decreased in group II than group I and III. MBD was detected in all patients of group II. Serum sclerostin and LDH were significantly increased in group II than group I. Group I and II had significantly higher levels of sclerostin when compared with group III. Group II had significantly higher levels of sclerostin and lower levels of ALP in comparison with group I. Serum sclerostin level was correlated positively with LDH and negatively with ALP and SSR amplitude. MBD was significantly affected by ISS stage III, LDH level, SSR affection and serum sclerostin level ≥ 0.40 ng/ml. SSR response affection was the most significant risk factor for advanced MBD followed by increased sclerostin level.
Conclusions
Serum sclerostin level was significantly increased and sympathetic activity was significantly decreased in MBD. Loss of the SSR response was the most significant risk factor for advanced MBD followed by increased sclerostin level.
Recommendations
Potentially validating the use of bone-turnover markers in larger studies, in addition to electrophysiological examination of SSR to stratify patients who are at high-risk for progressive MBD, as the use of newer agents with anabolic effects such as anti-sclerostin antibodies have shown potential in repair of MBD. These newer agents could potentially change the treatment landscape in patients with MBD.
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13
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Huang WL, Ko LC, Liao SC. The association between heart rate variability and skin conductance: a correlation analysis in healthy individuals and patients with somatic symptom disorder comorbid with depression and anxiety. J Int Med Res 2022; 50:3000605221127104. [PMID: 36177841 PMCID: PMC9528031 DOI: 10.1177/03000605221127104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective To investigate the correlations between heart rate variability (HRV) and skin conductance (SC) in two populations under three different situations. Methods This cross-sectional study enrolled patients with somatic symptom disorder comorbid with depression and anxiety and healthy individuals without a psychiatric history. The biological signals were measured under three conditions: resting state, during a cognitive task and during paced breathing. Pearson’s correlation analysis and the generalized estimating equation were used to examine the correlations between SC and HRV in the two populations under the three situations. Results The study enrolled 97 patients with somatic symptom disorder comorbid with depression and anxiety and 96 healthy individuals. In healthy individuals, the ratio of low-frequency power to high frequency power (LF/HF) and normalized LF (LF%) were significantly correlated with SC in the resting state and during a cognitive task, but the correlation coefficients were low level. In patients with somatic symptom disorder comorbid with depression and anxiety, LF/HF and LF% did not show significant correlations with SC under any situation. Conclusions The two different populations and three situations might have affected the significance of the LF/HF-SC and LF%-SC correlations. The generally low correlations indicate that LF/HF and LF% cannot fully reflect the sympathetic cholinergic activity represented by SC.
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Affiliation(s)
- Wei-Lieh Huang
- Department of Psychiatry, National Taiwan University Hospital Yunlin Branch, Yunlin.,Department of Psychiatry, College of Medicine, National Taiwan University, Taipei.,Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei
| | - Li-Chin Ko
- Department of Neurology, National Taiwan University Hospital, Taipei
| | - Shih-Cheng Liao
- Department of Psychiatry, College of Medicine, National Taiwan University, Taipei.,Department of Psychiatry, National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu Hospital, Hsin-Chu City
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14
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Habek M, Andabaka M, Fanciulli A, Jakob GB, Drulović J, Leys F, Di Pauli F, Hegen H, Auer M, Pekmezović T, Mesaroš Š, Jovičević V, Junaković A, Wenning GK, Deisenhammer F, Gabelić T, Barun B, Adamec I, Krbot Skorić M. Sudomotor dysfunction in people with neuromyelitis optica spectrum disorders. Eur J Neurol 2022; 29:2772-2780. [DOI: 10.1111/ene.15413] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 04/22/2022] [Accepted: 05/18/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Mario Habek
- University Hospital Center Zagreb Department of Neurology, Referral Center for Autonomic Nervous System Disorders Zagreb Croatia
- School of Medicine University of Zagreb Zagreb Croatia
| | - Marko Andabaka
- Faculty of Medicine University of Belgrade Belgrade Serbia
| | | | - Gregor Brecl Jakob
- University Medical Centre Ljubljana Department of Neurology Ljubljana Slovenia
| | - Jelena Drulović
- Faculty of Medicine University of Belgrade Belgrade Serbia
- University Clinical Center of Serbia, Clinic of Neurology Belgrade Serbia
| | - Fabian Leys
- Medical University of Innsbruck Department of Neurology Innsbruck Austria
| | - Franziska Di Pauli
- Medical University of Innsbruck Department of Neurology Innsbruck Austria
| | - Harald Hegen
- Medical University of Innsbruck Department of Neurology Innsbruck Austria
| | - Michael Auer
- Medical University of Innsbruck Department of Neurology Innsbruck Austria
| | | | - Šarlota Mesaroš
- Faculty of Medicine University of Belgrade Belgrade Serbia
- University Clinical Center of Serbia, Clinic of Neurology Belgrade Serbia
| | - Vanja Jovičević
- University Clinical Center of Serbia, Clinic of Neurology Belgrade Serbia
| | - Anamari Junaković
- University Hospital Center Zagreb Department of Neurology, Referral Center for Autonomic Nervous System Disorders Zagreb Croatia
| | - Gregor K. Wenning
- Medical University of Innsbruck Department of Neurology Innsbruck Austria
| | | | - Tereza Gabelić
- University Hospital Center Zagreb Department of Neurology, Referral Center for Autonomic Nervous System Disorders Zagreb Croatia
- School of Medicine University of Zagreb Zagreb Croatia
| | - Barbara Barun
- University Hospital Center Zagreb Department of Neurology, Referral Center for Autonomic Nervous System Disorders Zagreb Croatia
- School of Medicine University of Zagreb Zagreb Croatia
| | - Ivan Adamec
- University Hospital Center Zagreb Department of Neurology, Referral Center for Autonomic Nervous System Disorders Zagreb Croatia
- School of Medicine University of Zagreb Zagreb Croatia
| | - Magdalena Krbot Skorić
- University Hospital Center Zagreb Department of Neurology, Referral Center for Autonomic Nervous System Disorders Zagreb Croatia
- Faculty of Electrical Engineering and Computing University of Zagreb Zagreb Croatia
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15
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Small-Fiber-Neuropathien. DGNEUROLOGIE 2022; 5. [PMCID: PMC9559077 DOI: 10.1007/s42451-022-00488-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Die Small-Fiber-Neuropathie (SFN) ist eine Erkrankung des peripheren Nervensystems aufgrund einer isolierten oder vorwiegenden Schädigung dünn myelinisierter Aδ-Fasern und/oder unmyelinisierter C‑Fasern. Für die sichere Diagnose einer SFN ist neben der klinischen Symptomatik mit Schmerzen und Sensibilitätsstörungen, typischerweise mit distal betonter Ausbreitung, der apparative Nachweis einer Rarefizierung oder einer Funktionsstörung der dünn myelinisierten Aδ-Fasern und/oder der unmyelinisierten C‑Fasern gefordert. Im vorliegenden Beitrag wird eine Übersicht über die diagnostischen Verfahren zum Nachweis einer SFN sowie über mögliche Ursachen und Behandlungsoptionen gegeben.
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16
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Mahfouz FM, Park SB, Li T, Timmins HC, Horvath LG, Harrison M, Grimison P, King T, Goldstein D, Mizrahi D. Association of electrochemical skin conductance with neuropathy in chemotherapy-treated patients. Clin Auton Res 2022; 32:497-506. [PMID: 36129622 PMCID: PMC9719444 DOI: 10.1007/s10286-022-00895-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 09/06/2022] [Indexed: 01/31/2023]
Abstract
PURPOSE Chemotherapy-induced peripheral neuropathy (CIPN) is an adverse event of cancer treatment that can affect sensory, motor, or autonomic nerves. Assessment of autonomic neuropathy is challenging, with limited available tools. Accordingly, it is not routinely assessed in chemotherapy-treated patients. In this study, we aimed to examine whether electrochemical skin conductance (ESC) via Sudoscan, a potential measure of autonomic function, associates with subjective and objective measures of CIPN severity and autonomic neuropathy. METHODS A cross-sectional assessment of patients who completed neurotoxic chemotherapy 3-24 months prior was undertaken using CIPN patient-reported outcomes (EORTC-QLQ-CIPN20), clinically graded scale (NCI-CTCAE), neurological examination score (TNSc), autonomic outcome measure (SAS), and Sudoscan. Differences in CIPN severity between participants with or without ESC dysfunction were investigated. Linear regression analyses were used to identify whether ESC values could predict CIPN severity. RESULTS A total of 130 participants were assessed, with 93 participants classified with CIPN according to the clinically graded scale (NCI-CTCAE/grade ≥ 1), while 49% demonstrated hands or feet ESC dysfunction (n = 46). Participants with ESC dysfunction did not significantly differ from those with no dysfunction on multiple CIPN severity measures (clinical-grade, patient-report, neurological examination), and no differences on the autonomic outcome measure (SAS) (all p > 0.0063). Linear regression analyses showed that CIPN could not be predicted by ESC values. CONCLUSIONS The inability of ESC values via Sudoscan to predict clinically-graded and patient-reported CIPN or autonomic dysfunction questions its clinical utility for chemotherapy-treated patients. The understanding of autonomic neuropathy with chemotherapy treatment remains limited and must be addressed to improve quality of life in cancer survivors.
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Affiliation(s)
- Fawaz Mayez Mahfouz
- grid.1013.30000 0004 1936 834XBrain and Mind Centre, School of Medical Sciences, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW 2050 Australia
| | - Susanna B. Park
- grid.1013.30000 0004 1936 834XBrain and Mind Centre, School of Medical Sciences, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW 2050 Australia
| | - Tiffany Li
- grid.1013.30000 0004 1936 834XBrain and Mind Centre, School of Medical Sciences, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW 2050 Australia
| | - Hannah C. Timmins
- grid.1013.30000 0004 1936 834XBrain and Mind Centre, School of Medical Sciences, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW 2050 Australia
| | - Lisa G. Horvath
- grid.419783.0Chris O’Brien Lifehouse, Camperdown, NSW 2050 Australia ,grid.1013.30000 0004 1936 834XSydney Medical School, The University of Sydney, Camperdown, NSW 2050 Australia ,grid.413249.90000 0004 0385 0051Royal Prince Alfred Hospital, Camperdown, NSW 2050 Australia
| | - Michelle Harrison
- grid.419783.0Chris O’Brien Lifehouse, Camperdown, NSW 2050 Australia ,grid.415994.40000 0004 0527 9653Department of Medical Oncology, Liverpool Hospital, Liverpool, NSW 2170 Australia
| | - Peter Grimison
- grid.419783.0Chris O’Brien Lifehouse, Camperdown, NSW 2050 Australia ,grid.1013.30000 0004 1936 834XSydney Medical School, The University of Sydney, Camperdown, NSW 2050 Australia
| | - Tracy King
- grid.1013.30000 0004 1936 834XCancer Nursing Research Unit, The University of Sydney, Camperdown, NSW 2050 Australia ,grid.413249.90000 0004 0385 0051Institute of Haematology, Royal Prince Alfred Hospital, Camperdown, NSW 2050 Australia
| | - David Goldstein
- grid.1005.40000 0004 4902 0432Prince of Wales Clinical School, Faculty of Medicine and Health, UNSW Sydney, Randwick, NSW 2031 Australia ,grid.415193.bDepartment of Medical Oncology, Prince of Wales Hospital, Randwick, NSW 2031 Australia
| | - David Mizrahi
- grid.1005.40000 0004 4902 0432Prince of Wales Clinical School, Faculty of Medicine and Health, UNSW Sydney, Randwick, NSW 2031 Australia ,grid.1013.30000 0004 1936 834XThe Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Camperdown, NSW 2050 Australia
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Abstract
SUMMARY The autonomic nervous system is a complex neural network that controls several organ systems. Its assessment includes a detailed history of autonomic functions, clinical examination, and autonomic tests. Most widely used is a battery of tests that assess cardiovascular reflex autonomic and sudomotor tests, which include deep breathing (assesses parasympathetic function), Valsalva maneuver, tilt test (both assess parasympathetic and adrenergic functions), and sudomotor testing for the evaluation of postganglionic sudomotor fibers. These basic tests represent a foundation of autonomic testing. Nevertheless, the autonomic nervous system also controls organ systems not directly assessed by basic tests. This review describes a number of auxiliary autonomic tests that can be used in addition to basic autonomic tests or can be used independently to explore particular autonomic functions or to answer a specific clinical question. The auxiliary tests described in this review evaluate cardiovascular, thermoregulatory, gastrointestinal, genitourinary, eye, and exocrine functions. These tests are cold pressor test, sustained handgrip maneuver, reverse tilt test, venoarteriolar reflex, laser Doppler flare imaging, microneurography, neck suction, lower body negative pressure, venous occlusion plethysmography, pharmacologic assessment of postganglionic sympathetic outflow, plasma norepinephrine, sympathetic skin response, video cinefluoroscopic swallowing test, esophageal manometry test, small bowel manometry test, wireless motility capsule test, urodynamic studies, penile plethysmography, intracavernosal papaverine injection, infrared video pupillography, corneal confocal microscopy, pupillary response to dilute pilocarpine and hydroxyamphetamine, Schirmer test, tear osmolarity test, and salivary secretion test. The protocol of each test is described in detail. This review can be used as a quick reference for the auxiliary autonomic tests.
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Affiliation(s)
- Rodrigo C Quispe
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, U.S.A.; and
| | - Peter Novak
- Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, U.S.A
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18
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Carmichael J, Fadavi H, Ishibashi F, Shore AC, Tavakoli M. Advances in Screening, Early Diagnosis and Accurate Staging of Diabetic Neuropathy. Front Endocrinol (Lausanne) 2021; 12:671257. [PMID: 34122344 PMCID: PMC8188984 DOI: 10.3389/fendo.2021.671257] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 03/17/2021] [Indexed: 12/14/2022] Open
Abstract
The incidence of both type 1 and type 2 diabetes is increasing worldwide. Diabetic peripheral neuropathy (DPN) is among the most distressing and costly of all the chronic complications of diabetes and is a cause of significant disability and poor quality of life. This incurs a significant burden on health care costs and society, especially as these young people enter their peak working and earning capacity at the time when diabetes-related complications most often first occur. DPN is often asymptomatic during the early stages; however, once symptoms and overt deficits have developed, it cannot be reversed. Therefore, early diagnosis and timely intervention are essential to prevent the development and progression of diabetic neuropathy. The diagnosis of DPN, the determination of the global prevalence, and incidence rates of DPN remain challenging. The opinions vary about the effectiveness of the expansion of screenings to enable early diagnosis and treatment initiation before disease onset and progression. Although research has evolved over the years, DPN still represents an enormous burden for clinicians and health systems worldwide due to its difficult diagnosis, high costs related to treatment, and the multidisciplinary approach required for effective management. Therefore, there is an unmet need for reliable surrogate biomarkers to monitor the onset and progression of early neuropathic changes in DPN and facilitate drug discovery. In this review paper, the aim was to assess the currently available tests for DPN's sensitivity and performance.
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Affiliation(s)
- Josie Carmichael
- Diabetes and Vascular Research Centre, National Institute for Health Research, Exeter Clinical Research Facility, University of Exeter Medical School, Exeter, United Kingdom
| | - Hassan Fadavi
- Peripheral Neuropathy Group, Imperial College, London, United Kingdom
| | - Fukashi Ishibashi
- Internal Medicine, Ishibashi Medical and Diabetes Centre, Hiroshima, Japan
| | - Angela C Shore
- Diabetes and Vascular Research Centre, National Institute for Health Research, Exeter Clinical Research Facility, University of Exeter Medical School, Exeter, United Kingdom
| | - Mitra Tavakoli
- Diabetes and Vascular Research Centre, National Institute for Health Research, Exeter Clinical Research Facility, University of Exeter Medical School, Exeter, United Kingdom
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19
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Zhang L, Zhang X, Du L, Zhang C, Li H. Cholinergic- rather than adrenergic-induced sweating play a role in developing and developed rat eccrine sweat glands. Exp Anim 2020; 70:218-224. [PMID: 33298631 PMCID: PMC8150243 DOI: 10.1538/expanim.20-0144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Both cholinergic and adrenergic stimulation can induce sweat secretion in human eccrine sweat glands, but whether cholinergic and adrenergic stimulation play same roles in rat eccrine sweat glands is still controversial. To explore the innervations, and adrenergic- and cholinergic-induced secretory response in developing and developed rat eccrine sweat glands, rat hind footpads from embryonic day (E) 15.5-20.5, postanal day (P) 1-14, P21 and adult were fixed, embedded, sectioned and subjected to immunofluorescence staining for general fiber marker protein gene product 9.5 (PGP 9.5), adrenergic fiber marker tyrosine hydroxylase (TH) and cholinergic fiber marker vasoactive intestinal peptide (VIP), and cholinergic- and adrenergic-induced sweat secretion was detected at P1-P21 and adult rats by starch-iodine test. The results showed that eccrine sweat gland placodes of SD rats were first appeared at E19.5, and the expression of PGP 9.5 was detected surrounding the sweat gland placodes at E19.5, TH at P7, and VIP at P11. Pilocarpine-induced sweat secretion was first detected at P16 in hind footpads by starch-iodine test. There was no measurable sweating when stimulated by alpha- or beta-adrenergic agonists at all the examined time points. We conclude that rat eccrine sweat glands, just as human eccrine sweat glands, co-express adrenergic and cholinergic fibers, but different from human eccrine sweat glands, cholinergic- rather than adrenergic-induced sweating plays a role in the developing and developed rat eccrine sweat glands.
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Affiliation(s)
- Lei Zhang
- Mental Health Center, Taihe Hospital, Hubei University of Medicine, 32 South Renmin Road, Shiyan 442000, Hubei Province, P.R. China
| | - Xiang Zhang
- Department of Wound Repair and Dermatologic Surgery, Taihe Hospital, Hubei University of Medicine, 32 South Renmin Road, Shiyan 442000, Hubei Province, P.R. China
| | - Lijie Du
- Department of Wound Repair and Dermatologic Surgery, Taihe Hospital, Hubei University of Medicine, 32 South Renmin Road, Shiyan 442000, Hubei Province, P.R. China
| | - Cuiping Zhang
- Research Center for Tissue Repair and Regeneration affiliated to the Medical Innovation Research Department and Fourth Medical Center of PLA General Hospital, Beijing 100048, P.R. China
| | - Haihong Li
- Department of Wound Repair and Dermatologic Surgery, Taihe Hospital, Hubei University of Medicine, 32 South Renmin Road, Shiyan 442000, Hubei Province, P.R. China
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20
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Abstract
Small fiber neuropathy (SFN) is a prevalent neurologic syndrome. Testing methods have emerged in recent years to better diagnose it, including autonomic tests and skin punch biopsy. SFN can present in a non-length-dependent fashion and can be mistaken for syndromes such as fibromyalgia and complex regional pain syndrome. SFN is caused by a variety of metabolic, infectious, genetic, and inflammatory diseases. Recently treatments have emerged for TTR amyloid neuropathy and Fabry disease, and novel biomarkers have been found both in genetic and inflammatory SFN syndromes. Ongoing trials attempt to establish the efficacy of intravenous immunoglobulin in inflammatory SFN syndromes.
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Affiliation(s)
- Lawrence A Zeidman
- Neuromuscular-EMG Division, Department of Neurology, Loyola University Chicago, Loyola University Medical Center, Stritch School of Medicine, 2160 South First Avenue, Maguire Building - Room 2700, Maywood, IL 60153-3328, USA.
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21
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Palma JA, Gupta A, Sierra S, Gomes I, Balgobin B, Norcliffe-Kaufmann L, Devi LA, Kaufmann H. Autoantibodies Blocking M 3 Muscarinic Receptors Cause Postganglionic Cholinergic Dysautonomia. Ann Neurol 2020; 88:1237-1243. [PMID: 32833276 DOI: 10.1002/ana.25882] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 08/19/2020] [Accepted: 08/19/2020] [Indexed: 12/31/2022]
Abstract
A 10-year-old girl presented with ileus, urinary retention, dry mouth, lack of tears, fixed dilated pupils, and diffuse anhidrosis 7 days after a febrile illness. We hypothesized that her syndrome was due to autoimmunity against muscarinic acetylcholine receptors, blocking their activation. Using an indirect enzyme-linked immunosorbent assay for all 5 muscarinic receptors (M1 -M5 ), we identified in the patient's serum antibodies that selectively bound to M3 receptors. In vitro functional studies confirmed that these autoantibodies selectively blocked M3 receptor activation. Thus, autoantibodies against M3 acetylcholine receptors cause acute postganglionic cholinergic dysautonomia. ANN NEUROL 2020;88:1237-1243.
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Affiliation(s)
- Jose-Alberto Palma
- Department of Neurology, Dysautonomia Center, New York University School of Medicine, New York, New York, USA
| | - Achla Gupta
- Department of Pharmacological Sciences, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Salvador Sierra
- Department of Pharmacological Sciences, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Ivone Gomes
- Department of Pharmacological Sciences, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Bhumika Balgobin
- Department of Neurology, Dysautonomia Center, New York University School of Medicine, New York, New York, USA
| | - Lucy Norcliffe-Kaufmann
- Department of Neurology, Dysautonomia Center, New York University School of Medicine, New York, New York, USA
| | - Lakshmi A Devi
- Department of Pharmacological Sciences, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Horacio Kaufmann
- Department of Neurology, Dysautonomia Center, New York University School of Medicine, New York, New York, USA
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22
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Hijazi MM, Buchmann SJ, Sedghi A, Illigens BM, Reichmann H, Schackert G, Siepmann T. Assessment of cutaneous axon-reflex responses to evaluate functional integrity of autonomic small nerve fibers. Neurol Sci 2020; 41:1685-1696. [PMID: 32125538 PMCID: PMC7359149 DOI: 10.1007/s10072-020-04293-w] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2019] [Accepted: 02/11/2020] [Indexed: 12/12/2022]
Abstract
Cutaneous autonomic small nerve fibers encompass unmyelinated C-fibers and thinly myelinated Aδ-fibers, which innervate dermal vessels (vasomotor fibers), sweat glands (sudomotor fibers), and hair follicles (pilomotor fibers). Analysis of their integrity can capture early pathology in autonomic neuropathies such as diabetic autonomic neuropathy or peripheral nerve inflammation due to infectious and autoimmune diseases. Furthermore, intraneural deposition of alpha-synuclein in synucleinopathies such as Parkinson’s disease can lead to small fiber damage. Research indicated that detection and quantitative analysis of small fiber pathology might facilitate early diagnosis and initiation of treatment. While autonomic neuropathies show substantial etiopathogenetic heterogeneity, they have in common impaired functional integrity of small nerve fibers. This impairment can be evaluated by quantitative analysis of axonal responses to iontophoretic application of adrenergic or cholinergic agonists to the skin. The axon-reflex can be elicited in cholinergic sudomotor fibers to induce sweating and in cholinergic vasomotor fibers to induce vasodilation. Currently, only few techniques are available to quantify axon-reflex responses, the majority of which is limited by technical demands or lack of validated analysis protocols. Function of vasomotor small fibers can be analyzed using laser Doppler flowmetry, laser Doppler imaging, and laser speckle contrast imaging. Sudomotor function can be assessed using quantitative sudomotor axon-reflex test, silicone imprints, and quantitative direct and indirect testing of sudomotor function. More recent advancements include analysis of piloerection (goose bumps) following stimulation of adrenergic small fibers using pilomotor axon-reflex test. We provide a review of the current literature on axon-reflex tests in cutaneous autonomic small fibers.
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Affiliation(s)
- Mido M Hijazi
- Department of Neurosurgery, University Hospital Carl Gustav Carus, Technische Universität Dresden, Fetscherstr 74, 01307, Dresden, Germany
| | - Sylvia J Buchmann
- Department of Anaesthesiology, Operative Intensive Care Medicine and Pain Medicine, Vivantes Klinikum Spandau, Berlin, Germany
| | - Annahita Sedghi
- Department of Neurology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Ben M Illigens
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Heinz Reichmann
- Department of Neurology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Gabriele Schackert
- Department of Neurosurgery, University Hospital Carl Gustav Carus, Technische Universität Dresden, Fetscherstr 74, 01307, Dresden, Germany
| | - Timo Siepmann
- Department of Neurology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.
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23
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D'Amato C, Greco C, Lombardo G, Frattina V, Campo M, Cefalo CMA, Izzo V, Lauro D, Spallone V. The diagnostic usefulness of the combined COMPASS 31 questionnaire and electrochemical skin conductance for diabetic cardiovascular autonomic neuropathy and diabetic polyneuropathy. J Peripher Nerv Syst 2020; 25:44-53. [PMID: 31985124 DOI: 10.1111/jns.12366] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2019] [Revised: 01/18/2020] [Accepted: 01/21/2020] [Indexed: 01/01/2023]
Abstract
The study investigated the diagnostic performance for diabetic cardiovascular autonomic neuropathy (CAN) and diabetic polyneuropathy (DPN) of the combined use of composite autonomic symptom score (COMPASS) 31, validated questionnaire for autonomic symptoms of CAN, and electrochemical skin conductance (ESC), proposed for detecting DPN and CAN. One-hundred and two participants with diabetes (age 57 ± 14 years, duration 17 ± 13 years) completed the COMPASS 31 before assessing cardiovascular reflex tests (CARTs), neuropathic symptoms, signs, vibratory perception threshold (VPT), thermal thresholds (TT), and ESC using Sudoscan. Two patterns were evaluated: (a) the combined abnormalities in both tests (COMPASS 31+ESC), and (b) the abnormality in COMPASS 31 and/or ESC (COMPASS 31 and/or ESC). CAN (≥1 abnormal CART) and confirmed CAN (≥2 abnormal CARTs) were present in 28.1% and 12.5%, DPN (two abnormalities among symptoms, signs, VPT, and TT) in 52%, abnormal COMPASS 31 (total weighted score >16.44) in 48% and abnormal ESC (hands ESC <50 μS and/or feet ESC <70 μS) in 47.4%. Both the patterns-COMPASS 31+ESC and COMPASS 31 and/or ESC-were associated with CAN and DPN (P < .01). COMPASS 31 and ESC reached a sensitivity of 75% and 83% for confirmed CAN, and a specificity of 65% and 67% for DPN. When combining the tests, the sensitivity for CAN rose by up to 100% for CAN and the specificity up to 89% for DPN. The combination of the tests can allow a stepwise screening strategy for CAN, by suggesting CAN absence with combined normality, and prompting to CARTs with combined abnormality.
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Affiliation(s)
- Cinzia D'Amato
- Endocrinology, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Carla Greco
- Endocrinology, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Giorgio Lombardo
- Endocrinology, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Valentina Frattina
- Endocrinology, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Mariagrazia Campo
- Endocrinology, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Chiara M A Cefalo
- Endocrinology, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Valentina Izzo
- Endocrinology, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Davide Lauro
- Endocrinology, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Vincenza Spallone
- Endocrinology, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
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Li YP, Yan ZQ, Han LP, Yin AL, Xu JY, Zhai YR, Hao S, Zhang L, Xie Y. The Association Between Phosphorylated Neurofilament Heavy Chain (pNF-H) and Small Fiber Neuropathy (SFN) in Patients with Impaired Glucose Tolerance. Diabetes Ther 2020; 11:71-81. [PMID: 31673971 PMCID: PMC6965567 DOI: 10.1007/s13300-019-00716-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION Small fiber neuropathy (SFN)-the early stage of diabetic peripheral neuropathy (DPN)-progresses gradually and is difficult to diagnose using neurophysiological tests. To facilitate the early diagnosis of SFN, biomarkers for SFN must be identified. The purpose of this study was to investigate the characteristics of SFN in prediabetic patients and the relationship between pNF-H and SFN. METHODS 44 IGT patients (inpatients and outpatients) were selected at random. 33 healthy subjects served as controls. Data on clinical characteristics and laboratory parameters were collected. Quantitative sensory testing (QST), electromyography (EMG), and Sudoscan were performed, and pNF-H was measured by ELISA. RESULTS 24 of the 44 patients with impaired glucose tolerance (IGT) were diagnosed with SFN according to the modified Toronto Diabetic Neuropathy Expert Group consensus criteria. The thermal sensory thresholds of the IGT-SFN group were significantly different from those of the CTRL group (p < 0.05), except for the heat pain threshold. The sensory nerve action potential (SNAP) of the sural nerve was 12.39 in the IGT-SFN group, which was significantly lower than those in the other groups. No significant difference in nerve conduction velocity (NCV) was observed among the three groups. The electrochemical skin conductance (ESC) in the IGT-SFN group was 69.78 ± 14.03uS, which was significantly lower than that in the CTRL group. The pNF-H in the IGT-SFN group was 170.6 (140.0, 223.6) pg/ml, which was significantly higher than those in the CTRL and IGT-non-SFN groups (76.55 and 64.7 pg/ml, respectively). Multivariate regression analysis demonstrated that pNF-H and 2h plasma glucose were independently correlated with SFN; the ORs (95% CI) were 1.429 (1.315, 1.924) and 2.375 (1.157, 4.837), respectively. CONCLUSIONS Serum pNF-H may be associated with SFN in IGT patients, and serum pNF-H could therefore serve as a sensitive biomarker for the detection of SFN.
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Affiliation(s)
- Yu-Peng Li
- Tianjin Medical University Metabolic Diseases Hospital & Tianjin Medical University Chu Hsien-I Memorial Hospital, Tianjin, China.
- Tianjin Institute of Endocrinology, Tianjin, China.
- NHC Key Laboratory of Hormones and Development (Tianjin Medical University), Tianjin Key Laboratory of Metabolic Diseases, Tianjin, China.
| | - Zhong-Qing Yan
- Tianjin Medical University Metabolic Diseases Hospital & Tianjin Medical University Chu Hsien-I Memorial Hospital, Tianjin, China
- Tianjin Institute of Endocrinology, Tianjin, China
- NHC Key Laboratory of Hormones and Development (Tianjin Medical University), Tianjin Key Laboratory of Metabolic Diseases, Tianjin, China
| | - Li-Ping Han
- Tianjin Medical University Metabolic Diseases Hospital & Tianjin Medical University Chu Hsien-I Memorial Hospital, Tianjin, China
- Tianjin Institute of Endocrinology, Tianjin, China
- NHC Key Laboratory of Hormones and Development (Tianjin Medical University), Tianjin Key Laboratory of Metabolic Diseases, Tianjin, China
| | - Ai-Li Yin
- Tianjin Medical University Metabolic Diseases Hospital & Tianjin Medical University Chu Hsien-I Memorial Hospital, Tianjin, China
- Tianjin Institute of Endocrinology, Tianjin, China
- NHC Key Laboratory of Hormones and Development (Tianjin Medical University), Tianjin Key Laboratory of Metabolic Diseases, Tianjin, China
| | - Jin-Yong Xu
- Tianjin Medical University Metabolic Diseases Hospital & Tianjin Medical University Chu Hsien-I Memorial Hospital, Tianjin, China
- Tianjin Institute of Endocrinology, Tianjin, China
- NHC Key Laboratory of Hormones and Development (Tianjin Medical University), Tianjin Key Laboratory of Metabolic Diseases, Tianjin, China
| | - Ya-Ran Zhai
- Tianjin Medical University Metabolic Diseases Hospital & Tianjin Medical University Chu Hsien-I Memorial Hospital, Tianjin, China
- Tianjin Institute of Endocrinology, Tianjin, China
- NHC Key Laboratory of Hormones and Development (Tianjin Medical University), Tianjin Key Laboratory of Metabolic Diseases, Tianjin, China
| | - Sai Hao
- Tianjin Medical University Metabolic Diseases Hospital & Tianjin Medical University Chu Hsien-I Memorial Hospital, Tianjin, China
- Tianjin Institute of Endocrinology, Tianjin, China
- NHC Key Laboratory of Hormones and Development (Tianjin Medical University), Tianjin Key Laboratory of Metabolic Diseases, Tianjin, China
| | - Lin Zhang
- Tianjin Medical University Metabolic Diseases Hospital & Tianjin Medical University Chu Hsien-I Memorial Hospital, Tianjin, China
- Tianjin Institute of Endocrinology, Tianjin, China
- NHC Key Laboratory of Hormones and Development (Tianjin Medical University), Tianjin Key Laboratory of Metabolic Diseases, Tianjin, China
| | - Yun Xie
- Tianjin Medical University Metabolic Diseases Hospital & Tianjin Medical University Chu Hsien-I Memorial Hospital, Tianjin, China.
- Tianjin Institute of Endocrinology, Tianjin, China.
- NHC Key Laboratory of Hormones and Development (Tianjin Medical University), Tianjin Key Laboratory of Metabolic Diseases, Tianjin, China.
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Panagoulias GS, Eleftheriadou I, Papanas N, Manes C, Kamenov Z, Tesic D, Bousboulas S, Tentolouris A, Jude EB, Tentolouris N. Dryness of Foot Skin Assessed by the Visual Indicator Test and Risk of Diabetic Foot Ulceration: A Prospective Observational Study. Front Endocrinol (Lausanne) 2020; 11:625. [PMID: 33013702 PMCID: PMC7506164 DOI: 10.3389/fendo.2020.00625] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 07/30/2020] [Indexed: 12/24/2022] Open
Abstract
Research Question: Previous cross-sectional studies have shown an association between sudomotor dysfunction and diabetic foot ulceration (DFU). The aim of this prospective multicenter study was to determine the role of dryness of foot skin and of established neurological modalities in the prediction of risk for foot ulceration in a cohort of individuals with diabetes mellitus (DM). Design: The study was conducted from 2012 to 2017. A total of 308 subjects with DM without history of DFU or critical limb ischemia completed the study. Diabetic neuropathy was assessed using the neuropathy symptom score (NSS) and neuropathy disability score (NDS). In a subset of participants, vibration perception threshold (VPT) was evaluated. Dryness of foot skin was assessed by the visual indicator plaster method (IPM). The diagnostic performance of the above neurological modalities for prediction of DFU was tested by receiver operating characteristic curve (ROC) analysis. Results: During the 6-year follow-up, 55 patients (annual ulceration incidence 2.97%) developed DFU. Multivariate Cox-regression analysis after controlling for the effect of age, gender, and DM duration demonstrated that the risk (hazard ratio, 95% confidence intervals) of DFU increased significantly with either abnormal IPM (3.319, 1.460-7.545, p = 0.004) or high (≥6) NDS (2.782, 1.546-5.007, p = 0.001) or high (≥25 volts) VPT (2.587, 1.277-5.242, p = 0.008). ROC analysis showed that all neurological modalities could discriminate participants who developed DFU (p < 0.001). IPM testing showed high sensitivity (0.86) and low specificity (0.49), while high vs. low NDS and VPT showed low sensitivity (0.40 and 0.39, respectively) and high specificity (0.87 and 0.89, respectively) for identification of patients at risk for DFU. Conclusion: Dryness of foot skin assessed by the IPM predicts the development of DFU. IPM testing has high sensitivity, whereas high NDS and VPT have high specificity in identifying subjects at risk for DFU. The IPM can be included in the screening methods for identification of the foot at risk.
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Affiliation(s)
- Georgios S. Panagoulias
- First Department of Propaedeutic Internal Medicine, Medical School, National and Kapodistrian University of Athens, Laiko General Hospital, Athens, Greece
| | - Ioanna Eleftheriadou
- First Department of Propaedeutic Internal Medicine, Medical School, National and Kapodistrian University of Athens, Laiko General Hospital, Athens, Greece
| | - Nikolaos Papanas
- Second Department of Internal Medicine, Diabetes Center, Democritus University of Thrace, University Hospital of Alexandroupolis, Alexandroupoli, Greece
| | - Christos Manes
- Diabetes Center, Papageorgiou General Hospital, Thessaloniki, Greece
| | - Zdravko Kamenov
- Diabetes Outpatient Clinic, University Hospital Alexandrovska, Medical University—Sofia, Sofia, Bulgaria
| | - Dragan Tesic
- Clinic for Endocrinology, Diabetes and Diseases of Metabolism, Clinical Center of Vojvodina, Medical Faculty, University Novi Sad, Novi Sad, Serbia
| | - Stavros Bousboulas
- Diabetes Outpatient Clinic, “St. Panteleimon” General State Hospital, Nikaia, Greece
| | - Anastasios Tentolouris
- First Department of Propaedeutic Internal Medicine, Medical School, National and Kapodistrian University of Athens, Laiko General Hospital, Athens, Greece
| | - Edward B. Jude
- Tameside Hospital NHS Foundation Trust and University of Manchester, Ashton-under-Lyne, United Kingdom
| | - Nikolaos Tentolouris
- First Department of Propaedeutic Internal Medicine, Medical School, National and Kapodistrian University of Athens, Laiko General Hospital, Athens, Greece
- *Correspondence: Nikolaos Tentolouris
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Abstract
Sensory polyneuropathies, which are caused by dysfunction of peripheral sensory nerve fibers, are a heterogeneous group of disorders that range from the common diabetic neuropathy to the rare sensory neuronopathies. The presenting symptoms, acuity, time course, severity, and subsequent morbidity vary and depend on the type of fiber that is affected and the underlying cause. Damage to small thinly myelinated and unmyelinated nerve fibers results in neuropathic pain, whereas damage to large myelinated sensory afferents results in proprioceptive deficits and ataxia. The causes of these disorders are diverse and include metabolic, toxic, infectious, inflammatory, autoimmune, and genetic conditions. Idiopathic sensory polyneuropathies are common although they should be considered a diagnosis of exclusion. The diagnostic evaluation involves electrophysiologic testing including nerve conduction studies, histopathologic analysis of nerve tissue, serum studies, and sometimes autonomic testing and cerebrospinal fluid analysis. The treatment of these diseases depends on the underlying cause and may include immunotherapy, mitigation of risk factors, symptomatic treatment, and gene therapy, such as the recently developed RNA interference and antisense oligonucleotide therapies for transthyretin familial amyloid polyneuropathy. Many of these disorders have no directed treatment, in which case management remains symptomatic and supportive. More research is needed into the underlying pathophysiology of nerve damage in these polyneuropathies to guide advances in treatment.
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Affiliation(s)
- Kelly Graham Gwathmey
- Virginia Commonwealth University, Department of Neurology, 1101 E. Marshall Street, PO Box 980599, Richmond, VA 23298, USA
| | - Kathleen T Pearson
- Virginia Commonwealth University, Department of Neurology, 1101 E. Marshall Street, PO Box 980599, Richmond, VA 23298, USA
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Mendoza-Velásquez JJ, Flores-Vázquez JF, Barrón-Velázquez E, Sosa-Ortiz AL, Illigens BMW, Siepmann T. Autonomic Dysfunction in α-Synucleinopathies. Front Neurol 2019; 10:363. [PMID: 31031694 PMCID: PMC6474181 DOI: 10.3389/fneur.2019.00363] [Citation(s) in RCA: 71] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Accepted: 03/25/2019] [Indexed: 12/20/2022] Open
Abstract
The α-synucleinopathies are a group of neurodegenerative diseases characterized by abnormal accumulation of insoluble α-synuclein in neurons and glial cells, comprising Parkinson's disease (PD), dementia with Lewy bodies (DLB) and multiple system atrophy (MSA). Although varying in prevalence, symptom patterns, and severity among disorders, all α-synucleinopathies have in common autonomic nervous system dysfunctions, which reduce quality of life. Frequent symptoms among α-synucleinopathies include constipation, urinary and sexual dysfunction, and cardiovascular autonomic symptoms such as orthostatic hypotension, supine hypertension, and reduced heart rate variability. Symptoms due to autonomic dysfunction can appear before motor symptom onset, particularly in MSA and PD, hence, detection and quantitative analysis of these symptoms can enable early diagnosis and initiation of treatment, as well as identification of at-risk populations. While patients with PD, DLB, and MSA show both central and peripheral nervous system involvement of α-synuclein pathology, pure autonomic failure (PAF) is a condition characterized by generalized dysregulation of the autonomic nervous system with neuronal cytoplasmic α-synuclein inclusions in the peripheral autonomic small nerve fibers. Patients with PAF often present with orthostatic hypotension, reduced heart rate variability, anhydrosis, erectile dysfunction, and constipation, without motor or cognitive impairment. These patients also have an increased risk of developing an α-synucleinopathy with central involvement, such as PD, DLB, or MSA in later life, possibly indicating a pathophysiological disease continuum. Pathophysiological aspects, as well as developments in diagnosing and treating dysautonomic symptoms in patients with α-synucleinopathies are discussed in this review.
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Affiliation(s)
- José Javier Mendoza-Velásquez
- Division of Health Care Sciences, Center for Clinical Research and Management Education, Dresden International University, Dresden, Germany
- Department of Psychiatry and Mental Health, School of Medicine, National Autonomous University of Mexico, Mexico City, Mexico
| | - Juan Francisco Flores-Vázquez
- Dementia Laboratory, National Institute of Neurology and Neurosurgery, Ciudad de Mexico, Mexico
- Faculty of Medical Sciences, University of Groningen, Groningen, Netherlands
| | - Evalinda Barrón-Velázquez
- Department of Psychiatry and Mental Health, School of Medicine, National Autonomous University of Mexico, Mexico City, Mexico
| | - Ana Luisa Sosa-Ortiz
- Dementia Laboratory, National Institute of Neurology and Neurosurgery, Ciudad de Mexico, Mexico
| | - Ben-Min Woo Illigens
- Division of Health Care Sciences, Center for Clinical Research and Management Education, Dresden International University, Dresden, Germany
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
| | - Timo Siepmann
- Division of Health Care Sciences, Center for Clinical Research and Management Education, Dresden International University, Dresden, Germany
- Department of Neurology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
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Ziemssen T, Siepmann T. The Investigation of the Cardiovascular and Sudomotor Autonomic Nervous System-A Review. Front Neurol 2019; 10:53. [PMID: 30809183 PMCID: PMC6380109 DOI: 10.3389/fneur.2019.00053] [Citation(s) in RCA: 76] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Accepted: 01/15/2019] [Indexed: 01/09/2023] Open
Abstract
The autonomic nervous system as operating system of the human organism permeats all organ systems with its pathways permeating that it is involved with virtually all diseases. Anatomically a central part, an afferent part and sympathetic and parasympathetic efferent system can be distinguished. Among the different functional subsystems of the autonomic nervous system, the cardiovascular autonomic nervous system is most frequently examined with easily recordable cardiovascular biosignals as heart rate and blood pressure. Although less widely established, sudomotor tests pose a useful supplement to cardiovascular autonomic assessment as impaired neurogenic sweating belongs to the earliest clinical signs of various autonomic neuropathies as well as neurodegenerative disorders and significantly reduces quality of life. Clinically at first, the autonomic nervous system is assessed with a detailed history of clinical autonomic function and a general clinical examination. As a lof of confounding factors can influence autonomic testing, subjects should be adequately prepared in a standardized way. Autonomic testing is usually performed in that way that the response of the autonomic nervous system to a well-defined challenge is recorded. As no single cardiovascular autonomic test is sufficiently reliable, it is recommended to use a combination of different approaches, an autonomic test battery including test to measure parasympathetic and sympathetic cardiovascular function (deep breathing test, Valsalva maneuver, tilt, or pressor test). More specialized tests include carotid sinus massage, assessment of baroreceptor reflex function, pharmacological tests or cardiac, and regional hemodynamic measurements. Techniques to measure functional integrity of sudomotor nerves include the quantitative sudomotor axon reflex sweat test, analysis of the sympathetic skin response as well as the thermoregulatory sweat test. In addition to these rather established techniques more recent developments have been introduced to reduce technical demands and interindividual variability such as the quantitative direct and indirect axon reflex testing or sudoscan. However, diagnostic accuracy of these tests remains to be determined. We reviewed the current literature on currently available autonomic cardiovascular and sudomotor tests with a focus on their physiological and technical mechanisms as well as their diagnostic value in the scientific and clinical setting.
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Affiliation(s)
- Tjalf Ziemssen
- Autonomic and Neuroendocrinological Functional Laboratory, Center of Clinical Neuroscience, Neurological University Clinic Carl Gustav Carus, Dresden, Germany
| | - Timo Siepmann
- Neurological University Clinic Carl Gustav Carus, Dresden, Germany
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