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Marcinkevics Z, Rubins U, Aglinska A, Logina I, Glazunovs D, Grabovskis A. Contactless photoplethysmography for assessment of small fiber neuropathy. Front Physiol 2023; 14:1180288. [PMID: 37727661 PMCID: PMC10505793 DOI: 10.3389/fphys.2023.1180288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Accepted: 08/02/2023] [Indexed: 09/21/2023] Open
Abstract
Chronic pain is a prevalent condition affecting approximately one-fifth of the global population, with significant impacts on quality of life and work productivity. Small fiber neuropathies are a common cause of chronic pain, and current diagnostic methods rely on subjective self-assessment or invasive skin biopsies, highlighting the need for objective noninvasive assessment methods. The study aims to develop a modular prototype of a contactless photoplethysmography system with three spectral bands (420, 540, and 800 nm) and evaluate its potential for assessing peripheral neuropathy patients via a skin topical heating test and spectral analyses of cutaneous flowmotions. The foot topical skin heating test was conducted on thirty volunteers, including fifteen healthy subjects and fifteen neuropathic patients. Four cutaneous nerve fiber characterizing parameters were evaluated at different wavelengths, including vasomotor response trend, flare area, flare intensity index, and the spectral power of cutaneous flowmotions. The results show that neuropathic patients had significantly lower vasomotor response (50%), flare area (63%), flare intensity index (19%), and neurogenic component (54%) of cutaneous flowmotions compared to the control group, independent of photoplethysmography spectral band. An absolute value of perfusion was 20%-30% higher in the 420 nm band. Imaging photoplethysmography shows potential as a cost-effective alternative for objective and non-invasive assessment of neuropathic patients, but further research is needed to enhance photoplethysmography signal quality and establish diagnostic criteria.
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Affiliation(s)
- Zbignevs Marcinkevics
- Department of Human and Animal Physiology, Faculty of Biology, University of Latvia, Riga, Latvia
- Biophotonics Laboratory, Institute of Atomic Physics and Spectroscopy, University of Latvia, Riga, Latvia
| | - Uldis Rubins
- Biophotonics Laboratory, Institute of Atomic Physics and Spectroscopy, University of Latvia, Riga, Latvia
| | - Alise Aglinska
- Department of Human and Animal Physiology, Faculty of Biology, University of Latvia, Riga, Latvia
| | - Inara Logina
- Department of Neurology and Neurosurgery, Riga Stradins University, Riga, Latvia
| | - Dmitrijs Glazunovs
- Department of Neurology and Neurosurgery, Riga Stradins University, Riga, Latvia
| | - Andris Grabovskis
- Biophotonics Laboratory, Institute of Atomic Physics and Spectroscopy, University of Latvia, Riga, Latvia
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Koutsouraki E, Theodoros K, Eleni G, Marianna K, Areti N, Ariadni K, Dimitrios M. Autonomic nervous system disorders in multiple sclerosis. J Neurol 2023:10.1007/s00415-023-11725-y. [PMID: 37084150 DOI: 10.1007/s00415-023-11725-y] [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: 01/13/2023] [Revised: 04/11/2023] [Accepted: 04/12/2023] [Indexed: 04/22/2023]
Abstract
Multiple sclerosis (MS) is a chronic progressive demyelinating disease of the central nervous system (CNS), which also affects the autonomic nervous system (ANS). Manifestations of MS in the ANS include urological, sexual, gastrointestinal, cardiovascular, and thermoregulatory disorders as well as increased fatigue. These problems are common yet are often underestimated due to the non-specificity of the symptoms and the limited evaluation of the ANS in the usual clinical practice. Most of these symptoms seem to be related to localized lesions in the CNS. However, the mechanisms by which these disorders are caused in MS have not been fully investigated, thus preventing any focused etiological treatment. The most common disorders of the ANS in MS represent a challenge for clinicians due to the variability of the clinical picture and our minimal data on their diagnosis and treatment. Early diagnosis and initiation of individualized treatment regimens, often in need of multiple approaches, seem to yield the best results in managing ANS dysfunction in MS patients.
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Affiliation(s)
- Effrosyni Koutsouraki
- First Department of Neurology, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece.
| | | | | | | | | | - Koukoulidou Ariadni
- Nursing School, International University of Greece, Sindos, Thessaloniki, Greece
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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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Rasmussen TK, Karlsson P, Finnerup NB, Jensen TS, Nyengaard JR, Terkelsen AJ. Functional and structural markers of peripheral microvascular autonomic neuropathy. Muscle Nerve 2023; 67:146-153. [PMID: 36504143 PMCID: PMC10108116 DOI: 10.1002/mus.27770] [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: 03/23/2022] [Revised: 12/05/2022] [Accepted: 12/06/2022] [Indexed: 12/14/2022]
Abstract
INTRODUCTION/AIMS Autonomic dysfunction is a common complication of small-fiber neuropathy (SFN). In this study we aimed to assess the applicability of autonomic microvascular indices as a potential marker for SFN assessment. METHODS Fifteen patients with confirmed SFN (idiopathic neuropathy [n = 10], chemotherapy-induced peripheral neuropathy [n = 2], impaired glucose tolerance [n = 1], hereditary transthyretin amyloidosis (hATTR) [n = 1], pulmonary sarcoidosis [n = 1]) and 15 matched control subjects underwent assessment of vascular skin responses assessed through laser Doppler flowmetry and evaluation of microvascular vessel and nerve density in skin biopsies. All participants underwent peripheral autonomic evaluation by quantitative sudomotor axon reflex testing (QSART). RESULTS We found no significant differences in vascular skin responses, or in any microvascular skin biopsy markers, when comparing SFN with control subjects. We found no correlation between vascular skin responses and skin biopsy indices. We saw no significant difference in any microvascular indices when comparing subjects with and without impaired sudomotor function. DISCUSSION Our findings suggest markers of peripheral microvascular innervation and function are not associated with the diagnosis of SFN. Furthermore, we saw no association between microvascular markers and sudomotor function, suggesting that these are independent and unrelated components of the autonomic nervous system.
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Affiliation(s)
- Thorsten K Rasmussen
- Danish Pain Research Center, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Páll Karlsson
- Danish Pain Research Center, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.,Core Center for Molecular Morphology, Section for Stereology and Microscopy, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Nanna B Finnerup
- Danish Pain Research Center, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.,Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
| | - Troels S Jensen
- Danish Pain Research Center, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Jens R Nyengaard
- Core Center for Molecular Morphology, Section for Stereology and Microscopy, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.,Department of Pathology, Aarhus University Hospital, Aarhus, Denmark
| | - Astrid J Terkelsen
- Danish Pain Research Center, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.,Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
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A reappraisal of the presence of small or large fiber neuropathy in patients with erythromelalgia. Neurophysiol Clin 2021; 51:349-355. [PMID: 33888389 DOI: 10.1016/j.neucli.2021.03.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 03/31/2021] [Accepted: 03/31/2021] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To assess the contribution of large and small nerve fiber alteration in erythromelalgia (EM). METHODS Thirty-three EM patients were included and underwent clinical evaluation based on EM severity score, DN4, and Utah Early Neuropathy Scale (UENS) score. Neurophysiological evaluation consisted in nerve conduction studies (NCS) for large nerve fibers and specific tests for small nerve fibers: electrochemical skin conductance, cold and warm detection thresholds, and laser evoked potentials. Finally, the evaluation of vascular changes was based on the presence of clinical feature of microvascular disorders and the measurement of the Toe Pressure Index (TPI). RESULTS While 28 patients (85%) had vascular alteration on TPI or clinical features, 23 patients (70%) had small-fiber neuropathy on neurophysiological tests, and only 10 patients (30%) had large fiber neuropathy on NCS. Regarding clinical scores, there was no difference between groups (presence or absence of large- or small-fiber neuropathy or microvascular disorder) except for a higher UENS score in patients with large fiber neuropathy. CONCLUSION Peripheral neuropathy, mostly involving small nerve fibers, is almost as common as microvascular changes in EM, but remains inconstant and not related to a specific neuropathic pattern or higher clinical severity. SIGNIFICANCE The association of neuropathic and vascular factors is not systematic in EM, this syndrome being characterized by different pathophysiological mechanisms leading to a common clinical phenotype.
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Marcinkevics Z, Aglinska A, Rubins U, Grabovskis A. Remote Photoplethysmography for Evaluation of Cutaneous Sensory Nerve Fiber Function. SENSORS 2021; 21:s21041272. [PMID: 33670087 PMCID: PMC7916836 DOI: 10.3390/s21041272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 02/06/2021] [Accepted: 02/08/2021] [Indexed: 11/23/2022]
Abstract
About 2% of the world’s population suffers from small nerve fiber dysfunction, neuropathy, which can result in severe pain. This condition is caused by damage to the small nerve fibers and its assessment is challenging, due to the lack of simple and objective diagnostic techniques. The present study aimed to develop a contactless photoplethysmography system using simple instrumentation, for objective and non-invasive assessment of small cutaneous sensory nerve fiber function. The approach is based on the use of contactless photoplethysmography for the characterization of skin flowmotions and topical heating evoked vasomotor responses. The feasibility of the technique was evaluated on volunteers (n = 14) using skin topical anesthesia, which is able to produce temporary alterations of cutaneous nerve fibers function. In the treated skin region in comparison to intact skin: neurogenic and endothelial component of flowmotions decreased by ~61% and 41%, the local heating evoked flare area decreased by ~44%, vasomotor response trend peak and nadir were substantially reduced. The results indicate for the potential of the remote photoplethysmography in the assessment of the cutaneous nerve fiber function. It is believed that in the future this technique could be used in the clinics as an affordable alternative to laser Doppler imaging technique.
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Affiliation(s)
- Zbignevs Marcinkevics
- Department of Human and Animal Physiology, Faculty of Biology, University of Latvia, Jelgavas St.1, LV-1004 Riga, Latvia
- Biophotonics Laboratory, Institute of Atomic Physics and Spectroscopy, University of Latvia, Jelgavas St. 3, LV-1004 Riga, Latvia; (A.A.); (U.R.); (A.G.)
- Correspondence:
| | - Alise Aglinska
- Biophotonics Laboratory, Institute of Atomic Physics and Spectroscopy, University of Latvia, Jelgavas St. 3, LV-1004 Riga, Latvia; (A.A.); (U.R.); (A.G.)
| | - Uldis Rubins
- Biophotonics Laboratory, Institute of Atomic Physics and Spectroscopy, University of Latvia, Jelgavas St. 3, LV-1004 Riga, Latvia; (A.A.); (U.R.); (A.G.)
| | - Andris Grabovskis
- Biophotonics Laboratory, Institute of Atomic Physics and Spectroscopy, University of Latvia, Jelgavas St. 3, LV-1004 Riga, Latvia; (A.A.); (U.R.); (A.G.)
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Chiaramonte R, Romano M, Vecchio M. A Systematic Review of the Diagnostic Methods of Small Fiber Neuropathies in Rehabilitation. Diagnostics (Basel) 2020; 10:E613. [PMID: 32825514 PMCID: PMC7554909 DOI: 10.3390/diagnostics10090613] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 08/10/2020] [Accepted: 08/18/2020] [Indexed: 12/12/2022] Open
Abstract
This systematic review describes the several methods to diagnose and measure the severity of small fiber neuropathies and aims to guide the physician to define all the diagnostic approaches for adopting the best strategies described in the current literature. The search was conducted in PubMed, EMBASE, Cochrane Library and Web of Science. Two reviewers independently reviewed and came to consensus on which articles met inclusion/exclusion criteria. The authors excluded all the duplicates, animals' studies, and included the English articles in which the diagnostic measures were finalized to assess the effectiveness of rehabilitation and pharmacologic treatment of patients with small fiber neuropathies. The search identified a total of 975 articles with the keywords "small fiber neuropathy" AND "rehabilitation" OR "therapy" OR "treatment". Seventy-eight selected full-text were analyzed by the reviewers. Forty-one publications met the inclusion criteria and were included in the systematic review. Despite the range of diagnostic tools for the assessment of small fiber neuropathy, other robust trials are needed. In addition, always different diagnostic approaches are used, a unique protocol could be important for the clinicians. More research is needed to build evidence for the best diagnostic methodologies and to delineate a definitive diagnostic protocol.
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Affiliation(s)
- Rita Chiaramonte
- Department of Biomedical and Biotechnological Sciences, Section of Pharmacology, University of Catania, 95125 Catania, Italy
| | - Marcello Romano
- Neurology Unit, Azienda Ospedaliera Ospedali Riuniti Villa Sofia Cervello, 90100 Palermo, Italy;
| | - Michele Vecchio
- Department of Biomedical and Biotechnological Sciences, Section of Pharmacology, University of Catania, 95125 Catania, Italy
- Rehabilitation Unit, AOU Policlinico Vittorio Emanuele, University of Catania, 95125 Catania, Italy
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Lakatos S, Jancsó G, Horváth Á, Dobos I, Sántha P. Longitudinal Study of Functional Reinnervation of the Denervated Skin by Collateral Sprouting of Peptidergic Nociceptive Nerves Utilizing Laser Doppler Imaging. Front Physiol 2020; 11:439. [PMID: 32528300 PMCID: PMC7253695 DOI: 10.3389/fphys.2020.00439] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Accepted: 04/08/2020] [Indexed: 11/13/2022] Open
Abstract
Restitution of cutaneous sensory function is accomplished by neural regenerative processes of distinct mechanisms following peripheral nerve lesions. Although methods available for the study of functional cutaneous nerve regeneration are specific and accurate, they are unsuitable for the longitudinal follow-up of the temporal and spatial aspects of the reinnervation process. Therefore, the aim of this study was to develop a new, non-invasive approach for the longitudinal examination of cutaneous nerve regeneration utilizing the determination of changes in the sensory neurogenic vasodilatatory response, a salient feature of calcitonin gene-related peptide-containing nociceptive afferent nerves, with scanning laser Doppler flowmetry. Scanning laser Doppler imaging was applied to measure the intensity and spatial extent of sensory neurogenic vasodilatation elicited by the application of mustard oil onto the dorsal skin of the rat hindpaw. Mustard oil induced reproducible and uniform increases in skin perfusion reaching maximum values at 2-4 min after application whereafter the blood flow gradually returned to control level after about 8-10 min. Transection and ligation of the saphenous nerve largely eliminated the vasodilatatory response in the medial aspect of the dorsal skin of the hindpaw. In the 2 nd to 4 th weeks after injury, the mustard oil-induced vasodilatatory reaction gradually recovered. Since regeneration of the saphenous nerve was prevented, the recovery of the vasodilatatory response may be accounted for by the collateral sprouting of neighboring intact sciatic afferent nerve fibers. This was supported by the elimination of the vasodilatatory response in both the saphenous and sciatic innervation territories following local treatment of the sciatic nerve with capsaicin to defunctionalize nociceptive afferent fibers. The present findings demonstrate that this novel technique utilizing scanning laser Doppler flowmetry to quantitatively measure cutaneous sensory neurogenic vasodilatation, a vascular response mediated by peptidergic nociceptive nerves, is a reliable non-invasive approach for the longitudinal study of nerve regeneration in the skin.
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Affiliation(s)
- Szandra Lakatos
- Department of Physiology, University of Szeged, Szeged, Hungary
| | - Gábor Jancsó
- Department of Physiology, University of Szeged, Szeged, Hungary
| | - Ágnes Horváth
- 1st Department of Internal Medicine, University of Szeged, Szeged, Hungary
| | - Ildikó Dobos
- Department of Physiology, University of Szeged, Szeged, Hungary
| | - Péter Sántha
- Department of Physiology, University of Szeged, Szeged, Hungary
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Sohn E, Suh BC, Wang N, Freeman R, Gibbons CH. A novel method to quantify cutaneous vascular innervation. Muscle Nerve 2020; 62:492-501. [PMID: 32270499 DOI: 10.1002/mus.26889] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 03/30/2020] [Accepted: 04/05/2020] [Indexed: 12/11/2022]
Abstract
INTRODUCTION To develop a new method to quantify the density of nerves, vessels, and the neurovascular contacts, we studied skin biopsies in diabetes and control subjects. METHODS Skin biopsies with dual immunofluorescent staining were used to visualize nerves and blood vessels. The density of nerves, vessels, and their neurovascular contacts were quantified with unbiased stereology. Results were compared with examination findings, validated questionnaires, and autonomic function. RESULTS In tissue from 19 controls and 20 patients with diabetes, inter-rater and intra-rater intraclass correlation coefficients were high (>0.85; P < .001) for all quantitative methods. In diabetes, the nerve densities (P < .05), vessel densities (P < .01), and the neurovascular densities (P < .01) were lower compared with 20 controls. Results correlated with autonomic function, examination and symptom scores. DISCUSSION We report an unbiased, stereological method to quantify the cutaneous nerve, vessel and neurovascular density and offer new avenues of investigation into cutaneous neurovascular innervation in health and disease.
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Affiliation(s)
- Eunhee Sohn
- Department of Neurology, Chungnam University Hospital, Daejeon, South Korea
| | - Bum Chun Suh
- Department of Neurology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Ningshan Wang
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Roy Freeman
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Christopher H Gibbons
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
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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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Glatte P, Buchmann SJ, Hijazi MM, Illigens BMW, Siepmann T. Architecture of the Cutaneous Autonomic Nervous System. Front Neurol 2019; 10:970. [PMID: 31551921 PMCID: PMC6746903 DOI: 10.3389/fneur.2019.00970] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Accepted: 08/23/2019] [Indexed: 12/12/2022] Open
Abstract
The human skin is a highly specialized organ for receiving sensory information but also to preserve the body's homeostasis. These functions are mediated by cutaneous small nerve fibers which display a complex anatomical architecture and are commonly classified into cutaneous A-beta, A-delta and C-fibers based on their diameter, myelinization, and velocity of conduction of action potentials. Knowledge on structure and function of these nerve fibers is relevant as they are selectively targeted by various autonomic neuropathies such as diabetic neuropathy or Parkinson's disease. Functional integrity of autonomic skin nerve fibers can be assessed by quantitative analysis of cutaneous responses to local pharmacological induction of axon reflex responses which result in dilation of cutaneous vessels, sweating, or piloerection depending on the agent used to stimulate this neurogenic response. Sensory fibers can be assessed using quantitative sensory test. Complementing these functional assessments, immunohistochemical staining of superficial skin biopsies allow analysis of structural integrity of cutaneous nerve fibers, a technique which has gained attention due to its capacity of detecting pathogenic depositions of alpha-synuclein in patients with Parkinson's disease. Here, we reviewed the current literature on the anatomy and functional pathways of the cutaneous autonomic nervous system as well as diagnostic techniques to assess its functional and structural integrity.
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Affiliation(s)
- Patrick Glatte
- Department of Neurology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Sylvia J Buchmann
- Department of Neurology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Mido Max Hijazi
- Department of Neurosurgery, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Ben Min-Woo Illigens
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
| | - Timo Siepmann
- Department of Neurology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
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12
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Illigens BMW, Gibbons CH. Autonomic testing, methods and techniques. HANDBOOK OF CLINICAL NEUROLOGY 2019; 160:419-433. [PMID: 31277866 DOI: 10.1016/b978-0-444-64032-1.00028-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
The evaluation of autonomic function requires indirect assessment of neurophysiologic function using specialized equipment that is often available only at tertiary care centers, with few specialists available. However, the evaluation of autonomic function is rooted in basic physiology, and the results can be interpreted by careful consideration of the context of the problem. Many automated devices have become widely available to test autonomic function, but they tend to gather inadequate data leading to frequent misdiagnosis and clinical confusion. We review the details necessary for the neurophysiologist to properly perform, and interpret, autonomic function testing.
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Affiliation(s)
- Ben M W Illigens
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
| | - Christopher H Gibbons
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States.
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13
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Zouari HG, Ng Wing Tin S, Wahab A, Damy T, Lefaucheur JP. Assessment of autonomic innervation of the foot in familial amyloid polyneuropathy. Eur J Neurol 2018; 26:94-e10. [PMID: 30102818 DOI: 10.1111/ene.13774] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Accepted: 08/09/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND PURPOSE Distal involvement of autonomic nerve fibers is critical in familial amyloid polyneuropathy (FAP) due to transthyretin (TTR) mutation. This study compares different methods for assessing autonomic foot innervation in TTR-FAP patients. METHODS Three groups of seven TTR-FAP patients were included, according to disease severity: clinically asymptomatic, moderate or advanced neuropathy. The autonomic investigation included the eutectic mixture of local anesthetics test and laser Doppler flowmetry for vasomotor aspects and the Sudoscan® (measuring electrochemical skin conductance) and Neuropad® test for sudomotor aspects. Somatic innervation was assessed by performing nerve conduction studies, quantitative sensory testing [including vibration, cold and warm detection threshold (WDT) measurements] and laser evoked potentials. RESULTS The results of all neurophysiological tests varied according to TTR-FAP severity (P ≤ 0.01, Kruskal-Wallis test), except for the eutectic mixture of local anesthetics test and laser Doppler flowmetry variables. In addition, the sudomotor tests (Sudoscan or Neuropad) or WDT measurement provided early markers of neuropathy in two of the seven asymptomatic carriers. Finally, all neurophysiological results correlated with the Neuropathy Impairment Score (r values between -0.88 and -0.66, P < 0.005, Spearman test), except the cold detection threshold. CONCLUSIONS The Neuropad test could be used to detect TTR-FAP onset, but confirmation requires electrochemical skin conductance and WDT measurement. The Sudoscan technique, but not the Neuropad test (at least assessed at a fixed time point), could be valuable to follow the progression of the neuropathy. Follow-up investigation should also include large-fiber investigation (e.g. nerve conduction studies and vibration detection threshold). Conversely, reliable tests for assessing vasomotor disturbances in limb extremities of TTR-FAP patients are still awaited.
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Affiliation(s)
- H G Zouari
- EA 4391, Faculté de Médecine, Université Paris Est Créteil, Créteil, France.,Service de Physiologie, Explorations Fonctionnelles, Unité de Neurophysiologie Clinique, Hôpital Henri Mondor, Assistance Publique - Hôpitaux de Paris, Créteil, France.,Service d'Explorations Fonctionnelles, CHU Habib Bourguiba, Sfax, Tunisie
| | - S Ng Wing Tin
- Service de Physiologie, Explorations Fonctionnelles et Médecine du Sport, Hôpital Avicenne, Assistance Publique - Hôpitaux de Paris, Bobigny, France.,EA 2363, UFR SMBH, Université Paris 13, Bobigny, France
| | - A Wahab
- EA 4391, Faculté de Médecine, Université Paris Est Créteil, Créteil, France.,Service de Physiologie, Explorations Fonctionnelles, Unité de Neurophysiologie Clinique, Hôpital Henri Mondor, Assistance Publique - Hôpitaux de Paris, Créteil, France
| | - T Damy
- Service de Cardiologie, Unité d'Insuffisance, Hôpital Henri Mondor, Assistance Publique - Hôpitaux de Paris, Créteil, France.,GRC Institut de Recherche sur l'Amylose, Faculté de Médecine, Université Paris Est Créteil, Créteil, France.,Réseau Amylose Henri-Mondor, Hôpital Henri Mondor, Créteil, France
| | - J-P Lefaucheur
- EA 4391, Faculté de Médecine, Université Paris Est Créteil, Créteil, France.,Service de Physiologie, Explorations Fonctionnelles, Unité de Neurophysiologie Clinique, Hôpital Henri Mondor, Assistance Publique - Hôpitaux de Paris, Créteil, France.,Réseau Amylose Henri-Mondor, Hôpital Henri Mondor, Créteil, France
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14
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Loavenbruck A, Sit N, Provitera V, Kennedy W. High-resolution axon reflex sweat testing for diagnosis of neuropathy. Clin Auton Res 2018; 29:55-62. [DOI: 10.1007/s10286-018-0546-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Accepted: 07/05/2018] [Indexed: 02/03/2023]
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15
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Should Skin Biopsies Be Performed in Patients Suspected of Having Parkinson's Disease? PARKINSONS DISEASE 2017; 2017:6064974. [PMID: 29214093 PMCID: PMC5682910 DOI: 10.1155/2017/6064974] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Revised: 08/30/2017] [Accepted: 09/12/2017] [Indexed: 11/17/2022]
Abstract
In patients with Parkinson's disease (PD), the molecularly misfolded form of α-synuclein was recently identified in cutaneous autonomic nerve fibers which displayed increased accumulation even in early disease stages. However, the underlying mechanisms of synucleinopathic nerve damage and its implication for brain pathology in later life remain to be elucidated. To date, specific diagnostic tools to evaluate small fiber pathology and to discriminate neurodegenerative proteinopathies are rare. Recently, research has indicated that deposition of α-synuclein in cutaneous nerve fibers quantified via immunohistochemistry in superficial skin biopsies might be a valid marker of PD which could facilitate early diagnosis and monitoring of disease progression. However, lack of standardization of techniques to quantify neural α-synuclein deposition limits their utility in clinical practice. Additional challenges include the identification of potential distinct morphological patterns of intraneural α-synuclein deposition among synucleinopathies to facilitate diagnostic discrimination and determining the degree to which structural damage relates to dysfunction of nerve fibers targeted by α-synuclein. Answering these questions might improve our understanding of the pathophysiological role of small fiber neuropathy in Parkinson's disease, help identify new treatment targets, and facilitate assessment of response to neuroprotective treatment.
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16
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Kubasch ML, Kubasch AS, Torres Pacheco J, Buchmann SJ, Illigens BMW, Barlinn K, Siepmann T. Laser Doppler Assessment of Vasomotor Axon Reflex Responsiveness to Evaluate Neurovascular Function. Front Neurol 2017; 8:370. [PMID: 28855885 PMCID: PMC5557735 DOI: 10.3389/fneur.2017.00370] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Accepted: 07/14/2017] [Indexed: 01/19/2023] Open
Abstract
The vasomotor axon reflex can be evoked in peripheral epidermal nociceptive C-fibers to induce local vasodilation. This neurogenic flare response is a measure of C-fiber functional integrity and therefore shows impairment in patients with small fiber neuropathy. Laser Doppler flowmetry (LDF) and laser Doppler imaging (LDI) are both techniques to analyze vasomotor small fiber function by quantifying the integrity of the vasomotor-mediated axon reflex. While LDF assesses the flare response following acetylcholine iontophoresis with temporal resolution at a single defined skin point, LDI records flare responses with spatial and temporal resolution, generating a two-dimensional map of superficial blood flow. LDF is characterized by a high intra- and interindividual measurement variability, which is smaller in LDI due to its spatial resolution. Nevertheless, LDI still lacks standardized methods for image analysis. Consequently, use of the technique currently remains on an experimental level. Here, we sought to review the current literature on laser Doppler assessment of vasomotor function and discuss potential future applications of established techniques as well as those that are still experimental.
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Affiliation(s)
- Marie Luise Kubasch
- Department of Neurology, Carl Gustav Carus University Hospital, Technische Universität Dresden, Dresden, Germany
| | - Anne Sophie Kubasch
- Center for Rare Diseases, Children's Hospital, Carl Gustav Carus University Hospital, Technische Universität Dresden, Dresden, Germany
| | | | - Sylvia J Buchmann
- Department of Neurology, Charite University Medicine, Berlin, Germany
| | - Ben Min-Woo Illigens
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
| | - Kristian Barlinn
- Department of Neurology, Carl Gustav Carus University Hospital, Technische Universität Dresden, Dresden, Germany
| | - Timo Siepmann
- Department of Neurology, Carl Gustav Carus University Hospital, Technische Universität Dresden, Dresden, Germany
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17
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Wu Y, Nieuwenhoff MD, Huygen FJPM, van der Helm FCT, Niehof S, Schouten AC. Characterizing human skin blood flow regulation in response to different local skin temperature perturbations. Microvasc Res 2016; 111:96-102. [PMID: 28011052 DOI: 10.1016/j.mvr.2016.12.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Revised: 12/17/2016] [Accepted: 12/19/2016] [Indexed: 11/18/2022]
Abstract
Small nerve fibers regulate local skin blood flow in response to local thermal perturbations. Small nerve fiber function is difficult to assess with classical neurophysiological tests. In this study, a vasomotor response model in combination with a heating protocol was developed to quantitatively characterize the control mechanism of small nerve fibers in regulating skin blood flow in response to local thermal perturbation. The skin of healthy subjects' hand dorsum (n=8) was heated to 42°C with an infrared lamp, and then naturally cooled down. The distance between the lamp and the hand was set to three different levels in order to change the irradiation intensity on the skin and implement three different skin temperature rise rates (0.03°C/s, 0.02°C/s and 0.01°C/s). A laser Doppler imager (LDI) and a thermographic video camera recorded the temporal profile of the skin blood flow and the skin temperature, respectively. The relationship between the skin blood flow and the skin temperature was characterized by a vasomotor response model. The model fitted the skin blood flow response well with a variance accounted for (VAF) between 78% and 99%. The model parameters suggested a similar mechanism for the skin blood flow regulation with the thermal perturbations at 0.03°C/s and 0.02°C/s. But there was an accelerated skin vasoconstriction after a slow heating (0.01°C/s) (p-value<0.05). An attenuation of the skin vasodilation was also observed in four out of the seven subjects during the slow heating (0.01°C/s). Our method provides a promising way to quantitatively assess the function of small nerve fibers non-invasively and non-contact.
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Affiliation(s)
- Y Wu
- Department of Biomechanical Engineering, Delft University of Technology, Mekelweg 2, 2628CD Delft, The Netherlands.
| | - M D Nieuwenhoff
- Department of Anesthesiology and Pain Medicine, Erasmus MC University Medical Center, P.O. box 2040, 3000CA Rotterdam, The Netherlands.
| | - F J P M Huygen
- Department of Anesthesiology and Pain Medicine, Erasmus MC University Medical Center, P.O. box 2040, 3000CA Rotterdam, The Netherlands.
| | - F C T van der Helm
- Department of Biomechanical Engineering, Delft University of Technology, Mekelweg 2, 2628CD Delft, The Netherlands.
| | - S Niehof
- Department of Biomechanical Engineering, Delft University of Technology, Mekelweg 2, 2628CD Delft, The Netherlands; Department of Anesthesiology and Pain Medicine, Erasmus MC University Medical Center, P.O. box 2040, 3000CA Rotterdam, The Netherlands; Department of Information, Medical Technology and Services, Maasstad Hospital, Haastrechtstraat 7D, 3079DC Rotterdam, The Netherlands.
| | - A C Schouten
- Department of Biomechanical Engineering, Delft University of Technology, Mekelweg 2, 2628CD Delft, The Netherlands; Department of Biomechanical Engineering, MIRA Institute, University of Twente, Building Zuidhorst, P.O. box 217, 7500AE Enschede, The Netherlands.
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18
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Nieuwenhoff MD, Wu Y, Huygen FJPM, Schouten AC, van der Helm FCT, Niehof SP. Reproducibility of axon reflex-related vasodilation assessed by dynamic thermal imaging in healthy subjects. Microvasc Res 2016; 106:1-7. [PMID: 26956622 DOI: 10.1016/j.mvr.2016.03.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Revised: 03/01/2016] [Accepted: 03/02/2016] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Small nerve fiber dysfunction is an early feature of diabetic neuropathy. There is a strong clinical need for a non-invasive method to assess small nerve fiber function. Small nerve fibers mediate axon reflex-related vasodilation and play an important role in thermoregulation. Assessing the reflex vasodilation after local heating might elucidate some aspects of small fiber functioning. In this study, we determined the reproducibility of the reflex vasodilation after short local heating in healthy subjects, assessed with thermal imaging and laser Doppler imaging. METHODS Healthy subjects underwent six heating rounds in one session (protocol I, N=10) or spread over two visits (protocol II, N=20). Reflex vasodilation was elicited by heating the skin to 42°C with an infrared lamp. Skin temperature and skin blood flow were recorded during heating and recovery with a thermal imaging camera and a laser Doppler imager. Skin temperature curves were fitted with a mathematical model to describe the heating and recovery phase with time constant tau (tauHeat and tauCool1). RESULTS The reproducibility of tau within a session was moderate to excellent (intra-class correlation coefficient 0.42-0.86) and good (0.71-0.72) between different sessions. Within one session the differences in tauHeat were small (bias±SD -1.3±18.9s); the bias between two visits was -1.2±12.2s. For tauCool1 the differences were also small, 1.4±6.6s within a session and between visits -1.4±11.6s. CONCLUSIONS The heat induced axon reflex-related vasodilation, assessed with thermal imaging and laser Doppler imaging, was reproducible both within a session and between different sessions. Tau describes the temporal profile in one parameter and represents the effects of all changes including blood flow and as such, is an indicator of the vasodilator function. TauHeat and tauCool1 can accurately describe the dynamics of the axon reflex-related vasodilator response in the heating and recovery phase respectively.
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Affiliation(s)
- M D Nieuwenhoff
- Department of Anesthesiology and Pain Medicine, Erasmus MC University Medical Center, Room Ba-430, P.O. box 2040, 3000CA Rotterdam, The Netherlands.
| | - Y Wu
- Department of Biomechanical Engineering, Delft University of Technology, Mekelweg 2, 2628CD Delft, The Netherlands.
| | - F J P M Huygen
- Department of Anesthesiology and Pain Medicine, Erasmus MC University Medical Center, Room Ba-430, P.O. box 2040, 3000CA Rotterdam, The Netherlands.
| | - A C Schouten
- Department of Biomechanical Engineering, Delft University of Technology, Mekelweg 2, 2628CD Delft, The Netherlands; Department of Biomechanical Engineering, MIRA Institute, University of Twente, Building Zuidhorst, P.O. box 217, 7500AE Enschede, The Netherlands.
| | - F C T van der Helm
- Department of Biomechanical Engineering, Delft University of Technology, Mekelweg 2, 2628CD Delft, The Netherlands.
| | - S P Niehof
- Department of Anesthesiology and Pain Medicine, Erasmus MC University Medical Center, Room Ba-430, P.O. box 2040, 3000CA Rotterdam, The Netherlands.
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Abstract
Despite progression in the development of pharmacological therapy, treatment of alpha synucleinopathies, such as Parkinson's disease (PD) and some atypical parkinsonism syndromes, is still challenging. To date, our knowledge of the mechanisms whereby the pathological form of alpha-synuclein causes structural and functional damage to the nervous system is limited and, consequently, there is a lack of specific diagnostic tools to evaluate pathology in these patients and differentiate PD from other neurodegenerative proteinopathies. Recent studies indicated that alpha-synuclein deposition in cutaneous small nerve fibers assessed by skin biopsies might be a valid disease marker of PD and facilitate early differentiation of PD from atypical parkinsonism syndromes. This observation is relevant since early diagnosis may enable timely treatment and improve quality of life. However, challenges include the necessity of standardizing immunohistochemical analysis techniques and the identification of potential distinct patterns of intraneural alpha-synuclein deposition among synucleinopathies. In this perspective, we explore the scientific and clinical opportunities arising from alpha-synuclein assessment using skin biopsies. These include elucidation of the peripheral nervous system pathology of PD and other synucleinopathies, identification of novel targets to study response to neuroprotective treatment, and improvement of clinical management. Furthermore, we discuss future challenges in exploring the diagnostic value of skin biopsy assessment for alpha-synuclein deposition and implementing the technique in clinical practice.
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Affiliation(s)
- Timo Siepmann
- Department of Neurology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Ben Min-Woo Illigens
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Kristian Barlinn
- Department of Neurology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
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20
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Siepmann T, Penzlin AI, Frenz E, Barlinn K, Weidner K, Ziemssen T, Reichmann H, Illigens BMW. [Sensory and autonomic small fiber neuropathy]. MMW Fortschr Med 2015; 157 Spec No 2:60-4; quiz 65. [PMID: 26953479 DOI: 10.1007/s15006-015-3300-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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21
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Pintér A, Cseh D, Sárközi A, Illigens BM, Siepmann T. Autonomic Dysregulation in Multiple Sclerosis. Int J Mol Sci 2015; 16:16920-52. [PMID: 26213927 PMCID: PMC4581177 DOI: 10.3390/ijms160816920] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2015] [Revised: 07/13/2015] [Accepted: 07/20/2015] [Indexed: 02/07/2023] Open
Abstract
Multiple sclerosis (MS) is a chronic, progressive central neurological disease characterized by inflammation and demyelination. In patients with MS, dysregulation of the autonomic nervous system may present with various clinical symptoms including sweating abnormalities, urinary dysfunction, orthostatic dysregulation, gastrointestinal symptoms, and sexual dysfunction. These autonomic disturbances reduce the quality of life of affected patients and constitute a clinical challenge to the physician due to variability of clinical presentation and inconsistent data on diagnosis and treatment. Early diagnosis and initiation of individualized interdisciplinary and multimodal strategies is beneficial in the management of autonomic dysfunction in MS. This review summarizes the current literature on the most prevalent aspects of autonomic dysfunction in MS and provides reference to underlying pathophysiological mechanisms as well as means of diagnosis and treatment.
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Affiliation(s)
- Alexandra Pintér
- Institute of Human Physiology and Clinical Experimental Research, Faculty of Medicine, Semmelweis University, Budapest 1085, Hungary.
- Center for Clinical Research and Management Education, Division of Health Care Sciences, Dresden International University, Dresden 01067, Germany.
| | - Domonkos Cseh
- Institute of Human Physiology and Clinical Experimental Research, Faculty of Medicine, Semmelweis University, Budapest 1085, Hungary.
| | - Adrienn Sárközi
- Institute of Human Physiology and Clinical Experimental Research, Faculty of Medicine, Semmelweis University, Budapest 1085, Hungary.
| | - Ben M Illigens
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA.
| | - Timo Siepmann
- Center for Clinical Research and Management Education, Division of Health Care Sciences, Dresden International University, Dresden 01067, Germany.
- Department of Neurology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden 01307, Germany.
- Department of Psychotherapy and Psychosomatic Medicine, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden 01307, Germany.
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22
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Siepmann T, Illigens BMW, Reichmann H, Ziemssen T. [Axon-reflex based nerve fiber function assessment in the detection of autonomic neuropathy]. DER NERVENARZT 2015; 85:1309-14. [PMID: 25047406 DOI: 10.1007/s00115-014-4120-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Axon-reflex-based tests of peripheral small nerve fiber function including techniques to quantify vasomotor and sudomotor responses following acetylcholine iontophoresis are used in the assessment of autonomic neuropathy. However, the established axon-reflex-based techniques, laser Doppler flowmetry (LDF) to assess vasomotor function and quantitative sudomotor axon-reflex test (QSART) to measure sudomotor function, are limited by technically demanding settings as well as interindividual variability and are therefore restricted to specialized clinical centers. New axon-reflex tests are characterized by quantification of axon responses with both temporal and spatial resolution and include "laser Doppler imaging (LDI) axon-reflex flare area test" to assess vasomotor function, the quantitative direct and indirect test of sudomotor function (QDIRT) to quantify sudomotor function, as well as the quantitative pilomotor axon-reflex test (QPART), a technique to measure pilomotor nerve fiber function using adrenergic cutaneous stimulation through phenylephrine iontophoresis. The effectiveness of new axon-reflex tests in the assessment of neuropathy is currently being investigated in clinical studies.
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Affiliation(s)
- T Siepmann
- Klinik und Poliklinik für Neurologie, Universitätsklinik Carl Gustav Carus, Technische Universität Dresden, Dresden, Deutschland,
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Penzlin AI, Siepmann T, Illigens BMW, Weidner K, Siepmann M. Heart rate variability biofeedback in patients with alcohol dependence: a randomized controlled study. Neuropsychiatr Dis Treat 2015; 11:2619-27. [PMID: 26557753 PMCID: PMC4624058 DOI: 10.2147/ndt.s84798] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND AND OBJECTIVE In patients with alcohol dependence, ethyl-toxic damage of vasomotor and cardiac autonomic nerve fibers leads to autonomic imbalance with neurovascular and cardiac dysfunction, the latter resulting in reduced heart rate variability (HRV). Autonomic imbalance is linked to increased craving and cardiovascular mortality. In this study, we sought to assess the effects of HRV biofeedback training on HRV, vasomotor function, craving, and anxiety. METHODS We conducted a randomized controlled study in 48 patients (14 females, ages 25-59 years) undergoing inpatient rehabilitation treatment. In the treatment group, patients (n=24) attended six sessions of HRV biofeedback over 2 weeks in addition to standard rehabilitative care, whereas, in the control group, subjects received standard care only. Psychometric testing for craving (Obsessive Compulsive Drinking Scale), anxiety (Symptom Checklist-90-Revised), HRV assessment using coefficient of variation of R-R intervals (CVNN) analysis, and vasomotor function assessment using laser Doppler flowmetry were performed at baseline, immediately after completion of treatment or control period, and 3 and 6 weeks afterward (follow-ups 1 and 2). RESULTS Psychometric testing showed decreased craving in the biofeedback group immediately postintervention (OCDS scores: 8.6±7.9 post-biofeedback versus 13.7±11.0 baseline [mean ± standard deviation], P<0.05), whereas craving was unchanged at this time point in the control group. Anxiety was reduced at follow-ups 1 and 2 post-biofeedback, but was unchanged in the control group (P<0.05). Following biofeedback, CVNN tended to be increased (10.3%±2.8% post-biofeedback, 10.1%±3.5% follow-up 1, 10.1%±2.9% follow-up 2 versus 9.7%±3.6% baseline; P=not significant). There was no such trend in the control group. Vasomotor function assessed using the mean duration to 50% vasoconstriction of cutaneous vessels after deep inspiration was improved following biofeedback immediately postintervention and was unchanged in the control group (P<0.05). CONCLUSION Our data indicate that HRV biofeedback might be useful to decrease anxiety, increase HRV, and improve vasomotor function in patients with alcohol dependence when complementing standard rehabilitative inpatient care.
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Affiliation(s)
- Ana Isabel Penzlin
- Institute of Clinical Pharmacology, Technische Universität Dresden, Dresden, Saxony, Germany
| | - Timo Siepmann
- Department of Neurology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Saxony, Germany
| | - Ben Min-Woo Illigens
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Kerstin Weidner
- Department of Psychotherapy and Psychosomatic Medicine, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Saxony, Germany
| | - Martin Siepmann
- Department of Psychotherapy and Psychosomatic Medicine, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Saxony, Germany
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