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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Lv Y, Yang Z, Xiang L, Yu M, Zhao S, Zhang X, Li R. Lower Limb Arterial Ischemia: An Independent Risk Factor of Sudomotor Dysfunction in Type 2 Diabetes. Diabetes Metab Syndr Obes 2023; 16:883-891. [PMID: 37012930 PMCID: PMC10066695 DOI: 10.2147/dmso.s402797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 03/17/2023] [Indexed: 03/29/2023] Open
Abstract
BACKGROUND As an early manifestation of diabetic peripheral neuropathy (DPN), sudomotor dysfunction significantly increases the risk of diabetic foot ulcer. The pathogenesis of sudomotor dysfunction is still unclear. Lower limb ischemia may be related to sudomotor dysfunction, but few studies have explored it. The purpose of this study is to explore the relationship between sudomotor function and comprehensive lower limb arterial ischemia including large arteries, small arteries and microvascular in type 2 diabetes mellitus (T2DM). PATIENTS AND METHODS 511 T2DM patients were enrolled in this cross-sectional study. Sudomotor function was assessed qualitatively and quantitatively by Neuropad. Lower limb arterial ischemia was defined as any abnormality of the ankle brachial index (ABI), toe brachial index (TBI) or transcutaneous oxygen tension (TcPO2). RESULTS In this study, 75.1% of patients had sudomotor dysfunction. Compared with normal sudomotor function, patients with sudomotor dysfunction had a higher incidence of lower limb arterial ischemia (51.2% vs 36.2%, p = 0.004). Similarly, compared with the non-arterial ischemia group, the proportion of sudomotor disorders was higher in the arterial ischemia group (p = 0.004). Low TBI and low TcPO2 groups also had a higher proportion of sudomotor disorders (all p < 0.05).Compare with normal groups, low ABI, low TBI, and low TcPO2 groups had lower Slop4 which quantitatively reflecting Neuropad discoloration. Arterial ischemia was an independent risk factor for sudomotor dysfunction [OR = 1.754, p = 0.024]. Low TcPO2 also independently increased the risk of sudomotor disorders [OR = 2.231, p = 0.026]. CONCLUSION Lower limb arterial ischemia is an independent risk factor of sudomotor dysfunction. Especially below the ankle (BTA) small arteries and microvascular ischemia may also be involved in the occurrence of sudomotor disorders.
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Affiliation(s)
- Yuhuan Lv
- Department of Endocrinology, the First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, People’s Republic of China
| | - Zheng Yang
- Department of Endocrinology, the First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, People’s Republic of China
| | - Linyu Xiang
- Department of Endocrinology, the First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, People’s Republic of China
| | - Meng Yu
- Department of Endocrinology, the First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, People’s Republic of China
| | - Subei Zhao
- Department of Endocrinology, the First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, People’s Republic of China
| | - Xiaoru Zhang
- Department of Endocrinology, the First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, People’s Republic of China
| | - Rong Li
- Department of Endocrinology, the First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, People’s Republic of China
- Correspondence: Rong Li, The Department of Endocrinology, the First Affiliated Hospital of Chongqing Medical University, YouYi Road 1#, Yuzhong District, Chongqing, People’s Republic of China, Email
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Nolano M, Caporaso G, Manganelli F, Stancanelli A, Borreca I, Mozzillo S, Tozza S, Dubbioso R, Iodice R, Vitale F, Koay S, Vichayanrat E, da Silva FV, Santoro L, Iodice V, Provitera V. Phosphorylated α-Synuclein Deposits in Cutaneous Nerves of Early Parkinsonism. J Parkinsons Dis 2022; 12:2453-2468. [PMID: 36373295 DOI: 10.3233/jpd-223421] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND The role of peripheral phosphorylated-α-Synuclein (p-α-syn) deposition on nerve degeneration in synucleinopathies is still unknown. OBJECTIVE To assess the cutaneous neural distribution of p-α-Syn deposits and its correlation with clinical data and with morphology and function of cutaneous sensory and autonomic nerves in early Parkinson's disease (PD) and multiple system atrophy-parkinson type (MSA-p). METHODS We recruited 57 PD (F/M = 21/36; age 63.5±9.4 years) and 43 MSA-p (F/M = 16/27; age 62.3±9.0 years) patients within 2 years from motor symptoms. We applied questionnaires and clinical scales, sensory thresholds, and sudomotor testing to assess severity of motor and non-motor involvement and sensory and autonomic dysfunction. We quantified, in skin biopsy from thigh, leg, and fingertip, epidermal, pilomotor, and sudomotor nerve fibers, Meissner corpuscles and intrapapillary myelinated endings and the neural distribution of p-α-syn deposits. RESULTS Compared to controls, we found a cutaneous denervation paralleling functional and clinical impairment. Sensory and autonomic denervation was more severe in MSA-p than in PD. Deposits of p-α-syn were found in the majority of patients, with no significant differences among sites in both groups. Higher occurrence of p-α-syn deposits in autonomic nerves differentiated (p < 0.01) PD from MSA-p. p-α-syn deposits correlated positively with sudomotor function, epidermal, pilomotor and sudomotor nerve densities, and inversely with non-motor symptoms and disease progression. CONCLUSION Our work demonstrated an early peripheral sensory and autonomic involvement in synucleinopathies, more severe in MSA-p than in PD. Higher p-α-syn deposits in autonomic nerves differentiated PD from MSA-p. p-α-syn deposits were associated with preserved innervation and slower disease progression.
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Affiliation(s)
- Maria Nolano
- Neurology Department, Skin Biopsy Laboratory, Istituti Clinici Scientifici Maugeri IRCCS, Telese Terme, Italy.,Department of Neurosciences, Reproductive Sciences and Odontostomatology, University Federico II of Naples, Naples, Italy
| | - Giuseppe Caporaso
- Neurology Department, Skin Biopsy Laboratory, Istituti Clinici Scientifici Maugeri IRCCS, Telese Terme, Italy
| | - Fiore Manganelli
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University Federico II of Naples, Naples, Italy
| | - Annamaria Stancanelli
- Neurology Department, Skin Biopsy Laboratory, Istituti Clinici Scientifici Maugeri IRCCS, Telese Terme, Italy
| | - Ilaria Borreca
- Neurology Department, Skin Biopsy Laboratory, Istituti Clinici Scientifici Maugeri IRCCS, Telese Terme, Italy
| | - Stefania Mozzillo
- Neurology Department, Skin Biopsy Laboratory, Istituti Clinici Scientifici Maugeri IRCCS, Telese Terme, Italy
| | - Stefano Tozza
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University Federico II of Naples, Naples, Italy
| | - Raffaele Dubbioso
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University Federico II of Naples, Naples, Italy
| | - Rosa Iodice
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University Federico II of Naples, Naples, Italy
| | - Floriana Vitale
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University Federico II of Naples, Naples, Italy
| | - Shiwen Koay
- Department of Brain, Repair and Rehabilitation, University College London Queen Square Institute of Neurology, London, UK.,Autonomic Unit, The National Hospital for Neurology and Neurosurgery, London, UK
| | - Ekawat Vichayanrat
- Autonomic Unit, The National Hospital for Neurology and Neurosurgery, London, UK
| | | | - Lucio Santoro
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University Federico II of Naples, Naples, Italy
| | - Valeria Iodice
- Department of Brain, Repair and Rehabilitation, University College London Queen Square Institute of Neurology, London, UK.,Autonomic Unit, The National Hospital for Neurology and Neurosurgery, London, UK
| | - Vincenzo Provitera
- Neurology Department, Skin Biopsy Laboratory, Istituti Clinici Scientifici Maugeri IRCCS, Telese Terme, Italy
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Gavan DE, Gavan A, Bondor CI, Florea B, Bowling FL, Inceu GV, Colobatiu L. SUDOSCAN, an Innovative, Simple and Non-Invasive Medical Device for Assessing Sudomotor Function. Sensors (Basel) 2022; 22:7571. [PMID: 36236669 PMCID: PMC9573142 DOI: 10.3390/s22197571] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 09/29/2022] [Accepted: 10/04/2022] [Indexed: 06/16/2023]
Abstract
Diabetic autonomic neuropathy is probably the most undiagnosed but serious complication of diabetes. The main objectives were to assess the prevalence of peripheral and autonomic neuropathy in a population of diabetic patients, analyze it in a real-life outpatient unit scenario and determine the feasibility of performing SUDOSCAN tests together with widely used tests for neuropathy. A total of 33 patients were included in the study. Different scoring systems (the Toronto Clinical Neuropathy Score-TCNS; the Neuropathy Disability Score-NDS; and the Neuropathy Symptom Score-NSS) were applied to record diabetic neuropathy (DN), while the SUDOSCAN medical device was used to assess sudomotor function, detect diabetic autonomic neuropathy and screen for cardiac autonomic neuropathy (CAN). Fifteen (45.5%) patients had sudomotor dysfunction. The SUDOSCAN CAN risk score was positively correlated with the hands' electrochemical sweat conductance (ESC), diastolic blood pressure (DBP), the level of the glycated hemoglobin, as well as with the TCNS, NDS and NSS. Performing SUDOSCAN tests together with other tests for DN proved to be a feasible approach that could be used in daily clinical practice in order to screen for DN, as well as for the early screening of CAN, before more complex and time-consuming tests.
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Affiliation(s)
- Dana Elena Gavan
- Clinic of Podiatry, 10 Iuliu Moldovan Street, 400348 Cluj-Napoca, Romania
| | - Alexandru Gavan
- Department of Medical Devices, Faculty of Pharmacy, Iuliu Hatieganu University of Medicine and Pharmacy, 4 Louis Pasteur Street, 400349 Cluj-Napoca, Romania
| | - Cosmina Ioana Bondor
- Department of Medical Informatics and Biostatistics, Faculty of Medicine, Iuliu Hatieganu University of Medicine and Pharmacy, 6 Louis Pasteur Street, 400349 Cluj-Napoca, Romania
| | - Bogdan Florea
- Clinic of Podiatry, 10 Iuliu Moldovan Street, 400348 Cluj-Napoca, Romania
| | - Frank Lee Bowling
- Faculty of Medicine, University of Manchester, Oxford Road, Manchester M13 9PL, UK
- Department of Vascular Surgery and Reconstructive Microsurgery, “Victor Babes” University of Medicine and Pharmacy, 2 Eftimie Murgu Square, 300041 Timisoara, Romania
| | - Georgeta Victoria Inceu
- Department of Diabetes, Nutrition and Metabolical Diseases, Faculty of Medicine, Iuliu Hatieganu University of Medicine and Pharmacy, 2–4 Clinicilor Street, 400006 Cluj-Napoca, Romania
| | - Liora Colobatiu
- Department of Medical Devices, Faculty of Pharmacy, Iuliu Hatieganu University of Medicine and Pharmacy, 4 Louis Pasteur Street, 400349 Cluj-Napoca, Romania
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Casellini CM, Parson HK, Bailey MD, Dyson T, Van Voorhees AS, Vinik AI, Siraj ES. Cardiac and Sudomotor Autonomic Function in Subjects with Psoriasis With and Without Metabolic Syndrome. Metab Syndr Relat Disord 2022; 20:234-242. [PMID: 35532949 DOI: 10.1089/met.2021.0112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Purpose: Studies have shown that subjects with psoriasis (PsO) are associated with an increased risk of developing metabolic syndrome (MetS), diabetes, and cardiovascular disease. In addition, MetS and diabetes are associated with autonomic dysfunction (AD). The aim of this study was to investigate cardiac and sudomotor autonomic function in subjects with PsO and without diabetes. Methods: A cross-sectional study was performed in 20 subjects with PsO, compared with age- and sex-matched 21 healthy controls, and 20 subjects with MetS. Subjects underwent skin evaluation by dermatologist, glycated hemoglobin (HbA1c), insulin, glucose, and lipid levels, sudomotor function testing with Sudoscan™ device (Impeto Medical, Paris, France), and cardiac autonomic function testing with ANSAR device (ANX 3.0; ANSAR Group, Inc., Philadelphia, PA). Quality of Life (QOL) and peripheral neurologic function were also assessed. Results: Participants with PsO were significantly more obese, had higher levels of fasting insulin and triglycerides, and were more insulin resistant when compared to controls. Subjects with PsO showed significantly worse cardiac autonomic function when compared to control and MetS groups. Sudomotor function and QOL scores were similar between the groups. Subgroup analysis of PsO subjects without MetS criteria (n = 15) showed persistent significantly deteriorated cardiac autonomic function when compared to the other two groups. Conclusion: This study suggests an association between PsO and cardiac AD, independent of the presence of overt dysglycemia and MetS. Additional larger studies are needed to clarify the significance of these findings and the relationship between PsO, AD, and metabolic disease.
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Affiliation(s)
- Carolina M Casellini
- Strelitz Diabetes Center, Endocrine & Metabolic Disorders, Department of Internal Medicine, Eastern Virginia Medical School, Norfolk, Virginia, USA
| | - Henri K Parson
- Strelitz Diabetes Center, Endocrine & Metabolic Disorders, Department of Internal Medicine, Eastern Virginia Medical School, Norfolk, Virginia, USA
| | - Michael D Bailey
- Strelitz Diabetes Center, Endocrine & Metabolic Disorders, Department of Internal Medicine, Eastern Virginia Medical School, Norfolk, Virginia, USA
| | - Taylor Dyson
- Department of Dermatology, Eastern Virginia Medical School, Norfolk, Virginia, USA
| | - Abby S Van Voorhees
- Department of Dermatology, Eastern Virginia Medical School, Norfolk, Virginia, USA
| | - Aaron I Vinik
- Strelitz Diabetes Center, Endocrine & Metabolic Disorders, Department of Internal Medicine, Eastern Virginia Medical School, Norfolk, Virginia, USA
| | - Elias S Siraj
- Strelitz Diabetes Center, Endocrine & Metabolic Disorders, Department of Internal Medicine, Eastern Virginia Medical School, Norfolk, Virginia, USA
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Allegra A, Rizzo V, Innao V, Alibrandi A, Mazzeo A, Leanza R, Terranova C, Gentile L, Girlanda P, Allegra AG, Alonci A, Musolino C. Diagnostic utility of Sudoscan for detecting bortezomib-induced painful neuropathy: a study on 18 patients with multiple myeloma. Arch Med Sci 2022; 18:696-703. [PMID: 35591819 PMCID: PMC9102521 DOI: 10.5114/aoms/114269] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2019] [Accepted: 11/16/2019] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION In the past few years, treatment of multiple myeloma has undergone a deep change for the employment of novel treatment comprising proteasome inhibitors. Bortezomib is a first-line drug in therapy of multiple myeloma. The onset of peripheral neuropathy is a dose-limiting collateral effect of the drug. This neuropathy is a distal symmetric neuropathy that affects both large and small fibers. Nerve conduction study (NCS) can be used for the diagnosis of bortezomib neuropathy, but this technique demonstrates alterations of the large nerve fibers. Sudoscan is a novel technique utilized to offer an evaluation of sudomotor function. The main objective of this study was to compare the sensitivity and diagnostic specificity of Sudoscan with respect to the nerve conduction study after bortezomib treatment. MATERIAL AND METHODS A total of 18 multiple myeloma patients were studied, 10 (55.5%) men and 8 (44.5%) women. Patients were analyzed at baseline and after 6 months of treatment with bortezomib. Subjects were submitted to nerve conduction study and electrochemical skin conductance evaluation with the Sudoscan device. Patients were also submitted to a clinical measure of pain and neuropathy. RESULTS At baseline NCS showed that only the mean sural SAP amplitude was below the 2SD lower limit of normal in 3 (16.7%) patients, while at same time we found an alteration of Sudoscan profiles in 2 (11.1%) patients. After 6 months of treatment, the NCS profiles were altered in 13 (72.2%) patients, and the Sudoscan profiles were modified in 11 (61.1%) subjects. CONCLUSIONS Our results suggest that Sudoscan can be considered for the diagnosis of bortezomib-induced neuropathy. It is objective, reproducible, and surely easier than the traditional nerve conduction study. Sudoscan may be a useful help to manage the therapeutic interventions in multiple myeloma.
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Affiliation(s)
- Alessandro Allegra
- Division of Hematology, Department of Human Pathology in Adulthood and Childhood “Gaetano Barresi”, University of Messina, Messina, Italy
| | - Vincenzo Rizzo
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Vanessa Innao
- Division of Hematology, Department of Human Pathology in Adulthood and Childhood “Gaetano Barresi”, University of Messina, Messina, Italy
| | - Angela Alibrandi
- Department of Economics, Unit of Statistical and Mathematical Sciences, University of Messina, Messina, Italy
| | - Anna Mazzeo
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Rossana Leanza
- Division of Hematology, Department of Human Pathology in Adulthood and Childhood “Gaetano Barresi”, University of Messina, Messina, Italy
| | - Carmen Terranova
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Luca Gentile
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Paolo Girlanda
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Andrea Gaetano Allegra
- Division of Hematology, Department of Human Pathology in Adulthood and Childhood “Gaetano Barresi”, University of Messina, Messina, Italy
| | - Andrea Alonci
- Division of Hematology, Department of Human Pathology in Adulthood and Childhood “Gaetano Barresi”, University of Messina, Messina, Italy
| | - Caterina Musolino
- Division of Hematology, Department of Human Pathology in Adulthood and Childhood “Gaetano Barresi”, University of Messina, Messina, Italy
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Zwack CC, McDonald R, Tursunalieva A, Cooray A, Lambert GW, Lambert EA. Does autonomic nervous system dysfunction influence cardiovascular disease risk in young adults with intellectual disability? Am J Physiol Heart Circ Physiol 2020; 320:H891-H900. [PMID: 33566748 DOI: 10.1152/ajpheart.00807.2020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
People with intellectual disability (ID) experience cardiometabolic-related morbidity and mortality. However, it has been suggested that this population presents and lives with underestimated cardiovascular risk factors at a younger age, hence affecting their overall health and quality of life and contributing to early mortality. We assessed autonomic nervous system function in subjects with ID (n = 39), aged 18-45 yr, through measures of sudomotor function, heart rate and systolic blood pressure variability, and cardiac baroreflex function. Traditional clinical cardiovascular measurements and a biochemical analysis were also undertaken. We found that young adults with ID presented with sudomotor dysfunction, impaired cardiac baroreflex sensitivity, and systolic blood pressure variability, when compared with age-matched control subjects (n = 38). Reduced hand and feet electrochemical skin conductance and asymmetry were significantly associated with having a moderate-profound ID. Autonomic dysfunction in individuals with ID persisted after controlling for age, sex, and other metabolic parameters. Subjects in the ID group also showed significantly increased blood pressure, body mass index, and waist/hip circumference ratio, as well as increased plasma hemoglobin A1c and high-sensitivity C-reactive protein levels. We conclude that autonomic dysfunction is present in young adults with ID and is more marked in those with more severe disability. These finding have important implications in developing preventative strategies to reduce the risk of cardiovascular disease in people with ID.NEW & NOTEWORTHY Adults with intellectual disability experience higher risk of premature death than the general population. Our investigation highlights increased cardiovascular risk markers and autonomic dysfunction in young adults with intellectual disability compared with control adults. Autonomic dysfunction was more marked in those with a more severe disability but independent of cardiovascular parameters. Assessment of autonomic nervous system (ANS) function may provide insight into the mechanisms of cardiometabolic disease development and progression in young adults with intellectual disability.
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Affiliation(s)
- Clara C Zwack
- Iverson Health Innovation Research Institute and School of Health Sciences, Faculty of Health, Arts and Design, Swinburne University of Technology, Hawthorn, Victoria, Australia
| | - Rachael McDonald
- Iverson Health Innovation Research Institute and School of Health Sciences, Faculty of Health, Arts and Design, Swinburne University of Technology, Hawthorn, Victoria, Australia
| | - Ainura Tursunalieva
- Department of Econometrics and Business Statistics, Monash University, Clayton, Victoria, Australia
| | - Amali Cooray
- Iverson Health Innovation Research Institute and School of Health Sciences, Faculty of Health, Arts and Design, Swinburne University of Technology, Hawthorn, Victoria, Australia
| | - Gavin W Lambert
- Iverson Health Innovation Research Institute and School of Health Sciences, Faculty of Health, Arts and Design, Swinburne University of Technology, Hawthorn, Victoria, Australia
| | - Elisabeth A Lambert
- Iverson Health Innovation Research Institute and School of Health Sciences, Faculty of Health, Arts and Design, Swinburne University of Technology, Hawthorn, Victoria, Australia
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Affes Z, Lionnet F, Livrozet M, Santin A, Frochot V, Letavernier E, Lefaucheur JP, Haymann JP. High prevalence of altered sudomotor function in homozygous sickle cell patients: influence of age and anaemia. Br J Haematol 2019; 186:e50-e52. [PMID: 30937883 DOI: 10.1111/bjh.15892] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- Zied Affes
- Service d'Explorations Fonctionnelles Multidisciplinaires, Assistance Publique - Hôpitaux de Paris (AP-HP), Hôpital Tenon, Paris, France
| | - François Lionnet
- Centre for Sickle Cell Disease, Hôpital Tenon, Assistance Publique-Hopitaux de Paris, Paris, France
| | - Marine Livrozet
- Service d'Explorations Fonctionnelles Multidisciplinaires, Assistance Publique - Hôpitaux de Paris (AP-HP), Hôpital Tenon, Paris, France.,Sorbonne Université, INSERM, UMR_S 1155, AP-HP, Hôpital Tenon, Paris, France
| | - Aline Santin
- Centre for Sickle Cell Disease, Hôpital Tenon, Assistance Publique-Hopitaux de Paris, Paris, France
| | - Vincent Frochot
- Service d'Explorations Fonctionnelles Multidisciplinaires, Assistance Publique - Hôpitaux de Paris (AP-HP), Hôpital Tenon, Paris, France.,Sorbonne Université, INSERM, UMR_S 1155, AP-HP, Hôpital Tenon, Paris, France
| | - Emmanuel Letavernier
- Service d'Explorations Fonctionnelles Multidisciplinaires, Assistance Publique - Hôpitaux de Paris (AP-HP), Hôpital Tenon, Paris, France.,Sorbonne Université, INSERM, UMR_S 1155, AP-HP, Hôpital Tenon, Paris, France
| | - Jean-Pascal Lefaucheur
- EA 4391, Nerve Excitability and Therapeutics, Faculty of Medicine, Paris Est Créteil University, Créteil, France.,Department of Physiology, Henri Mondor Hospital, Assistance Publique - Hôpitaux de Paris, Créteil, France
| | - Jean-Philippe Haymann
- Service d'Explorations Fonctionnelles Multidisciplinaires, Assistance Publique - Hôpitaux de Paris (AP-HP), Hôpital Tenon, Paris, France.,Sorbonne Université, INSERM, UMR_S 1155, AP-HP, Hôpital Tenon, Paris, France
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11
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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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12
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Abstract
Objective: The performance of the Sudoscan technology for diagnosing diabetic polyneuropathy (DPN) was evaluated against the quantitative sudomotor axon reflex test (QSART). Furthermore, the association of Sudoscan with two clinical neuropathy scoring systems was evaluated. Methods: Forty-seven patients with type 2 diabetes (20 without DPN, 27 with DPN) and 16 matched controls were examined for neuropathic symptoms and for the extent of sensory deficits. Sweat latency and volume by QSART and the skin electrochemical conductance (ESC) by Sudoscan were measured. Results: The feet and hand ESC was significantly lower in patients with DPN as compared to controls. Patients with DPN had also lower hand ESC than patients without DPN. Sensitivity and specificity of feet and hand ESC for detecting DPN were 70/85% and 53/50% respectively. QSART could not differentiate between the three groups. ESC was inversely related to neuropathic symptoms and sensory impairment. ESC was significantly correlated with sensory impairment and pain. Conclusions: Sudoscan shows a good performance in detecting subjects with DPN and it correlates well with clinical signs and symptoms of neuropathy. Significance: This study provides evidence that Sudoscan has high potential to be used as screening tool for DPN and possibly also for small fiber neuropathy in diabetic patients. HIGHLIGHTS - The sudomotor function test Sudoscan shows a good performance to detect diabetes peripheral neuropathy.- Sudoscan measures significantly correlate with clinical signs and symptoms of neuropathy.- The Sudoscan technology may help to secure clinical diagnosis of small fiber neuropathy.
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Affiliation(s)
- Sarah-Maria Krieger
- Autonomic and Neuroendocrinological Laboratory Dresden, Center of Clinical Neuroscience, University Hospital Carl Gustav Carus, Dresden, Germany
| | - Manja Reimann
- Autonomic and Neuroendocrinological Laboratory Dresden, Center of Clinical Neuroscience, University Hospital Carl Gustav Carus, Dresden, Germany
| | - Rocco Haase
- Autonomic and Neuroendocrinological Laboratory Dresden, Center of Clinical Neuroscience, University Hospital Carl Gustav Carus, Dresden, Germany
| | - Elena Henkel
- GWT-TUD mbH, Study Center Professor Hanefeld, Dresden, Germany
| | | | - Tjalf Ziemssen
- Autonomic and Neuroendocrinological Laboratory Dresden, Center of Clinical Neuroscience, University Hospital Carl Gustav Carus, Dresden, Germany
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Shivaprasad C, Goel A, Vilier A, Calvet JH. Normative Values for Electrochemical Skin Conductance Measurements for Quantitative Assessment of Sudomotor Function in Healthy Indian Adults. Indian J Endocrinol Metab 2018; 22:57-61. [PMID: 29535938 PMCID: PMC5838912 DOI: 10.4103/ijem.ijem_389_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
CONTEXT Electrochemical skin conductance (ESC) test is a widely accepted objective technique for quantitatively assessing sudomotor dysfunction, which is one of the earliest-detected neurophysiologic abnormalities in diabetic patients with distal symmetric polyneuropathy. AIMS This study aimed to provide normative data for ESC values among healthy Indian participants and assess the potential influence of age, sex, and body mass index (BMI) on ESC measurements. SETTINGS AND DESIGN A sample of 217 healthy participants aged 18-75 years were recruited and assessed for parameters including age, gender, BMI, and ESC measurements of the hands and feet. STATISTICAL ANALYSIS USED The Shapiro-Wilk test was used to assess the normality of the data. Pearson's correlation was used to evaluate the association between age, gender, and BMI, and ESC measurements. RESULTS The mean age of the participants was 43.3 ± 13.2 years, and mean BMI was 26.0 ± 4.3 kg/m2. Mean ESC for the hands and feet was 68.9 ± 13.1 and 71 ± 12.9 micro-Siemens, respectively, and there was a significant correlation between values from the right and left hands and feet (r = 0.9, P < 0.0001). A significant correlation was also observed between ESC measurements of the hands and feet (r = 0.94, P < 0.0001). ESC values of both hands and feet declined with age. A weak but significant inverse correlation between ESC and age was observed for the hands (r = 0.02, P = 0.01) and for the feet (r = 0.12, P < 0.0001). There was no significant difference in hand or feet ESC measurement between male and female participants. No significant correlation was observed between BMI and ESC of hands or feet. Only age was identified as a significant determinant of ESC on multivariate logistic regression analysis. CONCLUSIONS Normative values for Indians are lower than that reported for Caucasians.
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Affiliation(s)
- C. Shivaprasad
- Department of Endocrinology, Vydehi Institute of Medical Sciences, Bengaluru, Karnataka, India
| | - Amit Goel
- Department of Endocrinology, Vydehi Institute of Medical Sciences, Bengaluru, Karnataka, India
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Pramanik S, Ghosh S, Mukhopadhyay P, Bhattacharjee R, Mukherjee B, Mondal SA, Ghosh I, Bari R, Chowdhury S. Thyroid Status in Patients with Type 2 Diabetes Attending a Tertiary Care Hospital in Eastern India. Indian J Endocrinol Metab 2018; 22:112-115. [PMID: 29535948 PMCID: PMC5838889 DOI: 10.4103/ijem.ijem_572_17] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE Type 2 diabetes mellitus and thyroid dysfunction (TD) are two major public health endocrine problem, but the prevalence of TD and iodine status in patients with T2 DM in India is less studied. The study objective was to explore the prevalence of TD and to evaluate iodine health in type 2 diabetes patients attending a tertiary care center in Eastern India. METHODS Consecutive 100 patients with diabetes attending outpatient department were evaluated clinically and biochemically (thyrotropin [TSH], free thyroxine, anti-TPO antibody, and urinary iodine). We excluded pregnant women or patients taking drugs that can alter thyroid function. Subclinical hypothyroid and overt hypothyroidism were diagnosed as per standard definitions. RESULTS Out of 100 patients were analyzed, 51 (51%) were male. Mean (±standard deviation) age was 45.4 ± 11.2 years, body mass index 24.1 ± 4.28 kg/m2, and duration of diabetes 7.76 ± 5.77 years. The prevalence of subclinical hypothyroidism and overt hypothyroidism was 23/100 (23%) and 3/100 (3%), respectively. Thyroid autoantibody was positive in 13 (13.1%) patients. All patients were iodine sufficient. A trend toward increased neuropathy (r = 0.45) and nephropathy (r = -0.29) was associated with rising TSH. CONCLUSION Almost one in four people living with diabetes are suffering from TD. Thus, routine screening should be implemented. Salt iodination program is a huge success in this part of the country.
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Affiliation(s)
| | - Sujoy Ghosh
- Department of Endocrinology, IPGMER, Kolkata, West Bengal, India
| | | | | | | | - Samim Ali Mondal
- Department of Endocrinology, IPGMER, Kolkata, West Bengal, India
| | - Ipsita Ghosh
- Department of Endocrinology, IPGMER, Kolkata, West Bengal, India
| | - Ranajit Bari
- Department of Endocrinology, IPGMER, Kolkata, West Bengal, India
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15
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Bordier L, Dolz M, Monteiro L, Névoret ML, Calvet JH, Bauduceau B. Accuracy of a Rapid and Non-Invasive Method for the Assessment of Small Fiber Neuropathy Based on Measurement of Electrochemical Skin Conductances. Front Endocrinol (Lausanne) 2016; 7:18. [PMID: 26973597 PMCID: PMC4770015 DOI: 10.3389/fendo.2016.00018] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2015] [Accepted: 02/15/2016] [Indexed: 01/16/2023] Open
Affiliation(s)
- Lyse Bordier
- Service d’Endocrinologie, Hôpital d’Instruction-des-Armées-Bégin, Saint-Mandé, France
| | - Manuel Dolz
- Service d’Endocrinologie, Hôpital d’Instruction-des-Armées-Bégin, Saint-Mandé, France
| | | | | | | | - Bernard Bauduceau
- Service d’Endocrinologie, Hôpital d’Instruction-des-Armées-Bégin, Saint-Mandé, France
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16
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Asahina M, Mathias CJ, Katagiri A, Low DA, Vichayanrat E, Fujinuma Y, Yamanaka Y, Kuwabara S. Sudomotor and cardiovascular dysfunction in patients with early untreated Parkinson's disease. J Parkinsons Dis 2015; 4:385-93. [PMID: 24577504 DOI: 10.3233/jpd-130326] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND According to Braak staging of Parkinson's disease (PD), detection of autonomic dysfunction would help with early diagnosis of PD. OBJECTIVE To determine whether the autonomic nervous system is involved in the early stage of PD, we evaluated cardiovascular and sudomotor function in early untreated PD patients. METHODS Orthostatic blood pressure regulation, heart rate variability, skin vasomotor function, and palmar sympathetic sweat responses were examined in 50 early untreated PD patients and 20 healthy control subjects. RESULTS The mean decrease in systolic blood pressure during head-up tilt in PD patients was mildly but significantly larger than in controls (p = 0.0001). There were no differences between the 2 groups in heart rate variability, with analysis of low frequency (LF; mediated by baroreflex feedback), and high frequency (HF; mainly reflecting parasympathetic vagal) modulation. However, LF/HF, an index of sympatho-parasympathetic balance, was lower in the PD group than in controls (p = 0.02). Amplitudes of palmar sweat responses to deep inspiration (p = 0.004), mental arithmetic (p = 0.01), and exercise (p = 0.01) in PD patients were lower than in controls, with negative correlations with motor severity. Amplitudes of palmar skin vasomotor reflexes in PD patients did not differ from controls. CONCLUSIONS Our study indicates impairment of sympathetic cardiovascular and sudomotor function with orthostatic dysregulation of blood pressure control, reduced LF/HF and reduction in palm sweat responses even in early untreated PD patients.
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Affiliation(s)
- Masato Asahina
- Department of Neurology, Chiba University Graduate School of Medicine, Inohana, Chuo-ku, Chiba, Japan
| | - Christopher J Mathias
- Autonomic and Neurovascular Medicine Unit, St Mary's Hospital, Imperial College London, London, UK Autonomic Unit, The National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
| | - Akira Katagiri
- Department of Neurology, Chiba University Graduate School of Medicine, Inohana, Chuo-ku, Chiba, Japan
| | - David A Low
- Autonomic and Neurovascular Medicine Unit, St Mary's Hospital, Imperial College London, London, UK Autonomic Unit, The National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
| | - Ekawat Vichayanrat
- Autonomic and Neurovascular Medicine Unit, St Mary's Hospital, Imperial College London, London, UK Autonomic Unit, The National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
| | - Yoshikatsu Fujinuma
- Department of Neurology, Chiba University Graduate School of Medicine, Inohana, Chuo-ku, Chiba, Japan
| | - Yoshitaka Yamanaka
- Department of Neurology, Chiba University Graduate School of Medicine, Inohana, Chuo-ku, Chiba, Japan
| | - Satoshi Kuwabara
- Department of Neurology, Chiba University Graduate School of Medicine, Inohana, Chuo-ku, Chiba, Japan
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Struhal W, Javor A, Benesch T, Vosko MR, Ransmayr G. The Peripheral Sympathetic Neuron is Intact in Alzheimer's Disease and Behavioral Variant of Frontotemporal Dementia. Am J Alzheimers Dis Other Demen 2015; 30:400-4. [PMID: 25280792 PMCID: PMC10852730 DOI: 10.1177/1533317514552319] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION The study was undertaken to evaluate the postganglionic sympathetic sudomotor function employing the quantitative sudomotor axon reflex test (QSART) in tauopathies Alzheimer's disease (AD) and behavioral variant of frontotemporal dementia (bvFTD). METHODS Patients were recruited in a prospective pilot study. A structured history was taken and QSART was recorded. RESULTS In all, 15 patients with AD (7 female) and 14 patients with bvFTD (9 female) were included. Mean age (±standard deviation) of patients with AD and bvFTD was 74 ± 9 and 71 ± 10 years, respectively. Severe sudomotor dysfunction (Composite Autonomic Severity sudomotor score 3) was present in 3 (20%) patients with AD and 0 (0%) patients with bvFTD (P = .037). The upper extremity was only involved in 1 patient with AD and 1 patient with bvFTD. Sweat results of the 4 recording sites did not differ between both groups. Patients' history correlated with severe autonomic symptoms as assessed with QSART. CONCLUSION Postganglionic sudomotor involvement in AD and bvFTD is most likely not part of the disease.
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Affiliation(s)
- Walter Struhal
- Autonomic Unit, Department of Neurology and Psychiatry, Johannes Kepler University, Linz, Austria
| | - Andrija Javor
- Autonomic Unit, Department of Neurology and Psychiatry, Johannes Kepler University, Linz, Austria
| | - Thomas Benesch
- Department of Medical Statistics, Vienna Medical University, Vienna, Austria
| | - Milan R Vosko
- Autonomic Unit, Department of Neurology and Psychiatry, Johannes Kepler University, Linz, Austria
| | - Gerhard Ransmayr
- Autonomic Unit, Department of Neurology and Psychiatry, Johannes Kepler University, Linz, Austria
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18
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Abstract
Autonomic testing is used to define the role of the autonomic nervous system in diverse clinical and research settings. Because most of the autonomic nervous system is inaccessible to direct physiological testing, in the clinical setting the most widely used techniques entail the assessment of an end-organ response to a physiological provocation. The noninvasive measures of cardiovascular parasympathetic function involve the assessment of heart rate variability while the measures of cardiovascular sympathetic function assess the blood pressure response to physiological stimuli. Tilt-table testing, with or without pharmacological provocation, has become an important tool in the assessment of a predisposition to neurally mediated (vasovagal) syncope, the postural tachycardia syndrome, and orthostatic hypotension. Distal, postganglionic, sympathetic cholinergic (sudomotor) function may be evaluated by provoking axon reflex mediated sweating, e.g., the quantitative sudomotor axon reflex (QSART) or the quantitative direct and indirect axon reflex (QDIRT). The thermoregulatory sweat test provides a nonlocalizing measure of global pre- and postganglionic sudomotor function. Frequency domain analyses of heart rate and blood pressure variability, microneurography, and baroreflex assessment are currently research tools but may find a place in the clinical assessment of autonomic function in the future.
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Affiliation(s)
- Roy Freeman
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
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