59. Can sacral SSR recordings be useful in the assessment of autonomic nervous dysfunction in patients with sacral-pudendal impairment?

Abstract

While it is well know the usefulness of neurophysiological tests to investigate somatic nervous system of pelvic floor, it is not yet recognized the real efficacy of sympathetic skin response (SSR). In the last years we examined more than 1500 patients with different pelvic disorders (age range 7–85 years). All patients were studied with pudendal EMG, SEP, MEP, sacral reflexes. SSR was recorded from skin of sacral area (i.e. penis or mons pubis, perineal area, perianal area according to symptoms), applying random single square pulses at wrist or supraorbital region. SSR latency and amplitude were measured and the results were compared by mean age with those of control group. We observed alterations in latency and/or amplitude and in some cases SSR changes were the only present abnormality. We have also observed that it is important to differentiate anterior from posterior perineal area in SSR recording. SSR test may be a useful tool to investigate autonomic sacral involvement, because until now it is the only test to explore autonomic system. In our experience SSR is always present, in absence of pathology, so it could become a standard investigation for clinical routine of patients with sacral disorders.