Abnormal Sympathetic Skin Response Research Articles

Study on the relationship between peripheral nerve fiber types and levodopa usage in Parkinson's disease.

<p>The aim of this study is to comprehensively determine the types of affected fibers in Parkinson&rsquo;s disease (PD) patients by employing nerve conduction studies (NCS), sympathetic skin response (SSR) examinations, and current perception threshold (CPT) testing and to analyze the correlation between levodopa use and nerve involvement.</p>. <p>This retrospective study included 36 clinically diagnosed PD patients who were recruited between January 2018 and April 2019. All patients underwent NCS, SSR testing, and CPT sensory examinations. Additionally, the PD patients were assessed for disease staging using the Hoehn and Yahr (H-Y) scale.&nbsp;</p>. <p>Fifteen patients were included in the tremor-dominant subtype, ten patients in the rigid-dominant subtype, and eleven patients in the mixed subtype. Eleven patients were using levodopa, while twenty-five patients had never used any anti-Parkinson&rsquo;s medication. Ten patients (28%) showed abnormal sympathetic skin responses (SSR). The CPT examination revealed sensory abnormalities in twenty-four patients (67%), with eighteen patients (75%) experiencing sensory hypersensitivity and six patients (25%) experiencing sensory hypoesthesia. Twelve patients (33%) had normal CPT results. Among the patients with abnormal CPT findings, seven cases (29%) involved large myelinated fiber damage, twenty-two cases (92%) involved small myelinated fiber damage, and nineteen cases (79%) involved unmyelinated fiber damage. The rate of sensory abnormalities was 64% (7/11) in the levodopa group and 68% (17/25) in the non-levodopa group, with no statistically significant difference between the two groups.&nbsp;</p>. <p>The incidence of abnormal CPT findings in PD patients was higher than that of abnormal SSR responses, suggesting that nerve fiber damage primarily affects small fiber nerves (SFN).</p>.

Autonomic Dysfunction in Amyotrophic Lateral Sclerosis - A Case-Control Study.

This study aimed to explore autonomic nervous system involvement in amyotrophic lateral sclerosis (ALS) patients by evaluating sympathetic skin response (SSR). The study included 35 sporadic (ALS) patients (cases), and 35 healthy age and sex-matched participants (controls) aged <60 years. SSR was recorded in the electrophysiology lab of the Neurology Department of Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh. Patients with diseases associated with peripheral or autonomic neuropathy were excluded. Prolonged latency (delayed SSR) or an absent response was considered abnormal SSR. SSR was found to be abnormal in 17 (48.6 %) ALS cases, with an absent response in the upper limbs of six cases (17.1%). Abnormal SSR was more prevalent in the lower limbs, with 33 (94.3%) and 20 (57.1%) cases having a delayed or absent response, respectively. In comparison, SSR was normal in all control participants (P-value <0.05). Abnormal SSR was significantly more common in the lower limbs of ALS cases with bulbar palsy than those without bulbar palsy (P-value=0.04). There was no association of SSR with disease severity and duration. ALS is significantly associated with abnormal SSR, indicating autonomic nervous system involvement. There could also be an association between bulbar palsy and abnormal SSR among ALS patients. Further studies should be carried out to determine the association of abnormal SSR with disease severity, duration, and type.

Abnormal quantitative sudomotor axon reflex test results in patients with tinnitus as a possible indicator of small fiber neuropathy.

A few cases of small fiber neuropathy (SFN) and tinnitus (TN) associated with coronavirus disease 2019 have been reported. However, the relationship between SFN and TN has not been studied. This study investigated a possible relationship between SFN and patients with TN (PwTNs) using autonomic function tests (AFTs) including quantitative sudomotor axon reflex tests (QSART). We performed QSARTs and other AFTs such as the Sympathetic skin response (SSR), Valsalva ratio (VR), and heart rate variability (HRV). The QSART results, obtained at seven hospitals using same protocols, were compared between PwTNs and healthy controls. We confirmed the abnormalities in SSR, VR, and HRV in PwTNs, although those parasympathetic AFTs were not performed in healthy controls. Additionally, we checked Tinnitus handicap inventory (THI) scores for PwTNs and ~50% of PwTNs had low-grade disability, whereas 9.3% had high-grade disability. Data from 57 PwTNs and 122 healthy controls were analyzed. The sweat volumes of QSART in the older age group tended to be higher in the PwTNs than in age-matched healthy controls, and significant differences between the PwTN and control groups were observed in the feet in both sexes (p < 0.001) and in the arms in women (p = 0.013). In the younger age group, the sweat volumes in the feet of men were higher in PwTNs than in healthy controls (p = 0.017). No association was observed between THI and QSART scores. In this study, the sweat volumes in QSARTs were higher in PwTNs than in healthy controls. However, abnormal SSR, HRV, and VR results were not commonly observed in PwTNs. Although the results should be interpreted with caution because of limitations in study, PwTNs might also have SFN apart from dysautonomia. This is the first study to perform QSART with other parasympathetic AFTs in PwTNs. However, larger and more rigorously controlled studies will be needed to reveal the relationship between SFN and TN in the future.

Sympathetic skin response for early detection of type 2 diabetic peripheral neuropathy and nephropathy.

Diabetic peripheral neuropathy (DPN) and diabetic nephropathy (DN) are common complications of type 2 diabetes mellitus (T2DM). Although nerve conduction studies (NCS) and sympathetic skin response (SSR) can detect DPN, the more sensitive method for early diagnosis remains unclear. Furthermore, whether DPN can be used as a predictor for diabetic nephropathy needs clarification. We evaluated nerve conduction studies, sympathetic skin response, and the diabetic nephropathy indicator microalbuminuria (MAU) in 192 patients with type 2 diabetes mellitus and 50 healthy controls. Patients with type 2 diabetes mellitus showed a lower sensory nerve conduction velocity (SCV), sensory active nerve potential (SNAP), motor nerve conduction velocity (MCV), and compound motor action potential (CMAP) than the controls on NCS. Abnormal rates for nerve conduction studies and sympathetic skin response were 75.0% and 83.3%, respectively, in patients with type 2 diabetes mellitus. Interestingly, 54.2% of patients with normal nerve conduction studies had an abnormal sympathetic skin response. Moreover, we found a positive correlation between sympathetic skin response and microalbuminuria for the first time. The abnormal rate of microalbuminuria was 53.8%, lower than that of abnormal nerve conduction studies or sympathetic skin response patients. Sympathetic skin response is a more sensitive method than nerve conduction studies for the early diagnosis of diabetic peripheral neuropathy. Abnormal sympathetic skin response might serve as an indicator for early diabetic nephropathy. Additionally, diabetic peripheral neuropathy may occur earlier than diabetic nephropathy in the development of type 2 diabetes mellitus.

Sympathetic skin response (SSR) in pediatric Guillain-Barré syndrome.

In the present study, sympathetic skin response (SSR) characteristics were explored in children with Guillain-Barré syndrome (GBS) and the value of early diagnosis and prognostic evaluation in GBS complicated by autonomic dysfunction (AD) was evaluated. A total of 25 children with GBS and 30 healthy controls (HCs) were enrolled in this prospective study. SSR findings for the two groups were compared. SSR and nerve conduction study (NCS) results were compared among patients with GBS, and differences in clinical characteristics between the groups with abnormal and normal SSR were analyzed. Within the GBS group, six patients (24%) required mechanical ventilation, 17 patients (66.7%) had AD, 18 patients (72%) had an abnormal SSR, and 13 patients (52%) had AD combined with SSR abnormalities. There was a statistically significant difference in SSR latency in the lower limbs between the GBS group and HCs (P < 0.05). There was no statistically significant difference between SSR and NCS results in the acute phase of GBS (P > 0.05), and there was no significant difference in the rate of AD or in Hughes functional grade at nadir between the groups with abnormal and normal SSR (P>0.05). However, there was a statistically significant difference between the results of SSR and NCS tests during the recovery phase (P = 0.003). Abnormal SSR mainly occurred in cases of the acute inflammatory demyelinating polyradiculoneuropathy (AIDP) subtype. In addition, SSR was abnormal in all pediatric GBS patients with poor prognosis 1 month after onset of symptoms. Two-thirds of the children with GBS have AD. SSR could be used for early diagnosis and follow-up of GBS and may also be helpful in evaluating disease severity and short-term prognosis.

Characteristics of sympathetic skin response in children with Guillain-Barré syndrome

To explore the value of sympathetic skin response (SSR) in the early diagnosis and prognostic evaluation of Guillain-Barre syndrome (GBS) in children. A retrospective analysis was conducted on the clinical data of 25 children with GBS who were diagnosed from October 2018 to November 2022, and 30 children who were diagnosed with Tourette's syndrome during the same period were selected as the control group. The characteristics of SSR were compared between the two groups, and the association of SSR with autonomic dysfunction (AD), disease severity, and prognosis was analyzed. The GBS group had a significantly higher abnormal rate of SSR than the control group during the acute phase (P<0.001). SSR combined with early nerve conduction (within 2 weeks after onset) had a sensitivity of 84%, a specificity of 100%, and an accuracy of 93% in the diagnosis of GBS. There were no significant differences in the proportion of AD cases, as well as the Hughes scores during the disease peak, between the abnormal and normal SSR groups (P>0.05). All 7 children with poor short-term prognosis (at 1 month after onset) had abnormal SSR. SSR can be used for the early diagnosis of GBS and the monitoring of treatment response in children.

Study of sympathetic skin response in patients with COVID-19 infection.

ObjectivesMany articles hypothesized the potential role of autonomic nervous system in the pathogenesis and outcome of COVID-19 infection. Several studies reported both central and peripheral nervous system involvement in COVID-19 as well. Up to our knowledge, there is no study evaluating whether this virus could invade the autonomic nervous system affecting its function adversely. Sympathetic skin response (SSR) has long been used as a method of evaluating the autonomic nervous system. Regarding the importance of the autonomic nervous system in hemostasis and wide consequences of COVID-19 infection, we designed this study to evaluate the autonomic nervous system function in patients recovered from COVID-19 compared with normal population who are not yet infected by this virus by the means of SSR. MethodsThis case–control study included 70 patients surviving COVID-19 who met the inclusion and exclusion criteria that went under SSR. The data gathered were compared with those without the history of any symptoms attributable to COVID-19 during the pandemic.ResultsThere was a correlation between COVID-19 infection and abnormal SSR (p value < 0.0001) with the most effect on the latency prolongation of the action potential recorded from the median nerve at palms (effect size: right: 3.90, left: 3.69). Moreover, the greater severity of the disease correlated with more abnormality of parameters recorded by SSR technique.ConclusionsAbnormal SSR parameters could be a good indicator of autonomic nervous system involvement in patients with COVID-19 infection. It might be a predictor of disease severity, clinical outcomes and prognosis as well.

The 482nd case: vomiting, paroxysmal dizziness and anhidrosis

A 31-year-old woman was admitted to Peking Union Medical College Hospital presented with intermittent vomiting and abdominal pain for 2 years, and recurrence with paroxysmal dizziness for 1 month. This patient was diagnosed with systemic lupus erythematosus (SLE) 2 years ago with involvement of gastrointestinal and urinary tracts. One month ago, repeated vomiting and nausea recurred. No laboratory and imaging abnormalities were found in central nervous system and gastrointestinal evaluation. Orthostatic hypotension and fluctuation of blood pressure were recorded during hospitalization. Combined with sexual dysfunction, left adie pupil, anhidrosis and abnormal sympathetic skin response, autonomic nerve dysfunction related to SLE was diagnosed. After treated with pulse glucocorticoids and intravenous immunoglobulin, the patient's symptoms improved remarkably. Orthostatic hypotension in SLE patients may link to autonomic nerve dysfunction.

The Dysfunctional Autonomic Function and "Dysfunctional" Fatigue in Drug Naïve Parkinson's Disease.

Fatigue is a common and disabling non-motor symptom in Parkinson's disease (PD). Autonomic dysfunction is suggested as the possible pathophysiology of fatigue, but it has not been investigated in drug-naïve PD patients. In the present study, the relationship between fatigue and autonomic dysfunction in drug-naïve PD patients was investigated. In the present study, 89 drug-naïve PD patients were analyzed. The Parkinson's disease fatigue scale (PFS) was used to divide the patients into fatigue (mean PFS≥3.3) and non-fatigue groups (mean PFS < 3.3). The autonomic function test (AFT), Scale for Outcomes in Parkinson's Disease-Autonomic (SCOPA-AUT), Unified Parkinson's Disease Rating Scale (UPDRS)-I, -II, -III, modified Hoehn and Yahr (H&Y) scale, Montreal Cognitive Assessment (MoCA), Parkinson's Disease Questionnaire-39 (PDQ-39), Parkinson's Disease Sleep Scale (PDSS), and Beck Depress Index (BDI) were performed in all the participants. The AFT results and clinical scales were compared using multiple logistic regression analysis. The prevalence of fatigue was 23.6% (n = 21) in drug-naïve PD patients. Total SCOPA-AUT score was higher in the fatigue group than in the non-fatigue group. The fatigue group had lower inspiratory:expiratory (I:E) ratio and Valsalva ratio. The prevalence of abnormal sympathetic skin response and orthostatic hypotension (OH) was 19% and 38.1%, respectively, in the fatigue group. Regression model analysis revealed that SCOPA-AUT and OH were the most related factor of fatigue in drug-naïve PD patients. Autonomic dysfunction in drug-naïve PD patients was investigated using a subjective scale as well as objective tests. The results indicated that fatigue is associated with autonomic dysfunction, especially OH, in drug-naïve PD patients.

P67-T The value of Sympathetic Skin Response in diagnosing Complex Regional Pain Syndrome

CPRS is a highly painful disorder affecting a limb, usually following traumatic injury. The syndrome includes continuous pain, inflammation and tissue hypoxia, sympathetic dysregulation, small fibre damage, serum antibodies, central sensitization and cortical reorganization. The diagnosis is clinical and can be supported by complementary bone scintigraphy and thermography. Our purpose is to evaluate the role of Sympathetic Skin Response (SSR) in diagnosing CPRS. A prospective and descriptive study was carried out with 51 patients in initial stages of CPRS. SSR was measured in affected and unaffected hands or feet after 3 stimuli applied to contralateral median or posterior tibial nerves. Values were considered abnormal when peak to peak amplitude response was >50% compared to contralateral extremity. Thermal sensory and pain thresholds were also evaluated. Clinical symptoms and signs were recorded: continuous pain, allodynia, changes in thermoalgesic sensitivity, hyperalgesia, inflammation, swelling and limb dysfunction. We studied the correlation between clinical signs and SSR changes. Mobility impairment was found in 78% of patients, followed by swelling (68%), sweating (37%) and allodynia (24%). SSR was abnormal in 49% of patients, who presented a significant correlation between abnormal SSR response, swelling, thermal sensory thresholds and temperature changes (p < 0.05). SSR can be a useful tool for CPRS diagnosis. It may be used as a means of documenting sympathetic dysfunction and help in treatment decision management as it assists in the clarification of the many controversies regarding the cause of CPRS, which remains unknown.

O-1-06. Relationships between sympathetic skin responses and 123I-etaiodobenzylguanidine myocardial scintigraphy in neurological disorders

While various neurological disorders show abnormalities of both skin and cardiac sympathetic nerve functions, their relationship and clinical relevance have not been fully clarified. We investigated the relationship between abnormalities of the sympathetic skin responses (SSR) and 123I-metaiodobenzyl-guanidine (MIBG) myocardial scintigraphy in neurological disorders. We recorded both of these examinations in 19 patients with Parkinson’s disease or dementia with Lewy bodies, 7 with multiple system atrophy, 7 with other parkinsonism and 10 with others diseases. We excluded the cases complicated with myelopathy or neuropathy. We analyzed the relationship between SSR and the heart/mediastinum (H/M) ratio of the delayed image of MIBG myocardial scintigraphy using Welch’s t -test and Pearson’s chi-square test. We defined abnormal SSR as dissipation in at least two limbs. The mean H/M ratio in the patients with abnormal SSR was significantly lower (1.76) than that in those with normal SSR (2.51; p = 0.0014 by Welch’s t -test). Chisquare test also showed a significant difference across the patient subgroups showing normal or abnormal SSR and H/M ratio (p = 0.0017). In conclusion, the peripheral sympathetic skin and heart nerves may be concomitantly involved in the systemic autonomic nervous disorders.

Neuroelectrophysiological characteristics of peripheral neuropathy in primary Sjögren's syndrome: study protocol for a prospective case series and pre-preliminary results

Background and objectives: Sjogren's syndrome (SS) is a chronic progressive autoimmune disease. The incidence of peripheral nervous system damage in patients with primary SS (pSS) is 10–30%. Previous studies have shown that there are multiple electrophysiological manifestations in pSS patients presenting with peripheral neuropathy. However, there is no consensus on its neuroelectrophysiological manifestations. Peripheral neuropathy associated with pSS is easily confused with peripheral neuropathy of other etiologies. We hope to observe the neuroelectrophysiological manifestations of peripheral neuropathy associated with pSS to assist in the diagnosis of the disease. Design: A prospective case series. Methods: A total of 100 pSS patients with peripheral neuropathy receiving treatment in the Department of Neurology, First Affiliated Hospital of Kunming Medical University, China will be included in this study. Fifty-two patients presenting with peripheral neuropathy associated with pSS have been included in a preliminary investigation. Outcome measures and preliminary results: The primary outcome measure is the incidence of abnormal motor nerve conduction velocity in these patients. The secondary outcome measures are the incidences of abnormalities in terminal motor latencies, compound muscle action potential amplitudes, sensory nerve conduction velocities, sensory nerve action potential amplitudes, F waves, and sympathetic skin responses. The results of 52 patients included in the preliminary study showed that the incidences of each electrophysiological index was similar between the upper and lower extremities. Abnormal motor nerve conduction velocity occurred more frequently than abnormal compound muscle action potential amplitude. Abnormal sensory nerve conduction velocity was observed significantly more often than abnormal sensory nerve action potential amplitude. Abnormal motor nerve conduction velocity had a similar incidence to abnormal sensory nerve conduction velocity. Abnormal compound muscle action potential amplitude had a similar incidence to abnormal sensory nerve action potential amplitude. Abnormal F waves were observed significantly less frequently than abnormal motor nerve conduction study. Abnormal sympathetic skin response was seen with a similar incidence to abnormal motor nerve conduction study. Discussion: The results of this study, as indicated by the preliminary investigation, will reveal the neuroelectrophysiological abnormalities in peripheral neuropathy associated with pSS, which will aid diagnosis of the disease. Ethics and dissemination: This study was approved by Medical Ethics Committee of Kunming Medical University of China on October 14 th , 2005 (approval No. 20051014). The study protocol was designed in September 2016 and registered in April 2018. The study protocol received ethics approval from Medical Ethics Committee of Kunming Medical University of China on October 14 th , 2016 (approval No. 2016101411). Patient recuritment for the preliminary study was performed during January to October 2017. Patient recuritment for this study will begin in June 2018. Data collection will end in December 2020. The current study will be performed from June 2018 to December 2020. Results will be disseminated through presentations at scientific meetings and/or by publication in a peer-reviewed journal. Anonymized trial data will be published at www.figshare.com . Trial registration: This trial was registered with the Chinese Clinical Trial Registry (registration number: ChiCTR1800015669).

Diabetic and sympathetic influences on the water permeability barrier function of human skin as measured using transepidermal water loss: A case-control study.

The presence of long-standing hyperglycemic conditions has been suggested to lead to many skin problems associated with an impaired skin barrier function. However, the relationship between impaired skin barrier status and altered peripheral nervous system function has not yet been determined. The purpose of this study was to investigate the water evaporation rate as a measure of the permeability barrier function of diabetic skin and its relationship to diabetic sensorimotor polyneuropathy (DSPN) and peripheral autonomic neuropathy (PAN) using well-controlled confounding variables.This case-control study included 42 participants with chronic diabetes and 43 matched healthy controls. The diabetic group underwent a nerve conduction study and sympathetic skin response (SSR) test to confirm the presence of DSPN and PAN, respectively. Different skin regions were analyzed using the noninvasive Tewameter instrument (Courage + Khazaka Electronic GmbH, Cologne, Germany). The impacts of PAN, DSPN, age, and diabetes duration on the values of transepidermal water loss (TEWL) were each analyzed and compared between the groups.Regardless of the presence of DSPN or PAN, the TEWL values as measured on the distal extremities were significantly lower in the diabetic group than in the control group. In the diabetic group, participants with abnormal SSR test results showed decreased TEWL values in the finger, sole, and first toe, as compared with participants with normal SSR test results. In the control group, age showed a negative correlation with the TEWL values with respect to some measured regions. However, in the diabetic group, there was no significant correlation between either patient age or diabetes duration and TEWL values.The presence of a long-term hyperglycemic state can reduce the permeability barrier function of the skin, a phenomenon that might be related to the presence of an impaired peripheral sympathetic nervous system, rather than peripheral sensorimotor denervation.

Characteristics of sympathetic skin response in patients with multiple system atrophy

Objective: To provide evidence for early clinical diagnosis of multiple system atrophy(MSA)by studying the characteristics of sympathetic skin responses(SSR) in the patients with MSA. Methods: A total of 47 MSA patients and 32 healthy individuals were enrolled as case group and normal control(NC) group, from in and out patients of Neurology Department of Navy General Hospital from July 2013 to August 2015. SSR was tested by Nicolet electromyography, the latency and abnormal and disappeared rate of SSR were compared. Results: The SSR latency of upper limbs and lower limbs in MSA group had statistical significance compared respectively with the NCgroup (upper limbs: SSR latency was(1 485±187)ms in MSA group, and(1 375±108)ms in NC group, P<0.05; lower limbs: SSR latency was(2 200±386)ms in MSA group, and(1 994±240)ms in NC group, P<0.05). Sex and age had no significant effect on the latency and the abnormal and disappeared rate of SSR in two groups (P>0.05). The upper and lower limb SSR latency in MSA patients with disease duration more than 2 years(SSR latency was (1 592±160)ms in upper limb and (2 268±254)ms in lower limb) were longer than those within 2 years(SSR latency was (1 453±184)ms in upper limb and (2 190±442)ms in lower limb), but only the upper limbs had significantly statistical differences (P<0.05). Both SSR abnormal rate and SSR disappeared rate in MSA patients whose disease duration were more than 2 years(SSR abnormal rate: 85.00%, SSR disappeared rate: 75.00%) were higher than those with shorter disease duration(SSR abnormal rate: 55.56%, SSR disappeared rate: 22.22%), and both were statistically significant (SSR abnormal rate: P<0.05, SSR disappeared rate: P<0.001). The upper and lower limb SSR latency of MSA-C subgroup had no statistical difference compared with MSA-P subgroup(P>0.05). The SSR abnormal rate in MSA-C subgroup(78.13%) was higher than that of MSA-P subgroup(46.76%), and were statistically significant (P<0.05). The SSR disappeared rate in MSA-C subgroup has no statistical difference compared with the MSA-P subgroup(P>0.05). Conclusions: SSR is helpful to diagnose MSA. The latency and the abnormal and disappeared rate of SSR are significantly increased with the extension of MSA duration. The SSR abnormal rate in MSA-C patients is higher than that in MSA-P patients, and symmetrically abnormal SSR is more supporting the diagnosis of MSA.

Correlations of neurophysiological features with clinical manifestation in patients with diabetic peripheral neuropathy

Objective To explore the correlation of electrophysiological features with clinical manifestation in patients with diabetic peripheral neuropathy(DPN). Methods The clinical data of 306 patients with DPN undergoing nerve conduction study (NCS) during May 2013 to June 2015 were retrospectively analyzed. Among 306 patients, 304 were type 2, and 2 were type 1 diabetes with a mean age of 64.1 years and disease duration of 1 week-31 years. The relationship between the electrophysiological features and clinical manifestations was evaluated. Nerve conduction studies and F-wave and in sympathetic skin response were analyzed. Results ① NCS in lower limbs presented more abnormalities than that in upper limbs. There was the highest prevalence of not elicited sensory potential in Tibial nerve [56.9%(174/306), χ2=175.9] and the highest prevalence of not elicited motor potential in peroneal nerve [7.8%(24/306), χ2=1 103.1]. Amplitude abnormality was more severe in sensory nerve than that in motor nerve [41.4%(507/1 224) vs. 10.8%(132/1 224), χ2=559.2]. The ratio of abnormal motor conduction velocity or distal latency was higher than that of amplitude decreased [22.9%(280/1 224) vs. 10.8%(132/1 224), χ2=1 077.4]. ② The abnormal ratios of the shortest F-wave latency was lower than that of the prolonged distal latency in median and tibial nerve [5.4%(33/612) vs. 20.6%(126/612), χ2=607.6]. ③ The abnormal ratio of sympathetic skin response (SSR) in lower limbs were higher than that of upper limbs [40.2%(246/612)vs. 27.3%(167/612), χ2=129.4, P<0.001], abnormal ratio of amplitude was higher than that of the prolonged latency [30.1%(368/1 224) vs. 4.7%(58/1224), χ2=1 040.5, P<0.001]. Among the 99 cases presenting abnormal SSR in upper limbs, 32 cases were normal in conventional NCS. Among the 127 cases presenting abnormal SSR in lower limbs, 7 cases were normal in conventional NCS. ④Disease course and glycosylated hemoglobin values were positively correlated with the distal motor latency, and negatively correlated with the nerve conduction velocity and amplitude. Conclusion Electrophysiological features of DPN is mainly shown in axon of the distal sensory nerve. Long duration and hyperglycemia may lead to more abnormalities in electrophysiological tests. Key words: Diabetic neuropathies; Peripheral nerves; Neural conduction studies; Electrophysiology

A study of autonomic dysfunction and sympathetic skin response in motor neuron disease

To explore the symptoms of autonomic dysfunction and sympathetic skin response (SSR) abnormality in patients of motor neuron disease (MND). The clinical features of autonomic dysfunction were collected as follows: dermal numbness or pruritus, parahidrosis, xerostomia, salivation, abnormal skin temperature, orthostatic hypotension, mydriasis, ptosis or abnormal pupillary light reflex, constipation, voiding dysfunction and sexual dysfunction. SSR was performed and the results were judged according to the normal range of our laboratory. Abnormality rate in MND patients was calculated. The relationship between clinical symptoms and SSR parameters were analyzed statistically. Among a total of 142 MND patients, the symptom incidences of autonomic dysfunction were as follows: dermal numbness (53.5%), dermal pruritus (15.5%), parahidrosis (10.6%), xerostomia (9.1%), salivation (2.1%), abnormal skin temperature (14.8%), orthostatic hypotension (2.1%), constipation (16.2%), voiding dysfunction (9.9%) and sexual dysfunction (1.4%). Abnormal SSR was found in 51/142 (35.9%) patients, including 12(8.5%) in palmar and 47(33.1%) in plantar. The features of abnormal SSR included delayed latency of palmar (P < 0.05) and decreased amplitudes of both palmar and plantar compared with normal ranges (P < 0.01 respectively). The group of patients with lumbosacral onset had a higher abnormal rate of SSR than those of other onset sites. There was no significant correlation between clinical symptoms and abnormal SSR parameters. The patients of MND exhibit autonomic dysfunctions of skin, gland secretion, cardiovascular system and sphincters. Some of them show abnormal SSR with prolonged latency and decreased amplitude. The abnormalities of SSR are not related to clinical features of autonomic dysfunction. Those with an onset of lower limbs have a higher rate of abnormal SSR.

Réponses cutanées sympathiques et sclérose en plaques : étude descriptive, prospective et association aux troubles neuropérinéaux

Describe the sympathetic skin responses (SSRs), reflecting the sweat activity mediated by the sympathetic nervous system, in patients with multiple sclerosis (MS) followed for urinary disorders and associate SSRs abnormalities with neuroperineal disorders. Prospective monocentric study of a population suffering from MS, who received symptom scores (Expanded Disability Status Scale [EDSS], Urinary Symptoms Profile [USP], Neurogenic Bowel Dysfunction [NBD], International Index of Erectile Function [IIEF] and Female Sexual Function Index [FSFI]) and whose SSRs were collected from the hand palm, the foot sole and the genital skin after mechanical stimulation, before and after anticholinergic drug. Twenty-eight patients were included. Among them, 18 had an abolition of SSR, respectively 10, 14 and 17 at palm, perineum and foot sole. The absence of SSR was not related (P>0.05) with the duration of disease, the EDSS score, USP, IIEF15 or NBD scores. There was a statistically significant relationship between the abolition of SSR at perineum and women genitosexual disorders (P=0.01). Anticholinergic drugs remove 40 % of SSRs at hand and 67% at foot. The abolition of SSR at perineum was associated with the abolition of the SSR at sole (P=4 × 10(-5)). In these MS patients with neuroperineal disorders, more than half showed abnormal SSR. These abnormalities did not seem associated with urinary or rectal disorders but with genitosexual disorders in women. Under anticholinergic treatment, SSR frequently disappeared at palm and foot sole. 4.

P214: Study of sympathetic skin response in diabetic patients with soft tissue rheumatism of the hand

P214: Study of sympathetic skin response in diabetic patients with soft tissue rheumatism of the hand

Sympathetic skin response in patients with vascular erectile dysfunction.

PurposeWe aimed to investigate the utility of sympathetic skin response (SSR) test for evaluating vasculogenic erectile dysfunction (ED) which is the most common type of impotence.Materials and MethodsMen in the age group of 28 to 60 years and suffering from vasculogenic ED, as confirmed by a papaverin test and color Doppler sonography, at least for 6 months referred from our university urology department were included. We used the International Index of Erectile Function (IIEF-5) for grading severity of dysfunction and recorded the SSR of every patient from the median, tibial, and dorsal nerves of the penis. One-way analysis of variance (ANOVA), independent t-test and Pearson's correlation coefficient were used for comparing quantitative variables, and Fisher's Exact test was used for comparing qualitative variables. The Mann-Whitney U Test and the Kruskal-Wallis test were performed for analysis of data that were not normally distributed. A p value of less than 0.05 was considered significant.ResultsForty-two patients were recruited for the study. We found a strong statistical relationship between the IIEF score and the pathologic SSR registered from every mentioned nerve. Patients with abnormal SSR had more severe ED according to IIEF score (p<0.001). In addition, the IIEF score had a significantcorrelation with diabetes mellitus and cardiovascular disease (t-test; p<0.05).ConclusionsOur results confirmed the presence of autonomic dysfunction in patients with vasculogenic impotence via an SSR test. We suggest evaluating the efficacy of the SSR test in patients with vascular impotence for treatment response monitoring in future studies.

SAT0413 Sympathetic Skin Response in Diabetic Patients with Soft Tissue Rheumatism of the Hand

BackgroundMusculoskeletal complications of the hand may be very debilitating for the diabetic patient. The most commonly recognized complications are trigger finger, tenosynovitis, Dupuytren’s contrcture, carpal tunnel syndrome (CTS), and limited...