Sympathetic Skin Response Amplitude Research Articles

Association Analyses of Autonomic Dysfunction and Sympathetic Skin Response in Motor Subtypes of Parkinson's Disease.

Introduction: Autonomic dysfunction is a common and disabling non-motor symptom of Parkinson's disease (PD). We aimed to understand autonomic dysfunction in PD motor subtypes, the pattern of sympathetic skin response (SSR) to motor asymmetry, and the association of SSR with autonomic and motor dysfunctions.Methods: A total of 101 PD patients of Han Chinese were included. Unified PD rating scale (UPDRS), scales for outcomes in PD-autonomic symptoms (SCOPA-AUT), orthostatic hypotension, and SSR were evaluated.Results: SCOPA-AUT and incidences of orthostatic hypotension and absent SSR were worse in the subtype of postural instability gait disorder (PIGD) than the subtypes of tremor dominant and intermediate. SSR latency and amplitude were asymmetrical corresponding to the accentuation of motor severity. Patients with absent SSR had worse UPDRS and SCOPA-AUT scores. SSR parameters of the severe side in patients with SSR showed no independent association with the scores.Conclusion: Our results support that autonomic dysfunction is more severe in the PIGD than other subtypes and demonstrate an asymmetry of SSR in PD patients. Absent SSR may indicate worse autonomic and motor symptoms, but SSR parameters are not sufficient to evaluate the severity of the dysfunctions.

Acute effects of contrast bath on sympathetic skin response in patients with poststroke complex regional pain syndrome

Purpose Complex regional pain syndrome (CRPS) is one of the common complications in stroke patients. Sympathetic dysfunction is usually considered underlying pathology. The evidence for contrast bath (CB) used in the treatment of CRPS is limited. The aim of the study is to investigate the possible effects of CB on the sympathetic activity in poststroke CRPS. Materials and methods Stroke patients with CRPS (CRPS group) and without CRPS (control group) were included in the study. Age, gender, duration of stroke, aetiology, plegic side, dominant hand, spasticity level, Brunnstrom stages, and comorbidities were recorded. CB was performed for one session to the plegic side of the CRPS and control groups. Sympathetic skin responses (SSR) was recorded from the plegic and healthy hands of participants at pre-CB and post-CB. Results Each group consisted of 20 participants. No significant difference was detected in stroke duration, aetiology, and Brunnstrom stages between groups. Elbow spasticity level was significantly higher in CRPS group (p = .034). SSR amplitudes of plegic hands were significantly decreased after CB in CRPS and control groups (p = .0002, p = .013 respectively). Also, CB reduced the SSR amplitude of healty side in CRPS group (p = .003). There was no statistically significant change in SSR latency or percentage changes of SSR amplitude and latency after CB in both groups. Conclusion CB leads to a significant reduction in sympathetic activity of plegic side of stroke patients. Also, CB to the plegic side has an inhibitory effect on sympathetic activity of healty side in poststroke CRPS. ClinicalTrials.gov ID: NCT04198532

Pain-autonomic interaction: A surrogate marker of central sensitization.

Central sensitization represents a key pathophysiological mechanism underlying the development of neuropathic pain, often manifested clinically as mechanical allodynia and hyperalgesia. Adopting a mechanism-based treatment approach relies highly on the ability to assess the presence of central sensitization. The aim of the study was to investigate potential pain-autonomic readouts to operationalize experimentally induced central sensitization in the area of secondary hyperalgesia. Pinprick evoked potentials (PEPs) and sympathetic skin responses (SSRs) were recorded in 20 healthy individuals. Three blocks of PEP and SSR recordings were performed before and after heat-induced secondary hyperalgesia. All measurements were also performed before and after a control condition. Multivariate analyses were performed using linear mixed-effect regression models to examine the effect of experimentally induced central sensitization on PEP and SSR parameters (i.e. amplitudes, latencies and habituation) and on pinprick pain ratings. The noxious heat stimulation induced robust mechanical hyperalgesia with a significant increase in PEP and SSR amplitudes (p<0.001) in the area of secondary hyperalgesia. Furthermore, PEP and SSR habituation were reduced (p<0.001) after experimentally induced central sensitization. The findings demonstrate that combined recordings of PEPs and SSRs are sensitive to objectify experimentally induced central sensitization and may have a great potential to reveal its presence in clinical pain conditions. Corroborating current pain phenotyping with pain-autonomic markers has the potential to unravel central sensitization along the nociceptive neuraxis and might provide a framework for mechanistically founded therapies. Our findings provide evidence that combined recordings of sympathetic skin responses (SSRs) and pinprick evoked potentials (PEPs) might be able to unmask central sensitization induced through a well-established experimental pain model in healthy individuals. As such, these novel readouts of central sensitization might attain new insights towards complementing clinical pain phenotyping.

Evaluation of the Sympathetic Skin Response in Men with Chronic Prostatitis: A Case-Control Study.

BackgroundEtiological factors involved in chronic prostatitis (CP) type IIIb and chronic pelvic pain are not sufficiently understood; however, the nervous system has a significant role in the generation and maintenance of chronic pelvic pain. This study was designed to evaluate the sympathetic skin response (SSR) in men with CP type IIIb compared to normal population.Patients and MethodsFor two years, about 14 patients suffering from CP type IIIb according to NIH-CPSI and 26 healthy control men were enrolled in this study. SSR was performed in all the subjects with a standard method. Bilateral palmar and plantar latency and amplitude of SSR were recorded in response to the median and tibial nerve electrical stimulations. SSR is considered abnormal when the latency is prolonged, and the amplitude reduced.ResultsSSR latency in the left and right median nerve was significantly prolonged in the patient with CP type IIIb group compared to the control group (p=0.039 and 0.006, respectively). Additionally, the amplitude was reduced in patients with CP type IIIb group compared to the control group in the right tibial nerve (p=0.017).ConclusionSympathetic skin response may be a helpful diagnostic test for men with chronic prostatitis type IIIb. However, this observation needs to be validated in a large sample cohort study with long-term follow-up.

Intra tester reliability of sympathetic skin responses in subjects with primary palmar hyperhidrosis

BackgroundPrimary palmar hyperhidrosis (PPH) is a disorder related to sympathetic dysfunction. Iontophoresis can be used to reduce sweating rate. Sympathetic skin response (SSR) is commonly used to evaluate the sympathetic system. However, scarce evidence exists about the reliability of SSR parameters. ObjectiveTo assess the relative and absolute reliability of SSR before and after the application of iontophoresis with aluminum chloride hexahydrate (ACH) gel or tap water in subjects with PPH. MethodsTwenty subjects were randomized to receive either iontophoresis with ACH gel or tap water. Three SSRs (amplitude and latency) with 5 s intervals from both hands in both groups were recorded before and after the application of iontophoresis for 30 min. Reliability of amplitude and latency of the SSR was assessed using intraclass correlation coefficient (ICC) with 95% confidence intervals, standard error of measurement (SEM), and minimal detectable change (MDC). ResultsAmplitudes and latencies of SSR showed good to excellent test–retest reliability for ICC in both groups before iontophoresis. Except for right hand latency which was moderate (0.5–0.75). After iontophoresis, the ACH gel group still showed good to excellent agreement for SSR parameters, while the reliability of SSR parameters in the tap water group was reduced. ConclusionSubjects with PPH showed high intra-rater reliability for SSR parameters which was maintained after ACH gel iontophoresis and decreased after tap water iontophoresis. It seems that media used for iontophoresis or the state of media (gel vs liquid) may affect the reliability of SSR. Further research is recommended.

Characteristics of sympathetic skin response in patients with Parkinson's disease accompanied by lower limb edema

Lower limb edema significantly impairs the quality of life of Parkinson's disease (PD) patients and impedes their nursing care. A cross-sectional study was conducted on 42 PD patients and 38 healthy controls. Hoehn & Yahr (HY) and Unified Parkinson's Disease Rating Scale part I-IV (UPDRS I-IV) scales were used to assess the severity of PD, and electromyography was used to measure the sympathetic skin response (SSR). The general clinical characteristics, medication status and assessment of other autonomic nervous functions were also recorded. Patients were classified into PDE (edema) and PDNE (non-edema) subgroups, and had similar age, disease duration, HY scale, and autonomic nervous function assessment other than SSR. However, PDE patients had higher UPDRS II and III (activities of daily living and motor examination) subscores compared to PDNE patients (P=0.004 and P=0.012, respectively). The amplitude of SSR in the lower limbs was lower and the latency prolonged in PD patients, and these changes were more pronounced in the PDE subgroup. Finally, 83% of the PDE patients were regularly taking pramipexole, compared to 25% in the PDNE group. PD patients with lower limb edema have lower SSR amplitude and longer latency. Oral intake of pramipexole may be a contributing risk factor for edema.

Sympathetic skin response impairment: A good predictor of bone loss in electrical burn victims

IntroductionBurn victims are reported to have more possibility of bone loss in acute phase of injury partly due to sympathetic dysfunction and catecholamine increase beside other hypermetabolic responses. These patients are also prone to autonomic neuropathy and sympathetic skin response (SSR) impairment. We aim to investigate the correlation between SSR in the acute phase and bone mineral density (BMD) parameters in electrical burn patients and determine whether the SSR parameter in initial weeks of the event is a good predictor of bone loss in long term. Materials and methodsSixty two individuals exposed to low voltage(<1000 V) electrical current were invited to a cohort study. The SSR was recorded from their four limbs in 2–5 weeks after injury. Then, dual X-ray absorptiometry (DXA) was done to measure their BMD, T-score and Z –score, 9–12 months later. The correlation between SSR parameters in acute phase and DXA indexes was evaluated using Spearman test. A Roc curve was charted to point out a cut-off value for SSR amplitude and latency in respect to T-score to predict the subsequent bone loss. ResultAll the patients were male with a mean age of 34.09 years. Biphasic SSR parameters showed a significant correlation with lumbar BMD in a confidence interval of 99.9%. SSR amplitude threshold of 293.75 μV and latency of 2.15 s had a 100% sensitivity and 94% and 83% specificity respectively for predicting the bone loss (T-score<-1) in long term. The area under Roc curve was 0.94 and 0.99 in terms of SSR amplitude and latency. ConclusionSSR recorded in the first few weeks after electrical injury is a good predictor of bone loss in long term, so we recommend this test as a guide for screening the patients at risk for osteoporosis in electrical burn and formulating the preventive measurements.

Analysis of peripheral nerve and autonomic nervous system function and the stage of microangiopathy in patients with secondary Raynaud's phenomenon in the course of connective tissue diseases.

The pathogenesis of secondary Raynaud's phenomenon (SRP) associated with connective tissue diseases (CTD) is not entirely understood. Nervous system dysfunction and microangiopathy are considered to be causes of this pathology. Peripheral and autonomic nervous system function, the stage of microangiopathy, and the relationships between these in patients with SRP were analyzed. In the study, 20 patients with CTD-related SRP and 30 healthy controls were subject to capillaroscopy, standard conduction velocity tests and conduction velocity distribution (CVD) tests in ulnar and peroneal nerves, heart rate variability (HRV), and sympathetic skin response (SSR) tests. There were no significant differences in the standard motor and sensory conduction velocity tests, or in CVD tests in the ulnar and peroneal nerves in SRP patients compared with the controls. The patients with SRP had a significantly lower SSR amplitude and longer latency in hands and feet. The patients with CTD-related SRP had a significantly lower mean HRV with higher low frequency (LF) values in the spectral analysis and expiration/inspiration ratio (E/I) during deep breathing. There was no correlation between the stage of microangiopathy and neurophysiological test results. Correct standard conduction velocity and CVD testing in patients with SPR suggest that vasomotor disturbances may occur in CTD regardless of peripheral neuropathy. The lack of relationship between SSR and microangiopathy could confirm that these 2 processes occur independently in patients with CTD-related SRP. Autonomic nervous system impairment together with normal peripheral nerve function suggest the central origin of CTD-related SRP.

Correlation of perceptive temperature threshold of oral mucosa and sympathetic skin response

Objectives: To explore the critical values of temperature perception in various mucosa sites of oral cavity and to draw the perceptive temperature threshold maps in healthy volunteers. To observe the interrelationship between subjective cognitive perception and sympathetic skin response (SSR) under various levels of thermal stimuli. Methods: Forty-two healthy volunteers (recruited from the students of Tianjin Medical University, 16 females and 26 males) were enrolled in the present study. The whole oral mucosa of each subject was divided into multiple partitions according to the mucosa type as well as tooth position. Peltier patch (commodity name) semiconductor chip was placed in the central part of each subarea of the mucosa. The stimulus was increased or decreased at 1 ℃ each time from a baseline temperature of 37 ℃. Warm (WT) and cold (CT) perception thresholds were measured thereafter respectively. A topographic temperature map of the oral mucosa for each subject was drew. Furthermore, the SSR was elicited and recorded at three temperature levels of 50 ℃, 55 ℃, 60 ℃ respectively. Analog test with visual analogue scale (VAS) and McGill scales were also performed. Data were statistically analyzed with variance and generalized estimation equation. Results: The tip of the tongue was the most sensitive area with both WT [(38.8±2.1) ℃, P<0.05] and CT [(23.5±4.2) ℃, P<0.05]. The highest heat threshold of gingival mucosa was in the left lower posterior teeth area [(49.9±3.7) ℃, P<0.05], and the highest cold threshold of gingival mucosa was in the left upper posterior teeth area [(15.9±5.5) ℃, P<0.05]. The perceptive temperature threshold increased gradually from the midline to both left and right sides were observed symmetrically and bilaterally. There was no statistically significant differences in temperature perception threshold between males and females [WT, male (44.8±3.1) ℃, female (44.8±3.2) ℃, OR=1.100, P=0.930; CT, Male (18.4±4.9) ℃, female (20.8±4.8) ℃, OR=0.157, P=0.210]. The SSR amplitude at sites of the tongue tip and the lower lip were increased with the rise of temperature [tongue tip (4.58±4.04) mv, P<0.05, lower lip (2.89±3.01) mv, P<0.05]. However, SSR amplitude values had no significant differences between males and females [tongue tip, male (2.00±2.16) mv, female (1.89±1.20) mv, P=0.890; lower lip, male (0.94±0.82) mv, female (0.85±0.68) mv, P=0.887]. Nevertheless, the amplitude of SSR and the VAS score of subjects showed a similar trend. Conclusions: The temperature perception levels were different amongst sites of lip, buccal mucosa, tongue dorsal mucosa and gingival mucosa. SSR amplitude values could reflect the responses of the mouth to the thermal stimuli.

Electrophysiological evaluation of peripheral nerve in patients with impaired glucose tolerance

This study retrospectively reviewed 75 patients with impaired glucose tolerance(IGT)admitted in our hospital from March 2015 to October 2015. All patients underwent Toronto clinical scoring system(TCSS) evaluation. Patients with IGT were further divided into normal score group(TCSS-N, n=50)and abnormal score group(TCSS-A, n=25)according to their scoring results, and 30 healthy volunteers were served as control group. All patients and controls underwent motor and sensory nerve conduction studies, as well as sympathetic skin response(SSR)test using the Keypoint.Net(Medoc Ltd)electromyogram device. The results showed that the SSR amplitude of lower limbs was reduced [(0.61±0.44 vs 1.00±0.33)mv, P<0.05] and latency of lower limbs was extended [(1 880±282 vs 1 642±256)ms, P<0.05]in IGT group compared with control group. But median, ulnar, tibial, and peroneal nerve sensory and motor conduction revealed no difference between two groups. In TCSS-A group, the SSR amplitude of lower limbs was reduced [(0.47±0.39)mv, P<0.05], latency of lower limbs was extended [(2 062±291)ms, P<0.05]and the sensory nerve action potential(SNAP)amplitude of the tibial nerve was significantly lower compared with control group [(1.83±0.37 vs 2.07±0.30)μv, P<0.05]. Compared to TCSS-N group, latency of lower limbs was extended [(2 062±291 vs 1 808±246)ms, P<0.05]in TCSS-A group. The SSR amplitude of lower limbs were reduced[(0.66±0.44)mv, P<0.05]and latency were prolonged(P<0.05)in TCSS-N group compared with control group. Pearson correlation analysis showed that the SSR amplitude and latency of the lower limbs were correlated with the postprandial blood glucose, blood glucose fluctuation, body weight, as well as body mass index. These results suggest that there exists peripheral nerve damage in the patients with IGT, mainly involving the small fiber nerve of the lower limbs. Large fibers may also be mildly affected as the disease progresses. (Chin J Endocrinol Metab, 2017, 33: 574-577) Key words: Peripheral nerve; Impaired glucose tolerance; Nerve conduction; Sympathetic skin response

Measurement of electrochemical conductance of penile skin using Sudoscan®: A new tool to assess neurogenic impotence

To investigate the value of electrochemical skin conductance (ESC) measurement at penile level using Sudoscan® for the diagnosis of neurogenic impotence in diabetics. The following neurophysiological parameters were assessed in 25 male diabetics who complained of impotence and 25 age-matched normal male subjects without erectile dysfunction (age range: 29-70 years): ESC, sympathetic skin responses (SSR), warm detection thresholds (WDT), and cold detection thresholds (CDT) for the penis and the feet, vibration detection thresholds (VDT) for the penis, and sensory nerve conduction study of the dorsal nerve of the penis (DNP) with sensory nerve action potential (SNAP) recording. Diabetic patients with impotence differed from controls with regard to most neurophysiological results at both penile and foot levels. Among penile innervation variables in the group of impotent diabetics, penile ESC was found to be the most frequently abnormal (80% of patients), followed by penile WDT, CDT, and DNP-SNAP amplitude (52% of patients), and then penile SSR amplitude and VDT (44% of patients). Various combinations of abnormalities were observed: penile ESC was the only abnormal test in 2 patients, while all tests were abnormal in 2 patients and remained normal in only one patient. Erectile dysfunction is common in diabetic men, but the diagnosis of a neurogenic origin is challenging. This study showed that ESC measurement using Sudoscan® is feasible and more sensitive than SSR recordings to show penile sympathetic innervation impairment. This new test should be further studied to better define its diagnostic accuracy and clinical correlates.

Assessment of sympathetic skin response to acne vulgaris

Acne vulgaris (AV) is a common pilosebase unit disease characterized by peripheral inflammation. Because it is associated with the peripheral nervous system, the cranial nervous system and the autonomic nervous system, the skin is a neuroimmunoendocrine organ. Various neuroendocrine hormones and catecholamines are also released by keratinocytes, which stimulate inflammation in the pilosebase unit. In this study, sympathetic skin response (SSR) evaluating the sympathetic nervous system function as a reflex against internal and external stimuli in AV will be evaluated. 31 AV patients (mean age: 22.48 ± 2.35, 20 female, 11 male) and 29 healthy volunteers (mean age: 23.19 ± 1.27, 18 female, 11 male) between the ages of 18-30 were included in the study. All patient and control groups were questioned about detailed disease and medication intake history. Dermatologic examination was performed by a single experienced dermatologist, and global acne score (GAS) was calculated. For SSR measurement, both median nerve were warned separately on both wrists. The frequency filters is set to 0.5-2000 Hz and the analysis time is set to about 10 seconds. The SSR latencies were recorded in seconds (s) and the amplitudes were recorded in millivolts (mV). The mean age and sex of the groups were similar (p> 0,05, for each). There was no significant difference between AV and healthy control groups in terms of SSR latencies and amplitudes in both extremes ((p> 0.05, for each) AV patients had a mean GAS of 15.61. There was no correlation between GAS and latency and amplitude values of both extremities in AV patients (p> 0.05). As a result, it was found that SSR did not differ from normal people in AV cases. Changes in the autonomic nervous system in AV should be evaluated with more sensitive tests.

Autonomic dysfunction in patients with essential tremor.

The aim of this study was to evaluate the autonomic function in patients with essential tremor (ET). Thirty-one adult patients with ET and 26 healthy controls were enrolled in the study. The electrophysiological evaluations of the autonomic nervous system function were performed by sympathetic skin response (SSR) and R-R interval variation (RRIV) tests. The mean latency of SSR in ET patients was significantly delayed compared with the controls (P=0.01). The mean amplitude of sympathetic skin response was significantly lower in ET patients in comparison to the controls (P=0.001). No differences were found in mean RRIV values in both group subjects. Sympathetic dysfunction may occur in patients with ET. This may be easily demonstrated by SSR tests.

Sympathetic skin response following single and combined sound and electrical stimuli in young healthy subjects

Introduction. Sympathetic skin response (SSR) is applied in evaluation of dysfunctions in autonomic nervous system. Among others, electrical and sound stimuli are most frequently used to evoke SSR. Aim. The aim of this study was to determine if the bell ring stimulus with parameters different from standard sound stimulation evokes similar reactions in autonomic system as electrical stimulus with defined parameters. Material and methods. SSR parameters were recorded following simultaneous sound and electrical stimulation. Twenty young volunteers (aged 23 ± 2.1 years) were examined once with SSR and R‑R interval variation (RRIV) tests in order to confirm lack of functional changes in autonomic nervous system. Results. Values of mean amplitudes of SSR were always higher during recordings from upper limbs than the lower ones irrespective of the three types of applied stimuli. Mean values of latencies were comparable when SSR were induced with acoustic, electrical and both stimuli during recordings performed from upper and lower extremities. Bell ring stimulus influenced only mean values of SSR area recorded both from upper (p ≤ 0.011) and lower (p ≤ 0.023) extremities. Heart beats variability in RRIV recordings changed at 13.5% which is comparable to results obtained by other authors. Conclusions. Results indicate that the application of different modalities stimuli evokes SSR with comparable parameters. Each of them can be used for objective evaluation of the sympathetic nervous system function. Both SSR and RRIV tests evaluating the function of two effector types should be applied for the diagnosis of the probable dysautonomia in patients who show unclear clinical symptoms.

Neurophysiological and clinical effects of dry needling in patients with upper trapezius myofascial trigger points

Dry needling (DN) is a widely used in treatment of myofascial trigger points (MTrPs). The purpose of this pretest-posttest clinical trial was to investigate the neurophysiological and clinical effects of DN in patients with MTrPs. A sample of 20 patients (3 man, 17 women; mean age 31.7±10.8) with upper trapezius MTrPs received one session of deep DN. The outcomes of neuromuscular junction response (NMJR), sympathetic skin response (SSR), pain intensity (PI) and pressure pain threshold (PPT) were measured at baseline and immediately after DN. There were significant improvements in SSR latency and amplitude, pain, and PPT after DN. The NMJR decreased and returned to normal after DN. A single session of DN to the active upper trapezius MTrP was effective in improving pain, PPT, NMJR, and SSR in patients with myofascial trigger points. Further studies are needed.

The diagnostic accuracy of Sudoscan in transthyretin familial amyloid polyneuropathy.

Transthyretin familial amyloid polyneuropathy (TTR-FAP) is an axonal sensory-motor and autonomic neuropathy. Reliable quantification of sudomotor function could prove essential in the diagnosis and early treatment management. We aim to assess the diagnostic value of a new sudomotor test (Sudoscan) in TTR-FAP. One hundred and thirty-three TTR-FAP Val30Met carriers, divided in asymptomatic and symptomatic stage 1, were compared with 37 healthy controls. We analyzed the right sural sensory nerve action potential (SNAP), the plantar sympathetic skin response (SSR) and the electrochemical skin conductance (ESC) measured by Sudoscan in both hands and feet. All neurophysiological measures were significantly worse in the symptomatic group. However, feet ESC was the only test distinguishing symptomatic patients with autonomic dysfunction from those without autonomic dysfunction, and both groups from asymptomatic subjects and healthy controls. Feet ESC was a significant independent predictor for the presence of symptoms and autonomic failure, after adjusting for demographic characteristics, sural SNAP and SSR amplitudes (p<0.05). Feet ESC showed 76% sensitivity and 85% specificity for detection of dysautonomia. Feet ESC is a sensitive test to assess early autonomic dysfunction in TTR-FAP subjects. This investigation should be considered for routine assessment in this population. Abnormal feet responses on Sudoscan support early diagnosis in TTR-FAP.

Autonomic dysfunction and osteoporosis after electrical burn

IntroductionSeveral studies have shown the importance of the sympathetic nervous system in bone metabolism. There is an evidence of sympathetic skin response (SSR) impairment in electrical burn patients up to 2 years after their injuries. The acute phase of burn is accompanied by increased bone resorption. Whether the prolonged dysfunction of sympathetic nervous system may result in bone metabolism derangement even after the acute phase of electrical burn is the inspiring question for this study. And we tried to find correlation between SSR abnormality and areal bone mineral density (BMD) in electrical burn patients 6 months or more after the incidents. Methods and materials42 electrical burn patients (≥6 months prior to study) who did not have a known joint or bone disease, history of neuropathy (central or peripheral), diabetes mellitus or consumption of any drug affecting the autonomic nervous system or evidence of neuropathy in nerve conduction study were recruited. We also gathered a control group of 50 healthy subjects (without electrical burn or the exclusion criteria). They went under dual energy X-ray absorptiometry and SSR study. Data were analyzed statistically with SPSS 16.0 making use of independent t-test and Pearson correlation coefficient. P<0.05 was considered significant statistically. ResultsAreal BMD was significantly lower in electrical burn patients than control group (P<0.001). SSR latency was significantly prolonged and its amplitude was significantly reduced in burn patients compared to control group (P<0.001). In burn patients there was an inverse correlation of areal BMD of lumbar vertebrae, left femur neck and total femur with SSR latency and a direct correlation of areal BMD with SSR amplitude. In control group there was just direct correlation of areal BMD of lumbar vertebrae and left femur neck with SSR amplitude. ConclusionElectrical burn patients are at risk of reduced areal BMD long after their injuries. Sympathetic derangement and impaired SSR are correlated with reduction in areal BMD in these patients.

ID 452 – Sympathetic skin response in stroke patients

Sympathetic dysfunction could lead to life-threatening complications. The aim of this study was to investigate the relationship between the size, location, nature of the lesion, and the sympathetic skin response (SSR). Thirty patients with stroke and 30 healthy subjects were included in this study. All patients were investigated by using brain imaging and clinical scales. SSRs were elicited on four extremities in both groups. Latency and amplitude values of the responses were measured. In the patient group, SSR were analyzed both in the early (in the first month) and the late stages (one month later first recording) of the patients. In early stage, the mean amplitudes were significantly decreased compared with both late stage and controls; whereas mean latency did not change among groups. A significant correlation was observed between the improvement which determined by using the functional scales and changing of SSR amplitude. There was no significant relationship was found between the properties of the lesion and SSR parameters. Sympathetic involvement was confirmed in early stage of the stroke. It was found an improvement in SSR amplitudes parallel to clinical recovery. SSR might be used as a simple and useful method to show sympathetic abnormality and follow functional improving.

Sympathetic Skin Response in Amyotrophic Lateral Sclerosis.

Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disorder characterized by progressive loss of motor neurons, but it is increasingly recognized to be a more disseminated disease. The literature on the involvement of the sympathetic skin response (SSR) in ALS is few. We reviewed the literature with specific emphasis on SSR in ALS and investigated SSR in 120 patients with sporadic ALS and in 130 age-matched healthy subjects to determine the effects of SSR in ALS patients. The SSR was conducted in all ALS patients and healthy subjects. We found prolonged mean SSR latency in ALS patients, and the mean SSR amplitude is reduced compared with that of control subjects, especially in their low extremities (P < 0.05). The disease duration seems to have little impact on the SSR latency and amplitude (P > 0.05). Yet, whichever arm or leg involved, the overall difference in lower extremity SSR measurements between the two groups is significant (P < 0.05). And there is no correlation between initial manifestation of autonomic nervous impairment and amplitude and latency of SSR (P > 0.05). The SSR impairment occurs mainly in lower extremities, which is earlier than clinical manifestation of autonomic nervous impairment in ALS. This may be a subclinical manifestation of ALS. We hypothesize that these results are caused by damage to the unmyelinated postganglionic fibers in ALS patients.

The autonomic dysfunction in patients with lupus disease: An electrophysiological study.

Background:The aim of this study was to investigate autonomic nervous system (ANS) function by using electrophysiological tests in patients with systemic lupus erythematosus (SLE).Materials and Methods:This descriptive analytical study was done on 28 individuals with a history of lupus and ten age- and sex-matched healthy objects were being selected randomly. The autonomy questionnaire has been used to determine clinical symptom of ANS involvement. The electrophysiological assessments of ANS function were performed by sympathetic skin response (SSR). The mean values of sympathetic (SSR latency and amplitude) parameters were compared to determine any correlations between SSR parameters and clinical characteristics of ANS.Results:28 SLE patients (3 males, 25 females) with a mean age of 34.6 ± 9.74 years and 10 control subjects (4 males, 6 females) with a mean age of 36.8 ± 6.43 years were included in the study. Among patients 17 (60.7%) exhibited autonomic symptoms. Headache was the most common issue with the highest percentage rate (41.17%). The mean latency and amplitude of SSR were increased (1.52 ± 0.16 vs. 1.39 ± 0.16 and 107 ± 15.6 vs. 110 ± 15.6, respectively), compared to control. A significant difference was observed between the SSR test results of patients with lupus compared to normal healthy objects (P < 0.05). R = 0.43 correlation was found between autonomy questionnaire scores and SSR (P < 0.05).Conclusion:It could be concluded that latency measures in SSR test can be used as a valuable and accurate evaluation guideline for autonomic system assessment.