Titre du document / Document title

Detection of small-fiber neuropathy by sudomotor testing

Auteur(s) / Author(s)

LOW Victoria A. ⁽¹⁾ ; SANDRONI Paola ⁽¹⁾ ; FEALEY Robert D. ⁽¹⁾ ; LOW Phillip A. ⁽¹⁾ ;

Affiliation(s) du ou des auteurs / Author(s) Affiliation(s)

⁽¹⁾ Department of Neurology, Mayo Clinic, Guggenheim 811, 200 First Street SW, Rochester, Minnesota 55905, ETATS-UNIS

Résumé / Abstract

The symptoms of burning sensation affecting the feet, thought to be due to a distal small-fiber neuropathy (DSFN) affecting somatic unmyelinated fibers, are usually accompanied by vasomotor or sudomotor changes suggestive of involvement of autonomic fibers. We therefore examined the relationship between pattern of anhidrosis and DSFN and its etiology, comparing patients with "pure" DSFN (with normal nerve conduction) to those with clinical DSFN (minor conduction abnormalities). We reviewed 125 cases with a clinical phenotype of DSFN. These patients had distal burning discomfort, variable sensory deficits, and intact motor function. All had undergone assessment with thermoregulatory sweat test (TST), autonomic reflex screen (ARS), and nerve conduction studies and electromyography (NCS/EMG). TST showed a distal pattern of anhidrosis in 74%. The quantitative sudomotor axon reflex test (QSART) was abnormal in 74%, with 80% of those having a length-dependent pattern of anhidrosis/hypohidrosis. In total, 93% of patients had a distal pattern of abnormality on QSART or TST. The Composite Autonomic Severity Score (CASS) was used to quantify the severity and distribution of autonomic deficits: 98% had CASS abnormality (sudomotor, 98%; adrenergic, 43%; cardiovagal, 35%). EMG was normal or showed unrelated abnormalities in 75%. The most common etiologies of DSFN were idiopathic (73%), presumed hereditary (18%), and diabetes (10%). Sudomotor examination is thus a highly sensitive detection tool in DSFN. Autonomic involvement is mainly distal, and additionally may involve adrenergic and the long cardiovagal fibers.

Revue / Journal Title

Muscle & nerve   ISSN 0148-639X   CODEN MUNEDE 

Source / Source

2006, vol. 34, n^o1, pp. 57-61 [5 page(s) (article)] (13 ref.)

Langue / Language

Anglais

Editeur / Publisher

Wiley, New York, NY, ETATS-UNIS  (1978) (Revue)

Mots-clés anglais / English Keywords

Endocrinopathy ; Immunopathology ; Bullous dermatosis ; Neurological disorder ; Electrophysiology ; Skin disease ; Sweat gland disease ; Nervous system diseases ; Axon reflex ; Human ; Hereditary ; Idiopathic ; Anhidrosis ; Dyshidrosis ; Abnormal reflex ; Neuropathy ; Electromyography ; Sweat ; Sensory disorder ; Phenotype ; Nerve conduction ; Unmyelinated nerve fiber ; Foot ; Sensation ;

Mots-clés français / French Keywords

Endocrinopathie ; Immunopathologie ; Dermatose bulleuse ; Trouble neurologique ; Electrophysiologie ; Peau pathologie ; Glande sudoripare pathologie ; Système nerveux pathologie ; Réflexe d'axone ; Homme ; Héréditaire ; Idiopathique ; Anhidrose ; Dyshidrose ; Trouble réflexe ; Neuropathie ; Electromyographie ; Sueur ; Trouble sensoriel ; Phénotype ; Conduction nerveuse ; Fibre nerveuse amyélinique ; Pied ; Sensation ;

Mots-clés espagnols / Spanish Keywords

Endocrinopatía ; Inmunopatología ; Dermatosis bulosa ; Trastorno neurológico ; Electrofisiología ; Piel patología ; Glándula sudorípara patología ; Sistema nervioso patología ; Hombre ; Hereditario ; Idiopático ; Anhidrosis ; Dishidrosis ; Trastorno reflejo ; Neuropatía ; Electromiografía ; Sudor ; Trastorno sensorial ; Fenotipo ; Conducción nerviosa ; Fibra nerviosa amielínica ; Pie ; Sensación ;

Mots-clés d'auteur / Author Keywords

anhidrosis ; Composite Autonomic Severity Score (CASS) ; distal small-fiber neuropathy (DSFN) ; quantitative sudomotor axon reflex test (QSART) ; thermoregulatory sweat test (TST) ;

Localisation / Location

INIST-CNRS, Cote INIST : 18909, 35400013892758.0060