Autonomic impairment in  painful neuropathy

Novak, Vera; Freimer, Miriam; Kissel, John T.; Sahenk, Zarife; Periquet, I.M.; Nash, Susan M.; Collins, Michael; Mendell, Jerry R.

doi:10.1212/wnl.56.7.861

Cited by 163 publications

(122 citation statements)

References 28 publications

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“…Although the association with somatic autonomic neuropathy demands a more specific validation with quantitative sudomotor testing using the gold standard for sudomotor testing, Q-SART [22,23], this was not available in our laboratory.…”

Section: Discussionmentioning

confidence: 99%

The Neuropad test: a visual indicator test for human diabetic neuropathy

et al. 2008

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Aims/hypothesis The commercially available Neuropad test was developed as a simple visual indicator test to evaluate diabetic neuropathy. It uses a colour change to define the integrity of skin sympathetic cholinergic innervation. We compared the results of Neuropad assessment in the foot with established measures of somatic and autonomic neuropathy. Methods Fifty-seven diabetic patients underwent Neuropad assessment, quantitative sensory and autonomic function testing, and evaluation of intra-epidermal nerve fibre density in foot skin biopsies. Results Neuropad responses correlated with the neuropathy disability score (r s =0.450, p<0.001), neuropathic symptom score (r s =0.288, p=0.03), cold detection threshold (r s = 0.394, p=0.003), heat-as-pain perception threshold visual analogue score 0.5 (r s =0.279, p=0.043) and deep-breathing heart rate variability (r s =−0.525, p<0.001). Intra-epidermal nerve fibre density (fibres/mm) compared with age-and sexmatched control subjects (11.06±0.82) was non-significantly reduced (7.37±0.93) in diabetic patients with a normal Neuropad response and significantly reduced in patients with a patchy (5.01±0.93) or absent (5.02±0.77) response (p= 0.02). The sensitivity of an abnormal Neuropad response in detecting clinical neuropathy (neuropathy disability score ≥5) was 85% (negative predictive value 71%) and the specificity was 45% (positive predictive value 69%). Conclusions/interpretation The Neuropad test may be a simple indicator for screening patients with diabetic neuropathy.

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Section: Discussionmentioning

confidence: 99%

The Neuropad test: a visual indicator test for human diabetic neuropathy

et al. 2008

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“…7,[17][18][19] Several studies have demonstrated that QSART can determine sudomotor abnormalities with relatively high sensitivity and specificity in many types of polyneuropathies (Class II and III). [4][5][6][7]16,17,[19][20][21] In three Class III studies, QSART was shown capable of detecting distal small fiber polyneuropathy with a sensitivity of Ͼ75%. [17][18][19] Skin vasomotor reflexes assessed by monitoring skin blood flow using laser Doppler flowmeter have not been well studied.…”

Section: Analysis Of Evidencementioning

confidence: 99%

“…[4][5][6][7]16,17,[19][20][21] In three Class III studies, QSART was shown capable of detecting distal small fiber polyneuropathy with a sensitivity of Ͼ75%. [17][18][19] Skin vasomotor reflexes assessed by monitoring skin blood flow using laser Doppler flowmeter have not been well studied. Limited data from one Class III study using this technique demonstrated an unacceptably large coefficient of variation.…”

Section: Analysis Of Evidencementioning

confidence: 99%

Practice Parameter: Evaluation of distal symmetric polyneuropathy: Role of autonomic testing, nerve biopsy, and skin biopsy (an evidence-based review) [RETIRED]

England¹,

Gronseth²,

Franklin³

et al. 2009

Neurology

287

142

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“…The most useful tests are quantitative sudomotor axon reflex test (QSART), thermoregulatory sweat test, heart rate responses to deep breathing, Valsalva ratio, and surface skin temperature (Novak et al, 2001). The value of autonomic testing in patients with general neuropathic pain disorder, painful small-fiber neuropathy with burning feet has been shown in several studies.…”

Section: Autonomic Function Testingmentioning

confidence: 99%