Peripheral Vascular and Sweat-Gland Reflexes in Diabetic Neuropathy

Goadby, H. K.; Downman, C. B. B.

doi:10.1042/cs0450281

Cited by 9 publications

(8 citation statements)

References 3 publications

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“…The SSR specifically tests skin sympathetic fibers and not the parasympathetic or the motor sympathetic fibers that mediate many of the clinical symptoms of dysautonomia. It is a common clinical observation that sudomotor function is disordered in peripheral neuropathies such as diabetic neuropathy, even when there is no evidence of other autonomic function abnormalities; in other words, it is the most sensitive way to test the peripheral nervous function [10, 11]. In these patients the test is more consistently abnormal when dysautonomia is associated with a severe peripheral neuropathy (e.g., diabetics).…”

Section: Discussionmentioning

confidence: 99%

Sympathetic Skin Response in Hemodialysis Patients: Correlation with Nerve Conduction Studies and Adequacy of Dialysis

Robles

Solís²,

Albarrán³

et al. 1999

Nephron

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A sympathetic skin response (SSR) test was performed in diabetic and nondiabetic patients undergoing regular hemodialysis and the results correlated with nerve conduction studies (NCS): sensory conduction velocity (SCV) and motor conduction velocity (MCV). Comparisons were made between diabetic and nondiabetic patients and between cuprophane and polyacrylonitrile membrane dialyzed patients. Six nondiabetic uremic patients (30%) and all diabetic patients had no SSR. Eight nondiabetic uremic patients (40%) had a mildly impaired response. Nondiabetic patients with a normal response were younger (31.1 ± 16.4 years) than the patients with abnormal SSR, whether mildly impaired response (58.3 ± 20.3 years; p < 0.05, Anova) or absent response (65.3 ± 13.8 years; p < 0.01, Anova). SCV, MCV, and SSR values were reduced (p < 0.01) in uremic patients with respect to normal subjects. Severity and frequencies of sensory NCS abnormalities in nondiabetic patients were: normal 20%, mildly impaired 75%, and severely impaired 5%. Severity and frequencies of motor conduction abnormalities were: normal 80%, mildly impaired 20%, severely impaired 0%. The SSR abnormality incidence in patients with a normal NCS was similar to that in patients with either mildly or severely impaired NCS (chi-square test). There was a positive linear correlation between the SSR amplitude and SCV (r = 0.52, p < 0.01) and MCV (r = 0.49, p < 0.01). The SSR latency was also significantly related to SCV (r = 0.66, p < 0.01) and MCV (r = 0.61, p < 0.01). A significant negative correlation was found between age and SSR parameters, amplitude (r = –0.56, p < 0.01) and latency (r = –0.66, p < 0.01). No correlation was found between duration of hemodialysis or Kt/V and SSR. No differences were found in SSR, NCS, or Kt/V values between cuprophane membrane and polyacrylonitrile membrane dialyzed patients (Student’s t test). The relationship between NCS and SSR in uremic patients was confirmed. Old age and diabetes mellitus, but not the dialysisis membrane used, were confirmed as synergistic factors of neuropathic impairment. It appeared that SSR is more sensitive than NCS in detecting polyneuropathy in uremic patients on hemodialysis.

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Section: Discussionmentioning

confidence: 99%

Sympathetic Skin Response in Hemodialysis Patients: Correlation with Nerve Conduction Studies and Adequacy of Dialysis

Robles

Solís²,

Albarrán³

et al. 1999

Nephron

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“…Sympathetic responsiveness: Subjects were stressed with arousal stimuli, such as cough, gasp, loud noises and mental summation [14][15][16]. The resulting reduction in big toe blood flow following each stimulus was recorded by two methods.…”

Section: Me~o~mentioning

confidence: 99%

Blood flow patterns in painful diabetic neuropathy

1984

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Summary.Peripheral blood flow is known to be qualitatively increased in diabetic patients with neuropathy. We have measured the actual blood flow in the feet of diabetic patients with neuropathy using non-invasive mercury strain gauge plethysmography and Doppler sonogram techniques and shown that it is increased on average five times above normal at an ambient temperature of 20 ~ -22 ~ Moreover, reduction of this high flow by sympathetic arousal stimuli proved possible in those with severe painful neuropathy contrasting strongly with failure to reverse it in those with severe non-painful sensory neuropathy. Reduction of blood flow was associated with reduction in neuropathic pain. We studied 22 diabetic patients with severe sensory neuropathy and eight with painful neuropathy. High resting foot blood flows were demonstrated in both groups with neuropathy. The big toe flow in those with severe sensory neuropathy was 29.3 + 9.2 ml. rain-1. 100m1-1 (mean+-SD) and in the painful neuropathy group, 25.9+_7.5, compared with 5.2+2.4ml.min -1. 100m1-1 in the non-diabetic control subjects (p<0.001). High foot skin temperatures were also recorded in the groups with neuropathy, reflecting the high blood flow. The subjects with painful neuropathy retained the ability to constrict peripheral blood vessels in response to arousal stimuli, and reduce peripheral flow on average by 32% compared with the patients with sensory neuropathy who responded on average by only 10%. The demonstration of a peripheral sympathetic defect, responsible for the high blood flow and the potential reversal of such flow in painful neuropathy may be important in our further understanding of the aetiology of such pain and its treatment.Key words: Diabetes mellitus, peripheral blood flow, sensory neuropathy, painful neuropathy, peripheral sympathetic neuropathy.During the nineteenth century, the feet of diabetic patients with peripheral neuropathy were observed to be hot and erythematous [1] and the blood flow in such feet was considered to be increased. This increase is now thought to be due to the dilation of denervated arteriovenous shunts [2-9] normally controlled by sympathetic nerves.Measurement of actual blood flow in diabetic neuropathic feet has only been undertaken in one previous study [10]. Blood flow was not found to be increased in neuropathic subjects probably because the studies were conducted by waterbath plethysmography at 32~ causing vasodilatation and increased flow in the control subjects.The aim of this study was to measure the magnitude of resting foot blood flow in a group of diabetic patients with severe sensory neuropathy and to discover whether the hot, burning foot, so characteristic of distal painful neuropathy, also has a high resting flow resulting from a peripheral sympathetic defect. In addition, the sympathetic responses of both types of neuropathy were tested to discover whether either retained the ability to reduce peripheral flow by vasoconstriction, and whether any benefits might result from this. Subjects and metho...

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“…the sympathetic skin response (SSR), induced by electrical stimulation was useful for evaluating the function of sympathetic nerve postganglionic unmyelinated fibres. 2,3 Recording the SSR is a non-invasive method for evaluating peripheral sympathetic nerve activity, using skin sweat gland function as an index. However, because of habituation and the effects of different psychological states, such as consciousness and emotion, the appearance of the evoked potential varies widely.…”

Section: Introductionmentioning

confidence: 99%

Sympathetic Skin Response in Patients with Spinal Cord Injury

Ogura¹,

Kubo²,

Lee³

et al. 2004

J Orthop Surg (Hong Kong)

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either the upper or lower limbs. In patients with a thoracic cord injury, some responded at the upper limbs but none at the lower limbs; some responded at neither upper nor the lower limbs; and some responded at both upper and lower limbs. The conducting pathway of sympathetic skin response in the spinal cord for the upper limbs descends to the upper thoracic cord (T4-6), and the conducting pathway for the lower limbs departs from the spinal cord at the lower thoracic cord (T9-10). Conclusion. It appears that sympathetic skin response should be used for the evaluation and morbid investigation of the functional abnormalities of the sympathetic nervous system in patients with spinal cord lesions such as spinal cord injuries, cervical spondylosis, and spinal canal stenosis.

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Peripheral Vascular and Sweat-Gland Reflexes in Diabetic Neuropathy

Cited by 9 publications

References 3 publications

Sympathetic Skin Response in Hemodialysis Patients: Correlation with Nerve Conduction Studies and Adequacy of Dialysis

Sympathetic Skin Response in Hemodialysis Patients: Correlation with Nerve Conduction Studies and Adequacy of Dialysis

Blood flow patterns in painful diabetic neuropathy

Sympathetic Skin Response in Patients with Spinal Cord Injury

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