Sudomotor dysfunction in patients with gluten neuropathy

Abstract

Background and aim Gluten neuropathy (GN) is a common neurological manifestation of gluten sensitivity (GS), characterized by serological evidence of GS, while other risk factors for developing neuropathy are absent. The degree of small fiber dysfunction in GN has not been studied in depth to date. Small fiber involvement may lead to pain, thermal perception abnormalities, and sweat gland dysfunction. Sudomotor innervation refers to the cholinergic innervation of the sympathetic nervous system through small fibers in the sweat glands. The aim of our study was to assess the sudomotor function of GN patients. Methods Patients with GN were recruited. Clinical and neurophysiological data were obtained. HLA-DQ genotyping was performed. The skin electrochemical conductance (ESC) was measured with SUDOSCANTM. Results Thirty-two patients (25 males, mean age 69.5±10.2 years) were recruited. Thirteen patients (40.6%) had abnormal sudomotor function of the hands. Sixteen patients (50%) had abnormal sudomotor function of the feet. Twenty-one patients (65.6%) had abnormal sudomotor function of either the hands or feet. Sudomotor dysfunction did not correlate with the type of neuropathy (length-dependent neuropathy or sensory ganglionopathy), gluten-free diet adherence, severity of neuropathy, and duration of disease or HLA-DQ genotype. No differences in the ESC were found between patients with painful and patients with painless GN. Conclusion Sudomotor dysfunction affects two-thirds of patients with GN. The lack of correlation between pain and sudomotor dysfunction suggests different patterns of small fiber involvement in patients with GN.

Diagnostic and Treatment Options to the Patients Presenting with Neurological Symptoms Caused by Celiac Disease

“…Sudoscan has also been used in studies to diagnose neuropathy in patients with CD. Sudoscan offers a non-invasive, objective and measurable approach to evaluate the sudomotor function by measuring electrochemical skin conductance (43). One study diagnosed small fiber neuropathy by using Sudoscan in 32 individuals with CD (43).…”

“…Sudoscan offers a non-invasive, objective and measurable approach to evaluate the sudomotor function by measuring electrochemical skin conductance (43). One study diagnosed small fiber neuropathy by using Sudoscan in 32 individuals with CD (43). Sudomotor dysfunction is seen as one of the symptoms that appear earlier in neuropathies of distal small fibers.…”

What’s New in Neuropathy?

“…Note that gluten neuropathy patients may not have gastrointestinal symptoms [ 36 ]. Gluten neuropathy may be best defined as a neurological manifestation of gluten sensitivity, up to and including celiac disease [ 43 ].…”

“…Sudoscan™, Impeto Medical, Issy-les-Moulineaux, France) which can measure such sweat gland function in hands or feet [ 45 ]. Dysfunction of peripheral C sympathetic fibers affects about two-thirds of all patients with gluten neuropathy [ 43 ]. However, sudomotor dysfunction is not associated with a specific electrophysiological type of neuropathy, its severity, or whether or not the patient is on a strict gluten-free diet [ 43 ].…”