脑梗死部位与交感神经皮肤反应的相关性研究

目的 :研究脑梗死时交感神经皮肤反应 (SSR)的异常变化与梗死部位的关系。方法 :对 64例脑梗死患者测试SSR ,并比较大脑中动脉供血区梗死 (MCAI)与脑干梗死SSR异常的特点。结果 :脑梗死组SSR异常率 62 5 % ,MCAI单侧SSR异常率明显高于脑干梗死组 (P <0 0 5 ) ,双侧SSR异常脑干梗死组显著高于MCAI组 (P <0 0 1)。结论 :脑梗死后存在严重的交感神经功能障碍     

以躯体症状为主的抑郁症患者的交感神经皮肤反应研究

目的　探讨以躯体症状为主的抑郁症患者的自主神经功能,以寻求此类患者的临床诊断依据。方法　对40例以躯体症状为主的抑郁症患者及3 7例不伴躯体症状的抑郁症患者和3 8名健康人分别进行了交感神经皮肤反应(SSR)测定。结果　以躯体症状为主的抑郁症组SSR测定异常率为75% ,不伴躯体症状的抑郁症患者SSR测定异常率为49% ,两病例组SSR波潜伏期延长明显,波幅降低,与对照组相比存在显著性差异(P <0 . 0 1 )。而以躯体症状为主的抑郁症组与不伴躯体症状的抑郁症组SSR波潜伏期和波幅比较也存在显著性差异(P <0 . 0 1 )。结论　以躯体症状为主的抑郁症患者自主神经功能存在较严重的损害,SSR可判断以躯体症状为主的抑郁症患者的自主神经功能状况,为识别抑郁症提供了较为有效的手段。     

交感神经皮肤反应在帕金森病中的应用

目的探讨交感神经皮肤反应(SSR)在帕金森病(PD)患者自主神经损害中的评价作用。方法选用36例PD患者和30例健康对照者作为研究对象,行SSR检测,并对患者进行SCOPA-AUT评分及H-Y分级,评价SSR与PD自主神经损害的相关性。结果 PD患者SSR总异常率61.1%;H-Y评分0~1.5分者,SSR异常率为35.7%,H-Y评分2.0分者,SSR异常率77.3%;伴随自主神经症状的PD患者中(PD-AS),SSR异常率85.7%;不伴随自主神经症状者(PD-NAS),SSR异常率26.7%。结论 SSR可客观评价PD患者自主神经功能障碍,并检测PD自主神经的亚临床损害,且随患者运动症状加重,SSR异常越明显。     

有机磷中毒所致迟发性神经病的交感神经皮肤电反应研究

目的 探讨交感神经皮肤电反应（SSR）对有机磷中毒引起的迟发性神经病（OPIDN）的诊断价值。方法 对34例OPIDN患者和31例正常人的SSR进行检测。结果 34例OPIDN患者SSR异常20例（58.82%)。其中12例有自主神经症状者11例（91.67%)SSR异常，22例无自主神经症状者9例（40.91%)SSR异常。结论 SSR能客观有效地反映自主神经功能障碍，为OPIDN患者早期诊断提供依据。且方法简便，安全。     

皮肤交感反应在糖尿病周围神经病早期诊断中的价值

目的　探讨皮肤交感反应 (SSR)与糖尿病自主神经系统交感神经病变的关系 ,为糖尿病自主神经系统病变的早期诊断提供客观依据。方法　对 80例糖尿病患者及 30名健康人四肢进行SSR测定 ,对两组SSR各波潜伏期及波幅的均值行t检验。结果　两组SSR的起始潜伏期、N波、P波潜伏期比较差异有显著意义 (P <0 0 0 1) ;N波波幅、P波波幅差异无显著意义 (P >0 0 5 )。健康对照组全部可引出SSR ,而糖尿病组仅 2例患者四肢可正常引出SSR ,78例 (97 5 % )患者至少有一肢SSR潜伏期异常。结论　SSR为糖尿病性自主神经系统交感神经病变的早期诊断提供了新的方法和客观依据 ,可发现糖尿病自主神经系统交感神经纤维的早期病变。     

2型糖尿病患者交感神经皮肤反应及F波的研究

目的:探讨交感神经皮肤反应(SSR)及F波在2型糖尿病周围神经病中的诊断价值。对64例2型糖尿病患者进行交感神经皮肤反应(SSR)及F波检测,并与40例正常人进行对比分析。结果:患者组上下肢SSR的潜伏期及波幅,F波的平均潜伏期,F波时限及F波出现率均较对照组有显著性差异,SSR异常率为42.2％,F波的异常率为37.5％,SSR及F波导常与患者的病程相关,而与血糖水平无关。结论:SSR及F波可作为评价2型糖尿患者自主神经及周围运动纤维近端损害的客观指标。     

颈交感神经节阻滞治疗偏头痛及其对交感神经皮肤反应的影响

目的探讨颈交感神经节阻滞治疗偏头痛的疗效及其对交感神经皮肤反应的影响。方法颈交感神经节阻滞受用颈6横突法，每日1次，两侧交替阻滞，共7次；应用神经电生理测定36例偏头痛患者治疗前后和30例健康人交感神经皮肤反应（SSR）。结果偏头痛患者经颈交感神经节阻滞后头痛次数减少、头痛时间缩短、程度减轻，与治疗前比较有显著性差异（P〈0．01）。偏头痛患者交感神经皮肤反应的潜伏期均明显长于对照组（P〈0．01），而波幅显著低于对照组（P〈0．01）；颈交感神经节阻滞后偏头痛患者交感神经皮肤反应恢复正常。结论颈交感神经节阻滞治疗偏头痛具有良好的疗效，并能改善偏头痛患者的自主神经功能（ANS）。     

帕金森病患者的交感神经皮肤电反应临床分析

本文对50例帕金森病患者及与之相匹配的30例健康人进行交感神经皮肤电感应(SSR)检测,以探讨SSR在帕金森(PD)患者自主神经功能障碍中的价值. 1 材料与方法 1.1 一般资料     

100例2型糖尿病患者交感神经皮肤反应研究

目的探讨交感神经皮肤反应(SSR)检测在评价2型糖尿病(T2DM)自主神经损害中的价值.方法对100例T2DM患者进行SSR检测,30例健康志愿者作为对照.结果2组SSR的起始潜伏期、N波潜伏期、波幅、面积比较差异有显著性意义(P＜0.05),P波潜伏期差异无显著性意义(P＞0.05).T2DM组72例(72%)患者至少有一肢SSR异常.血糖控制满意组和血糖控制不良组比较,起始和N波潜伏期差异有统计学意义(P＜0.05),波幅和面积无显著性意义(P＞0.05).T2DM组病程＜5年与病程≥5年比较,潜伏期、波幅、面积差异均无统计学意义(P＞0.05).结论SSR可作为评价T2DM自主神经损害的客观电生理指标;T2DM患者SSR与血糖控制水平相关,与病程无关.     

躯体形式障碍患者的负性情绪与交感神经皮肤反应研究

躯体形式障碍(somatoform disorder)的主要特征为反复诉说躯体不适而未能发现器质性病变。有报道显示,躯体形式障碍患者存在焦虑、抑郁等负性情绪以及自主神经功能紊乱[1]。交感神经皮肤反应(sympathetic skin response,SSR)是一种与汗腺活动有关并反映交感神经节后纤维兴奋性的表皮电位,临床上用于检测相关疾病所致的植物神经功能失常[2]。我们对53例躯体形式障碍患者进行了焦虑和抑郁自评量表(SAS和SDS)评定以及SSR检测,并以正常健康组作对照,以研究此类患者的负性情绪及自主神经功能。1资料1·1研究对象:53例躯体形式障碍(下称患者…     

Abnormal vasoreaction to arousal stimuli--an early sign of diabetic sympathetic neuropathy demonstrated by laser Doppler flowmetry.

Early diagnosis of diabetic autonomic neuropathy contributes to the prevention of serious complications and improves the prognosis of patients with diabetes. Common tests of peripheral autonomic function are the quantitative sudomotor axon reflex test or the sympathetic skin response (SSR). Quantitative sudomotor axon reflex test is quantifiable but technically demanding. Sympathetic skin response cannot be quantified easily. To study whether measurement of skin vasomotion is suited to assess early sympathetic peripheral neuropathy, we monitored skin blood flow at the index finger pulp using laser Doppler flowmetry before and after electrical stimulation. We assured that the stimulus was sufficient to elicit an efferent sympathetic response by monitoring palmar SSR ipsilateral to the flow measurement. In 21 diabetic patients with at least stage one polyneuropathy and 21 age-matched controls, SSR was recorded from one palm and sole following electrical stimulation at the contralateral wrist. Sympathetic skin response was present at the palms in all patients and controls and absent at the sole of two patients only. Eight patients (38.9%) had abnormal SSR, with absent plantar responses in two patients, prolonged plantar latencies in six patients, and prolonged volar SSR latencies in two patients. Skin blood flow responses were more often abnormal (46.1%) than SSR (P < 0.05), responses were delayed in two patients and absent in another 8 patients. Skin blood flow retest reliability was high with a repeatability coefficient of 10.64% in controls and 12.34 % in patients. Skin blood flow monitoring after sympathetic stimulation provides a reproducible parameter of sympathetic vasomotor control and complements the diagnostic value of SSR testing.     

DYSAUTONOMIA IN CRYOGLOBULINEMIC AND ALCOHOLIC NEUROPATHIES

Sympathetic Skin Response (SSR) can evaluate the activity of both sensory afferent and sudomotor sympathetic efferent fibres in peripheral neuropathy (PN). This electrophysiological test was performed in two groups of patients: one with HCV-related mixed cryoglobulinemia (MC) and the other with chronic alcoholism (CA). Thirty consecutive HCV-related MC patients, 25 female and 5 male, aged 35–74 years and thirty-three consecutive CA patients, 8 female and 25 male, aged 24–69 years were studied. In all cases, neurological exam, peroneal, sural and ulnar nerve conduction velocity, standardised test battery for autonomic disorder (defined according to Bellavere, 1990) and SSR (recorded with electrodes attached to the palm and sole and considered abnormal if no response was recorded) were performed.
PN was found in 27 MC patients (90%) and in 23 CA patients (69.6%). Autonomic dysfunction, shown by cardiovascular tests, was found in 3 MC patients, all with PN and in 6 CA subjects, all but one with PN. SSR resulted absent in 12 MC patients (40%): three of them with and 9 without dysautonomia; SSR was also absent in 9 CA patients (27.2%) (1 with and 8 without dysautonomia).
In MC and CA patients, autonomic dysfunction frequency increases when SSR is studied together with standard cardiovascular tests. SSR provides further information about sympathetic autonomic system activity and therefore it is advisable to add this investigation to tests usually utilized in functional evaluation of autonomic nervous system.     

Cardiovascular autonomic function and sympathetic skin response in chronic inflammatory demyelinating polyradiculoneuropathy

Quantitative cardiovascular autonomic function tests (AFTs) and sympathetic skin response (SSR) were performed in 12 patients with chronic inflammatory demyelinating polyradiculoneuropathy (CIDP). Parasympathetic autonomic function was examined by Valsalva ratio and R-R interval variation during rest and deep breathing. Sympathetic autonomic function was evaluated by blood pressure responses to sustained handgrip and active standing. Using quantitative AFTs, subclinical autonomic dysfunction was demonstrated in three (25%) patients. Abnormal SSR was seen in six (50%) patients. Thus, mild autonomic dysfunction is present in many CIDP patients. The autonomic abnormalities involve parasympathetic or sympathetic components; in the sympathetic nervous system, both vasomotor and sudomotor fibers may be involved.     

Sympathetic skin response in diabetic neuropathy

The sympathetic skin response (SSR) was studied in 47 diabetic patients selected for the presence of symptoms and clinical signs of peripheral neuropathy and in 24 normal control subjects. The SSR was present in all controls but was absent at the foot in 66% and at the hand in 27.7% of the diabetic patients. Absence of the SSR failed to correlate with other electrophysiologic parameters on routine nerve conduction and electromyographic studies. Although absent SSR was more often found in patients with symptoms of autonomic dysfunction (P less than 0.05), there was no correlation with any specific symptoms of autonomic involvement. The SSR was frequently absent, at least in the foot, in those patients with abnormal cardiac beat-to-beat variability (expiratory: inspiratory, E:I, ratio) and pupil cycle time (PCT). In addition there was a good correlation between the amplitude of the SSR and the value of the E:I ratio (r = 0.81, P less than 0.001). The SSR may be a valuable adjunct in the assessment of autonomic involvement in diabetic neuropathy, but its sensitivity requires further evaluation.     

Sympathetic skin response in patients with chronic renal failure

Sympathetic skin response (SSR) was measured in 20 normal healthy subjects and in 22 patients with chronic renal failure on regular hemodialysis, and its correlation with abnormalities of sensorimotor nerve conduction study and clinical autonomic symptoms was investigated. Nerve conduction studies (NCS) were abnormal in 17 of 22 patients (77.3%), and SSR was absent in 14 of 22 patients (63.6%). Patients were divided into three groups based on their SSR response: patients with normal SSR (n:8, 36.4%), patients with absent SSR in the foot only (n:9, 40.9%), and patients with absent SSR in both hand and foot (n : 5, 22.7%). Good correlation between abnormalities of NCS and absent SSR was observed. No correlation was noted between patient age, sex, duration of hemodialysis, duration of renal failure history, and absent SSR. However, statistically significant correlation was found between mean amplitude of the foot SSRs and sensorimotor nerve conduction velocities, and weekly frequency of hemodialysis.     

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 in diabetic peripheral neuropathy

There were 72 diabetic patients with clinical evidence of sensorimotor peripheral neuropathy investigated to determine the sensitivity of the sympathetic skin response test (SSR) for detection of sudomotor dysfunction and its correlation with other autonomic function tests, autonomic symptoms, and degree of peripheral neuropathy. Nerve conduction velocities (NCV) were abnormal in all patients, SSR was absent in 60 of 72 patients (83%), Valsalva test was abnormal in 32 of 67 patients (48%) who had the test, and 6 of 72 (9%) had orthostatic hypotension. Statistically significant correlation was found between the Valsalva test abnormality, the degree of peripheral neuropathy, and the SSR in our patients. All patients with orthostatic hypotension had an absent SSR and an abnormal Valsalva test. Most patients had one or more autonomic signs or symptoms. Orthostatic dizziness only correlated with SSR, however. These results suggest that sudomotor activity detected by sympathetic skin response is a valuable test for investigation of dysautonomia in diabetic peripheral neuropathy.     

Sympathetic skin response in Guillain-Barré syndrome

Dysautonomia is a common feature of Guillain—Barré (GB) syndrome and is sometimes the cause of significant morbidity and death. Changes in sympathetic skin response (SSR) may be one of the accompaniments of dysautonomia. An attempt was made to correlate SSR changes with clinical and electrophysiologic features in a group of 24 patients with GB syndrome fulfilling NINDS (National Institute of Neurological Disorders and Stroke) criteria. A total of nine patients had absent SSR. Thirteen patients had clinical dysautonomia, of whom five had absent SSR. Five patients had features of predominant axonal damage and preserved SSR. A trend towards correlation of SSR abnormalities with common peroneal nerve conduction parameters (velocity and compound muscle action potential amplitude) was noted. We conclude that SSR abnormalities are common in GB syndrome and may be complementry to bed-side tests for autonomic dysfunction.

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Sympathetic skin response in Guillain-Barré syndrome

     

Post-ganglionic autonomic neuropathy associated with anti-glutamic acid decarboxylase antibodies

Purpose

Antibodies to glutamic acid decarboxylase (GAD-Abs) have been associated with several conditions, rarely involving the autonomic nervous system. Here, we describe two patients complaining of autonomic symptoms in whom a post-ganglionic autonomic neuropathy has been demonstrated in association with significantly elevated serum and CSF GAD-Abs levels.

Methods

Patients underwent nerve conduction studies, sympathetic skin response testing, evaluation of autonomic control of the cardiovascular system and skin biopsy. Also, serum screening to exclude predisposing causes of peripheral neuropathy was performed. Anti-GAD65 antibodies were evaluated in serum and CSF.

Results

GAD-Abs titer was increased in both serum and CSF in both patients. Sympathetic skin response was absent and skin biopsy revealed a non-length-dependent small-fiber neuropathy with sympathetic cholinergic and adrenergic post-ganglionic damage in both patients. Nerve conduction studies and evaluation of autonomic control of the cardiovascular system were normal in both patients. Both patients were treated with steroids with good, but partial, (patient 2) recovery of the autonomic dysfunctions.

Conclusions

Although the pathophysiological mechanisms involved are not fully defined, GAD-abs positivity in serum and CSF should be searched in patients with autonomic neuropathy when no other acquired causes are evident. This positivity may help to clarify autoimmune etiology and, subsequently, to consider immunomodulatory treatment.

     

Is pruritus in chronic uremic patients related to peripheral somatic and autonomic neuropathy? Study by R-R interval variation test (RRIV) and by sympathetic skin response (SSR).

The problem of pruritus in uremic dialysed patients remains unsolved. The etiology of pruritus has not been precisely explained, and sometimes no efficient treatment is available. The aim of this study was to analyse the relationship between somatic neuropathy and pruritus as well as the relationship between pruritus and dysautonomia. Fifty-one patients with end-stage renal failure underwent basic neurological examination, nerve conduction velocity studies, and pruritus assessment by means of a questionnaire. Two tests were used to assess the autonomic nervous system, namely the R-R interval variation test in basal and profound breath conditions (RRIV) and the sympathetic skin response (SSR). Pruritus was found in 63% patients of the sample. Most of them had clinical symptoms and signs of peripheral sensorimotor neuropathy and dysautonomia. About 59% of uremic patients revealed abnormally reduced RRIV. About 45% of patients had abnormal (delayed or absent) SSR. The pruritus in uremic patients occurred significantly more frequently (P < 0.01) in patients with paresthesia. A nonsignificant but sizeable trend towards a relationship of pruritus with hypohidrosis and pathological SSR results was also observed. There was no relationship between the pruritus presence and RRIV results. According to our results the activity of the nervous system might play an important role in the mechanism of uremic pruritus, but paradoxically this latter appeared more tightly related to somatic neuropathy than to autonomic dysfunction. Our results also suggest that SSR may become a useful technique for the assessment of autonomic dysfunction in uremic patients.