Sympathetic Skin Response in the Dia­gnosis of Small Fibre Neuropaty

Authors: E. Vlčková 1,2;  I. Šrotová 1,2;  J. Bednařík 1,2
Authors‘ workplace: Neurologická klinika LF MU a FN Brno 1;  CEITEC – Středoevropský technologický institut, MU, Brno 2
Published in: Cesk Slov Neurol N 2016; 79/112(1): 52-60
Category: Original Paper


Sympathetic skin response (SSR) is a simple and widely available test of sudomotor functions. Afferent part of this polysynaptic reflex is variable, while the efferent direction of the reflex arch is via thin unmyelinated C fibres. No reliable study of the SSR diagnostic validity in patients with sensory small fiber neuropathy (SFN) has so far been published. In clinical practice, however, we repeatedly meet patients, who have been diagnosed with SFN based solely on abnormal SSR. The aim of the study was to evaluate diagnostic validity of SSR in patients with sensory small fibre neuropathy.

SSR was recorded from palms and soles of 69 patients with painful sensory neuropathy (33 of them with pure SFN and 36 with mixed small and large nerve fibre dysfunction) using electrical stimulation and inspiratory gasp stimuli. Small nerve fiber involvement was confirmed by reduced intraepidermal nerve fiber densities in skin biopsy samples of all cases. The results were compared with those of 89 healthy controls. The outcome for health controls were also used to establish age-stratified normative data. We assessed electric stimuli and sudden inspiration response recall end their reproducibility, amplitude and latency.

Both the SSR latencies and amplitudes showed very low diagnostic validity in small fibre neuropathy patients. The absence of SSR response represented the most reliable abnormality. However, using this parameter, dysfunction of small autonomic nerve fibres has only been found in a small part of our sensory neuropathy patients: sensitivity did not exceed 10% in pure SFN patients and 33% in those with mixed small and large nerve fibre dysfunction (where more pronounced small sensory nerve fibre involvement has previously been found).

Considering its low sensitivity, SSR should not be used as the only test to confirm sensory small fibre neuropathy.

The authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study.

The Editorial Board declares that the manuscript met the ICMJE “uniform requirements” for biomedical papers.


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