Contact heat evoked potentials – impact of physiological variables

Authors: J. Raputová 1,2;  E. Vlčková 1,2;  J. Kočica 1,2;  T. Skutil 1;  A. Rajdová 1,2;  D. Kec 1,2;  J. Bednařík 1,2
Authors‘ workplace: Neurologická klinika LF MU a FN Brno 1;  CEITEC – Středoevropský technologický, institut, Brno 2
Published in: Cesk Slov Neurol N 2019; 82(1): 76-83
Category: Original Paper



Contact heat evoked potentials (CHEPs) represent a new neurophysiological method of functional testing of small nerve fibers and the spinothalamic tracts. The study aimed to confirm the validity of published normal values for this method in the Czech population and to evaluate the influence of physiological and test-related variables on the CHEPs response.

Patients and methods:

Two groups were included in the study – a healthy control group (97 healthy volunteers; 53 women; age range 20–82 years) and a group of patients with diabetic distal sensorimotor polyneuropathy (DSPN group, 37 patients; 14 women; age range 29–77 years). In all of the participants, CHEPs were examined in the dorsum of the hand and above the ankle using basic and intensive temperature algorithm.


The CHEPs testing was mostly well-tolerated. The vast majority of the latencies and amplitudes of the CHEPs responses obtained in the healthy control group fell within the reference range according to the published normal values. Test-related variables showed also a highly significant impact on CHEPs values – the latencies were shorter in hands (compared to the calf) and whenever the intensive temperature algorithm was used (p < 0.001 in both cases). Women had significantly higher amplitudes and shorter latencies (p < 0.05). Older volunteers had significantly lower amplitudes (p < 0.05) than the younger ones. The DSPN group had longer latencies (p < 0.05) and lower amplitudes (p < 0.05) in comparison with control group.


The study confirmed validity of published normal values for the Czech population. For precise evaluation of the results, physiological (gender, age) and test-related parameters (tested area, temperature algorithm) should be taken into account. On a group level, CHEPs proved to be a useful tool for small-nerve fiber dysfunction assessment in DSPN.

Key words:

somatosensory evoked potentials – small fi ber neuropathy – spinothalamic tract – neuropathic pain – reference values

The authors declare they have no potential confl icts 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.







CHEP试验基本耐受。健康对照组获得的CHEP反应的绝大多数延迟和振幅都在参考范围内,这是根据公布的正常值得出的。与测试相关的变量对CHEP值也有非常显著的影响——与小腿相比,手部的延迟时间更短,而且无论何时使用强化温度算法(两种情况下p < 0.001)。女性患者的波幅明显增高,潜伏期明显缩短(p < 0.05)。老年志愿者的振幅明显低于年轻志愿者(p < 0.05)。与对照组相比,DSPN组延迟时间较长(p < 0.05),振幅较低(p < 0.05)。







1. Haanpää M, Attal N, Backonja M et al. NeuPSIG guidelines on neuropathic pain assessment. Pain 2011; 152 (1): 14–27. doi: 10.1016/j.pain.2010.07.031.
2. Granovsky Y, Anand P, Nakae A et al. Normative data for A contact heat evoked potentials in adult population: a multicenter study. Pain 2016; 157 (5): 1156–1163. doi: 10.1097/j.pain.0000000000000495.
3. Cruccu G, Sommer C, Anand P et al. EFNS guidelines on neuropathic pain assessment: revised 2009. Eur J Neurol 2010; 17 (8): 1010–1018. doi: 10.1111/j.1468-1331.2010.02969.x.
4. Atherton DD, Facer P, Roberts KM et al. Use of the novel Contact Heat Evoked Potential Stimulator (CHEPS) for the assessment of small fibre neuropathy: correlations with skin flare responses and intra-epidermal nerve fibre counts. BMC Neurol 2007; 7: 21. doi: 10.1186/1471-2377-7-21.
5. Chao CC, Hsieh SC, Tseng MT et al. Patterns of contact heat evoked potentials (CHEP) in neuropathy with skin denervation: correlation of CHEP amplitude with intraepidermal nerve fiber density. Clin Neurophysiol 2008; 119 (3): 653–661. doi: 10.1016/j.clinph.2007.11. 043.
6. Wong MC, Chung JW. Feasibility of contact heat evoked potentials for detection of diabetic neuropathy. Muscle Nerve 2011; 44 (6): 902–906. doi: 10.1002/mus.22192.
7. Ulrich A, Haefeli J, Blum J et al. Improved diagnosis of spinal cord disorders with contact heat evoked potentials. Neurology 2013; 80 (15): 1393–1399. doi: 10.1212/WNL.0b013e31828c2ed1.
8. Kramer JL, Haefeli J, Curt A et al. Increased baseline temperature improves the acquisition of contact heat evoked potentials after spinal cord injury. Clin Neurophysiol 2012; 123 (3): 582–589. doi: 10.1016/j.clinph.2011.08.013.
9. Chen AC, Niddam DM, Arendt-Nielsen L. Contact heat evoked potentials as a valid means to study nociceptive pathways in human subjects. Neurosci Lett 2001; 316 (2): 79–82.
10. Wydenkeller S, Wirz R, Halder P. Spinothalamic tract conduction velocity estimated using contact heat evoked potentials: what needs to be considered. Clin Neurophysiol 2008; 119 (4): 812–821. doi: 10.1016/j.clinph.2007.12.007.
11. Jutzeler CR, Rosner J, Rinert J et al. Normative data for the segmental acquisition of contact heat evoked potentials in cervical dermatomes. Sci Rep 2016; 6: 34660. doi: 10.1038/srep34660.
12. Baumgärtner U, Greffrath W, Treede RD. Contact heat and cold, mechanical, electrical and chemical stimuli to elicit small fiber-evoked potentials: merits and limitations for basic science and clinical use. Neurophysiol Clin 2012; 42 (5): 267–280. doi: 10.1016/j.neucli. 2012.06.002.
13. Lagerburg V, Bakkers M, Bouwhuis A et al. Contact heat evoked potentials: normal values and use in small-fiber neuropathy. Muscle Nerve 2015; 51 (5): 743–749. doi: 10.1002/mus.24465.
14. Rosner J, Hubli M, Hostettler P et al. Contact heat evoked potentials: Reliable acquisition from lower extremities. Clin Neurophysiol 2018; 129 (3): 584–591. doi: 10.1016/j.clinph.2017.12.034.
15. Tesfaye S, Boulton AJ, Dyck PJ et al. Diabetic neuropathies: update on definitions, diagnostic criteria, estimation of severity, and treatments. Diabetes Care 2010; 33 (10): 2285–2293. doi: 10.2337/ dc10-1303.
16. Jutzeler CR, Ulrich A, Huber B et al. Improved diagnosis of cervical spondylotic myelopathy with contact heat evoked potentials. J Neurotrauma 2017; 34 (12) : 2045–2053. doi: 10.1089/neu.2016.4891.

Paediatric neurology Neurosurgery Neurology

Article was published in

Czech and Slovak Neurology and Neurosurgery

Issue 1

2019 Issue 1

Most read in this issue
Forgotten password

Enter the email address that you registered with. We will send you instructions on how to set a new password.


Don‘t have an account?  Create new account