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Axon-Reflex-basierte Nervenmessverfahren in der Diagnostik autonomer Neuropathie

Axon-reflex based nerve fiber function assessment in the detection of autonomic neuropathy

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Zusammenfassung

Axon-Reflex-basierte funktionelle Messverfahren kutaner Nervenfasern werden in der Diagnostik autonomer Neuropathien angewendet. Sie umfassen quantitative Methoden zur Erfassung vasomotorischer und sudomotorischer Antwortreaktionen auf die iontophoretische Applikation von Acetylcholin. Die etablierten Axon-Reflex-Messverfahren „laser Doppler flowmetry“ (LDF) zur vasomotorischen und „quantitative sudomotor axon-reflex test“ (QSART) zur sudomotorischen Funktionsmessung sind durch hohen technischen Aufwand und interindividuelle Variabilität limitiert. Sie bleiben daher in der Regel spezialisierten klinischen Zentren vorbehalten. Neue Axon-Reflex-basierte Verfahren zeichnen sich durch die Erfassung der axonalen Antwortreaktionen mit zeitlicher und zweidimensionaler Auflösung aus. Diese umfassen den „laser Doppler imaging (LDI) axon-reflex flare area test“ zur vasomotorischen, den „quantitative direct and indirect test of sudomotor function“ (QDIRT) zur sudomotorischen Funktionsmessung sowie den „quantitative pilomotor axon-reflex test“ (QPART), ein Verfahren zur Messung der pilomotorischen Nervenfunktion mithilfe adrenerger Stimulation der Haut durch Phenylephriniontophorese. Die Effektivität neuer Axon-Reflex-basierter Messverfahren in der Neuropathiediagnostik ist Gegenstand derzeitiger klinischer Prüfung.

Summary

Axon-reflex-based tests of peripheral small nerve fiber function including techniques to quantify vasomotor and sudomotor responses following acetylcholine iontophoresis are used in the assessment of autonomic neuropathy. However, the established axon-reflex-based techniques, laser Doppler flowmetry (LDF) to assess vasomotor function and quantitative sudomotor axon-reflex test (QSART) to measure sudomotor function, are limited by technically demanding settings as well as interindividual variability and are therefore restricted to specialized clinical centers. New axon-reflex tests are characterized by quantification of axon responses with both temporal and spatial resolution and include “laser Doppler imaging (LDI) axon-reflex flare area test” to assess vasomotor function, the quantitative direct and indirect test of sudomotor function (QDIRT) to quantify sudomotor function, as well as the quantitative pilomotor axon-reflex test (QPART), a technique to measure pilomotor nerve fiber function using adrenergic cutaneous stimulation through phenylephrine iontophoresis. The effectiveness of new axon-reflex tests in the assessment of neuropathy is currently being investigated in clinical studies.

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Einhaltung ethischer Richtlinien

Interessenkonflikt. T. Siepmann, B.M.-W. Illigens, H. Reichmann und T. Ziemssen gibt an, dass kein Interessenkonflikt besteht. Der Beitrag enthält keine Studien an Menschen oder Tieren.

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Authors and Affiliations

  1. Klinik und Poliklinik für Neurologie, Universitätsklinik Carl Gustav Carus, Technische Universität Dresden, Dresden, Deutschland

    T. Siepmann, H. Reichmann & T. Ziemssen

  2. Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA

    B.M.-W. Illigens

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  1. T. Siepmann
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  2. B.M.-W. Illigens
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  3. H. Reichmann
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  4. T. Ziemssen
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Correspondence to T. Siepmann.

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Siepmann, T., Illigens, BW., Reichmann, H. et al. Axon-Reflex-basierte Nervenmessverfahren in der Diagnostik autonomer Neuropathie. Nervenarzt 85, 1309–1314 (2014). https://doi.org/10.1007/s00115-014-4120-9

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