Assessment of sudomotor function
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To review the currently available literature on clinical autonomic tests of sudomotor function.
We searched PubMED/MEDLINE for articles on technical principles and clinical applications of sudomotor tests with a focus on their drawbacks and perspectives in order to provide a narrative review.
The quantitative sudomotor axon reflex sweat test (QSART) is the most widely used test of sudomotor function. The technique captures pathology with low intra- and inter-subject variability but is limited by technical demands. The thermoregulatory sweat test comprises topographic sweat pattern analysis of the ventral skin surface and allows differentiating preganglionic from postganglionic sudomotor damage when combined with a small fiber test such as QSART. The sympathetic skin response also belongs to the more established techniques and is used in lie detection systems due to its high sensitivity for sudomotor responses to emotional stimuli. However, its clinical utility is limited by high variability of measurements, both within and between subjects. Newer and, therefore, less widely established techniques include silicone impressions, quantitative direct and indirect axon reflex testing, sensitive sweat test, and measurement of electrochemical skin conductance. The spoon test does not allow a quantitative assessment of the sweat response but can be used as bedside-screening tool of sudomotor dysfunction.
While new autonomic sudomotor function testings have been developed and studied over the past decades, the most were well-studied and established techniques QSART and TST remain the gold standard of sudomotor assessment. Combining these techniques allows for sophisticated analysis of neurally mediated sudomotor impairment. However, newer techniques display potential to complement gold standard techniques to further improve their precision and diagnostic value.
KeywordsSweat Neuropathy Small fiber Sympathetic Autonomic
The authors express their sincere gratitude to and thank Professor Roy Freeman and Professor Christopher Gibbons for their mentorship and support.
SJB drafted the first version of the manuscript. AIP, MLK, BMW and TS have made substantial contributions to reviewing the manuscript for intellectual content, language and design. SJB, BMW and TS have made substantial contributions to drafting the figures displayed in this article.
Compliance with ethical standards
Conflict of interest
The authors have no financial conflicts of interests to report. Dr. Siepmann’s research is supported by grants from the Michael J. Fox Foundation, the German Parkinson’s Disease Association (DPG) and Prothena Biosciences. Dr. Illigens’ research is supported by grants from the Michael J. Fox Foundation.
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