Abstract
Objective
We have previously shown that sudomotor dysfunction in autoimmune autonomic ganglionopathy is severe, widespread, and predominantly post-ganglionic. However, the long-term changes in sudomotor function have not been studied in detail. Our objective was to characterize the long-term changes in sudomotor dysfunction in patients with autoimmune autonomic ganglionopathy.
Methods
Changes in sudomotor function were compared in a cohort of nine α3 nAChR antibody positive autoimmune autonomic ganglionopathy patients over an approximate 5-year period. Standard measurements of sudomotor function were used including the thermoregulatory sweat test and quantitative sudomotor axon reflex test.
Results
Total body anhidrosis on thermoregulatory sweat testing showed improvement in four of nine patients. Quantitative sudomotor axon reflex testing for both forearm and foot sites was variable with four of nine patients showing improvement in total sweat output. Distribution of sudomotor dysfunction at follow-up was post-ganglionic in seven of nine patients at the foot site and three of nine patients at the forearm site. Overall, sudomotor dysfunction was post-ganglionic in seven of nine patients throughout the follow-up period (62.4 ± 19.4 months).
Interpretation
Sudomotor dysfunction in autoimmune autonomic ganglionopathy was severe and widespread throughout the follow-up period for the majority of patients studied. Sudomotor dysfunction was predominantly post-ganglionic throughout the follow-up period.
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References
Drachman DB, Adams RN, Stanley EF, Pestronk A (1980) Mechanisms of acetylcholine receptor loss in myasthenia gravis. J Neurol Neurosurg Psychiatry 43:601–610
Fealey R (2008) Thermoregulatory sweat test. In: Low PA, Benarroch EE (eds) Clinical autonomic disorders. Lippincott, Williams and Wilkins, Philadelphia, pp 244–263
Fealey RD, Low PA, Thomas JE (1989) Thermoregulatory sweating abnormalities in diabetes mellitus. Mayo Clin Proc 64:617–628
Iodice V, Kimpinski K, Vernino S, Sandroni P, Fealey RD, Low PA (2009) Efficacy of immunotherapy in seropositive and seronegative putative autoimmune autonomic ganglionopathy. Neurology 72:2002–2008
Kimpinski K, Iodice V, Sandroni P, Fealey RD, Vernino S, Low PA (2009) Sudomotor dysfunction in autoimmune autonomic ganglionopathy. Neurology 73:1501–1506
Klein CM, Vernino S, Lennon VA, Sandroni P, Fealey RD, Benrud-Larson LM, Sletten D, Low PA (2003) The spectrum of autoimmune autonomic neuropathies. Ann Neurol 53:752–758
Low PA (1993) Composite autonomic scoring scale for laboratory quantification of generalized autonomic failure. Mayo Clin Proc 68:748–752
Low PA (2004) Evaluation of sudomotor function. Clin Neurophysiol 115:1506–1513
Low PA, Denq JC, Opfer-Gehrking TL, Dyck PJ, O’Brien PC, Slezak JM (1997) Effect of age and gender on sudomotor and cardiovagal function and blood pressure response to tilt in normal subjects. Muscle Nerve 20:1561–1568
Low PA, Sletten DM (2008) Laboratory evaluation of autonomic failure. In: Low PA, Benarroch EE (eds) Clinical autonomic disorders. Lippincott Williams and Wilkins, Philadelphia, pp 130–163
Sandroni P, Vernino S, Klein CM, Lennon VA, Benrud-Larson L, Sletten D, Low PA (2004) Idiopathic autonomic neuropathy: comparison of cases seropositive and seronegative for ganglionic acetylcholine receptor antibody. Arch Neurol 61:44–48
Skok MV, Voitenko LP, Voitenko SV, Lykhmus EY, Kalashnik EN, Litvin TI, Tzartos SJ, Skok VI (1999) Alpha subunit composition of nicotinic acetylcholine receptors in the rat autonomic ganglia neurons as determined with subunit-specific anti-alpha(181–192) peptide antibodies. Neuroscience 93:1427–1436
Suarez GA, Fealey RD, Camilleri M, Low PA (1994) Idiopathic autonomic neuropathy: clinical, neurophysiologic, and follow-up studies on 27 patients. Neurology 44:1675–1682
Vernino S, Ermilov LG, Sha L, Szurszewski JH, Low PA, Lennon VA (2004) Passive transfer of autoimmune autonomic neuropathy to mice. J Neurosci 24:7037–7042
Vernino S, Lennon VA (2003) Neuronal ganglionic acetylcholine receptor autoimmunity. Ann NY Acad Sci 998:211–214
Vernino S, Low PA, Fealey RD, Stewart JD, Farrugia G, Lennon VA (2000) Autoantibodies to ganglionic acetylcholine receptors in autoimmune autonomic neuropathies. N Engl J Med 343:847–855
Vernino S, Low PA, Lennon VA (2003) Experimental autoimmune autonomic neuropathy. J Neurophysiol 90:2053–2059
Wang Z, Low PA, Jordan J, Freeman R, Gibbons CH, Schroeder C, Sandroni P, Vernino S (2007) Autoimmune autonomic ganglionopathy: IgG effects on ganglionic acetylcholine receptor current. Neurology 68:1917–1921
Acknowledgments
This work was supported in part by National Institutes of Health (NS 32352, NS 44233, NS 22352, NS 43364, NS065738), Mayo CTSA (UL1 RR24150), and Mayo Funds. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institute of Neurological Disorders and Stroke or the National Institutes of Health.
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Kimpinski, K., Iodice, V., Sandroni, P. et al. Sudomotor dysfunction in autoimmune autonomic ganglionopathy: a follow-up study. Clin Auton Res 22, 131–136 (2012). https://doi.org/10.1007/s10286-011-0152-4
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DOI: https://doi.org/10.1007/s10286-011-0152-4