HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Figures Only Full Text Full Text (PDF) Correspondence: Submit a response Alert me when this article is cited Alert me when Correspondence are posted Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Novak, V. Articles by Mendell, J.R. Search for Related Content PubMed PubMed Citation Articles by Novak, V. Articles by Mendell, J.R.

Autonomic impairment in painful neuropathy

From the Department of Neurology, The Ohio State University, Columbus.

Address correspondence and reprint requests to Dr. Vera Novak, Department of Neurology, The Ohio State University, 408 Means Hall, 1654 Upham Drive, Columbus, OH 43210; e-mail: novak.91{at}osu.edu

OBJECTIVES: 1) To determine the degree and distribution and quantitate the severity of autonomic impairment in painful neuropathy (PN). 2) To assess the role of autonomic testing in evaluating PN.

METHODS: The authors studied 92 patients with PN (60 women and 32 men, age 56.9 ± 12.4 years) using: 1) autonomic reflex testing (ART), Quantitative Sudomotor Axon Reflex Test (QSART), cardiac–vagal, head-up tilt, and surface skin temperature; 2) autonomic symptoms questionnaire; 3) nerve conduction (NCS) and laboratory studies; 4) quantitative sensory testing; 5) skin biopsy; and 6) Composite Autonomic Symptoms Score (CASS) scale to grade ART results from 0 (normal) to 10 (autonomic failure).

RESULTS: Autonomic involvement in PN had characteristic features. Main symptoms were pain, secretory and skin vasomotor signs, hypertension, and impotence. ART results were abnormal in 86 (93.5%) (CASS < 4), QSART in 67 (72.8%), cardiac–vagal index in 58 (63%), skin temperature in 51 (55.4%), orthostatic hypertension in 39 (42.3%), and family history of PN in 26 (21%) of patients. Group 1 (abnormal NCS) (n = 45) had more severe ART and sensory abnormalities than the Group 2 (normal NCS) (n = 47): 1) CASS 2.0 ± 0.96 vs 1.55 ± 0.88 (p < 0.01), cardiac–vagal index (p < 0.02), skin temperature (p < 0.02), hypertension (p < 0.03), cooling (p < 0.002), and vibration (p < 0.0005) thresholds.

CONCLUSIONS: Autonomic symptoms in painful neuropathy are predominantly cholinergic and form a unique constellation of features that are distinct from other autonomic neuropathies.

This article has been cited by other articles:

				J. TAVEE and L. ZHOU Small fiber neuropathy: A burning problem Cleveland Clinic Journal of Medicine, May 1, 2009; 76(5): 297 - 305. [Abstract] [Full Text] [PDF]

				J. D. England, G. S. Gronseth, G. Franklin, G. T. Carter, L. J. Kinsella, J. A. Cohen, A. K. Asbury, K. Szigeti, J. R. Lupski, N. Latov, et al. Practice Parameter: Evaluation of distal symmetric polyneuropathy: Role of autonomic testing, nerve biopsy, and skin biopsy (an evidence-based review): Report of the American Academy of Neurology, American Association of Neuromuscular and Electrodiagnostic Medicine, and American Academy of Physical Medicine and Rehabilitation Neurology, January 13, 2009; 72(2): 177 - 184. [Abstract] [Full Text] [PDF]

				H L Teoh, A Chow, and E P Wilder-Smith Skin wrinkling for diagnosing small fibre neuropathy: comparison with epidermal nerve density and sympathetic skin response J. Neurol. Neurosurg. Psychiatry, July 1, 2008; 79(7): 835 - 837. [Abstract] [Full Text] [PDF]

				G. Devigili, V. Tugnoli, P. Penza, F. Camozzi, R. Lombardi, G. Melli, L. Broglio, E. Granieri, and G. Lauria The diagnostic criteria for small fibre neuropathy: from symptoms to neuropathology Brain, July 1, 2008; 131(7): 1912 - 1925. [Abstract] [Full Text] [PDF]

				K C Gorson, D N Herrmann, R Thiagarajan, T H Brannagan, R L Chin, L J Kinsella, and A H Ropper Non-length dependent small fibre neuropathy/ganglionopathy J. Neurol. Neurosurg. Psychiatry, February 1, 2008; 79(2): 163 - 169. [Abstract] [Full Text] [PDF]

				M.-T. Tseng, S.-C. Hsieh, C.-T. Shun, K.-L. Lee, C.-L. Pan, W.-M. Lin, Y.-H. Lin, C.-L. Yu, and S.-T. Hsieh Skin denervation and cutaneous vasculitis in systemic lupus erythematosus Brain, April 1, 2006; 129(4): 977 - 985. [Abstract] [Full Text] [PDF]

				E. Fink and A. L. Oaklander Small-fiber neuropathy: answering the burning questions. Sci. Aging Knowl. Environ., February 15, 2006; 2006(6): pe7 - pe7. [Abstract] [Full Text]

				A. Oaklander Erythromelalgia: Small-Fiber Neuropathy by Any Other Name? Pediatrics, July 1, 2005; 116(1): 293 - 294. [Full Text] [PDF]

				A. A. Amato and A. L. Oaklander Case 16-2004 - A 76-Year-Old Woman with Numbness and Pain in the Feet and Legs N. Engl. J. Med., May 20, 2004; 350(21): 2181 - 2189. [Full Text] [PDF]

				W. Singer, J. M. Spies, J. McArthur, J. Low, J. W. Griffin, K. K. Nickander, V. Gordon, and P. A. Low Prospective evaluation of somatic and autonomic small fibers in selected autonomic neuropathies Neurology, February 24, 2004; 62(4): 612 - 618. [Abstract] [Full Text] [PDF]

				C.-L. Pan, T.-J. Tseng, Y.-H. Lin, M.-C. Chiang, W.-M. Lin, and S.-T. Hsieh Cutaneous innervation in Guillain-Barre syndrome: pathology and clinical correlations Brain, February 1, 2003; 126(2): 386 - 397. [Abstract] [Full Text] [PDF]

				M.-C. Chiang, Y.-H. Lin, C.-L. Pan, T.-J. Tseng, W.-M. Lin, and S.-T. Hsieh Cutaneous innervation in chronic inflammatory demyelinating polyneuropathy Neurology, October 8, 2002; 59(7): 1094 - 1098. [Abstract] [Full Text] [PDF]