Electrochemical skin conductance: a systematic review
- 545 Downloads
Currently available techniques for the evaluation of small fiber neuropathy and related sudomotor function remain suboptimal. Electrochemical skin conductance (ESC) has recently been introduced as a simple noninvasive and fast method for the detection of sudomotor dysfunction. The purpose of this review is to synthesize and appraise research using ESC measurements for sudomotor evaluation in adults.
Electronic databases including MEDLINE and Google Scholar were searched (up to March 13, 2017). The search strategy included the following terms: "electrochemical skin conductance,” “Sudoscan,” and “EZSCAN.” Evidence was graded according to defined quality indicators including (1) level of evidence; (2) use of established tests as reference tests (e.g., quantitative sudomotor axon test [QSART], sympathetic skin responses [SSR], thermoregulatory sweat test [TST], and skin biopsies to assess sudomotor and epidermal small fibers); (3) use of consecutive/non-consecutive subjects; and (4) study design (prospective/retrospective).
A total of 24 studies met the inclusion criteria. These were classified into preclinical, normative, comparative/diagnostic, or interventional. ESC measurement properties, diagnostic accuracy, and similarities to and differences from established tests were examined.
ESC measurements expand the arsenal of available tests for the evaluation of sudomotor dysfunction. The advantages and disadvantages of ESC versus established tests for evaluating sudomotor/small fiber function reviewed herein should be used as evidence to inform future guidelines on the assessment of sudomotor function.
KeywordsElectrochemical skin conductance ESC Sudoscan Small fiber neuropathy Dysautonomia Autonomic
The author thanks Phillipe Brunswick, Impeto Medical, for clarification of principles for ESC measurements.
Compliance with ethical standards
Conflict of interest
The Sudoscan® device was donated to the author by Impeto Medical. Dr. Novak has received funding support from Impeto Medical.
- 2.England JD, Gronseth GS, Franklin G et al (2009) 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 72:177–184. doi: 10.1212/01.wnl.0000336345.70511.0f CrossRefGoogle Scholar
- 3.Lauria G, Hsieh ST, Johansson O et al (2010) European Federation of Neurological Societies/Peripheral Nerve Society Guideline on the use of skin biopsy in the diagnosis of small fiber neuropathy. Report of a joint task force of the European Federation of Neurological Societies and the Peripheral Nerve Society. Eur J Neurol 17(903–912):e44–e49. doi: 10.1111/j.1468-1331.2010.03023.x Google Scholar
- 7.14 Autonomic Testing Policy v001.pdf. https://www.aan.com/uploadedFiles/Website_Library_Assets/Documents/3.Practice_Management/1.Reimbursement/1.Billing_and_Coding/5.Coverage_Policies/14%20Autonomic%20Testing%20Policy%20v001.pdf Accessed 3/18/2017
- 9.Ayoub H, Calvet JH, Lair V et al (2012) Electrochemical basis for EZSCAN/SUDOSCAN: a quick, simple, and non-invasive method to evaluate sudomotor dysfunctions. In: Chun JH (ed) Developments in electrochemistry. ISBN 978-953-51-0851-1. https://www.intechopen.com/books/developments-in-electrochemistry/electrochemical-basis-for-ezscansudoscan-a-quick-simple-and-non-invasive-method-to-evaluate-sudomot
- 11.Vinik AI, Nevoret M-L, Casellini C (2015) The new age of sudomotor function testing: a sensitive and specific biomarker for diagnosis, estimation of severity, monitoring progression, and regression in response to intervention. Front Endocrinol 6:94. doi: 10.3389/fendo.2015.00094 CrossRefGoogle Scholar
- 13.Shibasaki M, Crandall CG (2010) Mechanisms and controllers of eccrine sweating in humans. Front Biosci 2:685–696Google Scholar
- 24.Calvet JH, Dupin J, Winiecki H, Schwarz PEH (2013) Assessment of small fiber neuropathy through a quick, simple and non invasive method in a German diabetes outpatient clinic. Exp Clin Endocrinol Diabetes Off J Ger Soc Endocrinol Ger Diabetes Assoc 121:80–83. doi: 10.1055/s-0032-1323777 Google Scholar
- 33.England JD, Gronseth GS, Franklin G et al (2005) Distal symmetric polyneuropathy: a definition for clinical research: report of the American Academy of Neurology, the American Association of Electrodiagnostic Medicine, and the American Academy of Physical Medicine and Rehabilitation. Neurology 64:199–207. doi: 10.1212/01.WNL.0000149522.32823.EA CrossRefGoogle Scholar
- 47.Brunswick P, Bocquet N (2014) United States Patent: 8918170—Electrophysiological analysis systemGoogle Scholar
- 51.Zonana J (1993) Hypohidrotic (anhidrotic) ectodermal dysplasia: molecular genetic research and its clinical applications. Semin Dermatol 12:241–246Google Scholar
- 57.Claus D, Schondorf R (1999) Sympathetic skin response. The International Federation of Clinical Neurophysiology. Electroencephalogr Clin Neurophysiol Suppl 52:277–282Google Scholar