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High-resolution axon reflex sweat testing for diagnosis of neuropathy

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Abstract

Objective

The aim of this study was to report a method that quantifies axon reflex sweating from individual sweat glands with nanoliter precision. Measurement of the axon reflex is generally expressed as a single variable (e.g., the flare area or total sweat volume). High-definition videography enables precise measurement of sweating from single, axon reflex-stimulated sweat glands (SGs).

Methods

The sudomotor axon reflex was activated in healthy subjects and subjects with peripheral neuropathy by iontophoresis of 10% acetylcholine. Sweating was simultaneously imaged for 5 min in a 2.5-cm2 area of iodine-coated skin to one side of the stimulus, using a customized high-resolution camera with starch-coated transparent tape over a rigid viewing screen. A second video then imaged the directly stimulated sweating. The indirect sweat response was quantified in terms of sweat gland number and distance from the stimulation site (radius), sweat rate per gland, and total sweat.

Results

Fifty-two healthy control and twenty subjects with neuropathy underwent testing at the foot, calf, thigh, and hand. Normal ranges were calculated for SG density, mean sweat rate per SG, and total sweat volume. Neuropathy subjects demonstrated reduced sweating, and values differed between body sites.

Interpretation

The described method precisely measures the total and individual sweat output of hundreds of SGs in response to a standard, axon reflex-mediated stimulus, and quantifies alterations in axon reflex sweating seen in peripheral neuropathy.

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Authors and Affiliations

  1. Department of Neurology, University of Minnesota, Minneapolis, MN, USA

    Adam Loavenbruck, Nathan Sit & William Kennedy

  2. Telese Terme, ‘S. Maugeri’ Foundation IRCCS, Benevento, Italy

    Vincenzo Provitera

Authors
  1. Adam Loavenbruck
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  2. Nathan Sit
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  3. Vincenzo Provitera
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  4. William Kennedy
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Correspondence to Adam Loavenbruck.

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Loavenbruck, A., Sit, N., Provitera, V. et al. High-resolution axon reflex sweat testing for diagnosis of neuropathy. Clin Auton Res 29, 55–62 (2019). https://doi.org/10.1007/s10286-018-0546-7

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  • DOI: https://doi.org/10.1007/s10286-018-0546-7

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