Testing the Autonomic System

  • J. H. Abicht


The diagnosis of autonomic neuropathy, which is considered an important cause of organic impotence [18, 46], is difficult. Symptoms of autonomic failure are not specific [37, 41, 50, 53], do not always correlate with impotence [38], and methods for the direct measurement and assessment of autonomic function in human subjects are not presently available.


Diabetic Neuropathy Autonomic Neuropathy Continuous Subcutaneous Insulin Infusion Autonomic Failure Heart Rate Variation 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Abicht J, Bautsch BW, Mitzkat HJ (1988) Untersuchungen zur Beurteilung von Validität und Empfindlichkeit verschiedener Funktionstests des autonomen Nervensystemes bei Typ-I- und Typ-Il-Diabetikern. Akt Endokrin Stoffw 9: 124Google Scholar
  2. 2.
    Alloussi S, Mast GJ, Kopper B, Ziegler M (1985) Harnblasenentleerungsstörung als Folge einer sakralen autonomen diabetischen Neuropathie. Urologe (A) 24: 291 - 295Google Scholar
  3. 3.
    Bannister R, Mathias C (1988) Testing autonomic reflexes. In: Bannister R (ed) Autonomic failure. A textbook of clinical disorders of the autonomic nervous system, 2nd edn. Oxford University Press, New York, pp 289 - 308Google Scholar
  4. 4.
    Bautsch BW (1990) Untersuchungen zur Diagnostik der diabetischen autonomen Neuropathie. Standardisierung und Beurteilung der Aussagekraft von sechs kardiovaskulären Tests und eines Verfahrens zur Prüfung der Temperatursensibilität. Thesis, Medical School HannoverGoogle Scholar
  5. 5.
    Bennett T, Gardiner SM (1988) Cardiovascular pathophysiology in diabetes mellitus. In: Bannister R (ed) Autonomic failure. A textbook of clinical disorders of the autonomic nervous system, 2nd edn. Oxford University Press, New York, pp 654 - 666Google Scholar
  6. 6.
    Bertelsmann FW, Heimaans JJ, Weber EJM, van der Veen EA, Schouten JA (1985). Thermal discrimination thresholds in normal subjects and in patients with diabetic neuropathy. J Neurol Neurosurg Psychiatry 48: 686 - 690PubMedCrossRefGoogle Scholar
  7. 7.
    Campbell IW, Ewing DJ, Clarke BF, Duncan UP (1974) Testicular pain sensation in diabetic autonomic neuropathy. Br Med J 2: 638 - 639PubMedCrossRefGoogle Scholar
  8. 8.
    Cicmir I, Kashiwagi S, Berger H, Koschinski T, Gries FA (1983) Improvement of autonomic nerve function after one year of continuous subcutaneous insulin infusion. Diabetologia 25: 147Google Scholar
  9. 9.
    Clarke BF, Ewing DJ, Campbell IW (1979) Diabetic autonomic neuropathy. Diabetologia 17: 195 - 212PubMedCrossRefGoogle Scholar
  10. 10.
    Consensus Statement (1988) Report and Recommendations of the San Antonio Conference on Diabetic Neuropathy. Diabetes Care 9: 592 - 597Google Scholar
  11. 11.
    Dyck PJ, Zimmerman IR, O’Brian PC, Ness A, Caskey PE, Karnes J, Buskek WC (1978) Automated systems to evaluate touch-pressure vibration anf thermal cutaneous sensation in man. Ann Neurol 4: 502 - 510PubMedCrossRefGoogle Scholar
  12. 12.
    Dyck PJ, Karnes J, Lais A, Lofgren EP, Stevens JC (1984) Pathological alterations of the peripheral nervous systems of humans. In: Dyck PJ, Thomas PK, Lambert EH, Runge R (eds) Peripheral neuropathy, 2nd edn. Saunders, Philadelphia, pp 760 - 870Google Scholar
  13. 13.
    Dyck PJ, Karnes J, O’Brien PC (1987) Diagnosis, staging and classification of diabetic neuropathy and association with other complications. In: Dyck PJ, Asbury AK, Winegrad AI, Porte E jr (eds) Diabetic neuropathy. Saunders, Philadelphia, pp 36 - 44Google Scholar
  14. 14.
    Dyck PJ, Buskek W, Spring E, Karnes J, Litchy WJ, O’Brian PC, Service FJ (1987) Vibratory and cooling detection thresolds compared with other tests in diagnosing and staging diabetic neuropathy. Diabetes Care 10: 432 - 440PubMedCrossRefGoogle Scholar
  15. 15.
    Ewing DJ, Clarke BF (1986) Diabetic autonomic neuropathy: Present insights and future prospects. Diabetes Care 9: 648-665Google Scholar
  16. 16.
    Ewing DJ, Campbell IW, Clarke BF (1980) The natural history of diabetic autonomic neuropathy. Q J Med, 193: 95 - 108Google Scholar
  17. 17.
    Ewing DJ, Martyn CN, Young RJ, Clarke BF (1985) The value of cardiovascular autonomic function tests: 10 years experience in diabetes. Diabetes Care 8: 491 - 498PubMedCrossRefGoogle Scholar
  18. 18.
    Faerman I, Glocer L, Fox D, Jadinsky MN, Rapaport M (1974) Impotence and diabetes. Histological studies of the autonomic vervous fibres of the corpora cavernosa in impotent diabetic males. Diabetes 23: 971-976Google Scholar
  19. 19.
    Fagius J (1985) Autonomic neurophysiology in long-term diabetes. J Clin Physiol (Suppl 5 ) 5: 74 - 78Google Scholar
  20. 20.
    Fedele D, Negrin P, Cardone, C (1984) Influence of continuous subcutaneous insulin infusion ( CSII) treatment on diabetic somatic and autonomic neuropathy. J Endocrinol Invest 7: 623-628Google Scholar
  21. 21.
    Fowler CJ, Carroll MB, Burns D, Howe N, Robinson K (1987) A portable system for measuring cutaneous thresholds for warming and cooling. J Neurol Neurosurg Psychiatry 50: 1211 - 1215PubMedCrossRefGoogle Scholar
  22. 22.
    Fowler CJ, Ali Z, Kirby RS, Pryor JP (1988) The value of testing for unmyelinated fibre sensory neuropathy in diabetic impotence. Br J Urol 61: 63 - 67PubMedCrossRefGoogle Scholar
  23. 23.
    Genovely H, Pfeifer MA (1988) RR-variation: The autonomic test of choice in diabetes. Diabet Metab Rev 4: 255-271Google Scholar
  24. 24.
    Gerstenberg TC, Bradley, WE (1983) Nerve conduction velocity measurement of dorsal nerve of penis in normal and impotent males. Urology 22: 90 - 92CrossRefGoogle Scholar
  25. 25.
    Gu J, Polak JM, Lazarides M et al (1984) Decrease of vasoactive intestinal polypeptide ( VIP) in the penises from impotent men. Lancet 2: 315-318Google Scholar
  26. 26.
    Guy RJC, Watkins PJ (1985) The relationship of autonomic and peripheral neuropathy in diabetes mellitus. J Auton Nery Syst 14: 103CrossRefGoogle Scholar
  27. 27.
    Guy RJC, Clark CA, Malcolm PN, Watkins PJ (1985) Evaluation of thermal and vibration sensation in diabetic neuropathy. Diabetologia 28: 131 - 137PubMedGoogle Scholar
  28. 28.
    Jamal GA, Hansen S, Weir AI, Ballantyne JB (1986) An improved automated method for the measurement of thermal thresholds. J Neurol Neurosurg Psychiatry 48: 354360Google Scholar
  29. 29.
    Kirby RS, Fowler CJ (1988) Bladder and sexual dysfunction in diseases affecting the autonomic nervous system. In: Bannister R (ed) Autonomic failure. A textbook of clinical disorders of the autonomic nervous system, 2nd edn. Oxford University Press, New York, pp 413 - 431Google Scholar
  30. 30.
    Lehmann WP, Haslbeck M, Müller J, Melmert H, Strian F (1985) Frühdiagnose der autonomen Diabetes-Neuropathie mit Hilfe der Temperatursensibilität. Dtsch Med Wochenschr 110: 639 - 642PubMedCrossRefGoogle Scholar
  31. 31.
    Levy DM, Karanth SS, Springall DR, Polak JM (1989) Depletion of cutaneous nerves and neuropeptides in diabetes mellitus: an immunocytochemical study. Diabetologia 32: 427 - 433PubMedCrossRefGoogle Scholar
  32. 32.
    Lincoln J, Crowe R, Blackley PF, Pryor JP, Lumley JS, Burnstock G (1987) Changes in vipergic, cholinergic and adrenergic innervation of human penile tissue in diabetic and non-diabetic males. J Urol 137: 1053 - 1059PubMedGoogle Scholar
  33. 33.
    Lindberger M, Schröder HD, Schultzberg M, Kristensson K, Persson A, Ostmann J, Link H (1989) Nerve fibre studies in skin biopsies in peripheral neuropathies. I. Immunohistochemical analysis of neuropeptides in diabetes mellitus. J Neurol Sci 93: 289-296Google Scholar
  34. 34.
    Low PA (1984) Quantitation of autonomic responses. In: Dyck PJ, Thomas PK, Lambert EH, Bunge R (eds) Peripheral neuropathy, 2nd edn, vol 1. Saunders, Philadelphia, pp 1139 - 1165Google Scholar
  35. 35.
    Lue TF, Zeineh SJ, Schmidt RA et al. (1984) Neuroanatomy of penile erection: Its relevance to iatrogenic impotence. J Urol 131: 273-280Google Scholar
  36. 36.
    McCulloch DK, Young RJ, Prescott RJ, Campbell IW, Clarke BJ (1984) The natural history of impotence in diabetic men. Diabetologia 26: 437 - 440PubMedCrossRefGoogle Scholar
  37. 37.
    McLeod JG (1988) Autonomic dysfunction in peripheral nerve disease. In: Bannister R (ed) Autonomic failure. A textbook of clinical disorders of the autonomic nervous system, 2nd edn. Oxford University Press, New York, pp 607 - 624Google Scholar
  38. 38.
    Palmer JDK, Fink S, Burger RH (1986) Diabetic secondary impotence: neuropathic factor as measured by peripheral motor nerve conduction. Urology 28: 197 - 200PubMedCrossRefGoogle Scholar
  39. 39.
    Parys BT, Evans CM, Parsons KF (1988) Bulbuscavernosus reflex latency in the investigation of diabetic impotence. Br J Urol 61: 59 - 62PubMedCrossRefGoogle Scholar
  40. 40.
    Pfeifer MA, Halter JB, Weinberg CR, Cook D, Best L, Reenan A, Porte D Jr (1983) Differential changes of autonomic nervous system function with age in man. Am J Med 75: 249 - 258PubMedCrossRefGoogle Scholar
  41. 41.
    Pozza G, Comi G, Librenti MC, Canal N (1987) Clinical aspects and treatment of diabetic peripheral and autonomic neuropathy. Front Diabetes 8: 160 - 176Google Scholar
  42. 42.
    Quadri R, Veglio M, Flecchia D, Tonda L, Lorenzo F de, Chiandussi L, Fonzo D (1989) Autonomic neuropathy and sexual impotence in diabetic patients: Analysis of cardiovascular reflexes. Andrologia 21: 346-352Google Scholar
  43. 43.
    Saenz de Tejada I, Goldstein I, Azadzoi K, Krane RJ, Cohen RA (1989) Impaired neurogenic and endothelium-mediated relaxation of penile smooth muscle from diabetic men with impotence. N Engl J Med 320: 1025 - 1030PubMedCrossRefGoogle Scholar
  44. 44.
    Sarica Y, Karacan I (1987) Bulbuscavernosus reflex to somatic and visceral nerve stimulation in normal subjects and in diabetics with erectile impotence. J Urol 138: 55 - 58PubMedGoogle Scholar
  45. 45.
    Scherb WH, Bähren W, Stief CG, Gallwitz A, Thon W, Kriebel J (1987) Neurophysiological evaluation of patients with neurogenic erectile dysfunction. Clin Neurol Neurosurg (Suppl 1 ) 89: 88Google Scholar
  46. 46.
    Sharlip ID (1984) Clinical andrology. In: Smith DR (ed) General urology, 11th edn. Lange Medical Publications, Los Altos, CA, pp 622 - 626Google Scholar
  47. 47.
    Siroky MB, Sax DS, Krane RJ (1979) Sacral signal tracing: The electrophysiology of the bulbuscavernosus reflex. J Urol 122: 661-664Google Scholar
  48. 48.
    Solders G (1988) Discomfort after fascicular nerve biopsy. Acta Neurol Scand 77: 503 - 504PubMedCrossRefGoogle Scholar
  49. 49.
    Stief CG (1991) Diagnosis of autonomic impotence (SPACE). In: Jonas U, Thon WF, Stief CG (eds) Erectile dysfunction. Springer, Berlin Heidelberg New York TokyoGoogle Scholar
  50. 50.
    Sundkvist G (1981) Autonomic nervous dysfunction in asymptomatic diabetic patient with signs of peripheral neuropathy. Diabetes Care 4: 529 - 534PubMedCrossRefGoogle Scholar
  51. 51.
    Thomas PK, Brown MJ (1987) Diabetic polyneuropathy. In: Dyck PJ, Thomas PK, Asbury AK, Winegrad AI, Porte D Jr (eds) Diabetic neuropathy. Saunders, Philadelphia, pp 56 - 65Google Scholar
  52. 52.
    Wallin BG (1988) Intraneural recordings of normal and abnormal sympathetic activity in man. In: Bannister R (ed) Autonomic failure. A textbook of clinical disorders of the autonomic nervous system, 2nd edn. Oxford University Press, New York, pp 177 - 196Google Scholar
  53. 53.
    Wieling W, Borst C, Lieshout, JJ van. Sprangers RLH, Karemaker JM, Brederode JFM van, Montfrans GA, Dunning AJ (1985) Assessment of methods of estimate impairment of vagal and sympathetic cardiovascular innervation of the heart in diabetic autonomic neuropathy. Neth J Med 28: 383 - 392PubMedGoogle Scholar
  54. 54.
    Wrabek AJ (1985) Bulbuscavernosus reflex testing in 100 consecutive cases of erectile dysfunction. Urology 25: 495 - 498CrossRefGoogle Scholar
  55. 55.
    Young RJ, Maclntyre CA, Martyn CN et al (1986) Progression of subclinical polyneuropathy in young patients with type I (insulin-dependent) diabetes: associated with glycaemic control and microangiopathy (microvascular complications). Diabetologia 29: 156 - 161PubMedCrossRefGoogle Scholar
  56. 56.
    Ziegler D, Mayer P, Gries F (1988) Evaluation of thermal, pain and vibration sensation thresholds in newly diagnosed type I diabetic patients. J Neurol Neurosurg Psychiatry 51: 1420 - 1424PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 1991

Authors and Affiliations

  • J. H. Abicht

There are no affiliations available

Personalised recommendations