Botulinum toxin A for palmar hyperhidrosis: assessment with sympathetic skin responses evoked by train of stimuli.

Objective assessment of the effect of botulinum toxin A (BT) treatment in primary palmar hyperhidrosis (PH) is attempted by different methods. We decided to use for this purpose sympathetic skin responses evoked by train of stimuli (TSSR). Twenty patients with severe PH (five female, median age 24, range 18-36) were examined regularly over 3 months after receiving 50 UI BT in each palm. TSSR were recorded from the palms after sensory stimulation by a train of three supramaximal electric pulses 3 millisecond apart. Results were compared to longitudinally studied TSSR of 20 healthy sex- and age-matched control subjects. All hyperhidrosis patients reported excellent improvement. TSSR amplitudes decreased at week 1 (mean 54% range 48%-67%) and over the following months in a clinically significant trend (slope R=-.82, P<.0001). TSSR in controls changed insignificantly (±13% from the baseline). The difference between patients and controls was highly significant at any time point (P<.001). This study suggests that TSSR may help in assessment of treatments in PH. It confirms objectively the efficacy of BT in PH.

Quick, non-invasive and quantitative assessment of small fiber neuropathy in patients receiving chemotherapy.

Chemotherapy-induced peripheral neurotoxicity (CIPN) is a common, potentially severe and dose-limiting adverse effect; however, it is poorly investigated at an early stage due to the lack of a simple assessment tool. As sweat glands are innervated by small autonomic C-fibers, sudomotor function testing has been suggested for early screening of peripheral neuropathy. This study aimed to evaluate Sudoscan, a non-invasive and quantitative method to assess sudomotor function, in the detection and follow-up of CIPN. Eighty-eight patients receiving at least two infusions of Oxaliplatin only (45.4%), Paclitaxel only (14.8%), another drug only (28.4%) or two drugs (11.4%) were enrolled in the study. At each chemotherapy infusion the accumulated dose of chemotherapy was calculated and the Total Neuropathy Score clinical version (TNSc) was carried out. Small fiber neuropathy was assessed using Sudoscan (a 3-min test). The device measures the Electrochemical Skin Conductance (ESC) of the hands and feet expressed in microSiemens (µS). For patients receiving Oxaliplatin mean hands ESC changed from 73 ± 2 to 63 ± 2 and feet ESC from 77 ± 2 to 66 ± 3 µS (p < 0.001) while TNSc changed from 2.9 ± 0.5 to 4.3 ± 0.4. Similar results were observed in patients receiving Paclitaxel or another neurotoxic chemotherapy. During the follow-up, ESC values of both hands and feet with a corresponding TNSc < 2 were 70 ± 2 and 73 ± 2 µS respectively while they were 59 ± 1.4 and 64 ± 1.5 µS with a corresponding TNSc ≥ 6 (p < 0.0001 and p = 0.0003 respectively). This preliminary study suggests that small fiber neuropathy could be screened and followed using Sudoscan in patients receiving chemotherapy.

Assessment of small fiber neuropathy through a quick, simple and non invasive method in a German diabetes outpatient clinic.

INTRODUCTION: Sudomotor dysfunction is one of the earliest neurophysiologic abnormalities to manifest in distal small fiber neuropathy. SUDOSCAN® was developed to provide a non invasive, quick, simple and quantitative measurement of sweat function. The aim of this observational study was to assess sweat function in a diabetes outpatient consult clinic in Germany. METHODS: The study was conducted from February 2009 to March 2011 on patients of a diabetes outpatient clinic in Germany with type 1 and type 2 diabetes, and was conducted parallel to standard care. Sweat function was evaluated by measuring the electrochemical conductance (ESC) of the hands and feet. The method's reproducibility between 2 devices and a follow-up according to insulin administration were also assessed. RESULTS: 52 patients with type 1 diabetes and 115 patients with type 2 diabetes (69 receiving insulin) were involved in this observational study. Hand and foot conductances were lower in patients with type 2 diabetes when compared to patients with type 1 diabetes. A slight decrease in hand and foot conductances was observed in patients with type 2 diabetes without insulin, while an increase was observed in patients receiving insulin (-3.8±9.7 vs. 1.0±9.7 µS, p=0.02 for the hands and -2.2±7.5 vs. 4.1±8.8 µS, p<0.001 for the feet). Coefficient of correlation between measurements performed with the 2 different devices was 0.85 for hands and 0.93 for feet, p<0.001. No safety concern was reported and none of the subjects experienced discomfort during the tests. CONCLUSION: This preliminary study shows that the assessment of small C fiber neuropathy can be performed non invasively, quickly and effectively in standard diabetes outpatient practice with very good reproducibility. The observation that electrochemical skin conductance improves with intensified insulin treatment must be confirmed in a clinical study performed on a larger population.

The effects of smoking on selective attention as measured by startle reflex, skin conductance, and heart rate responses to auditory startle stimuli.

The present study examined the effects of cigarette smoking on attentional processing by measuring nondeprived smokers' (n=39), minimally deprived smokers' (n=36), and nonsmokers' (n=34) startle eyeblink reflex, heart rate, and skin conductance responses (SCR) to acoustic startle stimuli (105 dB) during directed attention tasks. Whereas smokers demonstrated smaller startle responses than nonsmokers during a directed attention visual task, no difference in startle response magnitude emerged between the two smoking groups, nor did we observe an effect of smoking on SCR or heart rate response to the startle stimuli. Our findings suggest that smokers differ from nonsmokers in their selective attention abilities and that smoking does not enhance minimally deprived smokers' selective attention.

Bedside assessment of sympathetic skin response after spinal cord injury: a brief report comparing inspiratory gasp and visual stimulus.

STUDY DESIGN: A case control study in five controls, and 20 tetraplegic and paraplegic patients, complete and incomplete. OBJECTIVE: The aim was to assess the feasibility of a simple test for sympathetic system preservation after spinal cord damage in a pain-free manner and which could be undertaken worldwide without specialist equipment or manpower. SETTINGS: Patients were attending the Southport Regional Spinal Injuries Centre, England, either as outpatients or as in-patients during rehabilitation. METHODS: The sympathetic skin response (SSR) was recorded on a single-channel ECG recorder from the right hand and right foot in turn after inspiratory gasp (IG) or visual stimulation. RESULTS: Unlike the visually evoked SSR, the gasp-evoked SSR was reliable, albeit of variable amplitude, and there was little difference between the hand and foot. Paraplegics had similar SSRs in the hands as the controls. There was minor insignificant habituation of response for the gasp reflex. There was occasional unexpected SSR distally in patients with complete lesions, and in patients with incomplete lesions the responses could not have been predicted from the sensory motor pattern. CONCLUSIONS: Trained IG induces an SSR which is sufficient to elucidate sympathetic loss following spinal cord injury. It is superior to visual stimulation in this respect. Habituation is not a problem with at least 1 min between tests, and high doses of anticholinergics agents may impair the response.

Effect of avicatonin (chicken carbocalcitonin) on galvanic skin response: a randomized, prospective, double-blind, controlled study for an objective assessment of pain.

In an attempt to objectively evaluate the analgesic effect of avicatonin (chicken carbocalcitonin), galvanic skin response (GSR) was recorded in 18 patients with osteoporosis or osteopenia and backache in a randomized, prospective, double-blind, controlled study. Backache on examination and in daily living was assessed weekly by scores utilizing a questionnaire. After two measurements 1 week apart on induction of backache with a maximum anterior flexion of the back from a supine position, either 20 units of avicatonin or inactive placebo was intramuscularly injected once a week for 4 consecutive weeks. In the avicatonin group but not in the placebo group, the area under the curve (AUC) of GSR tracing was decreased, giving a significant difference between the avicatonin and placebo groups after the second week. The pain score obtained by questionnaire decreased in both groups, suggesting a placebo effect. Galvanic skin response may provide a breakthrough to the objective and reliable evaluation of the biological response to pain which could not be accomplished by questionnaires based on subjective impression markedly influenced by emotional and psychological factors.

Functional assessment of the stratum corneum under the influence of oral aromatic retinoid (etretinate) in guinea-pigs and humans. Comparison with topical retinoic acid treatment.

Clinically we have noted that the skin of patients treated with long-term oral etretinate becomes uniformly soft and smooth to touch, like facial skin that becomes smoother and less wrinkled following treatment with topical tretinoin. This suggests that retinoids, whether used systemically or topically, alter the physical properties of the skin, particularly of the stratum corneum (SC). To study the influence of retinoids on the SC, we serially assessed the functional properties of the SC non-invasively in retinoid-treated humans and experimental animals. SC hydration and barrier function were assessed by measurement of high-frequency conductance and transepidermal water loss (TEWL), respectively. Daily application of topical retinoic acid creams was found to rapidly induce a time- and dose-dependent, linear increase in SC hydration of the forearm skin of healthy adults over a 2-week period and to compromise its water barrier function in a similar fashion. Systemic administration of high-dosage etretinate, 4 or 8 mg/kg/day, to guinea-pigs also induced dose-dependent increases in both SC hydration and TEWL measured on the plantar skin after 1 month. Moreover, in the animals given etretinate 4 mg/kg/day we confirmed a slight but significant decrease in the number of cell layers of the plantar SC. Likewise, patients with various dermatoses began to show similar functional changes of the SC in the uninvolved skin of the flexor surface of the forearms 3 weeks after the start of oral etretinate treatment, consisting of 50 mg daily for 2 weeks, followed by gradual dose tapering.(ABSTRACT TRUNCATED AT 250 WORDS)

Cue exposure as an assessment technique in the management of a heroin addict: case report.

A recently-detoxified heroin addict was exposed to a battery of drug-related stimuli which he had previously assisted in identifying as personally relevant. Skin conductance was measured during exposure to both drug-related stimuli and neutral stimulus items. The amplitude of the first skin conductance response following stimulus presentation and the number of skin conductance responses during stimulus presentation were significantly different for the drug-related and neutral stimuli. Post-exposure subjective ranking of the drug-related items differed markedly from pre-exposure ranking; and the post-exposure subjective rankings were closer to the ranked order of the measured physiological responses than the pre-exposure subjective rankings. The use of cue exposure assessment in planning treatment for relapse prevention and the possible importance of idiosyncratic cues in the environment are discussed.

[Objective assessment of the effect of sodium lauryl sulfate on the surface of the skin in childhood]. / Beitrag zur Objektivierung des Einflusses von Natriumlaurylsulfat auf die Hautoberfläche im Kindesalter.

The influence of sodium lauryl sulfate on physiological properties of the skin surface in children was assessed by continuous measuring of electric conductivity in the course of iontophoresis with physiological solution. The results achieved have shown that even very low concentrations of sodium lauryl sulfate (0.1% water solution) provoke changes of physiological properties in the skin surface. A concentration of 0.5% has been established to be the limit concentration of sodium lauryl sulfate which can evidently injure the barrier functions. The degree of changes in electric conductivity was not dependent on the intensity of the skin irritation.

[Characterization of the effect of analgesics on the assessment of experimental pain in man. Pethidine and tramadol in a double-blind comparison]. / Charakterisierung der Wirkung von Analgetika durch experimentelle Schmerzmessung am Menschen. Pethidin und Tramadol im Doppelblindvergleich.

The effect of the opioid analgesics tramadol and pethidine on experimentally induced pain was investigated in a double blind study with healthy volunteers. Using a constant current shocker, compensating the changes of the skin resistance, a constantly increasing pain stimulus was produced. Detection-, pain-, and tolerance-thresholds were assessed before and three times after intravenous injection of either pethidine (1 mg/kg bodyweight), tramadol (2 mg/kg bodyweight) or placebo (NaCl). While the two analgesics caused an increase of all three thresholds the placebo did not cause any threshold changes. The rise of the detection threshold after application of tramadol and pethidine suggests a sedation effect. However, in relation to the analgesic effect this sedation effect is stronger with tramadol than with pethidine. With the dosage used in this experiment, there is no difference in the analgesic effect of tramadol and pethidine. Compensating for intra- and interindividual changes in skin resistance, the pain stimulation method used in this study provides a good quantification of the effects of analgesics.

Clinical and physiological assessment of chlorazepate, diazepam and placebo in anxious neurotics.

A 28-day double-blind assessment of chlorazepate dipotassium, diazepam and placebo was done on 30 outpatient neurotics with a primary symptom of anxiety. Acute, sub-acute and more chronic effects of the drug were assessed after 3 hours, 14 days and 28 days of drug administration. A battery of psychiatric ratings as well as physiological and psychophysiological assessments were done at each period. The psychometric assessments showed a trend for diazepam to be the most anxiolytic of the three drugs, followed by chlorazepate and then placebo. These measurements did not reach uniform statistically significant differences. Psychological measurements demonstrated the same trends, but some of these reached statistically significant levels. These parameters also indicate a slightly different mode of action of the two drugs at equimolecular doses. Diazepam would depress baseline and stimulation arousal, whereas chlorazepate would decrease baseline CNS arousal, but facilitate CNS response upon stimulation.