Ann Rehabil Med.  2017 Dec;41(6):1028-1038. 10.5535/arm.2017.41.6.1028.

Rapid, Objective and Non-invasive Diagnosis of Sudomotor Dysfunction in Patients With Lower Extremity Dysesthesia: A Cross-Sectional Study

• Chae CS
• Park GY
• Choi YM
• Jung S
• Kim S
• Sohn D
• Im S

• KMID: 2400288
• DOI: http://doi.org/10.5535/arm.2017.41.6.1028

Abstract

OBJECTIVE
To determine whether patients with lumbosacral (LS) radiculopathy and peripheral polyneuropathy (PPNP) exhibit sudomotor abnormalities and whether SUDOSCAN (Impeto Medical, Paris, France) can complement nerve conduction study (NCS) and electromyography (EMG).
METHODS
Outpatients with lower extremity dysesthesia underwent electrophysiologic studies and SUDOSCAN. They were classified as normal (group A), LS radiculopathy (group B), or PPNP (group C). Pain severity was measured by the Michigan Neuropathy Screening Instrument (MNSI) and visual analogue scale (VAS). Demographic features, electrochemical skin conductance (ESC) values on hands and feet, and SUDOSCAN-risk scores were analyzed.
RESULTS
There were no statistical differences in MNSI and VAS among the three groups. Feet-ESC and hands-ESC values in group C were lower than group A and B. SUDOSCAN-risk score in group B and C was higher than group A. With a cut-off at 48 microSiemens of feet-ESC, PPNP was detected with 57.1% sensitivity and 94.2% specificity (area under the curve [AUC]=0.780; 95% confidence interval [CI], 0646-0.915). With a SUDOSCAN-risk score cut-off at 29%, NCS and EMG abnormalities related to LS radiculopathy and PPNP were detected with 64.1% sensitivity and 84.2% specificity (AUC=0.750; 95% CI, 0.674-0.886).
CONCLUSION
SUDOSCAN can discriminate outpatients with abnormal electrophysiological findings and sudomotor dysfunction. This technology may be a complementary tool to NCS and EMG in outpatients with lower extremity dysesthesia.

Keyword

Radiculopathy; Diabetes mellitus; Polyneuropathies; Small fiber neuropathy; Galvanic skin response

MeSH Terms

Complement System Proteins
Cross-Sectional Studies*
Diabetes Mellitus
Diagnosis*
Electromyography
Erythromelalgia
Foot
Galvanic Skin Response
Hand
Humans
Lower Extremity*
Mass Screening
Michigan
Neural Conduction
Outpatients
Paresthesia*
Polyneuropathies
Radiculopathy
Sensitivity and Specificity
Skin
Complement System Proteins

Figure

• 

  Fig. 1 Flow chart of participants. NCS, nerve conduction study; EMG, electromyography; LS, lumbosacral; PPNP, peripheral polyneuropathy.

• 

  Fig. 2 Position of a subject undergoing a typical SUDOSCAN examination performed in standing position with full contact of electrodes on the hands (A) and the feet (B).

• 

  Fig. 3 Representative figures from each group obtained from SUDOSCAN. (A) Results obtained in a patient who showed normal NCS and needle EMG findings with normal mean feet ESC with low SUDOSCAN risk score. (B) Results obtained in a patient with needle EMG findings compatible with lumbosacral radiculopathies with normal mean feet ESC but increased SUDOSCAN-risk score. (C) Results obtained in a patient with NCS findings compatible with peripheral polyneuropathy with low mean feet ESC and increased SUDOSCAN-risk score. NSC, nerve conduction study; EMG, electromyography; ESC, electrochemical skin conductance.

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