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Sudomotor

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899: 341:, variability and the availability of normative data. However, it is important to note that all sudomotor function assessments are not specific for small fiber or sudomotor neuropathy, as they can also yield abnormal results from disorders of the sweat glands themselves. The following is a list of methods used in clinical practice and clinical research for sudomotor assessment. 840:. In addition, there is significant intra-individual and inter-individual variability, and SSR declines with age and is commonly absent in individuals over the age of 50.  SSR is only considered a surrogate marker of sudomotor function and its results should be interpreted in the context of other sudomotor testing. 848:
The spoon test, developed in 1964 by Dr. Ernest Bors, relies on assessment of the smooth movement of the convex side of a spoon along the surface of the patient’s skin. In patients with sudomotor dysfunction, the spoon will slide in a smooth and uninterrupted fashion. Conversely, the spoon’s movement
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is positioned on the patient’s palm or sole, along with a reference electrode on the dorsal side of the same body area. A change in skin potential is then induced either through electrical stimulation or deep breathing. The recorded SSR is then plotted on a graph and analyzed for presence or absence,
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Vinik, Aaron I.; Smith, A. Gordon; Singleton, J. Robinson; Callaghan, Brian; Freedman, Barry I.; Tuomilehto, Jaakko; Bordier, Lyse; Bauduceau, Bernard; Roche, Frederic (June 2016). "Normative Values for Electrochemical Skin Conductances and Impact of Ethnicity on Quantitative Assessment of Sudomotor
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Thermoregulatory Sweat Test (TST) and Quantitative Sudomotor Axon Reflex Test (QSART) are considered the gold standards for assessment of sudomotor function. Newer methods may offer simpler, potentially more sensitive, and more widely available alternatives for screening and monitoring in the clinic
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solution. At the onset of sweating, the reaction of sweat with the povidone-iodine solution and corn starch results in the appearance of a black spot. A customized miniature camera can follow the secretions of up to 400 sweat glands at a time for up to 60 seconds, analyzing the enlargement rate and
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age groups, and it has been demonstrated that ESC values begin to decrease in the eighth decade of life. ESC has the potential to be a useful tool for detecting small fiber neuropathies. It is highly sensitive, rapid, more accessible and less technically complex than current gold standard sudomotor
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is released steadily onto the skin within the inner compartment. The middle compartment acts as a buffer between the inner and outer compartments to prevent direct stimulation of sweat glands or leakage of the acetylcholine solution. The outflow humidity of the nitrogen gas after passing across the
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Although QDIRT is less technically demanding than QSART or TST, it still requires trained staff and an environmentally controlled room; iontophoresis may cause skin irritation or burning; the skin areas studied using QDIRT are not pre-defined, thus limiting the interindividual comparability of the
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Saad, Mehdi; Psimaras, Dimitri; Tafani, Camille; Sallansonnet-Froment, Magali; Calvet, Jean-Henri; Vilier, Alice; Tigaud, Jean-Marie; Bompaire, Flavie; Lebouteux, Marie; de Greslan, Thierry; Ceccaldi, Bernard; Poirier, Jean-Michel; Ferrand, François-Régis; Le Moulec, Sylvestre; Huillard, Olivier;
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D'Amato, Cinzia; Greco, Carla; Lombardo, Giorgio; Frattina, Valentina; Campo, Mariagrazia; Cefalo, Chiara M. A.; Izzo, Valentina; Lauro, Davide; Spallone, Vincenza (March 2020). "The diagnostic usefulness of the combined COMPASS 31 questionnaire and electrochemical skin conductance for diabetic
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Papanas, Nikolaos; Giassakis, Georgios; Papatheodorou, Konstantinos; Papazoglou, Dimitrios; Monastiriotis, Christodoulos; Christakidis, Dimitrios; Piperidou, Haritomeni; Maltezos, Efstratios (November 2007). "Sensitivity and specificity of a new indicator test (Neuropad) for the diagnosis of
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and mineral oil. The indicator dye changes color with the onset of sweating. Digital photographs of the color change are recorded every 15 seconds over approximately 7 minutes.  Spatial and temporal analysis of sweat droplets as well as direct and indirect sweat response are measured.
90:. Eccrine glands are the predominant sweat gland in the human body with numbers totaling up to 4 million. They are located within the reticular dermal layer of the skin and distributed across nearly the entire surface of the body with the largest numbers occurring in the palms and soles. 385:
When used in conjunction with postganglionic sudomotor function testing, such as the quantitative sudomotor axon reflex test (QSART), it can differentiate a preganglionic lesion from a postganglionic lesion. A distal anhidrotic pattern is characteristic of length-dependent
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Ramachandran, Ambady; Moses, Anand; Shetty, Samith; Thirupurasundari, Chandragiri Janakiraman; Seeli, Abraham Catherin; Snehalatha, Chamukuttan; Singvi, Sunil; Deslypere, Jean-Paul (June 2010). "A new non-invasive technology to screen for dysglycaemia including diabetes".
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Khalfallah, Kamel; Ayoub, Hanna; Calvet, Jean Henry; Neveu, Xavier; Brunswick, Philippe; Griveau, Sophie; Lair, Virginie; Cassir, Michel; Bedioui, Fethi (March 2012). "Noninvasive Galvanic Skin Sensor for Early Diagnosis of Sudomotor Dysfunction: Application to Diabetes".
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Yajnik, C.S.; Kantikar, V.; Pande, A.; Deslypere, J.-P.; Dupin, J.; Calvet, J.-H.; Bauduceau, B. (April 2013). "Screening of cardiovascular autonomic neuropathy in patients with diabetes using non-invasive quick and simple assessment of sudomotor function".
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Inspection of the patient’s skin, particularly on the lower extremities, in conjunction with a thorough medical history, can provide valuable information regarding the possible presence of sudomotor dysfunction. Evidence of altered skin hydration, such as
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Loavenbruck, Adam J.; Hodges, James S.; Provitera, Vincenzo; Nolano, Maria; Wendelshafer-Crabb, Gwen; Kennedy, William R. (June 2017). "A device to measure secretion of individual sweat glands for diagnosis of peripheral neuropathy: Loavenbruck et al".
615:(HRV) indices, intraepidermal nerve fiber density, sweat gland nerve fiber density and quantitative sudomotor axon reflex testing (QSART). In addition to diabetes, low ESC values have been reported in association with increased severity of diabetic 868:
taken from the distal leg, distal thigh, and proximal thigh prepared for standard analysis of intraepidermal nerve fiber density (IENFD). Nerve fibers innervating sweat glands are stained with Protein Gene Product 9.5 and quantified using manual
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Caccia, MR; Dezuanni, E; Salvaggio, A; Osio, M; Bevilacqua, M; Norbiato, G; Mangoni, A (1991). "Sympathetic skin response versus maximum motor and sensory conduction velocity to detect subclinical neuropathy in non-insulin-dependent diabetics".
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Khalfallah, Kamel; Calvet, Jean-Henri; Brunswick, Philippe; Névoret, Marie-Laure; Ayoub, Hanna; Cassir, Michel (2020). "A Simple and Accurate Method to Assess Autonomic Nervous System through Sudomotor Function". In Yurish, Sergey (ed.).
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heads. The pad is kept on each foot for ten minutes and the final color is recorded. A full change in color from blue to pink is considered a normal sweat response, while an absent or incomplete color change is considered abnormal.
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Machado-Moreira, Christiano A.; Smith, Foske M.; van den Heuvel, Anne M. J.; Mekjavic, Igor B.; Taylor, Nigel A. S. (September 2008). "Sweat secretion from the torso during passively-induced and exercise-related hyperthermia".
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The silicone imprint method is relatively inexpensive and can be performed in non-specialized testing centers; however, the method is prone to artifacts caused by residual hair and dirt, as well as skin surface texture and
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The flow of Cl ions in the sweat secreted from the activated sweat glands are captured by the anode. This process is repeated twice for the feet and twice for the hands with the right and left electrodes alternating as the
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Liatis, S.; Marinou, K.; Tentolouris, N.; Pagoni, S.; Katsilambros, N. (December 2007). "Usefulness of a new indicator test for the diagnosis of peripheral and autonomic neuropathy in patients with diabetes mellitus".
773:. It allows for the quantification of sweat from each individual sweat gland, as well as their location and distribution, thus providing both temporal and spatial resolution. The procedure is initiated by the 446:
receptors on the sudomotor nerve terminals, which transmit the action potential antidromically to axon branch points and then orthodromically to adjacent sudomotor nerves and glands (indirect sweat response).
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on an examination table. An indicator dye is evenly applied to the ventral surface of the patient’s skin excluding the eyes, ears, and perioral region. The dye changes color in response to a decrease in skin
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electrochemical studies were then carried out in conventional three-electrode cells to identify the origin of currents measured upon the application of low voltage potentials with variable amplitudes to
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Goldwasser, François; Taillia, Hervé; Maisonobe, Thierry; Ricard, Damien (1 April 2016). "Quick, non-invasive and quantitative assessment of small fiber neuropathy in patients receiving chemotherapy".
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Peltier, Amanda; Smith, A. Gordon; Russell, James W.; Sheikh, Kiran; Bixby, Billie; Howard, James; Goldstein, Jonathan; Song, Yanna; Wang, Lily; Feldman, Eva L.; Singleton, J. Robinson (April 2009).
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Hoeijmakers, Janneke G.; Faber, Catharina G.; Lauria, Giuseppe; Merkies, Ingemar S.; Waxman, Stephen G. (July 2012). "Small-fibre neuropathies—advances in diagnosis, pathophysiology and management".
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which occurs upon the onset of sweating as the room temperature is gradually raised. Pictures are taken to record the patient’s sweating patterns. In addition, a TST% is calculated by dividing the
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The procedure is relatively quick and the camera is portable. However, further testing is needed to establish normative data and to confirm its utility in autonomic testing. As the test lacks an
409:(QSART) was developed in 1983 by Phillip Low as a quantitative method for the identification of localized postganglionic sudomotor dysfunction. Three-compartment sweat capsules are placed on the 748:
sweating; however, it utilizes an automated imaging analysis software that is less technically complex. Prior to iontophoresis, the skin is dried and covered with an indicator dye consisting of
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procedure may cause skin irritation and discomfort. QSART requires highly specialized equipment needing regular calibration, a humidity- and temperature-controlled room, and trained personnel.
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SGNFD can potentially be used as a surrogate anatomical marker for sudomotor function. However, it is not a direct assessment of the sweat response, and normative data must be established.
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SSR refers to the change in skin resistance to electrical conduction associated with the sympathetic activation of sudomotor function in response to external or internal stimuli, such as
272:, and pure autonomic failure. Sudomotor dysfunction can manifest as increased or decreased sweating patterns. Both patterns have the potential to affect an individual’s quality of life. 1574:"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" 809:, deep breathing, and mental stress. It is mediated by a poorly understood somato-sympathetic reflex with spinal, bulbar, and suprabulbar components. The SSR is frequently utilized in 2255:
Selvarajah, Dinesh; Cash, Tom; Davies, Jennifer; Sankar, Adithya; Rao, Ganesh; Grieg, Marni; Pallai, Shillo; Gandhi, Rajiv; Wilkinson, Iain D.; Tesfaye, Solomon (12 October 2015).
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for processing. In addition, there are warm-sensitive neurons located within the preoptic nucleus that detect increases in core body temperature. Efferent pathways then descend
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sudomotor function objectively. The test is performed in a standardized room with the temperature preheated to 45–50 °C and humidity set to 35–40%.  The patient lies
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sudomotor function outside of specialized autonomic testing centers. It combines elements of TST, QSART, and the silicone imprint method. Similar to QSART, it involves the
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Luk, Andrea O. Y.; Fu, Wai-Chi; Li, Xue; Ozaki, Risa; Chung, Harriet H. Y.; Wong, Rebecca Y. M.; So, Wing-Yee; Chow, Francis C. C.; Chan, Juliana C. N. (13 August 2015).
325:, but this procedure is invasive and inappropriate for long term follow-up. Sudomotor testing can be a valuable diagnostic tool for the early detection of small fiber 3231:
Coon, Elizabeth A.; Fealey, Robert D.; Sletten, David M.; Mandrekar, Jay N.; Benarroch, Eduardo E.; Sandroni, Paola; Low, Phillip A.; Singer, Wolfgang (March 2017).
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Fabry, Vincent; Gerdelat, Angélique; Acket, Blandine; Cintas, Pascal; Rousseau, Vanessa; Uro-Coste, Emmanuelle; Evrard, Solène M.; Pavy-Le Traon, Anne (5 May 2020).
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The TST has proven to be a sensitive measure of sudomotor function. However, it is time-consuming and requires a highly specialized facility with trained personnel.
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Hilz, Max J.; Stemper, Brigitte; Axelrod, Felicia B. (1 May 1999). "Sympathetic skin response differentiates hereditary sensory autonomic neuropathies III and IV".
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formation; the accuracy of the results depends on the silicone material used; the processing of the sweat impressions is time consuming; and the technique requires
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Low, P. A.; Caskey, P. E.; Tuck, R. R.; Fealey, R. D.; Dyck, P. J. (November 1983). "Quantitative sudomotor axon reflex test in normal and neuropathic subjects".
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Buchmann, Sylvia J.; Penzlin, Ana Isabel; Kubasch, Marie Luise; Illigens, Ben Min-Woo; Siepmann, Timo (February 2019). "Assessment of sudomotor function".
2583:"Accuracy of a Rapid and Non-Invasive Method for the Assessment of Small Fiber Neuropathy Based on Measurement of Electrochemical Skin Conductances" 171:
M3 receptors on the basolateral membrane of the clear cells in the secretory coil of the eccrine gland. This triggers the release of intracellular
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Casellini, Carolina M.; Parson, Henri K.; Hodges, Kim; Edwards, Joshua F.; Lieb, David C.; Wohlgemuth, Stephen D.; Vinik, Aaron I. (3 May 2016).
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The measurement requires no specific patient preparation or medical personnel training. The test lasts less than 3 minutes, and is innocuous and
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Leclair-Visonneau, Laurène; Bosquet, Tristan; Magot, Armelle; Fayet, Guillemette; Gras-Le Guen, Christèle; Hamel, Antoine; Péréon, Yann (2016).
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Dyck, Peter J.; Overland, Carol J.; Low, Phillip A.; Litchy, William J.; Davies, Jenny L.; Dyck, P. James B.; O'Brien, Peter C. (August 2010).
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Hijazi, Mido M.; Buchmann, Sylvia J.; Sedghi, Annahita; Illigens, Ben M.; Reichmann, Heinz; Schackert, Gabriele; Siepmann, Timo (1 July 2020).
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Low, Victoria A.; Sandroni, Paola; Fealey, Robert D.; Low, Phillip A. (July 2006). "Detection of small-fiber neuropathy by sudomotor testing".
3510:"Signs and symptoms versus nerve conduction studies to diagnose diabetic sensorimotor polyneuropathy: Cl vs. NPhys trial: Cl vs. NPhys Trial" 2038: 1315: 999: 700:
sweat response; however, unlike QSART, it allows for spatial but not temporal resolution of the sweat response. Following iontophoresis of a
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electrodes applied to the skin during clinical tests. These studies also evaluated the influence of different parameters in sweat (e.g.,
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QSART is sensitive and specific for detecting postganglionic small fiber dysfunction. However, some studies have found it to have a high
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Vitale, G.I.; Quatrale, R.P.; Giles, P.J.; Birnbaum, J.E. (July 1986). "Electrical field stimulation of isolated primate sweat glands".
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Gibbons, Christopher; Freeman, Roy (August 2004). "The evaluation of small fiber function—autonomic and quantitative sensory testing".
2524:"Bariatric Surgery Restores Cardiac and Sudomotor Autonomic C-Fiber Dysfunction towards Normal in Obese Subjects with Type 2 Diabetes" 97:
in response to both emotional and thermal stimulation. Eccrine glands are primarily innervated by small-diameter, unmyelinated class
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Fealey, Robert D.; Low, Phillip A.; Thomas, Juergen E. (June 1989). "Thermoregulatory Sweating Abnormalities in Diabetes Mellitus".
806: 782: 623:. It has also been shown to be sensitive to change after different interventions in subjects with T2DM. ESC measurements are highly 592: 443: 387: 379: 304: 168: 3932:
Khurana, Ramesh K.; Russell, Colin (April 2017). "The spoon test: a valid and reliable bedside test to assess sudomotor function".
557:, lactate) on the obtained currents.  These studies formed the basis for the ESC methodology of measuring sudomotor function. 382:
skin area by the total skin area and multiplying by 100. The TST% acts as an indicator of the severity of neurologic impairment.
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Bordier, Lyse; Dolz, Manuel; Monteiro, Linsay; Névoret, Marie-Laure; Calvet, Jean-Henri; Bauduceau, Bernard (29 February 2016).
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to develop a computational tool for measuring chloride ion flow through a sweat gland in response to an imposed voltage. 
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to deliver the acetylcholine into the dermal skin layers. The acetylcholine binds to sweat glands (direct sweat response), and
406: 3329:"Early Detection of Orthostatic Hypotension by Quantitative Sudomotor Axon Reflex Test (QSART) in Type 2 Diabetic Patients" 1917:
Krieger, Sarah-Maria; Reimann, Manja; Haase, Rocco; Henkel, Elena; Hanefeld, Markolf; Ziemssen, Tjalf (26 September 2018).
569:. A conductance deduced from the resulting current between the electrodes and the voltages is reported as ESC, measured in 712:
or computer-assisted analysis, for sweat droplet size, number, and distribution, and compared to lower limits of normal.
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Sweat production is measured as the change in relative humidity over time. The temporal resolution, magnitude, and onset
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Gerrett, Nicola; Griggs, Katy; Redortier, Bernard; Voelcker, Thomas; Kondo, Narihiko; Havenith, George (1 August 2018).
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solution over a 2.25 cm skin area, which stimulates the underlying sweat glands directly through the activation of
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peripheral neuropathy in type 2 diabetes patients: a comparison with clinical examination and nerve conduction study".
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Freedman, Barry I.; Smith, Susan Carrie; Bagwell, Benjamin M.; Xu, Jianzhao; Bowden, Donald W.; Divers, Jasmin (2015).
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Casellini, Carolina M.; Parson, Henri K.; Richardson, Margaret S.; Nevoret, Marie L.; Vinik, Aaron I. (November 2013).
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due to the hydration of cobalt ions. One pad is applied to the plantar surface of each foot in between the 1st and 2nd
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There are several methods available for the assessment of sudomotor function. They vary in cost, technical complexity,
2025: 733: 677: 673: 669: 604: 600: 366: 102: 3048:"Sympathetic skin responses (SSRs) in monofocal brain lesions: topographical aspects of central sympathetic pathways" 943:, and ulcers, can be suggestive of sudomotor dysfunction. Presence of intense foot odor may be another presentation. 465:, and low diagnostic sensitivity. It is also sensitive to various factors such as caffeine and medications, and the 362: 136: 105: 2257:"SUDOSCAN: A Simple, Rapid, and Objective Method with Potential for Screening for Diabetic Peripheral Neuropathy" 354: 112: 2834:"Assessment of cutaneous axon-reflex responses to evaluate functional integrity of autonomic small nerve fibers" 595:. Sudoscan has been shown to be useful in the detection of small fiber neuropathy in patients with and without 253: 23: 3746:"Electrochemical skin conductance for quantitative assessment of sweat function: Normative values in children" 2473:
Zhu, Ling; Zhao, Xiaolan; Zeng, Ping; Zhu, Jianguo; Yang, Shuwen; Liu, Annan; Song, Yuehua (November 2016).
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Boger, M.S.; Hulgan, T.; Haas, D.W.; Mitchell, V.; Smith, A.G.; Singleton, J.R.; Peltier, A.C. (July 2012).
680:, is not recommended for children and patients over the age of 70, and is sensitive to certain medications. 3789:"Sympathetic skin response--a method of assessing unmyelinated axon dysfunction in peripheral neuropathies" 769:
The SST was recently developed by Adam Loavenbruck and colleagues in 2017 for the evaluation of individual
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Freedman, Barry I.; Bowden, Donald W.; Smith, Susan Carrie; Xu, Jianzhao; Divers, Jasmin (January 2014).
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Rittié, Laure; Sachs, Dana L.; Orringer, Jeffrey S.; Voorhees, John J.; Fisher, Gary J. (January 2013).
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The QDIRT was developed in 2008 by Christopher Gibbons and colleagues as a means for the evaluation of
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to secrete Cl ions by eccrine glands, thus providing a quantitative measurement of sudomotor function.
1973:"Sudoscan, a Noninvasive Tool for Detecting Diabetic Small Fiber Neuropathy and Autonomic Dysfunction" 2535: 2268: 2209: 2198:"The Clinical Utility of SUDOSCAN in Chronic Kidney Disease in Chinese Patients with Type 2 Diabetes" 2064: 608: 587:
In general, decreased ESC values indicate a higher risk of sudomotor dysfunction, and thus a greater
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model of the skin was devised, reproducing the behavior of chloride ions and the properties of their
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Quattrini, C.; Jeziorska, M.; Tavakoli, M.; Begum, P.; Boulton, A. J. M.; Malik, R. A. (June 2008).
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glands. Eccrine glands open directly onto the surface of the skin, while apocrine glands open into
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M3 receptors. Immediately following iontophoresis, the skin is dried, and then covered with a 10%
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Itch, Hiroshi; Uebori, Seiji; Asai, Mahito; Kashiwaya, Tagui; Atoh, Keita; Making, Isao (2003).
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can cause social embarrassment, while insufficient sweating can result in heat intolerance and
3949: 3920: 3869: 3840: 3818: 3775: 3724: 3694: 3649: 3619: 3590:"Relationships between electrochemical skin conductance and kidney disease in Type 2 diabetes" 3568: 3539: 3496: 3453: 3416: 3380: 3350: 3315: 3262: 3233:"Anhidrosis in multiple system atrophy involves pre‐ and postganglionic sudomotor dysfunction" 3213: 3153: 3112: 3069: 3015: 2962: 2917: 2863: 2811: 2767: 2723: 2665: 2614: 2563: 2504: 2455: 2401: 2342: 2296: 2237: 2175: 2115: 2034: 2002: 1950: 1899: 1842: 1807: 1764: 1720: 1654: 1605: 1546: 1511: 1462: 1431:
Themistocleous, Andreas C; Ramirez, Juan D; Serra, Jordi; Bennett, David L H (December 2014).
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of small fiber neuropathies is Intraepidermal Nerve Fiber Density (IENFD) measured from punch
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storages and an influx of extracellular calcium which ultimately results in the movement of
51: 35: 824:(EMG) equipment in a lightly dimmed, humidity- and temperature-controlled room. A surface 786: 749: 721: 624: 596: 550: 462: 431: 358: 338: 300: 1249:"The Investigation of the Cardiovascular and Sudomotor Autonomic Nervous System—A Review" 631:. For that purpose, normative reference values have been established on a total of 1,350 252:
sudomotor function can occur in any disorder that directly and/or indirectly affects the
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in normal controls will be frequently interrupted by the presence of sweat on the skin.
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of autonomic and small fiber neuropathies, particularly those associated with diabetes.
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Novak, Peter (February 2019). "Electrochemical skin conductance: a systematic review".
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of the sweat response are digitally recorded and analyzed using specialized software.
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Gagnon, Daniel; Crandall, Craig G. (2018). "Sweating as a heat loss thermoeffector".
870: 774: 741: 737: 693: 501: 466: 418: 293: 273: 164: 87: 63: 59: 55: 3881: 3736: 3580: 3428: 3412: 3345: 3328: 3165: 3081: 3027: 2779: 2735: 2084: 1854: 1448: 1417: 1371: 1226: 1182: 1025:"Eccrine Sweat Glands are Major Contributors to Reepithelialization of Human Wounds" 3961: 3605: 2974: 2807: 2127: 1776: 1558: 853: 628: 124: 31: 3661:
Raisanen, Anu; Eklund, Jyrki; Calvet, Jean-Henri; Tuomilehto, Jaakko (June 2014).
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is complete (about 5 minutes). The silicone imprints are then analyzed, either by
3891:"The spoon test: a simple bedside test for assessing sudomotor autonomic failure" 3376: 3199: 2548: 2281: 2222: 1759: 1742: 1497: 1040: 573:(μS), and is proportional to the Cl flow to the skin surface, that is to say the 1298:
Freeman, Roy; Chapleau, Mark W. (2013). "Testing the autonomic nervous system".
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Quinton, Paul M. (June 2007). "Cystic Fibrosis: Lessons from the Sweat Gland".
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neurons through the lateral spinothalamic tract to the preoptic nucleus of the
3945: 3761: 3720: 3394:"Sweat from gland to skin surface: production, transport, and skin absorption" 3184:"Quantification of sweat gland innervation: A clinical-pathologic correlation" 3108: 3011: 2718: 2701: 2111: 2076: 1706: 1210: 1166: 889: 874: 709: 636: 427: 249: 2599: 2440: 2386: 1935: 1590: 1542: 1265: 3679: 1640: 825: 814: 656:(II) salt indicator that changes color from blue to pink in the presence of 509: 318: 277: 94: 46:
of sweat is the body’s most effective method of heat reduction and the only
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Gibbons, C. H.; Illigens, B. M. W.; Wang, N.; Freeman, R. (28 April 2009).
3157: 3116: 3019: 2966: 2921: 2867: 2815: 2771: 2727: 2669: 2618: 2567: 2508: 2475:"Study on autonomic dysfunction and metabolic syndrome in Chinese patients" 2459: 2405: 2346: 2300: 2241: 2179: 2119: 2006: 1954: 1903: 1768: 1724: 1658: 1609: 1572:
Vinik, Aaron I.; Nevoret, Marie-Laure; Casellini, Carolina (11 June 2015).
1550: 1515: 1466: 1433:"The clinical approach to small fibre neuropathy and painful channelopathy" 1409: 1363: 1325: 1284: 1218: 1174: 1112: 1058: 1009: 3924: 3906: 3865: 3844: 3822: 3804: 3572: 3073: 2886:
Gibbons, C. H.; Illigens, B. M.W.; Centi, J.; Freeman, R. (10 June 2008).
2702:"The Neuropad test: a visual indicator test for human diabetic neuropathy" 2660: 2651: 1988: 1846: 1838: 1811: 2337: 940: 689: 657: 513: 422: 310:. In some cases, it may be the only detectable neurologic manifestation. 289: 257: 176: 1743:"Thermoregulatory disorders and illness related to heat and cold stress" 2993:"Sympathetic skin response: Basic mechanisms and clinical applications" 641: 574: 566: 493: 417:
of the foot. The outer compartment of the capsule is filled with a 10%
410: 269: 172: 148: 47: 39: 3525: 3482: 3465:
Gibbons, Christopher H; Wang, Ningshan; Freeman, Roy (December 2010).
3248: 3148: 3131: 2958: 2490: 2328: 2161: 1885: 1401: 984:
Thermoregulation: From Basic Neuroscience to Clinical Neurology Part I
111:. Increases in body and skin temperature are detected by visceral and 30:
activity in response to various environmental and individual factors.
2991:
Vetrugno, R.; Liguori, R.; Cortelli, P.; Montagna, P. (August 2003).
790:
area of each spot. The test is then repeated for replicate analysis.
653: 632: 370: 209: 3467:"Capsaicin Induces Degeneration of Cutaneous Autonomic Nerve Fibers" 2888:"QDIRT: Quantitative direct and indirect test of sudomotor function" 704:, a thin layer of silicone is applied to the tested skin area until 676:, and its potential as an at-home test. However, Neuropad has lower 1302:. Handbook of Clinical Neurology. Vol. 115. pp. 115–136. 986:. Handbook of Clinical Neurology. Vol. 156. pp. 211–232. 797:
response, it has a limited ability to assess nerve fiber function.
2315:
cardiovascular autonomic neuropathy and diabetic polyneuropathy".
635:
participants. Normative ESC values have also been established for
611:. Sudoscan has been compared with other reference tests including 562: 151:
with postganglionic cholinergic sudomotor (and to a lesser extent
3667:
International Journal of Environmental Research and Public Health
2686: 3132:"Simple methods of examination in paraplegia: I. the spoon test" 554: 414: 160: 132: 3787:
Shahani, B T; Halperin, J J; Boulu, P; Cohen, J (1 May 1984).
1684: 1682: 1680: 1678: 1676: 1674: 1672: 1670: 1668: 1342:
Freeman, Roy (April 2005). "Autonomic peripheral neuropathy".
1242: 1240: 1238: 1236: 893: 761:
test; and little normative or performance data are available.
516: 484:
method for the assessment of sudomotor function that utilizes
2146:"Electrochemical Skin Conductance in Diabetic Kidney Disease" 299:
Sudomotor dysfunction is one of the most common and earliest
531: 1689:
Illigens, Ben M. W.; Gibbons, Christopher H. (April 2009).
375: 159:
sympathetic ganglia. When the action potential reaches the
2939: 2937: 2935: 2933: 2931: 430:. Once a stable baseline of outflow humidity is reached, 2018: 2016: 512:) for quantitative measurement of the resulting flow of 16:
Autonomic nervous system control of sweat gland activity
1966: 1964: 910: 434:
of the acetylcholine fluid is initiated by using a 2mA
2986: 2984: 2139: 2137: 1148: 1146: 1144: 1142: 50:
method available when the air temperature rises above
3177: 3175: 2881: 2879: 2877: 2424:"Which Method for Diagnosing Small Fiber Neuropathy?" 1482:"Measures of small-fiber neuropathy in HIV infection" 1140: 1138: 1136: 1134: 1132: 1130: 1128: 1126: 1124: 1122: 218: 185: 3041: 3039: 3037: 2827: 2825: 1247:
Ziemssen, Tjalf; Siepmann, Timo (12 February 2019).
852:
The spoon test is inexpensive, easy to perform, but
115:
thermoreceptors, which send signals via class C and
3895:
Journal of Neurology, Neurosurgery & Psychiatry
3793:
Journal of Neurology, Neurosurgery & Psychiatry
3286:"Cardiac Autonomic Neuropathy in Diabetes Mellitus" 2632: 2630: 2628: 2417: 2415: 2368:Porubcin, Michal G.; Novak, Peter (17 April 2020). 627:. Studies have shown ESC values to be dependent on 38:mechanism used by the body to prevent heat-related 832:The SSR is thought to be mainly influenced by the 233: 200: 2681: 2679: 2191: 2189: 640:function tests, and causes minimal-to-no patient 473:Electrochemical Skin Conductance (ESC) - Sudoscan 3889:Tsementzis, S A; Hitchcock, E R (1 April 1985). 1736: 1734: 1383: 1381: 401:Quantitative Sudomotor Axon Reflex Test (QSART) 1919:"Sudomotor Testing of Diabetes Polyneuropathy" 1691:"Sweat testing to evaluate autonomic function" 1337: 1335: 1625:"The Management of the Quinizarin Sweat Test" 813:studies and is a well-known component of the 728:Quantitative Direct and Indirect Test (QDIRT) 607:of 67 to 92%, as well as in the screening of 8: 1072: 1070: 1068: 2033:. IFSA Publishing, S.L. pp. 149–204. 413:, proximal and distal leg, as well as the 3914: 3812: 3769: 3688: 3678: 3613: 3594:Journal of Diabetes and Its Complications 3533: 3490: 3344: 3309: 3256: 3207: 3147: 3063: 2911: 2857: 2796:Journal of Diabetes and Its Complications 2717: 2659: 2608: 2598: 2557: 2547: 2498: 2449: 2439: 2395: 2385: 2336: 2290: 2280: 2231: 2221: 2169: 2027:Advances in Biosensors: Reviews, Volume 3 1996: 1944: 1934: 1893: 1758: 1714: 1648: 1599: 1589: 1505: 1456: 1274: 1264: 1102: 1048: 652:Neuropad utilizes an adhesive pad with a 296:due to altered epidermal moisturization. 224: 219: 217: 191: 186: 184: 3290:Methodist DeBakey Cardiovascular Journal 2947:Journal of the Peripheral Nervous System 2317:Journal of the Peripheral Nervous System 54:. In addition, sweat plays key roles in 3634:Diabetes Research and Clinical Practice 974: 860:Sweat Gland Nerve Fiber Density (SGNFD) 668:The strengths of Neuropad are its high 407:quantitative sudomotor axon reflex test 163:terminal of the postganglionic neuron, 143:in the intermediolateral column of the 3284:Agashe, Shruti; Petak, Steven (2018). 2640:Diabetes Technology & Therapeutics 1977:Diabetes Technology & Therapeutics 1199:European Journal of Applied Physiology 496:amplitudes) to electrically stimulate 167:is released which binds and activates 820:The test is performed using standard 7: 644:, so very suitable for routine use. 394:commonly seen in diabetic patients. 357:(TST) was developed in the 1940s by 3046:Linden, D.; Berlit, P. (May 1995). 1741:Cheshire, William P. (April 2016). 692:imprint utilizes the principles of 78:are primarily classified as either 3565:10.1111/j.1365-2133.1986.tb06218.x 3065:10.1111/j.1600-0404.1995.tb07023.x 2904:10.1212/01.wnl.0000314646.49565.c0 1308:10.1016/B978-0-444-52902-2.00007-2 992:10.1016/B978-0-444-63912-7.00013-8 526:can be obtained with the use of a 131:from the hypothalamus through the 14: 3750:Clinical Neurophysiology Practice 2479:Journal of Diabetes Investigation 1077:Baker, Lindsay B. (3 July 2019). 1029:The American Journal of Pathology 349:Thermoregulatory Sweat Test (TST) 241:, and water into the duct lumen. 2764:10.1111/j.1464-5491.2007.02280.x 963:Electrochemical skin conductance 897: 488:(the application of rectangular 478:Electrochemical skin conductance 3413:10.1152/japplphysiol.00872.2017 3346:10.2169/internalmedicine.42.560 1449:10.1136/practneurol-2013-000758 836:content of sweat secreted from 801:Sympathetic Skin Response (SSR) 480:is an objective, quantitative, 390:, such as the distal symmetric 280:. Depending on the severity of 3606:10.1016/j.jdiacomp.2013.09.006 3553:British Journal of Dermatology 2808:10.1016/j.jdiacomp.2006.08.003 2150:American Journal of Nephrology 1623:Guttmann, L. (1 August 1947). 1: 3646:10.1016/j.diabres.2010.01.023 3401:Journal of Applied Physiology 3052:Acta Neurologica Scandinavica 1804:10.1016/s0025-6196(12)65338-5 1356:10.1016/S0140-6736(05)74815-7 1095:10.1080/23328940.2019.1632145 3377:10.1016/j.diabet.2012.09.004 3200:10.1212/WNL.0b013e3181a2e8b8 2549:10.1371/journal.pone.0154211 2282:10.1371/journal.pone.0138224 2223:10.1371/journal.pone.0134981 1760:10.1016/j.autneu.2016.01.001 1629:Postgraduate Medical Journal 1498:10.1016/j.autneu.2012.04.001 1041:10.1016/j.ajpath.2012.09.019 508:from the human sweat to the 234:{\displaystyle {\ce {Na^+}}} 201:{\displaystyle {\ce {Cl^-}}} 147:. The preganglionic neurons 3934:Clinical Autonomic Research 3000:Clinical Autonomic Research 2100:Clinical Autonomic Research 1695:Clinical Autonomic Research 1155:Clinical Autonomic Research 864:SGNFD can be quantified in 355:thermoregulatory sweat test 3995: 3450:10.1152/physiol.00041.2006 2850:10.1007/s10072-020-04293-w 2587:Frontiers in Endocrinology 1578:Frontiers in Endocrinology 1300:Peripheral Nerve Disorders 887: 765:Sensitive Sweat Test (SST) 266:neurodegenerative diseases 3946:10.1007/s10286-017-0401-2 3762:10.1016/j.cnp.2016.07.001 3721:10.1007/s11060-015-2049-x 3709:Journal of Neuro-Oncology 3365:Diabetes & Metabolism 3130:Bors, Ernest (May 1964). 3109:10.1016/j.ncl.2004.03.002 3012:10.1007/s10286-003-0107-5 2719:10.1007/s00125-008-0987-y 2112:10.1007/s10286-017-0467-x 2077:10.1109/JSEN.2010.2103308 1707:10.1007/s10286-008-0506-8 1211:10.1007/s00421-007-0646-x 1167:10.1007/s10286-018-0530-2 939:, excessive skin dander, 3833:Acta Neurologica Belgica 2600:10.3389/fendo.2016.00018 2441:10.3389/fneur.2020.00342 2387:10.3389/fneur.2020.00273 1936:10.3389/fneur.2018.00803 1591:10.3389/fendo.2015.00094 1543:10.1038/nrneurol.2012.97 1531:Nature Reviews Neurology 1266:10.3389/fneur.2019.00053 829:latency, and amplitude. 597:type 2 diabetes mellitus 388:small fiber neuropathies 292:, ulcerations, and poor 254:autonomic nervous system 24:autonomic nervous system 3680:10.3390/ijerph110605839 1792:Mayo Clinic Proceedings 1641:10.1136/pgmj.23.262.353 684:Silicone Imprint Method 492:(DC) pulses of varying 3302:10.14797/mdcj-14-4-251 2428:Frontiers in Neurology 2374:Frontiers in Neurology 1923:Frontiers in Neurology 1747:Autonomic Neuroscience 1486:Autonomic Neuroscience 1253:Frontiers in Neurology 856:and not quantitative. 807:electrical stimulation 613:Heart Rate Variability 593:small fiber neuropathy 426:skin is measured by a 235: 202: 34:production is a vital 3907:10.1136/jnnp.48.4.378 3866:10.1212/wnl.52.8.1652 3805:10.1136/jnnp.47.5.536 2838:Neurological Sciences 2652:10.1089/dia.2015.0396 1989:10.1089/dia.2013.0129 1839:10.1002/ana.410140513 236: 203: 2057:IEEE Sensors Journal 930:Physical Examination 883: 609:diabetic nephropathy 498:eccrine sweat glands 216: 183: 3979:Medical terminology 3471:Annals of Neurology 2540:2016PLoSO..1154211C 2273:2015PLoSO..1038224S 2214:2015PLoSO..1034981L 2069:2012ISenJ..12..456K 1827:Annals of Neurology 1437:Practical Neurology 1350:(9466): 1259–1270. 958:Eccrine sweat gland 811:psychophysiological 744:solution to induce 702:cholinergic agonist 603:of 77 to 87% and a 284:, it may result in 141:cholinergic neurons 109:cholinergic neurons 3514:Muscle & Nerve 3237:Movement Disorders 3097:Neurologic Clinics 1874:Muscle & Nerve 1390:Muscle & Nerve 909:. You can help by 674:cost-effectiveness 621:metabolic syndrome 504:(the migration of 303:manifestations of 301:neurophysiological 274:Excessive sweating 268:, multiple system 231: 198: 20:Sudomotor function 3526:10.1002/mus.21661 3483:10.1002/ana.22126 3333:Internal Medicine 3249:10.1002/mds.26864 3194:(17): 1479–1486. 3149:10.1038/sc.1964.4 2959:10.1111/jns.12212 2898:(24): 2299–2304. 2758:(12): 1375–1380. 2752:Diabetic Medicine 2689:. Neuropad. 2014. 2491:10.1111/jdi.12524 2329:10.1111/jns.12366 2162:10.1159/000437342 2040:978-84-09-25125-4 1886:10.1002/mus.21210 1402:10.1002/mus.20551 1317:978-0-444-52902-2 1001:978-0-444-63912-7 927: 926: 486:chronoamperometry 258:diabetes mellitus 223: 190: 155:) neurons in the 93:Eccrine sweat is 3986: 3965: 3928: 3918: 3885: 3860:(8): 1652–1657. 3848: 3826: 3816: 3783: 3773: 3740: 3702: 3692: 3682: 3673:(6): 5839–5848. 3657: 3627: 3617: 3584: 3547: 3537: 3504: 3494: 3461: 3432: 3398: 3388: 3358: 3348: 3323: 3313: 3271: 3270: 3260: 3228: 3222: 3221: 3211: 3179: 3170: 3169: 3151: 3127: 3121: 3120: 3092: 3086: 3085: 3067: 3043: 3032: 3031: 2997: 2988: 2979: 2978: 2941: 2926: 2925: 2915: 2883: 2872: 2871: 2861: 2844:(7): 1685–1696. 2829: 2820: 2819: 2790: 2784: 2783: 2746: 2740: 2739: 2721: 2712:(6): 1046–1050. 2697: 2691: 2690: 2687:"Neuropad Movie" 2683: 2674: 2673: 2663: 2634: 2623: 2622: 2612: 2602: 2578: 2572: 2571: 2561: 2551: 2519: 2513: 2512: 2502: 2470: 2464: 2463: 2453: 2443: 2419: 2410: 2409: 2399: 2389: 2365: 2359: 2358: 2340: 2311: 2305: 2304: 2294: 2284: 2267:(10): e0138224. 2252: 2246: 2245: 2235: 2225: 2193: 2184: 2183: 2173: 2141: 2132: 2131: 2095: 2089: 2088: 2051: 2045: 2044: 2032: 2020: 2011: 2010: 2000: 1968: 1959: 1958: 1948: 1938: 1914: 1908: 1907: 1897: 1865: 1859: 1858: 1822: 1816: 1815: 1787: 1781: 1780: 1762: 1738: 1729: 1728: 1718: 1686: 1663: 1662: 1652: 1635:(262): 353–366. 1620: 1614: 1613: 1603: 1593: 1569: 1563: 1562: 1526: 1520: 1519: 1509: 1477: 1471: 1470: 1460: 1428: 1422: 1421: 1385: 1376: 1375: 1339: 1330: 1329: 1295: 1289: 1288: 1278: 1268: 1244: 1231: 1230: 1193: 1187: 1186: 1150: 1117: 1116: 1106: 1074: 1063: 1062: 1052: 1020: 1014: 1013: 979: 922: 919: 901: 894: 875:light microscopy 822:electromyography 436:electric current 421:solution, while 361:to measure both 240: 238: 237: 232: 230: 229: 228: 221: 207: 205: 204: 199: 197: 196: 195: 188: 52:skin temperature 36:thermoregulatory 3994: 3993: 3989: 3988: 3987: 3985: 3984: 3983: 3969: 3968: 3931: 3888: 3851: 3829: 3786: 3743: 3705: 3660: 3630: 3587: 3550: 3507: 3464: 3435: 3396: 3391: 3361: 3326: 3283: 3280: 3278:Further reading 3275: 3274: 3230: 3229: 3225: 3181: 3180: 3173: 3129: 3128: 3124: 3094: 3093: 3089: 3045: 3044: 3035: 2995: 2990: 2989: 2982: 2943: 2942: 2929: 2885: 2884: 2875: 2831: 2830: 2823: 2792: 2791: 2787: 2748: 2747: 2743: 2699: 2698: 2694: 2685: 2684: 2677: 2636: 2635: 2626: 2580: 2579: 2575: 2534:(5): e0154211. 2521: 2520: 2516: 2472: 2471: 2467: 2421: 2420: 2413: 2367: 2366: 2362: 2313: 2312: 2308: 2254: 2253: 2249: 2208:(8): e0134981. 2195: 2194: 2187: 2143: 2142: 2135: 2097: 2096: 2092: 2053: 2052: 2048: 2041: 2030: 2022: 2021: 2014: 1983:(11): 948–953. 1970: 1969: 1962: 1916: 1915: 1911: 1867: 1866: 1862: 1824: 1823: 1819: 1789: 1788: 1784: 1740: 1739: 1732: 1688: 1687: 1666: 1622: 1621: 1617: 1571: 1570: 1566: 1528: 1527: 1523: 1479: 1478: 1474: 1430: 1429: 1425: 1387: 1386: 1379: 1341: 1340: 1333: 1318: 1297: 1296: 1292: 1246: 1245: 1234: 1195: 1194: 1190: 1152: 1151: 1120: 1076: 1075: 1066: 1022: 1021: 1017: 1002: 981: 980: 976: 971: 949: 932: 923: 917: 914: 907:needs expansion 892: 886: 862: 846: 803: 787:povidone-iodine 767: 750:povidone-iodine 730: 722:standardization 696:to measure the 686: 650: 551:stainless steel 538:electrochemical 522:Currently, ESC 475: 463:reproducibility 403: 359:Ludwig Guttmann 351: 339:reproducibility 335: 247: 220: 214: 213: 187: 181: 180: 135:and medulla to 72: 17: 12: 11: 5: 3992: 3990: 3982: 3981: 3971: 3970: 3967: 3966: 3929: 3901:(4): 378–380. 3886: 3849: 3827: 3799:(5): 536–542. 3784: 3741: 3715:(2): 373–380. 3703: 3658: 3640:(3): 302–306. 3628: 3585: 3548: 3520:(2): 157–164. 3505: 3477:(6): 888–898. 3462: 3444:(3): 212–225. 3433: 3407:(2): 459–469. 3389: 3371:(2): 126–131. 3359: 3339:(7): 560–564. 3324: 3296:(4): 251–256. 3279: 3276: 3273: 3272: 3243:(3): 397–404. 3223: 3171: 3122: 3103:(3): 683–702. 3087: 3058:(5): 372–376. 3033: 3006:(4): 256–270. 2980: 2953:(2): 139–148. 2927: 2873: 2821: 2802:(6): 353–358. 2785: 2741: 2692: 2675: 2661:2027.42/140359 2646:(6): 391–398. 2624: 2573: 2514: 2485:(6): 901–907. 2465: 2411: 2360: 2306: 2247: 2185: 2156:(6): 438–447. 2133: 2090: 2063:(3): 456–463. 2046: 2039: 2012: 1960: 1909: 1880:(4): 529–535. 1860: 1833:(5): 573–580. 1817: 1798:(6): 617–628. 1782: 1730: 1664: 1615: 1564: 1537:(7): 369–379. 1521: 1472: 1443:(6): 368–379. 1423: 1377: 1331: 1316: 1290: 1232: 1205:(2): 265–270. 1188: 1118: 1089:(3): 211–259. 1064: 1035:(1): 163–171. 1015: 1000: 973: 972: 970: 967: 966: 965: 960: 955: 948: 945: 937:hyperkeratosis 931: 928: 925: 924: 904: 902: 888:Main article: 885: 882: 861: 858: 845: 842: 838:eccrine glands 802: 799: 766: 763: 734:postganglionic 729: 726: 706:polymerization 685: 682: 649: 646: 617:kidney disease 599:(T2DM) with a 528:medical device 500:, and reverse 490:direct current 474: 471: 402: 399: 392:polyneuropathy 367:postganglionic 350: 347: 334: 331: 286:hyperkeratosis 264:, infections, 246: 243: 227: 194: 103:postganglionic 88:hair follicles 71: 68: 22:refers to the 15: 13: 10: 9: 6: 4: 3: 2: 3991: 3980: 3977: 3976: 3974: 3963: 3959: 3955: 3951: 3947: 3943: 3939: 3935: 3930: 3926: 3922: 3917: 3912: 3908: 3904: 3900: 3896: 3892: 3887: 3883: 3879: 3875: 3871: 3867: 3863: 3859: 3855: 3850: 3846: 3842: 3839:(4): 213–22. 3838: 3834: 3828: 3824: 3820: 3815: 3810: 3806: 3802: 3798: 3794: 3790: 3785: 3781: 3777: 3772: 3767: 3763: 3759: 3755: 3751: 3747: 3742: 3738: 3734: 3730: 3726: 3722: 3718: 3714: 3710: 3704: 3700: 3696: 3691: 3686: 3681: 3676: 3672: 3668: 3664: 3659: 3655: 3651: 3647: 3643: 3639: 3635: 3629: 3625: 3621: 3616: 3611: 3607: 3603: 3599: 3595: 3591: 3586: 3582: 3578: 3574: 3570: 3566: 3562: 3558: 3554: 3549: 3545: 3541: 3536: 3531: 3527: 3523: 3519: 3515: 3511: 3506: 3502: 3498: 3493: 3488: 3484: 3480: 3476: 3472: 3468: 3463: 3459: 3455: 3451: 3447: 3443: 3439: 3434: 3430: 3426: 3422: 3418: 3414: 3410: 3406: 3402: 3395: 3390: 3386: 3382: 3378: 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Index

autonomic nervous system
sweat gland
Sweat
thermoregulatory
illness
evaporation
cooling
skin temperature
grip
microbial
wound healing
sweat glands
eccrine
apocrine
hair follicles
secreted
C-fibers
postganglionic
sympathetic
cholinergic neurons
peripheral
Aδ-fiber
somatic
hypothalamus
ipsilaterally
pons
preganglionic
cholinergic neurons
spinal cord
synapse

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