Assessment of sudomotor function

• Published in: Clinical autonomic research Vol. 29; no. 1; pp. 41 - 53
• Main Authors: Buchmann, Sylvia J., Penzlin, Ana Isabel, Kubasch, Marie Luise, Illigens, Ben Min-Woo, Siepmann, Timo
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.02.2019; Springer Nature B.V
• Subjects: Animals; Autonomic nervous system; Axons - physiology; Body Temperature Regulation - physiology; Cardiology; Diabetes; Endocrinology; Galvanic Skin Response - physiology; Gastroenterology; Humans; Medicine; Medicine & Public Health; Neurology; Ophthalmology; Review; Silicones; Skin Physiological Phenomena; Skin tests; Sweat; Sweat Glands - physiology; Sweating - physiology; Sympathetic nervous system; Therapeutic applications; Small fiber; Neuropathy; Sweat; Sympathetic; Autonomic
• ISSN: 0959-9851; 1619-1560; 1619-1560
• DOI: 10.1007/s10286-018-0530-2

Purpose To review the currently available literature on clinical autonomic tests of sudomotor function. Methods We searched PubMED/MEDLINE for articles on technical principles and clinical applications of sudomotor tests with a focus on their drawbacks and perspectives in order to provide a narrative review. Results The quantitative sudomotor axon reflex sweat test (QSART) is the most widely used test of sudomotor function. The technique captures pathology with low intra- and inter-subject variability but is limited by technical demands. The thermoregulatory sweat test comprises topographic sweat pattern analysis of the ventral skin surface and allows differentiating preganglionic from postganglionic sudomotor damage when combined with a small fiber test such as QSART. The sympathetic skin response also belongs to the more established techniques and is used in lie detection systems due to its high sensitivity for sudomotor responses to emotional stimuli. However, its clinical utility is limited by high variability of measurements, both within and between subjects. Newer and, therefore, less widely established techniques include silicone impressions, quantitative direct and indirect axon reflex testing, sensitive sweat test, and measurement of electrochemical skin conductance. The spoon test does not allow a quantitative assessment of the sweat response but can be used as bedside-screening tool of sudomotor dysfunction. Conclusion While new autonomic sudomotor function testings have been developed and studied over the past decades, the most were well-studied and established techniques QSART and TST remain the gold standard of sudomotor assessment. Combining these techniques allows for sophisticated analysis of neurally mediated sudomotor impairment. However, newer techniques display potential to complement gold standard techniques to further improve their precision and diagnostic value.