Clinical and electrophysiological characteristics of neuropathic pain in leprosy patients: A prospective cross-sectional study

Introduction: Neuropathic pain is a common and disabling late complication of leprosy. We investigated the clinical and electrophysiological characteristics of neuropathic pain in leprosy patients by evaluating nerve conduction, sympathetic skin response (SSR) and A-waves. Methods: Twenty one leprosy patients with neuropathic pain validated by the Douleur Neuropathique en 4 (DN4)Questionnaire were selected for study. Pain intensity was measured by the visual analog scale. Demographic and clinical data were collected for all patients. Clinical data included appraisal of the median, ulnar, radial, tibial and common peroneal nerves, assessment of the sympathetic skin response and conventional electrophysiological recordings. Results: Among all electroneuromyographic presentations, multifocal mononeuropathy was still the most prevalent. Sensory loss was observed more frequently than motor deficits. As most patients presented advanced clinical forms of leprosy and were under treatment, this high mean was found and the ulnar nerve was most frequently affected. The sympathetic skin response was absent in 16 patients. Higher DN4 Questionnaire scores were observed in women and in those receiving corticosteroid therapy. These inferences are possible to be made, but our study's limitations don't allow us to be certain about it. The statistical significance found only permits us to evidence what we related on the textual part of the study. Limitations: The small number of patients studied, the lack of sophisticated diagnostic methods for leprosy, as well as the difficulties in assessing nerve conduction were the main limitations of this study. Conclusion: The neurophysiological and clinical findings in leprous neuropathy were modest despite the conspicuous neuropathic pain. Although electrophysiological studies are a vital tool to verify nerve damage, variations in the clinical presentation of leprosy neuropathic pain render the diagnosis challenging. Further studies are needed to describe the neurophysiological evolution of this disease.

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Sympathetic skin response and R-R interval variation in uremic patients: Correlation with nerve conduction studies and clinical dysautonomia

Electroencephalography and Clinical Neurophysiology ◽

10.1016/0013-4694(93)91424-y ◽

1993 ◽

Vol 87 (2) ◽

pp. S120

Keyword(s):

Nerve Conduction ◽

Sympathetic Skin Response ◽

Nerve Conduction Studies ◽

Skin Response ◽

Uremic Patients

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Assessment of neuropathic pain in leprosy patients with relapse or treatment failure by infrared thermography: A cross-sectional study

PLoS Neglected Tropical Diseases ◽

10.1371/journal.pntd.0009794 ◽

2021 ◽

Vol 15 (9) ◽

pp. e0009794

Author(s):

Liliane Marques de Pinho Tiago ◽

Diogo Fernandes dos Santos ◽

Douglas Eulálio Antunes ◽

Letícia Marques Pinho Tiago ◽

Isabela Maria Bernardes Goulart

Keyword(s):

Neuropathic Pain ◽

Infrared Thermography ◽

Cross Sectional Study ◽

Sensory Loss ◽

Sectional Study ◽

Cross Sectional ◽

Assessment Protocol ◽

Significant Difference ◽

Leprosy Patients ◽

Hands And Feet

Background Neuropathic pain (NP) is one of the main complications of leprosy, and its management is challenging. Infrared thermography (IRT) has been shown to be effective in the evaluation of peripheral autonomic function resulting from microcirculation flow changes in painful syndromes. This study used IRT to map the skin temperature on the hands and feet of leprosy patients with NP. Methodology/Principal findings This cross-sectional study included 20 controls and 55 leprosy patients, distributed into 29 with NP (PWP) and 26 without NP (PNP). Thermal images of the hands and feet were captured with infrared camera and clinical evaluations were performed. Electroneuromyography (ENMG) was used as a complementary neurological exam. Instruments used for the NP diagnosis were visual analog pain scale (VAS), Douleur Neuropathic en 4 questions (DN4), and simplified neurological assessment protocol. The prevalence of NP was 52.7%. Pain intensity showed that 93.1% of patients with NP had moderate/severe pain. The most frequent DN4 items in individuals with NP were numbness (86.2%), tingling (86.2%) and electric shocks (82.7%). Reactional episodes type 1 were statistically significant in the PWP group. Approximately 81.3% of patients showed a predominance of multiple mononeuropathy in ENMG, 79.6% had sensory loss, and 81.4% showed some degree of disability. The average temperature in the patients’ hands and feet was slightly lower than in the controls, but without a significant difference. Compared to controls, all patients showed significant temperature asymmetry in almost all points assessed on the hands, except for two palmar points and one dorsal point. In the feet, there was significant asymmetry in all points, indicating a greater involvement of the lower limbs. Conclusion IRT confirmed the asymmetric pattern of leprosy neuropathy, indicating a change in the function of the autonomic nervous system, and proving to be a useful method in the approach of pain.

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R-R interval variation and the sympathetic skin response in the assessment of the autonomic nervous system in leprosy patients

Acta Neurologica Scandinavica ◽

10.1034/j.1600-0404.2003.01307.x ◽

2003 ◽

Vol 107 (1) ◽

pp. 42-49 ◽

Cited By ~ 12

Author(s):

H. Ulvi ◽

T. Yoldas ◽

R. Yigiter ◽

B. Mungen

Keyword(s):

Nervous System ◽

Autonomic Nervous System ◽

Sympathetic Skin Response ◽

Autonomic Nervous ◽

Skin Response ◽

Leprosy Patients

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P2-17 Correlation of sympathetic skin response and nerve conduction studies with urodynamic studies in diabetic patients with lower urinary tract symptoms

Clinical Neurophysiology ◽

10.1016/s1388-2457(10)60458-0 ◽

2010 ◽

Vol 121 ◽

pp. S111-S112

Author(s):

M. Modi ◽

R. Bansal ◽

S. Prabhakar ◽

A.K. Mandal ◽

M. Aggarwal ◽

...

Keyword(s):

Urinary Tract ◽

Lower Urinary Tract Symptoms ◽

Nerve Conduction ◽

Lower Urinary Tract ◽

Sympathetic Skin Response ◽

Nerve Conduction Studies ◽

Diabetic Patients ◽

Urinary Tract Symptoms ◽

Skin Response ◽

Lower Urinary

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Sympathetic Skin Response in Hemodialysis Patients: Correlation with Nerve Conduction Studies and Adequacy of Dialysis

Nephron ◽

10.1159/000045361 ◽

1999 ◽

Vol 82 (1) ◽

pp. 12-16 ◽

Cited By ~ 8

Author(s):

N.R. Robles ◽

M. Solis ◽

L. Albarran ◽

J.F. Esparrago ◽

F. Roncero ◽

...

Keyword(s):

Nerve Conduction ◽

Sympathetic Skin Response ◽

Hemodialysis Patients ◽

Nerve Conduction Studies ◽

Skin Response

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Peripheral Nerve Conduction And Sympathetic Skin Response Are Reliable Methods to Detect Diabetic Cardiac Autonomic Neuropathy

Frontiers in Endocrinology ◽

10.3389/fendo.2021.709114 ◽

2021 ◽

Vol 12 ◽

Author(s):

Xiaopu Lin ◽

Chuna Chen ◽

Yingshan Liu ◽

Yu Peng ◽

Zhenguo Chen ◽

...

Keyword(s):

Lower Limb ◽

Nerve Conduction ◽

Peroneal Nerve ◽

Operating Characteristic ◽

Sympathetic Skin Response ◽

Cardiac Autonomic Neuropathy ◽

Optimal Cutoff ◽

Skin Response ◽

Reliable Methods ◽

Diabetic Cardiac Autonomic Neuropathy

AimThis study aimed to investigate the role of nerve conduction studies (NCS) and sympathetic skin response (SSR) in evaluating diabetic cardiac autonomic neuropathy (DCAN).MethodsDCAN was diagnosed using the Ewing test combined with heart rate variability analysis. NCS and SSR were assessed by electrophysiological methods. The association between NCS/SSR and DCAN was assessed via multivariate regression and receiver-operating characteristic analyses.ResultsThe amplitude and conduction velocity of the motor/sensory nerve were found to be significantly lower in the DCAN+ group (all P < 0.05). A lower amplitude of peroneal nerve motor fiber was found to be associated with increased odds for DCAN (OR 2.77, P < 0.05). The SSR amplitude was lower while the SSR latency was longer in the DCAN+ group than in the DCAN– group. The receiver-operating characteristic analysis revealed that the optimal cutoff points of upper/lower limb amplitude of SSR to indicate DCAN were 1.40 mV (sensitivity, 61.9%; specificity, 66.3%, P < 0.001) and 0.85 mV (sensitivity, 66.7%; specificity, 68.5%, P < 0.001), respectively. The optimal cutoff points of upper/lower limb latency to indicate DCAN were 1.40 s (sensitivity, 61.9%; specificity, 62%, P < 0.05) and 1.81 s (sensitivity, 69.0%; specificity, 52.2%, P < 0.05), respectively.ConclusionsNCS and SSR are reliable methods to detect DCAN. Abnormality in the peroneal nerve (motor nerve) is crucial in predicting DCAN. SSR may help predict DCAN.

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Small Fiber Neuropathy Associated with Hyperlipidemia: Utility of Cutaneous Silent Periods and Autonomic Tests

ISRN Neurology ◽

10.1155/2014/579242 ◽

2014 ◽

Vol 2014 ◽

pp. 1-6 ◽

Cited By ~ 3

Author(s):

G. Morkavuk ◽

A. Leventoglu

Keyword(s):

Nerve Conduction ◽

Lower Extremities ◽

Sympathetic Skin Response ◽

Nerve Conduction Studies ◽

Small Fiber Neuropathy ◽

Small Fiber ◽

Significant Difference ◽

Autonomic Tests ◽

Skin Response ◽

Normal Nerve Conduction

Background. Established electrophysiological methods have limited clinical utility in the diagnosis of small fiber neuropathy. The cutaneous silent period (CSP) may be useful as a method for the evaluation of smaller and unmyelinated fiber dysfunctions. Hyperlipidemia is a very rare cause of small fiber neuropathy. In this study, hyperlipidemia and small fiber neuropathy in symptomatic patients with normal nerve conduction studies were evaluated with autonomic tests and cutaneous silent periods. Methods. Twenty-five patients with clinically suspected small fiber neuropathy and 23 healthy volunteers were included. CSP latency and duration, as well as CSP latency difference of the upper and lower extremities, were examined. Two tests were used to assess the autonomic nervous system, namely, the R-R interval variation test in basal and profound breath conditions and the sympathetic skin response. Results. Twenty-five patients with clinically suspected small fiber neuropathy and normal nerve conduction studies were compared with 23 controls. In the upper extremities, patients had prolonged CSP latencies (P=0.034) and shortened CSP durations (P=0.039), whereas in the lower extremities, patients had shortened CSP durations (P=0.001). The expiration-to-inspiration ratios were also reduced in patients groups. There was no significant difference between sympathetic skin response latencies and amplitude of the case and control groups. Conclusion. Our findings indicate that CSP may become a useful technique for the assessment of small fiber neuropathy in hyperlipidemic patients.

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Pain Processing and Vegetative Dysfunction in Fibromyalgia: A Study by Sympathetic Skin Response and Laser Evoked Potentials

Pain Research and Treatment ◽

10.1155/2017/9747148 ◽

2017 ◽

Vol 2017 ◽

pp. 1-12 ◽

Cited By ~ 3

Author(s):

Marina de Tommaso ◽

Katia Ricci ◽

Giuseppe Libro ◽

Eleonora Vecchio ◽

Marianna Delussi ◽

...

Keyword(s):

Central Nervous System ◽

Evoked Potentials ◽

Central Nervous System Involvement ◽

Sympathetic Skin Response ◽

Pain Processing ◽

Laser Evoked Potentials ◽

Number Of Patients ◽

Severity Scores ◽

Skin Response ◽

The Right

Background. A dysfunction of pain processing at central and peripheral levels was reported in fibromyalgia (FM). We aimed to correlate laser evoked potentials (LEPs), Sympathetic Skin Response (SSR), and clinical features in FM patients. Methods. Fifty FM patients and 30 age-matched controls underwent LEPs and SSR by the right hand and foot. The clinical evaluation included FM disability (FIQ) and severity scores (WPI), anxiety (SAS) and depression (SDS) scales, and questionnaires for neuropathic pain (DN4). Results. The LEP P2 latency and amplitude and the SSR latency were increased in FM group. This latter feature was more evident in anxious patients. The LEPs habituation was reduced in FM patients and correlated to pain severity scores. In a significant number of patients (32%) with higher DN4 and FIQ scores, SSR or LEP responses were absent. Conclusions. LEPs and SSR might contribute to clarifying the peripheral and central nervous system involvement in FM patients.

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Electrophysiological Evaluation of Peripheral and Autonomic Involvement in Leprosy

Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques ◽

10.1017/s0317167100003449 ◽

2004 ◽

Vol 31 (3) ◽

pp. 357-362 ◽

Cited By ~ 13

Author(s):

Aysun Soysal ◽

Turan Atay ◽

Tacettin Ozu ◽

Baki Arpaci

Keyword(s):

Sensory Nerve ◽

Sympathetic Skin Response ◽

Lepromatous Leprosy ◽

Control Group ◽

Evaluation Standard ◽

Standard Procedures ◽

Skin Response ◽

Leprosy Patients ◽

Skin Responses ◽

Sympathetic Skin Responses

Objective:Motor and sensory nerve conductions, F responses, sympathetic skin responses and R-R interval variations (RRIV) were studied to determine the type of peripheral neuropathy among patients with leprosy.Methods:Twenty-nine consecutive patients with leprosy (25 male, 4 female) hospitalized in the “Istanbul Leprosy Hospital'' between January - December, 1999 were included in this study. Ten patients had borderline lepromatous leprosy, and 19 had lepromatous leprosy. None of the patients studied had the tuberculoid form. The mean age was 55±12 years. The control group consisted of 30 (26 male, 4 female) healthy volunteers (mean age: 58.1±7.8 years). All subjects included in the study underwent neurological examination and electrophysiological evaluation. Standard procedures were performed for evaluating sensory and motor conduction studies. Motor studies were carried out on both left and right median, ulnar, tibial and common peroneal nerves while median, ulnar, sural and superficial peroneal nerves were examined for sensory studies. Sympathetic skin response recordings on both hands and RRIV recordings on precordial region were done in order to evaluate the autonomic involvement.Results:The lower extremity was found to be more severely affected than the upper, and sensory impairment predominated over motor. Of 58 upper limbs examined, no sympathetic skin responses was recorded in 46 (79.3%). Compared with the controls, the RRIVs of the leprosy patients were found to be reduced during both resting and deep forced hyperventilation.Conclusion:Our results indicate that leprosy causes a predominantly axonal polyneuropathy that is more severe in the lower extremities. Sensory nerve damage is accompanied by autonomic involvement.

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