Annals of Clinical Neurophysiology

The Korean Society of Clinical Neurophysiology (대한임상신경생리학회)
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Neurological aspects of anhidrosis: differential diagnoses and diagnostic tools

  • Park, Kee Hong (Department of Neurology, Gyeongsang National University Hospital) ;
  • Park, Ki-Jong (Department of Neurology, Gyeongsang National University Changwon Hospital)
  • Received : 2018.06.21
  • Accepted : 2018.08.13
  • Published : 2019.01.31
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Abstract

Anhidrosis refers to the condition in which the body does not respond appropriately to thermal stimuli by sweating. Sweating plays an important role in maintaining the body temperature, and its absence should not be overlooked since an elevated body temperature can cause various symptoms, even leading to death when uncontrolled. The various neurological disorders that can induce anhidrosis make a detailed neurological evaluation essential. The medication history of the patient should also be checked because anhidrosis can be caused by various drugs. The tests available for evaluating sweating include the quantitative sudomotor axon reflex sweat test, thermoregulatory sweat test, sympathetic skin response, and electrochemical skin conductance. Pathological findings can also be checked directly in a skin biopsy. This review discusses the differential diagnosis and evaluation of anhidrosis.

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References

  1. Chia KY, Tey HL. Approach to hypohidrosis. J Eur Acad Dermatol Venereol 2013;27:799-804. https://doi.org/10.1111/jdv.12014
  2. Munetsugu T, Fujimoto T, Oshima Y, Sano K, Murota H, Satoh T, et al. Revised guideline for the diagnosis and treatment of acquired idiopathic generalized anhidrosis in Japan. J Dermatol 2017;44:394-400. https://doi.org/10.1111/1346-8138.13649
  3. Sato K, Kang WH, Saga K, Sato KT. Biology of sweat glands and their disorders. I. normal sweat gland function. J Am Acad Dermatol 1989;20:537-563. https://doi.org/10.1016/S0190-9622(89)70063-3
  4. Folk GE Jr, Semken HA Jr. The evolution of sweat glands. Int J Biometeorol 1991;35:180-186. https://doi.org/10.1007/BF01049065
  5. Low PA. Testing the autonomic nervous system. Semin Neurol 2003;23:407-421. https://doi.org/10.1055/s-2004-817725
  6. Cheshire WP, Fealey RD. Drug-induced hyperhidrosis and hypohidrosis: incidence, prevention and management. Drug Saf 2008;31:109-126. https://doi.org/10.2165/00002018-200831020-00002
  7. Wenning GK, Colosimo C, Geser F, Poewe W. Multiple system atrophy. Lancet Neurol 2004;3:93-103. https://doi.org/10.1016/S1474-4422(03)00662-8
  8. Sandroni P, Ahlskog JE, Fealey RD, Low PA. Autonomic involvement in extrapyramidal and cerebellar disorders. Clin Auton Res 1991;1:147-155. https://doi.org/10.1007/BF01826212
  9. Lipp A, Sandroni P, Ahlskog JE, Fealey RD, Kimpinski K, Iodice V, et al. Prospective differentiation of multiple system atrophy from Parkinson disease, with and without autonomic failure. Arch Neurol 2009;66:742-750. https://doi.org/10.1001/archneurol.2009.71
  10. Thaisetthawatkul P, Boeve BF, Benarroch EE, Sandroni P, Ferman TJ, Petersen R, et al. Autonomic dysfunction in dementia with Lewy bodies. Neurology 2004;62:1804-1809. https://doi.org/10.1212/01.WNL.0000125192.69777.6D
  11. Korpelainen JT, Sotaniemi KA, Myllyla VV. Ipsilateral hypohidrosis in brain stem infarction. Stroke 1993;24:100-104. https://doi.org/10.1161/01.STR.24.1.100
  12. Davis SL, Wilson TE, White AT, Frohman EM. Thermoregulation in multiple sclerosis. J Appl Physiol (1985) 2010;109:1531-1537. https://doi.org/10.1152/japplphysiol.00460.2010
  13. Allen DR, Huang M, Parupia IM, Dubelko AR, Frohman EM, Davis SL. Impaired sweating responses to a passive whole body heat stress in individuals with multiple sclerosis. J Neurophysiol 2017;118:7-14. https://doi.org/10.1152/jn.00897.2016
  14. Singer W, Berini SE, Sandroni P, Fealey RD, Coon EA, Suarez MD, et al. Pure autonomic failure: predictors of conversion to clinical CNS involvement. Neurology 2017;88:1129-1136. https://doi.org/10.1212/WNL.0000000000003737
  15. Tesfaye S, Boulton AJM, Dyck PJ, Freeman R, Horowitz M, Kempler P, et al. Diabetic neuropathies: update on definitions, diagnostic criteria, estimation of severity, and treatments. Diabetes Care 2010;33:2285-2293. https://doi.org/10.2337/dc10-1303
  16. Fealey RD, Low PA, Thomas JE. Thermoregulatory sweating abnormalities in diabetes mellitus. Mayo Clin Proc 1989;64:617-628. https://doi.org/10.1016/S0025-6196(12)65338-5
  17. Zochodne DW. Autonomic involvement in Guillain-Barre syndrome: a review. Muscle Nerve 1994;17:1145-1155. https://doi.org/10.1002/mus.880171004
  18. Anandan C, Khuder SA, Koffman BM. Prevalence of autonomic dysfunction in hospitalized patients with Guillain-Barre syndrome. Muscle Nerve 2017;56:331-333. https://doi.org/10.1002/mus.25551
  19. Manganelli F, Dubbioso R, Nolano M, Iodice R, Pisciotta C, Provitera V, et al. Autoimmune autonomic ganglionopathy: a possible postganglionic neuropathy. Arch Neurol 2011;68:504-507. https://doi.org/10.1001/archneurol.2011.60
  20. Iodice V, Kimpinski K, Vernino S, Sandroni P, Fealey RD, Low PA. Efficacy of immunotherapy in seropositive and seronegative putative autoimmune autonomic ganglionopathy. Neurology 2009;72:2002-2008. https://doi.org/10.1212/WNL.0b013e3181a92b52
  21. Li Y, Jammoul A, Mente K, Li J, Shields RW, Vernino S, et al. Clinical experience of seropositive ganglionic acetylcholine receptor antibody in a tertiary neurology referral center. Muscle Nerve 2015;52:386-391. https://doi.org/10.1002/mus.24559
  22. Ohnishi A, Yamamoto T, Murai Y, Ando Y, Ando M, Hoshii Y, et al. Denervation of eccrine glands in patients with familial amyloidotic polyneuropathy type I. Neurology 1998;51:714-721. https://doi.org/10.1212/WNL.51.3.714
  23. Tugnoli V, Eleopra R, De Grandis D. Hyperhidrosis and sympathetic skin response in chronic alcoholic patients. Clin Auton Res 1999;9:17-22. https://doi.org/10.1007/BF02280692
  24. Hilz MJ. Assessment and evaluation of hereditary sensory and autonomic neuropathies with autonomic and neurophysiological examinations. Clin Auton Res 2002;12 Suppl 1:I33-I43. https://doi.org/10.1007/s102860200017
  25. Verrecchia E, Zampetti A, Antuzzi D, Ricci R, Ferri L, Morrone A, et al. The impact of fever/hyperthermia in the diagnosis of Fabry: a retrospective analysis. Eur J Intern Med 2016;32:26-30. https://doi.org/10.1016/j.ejim.2016.03.015
  26. Weller M, Wilhelm H, Sommer N, Dichgans J, Wietholter H. Tonic pupil, areflexia, and segmental anhidrosis: two additional cases of Ross syndrome and review of the literature. J Neurol 1992;239:231-234. https://doi.org/10.1007/BF00839146
  27. Chen YC, Wu CS, Chen GS, Khor GT, Chen CH, Huang P. Identification of subgroups of acquired idiopathic generalized anhidrosis. Neurologist 2008;14:318-320. https://doi.org/10.1097/NRL.0b013e318173e818
  28. Nakazato Y, Tamura N, Ohkuma A, Yoshimaru K, Shimazu K. Idiopathic pure sudomotor failure: anhidrosis due to deficits in cholinergic transmission. Neurology 2004;63:1476-1480. https://doi.org/10.1212/01.WNL.0000142036.54112.57
  29. Low PA, Tomalia VA, Park KJ. Autonomic function tests: some clinical applications. J Clin Neurol 2013;9:1-8. https://doi.org/10.3988/jcn.2013.9.1.1
  30. Low PA. Evaluation of sudomotor function. Clin Neurophysiol 2004;115:1506-1513. https://doi.org/10.1016/j.clinph.2004.01.023
  31. Sletten DM, Weigand SD, Low PA. Relationship of Q-sweat to quantitative sudomotor axon reflex test (QSART) volumes. Muscle Nerve 2010;41:240-246. https://doi.org/10.1002/mus.21464
  32. Illigens BM, Gibbons CH. Sweat testing to evaluate autonomic function. Clin Auton Res 2009;19:79-87. https://doi.org/10.1007/s10286-008-0506-8
  33. Elie B, Guiheneuc P. Sympathetic skin response: normal results in different experimental conditions. Electroencephalogr Clin Neurophysiol 1990;76:258-267. https://doi.org/10.1016/0013-4694(90)90020-K
  34. Gibbons C, Freeman R. The evaluation of small fiber function-autonomic and quantitative sensory testing. Neurol Clin 2004;22:683-702, vii. https://doi.org/10.1016/j.ncl.2004.03.002
  35. Casellini CM, Parson HK, Richardson MS, Nevoret ML, Vinik AI. Sudoscan, a noninvasive tool for detecting diabetic small fiber neuropathy and autonomic dysfunction. Diabetes Technol Ther 2013;15:948-953. https://doi.org/10.1089/dia.2013.0129
  36. Buchmann SJ, Penzlin AI, Kubasch ML, Illigens BM, Siepmann T. Assessment of sudomotor function. Clin Auton Res 2018 May 8. [Epub]. DOI:10.1007/s10286-018-0530-2.
  37. Novak P. Electrochemical skin conductance: a systematic review. Clin Auton Res 2017 Sep 26. [Epub]. DOI:10.1007/s10286-017-0467-x.
  38. Lauria G, Hsieh ST, Johansson O, Kenney WR, Leger JM, Mellgren SI, et al. European Federation of Neurological Societies/Peripheral Nerve Society Guideline on the use of skin biopsy in the diagnosis of small fiber neuropathy. Report of a joint task force of the European Federation of Neurological Societies and the Peripheral Nerve Society. Eur J Neurol 2010;17:903-912, e44-e49. https://doi.org/10.1111/j.1468-1331.2010.03023.x
  39. Chan AC, Wilder-Smith EP. Small fiber neuropathy: getting bigger! Muscle Nerve 2016;53:671-682. https://doi.org/10.1002/mus.25082
  40. Sohn EH. Skin biopsy: an emerging method for small nerve fiber evaluation. Ann Clin Neurophysiol 2018;20:3-11. https://doi.org/10.14253/acn.2018.20.1.3
  41. Tay LK, Chong WS. Acquired idiopathic anhidrosis: a diagnosis often missed. J Am Acad Dermatol 2014;71:499-506. https://doi.org/10.1016/j.jaad.2014.03.041

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