Sympathetic skin response in patients with

    myasthenia gravis

,XinLiu,Hui

    ;Huang,JianxiuHu

    ;DepartmentofNeurology,AffiliatedHospitalofNorthSichuanMedicalCollege,Nanchong637000,SichuanProvince,China

    ;Abstract

    ;BACKGRoUND:Theexaminationofsympatheticskinresponseisanimportantindexforassessingthe

    ;autonomicnervefunction,andpatientswithmyastheniagravisarealwaysaccompaniedbydysautonomia.

    ;Therefore.itwillbeimportanttoknowwhethersympatheticskinresponsecanbeusedastheindexforthe

    ;clinicalevaluationofmyastheniagravis.

    ;oBJECTIVE:Toinvestigatethediagnosticvalueofsympatheticskinresponseinthedamageofautonomic

    ;nervefunctionofpatientswithmyastheniagravis.

    ;DESIGN:Acase—controlledcomparativeobservation.

    ;SETTING:DepartmentofNeurologyandRoomofNerveElectromyogram.theAffiliatedHospitalofNorth

;SichuanMedicalCollege.

    ;PARTICIPANTS:Thirtyoutpatientsorinpatientswithmyastheniagraviswereselectedfromthe

    ;DepartmentofNeurology.theAffiliatedHospitalofNorthSichuanMedicalCollegefromMay2006toMay

    ;2007,including9malesand2lfemales,aged8—72yearswithameanageoff28

    ?5)yearsold.Theywere

    ;allaccordedwiththediagnosticstandardsofmyastheniagravis.accompaniedbvdjfferentseverityof

    ;autonomicnervesymptoms,includingpoorskinnutrition,sweatingofhandsandfeet,pyknocardia,

    ;persistenthypotension,abdominalpain,constipation,etc.Theyallhadnottakenanydrugaffectingthe

    ;autonomicnervefunctionbeforetheexamination.Informedconsentswereobtainedfromallthepatients.

    ;Meanwhile.30healthyphysicalexamineeswereenrolledasthenormalcontrolgroup.includingl0males

    ;and20females,agedl0—75yearswithameanageof(31?51yearsold.Approv

    alwasobtainedfromthe

    ;hospitalethiccommittee.

    ;METHoDS:AReradmission.thepatientswereexaminedwithsympatheticskinresponseusingDANTEC

    ;keypoint2.0electromyographyevokedpotentialapparatus(Danmark).Thechangesofthelatencyandwave

    ;amplitudeofsympatheticskinresponsewereobserved.Thesubjectsinthenormalcontrolgroupwere

    ;examinedwiththesamemethodsatphysicalexamination.Abnormalitywasiudgedbythedisappearanceof

    ;waveforn1.1atencylongerthanthatinthenormalcontrolgroupbyMean?2.5SD.orwaveamplitudelower

    ;thantheaveragevalueinthenormalcontrolgroupby50%.

    ;MAINoUTCoMEMEASURES:Theresultsofthelatencyandwaveamplitudeofsympatheticskin

    ;responsewerecomparedbetweenthepatientswithmyastheniagravisandnormalcontrols.

    ;RESULTS:Al1the30patientswithmyastheniagravisand30healthyphysicalexamineeswereinvolvedin

    ;thefinalanalysisofresults.Therewerenosignificantdifferencesbetweentheleftandrightupperandlower

    ;limbsinboththemyastheniagravisgroupandnormalcontrolgrouprP>0.05).Inthemyastheniagravis

    ;group,theabnormalrateofsympatheticskinresponsewas37%(11/30),thelatencywasprolongedandthe

    ;waveamplitudewasdecreasedascomparedwiththoseinthenormalcontrolgr

oup.andtherewere

    ;significantdifferencesrP<0.0l1.

    ;CONCLUSION:Sympatheticskinresponsecanbeusedasanelectrophysiologicalindexforjudgingthe

    ;damagesofautonomicnervefunctioninpatientswithmyastheniagravis. ;KeyWords:myastheniagravis;sympatheticskinresponse:autonomicnervefunction

    ;Received:2007-08-15;Accepted:2007-10-08(07-S-8-0753/SHM) ;Correspondingauthor:XiaomingWang,Master,Professor,Master.StutoqDepartmentofNeurology,AffiliatedHospital

    ;ofNorthSichuanMedicalCollege,Nanchong637000,SichuanProvince,China

    ;E-maihwangxm238@163.com

    ;HongningZhao?.Studying

    ;fOrmasteCsdegree.

    ;DepartmentofNeurology,

    ;AffiliatedHospitalofNorth

    ;SichuanMedicaICollege.

    ;Nanchong637000,

    ;SichuanProvince.China

    ;ZhaoHN,WangXM,Zhang

    ;JQ.YangDB,ZhaoXQ,Liu

;X,HuangH,Hu

    ;JXSympatheticskin

    ;responseinpatientswith

    ;myastheniagravis:A

    ;comparativeanalysisNeuraI

    ;RegenRes2007;2f”):675-7

    ;www.sjzsyjcom/Journal/

    ;0711/07-”-675.htmI

    ;675

    ;

    ;ZhaoHN.eta1./NeuralRegenerationResearch.2007,2(11).’675—7

    ;Inrecentyears,somescholarshavesuggestedthe ;generalizedtheoryofantibodyformyastheniagravis(MG), ;andtheserialinvestigativeoutcomesalsoshowedthatthere ;wereevidenceofcentralnervoussystemdamageand ;electr0phVsi0l0gicalabnormalitiesinMG.Meanwhile, ;patientswithMGmaybeaccompaniedbydysautonomia, ;andtheinvolvedclinicalmanifestationsareassociatedwith ;MG12.31.Sympatheticskinresponseisaskinreflexpotential ;evokedbyvariousstimulations.andithasbeenappliedin ;assessingtheautonomicnervefunctionincerebraIinfarction. ;diabeticautonomicneuropathy,Parkinsondisease,multiple

    ;sclerosis,etc.Inthisstudy,30patientswithMGweredetected ;withsympatheticskinresponse,andtheresultswere ;comparedwiththoseofhealthypeople,soasto

    ;electrophysiologicallyobservewhetherthereweredamagesof ;autonomicnervefunctioninpatientswithMG.

    ;SUBJE(_:sANDMEH1.0Ds

    ;SubJects

    ;ThirtyoutpatientsorinpatientswithMGwereselected ;fromtheDepartmentofNeurology,theAffiliatedHospitalof ;NorthSichuanMedicalCollegefromMay2006toMay2007, ;including9malesand2lfemales.aged8—72yearswitha

    ;meanageof(28?5)yearsold,thediseasecourseranged ;fromlt034monthswithanaverageof3.2months.

    ;Inclusivecriteria:?MetthediagnosticstandardsofMG

    ;Accompaniedbydifferentseverityofautonomicnerve ;symptoms,includingpoorskinnutrition,sweatingofhands ;andfeet,pyknocardia,persistenthypotension,abdominal ;pain,constipation,etc;?Hadnottakenanydrugaffecting

    ;theautonomicnervefunctionbeforetheexamination ;(anticholinesterasedrug,adrenomimetic).Informedconsents ;wereobtainedfromallthepatients.Patientsaccompaniedby ;diseasesaffectingtheautonomicnervesystemwere

    ;excluded,includingdiabetesmellitus,thyroiddysfunction, ;ethylism,Parkinsondisease,multiplesclerosis,etc.The ;modifiedOssermantypingwasIin4cases.1lain7cases. ;1lbinl3cases.IIIin4casesandIVin2cases.

    ;Meanwhile,30healthyphysicalexamineeswereenrolledas ;thenormalcontrolgroup,including10malesand20females, ;aged10—75yearswithameanageof(3l?5)yearsold.

    ;Theyallparticipatedinthestudyvoluntarily,andmatched ;withthoseinthepatientswithMGinsexandage.Those ;withhistoryofgeneralandnervoussystemdiseases, ;symptomsandphysicalsignsofautonomicdysfunctionwere ;excluded.Approvalwasobtainedfromthehospitalethic ;committee.

    ;Methods

    ;Afteradmission,thepatientswereexaminedwith ;676

    ;sympatheticskinresponseusingDANTECkeypoint2.0 ;electromyographyevokedpotentialapparatus(Denmark). ;Thewristmediannervewasstimulatedusingelectricpulse, ;surfaceelectrodewasusedastherecordingelectrode.andit ;wasplacedonthesideofhandorsole.Thereference ;electrodewasplacedatthesecondinterosseusofdorsumof

    ;handorfoot.itwasatabout30cmtofingerortoe.Theearth ;electrodewasplacedatl5—30cmabovewristorankle.the

    ;temperatureshouldbekeptat22—25?.andtheskin

    36.C.thestimulusintensity ;temperatureshouldbeat33—

    ;(takingflexionofthumbasthestandard)was3—9mA,and

    ;thedurationwas0.2ms.Theintervalwasatleastl0minutes. ;analyticaltimewas8s.sensitivitywas2mV.andthe ;averagevalueoftwostimulationswasused.Thechangesof ;thelatencyandwaveamplitudeofsympatheticskinresponse ;wereobserved.Thesubjectsinthenormalcontrolgroup ;wereexaminedwiththesamemethodsatphysical ;examination.

    ;Judgingstandardsforabnormality【4J.Therewas

    ;abnormalityifanyoneofthefollowingmanifestationswas ;observed:,\1)disappearanceofwaveform;latency ;longerthanthatinthenormalcontrolgroupbyMean?2.5SD; ;(waveamplitudelowerthantheaveragevalueinthe ;normalcontrolgroupby50%.

    ;Statisticalanalysis:Thedatawerestatisticallyanalyzedby ;thefirstandsecondauthorsusingSPSSl0.0software.The ;resultsofthemeasurementdatawereexpressedasMean?SD ;Theintergroupdifferenceswerecomparedusing,test.

;RESUU

    ;Quantitativeanalysisoftheparticipants

    ;Allthe30patientswithMGand30healthyphysical ;examineeswereinvolvedinthefinalanalysisofresults. ;Thelatencyandwaveamplitudeofsympatheticskin ;responseInleftandrightupperandlowerlimbs(Table1) ;Group

    ;Latency(ms)

    ;UpperlimbLowerlimb

    ;LeftRightLeftRight

    ;Group

    ;Waveamplitude(uV)

    ;UpperlimbLowerlimb

    ;LeftRiightLeftRight

    ;

    ;ZhaoHN.eta1./NeuralRegenerationResearch. ;2007,2(11):675.7

    ;Comparisonofthelatencyandwaveamplitudeof ;sympatheticskinresponsebetweenthetwogroups(Table2) ;IntheMGgroup,abnormalitiesofthelatencyor/andwave ;amplitudeofsympatheticskinresponsewereobservedin11 ;cases.andtheabnormalratewas36.7%f11/30);Thelatency

    ;wasprolongedandthewaveamplitudewasdecreasedas ;comparedwiththoseinthenormalcontrolgroup.andthere ;weresignificantdifierencesfP<0.011.

    ;Group

    ;Latency(ms)Waveamplitude(ktV)

    ;UpperlimbLowerlimbUpperlimbLowerlimb

    ;t

    ;P

    ;5.187

    ;<0.0l

    ;6.684

    ;<0.0l

    ;8.923

    ;<0.0l

    ;5.032

    ;<0.0l

    ;Sympatheticskinresponseisasurfacepotentialassociated ;withtheactivityofsudoriderousglandandreflectingthe ;sympatheticpostganglionicfibers,anditisclinicallyusedto ;detectdysautonomiacausedbyrelateddiseases,anditisan ;objectiveelectrophysi0l0gicalindex.Sympatheticskin ;responsecanbeevokedbyendogenousorexogenous