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QDIRT

Quantitative direct and indirect test of sudomotor function

From the Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA.

Address correspondence and reprint requests to Dr. Roy Freeman, Autonomic and Peripheral Nerve Laboratory, Department of Neurology, Beth Israel Deaconess Medical Center, 1 Deaconess Rd., Boston, MA 02215 rfreeman{at}bidmc.harvard.edu.

Objective: To develop a novel assessment of sudomotor function.

Background: Postganglionic sudomotor function is currently evaluated using the quantitative sudomotor axon reflex test (QSART) or silicone impressions. We hypothesize that high-resolution digital photography has advanced sufficiently to allow quantitative direct and indirect reflex testing of sudomotor function (QDIRT) with spatial and temporal resolution comparable to these techniques.

Methods: Sweating in 10 humans was stimulated on both forearms by iontophoresis of 10% acetylcholine. Silicone impressions were made and topical indicator dyes were digitally photographed every 15 seconds for 7 minutes after iontophoresis. Sweat droplets were quantified by size, location, and percent surface area. Each test was repeated eight times in each subject on alternating arms over 2 months. Another 10 subjects had silicone impressions, QDIRT, and QSART performed on the dorsum of the right foot.

Results: The percent area of sweat photographically imaged correlated with silicone impressions at 5 minutes on the forearm (r = 0.92, p < 0.01) and dorsal foot (r = 0.85, p < 0.01). The number of sweat droplets assessed with QDIRT correlated with the silicone impression, although the droplet number was lower (162 ± 28 vs 341 ± 56, p < 0.01, r = 0.83, p < 0.01). The sweat response and sweat onset latency assessed by QDIRT correlated with QSART measured at the dorsum of the foot (r = 0.63, p < 0.05; r = 0.52, p < 0.05).

Conclusions: The quantitative direct and indirect reflex test of sudomotor function (QDIRT) measured both the direct and the indirect sudomotor response with spatial resolution similar to that of silicone impressions, and with temporal resolution similar to that of the quantitative sudomotor axon reflex test (QSART). QDIRT provides a novel tool for the evaluation of postganglionic sudomotor function.

Abbreviations: QDIRT = quantitative direct and indirect reflex test of sudomotor function; QSART = quantitative sudomotor axon reflex test; SFN = small fiber neuropathy.

Supplemental data at www.neurology.org

Disclosure: The authors report no disclosures.

Received September 10, 2007. Accepted in final form February 25, 2008.