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The innervation of human skin
Session 51: The @npathetic
conduction
velocity (CV) of the sympathetic
five normal subjects
s11
Skin Response
in the axilia-middle
efferent branch was calculated in
finger tract by electrical stimulation
at the control&era1 wrist and by binaural acoustic burst. There were no significant differences between CVs of electrically and acoustically evoked responses along axilla-middle .Inger tract, the range being 0.8-1.3 m/see. The obtained data will discussed on the light of the central and peripheral physiology of the SSR in man. ’
15%031
s ympa~~etic Skin Response (SSR) Evoked by agnet~c ~timulatiQfl of Cervical Roots
Kaoru Matsunaga, Takenori Uozumi, Sadatoshi Tsuji, Yoshiyuki Murai. Department of Neuroiogy, University of Occupational and Environmental Health, SchooI of Medicine, Kitakyushu, Japan Sympathetic skin response (SSR) evoked by magnetic stimulation of cervical roots with a round coil (M-SSR) was studied in normal control subjects and patients with various neurological diseases. In 8 normal subjects, M-SSR was compared with SSRs evoked by other types of stimulation; single auditory clicks, electrical stimulation of right median nerve at wrist (E-SSR). bilateral supra-orbital nerves at forehead and deep inspiration. M-SSR showed the shortest latency and the largest amplitude both at the hand and foot among all methods. M-SSR had lit?le habituation, therefore it showed the lowest coefficient of variability in 8 responses. M-SSR and E-SSR were measured in two groups of various neurological diseases (group I: peripheral neuropathy (n = 24). group II: multiple sclerosis {n = 8) and multiple system atrophy (n = 6)). In 26 patients of them, the active sweat gland density (ASGD) in the dorsum of toot induced by iontophoresis of 1% pilocarpine was also measured. In I group,15 patients (63%) had absent E-SSR. however, only 9 patients (38%) had absent USSR. None of 8 patients with absent E-SSR and normal M-SSR showed abnormal ASGD. ASGDs obtained in the patients with absent M-SSR were significantly lower than those with normal M-SSR (p < 0.05). although there was no sigrrificant difference of ASGDs between the patients with absent E-SSR and with normal E-SSR. In all patients of group II, the results of USSR corresponded with those of E-SSR and the incidence of SSRs abnormalities was 43%. M-SSR is useful in evaluating the function of offerent pathway of sympathetic nervous system.
51-04
~~cr~~s~
af &art
Rate Variability Due to Whiplash
injury M. i
S. Koeppen, H.C. Diener. University of &en,
In whiplash injury cervico-cephalic pain is often accompanied by autonomic disturbances. The following questions were addressed: (i) Does the posttraumatic autonomic imbalance cause an aiteration of heart rate variability, (ii) which can be quantified by spectral EKG analysis and (iii) which may recover in a prospective follow up of 6 months. In 57 patients (f = 34; m = 23; x = 28 yrs. f8.8 SD) with ‘minor’ whiplash injury without neurological deficits EKG (Einthoven) was recorded (for 5 minutes) in a supine and standing position, during forced respiration and following Ewing manoeuvre. The variance of heart rate was spectrally analysed (FFT) initially after the trauma (x = 4 days) and reexamined 6. 12 and 24 weeks later. The spectral density of 3 defined frequency bands was calculated: BI (0.01-0.05 Hz!; Bll (0.05-0.15 Hz); BIII (0.15-0.5 Hz). Group statistics were carried out with reference to a cohort of sex and age matched normal subjects (n = 50: f = 28; m = 22; x = 28 yrs. f8.5 SD). In patients the absolute power of Bll was significantly decreased (p < 0.01) and the ratios of Bll : Bi, Bll : Bill and BII : Bl + Bill were reduced (p < 0.05). BII : Bill recovered to normal values during the follow up of 6 months. We conclude: (i) The reduced beat to beat variance in Bll indicates an autonomic imbalance following whiplash injury. (ii) The alteration in the variation of heart rate is mainly due to a relative sympathetic deficit since the vagal mediated, respiratory Bill remains unaffected. (iii) Spectral EKG analysis is of pragmatic value in quantifying posttraumatic autonomic disturbances and monitoring the time course of recovery.
n~e~atio~
of Human Skin
W.R. Kennedy, G. Wendelschafer-Crabb. Minneapolis Objective:
To demonstrate
T. Brelje.
the total innervation
University of
Minnesofa,
of normal human skin,
Methods: polyclonal
Thick frozen sections of skin biopsies were stained using rabbit
antisera
to neuro-peptides
and proteins
and cyanine
3.18 and
5.18 conjugated secondary antibodies, then visuailzed using a laser scanning confocal microscope. Images were col!ected in serial optical sections (Z series) at intervals of Z-4 wrn and projected by computer into a single in-focus image. Three-dimensional images were created by shifting the Z-series one pixel for a second micrograph. Results: Branches of dermal, presumed sensory nerve fibers, extend through the epidermis and end as small enlargements with territorial distribution in superficial layers. Some may be external to stratum granulosum. The rediscovery of epidermal nerve fibers will necessitate changes in current theories of peripheral sensation. Several axons enter sweat glands and encirc!e sweat tubules in a semi-regular fashion. Sweat ducts have a single longitudinally oriented nerve fiber. Arrector pilorum are heavily innervated by synaptophysin, acetylcholine esterase positive axons. Hair follicles display a compiex confluence of nerves heaviest at the bulb region. Conclusion: The quality of images obtained and the capability of computer 3-D graphic software to quantitate the surface area and volume of newes in sltin suggests that skin biopsy has potential to become a diagnostic procedure.
151-06 [ Sympathetic Skin Response: A ~a~~~t~v~ Test in Patients with Multiple Sclerosis t?Nisipeanu, VE. Drory, A.D. Korczyn. DeparimenfofNeurologL: Medical Center; icbilov Hospitai, iWAv,i: Israel
Sourasky
The sympathetic skin response (SSR) is a simple eiectrophysiologic test for assessment of central and peripheral autonomic disturbances, recently introduced in the evaluation of patients with multiple sclerosis (MS). The SSR was performed in the upper and lower limbs of 60 patients, 35 females, aged 19-64 years, with clinically definite MS. Mean expanded disability status score (EDSS) was 2.88, range O-8. 39 patients (65%) showed abnormal responses in at least one limb. The abnormalities correlated with EDSS. in individual limbs, SSR abnormalities did not correlate with aarticular neuroloaical deficits. indicatina that the resoonse can be affected by lesions at different leve!s of the nervous system. These results show the high sensitivity of the SSR in MS, comparable with that of evoked potentials. Because of its simplicity, the SSR can be useful in sequential patient evaluation, and probably in the assessment during drug trials.
51-07
Sympathetic Skin Response Evoked Potentials by Transc Stimulation: Normative Data
stor
0. Scarpino. G. Pelliccioni. M. Guidi. I.N.R.C.A., Ancona The sympathetic skin response (SSR) is a slow wave evoked from the activation of the efferent sympathetic fibers. The startle reflex (SR) is a myogenic response elicited with a serial rosfrocaudal activation of different body muscles. The SSR and SR can be evoked in normal subjects by different external applied arousal stimuli. The purpose of this work was to study the relationship of MEf’, SSR and SR all induced by magnetic stimulation, to elucidate their specific pathways and the possible modification with ageing. In two groups of normal subjects, one adult, the other elderly, we applied transcranial magnetic stimulation (TCS) to record slmulraneously MEP response from the hand muscles, SR response from mm. orbicularis oculi, masseter, sternocleidomastoid and SSR from surface palmar electrodes. The TCS is adequate to induce the three different responses, when the coil is centred at 4-5 cm laterally to the vertex. With this coil position it is possible to obtain in the cranial muscles the specific controlateral MEP associated with the SR response and at the hand level the MEP and the SSR response. The SSR and the SR represent respectively an autonomic and extrapiramidal motor output to a novelty stimuiation, probably reflecting a part of the orienting response. The magnetic transcranial stimulation is capable to induce these reflexes and to allow a simukaneous monitoring of the pyramidal motor tracts. Our data support that ageing differently affect these output pathways.
conduction
velocity (CV) of the sympathetic
five normal subjects
s11
Skin Response
in the axilia-middle
efferent branch was calculated in
finger tract by electrical stimulation
at the control&era1 wrist and by binaural acoustic burst. There were no significant differences between CVs of electrically and acoustically evoked responses along axilla-middle .Inger tract, the range being 0.8-1.3 m/see. The obtained data will discussed on the light of the central and peripheral physiology of the SSR in man. ’
15%031
s ympa~~etic Skin Response (SSR) Evoked by agnet~c ~timulatiQfl of Cervical Roots
Kaoru Matsunaga, Takenori Uozumi, Sadatoshi Tsuji, Yoshiyuki Murai. Department of Neuroiogy, University of Occupational and Environmental Health, SchooI of Medicine, Kitakyushu, Japan Sympathetic skin response (SSR) evoked by magnetic stimulation of cervical roots with a round coil (M-SSR) was studied in normal control subjects and patients with various neurological diseases. In 8 normal subjects, M-SSR was compared with SSRs evoked by other types of stimulation; single auditory clicks, electrical stimulation of right median nerve at wrist (E-SSR). bilateral supra-orbital nerves at forehead and deep inspiration. M-SSR showed the shortest latency and the largest amplitude both at the hand and foot among all methods. M-SSR had lit?le habituation, therefore it showed the lowest coefficient of variability in 8 responses. M-SSR and E-SSR were measured in two groups of various neurological diseases (group I: peripheral neuropathy (n = 24). group II: multiple sclerosis {n = 8) and multiple system atrophy (n = 6)). In 26 patients of them, the active sweat gland density (ASGD) in the dorsum of toot induced by iontophoresis of 1% pilocarpine was also measured. In I group,15 patients (63%) had absent E-SSR. however, only 9 patients (38%) had absent USSR. None of 8 patients with absent E-SSR and normal M-SSR showed abnormal ASGD. ASGDs obtained in the patients with absent M-SSR were significantly lower than those with normal M-SSR (p < 0.05). although there was no sigrrificant difference of ASGDs between the patients with absent E-SSR and with normal E-SSR. In all patients of group II, the results of USSR corresponded with those of E-SSR and the incidence of SSRs abnormalities was 43%. M-SSR is useful in evaluating the function of offerent pathway of sympathetic nervous system.
51-04
~~cr~~s~
af &art
Rate Variability Due to Whiplash
injury M. i
S. Koeppen, H.C. Diener. University of &en,
In whiplash injury cervico-cephalic pain is often accompanied by autonomic disturbances. The following questions were addressed: (i) Does the posttraumatic autonomic imbalance cause an aiteration of heart rate variability, (ii) which can be quantified by spectral EKG analysis and (iii) which may recover in a prospective follow up of 6 months. In 57 patients (f = 34; m = 23; x = 28 yrs. f8.8 SD) with ‘minor’ whiplash injury without neurological deficits EKG (Einthoven) was recorded (for 5 minutes) in a supine and standing position, during forced respiration and following Ewing manoeuvre. The variance of heart rate was spectrally analysed (FFT) initially after the trauma (x = 4 days) and reexamined 6. 12 and 24 weeks later. The spectral density of 3 defined frequency bands was calculated: BI (0.01-0.05 Hz!; Bll (0.05-0.15 Hz); BIII (0.15-0.5 Hz). Group statistics were carried out with reference to a cohort of sex and age matched normal subjects (n = 50: f = 28; m = 22; x = 28 yrs. f8.5 SD). In patients the absolute power of Bll was significantly decreased (p < 0.01) and the ratios of Bll : Bi, Bll : Bill and BII : Bl + Bill were reduced (p < 0.05). BII : Bill recovered to normal values during the follow up of 6 months. We conclude: (i) The reduced beat to beat variance in Bll indicates an autonomic imbalance following whiplash injury. (ii) The alteration in the variation of heart rate is mainly due to a relative sympathetic deficit since the vagal mediated, respiratory Bill remains unaffected. (iii) Spectral EKG analysis is of pragmatic value in quantifying posttraumatic autonomic disturbances and monitoring the time course of recovery.
n~e~atio~
of Human Skin
W.R. Kennedy, G. Wendelschafer-Crabb. Minneapolis Objective:
To demonstrate
T. Brelje.
the total innervation
University of
Minnesofa,
of normal human skin,
Methods: polyclonal
Thick frozen sections of skin biopsies were stained using rabbit
antisera
to neuro-peptides
and proteins
and cyanine
3.18 and
5.18 conjugated secondary antibodies, then visuailzed using a laser scanning confocal microscope. Images were col!ected in serial optical sections (Z series) at intervals of Z-4 wrn and projected by computer into a single in-focus image. Three-dimensional images were created by shifting the Z-series one pixel for a second micrograph. Results: Branches of dermal, presumed sensory nerve fibers, extend through the epidermis and end as small enlargements with territorial distribution in superficial layers. Some may be external to stratum granulosum. The rediscovery of epidermal nerve fibers will necessitate changes in current theories of peripheral sensation. Several axons enter sweat glands and encirc!e sweat tubules in a semi-regular fashion. Sweat ducts have a single longitudinally oriented nerve fiber. Arrector pilorum are heavily innervated by synaptophysin, acetylcholine esterase positive axons. Hair follicles display a compiex confluence of nerves heaviest at the bulb region. Conclusion: The quality of images obtained and the capability of computer 3-D graphic software to quantitate the surface area and volume of newes in sltin suggests that skin biopsy has potential to become a diagnostic procedure.
151-06 [ Sympathetic Skin Response: A ~a~~~t~v~ Test in Patients with Multiple Sclerosis t?Nisipeanu, VE. Drory, A.D. Korczyn. DeparimenfofNeurologL: Medical Center; icbilov Hospitai, iWAv,i: Israel
Sourasky
The sympathetic skin response (SSR) is a simple eiectrophysiologic test for assessment of central and peripheral autonomic disturbances, recently introduced in the evaluation of patients with multiple sclerosis (MS). The SSR was performed in the upper and lower limbs of 60 patients, 35 females, aged 19-64 years, with clinically definite MS. Mean expanded disability status score (EDSS) was 2.88, range O-8. 39 patients (65%) showed abnormal responses in at least one limb. The abnormalities correlated with EDSS. in individual limbs, SSR abnormalities did not correlate with aarticular neuroloaical deficits. indicatina that the resoonse can be affected by lesions at different leve!s of the nervous system. These results show the high sensitivity of the SSR in MS, comparable with that of evoked potentials. Because of its simplicity, the SSR can be useful in sequential patient evaluation, and probably in the assessment during drug trials.
51-07
Sympathetic Skin Response Evoked Potentials by Transc Stimulation: Normative Data
stor
0. Scarpino. G. Pelliccioni. M. Guidi. I.N.R.C.A., Ancona The sympathetic skin response (SSR) is a slow wave evoked from the activation of the efferent sympathetic fibers. The startle reflex (SR) is a myogenic response elicited with a serial rosfrocaudal activation of different body muscles. The SSR and SR can be evoked in normal subjects by different external applied arousal stimuli. The purpose of this work was to study the relationship of MEf’, SSR and SR all induced by magnetic stimulation, to elucidate their specific pathways and the possible modification with ageing. In two groups of normal subjects, one adult, the other elderly, we applied transcranial magnetic stimulation (TCS) to record slmulraneously MEP response from the hand muscles, SR response from mm. orbicularis oculi, masseter, sternocleidomastoid and SSR from surface palmar electrodes. The TCS is adequate to induce the three different responses, when the coil is centred at 4-5 cm laterally to the vertex. With this coil position it is possible to obtain in the cranial muscles the specific controlateral MEP associated with the SR response and at the hand level the MEP and the SSR response. The SSR and the SR represent respectively an autonomic and extrapiramidal motor output to a novelty stimuiation, probably reflecting a part of the orienting response. The magnetic transcranial stimulation is capable to induce these reflexes and to allow a simukaneous monitoring of the pyramidal motor tracts. Our data support that ageing differently affect these output pathways.