Association of Peripheral Autonomic Neuropathy and Sympathetic Skin Response in the Patients with Diabetic Polyneuropathy: A Pilot Study in Thailand.

OBJECTIVE Investigate the association of peripheral autonomic neuropathy (PAN) symptoms and sympathetic skin response (SSR) in the patients with diabetic polyneuropathy (DPN) as a pilot study in Thai patients. MATERIAL AND METHOD Sixty-eight DPN patients' limbs, conducted retrospectively between June 2012 and January 2014, were included and divided into two groups, 48 abnormal SSR limbs and 20 control limbs, respectively. All clinical data, demographic characteristics, PAN symptoms, and other associated factors were compared and analyzed. RESULTS A comparison between abnormal and normal SSR groups in DPN limbs showed no significant differences of age, gender, body mass index (BMI), comorbidity of hypertension and dyslipidemia, duration of PAN symptoms, associated neurological signs of impaired light touch sensation, and muscle weakness or atrophy (p-value > 0.05). The PAN symptoms, either anhidrosis or hypohidrosis, and hyporemia showed significantly correlated to abnormal SSRs (p-value = 0.003 and 0.028, respectively). Among symptoms of somatic small fiber neuropathy (SFN), burning paresthesia, and reduced thermal sensation revealed significantly correlated to abnormal SSRs (p-value = 0.032 and 0.021, respectively). Moreover, the study showed that history of fall in six months, history of foot ulcer in three months, impaired pinprick sensation, impaired proprioceptive sensation, decreased deep tendon reflex, burning paresthesia, reduced thermal sensation, either anhidrosis or hypohidrosis, and hyporemia had significantly associated with the occurrence of abnormal SSRs (p-value < 0.05). CONCLUSION There was the association between PAN symptoms and abnormal SSRs in DPN patients' limbs. These data support the recent findings of several studies that abnormal SSR has the association with history of foot ulceration in diabetic patients. It warrants further investigation into the clinical utility of the SSR in diabetic patients.