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November 13, 2019Research

Quantitative sensory testing predicts histological small fiber neuropathy in postural tachycardia syndrome

Sophia C.I. Billig, Joana C. Schauermann, Roman Rolke, Istvan Katona, Jörg B. Schulz, Andrea Maier
First published November 13, 2019, DOI: https://doi.org/10.1212/CPJ.0000000000000770
Sophia C.I. Billig
Department of Neurology (SCIB, JCS, AM, JBS), Department of Neuropathology (IK), Department of Palliative Care (RR), RWTH Aachen University; Research Training Group 2416 MultiSenses-MultiScales (JBS), Aachen; and Forschungszentrum Jülich GmbH (JBS), JARA-Brain Institute Molecular Neuroscience and Neuroimaging, Jülich, Germany.
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Joana C. Schauermann
Department of Neurology (SCIB, JCS, AM, JBS), Department of Neuropathology (IK), Department of Palliative Care (RR), RWTH Aachen University; Research Training Group 2416 MultiSenses-MultiScales (JBS), Aachen; and Forschungszentrum Jülich GmbH (JBS), JARA-Brain Institute Molecular Neuroscience and Neuroimaging, Jülich, Germany.
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Roman Rolke
Department of Neurology (SCIB, JCS, AM, JBS), Department of Neuropathology (IK), Department of Palliative Care (RR), RWTH Aachen University; Research Training Group 2416 MultiSenses-MultiScales (JBS), Aachen; and Forschungszentrum Jülich GmbH (JBS), JARA-Brain Institute Molecular Neuroscience and Neuroimaging, Jülich, Germany.
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Istvan Katona
Department of Neurology (SCIB, JCS, AM, JBS), Department of Neuropathology (IK), Department of Palliative Care (RR), RWTH Aachen University; Research Training Group 2416 MultiSenses-MultiScales (JBS), Aachen; and Forschungszentrum Jülich GmbH (JBS), JARA-Brain Institute Molecular Neuroscience and Neuroimaging, Jülich, Germany.
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Jörg B. Schulz
Department of Neurology (SCIB, JCS, AM, JBS), Department of Neuropathology (IK), Department of Palliative Care (RR), RWTH Aachen University; Research Training Group 2416 MultiSenses-MultiScales (JBS), Aachen; and Forschungszentrum Jülich GmbH (JBS), JARA-Brain Institute Molecular Neuroscience and Neuroimaging, Jülich, Germany.
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Andrea Maier
Department of Neurology (SCIB, JCS, AM, JBS), Department of Neuropathology (IK), Department of Palliative Care (RR), RWTH Aachen University; Research Training Group 2416 MultiSenses-MultiScales (JBS), Aachen; and Forschungszentrum Jülich GmbH (JBS), JARA-Brain Institute Molecular Neuroscience and Neuroimaging, Jülich, Germany.
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Citation
Quantitative sensory testing predicts histological small fiber neuropathy in postural tachycardia syndrome
Sophia C.I. Billig, Joana C. Schauermann, Roman Rolke, Istvan Katona, Jörg B. Schulz, Andrea Maier
Neurol Clin Pract Nov 2019, 10.1212/CPJ.0000000000000770; DOI: 10.1212/CPJ.0000000000000770

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Abstract

Background Retrospective investigation of the somatosensory profile and prediction of histologic small fiber neuropathy (SFN) in postural orthostatic tachycardia syndrome (POTS) was performed using quantitative sensory testing (QST) as a standardized noninvasive test.

Methods In this investigation, full data sets from 30 patients (age: 34.03 ± 10.82 years, n = 6 males), including results of autonomic function testing, norepinephrine values, skin biopsy, and QST, were retrospectively analyzed. The QST data were compared with healthy controls (HCs) (age: 34.20 ± 10.5 years, n = 6 males, t test: 0.95).

Results The evaluation of all QST parameters in POTS compared with HCs yielded differences in all thermal parameters (cold detection threshold: p < 0.05, warm detection threshold: p < 0.001, thermal sensory limen: p < 0.001, cold pain threshold: p < 0.05, and heat pain threshold: p < 0.001) and in paradoxical heat sensations (p < 0.05). Differences in nonpainful stimuli (mechanical detection threshold: p < 0.05 and vibration detection threshold: p < 0.001) were also detected. All patients who had clinical signs of SFN in combination with impairment of small fibers in QST also had SFN on skin biopsy.

Conclusion These results suggest that a non–region-specific SFN in POTS compared with controls can be detected by noninvasive QST that predicts histologic small fiber pathology.

  • Received June 29, 2019.
  • Accepted October 7, 2019.
  • © 2019 American Academy of Neurology

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