Quantitative Sensory Testing (quantitative + sensory_testing)

Distribution by Scientific Domains


Selected Abstracts


QUANTITATIVE SENSORY TESTING AND SWEAT FUNCTION IN FRIEDREICH'S ATAXIA.

JOURNAL OF THE PERIPHERAL NERVOUS SYSTEM, Issue 1 2000
CORRELATION WITH CUTANEOUS INNERVATION
To evaluate small fiber function in Friedreich's Ataxia (FA), we performed in 7 patients pin-prick, thermal thresholds, and sweat test. All tests were performed in four different sites: hand dorsum, anterior thigh, lateral distal leg, and foot dorsum. The same subjects underwent 3 mm punch skin biopsy from fingertip, anterior thigh, and lateral distal leg. We used a thin needle mounted on a calibrated nylon wire for the pin-prick test, and a Medoc 2001 TSA system for thermal threshold assessment. Sweat test was performed using a silicon mold after stimulation with pilocarpine by iontophoresis. Skin specimens, cut into 100-,m-thick sections, were double-stained using primary antibodies specific for collagen and nervous fibers and secondary antibodies labeled with Cy3 and Cy5 fluorophores. Tridimensional digitized images were obtained from z-series of 2-,m-thick optical sections acquired with a confocal microscope. We found in all patients in the more distal sites definite signs of functional impairment of the small fibers. These data correlated with the skin innervation morphological findings that showed, in the same sites, a sensible loss of small fibers regarding both the epidermal free endings and the subepidermal neural plexus. Less severe morphological abnormalities were found in the proximal sites. The large fiber neuropathy in FA is well documented. Our data show a length-dependent involvement of small fibers in the pathological process. [source]


Quantitative Sensory Testing in Patients With Chronic Unilateral Radicular Neuropathic Pain and Active Spinal Cord Stimulation

NEUROMODULATION, Issue 3 2006
Dirk Rasche MD
Abstract Objectives., Spinal cord stimulation (SCS) is an effective treatment option for chronic radicular neuropathic pain syndromes. This prospective study was performed to examine the peripheral effects of SCS on sensation using quantitative sensory testing (QST). Materials and Methods., We measured two consecutive QST measurements for thermal, tactile-static, tactile-dynamic, vibratory, and pain sensation of the lower limbs in seven patients with chronic unilateral radicular neuropathic pain who underwent SCS implantation for their pain. Measurements were performed when SCS was turned off and once again during SCS and subsequent reduced pain levels. Results., Baseline QST demonstrated significantly increased thresholds for tactile and warm and cold detection in the pain area. With SCS active, a significant reduction of the cold and warm perception and mechanical detection thresholds was found on the painful side (p < 0.01). Although not significant (p > 0.01), altered sensory thresholds with active SCS also were found at the healthy side where no paresthesias were felt. Conclusion., SCS leads to bilateral subclinical effects even if the evoked paresthesias are only unilateral. Pain perception thresholds are not altered with therapeutic SCS. [source]


ORIGINAL RESEARCH,EJACULATORY DISORDERS: Quantitative Sensory Testing of Peripheral Thresholds in Patients with Lifelong Premature Ejaculation: A Case-Controlled Study

THE JOURNAL OF SEXUAL MEDICINE, Issue 6 2009
Andrea Salonia MD
ABSTRACT Introduction., The main functional factors related to lifelong premature ejaculation (PE) etiology have been suggested to be penile hypersensitivity, greater cortical penile representation, and disturbance of central serotoninergic neurotransmission. Aims., To quantitatively assess penile sensory thresholds in European Caucasian patients with lifelong PE using the Genito-Sensory Analyzer (GSA, Medoc, Ramat Yishai, Israel) as compared with those of an age-comparable sample of volunteers without any ejaculatory compliant. Methods., Forty-two consecutive right-handed, fully potent patients with lifelong PE and 41 right-handed, fully potent, age-comparable volunteers with normal ejaculatory function were enrolled. Each man was assessed via comprehensive medical and sexual history; detailed physical examination; subjective scoring of sexual symptoms with the International Index of Erectile Function; and four consecutive measurements of intravaginal ejaculatory latency time with the stopwatch method. All men completed a detailed genital sensory evaluation using the GSA; thermal and vibratory sensation thresholds were computed at the pulp of the right index finger, and lateral aspect of penile shaft and glans, bilaterally. Main Outcome Measures., Comparing quantitatively assessed penile thermal and vibratory sensory thresholds between men with lifelong PE and controls without any ejaculatory compliant. Results., Patients showed significantly higher (P < 0.001) thresholds at the right index finger but similar penile and glans thresholds for warm sensation as compared with controls. Cold sensation thresholds were not significantly different between groups at the right index finger or penile shaft, but glans thresholds for cold sensation were bilaterally significantly lower (P = 0.01) in patients. Patients showed significantly higher (all P , 0.04) vibratory sensation thresholds for right index finger, penile shaft, and glans, bilaterally, as compared with controls. Conclusions., Quantitative sensory testing analysis suggests that patients with lifelong PE might have a hypo- rather than hypersensitivity profile in terms of peripheral sensory thresholds. The peripheral neuropathophysiology of lifelong PE remains to be clarified. Salonia A, Saccà A, Briganti A, Carro UD, Dehò F, Zanni G, Rocchini L, Raber M, Guazzoni G, Rigatti P, and Montorsi F. Quantitative sensory testing of peripheral thresholds in patients with lifelong premature ejaculation: A case-controlled study. J Sex Med 2009;6:1755,1762. [source]


Idiopathic polyneuropathy and impaired glucose metabolism in a Norwegian patient series

EUROPEAN JOURNAL OF NEUROLOGY, Issue 8 2008
M. Nebuchennykh
Background and purpose:, North American studies have indicated a high prevalence of impaired glucose tolerance (IGT) in patients with sensory polyneuropathy. We searched for the occurrence of IGT in a Norwegian patient material with polyneuropathy. Methods:, Seventy patients with symptoms and signs of sensory polyneuropathy were included. Cases with known causes of neuropathy were excluded. All patients underwent a 2 h oral glucose tolerance test (OGTT). Nerve conduction studies (NCS), quantitative sensory testing (QST) and skin biopsy with assessment of intra-epidermal nerve fibre (IENF) density were performed. Results:, Sixteen patients (23%) had impaired glucose metabolism (IGM): 2 (3%) were found to have diabetes, 9 (13%) had IGT, 3 (4%) had impaired fasting glucose (IFG) and 2 (3%) both IFG and IGT. About 62% of the patients with IGM and polyneuropathy and 50% of those with chronic idiopathic axonal polyneuropathy (CIAP) had abnormalities on NCS. Reduction of IENF occurred in 37% of the patients with IGM and 43% of those with CIAP. Conclusions:, Patients with polyneuropathy and IGM had essentially the same degree of involvement of small and large nerve fibres as patients with CIAP. IGT seems less frequent in Norwegian patients with polyneuropathy than reported in North American populations. [source]


Intraepidermal nerve fibre density, quantitative sensory testing and nerve conduction studies in a patient material with symptoms and signs of sensory polyneuropathy

EUROPEAN JOURNAL OF NEUROLOGY, Issue 2 2006
S. Løseth
Small diameter nerve fibre (SDNF) neuropathy is an axonal sensory neuropathy affecting unmyelinated (C) and thin myelinated (A-delta) fibres. We have evaluated 75 patients with symptoms and signs suggesting SDNF dysfunction with or without symptoms and signs of co-existing large diameter nerve fibre involvement. The patients were examined clinically and underwent skin biopsy, quantitative sensory testing (QST) and nerve conduction studies (NCS). The purpose of this study was to compare the relationship between the different methods and in particular measurements of thermal thresholds and intraepidermal nerve fibre (IENF) density in the same site of the distal leg. The main subdivision of the patient material was made according to the overall NCS pattern. Patients with normal NCS (38) had 6.4 ± 3.8 and patients with abnormal NCS (37) had 4.4 ± 3.4 IENF per mm (P = 0.02). Limen (difference between warm and cold perception thresholds) was significantly higher (more abnormal) in those with abnormal than in those with normal NCS (22.1 ± 9.1 vs. 13.4 ± 5.6, P < 0.0001). Cold perception threshold was more abnormal (P < 0.0001) than warm perception threshold (P = 0.002). Correlation between IENF and QST was statistically significant only when NCS was abnormal, and thus dependent of a more severe neuropathic process in SDNFs. [source]


Persistent sensory dysfunction in pain-free herniotomy

ACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 3 2010
E. K. AASVANG
Background: Persistent post-herniotomy pain may be a neuropathic pain state based on the finding of a persistent sensory dysfunction. However, detailed information on the normal distribution of sensory function in pain-free post-herniotomy patients hinders identification of exact pathogenic mechanisms. Therefore, we aimed to establish normative data on sensory function in pain-free patients >1 year after a groin herniotomy. Methods: Sensory thresholds were assessed in 40 pain-free patients by a standardized quantitative sensory testing (QST). Secondary endpoints included comparison of sensory function between the operated and the naïve side, and correlation between sensory function modalities. Results: QST showed that on the operated side, thermal data were normally distributed, but mechanical pressure and pinch thresholds were normalized only after log-transformation, and cold pain and pressure tolerance could not be normalized. Comparison of QST results revealed significant (P<0.01) cutaneous hypoesthesia/hyperalgesia, but also significant pressure hyperalgesia (P<0.01) and decreased pressure tolerance (P=0.02) on the operated vs. the naïve side. Wind-up was seen in 6 (15%) but with a low pain intensity. Conclusion: Persistent sensory dysfunction is common in pain-free post-herniotomy patients. Future studies of sensory function in persistent post-herniotomy pain should compare the findings to the present data in order to characterize individual patients and potentially identify subgroups, which may aid in allocation of patients to pharmacological or surgical treatment. [source]


Late sensory function after intraoperative capsaicin wound instillation

ACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 2 2010
E. K. AASVANG
Background: Intense capsaicin-induced C-fiber stimulation results in reversible lysis of the nerve soma, thereby making capsaicin wound instillation of potential interest for the treatment of post-operative pain. Clinical histological and short-term sensory studies suggest that the C-fiber function is partly re-established after skin injection of capsaicin. However, no study has evaluated the long-term effects of wound instillation of purified capsaicin on sensory functions. Methods: Patients included in a double-blind placebo-controlled randomized study of the analgesic effect of capsaicin after groin hernia repair were examined by quantitative sensory testing before, 1 week and 2 years post-operatively. The primary endpoint was occurrence of hyperalgesia/allodynia. The secondary endpoints were acute and late sensory changes between the two patient groups. Patients were blinded to the allocated treatment. Results: Twenty (100%) capsaicin and 16 (76%) placebo-treated patients were seen at the year follow-up. Hyperalgesia was seen in five capsaicin- vs. one placebo-treated patient (P=0.2). The mechanical detection threshold was significantly increased on the operated side in the capsaicin vs. placebo group at the 1-week follow-up (P<0.05), but was not different at the year follow-up (P=0.3). There were no other significant differences in sensory function on the operated side between groups at the pre-operative, 1-week or year post-operative follow-up (P>0.05). The sensory function on the contralateral side was comparable between groups throughout the study (P>0.1). Conclusion: This small-volume study calls for further long-term safety studies of wound capsaicin instillation. [source]


Abstracts of the 8th Meeting of the Italian Peripheral Nerve Study Group: 24

JOURNAL OF THE PERIPHERAL NERVOUS SYSTEM, Issue 1 2003
M Piatti
The present study was performed with the aim to compare different clinically-based neurotoxicity scales with a more extended composite scale (Total Neuropathy Scale) already validated in diabetic patients, in order to improve the grading of chemotherapy-induced peripheral neuropathy (CIPN) severity. The features of CIPN were evaluated in a series of women affected by locally advanced squamous cervical carcinoma treated with cisplatin and paclitaxel, based chemotherapy by clinical examination, neurophysiology and quantitative sensory testing of vibration threshold (VDT); the ECOG, Ajani and NCIC-CTC grades were assessed by a neurologist after clinical examination and the TNS was calculated after additional instrumental examination. At the same time, the treating oncologist, who was blinded as regards the results of the neurological examination, assessed the NCIC-CTC sensory neurotoxicity grade. The correlation existing between the different evaluations was evaluated with the Spearman test on a total of 97 visits. Our results indicate for all the neurotoxicity scales commonly used by oncologists and evaluated in this study a significant correlation with TNS; the interexaminer agreement comparison evaluation evidenced that in several cases the neurologist attributed a higher grade in the NCIC-CTC scale than the oncologist, and this discrepancy was mainly due to a different evaluation of the sensory impairment. In conclusion, the TNS can be used to assess effectively the severity of CIPN and the results of this evaluation can be reliably correlated with the oncological grading of sensory peripheral neurotoxicity; the wider range of TNS values, however, can allow a more accurate grading of the sensory impairment, a feature which can improve the estimate of CIPN changes, particularly in clinical trials; finally, the use of standardized methods of examination of the sensory function (e.g. the semiquantitative measure of vibration sensibility using the 128 Hz tuning fork) may reduce the interexaminer disagreement. [source]


Influence of deep brain stimulation and levodopa on sensory signs in Parkinson's disease,

MOVEMENT DISORDERS, Issue 9 2010
Janne Gierthmühlen MD
Abstract To examine the effects of levodopa (L -dopa) and deep brain stimulation of the subthalamic nucleus (STN-DBS) on sensory symptoms and signs in Parkinson's disease (PD). Seventeen patients with PD were included. (1) Presence of sensory symptoms and (2) effects of L -dopa and STN-DBS on sensory symptoms and signs [assessed by quantitative sensory testing (QST)] were examined 6 months after starting STN-DBS. In addition, in 12 of these patients, presence of sensory symptoms prior and post STN-DBS was compared. Pain was most frequently nociceptive. In about 30,40%, pain and sensory symptoms were associated with PD motor symptoms. In most of these cases, pain responded to L -dopa. Intensity of pain was reduced post STN-DBS compared to pre STN-DBS. L -Dopa had no influence on detection thresholds, whereas STN-DBS improved thermal detection thresholds. However, thermal and mechanical pain thresholds were uninfluenced by L -dopa or STN-DBS. Although some patients reported an improvement of pain with STN-DBS or L -dopa, objectively pain sensitivity as assessed by QST was not altered by STN-DBS or L -dopa suggesting that there is no evidence for a direct modulation of central pain processing by L -dopa or STN-DBS. © 2010 Movement Disorder Society [source]


Quantitative Sensory Testing in Patients With Chronic Unilateral Radicular Neuropathic Pain and Active Spinal Cord Stimulation

NEUROMODULATION, Issue 3 2006
Dirk Rasche MD
Abstract Objectives., Spinal cord stimulation (SCS) is an effective treatment option for chronic radicular neuropathic pain syndromes. This prospective study was performed to examine the peripheral effects of SCS on sensation using quantitative sensory testing (QST). Materials and Methods., We measured two consecutive QST measurements for thermal, tactile-static, tactile-dynamic, vibratory, and pain sensation of the lower limbs in seven patients with chronic unilateral radicular neuropathic pain who underwent SCS implantation for their pain. Measurements were performed when SCS was turned off and once again during SCS and subsequent reduced pain levels. Results., Baseline QST demonstrated significantly increased thresholds for tactile and warm and cold detection in the pain area. With SCS active, a significant reduction of the cold and warm perception and mechanical detection thresholds was found on the painful side (p < 0.01). Although not significant (p > 0.01), altered sensory thresholds with active SCS also were found at the healthy side where no paresthesias were felt. Conclusion., SCS leads to bilateral subclinical effects even if the evoked paresthesias are only unilateral. Pain perception thresholds are not altered with therapeutic SCS. [source]


MULTIDISCIPLINARY PAIN ABSTRACTS: 12

PAIN PRACTICE, Issue 1 2004
Article first published online: 15 MAR 200
The purpose of this study was to investigate whether selective nerve fiber dysfunction, as assessed by quantitative sensory testing (QST), correlates with the effectiveness of epidural steroid injections (ESI) in patients with lumbar radiculopathy. Twenty patients with unilateral painful sciatica caused by disc herniation participated in this open study. Before ESI, quantitative thermal and mechanical sensory testing was conducted at the most painful dermatome and the contralateral dermatome. The primary outcome measure used was the self-recording of pain intensity twice daily with a 0,10 numerical pain scale (NPS). Secondary efficacy measures included the Short Form of the McGill Pain Questionnaire, the straight leg raising test, and the lumbar range of motion. A significant difference in all types of sensory thresholds between the affected and the contralateral dermatomes was detected at baseline. All outcome measures improved subsequent to the ESI. A significant positive correlation was found between the increase in cold sensation thresholds of the affected dermatome (Adelta-fiber dysfunction) and the improvement in NPS. The increase in touch and vibration thresholds (Abeta-fiber dysfunction) was found to be inversely correlated with the improvement in NPS. No correlation was found between heat sensation thresholds and any of the outcome measures. These results suggest that QST has the potential to be an important tool in the selection of the appropriate treatment for patients with sciatica and may assist in identifying the mechanisms of pain generation in these patients. [source]


Vascular endothelial growth factor gene transfer for diabetic polyneuropathy: A randomized, double-blinded trial,

ANNALS OF NEUROLOGY, Issue 4 2009
Allan H. Ropper MD
Objective Randomized, blinded trial of intramuscular gene transfer using plasmid vascular endothelial growth factor (VEGF) to treat diabetic polyneuropathy. Methods Diabetic patients with polyneuropathy were randomized to receive a VEGF-to-placebo ratio of 3:1. Three sets of injections were given at eight standardized sites adjacent to the sciatic, peroneal, and tibial nerves of one leg. Primary outcomes were change in symptom score at 6 months and a prespecified overall clinical and electrophysiological improvement score. Secondary outcomes were differences in symptoms, examination scores, visual analog pain scale, nerve conduction, and quantitative sensory testing. Results Thirty-nine patients received plasmid VEGF and 11 received placebo. Mean symptom score improved in both legs at 6 months, favoring VEGF over placebo (,1.2 ± 0.5 vs ,0.9 ± 0.5; p < 0.01 after adjustment for change in the untreated leg) and compared with the untreated leg (,0.7 ± 0.5; p = 0.02). The region of sensory loss and visual analog pain scale improved in the treated group (,1.5 vs ,0.5; p = 0.01). Twelve of 39 VEGF versus 2 of 11 placebo patients met criterion for overall improvement. Other measures including nerve conduction potentials did not improve. There were 84 adverse events in VEGF patients, and 22 were serious; there were 51 events in placebo patients, and 2 were serious. Interpretation Intramuscular plasmid VEGF gene transfer improved diabetic neuropathic symptoms, meeting primary end-point criteria for efficacy but not affecting most secondary measures. Treatment was associated with more serious adverse events that did not reach statistical significance. These results are not conclusive but may justify further clinical study. Ann Neurol 2009;65:386,393 [source]