Waveforms of Sympathetic Skin Response in Normal Subjects

Abstract

Objective: The sympathetic skin response (SSR) is used as an index of sudomotor sympathetic function. The aim of this study was to investigate whether there were differences in amplitude, latency and habituation among the different waveform patterns of SSR in normal subjects. Material and Methods: Fourteen SSRs were recorded from the palm skins of 47 normal subjects by electrical stimulations. Waveforms were classified as one of two types, namely, the P type, in which the positive component was larger than the negative, and the N type, in which the negative component was larger than the positive. The M pattern had both P and N type waveforms during consecutive recordings. Results: During successive stimulations, 11 of the 47 subjects had only P type waveforms (P pattern), 10 others only the N type (N pattern), and the remaining 26 (55.3%) both the P and N types (M pattern). The P pattern had a larger amplitude and shorter latency than the N pattern. The P type constituted 49.1% of all the SSRs. The P type made up 81% of the first evoked responses but only 13.5% of the last ones in the M pattern. SSR amplitudes gradually decreased but irregularly during the repeated stimulations, reflecting habituation. Conclusions: These results suggest that waveform patterns should also be considered when defining the normal ranges of SSR latency and amplitude. Futhermore, it might be advised to confirm the balanced distribution of the SSR waveform patterns in patient and control groups before comparing the values of amplitude and latency between the two groups. Key words: Waveform; Sympathetic skin response; Habituation

Keywords

• Waveform; Sympathetic skin response; Habituation

Normallerde Sempatik Deri Cevabı Dalga Formları+

Öz

Amaç: Sempatik deri cevabı (SDC) sudomotor sempatik fonksiyonun bir göstergesi olarak kullanılmaktadır. Bu çalışmanın amacı normal bireylerde farklı dalga formları arasında latans, amplitüd ve habitüasyonda farklılık olupolmadığını araştırmaktır. Gereç ve Yöntem: Elektriksel stimulasyonla 47 normal bireyin avuç içi derisinden 14 SDC kayıtlandı. Dalga formları ya pozitif komponenti negatif komponentinden daha büyük P tipi veya negatif komponenti pozitif komponentinden daha büyük N tipi olarak sınıflandırıldı. M paterni ardışık kayıtlamalar süresince hem P tip, hem de N tip dalga formlarına sahipti. Sonuçlar: Ardışık kayıtlamalar süresince, 47 bireyin 11'i sadece P tip (P paterni), 10'u sadece N tip (N paterni), 26'sı (%55.3) hem P tip hem de N tip dalga formlarına (M paterni) sahiptiler. P paterni N paterninden daha büyük bir amplitüd ve daha kısa bir latansa sahipti. Bütün SDC'larının %49.1'ini P tipi teşkil etmekteydi. M paterninde ilk uyarılmış cevapların %81'ini, fakat son uyarılmış cevapların yalnızca %13.5'ini P tip oluşturmuştu. Habitüasyonun bir göstergesi olarak, SDC amplitüdleri tekrarlayan stimuluslar süresince kademeli bir şekilde fakat düzensiz olarak azaldı. Yorum: Bu sonuçlar, SDC'ları amplitüd ve latansın normal ranjları tanımlandığında dalga formu paternlerinin de göz önüne alınması gerektiğini telkin etmektedir. Yine amplitüd ve latans değerleri karşılaştırılmadan önce hasta ve kontrol gruplarında SDC dalga tipi paternlerinin dağılımlarında eşitliğin saptanması tavsiye edilir. Anahtar kelimeler: Dalga formu, Sempatik deri cevabı, Habitüasyon

Anahtar Kelimeler

• Dalga formu, Sempatik deri cevabı, Habitüasyon

Kaynakça

1. Roberto Vetrugno, Rocco Liguori, Pietro Cortelli, Pasquale Montagna. Sympathetic skin response. Basic mechanisms and clinical applications. Clin Auton Res 2003; 13 : 256–270.
2. Toyokura M. Waveform and habituation of sympathetic skin response. Clin Neurophysiol 1998; 109: 178-183.
3. Toyokura M. Waveform variation and size of sympathetic skin response: regional difference between the sole and palm recordings. Clin Neurophysiol 1999; 110: 765–771.
4. Baba M, Watahiki Y, Matsunaga M, Takebe K. Sympathetic skin response in healthy man. Electromyogr clin Neurophysiol 1988; 28: 277–283.
5. Aramaki S, Kira Y, Hirasawa Y. A study of the normal values and habituation phenomenon of sympathetic skin response. Am J Phys Med Rehabil 1997; 76: 2-7.
6. Arunodaya GR, Taly AB. Sympathetic skin response: a decade later. J Neurol Sci 1995; 129: 81–89.
7. Cariga P, Catley M, Mathias CJ, Ellaway PH. Characteristics of habituation of the sympathetic skin response to repeated electrical stimuli in man. Clin Neurophysiol 2001; 112: 1875-1880.
8. Hoeldtke RD, Davis KM, Hshieh PB, Gaspar SR, Dworkin GE. Autonomic surface potential analysis: assessment of reproducibility and sensitivity. Muscle Nerve 1992; 15; 926–931.

9. Drory VE, Korczyn AD. Sympathetic skin response: age effect. Neurology 1993; 43: 1818–1820.
10. Francini F, Zoppi M, Maresca M, Procacci P. Skin potential and EMG changes induced by cutaneous electrical stimulation. I. Normal man in arousing and non-arousing environment. Appl Neurophysiol 1979; 42: 113–124.
11. Yokota T, Takahashi T, Kondo M, Fujimori B. Studies on the diphasic wave form of the galvanic skin reflex. Electroenceph Clin Neurophysiol 1959; 11: 687–696 .
12. Elie B, Guiheneuc P. Sympathetic skin response: normal results in different experimental conditions. Electroenceph Clin Neurophysiol 1990; 76: 258–267.
13. Levy DM, Reid G, Rowley DA, Abraham RR. Quantitative measures of sympathetic skin response in diabetes: relation to sudomotor and neurological function. J Neurol. Neurosurg Psychiatry 1992; 55: 902–908.
14. Shaver BA, Brusilow SW, Cooke RE. Origin of the galvanic skin response. Proc Soc Exp Biol NY 1962; 110: 559–564.
15. Takagi K, Nakayama T. Peripheral effector mechanism of galvanic skin reflex. Jpn J Physiol 1959; 9: 1–7.
16. Nakayama T, Takagi K. Two components involved in galvanic skin response. Jpn J Physiol 1958; 8; 21–30.
17. Yokota T, Takahashi T,Kondo M, Fujimori B. Studies on the diphasic wave form of the galvanic skin reflex. Electroenceph Clin Neurophysiol 1959; 11: 687–696.
18. Mitani H, Ishiyama Y, Hashimoto I. Equivalent current dipole estimated from SSR potential distribution over the human hand. Clin Neurophysiol 2003; 114: 233-238.
19. Toyokura M, Takeda H. Waveform of sympathetic skin response in diabetic patients. Clin Neurophysiol 2001; 112: 1229-1236.
20. Brasil-Neto JP, Carneiro CR. Monophasic negative sympathetic skin responses and autonomic dysfunction in carpal tunnel syndrome. Muscle Nerve 2004; 29: 330-1.
21. Brasil-Neto JP, Gonçalves CA, Araujo CD, Carneiro CR, Soares MVA. Circadian latency variability of sympathetic skin responses. Clin Auton Res 1998; 8: 237–239.
22. Kunimoto M,Kirno K, Elam M,Karisson T,Wallin BG. Non-linearity of skin resistance response to intraneural electrical stimulation of sudomotor nerves. Acta Physiol Scand 1992; 146: 385–392.
23. Bini G,Hagbarth KE,Hynninen P, Wallin BG. Thermoregulatory and rhythm generating mechanisms governing the sudomotor and vasoconstrictoroutflow in human cutaneous nerves. J Physiol 1980; 306: 537–552.
24. Manca D, Valls-Solé J, Callejas MA. Excitability recovery curve of the sympathetic skin response in healthy volunteers and patients with palmar hyperhidrosis. Clin Neurophysiol 2000; 111: 1767-1770.
25. Kira Y, Ogura T, Aramaki S, Kubo T, Hayasida T, Hirasawa Y. Sympathetic skin response evoked by respiratory stimulation as a measure of sympathetic function. Clin Neurophysiol 2001; 112; 861-865.