gms | German Medical Science

Objective: Disorders of the autonomic nervous system (ANS) are not uncommon and often result in chronic diseases refractory to usual therapy strategies. For example CRPS type I and II, palmar or axillary hyperhidrosis and Raynaud’s syndrome are significantly caused by affected or misdirected sympathetic nerve fibres. Often the degree of impairment of the sympathetic nervous system decides on the response to medication or interventional methods like SCS. On this account both the primary detection of sympathetic malfunction and follow-up of SCS influence with a less invasive and manageable diagnostic technique would be helpful.

Methods: 3 patients with iatrogenic or post-traumatic CRPS I/II of the upper limb were recruited using the criteria described by the IASP. Implantation of cervical SCS was performed in all patients. With a mean follow-up of 6 months hydration of the epidermis (stratum corneum) of the finger pads was determined using a non-invasive, skin capacitance meter (Corneometer^® CM 825, Courage+Khazaka, Köln, Germany). Affected and normal hands were compared without and under SCS influence.

Results: In each patient differences between CRPS affected hand and contralateral side could be demonstrated. In 2 patients preliminary postoperative data show an approximation of the values between healthy and affected extremities under spinal cord stimulation.

Conclusions: Measurement of epidermal hydration is easy applicable and seems to be a good method to document disbalances of the sudomotoric output in patients with sympathetic maintened disorders like CRPS. Moreover, generally follow-up of the modulative effects of SCS therapy on sympathetic activity could be possible.