SUDOSCAN in autoimmune small fiber neuropathy


SUDOSCAN in autoimmune
small fiber neuropathy

Trevino, Jorge A. M.D., Novak, Peter MD. Ph.D.
Article title: TS-HDS and FGFR3 Antibodies in Small Fiber Neuropathy and Dysautonomia.
Muscle Nerve. 2021 Apr 1

In this study JA Trevino and P Novak from Brigham and Women’s Hospital, Harvard Medical School, Boston, tested small fiber neuropathy (SFN) in idiopathic neuropathy population and explored the autoimmune etiology of this complication. Autoimmune SFN is a neuropathy where autoimmunity plays a causative role. According to one study, up to 19% of patients with idiopathic SFN may have underlying immunological abnormalities.

Antibodies to either trisulfated heparin disaccharide (anti-TS-HDS) or fibroblast growth factor receptor-3 (anti-FGFR3) have been found in patients with idiopathic sensory-predominant SFN suggesting that they may be useful markers of neural autoimmunity. TS-HDS/FGFR3 antibodies are present in patients with evidence of autonomic dysfunction.

This retrospective study aimed to describe the SFN and autonomic profile of patients with anti-TS-HDS and anti-FGFR3.

Small fiber neuropathy was defined as a combination of clinical signs suggestive of small fiber dysfunction and at least one of the following structural or functional variables: abnormal epidermal nerve fiber density (ENFD); abnormal sweat gland nerve fiber density (SGNFD); abnormal sudomotor testing using SUDOSCAN’s measures (the following normative values were used for ESC*/kg: hands ≥1.03μS/kg, feet ≥1.14 μS/kg).

(*) ESC: electrochemical skin conductance

322 patients were included in the study, abnormal ENFD was detected in 71.4%, abnormal ESC/kg (SUDOSCAN) in 63.3%, and abnormal SGNFD in 48.8% of patients.

Frequency of positive or negative Anti-FGFR3 was significantly different among patients with mixed SFN (abnormal ENFD and SGNFD; and combined functional-morphological SFN (Abnormal ENFD, SGNFD, ESC measured with SUDOSCAN)) (see table below).

Only mixed SFN definition segregated seropositive from seronegative patients for anti-FGFR3 but not for anti-TSHDS.

SUDOSCAN measures combined to skin biopsy could be a helpful test to diagnose immune small fiber neuropathy.

Skin biopsy results and antibody presence

Abbreviations: TS-HDS: Trisulfated heparin disaccharide antibody; FGFR3: Fibroblast growth factor
receptor 3 antibody; ENFD: Epidermal nerve fiber density; SGNFD: Sweat gland Nerve Fiber Density; ESC/kg: Electrochemical skin conductance adjusted for weight; +: abnormal results/positive antibody, -:
normal result/absent antibody.
Keywords: Small fiber neuropathy, autoimmune, TS-HDS, FGFR3, dysautonomia, ENFD, SGNFD, ESC, SUDOSCAN.

Impeto Medical

Impeto Medical


SUDOSCAN is a quick and non-invasive test that provides an accurate evaluation of sweat gland function reflecting the status of the autonomic nervous system.

With quantitative and reproducible results, SUDOSCAN allows physicians to detect early and follow-up peripheral neuropathy to monitor disease progression and assess treatment efficacy for better patient management.

SUDOSCAN efficacy has been evaluated in the assessment of small fiber neuropathies in several diseases and compared to reference tests recommended in guidelines.

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