Exploring hyperhidrosis and related thermoregulatory symptoms as a possible clinical identifier for the dysautonomic subtype of Parkinson’s disease.

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Exploring hyperhidrosis and related thermoregulatory symptoms as a possible clinical identifier for the dysautonomic subtype of Parkinson’s disease.

J Neurol. 2019 Apr 17;:

Authors: van Wamelen DJ, Leta V, Podlewska AM, Wan YM, Krbot K, Jaakkola E, Martinez-Martin P, Rizos A, Parry M, Metta V, Ray Chaudhuri K

Abstract
OBJECTIVE: To identify associated (non-)motor profiles of Parkinson’s disease (PD) patients with hyperhidrosis as a dominant problem.
METHODS: This is a cross-sectional, exploratory, analysis of participants enrolled in the Non-motor Longitudinal International Study (NILS; UKCRN No: 10084) at the Parkinson’s Centre at King’s College Hospital (London, UK). Hyperhidrosis scores (yes/no) on question 28 of the Non-Motor Symptom Questionnaire were used to classify patients with normal sweat function (n = 172) and excessive sweating (n = 56) (Analysis 1; n = 228). NMS scale (NMSS) question 30 scores were used to stratify participants based on hyperhidrosis severity (Analysis 2; n = 352) using an arbitrary severity grading: absent score 0 (n = 267), mild 1-4 (n = 49), moderate 5-8 (n = 17), and severe 9-12 (n = 19). NMS burden, as well as PD sleep scale (PDSS) scores were then analysed along with other correlates.
RESULTS: No differences were observed in baseline demographics between groups in either analysis. Patients with hyperhidrosis exhibited significantly higher total NMSS burden compared to those without (p < 0.001). Secondary analyses revealed higher dyskinesia scores, worse quality of life and PDSS scores, and higher anxiety and depression levels in hyperhidrosis patients (p < 0.001). Tertiary analyses revealed higher NMSS item scores for fatigue, sleep initiation, restless legs, urinary urgency, and unexplained pain (p < 0.001).
CONCLUSIONS: Chronic hyperhidrosis appears to be associated with a dysautonomia dominant subtype in PD patients, which is also associated with sleep disorders and a higher rate of dyskinesia (fluctuation-related hyperhidrosis). These data should prompt the concept of hyperhidrosis being used as a simple clinical screening tool to identify PD patients with autonomic symptoms.

PMID: 30997572 [PubMed – as supplied by publisher]

Hyperhidrosis and Dysautonomia in a Patient with a History of Tetraplegia following Cervical Facet Radiofrequency Ablation: A Case Report.

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Hyperhidrosis and Dysautonomia in a Patient with a History of Tetraplegia following Cervical Facet Radiofrequency Ablation: A Case Report.

PM R. 2019 Apr 15;:

Authors: Reddy R, Zardouz S, Rejai S, Chen J

Abstract
Chronic pain in those with spinal cord injury (SCI) can significantly impact quality of life, with prevalence ranging from 26%-96%1 . Treatment of chronic pain is notoriously challenging and unsatisfactory for providers and patients1,2 . Patients with traumatic SCI and fusion can develop adjacent-level degeneration3 . Facet-mediated pain can be treated with radiofrequency ablation (RFA) of the medial branch nerves that innervate the zygapophyseal joints4 .

PMID: 30985080 [PubMed – as supplied by publisher]

Glycopyrronium Tosylate (Qbrexza) for Hyperhidrosis

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Glycopyrronium Tosylate (Qbrexza) for Hyperhidrosis

Skin Therapy Lett. 2019 Mar;24(2):1-3

Authors: Nwannunu CE, Limmer AL, Coleman K, Shah R, Patel RR, Mui UN, Tyring SK

Abstract
Hyperhidrosis is a condition characterized by excessive sweat production beyond which is physiologically necessary for thermal regulation. Affecting over 4.8% of the United States population, studies have shown that severe primary hyperhidrosis interferes with daily activities and can be considered intolerable, negatively impacting a patient’s quality of life. Glycopyrronium tosylate is a topical anticholinergic agent that reduces sweat production by blocking the activation of acetylcholine receptors in peripheral sweat glands. In clinical trials, topical glycopyrronium tosylate, a pre-moistened cloth containing 2.4% glycopyrronium solution, was shown to be an effective, safe and non-invasive treatment for patients suffering from primary hyperhidrosis. This review examines the clinical trials of topical glycopyrronium tosylate and its role in primary hyperhidrosis. Glycopyrronium tosylate was recently US FDA-approved (as of June 2018) to manage patients with primary axillary hyperhidrosis.

PMID: 30970203 [PubMed – as supplied by publisher]

Analysis of Contact Position for Subthalamic Nucleus Deep Brain Stimulation-Induced Hyperhidrosis.

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Analysis of Contact Position for Subthalamic Nucleus Deep Brain Stimulation-Induced Hyperhidrosis.

Parkinsons Dis. 2019;2019:8180123

Authors: Yang C, Qiu Y, Wu X, Wang J, Wu Y, Hu X

Abstract
Objectives: To analyze the hyperhidrosis neural network structure induced by subthalamic nucleus (STN) – deep brain stimulation (DBS).
Materials and Methods: Patients with Parkinson’s disease treated with STN-DBS in Changhai Hospital between July 1, 2015, and December 1, 2016, were analyzed retrospectively. Using records of side effects of the intraoperative macrostimulation test, patients with skin sweats were selected as the sweating group. Based on the number of cases in the sweating group, the same number of patients was randomly selected from other STN-DBS patients without sweating to form the control group. The study standardized electrode position with Lead-DBS software to Montreal Neurological Institute (MNI) standard stereotactic space to compare the differences in three-dimensional coordinates of activated contacts between groups.
Results: Of 355 patients, 11 patients had sweats during intraoperative macrostimulation tests. There was no significant difference in the preoperative baseline information and the postoperative UPDRS-III improvement rate (Med-off, IPG-on) between groups. Contacts inducing sweat were more medial (X-axis) (11.02 ± 0.69 mm vs 11.98 ± 0.84 mm, P=0.00057) and more upward (Z-axis) (-7.15 ± 1.06 mm VS -7.98 ± 1.21 mm, P=0.032) than those of the control group. The straight-line distance between the center of the sweat contact and the nearest voxel of the red nucleus was closer than that of the control group (2.72 ± 0.65 mm VS 3.76 ± 0.85 mm, P=0.00012).
Conclusions: STN-DBS-induced sweat indicated that the contact was at superior medial of STN.

PMID: 30956787 [PubMed]

Intramedullary Spinal Cord Ganglioglioma Presenting as Hyperhidrosis: A Rare Case Report and literature Review.

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Intramedullary Spinal Cord Ganglioglioma Presenting as Hyperhidrosis: A Rare Case Report and literature Review.

World Neurosurg. 2019 Mar 20;:

Authors: Shi W, Zhao B, Yao J, Zhou Y, Tong M, Jing L, Wang G

Abstract
BACKGROUND: Hyperhidrosis is caused by sympathetic dysfunction of the central or peripheral nervous system. However, intramedullary spinal cord tumors presenting with hyperhidrosis as an initial symptom had been rarely reported in the literature.
CASE DESCRIPTION: This case involves an 18-year-old man who presented with abnormal enhanced sweating and flushing on the bilateral side of his face and neck that had persisted for 6 years. Magnetic resonance (MR) images revealed that, at the C7-T2 levels of the spinal cord, a large intramedullary tumor was involved in the cervico-thoracic region. The patient underwent gross total resection (GTR) of the tumor via the fluorescein-guided technique and intraoperative neurophysiological monitoring. The histopathological diagnosis revealed ganglioglioma. The symptoms gradually improved after the surgery, and the patient presented virtually complete remission at the end of an 18 months follow-up.
CONCLUSIONS: Few cases of intramedullary spinal cord tumors presenting as hyperhidrosis in clinical manifestation have been reported in the literature. Sympathetic irritation by the tumor, particularly in the location around the gray matter of the lateral spinal cord, may account for the hyperhidrosis as the initial symptom in present patient. Therefore, if a patient has autonomic dysfunction, the spine cord should be additionally examined using MR imaging.

PMID: 30904797 [PubMed – as supplied by publisher]