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The evaluation of the autonomic nervous system using the Finometer Pro device and sympathetic skin response (SSR): Results in 141 consecutive patients

Jochen Vehoff, Stefan Hägele-Link, Thomas Hundsberger & Barbara Tettenborn

abstract

The autonomic nervous system (ANS) may be differentially affected in several neurologic diseases. Unfortunately despite some guidelines there is no gold standard available for the evaluation of the ANS. Several methods are in clinical use.
We report our results of the evaluation of the ANS. Measurements are done with the Finometer Pro device (Finapres Medical Systems, NL). The different parts of the ANS are tested as follows (methodology published at the annual SSCN meeting in Lucerne 2009).
Parasympathetic cholinergic (PC): time domain based analysis of heart rate variability under the paradigms of breathing (at rest and deep breath) and valsalva manoeuvre (VM).
Sympathetic noradrenergic (SN): blood pressure changes following (VM), focusing on the reactive overshoot of blood pressure in phase IV after VM.
Orthostatic dysregulation: active standing.
Sympathetic cholinergic (SC): SSR.
141 consecutive patients with a mean age of 55 years (range: 16-86 years) (99 male, 42 female) were examined between May 2009 and February 2011. In all these patients dysfunction of the nervous system was suspected and a clinical neurologic examination with a special focus on autonomic symptoms was performed. Age adjusted normative values were adapted from Haegele-Link et al..

Out of the 141 patients tested, 81 (50 male, 31 female) had a complete set of data. In the 60 other patients, for technical or compliance reasons, at least one subtest was not analyzable. Out of the 81 patients 36 (44.4%) were considered to have a pathological testing (25 male, 11 female), meaning dysfunction at least in one part of the ANS.
Out of the male patients with a pathological testing 8 had a dysfunction of the PC system, 13 of the SN system, 8 of the SC system and 11 had orthostatic hypotension (OH).
Out of the female patients with a pathological testing 3 had a dysfunction of the PC system, 4 of the SN system, 3 of the SC system and 5 had OH. The combination of more than one dysfunctional test was seen in 11 male and 3 female patients.
Looking at the clinical diagnosis there was a large variety of different diagnoses. Among the most often were Parkinson's disease and other neurodegenerative diseases (n=13) as well as polyneuropathies of different origin (n=14).

Evaluation of the ANS using the FP and SSR is non-invasive and feasible in the clinical setting. In daily use, lack of standardization, technical aspects and compliance affect the results. Our next steps will be obtaining more data of healthy controls to create our own normative data and improving standardization and technical aspects of testing, for obtaining valid and reproducible date for evaluating and monitoring our patients.
   
citation Vehoff J, Hägele-Link S, Hundsberger T, & Tettenborn B (2011). The evaluation of the autonomic nervous system using the Finometer Pro device and sympathetic skin response (SSR): Results in 141 consecutive patients. Presented at Jahrestagung der Schweizerischen Gesellschaft für klinische Neurophysiologie (SGKN), Luzern.
   
type presentation (Deutsch)
date of publishing 20-5-2011
event Jahrestagung der Schweizerischen Gesellschaft für klinische Neurophysiologie (SGKN) (Luzern)
contact Jochen Vehoff