ABNORMAL MODULATION OF ELECTRODERMAL ACTIVITY BY THERMOALGESIC STIMULI IN PATIENTS WITH PRIMARY PALMAR HYPERHIDROSIS
Résumé
Background: We examined the effects of thermal stimulation on electrodermal activity (EDA) in patients with primary palmar hyperhidrosis (PPH). We hypothesized that temperature changes may induce abnormal sudomotor reactions because of simultaneous activation of sudomotor centers through thermal and emotional pathways. We compared patients before and after thoracoscopic sympathectomy. Methods: We studied 18 PPH patients and 20 controls. Patients reported subjective evaluation of their symptoms using a visual analogue scale for palmar sweating (ps-VAS) and for body sweating (bs-VAS). We applied focal thermal stimulation to quantify sensory perception and measure ongoing changes in EDA recorded from the palm of the hands. Results: Before sympathectomy, patients had lower sensory perception thresholds and higher EDA levels than controls. Increased EDA occurred along the whole test, with no significant modulation by changes in thermal stimulation. Sensory perception normalized after sympathectomy but thermal modulation of EDA remained abnormal whenever sudomotor activity was present after surgery. There was a significant positive correlation between EDA levels before treatment and the bs-VAS (from r=0.45 to r=0.57). Conclusions: Patients with PPH show perceptual abnormalities and exaggerated sudomotor reactions to thermoalgesic stimulation, consistent with central sensitization of sympathetic circuits. The reduced sympathetic outflow after thoracoscopic sympathectomy induced normalization of sensory perception but it did not modify the abnormal control of efferent sudomotor activity.
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