Table Info

Table 3.

Clinically available autonomic and small fiber function tests

Clinically available autonomic and small fiber function tests	What they measure	Modalities	Advantages	Disadvantages	Sensitivity/specificity	Reference
VM	Assesses the reduction in cardiac preload	Cardiovascular adrenergic	Provides quick results for analysis	Patients may experience increase in blood pressure	80% Sensitivity, 80% specificity	[56, 59, 67]
Tilt table test	Changes in blood volume due to gravity redistribution in the transition to an upright posture	Cardiovascular adrenergic	Provides quick results for analysis	Large range of long-term reproducibility (50–85%)	The sensitivity and specificity are difficult to establish	[56, 111]
SSW test	Degree of wrinkling, which reflects vasoconstriction controlled by sympathetic nerve fibers in the glabrous hand	Sudomotor	Simple to perform Cost-effective Does not require specialized equipment	Limited to the hands, because wrinkling in the feet is unreliable	- EMLA wrinkling: 81.6% sensitivity, 74.7% specificity - Water wrinkling: 71.4% sensitivity, 73% specificity	[60–63]
QSART	Quantitative assessment of postganglionic sudomotor function controlled by autonomic nerve fibers that cause sweating	Sudomotor	Able to assess the distribution of sudomotor impairment	Moderate test- retest reliability with a large standard error of measurement Norms only established for ≥ 10 years of age	Sensitivity of 80%	[16, 64–66]
QST	Psychophysical thresholds for cold and warm sensations	Thermal sensation	Non-invasive Easily performed More reproducible than QSART	High inter- operator, inter- patient and inter- test variability Cannot differentiate between central and peripheral causes	-	[69, 70, 72, 73]
Thermoregulatory sweat test (TST)	Percentage of anterior body surface anhidrosis	Sudomotor	Able to detect abnormality at any point along the sudomotor neuraxis Greater sensitivity than tests confined to sampled sites	Patients experience thermal discomfort of the heat stimulus which makes them reluctant to undergo repeat testing	80% Sensitivity	[56]
Sympathetic skin response (SSR)	Momentary changes in electrical potentials associated with induced sweating in palms and soles	Sudomotor	Simple to implement	Highly variable response Does not reflect degree of dysfunction	87.5% Sensitivity 88.2% Specificity	[56]

-: information not available

Declarations

Author contributions

ACYC, KO, and JV: Conceptualization. KO, ACYC, JV: Writing—original draft, Writing—review & editing. All authors contributed to manuscript revision, read and approved the submitted version.

Conflicts of interest

The authors declare that they have no conflicts of interest.

Ethical approval

Not applicable.

Consent to participate

Not applicable.

Consent to publication

Not applicable.

Availability of data and materials

Not applicable.

Funding

ACYC is supported by the Singapore Ministry of Health’s National Medical Research Council [MOH-000437-0] under its NMRC Research Training Fellowship. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Copyright

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