Invited review
Evaluation of sudomotor function

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Why evaluate sudomotor function?

The eccrine sweat gland is innervated by postganglionic sudomotor fibers. It plays an important role in thermoregulation. A diffuse loss of function can result in heat intolerance and excessive function, manifest as hyperhidrosis can be distressing. However, the importance of measurements of the sweat response resides in its value as an index of the severity and distribution of autonomic failure, and hence as an aid in the diagnosis of dysautonomia. For instance, the percent anhidrosis on the

Anatomy and physiology of sweating

Thermoreceptors are present in the preoptic-anterior hypothalamus area, responding to a deviation in core temperature relative to the temperature set point. However, other thermoreceptors in skin, viscera, and spinal cord are also important. Afferent impulses from these peripheral receptors travel in the spinothalamic tract afferent pathways, but also ascend as multisynaptic fiber pathways diffusely in the lateral spinal cord, to the reticular formation of the brain stem, and finally to the

QSART

The principle of the QSART can be surmised from Fig. 1. A commercial unit (QSWEAT) is essentially similar. When postganglionic sympathetic terminals are stimulated, an antidromic impulse occurs, reaches a branch point, then travels orthodromically to release acetylcholine from the nerve terminal. Acetylcholine traverses the neuroglandular junction and binds to M3 muscarinic receptors on eccrine sweat glands (Torres et al., 1991) to evoke the sweat response. Acetylcholinesterase in subcutaneous

Acknowledgements

This work was supported by grants from the NIH (NS32352, NS39722, and MO1 RR00585).

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