Monday, 4 November 2013

Sweating And Autonomic Neuropathy

Today's post from (see link below) is another one where a doctor answers questions about neuropathy. These are always useful if only because they give you an expert opinion and a direct line to what a doctor thinks about a particular condition. This article talks about autonomic neuropathy, a form of neuropathy that confuses many people because of its scope and wide ranging effects. In this case a patient asks about his or her abnormal sweating as a result of autonomic neuropathy (something that commonly happens to people with this condition).

“Ask the Doctor” Column: Autonomic Neuropathy

 This is a column in which leading clinicians answer your questions about neuropathy–usually one question per issue, and more when we are able. Please send your questions to “Ask the Doctor” c/o Neuropathy News, The Neuropathy Association, 60 East 42nd Street, Suite 942, New York, NY 10165.

DEAR DOCTOR: I am 45-years young and was diagnosed with idiopathic neuropathy almost ten years ago. At a recent follow-up with my neurologist, I shared that I was experiencing excessive sweating to the point that it was embarrassing and uncomfortable. After further evaluation and tests, my doctor shared that the excessive sweating is related to autonomic neuropathy. What is autonomic neuropathy and how is it managed? - D. N.

DR. JASVINDER CHAWLA RESPONDS: Autonomic neuropathies are a group of diseases and syndromes affecting the autonomic peripheral nerves. Autonomic peripheral nerves control several vital body functions, including blood pressure, heart rate, digestion, sexual function, and bowel and bladder emptying.

The symptoms of autonomic neuropathy vary depending on the degree and type of nerves affected; they usually develop gradually over time. When the digestive system is affected symptoms include constipation, diarrhea, feeling full with only a few bites after eating, and vomiting of undigested food. When the heart and lungs are affected, symptoms may include blood pressure changes with position causing dizziness when standing and shortness of breath with activity and/or exercise. When the urinary tract is affected, symptoms may include difficulty beginning to urinate, feeling of incomplete bladder emptying, and urinary incontinence. Other symptoms include sexual dysfunction, abnormal sweating, heat intolerance brought on by activity and exercise, and thinning of the skin (with susceptibility to bruising and poor healing).

An adequate amount of sweating is required to maintain or regulate the body’s core temperature. Sweating excessively and unpredictably is a medical condition called hyperhidrosis. Hyperhidrosis may be primary, resulting from an unidentified cause (or idiopathic); or it may be secondary resulting as a side-effect of medications or an underlying medical condition (e.g., endocrine diseases such as diabetes mellitus, hyperthyroidism, hyperpituitarism, and pheochromocytoma; peripheral nerve injury; Parkinson’s disease; reflex sympathetic dystrophy; and spinal injury, among others).

It is important to talk with your neurologist or your primary care doctor about these autonomic neuropathy symptoms. Your doctor will take a thorough history, perform a neurological examination, and order pertinent laboratory tests. It is also important to share with your doctor how your neuropathy and your symptoms of autonomic neuropathy are affecting your mood, sleep, and daily activities. Be prepared to also share the names of medications you have tried in the past to control your hyperhidrosis. This will help your doctor work with you to better understand the cause of the autonomic neuropathy symptoms, prescribe appropriate treatment, and address additional concerns about your neuropathy and the autonomic symptoms.

Therapy for hyperhidrosis can be challenging for both the patient and the physician. Overall, the treatment is aimed at managing the underlying cause. For idiopathic cases, the management is primarily symptomatic. Both topical (e.g., prescription strength antiperspirants) and oral prescription medications (e.g., anticholinergic drugs) can help treat hyperhidrosis. Other treatment options include iontophoresis (a therapy that uses water to conduct a mild electrical current through the skin’s surface) and botulinum toxin injections (a therapy that blocks the nerves that trigger the sweat glands). Besides medical therapy, severe cases can be treated surgically. This includes surgical sympathectomy (a procedure that involves cutting the nerves that carry signals from the sympathetic nerves to the sweat glands); surgical removal of the sweat glands in the affected areas; and, subcutaneous liposuction.

Jasvinder Chawla, M.B.B.S., M.D., M.B.A. is chief of Neurology at Edward Hines, Jr. VA Hospital, associate professor of Neurology and director of Neurology Residency Training Program at Loyola University Medical Center. He is also co-director of the Peripheral Neuropathy Center of Excellence at Hines VA. Dr. Chawla's clinical and research interest is in peripheral neuropathy, focusing on neuromuscular and autonomic disorders.

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