Sympathetic and somatic neuropathy in patients with scleroderma

ABSTRACT

Peripheral neurologic involvement is regarded as uncommon in systemic sclerosis. On the other hands, some studies showed that the peripheral nervous system is often affected in systemic sclerosis though it is not clearly understood whether the involvement represents a primary or a secondary event. Nonetheless, a number of patients develop parasthesia and neuropathic pain in their hands and occasionally precede the onset of clinical edema. To assess the sympathetic and somatic neuropathy in patients with scleroderma. Ten patients with scleroderma diagnosed according to the ACR criteria for systemic sclerosis 1980 as well as 10 healthy volunteers were included in the study. Included clinical neurological examination, semi-quantitative sensory testing, standard nerve conduction study of median, ulnar, common peroneal and sural nerves, needle EMG of the 1[st] dorsal interosseous and tibialis anterior, and electrically evoked sympathetic skin response [SSR] of the hand. Sensory symptoms was found in 5 patients, decrease of pinprick sensation was found in 4 patients, decrease of vibration sense was found in 4 patients, damped deep tendon jerks was found in 4 patients, unilateral facial parasthesia and hyposthesia in 2 patients. Nerve conduction study revealed low amplitude of the SNAP in 3 patients, slow sensory conduction in 2 patients and carpal tunnel syndrome in 4 patients. Slow motor conduction was found in the common peroneal nerve of a patient. Four patients showed poor SSR. The other 6 patients showed significant decrease of the amplitude and delayed latency of the SSR compared to the control subjects. Peripheral neuropathy in patients with scleroderma is not uncommon. It is predominantly sensory and sympathetic and seems to be non length dependent