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Sympathetic skin response in multiple sclerosis : a meta-analysis of case-control studies

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Date
01/2018
Author
Margaritella, Nicolò
Mendozzi, Laura
Garegnani, Massimo
Gilardi, Elisabetta
Nemni, Raffaello
Pugnetti, Luigi
Keywords
Case-control studies
Electric stimulation
Galvanic skin response
Humans
Lower extremity/physiopathology
Multiple sclerosis/diagnosis
Sympathetic nervous system/physiopathology
Upper extremity/physiopathology
QA Mathematics
RC0321 Neuroscience. Biological psychiatry. Neuropsychiatry
ZA4050 Electronic information resources
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Abstract
The usefulness of sympathetic skin responses (SSR) in multiple sclerosis (MS) has been advocated by several studies in the last 20 years; however, due to a great heterogeneity of findings, a comprehensive meta-analysis of case-control studies is in order to pinpoint consistencies and investigate the causes of discrepancies. We searched MEDLINE, EMBASE and Cochrane databases for case-control studies comparing SSR absence frequency and latency between patients with MS and healthy controls. Thirteen eligible studies including 415 MS patients and 331 healthy controls were identified. The pooled analysis showed that SSR can be always obtained in healthy controls while 34% of patients had absent SSRs in at least one limb (95% CI 22-47%; p < 0.0001) but with considerable heterogeneity across studies (I2 = 90.3%). Patients' age explained 22% of the overall variability and positive correlations were found with Expanded Disability Status Scale and disease duration. The pooled mean difference of SSR latency showed a significant increase in patients on both upper (193 ms; 95% CI 120-270 ms) and lower (350 ms; 95% CI 190-510 ms) extremities. We tested the discriminatory value of SSR latency thresholds defined as the 95% confidence interval (CI) upper bound of the healthy controls, and validated the results on a new dataset. The lower limb threshold of 1.964 s produces the best results in terms of sensitivity 0.86, specificity 0.67, positive predicted value 0.75 and negative predicted value 0.80. Despite a considerable heterogeneity of findings, there is evidence that SSR is a useful tool in MS.
Citation
Margaritella , N , Mendozzi , L , Garegnani , M , Gilardi , E , Nemni , R & Pugnetti , L 2018 , ' Sympathetic skin response in multiple sclerosis : a meta-analysis of case-control studies ' , Neurological Sciences , vol. 39 , no. 1 , pp. 45-52 . https://doi.org/10.1007/s10072-017-3111-6
Publication
Neurological Sciences
Status
Peer reviewed
DOI
https://doi.org/10.1007/s10072-017-3111-6
ISSN
1590-1874
Type
Journal item
Rights
Copyright The Author(s) 2017. This article is an open access publication. This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.
Description
The study was supported by a grant of the Italian Ministry of Health, Ricerca Corrente funding program 2014–2015 [RC2014].
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  • University of St Andrews Research
URI
http://hdl.handle.net/10023/25050

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