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Harumi Uetake - One of the best experts on this subject based on the ideXlab platform.
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correlation between Sudomotor function sweat gland duct size and corneal nerve fiber pathology in patients with type 2 diabetes mellitus
Journal of Diabetes Investigation, 2014Co-Authors: Fukashi Ishibashi, Rie Kojima, Asami Kawasaki, Emi Yamanaka, Aiko Kosaka, Harumi UetakeAbstract:Aims/Introduction To study the correlation between Sudomotor function, sweat gland duct size and corneal nerve fiber pathology in type 2 diabetes. Materials and Methods Sudomotor function was quantified by Neuropad test, and sweat gland duct and corneal nerve fibers were visualized by confocal microscopy in 78 patients with type 2 diabetes stratified by diabetic neuropathy and 28 control participants. Results In patients with diabetic neuropathy, Sudomotor function, as judged by the time required for complete color change of a Neuropad, was impaired compared with that of controls (P < 0.0001), thereby showing deterioration was related to the severity of diabetic neuropathy (P < 0.0001). Sweat gland ducts were smaller in patients without neuropathy than in controls (P < 0.0001), and further shrinking was seen in patients with severe diabetic neuropathy (P < 0.05). Patients without diabetic neuropathy showed reduced density and length (P < 0.001) of corneal nerve fibers and beading frequency (P < 0.0001), and increased tortuosity (P < 0.0001) compared with controls, and these changes deteriorated in patients with severe diabetic neuropathy. Sudomotor function was negatively associated with corneal nerve fibers (P < 0.002) and branches (P < 0.01), and influenced by the severity of diabetic neuropathy (P < 0.0001); sweat gland duct size correlated with serum triglycerides (P < 0.02), uric acid (P < 0.01), corneal nerve branch (P < 0.03), Sudomotor function (P < 0.03) and severity of neuropathy (P < 0.03). Conclusions Type 2 diabetic patients had Sudomotor dysfunction and smaller sweat gland ducts compared with controls. The stage of diabetic neuropathy and corneal nerve fiber pathology were independent predictors of Sudomotor dysfunction, and serum triglycerides, uric acid, corneal nerve branch, stage of diabetic neuropathy and Sudomotor function were predictors of sweat gland duct size.
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Correlation between Sudomotor function, sweat gland duct size and corneal nerve fiber pathology in patients with type 2 diabetes mellitus.
Journal of diabetes investigation, 2013Co-Authors: Fukashi Ishibashi, Rie Kojima, Asami Kawasaki, Emi Yamanaka, Aiko Kosaka, Harumi UetakeAbstract:Aims/Introduction To study the correlation between Sudomotor function, sweat gland duct size and corneal nerve fiber pathology in type 2 diabetes. Materials and Methods Sudomotor function was quantified by Neuropad test, and sweat gland duct and corneal nerve fibers were visualized by confocal microscopy in 78 patients with type 2 diabetes stratified by diabetic neuropathy and 28 control participants. Results In patients with diabetic neuropathy, Sudomotor function, as judged by the time required for complete color change of a Neuropad, was impaired compared with that of controls (P
Phillip A. Low - One of the best experts on this subject based on the ideXlab platform.
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Anhidrosis in multiple system atrophy involves pre- and postganglionic Sudomotor dysfunction.
Movement disorders : official journal of the Movement Disorder Society, 2016Co-Authors: Elizabeth A. Coon, Paola Sandroni, Robert D. Fealey, Phillip A. Low, David M. Sletten, Jay Mandrekar, Eduardo E. Benarroch, Wolfgang SingerAbstract:Background The objective of this study was to characterize the degree, pattern, lesion site, and temporal evolution of Sudomotor dysfunction in multiple system atrophy (MSA) and to evaluate differences by parkinsonian (MSA-parkinsonism) and cerebellar (MSA-cerebellar) subtypes. Methods All cases of MSA evaluated at Mayo Clinic Rochester between 2005 and 2010 with postganglionic Sudomotor testing and thermoregulatory sweat test were reviewed. Pattern and lesion site (preganglionic, postganglionic, or mixed) were determined based on thermoregulatory sweat test and postganglionic Sudomotor testing. Results The majority of the 232 patients were MSA-parkinsonism (145, 63%). Initial postganglionic Sudomotor testing was abnormal in 59%, whereas thermoregulatory sweat test was abnormal in 95% of all patients. MSA-parkinsonism patients were more likely to have an abnormal thermoregulatory sweat test compared with MSA-cerebellar (98% versus 90%, P = 0.006) and had a higher mean percentage of anhidrosis (57%) compared with MSA-cerebellar (48%; P = 0.033). Common anhidrosis patterns were regional (38%) and global (35%). The site of the lesion was preganglionic in 47% and mixed (preganglionic and postganglionic) in 41%. The increase in anhidrosis per year was 6.2% based on 70 repeat thermoregulatory sweat tests performed on 29 patients. The frequency of postganglionic Sudomotor abnormalities increased over time. Conclusions Our findings suggest: (1) Sudomotor dysfunction is almost invariably present in MSA and even more common and severe in MSA-parkinsonism than MSA-cerebellar; (2) a preganglionic pattern of sweat loss is common in MSA; however, pre- and postganglionic abnormalities may coexist; and (3) the increasing frequency of postganglionic Sudomotor dysfunction over time suggests involvement of postganglionic fibers or sweat glands later in the disease course. © 2016 International Parkinson and Movement Disorder Society
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Clinical Neurophysiology - Quantitative Sudomotor Axon Reflex and Related Tests
Clinical Neurophysiology, 2016Co-Authors: Phillip A. LowAbstract:Small distal nerve fibers are often selectively involved in some patients with axonal neuropathies (distal small-fiber neuropathy). One method of testing the integrity of these small nerve fibers is to study the postganglionic sympathetic Sudomotor “C” fiber function. The application of noninvasive, sensitive, quantitative, and dynamic tests of Sudomotor function significantly enhances the ability to quantitate one aspect of the autonomic deficit. The quantitative Sudomotor axon reflex test (QSART) has an important role in clinical applications to better definition of the course of neuropathy, its response to treatment, and further exploration of Sudomotor physiology. Simpler methods are available as screening tests. This chapter reviews the use of methods to measure Sudomotor fiber function.
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Quantitative Sudomotor Axon Reflex Test (QSART)
Encyclopedia of the Neurological Sciences, 2014Co-Authors: Phillip A. LowAbstract:The Quantitative Sudomotor Axon Reflex Test is a quantitative test of postganglionic Sudomotor function. The neural pathway is nicotinic and the sweat gland receptor is muscarinic. Stimulus consists of iontophoresed acetylcholine and evoked sweat volume is quantitated. The test is sensitive and reproducible in detecting denervation. Recording sites are over the arm and leg. There is extensive experience with the test in diabetic and other autonomic neuropathies, and in clinical trials.
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autonomic dysfunction in chronic inflammatory demyelinating polyradiculoneuropathy
Neurology, 2012Co-Authors: Juan J Figueroa, Paola Sandroni, Peter J Dyck, Ruple S Laughlin, J A Mercado, Rami Massie, Phillip A. LowAbstract:Objectives: Autonomic deficits in chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) have not been adequately quantitated. The Composite Autonomic Severity Score (CASS) is a validated instrument for laboratory quantitation of autonomic failure derived from standard autonomic reflex tests. We characterized dysautonomia in CIDP using CASS. Methods: Autonomic function was retrospectively analyzed in 47 patients meeting CIDP criteria. CASS ranges from 0 (normal) to 10 (pandysautonomia), reflecting summation of Sudomotor (0–3), cardiovagal (0–3), and adrenergic (0–4) subscores. Severity of neurologic deficits was measured with Neuropathy Impairment Score (NIS). Degree of small fiber involvement was assessed with quantitative sensation testing. Thermoregulatory sweat test (TST) was available in 8 patients. Results: Patients (25 men) were middle-aged (45.0 ± 14.9 years) with longstanding CIDP (3.5 ± 4.3 years) of moderate severity (NIS, 46.5 ± 32.7). Autonomic symptoms were uncommon, mainly gastrointestinal (9/47; 19%) and genitourinary (8/47; 17%). Autonomic deficits (CASS ≥1) were frequent (22/47; 47%) but very mild (CASS, 0.8 ± 0.9; CASS ≤3, all cases). Deficits were predominantly Sudomotor (16/47; 34%) and cardiovagal (10/47; 21%) with relative adrenergic sparing (4/47; 9%). TST was abnormal in 5 of 8 patients (anhidrosis range, 2%–59%). Sudomotor impairment was predominantly distal and postganglionic. Somatic deficits (disease duration, severity, small fiber deficits) did not predict presence of autonomic deficits. Conclusion: Our data characterize the autonomic involvement in classic CIDP as mild, cholinergic, and predominantly Sudomotor mainly as a result of lesions at the distal postganglionic axon. Extensive or severe autonomic involvement (CASS ≥4) in suspected CIDP should raise concern for an alternative diagnosis.
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Sudomotor dysfunction in autoimmune autonomic ganglionopathy: a follow-up study
Clinical Autonomic Research, 2011Co-Authors: Kurt Kimpinski, Steven Vernino, Valeria Iodice, Paola Sandroni, Robert D. Fealey, Phillip A. LowAbstract:Objective We have previously shown that Sudomotor dysfunction in autoimmune autonomic ganglionopathy is severe, widespread, and predominantly post-ganglionic. However, the long-term changes in Sudomotor function have not been studied in detail. Our objective was to characterize the long-term changes in Sudomotor dysfunction in patients with autoimmune autonomic ganglionopathy.
Frank Birklein - One of the best experts on this subject based on the ideXlab platform.
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Somatotopic arrangement of Sudomotor axon reflex sweating in humans.
Autonomic neuroscience : basic & clinical, 2005Co-Authors: Tanja Schlereth, Nadine Brosda, Frank BirkleinAbstract:Impaired sweating may be one of the first symptoms in neuropathies, and therefore the evaluation of sweating might facilitate their early detection. Sudomotor axon reflexes can be quantified by two different methods: quantitative Sudomotor axon reflex testing (QSART) measures the amount of local sweating, whereas staining with the iodine starch reaction assesses the extension of the Sudomotor axon reflex area. The aim of our study was to compare both tests at three different sites on the leg: foot, lower leg and thigh. QSART and iodine starch staining after iontophoretic stimulation with acetylcholine were performed on 15 male volunteers (mean age: 25; range 24-27 years) on the left resp. the right leg during a single session. QSART response, measured as area under the curve (AUC), was maximal at the lower leg (911 AUC), smaller at the dorsum of the foot (585 AUC) and even smaller at the thigh (480 AUC). The difference between lower leg and thigh was significant (p < 0.02). The Sudomotor axon reflex area was also biggest on the lower leg (39 cm(2)) followed by the foot dorsum (28 cm(2)), and then the thigh (16 cm(2)). The differences between lower leg and thigh as well as between lower leg and foot were significant (p < 0.01, resp. p < 0.04). The size of the Sudomotor axon reflex areas and QSART responses were correlated (p < 0.01). QSART and Sudomotor axon reflex areas had similar somatotopic arrangements in human skin. The bigger the axon reflex area was the stronger the QSART response was. This indicates that the size of the innervation territories of Sudomotor fibres covaries with the amount of local sweat production. The latter is a surrogate for increased sweat gland density or capacity in skin areas of dense Sudomotor innervation.
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Somatotopic arrangement of Sudomotor axon reflex sweating in humans.
Autonomic Neuroscience: Basic and Clinical, 2005Co-Authors: Tanja Schlereth, Nadine Brosda, Frank BirkleinAbstract:Abstract Background Impaired sweating may be one of the first symptoms in neuropathies, and therefore the evaluation of sweating might facilitate their early detection. Sudomotor axon reflexes can be quantified by two different methods: quantitative Sudomotor axon reflex testing (QSART) measures the amount of local sweating, whereas staining with the iodine starch reaction assesses the extension of the Sudomotor axon reflex area. The aim of our study was to compare both tests at three different sites on the leg: foot, lower leg and thigh. Methods QSART and iodine starch staining after iontophoretic stimulation with acetylcholine were performed on 15 male volunteers (mean age: 25; range 24–27 years) on the left resp. the right leg during a single session. Results QSART response, measured as area under the curve (AUC), was maximal at the lower leg (911 AUC), smaller at the dorsum of the foot (585 AUC) and even smaller at the thigh (480 AUC). The difference between lower leg and thigh was significant (p Conclusions QSART and Sudomotor axon reflex areas had similar somatotopic arrangements in human skin. The bigger the axon reflex area was the stronger the QSART response was. This indicates that the size of the innervation territories of Sudomotor fibres covaries with the amount of local sweat production. The latter is a surrogate for increased sweat gland density or capacity in skin areas of dense Sudomotor innervation.
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Spreading of Sudomotor axon reflexes in human skin.
Neurology, 2005Co-Authors: Tanja Schlereth, Nadine Brosda, Frank BirkleinAbstract:Background: Acetylcholine (ACh) activates both Sudomotor fibers and primary afferent nociceptors. This leads to Sudomotor and vasodilator axon reflexes, which can be diminished, for example, in neuropathies. In some neuropathies, however, there is increased axon reflex sweating, a response pattern that has never been observed for vasodilator flares. Objectives: To compare both types of axon reflexes and to elucidate possible differences. Methods: In healthy young male subjects, sweat response and flare reaction in response to ACh were quantified. Constant-current iontophoresis (300 mC) of ACh was performed on the lateral lower legs. The Sudomotor axon reflex was visualized with iodine starch staining, and the sweat response was quantified with capacitance hygrometry (quantitative Sudomotor axon reflex test [QSART]). The vasodilator flare was visualized and quantified by laser Doppler imaging. All measurements were performed during and for 10 minutes after finishing the iontophoresis. Results: The Sudomotor axon reflex area increased from 30.6 cm 2 at the end of the iontophoresis to 39.2 cm 2 ( p Conclusion: Despite fast cleavage of acetylcholine by cholinesterases, Sudomotor axon reflexes spread in the skin, indicating a possible peripheral amplification of sweating.
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Sudomotor function in sympathetic reflex dystrophy
Pain, 1997Co-Authors: Frank Birklein, A Spitzer, Ruth Sittl, D. Claus, Bernhard Neundörfer, Hermann-otto HandwerkerAbstract:Sudomotor functions were studied in 27 patients suffering from reflex sympathetic dystrophy (RSD) according to the criteria established by Bonica (18 women, 9 men; mean age 50±12.3 years; median duration of disease 8 weeks, range 2–468 weeks). To measure local sweating rates, two small chambers (5 cm2) were affixed to corresponding areas of hairy skin on the affected and unaffected limbs. Dry nitrogen gas was passed through the chambers (270 ml/min) and evaporation was recorded at both devices with hygrometers. Thermoregulatory sweating (TST) was induced by raising body temperature (intake of 0.5 l hot tea and infra-red irradiation). Local sweating was also induced through an axon reflex (QSART) by transcutaneous iontophoretic application of carbachol (5 min, 1 mA). In addition, skin temperature was measured on the affected and unaffected side by infra-red thermography. Mean skin temperature was significantly higher on the affected side (P<0.003). In spite of the temperature differences, there was no difference in basal sweating on the affected and unaffected side. However, both methods of Sudomotor stimulation lead to significantly greater sweating responses on the affected compared to the unaffected side (TST: P<0.05, QSART: P<0.004). Latency to onset of sweating was significantly shorter on the affected side under both test conditions (P<0.04 and P<0.003, respectively). Sweat responses were not correlated to absolute skin temperature but were probably related to the increased blood flow on the affected side. Our findings imply a differential disturbance of vasomotor and Sudomotor mechanisms in affected skin. Whereas vasoconstrictor activity is apparently lowered, Sudomotor output is either unaltered or may even be enhanced.
Fukashi Ishibashi - One of the best experts on this subject based on the ideXlab platform.
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correlation between Sudomotor function sweat gland duct size and corneal nerve fiber pathology in patients with type 2 diabetes mellitus
Journal of Diabetes Investigation, 2014Co-Authors: Fukashi Ishibashi, Rie Kojima, Asami Kawasaki, Emi Yamanaka, Aiko Kosaka, Harumi UetakeAbstract:Aims/Introduction To study the correlation between Sudomotor function, sweat gland duct size and corneal nerve fiber pathology in type 2 diabetes. Materials and Methods Sudomotor function was quantified by Neuropad test, and sweat gland duct and corneal nerve fibers were visualized by confocal microscopy in 78 patients with type 2 diabetes stratified by diabetic neuropathy and 28 control participants. Results In patients with diabetic neuropathy, Sudomotor function, as judged by the time required for complete color change of a Neuropad, was impaired compared with that of controls (P < 0.0001), thereby showing deterioration was related to the severity of diabetic neuropathy (P < 0.0001). Sweat gland ducts were smaller in patients without neuropathy than in controls (P < 0.0001), and further shrinking was seen in patients with severe diabetic neuropathy (P < 0.05). Patients without diabetic neuropathy showed reduced density and length (P < 0.001) of corneal nerve fibers and beading frequency (P < 0.0001), and increased tortuosity (P < 0.0001) compared with controls, and these changes deteriorated in patients with severe diabetic neuropathy. Sudomotor function was negatively associated with corneal nerve fibers (P < 0.002) and branches (P < 0.01), and influenced by the severity of diabetic neuropathy (P < 0.0001); sweat gland duct size correlated with serum triglycerides (P < 0.02), uric acid (P < 0.01), corneal nerve branch (P < 0.03), Sudomotor function (P < 0.03) and severity of neuropathy (P < 0.03). Conclusions Type 2 diabetic patients had Sudomotor dysfunction and smaller sweat gland ducts compared with controls. The stage of diabetic neuropathy and corneal nerve fiber pathology were independent predictors of Sudomotor dysfunction, and serum triglycerides, uric acid, corneal nerve branch, stage of diabetic neuropathy and Sudomotor function were predictors of sweat gland duct size.
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Correlation between Sudomotor function, sweat gland duct size and corneal nerve fiber pathology in patients with type 2 diabetes mellitus.
Journal of diabetes investigation, 2013Co-Authors: Fukashi Ishibashi, Rie Kojima, Asami Kawasaki, Emi Yamanaka, Aiko Kosaka, Harumi UetakeAbstract:Aims/Introduction To study the correlation between Sudomotor function, sweat gland duct size and corneal nerve fiber pathology in type 2 diabetes. Materials and Methods Sudomotor function was quantified by Neuropad test, and sweat gland duct and corneal nerve fibers were visualized by confocal microscopy in 78 patients with type 2 diabetes stratified by diabetic neuropathy and 28 control participants. Results In patients with diabetic neuropathy, Sudomotor function, as judged by the time required for complete color change of a Neuropad, was impaired compared with that of controls (P
B G Wallin - One of the best experts on this subject based on the ideXlab platform.
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Respiratory and cardiac modulation of single sympathetic vasoconstrictor and Sudomotor neurones to human skin.
The Journal of physiology, 1999Co-Authors: V G Macefield, B G WallinAbstract:1. The firing of single sympathetic neurones was recorded via tungsten microelectrodes in cutaneous fascicles of the peroneal nerve in awake humans. Studies were made of 17 vasoconstrictor neurones during cold-induced cutaneous vasoconstriction and eight Sudomotor neurones during heat-induced sweating. Oligounitary recordings were obtained from 8 cutaneous vasconstrictor and 10 Sudomotor sites. Skin blood flow was measured by laser Doppler flowmetry, and sweating by changes in skin electrical resistance within the innervation territory on the dorsum of the foot. 2. Perispike time histograms revealed respiratory modulation in 11 (65 %) vasoconstrictor and 4 (50 %) Sudomotor neurones. After correcting for estimated conduction delays, the firing probability was higher in inspiration for both classes of neurone. Measured from the oligounitary recordings, the respiratory modulation indices were 67. 7 +/- 3.9 % for vasoconstrictor and 73.5 +/- 5.7 % for Sudomotor neurones (means +/- s.e.m.). As previously found for Sudomotor neurones, cardiac rhythmicity was expressed by 7 (41 %) vasoconstrictor neurones, 5 of which showed no significant coupling to respiration. Measured from the oligounitary records, the cardiac modulation of cutaneous vasoconstrictor activity was 58.6 +/- 4.9 %, compared with 74.4 +/- 6.4 % for Sudomotor activity. 3. Both vasoconstrictor and Sudomotor neurones displayed low average firing rates (0.53 and 0.62 Hz, respectively). The percentage of cardiac intervals in which units fired was 38 % and 35 %, respectively. Moreover, when considering only those cardiac intervals when a unit fired, vasoconstrictor and Sudomotor neurones generated a single spike 66 % and 67 % of the time. Rarely were more than four spikes generated by a single neurone. 4. We conclude that human cutaneous vasoconstrictor and Sudomotor neurones share several properties: both classes contain subpopulations that are modulated by respiration and/or the cardiac cycle. The data suggest that the intensity of a multi-unit burst of vasoconstrictor or Sudomotor impulses is probably governed primarily by firing incidence and the recruitment of additional neurones, rather than by an increase in the number of spikes each unit contributes to a burst.
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Respiratory and cardiac modulation of single sympathetic vasoconstrictor and Sudomotor neurones to human skin
The Journal of Physiology, 1999Co-Authors: Vaughan G. Macefield, B G WallinAbstract:Respiratory modulation in the firing of postganglionic sympathetic neurones has been studied extensively in the anaesthetized cat and rat. In the cat, single muscle vasoconstrictor neurones fire during inspiration, whereas most cutaneous vasoconstrictor neurones show no modulation and Sudomotor neurones discharge primarily in expiration (Boczek-Funcke et al. 1992a, b). In the rat, on the other hand, muscle and cutaneous vasoconstrictor neurones fire only during expiration (Habler et al. 1993, 1994, 1996; Johnson & Gilbey, 1996). However, Johnson & Gilbey (1996) recently showed that while the firing of some cutaneous vasoconstrictor neurones displayed respiratory rhythmicity, the discharge of others was independent of the central or peripheral respiratory rhythm. No evidence of cardiac rhythmicity was reported. In humans, single postganglionic muscle vasoconstrictor neurones fire with a respiratory rhythm, in addition to the dominant cardiac rhythm (Macefield et al. 1994). Furthermore, the respiratory periodicity is independent of the associated changes in blood pressure, so it cannot be explained by baroreceptor influences (Macefield & Wallin, 1995). A subpopulation of single human Sudomotor neurones also express a cardiac rhythmicity, albeit weak, but it is unknown whether they are modulated by respiration (Macefield & Wallin, 1996). In the present study we continued our assessment of the firing properties of single sympathetic neurones in awake humans, by recording from single vasoconstrictor fibres innervating blood vessels in the skin on the dorsum of the foot. While multi-unit bursts of sympathetic activity in human cutaneous nerve fascicles often contain both vasoconstrictor and Sudomotor (and in some instances vasodilator or pilomotor) impulses, it is known that exposing subjects to a cold or a warm environment can bias the sympathetic outflow towards essentially ‘pure’ vasoconstrictor or Sudomotor neural traffic, respectively (Bini et al. 1980a, b). In the present study, vasoconstrictor activity was induced by whole-body cooling and external arousal stimuli that could lead to coactivation of Sudomotor neurones were minimized. While multi-unit skin sympathetic activity may display a respiratory rhythm (Delius et al. 1972b; Hagbarth et al. 1972; Bini et al. 1980B), it is unknown whether each class of cutaneous sympathetic neurones expresses respiratory modulation. The primary purpose of the present investigation was to determine whether single cutaneous vasoconstrictor neurones exhibit respiratory and/or cardiac rhythmicity. Furthermore, we have reanalysed our recordings from single Sudomotor neurones to assess whether these neurones fire with a respiratory periodicity.
