Abstract
The prevalence of annoying hyperhidrosis (HH) in patients with spinal cord traumatic lesions was investigated by a questionnaire. A total of 192 patients were sent the questionnaire, 154 patients answered, and 41 patients reported annoying sweating. Of these 41 patients, 13 had a somatic underlying cause and 28 indicated having annoying HH without a contributing somatic cause.
Twenty-five patients with spinal cord injury (SCI) were included in a double-blind, randomized, placebo-controlled, crossover trial using dextropropoxyphene hydrochloride (DP) in a slow release form (Abalgin Retard® 150 mg Benzon Pharma A/S, Copenhagen) twice a day, for the treatment of annoying HH. Nineteen patients with lesions between C4 and L4 completed the study. Eight found the active drug to be so effective that they wanted to continue the treatment while 3 preferred placebo. Six patients dropped out, 5 due to adverse effects. There was a trend towards an effect on sweating in daytime (p = 0.08–0.14). Given that the patients had a preference, which 15 of 19 had, the true frequency of patients preferring active treatment ranged from 32 to 84% (95% exact confidence limits). For those with SCI above T6 level the limits ranged from 40 to 97%.
We conclude that in spite of the lack of statistically significant effect, it seems worthwhile to try DP for annoying HH, especially in patients with lesions above T6 level.
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Guttmann L (1973) Spinal Cord Injuries. Comprehensive Management and Research. Blackwell, Oxford: 271–343.
Tashjian E A, Richter K J (1985) The value of propoxyphene hydrochloride (Darvon®) for the treatment of hyperhidrosis in the spinal cord injured patient. An anecdotal experience and case reports. Paraplegia 23: 349–353.
Kayaalp S O, Mclsaac R J (1970) Differential blockade and potentiation of transmission in a sympathetic ganglion. J Pharmacol Exp Ther 137: 193–204.
Zelis R, Mansour E J, Capone R J, Mason D T (1974) The cardiovascular effects of morphine. J Clin Invest 54: 1247–1258.
Prescott R J (1981) The comparison of success rates in cross-over trials in the presence of an order effect. J R Stat Soc (Series C), Appl Stat 30(1): 9–19.
Kewalramani L S (1980) Autonomic dysreflexia in traumatic myelopathy. Am J Phys Med 59(1): 1–21.
Fast A (1977) Reflex sweating in patients with spinal cord injury: a review. Arch Phys Med Rehabil 10: 435–437.
Guttmann L, Whitteridge D (1947) Effects of bladder distension on autonomie mechanisms after spinal cord injuries. Brain 70: 361–404.
Yasuda K, Ito H, Hama T (1978) Management of autonomie hyperreflexia of high spinal cord lesions in acute and recovery stage. Nippon Hinyokiko Gakkai Zasshi 69(12): 1543–1551.
Johnson R H (1974) Sweating. Contemp Neurol (series 11): 179–198.
Guttmann L (1940) Topographic studies of disturbances of sweat secretion after complete lesion of peripheral nerves. J Neurol Psychiatry 3: 197–210.
Johnson R H (1971) Temperature regulation in paraplegia. Paraplegia 9: 135–145.
Normell L A (1974) Distribution of impaired cutaneous vasomotor and sudomotor function in paraplegic man. Scand Clin Lab Invest 33(suppl 138): 25–41.
Head H, Riddoch G (1917) The autonomie bladder, excessive sweating, and some other reflex conditions, in gross injuries of the spinal cord. Brain 40: 188–263.
Johnson B, Pallares V, Thomason R, Sadove M S (1975) Autonomie hyperreflexia: a review. Mil Med 140: 345–49.
Kneisley L W (1977) Hyperhidrosis in paraplegia. Arch Neurol 34: 536–539.
List C F, Pimenta A D (1944) Sweat secretion in man. Arch Neurol Psychiatry 51(6): 501–507.
Leivy D M (1968) Failure of lumbar sympathectomy in the relief of hyperhidrosis. J Neurosurg 29(1): 65–69.
Bors E, French J D (1952) Management of paroxysmal hypertension following injuries to cervical and thoracic segments of spinal cord. Arch Surg 64: 803–12.
Kurnick N B (1956) Autonomie hyperreflexia and its control in patients with spinal cord lesions. Ann Intern Med 44: 678–86.
Scheibert C D (1955) Studies on the sacral reflex arc in paraplegia. J Neurosurg 12: 468–474.
Allen J A, Roddie I C (1972) The role of circulating catecholamines in sweat production in man. J Physiol 227: 801–814.
Huckaba C, Frewin D B, Downey J A, Tarn H S, Darling R C, Cheh H Y (1976) Sweating responses of normal, paraplegic and anhidrotic subjects. Arch Phys Med Rehabil 57: 268–274.
Downey J A, Huckaba C E, Kelley P S, Tarn H S, Darling R C, Cheh H Y (1976) Sweating responses to central and peripheral heating in spinal man. J Appl Physiol 40(5): 701–706.
Stanworth P A (1982) The significance of hyperhidrosis in patients with post-traumatic syringomyelia. Paraplegia 20: 282–287.
Khurana R K 1987 Orthostatic hypotension-induced autonomic dysreflexia. Neurology 37: 1221–1224.
Ottomo M, Heimburger R F (1980) Alternating Horners syndrome and hyperhidrosis due to durai adhesions following cervical spinal cord injury. J Neurosurg 53(1): 97–100.
Shessel F S, Carrion H M, Politano V A (1978) Phenoxybenzamine and sweating in the spinal cord injury patients. J Urol 120(1): 60–61.
Staas W E, Nemunaitis G (1989) Management of reflex sweating in spinal cord injured patients. Arch Phys Med Rehabil 70: 544–546.
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Andersen, L., Biering-Sørensen, F., Müller, P. et al. The prevalence of hyperhidrosis in patients with spinal cord injuries and an evaluation of the effect of dextropropoxyphene hydrochloride in therapy. Spinal Cord 30, 184–191 (1992). https://doi.org/10.1038/sc.1992.53
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DOI: https://doi.org/10.1038/sc.1992.53