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Updated: Nov 26, 2025
Quantitative Autonomic Testing
Published on: July 19, 2011
Quantitative sensory testing predicts histological small fiber neuropathy in postural tachycardia syndrome
Sophia C I Billig1, Joana C Schauermann1, Roman Rolke1
1Department of Neurology (SCIB, JCS, AM, JBS), Department of Neuropathology (IK), Department of Palliative Care (RR), RWTH Aachen University; Research Training Group 2416 MultiSenses-MultiScales (JBS), Aachen; and Forschungszentrum Jülich GmbH (JBS), JARA-Brain Institute Molecular Neuroscience and Neuroimaging, Jülich, Germany.
Background:
Retrospective investigation of the somatosensory profile and prediction of histologic small fiber neuropathy (SFN) in postural orthostatic tachycardia syndrome (POTS) was performed using quantitative sensory testing (QST) as a standardized noninvasive test.
Methods:
In this investigation, full data sets from 30 patients (age: 34.03 ± 10.82 years, n = 6 males), including results of autonomic function testing, norepinephrine values, skin biopsy, and QST, were retrospectively analyzed. The QST data were compared with healthy controls (HCs) (age: 34.20 ± 10.5 years, n = 6 males, t test: 0.95).
Results:
The evaluation of all QST parameters in POTS compared with HCs yielded differences in all thermal parameters (cold detection threshold: p < 0.05, warm detection threshold: p < 0.001, thermal sensory limen: p < 0.001, cold pain threshold: p < 0.05, and heat pain threshold: p < 0.001) and in paradoxical heat sensations (p < 0.05). Differences in nonpainful stimuli (mechanical detection threshold: p < 0.05 and vibration detection threshold: p < 0.001) were also detected. All patients who had clinical signs of SFN in combination with impairment of small fibers in QST also had SFN on skin biopsy.
Conclusion:
These results suggest that a non-region-specific SFN in POTS compared with controls can be detected by noninvasive QST that predicts histologic small fiber pathology.
