Related Experiment Video
Updated: Aug 5, 2026
Transauricular Vagus Nerve Stimulation and Electroencephalographic Assessment in Disorders of Consciousness
Published on: July 11, 2025
Value of Sympathetic Skin Response for Identifying Paroxysmal Sympathetic Hyperactivity in Patients with Prolonged
Juanjuan Fu1,2, Yongli Wu2, Lizhi Liu2
1Department of Rehabilitation Medicine, Zhongda Hospital, Southeast University, Nanjing, 210000, China.
Objective:
This study aimed to explore the value of sympathetic skin response (SSR) for identifying paroxysmal sympathetic hyperactivity (PSH) in patients with prolonged disorders of consciousness (PDOC).
Methods:
This retrospective observational study included 124 consecutive patients with PDOC from March 2022 to March 2024. On the basis of the PSH Assessment Method (PSH-AM), the patients were classified into the PSH-positive (PSH + , n = 43) and PSH-negative (PSH - , n = 81) groups. Among them, 75 patients (PSH - , n = 44; PSH + , n = 31) with elicitable SSR were included in the final analysis.
Results:
There were no significant differences between groups in the SSR elicitation rate (P = 0.08) or in SSR latency (P > 0.05). By contrast, both SSR amplitude and SSR amplitude difference were significantly elevated in the PSH + group compared with the PSH- group (P < 0.001). In patients with elicitable SSR (n = 75), multivariable logistic regression analysis including age, CRS-R score, right SSR amplitude, left SSR amplitude, and SSR amplitude difference simultaneously (with no significant multicollinearity) demonstrated that only the SSR amplitude difference was independently associated with PSH (OR per 0.1 mV = 2.08; 95% CI: 1.49-3.45, P = 0.004). ROC analysis showed that the SSR amplitude difference had excellent diagnostic accuracy (AUC = 0.96; 95% CI: 0.93-0.998). The sensitivity analysis, including 124 patients (with absent SSR coded as 0 mV), indicated that age (OR = 0.96; 95% CI: 0.92-0.999, P = 0.05), CRS-R score (OR = 0.77; 95% CI: 0.65-0.89, P = 0.001), and SSR amplitude difference (OR per 0.1 mV = 1.47; 95% CI: 1.22-1.86, P < 0.001) were independently associated with PSH. ROC analysis demonstrated that the SSR amplitude difference alone had good diagnostic accuracy (AUC = 0.77; 95% CI: 0.666-0.875), and the combination of age, CRS-R score, and SSR amplitude difference achieved the highest diagnostic accuracy (AUC = 0.888; 95% CI: 0.826-0.951).
Conclusions:
The SSR amplitude difference is independently associated with PSH in patients with PDOC and demonstrates high diagnostic accuracy, both alone and in combination with age and CRS-R score. It may serve as a valuable, noninvasive electrophysiological marker to aid in identifying PSH in this patient population.
