Recordings of pre- and postoperative sympathetic skin response in patients with palmar hyperhidrosis

Transthoracic endoscopic sympathectomy is an accepted standard surgical treatment for hyperhidrosis palmaris. During the past 4 years, more than 500 patients underwent this kind of surgical treatment at our institution with a 98% success rate. About 50% of cases were found to have compensatory sweating. We measured the sympathetic skin response (SSR) and R-R interval variation (RRIV) in 38 normal control subjects, and 50 consecutive patients with palmar hyperhidrosis before and 2 weeks after transthoracic endoscopic T2-3 sympathectomy. Before sympathectomy SSR was absent in 36% of patients on deep inspiratory stimulation and in 20% on electrical stimulation. After T2-3 sympathectomy, SSR in the palms was absent in 64% of patients with deep inspiration stimulation and in 76% on electrical stimulation. A decrease in the SSR amplitude in the soles was found in 40% on deep inspiration and in 54% of patients on electrical stimulation. RRIV was not significantly influenced 2 weeks after sympathectomy. The high abnormal rate of SSR in the patient group indicated that an abnormal regulation of the sudomotor control center played an important role in palmar hyperhidrosis.