Autonomic Dysfunction in Postmenopausal Women with the Carpal Tunnel Syndrome
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Neurophysiology, Vol. 52, No. 3, May, 2020
Autonomic Dysfunction in Postmenopausal Women with the Carpal Tunnel Syndrome B. Cevik,1 S. Kurt,1 O. Sumbul,1 and D. Aksoy1 Received May 26, 2019 Women frequently experience rather severe autonomic symptoms during the postmenopausal period. The carpal tunnel syndrome (CTS) is also known to be accompanied by certain autonomic symptoms. We aimed to evaluate some autonomic functions in postmenopausal women suffering from CTS. In this case-control study, we performed median nerve conduction and sympathetic skin response (SSR) tests. All patients and healthy individuals were questioned about the autonomic symptoms at the hands (red or purple skin coloration, excessive sweating, and feeling cold) and also about hot flashes and night sweats. The data from 80 women with postmenopausal idiopathic CTS were compared with those from 75 post menopausal women without this syndrome. About half (47.5%) of the CTS patients had complaints of red or purple discoloration, 66.3% complained about sweating, and 12.5% complained about feeling cold in their hands, while the corresponding rates were 21.3%, 17.3% and 4.0% in the control group. There was a statistically significant difference between the control and patient groups in terms of sweating (P < 0.001) and discoloration (P = 0.034). Among postmenopausal vasomotor symptoms, hot flashes (P < 0.001) and night sweats (P = 0.026) were significantly more frequent in patients with CTS. The latter demonstrated a higher mean SSR amplitude (P = 0.02) and longer mean SSR latency (P = 0.01). We conclude that the effects of hormonal changes (mainly reduced estrogen levels) on autonomic functions are noticeably aggravated by the respective autonomic effects in CTS patients.
Keywords: autonomic dysfunction, carpal tunnel syndrome, menopause, postmenopausal women, sympathetic skin response
INTRODUCTION Carpal tunnel syndrome (CTS) is a rather common peripheral nerve entrapment neuropathy. Median sensory and motor nerve conduction studies (NCSs) produce valid and reproducible clinical laboratory findings that confirm a clinical diagnosis of CTS with a high degree of reliability and specificity [1]. Autonomic nerve fibers are a significant component in the peripheral nerve [2]. However, only the function of the myelinated fibers (fast-conducting ones) can be examined by NCS; responses of the unmyelinated fibers, such as C afferents and postganglionic sympathetic fibers, almost always cannot be detected using such approach [1–3]. A sympathetic skin response (SSR), the longlatency electrical response obtained from the skin surface by stimulation of a peripheral nerve, is Department of Neurology, Tokat Gaziosmanpasa University Faculty of Medicine, Tokat, Turkey. Correspondence should be addressed to B. Cevik (e-mail: [email protected]). 1
considered an index characterizing the peripheral autonomic nerve fiber function. The SSR is reduced or absent in systemic neuropathies and dysautonomic syndromes [3]. Considering that women rather frequently e
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