PA Research Foundation and its supporters have helped bring a potentially life changing piece of machinery for patients with Amyloidosis to the Queensland Amyloidosis Centre at the PA Hospital.
The only piece of equipment of its kind in Queensland, the Sudoscan machine can help improve quality of life through earlier detection of neuropathy in patients with Amyloidosis.
Sudoscan is a non-invasive test and simply requires patients to place their hands and feet on steel electrodes where their sweat glands are analysed so a reading of their electrochemical skin conductance can be measured. The results are automated and available within minutes. It requires no patient preparation.
Small fibre neuropathy occurs very early in the process and affects the autonomic nervous system that regulates critical bodily functions like heart rate, blood pressure, gut movement, respiration, sweating, tearing and sexual function. Sudomotor (sweat) dysfunction can be one of the earliest detectable abnormalities in distal small fiber nerve dysfunction. Quantitative assessment of sweat response has been proposed as an index of the severity of autonomic failure as well as an early indicator for regeneration of small fibres.
Measuring the function of these glands has traditionally involved very tedious testing like Quantitative Sudomotor Axon Reflex Test (QSART). This testing involves expensive equipment, is not widely available, is complex and time consuming with extensive patient preparation and its reporting is quite subjective. Resultantly, assessment of autonomic dysfunction has largely relied on bedside crude measures like lying standing BP recording which, while helpful, is affected quite late in the piece. It cannot be reliably used in early detection of involvement of this important part of the nervous system where employing newly available treatments can prove to be life changing.
Dr Nabeel Sheikh, one of the main clinicians who helped bring the Sudoscan to the PA Hospital, said the machine is a great tool in preserving quality of life.
“The Sudoscan has now been recommended as a tool to regularly monitor patients, every six to 12 months,” he said.
“You're not talking about patients who have advanced disease. It’s more for patients who actually have a milder disease whom if you check their nerves with a conventional nerve conduction study, that only measures large fibers, it would be normal. So, with the conventional study you could miss a huge proportion of patients who have begun to develop a decay of their nerves.”
“If treated timely, these would be the people who have a lot more at stake. They've not missed the boat and they can benefit from therapy. It’s especially more relevant now, in 2024, because more therapies have become available.”
“In particular, one of the gene therapies has just been listed on the Pharmaceutical Benefits Scheme. This will change the course of disease for a lot of patients.”
Dr Sheikh believes the Sudoscan will be a game changer for patients in identifying signs of neuropathy early so that treatments can be instituted early.
“When patients develop neuropathy to the degree that it starts affecting the autonomic functions and causing pain, the deficits are mostly there to stay,” he said.
“But particularly where the actual nerve fiber gets affected, then there may be no going back and the lost nerve tissue does not recover. You can prevent or you can retard progression, but there's no rolling back.”
“If someone’s developed disbalance and autonomic neuropathy related problems such as erectile dysfunction, postural hypotension, constipation, or gastric dysmotility, they are going suffer from those problems and we may not be able to reverse a lot of it. It is here that we could make the most difference.”
“The Sudoscan is more relevant and important, because it helps us detect and monitor those people who have not yet developed a full-blown complete irreversible stage of neuropathy.”
“The equipment itself costs around $30,000, but the full autonomic function test lab set up would be much more than that, not all of neurologists would have the expertise to interpret those tests and not all of our scientists would be trained to perform those tests,” Dr Sheikh said.
More than just a piece of equipment that will help maintain quality of life for thousands of patients going forward, the machine will also save the health system potentially hundreds of thousands of dollars.
You can help make equipment like the Sudoscan possible by choosing the PA as your place to give here.
