Attempted reversible sympathetic ganglion block by an implantable neurostimulator.
OBJECTIVE
Primary palmar hyperhidrosis is a pathological condition of excessive perspiration of the hands of unknown aetiology. The only effective treatment for permanent cure is the ablation of the sympathetic ganglia supplying the hands. One of the sequelae is compensatory sweating, namely increased perspiration in other parts of the body. Its mechanism is unknown. In a small proportion of patients, it may attend devastating proportions. It has practically no remedy, and the degree of compensatory hyperhidrosis is unpredictable prior to sympathectomy. The purpose of the present study was to obtain a reversible sympathetic block which may disclose subjects prone to develop severe compensatory hyperhidrosis and unfit for permanent ganglionic ablation.


METHODS
In three dogs, an experimental electrode was implanted via a left thoracotomy on the stellate ganglion, connected to a stimulator. The stimulation was activated after recovery. The contralateral ganglion served as control. Effect of the stimulation was assessed by observing the development of Horner's syndrome, which includes the appearance of miosis, ptosis and enophthalmus. Reversal of the sympathetic block was expected when the neurostimulation was discontinued and assessed by the disappearance of these signs.


RESULTS
Stimulation produced only a partial effect - an incomplete Horner's syndrome (miosis and sometime ptosis), which was not completely reversible after ceasing the stimulation.


CONCLUSIONS
Although neurostimulation achieved a partial sympathetic block, the present method failed to obtain a completely reversible effect. However, these results may indicate that different nervous pathways moderate the various components of the Horner's triad. Concerning the creation of a reversible sympathectomy; other approaches must be sought after.
Department of Surgery B,  Haemek Medical Center, Afula,  Israel.
Doron
D
Kopelman
Mario G
MG
Costa
Jacob
J
Bejar
Asaph
A
Zaretsky
Moshe
M
Hashmonai
D000818:Animals; D001340:Autonomic Nerve Block / Q000009:adverse effects / Q000295:instrumentation*; D004285:Dogs; D004599:Electric Stimulation Therapy / Q000009:adverse effects / Q000295:instrumentation*; D006732:Horner Syndrome / Q000209:etiology / Q000503:physiopathology; D006945:Hyperhidrosis / Q000503:physiopathology / Q000628:therapy*; D058542:Implantable Neurostimulators; D008422:Materials Testing; D020127:Recovery of Function; D013233:Stellate Ganglion / Q000503:physiopathology*; D013546:Sweating; D013997:Time Factors