Migraine occurrence and trembling of the hands may improve.
(They also claim, that Copensatory Hyperhidorsis is) "tolerable by most patients and only 5% describe it as troublesome. Some patients say it improves with time."
http://www.handsweat.com/sideeff.html
There has been no clinical evaluation of the severity of the so called CS to this day. Surgeons who perform the surgery and profit from it claim it to be close to insignificant..that even improves with time. Other sources will state 90% of severe CS, and 25% disabling CS. Surely it can not be just a question of semantics when you have a 25% chance of being disabled after an elective surgery!
Doctors are unable to support their claims about the positive outcomes of the surgery. There has been no controlled trial to support their positive advertising, and it is left solely to the discretion of the surgeon to admit or deny the incidence and severity of the side-effects.
permanent sympathetic nerve damage and hyperthermia due to sympathectomy
"Virtual sympathectomy" secondary to repeated stellate ganglion nerve blocks leading to permanent sympathetic nerve damage and hyperthermia (heat leakage)"
www.rsdrx.com/crps_and_sympathectomy.htm
www.rsdrx.com/crps_and_sympathectomy.htm
acute response to surgical denervation and abrupt release of sympathetic tone
Intraoperative predictability of successful outcome depends on monitoring of the acute response to surgical denervation and abrupt release of sympathetic tone.
Information on the long-term physiological sequelae is emerging rapidly. Preoperatively, in addition to abnormal sudomotor control, sympathetic cardiovascular regulation may be affected mildly in severe cases of hyperhidrosis. A blunted reflex bradycardia response to parasympathomimetic maneuvers such as Valsalva maneuver or cold water face immersion, as well as an increased heart rate response
to orthostatic stress, suggests a hyperfunctioning sympathetic discharge that is reversed after ETS.25,69 Because sympathetic cardiac accelerator fibers exit the spinal cord from segments T1 to T4, ETS is believed to simulate a mild physiological !-adrenergic blockade.70 This is because the heart rate at rest and during maximal exercise is lower 6 weeks postoperatively
DIAGNOSIS AND TREATMENT OF HYPERHIDROSIS, CONCISE REVIEW FOR CLINICIANS
Mayo Clin Proc. • May 2005;80(5):657-666
Information on the long-term physiological sequelae is emerging rapidly. Preoperatively, in addition to abnormal sudomotor control, sympathetic cardiovascular regulation may be affected mildly in severe cases of hyperhidrosis. A blunted reflex bradycardia response to parasympathomimetic maneuvers such as Valsalva maneuver or cold water face immersion, as well as an increased heart rate response
to orthostatic stress, suggests a hyperfunctioning sympathetic discharge that is reversed after ETS.25,69 Because sympathetic cardiac accelerator fibers exit the spinal cord from segments T1 to T4, ETS is believed to simulate a mild physiological !-adrenergic blockade.70 This is because the heart rate at rest and during maximal exercise is lower 6 weeks postoperatively
DIAGNOSIS AND TREATMENT OF HYPERHIDROSIS, CONCISE REVIEW FOR CLINICIANS
Mayo Clin Proc. • May 2005;80(5):657-666
denervation supersensitivity of alpha receptors after sympathectomy
There is, however, considerable risk of developing a post-sympathectomy pain syndrome that may be the result of a denervation supersensitivity of alpha receptors.
www.mc.vanderbilt.edu/.../Complex%20Regional%20Pain%20Syndrome-1...
Paradoxically it has been suggested that in some cases there may be abnormal vasoconstriction rather than the expected vasodilatation after sympathectomy.
ats.ctsnetjournals.org/cgi/content/full/84/3/1025 compensatory disease may not be immediate after sympathectomy
Newer techniques include the use of clips instead of complete transsection of the nerve but reversal is not always possible as nerve destruction can be quick and compensatory disease may not be immediate.
The main complications with sympathectomy include compensatory sweating, phantom sweating, gustatory sweating, Horner syndrome, and neuralgia.
Management of Hyperhidrosis
Aamir Haider, Nowell Solish and Nicholas J. Lowe
www.sweatclinicsofcanada.com/Book.pdf
The main complications with sympathectomy include compensatory sweating, phantom sweating, gustatory sweating, Horner syndrome, and neuralgia.
Management of Hyperhidrosis
Aamir Haider, Nowell Solish and Nicholas J. Lowe
www.sweatclinicsofcanada.com/Book.pdf
This injures all the neurons at this level of the spinal cord, some of which may die, and may predispose the patient to spinal cord reorganization and severe compensatory hyperhidrosis
Sympathectomy vs sympathotomy. Sympathectomy, with use of ganglionectomy and by definition, must sever the primary axon from the neuron in the intermediolateral cell column of the spinal cord (red) before primary or collateral synapse in the T2 ganglion. This injures all the neurons at this level of the spinal cord, some of which may die, and may predispose the patient to spinal cord reorganization and severe compensatory hyperhidrosis. Sympathotomy interrupts only axons after potential T2 ganglion synapses, a less injurious effect on the neuron, and is the least destructive procedure possible with successful treatment
of palmar hyperhidrosis.
Mayo Clin Proc 2003;78:167-172. http://www.mayoclinic.org/medicalprofs/enlargeimage5096.html
of palmar hyperhidrosis.
Mayo Clin Proc 2003;78:167-172. http://www.mayoclinic.org/medicalprofs/enlargeimage5096.html
Sensory nerves impair sympathetic reinnervation and recovery of smooth muscle function
We conclude that sensory nerves limit the extent of sympathetic reinnervation and functional recovery that can occur following neonatal sympathetic denervation.
http://www.ncbi.nlm.nih.gov/pubmed/1397180
http://www.ncbi.nlm.nih.gov/pubmed/1397180
Sympathectomy alters bone architecture
These data indicate that guanethidine-induced sympathectomy caused a negative balance of bone metabolism, leading to decreased mass by regulating deposition rather than resorption during modeling and remodeling of bone.
http://www.ncbi.nlm.nih.gov/pubmed/18449939
http://www.ncbi.nlm.nih.gov/pubmed/18449939
obliteration of the cervical sympathetic peripheral innervation impairs the capability to produce an induced febrile response.
http://www.sciencedirect.com/science/article/pii/S0165572809000575
reduction in hypothalamic dopamine after sympathectomy, which leads to an increase in serum prolactin level
At this point, it is particularly interesting to recall the earlier reports of middle ear bone remodeling in the gerbil after chemical sympathectomy by guanethidine sulfate (86) or hydroxydopamine (85). Although these neurotoxins do eliminate sympathetic activity, there are, in parallel, major central consequences. In particular, both treatments reduce hypothalamic dopamine, which leads to an increase in serum prolactin levels.
http://ajpendo.physiology.org/content/293/5/E1224.full
"Again, patients admitted with any malignancy, cholecystectomy, thyroidectomy, renal disease, cardiac disease, sympathectomy, or vascular graft were eliminated as controls."
This article reviews the evidence that neuroleptics may increase the risk of breast cancer via their effects on prolactin secretion.
Paul M. Schyve; Francine Smithline; Herbert Y. Meltzer
Neuroleptic-induced Prolactin Level Elevation and Breast Cancer: An Emerging Clinical Issue
Arch Gen Psychiatry, Nov 1978; 35: 1291 - 1301.
http://ajpendo.physiology.org/content/293/5/E1224.full
"Again, patients admitted with any malignancy, cholecystectomy, thyroidectomy, renal disease, cardiac disease, sympathectomy, or vascular graft were eliminated as controls."
This article reviews the evidence that neuroleptics may increase the risk of breast cancer via their effects on prolactin secretion.
Paul M. Schyve; Francine Smithline; Herbert Y. Meltzer
Neuroleptic-induced Prolactin Level Elevation and Breast Cancer: An Emerging Clinical Issue
Arch Gen Psychiatry, Nov 1978; 35: 1291 - 1301.
Body temperature is highly correlated with plasma prolactin in thermally stressed men
(78), suggesting that normal heat defense is associated with decreased central dopamine, and
intraventricular haloperidol produces a coordinated heat-defense response (79). These reports refute a
unique or essential role for central dopamine antagonism in neuroleptic malignant syndrome hyperthermia
and provide additional evidence that state-dependent factors are important mediators of dopamine
antagonist effects.
There is substantial evidence to support the hypothesis that dysregulated sympathetic nervous system hyperactivity is responsible for most, if not all, features of neuroleptic malignant syndrome. A predisposition to more extreme sympathetic nervous system activation and/or dysfunction in response to emotional or psychological stress may constitute a trait vulnerability for neuroleptic malignant syndrome, which, when coupled with state variables such as acute psychic distress or dopamine receptor antagonism, produces the clinical syndrome of neuroleptic malignant syndrome. This hypothesis provides a more comprehensive explanation for existing clinical data than do the current alternatives.
http://ajp.psychiatryonline.org/cgi/content/full/156/2/169
(78), suggesting that normal heat defense is associated with decreased central dopamine, and
intraventricular haloperidol produces a coordinated heat-defense response (79). These reports refute a
unique or essential role for central dopamine antagonism in neuroleptic malignant syndrome hyperthermia
and provide additional evidence that state-dependent factors are important mediators of dopamine
antagonist effects.
There is substantial evidence to support the hypothesis that dysregulated sympathetic nervous system hyperactivity is responsible for most, if not all, features of neuroleptic malignant syndrome. A predisposition to more extreme sympathetic nervous system activation and/or dysfunction in response to emotional or psychological stress may constitute a trait vulnerability for neuroleptic malignant syndrome, which, when coupled with state variables such as acute psychic distress or dopamine receptor antagonism, produces the clinical syndrome of neuroleptic malignant syndrome. This hypothesis provides a more comprehensive explanation for existing clinical data than do the current alternatives.
http://ajp.psychiatryonline.org/cgi/content/full/156/2/169
dural blood flow decreased significantly in the cervical sympathectomy group
Migraine may affect the autonomic nervous system, but the mechanisms remain unclear. The sympathetic and parasympathetic nervous systems may play different roles in the attack. To explore the effect of blocking the cervical sympathetic nerve on vasodilation of the meningeal vessels, jugular vein calcitonin gene-related peptide (CGRP) and meningeal blood flow changes were measured before and after transection of the cervical sympathetic nerve by electrically stimulating the trigeminal ganglion in Sprague–Dawley (SD) rats. We found that CGRP level and meningeal blood flow increased in both the sham-operated and sympathectomized groups (p
<0.05). Compared with the sham-operated group, dural blood flow decreased significantly in the cervical sympathectomy group, but CGRP level was not significantly different between these two groups. The cervical sympathetic nerve may play an important role in the process of neurogenic dural vasodilation in rats; this effect is not entirely dependent on CGRP level.
http://www.autonomicneuroscience.com/article/S1566-0702%2811%2900026-9/abstract
<0.05). Compared with the sham-operated group, dural blood flow decreased significantly in the cervical sympathectomy group, but CGRP level was not significantly different between these two groups. The cervical sympathetic nerve may play an important role in the process of neurogenic dural vasodilation in rats; this effect is not entirely dependent on CGRP level.http://www.autonomicneuroscience.com/article/S1566-0702%2811%2900026-9/abstract
Effects of upper abdominal sympathectomy on gastric acid, serum gastrin, and catecholamines
Selective upper abdominal sympathectomy increased basal acid output in rats but was without effect on stimulated acid output, serum gastrin concentration, and gastric mucosal histidine decarboxylase activity. The sympathectomy was verified by fluorescence histochemistry and determination of tissue catecholamines. A drastic reduction in tissue noradrenaline, adrenaline, and dopamine levels occurred after sympathectomy, and fluorescence microscopy showed a complete loss of adrenergic nerve fibers. Vagotomy reduced catecholamine levels in the stomach wall by 50% but did not affect the catecholamine content in the pancreas and small bowel. Surprisingly, combined vagotomy and upper abdominal sympathectomy resulted in lower catecholamine levels than sympathectomy alone in extragastric but not in gastric tissues.
http://www.ncbi.nlm.nih.gov/pubmed/6515311
http://www.ncbi.nlm.nih.gov/pubmed/6515311
Extreme caution is called for when considering surgical sympathectomy
Surgical sympathectomy is carried out on the basis of poor quality evidence, studies without
control groups, and personal experience. Though it would appear logical (and has been
suggested) that surgical sympathectomy is indicated primarily for patients with confirmed
'sympathetic-dependent pain, other authors take the view that the treatment results are
not correlated to this. Eighteen percent of patients undergoing sympathectomy for
neuropathic pain experience compensatory hyperhidrosis and 25% experience neuropathic
complications.
Extreme caution is called for when considering surgical sympathectomy for pain control in
CRPS-I. The procedure should be conducted in the context of a trial in order to ascertain
the efficacy and potential risks.
Guideline
INITIATIVE:
Netherlands Society of Rehabilitation Specialists
Netherlands Society of Anaesthesiologists
WITH THE SUPPORT OF:
Institute for Healthcare Improvement CBO
www.cbo.nl/Downloads/341/rl_crps_eng_07.pdf
control groups, and personal experience. Though it would appear logical (and has been
suggested) that surgical sympathectomy is indicated primarily for patients with confirmed
'sympathetic-dependent pain, other authors take the view that the treatment results are
not correlated to this. Eighteen percent of patients undergoing sympathectomy for
neuropathic pain experience compensatory hyperhidrosis and 25% experience neuropathic
complications.
Extreme caution is called for when considering surgical sympathectomy for pain control in
CRPS-I. The procedure should be conducted in the context of a trial in order to ascertain
the efficacy and potential risks.
Guideline
INITIATIVE:
Netherlands Society of Rehabilitation Specialists
Netherlands Society of Anaesthesiologists
WITH THE SUPPORT OF:
Institute for Healthcare Improvement CBO
www.cbo.nl/Downloads/341/rl_crps_eng_07.pdf
Decreased tanning response after video-assisted thoracoscopic sympathectomy
http://www.ncbi.nlm.nih.gov/pubmed/18794484
Skin depigmentation: could it be a complication caused by thoracic sympathectomy?
lumbar sympathectomy results in loss of ejaculation
Sympathectomy for the long term management of such patients has been carried out (Abel et al., 1974) and success reported. Loss of ejaculation does follow sympathectomy but his is a minor problem in patients who have an already destroyed sacral cord. (p. 410)
During fever pyrogen is released from leucocytes and his agent causes the disturbed thermoregulation (Atkinson, 1960). For his response to occur, an intact efferent sympathetic system is requred because fever can be markedly reduced by bilateral sympathectomy in he cat (Pinkston, 1935). (p.193)
The autonomic nervous system: an introduction to basic and clinical concepts By Otto Appenzeller, Emilio Oribe, Elsevier Health Sciences, 1997 - Medical
During fever pyrogen is released from leucocytes and his agent causes the disturbed thermoregulation (Atkinson, 1960). For his response to occur, an intact efferent sympathetic system is requred because fever can be markedly reduced by bilateral sympathectomy in he cat (Pinkston, 1935). (p.193)
The autonomic nervous system: an introduction to basic and clinical concepts By Otto Appenzeller, Emilio Oribe, Elsevier Health Sciences, 1997 - Medical
significant change after sympathectomy: reduced sympathetic and increased vagal tone
http://www.sciencedirect.com/science/article/pii/S0167527399001011
