"return of sweating in the hands is common occurrence in patients followed up for sufficient length of time"

Annals of the Royal College of Surgeons of England (1989) vol. 7.1

significant number of primary hyperhidrosis patients (more than 70%) were so pleased with the results that they decided to forgo the surgery

At the beginning of our study, thoracic sympathectomy was indicated indiscriminately to all primary hyperhidrosis patients. The authors observed a number of patients who were dissatisfied with the results obtained from this technique, particularly due to the undesirable but frequent side effect of compensatory hyperhidrosis. Hyperhidrosis is a condition that deeply affects the individual's emotional component, and many of them, despite being warned previously, are not psychologically prepared to address this new situation. The authors then included a psychologist in the study and directed the patients for routine psychological evaluations to prepare and better select them for surgery. In addition, the authors began to study a pharmacological formula to medicate these patients for the same purpose. Oxybutynin is an anticholinergic drug that has been used safely at high doses (up to 15 mg/day) to treat micturition disorders, and a side effect observed in these patients has been diminished sudoresis. Studies conducted by our group have documented the clinical benefits of a low dose of oxybutynin (10 mg/day). The authors found that a significant number of primary hyperhidrosis patients (more than 70%) were so pleased with the results that they decided to forgo the surgery [50-53].

Expert Review of Dermatology7.6 (Dec 2012): 529-538.

Neuralgia due to sympathectomy

Depending on the skill of the surgeon and difficulty encountered performing various intraoperative maneuvers, the incidence of complications following sympathectomy should be the same as that following any other extraperitoneal or extrapleural operation. However, a frequent complication following sympathectomy, and one which is apparently unrelated to operative technique, is that of postsympathectomy neuralgia.

This neuralgia is characterized by aching thigh pain after lumbar sympathectomy or aching shoulder and arm pain after cervical sympathectomy. The pain is intense in severity, sudden in onset and disappearance, and not related to any major neurologic manifestations.

Recently we have reviewed the files of the Vascular Surgical Service at the West Roxbury Veteran's Hospital and the literature on this condition. This report is a presentation of our findings.

Incidence  Pain following sympathectomy has been described as "an all too common complaint."⁸ Reports have varied in incidence from 2.1% to "practically every case."

http://archsurg.jamanetwork.com/article.aspx?articleid=560162

Cerebral sympathetic nerve activity has a major regulatory role in the cerebral circulation in REM sleep

Cassaglia PA, Griffiths RI, Walker AM. Source Ritchie Centre for Baby Health Research, Monash Institute of Medical Research, Monash University, Melbourne, Australia. 

Abstract Sympathetic nerve activity (SNA) in neurons projecting to skeletal muscle blood vessels increases during rapid-eye-movement (REM) sleep, substantially exceeding SNA of non-REM (NREM) sleep and quiet wakefulness (QW). Similar SNA increases to cerebral blood vessels may regulate the cerebral circulation in REM sleep, but this is unknown. We hypothesized that cerebral SNA increases during phasic REM sleep, constricting cerebral vessels as a protective mechanism against cerebral hyperperfusion during the large arterial pressure surges that characterize this sleep state. We tested this hypothesis using a newly developed model to continuously record SNA in the superior cervical ganglion (SCG) before, during, and after arterial pressure surges occurring during REM in spontaneously sleeping lambs. Arterial pressure (AP), intracranial pressure (ICP), cerebral blood flow (CBF), cerebral vascular resistance [CVR = (AP - ICP)/CBF], and SNA from the SCG were recorded in lambs (n = 5) undergoing spontaneous sleep-wake cycles. In REM sleep, CBF was greatest (REM > QW = NREM, P < 0.05) and CVR was least (REM < QW = NREM, P < 0.05). SNA in the SCG did not change from QW to NREM sleep but increased during tonic REM sleep, with a further increase during phasic REM sleep (phasic REM > tonic REM > QW = NREM, P < 0.05). Coherent averaging revealed that SNA increases preceded AP surges in phasic REM sleep by 12 s (P < 0.05). We report the first recordings of cerebral SNA during natural sleep-wake cycles. SNA increases markedly during tonic REM sleep, and further in phasic REM sleep. As SNA increases precede AP surges, they may serve to protect the brain against potentially damaging intravascular pressure changes or hyperperfusion in REM sleep. 

Comment in Have a safe night: intimate protection against cerebral hyperperfusion during REM sleep. [J Appl Physiol. 2009] PMID:   19150858   [PubMed - indexed for MEDLINE]  Free full text

Autonomic neuropathy in the skin following sympathectomy

In diabetics with the anhidrotic syndrome, autonomic nerve fibres were studied in skin biopsies using argentic techniques and light microscopy. The Minor test was used to differentiate normal from anhidrotic skin areas. In the anhidrotic areas, histology of the nerve fibres showed beading, spindle-shaped thickening and fragmentation adjacent to the sweat glands. These changes were similar to those observed in two patients who had previously undergone lumbar sympathectomy. No abnormalities of the sympathetic nerve endings could be found in biopsies taken from normal areas of the forearm of the same patients. We conclude that the diabetic anhidrotic syndrome, a form of diabetic autonomic neuropathy, is due to a lesion of the sympathetic nerve supply to the skin. I. Faerman1, E. Faccio3, I. Calb2, J. Razumny1, N. Franco2, A. Dominguez2 and H. A. Podestá1

Diabetologia

Volume 22, Number 2 / February, 1982