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Heldestad Lilliesköld, Victoria
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Publikasjoner (7 av 7) Visa alla publikasjoner
Heldestad Lilliesköld, V. & Nordh, E. (2018). Method-of-limits: Cold and warm perception thresholds at proximal and distal body regions. Clinical neurophysiology practice, 3, 134-140
Åpne denne publikasjonen i ny fane eller vindu >>Method-of-limits: Cold and warm perception thresholds at proximal and distal body regions
2018 (engelsk)Inngår i: Clinical neurophysiology practice, ISSN 2467-981X, Vol. 3, s. 134-140Artikkel i tidsskrift (Fagfellevurdert) Published
Abstract [en]

Objective: Thermal quantitative sensory testing with the 'Method-of-Limits' is an established rationale for detection of small nerve fiber dysfunction, but adequate reference values are crucial for such evaluations, regardless of the underlying cause. This study assessed reference data for cold- (CPT) and warm- (WPT) perception thresholds at both proximal and distal sites in eight body regions of the lower and upper extremities, all determined within the same test session for each subject.

Methods: Seventy-five healthy subjects (aged 16-72 years) were tested according to the method-of-limit for CPT and WPT at the dorsum of the foot, the medial and lateral lower leg, the ventral thigh, the thenar eminence, the radial and ulnar part of the lower arm, and the anterior deltoid part of the upper arm.

Results: Overall, thermal perception thresholds (TPT) varied with test location, but were higher in the lower than in the upper part of the body, also WPT were generally higher than CPT. TPT at the dorsum foot highly correlated with age, while inconsistent correlations were noted between TPT and age or height at other tested locations.

Conclusion: This study describes for the first time reference values at eight defined body regions, at both proximal and distal sites.

Significance: The report enables refined evaluations of general small nerve fiber function, as assessed by quantitative thermal sensory testing with the Method-of-Limits.

Emneord
Cold perception thresholds, Method-of-Limits, Reference data, Small nerve fiber, Warm perception thresholds
HSV kategori
Identifikatorer
urn:nbn:se:umu:diva-151908 (URN)10.1016/j.cnp.2018.06.004 (DOI)30215024 (PubMedID)2-s2.0-85050128934 (Scopus ID)
Tilgjengelig fra: 2018-09-17 Laget: 2018-09-17 Sist oppdatert: 2018-10-03bibliografisk kontrollert
Carlsson, D., Burström, L., Heldestad Lilliesköld, V., Nilsson, T., Nordh, E. & Wahlström, J. (2014). Neurosensory sequelae assessed by thermal and vibrotactile perception thresholds after local cold injury. International Journal of Circumpolar Health, 73, Article ID 23540.
Åpne denne publikasjonen i ny fane eller vindu >>Neurosensory sequelae assessed by thermal and vibrotactile perception thresholds after local cold injury
Vise andre…
2014 (engelsk)Inngår i: International Journal of Circumpolar Health, ISSN 1239-9736, E-ISSN 2242-3982, Vol. 73, artikkel-id 23540Artikkel i tidsskrift (Fagfellevurdert) Published
Abstract [en]

Background. Local freezing cold injuries are common in the north and sequelae to cold injury can persist many years. Quantitative sensory testing (QST) can be used to assess neurosensory symptoms but has previously not been used on cold injury patients.

Objective. To evaluate neurosensory sequelae after local freezing cold injury by thermal and vibrotactile perception thresholds and by symptom descriptions.

Design. Fifteen patients with a local freezing cold injury in the hands or feet, acquired during military training, were studied with QST by assessment of vibrotactile (VPT), warmth (WPT) and cold (CPT) perception thresholds 4 months post-injury. In addition, a follow-up questionnaire, focusing on neurovascular symptoms, was completed 4 months and 4 years post-injury.

Results. QST demonstrated abnormal findings in one or both affected hands for VPT in 6 patients, for WPT in 4 patients and for CPT in 1 patient. In the feet, QST was abnormal for VPT in one or both affected feet in 8 patients, for WPT in 6 patients and for CPT in 4 patients. Freezing cold injury related symptoms, e. g. pain/discomfort when exposed to cold, cold sensation and white fingers were common at 4 months and persisted 4 years after the initial injury.

Conclusions. Neurosensory sequelae after local freezing cold injury, in terms of abnormal thermal and/or vibration perception thresholds, may last at least 4 months after the initial injury. Symptoms such as pain/discomfort at cold exposure, cold sensations and white fingers may persist at least 4 years after the initial injury.

Emneord
case series, neurovascular, quantitative sensory testing, military, frostbite, Sweden
HSV kategori
Identifikatorer
urn:nbn:se:umu:diva-87184 (URN)10.3402/ijch.v73.23540 (DOI)000331885300001 ()24624368 (PubMedID)
Tilgjengelig fra: 2014-03-25 Laget: 2014-03-24 Sist oppdatert: 2019-11-25bibliografisk kontrollert
Heldestad, V., Wiklund, U., Hörnsten, R., Obayashi, K., Suhr, O. B. & Nordh, E. (2011). Comparison of quantitative sensory testing and heart rate variability in Swedish Val30Met ATTR. Amyloid: Journal of Protein Folding Disorders, 18(4), 183-190
Åpne denne publikasjonen i ny fane eller vindu >>Comparison of quantitative sensory testing and heart rate variability in Swedish Val30Met ATTR
Vise andre…
2011 (engelsk)Inngår i: Amyloid: Journal of Protein Folding Disorders, ISSN 1350-6129, E-ISSN 1744-2818, Vol. 18, nr 4, s. 183-190Artikkel i tidsskrift (Fagfellevurdert) Published
Abstract [en]

Patients with transthyretin amyloidosis (ATTR) polyneuropathy, a hereditary fatal disease, often report defects in both thermal perception and autonomic nervous system function as their first clinical symptoms. While elevated thermal perception thresholds (TPT) for cold and warmth only recently have been shown as an early marker of small nerve fiber dysfunction in these patients, heart rate variability (HRV) has frequently been used to quantify autonomic neuropathy. The main purpose with this report was to elucidate a possible relationship between estimates of HRV and TPT in a selected group of early and late-onset Swedish Val30Met ATTR patients. The results show significantly more pronounced elevation of TPT in early compared to late-onset patients. Significant correlations between HRV and TPT were found among late-onset cases, indicating a possible relationship between loss of thin nerve fibers in somatic and autonomic nerves, while generally no such relationships were found among early-onset cases. This observation emphasizes the importance of testing both HRV and TPT to ensure optimal early detection of neuropathic changes in an as wide as possible range of small nerve fibers in suspected ATTR patients. This is of particular importance as the phenotype of the ATTR disease varies between groups with different age of onset.

sted, utgiver, år, opplag, sider
Pearl River, NY: Parthenon Pub., 2011
Emneord
amyloid, cold perception thresholds, early-onset, FAP, heart rate variability, late-onset, quantitative, sensory testing, transthyretin, val30met, warm perception thresholds
HSV kategori
Identifikatorer
urn:nbn:se:umu:diva-49187 (URN)10.3109/13506129.2011.614294 (DOI)22035563 (PubMedID)
Tilgjengelig fra: 2011-11-02 Laget: 2011-11-02 Sist oppdatert: 2018-06-08bibliografisk kontrollert
Heldestad, V. (2011). Methodological aspects and usefulness of Quantitative Sensory Testing in early small fiber polyneuropathy: a clinical study in Swedish hereditary transthyretin amyloidosis patients. (Doctoral dissertation). Umeå: Umeå universitet
Åpne denne publikasjonen i ny fane eller vindu >>Methodological aspects and usefulness of Quantitative Sensory Testing in early small fiber polyneuropathy: a clinical study in Swedish hereditary transthyretin amyloidosis patients
2011 (engelsk)Doktoravhandling, med artikler (Annet vitenskapelig)
Abstract [en]

Generalised polyneuropathy (PNP) is a common cause to neurological impairment, and may be an early symptom of a severe systemic disease. One such illness is hereditary transthyretin (TTR) amyloidosis (ATTR), a progressive fatal disorder caused by a mutation on the TTR gene. More than 100 such mutations have been found worldwide, of which Val30Met is the most common neuropathic variant with initial clinical manifestations indicating small fiber impairment. Differences in onset age, penetrance and phenotypes are present between endemic areas. Liver transplantation generally slows the progress of the symptom development, especially in patients with short disease duration. Ongoing research has also shown promising results with drug interventions. In any event, early diagnosis of PNP onset in ATTR patients is crucial to ensure early therapeutic interventions. Nerve conduction studies (NCS) and electromyography (EMG) provide the basis for evaluation of the functional state of the thick myelinated nerve fibres in patients with symptoms of PNP, but no such quantitative methods are available for the thin myelinated or unmyelinated fibers. Instead, a psychophysical method with thermal quantitative sensory testing (QST) can provide indirect information about the overall function in the afferent small fiber systems. The purpose of thesis was to evaluate the applicability of QST by the Method-of-limits (MLI) for early detection of PNP in Swedish ATTR patients with the Val30Met mutation.

In healthy subjects the repeatability of the MLI was assessed, and reference values for thermal perception thresholds (TPT) in several body regions were determined. No significant differences in TPT or pain thresholds were found at repeated testing with MLI, indicating that the MLI is a reliable method. However, the results show that the arrangement of the testing order is of importance, as cold (CT) and warm (WT) perception thresholds were significantly elevated when tested after thermal pain assessments, instead of before. I general, the TPT was more elevated at lower parts of the body compared to the upper part, and with higher WT than CT, fully in accordance with the underlying anatomical and physiological prerequisites for QST. In biopsy verified ATTR patients lacking EMG and NCS abnormalities, significantly elevated TPT were found compared to controls. Furthermore, significantly more increased TPT were observed in patients with an early onset of the disease, compared those with a late onset. Finally, a combined detailed evaluation of QST and heart rate variability (HRV) analyses demonstrated correlations between QST and HRV abnormalities in patients with late onset, but not in those with early onset.

The present thesis emphasizes the importance of incorporating QST early in the clinical evaluation of ATTR patients with a Val30Met mutation and with symptoms of thin fiber PNP. This is particularly indicated when patients report symptoms, or show signs, of neuropathic small fiber affection, but simultaneously exhibit normal EMG and NCS findings. The results furthermore underline the importance of performing both QST and HRV for a complete evaluation of both the thin somatic and autonomic nerve fibers, as both types of nerves may be affected early in the ATTR disease.

sted, utgiver, år, opplag, sider
Umeå: Umeå universitet, 2011. s. 67
Serie
Umeå University medical dissertations, ISSN 0346-6612 ; 1470
Emneord
Amyloidosis, cold thresholds, heart rate variability, method-of-limits, quantitative sensory testing, transthyretine, warm thresholds
HSV kategori
Forskningsprogram
klinisk neurofysiologi
Identifikatorer
urn:nbn:se:umu:diva-50617 (URN)978-91-7459-320-4 (ISBN)
Disputas
2012-01-13, Sal B (Rosa salen), by 1D, 9 tr, Norrlands Universitetssjukhus, Umeå, 09:00 (svensk)
Opponent
Veileder
Tilgjengelig fra: 2011-12-22 Laget: 2011-12-15 Sist oppdatert: 2018-06-08bibliografisk kontrollert
Heldestad, V., Linder, J., Sellersjö, L. & Nordh, E. (2010). Reproducibility and influence of test modality order on thermal perception and thermal pain thresholds in quantitative sensory testing. Clinical Neurophysiology, 121(11), 1878-1885
Åpne denne publikasjonen i ny fane eller vindu >>Reproducibility and influence of test modality order on thermal perception and thermal pain thresholds in quantitative sensory testing
2010 (engelsk)Inngår i: Clinical Neurophysiology, ISSN 1388-2457, E-ISSN 1872-8952, Vol. 121, nr 11, s. 1878-1885Artikkel i tidsskrift (Fagfellevurdert) Published
Abstract [en]

The findings show that QST with the MLI is a reliable tool for indirect evaluation of human small nerve fiber function.

Emneord
Method of limits; Quantitative sensory testing; Reproducibility; Thermal pain thresholds; Thermal perception thresholds
HSV kategori
Identifikatorer
urn:nbn:se:umu:diva-42326 (URN)10.1016/j.clinph.2010.03.055 (DOI)000282158200012 ()20478739 (PubMedID)
Tilgjengelig fra: 2011-04-07 Laget: 2011-04-07 Sist oppdatert: 2018-06-08bibliografisk kontrollert
Heldestad, V. & Nordh, E. (2007). Quantified sensory abnormalities in early genetically verified transthyretin amyloid polyneuropathy. Muscle and Nerve, 35(2), 189-195
Åpne denne publikasjonen i ny fane eller vindu >>Quantified sensory abnormalities in early genetically verified transthyretin amyloid polyneuropathy
2007 (engelsk)Inngår i: Muscle and Nerve, ISSN 0148-639X, E-ISSN 1097-4598, Vol. 35, nr 2, s. 189-195Artikkel i tidsskrift (Fagfellevurdert) Published
Emneord
Adult, Age Factors, Amyloid Neuropathies/*complications/genetics, Female, Humans, Male, Methionine/genetics, Peripheral Nerves/*physiopathology, Prealbumin/genetics, Sensory Thresholds/*physiology, Somatosensory Disorders/*etiology/genetics, Temperature, Valine/genetics
HSV kategori
Identifikatorer
urn:nbn:se:umu:diva-10680 (URN)10.1002/mus.20689 (DOI)17094098 (PubMedID)
Tilgjengelig fra: 2008-10-17 Laget: 2008-10-17 Sist oppdatert: 2018-06-09bibliografisk kontrollert
Heldestad, V. & Nordh, E.Thermal perception thresholds: reference data and response characteristics.
Åpne denne publikasjonen i ny fane eller vindu >>Thermal perception thresholds: reference data and response characteristics
(engelsk)Manuskript (preprint) (Annet vitenskapelig)
Abstract [en]

Objective: To establish reference data for separate cold and warm perception thresholds at quantitative sensory testing with the method-of-limits at eight different body regions, and to evaluate the psychophysical response characteristics to consecutive cold and warm stimuli.

Methods: 75 healthy subjects were tested at the dorsum of the foot, the medial and lateral lower leg, the ventral thigh, the thenar eminence, the radial and ulnar part of the lower arm, and the anterior deltoid part of the upper arm. Thermal perception thresholds were assessed with the method of limits, and estimated from the average responses during ten consecutive cold and warm stimuli.

Results: At all tested sites, the TPT were significantly higher in the lower part of the body compared to the upper, and also the warm thresholds were significantly higher than the cold thresholds. Inconsistent correlations were noted between thermal perception thresholds and age or height, but thresholds at the dorsal foot were highly correlated with age.

Conclusions: Reference data from separate body regions in the lower and upper extremities are essential for adequate evaluation of thermal detection and perception capacity. At testing of thermal thresholds in individual subjects the thermal perception generally decreases distally in elderly and particularly in the lower extremities.

Emneord
Cold perception thresholds, Method of limits, Reference data, Stimuli response characteristics, Warm perception thresholds
HSV kategori
Forskningsprogram
klinisk neurofysiologi
Identifikatorer
urn:nbn:se:umu:diva-50586 (URN)
Tilgjengelig fra: 2011-12-14 Laget: 2011-12-14 Sist oppdatert: 2018-06-08bibliografisk kontrollert
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