Innovative treatment option for excessive sweating

An estimated 3 percent of the world population, or about 197 million people suffer from some form of hyperhidrosis (excessive sweating), many of whom do not receive proper diagnosis or treatment.

Hyperhidrosis is a medical condition in which the body sweats three to four times the normal amount. This can lead to undue embarrassment, social and psychological problems, and in the most severe cases, impede normal day-to-day functions. The exact cause of hyperhidrosis is unknown, but researchers have linked it to over activity of the nerves that send signals to the sweat glands in the skin.

This condition typically affects any of the following areas: the palms (palmar hyperhidrosis), the underarms (axillary hyperhidrosis), the face (facial hyperhidrosis), or the feet (plantar hyperhidrosis). Treatment for hyperhidrosis depends on the area of the body affected, but in general consists of the following options: topical and oral medications, iontophoresis, botulinum toxin (Botox) injections, and when these nonsurgical options have proven ineffective – surgery.

Researchers at Barrow Neurological Institute in Phoenix analyzed the outcome of 300 consecutive patients undergoing bilateral sympathectomy for hyperhidrosis between May 1996 and April 2005. One hundred and twenty-nine patients presented with palmar hyperhidrosis, 11 with axillary hyperhidrosis, and 160 with both axillary and palmar hyperhidrosis. The mean age of patients was 27.9. Average follow-up was 10.3 months (range 0.5-36) and obtained either in the clinic, by phone or by written questionnaire.

The results of this study, Biportal Thoracoscopic Sympathectomy for Hyperhidrosis: Experience with 300 Patients, will be presented by Gregory Lekovic, MD, PhD, JD, 5:00 to 5:10 p.m. on Tuesday, April 17, 2007, during the 75th Annual Meeting of the American Association of Neurological Surgeons in Washington, D.C. Co-authors are Scott Wait, MD, Kathy J. Kenny, RN, MS, and Curtis A. Dickman, MD.

Advances in technology now enable sympathectomy surgery to be performed thorascopically, using a minimally invasive procedure in which a tiny fiberoptic camera and small surgical instruments are inserted through three small incisions (usually less than half an inch). The nerves that cause the excessive sweating are identified by the camera and then cut. After one side is completed, the identical procedure is performed on the opposite side. In the 300 patients in this research study, the following outcomes were noted:

• Complete resolution of palmar and axillary hyperhidrosis was seen in 99.3 percent and 61 percent of patients, respectively.
• Serious intraoperative complications included two arrythmias (asystole requiring cardioversion in one patient, bradycardia that resolved without treatment or sequelae in one patient) and postoperative depression in one patient.
• Nine patients had postoperative pneumothorax (accumulation of air or gas in the pleural cavity), of which five required chest tube drainage.
• An additional four patients required prophylactic chest tube drainage due to pleural adhesions.
• Severe compensatory hyperhidrosis affected 16 patients. Compensatory hyperhidrosis is typically the most common side effect following surgery. Although patients may no longer sweat excessively in their hands, underarms and/or feet, they often will sweat more in another part of the body, such as the chest, back or legs.
• Seven patients developed Horner's syndrome. Horner's syndrome results from inadvertent damage to nerves above those that were cut. This can result in decreased facial sweating, drooping of the eyelid and decreased pupil size on the same side of the body where the nerves were inadvertently injured. Sometimes these symptoms are reversible over a period of weeks to months, but in other cases, may be permanent.
• Six patients were affected by intercostal neuralgia, which is pain caused by damage to the nerves located between the ribs.

“Thoracoscopic sympathectomy is an effective and low-morbidity treatment for patients suffering from severe palmar and axillary hyperhidrosis, in particular when other treatment options have not alleviated the symptoms,” said Dr. Lekovic.

Founded in 1931 as the Harvey Cushing Society, the American Association of Neurological Surgeons (AANS) is a scientific and educational association with more than 6,800 members worldwide. The AANS is dedicated to advancing the specialty of neurological surgery in order to provide the highest quality of neurosurgical care to the public. All active members of the AANS are certified by the American Board of Neurological Surgery, the Royal College of Physicians and Surgeons (Neurosurgery) of Canada or the Mexican Council of Neurological Surgery, AC. Neurological surgery is the medical specialty concerned with the prevention, diagnosis, treatment and rehabilitation of disorders that affect the entire nervous system, including the spinal column, spinal cord, brain and peripheral nerves.