39 Silicone impressions Prone to artifacts Suboptimal quality of dental molds76 Time consuming No temporal resolution It cannot discriminate between neurogenic and gland-related impairment Not standardized Challenging skin and environment preparation153 Level 4 Quantitative Direct and Indirect Test of sudomotor function (QDIRT) Staff needs to be trained If the dye on a skin area is already colorchanged, it cannot be quantified Low inter-individual comparability due to lack of predefined skin areas Indirect areas may lack indicator dye Not yet validated153 Level 4 Sympathetic Skin Response (SSR) Low inter-individual comparability It declines with age and may be absent in subject older than 50 years It is a surrogate measure of sudomotor function, patients with congenital absence of sweat will still have an SSR response76 Level 1154 Sudoscan/EZSCAN Normative values used in studies are inconsistent Insufficient evidence supports the claim that sudoscan tests sudomotor or sensory nerve fiber function Many studies are manufacturer-supported155 Level 177 Laser Doppler Imaging flare (LDIflare) The original method is time consuming (30-90 min), which limits routine clinical use A modified method is proposed to be less time consuming (<30 min)156, but is not yet widely applied by other research groups157 Level 4 Neuropad Data on diagnostic value differ 132,158,159 Manufacturer’s instructions, might be suboptimal Limited data available on skin temperature influences159 Level 1 Water Induced Skin Wrinkling (WISW) No standard method to determine abnormal threshold Each laboratory should determine own agematched cut-off values for normal and abnormal wrinkling160 Level 1 Sympathetic noradrenergic tests Quantitative Pilomotor Axon-Reflex Test (QPART) Only tested in small populations No normative values Influenced by strong emotions and room temperature153 Level 4 MIBG/SPECT No standardized method available No normative values Level 2 41 2
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