Diagnostic utility of Sudoscan for detecting Bortezomib-induced painful neuropathy

Objective: Bortezomib is a first-line drug in therapy of multiple myeloma. The onset of peripheral neuropathy is a dose limiting collateral effect of the drug. This neuropathy is a distal symmetric small fiber neuropathy. Nerve conduction study can be used for the diagnosis of bortezomib neuropathy, but this technique can only demonstrate alterations of the large fiber nerves. Sudoscan is a novel technique utilized to offer an evaluation of sudomotor function. The main objective of this study was to compare the sensitivity and diagnostic specificity of Sudoscan with respect the electromyographic examination after bortezomib treatment. Methods: Patients were analyzed at baseline and after six months of treatment with Bortezomib. Subjects were submitted to electromyography and electrochemical skin conductance evaluation with the Sudoscan device. Patients were also submitted to a clinical measure of pain and neuropathy. Results: Our results suggest that Sudoscan is a trustworthy option when evaluating MM patients for the diagnosis of small fiber neuropathy. It is objective, reproducible, and surely easier than the traditional electromyographic technique. Conclusion: Sudoscan may be a useful help to manage the therapeutic interventions in MM. Significance: This study is the first to assess sudomotor dysfunction in patients with multiple myeloma using a Sudoscan.