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RSNA: Sweaty Palms Come Up Dry After Percutaneous Treatment

By Peggy Peck, Managing Editor, MedPage Today

Reviewed by Robert Jasmer, MD; Assistant Professor of Medicine, University of California, San Francisco

November 30, 2005

Also covered by: Forbes

MedPage Today Action Points

* Be aware that this procedure is not currently being performed in the U.S.

* This study was published as an abstract and presented at a conference either as an oral or poster presentation. These data and conclusions should be considered to be preliminary as they have not yet been reviewed and published in a peer-reviewed publication.



Hugues Brat M.D. Hornu, Belgium

CHICAGO, Nov. 30 - Interventional radiologists in Belgium have devised a fast and highly effective cure for sweaty palms.

Using CT fluoroscopy to guide their needles, the radiologists have devised a percutaneous approach that they described as just as effective as surgical or endoscopic sympathectomy, but at just a fraction of the cost and with a complication rate approaching zero.

"The patient enters the CT with sweaty palms, we inject him, he rolls over and the sweaty palms are gone," said Hugues Brat, M.D., of Centre Hospitalier Hornu-Frameries in Hornu, Belgium, at a press conference at the Radiological Society of North America meeting here. "He is cured."

Dr. Brat will report on the new procedure Thursday at an RSNA plenary session, describing results in 50 patients ages 18 to 37. Thirty-five of the patients were women. About 3% of the population suffers from primary palmar hyperhidrosis, and in about 1% the condition is disabling.

The dripping palms are caused by a malfunction in the sympathetic nervous system. Surgical and endoscopic sympathectomy solve the problem by cutting the ganglia the sympathetic nerve junction in the chest, said Dr. Brat. "We do essentially the same thing, but instead of cutting we use an injection of phenol to kill the nerve."

After an injection of saline to widen the extrapleural space to avoid pneumothorax, a flexible needle is inserted through the patient's back at the third vertebra he said. Phenol is then injected into the sympathetic ganglia, which kills the nerve, he said.

Each patient requires two treatments -- one for each hand. The entire procedure is visualized using multi-slice CT fluoroscopy and requires only local anesthesia.

The treatment stops sweating in the palms and the underarms, he said. But in a small number of patients compensatory sweating in the chest or the feet occurs after the procedure. "For the feet, the problem can be handled with a second sympathectomy procedure, but this time the needle is inserted in the lumbar region, rather than at the third vertebra," he said.

In the study, 47 patients had immediate success, he said. Three patients were successfully treated with the second injection.

Sixteen patients had transient side-effects including minor chest pain "but those symptoms resolved within hours."

By contrast, surgical sympathectomy is associated with a number of risks including Horner's syndrome, bleeding and partial paralysis, he said.

Another minimally invasive option is injecting Botox into the palm, but Dr. Brat said those injections are painful and must be repeated every six months. "We have five-year data and we can confirm that this percutaneous treatment can cure palmar hyperhidrosis," he said. Although he only reported the results of the 50-patient series, he said "we have done more than 300 patients in Belgium."

Michael C. Soulen, M.D., a professor of radiology and surgery at the University of Pennsylvania, agreed that the results reported by Dr. Brat are impressive. "But no one in the United States is doing this procedure," he said.

Nonetheless, he said the data reported by Dr. Brat are likely to have interventional radiologists lining up for training.

Dr. Brat said he and his colleagues plan to launch a worldwide internet-based training program for the procedure within months.

Primary source: Radiological Society of North America



Interactive case: Hypercalcemia (more...)

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seeing as this needle method suggests that something can be injected on or in the T-level nerves without surgery, does this mean that they could potentialy substitute the nerve killing drug for say Botox, thus allowing a chemical block, and not killing the nerve, which may provide an in-sight to a patients reaction to a full ETS? or maybe u could just have the injections every now and then and stop if unwanted symptoms occur?

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Exactly, abacab!

High failure rate. The only good side is that at least we don't have any major cutting (if botox is used).

I mean, the whole world is just hoping and praying that Stem Cell research can advance for the HEALING of damaged nervous cells (among other types) and then we go CUTTING ours off. :roll:

I don't get it.

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