Autonomic dysfunction in Parkinson's disease assessed by sympathetic skin response: a prospective clinical and neurophysiological trial on 50 patients

Abstract

To verify possible dysfunction of sympathetic skin activity in Parkinson's disease (PD), we studied the electrically evoked sympathetic skin responses (SSR) bilaterally at hands and feet in a group of 50 PD patients and in normal subjects. SSR was present in all patients. Nevertheless, significant differences in the latency and amplitude values were noted. In the group of patients prolongation of latency as well as the reduction of SSR amplitude correlates with age. The longer the disease the more SSR abnormalities could be found. Gender, type of clinical manifestation of PD or medication had no statistically significant effects. However, motor symptom asymmetries evaluated separately for each body side correlated well with interside asymmetries of SSR.

Suppressed sympathetic skin response in Parkinson disease

“…However, some investigators have reported prolonged SSR latencies and low amplitudes in patients with PD [20][21][22][23]33]. We also were able to demonstrate a correlation between SSR amplitudes and duration of disease, disease severity, and tremor score.…”

“…Information regarding SSRs in PD has been controversial: it has been claimed variously that SSR latencies are increased [20,21], that amplitudes are reduced [22][23], or that responses are even absent [20,24,25], and the pathophysiology causing SSR abnormalities is thought to be both disturbance of the central regulation in the reflex arch [25] and dysfunction of the postganglionic neurons [23]. It also has been suggested that the presence of abnormalities in SSR increases along with PD disease duration and functional disability [21], but there are no prospective studies on the effects of PD medication on SSR.To assess the influence of the PD process and PD medication on sympathetic sudomotor function, we measured SSRs to electric and auditory stimulations prospectively in untreated patients with PD who were randomized for treatment with levodopa/carbidopa, bromocriptine, or selegiline, and we repeated the measurements 6 months later and again after a subsequent 6-week washout period. The SSRs were correlated to the clinical findings.…”

“…The responses are mediated through a reflex arch that includes sensory afferents, central coupling, and efferent controlled output [10]. The efferent pathway consists of preganglionic and postganglionic sympathetic neurons [10,13].SSRs have proved useful not only in the assessment of autonomic dysfunction in diabetic and other peripheral neuropathies [13][14][15][16][17][18][19], but also in diseases affecting the central pathways [20][21][22][23][24][25][26][27][28]. Information regarding SSRs in PD has been controversial: it has been claimed variously that SSR latencies are increased [20,21], that amplitudes are reduced [22][23], or that responses are even absent [20,24,25], and the pathophysiology causing SSR abnormalities is thought to be both disturbance of the central regulation in the reflex arch [25] and dysfunction of the postganglionic neurons [23].…”

Evaluation of Sympathetic Skin Response and F Wave in Fibromyalgia Syndrome Patients

“…[7] A simple and reliable neurophysiologic method to evaluate the ANS is the study of the sympathetic skin response (SSR). [8,9] Using an electrical stimulation, the eccrine sweat glands of the skin are activated via a reflex loop which includes large, myelinated sensory fibers, central synapses and efferent sympathetic preand post-ganglionic nerve fibers. [9] Fibromyalgia syndrome has complex symptoms and the role of the peripheral nervous system (PNS) in these is not yet clear.…”

Aging Effects of Sympathetic Reflex Activities on Skin Nerves

“…The SSR was recorded based on methods described previously by Shahani et al [6] and Braune et al [7]. Surface electrodes were applied to the sole and dorsum of the right foot.…”