Large-Fiber Neuropathy in Parkinson’s Disease: Clinical, Biological, and Electroneurographic Assessment of a Romanian Cohort

Vanta, Oana Maria; Tohănean, Nicoleta; Pintea, Sebastian; Perju‐Dumbravă, Lăcrămioara

doi:10.3390/jcm8101533

Cited by 8 publications

(7 citation statements)

References 52 publications

(155 reference statements)

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“…These results are in contrast to previous studies, where an increased prevalence of large fiber neuropathy in PD has been reported, when evaluated with both NCS and clinical rating scales 16,23,24 . In those studies, neuropathy was suggested to be associated with alterations in the vitamin B12-dependent methionine cycle, mediated by chronic exposure to L-dopa and thus associated with elevated levels of p-homocysteine and s-MMA 16,23,24 . In the present study, 60% of the PD patients were taking vitamin B12 or multivitamin supplements, and the median levels of p-homocysteine and s-MMA were within normal range.…”

Section: Discussioncontrasting

confidence: 99%

Parkinson’s disease with restless legs syndrome—an in vivo corneal confocal microscopy study

Andréasson

Lagali

Badian

et al. 2021

npj Parkinsons Dis.

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Small fiber neuropathy (SFN) has been suggested as a trigger of restless legs syndrome (RLS). An increased prevalence of peripheral neuropathy has been demonstrated in Parkinson’s disease (PD). We aimed to investigate, in a cross-sectional manner, whether SFN is overrepresented in PD patients with concurrent RLS relative to PD patients without RLS, using in vivo corneal confocal microscopy (IVCCM) and quantitative sensory testing (QST) as part of small fiber assessment. Study participants comprised of age- and sex-matched PD patients with (n = 21) and without RLS (n = 21), and controls (n = 13). Diagnosis of RLS was consolidated with the sensory suggested immobilization test. Assessments included nerve conduction studies (NCS), Utah Early Neuropathy Scale (UENS), QST, and IVCCM, with automated determination of corneal nerve fiber length (CNFL) and branch density (CNBD) from wide-area mosaics of the subbasal nerve plexus. Plasma neurofilament light (p-NfL) was determined as a measure of axonal degeneration. No significant differences were found between groups when comparing CNFL (p = 0.81), CNBD (p = 0.92), NCS (p = 0.82), and QST (minimum p = 0.54). UENS scores, however, differed significantly (p = 0.001), with post-hoc pairwise testing revealing higher scores in both PD groups relative to controls (p = 0.018 and p = 0.001). Analysis of all PD patients (n = 42) revealed a correlation between the duration of l-dopa therapy and CNBD (ρ = −0.36, p = 0.022), and p-NfL correlated with UENS (ρ = 0.35, p = 0.026) and NCS (ρ = −0.51, p = 0.001). Small and large fiber neuropathy do not appear to be associated with RLS in PD. Whether peripheral small and/or large fiber pathology associates with central neurodegeneration in PD merits further longitudinal studies.

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Section: Discussioncontrasting

confidence: 99%

Parkinson’s disease with restless legs syndrome—an in vivo corneal confocal microscopy study

Andréasson

Lagali

Badian

et al. 2021

npj Parkinsons Dis.

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“…Patients in the PN group were older, in more advanced stages, with longer PD duration and scored higher in the UPDRS scale, than those in the non-PN group. PN in this cohort was previously shown to be related to L-Dopa intake; possible causes and relations of PN to PD in this cohort were previously discussed and PN was linked to vitamin B12 and folate deficiencies and high daily doses of L-Dopa (46). Nevertheless, PN in PD seems to be more common in advanced stages of PD and linked to higher doses of L-Dopa and might represent a more severe phenotype of PD (49).…”

Section: Discussionmentioning

confidence: 58%

“…Seventy-three PD patients (49.3% females, mean age 65.44 (9.87)) from the previous study were included (46). Two patients scored below 24 points on MMse but due to motor impairment and 10 patients received medication for anxiety or depression.…”

Section: Results Hrqol In Pn Versus Non-pn Groupsmentioning

confidence: 99%

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The impact of associated large-fiber peripheral neuropathy on health-related quality of life in Parkinson’s disease – results from a Romanian cohort

Vanta¹,

Pintea²,

Perju‐Dumbravă³

2019

Ro J Neurol.

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background. Recent studies described a higher prevalence of peripheral neuropathy (PN) in Parkinson's disease that was linked to L-Dopa exposure. Peripheral neuropathies are known causes of a decreased health-related quality of life (HrQoL). Until now, no studies addressed the issue of how or if associated PN in PD affects HrQoL. Methods. In a cross-sectional, observational study, 73 non-demented PD patients, from which 36 with confirmed PN based on clinical (using the Toronto Clinical Neuropathy Scale-TCSS) and nerve conduction studies completed the Romanian version of PDQ-39. results. Significant differences between mean scores in Motor (49.86 (27.61) vs. 31.50 (26.24), p = 0.005), Activities of daily living (49.86 (27.61) vs. 31.75 (30.10), p = 0.003) and body discomfort (52.54 (29.54) vs. 23.64 (18.48), p = 0.002) domains of PDQ-39 in the PN-PD group versus non-PN group were observed. TCSS significantly correlated to motor, emotional well-being and body discomfort domains (r = 0.406 p< 0.001; r = 0.316 p = 0.007; r = 0.356 p = 0.002, respectively). The multivariate linear regression model showed that motor impairment and PN correlated to motor domain (beta = 0.601, p = 0.000; beta = 0.211 p = 0.041, respectively) and PN significantly correlated to body discomfort domain (beta = 0.314, p = 0.020) of PDQ-39. conclusions. The presence of associated PN in PD determines a further deterioration of HrQol in subjects with already a poorer HrQol.

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“…L-DOPA: Neuropathy due to L-DOPA is a length-dependent, sensory axonopathy, possibly related to elevated homocysteine or neuronal deposition of α -synuclein. In a study of 73 Parkinson patients without a history of previous PNP, 67.3% of those taking L-DOPA developed a PNP, whereas in the non-L-DOPA group only one patient developed PNP [ 36 ]. The results imply that long-term L-DOPA intake can secondarily cause vitamin-B12 and folate deficiency and consecutively PNP [ 36, 37 ].…”

Section: Acquired Neuropathiesmentioning

confidence: 99%

Orphan Peripheral Neuropathies

Finsterer

Löscher

Wanschitz

et al. 2021

JND

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Objectives: Generally, neuropathies of peripheral nerves are a frequent condition (prevalence 2–3%) and most frequently due to alcoholism, diabetes, renal insufficiency, malignancy, toxins, or drugs. However, the vast majority of neuropathies has orphan status. This review focuses on the etiology, frequency, diagnosis, and treatment of orphan neuropathies. Methods: Literature review Results: Rareness of diseases is not uniformly defined but in the US an orphan disease is diagnosed if the prevalence is <1:200000, in Europe if <5:10000. Most acquired and hereditary neuropathies are orphan diseases. Often the causative variant has been reported only in a single patient or family, particularly the ones that are newly detected (e.g. SEPT9, SORD). Among the complex neuropathies (hereditary multisystem disorders with concomitant neuropathies) orphan forms have been reported among mitochondrial disorders (e.g. NARP, MNGIE, SANDO), spinocerebellar ataxias (e,g, TMEM240), hereditary spastic paraplegias (e.g UBAP1), lysosomal storage disease (e.g. Schindler disease), peroxisomal disorders, porphyrias, and other types (e.g. giant axonal neuropathy, Tangier disease). Orphan acquired neuropathies include the metabolic neuropathies (e.g. vitamin-B1, folic acid), toxic neuropathies (e.g. copper, lithium, lead, arsenic, thallium, mercury), infectious neuropathies, immune-mediated (e.g. Bruns-Garland syndrome), and neoplastic/paraneoplastic neuropathies. Conclusions: Though orphan neuropathies are rare per definition they constitute the majority of neuropathies and should be considered as some of them are easy to identify and potentially treatable, as clarification of the underlying cause may contribute to the knowledge about etiology and pathophysiology of these conditions, and as the true prevalence may become obvious only if all ever diagnosed cases are reported.

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Large-Fiber Neuropathy in Parkinson’s Disease: Clinical, Biological, and Electroneurographic Assessment of a Romanian Cohort

Cited by 8 publications

References 52 publications

Parkinson’s disease with restless legs syndrome—an in vivo corneal confocal microscopy study

Parkinson’s disease with restless legs syndrome—an in vivo corneal confocal microscopy study

The impact of associated large-fiber peripheral neuropathy on health-related quality of life in Parkinson’s disease – results from a Romanian cohort

Orphan Peripheral Neuropathies

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