Small (autonomic) and large fiber neuropathy in Parkinson disease and parkinsonism

Abstract

BackgroundRecent studies have reported that peripheral neuropathy (PN) is common in patients with Parkinson’s disease (PD) and raised the possibility that levodopa neurotoxicity is the main culprit.MethodsWe evaluated the presence of large & small (autonomic) fiber PN in 54 consecutive patients with PD or parkinsonism in a tertiary outpatient clinic from Brazil. Initial PN screening consisted of history/neurological exam and skin wrinkling test (SWT). In addition, we also performed Nerve conduction studies/Electromyography (NCS/EMG) in all patients with PN signs/symptoms and/or abnormal SWT.ResultsThirty eight patients with PD (10 women, mean age: 63 ± 2.1 years, P < 0.05 versus parkinsonism, mean disease duration: 8 ± 0.8 years) and 16 patients with other forms of parkinsonism [7 women, mean age: 50.1 ± 3.9 years, mean disease duration: 6.9 ± 1.1 years] completed clinical neuromuscular evaluation. SWT was performed in 48 patients (33 PD, 15 parkinsonism). In the PD group, SWT was abnormal in 57.6 % of the tested patients (comprising 50 % of all PD patients). In the parkinsonism group, SWT was abnormal in 37.5 % (comprising 35.3 % of all parkinsonism patients). NCS/EMG was performed in 39 patients (26 PD and 13 parkinsonism). Twelve out of the 26 PD (34.2 % of all PD) and 4 out of the 13 parkinsonism (23.5 % of all parkinsonism) had abnormal NCS/EMG results. Neuropathy prevalence was similar in PD and parkinsonism groups as detected either by NCS/EMG or SWT.ConclusionsLarge fiber and small (autonomic) fiber PN are common in patients with PD and parkinsonism. The etiology for the neuropathy was likely to be multifactorial and may be secondary to PD itself.Electronic supplementary materialThe online version of this article (doi:10.1186/s12883-016-0667-3) contains supplementary material, which is available to authorized users.

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

“…Age and PD duration contribute indirectly to the severity of PNP in PD. Nonetheless, a clear link between PD duration, age, and PNP in PD, relations that were albeit revealed in other published studies [6,7,8,9,15,52], could not be established in the present work. On the other hand, the risk for PNP was not stratified, in contrast to the study of Ceravolo et al [15].…”

Clinical diagnosis and management of small fiber neuropathy: an update on best practice

“…SFN has been reported in patients with Gaucher disease as possible explanation for neuropathic origin of chronic pain [65]. Finally, SFN has been also described in association with disorders characterized by widespread pain such as fibromyalgia [5] and Ehlers-Danlos syndrome [66], and in neurodegenerative diseases like Parkinson's disease [14][15][16][17][18][19][20][21] and ALS [10][11][12][13].…”

“…The introduction of skin biopsy, which allows a reliable quantification of intraepidermal nerve fiber density (IENFD), has been a milestone for the diagnosis of SFN [8,9]. In the following decades, a flourishing of studies widened the spectrum of diseases associated with small nerve fiber degeneration, from painless amyotrophic lateral sclerosis [10][11][12][13] and Parkinson's disease [14][15][16][17][18][19][20][21] to painful erythromelalgia [22]. These findings further emphasized that the diagnosis of SFN cannot disregard the clinical context and the accurate characterization of patients' phenotype.…”

Cutaneous Autonomic Pilomotor Testing to Unveil the Role of Neuropathy Progression in Early Parkinson’s Disease (CAPTURE PD): Protocol for a Multicenter Study

“…The technique is easy to use and inexpensive. However in this study, it remained unclear to what degree observed differences in wrinkling of the skin did reflect postganglionic small nerve fiber function rather than large fiber integrity limiting interpretability of the results ( 22 ).…”