Sympathetic skin response and R‐R interval variability in multipele system atrophy and idiopathic Parkinson's disease

Bordet, Régis; Benhadjali, J.; Destée, Alain; Hurtevent, J. F.; Bourriez, Jean‐Louis; Guieu, J.D.

doi:10.1002/mds.870110309

Cited by 56 publications

(46 citation statements)

References 17 publications

(6 reference statements)

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“…21 Nine of 13 (69.2%) MSA patients had an abnormal SSR compared to only 1/13 (7.7%) PD patients for a sensitivity of 69% and a specificity of 92%. RRIV after deep breathing was abnormal in 8/9 (89%) patients with MSA compared to only 3/11 (27.3%) patients with PD (p ϭ 0.02).…”

Section: Analysis Of the Evidence Question 1: Which Clinical Featurementioning

confidence: 89%

“…A variety of noninvasive or minimally invasive procedures have been proposed to distinguish PD from parkinsonian syndromes. Twelve Class III articles [21][22][23][24][25][26][27][28][29][30][31] were identified (table E-3). In these studies, diagnosis of PD or other parkinsonian syndromes were based on clinical criteria.…”

Section: Analysis Of the Evidence Question 1: Which Clinical Featurementioning

confidence: 99%

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Practice Parameter: Diagnosis and prognosis of new onset Parkinson disease (an evidence-based review) [RETIRED]

et al. 2006

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Abstract-Objective:To define key issues in the diagnosis of Parkinson disease (PD), to define features influencing progression, and to make evidence-based recommendations. Two clinical questions were identified: 1) Which clinical features and diagnostic modalities distinguish PD from other parkinsonian syndromes? 2) Which clinical features predict rate of disease progression? Methods: Systematic review of the literature was completed. Articles were classified according to a four-tiered level of evidence scheme. Recommendations were based on the evidence. Results and Conclusions: 1. Early falls, poor response to levodopa, symmetry of motor manifestations, lack of tremor, and early autonomic dysfunction are probably useful in distinguishing other parkinsonian syndromes from Parkinson disease (PD). 2. Levodopa or apomorphine challenge and olfactory testing are probably useful in distinguishing PD from other parkinsonian syndromes. 3. Predictive factors for more rapid motor progression, nursing home placement, and shorter survival time include older age at onset of PD, associated comorbidities, presentation with rigidity and bradykinesia, and decreased dopamine responsiveness. Future research into methods for earlier and more accurate diagnosis of the disease and identification and clarification of predictive factors of rapid disease progression is warranted. NEUROLOGY 2006;66:968-975

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Section: Analysis Of the Evidence Question 1: Which Clinical Featurementioning

confidence: 89%

Section: Analysis Of the Evidence Question 1: Which Clinical Featurementioning

confidence: 99%

Practice Parameter: Diagnosis and prognosis of new onset Parkinson disease (an evidence-based review) [RETIRED]

et al. 2006

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“…The R-R interval variation (R-R ratio) during the Valsalva manoeuvre has been found statistically significantly different in patients with MSA with respect to those with Parkinson's disease. 10,11 However, evaluation of the R-R ratio in these instances still requires a postural change or a Valsalva manoeuvre that some bradykinetic patients are not able to perform with the degree of competence required to obtain a meaningful result. The technique introduced here permits the study of changes induced in the R-R interval by an acoustic startling stimulus and, therefore, is free from physical limitations.…”

Section: Discussionmentioning

confidence: 99%

Effects of a startle on heart rate in patients with multiple system atrophy

et al. 2002

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The patient cooperation usually required for neurophysiological assessment of autonomic cardioregulatory function is difficult to obtain from patients with bradykinesia. A particularly interesting condition occurs in multiple system atrophy (MSA), which features both bradykinesia and autonomic dysfunction. Another characteristic of patients with MSA is their normal motor reaction to a startling stimulus. We used startle as a stimulus for testing autonomic cardioregulatory function in patients with MSA, thus avoiding the need for patient cooperation. In 10 healthy volunteers and 8 MSA patients, we recorded the electrocardiographic QRS complex with surface electrodes attached over the chest and delivered an acoustic startle stimulus after 8 seconds of baseline recording. We calculated the ratio between the pre-stimulus and the post-stimulus heart beat intervals (R-R ratio) by dividing the mean prestimulus R-R interval by the shortest R-R interval obtained within 10 seconds poststimulus. Healthy volunteers had a significant shortening of the R-R interval. The peak of the effect occurred after 2 to 5 seconds, with a mean R-R ratio of 1.14 (S.D. = 0.09). In contrast, R-R shortening was markedly reduced in patients, even though they had a normal motor response. The mean R-R ratio in patients was 1.03 (S.D. = 0.03), significantly lower than in healthy volunteers (P < 0.01). Our results demonstrate an abnormally reduced modulation of the heart beat frequency in patients with MSA, compatible with a dysfunction on pathways responsible for autonomic regulation. The method described here may be useful in the assessment of cardioregulatory function in poorly cooperative patients with normal startle responses.

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“…It was reported that the RRIV correlates with dysautonomia in peripheral neuropathies such as diabetic polyneuropathy and Guillain-Barré syndrome. 18 Considering the peripheral lesions, deformations and contractures which are frequently seen in leprosy patients and create considerable difficulties in SSR studies, the RRIV seems to be a more practical and reliable method for detecting autonomic dysfunction. To our knowledge, there is no RRIV study in patients with leprosy dealing with the parasympathetic function of autonomic nervous system.…”

Section: Discussionmentioning

confidence: 99%

Electrophysiological Evaluation of Peripheral and Autonomic Involvement in Leprosy

Soysal

Atay

Ozu

et al. 2004

Can. j. neurol. sci.

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Objective:Motor and sensory nerve conductions, F responses, sympathetic skin responses and R-R interval variations (RRIV) were studied to determine the type of peripheral neuropathy among patients with leprosy.Methods:Twenty-nine consecutive patients with leprosy (25 male, 4 female) hospitalized in the “Istanbul Leprosy Hospital'' between January - December, 1999 were included in this study. Ten patients had borderline lepromatous leprosy, and 19 had lepromatous leprosy. None of the patients studied had the tuberculoid form. The mean age was 55±12 years. The control group consisted of 30 (26 male, 4 female) healthy volunteers (mean age: 58.1±7.8 years). All subjects included in the study underwent neurological examination and electrophysiological evaluation. Standard procedures were performed for evaluating sensory and motor conduction studies. Motor studies were carried out on both left and right median, ulnar, tibial and common peroneal nerves while median, ulnar, sural and superficial peroneal nerves were examined for sensory studies. Sympathetic skin response recordings on both hands and RRIV recordings on precordial region were done in order to evaluate the autonomic involvement.Results:The lower extremity was found to be more severely affected than the upper, and sensory impairment predominated over motor. Of 58 upper limbs examined, no sympathetic skin responses was recorded in 46 (79.3%). Compared with the controls, the RRIVs of the leprosy patients were found to be reduced during both resting and deep forced hyperventilation.Conclusion:Our results indicate that leprosy causes a predominantly axonal polyneuropathy that is more severe in the lower extremities. Sensory nerve damage is accompanied by autonomic involvement.

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Sympathetic skin response and R‐R interval variability in multipele system atrophy and idiopathic Parkinson's disease

Cited by 56 publications

References 17 publications

Practice Parameter: Diagnosis and prognosis of new onset Parkinson disease (an evidence-based review) [RETIRED]

Practice Parameter: Diagnosis and prognosis of new onset Parkinson disease (an evidence-based review) [RETIRED]

Effects of a startle on heart rate in patients with multiple system atrophy

Electrophysiological Evaluation of Peripheral and Autonomic Involvement in Leprosy

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