Two-Year observational study of autonomic skin function in patients with Parkinson's disease compared to healthy individuals

Eur J Neurol. 2023 May;30(5):1281-1292. doi: 10.1111/ene.15733. Epub 2023 Feb 24.

Abstract

Background and purpose: We characterized autonomic pilomotor and sudomotor skin function in early Parkinson's disease (PD) longitudinally.

Methods: We enrolled PD patients (Hoehn and Yahr 1-2) and healthy controls from movement disorder centers in Germany, Hungary, and the United States. We evaluated axon-reflex responses in adrenergic sympathetic pilomotor nerves and in cholinergic sudomotor nerves and assessed sympathetic skin response (SSR), predominantly parasympathetic neurocardiac function via heart rate variability, and disease-related symptoms at baseline, after 2 weeks, and after 1 and 2 years.

Clinicaltrials: gov: NCT03043768.

Results: We included 38 participants: 26 PD (60% females, aged 62.4 ± 7.4 years, mean ± SD) and 12 controls (75% females, aged 59.5 ± 5.8 years). Pilomotor function was reduced in PD compared to controls at baseline when quantified via spatial axon-reflex spread (78 [43-143], median [interquartile range] mm2 vs. 175 [68-200] mm2 , p = 0.01) or erect hair follicle count in the axon-reflex region (8 [6-10] vs. 11 [6-16], p = 0.008) and showed reliability absent any changes from baseline to Week 2 (p = not significant [ns]). Between-group differences increased over the course of 2 years (p < 0.05), although no decline was observed within groups (p = ns). Pilomotor impairment in PD correlated with motor symptoms (rho = -0.59, p = 0.017) and was not lateralized (p = ns). Sudomotor axon-reflex and neurocardiac function did not differ between groups (p = ns), but SSR was reduced in PD (p = 0.0001).

Conclusions: Impairment of adrenergic sympathetic pilomotor function and SSR in evolving PD is not paralleled by changes to cholinergic sudomotor function and parasympathetic neurocardiac function, suggesting a sympathetic pathophysiology. A pilomotor axon-reflex test might be useful to monitor PD-related pathology.

Keywords: Parkinson disease; autonomic nervous system; nerve; skin; synucleinopathy.

Publication types

  • Observational Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adrenergic Agents
  • Autonomic Nervous System
  • Autonomic Nervous System Diseases* / etiology
  • Female
  • Humans
  • Male
  • Parkinson Disease* / diagnosis
  • Reproducibility of Results
  • Skin / pathology

Substances

  • Adrenergic Agents

Associated data

  • ClinicalTrials.gov/NCT03043768