Vincenzo Provitera1, Maria Nolano2, Giuseppe Caporaso2, Annamaria Stancanelli2, Fiore Manganelli2, Rosa Iodice2, Mona M Selim2, Anna De Rosa2, Bernardo Lanzillo2, Maria Teresa Pellecchia2, Giuseppe De Michele2, Lucio Santoro2. 1. From the Neurology Division (V.P., M.N., G.C., A.S., B.L.), "Salvatore Maugeri" Foundation, Medical Center of Telese Terme (BN); the Department of Neurosciences and Reproductive and Odontostomatologic Sciences (F.M., R.I., A.D.R., G.D.M., L.S.), University "Federico II" of Naples, Italy; the Department of Neurology (M.M.S.), University of Minnesota, Minneapolis; and the Center for Neurodegenerative Diseases (M.T.P.), University of Salerno, Italy. vincenzo.provitera@fsm.it. 2. From the Neurology Division (V.P., M.N., G.C., A.S., B.L.), "Salvatore Maugeri" Foundation, Medical Center of Telese Terme (BN); the Department of Neurosciences and Reproductive and Odontostomatologic Sciences (F.M., R.I., A.D.R., G.D.M., L.S.), University "Federico II" of Naples, Italy; the Department of Neurology (M.M.S.), University of Minnesota, Minneapolis; and the Center for Neurodegenerative Diseases (M.T.P.), University of Salerno, Italy.
Abstract
OBJECTIVE: To evaluate postganglionic autonomic involvement in multiple system atrophy (MSA). METHODS: We quantified sudomotor innervation in skin biopsy of 29 patients with MSA (19 male and 10 female; age 60.0 ± 7.7 years) and 29 age- and sex-matched healthy subjects. Samples were obtained from thigh and leg and, in 20 out of the 29 cases, also from fingertip. Dysautonomic complaints were evaluated by SCOPA-AUT, a self-administered questionnaire. Sudomotor function was evaluated in a subgroup of patients by the silastic imprint test. Skin samples were processed by indirect immunofluorescence using pan-neuronal and selective cholinergic markers. Total length of sudomotor nerves was measured on digital confocal images using a semiautomated morphometric approach. RESULTS: Measurements of sudomotor nerve density (total length of nerve per volume of glandular tissue) favorably correlated to values obtained using a stereologic unbiased method. Sudomotor nerve density was lower in patients compared to controls in all the examined sites (0.9 ± 0.2 vs 1.9 ± 0.4 nm/μm(3), p < 0.001, in fingertip; 0.7 ± 0.2 vs 1.9 ± 0.5 nm/µm(3), p < 0.001, in thigh; 0.6 ± 0.2 vs 1.8 ± 0.4 nm/µm(3), p < 0.001, in leg). CONCLUSIONS: Our data support the hypothesis that postganglionic impairment occurs in MSA and may contribute with the coexisting degeneration of central structures to the development of dysautonomic disorders in this condition.
OBJECTIVE: To evaluate postganglionic autonomic involvement in multiple system atrophy (MSA). METHODS: We quantified sudomotor innervation in skin biopsy of 29 patients with MSA (19 male and 10 female; age 60.0 ± 7.7 years) and 29 age- and sex-matched healthy subjects. Samples were obtained from thigh and leg and, in 20 out of the 29 cases, also from fingertip. Dysautonomic complaints were evaluated by SCOPA-AUT, a self-administered questionnaire. Sudomotor function was evaluated in a subgroup of patients by the silastic imprint test. Skin samples were processed by indirect immunofluorescence using pan-neuronal and selective cholinergic markers. Total length of sudomotor nerves was measured on digital confocal images using a semiautomated morphometric approach. RESULTS: Measurements of sudomotor nerve density (total length of nerve per volume of glandular tissue) favorably correlated to values obtained using a stereologic unbiased method. Sudomotor nerve density was lower in patients compared to controls in all the examined sites (0.9 ± 0.2 vs 1.9 ± 0.4 nm/μm(3), p < 0.001, in fingertip; 0.7 ± 0.2 vs 1.9 ± 0.5 nm/µm(3), p < 0.001, in thigh; 0.6 ± 0.2 vs 1.8 ± 0.4 nm/µm(3), p < 0.001, in leg). CONCLUSIONS: Our data support the hypothesis that postganglionic impairment occurs in MSA and may contribute with the coexisting degeneration of central structures to the development of dysautonomic disorders in this condition.
Authors: Maria Nolano; Fiore Manganelli; Vincenzo Provitera; Chiara Pisciotta; Annamaria Stancanelli; Giuseppe Caporaso; Rosa Iodice; Michael E Shy; Lucio Santoro Journal: Neurology Date: 2014-12-24 Impact factor: 9.910
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