AIMS: Disorders of the autonomic nervous system (ANS) have a variable degree of clinical relevance in patients with Parkinson's disease (PD). Here, we assessed whether subclinical autonomic dysfunction, as evaluated by a complete battery of autonomic function tests (AFTs), correlates with PD progression. METHODS: A series of 27 consecutive patients with PD underwent extensive ANS investigations including the head-up tilt test (HUTT), Valsalva maneuver, deep-breathing test, and handgrip test (HG); further, they performed 123I-meta-iodobenzylguanidine (MIBG) scintigraphy. RESULTS: Seven of the 27 patients showed orthostatic hypotension (OH) at HUTT and pathological responses to the deep-breathing and HG test and Valsalva maneuver. The majority of the remaining 20 patients with PD showed pathological responses to deep-breathing (n = 13) and/or HG (n = 11). Only 3 of 27 suffered relevant OH. MIBG uptake of myocardium was decreased in 19 patients with PD (H/M ratio 1.3 ± 0.2). Prolonged clinical observation (>3 years), persistent response to levodopa, and MIBG repetition allowed us to exclude negative MIBG as attributable to atypical Parkinsonism. MIBG uptake did not correlate with OH and other AFTs. Both HG test response and MIBG did correlate with the Unified Parkinson's Disease Rating Scale (UPDRS) motor score and disease duration. A positive correlation emerged between diastolic blood pressure (DBP) response to HG test and MIBG and with systolic blood pressure (SBP) response at tilt test. CONCLUSIONS: Our investigation suggests that ANS impairment affects the majority of patients with PD, even those PD patients showing negative MIBG, irrespective of clinical neurovegetative symptoms. The strict correlation that has been revealed with disease progression supports the routine utilization of AFTs as a reliable and inexpensive tool for monitoring peripheral sympathetic dysfunction in PD and optimizing therapy.
AIMS: Disorders of the autonomic nervous system (ANS) have a variable degree of clinical relevance in patients with Parkinson's disease (PD). Here, we assessed whether subclinical autonomic dysfunction, as evaluated by a complete battery of autonomic function tests (AFTs), correlates with PD progression. METHODS: A series of 27 consecutive patients with PD underwent extensive ANS investigations including the head-up tilt test (HUTT), Valsalva maneuver, deep-breathing test, and handgrip test (HG); further, they performed 123I-meta-iodobenzylguanidine (MIBG) scintigraphy. RESULTS: Seven of the 27 patients showed orthostatic hypotension (OH) at HUTT and pathological responses to the deep-breathing and HG test and Valsalva maneuver. The majority of the remaining 20 patients with PD showed pathological responses to deep-breathing (n = 13) and/or HG (n = 11). Only 3 of 27 suffered relevant OH. MIBG uptake of myocardium was decreased in 19 patients with PD (H/M ratio 1.3 ± 0.2). Prolonged clinical observation (>3 years), persistent response to levodopa, and MIBG repetition allowed us to exclude negative MIBG as attributable to atypical Parkinsonism. MIBG uptake did not correlate with OH and other AFTs. Both HG test response and MIBG did correlate with the Unified Parkinson's Disease Rating Scale (UPDRS) motor score and disease duration. A positive correlation emerged between diastolic blood pressure (DBP) response to HG test and MIBG and with systolic blood pressure (SBP) response at tilt test. CONCLUSIONS: Our investigation suggests that ANS impairment affects the majority of patients with PD, even those PDpatients showing negative MIBG, irrespective of clinical neurovegetative symptoms. The strict correlation that has been revealed with disease progression supports the routine utilization of AFTs as a reliable and inexpensive tool for monitoring peripheral sympathetic dysfunction in PD and optimizing therapy.
Authors: Christine Eckhardt; Florian Krismer; Eveline Donnemiller; Sabine Eschlböck; Alessandra Fanciulli; Cecilia Raccagni; Sylvia Bösch; Katherina Mair; Christoph Scherfler; Atbin Djamshidian; Christian Uprimny; Bernhard Metzler; Klaus Seppi; Werner Poewe; Stefan Kiechl; Irene Virgolini; Gregor K Wenning Journal: Clin Auton Res Date: 2022-02-11 Impact factor: 5.625
Authors: Jasjit S Suri; Mahesh A Maindarkar; Sudip Paul; Puneet Ahluwalia; Mrinalini Bhagawati; Luca Saba; Gavino Faa; Sanjay Saxena; Inder M Singh; Paramjit S Chadha; Monika Turk; Amer Johri; Narendra N Khanna; Klaudija Viskovic; Sofia Mavrogeni; John R Laird; Martin Miner; David W Sobel; Antonella Balestrieri; Petros P Sfikakis; George Tsoulfas; Athanase D Protogerou; Durga Prasanna Misra; Vikas Agarwal; George D Kitas; Raghu Kolluri; Jagjit S Teji; Mustafa Al-Maini; Surinder K Dhanjil; Meyypan Sockalingam; Ajit Saxena; Aditya Sharma; Vijay Rathore; Mostafa Fatemi; Azra Alizad; Padukode R Krishnan; Tomaz Omerzu; Subbaram Naidu; Andrew Nicolaides; Kosmas I Paraskevas; Mannudeep Kalra; Zoltán Ruzsa; Mostafa M Fouda Journal: Diagnostics (Basel) Date: 2022-06-24
Authors: Jian-Hua Mao; Sasha A Langley; Yurong Huang; Michael Hang; Kristofer E Bouchard; Susan E Celniker; James B Brown; Janet K Jansson; Gary H Karpen; Antoine M Snijders Journal: Sci Rep Date: 2015-11-09 Impact factor: 4.379