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.
Highlights
Recent 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
A third of the PD patients and 31 % of the parkinsonism group were treated with pramipexol while 38.9 % of the PD and none from the parkinsonism group were treated with amantadine and only 8.3 and 18.8 were treated with biperiden
Results of large fiber neuropathy assessment Nerve conduction studies (NCS)/EMG was performed in 39 patients (26 PD and 13 with other forms of parkinsonism). 12 out of the 26 PD (34.2 % of all PD) and 4 out of the 13 from the parkinsonism group (23.5 % of all patients from the parkinsonism group) had abnormal Nerve conduction studies/Electromyography (NCS/EMG) results
Summary
Recent 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. Autonomic involvement was extensively described in Parkinson’s disease (PD) and other forms of parkinsonism (e.g. multiple system atrophy, Lewy body disease), the presence of sensorimotor peripheral neuropathy (PN) was only detailed in case reports and small case series until recently [1, 2]. Neuropathy phenotype was diverse and included demyelinating neuropathies. Additional observations have broadened the clinical spectrum of peripheral neuropathies in PD patients to include demyelinating and small fiber neuropathies [9,10,11]. We describe the results of a study aimed to screen large and small (autonomic) fiber neuropathy in patients with PD and parkinsonism. Part of this study has been reported in abstract form elsewhere [12]
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