Abstract
We assessed small nerve fibre degeneration and regeneration in more and less affected sides in Parkinson’s disease (PD). Bilateral skin biopsies from 23 PD patients were immunostained for PGP9.5 for Intraepidermal Nerve Fibre Density (IENFD) and GAP-43 for mean axonal length (MAL), total epidermal (TNFL) and subepidermal nerve fibre length (SKTNFL). IENFD (p < 0.001) and SKTNFL (p < 0.001) were lower, whilst MAL (p < 0.001) and TNFL (p < 0.05) were higher in more affected versus less affected side. These results suggest increased small nerve fibre degeneration accompanied by enhanced nerve regeneration on the side more affected by PD and GAP-43 usefulness in skin biopsy assessment.
Highlights
We assessed small nerve fibre degeneration and regeneration in more and less affected sides in Parkinson’s disease (PD)
In our studies in patients with PD, using PGP9.5, we have shown a reduction in Intraepidermal Nerve Fibre Density (IENFD) and corneal small nerve fibre density and related it to autonomic dysfunction and the perception of affective touch [9, 10]
Previous skin biopsy studies have established increased neurodegeneration on the more affected side, these studies have only used PGP9.5 immunostaining were not fully able to establish the asymmetry of enhanced regeneration [19, 20]
Summary
We assessed small nerve fibre degeneration and regeneration in more and less affected sides in Parkinson’s disease (PD). A recent systematic review in over 1300 PD patients showed large fibre PN in 16.3% and small fibre neuropathy in 56.9% of those who had a skin biopsy [2], compared to a 5.5% prevalence of PN in the general population [3]. Intraepidermal nerve fibre density (IENFD) is the gold standard measure to quantify loss of skin innervation to diagnose a small fibre neuropathy (SFN) [5].
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