The role of autonomic testing in the differentiation of Parkinson’s disease from multiple system atrophy
Identifieur interne : 000746 ( Pmc/Checkpoint ); précédent : 000745; suivant : 000747The role of autonomic testing in the differentiation of Parkinson’s disease from multiple system atrophy
Auteurs : Kurt Kimpinski [Canada] ; Valeria Iodice [Royaume-Uni] ; Duane D. Burton [États-Unis] ; Michael Camilleri [États-Unis] ; Brian P. Mullan [États-Unis] ; Axel Lipp [Allemagne] ; Paola Sandroni [États-Unis] ; Tonette L. Gehrking [États-Unis] ; David M. Sletten [États-Unis] ; J E. Ahlskog [États-Unis] ; Robert D. Fealey [États-Unis] ; Wolfgang Singer [États-Unis] ; Phillip A. Low [États-Unis]Source :
- Journal of the Neurological Sciences [ 0022-510X ] ; 2012.
Abstract
Differentiation of idiopathic Parkinson's disease (PD) from multiple system atrophy (MSA) can be difficult. Methods devised to help distinguish the two disorders include standardized autonomic testing and cardiac imaging with iodine-123 meta-iodobenzylguanidine myocardial scintigraphy. MSA patients had more severe adrenergic and overall autonomic dysfunction when compared to control and PD patients. Area of anhidrosis on thermoregulatory sweat testing was greater in MSA (67.4±12.42, p<0.001) versus PD patients (area of anhidrosis, 1.7±2.96). Postganglionic cardiac sympathetic innervation (iodine-123 meta-iodobenzylguanidine) expressed as heart to mediastinal ratio was significantly lower in Parkinson's disease patients (1.4±0.40, p=0.025) compared to controls (2.0±0.29), but not in multiple system atrophy (2.0±0.76). These findings indicate that autonomic dysfunction is generalized and predominantly preganglionic in multiple system atrophy, and postganglionic in Parkinson's disease. In our hands the Thermoregulatory Sweat Test provides the best distinction between MSA and PD. However further confirmatory studies using larger patient numbers are required. Currently a combination of clinical judgment and autonomic testing are recommended to help differentiate MSA and PD.
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DOI: 10.1016/j.jns.2012.02.023
PubMed: 22421352
PubMed Central: 3340456
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Burton</name><affiliation wicri:level="1"><nlm:aff id="A3">Department of Imaging and Physiology, Mayo Clinic, Rochester, MN, USA</nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Department of Imaging and Physiology, Mayo Clinic, Rochester, MN</wicri:regionArea><wicri:noRegion>MN</wicri:noRegion></affiliation></author><author><name sortKey="Camilleri, Michael" sort="Camilleri, Michael" uniqKey="Camilleri M" first="Michael" last="Camilleri">Michael Camilleri</name><affiliation wicri:level="1"><nlm:aff id="A4">Department of Clinical Enteric Neuroscience, Mayo Clinic, Rochester, MN, USA</nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Department of Clinical Enteric Neuroscience, Mayo Clinic, Rochester, MN</wicri:regionArea><wicri:noRegion>MN</wicri:noRegion></affiliation></author><author><name sortKey="Mullan, Brian P" sort="Mullan, Brian P" uniqKey="Mullan B" first="Brian P." last="Mullan">Brian P. Mullan</name><affiliation wicri:level="1"><nlm:aff id="A5">Department of Nuclear Medicine, Mayo Clinic, Rochester, MN, USA</nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Department of Nuclear Medicine, Mayo Clinic, Rochester, MN</wicri:regionArea><wicri:noRegion>MN</wicri:noRegion></affiliation></author><author><name sortKey="Lipp, Axel" sort="Lipp, Axel" uniqKey="Lipp A" first="Axel" last="Lipp">Axel Lipp</name><affiliation wicri:level="3"><nlm:aff id="A6">Department of Neurology, Charité–University Medizin Berlin, Berlin, Germany</nlm:aff><country xml:lang="fr">Allemagne</country><wicri:regionArea>Department of Neurology, Charité–University Medizin Berlin, Berlin</wicri:regionArea><placeName><region type="land" nuts="3">Berlin</region><settlement type="city">Berlin</settlement></placeName></affiliation></author><author><name sortKey="Sandroni, Paola" sort="Sandroni, Paola" uniqKey="Sandroni P" first="Paola" last="Sandroni">Paola Sandroni</name><affiliation wicri:level="1"><nlm:aff id="A7">Department of Neurology, Mayo Clinic, Rochester, MN, USA</nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Department of Neurology, Mayo Clinic, Rochester, MN</wicri:regionArea><wicri:noRegion>MN</wicri:noRegion></affiliation></author><author><name sortKey="Gehrking, Tonette L" sort="Gehrking, Tonette L" uniqKey="Gehrking T" first="Tonette L." last="Gehrking">Tonette L. Gehrking</name><affiliation wicri:level="1"><nlm:aff id="A7">Department of Neurology, Mayo Clinic, Rochester, MN, USA</nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Department of Neurology, Mayo Clinic, Rochester, MN</wicri:regionArea><wicri:noRegion>MN</wicri:noRegion></affiliation></author><author><name sortKey="Sletten, David M" sort="Sletten, David M" uniqKey="Sletten D" first="David M." last="Sletten">David M. Sletten</name><affiliation wicri:level="1"><nlm:aff id="A7">Department of Neurology, Mayo Clinic, Rochester, MN, USA</nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Department of Neurology, Mayo Clinic, Rochester, MN</wicri:regionArea><wicri:noRegion>MN</wicri:noRegion></affiliation></author><author><name sortKey="Ahlskog, J E" sort="Ahlskog, J E" uniqKey="Ahlskog J" first="J E." last="Ahlskog">J E. Ahlskog</name><affiliation wicri:level="1"><nlm:aff id="A7">Department of Neurology, Mayo Clinic, Rochester, MN, USA</nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Department of Neurology, Mayo Clinic, Rochester, MN</wicri:regionArea><wicri:noRegion>MN</wicri:noRegion></affiliation></author><author><name sortKey="Fealey, Robert D" sort="Fealey, Robert D" uniqKey="Fealey R" first="Robert D." last="Fealey">Robert D. Fealey</name><affiliation wicri:level="1"><nlm:aff id="A7">Department of Neurology, Mayo Clinic, Rochester, MN, USA</nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Department of Neurology, Mayo Clinic, Rochester, MN</wicri:regionArea><wicri:noRegion>MN</wicri:noRegion></affiliation></author><author><name sortKey="Singer, Wolfgang" sort="Singer, Wolfgang" uniqKey="Singer W" first="Wolfgang" last="Singer">Wolfgang Singer</name><affiliation wicri:level="1"><nlm:aff id="A7">Department of Neurology, Mayo Clinic, Rochester, MN, USA</nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Department of Neurology, Mayo Clinic, Rochester, MN</wicri:regionArea><wicri:noRegion>MN</wicri:noRegion></affiliation></author><author><name sortKey="Low, Phillip A" sort="Low, Phillip A" uniqKey="Low P" first="Phillip A." last="Low">Phillip A. Low</name><affiliation wicri:level="1"><nlm:aff id="A7">Department of Neurology, Mayo Clinic, Rochester, MN, USA</nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Department of Neurology, Mayo Clinic, Rochester, MN</wicri:regionArea><wicri:noRegion>MN</wicri:noRegion></affiliation></author></analytic><series><title level="j">Journal of the Neurological Sciences</title><idno type="ISSN">0022-510X</idno><idno type="eISSN">1878-5883</idno><imprint><date when="2012">2012</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><p id="P2">Differentiation of idiopathic Parkinson's disease (PD) from multiple system atrophy (MSA) can be difficult. Methods devised to help distinguish the two disorders include standardized autonomic testing and cardiac imaging with iodine-123 meta-iodobenzylguanidine myocardial scintigraphy. MSA patients had more severe adrenergic and overall autonomic dysfunction when compared to control and PD patients. Area of anhidrosis on thermoregulatory sweat testing was greater in MSA (67.4±12.42, p<0.001) versus PD patients (area of anhidrosis, 1.7±2.96). Postganglionic cardiac sympathetic innervation (iodine-123 meta-iodobenzylguanidine) expressed as heart to mediastinal ratio was significantly lower in Parkinson's disease patients (1.4±0.40, p=0.025) compared to controls (2.0±0.29), but not in multiple system atrophy (2.0±0.76). These findings indicate that autonomic dysfunction is generalized and predominantly preganglionic in multiple system atrophy, and postganglionic in Parkinson's disease. In our hands the Thermoregulatory Sweat Test provides the best distinction between MSA and PD. However further confirmatory studies using larger patient numbers are required. Currently a combination of clinical judgment and autonomic testing are recommended to help differentiate MSA and PD.</p></div></front></TEI><pmc article-type="research-article"><pmc-comment>The publisher of this article does not allow downloading of the full text in XML form.</pmc-comment>
<pmc-dir>properties manuscript</pmc-dir>
<front><journal-meta><journal-id journal-id-type="nlm-journal-id">0375403</journal-id><journal-id journal-id-type="pubmed-jr-id">5010</journal-id><journal-id journal-id-type="nlm-ta">J Neurol Sci</journal-id><journal-id journal-id-type="iso-abbrev">J. Neurol. Sci.</journal-id><journal-title-group><journal-title>Journal of the Neurological Sciences</journal-title></journal-title-group><issn pub-type="ppub">0022-510X</issn><issn pub-type="epub">1878-5883</issn></journal-meta><article-meta><article-id pub-id-type="pmid">22421352</article-id><article-id pub-id-type="pmc">3340456</article-id><article-id pub-id-type="doi">10.1016/j.jns.2012.02.023</article-id><article-id pub-id-type="manuscript">NIHMS360797</article-id><article-categories><subj-group subj-group-type="heading"><subject>Article</subject></subj-group></article-categories><title-group><article-title>The role of autonomic testing in the differentiation of Parkinson’s disease from multiple system atrophy</article-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Kimpinski</surname><given-names>Kurt</given-names></name><xref ref-type="aff" rid="A1">1</xref></contrib><contrib contrib-type="author"><name><surname>Iodice</surname><given-names>Valeria</given-names></name><xref ref-type="aff" rid="A2">2</xref></contrib><contrib contrib-type="author"><name><surname>Burton</surname><given-names>Duane D.</given-names></name><xref ref-type="aff" rid="A3">3</xref></contrib><contrib contrib-type="author"><name><surname>Camilleri</surname><given-names>Michael</given-names></name><xref ref-type="aff" rid="A4">4</xref></contrib><contrib contrib-type="author"><name><surname>Mullan</surname><given-names>Brian P.</given-names></name><xref ref-type="aff" rid="A5">5</xref></contrib><contrib contrib-type="author"><name><surname>Lipp</surname><given-names>Axel</given-names></name><xref ref-type="aff" rid="A6">6</xref></contrib><contrib contrib-type="author"><name><surname>Sandroni</surname><given-names>Paola</given-names></name><xref ref-type="aff" rid="A7">7</xref></contrib><contrib contrib-type="author"><name><surname>Gehrking</surname><given-names>Tonette L.</given-names></name><xref ref-type="aff" rid="A7">7</xref></contrib><contrib contrib-type="author"><name><surname>Sletten</surname><given-names>David M.</given-names></name><xref ref-type="aff" rid="A7">7</xref></contrib><contrib contrib-type="author"><name><surname>Ahlskog</surname><given-names>J E.</given-names></name><xref ref-type="aff" rid="A7">7</xref></contrib><contrib contrib-type="author"><name><surname>Fealey</surname><given-names>Robert D.</given-names></name><xref ref-type="aff" rid="A7">7</xref></contrib><contrib contrib-type="author"><name><surname>Singer</surname><given-names>Wolfgang</given-names></name><xref ref-type="aff" rid="A7">7</xref></contrib><contrib contrib-type="author"><name><surname>Low</surname><given-names>Phillip A.</given-names></name><xref ref-type="aff" rid="A7">7</xref><xref rid="FN1" ref-type="author-notes">*</xref></contrib></contrib-group><aff id="A1"><label>1</label>Department of Clinical Neurological Sciences, London Health Sciences Centre, University of Western Ontario, London, ON, Canada</aff><aff id="A2"><label>2</label>Neurovascular and Autonomic Medicine Unit, Imperial College, London, UK</aff><aff id="A3"><label>3</label>Department of Imaging and Physiology, Mayo Clinic, Rochester, MN, USA</aff><aff id="A4"><label>4</label>Department of Clinical Enteric Neuroscience, Mayo Clinic, Rochester, MN, USA</aff><aff id="A5"><label>5</label>Department of Nuclear Medicine, Mayo Clinic, Rochester, MN, USA</aff><aff id="A6"><label>6</label>Department of Neurology, Charité–University Medizin Berlin, Berlin, Germany</aff><aff id="A7"><label>7</label>Department of Neurology, Mayo Clinic, Rochester, MN, USA</aff><author-notes><corresp id="FN1"><label>*</label>Corresponding Author: Phillip A. Low, Mayo Clinic, 200 First Street SW, Rochester, MN, USA, 55905, Phone: 507-284-3375, Fax: 507-284-3133</corresp></author-notes><pub-date pub-type="nihms-submitted"><day>8</day><month>3</month><year>2012</year></pub-date><pub-date pub-type="epub"><day>14</day><month>3</month><year>2012</year></pub-date><pub-date pub-type="ppub"><day>15</day><month>6</month><year>2012</year></pub-date><pub-date pub-type="pmc-release"><day>15</day><month>6</month><year>2013</year></pub-date><volume>317</volume><issue>1-2</issue><fpage>92</fpage><lpage>96</lpage><permissions><copyright-statement>© 2012 Elsevier B.V. All rights reserved.</copyright-statement><copyright-year>2012</copyright-year></permissions><abstract><p id="P2">Differentiation of idiopathic Parkinson's disease (PD) from multiple system atrophy (MSA) can be difficult. Methods devised to help distinguish the two disorders include standardized autonomic testing and cardiac imaging with iodine-123 meta-iodobenzylguanidine myocardial scintigraphy. MSA patients had more severe adrenergic and overall autonomic dysfunction when compared to control and PD patients. Area of anhidrosis on thermoregulatory sweat testing was greater in MSA (67.4±12.42, p<0.001) versus PD patients (area of anhidrosis, 1.7±2.96). Postganglionic cardiac sympathetic innervation (iodine-123 meta-iodobenzylguanidine) expressed as heart to mediastinal ratio was significantly lower in Parkinson's disease patients (1.4±0.40, p=0.025) compared to controls (2.0±0.29), but not in multiple system atrophy (2.0±0.76). These findings indicate that autonomic dysfunction is generalized and predominantly preganglionic in multiple system atrophy, and postganglionic in Parkinson's disease. In our hands the Thermoregulatory Sweat Test provides the best distinction between MSA and PD. However further confirmatory studies using larger patient numbers are required. Currently a combination of clinical judgment and autonomic testing are recommended to help differentiate MSA and PD.</p></abstract><kwd-group><kwd>multiple system atrophy</kwd><kwd>Parkinson’s disease</kwd><kwd><sup>123</sup>I MIBG myocardial scintigraphy</kwd><kwd>autonomic reflex screen</kwd></kwd-group><funding-group><award-group><funding-source country="United States">National Institute of Neurological Disorders and Stroke : NINDS</funding-source><award-id>P50 NS032352-15 || NS</award-id></award-group><award-group><funding-source country="United States">National Institute of Neurological Disorders and Stroke : NINDS</funding-source><award-id>P50 NS032352-14 || NS</award-id></award-group><award-group><funding-source country="United States">National Institute of Neurological Disorders and Stroke : NINDS</funding-source><award-id>P50 NS032352-13 || NS</award-id></award-group><award-group><funding-source country="United States">National Institute of Neurological Disorders and Stroke : NINDS</funding-source><award-id>P50 NS032352-12 || NS</award-id></award-group><award-group><funding-source country="United States">National Institute of Neurological Disorders and Stroke : NINDS</funding-source><award-id>P50 NS032352-11 || NS</award-id></award-group><award-group><funding-source country="United States">National Institute of Neurological Disorders and Stroke : NINDS</funding-source><award-id>P50 NS032352-10 || NS</award-id></award-group><award-group><funding-source country="United States">National Institute of Neurological Disorders and Stroke : NINDS</funding-source><award-id>P50 NS032352-09 || NS</award-id></award-group><award-group><funding-source country="United States">National Institute of Neurological Disorders and Stroke : NINDS</funding-source><award-id>P50 NS032352-08 || NS</award-id></award-group><award-group><funding-source country="United States">National Institute of Neurological Disorders and Stroke : NINDS</funding-source><award-id>P50 NS032352-07 || NS</award-id></award-group><award-group><funding-source country="United States">National Institute of Neurological Disorders and Stroke : NINDS</funding-source><award-id>P50 NS032352-06A1 || NS</award-id></award-group><award-group><funding-source country="United States">National Institute of Neurological Disorders and Stroke : NINDS</funding-source><award-id>P50 NS032352-05 || NS</award-id></award-group></funding-group></article-meta></front></pmc><affiliations><list><country><li>Allemagne</li><li>Canada</li><li>Royaume-Uni</li><li>États-Unis</li></country><region><li>Angleterre</li><li>Berlin</li><li>Grand Londres</li></region><settlement><li>Berlin</li><li>Londres</li></settlement></list><tree><country name="Canada"><noRegion><name sortKey="Kimpinski, Kurt" sort="Kimpinski, Kurt" uniqKey="Kimpinski K" first="Kurt" last="Kimpinski">Kurt Kimpinski</name></noRegion></country><country name="Royaume-Uni"><region name="Angleterre"><name sortKey="Iodice, Valeria" sort="Iodice, Valeria" uniqKey="Iodice V" first="Valeria" last="Iodice">Valeria Iodice</name></region></country><country name="États-Unis"><noRegion><name sortKey="Burton, Duane D" sort="Burton, Duane D" uniqKey="Burton D" first="Duane D." last="Burton">Duane D. Burton</name></noRegion><name sortKey="Ahlskog, J E" sort="Ahlskog, J E" uniqKey="Ahlskog J" first="J E." last="Ahlskog">J E. Ahlskog</name><name sortKey="Camilleri, Michael" sort="Camilleri, Michael" uniqKey="Camilleri M" first="Michael" last="Camilleri">Michael Camilleri</name><name sortKey="Fealey, Robert D" sort="Fealey, Robert D" uniqKey="Fealey R" first="Robert D." last="Fealey">Robert D. Fealey</name><name sortKey="Gehrking, Tonette L" sort="Gehrking, Tonette L" uniqKey="Gehrking T" first="Tonette L." last="Gehrking">Tonette L. Gehrking</name><name sortKey="Low, Phillip A" sort="Low, Phillip A" uniqKey="Low P" first="Phillip A." last="Low">Phillip A. Low</name><name sortKey="Mullan, Brian P" sort="Mullan, Brian P" uniqKey="Mullan B" first="Brian P." last="Mullan">Brian P. Mullan</name><name sortKey="Sandroni, Paola" sort="Sandroni, Paola" uniqKey="Sandroni P" first="Paola" last="Sandroni">Paola Sandroni</name><name sortKey="Singer, Wolfgang" sort="Singer, Wolfgang" uniqKey="Singer W" first="Wolfgang" last="Singer">Wolfgang Singer</name><name sortKey="Sletten, David M" sort="Sletten, David M" uniqKey="Sletten D" first="David M." last="Sletten">David M. Sletten</name></country><country name="Allemagne"><region name="Berlin"><name sortKey="Lipp, Axel" sort="Lipp, Axel" uniqKey="Lipp A" first="Axel" last="Lipp">Axel Lipp</name></region></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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