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Fründt O, Grashorn W, Buhmann C, Forkmann K, Mainka T, Bingel U, Schmidt K. Quantitative Sensory Testing (QST) in Drug-Naïve Patients with Parkinson's Disease. JOURNAL OF PARKINSONS DISEASE 2020; 9:369-378. [PMID: 30829618 DOI: 10.3233/jpd-181513] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Pain is highly prevalent in patients with Parkinson's disease (PD), but underlying pathophysiological mechanisms are largely unclear. Alterations in somatosensory processing might contribute to sensory abnormalities in PD. OBJECTIVE This study investigated sensory processing in PD patients. METHODS We used the standardized "Quantitative Sensory Testing" (QST) protocol (German Research Network on Neuropathic Pain) to investigate 13 somatosensory parameters in 19 PD patients naïve to dopaminergic medication and 19 healthy controls matched for age, gender, and handedness. We tested for differences in sensory parameters between i) drug-naïve PD patients and healthy controls, ii) patients' more and less affected body side, and iii) for an association of somatosensory parameters with disease-specific factors. RESULTS We did not observe any significant group differences in somatosensory parameters between PD patients and healthy subjects. In PD patients, QST mean z-scores did not differ between the predominantly and the less affected body side, PD patients with and without PD-specific chronic pain or between different PD subtypes. Age, but not PD disease severity, was associated with a greater loss of function in thermal and mechanical detection thresholds. CONCLUSIONS Somatosensory processing, as assessed with the well-established QST protocol, was normal in drug-naïve PD patients. Thus, somatosensory abnormalities previously reported in medicated PD patients might rather be a result of dopaminergic medication, or may occur later in the course of the disease or with increasing age.
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Affiliation(s)
- Odette Fründt
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Wiebke Grashorn
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Carsten Buhmann
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Katarina Forkmann
- Department of Neurology, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Tina Mainka
- Department of Neurology, Charité Berlin, Berlin
| | - Ulrike Bingel
- Department of Neurology, University Hospital Essen, University Duisburg-Essen, Essen, Germany.,Erwin L. Hahn Institute for magnetic resonance imaging, Essen, Germany
| | - Katharina Schmidt
- Department of Neurology, University Hospital Essen, University Duisburg-Essen, Essen, Germany
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Nolano M, Provitera V, Manganelli F, Iodice R, Stancanelli A, Caporaso G, Saltalamacchia A, Califano F, Lanzillo B, Picillo M, Barone P, Santoro L. Loss of cutaneous large and small fibers in naive and l-dopa-treated PD patients. Neurology 2017; 89:776-784. [PMID: 28747449 DOI: 10.1212/wnl.0000000000004274] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Accepted: 05/30/2017] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE To study small and large fiber pathology in drug-naive and l-dopa-treated patients affected by Parkinson disease (PD) in early phases, before the occurrence of neuropathic electrophysiologic abnormalities. METHODS We enrolled 85 patients with idiopathic PD (male/female 49/36, age 61.3 ± 9.7 years) without electrophysiologic signs of neuropathy, including 48 participants naive to l-dopa treatment. All patients underwent clinical, functional, and morphologic assessment of sensory and autonomic nerves through dedicated questionnaires, quantitative sensory testing, sympathetic skin response, dynamic sweat test, and punch biopsies from glabrous and hairy skin. Sensory and autonomic innervation was visualized with specific antibodies and analyzed by confocal microscopy. Data were compared with those obtained from sex- and age-comparable healthy controls. In 35 patients, skin biopsies were performed bilaterally to evaluate side-to-side differences. RESULTS Intraepidermal nerve fiber density was lower in patients compared to controls in all the examined sites (p < 0.001). The loss was higher in the more affected side (p < 0.01). A loss of autonomic nerves to vessels, sweat glands, and arrector pili muscles and of Meissner corpuscles and their myelinated endings in glabrous skin was found (p < 0.001). Patients showed increased tactile and thermal thresholds, impairment of mechanical pain perception, and reduced sweat output (p < 0.001). The naive and l-dopa-treated groups differed only for Meissner corpuscle density (p < 0.001). CONCLUSIONS Both large and small fiber pathology occurs in the early stages of PD and may account for the sensory and autonomic impairment. l-Dopa affects the 2 populations of fibers differently.
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Affiliation(s)
- Maria Nolano
- From the Neurology Department (M.N., V.P., A.S., G.C., A.S., F.C., B.L.), Istituti Clinici Scientifici Maugeri SpA Società Benefit, IRCCS Telese Terme, Benevento; Department of Neurosciences, Reproductive Sciences and Odontostomatology (F.M., R.I., L.S.), University Federico II of Naples; and Centre for Neurodegenerative Diseases (M.P., P.B.), Department of Medicine and Surgery, Neuroscience Section, University of Salerno, Italy.
| | - Vincenzo Provitera
- From the Neurology Department (M.N., V.P., A.S., G.C., A.S., F.C., B.L.), Istituti Clinici Scientifici Maugeri SpA Società Benefit, IRCCS Telese Terme, Benevento; Department of Neurosciences, Reproductive Sciences and Odontostomatology (F.M., R.I., L.S.), University Federico II of Naples; and Centre for Neurodegenerative Diseases (M.P., P.B.), Department of Medicine and Surgery, Neuroscience Section, University of Salerno, Italy
| | - Fiore Manganelli
- From the Neurology Department (M.N., V.P., A.S., G.C., A.S., F.C., B.L.), Istituti Clinici Scientifici Maugeri SpA Società Benefit, IRCCS Telese Terme, Benevento; Department of Neurosciences, Reproductive Sciences and Odontostomatology (F.M., R.I., L.S.), University Federico II of Naples; and Centre for Neurodegenerative Diseases (M.P., P.B.), Department of Medicine and Surgery, Neuroscience Section, University of Salerno, Italy
| | - Rosa Iodice
- From the Neurology Department (M.N., V.P., A.S., G.C., A.S., F.C., B.L.), Istituti Clinici Scientifici Maugeri SpA Società Benefit, IRCCS Telese Terme, Benevento; Department of Neurosciences, Reproductive Sciences and Odontostomatology (F.M., R.I., L.S.), University Federico II of Naples; and Centre for Neurodegenerative Diseases (M.P., P.B.), Department of Medicine and Surgery, Neuroscience Section, University of Salerno, Italy
| | - Annamaria Stancanelli
- From the Neurology Department (M.N., V.P., A.S., G.C., A.S., F.C., B.L.), Istituti Clinici Scientifici Maugeri SpA Società Benefit, IRCCS Telese Terme, Benevento; Department of Neurosciences, Reproductive Sciences and Odontostomatology (F.M., R.I., L.S.), University Federico II of Naples; and Centre for Neurodegenerative Diseases (M.P., P.B.), Department of Medicine and Surgery, Neuroscience Section, University of Salerno, Italy
| | - Giuseppe Caporaso
- From the Neurology Department (M.N., V.P., A.S., G.C., A.S., F.C., B.L.), Istituti Clinici Scientifici Maugeri SpA Società Benefit, IRCCS Telese Terme, Benevento; Department of Neurosciences, Reproductive Sciences and Odontostomatology (F.M., R.I., L.S.), University Federico II of Naples; and Centre for Neurodegenerative Diseases (M.P., P.B.), Department of Medicine and Surgery, Neuroscience Section, University of Salerno, Italy
| | - Annamaria Saltalamacchia
- From the Neurology Department (M.N., V.P., A.S., G.C., A.S., F.C., B.L.), Istituti Clinici Scientifici Maugeri SpA Società Benefit, IRCCS Telese Terme, Benevento; Department of Neurosciences, Reproductive Sciences and Odontostomatology (F.M., R.I., L.S.), University Federico II of Naples; and Centre for Neurodegenerative Diseases (M.P., P.B.), Department of Medicine and Surgery, Neuroscience Section, University of Salerno, Italy
| | - Francesca Califano
- From the Neurology Department (M.N., V.P., A.S., G.C., A.S., F.C., B.L.), Istituti Clinici Scientifici Maugeri SpA Società Benefit, IRCCS Telese Terme, Benevento; Department of Neurosciences, Reproductive Sciences and Odontostomatology (F.M., R.I., L.S.), University Federico II of Naples; and Centre for Neurodegenerative Diseases (M.P., P.B.), Department of Medicine and Surgery, Neuroscience Section, University of Salerno, Italy
| | - Bernardo Lanzillo
- From the Neurology Department (M.N., V.P., A.S., G.C., A.S., F.C., B.L.), Istituti Clinici Scientifici Maugeri SpA Società Benefit, IRCCS Telese Terme, Benevento; Department of Neurosciences, Reproductive Sciences and Odontostomatology (F.M., R.I., L.S.), University Federico II of Naples; and Centre for Neurodegenerative Diseases (M.P., P.B.), Department of Medicine and Surgery, Neuroscience Section, University of Salerno, Italy
| | - Marina Picillo
- From the Neurology Department (M.N., V.P., A.S., G.C., A.S., F.C., B.L.), Istituti Clinici Scientifici Maugeri SpA Società Benefit, IRCCS Telese Terme, Benevento; Department of Neurosciences, Reproductive Sciences and Odontostomatology (F.M., R.I., L.S.), University Federico II of Naples; and Centre for Neurodegenerative Diseases (M.P., P.B.), Department of Medicine and Surgery, Neuroscience Section, University of Salerno, Italy
| | - Paolo Barone
- From the Neurology Department (M.N., V.P., A.S., G.C., A.S., F.C., B.L.), Istituti Clinici Scientifici Maugeri SpA Società Benefit, IRCCS Telese Terme, Benevento; Department of Neurosciences, Reproductive Sciences and Odontostomatology (F.M., R.I., L.S.), University Federico II of Naples; and Centre for Neurodegenerative Diseases (M.P., P.B.), Department of Medicine and Surgery, Neuroscience Section, University of Salerno, Italy
| | - Lucio Santoro
- From the Neurology Department (M.N., V.P., A.S., G.C., A.S., F.C., B.L.), Istituti Clinici Scientifici Maugeri SpA Società Benefit, IRCCS Telese Terme, Benevento; Department of Neurosciences, Reproductive Sciences and Odontostomatology (F.M., R.I., L.S.), University Federico II of Naples; and Centre for Neurodegenerative Diseases (M.P., P.B.), Department of Medicine and Surgery, Neuroscience Section, University of Salerno, Italy
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