title: Concentrations of indoleamine metabolic intermediates in the ventricular cerebrospinal fluid of advanced Parkinson's patients with severe postural instability and gait disorders.
abstract: Postural instability and gait disorders (PIGD) are the primary causes of disability in many but not all advanced Parkinson's disease (PD) patients. We have measured the concentrations of serotonin, 5-hydroxytryptophan (5-HTP), 5-hydroxy-3-indoleacetic acid (5-HIAA), and homovanillic acid (HVA) in samples of ventricular cerebrospinal fluid from ten PD patients with severe disability from PIGD and from ten PD patients with tremor and levodopa induced dyskinesia as their predominant motor dysfunction. The two groups were prospectively matched for duration of disease and age. No significant differences between the two groups were found in the concentration (mean +/- SD in ng/ml, PIGD dominant vs. tremor-dyskinesia dominant) of 5-HIAA (106 +/- 50 vs. 99 +/- 34) or HVA (1,068 +/- 595 vs. 881 +/- 469). Serotonin concentration was significantly lower (0.7 +/- 0.5 vs. 1.5 +/- 0.9) and 5-HTP concentration was substantially higher (684 +/- 1,054 vs. 6 +/- 5) in the patient group with PIGD as their predominant symptoms. Thus, the distinguishing feature of patients with severe PIGD appears to be a derangement in indoleamine metabolism at the reaction step catalyzed by aromatic amino acid decarboxylase (AADC). These findings suggest that aggravation of PIGD in advanced Parkinson's may be related in part to impaired serotonergic transmission secondary to inhibition or down regulation of AADC.
authors.affiliation: Clinical Neuroscience Research Group, Loma Linda University, Loma Linda Medical Center, CA 92350, U.S.A.
authors.forename: R P
authors.initials: RP
authors.lastname: Iacono
authors.forename: S M
authors.initials: SM
authors.lastname: Kuniyoshi
authors.forename: J R
authors.initials: JR
authors.lastname: Ahlman
authors.forename: G J
authors.initials: GJ
authors.lastname: Zimmerman
authors.forename: G
authors.initials: G
authors.lastname: Maeda
authors.forename: R D
authors.initials: RD
authors.lastname: Pearlstein
mesh_terms: D006916:5-Hydroxytryptophan / Q000134:cerebrospinal fluid; D000368:Aged; D001679:Biogenic Amines / Q000378:metabolism*; D002552:Cerebral Ventricles / Q000378:metabolism; D005684:Gait; D006719:Homovanillic Acid / Q000134:cerebrospinal fluid; D006801:Humans; D006897:Hydroxyindoleacetic Acid / Q000134:cerebrospinal fluid; D007211:Indoles / Q000378:metabolism*; D008875:Middle Aged; D009994:Osmolar Concentration; D010300:Parkinson Disease / Q000134:cerebrospinal fluid* / Q000503:physiopathology*; D011187:Posture; D012701:Serotonin / Q000134:cerebrospinal fluid
chemical_list: D001679:Biogenic Amines; D007211:Indoles; D012701:Serotonin; D006897:Hydroxyindoleacetic Acid; D006916:5-Hydroxytryptophan; D006719:Homovanillic Acid