title: Skin biopsy for assessment of autonomic denervation in Parkinson's disease.
abstract: Autonomic dysfunction in Parkinson's disease (PD) is considered a late complication of the disease or an adverse effect of anti-parkinsonian medications. Morphological changes are demonstrated only by postmortem examination. The study objective was to evaluate peripheral autonomic neural involvement in PD using punch skin biopsy. The study sample included 22 patients (mean age 50 +/- 7.7 years, mean disease duration 5.3 +/- 3.8 years) and 19 controls. Four-millimeter skin biopsies were immunohistochemically stained with anti-PGP 9.5 antibody. Autonomic innervation of the blood vessels, sweat glands, and erector pili muscles was assessed and rated from 0 (normal) to 2 (severe). Cutaneous autonomic innervation was decreased in patients compared to controls. Semi quantitative analysis demonstrated reduced autonomic innervation of the blood vessels (1.0 +/- 0.8 vs. 0.42 +/- 0.8 in controls; p < 0.02), of sweat glands (0.95 +/- 0.67 vs. 0.47 +/- 0.61; p < 0.02) and of the erector pili muscles (1.06 +/- 0.55 vs 0.21 +/- 0.42; p < 0.001). This method demonstrates that the peripheral autonomic system is affected in PD at early stage of the disease and that autonomic involvement in PD may be more prevalent than previously thought.
authors.affiliation: Department of Neurology, Edith Wolfson Medical Center, Holon, Israel.
authors.forename: R
authors.initials: R
authors.lastname: Dabby
authors.forename: R
authors.initials: R
authors.lastname: Djaldetti
authors.forename: M
authors.initials: M
authors.lastname: Shahmurov
authors.forename: T A
authors.initials: TA
authors.lastname: Treves
authors.forename: B
authors.initials: B
authors.lastname: Gabai
authors.forename: E
authors.initials: E
authors.lastname: Melamed
authors.forename: M
authors.initials: M
authors.lastname: Sadeh
authors.forename: I
authors.initials: I
authors.lastname: Avinoach
mesh_terms: D000328:Adult; D017763:Autonomic Denervation; D001808:Blood Vessels / Q000378:metabolism / Q000473:pathology; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D008297:Male; D008875:Middle Aged; D009130:Muscle, Smooth / Q000187:drug effects / Q000502:physiology; D010300:Parkinson Disease / Q000175:diagnosis* / Q000473:pathology*; D010863:Piloerection / Q000187:drug effects / Q000502:physiology; D012039:Regional Blood Flow / Q000187:drug effects / Q000502:physiology; D012867:Skin / Q000098:blood supply / Q000294:innervation* / Q000473:pathology*; D013545:Sweat Glands / Q000187:drug effects / Q000502:physiology; D043222:Ubiquitin Thiolesterase / Q000737:chemistry / Q000378:metabolism
chemical_list: C482860:UCHL1 protein, human; D043222:Ubiquitin Thiolesterase