title: Myocardial sympathetic degeneration correlates with clinical phenotype of Parkinson's disease.
abstract: In idiopathic Parkinson's disease (PD), different clinical subtypes are distinguished due to predominant motor symptoms: a tremor-dominant type (TDT), an akinetic rigid type (ART), and a mixed type (MT). We compared myocardial sympathetic innervation, measured by MIBG scintigraphy, in different subtypes of PD at early and advanced stages of PD. We applied MIBG scintigraphy in 102 patients with PD. About 57 patients were at Hoehn and Yahr (H&Y) stage 1, 22 at H&Y stage 2, and 23 at H&Y stages 3 and 4. For quantification of myocardial MIBG uptake, the heart-to-mediastinum (H/M) count-ratio was calculated. At all H&Y stages, myocardial MIBG uptake was significantly higher in TDT patients than in ART or MT patients (P < 0.05; ANOVA). Furthermore, at each H&Y stage, myocardial MIBG uptake correlated significantly with severity of hypokinesia (P < 0.05; Spearman's correlation) and rigidity (P < 0.05), but not with severity of resting or postural tremor. The significant correlation between myocardial sympathetic degeneration and severity of hypokinesia and rigidity suggests that myocardial sympathetic degeneration and hypokinetic-rigid symptoms develop in a closely coupled manner in early as well as advanced PD. No such correlation can be found between myocardial sympathetic degeneration and parkinsonian tremor.
authors.affiliation: Department of Neurology, Saarland University, D-66421 Homburg/Saar, Germany. nejspi@uniklinik-saarland.de
authors.forename: Jörg
authors.initials: J
authors.lastname: Spiegel
authors.forename: Dirk
authors.initials: D
authors.lastname: Hellwig
authors.forename: Georgios
authors.initials: G
authors.lastname: Farmakis
authors.forename: Wolfgang H
authors.initials: WH
authors.lastname: Jost
authors.forename: Samuel
authors.initials: S
authors.lastname: Samnick
authors.forename: Klaus
authors.initials: K
authors.lastname: Fassbender
authors.forename: Carl-Martin
authors.initials: CM
authors.lastname: Kirsch
authors.forename: Ulrich
authors.initials: U
authors.lastname: Dillmann
mesh_terms: D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D001342:Autonomic Nervous System Diseases / Q000150:complications* / Q000000981:diagnostic imaging / Q000473:pathology*; D001794:Blood Pressure; D005260:Female; D006801:Humans; D007457:Iodine Radioisotopes / Q000493:pharmacokinetics; D008297:Male; D008875:Middle Aged; D009206:Myocardium / Q000473:pathology*; D010300:Parkinson Disease / Q000150:complications* / Q000000981:diagnostic imaging / Q000473:pathology; D010641:Phenotype; D011877:Radionuclide Imaging / Q000379:methods; D012720:Severity of Illness Index
chemical_list: D007457:Iodine Radioisotopes