title: Small (autonomic) and large fiber neuropathy in Parkinson disease and parkinsonism.
abstract: BACKGROUND
  Recent studies have reported that peripheral neuropathy (PN) is common in patients with Parkinson's disease (PD) and raised the possibility that levodopa neurotoxicity is the main culprit.
  
  
  METHODS
  We evaluated the presence of large & small (autonomic) fiber PN in 54 consecutive patients with PD or parkinsonism in a tertiary outpatient clinic from Brazil. Initial PN screening consisted of history/neurological exam and skin wrinkling test (SWT). In addition, we also performed Nerve conduction studies/Electromyography (NCS/EMG) in all patients with PN signs/symptoms and/or abnormal SWT.
  
  
  RESULTS
  Thirty eight patients with PD (10 women, mean age: 63 ± 2.1 years, P < 0.05 versus parkinsonism, mean disease duration: 8 ± 0.8 years) and 16 patients with other forms of parkinsonism [7 women, mean age: 50.1 ± 3.9 years, mean disease duration: 6.9 ± 1.1 years] completed clinical neuromuscular evaluation. SWT was performed in 48 patients (33 PD, 15 parkinsonism). In the PD group, SWT was abnormal in 57.6% of the tested patients (comprising 50% of all PD patients). In the parkinsonism group, SWT was abnormal in 37.5% (comprising 35.3% of all parkinsonism patients). NCS/EMG was performed in 39 patients (26 PD and 13 parkinsonism). Twelve out of the 26 PD (34.2% of all PD) and 4 out of the 13 parkinsonism (23.5% of all parkinsonism) had abnormal NCS/EMG results. Neuropathy prevalence was similar in PD and parkinsonism groups as detected either by NCS/EMG or SWT.
  
  
  CONCLUSIONS
  Large fiber and small (autonomic) fiber PN are common in patients with PD and parkinsonism. The etiology for the neuropathy was likely to be multifactorial and may be secondary to PD itself.
authors.affiliation: Federal University of Ceará (UFC), Professor Costa Mendes Street, 949, Fortaleza, Ceará, Brazil.
authors.forename: Davi Farias
authors.initials: DF
authors.lastname: de Araújo
authors.affiliation: Federal University of Ceará (UFC), Professor Costa Mendes Street, 949, Fortaleza, Ceará, Brazil.
authors.forename: Antônio Pinto
authors.initials: AP
authors.lastname: de Melo Neto
authors.affiliation: Federal University of Ceará (UFC), Professor Costa Mendes Street, 949, Fortaleza, Ceará, Brazil.
authors.forename: Ítalo Sérgio Cavalcante
authors.initials: ÍS
authors.lastname: Oliveira
authors.affiliation: Federal University of Ceará (UFC), Professor Costa Mendes Street, 949, Fortaleza, Ceará, Brazil.
authors.forename: Beatriz Soares
authors.initials: BS
authors.lastname: Brito
authors.affiliation: Federal University of Ceará (UFC), Professor Costa Mendes Street, 949, Fortaleza, Ceará, Brazil.
authors.forename: Ineusi Teixeira
authors.initials: IT
authors.lastname: de Araújo
authors.affiliation: Federal University of Ceará (UFC), Professor Costa Mendes Street, 949, Fortaleza, Ceará, Brazil.
authors.forename: Ingrid Sousa
authors.initials: IS
authors.lastname: Barros
authors.affiliation: Departamento de Saúde Comunitária, State University of Ceará (UECE), Fortaleza, Ceará, Brazil.
authors.forename: José Wellington Oliveira
authors.initials: JW
authors.lastname: Lima
authors.affiliation: Department of Internal Medicine, Neurology Division, Federal University of Ceará, Professor Costa Mendes Street, 1608, Fortaleza, Ceará, Brazil.
authors.forename: Wagner Goes
authors.initials: WG
authors.lastname: Horta
authors.affiliation: Department of Internal Medicine, Neurology Division, Federal University of Ceará, Professor Costa Mendes Street, 1608, Fortaleza, Ceará, Brazil. gondimfranc@gmail.com.
authors.forename: Francisco de Assis Aquino
authors.initials: Fde A
authors.lastname: Gondim
mesh_terms: D000367:Age Factors; D000368:Aged; D000978:Antiparkinson Agents / Q000009:adverse effects / Q000627:therapeutic use*; D001342:Autonomic Nervous System Diseases / Q000209:etiology; D017776:Autonomic Pathways / Q000187:drug effects*; D048909:Diabetes Complications; D004576:Electromyography / Q000379:methods; D005260:Female; D006801:Humans; D007980:Levodopa / Q000009:adverse effects / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D009431:Neural Conduction / Q000502:physiology; D009469:Neuromuscular Junction / Q000502:physiology; D010300:Parkinson Disease / Q000188:drug therapy*; D020734:Parkinsonian Disorders / Q000188:drug therapy*; D010523:Peripheral Nervous System Diseases / Q000209:etiology*; D012867:Skin / Q000294:innervation
chemical_list: D000978:Antiparkinson Agents; D007980:Levodopa
keywords: Neuromuscular disorders; Parkinsonism; Parkinson’s disease; Peripheral neuropathy; Skin Wrinkling test