title: Pilomotor function is impaired in patients with Parkinson's disease: A study of the adrenergic axon-reflex response and autonomic functions.
abstract: Autonomic nervous system disturbances including sweating abnormalities and cardiovascular symptoms are frequent in Parkinson's disease (PD) and often precede motor involvement. Cholinergic vasomotor and sudomotor skin nerves are impaired in patients with PD even at early disease stages. We hypothesized that adrenergic pilomotor nerve function is similarly impaired in early PD and might constitute a novel diagnostic target.
  
  
  
  We conducted a study in 12 PD patients (Hoehn&Yahr 1-2) and 12 healthy control subjects. Pilomotor function was evaluated after iontophoresis of phenylephrine on the dorsal forearm to elicit axon-reflex mediated pilomotor erection (goose bumps). Silicone impressions were obtained, scanned and quantified for pilomotor muscle impressions by number, area and axon-reflex spread. Vasomotor function was evaluated using laser Doppler flowmetry and sudomotor function via sympathetic skin response. Cardiac autonomic function was assessed via heart rate variability. Severity of autonomic symptoms was evaluated using the Scales for Outcomes in Parkinson's disease-Autonomic questionnaire.
  
  
  
  Pilomotor response was reduced in PD patients compared to control subjects (impression number: 12.2 ± 8.2 vs. 16.5 ± 5.9, p < 0.05; impression area: 10.8 ± 2.2 mm2vs. 24.8 ± 3.1 mm2, p < 0.01; axon-reflex spread: 89.0 ± 10.6 mm2vs. 185.9 ± 10.8 mm2, p < 0.01) and correlated negatively with severity of autonomic symptoms (p < 0.01). Similarly, sudomotor (p < 0.01) and vasomotor (p < 0.05) but not cardiac autonomic (p = n.s.) function were reduced in PD patients versus control subjects.
  
  
  
  Pilomotor function is impaired in early stages of PD. Pilomotor axon-reflex assessment might be useful in the investigation of disease related pathology and supplement other clinical markers of autonomic neuropathy in PD.
authors: Department of Neurology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany. Electronic address: timo.siepmann@uniklinikum-dresden.de.
authors: Timo
authors: T
authors: Siepmann
authors: Department of Neurology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.
authors: Elka
authors: E
authors: Frenz
authors: Institute of Clinical Pharmacology, Medical Faculty Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.
authors: Ana Isabel
authors: AI
authors: Penzlin
authors: Portland, OR, USA.
authors: Susan
authors: S
authors: Goelz
authors: Prothena Biosciences Inc, South San Francisco, CA, USA.
authors: Wagner
authors: W
authors: Zago
authors: Department of Cardiac Surgery, Children's Hospital Boston, Harvard Medical School, Boston, MA, USA.
authors: Ingeborg
authors: I
authors: Friehs
authors: Department of Neurology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.
authors: Marie Luise
authors: ML
authors: Kubasch
authors: Department of Neurology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.
authors: Miriam
authors: M
authors: Wienecke
authors: Department of Neurology, Universitätsmedizin Rostock, Rostock, Germany.
authors: Matthias
authors: M
authors: Löhle
authors: Department of Neurology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.
authors: Wiebke
authors: W
authors: Schrempf
authors: Department of Neurology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.
authors: Kristian
authors: K
authors: Barlinn
authors: Institute of Clinical Pharmacology, Medical Faculty Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.
authors: Joachim
authors: J
authors: Siegert
authors: Department of Neurology, Universitätsmedizin Rostock, Rostock, Germany.
authors: Alexander
authors: A
authors: Storch
authors: Department of Neurology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.
authors: Heinz
authors: H
authors: Reichmann
authors: Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
authors: Ben Min-Woo
authors: BM
authors: Illigens
mesh_terms: D018663:Adrenergic Agents; D058646:Adrenergic alpha-1 Receptor Agonists / Q000494:pharmacology; D000368:Aged; D001342:Autonomic Nervous System Diseases / Q000209:etiology*; D001369:Axons / Q000187:drug effects / Q000502:physiology*; D005260:Female; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D017078:Laser-Doppler Flowmetry; D008297:Male; D008875:Middle Aged; D010300:Parkinson Disease / Q000150:complications*; D010656:Phenylephrine / Q000494:pharmacology*; D012018:Reflex / Q000187:drug effects / Q000502:physiology*; D012720:Severity of Illness Index; D012867:Skin / Q000098:blood supply / Q000294:innervation*; D018709:Statistics, Nonparametric
chemical_list: D018663:Adrenergic Agents; D058646:Adrenergic alpha-1 Receptor Agonists; D010656:Phenylephrine
keywords: Autonomic; Axon-reflex; Diagnosis; Parkinson's disease; Pilomotor