Article

Journal of Neural Transmission

, Volume 113, Issue 9, pp 1169-1176

First online:

Skin biopsy for assessment of autonomic denervation in Parkinson’s disease

  • R. DabbyAffiliated withDepartment of Neurology, Edith Wolfson Medical Center
  • , R. DjaldettiAffiliated withDepartment of Neurology, Rabin Medical Center
  • , M. ShahmurovAffiliated withInstitute of Pathology, Edith Wolfson Medical Center
  • , T. A. TrevesAffiliated withDepartment of Neurology, Rabin Medical Center
  • , B. GabaiAffiliated withDepartment of Dermatology, Rabin Medical CenterSackler Faculty of Medicine, Tel Aviv University
  • , E. MelamedAffiliated withDepartment of Neurology, Rabin Medical Center
  • , M. SadehAffiliated withDepartment of Neurology, Edith Wolfson Medical Center
  • , I. AvinoachAffiliated withInstitute of Pathology, Edith Wolfson Medical Center

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Summary.

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.

Keywords: Parkinson’s disease, autonomic denervation, skin biopsy, PGP 9.5.