The hypothalamus in Parkinson Disease

  • Sandyk R. 
  • Iacono R. P. 
  • Bamford C. R. 
Editorial

Abstract

It is currently believed that Parkinson disease (PD) is due to a degenerative process that independently damages multiple areas of the central and peripheral nervous system. Loss of nigrostriatal dopamine is now widely recognized as being directly related to the motor symptoms in Parkinson's disease. Parkinsonian patients also exhibit symptoms and signs suggestive of hypothalamic dysfunction (e.g. dysautonomia, impaired heat tolerance). The latter clinical features are supported by pathological, biochemical and endocrinological findings. Lewy body formation has been demonstrated in every nucleus of the hypothalamus, specifically the tuberomamillary and posterior hypothalamic. Preferential involvement of the hypothalamus was also noted in patients after post-encephalitic parkinsonism. Loss of dopamine (30–40%) in the hypothalamus of affected patients has been shown in recent studies, and is compatible with the reported abnormalities of growth hormone release in response to L-dopa administration, elevated plasma levels of MSH, and reduced CSF levels of somatostatin and beta-endorphins in these patients. Deranged immunological mechanisms have been found in PD patients including the presence of autoantibodies against sympathetic ganglia neurons, adrenal medulla and caudate nucleus. On the evidence of on pathological studies demonstrating the early vulnerability of the hypothalamus in aging and PD, and the known role of the hypoth lamus in immune modulation, we expect that it will be shown that primary damage ot the hypothalamus leads to subsequent secondary degeneration of structures receiving direct projections from the hypothalamus. Within this framework, the dopaminergic systems may be damaged, since striatal dopamine synthesis and receptor sensitivity have been shown to be regulated by ACTH and alpha-MSH through direct arcuate nucleus-striatal projections. We also demonstrate that virtually all other areas well known to be impacted upon in Parkinson disease receive significant hypothalamic peptidergic projections.

Key-Words

Parkinson disease 

Sommario

Si ritiene correntemente che la malattia di Parkinson (P.D.) sia dovuta ad un processo degenerativo che danneggia numerose zone del sistema nervoso centrale e di quello periferico. Si sa che la carenza di dopomine nigrostriale è certamente correlata ai disturbi motori in questa malattia. Ma i parkinsoniani hanno anche sintomi e segni suggestivi per un interessamento ipotalamico (disautonomia e ridotta tolleranza al calore). Questi aspetti clinici sono dovuti a fattori patologici sia biochimici che endocrinologici. È stata dimostrata la formazione di corpi Lewy in ogni nucleo dell'ipotolamo specialmente in quelli tubero mamillare e posteriori e un interessamento preferenziale, dell'ipotolamo è stato segnalato in pazienti affetti da parkinsonismo postencefalitico. Una perdita di dopamina del 30/40% nell'ipotalamo è stata vista in recenti ricerche ed è compatibile con la anormalità di formazione dell'ormone della crescita in risposta all'L-dopa e livelli ridotti di somatostatina e di beta-endorfina nel liquor. Meccanismi di sregolazione immunologica sono stati trovati in pazienti parkinsoniani quale la presenza di autoanticorpi contro neuroni dei gangli simpatici e del nucleo candato. Poiché sappiamo che vi è una precoce vulnerabilità dell'ipotalamo nella vecchiaia e nel morbo di Parkinson e conosciamo il ruolo delliipotalamo nell'immunamodulazione ci attendiamo che un danno primitivo dell'ipotalamo posti a una secondaria degenerazione delle strutture che ricevono una diretta proiezione dell'ipotalamo. All'interno di questa struttura i sistemi dopasinergici possono essere danneggiati del momento che la sintesi di dopamina e la sensibilità dei recettori sono regolata dall'ACTH e dell'ormone stimolante le alpha-melanoiti attraverso la proiezione arcate nucleostristriatali. Noi dimostriamo inoltre che virtualmente tutte le altre aree interessate nel morbo di Parkinson ricevono importanti proiezioni ipotalamiche peptidergiche.

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Copyright information

© Masson Italia Editori 1987

Authors and Affiliations

  • Sandyk R. 
    • 2
  • Iacono R. P. 
    • 1
  • Bamford C. R. 
    • 2
  1. 1.Department of Surgery (Neurosurgery)University of ArizonaTucson
  2. 2.M.Sc. Department of NeurologyArizona Health Sciences CenterTucson

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