Suppressed sympathetic skin response in Parkinson disease
The sympathetic skin response (SSR) was used to evaluate sympathetic sudomotor activity in Parkinson disease (PD) and the effects of antiparkinsonian medication on the disease. We recorded SSRs to electric and auditory stimulation in 58 untreated patients with PD and in 20 healthy controls. In addition to amplitude and latency measurements, we examined the number of SSRs evoked by a single stimulus and the response adaptation after repetitive stimuli. The patients with PD subsequently were randomized for administration of levodopa/carbidopa (n=19), bromocriptine (n=20), or selegiline (n=19) as their initial treatment. The measurement were repeated after 6 months of medication and after a washout period. SSR amplitudes were significantly lower in patients with PD than in the control subjects at baseline. The amplitude reduction was more pronounced in patients with high Unified Parkinson's Disease Rating Scale scores, in those with high tremor scores, and in those with PD symptoms that had lasted more than 1 year. The levodopa/carbidopa and bromocriptine treatments did not influence SSRs, although selegiline slightly decreased the amplitude. The synchronous responses after a single stimulus were often repetitive in the patients with PD than in the controls, although the response adaptation tendencies were similar. In conclusion, the degenerative process in PD involves the sudomotor system as reflected by the progressive suppression of SSR amplitudes with a correlation to PD symptom duration and clinical disability, whereas PD medications seems to have only minor effects. The changes in amplitude and the repetitiveness of SSRs with normal adaptation may be caused by deficits at several levels of the SSR reflex arch.
Key wordsParkinson disease autonomic nervous system sympathetic skin response Parkinson disease medication
Unable to display preview. Download preview PDF.
- 7.Camerlingo M, Aillon C, Bottacchi E et al. Parasympathetic assessment in Parkinson's disease. In:Advances in neurology Vol. 45 Yahr MD, Bergmann J, eds. New York: Raven; 1986. pp. 267–269.Google Scholar
- 8.Turkka JT, Tolonen U, Myllylä VV. Cardiovascular reflexes in Parkinson's disease.Eur Neurol 1987; 1:104–112.Google Scholar
- 24.Korczyn AD. Autonomic nervous system disturbances in Parkinson's disease. In:Advances in neurology. Vol. 53. Streifler MB, Korczyn AD, Melamed E, et al. eds. New York: Raven, 1990. pp. 463–468.Google Scholar
- 25.Wang SJ, Fuh JL, Shan DE, et al. Sympathetic skin response and R-R interval variation in Parkinson's disease.Mov Disord 1993; 2:151–157.Google Scholar
- 29.Daniel SE, Lees AJ. Parkinson's Disease Society Brain Bank, London: overview and research.J. Neural Transm 1993; 39(suppl): S165-S172.Google Scholar
- 31.Fahn S, Elton RL, the members of the UPDRS Development Committee. UPDRS: Unified Parkinson's Disease Rating Scale. In:Recent development in Parkinson's disease. Vol. 2. Fahn S Marsden CD, Calne DB, et al. eds. Florham Park, NJ: Macmillan Health Care Information; 1987. pp. 153–164.Google Scholar
- 34.Schondorf R. The role of the sympathetic skin response in the assessment of the autonomic function. In:Clinical autonomic disorders-evaluation and management. Low PE ed. New York: Little, Brown; 1993. pp. 231–241.Google Scholar