Clinical Autonomic Research

, Volume 10, Issue 6, pp 337–342 | Cite as

Suppressed sympathetic skin response in Parkinson disease

  • Tarja H. Haapaniemi
  • Juha T. Korpelainen
  • Uolevi Tolonen
  • Kalervo Suominen
  • Kyösti A. Sotaniemi
  • Vilho V. Myllylä
Research Paper

Abstract

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 words

Parkinson disease autonomic nervous system sympathetic skin response Parkinson disease medication 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    van Dijk JG, Haan J, Zwinderman K, et al. Autonomic nervous system dysfunction in Parkinson's disease: Relationship with age, medication, duration and severity.J Neurol Neurosurg Psychiatry 1993; 56:1090–1095.PubMedGoogle Scholar
  2. 2.
    Piha SJ, Rinne UK, Seppänen A. Autonomic dysfunction in recent onset and advanced parkinson's disease.Clin Neurol Neurosurg 1988; 90:221–226.CrossRefPubMedGoogle Scholar
  3. 3.
    Singer C, Weiner WJ, Sanches-Ramos JR. Autonomic dysfunction in men with Parkinson's disease.Eur Neurol 1992; 32:134–140.PubMedGoogle Scholar
  4. 4.
    Magalhães M, Wenning GK, Daniel SE, et al. Autonomic dysfunction in pathologically confirmed multiple system atrophy and idiopathic Parkinson's disease: a retrospective comparison.Acta Neurol Scand 1995; 91:98–102.PubMedGoogle Scholar
  5. 5.
    Gross M, Bannister R, Godwin-Austen R. Orthostatic hypotension in Parkinson's disease.Lancet 1972; 1:174–176.PubMedGoogle Scholar
  6. 6.
    Goetz CG, Lutge W, Tanner CM. Autonomic dysfunction in Parkinson's disease.Neurology 1986; 36:73–75.PubMedGoogle Scholar
  7. 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. 8.
    Turkka JT, Tolonen U, Myllylä VV. Cardiovascular reflexes in Parkinson's disease.Eur Neurol 1987; 1:104–112.Google Scholar
  9. 9.
    Meco G, Pratesi L, Bonifati V. Cardiovascular reflexes and autonomic dysfunction in Parkinson's disease.J Neurol 1991; 238:195–199.CrossRefPubMedGoogle Scholar
  10. 10.
    Fagius J, Wallin BG. Sympathetic reflex latencies and conduction velocities in normal man.J Neurol Sci 1980; 47:433–448.PubMedGoogle Scholar
  11. 11.
    Uncini A, Pullman SL, Lovelace RE et al. The sympathetic skin response: normal values, elucation of afferent components and application limits.J Neurol Sci 1988; 87:299–306.CrossRefPubMedGoogle Scholar
  12. 12.
    Elie B, Guiheneuc P. Sympathetic skin response: normal results in different experimental conditions.Electroencephalogr Clin Neurophysiol 1990; 76:258–267.PubMedGoogle Scholar
  13. 13.
    Shahani BT, Day TJ, Ros D et al. RR interval variation and the sympathetic skin response in the assessment of autonomic function in peripheral neuropathy.Arch Neurol 1990; 47:659–664.PubMedGoogle Scholar
  14. 14.
    Soliven B, Maselli R, Jaspan J, et al. Sumpathetic skin response in diabetic neuropathy.Muscle Nerve 1987; 10:711–716.CrossRefPubMedGoogle Scholar
  15. 15.
    Montagna P, Salvi F, Liguori R. Sympathetic skin response in familial amyloid polyneuropathy [letter].Muscle Nerve 1988; 11:183–184.CrossRefPubMedGoogle Scholar
  16. 16.
    Niakan E, Harati Y. Sympathetic skin response in diabetic peripheral neuropathy.Muscle Nerve 1988; 11:711–716.CrossRefGoogle Scholar
  17. 17.
    Watahiki Y, Baba M, Matsunaga M, et al. Sympathetic skin response in diabetic neuropathy.Electromyogr Clin Neurophysiol 1989; 29:155–159.PubMedGoogle Scholar
  18. 18.
    Solders G, Andersson T, Persson A. Central conduction and autonomic nervous system in HMSN I.Muscle Nerve 1991; 14:1074–1079.CrossRefPubMedGoogle Scholar
  19. 19.
    Levy DM, Reid G, Rowley DA, et al. Quantitative measures of sympathetic skin response in diabetes: relation to sudomotor neurological function.J Neurol Neurosurg Psychiatry 1992; 55:902–908.PubMedGoogle Scholar
  20. 20.
    Taly AB, Muthane UB. Involvement of peripheral nervous system in juvenile Parkinson's disease.Acta Neurol Scand 1992; 85:272–275.PubMedGoogle Scholar
  21. 21.
    Braune HJ, Korchounov AM, Schipper HI. Autonomic dysfunction in Parkinson's disease assessed by sympathetic skin response: a prospective clinical and neurophysiological trial on 50 patients.Acta Neurol Scand 1997; 95:293–297.PubMedGoogle Scholar
  22. 22.
    Mano Y, Nakamuro T, Takayanagi T, et al. Sweat function in Parkinson's disease.J Neurol 1994; 241:573–576.CrossRefPubMedGoogle Scholar
  23. 23.
    Hirashima F, Yokota T, Hayashi M. Sympathetic skin response in Parkinson's disease.Acta Neurol Scand 1996; 93:127–132.PubMedGoogle Scholar
  24. 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. 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
  26. 26.
    Bordet R, Benhadjali J, Destee A, et al. Sympathetic skin response and R-R interval variability in multiple system atrophy and idiopathic Parkinson's disease.Mov Disord 1996; 11:268–272.CrossRefPubMedGoogle Scholar
  27. 27.
    Korpelainen JT, Tolonen U, Sotaniemi KA, et al. Suppressed sympathetic skin response in brain infarction.Stroke 1993; 24:1389–1392.PubMedGoogle Scholar
  28. 28.
    Yokota T, Matsunaga T, Okiyama R et al. Sympathetic skin response in patients with multiple sclerosis compared with patients with spinal cord transections and normal controls.Brain 1991; 114:1381–1394.PubMedGoogle Scholar
  29. 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
  30. 30.
    Hoehn MM, Yahr MD. Parkinsonism: onset, progression, and mortality.Neurology 1967; 17:427–442.PubMedGoogle Scholar
  31. 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
  32. 32.
    Shahani BT, Halperin JJ, Boulu P, et al. Sympathetic skin response—a method assessing unmyelinated axon dysfunction in peripheral neuropathies.J Neurol Neurosurg Psychiatry 1984; 47:536–542.PubMedGoogle Scholar
  33. 33.
    Fusina S, Conte L, Bertolasi E, et al. Sympathetic skin response in early stage idiopathic Parkinson's disease.Clin Neurophysiol 1999; 110:358–366.CrossRefPubMedGoogle Scholar
  34. 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
  35. 35.
    Lin TK, Chee EC, Chen HJ, et al. Abnormal sympathetic skin response in patients with palmar hyperhidrosis.Muscle Nerve 1995; 18:917–919.CrossRefPubMedGoogle Scholar
  36. 36.
    Bini G, Hagbarth KE, Hynninen P, et al. Thermoregulatory and rhythm-generating mechanisms governing the sudomotor and vasoconstrictor outflow in human cutaneous nerves.J Physiol 1980; 306:537–552.PubMedGoogle Scholar
  37. 37.
    Tugnoli V, Eleopra R, De Grandis D. Hyperhidrosis and sympa thetic skin response in chronic alcoholic patients.Clin Auton Res 1999; 9:17–22.CrossRefPubMedGoogle Scholar
  38. 38.
    Wilcott RC. Electrical stimulation of the anterior cortex and skin potential responses in cat.J Comp Physiol Psychol 1969, 69:465–472.PubMedGoogle Scholar
  39. 39.
    Langston JW, Forno LS. The hypothalamus in Parkinson's disease.Ann Neurol 1978; 3:129–133.CrossRefPubMedGoogle Scholar
  40. 40.
    Wakabayashi K, Takahashi H, Ohama E, et al. Lewy bodies in the visceral autonomic nervous system in Parkinson's disease.Adv Neurol 1993: 60:609–612.PubMedGoogle Scholar
  41. 41.
    Rajput AH, Rozdisky B. Dysautonomia in parkinsonism: a clinico pathological study.J Neurol Neurosurg Psychiatry 1976. 39:1092–1100.PubMedGoogle Scholar
  42. 42.
    Linden D, Berlit P. Sympathetic skin response (SSRs) in mono phocal brain lesions: topographical aspects of central sympathetic pathways.Acta Neurol Scand 1995; 91:372–376.PubMedGoogle Scholar

Copyright information

© Lippincott Williams & Wilkins 2000

Authors and Affiliations

  • Tarja H. Haapaniemi
    • 2
  • Juha T. Korpelainen
    • 2
  • Uolevi Tolonen
    • 1
  • Kalervo Suominen
    • 1
  • Kyösti A. Sotaniemi
    • 2
  • Vilho V. Myllylä
    • 2
  1. 1.Department of Clinical NeurophysiologyUniversity of OuluOuluFinland
  2. 2.Department of NeurologyUniversity of OuluOuluFinland

Personalised recommendations