Thermoregulatory Dysfunction in Parkinson’s Disease

  • Mark S. LeDouxEmail author
Part of the Current Clinical Neurology book series (CCNEU)


Homeotherms, such as humans with Parkinson’s disease, must maintain core body temperature in a narrow range in the face of fluctuating environmental surroundings and endogenous heat production. A complex and highly integrated collection of autonomic, endocrine, and behavioral responses are involved in the maintenance of core temperature. Dopaminergic innervation of the preoptic and anterior hypothalamus plays an important role in the central nervous system’s control of body temperature. Due to a combination of central dopamine deficiency and peripheral autonomic dysfunction, individuals with Parkinson’s disease may experience heat and/or cold intolerance and paroxysmal hyperhidrosis. Sudomotor dysfunction in Parkinson’s disease can be documented with the sympathetic skin response and quantitative sudomotor axon reflex and thermoregulatory sweat tests.


Parkinson’s disease Thermoregulatory Sweat Sympathetic Hypothalamus Autonomic Dopamine Sudomotor 


  1. 1.
    Kelso SR, Perlmutter MN, Boulant JA. Thermosensitive single-unit activity of in vitro hypothalamic slices. Am J Physiol. 1982;242:R77–84.PubMedGoogle Scholar
  2. 2.
    Smith JE, Jansen AS, Gilbey MP, Loewy AD. CNS cell groups projecting to sympathetic outflow of tail artery: neural circuits involved in heat loss in the rat. Brain Res. 1998;786:153–64.PubMedCrossRefGoogle Scholar
  3. 3.
    Lin MT, Chandra A, Tsay BL, Chern YF. Hypothalamic and striatal dopamine receptor activation inhibits heat production in the rat. Am J Physiol. 1982;242:R471–81.PubMedGoogle Scholar
  4. 4.
    Scott IM, Boulant JA. Dopamine effects on thermosensitive neurons in hypothalamic tissue slices. Brain Res. 1984;306:157–63.PubMedCrossRefGoogle Scholar
  5. 5.
    Hasegawa H, Yazawa T, Yasumatsu M, Otokawa M, Aihara Y. Alteration in dopamine metabolism in the thermoregulatory center of exercising rats. Neurosci Lett. 2000;289:161–4.PubMedCrossRefGoogle Scholar
  6. 6.
    Salmi P. Independent roles of dopamine D1 and D2/3 receptors in rat thermoregulation. Brain Res. 1998;781:188–93.PubMedCrossRefGoogle Scholar
  7. 7.
    Perachon S, Betancur C, Pilon C, Rostene W, Schwartz JC, Sokoloff P. Role of dopamine D3 receptors in ­thermoregulation: a reappraisal. Neuroreport. 2000;11:221–5.PubMedCrossRefGoogle Scholar
  8. 8.
    Lefrant JY, Muller L, De La Coussaye JE, et al. Temperature measurement in intensive care patients: comparison of urinary bladder, oesophageal, rectal, axillary, and inguinal methods versus pulmonary artery core method. Intensive Care Med. 2003;29:414–8.PubMedGoogle Scholar
  9. 9.
    Fulbrook P. Core body temperature measurement: a comparison of axilla, tympanic membrane and pulmonary artery blood temperature. Intensive Crit Care Nurs. 1997;13:266–72.PubMedCrossRefGoogle Scholar
  10. 10.
    Knezevic W, Bajada S. Peripheral autonomic surface potential. A quantitative technique for recording sympathetic conduction in man. J Neurol Sci. 1985;67:239–51.PubMedCrossRefGoogle Scholar
  11. 11.
    Low PA, Opfer-Gehrking TL, Kihara M. In vivo studies on receptor pharmacology of the human eccrine sweat gland. Clin Auton Res. 1992;2:29–34.PubMedCrossRefGoogle Scholar
  12. 12.
    Cohen J, Low P, Fealey R, Sheps S, Jiang NS. Somatic and autonomic function in progressive autonomic failure and multiple system atrophy. Ann Neurol. 1987;22:692–9.PubMedCrossRefGoogle Scholar
  13. 13.
    Fealey RD, Low PA, Thomas JE. Thermoregulatory sweating abnormalities in diabetes mellitus. Mayo Clin Proc. 1989;64:617–28.PubMedCrossRefGoogle Scholar
  14. 14.
    Faden AI, Chan P, Mendoza E. Progressive isolated segmental anhidrosis. Arch Neurol. 1982;39:172–5.PubMedCrossRefGoogle Scholar
  15. 15.
    Kihara M, Sugenoya J, Takahashi A. The assessment of sudomotor dysfunction in multiple system atrophy. Clin Auton Res. 1991;1:297–302.PubMedCrossRefGoogle Scholar
  16. 16.
    Bornmyr S, Castenfors J, Svensson H, Wroblewski M, Sundkvist G, Wollmer P. Detection of autonomic sympathetic dysfunction in diabetic patients. A study using laser Doppler imaging. Diabetes Care. 1999;22:593–7.PubMedCrossRefGoogle Scholar
  17. 17.
    Stanton AW, Levick JR, Mortimer PS. Assessment of noninvasive tests of cutaneous vascular control in the forearm using a laser Doppler meter and a Finapres blood pressure monitor. Clin Auton Res. 1995;5:37–47.PubMedCrossRefGoogle Scholar
  18. 18.
    Gubbay SS, Barwick DD. Two cases of accidental hypothermia in Parkinson’s disease with unusual EEG findings. J Neurol Neurosurg Psychiatry. 1966;29:459–66.PubMedCrossRefGoogle Scholar
  19. 19.
    Siddiqui MF, Rast S, Lynn MJ, Auchus AP, Pfeiffer RF. Autonomic dysfunction in Parkinson’s disease: a comprehensive symptom survey. Parkinsonism Relat Disord. 2002;8:277–84.PubMedCrossRefGoogle Scholar
  20. 20.
    Gowers WR. A manual of disease of nervous system. Philadelphia: Blakiston; 1888.Google Scholar
  21. 21.
    Charcot JM. Maladies de système nerveux, vol. 1. Paris: Battaille; 1892.Google Scholar
  22. 22.
    Lees AJ. When did Ray Kennedy’s Parkinson’s disease begin? Mov Disord. 1992;7:110–6.PubMedCrossRefGoogle Scholar
  23. 23.
    Pursiainen V, Haapaniemi TH, Korpelainen JT, Sotaniemi KA, Myllylä VV. Sweating in Parkinsonian patients with wearing-off. Mov Disord. 2007;22:828–32.PubMedCrossRefGoogle Scholar
  24. 24.
    Appenzeller O, Goss JE. Autonomic deficits in Parkinson’s disease. Arch Neurol. 1971;24:50–7.PubMedCrossRefGoogle Scholar
  25. 25.
    Sage JI, Mark MH. Drenching sweats as an off phenomenon in Parkinson’s disease: treatment and relation to plasma levodopa profile. Ann Neurol. 1995;37:120–2.PubMedCrossRefGoogle Scholar
  26. 26.
    Pfeiffer RF, Sucha EL. “On-off”-induced lethal hyperthermia. Mov Disord. 1989;4:338–41.PubMedCrossRefGoogle Scholar
  27. 27.
    Keyser DL, Rodnitzky RL. Neuroleptic malignant syndrome in Parkinson’s disease after withdrawal or alteration of dopaminergic therapy. Arch Intern Med. 1991;151:794–6.PubMedCrossRefGoogle Scholar
  28. 28.
    Gordon PH, Frucht SJ. Neuroleptic malignant syndrome in advanced Parkinson’s disease. Mov Disord. 2001;16:960–2.PubMedCrossRefGoogle Scholar
  29. 29.
    Mizuta E, Yamasaki S, Nakatake M, Kuno S. Neuroleptic malignant syndrome in a parkinsonian woman during the premenstrual period. Neurology. 1993;43:1048–9.PubMedCrossRefGoogle Scholar
  30. 30.
    Serrano-Duenas M. Neuroleptic malignant syndrome-like, or-dopaminergic malignant syndrome-due to levodopa therapy withdrawal. Clinical features in 11 patients. Parkinsonism Relat Disord. 2003;9:175–8.PubMedCrossRefGoogle Scholar
  31. 31.
    Aminoff MJ, Wilcox CS. Assessment of autonomic function in patients with a Parkinsonian syndrome. Br Med J. 1971;4:80–4.PubMedCrossRefGoogle Scholar
  32. 32.
    Goetz CG, Lutge W, Tanner CM. Autonomic dysfunction in Parkinson’s disease. Neurology. 1986;36:73–5.PubMedCrossRefGoogle Scholar
  33. 33.
    Sandroni P, Ahlskog JE, Fealey RD, Low PA. Autonomic involvement in extrapyramidal and cerebellar disorders. Clin Auton Res. 1991;1:147–55.PubMedCrossRefGoogle Scholar
  34. 34.
    Haapaniemi TH, Korpelainen JT, Tolonen U, Suominen K, Sotaniemi KA, Myllylä VV. Suppressed sympathetic skin response in Parkinson disease. Clin Auton Res. 2000;10:337–42.PubMedCrossRefGoogle Scholar
  35. 35.
    Turkka JT, Myllylä VV. Sweating dysfunction in Parkinson’s disease. Eur Neurol. 1987;26:1–7.PubMedCrossRefGoogle Scholar
  36. 36.
    Kihara M, Kihara Y, Tukamoto T, Nishimura Y, Watanabe H, Hanakago R, Takahashi A. Assessment of sudomotor dysfunction in early Parkinson’s disease. Eur Neurol. 1993;33:363–5.PubMedCrossRefGoogle Scholar
  37. 37.
    Mano Y, Nakamuro T, Takayanagi T, Mayer RF. Sweat function in Parkinson’s disease. J Neurol. 1994;241:573–6.PubMedCrossRefGoogle Scholar
  38. 38.
    Hirashima F, Yokota T, Hayashi M. Sympathetic skin response in Parkinson’s disease. Acta Neurol Scand. 1996;93:127–32.PubMedCrossRefGoogle Scholar
  39. 39.
    De Marinis M, Stocchi F, Testa SR, DePandis F, Agnoli A. Alterations of thermoregulation in Parkinson’s disease. Funct Neurol. 1991;6:279–83.PubMedGoogle Scholar
  40. 40.
    Korpelainen JT, Sotaniemi KA, Myllylä VV. Autonomic nervous system disorders in stroke. Clin Auton Res. 1999;9:325–33.PubMedCrossRefGoogle Scholar
  41. 41.
    Ueno M, Tokunaga Y, Terachi S, Gondo K, Hara T. Asymmetric sweating in a child with multiple sclerosis. Pediatr Neurol. 2000;23:74–6.PubMedCrossRefGoogle Scholar
  42. 42.
    Smith CD. A hypothalamic stroke producing recurrent hemihyperhidrosis. Neurology. 2001;56:1394–6.PubMedCrossRefGoogle Scholar
  43. 43.
    Lewy FH. Paralysis agitans. I. Pathologische Anatomie. In: Lewandowsky M, editor. Handbuch der Neurologie, vol. 3. Berlin: Springer; 1912. p. 920–33.Google Scholar
  44. 44.
    Den Hartog Jager WA, Bethlem J. The distribution of Lewy bodies in the central and autonomic nervous systems in idiopathic paralysis agitans. J Neurol Neurosurg Psychiatry. 1960;23:283–90.CrossRefGoogle Scholar
  45. 45.
    Rajput AH, Rozdilsky B. Dysautonomia in Parkinsonism: a clinicopathological study. J Neurol Neurosurg Psychiatry. 1976;39:1092–100.PubMedCrossRefGoogle Scholar
  46. 46.
    Forno LS, Norville RL. Ultrastructure of Lewy bodies in stellate ganglia. Acta Neuropathol. 1976;34:183–97.PubMedCrossRefGoogle Scholar
  47. 47.
    Wakabayashi K, Takahashi H. Neuropathology of autonomic nervous system in Parkinson’s disease. Eur Neurol. 1997;38 suppl 2:2–7.PubMedCrossRefGoogle Scholar
  48. 48.
    Wenning GK, Tison F, Ben Shlomo Y, Daniel SE, Quinn NP. Multiple system atrophy: a review of 203 pathologically proven cases. Mov Disord. 1997;12:133–47.PubMedCrossRefGoogle Scholar
  49. 49.
    Wakabayashi K, Takahashi H. The intermediolateral nucleus and Clarke’s column in Parkinson’s disease. Acta Neuropathol. 1997;94:287–9.PubMedCrossRefGoogle Scholar
  50. 50.
    Langston JW, Forno LS. Hypothalamus in Parkinson’s disease. Ann Neurol. 1978;3:129–33.PubMedCrossRefGoogle Scholar
  51. 51.
    Dabby R, Djaldetti R, Shahmurov M, Treves TA, Gabai B, Melamed E, Sadeh M, Avinoach I. Skin biopsy for assessment of autonomic denervation in Parkinson’s disease. J Neural Transm. 2006;113:1169–76.PubMedCrossRefGoogle Scholar
  52. 52.
    Kawada M, Tamada Y, Simizu H, Yanagishita T, Yamashita N, Ishida N, Watanabe D, Yoshida M, Ibi T, Sahashi K, Hashizume Y, Matsumoto Y. Reduction in QSART and vasoactive intestinal polypeptide expression in the skin of Parkinson’s disease patients and its relation to dyshidrosis. J Cutan Pathol. 2009;36:517–21.PubMedCrossRefGoogle Scholar
  53. 53.
    Riley DE, Chelimsky TC. Autonomic nervous system testing may not distinguish multiple system atrophy from Parkinson’s disease. J Neurol Neurosurg Psychiatry. 2003;74:56–60.PubMedCrossRefGoogle Scholar
  54. 54.
    Thaisetthawatkul P, Boeve BF, Benarroch EE, Sandroni P, Ferman TJ, Petersen R, Low PA. Autonomic dysfunction in dementia with Lewy bodies. Neurology. 2004;62:1804–9.PubMedCrossRefGoogle Scholar
  55. 55.
    Lipp A, Sandroni P, Ahlskog JE, Fealey RD, Kimpinski K, Iodice V, Gehrking TL, Weigand SD, Sletten DM, Gehrking JA, Nickander KK, Singer W, Maraganore DM, Gilman S, Wenning GK, Shults CW, Low PA. Prospective differentiation of multiple system atrophy from Parkinson disease, with and without autonomic failure. Arch Neurol. 2009;66:742–50.PubMedCrossRefGoogle Scholar
  56. 56.
    Klein C, Brown R, Wenning G, Quinn N. The “cold hands sign” in multiple system atrophy. Mov Disord. 1997;12:514–8.PubMedCrossRefGoogle Scholar
  57. 57.
    Low PA. Composite autonomic scoring scale for laboratory quantification of generalized autonomic failure. Mayo Clin Proc. 1993;68:748–52.PubMedCrossRefGoogle Scholar
  58. 58.
    Bordet R, Benhadjali J, Destee A, Hurtevent JF, Bourriez JL, Guieu JD. Sympathetic skin response and R-R interval variability in multiple system atrophy and idiopathic Parkinson’s disease. Mov Disord. 1996;11:268–72.PubMedCrossRefGoogle Scholar
  59. 59.
    De Marinis M, Stocchi F, Gregori B, Accornero N. Sympathetic skin response and cardiovascular autonomic function tests in Parkinson’s disease and ­multiple system atrophy with autonomic failure. Mov Disord. 2000;15:1215–20.PubMedCrossRefGoogle Scholar
  60. 60.
    Pierangeli G, Provini F, Maltoni P, Barletta G, Contin M, Lugaresi E, Montagna P, Cortelli P. Nocturnal body core temperature falls in Parkinson’s disease but not in Multiple-System Atrophy. Mov Disord. 2001;16:226–32.PubMedCrossRefGoogle Scholar
  61. 61.
    Low PA, Ahlskog JE, Petersen RC, Waring SC, Esteban-Santillan C, Kurland LT. Autonomic failure in Guamanian neurodegenerative disease. Neurology. 1997;49:1031–4.PubMedCrossRefGoogle Scholar
  62. 62.
    Sanghera MK, Ward C, Stewart RM, Mewes K, Simpson RK, Lai EC. Alleviation of drenching sweats following subthalamic deep brain stimulation in a patient with Parkinson’s disease – a case report. J Neurol Sci. 2009;285:246–9.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  1. 1.University of Tennessee Health Science CenterMemphisUSA

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