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Part of the book series: Current Clinical Neurology ((CCNEU))

Abstract

Patients with Parkinson’s disease (PD) must maintain core body temperature in a narrow range despite fluctuations in both endogenous heat production and environmental conditions. The hypothalamus and peripheral autonomic nervous system are essential neuroanatomical substrates for thermoregulation. In the preoptic/anterior hypothalamus, dopamine excites warm-sensitive neurons and inhibits cold-sensitive neurons. Hypothalamic dopamine deficiency may perturb normal thermoregulatory responses. Several features of both the neuroleptic malignant syndrome (NMS) and the NMS-like syndrome associated with levodopa withdrawal are likely the result of inadequate stimulation of hypothalamic dopamine receptors. In PD, thermoregulatory dysfunction can also manifest as heat and cold intolerance, paroxysmal head and neck hyperhidrosis, and dry skin in the lower extremities. Tests of sudomotor function, such as the sympathetic skin response, quantitative sudomotor axon reflex test, thermoregulatory sweat test, silastic sweat imprint, and quantitative thermoregulatory sweat test, are often abnormal in PD, particularly in its more advanced stages. Therefore, clinicians should be cautious when using thermoregulatory testing to differentiate PD from other neurodegenerative disorders (e.g., multiple system atrophy [MSA]). In early PD, thermoregulatory dysfunction is mostly consistent with central and preganglionic autonomic dysfunction. As PD progresses, an increasing percentage of patients will also show evidence of postganglionic sympathetic abnormalities.

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© 2005 Humana Press Inc., Totowa, NJ

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LeDoux, M.S. (2005). Thermoregulatory Dysfunction. In: Pfeiffer, R.F., Bodis-Wollner, I. (eds) Parkinson’s Disease and Nonmotor Dysfunction. Current Clinical Neurology. Humana Press. https://doi.org/10.1385/1-59259-859-5:159

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  • DOI: https://doi.org/10.1385/1-59259-859-5:159

  • Publisher Name: Humana Press

  • Print ISBN: 978-1-58829-316-9

  • Online ISBN: 978-1-59259-859-5

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