The role of autonomic testing in the differentiation of Parkinson's disease from multiple system atrophy

Kurt Kimpinski, Valeria Iodice, Duane D. Burton, Michael Camilleri, Brian P. Mullan, Axel Lipp, Paola Sandroni, Tonette L. Gehrking, David M. Sletten, J. E. Ahlskog, Robert D. Fealey, Wolfgang Singer, Phillip Anson Low

Research output: Contribution to journalArticle

28 Citations (Scopus)

Abstract

Differentiation of idiopathic Parkinson's disease (PD) from multiple system atrophy (MSA) can be difficult. Methods devised to help distinguish the two disorders include standardized autonomic testing and cardiac imaging with iodine-123 meta-iodobenzylguanidine myocardial scintigraphy. MSA patients had more severe adrenergic and overall autonomic dysfunction when compared to control and PD patients. Area of anhidrosis on thermoregulatory sweat test was greater in MSA (67.4 ± 12.42, p < 0.001) versus PD patients (area of anhidrosis, 1.7 ± 2.96). Postganglionic cardiac sympathetic innervation (iodine-123 meta-iodobenzylguanidine) expressed as heart to mediastinal ratio was significantly lower in Parkinson's disease patients (1.4 ± 0.40, p = 0.025) compared to controls (2.0 ± 0.29), but not in multiple system atrophy (2.0 ± 0.76). These findings indicate that autonomic dysfunction is generalized and predominantly preganglionic in multiple system atrophy, and postganglionic in Parkinson's disease. In our hands the thermoregulatory sweat test provides the best distinction between MSA and PD. However further confirmatory studies using larger patient numbers are required. Currently a combination of clinical judgment and autonomic testing is recommended to help differentiate MSA and PD.

Original languageEnglish (US)
Pages (from-to)92-96
Number of pages5
JournalJournal of the Neurological Sciences
Volume317
Issue number1-2
DOIs
StatePublished - Jun 15 2012

Fingerprint

Multiple System Atrophy
Parkinson Disease
Hypohidrosis
3-Iodobenzylguanidine
Sweat
Iodine
Myocardial Perfusion Imaging
Adrenergic Agents

Keywords

  • I MIBG myocardial scintigraphy
  • Autonomic reflex screen
  • Multiple system atrophy
  • Parkinson's disease

ASJC Scopus subject areas

  • Clinical Neurology
  • Neurology

Cite this

The role of autonomic testing in the differentiation of Parkinson's disease from multiple system atrophy. / Kimpinski, Kurt; Iodice, Valeria; Burton, Duane D.; Camilleri, Michael; Mullan, Brian P.; Lipp, Axel; Sandroni, Paola; Gehrking, Tonette L.; Sletten, David M.; Ahlskog, J. E.; Fealey, Robert D.; Singer, Wolfgang; Low, Phillip Anson.

In: Journal of the Neurological Sciences, Vol. 317, No. 1-2, 15.06.2012, p. 92-96.

Research output: Contribution to journalArticle

Kimpinski, K, Iodice, V, Burton, DD, Camilleri, M, Mullan, BP, Lipp, A, Sandroni, P, Gehrking, TL, Sletten, DM, Ahlskog, JE, Fealey, RD, Singer, W & Low, PA 2012, 'The role of autonomic testing in the differentiation of Parkinson's disease from multiple system atrophy', Journal of the Neurological Sciences, vol. 317, no. 1-2, pp. 92-96. https://doi.org/10.1016/j.jns.2012.02.023
Kimpinski, Kurt ; Iodice, Valeria ; Burton, Duane D. ; Camilleri, Michael ; Mullan, Brian P. ; Lipp, Axel ; Sandroni, Paola ; Gehrking, Tonette L. ; Sletten, David M. ; Ahlskog, J. E. ; Fealey, Robert D. ; Singer, Wolfgang ; Low, Phillip Anson. / The role of autonomic testing in the differentiation of Parkinson's disease from multiple system atrophy. In: Journal of the Neurological Sciences. 2012 ; Vol. 317, No. 1-2. pp. 92-96.
@article{1cbbb13dd3654535882eb23a5c6035d0,
title = "The role of autonomic testing in the differentiation of Parkinson's disease from multiple system atrophy",
abstract = "Differentiation of idiopathic Parkinson's disease (PD) from multiple system atrophy (MSA) can be difficult. Methods devised to help distinguish the two disorders include standardized autonomic testing and cardiac imaging with iodine-123 meta-iodobenzylguanidine myocardial scintigraphy. MSA patients had more severe adrenergic and overall autonomic dysfunction when compared to control and PD patients. Area of anhidrosis on thermoregulatory sweat test was greater in MSA (67.4 ± 12.42, p < 0.001) versus PD patients (area of anhidrosis, 1.7 ± 2.96). Postganglionic cardiac sympathetic innervation (iodine-123 meta-iodobenzylguanidine) expressed as heart to mediastinal ratio was significantly lower in Parkinson's disease patients (1.4 ± 0.40, p = 0.025) compared to controls (2.0 ± 0.29), but not in multiple system atrophy (2.0 ± 0.76). These findings indicate that autonomic dysfunction is generalized and predominantly preganglionic in multiple system atrophy, and postganglionic in Parkinson's disease. In our hands the thermoregulatory sweat test provides the best distinction between MSA and PD. However further confirmatory studies using larger patient numbers are required. Currently a combination of clinical judgment and autonomic testing is recommended to help differentiate MSA and PD.",
keywords = "I MIBG myocardial scintigraphy, Autonomic reflex screen, Multiple system atrophy, Parkinson's disease",
author = "Kurt Kimpinski and Valeria Iodice and Burton, {Duane D.} and Michael Camilleri and Mullan, {Brian P.} and Axel Lipp and Paola Sandroni and Gehrking, {Tonette L.} and Sletten, {David M.} and Ahlskog, {J. E.} and Fealey, {Robert D.} and Wolfgang Singer and Low, {Phillip Anson}",
year = "2012",
month = "6",
day = "15",
doi = "10.1016/j.jns.2012.02.023",
language = "English (US)",
volume = "317",
pages = "92--96",
journal = "Journal of the Neurological Sciences",
issn = "0022-510X",
publisher = "Elsevier",
number = "1-2",

}

TY - JOUR

T1 - The role of autonomic testing in the differentiation of Parkinson's disease from multiple system atrophy

AU - Kimpinski, Kurt

AU - Iodice, Valeria

AU - Burton, Duane D.

AU - Camilleri, Michael

AU - Mullan, Brian P.

AU - Lipp, Axel

AU - Sandroni, Paola

AU - Gehrking, Tonette L.

AU - Sletten, David M.

AU - Ahlskog, J. E.

AU - Fealey, Robert D.

AU - Singer, Wolfgang

AU - Low, Phillip Anson

PY - 2012/6/15

Y1 - 2012/6/15

N2 - Differentiation of idiopathic Parkinson's disease (PD) from multiple system atrophy (MSA) can be difficult. Methods devised to help distinguish the two disorders include standardized autonomic testing and cardiac imaging with iodine-123 meta-iodobenzylguanidine myocardial scintigraphy. MSA patients had more severe adrenergic and overall autonomic dysfunction when compared to control and PD patients. Area of anhidrosis on thermoregulatory sweat test was greater in MSA (67.4 ± 12.42, p < 0.001) versus PD patients (area of anhidrosis, 1.7 ± 2.96). Postganglionic cardiac sympathetic innervation (iodine-123 meta-iodobenzylguanidine) expressed as heart to mediastinal ratio was significantly lower in Parkinson's disease patients (1.4 ± 0.40, p = 0.025) compared to controls (2.0 ± 0.29), but not in multiple system atrophy (2.0 ± 0.76). These findings indicate that autonomic dysfunction is generalized and predominantly preganglionic in multiple system atrophy, and postganglionic in Parkinson's disease. In our hands the thermoregulatory sweat test provides the best distinction between MSA and PD. However further confirmatory studies using larger patient numbers are required. Currently a combination of clinical judgment and autonomic testing is recommended to help differentiate MSA and PD.

AB - Differentiation of idiopathic Parkinson's disease (PD) from multiple system atrophy (MSA) can be difficult. Methods devised to help distinguish the two disorders include standardized autonomic testing and cardiac imaging with iodine-123 meta-iodobenzylguanidine myocardial scintigraphy. MSA patients had more severe adrenergic and overall autonomic dysfunction when compared to control and PD patients. Area of anhidrosis on thermoregulatory sweat test was greater in MSA (67.4 ± 12.42, p < 0.001) versus PD patients (area of anhidrosis, 1.7 ± 2.96). Postganglionic cardiac sympathetic innervation (iodine-123 meta-iodobenzylguanidine) expressed as heart to mediastinal ratio was significantly lower in Parkinson's disease patients (1.4 ± 0.40, p = 0.025) compared to controls (2.0 ± 0.29), but not in multiple system atrophy (2.0 ± 0.76). These findings indicate that autonomic dysfunction is generalized and predominantly preganglionic in multiple system atrophy, and postganglionic in Parkinson's disease. In our hands the thermoregulatory sweat test provides the best distinction between MSA and PD. However further confirmatory studies using larger patient numbers are required. Currently a combination of clinical judgment and autonomic testing is recommended to help differentiate MSA and PD.

KW - I MIBG myocardial scintigraphy

KW - Autonomic reflex screen

KW - Multiple system atrophy

KW - Parkinson's disease

UR - http://www.scopus.com/inward/record.url?scp=84860314154&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84860314154&partnerID=8YFLogxK

U2 - 10.1016/j.jns.2012.02.023

DO - 10.1016/j.jns.2012.02.023

M3 - Article

VL - 317

SP - 92

EP - 96

JO - Journal of the Neurological Sciences

JF - Journal of the Neurological Sciences

SN - 0022-510X

IS - 1-2

ER -