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. 2019 Jul;266(7):1736-1742.
doi: 10.1007/s00415-019-09325-w. Epub 2019 Apr 17.

Exploring hyperhidrosis and related thermoregulatory symptoms as a possible clinical identifier for the dysautonomic subtype of Parkinson's disease

Daniel J van Wamelen  1   2   3 , Valentina Leta  4   5 , Aleksandra M Podlewska  4   5 , Yi-Min Wan  4   5 , Katarina Krbot  4   5   6 , Elina Jaakkola  7 , Pablo Martinez-Martin  8 , Alexandra Rizos  4   5 , Miriam Parry  4   5 , Vinod Metta  5 , Kallol Ray Chaudhuri  4   5
Affiliations

Exploring hyperhidrosis and related thermoregulatory symptoms as a possible clinical identifier for the dysautonomic subtype of Parkinson's disease

Daniel J van Wamelen et al. J Neurol. 2019 Jul.

Abstract

Objective: To identify associated (non-)motor profiles of Parkinson's disease (PD) patients with hyperhidrosis as a dominant problem.

Methods: This is a cross-sectional, exploratory, analysis of participants enrolled in the Non-motor Longitudinal International Study (NILS; UKCRN No: 10084) at the Parkinson's Centre at King's College Hospital (London, UK). Hyperhidrosis scores (yes/no) on question 28 of the Non-Motor Symptom Questionnaire were used to classify patients with normal sweat function (n = 172) and excessive sweating (n = 56) (Analysis 1; n = 228). NMS scale (NMSS) question 30 scores were used to stratify participants based on hyperhidrosis severity (Analysis 2; n = 352) using an arbitrary severity grading: absent score 0 (n = 267), mild 1-4 (n = 49), moderate 5-8 (n = 17), and severe 9-12 (n = 19). NMS burden, as well as PD sleep scale (PDSS) scores were then analysed along with other correlates.

Results: No differences were observed in baseline demographics between groups in either analysis. Patients with hyperhidrosis exhibited significantly higher total NMSS burden compared to those without (p < 0.001). Secondary analyses revealed higher dyskinesia scores, worse quality of life and PDSS scores, and higher anxiety and depression levels in hyperhidrosis patients (p < 0.001). Tertiary analyses revealed higher NMSS item scores for fatigue, sleep initiation, restless legs, urinary urgency, and unexplained pain (p < 0.001).

Conclusions: Chronic hyperhidrosis appears to be associated with a dysautonomia dominant subtype in PD patients, which is also associated with sleep disorders and a higher rate of dyskinesia (fluctuation-related hyperhidrosis). These data should prompt the concept of hyperhidrosis being used as a simple clinical screening tool to identify PD patients with autonomic symptoms.

Keywords: Autonomic; Dyskinesia; Hyperhidrosis; Non-motor symptoms; Parkinson’s disease.

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Conflict of interest statement

On behalf of all authors, the corresponding author states that there is no conflict of interest.

Figures

Fig. 1
Fig. 1
Non-motor symptom Scale total scores differences between Parkinson’s disease patients with hyperhidrosis and no hyperhidrosis and across the different severities of hyperhidrosis. NMSQ Non-motor symptom questionnaire, NMSS Non-motor symptom scale, ***p < 0.001. Statistical differences tested using Mann–Whitney U and Kruskal–Wallis tests
See this image and copyright information in PMC

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