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. 2020 Oct;7(10):1898-1907.
doi: 10.1002/acn3.51182. Epub 2020 Sep 17.

Correlates of polyneuropathy in Parkinson's disease

Eva Kühn  1 , Paulina Averdunk  1 , Sophie Huckemann  1 , Katharina Müller  1 , Anne-Sophie Biesalski  1 , Florian Hof Zum Berge  1 , Jeremias Motte  1 , Anna Lena Fisse  1 , Christiane Schneider-Gold  1 , Ralf Gold  1   2 , Kalliopi Pitarokoili  1 , Lars Tönges  1   2
Affiliations

Correlates of polyneuropathy in Parkinson's disease

Eva Kühn et al. Ann Clin Transl Neurol. 2020 Oct.

Abstract

Objective: Previous studies in Parkinson's disease (PD) patients have demonstrated a high prevalence of polyneuropathy (PNP) and pronounced alpha-Synuclein pathology in dermal nerve fibers already at early disease stages. The aim of this study was to analyze associations between the prevalence and severity of PNP with nonmotor and motor symptoms in PD patients.

Methods: Fifty PD patients were characterized comprehensively for the presence of clinical symptoms (nonmotor and motor), electrophysiologic alterations and - for the first time - using high-resolution ultrasound of peripheral nerves.

Results: Sixty-two percent of PD patients showed electrophysiological pathology of PNP. The prevalence of patient-reported PNP symptoms was 86% and was particularly present in patients with longer disease duration, compromised scores of nonmotor and motor symptoms as well as with a negative evaluation of quality of life. Seventy-five percent of patients showed morphologic alterations similar to axonal PNP in high-resolution ultrasound compared to healthy controls.

Interpretation: The study demonstrates the high burden of peripheral nervous system disease in Parkinson's disease. It advocates further studies to delineate the underlying pathophysiological mechanisms in order to optimize treatment approaches for PD, including the associated PNP.

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Conflict of interest statement

Paulina Averdunk, Eva Kühn, Sophie Huckemann, Katharina Müller, Anne‐Sophie Biesalski, Florian Hof zum Berge, Dr. Motte, Dr. Schneider‐Gold, Dr. Gold, Dr. Pitarokoili, and Dr. Tönges report no disclosures. Dr. Fisse: owns shares of Fresenius SE & Co., Gilead Sciences, Medtronic PLC and Novartis AG.

Figures

Figure 1
Figure 1
Study flow diagram.
Figure 2
Figure 2
(A) MDS‐UPDRS III in relation to NSS (r s = 0.401; P = 0.002; n = 49). (B) MDS‐UPDRS II in relation to NSS (r s = 0.467; P < 0.001; n = 49). (C) NMSQuest in relation to NSS (r s = 0.582; P < 0.001; n = 49). (D) PDQ‐39 in relation to NSS. (r s = 0.432; P = 0.001; n = 49). (E) Amplitude of the tibial nerve in Hoehn and Yahr Groups (n = 50). (F) MDS‐UPDRS III in relation to the amplitude of the tibial nerve (r = −0.582, P < 0.001; n = 50). (G) Amplitude of the tibial nerve in relation to disease duration (r = −0.326; P = 0.01; n = 50). (H) Amplitude of the tibial nerve in relation to age at the time of examination (r = −0.49; P < 0.001; n = 50). MDS‐UPDRS, MDS‐Unified Parkinson's Disease Rating Scale; PDQ‐39, Parkinson's Disease Questionnaire.
Figure 3
Figure 3
(A–H) High‐resolution ultrasound of peripheral nerves at entrapment sites: PD patients (A, C, E, and G; for all n = 45) versus controls (B, D, F, and H; for all n = 75): A and B: median nerve: carpal tunnel. (C and D) Ulnar nerve: Loge de Guyon. (E and F) Ulnar nerve: sulcus. (G and H) Fibular nerve: head. PD, Parkinson’s disease.
Figure 4
Figure 4
Proportion of PD patients with an increased CSA in 45 patients with (PD/PNP+) or without (PD/PNP−) diagnosis of polyneuropathy in nerve conduction study at entrapment points. PD, Parkinson’s disease; CSA, cross‐sectional area; PNP, polyneuropathy.
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