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Neurology. 2014 Mar 11;82(10):858-64. doi: 10.1212/WNL.0000000000000204. Epub 2014 Feb 5.

Submandibular gland needle biopsy for the diagnosis of Parkinson disease.

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From the Parkinson's Disease and Movement Disorders Center (C.H.A., E.D.-D., A.D.), Department of Neurology, Mayo Clinic, Scottsdale; Banner Sun Health Research Institute (B.N.D., J.H., J.H.-W., G.S., L.I.S., H.A.S., D.G.W., T.G.B.), Sun City; the Department of Otolaryngology (M.L.H., D.G.L., T.N.), Mayo Clinic, Phoenix, AZ; and the Tokyo Institute of Psychiatry (H.A.), Tokyo, Japan.



This study investigates salivary gland biopsies in living patients with Parkinson disease (PD).


Patients with PD for ≥5 years underwent outpatient transcutaneous needle core biopsies (18-gauge or 16-gauge) of 1 submandibular gland. Minor salivary glands were removed via a small incision in the lower lip. Tissue was fixed in formalin and serial 6-µm paraffin sections were immunohistochemically stained for phosphorylated α-synuclein and reviewed for evidence of Lewy type α-synucleinopathy (LTS).


Fifteen patients with PD were biopsied: 9 female/6 male, mean age 68.7 years, mean PD duration 11.8 years. Twelve of the needle core biopsies had microscopically evident submandibular gland tissue to assess and 9/12 (75%) had LTS. Only 1/15 (6.7%) minor salivary gland biopsies were positive for LTS. Five patients had an adverse event; all were minor and transient.


This study demonstrates the feasibility of performing needle core biopsies of the submandibular gland in living patients with PD to assess LTS. Although this was a small study, this tissue biopsy method may be important for tissue confirmation of PD in patients being considered for invasive procedures and in research studies of other PD biomarkers.

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