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Parkinsonism Relat Disord. 2015 Dec;21(12):1454-60. doi: 10.1016/j.parkreldis.2015.10.019. Epub 2015 Nov 3.

Small fiber neuropathy in Parkinson's disease: A clinical, pathological and corneal confocal microscopy study.

Author information

1
Department of Neurology, Greater Manchester Neuroscience Centre, Salford Royal NHS Foundation Trust, Salford, UK; Institute of Brain, Behaviour and Mental Health, University of Manchester, Manchester, UK. Electronic address: lewis.kass-iliyya@postgrad.manchester.ac.uk.
2
Institute of Human Development, University of Manchester, Manchester, UK. Electronic address: saad.javed@student.manchester.ac.uk.
3
Department of Neurology, Greater Manchester Neuroscience Centre, Salford Royal NHS Foundation Trust, Salford, UK. Electronic address: david.gosal@srft.nhs.uk.
4
Department of Neurology, Greater Manchester Neuroscience Centre, Salford Royal NHS Foundation Trust, Salford, UK; Institute of Brain, Behaviour and Mental Health, University of Manchester, Manchester, UK. Electronic address: christopher.kobylecki@manchester.ac.uk.
5
Department of Neurology, Greater Manchester Neuroscience Centre, Salford Royal NHS Foundation Trust, Salford, UK. Electronic address: andrew.marshall@manchester.ac.uk.
6
Institute of Human Development, University of Manchester, Manchester, UK; Weill Cornell Medical College, Doha, Qatar. Electronic address: inp2002@qatar-med.cornell.edu.
7
Institute of Human Development, University of Manchester, Manchester, UK; Weill Cornell Medical College, Doha, Qatar. Electronic address: g.ponirakis@gmail.com.
8
Institute of Human Development, University of Manchester, Manchester, UK. Electronic address: mitra.tavakoli@manchester.ac.uk.
9
Institute of Human Development, University of Manchester, Manchester, UK. Electronic address: maryam.ferdousi@manchester.ac.uk.
10
Department of Clinical Neuroscience, King's College, London, UK. Electronic address: chaudhuriray@hotmail.com.
11
Institute of Human Development, University of Manchester, Manchester, UK. Electronic address: maria.jeziorska@manchester.ac.uk.
12
Institute of Human Development, University of Manchester, Manchester, UK; Weill Cornell Medical College, Doha, Qatar. Electronic address: ram2045@qatar-med.cornell.edu.
13
Department of Neurology, Greater Manchester Neuroscience Centre, Salford Royal NHS Foundation Trust, Salford, UK; Institute of Brain, Behaviour and Mental Health, University of Manchester, Manchester, UK. Electronic address: monty.silverdale@srft.nhs.uk.

Abstract

Autonomic and somatic denervation is well established in Parkinson's disease (PD).

OBJECTIVES:

(1) To determine whether corneal confocal microscopy (CCM) can non-invasively demonstrate small nerve fiber damage in PD. (2) To identify relationships between corneal nerve parameters, intraepidermal nerve fiber density (IENFD) and clinical features of PD.

METHODS:

Twenty-six PD patients and 26 controls underwent CCM of both eyes. 24/26 PD patients and 10/26 controls underwent skin biopsies from the dorsa of both feet. PD patients underwent assessment of parasympathetic function [deep breathing heart rate variability (DB-HRV)], autonomic symptoms [scale for outcomes in Parkinson's disease - autonomic symptoms (SCOPA-AUT)], motor symptoms [UPDRS-III "ON"] and cumulative Levodopa dose.

RESULTS:

PD patients had significantly reduced corneal nerve fiber density (CNFD) with increased corneal nerve branch density (CNBD) and corneal nerve fiber length (CNFL) compared to controls. CNBD and CNFL but not CNFD correlated inversely with UPDRS-III and SCOPA-AUT. All CCM parameters correlated strongly with DB-HRV. There was no correlation between CCM parameters and disease duration, cumulative Levodopa dose or pain. IENFD was significantly reduced in PD compared to controls and correlated with CNFD and UPDRS-III. However, unlike CCM measures, IENFD correlated with disease duration and cumulative Levodopa dose but not with autonomic dysfunction.

CONCLUSION:

CCM identifies corneal nerve fiber pathology, which correlates with autonomic symptoms, parasympathetic deficits and motor scores in patients with PD. IENFD is also reduced and correlates with CNFD and motor symptoms but not parasympathetic deficits, indicating it detects different aspects of peripheral nerve pathology in PD.

KEYWORDS:

Confocal microscopy; Cornea; Intraepidermal nerve fiber density; Parkinson's disease; Small fiber neuropathy

PMID:
26578039
PMCID:
PMC4671992
DOI:
10.1016/j.parkreldis.2015.10.019
[Indexed for MEDLINE]
Free PMC Article

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