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Cell Tissue Res. 2018 Jul;373(1):267-286. doi: 10.1007/s00441-018-2851-9. Epub 2018 Jun 4.

Peripheral and central autonomic nervous system: does the sympathetic or parasympathetic nervous system bear the brunt of the pathology during the course of sporadic PD?

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Department of Neurology, Kanto Central Hospital, 6-25-1 Kami-Yoga, Setagaya-ku, Tokyo, 158-8531, Japan.
Institute of Clinical Neuroanatomy, J. W. Goethe-University, Theodor-Stern-Kai 7, 60590, Frankfurt/Main, Germany.
Neurological Tissue Bank of the Biobank-Hospital Clinic-IDIBAPS, Barcelona, Spain.
Institute of Neurology, Medical University of Vienna, Vienna, Austria.


It is a well-established fact that the sympathetic, parasympathetic and enteric nervous systems are affected at early stages in Parkinson's disease (PD). However, it is not yet clarified whether the earliest pathological events preferentially occur in any of these three divisions of the autonomic nervous system (ANS). Significant involvement of the peripheral autonomic nervous system of the heart and gastrointestinal tract has been documented in PD. Accumulating evidence suggests that the PD pathology spreads centripetally from the peripheral to central nervous system through autonomic nerve fibers, implicating the ANS as a major culprit in PD pathogenesis and a potential target for therapy. This study begins with a brief overview of the structures of the central and peripheral autonomic nervous system and then outlines the major clinicopathological manifestations of cardiovascular and gastrointestinal disturbances in PD.


Autonomic nervous system; Cardiovascular autonomic test; Enteric nervous system; Gastrointestinal system; Heart rate variability; Lewy body; Orthostatic hypotension; Parasympathetic; Parkinson’s disease; Sympathetic; Tyrosine hydroxylase; meta-Iodobenzylguanidine cardiac scintigraphy; α-Synuclein

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