Zis Panagiotis, Grünewald Richard A, Chaudhuri Ray Kallol, Hadjivassiliou Marios
Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK; University of Sheffield, UK.
Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK.
J Neurol Sci. 2017 Jul 15;378:204-209. doi: 10.1016/j.jns.2017.05.023. Epub 2017 May 11.
Parkinson's disease (PD) has been associated with peripheral neuropathy (PN). PN has been demonstrated in some rare genetic forms of PD (e.g. PARK2 mutations) but has also been linked to levodopa exposure.
The aim of this systematic review is to clarify any evidence of peripheral nervous system involvement in idiopathic PD.
A systematic computer-based literature search was conducted on PubMed database.
The pooled estimate of the prevalence of large fiber PN in PD was 16.3% (based on 1376 patients). The pooled estimate of the prevalence of biopsy-proven small fiber neuropathy was 56.9% (based on 72 patients). Large fiber PN in PD is in the majority of cases distal, symmetrical, axonal and predominantly sensory. There are, however, few reports of chronic idiopathic demyelinating polyneuropathy and very occasional cases of acute neuropathies. Although nerve conduction studies have been performed in the majority of the studies, they included only a limited number of nerves, mainly in the lower limbs. There is little evidence to support a direct link between levodopa treatment and the development of PN in idiopathic PD. In the majority of the cases PN has been linked to abnormalities in vitamin B12, methylmalonic acid or fasting homocysteine levels. Additional aetiological risk factors for PN may be responsible for any apparent link between PD and PN.
Large-scale prospective studies with long-term follow-up with detailed baseline assessments are needed in order to understand the natural history of PN in PD, both on clinical and neurophysiological parameters.
帕金森病（PD）与周围神经病变（PN）有关。PN已在某些罕见的遗传性PD形式中得到证实（例如PARK2突变），但也与左旋多巴暴露有关。
本系统评价的目的是阐明特发性PD中周围神经系统受累的任何证据。
在PubMed数据库上进行基于计算机的系统文献检索。
PD中大型纤维PN患病率的汇总估计为16.3%（基于1376例患者）。经活检证实的小型纤维神经病变患病率的汇总估计为56.9%（基于72例患者）。PD中的大型纤维PN在大多数情况下是远端性、对称性、轴索性且主要为感觉性的。然而，关于慢性特发性脱髓鞘性多发性神经病的报道很少，急性神经病的病例也非常罕见。尽管大多数研究都进行了神经传导研究，但它们仅包括有限数量的神经，主要是下肢神经。几乎没有证据支持左旋多巴治疗与特发性PD中PN的发生之间存在直接联系。在大多数情况下，PN与维生素B12、甲基丙二酸或空腹同型半胱氨酸水平异常有关。PN的其他病因风险因素可能是PD与PN之间任何明显联系的原因。
需要进行大规模前瞻性研究，并进行长期随访和详细的基线评估，以便从临床和神经生理学参数两方面了解PD中PN的自然病程。
