Department of Neurology, Clinical Research Center of Neurological Diseases, The Second Affiliated Hospital of Soochow University, Suzhou, China.
Department of Neurology, Yixing People's Hospital, Yixing, China.
Acta Neurol Scand. 2022 Jul;146(1):75-81. doi: 10.1111/ane.13624. Epub 2022 Apr 24.
To determine the function of each type of peripheral nerve fiber and investigate the possible role of levodopa (LD) in peripheral neuropathy (PN) in Parkinson's disease (PD) patients.
We enrolled 60 patients with idiopathic PD. All PD patients were divided into three groups: levodopa exposure >3 years (LELD), levodopa exposure ≤3 years (SELD) and de novo patients with PD (NOLD). The current perception threshold (CPT), which was measured by Neurometer at 2000, 250 and 5 Hz, the level of homocysteine, Vitamin B12 and folic acid in plasma, were compared with those of sex- and age-matched healthy controls (HCs).
Current perception threshold was higher at 250 Hz (p < .05) and 5 Hz (p < .05) in the LELD group than the NOLD, SELD, and control group. CPT was lower at 5 Hz in the NOLD than in the HCs group (p < .05). The CPT of the more affected side of PD patients was positively correlated with H-Y stage at 5 Hz current stimulation (r = .42, p = .01). Multivariate logistic regression analysis showed that elevated homocysteine levels were the risk factor of sensory nerve injury in PD patients (p < .01). Serum homocysteine levels were positively correlated with levodopa (LD) daily dose, LD equivalent daily dose, and LD cumulative lifetime dose (p < .05).
Peripheral neuropathy in PD patients can occur in the early stage of PD exhibiting as hyperesthesia and is fiber selectivity, especially for Aδ and C nerve fibers. PN in PD patients is related to PD itself and long-term LD exposure. Elevated plasma homocysteine is a risk factor for PN in PD patients.
确定每种周围神经纤维的功能，并研究左旋多巴（LD）在帕金森病（PD）患者周围神经病变（PN）中的可能作用。
我们纳入了 60 例特发性 PD 患者。所有 PD 患者分为三组：左旋多巴暴露时间>3 年（LELD）、左旋多巴暴露时间≤3 年（SELD）和初诊 PD 患者（NOLD）。使用 Neurometer 测量 2000、250 和 5 Hz 时的电流感觉阈值（CPT），并比较血浆同型半胱氨酸、维生素 B12 和叶酸水平与性别和年龄匹配的健康对照组（HCs）。
LELD 组在 250 Hz（p<0.05）和 5 Hz（p<0.05）时的电流感觉阈值均高于 NOLD、SELD 和对照组。NOLD 组的 CPT 较 HCs 组在 5 Hz 时更低（p<0.05）。PD 患者患侧 CPT 与 5 Hz 时的 H-Y 分期呈正相关（r=0.42，p=0.01）。多变量 logistic 回归分析显示，高同型半胱氨酸水平是 PD 患者感觉神经损伤的危险因素（p<0.01）。血清同型半胱氨酸水平与左旋多巴（LD）日剂量、LD 等效日剂量和 LD 累积终生剂量呈正相关（p<0.05）。
PD 患者的周围神经病变可在 PD 的早期阶段发生，表现为感觉过敏，且具有纤维选择性，特别是 Aδ 和 C 神经纤维。PD 患者的 PN 与 PD 本身和长期 LD 暴露有关。血浆同型半胱氨酸升高是 PD 患者 PN 的危险因素。
