Ramachandran Aparna, Jose James, Gafoor V Abdul, Das Smita, Balaram Neetha
Department of Neurology, Government Medical College, Kozhikode, Kerala, India.
Ann Indian Acad Neurol. 2022 Nov-Dec;25(6):1109-1115. doi: 10.4103/aian.aian_669_22. Epub 2022 Dec 3.
A lesser studied aspect of Parkinson's disease (PD) is its associated peripheral sensory-motor neuropathy. Peripheral neuropathy is an intriguing aspect of PD, a problem not given sufficient attention and which if tackled properly could make a difference to the multifaceted sufferings of the PD patient. Studies regarding the prevalence of peripheral neuropathy and its risk factors in patients with PD are scarce from the Indian subcontinent.
This prospective observational study was conducted in a tertiary care teaching hospital in South India. Patients diagnosed with idiopathic Parkinson's disease (IPD) were screened and enrolled. All the patients underwent detailed evaluation of symptoms, signs, and electrophysiology (Nerve conduction study, Sympathetic skin response), stimulated skin wrinkling with Eutectic Mixture of Local Anesthetics. Patients found to have large/small fiber neuropathy underwent additional tests to exclude other causes of neuropathy.
A total of 154 patients with IPD were enrolled in the study (mean age: 61.96 ± 9.15 years, mean duration of disease was 4.08 ± 3.16 years). The mean Hoehn and Yahr (H and Y) score was 2.3 ± 0.825 and the mean Unified Parkinsons Disease Rating Scale (UPDRS)-3 score in the ON state was 23.07 ± 11.14. The mean cumulative levodopa dose was 482.68 ± 651.76 (median: 292; range: 4728.57) grams. Peripheral neuropathy was found in 49 patients (31.8%), large fiber in 28 (18.2%) and small fiber in 47 (30.5%); an overlap of large and small fiber neuropathy was seen in 26 patients (16.9%). Around 34% of patients had serum homocysteine levels >20 mg/dl. In univariate analysis, duration of disease, levodopa cumulative dose, serum homocysteine level, H and Y score, UPDRS-3 ON score, Toronto Clinical Neuropathy Score ( < 0.001 for all), age at presentation, and rigidity predominant presentation ( = 0.02 for both) were associated with large fiber neuropathy. All of these variables were also associated with the presence of small fiber neuropathy ( = 0.004 for age at presentation and < 0.001 for rest), except the type of PD presentation. However, in multivariate logistic regression analysis, only duration of disease, levodopa cumulative dose, and H and Y score were associated with the presence of large and small fiber neuropathy.
In our cohort, majority of the patients were in early-stage PD and around one-fifth and one-third of patients suffer from large and small fiber polyneuropathy, respectively. Large and small fiber neuropathy in PD is mainly associated with duration of disease, levodopa cumulative dose, and H and Y score.
帕金森病（PD）较少被研究的一个方面是其相关的周围感觉运动神经病变。周围神经病变是PD中一个引人关注的方面，这一问题未得到足够重视，而如果妥善解决，可能会对PD患者的多方面痛苦产生影响。来自印度次大陆的关于PD患者周围神经病变患病率及其危险因素的研究很少。
这项前瞻性观察性研究在印度南部的一家三级护理教学医院进行。对诊断为特发性帕金森病（IPD）的患者进行筛查并纳入研究。所有患者均接受了症状、体征和电生理学（神经传导研究、交感皮肤反应）的详细评估，采用局部麻醉剂的共晶混合物刺激皮肤起皱。发现有大/小纤维神经病变的患者接受了额外检查以排除神经病变的其他原因。
共有154例IPD患者纳入研究（平均年龄：61.96±9.15岁，平均病程为4.08±3.16年）。平均Hoehn和Yahr（H和Y）评分为2.3±0.825，开期的平均统一帕金森病评定量表（UPDRS）-3评分为23.07±11.14。左旋多巴的平均累积剂量为482.68±651.76（中位数：292；范围：4728.57）克。49例患者（31.8%）发现有周围神经病变，28例（18.2%）有大纤维病变，47例（30.5%）有小纤维病变；26例患者（16.9%）存在大、小纤维神经病变重叠。约34%的患者血清同型半胱氨酸水平>20mg/dl。在单因素分析中，病程、左旋多巴累积剂量、血清同型半胱氨酸水平、H和Y评分、UPDRS-3开期评分、多伦多临床神经病变评分（所有均<0.001）、发病年龄以及以强直为主的表现（两者均为=0.02）与大纤维神经病变相关。所有这些变量也与小纤维神经病变的存在相关（发病年龄为=0.004，其余均<0.001），除了PD的表现类型。然而，在多因素逻辑回归分析中，只有病程、左旋多巴累积剂量和H和Y评分与大、小纤维神经病变的存在相关。
在我们的队列中，大多数患者处于PD早期，约五分之一和三分之一的患者分别患有大纤维和小纤维多发性神经病变。PD中的大、小纤维神经病变主要与病程、左旋多巴累积剂量和H和Y评分相关。
