Tags

Type your tag names separated by a space and hit enter

Skin Biopsy May Help to Distinguish Multiple System Atrophy-Parkinsonism from Parkinson's Disease with Orthostatic Hypotension.
Mov Disord. 2020 Jun 18 [Online ahead of print]MD

Abstract

BACKGROUND

The differential diagnosis between multiple system atrophy parkinsonism type (MSA-P) and Parkinson's disease with orthostatic hypotension (PD+OH) is difficult because the 2 diseases have a similar clinical picture. The aim of this study is to distinguish MSA-P from PD+OH by immunostaining for abnormal phosphorylated α-synuclein at serine 129 (p-syn) in cutaneous nerves.

METHOD

We recruited 50 patients with parkinsonism and chronic orthostatic hypotension: 25 patients fulfilled the diagnostic criteria for MSA-P and 25 patients for PD+OH. The patients underwent a skin biopsy from the cervical area, thigh, and leg to analyze somatic and autonomic skin innervation and p-syn in skin nerves.

RESULTS

Intraneural p-syn positivity was found in 72% of patients with MSA-P, mainly in distal skin sites. More important, p-syn deposits in MSA-P differed from PD+OH because they were mainly found in somatic fibers of subepidermal plexi, whereas scant autonomic fiber involvement was found in only 3 patients. All patients with PD+OH displayed widely distributed p-syn deposits in the autonomic skin fibers of proximal and distal skin sites, whereas somatic fibers were affected only slightly in 4 patients with PD+OH. Skin innervation mirrored p-syn deposits because somatic innervation was mainly reduced in MSA-P. Sympathetic innervation was damaged in PD+OH but fairly preserved in MSA-P.

CONCLUSIONS

The p-syn in cutaneous nerves allows the differentiation of MSA-P from PD+OH; MSA-P mainly shows somatic fiber involvement with relatively preserved autonomic innervation; and by contrast, PD+OH displays prevalent abnormal p-syn deposits and denervation in autonomic postganglionic nerves. © 2020 International Parkinson and Movement Disorder Society.

Authors+Show Affiliations

IRCCS Istituto delle Scienze Neurologiche di Bologna, UOC Clinica Neurologica, Bologna, Italy.IRCCS Istituto delle Scienze Neurologiche di Bologna, UOC Clinica Neurologica, Bologna, Italy.IRCCS Istituto delle Scienze Neurologiche di Bologna, UOC Clinica Neurologica, Bologna, Italy. Dipartimento di Scienze Biomediche e Neuromotorie, Università di Bologna, Italia.Department of Advanced Medical and Surgery Sciences, Università della Campania Luigi Vanvitelli, Napoli, Italia.Department of Advanced Medical and Surgery Sciences, Università della Campania Luigi Vanvitelli, Napoli, Italia.Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italia.Parkinson Institute ASST Gaetano Pini-CTO, Milano, Italia.Parkinson Institute ASST Gaetano Pini-CTO, Milano, Italia.IRCCS Istituto delle Scienze Neurologiche di Bologna, UOC Clinica Neurologica, Bologna, Italy.IRCCS Istituto delle Scienze Neurologiche di Bologna, UOC Clinica Neurologica, Bologna, Italy.IRCCS Istituto delle Scienze Neurologiche di Bologna, UOC Clinica Neurologica, Bologna, Italy.IRCCS Istituto delle Scienze Neurologiche di Bologna, UOC Clinica Neurologica, Bologna, Italy.Parkinson Institute ASST Gaetano Pini-CTO, Milano, Italia.Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italia.Department of Advanced Medical and Surgery Sciences, Università della Campania Luigi Vanvitelli, Napoli, Italia.IRCCS Istituto delle Scienze Neurologiche di Bologna, UOC Clinica Neurologica, Bologna, Italy. Dipartimento di Scienze Biomediche e Neuromotorie, Università di Bologna, Italia.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32557839

Citation

Donadio, Vincenzo, et al. "Skin Biopsy May Help to Distinguish Multiple System Atrophy-Parkinsonism From Parkinson's Disease With Orthostatic Hypotension." Movement Disorders : Official Journal of the Movement Disorder Society, 2020.
Donadio V, Incensi A, Rizzo G, et al. Skin Biopsy May Help to Distinguish Multiple System Atrophy-Parkinsonism from Parkinson's Disease with Orthostatic Hypotension. Mov Disord. 2020.
Donadio, V., Incensi, A., Rizzo, G., De Micco, R., Tessitore, A., Devigili, G., Del Sorbo, F., Bonvegna, S., Infante, R., Magnani, M., Zenesini, C., Vignatelli, L., Cilia, R., Eleopra, R., Tedeschi, G., & Liguori, R. (2020). Skin Biopsy May Help to Distinguish Multiple System Atrophy-Parkinsonism from Parkinson's Disease with Orthostatic Hypotension. Movement Disorders : Official Journal of the Movement Disorder Society. https://doi.org/10.1002/mds.28126
Donadio V, et al. Skin Biopsy May Help to Distinguish Multiple System Atrophy-Parkinsonism From Parkinson's Disease With Orthostatic Hypotension. Mov Disord. 2020 Jun 18; PubMed PMID: 32557839.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Skin Biopsy May Help to Distinguish Multiple System Atrophy-Parkinsonism from Parkinson's Disease with Orthostatic Hypotension. AU - Donadio,Vincenzo, AU - Incensi,Alex, AU - Rizzo,Giovanni, AU - De Micco,Rosa, AU - Tessitore,Alessandro, AU - Devigili,Grazia, AU - Del Sorbo,Francesca, AU - Bonvegna,Salvatore, AU - Infante,Rossella, AU - Magnani,Martina, AU - Zenesini,Corrado, AU - Vignatelli,Luca, AU - Cilia,Roberto, AU - Eleopra,Roberto, AU - Tedeschi,Gioacchino, AU - Liguori,Rocco, Y1 - 2020/06/18/ PY - 2020/02/08/received PY - 2020/04/29/revised PY - 2020/05/05/accepted PY - 2020/6/20/entrez KW - misfolded alpha-synuclein KW - multiple system atrophy KW - orthostatic hypotension KW - parkinsonism KW - skin biopsy JF - Movement disorders : official journal of the Movement Disorder Society JO - Mov. Disord. N2 - BACKGROUND: The differential diagnosis between multiple system atrophy parkinsonism type (MSA-P) and Parkinson's disease with orthostatic hypotension (PD+OH) is difficult because the 2 diseases have a similar clinical picture. The aim of this study is to distinguish MSA-P from PD+OH by immunostaining for abnormal phosphorylated α-synuclein at serine 129 (p-syn) in cutaneous nerves. METHOD: We recruited 50 patients with parkinsonism and chronic orthostatic hypotension: 25 patients fulfilled the diagnostic criteria for MSA-P and 25 patients for PD+OH. The patients underwent a skin biopsy from the cervical area, thigh, and leg to analyze somatic and autonomic skin innervation and p-syn in skin nerves. RESULTS: Intraneural p-syn positivity was found in 72% of patients with MSA-P, mainly in distal skin sites. More important, p-syn deposits in MSA-P differed from PD+OH because they were mainly found in somatic fibers of subepidermal plexi, whereas scant autonomic fiber involvement was found in only 3 patients. All patients with PD+OH displayed widely distributed p-syn deposits in the autonomic skin fibers of proximal and distal skin sites, whereas somatic fibers were affected only slightly in 4 patients with PD+OH. Skin innervation mirrored p-syn deposits because somatic innervation was mainly reduced in MSA-P. Sympathetic innervation was damaged in PD+OH but fairly preserved in MSA-P. CONCLUSIONS: The p-syn in cutaneous nerves allows the differentiation of MSA-P from PD+OH; MSA-P mainly shows somatic fiber involvement with relatively preserved autonomic innervation; and by contrast, PD+OH displays prevalent abnormal p-syn deposits and denervation in autonomic postganglionic nerves. © 2020 International Parkinson and Movement Disorder Society. SN - 1531-8257 UR - https://www.unboundmedicine.com/medline/citation/32557839/Skin_Biopsy_May_Help_to_Distinguish_Multiple_System_Atrophy-Parkinsonism_from_Parkinson's_Disease_with_Orthostatic_Hypotension L2 - https://doi.org/10.1002/mds.28126 DB - PRIME DP - Unbound Medicine ER -
Try the Free App:
Prime PubMed app for iOS iPhone iPad
Prime PubMed app for Android
Prime PubMed is provided
free to individuals by:
Unbound Medicine.