Postganglionic sudomotor denervation in patients with multiple system atrophy.

Abstract

OBJECTIVE:

To evaluate postganglionic autonomic involvement in multiple system atrophy (MSA).

METHODS:

We quantified sudomotor innervation in skin biopsy of 29 patients with MSA (19 male and 10 female; age 60.0 ± 7.7 years) and 29 age- and sex-matched healthy subjects. Samples were obtained from thigh and leg and, in 20 out of the 29 cases, also from fingertip. Dysautonomic complaints were evaluated by SCOPA-AUT, a self-administered questionnaire. Sudomotor function was evaluated in a subgroup of patients by the silastic imprint test. Skin samples were processed by indirect immunofluorescence using pan-neuronal and selective cholinergic markers. Total length of sudomotor nerves was measured on digital confocal images using a semiautomated morphometric approach.

RESULTS:

Measurements of sudomotor nerve density (total length of nerve per volume of glandular tissue) favorably correlated to values obtained using a stereologic unbiased method. Sudomotor nerve density was lower in patients compared to controls in all the examined sites (0.9 ± 0.2 vs 1.9 ± 0.4 nm/μm(3), p < 0.001, in fingertip; 0.7 ± 0.2 vs 1.9 ± 0.5 nm/µm(3), p < 0.001, in thigh; 0.6 ± 0.2 vs 1.8 ± 0.4 nm/µm(3), p < 0.001, in leg).

CONCLUSIONS:

Our data support the hypothesis that postganglionic impairment occurs in MSA and may contribute with the coexisting degeneration of central structures to the development of dysautonomic disorders in this condition.

• Authors: Vincenzo Provitera, Maria Nolano, Giuseppe Caporaso, Annamaria Stancanelli, Fiore Manganelli, Rosa Iodice, Mona M Selim, Anna De Rosa, Bernardo Lanzillo, Maria Teresa Pellecchia, Giuseppe De Michele, Lucio Santoro
• Journal: Neurology (Neurology) Vol. 82 Issue 24 Pg. 2223-9 (Jun 17 2014) ISSN: 1526-632X [Electronic] United States
• PMID: 24838791 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: © 2014 American Academy of Neurology.

Topics

• Aged
• Autonomic Denervation
• Autonomic Fibers, Postganglionic (pathology)
• Autonomic Nervous System Diseases (etiology)
• Case-Control Studies
• Female
• Humans
• Male
• Middle Aged
• Multiple System Atrophy (complications)
• Skin (innervation)
• Surveys and Questionnaires