Suppressed sympathetic skin response in Parkinson disease

Abstract

The sympathetic skin response (SSR) was used to evaluate sympathetic sudomotor activity in Parkinson disease (PD) and the effects of antiparkinsonian medication on the disease. We recorded SSRs to electric and auditory stimulation in 58 untreated patients with PD and in 20 healthy controls. In addition to amplitude and latency measurements, we examined the number of SSRs evoked by a single stimulus and the response adaptation after repetitive stimuli. The patients with PD subsequently were randomized for administration of levodopa/ carbidopa (n = 19), bromocriptine (n = 20), or selegiline (n = 19) as their initial treatment. The measurements were repeated after 6 months of medication and after a washout period. SSR amplitudes were significantly lower in patients with PD than in the control subjects at baseline. The amplitude reduction was more pronounced in patients with high Unified Parkinson's Disease Rating Scale scores, in those with high tremor scores, and in those with PD symptoms that had lasted more than 1 year. The levodopa/carbidopa and bromocriptine treatments did not influence SSRs, although selegiline slightly decreased the amplitude. The synchronous responses after a single stimulus were more often repetitive in the patients with PD than in the controls, although the response adaptation tendencies were similar. In conclusion, the degenerative process in PD involves the sudomotor system as reflected by the progressive suppression of SSR amplitudes with a correlation to PD symptom duration and clinical disability, whereas PD medications seems to have only minor effects. The changes in amplitude and the repetitiveness of SSRs with normal adaptation may be caused by deficits at several levels of the SSR reflex arch.

A Survey of SSR Mechanism and Application

“…A commonly used form of stimulation is to apply a snapping sound of 65 to 105 dB through a pair of headphones [32,33], or a snapping sound along with an electrical stimulation [34].…”

Sweating dysfunctions in Parkinson’s disease

“…If the contraction period lengthens, the SSR abnormality becomes more pronounced [16,26,29,31]. SSR abnormalities develop readily in the affected motor side [13,24,25]. In those studies that examined SSR abnormalities in the upper and lower limbs, pathological abnormalities have been reported in only the upper limb [10,14] or both the upper and lower limbs [15,24,26], but there have been no reports of only a lower limb abnormality.…”

“…SSR abnormalities develop readily in the affected motor side [13,24,25]. In those studies that examined SSR abnormalities in the upper and lower limbs, pathological abnormalities have been reported in only the upper limb [10,14] or both the upper and lower limbs [15,24,26], but there have been no reports of only a lower limb abnormality. It has been reported that a disorder progresses upward from a lower limb in the multiple system atrophy (MSA), but a mental sweating disturbance may not necessarily begin from a lower limb in Parkinson's disease.…”

“…More affected on the affected motor side. Haapaniemi TH (2000) [24] SSR latency and amplitude were greater on the affected motor side. No drug effect.…”

“…Mental sweating (Table 3) Mental sweating abnormalities are evaluated using SSR [10,[13][14][15][16][23][24][25][26][27][28][29][30][31]. If the contraction period lengthens, the SSR abnormality becomes more pronounced [16,26,29,31].…”