Objective: We clarify the correlation between abnormality in 123I-metaiodobenzylguanidine (MIBG) scintigraphy and task-evoked pupillary response in Parkinson’s disease (PD) patients.

Background: MIBG scintigraphy is one of the supportive feature of Lewy body disease which can be demonstrate myocardial postganglionic sympathetic dysfunction. Recently, video eye trackers with a high-resolution camera has been utilized to measure the task-evoked pupillary response, however little work has been done to evaluate autonomic failure in PD.

Methods: 19 PD patients (mean age: 74.3 ± 8.2 years, Hoehn-Yahr stage: 2.9 ± 0.7, disease durations: 7.6 ± 5.3 years) were examined. Both MIBG scintigraphy and task-evoked pupillary response were evaluated in all patients. Pupil response was measured using the eye-tracking software at a sampling of 60 Hz. Pupillary response was measured using two conditions, (1) 18 second maximum hand grip tasks (HG) and (2) 10 second light stimulus from 80 lux to 400 lux (LS). Normal values were obtained from 10 healthy volunteers.

Results: Pupillary response in HG task in PD patients was significantly lower than in controls (24.4±4.8% vs 47.7±14.7%, p=0.001). Pupillary response in LS was 24.4±4.8% in PD group, and it was significantly correlated with disease durations (r=0.521, P=0.027), levodopa equivalent dose (r=0.498, P=0.036), and UPDRS partⅣ(r=0.0608, P=0.027). There was no correlation between pupillary response in HG and the heart to mediastinum (H/M) ratio in delayed image of 123I-MIBG cardiac scintigraphy. 

Conclusions: Pupillary response in PD patients could be utilized as an indicator of progression marker in PD. Further studies are warranted to explore the relationship between pupillary response and other autonomic failure in PD.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/pupil-evaluation-as-the-test-for-the-clinical-manifestations-of-parkinsons-disease/