Objective: To analyze the prevalence and the functional burden of autonomic neuropathy (AN) in advanced Parkinson’s disease (PD) patients who underwent subthalamic deep brain stimulation (STN-DBS) or levodopa-carbidopa intestinal gel infusion (LCIG)

Background: STN-DBS and LCIG are effective therapies for the management of advanced PD. Their clinical efficacy, however, may be limited by associated autonomic dysfunction, resulting in reduced activities of daily living (ADL) and quality of life (QoL) performances [1,2] despite treatment-associated reduction of motor complications

Methods: 60 advanced PD patients treated with DBS (n= 30) or LCIG (n= 30) were classified according to the presence (AN+) or absence (AN-) of dysautonomia. AN was defined by at least two abnormal parasympathetic tests, as measured by heart rate variability during deep breathing, lying to standing, and Valsalva maneuver, and at least one abnormal sympathetic test, measured by postural blood pressure response on the lying-to-standing test and to handgrip. ADL impairment, autonomic symptoms, cognitive status, motor performances and QoL were evaluated by means of ADL/iADL scales, SCOPA-AUT, MoCA, MDS-UPDRS-III, and PDQ-8

Results: The prevalence of AN was 48.3% (50% DBS vs 46.7% LCIG; p:0.796); 55.2% patients reported thermoregulatory, 44.8% urinary/sexual, 27.6% gastrointestinal, 17.2% cardiovascular, and 17.2% pupillomotor dysfunctions. AN+ patients, adjusting for cognitive impairment and motor disability, showed a three-fold increased prevalence of ADL/iADL impairment compared with AN- (OR=3.042; p:0.046). Orthostatic hypotension prevalence was 26.6% (23% DBS vs 30% LCIG; p:0.559) and was indipendently associated to higher ADL impairment (p≤ 0.047). SCOPA-AUT score correlated with QoL impairment, in particular for gastrointestinal (p<0.001), urinary/sexual (p=0.01) and cardiovascolar (p=0.017) regions. No differences were observed between DBS and LCIG patients, apart for worse cardiovascular impairment in LCIG (p = 0.039) and worse pupillomotor impairment in STN-DBS (p = 0.026), as measured by the SCOPA-AUT

Conclusions: AN is an independent risk factor for functional disability in advanced PD patients treated with DBS and LCIG. Thus, in addition to addressing motor disability, identifying and managing autonomic targets may be required to optimize the full potential of these advanced therapies[2]

References: [1] Kaufmann H, Goldstein DS. Autonomic dysfunction in Parkinson disease. Handb Clin Neurol 2013;117:259-78

[2] Espay AJ, LeWitt PA, Hauser RA, Merola A, Masellis M, Lang AE. Neurogenic orthostatic hypotension and supine hypertension in Parkinson’s disease and related synucleinopathies: prioritisation of treatment targets. Lancet Neurol 2016;15:954-66

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MDS Abstracts - https://www.mdsabstracts.org/abstract/burden-of-autonomic-neuropathy-in-parkinsons-disease-patients-treated-with-advanced-therapies/