Objective: To determine the value of testing hand temperature and its response to cooling for differential diagnosis of multiple system atrophy (MSA) versus Parkinson’s disease (PD).

Background: Autonomic dysfunction in MSA comprises orthostatic hypotension, urogenital disorders and, as reported in previous publications, disturbed neurovascular regulation of distal extremities. The latter could be helpful in clinical differentiation of MSA from PD. Previous studies compared hand temperature and its response to cooling in subjects with PD and probable MSA. Significant differences regarding hand temperature before and after cooling, as well as kinetics of natural rewarming were found. Only a minor study sample, however, was reported. Prevalence of disturbed neurovascular regulation in sizable patient cohorts and thereby its value for the differential diagnosis of some Parkinsonian syndromes remains obscure.

Methods: Here we report some particular results of a large retrospective study. For the patients hand temperature was initially measured at rest and consequently following a standard cooling – rewarming protocol, termed ice test (IT). Once the hand temperature at the end of 15-minute IT was lower than the initial temperature, IT was stated to be pathological in terms of defective neurovascular regulation, as a result, temperature decrement (initial minus endpoint temperature) was noted. The measurements were performed on 500 PD and 112 probable MSA patients.

Results: The hand skin temperatures did not differ significantly between those two groups. The frequency of pathological IT was higher in the MSA than the PD group (58,9% and 52,0% respectively, p =0,33). The frequencies of temperature decrement ≥1, 2, 3, 4, 5 and 6°C were consistently, but not significantly, higher in the MSA group. The presence of pathological IT correlated with patients age, age at onset of disease, UPDRS motor and total scores in the PD group. Interestingly, there was no such a correlation in the MSA group observed.

Conclusions: Defective extremity neurovascular regulation seems to be more common in MSA. Pathologic IT alone cannot be deployed as a confident marker for the differential diagnosis of MSA versus PD. The coexistence of pathologic IT together with other autonomic symptoms should be further investigated as a promising tool with greater specificity in clinical differentiation of MSA from PD.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/hand-skin-temperature-and-its-response-to-cooling-in-clinical-differentiation-of-multiple-system-atrophy-and-parkinsons-disease/