Objective: To assess the neurophysiologic cardiac autonomic findings and Sympathetic skin response (SSR) in a Tunisian cohort of Parkinson’s disease (PD).

Background: Prevalence of dysautonomia was estimated to 20-40% in PD. Both altered heart rate variability (HRV) and abnormal sympathetic sudomotor activity, resulting from peripheral autonomic synucleinopathy, can be neurophysiologically detected.

Methods: A cross-sectional study was conducted in the Department of Neurology at Razi Hospital in Tunisia (January 2015-December 2017) including 102 PD patients. Demographic, clinical and therapeutic data were collected. Cardiac parasympathetic (Heart rate variation to deep breathing (HR-DB), to Valsalva (HR-V), heart rate response to standing (HR-S)) and sympathetic (sympathetic skin response (SSR)) autonomic system were assessed. Patients were graded as per Ewing’s criteria into normal, early or definite autonomic dysfunction.

Results: In our study population, the sex-ratio was 1,8, the mean age was 65 years [36-88]; the mean age of onset of PD was 59 years [50-88] and the mean disease duration was 6 years [0,5-31]. Dysautonomic complaints were reported in 83,3%. The mean age of onset of dysautonomia was 62 years [28-87]. Neurophysiologic dysautonomia was found in 93,1%. Parasympathetic dysautonomia was found in 89,2% (early in 63,8% and definite in 25,4%). HR-DB was altered respectively in 6%, HR-V in 31,3% and HR-S in 84,7%. Sympathetic dysautonomia was found in 22,5% (associated to parasympathetic dysautonomia in 18,6% and isolated in 3,9%). There was no significant association between the existence of neurophysiologic autonomic dysfunction and dompaminergic drug intake (levodopa, dopaminergic agonists and amantadine).

Conclusions: Neurophysiologic autonomic dysfunction was almost constant in our Tunisian PD, however it still underdiagnosed in clinical practice. Parasympathetic dysautonomia was more common, mostly manifesting on altered HRV on standing. Further studies on genotyped cohorts are mandatory to correlate with clinico-genetic profiles.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/heart-rate-variability-and-sympathetic-skin-response-in-parkinsons-disease/