Autonomic Function Tests and MIBG in Parkinson's Disease: Correlation to Disease Duration and Motor Symptoms
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AIMS: Disorders of the autonomic nervous system (ANS) have a variable degree of clinical relevance in patients with Parkinson's disease (PD). Here, we assessed whether subclinical autonomic dysfunction, as evaluated by a complete battery of autonomic function tests (AFTs), correlates with PD progression. METHODS: A series of 27 consecutive patients with PD underwent extensive ANS investigations including the head-up tilt test (HUTT), Valsalva maneuver, deep-breathing test, and handgrip test (HG); further, they performed 123I-meta-iodobenzylguanidine (MIBG) scintigraphy. RESULTS: Seven of the 27 patients showed orthostatic hypotension (OH) at HUTT and pathological responses to the deep-breathing and HG test and Valsalva maneuver. The majority of the remaining 20 patients with PD showed pathological responses to deep-breathing (n = 13) and/or HG (n = 11). Only 3 of 27 suffered relevant OH. MIBG uptake of myocardium was decreased in 19 patients with PD (H/M ratio 1.3 ± 0.2). Prolonged clinical observation (>3 years), persistent response to levodopa, and MIBG repetition allowed us to exclude negative MIBG as attributable to atypical Parkinsonism. MIBG uptake did not correlate with OH and other AFTs. Both HG test response and MIBG did correlate with the Unified Parkinson's Disease Rating Scale (UPDRS) motor score and disease duration. A positive correlation emerged between diastolic blood pressure (DBP) response to HG test and MIBG and with systolic blood pressure (SBP) response at tilt test. CONCLUSIONS: Our investigation suggests that ANS impairment affects the majority of patients with PD, even those PD patients showing negative MIBG, irrespective of clinical neurovegetative symptoms. The strict correlation that has been revealed with disease progression supports the routine utilization of AFTs as a reliable and inexpensive tool for monitoring peripheral sympathetic dysfunction in PD and optimizing therapy.
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The absence of a BP overshoot and an absence of a HR increase during the Valsalva is pathognomonic for neurogenic OH, occurring in primary and secondary autonomic failure.
“There is strong evidence that the absence of a BP overshoot and an absence of a HR increase during the Valsalva is pathognomonic for neurogenic OH, occurring in primary and secondary autonomic failure, and the degree of hypotension and/or lack of compensation during forced expiration usually correlate with the degree of autonomic dysfunction and related symptoms. 138-143”
From 2018 ESC Guidelines for the diagnosis and management of syncope (2018) · cites this paper as [143]
In Autonomic Function Tests (page not provided), the seven Parkinson’s disease patients with orthostatic hypotension also had a decreased Valsalva heart-rate ratio and abnormal blood-pressure responses. The paper does not establish that absent BP overshoot and HR increase are pathognomonic for neurogenic OH in primary or secondary autonomic failure, nor that the Valsalva response correlates with symptom severity. (LLM, conf=0.86)
Experimental — accuracy not yet measuredThe degree of hypotension and/or lack of compensation during forced expiration usually correlate with the degree of autonomic dysfunction and related symptoms.
“There is strong evidence that the absence of a BP overshoot and an absence of a HR increase during the Valsalva is pathognomonic for neurogenic OH, occurring in primary and secondary autonomic failure, and the degree of hypotension and/or lack of compensation during forced expiration usually correlate with the degree of autonomic dysfunction and related symptoms. 138-143”
From 2018 ESC Guidelines for the diagnosis and management of syncope (2018) · cites this paper as [143]
The Autonomic Function Tests section reports abnormal Valsalva responses in all seven patients with orthostatic hypotension, supporting an association with autonomic impairment. It does not establish that the degree of the response correlates with dysfunction or symptoms; only three of those seven patients reported symptomatic episodes. (LLM, conf=0.84)
Experimental — accuracy not yet measuredThere is weak evidence that other autonomic function tests (30:15 ratio, cold pressure test, sustained hand grip test, and mental arithmetic) may be useful.
“There is weak evidence that these tests may be useful. 13,142,143,147”
From 2018 ESC Guidelines for the diagnosis and management of syncope (2018) · cites this paper as [143]
The Discussion (page unavailable) says isometric handgrip could be a useful autonomic test in Parkinson’s disease. The paper does not provide evidence for the 30:15 ratio, cold pressure test, or mental arithmetic, so it supports only one of the four tests attributed to it. (LLM, conf=0.88)
Experimental — accuracy not yet measuredBlunted or abolished variation in HR during deep breathing is suggestive of parasympathetic dysfunction.
“There is strong consensus that blunted or abolished variation is suggestive of parasympathetic dysfunction. 142,143,146,147”
From 2018 ESC Guidelines for the diagnosis and management of syncope (2018) · cites this paper as [143]
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- ª 2015 John Wiley & Sons Ltd CNS Neuroscience & Therapeutics 21 (2015) 727-732 731
- C. Rocchi et al. Autonomic Test and MIBG in Parkinson's Disease 17555949, 2015, 9, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/cns.12437 by Readcube (Labtiva Inc.), Wiley Online Library on [01/09/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License · DOI
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2018 ESC Guidelines for the diagnosis and management of syncope
Brignole, M., Moya, A., de Lange, F. J., Deharo, J.-C., Elliott, P. M., Fanciulli, A., Fedorowski, A., Furlan, R., Kenny, R. A., Martín, A., et al. (2018) · European Heart Journal · doi:10.1093/eurheartj/ehy037 · Cited by 1,951 · see citing works
- Authors
- Rocchi, C., Pierantozzi, M., Galati, S., Chiaravalloti, A., Pisani, V., Prosperetti, C., Lauretti, B., Stampanoni Bassi, M., Olivola, E., Schillaci, O., & Stefani, A.
- Affiliations
- University of Rome Tor Vergata (IT)
- Neurocenter of Southern Switzerland Lugano Switzerland
- Fondazione Santa Lucia (IT)
- Department of System Medicine, Neurology University of Rome “Tor Vergata” Rome Italy
- Corresponding author
- Stefani, Alessandro
- ORCID
- Venue
- CNS Neuroscience & Therapeutics
- Publisher
- Wiley
- Published
- 2015-07-24
- Volume
- 21
- Issue
- 9
- Pages
- 727-732
- ISSN
- 1755-5930 (ISSN-L)
- 1755-5949
- PMC
- PMC6493143
- OpenAlex
- W1943668241
- Cited by
- 31
- References
- 35
- Citations by year
- 2026: 1 · 2025: 3 · 2024: 2 · 2023: 2 · 2022: 4 · 2021: 2 · 2020: 2 · 2019: 2 · 2018: 5 · 2017: 6 · 2016: 1 · 2015: 1
- FWCI
- 3.04
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- CNS Neuroscience & Therapeutics (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Cineca Institutional Research Information System (Tor Vergata University) (submittedVersion)
- Funders
- Ministero della Salute
- Topics
- Health Sciences › Medicine › Neurology › Parkinson's Disease Mechanisms and Treatments
- Health Sciences › Medicine › Surgery › Cardiovascular Syncope and Autonomic Disorders
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Rate Variability and Autonomic Control
- Keywords
- Parkinson's disease, autonomic dysfunction, autonomic function testing, MIBG scintigraphy, orthostatic hypotension, head-up tilt, handgrip test, deep breathing test, Valsalva maneuver, sympathetic dysfunction, disease progression, motor symptoms, disease duration, levodopa response, atypical parkinsonism
- MeSH terms
- Adult, Aged, Antiparkinson Agents, Autonomic Nervous System, Blood Pressure, Female, Heart, Humans, Levodopa, Male, Middle Aged, Neurologic Examination, Parkinson Disease, Severity of Illness Index, Time Factors, Hand Strength, Radiopharmaceuticals, 3-Iodobenzylguanidine, Myocardial Perfusion Imaging
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