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LETTERS TO THE EDITOR
Year : 2022  |  Volume : 25  |  Issue : 6  |  Page : 1213-1214
 

Neuropathy in parkinson's disease. comment: Neuropathy in parkinson's disease: Risk determinants and impact on quality of life


1 Department of Internal Medicine, Federal University of Paraná, Curitiba, Brazil
2 Neurophysiology Service, America`s Neurological Clinic, Curitiba, Brazil

Date of Submission18-Aug-2022
Date of Decision20-Sep-2022
Date of Acceptance14-Oct-2022
Date of Web Publication17-Nov-2022

Correspondence Address:
Otto J H. Fustes
Av. Marechal Floriano 170, Sala 1509, 80090-020, Curitiba
Brazil
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/aian.aian_711_22

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How to cite this article:
H. Fustes OJ, H. Fustes OJ. Neuropathy in parkinson's disease. comment: Neuropathy in parkinson's disease: Risk determinants and impact on quality of life. Ann Indian Acad Neurol 2022;25:1213-4

How to cite this URL:
H. Fustes OJ, H. Fustes OJ. Neuropathy in parkinson's disease. comment: Neuropathy in parkinson's disease: Risk determinants and impact on quality of life. Ann Indian Acad Neurol [serial online] 2022 [cited 2023 Feb 6];25:1213-4. Available from: https://www.annalsofian.org/text.asp?2022/25/6/1213/361409




Sir,

We read with interest the Ravi Soumiya et al.,[1] original article about Neuropathy in Parkinson's Disease: Risk Determinants and Impact on Quality of Life.

This an excellent paper that illustrates, in every detail, the importance of recognizing neuropathy signs and symptoms impact on the quality of life in people with Parkinson's Disease (PD).

This article is an opportunity to discuss important aspects of this relationship, which we know today regardless of the medication used and which each day gains more attention not only from the neurologist specializing in neuromuscular diseases or movement disorders but also from the clinician and the resident. We have the following comments and concerns.

We miss the neurophysiological data in the results. In addition to the importance of recognizing the clinical manifestations of neuropathy in PD, the role of neurophysiology and especially electrodiagnostic nerve conduction studies (EDX) is important as a tool to validate the degree of involvement of motor or sensory nerve fibers.[2]

As well as the role of clinical tests such as the skin wrinkle test, neurophysiological tests such as pain-related evoked potential, or histological tests such as skin biopsy test to assess the fine nerve fibers and the autonomic system.[3],[4],[5]

Patients with PD have a wide range of non-motor characteristics, including anosmia, sleep disturbances, constipation, mood deflection, and pain, and its onset may even precede motor impairment,[6] so the assessment of peripheral nervous system involvement should be included in the management protocols of patients with PD.

In our study, 36 patients were diagnosed with PD who were referred for EDX with suspected clinical polyneuropathy. Thirty-two patients were receiving oral levodopa treatment. EDX of twenty-two patients demonstrated neuropathy abnormalities, and in 90.9% of these patients sensory neuropathy was confirmed. The most common nerve found to be compromised was the superficial fibular nerve (55.0%), followed by the sural (50.0%).[2]

We agree with Soumiya et al.,[1] among non-motor symptoms; neuropathy is an important symptom that affects patients with PD with an impact on their quality of life.

We thank the authors for the opportunity and would like to encourage multicentric studies on an interesting topic.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Soumiya R, Paul BS, Aggarwal R, Paul G. Neuropathy in Parkinson's disease: Risk determinants and impact on quality of life. Ann Indian Acad Neurol 2022;25:428-32.  Back to cited text no. 1
  [Full text]  
2.
Hernandez Fustes OJ, Hernandez Fustes OJ. Sensory neuropathy in Parkinson disease: Electrodiagnostic evaluation. Neurodiagn J 2020;60:177-84.  Back to cited text no. 2
    
3.
Hernández Fustes OJ, Kay CSK, Lorenzoni PJ, Ducci RD, Ribas MZ, Werneck LC, et al. Pain-related nociceptive evoked potential and skin wrinkle test in small fiber neuropathy. Arq Neuropsiquiatr 2022;80:545. doi: 10.1590/0004-282X-ANP-2021-0327.  Back to cited text no. 3
    
4.
Kobylecki C, Gosal D, Marshall A, Malik RA, Silverdale M. Small fibre neuropathy in Parkinson's disease: Comparison of skin biopsies from the more affected and less affected sides. J Parkinsons Dis 2019;9:761-5.  Back to cited text no. 4
    
5.
de Araújo DF, de Melo Neto AP, Oliveira íS, Brito BS, de Araújo IT, Barros IS, et al. Small (autonomic) and large fiber neuropathy in Parkinson disease and parkinsonism. BMC Neurol 2016;16:139. doi: 10.1186/s12883-016-0667-3.  Back to cited text no. 5
    
6.
Teive HAG, Bertucci Filho DC, Munhoz RP. Unusual motor and non-motor symptoms and signs in the early stage of Parkinson's disease. Arq Neuropsiquiatr 2016;74:781-4.  Back to cited text no. 6
    




 

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