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Postganglionic Sudomotor Dysfunction and Brain Glucose Hypometabolism in Patients with Multiple System Atrophy

 Seung Woo Kim  ;  Seok Jong Chung  ;  Sangwon Lee  ;  KyeongTaek Oh  ;  Sun Kook Yoo  ;  Phil Hyu Lee  ;  Seung Min Kim  ;  Ha Young Shin  ;  Mijin Yun 
 JOURNAL OF PARKINSONS DISEASE, Vol.11(3) : 1247-1256, 2021-08 
Journal Title
Issue Date
Multiple system atrophy ; autonomic dysfunction ; brain metabolism ; sudomotor dysfunction
Background: Sudomotor dysfunction is common in patients with multiple system atrophy (MSA). Postganglionic sudomotor dysfunction in MSA, which can be assessed using quantitative sudomotor axon reflex testing (QSART), results from the degeneration of preganglionic sympathetic neurons and direct loss of postganglionic fibers.

Objective: We investigate whether abnormal QSART responses in patients with MSA are associated with disease severity.

Methods: In this retrospective study, patients with probable MSA who underwent both 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG-PET/CT) and autonomic function tests were included. Autonomic function test results were integrated divided into three sub-scores, including sudomotor, cardiovagal, and adrenergic sub-scores. The sudomotor sub-score represented postganglionic sudomotor function. Unified Multiple System Atrophy Rating Scale (UMSARS) Part I, Part II, and sum of Part I and II scores (Part I + II) to reflect disease severity and 18F-FDG-PET/CT results were collected.

Results: Of 74 patients with MSA, 62.2%demonstrated abnormal QSART results. The UMSARS Part I + II score was significantly higher in the abnormal QSART group than in the normal QSART group (p = 0.037). In the regression analysis, both UMSARS Part I (β= 1.185, p = 0.013) and Part II (β= 1.266, p = 0.021) scores were significantly associated with the sudomotor sub-score. On 18F-FDG-PET/CT, the abnormal QSART group exhibited more severely decreased metabolic activity in the cerebellum and basal ganglia in patients with MSA-P and MSA-C, respectively. The sudomotor sub-score was significantly associated with regional metabolism in these areas.

Conclusion: Patients with MSA and postganglionic sudomotor dysfunction may have worse disease severity and greater neuropathological burden than those without.
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Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Medical Engineering (의학공학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Neurology (신경과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Nuclear Medicine (핵의학교실) > 1. Journal Papers
Yonsei Authors
Kim, Seung Min(김승민) ORCID logo https://orcid.org/0000-0002-4384-9640
Kim, Seung Woo(김승우) ORCID logo https://orcid.org/0000-0002-5621-0811
Shin, Ha Young(신하영) ORCID logo https://orcid.org/0000-0002-4408-8265
Yoo, Sun Kook(유선국) ORCID logo https://orcid.org/0000-0002-6032-4686
Yun, Mijin(윤미진) ORCID logo https://orcid.org/0000-0002-1712-163X
Lee, Phil Hyu(이필휴) ORCID logo https://orcid.org/0000-0001-9931-8462
Chung, Seok Jong(정석종) ORCID logo https://orcid.org/0000-0001-6086-3199
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