Aspectos clínicos e neurofisiológicos da neuropatia periférica na Doença de Parkinson

Abstract

In recent decades, the presence of peripheral neuropathy (PN) has been observed in patients with Parkinson's Disease (PD), especially in those undergoing chronic treatment with levodopa (LD). This study aims to identify the presence of clinical and electroneurophysiological alterations compatible with NP in individuals with PD. We selected 39 patients with PD, aged over 50 years and with stable doses of antiparkinsonian medication, according to the inclusion and exclusion criteria. All underwent a pre-established protocol: assessment of comorbidities and medications in use, screening for cognitive disorders and depressive symptoms, neurological assessment, application of specific scoring scales for the diagnosis of PN, laboratory tests, and electroneuromyography (ENMG). The presence of clinical neuropathy was verified through standardized and neurophysiological scales, through electroneuromyography of the sural, superficial fibular, sensory, and fibular, motor nerves. After applying the clinical scales, the presence of signs and symptoms characterizing PN was found in 56.4% of the participants, who were, on average, older (70.7 ± 8.4 years) in relation to those without clinical neuropathy (61.7 ± 9.9 years). Three groups of patients were compared: with clinical PN and altered ENMG; with clinical PN and normal ENMG and without PN and normal ENMG. Of the patients with clinical PN, only 27.2% showed changes in ENMG, evidenced by the significant reduction in the mean values of sural nerve amplitudes, on both sides, right (Kruskal-Wallis: H = 12.083; p = 0.002) and left (Kruskal-Wallis: H = 13.585; p = 0.001), as well as all parameters analyzed (latency, velocity and amplitude) of the superficial peroneal nerve (p < 0.05), in the group of patients “with clinical PN and ENMG altered” in relation to the other groups. According to the literature, these neurophysiological aspects may be sufficient to characterize this neuropathy as sensory axon. Studies with a larger sample should be developed to better clarify these findings. The identification of PN during the progression of PD is extremely important so that appropriate conducts and therapies can be established