Sympathetic cardiac denervation in Parkinson's disease and pure autonomic failure but not in multiple system atrophy

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Abstract
Three neurodegenerative diseases causing primary autonomic failure are pure autonomic failure (PAF), Parkinson's disease (PD), and multiple system atrophy (MSA). Differential diagnoses among these diseases are often difficult especially in early disease stage. For example, it may be difficult to determine whether a patient with parkinsonism and autonomic failure has PD or MSA. Recently, a decrease in myocardial uptake of meta-iodobenzylguanidine (MIBG), an analogue of norepinephrine, has been reported in PD but not in MSA using [123I]MIBG myocardial scintigraphy.1 This new imaging approach is thought to be of significance in the diagnosis and characterisation of akinetic rigid syndromes, especially PD. After that, we reported severe loss of cardiac sympathetic nerves in one patient with PD but not in one patient with MSA, which accounts for a difference in myocardial uptake of MIBG between PD and MSA.2 However, our observation was based on the study in only a single patient of each disease. In this study, we immunohistochemically examined the heart tissues from four patients with PD, three patients with MSA, and one patient with PAF, and showed the involvement of postganglionic cardiac sympathetic nerves in PD and PAF …

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