Objective: To investigate whether cardiac sympathetic denervation increases the risk of the early wearing-off phenomenon in Parkinson’s disease (PD).

Background: Recent studies have suggested that preserved cardiac sympathetic denervation may be associated with a small motor burden in PD, and serve as a “good” marker which is not associated with other non-motor symptoms.

Methods: This hospital-based prospective study enrolled 266 de novo patients with PD who underwent 123I-metaiodobenzylguanidine (MIBG) scintigraphy on initial evaluation. The patients visited the outpatient clinic every 2-6 months, and were followed for a minimum of 18 months from the time they began taking dopaminergic medication. Each patient was assessed for the wearing-off phenomenon based on the clinical assessments and symptom diaries. Clinical events were analyzed from the date of evaluation by MIBG scintigraphy until the date of the first occurrence of the wearing-off phenomenon, or until the last follow-up date without wearing-off.

Results: During a mean follow-up period of 30.4 ± 14.8 months, 71 patients developed wearing-off. The wearing-off phenomenon occurred more in patients with decreased MIBG uptake. A Cox-regression analysis revealed that both low MIBG uptake and early onset age significantly predicted the development of wearing-off.

Conclusions: Our study suggests that a reduction in myocardial MIBG uptake in PD patients may be associated with a subsequent increased risk for the wearing-off phenomenon. Findings strongly supports that PD patients with normal cardiac sympathetic innervation might have less involvement of the midbrain dopaminergic circuitry, and a concomitant reduced risk for motor complications, such as wearing-off.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/cardiac-sympathetic-denervation-can-predict-the-wearing-off-phenomenon-in-patients-with-parkinsons-disease/