Objective: This study aims to clarify the compare vagus nerve atrophy with Parkinson’s disease (PD) and other atypical parkinsonism.

Background: Although the pathogenesis of the PD remains unclear, it has been hypothesized that alpha-synuclein is transmitted from the enteric nerve via the vagus nerve to the dorsal motor nucleus of the vagus (DMV), locus coeruleus, and substantia nigra[1]. Several studies have reported vagus nerve atrophy in PD[2][3][4][5], however, the association between other atypical parkinsonism, such as multiple system atrophy (MSA), progressive nuclear palsy (PSP) and corticobasal syndrome （CBS） and the vagus nerve has not been investigated.

Method: During July 2018 and February 2019, we examined the patients who admitted to our hospital due to parkinsonian symptoms. The neurosonologist who was blinded clinical information performed the cervical ultrasonography and measured the cross-sectional area and diameter of the vagus nerve. As a control, we measured the vagus nerve of the patients with ischemic stroke who admitted our hospital at the same study period.

Results: We enrolled 83 patients including 49 patients with parkinsonism including PD (median age 68 [IQR 60-74] years) and 34 patients with ischemic stroke (median age 70.5 [IQR 62-80] years) during the study period. In parkinsonism, 30 patients with PD, 7 with PSP, 9 with MSA were registered. The vagus nerve of the patients with parkinsonism was smaller than the patients with ischemic stroke (median of the cross-sectional area: right 2.30 vs 1.38 cm2; left 2.24 vs 1.31 cm2, p<0.01, respectively). Furthermore, the vagus nerve of the patients with PD and MSA was significantly smaller than the patients with ischemic stroke. On the other hand, the vagus nerve of the patients with other parkinsonism and ischemic stroke was similar.

Conclusion: In this study, we were able to evaluate for the first time the vagus nerve in patients with parkinsonism other than PD. The findings of the present study showed the vagus nerve was significantly atrophied especially in PD and MSA. Both of them were reported to affect the DMV and contribute to gastrointestinal dysfunction. The carotid ultrasonography revealed vagus nerve atrophy and may be useful to make a differential diagnose the parkinsonism.

References: 1. Hawkes CH, Del Tredici K, Braak H. Parkinson’s disease: A dual-hit hypothesis. Neuropathol Appl Neurobiol. 2007;33:599–614. 2. Pelz JO, Belau E, Fricke C, Classen J, Weise D. Axonal Degeneration of the Vagus Nerve in Parkinson’s Disease—A High-Resolution Ultrasound Study. Front Neurol. 2018;9 November:1–4. doi:10.3389/fneur.2018.00951. 3. Walter U, Tsiberidou P, Kersten M, Storch A, Löhle M. Atrophy of the Vagus Nerve in Parkinson’s Disease Revealed by High-Resolution Ultrasonography. Front Neurol. 2018;9 September:1–6. doi:10.3389/fneur.2018.00805. 4. Fedtke N, Witte OW, Prell T. Ultrasonography of the vagus nerve in Parkinson’s disease. Front Neurol. 2018;9 JUL:1–3. 5. Tsukita K, Taguchi T, Sakamaki-Tsukita H, Tanaka K, Suenaga T. The vagus nerve becomes smaller in patients with Parkinson’s disease: A preliminary cross-sectional study using ultrasonography. Parkinsonism Relat Disord. 2018; xxxx. doi:10.1016/j.parkreldis.2018.06.002.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/the-carotid-ultrasonography-revealed-vagus-nerve-atrophy-of-the-patients-with-parkinsonism/