Objective: To investigate the relationship between vagus nerve atrophy and clinical manifestation in Parkinson’s disease (PD).

Background: PD is the progressive neurodegenerative disease and causes not only motor symptoms but also non-motor symptoms including autonomic dysfunction. Recently, the alpha-synuclein ascending pathway via the vagus nerve has been noticed as one possibility of the pathogenesis of PD.

Method: During July 2018 and February 2019, we examined the patients who admitted to our hospital due to the 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. We recruited the patients with PD determined by the Movement Disorder Society Clinical Diagnostic Criteria for PD and evaluated disease duration, motor dysfunction, autonomic function, olfactory discrimination function and image findings such as 123I-MIBG cardiac scintigraphy. The assessment of constipation is based on history taking.

Results: We enrolled 30 patients with PD (median age: 62[54-70], disease duration: five years [1-10]). The third part of the Unified Parkinson’s Disease Rating Scale (UPDRS-III) was 29(median)[30(patients), 18-42(IQR)]. The Score of odor stick identification test for Japanese (OSIT-J) was 5.0(median)[25(patients), 2.5-8.0(IQR)] The coefficient of variation of R-R intervals was 1.89(median)[27(patients), 1.42-2.51(IQR)]. 123I-MIBG cardiac scintigraphy was evaluated 25 patients and cardiac MIBG uptake was reduced in twenty patients. 12 patients presented orthostatic hypotension and 19 patients had constipation. Constipation was associated with the sum of cross-sectional area of the right and left vagus nerve (P=0.02). On the other hand, disease duration, motor function, and olfactory discrimination function had no statistically significant relationship.

Conclusion: Our study suggested that vagus nerve atrophy was associated with constipation, whereas other autonomic functions and vagus nerve atrophy had no statistically significant relationship. This is compatible with the hypothesis that alpha-synuclein spreads from the enteric nervous system via the vagus nerve.

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-ultrasonographic-assessment-of-vagus-nerve-atrophy-comparison-with-autonomic-dysfunction-in-parkinsons-disease/