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Pathophysiology of somatosensory abnormalities in Parkinson disease

Nature Reviews Neurology volume 9, pages 687–697 (2013)Cite this article

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Abstract

Changes in sensory function that have been described in patients with Parkinson disease (PD) can be either 'pure' disorders of conscious perception such as elevations in sensory threshold, or disorders of sensorimotor integration, in which the interaction between sensory input and motor output is altered. In this article, we review the extensive evidence for disrupted tactile, nociceptive, thermal and proprioceptive sensations in PD, as well as the influences exerted on these sensations by dopaminergic therapy and deep brain stimulation. We argue that abnormal spatial and temporal processing of sensory information produces incorrect signals for the preparation and execution of voluntary movement. Sensory deficits are likely to be a consequence of the dopaminergic denervation of the basal ganglia that is the hallmark of PD. A possible mechanism to account for somatosensory deficits is one in which disease-related dopaminergic denervation leads to a loss of response specificity, resulting in transmission of noisier and less-differentiated information to cortical regions. Changes in pain perception might have a different explanation, possibly involving disease-related effects outside the basal ganglia, including involvement of peripheral pain receptors, as well as structures such as the periaqueductal grey matter and non-dopaminergic neurotransmitter systems.

Key Points

  • Extensive evidence has been obtained for disrupted tactile, nociceptive, thermal and proprioceptive sensations in Parkinson disease

  • Effects of dopaminergic therapy and deep brain stimulation on somatosensory function have been reported

  • The observation that many sensory changes occur early in the course of the disease, when the extent of pathology is limited, suggests a primary role for basal ganglia

  • Multiple mechanisms contribute to changes in sensation, and the role of each may vary with progression of the disease

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Figure 1: Tactile abnormalities in patients with PD.
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Authors and Affiliations

  1. Neuromed Institute IRCCS, Via Atinense 18, Pozzilli, 86077, IS, Italy

    Antonella Conte

  2. Department of Neurology and Psychiatry, Sapienza University of Rome, Viale dell'Università 30, Rome, 00185, Italy

    Nashaba Khan & Alfredo Berardelli

  3. Department of Neuroscience and Sensory Organs, “Aldo Moro” University of Bari, Piazza Giulio Cesare 11, Bari, 70124, Italy

    Giovanni Defazio

  4. UCL Institute of Neurology, Queen Square, London, WC1N 3BG, UK

    John C. Rothwell

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  1. Antonella Conte
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  2. Nashaba Khan
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  3. Giovanni Defazio
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  4. John C. Rothwell
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  5. Alfredo Berardelli
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Contributions

A. Conte and N. Khan researched the data for the article. A. Berardelli and J. C. Rothwell made substantial contributions to discussions of the content. A. Conte and N. Khan wrote the article. G. Defazio reviewed and edited the manuscript before submission.

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Correspondence to Alfredo Berardelli.

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Conte, A., Khan, N., Defazio, G. et al. Pathophysiology of somatosensory abnormalities in Parkinson disease. Nat Rev Neurol 9, 687–697 (2013). https://doi.org/10.1038/nrneurol.2013.224

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