{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T12:23:25Z","timestamp":1789043005259,"version":"build-2803163510"},"reference-count":40,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2020,6,18]],"date-time":"2020-06-18T00:00:00Z","timestamp":1592438400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["movementdisorders.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Movement Disorders"],"published-print":{"date-parts":[[2020,9]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The differential diagnosis between multiple system atrophy parkinsonism type (MSA\u2010P) and Parkinson's disease with orthostatic hypotension (PD+OH) is difficult because the 2 diseases have a similar clinical picture. The aim of this study is to distinguish MSA\u2010P from PD+OH by immunostaining for abnormal phosphorylated \u03b1\u2010synuclein at serine 129 (p\u2010syn) in cutaneous nerves.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Method<\/jats:title>\n                    <jats:p>We recruited 50 patients with parkinsonism and chronic orthostatic hypotension: 25 patients fulfilled the diagnostic criteria for MSA\u2010P and 25 patients for PD+OH. The patients underwent a skin biopsy from the cervical area, thigh, and leg to analyze somatic and autonomic skin innervation and p\u2010syn in skin nerves.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Intraneural p\u2010syn positivity was found in 72% of patients with MSA\u2010P, mainly in distal skin sites. More important, p\u2010syn deposits in MSA\u2010P differed from PD+OH because they were mainly found in somatic fibers of subepidermal plexi, whereas scant autonomic fiber involvement was found in only 3 patients. All patients with PD+OH displayed widely distributed p\u2010syn deposits in the autonomic skin fibers of proximal and distal skin sites, whereas somatic fibers were affected only slightly in 4 patients with PD+OH. Skin innervation mirrored p\u2010syn deposits because somatic innervation was mainly reduced in MSA\u2010P. Sympathetic innervation was damaged in PD+OH but fairly preserved in MSA\u2010P.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The p\u2010syn in cutaneous nerves allows the differentiation of MSA\u2010P from PD+OH; MSA\u2010P mainly shows somatic fiber involvement with relatively preserved autonomic innervation; and by contrast, PD+OH displays prevalent abnormal p\u2010syn deposits and denervation in autonomic postganglionic nerves. \u00a9 2020 International Parkinson and Movement Disorder Society<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/mds.28126","type":"journal-article","created":{"date-parts":[[2020,6,18]],"date-time":"2020-06-18T11:35:37Z","timestamp":1592480137000},"page":"1649-1657","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":83,"title":["Skin Biopsy May Help to Distinguish Multiple System Atrophy\u2013Parkinsonism from Parkinson's Disease With Orthostatic Hypotension"],"prefix":"10.1002","volume":"35","author":[{"given":"Vincenzo","family":"Donadio","sequence":"first","affiliation":[{"name":"IRCCS Istituto delle Scienze Neurologiche di Bologna, UOC Clinica Neurologica, Bologna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alex","family":"Incensi","sequence":"additional","affiliation":[{"name":"IRCCS Istituto delle Scienze Neurologiche di Bologna, UOC Clinica Neurologica, Bologna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giovanni","family":"Rizzo","sequence":"additional","affiliation":[{"name":"IRCCS Istituto delle Scienze Neurologiche di Bologna, UOC Clinica Neurologica, Bologna, Italy"},{"name":"Dipartimento di Scienze Biomediche e Neuromotorie Universit\u00e0 di Bologna  Italia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rosa","family":"De 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