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March 11, 2014; 82 (10) Article

Submandibular gland needle biopsy for the diagnosis of Parkinson disease

Charles H. Adler, Brittany N. Dugger, Michael L. Hinni, David G. Lott, Erika Driver-Dunckley, Jose Hidalgo, Jonette Henry-Watson, Geidy Serrano, Lucia I. Sue, Thomas Nagel, Amy Duffy, Holly A. Shill, Haruhiko Akiyama, Douglas G. Walker, Thomas G. Beach
First published February 5, 2014, DOI: https://doi.org/10.1212/WNL.0000000000000204
Charles H. Adler
From the Parkinson's Disease and Movement Disorders Center (C.H.A., E.D.-D., A.D.), Department of Neurology, Mayo Clinic, Scottsdale; Banner Sun Health Research Institute (B.N.D., J.H., J.H.-W., G.S., L.I.S., H.A.S., D.G.W., T.G.B.), Sun City; the Department of Otolaryngology (M.L.H., D.G.L., T.N.), Mayo Clinic, Phoenix, AZ; and the Tokyo Institute of Psychiatry (H.A.), Tokyo, Japan.
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Brittany N. Dugger
From the Parkinson's Disease and Movement Disorders Center (C.H.A., E.D.-D., A.D.), Department of Neurology, Mayo Clinic, Scottsdale; Banner Sun Health Research Institute (B.N.D., J.H., J.H.-W., G.S., L.I.S., H.A.S., D.G.W., T.G.B.), Sun City; the Department of Otolaryngology (M.L.H., D.G.L., T.N.), Mayo Clinic, Phoenix, AZ; and the Tokyo Institute of Psychiatry (H.A.), Tokyo, Japan.
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Michael L. Hinni
From the Parkinson's Disease and Movement Disorders Center (C.H.A., E.D.-D., A.D.), Department of Neurology, Mayo Clinic, Scottsdale; Banner Sun Health Research Institute (B.N.D., J.H., J.H.-W., G.S., L.I.S., H.A.S., D.G.W., T.G.B.), Sun City; the Department of Otolaryngology (M.L.H., D.G.L., T.N.), Mayo Clinic, Phoenix, AZ; and the Tokyo Institute of Psychiatry (H.A.), Tokyo, Japan.
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David G. Lott
From the Parkinson's Disease and Movement Disorders Center (C.H.A., E.D.-D., A.D.), Department of Neurology, Mayo Clinic, Scottsdale; Banner Sun Health Research Institute (B.N.D., J.H., J.H.-W., G.S., L.I.S., H.A.S., D.G.W., T.G.B.), Sun City; the Department of Otolaryngology (M.L.H., D.G.L., T.N.), Mayo Clinic, Phoenix, AZ; and the Tokyo Institute of Psychiatry (H.A.), Tokyo, Japan.
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Erika Driver-Dunckley
From the Parkinson's Disease and Movement Disorders Center (C.H.A., E.D.-D., A.D.), Department of Neurology, Mayo Clinic, Scottsdale; Banner Sun Health Research Institute (B.N.D., J.H., J.H.-W., G.S., L.I.S., H.A.S., D.G.W., T.G.B.), Sun City; the Department of Otolaryngology (M.L.H., D.G.L., T.N.), Mayo Clinic, Phoenix, AZ; and the Tokyo Institute of Psychiatry (H.A.), Tokyo, Japan.
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Jose Hidalgo
From the Parkinson's Disease and Movement Disorders Center (C.H.A., E.D.-D., A.D.), Department of Neurology, Mayo Clinic, Scottsdale; Banner Sun Health Research Institute (B.N.D., J.H., J.H.-W., G.S., L.I.S., H.A.S., D.G.W., T.G.B.), Sun City; the Department of Otolaryngology (M.L.H., D.G.L., T.N.), Mayo Clinic, Phoenix, AZ; and the Tokyo Institute of Psychiatry (H.A.), Tokyo, Japan.
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Jonette Henry-Watson
From the Parkinson's Disease and Movement Disorders Center (C.H.A., E.D.-D., A.D.), Department of Neurology, Mayo Clinic, Scottsdale; Banner Sun Health Research Institute (B.N.D., J.H., J.H.-W., G.S., L.I.S., H.A.S., D.G.W., T.G.B.), Sun City; the Department of Otolaryngology (M.L.H., D.G.L., T.N.), Mayo Clinic, Phoenix, AZ; and the Tokyo Institute of Psychiatry (H.A.), Tokyo, Japan.
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Geidy Serrano
From the Parkinson's Disease and Movement Disorders Center (C.H.A., E.D.-D., A.D.), Department of Neurology, Mayo Clinic, Scottsdale; Banner Sun Health Research Institute (B.N.D., J.H., J.H.-W., G.S., L.I.S., H.A.S., D.G.W., T.G.B.), Sun City; the Department of Otolaryngology (M.L.H., D.G.L., T.N.), Mayo Clinic, Phoenix, AZ; and the Tokyo Institute of Psychiatry (H.A.), Tokyo, Japan.
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Lucia I. Sue
From the Parkinson's Disease and Movement Disorders Center (C.H.A., E.D.-D., A.D.), Department of Neurology, Mayo Clinic, Scottsdale; Banner Sun Health Research Institute (B.N.D., J.H., J.H.-W., G.S., L.I.S., H.A.S., D.G.W., T.G.B.), Sun City; the Department of Otolaryngology (M.L.H., D.G.L., T.N.), Mayo Clinic, Phoenix, AZ; and the Tokyo Institute of Psychiatry (H.A.), Tokyo, Japan.
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Thomas Nagel
From the Parkinson's Disease and Movement Disorders Center (C.H.A., E.D.-D., A.D.), Department of Neurology, Mayo Clinic, Scottsdale; Banner Sun Health Research Institute (B.N.D., J.H., J.H.-W., G.S., L.I.S., H.A.S., D.G.W., T.G.B.), Sun City; the Department of Otolaryngology (M.L.H., D.G.L., T.N.), Mayo Clinic, Phoenix, AZ; and the Tokyo Institute of Psychiatry (H.A.), Tokyo, Japan.
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Amy Duffy
From the Parkinson's Disease and Movement Disorders Center (C.H.A., E.D.-D., A.D.), Department of Neurology, Mayo Clinic, Scottsdale; Banner Sun Health Research Institute (B.N.D., J.H., J.H.-W., G.S., L.I.S., H.A.S., D.G.W., T.G.B.), Sun City; the Department of Otolaryngology (M.L.H., D.G.L., T.N.), Mayo Clinic, Phoenix, AZ; and the Tokyo Institute of Psychiatry (H.A.), Tokyo, Japan.
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Holly A. Shill
From the Parkinson's Disease and Movement Disorders Center (C.H.A., E.D.-D., A.D.), Department of Neurology, Mayo Clinic, Scottsdale; Banner Sun Health Research Institute (B.N.D., J.H., J.H.-W., G.S., L.I.S., H.A.S., D.G.W., T.G.B.), Sun City; the Department of Otolaryngology (M.L.H., D.G.L., T.N.), Mayo Clinic, Phoenix, AZ; and the Tokyo Institute of Psychiatry (H.A.), Tokyo, Japan.
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Haruhiko Akiyama
From the Parkinson's Disease and Movement Disorders Center (C.H.A., E.D.-D., A.D.), Department of Neurology, Mayo Clinic, Scottsdale; Banner Sun Health Research Institute (B.N.D., J.H., J.H.-W., G.S., L.I.S., H.A.S., D.G.W., T.G.B.), Sun City; the Department of Otolaryngology (M.L.H., D.G.L., T.N.), Mayo Clinic, Phoenix, AZ; and the Tokyo Institute of Psychiatry (H.A.), Tokyo, Japan.
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Douglas G. Walker
From the Parkinson's Disease and Movement Disorders Center (C.H.A., E.D.-D., A.D.), Department of Neurology, Mayo Clinic, Scottsdale; Banner Sun Health Research Institute (B.N.D., J.H., J.H.-W., G.S., L.I.S., H.A.S., D.G.W., T.G.B.), Sun City; the Department of Otolaryngology (M.L.H., D.G.L., T.N.), Mayo Clinic, Phoenix, AZ; and the Tokyo Institute of Psychiatry (H.A.), Tokyo, Japan.
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Thomas G. Beach
From the Parkinson's Disease and Movement Disorders Center (C.H.A., E.D.-D., A.D.), Department of Neurology, Mayo Clinic, Scottsdale; Banner Sun Health Research Institute (B.N.D., J.H., J.H.-W., G.S., L.I.S., H.A.S., D.G.W., T.G.B.), Sun City; the Department of Otolaryngology (M.L.H., D.G.L., T.N.), Mayo Clinic, Phoenix, AZ; and the Tokyo Institute of Psychiatry (H.A.), Tokyo, Japan.
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Full PDF
Citation
Submandibular gland needle biopsy for the diagnosis of Parkinson disease
Charles H. Adler, Brittany N. Dugger, Michael L. Hinni, David G. Lott, Erika Driver-Dunckley, Jose Hidalgo, Jonette Henry-Watson, Geidy Serrano, Lucia I. Sue, Thomas Nagel, Amy Duffy, Holly A. Shill, Haruhiko Akiyama, Douglas G. Walker, Thomas G. Beach
Neurology Mar 2014, 82 (10) 858-864; DOI: 10.1212/WNL.0000000000000204

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Abstract

Objective: This study investigates salivary gland biopsies in living patients with Parkinson disease (PD).

Methods: Patients with PD for ≥5 years underwent outpatient transcutaneous needle core biopsies (18-gauge or 16-gauge) of 1 submandibular gland. Minor salivary glands were removed via a small incision in the lower lip. Tissue was fixed in formalin and serial 6-µm paraffin sections were immunohistochemically stained for phosphorylated α-synuclein and reviewed for evidence of Lewy type α-synucleinopathy (LTS).

Results: Fifteen patients with PD were biopsied: 9 female/6 male, mean age 68.7 years, mean PD duration 11.8 years. Twelve of the needle core biopsies had microscopically evident submandibular gland tissue to assess and 9/12 (75%) had LTS. Only 1/15 (6.7%) minor salivary gland biopsies were positive for LTS. Five patients had an adverse event; all were minor and transient.

Conclusions: This study demonstrates the feasibility of performing needle core biopsies of the submandibular gland in living patients with PD to assess LTS. Although this was a small study, this tissue biopsy method may be important for tissue confirmation of PD in patients being considered for invasive procedures and in research studies of other PD biomarkers.

GLOSSARY

AD=
Alzheimer disease;
GI=
gastrointestinal;
LTS=
Lewy type α-synucleinopathy;
PD=
Parkinson disease;
PNS=
peripheral nervous system

Footnotes

  • ↵* These authors contributed equally to this work.

  • Go to Neurology.org for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.

  • Received June 24, 2013.
  • Accepted in final form November 15, 2013.
  • © 2014 American Academy of Neurology
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