Authors' replies to the comments of Giugni et al. on 'Hiccups in Parkinson's disease: an overlooked non-motor symptom?'.

摘要

We wish to thank Dr. Giugni et al. for their interest in and comments on our article [1], and would like to respond as follows. We agree with their comment that hiccups can be caused by diverse metabolic and physiological disorders including not only those of the brainstem but also peripheral nerves. In Parkinson's disease, Lewy body pathologies, characterized by alpha-synu-clein-immunopositive aggregations or inclusions, are observable in enteric nerves [2]. In addition, based on histological studies of catecholaminergic fiber degenerations in the myocardium [3], it is proposed that alpha-synuclein depositions in autonomic nerve endings may be one of the initial pathological changes in Parkinson's disease. Therefore, it is possible to consider that enteric nerves in the gastric epithelium and/or submucosal plexus may be involved and eventually contribute to the pathophysiological mechanisms underlying hiccups, if they appear in the early phase of illness.