Hyperhidrosis is a problem in some patients with PD, and when severe, this symptom can be severely disabling. Little is known about the problem due to a paucity of careful studies. A small study (71) demonstrated that PD patients generate more sweat when exposed to heat than control patients and that excessive sweating increases with disease severity. Swinn et al. (72) recruited 77 consecutive PD patients and 40 controls for a study of sweating. The authors designed their own questionnaire to evaluate sweating, which consisted of 41 questions. PD patients were much more likely than controls to report excess sweating, particularly episodes of whole body, drenching sweats (44% of PD patients vs. 10% of controls). Hypohidrosis was also reported, but the frequency in PD patients was not significantly different from controls. PD patients tended to experience sweating episodes when they were "off" or "on" with dyskine-sia and 70% of patients who had dyskinesia reported excessive sweating. Sweating problems did not appear to be related to disease duration or severity. Other autonomic symptoms (urinary frequency and sialorrhea) were correlated with excess sweating. Patients who experienced drenching sweats had an impaired quality of life.
Treatment of sweating problems in PD is difficult, and no clear guidelines or evidence-based recommendations exist. Since some episodes are associated with off periods and others with dyskinesia, efforts should be made to reduce off time as much as possible while avoiding dyskinesia by adjusting antiparkinsonian medications. Although some have suggested treatment with L-dihydroxyphenylalanine or beta blockers, no studies have been published which evaluate these treatments in PD (73). Although there is a growing literature on the treatment of focal hyper-hidrosis with botulinum toxin injections (74-78), this therapy has not been studied in PD-related sweating disorders and would not be expected to be applicable to those patients with whole-body drenching sweats due to the practical problem of administering the drug to the target tissue. Beyond attempted pharmacological treatments, Swinn et al. (72) suggest that PD patients with hyperhidrosis be counseled to avoid hot environments, overactivity, or poorly ventilated clothing.
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