While our understanding of tau aggregation in peripheral nerve tissues is still limited in histopathological studies,11-13 it has been well documented in α-synucleinopathies.5 In PD/LBD, α-synuclein predominantly accumulates in the axons,32 and in multiple system atrophy (MSA), it accumulates in Schwann cells.21 Furthermore, animal studies have suggested that α-synuclein may accumulate in the PNS before affecting the corresponding nuclei in the CNS.33,34 In addition, these models have been shown to result in associated peripheral neurological symptoms.35,36. This evidence concerns the gene MAPT and Parkinson disease.