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Fanciulli A, Stankovic I, Krismer F, Seppi K, Levin J, Wenning GK. Multiple system atrophy. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2019; 149:137-192. [PMID: 31779811 DOI: 10.1016/bs.irn.2019.10.004] [Citation(s) in RCA: 61] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Multiple system atrophy (MSA) is a sporadic, adult-onset, relentlessly progressive neurodegenerative disorder, clinically characterized by various combinations of autonomic failure, parkinsonism and ataxia. The neuropathological hallmark of MSA are glial cytoplasmic inclusions consisting of misfolded α-synuclein. Selective atrophy and neuronal loss in striatonigral and olivopontocerebellar systems underlie the division into two main motor phenotypes of MSA-parkinsonian type and MSA-cerebellar type. Isolated autonomic failure and REM sleep behavior disorder are common premotor features of MSA. Beyond the core clinical symptoms, MSA manifests with a number of non-motor and motor features. Red flags highly specific for MSA may provide clues for a correct diagnosis, but in general the diagnostic accuracy of the second consensus criteria is suboptimal, particularly in early disease stages. In this chapter, the authors discuss the historical milestones, etiopathogenesis, neuropathological findings, clinical features, red flags, differential diagnosis, diagnostic criteria, imaging and other biomarkers, current treatment, unmet needs and future treatments for MSA.
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Affiliation(s)
| | - Iva Stankovic
- Neurology Clinic, Clinical Center of Serbia, School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Florian Krismer
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Klaus Seppi
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Johannes Levin
- Department of Neurology, Ludwig-Maximilians-Universität München, Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE) e.V., Munich Cluster of Systems Neurology (SyNergy), Munich, Germany
| | - Gregor K Wenning
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
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102
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Panicker JN, Simeoni S, Miki Y, Batla A, Iodice V, Holton JL, Sakakibara R, Warner TT. Early presentation of urinary retention in multiple system atrophy: can the disease begin in the sacral spinal cord? J Neurol 2019; 267:659-664. [PMID: 31720822 PMCID: PMC7035234 DOI: 10.1007/s00415-019-09597-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 10/16/2019] [Accepted: 10/19/2019] [Indexed: 01/23/2023]
Abstract
Lower urinary tract (LUT) dysfunction presents early in multiple system atrophy (MSA), usually initially as urinary urgency, frequency and incontinence, and voiding difficulties/urinary retention becomes apparent over time. We have observed a subset of patients who instead presented initially with urinary retention requiring catheterisation. At presentation, these patients had only subtle neurological signs that would not fulfil the diagnostic criteria of MSA; however, the anal sphincter electromyography (EMG) was abnormal and they reported bowel and sexual dysfunction, suggesting localisation at the level of the sacral spinal cord. They subsequently developed classical neurological signs, meeting the diagnostic criteria for probable MSA. One patient was confirmed to have MSA at autopsy. We postulate that in a subset of patients with MSA, the disease begins in the sacral spinal cord and then spreads to other regions resulting in the classical signs of MSA. The transmissibility of alpha-synuclein has been demonstrated in animal models and the spread of pathology from sacral cord to other regions of the central nervous system is therefore plausible. Patients presenting with urinary retention and mild neurological features would be an ideal group for experimental trials evaluating neuroprotection in MSA
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Affiliation(s)
- Jalesh N Panicker
- Department of Uro-Neurology, The National Hospital for Neurology and Neurosurgery, Queen Square, London, WC1N 3BG, UK
- UCL Queen Square Institute of Neurology, London, WC1N 3BG, UK
| | - Sara Simeoni
- Department of Uro-Neurology, The National Hospital for Neurology and Neurosurgery, Queen Square, London, WC1N 3BG, UK.
| | - Yasuo Miki
- Reta Lila Weston Institute of Neurological Studies and Queen Square Brain Bank, UCL Queen Square Institute of Neurology, London, UK
- Department of Neuropathology, Institute of Brain Science, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Amit Batla
- UCL Queen Square Institute of Neurology, London, WC1N 3BG, UK
- Department of Neurology, Luton and Dunstable University Hospital, Luton, UK
| | - Valeria Iodice
- UCL Queen Square Institute of Neurology, London, WC1N 3BG, UK
- Autonomics Unit, The National Hospital for Neurology and Neurosurgery, Queen Square, London, WC1N 3BG, UK
| | - Janice L Holton
- Reta Lila Weston Institute of Neurological Studies and Queen Square Brain Bank, UCL Queen Square Institute of Neurology, London, UK
| | - Ryuji Sakakibara
- Neurology, Internal Medicine, Sakura Medical Center, Toho University, Sakura, Japan
| | - Thomas T Warner
- Reta Lila Weston Institute of Neurological Studies and Queen Square Brain Bank, UCL Queen Square Institute of Neurology, London, UK
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Differentiation Between Multiple System Atrophy and Other Spinocerebellar Degenerations Using Diffusion Kurtosis Imaging. Acad Radiol 2019; 26:e333-e339. [PMID: 30658931 DOI: 10.1016/j.acra.2018.12.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Revised: 12/10/2018] [Accepted: 12/18/2018] [Indexed: 01/29/2023]
Abstract
RATIONALE AND OBJECTIVE Differentiation between multiple system atrophy (MSA) and other spinocerebellar degenerations showing cerebellar ataxia is often difficult. Hence, we investigated whether magnetic resonance diffusion kurtosis imaging (DKI) could detect pathological changes that occur in these patients and be used for differential diagnosis. METHODS Thirty-six subjects (12 patients with MSA accompanied by predominant cerebellar ataxia [MSA-C], 10 patients with spinocerebellar ataxias [SCAs] or sporadic adult-onset ataxia of unknown etiology [SAOA], and 14 healthy controls) were examined using 1.5- or 3-T magnetic resonance scanners. From the DKI data, the mean kurtosis, fractional anisotropy, and mean diffusivity values of the pontine crossing tract (PCT), middle cerebellar peduncle, and cerebellum were automatically measured, and the ratios against the values of the corpus callosum were calculated. RESULTS We found significant decreases in mean kurtosis and fractional anisotropy ratios in the PCT and middle cerebellar peduncle, and a significant increase in the mean diffusivity ratio in the PCT in the MSA-C group, as compared with the SCA/SAOA and control groups (p < 0.027-0.001). Among these metrics, there were no significant differences in the diagnostic performance. By contrast, the ratios in the cerebellum showed no significant differences between the MSA-C and SCA/SAOA groups but were significantly altered when compared with the controls (p < 0.001). CONCLUSION Quantitative DKI analyses can be used to differentiate between patients with MSA-C and those with SCA/SAOA.
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104
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Contextualizing the pathology in the essential tremor cerebellar cortex: a patholog-omics approach. Acta Neuropathol 2019; 138:859-876. [PMID: 31317229 DOI: 10.1007/s00401-019-02043-7] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Revised: 07/08/2019] [Accepted: 07/08/2019] [Indexed: 12/17/2022]
Abstract
Several morphological changes, centered in/around Purkinje cells (PCs), have been identified in the cerebellum of essential tremor (ET) patients. These changes have not been contextualized within a broader degenerative disease spectrum, limiting their interpretability. To address this, we compared the severity and patterning of degenerative changes within the cerebellar cortex in patients with ET, other neurodegenerative disorders of the cerebellum (spinocerebellar ataxias (SCAs), multiple system atrophy (MSA)], and other disorders that may involve the cerebellum [Parkinson's disease (PD), dystonia]. Using a postmortem series of 156 brains [50 ET, 23 SCA (6 SCA3; 17 SCA 1, 2 or 6), 15 MSA, 29 PD, 14 dystonia, 25 controls], we generated data on 37 quantitative morphologic metrics, which were grouped into 8 broad categories: (1) PC loss, (2) heterotopic PCs, (3) PC dendritic changes, (4) PC axonal changes (torpedoes), (5) PC axonal changes (other than torpedoes), (6) PC axonal changes (torpedo-associated), (7) basket cell axonal hypertrophy, (8) climbing fiber-PC synaptic changes. Our analyses used z scored raw data for each metric across all diagnoses (5772 total data items). Principal component analysis revealed that diagnostic groups were not uniform with respect to cerebellar pathology. Dystonia and PD each differed from controls in only 2/37 metrics, whereas ET differed in 21, SCA3 in 8, MSA in 19, and SCA1/2/6 in 26 metrics. Comparing ET with primary disorders of cerebellar degeneration (i.e., SCAs), we observed a spectrum of changes reflecting differences of degree, being generally mild in ET and SCA3 and more severe in SCA1/2/6. Comparative analyses across morphologic categories demonstrated differences in relative expression, defining distinctive patterns of changes in these groups. Thus, the degree of cerebellar degeneration in ET aligns it with a milder end in the spectrum of cerebellar degenerative disorders, and a somewhat distinctive signature of degenerative changes marks each of these disorders.
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105
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Hsiao JHT, Purushothuman S, Jensen PH, Halliday GM, Kim WS. Reductions in COQ2 Expression Relate to Reduced ATP Levels in Multiple System Atrophy Brain. Front Neurosci 2019; 13:1187. [PMID: 31736705 PMCID: PMC6838639 DOI: 10.3389/fnins.2019.01187] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Accepted: 10/21/2019] [Indexed: 11/13/2022] Open
Abstract
Multiple system atrophy (MSA) is a progressive neurodegenerative disease clinically characterized by parkinsonism and cerebellar ataxia, and pathologically by oligodendrocyte α-synuclein inclusions. Genetic variants of COQ2 are associated with an increased risk for MSA in certain populations. Also, deficits in the level of coenzyme Q10 and its biosynthetic enzymes are associated with MSA. Here, we measured ATP levels and expression of biosynthetic enzymes for coenzyme Q10, including COQ2, in multiple regions of MSA and control brains. We found a reduction in ATP levels in disease-affected regions of MSA brain that associated with reduced expression of COQ2 and COQ7, supporting the concept that abnormalities in the biosynthesis of coenzyme Q10 play an important role in the pathogenesis of MSA.
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Affiliation(s)
- Jen-Hsiang T. Hsiao
- Brain and Mind Centre and Central Clinical School, The University of Sydney, Sydney, NSW, Australia
- School of Medical Sciences, University of New South Wales & Neuroscience Research Australia, Randwick, NSW, Australia
| | - Sivaraman Purushothuman
- Brain and Mind Centre and Central Clinical School, The University of Sydney, Sydney, NSW, Australia
| | - Poul H. Jensen
- Department of Biomedicine, DANDRITE-Danish Research Institute of Translational Neuroscience, Aarhus University, Aarhus, Denmark
| | - Glenda M. Halliday
- Brain and Mind Centre and Central Clinical School, The University of Sydney, Sydney, NSW, Australia
- School of Medical Sciences, University of New South Wales & Neuroscience Research Australia, Randwick, NSW, Australia
| | - Woojin Scott Kim
- Brain and Mind Centre and Central Clinical School, The University of Sydney, Sydney, NSW, Australia
- School of Medical Sciences, University of New South Wales & Neuroscience Research Australia, Randwick, NSW, Australia
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106
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Brettschneider J, Suh E, Robinson JL, Fang L, Lee EB, Irwin DJ, Grossman M, Van Deerlin VM, Lee VMY, Trojanowski JQ. Converging Patterns of α-Synuclein Pathology in Multiple System Atrophy. J Neuropathol Exp Neurol 2019; 77:1005-1016. [PMID: 30203094 DOI: 10.1093/jnen/nly080] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
We aimed to determine patterns of α-synuclein (α-syn) pathology in multiple system atrophy (MSA) using 70-µm-thick sections of 20 regions of the central nervous system of 37 cases with striato-nigral degeneration (SND) and 10 cases with olivo-ponto-cerebellar atrophy (OPCA). In SND cases with the shortest disease duration (phase 1), α-syn pathology was observed in striatum, lentiform nucleus, substantia nigra, brainstem white matter tracts, cerebellar subcortical white matter as well as motor cortex, midfrontal cortex, and sensory cortex. SND with increasing duration of disease (phase 2) was characterized by involvement of spinal cord and thalamus, while phase 3 was characterized by involvement of hippocampus and amygdala. Cases with the longest disease duration (phase 4) showed involvement of the visual cortex. We observed an increasing overlap of α-syn pathology with increasing duration of disease between SND and OPCA, and noted increasingly similar regional distribution patterns of α-syn pathology. The GBA variant, p.Thr408Met, was found to have an allele frequency of 6.94% in SND cases which was significantly higher compared with normal (0%) and other neurodegenerative disease pathologies (0.74%), suggesting that it is associated with MSA. Our findings indicate that SND and OPCA show distinct early foci of α-syn aggregations, but increasingly converge with longer disease duration to show overlapping patterns of α-syn pathology.
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Affiliation(s)
- Johannes Brettschneider
- Center for Neurodegenerative Disease Research (CNDR), University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
| | - EunRan Suh
- Department of Pathology and Laboratory Medicine, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
| | - John L Robinson
- Center for Neurodegenerative Disease Research (CNDR), University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
| | - Lubin Fang
- Clinical Neuroanatomy Section, Department of Neurology, Center for Biomedical Research, University of Ulm, Ulm, Germany
| | - Edward B Lee
- Center for Neurodegenerative Disease Research (CNDR), University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania.,Department of Pathology and Laboratory Medicine, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
| | - David J Irwin
- Center for Neurodegenerative Disease Research (CNDR), University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania.,Department of Pathology and Laboratory Medicine, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
| | - Murray Grossman
- Center for Neurodegenerative Disease Research (CNDR), University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania.,Department of Pathology and Laboratory Medicine, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
| | - Vivianna M Van Deerlin
- Department of Pathology and Laboratory Medicine, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
| | - Virginia M-Y Lee
- Center for Neurodegenerative Disease Research (CNDR), University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania.,Department of Pathology and Laboratory Medicine, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
| | - John Q Trojanowski
- Center for Neurodegenerative Disease Research (CNDR), University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania.,Department of Pathology and Laboratory Medicine, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
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107
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Cognitive impairment and structural brain damage in multiple system atrophy-parkinsonian variant. J Neurol 2019; 267:87-94. [DOI: 10.1007/s00415-019-09555-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 09/19/2019] [Accepted: 09/23/2019] [Indexed: 10/25/2022]
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108
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He SJ, Liu ZY, Yang YJ, Shen C, Du YJ, Zhou XY, Zhao J, Sun YM, Yang K, Wu JJ, Liu FT, Wang J. Considerations before initiating therapy in Parkinsonism: basing on the quality of life. J Neurol 2019; 266:3119-3125. [PMID: 31535268 DOI: 10.1007/s00415-019-09545-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2019] [Revised: 09/11/2019] [Accepted: 09/13/2019] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Improvement of quality-of-life (QoL) has been termed as a primary objective in initiating therapy in both Parkinson's disease (PD) and multiple system atrophy Parkinsonian subtype (MSA-P). We aimed to compare the determinants of life quality in drug naïve PD and MSA-P patients. METHODS Eighty-six drug-naïve PD patients and thirty-five drug-naïve MSA-P patients were included to explore the determinants of QoL. Demographic information, motor deficits, and non-motor symptoms were included in the clinical assessment. RESULTS Both motor and non-motor functions were more severely impaired in the drug-naïve MSA-P patients, with higher PDQ-39 scores indicating poorer QoL. Physical discomfort and stigma were the main affected sub-domains in PD, while mobility and activity of daily life were the main affected ones in MSA-P. BECK depressive scores and UPDRS-III scores were independent variables of PDQ-39 in MSA-P patients. Age, depression, disease stages and non-motor scores were independent variables of PDQ-39 in PD patients. INTERPRETATION Drug-naïve MSA-P patients suffered from more severe motor and non-motor disability, as well as poorer QoL. Depression and non-motor symptoms were proved to be the most critical determinants for QoL in PD, while motor function was supposed to be the major determinant for MSA-P. When initiating therapy, physicians need to focus more on motor functions in drug-naïve MSA-P patients, but on depression in PD patients.
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Affiliation(s)
- Shu-Jin He
- Department of Neurology and National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, 12 Wulumuqi Zhong Road, Jing'an District, Shanghai, 200040, China
| | - Zhen-Yang Liu
- Department of Neurology and National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, 12 Wulumuqi Zhong Road, Jing'an District, Shanghai, 200040, China
- Intensive Care Unit, Huashan Hospital (West Campus), Fudan University, Shanghai, 201107, China
| | - Yu-Jie Yang
- Department of Neurology and National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, 12 Wulumuqi Zhong Road, Jing'an District, Shanghai, 200040, China
| | - Cong Shen
- Department of Neurology and National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, 12 Wulumuqi Zhong Road, Jing'an District, Shanghai, 200040, China
| | - Yu-Jie Du
- Department of Neurology and National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, 12 Wulumuqi Zhong Road, Jing'an District, Shanghai, 200040, China
| | - Xin-Yue Zhou
- Department of Neurology and National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, 12 Wulumuqi Zhong Road, Jing'an District, Shanghai, 200040, China
| | - Jue Zhao
- Department of Neurology and National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, 12 Wulumuqi Zhong Road, Jing'an District, Shanghai, 200040, China
| | - Yi-Min Sun
- Department of Neurology and National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, 12 Wulumuqi Zhong Road, Jing'an District, Shanghai, 200040, China
| | - Ke Yang
- Department of Neurology and National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, 12 Wulumuqi Zhong Road, Jing'an District, Shanghai, 200040, China
| | - Jian-Jun Wu
- Department of Neurology and National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, 12 Wulumuqi Zhong Road, Jing'an District, Shanghai, 200040, China
| | - Feng-Tao Liu
- Department of Neurology and National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, 12 Wulumuqi Zhong Road, Jing'an District, Shanghai, 200040, China.
| | - Jian Wang
- Department of Neurology and National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, 12 Wulumuqi Zhong Road, Jing'an District, Shanghai, 200040, China.
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Nwabuobi L, Tomishon D, Shneider NA, Fahn S, Vonsattel JP, Cortes E. Multiple System Atrophy With Predominant Striatonigral Degeneration and TAR DNA-Binding Protein of 43 kDa Pathology: An Unusual Variant of Multiple System Atrophy. Mov Disord Clin Pract 2019; 6:661-666. [PMID: 31745474 DOI: 10.1002/mdc3.12823] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Revised: 05/24/2019] [Accepted: 06/13/2019] [Indexed: 12/11/2022] Open
Abstract
Background The pathological hallmark in MSA is oligodendrocytic glial cytoplasmic inclusions (GCIs) containing α-synuclein, in addition to neuronal loss and astrogliosis especially involving the striatonigral and olivopontocerebellar systems. Rarely, TAR DNA-binding protein of 43 kDa (TDP-43), a component of ubiquitinated inclusions observed mainly in amyotrophic lateral sclerosis and frontotemporal lobar degeneration has been demonstrated in cases of MSA and, more recently, was shown to colocalize with α-synuclein pathology in GCIs in 2 patients. Methods A 66-year-old woman presented with a syndrome characterized by spasticity, dysautonomia, bulbar dysfunction, and parkinsonism. Symptoms progressed until her death at age 74. Neuropathological evaluation was performed at the New York Brain Bank at Columbia University. Results On gross examination, there was striking severe volume loss of the left striatum compared to mild involvement of the right striatum. Microscopically, neuronal loss and gliosis of the putamen and globus pallidus were severe on the left side, in contrast to mild involvement on the right side. Immunohistochemistry for α-synuclein revealed widespread GCIs. The sections subjected to TDP-43 antibodies showed a few GCIs with definite nucleocytoplasmic translocation of the labeling within the lenticular nucleus and within the paracentral cortex. Conclusions This report adds to the evidence that TDP-43 and α-synuclein colocalize in GCIs. Whether this coexistence contributes to the pathogenesis of a subset of MSA patients or is an age-related process is not known. More cases with these peculiar pathological hallmarks might help determine whether TDP-43 contributes to neurodegeneration in a subset of patients with MSA.
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Affiliation(s)
- Lynda Nwabuobi
- Department of Neurology Columbia University Medical Center New York New York USA
| | - Darya Tomishon
- Department of Neurology Columbia University Medical Center New York New York USA
| | - Neil A Shneider
- Department of Neurology Columbia University Medical Center New York New York USA
| | - Stanley Fahn
- Department of Neurology Columbia University Medical Center New York New York USA
| | - Jean Paul Vonsattel
- Department of Pathology Columbia University Medical Center New York New York USA
| | - Etty Cortes
- Department of Pathology Columbia University Medical Center New York New York USA
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110
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Quantitative autonomic function test in differentiation of multiple system atrophy from idiopathic Parkinson disease. Chin Med J (Engl) 2019; 132:1919-1924. [PMID: 31373907 PMCID: PMC6708682 DOI: 10.1097/cm9.0000000000000359] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Supplemental Digital Content is available in the text Background: Differential diagnosis of idiopathic Parkinson disease (IPD) and multiple system atrophy-Parkinson type (MSA-P) is challenging since they share clinical features with parkinsonism and autonomic dysfunction. To distinguish MSA-P from IPD when the symptoms are relatively mild, we investigated the usefulness of the quantitative fractionalized autonomic indexes and evaluated the correlations of autonomic test indexes and functional status. Methods: Thirty-six patients with parkinsonism (22 with IPD and 14 with MSA-P) in Soonchunhyang University Bucheon Hospital from February 2014 to June 2015 were prospectively enrolled in the study. We compared fractionalized autonomic indexes and composite autonomic scoring scale between patients with IPD and MSA-P with Hoehn and Yahr (H&Y) score ≤3. Parasympathetic indexes included expiratory/inspiratory ratio during deep breathing, Valsalva ratio (VR), and regression slope of systolic blood pressure (BP) in early phase II (vagal baroreflex sensitivity) during Valsalva maneuver. Sympathetic adrenergic indexes were pressure recovery time (PRT) and adrenergic baroreflex sensitivity (BRSa) (BP decrement associated with phase 3 divided by the PRT), sympathetic index 1, sympathetic index 3, early phase II mean BP drop, and pulse pressure reduction rate. Additionally, we compared the unified multiple system atrophy rating scale (UMSARS) and H&Y scores and the autonomic indexes in all patients. Results: PRT was significantly different between the IPD and MSA-P groups (P = 0.004) despite the similar BP drop during tilt. Cut-off value of PRT was 5.5 s (sensitivity, 71.4%; specificity, 72.7%). VR (r = −0.455, P = 0.009) and BRSa (r = −0.356, P = 0.036) demonstrated a significant correlation with UMSARS and H&Y scores. Conclusions: Among the cardiovascular autonomic indexes, PRT can be a useful parameter in differentiating the early stage of MSA-P from that of IPD. Moreover, VR, and BRSa may be the optimal indexes in determining functional symptom severity.
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111
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Mitchell T, Archer DB, Chu WT, Coombes SA, Lai S, Wilkes BJ, McFarland NR, Okun MS, Black ML, Herschel E, Simuni T, Comella C, Xie T, Li H, Parrish TB, Kurani AS, Corcos DM, Vaillancourt DE. Neurite orientation dispersion and density imaging (NODDI) and free-water imaging in Parkinsonism. Hum Brain Mapp 2019; 40:5094-5107. [PMID: 31403737 DOI: 10.1002/hbm.24760] [Citation(s) in RCA: 70] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 07/08/2019] [Accepted: 07/31/2019] [Indexed: 02/05/2023] Open
Abstract
Neurite orientation dispersion and density imaging (NODDI) uses a three-compartment model to probe brain tissue microstructure, whereas free-water (FW) imaging models two-compartments. It is unknown if NODDI detects more disease-specific effects related to neurodegeneration in Parkinson's disease (PD) and atypical Parkinsonism. We acquired multi- and single-shell diffusion imaging at 3 Tesla across two sites. NODDI (using multi-shell; isotropic volume [Viso]; intracellular volume [Vic]; orientation dispersion [ODI]) and FW imaging (using single-shell; FW; free-water corrected fractional anisotropy [FAt]) were compared with 44 PD, 21 multiple system atrophy Parkinsonian variant (MSAp), 26 progressive supranuclear palsy (PSP), and 24 healthy control subjects in the basal ganglia, midbrain/thalamus, cerebellum, and corpus callosum. There was elevated Viso in posterior substantia nigra across Parkinsonisms, and Viso, Vic, and ODI were altered in MSAp and PSP in the striatum, globus pallidus, midbrain, thalamus, cerebellum, and corpus callosum relative to controls. The mean effect size across regions for Viso was 0.163, ODI 0.131, Vic 0.122, FW 0.359, and FAt 0.125, with extracellular compartments having the greatest effect size. A key question addressed was if these techniques discriminate PD and atypical Parkinsonism. Both NODDI (AUC: 0.945) and FW imaging (AUC: 0.969) had high accuracy, with no significant difference between models. This study provides new evidence that NODDI and FW imaging offer similar discriminability between PD and atypical Parkinsonism, and FW had higher effect sizes for detecting Parkinsonism within regions across the basal ganglia and cerebellum.
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Affiliation(s)
- Trina Mitchell
- Laboratory for Rehabilitation Neuroscience, Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, Florida
| | - Derek B Archer
- Laboratory for Rehabilitation Neuroscience, Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, Florida
| | - Winston T Chu
- Laboratory for Rehabilitation Neuroscience, Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, Florida.,J. Crayton Pruitt Family Department of Biomedical Engineering, University of Florida, Gainesville, Florida
| | - Stephen A Coombes
- Laboratory for Rehabilitation Neuroscience, Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, Florida
| | - Song Lai
- Department of Radiation Oncology & CTSI Human Imaging Core, University of Florida, Gainesville, Florida
| | - Bradley J Wilkes
- Laboratory for Rehabilitation Neuroscience, Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, Florida
| | - Nikolaus R McFarland
- Department of Neurology and Center for Movement Disorders and Neurorestoration, College of Medicine, University of Florida, Gainesville, Florida
| | - Michael S Okun
- Department of Neurology and Center for Movement Disorders and Neurorestoration, College of Medicine, University of Florida, Gainesville, Florida
| | - Mieniecia L Black
- Laboratory for Rehabilitation Neuroscience, Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, Florida
| | - Ellen Herschel
- Department of Physical Therapy and Human Movement Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Tanya Simuni
- Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Cynthia Comella
- Department of Neurological Sciences, Rush University Medical Center, Chicago, Illinois
| | - Tao Xie
- Department of Neurology, University of Chicago Medicine, Chicago, Illinois
| | - Hong Li
- Department of Public Health Sciences, Medical College of South Carolina, Charleston, South Carolina
| | - Todd B Parrish
- Department of Radiology, Northwestern Feinberg School of Medicine, Chicago, Illinois
| | - Ajay S Kurani
- Department of Radiology, Northwestern Feinberg School of Medicine, Chicago, Illinois
| | - Daniel M Corcos
- Department of Physical Therapy and Human Movement Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - David E Vaillancourt
- Laboratory for Rehabilitation Neuroscience, Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, Florida.,J. Crayton Pruitt Family Department of Biomedical Engineering, University of Florida, Gainesville, Florida.,Department of Neurology and Center for Movement Disorders and Neurorestoration, College of Medicine, University of Florida, Gainesville, Florida
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112
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Quantitative analysis of nasal transcripts reveals potential biomarkers for Parkinson's disease. Sci Rep 2019; 9:11111. [PMID: 31366968 PMCID: PMC6668404 DOI: 10.1038/s41598-019-47579-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Accepted: 07/17/2019] [Indexed: 12/12/2022] Open
Abstract
Patients with Parkinson's disease (PD) oftentimes develop olfactory dysfunction in their early stages, converting the nasal environment into a useful source of potential biomarkers. Here we determined the possible application of nasal fluid cells for PD biomarker identification. Thirty PD patients and 13 age-matched healthy controls were enrolled in this study. Messenger RNA levels of selected PD-related genes were monitored through real-time quantitative PCR. Target gene transcripts can be efficiently amplified from the cDNA library from human nasal fluid cell pellets. And subsequent analysis showed both a marked downregulation of parkin transcripts and an upregulation of AIMP2 in PD patients when compared to controls (cutoff value = 1.753 for with 84.2% sensitivity and 84.6% specificity; 0.359 for parkin with 76.7% sensitivity and 76.9 specificity). Moreover, alteration pattern of parkin and AIMP2 in PD was distinct from another neurodegenerative disease, multiple system atrophy. Analysis in both the early and late stages of PD cases reported that parkin levels inversely correlated with PD stages. Our results validate the practical value of easily accessible nasal fluid cells and the utility of both AIMP2 and parkin as potential biomarkers for PD diagnosis.
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113
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Marsili L, Bologna M, Kojovic M, Berardelli A, Espay AJ, Colosimo C. Dystonia in atypical parkinsonian disorders. Parkinsonism Relat Disord 2019; 66:25-33. [PMID: 31443953 DOI: 10.1016/j.parkreldis.2019.07.030] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 07/19/2019] [Accepted: 07/22/2019] [Indexed: 02/06/2023]
Abstract
Dystonia is common in the classic atypical parkinsonian disorders such as multiple system atrophy, progressive supranuclear palsy and corticobasal degeneration, and to a lesser extent in dementia with Lewy bodies. Its clinical phenomenology, including body distribution, timing of appearance, severity, and relationship to dopaminergic and other medications may vary considerably within and between atypical parkinsonian disorders. From a pathophysiological standpoint, the coexistence of dystonia with parkinsonism challenges the functional model of the basal ganglia. Clinical recognition of specific dystonic features may assist in the differential diagnosis of atypical parkinsonian disorders and in distinguishing them from Parkinson's disease. The presence of dystonia in atypical parkinsonian disorders informs management decisions. Reduction or withdrawal of levodopa should be considered if there is a close relationship between the onset of dystonia with periods of high dopaminergic tone. Botulinum neurotoxin may be considered in focal presentations. We here provide an updated overview of dystonia arising in the setting of atypical parkinsonian disorders, summarizing relevant clinical and clinicopathological studies, underlying pathophysiological mechanisms, diagnostic clues and potential pitfalls in the diagnosis. Finally, we suggest a tailored therapeutic approach for the management of these patients.
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Affiliation(s)
- Luca Marsili
- Gardner Family Center for Parkinson's Disease and Movement Disorders, Department of Neurology, University of Cincinnati, Cincinnati, OH, USA
| | - Matteo Bologna
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy; IRCCS Neuromed, Pozzilli (IS), Italy
| | - Maja Kojovic
- Department of Neurology, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Alfredo Berardelli
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy; IRCCS Neuromed, Pozzilli (IS), Italy
| | - Alberto J Espay
- Gardner Family Center for Parkinson's Disease and Movement Disorders, Department of Neurology, University of Cincinnati, Cincinnati, OH, USA
| | - Carlo Colosimo
- Department of Neurology, Santa Maria University Hospital, Terni, Italy.
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114
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Monzio Compagnoni G, Di Fonzo A. Understanding the pathogenesis of multiple system atrophy: state of the art and future perspectives. Acta Neuropathol Commun 2019; 7:113. [PMID: 31300049 PMCID: PMC6624923 DOI: 10.1186/s40478-019-0730-6] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2019] [Accepted: 04/27/2019] [Indexed: 12/21/2022] Open
Abstract
Multiple System Atrophy (MSA) is a severe neurodegenerative disease clinically characterized by parkinsonism, cerebellar ataxia, dysautonomia and other motor and non-motor symptoms. Although several efforts have been dedicated to understanding the causative mechanisms of the disease, MSA pathogenesis remains widely unknown. The aim of the present review is to describe the state of the art about MSA pathogenesis, with a particular focus on alpha-synuclein accumulation and mitochondrial dysfunction, and to highlight future possible perspectives in this field. In particular, this review describes the most widely investigated hypotheses explaining alpha-synuclein accumulation in oligodendrocytes, including SNCA expression, neuron-oligodendrocyte protein transfer, impaired protein degradation and alpha-synuclein spread mechanisms. Afterwards, several recent achievements in MSA research involving mitochondrial biology are described, including the role of COQ2 mutations, Coenzyme Q10 reduction, respiratory chain dysfunction and altered mitochondrial mass. Some hints are provided about alternative pathogenic mechanisms, including inflammation and impaired autophagy. Finally, all these findings are discussed from a comprehensive point of view, putative explanations are provided and new research perspectives are suggested. Overall, the present review provides a comprehensive and up-to-date overview of the mechanisms underlying MSA pathogenesis.
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115
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Miki Y, Foti SC, Asi YT, Tsushima E, Quinn N, Ling H, Holton JL. Improving diagnostic accuracy of multiple system atrophy: a clinicopathological study. Brain 2019; 142:2813-2827. [DOI: 10.1093/brain/awz189] [Citation(s) in RCA: 81] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 04/06/2019] [Accepted: 04/28/2019] [Indexed: 01/22/2023] Open
Abstract
AbstractClinical diagnosis of multiple system atrophy is challenging and many patients with Lewy body disease (i.e. Parkinson’s disease or dementia with Lewy bodies) or progressive supranuclear palsy are misdiagnosed as having multiple system atrophy in life. The clinical records of 203 patients with a clinical diagnosis of multiple system atrophy were reviewed to identify diagnostic pitfalls. We also examined 12 features supporting a diagnosis of multiple system atrophy (red flag features: orofacial dystonia, disproportionate antecollis, camptocormia and/or Pisa syndrome, contractures of hands or feet, inspiratory sighs, severe dysphonia, severe dysarthria, snoring, cold hands and feet, pathological laughter and crying, jerky myoclonic postural/action tremor and polyminimyoclonus) and seven disability milestones (frequent falls, use of urinary catheters, wheelchair dependent, unintelligible speech, cognitive impairment, severe dysphagia, residential care). Of 203 cases, 160 (78.8%) were correctly diagnosed in life and had pathologically confirmed multiple system atrophy. The remaining 21.2% (43/203) had alternative pathological diagnoses including Lewy body disease (12.8%; n = 26), progressive supranuclear palsy (6.4%; n = 13), cerebrovascular diseases (1%; n = 2), amyotrophic lateral sclerosis (0.5%; n = 1) and cerebellar degeneration (0.5%; n = 1). More patients with multiple system atrophy developed ataxia, stridor, dysphagia and falls than patients with Lewy body disease; resting tremor, pill-rolling tremor and hallucinations were more frequent in Lewy body disease. Although patients with multiple system atrophy and progressive supranuclear palsy shared several symptoms and signs, ataxia and stridor were more common in multiple system atrophy. Multiple logistic regression analysis revealed increased likelihood of multiple system atrophy versus Lewy body disease and progressive supranuclear palsy if a patient developed orthostatic hypotension or urinary incontinence with the requirement for urinary catheters [multiple system atrophy versus Lewy body disease: odds ratio (OR): 2.0, 95% confidence interval (CI): 1.1–3.7, P = 0.021; multiple system atrophy versus progressive supranuclear palsy: OR: 11.2, 95% CI: 3.2–39.2, P < 0.01]. Furthermore, autonomic dysfunction within the first 3 years from onset can differentiate multiple system atrophy from progressive supranuclear palsy (multiple system atrophy versus progressive supranuclear palsy: OR: 3.4, 95% CI: 1.2–9.7, P = 0.023). Multiple system atrophy patients with predominant parkinsonian signs had a higher number of red flag features than patients with Lewy body disease (OR: 8.8, 95% CI: 3.2–24.2, P < 0.01) and progressive supranuclear palsy (OR: 4.8, 95% CI: 1.7–13.6, P < 0.01). The number of red flag features in multiple system atrophy with predominant cerebellar signs was also higher than in Lewy body disease (OR: 7.0, 95% CI: 2.5–19.5, P < 0.01) and progressive supranuclear palsy (OR: 3.1, 95% CI: 1.1–8.9, P = 0.032). Patients with multiple system atrophy had shorter latency to reach use of urinary catheter and longer latency to residential care than progressive supranuclear palsy patients, whereas patients with Lewy body disease took longer to reach multiple milestones than patients with multiple system atrophy. The present study has highlighted features which should improve the ante-mortem diagnostic accuracy of multiple system atrophy.
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Affiliation(s)
- Yasuo Miki
- Queen Square Brain Bank for Neurological Disorders, UCL Queen Square Institute of Neurology, 1 Wakefield Street, London, UK
- Department of Neuropathology, Institute of Brain Science, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Sandrine C Foti
- Queen Square Brain Bank for Neurological Disorders, UCL Queen Square Institute of Neurology, 1 Wakefield Street, London, UK
| | - Yasmine T Asi
- Queen Square Brain Bank for Neurological Disorders, UCL Queen Square Institute of Neurology, 1 Wakefield Street, London, UK
| | - Eiki Tsushima
- Department of Comprehensive Rehabilitation Science, Hirosaki University Graduate School of Health Sciences, Hirosaki, Japan
| | - Niall Quinn
- UCL Queen Square Institute of Neurology, London, UK
| | - Helen Ling
- Queen Square Brain Bank for Neurological Disorders, UCL Queen Square Institute of Neurology, 1 Wakefield Street, London, UK
- Reta Lila Weston Institute of Neurological Studies, UCL Queen Square Institute of Neurology, 1 Wakefield Street, London, UK
| | - Janice L Holton
- Queen Square Brain Bank for Neurological Disorders, UCL Queen Square Institute of Neurology, 1 Wakefield Street, London, UK
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116
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Ryu HS, Oh M, Oh JS, Moon H, Park KW, Lee C, You S, Kim MJ, Kim YJ, Kim J, Kim K, Kim JS, Chung SJ. Distinct clinical features of predominant pre-synaptic and trans-synaptic nigrostriatal dysfunction in multiple system atrophy. J Neurol Sci 2019; 402:100-106. [DOI: 10.1016/j.jns.2019.05.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Revised: 05/09/2019] [Accepted: 05/14/2019] [Indexed: 12/31/2022]
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117
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Kaindlstorfer C, Stefanova N, Garcia J, Krismer F, Döbrössy M, Göbel G, Jellinger K, Granata R, Wenning GK. L-dopa response pattern in a rat model of mild striatonigral degeneration. PLoS One 2019; 14:e0218130. [PMID: 31181111 PMCID: PMC6557500 DOI: 10.1371/journal.pone.0218130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Accepted: 05/26/2019] [Indexed: 11/23/2022] Open
Abstract
Background Unresponsiveness to dopaminergic therapies is a key feature in the diagnosis of multiple system atrophy (MSA) and a major unmet need in the treatment of MSA patients caused by combined striatonigral degeneration (SND). Transgenic, alpha-synuclein animal models do not recapitulate this lack of levodopa responsiveness. In order to preclinically study interventions including striatal cell grafts, models that feature SND are required. Most of the previous studies focused on extensive nigral and striatal lesions corresponding to advanced MSA-P/SND. The aim of the current study was to replicate mild stage MSA-P/SND with L-dopa failure. Methods and results Two different striatal quinolinic acid (QA) lesions following a striatal 6-OHDA lesion replicating mild and severe MSA-P/SND, respectively, were investigated and compared to 6-OHDA lesioned animals. After the initial 6-OHDA lesion there was a significant improvement of motor performance after dopaminergic stimulation in the cylinder and stepping test (p<0.001). Response to L-dopa treatment declined in both MSA-P/SND groups reflecting striatal damage of lateral motor areas in contrast to the 6-OHDA only lesioned animals (p<0.01). The remaining striatal volume correlated strongly with contralateral apomorphine induced rotation behaviour and contralateral paw use during L-dopa treatment in cylinder and stepping test (p<0.001). Conclusion Our novel L-dopa response data suggest that L-dopa failure can be induced by restricted lateral striatal lesions combined with dopaminergic denervation. We propose that this sequential striatal double-lesion model replicates a mild stage of MSA-P/SND and is suitable to address neuro-regenerative therapies aimed at restoring dopaminergic responsiveness.
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Affiliation(s)
- Christine Kaindlstorfer
- Division of Neurobiology, Department of Neurology, Medical University Innsbruck, Innsbruck, Austria
- * E-mail:
| | - Nadia Stefanova
- Division of Neurobiology, Department of Neurology, Medical University Innsbruck, Innsbruck, Austria
| | - Joanna Garcia
- University Medical Centre Freiburg, Department of Neurosurgery, Freiburg, Germany
| | - Florian Krismer
- Division of Neurobiology, Department of Neurology, Medical University Innsbruck, Innsbruck, Austria
| | - Máté Döbrössy
- University Medical Centre Freiburg, Department of Neurosurgery, Freiburg, Germany
| | - Georg Göbel
- Medical University Innsbruck, Department of Medical Statistics, Informatics and Health Economics, Innsbruck, Austria
| | | | - Roberta Granata
- Division of Neurobiology, Department of Neurology, Medical University Innsbruck, Innsbruck, Austria
| | - Gregor Karl Wenning
- Division of Neurobiology, Department of Neurology, Medical University Innsbruck, Innsbruck, Austria
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118
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Uwatoko H, Hama Y, Iwata IT, Shirai S, Matsushima M, Yabe I, Utsumi J, Sasaki H. Identification of plasma microRNA expression changes in multiple system atrophy and Parkinson's disease. Mol Brain 2019; 12:49. [PMID: 31088501 PMCID: PMC6518614 DOI: 10.1186/s13041-019-0471-2] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Accepted: 05/01/2019] [Indexed: 12/12/2022] Open
Abstract
MicroRNAs (miRNAs) are endogenous small (18–25 nt), single-stranded, non-coding RNAs that play key roles in post-transcriptional gene expression regulation. The expression profiles of miRNAs in biofluids and tissues change in various diseases. Multiple system atrophy (MSA) and Parkinson’s disease (PD) are both categorized as α-synucleinopathies and often present with similar clinical manifestations. This study aimed to identify miRNAs that are differently expressed in plasma samples of PD patients, MSA patients, and healthy controls. We used microarray analysis to screen for miRNAs that are up- and down-regulated in these patients and analyzed the relative-quantitative expression levels of the identified miRNAs by reverse transcription quantitative polymerase chain reaction (RT-qPCR). Hsa-miR-671-5p, hsa-miR-19b-3p, and hsa-miR-24-3p showed significantly different expression levels among patients with MSA-C, MSA-P, or PD, and healthy controls. Hsa-miR-671-5p levels were lower in the MSA-P and PD than the MSA-C and control groups, hsa-miR-19b-3p levels were higher in the PD than the other groups, and hsa-miR-24-3p levels were higher in the PD than the MSA-C group. Hsa-miR-671-5p was the first miRNA shown to be expressed differently between MSA-C and MSA-P in plasma. Interestingly, the expression levels of hsa-miR-19b-3p and hsa-miR-24-3p were positively correlated, indicating that these miRNAs may be involved in the same processes in PD pathogenesis. Our findings suggest that hsa-miR-671-5p, hsa-miR-19b-3p, and hsa-miR-24-3p may reflect the pathophysiology or symptoms of PD and MSA.
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Affiliation(s)
- Hisashi Uwatoko
- Department of Neurology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, North 15 West 7, Kita-Ku, Sapporo, Hokkaido, 060-8368, Japan.
| | - Yuka Hama
- Department of Neurology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, North 15 West 7, Kita-Ku, Sapporo, Hokkaido, 060-8368, Japan
| | - Ikuko Takahashi Iwata
- Department of Neurology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, North 15 West 7, Kita-Ku, Sapporo, Hokkaido, 060-8368, Japan
| | - Shinichi Shirai
- Department of Neurology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, North 15 West 7, Kita-Ku, Sapporo, Hokkaido, 060-8368, Japan
| | - Masaaki Matsushima
- Department of Neurology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, North 15 West 7, Kita-Ku, Sapporo, Hokkaido, 060-8368, Japan
| | - Ichiro Yabe
- Department of Neurology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, North 15 West 7, Kita-Ku, Sapporo, Hokkaido, 060-8368, Japan
| | - Jun Utsumi
- Department of Neurology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, North 15 West 7, Kita-Ku, Sapporo, Hokkaido, 060-8368, Japan
| | - Hidenao Sasaki
- Department of Neurology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, North 15 West 7, Kita-Ku, Sapporo, Hokkaido, 060-8368, Japan
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119
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Stankovic I, Quinn N, Vignatelli L, Antonini A, Berg D, Coon E, Cortelli P, Fanciulli A, Ferreira JJ, Freeman R, Halliday G, Höglinger GU, Iodice V, Kaufmann H, Klockgether T, Kostic V, Krismer F, Lang A, Levin J, Low P, Mathias C, Meissner WG, Kaufmann LN, Palma JA, Panicker JN, Pellecchia MT, Sakakibara R, Schmahmann J, Scholz SW, Singer W, Stamelou M, Tolosa E, Tsuji S, Seppi K, Poewe W, Wenning GK. A critique of the second consensus criteria for multiple system atrophy. Mov Disord 2019; 34:975-984. [PMID: 31034671 DOI: 10.1002/mds.27701] [Citation(s) in RCA: 68] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Revised: 03/02/2019] [Accepted: 04/01/2019] [Indexed: 01/16/2023] Open
Affiliation(s)
- Iva Stankovic
- Neurology Clinic, Clinical Center of Serbia, School of Medicine, University of Belgrade, Belgrade, Serbia.,Department of Neurology, Innsbruck Medical University, Innsbruck, Austria
| | - Niall Quinn
- University College London, Institute of Neurology, Queen Square, London, UK
| | - Luca Vignatelli
- Istituto di Ricovero e Cura a Carattere Scientifico, Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Angelo Antonini
- Department of Neuroscience, University of Padua, Padua, Italy
| | - Daniela Berg
- Department of Neurology, Christian Albrecht University, Kiel, Germany.,Hertie Institute for Clinical Brain Research Tübingen, Tübingen, Germany
| | - Elizabeth Coon
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - Pietro Cortelli
- Istituto di Ricovero e Cura a Carattere Scientifico, Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy.,Dipartimento Scienze Biomediche e Neuromotorie, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | | | - Joaquim J Ferreira
- Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Roy Freeman
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Glenda Halliday
- Brain and Mind Centre, Sydney Medical School, University of Sydney, Camperdown, Australia; School of Medical Sciences, University of New South Wales, Wales, Kensington, Australia; and Neuroscience Research Australia, Randwick, Australia
| | - Günter U Höglinger
- Department of Neurology, Technische Universität München, and German Center for Neurodegenerative Diseases, München, Germany
| | - Valeria Iodice
- Autonomic Unit, National Hospital for Neurology and Neurosurgery, Queen Square/Division of Clinical Neurology, Institute of Neurology, University College London, London, UK
| | - Horacio Kaufmann
- Dysautonomia Center, Langone Medical Center, New York University School of Medicine, New York, New York, USA
| | - Thomas Klockgether
- Department of Neurology, University of Bonn, and German Center for Neurodegenerative Diseases, Bonn, Germany
| | - Vladimir Kostic
- Neurology Clinic, Clinical Center of Serbia, School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Florian Krismer
- Department of Neurology, Innsbruck Medical University, Innsbruck, Austria
| | - Anthony Lang
- Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, University Health Network, Division of Neurology, University of Toronto, Toronto, Ontario, Canada
| | - Johannes Levin
- Department of Neurology, Ludwig-Maximilians-Universität München, and German Center for Neurodegenerative Diseases, München, Germany
| | - Phillip Low
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - Christopher Mathias
- Autonomic and Neurovascular Medicine Centre, Hospital of St John & St Elizabeth, London, UK.,Lindo Wing, Imperial College Healthcare National Health Service Trust, St Mary's Hospital, London, UK.,Queen Square Institute of Neurology, University College London, London, UK
| | - Wassillios G Meissner
- French Reference Center for MSA, Department of Neurology, University Hospital Bordeaux, Bordeaux, France.,Institute of Neurodegenerative Disorders, University Bordeaux, Bordeaux, France
| | - Lucy Norcliffe Kaufmann
- Dysautonomia Center, Langone Medical Center, New York University School of Medicine, New York, New York, USA
| | - Jose-Alberto Palma
- Dysautonomia Center, Langone Medical Center, New York University School of Medicine, New York, New York, USA
| | - Jalesh N Panicker
- University College London, Institute of Neurology, Queen Square, London, UK.,Department of Uro-Neurology, The National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
| | - Maria Teresa Pellecchia
- Center for Neurodegenerative Diseases, Department of Medicine and Surgery, Neuroscience Section, University of Salerno, Fisciano, Italy
| | - Ryuji Sakakibara
- Neurology, Internal Medicine, Sakura Medical Center, Toho University, Sakura, Japan
| | - Jeremy Schmahmann
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Sonja W Scholz
- Neurodegenerative Diseases Research Unit, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland, USA.,Department of Neurology, Johns Hopkins University Medical Center, Baltimore, Maryland, USA
| | - Wolfgang Singer
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - Maria Stamelou
- HYGEIA Hospital, Athens, Greece, Neurology Clinic, University Marburg, Marburg, Germany.,Department of Neurology, University of Athens, Athens, Greece
| | - Eduardo Tolosa
- Neurology Service, Hospital Clinic de Barcelona, IDIBAPS, CIBERNED, Barcelona, Spain
| | - Shoji Tsuji
- Department of Molecular Neurology, The University of Tokyo, Graduate School of Medicine, Tokyo, Japan.,International University of Health and Welfare, Chiba, Japan
| | - Klaus Seppi
- Department of Neurology, Innsbruck Medical University, Innsbruck, Austria
| | - Werner Poewe
- Department of Neurology, Innsbruck Medical University, Innsbruck, Austria
| | - Gregor K Wenning
- Department of Neurology, Innsbruck Medical University, Innsbruck, Austria
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Yang H, Wang N, Luo X, Lv H, Liu H, Fan G. Altered functional connectivity of dentate nucleus in parkinsonian and cerebellar variants of multiple system atrophy. Brain Imaging Behav 2019; 13:1733-1745. [DOI: 10.1007/s11682-019-00097-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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121
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Chelban V, Bocchetta M, Hassanein S, Haridy NA, Houlden H, Rohrer JD. An update on advances in magnetic resonance imaging of multiple system atrophy. J Neurol 2019; 266:1036-1045. [PMID: 30460448 PMCID: PMC6420901 DOI: 10.1007/s00415-018-9121-3] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Accepted: 11/11/2018] [Indexed: 02/08/2023]
Abstract
In this review, we describe how different neuroimaging tools have been used to identify novel MSA biomarkers, highlighting their advantages and limitations. First, we describe the main structural MRI changes frequently associated with MSA including the 'hot cross-bun' and 'putaminal rim' signs as well as putaminal, pontine, and middle cerebellar peduncle (MCP) atrophy. We discuss the sensitivity and specificity of different supra- and infratentorial changes in differentiating MSA from other disorders, highlighting those that can improve diagnostic accuracy, including the MCP width and MCP/superior cerebellar peduncle (SCP) ratio on T1-weighted imaging, raised putaminal diffusivity on diffusion-weighted imaging, and increased T2* signal in the putamen, striatum, and substantia nigra on susceptibility-weighted imaging. Second, we focus on recent advances in structural and functional MRI techniques including diffusion tensor imaging (DTI), resting-state functional MRI (fMRI), and arterial spin labelling (ASL) imaging. Finally, we discuss new approaches for MSA research such as multimodal neuroimaging strategies and how such markers may be applied in clinical trials to provide crucial data for accurately selecting patients and to act as secondary outcome measures.
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Affiliation(s)
- Viorica Chelban
- Department of Neuromuscular Diseases, UCL Institute of Neurology, Queen Square, London, WC1N 3BG, UK
- Department of Neurology and Neurosurgery, Institute of Emergency Medicine, Toma Ciorbă 1, 2052, Chisinau, Moldova
| | - Martina Bocchetta
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Institute of Neurology, Queen Square, WC1N 3BG, London, UK
| | - Sara Hassanein
- Diagnostic Radiology department, Faculty of Medicine Assiut University, Assiut, Egypt
- Department of Brain, Repair and Rehabilitation, UCL Institute of Neurology, Queen Square, WC1N 3BG, London, UK
| | - Nourelhoda A Haridy
- Department of Neuromuscular Diseases, UCL Institute of Neurology, Queen Square, London, WC1N 3BG, UK
- Department of Neurology and Psychiatry, Faculty of Medicine, Assiut University Hospital, Assiut, Egypt
| | - Henry Houlden
- Department of Neuromuscular Diseases, UCL Institute of Neurology, Queen Square, London, WC1N 3BG, UK
| | - Jonathan D Rohrer
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Institute of Neurology, Queen Square, WC1N 3BG, London, UK.
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Sprenger A, Hanssen H, Hagedorn I, Prasuhn J, Rosales RL, Jamora RDG, Diesta CC, Domingo A, Klein C, Brüggemann N, Helmchen C. Eye movement deficits in X-linked dystonia-parkinsonism are related to striatal degeneration. Parkinsonism Relat Disord 2019; 61:170-178. [DOI: 10.1016/j.parkreldis.2018.10.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Revised: 09/14/2018] [Accepted: 10/14/2018] [Indexed: 11/16/2022]
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Zhang L, Cao B, Zou Y, Wei QQ, Ou R, Zhao B, Yang J, Wu Y, Shang H. Prevalence of and factors associated with postural deformities in Chinese patients with multiple system atrophy. Parkinsonism Relat Disord 2019; 64:324-327. [PMID: 30987897 DOI: 10.1016/j.parkreldis.2019.03.024] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Revised: 03/13/2019] [Accepted: 03/25/2019] [Indexed: 02/05/2023]
Abstract
OBJECTIVE The prevalence of postural deformities in patients with multiple system atrophy (MSA) has varied among previous studies. The objective of our study was to investigate the prevalence of and factors associated with postural deformities in Chinese MSA patients. METHODS A total of 732 MSA patients were consecutively enrolled in the current study. Clinical data including age, sex, age of onset, disease duration, onset symptom and treatment were collected. The Unified Multiple System Atrophy Rating Scale (UMSARS) was used to evaluate the severity of the disease. RESULTS One hundred and fourteen (15.6%) patients presented with camptocormia. Thirty-one (4.2%) patients manifested with Pisa syndrome. Twenty-four (3.3%) patients presented with antecollis. Patients who exhibited postural deformities were more common among the MSA patients with predominant parkinsonism (MSA-P) (P < 0.05). In addition, MSA patients with postural deformities had a longer disease duration compared to those patients without postural deformities (P < 0.001). After adjusting for disease duration, compared with patients without postural deformities, MSA patients with postural deformities presented with higher score of UMSARS-I (P < 0.001), UMSARS-II (P < 0.001), UMSARS-IV (P < 0.001), and total UMSARS (P < 0.001) scores. The binary logistic regression model indicated that the factors associated with postural deformity in MSA patients were the total UMSARS score (OR = 1.076, P < 0.001) and MSA-P subtype (OR = 3.870, P < 0.001). CONCLUSION Postural deformities were common in Chinese MSA patients. Camptocormia was the most common type of postural deformity, followed by Pisa syndrome and antecollis. The factors associated with postural deformity were the severity of the disease and MSA-P subtype.
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Affiliation(s)
- LingYu Zhang
- Department of Neurology and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Bei Cao
- Department of Neurology and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yutong Zou
- West China School of Medicine, Sichuan University, Chengdu, Sichuan, China
| | - Qian-Qian Wei
- Department of Neurology and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - RuWei Ou
- Department of Neurology and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Bi Zhao
- Department of Neurology and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Jing Yang
- Department of Neurology and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Ying Wu
- Department of Neurology and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - HuiFang Shang
- Department of Neurology and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, Sichuan, China
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Warnecke T, Vogel A, Ahring S, Gruber D, Heinze HJ, Dziewas R, Ebersbach G, Gandor F. The Shaking Palsy of the Larynx-Potential Biomarker for Multiple System Atrophy: A Pilot Study and Literature Review. Front Neurol 2019; 10:241. [PMID: 30972002 PMCID: PMC6443854 DOI: 10.3389/fneur.2019.00241] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Accepted: 02/25/2019] [Indexed: 12/14/2022] Open
Abstract
In its early stages multiple system atrophy (MSA), a neurodegenerative movement disorder, can be difficult to differentiate from idiopathic Parkinson's disease (PD), and emphasis has been put on identifying premotor symptoms to allow for its early identification. The occurrence of vegetative symptoms in addition to motor impairment, such as orthostatic hypotension and neurogenic bladder dysfunction, enable the clinical diagnosis in the advanced stages of the disease. Usually with further disease progression, laryngeal abnormalities become clinically evident and can manifest in laryngeal stridor due to impaired vocal fold motion, such as vocal fold abduction restriction, mostly referred to as vocal fold paresis, or paradoxical vocal fold adduction during inspiration. While the pathogenesis of laryngeal stridor is discussed controversially, its occurrence is clearly associated with reduced life expectancy. Before the clinical manifestation of laryngeal dysfunction however, abnormal vocal fold motion can already be seen in patients that might not yet fulfill the diagnostic criteria of MSA. In this article we summarize the current literature on pharyngolaryngeal findings in MSA and report preliminary findings from a pilot study investigating eight consecutive MSA patients. Patients showed varying speech abnormalities. Only 2/8 patients exhibited laryngeal stridor. However, during FEES, all patients presented with irregular arytenoid cartilages movements and vocal fold abduction restriction. 3/8 showed vocal fold fixation and 1/8 paradoxical vocal fold motion. All patients presented with oropharyngeal dysphagia, 5/8 with penetration or aspiration events. We suggest that specific abnormal vocal fold motion can help identifying MSA patients and may allow for delimiting this disorder from idiopathic PD. These findings therefore may serve as a novel clinical biomarker for MSA. Based on the available data and our preliminary clinical experience we developed a standardized easy-to-implement task-protocol to be performed during flexible endoscopic evaluation of swallowing (FEES) for detection of MSA-related pharyngolaryngeal movement disorders. Furthermore, we initiated a prospective study to evaluate the diagnostic utility of this protocol.
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Affiliation(s)
- Tobias Warnecke
- Department of Neurology, University of Münster, Münster, Germany
| | - Annemarie Vogel
- Hospital for Movement Disorders/Parkinson's Disease, Beelitz-Heilstätten, Germany
| | - Sigrid Ahring
- Department of Neurology, University of Münster, Münster, Germany
| | - Doreen Gruber
- Hospital for Movement Disorders/Parkinson's Disease, Beelitz-Heilstätten, Germany.,Department of Neurology, Otto-von-Guericke University, Magdeburg, Germany
| | - Hans-Jochen Heinze
- Department of Neurology, Otto-von-Guericke University, Magdeburg, Germany
| | - Rainer Dziewas
- Department of Neurology, University of Münster, Münster, Germany
| | - Georg Ebersbach
- Hospital for Movement Disorders/Parkinson's Disease, Beelitz-Heilstätten, Germany
| | - Florin Gandor
- Hospital for Movement Disorders/Parkinson's Disease, Beelitz-Heilstätten, Germany.,Department of Neurology, Otto-von-Guericke University, Magdeburg, Germany
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125
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Kumar CM, Seet E, Singh RK, Joshi GP. Anesthesia in Patients With Multiple-System Atrophy: A Narrative Review and Practice Guidance. A A Pract 2019; 12:176-179. [DOI: 10.1213/xaa.0000000000000939] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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126
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Wijemanne S, Jankovic J. Hand, foot, and spine deformities in parkinsonian disorders. J Neural Transm (Vienna) 2019; 126:253-264. [PMID: 30809710 DOI: 10.1007/s00702-019-01986-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Accepted: 02/09/2019] [Indexed: 12/31/2022]
Abstract
Hand and foot deformities, known as "striatal deformities", and other musculoskeletal abnormalities such as dropped head, bent spine, camptocormia, scoliosis and Pisa syndrome, are poorly understood and often misdiagnosed features of Parkinson's disease and other parkinsonian syndromes. These deformities share some similarities with known rheumatologic conditions and can be wrongly diagnosed as rheumatoid arthritis, osteoarthritis, psoriatic arthritis, Dupuytren's contracture, trigger finger, or other rheumatologic or orthopedic conditions. Neurologists, rheumatologists, and other physicians must be familiar with these deformities to prevent misdiagnosis and unnecessary diagnostic tests, and to recommend appropriate treatment options.
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Affiliation(s)
| | - Joseph Jankovic
- Parkinson's Disease Center and Movement Disorders Clinic, Department of Neurology, Baylor College of Medicine, 7200 Cambridge St, Suite #9A, Houston, TX, 77030, USA.
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McCormack A, Keating DJ, Chegeni N, Colella A, Wang JJ, Chataway T. Abundance of Synaptic Vesicle-Related Proteins in Alpha-Synuclein-Containing Protein Inclusions Suggests a Targeted Formation Mechanism. Neurotox Res 2019; 35:883-897. [PMID: 30796693 DOI: 10.1007/s12640-019-00014-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Revised: 01/31/2019] [Accepted: 02/08/2019] [Indexed: 01/26/2023]
Abstract
Proteinaceous α-synuclein-containing inclusions are found in affected brain regions in patients with Parkinson's disease (PD), Dementia with Lewy bodies (DLB) and multiple system atrophy (MSA). These appear in neurons as Lewy bodies in both PD and DLB and as glial cytoplasmic inclusions (GCIs) in oligodendrocytes in MSA. The role they play in the pathology of the diseases is unknown, and relatively little is still known about their composition. By purifying the inclusions from the surrounding tissue and comprehensively analysing their protein composition, vital clues to the formation mechanism and role in the disease process may be found. In this study, Lewy bodies were purified from postmortem brain tissue from DLB cases (n = 2) and GCIs were purified from MSA cases (n = 5) using a recently improved purification method, and the purified inclusions were analysed by mass spectrometry. Twenty-one percent of the proteins found consistently in the GCIs and LBs were synaptic-vesicle related. Identified proteins included those associated with exosomes (CD9), clathrin-mediated endocytosis (clathrin, AP-2 complex, dynamin), retrograde transport (dynein, dynactin, spectrin) and synaptic vesicle fusion (synaptosomal-associated protein 25, vesicle-associated membrane protein 2, syntaxin-1). This suggests that the misfolded or excess α-synuclein may be targeted to inclusions via vesicle-mediated transport, which also explains the presence of the neuronal protein α-synuclein within GCIs.
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Affiliation(s)
- Amellia McCormack
- Flinders Proteomics Facility, College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, 5042, Australia
| | - Damien J Keating
- College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, 5042, Australia
| | - Nusha Chegeni
- Flinders Proteomics Facility, College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, 5042, Australia
| | - Alex Colella
- Flinders Proteomics Facility, College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, 5042, Australia.,Department of Immunology, Flinders Medical Centre and Flinders University, SA Pathology, Bedford Park, South Australia, 5042, Australia
| | - Jing Jing Wang
- Department of Immunology, Flinders Medical Centre and Flinders University, SA Pathology, Bedford Park, South Australia, 5042, Australia
| | - Tim Chataway
- Flinders Proteomics Facility, College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, 5042, Australia.
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Do multiple system atrophy and Parkinson's disease show distinct patterns of volumetric alterations across hippocampal subfields? An exploratory study. Eur Radiol 2019; 29:4948-4956. [PMID: 30796577 DOI: 10.1007/s00330-019-06043-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Revised: 12/25/2018] [Accepted: 01/24/2019] [Indexed: 12/21/2022]
Abstract
OBJECTIVES To investigate the volumetric alterations of hippocampal subfields and identify which subfields contribute to mild cognitive impairment (MCI) in multiple system atrophy (MSA) and Parkinson's disease (PD). METHODS Thirty MSA-MCI, 26 PD-MCI, and 30 healthy controls were administered cognitive assessment, along with hippocampal segmentation using FreeSurfer 6.0 after a 3-T MRI scan. Regression analyses were performed between the volumes of hippocampal subfields and cognitive variables. RESULTS Compared with healthy controls, the volume of the hippocampal fissure was enlarged in PD-MCI patients, while left Cornu Ammonis (CA2-CA3), bilateral molecular layer, bilateral hippocampus-amygdala transition area, right subiculum, right CA1, right presubiculum, right parasubiculum, and bilateral whole hippocampus were reduced in the MSA-MCI group. Moreover, volumetric reductions of the bilateral hippocampal tail, bilateral CA1, bilateral presubiculum, bilateral molecular layer, left CA2-CA3, left hippocampus-amygdala transition area, right parasubiculum, and bilateral whole hippocampus were found in MSA-MCI relative to the PD-MCI group. The volumes of the left CA2-CA3 (B = - 11.34, p = 0.006) and left parasubiculum (B = 4.63, p = 0.01) were respectively correlated with language and abstraction functions. The volumes of the left fimbria (B = 6.99, p = 0.002) and left hippocampus-amygdala transition area (B = 2.28, p = 0.009) were correlated with visuospatial/executive function. CONCLUSIONS The MSA-MCI patients showed more widespread impairment of hippocampal subfields compared with the PD-MCI group, involving trisynaptic loop and amygdala-hippocampus interactions. The alteration of CA, hippocampus-amygdala transition area, and fimbria still requires further comparison between the two patient groups. KEY POINTS • The atrophy patterns of hippocampal subfields differed between MSA and PD patients. • MSA has widespread change in trisynaptic loop and amygdala-hippocampus interactions. • The atrophy patterns may help to understand the differences of cognitive impairment in MSA and PD.
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Cerebellar resting-state functional connectivity in Parkinson's disease and multiple system atrophy: Characterization of abnormalities and potential for differential diagnosis at the single-patient level. NEUROIMAGE-CLINICAL 2019; 22:101720. [PMID: 30785051 PMCID: PMC6383182 DOI: 10.1016/j.nicl.2019.101720] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Revised: 02/03/2019] [Accepted: 02/12/2019] [Indexed: 01/15/2023]
Abstract
Background Recent studies using resting-state functional connectivity and machine-learning to distinguish patients with neurodegenerative diseases from other groups of subjects show promising results. This approach has not been tested to discriminate between Parkinson's disease (PD) and multiple system atrophy (MSA) patients. Objectives Our first aim is to characterize possible abnormalities in resting-state functional connectivity between the cerebellum and a set of intrinsic-connectivity brain networks and between the cerebellum and different regions of the striatum in PD and MSA. The second objective of this study is to assess the potential of cerebellar connectivity measures to distinguish between PD and MSA patients at the single-patient level. Methods Fifty-nine healthy controls, 62 PD patients, and 30 MSA patients underwent resting-state functional MRI with a 3T scanner. Independent component analysis and dual regression were used to define seven resting-state networks of interest. To assess striatal connectivity, a seed-to-voxel approach was used after dividing the striatum into six regions bilaterally. Measures of cerebellar-brain network and cerebellar-striatal connectivity were then used as features in a support vector machine to discriminate between PD and MSA patients. Results MSA patients displayed reduced cerebellar connectivity with different brain networks and with the striatum compared with PD patients and with controls. The classification procedure achieved an overall accuracy of 77.17% with 83.33% of the MSA subjects and 74.19% of the PD patients correctly classified. Conclusion Our findings suggest that measures of cerebellar functional connectivity have the potential to distinguish between PD and MSA patients. Reduced cerebellar functional connectivity in MSA compared with healthy controls. Reduced cerebellar-striatal functional connectivity in MSA compared with PD. Reduced connectivity between cerebellum and brain networks in MSA compared with PD. Cerebellar connectivity might help discriminate between MSA and PD patients.
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Guevara C, de Grazia J, Baabor P, Soruco W. Self-reported urinary impairment identifies 'fast progressors' in terms of neuronal loss in multiple system atrophy. Auton Neurosci 2019; 217:1-6. [PMID: 30704970 DOI: 10.1016/j.autneu.2018.12.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 11/11/2018] [Accepted: 12/13/2018] [Indexed: 11/12/2022]
Abstract
INTRODUCTION MSA is an adult-onset, sporadic, progressive parkinsonian syndrome characterised by the presence of akinesia, cerebellar dysfunction, autonomic failure and pyramidal signs. Annualized-whole-brain atrophy rate (a-WBAR) is an informative way to quantify disease progression. In this longitudinal work we investigate the correlations of a-WBAR with clinical scales for motor impairment, autonomic disability and cognitive decline in MSA and explore how atrophy progresses within the brain. METHOD Fourty-one MSA patients were studied using Structural Imaging Evaluation with Normalization of Atrophy (SIENA). SIENA is an MRI-based algorithm that quantifies brain tissue volume. Clinical parameters were explored using the 18-item Movement Disorder Society-sponsored revision of the Unified Parkinson's Disease Rating Scale, the Hoehn and Yahr Scale, the Frontal Assessment Battery and the Natural History and Neuroprotection in Parkinson Plus Syndromes scale (sub-items for orthostatic and urinary functions). RESULTS The mean (±SD) age was 60.4 years ± 7.7 and a-WBAR was 1.65% ± 0.9. Demographics and clinical ratings at the time of the first scan were non-significantly associated with a-WBAR. The only exception was the baseline urinary score with a weak but significant association (R2 = 0.15, p = 0.04). Progression of grey matter atrophy was detected in the left superior temporal gyrus, right middle frontal gyrus, right frontopolar region and midbrain. CONCLUSION Urinary impairment at baseline may help to identify 'fast progressors' in terms of neuronal loss, particularly in the frontal and temporal lobes. Thus, urinary impairment should be recognized as a key target for disease modifying therapeutic interventions in MSA.
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Affiliation(s)
- Carlos Guevara
- Facultad de Medicina, Universidad de Chile, Santos Dummont 999, Santiago, Chile.
| | - José de Grazia
- Facultad de Medicina, Universidad de Chile, Santos Dummont 999, Santiago, Chile
| | - Pablo Baabor
- Facultad de Medicina, Universidad de Chile, Santos Dummont 999, Santiago, Chile
| | - Wendy Soruco
- Facultad de Medicina, Universidad de Chile, Santos Dummont 999, Santiago, Chile
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131
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Moretti DV. Available and future treatments for atypical parkinsonism. A systematic review. CNS Neurosci Ther 2019; 25:159-174. [PMID: 30294976 PMCID: PMC6488913 DOI: 10.1111/cns.13068] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 09/01/2018] [Accepted: 09/05/2018] [Indexed: 01/02/2023] Open
Abstract
AIMS Success in treating patients with atypical parkinsonian syndromes, namely progressive supranuclear palsy (PSP), cortico-basal degeneration (CBD), multiple system atrophy (MSA), Parkinson's disease with dementia (PDD), and Lewy body dementia with (LBD), remains exceedingly low. The present work overviews the most influential research literature collected on MEDLINE, ISI Web of Science, Cochrane Library, and Scopus for available treatment in atypical parkinsonisms without time restriction. DISCUSSION Transdermal rotigotine, autologous mesenchymal stem cells, tideglusib, and coenzyme Q10 along with donepezil, rivastigmine, memantine, and the deep brain stimulation have shown some benefits in alleviating symptoms in APS. Moreover, many new clinical trials are ongoing testing microtubule stabilizer, antitau monoclonal antibody, tau acetylation inhibition, cell replacement, selective serotonin reuptake inhibitor, active immunization, inhibition of toxic α-synuclein oligomers formation, and inhibition of microglia. CONCLUSION A detailed knowledge of the pathological mechanism underlying the disorders is needed, and disease-modifying therapies are required to offer better therapeutic options to physician and caregivers of APS patients.
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132
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Olfati N, Shoeibi A, Litvan I. Progress in the treatment of Parkinson-Plus syndromes. Parkinsonism Relat Disord 2019; 59:101-110. [DOI: 10.1016/j.parkreldis.2018.10.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2018] [Revised: 09/27/2018] [Accepted: 10/01/2018] [Indexed: 01/04/2023]
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133
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Genetic mimics of the non-genetic atypical parkinsonian disorders – the ‘atypical’ atypical. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2019; 149:327-351. [DOI: 10.1016/bs.irn.2019.10.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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134
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Bhidayasiri R, Rattanachaisit W, Phokaewvarangkul O, Lim TT, Fernandez HH. Exploring bedside clinical features of parkinsonism: A focus on differential diagnosis. Parkinsonism Relat Disord 2018; 59:74-81. [PMID: 30502095 DOI: 10.1016/j.parkreldis.2018.11.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Revised: 10/29/2018] [Accepted: 11/04/2018] [Indexed: 12/12/2022]
Abstract
The proper diagnosis of parkinsonian disorders usually involves three steps: identifying core features of parkinsonism; excluding other causes; and collating supportive evidence based on clinical signs or investigations. While the recognition of cardinal parkinsonian features is usually straightforward, the appreciation of clinical features suggestive of specific parkinsonian disorders can be challenging, and often requires greater experience and skills. In this review, we outline the clinical features that are relevant to the differential diagnosis of common neurodegenerative parkinsonian disorders, including Parkinson's disease, multiple system atrophy, progressive supranuclear palsy, and corticobasal degeneration. We aim to make this process relatable to clinicians-in-practice, therefore, have categorised the list of clinical features into groups according to the typical sequence on how clinicians would elicit them during the examination, starting with observation of facial expression and clinical signs of the face, spotting eye movement abnormalities, examination of tremors and jerky limb movements, and finally, examination of posture and gait dysfunction. This review is not intended to be comprehensive. Rather, we have focused on the most common clinical signs that are potentially key to making the correct diagnosis and those that do not require special skills or training for interpretation. Evidence is also provided, where available, such as diagnostic criteria, consensus statements, clinicopathological studies or large multi-centre registries. Pitfalls are also discussed when relevant to the diagnosis. While no clinical signs are pathognomonic for certain parkinsonian disorders, certain clinical clues may assist in narrowing a differential diagnosis and tailoring focused investigations for the individual patient.
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Affiliation(s)
- Roongroj Bhidayasiri
- Chulalongkorn Center of Excellence for Parkinson's Disease & Related Disorders, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, 10330, Thailand; Department of Neurology, Juntendo University, Tokyo, Japan.
| | - Watchara Rattanachaisit
- Chulalongkorn Center of Excellence for Parkinson's Disease & Related Disorders, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, 10330, Thailand
| | - Onanong Phokaewvarangkul
- Chulalongkorn Center of Excellence for Parkinson's Disease & Related Disorders, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, 10330, Thailand
| | | | - Hubert H Fernandez
- Center for Neurological Restoration, Cleveland Clinic, Cleveland, OH, USA
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Brettschneider J, Suh E, Robinson JL, Fang L, Lee EB, Irwin DJ, Grossman M, Van Deerlin VM, Lee VMY, Trojanowski JQ. Converging Patterns of α-Synuclein Pathology in Multiple System Atrophy. J Neuropathol Exp Neurol 2018; 77. [PMID: 30203094 PMCID: PMC6181179 DOI: 10.1093/jnen/nly080#supplementary-data] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/31/2023] Open
Abstract
We aimed to determine patterns of α-synuclein (α-syn) pathology in multiple system atrophy (MSA) using 70-µm-thick sections of 20 regions of the central nervous system of 37 cases with striato-nigral degeneration (SND) and 10 cases with olivo-ponto-cerebellar atrophy (OPCA). In SND cases with the shortest disease duration (phase 1), α-syn pathology was observed in striatum, lentiform nucleus, substantia nigra, brainstem white matter tracts, cerebellar subcortical white matter as well as motor cortex, midfrontal cortex, and sensory cortex. SND with increasing duration of disease (phase 2) was characterized by involvement of spinal cord and thalamus, while phase 3 was characterized by involvement of hippocampus and amygdala. Cases with the longest disease duration (phase 4) showed involvement of the visual cortex. We observed an increasing overlap of α-syn pathology with increasing duration of disease between SND and OPCA, and noted increasingly similar regional distribution patterns of α-syn pathology. The GBA variant, p.Thr408Met, was found to have an allele frequency of 6.94% in SND cases which was significantly higher compared with normal (0%) and other neurodegenerative disease pathologies (0.74%), suggesting that it is associated with MSA. Our findings indicate that SND and OPCA show distinct early foci of α-syn aggregations, but increasingly converge with longer disease duration to show overlapping patterns of α-syn pathology.
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Affiliation(s)
- Johannes Brettschneider
- Center for Neurodegenerative Disease Research (CNDR), University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
| | - EunRan Suh
- Department of Pathology and Laboratory Medicine, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
| | - John L Robinson
- Center for Neurodegenerative Disease Research (CNDR), University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
| | - Lubin Fang
- Clinical Neuroanatomy Section, Department of Neurology, Center for Biomedical Research, University of Ulm, Ulm, Germany
| | - Edward B Lee
- Center for Neurodegenerative Disease Research (CNDR), University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
- Department of Pathology and Laboratory Medicine, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
| | - David J Irwin
- Center for Neurodegenerative Disease Research (CNDR), University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
- Department of Pathology and Laboratory Medicine, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
| | - Murray Grossman
- Center for Neurodegenerative Disease Research (CNDR), University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
- Department of Pathology and Laboratory Medicine, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
| | - Vivianna M Van Deerlin
- Department of Pathology and Laboratory Medicine, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
| | - Virginia M -Y Lee
- Center for Neurodegenerative Disease Research (CNDR), University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
- Department of Pathology and Laboratory Medicine, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
| | - John Q Trojanowski
- Center for Neurodegenerative Disease Research (CNDR), University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
- Department of Pathology and Laboratory Medicine, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
- Send correspondence to: John Q. Trojanowski, MD, PhD, CNDR, University of Pennsylvania School of Medicine, 3rd Floor Maloney Building, 3600 Spruce Street, Philadelphia, PA 19104; E-mail:
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Zhang L, Zhang L, Xue F, Yue K, Peng H, Wu Y, Sha O, Yang L, Ding Y. Brain morphological alteration and cognitive dysfunction in multiple system atrophy. Quant Imaging Med Surg 2018; 8:1030-1038. [PMID: 30598880 DOI: 10.21037/qims.2018.11.02] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Multiple system atrophy (MSA) is a progressive neurodegenerative disease in adults, manifesting various clinical symptoms including autonomic nerve dysfunction, Parkinson's syndrome, cerebellar ataxia, and pyramidal sign. The clinical diagnosis and classification of MSA are mainly dependent on motion and non-motion symptoms, such as autonomic nerve dysfunction. In addition, an increasing amount of clinical and pathological evidence has shown that about half of the MSA patients exhibit distinct types and levels of cognitive dysfunction. However, cognitive dysfunction has not been included in the current diagnosis criteria of MSA. In most cases, it was even used as an exclusion criterion of MSA. Based on the neuroimaging, neuropathology and neuropsychology, this review summarized the morphological changes of the brain in the patients with MSA, and discussed possible brain regions that could be associated with cognitive impairment. The article may provide a theoretical basis for incorporating cognitive dysfunction into the criteria of MSA diagnosis.
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Affiliation(s)
- Lihong Zhang
- Department of Neurology, The Second Hospital of Hebei Medical University, Shijiazhuang 050000, China
| | - Li Zhang
- Department of Anatomical and Cellular Pathology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Fang Xue
- Department of Neurology, The Second Hospital of Hebei Medical University, Shijiazhuang 050000, China
| | - Kathy Yue
- School of Public Health, University of Minnesota, Minneapolis, MN 55455, USA
| | - Haixin Peng
- Department of Food Science and Nutrition, Sichuan Agricultural University, Chengdu 611130, China
| | - Ya'nan Wu
- Department of Neurology, The Second Hospital of Hebei Medical University, Shijiazhuang 050000, China
| | - Ou Sha
- Department of Anatomy, Histology and Developmental Biology, School of Basic Medical Sciences, Shenzhen University Health Science Centre, Shenzhen 518060, China
| | - Lan Yang
- Department of Neurology, The Second Hospital of Hebei Medical University, Shijiazhuang 050000, China
| | - Yan Ding
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
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Bhidayasiri R, Sringean J, Reich SG, Colosimo C. Red flags phenotyping: A systematic review on clinical features in atypical parkinsonian disorders. Parkinsonism Relat Disord 2018; 59:82-92. [PMID: 30409560 DOI: 10.1016/j.parkreldis.2018.10.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Revised: 09/28/2018] [Accepted: 10/04/2018] [Indexed: 12/18/2022]
Abstract
To establish a clinical diagnosis of a parkinsonian disorder, physicians rely on their ability to identify relevant red flags, in addition to cardinal features, to support or refute their working diagnosis in an individual patient. The term 'red flag', was originally coined in 1989 to define the presence of non-cardinal features that may raise a suspicion of multiple system atrophy (MSA), or at least suggest alternative diagnosis to Parkinson's disease (PD). Since then, the term 'red flag', has been consistently used in the literature to denote the clinical history or signs that may signal to physicians the possibility of an atypical parkinsonian disorder (APD). While most red flags were originally based on expert opinion, many have gained acceptance and are now included in validated clinical diagnostic criteria of PD and APDs. The clinical appreciation of red flags, in conjunction with standard criteria, may result in a more accurate and earlier diagnosis compared to standard criteria alone. However, red flags can be clinical signs that are non-neurological, making the systematic assessment for them a real challenge in clinical practice. Here, we have conducted a systematic review to identify red flags and their clinical evidence in the differential diagnosis of common degenerative parkinsonism, including PD, MSA, progressive supranuclear palsy (PSP), corticobasal degeneration (CBD), and dementia with Lewy body (DLB). Increasing awareness and appropriate use of red flags in clinical practice may benefit physicians in the diagnosis and management of their patients with parkinsonism.
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Affiliation(s)
- Roongroj Bhidayasiri
- Chulalongkorn Center of Excellence for Parkinson's Disease & Related Disorders, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, 10330, Thailand; Department of Neurology, Juntendo University, Tokyo, Japan.
| | - Jirada Sringean
- Chulalongkorn Center of Excellence for Parkinson's Disease & Related Disorders, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, 10330, Thailand
| | - Stephen G Reich
- Department of Neurology, University of Maryland School of Medicine, Baltimore, USA
| | - Carlo Colosimo
- Department of Neurology, Santa Maria University Hospital, Terni, Italy
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Abstract
PURPOSE OF REVIEW Patients with Parkinson's disease (PD) often display gastrointestinal and genitourinary autonomic symptoms years or even decades prior to diagnosis. These symptoms are thought to be caused in part by pathological α-synuclein inclusions in the peripheral autonomic and enteric nervous systems. It has been proposed that the initial α-synuclein aggregation may in some PD patients originate in peripheral nerve terminals and then spread centripetally to the spinal cord and brainstem. In vivo imaging methods can directly quantify the degeneration of the autonomic nervous system as well as the functional consequences such as perturbed motility. Here, we review the methodological principles of these imaging techniques and the major findings in patients with PD and atypical parkinsonism. RECENT FINDINGS Loss of sympathetic and parasympathetic nerve terminals in PD can be visualized using radiotracer imaging, including 123I-MIBG scintigraphy, and 18F-dopamine and 11C-donepezil PET. Recently, ultrasonographical studies disclosed reduced diameter of the vagal nerves in PD patients. Radiological and radioisotope techniques have demonstrated dysmotility and prolonged transit time throughout all subdivisions of the gastrointestinal tract in PD. The prevalence of objective dysfunction as measured with these imaging methods is often considerably higher compared to the prevalence of subjective symptoms experienced by the patients. Degeneration of the autonomic nervous system may play a key role in the pathogenesis of PD. In vivo imaging techniques provide powerful and noninvasive tools to quantify the degree and extent of this degeneration and its functional consequences.
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Affiliation(s)
- Karoline Knudsen
- Department of Nuclear Medicine and PET Centre Aarhus University Hospital, Institute of Clinical Medicine Aarhus University, Norrebrogade 44, Building 10, 8000, Aarhus C, Denmark
| | - Per Borghammer
- Department of Nuclear Medicine and PET Centre Aarhus University Hospital, Institute of Clinical Medicine Aarhus University, Norrebrogade 44, Building 10, 8000, Aarhus C, Denmark.
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Abstract
Progressive supranuclear palsy, corticobasal degeneration and multiple system atrophy account for approximately 10% of neurodegenerative parkinsonism. Considerable clinical overlap exists between these disorders that extends to features considered characteristic of each disease. Clinical diagnostic criteria have attempted to increase the accuracy of clinical diagnosis as accurate diagnosis is necessary to inform prognosis and to facilitate the recognition of disease-modifying treatments. Currently no such treatment exists. Nevertheless, many clinical trials aiming to change the natural history of these diseases are ongoing. The spread and accumulation of abnormal proteins are among the pathophysiological mechanisms targeted. For the time being, however, only symptomatic treatment is available. Levodopa is used to treat parkinsonism, but patients usually show a poor or transient response. Amantadine is also used in practice for the same indication. Botulinum toxin can alleviate focal dystonic manifestations. Addressing non-motor manifestations is limited by the potential of available drugs to impact on other aspects of the disease. Most of the new symptomatic formulations under study are focused on orthostatic hypotension in multiple system atrophy. Exercise, occupational, physical, and speech therapy and psychotherapy should always accompany pharmacological approaches.
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Batla A, De Pablo-Fernandez E, Erro R, Reich M, Calandra-Buonaura G, Barbosa P, Balint B, Ling H, Islam S, Cortelli P, Volkmann J, Quinn N, Holton JL, Warner TT, Bhatia KP. Young-onset multiple system atrophy: Clinical and pathological features. Mov Disord 2018; 33:1099-1107. [DOI: 10.1002/mds.27450] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2017] [Revised: 02/19/2018] [Accepted: 04/19/2018] [Indexed: 01/07/2023] Open
Affiliation(s)
- Amit Batla
- University College London (UCL) Institute of Neurology; London UK
| | - Eduardo De Pablo-Fernandez
- Reta Lila Weston Institute of Neurological Studies; UCL Institute of Neurology; London UK
- Queen Square Brain Bank for Neurological Disorders, UCL Institute of Neurology; London UK
| | - Roberto Erro
- University College London (UCL) Institute of Neurology; London UK
- Center for Neurodegenerative diseases, Department of Medicine, Surgery and Dentistry; University of Salerno; Salerno Italy
| | - Martin Reich
- Department of Neurology; University Clinic of Würzburg; Würzburg Germany
| | - Giovanna Calandra-Buonaura
- Istituti di Ricovero e Cura a Carattere. Scientifico (IRCCS) Institute of Science and Neurology of Bologna; Bologna Italy
- Department of Biomedical and Neuromotor Sciences; University of Bologna; Bologna Italy
| | - Pedro Barbosa
- Reta Lila Weston Institute of Neurological Studies; UCL Institute of Neurology; London UK
- Queen Square Brain Bank for Neurological Disorders, UCL Institute of Neurology; London UK
| | - Bettina Balint
- University College London (UCL) Institute of Neurology; London UK
- Department of Neurology; University Hospital Heidelberg; Heidelberg Germany
| | - Helen Ling
- Reta Lila Weston Institute of Neurological Studies; UCL Institute of Neurology; London UK
- Queen Square Brain Bank for Neurological Disorders, UCL Institute of Neurology; London UK
| | | | - Pietro Cortelli
- Istituti di Ricovero e Cura a Carattere. Scientifico (IRCCS) Institute of Science and Neurology of Bologna; Bologna Italy
- Department of Biomedical and Neuromotor Sciences; University of Bologna; Bologna Italy
| | - Jens Volkmann
- Department of Neurology; University Clinic of Würzburg; Würzburg Germany
| | - Niall Quinn
- National Hospital for Neurology and Neurosurgery; London UK
| | - Janice L. Holton
- Reta Lila Weston Institute of Neurological Studies; UCL Institute of Neurology; London UK
- Queen Square Brain Bank for Neurological Disorders, UCL Institute of Neurology; London UK
- Department of Molecular Neuroscience, UCL Institute of Neurology; University College London; London UK
| | - Thomas T. Warner
- Reta Lila Weston Institute of Neurological Studies; UCL Institute of Neurology; London UK
- Queen Square Brain Bank for Neurological Disorders, UCL Institute of Neurology; London UK
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141
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Deep brain stimulation does not enhance neuroinflammation in multiple system atrophy. Neurobiol Dis 2018; 118:155-160. [PMID: 30026036 DOI: 10.1016/j.nbd.2018.07.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 07/06/2018] [Accepted: 07/15/2018] [Indexed: 01/25/2023] Open
Abstract
Slowly progressive, levodopa-responsive multiple system atrophy (MSA) may be misdiagnosed as Parkinson's disease (PD). Deep brain stimulation (DBS) is mostly ineffective in these patients and may even worsen the clinical course. Here we assessed whether neuropathological differences between patients with MSA who were treated with DBS of the subthalamic nucleus because of a misleading clinical presentation and typical disease cases may explain the more benign disease course of the former, and also the rapid clinical decline after surgery. The post-mortem assessment included the subthalamic nucleus, the globus pallidus, the thalamus and the putamen in five patients with MSA who received DBS and nine typical disease cases. There was no evidence for distinct neuroinflammatory profiles between both groups that could be related to the surgical procedure or that could explain the rapid clinical progression during DBS. Patients who received deep brain stimulation displayed a higher proportion of α-synuclein bearing neuronal cytoplasmic inclusions in the putamen compared with typical cases, while the number of surviving neurons was not different between groups. Our findings suggest that DBS does not induce neuroinflammatory changes in patients with MSA, at least several years after the surgery. We further hypothesize that the peculiar pattern of α-synuclein pathology may contribute to differences in the clinical phenotype, with a greater proportion of neuronal inclusions in the putamen being associated to a milder, "PD-like" phenotype with sustained levodopa response and slower disease progression.
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142
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Komatsu H, Kato M, Kinpara T, Ono T, Kakuto Y. Possible multiple system atrophy with predominant parkinsonism in a patient with chronic schizophrenia: a case report. BMC Psychiatry 2018; 18:141. [PMID: 29783976 PMCID: PMC5963188 DOI: 10.1186/s12888-018-1714-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Accepted: 05/02/2018] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Multiple system atrophy (MSA) is an adult-onset, rare, and progressive neurodegenerative disorder characterized by a varying combination of autonomic failure, cerebellar ataxia, and parkinsonism. MSA is categorized as MSA-P with predominant parkinsonism, and as MSA-C with predominant cerebellar features. The prevalence of MSA has been reported to be between 1.86 and 4.9 cases per 100,000 individuals. In contrast, approximately 1% of the population is affected by schizophrenia during their lifetime; therefore, MSA-P comorbidity is very rare in schizophrenic patients. However, when the exacerbation or progression of parkinsonism occurs in patients with schizophrenia treated with antipsychotics, it is necessary to consider rare neurodegenerative disorders, including MSA-P, in the differential diagnosis of parkinsonism. CASE PRESENTATION A 60-year-old female patient with chronic schizophrenia developed possible MSA-P. She had been treated mainly with typical antipsychotics, and presented with urinary incontinence, nocturnal polyuria, and dysarthria around 2011. In 2014, she developed worsening parkinsonian symptoms and autonomic dysfunction. Although her antipsychotic medication was switched to an atypical antipsychotic and the dose reduced, her parkinsonism was not improved. In 2015, modified electroconvulsive therapy produced slight improvements in the symptoms; however, she shortly returned to her symptomatic state. A combination of cardiac 123I-meta-iodobenzylguanidine scintigraphy and 123I-FP-CIT single-photon emission computed tomography imaging, in addition to brain magnetic resonance imaging findings, helped to discriminate MSA-P from other sources of parkinsonism. L-dopa had been prescribed, but she responded poorly and died in the spring of 2016. CONCLUSIONS This case report highlights the importance of considering MSA-P in the differential diagnosis for parkinsonism in a patient being treated with antipsychotics for chronic schizophrenia. MSA-P should be considered in patients presenting with worsening and progressing parkinsonism, especially when accompanied by autonomic dysfunction or cerebellar ataxia. Although a definite diagnosis of MSA-P requires autopsy confirmation, a combination of brain magnetic resonance imaging and nuclear medicine scans may help to differentiate suspected MSA-P from the other parkinsonian syndromes. This case also demonstrates that MSA with parkinsonism that is poorly responsive to L-dopa may improve shortly after modified electroconvulsive therapy without worsening psychiatric symptoms.
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Affiliation(s)
- Hiroshi Komatsu
- Department of Psychiatry, Miyagi Psychiatric Center, Mubanchi, Tekurada, Natori, 981-1231, Japan.
| | - Masaaki Kato
- Department of Neurology, Minami Tohoku Hospital, Iwanuma, 989-2483, Japan
| | - Teiko Kinpara
- Department of Neurology, Kohnan Hospital, Sendai, 982-8523, Japan
| | - Takashi Ono
- Department of Psychiatry, Miyagi Psychiatric Center, Mubanchi, Tekurada, Natori, 981-1231, Japan
| | - Yoshihisa Kakuto
- Department of Psychiatry, Miyagi Psychiatric Center, Mubanchi, Tekurada, Natori, 981-1231, Japan
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143
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Rohrer G, Höglinger GU, Levin J. Symptomatic therapy of multiple system atrophy. Auton Neurosci 2018; 211:26-30. [DOI: 10.1016/j.autneu.2017.10.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Revised: 10/20/2017] [Accepted: 10/20/2017] [Indexed: 12/21/2022]
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Constantinides VC, Paraskevas GP, Velonakis G, Toulas P, Stamboulis E, Kapaki E. MRI Planimetry and Magnetic Resonance Parkinsonism Index in the Differential Diagnosis of Patients with Parkinsonism. AJNR Am J Neuroradiol 2018; 39:1047-1051. [PMID: 29622555 DOI: 10.3174/ajnr.a5618] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Accepted: 02/07/2018] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Differential diagnosis of multiple system atrophy, progressive supranuclear palsy, and corticobasal degeneration from Parkinson disease on clinical grounds is often difficult. MR imaging biomarkers could assist in a more accurate diagnosis. We examined the utility of MR imaging surface measurements (MR imaging planimetry) in the differential diagnosis of patients with parkinsonism. MATERIALS AND METHODS Fifty-two patients with Parkinson-plus (progressive supranuclear palsy, n = 24; corticobasal degeneration, n = 9; multiple system atrophy, n = 19), 18 patients with Parkinson disease, and 15 healthy controls were included. Corpus callosum, midbrain, and pons surfaces; relevant indices; and the Magnetic Resonance Parkinsonism Index were calculated. Corpus callosum subsection analysis was performed, and the corpus callosum posteroanterior gradient was introduced. RESULTS A Magnetic Resonance Parkinsonism Index value of >12.6 discriminated progressive supranuclear palsy from other causes of parkinsonism with a 91% sensitivity and 95% specificity. No planimetry measurement could accurately discriminate those with multiple system atrophy with parkinsonism from patients with Parkinson disease. A corpus callosum posteroanterior gradient value of ≤191 was highly specific (97%) and moderately sensitive (75%) for the diagnosis of corticobasal degeneration versus all other groups. A midbrain-to-corpus callosum posteroanterior gradient ratio of ≤0.45 was highly indicative of progressive supranuclear palsy over corticobasal degeneration (sensitivity 86%, specificity 88%). CONCLUSIONS MR imaging planimetry measurements are potent imaging markers of progressive supranuclear palsy and promising markers of corticobasal degeneration but do not seem to assist in the diagnosis of multiple system atrophy with parkinsonism.
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Affiliation(s)
- V C Constantinides
- From the 1st Department of Neurology (V.C.C., G.P.P., E.S., E.K.), National and Kapodistrian University of Athens, Medical School, Eginition Hospital, Athens, Greece
| | - G P Paraskevas
- From the 1st Department of Neurology (V.C.C., G.P.P., E.S., E.K.), National and Kapodistrian University of Athens, Medical School, Eginition Hospital, Athens, Greece
| | - G Velonakis
- Research Unit of Radiology (G.V., P.T.), 2nd Department of Radiology, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - P Toulas
- Research Unit of Radiology (G.V., P.T.), 2nd Department of Radiology, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - E Stamboulis
- From the 1st Department of Neurology (V.C.C., G.P.P., E.S., E.K.), National and Kapodistrian University of Athens, Medical School, Eginition Hospital, Athens, Greece
| | - E Kapaki
- From the 1st Department of Neurology (V.C.C., G.P.P., E.S., E.K.), National and Kapodistrian University of Athens, Medical School, Eginition Hospital, Athens, Greece
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145
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Lee HH, Seo HG, Kim KD, Lee SH, Lee WH, Oh BM, Lee WW, Kim Y, Kim A, Kim HJ, Jeon B, Han TR. Characteristics of Early Oropharyngeal Dysphagia in Patients with Multiple System Atrophy. NEURODEGENER DIS 2018; 18:84-90. [PMID: 29621788 DOI: 10.1159/000487800] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Accepted: 02/16/2018] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND/AIMS Dysphagia, a symptom of multiple system atrophy (MSA), is a major clinical concern. In this study, we investigate the characteristics of early oropharyngeal dysphagia (OD) in patients with MSA, and the differences between MSA subtypes. METHODS Patients enrolled in the study had previously been diagnosed with MSA at the clinic of the Department of Neurology, and had been referred for a videofluoroscopic swallowing study (VFSS), between 2005 and 2014, to check for dysphagia. The clinical characteristics and VFSS findings were analyzed and compared between the MSA subtypes. RESULTS This study enrolled 59 patients with MSA (24 men; 31 with MSA-P, 21 with MSA-C, and 7 with MSA-PC). Dysphagia symptoms were mostly limited to aspiration symptoms (90.48%) in patients with MSA-C, while difficulty in swallowing, increased mealtime, and drooling were frequent in those with MSA-P. The most common VFSS finding amongst patients was vallecular residue (n = 53, 89.8%), followed by penetration/aspiration (n = 40, 67.8%), and coating of the pharyngeal wall (n = 39, 66.1%). Comparison analysis between subtypes showed that apraxia and vallecular residue were more frequent and severe in MSA-P than in MSA-C (p = 0.033 and p = 0.010, respectively). CONCLUSION Understanding early OD characteristics in patients with MSA and the differences between MSA subtypes could be helpful in managing dysphagia in patients with MSA. Several dysphagia symptoms similar to those of Parkinson disease were frequently observed in MSA-P, but not in MSA-C. A follow-up study is needed to elucidate the natural course of OD in MSA patients and the difference between MSA subtypes.
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Affiliation(s)
- Hyun Haeng Lee
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Jongno-Gu, Seoul, Republic of Korea
| | - Han Gil Seo
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Jongno-Gu, Seoul, Republic of Korea
| | - Kwang-Dong Kim
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Jongno-Gu, Seoul, Republic of Korea
| | - Seung Hak Lee
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Jongno-Gu, Seoul, Republic of Korea
| | - Woo Hyung Lee
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Jongno-Gu, Seoul, Republic of Korea.,Department of Biomedical Engineering, Seoul National University College of Medicine, Jongno-Gu, Seoul, Republic of Korea
| | - Byung-Mo Oh
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Jongno-Gu, Seoul, Republic of Korea
| | - Woong-Woo Lee
- Department of Neurology, Nowon Eulji Medical Center, Eulji University, Nowon-Gu, Seoul, Republic of Korea
| | - Yoon Kim
- Department of Neurology, Seoul National University College of Medicine, Seoul National University Hospital, Jongno-Gu, Seoul, Republic of Korea
| | - Aryun Kim
- Department of Neurology, Seoul National University College of Medicine, Seoul National University Hospital, Jongno-Gu, Seoul, Republic of Korea
| | - Han-Joon Kim
- Department of Neurology, Seoul National University College of Medicine, Seoul National University Hospital, Jongno-Gu, Seoul, Republic of Korea
| | - Beomseok Jeon
- Department of Neurology, Seoul National University College of Medicine, Seoul National University Hospital, Jongno-Gu, Seoul, Republic of Korea
| | - Tai Ryoon Han
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Jongno-Gu, Seoul, Republic of Korea
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Erkkinen MG, Kim MO, Geschwind MD. Clinical Neurology and Epidemiology of the Major Neurodegenerative Diseases. Cold Spring Harb Perspect Biol 2018; 10:a033118. [PMID: 28716886 PMCID: PMC5880171 DOI: 10.1101/cshperspect.a033118] [Citation(s) in RCA: 564] [Impact Index Per Article: 94.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Neurodegenerative diseases are a common cause of morbidity and cognitive impairment in older adults. Most clinicians who care for the elderly are not trained to diagnose these conditions, perhaps other than typical Alzheimer's disease (AD). Each of these disorders has varied epidemiology, clinical symptomatology, laboratory and neuroimaging features, neuropathology, and management. Thus, it is important that clinicians be able to differentiate and diagnose these conditions accurately. This review summarizes and highlights clinical aspects of several of the most commonly encountered neurodegenerative diseases, including AD, frontotemporal dementia (FTD) and its variants, progressive supranuclear palsy (PSP), corticobasal degeneration (CBD), Parkinson's disease (PD), dementia with Lewy bodies (DLB), multiple system atrophy (MSA), and Huntington's disease (HD). For each condition, we provide a brief overview of the epidemiology, defining clinical symptoms and diagnostic criteria, relevant imaging and laboratory features, genetics, pathology, treatments, and differential diagnosis.
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Affiliation(s)
- Michael G Erkkinen
- Department of Neurology, Memory and Aging Center, University of California, San Francisco, San Francisco, California 94158
| | - Mee-Ohk Kim
- Department of Neurology, Memory and Aging Center, University of California, San Francisco, San Francisco, California 94158
| | - Michael D Geschwind
- Department of Neurology, Memory and Aging Center, University of California, San Francisco, San Francisco, California 94158
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147
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MEETING REPORTER. Curr Opin Neurol 2018; 30 Suppl 1:1-24. [DOI: 10.1097/wco.0000000000000521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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148
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Koga S, Dickson DW. Recent advances in neuropathology, biomarkers and therapeutic approach of multiple system atrophy. J Neurol Neurosurg Psychiatry 2018; 89:175-184. [PMID: 28860330 DOI: 10.1136/jnnp-2017-315813] [Citation(s) in RCA: 77] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Revised: 07/07/2017] [Accepted: 08/16/2017] [Indexed: 01/20/2023]
Abstract
Multiple system atrophy (MSA) is a progressive neurodegenerative disorder characterised by a variable combination of autonomic failure, levodopa-unresponsive parkinsonism, cerebellar ataxia and pyramidal symptoms. The pathological hallmark is the oligodendrocytic glial cytoplasmic inclusion (GCI) consisting of α-synuclein; therefore, MSA is included in the category of α-synucleinopathies. MSA has been divided into two clinicopathological subtypes: MSA with predominant parkinsonism and MSA with predominant cerebellar ataxia, which generally correlate with striatonigral degeneration and olivopontocerebellar atrophy, respectively. It is increasingly recognised, however, that clinical and pathological features of MSA are broader than previously considered.In this review, we aim to describe recent advances in neuropathology of MSA from a review of the literature and from information derived from review of nearly 200 definite MSA cases in the Mayo Clinic Brain Bank. In light of these new neuropathological findings, GCIs and neuronal cytoplasmic inclusions play an important role in clinicopathological correlates of MSA. We also focus on clinical diagnostic accuracy and differential diagnosis of MSA as well as candidate biomarkers. We also review some controversial topics in MSA. Cognitive impairment, which has been a non-supporting feature of MSA, is considered from both clinical and pathological perspectives. The cellular origin of α-synuclein in GCI and a 'prion hypothesis' are discussed. Finally, completed and ongoing clinical trials targeting disease modification, including immunotherapy, are summarised.
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Affiliation(s)
- Shunsuke Koga
- Department of Neuroscience, Mayo Clinic, Jacksonville, Florida, USA
| | - Dennis W Dickson
- Department of Neuroscience, Mayo Clinic, Jacksonville, Florida, USA
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149
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Stridor combined with other sleep breathing disorders in multiple system atrophy: a tailored treatment? Sleep Med 2018; 42:53-60. [DOI: 10.1016/j.sleep.2017.12.008] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Revised: 12/21/2017] [Accepted: 12/22/2017] [Indexed: 11/21/2022]
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150
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McKay JH, Cheshire WP. First symptoms in multiple system atrophy. Clin Auton Res 2018; 28:215-221. [PMID: 29313153 PMCID: PMC5859695 DOI: 10.1007/s10286-017-0500-0] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Accepted: 12/29/2017] [Indexed: 01/01/2023]
Abstract
Purpose The initial symptoms of multiple system atrophy (MSA) and, in particular, early autonomic symptoms, have received less attention than motor symptoms. Whereas pathognomonic motor signs are essential to diagnostic specificity, early symptoms important to recognition of a neurodegenerative disorder may be less apparent or diagnostically ambiguous. This observational study sought to identify the very earliest symptoms in the natural history of MSA. Methods Detailed clinical histories focusing on early symptoms were obtained from 30 subjects recently diagnosed with MSA. Historical data were correlated with neurological examinations and laboratory autonomic testing. Results Subjects’ mean age was 63.9 years. Ten were classified as having MSA-P and 20 MSA-C. The evaluations occurred 2.9 ± 0.4 months after diagnosis. The first symptom of MSA was autonomic in 22 (73%) and motor in 3 (10%) subjects (p < 0.0001). The most frequent first symptom was erectile failure, which occurred in all men beginning 4.2 ± 2.6 years prior to diagnosis. After erectile failure, postural lightheadness or fatigue following exercise, urinary urgency or hesitancy, and violent dream enactment behavior consistent with REM behavioral sleep disorder were the most frequent initial symptoms. Neither the order of symptom progression, which was highly variable, nor autonomic severity scores differentiated between MSA-P and MSA-C. Conclusions The first symptoms of MSA are frequently autonomic and may predate recognition of motor manifestations. Orthostatic hypotension and, in men, erectile failure are among the first symptoms that, when evaluated in the context of associated clinical findings, may facilitate accurate and earlier diagnosis.
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Affiliation(s)
- Jake H McKay
- Department of Neurology, Mayo Clinic, 4500 San Pablo Rd., Jacksonville, FL, 32224, USA
| | - William P Cheshire
- Department of Neurology, Mayo Clinic, 4500 San Pablo Rd., Jacksonville, FL, 32224, USA.
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