151
|
Respondek G, Stamelou M, Höglinger GU. Classification of atypical parkinsonism per pathology versus phenotype. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2019; 149:37-47. [PMID: 31779821 DOI: 10.1016/bs.irn.2019.10.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
The umbrella term "atypical parkinsonism" refers to a clinical presentation with various causes, emphasizing the clinical commonality of diseases in which atypical parkinsonism can present. This term is useful for describing the phenomenology of a movement disorder and to classify patients according to their clinical presentation. In contrast to this classification per phenotype, a classification per pathology is needed when it comes to understanding the pathogenesis and designing and delivering disease-modifying therapeutic interventions. Clinico-pathological correlation studies have revealed enormous clinical heterogeneity and vast clinical overlap in pathologically defined diseases related to atypical parkinsonism. Thus, the classification of patients with atypical parkinsonism per phenotype has limited validity for predicting the underlying pathology. This chapter will contrast the phenotype-driven classification and the pathology-driven classification of neurodegenerative diseases related to atypical parkinsonism and discuss future directions to improve pathology-specific diagnosis.
Collapse
Affiliation(s)
- Gesine Respondek
- Department for Neurology Hannover Medical School (MHH), Hannover, Germany; German Center for Neurodegenerative Diseases (DZNE), Munich, Germany
| | - Maria Stamelou
- Parkinson's Disease and Movement Disorders Department, HYGEIA Hospital, Athens, Greece; Aiginiteion Hospital, First Department of Neurology, University of Athens, Greece; Clinic for Neurology, Philipps University, Marburg, Germany
| | - Günter U Höglinger
- Department for Neurology Hannover Medical School (MHH), Hannover, Germany; German Center for Neurodegenerative Diseases (DZNE), Munich, Germany
| |
Collapse
|
152
|
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.
Collapse
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
| |
Collapse
|
153
|
Trošt M, Perovnik M, Pirtošek Z. Correlations of Neuropsychological and Metabolic Brain Changes in Parkinson's Disease and Other α-Synucleinopathies. Front Neurol 2019; 10:1204. [PMID: 31798525 PMCID: PMC6868095 DOI: 10.3389/fneur.2019.01204] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Accepted: 10/28/2019] [Indexed: 12/14/2022] Open
Abstract
Cognitive impairment is a common feature in Parkinson's disease (PD) and other α-synucleinopathies as 80% of PD patients develop dementia within 20 years. Early cognitive changes in PD patients present as a dysexecutive syndrome, broadly characterized as a disruption of the fronto-striatal dopamine network. Cognitive deficits in other domains (recognition memory, attention processes and visuospatial abilities) become apparent with the progression of PD and development of dementia. In dementia with Lewy bodies (DLB) the cognitive impairment develops early or even precedes parkinsonism and it is more pronounced in visuospatial skills and memory. Cognitive impairment in the rarer α-synucleinopathies (multiple system atrophy and pure autonomic failure) is less well studied. Metabolic brain imaging with positron emission tomography and [18F]-fluorodeoxyglucose (FDG-PET) is a well-established diagnostic method in neurodegenerative diseases, including dementias. Changes in glucose metabolism precede those seen on structural magnetic resonance imaging (MRI). Reduction in glucose metabolism and atrophy have been suggested to represent consecutive changes of neurodegeneration and are linked to specific cognitive disorders (e.g., dysexecutive syndrome, memory impairment, visuospatial deficits etc.). Advances in the statistical analysis of FDG-PET images enabling a network analysis broadened our understanding of neurodegenerative brain processes. A specific cognitive pattern related to PD was identified by applying voxel-based network modeling approach. The magnitude of this pattern correlated significantly with patients' cognitive skills. Specific metabolic brain changes were observed also in patients with DLB as well as in a prodromal phase of α-synucleinopathy: REM sleep behavior disorder. Metabolic brain imaging with FDG-PET is a reliable biomarker of neurodegenerative brain diseases throughout their course, precisely reflecting their topographic distribution, stage and functional impact.
Collapse
Affiliation(s)
- Maja Trošt
- Department for Neurology, University Medical Center Ljubljana, Ljubljana, Slovenia.,Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia.,Department for Nuclear Medicine, University Medical Center Ljubljana, Ljubljana, Slovenia
| | - Matej Perovnik
- Department for Neurology, University Medical Center Ljubljana, Ljubljana, Slovenia
| | - Zvezdan Pirtošek
- Department for Neurology, University Medical Center Ljubljana, Ljubljana, Slovenia.,Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| |
Collapse
|
154
|
Okamoto LE, Shibao CA, Gamboa A, Diedrich A, Raj SR, Black BK, Robertson D, Biaggioni I. Synergistic Pressor Effect of Atomoxetine and Pyridostigmine in Patients With Neurogenic Orthostatic Hypotension. Hypertension 2019; 73:235-241. [PMID: 30571543 DOI: 10.1161/hypertensionaha.118.11790] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Patients with autonomic failure are characterized by disabling orthostatic hypotension because of impaired sympathetic activity, but even severely affected patients have residual sympathetic tone which can be harnessed for their treatment. For example, norepinephrine transporter blockade with atomoxetine raises blood pressure (BP) in autonomic failure patients by increasing synaptic norepinephrine concentrations; acetylcholinesterase inhibition with pyridostigmine increases BP by facilitating ganglionic cholinergic neurotransmission to increase sympathetic outflow. We tested the hypothesis that pyridostigmine will potentiate the pressor effect of atomoxetine and improve orthostatic tolerance and symptoms in patients with severe autonomic failure. Twelve patients received a single oral dose of either placebo, pyridostigmine 60 mg, atomoxetine 18 mg or the combination on separate days in a single blind, crossover study. BP was assessed seated and standing before and 1-hour postdrug. In these severely affected patients, neither pyridostigmine nor atomoxetine improved BP or orthostatic tolerance compared with placebo. The combination, however, significantly increased seated BP in a synergistic manner (133±9/80±4 versus 107±6/66±4 mm Hg for placebo, 105±5/67±3 mm Hg for atomoxetine, and 99±6/64±4 mm Hg for pyridostigmine; P<0.001); the maximal increase in seated BP with the combination was 33±8/18±3 mm Hg at 60 minutes postdrug. Only the combination showed a significant improvement of orthostatic tolerance and symptoms. In conclusion, the combination pyridostigmine and atomoxetine had a synergistic effect on seated BP which was associated with improvement in orthostatic tolerance and symptoms. This pharmacological approach could be useful in patients with severe autonomic failure but further safety and long-term efficacy studies are needed.
Collapse
Affiliation(s)
- Luis E Okamoto
- From the Vanderbilt Autonomic Dysfunction Center (L.E.O., C.A.S., A.G. A.D., S.R.R., B.K.B., D.R., I.B.), Vanderbilt University School of Medicine, Nashville, TN.,Division of Clinical Pharmacology (L.E.O., C.A.S., A.G., A.D., S.R.R., B.K.B., D.R., I.B.), Vanderbilt University School of Medicine, Nashville, TN.,Department of Medicine (L.E.O., C.A.S., A.G., A.D., S.R.R., B.K.B., D.R., I.B.), Vanderbilt University School of Medicine, Nashville, TN
| | - Cyndya A Shibao
- From the Vanderbilt Autonomic Dysfunction Center (L.E.O., C.A.S., A.G. A.D., S.R.R., B.K.B., D.R., I.B.), Vanderbilt University School of Medicine, Nashville, TN.,Division of Clinical Pharmacology (L.E.O., C.A.S., A.G., A.D., S.R.R., B.K.B., D.R., I.B.), Vanderbilt University School of Medicine, Nashville, TN.,Department of Medicine (L.E.O., C.A.S., A.G., A.D., S.R.R., B.K.B., D.R., I.B.), Vanderbilt University School of Medicine, Nashville, TN
| | - Alfredo Gamboa
- From the Vanderbilt Autonomic Dysfunction Center (L.E.O., C.A.S., A.G. A.D., S.R.R., B.K.B., D.R., I.B.), Vanderbilt University School of Medicine, Nashville, TN.,Division of Clinical Pharmacology (L.E.O., C.A.S., A.G., A.D., S.R.R., B.K.B., D.R., I.B.), Vanderbilt University School of Medicine, Nashville, TN.,Department of Medicine (L.E.O., C.A.S., A.G., A.D., S.R.R., B.K.B., D.R., I.B.), Vanderbilt University School of Medicine, Nashville, TN
| | - André Diedrich
- From the Vanderbilt Autonomic Dysfunction Center (L.E.O., C.A.S., A.G. A.D., S.R.R., B.K.B., D.R., I.B.), Vanderbilt University School of Medicine, Nashville, TN.,Division of Clinical Pharmacology (L.E.O., C.A.S., A.G., A.D., S.R.R., B.K.B., D.R., I.B.), Vanderbilt University School of Medicine, Nashville, TN.,Department of Medicine (L.E.O., C.A.S., A.G., A.D., S.R.R., B.K.B., D.R., I.B.), Vanderbilt University School of Medicine, Nashville, TN.,Department of Biomedical Engineering (A.D.), Vanderbilt University School of Medicine, Nashville, TN
| | - Satish R Raj
- From the Vanderbilt Autonomic Dysfunction Center (L.E.O., C.A.S., A.G. A.D., S.R.R., B.K.B., D.R., I.B.), Vanderbilt University School of Medicine, Nashville, TN.,Division of Clinical Pharmacology (L.E.O., C.A.S., A.G., A.D., S.R.R., B.K.B., D.R., I.B.), Vanderbilt University School of Medicine, Nashville, TN.,Department of Medicine (L.E.O., C.A.S., A.G., A.D., S.R.R., B.K.B., D.R., I.B.), Vanderbilt University School of Medicine, Nashville, TN.,Department of Pharmacology (S.R.R., D.R., I.B.), Vanderbilt University School of Medicine, Nashville, TN.,Department of Cardiac Sciences, Libin Cardiovascular Institute of Alberta, University of Calgary, Canada (S.R.R.)
| | - Bonnie K Black
- From the Vanderbilt Autonomic Dysfunction Center (L.E.O., C.A.S., A.G. A.D., S.R.R., B.K.B., D.R., I.B.), Vanderbilt University School of Medicine, Nashville, TN.,Division of Clinical Pharmacology (L.E.O., C.A.S., A.G., A.D., S.R.R., B.K.B., D.R., I.B.), Vanderbilt University School of Medicine, Nashville, TN.,Department of Medicine (L.E.O., C.A.S., A.G., A.D., S.R.R., B.K.B., D.R., I.B.), Vanderbilt University School of Medicine, Nashville, TN
| | - David Robertson
- From the Vanderbilt Autonomic Dysfunction Center (L.E.O., C.A.S., A.G. A.D., S.R.R., B.K.B., D.R., I.B.), Vanderbilt University School of Medicine, Nashville, TN.,Division of Clinical Pharmacology (L.E.O., C.A.S., A.G., A.D., S.R.R., B.K.B., D.R., I.B.), Vanderbilt University School of Medicine, Nashville, TN.,Department of Medicine (L.E.O., C.A.S., A.G., A.D., S.R.R., B.K.B., D.R., I.B.), Vanderbilt University School of Medicine, Nashville, TN.,Department of Pharmacology (S.R.R., D.R., I.B.), Vanderbilt University School of Medicine, Nashville, TN.,Department of Neurology (D.R.), Vanderbilt University School of Medicine, Nashville, TN
| | - Italo Biaggioni
- From the Vanderbilt Autonomic Dysfunction Center (L.E.O., C.A.S., A.G. A.D., S.R.R., B.K.B., D.R., I.B.), Vanderbilt University School of Medicine, Nashville, TN.,Division of Clinical Pharmacology (L.E.O., C.A.S., A.G., A.D., S.R.R., B.K.B., D.R., I.B.), Vanderbilt University School of Medicine, Nashville, TN.,Department of Medicine (L.E.O., C.A.S., A.G., A.D., S.R.R., B.K.B., D.R., I.B.), Vanderbilt University School of Medicine, Nashville, TN.,Department of Pharmacology (S.R.R., D.R., I.B.), Vanderbilt University School of Medicine, Nashville, TN
| |
Collapse
|
155
|
Richard C, Amarenco G, Palma JA, Kaufmann H, Drapier S, Gamé X, Brucker B, Peyronnet B. Early bladder dysfunction in multiple system atrophy: who seek shall find. Clin Auton Res 2019; 29:625-626. [PMID: 31705345 DOI: 10.1007/s10286-019-00648-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Accepted: 11/05/2019] [Indexed: 11/24/2022]
Affiliation(s)
- Claire Richard
- Department of Urology, University of Rennes, Rennes, France.
| | - Gérard Amarenco
- Sorbonne Université, GRC 01 GREEN, APHP, Hôpital Tenon, Paris, France
| | | | | | - Sophie Drapier
- Department of Neurology, University of Rennes, Rennes, France
| | - Xavier Gamé
- Department of Urology, University of Toulouse, Toulouse, France
| | | | | |
Collapse
|
156
|
Unger RH, Flanigan PM, Khosravi M, Leverenz JB, Tousi B. Clinical and Imaging Characteristics Associated with Color Vision Impairment in Lewy Body Disease. J Alzheimers Dis 2019; 72:1233-1240. [PMID: 31683482 DOI: 10.3233/jad-190727] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Color vision impairment (CVI) has been reported in dementia with Lewy bodies (DLB) and prodromal Lewy body disease (pro-LBD). OBJECTIVE In order to better characterize the diagnostic value of CVI testing, we compared the prevalence of CVI in patients with with Lewy body disease compared to Alzheimer's disease (AD), and we examined clinical and imaging characteristics associated with CVI in patients with DLB and suspected pro-LBD. METHODS We retrospectively reviewed medical records, dopamine transporter (DaT-SPECT) imaging, and volumetric MRI from patients with AD, DLB, and suspected pro-LBD who underwent an online Farnsworth D-15 color vision test. RESULTS 111 patients (62 DLB, 25 pro-LBD, and 24 AD) were included with a median age of 75 years. Newly diagnosed CVI was present in 67% of patients with DLB, 44% of patients with pro-LBD, and 18% of patients with AD. In patients with DLB, CVI was associated with lower Montreal Cognitive Assessment (MoCA) scores and lower sub-scores in visuospatial/executive function, naming, and language. In a multivariable logistic regression model, a diagnosis of DLB or pro-LBD compared to AD, and a lower composite MoCA score in visuospatial/executive function, naming, and language were associated with CVI controlling for age and gender. Among 17 DLB patients who underwent volumetric MRI, patients with CVI (n = 9) demonstrated lower normative volumetric percentiles in the right transverse superior temporal lobe. CONCLUSION We provide further evidence that CVI can help differentiate DLB from AD, and we suggest that CVI may be an indicator of cognitive decline and disease progression in DLB.
Collapse
Affiliation(s)
- Robert H Unger
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, USA.,Lou Ruvo Center for Brain Health, Cleveland Clinic, Cleveland, OH, USA
| | - Patrick M Flanigan
- Department of Neurosurgery, UCLA David Geffen School of Medicine, Los Angeles, CA, USA
| | - Mitra Khosravi
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN, USA
| | - James B Leverenz
- Lou Ruvo Center for Brain Health, Cleveland Clinic, Cleveland, OH, USA
| | - Babak Tousi
- Lou Ruvo Center for Brain Health, Cleveland Clinic, Cleveland, OH, USA
| |
Collapse
|
157
|
Meissner WG, Fernagut PO, Dehay B, Péran P, Traon APL, Foubert-Samier A, Lopez Cuina M, Bezard E, Tison F, Rascol O. Multiple System Atrophy: Recent Developments and Future Perspectives. Mov Disord 2019; 34:1629-1642. [PMID: 31692132 DOI: 10.1002/mds.27894] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 09/03/2019] [Accepted: 09/15/2019] [Indexed: 02/06/2023] Open
Abstract
Multiple system atrophy (MSA) is a rare and fatal neurodegenerative disorder characterized by a variable combination of parkinsonism, cerebellar impairment, and autonomic dysfunction. The pathologic hallmark is the accumulation of aggregated α-synuclein in oligodendrocytes, forming glial cytoplasmic inclusions, which qualifies MSA as a synucleinopathy together with Parkinson's disease and dementia with Lewy bodies. The underlying pathogenesis is still not well understood. Some symptomatic treatments are available, whereas neuroprotection remains an urgent unmet treatment need. In this review, we critically appraise significant developments of the past decade with emphasis on pathogenesis, diagnosis, prognosis, and treatment development. We further discuss unsolved questions and highlight some perspectives. © 2019 International Parkinson and Movement Disorder Society.
Collapse
Affiliation(s)
- Wassilios G Meissner
- CRMR Atrophie Multisystématisée, CHU Bordeaux, Service de Neurologie, Bordeaux, France.,Institut des Maladies Neurodégénératives, Univ. de Bordeaux, Bordeaux, France.,CNRS, Institut des Maladies Neurodégénératives, Bordeaux, France.,Dept. of Medicine, University of Otago, Christchurch, New Zealand Brain Research Institute, Christchurch, New Zealand
| | - Pierre-Olivier Fernagut
- Institut des Maladies Neurodégénératives, Univ. de Bordeaux, Bordeaux, France.,CNRS, Institut des Maladies Neurodégénératives, Bordeaux, France.,Laboratoire de Neurosciences Expérimentales et Cliniques, Université de Poitiers, Poitiers, France.,INSERM, Laboratoire de Neurosciences Expérimentales et Cliniques, Poitiers, France
| | - Benjamin Dehay
- Institut des Maladies Neurodégénératives, Univ. de Bordeaux, Bordeaux, France.,CNRS, Institut des Maladies Neurodégénératives, Bordeaux, France
| | - Patrice Péran
- ToNIC, Toulouse NeuroImaging Center, Université de Toulouse, Toulouse, France
| | - Anne Pavy-Le Traon
- Services de Neurologie, CRMR Atrophie Multisystématisée, Toulouse, Institut des Maladies Métaboliques et Cardiovasculaires, Toulouse, France
| | - Alexandra Foubert-Samier
- CRMR Atrophie Multisystématisée, CHU Bordeaux, Service de Neurologie, Bordeaux, France.,Institut des Maladies Neurodégénératives, Univ. de Bordeaux, Bordeaux, France.,Inserm, Bordeaux Population Health Research Center, Bordeaux University, Bordeaux, France
| | - Miguel Lopez Cuina
- Institut des Maladies Neurodégénératives, Univ. de Bordeaux, Bordeaux, France.,CNRS, Institut des Maladies Neurodégénératives, Bordeaux, France
| | - Erwan Bezard
- Institut des Maladies Neurodégénératives, Univ. de Bordeaux, Bordeaux, France.,CNRS, Institut des Maladies Neurodégénératives, Bordeaux, France
| | - François Tison
- CRMR Atrophie Multisystématisée, CHU Bordeaux, Service de Neurologie, Bordeaux, France.,Institut des Maladies Neurodégénératives, Univ. de Bordeaux, Bordeaux, France.,CNRS, Institut des Maladies Neurodégénératives, Bordeaux, France
| | - Olivier Rascol
- Services de Neurologie et de Pharmacologie Clinique, Centre de Reference AMS, Centre d'Investigation Clinique, Réseau NS-Park/FCRIN et Centre of Excellence for Neurodegenerative Disorders (COEN) de Toulouse, CHU de Toulouse, Toulouse 3 University, Toulouse, France
| |
Collapse
|
158
|
|
159
|
Isonaka R, Gibbons CH, Wang N, Freeman R, Goldstein DS. Association of innervation-adjusted alpha-synuclein in arrector pili muscles with cardiac noradrenergic deficiency in autonomic synucleinopathies. Clin Auton Res 2019; 29:587-593. [PMID: 31673840 DOI: 10.1007/s10286-019-00644-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Accepted: 10/08/2019] [Indexed: 12/27/2022]
Abstract
BACKGROUND Autonomic synucleinopathies feature deposition of the protein alpha-synuclein (AS) in neurons [e.g., Lewy body neurogenic orthostatic hypotension (nOH)] or glial cells (multiple system atrophy, MSA). AS in skin biopsies might provide biomarkers of these diseases; however, this approach would be complicated or invalidated if there were substantial loss of AS-containing nerves. We report AS content in arrector pili muscles in skin biopsies after adjustment for local innervation in patients with Lewy body nOH or MSA. Cardiac sympathetic neuroimaging by myocardial 18F-dopamine positron emission tomography (PET) was done to examine pathophysiological correlates of innervation-adjusted AS. METHODS Thirty-one patients (19 Lewy body nOH, 12 MSA) underwent thoracic 18F-dopamine PET and skin biopsies. AS signal intensity analyzed by immunofluorescence microscopy was adjusted for innervation by the ratio of AS to protein gene product (PGP) 9.5, a pan-axonal marker (Harvard lab site), or the ratio of AS to tyrosine hydroxylase (TH), an indicator of catecholaminergic neurons (NIH lab site). RESULTS The Lewy body nOH group had higher ratios of AS/PGP 9.5 or log AS/TH than did the MSA group (0.89 ± 0.05 vs. 0.66 ± 0.04, -0.13 ± 0.05 vs. -1.60 ± 0.33; p < 0.00001 each). All 19 Lewy body patients had AS/PGP 9.5 > 0.8 or log AS/TH > 1.2 and had myocardial 18F-dopamine-derived radioactivity < 6000 nCi-kg/cc-mCi, the lower limit of normal. Two MSA patients (17%) had increased AS/PGP or log AS/TH, and two (17%) had low 18F-dopamine-derived radioactivity. CONCLUSIONS Lewy body forms of nOH are associated with increased innervation-adjusted AS in arrector pili muscles and neuroimaging evidence of myocardial noradrenergic deficiency.
Collapse
Affiliation(s)
- Risa Isonaka
- Autonomic Medicine Section (formerly Clinical Neurocardiology Section), Clinical Neurosciences Program, Division of Intramural Research, National Institute of Neurological Disorders and Stroke, National Institutes of Health, 9000 Rockville Pike MSC-1620, Building 10 Room 8N260, Bethesda, MD, 20892-1620, USA
| | | | - Ningshan Wang
- Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Roy Freeman
- Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - David S Goldstein
- Autonomic Medicine Section (formerly Clinical Neurocardiology Section), Clinical Neurosciences Program, Division of Intramural Research, National Institute of Neurological Disorders and Stroke, National Institutes of Health, 9000 Rockville Pike MSC-1620, Building 10 Room 8N260, Bethesda, MD, 20892-1620, USA.
| |
Collapse
|
160
|
Coon EA, Singer W, Low PA. Pure Autonomic Failure. Mayo Clin Proc 2019; 94:2087-2098. [PMID: 31515103 PMCID: PMC6826339 DOI: 10.1016/j.mayocp.2019.03.009] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Revised: 03/06/2019] [Accepted: 03/12/2019] [Indexed: 12/17/2022]
Abstract
Pure autonomic failure (PAF) is a neurodegenerative disorder of the autonomic nervous system clinically characterized by orthostatic hypotension. The disorder has also been known as Bradbury-Eggleston syndrome, named for the authors of the 1925 seminal description. Patients typically present in midlife or later with orthostatic hypotension or syncope. Autonomic failure may also manifest as genitourinary, bowel, and thermoregulatory dysfunction. With widespread involvement, patients may present to a variety of different specialties and require multidisciplinary treatment approaches. Pathologically, PAF is characterized by predominantly peripheral deposition of α-synuclein. However, patients with PAF may progress into other synucleinopathies with central nervous system involvement.
Collapse
|
161
|
Palma JA, Norcliffe-Kaufmann L, Kaufmann H. Orthostatic Hypotension as a Prodromal Marker of α-Synucleinopathies. JAMA Neurol 2019; 75:1154. [PMID: 30105358 DOI: 10.1001/jamaneurol.2018.2248] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Jose-Alberto Palma
- Department of Neurology, Dysautonomia Center, New York University School of Medicine, New York
| | - Lucy Norcliffe-Kaufmann
- Department of Neurology, Dysautonomia Center, New York University School of Medicine, New York
| | - Horacio Kaufmann
- Department of Neurology, Dysautonomia Center, New York University School of Medicine, New York
| |
Collapse
|
162
|
Abstract
Orthostatic hypotension (OH) is a sustained fall in blood pressure on standing that can cause symptoms of organ hypoperfusion. OH is associated with increased morbidity and mortality and leads to a significant number of hospital admissions. OH can be caused by volume depletion, blood loss, cardiac pump failure, large varicose veins, medications, or defective activation of sympathetic nerves and reduced norepinephrine release upon standing. Neurogenic OH is a frequent and disabling problem in patients with synucleinopathies such as Parkinson disease, multiple system atrophy, and pure autonomic failure, and it is commonly associated with supine hypertension. Several therapeutic options are available.
Collapse
|
163
|
Triplett JD, Benarroch EE, Cutsforth-Gregory JK. Pure autonomic failure presenting as Harlequin syndrome. Auton Neurosci 2019; 220:102559. [DOI: 10.1016/j.autneu.2019.102559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 05/16/2019] [Accepted: 06/13/2019] [Indexed: 11/26/2022]
|
164
|
Norcliffe-Kaufmann L, Palma JA, Kaufmann H. A validated test for neurogenic orthostatic hypotension at the bedside. Ann Neurol 2019; 84:959-960. [PMID: 30341962 DOI: 10.1002/ana.25362] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Accepted: 10/15/2018] [Indexed: 12/17/2022]
Affiliation(s)
- Lucy Norcliffe-Kaufmann
- Department of Neurology, Dysautonomia Center, New York University School of Medicine, New York, NY
| | - Jose-Alberto Palma
- Department of Neurology, Dysautonomia Center, New York University School of Medicine, New York, NY
| | - Horacio Kaufmann
- Department of Neurology, Dysautonomia Center, New York University School of Medicine, New York, NY
| |
Collapse
|
165
|
Kevadiya BD, Ottemann BM, Thomas MB, Mukadam I, Nigam S, McMillan J, Gorantla S, Bronich TK, Edagwa B, Gendelman HE. Neurotheranostics as personalized medicines. Adv Drug Deliv Rev 2019; 148:252-289. [PMID: 30421721 PMCID: PMC6486471 DOI: 10.1016/j.addr.2018.10.011] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Revised: 10/22/2018] [Accepted: 10/23/2018] [Indexed: 12/16/2022]
Abstract
The discipline of neurotheranostics was forged to improve diagnostic and therapeutic clinical outcomes for neurological disorders. Research was facilitated, in largest measure, by the creation of pharmacologically effective multimodal pharmaceutical formulations. Deployment of neurotheranostic agents could revolutionize staging and improve nervous system disease therapeutic outcomes. However, obstacles in formulation design, drug loading and payload delivery still remain. These will certainly be aided by multidisciplinary basic research and clinical teams with pharmacology, nanotechnology, neuroscience and pharmaceutic expertise. When successful the end results will provide "optimal" therapeutic delivery platforms. The current report reviews an extensive body of knowledge of the natural history, epidemiology, pathogenesis and therapeutics of neurologic disease with an eye on how, when and under what circumstances neurotheranostics will soon be used as personalized medicines for a broad range of neurodegenerative, neuroinflammatory and neuroinfectious diseases.
Collapse
Affiliation(s)
- Bhavesh D Kevadiya
- Department of Pharmacology and Experimental Neuroscience, University of Nebraska Medical Center, Omaha, NE, USA
| | - Brendan M Ottemann
- Department of Pharmacology and Experimental Neuroscience, University of Nebraska Medical Center, Omaha, NE, USA
| | - Midhun Ben Thomas
- Department of Pharmacology and Experimental Neuroscience, University of Nebraska Medical Center, Omaha, NE, USA
| | - Insiya Mukadam
- Department of Pharmaceutical Sciences, University of Nebraska Medical Center, Omaha, NE, USA
| | - Saumya Nigam
- Department of Pharmacology and Experimental Neuroscience, University of Nebraska Medical Center, Omaha, NE, USA
| | - JoEllyn McMillan
- Department of Pharmacology and Experimental Neuroscience, University of Nebraska Medical Center, Omaha, NE, USA
| | - Santhi Gorantla
- Department of Pharmacology and Experimental Neuroscience, University of Nebraska Medical Center, Omaha, NE, USA
| | - Tatiana K Bronich
- Department of Pharmaceutical Sciences, University of Nebraska Medical Center, Omaha, NE, USA
| | - Benson Edagwa
- Department of Pharmacology and Experimental Neuroscience, University of Nebraska Medical Center, Omaha, NE, USA
| | - Howard E Gendelman
- Department of Pharmacology and Experimental Neuroscience, University of Nebraska Medical Center, Omaha, NE, USA; Department of Pharmaceutical Sciences, University of Nebraska Medical Center, Omaha, NE, USA.
| |
Collapse
|
166
|
Abstract
In this chapter, we describe the history, presentation, diagnosis and treatment of pure autonomic failure (PAF). The pathology underlying this condition is thought to involve the deposition of alpha synuclein in the autonomic ganglia leading to diminished norepinephrine release and progressive autonomic dysfunction. We focus on various neurophysiological tests that may be used to evaluate the function of the peripheral autonomic nervous system including quantitative sudomotor axon reflex testing, thermoregulatory sweat testing, and others. These may help evaluate and diagnose various disorders of autonomic failure and neurogenic orthostatic hypotension including multiple system atrophy and Parkinson's disease dysautonomia. Management of PAF, including the therapeutic role of recent advances in pharmacologic treatment, is discussed.
Collapse
|
167
|
Chelban V, Vichayanrat E, Schottlaende L, Iodice V, Houlden H. Autonomic dysfunction in genetic forms of synucleinopathies. Mov Disord 2019; 33:359-371. [PMID: 29508456 DOI: 10.1002/mds.27343] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Revised: 01/01/2018] [Accepted: 01/19/2018] [Indexed: 12/31/2022] Open
Abstract
The discovery of genetic links between alpha-synuclein and PD has opened unprecedented opportunities for research into a new group of diseases, now collectively known as synucleinopathies. Autonomic dysfunction, including cardiac sympathetic denervation, has been reported in familial forms of synucleinopathies that have Lewy bodies at the core of their pathogenesis. SNCA mutations and multiplications, LRRK2 disease with Lewy bodies as well as other common, sporadic forms of idiopathic PD, MSA, pure autonomic failure, and dementia with Lewy bodies have all been associated with dysautonomia. By contrast, in familial cases of parkinsonism without Lewy bodies, such as in PARK2, the autonomic profile remains normal throughout the course of the disease. The degeneration of the central and peripheral autonomic systems in genetic as well as sporadic forms of neurodegenerative synucleinopathies correlates with the accumulation of alpha-synuclein immunoreactive-containing inclusions. Given that dysautonomia has a significant impact on the quality of life of sufferers and autonomic symptoms are generally treatable, a prompt diagnostic testing and treatment should be provided. Moreover, new evidence suggests that autonomic dysfunction can be used as an outcome prediction factor in some forms of synucleinopathies or premotor diagnostic markers that could be used in the future to define further research avenues. In this review, we describe the autonomic dysfunction of genetic synucleinopathies in comparison to the dysautonomia of sporadic forms of alpha-synuclein accumulation and provide the reader with an up-to-date overview of the current understanding in this fast-growing field. © 2018 International Parkinson and Movement Disorder Society.
Collapse
Affiliation(s)
- Viorica Chelban
- Department of Molecular Neuroscience, UCL Institute of Neurology, London, United Kingdom, and National Hospital for Neurology and Neurosurgery, London, United Kingdom.,Department of Neurology and Neurosurgery, Institute of Emergency Medicine, Chisinau, Republic of Moldova
| | - Ekawat Vichayanrat
- Autonomic Unit, National Hospital for Neurology and Neurosurgery, UCL NHS Trust, London, United Kingdom
| | - Lucia Schottlaende
- Department of Molecular Neuroscience, UCL Institute of Neurology, London, United Kingdom, and National Hospital for Neurology and Neurosurgery, London, United Kingdom.,Dubowitz Neuromuscular Centre, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Valeria Iodice
- Autonomic Unit, National Hospital for Neurology and Neurosurgery, UCL NHS Trust, London, United Kingdom.,Institute of Neurology, University College London, London, United Kingdom
| | - Henry Houlden
- Department of Molecular Neuroscience, UCL Institute of Neurology, London, United Kingdom, and National Hospital for Neurology and Neurosurgery, London, United Kingdom
| |
Collapse
|
168
|
Carmona-Abellan M, Gabilondo I, Murueta-Goyena A, Khurana V, Tijero B, Luquin MR, Acera M, Del Pino R, Gardeazabal J, Martínez-Valbuena I, Sanchez-Pernaute R, Gómez-Esteban JC. Small fiber neuropathy and phosphorylated alpha-synuclein in the skin of E46K-SNCA mutation carriers. Parkinsonism Relat Disord 2019; 65:139-145. [PMID: 31178336 DOI: 10.1016/j.parkreldis.2019.05.038] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Revised: 05/28/2019] [Accepted: 05/29/2019] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND OBJECTIVE In 2004 we described the E46K mutation in alpha-synuclein gene (E46K-SNCA), a rare point mutation causing an aggressive Lewy body disease with early prominent non-motor features and small fiber denervation of myocardium. Considering the potential interest of the skin as a target for the development of biomarkers in Parkinson's Disease (PD), in this work we aimed to evaluate structural and functional integrity of small autonomic nerve fibers and phosphorylated alpha-synuclein (p-synuclein) deposition in the skin of E46K-SNCA carriers as compared to those observed in parkin gene mutation (PARK2) carriers and healthy controls. PATIENTS AND METHODS We studied 7 E46K-SNCA carriers (3 dementia with Lewy bodies, 2 pure autonomic failure, 1 PD and 1 asymptomatic), 2 PARK2 carriers and 2 healthy controls to quantify intraepidermal nerve fiber density and p-synuclein deposition with cervical skin punch biopsies (immunohistochemistry against anti PGP9.5/UCHL-1, TH and p-synuclein) and sudomotor function with electrochemical skin conductance (ESC) (SudoScan). RESULTS All E46K-SNCA carriers had moderate to severe p-synuclein deposits and small fiber neurodegeneration in different epidermal and dermal structures including nerve fascicles and glands, especially in carriers with Pure Autonomic Failure, while p-synuclein aggregates where absent in healthy controls and in one of two PARK2 carriers. The severity of the latter skin abnormalities in E46K-SNCA were correlated with sudomotor dysfunction (lower ESC) in hands (p = 0.035). INTERPRETATION These results together with our previous findings support the relevance of E46K-SNCA mutation as a suitable model to study small fiber neuropathy in Lewy body diseases.
Collapse
Affiliation(s)
- Mar Carmona-Abellan
- Neurodegenerative Diseases Group, Biocruces Bizkaia Health Research Institute, Cruces-Barakaldo, Bizkaia, Spain
| | - Inigo Gabilondo
- Neurodegenerative Diseases Group, Biocruces Bizkaia Health Research Institute, Cruces-Barakaldo, Bizkaia, Spain; Neurology Department, Cruces University Hospital, Cruces-Barakaldo, Bizkaia, Spain; Ikerbasque: The Basque Foundation for Science, Bilbao, Spain
| | - Ane Murueta-Goyena
- Neurology Department, Cruces University Hospital, Cruces-Barakaldo, Bizkaia, Spain
| | - Vikram Khurana
- Ann Romney Center for Neurologic Disease, Department of Neurology, Brigham and Women's Hospital and Harvard Medical School, Boston, USA
| | - Beatriz Tijero
- Neurodegenerative Diseases Group, Biocruces Bizkaia Health Research Institute, Cruces-Barakaldo, Bizkaia, Spain; Neurology Department, Cruces University Hospital, Cruces-Barakaldo, Bizkaia, Spain
| | - María Rosario Luquin
- Department of Neurology, Clínica Universitaria de Navarra, Universidad de Navarra, Pamplona, Spain
| | - Marian Acera
- Neurodegenerative Diseases Group, Biocruces Bizkaia Health Research Institute, Cruces-Barakaldo, Bizkaia, Spain
| | - Rocío Del Pino
- Neurodegenerative Diseases Group, Biocruces Bizkaia Health Research Institute, Cruces-Barakaldo, Bizkaia, Spain
| | - Jesús Gardeazabal
- Dermatology Department, Cruces University Hospital, Cruces-Barakaldo, Bizkaia, Spain
| | - Ivan Martínez-Valbuena
- Department of Neurology, Clínica Universitaria de Navarra, Universidad de Navarra, Pamplona, Spain
| | | | - Juan Carlos Gómez-Esteban
- Neurodegenerative Diseases Group, Biocruces Bizkaia Health Research Institute, Cruces-Barakaldo, Bizkaia, Spain; Neurology Department, Cruces University Hospital, Cruces-Barakaldo, Bizkaia, Spain.
| |
Collapse
|
169
|
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: 61] [Impact Index Per Article: 12.2] [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
| | | |
Collapse
|
170
|
Mendoza-Velásquez JJ, Flores-Vázquez JF, Barrón-Velázquez E, Sosa-Ortiz AL, Illigens BMW, Siepmann T. Autonomic Dysfunction in α-Synucleinopathies. Front Neurol 2019; 10:363. [PMID: 31031694 PMCID: PMC6474181 DOI: 10.3389/fneur.2019.00363] [Citation(s) in RCA: 71] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Accepted: 03/25/2019] [Indexed: 12/20/2022] Open
Abstract
The α-synucleinopathies are a group of neurodegenerative diseases characterized by abnormal accumulation of insoluble α-synuclein in neurons and glial cells, comprising Parkinson's disease (PD), dementia with Lewy bodies (DLB) and multiple system atrophy (MSA). Although varying in prevalence, symptom patterns, and severity among disorders, all α-synucleinopathies have in common autonomic nervous system dysfunctions, which reduce quality of life. Frequent symptoms among α-synucleinopathies include constipation, urinary and sexual dysfunction, and cardiovascular autonomic symptoms such as orthostatic hypotension, supine hypertension, and reduced heart rate variability. Symptoms due to autonomic dysfunction can appear before motor symptom onset, particularly in MSA and PD, hence, detection and quantitative analysis of these symptoms can enable early diagnosis and initiation of treatment, as well as identification of at-risk populations. While patients with PD, DLB, and MSA show both central and peripheral nervous system involvement of α-synuclein pathology, pure autonomic failure (PAF) is a condition characterized by generalized dysregulation of the autonomic nervous system with neuronal cytoplasmic α-synuclein inclusions in the peripheral autonomic small nerve fibers. Patients with PAF often present with orthostatic hypotension, reduced heart rate variability, anhydrosis, erectile dysfunction, and constipation, without motor or cognitive impairment. These patients also have an increased risk of developing an α-synucleinopathy with central involvement, such as PD, DLB, or MSA in later life, possibly indicating a pathophysiological disease continuum. Pathophysiological aspects, as well as developments in diagnosing and treating dysautonomic symptoms in patients with α-synucleinopathies are discussed in this review.
Collapse
Affiliation(s)
- José Javier Mendoza-Velásquez
- Division of Health Care Sciences, Center for Clinical Research and Management Education, Dresden International University, Dresden, Germany
- Department of Psychiatry and Mental Health, School of Medicine, National Autonomous University of Mexico, Mexico City, Mexico
| | - Juan Francisco Flores-Vázquez
- Dementia Laboratory, National Institute of Neurology and Neurosurgery, Ciudad de Mexico, Mexico
- Faculty of Medical Sciences, University of Groningen, Groningen, Netherlands
| | - Evalinda Barrón-Velázquez
- Department of Psychiatry and Mental Health, School of Medicine, National Autonomous University of Mexico, Mexico City, Mexico
| | - Ana Luisa Sosa-Ortiz
- Dementia Laboratory, National Institute of Neurology and Neurosurgery, Ciudad de Mexico, Mexico
| | - Ben-Min Woo Illigens
- Division of Health Care Sciences, Center for Clinical Research and Management Education, Dresden International University, Dresden, Germany
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
| | - Timo Siepmann
- Division of Health Care Sciences, Center for Clinical Research and Management Education, Dresden International University, Dresden, Germany
- Department of Neurology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| |
Collapse
|
171
|
Postuma RB, Berg D. Prodromal Parkinson's Disease: The Decade Past, the Decade to Come. Mov Disord 2019; 34:665-675. [DOI: 10.1002/mds.27670] [Citation(s) in RCA: 80] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 02/22/2019] [Accepted: 02/28/2019] [Indexed: 01/02/2023] Open
Affiliation(s)
- Ronald B. Postuma
- Department of NeurologyMontreal General Hospital Montreal, Quebec Canada
| | - Daniela Berg
- Department of NeurologyChristian‐Albrechts‐University of Kiel Kiel Germany
| |
Collapse
|
172
|
Dopamine transporter imaging versus myocardial MIBG scintigraphy for the diagnosis of prodromal synucleinopathies-and other updates on autonomic research. Clin Auton Res 2019; 29:211-213. [PMID: 30904961 DOI: 10.1007/s10286-019-00600-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Accepted: 02/27/2019] [Indexed: 10/27/2022]
|
173
|
Progressive supranuclear palsy and multiple system atrophy: clinicopathological concepts and therapeutic challenges. Curr Opin Neurol 2019; 31:448-454. [PMID: 29746401 DOI: 10.1097/wco.0000000000000581] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
PURPOSE OF REVIEW This update discusses novel aspects on clinicopathological concepts and therapeutic challenges in progressive supranuclear palsy (PSP) and multiple system atrophy (MSA), arising from publications of the last 1.5 years. RECENT FINDINGS The clinical criteria for diagnosis of PSP have been revised. Clinical variability of pathologically defined PSP and MSA makes the development of mature biomarkers for early diagnosis and biomarker-based trial design indispensable. Novel molecular techniques for biomarker supported diagnosis of PSP and MSA and for monitoring disease progression are being studied. Research in the pathophysiology of both diseases generates gradual progress in the understanding of the underlying processes. Several promising disease-modifying therapeutic approaches for PSP and MSA are now moving into clinical trials. SUMMARY Recent research generates insights in the pathophysiological relevant processes and raises hope for earlier clinical diagnosis and disease-modifying therapies of patients with PSP and MSA.
Collapse
|
174
|
Vallelonga F, Di Stefano C, Merola A, Romagnolo A, Sobrero G, Milazzo V, Burrello A, Burrello J, Zibetti M, Veglio F, Maule S. Blood pressure circadian rhythm alterations in alpha-synucleinopathies. J Neurol 2019; 266:1141-1152. [DOI: 10.1007/s00415-019-09244-w] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 02/09/2019] [Accepted: 02/14/2019] [Indexed: 12/28/2022]
|
175
|
Rafanelli M, Walsh K, Hamdan MH, Buyan-Dent L. Autonomic dysfunction: Diagnosis and management. HANDBOOK OF CLINICAL NEUROLOGY 2019; 167:123-137. [PMID: 31753129 DOI: 10.1016/b978-0-12-804766-8.00008-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
The autonomic nervous system is designed to maintain physiologic homeostasis. Its widespread connections make it vulnerable to disruption by many disease processes including primary etiologies such as Parkinson's disease, multiple system atrophy, dementia with Lewy bodies, and pure autonomic failure and secondary etiologies such as diabetes mellitus, amyloidosis, and immune-mediated illnesses. The result is numerous symptoms involving the cardiovascular, gastrointestinal, and urogenital systems. Patients with autonomic dysfunction (AUD) often have peripheral and/or cardiac denervation leading to impairment of the baroreflex, which is known to play a major role in determining hemodynamic outcome during orthostatic stress and low cardiac output states. Heart rate and plasma norepinephrine responses to orthostatic stress are helpful in diagnosing impairment of the baroreflex in patients with orthostatic hypotension (OH) and suspected AUD. Similarly, cardiac sympathetic denervation diagnosed with MIBG scintigraphy or 18F-DA PET scanning has also been shown to be helpful in distinguishing preganglionic from postganglionic involvement and in diagnosing early stages of neurodegenerative diseases. In this chapter, we review the causes of AUD, the pathophysiology and resulting cardiovascular manifestations with emphasis on the diagnosis and treatment of OH.
Collapse
Affiliation(s)
- Martina Rafanelli
- Division of Geriatric Cardiology and Medicine, University of Florence, Florence, Italy
| | - Kathleen Walsh
- Division of Cardiovascular Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States
| | - Mohamed H Hamdan
- Division of Cardiovascular Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States
| | - Laura Buyan-Dent
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States.
| |
Collapse
|
176
|
Balagny P, Wanono R, d'Ortho MP, Vidal-Petiot E. Reply to validation of the new diagnostic tests for neurogenic orthostatic hypotension. Ann Neurol 2018; 84:957-958. [DOI: 10.1002/ana.25363] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Accepted: 09/04/2018] [Indexed: 11/11/2022]
Affiliation(s)
- Pauline Balagny
- Physiology Department; Bichat Hospital, Assistance Publique-Hôpitaux de Paris
- Paris Diderot University, Sorbonne Paris Cité
| | - Ruben Wanono
- Physiology Department; Bichat Hospital, Assistance Publique-Hôpitaux de Paris
- Paris Diderot University, Sorbonne Paris Cité
| | - Marie-Pia d'Ortho
- Physiology Department; Bichat Hospital, Assistance Publique-Hôpitaux de Paris
- Paris Diderot University, Sorbonne Paris Cité
| | - Emmanuelle Vidal-Petiot
- Physiology Department; Bichat Hospital, Assistance Publique-Hôpitaux de Paris
- Paris Diderot University, Sorbonne Paris Cité
- Inserm U1149, Center for Research on Inflammation; Paris France
| |
Collapse
|
177
|
Aljohar A, Muayqil T, Aldeeri A, Jammah A, Hersi A, Alhabib K. Pure Autonomic Failure with Asymptomatic Hypertensive Urgency: A Case Report and Literature Review. Case Rep Neurol 2018; 10:357-362. [PMID: 30687067 PMCID: PMC6341310 DOI: 10.1159/000495605] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 11/19/2018] [Indexed: 11/19/2022] Open
Abstract
We report the case study of a 70-year-old gentleman who presented with isolated, slowly progressive dizziness after prolonged standing and was eventually diagnosed with pure autonomic failure. Initially, his symptoms improved with the use of midodrine and fludrocortisone, but gradually became refractory and disabling. Despite multiple therapeutic interventions, his symptoms persisted along with worsening supine hypertension. We discuss the challenges faced in the treatment of an uncommon condition and discuss the clinical utility of performing serial 24-h ambulatory monitoring to detect subclinical blood pressure fluctuations.
Collapse
Affiliation(s)
- Alwaleed Aljohar
- Department of Internal Medicine, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia
| | - Taim Muayqil
- Division of Neurology, Department of Internal Medicine, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia
| | - Abdulrahman Aldeeri
- Department of Internal Medicine, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia
| | - Anwar Jammah
- Department of Internal Medicine, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia
| | - Ahmad Hersi
- Department of Adult Cardiology, King Fahad Cardiac Center, King Saud University, Riyadh, Saudi Arabia
| | - Khalid Alhabib
- Department of Adult Cardiology, King Fahad Cardiac Center, King Saud University, Riyadh, Saudi Arabia
- *Prof. Khalid Alhabib, Department of Adult Cardiology, King Fahad Cardiac Center, King Saud University, PO Box 7805, Riyadh 11472 (Saudi Arabia), E-Mail
| |
Collapse
|
178
|
Zalewski P, Slomko J, Zawadka-Kunikowska M. Autonomic dysfunction and chronic disease. Br Med Bull 2018; 128:61-74. [PMID: 30418540 DOI: 10.1093/bmb/ldy036] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Accepted: 10/11/2018] [Indexed: 12/27/2022]
Abstract
INTRODUCTION The majority of chronic diseases are accompanied by symptoms of more or less pronounced dysautonomia, which frequently and noticeably deteriorate the quality of patients' life. SOURCES OF DATA Pubmed. AREAS OF AGREEMENT Functional disorders in the autonomic nervous system (ANS) require very precise diagnostics; frequently involving several specialists and a number of diagnostic tests. AREAS OF CONTROVERSY Dysautonomia symptoms are of a very discrete nature and may develop much earlier than symptoms specific for a given chronic disease, significantly influencing the treatment process itself. GROWING POINTS ANS dysfunctions should be considered at each stage of the diagnostic and treatment processes, as a predictor for the patient's clinical condition. AREAS TIMELY FOR DEVELOPING RESEARCH Many researchers indicate that a decrease in dysautonomia intensity has a direct effect on the progress of the underlying disease and undoubtedly contributes to the improvement of the general health condition or to symptoms remission.
Collapse
Affiliation(s)
- Pawel Zalewski
- Department of Hygiene, Epidemiology and Ergonomics, Division of Ergonomics and Exercise Physiology, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, ul. M. Sklodowskiej-Curie 9, Bydgoszcz, Poland
| | - Joanna Slomko
- Department of Hygiene, Epidemiology and Ergonomics, Division of Ergonomics and Exercise Physiology, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, ul. M. Sklodowskiej-Curie 9, Bydgoszcz, Poland
| | - Monika Zawadka-Kunikowska
- Department of Hygiene, Epidemiology and Ergonomics, Division of Ergonomics and Exercise Physiology, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, ul. M. Sklodowskiej-Curie 9, Bydgoszcz, Poland
| |
Collapse
|
179
|
Sakakibara R, Tateno F, Aiba Y, Ogata T, Kishi M, Terada H, Inaoka T, Nakatsuka T, Matsuoka K. MIBG Myocardial Scintigraphy Identifies Premotor PD/DLB During a Negative DAT Scan Period: Second Report. Mov Disord Clin Pract 2018; 6:46-50. [PMID: 30746415 DOI: 10.1002/mdc3.12697] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2018] [Revised: 09/22/2018] [Accepted: 09/25/2018] [Indexed: 12/21/2022] Open
Abstract
Objectives Neuroimaging markers for Parkinson's disease (PD)/dementia with Lewy bodies (DLB) include dopamine transporter (DAT) scanning and metaiodobenzylguanidine (MIBG) myocardial scintigraphy. It is unknown which marker is useful to identify the premotor phase PD/DLB. We reported four patients who, during a negative DAT scan period, had a positive MIBG result that suggested premotor PD/DLB. Here we report 18 additional patients. Methods This study was a prospective cohort study. The recruiting period was five years; prospective follow-up period, 5.5 ± 3.0 years; and a once a year (minimum) follow-up visit. We recruited 745 referred subjects. The inclusion criteria were having at least one of the following known PD nonmotor features: (1) autonomic: postural hypotension (pure autonomic failure [PAF]), constipation, bladder dysfunction; (2) sleep: REM sleep behavior disorder (RBD); and (3) cognitive: mild cognitive impairment or psychiatric symptoms. Also, the patient had to have undergone both DAT and MIBG tests. Results Only 18 patients fulfilled these criteria. Their characteristics were: elderly (mean age 75.5 years), with long histories (onset 61.0 years; duration 14.5 years), and predominately male (14 men, four women). The patients' neurologic diagnoses were constipation/RBD in 10, constipation/RBD/PAF in six, and constipation/PAF in two. During the follow-up period, seven patients developed PD or DLB. An abnormal MIBG result was noted in 94%, and an abnormal DAT result was noted in 56%. Conclusions MIBG has the potential to be a useful marker during the DAT scan negative period to identify premotor PD/DLB, but further studies are needed.
Collapse
Affiliation(s)
- Ryuji Sakakibara
- Neurology, Internal Medicine, Sakura Medical Center Toho University Sakura Japan
| | - Fuyuki Tateno
- Neurology, Internal Medicine, Sakura Medical Center Toho University Sakura Japan
| | - Yosuke Aiba
- Neurology, Internal Medicine, Sakura Medical Center Toho University Sakura Japan
| | - Tsuyoshi Ogata
- Neurology, Internal Medicine, Sakura Medical Center Toho University Sakura Japan
| | - Masahiko Kishi
- Neurology, Internal Medicine, Sakura Medical Center Toho University Sakura Japan
| | - Hitoshi Terada
- Radiology, Sakura Medical Center Toho University Sakura Japan
| | - Tsutomu Inaoka
- Radiology, Sakura Medical Center Toho University Sakura Japan
| | | | - Katsuyoshi Matsuoka
- Gastroenterology, Internal Medicine, Sakura Medical Center Toho University Sakura Japan
| |
Collapse
|
180
|
Cheshire WP. Chemical pharmacotherapy for the treatment of orthostatic hypotension. Expert Opin Pharmacother 2018; 20:187-199. [DOI: 10.1080/14656566.2018.1543404] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
|
181
|
Palma JA. Autonomic dysfunction in sleep disorders: introduction to the series. Clin Auton Res 2018; 28:507-508. [PMID: 30328032 DOI: 10.1007/s10286-018-0571-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Accepted: 10/11/2018] [Indexed: 12/14/2022]
Affiliation(s)
- Jose-Alberto Palma
- Department of Neurology, Dysautonomia Center, New York University School of Medicine, New York, NY, USA.
| |
Collapse
|
182
|
Palma JA, Norcliffe-Kaufmann L, Martinez J, Kaufmann H. Supine plasma NE predicts the pressor response to droxidopa in neurogenic orthostatic hypotension. Neurology 2018; 91:e1539-e1544. [PMID: 30232253 DOI: 10.1212/wnl.0000000000006369] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Accepted: 07/12/2018] [Indexed: 01/04/2023] Open
Abstract
OBJECTIVE To test whether the plasma levels of norepinephrine (NE) in patients with neurogenic orthostatic hypotension (nOH) predict their pressor response to droxidopa. METHODS This was an observational study, which included patients with nOH. All patients had standardized autonomic function testing including determination of venous plasma catecholamine levels drawn through an indwelling catheter while resting supine. This was followed by a droxidopa titration with 100 mg increments in successive days until relief of symptoms, side effects, or the maximum dose of 600 mg was reached. No response was defined as an increase of <10 mm Hg in systolic blood pressure (BP) after 3-minute standing 1 hour after droxidopa administration. Nonlinear regression models were used to determine the relationship between BP response and plasma NE levels. RESULTS We studied 20 patients with nOH due to Parkinson disease, pure autonomic failure, multiple system atrophy, or autoimmune autonomic neuropathies. Their supine plasma NE levels ranged from 44 to 850 pg/mL. Lower supine plasma NE levels were associated with greater pressor effect 1 hour after dose (R2 = 0.49) and higher standing BP (R2 = 0.45). Patients with no pressor response to droxidopa had higher NE levels (382 ± 100 vs 115 ± 20 pg/mL, p = 0.0014). A supine NE level of <219.5 pg/mL had 83% sensitivity and 93% specificity to predict a pressor response (area under the curve = 0.95, p = 0.0023). CONCLUSIONS In patients with nOH, lower supine resting plasma NE levels are associated with a greater pressor effect of droxidopa treatment. This finding should help identify patients with nOH most likely to respond to standard doses of droxidopa. CLASSIFICATION OF EVIDENCE This study provides Class I evidence that lower supine plasma NE levels accurately identify patients with nOH more likely to have a greater pressor effect from droxidopa.
Collapse
Affiliation(s)
- Jose-Alberto Palma
- From the Department of Neurology, Dysautonomia Center, New York University School of Medicine
| | - Lucy Norcliffe-Kaufmann
- From the Department of Neurology, Dysautonomia Center, New York University School of Medicine
| | - Jose Martinez
- From the Department of Neurology, Dysautonomia Center, New York University School of Medicine
| | - Horacio Kaufmann
- From the Department of Neurology, Dysautonomia Center, New York University School of Medicine.
| |
Collapse
|
183
|
Watanabe H, Riku Y, Hara K, Kawabata K, Nakamura T, Ito M, Hirayama M, Yoshida M, Katsuno M, Sobue G. Clinical and Imaging Features of Multiple System Atrophy: Challenges for an Early and Clinically Definitive Diagnosis. J Mov Disord 2018; 11:107-120. [PMID: 30086614 PMCID: PMC6182302 DOI: 10.14802/jmd.18020] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Revised: 05/08/2018] [Accepted: 05/24/2018] [Indexed: 12/13/2022] Open
Abstract
Multiple system atrophy (MSA) is an adult-onset, progressive neurodegenerative disorder. Patients with MSA show various phenotypes during the course of their illness, including parkinsonism, cerebellar ataxia, autonomic failure, and pyramidal signs. Patients with MSA sometimes present with isolated autonomic failure or motor symptoms/ signs. The median duration from onset to the concomitant appearance of motor and autonomic symptoms is approximately 2 years but can range up to 14 years. As the presence of both motor and autonomic symptoms is essential for the current diagnostic criteria, early diagnosis is difficult when patients present with isolated autonomic failure or motor symptoms/signs. In contrast, patients with MSA may show severe autonomic failure and die before the presentation of motor symptoms/signs, which are currently required for the diagnosis of MSA. Recent studies have also revealed that patients with MSA may show nonsupporting features of MSA such as dementia, hallucinations, and vertical gaze palsy. To establish early diagnostic criteria and clinically definitive categorization for the successful development of disease-modifying therapy or symptomatic interventions for MSA, research should focus on the isolated phase and atypical symptoms to develop specific clinical, imaging, and fluid biomarkers that satisfy the requirements for objectivity, for semi- or quantitative measurements, and for uncomplicated, worldwide availability. Several novel techniques, such as automated compartmentalization of the brain into multiple parcels for the quantification of gray and white matter volumes on an individual basis and the visualization of α-synuclein and other candidate serum and cerebrospinal fluid biomarkers, may be promising for the early and clinically definitive diagnosis of MSA.
Collapse
Affiliation(s)
- Hirohisa Watanabe
- Brain and Mind Research Center, Nagoya University, Nagoya, Japan
- Department of Neurology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yuichi Riku
- Department of Neurology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kazuhiro Hara
- Department of Neurology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kazuya Kawabata
- Department of Neurology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Tomohiko Nakamura
- Department of Neurology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | | | - Masaaki Hirayama
- Department of Pathophysiological Laboratory Science, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Mari Yoshida
- Institute for Medical Science of Aging, Aichi Medical University, Nagakute, Japan
| | - Masahisa Katsuno
- Department of Neurology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Gen Sobue
- Brain and Mind Research Center, Nagoya University, Nagoya, Japan
| |
Collapse
|
184
|
|
185
|
Savica R, Boeve BF, Mielke MM. Orthostatic Hypotension as a Prodromal Marker of α-Synucleinopathies-Reply. JAMA Neurol 2018; 75:1155. [PMID: 30105350 DOI: 10.1001/jamaneurol.2018.2251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Rodolfo Savica
- Department of Neurology, Mayo Clinic, Rochester, Minnesota.,Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
| | | | - Michelle M Mielke
- Department of Neurology, Mayo Clinic, Rochester, Minnesota.,Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
| |
Collapse
|
186
|
Giannini G, Calandra-Buonaura G, Asioli GM, Cecere A, Barletta G, Mignani F, Ratti S, Guaraldi P, Provini F, Cortelli P. The natural history of idiopathic autonomic failure: The IAF-BO cohort study. Neurology 2018; 91:e1245-e1254. [PMID: 30135257 DOI: 10.1212/wnl.0000000000006243] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Accepted: 06/28/2018] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To retrospectively describe clinical and instrumental features of a cohort of patients with at least a 5-year history of idiopathic autonomic failure (IAF) longitudinally evaluated at the Autonomic Unit of the University of Bologna (IAF-Bo cohort). METHODS We identified patients with at least a 5-year history of IAF who were referred to our department from 1989 to 2016 and evaluated at least once a year during the disease course. Clinical and instrumental data were collected from medical records. Clinical variables were categorized as early if presenting within 3 years from disease onset. Predictors associated with conversion to other synucleinopathies were identified in a Cox regression analysis. RESULTS The IAF-Bo cohort included 50 patients (39 male, 19 deceased at the last follow-up). At the last follow-up visit, 34 patients retained IAF phenotype (ncIAF group), while 16 developed a CNS synucleinopathy (converters group). Specific clinical and instrumental features were represented differently in the converters and ncIAF groups. The converters group showed a higher risk of death than the ncIAF group. Early onset of urinary dysfunction, early onset of REM sleep behavior disorder, and a Valsalva ratio ≥1.25 were identified as variables associated with phenoconversion. CONCLUSIONS This is one of the largest studies on the natural history of a cohort of patients with at least a 5-year history of IAF, showing a percentage of phenoconversion of 32%. We demonstrated that specific clinical and instrumental features entail an increased probability of phenoconversion. These findings could contribute to a better definition of the nature of IAF and to the identification of early markers of phenoconversion.
Collapse
Affiliation(s)
- Giulia Giannini
- From the IRCCS Institute of Neurological Sciences of Bologna (G.G., G.C.-B, A.C., G.B., F.M., F.P., P.C.); Department of Biomedical and NeuroMotor Sciences (G.G., G.C.-B., G.M.A., G.B., S.R., F.P., P.C.), Alma Mater Studiorum-University of Bologna; and Neurology Outpatient Clinic (P.G.), Department of Primary Care, Local Health Authority of Modena, Italy
| | - Giovanna Calandra-Buonaura
- From the IRCCS Institute of Neurological Sciences of Bologna (G.G., G.C.-B, A.C., G.B., F.M., F.P., P.C.); Department of Biomedical and NeuroMotor Sciences (G.G., G.C.-B., G.M.A., G.B., S.R., F.P., P.C.), Alma Mater Studiorum-University of Bologna; and Neurology Outpatient Clinic (P.G.), Department of Primary Care, Local Health Authority of Modena, Italy
| | - Gian Maria Asioli
- From the IRCCS Institute of Neurological Sciences of Bologna (G.G., G.C.-B, A.C., G.B., F.M., F.P., P.C.); Department of Biomedical and NeuroMotor Sciences (G.G., G.C.-B., G.M.A., G.B., S.R., F.P., P.C.), Alma Mater Studiorum-University of Bologna; and Neurology Outpatient Clinic (P.G.), Department of Primary Care, Local Health Authority of Modena, Italy
| | - Annagrazia Cecere
- From the IRCCS Institute of Neurological Sciences of Bologna (G.G., G.C.-B, A.C., G.B., F.M., F.P., P.C.); Department of Biomedical and NeuroMotor Sciences (G.G., G.C.-B., G.M.A., G.B., S.R., F.P., P.C.), Alma Mater Studiorum-University of Bologna; and Neurology Outpatient Clinic (P.G.), Department of Primary Care, Local Health Authority of Modena, Italy
| | - Giorgio Barletta
- From the IRCCS Institute of Neurological Sciences of Bologna (G.G., G.C.-B, A.C., G.B., F.M., F.P., P.C.); Department of Biomedical and NeuroMotor Sciences (G.G., G.C.-B., G.M.A., G.B., S.R., F.P., P.C.), Alma Mater Studiorum-University of Bologna; and Neurology Outpatient Clinic (P.G.), Department of Primary Care, Local Health Authority of Modena, Italy
| | - Francesco Mignani
- From the IRCCS Institute of Neurological Sciences of Bologna (G.G., G.C.-B, A.C., G.B., F.M., F.P., P.C.); Department of Biomedical and NeuroMotor Sciences (G.G., G.C.-B., G.M.A., G.B., S.R., F.P., P.C.), Alma Mater Studiorum-University of Bologna; and Neurology Outpatient Clinic (P.G.), Department of Primary Care, Local Health Authority of Modena, Italy
| | - Stefano Ratti
- From the IRCCS Institute of Neurological Sciences of Bologna (G.G., G.C.-B, A.C., G.B., F.M., F.P., P.C.); Department of Biomedical and NeuroMotor Sciences (G.G., G.C.-B., G.M.A., G.B., S.R., F.P., P.C.), Alma Mater Studiorum-University of Bologna; and Neurology Outpatient Clinic (P.G.), Department of Primary Care, Local Health Authority of Modena, Italy
| | - Pietro Guaraldi
- From the IRCCS Institute of Neurological Sciences of Bologna (G.G., G.C.-B, A.C., G.B., F.M., F.P., P.C.); Department of Biomedical and NeuroMotor Sciences (G.G., G.C.-B., G.M.A., G.B., S.R., F.P., P.C.), Alma Mater Studiorum-University of Bologna; and Neurology Outpatient Clinic (P.G.), Department of Primary Care, Local Health Authority of Modena, Italy
| | - Federica Provini
- From the IRCCS Institute of Neurological Sciences of Bologna (G.G., G.C.-B, A.C., G.B., F.M., F.P., P.C.); Department of Biomedical and NeuroMotor Sciences (G.G., G.C.-B., G.M.A., G.B., S.R., F.P., P.C.), Alma Mater Studiorum-University of Bologna; and Neurology Outpatient Clinic (P.G.), Department of Primary Care, Local Health Authority of Modena, Italy
| | - Pietro Cortelli
- From the IRCCS Institute of Neurological Sciences of Bologna (G.G., G.C.-B, A.C., G.B., F.M., F.P., P.C.); Department of Biomedical and NeuroMotor Sciences (G.G., G.C.-B., G.M.A., G.B., S.R., F.P., P.C.), Alma Mater Studiorum-University of Bologna; and Neurology Outpatient Clinic (P.G.), Department of Primary Care, Local Health Authority of Modena, Italy.
| |
Collapse
|
187
|
Features of autonomic dysfunction in the patients with Parkinson’s disease on the background of autoimmune pathology. Fam Med 2018. [DOI: 10.30841/2307-5112.3.2018.146693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
|
188
|
Bladder dysfunction as the initial presentation of multiple system atrophy: a prospective cohort study. Clin Auton Res 2018; 29:627-631. [DOI: 10.1007/s10286-018-0550-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Accepted: 07/16/2018] [Indexed: 10/28/2022]
|
189
|
Cutsforth-Gregory JK. Catechol neurochemistry in the autonomic clinic: helpful but not absolutely required. Clin Auton Res 2018; 28:267-268. [DOI: 10.1007/s10286-018-0533-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Accepted: 05/10/2018] [Indexed: 10/16/2022]
|
190
|
Barone DA, Henchcliffe C. Rapid eye movement sleep behavior disorder and the link to alpha-synucleinopathies. Clin Neurophysiol 2018; 129:1551-1564. [PMID: 29883833 DOI: 10.1016/j.clinph.2018.05.003] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Revised: 05/10/2018] [Accepted: 05/18/2018] [Indexed: 01/09/2023]
Abstract
Rapid eye movement (REM) sleep behavior disorder (RBD) involves REM sleep without atonia in conjunction with a recurrent nocturnal dream enactment behavior, with vocalizations such as shouting and screaming, and motor behaviors such as punching and kicking. Secondary RBD is well described in association with neurological disorders including Parkinson's disease (PD), multiple system atrophy (MSA), and other conditions involving brainstem structures such as tumors. However, RBD alone is now considered to be a potential harbinger of later development of neurodegenerative disorders, in particular PD, MSA, dementia with Lewy bodies (DLB), and pure autonomic failure. These conditions are linked by their underpinning pathology of alpha-synuclein protein aggregation. In RBD, it is therefore important to recognize the potential risk for later development of an alpha-synucleinopathy, and to investigate for other potential causes such as medications. Other signs and symptoms have been described in RBD, such as orthostatic hypotension, or depression. While it is important to recognize these features to improve patient management, they may ultimately provide clinical clues that will lead to risk stratification for phenoconversion. A critical need is to improve our ability to counsel patients, particularly with regard to prognosis. The ability to identify who, of those with RBD, is at high risk for later neurodegenerative disorders will be paramount, and would in addition advance our understanding of the prodromal stages of the alpha-synucleinopathies. Moreover, recognition of at-risk individuals for neurodegenerative disorders may ultimately provide a platform for the testing of possible neuroprotective agents for these neurodegenerative disorders.
Collapse
|
191
|
Palma JA, Mano T. Central or peripheral autonomic dysfunction in Parkinson disease: Does it matter? Neurology 2018; 90:1045-1046. [PMID: 29728530 DOI: 10.1212/wnl.0000000000005624] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Jose-Alberto Palma
- From the Department of Neurology (J.-A.P.), Dysautonomia Center, New York University School of Medicine, New York; and Gifu University of Medical Science (T.M.), Seki, Japan.
| | - Tadaaki Mano
- From the Department of Neurology (J.-A.P.), Dysautonomia Center, New York University School of Medicine, New York; and Gifu University of Medical Science (T.M.), Seki, Japan
| |
Collapse
|
192
|
Palma JA, Norcliffe-Kaufmann L, Kaufmann H. Diagnosis of multiple system atrophy. Auton Neurosci 2018; 211:15-25. [PMID: 29111419 PMCID: PMC5869112 DOI: 10.1016/j.autneu.2017.10.007] [Citation(s) in RCA: 87] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Revised: 10/19/2017] [Accepted: 10/20/2017] [Indexed: 02/08/2023]
Abstract
Multiple system atrophy (MSA) may be difficult to distinguish clinically from other disorders, particularly in the early stages of the disease. An autonomic-only presentation can be indistinguishable from pure autonomic failure. Patients presenting with parkinsonism may be misdiagnosed as having Parkinson disease. Patients presenting with the cerebellar phenotype of MSA can mimic other adult-onset ataxias due to alcohol, chemotherapeutic agents, lead, lithium, and toluene, or vitamin E deficiency, as well as paraneoplastic, autoimmune, or genetic ataxias. A careful medical history and meticulous neurological examination remain the cornerstone for the accurate diagnosis of MSA. Ancillary investigations are helpful to support the diagnosis, rule out potential mimics, and define therapeutic strategies. This review summarizes diagnostic investigations useful in the differential diagnosis of patients with suspected MSA. Currently used techniques include structural and functional brain imaging, cardiac sympathetic imaging, cardiovascular autonomic testing, olfactory testing, sleep study, urological evaluation, and dysphagia and cognitive assessments. Despite advances in the diagnostic tools for MSA in recent years and the availability of consensus criteria for clinical diagnosis, the diagnostic accuracy of MSA remains sub-optimal. As other diagnostic tools emerge, including skin biopsy, retinal biomarkers, blood and cerebrospinal fluid biomarkers, and advanced genetic testing, a more accurate and earlier recognition of MSA should be possible, even in the prodromal stages. This has important implications as misdiagnosis can result in inappropriate treatment, patient and family distress, and erroneous eligibility for clinical trials of disease-modifying drugs.
Collapse
Affiliation(s)
- Jose-Alberto Palma
- Department of Neurology, Dysautonomia Center, New York University School of Medicine, NY, USA
| | - Lucy Norcliffe-Kaufmann
- Department of Neurology, Dysautonomia Center, New York University School of Medicine, NY, USA
| | - Horacio Kaufmann
- Department of Neurology, Dysautonomia Center, New York University School of Medicine, NY, USA.
| |
Collapse
|
193
|
Norcliffe-Kaufmann L, Kaufmann H, Palma JA, Shibao CA, Biaggioni I, Peltier AC, Singer W, Low PA, Goldstein DS, Gibbons CH, Freeman R, Robertson D. Orthostatic heart rate changes in patients with autonomic failure caused by neurodegenerative synucleinopathies. Ann Neurol 2018; 83:522-531. [PMID: 29405350 PMCID: PMC5867255 DOI: 10.1002/ana.25170] [Citation(s) in RCA: 123] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Revised: 02/01/2018] [Accepted: 02/01/2018] [Indexed: 12/16/2022]
Abstract
OBJECTIVE Blunted tachycardia during hypotension is a characteristic feature of patients with autonomic failure, but the range has not been defined. This study reports the range of orthostatic heart rate (HR) changes in patients with autonomic failure caused by neurodegenerative synucleinopathies. METHODS Patients evaluated at sites of the U.S. Autonomic Consortium (NCT01799915) underwent standardized autonomic function tests and full neurological evaluation. RESULTS We identified 402 patients with orthostatic hypotension (OH) who had normal sinus rhythm. Of these, 378 had impaired sympathetic activation (ie, neurogenic OH) and based on their neurological examination were diagnosed with Parkinson disease, dementia with Lewy bodies, pure autonomic failure, or multiple system atrophy. The remaining 24 patients had preserved sympathetic activation and their OH was classified as nonneurogenic, due to volume depletion, anemia, or polypharmacy. Patients with neurogenic OH had twice the fall in systolic blood pressure (SBP; -44 ± 25 vs -21 ± 14 mmHg [mean ± standard deviation], p < 0.0001) but only one-third of the increase in HR of those with nonneurogenic OH (8 ± 8 vs 25 ± 11 beats per minute [bpm], p < 0.0001). A ΔHR/ΔSBP ratio of 0.492 bpm/mmHg had excellent sensitivity (91.3%) and specificity (88.4%) to distinguish between patients with neurogenic from nonneurogenic OH (area under the curve = 0.96, p < 0.0001). Within patients with neurogenic OH, HR increased more in those with multiple system atrophy (p = 0.0003), but there was considerable overlap with patients with Lewy body disorders. INTERPRETATION A blunted HR increase during hypotension suggests a neurogenic cause. A ΔHR/ΔSBP ratio < 0.5 bpm/mmHg is diagnostic of neurogenic OH. Ann Neurol 2018;83:522-531.
Collapse
Affiliation(s)
- Lucy Norcliffe-Kaufmann
- Department of Neurology, Dysautonomia Center, New York University School of Medicine, New York, NY
| | - Horacio Kaufmann
- Department of Neurology, Dysautonomia Center, New York University School of Medicine, New York, NY
| | - Jose-Alberto Palma
- Department of Neurology, Dysautonomia Center, New York University School of Medicine, New York, NY
| | - Cyndya A. Shibao
- Departments of Medicine and Pharmacology, Vanderbilt University Medical Center, Nashville, TN
| | - Italo Biaggioni
- Departments of Medicine and Pharmacology, Vanderbilt University Medical Center, Nashville, TN
| | - Amanda C. Peltier
- Departments of Medicine and Pharmacology, Vanderbilt University Medical Center, Nashville, TN
| | | | | | - David S. Goldstein
- Clinical Neurocardiology Section, National Institute of Neurological Disorders and Stroke, NIH, Bethesda, MD
| | - Christopher H. Gibbons
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Roy Freeman
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - David Robertson
- Departments of Medicine and Pharmacology, Vanderbilt University Medical Center, Nashville, TN
| |
Collapse
|
194
|
Palma JA, Kaufmann H. Treatment of autonomic dysfunction in Parkinson disease and other synucleinopathies. Mov Disord 2018; 33:372-390. [PMID: 29508455 PMCID: PMC5844369 DOI: 10.1002/mds.27344] [Citation(s) in RCA: 130] [Impact Index Per Article: 21.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Revised: 01/11/2018] [Accepted: 01/24/2018] [Indexed: 12/12/2022] Open
Abstract
Dysfunction of the autonomic nervous system afflicts most patients with Parkinson disease and other synucleinopathies such as dementia with Lewy bodies, multiple system atrophy, and pure autonomic failure, reducing quality of life and increasing mortality. For example, gastrointestinal dysfunction can lead to impaired drug pharmacodynamics causing a worsening in motor symptoms, and neurogenic orthostatic hypotension can cause syncope, falls, and fractures. When recognized, autonomic problems can be treated, sometimes successfully. Discontinuation of potentially causative/aggravating drugs, patient education, and nonpharmacological approaches are useful and should be tried first. Pathophysiology-based pharmacological treatments that have shown efficacy in controlled trials of patients with synucleinopathies have been approved in many countries and are key to an effective management. Here, we review the treatment of autonomic dysfunction in patients with Parkinson disease and other synucleinopathies, summarize the nonpharmacological and current pharmacological therapeutic strategies including recently approved drugs, and provide practical advice and management algorithms for clinicians, with focus on neurogenic orthostatic hypotension, supine hypertension, dysphagia, sialorrhea, gastroparesis, constipation, neurogenic overactive bladder, underactive bladder, and sexual dysfunction. © 2018 International Parkinson and Movement Disorder Society.
Collapse
Affiliation(s)
- Jose-Alberto Palma
- Department of Neurology, Dysautonomia Center, New York University School of Medicine, New York, New York, USA
| | - Horacio Kaufmann
- Department of Neurology, Dysautonomia Center, New York University School of Medicine, New York, New York, USA
| |
Collapse
|
195
|
Palma JA. Autonomic dysfunction in Parkinson's disease and other synucleinopathies: Introduction to the series. Mov Disord 2018; 33:347-348. [PMID: 29436737 PMCID: PMC5840012 DOI: 10.1002/mds.27347] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Accepted: 01/26/2018] [Indexed: 12/24/2022] Open
Affiliation(s)
- Jose-Alberto Palma
- Department of Neurology, Dysautonomia Center, New York University School of Medicine, New York
| |
Collapse
|
196
|
St Louis EK, Boeve AR, Boeve BF. REM Sleep Behavior Disorder in Parkinson's Disease and Other Synucleinopathies. Mov Disord 2018; 32:645-658. [PMID: 28513079 DOI: 10.1002/mds.27018] [Citation(s) in RCA: 106] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Revised: 03/15/2017] [Accepted: 03/16/2017] [Indexed: 12/15/2022] Open
Abstract
Rapid eye movement sleep behavior disorder is characterized by dream enactment and complex motor behaviors during rapid eye movement sleep and rapid eye movement sleep atonia loss (rapid eye movement sleep without atonia) during polysomnography. Rapid eye movement sleep behavior disorder may be idiopathic or symptomatic and in both settings is highly associated with synucleinopathy neurodegeneration, especially Parkinson's disease, dementia with Lewy bodies, multiple system atrophy, and pure autonomic failure. Rapid eye movement sleep behavior disorder frequently manifests years to decades prior to overt motor, cognitive, or autonomic impairments as the presenting manifestation of synucleinopathy, along with other subtler prodromal "soft" signs of hyposmia, constipation, and orthostatic hypotension. Between 35% and 91.9% of patients initially diagnosed with idiopathic rapid eye movement sleep behavior disorder at a sleep center later develop a defined neurodegenerative disease. Less is known about the long-term prognosis of community-dwelling younger patients, especially women, and rapid eye movement sleep behavior disorder associated with antidepressant medications. Patients with rapid eye movement sleep behavior disorder are frequently prone to sleep-related injuries and should be treated to prevent injury with either melatonin 3-12 mg or clonazepam 0.5-2.0 mg to limit injury potential. Further evidence-based studies about rapid eye movement sleep behavior disorder are greatly needed, both to enable accurate prognostic prediction of end synucleinopathy phenotypes for individual patients and to support the application of symptomatic and neuroprotective therapies. Rapid eye movement sleep behavior disorder as a prodromal synucleinopathy represents a defined time point at which neuroprotective therapies could potentially be applied for the prevention of Parkinson's disease, dementia with Lewy bodies, multiple system atrophy, and pure autonomic failure. © 2017 International Parkinson and Movement Disorder Society.
Collapse
Affiliation(s)
- Erik K St Louis
- Center for Sleep Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota, USA.,Department of Neurology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Angelica R Boeve
- Center for Sleep Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota, USA.,Department of Neurology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Bradley F Boeve
- Center for Sleep Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota, USA.,Department of Neurology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| |
Collapse
|
197
|
Cerebrospinal fluid and serum MHPG improve Alzheimer's disease versus dementia with Lewy bodies differential diagnosis. ALZHEIMER'S & DEMENTIA: DIAGNOSIS, ASSESSMENT & DISEASE MONITORING 2018; 10:172-181. [PMID: 29552632 PMCID: PMC5852321 DOI: 10.1016/j.dadm.2018.01.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Introduction Given the challenges concerning the differential diagnosis of dementia, we investigated the possible added value of monoaminergic compounds to the standard cerebrospinal fluid (CSF) Alzheimer's disease (AD) biomarkers. Particularly, regarding the AD versus dementia with Lewy bodies (DLB) comparison, monoamines or their metabolites might have added discriminative value as there is a more severe neuropathological burden in the locus coeruleus of DLB patients, the principal site of noradrenaline synthesis. Methods We applied enzyme-linked immunosorbent assay (ELISA) to analyze CSF amyloid β peptide of 42 amino acids, total tau, and tau phosphorylated at threonine 181, in patients with AD, frontotemporal dementia, DLB/Parkinson's disease dementia, and controls. Reversed-phase high-performance liquid chromatography with electrochemical detection was implemented to study monoamine and metabolite levels in CSF and serum. Stepwise forward conditional logistic regression and receiver operating characteristic (ROC) curve analyses were performed to assess the diagnostic accuracy of these newly fitted models containing the most discriminative indicators of disease status. Results Most significant differences in CSF and serum were confined to the noradrenergic system. More specifically, CSF 3-methoxy-4-hydroxyphenylglycol (MHPG) levels were higher, whereas serum MHPG levels were lower, in DLB patients compared with all other groups. Addition of CSF and serum MHPG levels to the CSF AD biomarker panel significantly increased diagnostic accuracy between DLB/Parkinson's disease dementia and AD. Interestingly, a model only including CSF and serum MHPG without the classic AD biomarker panel reached similar area under the curve values. Discussion We hypothesize that varying degrees of neuronal loss in the locus coeruleus of DLB/Parkinson's disease dementia versus AD patients result in differentially altered MHPG levels, making this metabolite a valuable biomarker.
Collapse
|
198
|
Isonaka R, Sullivan P, Jinsmaa Y, Corrales A, Goldstein DS. Spectrum of abnormalities of sympathetic tyrosine hydroxylase and alpha-synuclein in chronic autonomic failure. Clin Auton Res 2018; 28:223-230. [PMID: 29396794 DOI: 10.1007/s10286-017-0495-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Accepted: 12/19/2017] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Lewy body forms of primary chronic autonomic failure (CAF) such as incidental Lewy body disease (ILBD), Parkinson's disease (PD), and pure autonomic failure evolving into dementia with Lewy bodies (PAF+DLB) feature cardiac sympathetic denervation, whereas multiple system atrophy (MSA) in most cases does not. What links Lewy bodies with cardiac sympathetic denervation in CAF? In familial PD, abnormalities of the alpha-synuclein (AS) gene cause CAF and cardiac sympathetic denervation; and in sporadic PD, brainstem Lewy bodies contain AS co-localized with tyrosine hydroxylase (TH), a marker of catecholaminergic neurons. Cytotoxicity from AS deposition within sympathetic neurons might explain noradrenergic denervation in Lewy body forms of CAF. We used immunofluorescence microscopy (IM) to explore this possibility in sympathetic ganglia obtained at autopsy from CAF patients. METHODS Immunoreactive AS and TH were imaged in sympathetic ganglion tissue from 6 control subjects (2 with ILBD), 5 PD patients (1 with concurrent PSP), and 3 patients with CAF (2 PAF + DLB, 1 MSA). RESULTS MSA involved normal ganglionic TH and no AS deposition. In ILBD TH was variably decreased, and TH and AS were co-localized in Lewy bodies. In PD TH was substantially decreased, and TH and AS were co-localized in Lewy bodies. In PAF + DLB TH was virtually absent, but AS was present in Lewy bodies. The PD + PSP patient had AS co-localized with tau but not TH. CONCLUSIONS Sympathetic denervation and intraneuronal AS deposition are correlated across CAF syndromes, consistent with a pathogenic contribution of synucleinopathy to cardiac noradrenergic deficiency in Lewy body diseases.
Collapse
Affiliation(s)
- Risa Isonaka
- Clinical Neurocardiology Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, 10 Center Drive MSC-1620, Building 10 Room 8N260, Bethesda, MD, 20892-1620, USA
| | - Patti Sullivan
- Clinical Neurocardiology Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, 10 Center Drive MSC-1620, Building 10 Room 8N260, Bethesda, MD, 20892-1620, USA
| | - Yunden Jinsmaa
- Clinical Neurocardiology Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, 10 Center Drive MSC-1620, Building 10 Room 8N260, Bethesda, MD, 20892-1620, USA
| | - Abraham Corrales
- Clinical Neurocardiology Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, 10 Center Drive MSC-1620, Building 10 Room 8N260, Bethesda, MD, 20892-1620, USA
| | - David S Goldstein
- Clinical Neurocardiology Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, 10 Center Drive MSC-1620, Building 10 Room 8N260, Bethesda, MD, 20892-1620, USA.
| |
Collapse
|
199
|
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.
Collapse
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.
| |
Collapse
|
200
|
Autonomic dysfunction predicts poor outcome in stroke: Updates on recent autonomic research. Clin Auton Res 2018; 28:9-11. [PMID: 29305815 DOI: 10.1007/s10286-017-0498-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Accepted: 12/21/2017] [Indexed: 10/18/2022]
|