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Dhar N, Madhaw G, Kumar N. External Anal- and Urethral-Sphincter Electromyography for Differentiating MSA-P, PD and PSP: Using a Needle to Sort the Haystack! Ann Indian Acad Neurol 2023; 26:221-222. [PMID: 37538438 PMCID: PMC10394450 DOI: 10.4103/aian.aian_154_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 02/19/2023] [Indexed: 08/05/2023] Open
Affiliation(s)
- Nikita Dhar
- Department of Neurosciences, Alchemist Hospital, Panchkula, Haryana, India
| | - Govind Madhaw
- Department of Neurology, Centre of Neurosciences, Ranchi, Jharkhand, India
| | - Niraj Kumar
- Department of Neurology and Division of Sleep Medicine, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
- Department of Neurology, All India Institute of Medical Sciences, Bibinagar (Hyderabad Metropolitan Region), Telangana, India
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2
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Todisco M, Cosentino G, Scardina S, Fresia M, Prunetti P, Pisani A, Alfonsi E. Diagnostic and Prognostic Value of External Anal Sphincter
EMG
Patterns in Multiple System Atrophy. Mov Disord 2022; 37:1069-1074. [PMID: 35122320 PMCID: PMC9305564 DOI: 10.1002/mds.28938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 01/06/2022] [Accepted: 01/09/2022] [Indexed: 11/08/2022] Open
Abstract
Background It is debated whether external anal sphincter (EAS) electromyography can distinguish between multiple system atrophy (MSA) and Parkinson's disease (PD), whereas its usefulness for MSA prognosis is unknown. Objectives We explored the diagnostic and prognostic value and clinical correlations of EAS electromyography patterns in MSA. Methods We collected clinical data and EAS electromyography findings in 72 patients with MSA and 21 with PD. Results We identified four EAS patterns. The normal pattern was frequently observed in PD and associated with prolonged survival when identified in MSA. Abnormal patterns were predominant in MSA. The most severe pattern was associated with the highest likelihood of MSA diagnosis and with the worst prognosis in the MSA cohort. MSA patients with EAS abnormalities often showed urogenital symptoms and fecal incontinence. Conclusions The increasing severity of EAS electromyography patterns paralleled diagnostic accuracy and survival in MSA, and correlated with prevalence of bladder and bowel symptoms. © 2022 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society
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Affiliation(s)
- Massimiliano Todisco
- Translational Neurophysiology Research Unit IRCCS Mondino Foundation Pavia Italy
- Movement Disorders Research Center IRCCS Mondino Foundation Pavia Italy
- Department of Brain and Behavioral Sciences University of Pavia Pavia Italy
| | - Giuseppe Cosentino
- Translational Neurophysiology Research Unit IRCCS Mondino Foundation Pavia Italy
- Department of Brain and Behavioral Sciences University of Pavia Pavia Italy
| | - Serena Scardina
- Department of Biomedicine, Neuroscience and advanced Diagnostics (BIND) University of Palermo Palermo Italy
| | - Mauro Fresia
- Translational Neurophysiology Research Unit IRCCS Mondino Foundation Pavia Italy
| | - Paolo Prunetti
- Translational Neurophysiology Research Unit IRCCS Mondino Foundation Pavia Italy
| | - Antonio Pisani
- Movement Disorders Research Center IRCCS Mondino Foundation Pavia Italy
- Department of Brain and Behavioral Sciences University of Pavia Pavia Italy
| | - Enrico Alfonsi
- Translational Neurophysiology Research Unit IRCCS Mondino Foundation Pavia Italy
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3
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Gastrointestinal dysfunction in the synucleinopathies. Clin Auton Res 2020; 31:77-99. [PMID: 33247399 DOI: 10.1007/s10286-020-00745-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 11/04/2020] [Indexed: 12/15/2022]
Abstract
Interest in gastrointestinal dysfunction in Parkinson's disease has blossomed over the past 30 years and has generated a wealth of investigation into this non-motor aspect of the disorder, research that has encompassed its pathophysiology, its clinical features, and its impact on quality of life. The question of gastrointestinal dysfunction in the other synucleinopathies has not received nearly as much attention, but information and knowledge are growing. In this review, the current knowledge, controversies, and gaps in our understanding of the pathophysiology of gastrointestinal dysfunction in Parkinson's disease and the other synucleinopathies will be addressed, and extended focus will be directed toward the clinical problems involving saliva management, swallowing, gastric emptying, small intestinal function, and bowel function that are so problematic in these disorders.
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4
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Cao Z, Wu Y, Liu G, Jiang Y, Wang X, Wang Z, Feng T. Differential Diagnosis of Multiple System Atrophy-Parkinsonism and Parkinson's Disease Using α-Synuclein and External Anal Sphincter Electromyography. Front Neurol 2020; 11:1043. [PMID: 33041984 PMCID: PMC7527535 DOI: 10.3389/fneur.2020.01043] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 08/10/2020] [Indexed: 11/30/2022] Open
Abstract
Background and aim: Discriminating multiple system atrophy-parkinsonism (MSA-P) from Parkinson's disease (PD) is challenging. We aimed to provide a new method to make an identification between MSA-P and PD by combining biofluid marker with electrophysiology marker. Methods: The XYCQ EV Enrichment KIT was applied to extract extracellular vesicles (EVs) from saliva. The levels of α-syn which included total α-syn (α- synTotal), phosphorylated-ser129 α-syn (α-synPS129) and oligomeric α-syn (α-synOlig) in EVs of saliva were tested by new developed Electrochemiluminescence (ECL) assays. We collected multi-motor unit potential (MUP) of all participants who conducted external anal sphincter electromyography (EAS-EMG). The duration, phase, amplitude and satellite potential of EAS-EMG were analyzed. The Receiver operator characteristic (ROC) curve was adopted to analyze the diagnostic utility of α-syn in EVs of saliva, EAS-EMG for MSA-P. Results: In EVs of saliva, the α-synTotal concentrations were lower in MSA-P than PD (P = 0.003). No significant difference was shown in α-synOlig and α-synPS129. α-synTotal 4.46 pg/ng distinguished MSA-P from PD with area under the curve (AUC) 0.804. Compared with PD, the duration, phase and satellite potential of EAS-EMG in MSA-P were increased (P = 0.002, 0.008, 0.001). There was no significant difference in amplitude. ROC curve showed that the duration (AUC: 0.780), phase (AUC: 0.751), and satellite potential (AUC: 0.809) had both diagnostic value for MSA-P. The combination of α-synTotal in salivary EVs and EAS-EMG (including duration, phase and satellite potential) could efficiently make a differentiation between MSA-P and PD with sensitivity of 100% and specificity of 86%. The AUC value was 0.901. Conclusion: The study suggested the combination of α-synTotal in salivary EVs and EAS-EMG could help efficiently distinguish MSA-P from PD.
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Affiliation(s)
- Zhentang Cao
- Department of Movement Disorders, Center for Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Yufeng Wu
- Department of Laboratory Medicine, Peking University Third Hospital, Beijing, China
| | - Genliang Liu
- Department of Movement Disorders, Center for Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Ying Jiang
- Department of Movement Disorders, Center for Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Xuemei Wang
- Department of Movement Disorders, Center for Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Zhan Wang
- Department of Movement Disorders, Center for Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Tao Feng
- Department of Movement Disorders, Center for Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Parkinson's Disease Center, Beijing Institute for Brain Disorders, Capital Medical University, Beijing, China
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5
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Bianchi F, Squintani GM, Osio M, Morini A, Bana C, Ardolino G, Barbieri S, Bertolasi L, Caramelli R, Cogiamanian F, Currà A, de Scisciolo G, Foresti C, Frasca V, Frasson E, Inghilleri M, Maderna L, Motti L, Onesti E, Romano MC, Del Carro U. Neurophysiology of the pelvic floor in clinical practice: a systematic literature review. FUNCTIONAL NEUROLOGY 2018; 22:173-193. [PMID: 29306355 DOI: 10.11138/fneur/2017.32.4.173] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Neurophysiological testing of the pelvic floor is recognized as an essential tool to identify pathophysiological mechanisms of pelvic floor disorders, support clinical diagnosis, and aid in therapeutic decisions. Nevertheless, the diagnostic value of these tests in specific neurological diseases of the pelvic floor is not completely clarified. Seeking to fill this gap, the members of the Neurophysiology of the Pelvic Floor Study Group of the Italian Clinical Neurophysiology Society performed a systematic review of the literature to gather available evidence for and against the utility of neurophysiological tests. Our findings confirm the utility of some tests in specific clinical conditions [e.g. concentric needle electromyography, evaluation of sacral reflexes and of pudendal somatosensory evoked potentials (pSEPs) in cauda equina and conus medullaris lesions, and evaluation of pSEPs and perineal sympathetic skin response in spinal cord lesions], and support their use in clinical practice. Other tests, particularly those not currently supported by high-level evidence, when employed in individual patients, should be evaluated in the overall clinical context, or otherwise used for research purposes.
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Yamamoto T, Asahina M, Yamanaka Y, Uchiyama T, Hirano S, Fuse M, Koga Y, Sakakibara R, Kuwabara S. Postvoid residual predicts the diagnosis of multiple system atrophy in Parkinsonian syndrome. J Neurol Sci 2017; 381:230-234. [DOI: 10.1016/j.jns.2017.08.3262] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Revised: 08/21/2017] [Accepted: 08/30/2017] [Indexed: 11/17/2022]
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7
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Cai ZY, Niu XT, Pan J, Ni PQ, Wang X, Shao B. The value of the bulbocavernosus reflex and pudendal nerve somatosensory evoked potentials in distinguishing between multiple system atrophy and Parkinson's disease at an early stage. Acta Neurol Scand 2017; 136:195-203. [PMID: 27861715 DOI: 10.1111/ane.12710] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/24/2016] [Indexed: 01/04/2023]
Abstract
OBJECTIVES This study was designed to investigate the clinical value of the bulbocavernosus reflex (BCR) and pudendal nerve somatosensory evoked potentials (PSEPs) in the differential diagnosis between multiple system atrophy (MSA) and Parkinson's disease (PD) in early stage. MATERIALS AND METHODS A total of 31 patients with MSA, 45 patients with PD, and 60 healthy participants were included in this study. A Keypoint EMG/EP system was used for BCR and PSEP measurements. Electrophysiological parameters were collected for statistical analysis. RESULTS The BCR elicitation rates were significantly lower in the patients with MSA than in the patients with PD (P<.05). Prolonged BCR latencies were found in the MSA group compared to the PD and control groups (P<.05). Bulbocavernosus reflex latencies were significantly prolonged in patients with MSA compared with PD patients showing early urogenital symptoms (P<.05). There was no significant difference in PSEP P41 latencies among the three groups (P=.434 in males, P=.948 in females). Both BCR and PSEP amplitudes were significantly lower in the MSA/PD group than in the control group (P<.001). CONCLUSIONS Pudendal nerve damage is more severe in MSA than in PD. Prolonged BCR latency may be valuable for distinguishing between MSA and PD in the early stages. BCR and PSEP testing may also contribute to localized and qualitative diagnosis of the distribution of neurodegenerative pathologies in these two disorders.
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Affiliation(s)
- Z.-Y. Cai
- Department of Neurology; First Affiliated Hospital of Wenzhou Medical University; Wenzhou Zhejiang China
| | - X.-T. Niu
- Department of Neurology; First Affiliated Hospital of Wenzhou Medical University; Wenzhou Zhejiang China
| | - J. Pan
- Department of Neurology; First Affiliated Hospital of Wenzhou Medical University; Wenzhou Zhejiang China
| | - P.-Q. Ni
- Department of Neurology; First Affiliated Hospital of Wenzhou Medical University; Wenzhou Zhejiang China
| | - X. Wang
- Department of Neurology; First Affiliated Hospital of Wenzhou Medical University; Wenzhou Zhejiang China
| | - B. Shao
- Department of Neurology; First Affiliated Hospital of Wenzhou Medical University; Wenzhou Zhejiang China
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8
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Yamamoto T, Asahina M, Yamanaka Y, Uchiyama T, Hirano S, Fuse M, Koga Y, Sakakibara R, Kuwabara S. The Utility of Post-Void Residual Volume versus Sphincter Electromyography to Distinguish between Multiple System Atrophy and Parkinson's Disease. PLoS One 2017; 12:e0169405. [PMID: 28060892 PMCID: PMC5217958 DOI: 10.1371/journal.pone.0169405] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2016] [Accepted: 12/16/2016] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To determine the ability of sphincter electromyography (EMG) and post-void residual urine volume (PVR) during a free-flow study and a pressure-flow study (PFS) for distinguishing multiple system atrophy (MSA) from Parkinson's disease (PD). METHODS We retrospectively reviewed 241 case records; both urodynamic study and sphincter EMG were performed in patients with MSA (n = 147) and PD (n = 94). RESULTS There was a statistically significant difference (p < 0.01) in the mean PVR during the free-flow study (113.1 ± 7.5 mL in MSA and 40.4 ± 3.8 mL in PD), mean PVR during PFS (230.1 ± 12.6 mL in MSA and 71.7 ± 6.6 mL in PD), and mean duration of MUP for sphincter EMG (9.3 ± 0.1 ms in MSA and 7.7 ± 0.1 ms in PD). The area under the curve used for differentiating MSA from PD was 0.79 and 0.73 for PVR during PFS and the free-flow study, respectively. There was a mean duration of 0.69 ms for the sphincter EMG. CONCLUSIONS The present results suggested that PVR was more appropriate than sphincter EMG for differentiating MSA from PD.
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Affiliation(s)
- Tatsuya Yamamoto
- Department of Neurology, Chiba University Graduate School of Medicine, Chiba, Japan
- * E-mail:
| | - Masato Asahina
- Department of Neurology, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Yoshitaka Yamanaka
- Department of Neurology, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Tomoyuki Uchiyama
- Department of Neurology, Chiba University Graduate School of Medicine, Chiba, Japan
- Department of Neurology, Continence Center, Dokkyo Medical University, Tochigi, Japan
| | - Shigeki Hirano
- Department of Neurology, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Miki Fuse
- Department of Urology, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Yasuko Koga
- Department of Molecular Diagnosis, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Ryuji Sakakibara
- Department of Neurology, Chiba University Graduate School of Medicine, Chiba, Japan
- Neurology Division, Department of Internal Medicine, Sakura Medical Center, Toho University, Sakura, Japan
| | - Satoshi Kuwabara
- Department of Neurology, Chiba University Graduate School of Medicine, Chiba, Japan
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9
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Winge K. Lower urinary tract dysfunction in patients with parkinsonism and other neurodegenerative disorders. HANDBOOK OF CLINICAL NEUROLOGY 2015; 130:335-56. [DOI: 10.1016/b978-0-444-63247-0.00019-5] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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10
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Lin DJ, Hermann KL, Schmahmann JD. Multiple system atrophy of the cerebellar type: clinical state of the art. Mov Disord 2014; 29:294-304. [PMID: 24615754 DOI: 10.1002/mds.25847] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2013] [Revised: 12/27/2013] [Accepted: 01/27/2014] [Indexed: 01/21/2023] Open
Abstract
Multiple system atrophy (MSA) is a late-onset, sporadic neurodegenerative disorder clinically characterized by autonomic failure and either poorly levodopa-responsive parkinsonism or cerebellar ataxia. It is neuropathologically defined by widespread and abundant central nervous system α-synuclein-positive glial cytoplasmic inclusions and striatonigral and/or olivopontocerebellar neurodegeneration. There are two clinical subtypes of MSA distinguished by the predominant motor features: the parkinsonian variant (MSA-P) and the cerebellar variant (MSA-C). Despite recent progress in understanding the pathobiology of MSA, investigations into the symptomatology and natural history of the cerebellar variant of the disease have been limited. MSA-C presents a unique challenge to both clinicians and researchers alike. A key question is how to distinguish early in the disease course between MSA-C and other causes of adult-onset cerebellar ataxia. This is a particularly difficult question, because the clinical framework for conceptualizing and studying sporadic adult-onset ataxias continues to undergo flux. To date, several investigations have attempted to identify clinical features, imaging, and other biomarkers that may be predictive of MSA-C. This review presents a clinically oriented overview of our current understanding of MSA-C with a focus on evidence for distinguishing MSA-C from other sporadic, adult-onset ataxias.
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Affiliation(s)
- David J Lin
- Ataxia Unit, Laboratory for Neuroanatomy and Cerebellar Neurobiology, Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts, USA
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11
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Linder J, Libelius R, Nordh E, Holmberg B, Stenlund H, Forsgren L. Anal sphincter electromyography in patients with newly diagnosed idiopathic parkinsonism. Acta Neurol Scand 2012; 126:248-55. [PMID: 22211900 DOI: 10.1111/j.1600-0404.2011.01633.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/30/2011] [Indexed: 12/01/2022]
Abstract
OBJECTIVES The differential diagnosis of patients with idiopathic parkinsonism is difficult, especially early in the course of the disease. External anal sphincter electromyography (EAS-EMG) has been reported to be of value in the differential diagnosis between Parkinson's disease (PD) and multiple system atrophy (MSA). Patients with MSA are reported to have pathological EAS-EMG and patients with PD are reported to have significantly less pathological EAS-EMG results. Comparisons between patients with parkinsonian disorders have usually been made many years into the disease, and thus it is largely unknown if the results of EAS-EMG can be used to distinguish the different diagnoses in the early phase of the disease. MATERIALS AND METHODS We investigated 148 newly diagnosed patients with idiopathic parkinsonism from a population-based incidence cohort (100 definite PD, 21 probable PD, 16 MSA, 11 progressive supranuclear palsy, and 40 controls) with EAS-EMG within 3 months of their first visit and, in the majority of patients, before start of treatment with dopaminergic drugs. The clinical diagnoses were made using established clinical diagnostic criteria after a median follow-up of 3 years. RESULTS All patient groups had more pathological EAS-EMG results than controls. No EAS-EMG differences were found between the patient groups, especially not between PD and MSA. CONCLUSIONS External anal sphincter electromyography examination cannot separate the different parkinsonian subgroups from each other in early course of the diseases.
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Affiliation(s)
- J. Linder
- Department of Pharmacology and Clinical Neuroscience, Epidemiology and Public Health Sciences; Umeå University; Umeå; Sweden
| | - R. Libelius
- Department of Pharmacology and Clinical Neuroscience, Epidemiology and Public Health Sciences; Umeå University; Umeå; Sweden
| | - E. Nordh
- Department of Pharmacology and Clinical Neuroscience, Epidemiology and Public Health Sciences; Umeå University; Umeå; Sweden
| | - B. Holmberg
- Institute of Neuroscience and Physiology/Neurology; Göteborg University; Göteborg; Sweden
| | - H. Stenlund
- Department of Public Health and Clinical Medicine, Epidemiology and Public Health Sciences; Umeå University; Umeå; Sweden
| | - L. Forsgren
- Department of Pharmacology and Clinical Neuroscience, Epidemiology and Public Health Sciences; Umeå University; Umeå; Sweden
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12
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Yamamoto T, Sakakibara R, Uchiyama T, Yamaguchi C, Nomura F, Ito T, Yanagisawa M, Yano M, Awa Y, Yamanishi T, Hattori T, Kuwabara S. Receiver operating characteristic analysis of sphincter electromyography for parkinsonian syndrome. Neurourol Urodyn 2012; 31:1128-34. [DOI: 10.1002/nau.22208] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2011] [Accepted: 01/11/2012] [Indexed: 01/07/2023]
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13
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Fowler CJ, Dalton C, Panicker JN. Review of neurologic diseases for the urologist. Urol Clin North Am 2010; 37:517-26. [PMID: 20955903 DOI: 10.1016/j.ucl.2010.07.004] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
This article reviews the neurologic conditions associated with a high prevalence of bladder dysfunction and about which significant advances in understanding have occurred in recent years. The importance of the frontal lobes for bladder control has been confirmed through functional brain imaging, and recent findings in the elderly with incontinence suggest the problem may result from disconnection of important frontal areas caused by white matter disease. The very different urologic profile of the two sometimes-confused conditions, multiple system atrophy and Parkinson's disease, is clarified. The advances in treatments for multiple sclerosis in recent years have been remarkable and are briefly described.
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Affiliation(s)
- Clare J Fowler
- UCL Institute of Neurology and National Hospital for Neurology and Neurosurgery, UCLH, Box 71, Queen Square, London WC1N 3BG, UK.
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14
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Winge K, Jennum P, Lokkegaard A, Werdelin L. Anal sphincter EMG in the diagnosis of parkinsonian syndromes. Acta Neurol Scand 2010; 121:198-203. [PMID: 19785640 DOI: 10.1111/j.1600-0404.2009.01169.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND The role of electromyography (EMG) recorded from the external anal sphincter (EAS) in the diagnosis of atypical parkinsonian syndromes is a matter for continuous debate. Most studies addressing this issue are retrospective. METHODS In this study, we prospectively investigated six patients with Parkinson's Disease (IPD), 14 patients with multiple system atrophy (MSA) and eight with progressive supranuclear palsy (PSP) using EMG of the EAS, motor-evoked potential (MEP) to the EAS and EMG of m. gastrocnemius and nerve conduction velocity measured at the sural nerve. Patients were followed up for 2 years to secure correct diagnosis. RESULTS The mean duration of motor unit potentials (MUPs) recorded from the EAS was significantly longer in patients with MSA and PSP compared with MUPs recorded from patients with PD (P < 0.005 for both). There were no signs of diffuse loss of motor neurons or peripheral neuropathy. MEP revealed signs of supranuclear affection in patients with MSA, whereas in patients with PSP the mechanism is a focal loss of motor neurons in Onuf's nucleus. CONCLUSION Abnormal EMG of the EAS is strongly suggestive of atypical parkinsonism and the pathophysiology may be different in patients with MSA and PSP.
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Affiliation(s)
- K Winge
- Copenhagen Movement Disorders Centre, Bispebjerg University Hospital, Copenhagen NV, Denmark.
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15
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Antoniades CA, Barker RA. The search for biomarkers in Parkinson's disease: a critical review. Expert Rev Neurother 2009; 8:1841-52. [PMID: 19086880 DOI: 10.1586/14737175.8.12.1841] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Parkinson's disease (PD) is a progressive neurodegenerative disorder that primarily presents with features of bradykinesia, rigidity and tremor, and has, as part of its core pathology, the degeneration of dopaminergic neurons in the substantia nigra pars compacta. There is a great need for the development of a reliable diagnostic tool to improve promptness of diagnosis, definition of disease subtypes, and to monitor disease progression and demonstrate treatment efficacy in the case of disease modifying therapies. Current biomarkers range from objective clinical tools, to neuroimaging, to 'wet' markers involving blood and cerebrospinal fluid. To date, all candidate biomarkers for PD have failed to be developed into a clinically useful tool. Ideally, a combination of sensitive markers will be needed, not only to predict the onset of PD, but also to help in subtype classification and to follow progression. Here, we critically review various PD biomarker studies.
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Affiliation(s)
- Chrystalina A Antoniades
- Cambridge Centre for Brain Repair, Department of Clinical Neurosciences, University of Cambridge, Forvie Site, Cambridge CB22PY, UK.
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16
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Abstract
BACKGROUND It has been almost 4 decades since the descriptions of the 3 parts of multiple system atrophy (MSA) have taken place, characterized clinically by dysautonomia, parkinsonism, and cerebellar dysfunction. The discovery of a distinctive pathologic maker has finally provided the conceptual synthesis of these 3 entities into the universal designation of MSA as a distinct disease process with a complex combination of clinical presentations. Although advances have been made in terms of awareness and knowledge concerning the clinical features and pathophysiology of MSA, it remains challenging for neurologists who treat these patients to differentiate MSA from its mimics as well as providing them with effective treatment. REVIEW SUMMARY The aim of this review is to provide an overview of the advances in the knowledge of the disease, to highlight typical features useful for the recognition of its entity, and to enlist different treatment options. CONCLUSION Despite the fact that there is still no treatment modality that can alter the disease progression, a number of useful symptomatic treatment measures are available and should be offered to patients to ameliorate the nonmotor features of MSA and even the motor features that may at least transiently respond to treatment.
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17
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Sphincter EMG as a diagnostic tool in autonomic disorders. Clin Auton Res 2008; 19:20-31. [DOI: 10.1007/s10286-008-0489-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2008] [Accepted: 07/02/2008] [Indexed: 12/30/2022]
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18
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Colosimo C, Vanacore N, Bonifati V, Fabbrini G, Rum A, De Michele G, De Mari M, Bonuccelli U, Nicholl DJ, Meco G. Clinical diagnosis of multiple system atrophy: level of agreement between Quinn's criteria and the consensus conference guidelines. Acta Neurol Scand 2008. [DOI: 10.1034/j.1600-0404.2001.d01-32.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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19
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Podnar S. Neurophysiology of the neurogenic lower urinary tract disorders. Clin Neurophysiol 2007; 118:1423-37. [PMID: 17466586 DOI: 10.1016/j.clinph.2007.01.022] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2006] [Revised: 01/08/2007] [Accepted: 01/30/2007] [Indexed: 10/23/2022]
Abstract
The nervous system structures involved in the control of the lower urinary tract (LUT) are usually divided using a neuroanatomical classification system into suprapontine, pontine, spinal and sacral. In all patients with LUT symptoms, after exclusion of local causes, a nervous system disorder needs to be considered. For the diagnosis of neurogenic LUT disorders, in addition to clinical assessment, neurophysiologic testing might be useful. Imaging and other laboratory studies (e.g., cystometry) often provide relevant additional information. Neurophysiologic tests are more useful in patients with sacral compared with suprasacral disorders. Although in patients with LUT disorders external urethral sphincter (EUS) electromyography (EMG) would seem the most appropriate, anal sphincter EMG is the single most useful diagnostic test, particularly for focal sacral lesions, and atypical parkinsonism. Another clinically useful method that tests the sacral segments, and complements EMG, is the sacral (penilo/clitoro-cavernosus) reflex. Kinesiologic EMG is useful to demonstrate detrusor sphincter dyssynergia (i.e., increased EUS activity during bladder contraction), which is particularly common in spinal cord disease. Somatosensory evoked potential (SEP) and motor evoked potential (MEP) studies (cortical and lumbar) may be useful to diagnose clinically silent central lesions. MEP, in addition, seems to be very promising in research into cortical excitability. Theoretically, cortical SEP on bladder/urethra stimulation would be much more useful than pudendal SEP because it tests thin nerve afferents from the pelvic viscera. However, the utility of this technique is limited by technical difficulties, which can be partially overcome by the concomitant recording of a palmar sympathetic skin response (SSR). SSR recorded from the saddle region is also useful for testing the lumbosacral sympathetic system. Although the technique of detrusor EMG has been recently described in humans, a clinically useful test for evaluating the sacral parasympathetic system, which is crucial for LUT functioning, is still lacking.
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Affiliation(s)
- Simon Podnar
- Institute of Clinical Neurophysiology, Division of Neurology, University Medical Center Ljubljana, SI-1525 Ljubljana, Slovenia.
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Abstract
The term parkinsonian syndromes refers to a group of disorders whose clinical features overlap those of idiopathic Parkinson's disease. The four major entities include three important neurodegenerations, multiple system atrophy, progressive supranuclear palsy, and corticobasal degeneration, and a lacunar cerebrovascular disorder, vascular parkinsonism. This article reviews the epidemiology, pathology, clinical features, diagnosis, and management of these disorders.
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Affiliation(s)
- Sid Gilman
- Department of Neurology, University of Michigan, 300 North Ingalls, 3D15, Ann Arbor, MI 48109-0489, USA.
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Suchowersky O, Reich S, Perlmutter J, Zesiewicz T, Gronseth G, Weiner WJ. Practice Parameter: diagnosis and prognosis of new onset Parkinson disease (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology 2006; 66:968-75. [PMID: 16606907 DOI: 10.1212/01.wnl.0000215437.80053.d0] [Citation(s) in RCA: 161] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To define key issues in the diagnosis of Parkinson disease (PD), to define features influencing progression, and to make evidence-based recommendations. Two clinical questions were identified: 1) Which clinical features and diagnostic modalities distinguish PD from other parkinsonian syndromes? 2) Which clinical features predict rate of disease progression? METHODS Systematic review of the literature was completed. Articles were classified according to a four-tiered level of evidence scheme. Recommendations were based on the evidence. RESULTS AND CONCLUSIONS 1. Early falls, poor response to levodopa, symmetry of motor manifestations, lack of tremor, and early autonomic dysfunction are probably useful in distinguishing other parkinsonian syndromes from Parkinson disease (PD). 2. Levodopa or apomorphine challenge and olfactory testing are probably useful in distinguishing PD from other parkinsonian syndromes. 3. Predictive factors for more rapid motor progression, nursing home placement, and shorter survival time include older age at onset of PD, associated comorbidities, presentation with rigidity and bradykinesia, and decreased dopamine responsiveness. Future research into methods for earlier and more accurate diagnosis of the disease and identification and clarification of predictive factors of rapid disease progression is warranted.
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Abstract
The neurophysiological techniques currently available to evaluate anorectal disorders include concentric needle electromyography (EMG) of the external anal sphincter, anal nerve terminal motor latency (TML) measurement in response to transrectal electrical stimulation or sacral magnetic stimulation, motor evoked potentials (MEPs) of the anal sphincter to transcranial magnetic cortical stimulation, cortical recording of somatosensory evoked potentials (SEPs) to anal nerve stimulation, quantification of electrical or thermal sensory thresholds (QSTs) within the anal canal, sacral anal reflex (SAR) latency measurement in response to pudendal nerve or perianal stimulation, and perianal recording of sympathetic skin responses (SSRs). In most cases, a comprehensive approach using several tests is helpful for diagnosis: needle EMG signs of sphincter denervation or prolonged TML give evidence for anal motor nerve lesion; SEP/QST or SSR abnormalities can suggest sensory or autonomic neuropathy; and in the absence of peripheral nerve disorder, MEPs, SEPs, SSRs, and SARs can assist in demonstrating and localizing spinal or supraspinal disease. Such techniques are complementary to other methods of investigation, such as pelvic floor imaging and anorectal manometry, to establish the diagnosis and guide therapeutic management of neurogenic anorectal disorders.
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Affiliation(s)
- Jean-Pascal Lefaucheur
- Service de Physiologie, Explorations Fonctionnelles, Centre Hospitalier Universitaire Henri Mondor, 51 Avenue du Maréchal de Lattre de Tassigny, 94010 Créteil, France.
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Vodusek DB. How to diagnose MSA early: the role of sphincter EMG. J Neural Transm (Vienna) 2005; 112:1657-68. [PMID: 16284909 DOI: 10.1007/s00702-005-0377-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2005] [Accepted: 09/10/2005] [Indexed: 10/25/2022]
Abstract
Multiple system atrophy (MSA) is a degenerative disease manifesting a combination of parkinsonism, cerebellar, pyramidal, and autonomic (including urinary, sexual and anorectal) dysfunction. It is pathomorphologically defined, but lacks a definitive clinical diagnostic test. In patients with probable MSA, abnormal sphincter EMG, as compared to control subjects, has been found in the majority of patients in all the different forms of the disease in most studies, including patients who, as yet, have no urological or anorectal problems. Patients with Parkinson's disease (PD) as a rule do not show marked sphincter EMG abnormalities in the first five years of the disease. Thus, abnormal spontaneous activity or marked motor unit potential changes in sphincter muscles are helpful in distinguishing MSA from PD in the first five years after the onset of symptoms and signs, and from pure autonomic failure, as well as from cerebellar ataxias, if other causes for sphincter denervation have been ruled out. EMG does not distinguish MSA from progressive supranuclear palsy. How early in the course of MSA these abnormalities become significant enough to support diagnosis remains to be established by prospective studies.
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Affiliation(s)
- D B Vodusek
- Division of Neurology, University Medical Center, Ljubljana, Slovenia.
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25
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Hahn K, Ebersbach G. Sonographic assessment of urinary retention in multiple system atrophy and idiopathic Parkinson's disease. Mov Disord 2005; 20:1499-502. [PMID: 16037912 DOI: 10.1002/mds.20586] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Sonography of the bladder was performed before and after voluntary voiding in 20 subjects with possible/probable multiple system atrophy (MSA), 20 patients with idiopathic Parkinson's disease (PD), and 20 healthy controls. Mean residual volume was 173 ml (SD, 194) in MSA and significantly increased compared to both PD (21 ml; SD, 49) and controls (13 ml; SD, 12). Incomplete voiding (>100 ml of residual volume) was found in 11 subjects with MSA but only in 1 patient with PD. Positive predictive value of increased residual volume for MSA was 91.6% in this study, whereas negative predictive value was only 67.8. Bladder sonography is an objective, simple, and safe tool that allows one to screen for urinary retention, which is highly suggestive but incompletely sensitive for MSA. Because sonography is easily accessible and rapidly performed, it is feasible for routine assessment of atypical Parkinsonism.
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Affiliation(s)
- Kirsten Hahn
- Movement Disorder Clinic, Beelitz-Heilstätten, Germany
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26
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Gurevich TY, Groozman GB, Giladi N, Drory VE, Hausdorff JM, Korczyn AD. R-R interval variation in Parkinson's disease and multiple system atrophy. Acta Neurol Scand 2004; 109:276-9. [PMID: 15016010 DOI: 10.1111/j.1600-0404.2004.00226.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To investigate whether the cardiac R-R interval variation (RRIV) is of value in differentiating patients with Parkinson's disease (PD) from multiple system atrophy (MSA). BACKGROUND RRIV assessment is a simple procedure, reflecting mainly vagal efferent activity. Reduced RRIV was reported in MSA. METHODS RRIV at rest and after 120 s of deep breathing was assessed blindly to clinical diagnosis in 22 PD and 20 MSA patients. The results were compared with data from 23 age-matched healthy subjects. RESULTS RRIV at rest was 7.1 +/- 2.7% in PD and 9.7 +/- 7.2% in MSA, increasing after deep breathing to 11.2 +/- 6.3 and 12.3 +/- 6.6% correspondingly. The frequency of the RRIV abnormalities in the PD group (4/22, 18.2%) and MSA (6/20, 30%) were higher than among controls (P < 0.004). CONCLUSIONS RRIV, either at rest or after deep breathing, may be abnormal both in PD and MSA, but does not distinguish between these disorders.
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Affiliation(s)
- T Yu Gurevich
- Department of Neurology, Tel-Aviv Sourasky Medical Center, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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27
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Abstract
Multiple system atrophy (MSA) is a sporadic neurodegenerative disorder characterised clinically by any combination of parkinsonian, autonomic, cerebellar, or pyramidal signs and pathologically by cell loss, gliosis, and glial cytoplasmic inclusions in several CNS structures. Owing to the recent advances in its molecular pathogenesis, MSA has been firmly established as an alpha-synucleinopathy along with other neurodegenerative diseases. In parallel, the clinical recognition of MSA has improved and the recent consensus diagnostic criteria have been widely established in the research community as well as movement disorders clinics. Although the diagnosis of this disorder is largely based on clinical expertise, several investigations have been proposed in the past decade to assist in early differential diagnosis. Symptomatic therapeutic strategies are still limited; however, several candidate neuroprotective agents have entered phase II and phase III clinical trials.
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Affiliation(s)
- Gregor K Wenning
- Department of Neurology, University Hospital, A-6020 Innsbruck, Austria
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28
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Abstract
Electromyographic studies of the sphincter in patients with multiple system atrophy have shown increased duration and polyphasia of motor unit potentials. These electrophysiological markers have been used to argue for the selective degeneration of sacral motor neurons in Onuf's nucleus in patients with multiple system atrophy. Studies comparing sphincter electromyographic changes in patients with multiple system atrophy and Parkinson's disease have shown significant differences between these two patient populations. Despite the controversy surrounding this claim, recent studies using quantitative electromyographic techniques support the view that reinnervation of the anal sphincter muscles may be a useful diagnostic marker for distinguishing multiple system atrophy from Parkinson's disease. A critical review of these data is needed to assess the validity and reliability of electromyographic changes in multiple system atrophy.
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Affiliation(s)
- Frederick Nahm
- Center for Peripheral and Autonomic Nerve Disorders, Harvard Medical School, Beth Israel Deaconess Medical Center, One Deaconess Road, Palmer 111, Boston, Massachusetts 02215, USA
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Litvan I, Bhatia KP, Burn DJ, Goetz CG, Lang AE, McKeith I, Quinn N, Sethi KD, Shults C, Wenning GK. Movement Disorders Society Scientific Issues Committee report: SIC Task Force appraisal of clinical diagnostic criteria for Parkinsonian disorders. Mov Disord 2003; 18:467-86. [PMID: 12722160 DOI: 10.1002/mds.10459] [Citation(s) in RCA: 711] [Impact Index Per Article: 33.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
As there are no biological markers for the antemortem diagnosis of degenerative parkinsonian disorders, diagnosis currently relies upon the presence and progression of clinical features and confirmation depends on neuropathology. Clinicopathologic studies have shown significant false-positive and false-negative rates for diagnosing these disorders, and misdiagnosis is especially common during the early stages of these diseases. It is important to establish a set of widely accepted diagnostic criteria for these disorders that may be applied and reproduced in a blinded fashion. This review summarizes the findings of the SIC Task Force for the study of diagnostic criteria for parkinsonian disorders in the areas of Parkinson's disease, dementia with Lewy bodies, progressive supranuclear palsy, multiple system atrophy, and corticobasal degeneration. In each of these areas, diagnosis continues to rest on clinical findings and the judicious use of ancillary studies.
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Affiliation(s)
- Irene Litvan
- Movement Disorder Program, University of Louisville, KY 40205, USA.
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30
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Podnar S, Fowler CJ. Sphincter electromyography in diagnosis of multiple system atrophy: technical issues. Muscle Nerve 2003; 29:151-6. [PMID: 14694513 DOI: 10.1002/mus.10478] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Possible technical reasons for the controversy over the role of sphincter electromyography (EMG) in the diagnosis of multiple system atrophy (MSA) were analyzed. In a review of the literature, a high sensitivity (>60%) was found reported in 11 studies that included late components, and no value of the test was found in 4 studies that excluded them. This was also corroborated in a pilot study of 5 patients with probable MSA. With late components included, the mean motor unit potential (MUP) duration was prolonged in all 4 patients with an adequate single-MUP analysis sample and, with late components excluded, in 2 of 5 patients on multi-MUP analysis. At least in diagnostic EMG of MSA patients, late components should be included in the measurement of MUP duration.
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Affiliation(s)
- Simon Podnar
- Institute of Clinical Neurophysiology, University Medical Center Ljubljana, SI-1525 Ljubljana, Slovenia.
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31
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Abstract
BACKGROUND Freezing of gait (FOG) is a mysterious symptom, observed in different parkinsonian syndromes, but considered to be rare in multiple system atrophy (MSA). OBJECTIVE To assess the frequency of FOG in patients with MSA. METHOD We studied the presence of FOG in 28 patients with clinical diagnosis of MSA. 21 patients had probable MSA and 7 had possible MSA. The clinical diagnosis was based on neurological examination performed by at least two experienced movement disorders specialists as well as on the results of ancillary examinations and the course of the disease. In 22 patients MSA was predominated by parkinsonism (MSA-P) and in 6 by cerebellar signs (MSA-C). The patients' mean age was 66.8+/-10.3 years, mean disease duration 6.4+/-4.0 years and mean worst Hoehn and Yahr (H&Y) stage was 3.6+/-0.6. Presence and severity of FOG was assessed during the last office visit, by the recently validated FOG questionnaire (FOG-Q), with a maximal score of 24, while patients that received at least one point in the last four questions were classified as having FOG. Severity of FOG was determined by the sum of these last four out of six questions (maximal score is 16). FOG-Q total score reflected general function and walking ability disturbances, caused by FOG. The comparison between groups of patients was performed by way of the Mann-Whitney two-sample test and chi-square or Fisher's exact tests. Correlations between various parameters were calculated using Spearman's correlation coefficient. RESULTS Twenty-one patients were able to walk and 7 were bedridden at the time of the study. FOG appeared in a total of 75% of all MSA patients (in 82% of patients with MSA-P and in 50% patients with MSA-C). In the MSA-P group disease duration was about the same among 'freezers' and 'non-freezers', while among the MSA-C patients it was significantly shorter in the non-freezers. Mean score of the freezing subdivision of the FOG-Q was 8.2+/-5.1 for MSA-P group and 4.5+/-5.1 for MSA-C one. Mean FOG-Q total score was 9.1+/-4.0 and 6.2+/-4.6 (p>0.05) for MSA-P and MSA-C patients, respectively. CONCLUSION Freezing of gait is a common symptom in MSA, both in MSA-P and MSA-C.
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Affiliation(s)
- Tanya Gurevich
- Department of Neurology, Tel-Aviv Sourasky Medical Center (Affiliated with Sackler School of Medicine), Tel-Aviv University, 6 Weizmann Street, 64239, Tel-Aviv, Israel.
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32
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Abstract
Multiple system atrophy (MSA) is a sporadic neurodegenerative disorder that usually manifests when an individual is in his/her early fifties and progresses relentlessly with a mean survival of 9 years. Clinically, MSA is dominated by autonomic/urogenital failure which may be associated with either parkinsonism (MSA-P subtype) in 80% of cases or with cerebellar ataxia (MSA-C subtype) in 20% of cases. Pathologically, MSA is characterised by a neuronal multisystem degeneration and abnormal glial cytoplasmic inclusions containing alpha-synuclein aggregates. Autonomic and urogenital features of MSA should be identified early on because they can be treated effectively in many instances. In contrast, pharmacological treatment of motor features is often disappointing, except for a minority of patients with MSA-P who derive transient benefit from levodopa treatment. In the future, neurotransplantation may extend or improve the treatment response in MSA-P, but further preclinical evidence is required prior to clinical application. Neuroprotection strategies may slow down disease progression in MSA and the results of the first double-blind trial of riluzole (an inhibitor of glutamate release) in patients with MSA will be available in 2004.
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Affiliation(s)
- G K Wenning
- Department of Neurology, University Hospital, Innsbruck, Austria.
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Gilad R, Giladi N, Korczyn AD, Gurevich T, Sadeh M. Quantitative anal sphincter EMG in multisystem atrophy and 100 controls. J Neurol Neurosurg Psychiatry 2001; 71:596-9. [PMID: 11606668 PMCID: PMC1737580 DOI: 10.1136/jnnp.71.5.596] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To evaluate data of quantitative anal sphincter EMG in normal controls and to compare them with patients with multiple system atrophy (MSA). METHODS Quantitative anal sphincter EMG were performed on 100 normal controls and 11 patients with MSA to characterise EMG data in these two groups. RESULTS In the normal controls, there was a trend for increased motor unit potential (MUP) amplitude, duration, area, and polyphasicity with advancing age. Patients with MSA exhibited similar MUP size and fibre density. Significant differences were found only in parameters of the recruitment pattern, which were reduced in MSA, with a diminution in the number of active MUPs during rest. CONCLUSIONS These results may reflect either decreased number of motor cells in Onuf's nucleus without significant consequential reinnervation, or upper motor neuron involvement affecting the anal sphincter in MSA. They further underline the importance of comparative data for age matched controls.
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Affiliation(s)
- R Gilad
- Department of Neurology, Wolfson Medical Center, Holon 58100, Israel.
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Abstract
Dysfunction of the autonomic nervous system is an under-recognised but important aspect of the aetiological and clinical manifestation of primary degenerative dysautonomias such as multiple system atrophy (MSA) and Parkinson's disease (PD). Although the clinical presentation of dysautonomia in these two disorders may overlap, yet pathological and in vivo imaging studies suggest considerable differences. Functional imaging studies suggest that selective cardiac sympathetic denervation may occur early in PD but not in other parkinsonian syndromes. The clinical implication of this apparently disease specific peripheral dysautonomia is unknown and would be the subject of much interest in future years. Dysautonomia in degenerative disorders also affect respiration, genitourinary function and sleep. Sleep related disorders such as rapid eye movement behaviour disorder and urinary voiding dysfunction appear to precede the development of PD related symptoms while patients with sporadic ataxia have been shown to progress to develop MSA. Dysautonomia has also been recognised in other movement disorders, examples being the combination of dystonia and complex regional pain syndrome with elevated HLA-DR13 and late onset Huntington's disease presenting with dominant parkinsonism and minimal chorea. These studies have helped progress in various diagnostic and management parameters in relation to autonomic dysfunction and movement disorders.
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Affiliation(s)
- K R Chaudhuri
- Regional Movement Disorders and Autonomic Unit, Department of Neurology, King's College Hospital, London, UK.
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35
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Abstract
Multiple system atrophy (MSA) is a degenerative disease manifesting a combination of parkinsonism, cerebellar, pyramidal, and autonomic (including urinary, sexual, and anorectal) dysfunction. It is pathomorphologically defined, but lacks a definitive clinical diagnostic test. Sphincter electromyography (EMG), reflecting Onuf's nucleus degeneration, has been proposed as a helpful test; its value has been reevaluated by a critical review of the literature. In patients with probable MSA, abnormal sphincter EMG, as compared to control subjects, has been found in the majority of patients in all the different forms of the disease in most studies, including patients who, as yet, have no urological or anorectal problems. The prevalence of abnormalities in the early stages of MSA is as yet unclear. Patients with Parkinson's disease (PD) as a rule do not show severe sphincter EMG abnormalities in the early stage of the disease. Anal sphincter EMG abnormalities (abnormal spontaneous activity or motor unit potential changes three standard deviations above valid control data) distinguish MSA from PD in the first 5 years after the onset of symptoms and signs, and from pure autonomic failure, as well as from cerebellar ataxias, if other causes for sphincter denervation have been ruled out. With such criteria, the sensitivity of the method is, however, low. EMG does not distinguish MSA from progressive supranuclear palsy. Future studies should use standardized anal sphincter EMG to better compare results from different centers and precisely define the sensitivity and specificity of the method.
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Affiliation(s)
- D B Vodusek
- Institute of Clinical Neurophysiology, Division of Neurology, University Medical Center, Ljubljana, Slovenia.
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36
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Libelius R, Johansson F. Quantitative electromyography of the external anal sphincter in Parkinson's disease and multiple system atrophy. Muscle Nerve 2000; 23:1250-6. [PMID: 10918263 DOI: 10.1002/1097-4598(200008)23:8<1250::aid-mus14>3.0.co;2-w] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The distinction of multiple system atrophy (MSA) from Parkinson's disease (PD) can be difficult, especially early in the disease. In MSA degeneration of sacral anterior horn cells (Onuf's nucleus) results in denervation-reinnervation of anal and urethral sphincter muscles, which can be recognized as neurogenic electromyographic (EMG) changes of motor unit potentials. Sphincter EMG has therefore been recommended as a test for distinguishing MSA from PD. Our results confirm the presence of marked neurogenic EMG changes of the external anal sphincter muscle in patients with probable MSA compared to healthy controls. However, in patients with probable PD, our quantitative EMG data show a scatter from normal to marked neurogenic changes and the degree of EMG abnormality is correlated to the duration of the disease. Thus an abnormal sphincter EMG cannot be taken as a strong indicator of MSA rather than PD in the individual patient, especially in long-standing cases.
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Affiliation(s)
- R Libelius
- Division of Clinical Neurophysiology, Department of Pharmacology and Clinical Neuroscience, Umeå University Hospital, Sweden.
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