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Quan M, Gao J, Xu S, Guo D, Jia J, Wang W. Comparison of tandospirone and escitalopram as a symptomatic treatment in Multiple System Atrophy-cerebellar ataxia: An open-label, non-controlled, 4 weeks observational study. J Psychiatr Res 2023; 168:133-139. [PMID: 37907036 DOI: 10.1016/j.jpsychires.2023.10.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Revised: 07/30/2023] [Accepted: 10/14/2023] [Indexed: 11/02/2023]
Abstract
BACKGROUND Multiple system atrophy (MSA) is a neurodegenerative disorder characterized by autonomic failure and motor dysfunction in parkinsonism and/or cerebellar ataxia. Patients with MSA usually present with depression and anxiety symptoms. This observational study of patients with MSA-cerebellar subtype (MSA-C) with subthreshold depression/anxiety symptoms aimed to compare the efficacy of escitalopram oxalate (an antidepressant drug) and tandospirone citrate (an anxiolytic drug). METHODS Fifty-six MSA-C patients were included, with 28 patients in each treatment group. One group received escitalopram oxalate 10 mg/day and the other group received tandospirone citrate 30 mg/day. The patients were evaluated at baseline and after 4 weeks. Several psychiatric and neurological tests were performed, including the Hamilton Anxiety Rating Scale (HAMA), Hamilton Depression Rating Scale (HAMD), Scale for the Assessment and Rating of Ataxia (SARA), and the Scale for Outcomes in Parkinson's Disease for Autonomic Symptoms (SCOPA-AUT). Furthermore, post-void residual urine volume (PVR) and blood pressure were measured. RESULTS There was a more substantial reduction in the HAMA/HAMD, scores of stance, finger tracking, and finger nose test in the SARA, and PVR in the tandospirone group. There was a more substantial reduction in scores of dysuria, light-headed when standing up, syncope and hyperhidrosis in the SCOPA-AUT in the escitalopram group (p's < 0.05). CONCLUSIONS Tandospirone citrate was more effective in improving depression/anxiety and some cerebellar ataxia symptoms, whereas escitalopram was more effective in improving some autonomic symptoms in MSA-C patients over a short-term period in an open-label observational study without a control group. Further research is needed to evaluate the long-term effects of tandospirone and escitalopram in MSA-C in long-term placebo controlled trials.
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Affiliation(s)
- Meina Quan
- Innovation Center for Neurological Disorders and Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Jing Gao
- Innovation Center for Neurological Disorders and Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China; Department of Neurology, Chaoyang Center Hospital, Chaoyang, Liaoning, China
| | - Shuo Xu
- Innovation Center for Neurological Disorders and Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Dongmei Guo
- Innovation Center for Neurological Disorders and Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Jianping Jia
- Innovation Center for Neurological Disorders and Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Wei Wang
- Innovation Center for Neurological Disorders and Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China.
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Zhang J, Han J, Shi Z, Zhang J, Zhou Z, Liu J, Yang G, Sun Y, Gu P, Zhao P, Ma L, Gong Z, Zhao J, Liu S, Liu C, Zhai X, Shang W, Chen Z, Gan J, Ma L, Hu W, Zhu H, Ji Y. The characteristic of nonmotor symptoms with different phenotypes and onsets in multiple system atrophy patients. J Clin Neurosci 2023; 109:1-5. [PMID: 36634471 DOI: 10.1016/j.jocn.2022.12.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Revised: 11/26/2022] [Accepted: 12/13/2022] [Indexed: 01/11/2023]
Abstract
OBJECTIVES The characteristic of nonmotor symptoms in patients with multiple system atrophy (MSA) has varied among previous studies. The objective was to investigatethe nonmotor characteristics in MSA patients with different phenotypes, sex and different onset patterns. METHODS We performed a retrospective review of 1492 MSA patients. All cases were evaluatedby neurologists and assessed with motormanifestations, nonmotor symptoms, auxiliary examinationand brain MRI scans. RESULTS Multiple system atrophy-cerebellar ataxia (MSA-C) was the predominant phenotype in 998 patients. Average age of onset (56.8 ± 9.2 years) was earlier, the disease duration (2.4 ± 2.2 year) was shorter and brain MRI abnormalities (49.2 %) were more frequently in MSA-C (P < 0.001). Multiple system atrophy-parkinsonism (MSA-P) patients were more likely to have nonmotor symptoms. After adjusted significant parameters, urinary dysfunction (OR 1.441, 95 %CI = 1.067-1.946, P = 0.017), constipation (OR 1.482, 95 %CI = 1.113-1.973, P = 0.007), cognitive impairment (OR 1.509, 95 %CI = 1.074-2.121, P = 0.018) and drooling (OR 2.095, 95 %CI = 1.248-3.518, P = 0.005) were associated with the MSA-P phenotype. Males were more likely to have orthostatic hypotension, urinary dysfunction, sexual dysfunction, drooling and females in constipation and probable RBD. In different onset patterns, constipation (59.2 %) and probable RBD (28.4 %) were more frequently in autonomiconset pattern. CONCLUSIONS MSA-C is the predominant phenotype in Chinese patients, while many nonmotor symptoms are more common in MSA-P phenotype. Patients with different sex and onset patterns have different nonmotor characteristics. The different clinical features identified could help the physician counseling of MSA patients more easily and more accurately.
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Affiliation(s)
- Jinhong Zhang
- Clinical College of Neurology, Neurosurgery and Neurorehabilitation, Tianjin Medical University, Tianjin 300070, China; Department of Neurology, Cangzhou People's Hospital, Cangzhou, Hebei 061000, China
| | - Jiuyan Han
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China
| | - Zhihong Shi
- Tianjin Key Laboratory of Cerebrovascular and of Neurodegenerative Diseases, Tianjin 300350, China; Tianjin Dementia Institute, Department of Neurology, Tianjin Huan hu Hospital, Tianjin 300350, China
| | - Jiewen Zhang
- Department of Neurology, Henan Provincial People's Hospital, Zhengzhou 450003, China
| | - Zhi Zhou
- Department of Neurology, China-Japan Friendship Hospital, Beijing 100029, China
| | - Junyan Liu
- Department of Neurology, Hebei Medical University Third Affiliated Hospital, Shijiazhuang, Hebei 050051, China
| | - Gaiqing Yang
- Department of Neurology, Central Hospital Affiliated to Zhengzhou University, Zhengzhou, Henan 450007, China
| | - Yongan Sun
- Department of Neurology, Peking University First Hospital, Beijing 100034, China
| | - Ping Gu
- Department of Neurology, Hebei Medical University First Affiliated Hospital, Shijiazhuang, Hebei 050030, China
| | - Ping Zhao
- Department of Neurology, Second Hospital of Tianjin Medical University, Tianjin 300211, China
| | - Lili Ma
- Department of Neurology Ward 3, Kaifeng Central Hospital, Kaifeng, Henan 475001, China
| | - Zhongying Gong
- Department of Neurology, Tianjin First Central Hospital, Tianjin 300190, China
| | - Jingxia Zhao
- Department of Neurology, Hebei Medical University Fourth Affiliated Hospital and Hebei Provincial Tumor Hospital, Shijiazhuang, Hebei 050011, China
| | - Shuai Liu
- Tianjin Key Laboratory of Cerebrovascular and of Neurodegenerative Diseases, Tianjin 300350, China; Tianjin Dementia Institute, Department of Neurology, Tianjin Huan hu Hospital, Tianjin 300350, China
| | - Chunyan Liu
- Department of Neurology, Beijing Aerospace General Hospital, Beijing 100012, China
| | - Xiaoyan Zhai
- Department of Neurology, Hebei General Hospital, Shijiazhuang, Hebei 050051, China
| | - Wanyu Shang
- Department of Neurology, Second Affiliated Hospital of Hebei, Shi Jiazhuang, Hebei 050000, China
| | - Zhichao Chen
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China
| | - Jinghuan Gan
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China
| | - Lingyun Ma
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China
| | - Wenzheng Hu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China
| | - Hongcan Zhu
- Department of Neurology, Zhengzhou University First Affiliated Hospital, Zhengzhou, Henan 450052, China.
| | - Yong Ji
- Clinical College of Neurology, Neurosurgery and Neurorehabilitation, Tianjin Medical University, Tianjin 300070, China; Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China; Tianjin Key Laboratory of Cerebrovascular and of Neurodegenerative Diseases, Tianjin Dementia Institute, Department of Neurology, Tianjin Huan hu Hospital, Tianjin 300350, China.
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Choi W, Cha KH, Park H, Huh S, Ko SH, Shin YI, Min JH. Urodynamic Study in Multiple System Atrophy: A Retrospective Observational Study. BRAIN & NEUROREHABILITATION 2023; 16:e7. [PMID: 37033007 PMCID: PMC10079477 DOI: 10.12786/bn.2023.16.e7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 03/15/2023] [Accepted: 03/17/2023] [Indexed: 04/05/2023] Open
Abstract
This retrospective study aimed to evaluate the characteristics of neurogenic bladder in patients with multiple systemic atrophy and distinguish between cerebellar and parkinsonian-type urodynamic patterns. We reviewed 19 patients diagnosed with multiple systemic atrophy with low urinary tract symptoms who underwent an urodynamic study at Pusan National University Yangsan Hospital between March 2010 and February 2022. This study did not account for the differences observed between the multiple system atrophy subtypes in the voiding phase. Urodynamic study is an effective tool to understand the complicated bladder pattern in patients with multiple system atrophy.
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Affiliation(s)
- Woosik Choi
- Department of Rehabilitation Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Kyoung-Hyeon Cha
- Department of Rehabilitation Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Haeri Park
- Department of Rehabilitation Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Sungchul Huh
- Department of Rehabilitation Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea
- Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Sung-Hwa Ko
- Department of Rehabilitation Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea
- Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
- Department of Rehabilitation Medicine, Pusan National University School of Medicine, Busan, Korea
| | - Yong-Il Shin
- Department of Rehabilitation Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea
- Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
- Department of Rehabilitation Medicine, Pusan National University School of Medicine, Busan, Korea
| | - Ji Hong Min
- Department of Rehabilitation Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea
- Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
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Lazzeri G, Franco G, Difonzo T, Carandina A, Gramegna C, Vergari M, Arienti F, Naci A, Scatà C, Monfrini E, Dias Rodrigues G, Montano N, Comi GP, Saetti MC, Tobaldini E, Di Fonzo A. Cognitive and Autonomic Dysfunction in Multiple System Atrophy Type P and C: A Comparative Study. Front Neurol 2022; 13:912820. [PMID: 35785342 PMCID: PMC9243310 DOI: 10.3389/fneur.2022.912820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 05/19/2022] [Indexed: 11/13/2022] Open
Abstract
Multiple System Atrophy (MSA) is a rare neurodegenerative disease, clinically defined by a combination of autonomic dysfunction and motor involvement, that may be predominantly extrapyramidal (MSA-P) or cerebellar (MSA-C). Although dementia is generally considered a red flag against the clinical diagnosis of MSA, in the last decade the evidence of cognitive impairment in MSA patients has been growing. Cognitive dysfunction appears to involve mainly, but not exclusively, executive functions, and may have different characteristics and progression in the two subtypes of the disease (i.e., MSA-P and MSA-C). Despite continued efforts, combining in-vivo imaging studies as well as pathological studies, the physiopathological bases of cognitive involvement in MSA are still unclear. In this view, the possible link between cardiovascular autonomic impairment and decreased cognitive performance, extensively investigated in PD, needs to be clarified as well. In the present study, we evaluated a cohort of 20 MSA patients (9 MSA-P, 11 MSA-C) by means of a neuropsychological battery, hemodynamic assessment (heart rate and arterial blood pressure) during rest and active standing and bedside autonomic function tests assessed by heart rate variability (HRV) parameters and sympathetic skin response (SSR) in the same experimental session. Overall, global cognitive functioning, as indicated by the MoCA score, was preserved in most patients. However, short- and long-term memory and attentional and frontal-executive functions were moderately impaired. When comparing MSA-P and MSA-C, the latter obtained lower scores in tests of executive functions and verbal memory. Conversely, no statistically significant difference in cardiovascular autonomic parameters was identified between MSA-P and MSA-C patients. In conclusion, moderate cognitive deficits, involving executive functions and memory, are present in MSA, particularly in MSA-C patients. In addition, our findings do not support the role of dysautonomia as a major driver of cognitive differences between MSA-P and MSA-C.
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Affiliation(s)
- Giulia Lazzeri
- Neurology Unit, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
- Centro Dino Ferrari, Neuroscience Section, Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Giulia Franco
- Neurology Unit, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
- Centro Dino Ferrari, Neuroscience Section, Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Teresa Difonzo
- Neurology Unit, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Angelica Carandina
- Department of Internal Medicine, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Chiara Gramegna
- PhD Program in Neuroscience, School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Maurizio Vergari
- Neurophysiology Unit, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Federica Arienti
- Neurology Unit, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
- Centro Dino Ferrari, Neuroscience Section, Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Anisa Naci
- Neurophysiology Unit, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Costanza Scatà
- Department of Internal Medicine, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
- Department of General Psychology, University of Padua, Padua, Italy
| | - Edoardo Monfrini
- Neurology Unit, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
- Centro Dino Ferrari, Neuroscience Section, Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | | | - Nicola Montano
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Giacomo P. Comi
- Neurology Unit, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
- Centro Dino Ferrari, Neuroscience Section, Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Maria Cristina Saetti
- Neurology Unit, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
- Centro Dino Ferrari, Neuroscience Section, Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Eleonora Tobaldini
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Alessio Di Fonzo
- Neurology Unit, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
- Centro Dino Ferrari, Neuroscience Section, Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
- *Correspondence: Alessio Di Fonzo
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Eschlböck S, Kiss G, Krismer F, Fanciulli A, Kaindlstorfer C, Raccagni C, Seppi K, Kiechl S, Panicker JN, Wenning GK. Urodynamic Evaluation in Multiple System Atrophy: A Retrospective Cohort Study. Mov Disord Clin Pract 2021; 8:1052-1060. [PMID: 34631941 PMCID: PMC8485589 DOI: 10.1002/mdc3.13307] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 06/13/2021] [Accepted: 06/27/2021] [Indexed: 12/19/2022] Open
Abstract
Background Urological dysfunction in patients with multiple system atrophy (MSA) is one of the main manifestations of autonomic failure. Urodynamic examination is clinically relevant since underlying pathophysiology of lower urinary tract (LUT) dysfunction can be variable. Objective Evaluation of the pathophysiology of urological symptoms and exploration of differences in urodynamic patterns of LUT dysfunction between MSA-P and MSA-C. Methods Retrospective study of patients with possible and probable MSA who were referred for urodynamic studies between 2004 and 2019. Demographic data, medical history, physical examination and urodynamic studies assessing storage and voiding dysfunction were obtained. Results Seventy-four patients were included in this study (MSA-P 64.9% n = 48; median age 62.5 (IQR 56.8-70) years). Detrusor overactivity during filling phase was noted in 58.1% (n = 43) of the patients. In the voiding phase, detrusor sphincter dyssynergia and detrusor underactivity were observed in 24.6% (n = 17) and in 62.1% (n = 41) of the patients, respectively. A postmicturition residual volume of over 100 ml was present in 71.4% (n = 50) of the patients. Comparison of MSA subtypes showed weaker detrusor contractility in MSA-P compared to MSA-C [pdetQmax 26.2 vs. 34.4 cmH20, P = 0.04]. In 56.2% (n = 41) of patients pathophysiology of LUT dysfunction was deemed to be neurogenic and consistent with the diagnosis of MSA. In 35.6% (n = 26) urodynamic pattern suggested other urological co-morbidities. Conclusion Urodynamic evaluation is an important tool to analyze the pattern of LUT dysfunction in MSA. Impaired detrusor contractility was seen more in MSA-P which needs to be investigated in further studies.
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Affiliation(s)
- Sabine Eschlböck
- Department of Neurology Medical University of Innsbruck Innsbruck Austria
| | - Gustav Kiss
- Division of Neurourology, Department of Urology Medical University of Innsbruck Innsbruck Austria
| | - Florian Krismer
- Department of Neurology Medical University of Innsbruck Innsbruck Austria
| | | | | | - Cecilia Raccagni
- Department of Neurology Medical University of Innsbruck Innsbruck Austria.,Department of Neurology Regional General Hospital Bolzano Italy
| | - Klaus Seppi
- Department of Neurology Medical University of Innsbruck Innsbruck Austria
| | - Stefan Kiechl
- Department of Neurology Medical University of Innsbruck Innsbruck Austria
| | - Jalesh N Panicker
- Department of Uro-Neurology The National Hospital for Neurology and Neurosurgery, and UCL Queen Square Institute of Neurology London United Kingdom
| | - Gregor K Wenning
- Department of Neurology Medical University of Innsbruck Innsbruck Austria
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Shin JH, Park KW, Heo KO, Chung SJ, Choo MS. Urodynamic study for distinguishing multiple system atrophy from Parkinson disease. Neurology 2019; 93:e946-e953. [PMID: 31371567 DOI: 10.1212/wnl.0000000000008053] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Accepted: 04/08/2019] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To evaluate the differences in urodynamic findings between multiple system atrophy (MSA) and Parkinson disease (PD) and to identify the differential diagnostic ability of urodynamic study. METHODS We reviewed patients with MSA or PD who underwent urodynamic studies between January 2011 and August 2018. Patients with probable MSA and PD determined by movement disorder specialists at our center were included. Patients with alleged MSA or PD from outside hospitals, atypical or secondary parkinsonism, and any history of pelvic operation or radiation therapy were excluded. RESULTS A total of 219 patients, 107 with MSA (male:female 50:57) and 112 with PD (male:female 57:55), were included. Patients with MSA had shorter disease duration and were referred for urologic evaluation earlier (p < 0.001). Detrusor overactivity and associated urine leakage were prominent in PD (p < 0.001). Patients with MSA showed lower maximal flow rate (4.0 ± 5.8 vs 9.1 ± 8.3 mL/s, p < 0.001) and larger postvoid residual (290.8 ± 196.7 vs 134.0 ± 188.1 mL, p < 0.001) with decreased compliance (44.9% vs 10.7%, p < 0.001) and impaired contractility (24.9 ± 33.8 vs 65.7 ± 51.1, p < 0.001). Postvoid residual from a pressure-flow study had the highest sensitivity and specificity (74.8% and 75.9%), followed by detrusor pressure at maximal uroflow (72.6% and 70.5%), bladder contractility index, and postvoid residual from uroflowmetry (71.0% and 70.5%, respectively). CONCLUSIONS Patients with MSA showed lower maximal flow rate, larger postvoid residual with decreased compliance, and impaired contractility, whereas patients with PD had higher incidence of detrusor overactivity and associated leakage. For differential diagnosis, postvoid residual from a pressure-flow study provided the best sensitivity and specificity. CLASSIFICATION OF EVIDENCE This study provides Class III evidence that urodynamic measures can distinguish patients with MSA from those with PD.
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Affiliation(s)
- Jung Hyun Shin
- From the Departments of Urology (J.H.S., K.O.H., M.-S.C.) and Neurology (K.W.P., S.J.C.), Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Kye Won Park
- From the Departments of Urology (J.H.S., K.O.H., M.-S.C.) and Neurology (K.W.P., S.J.C.), Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Kyeong Ok Heo
- From the Departments of Urology (J.H.S., K.O.H., M.-S.C.) and Neurology (K.W.P., S.J.C.), Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sun Ju Chung
- From the Departments of Urology (J.H.S., K.O.H., M.-S.C.) and Neurology (K.W.P., S.J.C.), Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Myung-Soo Choo
- From the Departments of Urology (J.H.S., K.O.H., M.-S.C.) and Neurology (K.W.P., S.J.C.), Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
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Yamamoto T, Yamanaka Y, Sugiyama A, Hirano S, Uchiyama T, Asahina M, Sakakibara R, Kuwabara S. The severity of motor dysfunctions and urinary dysfunction is not correlated in multiple system atrophy. J Neurol Sci 2019; 400:25-29. [PMID: 30884369 DOI: 10.1016/j.jns.2019.03.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 02/24/2019] [Accepted: 03/09/2019] [Indexed: 02/08/2023]
Abstract
OBJECTIVE Although it is well known that patients with multiple system atrophy (MSA) cerebellar dominant type (MSA-C) show severe autonomic dysfunction, the relationship between autonomic and motor dysfunction remains uncertain. Previously we reported that severe urinary voiding dysfunction is useful in differential diagnosis of MSA and other diseases. Herein, we aimed to clarify the relationship between the severity of motor dysfunctions and urinary dysfunction. METHOD This study is a retrospective review of 46 patients with MSA-C diagnosed according to Gilman's second consensus criteria. The severity of motor dysfunctions was evaluated using International Cooperative Ataxia Rating Scale (ICARS). Urinary voiding dysfunction was evaluated by measuring post-void residual (PVR). The mean duration of motor unit potentials in external anal sphincter muscles on electromyography, which represents the severity of neurodegeneration in Onuf's nucleus, was also examined. RESULTS The mean age of patients was 63.8 ± 8.2 years and mean disease duration was 3.0 ± 1.9 years. The mean ICARS score was 40.1 ± 14.7. The mean PVR was 119.1 ± 102 ml and the mean duration of motor unit potentials (MUPs) in anal sphincter electromyography was 9.2 ± 2.2 ms. The correlation coefficient between ICARS and PVR was 0.093 (p = .539), and between ICARS and mean duration of MUPs was 0.105 (p = .811). A significant positive correlation (r = 0.296, p = .005) was noted between PVR and the mean duration of MUP. CONCLUSION Motor and urinary dysfunctions were not correlated in MSA-C.
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Affiliation(s)
- Tatsuya Yamamoto
- Department of Neurology, Chiba University Graduate School of Medicine, Chiba, Japan.
| | - Yoshitaka Yamanaka
- Department of Neurology, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Atsuhiko Sugiyama
- Department of Neurology, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Shigeki Hirano
- 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, International University of Health and Welfare, Ichikawa, Japan
| | | | - Ryuji Sakakibara
- 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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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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