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Yoon H, Kwon H, Lee SU, Park E, Lee CN, Kim BJ, Kim JS, Park KW. Scale for Ocular Motor Disorders in Ataxia (SODA) in Patients with Multiple System Atrophy. CEREBELLUM (LONDON, ENGLAND) 2024; 23:1369-1376. [PMID: 38117451 DOI: 10.1007/s12311-023-01653-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/16/2023] [Indexed: 12/21/2023]
Abstract
A clinical scale fully dedicated to evaluating ocular motor abnormalities is required for now. We investigated the utility of a recently developed Scale for Ocular motor Disorders in Ataxia (SODA) in patients with multiple system atrophy (MSA). We prospectively assessed SODA in consecutive patients with MSA between August 2021 and August 2023 at the Korea University Medical Center. The results of the clinical exam-based SODA were compared with those measured using video-oculography (VOG-guided SODA). We also compared the findings with other established clinical scales targeting patients with MSA, including the Unified Multiple System Atrophy Rating Scale (UMSARS) I-II, Movement Disorder Society-Unified Parkinson's Disease Rating Scale motor part (UPDRS-III), Scale for Assessment of Rating of Ataxia (SARA), Composite Autonomic Symptom Score-31 (COMPASS-31), and Composite Autonomic Severity Score (CASS). Twenty patients were enrolled in our study (17 with cerebellar-type MSA and three with Parkinson-type MSA). Scores ranged from 1 to 14 (median [interquartile range (IQR)] = 8 [5-10]). Among the subscales, saccades had a median score of 2.5 (IQR = 1-3), followed by ocular pursuit (1 [0-1]), nystagmus (1 [0-2]), saccadic intrusions (1 [0-1]), vestibulo-ocular reflex (VOR) (0.5 [0-1]), ocular alignment (0 [0-1]), and VOR cancellation (1 [0-1]). The clinical-exam-based SODA (p = 0.020) and VOG-guided SODA (p = 0.034) positively correlated with disease duration. No correlation was found between clinical exam-based SODA and other scales. Skew deviation, gaze-evoked nystagmus, VOR cancellation, and smooth pursuit had the highest precision among the items. Ocular misalignment and spontaneous and positional nystagmus were frequently false positive and were poorly detected with clinical exam-based SODA. Six patients with repeated evaluation exhibited higher scores, along with deterioration documented on other clinical scales. The SODA can reliably predict neurodegeneration as an additional clinical surrogate in MSA.
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Affiliation(s)
- Hojin Yoon
- Department of Neurology, Korea University Medical Center, 73 Goryeodae-ro, Seongbuk-gu, Seoul, 02841, South Korea
| | - Hanim Kwon
- Department of Neurology, Korea University Ansan Hospital, Ansan, South Korea
| | - Sun-Uk Lee
- Department of Neurology, Korea University Medical Center, 73 Goryeodae-ro, Seongbuk-gu, Seoul, 02841, South Korea.
- Neurotology and Neuro-ophthalmology Laboratory, Korea University Anam Hospital, Seoul, South Korea.
| | - Euyhyun Park
- Neurotology and Neuro-ophthalmology Laboratory, Korea University Anam Hospital, Seoul, South Korea
- Department of Otorhinolaryngology-Head and Neck Surgery, Korea University College of Medicine, Seoul, South Korea
| | - Chan-Nyoung Lee
- Department of Neurology, Korea University Medical Center, 73 Goryeodae-ro, Seongbuk-gu, Seoul, 02841, South Korea
| | - Byung-Jo Kim
- Department of Neurology, Korea University Medical Center, 73 Goryeodae-ro, Seongbuk-gu, Seoul, 02841, South Korea
- BK21 FOUR Program in Learning Health Systems, Korea University, Seoul, South Korea
| | - Ji-Soo Kim
- Department of Neurology, Seoul National University College of Medicine, Seoul, South Korea
- Dizziness Center, Clinical Neuroscience Center, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Kun-Woo Park
- Department of Neurology, Korea University Medical Center, 73 Goryeodae-ro, Seongbuk-gu, Seoul, 02841, South Korea
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Stankovic I, Kuijpers M, Kaufmann H. An update on multiple system atrophy. Curr Opin Neurol 2024; 37:400-408. [PMID: 38828714 PMCID: PMC11219253 DOI: 10.1097/wco.0000000000001285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2024]
Abstract
PURPOSE OF REVIEW Multiple system atrophy (MSA) is a rapidly progressive synucleinopathy characterized by autonomic failure, parkinsonism, and cerebellar ataxia. Here, we provide an update on α-synuclein's role in MSA pathophysiology and review the new Movement Disorders Society (MDS) diagnostic criteria and the utility of α-synuclein-based biomarkers. We also highlight ongoing efforts toward clinical trial readiness and review potential disease-modifying therapies undergoing clinical trials. RECENT FINDINGS A role of urinary tract infections in triggering α-synuclein aggregation and contribution of genes implicated in oligodendroglial development have been suggested in the MSA pathophysiology. The clinically probable MSA category of the new diagnostic criteria shows improved accuracy in early disease stages. Predictors of phenoconversion from pure autonomic failure to MSA are now better defined. Alpha-synuclein strains in CSF and serum, phosphorylated α-synuclein deposits in the skin, and brain α-synuclein pathology visualized using PET ligand [18F]ACI-12589 are emerging as valuable diagnostic tools. Clinical trials in MSA investigate drugs targeting α-synuclein aggregation or preventing α-synuclein expression, along with stem cell and gene therapies to halt disease progression. SUMMARY New MSA diagnostic criteria and α-synuclein-based biomarkers may enhance diagnostic accuracy while promising therapies are in development to address disease progression.
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Affiliation(s)
- Iva Stankovic
- Neurology Clinic, University Clinical Center of Serbia, School of Medicine, University of Belgrade, Serbia
| | - Mechteld Kuijpers
- Dysautonomia Center, Langone Medical Center, New York University School of Medicine, New York, NY, USA
| | - Horacio Kaufmann
- Dysautonomia Center, Langone Medical Center, New York University School of Medicine, New York, NY, USA
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Makawita C, Ananthavarathan P, de Silva R, Malek N. A Systematic Review of the Spectrum and Prevalence of Non-motor Symptoms in Multiple System Atrophy. CEREBELLUM (LONDON, ENGLAND) 2024; 23:1642-1650. [PMID: 38227270 DOI: 10.1007/s12311-023-01642-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/28/2023] [Indexed: 01/17/2024]
Abstract
BACKGROUND Patients with Multiple System Atrophy (MSA) frequently report non-motor symptoms, and several research groups have highlighted this. OBJECTIVE We systematically searched for and reviewed papers assessing prevalence of non-motor symptoms (NMS) in MSA patients as reported in the scientific literature. METHODS We performed a systematic review of studies of subjects with MSA (involving > 10 patients) who were assessed for NMS, published in the English literature in PUBMED and EMBASE databases from 1947-2022. RESULTS 23 research papers, with data from 2648 clinically diagnosed and 171 pathologically verified cases of MSA were included, along with 238 controls. Mean age for MSA cases was 61.3 (9.2) years, mean disease duration 3.6 (2.7) years. 57.9% were male. Our analysis showed that the prevalence of cognitive issues in MSA varied widely (between 15-100%); dementia per se was uncommon, but assessment in advanced stages of MSA is impacted by unintelligible speech (which may be noted in a quarter of cases). The prevalence of depressive symptoms in MSA was between 44-88%. Sleep disturbances were reported by 17-89%, with REM-sleep behaviour disorder (RBD) rates as high as 75%. Pain was reported by 40-47% of patients: rheumatic or musculoskeletal sources of pain being commonest. Fatigue was reported by 29-60% of patients. Symptoms of autonomic failure in MSA were seen in 34-96.5% patients at baseline. CONCLUSION In routine clinical practice, NMS in MSA are under-recognised by clinicians. These impact hugely on patient quality of life and contribute to their overall morbidity. A methodical ascertainment of these complaints will address an unmet need, and lead to a more holistic approach of care for individuals with MSA.
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Affiliation(s)
- Chulika Makawita
- Department of Neurology, Essex Centre for Neurological Sciences, Queen's Hospital, Romford, Essex, RM7 0AG, UK.
| | | | - Rajith de Silva
- Department of Neurology, Essex Centre for Neurological Sciences, Queen's Hospital, Romford, Essex, RM7 0AG, UK
| | - Naveed Malek
- Department of Neurology, Essex Centre for Neurological Sciences, Queen's Hospital, Romford, Essex, RM7 0AG, UK
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Millar Vernetti P, Norcliffe-Kaufmann L, Palma JA, Biaggioni I, Shibao CA, Peltier A, Freeman R, Gibbons C, Goldstein DS, Low PA, Singer W, Coon EA, Miglis MG, Wenning GK, Fanciulli A, Vernino S, Betensky RA, Kaufmann H. Phenoconversion in pure autonomic failure: a multicentre prospective longitudinal cohort study. Brain 2024; 147:2440-2448. [PMID: 38366572 PMCID: PMC11224600 DOI: 10.1093/brain/awae033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 12/20/2023] [Accepted: 01/09/2024] [Indexed: 02/18/2024] Open
Abstract
We aimed to describe the clinical features of patients with pure autonomic failure (PAF) preceding phenoconversion that could be useful as predictive markers for advancing α-synuclein-associated neurodegeneration of the brain. Patients diagnosed with PAF were evaluated at eight centres (seven US-based and one European) and enrolled in a longitudinal observational cohort study (NCT01799915). Subjects underwent detailed assessments of motor, sleep, olfactory, cognitive and autonomic function and were followed prospectively to determine whether they developed parkinsonism or dementia for up to 10 years. We identified incident cases of Parkinson's disease (PD), dementia with Lewy bodies (DLB) or multiple system atrophy (MSA) and computed hazard ratios for phenoconversion as functions of clinical features. A total of 209 participants with PAF with a median disease duration of 6 years (IQR: 3-10) were enrolled. Of those, 149 provided follow-up information at an office or telemedicine visit. After a mean follow-up duration of 3 years, 48 (33%) participants phenoconverted (42% to PD, 35% to DLB and 23% to MSA). Faster phenoconversion from study enrolment to any diagnosis was associated with urinary and sexual dysfunction [hazard ratio (HR) 5.9, 95% confidence interval (CI): 1.6-22 and HR: 3.6, 95% CI: 1.1-12] followed by subtle motor signs (HR: 2.7, 95% CI: 1.2-6), trouble swallowing (HR 2.5, 95% CI: 1.4-4.5) and changes in speech (HR:2.4, 95% CI:1.1-4.8) at enrolment. Subjects reporting deterioration of handwriting were more likely to phenoconvert to PD (HR: 2.6, 95% CI: 1.1-5.9) and those reporting difficulty handling utensils were more likely to phenoconvert to DLB (HR: 6.8, 95% CI: 1.2-38). Patients with a younger age of PAF onset (HR: 11, 95% CI: 2.6-46), preserved olfaction (HR: 8.7, 95% CI: 1.7-45), anhidrosis (HR: 1.8, 95% CI: 1-3.1, P = 0.042) and severe urinary problems (HR 1.6, 95% CI: 1-2.5, P = 0.033) were more likely to phenoconvert to MSA. The best autonomic predictor of PD was a blunted heart rate increase during the tilt-table test (HR: 6.1, 95% CI: 1.4-26). Patients with PAF have an estimated 12% (95% CI: 9-15%) per year annual risk following study entry of phenoconverting to a manifest CNS synucleinopathy.
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Affiliation(s)
- Patricio Millar Vernetti
- Department of Neurology, New York University Grossman School of Medicine, New York, NY 10016, USA
| | - Lucy Norcliffe-Kaufmann
- Department of Neurology, New York University Grossman School of Medicine, New York, NY 10016, USA
| | - Jose-Alberto Palma
- Department of Neurology, New York University Grossman School of Medicine, New York, NY 10016, USA
| | - Italo Biaggioni
- Department of Pharmacology, Vanderbilt University, Nashville, TN 37232, USA
| | - Cyndya A Shibao
- Department of Pharmacology, Vanderbilt University, Nashville, TN 37232, USA
| | - Amanda Peltier
- Department of Pharmacology, Vanderbilt University, Nashville, TN 37232, USA
| | - Roy Freeman
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
| | - Christopher Gibbons
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
| | - David S Goldstein
- Autonomic Medicine Section, Clinical Neurosciences Program, Division of Intramural Research, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD 20892, USA
| | - Phillip A Low
- Department of Neurology, Mayo Clinic, Rochester, MN 55905, USA
| | - Wolfgang Singer
- Department of Neurology, Mayo Clinic, Rochester, MN 55905, USA
| | | | - Mitchell G Miglis
- Department of Neurology and Neurological Sciences, Stanford University, Palo Alto, CA 94304, USA
| | - Gregor K Wenning
- Department of Neurology, Medical University of Innsbruck, Innsbruck, 6020, Austria
| | - Alessandra Fanciulli
- Department of Neurology, Medical University of Innsbruck, Innsbruck, 6020, Austria
| | - Steven Vernino
- Department of Neurology, University of Texas Southwestern, Dallas, TX 75390, USA
| | - Rebecca A Betensky
- Department of Biostatistics, School of Global Public Health, New York University, New York, NY 10003, USA
| | - Horacio Kaufmann
- Department of Neurology, New York University Grossman School of Medicine, New York, NY 10016, USA
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Cámara A, Compta Y, Baixauli M, Maragall L, Pérez-Soriano A, Montagut N, Ahuir M, Ludeña E, Peri L, Fernández N, Villote S, Lopez de Los Reyes JC, Navarro-Otano J, Zaro I, Muñoz E, Buongiorno M, Caballol N, Pont-Sunyer C, Puente V, Giraldo D, Valldeoriola F, Lombraña M, Martí MJ. Pilot therapeutic education program in multiple system atrophy: Safety, quality of life and satisfaction from a national registry based longitudinal study. Parkinsonism Relat Disord 2024; 124:106993. [PMID: 38735163 DOI: 10.1016/j.parkreldis.2024.106993] [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: 03/05/2024] [Revised: 04/19/2024] [Accepted: 04/29/2024] [Indexed: 05/14/2024]
Abstract
BACKGROUND Therapeutic education programs are effective in several chronic conditions. However, evidence is lacking in multiple system atrophy (MSA). We aimed to assess efficacy and safety of a comprehensive therapeutic education program in people with MSA (PwMSA) and their caregivers. METHODS In this prospective longitudinal study we included 16 PwMSA and their main caregivers in 4 groups of 4 dyads each. The program consisted of eight 60-min interdisciplinary sessions: introduction, orthostatic hypotension, speech therapy, gait and respiratory physiotherapy, psychological support, urinary dysfunction, occupational therapy/social work. UMSARS, NMSS, PDQ39, EQ5 and Zarit scales were administered at baseline and 6 months later. After each session participants filled-out a modified EduPark satisfaction questionnaire and a Likert scale. Educational material was generated for each session after suggestions by participants. RESULTS At baseline PwMSA and caregivers were comparable in age and sex, with significant correlation between UMSARS-IV (disability) and PDQ39 (quality of life). Adherence to sessions was of 94,92 %. Total modified EduPark scores and Likert scales did not differ in PwMSA vs. caregivers, mild-moderate vs. severe-advanced cases or between genders. The significant difference in satisfaction across sessions (p = 0.03) was driven by higher scores in speech, respiratory and occupational therapy sessions. Longitudinally there was no significant worsening in any scale, nor a significant increase post-vs. pre-program in the number of consultations. CONCLUSIONS The healthcare education program in MSA was feasible, satisfactory, and safe for patients and caregivers. The educational material of the program is being forwarded to incident MSA cases attending our clinic.
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Affiliation(s)
- A Cámara
- Parkinson's Disease & Movement Disorders Unit and Hospital de Dia de Malalties Neurodegeneratives (HDMND), Neurology Service, Hospital Clínic / IDIBAPS / CIBERNED / European Reference Network for Rare Neurological Diseases (ERN-RND / Institut de Neurociències, Universitat de Barcelona, Catalonia, Spain.
| | - Y Compta
- Parkinson's Disease & Movement Disorders Unit and Hospital de Dia de Malalties Neurodegeneratives (HDMND), Neurology Service, Hospital Clínic / IDIBAPS / CIBERNED / European Reference Network for Rare Neurological Diseases (ERN-RND / Institut de Neurociències, Universitat de Barcelona, Catalonia, Spain.
| | - M Baixauli
- Urology Service. Hospital Clinic de Barcelona, Barcelona, Spain
| | - L Maragall
- Parkinson's Disease & Movement Disorders Unit and Hospital de Dia de Malalties Neurodegeneratives (HDMND), Neurology Service, Hospital Clínic / IDIBAPS / CIBERNED / European Reference Network for Rare Neurological Diseases (ERN-RND / Institut de Neurociències, Universitat de Barcelona, Catalonia, Spain
| | - A Pérez-Soriano
- Parkinson's Disease & Movement Disorders Unit and Hospital de Dia de Malalties Neurodegeneratives (HDMND), Neurology Service, Hospital Clínic / IDIBAPS / CIBERNED / European Reference Network for Rare Neurological Diseases (ERN-RND / Institut de Neurociències, Universitat de Barcelona, Catalonia, Spain
| | - N Montagut
- Parkinson's Disease & Movement Disorders Unit and Hospital de Dia de Malalties Neurodegeneratives (HDMND), Neurology Service, Hospital Clínic / IDIBAPS / CIBERNED / European Reference Network for Rare Neurological Diseases (ERN-RND / Institut de Neurociències, Universitat de Barcelona, Catalonia, Spain
| | - M Ahuir
- Psychology Unit Hospital Clinic de Barcelona, Barcelona, Spain
| | - E Ludeña
- Parkinson's Disease & Movement Disorders Unit and Hospital de Dia de Malalties Neurodegeneratives (HDMND), Neurology Service, Hospital Clínic / IDIBAPS / CIBERNED / European Reference Network for Rare Neurological Diseases (ERN-RND / Institut de Neurociències, Universitat de Barcelona, Catalonia, Spain
| | - L Peri
- Psychology Unit Hospital Clinic de Barcelona, Barcelona, Spain
| | - N Fernández
- Parkinson's Disease & Movement Disorders Unit and Hospital de Dia de Malalties Neurodegeneratives (HDMND), Neurology Service, Hospital Clínic / IDIBAPS / CIBERNED / European Reference Network for Rare Neurological Diseases (ERN-RND / Institut de Neurociències, Universitat de Barcelona, Catalonia, Spain
| | - S Villote
- Parkinson's Disease & Movement Disorders Unit and Hospital de Dia de Malalties Neurodegeneratives (HDMND), Neurology Service, Hospital Clínic / IDIBAPS / CIBERNED / European Reference Network for Rare Neurological Diseases (ERN-RND / Institut de Neurociències, Universitat de Barcelona, Catalonia, Spain
| | - J C Lopez de Los Reyes
- Parkinson's Disease & Movement Disorders Unit and Hospital de Dia de Malalties Neurodegeneratives (HDMND), Neurology Service, Hospital Clínic / IDIBAPS / CIBERNED / European Reference Network for Rare Neurological Diseases (ERN-RND / Institut de Neurociències, Universitat de Barcelona, Catalonia, Spain
| | - J Navarro-Otano
- Parkinson's Disease & Movement Disorders Unit and Hospital de Dia de Malalties Neurodegeneratives (HDMND), Neurology Service, Hospital Clínic / IDIBAPS / CIBERNED / European Reference Network for Rare Neurological Diseases (ERN-RND / Institut de Neurociències, Universitat de Barcelona, Catalonia, Spain
| | - I Zaro
- Parkinson's Disease & Movement Disorders Unit and Hospital de Dia de Malalties Neurodegeneratives (HDMND), Neurology Service, Hospital Clínic / IDIBAPS / CIBERNED / European Reference Network for Rare Neurological Diseases (ERN-RND / Institut de Neurociències, Universitat de Barcelona, Catalonia, Spain
| | - E Muñoz
- Parkinson's Disease & Movement Disorders Unit and Hospital de Dia de Malalties Neurodegeneratives (HDMND), Neurology Service, Hospital Clínic / IDIBAPS / CIBERNED / European Reference Network for Rare Neurological Diseases (ERN-RND / Institut de Neurociències, Universitat de Barcelona, Catalonia, Spain
| | | | - N Caballol
- Hospital Moisès Broggi, Sant Joan Despí, Spain
| | | | - V Puente
- Hospital del Mar, Barcelona, Spain
| | - D Giraldo
- Hospital Comarcal Sant Jaume de Calella, Spain
| | - F Valldeoriola
- Parkinson's Disease & Movement Disorders Unit and Hospital de Dia de Malalties Neurodegeneratives (HDMND), Neurology Service, Hospital Clínic / IDIBAPS / CIBERNED / European Reference Network for Rare Neurological Diseases (ERN-RND / Institut de Neurociències, Universitat de Barcelona, Catalonia, Spain
| | - M Lombraña
- Parkinson's Disease & Movement Disorders Unit and Hospital de Dia de Malalties Neurodegeneratives (HDMND), Neurology Service, Hospital Clínic / IDIBAPS / CIBERNED / European Reference Network for Rare Neurological Diseases (ERN-RND / Institut de Neurociències, Universitat de Barcelona, Catalonia, Spain
| | - M J Martí
- Parkinson's Disease & Movement Disorders Unit and Hospital de Dia de Malalties Neurodegeneratives (HDMND), Neurology Service, Hospital Clínic / IDIBAPS / CIBERNED / European Reference Network for Rare Neurological Diseases (ERN-RND / Institut de Neurociències, Universitat de Barcelona, Catalonia, Spain
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Wada T, Sugaya K, Asano Y, Nakata Y, Naito R, Kawazoe T, Saitoh Y, Bokuda K, Tobisawa S, Shimizu T, Takahashi K. Association of dysphagia severity in multiple system atrophy with the specific binding ratio on dopamine transporter SPECT. J Neurol Sci 2024; 463:123116. [PMID: 38981418 DOI: 10.1016/j.jns.2024.123116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2024] [Revised: 06/12/2024] [Accepted: 06/26/2024] [Indexed: 07/11/2024]
Abstract
OBJECTIVE Dysphagia in multiple system atrophy (MSA) is life-threatening and is caused by parkinsonism with cerebellar ataxia as a contributing factor. The present study investigated the relationship between dysphagia severity in MSA and the specific binding ratio (SBR) on dopamine transporter (DaT) SPECT using the Hyodo score, a qualitative scale for use with fiberoptic endoscopic evaluation of swallowing (FEES). METHODS Hyodo score's ability to predict aspiration during a FEES examination of 88 patients with MSA was first tested. Then the clinical characteristics, Hyodo score, and SBR of patients with either predominant parkinsonism (MSA-P; n = 11) or cerebellar ataxia (MSA-C; n = 25) who underwent FEES and DaT SPECT simultaneously were compared. RESULTS Logistic regression demonstrated that the Hyodo score was a significant predictive factor of aspiration (p = 0.003). The MSA-P group had a significantly higher Hyodo score (p = 0.026) and lower SBR (p = 0.011) than the MSA-C group while neither group demonstrated any significant difference in disease duration at the FEES examination. Linear regression demonstrated a significant, inverse correlation between the Hyodo score and SBR in the MSA-P (p = 0.044; r = -0.616) and MSA-C (p = 0.044; r = -0.406) groups. When the effect of SBR was removed by analysis of covariance, no significant difference in the Hyodo score remained between the groups. CONCLUSIONS Our results suggested an association between presynaptic changes in nigrostriatal dopaminergic neurons and dysphagia severity in MSA which largely contributes to the difference in dysphagia severity between MSA-P and MSA-C.
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Affiliation(s)
- Takahide Wada
- Department of Neurology, Tokyo Metropolitan Neurological Hospital (TMNH), Tokyo, Japan.
| | - Keizo Sugaya
- Department of Neurology, Tokyo Metropolitan Neurological Hospital (TMNH), Tokyo, Japan
| | - Yuri Asano
- Department of Neurology, Tokyo Metropolitan Neurological Hospital (TMNH), Tokyo, Japan
| | | | - Rie Naito
- Department of Neuro-otology, TMNH, Tokyo, Japan
| | - Tomoya Kawazoe
- Department of Neurology, Tokyo Metropolitan Neurological Hospital (TMNH), Tokyo, Japan
| | - Yuji Saitoh
- Department of Neurology, Tokyo Metropolitan Neurological Hospital (TMNH), Tokyo, Japan
| | - Kota Bokuda
- Department of Neurology, Tokyo Metropolitan Neurological Hospital (TMNH), Tokyo, Japan
| | - Shinsuke Tobisawa
- Department of Neurology, Tokyo Metropolitan Neurological Hospital (TMNH), Tokyo, Japan
| | - Toshio Shimizu
- Department of Neurology, Tokyo Metropolitan Neurological Hospital (TMNH), Tokyo, Japan
| | - Kazushi Takahashi
- Department of Neurology, Tokyo Metropolitan Neurological Hospital (TMNH), Tokyo, Japan
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7
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Raghavan S, Lesnick TG, Castillo AM, Reid RI, Fought AJ, Thostenson KB, Johnson Sparrman KL, Gehrking TL, Gehrking JA, Sletten DM, Low PA, Singer W, Vemuri P. White Matter Abnormalities Track Disease Progression in Multiple System Atrophy. Mov Disord Clin Pract 2024. [PMID: 38923361 DOI: 10.1002/mdc3.14147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Revised: 04/16/2024] [Accepted: 05/26/2024] [Indexed: 06/28/2024] Open
Abstract
BACKGROUND White matter (WM) abnormalities have been implicated in clinically relevant functional decline in multiple system atrophy (MSA). OBJECTIVE To identify the WM and gray matter (GM) abnormalities in MSA and assess the utility of longitudinal structural and diffusion changes as surrogate markers for tracking disease progression in MSA. METHODS Twenty-seven participants with early MSA [15 with clinically predominant cerebellar (MSA-C) and 12 with clinically predominant parkinsonian features (MSA-P)] and 14 controls were enrolled as a part of our prospective, longitudinal study of synucleinopathies. Using structural magnetic resonance imaging (MRI) and diffusion MRI (diffusion tensor and neurite orientation and dispersion density imaging), we analyzed whole and regional brain changes in these participants. We also evaluated temporal imaging trajectories based on up to three annual follow-up scans and assessed the impact of baseline diagnosis on these imaging biomarkers using mixed-effect models. RESULTS MSA patients exhibited more widespread WM changes than GM, particularly in the cerebellum and brainstem, with greater severity in MSA-C. Structural and diffusion measures in the cerebellum WM and brainstem deteriorated with disease progression. Rates of progression of these abnormalities were similar in both MSA subtypes, reflecting increasing overlap of clinical features over time. CONCLUSION WM abnormalities are core features of MSA disease progression and advance at similar rates in clinical MSA subtypes. Multimodal MRI imaging reveals novel insights into the distribution and pattern of brain abnormalities and their progression in MSA. Selected structural and diffusion measures may be useful for tracking disease progression in MSA clinical trials.
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Affiliation(s)
| | - Timothy G Lesnick
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | - Anna M Castillo
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | - Robert I Reid
- Department of Information Technology, Mayo Clinic, Rochester, MN, USA
| | - Angela J Fought
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | | | | | | | | | | | - Phillip A Low
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
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Shiina K, Tsunemi T, Hattori N. Cerebellar blood perfusion is a diagnostic, but not a prognostic, marker for parkinsonian-dominant type multiple system atrophy. Parkinsonism Relat Disord 2024; 123:106975. [PMID: 38677216 DOI: 10.1016/j.parkreldis.2024.106975] [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: 10/17/2023] [Revised: 02/13/2024] [Accepted: 04/15/2024] [Indexed: 04/29/2024]
Abstract
INTRODUCTION Multiple system atrophy (MSA) is clinically characterized by various neurological symptoms. According to the diagnostic criteria, MSA is classified into parkinsonian-dominant type (MSA-P) or cerebellar ataxia-dominant type (MSA-C) based on the predominant signs displayed. Recently, N-isopropyl-p-[123I] iodoamphetamine (123I-IMP) single-photon emission computed tomography (SPECT), a radiological examination evaluating brain perfusion, has been successful in detecting cerebellar hypoperfusion in MSA-P patients, demonstrating its utility in the early detection of cerebellar dysfunction. In this study, we further explored whether this cerebellar hypoperfusion impacts the clinical features of MSA-P, whether it is observable in patients without cerebellar symptoms, and, most importantly, whether it influences the prognosis of MSA-P. METHODS We conducted a retrospective analysis of 88 MSA patients who were admitted to our department for the last fifteen years. Clinical data were collected, and cerebellar perfusion was examined using 123I-IMP SPECT. This analysis includes the application of the three-dimensional stereotactic surface projection (3D-SSP) technique and Z-score. RESULTS Cerebellar perfusion decreased in MSA-P patients without cerebellar ataxia, compared to healthy individuals (p = 0.0017). The Receiver Operating Characteristic (ROC) curve demonstrated a moderate ability to distinguish MSA-P patients without cerebellar ataxia (MSA-Pp) from healthy controls (AUC = 0.6832). Among MSA-Pp, those exhibiting cerebellar hypoperfusion showed relatively improved neurological prognosis, although the difference was not statistically significant when compared to those with normal cerebellar perfusion. CONCLUSION Assessing cerebellar perfusion through IMP-SPECT proves valuable in detecting subclinical cerebellar dysfunction in MSA-Pp. Importantly, cerebellar hypoperfusion does not correlate with a poorer neurological prognosis.
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Affiliation(s)
- Kenta Shiina
- Department of Neurology, Juntendo University Faculty of Medicine, 2-1-1, Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Taiji Tsunemi
- Department of Neurology, Juntendo University Faculty of Medicine, 2-1-1, Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan.
| | - Nobutaka Hattori
- Department of Neurology, Juntendo University Faculty of Medicine, 2-1-1, Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
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9
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Mozzanica F, Pizzorni N, Eplite A, Ginocchio D, Colombo A, Mora G, Ambrogi F, Warnecke T, Schindler A. Swallowing Characteristics in Patients with Multiple System Atrophy Analyzed Using FEES Examination. Dysphagia 2024; 39:387-397. [PMID: 37733099 PMCID: PMC11127813 DOI: 10.1007/s00455-023-10619-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 08/14/2023] [Indexed: 09/22/2023]
Abstract
Patients with multiple system atrophy (MSA) frequently experience dysphagia but only few studies analyzed its characteristics. The aim of this study was to describe the swallowing characteristics in these patients using fiberoptic endoscopic evaluation of swallowing (FEES). In addition, the swallowing abilities in patients with predominantly cerebellar MSA (MSA-C) and predominantly parkinsonian MSA (MSA-P) were compared. Twenty-five patients with MSA (16 MSA-P and 9 MSA-C) were enrolled. Clinical data including age, sex, functional oral intake scale (FOIS) score, body mass index (BMI) and the results of the global disability-unified MSA rating scale (GD-UMSARS) were collected. Three different textures of food (liquid, semisolid, solid) were provided during FEES examination. The characteristics of dysphagia (safety, efficiency, phenotype) and laryngeal movement alterations were analyzed. Delayed pharyngeal phase (92%) and posterior oral incontinence (52%) were the phenotypes more frequently seen. Penetration was more frequent with Liquid (68%), while aspiration occurred only with Liquid (20%). Residues of ingested food were demonstrated both in the pyriform sinus and in the vallecula with all the consistencies. Vocal fold motion impairment was the laryngeal movement alteration most frequently encountered (56%). No significant differences between patients with MSA-P and MSA-C in the dysphagia characteristics and laryngeal movement alterations were found. Patients with MSA frequently experience swallowing impairment and altered laryngeal mobility. Dysphagia characteristics and laryngeal movements alterations seems to be similar in MSA-C and MSA-P.
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Affiliation(s)
- Francesco Mozzanica
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.
- IRCCS Multimedica, Ospedale San Giuseppe, Milan, Italy.
| | - Nicole Pizzorni
- Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
| | - Angelo Eplite
- Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
| | - Daniela Ginocchio
- Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
| | - Anna Colombo
- Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
| | - Gabriele Mora
- ALS Center, Istituti Clinici Scientifici Maugeri IRCCS, Milan, Italy
| | - Federico Ambrogi
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Tobias Warnecke
- Department of Neurology and Neurorehabilitation at the Klinikum Osnabrück, Academic Teaching Hospital of the Westfälische Wilhelms-University of Münster, Osnabrück, Germany
| | - Antonio Schindler
- Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
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10
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Kobylecki C, Chelban V, Goh YY, Michou E, Fumi R, Theilmann Jensen M, Mohammad R, Costantini A, Vijiaratnam N, Pavey S, Pavese N, Leigh PN, Rowe JB, Hu MT, Church A, Morris HR, Houlden H. Frequency and outcomes of gastrostomy insertion in a longitudinal cohort study of atypical parkinsonism. Eur J Neurol 2024; 31:e16258. [PMID: 38407533 PMCID: PMC11235814 DOI: 10.1111/ene.16258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 01/21/2024] [Accepted: 02/08/2024] [Indexed: 02/27/2024]
Abstract
BACKGROUND Multiple system atrophy (MSA), progressive supranuclear palsy (PSP) and corticobasal syndrome (CBS) show a high prevalence and rapid progression of dysphagia, which is associated with reduced survival. Despite this, the evidence base for gastrostomy is poor, and the optimal frequency and outcomes of this intervention are not known. We aimed to characterise the prevalence and outcomes of gastrostomy in patients with these three atypical parkinsonian disorders. METHOD We analysed data from the natural history and longitudinal cohorts of the PROSPECT-M-UK study with up to 60 months of follow-up from baseline. Survival post-gastrostomy was analysed using Kaplan-Meier survival curves. RESULTS In a total of 339 patients (mean age at symptom onset 63.3 years, mean symptom duration at baseline 4.6 years), dysphagia was present in >50% across all disease groups at baseline and showed rapid progression during follow-up. Gastrostomy was recorded as recommended in 44 (13%) and performed in 21 (6.2%; MSA 7, PSP 11, CBS 3) of the total study population. Median survival post-gastrostomy was 24 months compared with 12 months where gastrostomy was recommended but not done (p = 0.008). However, this was not significant when correcting for age and duration of symptoms at the time of procedure or recommendation. CONCLUSIONS Gastrostomy was performed relatively infrequently in this cohort despite the high prevalence of dysphagia. Survival post-gastrostomy was longer than previously reported, but further data on other outcomes and clinician and patient perspectives would help to guide use of this intervention in MSA, PSP and CBS.
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Affiliation(s)
- Christopher Kobylecki
- Division of Neuroscience, Manchester Academic Health Science CentreUniversity of ManchesterManchesterUK
- Department of Neurology, Manchester Centre for Clinical NeurosciencesNorthern Care Alliance NHS Foundation TrustSalfordUK
| | - Viorica Chelban
- Department of Neuromuscular Diseases, Queen Square Institute of NeurologyUniversity College LondonLondonUK
- Neurobiology and Medical Genetics Laboratory“Nicolae Testemitanu” State University of Medicine and PharmacyChisinauRepublic of Moldova
| | - Yee Yen Goh
- Department of Neuromuscular Diseases, Queen Square Institute of NeurologyUniversity College LondonLondonUK
| | - Emilia Michou
- Division of Diabetes, Endocrinology and GastroenterologyUniversity of ManchesterManchesterUK
- Department of Speech and Language Therapy, School of Health Rehabilitation SciencesUniversity of PatrasPatrasGreece
| | - Riona Fumi
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of NeurologyUniversity College LondonLondonUK
| | - Marte Theilmann Jensen
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of NeurologyUniversity College LondonLondonUK
| | - Rahema Mohammad
- Department of Neuromuscular Diseases, Queen Square Institute of NeurologyUniversity College LondonLondonUK
| | - Alyssa Costantini
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of NeurologyUniversity College LondonLondonUK
| | - Nirosen Vijiaratnam
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of NeurologyUniversity College LondonLondonUK
| | | | - Nicola Pavese
- Clinical Ageing Research UnitNewcastle UniversityNewcastleUK
| | - P. Nigel Leigh
- Department of NeuroscienceBrighton and Sussex Medical SchoolBrightonUK
| | - James B. Rowe
- Department of Clinical Neurosciences, Cambridge Centre for Parkinson‐Plus, Cambridge University Hospitals NHS TrustUniversity of CambridgeCambridgeUK
| | - Michele T. Hu
- Division of Neurology, Nuffield Department of Clinical NeurosciencesUniversity of OxfordOxfordUK
| | | | - Huw R. Morris
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of NeurologyUniversity College LondonLondonUK
| | - Henry Houlden
- Department of Neuromuscular Diseases, Queen Square Institute of NeurologyUniversity College LondonLondonUK
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11
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Shi C, Guo G, Wang W, Yu H, Fan H, Wu P, Song P, Gong D. Impaired glymphatic clearance in multiple system atrophy: A diffusion spectrum imaging study. Parkinsonism Relat Disord 2024; 123:106950. [PMID: 38555791 DOI: 10.1016/j.parkreldis.2024.106950] [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: 11/30/2023] [Revised: 02/17/2024] [Accepted: 03/23/2024] [Indexed: 04/02/2024]
Abstract
INTRODUCTION Impaired α-synuclein clearance is pivotal in the pathogenesis of neurodegenerative diseases. We evaluated glymphatic clearance in multiple system atrophy (MSA) patients using advanced imaging. METHODS Forty-four MSA patients (11 with MSA-parkinsonian type [MSA-P] and 33 with MSA-cerebellar type [MSA-C]) and 30 healthy controls were studied using diffusion spectrum magnetic resonance imaging (DSI-MRI). Diffusivities were measured along the x-, y-, and z-axes to calculate the Analysis Along the Perivascular Space (ALPS) index. Comparisons of the ALPS index were conducted between MSA patients and controls and among MSA subtypes. The ALPS index correlation with the Unified Multiple System Atrophy Rating Scale (UMSARS) scores was also analyzed. RESULTS The ALPS index differed significantly between patients with MSA and healthy controls, with lower values observed in the former (1.46 ± 0.17 versus1.63 ± 0.12, p < 0.001). Both MSA-P and MSA-C patients had lower ALPS-index (1.40 ± 0.13, p < 0.001; 1.47 ± 0.18, p = 0.003, respectively), but there was no significant difference between the two (p = 0.22). No correlation was found between the ALPS index and clinical scores for UMASRS I (r = -0.08, p = 0.61), UMASRS II (r = -0.04, p = 0.81), or UMASRS I + II (r = -0.05, p = 0.74). CONCLUSION MSA patients show reduced glymphatic clearance as measured by the ALPS index, underscoring the utility of this imaging method in neurodegenerative disease research.
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Affiliation(s)
- Chuanying Shi
- Department of Radiology, Liaocheng People's Hospital, Liaocheng, China.
| | - Guifang Guo
- Department of Radiology, Liaocheng People's Hospital, Liaocheng, China
| | - Weifei Wang
- Department of Neurology, Liaocheng People's Hospital, Liaocheng, China
| | - Haiyan Yu
- Department of Neurology, Liaocheng People's Hospital, Liaocheng, China
| | - Hua Fan
- Department of Radiology, Liaocheng People's Hospital, Liaocheng, China
| | - Peng Wu
- Philips Healthcare, Shanghai, 200072, China
| | - Peiji Song
- Department of Radiology, Jinan Central Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Dianrong Gong
- Department of Neurology, Liaocheng People's Hospital, Liaocheng, China
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12
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Pasquini J, Firbank MJ, Best L, Foster V, Galley D, Silani V, Ceravolo R, Petrides G, Brooks DJ, Anderson KN, Pavese N. Hypothalamic involvement in multiple system atrophy: A structural MRI study. J Neurol Sci 2024; 460:122985. [PMID: 38581741 DOI: 10.1016/j.jns.2024.122985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 03/15/2024] [Accepted: 03/31/2024] [Indexed: 04/08/2024]
Abstract
OBJECTIVE To investigate hypothalamic atrophy and its clinical correlates in multiple system atrophy (MSA) in-vivo. BACKGROUND MSA is characterized by autonomic dysfunction and parkinsonian/cerebellar manifestations. The hypothalamus regulates autonomic and homeostatic functions and is also involved in memory and learning processes. METHODS 11 MSA, 18 Parkinson's Disease (PD) and 18 Healthy Controls (HC) were included in this study. A validated and automated hypothalamic segmentation tool was applied to 3D-T1-weighted images acquired on a 3T MRI scanner. MSA hypothalamic volumes were compared to those of PD and HC. Furthermore, the association between hypothalamic volumes and scores of autonomic, depressive, sleep and cognitive manifestations were investigated. RESULTS Posterior hypothalamus volume was reduced in MSA compared to controls (t = 2.105, p = 0.041) and PD (t = 2.055, p = 0.046). Total hypothalamus showed a trend towards a reduction in MSA vs controls (t = 1.676, p = 0.101). Reduced posterior hypothalamus volume correlated with worse MoCA scores in the parkinsonian (MSA + PD) group and in each group separately, but not with autonomic, sleep, or depression scores. CONCLUSIONS In-vivo structural hypothalamic involvement may be present in MSA. Reduced posterior hypothalamus volume, which includes the mammillary bodies and lateral hypothalamus, is associated with worse cognitive functioning. Larger studies on hypothalamic involvement in MSA and its clinical correlates are needed.
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Affiliation(s)
- Jacopo Pasquini
- Clinical Ageing Research Unit, Newcastle University, Newcastle upon Tyne NE4 5PL, United Kingdom; Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Michael J Firbank
- Institute of Translational and Clinical Research, Newcastle University, Newcastle upon Tyne NE4 5PL, United Kingdom
| | - Laura Best
- Regional Neurosciences Centre, Royal Victoria Hospital, Belfast, United Kingdom
| | - Victoria Foster
- Clinical Ageing Research Unit, Newcastle University, Newcastle upon Tyne NE4 5PL, United Kingdom
| | - Debra Galley
- Clinical Ageing Research Unit, Newcastle University, Newcastle upon Tyne NE4 5PL, United Kingdom
| | - Vincenzo Silani
- Department of Neurology and Laboratory of Neuroscience, Istituto Auxologico Italiano IRCCS, Milan, Italy; Department of Pathophysiology and Transplantation, Dino Ferrari Center, Università degli Studi di Milano, Milan, Italy
| | - Roberto Ceravolo
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy; Neurodegenerative Diseases Center, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - George Petrides
- Nuclear Medicine Department, Newcastle Upon Tyne Hospitals NHS Foundation Trust, UK
| | - David J Brooks
- Institute of Translational and Clinical Research, Newcastle University, Newcastle upon Tyne NE4 5PL, United Kingdom; Department of Nuclear Medicine and PET Centre, Institute of Clinical Medicine Aarhus University, Aarhus 8200, Denmark
| | - Kirstie N Anderson
- Regional Sleep Service, Newcastle upon Tyne NHS Hospitals NHS Foundation Trust, UK
| | - Nicola Pavese
- Clinical Ageing Research Unit, Newcastle University, Newcastle upon Tyne NE4 5PL, United Kingdom; Department of Nuclear Medicine and PET Centre, Institute of Clinical Medicine Aarhus University, Aarhus 8200, Denmark.
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13
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Raccagni C, Sidoroff V, Paraschiv-Ionescu A, Roth N, Schönherr G, Eskofier B, Gassner H, Kluge F, Teatini F, Seppi K, Goebel G, Benninger DH, Aminian K, Klucken J, Wenning G. Effects of physiotherapy and home-based training in parkinsonian syndromes: protocol for a randomised controlled trial (MobilityAPP). BMJ Open 2024; 14:e081317. [PMID: 38692728 PMCID: PMC11086482 DOI: 10.1136/bmjopen-2023-081317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 12/14/2023] [Indexed: 05/03/2024] Open
Abstract
INTRODUCTION Gait and mobility impairment are pivotal signs of parkinsonism, and they are particularly severe in atypical parkinsonian disorders including multiple system atrophy (MSA) and progressive supranuclear palsy (PSP). A pilot study demonstrated a significant improvement of gait in patients with MSA of parkinsonian type (MSA-P) after physiotherapy and matching home-based exercise, as reflected by sensor-based gait parameters. In this study, we aim to investigate whether a gait-focused physiotherapy (GPT) and matching home-based exercise lead to a greater improvement of gait performance compared with a standard physiotherapy/home-based exercise programme (standard physiotherapy, SPT). METHODS AND ANALYSIS This protocol was deployed to evaluate the effects of a GPT versus an active control undergoing SPT and matching home-based exercise with regard to laboratory gait parameters, physical activity measures and clinical scales in patients with Parkinson's disease (PD), MSA-P and PSP. The primary outcomes of the trial are sensor-based laboratory gait parameters, while the secondary outcome measures comprise real-world derived parameters, clinical rating scales and patient questionnaires. We aim to enrol 48 patients per disease group into this double-blind, randomised-controlled trial. The study starts with a 1 week wearable sensor-based monitoring of physical activity. After randomisation, patients undergo a 2 week daily inpatient physiotherapy, followed by 5 week matching unsupervised home-based training. A 1 week physical activity monitoring is repeated during the last week of intervention. ETHICS AND DISSEMINATION This study, registered as 'Mobility in Atypical Parkinsonism: a Trial of Physiotherapy (Mobility_APP)' at clinicaltrials.gov (NCT04608604), received ethics approval by local committees of the involved centres. The patient's recruitment takes place at the Movement Disorders Units of Innsbruck (Austria), Erlangen (Germany), Lausanne (Switzerland), Luxembourg (Luxembourg) and Bolzano (Italy). The data resulting from this project will be submitted to peer-reviewed journals, presented at international congresses and made publicly available at the end of the trial. TRIAL REGISTRATION NUMBER NCT04608604.
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Affiliation(s)
- Cecilia Raccagni
- Department of Neurology, Provincial Hospital of Bolzano (SABES-ASDAA), Lehrkrankenhaus der Paracelsus Medizinischen Privatuniversität, Bolzano, Italy
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Victoria Sidoroff
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | | | - Nils Roth
- Artificial Intelligence in Biomedical Engineering, FAU, Erlangen, Germany
| | - Gudrun Schönherr
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Björn Eskofier
- Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Heiko Gassner
- Department of Molecular Neurology, Erlangen University Hospital, Erlangen, Germany
| | - Felix Kluge
- Machine Learning and Data Analytics Lab, Department of Computer Science, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Francesco Teatini
- Department of Neurology, Provincial Hospital of Bolzano (SABES-ASDAA), Lehrkrankenhaus der Paracelsus Medizinischen Privatuniversität, Bolzano, Italy
| | - Klaus Seppi
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Georg Goebel
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - David H Benninger
- Service de Neurologie, Départment des Neurosciences Cliniques, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Kamiar Aminian
- Ecole Polytechnique Federale de Lausanne, Lausanne, Switzerland
| | - Jochen Klucken
- Department of Molecular Neurology, Friedrich-Alexander University Erlangen, Nürnberg, Germany
- Luxembourg Centre for Systems Biomedicine (LCSB), University of Luxembourg, Esch-sur-Alzette, Luxembourg
- Digital Medicine - Dep. of Precision Health, Luxembourg Institute of Health, Strassen, Luxembourg
- Digital Medicine, Centre Hospitalier de Luxembourg, Luxembourg, Luxembourg
| | - Gregor Wenning
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
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14
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Roeben B, Liepelt-Scarfone I, Lerche S, Zimmermann M, Wurster I, Sünkel U, Schulte C, Deuschle C, Eschweiler GW, Maetzler W, Gasser T, Berg D, Brockmann K. Longitudinal cognitive decline characterizes the profile of non-PD-manifest GBA1 mutation carriers. NPJ Parkinsons Dis 2024; 10:88. [PMID: 38649346 PMCID: PMC11035543 DOI: 10.1038/s41531-024-00706-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 04/08/2024] [Indexed: 04/25/2024] Open
Abstract
With disease-modifying treatment for Parkinson's disease (PD) associated with variants in the glucocerebrosidase gene (GBA1) under way, the challenge to design clinical trials with non-PD-manifest GBA mutation carriers (GBA1NMC) comes within close reach. To delineate trajectories of motor and non-motor markers as well as serum neurofilament light (sNfL) levels and to evaluate clinical endpoints as outcomes for clinical trials in GBA1NMC, longitudinal data of 56 GBA1NMC carriers and 112 age- and sex-matched GBA1 wildtype participants (GBA1wildtype) with up to 9 years of follow-up was analyzed using linear mixed-effects models (LMEM) and Kaplan-Meier survival analysis of clinical endpoints for motor and cognitive function. GBA1NMC showed worse performance in Pegboard, 20 m fast walking, global cognition as well as in executive and memory function at baseline. Longitudinally, LMEM revealed a higher annual increase of the MDS-UPDRS III bradykinesia subscore in GBA1NMC compared to GBA1wildtype, but comparable trajectories of all other motor and non-motor markers as well as sNfL. Kaplan-Meier survival analysis showed a significantly earlier progression to clinical endpoints of cognitive decline in GBA1NMC. Incidence of PD was significantly higher in GBA1NMC. In conclusion, our study extends data on GBA1NMC indicating early cognitive decline as a potentially characteristic feature. Comprehensive longitudinal assessments of cognitive function are crucial to delineate the evolution of early changes in GBA1NMC enabling a more accurate stratification and allow for a more precise definition of trial design and sample size.
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Grants
- Dr. Roeben was supported by the Clinician Scientist program of the Medical Faculty of the University of Tübingen (grant #478-0-0).
- Janssen Research and Development (Janssen R&D)
- Michael J. Fox Foundation for Parkinson’s Research (Michael J. Fox Foundation)
- European Commission (EC)
- EC | Horizon 2020 Framework Programme (EU Framework Programme for Research and Innovation H2020)
- Novartis
- International Parkinson Fonds (Germany) GmbH (IPD) German Ministry for Education and Research (BMBF)
- Dr. Zimmermann was supported by the Clinician Scientist program of the Medical Faculty of the University of Tübingen (grant #481-0-0).
- Dr. Wurster received funding from the Michael J. Fox Foundation in form of the Edmond J. Safra Fellowship in Movement Disorders.
- German Ministry for Education and Research (BMBF), German Research Council (DFG), German Innovationsfonds
- Robert Bosch Stiftung (Robert Bosch Foundation)
- Dr. Maetzler receives or received funding from the European Union, the German Federal Ministry of Education of Research, German Research Council, Michael J. Fox Foundation, Robert Bosch Foundation, Neuroalliance, Lundbeck, Sivantos and Janssen.
- Dr. Gasser receives research support from Novartis, the European Union, BMBF (the Federal Ministry of Education and Research), and Helmholtz Association.
- Janssen Pharmaceuticals (Janssen Pharmaceuticals, Inc.)
- Teva Pharmaceutical Industries (Teva Pharmaceutical Industries Ltd.)
- Abbott | Abbott Pharmaceuticals
- Boehringer Ingelheim (Boehringer Ingelheim Pharmaceuticals)
- UCB | UCB US
- Deutsches Zentrum für Neurodegenerative Erkrankungen (German Center for Neurodegenerative Diseases)
- Dr. Berg has received funding for travel or speaker honoraria from Lundbeck Inc., Novartis, UCB/ SCHWARZ PHARMA, Merck Serono, Biogen, Zambon, AbbVie, and BIALLtd.; and has received research support from Janssen, Teva Pharmaceutical Industries Ltd., Solvay Pharmaceuticals, Inc./Abbott, Boehringer, UCB, Michael J Fox Foundation, BMBF, dPV (German Parkinson’s disease association), Neuroallianz, DZNE, Center of Integrative Neurosciences and the Damp Foundation.
- Dr. Brockmann has received research grants from the University of Tuebingen (Clinician Scientist), the German Society of Parkinson’s disease (dpv), the Michael J. Fox Foundation (MJFF), the German Centre for Neurodegenerative Diseases (DZNE, MIGAP) and the German Federal Ministry of Education and Research (BMBF) in the frame of ERACoSysMed2 (FKZ 031L0137B).
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Affiliation(s)
- Benjamin Roeben
- Center of Neurology, Department of Neurodegeneration and Hertie-Institute for Clinical Brain Research, University of Tübingen, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany.
- German Center for Neurodegenerative Diseases, University of Tübingen, Otfried-Müller-Str. 27, 72076, Tübingen, Germany.
| | - Inga Liepelt-Scarfone
- Center of Neurology, Department of Neurodegeneration and Hertie-Institute for Clinical Brain Research, University of Tübingen, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany
- German Center for Neurodegenerative Diseases, University of Tübingen, Otfried-Müller-Str. 27, 72076, Tübingen, Germany
- IB-Hochschule, Stuttgart, Germany
| | - Stefanie Lerche
- Center of Neurology, Department of Neurodegeneration and Hertie-Institute for Clinical Brain Research, University of Tübingen, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany
- German Center for Neurodegenerative Diseases, University of Tübingen, Otfried-Müller-Str. 27, 72076, Tübingen, Germany
| | - Milan Zimmermann
- Center of Neurology, Department of Neurodegeneration and Hertie-Institute for Clinical Brain Research, University of Tübingen, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany
- German Center for Neurodegenerative Diseases, University of Tübingen, Otfried-Müller-Str. 27, 72076, Tübingen, Germany
| | - Isabel Wurster
- Center of Neurology, Department of Neurodegeneration and Hertie-Institute for Clinical Brain Research, University of Tübingen, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany
- German Center for Neurodegenerative Diseases, University of Tübingen, Otfried-Müller-Str. 27, 72076, Tübingen, Germany
| | - Ulrike Sünkel
- Center of Neurology, Department of Neurodegeneration and Hertie-Institute for Clinical Brain Research, University of Tübingen, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany
- Department of Psychiatry and Psychotherapy, University of Tübingen, Calwer Str. 14, 72076, Tübingen, Germany
| | - Claudia Schulte
- German Center for Neurodegenerative Diseases, University of Tübingen, Otfried-Müller-Str. 27, 72076, Tübingen, Germany
| | - Christian Deuschle
- Center of Neurology, Department of Neurodegeneration and Hertie-Institute for Clinical Brain Research, University of Tübingen, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany
- German Center for Neurodegenerative Diseases, University of Tübingen, Otfried-Müller-Str. 27, 72076, Tübingen, Germany
| | - Gerhard W Eschweiler
- Department of Psychiatry and Psychotherapy, University of Tübingen, Calwer Str. 14, 72076, Tübingen, Germany
- Geriatric Center at the University Hospital of Tübingen, Calwer Str. 14, 72076, Tübingen, Germany
| | - Walter Maetzler
- Department of Neurology, University Hospital Schleswig-Holstein, Campus Kiel, and Kiel University, Arnold-Heller-Straße 3, 24105, Kiel, Germany
| | - Thomas Gasser
- Center of Neurology, Department of Neurodegeneration and Hertie-Institute for Clinical Brain Research, University of Tübingen, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany
- German Center for Neurodegenerative Diseases, University of Tübingen, Otfried-Müller-Str. 27, 72076, Tübingen, Germany
| | - Daniela Berg
- Center of Neurology, Department of Neurodegeneration and Hertie-Institute for Clinical Brain Research, University of Tübingen, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany
- Department of Neurology, University Hospital Schleswig-Holstein, Campus Kiel, and Kiel University, Arnold-Heller-Straße 3, 24105, Kiel, Germany
| | - Kathrin Brockmann
- Center of Neurology, Department of Neurodegeneration and Hertie-Institute for Clinical Brain Research, University of Tübingen, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany
- German Center for Neurodegenerative Diseases, University of Tübingen, Otfried-Müller-Str. 27, 72076, Tübingen, Germany
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Panegyres PK, Lind KL, MacFarlane CA, Gurney AL. Medicinal cannabis in neurodegenerative disorders: an open label, dose finding, safety and efficacy study. Neurodegener Dis Manag 2024; 14:35-46. [PMID: 38639578 DOI: 10.2217/nmt-2023-0011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Accepted: 02/20/2024] [Indexed: 04/20/2024] Open
Abstract
Aim: Currently, there exist no curative treatments for neurodegenerative disorders. Recently, there has been a resurgence of interest in the use of medicinal cannabis to improve neurological conditions. Methods: A 12-month, open label, dose-finding, safety and efficacy study was conducted including 48 subjects with a variety of neurodegenerative disorders. Results: In our participants, we observed a reduction in pain, improved sleep, enhanced well-being and less agitation. Conclusion: Our findings suggest that medicinal cannabis might be useful in patients with neurodegenerative disorders in controlling pain, enhancing sleep, reducing difficult behaviors, controlling unusual and complex symptoms when other treatments have failed - this offers medicinal cannabis a role in palliation.
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Affiliation(s)
- Peter K Panegyres
- Neurodegenerative Disorders Research Pty Ltd, West Perth, 6005, Western Australia
- School of Medicine, The University of Western Australia, Nedlands, 6009, Australia
| | - Kerry L Lind
- Neurodegenerative Disorders Research Pty Ltd, West Perth, 6005, Western Australia
| | - Cheryl A MacFarlane
- Neurodegenerative Disorders Research Pty Ltd, West Perth, 6005, Western Australia
| | - Allana L Gurney
- Neurodegenerative Disorders Research Pty Ltd, West Perth, 6005, Western Australia
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Leys F, Eschlböck S, Campese N, Mahlknecht P, Peball M, Goebel G, Sidoroff V, Krismer F, Granata R, Kiechl S, Poewe W, Seppi K, Wenning GK, Fanciulli A. Sex-related differences in the clinical presentation of multiple system atrophy. Clin Auton Res 2024; 34:253-268. [PMID: 38630378 PMCID: PMC11127878 DOI: 10.1007/s10286-024-01028-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Accepted: 03/20/2024] [Indexed: 05/26/2024]
Abstract
PURPOSE To investigate sex-related differences in the clinical presentation of multiple system atrophy (MSA) through a literature review and an analysis of a retrospective cohort. METHODS The PubMed database was searched for articles including sex-related information in MSA. In a retrospective Innsbruck cohort, we investigated the baseline to last available follow-up clinical-demographic differences between men and women with MSA in a univariate fashion, followed by multivariable binary regression analysis. RESULTS The literature search yielded 46 publications with sex-related information in MSA. Most studies found comparable survival rates between the sexes, while some recent reports suggested a potential survival benefit for women, possibly due to initial motor onset and overall less severe autonomic failure compared to men. The retrospective Innsbruck MSA cohort comprised 56 female and 60 male individuals with a comparable median follow-up of 27 months. At baseline, female sex was independently associated with depression (odds ratio [OR] 4.7; p = 0.007) and male sex with severe orthostatic hypotension (OR 5.5; p = 0.016). In addition, at last follow-up, female sex was associated with the intake of central nervous system-active drugs (OR 4.1; p = 0.029), whereas male sex was associated with the presence of supine hypertension (OR 3.0; p = 0.020) and the intake of antihypertensive medications (OR 8.7; p = 0.001). Male sex was also associated with initiation of antihypertensive medications over the observation period (OR 12.4; p = 0.004). CONCLUSION The available literature and findings of the present study indicate sex-related differences in the clinical presentation of MSA and its evolution over time, highlighting the importance of considering sex in symptom exploration, therapeutic decision-making, and future clinical trial design.
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Affiliation(s)
- Fabian Leys
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Sabine Eschlböck
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
- Department of Neurology, Hochzirl-Natters Hospital, Zirl, Austria
| | - Nicole Campese
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Philipp Mahlknecht
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Marina Peball
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Georg Goebel
- Institute of Medical Statistics and Informatics, Medical University of Innsbruck, Innsbruck, Austria
| | - Victoria Sidoroff
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Florian Krismer
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Roberta Granata
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Stefan Kiechl
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Werner Poewe
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Klaus Seppi
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
- Department of Neurology, Provincial Hospital of Kufstein, Kufstein, Austria
| | - Gregor K Wenning
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
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Bendetowicz D, Fabbri M, Sirna F, Fernagut PO, Foubert-Samier A, Saulnier T, Le Traon AP, Proust-Lima C, Rascol O, Meissner WG. Recent Advances in Clinical Trials in Multiple System Atrophy. Curr Neurol Neurosci Rep 2024; 24:95-112. [PMID: 38416311 DOI: 10.1007/s11910-024-01335-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/13/2024] [Indexed: 02/29/2024]
Abstract
PURPOSE OF REVIEW This review summarizes previous and ongoing neuroprotection trials in multiple system atrophy (MSA), a rare and fatal neurodegenerative disease characterized by parkinsonism, cerebellar, and autonomic dysfunction. It also describes the preclinical therapeutic pipeline and provides some considerations relevant to successfully conducting clinical trials in MSA, i.e., diagnosis, endpoints, and trial design. RECENT FINDINGS Over 30 compounds have been tested in clinical trials in MSA. While this illustrates a strong treatment pipeline, only two have reached their primary endpoint. Ongoing clinical trials primarily focus on targeting α-synuclein, the neuropathological hallmark of MSA being α-synuclein-bearing glial cytoplasmic inclusions. The mostly negative trial outcomes highlight the importance of better understanding underlying disease mechanisms and improving preclinical models. Together with efforts to refine clinical measurement tools, innovative statistical methods, and developments in biomarker research, this will enhance the design of future neuroprotection trials in MSA and the likelihood of positive outcomes.
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Affiliation(s)
- David Bendetowicz
- Univ. Bordeaux, CNRS, IMN, UMR5293, Bordeaux, France.
- CHU Bordeaux, Service de Neurologie des Maladies Neurodégénératives, IMNc, CRMR AMS, NS-Park/FCRIN Network, Bordeaux, France.
| | - Margherita Fabbri
- MSA French Reference Center, Univ. Hospital Toulouse, Toulouse, France
- Univ. Toulouse, CIC-1436, Departments of Clinical Pharmacology and Neurosciences, NeuroToul COEN Center, NS-Park/FCRIN Network, Toulouse University Hospital, Inserm, U1048/1214, Toulouse, France
| | - Federico Sirna
- Univ. Bordeaux, INSERM, BPH, U1219, IPSED, Bordeaux, France
| | - Pierre-Olivier Fernagut
- Université de Poitiers, Laboratoire de Neurosciences Expérimentales et Cliniques, INSERM UMR-S 1084, Poitiers, France
| | - Alexandra Foubert-Samier
- Univ. Bordeaux, CNRS, IMN, UMR5293, Bordeaux, France
- CHU Bordeaux, Service de Neurologie des Maladies Neurodégénératives, IMNc, CRMR AMS, NS-Park/FCRIN Network, Bordeaux, France
- Univ. Bordeaux, INSERM, BPH, U1219, IPSED, Bordeaux, France
| | | | - Anne Pavy Le Traon
- MSA French Reference Center, Univ. Hospital Toulouse, Toulouse, France
- Univ. Toulouse, CIC-1436, Departments of Clinical Pharmacology and Neurosciences, NeuroToul COEN Center, NS-Park/FCRIN Network, Toulouse University Hospital, Inserm, U1048/1214, Toulouse, France
| | | | - Olivier Rascol
- MSA French Reference Center, Univ. Hospital Toulouse, Toulouse, France
- Univ. Toulouse, CIC-1436, Departments of Clinical Pharmacology and Neurosciences, NeuroToul COEN Center, NS-Park/FCRIN Network, Toulouse University Hospital, Inserm, U1048/1214, Toulouse, France
| | - Wassilios G Meissner
- Univ. Bordeaux, CNRS, IMN, UMR5293, Bordeaux, France
- CHU Bordeaux, Service de Neurologie des Maladies Neurodégénératives, IMNc, CRMR AMS, NS-Park/FCRIN Network, Bordeaux, France
- Department of Medicine, University of Otago, Christchurch, and New Zealand Brain Research Institute, Christchurch, New Zealand
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Sun Y, Wei L, Li F, Ling C, Zhai F, Lv Y, Zhou H, Zhang C, Ma J, Chen J, Sun W, Wang Z. Associations of sleep-related variables with reverse dipping patterns of blood pressure in α-synucleinopathies. Parkinsonism Relat Disord 2024; 121:106046. [PMID: 38367532 DOI: 10.1016/j.parkreldis.2024.106046] [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: 09/09/2023] [Revised: 02/08/2024] [Accepted: 02/10/2024] [Indexed: 02/19/2024]
Abstract
INTRODUCTION The reverse dipping blood pressure (BP) pattern is very common in α-synucleinopathies. We aimed to explore the associations of sleep-related variables with abnormal BP circadian rhythms in Parkinson's disease (PD) and multiple system atrophy (MSA). METHODS A total of 126 patients, 76 with PD and 50 with MSA, were included. All participants underwent ambulatory BP monitoring and full-night polysomnography (PSG). We analyzed abnormal dipping patterns and sleep-related parameters, including moderate to severe obstructive sleep apnea (OSA), rapid eye movement behavior disorder (RBD), average oxygen saturation (SaO2%), lowest SaO2%, duration of SaO2% <90%, and apnea-hypopnea index (AHI). Binary logistic regression was performed to explore the associations between paraclinical variables, sleep-related variables, and reverse dipping patterns. RESULTS Reverse dipping patterns were predominant in patients with PD (58.5 %) and MSA (68.0 %). Patients with MSA had higher AHI, RBD, and lower average SaO2% than those with PD. Taking both diseases together as a whole group of α-synucleinopathies, logistic regression analysis indicates the Hoehn-Yahr stage (odds ratio [OR] = 2.00 for reverse systolic and 2.34 for reverse diastolic dipping patterns), moderate to severe OSA (OR = 2.71 for reverse systolic and 2.53 for reverse diastolic dipping patterns), average SaO2% (OR = 1.35 for reverse systolic dipping patterns), and male sex (OR = 2.70 for reverse diastolic dipping patterns) were independently associated with reverse dipping patterns. CONCLUSIONS Reverse dipping patterns were common in patients with PD and MSA. Hoehn-Yahr stage, moderate to severe OSA, average SaO2%, and male sex were associated with reverse dipping patterns in α-synucleinopathy.
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Affiliation(s)
- Yunchuang Sun
- Department of Neurology, Peking University First Hospital, NO.8 Xishiku Street, Xicheng District, Beijing, 100034, China; Beijing Key Laboratory of Neurovascular Disease Discovery, Beijing, 100034, China
| | - Luhua Wei
- Department of Neurology, Peking University First Hospital, NO.8 Xishiku Street, Xicheng District, Beijing, 100034, China
| | - Fan Li
- Department of Neurology, Peking University First Hospital, NO.8 Xishiku Street, Xicheng District, Beijing, 100034, China
| | - Chen Ling
- Department of Neurology, Peking University First Hospital, NO.8 Xishiku Street, Xicheng District, Beijing, 100034, China
| | - Fei Zhai
- Department of Neurology, Shijiazhuang People's Hospital, NO.9 Fangbei Road, Chang'an District, Shijiazhuang City, Hebei province, 050011, China
| | - Yunfeng Lv
- Department of Neurology, Northeast International Hospital, NO.169 ChangJiang South Street, HuangGu District, ShenYang City, Liaoning province, 110031, China
| | - Hong Zhou
- Department of Neurology, Civil Aviation General Hospital, Beijing, 100123, China
| | - Cheng Zhang
- Department of Respiratory and Critical Care Medicine, Peking University First Hospital, NO.8 Xishiku Street, Xicheng District, Beijing, 100034, China
| | - Jing Ma
- Department of Respiratory and Critical Care Medicine, Peking University First Hospital, NO.8 Xishiku Street, Xicheng District, Beijing, 100034, China
| | - Jing Chen
- Department of Neurology, Peking University First Hospital, NO.8 Xishiku Street, Xicheng District, Beijing, 100034, China
| | - Wei Sun
- Department of Neurology, Peking University First Hospital, NO.8 Xishiku Street, Xicheng District, Beijing, 100034, China.
| | - Zhaoxia Wang
- Department of Neurology, Peking University First Hospital, NO.8 Xishiku Street, Xicheng District, Beijing, 100034, China; Beijing Key Laboratory of Neurovascular Disease Discovery, Beijing, 100034, China.
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Niu X, Yin P, Guan C, Shao Q, Cui G, Zan K, Xu C. Corneal confocal microscopy may help to distinguish Multiple System Atrophy from Parkinson's disease. NPJ Parkinsons Dis 2024; 10:63. [PMID: 38493181 PMCID: PMC10944503 DOI: 10.1038/s41531-024-00680-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 03/07/2024] [Indexed: 03/18/2024] Open
Abstract
Multiple system atrophy (MSA) and Parkinson's disease (PD) have clinical overlapping symptoms, which makes differential diagnosis difficult. Our research aimed to distinguish MSA from PD using corneal confocal microscopy (CCM), a noninvasive and objective test. The study included 63 PD patients, 30 MSA patients, and 31 healthy controls (HC). When recruiting PD and MSA, questionnaires were conducted on motor and non-motor functions, such as autonomic and cognitive functions. Participants underwent CCM to quantify the corneal nerve fibers. Corneal nerve fiber density (CNFD) and corneal nerve fiber length (CNFL) values in MSA are lower than PD (MSA vs. PD: CNFD, 20.68 ± 6.70 vs. 24.64 ± 6.43 no./mm2, p < 0.05; CNFL, 12.01 ± 3.25 vs. 14.17 ± 3.52 no./mm2, p < 0.05). In MSA + PD (combined), there is a negative correlation between CNFD and the Orthostatic Grading Scale (OGS) (r = -0.284, p = 0.007). Similarly, CNFD in the only MSA group was negatively correlated with the Unified Multiple System Atrophy Rating Scale I and II (r = -0.391, p = 0.044; r = -0.382, p = 0.049). CNFD and CNFL were inversely associated with MSA (CNFD: β = -0.071; OR, 0.932; 95% CI, 0.872 ~ 0.996; p = 0.038; CNFL: β = -0.135; OR, 0.874; 95% CI, 0.768-0.994; p = 0.040). Furthermore, we found the area under the receiver operating characteristic curve (ROC) of CNFL was the largest, 72.01%. The CCM could be an objective and sensitive biomarker to distinguish MSA from PD. It visually reflects a more severe degeneration in MSA compared to PD.
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Affiliation(s)
- Xuebin Niu
- Department of Neurology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
- Department of Neurology, The First Clinical College, Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Peixiao Yin
- Department of Neurology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
- Department of Neurology, The First Clinical College, Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Chenyang Guan
- Department of Neurology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
- Department of Neurology, The First Clinical College, Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Qiuyue Shao
- Department of Neurology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
- Department of Neurology, The First Clinical College, Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Guiyun Cui
- Department of Neurology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
- Department of Neurology, The First Clinical College, Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Kun Zan
- Department of Neurology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China.
- Department of Neurology, The First Clinical College, Xuzhou Medical University, Xuzhou, Jiangsu, China.
| | - Chuanying Xu
- Department of Neurology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China.
- Department of Neurology, The First Clinical College, Xuzhou Medical University, Xuzhou, Jiangsu, China.
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Mishra B, Sudheer P, Rajan R, Agarwal A, Srivastava MVP, Nilima N, Vishnu VY. Bridging the gap between statistical significance and clinical relevance: A systematic review of minimum clinically important difference (MCID) thresholds of scales reported in movement disorders research. Heliyon 2024; 10:e26479. [PMID: 38439837 PMCID: PMC10909673 DOI: 10.1016/j.heliyon.2024.e26479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 01/16/2024] [Accepted: 02/14/2024] [Indexed: 03/06/2024] Open
Abstract
Background Minimum clinically important difference (MCID) is the smallest change in an outcome measure that is considered clinically meaningful. Using validated MCID thresholds for outcomes powers trials adequately to detect meaningful treatment effects, aids in their interpretation and guides development of new outcome measures. Objectives To provide a comprehensive summary of MCID thresholds of various symptom severity scales reported in movement disorder. Methods We conducted systematic review of the literature and included studies of one or more movement disorders, and reporting MCID scales. Results 2763 reports were screened. Final review included 32 studies. Risk of bias (RoB) assessment showed most studies were of good quality. Most commonly evaluated scale was Unified Parkinson's Disease Rating Scale (UPDRS) (11 out of 32). Four studies assessing MDS-UPDRS had assessed its different sub-parts, reporting a change of 2.64,3.05,3.25 and 0.9 points to detect clinically meaningful improvement and 2.45,2.51,4.63 and 0.8 points to detect clinically meaningful worsening, for the Part I, II, III and IV, respectively. For Parts II + III, I + II + III and I + II + III + IV, MCID thresholds reported for clinically meaningful improvement were 5.73, 4.9, 6.7 and 7.1 points respectively; while those for clinically meaningful worsening were 4.7, 4.2, 5.2 and 6.3 points, respectively. MCID thresholds reported for other scales included Abnormal Involuntary Movement Scale (AIMS), Toronto Western Spasmodic Torticollis Rating Scale (TWSRS), and Burke-Fahn-Marsden Dystonia Scale (BFMD). Conclusion This review summarizes all the MCID thresholds currently reported in Movement disorders research and provides a comprehensive resource for future trials, highlighting the need for standardized and validated MCID scales in movement disorder research.
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Affiliation(s)
- Biswamohan Mishra
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Pachipala Sudheer
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Roopa Rajan
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Ayush Agarwal
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - M V Padma Srivastava
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Nilima Nilima
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
| | - Venugopalan Y Vishnu
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
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21
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Saulnier T, Fabbri M, Le Goff M, Helmer C, Pavy-Le Traon A, Meissner WG, Rascol O, Proust-Lima C, Foubert-Samier A. Patient-perceived progression in multiple system atrophy: natural history of quality of life. J Neurol Neurosurg Psychiatry 2024:jnnp-2023-332733. [PMID: 38453477 DOI: 10.1136/jnnp-2023-332733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 02/17/2024] [Indexed: 03/09/2024]
Abstract
BACKGROUND Health-related quality of life (Hr-QoL) scales provide crucial information on neurodegenerative disease progression, help improve patient care and constitute a meaningful endpoint for therapeutic research. However, Hr-QoL progression is usually poorly documented, as for multiple system atrophy (MSA), a rare and rapidly progressing alpha-synucleinopathy. This work aimed to describe Hr-QoL progression during the natural course of MSA, explore disparities between patients and identify informative items using a four-step statistical strategy. METHODS We leveraged the data of the French MSA cohort comprising annual assessments with the MSA-QoL questionnaire for more than 500 patients over up to 11 years. A four-step strategy (1) determined the subdimensions of Hr-QoL, (2) modelled the subdimension trajectories over time, (3) mapped item impairments with disease stages and (4) identified most informative items. RESULTS Four dimensions were identified. In addition to the original motor, non-motor and emotional domains, an oropharyngeal component was highlighted. While the motor and oropharyngeal domains deteriorated rapidly, the non-motor and emotional aspects were already impaired at cohort entry and deteriorated slowly over the disease course. Impairments were associated with sex, diagnosis subtype and delay since symptom onset. Except for the emotional domain, each dimension was driven by key identified items. CONCLUSION The multidimensional Hr-QoL deteriorates progressively over the course of MSA and brings essential knowledge for improving patient care. As exemplified with MSA, the thorough description of Hr-QoL over time using the four-step strategy can provide perspectives on neurodegenerative diseases' management to ultimately deliver better support focused on the patient's perspective.
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Affiliation(s)
- Tiphaine Saulnier
- Bordeaux Population Health Research Center, Inserm U1219, University of Bordeaux, Bordeaux, France
| | - Margherita Fabbri
- MSA French Reference Center, University Hospital Toulouse, Toulouse, France
- Departments of Clinical Pharmacology and Neurosciences, University of Toulouse, CIC-1436, NeuroToul COEN Center, NS-Park/FCRIN Network, Toulouse University Hospital, Inserm U1048/1214, Toulouse, France
| | - Mélanie Le Goff
- Bordeaux Population Health Research Center, Inserm U1219, University of Bordeaux, Bordeaux, France
| | - Catherine Helmer
- Bordeaux Population Health Research Center, Inserm U1219, University of Bordeaux, Bordeaux, France
- CIC1401-EC, Inserm, Bordeaux, France
| | - Anne Pavy-Le Traon
- MSA French Reference Center, University Hospital Toulouse, Toulouse, France
- Departments of Clinical Pharmacology and Neurosciences, University of Toulouse, CIC-1436, NeuroToul COEN Center, NS-Park/FCRIN Network, Toulouse University Hospital, Inserm U1048/1214, Toulouse, France
| | - Wassilios G Meissner
- CHU Bordeaux, Service de Neurologie des Maladies Neurodégénératives, IMNc, CRMR AMS, NS-Park/FCRIN Network, University of Bordeaux, CNRS, IMN, UMR5293, Bordeaux, France
- Department of Medicine, University of Otago, New Zealand Brain Research Institute, Christchurch, New Zealand
| | - Olivier Rascol
- MSA French Reference Center, University Hospital Toulouse, Toulouse, France
- Departments of Clinical Pharmacology and Neurosciences, University of Toulouse, CIC-1436, NeuroToul COEN Center, NS-Park/FCRIN Network, Toulouse University Hospital, Inserm U1048/1214, Toulouse, France
| | - Cecile Proust-Lima
- Bordeaux Population Health Research Center, Inserm U1219, University of Bordeaux, Bordeaux, France
- CIC1401-EC, Inserm, Bordeaux, France
| | - Alexandra Foubert-Samier
- Bordeaux Population Health Research Center, Inserm U1219, University of Bordeaux, Bordeaux, France
- CIC1401-EC, Inserm, Bordeaux, France
- CHU Bordeaux, Service de Neurologie des Maladies Neurodégénératives, IMNc, CRMR AMS, NS-Park/FCRIN Network, University of Bordeaux, CNRS, IMN, UMR5293, Bordeaux, France
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22
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Sinai A, Nassar M, Shornikov L, Constantinescu M, Zaaroor M, Schlesinger I. Focused Ultrasound Thalamotomy for Tremor Relief in Atypical Parkisnsonism. PARKINSON'S DISEASE 2024; 2024:6643510. [PMID: 38476865 PMCID: PMC10932618 DOI: 10.1155/2024/6643510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 12/04/2023] [Accepted: 02/08/2024] [Indexed: 03/14/2024]
Abstract
Background Magnetic resonance imaging (MRI)-guided focused ultrasound (FUS) VIM-thalamotomy has established efficacy and safety in tremor relief in patients with essential tremor and Parkinson's disease. The efficacy and safety in patients with atypical parkinsonism have not been reported. Objective To report on the efficacy and safety of FUS VIM-thalamotomy in 8 patients with parkinsonism, multiple system atrophy-Parkinsonian type (MSA-P) (n = 5), and dementia with Lewy bodies (DLB) (n = 3). Methods Tremor was assessed in the treated hemibody using the Clinical Rating Scale for Tremor (CRST). The motor Unified MSA Rating Scale (UMSAR) was used in the MSA-P and motor sections of the Unified Parkinson's Disease Rating Scale (UPDRS-III) in DLB patients. Cognition was measured using the Montreal Cognitive Assessment (MoCA). Results In MSA-P and DLB patients, there was immediate tremor relief. CRST scores measured on the treated side improved compared to baseline. During the follow-up of up to 1 year tremor reduction persisted. The change in CRST scores at different time points did not reach statistical significance, probably due to the small sample size. Adverse events were transient and resolved within a year. Conclusions In our experience, FUS VIM-thalamotomy was effective in patients with MSA-P and DLB. Larger, controlled studies are needed to verify our preliminary observations.
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Affiliation(s)
- Alon Sinai
- Department of Neurosurgery, Rambam Health Care Campus, Haifa, Israel
| | - Maria Nassar
- Department of Neurology, Rambam Health Care Campus, Haifa, Israel
| | - Lev Shornikov
- Department of Neurology, Rambam Health Care Campus, Haifa, Israel
| | | | - Menashe Zaaroor
- Department of Neurosurgery, Rambam Health Care Campus, Haifa, Israel
- Technion Faculty of Medicine, Haifa, Israel
| | - Ilana Schlesinger
- Department of Neurology, Rambam Health Care Campus, Haifa, Israel
- Technion Faculty of Medicine, Haifa, Israel
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23
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Mir MJ, Childers JT, Wheeler-Hegland K. Cough Correlates of Functional Swallow Outcomes in Atypical Parkinsonism. Mov Disord Clin Pract 2024; 11:265-275. [PMID: 38229245 DOI: 10.1002/mdc3.13965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 11/20/2023] [Accepted: 12/15/2023] [Indexed: 01/18/2024] Open
Abstract
BACKGROUND Swallow and cough impairments lead to aspiration and reduced clearance of aspirate material. Both behaviors are impaired in Parkinson's disease, but it is unknown whether a similar relationship of dysfunction exists in forms of atypical Parkinsonism (APD). Elucidating this association in APD may lead to early, comprehensive airway protection treatment. OBJECTIVES We tested the hypotheses that swallow deficits in APD are associated with impaired cough and that airway protective dysfunction is associated with longer disease duration. METHODS Swallowing difficulty was described by 11 participants with APD. Penetration-Aspiration Scale (PAS) and DIGEST scores for thin liquid trials were extracted from medical records of videofluoroscopic swallow study reports. Voluntary and capsaicin induced-reflex cough measures of flow, volume, and timing were analyzed. RESULTS While most participants did not have post-swallow residue, ~80% received abnormal PAS scores and reported swallowing difficulty. Those with abnormal PAS scores had lower voluntary cough expired volume (P = 0.037; mean rank difference = 5.0); lower reflex inspiratory flow rate (P = 0.034; mean rank difference = 5.5); and longer reflex expiratory flow rise time (P = 0.034; mean rank difference = 5.5). Higher PAS scores and reduced reflex cough volume acceleration were significantly correlated (r = -0.63; P = 0.04) and longer disease duration predicted larger voluntary cough expired volume (R2 = 0.72) and longer flow rise times (R2 = 0.47). CONCLUSIONS As swallow safety worsens, so might the ability to clear the airways with effective cough in in APD; particularly with longer disease duration. Assessing cough in conjunction with swallowing is important for informing airway protection treatment plans in APD.
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Affiliation(s)
- Michela J Mir
- Breathing Research and Therapeutics Center, Department of Physical Therapy, University of Florida, Gainesville, Florida, USA
- Brooks Clinical Research Center, Brooks Rehabilitation, Jacksonville, Florida, USA
| | - Justin T Childers
- College of Medicine, Florida Atlantic University, Boca Raton, Florida, USA
| | - Karen Wheeler-Hegland
- Norman Fixel Institute for Neurological Diseases, UF Health, Gainesville, Florida, USA
- Upper Airway Dysfunction Lab, Department of Speech, Language, and Hearing Sciences, University of Florida, Gainesville, Florida, USA
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24
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Toś M, Grażyńska A, Antoniuk S, Siuda J. Impulse Control Disorders in Parkinson's Disease and Atypical Parkinsonian Syndromes-Is There a Difference? Brain Sci 2024; 14:181. [PMID: 38391755 PMCID: PMC10886884 DOI: 10.3390/brainsci14020181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 02/10/2024] [Accepted: 02/14/2024] [Indexed: 02/24/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Impulse control disorders (ICDs) are characterized by potentially harmful actions resulting from disturbances in the self-control of emotions and behavior. ICDs include disorders such as gambling, hypersexuality, binge eating, and compulsive buying. ICDs are known non-motor symptoms in Parkinson's disease (PD) and are associated primarily with the use of dopaminergic treatment (DRT) and especially dopamine agonists (DA). However, in atypical parkinsonism (APS), such as progressive supranuclear palsy (PSP) or multiple system atrophy (MSA), there are only single case reports of ICDs without attempts to determine the risk factors for their occurrence. Moreover, numerous reports in the literature indicate increased impulsivity in PSP. Our study aimed to determine the frequency of individual ICDs in APS compared to PD and identify potential factors for developing ICDs in APS. MATERIALS AND METHODS Our prospective study included 185 patients with PD and 35 with APS (27 patients with PSP and 9 with MSA) hospitalized between 2020 and 2023 at the Neurological Department of University Central Hospital in Katowice. Each patient was examined using the Questionnaire for Impulsive-Compulsive Disorders in Parkinson's Disease (QUIP) to assess ICDs. Additionally, other scales were used to assess the advancement of the disease, the severity of depression, and cognitive impairment. Information on age, gender, age of onset, disease duration, and treatment used were collected from medical records and patient interviews. RESULTS ICDs were detected in 23.39% of patients with PD (including binge eating in 11.54%, compulsive buying in 10.44%, hypersexuality in 8.79%, and pathological gambling in 4.40%), in one patient with MSA (hypersexuality and pathological gambling), and in 18.52% of patients with PSP (binge eating in 3.70%, compulsive buying in 7.41%, and hypersexuality in 11.11%). We found no differences in the frequency of ICDs between individual diseases (p = 0.4696). We confirmed that the use of higher doses of DA and L-dopa in patients with PD, as well as a longer disease duration and the presence of motor complications, were associated with a higher incidence of ICDs. However, we did not find any treatment effect on the incidence of ICDs in APS. CONCLUSIONS ICDs are common and occur with a similar frequency in PD and APS. Well-described risk factors for ICDs in PD, such as the use of DRT or longer disease duration, are not fully reflected in the risk factors for ICDs in APS. This applies especially to PSP, which, unlike PD and MSA, is a tauopathy in which, in addition to the use of DRT, other mechanisms related to the disease, such as disorders in neuronal loops and neurotransmitter deficits, may influence the development of ICDs. Further prospective multicenter studies recruiting larger groups of patients are needed to fully determine the risk factors and mechanisms of ICD development in APS.
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Affiliation(s)
- Mateusz Toś
- Department of Neurology, Faculty of Medical Sciences in Katowice, Medical University of Silesia, 40-055 Katowice, Poland
| | - Anna Grażyńska
- Department of Imaging Diagnostics and Interventional Radiology, Kornel Gibiński Independent Public Central Clinical Hospital, Medical University of Silesia, 40-055 Katowice, Poland
| | - Sofija Antoniuk
- St. Barbara Regional Specialist Hospital No. 5, 41-200 Sosnowiec, Poland
| | - Joanna Siuda
- Department of Neurology, Faculty of Medical Sciences in Katowice, Medical University of Silesia, 40-055 Katowice, Poland
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25
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Ndayisaba A, Pitaro AT, Willett AS, Jones KA, de Gusmao CM, Olsen AL, Kim J, Rissanen E, Woods JK, Srinivasan SR, Nagy A, Nagy A, Mesidor M, Cicero S, Patel V, Oakley DH, Tuncali I, Taglieri-Noble K, Clark EC, Paulson J, Krolewski RC, Ho GP, Hung AY, Wills AM, Hayes MT, Macmore JP, Warren L, Bower PG, Langer CB, Kellerman LR, Humphreys CW, Glanz BI, Dielubanza EJ, Frosch MP, Freeman RL, Gibbons CH, Stefanova N, Chitnis T, Weiner HL, Scherzer CR, Scholz SW, Vuzman D, Cox LM, Wenning G, Schmahmann JD, Gupta AS, Novak P, Young GS, Feany MB, Singhal T, Khurana V. Clinical Trial-Ready Patient Cohorts for Multiple System Atrophy: Coupling Biospecimen and iPSC Banking to Longitudinal Deep-Phenotyping. CEREBELLUM (LONDON, ENGLAND) 2024; 23:31-51. [PMID: 36190676 PMCID: PMC9527378 DOI: 10.1007/s12311-022-01471-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 08/26/2022] [Indexed: 11/30/2022]
Abstract
Multiple system atrophy (MSA) is a fatal neurodegenerative disease of unknown etiology characterized by widespread aggregation of the protein alpha-synuclein in neurons and glia. Its orphan status, biological relationship to Parkinson's disease (PD), and rapid progression have sparked interest in drug development. One significant obstacle to therapeutics is disease heterogeneity. Here, we share our process of developing a clinical trial-ready cohort of MSA patients (69 patients in 2 years) within an outpatient clinical setting, and recruiting 20 of these patients into a longitudinal "n-of-few" clinical trial paradigm. First, we deeply phenotype our patients with clinical scales (UMSARS, BARS, MoCA, NMSS, and UPSIT) and tests designed to establish early differential diagnosis (including volumetric MRI, FDG-PET, MIBG scan, polysomnography, genetic testing, autonomic function tests, skin biopsy) or disease activity (PBR06-TSPO). Second, we longitudinally collect biospecimens (blood, CSF, stool) and clinical, biometric, and imaging data to generate antecedent disease-progression scores. Third, in our Mass General Brigham SCiN study (stem cells in neurodegeneration), we generate induced pluripotent stem cell (iPSC) models from our patients, matched to biospecimens, including postmortem brain. We present 38 iPSC lines derived from MSA patients and relevant disease controls (spinocerebellar ataxia and PD, including alpha-synuclein triplication cases), 22 matched to whole-genome sequenced postmortem brain. iPSC models may facilitate matching patients to appropriate therapies, particularly in heterogeneous diseases for which patient-specific biology may elude animal models. We anticipate that deeply phenotyped and genotyped patient cohorts matched to cellular models will increase the likelihood of success in clinical trials for MSA.
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Affiliation(s)
- Alain Ndayisaba
- Department of Neurology, Building for Transformative Medicine Room 10016L, Brigham and Women's Hospital and Harvard Medical School, 60 Fenwood Road, Boston, 02115, USA
- Division of Clinical Neurobiology, Department of Neurology, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria
| | - Ariana T Pitaro
- Department of Neurology, Building for Transformative Medicine Room 10016L, Brigham and Women's Hospital and Harvard Medical School, 60 Fenwood Road, Boston, 02115, USA
| | - Andrew S Willett
- Department of Neurology, Building for Transformative Medicine Room 10016L, Brigham and Women's Hospital and Harvard Medical School, 60 Fenwood Road, Boston, 02115, USA
| | - Kristie A Jones
- Department of Neurology, Building for Transformative Medicine Room 10016L, Brigham and Women's Hospital and Harvard Medical School, 60 Fenwood Road, Boston, 02115, USA
| | - Claudio Melo de Gusmao
- Department of Neurology, Building for Transformative Medicine Room 10016L, Brigham and Women's Hospital and Harvard Medical School, 60 Fenwood Road, Boston, 02115, USA
| | - Abby L Olsen
- Department of Neurology, Building for Transformative Medicine Room 10016L, Brigham and Women's Hospital and Harvard Medical School, 60 Fenwood Road, Boston, 02115, USA
| | - Jisoo Kim
- Department of Radiology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, 02115, USA
| | - Eero Rissanen
- Department of Neurology, Building for Transformative Medicine Room 10016L, Brigham and Women's Hospital and Harvard Medical School, 60 Fenwood Road, Boston, 02115, USA
| | - Jared K Woods
- Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, 02115, USA
| | - Sharan R Srinivasan
- Department of Neurology, Building for Transformative Medicine Room 10016L, Brigham and Women's Hospital and Harvard Medical School, 60 Fenwood Road, Boston, 02115, USA
- Department of Neurology, University of Michigan, Ann Arbor, MI , 48103, USA
| | - Anna Nagy
- Department of Neurology, Building for Transformative Medicine Room 10016L, Brigham and Women's Hospital and Harvard Medical School, 60 Fenwood Road, Boston, 02115, USA
| | - Amanda Nagy
- Department of Neurology, Building for Transformative Medicine Room 10016L, Brigham and Women's Hospital and Harvard Medical School, 60 Fenwood Road, Boston, 02115, USA
| | - Merlyne Mesidor
- Department of Neurology, Building for Transformative Medicine Room 10016L, Brigham and Women's Hospital and Harvard Medical School, 60 Fenwood Road, Boston, 02115, USA
| | - Steven Cicero
- Department of Neurology, Building for Transformative Medicine Room 10016L, Brigham and Women's Hospital and Harvard Medical School, 60 Fenwood Road, Boston, 02115, USA
| | - Viharkumar Patel
- Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, 02115, USA
| | - Derek H Oakley
- Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, 02114, USA
| | - Idil Tuncali
- Department of Neurology, Building for Transformative Medicine Room 10016L, Brigham and Women's Hospital and Harvard Medical School, 60 Fenwood Road, Boston, 02115, USA
| | - Katherine Taglieri-Noble
- Department of Neurology, Building for Transformative Medicine Room 10016L, Brigham and Women's Hospital and Harvard Medical School, 60 Fenwood Road, Boston, 02115, USA
| | - Emily C Clark
- Department of Neurology, Building for Transformative Medicine Room 10016L, Brigham and Women's Hospital and Harvard Medical School, 60 Fenwood Road, Boston, 02115, USA
| | - Jordan Paulson
- Department of Neurology, Building for Transformative Medicine Room 10016L, Brigham and Women's Hospital and Harvard Medical School, 60 Fenwood Road, Boston, 02115, USA
| | - Richard C Krolewski
- Department of Neurology, Building for Transformative Medicine Room 10016L, Brigham and Women's Hospital and Harvard Medical School, 60 Fenwood Road, Boston, 02115, USA
| | - Gary P Ho
- Department of Neurology, Building for Transformative Medicine Room 10016L, Brigham and Women's Hospital and Harvard Medical School, 60 Fenwood Road, Boston, 02115, USA
| | - Albert Y Hung
- Department of Neurology, Building for Transformative Medicine Room 10016L, Brigham and Women's Hospital and Harvard Medical School, 60 Fenwood Road, Boston, 02115, USA
- Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, 02114, USA
| | - Anne-Marie Wills
- Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, 02114, USA
| | - Michael T Hayes
- Department of Neurology, Building for Transformative Medicine Room 10016L, Brigham and Women's Hospital and Harvard Medical School, 60 Fenwood Road, Boston, 02115, USA
| | - Jason P Macmore
- Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, 02114, USA
| | | | - Pamela G Bower
- The Multiple System Atrophy Coalition, Inc., 7918 Jones Branch Drive, Suite 300, McLean, VA, 22102, USA
| | - Carol B Langer
- The Multiple System Atrophy Coalition, Inc., 7918 Jones Branch Drive, Suite 300, McLean, VA, 22102, USA
| | - Lawrence R Kellerman
- The Multiple System Atrophy Coalition, Inc., 7918 Jones Branch Drive, Suite 300, McLean, VA, 22102, USA
| | - Christopher W Humphreys
- Department of Pulmonary, Sleep and Critical Care Medicine, Salem Hospital, MassGeneral Brigham, Salem, MA, 01970, USA
| | - Bonnie I Glanz
- Department of Neurology, Building for Transformative Medicine Room 10016L, Brigham and Women's Hospital and Harvard Medical School, 60 Fenwood Road, Boston, 02115, USA
| | - Elodi J Dielubanza
- Department of Urology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, 02115, USA
| | - Matthew P Frosch
- Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, 02114, USA
| | - Roy L Freeman
- Department of Neurology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, 02115, USA
| | - Christopher H Gibbons
- Department of Neurology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, 02115, USA
| | - Nadia Stefanova
- Division of Clinical Neurobiology, Department of Neurology, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria
| | - Tanuja Chitnis
- Department of Neurology, Building for Transformative Medicine Room 10016L, Brigham and Women's Hospital and Harvard Medical School, 60 Fenwood Road, Boston, 02115, USA
| | - Howard L Weiner
- Department of Neurology, Building for Transformative Medicine Room 10016L, Brigham and Women's Hospital and Harvard Medical School, 60 Fenwood Road, Boston, 02115, USA
| | - Clemens R Scherzer
- Department of Neurology, Building for Transformative Medicine Room 10016L, Brigham and Women's Hospital and Harvard Medical School, 60 Fenwood Road, Boston, 02115, USA
| | - Sonja W Scholz
- Laboratory of Neurogenetics, Disorders and Stroke, National Institute of Neurological, National Institute of Neurological Disorders and Stroke, Bethesda, MD, 20892, USA
- Department of Neurology, Johns Hopkins University Medical Center, Baltimore, MD, 21287, USA
| | - Dana Vuzman
- Department of Biomedical Informatics, Harvard Medical School, Boston, MA, USA
- Division of Genetics, Department of Medicine, Brigham and Women's Hospital, Boston, MA, 02115, USA
| | - Laura M Cox
- Department of Neurology, Building for Transformative Medicine Room 10016L, Brigham and Women's Hospital and Harvard Medical School, 60 Fenwood Road, Boston, 02115, USA
| | - Gregor Wenning
- Division of Clinical Neurobiology, Department of Neurology, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria
| | - Jeremy D Schmahmann
- Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, 02114, USA
| | - Anoopum S Gupta
- Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, 02114, USA
| | - Peter Novak
- Department of Neurology, Building for Transformative Medicine Room 10016L, Brigham and Women's Hospital and Harvard Medical School, 60 Fenwood Road, Boston, 02115, USA
| | - Geoffrey S Young
- Department of Radiology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, 02115, USA
| | - Mel B Feany
- Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, 02115, USA
| | - Tarun Singhal
- Department of Neurology, Building for Transformative Medicine Room 10016L, Brigham and Women's Hospital and Harvard Medical School, 60 Fenwood Road, Boston, 02115, USA
| | - Vikram Khurana
- Department of Neurology, Building for Transformative Medicine Room 10016L, Brigham and Women's Hospital and Harvard Medical School, 60 Fenwood Road, Boston, 02115, USA.
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26
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Matsushima M, Nagai A, Nomachi R, Kudo A, Eguchi K, Wakita M, Shirai S, Iwata I, Horiuchi K, Matsuoka T, Ura S, Houzen H, Yabe I. Reliability of the unified multiple system atrophy rating scale using the telephone. Clin Neurol Neurosurg 2024; 237:108147. [PMID: 38325040 DOI: 10.1016/j.clineuro.2024.108147] [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: 04/20/2022] [Revised: 01/26/2024] [Accepted: 01/28/2024] [Indexed: 02/09/2024]
Abstract
OBJECTIVE The unified multiple system atrophy rating scale (UMSARS) was used to evaluate various symptoms of multiple system atrophy (MSA). And UMSARS part 1 was originally developed for use in interviews, but the need for telemedicine is increasing in COVID-19 pandemic. The purpose of this study is to evaluate the reliability of the UMSARS part 1 telephone survey. METHODS Thirty-two MSA patients took the UMSARS part 1 face-to-face, followed by two more telephone evaluations. Intraclass correlation coefficients (ICC) and Cronbach's alpha (α) coefficients were calculated, and the inter-rater reliability was determined. At the same time, we asked about the problems in COVID-19 pandemic. RESULTS The study participants included 15 men and 17 women with mean age of 67.1 years (SD, 8.3). For the total UMSARS part 1 score, the inter-rater ICC and Cronbach's α coefficient were 0.89 to 0.92, and 0.84 to 0.87, respectively. More than half of the items had a relatively high ICC. Cronbach's α coefficients were more than 0.7 for all items. Changes that occurred in COVID-19 pandemic included reduced outings and lack of rehabilitation in about half of the cases. CONCLUSION The UMSARS part 1 has high inter-rater reliability and internal consistency. Evaluation of subjective symptoms showed that some variability could occur. In addition, there was concern about the influence of lack of rehabilitation due to COVID-19 pandemic.
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Affiliation(s)
- Masaaki Matsushima
- Department of Neurology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Japan.
| | - Azusa Nagai
- Department of Neurology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Japan
| | - Rie Nomachi
- Department of Neurology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Japan
| | - Akihiko Kudo
- Department of Neurology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Japan
| | - Katsuki Eguchi
- Department of Neurology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Japan
| | - Masahiro Wakita
- Department of Neurology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Japan
| | - Shinichi Shirai
- Department of Neurology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Japan
| | - Ikuko Iwata
- Department of Neurology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Japan
| | | | | | - Shigehisa Ura
- Department of Neurology, Japanese Red Cross Asahikawa Hospital, Japan
| | - Hideki Houzen
- Department of Neurology, Obihiro Kosei Hospital, Japan
| | - Ichiro Yabe
- Department of Neurology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Japan
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27
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Rahayel S, Postuma R, Baril AA, Misic B, Pelletier A, Soucy JP, Montplaisir J, Dagher A, Gagnon JF. 99mTc-HMPAO SPECT Perfusion Signatures Associated With Clinical Progression in Patients With Isolated REM Sleep Behavior Disorder. Neurology 2024; 102:e208015. [PMID: 38315966 PMCID: PMC10890831 DOI: 10.1212/wnl.0000000000208015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 10/03/2023] [Indexed: 02/07/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Idiopathic/isolated REM sleep behavior disorder (iRBD) is associated with dementia with Lewy bodies and Parkinson disease. Despite evidence of abnormal cerebral perfusion in iRBD, there is currently no pattern that can predict whether an individual will develop dementia with Lewy bodies or Parkinson disease. The objective was to identify a perfusion signature associated with conversion to dementia with Lewy bodies in iRBD. METHODS Patients with iRBD underwent video-polysomnography, neurologic and neuropsychological assessments, and baseline 99mTc-HMPAO SPECT to assess relative cerebral blood flow. Partial least squares correlation was used to identify latent variables that maximized covariance between 27 clinical features and relative gray matter perfusion. Patient-specific scores on the latent variables were used to test the association with conversion to dementia with Lewy bodies compared with that with Parkinson disease. The signature's expression was also assessed in 24 patients with iRBD who underwent a second perfusion scan, 22 healthy controls, and 19 individuals with Parkinson disease. RESULTS Of the 137 participants, 93 underwent SPECT processing, namely 52 patients with iRBD (67.9 years, 73% men), 19 patients with Parkinson disease (67.3 years, 37% men), and 22 controls (67.0 years, 73% men). Of the 47 patients with iRBD followed up longitudinally (4.5 years), 12 (26%) developed a manifest synucleinopathy (4 dementia with Lewy bodies and 8 Parkinson disease). Analysis revealed 2 latent variables between relative blood flow and clinical features: the first was associated with a broad set of features that included motor, cognitive, and perceptual variables, age, and sex; the second was mostly associated with cognitive features and RBD duration. When brought back into the patient's space, the expression of the first variable was associated with conversion to a manifest synucleinopathy, whereas the second was associated with conversion to dementia with Lewy bodies. The expression of the patterns changed over time and was associated with worse motor features. DISCUSSION This study identified a brain perfusion signature associated with cognitive impairment in iRBD and transition to dementia with Lewy bodies. This signature, which can be derived from individual scans, has the potential to be developed into a biomarker that predicts dementia with Lewy bodies in at-risk individuals.
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Affiliation(s)
- Shady Rahayel
- From the Department of Medicine (S.R., A.-A.B.), University of Montreal; Centre for Advanced Research in Sleep Medicine (S.R., R.P., A.-A.B., A.P., J.M., J.-F.G.), CIUSSS-NÎM - Hôpital du Sacré-Cœur de Montréal; Department of Neurology (R.P., A.P.), Montreal General Hospital; The Neuro (Montreal Neurological Institute-Hospital) (B.M., J.-P.S., A.D.), McGill University; Department of Psychiatry (J.M.), University of Montreal; and Department of Psychology (J.-F.G.), Université du Québec à Montréal, Canada
| | - Ronald Postuma
- From the Department of Medicine (S.R., A.-A.B.), University of Montreal; Centre for Advanced Research in Sleep Medicine (S.R., R.P., A.-A.B., A.P., J.M., J.-F.G.), CIUSSS-NÎM - Hôpital du Sacré-Cœur de Montréal; Department of Neurology (R.P., A.P.), Montreal General Hospital; The Neuro (Montreal Neurological Institute-Hospital) (B.M., J.-P.S., A.D.), McGill University; Department of Psychiatry (J.M.), University of Montreal; and Department of Psychology (J.-F.G.), Université du Québec à Montréal, Canada
| | - Andrée-Ann Baril
- From the Department of Medicine (S.R., A.-A.B.), University of Montreal; Centre for Advanced Research in Sleep Medicine (S.R., R.P., A.-A.B., A.P., J.M., J.-F.G.), CIUSSS-NÎM - Hôpital du Sacré-Cœur de Montréal; Department of Neurology (R.P., A.P.), Montreal General Hospital; The Neuro (Montreal Neurological Institute-Hospital) (B.M., J.-P.S., A.D.), McGill University; Department of Psychiatry (J.M.), University of Montreal; and Department of Psychology (J.-F.G.), Université du Québec à Montréal, Canada
| | - Bratislav Misic
- From the Department of Medicine (S.R., A.-A.B.), University of Montreal; Centre for Advanced Research in Sleep Medicine (S.R., R.P., A.-A.B., A.P., J.M., J.-F.G.), CIUSSS-NÎM - Hôpital du Sacré-Cœur de Montréal; Department of Neurology (R.P., A.P.), Montreal General Hospital; The Neuro (Montreal Neurological Institute-Hospital) (B.M., J.-P.S., A.D.), McGill University; Department of Psychiatry (J.M.), University of Montreal; and Department of Psychology (J.-F.G.), Université du Québec à Montréal, Canada
| | - Amélie Pelletier
- From the Department of Medicine (S.R., A.-A.B.), University of Montreal; Centre for Advanced Research in Sleep Medicine (S.R., R.P., A.-A.B., A.P., J.M., J.-F.G.), CIUSSS-NÎM - Hôpital du Sacré-Cœur de Montréal; Department of Neurology (R.P., A.P.), Montreal General Hospital; The Neuro (Montreal Neurological Institute-Hospital) (B.M., J.-P.S., A.D.), McGill University; Department of Psychiatry (J.M.), University of Montreal; and Department of Psychology (J.-F.G.), Université du Québec à Montréal, Canada
| | - Jean-Paul Soucy
- From the Department of Medicine (S.R., A.-A.B.), University of Montreal; Centre for Advanced Research in Sleep Medicine (S.R., R.P., A.-A.B., A.P., J.M., J.-F.G.), CIUSSS-NÎM - Hôpital du Sacré-Cœur de Montréal; Department of Neurology (R.P., A.P.), Montreal General Hospital; The Neuro (Montreal Neurological Institute-Hospital) (B.M., J.-P.S., A.D.), McGill University; Department of Psychiatry (J.M.), University of Montreal; and Department of Psychology (J.-F.G.), Université du Québec à Montréal, Canada
| | - Jacques Montplaisir
- From the Department of Medicine (S.R., A.-A.B.), University of Montreal; Centre for Advanced Research in Sleep Medicine (S.R., R.P., A.-A.B., A.P., J.M., J.-F.G.), CIUSSS-NÎM - Hôpital du Sacré-Cœur de Montréal; Department of Neurology (R.P., A.P.), Montreal General Hospital; The Neuro (Montreal Neurological Institute-Hospital) (B.M., J.-P.S., A.D.), McGill University; Department of Psychiatry (J.M.), University of Montreal; and Department of Psychology (J.-F.G.), Université du Québec à Montréal, Canada
| | - Alain Dagher
- From the Department of Medicine (S.R., A.-A.B.), University of Montreal; Centre for Advanced Research in Sleep Medicine (S.R., R.P., A.-A.B., A.P., J.M., J.-F.G.), CIUSSS-NÎM - Hôpital du Sacré-Cœur de Montréal; Department of Neurology (R.P., A.P.), Montreal General Hospital; The Neuro (Montreal Neurological Institute-Hospital) (B.M., J.-P.S., A.D.), McGill University; Department of Psychiatry (J.M.), University of Montreal; and Department of Psychology (J.-F.G.), Université du Québec à Montréal, Canada
| | - Jean-François Gagnon
- From the Department of Medicine (S.R., A.-A.B.), University of Montreal; Centre for Advanced Research in Sleep Medicine (S.R., R.P., A.-A.B., A.P., J.M., J.-F.G.), CIUSSS-NÎM - Hôpital du Sacré-Cœur de Montréal; Department of Neurology (R.P., A.P.), Montreal General Hospital; The Neuro (Montreal Neurological Institute-Hospital) (B.M., J.-P.S., A.D.), McGill University; Department of Psychiatry (J.M.), University of Montreal; and Department of Psychology (J.-F.G.), Université du Québec à Montréal, Canada
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Siejka TP, Bertram KL, Tang HM, Thyagarajan D, O’Brien TJ, Butzkueven H, Vivash L, Harding IH. Monash-Alfred protocol for assessment of atypical parkinsonian syndromes (MAP-APS). BMJ Neurol Open 2024; 6:e000553. [PMID: 38268757 PMCID: PMC10806876 DOI: 10.1136/bmjno-2023-000553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 11/12/2023] [Indexed: 01/26/2024] Open
Abstract
Introduction Atypical parkinsonian syndromes (APS) are rare neurodegenerative syndromes for which parkinsonism is one significant feature. APS includes progressive supranuclear palsy (PSP), multiple system atrophy (MSA) and corticobasal syndrome (CBS). The diagnosis of APS remains reliant on clinical features with no available diagnostic or prognostic biomarker. Clinical scales remain the gold standard assessment measures in clinical trials and research. The lack of standardised approach for research cohorts has contributed to shortcomings in disease understanding and limits collaboration between researchers. The primary objectives of this study are to (1) establish an assessment protocol for parkinsonian syndromes and (2) to implement it at a single site to establish the viability and utility of populating a clinical and biological databank of patients with APS. Methods The Monash Alfred Protocol for Assessment of APS was devised by expert consensus within a broad multidisciplinary team. Eligible patients are diagnosed as possible or probable PSP, MSA or CBS by a consultant neurologist with expertise in movement disorders. Participants will be assessed at recruitment and then annually for up to 3 years; individuals within 5 years of index symptom onset will also undergo a once-off 6-month assessment. Ethics and dissemination Each participant or their legally authorised representative will provide informed written consent prior to commencement of the study. Data will be stored on a locally hosted Research Electronic Data Capture database. Trial registration number Australian New Zealand Clinical Trials Registry (ANZCTN 12622000923763).
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Affiliation(s)
- Timothy P Siejka
- Monash University Central Clinical School, Melbourne, Victoria, Australia
- Alfred Health Neurology, Melbourne, Victoria, Australia
| | - Kelly L Bertram
- Monash University Central Clinical School, Melbourne, Victoria, Australia
- Alfred Health Neurology, Melbourne, Victoria, Australia
| | - Huiliang M Tang
- Monash University Central Clinical School, Melbourne, Victoria, Australia
- Alfred Health Neurology, Melbourne, Victoria, Australia
| | - Dominic Thyagarajan
- Monash University Central Clinical School, Melbourne, Victoria, Australia
- Alfred Health Neurology, Melbourne, Victoria, Australia
| | - Terence J O’Brien
- Monash University Central Clinical School, Melbourne, Victoria, Australia
- Alfred Health Neurology, Melbourne, Victoria, Australia
| | - Helmut Butzkueven
- Monash University Central Clinical School, Melbourne, Victoria, Australia
- Alfred Health Neurology, Melbourne, Victoria, Australia
| | - Lucy Vivash
- Monash University Central Clinical School, Melbourne, Victoria, Australia
- Alfred Health Neurology, Melbourne, Victoria, Australia
| | - Ian H Harding
- Monash University Central Clinical School, Melbourne, Victoria, Australia
- Alfred Health Neurology, Melbourne, Victoria, Australia
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Villena-Salinas J, Ortega-Lozano SJ, Amrani-Raissouni T, Agüera-Morales E, Caballero-Villarraso J. Comparative Study between the Diagnostic Effectiveness of Brain SPECT with [ 123I]Ioflupane and [ 123I]MIBG Scintigraphy in Multiple System Atrophy. Biomedicines 2024; 12:102. [PMID: 38255208 PMCID: PMC10813386 DOI: 10.3390/biomedicines12010102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 12/23/2023] [Accepted: 12/28/2023] [Indexed: 01/24/2024] Open
Abstract
BACKGROUND Multiple system atrophy (MSA) is a neurodegenerative disease. It has a fast progression, so early diagnosis is decisive. Two functional imaging tests can be involved in its diagnosis: [123I]Ioflupane SPECT and [123I]MIBG scintigraphy. Our aim is to comparatively analyze the diagnostic performance of both techniques. METHODS 46 patients (24 males and 22 females) with MSA underwent [123I]Ioflupane SPECT and [123I]MIBG scintigraphy. In each of these techniques, qualitative assessment was compared with quantitative assessment. RESULTS SPECT visual assessment was positive in 93.5% of subjects (S = 95.24%; PPV = 93.02%). A cut-off of 1.363 was established for overall S/O index (S = 85.7%, E = 100%). Visual assessment of scintigraphy was positive in 73.1% (S = 78.57%, PPV = 94.29%). For the delayed heart/medistinum ratio (HMR) a cut-off of 1.43 (S = 85.3, E = 100%) was obtained. For each unit increase in delayed HMR, the suspicion of MSA increased by 1.58 (OR = 1.58, p < 0.05). The quantitative assessment showed an association with the visual assessment for each technique (p < 0.05). CONCLUSIONS Both tests are useful in MSA diagnosis. Comparatively, we did not observe a clear superiority of either. Striatal and myocardial deterioration do not evolve in parallel. Qualitative assessment is crucial in both techniques, together with the support of quantitative analysis. Delayed HMR shows a direct relationship with the risk of MSA.
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Affiliation(s)
- Javier Villena-Salinas
- Nuclear Medicine Service, Virgen de la Victoria University Hospital, 29010 Málaga, Spain; (J.V.-S.); (S.J.O.-L.); (T.A.-R.)
| | - Simeón José Ortega-Lozano
- Nuclear Medicine Service, Virgen de la Victoria University Hospital, 29010 Málaga, Spain; (J.V.-S.); (S.J.O.-L.); (T.A.-R.)
| | - Tomader Amrani-Raissouni
- Nuclear Medicine Service, Virgen de la Victoria University Hospital, 29010 Málaga, Spain; (J.V.-S.); (S.J.O.-L.); (T.A.-R.)
| | - Eduardo Agüera-Morales
- Neurology Service, Reina Sofia University Hospital, 14004 Cordoba, Spain;
- Maimónides Biomedical Research Institute of Córdoba (IMIBIC), 14004 Córdoba, Spain
| | - Javier Caballero-Villarraso
- Maimónides Biomedical Research Institute of Córdoba (IMIBIC), 14004 Córdoba, Spain
- Clinical Analyses Service, Reina Sofía University Hospital, 14004 Córdoba, Spain
- Department of Biochemistry and Molecular Biology, Universidad of Córdoba, 14071 Córdoba, Spain
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30
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Clement G, Cavillon G, Vuillier F, Bouhaddi M, Béreau M. Unveiling autonomic failure in synucleinopathies: Significance in diagnosis and treatment. Rev Neurol (Paris) 2024; 180:79-93. [PMID: 38216420 DOI: 10.1016/j.neurol.2023.12.004] [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: 10/27/2023] [Revised: 12/19/2023] [Accepted: 12/20/2023] [Indexed: 01/14/2024]
Abstract
Autonomic failure is frequently encountered in synucleinopathies such as multiple system atrophy (MSA), Parkinson's disease (PD), Lewy body disease, and pure autonomic failure (PAF). Cardiovascular autonomic failure affects quality of life and can be life threatening due to the risk of falls and the increased incidence of myocardial infarction, stroke, and heart failure. In PD and PAF, pathogenic involvement is mainly post-ganglionic, while in MSA, the involvement is mainly pre-ganglionic. Cardiovascular tests exploring the autonomic nervous system (ANS) are based on the analysis of continuous, non-invasive recordings of heart rate and digital blood pressure (BP). They assess facets of sympathetic and parasympathetic activities and provide indications on the integrity of the baroreflex arc. The tilt test is widely used in clinical practice. It can be combined with catecholamine level measurement and analysis of baroreflex activity and cardiac variability for a detailed analysis of cardiovascular damage. MIBG myocardial scintigraphy is the most sensitive test for early detection of autonomic dysfunction. It provides a useful measure of post-ganglionic sympathetic fiber integrity and function and is therefore an effective tool for distinguishing PD from other parkinsonian syndromes such as MSA. Autonomic cardiovascular investigations differentiate between certain parkinsonian syndromes that would otherwise be difficult to segregate, particularly in the early stages of the disease. Exploring autonomic failure by gathering information about residual sympathetic tone, low plasma norepinephrine levels, and supine hypertension can guide therapeutic management of orthostatic hypotension (OH).
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Affiliation(s)
- G Clement
- Service de neurologie électrophysiologie clinique, CHU de Besançon, 3, boulevard Alexandre-Fleming, 25030 Besançon cedex, France; Centre expert Parkinson, CHU de Besançon, 3, boulevard Alexandre-Fleming, 25030 Besançon cedex, France.
| | - G Cavillon
- Service de neurologie électrophysiologie clinique, CHU de Besançon, 3, boulevard Alexandre-Fleming, 25030 Besançon cedex, France; Centre expert Parkinson, CHU de Besançon, 3, boulevard Alexandre-Fleming, 25030 Besançon cedex, France
| | - F Vuillier
- Laboratoire d'anatomie, UFR santé, université de Franche-Comté, 19, rue Ambroise-Paré, 25030 Besançon cedex, France
| | - M Bouhaddi
- Laboratoire de physiologie-explorations fonctionnelles, CHU de Besançon, 3, boulevard Alexandre-Fleming, 25030 Besançon cedex, France
| | - M Béreau
- Service de neurologie électrophysiologie clinique, CHU de Besançon, 3, boulevard Alexandre-Fleming, 25030 Besançon cedex, France; Centre expert Parkinson, CHU de Besançon, 3, boulevard Alexandre-Fleming, 25030 Besançon cedex, France
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Savoie FA, Arpin DJ, Vaillancourt DE. Magnetic Resonance Imaging and Nuclear Imaging of Parkinsonian Disorders: Where do we go from here? Curr Neuropharmacol 2024; 22:1583-1605. [PMID: 37533246 DOI: 10.2174/1570159x21666230801140648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 01/11/2023] [Accepted: 01/13/2023] [Indexed: 08/04/2023] Open
Abstract
Parkinsonian disorders are a heterogeneous group of incurable neurodegenerative diseases that significantly reduce quality of life and constitute a substantial economic burden. Nuclear imaging (NI) and magnetic resonance imaging (MRI) have played and continue to play a key role in research aimed at understanding and monitoring these disorders. MRI is cheaper, more accessible, nonirradiating, and better at measuring biological structures and hemodynamics than NI. NI, on the other hand, can track molecular processes, which may be crucial for the development of efficient diseasemodifying therapies. Given the strengths and weaknesses of NI and MRI, how can they best be applied to Parkinsonism research going forward? This review aims to examine the effectiveness of NI and MRI in three areas of Parkinsonism research (differential diagnosis, prodromal disease identification, and disease monitoring) to highlight where they can be most impactful. Based on the available literature, MRI can assist with differential diagnosis, prodromal disease identification, and disease monitoring as well as NI. However, more work is needed, to confirm the value of MRI for monitoring prodromal disease and predicting phenoconversion. Although NI can complement or be a substitute for MRI in all the areas covered in this review, we believe that its most meaningful impact will emerge once reliable Parkinsonian proteinopathy tracers become available. Future work in tracer development and high-field imaging will continue to influence the landscape for NI and MRI.
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Affiliation(s)
- Félix-Antoine Savoie
- Department of Applied Physiology and Kinesiology, Laboratory for Rehabilitation Neuroscience, University of Florida, Gainesville, FL, USA
| | - David J Arpin
- Department of Applied Physiology and Kinesiology, Laboratory for Rehabilitation Neuroscience, University of Florida, Gainesville, FL, USA
| | - David E Vaillancourt
- Department of Applied Physiology and Kinesiology, Laboratory for Rehabilitation Neuroscience, University of Florida, Gainesville, FL, USA
- Department of Neurology, Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, USA
- J. Crayton Pruitt Family Department of Biomedical Engineering, University of Florida, Gainesville, FL, USA
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Zhou H, Wei L, Jiang Y, Wang X, Sun Y, Li F, Chen J, Sun W, Zhang L, Zhao G, Wang Z. Abnormal Ocular Movement in the Early Stage of Multiple-System Atrophy With Predominant Parkinsonism Distinct From Parkinson's Disease. J Clin Neurol 2024; 20:37-45. [PMID: 38179630 PMCID: PMC10782091 DOI: 10.3988/jcn.2023.0037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 04/02/2023] [Accepted: 05/01/2023] [Indexed: 01/06/2024] Open
Abstract
BACKGROUND AND PURPOSE The eye-movement examination can be applied as a noninvasive method to identify multiple-system atrophy (MSA). Few studies have investigated eye movements during the early stage of MSA with predominant parkinsonism (MSA-P). We aimed to determine the characteristic oculomotor changes in the early stage of MSA-P. METHODS We retrospectively selected 17 patients with MSA-P and 40 with Parkinson's disease (PD) with disease durations of less than 2 years, and 40 age-matched healthy controls (HCs). Oculomotor performance in the horizontal direction was measured in detail using videonystagmography. RESULTS We found that the proportions of patients with MSA-P and PD exhibiting abnormal eye movements were 82.4% and 77.5%, respectively, which were significantly higher than that in the HCs (47.5%, p<0.05). Compared with HCs, patients with MSA-P presented significantly higher abnormal proportions of fixation and gaze-holding (17.6% vs. 0%), without-fixation (47.1% vs. 0%), prolonged latency in reflexive saccades (29.4% vs. 5.0%), memory-guided saccades (93.3% vs. 10.0%), and catch-up saccades in smooth-pursuit movement (SPM, 41.2% vs. 0) (all p<0.05). Compared with those with PD, patients with MSA-P presented a significantly higher proportion of catch-up saccades in SPM (41.2% vs. 2.5%, p<0.001). CONCLUSIONS MSA-P presented the characteristic of catch-up saccades in SPM in the early stage, which may provide some value in differentiating MSA-P from PD.
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Affiliation(s)
- Hong Zhou
- Department of Neurology, Peking University First Hospital, Beijing, China
- Department of Neurology, Civil Aviation General Hospital, Beijing, China
| | - Luhua Wei
- Department of Neurology, Peking University First Hospital, Beijing, China
- Beijing Key Laboratory of Neurovascular Disease Discovery, Beijing, China
| | - Yanyan Jiang
- Department of Neurology, Peking University First Hospital, Beijing, China
| | - Xia Wang
- Department of Neurology, Peking University First Hospital, Beijing, China
- Beijing Key Laboratory of Neurovascular Disease Discovery, Beijing, China
| | - Yunchuang Sun
- Department of Neurology, Peking University First Hospital, Beijing, China
- Beijing Key Laboratory of Neurovascular Disease Discovery, Beijing, China
| | - Fan Li
- Department of Neurology, Peking University First Hospital, Beijing, China
- Beijing Key Laboratory of Neurovascular Disease Discovery, Beijing, China
| | - Jing Chen
- Department of Neurology, Peking University First Hospital, Beijing, China
- Beijing Key Laboratory of Neurovascular Disease Discovery, Beijing, China
| | - Wei Sun
- Department of Neurology, Peking University First Hospital, Beijing, China
- Beijing Key Laboratory of Neurovascular Disease Discovery, Beijing, China
| | - Lin Zhang
- Department of Neurology, UC Davis Medical Center, Sacramento, CA, USA
| | - Guiping Zhao
- Department of Neurology, Peking University First Hospital, Beijing, China
- Beijing Key Laboratory of Neurovascular Disease Discovery, Beijing, China.
| | - Zhaoxia Wang
- Department of Neurology, Peking University First Hospital, Beijing, China
- Beijing Key Laboratory of Neurovascular Disease Discovery, Beijing, China.
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Li X, Bai J, Guo X, Mu Y, Di Z, Zhang G, Wang B, Zhang Y, Liu X, Shi Y, Lin S, Wu L, Bai Y, Liu X. Identifying New Subtypes of Multiple System Atrophy Using Cluster Analysis. JOURNAL OF PARKINSON'S DISEASE 2024; 14:777-795. [PMID: 38640168 PMCID: PMC11191464 DOI: 10.3233/jpd-230344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/10/2024] [Indexed: 04/21/2024]
Abstract
Background Multiple system atrophy (MSA) is a disease with diverse symptoms and the commonly used classifications, MSA-P and MSA-C, do not cover all the different symptoms seen in MSA patients. Additionally, these classifications do not provide information about how the disease progresses over time or the expected outcome for patients. Objective To explore clinical subtypes of MSA with a natural disease course through a data-driven approach to assist in the diagnosis and treatment of MSA. Methods We followed 122 cases of MSA collected from 3 hospitals for 3 years. Demographic characteristics, age of onset, clinical signs, scale assessment scores, and auxiliary examination were collected. Age at onset; time from onset to assisted ambulation; and UMSARS I, II, and IV, COMPASS-31, ICARS, and UPDRS III scores were selected as clustering elements. K-means, partitioning around medoids, and self-organizing maps were used to analyze the clusters. Results The results of all three clustering methods supported the classification of three MSA subtypes: The aggressive progression subtype (MSA-AP), characterized by mid-to-late onset, rapid progression and severe clinical symptoms; the typical subtype (MSA-T), characterized by mid-to-late onset, moderate progression and moderate severity of clinical symptoms; and the early-onset slow progression subtype (MSA-ESP), characterized by early-to-mid onset, slow progression and mild clinical symptoms. Conclusions We divided MSA into three subtypes and summarized the characteristics of each subtype. According to the clustering results, MSA patients were divided into three completely different types according to the severity of symptoms, the speed of disease progression, and the age of onset.
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Affiliation(s)
- Xiaobing Li
- Department of Neurology, Xijing Hospital, Air Force Medical University, Xi’an, Shaanxi, China
| | - Jing Bai
- Department of Neurology, Xijing Hospital, Air Force Medical University, Xi’an, Shaanxi, China
| | - Xin Guo
- Department of Neurology, Xijing Hospital, Air Force Medical University, Xi’an, Shaanxi, China
| | - Yaqian Mu
- Department of Neurology, Xijing Hospital, Air Force Medical University, Xi’an, Shaanxi, China
| | - Zhengli Di
- Department of Neurology, Xi’an Central Hospital, Xi’an, Shaanxi, China
| | - Gejuan Zhang
- Department of Neurology, Xi’an Third Hospital, Xi’an, Shaanxi, China
| | - Bo Wang
- Department of Epidemiology, Air Force Medical University, School of Public Health, Xi’an, Shaanxi, China
| | - Yun Zhang
- Department of Neurology, Xi’an Ninth Hospital, Xi’an, Shaanxi, China
| | - Xinyao Liu
- Department of Neurology, Xijing Hospital, Air Force Medical University, Xi’an, Shaanxi, China
| | - Yan Shi
- Department of Neurology, Xijing Hospital, Air Force Medical University, Xi’an, Shaanxi, China
| | - Shinuan Lin
- GYENNO Science Co., Ltd., Shenzhen, Guangdong, China
- HUST – GYENNO CNS, Intelligent Digital Medicine Technology Center, Wuhan, China
| | - Linyu Wu
- GYENNO Science Co., Ltd., Shenzhen, Guangdong, China
- HUST – GYENNO CNS, Intelligent Digital Medicine Technology Center, Wuhan, China
| | - Ya Bai
- Department of Neurology, Xijing Hospital, Air Force Medical University, Xi’an, Shaanxi, China
| | - Xuedong Liu
- Department of Neurology, Xijing Hospital, Air Force Medical University, Xi’an, Shaanxi, China
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Rau A, Hosp JA, Rijntjes M, Weiller C, Kellner E, Berberovic E, Oikonomou P, Jost WH, Reisert M, Urbach H, Schröter N. Cerebellar, Not Nigrostriatal Degeneration Impairs Dexterity in Multiple System Atrophy. Mov Disord 2024; 39:130-140. [PMID: 38013497 DOI: 10.1002/mds.29661] [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: 07/13/2023] [Accepted: 10/30/2023] [Indexed: 11/29/2023] Open
Abstract
BACKGROUND Multiple system atrophy (MSA) clinically manifests with either predominant nigrostriatal or cerebellopontine degeneration. This corresponds to two different phenotypes, one with predominant Parkinson's symptoms (MSA-P [multiple system atrophy-parkinsonian subtype]) and one with predominant cerebellar deficits (MSA-C [multiple system atrophy-cerebellar subtype]). Both nigrostriatal and cerebellar degeneration can lead to impaired dexterity, which is a frequent cause of disability in MSA. OBJECTIVE The aim was to disentangle the contribution of nigrostriatal and cerebellar degeneration to impaired dexterity in both subtypes of MSA. METHODS We thus investigated nigrostriatal and cerebellopontine integrity using diffusion microstructure imaging in 47 patients with MSA-P and 17 patients with MSA-C compared to 31 healthy controls (HC). Dexterity was assessed using the 9-Hole Peg Board (9HPB) performance. RESULTS Nigrostriatal degeneration, represented by the loss of cells and neurites, leading to a larger free-fluid compartment, was present in MSA-P and MSA-C when compared to HCs. Whereas no intergroup differences were observed between the MSAs in the substantia nigra, MSA-P showed more pronounced putaminal degeneration than MSA-C. In contrast, a cerebellopontine axonal degeneration was observed in MSA-P and MSA-C, with stronger effects in MSA-C. Interestingly, the degeneration of cerebellopontine fibers is associated with impaired dexterity in both subtypes, whereas no association was observed with nigrostriatal degeneration. CONCLUSION Cerebellar dysfunction contributes to impaired dexterity not only in MSA-C but also in MSA-P and may be a promising biomarker for disease staging. In contrast, no significant association was observed with nigrostriatal dysfunction. © 2023 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Alexander Rau
- Department of Neuroradiology, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Department of Diagnostic and Interventional Radiology, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Jonas A Hosp
- Department of Neurology and Clinical Neuroscience, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Michel Rijntjes
- Department of Neurology and Clinical Neuroscience, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Cornelius Weiller
- Department of Neurology and Clinical Neuroscience, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Elias Kellner
- Medical Physics, Department of Diagnostic and Interventional Radiology, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | | | | | | | - Marco Reisert
- Medical Physics, Department of Diagnostic and Interventional Radiology, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Department of Stereotactic and Functional Neurosurgery, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Horst Urbach
- Department of Neuroradiology, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Nils Schröter
- Department of Neurology and Clinical Neuroscience, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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Krismer F, Péran P, Beliveau V, Seppi K, Arribarat G, Pavy-Le Traon A, Meissner WG, Foubert-Samier A, Fabbri M, Schocke MM, Gordon MF, Wenning GK, Poewe W, Rascol O, Scherfler C. Progressive Brain Atrophy in Multiple System Atrophy: A Longitudinal, Multicenter, Magnetic Resonance Imaging Study. Mov Disord 2024; 39:119-129. [PMID: 37933745 DOI: 10.1002/mds.29633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Revised: 08/27/2023] [Accepted: 09/28/2023] [Indexed: 11/08/2023] Open
Abstract
OBJECTIVE To determine the rates of brain atrophy progression in vivo in patients with multiple system atrophy (MSA). BACKGROUND Surrogate biomarkers of disease progression are a major unmet need in MSA. Small-scale longitudinal studies in patients with MSA using magnetic resonance imaging (MRI) to assess progression of brain atrophy have produced inconsistent results. In recent years, novel MRI post-processing methods have been developed enabling reliable quantification of brain atrophy in an automated fashion. METHODS Serial 3D-T1-weighted MRI assessments (baseline and after 1 year of follow-up) of 43 patients with MSA were analyzed and compared to a cohort of early-stage Parkinson's disease (PD) patients and healthy controls (HC). FreeSurfer's longitudinal analysis stream was used to determine the brain atrophy rates in an observer-independent fashion. RESULTS Mean ages at baseline were 64.4 ± 8.3, 60.0 ± 7.5, and 59.8 ± 9.2 years in MSA, PD patients and HC, respectively. A mean disease duration at baseline of 4.1 ± 2.5 years in MSA patients and 2.3 ± 1.4 years in PD patients was observed. Brain regions chiefly affected by MSA pathology showed progressive atrophy with annual rates of atrophy for the cerebellar cortex, cerebellar white matter, pons, and putamen of -4.24 ± 6.8%, -8.22 ± 8.8%, -4.67 ± 4.9%, and - 4.25 ± 4.9%, respectively. Similar to HC, atrophy rates in PD patients were minimal with values of -0.41% ± 1.8%, -1.47% ± 4.1%, -0.04% ± 1.8%, and -1.54% ± 2.2% for cerebellar cortex, cerebellar white matter, pons, and putamen, respectively. CONCLUSIONS Patients with MSA show significant brain volume loss over 12 months, and cerebellar, pontine, and putaminal volumes were the most sensitive to change in mid-stage disease. © 2023 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Florian Krismer
- Department of Neurology, Medical University Innsbruck, Innsbruck, Austria
- Neuroimaging Research Core Facility, Medical University Innsbruck, Innsbruck, Austria
| | - Patrice Péran
- ToNIC, Toulouse NeuroImaging Center, Université de Toulouse, INSERM, UPS, Toulouse, France
| | - Vincent Beliveau
- Department of Neurology, Medical University Innsbruck, Innsbruck, Austria
- Neuroimaging Research Core Facility, Medical University Innsbruck, Innsbruck, Austria
| | - Klaus Seppi
- Department of Neurology, Medical University Innsbruck, Innsbruck, Austria
- Neuroimaging Research Core Facility, Medical University Innsbruck, Innsbruck, Austria
| | - Germain Arribarat
- ToNIC, Toulouse NeuroImaging Center, Université de Toulouse, INSERM, UPS, Toulouse, France
| | - Anne Pavy-Le Traon
- French Reference Center for MSA, Neurology Department, University Hospital of Toulouse and INSERM-Institute of Cardiovascular and Metabolic Diseases (I2MC) UMR1297, Toulouse, France
| | - Wassilios G Meissner
- CHU Bordeaux, Service de Neurologie des Maladies Neurodégénératives, IMNc, CRMR AMS, Bordeaux, France
- University of Bordeaux, CNRS, IMN, UMR 5293, Bordeaux, France
- Department of Medicine, University of Otago, Christchurch, and New Zealand Brain Research Institute, Christchurch, New Zealand
| | - Alexandra Foubert-Samier
- CHU Bordeaux, Service de Neurologie des Maladies Neurodégénératives, IMNc, CRMR AMS, Bordeaux, France
- University of Bordeaux, CNRS, IMN, UMR 5293, Bordeaux, France
- INSERM, UMR1219, Bordeaux Population Health Research Center, University of Bordeaux, ISPED, Bordeaux, France
| | - Margherita Fabbri
- French Reference Center for MSA, Clinical Investigation Center CIC1436, Departments of Clinical Pharmacology and Neurosciences, NS-Park/FCRIN Network and NeuroToul Center of Excellence for Neurodegeneration, INSERM, University Hospital of Toulouse and University of Toulouse, Toulouse, France
| | - Michael M Schocke
- Neuroimaging Research Core Facility, Medical University Innsbruck, Innsbruck, Austria
| | | | - Gregor K Wenning
- Department of Neurology, Medical University Innsbruck, Innsbruck, Austria
| | - Werner Poewe
- Department of Neurology, Medical University Innsbruck, Innsbruck, Austria
- Neuroimaging Research Core Facility, Medical University Innsbruck, Innsbruck, Austria
| | - Olivier Rascol
- French Reference Center for MSA, Clinical Investigation Center CIC1436, Departments of Clinical Pharmacology and Neurosciences, NS-Park/FCRIN Network and NeuroToul Center of Excellence for Neurodegeneration, INSERM, University Hospital of Toulouse and University of Toulouse, Toulouse, France
| | - Christoph Scherfler
- Department of Neurology, Medical University Innsbruck, Innsbruck, Austria
- Neuroimaging Research Core Facility, Medical University Innsbruck, Innsbruck, Austria
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Bartošová T, Klempíř J, Hansíková H. Coenzyme Q10: A Biomarker in the Differential Diagnosis of Parkinsonian Syndromes. Antioxidants (Basel) 2023; 12:2104. [PMID: 38136223 PMCID: PMC10740444 DOI: 10.3390/antiox12122104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 12/08/2023] [Accepted: 12/10/2023] [Indexed: 12/24/2023] Open
Abstract
Multiple system atrophy (MSA) is generally a sporadic neurodegenerative disease which ranks among atypical Parkinson's syndromes. The main clinical manifestation is a combination of autonomic dysfunction and parkinsonism and/or cerebellar disability. The disease may resemble other Parkinsonian syndromes, such as Parkinson's disease (PD) or progressive supranuclear palsy (PSP), from which MSA could be hardly distinguishable during the first years of progression. Due to the lack of a reliable and easily accessible biomarker, the diagnosis is still based primarily on the clinical picture. Recently, reduced levels of coenzyme Q10 (CoQ10) were described in MSA in various tissues, including the central nervous system. The aim of our study was to verify whether the level of CoQ10 in plasma and lymphocytes could serve as an easily available diagnostic biomarker of MSA. The study reported significantly lower levels of CoQ10 in the lymphocytes of patients with MSA compared to patients with PD and controls. The reduction in CoQ10 levels in lymphocytes correlated with the increasing degree of clinical involvement of patients with MSA. CoQ10 levels in lymphocytes seem to be a potential biomarker of disease progression.
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Affiliation(s)
- Tereza Bartošová
- Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital in Prague, 121 08 Prague, Czech Republic; (T.B.); (J.K.)
| | - Jiří Klempíř
- Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital in Prague, 121 08 Prague, Czech Republic; (T.B.); (J.K.)
| | - Hana Hansíková
- Laboratory for Study of Mitochondrial Disorders, Department of Pediatrics and Inherited Metabolic Disorders, First Faculty of Medicine, Charles University and General University Hospital in Prague, 128 08 Prague, Czech Republic
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Singer W, Schmeichel AM, Sletten DM, Gehrking TL, Gehrking JA, Trejo-Lopez J, Suarez MD, Anderson JK, Bass PH, Lesnick TG, Low PA. Neurofilament light chain in spinal fluid and plasma in multiple system atrophy: a prospective, longitudinal biomarker study. Clin Auton Res 2023; 33:635-645. [PMID: 37603107 PMCID: PMC10840936 DOI: 10.1007/s10286-023-00974-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 08/10/2023] [Indexed: 08/22/2023]
Abstract
PURPOSE There is a critical need for reliable diagnostic biomarkers as well as surrogate markers of disease progression in multiple system atrophy (MSA). Neurofilament light chain (NfL) has been reported to potentially meet those needs. We therefore sought to explore the value of NfL in plasma (NfL-p) in contrast to cerebrospinal fluid (NfL-c) as a diagnostic marker of MSA, and to assess NfL-p and NfL-c as markers of clinical disease progression. METHODS Well-characterized patients with early MSA (n = 32), Parkinson's disease (PD; n = 21), and matched controls (CON; n = 15) were enrolled in a prospective, longitudinal study of synucleinopathies with serial annual evaluations. NfL was measured using a high-sensitivity immunoassay, and findings were assessed by disease category and relationship with clinical measures of disease progression. RESULTS Measurements of NfL-c were highly reproducible across immunoassay platforms (Pearson, r = 0.99), while correlation between NfL-c and -p was only moderate (r = 0.66). NfL was significantly higher in MSA compared with CON and PD; the separation was essentially perfect for NfL-c, but there was overlap, particularly with PD, for NfL-p. While clinical measures of disease severity progressively increased over time, NfL-c and -p remained at stable elevated levels within subjects across serial measurements. Neither change in NfL nor baseline NfL were significantly associated with changes in clinical markers of disease severity. CONCLUSIONS These findings confirm NfL-c as a faithful diagnostic marker of MSA, while NfL-p showed less robust diagnostic value. The significant NfL elevation in MSA was found to be remarkably stable over time and was not predictive of clinical disease progression.
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Affiliation(s)
- Wolfgang Singer
- Department of Neurology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
| | - Ann M Schmeichel
- Department of Neurology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - David M Sletten
- Department of Neurology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Tonette L Gehrking
- Department of Neurology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Jade A Gehrking
- Department of Neurology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Jorge Trejo-Lopez
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Mariana D Suarez
- Department of Neurology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Jennifer K Anderson
- Department of Neurology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Pamela H Bass
- Department of Neurology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Timothy G Lesnick
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | - Phillip A Low
- Department of Neurology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
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38
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Zhang L, Hou Y, Li C, Wei Q, Ou R, Liu K, Lin J, Yang T, Xiao Y, Jiang Q, Zhao B, Shang H. Longitudinal evolution of sleep disturbances in early multiple system atrophy: a 2-year prospective cohort study. BMC Med 2023; 21:454. [PMID: 37993943 PMCID: PMC10664599 DOI: 10.1186/s12916-023-03176-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 11/14/2023] [Indexed: 11/24/2023] Open
Abstract
BACKGROUND The progression of sleep disturbances remains unclear in patients with early multiple system atrophy (MSA). We aimed to explore the frequency, severity, and coexistence of 2-year longitudinal changes of sleep disturbances including REM sleep behavior disorder (RBD), excessive daytime sleepiness (EDS), and Parkinson's disease-related sleep problems (PD-SP) in early MSA. METHODS MSA patients with a disease duration < 3 years were enrolled to complete a 2-year follow-up visit. Sleep disturbances including RBD, EDS, and PD-SP were assessed using the RBD Screening Questionnaire, Epworth sleepiness scale, and PD sleep scale-2, respectively. RESULTS A total of 220 patients with MSA enrolled in the study and 90 patients completed the 2-year follow-up visit. The score of all three sleep disturbances significantly increased over the 2-year follow-up in MSA and MSA with the predominant parkinsonism group (all p < 0.05). The frequency of PD-SP (from 14.5 to 26.7%) and EDS (from 17.7 to 37.8%) was progressively increased (all p < 0.05) except for RBD (from 51.8 to 65.6%, p = 0.152) over the 2-year follow-up in MSA. The frequency of coexistence of two or three sleep disturbances also increased over time. The most common sleep disturbance was RBD, followed by EDS and PD-SP over the 2-year follow-up. CONCLUSIONS The present study demonstrated that the frequency of different types of sleep disturbances progressively increased except for RBD and the coexistence of two or three sleep disturbances became more common over time in early MSA. Our study suggested that the assessment and management of sleep disturbances should begin early in MSA.
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Affiliation(s)
- Lingyu Zhang
- Department of Neurology, Laboratory of Neurodegenerative Disorders, Rare Diseases Center, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
- Health Management Center, General Practice Medical Center, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, China
| | - Yanbing Hou
- Department of Neurology, Laboratory of Neurodegenerative Disorders, Rare Diseases Center, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Chunyu Li
- Department of Neurology, Laboratory of Neurodegenerative Disorders, Rare Diseases Center, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Qianqian Wei
- Department of Neurology, Laboratory of Neurodegenerative Disorders, Rare Diseases Center, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Ruwei Ou
- Department of Neurology, Laboratory of Neurodegenerative Disorders, Rare Diseases Center, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Kuncheng Liu
- Department of Neurology, Laboratory of Neurodegenerative Disorders, Rare Diseases Center, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Junyu Lin
- Department of Neurology, Laboratory of Neurodegenerative Disorders, Rare Diseases Center, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Tianmi Yang
- Department of Neurology, Laboratory of Neurodegenerative Disorders, Rare Diseases Center, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Yi Xiao
- Department of Neurology, Laboratory of Neurodegenerative Disorders, Rare Diseases Center, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Qirui Jiang
- Department of Neurology, Laboratory of Neurodegenerative Disorders, Rare Diseases Center, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Bi Zhao
- Department of Neurology, Laboratory of Neurodegenerative Disorders, Rare Diseases Center, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Huifang Shang
- Department of Neurology, Laboratory of Neurodegenerative Disorders, Rare Diseases Center, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China.
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Carmona-Abellan M, Del Pino R, Murueta-Goyena A, Acera M, Tijero B, Berganzo K, Gabilondo I, Gómez-Esteban JC. Multiple system atrophy: Clinical, evolutive and histopathological characteristics of a series of cases. Neurologia 2023; 38:609-616. [PMID: 37996211 DOI: 10.1016/j.nrleng.2021.04.008] [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: 12/02/2020] [Accepted: 04/06/2021] [Indexed: 11/25/2023] Open
Abstract
BACKGROUND AND OBJECTIVE Multiple system atrophy is a rare and fatal neurodegenerative disorder, characterized by autonomic dysfunction in association with either parkinsonism or cerebellar signs. The pathologic hallmark is the presence of alpha-synuclein aggregates in oligodendrocytes, forming glial cytoplasmic inclusions. Clinically, it may be difficult to distinguish form other parkinsonisms or ataxias, particularly in the early stages of the disease. In this case series we aim to describe in detail the features of MSA patients. MATERIAL AND METHODS Unified MSA Rating Scale (UMSARS) score, structural and functional imaging and cardiovascular autonomic testing, are summarized since early stages of the disease. RESULTS UMSARS proved to be useful to perform a follow-up being longitudinal examination essential to stratify risk of poor outcome. Neuropathological diagnosis showed an overlap between parkinsonian and cerebellar subtypes, with some peculiarities that could help to distinguish from other subtypes. CONCLUSION A better description of MSA features with standardized test confirmed by means of neuropathological studies could help to increase sensitivity.
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Affiliation(s)
- M Carmona-Abellan
- Neurodegenerative Diseases Division, Health Research Institute Biocruces, Barakaldo, Bizkaia, Spain.
| | - R Del Pino
- Neurodegenerative Diseases Division, Health Research Institute Biocruces, Barakaldo, Bizkaia, Spain
| | - A Murueta-Goyena
- Neurodegenerative Diseases Division, Health Research Institute Biocruces, Barakaldo, Bizkaia, Spain
| | - M Acera
- Neurodegenerative Diseases Division, Health Research Institute Biocruces, Barakaldo, Bizkaia, Spain
| | - B Tijero
- Neurodegenerative Diseases Division, Health Research Institute Biocruces, Barakaldo, Bizkaia, Spain; Hospital Universitario de Cruces, Barakaldo, Bizkaia, Spain
| | - K Berganzo
- Hospital Universitario de Basurto, Bilbao, Bizkaia, Spain
| | - I Gabilondo
- Neurodegenerative Diseases Division, Health Research Institute Biocruces, Barakaldo, Bizkaia, Spain; Hospital Universitario de Cruces, Barakaldo, Bizkaia, Spain; Ikerbasque, The Basque Foundation for Science, Spain
| | - J C Gómez-Esteban
- Neurodegenerative Diseases Division, Health Research Institute Biocruces, Barakaldo, Bizkaia, Spain; Hospital Universitario de Cruces, Barakaldo, Bizkaia, Spain
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Di Luca DG, Ramirez-Gomez C, Germann J, Santyr B, Boutet A, Milosevic L, Lang AE, Kalia SK, Lozano AM, Fasano A. Deep Brain Stimulation of the Globus Pallidus Internus and Externus in Multiple System Atrophy. Mov Disord 2023; 38:2121-2125. [PMID: 37544011 DOI: 10.1002/mds.29573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 06/17/2023] [Accepted: 07/20/2023] [Indexed: 08/08/2023] Open
Abstract
BACKGROUND Multiple system atrophy with parkinsonism (MSA-P) is a progressive condition with no effective treatment. OBJECTIVE The aim of this study was to describe the safety and efficacy of deep brain stimulation (DBS) of globus pallidus pars interna and externa in a cohort of patients with MSA-P. METHODS Six patients were included. Changes in Movement Disorders Society Unified Parkinson's Disease Rating Scale Part III (MDS-UPDRS III), Parkinson's Disease Questionnaire (PDQ-39) scores, and levodopa equivalent daily dose were compared before and after DBS. Electrode localization and volume tissue activation were calculated. RESULTS DBS surgery did not result in any major adverse events or intraoperative complications. Overall, no differences in MDS-UPDRS III scores were demonstrated (55.2 ± 17.6 preoperatively compared with 67.3 ± 19.2 at 1 year after surgery), although transient improvement in mobility and dyskinesia was reported in some subjects. CONCLUSIONS Globus pallidus pars interna and externa DBS for patients with MSA-P did not result in major complications, although it did not provide significant clinical benefit as measured by MDS-UPDRS III. © 2023 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Daniel G Di Luca
- Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, UHN, Toronto, Ontario, Canada
- Division of Neurology, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Department of Neurology, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Carolina Ramirez-Gomez
- Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, UHN, Toronto, Ontario, Canada
- Division of Neurology, University of Toronto, Toronto, Ontario, Canada
| | - Jurgen Germann
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Brendan Santyr
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Alexandre Boutet
- Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
| | - Luka Milosevic
- Institute of Biomedical Engineering, University of Toronto, Toronto, Ontario, Canada
- Institute of Medical Sciences, University of Toronto, Toronto, Ontario, Canada
- Krembil Brain Institute, Toronto, Ontario, Canada
- Center for Advancing Neurotechnological Innovation to Application, Toronto, Ontario, Canada
| | - Anthony E Lang
- Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, UHN, Toronto, Ontario, Canada
- Krembil Brain Institute, Toronto, Ontario, Canada
| | - Suneil K Kalia
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
- Krembil Brain Institute, Toronto, Ontario, Canada
- Center for Advancing Neurotechnological Innovation to Application, Toronto, Ontario, Canada
| | - Andres M Lozano
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
- Krembil Brain Institute, Toronto, Ontario, Canada
- Center for Advancing Neurotechnological Innovation to Application, Toronto, Ontario, Canada
| | - Alfonso Fasano
- Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, UHN, Toronto, Ontario, Canada
- Division of Neurology, University of Toronto, Toronto, Ontario, Canada
- Krembil Brain Institute, Toronto, Ontario, Canada
- Center for Advancing Neurotechnological Innovation to Application, Toronto, Ontario, Canada
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Xiao Y, Zhang L, Wei Q, Ou R, Hou Y, Liu K, Lin J, Yang T, Qirui J, Shang H. Modified version of unified multiple system atrophy rating scale for remote video-based assessments. NPJ Parkinsons Dis 2023; 9:147. [PMID: 37891215 PMCID: PMC10611709 DOI: 10.1038/s41531-023-00590-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 10/11/2023] [Indexed: 10/29/2023] Open
Abstract
We modified the original Unified Multiple System Atrophy Rating Scale (UMSARS) for remote video-based visits by excluding ocular motor dysfunction, increased tone, and body sway, resulting in a 23-item UMSARS (mUMSARS-23). The mUMSARS-23 demonstrated excellent reliability and strong validity when compared to the original scale, making it a promising tool for conducting video-based virtual assessments in patients with multiple system atrophy.
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Affiliation(s)
- Yi Xiao
- Department of Neurology, Rare Disease Center, Laboratory of Neurodegenerative Disorders, National Clinical Research Center for Geriatric, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Lingyu Zhang
- Health Management Center, West China Hospital of Sichuan University, Chengdu, China
| | - Qianqian Wei
- Department of Neurology, Rare Disease Center, Laboratory of Neurodegenerative Disorders, National Clinical Research Center for Geriatric, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Ruwei Ou
- Department of Neurology, Rare Disease Center, Laboratory of Neurodegenerative Disorders, National Clinical Research Center for Geriatric, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yanbing Hou
- Department of Neurology, Rare Disease Center, Laboratory of Neurodegenerative Disorders, National Clinical Research Center for Geriatric, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Kuncheng Liu
- Department of Neurology, Rare Disease Center, Laboratory of Neurodegenerative Disorders, National Clinical Research Center for Geriatric, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Junyu Lin
- Department of Neurology, Rare Disease Center, Laboratory of Neurodegenerative Disorders, National Clinical Research Center for Geriatric, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Tianmi Yang
- Department of Neurology, Rare Disease Center, Laboratory of Neurodegenerative Disorders, National Clinical Research Center for Geriatric, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Jiang Qirui
- Department of Neurology, Rare Disease Center, Laboratory of Neurodegenerative Disorders, National Clinical Research Center for Geriatric, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Huifang Shang
- Department of Neurology, Rare Disease Center, Laboratory of Neurodegenerative Disorders, National Clinical Research Center for Geriatric, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
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Proust-Lima C, Saulnier T, Philipps V, Traon APL, Péran P, Rascol O, Meissner WG, Foubert-Samier A. Describing complex disease progression using joint latent class models for multivariate longitudinal markers and clinical endpoints. Stat Med 2023; 42:3996-4014. [PMID: 37461227 DOI: 10.1002/sim.9844] [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: 02/10/2022] [Revised: 01/31/2023] [Accepted: 06/26/2023] [Indexed: 09/05/2023]
Abstract
Neurodegenerative diseases are characterized by numerous markers of progression and clinical endpoints. For instance, multiple system atrophy (MSA), a rare neurodegenerative synucleinopathy, is characterized by various combinations of progressive autonomic failure and motor dysfunction, and a very poor prognosis. Describing the progression of such complex and multi-dimensional diseases is particularly difficult. One has to simultaneously account for the assessment of multivariate markers over time, the occurrence of clinical endpoints, and a highly suspected heterogeneity between patients. Yet, such description is crucial for understanding the natural history of the disease, staging patients diagnosed with the disease, unravelling subphenotypes, and predicting the prognosis. Through the example of MSA progression, we show how a latent class approach modeling multiple repeated markers and clinical endpoints can help describe complex disease progression and identify subphenotypes for exploring new pathological hypotheses. The proposed joint latent class model includes class-specific multivariate mixed models to handle multivariate repeated biomarkers possibly summarized into latent dimensions and class-and-cause-specific proportional hazard models to handle time-to-event data. Maximum likelihood estimation procedure, validated through simulations is available in the lcmm R package. In the French MSA cohort comprising data of 598 patients during up to 13 years, five subphenotypes of MSA were identified that differ by the sequence and shape of biomarkers degradation, and the associated risk of death. In posterior analyses, the five subphenotypes were used to explore the association between clinical progression and external imaging and fluid biomarkers, while properly accounting for the uncertainty in the subphenotypes membership.
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Affiliation(s)
- Cécile Proust-Lima
- Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, U1219, Bordeaux, France
- Inserm, CIC1401-EC, Bordeaux, France
| | - Tiphaine Saulnier
- Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, U1219, Bordeaux, France
| | - Viviane Philipps
- Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, U1219, Bordeaux, France
| | - Anne Pavy-Le Traon
- MSA Reference Center and CIC-1436, Department of Clinical Pharmacology and Neurosciences, NeuroToul COEN Center, University of Toulouse 3, CHU of Toulouse, INSERM, Toulouse, France
| | - Patrice Péran
- ToNIC, Toulouse NeuroImaging Center, Univ Toulouse, Inserm, UPS, Toulouse, France
| | - Olivier Rascol
- MSA Reference Center and CIC-1436, Department of Clinical Pharmacology and Neurosciences, NeuroToul COEN Center, University of Toulouse 3, CHU of Toulouse, INSERM, Toulouse, France
| | - Wassilios G Meissner
- Univ. Bordeaux, CNRS, IMN, UMR5293, Bordeaux, France
- Dept. Medicine, University of Otago, Christchurch, and New Zealand Brain Research Institute, Christchurch, New Zealand
| | - Alexandra Foubert-Samier
- Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, U1219, Bordeaux, France
- Inserm, CIC1401-EC, Bordeaux, France
- Univ. Bordeaux, CNRS, IMN, UMR5293, Bordeaux, France
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Peng L, Wan L, Liu M, Long Z, Chen D, Yuan X, Tang Z, Fu Y, Zhu S, Lei L, Wang C, Peng H, Shi Y, He L, Yuan H, Wan N, Hou X, Xia K, Li J, Chen C, Qiu R, Tang B, Chen Z, Jiang H. Diagnostic and prognostic performance of plasma neurofilament light chain in multiple system atrophy: a cross-sectional and longitudinal study. J Neurol 2023; 270:4248-4261. [PMID: 37184660 DOI: 10.1007/s00415-023-11741-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 04/22/2023] [Accepted: 04/24/2023] [Indexed: 05/16/2023]
Abstract
BACKGROUND The longitudinal dynamics of neurofilament light chain (NfL) in multiple system atrophy (MSA) were incompletely illuminated. This study aimed to explore whether the plasma NfL (pNfL) could serve as a potential biomarker of clinical diagnosis and disease progression for MSA. METHODS We quantified pNfL concentrations in both a large cross-sectional cohort with 214 MSA individuals, 65 PD individuals, and 211 healthy controls (HC), and a longitudinal cohort of 84 MSA patients. Propensity score matching (PSM) was used to balance the age between the three groups. The pNfL levels between groups were compared using Kruskal-Wallis test. Linear mixed models were performed to explore the disease progression-associated factors in longitudinal MSA cohort. Random forest model as a complement to linear models was employed to quantify the importance of predictors. RESULTS Before and after matching the age by PSM, the pNfL levels could reliably differentiate MSA from HC and PD groups, but only had mild potential to distinguish PD from HC. By combining linear and nonlinear models, we demonstrated that pNfL levels at baseline, rather than the change rate of pNfL, displayed potential prognostic value for progression of MSA. The combination of baseline pNfL levels and other modifiers, such as subtypes, Hoehn-Yahr stage at baseline, was first shown to improve the diagnosis accuracy. CONCLUSIONS Our study contributed to a better understanding of longitudinal dynamics of pNfL in MSA, and validated the values of pNfL as a non-invasive sensitive biomarker for the diagnosis and progression. The combination of pNfL and other factors is recommended for better monitoring and prediction of MSA progression.
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Affiliation(s)
- Linliu Peng
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China
| | - Linlin Wan
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China
- Key Laboratory of Hunan Province in Neurodegenerative Disorders, Central South University, Changsha, 410008, Hunan, China
- Department of Radiology, Xiangya Hospital, Central South University, Changsha, Hunan, China
- National International Collaborative Research Center for Medical Metabolomics, Central South University, Changsha, 410008, Hunan, China
| | - Mingjie Liu
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China
- Department of Neurology, the Affiliated Nanhua Hospital, University of South China, Hengyang, 421002, Hunan, China
| | - Zhe Long
- Department of Neurology, The Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan, China
| | - Daji Chen
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China
| | - Xinrong Yuan
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China
| | - Zhichao Tang
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China
| | - You Fu
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China
| | - Sudan Zhu
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China
| | - Lijing Lei
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China
| | - Chunrong Wang
- Department of Pathology, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China
| | - Huirong Peng
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China
| | - Yuting Shi
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China
| | - Lang He
- Department of Pathology, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China
| | - Hongyu Yuan
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China
| | - Na Wan
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China
| | - Xuan Hou
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China
| | - Kun Xia
- Center for Medical Genetics, School of Life Sciences, Central South University, Changsha, 410008, Hunan, China
- Hunan Key Laboratory of Medical Genetics, Central South University, Changsha, 410008, Hunan, China
| | - Jinchen Li
- Key Laboratory of Hunan Province in Neurodegenerative Disorders, Central South University, Changsha, 410008, Hunan, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China
| | - Chao Chen
- Center for Medical Genetics, School of Life Sciences, Central South University, Changsha, 410008, Hunan, China
- Hunan Key Laboratory of Medical Genetics, Central South University, Changsha, 410008, Hunan, China
| | - Rong Qiu
- School of Computer Science and Engineering, Central South University, Changsha, 410083, Hunan, China
| | - Beisha Tang
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China
- Key Laboratory of Hunan Province in Neurodegenerative Disorders, Central South University, Changsha, 410008, Hunan, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China
- Hunan International Scientific and Technological Cooperation Base of Neurodegenerative and Neurogenetic Diseases, Changsha, China
| | - Zhao Chen
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China.
- Key Laboratory of Hunan Province in Neurodegenerative Disorders, Central South University, Changsha, 410008, Hunan, China.
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China.
- Hunan International Scientific and Technological Cooperation Base of Neurodegenerative and Neurogenetic Diseases, Changsha, China.
| | - Hong Jiang
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China.
- Department of Neurology, The Third Xiangya Hospital of Central South University, Changsha, 410013, Hunan, China.
- Key Laboratory of Hunan Province in Neurodegenerative Disorders, Central South University, Changsha, 410008, Hunan, China.
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China.
- Hunan International Scientific and Technological Cooperation Base of Neurodegenerative and Neurogenetic Diseases, Changsha, China.
- National International Collaborative Research Center for Medical Metabolomics, Central South University, Changsha, 410008, Hunan, China.
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Street D, Jabbari E, Costantini A, Jones PS, Holland N, Rittman T, Jensen MT, Chelban V, Goh YY, Guo T, Heslegrave AJ, Roncaroli F, Klein JC, Ansorge O, Allinson KSJ, Jaunmuktane Z, Revesz T, Warner TT, Lees AJ, Zetterberg H, Russell LL, Bocchetta M, Rohrer JD, Burn DJ, Pavese N, Gerhard A, Kobylecki C, Leigh PN, Church A, Hu MTM, Houlden H, Morris H, Rowe JB. Progression of atypical parkinsonian syndromes: PROSPECT-M-UK study implications for clinical trials. Brain 2023; 146:3232-3242. [PMID: 36975168 PMCID: PMC10393398 DOI: 10.1093/brain/awad105] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 02/11/2023] [Accepted: 02/21/2023] [Indexed: 03/29/2023] Open
Abstract
The advent of clinical trials of disease-modifying agents for neurodegenerative disease highlights the need for evidence-based end point selection. Here we report the longitudinal PROSPECT-M-UK study of progressive supranuclear palsy (PSP), corticobasal syndrome (CBS), multiple system atrophy (MSA) and related disorders, to compare candidate clinical trial end points. In this multicentre UK study, participants were assessed with serial questionnaires, motor examination, neuropsychiatric and MRI assessments at baseline, 6 and 12 months. Participants were classified by diagnosis at baseline and study end, into Richardson syndrome, PSP-subcortical (PSP-parkinsonism and progressive gait freezing subtypes), PSP-cortical (PSP-frontal, PSP-speech and language and PSP-CBS subtypes), MSA-parkinsonism, MSA-cerebellar, CBS with and without evidence of Alzheimer's disease pathology and indeterminate syndromes. We calculated annual rate of change, with linear mixed modelling and sample sizes for clinical trials of disease-modifying agents, according to group and assessment type. Two hundred forty-three people were recruited [117 PSP, 68 CBS, 42 MSA and 16 indeterminate; 138 (56.8%) male; age at recruitment 68.7 ± 8.61 years]. One hundred and fifty-nine completed the 6-month assessment (82 PSP, 27 CBS, 40 MSA and 10 indeterminate) and 153 completed the 12-month assessment (80 PSP, 29 CBS, 35 MSA and nine indeterminate). Questionnaire, motor examination, neuropsychiatric and neuroimaging measures declined in all groups, with differences in longitudinal change between groups. Neuroimaging metrics would enable lower sample sizes to achieve equivalent power for clinical trials than cognitive and functional measures, often achieving N < 100 required for 1-year two-arm trials (with 80% power to detect 50% slowing). However, optimal outcome measures were disease-specific. In conclusion, phenotypic variance within PSP, CBS and MSA is a major challenge to clinical trial design. Our findings provide an evidence base for selection of clinical trial end points, from potential functional, cognitive, clinical or neuroimaging measures of disease progression.
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Affiliation(s)
- Duncan Street
- University of Cambridge Department of Clinical Neurosciences and Cambridge University Hospitals NHS Trust, Cambridge, CB2 OQQ, UK
| | - Edwin Jabbari
- Department of Clinical and Movement Neurosciences, University College London, Queen Square Institute of Neurology, London, WC1N 3BG, UK
- Movement Disorders Centre, University College London, Queen Square Institute of Neurology, London, WC1N 3BG, UK
| | - Alyssa Costantini
- Department of Clinical and Movement Neurosciences, University College London, Queen Square Institute of Neurology, London, WC1N 3BG, UK
- Movement Disorders Centre, University College London, Queen Square Institute of Neurology, London, WC1N 3BG, UK
| | - P Simon Jones
- University of Cambridge Department of Clinical Neurosciences and Cambridge University Hospitals NHS Trust, Cambridge, CB2 OQQ, UK
| | - Negin Holland
- University of Cambridge Department of Clinical Neurosciences and Cambridge University Hospitals NHS Trust, Cambridge, CB2 OQQ, UK
| | - Timothy Rittman
- University of Cambridge Department of Clinical Neurosciences and Cambridge University Hospitals NHS Trust, Cambridge, CB2 OQQ, UK
| | - Marte T Jensen
- Department of Clinical and Movement Neurosciences, University College London, Queen Square Institute of Neurology, London, WC1N 3BG, UK
- Movement Disorders Centre, University College London, Queen Square Institute of Neurology, London, WC1N 3BG, UK
| | - Viorica Chelban
- Department of Neuromuscular Diseases, University College London, Queen Square Institute of Neurology, London, WC1N 3BG, UK
- Neurobiology and Medical Genetics Laboratory, ‘Nicolae Testemitanu’ State University of Medicine and Pharmacy, Chisinau 2004, Republic of Moldova
| | - Yen Y Goh
- Department of Neuromuscular Diseases, University College London, Queen Square Institute of Neurology, London, WC1N 3BG, UK
| | - Tong Guo
- Department of Clinical and Movement Neurosciences, University College London, Queen Square Institute of Neurology, London, WC1N 3BG, UK
| | - Amanda J Heslegrave
- Department of Neurodegenerative Disease, University College London, Queen Square Institute of Neurology, London, WC1N 3BG, UK
- UK Dementia Research Institute, University College London, London, W1T 7NF, UK
| | - Federico Roncaroli
- Geoffrey Jefferson Brain Research Centre, Division of Neuroscience, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, M6 8HD, UK
| | - Johannes C Klein
- Wellcome Centre for Integrative Neuroimaging, Oxford Centre for Functional MRI of the Brain, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, OX3 9DU, UK
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, OX3 9DU, UK
| | - Olaf Ansorge
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, OX3 9DU, UK
| | - Kieren S J Allinson
- University of Cambridge Department of Clinical Neurosciences and Cambridge University Hospitals NHS Trust, Cambridge, CB2 OQQ, UK
| | - Zane Jaunmuktane
- Department of Clinical and Movement Neurosciences, University College London, Queen Square Institute of Neurology, London, WC1N 3BG, UK
- Queen Square Brain Bank for Neurological Disorders, University College London, Queen Square Institute of Neurology, London, WC1N 3BG, UK
- Reta Lila Weston Institute, University College London, Queen Square Institute of Neurology, London, WC1N 3BG, UK
| | - Tamas Revesz
- Queen Square Brain Bank for Neurological Disorders, University College London, Queen Square Institute of Neurology, London, WC1N 3BG, UK
- Reta Lila Weston Institute, University College London, Queen Square Institute of Neurology, London, WC1N 3BG, UK
| | - Thomas T Warner
- Queen Square Brain Bank for Neurological Disorders, University College London, Queen Square Institute of Neurology, London, WC1N 3BG, UK
- Reta Lila Weston Institute, University College London, Queen Square Institute of Neurology, London, WC1N 3BG, UK
| | - Andrew J Lees
- Queen Square Brain Bank for Neurological Disorders, University College London, Queen Square Institute of Neurology, London, WC1N 3BG, UK
- Reta Lila Weston Institute, University College London, Queen Square Institute of Neurology, London, WC1N 3BG, UK
| | - Henrik Zetterberg
- Department of Neurodegenerative Disease, University College London, Queen Square Institute of Neurology, London, WC1N 3BG, UK
- UK Dementia Research Institute, University College London, London, W1T 7NF, UK
- Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, 431 30 Mölndal, Sweden
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Salhgrenska Academy at the University of Gothenburg, 413 45 Goteborg, Sweden
- Hong Kong Center for Neurodegenerative Diseases, Hong Kong Science Park, Shatin, N.T., Hong Kong, China
| | - Lucy L Russell
- Department of Neurodegenerative Disease, University College London, Queen Square Institute of Neurology, London, WC1N 3BG, UK
| | - Martina Bocchetta
- Centre for Cognitive and Clinical Neuroscience, Division of Psychology, Department of Life Sciences, College of Health, Medicine and Life Sciences, Brunel University London, London, UB8 3PH, UK
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, University College London, London, WC1N 3BG, UK
| | - Jonathan D Rohrer
- Department of Neurodegenerative Disease, University College London, Queen Square Institute of Neurology, London, WC1N 3BG, UK
| | - David J Burn
- Faculty of Medical Sciences, Newcastle University, Newcastle, NE2 4HH, UK
| | - Nicola Pavese
- Clinical Ageing Research Unit, Newcastle University, Newcastle, NE4 5PL, UK
| | - Alexander Gerhard
- Division of Neuroscience, Wolfson Molecular Imaging Centre, University of Manchester, Manchester, N20 3LJ, UK
- Departments of Geriatric Medicine and Nuclear Medicine, Center for Translational Neuro- and Behavioral Sciences, University Medicine Essen, 45356 Essen, Germany
| | - Christopher Kobylecki
- Division of Neuroscience, Wolfson Molecular Imaging Centre, University of Manchester, Manchester, N20 3LJ, UK
- Department of Neurology, Manchester Academic Health Science Centre, Northern Care Alliance NHS Foundation Trust, Salford, M13 9NQ, UK
| | - P Nigel Leigh
- Department of Neuroscience, Brighton and Sussex Medical School, Brighton, BN1 9PX, UK
| | - Alistair Church
- Department of Neurology, Royal Gwent Hospital, Newport, NP20 2UB, UK
| | - Michele T M Hu
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, OX3 9DU, UK
- Department of Physiology, Anatomy and Genetics, Oxford Parkinson’s Disease Centre, University of Oxford, Oxford, OX1 3QU, UK
| | - Henry Houlden
- Department of Clinical and Movement Neurosciences, University College London, Queen Square Institute of Neurology, London, WC1N 3BG, UK
- Movement Disorders Centre, University College London, Queen Square Institute of Neurology, London, WC1N 3BG, UK
- Department of Neuromuscular Diseases, University College London, Queen Square Institute of Neurology, London, WC1N 3BG, UK
| | - Huw Morris
- Department of Clinical and Movement Neurosciences, University College London, Queen Square Institute of Neurology, London, WC1N 3BG, UK
- Movement Disorders Centre, University College London, Queen Square Institute of Neurology, London, WC1N 3BG, UK
| | - James B Rowe
- University of Cambridge Department of Clinical Neurosciences and Cambridge University Hospitals NHS Trust, Cambridge, CB2 OQQ, UK
- Medical Research Council Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, CB2 7EF, UK
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Wan L, Zhu S, Chen Z, Qiu R, Tang B, Jiang H. Multidimensional biomarkers for multiple system atrophy: an update and future directions. Transl Neurodegener 2023; 12:38. [PMID: 37501056 PMCID: PMC10375766 DOI: 10.1186/s40035-023-00370-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 07/11/2023] [Indexed: 07/29/2023] Open
Abstract
Multiple system atrophy (MSA) is a fatal progressive neurodegenerative disease. Biomarkers are urgently required for MSA to improve the diagnostic and prognostic accuracy in clinic and facilitate the development and monitoring of disease-modifying therapies. In recent years, significant research efforts have been made in exploring multidimensional biomarkers for MSA. However, currently few biomarkers are available in clinic. In this review, we systematically summarize the latest advances in multidimensional biomarkers for MSA, including biomarkers in fluids, tissues and gut microbiota as well as imaging biomarkers. Future directions for exploration of novel biomarkers and promotion of implementation in clinic are also discussed.
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Affiliation(s)
- Linlin Wan
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, 410008, China
- Key Laboratory of Hunan Province in Neurodegenerative Disorders, Central South University, Changsha, 410008, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, 410008, China
- Department of Radiology, Xiangya Hospital, Central South University, Changsha, 410008, China
- National International Collaborative Research Center for Medical Metabolomics, Central South University, Changsha, 410008, China
| | - Sudan Zhu
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, 410008, China
| | - Zhao Chen
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, 410008, China
- Key Laboratory of Hunan Province in Neurodegenerative Disorders, Central South University, Changsha, 410008, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, 410008, China
- Hunan International Scientific and Technological Cooperation Base of Neurodegenerative and Neurogenetic Diseases, Changsha, 410008, China
| | - Rong Qiu
- School of Computer Science and Engineering, Central South University, Changsha, 410083, China
| | - Beisha Tang
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, 410008, China
- Key Laboratory of Hunan Province in Neurodegenerative Disorders, Central South University, Changsha, 410008, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, 410008, China
- Hunan International Scientific and Technological Cooperation Base of Neurodegenerative and Neurogenetic Diseases, Changsha, 410008, China
| | - Hong Jiang
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, 410008, China.
- Department of Neurology, The Third Xiangya Hospital, Central South University, Changsha, 410013, China.
- Key Laboratory of Hunan Province in Neurodegenerative Disorders, Central South University, Changsha, 410008, China.
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, 410008, China.
- Hunan International Scientific and Technological Cooperation Base of Neurodegenerative and Neurogenetic Diseases, Changsha, 410008, China.
- National International Collaborative Research Center for Medical Metabolomics, Central South University, Changsha, 410008, China.
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Painous C, Pascual-Diaz S, Muñoz-Moreno E, Sánchez V, Pariente JC, Prats-Galino A, Soto M, Fernández M, Pérez-Soriano A, Camara A, Muñoz E, Valldeoriola F, Caballol N, Pont-Sunyer C, Martin N, Basora M, Tio M, Rios J, Martí MJ, Bargalló N, Compta Y. Midbrain and pons MRI shape analysis and its clinical and CSF correlates in degenerative parkinsonisms: a pilot study. Eur Radiol 2023; 33:4540-4551. [PMID: 36773046 PMCID: PMC10290009 DOI: 10.1007/s00330-023-09435-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 10/19/2022] [Accepted: 01/08/2023] [Indexed: 02/12/2023]
Abstract
OBJECTIVES To conduct brainstem MRI shape analysis across neurodegenerative parkinsonisms and control subjects (CS), along with its association with clinical and cerebrospinal fluid (CSF) correlates. METHODOLOGY We collected demographic and clinical variables, performed planimetric and shape MRI analyses, and determined CSF neurofilament-light chain (NfL) levels in 84 participants: 11 CS, 12 with Parkinson's disease (PD), 26 with multiple system atrophy (MSA), 21 with progressive supranuclear palsy (PSP), and 14 with corticobasal degeneration (CBD). RESULTS MSA featured the most extensive and significant brainstem shape narrowing (that is, atrophy), mostly in the pons. CBD presented local atrophy in several small areas in the pons and midbrain compared to PD and CS. PSP presented local atrophy in small areas in the posterior and upper midbrain as well as the rostral pons compared to MSA. Our findings of planimetric MRI measurements and CSF NfL levels replicated those from previous literature. Brainstem shape atrophy correlated with worse motor state in all parkinsonisms and with higher NfL levels in MSA, PSP, and PD. CONCLUSION Atypical parkinsonisms present different brainstem shape patterns which correlate with clinical severity and neuronal degeneration. In MSA, shape analysis could be further explored as a potential diagnostic biomarker. By contrast, shape analysis appears to have a rather limited discriminant value in PSP. KEY POINTS • Atypical parkinsonisms present different brainstem shape patterns. • Shape patterns correlate with clinical severity and neuronal degeneration. • In MSA, shape analysis could be further explored as a potential diagnostic biomarker.
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Affiliation(s)
- C Painous
- Parkinson's Disease & Movement Disorders Unit, Parkinson's Disease and Other Degenerative Movement Disorders Team, Neurology Service, Hospital Clínic de Barcelona, IDIBAPS, CIBERNED (CB06/05/0018-ISCIII), ERN-RND, Institut Clínic de Neurociències (UBNeuro), Department of Medicine, School of Medicine, Universitat de Barcelona, Catalonia, Barcelona, Spain
- Lab of Parkinson Disease and Other Neurodegenerative Movement Disorders, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Institut de Neurociències, Hospital Clínic de Barcelona, Institut de Neurociències (UBNeuro), Universitat de Barcelona, Catalonia, Barcelona, Spain
| | - S Pascual-Diaz
- Magnetic Resonance Imaging Core Facility, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
- Laboratory of Surgical Neuroanatomy (LSNA), Universitat de Barcelona, Barcelona, Spain
| | - E Muñoz-Moreno
- Magnetic Resonance Imaging Core Facility, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
| | - V Sánchez
- Centre de Diagnostic Per La Imatge (CDIC), Hospital Clinic, Barcelona, Spain
| | - J C Pariente
- Magnetic Resonance Imaging Core Facility, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
| | - A Prats-Galino
- Centre de Diagnostic Per La Imatge (CDIC), Hospital Clinic, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
| | - M Soto
- Lab of Parkinson Disease and Other Neurodegenerative Movement Disorders, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Institut de Neurociències, Hospital Clínic de Barcelona, Institut de Neurociències (UBNeuro), Universitat de Barcelona, Catalonia, Barcelona, Spain
| | - M Fernández
- Lab of Parkinson Disease and Other Neurodegenerative Movement Disorders, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Institut de Neurociències, Hospital Clínic de Barcelona, Institut de Neurociències (UBNeuro), Universitat de Barcelona, Catalonia, Barcelona, Spain
| | - A Pérez-Soriano
- Parkinson's Disease & Movement Disorders Unit, Parkinson's Disease and Other Degenerative Movement Disorders Team, Neurology Service, Hospital Clínic de Barcelona, IDIBAPS, CIBERNED (CB06/05/0018-ISCIII), ERN-RND, Institut Clínic de Neurociències (UBNeuro), Department of Medicine, School of Medicine, Universitat de Barcelona, Catalonia, Barcelona, Spain
- Lab of Parkinson Disease and Other Neurodegenerative Movement Disorders, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Institut de Neurociències, Hospital Clínic de Barcelona, Institut de Neurociències (UBNeuro), Universitat de Barcelona, Catalonia, Barcelona, Spain
| | - A Camara
- Parkinson's Disease & Movement Disorders Unit, Parkinson's Disease and Other Degenerative Movement Disorders Team, Neurology Service, Hospital Clínic de Barcelona, IDIBAPS, CIBERNED (CB06/05/0018-ISCIII), ERN-RND, Institut Clínic de Neurociències (UBNeuro), Department of Medicine, School of Medicine, Universitat de Barcelona, Catalonia, Barcelona, Spain
- Lab of Parkinson Disease and Other Neurodegenerative Movement Disorders, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Institut de Neurociències, Hospital Clínic de Barcelona, Institut de Neurociències (UBNeuro), Universitat de Barcelona, Catalonia, Barcelona, Spain
| | - E Muñoz
- Parkinson's Disease & Movement Disorders Unit, Parkinson's Disease and Other Degenerative Movement Disorders Team, Neurology Service, Hospital Clínic de Barcelona, IDIBAPS, CIBERNED (CB06/05/0018-ISCIII), ERN-RND, Institut Clínic de Neurociències (UBNeuro), Department of Medicine, School of Medicine, Universitat de Barcelona, Catalonia, Barcelona, Spain
- Lab of Parkinson Disease and Other Neurodegenerative Movement Disorders, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Institut de Neurociències, Hospital Clínic de Barcelona, Institut de Neurociències (UBNeuro), Universitat de Barcelona, Catalonia, Barcelona, Spain
| | - F Valldeoriola
- Parkinson's Disease & Movement Disorders Unit, Parkinson's Disease and Other Degenerative Movement Disorders Team, Neurology Service, Hospital Clínic de Barcelona, IDIBAPS, CIBERNED (CB06/05/0018-ISCIII), ERN-RND, Institut Clínic de Neurociències (UBNeuro), Department of Medicine, School of Medicine, Universitat de Barcelona, Catalonia, Barcelona, Spain
- Lab of Parkinson Disease and Other Neurodegenerative Movement Disorders, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Institut de Neurociències, Hospital Clínic de Barcelona, Institut de Neurociències (UBNeuro), Universitat de Barcelona, Catalonia, Barcelona, Spain
| | - N Caballol
- UParkinson Centro Médico Teknon, Grupo Hospitalario Quirón Salud, Barcelona, Spain
- Department of Neurology, Hospital Sant Joan Despí Moisès Broggi and Hospital General de L'Hospitalet, Consorci Sanitari Integral, Barcelona, Spain
| | - C Pont-Sunyer
- Neurology Unit, Hospital General de Granollers, Universitat Internacional de Catalunya, Barcelona, Spain
| | - N Martin
- Department of Anaesthesiology, Hospital Clinic, Barcelona, Spain
| | - M Basora
- Department of Anaesthesiology, Hospital Clinic, Barcelona, Spain
| | - M Tio
- Department of Anaesthesiology, Hospital Clinic, Barcelona, Spain
| | - J Rios
- Medical Statistics Core Facility, IDIBAPS & Biostatistics Unit, Faculty of Medicine, Universitat Autònoma de Barcelona, Barcelona, Catalonia, Spain
| | - M J Martí
- Parkinson's Disease & Movement Disorders Unit, Parkinson's Disease and Other Degenerative Movement Disorders Team, Neurology Service, Hospital Clínic de Barcelona, IDIBAPS, CIBERNED (CB06/05/0018-ISCIII), ERN-RND, Institut Clínic de Neurociències (UBNeuro), Department of Medicine, School of Medicine, Universitat de Barcelona, Catalonia, Barcelona, Spain
- Lab of Parkinson Disease and Other Neurodegenerative Movement Disorders, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Institut de Neurociències, Hospital Clínic de Barcelona, Institut de Neurociències (UBNeuro), Universitat de Barcelona, Catalonia, Barcelona, Spain
| | - N Bargalló
- Magnetic Resonance Imaging Core Facility, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain.
- Laboratory of Surgical Neuroanatomy (LSNA), Universitat de Barcelona, Barcelona, Spain.
- Neuroradiology Service, Hospital Clínic de Barcelona, 170 Villarroel Street, 08036, Barcelona, Spain.
| | - Y Compta
- Parkinson's Disease & Movement Disorders Unit, Parkinson's Disease and Other Degenerative Movement Disorders Team, Neurology Service, Hospital Clínic de Barcelona, IDIBAPS, CIBERNED (CB06/05/0018-ISCIII), ERN-RND, Institut Clínic de Neurociències (UBNeuro), Department of Medicine, School of Medicine, Universitat de Barcelona, Catalonia, Barcelona, Spain.
- Lab of Parkinson Disease and Other Neurodegenerative Movement Disorders, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Institut de Neurociències, Hospital Clínic de Barcelona, Institut de Neurociències (UBNeuro), Universitat de Barcelona, Catalonia, Barcelona, Spain.
- Neuroradiology Service, Hospital Clínic de Barcelona, 170 Villarroel Street, 08036, Barcelona, Spain.
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Srp M, Bartosova T, Klempir J, Lagnerova R, Gal O, Listvanova T, Jech R, Ruzicka E, Hoskovcova M. Expiratory Muscle Strength Training in Multiple System Atrophy: A Pilot Study. Mov Disord Clin Pract 2023; 10:1060-1065. [PMID: 37476315 PMCID: PMC10354620 DOI: 10.1002/mdc3.13765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 02/05/2023] [Accepted: 04/19/2023] [Indexed: 07/22/2023] Open
Abstract
Background The effects of expiratory muscle strength training (EMST) has not yet been investigated in MSA patients. Objective The primary objective was to test the effects of EMST on expiratory muscle strength and voluntary peak cough flow (vPCF) in patients with multiple system atrophy (MSA). The secondary objective was to assess the suitability of the pulmonary dysfunction index as a tool for identifying MSA patients with expiratory muscle weakness and reduced voluntary peak cough flow. Methods This was an open label, non-controlled study, with an 8-week intensive home-based EMST protocol. The outcome measures included: maximal expiratory pressure (MEP) and vPCF. The sensitivity and specificity of the index of pulmonary dysfunction in the respiratory diagnostic process were assessed using receiver operating characteristic (ROC) analysis. Results Fifteen MSA patients were enrolled in the study. Twelve MSA patients completed the training period. After the training period, MEP significantly increased (P = 0.006). Differences in vPCF were not significant (P = 0.845). ROC analysis indicated that the overall respiratory diagnostic accuracy of the index of pulmonary dysfunction had an outstanding capability to detect patients at risk of less effective coughing and an acceptable capability of detecting patients with decreased expiratory muscle strength. Conclusions These findings indicate non-significant differences in vPCF after 8 weeks of EMST. The index of pulmonary dysfunction appears to be a promising prognostic screening tool for identifying altered cough efficacy in MSA patients. Test cut-offs may be used to select an appropriate respiratory physiotherapy technique.
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Affiliation(s)
- Martin Srp
- Department of Neurology and Centre of Clinical NeuroscienceFirst Faculty of Medicine, Charles University and General University Hospital in PraguePragueCzech Republic
| | - Tereza Bartosova
- Department of Neurology and Centre of Clinical NeuroscienceFirst Faculty of Medicine, Charles University and General University Hospital in PraguePragueCzech Republic
| | - Jiri Klempir
- Department of Neurology and Centre of Clinical NeuroscienceFirst Faculty of Medicine, Charles University and General University Hospital in PraguePragueCzech Republic
| | - Rebeka Lagnerova
- Department of Neurology and Centre of Clinical NeuroscienceFirst Faculty of Medicine, Charles University and General University Hospital in PraguePragueCzech Republic
| | - Ota Gal
- Department of Neurology and Centre of Clinical NeuroscienceFirst Faculty of Medicine, Charles University and General University Hospital in PraguePragueCzech Republic
| | - Tereza Listvanova
- Department of Neurology and Centre of Clinical NeuroscienceFirst Faculty of Medicine, Charles University and General University Hospital in PraguePragueCzech Republic
| | - Robert Jech
- Department of Neurology and Centre of Clinical NeuroscienceFirst Faculty of Medicine, Charles University and General University Hospital in PraguePragueCzech Republic
| | - Evzen Ruzicka
- Department of Neurology and Centre of Clinical NeuroscienceFirst Faculty of Medicine, Charles University and General University Hospital in PraguePragueCzech Republic
| | - Martina Hoskovcova
- Department of Neurology and Centre of Clinical NeuroscienceFirst Faculty of Medicine, Charles University and General University Hospital in PraguePragueCzech Republic
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Zhang L, Hou Y, Wei Q, Ou R, Liu K, Lin J, Yang T, Xiao Y, Zhao B, Shang H. Diagnostic utility of movement disorder society criteria for multiple system atrophy. Front Aging Neurosci 2023; 15:1200563. [PMID: 37396656 PMCID: PMC10310919 DOI: 10.3389/fnagi.2023.1200563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 05/26/2023] [Indexed: 07/04/2023] Open
Abstract
Background The 2008 criteria for the diagnosis of multiple system atrophy (MSA) has been widely used for more than 10 years, but the sensitivity is low, particularly for patients in the early stage. Recently, a new MSA diagnostic criteria was developed. Objective The objective of the study was to assess and compare the diagnostic utility of the new movement disorder society (MDS) MSA criteria with the 2008 MSA criteria. Methods This study included patients diagnosed with MSA between January 2016 and October 2021. All patients underwent regular face-to-face or telephonic follow-ups every year until October 2022. A total of 587 patients (309 males and 278 females) were retrospectively reviewed to compare the diagnostic accuracy of the MDS MSA criteria to that of the 2008 MSA criteria (determined by the proportion of patients categorized as established or probable MSA). Autopsy is the gold standard diagnosis of MSA, which is not available in clinical practice. Thus, we applied the 2008 MSA criteria at the last review as the reference standard. Results The sensitivity of the MDS MSA criteria (93.2%, 95% CI = 90.5-95.2%) was significantly higher than that of the 2008 MSA criteria (83.5%, 95% CI = 79.8-86.6%) (P < 0.001). Additionally, the sensitivity of the MDS MSA criteria was maintained robustly across different subgroups, defined by diagnostic subtype, disease duration, and the type of symptom[s] at onset. Importantly, the specificities were not significantly different between the MDS MSA criteria and the 2008 MSA criteria (P > 0.05). Conclusion The present study demonstrated that the MDS MSA criteria exhibited good diagnostic utility for MSA. The new MDS MSA criteria should be considered as a useful diagnostic tool for clinical practice and future therapeutic trials.
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Chen Y, Huang H, Zhang P, Xu Y, Chen Y. Constipation in multiple system atrophy: a pilot study in Chinese patients. Front Neurol 2023; 14:1202279. [PMID: 37360344 PMCID: PMC10289683 DOI: 10.3389/fneur.2023.1202279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 05/16/2023] [Indexed: 06/28/2023] Open
Abstract
Objective This study aimed to investigate the prevalence and clinical characteristics of subjective constipation in Chinese patients with multiple system atrophy (MSA), as well as the timing of constipation onset relative to the occurrence of motor symptoms. Methods A total of 200 patients who were consecutively admitted to two large Chinese hospitals from February 2016 to June 2021 and subsequently diagnosed with probable MSA were enrolled in this cross-sectional study. Demographic and constipation-related clinical data were collected, and motor and non-motor symptoms were assessed using various scales and questionnaires. Subjective constipation was defined using ROME III criteria. Results The frequency of constipation was 53.5, 59.7, and 39.3% in MSA, MSA with predominately parkinsonism (MSA-P), and MSA with predominately cerebellar ataxia (MSA-C), respectively. MSA-P subtype and high total UMSARS scores were associated with constipation in MSA. Similarly, the high total UMSARS scores were associated with constipation in MSA-P and MSA-C patients. Among the 107 patients with constipation, 59.8% began experiencing it before the onset of motor symptoms, and the interval between constipation and occurrence of motor symptoms was significantly longer in these patients than in those who experienced constipation after onset of motor symptoms. Conclusion Constipation is a highly prevalent non-motor symptom in MSA and more often occurs before the onset of motor symptoms. The results of this study may help guide future research into MSA pathogenesis in its earliest stages.
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Affiliation(s)
- Yalan Chen
- Department of Neurology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Hongyan Huang
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Peng Zhang
- Department of Neurology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yanming Xu
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yangmei Chen
- Department of Neurology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Chen Y, Wang H, Huang H, Chen Y, Xu Y. Freezing of gait in Chinese patients with multiple system atrophy: prevalence and risk factors. Front Neurosci 2023; 17:1194904. [PMID: 37351425 PMCID: PMC10282176 DOI: 10.3389/fnins.2023.1194904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 05/22/2023] [Indexed: 06/24/2023] Open
Abstract
Objective Freezing of gait (FOG) is common in neurodegenerative forms of atypical parkinsonism, but few studies have examined FOG in multiple system atrophy (MSA). In this study, we examined the prevalence of freezing of gait and its relationship to clinical features in a large cohort of Chinese MSA patients. Methods This exploratory study included 202 Chinese patients with probable MSA. FOG was defined as a score ≥ 1 on item 14 of the Unified Parkinson's Disease Rating Scale. Patients with or without FOG were compared in terms of the Unified MSA Rating Scale (UMSARS) as well as cognitive and neuropsychiatric assessments. Results The frequency of FOG was 48.0, 52.1, and 38.7% in MSA, MSA with predominant parkinsonism (MSA-P), and MSA with predominant cerebellar ataxia (MSA-C), respectively. FOG was associated with worse subscores on parts I, II and IV of the UMSARS as well as worse total UMSARS score; greater likelihood of speech difficulties, falls, gait impairment and balance disorder; more severe symptoms of anxiety and depression; and lower activities of daily living. The binary logistic regression model indicated that higher total UMSARS scores were associated with FOG in MSA, MSA-P, and MSA-C patients. Conclusion Freezing of gait may be common among Chinese MSA patients, FOG may correlate with severe motor symptoms, anxiety, depression and activities of daily living. Total UMSARS score may be an independent risk factor for FOG.
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Affiliation(s)
- Yalan Chen
- Department of Neurology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Hui Wang
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Hongyan Huang
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yangmei Chen
- Department of Neurology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yanming Xu
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
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