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Iyer V, Venkiteswaran K, Savaliya S, Lieu CA, Handly E, Gilmour TP, Kunselman AR, Subramanian T. The cross-hemispheric nigrostriatal pathway prevents the expression of levodopa-induced dyskinesias. Neurobiol Dis 2021; 159:105491. [PMID: 34461264 PMCID: PMC8597404 DOI: 10.1016/j.nbd.2021.105491] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 08/17/2021] [Accepted: 08/25/2021] [Indexed: 11/29/2022] Open
Abstract
Parkinson's disease (PD) is a neurodegenerative movement disorder that is routinely treated with levodopa. Unfortunately, long-term dopamine replacement therapy using levodopa leads to levodopa-induced dyskinesias (LID), a significant and disabling side-effect. Clinical findings indicate that LID typically only occurs following the progression of PD motor symptoms from the unilateral (Hoehn and Yahr (HY) Stage I) to the bilateral stage (HY Stage II). This suggests the presence of some compensatory interhemispheric mechanisms that delay the occurrence of LID. We therefore investigated the role of interhemispheric connections of the nigrostriatal pathway on LID expression in a rat model of PD. The striatum of one hemisphere of rats was first injected with a retrograde tracer to label the ipsi- and cross-hemispheric nigrostriatal pathways. Rats were then split into groups and unilaterally lesioned in the striatum or medial forebrain bundle of the tracer-injected hemisphere to induce varying levels of hemiparkinsonism. Finally, rats were treated with levodopa and tested for the expression of LID. Distinct subsets emerged from rats that underwent the same lesioning paradigm based on LID. Strikingly, non-dyskinetic rats had significant sparing of their cross-hemispheric nigrostriatal pathway projecting from the unlesioned hemisphere. In contrast, dyskinetic rats only had a small proportion of this cross-hemispheric nigrostriatal pathway survive lesioning. Crucially, both non-dyskinetic and dyskinetic rats had nearly identical levels of ipsi-hemispheric nigrostriatal pathway survival and parkinsonian motor deficits. Our data suggest that the survival of the cross-hemispheric nigrostriatal pathway plays a crucial role in preventing the expression of LID and represents a potentially novel target to halt the progression of this devastating side-effect of a common anti-PD therapeutic.
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Affiliation(s)
- Vishakh Iyer
- Department of Neurology and Neural and Behavioral Sciences, The Pennsylvania State University College of Medicine, Hershey, PA, United States of America
| | - Kala Venkiteswaran
- Department of Neurology and Neural and Behavioral Sciences, The Pennsylvania State University College of Medicine, Hershey, PA, United States of America
| | - Sandip Savaliya
- Department of Neurosurgery, The Pennsylvania State University College of Medicine, Hershey, PA, United States of America
| | - Christopher A Lieu
- Department of Neurology and Neural and Behavioral Sciences, The Pennsylvania State University College of Medicine, Hershey, PA, United States of America
| | - Erin Handly
- Department of Neurology and Neural and Behavioral Sciences, The Pennsylvania State University College of Medicine, Hershey, PA, United States of America
| | - Timothy P Gilmour
- Department of Electrical Engineering, John Brown University, Siloam Springs, AR, United States of America
| | - Allen R Kunselman
- Department of Public Health Sciences, The Pennsylvania State University College of Medicine, Hershey, PA, United States of America
| | - Thyagarajan Subramanian
- Department of Neurology and Neural and Behavioral Sciences, The Pennsylvania State University College of Medicine, Hershey, PA, United States of America.
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Lane EL. L-DOPA for Parkinson's disease-a bittersweet pill. Eur J Neurosci 2018; 49:384-398. [PMID: 30118169 DOI: 10.1111/ejn.14119] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Revised: 07/23/2018] [Accepted: 07/30/2018] [Indexed: 01/02/2023]
Abstract
3,4-dihydroxy-L-phenylalanine (L-DOPA) is the gold standard treatment for Parkinson's disease. It has earned that title through its highly effective treatment of some of the motor symptoms in the early stages of the disease but it is a far from perfect drug. The inevitable long-term treatment that comes with this chronic neurodegenerative condition raises the risk significantly of the development of motor fluctuations including disabling L-DOPA-induced dyskinesia. Being unsurpassed as a therapy means that understanding the mechanisms of dyskinesia priming and induction is vital to the search for therapies to treat these side effects and allow optimal use of L-DOPA. However, L-DOPA use may also have consequences (positive or negative) for the development of other interventions, such as cell transplantation, which are designed to treat or repair the ailing brain. This review looks at the issues around the use of L-DOPA with a focus on its potential impact on advanced reparative interventions.
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Affiliation(s)
- Emma L Lane
- Cardiff School of Pharmacy and Pharmaceutical Sciences, Cardiff University, Cardiff, UK
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Shalash A, Abushady E, Hamid E, Salama M, Ibrahim YA. Patient with Hemiparkinsonism Secondary to a Gun Pellet in the Contralateral Substantia Nigra. Mov Disord Clin Pract 2017; 5:103-104. [PMID: 30868100 DOI: 10.1002/mdc3.12566] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Revised: 10/25/2017] [Accepted: 10/26/2017] [Indexed: 11/11/2022] Open
Abstract
A 33 year-old male presented with right upper limb rest tremor that disappeared on action, posture associated with bradykinesia, and rigidity of right upper and lower limbs (Video S1). Patient also presented right-sided pyramidal weakness (grade 4), hyperreflexia, extensor plantar response, and hemihypesthesia. Skull X-ray and computed tomography (CT) of the brain showed several metal pellets producing multiple artifacts (Fig. 1A,B). Only one pellet settled in brain parenchyma (left midbrain), while other pellets settled in the skull bone (Fig. 1A). Transcranial sonography (TCS) was performed, confirming that the midbrain pellet was placed within the left substantia nigra (Fig. 1C). Levodopa challenge test was conducted, showing no improvement (pre- and post-l-dopa motor UPDRS were 21 and 20, respectively). A further chronic trial of l-dopa (for 3 months) also proved negative. Biperiden and propranolol were also tried with negative results. Figure 1Computed tomography (CT) of the brain and X-ray skull showed several pellets that produced multiple streak artifacts (Fig. 1A,B). Only one pellet rested in the brain parenchyma, the left (contralateral) midbrain as detected by CT (Fig. 1A), and transcranial sonography (Esaote MyLab Five, Providian, Italy) via temporal window (Fig. 1C). Abbreviations: SN, substantia nigra.Hemiparkinsonism has been previously reported secondary to midbrain lesions.1, 2 To the best of our knowledge, movement disorders (secondary to brain injuries) related to bullet fragments have been scantly reported. In one reported case, hemiparkinsonism and dystonia were the result of a bullet in midbrain,2 and in another, dystonia was caused by a bullet in internal capsule.3.
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Affiliation(s)
- Ali Shalash
- Department of Neurology Faculty of Medicine Ain Shams University Cairo Egypt
| | - Eman Abushady
- Department of Neurology Faculty of Medicine Ain Shams University Cairo Egypt
| | - Eman Hamid
- Department of Neurology Faculty of Medicine Ain Shams University Cairo Egypt
| | - Mohamed Salama
- Medical Experimental Research Center (MERC) Faculty of Medicine Mansoura University Mansoura Egypt
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Martínez-Simón J, Sáez-Zea C, Katati MJ, Escamilla-Sevilla F, Mínguez-Castellanos A. Posthemorrhagic Hemiparkinsonism Treated by Unilateral Pallidal Stimulation. Mov Disord Clin Pract 2014; 1:139-141. [DOI: 10.1002/mdc3.12024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2013] [Revised: 02/13/2014] [Accepted: 03/25/2014] [Indexed: 11/10/2022] Open
Affiliation(s)
- Josefina Martínez-Simón
- Department of Neurology; Instituto de Investigación Biosanitaria de Granada; Hospital Universitario Virgen de las Nieves; Granada Spain
| | - Carmen Sáez-Zea
- Department of Neurology; Instituto de Investigación Biosanitaria de Granada; Hospital Universitario Virgen de las Nieves; Granada Spain
- Area of Psychobiology; Department of Psychology; Faculty of Humanities and Education; University of Jaén; Jaén Spain
| | - Majed J. Katati
- Department of Neurosurgery; Instituto de Investigación Biosanitaria de Granada; Hospital Universitario Virgen de las Nieves; Granada Spain
| | - Francisco Escamilla-Sevilla
- Department of Neurology; Instituto de Investigación Biosanitaria de Granada; Hospital Universitario Virgen de las Nieves; Granada Spain
| | - Adolfo Mínguez-Castellanos
- Department of Neurology; Instituto de Investigación Biosanitaria de Granada; Hospital Universitario Virgen de las Nieves; Granada Spain
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Pita Lobo P, Coelho M, Mestre TA, Rosa MM, Ferreira JJ. Wearing-off phenomena and levodopa-induced dyskinesias in posttraumatic hemiparkinsonism. Mov Disord 2013; 28:1212-4. [PMID: 23861327 DOI: 10.1002/mds.25556] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2012] [Revised: 04/29/2013] [Accepted: 05/06/2013] [Indexed: 11/09/2022] Open
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Cerasa A, Salsone M, Morelli M, Pugliese P, Arabia G, Gioia CM, Novellino F, Quattrone A. Age at onset influences neurodegenerative processes underlying PD with levodopa-induced dyskinesias. Parkinsonism Relat Disord 2013; 19:883-8. [PMID: 23769805 DOI: 10.1016/j.parkreldis.2013.05.015] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2013] [Revised: 05/13/2013] [Accepted: 05/22/2013] [Indexed: 11/19/2022]
Abstract
PURPOSE Recently, we demonstrated that PD patients with levodopa-induced dyskinesias are characterized by neuroanatomical and functional changes involving the prefrontal cortex. When compared with non-dyskinetic PD patients, dyskinetic PD patients showed increased volume of the inferior frontal cortex and a dysfunctional imbalance between this region and the supplementary motor area during motor task. In the current study, we investigated the impact of age at onset of the disease on the neuroanatomical characteristics of dyskinetic patients, because it is well known that early-onset PD patients usually develop dyskinesias sooner with respect to late-onset PD. METHODS Whole-brain voxel-wise investigations of gray matter volume and cortical thickness were carried out in dyskinetic (n = 33), non-dyskinetic PD patients (n = 33) and in age-sex-matched healthy controls (n = 40). Neuroimaging analyses were performed separately according to the age at onset (early < 50 y > late). RESULTS Independent of age at onset, dyskinetic PD patients showed altered morphology in the inferior frontal cortex when compared with non-dyskinetic patients. Moreover, additional significant abnormalities emerged in the early- and late-onset PD patients when compared to controls. In fact, early-onset dyskinetic patients showed increased volume in a large cluster of the midbrain encompassing substantia nigra and red nucleus, whereas late-onset dyskinetic patients were characterized by abnormal gray matter increase in the supplementary motor area. DISCUSSION Our findings demonstrate different patterns of brain abnormalities in patients with LID according to age at onset, highlighting the role of the nigral pathology in early-onset and of the cortical pathology in late-onset patients with PD.
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Affiliation(s)
- Antonio Cerasa
- Neuroimaging Research Unit, Institute of Neurological Sciences, National Research Council, Germaneto, CZ, Italy
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Mehanna R, Jankovic J. Movement disorders in multiple sclerosis and other demyelinating diseases. J Neurol Sci 2013; 328:1-8. [DOI: 10.1016/j.jns.2013.02.007] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2012] [Revised: 02/05/2013] [Accepted: 02/13/2013] [Indexed: 02/08/2023]
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Kim HJ, Yun JY, Kim JM, Kim YK, Erm G, Kim SE, Jeon BS. Extranigral extension of structural midbrain lesions overshadows parkinsonism. J Neural Transm (Vienna) 2011; 118:1209-13. [PMID: 21298299 DOI: 10.1007/s00702-011-0584-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2010] [Accepted: 01/09/2011] [Indexed: 11/25/2022]
Abstract
We report on a clinicoanatomical analysis of five patients with structural midbrain lesions who shared severe nigrostriatal dopaminergic denervation but presented different involuntary movements. The main clinical phenotype was parkinsonism in only one case; it was choreoballism in three cases and tremor and dystonia in one case. Structural midbrain lesions are likely to involve structures additional to nigral dopaminergic neurons. The extent of extranigral involvement may determine the diverse clinical manifestations associated with the structural midbrain lesions.
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Affiliation(s)
- Hee Jin Kim
- Department of Neurology, Konkuk University Hospital, Seoul, Korea
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Lieu CA, Deogaonkar M, Bakay RAE, Subramanian T. Dyskinesias do not develop after chronic intermittent levodopa therapy in clinically hemiparkinsonian rhesus monkeys. Parkinsonism Relat Disord 2010; 17:34-9. [PMID: 21074478 DOI: 10.1016/j.parkreldis.2010.10.010] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2010] [Revised: 10/18/2010] [Accepted: 10/19/2010] [Indexed: 11/26/2022]
Abstract
The stable 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP)-induced hemiparkinsonian (HP) rhesus monkey model of Parkinson's disease (PD) has been frequently used to test preclinical experimental therapeutics targeted to treat patients with advanced PD who suffer from motor fluctuations and drug-induced dyskinesias. We retrospectively analyzed data from 17 stable HP rhesus monkeys treated long-term with chronic intermittent dosing of levodopa (LD) in an attempt to induce choreoathetoid and dystonic dyskinesias. Rhesus monkeys in stable HP state for greater than 6 months as confirmed by multiple blinded behavioral ratings and (18)F-dopa Positron Emission Tomography (PET) were treated with optimal doses of LD to provide maximal amelioration of unilateral clinical parkinsonism without any adverse effects. Thereafter, each animal was given chronic intermittent daily challenge with doses of LD up to 700 mg/day orally or with 300 mg/kg/day parenteral injections. LD treatments failed to induce choreoathetoid and dystonic dyskinesias in these animals despite chronic intermittent high dose administration. These results suggest that the stable strictly unilateral HP rhesus monkey model of PD may not be a suitable animal model to test experimental therapeutics targeted against dyskinesias, and that bilateral parkinsonian rhesus models that readily demonstrate drug-induced dyskinesias and clinically relevant motor fluctuations are more appropriate for preclinical experimental testing of therapies designed to treat patients with advanced PD.
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Affiliation(s)
- Christopher A Lieu
- Department of Neurology, The Pennsylvania State University College of Medicine, Hershey, PA, USA
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Momjian-Mayor I, Coeytaux A, Castillo V, Vokatch N, Delavelle J, Burkhard PR. Foot dystonia as the only manifestation of unilateral nigral atrophy. Mov Disord 2008; 23:1951-4. [DOI: 10.1002/mds.22109] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Valkovic P, Krastev G, Mako M, Leitner P, Gasser T. A unique case of coincidence of early onset Parkinson's disease and multiple sclerosis. Mov Disord 2007; 22:2278-81. [PMID: 17914725 DOI: 10.1002/mds.21642] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
We report on a patient who developed left arm rest/postural tremor at age 24 and responded well to trihexyphenidyl. One year later spastic paraparesis appeared, and multiple sclerosis was diagnosed on the basis of clinical, radiological, and laboratory evidence. Although paraparesis improved after immunosuppressant therapy, a complete picture of an asymmetric parkinsonian syndrome gradually developed. Excellent response to levodopa, drug-induced dyskinesias, and DaTSCAN revealing pathology congruent with Parkinson's disease (PD) indicate a coincidental etiopathogenetic relationship of both clinical entities: multiple sclerosis and PD. Genetic analyses focusing on autosomal recessive parkinsonism (parkin, DJ1, and PINK1) were negative. To the best of our knowledge, only 15 cases of parkinsonism in association with multiple sclerosis have been reported, and their relationship has been interpreted to be either causal or coincidental. This is the first report of a coincidence of both entities, in which the parkinsonian syndrome developed first and before age 30.
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Affiliation(s)
- Peter Valkovic
- Department of Neurology, Trnavian University Hospital, Trnava, Slovakia.
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Růžička E, Roth J, Jech R, Vymazal J, Urgošík D. Reply: Hemiparkinsonism and levodopa-induced dyskinesias following focal nigral lesion. Mov Disord 2006. [DOI: 10.1002/mds.21164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Alves R, Barbosa E, Scaff M. Hemiparkinsonism and levodopa-induced dyskinesias following focal nigral lesion. Mov Disord 2006; 21:2267-8; author reply 2268. [PMID: 17078068 DOI: 10.1002/mds.21167] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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Current awareness: Pharmacoepidemiology and drug safety. Pharmacoepidemiol Drug Saf 2005. [DOI: 10.1002/pds.1034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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