1
|
Gupta M. Vascular Parkinsonism-A Revisit. Ann Indian Acad Neurol 2024; 27:3-4. [PMID: 38495235 PMCID: PMC10941897 DOI: 10.4103/aian.aian_234_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 04/14/2023] [Accepted: 04/14/2023] [Indexed: 03/19/2024] Open
Affiliation(s)
- Meena Gupta
- Director Neurolohy, Paras Hospital, Gurugram, Haryana, India
| |
Collapse
|
2
|
Tan AH, Gatto EM. Movement Disorder Rounds: Learning through observation, Building on collective experiences. Parkinsonism Relat Disord 2023; 110:105396. [PMID: 37045676 DOI: 10.1016/j.parkreldis.2023.105396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/07/2023]
|
3
|
Goh YY, Saunders E, Pavey S, Rushton E, Quinn N, Houlden H, Chelban V. Multiple system atrophy. Pract Neurol 2023; 23:208-221. [PMID: 36927875 DOI: 10.1136/pn-2020-002797] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/16/2023] [Indexed: 03/18/2023]
Abstract
This is a practical guide to diagnosing and managing multiple system atrophy (MSA). We explain the newly published Movement Disorders Society Consensus Diagnostic Criteria, which include new 'Clinically Established MSA' and 'Possible Prodromal MSA' categories, hopefully reducing time to diagnosis. We then highlight the key clinical features of MSA to aid diagnosis. We include a list of MSA mimics with suggested methods of differentiation from MSA. Lastly, we discuss practical symptom management in people living with MSA, including balancing side effects, with the ultimate aim of improving quality of life.
Collapse
Affiliation(s)
- Yee Yen Goh
- Neuromuscular Diseases, UCL Queen Square Institute of Neurology, London, UK
| | | | | | | | - Niall Quinn
- Neuromuscular Diseases, UCL Queen Square Institute of Neurology, London, UK
| | - Henry Houlden
- Neuromuscular Diseases, UCL Queen Square Institute of Neurology, London, UK
| | - Viorica Chelban
- Neuromuscular Diseases, UCL Queen Square Institute of Neurology, London, UK .,Neurobiology and Medical Genetics Laboratory, "Nicolae Testemitanu" State University of Medicine and Pharmacy, Chisinau, Moldova
| |
Collapse
|
4
|
Belić M, Radivojević Z, Bobić V, Kostić V, Đurić-Jovičić M. Quick computer aided differential diagnostics based on repetitive finger tapping in Parkinson’s disease and atypical parkinsonisms. Heliyon 2023; 9:e14824. [PMID: 37077676 PMCID: PMC10107087 DOI: 10.1016/j.heliyon.2023.e14824] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Revised: 03/06/2023] [Accepted: 03/17/2023] [Indexed: 03/30/2023] Open
Abstract
Background Parkinson's disease (PD) is the second most common neurodegenerative disorder whose prevalence rises with age, yet clinical diagnosis is still a challenging task due to similar manifestations of other neurodegenerative movement disorders. In untreated patients or those with unclear responses to medication, correct percentages of early diagnoses go as low as 26%. Technology has been used in various forms to facilitate discerning between persons with PD and healthy individuals, but much less work has been dedicated to separating PD and atypical parkinsonisms. Methods A wearable system was developed based on inertial sensors that capture the movements of fingers during repetitive finger tapping. A k-nearest-neighbor classifier was used on features extracted from gyroscope recordings for quick aid in differential diagnostics, discerning patients with PD, progressive supranuclear palsy (PSP), multiple system atrophy (MSA) and healthy controls (HC). Results The overall classification accuracy achieved was 85.18% in the multiclass setup. MSA and HC groups were the easiest to discern (100%), while PSP was the most elusive diagnosis, as some patients were incorrectly assigned to MSA and HC groups. Conclusions The system shows potential for use as a tool for quick diagnostic aid, and in the era of big data, offers a means of standardization of data collection that could allow scientists to aggregate multi-center data for further research.
Collapse
|
5
|
Dulski J, Cerquera-Cleves C, Milanowski L, Kwiatek-Majkusiak J, Koziorowski D, Ross OA, Pentela-Nowicka J, Sławek J, Wszolek ZK. L-Dopa response, choreic dyskinesia, and dystonia in Perry syndrome. Parkinsonism Relat Disord 2022; 100:19-23. [PMID: 35691177 DOI: 10.1016/j.parkreldis.2022.05.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Revised: 05/25/2022] [Accepted: 05/29/2022] [Indexed: 10/18/2022]
Abstract
INTRODUCTION A marked response to L-Dopa and L-Dopa-induced dyskinesia (LID) make the diagnosis of Parkinson's disease (PD) highly likely. This paper evaluates response to L-Dopa in Perry syndrome (PS), parkinsonism with distinct molecular and neuropathologic characteristics. METHODS Six patients with PS with a mean follow-up of 5 years (0.5-12) were assessed by movement disorder specialists and video recorded in states off and on. Additionally, DATSCAN-SPECT was performed in 3 subjects. RESULTS Four patients displayed a marked and sustained response to L-Dopa and LID. Additionally, we observed a distinct pattern of off-state predominant craniocervical dystonia responsive to L-Dopa in 4 patients, truncal dystonia in one, and dystonic head tremor in another. DATSCAN-SPECT was abnormal in 3 patients. CONCLUSIONS Patients with PS may present PD-like parkinsonism with a marked and sustained response to L-Dopa and LID. The characteristic pattern of craniocervical dystonia may be a helpful clue to the diagnosis of PS.
Collapse
Affiliation(s)
- Jarosław Dulski
- Department of Neurology, Mayo Clinic, Jacksonville, FL, USA; Division of Neurological and Psychiatric Nursing, Faculty of Health Sciences, Medical University of Gdansk, Gdansk, Poland; Neurology Department, St Adalbert Hospital, Copernicus PL Ltd., Gdansk, Poland
| | - Catalina Cerquera-Cleves
- Neurology Unit, Pontificia Universidad Javeriana, San Ignacio Hospital, Bogotá, Colombia; Movement Disorders Clinic, Clínica Universitaria Colombia, Bogotá, Colombia
| | - Lukasz Milanowski
- Department of Neurology, Mayo Clinic, Jacksonville, FL, USA; Department of Neuroscience, Mayo Clinic, Jacksonville, FL, USA; Department of Neurology, Faculty of Health Science, Medical University of Warsaw, Warsaw, Poland
| | | | - Dariusz Koziorowski
- Department of Neurology, Faculty of Health Science, Medical University of Warsaw, Warsaw, Poland
| | - Owen A Ross
- Department of Neuroscience, Mayo Clinic, Jacksonville, FL, USA
| | | | - Jarosław Sławek
- Division of Neurological and Psychiatric Nursing, Faculty of Health Sciences, Medical University of Gdansk, Gdansk, Poland; Neurology Department, St Adalbert Hospital, Copernicus PL Ltd., Gdansk, Poland
| | | |
Collapse
|
6
|
Shin HW, Hong SW, Youn YC. Clinical Aspects of the Differential Diagnosis of Parkinson's Disease and Parkinsonism. J Clin Neurol 2022; 18:259-270. [PMID: 35589315 PMCID: PMC9163948 DOI: 10.3988/jcn.2022.18.3.259] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 01/14/2022] [Accepted: 01/14/2022] [Indexed: 11/17/2022] Open
Abstract
Parkinsonism is a clinical syndrome presenting with bradykinesia, tremor, rigidity, and postural instability. Nonmotor symptoms have recently been included in the parkinsonian syndrome, which was traditionally associated with motor symptoms only. Various pathologically distinct and unrelated diseases have the same clinical manifestations as parkinsonism or parkinsonian syndrome. The etiologies of parkinsonism are classified as neurodegenerative diseases related to the accumulation of toxic protein molecules or diseases that are not neurodegenerative. The former class includes Parkinson's disease (PD), multiple-system atrophy, progressive supranuclear palsy, and corticobasal degeneration. Over the past decade, clinical diagnostic criteria have been validated and updated to improve the accuracy of diagnosing these diseases. The latter class of disorders unrelated to neurodegenerative diseases are classified as secondary parkinsonism, and include drug-induced parkinsonism (DIP), vascular parkinsonism, and idiopathic normal-pressure hydrocephalus (iNPH). DIP and iNPH are regarded as reversible and treatable forms of parkinsonism. However, studies have suggested that the absence of protein accumulation in the nervous system as well as managing the underlying causes do not guarantee recovery. Here we review the differential diagnosis of PD and parkinsonism, mainly focusing on the clinical aspects. In addition, we describe recent updates to the clinical criteria of various disorders sharing clinical symptoms with parkinsonism.
Collapse
Affiliation(s)
- Hae-Won Shin
- Department of Neurology, Chung-Ang University College of Medicine, Seoul, Korea
| | - Sang-Wook Hong
- Department of Neurology, Chung-Ang University College of Medicine, Seoul, Korea
| | - Young Chul Youn
- Department of Neurology, Chung-Ang University College of Medicine, Seoul, Korea.
| |
Collapse
|
7
|
A nationwide study of the incidence, prevalence and mortality of Parkinson's disease in the Norwegian population. NPJ Parkinsons Dis 2022; 8:19. [PMID: 35236852 PMCID: PMC8891365 DOI: 10.1038/s41531-022-00280-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 01/12/2022] [Indexed: 01/19/2023] Open
Abstract
Epidemiological studies of Parkinson's disease (PD) show variable and partially conflicting findings with regard to incidence, prevalence, and mortality. These differences are commonly attributed to technical and methodological factors, including small sample sizes, differences in diagnostic practices, and population heterogeneity. We leveraged the Norwegian Prescription Database, a population-based registry of drug prescriptions dispensed from Norwegian pharmacies to assess the incidence, prevalence, and mortality of PD in Norway. The diagnosis of PD was defined based on the prescription of dopaminergic drugs for the indication of PD over a continuous time. During 2004-2017, 12,229 males and 9831 females met our definition for PD diagnosis. PD prevalence increased over the observation period, with larger changes observed in the older age groups. Incidence and prevalence of PD increased with age, peaking at 85 years. The male/female prevalence ratio was 1.5 across all ages, whereas the incidence ratio increased with age, from 1.4 in those 60 years, to 2.03 among those >90 years. While PD mortality was generally higher than that of the general population, mortality odds ratios decreased with age, approaching 1.0 among individuals >90 years old. When adjusted for the sex-specific mortality of the general population, the mortality among females with PD was equal to or higher than the mortality among males with PD. Our findings demonstrate that the epidemiological features of PD, including sex-differences, are age and time-period dependent and indicate that sex differences in PD mortality are unlikely to stem from disease-specific negative impact of survival in males.
Collapse
|
8
|
"Parkinson's disease" on the way to progressive supranuclear palsy: a review on PSP-parkinsonism. Neurol Sci 2021; 42:4927-4936. [PMID: 34532773 DOI: 10.1007/s10072-021-05601-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 09/06/2021] [Indexed: 12/12/2022]
Abstract
Progressive supranuclear palsy (PSP) is a progressive atypical parkinsonian syndrome characterised by postural instability, supranuclear ophthalmoplegia, dysarthria, dysphagia, executive dysfunction and other features. This clinical presentation represents the classic PSP-Richardson syndrome (PSP-RS). However, several other clinical subtypes have been recognised, including PSP-parkinsonism (PSP-P), probably the second most common PSP variant. Unlike PSP-RS, PSP-P often presents with an asymmetric onset, tremor and a moderate initial response to levodopa, especially during the first years of the disease, thus resembling Parkinson's disease (PD). It runs a more favourable course, but over time, PSP-P may evolve clinically into PSP-RS. Therefore, it may seem that PSP-P stands clinically between PD and PSP. There are several peculiarities that can distinguish PSP-P from these entities. As there is lack of systematic reviews on PSP-P in the literature, we decided to summarise all the necessary data about the epidemiology, clinical picture, neuroimaging, genetics and other aspects of this PSP variant in order to provide complete information for the reader.
Collapse
|
9
|
Seger AD, Farrher E, Doppler CEJ, Gogishvili A, Worthoff WA, Filss CP, Barbe MT, Holtbernd F, Shah NJ, Fink GR, Sommerauer M. Putaminal y-Aminobutyric Acid Modulates Motor Response to Dopaminergic Therapy in Parkinson's Disease. Mov Disord 2021; 36:2187-2192. [PMID: 34096652 DOI: 10.1002/mds.28674] [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: 02/19/2021] [Revised: 05/11/2021] [Accepted: 05/12/2021] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Motor response to dopaminergic therapy is a characteristic of patients with Parkinson's disease (PD). Whether nondopaminergic neurotransmitters contribute to treatment response is uncertain. OBJECTIVES The aim of this study is to determine whether putaminal y-aminobutyric acid (GABA) levels are associated with dopaminergic motor response. METHODS We assessed putaminal GABA levels in 19 PD patients and 13 healthy controls (HCs) utilizing ultra-high field proton magnetic resonance spectroscopy. Motor performance was evaluated using the Movement Disorder Society-Unified Parkinson's Disease Rating Scale, Part III, in the ON and OFF states. Statistical analysis comprised group comparisons, correlation analysis, and multiple linear regression. RESULTS In PD, GABA levels were significantly higher compared to HCs (1.50 ± 0.26 mM vs. 1.26 ± 0.31 mM, P = 0.022). Furthermore, GABA levels were independent predictors of absolute and relative dopaminergic treatment response. CONCLUSIONS Our findings indicate that elevated putaminal GABA levels are associated with worse dopaminergic response in PD, emphasizing the essential role of nondopaminergic neurotransmitters in motor response. © 2021 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
Collapse
Affiliation(s)
- Aline D Seger
- Department of Neurology, University Hospital Cologne, Faculty of Medicine, University of Cologne, Köln, Germany.,Institute of Neuroscience and Medicine (INM-3), Forschungszentrum Jülich, Jülich, Germany
| | - Ezequiel Farrher
- Institute of Neuroscience and Medicine 4, Medical Imaging Physics, Forschungszentrum Jülich, Jülich, Germany
| | - Christopher E J Doppler
- Department of Neurology, University Hospital Cologne, Faculty of Medicine, University of Cologne, Köln, Germany.,Institute of Neuroscience and Medicine (INM-3), Forschungszentrum Jülich, Jülich, Germany
| | - Ana Gogishvili
- Institute of Neuroscience and Medicine 4, Medical Imaging Physics, Forschungszentrum Jülich, Jülich, Germany.,Engineering Physics Department, Georgian Technical University, Tbilisi, Georgia
| | - Wieland A Worthoff
- Institute of Neuroscience and Medicine 4, Medical Imaging Physics, Forschungszentrum Jülich, Jülich, Germany
| | - Christian P Filss
- Institute of Neuroscience and Medicine 4, Medical Imaging Physics, Forschungszentrum Jülich, Jülich, Germany
| | - Michael T Barbe
- Department of Neurology, University Hospital Cologne, Faculty of Medicine, University of Cologne, Köln, Germany
| | - Florian Holtbernd
- Institute of Neuroscience and Medicine 4, Medical Imaging Physics, Forschungszentrum Jülich, Jülich, Germany.,Department of Neurology, RWTH Aachen University, Aachen, Germany.,JARA-BRAIN-Translational Medicine, Aachen, Germany
| | - N Jon Shah
- Institute of Neuroscience and Medicine 4, Medical Imaging Physics, Forschungszentrum Jülich, Jülich, Germany.,Department of Neurology, RWTH Aachen University, Aachen, Germany.,JARA-BRAIN-Translational Medicine, Aachen, Germany.,Institute of Neuroscience and Medicine 11 (INM-11), JARA, Forschungszentrum, Jülich, Germany
| | - Gereon R Fink
- Department of Neurology, University Hospital Cologne, Faculty of Medicine, University of Cologne, Köln, Germany.,Institute of Neuroscience and Medicine (INM-3), Forschungszentrum Jülich, Jülich, Germany
| | - Michael Sommerauer
- Department of Neurology, University Hospital Cologne, Faculty of Medicine, University of Cologne, Köln, Germany.,Institute of Neuroscience and Medicine (INM-3), Forschungszentrum Jülich, Jülich, Germany
| |
Collapse
|
10
|
Schniepp R, Möhwald K, Wuehr M. [Options for the symptomatic treatment of chronic neurological gait disorders]. FORTSCHRITTE DER NEUROLOGIE-PSYCHIATRIE 2021; 89:243-253. [PMID: 33893628 DOI: 10.1055/a-1472-5860] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Gait and mobility impairments are common and relevant in patients with chronic neurological disorders. It reduces the health-related quality of life and induces falls with morbidity. Symptomatic treatment options are therefore necessary in order to improve the health status of patients with neurological disorders.By means of a selective literature research focusing on studies with specific gait-related outcome measures. We discuss the differential treatment options for (1) hypokinetic gait disorders (Parkinson´s disease, Normal pressure hydrocephalus, vascular encephalopathy), (2) gait unsteadiness with ataxia (sensory and cerebellar ataxia), and (3) gait with spasticity and paresis (due to multiple sclerosis). Therapeutical options for the symptomatic treatment of gait disorders comprise non-pharmacological and pharmacological approaches. Both address the functional domains of "locomotion", "postural control", "modulation" and "adaptability" of gait.Pharmacological options are orientated to pathophysiology of the underlying diseases. Supportive physiotherapeutic interventions offer broader and unspecific options for treatment. Clinical conditions that specifically disturb the execution of locomotion or gait can also be addressed by the provision of physical therapy or supportive devices.Effective options for the symptomatic treatment of patients with neurological gait disorders are available. Applications of options addressing the pathophysiology of the underlying disease, a functional domain-based exercise and physiotherapy program, and the provision of walking aides for specific symptoms that further worsen gait performance can be recommended.
Collapse
Affiliation(s)
- Roman Schniepp
- Deutsches Schwindel- und Gleichgewichtszentrum, Ludwig-Maximilians Universität München.,Neurologische Klinik, Ludwig-Maximilians Universität München
| | - Ken Möhwald
- Deutsches Schwindel- und Gleichgewichtszentrum, Ludwig-Maximilians Universität München.,Neurologische Klinik, Ludwig-Maximilians Universität München
| | - Max Wuehr
- Deutsches Schwindel- und Gleichgewichtszentrum, Ludwig-Maximilians Universität München
| |
Collapse
|
11
|
Prediction of the Clinical Severity of Progressive Supranuclear Palsy by Diffusion Tensor Imaging. J Clin Med 2019; 9:jcm9010040. [PMID: 31878122 PMCID: PMC7020078 DOI: 10.3390/jcm9010040] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 12/14/2019] [Accepted: 12/15/2019] [Indexed: 01/06/2023] Open
Abstract
Progressive supranuclear palsy (PSP) is characterized by a rapid and progressive clinical course. A timely and objective image-based evaluation of disease severity before standard clinical assessments might increase the diagnostic confidence of the neurologist. We sought to investigate whether features from diffusion tensor imaging of the entire brain with a machine learning algorithm, rather than a few pathogenically involved regions, may predict the clinical severity of PSP. Fifty-three patients who met the diagnostic criteria for probable PSP were subjected to diffusion tensor imaging. Of them, 15 underwent follow-up imaging. Clinical severity was assessed by the neurological examinations. Mean diffusivity and fractional anisotropy maps were spatially co-registered, normalized, and parcellated into 246 brain regions from the human Brainnetome atlas. The predictors of clinical severity from a stepwise linear regression model were determined after feature reduction by the least absolute shrinkage and selection operator. Performance estimates were obtained using bootstrapping, cross-validation, and through application of the model in the patients who underwent repeated imaging. The algorithm confidently predicts the clinical severity of PSP at the individual level (adjusted R2: 0.739 and 0.892, p < 0.001). The machine learning algorithm for selection of diffusion tensor imaging-based features is accurate in predicting motor subscale of unified Parkinson’s disease rating scale and postural instability and gait disturbance of PSP.
Collapse
|
12
|
van Eimeren T, Antonini A, Berg D, Bohnen N, Ceravolo R, Drzezga A, Höglinger GU, Higuchi M, Lehericy S, Lewis S, Monchi O, Nestor P, Ondrus M, Pavese N, Peralta MC, Piccini P, Pineda-Pardo JÁ, Rektorová I, Rodríguez-Oroz M, Rominger A, Seppi K, Stoessl AJ, Tessitore A, Thobois S, Kaasinen V, Wenning G, Siebner HR, Strafella AP, Rowe JB. Neuroimaging biomarkers for clinical trials in atypical parkinsonian disorders: Proposal for a Neuroimaging Biomarker Utility System. ALZHEIMER'S & DEMENTIA (AMSTERDAM, NETHERLANDS) 2019; 11:301-309. [PMID: 30984816 PMCID: PMC6446052 DOI: 10.1016/j.dadm.2019.01.011] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
INTRODUCTION Therapeutic strategies targeting protein aggregations are ready for clinical trials in atypical parkinsonian disorders. Therefore, there is an urgent need for neuroimaging biomarkers to help with the early detection of neurodegenerative processes, the early differentiation of the underlying pathology, and the objective assessment of disease progression. However, there currently is not yet a consensus in the field on how to describe utility of biomarkers for clinical trials in atypical parkinsonian disorders. METHODS To promote standardized use of neuroimaging biomarkers for clinical trials, we aimed to develop a conceptual framework to characterize in more detail the kind of neuroimaging biomarkers needed in atypical parkinsonian disorders, identify the current challenges in ascribing utility of these biomarkers, and propose criteria for a system that may guide future studies. RESULTS As a consensus outcome, we describe the main challenges in ascribing utility of neuroimaging biomarkers in atypical parkinsonian disorders, and we propose a conceptual framework that includes a graded system for the description of utility of a specific neuroimaging measure. We included separate categories for the ability to accurately identify an intention-to-treat patient population early in the disease (Early), to accurately detect a specific underlying pathology (Specific), and the ability to monitor disease progression (Progression). DISCUSSION We suggest that the advancement of standardized neuroimaging in the field of atypical parkinsonian disorders will be furthered by a well-defined reference frame for the utility of biomarkers. The proposed utility system allows a detailed and graded description of the respective strengths of neuroimaging biomarkers in the currently most relevant areas of application in clinical trials.
Collapse
Affiliation(s)
- Thilo van Eimeren
- Multimodal Neuroimaging, Department of Nuclear Medicine, Medical Faculty and University Hospital, University of Cologne, Cologne, Germany
- German Centre for Neurodegenerative Diseases (DZNE), Bonn-Cologne, Germany
| | - Angelo Antonini
- Department of Neuroscience, University of Padua, Padua, Italy
| | - Daniela Berg
- Department of Neurology, UKSH, Campus Kiel, Christian-Albrechts-University, Kiel, Germany
| | - Nico Bohnen
- Division of Nuclear Medicine, Department of Radiology, University of Michigan, and VAMC, Ann Arbor, MI, USA
- Department of Neurology, University of Michigan, Ann Arbor, MI, USA
- VAMC, Ann Arbor, MI, USA
| | - Roberto Ceravolo
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Alexander Drzezga
- Multimodal Neuroimaging, Department of Nuclear Medicine, Medical Faculty and University Hospital, University of Cologne, Cologne, Germany
- German Centre for Neurodegenerative Diseases (DZNE), Bonn-Cologne, Germany
- Forschungszentrum Jülich, INM-2, Jülich, Germany
| | - Günter U. Höglinger
- German Centre for Neurodegenerative Diseases (DZNE), and Technical University Munich, Department of Neurology, Munich, Germany
| | - Makoto Higuchi
- National Institutes for Quantum and Radiological Science and Technology, Chiba, Japan
| | - Stephane Lehericy
- Institut du Cerveau et de la Moelle épinière – ICM, Centre de NeuroImagerie de Recherche – CENIR, ICM Team “Movement Investigations and Therapeutics”, Sorbonne Universités, Inserm U1127, CNRS UMR, Paris, France
| | - Simon Lewis
- Brain & Mind Centre, Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Oury Monchi
- Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
- Department of Radiology, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Peter Nestor
- Queensland Brain Institute, University of Queensland, Brisbane, QLD, Australia
- Mater Hospital, South Brisbane, QLD, Australia
| | - Matej Ondrus
- AXON Neuroscience CRM Services SE, Bratislava, Slovak Republic
| | - Nicola Pavese
- Newcastle Magnetic Resonance Centre & Positron Emission Tomography Centre, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - María Cecilia Peralta
- Center for Medical Education and Clinical Research, Section of Neurology, Buenos Aires, Argentina
| | - Paola Piccini
- Department of Medicine, Imperial College London, London, United Kingdom
| | - José Ángel Pineda-Pardo
- hmCINAC, University Hospital HM Puerta del Sur, CEU-San Pablo University, Móstoles, Madrid, Spain
| | - Irena Rektorová
- First Department of Neurology – Faculty of Medicine and CEITEC MU, Masaryk University, Brno, Czech Republic
| | | | - Axel Rominger
- Department of Nuclear Medicine, Inselspital, Universitätsspital Bern, Bern, Switzerland
| | - Klaus Seppi
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - A. Jon Stoessl
- Pacific Parkinson’s Research Centre, University of British Columbia, Vancouver, Canada
| | - Alessandro Tessitore
- Department of Medical, Surgery, Neurological, Metabolic and Aging Sciences, University of Campania, “L. Vanvitelli”, Caserta CE, Italy
| | - Stephane Thobois
- Université de Lyon, Université Claude Bernard Lyon 1, Faculté de Medecine Lyon Sud Charles Merieux, Lyon, France
- Hospices Civils de Lyon, Hopital Neurologique Pierre Wertheimer, Neurologie C, Lyon, France
- CNRS, Institut des Sciences Cognitives, Bron, France
| | - Valtteri Kaasinen
- Department of Neurology, University of Turku, Turku, Finland
- Division of Clinical Neurosciences, Turku University Hospital, Turku, Finland
| | - Gregor Wenning
- Division of Clinical Neurology, Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Hartwig R. Siebner
- Danish Research Centre for Magnetic Resonance, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
| | - Antonio P. Strafella
- E.J. Safra Parkinson Disease Program, Toronto Western Hospital & Krembil Research Institute, UHN, Toronto, Ontario, Canada
- Research Imaging Centre, Campbell Family Mental Health Research Institute, CAMH, Toronto, Ontario, Canada
- University of Toronto, Toronto, Ontario, Canada
| | - James B. Rowe
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom
| |
Collapse
|
13
|
Fanciulli A, Stankovic I, Krismer F, Seppi K, Levin J, Wenning GK. Multiple system atrophy. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2019; 149:137-192. [PMID: 31779811 DOI: 10.1016/bs.irn.2019.10.004] [Citation(s) in RCA: 61] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Multiple system atrophy (MSA) is a sporadic, adult-onset, relentlessly progressive neurodegenerative disorder, clinically characterized by various combinations of autonomic failure, parkinsonism and ataxia. The neuropathological hallmark of MSA are glial cytoplasmic inclusions consisting of misfolded α-synuclein. Selective atrophy and neuronal loss in striatonigral and olivopontocerebellar systems underlie the division into two main motor phenotypes of MSA-parkinsonian type and MSA-cerebellar type. Isolated autonomic failure and REM sleep behavior disorder are common premotor features of MSA. Beyond the core clinical symptoms, MSA manifests with a number of non-motor and motor features. Red flags highly specific for MSA may provide clues for a correct diagnosis, but in general the diagnostic accuracy of the second consensus criteria is suboptimal, particularly in early disease stages. In this chapter, the authors discuss the historical milestones, etiopathogenesis, neuropathological findings, clinical features, red flags, differential diagnosis, diagnostic criteria, imaging and other biomarkers, current treatment, unmet needs and future treatments for MSA.
Collapse
Affiliation(s)
| | - Iva Stankovic
- Neurology Clinic, Clinical Center of Serbia, School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Florian Krismer
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Klaus Seppi
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Johannes Levin
- Department of Neurology, Ludwig-Maximilians-Universität München, Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE) e.V., Munich Cluster of Systems Neurology (SyNergy), Munich, Germany
| | - Gregor K Wenning
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| |
Collapse
|
14
|
Isonaka R, Gibbons CH, Wang N, Freeman R, Goldstein DS. Association of innervation-adjusted alpha-synuclein in arrector pili muscles with cardiac noradrenergic deficiency in autonomic synucleinopathies. Clin Auton Res 2019; 29:587-593. [PMID: 31673840 DOI: 10.1007/s10286-019-00644-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Accepted: 10/08/2019] [Indexed: 12/27/2022]
Abstract
BACKGROUND Autonomic synucleinopathies feature deposition of the protein alpha-synuclein (AS) in neurons [e.g., Lewy body neurogenic orthostatic hypotension (nOH)] or glial cells (multiple system atrophy, MSA). AS in skin biopsies might provide biomarkers of these diseases; however, this approach would be complicated or invalidated if there were substantial loss of AS-containing nerves. We report AS content in arrector pili muscles in skin biopsies after adjustment for local innervation in patients with Lewy body nOH or MSA. Cardiac sympathetic neuroimaging by myocardial 18F-dopamine positron emission tomography (PET) was done to examine pathophysiological correlates of innervation-adjusted AS. METHODS Thirty-one patients (19 Lewy body nOH, 12 MSA) underwent thoracic 18F-dopamine PET and skin biopsies. AS signal intensity analyzed by immunofluorescence microscopy was adjusted for innervation by the ratio of AS to protein gene product (PGP) 9.5, a pan-axonal marker (Harvard lab site), or the ratio of AS to tyrosine hydroxylase (TH), an indicator of catecholaminergic neurons (NIH lab site). RESULTS The Lewy body nOH group had higher ratios of AS/PGP 9.5 or log AS/TH than did the MSA group (0.89 ± 0.05 vs. 0.66 ± 0.04, -0.13 ± 0.05 vs. -1.60 ± 0.33; p < 0.00001 each). All 19 Lewy body patients had AS/PGP 9.5 > 0.8 or log AS/TH > 1.2 and had myocardial 18F-dopamine-derived radioactivity < 6000 nCi-kg/cc-mCi, the lower limit of normal. Two MSA patients (17%) had increased AS/PGP or log AS/TH, and two (17%) had low 18F-dopamine-derived radioactivity. CONCLUSIONS Lewy body forms of nOH are associated with increased innervation-adjusted AS in arrector pili muscles and neuroimaging evidence of myocardial noradrenergic deficiency.
Collapse
Affiliation(s)
- Risa Isonaka
- Autonomic Medicine Section (formerly Clinical Neurocardiology Section), Clinical Neurosciences Program, Division of Intramural Research, National Institute of Neurological Disorders and Stroke, National Institutes of Health, 9000 Rockville Pike MSC-1620, Building 10 Room 8N260, Bethesda, MD, 20892-1620, USA
| | | | - Ningshan Wang
- Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Roy Freeman
- Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - David S Goldstein
- Autonomic Medicine Section (formerly Clinical Neurocardiology Section), Clinical Neurosciences Program, Division of Intramural Research, National Institute of Neurological Disorders and Stroke, National Institutes of Health, 9000 Rockville Pike MSC-1620, Building 10 Room 8N260, Bethesda, MD, 20892-1620, USA.
| |
Collapse
|
15
|
Jost WH, Lingor P, Tönges L, Schwarz J, Buhmann C, Kassubek J, Schrag A. Dyskinesia in multiple system atrophy and progressive supranuclear palsy. J Neural Transm (Vienna) 2019; 126:925-932. [PMID: 31087195 DOI: 10.1007/s00702-019-02012-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Accepted: 05/06/2019] [Indexed: 01/06/2023]
Abstract
In the differential diagnosis of Parkinson syndromes, the response to L-Dopa is an essential criterion for the diagnosis of idiopathic Parkinson's syndrome (IPS), and the presence of L-Dopa-induced dyskinesia (LID) is considered a supportive criterion. This implies that in the presence of LID an atypical Parkinson-syndrome (APS) is unlikely. However, dyskinesia, and in particular LID, can also be present in APS such as MSA and PSP, although less frequently, and with varying clinical appearance. We conclude that whilst presence of dyskinesia provides support for a diagnosis of IPD, they do not allow reliable differentiation from APS.
Collapse
Affiliation(s)
- Wolfgang H Jost
- Parkinson-Klinik Ortenau, Kreuzbergstr. 12, 77709, Wolfach, Germany.
| | - Paul Lingor
- Klinik für Neurologie, Klinikum Rechts der Isar der TU München, Munich, Germany
| | - Lars Tönges
- Department of Neurology, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany
- Neurodegeneration Research, Protein Research Unit Ruhr (PURE), Ruhr University Bochum, Bochum, Germany
| | | | - Carsten Buhmann
- Department of Neurology, University Clinic Eppendorf, Hamburg, Germany
| | - Jan Kassubek
- Department of Neurology, University of Ulm, Ulm, Germany
| | | |
Collapse
|
16
|
Long-term treatment with rotigotine in drug-naïve PSP patients. Acta Neurol Belg 2019; 119:113-116. [PMID: 30062400 DOI: 10.1007/s13760-018-0993-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2017] [Accepted: 07/25/2018] [Indexed: 12/13/2022]
Abstract
Progressive supranuclear palsy (PSP) is a severe neurodegenerative disease still lacking of alleviating treatments for either cognitive or motor disturbances. Aimed at widening the spectrum of therapeutic options, here, we describe efficacy and safety of a long-term treatment with Rotigotine, a non-ergolinic dopamine agonist, in PSP. Seven PSP drug-naïve patients, presenting with Richardson's syndrome, received up to 6 mg/24 h transdermal patch for 42 weeks as unique therapy. Adverse effects were recorded; efficacy was measured by comparing baseline and final treatment scores of Montreal Cognitive Assessment (MoCA), Unified Parkinson Disease Rating Scale part3, and PSP rating scale (PSP-RS). At the end of our observation, no significant adverse events occurred; the cognitive item of PSP-RS was improved and MoCA score was similar at baseline. Contrariwise, motor disturbances worsened according to disease progression. Our observation thus suggests that long-term treatment with low doses of rotigotine is well tolerated and may support cognitive functions of PSP patients.
Collapse
|
17
|
Olfati N, Shoeibi A, Litvan I. Progress in the treatment of Parkinson-Plus syndromes. Parkinsonism Relat Disord 2019; 59:101-110. [DOI: 10.1016/j.parkreldis.2018.10.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2018] [Revised: 09/27/2018] [Accepted: 10/01/2018] [Indexed: 01/04/2023]
|
18
|
Regional gray matter changes and age predict individual treatment response in Parkinson's disease. NEUROIMAGE-CLINICAL 2018; 21:101636. [PMID: 30558868 PMCID: PMC6413309 DOI: 10.1016/j.nicl.2018.101636] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Revised: 08/30/2018] [Accepted: 12/09/2018] [Indexed: 01/02/2023]
Abstract
We aimed at testing the potential of biomarkers in predicting individual patient response to dopaminergic therapy for Parkinson's disease. Treatment efficacy was assessed in 30 Parkinson's disease patients as motor symptoms improvement from unmedicated to medicated state as assessed by the Unified Parkinson's Disease Rating Scale score III. Patients were stratified into weak and strong responders according to the individual treatment response. A multiple regression was implemented to test the prediction accuracy of age, disease duration and treatment dose and length. Univariate voxel-based morphometry was applied to investigate differences between the two groups on age-corrected T1-weighted magnetic resonance images. Multivariate support vector machine classification was used to predict individual treatment response based on neuroimaging data. Among clinical data, increasing age predicted a weaker treatment response. Additionally, weak responders presented greater brain atrophy in the left temporoparietal operculum. Support vector machine classification revealed that gray matter density in this brain region, including additionally the supplementary and primary motor areas and the cerebellum, was able to differentiate weak and strong responders with 74% accuracy. Remarkably, age and regional gray matter density of the left temporoparietal operculum predicted both and independently treatment response as shown in a combined regression analysis. In conclusion, both increasing age and reduced gray matter density are valid and independent predictors of dopaminergic therapy response in Parkinson's disease.
Collapse
|
19
|
Kasanuki K, Josephs KA, Ferman TJ, Murray ME, Koga S, Konno T, Sakae N, Parks A, Uitti RJ, Van Gerpen JA, Graff-Radford NR, Wszolek ZK, Dickson DW. Diffuse Lewy body disease manifesting as corticobasal syndrome: A rare form of Lewy body disease. Neurology 2018; 91:e268-e279. [PMID: 29898972 DOI: 10.1212/wnl.0000000000005828] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2017] [Accepted: 04/13/2018] [Indexed: 01/31/2023] Open
Abstract
OBJECTIVE To describe clinical and pathologic characteristics of diffuse Lewy body disease (DLBD) manifesting as corticobasal syndrome (CBS). METHODS In 523 autopsy-confirmed cases of DLBD, we identified 11 patients diagnosed with CBS. For comparison, we studied 22 DLBD brains with antemortem presentation of dementia with Lewy bodies (DLB). Given previous studies suggesting the importance of pathology in peri-Rolandic cortices in CBS, we used digital pathology to count Lewy bodies and to quantify intracytoplasmic and neuritic α-synuclein and phospho-tau burden in the motor cortex. RESULTS DLBD patients with antemortem features of CBS were significantly younger at disease onset and less likely to have REM sleep behavior disorder than DLBD cases who met clinical criteria for DLB during life. Patients with DLBD manifesting as CBS had more Lewy bodies in the motor cortex than DLBD manifesting as clinically probable DLB. Three cases had concomitant progressive supranuclear palsy and 4 cases had concomitant Alzheimer disease as probable correlates of CBS. CONCLUSION The neuropathology underlying CBS is heterogeneous, including corticobasal degeneration, Alzheimer disease, and progressive supranuclear palsy. This study suggests that atypical variants of Lewy body disease with severe peri-Rolandic Lewy-related pathology can present clinically as CBS. Patients with DLBD who present as CBS tend to have an earlier age at onset and are less likely to have clinical features of DLB, such as dream enactment behavior during sleep, visual hallucinations, and levodopa-responsive parkinsonism. Future studies with biofluid or molecular imaging biomarkers for α-synuclein will permit better recognition of this uncommon pathologic substrate of CBS.
Collapse
Affiliation(s)
- Koji Kasanuki
- From the Departments of Neuroscience (K.K., M.E.M., S.K., N.S., J.A.V.G., D.W.D.), Psychiatry and Psychology (T.J.F., A.P.), and Neurology (T.K., R.J.U., N.R.G.-R., Z.K.W.), Mayo Clinic, Jacksonville, FL; and Behavioral Neurology (K.A.J.), Department of Neurology, Mayo Clinic, Rochester, MN
| | - Keith A Josephs
- From the Departments of Neuroscience (K.K., M.E.M., S.K., N.S., J.A.V.G., D.W.D.), Psychiatry and Psychology (T.J.F., A.P.), and Neurology (T.K., R.J.U., N.R.G.-R., Z.K.W.), Mayo Clinic, Jacksonville, FL; and Behavioral Neurology (K.A.J.), Department of Neurology, Mayo Clinic, Rochester, MN
| | - Tanis J Ferman
- From the Departments of Neuroscience (K.K., M.E.M., S.K., N.S., J.A.V.G., D.W.D.), Psychiatry and Psychology (T.J.F., A.P.), and Neurology (T.K., R.J.U., N.R.G.-R., Z.K.W.), Mayo Clinic, Jacksonville, FL; and Behavioral Neurology (K.A.J.), Department of Neurology, Mayo Clinic, Rochester, MN
| | - Melissa E Murray
- From the Departments of Neuroscience (K.K., M.E.M., S.K., N.S., J.A.V.G., D.W.D.), Psychiatry and Psychology (T.J.F., A.P.), and Neurology (T.K., R.J.U., N.R.G.-R., Z.K.W.), Mayo Clinic, Jacksonville, FL; and Behavioral Neurology (K.A.J.), Department of Neurology, Mayo Clinic, Rochester, MN
| | - Shunsuke Koga
- From the Departments of Neuroscience (K.K., M.E.M., S.K., N.S., J.A.V.G., D.W.D.), Psychiatry and Psychology (T.J.F., A.P.), and Neurology (T.K., R.J.U., N.R.G.-R., Z.K.W.), Mayo Clinic, Jacksonville, FL; and Behavioral Neurology (K.A.J.), Department of Neurology, Mayo Clinic, Rochester, MN
| | - Takuya Konno
- From the Departments of Neuroscience (K.K., M.E.M., S.K., N.S., J.A.V.G., D.W.D.), Psychiatry and Psychology (T.J.F., A.P.), and Neurology (T.K., R.J.U., N.R.G.-R., Z.K.W.), Mayo Clinic, Jacksonville, FL; and Behavioral Neurology (K.A.J.), Department of Neurology, Mayo Clinic, Rochester, MN
| | - Nobutaka Sakae
- From the Departments of Neuroscience (K.K., M.E.M., S.K., N.S., J.A.V.G., D.W.D.), Psychiatry and Psychology (T.J.F., A.P.), and Neurology (T.K., R.J.U., N.R.G.-R., Z.K.W.), Mayo Clinic, Jacksonville, FL; and Behavioral Neurology (K.A.J.), Department of Neurology, Mayo Clinic, Rochester, MN
| | - Adam Parks
- From the Departments of Neuroscience (K.K., M.E.M., S.K., N.S., J.A.V.G., D.W.D.), Psychiatry and Psychology (T.J.F., A.P.), and Neurology (T.K., R.J.U., N.R.G.-R., Z.K.W.), Mayo Clinic, Jacksonville, FL; and Behavioral Neurology (K.A.J.), Department of Neurology, Mayo Clinic, Rochester, MN
| | - Ryan J Uitti
- From the Departments of Neuroscience (K.K., M.E.M., S.K., N.S., J.A.V.G., D.W.D.), Psychiatry and Psychology (T.J.F., A.P.), and Neurology (T.K., R.J.U., N.R.G.-R., Z.K.W.), Mayo Clinic, Jacksonville, FL; and Behavioral Neurology (K.A.J.), Department of Neurology, Mayo Clinic, Rochester, MN
| | - Jay A Van Gerpen
- From the Departments of Neuroscience (K.K., M.E.M., S.K., N.S., J.A.V.G., D.W.D.), Psychiatry and Psychology (T.J.F., A.P.), and Neurology (T.K., R.J.U., N.R.G.-R., Z.K.W.), Mayo Clinic, Jacksonville, FL; and Behavioral Neurology (K.A.J.), Department of Neurology, Mayo Clinic, Rochester, MN
| | - Neill R Graff-Radford
- From the Departments of Neuroscience (K.K., M.E.M., S.K., N.S., J.A.V.G., D.W.D.), Psychiatry and Psychology (T.J.F., A.P.), and Neurology (T.K., R.J.U., N.R.G.-R., Z.K.W.), Mayo Clinic, Jacksonville, FL; and Behavioral Neurology (K.A.J.), Department of Neurology, Mayo Clinic, Rochester, MN
| | - Zbigniew K Wszolek
- From the Departments of Neuroscience (K.K., M.E.M., S.K., N.S., J.A.V.G., D.W.D.), Psychiatry and Psychology (T.J.F., A.P.), and Neurology (T.K., R.J.U., N.R.G.-R., Z.K.W.), Mayo Clinic, Jacksonville, FL; and Behavioral Neurology (K.A.J.), Department of Neurology, Mayo Clinic, Rochester, MN
| | - Dennis W Dickson
- From the Departments of Neuroscience (K.K., M.E.M., S.K., N.S., J.A.V.G., D.W.D.), Psychiatry and Psychology (T.J.F., A.P.), and Neurology (T.K., R.J.U., N.R.G.-R., Z.K.W.), Mayo Clinic, Jacksonville, FL; and Behavioral Neurology (K.A.J.), Department of Neurology, Mayo Clinic, Rochester, MN.
| |
Collapse
|
20
|
Komatsu H, Kato M, Kinpara T, Ono T, Kakuto Y. Possible multiple system atrophy with predominant parkinsonism in a patient with chronic schizophrenia: a case report. BMC Psychiatry 2018; 18:141. [PMID: 29783976 PMCID: PMC5963188 DOI: 10.1186/s12888-018-1714-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Accepted: 05/02/2018] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Multiple system atrophy (MSA) is an adult-onset, rare, and progressive neurodegenerative disorder characterized by a varying combination of autonomic failure, cerebellar ataxia, and parkinsonism. MSA is categorized as MSA-P with predominant parkinsonism, and as MSA-C with predominant cerebellar features. The prevalence of MSA has been reported to be between 1.86 and 4.9 cases per 100,000 individuals. In contrast, approximately 1% of the population is affected by schizophrenia during their lifetime; therefore, MSA-P comorbidity is very rare in schizophrenic patients. However, when the exacerbation or progression of parkinsonism occurs in patients with schizophrenia treated with antipsychotics, it is necessary to consider rare neurodegenerative disorders, including MSA-P, in the differential diagnosis of parkinsonism. CASE PRESENTATION A 60-year-old female patient with chronic schizophrenia developed possible MSA-P. She had been treated mainly with typical antipsychotics, and presented with urinary incontinence, nocturnal polyuria, and dysarthria around 2011. In 2014, she developed worsening parkinsonian symptoms and autonomic dysfunction. Although her antipsychotic medication was switched to an atypical antipsychotic and the dose reduced, her parkinsonism was not improved. In 2015, modified electroconvulsive therapy produced slight improvements in the symptoms; however, she shortly returned to her symptomatic state. A combination of cardiac 123I-meta-iodobenzylguanidine scintigraphy and 123I-FP-CIT single-photon emission computed tomography imaging, in addition to brain magnetic resonance imaging findings, helped to discriminate MSA-P from other sources of parkinsonism. L-dopa had been prescribed, but she responded poorly and died in the spring of 2016. CONCLUSIONS This case report highlights the importance of considering MSA-P in the differential diagnosis for parkinsonism in a patient being treated with antipsychotics for chronic schizophrenia. MSA-P should be considered in patients presenting with worsening and progressing parkinsonism, especially when accompanied by autonomic dysfunction or cerebellar ataxia. Although a definite diagnosis of MSA-P requires autopsy confirmation, a combination of brain magnetic resonance imaging and nuclear medicine scans may help to differentiate suspected MSA-P from the other parkinsonian syndromes. This case also demonstrates that MSA with parkinsonism that is poorly responsive to L-dopa may improve shortly after modified electroconvulsive therapy without worsening psychiatric symptoms.
Collapse
Affiliation(s)
- Hiroshi Komatsu
- Department of Psychiatry, Miyagi Psychiatric Center, Mubanchi, Tekurada, Natori, 981-1231, Japan.
| | - Masaaki Kato
- Department of Neurology, Minami Tohoku Hospital, Iwanuma, 989-2483, Japan
| | - Teiko Kinpara
- Department of Neurology, Kohnan Hospital, Sendai, 982-8523, Japan
| | - Takashi Ono
- Department of Psychiatry, Miyagi Psychiatric Center, Mubanchi, Tekurada, Natori, 981-1231, Japan
| | - Yoshihisa Kakuto
- Department of Psychiatry, Miyagi Psychiatric Center, Mubanchi, Tekurada, Natori, 981-1231, Japan
| |
Collapse
|
21
|
Rohrer G, Höglinger GU, Levin J. Symptomatic therapy of multiple system atrophy. Auton Neurosci 2018; 211:26-30. [DOI: 10.1016/j.autneu.2017.10.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Revised: 10/20/2017] [Accepted: 10/20/2017] [Indexed: 12/21/2022]
|
22
|
Clinical and biological phenotypes of frontotemporal dementia: Perspectives for disease modifying therapies. Eur J Pharmacol 2017; 817:76-85. [DOI: 10.1016/j.ejphar.2017.05.056] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Revised: 03/28/2017] [Accepted: 05/30/2017] [Indexed: 12/12/2022]
|
23
|
Miguel-Puga A, Villafuerte G, Salas-Pacheco J, Arias-Carrión O. Therapeutic Interventions for Vascular Parkinsonism: A Systematic Review and Meta-analysis. Front Neurol 2017; 8:481. [PMID: 29018399 PMCID: PMC5614922 DOI: 10.3389/fneur.2017.00481] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Accepted: 08/30/2017] [Indexed: 11/24/2022] Open
Abstract
Background Vascular parkinsonism (VP) is defined as the presence of parkinsonian syndrome, evidence of cerebrovascular disease, and an established relationship between the two disorders. However, the diagnosis of VP is problematic, particularly for the clinician confronted with moving from diagnosis to treatment. Given the different criteria used in the diagnosis of VP, the effectiveness of available therapeutic interventions for this disease are currently unknown. Methods To assess the clinical response of all published therapeutic interventions for VP that have been reported in the literature, we conducted a systematic review looking for VP subjects treated with any therapeutic intervention. To clarify the prevalence of responsiveness to levodopa among VP subjects, we conducted a meta-analysis of 17 observational studies retrieved with the search criteria of our review. Also, four studies were included in a second analysis to explore if nigrostriatal lesion affected the prevalence of levodopa response in VP subjects. Relevant articles were identified from MEDLINE, Scopus, and Web of Science published until June 2017. Results 436 non-duplicate citations were identified for screening, 107 articles were assessed for eligibility, and only 23 observational studies were included in this review. No randomized clinical trials were found. Four different therapies were found in the literature; among them, levodopa was the only one repetitively reported. The calculated event rate of levodopa response in VP subjects was of 0.304 [95% confidence interval (CI) of 0.230–0.388]. The overall odds ratio for good response to levodopa in VP with lesion in the nigrostriatal pathway vs. no lesion in the nigrostriatal pathway was 15.15 (95% CI: 5.2–44.17). Conclusion Despite the lack of randomized controlled trials, results of this systematic review and meta-analysis show that VP subjects, as operationally defined here, have a low response rate to levodopa; nigrostriatal lesion could be used as a proxy predictor of levodopa response in VP subjects. Other therapies seem to be co-adjuvant. Randomized controlled trials with a clear definition of VP are necessary to be able to assign positive or negative predictive values to available treatments and to recommend any of the therapeutic interventions for these subjects.
Collapse
Affiliation(s)
- Adán Miguel-Puga
- Unidad de Trastornos del Movimiento y Sueño (TMS), Hospital General Dr. Manuel Gea González, México City, México.,Plan de Estudios Combinados en Medicina (PECEM), Facultad de Medicina, Universidad Nacional Autónoma de México, México City, México
| | - Gabriel Villafuerte
- Unidad de Trastornos del Movimiento y Sueño (TMS), Hospital General Dr. Manuel Gea González, México City, México.,Plan de Estudios Combinados en Medicina (PECEM), Facultad de Medicina, Universidad Nacional Autónoma de México, México City, México
| | - José Salas-Pacheco
- Instituto de Investigación Científica, Universidad Juárez del Estado de Durango, Durango, México
| | - Oscar Arias-Carrión
- Unidad de Trastornos del Movimiento y Sueño (TMS), Hospital General Dr. Manuel Gea González, México City, México.,Centro de Innovación Médica Aplicada (CIMA), Hospital General Dr. Manuel Gea González, México City, México
| |
Collapse
|
24
|
van Os NJH, Haaxma CA, van der Flier M, Merkus PJFM, van Deuren M, de Groot IJM, Loeffen J, van de Warrenburg BPC, Willemsen MAAP. Ataxia-telangiectasia: recommendations for multidisciplinary treatment. Dev Med Child Neurol 2017; 59:680-689. [PMID: 28318010 DOI: 10.1111/dmcn.13424] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/04/2017] [Indexed: 12/29/2022]
Abstract
Ataxia-telangiectasia is a rare, neurodegenerative, and multisystem disease, characterized by cerebellar ataxia, oculocutaneous telangiectasia, immunodeficiency, progressive respiratory failure, and an increased risk of malignancies. It demands specialized care tailored to the individual patient's needs. Besides the classic ataxia-telangiectasia phenotype, a variant phenotype exists with partly overlapping but some distinctive disease characteristics. This guideline summarizes frequently encountered medical problems in the disease course of patients with classic and variant ataxia-telangiectasia, in the domains of neurology, immunology and infectious diseases, pulmonology, anaesthetic and perioperative risk, oncology, endocrinology, and nutrition. Furthermore, it provides a practical guide with evidence- and expert-based recommendations for the follow-up and treatment of all these different clinical topics.
Collapse
Affiliation(s)
- Nienke J H van Os
- Department of Neurology, Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Charlotte A Haaxma
- Department of Neurology, Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Michiel van der Flier
- Department of Pediatric Infectious Diseases and Immunology, Amalia Children's Hospital and Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Peter J F M Merkus
- Department of Pediatric Pulmonology, Amalia Children's Hospital and Canisius Wilhelmina Hospital, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Marcel van Deuren
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Imelda J M de Groot
- Department of Rehabilitation Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jan Loeffen
- Department of Pediatric Oncology and Hematology, Sophia Children's Hospital, Erasmus Medical Centre, Rotterdam, the Netherlands
| | - Bart P C van de Warrenburg
- Department of Neurology, Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Michèl A A P Willemsen
- Department of Neurology, Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Center, Nijmegen, The Netherlands
| | | |
Collapse
|
25
|
Schreglmann SR, Bhatia KP, Stamelou M. Advances in the Clinical Differential Diagnosis of Parkinson's Disease. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2017; 132:79-127. [PMID: 28554422 DOI: 10.1016/bs.irn.2017.01.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The differential diagnosis of Parkinson's disease has widened considerably in recent years. This chapter aims to summarize the current knowledge on the clinical differential diagnoses of sporadic Parkinson's disease. As the number of monogenic familial Parkinson's disease variants and risk factors is growing, so is the number of appreciated etiologies of atypical parkinsonian and other pallidopyramidal syndromes. This work aims at summarizing the current knowledge on both motor and nonmotor neurological signs and symptoms that aid the clinical diagnosis of Parkinson's disease and its differential diagnoses.
Collapse
Affiliation(s)
| | | | - Maria Stamelou
- University of Athens Medical School, Hospital Attikon, Athens, Greece; HYGEIA Hospital, Athens, Greece; Philipps University, Marburg, Germany.
| |
Collapse
|
26
|
Levin J, Kurz A, Arzberger T, Giese A, Höglinger GU. The Differential Diagnosis and Treatment of Atypical Parkinsonism. DEUTSCHES ARZTEBLATT INTERNATIONAL 2017; 113:61-9. [PMID: 26900156 DOI: 10.3238/arztebl.2016.0061] [Citation(s) in RCA: 75] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/11/2015] [Revised: 11/20/2015] [Accepted: 11/20/2015] [Indexed: 12/22/2022]
Abstract
BACKGROUND Aside from idiopathic Parkinson syndrome (Parkinson's disease), there are a number of other, so-called atypical parkinsonian syndromes: dementia with Lewy bodies (DLB), multiple system atrophy (MSA), progressive supranuclear palsy (PSP), and corticobasal degeneration (CBD). DLB is a common disease, with a prevalence of 0.4% (400 cases per 100 000 persons) in the elderly; MSA and PSP both have a prevalence of 5 to 10 per 100 000 persons, while the prevalence of CBD is about 1 per 100 000. METHODS This review is based on pertinent publications retrieved by a selective literature search. RESULTS The atypical parkinsonian syndromes are synucleinopathies and tauopathies, i.e., disorders characterized by the abnormal deposition of the proteins α-synuclein and tau. The site of deposition is correlated with the clinical features. In DLB, synuclein is mainly deposited in neocortical neurons, with some brain stem involvement as well. The main clinical features are dementia and, later on, parkinsonism. In MSA, synuclein is deposited in oligodendrocytes, mainly in the cerebellum but also in the brain stem; the main clinical feature is autonomic dysfunction combined with parkinsonism or cerebellar ataxia. Synucleinopathies often impair REM (rapid eye movement) sleep. PSP and CBD, on the other hand, are primary tauopathies. PSP usually causes predominantly supranuclear vertical gaze palsy and early postural instability with falls, less commonly parkinsonism (PSP-P) or frontotemporal dementia (PSP-FTD) as its most prominent feature. CBD typically manifests itself as markedly asymmetrical parkinsonism with apraxia or cortical sensory disturbance. At present, there is no accepted causal treatment for any of these disorders; the available symptomatic treatments are of limited efficacy and are supported only by low-level evidence. CONCLUSION Causal treatments for neurodegenerative diseases are now being developed and tested, and thus a molecular diagnosis is desirable. This will require the cooperation of primary care physicians with specialized centers.
Collapse
Affiliation(s)
- Johannes Levin
- Department of Neurology, Klinikum rechts der Isar, Technische Universität München and Chair for Translational Neurodegeneration, German Center for Neurodegenerative Diseases (DZNE), Munich, Department of Neurology, Ludwig-Maximilians-Universität München, German Center for Neurodegenerative Diseases (DZNE), Munich, Department of Psychiatry and Psychotherapy, Klinikum rechts der Isar, Technische Universität München, Center for Neuropathology and Prion Research (ZNP), Ludwig-Maximilians-Universität München, Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-Universität München
| | | | | | | | | |
Collapse
|
27
|
Abstract
OPINION STATEMENT Treatment of patients with multiple system atrophy (MSA) is complex and purely symptomatic to date. No disease-modifying treatment is available so far, leaving a survival time of usually less than 10 years after diagnosis is made. Clinically, two forms of movement disorders characterize this disease, either a hypokinetic rigid parkinsonian movement disorder in MSA of the parkinsonian type or ataxia in MSA of the cerebellar type. In both variants of the disease, autonomic symptoms are mandatory for establishing the diagnosis of MSA. While hypokinetic rigid symptoms of patients with MSA of the parkinsonian type can respond to some extent to dopaminergic treatment, no effective symptomatic treatment for the cerebellar symptoms is available so far. Particular attention should be paid to autonomic symptoms, as these symptoms are known to strongly affect the patients' quality of life. Here, we discuss the current state of the art in MSA treatment.
Collapse
Affiliation(s)
- Sylvia Maaß
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE) and Klinik für Neurologie, Klinikum rechts der Isar, Technische Universität München, Feodor-Lynen Str. 17, 81377, Munich, Germany
| | - Johannes Levin
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE) and Klinik für Neurologie, Klinikum rechts der Isar, Technische Universität München, Feodor-Lynen Str. 17, 81377, Munich, Germany.,Neurologische Klinik, Ludwig-Maximilians-Universität München, Klinikum der Universität-Großhadern, Marchioninistraße 15, 81377, Munich, Germany
| | - Günter Höglinger
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE) and Klinik für Neurologie, Klinikum rechts der Isar, Technische Universität München, Feodor-Lynen Str. 17, 81377, Munich, Germany.
| |
Collapse
|
28
|
Pradhan S, Tandon R. Progressive supra-nuclear palsy: frequency of cardinal extrapyramidal features at first presentation: Table 1. Postgrad Med J 2015; 91:274-7. [DOI: 10.1136/postgradmedj-2014-132696] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2014] [Accepted: 03/17/2015] [Indexed: 11/04/2022]
|
29
|
Perez-Lloret S, Flabeau O, Fernagut PO, Pavy-Le Traon A, Rey MV, Foubert-Samier A, Tison F, Rascol O, Meissner WG. Current Concepts in the Treatment of Multiple System Atrophy. Mov Disord Clin Pract 2015; 2:6-16. [PMID: 30363880 DOI: 10.1002/mdc3.12145] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2014] [Revised: 12/13/2014] [Accepted: 12/18/2014] [Indexed: 12/21/2022] Open
Abstract
MSA is a progressive neurodegenerative disorder characterized by autonomic failure and a variable combination of poor levodopa-responsive parkinsonism and cerebellar ataxia (CA). Current therapeutic management is based on symptomatic treatment. Almost one third of MSA patients may benefit from l-dopa for the symptomatic treatment of parkinsonism, whereas physiotherapy remains the best therapeutic option for CA. Only midodrine and droxidopa were found to be efficient for neurogenic hypotension in double-blind, controlled studies, whereas other symptoms of autonomic failure may be managed with off-label treatments. To date, no curative treatment is available for MSA. Recent results of neuroprotective and -restorative trials have provided some hope for future advances. Considerations for future clinical trials are also discussed in this review.
Collapse
Affiliation(s)
- Santiago Perez-Lloret
- Laboratory of Epidemiology and Experimental Pharmacology Institute for Biomedical Research (BIOMED) School of Medical Sciences Pontifical Catholic University of Argentina (UCA) Buenos Aires Argentina.,The National Scientific and Technical Research Council (CONICET) Buenos Aires Argentina
| | - Olivier Flabeau
- Department of Neurology Center Hospitalier de la Côte Basque Bayonne France
| | - Pierre-Olivier Fernagut
- Institut des Maladies Neurodégénératives Université de Bordeaux Bordeaux France.,CNRS Institut des Maladies Neurodégénératives Bordeaux France
| | - Anne Pavy-Le Traon
- Departments of Clinical Pharmacology and Neurosciences University Hospital and University of Toulouse 3 Toulouse France.,French Reference Center for MSA Toulouse University Hospital Toulouse France
| | - María Verónica Rey
- Laboratory of Epidemiology and Experimental Pharmacology Institute for Biomedical Research (BIOMED) School of Medical Sciences Pontifical Catholic University of Argentina (UCA) Buenos Aires Argentina.,The National Scientific and Technical Research Council (CONICET) Buenos Aires Argentina
| | - Alexandra Foubert-Samier
- Institut des Maladies Neurodégénératives Université de Bordeaux Bordeaux France.,CNRS Institut des Maladies Neurodégénératives Bordeaux France.,French Reference Center for MSA Bordeaux University Hospital Bordeaux France
| | - Francois Tison
- Institut des Maladies Neurodégénératives Université de Bordeaux Bordeaux France.,CNRS Institut des Maladies Neurodégénératives Bordeaux France.,French Reference Center for MSA Bordeaux University Hospital Bordeaux France
| | - Olivier Rascol
- Departments of Clinical Pharmacology and Neurosciences University Hospital and University of Toulouse 3 Toulouse France.,French Reference Center for MSA Toulouse University Hospital Toulouse France
| | - Wassilios G Meissner
- Institut des Maladies Neurodégénératives Université de Bordeaux Bordeaux France.,CNRS Institut des Maladies Neurodégénératives Bordeaux France.,French Reference Center for MSA Bordeaux University Hospital Bordeaux France
| |
Collapse
|
30
|
Racette BA. Manganism in the 21st century: the Hanninen lecture. Neurotoxicology 2014; 45:201-7. [PMID: 24148923 PMCID: PMC3992192 DOI: 10.1016/j.neuro.2013.09.007] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2013] [Revised: 08/27/2013] [Accepted: 09/22/2013] [Indexed: 11/24/2022]
Abstract
Since the original description of the health effects of inhaled occupational manganese (Mn) by Couper in 1837, an extensive literature details the clinical syndrome and pathophysiology of what was thought to be a rare condition. In the last decade, conventional wisdom regarding the clinicopathological effects of Mn has been challenged. Past exposures to Mn were an order of magnitude higher than modern exposures in developed countries; therefore, the clinical syndrome seen in the time of Couper is no longer typical of modern Mn exposed workers. Parkinsonism (rigidity, bradykinesia, rest tremor, and postural instability) is present in 15% of Mn-exposed workers in welding industries, and these parkinsonian signs are associated with reduced health status and quality of life. These parkinsonian signs also overlap considerably with the clinical findings seen in early stages of Parkinson's disease (PD); although, molecular imaging suggests that Mn-exposed workers have dopaminergic dysfunction in a pattern unique from PD. Furthermore, geographic information system studies demonstrate that regions of the US with high industrial Mn emissions have an increased incidence of PD and increased PD associated mortality. This review will contrast historical, descriptive human studies in Mn-exposed subjects with more recent data and will suggest a research agenda for the 21st century.
Collapse
Affiliation(s)
- Brad A Racette
- Department of Neurology, Washington University School of Medicine, 660 S. Euclid Avenue, Box 8111, St. Louis, MO 63110, USA; University of the Witwatersrand, School of Public Health, Faculty of Health Sciences, Johannesburg, South Africa.
| |
Collapse
|
31
|
Barrett M, Yan G, Abbott RD, Willis AW. Disparities in deep brain stimulation surgery among insured elders with Parkinson disease. Neurology 2014; 83:1684-5. [PMID: 25349276 PMCID: PMC10845845 DOI: 10.1212/wnl.0000000000000974] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
|
32
|
Moretti DV, Binetti G, Zanetti O, Frisoni GB. Behavioral and neurophysiological effects of transdermal rotigotine in atypical parkinsonism. Front Neurol 2014; 5:85. [PMID: 24926284 PMCID: PMC4046164 DOI: 10.3389/fneur.2014.00085] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2013] [Accepted: 05/16/2014] [Indexed: 11/27/2022] Open
Abstract
Effective therapies for the so-called atypical parkinsonian syndrome (APS) such as multiple system atrophy (MSA), progressive supranuclear palsy (PSP), or corticobasal syndrome (CBS) are not available. Dopamine agonists (DA) are not often used in APS because of inefficacy and in a minority of case, their side effects, like dyskinesias, impairment of extrapyramidal symptoms or the appearance of psychosis, and REM sleep behavioral disorders (RBD). Transdermal rotigotine (RTG) is a non-ergot dopamine agonist indicated for use in early and advanced Parkinson’s disease with a good tolerability and safety. Moreover, its action on a wide range of dopamine receptors, D1, D2, D3, unlike other DA, could make it a good option in APS, where a massive dopamine cell loss is documented. In this pilot, observational open-label study we evaluate the efficacy and tolerability of RTG in patients affected by APS. Thirty-two subjects with diagnosis of APS were treated with transdermal RTG. APS diagnosis was: MSA parkinsonian type (MSA-P), MSA cerebellar type (MSA-C), PSP, and CBS. Patients were evaluated by UPDRS-III, neuropsychiatric inventory, mini mental state examination at baseline, and after 6, 12, and 18 months. The titration schedule was maintained very flexible, searching the major clinical effect and the minor possible adverse events (AEs) at each visit. AEs were recorded. APS patients treated with RTG show an overall decrease of UPDRS-III scores without increasing behavioral disturbances. Only three patients were dropped out of the study. Main AEs were hypotension, nausea, vomiting, drowsiness, and tachycardia. The electroencephalographic recording power spectra analysis shows a decrease of theta and an increase of low alpha power. In conclusion, transdermal RTG seems to be effective and well tolerated in APS patients.
Collapse
Affiliation(s)
| | | | - Orazio Zanetti
- IRCCS San Giovanni di Dio Fatebenefratelli , Brescia , Italy
| | | |
Collapse
|
33
|
Compassionate trial of levodopa carbidopa intestinal gel infusion in two patients with progressive supranuclear palsy. Clin Neurol Neurosurg 2014; 116:1-3. [PMID: 24388506 DOI: 10.1016/j.clineuro.2013.11.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2013] [Revised: 10/27/2013] [Accepted: 11/15/2013] [Indexed: 11/22/2022]
|
34
|
Herbert MK, Kuiperij HB, Bloem BR, Verbeek MM. Levels of HVA, 5-HIAA, and MHPG in the CSF of vascular parkinsonism compared to Parkinson’s disease and controls. J Neurol 2013; 260:3129-33. [DOI: 10.1007/s00415-013-7126-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2013] [Revised: 09/18/2013] [Accepted: 09/19/2013] [Indexed: 11/24/2022]
|
35
|
Hellwig S, Kreft A, Amtage F, Tüscher O, Winz OH, Hellwig B, Weiller C, Weber WA, Vach W, Meyer PT. 123I-iodobenzamide SPECT is not an independent predictor of dopaminergic responsiveness in patients with suspected atypical parkinsonian syndromes. J Nucl Med 2013; 54:2081-6. [PMID: 24115529 DOI: 10.2967/jnumed.113.122010] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
UNLABELLED The prediction of dopaminergic responsiveness in patients with parkinsonism is desirable for effective treatment strategies. We investigated whether striatal dopamine D2/D3 receptor (D2R) binding assessed by (123)I-iodobenzamide SPECT is an independent predictor of dopaminergic responsiveness in patients with parkinsonism. METHODS Seventy-eight patients with clinically suspected atypical parkinsonian syndrome (APS) were prospectively recruited for imaging. To quantify striatal D2R binding, (123)I-iodobenzamide SPECT datasets were subjected to an observer-independent, regions-of-interest analysis. A final clinical diagnosis of Lewy-body disease (LBD) or APS was made after a mean follow-up of 12 mo. On the basis of follow-up data, dopaminergic responsiveness was classified as 0 (none), 1 (transient), 2 (sustained mild), or 3 (sustained strong). Uni- and multivariate analyses of the relationship between treatment response, D2R binding, and confounding variables were conducted. RESULTS Sixty patients with clinically verified LBD (n = 28; 22/28 with Parkinson disease) or APS (n = 32), in whom dopaminergic responsiveness could be assessed (n = 19/13/15/13 in categories 0/1/2/3; 18 were excluded because of insufficient dosing), were included in the statistical analysis. Univariate analyses revealed that a sustained treatment response was significantly associated with higher D2R binding, clinical diagnosis of LBD, lower Hoehn and Yahr scores, and younger age. After multivariate correction of D2R binding for diagnosis, age, symptom duration, Hoehn and Yahr score, and dopaminergic pretreatment, no association was found between D2R binding and treatment response, either in the pooled group or in LBD or APS subgroups. CONCLUSION Striatal D2R binding assessed by (123)I-iodobenzamide SPECT does not provide additional predictive information about treatment response beyond other clinical variables, most notably the clinical diagnosis.
Collapse
Affiliation(s)
- Sabine Hellwig
- Department of Neurology, University Hospital Freiburg, Freiburg, Germany
| | | | | | | | | | | | | | | | | | | |
Collapse
|
36
|
Xi H, Chen L, Huang H, Zhang F, Liu Y, Chen D, Xiao J. Preliminary report of multiple cell therapy for patients with multiple system atrophy. Cell Transplant 2013; 22 Suppl 1:S93-9. [PMID: 23992875 DOI: 10.3727/096368913x672145] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
The aim of this study is to explore the safety and therapeutic effect of multiple cell transplantations on patients with multiple system atrophy. Ten patients suffering from multiple system atrophy were treated by multiple cell transplantations from August 2005 to March 2011. They were six males and four females, with an average age of 51.90 ± 12.92 years (23-66 years). Multiple cell types were transplanted by intravenous, intrathecal, and intracranial routes; for example, 0.4-0.5 × 10(6)/kg umbilical cord mesenchymal cells by intravenous drip, intrathecal implantation of 2.0 × 10(6) Schwann cells and 2.0-5.0 × 10(6) neural progenitor cells through cerebellar cistern puncture, or 2 × 10(6) olfactory ensheathing cells and 4 × 10(6) neural progenitor cells injected into key points for neural network restoration (KPNNR). The neurological function was assessed before and after treatment with the International Cooperative Ataxia Rating Scale (ICARS) by the World Federation of Neurology and the Unified Multiple System Atrophy Rating Scale (UMSARS). The patients achieved neurological function amelioration after treatment, which included improvements in walking ability, gaits, standing, speech, and muscular tension; the ICARS score decreased from a preoperative 46.30 ± 14.50 points to postoperative 41.90 ± 18.40 points (p = 0.049). The UMSARS score decreased from preoperative 50.00 ± 20.65 points to postoperative 46.56 ± 23.05 points (p = 0.037). Among them, two patients remained stable and underwent a second treatment 0.5-1 year after the first therapy. After treatment, five patients were followed up for more than 6 months. Balance and walking ability improved further in four patients, while one patient remained stable for over 6 months. In conclusion, a strategy of comprehensive cell-based neurorestorative therapy for patients with multiple system atrophy is safe and appears to be beneficial. This manuscript is published as part of the International Association of Neurorestoratology (IANR) supplement issue of Cell Transplantation.
Collapse
|
37
|
Abstract
The use of functional imaging in neurodegenerative diseases has increased in recent years, with applications in research into the underlying pathophysiology, aiding in diagnosis, or evaluating new treatments. In Parkinson's disease (PD), these imaging methods have expanded our understanding of the disease beyond dopaminergic deficits. Moreover, functional imaging methods have described alterations in functional networks relating not only to the motor symptoms, but also to many nonmotor features of PD, such as cognitive dysfunction. From a clinical viewpoint, functional imaging methods can assist in monitoring disease progression, such as in the context of clinical trials, and holds the potential to aid in early diagnosis of PD and differentiation from other parkinsonian disorders.
Collapse
|
38
|
Bansil S, Prakash N, Kaye J, Wrigley S, Manata C, Stevens-Haas C, Kurlan R. Movement disorders after stroke in adults: a review. TREMOR AND OTHER HYPERKINETIC MOVEMENTS (NEW YORK, N.Y.) 2012; 2. [PMID: 23440948 PMCID: PMC3570045 DOI: 10.7916/d86w98tb] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/02/2011] [Accepted: 07/27/2011] [Indexed: 01/14/2023]
Abstract
Background Movement disorders occur in association with stroke and may have important clinical implications. Methods We reviewed the medical literature regarding the clinical phenomenology, prevalence, localization and etiologic implications, and treatments for movement disorders occurring after stroke in adult patients. Results Movement disorders occur uncommonly after stroke and include both hyperkinetic and parkinsonian conditions. They can occur at the time of stroke or appear as a later manifestation. Stroke lesions are typically due to small vessel cerebrovascular disease in the middle or posterior cerebral artery territory, vessels supplying the basal ganglia. Hemorrhagic lesions are more likely to induce hyperkinetic movements. Movement disorders in the setting of stroke tend to resolve spontaneously over time. Medical and surgical therapies are available to treat the movement problems. Discussion Movement disorders after stroke can be helpful in localizing lesions after stroke, determining the etiology of stroke, may need to be a target for therapy and may importantly influence long term outcome.
Collapse
Affiliation(s)
- Shalini Bansil
- Atlantic Neuroscience Institute, Overlook Hospital, Summit, New Jersey, United States of America
| | | | | | | | | | | | | |
Collapse
|
39
|
Flabeau O, Meissner WG, Tison F. Multiple system atrophy: current and future approaches to management. Ther Adv Neurol Disord 2011; 3:249-63. [PMID: 21179616 DOI: 10.1177/1756285610375328] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Multiple system atrophy (MSA) is a rare neurodegenerative disorder without any effective treatment in slowing or stopping disease progression. It is characterized by poor levodopa responsive Parkinsonism, cerebellar ataxia, pyramidal signs and autonomic failure in any combination. Current therapeutic strategies are primarily based on dopamine replacement and improvement of autonomic failure. However, symptomatic management remains disappointing and no curative treatment is yet available. Recent experimental evidence has confirmed the key role of alpha-synuclein aggregation in the pathogenesis of MSA. Referring to this hypothesis, transgenic and toxic animal models have been developed to assess candidate drugs for MSA. The standardization of diagnosis criteria and assessment procedures will allow large multicentre clinical trials to be conducted. In this article we review the available symptomatic treatment, recent results of studies investigating potential neuroprotective drugs, and future approaches for the management in MSA.
Collapse
Affiliation(s)
- Olivier Flabeau
- Department of Neurology, University Hospital of Bordeaux, Bordeaux, France
| | | | | |
Collapse
|
40
|
Abstract
Progressive supranuclear palsy is a rare, degenerative brain disorder and the second most common syndrome in which the patient exhibits 'parkinsonism', that is, a variety of symptoms involving problems with movement. General symptoms include difficulties with gait and balance; the patient walking clumsily and often falling backwards. The syndrome can be difficult to diagnose and visual signs and symptoms can help to separate it from closely related movement disorders such as Parkinson's disease, multiple system atrophy, dementia with Lewy bodies and corticobasal degeneration. A combination of the presence of vertical supranuclear gaze palsy, fixation instability, lid retraction, blepharospasm and apraxia of eyelid opening and closing may be useful visual signs in the identification of progressive supranuclear palsy. As primary eye-care practitioners, optometrists should be able to identify the visual problems of patients with this disorder and be expected to work with patients and their carers to manage their visual welfare.
Collapse
|
41
|
Messina D, Cerasa A, Condino F, Arabia G, Novellino F, Nicoletti G, Salsone M, Morelli M, Lanza PL, Quattrone A. Patterns of brain atrophy in Parkinson’s disease, progressive supranuclear palsy and multiple system atrophy. Parkinsonism Relat Disord 2011; 17:172-6. [DOI: 10.1016/j.parkreldis.2010.12.010] [Citation(s) in RCA: 127] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2010] [Revised: 12/06/2010] [Accepted: 12/08/2010] [Indexed: 12/16/2022]
|
42
|
Kohli J, Brandt N. Multiple-system atrophy and medications: how to minimize the risk of falling. THE CONSULTANT PHARMACIST : THE JOURNAL OF THE AMERICAN SOCIETY OF CONSULTANT PHARMACISTS 2011; 26:190-196. [PMID: 21402519 DOI: 10.4140/tcp.n.2011.190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
An 89-year-old female resident in the assisted living section of a continuing care retirement community complained of dizziness and lightheadedness at 10 am daily and was experiencing frequent falls. The facility staff requested a consultant pharmacist perform an extensive review of her medications and medical conditions. Following a chart review and interview with the resident, the consultant pharmacist found that her past medical history consists of coronary artery disease, atrial fibrillation, congestive heart failure, hypertension, dyslipidemia, osteoporosis, gastroesophageal reflux disease, glaucoma, mild dementia, overactive bladder, and Parkinson's disease (PD). The nursing staff monitored the resident's blood pressure during these episodes and determined that the resident was experiencing orthostatic hypotension (OH). During the review, the consultant pharmacist found a recent neurology note that concluded the resident may have multiple-system atrophy (MSA) and her therapy for PD may not be beneficial. As autonomic dysfunction is a common feature of MSA, it is important to minimize the use of medications that can cause or aggravate OH. Additionally, data suggest only a modest and nonsustained response to levodopa in patients with MSA. Therefore, the pharmacist recommended multiple medication changes as well as follow-up monitoring by the patient and assisted living community staff to minimize medication-related problems such as falls.
Collapse
Affiliation(s)
- Janet Kohli
- Omnicare Pharmacy Services, Pittsburgh, Pennsylvania 15205, USA.
| | | |
Collapse
|
43
|
How parkinsonism influences life: the patients’ point of view. Neurol Sci 2010; 32:125-31. [DOI: 10.1007/s10072-010-0435-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2009] [Accepted: 09/22/2010] [Indexed: 10/18/2022]
|
44
|
Warnecke T, Oelenberg S, Teismann I, Hamacher C, Lohmann H, Ringelstein EB, Dziewas R. Endoscopic characteristics and levodopa responsiveness of swallowing function in progressive supranuclear palsy. Mov Disord 2010; 25:1239-45. [PMID: 20629130 DOI: 10.1002/mds.23060] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Dysphagia is a frequent and early symptom in progressive supranuclear palsy (PSP) predisposing patients to aspiration pneumonia. Fiberoptic endoscopic evaluation of swallowing (FEES) has emerged as a valuable apparative tool for objective evaluation of neurogenic dysphagia. This is the first study using FEES to investigate the nature of swallowing impairment in PSP. Eighteen consecutive PSP patients (mean age 69.7 +/- 9.0 years) were included. The salient findings of FEES in PSP patients were compared with those of 15 patients with Parkinson's disease (PD). In 7 PSP patients, a standardized FEES protocol was performed to explore levodopa (L-dopa) responsiveness of dysphagia. Most frequent abnormalities detected by FEES were bolus leakage, delayed swallowing reflex, and residues in valleculae and piriformes. Aspiration events with at least one food consistency occurred in nearly 30% of PSP patients. Significant pharyngeal saliva pooling was observed in 4 PSP patients. We found no difference of salient endoscopic findings between PSP and PD patients. Endoscopic dysphagia severity in PSP correlated positively with disease duration, clinical disability, and cognitive impairment. No correlation was found with dysarthria severity. In early PSP patients, swallowing dysfunction was solely characterized by liquid leakage with the risk of predeglutitive aspiration during the oral phase of swallowing. Two PSP patients showed relevant improvement of swallowing function after L-dopa challenge. Chin tuck-maneuver, hard swallow, and modification of food consistency were identified as the most effective therapeutic interventions. In conclusion, FEES assessment can deliver important findings for the diagnosis and refined therapy of dysphagia in PSP patients.
Collapse
Affiliation(s)
- Tobias Warnecke
- Department of Neurology, University Hospital of Münster, Münster, Germany.
| | | | | | | | | | | | | |
Collapse
|
45
|
Sakamoto R, Tsuchiya K, Mimura M. Clinical heterogeneity in progressive supranuclear palsy: Problems of clinical diagnostic criteria of NINDS-SPSP in a retrospective study of seven Japanese autopsy cases. Neuropathology 2010; 30:24-35. [DOI: 10.1111/j.1440-1789.2009.01032.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
46
|
Sakamoto R, Tsuchiya K, Yoshida R, Itoh Y, Furuta N, Kosuga A, Sugai Y, Mimura M. Progressive supranuclear palsy combined with Alzheimer's disease: A clinicopathological study of two autopsy cases. Neuropathology 2009; 29:219-29. [DOI: 10.1111/j.1440-1789.2008.00968.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
47
|
|
48
|
Pinkhardt EH, Jürgens R, Becker W, Valdarno F, Ludolph AC, Kassubek J. Differential diagnostic value of eye movement recording in PSP-parkinsonism, Richardson's syndrome, and idiopathic Parkinson's disease. J Neurol 2009; 255:1916-25. [PMID: 19224319 DOI: 10.1007/s00415-009-0027-y] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2008] [Revised: 04/27/2008] [Accepted: 06/04/2008] [Indexed: 11/30/2022]
Abstract
Vertical gaze palsy is a highly relevant clinical sign in parkinsonian syndromes. As the eponymous sign of progressive supranuclear palsy (PSP), it is one of the core features in the diagnosis of this disease. Recent studies have suggested a further differentiation of PSP in Richardson's syndrome (RS) and PSP-parkinsonism (PSPP). The aim of this study was to search for oculomotor abnormalities in the PSP-P subset of a sample of PSP patients and to compare these findings with those of (i) RS patients, (ii) patients with idiopathic Parkinson's disease (IPD), and (iii) a control group. Twelve cases of RS, 5 cases of PSP-P, and 27 cases of IPD were examined by use of video-oculography (VOG) and compared to 23 healthy normal controls. Both groups of PSP patients (RS, PSP-P) had significantly slower saccades than either IPD patients or controls, whereas no differences in saccadic eye peak velocity were found between the two PSP groups or in the comparison of IPD with controls. RS and PSP-P were also similar to each other with regard to smooth pursuit eye movements (SPEM), with both groups having significantly lower gain than controls (except for downward pursuit); however, SPEM gain exhibited no consistent difference between PSP and IPD. A correlation between eye movement data and clinical data (Hoehn & Yahr scale or disease duration) could not be observed. As PSP-P patients were still in an early stage of the disease when a differentiation from IPD is difficult on clinical grounds, the clear-cut separation between PSP-P and IPD obtained by measuring saccade velocity suggests that VOG could contribute to the early differentiation between these patient groups.
Collapse
Affiliation(s)
- Elmar H Pinkhardt
- Department of Neurology, University of Ulm, Oberer Eselsberg 45, Ulm, Germany
| | | | | | | | | | | |
Collapse
|
49
|
Abstract
BACKGROUND It has been almost 4 decades since the descriptions of the 3 parts of multiple system atrophy (MSA) have taken place, characterized clinically by dysautonomia, parkinsonism, and cerebellar dysfunction. The discovery of a distinctive pathologic maker has finally provided the conceptual synthesis of these 3 entities into the universal designation of MSA as a distinct disease process with a complex combination of clinical presentations. Although advances have been made in terms of awareness and knowledge concerning the clinical features and pathophysiology of MSA, it remains challenging for neurologists who treat these patients to differentiate MSA from its mimics as well as providing them with effective treatment. REVIEW SUMMARY The aim of this review is to provide an overview of the advances in the knowledge of the disease, to highlight typical features useful for the recognition of its entity, and to enlist different treatment options. CONCLUSION Despite the fact that there is still no treatment modality that can alter the disease progression, a number of useful symptomatic treatment measures are available and should be offered to patients to ameliorate the nonmotor features of MSA and even the motor features that may at least transiently respond to treatment.
Collapse
|