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Jia S, Sun C, Zhong X, Wang K, Wang Z, Qi X, Qiu F. The High Value of External Anal- and Urethral-Sphincter Electromyography in Differential Diagnosis with MSA-P, PD, and PSP. Ann Indian Acad Neurol 2023; 26:241-246. [PMID: 37538423 PMCID: PMC10394455 DOI: 10.4103/aian.aian_496_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Revised: 02/09/2023] [Accepted: 02/16/2023] [Indexed: 08/05/2023] Open
Abstract
Objective It is a challenge to differentiate multiple system atrophy parkinsonism (MSA-P), Parkinson's disease (PD), and progressive supranuclear palsy (PSP). We aimed to explore the value of external anal-sphincter electromyography (EAS-EMG) and urethral-sphincter electromyography (US-EMG) in differential diagnosis with MSA-P, PD, and PSP. Methods A total of 149 subjects, including 27 MSA-P, 100 PD, and 22 PSP, were recruited. The average duration and amplitude of motor unit potentials (MUPs), percentage of polyphasic MUPs, amplitude during strong contraction, and recruitment pattern during maximal voluntary contraction were recorded. The differences in EAS-EMG and US-EMG results between MSA-P, PD, and PSP were analyzed. Results In EAS-EMG examination, the average duration of MUPs of MSA-P was significantly longer than that of PD and PSP; the percentage of polyphasic MUPs and the ratio of simple phase and simple-mix phase of MSA-P and PSP were significantly higher than that of PD; the amplitude during strong contraction of MSA-P was significantly lower than that of PD. In US-EMG examination, the average duration of MUPs in male MSA-P was significantly longer than that in male PD and PSP; the ratio of simple phase and simple-mix phase in male MSA-P was significantly higher than that in male PD; there was no statistical difference in US-EMG indexes between male PD and PSP male. And because only one female PSP was examined, only female MSA-P and PD were compared, the average duration of MUPs in female MSA-P was significantly longer than that in female PD; the ratio of simple phase and simple-mix phase in female MSA-P was significantly higher than that in female PD. Conclusion The average duration of MUPs and the ratio of the simple phase and simple-mix phase of EAS-EMG and US-EMG all can provide the basis for the differential diagnosis between MSA-P and PD. US-EMG can be used as a supplement to differentiate MSA-P from PD when EAS-EMG is limited. The only discriminating indicator between MSA-P and PSP seems to be the average duration of MUPs of EAS-EMG and US-EMG. There is still a lack of diagnostic electromyography indicators between PD and PSP.
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Affiliation(s)
- Shuangshuang Jia
- Navy Clinical College, The Fifth School of Clinical Medicine, Anhui Medical University, Hefei, 230032, Anhui Province, China
| | - Chenjing Sun
- Department of Neurology, The Sixth Medical Center of Chinese PLA General Hospital, Beijing 100048, China
| | - Xiaoling Zhong
- School of Medicine, South China University of Technology, Guangzhou, 510006, China
| | - Kunyu Wang
- Department of Neurology, The First Teaching Hospital of Jilin University, Changchun 130021, China
| | - Zhiwei Wang
- Department of Neurology, The Sixth Medical Center of Chinese PLA General Hospital, Beijing 100048, China
| | - Xiaokun Qi
- Department of Neurology, The Sixth Medical Center of Chinese PLA General Hospital, Beijing 100048, China
| | - Feng Qiu
- Navy Clinical College, The Fifth School of Clinical Medicine, Anhui Medical University, Hefei, 230032, Anhui Province, China
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2
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Dhar N, Madhaw G, Kumar N. External Anal- and Urethral-Sphincter Electromyography for Differentiating MSA-P, PD and PSP: Using a Needle to Sort the Haystack! Ann Indian Acad Neurol 2023; 26:221-222. [PMID: 37538438 PMCID: PMC10394450 DOI: 10.4103/aian.aian_154_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 02/19/2023] [Indexed: 08/05/2023] Open
Affiliation(s)
- Nikita Dhar
- Department of Neurosciences, Alchemist Hospital, Panchkula, Haryana, India
| | - Govind Madhaw
- Department of Neurology, Centre of Neurosciences, Ranchi, Jharkhand, India
| | - Niraj Kumar
- Department of Neurology and Division of Sleep Medicine, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
- Department of Neurology, All India Institute of Medical Sciences, Bibinagar (Hyderabad Metropolitan Region), Telangana, India
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Vichayanrat E, Hentzen C, Batla A, Simeoni S, Iodice V, Panicker JN. Lower urinary tract dysfunction in Parkinsonian syndromes. Neurol Sci 2021; 42:4045-4054. [PMID: 34318363 DOI: 10.1007/s10072-021-05411-y] [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: 05/28/2021] [Accepted: 06/14/2021] [Indexed: 12/21/2022]
Abstract
PURPOSE OF REVIEW The aim of this review is to outline the clinical presentation, pathophysiology and evaluation of lower urinary tract (LUT) dysfunction in Parkinson's disease and other parkinsonian syndromes including multiple system atrophy, dementia with Lewy bodies, progressive supranuclear palsy and corticobasal degeneration. RECENT FINDINGS LUT dysfunction commonly occurs in neurological disorders, including patients with parkinsonian syndromes. The pattern of LUT dysfunction and its severity are variable, depending upon the site of lesion within the neural pathways. Parkinsonian syndromes are broadly divided into Parkinson's disease (PD) and a typical parkinsonian syndromes such as multiple system atrophy (MSA), dementia with Lewy bodies (DLB), progressive supranuclear palsy (PSP) and corticobasal degeneration (CBD). Different parkinsonian syndromes have distinct clinical features (e.g. dysautonomia, early dementia, supranuclear gaze palsy, higher cortical signs), and the pattern of LUT dysfunction and its severity can differ. CONCLUSIONS LUT dysfunction is a common feature in patients with parkinsonian syndromes. Recognising the pattern of LUT dysfunction during the assessment of these patients can help management and possibly facilitate an earlier diagnosis.
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Affiliation(s)
- Ekawat Vichayanrat
- Department of Uro‑Neurology, The National Hospital for Neurology and Neurosurgery, Queen Square, London, UK.,Autonomic Unit, National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
| | - Claire Hentzen
- Department of Uro‑Neurology, The National Hospital for Neurology and Neurosurgery, Queen Square, London, UK.,Sorbonne Université, GRC 01, GREEN Groupe de Recherche Clinique en Neuro-Urologie, AP-HP, Hôpital Tenon, 4 rue de la Chine, 75020, Paris, France
| | - Amit Batla
- Faculty of Brain Sciences, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Sara Simeoni
- Department of Uro‑Neurology, The National Hospital for Neurology and Neurosurgery, Queen Square, London, UK.,Faculty of Brain Sciences, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Valeria Iodice
- Autonomic Unit, National Hospital for Neurology and Neurosurgery, Queen Square, London, UK.,Faculty of Brain Sciences, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Jalesh N Panicker
- Department of Uro‑Neurology, The National Hospital for Neurology and Neurosurgery, Queen Square, London, UK. .,Faculty of Brain Sciences, UCL Queen Square Institute of Neurology, University College London, London, UK.
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4
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Gastrointestinal dysfunction in movement disorders. Neurol Sci 2021; 42:1355-1365. [PMID: 33538914 DOI: 10.1007/s10072-021-05041-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 01/04/2021] [Indexed: 12/24/2022]
Abstract
PURPOSE OF REVIEW This article provides an overview of the clinical presentation, investigations, and treatment options for gastrointestinal tract (GIT) dysfunction in patients with Parkinson's disease (PD) and other movement disorders. RECENT FINDINGS GIT dysfunction commonly appears as constipation and fecal incontinence (mostly overflow, accompanied with sphincter failure in multiple system atrophy [MSA]). Bowel dysfunction (underactive) occurs irrespectively from the site of the neurologic lesion, which is in contrast to site-dependent bladder dysfunction (brain, overactive; periphery, underactive). GI emergencies may arise, including intestinal pseudo-obstruction, intussusception, volvulus, and stercoral ulcer (ulcer of the colon due to pressure and irritation resulting from severe, prolonged constipation). Bowel function tests in neurologic patients often show a combination of slow transit and anorectal dysfunction. Management for slow transit constipation includes bulking agents, softening agents, yogurt/probiotics, and prokinetic agents. Suppositories, botulinum toxin injections, and transanal irrigation are options for managing anorectal constipation. CONCLUSIONS Function of the bowel is commonly affected in PD and other movement disorders. Neurologists play an important role in assessing bowel symptoms in their patients and planning treatment strategies, often in collaboration with specialist teams.
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The Role of Pelvic Neurophysiology Testing in the Assessment of Patients with Voiding Dysfunction. CURRENT BLADDER DYSFUNCTION REPORTS 2020. [DOI: 10.1007/s11884-020-00613-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Abstract
Purpose of Review
The role of pelvic neurophysiology testing in the evaluation of patients with lower urinary tract (LUT) symptoms is explored in this review.
Recent Findings
Different neurophysiology tests such as sphincter EMG and pudendal somatosensory evoked potentials are useful in evaluating the sacral somatic afferent and efferent innervation. S2 and S3 dermatomal evoked potentials assess individual sacral roots and are feasible to perform using standard neurophysiology machines.
Summary
The innervation of the LUT has a substantial contribution from splanchnic and somatic nerves arising from the sacral segments. Pelvic neurophysiology tests, which assess somatic nerve functions, are therefore a useful tool in assessing sacral nerve functions in patients presenting with unexplained voiding dysfunction. In this review, the commonly performed neurophysiology studies that assess the S2, S3 and S4 sacral afferent and efferent pathways are outlined, and their clinical applications reviewed.
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Cao Z, Wu Y, Liu G, Jiang Y, Wang X, Wang Z, Feng T. Differential Diagnosis of Multiple System Atrophy-Parkinsonism and Parkinson's Disease Using α-Synuclein and External Anal Sphincter Electromyography. Front Neurol 2020; 11:1043. [PMID: 33041984 PMCID: PMC7527535 DOI: 10.3389/fneur.2020.01043] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 08/10/2020] [Indexed: 11/30/2022] Open
Abstract
Background and aim: Discriminating multiple system atrophy-parkinsonism (MSA-P) from Parkinson's disease (PD) is challenging. We aimed to provide a new method to make an identification between MSA-P and PD by combining biofluid marker with electrophysiology marker. Methods: The XYCQ EV Enrichment KIT was applied to extract extracellular vesicles (EVs) from saliva. The levels of α-syn which included total α-syn (α- synTotal), phosphorylated-ser129 α-syn (α-synPS129) and oligomeric α-syn (α-synOlig) in EVs of saliva were tested by new developed Electrochemiluminescence (ECL) assays. We collected multi-motor unit potential (MUP) of all participants who conducted external anal sphincter electromyography (EAS-EMG). The duration, phase, amplitude and satellite potential of EAS-EMG were analyzed. The Receiver operator characteristic (ROC) curve was adopted to analyze the diagnostic utility of α-syn in EVs of saliva, EAS-EMG for MSA-P. Results: In EVs of saliva, the α-synTotal concentrations were lower in MSA-P than PD (P = 0.003). No significant difference was shown in α-synOlig and α-synPS129. α-synTotal 4.46 pg/ng distinguished MSA-P from PD with area under the curve (AUC) 0.804. Compared with PD, the duration, phase and satellite potential of EAS-EMG in MSA-P were increased (P = 0.002, 0.008, 0.001). There was no significant difference in amplitude. ROC curve showed that the duration (AUC: 0.780), phase (AUC: 0.751), and satellite potential (AUC: 0.809) had both diagnostic value for MSA-P. The combination of α-synTotal in salivary EVs and EAS-EMG (including duration, phase and satellite potential) could efficiently make a differentiation between MSA-P and PD with sensitivity of 100% and specificity of 86%. The AUC value was 0.901. Conclusion: The study suggested the combination of α-synTotal in salivary EVs and EAS-EMG could help efficiently distinguish MSA-P from PD.
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Affiliation(s)
- Zhentang Cao
- Department of Movement Disorders, Center for Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Yufeng Wu
- Department of Laboratory Medicine, Peking University Third Hospital, Beijing, China
| | - Genliang Liu
- Department of Movement Disorders, Center for Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Ying Jiang
- Department of Movement Disorders, Center for Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Xuemei Wang
- Department of Movement Disorders, Center for Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Zhan Wang
- Department of Movement Disorders, Center for Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Tao Feng
- Department of Movement Disorders, Center for Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Parkinson's Disease Center, Beijing Institute for Brain Disorders, Capital Medical University, Beijing, China
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Qiu F, Wang K, Li T, Song D, Wang Z, Zhang H, Liu J, Ren M, Qi X. Differential Diagnosis Of Multiple-System Atrophy With Parkinson's Disease By External Anal- And Urethral-Sphincter Electromyography. Neuropsychiatr Dis Treat 2019; 15:3061-3067. [PMID: 31806975 PMCID: PMC6842278 DOI: 10.2147/ndt.s218073] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2019] [Accepted: 10/02/2019] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND The differential diagnosis of Parkinson's disease (PD) with multiple-system atrophy (MSA) is difficult because of their similarity in symptoms and signs. The objective of this study was to investigate the value of external anal-sphincter electromyography (EAS-EMG) and urethral-sphincter electromyography (US-EMG) in differentiating MSA from PD. METHODS A total of 201 patients, - 101 MSA and 100 PD - were recruited in this study. Average duration and amplitude of motor unit potentials (MUPs), percentage of polyphasic MUPs, amplitude during strong contractions, and recruitment patterns during maximal voluntary contractions were recorded and analyzed to assess diagnostic efficiency of EAS-EMG and US-EMG for MSA. RESULTS Significant differences in average MUP duration and recruitment patterns during maximal voluntary contractions were found between patients with MSA and patients with PD using both EAS-EMG (P<0.001, P<0.001) and US-EMG (P<0.001, P<0.001). The percentage of polyphasic MUPs and amplitude during strong contractions showed significant differences in MSA and PD using only EAS-EMG (P<0.001, P=0.005). Cutoff points for average MUP duration in EAS-EMG and US-EMG for differential diagnosis of MSA with PD were 10.9 and 11.1 milliseconds, respectively. With average MUP duration of EAS-EMG and US-EMG being applied jointly, sensitivity and specificity in distinguishing MSA from PD were 83.2% and 71.8%, respectively. CONCLUSION EAS-EMG and US-EMG were sensitive and specific methods for the diagnosis and differential diagnosis of MSA, and the combination of both would improve the diagnostic rate of MSA compared to only one method being used.
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Affiliation(s)
- Feng Qiu
- Department of Neurology, Sixth Medical Center of Chinese PLA General Hospital, Beijing, 100048, People's Republic of China
| | - Kunyu Wang
- Department of Neurology, Sixth Medical Center of Chinese PLA General Hospital, Beijing, 100048, People's Republic of China
| | - Tingting Li
- Department of Gastroenterology, Second Medical Center of Chinese PLA General Hospital, Beijing, 100853, People's Republic of China
| | - Dandan Song
- Department of Medicine, Beijing Northern Hospital of China North Industries Group Corporation, Beijing 100089, People's Republic of China
| | - Zhiwei Wang
- Department of Neurology, Sixth Medical Center of Chinese PLA General Hospital, Beijing, 100048, People's Republic of China
| | - Hailing Zhang
- Department of Neurology, Changhai Hospital, Shanghai 200433, People's Republic of China
| | - Jianguo Liu
- Department of Neurology, Sixth Medical Center of Chinese PLA General Hospital, Beijing, 100048, People's Republic of China
| | - Ming Ren
- Beijing Advanced Innovation Center for Big Data-Based Precision Medicine, Beihang University, Beijing 100191, People's Republic of China
| | - Xiaokun Qi
- Department of Neurology, Sixth Medical Center of Chinese PLA General Hospital, Beijing, 100048, People's Republic of China
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Sakakibara R, Tateno F, Yamamoto T, Uchiyama T, Yamanishi T. Urological dysfunction in synucleinopathies: epidemiology, pathophysiology and management. Clin Auton Res 2017; 28:83-101. [PMID: 29124503 DOI: 10.1007/s10286-017-0480-0] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2017] [Accepted: 10/24/2017] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Parkinson's disease (PD) and multiple system atrophy (MSA) are major neurogenerative diseases characterized pathologically by abnormal alpha-synuclein aggregation. PD and MSA are clinically characterized by motor disorder and bladder dysfunction (mainly urinary urgency and frequency, also called overactive bladder). However, few literatures are available concerning bladder dysfunction in PD or MSA. METHOD A systematic review. RESULTS The bladder dysfunction in MSA is more severe than that in PD for large post-void residual or urinary retention. These bladder dysfunctions presumably reflect the different nervous system pathologies. Overactive bladder in PD reflects lesions in the brain, e.g., in the prefrontal-nigrostriatal D1 dopaminergic bladder-inhibitory pathway. Overactive bladder in MSA reflects lesions similar to PD and the cerebellum (bladder-inhibitory), and the urinary retention in MSA presumably reflects lesions in the pontine micturition center and the sacral intermediolateral nucleus of the spinal cord (bladder-facilitatory). Bladder dysfunction not only impairs an individual's quality of life, it can also cause emergency hospitalizations due to acute retention and early institutionalization. Anticholinergics are the first-line treatment for bladder dysfunction in PD and MSA patients, but care should be taken for the management of bladder dysfunction-particularly in MSA patients due to the high prevalence of difficult emptying, which needs clean, intermittent catheterization. CONCLUSIONS This review summarizes the epidemiology, pathophysiology, and management of bladder dysfunction in individuals with PD or MSA.
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Affiliation(s)
- Ryuji Sakakibara
- Neurology, Internal Medicine, Sakura Medical Center, Toho University, 564-1 Shimoshizu, Sakura, 285-8741, Japan.
| | - Fuyuki Tateno
- Neurology, Internal Medicine, Sakura Medical Center, Toho University, 564-1 Shimoshizu, Sakura, 285-8741, Japan
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Yamamoto T, Asahina M, Yamanaka Y, Uchiyama T, Hirano S, Fuse M, Koga Y, Sakakibara R, Kuwabara S. Postvoid residual predicts the diagnosis of multiple system atrophy in Parkinsonian syndrome. J Neurol Sci 2017; 381:230-234. [DOI: 10.1016/j.jns.2017.08.3262] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Revised: 08/21/2017] [Accepted: 08/30/2017] [Indexed: 11/17/2022]
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10
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Yamamoto T, Asahina M, Yamanaka Y, Uchiyama T, Hirano S, Fuse M, Koga Y, Sakakibara R, Kuwabara S. The Utility of Post-Void Residual Volume versus Sphincter Electromyography to Distinguish between Multiple System Atrophy and Parkinson's Disease. PLoS One 2017; 12:e0169405. [PMID: 28060892 PMCID: PMC5217958 DOI: 10.1371/journal.pone.0169405] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2016] [Accepted: 12/16/2016] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To determine the ability of sphincter electromyography (EMG) and post-void residual urine volume (PVR) during a free-flow study and a pressure-flow study (PFS) for distinguishing multiple system atrophy (MSA) from Parkinson's disease (PD). METHODS We retrospectively reviewed 241 case records; both urodynamic study and sphincter EMG were performed in patients with MSA (n = 147) and PD (n = 94). RESULTS There was a statistically significant difference (p < 0.01) in the mean PVR during the free-flow study (113.1 ± 7.5 mL in MSA and 40.4 ± 3.8 mL in PD), mean PVR during PFS (230.1 ± 12.6 mL in MSA and 71.7 ± 6.6 mL in PD), and mean duration of MUP for sphincter EMG (9.3 ± 0.1 ms in MSA and 7.7 ± 0.1 ms in PD). The area under the curve used for differentiating MSA from PD was 0.79 and 0.73 for PVR during PFS and the free-flow study, respectively. There was a mean duration of 0.69 ms for the sphincter EMG. CONCLUSIONS The present results suggested that PVR was more appropriate than sphincter EMG for differentiating MSA from PD.
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Affiliation(s)
- Tatsuya Yamamoto
- Department of Neurology, Chiba University Graduate School of Medicine, Chiba, Japan
- * E-mail:
| | - Masato Asahina
- Department of Neurology, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Yoshitaka Yamanaka
- Department of Neurology, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Tomoyuki Uchiyama
- Department of Neurology, Chiba University Graduate School of Medicine, Chiba, Japan
- Department of Neurology, Continence Center, Dokkyo Medical University, Tochigi, Japan
| | - Shigeki Hirano
- Department of Neurology, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Miki Fuse
- Department of Urology, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Yasuko Koga
- Department of Molecular Diagnosis, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Ryuji Sakakibara
- Department of Neurology, Chiba University Graduate School of Medicine, Chiba, Japan
- Neurology Division, Department of Internal Medicine, Sakura Medical Center, Toho University, Sakura, Japan
| | - Satoshi Kuwabara
- Department of Neurology, Chiba University Graduate School of Medicine, Chiba, Japan
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11
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Yamamoto T, Asahina M, Yamanaka Y, Uchiyama T, Hirano S, Sugiyama A, Sakakibara R, Kuwabara S. Urinary Dysfunctions Are More Severe in the Parkinsonian Phenotype of Multiple System Atrophy. Mov Disord Clin Pract 2016; 3:275-281. [PMID: 30363569 DOI: 10.1002/mdc3.12289] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2015] [Revised: 09/16/2015] [Accepted: 09/19/2015] [Indexed: 12/20/2022] Open
Abstract
Background MSA is clinically classified into two phenotypes: parkinsonism predominant (MSA-P) and cerebellar ataxia predominant (MSA-C). However, little is known about the differences in urinary dysfunctions between MSA-C and MSA-P. We investigated the differences in urinary and cardiovascular dysfunctions between MSA-C and MSA-P. Methods We retrospectively reviewed the medical records of patients with MSA diagnosed as having probable or possible MSA according to Gilman's second consensus criteria from January 2007 to September 2013 in our hospital. Data regarding the initial symptoms, onset of urinary symptoms, and results of urodynamic (including anal sphincter electromyography) and head-up tilt tests were collected. Results A total of 100 patients with MSA, including 59 patients with MSA-C and 41 with MSA-P, were reviewed. Initial symptoms were autonomic (n = 12) and cerebellar (n = 47) in the MSA-C phenotype and were autonomic (n = 14) and parkinsonian (n = 27) in the MSA-P phenotypes. Urodynamic study indicated that bladder contraction was more severely impaired in patients with MSA-P than in those with MSA-C. In the head-up tilt test, the decrease in diastolic blood pressure was significantly larger in the MSA-P phenotype than that in the MSA-C phenotype. Acontractile bladder during the pressure flow study increased likelihood that the phenotype is MSA-P (odds ratio: 6.67; 95% confidence interval: 1.004-44.284; P = 0.050). Conclusions Urinary dysfunctions were more severe in MSA-P compared with MSA-C. Detailed urodynamic study was helpful for detecting subtle differences between MSA-C and MSA-P.
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Affiliation(s)
- Tatsuya Yamamoto
- Department of Neurology Chiba University Graduate School of Medicine Chiba Japan
| | - Masato Asahina
- Department of Neurology Chiba University Graduate School of Medicine Chiba Japan
| | - Yoshitaka Yamanaka
- Department of Neurology Chiba University Graduate School of Medicine Chiba Japan
| | - Tomoyuki Uchiyama
- Department of Neurology Chiba University Graduate School of Medicine Chiba Japan.,Department of Neurology Continence Center Dokkyo Medical University Tochigi Japan
| | - Shigeki Hirano
- Department of Neurology Chiba University Graduate School of Medicine Chiba Japan
| | - Atsuhiko Sugiyama
- Department of Neurology Chiba University Graduate School of Medicine Chiba Japan
| | - Ryuji Sakakibara
- Department of Neurology Chiba University Graduate School of Medicine Chiba Japan.,Neurology Division Department of Internal Medicine Sakura Medical Center Toho University Sakura Japan
| | - Satoshi Kuwabara
- Department of Neurology Chiba University Graduate School of Medicine Chiba Japan
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Tsuyusaki Y, Sakakibara R, Tateno F, Aiba Y, Kishi M, Tateno H, Ogata T, Inaoka T, Terada H, Suzuki Y. Multiple system atrophy presenting initially as spastic paraparesis. J Neurol Sci 2016; 360:176-8. [PMID: 26723996 DOI: 10.1016/j.jns.2015.11.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2015] [Revised: 11/07/2015] [Accepted: 11/30/2015] [Indexed: 10/22/2022]
Affiliation(s)
- Yohei Tsuyusaki
- Neurology, Internal Medicine, Sakura Medical Center, Toho University, Sakura, Japan
| | - Ryuji Sakakibara
- Neurology, Internal Medicine, Sakura Medical Center, Toho University, Sakura, Japan.
| | - Fuyuki Tateno
- Neurology, Internal Medicine, Sakura Medical Center, Toho University, Sakura, Japan
| | - Yosuke Aiba
- Neurology, Internal Medicine, Sakura Medical Center, Toho University, Sakura, Japan
| | - Masahiko Kishi
- Neurology, Internal Medicine, Sakura Medical Center, Toho University, Sakura, Japan
| | - Hiromi Tateno
- Neurology, Internal Medicine, Sakura Medical Center, Toho University, Sakura, Japan
| | - Tsuyoshi Ogata
- Neurology, Internal Medicine, Sakura Medical Center, Toho University, Sakura, Japan
| | - Tsutomu Inaoka
- Radiology, Sakura Medical Center, Toho University, Sakura, Japan
| | - Hitoshi Terada
- Radiology, Sakura Medical Center, Toho University, Sakura, Japan
| | - Yasuo Suzuki
- Gatroenterology, Sakura Medical Center, Toho University, Sakura, Japan
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Underactive and overactive bladders are related to motor function and quality of life in Parkinson's disease. Int Urol Nephrol 2015; 47:751-7. [PMID: 25792006 DOI: 10.1007/s11255-015-0951-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Accepted: 03/07/2015] [Indexed: 12/19/2022]
Abstract
AIM OF THE STUDY Overactive bladder occurs in up to 70% and underactive bladder in up to 50% of patients with Parkinson's disease (PD), which is thought to reflect an altered frontal-basal ganglia circuit. However, it is not clear how bladder disorder is related to motor function and to quality of life (QOL) in PD. We studied these relationships by conducting multiple regression (MR) and bivariate correlation (BV) statistical analyses. METHODS We recruited 58 PD patients, irrespective of the presence of bladder disorder: 35 men and 23 women of mean age 66.8 years, mean duration of the disease 5.4 years, and median score of Hoehn-Yahr stage 3. We administered a bladder questionnaire including two major types of lower urinary tract symptoms, 'overactive bladder (OAB)' and 'voiding difficulty,' in addition to a QOL index and a pressure-flow urodynamic study to detect detrusor overactivity (DO) during filling; and detrusor weakness, outlet obstruction, and post-void residuals (PVR) during voiding. We analyzed the results using the MR and BV methods. RESULTS (1) Motor impairment (by HY grades) was significantly related to detrusor weakness (P < 0.05 MR); voiding difficulty, OAB (P < 0.05 BV) (by de novo, levodopa honeymoon, and wearing-off); and voiding difficulty (P < 0.05 MR). (2) Bladder QOL was significantly related to OAB, increased bladder sensation (P < 0.05 MR) and voiding difficulty (P < 0.05 BV). (3) Male gender was significantly related to outlet obstruction, DO (P < 0.05 MR). (4) Age was significantly related to DO and PVR (P < 0.05 MR). Disease duration was significantly related to OAB (P < 0.05 MR). CONCLUSION From these results, detrusor weakness (relevant to motor impairment) and OAB (relevant to bladder QOL) are thought to be fundamental in PD. In contrast to the mechanism of OAB, the mechanism of detrusor weakness in PD remains unclear and warrants further exploration.
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Winge K. Lower urinary tract dysfunction in patients with parkinsonism and other neurodegenerative disorders. HANDBOOK OF CLINICAL NEUROLOGY 2015; 130:335-56. [DOI: 10.1016/b978-0-444-63247-0.00019-5] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Tateno F, Sakakibara R, Ogata T, Kishi M, Tsuyusaki Y, Takahashi O, Sugiyama M, Tateno A. Lower urinary tract function in dementia with Lewy bodies (DLB). Mov Disord 2014; 30:411-5. [PMID: 25356960 DOI: 10.1002/mds.25985] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2013] [Revised: 06/18/2014] [Accepted: 07/02/2014] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVES Dementia with Lewy bodies (DLB) is the second most common degenerative cause of dementia, whereas lower urinary tract (LUT) function in DLB patients has not been fully delineated. We investigated LUT function in DLB by clinical-urodynamic observations. METHODS We examined 32 patients with DLB (23 men, 9 women; aged 59-86 [mean, 75.9] years; disease duration, 0.2-17 [3.3] years). All patients underwent an electromyography-cystometry, and 21 patients underwent the sphincter motor unit potential analysis. RESULTS Ninety-one percent of patients had LUT symptoms: nighttime frequency (>8 times), 84%, and urinary incontinence (>1 per week), 50%. Detrusor overactivity was revealed in 87.1%, whereas postvoid residual was minimal. Neurogenic changes were shown in 50%. CONCLUSION LUT dysfunction is a common feature in DLB, attributable not only to dementia and immobility, but also to central and peripheral types of somato-autonomic dysfunction.
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Affiliation(s)
- Fuyuki Tateno
- Neurology, Internal Medicine, Sakura Medical Center, Toho University, Sakura, Japan
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Jian F, Pan H, Zhang Z, Lin J, Chen N, Zhang L, Wu Q, Wang H, Wang Y, Cui L, Tang X. Sphincter electromyography in diabetes mellitus and multiple system atrophy. Neurourol Urodyn 2014; 34:669-74. [PMID: 25042298 DOI: 10.1002/nau.22639] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2013] [Accepted: 04/24/2014] [Indexed: 11/10/2022]
Abstract
AIMS Abnormalities of external anal sphincter electromyography (EAS-EMG) characterize multiple system atrophy (MSA) and focal cauda equina or conus medullaris lesions. This study is designed to determine whether and how diabetic polyneuropathy (DPN) affects EAS as compared to the abnormalities seen in MSA. METHODS We conducted multi-motor unit potential (MUP) analysis of EAS in 22 healthy controls, 32 diabetes mellitus (DM) patients without neuropathy, 38 DPN patients, and 68 MSA patients. RESULTS DPN patients had a significant (P < 0.01) increase in MUP mean duration, mean amplitude, percentage of long duration MUPs, and satellite rate, but to a lesser extent than MSA. Mean duration and satellite rate showed the least overlap among different groups in individual value distributions. CONCLUSIONS Compared with MSA, DPN affects EAS to a lesser degree as judged by neurogenic MUP abnormalities in EMG. Mean duration and satellite rate may serve as the most discriminating aspects in MUP analysis of EAS.
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Affiliation(s)
- Fan Jian
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Hua Pan
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Zaiqiang Zhang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Jinxi Lin
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Na Chen
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Lei Zhang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Qing Wu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Han Wang
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Science, Beijing, China
| | - Yongjun Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Liying Cui
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Science, Beijing, China
| | - Xiaofu Tang
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Science, Beijing, China
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Yamamoto T, Sakakibara R, Uchiyama T, Yamaguchi C, Ohno S, Nomura F, Yanagisawa M, Hattori T, Kuwabara S. Time-dependent changes and gender differences in urinary dysfunction in patients with multiple system atrophy. Neurourol Urodyn 2013; 33:516-23. [PMID: 23754466 DOI: 10.1002/nau.22441] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2013] [Accepted: 05/03/2013] [Indexed: 11/05/2022]
Abstract
AIMS Because time-dependent changes and gender differences in urinary dysfunction in patients with multiple system atrophy (MSA) are yet unknown, we aimed to determine these parameters through a combination of urodynamic examination and the results of a questionnaire on urinary symptoms. METHODS We retrospectively reviewed 66 patients with MSA who responded to a urinary symptoms questionnaire and underwent urodynamic examination more than twice. The participants' mean age was 62 years and mean disease duration at the first urodynamic examination was 3.2 years. Mean duration between the first and second urodynamic examination was 441 days. RESULTS With regard to overall (both genders) time-dependent change, none of the urinary symptoms showed significant differences. In the urodynamic examination there were significant differences in reduced urine flow, increased post-void residuals, and decreased detrusor contractility at the second examination. With regard to gender differences, at the first examination, night-time urinary frequency, and voiding symptoms were significantly more severe in male than in female patients; however, at the second examination, except for urinary urgency, gender differences were not observed for any other symptoms. In urodynamic examination, the degree of detrusor contraction was significantly less in male patients at the first examination. However, no significant differences were found in urodynamic examination at the second examination. CONCLUSIONS The present study indicates that voiding dysfunction progressed without significant worsening of voiding symptoms. In addition, gender differences are important in evaluating urinary dysfunction being basically less severe in female than in male patients, at least during the early stage. Neurourol. Urodynam. 33:516-523, 2014. © 2013 Wiley Periodicals, Inc.
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Affiliation(s)
- Tatsuya Yamamoto
- Department of Neurology, Graduate School of Medicine, Chiba University, Chiba, Japan
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