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Azibte GT, Molla BA, Mulate ST, Melkamu SK, Ayalew ZS. Multiple system atrophy-cerebellar type: Diagnostic challenge in resource-limited settings case report. Clin Case Rep 2024; 12:e9142. [PMID: 38962459 PMCID: PMC11220500 DOI: 10.1002/ccr3.9142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 06/06/2024] [Accepted: 06/12/2024] [Indexed: 07/05/2024] Open
Abstract
Key Clinical Message This case report highlights the challenges of diagnosing MSA-C in resource-limited settings. MRI findings like the "hot cross bun" sign can be supportive, but the unavailability of advanced tools like seed amplification assay may delay diagnosis. Early diagnosis is crucial for proper symptom management. Abstract Multiple system atrophy is a rare neurodegenerative disorder affecting the pyramidal, autonomic, nigrostriatal, and cerebellar tracts. Multisystem atrophy should be considered in adults with progressive motor or autonomic dysfunctions. Clinical manifestations vary depending on the system, including bradykinesia, tremor, rigidity, cerebellar ataxia, and autonomic failure. Depending on the initial predominant manifestation, multisystem atrophy is classified as Parkinsonian (MSA-P) and cerebellar (MSA-C). Our patient presented with progressive loss of balance, rigidity, slurred speech, choking episodes, and loss of morning tumescence for 4 years, suggesting autonomic and cerebellar involvement. He was diagnosed with MSA after 4 years of initial presentation with combinations of magnetic resonant imaging findings and clinical manifestations. Diagnosing multiple system atrophy in such resource-limited areas is challenging. The unavailability of seed application tests and biomarkers significantly affected the delayed diagnosis.
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Affiliation(s)
- Gebeyehu Tessema Azibte
- Department of Internal MedicineAddis Ababa University College of Medicine and Health SciencesAddis AbabaEthiopia
| | - Bereket Abraha Molla
- Department of Internal MedicineAddis Ababa University College of Medicine and Health SciencesAddis AbabaEthiopia
| | - Sebhatleab Teju Mulate
- Department of Internal MedicineAddis Ababa University College of Medicine and Health SciencesAddis AbabaEthiopia
| | - Selam Kifelew Melkamu
- Department of NeurologyAddis Ababa University College of Medicine and Health SciencesAddis AbabaEthiopia
| | - Zekarias Seifu Ayalew
- Department of Internal MedicineAddis Ababa University College of Medicine and Health SciencesAddis AbabaEthiopia
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Raghavan S, Lesnick TG, Castillo AM, Reid RI, Fought AJ, Thostenson KB, Johnson Sparrman KL, Gehrking TL, Gehrking JA, Sletten DM, Low PA, Singer W, Vemuri P. White Matter Abnormalities Track Disease Progression in Multiple System Atrophy. Mov Disord Clin Pract 2024. [PMID: 38923361 DOI: 10.1002/mdc3.14147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Revised: 04/16/2024] [Accepted: 05/26/2024] [Indexed: 06/28/2024] Open
Abstract
BACKGROUND White matter (WM) abnormalities have been implicated in clinically relevant functional decline in multiple system atrophy (MSA). OBJECTIVE To identify the WM and gray matter (GM) abnormalities in MSA and assess the utility of longitudinal structural and diffusion changes as surrogate markers for tracking disease progression in MSA. METHODS Twenty-seven participants with early MSA [15 with clinically predominant cerebellar (MSA-C) and 12 with clinically predominant parkinsonian features (MSA-P)] and 14 controls were enrolled as a part of our prospective, longitudinal study of synucleinopathies. Using structural magnetic resonance imaging (MRI) and diffusion MRI (diffusion tensor and neurite orientation and dispersion density imaging), we analyzed whole and regional brain changes in these participants. We also evaluated temporal imaging trajectories based on up to three annual follow-up scans and assessed the impact of baseline diagnosis on these imaging biomarkers using mixed-effect models. RESULTS MSA patients exhibited more widespread WM changes than GM, particularly in the cerebellum and brainstem, with greater severity in MSA-C. Structural and diffusion measures in the cerebellum WM and brainstem deteriorated with disease progression. Rates of progression of these abnormalities were similar in both MSA subtypes, reflecting increasing overlap of clinical features over time. CONCLUSION WM abnormalities are core features of MSA disease progression and advance at similar rates in clinical MSA subtypes. Multimodal MRI imaging reveals novel insights into the distribution and pattern of brain abnormalities and their progression in MSA. Selected structural and diffusion measures may be useful for tracking disease progression in MSA clinical trials.
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Affiliation(s)
| | - Timothy G Lesnick
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | - Anna M Castillo
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | - Robert I Reid
- Department of Information Technology, Mayo Clinic, Rochester, MN, USA
| | - Angela J Fought
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | | | | | | | | | | | - Phillip A Low
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
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Liu M, Wang Z, Shang H. Multiple system atrophy: an update and emerging directions of biomarkers and clinical trials. J Neurol 2024; 271:2324-2344. [PMID: 38483626 PMCID: PMC11055738 DOI: 10.1007/s00415-024-12269-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Revised: 02/17/2024] [Accepted: 02/19/2024] [Indexed: 04/28/2024]
Abstract
Multiple system atrophy is a rare, debilitating, adult-onset neurodegenerative disorder that manifests clinically as a diverse combination of parkinsonism, cerebellar ataxia, and autonomic dysfunction. It is pathologically characterized by oligodendroglial cytoplasmic inclusions containing abnormally aggregated α-synuclein. According to the updated Movement Disorder Society diagnostic criteria for multiple system atrophy, the diagnosis of clinically established multiple system atrophy requires the manifestation of autonomic dysfunction in combination with poorly levo-dopa responsive parkinsonism and/or cerebellar syndrome. Although symptomatic management of multiple system atrophy can substantially improve quality of life, therapeutic benefits are often limited, ephemeral, and they fail to modify the disease progression and eradicate underlying causes. Consequently, effective breakthrough treatments that target the causes of disease are needed. Numerous preclinical and clinical studies are currently focusing on a set of hallmarks of neurodegenerative diseases to slow or halt the progression of multiple system atrophy: pathological protein aggregation, synaptic dysfunction, aberrant proteostasis, neuronal inflammation, and neuronal cell death. Meanwhile, specific biomarkers and measurements with higher specificity and sensitivity are being developed for the diagnosis of multiple system atrophy, particularly for early detection of the disease. More intriguingly, a growing number of new disease-modifying candidates, which can be used to design multi-targeted, personalized treatment in patients, are being investigated, notwithstanding the failure of most previous attempts.
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Affiliation(s)
- Min Liu
- Department of Neurology, Laboratory of Neurodegenerative Disorders, Rare Disease Center, West China Hospital, Sichuan University, No. 37 Guoxue Xiang, Chengdu, 610041, Sichuan, China
| | - Zhiyao Wang
- Department of Neurology, Laboratory of Neurodegenerative Disorders, Rare Disease Center, West China Hospital, Sichuan University, No. 37 Guoxue Xiang, Chengdu, 610041, Sichuan, China
| | - Huifang Shang
- Department of Neurology, Laboratory of Neurodegenerative Disorders, Rare Disease Center, West China Hospital, Sichuan University, No. 37 Guoxue Xiang, Chengdu, 610041, Sichuan, China.
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Li XY, Xue T, Lai H, Dai J, Peng F, Xu F, Zhu J, Li X, Hu J, Li W, He R, Chen L, Chen Y, Ding C, Zhao G, Chen X, Ye Q, Xu Z, Wang C. Pyruvate is modified by tea/coffee metabolites and reversely correlated with multiple system atrophy and Parkinson's disease. Heliyon 2024; 10:e26588. [PMID: 38434286 PMCID: PMC10906427 DOI: 10.1016/j.heliyon.2024.e26588] [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: 01/11/2024] [Revised: 02/07/2024] [Accepted: 02/15/2024] [Indexed: 03/05/2024] Open
Abstract
Introduction Multiple system atrophy (MSA) is a rapidly progressing neurodegenerative disorder. Although diverse biomarkers have been established for Parkinson's disease (PD), no widely accepted markers have been identified in MSA. Pyruvate and lactate are the end-product of glycolysis and crucial for brain metabolism. However, their correlation with MSA remains unclear. Moreover, it is elusive how lifestyles modify these metabolites. Methods To investigate the correlation and diagnostic value of plasma pyruvate and lactate levels in MSA and PD. Moreover, we explored how lifestyle-related metabolites interact with these metabolites in determining the disease risk. We assayed the 3 metabolites in pyruvate/lactate and 6 in the tea/coffee metabolic pathways by targeted mass spectrometry and evaluate their interactions and performance in diagnosis and differentiation between MSA and PD. Results We found that 7 metabolites were significantly different between MSA, PD and healthy controls (HCs). Particularly, pyruvate was increased in PD while significantly decreased in MSA patients. Moreover, the tea/coffee metabolites were negatively associated with the pyruvate level in HCs, but not in MSA and PD patients. Using machine-learning models, we showed that the combination of pyruvate and tea/coffee metabolites diagnosed MSA (AUC = 0.878) and PD (AUC = 0.833) with good performance. Additionally, pyruvate had good performance in distinguishing MSA from PD (AUC = 0.860), and the differentiation increased (AUC = 0.922) when combined with theanine and 1,3-dimethyluric acid. Conclusions This study demonstrates that pyruvate correlates reversely with MSA and PD, and may play distinct roles in their pathogenesis, which can be modified by lifestyle-related tea/coffee metabolites.
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Affiliation(s)
- Xu-Ying Li
- Department of Neurology and Neurobiology, Xuanwu Hospital of Capital Medical University, National Clinical Research Center for Geriatric Diseases, Beijing, 100053, China
- Institute of Genetics and Developmental Biology, Chinese Academy of Sciences, Beijing, 100101, China
| | - Teng Xue
- Zhongyuanborui Key Laboratory of Genetics and Metabolism, Guangdong-Macao In-depth Cooperation Zone in Hengqin, China
- Zhongguancun Biological and Medical Big Data Center, Beijing, China
| | - Hong Lai
- Department of Neurology and Neurobiology, Xuanwu Hospital of Capital Medical University, National Clinical Research Center for Geriatric Diseases, Beijing, 100053, China
| | - Jing Dai
- National Center for Occupational Safety and Health, NHC (National Center for Occupational Medicine of Coal Industry), Beijing, China
| | - Fangda Peng
- National Center for Occupational Safety and Health, NHC (National Center for Occupational Medicine of Coal Industry), Beijing, China
| | - Fanxi Xu
- Department of Neurology and Neurobiology, Xuanwu Hospital of Capital Medical University, National Clinical Research Center for Geriatric Diseases, Beijing, 100053, China
| | - Junge Zhu
- Department of Neurology and Neurobiology, Xuanwu Hospital of Capital Medical University, National Clinical Research Center for Geriatric Diseases, Beijing, 100053, China
| | - Xian Li
- Department of Neurology and Neurobiology, Xuanwu Hospital of Capital Medical University, National Clinical Research Center for Geriatric Diseases, Beijing, 100053, China
| | - Junya Hu
- Department of Neurobiology, Xuanwu Hospital of Capital Medical University, Beijing, 100053, China
| | - Wei Li
- Department of Neurobiology, Xuanwu Hospital of Capital Medical University, Beijing, 100053, China
| | - Raoli He
- Department of Neurology, Fujian Medical University Union Hospital, Institute of Neuroscience, Fujian Key Laboratory of Molecular Neurology, Fujian Medical University, Fuzhou, China
| | - Lina Chen
- Department of Neurology, Fujian Medical University Union Hospital, Institute of Neuroscience, Fujian Key Laboratory of Molecular Neurology, Fujian Medical University, Fuzhou, China
| | - Ying Chen
- Department of Neurology, Fujian Medical University Union Hospital, Institute of Neuroscience, Fujian Key Laboratory of Molecular Neurology, Fujian Medical University, Fuzhou, China
| | - Chunguang Ding
- National Center for Occupational Safety and Health, NHC (National Center for Occupational Medicine of Coal Industry), Beijing, China
| | - Guoguang Zhao
- Department of Neurosurgery, Xuanwu Hospital of Capital Medical University, Clinical Research Center for Epilepsy Capital Medical University, Beijing, China
| | - Xianyang Chen
- Zhongguancun Biological and Medical Big Data Center, Beijing, China
- Bao Feng Key Laboratory of Genetics and Metabolism, Beijing, China
| | - Qinyong Ye
- Department of Neurology, Fujian Medical University Union Hospital, Institute of Neuroscience, Fujian Key Laboratory of Molecular Neurology, Fujian Medical University, Fuzhou, China
| | - Zhiheng Xu
- Institute of Genetics and Developmental Biology, Chinese Academy of Sciences, Beijing, 100101, China
| | - Chaodong Wang
- Department of Neurology and Neurobiology, Xuanwu Hospital of Capital Medical University, National Clinical Research Center for Geriatric Diseases, Beijing, 100053, China
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Ng CC, Tan TLE. Multiple system atrophy-cerebellar subtype. QJM 2023; 116:1031-1032. [PMID: 37458507 DOI: 10.1093/qjmed/hcad171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 07/12/2023] [Indexed: 12/29/2023] Open
Affiliation(s)
- C C Ng
- Department of Neurology, Changi General Hospital, 2 Simei St 3, Singapore 529889, Singapore
| | - T L E Tan
- Department of Radiology, Changi General Hospital, 2 Simei St 3, Singapore 529889, Singapore
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Wang Z, Mo J, Zhang J, Feng T, Zhang K. Surface-Based Neuroimaging Pattern of Multiple System Atrophy. Acad Radiol 2023; 30:2999-3009. [PMID: 37495425 DOI: 10.1016/j.acra.2023.04.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 04/11/2023] [Accepted: 04/14/2023] [Indexed: 07/28/2023]
Abstract
RATIONALE AND OBJECTIVES Overlapping parkinsonism, cerebellar ataxia, and pyramidal signs render challenges in the clinical diagnosis of multiple system atrophy (MSA). The neuroimaging pattern is valuable to understand its pathophysiology and improve its diagnostic effect. MATERIALS AND METHODS We retrospectively obtained magnetic resonance imaging and susceptibility-weighted imaging in patients with MSA (including parkinsonian type [MSA-P] and cerebellar type [MSA-C]), Parkinson's disease, and normal controls. We quantified neuroimaging features to identify the optimal threshold for diagnosis. Furthermore, we explore neuroimaging patterns of MSA by mapping the subcortical morphological alterations and constructing a diagnostic model. RESULTS Compared to controls, normalized putaminal volume significantly decreased in patients with MSA-P (P < .001) and normalized pontine volume significantly decreased in patients with MSA-C (P < .001). The Youden index of the threshold-based clinical prediction model was 0.871-0.928 in patients with MSA. The neuroimaging pattern in patients with MSA was jointly located in the lateral putamen, and the neuroimaging pattern prediction model achieved a classification accuracy of 83.9%-100%. CONCLUSION The quantitative neuroimaging features and surface-based morphologic anomalies represent the markers of MSA and open new avenues for personalized clinical diagnosis.
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Affiliation(s)
- Zhan Wang
- Center for Movement Disorders, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China (Z.W., T.F.); China National Clinical Research Center for Neurological Disease, NCRC-ND, Beijing, China (Z.W., T.F.)
| | - Jiajie Mo
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China (J.M., J.Z., K.Z.); Department of Neurosurgery, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China (J.M., J.Z., K.Z.); Beijing Key Laboratory of Neurostimulation, Beijing, China (J.M., J.Z., K.Z.)
| | - Jianguo Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China (J.M., J.Z., K.Z.); Department of Neurosurgery, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China (J.M., J.Z., K.Z.); Beijing Key Laboratory of Neurostimulation, Beijing, China (J.M., J.Z., K.Z.)
| | - Tao Feng
- Center for Movement Disorders, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China (Z.W., T.F.); China National Clinical Research Center for Neurological Disease, NCRC-ND, Beijing, China (Z.W., T.F.)
| | - Kai Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China (J.M., J.Z., K.Z.); Department of Neurosurgery, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China (J.M., J.Z., K.Z.); Beijing Key Laboratory of Neurostimulation, Beijing, China (J.M., J.Z., K.Z.).
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Lyu H, Zhu X, He N, Li Q, Yin Q, Huang Y, Yan F, Liu J, Lu Y. Alterations in Resting-State MR Functional Connectivity of the Central Autonomic Network in Multiple System Atrophy and Relationship with Disease Severity. J Magn Reson Imaging 2023; 58:1472-1487. [PMID: 36988420 DOI: 10.1002/jmri.28693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 03/09/2023] [Accepted: 03/09/2023] [Indexed: 03/30/2023] Open
Abstract
BACKGROUND The central autonomic network (CAN) plays a critical role in the body's sympathetic and parasympathetic control. However, functional connectivity (FC) changes of the CAN in patients with multiple system atrophy (MSA) remain unknown. PURPOSE To investigate FC alterations of CAN in MSA patients. STUDY TYPE Prospective. POPULATION Eighty-two subjects (47 patients with MSA [44.7% female, 60.5 ± 6.9 years], 35 age- and sex-matched healthy controls [HC] [57.1% female, 62.5 ± 6.6 years]). FIELD STRENGTH/SEQUENCE 3-T, resting-state functional magnetic resonance imaging (rs-fMRI) using gradient echo-planar imaging (EPI), T1-weighted three-dimensional magnetization-prepared rapid gradient echo (3D MPRAGE) structural MRI. ASSESSMENT FC alterations were explored by using core modulatory regions of CAN as seeds, including midcingulate cortex, insula, amygdala, and ventromedial prefrontal cortex. Bartlett factor score (BFS) derived from a factor analysis of clinical assessments on disease severity was used as a grouping factor for moderate MSA (mMSA: BFS < 0) and severe MSA (sMSA: BFS > 0). STATISTICAL TESTS For FC analysis, the one-way ANCOVA with cluster-level family-wise error correction (statistical significance level of P < 0.025), and post hoc t-testing with Bonferroni correction or Tamhane's T2 correction (statistical significance level of adjusted-P < 0.05) were adopted. Correlation was assessed using Pearson correlation or Spearman correlation (statistical significance level of P < 0.05). RESULTS Compared with HC, patients with MSA exhibited significant FC aberrances between the CAN and brain areas of sensorimotor control, limbic network, putamen, and cerebellum. For MSA patients, most FC alterations of CAN, especially concerning FC between the right anterior insula and right primary sensorimotor cortices, were found to be significantly correlated with disease severity. FC changes were found to be more significant in sMSA group than in mMSA group when compared with HCs. DATA CONCLUSION MSA shows widespread FC changes of CAN, suggesting that abnormal functional integration of CAN may be involved in disease pathogenesis of MSA. LEVEL OF EVIDENCE 2 TECHNICAL EFFICACY: Stage 3.
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Affiliation(s)
- Haiying Lyu
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xue Zhu
- Department of Neurology and Institute of Neurology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Naying He
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qing Li
- MR Collaborations, Siemens Healthineers Ltd., Shanghai, China
| | - Qianyi Yin
- Department of Neurology and Institute of Neurology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Ruijin Hospital Lu Wan Branch, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yufei Huang
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Fuhua Yan
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jun Liu
- Department of Neurology and Institute of Neurology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yong Lu
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Cuoco S, Ponticorvo S, Bisogno R, Manara R, Esposito F, Di Salle G, Di Salle F, Amboni M, Erro R, Picillo M, Barone P, Pellecchia MT. Magnetic Resonance T1w/T2w Ratio in the Putamen and Cerebellum as a Marker of Cognitive Impairment in MSA: a Longitudinal Study. CEREBELLUM (LONDON, ENGLAND) 2023; 22:810-817. [PMID: 35982370 PMCID: PMC10485110 DOI: 10.1007/s12311-022-01455-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/30/2022] [Indexed: 06/15/2023]
Abstract
The exact pathophysiology of cognitive impairment in multiple system atrophy (MSA) is unclear. In our longitudinal study, we aimed to analyze (I) the relationships between cognitive functions and some subcortical structures, such as putamen and cerebellum assessed by voxel-based morphometry (VBM) and T1-weighted/T2-weighted (T1w/T2w) ratio, and (II) the neuroimaging predictors of the progression of cognitive deficits. Twenty-six patients with MSA underwent a comprehensive neuropsychological battery, motor examination, and brain MRI at baseline (T0) and 1-year follow-up (T1). Patients were then divided according to cognitive status into MSA with normal cognition (MSA-NC) and MSA with mild cognitive impairment (MCI). At T1, we divided the sample according to worsening/non worsening of cognitive status compared to baseline evaluation. Logistic regression analysis showed that age (β = - 9.45, p = .02) and T1w/T2w value in the left putamen (β = 230.64, p = .01) were significant predictors of global cognitive status at T0, explaining 65% of the variance. Logistic regression analysis showed that ∆-values of WM density in the cerebellum/brainstem (β = 2188.70, p = .02) significantly predicted cognitive worsening at T1, explaining 64% of the variance. Our results suggest a role for the putamen and cerebellum in the cognitive changes of MSA, probably due to their connections with the cortex. The putaminal T1w/T2w ratio may deserve further studies as a marker of cognitive impairment in MSA.
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Affiliation(s)
- Sofia Cuoco
- Center for Neurodegenerative Diseases (CEMAND), Department of Medicine, Surgery and Dentistry, Neuroscience Section, University of Salerno, 84131, Salerno, Italy
| | - Sara Ponticorvo
- Center for Neurodegenerative Diseases (CEMAND), Department of Medicine, Surgery and Dentistry, Neuroscience Section, University of Salerno, 84131, Salerno, Italy
| | - Rossella Bisogno
- Center for Neurodegenerative Diseases (CEMAND), Department of Medicine, Surgery and Dentistry, Neuroscience Section, University of Salerno, 84131, Salerno, Italy
| | - Renzo Manara
- Neuroradiology Unit, Department of Neurosciences, University of Padua, 35128, Padua, Italy
| | - Fabrizio Esposito
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli, Napoli, Italy
| | - Gianfranco Di Salle
- Scuola Superiore Di Studi Universitari E Perfezionamento Sant'Anna, Classe Di Scienze Sperimentali, Pisa, Italy
| | - Francesco Di Salle
- Center for Neurodegenerative Diseases (CEMAND), Department of Medicine, Surgery and Dentistry, Neuroscience Section, University of Salerno, 84131, Salerno, Italy
| | - Marianna Amboni
- Center for Neurodegenerative Diseases (CEMAND), Department of Medicine, Surgery and Dentistry, Neuroscience Section, University of Salerno, 84131, Salerno, Italy
| | - Roberto Erro
- Center for Neurodegenerative Diseases (CEMAND), Department of Medicine, Surgery and Dentistry, Neuroscience Section, University of Salerno, 84131, Salerno, Italy
| | - Marina Picillo
- Center for Neurodegenerative Diseases (CEMAND), Department of Medicine, Surgery and Dentistry, Neuroscience Section, University of Salerno, 84131, Salerno, Italy
| | - Paolo Barone
- Center for Neurodegenerative Diseases (CEMAND), Department of Medicine, Surgery and Dentistry, Neuroscience Section, University of Salerno, 84131, Salerno, Italy
| | - Maria Teresa Pellecchia
- Center for Neurodegenerative Diseases (CEMAND), Department of Medicine, Surgery and Dentistry, Neuroscience Section, University of Salerno, 84131, Salerno, Italy.
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Kim J, Kwon D, Kim SS, Lee K, Yoon H. Measurement of brainstem diameter in small-breed dogs using magnetic resonance imaging. Front Vet Sci 2023; 10:1183412. [PMID: 37519998 PMCID: PMC10374218 DOI: 10.3389/fvets.2023.1183412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 06/27/2023] [Indexed: 08/01/2023] Open
Abstract
Measurement of brainstem diameters (midbrain, pons, and medulla oblongata)is of potential clinical significance, as changes in brainstem size may decrease or increase due to age, neurodegenerative disorders, or neoplasms. In human medicine, numerous studies have reported the normal reference range of brainstem size, which is hitherto unexplored in veterinary medicine, particularly for small-breed dogs. Therefore, this study aims to investigate the reference range of brainstem diameters in small-breed dogs and to correlate the measurements with age, body weight (BW), and body condition score (BCS). Herein, magnetic resonance (MR) images of 544 small-breed dogs were evaluated. Based on the exclusion criteria, 193 dogs were included in the midbrain and pons evaluation, and of these, 119 dogs were included in the medulla oblongata evaluation. Using MR images, the height and width of the midbrain, pons, and medulla oblongata were measured on the median and transverse plane on the T1-weighted image. For the medulla oblongata, two points were measured for each height and width. The mean values of midbrain height (MH), midbrain width (MW), pons height (PH), pons width (PW), medulla oblongata height at the fourth ventricle level (MOHV), medulla oblongata height at the cervicomedullary (CM) junction level (MOHC), rostral medulla oblongata width (RMOW), and caudal medulla oblongata width (CMOW) were 7.18 ± 0.56 mm, 17.42 ± 1.21 mm, 9.73 ± 0.64 mm, 17.23 ± 1.21 mm, 6.06 ± 0.53 mm, 5.77 ± 0.40 mm, 18.93 ± 1.25 mm, and 10.12 ± 1.08 mm, respectively. No significant differences were found between male and female dogs for all the measurements. A negative correlation was found between age and midbrain diameter, including MH (p < 0.001) and MW (p = 0.002). All brainstem diameters were correlated positively with BW (p < 0.05). No significant correlation was found between BCS and all brainstem diameters. Brainstem diameters differed significantly between breeds (p < 0.05), except for MW (p = 0.137). This study assessed linear measurements of the brainstem diameter in small-breed dogs. We suggest that these results could be useful in assessing abnormal conditions of the brainstem in small-breed dogs.
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Affiliation(s)
- Jihyun Kim
- Department of Veterinary Medical Imaging, College of Veterinary Medicine, Jeonbuk National University, Iksan, Republic of Korea
| | - Danbee Kwon
- Bundang Leaders Animal Medical Center, Seongnam-si, Republic of Korea
| | - Sung-Soo Kim
- VIP Animal Medical Center, Seoul, Republic of Korea
| | - Kichang Lee
- Department of Veterinary Medical Imaging, College of Veterinary Medicine, Jeonbuk National University, Iksan, Republic of Korea
| | - Hakyoung Yoon
- Department of Veterinary Medical Imaging, College of Veterinary Medicine, Jeonbuk National University, Iksan, Republic of Korea
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Debnath J, Sharma V, Patrikar S, Krishna S, Shijith K, Keshav RR. Normal measurements of brainstem and related structures for all ages: An MRI-based morphometric study. Med J Armed Forces India 2023; 79:428-438. [PMID: 37441300 PMCID: PMC10334237 DOI: 10.1016/j.mjafi.2022.06.002] [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: 12/21/2021] [Accepted: 06/02/2022] [Indexed: 11/18/2022] Open
Abstract
Background Knowledge of the normal size of the brain stem and certain related structures play an important role in diagnosis of aging and neurodegenerative conditions affecting the brain. There is no well-established normative data for development and age-related changes pertaining to the brain stem and related structures in the Indian context. The objective of this study was to assess various linear and angle measurements of the brain stem, cerebral peduncles, middle cerebellar peduncles, and proximal cervical cord for all ages in patients who have undergone MRI brain for unrelated pathologies. Methods A record-based retrospective cross-sectional and analytical study. T1WI axial and sagittal images were studied for the following variables: Cerebral peduncle transverse thickness, Interpeduncular angle, Middle cerebellar peduncle transverse thickness, Ventral midbrain anteroposterior thickness, Midbrain height, Mamillopontine distance (MPD), Pontomesencephalic angle (PMA), Pons anteroposterior thickness, Medulla anteroposterior thickness and Spinal cord anteroposterior diameter. Results Significant differences (p = 0.001) were observed in nearly all the variables among various age groups. Males demonstrated significantly higher mean values (at 5% level of significance) for a majority of the variables. Most of the variables measured, e.g. Cerebral peduncle, Middle cerebellar peduncle, Ventral midbrain thickness, Midbrain height, Pons, Medulla, and Spinal Cord diameter, showed a steady and sharp increase in values from infancy and reached maximum values during the third decade, followed by a variable degree of decline in values. Conclusion Magnetic Resonance Imaging (MRI) morphometry of brainstem and related structures is easily doable and is also reproducible. Present study lays down normative data for the brainstem and certain related structures for all ages, which can be referred to in day-to-day practice.
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Affiliation(s)
| | - Vivek Sharma
- Formerly Professor (Radiodiagnosis), Bharati Vidyapeeth Medical College, Pune, India
| | - Seema Patrikar
- Lecturer in Statistics & Demography, Department of Community Medicine, Armed Forces Medical College, Pune, India
| | - Shyam Krishna
- Graded Specialist (Radiology), C/o UN Mission, India
| | - K.P. Shijith
- Senior Adviser (Radiology), Army Hospital (R&R), Delhi Cantt, India
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11
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Zhang L, Hou Y, Wei Q, Ou R, Liu K, Lin J, Yang T, Xiao Y, Zhao B, Shang H. Diagnostic utility of movement disorder society criteria for multiple system atrophy. Front Aging Neurosci 2023; 15:1200563. [PMID: 37396656 PMCID: PMC10310919 DOI: 10.3389/fnagi.2023.1200563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 05/26/2023] [Indexed: 07/04/2023] Open
Abstract
Background The 2008 criteria for the diagnosis of multiple system atrophy (MSA) has been widely used for more than 10 years, but the sensitivity is low, particularly for patients in the early stage. Recently, a new MSA diagnostic criteria was developed. Objective The objective of the study was to assess and compare the diagnostic utility of the new movement disorder society (MDS) MSA criteria with the 2008 MSA criteria. Methods This study included patients diagnosed with MSA between January 2016 and October 2021. All patients underwent regular face-to-face or telephonic follow-ups every year until October 2022. A total of 587 patients (309 males and 278 females) were retrospectively reviewed to compare the diagnostic accuracy of the MDS MSA criteria to that of the 2008 MSA criteria (determined by the proportion of patients categorized as established or probable MSA). Autopsy is the gold standard diagnosis of MSA, which is not available in clinical practice. Thus, we applied the 2008 MSA criteria at the last review as the reference standard. Results The sensitivity of the MDS MSA criteria (93.2%, 95% CI = 90.5-95.2%) was significantly higher than that of the 2008 MSA criteria (83.5%, 95% CI = 79.8-86.6%) (P < 0.001). Additionally, the sensitivity of the MDS MSA criteria was maintained robustly across different subgroups, defined by diagnostic subtype, disease duration, and the type of symptom[s] at onset. Importantly, the specificities were not significantly different between the MDS MSA criteria and the 2008 MSA criteria (P > 0.05). Conclusion The present study demonstrated that the MDS MSA criteria exhibited good diagnostic utility for MSA. The new MDS MSA criteria should be considered as a useful diagnostic tool for clinical practice and future therapeutic trials.
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12
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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.
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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
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13
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Yawata T, Takagi S, Tamura T, Sugihara G, Takahashi H. Psychosis treatment in a patient with Parkinsonian type multiple system atrophy using modified electroconvulsive therapy: a case report. Psychogeriatrics 2023; 23:364-367. [PMID: 36494911 DOI: 10.1111/psyg.12923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Revised: 11/18/2022] [Accepted: 11/28/2022] [Indexed: 12/14/2022]
Affiliation(s)
- Takumi Yawata
- Department of Psychiatry and Behavioral Sciences, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan.,Saitama Prefectural Psychiatric Hospital, Saitama, Japan
| | - Shunsuke Takagi
- Department of Psychiatry and Behavioral Sciences, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Takehiro Tamura
- Department of Psychiatry and Behavioral Sciences, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Genichi Sugihara
- Department of Psychiatry and Behavioral Sciences, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Hidehiko Takahashi
- Department of Psychiatry and Behavioral Sciences, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan.,Center for Brain Integration Research, Tokyo Medical and Dental University, Tokyo, Japan
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14
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Marxreiter F, Lambrecht V, Mennecke A, Hanspach J, Jukic J, Regensburger M, Herrler J, German A, Kassubek J, Grön G, Müller HP, Laun FB, Dörfler A, Winkler J, Schmidt MA. Parkinson's disease or multiple system atrophy: potential separation by quantitative susceptibility mapping. Ther Adv Neurol Disord 2023; 16:17562864221143834. [PMID: 36846471 PMCID: PMC9950607 DOI: 10.1177/17562864221143834] [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: 04/11/2022] [Accepted: 11/08/2022] [Indexed: 02/24/2023] Open
Abstract
Background Due to the absence of robust biomarkers, and the low sensitivity and specificity of routine imaging techniques, the differential diagnosis between Parkinson's disease (PD) and multiple system atrophy (MSA) is challenging. High-field magnetic resonance imaging (MRI) opened up new possibilities regarding the analysis of pathological alterations associated with neurodegenerative processes. Recently, we have shown that quantitative susceptibility mapping (QSM) enables visualization and quantification of two major histopathologic hallmarks observed in MSA: reduced myelin density and iron accumulation in the basal ganglia of a transgenic murine model of MSA. It is therefore emerging as a promising imaging modality on the differential diagnosis of Parkinsonian syndromes. Objectives To assess QSM on high-field MRI for the differential diagnosis of PD and MSA. Methods We assessed 23 patients (nine PDs and 14 MSAs) and nine controls using QSM on 3T and 7T MRI scanners at two academic centers. Results We observed increased susceptibility in MSA at 3T in prototypical subcortical and brainstem regions. Susceptibility measures of putamen, pallidum, and substantia nigra reached excellent diagnostic accuracy to separate both synucleinopathies. Increase toward 100% sensitivity and specificity was achieved using 7T MRI in a subset of patients. Magnetic susceptibility correlated with age in all groups, but not with disease duration in MSA. Sensitivity and specificity were particularly high for possible MSA, and reached 100% in the putamen. Conclusion Putaminal susceptibility measures, in particular on ultra-high-field MRI, may distinguish MSA patients from both, PD and controls, allowing an early and sensitive diagnosis of MSA.
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Affiliation(s)
| | | | - Angelika Mennecke
- Institute of Neuroradiology, University
Hospital Erlangen, Erlangen, Germany
| | - Jannis Hanspach
- Institute of Radiology, University Hospital
Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen,
Germany
| | - Jelena Jukic
- Department of Molecular Neurology, University
Hospital Erlangen, Erlangen, Germany
| | - Martin Regensburger
- Department of Molecular Neurology, University
Hospital Erlangen, Erlangen, Germany,Center for Rare Diseases, University Hospital
Erlangen, Erlangen, Germany
| | - Juergen Herrler
- Institute of Neuroradiology, University
Hospital Erlangen, Erlangen, Germany,Institute of Radiology, University Hospital
Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen,
Germany
| | - Alexander German
- Institute of Neuroradiology, University
Hospital Erlangen, Erlangen, Germany,Institute of Radiology, University Hospital
Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen,
Germany
| | - Jan Kassubek
- Department of Neurology, Ulm University, Ulm,
Germany
| | - Georg Grön
- Department of Psychiatry and Psychotherapy
III, Ulm University, Ulm, Germany
| | | | - Frederik B. Laun
- Institute of Radiology, University Hospital
Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen,
Germany
| | - Arnd Dörfler
- Institute of Neuroradiology, University
Hospital Erlangen, Erlangen, Germany
| | - Juergen Winkler
- Department of Molecular Neurology, University
Hospital Erlangen, Erlangen, Germany,Center for Rare Diseases, University Hospital
Erlangen, Erlangen, Germany
| | - Manuel A. Schmidt
- Institute of Neuroradiology, University
Hospital Erlangen, Erlangen, Germany
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15
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Ozawa M, Sakuta K, Miyagawa S, Yaguchi H. Multiple system atrophy with anti-NAE antibody refractory to immunotherapy: A case report. Clin Neurol Neurosurg 2022; 223:107504. [DOI: 10.1016/j.clineuro.2022.107504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 10/23/2022] [Accepted: 10/28/2022] [Indexed: 11/30/2022]
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16
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Iglseder B, Lange R. [Atypical Parkinson's syndrome in old age]. Z Gerontol Geriatr 2022; 55:421-430. [PMID: 35748931 DOI: 10.1007/s00391-022-02077-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/23/2022] [Indexed: 11/29/2022]
Abstract
Atypical Parkinson syndromes represent a neuropathologically heterogeneous group and include the clinical entities dementia with Lewy bodies (DLB), multiple system atrophy (MSA), progressive supranuclear palsy (PSP), and corticobasal degeneration (CBD). The DLB and MSA are characterized by deposition of the protein alpha-synuclein (synucleinopathy), PSP and CBD are characterized by deposition of tau protein, often in the form of neurofibrillary tangles in nerve and glial cells (tauopathy). Misfolding and aggregation of the aforementioned proteins causes degeneration of the affected cell populations but the disease also spreads to anatomically neighboring brain regions, thus contributing to disease progression. The clinical characteristics (poor response to dopaminergic treatment, ataxia, apraxia, vertical gaze palsy and rapid progression) enable a differentiation from idiopathic Parkinson's disease.
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Affiliation(s)
- Bernhard Iglseder
- Uniklinikum Salzburg, Christian-Doppler-Klinik, Ignaz-Harrer-Straße 79, 5020, Salzburg, Österreich
| | - Rüdiger Lange
- Klinikum Nürnberg, Paracelsus Medizinische Privatuniversität, Breslauerstr. 201, 90471, Nürnberg, Deutschland.
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17
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Advanced brain aging in multiple system atrophy compared to Parkinson's disease. Neuroimage Clin 2022; 34:102997. [PMID: 35397330 PMCID: PMC8987993 DOI: 10.1016/j.nicl.2022.102997] [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: 12/05/2021] [Revised: 03/07/2022] [Accepted: 03/28/2022] [Indexed: 11/24/2022]
Abstract
MSA, but not PD, exhibits advanced brain aging in gray matter and white matter. Brain age of gray matter is correlated with that of white matter in PD. Brain age measures can partly reveal associations with symptom severity. Brain features underlying brain age difference between MSA and PD are identified.
Multiple system atrophy (MSA) and Parkinson’s disease (PD) belong to alpha-synucleinopathy, but they have very different clinical courses and prognoses. An imaging biomarker that can differentiate between the two diseases early in the disease course is desirable for appropriate treatment. Neuroimaging-based brain age paradigm provides an individualized marker to differentiate aberrant brain aging patterns in neurodegenerative diseases. In this study, patients with MSA (N = 23), PD (N = 33), and healthy controls (N = 34; HC) were recruited. A deep learning approach was used to estimate brain-predicted age difference (PAD) of gray matter (GM) and white matter (WM) based on image features extracted from T1-weighted and diffusion-weighted magnetic resonance images, respectively. Spatial normative models of image features were utilized to quantify neuroanatomical impairments in patients, which were then used to estimate the contributions of image features to brain age measures. For PAD of GM (GM-PAD), patients with MSA had significantly older brain age (9.33 years) than those with PD (0.75 years; P = 0.002) and HC (-1.47 years; P < 0.001), and no significant difference was found between PD and HC (P = 1.000). For PAD of WM (WM-PAD), it was significantly greater in MSA (9.27 years) than that in PD (1.90 years; P = 0.037) and HC (-0.74 years; P < 0.001); there was no significant difference between PD and HC (P = 0.087). The most salient image features that contributed to PAD in MSA and PD were different. For GM, they were the orbitofrontal regions and the cuneus in MSA and PD, respectively, and for WM, they were the central corpus callosum and the uncinate fasciculus in MSA and PD, respectively. Our results demonstrated that MSA revealed significantly greater PAD than PD, which might be related to markedly different neuroanatomical contributions to brain aging. The image features with distinct contributions to brain aging might be of value in the differential diagnosis of MSA and PD.
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18
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Ge Y, Zheng W, Li Y, Dou W, Ren S, Chen Z, Wang Z. Altered Brain Volume, Microstructure Metrics and Functional Connectivity Features in Multiple System Atrophy. Front Aging Neurosci 2022; 14:799251. [PMID: 35663568 PMCID: PMC9162384 DOI: 10.3389/fnagi.2022.799251] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 04/22/2022] [Indexed: 11/14/2022] Open
Abstract
In order to deeply understand the specific patterns of volume, microstructure, and functional changes in Multiple System Atrophy patients with cerebellar ataxia syndrome (MSA-c), we perform the current study by simultaneously applying structural (T1-weighted imaging), Diffusion tensor imaging (DTI), functional (BOLD fMRI) and extended Network-Based Statistics (extended-NBS) analysis. Twenty-nine MSA-c type patients and twenty-seven healthy controls (HCs) were involved in this study. First, we analyzed the whole brain changes of volume, microstructure, and functional connectivity (FC) in MSA-c patients. Then, we explored the correlations between significant multimodal MRI features and the total Unified Multiple System Atrophy Rating Scale (UMSARS) scores. Finally, we searched for sensitive imaging biomarkers for the diagnosis of MSA-c using support vector machine (SVM) classifier. Results showed significant grey matter atrophy in cerebellum and white matter microstructural abnormalities in cerebellum, left fusiform gyrus, right precentral gyrus and lingual gyrus. Extended-NBS analysis found two significant different connected components, featuring altered functional connectivity related to left and right cerebellar sub-regions, respectively. Moreover, the reduced fiber bundle counts at right Cerebellum_3 (Cbe3) and decreased fractional anisotropy (FA) values at bilateral Cbe9 were negatively associated with total UMSARS scores. Finally, the significant features at left Cbe9, Cbe1, and Cbe7b were found to be useful as sensitive biomarkers to differentiate MSA-c from HCs according to the SVM analysis. These findings advanced our understanding of the neural pathophysiological mechanisms of MSA from the perspective of multimodal neuroimaging.
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Affiliation(s)
- Yunxiang Ge
- Department of Electronic Engineering, Beijing National Research Center for Information Science and Technology (BNRist), Tsinghua University, Beijing, China
| | - Weimin Zheng
- Department of Radiology, Aerospace Center Hospital, Beijing, China
| | - Yujia Li
- Department of Electronic Engineering, Beijing National Research Center for Information Science and Technology (BNRist), Tsinghua University, Beijing, China
| | - Weibei Dou
- Department of Electronic Engineering, Beijing National Research Center for Information Science and Technology (BNRist), Tsinghua University, Beijing, China
- *Correspondence: Weibei Dou,
| | - Shan Ren
- Department of Neurology, Dongfang Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Zhigang Chen
- Department of Neurology, Dongfang Hospital, Beijing University of Chinese Medicine, Beijing, China
- Zhigang Chen,
| | - Zhiqun Wang
- Department of Radiology, Aerospace Center Hospital, Beijing, China
- Zhiqun Wang,
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19
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Sekiya H, Koga S, Otsuka Y, Chihara N, Ueda T, Sekiguchi K, Yoneda Y, Kageyama Y, Matsumoto R, Dickson DW. Clinical and pathological characteristics of later onset multiple system atrophy. J Neurol 2022; 269:4310-4321. [PMID: 35305144 PMCID: PMC10315173 DOI: 10.1007/s00415-022-11067-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 03/01/2022] [Accepted: 03/04/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND In the current consensus criteria, onset after age 75 is considered as non-supporting for diagnosis of multiples system atrophy (MSA); however, some MSA patients present after age 75. Clinical and pathological characteristics of such later onset MSA (LO-MSA) compared to usual onset MSA (UO-MSA) remain poorly understood. METHODS The clinical cohort included patients from Kobe University Hospital and Amagasaki General Medical Center Hospital, while the autopsy cohort was from the brain bank at Mayo Clinic Florida. We identified 83 patients in the clinical cohort and 193 patients in the autopsy cohort. We divided MSA into two groups according to age at onset: UO-MSA (≤ 75) and LO-MSA (> 75). We compared clinical features and outcomes between the two groups in the clinical cohort and compared the findings to the autopsy cohort. RESULTS LO-MSA accounted for 8% in the clinical cohort and 5% in the autopsy cohort. The median time from onset to death or to life-saving tracheostomy was significantly shorter in LO-MSA than in UO-MSA in both cohorts (4.8 vs 7.9 years in the clinical cohort and 3.9 vs 7.5 years in the autopsy cohort; P = 0.043 and P < 0.0001, respectively). The median time from diagnosis to death was less than 3 years in LO-MSA in the clinical cohort. CONCLUSIONS Some MSA patients have late age of onset and short survival, limiting time for clinical decision making. MSA should be considered in the differential diagnosis of elderly patients with autonomic symptoms and extrapyramidal and/or cerebellar syndromes.
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Affiliation(s)
- Hiroaki Sekiya
- Department of Neuroscience, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA. .,Division of Neurology, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan.
| | - Shunsuke Koga
- Department of Neuroscience, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA
| | - Yoshihisa Otsuka
- Department of Neurology, Hyogo Prefectural Amagasaki General Medical Center Hospital, Amagasaki, Hyogo, Japan
| | - Norio Chihara
- Division of Neurology, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Takehiro Ueda
- Division of Neurology, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Kenji Sekiguchi
- Division of Neurology, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Yukihiro Yoneda
- Department of Neurology, Hyogo Prefectural Amagasaki General Medical Center Hospital, Amagasaki, Hyogo, Japan
| | - Yasufumi Kageyama
- Department of Neurology, Hyogo Prefectural Amagasaki General Medical Center Hospital, Amagasaki, Hyogo, Japan
| | - Riki Matsumoto
- Division of Neurology, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Dennis W Dickson
- Department of Neuroscience, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA
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Plasma Metabolite Markers of Parkinson's Disease and Atypical Parkinsonism. Metabolites 2021; 11:metabo11120860. [PMID: 34940618 PMCID: PMC8706715 DOI: 10.3390/metabo11120860] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 11/24/2021] [Accepted: 12/06/2021] [Indexed: 01/26/2023] Open
Abstract
Differentiating between Parkinson’s disease (PD) and the atypical Parkinsonian disorders of multiple system atrophy (MSA) and progressive supranuclear palsy (PSP) is difficult clinically due to overlapping symptomatology, especially at early disease stages. Consequently, there is a need to identify metabolic markers for these diseases and to develop them into viable biomarkers. In the present investigation, solution nuclear magnetic resonance and mass spectrometry metabolomics were used to quantitatively characterize the plasma metabolomes (a total of 167 metabolites) of a cohort of 94 individuals comprising 34 PD, 12 MSA, and 17 PSP patients, as well as 31 control subjects. The distinct and statistically significant differences observed in the metabolite concentrations of the different disease and control groups enabled the identification of potential plasma metabolite markers of each disorder and enabled the differentiation between the disorders. These group-specific differences further implicate disturbances in specific metabolic pathways. The two metabolites, formic acid and succinate, were altered similarly in all three disease groups when compared to the control group, where a reduced level of formic acid suggested an effect on pyruvate metabolism, methane metabolism, and/or the kynurenine pathway, and an increased succinate level suggested an effect on the citric acid cycle and mitochondrial dysfunction.
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21
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Mortezazadeh T, Seyedarabi H, Mahmoudian B, Islamian JP. Imaging modalities in differential diagnosis of Parkinson’s disease: opportunities and challenges. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2021. [DOI: 10.1186/s43055-021-00454-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Parkinson’s disease (PD) diagnosis is yet largely based on the related clinical aspects. However, genetics, biomarkers, and neuroimaging studies have demonstrated a confirming role in the diagnosis, and future developments might be used in a pre-symptomatic phase of the disease.
Main text
This review provides an update on the current applications of neuroimaging modalities for PD diagnosis. A literature search was performed to find published studies that were involved on the application of different imaging modalities for PD diagnosis. An organized search of PubMed/MEDLINE, Embase, ProQuest, Scopus, Cochrane, and Google Scholar was performed based on MeSH keywords and suitable synonyms. Two researchers (TM and JPI) independently and separately performed the literature search. Our search strategy in each database was done by the following terms: ((Parkinson [Title/Abstract]) AND ((“Parkinsonian syndromes ”[Mesh]) OR Parkinsonism [Title/Abstract])) AND ((PET [Title/Abstract]) OR “SPECT”[Mesh]) OR ((Functional imaging, Transcranial sonography [Title/Abstract]) OR “Magnetic resonance spectroscopy ”[Mesh]). Database search had no limitation in time, and our last update of search was in February 2021. To have a comprehensive search and to find possible relevant articles, a manual search was conducted on the reference list of the articles and limited to those published in English.
Conclusion
Early diagnosis of PD could be vital for early management and adequate neuroprotection. Recent neuroimaging modalities such as SPECT and PET imaging using radiolabeled tracers, MRI, and CT are used to discover the disease. By the modalities, it is possible to early diagnose dopaminergic degeneration and also to differentiate PD from others parkinsonian syndromes, to monitor the natural progression of the disease and the effect of neuroprotective treatments on the progression. In this regard, functional imaging techniques have provided critical insights and roles on PD.
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22
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Campabadal A, Abos A, Segura B, Monte-Rubio G, Perez-Soriano A, Giraldo DM, Muñoz E, Compta Y, Junque C, Marti MJ. Differentiation of multiple system atrophy subtypes by gray matter atrophy. J Neuroimaging 2021; 32:80-89. [PMID: 34506665 DOI: 10.1111/jon.12927] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 07/30/2021] [Accepted: 08/18/2021] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND AND PURPOSE Multiple system atrophy(MSA) is a rare adult-onset synucleinopathy that can be divided in two subtypes depending on whether the prevalence of its symptoms is more parkinsonian or cerebellar (MSA-P and MSA-C, respectively). The aim of this work is to investigate the structural MRI changes able to discriminate MSA phenotypes. METHODS The sample includes 31 MSA patients (15 MSA-C and 16 MSA-P) and 39 healthy controls. Participants underwent a comprehensive motor and neuropsychological battery. MRI data were acquired with a 3T scanner (MAGNETOM Trio, Siemens, Germany). FreeSurfer was used to obtain volumetric and cortical thickness measures. A Support Vector Machine (SVM) algorithm was used to assess the classification between patients' group using cortical and subcortical structural data. RESULTS After correction for multiple comparisons, MSA-C patients had greater atrophy than MSA-P in the left cerebellum, whereas MSA-P showed reduced volume bilaterally in the pallidum and putamen. Using deep gray matter volume ratios and mean cortical thickness as features, the SVM algorithm provided a consistent classification between MSA-C and MSA-P patients (balanced accuracy 74.2%, specificity 75.0%, and sensitivity 73.3%). The cerebellum, putamen, thalamus, ventral diencephalon, pallidum, and caudate were the most contributing features to the classification decision (z > 3.28; p < .05 [false discovery rate]). CONCLUSIONS MSA-C and MSA-P with similar disease severity and duration have a differential distribution of gray matter atrophy. Although cerebellar atrophy is a clear differentiator between groups, thalamic and basal ganglia structures are also relevant contributors to distinguishing MSA subtypes.
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Affiliation(s)
- Anna Campabadal
- Medical Psychology Unit, Department of Medicine, Institute of Neuroscience, University of Barcelona, Barcelona, Spain.,Institute of Biomedical Research August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Alexandra Abos
- Medical Psychology Unit, Department of Medicine, Institute of Neuroscience, University of Barcelona, Barcelona, Spain
| | - Barbara Segura
- Medical Psychology Unit, Department of Medicine, Institute of Neuroscience, University of Barcelona, Barcelona, Spain.,Institute of Biomedical Research August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Barcelona, Spain
| | - Gemma Monte-Rubio
- Medical Psychology Unit, Department of Medicine, Institute of Neuroscience, University of Barcelona, Barcelona, Spain
| | - Alexandra Perez-Soriano
- Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Barcelona, Spain.,Movement Disorders Unit, Neurology Service, Hospital Clínic de Barcelona, Barcelona, Spain.,Institute of Neuroscience, University of Barcelona, Barcelona, Spain
| | - Darly Milena Giraldo
- Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Barcelona, Spain.,Movement Disorders Unit, Neurology Service, Hospital Clínic de Barcelona, Barcelona, Spain.,Institute of Neuroscience, University of Barcelona, Barcelona, Spain
| | - Esteban Muñoz
- Institute of Biomedical Research August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Barcelona, Spain.,Movement Disorders Unit, Neurology Service, Hospital Clínic de Barcelona, Barcelona, Spain.,Institute of Neuroscience, University of Barcelona, Barcelona, Spain
| | - Yaroslau Compta
- Institute of Biomedical Research August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Barcelona, Spain.,Movement Disorders Unit, Neurology Service, Hospital Clínic de Barcelona, Barcelona, Spain.,Institute of Neuroscience, University of Barcelona, Barcelona, Spain
| | - Carme Junque
- Medical Psychology Unit, Department of Medicine, Institute of Neuroscience, University of Barcelona, Barcelona, Spain.,Institute of Biomedical Research August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Barcelona, Spain
| | - Maria Jose Marti
- Institute of Biomedical Research August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Barcelona, Spain.,Movement Disorders Unit, Neurology Service, Hospital Clínic de Barcelona, Barcelona, Spain.,Institute of Neuroscience, University of Barcelona, Barcelona, Spain
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23
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Ebina J, Hara K, Watanabe H, Kawabata K, Yamashita F, Kawaguchi A, Yoshida Y, Kato T, Ogura A, Masuda M, Ohdake R, Mori D, Maesawa S, Katsuno M, Kano O, Sobue G. Individual voxel-based morphometry adjusting covariates in multiple system atrophy. Parkinsonism Relat Disord 2021; 90:114-119. [PMID: 34481140 DOI: 10.1016/j.parkreldis.2021.07.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 07/16/2021] [Accepted: 07/23/2021] [Indexed: 02/04/2023]
Abstract
INTRODUCTION This study aimed to evaluate whether novel individual voxel-based morphometry adjusting covariates (iVAC), such as age, sex, and total intracranial volume, could increase the accuracy of a diagnosis of multiple system atrophy (MSA) and enable the differentiation of MSA from Parkinson's disease (PD). METHODS We included 53 MSA patients (MSA-C: 33, MSA-P: 20), 53 PD patients, and 189 healthy controls in this study. All participants underwent high-resolution T1-weighted imaging (WI) and T2-WI with a 3.0-T MRI scanner. We evaluated the occurrence of significant atrophic findings in the pons/middle cerebellar peduncle (MCP) and putamen on iVAC and compared these findings with characteristic changes on T2-WI. RESULTS On iVAC, abnormal findings were observed in the pons/MCP of 96.2% of MSA patients and in the putamen of 80% of MSA patients; however, on T2-WI, they were both observed at a frequency of 60.4% in MSA patients. On iVAC, all but one MSA-P patient (98.1%) showed significant atrophic changes in the pons/MCP or putamen. By contrast, 69.8% of patients with MSA showed abnormal signal changes in the pons/MCP or putamen on T2-WI. iVAC yielded 95.0% sensitivity and 96.2% specificity for differentiating MSA-P from PD. CONCLUSION iVAC enabled us to recognize the morphological characteristics of MSA visually and with high accuracy compared to T2-WI, indicating that iVAC is a potential diagnostic screening tool for MSA.
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Affiliation(s)
- Junya Ebina
- Brain and Mind Research Center, Nagoya University, Aichi, Japan; Division of Neurology, Department of Internal Medicine, Toho University Graduate School of Medicine, Tokyo, Japan
| | - Kazuhiro Hara
- Department of Neurology, Nagoya University Graduate School of Medicine, Aichi, Japan
| | - Hirohisa Watanabe
- Brain and Mind Research Center, Nagoya University, Aichi, Japan; Department of Neurology, Fujita Health University School of Medicine, Aichi, Japan.
| | - Kazuya Kawabata
- Brain and Mind Research Center, Nagoya University, Aichi, Japan; Department of Neurology, Nagoya University Graduate School of Medicine, Aichi, Japan
| | - Fumio Yamashita
- Division of Ultrahigh-Field MRI, Institute for Biomedical Sciences, Iwate Medical University, Iwate, Japan
| | - Atsushi Kawaguchi
- Education and Research Center for Community Medicine, Faculty of Medicine, Saga University, Saga, Japan
| | - Yusuke Yoshida
- Department of Neurology, Nagoya University Graduate School of Medicine, Aichi, Japan
| | - Toshiyasu Kato
- Department of Neurology, Nagoya University Graduate School of Medicine, Aichi, Japan
| | - Aya Ogura
- Department of Neurology, Nagoya University Graduate School of Medicine, Aichi, Japan
| | - Michihito Masuda
- Department of Neurology, Nagoya University Graduate School of Medicine, Aichi, Japan
| | - Reiko Ohdake
- Brain and Mind Research Center, Nagoya University, Aichi, Japan; Department of Neurology, Fujita Health University School of Medicine, Aichi, Japan
| | - Daisuke Mori
- Brain and Mind Research Center, Nagoya University, Aichi, Japan
| | - Satoshi Maesawa
- Brain and Mind Research Center, Nagoya University, Aichi, Japan; Department of Neurosurgery, Nagoya University Graduate School of Medicine, Aichi, Japan
| | - Masahisa Katsuno
- Department of Neurology, Nagoya University Graduate School of Medicine, Aichi, Japan
| | - Osamu Kano
- Division of Neurology, Department of Internal Medicine, Toho University Graduate School of Medicine, Tokyo, Japan
| | - Gen Sobue
- Brain and Mind Research Center, Nagoya University, Aichi, Japan.
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24
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Cortese A, Curro' R, Vegezzi E, Yau WY, Houlden H, Reilly MM. Cerebellar ataxia, neuropathy and vestibular areflexia syndrome (CANVAS): genetic and clinical aspects. Pract Neurol 2021; 22:14-18. [PMID: 34389644 DOI: 10.1136/practneurol-2020-002822] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/28/2021] [Indexed: 11/04/2022]
Abstract
Cerebellar ataxia, neuropathy and vestibular areflexia syndrome (CANVAS) typically presents in middle life with a combination of neuropathy, ataxia and vestibular disease, with patients reporting progressive imbalance, oscillopsia, sensory disturbance and a dry cough. Examination identifies a sensory neuropathy or neuronopathy and bilaterally impaired vestibulo-ocular reflex. The underlying genetic basis is of biallelic AAGGG expansions in the second intron of replication factor complex subunit 1 (RFC1). The frequency and phenotype spectrum of RFC1 disease is expanding, ranging from typical CANVAS to site-restricted variants affecting the sensory nerves, cerebellum and/or the vestibular system. Given the wide phenotype spectrum of RFC1, the differential diagnosis is broad. RFC1 disease due to biallelic AAGGG expansions is probably the most common cause of recessive ataxia. The key to suspecting the disease (and prompt genetic testing) is a thorough clinical examination assessing the three affected systems and noting the presence of chronic cough.
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Affiliation(s)
- Andrea Cortese
- Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology, London, UK .,Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Riccardo Curro'
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Elisa Vegezzi
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy.,IRCCS Mondino Foundation, Pavia, Lombardia, Italy
| | - Wai Yan Yau
- Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology, London, UK
| | - Henry Houlden
- Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology, London, UK
| | - Mary M Reilly
- Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology, London, UK
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25
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Cui B, Zheng W, Ren S, Chen Z, Wang Z. Differentiation of Cerebellum-Type and Parkinson-Type of Multiple System Atrophy by Using Multimodal MRI Parameters. Front Aging Neurosci 2021; 13:687649. [PMID: 34413766 PMCID: PMC8369927 DOI: 10.3389/fnagi.2021.687649] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 06/29/2021] [Indexed: 11/13/2022] Open
Abstract
Recent studies have demonstrated the structural and functional changes in patients with multiple system atrophy (MSA). However, little is known about the different parameter changes of the most vulnerable regions in different types of MSA. In this study, we collected resting-state structure, perfusion, and patients with functional magnetic resonance imaging (fMRI) data of cerebellum-type of MSA (MSA-c) and Parkinson-type of MSA (MSA-p). First, by simultaneously using voxel-based morphology (VBM), arterial spin labeling (ASL), and amplitude of low-frequency fluctuation (ALFF), we analyzed the whole brain differences of structure, perfusion, and functional activation between patients with MSA-c and MSA-p. Second, we explored the relationships among structure, perfusion, function, and the clinical variables in patients with MSA. Finally, we extracted the MRI parameters of a specific region to separate the two groups and search for a sensitive imaging biomarker. As a result, compared with patients with MSA-p type, patients with MSA-c type showed decreased structure atrophy in several cerebella and vermis subregions, reduced perfusion in bilateral cerebellum_4_5 and vermis_4_5, and an decreased ALFF values in the right lingual gyrus (LG) and fusiform (FFG). Subsequent analyses revealed the close correlations among structure, perfusion, function, and clinical variables in both MSA-c and MSA-p. Finally, the receiver operating characteristic (ROC) analysis showed that the regional cerebral blood flow (rCBF) of bilateral cerebellum_4_5/vermis_4_5 could differentiate the two groups at a relatively high accuracy, yielding the sensitivity of 100%, specificity of 79.2%, and the area under the curve (AUC) value of 0.936. These findings have important implications for understanding the underlying neurobiology of different types of MSA and added the new evidence for the disrupted rCBF, structure, and function of MSA, which may provide the potential biomarker for accurately detecting different types of patients with MSA and new ideas for the treatment of different types of MSA in the future.
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Affiliation(s)
- Bin Cui
- Department of Radiology, Aerospace Center Hospital, Beijing, China
| | - Weimin Zheng
- Department of Radiology, Aerospace Center Hospital, Beijing, China
| | - Shan Ren
- Department of Neurology, Dongfang Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Zhigang Chen
- Department of Neurology, Dongfang Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Zhiqun Wang
- Department of Radiology, Aerospace Center Hospital, Beijing, China
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26
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Amelioration of motor and nonmotor symptoms in cortical cerebellar atrophy and multiple system atrophy-cerebellar type by inpatient rehabilitation: a retrospective study. Int J Rehabil Res 2021; 44:104-109. [PMID: 33481455 DOI: 10.1097/mrr.0000000000000455] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Sporadic spinocerebellar degenerative diseases such as multiple system atrophy (cerebellar type) and cortical cerebellar atrophy typically present with cerebellar ataxia. Multiple system atrophy is characterized by ataxia, with parkinsonism, dysautonomia and neuropsychiatric symptoms, resulting in reduced quality of life. Effects of physical rehabilitation focused on motor symptoms with ataxia in nonmultiple system atrophy patients have been reported; however, without addressing concomitant nonmotor symptoms. Here, we examined the motor, nonmotor and quality of life effects of inpatient physical rehabilitation in 15 multiple systems atrophy and nine cortical cerebellar atrophy patients without dementia. Rehabilitation involved a 4-week hospitalization with physical, occupational and speech therapy. The following assessments were conducted at admission and discharge: the scale for the assessment and rating of ataxia for ataxia; Montreal cognitive assessment for cognition, hospital anxiety and depression scale for emotion and medical outcomes study short-form for health-related quality of life. Data were analyzed for statistical significance (P < 0.05) using the Wilcoxon signed-rank test. In patients with multiple system atrophy, rehabilitation significantly improved ataxia, cognition with mild cognitive impairment (73.3%) and health-related quality of life; however, patients with depression (86.7%) showed no improvement in emotional health and quality of life. Similar effects on motor and nonmotor symptoms were observed in patients with cortical cerebellar atrophy. This suggests that inpatient rehabilitation could not only improve motor and nonmotor functions, but also the quality of life in patients with spinocerebellar degenerative disease.
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27
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Cerebellar Atrophy in Multiple System Atrophy (Cerebellar Type) and Its Implication for Network Connectivity. THE CEREBELLUM 2021; 19:636-644. [PMID: 32472475 DOI: 10.1007/s12311-020-01144-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
We sought to assess structural and functional patterns of cerebellum in multiple system atrophy (cerebellar type), and investigate the associations of structural and functional cerebellar gray matter abnormalities. We collected magnetic resonance imaging data of 18 patients with multiple system atrophy (cerebellar type) and 18 health control subjects. The gray matter loss across the motor and cognitive cerebellar territories in patients was assessed using voxel-based morphometry. And change in the connectivity between the cerebellum and large-scale cortical networks was assessed using resting-state functional MRI analysis. Furthermore, we assessed the relationship between the extent of cerebellar atrophy and reduced-activation in the cerebellar-cortical and subthalamo-cerebellar functional connectivities. We confirmed the gray matter loss across the motor and cognitive cerebellar territories in patients and found that the extent of cerebellar atrophy was correlated with decreased connectivity between the cerebellum and large-scale cortical networks, including the default, frontal parietal, and sensorimotor networks. The volume reduction in the motor cerebellum was closely associated with the clinical motor severity. A post hoc analysis showed reduced-activation in the subthalamo-cerebellar functional connectivity without the subthalamic nucleus atrophy. These results emphasized significant atrophy in the cerebellar subsystem and its association with the large-scale cortical networks in multiple system atrophy (cerebellar type), which may improve our understanding of the neural pathophysiology mechanisms of disease.
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28
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Rocha EA, Mehta N, Távora-Mehta MZP, Roncari CF, Cidrão AADL, Elias Neto J. Dysautonomia: A Forgotten Condition - Part II. Arq Bras Cardiol 2021; 116:981-998. [PMID: 34008826 PMCID: PMC8121459 DOI: 10.36660/abc.20200422] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 11/04/2020] [Indexed: 12/15/2022] Open
Affiliation(s)
- Eduardo Arrais Rocha
- Hospital Universitário Walter Cantídio da Universidade Federal do Ceará (UFC) - Programa de Pós-graduação em Ciências Cardiovasculares da Faculdade de Medicina da UFC, Fortaleza, CE - Brasil
| | - Niraj Mehta
- Universidade Federal do Paraná, Curitiba, PR - Brasil.,Clínica de Eletrofisiologia do Paraná, Curitiba, PR - Brasil
| | | | - Camila Ferreira Roncari
- Departamento de Fisiologia e Farmacologia - Faculdade de Medicina da Universidade Federal do Ceará (UFC), Fortaleza, CE - Brasil
| | - Alan Alves de Lima Cidrão
- Programa de Pós-graduação em Ciências Cardiovasculares da Faculdade de Medicina da UFC, Fortaleza, CE - Brasil
| | - Jorge Elias Neto
- Serviço de Eletrofisiologia do Vitória Apart Hospital, Vitória, ES - Brasil
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29
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Muñoz-Lopetegi A, Berenguer J, Iranzo A, Serradell M, Pujol T, Gaig C, Muñoz E, Tolosa E, Santamaría J. Magnetic resonance imaging abnormalities as a marker of multiple system atrophy in isolated rapid eye movement sleep behavior disorder. Sleep 2021; 44:5911953. [PMID: 32978947 DOI: 10.1093/sleep/zsaa089] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 04/21/2020] [Indexed: 12/12/2022] Open
Abstract
STUDY OBJECTIVES Patients with isolated rapid eye movement (REM) sleep behavior disorder (IRBD) develop Parkinson disease (PD), dementia with Lewy bodies (DLB), or multiple system atrophy (MSA). Magnetic resonance imaging (MRI) is abnormal in MSA showing abnormalities in the putamen, cerebellum, and brainstem. Our objective was to evaluate the usefulness of MRI to detect MRI abnormalities in IRBD and predict development of MSA and not PD and DLB. METHODS In IRBD patients that eventually developed PD, DLB, and MSA, we looked for the specific structural MRI abnormalities described in manifest MSA (e.g. hot cross-bun sign, putaminal rim, and cerebellar atrophy). We compared the frequency of these MRI changes among groups of converters (PD, DLB, and MSA) and analyzed their ability to predict development of MSA. The clinical and radiological features of the IRBD patients that eventually converted to MSA are described in detail. RESULTS A total of 61 IRBD patients who underwent MRI phenoconverted to PD (n = 30), DLB (n = 26), and MSA (n = 5) after a median follow-up of 2.4 years from neuroimaging. MRI changes typical of MSA were found in four of the five (80%) patients who converted to MSA and in three of the 56 (5.4%) patients who developed PD or DLB. MRI changes of MSA had sensitivity of 80.0%, specificity of 94.6%, positive likelihood ratio of 14.9 (95% CI 4.6-48.8), and negative likelihood ratio of 0.2 (95% CI 0.04-1.2) to predict MSA. CONCLUSIONS In IRBD, conventional brain MRI is helpful to predict conversion to MSA. The specific MRI abnormalities of manifest MSA may be detected in its premotor stage.
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Affiliation(s)
- Amaia Muñoz-Lopetegi
- Center for Sleep Disorders, Neurology Service, Universitat de Barcelona, IDIBAPS, CIBERNED:CB06/05/0018-ISCIII, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Joan Berenguer
- Radiology Service, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Alex Iranzo
- Center for Sleep Disorders, Neurology Service, Universitat de Barcelona, IDIBAPS, CIBERNED:CB06/05/0018-ISCIII, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Monica Serradell
- Center for Sleep Disorders, Neurology Service, Universitat de Barcelona, IDIBAPS, CIBERNED:CB06/05/0018-ISCIII, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Teresa Pujol
- Radiology Service, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Carles Gaig
- Center for Sleep Disorders, Neurology Service, Universitat de Barcelona, IDIBAPS, CIBERNED:CB06/05/0018-ISCIII, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Esteban Muñoz
- Movement Disorders Unit, Neurology Service, Hospital Clínic de Barcelona, IDIBAPS, CIBERNED:CB06/05/0018-ISCIII, Barcelona, Spain
| | - Eduard Tolosa
- Movement Disorders Unit, Neurology Service, Hospital Clínic de Barcelona, IDIBAPS, CIBERNED:CB06/05/0018-ISCIII, Barcelona, Spain
| | - Joan Santamaría
- Center for Sleep Disorders, Neurology Service, Universitat de Barcelona, IDIBAPS, CIBERNED:CB06/05/0018-ISCIII, Hospital Clínic de Barcelona, Barcelona, Spain
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30
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Soni N, Ora M, Bathla G, Nagaraj C, Boles Ponto LL, Graham MM, Saini J, Menda Y. Multiparametric magnetic resonance imaging and positron emission tomography findings in neurodegenerative diseases: Current status and future directions. Neuroradiol J 2021; 34:263-288. [PMID: 33666110 DOI: 10.1177/1971400921998968] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Neurodegenerative diseases (NDDs) are characterized by progressive neuronal loss, leading to dementia and movement disorders. NDDs broadly include Alzheimer's disease, frontotemporal lobar degeneration, parkinsonian syndromes, and prion diseases. There is an ever-increasing prevalence of mild cognitive impairment and dementia, with an accompanying immense economic impact, prompting efforts aimed at early identification and effective interventions. Neuroimaging is an essential tool for the early diagnosis of NDDs in both clinical and research settings. Structural, functional, and metabolic imaging modalities, including magnetic resonance imaging (MRI) and positron emission tomography (PET), are widely available. They show encouraging results for diagnosis, monitoring, and treatment response evaluation. The current review focuses on the complementary role of various imaging modalities in relation to NDDs, the qualitative and quantitative utility of newer MRI techniques, novel radiopharmaceuticals, and integrated PET/MRI in the setting of NDDs.
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Affiliation(s)
- Neetu Soni
- University of Iowa Hospitals and Clinics, USA
| | - Manish Ora
- Department of Nuclear Medicine, SGPGIMS, India
| | - Girish Bathla
- Neuroradiology Department, University of Iowa Hospitals and Clinics, USA
| | - Chandana Nagaraj
- Department of Neuro Imaging and Interventional Radiology, NIMHANS, India
| | | | - Michael M Graham
- Division of Nuclear Medicine, University of Iowa Hospitals and Clinics, USA
| | - Jitender Saini
- Department of Neuro Imaging and Interventional Radiology, NIMHANS, India
| | - Yusuf Menda
- University of Iowa Hospitals and Clinics, USA
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31
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Zafarullah M, Durbin-Johnson B, Fourie ES, Hessl DR, Rivera SM, Tassone F. Metabolomic Biomarkers Are Associated With Area of the Pons in Fragile X Premutation Carriers at Risk for Developing FXTAS. Front Psychiatry 2021; 12:691717. [PMID: 34483988 PMCID: PMC8415564 DOI: 10.3389/fpsyt.2021.691717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 07/21/2021] [Indexed: 11/22/2022] Open
Abstract
Fragile X-associated tremor/ataxia syndrome (FXTAS) is a late adult-onset neurodegenerative disorder that affects movement and cognition in male and female carriers of a premutation allele (55-200 CGG repeats; PM) in the fragile X mental retardation (FMR1) gene. It is currently unknown how the observed brain changes are associated with metabolic signatures in individuals who develop the disorder over time. The primary objective of this study was to investigate the correlation between longitudinal changes in the brain (area of the pons, midbrain, and MCP width) and the changes in the expression level of metabolic biomarkers of early diagnosis and progression of FXTAS in PM who, as part of an ongoing longitudinal study, emerged into two distinct categories. These included those who developed symptoms of FXTAS (converters, CON) at subsequent visits and those who did not meet the criteria of diagnosis (non-converters, NCON) and were compared to age-matched healthy controls (HC). We assessed CGG repeat allele size by Southern Blot and PCR analysis. Magnetic Resonance Imaging (MRIs) acquisition was obtained on a 3T Siemens Trio scanner and metabolomic profile was obtained by ultra-performance liquid chromatography, accurate mass spectrometer, and an Orbitrap mass analyzer. Our findings indicate that differential metabolite levels are linked with the area of the pons between healthy control and premutation groups. More specifically, we observed a significant association of ceramides and mannonate metabolites with a decreased area of the pons, both at visit 1 (V1) and visit 2 (V2) only in the CON as compared to the NCON group suggesting their potential role in the development of the disorder. In addition, we found a significant correlation of these metabolic signatures with the FXTAS stage at V2 indicating their contribution to the progression and pathogenesis of FXTAS. Interestingly, these metabolites, as part of lipid and sphingolipid lipids pathways, provide evidence of the role that their dysregulation plays in the development of FXTAS and inform us as potential targets for personalized therapeutic development.
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Affiliation(s)
- Marwa Zafarullah
- Department of Biochemistry and Molecular Medicine, University of California, Davis, School of Medicine, Sacramento, CA, United States
| | - Blythe Durbin-Johnson
- Division of Biostatistics, School of Medicine, University of California, Davis, Davis, CA, United States
| | - Emily S Fourie
- Center for Mind and Brain, University of California, Davis, Davis, CA, United States.,Department of Psychology, University of California, Davis, Davis, CA, United States
| | - David R Hessl
- MIND Institute, University of California, Davis Medical Center, Sacramento, CA, United States.,Department of Psychiatry and Behavioral Sciences, University of California, Davis Medical Center, Sacramento, CA, United States
| | - Susan M Rivera
- Center for Mind and Brain, University of California, Davis, Davis, CA, United States.,Department of Psychology, University of California, Davis, Davis, CA, United States.,MIND Institute, University of California, Davis Medical Center, Sacramento, CA, United States
| | - Flora Tassone
- Department of Biochemistry and Molecular Medicine, University of California, Davis, School of Medicine, Sacramento, CA, United States.,MIND Institute, University of California, Davis Medical Center, Sacramento, CA, United States
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32
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Kwon KY, Lee M, Ju H, Im K. Diagnostic usefulness of putaminal abnormality on diffusion- and susceptibility-weighted imaging: two illustrative cases of multiple system atrophy-parkinsonian type. Neurol Sci 2020; 42:1211-1213. [PMID: 33025326 DOI: 10.1007/s10072-020-04770-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Accepted: 09/25/2020] [Indexed: 10/23/2022]
Affiliation(s)
- Kyum-Yil Kwon
- Department of Neurology, Soonchunhyang University Seoul Hospital, College of Medicine, Soonchunhyang University, 59 Daesagwan-ro, Yongsan-gu, Seoul, 04401, Republic of Korea.
| | - Mina Lee
- Department of Neurology, Soonchunhyang University Seoul Hospital, College of Medicine, Soonchunhyang University, 59 Daesagwan-ro, Yongsan-gu, Seoul, 04401, Republic of Korea
| | - Hyunjin Ju
- Department of Neurology, Soonchunhyang University Seoul Hospital, College of Medicine, Soonchunhyang University, 59 Daesagwan-ro, Yongsan-gu, Seoul, 04401, Republic of Korea
| | - Kayeong Im
- Department of Neurology, Soonchunhyang University Seoul Hospital, College of Medicine, Soonchunhyang University, 59 Daesagwan-ro, Yongsan-gu, Seoul, 04401, Republic of Korea
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Abstract
Multiple system atrophy (MSA) is a progressive neurodegenerative disease variably associated with motor, nonmotor, and autonomic symptoms, resulting from putaminal and cerebellar degeneration and associated with glial cytoplasmic inclusions enriched with α-synuclein in oligodendrocytes and neurons. Although symptomatic treatment of MSA can provide significant improvements in quality of life, the benefit is often partial, limited by adverse effects, and fails to treat the underlying cause. Consistent with the multisystem nature of the disease and evidence that motor symptoms, autonomic failure, and depression drive patient assessments of quality of life, treatment is best achieved through a coordinated multidisciplinary approach driven by the patient's priorities and goals of care. Research into disease-modifying therapies is ongoing with a particular focus on synuclein-targeted therapies among others. This review focuses on both current management and emerging therapies for this devastating disease.
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Affiliation(s)
- Matthew R. Burns
- Norman Fixel Institute for Neurological Diseases at UFHealth, Movement Disorders Division, Department of Neurology, University of Florida, 3009 SW Williston Rd, Gainesville, FL 32608 USA
| | - Nikolaus R. McFarland
- Norman Fixel Institute for Neurological Diseases at UFHealth, Movement Disorders Division, Department of Neurology, University of Florida, 3009 SW Williston Rd, Gainesville, FL 32608 USA
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34
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Jiang J, Wang J, Lin M, Wang X, Zhao J, Shang X. Bilateral middle cerebellar peduncle lesions: Neuroimaging features and differential diagnoses. Brain Behav 2020; 10:e01778. [PMID: 32755074 PMCID: PMC7559600 DOI: 10.1002/brb3.1778] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 07/16/2020] [Accepted: 07/19/2020] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVES Lesions limited to the bilateral middle cerebellar peduncles (MCPs) are uncommon. This retrospective study investigated diseases with a proclivity for the bilateral MCPs and explored the associations between their neuroimaging features and clinical findings for the differential diagnosis of such lesions. METHODS We enrolled 26 patients who were admitted to our department between January 2016 and March 2019 with bilateral MCP abnormalities on magnetic resonance imaging (MRI). The demographic, clinical, and neuroimaging characteristics, and the biomarkers and diagnoses were evaluated. RESULTS Although all patients exhibited symmetrical bilateral MCP hypointensities on T1-weighted imaging and hyperintensities on T2-weighted and fluid-attenuated inversion recovery imaging, they were diagnosed with different conditions. Diagnoses included acute cerebral infarction (ACI) (n = 9, 34.62%), Wallerian degeneration (WD) (n = 8, 30.77%), multiple system atrophy (MSA) (n = 6, 23.08%), neuromyelitis optica (NMO) (n = 1, 3.85%), heroin-induced leukoencephalopathy (n = 1, 3.85%), and primary central nervous system lymphoma (PCNSL) (n = 1, 3.85%). Patients with ACI exhibited bilateral MCP-restricted diffusion hyperintensities on diffusion-weighted imaging and corresponding stenosis or occlusion of the vertebrobasilar system. The initial MRI of patients with WD depicted pontine infarctions, while symmetrical MCP lesions were observed on follow-up MRI. Symmetrical MCP lesions, cruciform hyperintensity, and marked atrophy in the posterior fossa were characteristic manifestations of MSA. Longitudinally extensive myelitis affecting more than three vertebral segments on cervical MRI and positive serum AQP4-IgG may be indicative of NMO. Heroin-induced leukoencephalopathy was characterized by extra-symmetrical lesions in the posterior limbs of the internal capsules, while the anterior limbs were spared. PCNSL was indicated by a significant and characteristic "fist" sign on contrast-enhanced MRI. CONCLUSIONS Bilateral MCP lesions were most frequently observed in cerebrovascular diseases, followed by neurodegenerative diseases, inflammatory diseases, toxic encephalopathies, and lymphomas. Our findings demonstrate that bilateral MCP signal abnormalities are more common in patients with ACI and WD, with fewer degenerative processes than previously believed. The high frequency of WD may be attributed to the specific awareness of this pathology. WD can also present with stage-related restricted diffusion and should not be mistaken for a new infarction. The symmetrical bilateral MCP hypointensities on T1-weighted imaging and hyperintensities on T2-weighted imaging often raise concern regarding a demyelinating process. Our findings emphasize that neurologists should consider the aforementioned conditions and correlate the specific neuroimaging characteristics and medical history before arriving at the final diagnosis.
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Affiliation(s)
- Jiwei Jiang
- Department of Neurology, The First Affiliated Hospital of China Medical University, Shenyang City, Liaoning Province, China
| | - Jirui Wang
- Department of Neurology, The First Affiliated Hospital of China Medical University, Shenyang City, Liaoning Province, China
| | - Meiqing Lin
- Department of Neurology, The First Affiliated Hospital of China Medical University, Shenyang City, Liaoning Province, China
| | - Xiaoting Wang
- Department of Neurology, The First Affiliated Hospital of China Medical University, Shenyang City, Liaoning Province, China
| | - Jinli Zhao
- Department of Radiology, The First Affiliated Hospital of China Medical University, Shenyang City, Liaoning Province, China
| | - Xiuli Shang
- Department of Neurology, The First Affiliated Hospital of China Medical University, Shenyang City, Liaoning Province, China
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Cheng L, Wu X, Guo R, Wang Y, Wang W, He P, Lin H, Shen J. Discriminative pattern of reduced cerebral blood flow in Parkinson's disease and Parkinsonism-Plus syndrome: an ASL-MRI study. BMC Med Imaging 2020; 20:78. [PMID: 32660445 PMCID: PMC7359235 DOI: 10.1186/s12880-020-00479-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Accepted: 07/06/2020] [Indexed: 11/16/2022] Open
Abstract
Background Accurate identification of Parkinson’s disease (PD) and Parkinsonism-Plus syndrome (PPS), especially in the early stage of the disease, is very important. The purpose of this study was to investigate the discriminative spatial pattern of cerebral blood flow (CBF) between patients with PD and PPS. Methods Arterial spin labeling (ASL) perfusion-weighted imaging was performed in 20 patients with PD (mean age 56.35 ± 7.56 years), 16 patients with PPS (mean age 59.62 ± 6.89 years), and 17 healthy controls (HCs, mean age 54.17 ± 6.58 years). Voxel-wise comparison of the CBF was performed among PD, PPS, and HC groups. The receiver operating characteristic (ROC) curve was used to evaluate the performance of CBF in discriminating between PD and PPS. The relationship between CBF and non-motor neuropsychological scores was assessed by correlation analysis. Results PD group showed a significantly decreased CBF in the right cerebelum_crus2, the left middle frontal gyrus (MFG), the triangle inferior frontal gyrus (IFG_Tri), the left frontal medial orbital gyrus (FG_Med_Orb) and the left caudate nucleus (CN) compared with the HC group (P < 0.05). Besides the above regions, the left supplementary motor area (SMA), the right thalamus had decreased CBF in the PPS group compared with the HC group (P < 0.05). PPS group had lower CBF value in the left MFG, the left IFG_Tri, the left CN, the left SMA, and the right thalamus compared with the PD group (P < 0.05). CBFs in left IFG_Tri, the left CN, the left SMA, and the right thalamus had moderate to high capacity in discriminating between PD and PPS patients (AUC 0.719–0.831). The CBF was positively correlated with the Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) scores in PD patients, while positively correlated with the MMSE, Hamilton Anxiety Scale (HAMA), Hamilton Depression Scale (HAMD) scores in PPS patients (P < 0.05). Conclusion PD and PPS patients have certain discriminative patterns of reduced CBFs, which can be used as a surrogate marker for differential diagnosis.
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Affiliation(s)
- Lina Cheng
- Department of Radiology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, 510120, China.,Department of Radiology, Guangdong 999 Brain Hospital, Guangzhou, 510510, China
| | - Xiaoyan Wu
- Department of Radiology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, 510120, China
| | - Ruomi Guo
- Department of Radiology, The Third Affiliated Hospital, Sun Yat-Sen University, Guangzhou, 510630, China
| | - Yuzhou Wang
- Department of Neurology, Guangdong 999 Brain Hospital, Guangzhou, 510510, China
| | - Wensheng Wang
- Department of Radiology, Guangdong 999 Brain Hospital, Guangzhou, 510510, China
| | - Peng He
- Department of Radiology, Guangdong 999 Brain Hospital, Guangzhou, 510510, China
| | - Hanbo Lin
- Department of Radiology, Guangdong 999 Brain Hospital, Guangzhou, 510510, China
| | - Jun Shen
- Department of Radiology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, 510120, China.
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Yue T, Lu H, Yao XM, Du X, Wang LL, Guo DD, Liu YM. Elevated serum growth differentiation factor 15 in multiple system atrophy patients: A case control study. World J Clin Cases 2020; 8:2473-2483. [PMID: 32607324 PMCID: PMC7322433 DOI: 10.12998/wjcc.v8.i12.2473] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 05/09/2020] [Accepted: 05/12/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Multiple system atrophy (MSA) is a serious progressive neurodegenerative disease. Early diagnosis of MSA is very difficult, and diagnostic biomarkers are limited. Growth differentiation factor 15 (GDF15) is involved in the differentiation and progression of the central nervous system, and is widely distributed in peripheral blood, which may be a novel biomarker for MSA.
AIM To determine serum GDF15 levels, related factors and their potential diagnostic value in MSA patients, compared with Parkinson’s disease (PD) patients and healthy controls.
METHODS A case-control study was conducted, including 49 MSA patients, 50 PD patients and 50 healthy controls. Serum GDF15 levels were measured by human enzyme-linked immunosorbent assay, and the differences between the MSA, PD and control groups were analyzed. Further investigations were performed in different MSA subgroups according to age of onset, sex, clinical subtypes, diagnostic criteria, and disease duration. Receiver-operating characteristic curve analysis was used to evaluate the diagnostic value of GDF15, especially for the differential diagnosis between MSA and PD.
RESULTS Serum GDF15 levels were significantly higher in MSA patients than in PD patients and healthy controls (P = 0.000). Males and those with a disease duration of more than three years showed higher serum GDF15 levels (P = 0.043 and 0.000; respectively). Serum GDF15 levels may be a potential diagnostic biomarker for MSA patients compared with healthy controls and PD patients (cutoff: 470.42 pg/mL, sensitivity: 85.7%, specificity: 88.0%; cutoff: 1075.91 pg/mL, sensitivity: 51.0%, specificity: 96.0%; respectively).
CONCLUSION Serum GDF15 levels are significantly higher in MSA patients and provide suggestions on the etiology of MSA.
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Affiliation(s)
- Tao Yue
- Department of Neurology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan 250012, Shandong Province, China
- Department of Gerontology, Zibo Central Hospital, Zibo 255036, Shandong Province, China
| | - Hui Lu
- Department of Ophthalmology, Zibo Central Hospital, Zibo 255036, Shandong Province, China
| | - Xiao-Mei Yao
- Department of Gerontology, Jinan Central Hospital, Cheeloo College of Medicine, Shandong University, Jinan 250013, Shandong Province, China
| | - Xia Du
- Department of Neurology, Jinan Central Hospital Affiliated to Shandong University, Jinan 250013, Shandong Province, China
| | - Ling-Ling Wang
- Department of Neurology, Yantaishan Hospital, Yantai 264001, Shandong Province, China
| | - Dan-Dan Guo
- Department of Neurology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan 250012, Shandong Province, China
| | - Yi-Ming Liu
- Department of Neurology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan 250012, Shandong Province, China
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Tsukita K, Tachibana N, Hamano T. Appropriate assessment method of 123I-MIBG myocardial scintigraphy for the diagnosis of Lewy body diseases and idiopathic REM sleep behavior disorder. J Neurol 2020; 267:3248-3257. [DOI: 10.1007/s00415-020-09992-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 06/09/2020] [Accepted: 06/10/2020] [Indexed: 02/07/2023]
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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.
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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
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Parkinsonism in neurodegenerative diseases predominantly presenting with ataxia. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2019; 149:277-298. [PMID: 31779816 DOI: 10.1016/bs.irn.2019.10.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
The number of molecularly defined degenerative ataxia diseases is rapidly increasing, many of them involving complex multisystemic presentations including parkinsonism. The increasing number of novel ataxia genes -with most of them being ultra-rare - often makes it difficult for clinicians and scientists to identify the molecular diagnosis underlying these ataxia-parkinsonism syndromes. Here we aim to provide an overview on the most frequent diseases and molecular causes underlying ataxia-parkinsonism, focusing both on novel aspects of well-known causes of ataxia-parkinsonism (MSA-C, PSP-C, FXTAS, repeat-expansion spinocerebellar ataxias [SCAs], conventional mutation SCAs) as well as on more recently identified rare genetic causes of ataxia-parkinsonism (AT, POLG, SPG7). We demonstrate that frequency data and phenotype characteristics help to guide diagnostics in patients with unexplained ataxia-parkinsonism, while the newly identified rare genetic causes of ataxia-parkinsonism provide novel insights into molecular key pathways underlying the shared vulnerability of cerebellar and basal ganglia neurons.
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Cognitive impairment and structural brain damage in multiple system atrophy-parkinsonian variant. J Neurol 2019; 267:87-94. [DOI: 10.1007/s00415-019-09555-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 09/19/2019] [Accepted: 09/23/2019] [Indexed: 10/25/2022]
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Zheng W, Ren S, Zhang H, Liu M, Zhang Q, Chen Z, Wang Z. Spatial Patterns of Decreased Cerebral Blood Flow and Functional Connectivity in Multiple System Atrophy (Cerebellar-Type): A Combined Arterial Spin Labeling Perfusion and Resting State Functional Magnetic Resonance Imaging Study. Front Neurosci 2019; 13:777. [PMID: 31417345 PMCID: PMC6685442 DOI: 10.3389/fnins.2019.00777] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Accepted: 07/10/2019] [Indexed: 01/03/2023] Open
Abstract
Multiple system atrophy (MSA) is a progressive neurodegenerative disease. However, little is known about the regional cerebral blood flow (rCBF) and functional connectivity changes in the disease. In this study, the magnetic resonance imaging (MRI) data including 24MSA-c-type patients and 20 healthy controls were collected by using voxel wise arterial spin labeling (ASL) perfusion analysis, several regions of the altered rCBF were identified in the MSA c-type patients. And then, the changes of the functional connectivities of identified rCBF regions were analyzed by using functional MRI (fMRI). Finally, rCBF value of cerebellum was extracted to differentiate the MSA c-type patients and controls. Compared with the controls, the MSA c-type patients showed distinct disruption of rCBF in the cerebellum. The disconnection of the identified cerebellar regions was revealed in several regions in the MSAc-type patients, including right middle frontal gyrus (MFG), right precuneus, left superior temporal gyrus (STG), right lingual gyrus, left postcentral gyrus (PoCG), right cerebellum 7b, right cerebellum 8, and left cerebellum 4,5. These regions were involved in the default mode network (DMN), sensorimotor network, visual associated cortices, and cerebellum. Using the rCBF value of vermis as biomarker, the two groups can be differentiated and reached a sensitivity of 95.8% and specificity of 100%. This is the first study to demonstrate the MSA-specific rCBF abnormalities using the ASL method, which are closely associated with several functional networks on resting state fMRI. The rCBF of vermis might be used as the potential imaging biomarker for the early diagnosis of MSA c-type.
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Affiliation(s)
- Weimin Zheng
- Department of Radiology, Aerospace Center Hospital, Beijing, China
| | - Shan Ren
- Department of Neurology, Dongfang Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Hao Zhang
- Department of Radiology, Dongfang Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Ming Liu
- Department of Radiology, Dongfang Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Qiuhuan Zhang
- Department of Radiology, Dongfang Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Zhigang Chen
- Department of Neurology, Dongfang Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Zhiqun Wang
- Department of Radiology, Aerospace Center Hospital, Beijing, China
- Department of Radiology, Dongfang Hospital, Beijing University of Chinese Medicine, Beijing, China
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