1
|
Büeler S, Freund P, Kessler TM, Liechti MD, David G. Improved inter-subject alignment of the lumbosacral cord for group-level in vivo gray and white matter assessments: A scan-rescan MRI study at 3T. PLoS One 2024; 19:e0301449. [PMID: 38626171 PMCID: PMC11020367 DOI: 10.1371/journal.pone.0301449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 03/15/2024] [Indexed: 04/18/2024] Open
Abstract
INTRODUCTION Magnetic resonance imaging (MRI) enables the investigation of pathological changes in gray and white matter at the lumbosacral enlargement (LSE) and conus medullaris (CM). However, conducting group-level analyses of MRI metrics in the lumbosacral spinal cord is challenging due to variability in CM length, lack of established image-based landmarks, and unknown scan-rescan reliability. This study aimed to improve inter-subject alignment of the lumbosacral cord to facilitate group-level analyses of MRI metrics. Additionally, we evaluated the scan-rescan reliability of MRI-based cross-sectional area (CSA) measurements and diffusion tensor imaging (DTI) metrics. METHODS Fifteen participants (10 healthy volunteers and 5 patients with spinal cord injury) underwent axial T2*-weighted and diffusion MRI at 3T. We assessed the reliability of spinal cord and gray matter-based landmarks for inter-subject alignment of the lumbosacral cord, the inter-subject variability of MRI metrics before and after adjusting for the CM length, the intra- and inter-rater reliability of CSA measurements, and the scan-rescan reliability of CSA measurements and DTI metrics. RESULTS The slice with the largest gray matter CSA as an LSE landmark exhibited the highest reliability, both within and across raters. Adjusting for the CM length greatly reduced the inter-subject variability of MRI metrics. The intra-rater, inter-rater, and scan-rescan reliability of MRI metrics were the highest at and around the LSE (scan-rescan coefficient of variation <3% for CSA measurements and <7% for DTI metrics within the white matter) and decreased considerably caudal to it. CONCLUSIONS To facilitate group-level analyses, we recommend using the slice with the largest gray matter CSA as a reliable LSE landmark, along with an adjustment for the CM length. We also stress the significance of the anatomical location within the lumbosacral cord in relation to the reliability of MRI metrics. The scan-rescan reliability values serve as valuable guides for power and sample size calculations in future longitudinal studies.
Collapse
Affiliation(s)
- Silvan Büeler
- Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | - Patrick Freund
- Spinal Cord Injury Center, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
- Department of Neurophysics, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
- UCL Queen Square Institute of Neurology, Wellcome Trust Centre for Human Neuroimaging, University College London, London, United Kingdom
| | - Thomas M. Kessler
- Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | - Martina D. Liechti
- Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | - Gergely David
- Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
- Spinal Cord Injury Center, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| |
Collapse
|
2
|
Stankovic I, Fanciulli A, Sidoroff V, Wenning GK. A Review on the Clinical Diagnosis of Multiple System Atrophy. CEREBELLUM (LONDON, ENGLAND) 2023; 22:825-839. [PMID: 35986227 PMCID: PMC10485100 DOI: 10.1007/s12311-022-01453-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/30/2022] [Indexed: 06/15/2023]
Abstract
Multiple system atrophy (MSA) is a rare, adult-onset, progressive neurodegenerative disorder with major diagnostic challenges. Aiming for a better diagnostic accuracy particularly at early disease stages, novel Movement Disorder Society criteria for the diagnosis of MSA (MDS MSA criteria) have been recently developed. They introduce a neuropathologically established MSA category and three levels of clinical diagnostic certainty including clinically established MSA, clinically probable MSA, and the research category of possible prodromal MSA. The diagnosis of clinically established and clinically probable MSA is based on the presence of cardiovascular or urological autonomic failure, parkinsonism (poorly L-Dopa-responsive for the diagnosis of clinically established MSA), and cerebellar syndrome. These core clinical features need to be associated with supportive motor and non-motor features (MSA red flags) and absence of any exclusion criteria. Characteristic brain MRI markers are required for a diagnosis of clinically established MSA. A research category of possible prodromal MSA is devised to capture patients manifesting with autonomic failure or REM sleep behavior disorder and only mild motor signs at the earliest disease stage. There is a number of promising laboratory markers for MSA that may help increase the overall clinical diagnostic accuracy. In this review, we will discuss the core and supportive clinical features for a diagnosis of MSA in light of the new MDS MSA criteria, which laboratory tools may assist in the clinical diagnosis and which major differential diagnostic challenges should be borne in mind.
Collapse
Affiliation(s)
- Iva Stankovic
- Neurology Clinic, University Clinical Center of Serbia, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | | | - Victoria Sidoroff
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Gregor K Wenning
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| |
Collapse
|
3
|
Jia S, Sun C, Zhong X, Wang K, Wang Z, Qi X, Qiu F. The High Value of External Anal- and Urethral-Sphincter Electromyography in Differential Diagnosis with MSA-P, PD, and PSP. Ann Indian Acad Neurol 2023; 26:241-246. [PMID: 37538423 PMCID: PMC10394455 DOI: 10.4103/aian.aian_496_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Revised: 02/09/2023] [Accepted: 02/16/2023] [Indexed: 08/05/2023] Open
Abstract
Objective It is a challenge to differentiate multiple system atrophy parkinsonism (MSA-P), Parkinson's disease (PD), and progressive supranuclear palsy (PSP). We aimed to explore the value of external anal-sphincter electromyography (EAS-EMG) and urethral-sphincter electromyography (US-EMG) in differential diagnosis with MSA-P, PD, and PSP. Methods A total of 149 subjects, including 27 MSA-P, 100 PD, and 22 PSP, were recruited. The average duration and amplitude of motor unit potentials (MUPs), percentage of polyphasic MUPs, amplitude during strong contraction, and recruitment pattern during maximal voluntary contraction were recorded. The differences in EAS-EMG and US-EMG results between MSA-P, PD, and PSP were analyzed. Results In EAS-EMG examination, the average duration of MUPs of MSA-P was significantly longer than that of PD and PSP; the percentage of polyphasic MUPs and the ratio of simple phase and simple-mix phase of MSA-P and PSP were significantly higher than that of PD; the amplitude during strong contraction of MSA-P was significantly lower than that of PD. In US-EMG examination, the average duration of MUPs in male MSA-P was significantly longer than that in male PD and PSP; the ratio of simple phase and simple-mix phase in male MSA-P was significantly higher than that in male PD; there was no statistical difference in US-EMG indexes between male PD and PSP male. And because only one female PSP was examined, only female MSA-P and PD were compared, the average duration of MUPs in female MSA-P was significantly longer than that in female PD; the ratio of simple phase and simple-mix phase in female MSA-P was significantly higher than that in female PD. Conclusion The average duration of MUPs and the ratio of the simple phase and simple-mix phase of EAS-EMG and US-EMG all can provide the basis for the differential diagnosis between MSA-P and PD. US-EMG can be used as a supplement to differentiate MSA-P from PD when EAS-EMG is limited. The only discriminating indicator between MSA-P and PSP seems to be the average duration of MUPs of EAS-EMG and US-EMG. There is still a lack of diagnostic electromyography indicators between PD and PSP.
Collapse
Affiliation(s)
- Shuangshuang Jia
- Navy Clinical College, The Fifth School of Clinical Medicine, Anhui Medical University, Hefei, 230032, Anhui Province, China
| | - Chenjing Sun
- Department of Neurology, The Sixth Medical Center of Chinese PLA General Hospital, Beijing 100048, China
| | - Xiaoling Zhong
- School of Medicine, South China University of Technology, Guangzhou, 510006, China
| | - Kunyu Wang
- Department of Neurology, The First Teaching Hospital of Jilin University, Changchun 130021, China
| | - Zhiwei Wang
- Department of Neurology, The Sixth Medical Center of Chinese PLA General Hospital, Beijing 100048, China
| | - Xiaokun Qi
- Department of Neurology, The Sixth Medical Center of Chinese PLA General Hospital, Beijing 100048, China
| | - Feng Qiu
- Navy Clinical College, The Fifth School of Clinical Medicine, Anhui Medical University, Hefei, 230032, Anhui Province, China
| |
Collapse
|
4
|
Peelaerts W, Mercado G, George S, Villumsen M, Kasen A, Aguileta M, Linstow C, Sutter AB, Kuhn E, Stetzik L, Sheridan R, Bergkvist L, Meyerdirk L, Lindqvist A, Gavis MLE, Van den Haute C, Hultgren SJ, Baekelandt V, Pospisilik JA, Brudek T, Aznar S, Steiner JA, Henderson MX, Brundin L, Ivanova MI, Hannan TJ, Brundin P. Urinary tract infections trigger synucleinopathy via the innate immune response. Acta Neuropathol 2023; 145:541-559. [PMID: 36991261 PMCID: PMC10119259 DOI: 10.1007/s00401-023-02562-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 02/28/2023] [Accepted: 03/13/2023] [Indexed: 03/31/2023]
Abstract
Symptoms in the urogenital organs are common in multiple system atrophy (MSA), also in the years preceding the MSA diagnosis. It is unknown how MSA is triggered and these observations in prodromal MSA led us to hypothesize that synucleinopathy could be triggered by infection of the genitourinary tract causing ɑ-synuclein (ɑSyn) to aggregate in peripheral nerves innervating these organs. As a first proof that peripheral infections could act as a trigger in MSA, this study focused on lower urinary tract infections (UTIs), given the relevance and high frequency of UTIs in prodromal MSA, although other types of infection might also be important triggers of MSA. We performed an epidemiological nested-case control study in the Danish population showing that UTIs are associated with future diagnosis of MSA several years after infection and that it impacts risk in both men and women. Bacterial infection of the urinary bladder triggers synucleinopathy in mice and we propose a novel role of ɑSyn in the innate immune system response to bacteria. Urinary tract infection with uropathogenic E. coli results in the de novo aggregation of ɑSyn during neutrophil infiltration. During the infection, ɑSyn is released extracellularly from neutrophils as part of their extracellular traps. Injection of MSA aggregates into the urinary bladder leads to motor deficits and propagation of ɑSyn pathology to the central nervous system in mice overexpressing oligodendroglial ɑSyn. Repeated UTIs lead to progressive development of synucleinopathy with oligodendroglial involvement in vivo. Our results link bacterial infections with synucleinopathy and show that a host response to environmental triggers can result in ɑSyn pathology that bears semblance to MSA.
Collapse
Affiliation(s)
- Wouter Peelaerts
- Department of Neurodegenerative Science, Parkinson's Disease Center, Van Andel Institute, Grand Rapids, MI, USA
- Laboratory for Neurobiology and Gene Therapy, Department of Neurosciences, KU Leuven, Louvain, Belgium
- Laboratory for Virology and Gene Therapy, Department of Pharmacy and Pharmaceutical Sciences, KU Leuven, Louvain, Belgium
| | - Gabriela Mercado
- Department of Neurodegenerative Science, Parkinson's Disease Center, Van Andel Institute, Grand Rapids, MI, USA
| | - Sonia George
- Department of Neurodegenerative Science, Parkinson's Disease Center, Van Andel Institute, Grand Rapids, MI, USA
| | - Marie Villumsen
- Center for Clinical Research and Disease Prevention, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - Alysa Kasen
- Department of Neurodegenerative Science, Parkinson's Disease Center, Van Andel Institute, Grand Rapids, MI, USA
| | - Miguel Aguileta
- Department of Neurodegenerative Science, Parkinson's Disease Center, Van Andel Institute, Grand Rapids, MI, USA
| | - Christian Linstow
- Department of Neurodegenerative Science, Parkinson's Disease Center, Van Andel Institute, Grand Rapids, MI, USA
| | - Alexandra B Sutter
- Department of Neurology, University of Michigan, Ann Arbor, MI, USA
- Neuroscience Graduate Program, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Emily Kuhn
- Department of Neurodegenerative Science, Parkinson's Disease Center, Van Andel Institute, Grand Rapids, MI, USA
| | - Lucas Stetzik
- Department of Neurodegenerative Science, Parkinson's Disease Center, Van Andel Institute, Grand Rapids, MI, USA
| | - Rachel Sheridan
- Flow Cytometry Core Facility, Van Andel Institute, Grand Rapids, MI, USA
| | - Liza Bergkvist
- Department of Neurodegenerative Science, Parkinson's Disease Center, Van Andel Institute, Grand Rapids, MI, USA
| | - Lindsay Meyerdirk
- Department of Neurodegenerative Science, Parkinson's Disease Center, Van Andel Institute, Grand Rapids, MI, USA
| | - Allison Lindqvist
- Department of Neurodegenerative Science, Parkinson's Disease Center, Van Andel Institute, Grand Rapids, MI, USA
| | - Martha L Escobar Gavis
- Department of Neurodegenerative Science, Parkinson's Disease Center, Van Andel Institute, Grand Rapids, MI, USA
| | - Chris Van den Haute
- Laboratory for Neurobiology and Gene Therapy, Department of Neurosciences, KU Leuven, Louvain, Belgium
- Leuven Viral Vector Core, Department of Neurosciences, KU Leuven, Louvain, Belgium
| | - Scott J Hultgren
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO, USA
| | - Veerle Baekelandt
- Laboratory for Neurobiology and Gene Therapy, Department of Neurosciences, KU Leuven, Louvain, Belgium
- Leuven Viral Vector Core, Department of Neurosciences, KU Leuven, Louvain, Belgium
| | | | - Tomasz Brudek
- Centre for Neuroscience and Stereology, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - Susana Aznar
- Centre for Neuroscience and Stereology, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - Jennifer A Steiner
- Department of Neurodegenerative Science, Parkinson's Disease Center, Van Andel Institute, Grand Rapids, MI, USA
| | - Michael X Henderson
- Department of Neurodegenerative Science, Parkinson's Disease Center, Van Andel Institute, Grand Rapids, MI, USA
| | - Lena Brundin
- Department of Neurodegenerative Science, Parkinson's Disease Center, Van Andel Institute, Grand Rapids, MI, USA
| | - Magdalena I Ivanova
- Neuroscience Graduate Program, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Biophysics Program, University of Michigan, Ann Arbor, MI, USA
| | - Tom J Hannan
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO, USA
| | - Patrik Brundin
- Department of Neurodegenerative Science, Parkinson's Disease Center, Van Andel Institute, Grand Rapids, MI, USA.
- Pharma Research and Early Development (pRED), F. Hoffmann-La Roche, Basel, Switzerland.
| |
Collapse
|
5
|
Virameteekul S, Revesz T, Jaunmuktane Z, Warner TT, De Pablo-Fernández E. Pathological Validation of the MDS Criteria for the Diagnosis of Multiple System Atrophy. Mov Disord 2023; 38:444-452. [PMID: 36606594 DOI: 10.1002/mds.29304] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 12/09/2022] [Accepted: 12/13/2022] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND The recent International Parkinson and Movement Disorder Society diagnostic criteria for multiple system atrophy (MDS-MSA) have been developed to improve diagnostic accuracy although their diagnostic properties have not been evaluated. OBJECTIVES The aims were to validate the MDS-MSA diagnostic criteria against neuropathological diagnosis and compare their diagnostic performance to previous criteria and diagnosis in clinical practice. METHODS Consecutive patients with sporadic, progressive, adult-onset parkinsonism, or cerebellar ataxia from the Queen Square Brain Bank between 2009 and 2019 were selected and divided based on neuropathological diagnosis into MSA and non-MSA. Medical records were systematically reviewed, and clinical diagnosis was documented by retrospectively applying the MDS-MSA criteria, second consensus criteria, and diagnosis according to treating clinicians at early (within 3 years of symptom onset) and final stages. Diagnostic parameters (sensitivity, specificity, positive/negative predictive value, and accuracy) were calculated using neuropathological diagnosis as gold standard and compared between different criteria. RESULTS Three hundred eighteen patients (103 MSA and 215 non-MSA) were included, comprising 248 patients with parkinsonism and 70 with cerebellar ataxia. Clinically probable MDS-MSA showed excellent sensitivity (95.1%), specificity (94.0%), and accuracy (94.3%), although their sensitivity at early stages was modest (62.1%). Clinically probable MDS-MSA outperformed diagnosis by clinicians and by second consensus criteria. Clinically established MDS-MSA showed perfect specificity (100%) even at early stages although to the detriment of low sensitivity. MDS-MSA diagnostic accuracy did not differ according to clinical presentation (ataxia vs. parkinsonism). CONCLUSIONS MDS-MSA criteria demonstrated excellent diagnostic performance against neuropathological diagnosis and are useful diagnostic tools for clinical practice and research. © 2023 International Parkinson and Movement Disorder Society.
Collapse
Affiliation(s)
- Sasivimol Virameteekul
- Queen Square Brain Bank for Neurological Disorders, UCL Queen Square Institute of Neurology, London, United Kingdom
- Reta Lila Weston Institute of Neurological Studies, UCL Queen Square Institute of Neurology, London, United Kingdom
| | - Tamas Revesz
- Queen Square Brain Bank for Neurological Disorders, UCL Queen Square Institute of Neurology, London, United Kingdom
| | - Zane Jaunmuktane
- Queen Square Brain Bank for Neurological Disorders, UCL Queen Square Institute of Neurology, London, United Kingdom
| | - Thomas T Warner
- Queen Square Brain Bank for Neurological Disorders, UCL Queen Square Institute of Neurology, London, United Kingdom
- Reta Lila Weston Institute of Neurological Studies, UCL Queen Square Institute of Neurology, London, United Kingdom
| | - Eduardo De Pablo-Fernández
- Queen Square Brain Bank for Neurological Disorders, UCL Queen Square Institute of Neurology, London, United Kingdom
- Reta Lila Weston Institute of Neurological Studies, UCL Queen Square Institute of Neurology, London, United Kingdom
| |
Collapse
|
6
|
Haddad R, Panicker JN, Verbakel I, Dhondt K, Ghijselings L, Hervé F, Petrovic M, Whishaw M, Bliwise DL, Everaert K. The low dopamine hypothesis: A plausible mechanism underpinning residual urine, overactive bladder and nocturia (RON) syndrome in older patients. Prog Urol 2023; 33:155-171. [PMID: 36710124 DOI: 10.1016/j.purol.2023.01.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 12/21/2022] [Accepted: 01/09/2023] [Indexed: 01/29/2023]
Abstract
INTRODUCTION Aging is associated with a combination of several lower urinary tract (LUT) signs and symptoms, including residual urine, overactive bladder and nocturia. One of the mechanisms of this LUT dysfunction that has not been discussed in dept so far is the role of dopamine (DA). METHODS In this narrative review, we explore the dopaminergic hypothesis in the development of this combination of LUT signs and symptoms in older adults. RESULTS DA is one of the neurotransmitters whose regulation and production is disrupted in aging. In synucleinopathies, altered DAergic activity is associated with the occurrence of LUTS and sleep disorders. Projections of DAergic neurons are involved in the regulation of sleep, diuresis, and bladder activity. The low dopamine hypothesis could explain the genesis of a set of LUT signs and symptoms commonly seen in this population, including elevated residual urine, Overactive bladder syndrome and Nocturia (discussed as the RON syndrome). This presentation is however also common in older patients without synucleinopathies or neurological disorders and therefore we hypothesise that altered DAergic activity because of pathological aging, and selective destruction of DAergic neurons, could underpin the presentation of this triad of LUT dysfunction in the older population. CONCLUSION The concept of RON syndrome helps to better understand this common phenotypic presentation in clinical practice, and therefore serves as a useful platform to diagnose and treat LUTS in older adults. Besides recognizing the synucleinopathy "red flag" symptoms, this set of multi-causal LUT signs and symptoms highlights the inevitable need for combination therapy, a challenge in older people with their comorbidities and concomitant medications.
Collapse
Affiliation(s)
- R Haddad
- Department of Urology, NOPIA Research Group, Ghent University Hospital, Ghent, Belgium; GRC 001 GREEN Neuro-Urology Research Group, Sorbonne Université, Rothschild Academic Hospital, AP-HP, 75012 Paris, France.
| | - J N Panicker
- Department of Uro-Neurology, The National Hospital for Neurology and Neurosurgery and Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, United Kingdom
| | - I Verbakel
- Department of Urology, NOPIA Research Group, Ghent University Hospital, Ghent, Belgium
| | - K Dhondt
- Department of Psychiatry, Pediatric sleep center, Ghent University Hospital, Ghent, Belgium
| | - L Ghijselings
- Department of Urology, NOPIA Research Group, Ghent University Hospital, Ghent, Belgium
| | - F Hervé
- Department of Urology, NOPIA Research Group, Ghent University Hospital, Ghent, Belgium; Department of Urology, Cliniques Universitaires Saint Luc, Brussels, Belgium
| | - M Petrovic
- Department of Geriatrics, Ghent University Hospital, Ghent, Belgium
| | - M Whishaw
- Department of Aged Care, Royal Melbourne Hospital, Melbourne, Australia
| | - D L Bliwise
- Department of Neurology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - K Everaert
- Department of Urology, NOPIA Research Group, Ghent University Hospital, Ghent, Belgium
| |
Collapse
|
7
|
Sakakibara R, Sekiguchi Y, N Panicker J, Sekido N, Sugimoto H, Sugisaki Y, Shimizu A, Takahashi O, Ogata T, Sawai S, Tateno F, Aiba Y, Simeoni S. Female Urinary Retention Progressing to Possible Multiple System Atrophy-cerebellar Form after 12 Years. Intern Med 2022; 61:3599-3604. [PMID: 35569977 PMCID: PMC9790793 DOI: 10.2169/internalmedicine.8724-21] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
We herein report a 73-year-old Japanese woman with possible multiple system atrophy-cerebellar form (MSA-C) who suffered from urinary retention (sacral autonomic disorder) for 12 years before exhibiting cerebellar ataxia. A peculiar combination of findings on urodynamics and sphincter electromyography (EMG), e.g. detrusor hyperactivity with impaired contraction (DHIC), detrusor-sphincter dyssynergia (DSD) and neurogenic sphincter EMG (upper and lower neuron-type autonomic dysfunction), seems to have been predictive of future development of MSA.
Collapse
Affiliation(s)
- Ryuji Sakakibara
- Neurology, Internal Medicine, Sakura Medical Center, Toho University, Japan
| | - Yuki Sekiguchi
- Uro-gynecology, Female Medical Clinic 'Next Stage', Japan
| | - Jalesh N Panicker
- Department of Uro-Neurology, The National Hospital for Neurology and Neurosurgery, UK
| | | | | | | | - Ayami Shimizu
- Clinical Physiology Unit, Sakura Medical Center, Toho University, Japan
| | - Osamu Takahashi
- Clinical Physiology Unit, Sakura Medical Center, Toho University, Japan
| | - Tsuyoshi Ogata
- Neurology, Internal Medicine, Sakura Medical Center, Toho University, Japan
| | - Setsu Sawai
- Neurology, Internal Medicine, Sakura Medical Center, Toho University, Japan
| | - Fuyuki Tateno
- Neurology, Internal Medicine, Sakura Medical Center, Toho University, Japan
| | - Yosuke Aiba
- Neurology, Internal Medicine, Sakura Medical Center, Toho University, Japan
| | - Sara Simeoni
- Department of Uro-Neurology, The National Hospital for Neurology and Neurosurgery, UK
| |
Collapse
|
8
|
Yamamoto T, Pellecchia MT, Sakakibara R. Editorial: Autonomic dysfunction in multiple system atrophy. Front Neurol 2022; 13:1048895. [DOI: 10.3389/fneur.2022.1048895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 10/18/2022] [Indexed: 11/06/2022] Open
|
9
|
Optimized multi-echo gradient-echo magnetic resonance imaging for gray and white matter segmentation in the lumbosacral cord at 3 T. Sci Rep 2022; 12:16498. [PMID: 36192560 PMCID: PMC9530158 DOI: 10.1038/s41598-022-20395-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Accepted: 09/13/2022] [Indexed: 11/09/2022] Open
Abstract
Atrophy in the spinal cord (SC), gray (GM) and white matter (WM) is typically measured in-vivo by image segmentation on multi-echo gradient-echo magnetic resonance images. The aim of this study was to establish an acquisition and analysis protocol for optimal SC and GM segmentation in the lumbosacral cord at 3 T. Ten healthy volunteers underwent imaging of the lumbosacral cord using a 3D spoiled multi-echo gradient-echo sequence (Siemens FLASH, with 5 echoes and 8 repetitions) on a Siemens Prisma 3 T scanner. Optimal numbers of successive echoes and signal averages were investigated comparing signal-to-noise (SNR) and contrast-to-noise ratio (CNR) values as well as qualitative ratings for segmentability by experts. The combination of 5 successive echoes yielded the highest CNR between WM and cerebrospinal fluid and the highest rating for SC segmentability. The combination of 3 and 4 successive echoes yielded the highest CNR between GM and WM and the highest rating for GM segmentability in the lumbosacral enlargement and conus medullaris, respectively. For segmenting the SC and GM in the same image, we suggest combining 3 successive echoes. For SC or GM segmentation only, we recommend combining 5 or 3 successive echoes, respectively. Six signal averages yielded good contrast for reliable SC and GM segmentation in all subjects. Clinical applications could benefit from these recommendations as they allow for accurate SC and GM segmentation in the lumbosacral cord.
Collapse
|
10
|
Vichayanrat E, Valerio F, Koay S, De Pablo-Fernandez E, Panicker J, Morris H, Bhatia K, Chelban V, Houlden H, Quinn N, Navarro-Otano J, Miki Y, Holton J, Warner T, Mathias C, Iodice V. Diagnosing Premotor Multiple System Atrophy: Natural History and Autonomic Testing in an Autopsy-Confirmed Cohort. Neurology 2022; 99:e1168-e1177. [PMID: 35790426 PMCID: PMC9536739 DOI: 10.1212/wnl.0000000000200861] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Accepted: 05/02/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Nonmotor features precede motor symptoms in many patients with multiple system atrophy (MSA). However, little is known about differences between the natural history, progression, and prognostic factors for survival in patients with MSA with nonmotor vs motor presentations. We aimed to compare initial symptoms, disease progression, and clinical features at final evaluation and investigate differences in survival and natural history between patients with MSA with motor and nonmotor presentations. METHODS Medical records of autopsy-confirmed MSA cases at Queen Square Brain Bank who underwent both clinical examination and cardiovascular autonomic testing were identified. Clinical features, age at onset, sex, time from onset to diagnosis, disease duration, autonomic function tests, and plasma noradrenaline levels were evaluated. RESULTS Forty-seven patients with autopsy-confirmed MSA (age 60 ± 8 years; 28 men) were identified. Time from symptom onset to first autonomic evaluation was 4 ± 2 years, and the disease duration was 7.7 ± 2.2 years. Fifteen (32%) patients presented with nonmotor features including genitourinary dysfunction, orthostatic hypotension, or REM sleep behavior disorder before developing motor involvement (median delay 1-6 years). A third (5/15) were initially diagnosed with pure autonomic failure (PAF) before evolving into MSA. All these patients had normal supine plasma noradrenaline levels (332.0 ± 120.3 pg/mL) with no rise on head-up tilt (0.1 ± 0.3 pg/mL). Patients with MSA with early cardiovascular autonomic dysfunction (within 3 years of symptom onset) had shorter survival compared with those with later onset of cardiovascular autonomic impairment (6.8 years [5.6-7.9] vs 8.5 years [7.9-9.2]; p = 0.026). Patients with early urinary catheterization had shorter survival than those requiring catheterization later (6.2 years [4.6-7.8] vs 8.5 years [7.6-9.4]; p = 0.02). The survival of patients with MSA presenting with motor and nonmotor symptoms did not differ (p > 0.05). DISCUSSION Almost one-third of patients with MSA presented with nonmotor features, which could predate motor symptoms by up to 6 years. Cardiovascular autonomic failure and early urinary catheterization were predictors of poorer outcomes. A normal supine plasma noradrenaline level in patients presenting with PAF phenotype is a possible autonomic biomarker indicating later conversion to MSA.
Collapse
Affiliation(s)
- Ekawat Vichayanrat
- From the Autonomic Unit (E.V., F.V., S.K., J.N.-O., V.I.), National Hospital for Neurology and Neurosurgery, Queen Square; Department of Brain Repair and Rehabilitation (E.V., S.K., J.P., C.M., V.I.), Reta Lila Weston Institute for Neurological Studies (E.D.P.-F., N.Q., Y.M., J.H., T.W.), and Queen Square Brain Bank for Neurological Disorders (E.D.P.-F., N.Q., Y.M., J.H., T.W.), UCL Queen Square Institute of Neurology; Department of Uro Neurology (J.P.), National Hospital for Neurology and Neurosurgery; Department of Clinical and Movement Neuroscience (V.C., H.H.), and Department of Neuromuscular Diseases (Y.M.), UCL Institute of Neurology, Queen Square, London, United Kingdom; Service of Neurology (H.M., K.B.), Hospital Clinic, Barcelona, Spain and Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS); Department of Neuropathology (J.N.-O.), Institute of Brain Science, Hirosaki University Graduate School of Medicine, Japan; and The Lindo Wing (C.M.), Imperial College Healthcare NHS Trust, St Mary's Hospital, London, United Kingdom
| | - Fernanda Valerio
- From the Autonomic Unit (E.V., F.V., S.K., J.N.-O., V.I.), National Hospital for Neurology and Neurosurgery, Queen Square; Department of Brain Repair and Rehabilitation (E.V., S.K., J.P., C.M., V.I.), Reta Lila Weston Institute for Neurological Studies (E.D.P.-F., N.Q., Y.M., J.H., T.W.), and Queen Square Brain Bank for Neurological Disorders (E.D.P.-F., N.Q., Y.M., J.H., T.W.), UCL Queen Square Institute of Neurology; Department of Uro Neurology (J.P.), National Hospital for Neurology and Neurosurgery; Department of Clinical and Movement Neuroscience (V.C., H.H.), and Department of Neuromuscular Diseases (Y.M.), UCL Institute of Neurology, Queen Square, London, United Kingdom; Service of Neurology (H.M., K.B.), Hospital Clinic, Barcelona, Spain and Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS); Department of Neuropathology (J.N.-O.), Institute of Brain Science, Hirosaki University Graduate School of Medicine, Japan; and The Lindo Wing (C.M.), Imperial College Healthcare NHS Trust, St Mary's Hospital, London, United Kingdom
| | - Shiwen Koay
- From the Autonomic Unit (E.V., F.V., S.K., J.N.-O., V.I.), National Hospital for Neurology and Neurosurgery, Queen Square; Department of Brain Repair and Rehabilitation (E.V., S.K., J.P., C.M., V.I.), Reta Lila Weston Institute for Neurological Studies (E.D.P.-F., N.Q., Y.M., J.H., T.W.), and Queen Square Brain Bank for Neurological Disorders (E.D.P.-F., N.Q., Y.M., J.H., T.W.), UCL Queen Square Institute of Neurology; Department of Uro Neurology (J.P.), National Hospital for Neurology and Neurosurgery; Department of Clinical and Movement Neuroscience (V.C., H.H.), and Department of Neuromuscular Diseases (Y.M.), UCL Institute of Neurology, Queen Square, London, United Kingdom; Service of Neurology (H.M., K.B.), Hospital Clinic, Barcelona, Spain and Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS); Department of Neuropathology (J.N.-O.), Institute of Brain Science, Hirosaki University Graduate School of Medicine, Japan; and The Lindo Wing (C.M.), Imperial College Healthcare NHS Trust, St Mary's Hospital, London, United Kingdom
| | - Eduardo De Pablo-Fernandez
- From the Autonomic Unit (E.V., F.V., S.K., J.N.-O., V.I.), National Hospital for Neurology and Neurosurgery, Queen Square; Department of Brain Repair and Rehabilitation (E.V., S.K., J.P., C.M., V.I.), Reta Lila Weston Institute for Neurological Studies (E.D.P.-F., N.Q., Y.M., J.H., T.W.), and Queen Square Brain Bank for Neurological Disorders (E.D.P.-F., N.Q., Y.M., J.H., T.W.), UCL Queen Square Institute of Neurology; Department of Uro Neurology (J.P.), National Hospital for Neurology and Neurosurgery; Department of Clinical and Movement Neuroscience (V.C., H.H.), and Department of Neuromuscular Diseases (Y.M.), UCL Institute of Neurology, Queen Square, London, United Kingdom; Service of Neurology (H.M., K.B.), Hospital Clinic, Barcelona, Spain and Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS); Department of Neuropathology (J.N.-O.), Institute of Brain Science, Hirosaki University Graduate School of Medicine, Japan; and The Lindo Wing (C.M.), Imperial College Healthcare NHS Trust, St Mary's Hospital, London, United Kingdom
| | - Jalesh Panicker
- From the Autonomic Unit (E.V., F.V., S.K., J.N.-O., V.I.), National Hospital for Neurology and Neurosurgery, Queen Square; Department of Brain Repair and Rehabilitation (E.V., S.K., J.P., C.M., V.I.), Reta Lila Weston Institute for Neurological Studies (E.D.P.-F., N.Q., Y.M., J.H., T.W.), and Queen Square Brain Bank for Neurological Disorders (E.D.P.-F., N.Q., Y.M., J.H., T.W.), UCL Queen Square Institute of Neurology; Department of Uro Neurology (J.P.), National Hospital for Neurology and Neurosurgery; Department of Clinical and Movement Neuroscience (V.C., H.H.), and Department of Neuromuscular Diseases (Y.M.), UCL Institute of Neurology, Queen Square, London, United Kingdom; Service of Neurology (H.M., K.B.), Hospital Clinic, Barcelona, Spain and Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS); Department of Neuropathology (J.N.-O.), Institute of Brain Science, Hirosaki University Graduate School of Medicine, Japan; and The Lindo Wing (C.M.), Imperial College Healthcare NHS Trust, St Mary's Hospital, London, United Kingdom
| | - Huw Morris
- From the Autonomic Unit (E.V., F.V., S.K., J.N.-O., V.I.), National Hospital for Neurology and Neurosurgery, Queen Square; Department of Brain Repair and Rehabilitation (E.V., S.K., J.P., C.M., V.I.), Reta Lila Weston Institute for Neurological Studies (E.D.P.-F., N.Q., Y.M., J.H., T.W.), and Queen Square Brain Bank for Neurological Disorders (E.D.P.-F., N.Q., Y.M., J.H., T.W.), UCL Queen Square Institute of Neurology; Department of Uro Neurology (J.P.), National Hospital for Neurology and Neurosurgery; Department of Clinical and Movement Neuroscience (V.C., H.H.), and Department of Neuromuscular Diseases (Y.M.), UCL Institute of Neurology, Queen Square, London, United Kingdom; Service of Neurology (H.M., K.B.), Hospital Clinic, Barcelona, Spain and Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS); Department of Neuropathology (J.N.-O.), Institute of Brain Science, Hirosaki University Graduate School of Medicine, Japan; and The Lindo Wing (C.M.), Imperial College Healthcare NHS Trust, St Mary's Hospital, London, United Kingdom
| | - Kailash Bhatia
- From the Autonomic Unit (E.V., F.V., S.K., J.N.-O., V.I.), National Hospital for Neurology and Neurosurgery, Queen Square; Department of Brain Repair and Rehabilitation (E.V., S.K., J.P., C.M., V.I.), Reta Lila Weston Institute for Neurological Studies (E.D.P.-F., N.Q., Y.M., J.H., T.W.), and Queen Square Brain Bank for Neurological Disorders (E.D.P.-F., N.Q., Y.M., J.H., T.W.), UCL Queen Square Institute of Neurology; Department of Uro Neurology (J.P.), National Hospital for Neurology and Neurosurgery; Department of Clinical and Movement Neuroscience (V.C., H.H.), and Department of Neuromuscular Diseases (Y.M.), UCL Institute of Neurology, Queen Square, London, United Kingdom; Service of Neurology (H.M., K.B.), Hospital Clinic, Barcelona, Spain and Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS); Department of Neuropathology (J.N.-O.), Institute of Brain Science, Hirosaki University Graduate School of Medicine, Japan; and The Lindo Wing (C.M.), Imperial College Healthcare NHS Trust, St Mary's Hospital, London, United Kingdom
| | - Viorica Chelban
- From the Autonomic Unit (E.V., F.V., S.K., J.N.-O., V.I.), National Hospital for Neurology and Neurosurgery, Queen Square; Department of Brain Repair and Rehabilitation (E.V., S.K., J.P., C.M., V.I.), Reta Lila Weston Institute for Neurological Studies (E.D.P.-F., N.Q., Y.M., J.H., T.W.), and Queen Square Brain Bank for Neurological Disorders (E.D.P.-F., N.Q., Y.M., J.H., T.W.), UCL Queen Square Institute of Neurology; Department of Uro Neurology (J.P.), National Hospital for Neurology and Neurosurgery; Department of Clinical and Movement Neuroscience (V.C., H.H.), and Department of Neuromuscular Diseases (Y.M.), UCL Institute of Neurology, Queen Square, London, United Kingdom; Service of Neurology (H.M., K.B.), Hospital Clinic, Barcelona, Spain and Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS); Department of Neuropathology (J.N.-O.), Institute of Brain Science, Hirosaki University Graduate School of Medicine, Japan; and The Lindo Wing (C.M.), Imperial College Healthcare NHS Trust, St Mary's Hospital, London, United Kingdom
| | - Henry Houlden
- From the Autonomic Unit (E.V., F.V., S.K., J.N.-O., V.I.), National Hospital for Neurology and Neurosurgery, Queen Square; Department of Brain Repair and Rehabilitation (E.V., S.K., J.P., C.M., V.I.), Reta Lila Weston Institute for Neurological Studies (E.D.P.-F., N.Q., Y.M., J.H., T.W.), and Queen Square Brain Bank for Neurological Disorders (E.D.P.-F., N.Q., Y.M., J.H., T.W.), UCL Queen Square Institute of Neurology; Department of Uro Neurology (J.P.), National Hospital for Neurology and Neurosurgery; Department of Clinical and Movement Neuroscience (V.C., H.H.), and Department of Neuromuscular Diseases (Y.M.), UCL Institute of Neurology, Queen Square, London, United Kingdom; Service of Neurology (H.M., K.B.), Hospital Clinic, Barcelona, Spain and Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS); Department of Neuropathology (J.N.-O.), Institute of Brain Science, Hirosaki University Graduate School of Medicine, Japan; and The Lindo Wing (C.M.), Imperial College Healthcare NHS Trust, St Mary's Hospital, London, United Kingdom
| | - Niall Quinn
- From the Autonomic Unit (E.V., F.V., S.K., J.N.-O., V.I.), National Hospital for Neurology and Neurosurgery, Queen Square; Department of Brain Repair and Rehabilitation (E.V., S.K., J.P., C.M., V.I.), Reta Lila Weston Institute for Neurological Studies (E.D.P.-F., N.Q., Y.M., J.H., T.W.), and Queen Square Brain Bank for Neurological Disorders (E.D.P.-F., N.Q., Y.M., J.H., T.W.), UCL Queen Square Institute of Neurology; Department of Uro Neurology (J.P.), National Hospital for Neurology and Neurosurgery; Department of Clinical and Movement Neuroscience (V.C., H.H.), and Department of Neuromuscular Diseases (Y.M.), UCL Institute of Neurology, Queen Square, London, United Kingdom; Service of Neurology (H.M., K.B.), Hospital Clinic, Barcelona, Spain and Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS); Department of Neuropathology (J.N.-O.), Institute of Brain Science, Hirosaki University Graduate School of Medicine, Japan; and The Lindo Wing (C.M.), Imperial College Healthcare NHS Trust, St Mary's Hospital, London, United Kingdom
| | - Judith Navarro-Otano
- From the Autonomic Unit (E.V., F.V., S.K., J.N.-O., V.I.), National Hospital for Neurology and Neurosurgery, Queen Square; Department of Brain Repair and Rehabilitation (E.V., S.K., J.P., C.M., V.I.), Reta Lila Weston Institute for Neurological Studies (E.D.P.-F., N.Q., Y.M., J.H., T.W.), and Queen Square Brain Bank for Neurological Disorders (E.D.P.-F., N.Q., Y.M., J.H., T.W.), UCL Queen Square Institute of Neurology; Department of Uro Neurology (J.P.), National Hospital for Neurology and Neurosurgery; Department of Clinical and Movement Neuroscience (V.C., H.H.), and Department of Neuromuscular Diseases (Y.M.), UCL Institute of Neurology, Queen Square, London, United Kingdom; Service of Neurology (H.M., K.B.), Hospital Clinic, Barcelona, Spain and Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS); Department of Neuropathology (J.N.-O.), Institute of Brain Science, Hirosaki University Graduate School of Medicine, Japan; and The Lindo Wing (C.M.), Imperial College Healthcare NHS Trust, St Mary's Hospital, London, United Kingdom
| | - Yasuo Miki
- From the Autonomic Unit (E.V., F.V., S.K., J.N.-O., V.I.), National Hospital for Neurology and Neurosurgery, Queen Square; Department of Brain Repair and Rehabilitation (E.V., S.K., J.P., C.M., V.I.), Reta Lila Weston Institute for Neurological Studies (E.D.P.-F., N.Q., Y.M., J.H., T.W.), and Queen Square Brain Bank for Neurological Disorders (E.D.P.-F., N.Q., Y.M., J.H., T.W.), UCL Queen Square Institute of Neurology; Department of Uro Neurology (J.P.), National Hospital for Neurology and Neurosurgery; Department of Clinical and Movement Neuroscience (V.C., H.H.), and Department of Neuromuscular Diseases (Y.M.), UCL Institute of Neurology, Queen Square, London, United Kingdom; Service of Neurology (H.M., K.B.), Hospital Clinic, Barcelona, Spain and Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS); Department of Neuropathology (J.N.-O.), Institute of Brain Science, Hirosaki University Graduate School of Medicine, Japan; and The Lindo Wing (C.M.), Imperial College Healthcare NHS Trust, St Mary's Hospital, London, United Kingdom
| | - Janice Holton
- From the Autonomic Unit (E.V., F.V., S.K., J.N.-O., V.I.), National Hospital for Neurology and Neurosurgery, Queen Square; Department of Brain Repair and Rehabilitation (E.V., S.K., J.P., C.M., V.I.), Reta Lila Weston Institute for Neurological Studies (E.D.P.-F., N.Q., Y.M., J.H., T.W.), and Queen Square Brain Bank for Neurological Disorders (E.D.P.-F., N.Q., Y.M., J.H., T.W.), UCL Queen Square Institute of Neurology; Department of Uro Neurology (J.P.), National Hospital for Neurology and Neurosurgery; Department of Clinical and Movement Neuroscience (V.C., H.H.), and Department of Neuromuscular Diseases (Y.M.), UCL Institute of Neurology, Queen Square, London, United Kingdom; Service of Neurology (H.M., K.B.), Hospital Clinic, Barcelona, Spain and Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS); Department of Neuropathology (J.N.-O.), Institute of Brain Science, Hirosaki University Graduate School of Medicine, Japan; and The Lindo Wing (C.M.), Imperial College Healthcare NHS Trust, St Mary's Hospital, London, United Kingdom
| | - Thomas Warner
- From the Autonomic Unit (E.V., F.V., S.K., J.N.-O., V.I.), National Hospital for Neurology and Neurosurgery, Queen Square; Department of Brain Repair and Rehabilitation (E.V., S.K., J.P., C.M., V.I.), Reta Lila Weston Institute for Neurological Studies (E.D.P.-F., N.Q., Y.M., J.H., T.W.), and Queen Square Brain Bank for Neurological Disorders (E.D.P.-F., N.Q., Y.M., J.H., T.W.), UCL Queen Square Institute of Neurology; Department of Uro Neurology (J.P.), National Hospital for Neurology and Neurosurgery; Department of Clinical and Movement Neuroscience (V.C., H.H.), and Department of Neuromuscular Diseases (Y.M.), UCL Institute of Neurology, Queen Square, London, United Kingdom; Service of Neurology (H.M., K.B.), Hospital Clinic, Barcelona, Spain and Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS); Department of Neuropathology (J.N.-O.), Institute of Brain Science, Hirosaki University Graduate School of Medicine, Japan; and The Lindo Wing (C.M.), Imperial College Healthcare NHS Trust, St Mary's Hospital, London, United Kingdom
| | - Christopher Mathias
- From the Autonomic Unit (E.V., F.V., S.K., J.N.-O., V.I.), National Hospital for Neurology and Neurosurgery, Queen Square; Department of Brain Repair and Rehabilitation (E.V., S.K., J.P., C.M., V.I.), Reta Lila Weston Institute for Neurological Studies (E.D.P.-F., N.Q., Y.M., J.H., T.W.), and Queen Square Brain Bank for Neurological Disorders (E.D.P.-F., N.Q., Y.M., J.H., T.W.), UCL Queen Square Institute of Neurology; Department of Uro Neurology (J.P.), National Hospital for Neurology and Neurosurgery; Department of Clinical and Movement Neuroscience (V.C., H.H.), and Department of Neuromuscular Diseases (Y.M.), UCL Institute of Neurology, Queen Square, London, United Kingdom; Service of Neurology (H.M., K.B.), Hospital Clinic, Barcelona, Spain and Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS); Department of Neuropathology (J.N.-O.), Institute of Brain Science, Hirosaki University Graduate School of Medicine, Japan; and The Lindo Wing (C.M.), Imperial College Healthcare NHS Trust, St Mary's Hospital, London, United Kingdom
| | - Valeria Iodice
- From the Autonomic Unit (E.V., F.V., S.K., J.N.-O., V.I.), National Hospital for Neurology and Neurosurgery, Queen Square; Department of Brain Repair and Rehabilitation (E.V., S.K., J.P., C.M., V.I.), Reta Lila Weston Institute for Neurological Studies (E.D.P.-F., N.Q., Y.M., J.H., T.W.), and Queen Square Brain Bank for Neurological Disorders (E.D.P.-F., N.Q., Y.M., J.H., T.W.), UCL Queen Square Institute of Neurology; Department of Uro Neurology (J.P.), National Hospital for Neurology and Neurosurgery; Department of Clinical and Movement Neuroscience (V.C., H.H.), and Department of Neuromuscular Diseases (Y.M.), UCL Institute of Neurology, Queen Square, London, United Kingdom; Service of Neurology (H.M., K.B.), Hospital Clinic, Barcelona, Spain and Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS); Department of Neuropathology (J.N.-O.), Institute of Brain Science, Hirosaki University Graduate School of Medicine, Japan; and The Lindo Wing (C.M.), Imperial College Healthcare NHS Trust, St Mary's Hospital, London, United Kingdom.
| |
Collapse
|
11
|
Todisco M, Cosentino G, Scardina S, Fresia M, Prunetti P, Pisani A, Alfonsi E. Diagnostic and Prognostic Value of External Anal Sphincter
EMG
Patterns in Multiple System Atrophy. Mov Disord 2022; 37:1069-1074. [PMID: 35122320 PMCID: PMC9305564 DOI: 10.1002/mds.28938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 01/06/2022] [Accepted: 01/09/2022] [Indexed: 11/08/2022] Open
Abstract
Background It is debated whether external anal sphincter (EAS) electromyography can distinguish between multiple system atrophy (MSA) and Parkinson's disease (PD), whereas its usefulness for MSA prognosis is unknown. Objectives We explored the diagnostic and prognostic value and clinical correlations of EAS electromyography patterns in MSA. Methods We collected clinical data and EAS electromyography findings in 72 patients with MSA and 21 with PD. Results We identified four EAS patterns. The normal pattern was frequently observed in PD and associated with prolonged survival when identified in MSA. Abnormal patterns were predominant in MSA. The most severe pattern was associated with the highest likelihood of MSA diagnosis and with the worst prognosis in the MSA cohort. MSA patients with EAS abnormalities often showed urogenital symptoms and fecal incontinence. Conclusions The increasing severity of EAS electromyography patterns paralleled diagnostic accuracy and survival in MSA, and correlated with prevalence of bladder and bowel symptoms. © 2022 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society
Collapse
Affiliation(s)
- Massimiliano Todisco
- Translational Neurophysiology Research Unit IRCCS Mondino Foundation Pavia Italy
- Movement Disorders Research Center IRCCS Mondino Foundation Pavia Italy
- Department of Brain and Behavioral Sciences University of Pavia Pavia Italy
| | - Giuseppe Cosentino
- Translational Neurophysiology Research Unit IRCCS Mondino Foundation Pavia Italy
- Department of Brain and Behavioral Sciences University of Pavia Pavia Italy
| | - Serena Scardina
- Department of Biomedicine, Neuroscience and advanced Diagnostics (BIND) University of Palermo Palermo Italy
| | - Mauro Fresia
- Translational Neurophysiology Research Unit IRCCS Mondino Foundation Pavia Italy
| | - Paolo Prunetti
- Translational Neurophysiology Research Unit IRCCS Mondino Foundation Pavia Italy
| | - Antonio Pisani
- Movement Disorders Research Center IRCCS Mondino Foundation Pavia Italy
- Department of Brain and Behavioral Sciences University of Pavia Pavia Italy
| | - Enrico Alfonsi
- Translational Neurophysiology Research Unit IRCCS Mondino Foundation Pavia Italy
| |
Collapse
|
12
|
Wang S, Wang M, Zhang H. Effect Observation on Modified Zishen Tongguan Decoction Combined with Acupuncture in Treatment of Urinary Retention after Cervical Cancer Surgery and Its Influence on the Incidence of Adverse Reactions. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2021; 2021:7338276. [PMID: 34691221 PMCID: PMC8528598 DOI: 10.1155/2021/7338276] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 09/28/2021] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To explore the effect observation on modified Zishen Tongguan decoction combined with acupuncture in the treatment of urinary retention after cervical cancer surgery and its influence on the incidence of adverse reactions. METHODS The clinical data of 84 patients suffered from urinary retention after radical resection of cervical cancer (December 2018-December 2019) in the oncology department of Jinan Municipal Hospital of Traditional Chinese Medicine were selected for retrospective analysis. According to the order of admission, they were divided into group A (n = 42), treated with conventional therapy, modified Zishen Tongguan decoction, and acupuncture, and group B (n = 42), treated with conventional therapy. The clinical efficacy of the two groups was observed, the urination function indexes after therapy were recorded, and the clinical efficacy and incidence of adverse reactions were analyzed. RESULTS After therapy, compared with group B, the average urinary flow rate, maximum urinary flow rate, bladder compliance (BC) level value, and the number of patients with good recovery of bladder function of group A were obviously higher (P < 0.05), and the urination time and detrusor pressure were obviously lower (P < 0.001). There was no significant difference in the average scoring of overactive bladder syndrome score (OABSS) between the two groups at 7 days of therapy (p > 0.05). The average OABSS of group A at 14 days of therapy was obviously lower than that of group B (P < 0.001). Compared with group B, the total clinical effective rate of group A was obviously higher (P < 0.05), while the total incidence of adverse reactions was obviously lower (P < 0.05). CONCLUSION Modified Zishen Tongguan decoction combined with acupuncture is a reliable method to treat urinary retention after cervical cancer surgery, which greatly improves the urination function of patients, as well as the clinical efficacy. Further research will help create a better solution for patients with urinary retention after cervical cancer surgery.
Collapse
Affiliation(s)
- Shujuan Wang
- Traditional Chinese Medicine Dispensing Room, Jinan Municipal Hospital of Traditional Chinese Medicine, Jinan 250012, Shandong Province, China
| | - Min Wang
- Traditional Chinese Medicine Dispensing Room, Jinan Municipal Hospital of Traditional Chinese Medicine, Jinan 250012, Shandong Province, China
| | - Hongbin Zhang
- Department of Accupuncture, People's Hospital of Shizhong District of Jinan, Jinan 250024, Shandong Province, China
| |
Collapse
|
13
|
Eschlböck S, Kiss G, Krismer F, Fanciulli A, Kaindlstorfer C, Raccagni C, Seppi K, Kiechl S, Panicker JN, Wenning GK. Urodynamic Evaluation in Multiple System Atrophy: A Retrospective Cohort Study. Mov Disord Clin Pract 2021; 8:1052-1060. [PMID: 34631941 PMCID: PMC8485589 DOI: 10.1002/mdc3.13307] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 06/13/2021] [Accepted: 06/27/2021] [Indexed: 12/19/2022] Open
Abstract
Background Urological dysfunction in patients with multiple system atrophy (MSA) is one of the main manifestations of autonomic failure. Urodynamic examination is clinically relevant since underlying pathophysiology of lower urinary tract (LUT) dysfunction can be variable. Objective Evaluation of the pathophysiology of urological symptoms and exploration of differences in urodynamic patterns of LUT dysfunction between MSA-P and MSA-C. Methods Retrospective study of patients with possible and probable MSA who were referred for urodynamic studies between 2004 and 2019. Demographic data, medical history, physical examination and urodynamic studies assessing storage and voiding dysfunction were obtained. Results Seventy-four patients were included in this study (MSA-P 64.9% n = 48; median age 62.5 (IQR 56.8-70) years). Detrusor overactivity during filling phase was noted in 58.1% (n = 43) of the patients. In the voiding phase, detrusor sphincter dyssynergia and detrusor underactivity were observed in 24.6% (n = 17) and in 62.1% (n = 41) of the patients, respectively. A postmicturition residual volume of over 100 ml was present in 71.4% (n = 50) of the patients. Comparison of MSA subtypes showed weaker detrusor contractility in MSA-P compared to MSA-C [pdetQmax 26.2 vs. 34.4 cmH20, P = 0.04]. In 56.2% (n = 41) of patients pathophysiology of LUT dysfunction was deemed to be neurogenic and consistent with the diagnosis of MSA. In 35.6% (n = 26) urodynamic pattern suggested other urological co-morbidities. Conclusion Urodynamic evaluation is an important tool to analyze the pattern of LUT dysfunction in MSA. Impaired detrusor contractility was seen more in MSA-P which needs to be investigated in further studies.
Collapse
Affiliation(s)
- Sabine Eschlböck
- Department of Neurology Medical University of Innsbruck Innsbruck Austria
| | - Gustav Kiss
- Division of Neurourology, Department of Urology Medical University of Innsbruck Innsbruck Austria
| | - Florian Krismer
- Department of Neurology Medical University of Innsbruck Innsbruck Austria
| | | | | | - Cecilia Raccagni
- Department of Neurology Medical University of Innsbruck Innsbruck Austria.,Department of Neurology Regional General Hospital Bolzano Italy
| | - Klaus Seppi
- Department of Neurology Medical University of Innsbruck Innsbruck Austria
| | - Stefan Kiechl
- Department of Neurology Medical University of Innsbruck Innsbruck Austria
| | - Jalesh N Panicker
- Department of Uro-Neurology The National Hospital for Neurology and Neurosurgery, and UCL Queen Square Institute of Neurology London United Kingdom
| | - Gregor K Wenning
- Department of Neurology Medical University of Innsbruck Innsbruck Austria
| |
Collapse
|
14
|
Marmion DJ, Peelaerts W, Kordower JH. A historical review of multiple system atrophy with a critical appraisal of cellular and animal models. J Neural Transm (Vienna) 2021; 128:1507-1527. [PMID: 34613484 PMCID: PMC8528759 DOI: 10.1007/s00702-021-02419-8] [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: 07/06/2021] [Accepted: 09/15/2021] [Indexed: 12/31/2022]
Abstract
Multiple system atrophy (MSA) is a progressive neurodegenerative disorder characterized by striatonigral degeneration (SND), olivopontocerebellar atrophy (OPCA), and dysautonomia with cerebellar ataxia or parkinsonian motor features. Isolated autonomic dysfunction with predominant genitourinary dysfunction and orthostatic hypotension and REM sleep behavior disorder are common characteristics of a prodromal phase, which may occur years prior to motor-symptom onset. MSA is a unique synucleinopathy, in which alpha-synuclein (aSyn) accumulates and forms insoluble inclusions in the cytoplasm of oligodendrocytes, termed glial cytoplasmic inclusions (GCIs). The origin of, and precise mechanism by which aSyn accumulates in MSA are unknown, and, therefore, disease-modifying therapies to halt or slow the progression of MSA are currently unavailable. For these reasons, much focus in the field is concerned with deciphering the complex neuropathological mechanisms by which MSA begins and progresses through the course of the disease. This review focuses on the history, etiopathogenesis, neuropathology, as well as cell and animal models of MSA.
Collapse
Affiliation(s)
- David J Marmion
- Parkinson's Disease Research Unit, Department of Neurobiology, Barrow Neurological Institute, Phoenix, AZ, USA
| | - Wouter Peelaerts
- Laboratory for Neurobiology and Gene Therapy, Department of Neurosciences, Leuven Brain Institute, KU Leuven, Leuven, Belgium
| | - Jeffrey H Kordower
- ASU-Banner Neurodegenerative Disease Research Center, Biodesign Institute, Arizona State University, Tempe, AZ, USA.
| |
Collapse
|
15
|
Vichayanrat E, Hentzen C, Batla A, Simeoni S, Iodice V, Panicker JN. Lower urinary tract dysfunction in Parkinsonian syndromes. Neurol Sci 2021; 42:4045-4054. [PMID: 34318363 DOI: 10.1007/s10072-021-05411-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 06/14/2021] [Indexed: 12/21/2022]
Abstract
PURPOSE OF REVIEW The aim of this review is to outline the clinical presentation, pathophysiology and evaluation of lower urinary tract (LUT) dysfunction in Parkinson's disease and other parkinsonian syndromes including multiple system atrophy, dementia with Lewy bodies, progressive supranuclear palsy and corticobasal degeneration. RECENT FINDINGS LUT dysfunction commonly occurs in neurological disorders, including patients with parkinsonian syndromes. The pattern of LUT dysfunction and its severity are variable, depending upon the site of lesion within the neural pathways. Parkinsonian syndromes are broadly divided into Parkinson's disease (PD) and a typical parkinsonian syndromes such as multiple system atrophy (MSA), dementia with Lewy bodies (DLB), progressive supranuclear palsy (PSP) and corticobasal degeneration (CBD). Different parkinsonian syndromes have distinct clinical features (e.g. dysautonomia, early dementia, supranuclear gaze palsy, higher cortical signs), and the pattern of LUT dysfunction and its severity can differ. CONCLUSIONS LUT dysfunction is a common feature in patients with parkinsonian syndromes. Recognising the pattern of LUT dysfunction during the assessment of these patients can help management and possibly facilitate an earlier diagnosis.
Collapse
Affiliation(s)
- Ekawat Vichayanrat
- Department of Uro‑Neurology, The National Hospital for Neurology and Neurosurgery, Queen Square, London, UK.,Autonomic Unit, National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
| | - Claire Hentzen
- Department of Uro‑Neurology, The National Hospital for Neurology and Neurosurgery, Queen Square, London, UK.,Sorbonne Université, GRC 01, GREEN Groupe de Recherche Clinique en Neuro-Urologie, AP-HP, Hôpital Tenon, 4 rue de la Chine, 75020, Paris, France
| | - Amit Batla
- Faculty of Brain Sciences, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Sara Simeoni
- Department of Uro‑Neurology, The National Hospital for Neurology and Neurosurgery, Queen Square, London, UK.,Faculty of Brain Sciences, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Valeria Iodice
- Autonomic Unit, National Hospital for Neurology and Neurosurgery, Queen Square, London, UK.,Faculty of Brain Sciences, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Jalesh N Panicker
- Department of Uro‑Neurology, The National Hospital for Neurology and Neurosurgery, Queen Square, London, UK. .,Faculty of Brain Sciences, UCL Queen Square Institute of Neurology, University College London, London, UK.
| |
Collapse
|
16
|
Salih Abdulhadi A, Abdelmahmuod EA, Al‐Rubaiei J, Ali E, Mahfouz AE, Farooqi A. Urine retention as presenting manifestation of tuberculous meningitis complicated by lacunar infarction and transverse myelitis: Case report and literature review. Clin Case Rep 2021; 9:e04489. [PMID: 34322252 PMCID: PMC8301553 DOI: 10.1002/ccr3.4489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 05/06/2021] [Accepted: 05/09/2021] [Indexed: 12/01/2022] Open
Abstract
Early diagnosis and management of tuberculous meningitis will prevent lethal and fatal neurological complications such as acute infarction and permanent disability.
Collapse
Affiliation(s)
| | | | | | - Elrazi Ali
- Department of Internal MedicineHamad Medical CorporationDohaQatar
| | - Ahmed Emad Mahfouz
- Clinical Imaging DepartmentHamad Medical Corporation and Weill Cornell Medical School in QatarDohaQatar
| | - Amer Farooqi
- Department of Internal MedicineHamad Medical CorporationDohaQatar
| |
Collapse
|
17
|
Dayan E, Sklerov M. Autonomic disorders in Parkinson disease: Disrupted hypothalamic connectivity as revealed from resting-state functional magnetic resonance imaging. HANDBOOK OF CLINICAL NEUROLOGY 2021; 182:211-222. [PMID: 34266593 DOI: 10.1016/b978-0-12-819973-2.00014-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Converging evidence from diverse methodologies implicate the hypothalamus in the pathophysiology of Parkinson's disease (PD). Pathology in the hypothalamus and in hypothalamic pathways has been linked primarily to autonomic dysfunction, routinely experienced by individuals with PD throughout the course of the disease, sometimes predating onset of motor symptoms. Postmortem and molecular imaging studies have delineated pathologic changes in the hypothalamus and demonstrated alterations in neurotransmitter systems within this structure and associated pathways, which track the progression of the disease. More recently, functional interactions between the hypothalamus, thalamus, and striatum, as assessed using resting-state functional magnetic resonance imaging, were shown to be reduced in PD patients with high in comparison to those with low autonomic symptom burden. These functional changes may relate to micro- and macrostructural alterations which are also observed in PD. An examination of the hypothalamus and hypothalamic pathways can also shed light on atypical parkinsonian disorders and their distinct pathophysiologic characteristics relative to idiopathic PD. Altogether, the current state of knowledge on the involvement of the hypothalamus in PD is profound, yet emerging methodological advances are likely to move our understanding of hypothalamic pathology in PD significantly forward.
Collapse
Affiliation(s)
- Eran Dayan
- Department of Radiology and Biomedical Research Imaging Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States.
| | - Miriam Sklerov
- Department of Neurology, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| |
Collapse
|
18
|
Sakakibara R, Sakai D, Tateno F, Aiba Y. Urinary retention with occult meningeal reaction: a 'form fruste' meningitis-retention syndrome. BMJ Case Rep 2020; 13:13/11/e236625. [PMID: 33203783 DOI: 10.1136/bcr-2020-236625] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
We report the case of a 70-year-old Japanese man who was referred from a local urologist because of acute urinary retention (detrusor underactivity revealed by a urodynamics examination). A neurogenic urinary retention workup failed to reveal the aetiology, but a spinal tap incidentally showed occult meningeal reaction with positive oligoclonal band. The patient had no headache, nausea/vomiting or fever. Considering his clinical laboratory findings, his neural lesions seemed to involve the meninges and spinal cord, suggestive of 'form fruste' meningitis-retention syndrome. When clinicians encounter patients with urinary retention of undetermined aetiology, a spinal tap should be considered.
Collapse
Affiliation(s)
- Ryuji Sakakibara
- Neurology, Internal Medicine, Toho University, Sakura Medical Centre, Sakura, Chiba, Japan
| | - Daiki Sakai
- Neurology, Internal Medicine, Toho University, Sakura Medical Centre, Sakura, Chiba, Japan
| | - Fuyuki Tateno
- Neurology, Internal Medicine, Toho University, Sakura Medical Centre, Sakura, Chiba, Japan
| | - Yosuke Aiba
- Neurology, Internal Medicine, Toho University, Sakura Medical Centre, Sakura, Chiba, Japan
| |
Collapse
|
19
|
The Role of Pelvic Neurophysiology Testing in the Assessment of Patients with Voiding Dysfunction. CURRENT BLADDER DYSFUNCTION REPORTS 2020. [DOI: 10.1007/s11884-020-00613-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Abstract
Purpose of Review
The role of pelvic neurophysiology testing in the evaluation of patients with lower urinary tract (LUT) symptoms is explored in this review.
Recent Findings
Different neurophysiology tests such as sphincter EMG and pudendal somatosensory evoked potentials are useful in evaluating the sacral somatic afferent and efferent innervation. S2 and S3 dermatomal evoked potentials assess individual sacral roots and are feasible to perform using standard neurophysiology machines.
Summary
The innervation of the LUT has a substantial contribution from splanchnic and somatic nerves arising from the sacral segments. Pelvic neurophysiology tests, which assess somatic nerve functions, are therefore a useful tool in assessing sacral nerve functions in patients presenting with unexplained voiding dysfunction. In this review, the commonly performed neurophysiology studies that assess the S2, S3 and S4 sacral afferent and efferent pathways are outlined, and their clinical applications reviewed.
Collapse
|
20
|
Roy HA, Nettleton J, Blain C, Dalton C, Farhan B, Fernandes A, Georgopoulos P, Klepsch S, Lavelle J, Martinelli E, Panicker JN, Radoja I, Rapidi CA, Pereira E Silva R, Tudor K, Wagg AS, Drake MJ. Assessment of patients with lower urinary tract symptoms where an undiagnosed neurological disease is suspected: A report from an International Continence Society consensus working group. Neurourol Urodyn 2020; 39:2535-2543. [PMID: 32754994 DOI: 10.1002/nau.24469] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 07/16/2020] [Indexed: 11/10/2022]
Abstract
AIM Lower urinary tract symptoms (LUTS) are a common urological referral, which sometimes can have a neurological basis in a patient with no formally diagnosed neurological disease ("occult neurology"). Early identification and specialist input is needed to avoid bad LUTS outcomes, and to initiate suitable neurological management. METHODS The International Continence Society established a neurological working group to consider: Which neurological conditions may include LUTS as an early feature? What diagnostic evaluations should be undertaken in the LUTS clinic? A shortlist of conditions was drawn up by expert consensus and discussed at the annual congress of the International Neurourology Society. A multidisciplinary working group then generated recommendations for identifying clinical features and management. RESULTS The relevant conditions are multiple sclerosis, multiple system atrophy, normal pressure hydrocephalus, early dementia, Parkinsonian syndromes (including early Parkinson's Disease and Multiple System Atrophy) and spinal cord disorders (including spina bifida occulta with tethered cord, and spinal stenosis). In LUTS clinics, the need is to identify additional atypical features; new onset severe LUTS (excluding infection), unusual aspects (eg, enuresis without chronic retention) or "suspicious" symptoms (eg, numbness, weakness, speech disturbance, gait disturbance, memory loss/cognitive impairment, and autonomic symptoms). Where occult neurology is suspected, healthcare professionals need to undertake early appropriate referral; central nervous system imaging booked from LUTS clinic is not recommended. CONCLUSIONS Occult neurology is an uncommon underlying cause of LUTS, but it is essential to intervene promptly if suspected, and to establish suitable management pathways.
Collapse
Affiliation(s)
- Holly A Roy
- Neurosurgery Department, Derriford Hospital, University Hospitals Plymouth NHS Trust, Plymouth, UK
| | - Jeremy Nettleton
- Department of Urology, Cheltenham General Hospital, Gloucestershire Hospitals NHS Foundation Trust, Cheltenham, UK
| | - Camilla Blain
- Atkinson Morley Regional Neurosciences Centre, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Catherine Dalton
- Atkinson Morley Regional Neurosciences Centre, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Bilal Farhan
- UTMB Health Division of Urology, Galveston, Texas
| | - Ailton Fernandes
- Department of Urology, State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Petros Georgopoulos
- Department of Urology and Pelvic Floor Unit, Aarhus University Hospital, Aarhus, Denmark
| | - Sabine Klepsch
- Neurology Department, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - John Lavelle
- Veteran Affairs Palo Alto Health Care System, Palo Alto, California
| | | | - Jalesh N Panicker
- Department of Uro-Neurology, The National Hospital for Neurology and Neurosurgery, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, UK
| | - Ivan Radoja
- Department of Urology, University Hospital Centre Osijek, Faculty of Medicine, The J. J. Strossmayer University of Osijek, Osijek, Croatia
| | | | - Ricardo Pereira E Silva
- Department of Urology, Centro Hospitalar Universitário Lisboa Norte, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Katarina Tudor
- Department of Neurology, Unit for Headaches, Neurogenic Pain and Spinal Disorders, School of Medicine, University Hospital Centre Zagreb, University of Zagreb, Zagreb, Croatia
| | - Adrian S Wagg
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Marcus J Drake
- Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol Urological Institute, Bristol, UK
| |
Collapse
|
21
|
Garg D, Agarwal A. Comment on "Early presentation of urinary retention in multiple system atrophy: can the disease begin in the sacral spinal cord?". J Neurol 2019; 267:665. [PMID: 31807914 DOI: 10.1007/s00415-019-09659-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 11/27/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Divyani Garg
- Department of Neurology, Lady Hardinge Medical College, New Delhi, India.
| | - Ayush Agarwal
- Department of Neurology, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, India
| |
Collapse
|