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Thavarajasingam SG, El-Khatib M, Vemulapalli KV, Ramsay DSC, Ponniah HS, Fernandes RT, Kramer A, Eide PK. Inadequacies in iNPH diagnosis: envisioning a paradigm shift towards integrated, multi-modal testing, and consensus-driven research for improved patient outcomes. Acta Neurochir (Wien) 2023; 165:4055-4058. [PMID: 37578505 DOI: 10.1007/s00701-023-05754-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 07/13/2023] [Indexed: 08/15/2023]
Affiliation(s)
- Santhosh G Thavarajasingam
- Faculty of Medicine, Imperial College London, London, UK.
- Imperial Brain and Spine Initiative, London, UK.
| | - Mahmoud El-Khatib
- Faculty of Medicine, Imperial College London, London, UK
- Imperial Brain and Spine Initiative, London, UK
| | - Kalyan V Vemulapalli
- Faculty of Medicine, Imperial College London, London, UK
- Imperial Brain and Spine Initiative, London, UK
| | - Daniele S C Ramsay
- Faculty of Medicine, Imperial College London, London, UK
- Imperial Brain and Spine Initiative, London, UK
| | - Hariharan Subbiah Ponniah
- Faculty of Medicine, Imperial College London, London, UK
- Imperial Brain and Spine Initiative, London, UK
| | - Rafael T Fernandes
- Imperial Brain and Spine Initiative, London, UK
- Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal
| | - Andreas Kramer
- Department of Neurosurgery, University Medical Center Mainz, Mainz, Germany
| | - Per K Eide
- Department of Neurosurgery, Oslo University Hospital - Rikshospitalet, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
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Giannini G, Jusue-Torres I, Mantovani P, Mazza L, Pirina A, Valsecchi N, Milletti D, Albini-Riccioli L, Cevoli S, Yasar S, Palandri G. INPH and parkinsonism: A positive shunt response with a negative tap test. Front Neurol 2023; 14:1150258. [PMID: 37064209 PMCID: PMC10090367 DOI: 10.3389/fneur.2023.1150258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 03/07/2023] [Indexed: 03/31/2023] Open
Abstract
IntroductionThe aim of this study was to compare clinical and functional performances of idiopathic normal pressure hydrocephalus (INPH) patients with and without parkinsonism at the initial evaluation, 72 h after the cerebrospinal fluid tap test (CSF TT), and 6 months after ventriculoperitoneal shunt (VPS) surgery.Materials and methodsThis is an observational prospective study on patients with INPH who underwent VPS. Patients were classified into INPH with parkinsonism (INPH-P+) and without parkinsonism (INPH-P−). We used the time up and go (TUG) test, Tinetti Performance-Oriented Mobility Assessment (POMA) test, INPH grading scale (INHPGS), and modified Rankin scale (mRS) at baseline, 72 h after CSF TT, and 6 months after VPS surgery.ResultsA total of 64 patients with probable INPH were included, 12 patients with INPH-P+ and 52 controls with INPH-P−. Patients with INPH showed significant improvement in all clinical and neurological parameters after VPS including TUG, Tinetti POMA, INPHGS, and mRS (p < 0.001) with the exception of mRS where there was no significant change 72 h after CSF TT compared to baseline for patients with INPH (p = 0.182). Patients with INPH-P+ performed significantly worse than patients with INPH-P− on Tinetti POMA and mRS at baseline, at 72 h post-CSF TT, and at 6 months post-VPS with INPHGS being worst at 72 h post-CSF TT. There was no difference between patients with INPH-P+ and patients with INPH-P− for TUG at baseline (p = 0.270), at 72 h post-CSF TT (p = 0.487), and at 6 months post-VPS (p = 0.182). Patients with INPH-P+ did not show any change in any of the parameters at 72 h post-CSF TT compared to baseline; however, there was a trend toward improvement on TUG (p = 0.058), Tinetti gait (p = 0.062), and Tinetti total (p = 0.067). INPH-P+ significantly improved in all parameters 6 months post-VPS compared to baseline except for mRS (p = 0.124). Patients with INPH-P− significantly improved in all parameters at 72 h post-CSF TT and at 6 months post-VPS compared to baseline, respectively, except on mRS 72 h after CSF TT (p = 0.299).ConclusionPatients with INPH and parkinsonism overall do worse than patients without parkinsonism. An unsatisfying response to the CSF tap test in INPH patients with parkinsonism should not be used as an exclusion criterion from VPS surgery since patients with and without parkinsonism showed significant improvement post-VPS.
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Affiliation(s)
- Giulia Giannini
- Unit of Neurology, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
- Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy
| | | | - Paolo Mantovani
- Unit of Neurosurgery, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Liliana Mazza
- Dipartimento dell'Integrazione Geriatria, Ospedale Maggiore, AUSL Bologna, Bologna, Italy
| | - Alessandro Pirina
- Unit of Neurosurgery, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Nicola Valsecchi
- Unit of Neurosurgery, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - David Milletti
- Unit of Rehabilitation Medicine, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Luca Albini-Riccioli
- Unit of Neuroradiology, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Sabina Cevoli
- Unit of Neurology, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Sevil Yasar
- Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - Giorgio Palandri
- Unit of Neurosurgery, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
- *Correspondence: Giorgio Palandri
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Mostile G, Contrafatto F, Terranova R, Terravecchia C, Luca A, Sinitò M, Donzuso G, Cicero CE, Sciacca G, Nicoletti A, Zappia M. Turning and Sitting in Early Parkinsonism: Differences Between Idiopathic Normal Pressure Hydrocephalus Associated with Parkinsonism and Parkinson's Disease. Mov Disord Clin Pract 2023; 10:466-471. [PMID: 36949785 PMCID: PMC10026280 DOI: 10.1002/mdc3.13638] [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: 09/12/2022] [Revised: 11/10/2022] [Accepted: 11/27/2022] [Indexed: 12/14/2022] Open
Abstract
Background Differential diagnosis between idiopathic normal pressure hydrocephalus (iNPH) associated with parkinsonism (iNPH-P) and Parkinson's disease (PD) may prove difficult when evaluating patients with early parkinsonism. The objective of this study was to evaluate differences in mobility during standardized tasks between iNPH-P and PD. Methods We selected 21 iNPH-P and 21 pharmacologically untreated PD patients. They all performed the instrumented Timed Up and Go test at the time of diagnosis. Results Turning tasks showed longer duration and lower speed in iNPH-P than in PD. Vertical variation in acceleration during the sit-to-stand phase was lower in iNPH-P patients, whereas the duration of the stand-to-sit phase was longer. On walking, iNPH-P showed smaller stride length and a longer gait cycle duration. In multivariate analysis adjusting for age and cognitive status as potential confounders, average angular speed on turning before sitting was the discriminating parameter between the two groups. Conclusions Patients with iNPH-P showed specific abnormal mobility performances with respect to untreated PD, specifically during the turning-to-sitting transition.
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Affiliation(s)
- Giovanni Mostile
- Department of Medical and Surgical Sciences and Advanced Technologies "G.F. Ingrassia"University of CataniaCataniaItaly
- Oasi Research Institute‐IRCCSTroinaItaly
| | - Federico Contrafatto
- Department of Medical and Surgical Sciences and Advanced Technologies "G.F. Ingrassia"University of CataniaCataniaItaly
| | - Roberta Terranova
- Department of Medical and Surgical Sciences and Advanced Technologies "G.F. Ingrassia"University of CataniaCataniaItaly
| | - Claudio Terravecchia
- Department of Medical and Surgical Sciences and Advanced Technologies "G.F. Ingrassia"University of CataniaCataniaItaly
| | - Antonina Luca
- Department of Medical and Surgical Sciences and Advanced Technologies "G.F. Ingrassia"University of CataniaCataniaItaly
| | - Martina Sinitò
- Department of Medical and Surgical Sciences and Advanced Technologies "G.F. Ingrassia"University of CataniaCataniaItaly
| | - Giulia Donzuso
- Department of Medical and Surgical Sciences and Advanced Technologies "G.F. Ingrassia"University of CataniaCataniaItaly
| | - Calogero E. Cicero
- Department of Medical and Surgical Sciences and Advanced Technologies "G.F. Ingrassia"University of CataniaCataniaItaly
| | - Giorgia Sciacca
- Department of Medical and Surgical Sciences and Advanced Technologies "G.F. Ingrassia"University of CataniaCataniaItaly
| | - Alessandra Nicoletti
- Department of Medical and Surgical Sciences and Advanced Technologies "G.F. Ingrassia"University of CataniaCataniaItaly
| | - Mario Zappia
- Department of Medical and Surgical Sciences and Advanced Technologies "G.F. Ingrassia"University of CataniaCataniaItaly
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Belgrado E, Tereshko Y, Tuniz F, Lettieri C, Bagatto D, Fabbro S, Piccolo D, Gigli GL, Skrap M, Valente M. MDS-UDPRS-III in the diagnosis of idiopathic Normal Pressure Hydrocephalus and identification of candidates for Ventriculo-Peritoneal Shunting surgery. Results from a retrospective large cohort of patients. J Neurol Sci 2023; 445:120536. [PMID: 36587562 DOI: 10.1016/j.jns.2022.120536] [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: 08/22/2022] [Revised: 12/21/2022] [Accepted: 12/26/2022] [Indexed: 12/31/2022]
Abstract
OBJECTIVES To evaluate the entity of extrapyramidal signs, characterize them and evaluate the dynamics of change by the mean of MDS-UPDRS-III in iNPH patients after the TT to determine if this tool may help the diagnosis of iNPH and the identification of candidates for Ventriculo-Peritoneal Shunting. MATERIALS AND METHODS We retrospectively collected data from 120 patients with the initial diagnosis of possible iNPH; they underwent neurological examination by the means of MDS-UPDRS-III and other scales before and after Tap Test (TT). They were then classified as defined iNPH (57), probable iNPH (35), and NOT-iNPH (28) based on the clinical response after the Tap Test and VPS. RESULTS After the Tap Test, defined and probable iNPH groups improved by 3.35 (2.57-4.12, p < 0.001) and 3.43 (2.43-4.4, p < 0.001) points on MDS-UPDRS-III respectively; NOT-iNPH did not improve significantly on MDS-UPDRS-III and on any other variable studies. Defined iNPH also shifted significantly from asymmetric prevalence of symptoms to a more symmetric form (from 70% before to 57% after). CONCLUSION extrapyramidal signs improved significantly after the Tap Test in definite and probable iNPH patients. MDS-UPDRS-III may be a useful complementary tool in the diagnosis of iNPH and identification of candidates for Ventriculo-Peritoneal Shunting.
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Affiliation(s)
- Enrico Belgrado
- Department of Neurology, Udine University Hospital, Piazzale Santa Maria della Misericordia 15, 33100 Udine, Italy
| | - Yan Tereshko
- Department of Clinical Neurology, Udine University Hospital, Piazzale Santa Maria della Misericordia 15, 33100 Udine, Italy.
| | - Francesco Tuniz
- Department of Neurosurgery, University of Udine, Via Colugna 50, 33100 Udine, Italy
| | - Christian Lettieri
- Department of Neurology, Udine University Hospital, Piazzale Santa Maria della Misericordia 15, 33100 Udine, Italy
| | - Daniele Bagatto
- Department of Neuroradiology, University of Udine, Via Colugna 50, 33100 Udine, Italy
| | - Sara Fabbro
- Department of Neurosurgery, University of Udine, Via Colugna 50, 33100 Udine, Italy
| | - Daniele Piccolo
- Department of Neurosurgery, University of Udine, Via Colugna 50, 33100 Udine, Italy
| | - Gian Luigi Gigli
- Department of Clinical Neurology, Udine University Hospital, Piazzale Santa Maria della Misericordia 15, 33100 Udine, Italy
| | - Miran Skrap
- Department of Neurosurgery, University of Udine, Via Colugna 50, 33100 Udine, Italy
| | - Mariarosaria Valente
- Department of Clinical Neurology, Udine University Hospital, Piazzale Santa Maria della Misericordia 15, 33100 Udine, Italy
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Sakurai A, Tsunemi T, Shimada T, Kawamura K, Nakajima M, Miyajima M, Hattori N. Effect of comorbid Parkinson's disease and Parkinson's disease dementia on the course of idiopathic normal pressure hydrocephalus. J Neurosurg 2022; 137:1302-1309. [PMID: 35276660 DOI: 10.3171/2022.1.jns212282] [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: 10/27/2021] [Accepted: 01/10/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The objective of this study was to analyze the effect of concomitant Parkinson's disease (PD) and PD dementia (PD/PDD) on the course of idiopathic normal pressure hydrocephalus (iNPH), especially as related to the outcome of lumboperitoneal shunt (LPS) surgery. METHODS The authors retrospectively analyzed patients with iNPH without accompanying disorders (iNPH alone [iNPHa]) and iNPH concomitant with PD/PDD (iNPHc+PD/PDD) who had presented to their department between 2010 and 2019. The diagnosis of iNPHc+PD/PDD was established using the diagnostic criteria of the Movement Disorder Society. The effect of LPS surgery on clinical symptoms and striatum volumes was evaluated. RESULTS Thirty-three patients with iNPHa and 23 patients with iNPHc+PD/PDD were identified. Comorbid PD/PDD significantly worsened clinical outcome as measured by the iNPH grading scale, modified Rankin Scale (mRS), and Hoehn and Yahr (HY) scale. LPS surgery improved the iNPH score including gait disturbance (p < 0.01), cognitive impairment (p = 0.02), and urinary disturbance (p < 0.01) in iNPHa and improved gait disturbance (p = 0.01) and urinary disturbance (p = 0.03) in iNPHc+PD/PDD for 1 year. Comorbid synucleinopathies maintained worse mRS scores and HY stages for 3 years, and LPS surgery extended overall survival (p = 0.003), as well as the period of sustained mRS scores (p = 0.04) and HY stages (p = 0.004) in iNPHc+PD/PDD. Both caudate and putamen volumes were reduced in iNPHa (p < 0.01) compared to those in controls and in patients with iNPHc+PD/PDD compared to those in patients with PD/PDD (p < 0.01), and LPS surgery restored caudate volumes in both groups. CONCLUSIONS These results revealed that comorbid PD/PDD deteriorates the clinical course of iNPH and that LPS surgery is recommended regardless of this comorbidity.
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Affiliation(s)
- Anri Sakurai
- 1Department of Neurology, Juntendo University School of Medicine, Tokyo
| | - Taiji Tsunemi
- 1Department of Neurology, Juntendo University School of Medicine, Tokyo
| | - Tomoyo Shimada
- 1Department of Neurology, Juntendo University School of Medicine, Tokyo
| | - Kaito Kawamura
- 2Department of Neurosurgery, Juntendo University School of Medicine, Tokyo; and
| | - Madoka Nakajima
- 2Department of Neurosurgery, Juntendo University School of Medicine, Tokyo; and
| | - Masakazu Miyajima
- 3Department of Neurosurgery, Juntendo Tokyo Koto Geriatric Medical Center, Tokyo, Japan
| | - Nobutaka Hattori
- 1Department of Neurology, Juntendo University School of Medicine, Tokyo
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Mostile G, Fasano A, Zappia M. Parkinsonism in idiopathic normal pressure hydrocephalus: is it time for defining a clinical tetrad? Neurol Sci 2022; 43:5201-5205. [PMID: 35648268 PMCID: PMC9385815 DOI: 10.1007/s10072-022-06119-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 05/02/2022] [Indexed: 11/02/2022]
Abstract
Abstract
Background
Association between parkinsonism and idiopathic normal pressure hydrocephalus (iNPH) still remains debated. There is already plenty of evidences in the literature suggesting that this clinical sign can be considered as an integral part of the clinical spectrum of iNPH patients.
Methods
We reviewed the possible pitfalls in the core clinical definition of iNPH based on available international diagnostic criteria, phenomenology of parkinsonism in iNPH, and neuroimaging supporting the presence of parkinsonism in iNPH.
Conclusions
We argue that the diagnostic definition of the iNPH “triad” should be possibly reconsidered as a “tetrad” also including parkinsonism.
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Thavarajasingam SG, El-Khatib M, Vemulapalli KV, Iradukunda HAS, Laleye J, Russo S, Eichhorn C, Eide PK. Cerebrospinal fluid and venous biomarkers of shunt-responsive idiopathic normal pressure hydrocephalus: a systematic review and meta-analysis. Acta Neurochir (Wien) 2022; 164:1719-1746. [PMID: 35230552 PMCID: PMC9233649 DOI: 10.1007/s00701-022-05154-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 02/10/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Idiopathic normal pressure hydrocephalus (iNPH) is a neurodegenerative disease and dementia subtype involving disturbed cerebrospinal fluid (CSF) homeostasis. Patients with iNPH may improve clinically following CSF diversion through shunt surgery, but it remains a challenge to predict which patients respond to shunting. It has been proposed that CSF and blood biomarkers may be used to predict shunt response in iNPH. OBJECTIVE To conduct a systematic review and meta-analysis to identify which CSF and venous biomarkers predict shunt-responsive iNPH most accurately. METHODS Original studies that investigate the use of CSF and venous biomarkers to predict shunt response were searched using the following databases: Embase, MEDLINE, Scopus, PubMed, Google Scholar, and JSTOR. Included studies were assessed using the ROBINS-I tool, and eligible studies were evaluated utilising univariate meta-analyses. RESULTS The study included 13 studies; seven addressed lumbar CSF levels of amyloid-β 1-42, nine studies CSF levels of Total-Tau, six studies CSF levels of Phosphorylated-Tau, and seven studies miscellaneous biomarkers, proteomics, and genotyping. A meta-analysis of six eligible studies conducted for amyloid-β 1-42, Total-Tau, and Phosphorylated-Tau demonstrated significantly increased lumbar CSF Phosphorylated-Tau (- 0.55 SMD, p = 0.04) and Total-Tau (- 0.50 SMD, p = 0.02) in shunt-non-responsive iNPH, though no differences were seen between shunt responders and non-responders for amyloid-β 1-42 (- 0.26 SMD, p = 0.55) or the other included biomarkers. CONCLUSION This meta-analysis found that lumbar CSF levels of Phosphorylated-Tau and Total-Tau are significantly increased in shunt non-responsive iNPH compared to shunt-responsive iNPH. The other biomarkers, including amyloid-β 1-42, did not significantly differentiate shunt-responsive from shunt-non-responsive iNPH. More studies on the Tau proteins examining sensitivity and specificity at different cut-off levels are needed for a robust analysis of the diagnostic efficiency of the Tau proteins.
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Affiliation(s)
| | | | | | | | - Joshua Laleye
- Faculty of Medicine, Imperial College London, London, UK
| | - Salvatore Russo
- Department of Neurosurgery, Imperial College Healthcare NHS Trust, London, UK
| | - Christian Eichhorn
- Division of Internal Medicine, University Hospital Basel, Basel, Switzerland
| | - Per K Eide
- Department of Neurosurgery, Oslo University Hospital, Rikshospitalet, Oslo, Norway
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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Youn J, Todisco M, Zappia M, Pacchetti C, Fasano A. Parkinsonism and cerebrospinal fluid disorders. J Neurol Sci 2021; 433:120019. [PMID: 34674853 DOI: 10.1016/j.jns.2021.120019] [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: 05/15/2021] [Revised: 08/25/2021] [Accepted: 09/29/2021] [Indexed: 01/31/2023]
Abstract
BACKGROUND Although various motor manifestations can be seen in patients with cerebrospinal fluid (CSF) disorders, such as hydrocephalus or intracranial hypotension, the clinical presentation with parkinsonism is not clearly elucidated. METHODS We searched the literature for studies describing the occurrence of parkinsonism in subjects with normal pressure hydrocephalus (NPH), obstructive hydrocephalus, and intracranial hypotension. We analyzed the clinical presentation (particularly with respect to bradykinesia, rigidity, rest tremor, and gait disturbance/postural instability) as well as the response to treatment. RESULTS Parkinsonism was most commonly reported in NPH patients. Although gait disturbance/postural instability is a well-known motor symptom of NPH, other cardinal signs include upper limb involvement or asymmetric presentation. As for obstructive hydrocephalus, parkinsonism was mainly observed in subjects with aqueductal stenosis and more often after shunt surgery. Patients with NPH or obstructive hydrocephalus rarely improved with levodopa therapy, while most subjects only improved with shunt surgery. Although the mechanism is still controversial, a functional involvement of nigrostriatal pathway has been hypothesized based on imaging studies and case reports. Brain imaging is also helpful for atypical cases of intracranial hypotension presenting with parkinsonism. Parkinsonism improved after treatment in such cases as well. CONCLUSIONS Studies exploring the relationship between CSF disorders and parkinsonism are mainly descriptive and their quality is generally poor. However, considering that these disorders can be treated, clinicians' awareness of the differential diagnosis is important and future studies better exploring the underlying pathophysiological mechanisms are warranted. This article is part of the Special Issue "Parkinsonism across the spectrum of movement disorders and beyond" edited by Joseph Jankovic, Daniel D. Truong and Matteo Bologna.
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Affiliation(s)
- Jinyoung Youn
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea; Neuroscience Center, Samsung Medical Center, Seoul, Republic of Korea; Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, UHN, Division of Neurology, University of Toronto, Toronto, Ontario, Canada
| | - Massimiliano Todisco
- Parkinson's Disease and Movement Disorders Unit, IRCCS Mondino Foundation, Pavia, Italy; Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Mario Zappia
- Department of Medical, Surgical Sciences and Advanced Technologies 'G.F. Ingrassia', University of Catania, Catania, Italy
| | - Claudio Pacchetti
- Parkinson's Disease and Movement Disorders Unit, IRCCS Mondino Foundation, Pavia, Italy
| | - Alfonso Fasano
- Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, UHN, Division of Neurology, University of Toronto, Toronto, Ontario, Canada; Krembil Brain Institute, Toronto, Ontario, Canada.
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Bologna M, Truong D, Jankovic J. The etiopathogenetic and pathophysiological spectrum of parkinsonism. J Neurol Sci 2021; 433:120012. [PMID: 34642022 DOI: 10.1016/j.jns.2021.120012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 09/05/2021] [Accepted: 09/29/2021] [Indexed: 12/12/2022]
Abstract
Parkinsonism is a syndrome characterized by bradykinesia, rigidity, and tremor. Parkinsonism is a common manifestation of Parkinson's disease and other neurodegenerative diseases referred to as atypical parkinsonism. However, a growing body of clinical and scientific evidence indicates that parkinsonism may be part of the phenomenological spectrum of various neurological conditions to a greater degree than expected by chance. These include neurodegenerative conditions not traditionally classified as movement disorders, e.g., dementia and motor neuron diseases. In addition, parkinsonism may characterize a wide range of central nervous system diseases, e.g., autoimmune diseases, infectious diseases, cerebrospinal fluid disorders (e.g., normal pressure hydrocephalus), cerebrovascular diseases, and other conditions. Several pathophysiological mechanisms have been identified in Parkinson's disease and atypical parkinsonism. Conversely, it is not entirely clear to what extent the same mechanisms and key brain areas are also involved in parkinsonism due to a broader etiopathogenetic spectrum. We aimed to provide a comprehensive and up-to-date overview of the various etiopathogenetic and pathophysiological mechanisms of parkinsonism in a wide spectrum of neurological conditions, with a particular focus on the role of the basal ganglia involvement. The paper also highlights potential implications in the diagnostic approach and therapeutic management of patients. This article is part of the Special Issue "Parkinsonism across the spectrum of movement disorders and beyond" edited by Joseph Jankovic, Daniel D. Truong and Matteo Bologna.
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Affiliation(s)
- Matteo Bologna
- Department of Human Neurosciences, Sapienza University of Rome, Italy; IRCCS Neuromed, Pozzilli, IS, Italy.
| | - Daniel Truong
- Truong Neuroscience Institute, Orange Coast Memorial Medical Center, Fountain Valley, CA, USA; Department of Neurosciences, UC Riverside, Riverside, CA, USA
| | - Joseph Jankovic
- Parkinson's Disease Center and Movement Disorders Clinic, Department of Neurology, Baylor College of Medicine, Houston, TX, USA
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Sakurai A, Tsunemi T, Ishiguro Y, Okuzumi A, Hatano T, Hattori N. Comorbid alpha synucleinopathies in idiopathic normal pressure hydrocephalus. J Neurol 2021; 269:2022-2029. [PMID: 34468800 DOI: 10.1007/s00415-021-10778-1] [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: 06/10/2021] [Revised: 08/21/2021] [Accepted: 08/25/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVE This study aimed to determine the prevalence and clinical features of Parkinson's disease (PD)/PD dementia (PD/PDD) or dementia with Lewy bodies (DLB) in idiopathic normal pressure hydrocephalus (iNPH). METHODS Patients with iNPH who were admitted to the Department of Neurology, Juntendo University School of Medicine over the past 10 years have been retrospectively analyzed. The diagnosis of iNPH and concomitant PD/PDD or DLB was established using diagnostic criteria. Motor symptoms were assessed by the Movement Disorder Society-sponsored revision of the Unified Parkinson's Disease Rating Scale (MDS-UPDRS) III. 123I-ioflupane single-photon emission computed tomography (DaT-SPECT) and cerebrospinal fluid (CSF) real-time quaking-induced conversion (RT-QuIC)-based assay were performed for alpha synuclein aggregation. RESULTS Overall, 79 patients met the criteria for iNPH, of which 34 developed iNPH without accompanying disorders (iNPHa; 43%), 23 developed iNPH with comorbid PD/PDD (iNPHc + PD/PDD; 29.1%), and 8 developed iNPH with comorbid DLB (iNPHc + DLB; 10.1%). Significant differences in facial expansion and upper-limb parkinsonism were observed with a comorbidity of either PD/PDD or DLB. The specific binding ratio (SBR) of DaTscan was reduced in iNPHa (p = 0.02), but it reduced further with comorbid PD/PDD (p < 0.01) or DLB (p < 0.01). RT-QuIC was positive for all 13 comorbid PD/PDD and negative for all 19 iNPHa. CONCLUSION These results highlight that synucleinopathies coexist with iNPH. These can be differentiated by performing DaTscan and RT-QuIC, which can affect its clinical features.
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Affiliation(s)
- Anri Sakurai
- Department of Neurology, Juntendo University School of Medicine, 2-1-1 Hongo Bynkyo-ku, Tokyo, 113-8421, Japan
| | - Taiji Tsunemi
- Department of Neurology, Juntendo University School of Medicine, 2-1-1 Hongo Bynkyo-ku, Tokyo, 113-8421, Japan.
| | - Yuta Ishiguro
- Department of Neurology, Juntendo University School of Medicine, 2-1-1 Hongo Bynkyo-ku, Tokyo, 113-8421, Japan
| | - Ayami Okuzumi
- Department of Neurology, Juntendo University School of Medicine, 2-1-1 Hongo Bynkyo-ku, Tokyo, 113-8421, Japan
| | - Taku Hatano
- Department of Neurology, Juntendo University School of Medicine, 2-1-1 Hongo Bynkyo-ku, Tokyo, 113-8421, Japan
| | - Nobutaka Hattori
- Department of Neurology, Juntendo University School of Medicine, 2-1-1 Hongo Bynkyo-ku, Tokyo, 113-8421, Japan
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