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Andersen AM, Kaalund SS, Marner L, Salvesen L, Pakkenberg B, Olesen MV. Quantitative cellular changes in multiple system atrophy brains. Neuropathol Appl Neurobiol 2023; 49:e12941. [PMID: 37812040 DOI: 10.1111/nan.12941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 09/21/2023] [Accepted: 10/02/2023] [Indexed: 10/10/2023]
Abstract
Multiple system atrophy (MSA) is a neurodegenerative disorder characterised by a combined symptomatology of parkinsonism, cerebellar ataxia, autonomic failure and corticospinal dysfunction. In brains of MSA patients, the hallmark lesion is the aggregation of misfolded alpha-synuclein in oligodendrocytes. Even though the underlying pathological mechanisms remain poorly understood, the evidence suggests that alpha-synuclein aggregation in oligodendrocytes may contribute to the neurodegeneration seen in MSA. The primary aim of this review is to summarise the published stereological data on the total number of neurons and glial cell subtypes (oligodendrocytes, astrocytes and microglia) and volumes in brains from MSA patients. Thus, we include in this review exclusively the reports of unbiased quantitative data from brain regions including the neocortex, nuclei of the cerebrum, the brainstem and the cerebellum. Furthermore, we compare and discuss the stereological results in the context of imaging findings and MSA symptomatology. In general, the stereological results agree with the common neuropathological findings of neurodegeneration and gliosis in brains from MSA patients and support a major loss of nigrostriatal neurons in MSA patients with predominant parkinsonism (MSA-P), as well as olivopontocerebellar atrophy in MSA patients with predominant cerebellar ataxia (MSA-C). Surprisingly, the reports indicate only a minor loss of oligodendrocytes in sub-cortical regions of the cerebrum (glial cells not studied in the cerebellum) and negligible changes in brain volumes. In the past decades, the use of stereological methods has provided a vast amount of accurate information on cell numbers and volumes in the brains of MSA patients. Combining different techniques such as stereology and diagnostic imaging (e.g. MRI, PET and SPECT) with clinical data allows for a more detailed interdisciplinary understanding of the disease and illuminates the relationship between neuropathological changes and MSA symptomatology.
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Affiliation(s)
- Alberte M Andersen
- Centre for Neuroscience and Stereology, Department of Neurology, Bispebjerg-Frederiksberg Hospital, Copenhagen, Denmark
| | - Sanne S Kaalund
- Centre for Neuroscience and Stereology, Department of Neurology, Bispebjerg-Frederiksberg Hospital, Copenhagen, Denmark
| | - Lisbeth Marner
- Department of Clinical Physiology and Nuclear Medicine, Bispebjerg-Frederiksberg Hospital, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Lisette Salvesen
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Neurology, Bispebjerg-Frederiksberg Hospital, Copenhagen, Denmark
| | - Bente Pakkenberg
- Centre for Neuroscience and Stereology, Department of Neurology, Bispebjerg-Frederiksberg Hospital, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Mikkel V Olesen
- Centre for Neuroscience and Stereology, Department of Neurology, Bispebjerg-Frederiksberg Hospital, Copenhagen, Denmark
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Ghosh S. Breathing disorders in neurodegenerative diseases. HANDBOOK OF CLINICAL NEUROLOGY 2022; 189:223-239. [PMID: 36031306 DOI: 10.1016/b978-0-323-91532-8.00008-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Neurodegenerative disorders are a diverse group of conditions caused by progressive degeneration of neurons resulting in cognitive, motor, sensory, and autonomic dysfunction, leading to severe disability and death. Pulmonary dysfunction is relatively common in these conditions, may be present early in the disease, and is less well recognized and treated than other symptoms. There are variable disorders of upper and lower airways, central control of ventilation, strength of respiratory muscles, and breathing during sleep which further impact daily activities and quality of life and have the potential to injure vulnerable neurons. Laryngopharyngeal dysfunction affects speech, swallowing, and clearance of secretions, increases the risk of aspiration pneumonia, and can cause stridor and sudden death. In Parkinson's disease, L-Dopa benefits some pulmonary symptoms but there are limited pharmacological treatment options for pulmonary dysfunction. Targeted treatments include strengthening of respiratory muscles, positive airway pressure in sleep and techniques to improve cough efficacy. Well-designed clinical trials are needed to evaluate the long-term benefits of these interventions. Challenges for the future include earlier identification of pulmonary dysfunction in the clinic, institution of the most effective treatments (based on clinical trials that measure long-term meaningful outcomes) and the development of neuroprotective treatment.
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Affiliation(s)
- Soumya Ghosh
- Perron Institute for Neurological and Translational Science, University of Western Australia and Department of Neurology, Sir Charles Gairdner and Perth Children's Hospitals, Nedlands, WA, Australia.
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Alexoudi A, Deftereos S. CGRP Antagonists: Side Effects and Potential Parkinson’s Disease Development. Headache 2020; 60:789-790. [DOI: 10.1111/head.13770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Accepted: 01/06/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Athanasia Alexoudi
- Department of Neurosurgery National & Kapodistrian University of Athens Evangelismos Hospital Athens Greece
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Cao B, Wei QQ, Ou R, Zhao B, Hu T, Chen Y, Yang J, Lei F, Tang X, Shang HF. Impact of sleep-related breathing disorder on motor and non-motor symptoms in multiple system atrophy. Sleep Breath 2018; 22:981-987. [PMID: 29380098 DOI: 10.1007/s11325-018-1632-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Revised: 12/25/2017] [Accepted: 01/16/2018] [Indexed: 02/05/2023]
Abstract
INTRODUCTION Although several studies suggested that sleep-related breathing disorder (SRBD) is a frequent symptom of multiple system atrophy (MSA), whether SRBD has influence on the motor and non-motor symptoms of MSA is unknown. METHODS A total of 40 MSA patients and 40 healthy volunteers (HVs) underwent video-polysomnography (PSG) in the current study. All the MSA individuals were assessed using the Epworth Sleepiness Scale (ESS), Unified Multiple-System Atrophy Rating Scale (UMSARS), Hamilton Depression Scale (HAMD), Hamilton Anxiety Scale, Frontal assessment battery (FAB), Parkinson's Disease Questionnaire-39 (PDQ-39), and the Montreal Cognitive Assessment (MoCA). RESULTS We found apnea-hypopnea index (AHI) of the MSA patients recorded by PSG was 16.4 ± 20.2. SRBD was found in 65% of the MSA patients (26/40), which was significantly higher than HVs (8/40, 20%) (p = 0.0001). Compared to the MSA patients without SRBD, MSA individuals with SRBD showed higher total UMSARS, UMSARS-II, FAB, and HAMD scores, more frequent occurrence of excessive daytime sleepiness, hypopneas, longer mean times for hypopneas, and obstructive sleep apnea (OSA), as well as longer time for OSA. This study suggested that SRBD is frequently seen in MSA patients. CONCLUSION MSA individuals with SRBD are prone to be severe motor deficits, depression, frontal lobe dysfunction, and excessive daytime sleepiness.
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Affiliation(s)
- Bei Cao
- Department of Neurology, West China Hospital, SiChuan University, 610041, Chengdu, Sichuan, People's Republic of China
| | - Qian-Qian Wei
- Department of Neurology, West China Hospital, SiChuan University, 610041, Chengdu, Sichuan, People's Republic of China
| | - Ruwei Ou
- Department of Neurology, West China Hospital, SiChuan University, 610041, Chengdu, Sichuan, People's Republic of China
| | - Bi Zhao
- Department of Neurology, West China Hospital, SiChuan University, 610041, Chengdu, Sichuan, People's Republic of China
| | - Tao Hu
- Department of Neurology, West China Hospital, SiChuan University, 610041, Chengdu, Sichuan, People's Republic of China
| | - Yongping Chen
- Department of Neurology, West China Hospital, SiChuan University, 610041, Chengdu, Sichuan, People's Republic of China
| | - Jing Yang
- Department of Neurology, West China Hospital, SiChuan University, 610041, Chengdu, Sichuan, People's Republic of China
| | - Fei Lei
- Sleep Medicine Center, West China Hospital, Sichuan University, 610041, Chengdu, Sichuan, People's Republic of China
| | - Xiangdong Tang
- Sleep Medicine Center, West China Hospital, Sichuan University, 610041, Chengdu, Sichuan, People's Republic of China.
| | - Hui-Fang Shang
- Department of Neurology, West China Hospital, SiChuan University, 610041, Chengdu, Sichuan, People's Republic of China.
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Alfonsi E, Terzaghi M, Cosentino G, Tassorelli C, Manni R, Pozzi N, De Icco R, Bertino G, Todisco M, Alvisi E, Fresia M, Pacchetti C, Zangaglia R, Prunetti P, Moglia A. Specific patterns of laryngeal electromyography during wakefulness are associated to sleep disordered breathing and nocturnal stridor in multiple system atrophy. Parkinsonism Relat Disord 2016; 31:104-109. [DOI: 10.1016/j.parkreldis.2016.07.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Revised: 07/05/2016] [Accepted: 07/28/2016] [Indexed: 10/21/2022]
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