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Zhou D, Ma Q, Huang H, Xu X. Clinical value of video oculomotor evaluation in the differential diagnosis of multiple system atrophy and Parkinson's disease. Brain Behav 2024; 14:e3510. [PMID: 38715394 PMCID: PMC11077249 DOI: 10.1002/brb3.3510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 03/14/2024] [Accepted: 04/13/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND Multiple system atrophy (MSA) is a neurodegenerative disease that progresses rapidly and has a poor prognosis. This study aimed to assess the value of video oculomotor evaluation (VOE) in the differential diagnosis of MSA and Parkinson's disease (PD). METHODS In total, 28 patients with MSA, 31 patients with PD, and 30 age- and sex-matched healthy controls (HC) were screened and included in this study. The evaluation consisted of a gaze-holding test, smooth pursuit eye movement (SPEM), random saccade, and optokinetic nystagmus (OKN). RESULTS The MSA and PD groups had more abnormalities and decreased SPEM gain than the HC group (64.29%, 35.48%, 10%, p < .001). The SPEM gain in the MSA group was significantly lower than that in the PD group at specific frequencies. Patients with MSA and PD showed prolonged latencies in all saccade directions compared with those with HC. However, the two diseases had no significant differences in the saccade parameters. The OKN gain gradually decreased from the HC to the PD and the MSA groups (p < .05). Compared with the PD group, the gain in the MSA group was further decreased in the OKN test at 30°/s (Left, p = .010; Right p = .016). Receiver operating characteristic curves showed that the combination of oculomotor parameters with age and course of disease could aid in the differential diagnosis of patients with MSA and PD, with a sensitivity of 89.29% and a specificity of 70.97%. CONCLUSIONS The combination of oculomotor parameters and clinical data may aid in the differential diagnosis of MSA and PD. Furthermore, VOE is vital in the identification of neurodegenerative diseases.
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Affiliation(s)
- Dongxiao Zhou
- Department of Neurology, The First Affiliated Hospital, Sun Yat‐sen University, Guangdong Provincial Key Laboratory of Diagnosis and Treatment of Major Neurological DiseasesNational Key Clinical Department and Key Discipline of NeurologyGuangzhouChina
| | - Qian Ma
- Department of Neurology, The Fifth Affiliated HospitalSun Yat‐sen UniversityZhuhaiChina
| | - Haiwei Huang
- Department of Neurology, The First Affiliated Hospital, Sun Yat‐sen University, Guangdong Provincial Key Laboratory of Diagnosis and Treatment of Major Neurological DiseasesNational Key Clinical Department and Key Discipline of NeurologyGuangzhouChina
| | - Xue Xu
- Department of Neurology, The First Affiliated Hospital, Sun Yat‐sen University, Guangdong Provincial Key Laboratory of Diagnosis and Treatment of Major Neurological DiseasesNational Key Clinical Department and Key Discipline of NeurologyGuangzhouChina
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Inomata-Terada S, Fukuda H, Tokushige SI, Matsuda SI, Hamada M, Ugawa Y, Tsuji S, Terao Y. Abnormal saccade profiles in hereditary spinocerebellar degeneration reveal cerebellar contribution to visually guided saccades. Clin Neurophysiol 2023; 154:70-84. [PMID: 37572405 DOI: 10.1016/j.clinph.2023.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 06/17/2023] [Accepted: 07/16/2023] [Indexed: 08/14/2023]
Abstract
OBJECTIVE To study how the pathophysiology underlying hereditary spinocerebellar degeneration (spinocerebellar ataxia; SCA) with pure cerebellar manifestation evolves with disease progression using saccade recordings. METHODS We recorded visually- (VGS) and memory-guided saccade (MGS) task performance in a homogeneous population of 20 genetically proven SCA patients (12 SCA6 and eight SCA31 patients) and 19 normal controls. RESULTS For VGS but not MGS, saccade latency and amplitude were increased and more variable than those in normal subjects, which correlated with cerebellar symptom severity assessed using the International Cooperative Ataxia Rating Scale (ICARS). Parameters with significant correlations with cerebellar symptoms showed an aggravation after disease stage progression (ICARS > 50). The saccade velocity profile exhibited shortened acceleration and prolonged deceleration, which also correlated with disease progression. The main sequence relationship between saccade amplitude and peak velocity as well as saccade inhibitory control were preserved. CONCLUSIONS The cerebellum may be involved in initiating VGS, which was aggravated acutely during disease stage progression. Dysfunction associated with disease progression occurs mainly in the cerebellum and brainstem interaction but may also eventually involve cortical saccade processing. SIGNIFICANCE Saccade recording can reveal cerebellar pathophysiology underlying SCA with disease progression.
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Affiliation(s)
- Satomi Inomata-Terada
- Department of Medical Physiology, Faculty of Medicine, Kyorin University, Tokyo, Japan; Department of Neurology, Graduate School of Medicine, University of Tokyo, Japan
| | - Hideki Fukuda
- Segawa Memorial Neurological Clinic for Children, Tokyo, Japan
| | | | - Shun-Ichi Matsuda
- Department of Neurology, Graduate School of Medicine, University of Tokyo, Japan
| | - Masashi Hamada
- Department of Neurology, Graduate School of Medicine, University of Tokyo, Japan
| | - Yoshikazu Ugawa
- Department of Human Neurophysiology, Fukushima Medical University, Fukushima, Japan
| | - Shoji Tsuji
- Department of Neurology, Graduate School of Medicine, University of Tokyo, Japan
| | - Yasuo Terao
- Department of Medical Physiology, Faculty of Medicine, Kyorin University, Tokyo, Japan; Department of Neurology, Graduate School of Medicine, University of Tokyo, Japan.
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Schröter N, van Eimeren T, Classen J, Levin J, Redecker C, Wolz M, Tönges L. Significance of clinical symptoms and red flags in early differential diagnosis of Parkinson's disease and atypical Parkinsonian syndromes. J Neural Transm (Vienna) 2023; 130:839-846. [PMID: 37046147 PMCID: PMC10199882 DOI: 10.1007/s00702-023-02634-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 04/05/2023] [Indexed: 04/14/2023]
Abstract
The clinical presentation of Parkinson's disease and atypical Parkinsonian syndromes is often heterogeneous. Additional diagnostic procedures including brain imaging and biomarker analyses can help to appreciate the various syndromes, but a precise clinical evaluation and differentiation is always necessary. To better assess the relevance of distinct clinical symptoms that arose within 1 year of disease manifestation and evaluate their indicative potential for an atypical Parkinsonian syndrome, we conducted a modified Delphi panel with seven movement disorder specialists. Five different topics with several clinical symptom items were discussed and consensus criteria were tested. This resulted in distinct symptom patterns for each atypical Parkinsonian syndrome showing the multitude of clinical involvement in each neurodegenerative disease. Strongly discriminating clinical signs were few and levels of indication were variable. A prospective validation of the assessments made is needed. This demonstrates that both clinical evaluation and elaborate additional diagnostic procedures are needed to achieve a high diagnostic standard.
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Affiliation(s)
- Nils Schröter
- Department of Neurology and Clinical Neuroscience, Faculty of Medicine, Medical Center-University of Freiburg, University of Freiburg, Breisacher Str. 64, 79106, Freiburg, Germany.
| | - Thilo van Eimeren
- Department of Neurology, Faculty of Medicine, University of Cologne, Cologne, Germany
| | - Joseph Classen
- Department of Neurology, University of Leipzig, Leipzig, Germany
| | - Johannes Levin
- Department of Neurology, University Hospital, Ludwig-Maximilians-Universität München, Munich, Germany
- German Center for Neurodegenerative Diseases, Site Munich, Munich, Germany
- Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
| | | | - Martin Wolz
- Department of Neurology, Elblandklinikum Meißen, Meissen, Germany
| | - Lars Tönges
- Department of Neurology, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany
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Jia P, Zhang J, Han J, Ji Y. Clinical outcomes and cognitive impairments between progressive supranuclear palsy and multiple system atrophy. Brain Behav 2022; 12:e2827. [PMID: 36409061 PMCID: PMC9759125 DOI: 10.1002/brb3.2827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 09/14/2022] [Accepted: 11/01/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Both progressive supranuclear palsy (PSP) and multiple system atrophy (MSA) belong to atypical parkinsonian syndromes. It is important to differentiate these diseases accurately. We compared clinical outcomes and cognitive impairments between PSP and MSA. METHODS Eighty-five MSA parkinsonism type (MSA-P) patients and 76 PSP patients participated in this research. The Montreal Cognitive Assessment (MoCA) and the mini-mental state examination (MMSE) evaluated cognitive function. RESULTS MSA-P patients had a significantly higher incidence of dyskinesia, fall, urinary symptoms, and constipation, whereas patients with PSP had a higher incidence of tremor and salivation. MSA-P patients had higher MMSE and MoCA scores than PSP patients. The MMSE score showed a diagnostic cut-off score of 24.5 in PSP versus MSA-P. The MoCA score showed a diagnostic cut-off score of 20.5 in PSP versus MSA-P. CONCLUSION In conclusion, patients with PSP had differences in the clinical outcomes and cognitive impairments compared with MSA-P patients. PSP patients had more severe cognitive deficits. The score of MMSE and MoCA could be used in distinguishing MSA-P from PSP.
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Affiliation(s)
- Peifei Jia
- Clinical College of Neurology, Neurosurgery and Neurorehabilitation, Tianjin Medical University, Tianjin, China.,Department of Neurology, The Second Affiliated Hospital of Baotou Medical College, Baotou, China
| | - Jinhong Zhang
- Clinical College of Neurology, Neurosurgery and Neurorehabilitation, Tianjin Medical University, Tianjin, China.,Department of Neurology, Cangzhou People's Hospital, Cangzhou, Hebei, China
| | - Jiuyan Han
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yong Ji
- Department of Neurology, Tianjin Huanhu Hospital, Tianjin, China.,Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, China National Clinical Research Center for Neurological Diseases, Beijing, China
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Zhou H, Sun Y, Wei L, Wang X, Jiang Y, Li F, Chen J, Sun W, Zhang L, Zhao G, Wang Z. Quantitative assessment of oculomotor function by videonystagmography in multiple system atrophy. Clin Neurophysiol 2022; 141:15-23. [DOI: 10.1016/j.clinph.2022.05.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 04/30/2022] [Accepted: 05/29/2022] [Indexed: 11/25/2022]
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Deciphering the saccade velocity profile of progressive supranuclear palsy: A sign of latent cerebellar/brainstem dysfunction? Clin Neurophysiol 2021; 141:147-159. [PMID: 33632587 DOI: 10.1016/j.clinph.2020.12.023] [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: 05/12/2020] [Revised: 12/02/2020] [Accepted: 12/05/2020] [Indexed: 01/07/2023]
Abstract
OBJECTIVE To study whether the velocity profile of horizontal saccades could be used as an indicator of brainstem and cerebellar output dysfunction, depending on progressive supranuclear palsy (PSP) subtype. METHODS We compared the velocity profiles in 32 PSP patients of various subtypes with 38 age-matched normal subjects, including Richardson syndrome (RS), PSP-parkinsonism (PSPp), and pure akinesia (PAGF), and cerebellar subtypes of PSP (PSPc). RESULTS PSP patients showed reduced peak velocity along with increased duration, especially in the deceleration phase. This alteration was more prominent for larger target eccentricities (20-30 degrees), and correlated with disease severity. The changes were most pronounced in PSPc patients, with irregular increases and decreases in velocity profile, followed by RS patients, whereas the change was smaller in PSPp and normal in PAGF patients. CONCLUSIONS Saccade velocity profile can be an indicator of brainstem and/or cerebellar output. Altered velocity profile of PSP patients may reflect the pathology in the brainstem, but may also reflect cerebellar dysfunction, most prominently in PSPc. SIGNIFICANCE Saccade velocity profile may be used as an indicator of latent cerebellar/brainstem dysfunction.
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Tokushige SI, Matsuda S, Inomata-Terada S, Hamada M, Ugawa Y, Tsuji S, Terao Y. Premature saccades: A detailed physiological analysis. Clin Neurophysiol 2020; 132:63-76. [PMID: 33254099 DOI: 10.1016/j.clinph.2020.09.026] [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: 04/10/2020] [Revised: 08/04/2020] [Accepted: 09/07/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Premature saccades (PSs) are those made with latencies too short for the direction and amplitude to be specifically programmed. We sought to determine the minimum latency needed to establish accurate direction and amplitude, and observed what occurs when saccades are launched before this minimum latency. METHODS In Experiment 1, 249 normal subjects performed the gap saccade task with horizontal targets. In Experiment 2, 28 normal subjects performed the gap saccade task with the targets placed in eight directions. In Experiment 3, 38 normal subjects, 49 patients with Parkinson's disease (PD), and 10 patients with spinocerebellar degeneration (SCD) performed the gap saccade task with horizontal targets. RESULTS In Experiment 1, it took 100 ms to accurately establish saccade amplitudes and directions. In Experiment 2, however, the latencies needed for accurate amplitude and direction establishment were both approximately 150 ms. In Experiment 3, the frequencies of PSs in patients with PD and SCD were lower than those of normal subjects. CONCLUSIONS The saccade amplitudes and directions are determined simultaneously, 100-150 ms after target presentation. PSs may result from prediction of the oncoming target direction or latent saccade activities in the superior colliculus. SIGNIFICANCE Saccade direction and amplitude are determined simultaneously.
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Affiliation(s)
- Shin-Ichi Tokushige
- Department of Neurology, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo 113-8655, Japan; Department of Neurology, School of Medicine, Kyorin University, 6-20-2, Shinkawa, Mitaka, Tokyo 181-8611, Japan
| | - Shunichi Matsuda
- Department of Neurology, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo 113-8655, Japan; Department of Neurology, NTT Medical Center Tokyo, 5-9-22, Higashigotanda, Shinagawa-ku, Tokyo 141-0022, Japan
| | - Satomi Inomata-Terada
- Department of Neurology, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo 113-8655, Japan; Department of Medical Physiology, School of Medicine, Kyorin University, 6-20-2, Shinkawa, Mitaka, Tokyo 181-8611, Japan
| | - Masashi Hamada
- Department of Neurology, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Yoshikazu Ugawa
- Department of NeuroRegeneration, Fukushima Medical University, 1 Hikarigaoka, Fukushima 960-1295, Japan
| | - Shoji Tsuji
- Department of Molecular Neurology, The University of Tokyo and International University of Health and Welfare, 4-3, Kozunomori, Narita-shi, Chiba-ken 286-8686, Japan
| | - Yasuo Terao
- Department of Neurology, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo 113-8655, Japan; Department of Medical Physiology, School of Medicine, Kyorin University, 6-20-2, Shinkawa, Mitaka, Tokyo 181-8611, Japan.
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Terao Y, Tokushige SI, Inomata-Terada S, Fukuda H, Yugeta A, Ugawa Y. Differentiating early Parkinson's disease and multiple system atrophy with parkinsonism by saccade velocity profiles. Clin Neurophysiol 2019; 130:2203-2215. [DOI: 10.1016/j.clinph.2019.09.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Revised: 06/26/2019] [Accepted: 09/10/2019] [Indexed: 01/24/2023]
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Kodama S, Tokushige SI, Sugiyama Y, Sato K, Otsuka J, Shirota Y, Hamada M, Iwata A, Toda T, Tsuji S, Terao Y. Rituximab improves not only back stiffness but also "stiff eyes" in stiff person syndrome: Implications for immune-mediated treatment. J Neurol Sci 2019; 408:116506. [PMID: 31734550 DOI: 10.1016/j.jns.2019.116506] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2019] [Revised: 08/29/2019] [Accepted: 09/19/2019] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Stiff person syndrome (SPS) is usually characterized by truncal muscle rigidity and episodic painful spasms, but it sometimes appears with ocular symptoms called "stiff eyes". We recorded saccade movements in an SPS patient manifesting with "stiff eyes" conditions with slow saccade velocity and evaluated the effect of immunotherapy including rituximab on saccade parameters. METHODS We repeatedly conducted saccade eye recordings using video-based eye tracking system on a 42-year-old male SPS patient with slow saccade. The velocity and onset latency of visual guided saccades (VGS) were measured at each recording. Because VGS velocity is affected by saccade amplitude, estimated peak velocity (Vmax) was also calculated by taking the relationship between the velocity and the amplitude of saccade into account. RESULTS The mean VGS velocity improved significantly after two courses of rituximab administration compared with its lowest value. The estimated Vmax decreased as the clinical manifestations worsened, but it increased after rituximab administration. Other neurological symptoms in this patient such as muscle rigidity and gait instability also improved after the treatment. CONCLUSION Slow saccade in a "stiff eyes" patient improved after rituximab administration. Our study also indicated that the saccade eye recording is useful for evaluating the clinical condition of SPS when it is complicated with ocular symptoms.
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Affiliation(s)
- Satoshi Kodama
- Department of Neurology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan.
| | - Shin-Ichi Tokushige
- Department of Neurology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan; Department of Neurology, Kyorin University School of Medicine, 6-20-2 Shinkawa, Mitaka, Tokyo, Japan
| | - Yusuke Sugiyama
- Department of Neurology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Kazuya Sato
- Department of Neurology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Juuri Otsuka
- Department of Neurology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Yuichiro Shirota
- Department of Neurology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Masashi Hamada
- Department of Neurology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Atsushi Iwata
- Department of Neurology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Tatsushi Toda
- Department of Neurology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Shoji Tsuji
- Department of Neurology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Yasuo Terao
- Department of Neurology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan; Department of Cell Physiology, Kyorin University School of Medicine, 6-20-2 Shinkawa, Mitaka, Tokyo, Japan
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Eye movement abnormalities in essential tremor versus tremor dominant Parkinson’s disease. Clin Neurophysiol 2019; 130:683-691. [DOI: 10.1016/j.clinph.2019.01.026] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Revised: 01/14/2019] [Accepted: 01/31/2019] [Indexed: 11/21/2022]
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Sprenger A, Hanssen H, Hagedorn I, Prasuhn J, Rosales RL, Jamora RDG, Diesta CC, Domingo A, Klein C, Brüggemann N, Helmchen C. Eye movement deficits in X-linked dystonia-parkinsonism are related to striatal degeneration. Parkinsonism Relat Disord 2019; 61:170-178. [DOI: 10.1016/j.parkreldis.2018.10.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Revised: 09/14/2018] [Accepted: 10/14/2018] [Indexed: 11/16/2022]
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Comparison of gait parameters between drug-naïve patients diagnosed with multiple system atrophy with predominant parkinsonism and Parkinson's disease. Parkinsonism Relat Disord 2018; 60:87-91. [PMID: 30266299 DOI: 10.1016/j.parkreldis.2018.09.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2018] [Revised: 09/01/2018] [Accepted: 09/16/2018] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Even though gait symptoms are prominent in patients diagnosed with multiple system atrophy with predominant parkinsonism (MSA-P) compared with Parkinson's disease (PD), the gait patterns of MSA-P were not clearly elucidated. We investigated postural instability and gait disturbances in MSA-P compared with PD. METHODS We enrolled 34 drug-naïve patients with PD and 26 with MSA-P, and 18 normal controls in this study. Parkinsonism was evaluated by the Unified Parkinson's disease rating scale (UPDRS) part 3 and cognition was assessed with mini-mental status exam (MMSE). All the enrolled subjects underwent Pedoscan and GAITRite to objectively measure postural stability and gait. We compared the results of posturography and gait analysis among 3 groups, and performed correlation analysis of gait parameters with MMSE, UPDRS part 3 and posturography results. RESULTS No difference was detected in demographic and clinical variables, except tremor sub-score of UPDRS part 3, urinary symptoms and orthostatic hypotension. MSA-P patients showed larger total anterior-posterior and lateral movement of centre of pressure (COP), and widened base of support than PD patients. In correlation analysis, MMSE score, axial sub-score of UPDRS part 3 and lateral movement of COP were correlated with gait parameters in PD patients, while only axial sub-score was associated in MSA-P patients after controlling for age, sex, height, body weight, education year, and disease duration. CONCLUSION Even at an early stage, MSA-P patients demonstrated more postural instability and gait disturbance compared with PD patients, and the related factors with gait disturbance in PD and MSA-P might be different.
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Terao Y, Fukuda H, Sugiyama Y, Inomata-Terada S, Tokushige SI, Hamada M, Ugawa Y. Recording Horizontal Saccade Performances Accurately in Neurological Patients Using Electro-oculogram. J Vis Exp 2018. [PMID: 29608147 DOI: 10.3791/56934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
Electro-oculogram (EOG) has been widely used for clinical eye movement recording, especially horizontal saccades, although the video-oculography (VOG) has largely taken the place of it nowadays due to its higher spatial accuracy. However, there are situations in which EOG has clear advantages over VOG, e.g., subjects with narrow eye clefts or having cataract lenses, and patients with movement disorders. The present article shows that if properly implemented, EOG can achieve an accuracy almost as good as VOG with substantial stability for recording, while circumventing problems associated with VOG recording. The present paper describes a practical method for recording horizontal saccades using oculomotor paradigms with high accuracy and stability by EOG in neurological patients. The necessary measures are to use an Ag-AgCl electrode with a wide plastic fringe capable of reducing noise, and to wait for sufficient light adaptation to occur. This waiting period also helps to lower the impedance between the electrodes and the skin, thereby ensuring stable signal recorded as time goes by. Furthermore, re-calibration is performed as needed during the task performance. Using this method, the experimenter can avoid drifts of signals, as well as contamination of artifacts or noise from the electromyogram and electroencephalogram, and can collect sufficient data for clinical evaluation of saccades. Thus when implemented, EOG can still be a method of high practicability that can be widely applied to neurological patients, but may be effective also for studies in normal subjects.
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Affiliation(s)
- Yasuo Terao
- Department of Cell Physiology, Kyorin University;
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Huang HJ, Zhu XY, Wang X, Wang ZY, Zhang WL, Chen BC, Liu CF. The Bulbocavernosus Reflex in the Differential Diagnosis of Multiple System Atrophy with Predominant Parkinsonism and Parkinson's Disease. Front Neurol 2018; 8:697. [PMID: 29379463 PMCID: PMC5770797 DOI: 10.3389/fneur.2017.00697] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Accepted: 12/05/2017] [Indexed: 01/12/2023] Open
Abstract
Multiple system atrophy with predominant parkinsonism (MSA-P) is a degenerative disorder that presents with autonomic dysfunction, atypical parkinsonism, and ataxia. Parkinson's disease (PD) is an age-related neurological disorder of the central nervous system. Differentiation between MSA-P and PD is important because treatments, complications, and prognoses differ. The bulbocavernosus reflex (BCR) tests the afferent and efferent signals of the pudendal nerve as well as the sacral cord. In this study, we investigated differences in BCR parameters between MSA-P and PD patients. Thirty-eight MSA-P patients and 32 PD patients were selected to participate in our electrophysiological investigations. The Keypoint EMG/EP system was used to induce the BCR, and latencies and amplitudes were recorded for systematic statistical analyses. Area under the curve of the receiver operating characteristic was used to assess the specificity and sensitivity of the BCR parameters. A BCR was elicited in 76.32% of MSA-P patients and 93.75% of PD patients. The BCR latencies of the MSA-P group were longer than those of the PD group (p < 0.001). In addition, the MSA-P group had a lower BCR amplitude compared to the PD and control groups (p < 0.001). We discovered the difference between MSA-P and PD through BCR latencies and amplitudes. Compared to PD patients, MSA-P patients have longer latencies and lower amplitudes. Therefore, the BCR may be used to discriminate between MSA-P and PD in some cases.
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Affiliation(s)
- Huan-Jie Huang
- Department of Neurology, Suzhou Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University, Suzhou, China.,Department of Neurology, The First Affiliated Hospital, Wenzhou Medical University, Wenzhou, China
| | - Xing-Yu Zhu
- Department of Neurology, The First Affiliated Hospital, Wenzhou Medical University, Wenzhou, China.,School of the First Clinical Medical Sciences, Wenzhou Medical University, Wenzhou, China
| | - Xun Wang
- Department of Neurology, The First Affiliated Hospital, Wenzhou Medical University, Wenzhou, China
| | - Zhang-Yang Wang
- Department of Neurology, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Wan-Li Zhang
- Department of Neurology, The First Affiliated Hospital, Wenzhou Medical University, Wenzhou, China
| | - Bi-Cheng Chen
- Zhejiang Provincial Top Key Discipline in Surgery, Wenzhou Key Laboratory of Surgery, Department of Surgery, The First Affiliated Hospital, Wenzhou Medical University, Wenzhou, China
| | - Chun-Feng Liu
- Department of Neurology, Suzhou Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University, Suzhou, China
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Tarnutzer AA, Straumann D, Salman MS. Neuro-ophthalmologic assessment and investigations in children and adults with cerebellar diseases. THE CEREBELLUM: FROM EMBRYOLOGY TO DIAGNOSTIC INVESTIGATIONS 2018; 154:305-327. [DOI: 10.1016/b978-0-444-63956-1.00019-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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16
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Jellinger KA. Potential clinical utility of multiple system atrophy biomarkers. Expert Rev Neurother 2017; 17:1189-1208. [DOI: 10.1080/14737175.2017.1392239] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Brooks SH, Klier EM, Red SD, Mehta ND, Patel SS, Chuang AZ, Suescun J, Schiess MC, Sereno AB. Slowed Prosaccades and Increased Antisaccade Errors As a Potential Behavioral Biomarker of Multiple System Atrophy. Front Neurol 2017; 8:261. [PMID: 28676787 PMCID: PMC5476968 DOI: 10.3389/fneur.2017.00261] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Accepted: 05/24/2017] [Indexed: 02/06/2023] Open
Abstract
Current clinical diagnostic tools are limited in their ability to accurately differentiate idiopathic Parkinson’s disease (PD) from multiple system atrophy (MSA) and other parkinsonian disorders early in the disease course, but eye movements may stand as objective and sensitive markers of disease differentiation and progression. To assess the use of eye movement performance for uniquely characterizing PD and MSA, subjects diagnosed with PD (N = 21), MSA (N = 11), and age-matched controls (C, N = 20) were tested on the prosaccade and antisaccade tasks using an infrared eye tracker. Twenty of these subjects were retested ~7 months later. Saccade latencies, error rates, and longitudinal changes in saccade latencies were measured. Both PD and MSA patients had greater antisaccade error rates than C subjects, but MSA patients exhibited longer prosaccade latencies than both PD and C patients. With repeated testing, antisaccade latencies improved over time, with benefits in C and PD but not MSA patients. In the prosaccade task, the normal latencies of the PD group show that basic sensorimotor oculomotor function remain intact in mid-stage PD, whereas the impaired latencies of the MSA group suggest additional degeneration earlier in the disease course. Changes in antisaccade latency appeared most sensitive to differences between MSA and PD across short time intervals. Therefore, in these mid-stage patients, increased antisaccade errors combined with slowed prosaccade latencies might serve as a useful marker for early differentiation between PD and MSA, and, antisaccade performance, a measure of MSA progression. Together, our findings suggest that eye movements are promising biomarkers for early differentiation and progression of parkinsonian disorders.
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Affiliation(s)
- Sarah H Brooks
- Department of Cognitive Sciences, Rice University, Houston, TX, United States.,Department of Neurobiology and Anatomy, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Eliana M Klier
- Department of Neurobiology and Anatomy, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Stuart D Red
- Department of Neurobiology and Anatomy, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Neeti D Mehta
- Department of Cognitive Sciences, Rice University, Houston, TX, United States
| | - Saumil S Patel
- Department of Neurobiology and Anatomy, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, United States.,Department of Neuroscience, Baylor College of Medicine, Houston, TX, United States
| | - Alice Z Chuang
- Department of Ophthalmology, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Jessika Suescun
- Department of Neurology, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Mya C Schiess
- Department of Neurology, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Anne B Sereno
- Department of Neurobiology and Anatomy, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, United States
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Terao Y, Fukuda H, Tokushige SI, Inomata-Terada S, Ugawa Y. How Saccade Intrusions Affect Subsequent Motor and Oculomotor Actions. Front Neurosci 2017; 10:608. [PMID: 28127274 PMCID: PMC5226964 DOI: 10.3389/fnins.2016.00608] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Accepted: 12/21/2016] [Indexed: 11/25/2022] Open
Abstract
In daily activities, there is a close spatial and temporal coupling between eye and hand movements that enables human beings to perform actions smoothly and accurately. If this coupling is disrupted by inadvertent saccade intrusions, subsequent motor actions suffer from delays, and lack of coordination. To examine how saccade intrusions affect subsequent voluntary actions, we used two tasks that require subjects to make motor/oculomotor actions in response to a visual cue. One was the memory guided saccade (MGS) task, and the other the hand reaction time (RT) task. The MGS task required subjects to initiate a voluntary saccade to a memorized target location, which is indicated shortly before by a briefly presented cue. The RT task required subjects to release a button on detection of a visual target, while foveating on a central fixation point. In normal subjects of various ages, inadvertent saccade intrusions delayed subsequent voluntary motor, and oculomotor actions. We also studied patients with Parkinson's disease (PD), who are impaired not only in initiating voluntary saccades but also in suppressing unwanted reflexive saccades. Saccade intrusions also delayed hand RT in PD patients. However, MGS was affected by the saccade intrusion differently. Saccade intrusion did not delay MGS latency in PD patients who could perform MGS with a relatively normal latency. In contrast, in PD patients who were unable to initiate MGS within the normal time range, we observed slightly decreased MGS latency after saccade intrusions. What explains this paradoxical phenomenon? It is known that motor actions slow down when switching between controlled and automatic behavior. We discuss how the effect of saccade intrusions on subsequent voluntary motor/oculomotor actions may reflect a similar switching cost between automatic and controlled behavior and a cost for switching between different motor effectors. In contrast, PD patients were unable to initiate internally guided MGS in the absence of visual target and could perform only automatic visually guided saccades, and did not have to switch between automatic and controlled behavior. This lack of switching may explain the shortening of MGS latency by the saccade intrusion in PD patients.
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Affiliation(s)
- Yasuo Terao
- Department of Neurology, University of TokyoTokyo, Japan; Department of Cell Physiology, Kyorin UniversityTokyo, Japan
| | - Hideki Fukuda
- Segawa Neurological Clinic for Children Tokyo, Japan
| | | | | | - Yoshikazu Ugawa
- Department of Neurology, School of Medicine, Fukushima Medical UniversityFukushima, Japan; Fukushima Global Medical Science Center, Advanced Clinical Research Center, Fukushima Medical UniversityFukushima, Japan
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TERAO Y, FUKUDA H, HIKOSAKA O. What do eye movements tell us about patients with neurological disorders? - An introduction to saccade recording in the clinical setting. PROCEEDINGS OF THE JAPAN ACADEMY. SERIES B, PHYSICAL AND BIOLOGICAL SCIENCES 2017; 93:772-801. [PMID: 29225306 PMCID: PMC5790757 DOI: 10.2183/pjab.93.049] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Accepted: 08/17/2017] [Indexed: 06/01/2023]
Abstract
Non-invasive and readily implemented in the clinical setting, eye movement studies have been conducted extensively not only in healthy human subjects but also in patients with neurological disorders. The purpose of saccade studies is to "read out" the pathophysiology underlying neurological disorders from the saccade records, referring to known primate physiology. In the current review, we provide an overview of studies in which we attempted to elucidate the patterns of saccade abnormalities in over 250 patients with neurological disorders, including cerebellar ataxia and brainstem pathology due to neurodegenerative disorders, and what they tell about the pathophysiology of patients with neurological disorders. We also discuss how interventions, such as deep brain stimulation, affect saccade performance and provide further insights into the workings of the oculomotor system in humans. Finally, we argue that it is important to understand the functional significance and behavioral correlate of saccade abnormalities in daily life, which could require eye tracking methodologies to be performed in settings similar to daily life.
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Affiliation(s)
- Yasuo TERAO
- Department of Cell Physiology, Kyorin University, Tokyo, Japan
| | | | - Okihide HIKOSAKA
- Section of Neuronal Networks, Laboratory of Sensorimotor Research, National Eye Institute, U.S.A.
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Distinguishing spinocerebellar ataxia with pure cerebellar manifestation from multiple system atrophy (MSA-C) through saccade profiles. Clin Neurophysiol 2016; 128:31-43. [PMID: 27866117 DOI: 10.1016/j.clinph.2016.10.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Revised: 09/30/2016] [Accepted: 10/15/2016] [Indexed: 11/20/2022]
Abstract
OBJECTIVE Patients with spinocerebellar ataxia with pure cerebellar presentation (SCD) and multiple system atrophy (MSA-C) show similar symptoms at early stages, although cerebellofugal pathology predominates in SCD, and cerebellopetal pathology in MSA-C. We studied whether saccade velocity profiles, which reflect the accelerating and braking functions of the cerebellum, can differentiate these two disorders. METHODS We recorded visually guided (VGS) and memory guided saccades (MGS) in 29 MSA-C patients, 12 SCD patients, and 92 age-matched normal subjects, and compared their amplitude, peak velocity and duration (accelerating and decelerating phases). RESULTS Hypometria predominated in VGS and MGS of MSA-C, whereas hypometria was less marked in SCD, with hypermetria frequently noted in MGS. Peak velocity was reduced, and deteriorated with advancing disease both in SCD and MSA-C groups at smaller target eccentricities. The deceleration phase was prolonged in SCD compared to MSA-C and normal groups at larger target eccentricities, which deteriorated with advancing disease. CONCLUSION Saccades in MSA-C were characterized by a more prominent acceleration deficit and those in SCD by a more prominent braking defect, possibly caused by the cerebellopetal and cerebellofugal pathologies, respectively. SIGNIFICANCE Saccade profiles provide important information regarding the accelerating and braking signals of the cerebellum in spinocerebellar ataxia.
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Robertson EE, Hall DA, McAsey AR, O'Keefe JA. Fragile X-associated tremor/ataxia syndrome: phenotypic comparisons with other movement disorders. Clin Neuropsychol 2016; 30:849-900. [PMID: 27414076 PMCID: PMC7336900 DOI: 10.1080/13854046.2016.1202239] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Accepted: 06/12/2016] [Indexed: 12/16/2022]
Abstract
OBJECTIVE The purpose of this paper is to review the typical cognitive and motor impairments seen in fragile X-associated tremor/ataxia syndrome (FXTAS), essential tremor (ET), Parkinson disease (PD), spinocerebellar ataxias (SCAs), multiple system atrophy (MSA), and progressive supranuclear palsy (PSP) in order to enhance diagnosis of FXTAS patients. METHODS We compared the cognitive and motor phenotypes of FXTAS with each of these other movement disorders. Relevant neuropathological and neuroimaging findings are also reviewed. Finally, we describe the differences in age of onset, disease severity, progression rates, and average lifespan in FXTAS compared to ET, PD, SCAs, MSA, and PSP. We conclude with a flow chart algorithm to guide the clinician in the differential diagnosis of FXTAS. RESULTS By comparing the cognitive and motor phenotypes of FXTAS with the phenotypes of ET, PD, SCAs, MSA, and PSP we have clarified potential symptom overlap while elucidating factors that make these disorders unique from one another. In summary, the clinician should consider a FXTAS diagnosis and testing for the Fragile X mental retardation 1 (FMR1) gene premutation if a patient over the age of 50 (1) presents with cerebellar ataxia and/or intention tremor with mild parkinsonism, (2) has the middle cerebellar peduncle (MCP) sign, global cerebellar and cerebral atrophy, and/or subcortical white matter lesions on MRI, or (3) has a family history of fragile X related disorders, intellectual disability, autism, premature ovarian failure and has neurological signs consistent with FXTAS. Peripheral neuropathy, executive function deficits, anxiety, or depression are supportive of the diagnosis. CONCLUSIONS Distinct profiles in the cognitive and motor domains between these movement disorders may guide practitioners in the differential diagnosis process and ultimately lead to better medical management of FXTAS patients.
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Affiliation(s)
- Erin E Robertson
- a Department of Anatomy and Cell Biology , Rush University , Chicago , IL , USA
| | - Deborah A Hall
- b Department of Neurological Sciences , Rush University , Chicago , IL , USA
| | - Andrew R McAsey
- a Department of Anatomy and Cell Biology , Rush University , Chicago , IL , USA
| | - Joan A O'Keefe
- a Department of Anatomy and Cell Biology , Rush University , Chicago , IL , USA
- b Department of Neurological Sciences , Rush University , Chicago , IL , USA
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Matsumoto H. A neurophysiological examination of basal ganglia and cerebellum. Clin Neurophysiol 2016; 127:1007-1008. [DOI: 10.1016/j.clinph.2015.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Revised: 08/05/2015] [Accepted: 08/11/2015] [Indexed: 10/23/2022]
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