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Ozturk U, Ozturk O. Index of cardio-electrophysiological balance and Parkinson disease. Medicine (Baltimore) 2023; 102:e35075. [PMID: 37713825 PMCID: PMC10508417 DOI: 10.1097/md.0000000000035075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 08/14/2023] [Indexed: 09/17/2023] Open
Abstract
Neurodegeneration of the autonomic nervous systems due to Parkinson disease (PD) may lead to increase in the QT duration. In recent years, a new parameter index of cardio-electrophysiological balance (ICEB) was found. ICEB is a significant parameter of medicine related dysrhythmia. The purpose of this research is to assess ICEB in PD. Twenty-eight PD cases and 26 controls participated in our investigation. First diagnosed PD patients were registered in the research. The symptom progression of PD was assessed Modified Hoehn and Yahr Scale. Analyzed ECG variables are QRS, PR, QT, corrected QT (QTc) interval, ICEB and corrected index of cardio-electrophysiological balance (ICEBc). All cases had sinus rhythm. ICEB was analyzed by the ratio of QT/QRS. ICEBc was analyzed by the ratio of QTc/QRS. Twenty-eight PD cases participated in this research. Among PD cases, 15 patients were female (53.5%). The mean age of PD patients are 59.03 ± 9.94 years. There was no important difference between groups with respect to the clinical variables. The Modified Hoehn and Yahr Scale was appreciably higher in the PD group than the Control group. The heart rate of the PD group was significantly lower than that of the control group. PR intervals and QRS duration were similar in both groups. QT and QTc duration were significantly longer in PD patients. Also, the ICEB and ICEBc variables were appreciably higher in PD cases. The findings of our investigation suggest that ICEB is related to PD. ICEB can help to evaluate arrhythmia risk in patients with PD.
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Affiliation(s)
- Unal Ozturk
- Department of Neurology, Health Sciences University of Turkey, Diyarbakir Gazi Yasargil Education and Research Hospital, Diyarbakir, Turkey
| | - Onder Ozturk
- Department of Cardiology, Health Sciences University of Turkey, Diyarbakir Gazi Yasargil Education and Research Hospital, Diyarbakir, Turkey
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Lee B, Edling C, Ahmad S, LeBeau FEN, Tse G, Jeevaratnam K. Clinical and Non-Clinical Cardiovascular Disease Associated Pathologies in Parkinson's Disease. Int J Mol Sci 2023; 24:12601. [PMID: 37628780 PMCID: PMC10454288 DOI: 10.3390/ijms241612601] [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: 05/25/2023] [Revised: 07/30/2023] [Accepted: 07/31/2023] [Indexed: 08/27/2023] Open
Abstract
Despite considerable breakthroughs in Parkinson's disease (PD) research, understanding of non-motor symptoms (NMS) in PD remains limited. The lack of basic level models that can properly recapitulate PD NMS either in vivo or in vitro complicates matters. Even so, recent research advances have identified cardiovascular NMS as being underestimated in PD. Considering that a cardiovascular phenotype reflects sympathetic autonomic dysregulation, cardiovascular symptoms of PD can play a pivotal role in understanding the pathogenesis of PD. In this study, we have reviewed clinical and non-clinical published papers with four key parameters: cardiovascular disease risks, electrocardiograms (ECG), neurocardiac lesions in PD, and fundamental electrophysiological studies that can be linked to the heart. We have highlighted the points and limitations that the reviewed articles have in common. ECG and pathological reports suggested that PD patients may undergo alterations in neurocardiac regulation. The pathological evidence also suggested that the hearts of PD patients were involved in alpha-synucleinopathy. Finally, there is to date little research available that addresses the electrophysiology of in vitro Parkinson's disease models. For future reference, research that can integrate cardiac electrophysiology and pathological alterations is required.
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Affiliation(s)
- Bonn Lee
- School of Veterinary Medicine, Faculty of Health and Medical Sciences, University of Surrey, VSM Building, Daphne Jackson Road, Guildford GU2 7YW, UK; (B.L.); (C.E.); (S.A.); (G.T.)
| | - Charlotte Edling
- School of Veterinary Medicine, Faculty of Health and Medical Sciences, University of Surrey, VSM Building, Daphne Jackson Road, Guildford GU2 7YW, UK; (B.L.); (C.E.); (S.A.); (G.T.)
| | - Shiraz Ahmad
- School of Veterinary Medicine, Faculty of Health and Medical Sciences, University of Surrey, VSM Building, Daphne Jackson Road, Guildford GU2 7YW, UK; (B.L.); (C.E.); (S.A.); (G.T.)
| | - Fiona E. N. LeBeau
- Biosciences Institute, Faculty of Medical Sciences, The Medical School, Newcastle University, Framlington Place, Newcastle upon Tyne NE2 4HH, UK;
| | - Gary Tse
- School of Veterinary Medicine, Faculty of Health and Medical Sciences, University of Surrey, VSM Building, Daphne Jackson Road, Guildford GU2 7YW, UK; (B.L.); (C.E.); (S.A.); (G.T.)
- Kent and Medway Medical School, University of Kent and Canterbury Christ Church University, Canterbury CT2 7FS, UK
| | - Kamalan Jeevaratnam
- School of Veterinary Medicine, Faculty of Health and Medical Sciences, University of Surrey, VSM Building, Daphne Jackson Road, Guildford GU2 7YW, UK; (B.L.); (C.E.); (S.A.); (G.T.)
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3
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Baschieri F, Vitiello M, Cortelli P, Calandra-Buonaura G, Morgante F. Autonomic dysfunction in progressive supranuclear palsy. J Neurol 2023; 270:109-129. [PMID: 36042018 DOI: 10.1007/s00415-022-11347-w] [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: 06/30/2022] [Revised: 08/16/2022] [Accepted: 08/17/2022] [Indexed: 01/07/2023]
Abstract
BACKGROUND The degree of involvement of the autonomic nervous system in progressive supranuclear palsy (PSP) has been investigated in several studies, often providing conflicting results. There is a need for a better characterization of autonomic dysfunction in PSP, to enhance our understanding of this highly disabling neurodegenerative disease including patients' needs and possibly be of value for clinicians in the differential diagnosis among Parkinsonian syndromes. METHODS We applied a systematic methodology to review existing literature on Pubmed regarding autonomic nervous system involvement in PSP. RESULTS PSP reported quite frequently symptoms suggestive of autonomic dysfunction in all domains. Cardiovascular autonomic testing showed in some cases a certain degree of impairment (never severe). There was some evidence suggesting bladder dysfunction particularly in the storage phase. Dysphagia and constipation were the most common gastrointestinal symptoms. Instrumental tests seemed to confirm sudomotor and pupillomotor disturbances. CONCLUSIONS PSP patients frequently reported visceral symptoms, however objective testing showed that not always these reflected actual autonomic impairment. Further studies are needed to better delineate autonomic profile and its prognostic role in PSP.
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Affiliation(s)
- Francesca Baschieri
- Dipartimento di Scienze Biomediche e Neuromotorie, Università di Bologna, Bologna, Italy
| | - Maria Vitiello
- Neurology Unit, "M. Bufalini" Hospital, AUSL Romagna, Cesena, Italy
| | - Pietro Cortelli
- Dipartimento di Scienze Biomediche e Neuromotorie, Università di Bologna, Bologna, Italy
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Giovanna Calandra-Buonaura
- Dipartimento di Scienze Biomediche e Neuromotorie, Università di Bologna, Bologna, Italy.
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy.
| | - Francesca Morgante
- Neurosciences Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, London, UK
- Department of Experimental and Clinical Medicine, University of Messina, Messina, Italy
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Kermorgant M, Fernagut PO, Meissner WG, Arvanitis DN, N'Guyen D, Senard JM, Pavy-Le Traon A. Age and Gender Differences in Cardiovascular Autonomic Failure in the Transgenic PLP-syn Mouse, a Model of Multiple System Atrophy. Front Neurol 2022; 13:874155. [PMID: 35720100 PMCID: PMC9201283 DOI: 10.3389/fneur.2022.874155] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 05/11/2022] [Indexed: 12/02/2022] Open
Abstract
Multiple system atrophy (MSA) is a rare and progressive neurodegenerative disorder. Autonomic failure (AF) is one main clinical feature which has a significant impact on health-related quality of life. The neuropathological hallmark of MSA is the abnormal accumulation of α-synuclein in oligodendrocytes forming glial cytoplasmic inclusions. Only little is known about gender and age differences in AF in MSA. This study was carried out in 6 and 12 months old transgenic PLP-α-syn and WT male and female mice. Heart rate variability (HRV) was assessed both in time, frequential and non-linear domains. Baroreflex sensitivity (BRS) was estimated by the sequence method. Duration of ventricular depolarization and repolarization (QT/QTc intervals) were evaluated from the ECG signals. Three-way ANOVA (genotype x gender x age) with Sidak's method post-hoc was used to analyze data. BRS was significantly changed in PLP-α-syn mice and was age-dependent. QT and QTc intervals were not significantly modified in PLP-α-syn mice. An impaired HRV was observed at 12 months of age in PLP-α-syn female but not in male mice, indicative of cardiovascular AF.
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Affiliation(s)
- Marc Kermorgant
- INSERM DR Midi-Pyrénées Limousin, Institute of Cardiovascular and Metabolic Diseases (I2MC) UMR1297, University Hospital of Toulouse, Toulouse, France
- French Reference Center for Multiple System Atrophy, Neurology Department, University Hospital of Toulouse, Toulouse, France
- *Correspondence: Marc Kermorgant
| | - Pierre-Olivier Fernagut
- Univ. Bordeaux, CNRS, IMN, UMR 5293, Bordeaux, France
- Laboratoire de Neurosciences Expérimentales et Cliniques INSERM U1084, University of Poitiers, Poitiers, France
| | - Wassilios G. Meissner
- Univ. Bordeaux, CNRS, IMN, UMR 5293, Bordeaux, France
- CRMR AMS, Service de Neurologie - Maladies Neurodégénératives, CHU de Bordeaux, Bordeaux, France
- Department of Medicine, University of Otago, Christchurch, New Zealand
- New Zealand Brain Research Institute, Christchurch, New Zealand
| | - Dina N. Arvanitis
- INSERM DR Midi-Pyrénées Limousin, Institute of Cardiovascular and Metabolic Diseases (I2MC) UMR1297, University Hospital of Toulouse, Toulouse, France
| | - Du N'Guyen
- INSERM DR Midi-Pyrénées Limousin, Institute of Cardiovascular and Metabolic Diseases (I2MC) UMR1297, University Hospital of Toulouse, Toulouse, France
| | - Jean-Michel Senard
- INSERM DR Midi-Pyrénées Limousin, Institute of Cardiovascular and Metabolic Diseases (I2MC) UMR1297, University Hospital of Toulouse, Toulouse, France
- Department of Clinical Pharmacology, University Hospital of Toulouse, Toulouse, France
| | - Anne Pavy-Le Traon
- INSERM DR Midi-Pyrénées Limousin, Institute of Cardiovascular and Metabolic Diseases (I2MC) UMR1297, University Hospital of Toulouse, Toulouse, France
- French Reference Center for Multiple System Atrophy, Neurology Department, University Hospital of Toulouse, Toulouse, France
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Shinoda L, Damasceno L, Freitas L, Campos R, Cravo S, Scorza CA, Scorza FA, Faber J. Cardiac and Autonomic Dysfunctions Assessed Through Recurrence Quantitative Analysis of Electrocardiogram Signals and an Application to the 6-Hydroxydopamine Parkinson's Disease Animal Model. Front Physiol 2021; 12:725218. [PMID: 34899371 PMCID: PMC8653697 DOI: 10.3389/fphys.2021.725218] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 10/08/2021] [Indexed: 12/29/2022] Open
Abstract
A classic method to evaluate autonomic dysfunction is through the evaluation of heart rate variability (HRV). HRV provides a series of coefficients, such as Standard Deviation of n-n intervals (SDNN) and Root Mean Square of Successive Differences (RMSSD), which have well-established physiological associations. However, using only electrocardiogram (ECG) signals, it is difficult to identify proper autonomic activity, and the standard techniques are not sensitive and robust enough to distinguish pure autonomic modulation in heart dynamics from cardiac dysfunctions. In this proof-of-concept study we propose the use of Poincaré mapping and Recurrence Quantification Analysis (RQA) to identify and characterize stochasticity and chaoticity dynamics in ECG recordings. By applying these non-linear techniques in the ECG signals recorded from a set of Parkinson’s disease (PD) animal model 6-hydroxydopamine (6-OHDA), we showed that they present less variability in long time epochs and more stochasticity in short-time epochs, in their autonomic dynamics, when compared with those of the sham group. These results suggest that PD animal models present more “rigid heart rate” associated with “trembling ECG” and bradycardia, which are direct expressions of Parkinsonian symptoms. We also compared the RQA factors calculated from the ECG of animal models using four computational ECG signals under different noise and autonomic modulatory conditions, emulating the main ECG features of atrial fibrillation and QT-long syndrome.
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Affiliation(s)
- Lucas Shinoda
- Neuroscience Division, Department of Neurology and Neurosurgery, Escola Paulista de Medicina, Federal University of São Paulo, São Paulo, Brazil
| | - Laís Damasceno
- Neuroscience Division, Department of Neurology and Neurosurgery, Escola Paulista de Medicina, Federal University of São Paulo, São Paulo, Brazil
| | - Leandro Freitas
- Neuroscience Division, Department of Neurology and Neurosurgery, Escola Paulista de Medicina, Federal University of São Paulo, São Paulo, Brazil
| | - Ruy Campos
- Cardiovascular Division, Department of Physiology, Escola Paulista de Medicina, Federal University of São Paulo, São Paulo, Brazil
| | - Sergio Cravo
- Cardiovascular Division, Department of Physiology, Escola Paulista de Medicina, Federal University of São Paulo, São Paulo, Brazil
| | - Carla A Scorza
- Neuroscience Division, Department of Neurology and Neurosurgery, Escola Paulista de Medicina, Federal University of São Paulo, São Paulo, Brazil
| | - Fúlvio A Scorza
- Neuroscience Division, Department of Neurology and Neurosurgery, Escola Paulista de Medicina, Federal University of São Paulo, São Paulo, Brazil
| | - Jean Faber
- Neuroscience Division, Department of Neurology and Neurosurgery, Escola Paulista de Medicina, Federal University of São Paulo, São Paulo, Brazil.,Nucleus of Neuroengineering and Computation, Institute of Science and Technology, Federal University of São Paulo, São Paulo, Brazil
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Marsili L, Giannini G, Cortelli P, Colosimo C. Early recognition and diagnosis of multiple system atrophy: best practice and emerging concepts. Expert Rev Neurother 2021; 21:993-1004. [PMID: 34253122 DOI: 10.1080/14737175.2021.1953984] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Introduction: Multiple system atrophy (MSA) is a progressive degenerative disorder of the central and autonomic nervous systems characterized by parkinsonism, cerebellar ataxia, dysautonomia, and pyramidal signs. The confirmatory diagnosis is pathological, but clinical-diagnostic criteria have been developed to help clinicians. To date, the early diagnosis of MSA is challenging due to the lack of reliable diagnostic biomarkers.Areas covered: The authors reappraised the main clinical, neurophysiological, imaging, genetic, and laboratory evidence to help in the early diagnosis of MSA in the clinical and in the research settings. They also addressed the practical clinical issues in the differential diagnosis between MSA and other parkinsonian and cerebellar syndromes. Finally, the authors summarized the unmet needs in the early diagnosis of MSA and proposed the next steps for future research efforts in this field.Expert opinion: In the last decade, many advances have been achieved to help the correct MSA diagnosis since early stages. In the next future, the early diagnosis and correct classification of MSA, together with a better knowledge of the causative mechanisms of the disease, will hopefully allow the identification of suitable candidates to enroll in clinical trials and select the most appropriate disease-modifying strategies to slow down disease progression.
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Affiliation(s)
- Luca Marsili
- Gardner Family Center for Parkinson's Disease and Movement Disorders, Department of Neurology, University of Cincinnati, Cincinnati, OH, USA
| | - Giulia Giannini
- IRCCS Istituto delle Scienze Neurologiche di Bologna, UOC Clinica Neurologica NeuroMet, Ospedale Bellaria, Bologna, Italy.,Dipartimento di Scienze Biomediche e Neuromotorie, Università Bologna, Bologna, Italy
| | - Pietro Cortelli
- IRCCS Istituto delle Scienze Neurologiche di Bologna, UOC Clinica Neurologica NeuroMet, Ospedale Bellaria, Bologna, Italy.,Dipartimento di Scienze Biomediche e Neuromotorie, Università Bologna, Bologna, Italy
| | - Carlo Colosimo
- Department of Neurology, Santa Maria University Hospital, Terni, Italy
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Malkiewicz JJ, Malkiewicz M, Siuda J. Prevalence of QTc Prolongation in Patients with Parkinson's Disease. Assessment of the Effects of Drugs, Clinical Risk Factors and Used Correction Formula. J Clin Med 2021; 10:1396. [PMID: 33807236 PMCID: PMC8037693 DOI: 10.3390/jcm10071396] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 03/17/2021] [Accepted: 03/26/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Parkinson's disease (PD) is a possible risk factor for corrected QT interval (QTc) prolongation. PD patients frequently take QTc-prolonging drugs. The aim of the study was to assess the prevalence of QTc prolongation in PD and the influence of drugs and other potential risk factors on the QTc length in PD. METHODS 101 patients with PD and a good quality ECG were included in the study. The prolonged QTc was defined as ≥450 ms for men and ≥460 ms for women. Bazett's (QTcB) and Framingham (QTcF) formulas were utilized to calculate QTc. Data about sex, age, PD duration, disease's severity, comorbidities and QTc-prolonging drugs were collected. Multiple linear regressions with backward elimination were used to assess factors influencing the QTc. RESULTS A long QTc was presented in 13 patients (12.9%) for QTcB and 4 patients (4%) for QTcF. Longer QTc in PD patients was associated with older age, male sex and QTc-prolonging drugs regardless of the used formula. The QTcB was also significantly affected by the heart rate (HR). CONCLUSION QTc prolongation is common in PD. Age, drugs and male gender are potential risk factors for QTc prolongation in PD.
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Affiliation(s)
- Jakub J. Malkiewicz
- Department of Neurology, Faculty of Medical Sciences in Katowice, Medical University of Silesia in Katowice, University Clinical Center Prof. K. Gibiński, 14 Medyków Street, 40-752 Katowice, Poland;
| | - Maciej Malkiewicz
- Department of Gastroenterology with Subdivision of Internal Medicine, John Paul II Memorial Beskid Center of Oncology—Municipal Hospital in Bielsko Biala, 21 Stanisława Wyspiańskiego Street, 43-300 Bielsko-Biała, Poland;
| | - Joanna Siuda
- Department of Neurology, Faculty of Medical Sciences in Katowice, Medical University of Silesia in Katowice, University Clinical Center Prof. K. Gibiński, 14 Medyków Street, 40-752 Katowice, Poland;
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Zhong LL, Song YQ, Ju KJ, Chen AN, Cao H. Electrocardiogram Characteristics of Different Motor Types of Parkinson's Disease. Int J Gen Med 2021; 14:1057-1061. [PMID: 33790634 PMCID: PMC8006959 DOI: 10.2147/ijgm.s296769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 01/28/2021] [Indexed: 11/23/2022] Open
Abstract
AIM This study aims to investigate the electrocardiogram characteristics of the different motor types of Parkinson's disease. METHODS The data on 118 patients with Parkinson's disease (PD), who were initially diagnosed in the Outpatient and Inpatient Department, was collected. Among these 118 PD patients, 74 patients were assigned to the PIGD group, while 44 patients were assigned to the TD group, and their clinical features were analyzed, which included age, course, disease classification, and electrocardiogram parameters (PR, QRS, QT interval, and QTC). RESULTS The QT interval in PD patients was positively correlated with the course of the disease and Hoehn-Yahr stage, and the QT interval in the PIGD group was longer than that in the TD group. CONCLUSION A prolonged QT interval may indicate a longer disease period and a more severe disease condition.
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Affiliation(s)
- Ling-Ling Zhong
- Department of Neurology, The Affiliated Huaian No. 1 People’s Hospital of Nanjing Medical University, Huai’an, Jiangsu, People’s Republic of China
| | - Ya-Qi Song
- Department of Radiation Oncology, The Affiliated Huaian No. 1 People’s Hospital of Nanjing Medical University, Huai’an, Jiangsu, People’s Republic of China
| | - Ke-Ju Ju
- Department of Neurology, The Affiliated Huaian No. 1 People’s Hospital of Nanjing Medical University, Huai’an, Jiangsu, People’s Republic of China
| | - Ai-Nian Chen
- Department of Neurology, The Affiliated Huaian No. 1 People’s Hospital of Nanjing Medical University, Huai’an, Jiangsu, People’s Republic of China
| | - Hua Cao
- Department of Neurology, The Affiliated Huaian No. 1 People’s Hospital of Nanjing Medical University, Huai’an, Jiangsu, People’s Republic of China
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9
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Torres-Yaghi Y, Carwin A, Carolan J, Nakano S, Amjad F, Pagan F. QTc Interval Prolongation with Therapies Used to Treat Patients with Parkinson's Disease Psychosis: A Narrative Review. Neuropsychiatr Dis Treat 2021; 17:3791-3818. [PMID: 34992373 PMCID: PMC8714013 DOI: 10.2147/ndt.s324145] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 11/19/2021] [Indexed: 11/30/2022] Open
Abstract
In addition to the classic motor symptoms of Parkinson's disease (PD), people with PD frequently experience nonmotor symptoms that can include autonomic dysfunction and neuropsychiatric symptoms such as PD psychosis (PDP). Common patient characteristics, including older age, use of multiple medications, and arrhythmias, are associated with increased risk of corrected QT interval (QTc) prolongation, and treatments for PDP (antipsychotics, dementia medications) may further increase this risk. This review evaluates how medications used to treat PDP affect QTc interval from literature indexed in the PubMed and Embase databases. Although not indicated for the treatment of psychosis, dementia therapies such as donepezil, rivastigmine, memantine, and galantamine are often used with or without antipsychotics and have minimal effects on QTc interval. Among the antipsychotics, data suggesting clinically meaningful QTc interval prolongation are limited. However, many antipsychotics have other safety concerns. Aripiprazole, olanzapine, and risperidone negatively affect motor function and are not recommended for PDP. Quetiapine is often sedating, can exacerbate underlying neurogenic orthostatic hypotension, and may prolong the QTc interval. Pimavanserin was approved by the US Food and Drug Administration (FDA) in 2016 and remains the only FDA-approved medication available to treat hallucinations and delusions associated with PDP. However, pimavanserin can increase QTc interval by approximately 5-8 ms. The potential for QTc prolongation should be considered in patients with symptomatic cardiac arrhythmias and those receiving QT-prolonging medications. In choosing a medication to treat PDP, expected efficacy must be balanced with potential safety concerns for individual patients.
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Affiliation(s)
- Yasar Torres-Yaghi
- Department of Neurology, National Parkinson's Foundation Center for Excellence, Translational Neurotherapeutics Program, Movement Disorders Program, MedStar Georgetown University Hospital, Washington, DC, USA
| | - Amelia Carwin
- Department of Neurology, National Parkinson's Foundation Center for Excellence, Translational Neurotherapeutics Program, Movement Disorders Program, MedStar Georgetown University Hospital, Washington, DC, USA
| | - Jacob Carolan
- Department of Neurology, National Parkinson's Foundation Center for Excellence, Translational Neurotherapeutics Program, Movement Disorders Program, MedStar Georgetown University Hospital, Washington, DC, USA
| | - Steven Nakano
- Department of Neurology, National Parkinson's Foundation Center for Excellence, Translational Neurotherapeutics Program, Movement Disorders Program, MedStar Georgetown University Hospital, Washington, DC, USA
| | - Fahd Amjad
- Department of Neurology, National Parkinson's Foundation Center for Excellence, Translational Neurotherapeutics Program, Movement Disorders Program, MedStar Georgetown University Hospital, Washington, DC, USA
| | - Fernando Pagan
- Department of Neurology, National Parkinson's Foundation Center for Excellence, Translational Neurotherapeutics Program, Movement Disorders Program, MedStar Georgetown University Hospital, Washington, DC, USA
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10
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Abstract
PURPOSE OF REVIEW The present article reviews the pathophysiology of cardiac sympathetic denervation, the principles of positron emission tomography (PET) imaging of the sympathetic innervation of the heart and its potential clinical role, based on current and expected future evidence. RECENT FINDINGS Imaging of cardiac sympathetic denervation can be performed with radiolabeled noradrenaline analogues, e.g., 11C-hydroxyephedrine. A greater burden of sympathetic denervation carries prognostic significance, e.g., in patients with ischemic cardiomyopathy and a left ventricular ejection fraction ≤ 35%, who are more likely to experience sudden cardiac death. Abnormalities of sympathetic cardiac innervation have been demonstrated in hypertrophic, dilated, and arrhythmic right ventricular cardiomyopathies, and may be helpful in better phenotyping patients who will benefit from device therapy, e.g., cardiac resynchronization and implantable cardioverter-defibrillator implantation. The results of future trials, e.g., the Prediction of Arrhythmic Events with Positron Emission Tomography (PAREPET) II study, are awaited to inform on the role of PET cardiac sympathetic imaging in the selection of device therapy. PET cardiac sympathetic innervation imaging allows visualization and quantification of autonomic denervation secondary to various cardiac diseases, and has significant potential to influence clinical decision-making, e.g., the titration of pharmacotherapy and more directed selection of candidates for device implantation.
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11
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Pellecchia MT, Stankovic I, Fanciulli A, Krismer F, Meissner WG, Palma JA, Panicker JN, Seppi K, Wenning GK. Can Autonomic Testing and Imaging Contribute to the Early Diagnosis of Multiple System Atrophy? A Systematic Review and Recommendations by the Movement Disorder Society Multiple System Atrophy Study Group. Mov Disord Clin Pract 2020; 7:750-762. [PMID: 33043073 DOI: 10.1002/mdc3.13052] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 05/08/2020] [Accepted: 05/23/2020] [Indexed: 01/01/2023] Open
Abstract
Background In the current consensus diagnostic criteria, the diagnosis of probable multiple system atrophy (MSA) is based solely on clinical findings, whereas neuroimaging findings are listed as aid for the diagnosis of possible MSA. There are overlapping phenotypes between MSA-parkinsonian type and Parkinson's disease, progressive supranuclear palsy, and dementia with Lewy bodies, and between MSA-cerebellar type and sporadic adult-onset ataxia resulting in a significant diagnostic delay and misdiagnosis of MSA during life. Objectives In light of an ongoing effort to revise the current consensus criteria for MSA, the Movement Disorders Society Multiple System Atrophy Study Group performed a systematic review of original articles published before August 2019. Methods We included articles that studied at least 10 patients with MSA as well as participants with another disorder or control group for comparison purposes. MSA was defined by neuropathological confirmation, or as clinically probable, or clinically probable plus possible according to consensus diagnostic criteria. Results We discuss the pitfalls and benefits of each diagnostic test and provide specific recommendations on how to evaluate patients in whom MSA is suspected. Conclusions This systematic review of relevant studies indicates that imaging and autonomic function tests significantly contribute to increasing the accuracy of a diagnosis of MSA.
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Affiliation(s)
- Maria Teresa Pellecchia
- Center for Neurodegenerative Diseases, Department of Medicine, Neuroscience Section, University of Salerno Fisciano Italy
| | - Iva Stankovic
- Neurology Clinic, Clinical Center of Serbia School of Medicine, University of Belgrade Belgrade Serbia
| | | | - Florian Krismer
- Department of Neurology Innsbruck Medical University Innsbruck Austria
| | - Wassilios G Meissner
- French Reference Center for MSA, Department of Neurology University Hospital Bordeaux, Bordeaux and Institute of Neurodegenerative Disorders, University Bordeaux, Centre National de la Recherche Scientifique Unite Mixte de Recherche Bordeaux Bordeaux France
| | - Jose-Alberto Palma
- Dysautonomia Center, Langone Medical Center New York University School of Medicine New York New York USA
| | - Jalesh N Panicker
- Institute of Neurology, University College London London United Kingdom.,Department of Uro-Neurology The National Hospital for Neurology and Neurosurgery London United Kingdom
| | - Klaus Seppi
- Department of Neurology Innsbruck Medical University Innsbruck Austria
| | - Gregor K Wenning
- Department of Neurology Innsbruck Medical University Innsbruck Austria
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The environmental toxicant ziram enhances neurotransmitter release and increases neuronal excitability via the EAG family of potassium channels. Neurobiol Dis 2020; 143:104977. [PMID: 32553709 DOI: 10.1016/j.nbd.2020.104977] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Revised: 06/11/2020] [Accepted: 06/13/2020] [Indexed: 12/21/2022] Open
Abstract
Environmental toxicants have the potential to contribute to the pathophysiology of multiple complex diseases, but the underlying mechanisms remain obscure. One such toxicant is the widely used fungicide ziram, a dithiocarbamate known to have neurotoxic effects and to increase the risk of Parkinson's disease. We have used Drosophila melanogaster as an unbiased discovery tool to identify novel molecular pathways by which ziram may disrupt neuronal function. Consistent with previous results in mammalian cells, we find that ziram increases the probability of synaptic vesicle release by dysregulation of the ubiquitin signaling system. In addition, we find that ziram increases neuronal excitability. Using a combination of live imaging and electrophysiology, we find that ziram increases excitability in both aminergic and glutamatergic neurons. This increased excitability is phenocopied and occluded by null mutant animals of the ether a-go-go (eag) potassium channel. A pharmacological inhibitor of the temperature sensitive hERG (human ether-a-go-go related gene) phenocopies the excitability effects of ziram but only at elevated temperatures. seizure (sei), a fly ortholog of hERG, is thus another candidate target of ziram. Taken together, the eag family of potassium channels emerges as a candidate for mediating some of the toxic effects of ziram. We propose that ziram may contribute to the risk of complex human diseases by blockade of human eag and sei orthologs, such as hERG.
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13
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Sabino-Carvalho JL, Vianna LC. Altered cardiorespiratory regulation during exercise in patients with Parkinson's disease: A challenging non-motor feature. SAGE Open Med 2020; 8:2050312120921603. [PMID: 32435491 PMCID: PMC7222646 DOI: 10.1177/2050312120921603] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Accepted: 04/03/2020] [Indexed: 01/27/2023] Open
Abstract
The incidence of Parkinson’s disease is increasing worldwide. The motor dysfunctions are the hallmark of the disease, but patients also experience non-motor impairments, and over 40% of the patients experience coexistent abnormalities, such as orthostatic hypotension. Exercise training has been suggested as a coping resource to alleviate Parkinson’s disease symptoms and delay disease progression. However, the body of knowledge is showing that the cardiovascular response to exercise in patients with Parkinson’s disease is altered. Adequate cardiovascular and hemodynamic adjustments to exercise are necessary to meet the metabolic demands of working skeletal muscle properly. Therefore, since Parkinson’s disease affects parasympathetic and sympathetic branches of the autonomic nervous system and the latter are crucial in ensuring these adjustments are adequately made, the understanding of these responses during exercise in this population is necessary. Several neural control mechanisms are responsible for the autonomic changes in the cardiovascular and hemodynamic systems seen during exercise. In this sense, the purpose of the present work is to review the current knowledge regarding the cardiovascular responses to dynamic and isometric/resistance exercise as well as the mechanisms by which the body maintains appropriate perfusion pressure to all organs during exercise in patients with Parkinson’s disease. Results from patients with Parkinson’s disease and animal models of Parkinson’s disease provide the reader with a well-rounded knowledge base. Through this, we will highlight what is known and not known about how the neural control of circulation is responding during exercise and the adaptations that occur when individuals exercise regularly.
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Affiliation(s)
- Jeann L Sabino-Carvalho
- NeuroV̇ASQ̇-Integrative Physiology Laboratory, Faculty of Physical Education, University of Brasília, Brasília, Brazil
| | - Lauro C Vianna
- NeuroV̇ASQ̇-Integrative Physiology Laboratory, Faculty of Physical Education, University of Brasília, Brasília, Brazil.,Graduate Program in Medical Sciences, Faculty of Medicine, University of Brasília, Brasília, Brazil
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14
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Mamalyga ML, Mamalyga LM. [Circadian changes in the structure of cardiac rhythm during pre-symptomatic and symptomatic stages of Parkinson's disease]. Zh Nevrol Psikhiatr Im S S Korsakova 2018; 118:85-90. [PMID: 30251984 DOI: 10.17116/jnevro201811808185] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
AIM To study circadian regulation of heart rhythm during the pre-symptomatic (PS) and early symptomatic (ESS) stages of Parkinson's disease (PD) and determine the functionally most unfavorable periods during which there is a risk of life-threatening arrhythmias. MATERIAL AND METHODS The studies were performed on C57BL/6 mice. ECG monitoring was performed in online mode using a wireless telemetry system (ADInstruments Australia). RESULTS Characteristics of circadian changes heart rate during PS and ESS of PD were detected. During PS changes in the autonomic regulation of the heart occur at night. The increase at this time of the parasympathetic tone indicates compensatory mechanisms that prevent changes in the total power spectrum. However, they can't prevent the high risk of life-threatening arrhythmias. The early symptomatic stage leads to the changes in mechanisms of not only sympathetic, but also parasympathetic regulation of the heart, increase in sympathetic tone and disturbed structure of the heart rhythm over most of the day. The decrease in the total power of the spectrum indicates a decrease in the adaptive capacity of the cardiovascular system. The increase in the intervals of QT, QTc and Tpeak Tend, indicates a risk of life-threatening arrhythmias. CONCLUSION PD predetermines complications of circadian autonomic regulation of the heart during PS and ESS, which can become the pathogenetic basis for severe cerebrocardial disorders.
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Affiliation(s)
- M L Mamalyga
- Bakulev National Medical Research Center of Cardiovascular Surgery, Moscow, Russia
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15
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A molecular pathway analysis informs the genetic risk for arrhythmias during antipsychotic treatment. Int Clin Psychopharmacol 2018; 33:1-14. [PMID: 29064910 DOI: 10.1097/yic.0000000000000198] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Arrhythmias are a frequent and potentially fatal side effect of antipsychotic treatment. Strict ECG monitoring and clinical interviews are the standards used to prevent arrhythmias. A biologic predictive tool is missing. The identification of a genetic makeup at risk of antipsychotic-induced arrhythmias is the aim of the present investigation. The aim of this study was to identify a molecular pathway enriched in single nucleotide polymorphisms associated with antipsychotic-induced QTc modifications. In total, 661 schizophrenic individuals from the CATIE study, M=486 (73.52%), mean age=40.92±11.02, were included. QTc variation was measured as a phase-specific change-created variable. A nested mixed regression for a repeated-measures model served in R for the analysis of the clinical and treatment-related covariates and molecular pathway analysis. Plink was used for the genetic genome-wide analysis. Quality checking was the standard (genotype call rate>0.95; minor allele frequency>0.01; Hardy-Weinberg equilibrium<0.0001) and the inflation factor was controlled by λ values. Quetiapine and perphenazine were associated with QTc variation during phase 1. No other significant association was detected. No significant inflation was detected. A number of molecular pathways were associated with QT variation at a conservative (adjusted) P value less than 0.05, including pathways related to neuronal wiring and collagen biosynthesis, along with pathways related to K+ currents and cardiac contraction. Pathways related to neuronal wiring, collagen biosynthesis, and ion currents were identified as possibly involved in QTc modifications during antispsychotic treatment in SKZ patients.
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16
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Tahsili-Fahadan P, Geocadin RG. Heart-Brain Axis: Effects of Neurologic Injury on Cardiovascular Function. Circ Res 2017; 120:559-572. [PMID: 28154104 DOI: 10.1161/circresaha.116.308446] [Citation(s) in RCA: 152] [Impact Index Per Article: 21.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Revised: 01/06/2017] [Accepted: 01/06/2017] [Indexed: 01/23/2023]
Abstract
A complex interaction exists between the nervous and cardiovascular systems. A large network of cortical and subcortical brain regions control cardiovascular function via the sympathetic and parasympathetic outflow. A dysfunction in one system may lead to changes in the function of the other. The effects of cardiovascular disease on the nervous system have been widely studied; however, our understanding of the effects of neurological disorders on the cardiovascular system has only expanded in the past 2 decades. Various pathologies of the nervous system can lead to a wide range of alterations in function and structure of the cardiovascular system ranging from transient and benign electrographic changes to myocardial injury, cardiomyopathy, and even cardiac death. In this article, we first review the anatomy and physiology of the central and autonomic nervous systems in regard to control of the cardiovascular function. The effects of neurological injury on cardiac function and structure will be summarized, and finally, we review neurological disorders commonly associated with cardiovascular manifestations.
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Affiliation(s)
- Pouya Tahsili-Fahadan
- From the Neurosciences Critical Care Division, Departments of Neurology, Anesthesiology & Critical Care Medicine, and Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, MD
| | - Romergryko G Geocadin
- From the Neurosciences Critical Care Division, Departments of Neurology, Anesthesiology & Critical Care Medicine, and Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, MD.
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17
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Autonomic and electrocardiographic findings in Parkinson's disease. Auton Neurosci 2017; 205:93-98. [PMID: 28506500 DOI: 10.1016/j.autneu.2017.04.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Revised: 04/12/2017] [Accepted: 04/13/2017] [Indexed: 11/22/2022]
Abstract
Parkinson disease (PD) is a progressive neurodegenerative disorder characterized by motor and non-motor symptoms and signs. Many reports suggest that diminished heart rate variability occurs early, even prior to the cardinal signs of PD. In a longitudinal study of PD, we evaluated whether heart rate variability (HRV) obtained using a 10-second ECG tracing, and the electrocardiographic QT-interval would be associated with PD severity and progression. Subjects were derived from a longitudinal study of 1741 individuals with early, stable PD. The severity of PD was measured using the global statistical test (GST). In a subset, the heart rate corrected QT-interval (QTcB) was calculated for each electrocardiogram (ECG). The HRV was measured for each ECG and then transformed to fit a normal distribution. The baseline analysis included 653 subjects, with 256 completing the 5-year follow up study. There was an association (P<0.05) between QTcB and PD severity in individuals that were taking QT-interval affecting drugs. A longer QT-interval at baseline was associated with more advanced PD at 5years (P<0.05), and greater disease progression over 5years (P<0.05). There was an association between diminished HRV and an orthostatic decrease in standing blood pressure at baseline in individuals with PD (P<0.05). HRV was not associated with PD severity or progression. In conclusion, we were able to detect measurable associations between the QTcB interval and PD severity, PD severity 5years later, and the change in disease over time. However, routine ECG tracings appear inadequate for the evaluation of autonomic function in PD.
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18
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Del Tredici K, Braak H. Review: Sporadic Parkinson's disease: development and distribution of α-synuclein pathology. Neuropathol Appl Neurobiol 2016; 42:33-50. [PMID: 26662475 DOI: 10.1111/nan.12298] [Citation(s) in RCA: 269] [Impact Index Per Article: 33.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2015] [Revised: 12/04/2015] [Accepted: 12/13/2015] [Indexed: 12/17/2022]
Abstract
The development of α-synuclein immunoreactive aggregates in selectively vulnerable neuronal types of the human central, peripheral, and enteric nervous systems is crucial for the pathogenesis of sporadic Parkinson's disease. The presence of these lesions persists into the end phase of the disease, a process that is not subject to remission. The initial induction of α-synuclein misfolding and subsequent aggregation probably occurs in the olfactory bulb and/or the enteric nervous system. Each of these sites is exposed to potentially hostile environmental factors. Once formed, the aggregates appear to be capable of propagating trans-synaptically from nerve cell to nerve cell in a virtually self-promoting pathological process. A regional distribution pattern of aggregated α-synuclein emerges that entails the involvement of only a few types of susceptible and axonally interconnected projection neurons within the human nervous system. One major route of disease progression may originate in the enteric nervous system and retrogradely reach the dorsal motor nucleus of the vagal nerve in the lower brainstem. From there, the disease process proceeds chiefly in a caudo-rostral direction through visceromotor and somatomotor brainstem centres to the midbrain, forebrain, and cerebral cortex. Spinal cord centres may become involved by means of descending projections from involved lower brainstem nuclei as well as by sympathetic projections connecting the enteric nervous system with postganglionic peripheral ganglia and preganglionic nuclei of the spinal cord. The development of experimental cellular and animal models is helping to explain the mechanisms of how abnormal α-synuclein can undergo aggregation and how transmission along axonal connectivities can occur, thereby encouraging the initiation of potential disease-modifying therapeutic strategies for sporadic Parkinson's disease.
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Affiliation(s)
- K Del Tredici
- Clinical Neuroanatomy Section, Department of Neurology, Center for Biomedical Research, University of Ulm, Ulm, Germany
| | - H Braak
- Clinical Neuroanatomy Section, Department of Neurology, Center for Biomedical Research, University of Ulm, Ulm, Germany
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19
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Renoux C, Dell'Aniello S, Khairy P, Marras C, Bugden S, Turin TC, Blais L, Tamim H, Evans C, Steele R, Dormuth C, Ernst P. Ventricular tachyarrhythmia and sudden cardiac death with domperidone use in Parkinson's disease. Br J Clin Pharmacol 2016; 82:461-72. [PMID: 27062307 PMCID: PMC4972162 DOI: 10.1111/bcp.12964] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Revised: 03/15/2016] [Accepted: 04/02/2016] [Indexed: 11/29/2022] Open
Abstract
AIM Domperidone is preferentially used over other antiemetic agents to treat digestive symptoms in Parkinson's disease (PD). Concerns have been raised regarding an increased risk of ventricular tachyarrhythmia and sudden cardiac death (VT/SCD) associated with domperidone in the general population. However, the risk in PD is unknown. METHODS We conducted a multicentre retrospective cohort study using administrative databases from seven Canadian provinces and the UK Clinical Practice Research Datalink. Using a nested case-control analysis, we estimated the rate ratios (RRs) of VT/SCD associated with domperidone use compared to no use in patients newly-diagnosed with PD. VT/SCD events were identified using administrative medical records and vital statistics with a manual review of all potential cases. Meta-analytic methods were used to estimate overall effects across sites. RESULTS Among 214 962 patients with PD, 2907 cases of VT/SCD were identified during 886 581 person-years of follow-up (incidence rate 3.28 per 1000 persons per year). Current use of domperidone was associated with a non-statistically significant 22% increased risk of VT/SCD (RR 1.22; 95% CI 0.99-1.50) compared with no use. The risk was significantly elevated in those with a history of cardiovascular disease (RR 1.38; 95% CI 1.07-1.78), but not in those without (RR 1.21; 95% CI 0.81-1.81). Dose and duration of use did not affect the magnitude of the risk. CONCLUSION Domperidone use may increase the risk of VT/SCD in patients with PD, particularly those with a history of cardiovascular disease. This risk may be underestimated because of imprecision in identifying VT/SCD events.
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Affiliation(s)
- Christel Renoux
- Centre for Clinical Epidemiology, Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, QC, Canada.,Department of Neurology and Neurosurgery, McGill University, Montréal, QC, Canada.,Department of Epidemiology and Biostatistics, McGill University, Montréal, QC, Canada
| | - Sophie Dell'Aniello
- Centre for Clinical Epidemiology, Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, QC, Canada
| | - Paul Khairy
- Montreal Heart Institute Adult Congenital Center, Université de Montréal, Montréal, QC, Canada
| | - Connie Marras
- Morton and Gloria Shulman Movement Disorders Centre, Toronto Western Hospital and the Edmond J. Safra Program in Parkinson's Disease Research, University of Toronto, Toronto, ON, Canada
| | - Shawn Bugden
- Faculty of Health Sciences, College of Pharmacy, University of Manitoba, Winnipeg, MB, Canada
| | - Tanvir Chowdhury Turin
- Department of Family Medicine, Cumming School of Medicine, University of Calgary, Health Sciences Centre, Calgary, AB, Canada
| | - Lucie Blais
- Faculty of Pharmacy, University of Montreal, Montreal, QC, Canada
| | - Hala Tamim
- School of Kinesiology and Health Science, York University, Toronto, ON, Canada.,Department of Community Health and Epidemiology, Dalhousie University, Halifax, NS, Canada
| | - Charity Evans
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, SK, Canada
| | - Russell Steele
- Centre for Clinical Epidemiology, Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, QC, Canada.,Department of Mathematics and Statistics, McGill University, Montréal, QC, Canada
| | - Colin Dormuth
- Anesthesiology, Pharmacology & Therapeutics, University of British Columbia, Vancouver, BC, Canada
| | - Pierre Ernst
- Centre for Clinical Epidemiology, Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, QC, Canada.,Department of Medicine, Pulmonary Division, Jewish General Hospital, Montreal, QC, Canada
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20
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Heranval A, Lefaucheur R, Fetter D, Rouillé A, Le Goff F, Maltête D. Drugs with potential cardiac adverse effects: Retrospective study in a large cohort of parkinsonian patients. Rev Neurol (Paris) 2016; 172:318-23. [PMID: 27063094 DOI: 10.1016/j.neurol.2015.11.007] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Revised: 10/13/2015] [Accepted: 11/15/2015] [Indexed: 11/15/2022]
Abstract
INTRODUCTION/OBJECTIVE Drugs with potential cardiac adverse effects are commonly prescribed in Parkinson's disease (PD). To describe demographic and clinical characteristics in a group of PD patients with cardiac events and to evaluate risk factors. PATIENTS AND METHODS We sampled 506 consecutive PD patients (211 women/295 men), median age 68.3±10.6 years (range 36-95) and median disease duration 11.2±6.5 years (range 1-49). Medications with potential cardiac effects, i.e. QT prolongation (citalopram, escitalopram, venlafaxine, sertraline, domperidone, amantadine, solifenacin), ventricular arrhythmia (rivastigmine, clozapine, midodrine, sildenafil, tadalafil) and ischemic heart disease (rasagiline, entacapone, tadalafil) were recorded. Demographic and clinical data were collected prospectively; cardiac events were obtained retrospectively. RESULTS Twenty-four patients (4.7%) (9 women/15 men) presented a cardiac event. Fifteen (62.5%) patients had dysautonomia, 4 (16.6%) a history of heart disease and 8 (33.3%) were taking one or more drugs with a definite potential cardiac adverse effect. Age (75.9±6.6 yr vs. 67.8±11 yr), disease duration (14.7±3.6 yr vs. 11±6.5 yr), dysautonomia (62.5% vs. 24.5%) and dementia associated with PD (37.5% vs. 14.6%) were significantly higher in the group with cardiac events (P<0.05). Cofactors increasing the risk for cardiovascular events were age and dysautonomia. DISCUSSION/CONCLUSION Our results indicate that the neurodegenerative process in Parkinson's disease is associated with a higher risk of cardiovascular complications.
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Affiliation(s)
- A Heranval
- Department of Neurology, Rouen University Hospital, University of Rouen, 76031 Rouen, France
| | - R Lefaucheur
- Department of Neurology, Rouen University Hospital, University of Rouen, 76031 Rouen, France
| | - D Fetter
- Department of Neurology, Rouen University Hospital, University of Rouen, 76031 Rouen, France
| | - A Rouillé
- Department of Neurology, Rouen University Hospital, University of Rouen, 76031 Rouen, France
| | - F Le Goff
- Department of Neurology, Rouen University Hospital, University of Rouen, 76031 Rouen, France
| | - D Maltête
- Department of Neurology, Rouen University Hospital, University of Rouen, 76031 Rouen, France; Inserm U 1073, 76031 Rouen, France.
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21
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Sariahmetoglu H, Soysal A, Sen A, Yuksel B, Celiker S, Ciftci-Kavaklioglu B, Arpaci B. Forehead sympathetic skin responses in determining autonomic involvement in Parkinson’s disease. Clin Neurophysiol 2014; 125:2436-40. [DOI: 10.1016/j.clinph.2014.03.024] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2014] [Revised: 03/04/2014] [Accepted: 03/28/2014] [Indexed: 12/16/2022]
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22
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Kim JB, Hong S, Park JW, Cho DH, Park KJ, Kim BJ. Utility of corrected QT interval in orthostatic intolerance. PLoS One 2014; 9:e106417. [PMID: 25180969 PMCID: PMC4152255 DOI: 10.1371/journal.pone.0106417] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2014] [Accepted: 08/06/2014] [Indexed: 12/20/2022] Open
Abstract
We performed this study to determine whether electrocardiographic corrected QT (QTc) interval predicts alterations in sympathovagal balance during orthostatic intolerance (OI). We reviewed 1,368 patients presenting with symptoms suggestive of OI who underwent electrocardiography and composite autonomic function tests (AFTs). Patients with a positive response to the head-up tilt test were classified into orthostatic hypotension (OH), neurocardiogenic syncope (NCS), or postural orthostatic tachycardia syndrome (POTS) groups. A total of 275 patients (159 OH, 54 NCS, and 62 POTS) were included in the final analysis. Between-group comparisons of OI symptom grade, QTc interval, QTc dispersion, and each AFT measure were performed. QTc interval and dispersion were correlated with AFT measures. OH Patients had the most severe OI symptom grade and NCS patients the mildest. Patients with OH showed the longest QTc interval (448.8±33.6 msec), QTc dispersion (59.5±30.3 msec) and the lowest values in heart rate response to deep breathing (HRDB) (10.3±6.0 beats/min) and Valsalva ratio (1.3±0.2). Patients with POTS showed the shortest QTc interval (421.7±28.6 msec), the highest HRDB values (24.5±9.2 beats/min), Valsalva ratio (1.8±0.3), and proximal and distal leg sweat volumes in the quantitative sudomotor axon reflex test. QTc interval correlated negatively with HRDB (r = −0.443, p<0.001) and Valsalva ratio (r = −0.425, p<0.001). We found negative correlations between QTc interval and AFT values representing cardiovagal function in patients with OI. Our findings suggest that prolonged QTc interval may be considered to be a biomarker for detecting alterations in sympathovagal balance, especially cardiovagal dysfunction in OH.
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Affiliation(s)
- Jung Bin Kim
- Department of Neurology, Korea University Medical Center, Korea University College of Medicine, Seoul, Korea
| | - Soonwoong Hong
- Department of Neurology, Korea University Medical Center, Korea University College of Medicine, Seoul, Korea
| | - Jin-Woo Park
- Department of Neurology, Korea University Medical Center, Korea University College of Medicine, Seoul, Korea
| | - Dong-Hyuk Cho
- Department of Cardiology, Korea University Medical Center, Korea University College of Medicine, Seoul, Korea
| | - Ki-Jong Park
- Department of Neurology, Kyungsang University Medical Center, Jinjoo, Korea
| | - Byung-Jo Kim
- Department of Neurology, Korea University Medical Center, Korea University College of Medicine, Seoul, Korea
- * E-mail:
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23
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Matsumoto H, Sengoku R, Saito Y, Kakuta Y, Murayama S, Imafuku I. Sudden death in Parkinson's disease: a retrospective autopsy study. J Neurol Sci 2014; 343:149-52. [PMID: 24928079 DOI: 10.1016/j.jns.2014.05.060] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2014] [Revised: 05/15/2014] [Accepted: 05/19/2014] [Indexed: 10/25/2022]
Abstract
The aim of this paper is to reveal the causes of death and to verify sudden death of Parkinson's disease (PD) in an autopsy study. We reviewed the clinical data and the causes of death in 16 PD patients who had postmortem examinations. Prior to autopsy, nine patients died of known causes: five patients died of aspiration pneumonia, two of myocardial infarction, one of asphyxia, and one of dilated cardiomyopathy. Autopsy confirmed that the putative causes of death were compatible with the pathological ones. The remaining seven patients died suddenly of unknown causes. Autopsy revealed that the causes of death were asphyxia in two patients and perforation of a duodenal ulcer in one patient. Autopsy did not determine the causes of unknown death in the remaining four patients. Consequently, autopsy revealed that eight patients died of swallowing problems such as aspiration pneumonia and asphyxia, four of sudden death, three of cardiac problems, and one of a gastrointestinal problem. Although there was a bias that all patients had a postmortem examination, our study revealed that several PD patients died of sudden death without any satisfactory causes of death determined even by autopsy. Therefore, we propose that a non-negligible number of PD patients die of sudden death.
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Affiliation(s)
- Hideyuki Matsumoto
- Department of Neurology, Japanese Red Cross Medical Center, Japan; Department of Neurology, Yokohama Rosai Hospital, Japan.
| | - Renpei Sengoku
- Department of Neurology and Neuropathology, Tokyo Metropolitan Geriatric Hospital, Japan
| | - Yuko Saito
- Department of Pathology and Laboratory Medicine, National Center of Neurology and Psychiatry, Japan
| | - Yukio Kakuta
- Department of Pathology, Yokohama Rosai Hospital, Japan
| | - Shigeo Murayama
- Department of Neurology and Neuropathology, Tokyo Metropolitan Geriatric Hospital, Japan
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24
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Dombrowski K, Laskowitz D. Cardiovascular manifestations of neurologic disease. HANDBOOK OF CLINICAL NEUROLOGY 2014; 119:3-17. [PMID: 24365284 DOI: 10.1016/b978-0-7020-4086-3.00001-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Cardiac manifestations of neurologic diseases are common in clinical practice. There are numerous anatomic and pathophysiologic links between the normal and abnormal function of both systems. There are a number of brain-heart interactions which affect the care of patients as well as help guide therapeutic development. This is exemplified in the area of vascular neurology where knowledge of the brain-heart connection is essential not only for bedside management but where collaborative efforts between neurology and cardiology are key in developing new strategies for ischemic stroke prevention and treatment, atrial fibrillation, and interventional techniques. This chapter will focus on cardiac manifestations of neurologic disease, with special emphasis on vascular and intensive care neurology, epilepsy, and neurodegenerative and peripheral nervous system diseases.
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Affiliation(s)
- Keith Dombrowski
- Department of Medicine (Neurology), Duke University Medical Center, Durham, NC, USA.
| | - Daniel Laskowitz
- Department of Medicine (Neurology), Duke University Medical Center, Durham, NC, USA; Department of Anesthesiology, Duke University Medical Center, Durham, NC, USA
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25
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Cunnington AL, Hood K, White L. Outcomes of screening Parkinson's patients for QTc prolongation. Parkinsonism Relat Disord 2013; 19:1000-3. [PMID: 23871463 DOI: 10.1016/j.parkreldis.2013.07.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2013] [Revised: 06/26/2013] [Accepted: 07/03/2013] [Indexed: 01/08/2023]
Abstract
BACKGROUND Parkinson's disease (PD) patients are commonly prescribed medication that has recently been associated with QTc prolongation on electrocardiograms (ECG). In addition, research suggests that PD patients may be more at risk of QTc prolongation. OBJECTIVE To evaluate the outcomes of screening PD patients for QTc prolongation. METHODS ECG analysis of PD patients attending for routine outpatient PD review in 2012 who were prescribed medication that could potentially prolong their QTc interval. We noted prescribing changes and any repeat ECG findings. We also reviewed any recent ECGs of clinic patients not on QTc prolonging medication. RESULTS A third of our PD clinic patients (63/192) were prescribed QTc prolonging medication. Of these 61/63 (97%) ECGs were available. 20/61 (33%) showed QTc prolongation. 6/20 (30%) had significant prolongation >500 ms. 18/20 (90%) patients had medication changes made, and of the 12/18 (67%) ECGs repeated in this group all improved with 11 demonstrating normalisation of the QTc interval. Of the 51 available ECGs in patients not prescribed QTc prolonging medication 3/51 (6%) showed QTc prolongation. Statistical analysis showed that QTc prolongation was significantly associated with the prescription of QTC prolonging medication and stage of PD. CONCLUSION QTc prolongation in PD patients caused by medication is a major modifiable risk factor. A routine ECG should be considered if a PD patient is currently prescribed medication that can prolong the QTc interval. Also consideration should be given to performing this simple test prior to commencing QTc prolonging medication.
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Affiliation(s)
- Anne-Louise Cunnington
- Care of Elderly Department, Glasgow Royal Infirmary, 84 Castle Street, Glasgow G4 0SF, Scotland, United Kingdom; Stobhill Ambulatory Care Hospital, 133 Balornock Road, Glasgow G21 3UW, Scotland, United Kingdom.
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Park KM, Shin KJ, Kim SE, Park J, Ha SY, Kim BJ. Prolonged Corrected QT Interval in Patients with Myotonic Dystrophy Type 1. J Clin Neurol 2013; 9:186-91. [PMID: 23894242 PMCID: PMC3722470 DOI: 10.3988/jcn.2013.9.3.186] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2012] [Revised: 04/30/2013] [Accepted: 04/30/2013] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND AND PURPOSE Sudden cardiac death is one of the leading causes of death in patients with myotonic dystrophy type 1 (DM1). It has been proposed that a prolonged QT interval is associated with sudden cardiac death in several neurological diseases, including multiple system atrophy, idiopathic Parkinson's disease, and diabetic autonomic neuropathy. However, analyses of the corrected QT (QTc) interval in DM1 patients are rare in the literature. The purposes of this study were to determine the association between the QT interval and DM1, and the affecting factors. METHODS Thirty-nine patients diagnosed with DM1 through genetic testing were enrolled. The QTc interval (calculated using Bazett's formula: QTc=QT/√RR) was compared between these patients and 39 normal healthy controls. The clinical and laboratory factors affecting QTc interval in the patient group were investigated. RESULTS The QTc interval was significantly longer in the DM1 group (411.2±44.7 msec, mean±SD) than in the normal control group (355.6±20.6 msec). Intragroup analysis revealed that a prolonged QTc interval in DM1 patients was associated with being female and older, having a longer disease duration, and exhibiting abnormal electrocardiography findings. CONCLUSIONS The higher incidence of sudden cardiac death in the DM1 population is associated with the observed prolonged QTc interval in those patients.
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Affiliation(s)
- Kang Min Park
- Department of Neurology, Haeundae Paik Hospital, Inje University, Busan, Korea
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Malek NM, Grosset KA, Stewart D, Macphee GJ, Grosset DG. Prescription of drugs with potential adverse effects on cardiac conduction in Parkinson's disease. Parkinsonism Relat Disord 2013; 19:586-9. [DOI: 10.1016/j.parkreldis.2013.02.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2012] [Revised: 01/30/2013] [Accepted: 02/11/2013] [Indexed: 11/26/2022]
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Joers V, Seneczko K, Goecks NC, Kamp TJ, Hacker TA, Brunner KG, Engle JW, Barnhart TE, Nickles RJ, Holden JE, Emborg ME. Nonuniform cardiac denervation observed by 11C-meta-hydroxyephedrine PET in 6-OHDA-treated monkeys. PLoS One 2012; 7:e35371. [PMID: 22539969 PMCID: PMC3335153 DOI: 10.1371/journal.pone.0035371] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2011] [Accepted: 03/16/2012] [Indexed: 12/30/2022] Open
Abstract
Parkinson's disease presents nonmotor complications such as autonomic dysfunction that do not respond to traditional anti-parkinsonian therapies. The lack of established preclinical monkey models of Parkinson's disease with cardiac dysfunction hampers development and testing of new treatments to alleviate or prevent this feature. This study aimed to assess the feasibility of developing a model of cardiac dysautonomia in nonhuman primates and preclinical evaluations tools. Five rhesus monkeys received intravenous injections of 6-hydroxydopamine (total dose: 50 mg/kg). The animals were evaluated before and after with a battery of tests, including positron emission tomography with the norepinephrine analog (11)C-meta-hydroxyephedrine. Imaging 1 week after neurotoxin treatment revealed nearly complete loss of specific radioligand uptake. Partial progressive recovery of cardiac uptake found between 1 and 10 weeks remained stable between 10 and 14 weeks. In all five animals, examination of the pattern of uptake (using Logan plot analysis to create distribution volume maps) revealed a persistent region-specific significant loss in the inferior wall of the left ventricle at 10 (P<0.001) and 14 weeks (P<0.01) relative to the anterior wall. Blood levels of dopamine, norepinephrine (P<0.05), epinephrine, and 3,4-dihydroxyphenylacetic acid (P<0.01) were notably decreased after 6-hydroxydopamine at all time points. These results demonstrate that systemic injection of 6-hydroxydopamine in nonhuman primates creates a nonuniform but reproducible pattern of cardiac denervation as well as a persistent loss of circulating catecholamines, supporting the use of this method to further develop a monkey model of cardiac dysautonomia.
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Affiliation(s)
- Valerie Joers
- Preclinical Parkinson's Research Program, Wisconsin National Primate Research Center, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
- Neuroscience Training Program, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
| | - Kailie Seneczko
- Preclinical Parkinson's Research Program, Wisconsin National Primate Research Center, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
| | - Nichole C. Goecks
- Preclinical Parkinson's Research Program, Wisconsin National Primate Research Center, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
| | - Timothy J. Kamp
- Department of Medicine, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
| | - Timothy A. Hacker
- Department of Medicine, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
| | - Kevin G. Brunner
- Preclinical Parkinson's Research Program, Wisconsin National Primate Research Center, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
| | - Jonathan W. Engle
- Department of Medical Physics, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
| | - Todd E. Barnhart
- Department of Medical Physics, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
| | - R. Jerome Nickles
- Department of Medical Physics, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
| | - James E. Holden
- Preclinical Parkinson's Research Program, Wisconsin National Primate Research Center, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
- Department of Medical Physics, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
| | - Marina E. Emborg
- Preclinical Parkinson's Research Program, Wisconsin National Primate Research Center, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
- Neuroscience Training Program, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
- Department of Medical Physics, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
- * E-mail:
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McCauley MD, Wang T, Mike E, Herrera J, Beavers DL, Huang TW, Ward CS, Skinner S, Percy AK, Glaze DG, Wehrens XHT, Neul JL. Pathogenesis of lethal cardiac arrhythmias in Mecp2 mutant mice: implication for therapy in Rett syndrome. Sci Transl Med 2012; 3:113ra125. [PMID: 22174313 DOI: 10.1126/scitranslmed.3002982] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Rett syndrome is a neurodevelopmental disorder typically caused by mutations in methyl-CpG-binding protein 2 (MECP2) in which 26% of deaths are sudden and of unknown cause. To explore the hypothesis that these deaths may be due to cardiac dysfunction, we characterized the electrocardiograms in 379 people with Rett syndrome and found that 18.5% show prolongation of the corrected QT interval (QTc), an indication of a repolarization abnormality that can predispose to the development of an unstable fatal cardiac rhythm. Male mice lacking MeCP2 function, Mecp2(Null/Y), also have prolonged QTc and show increased susceptibility to induced ventricular tachycardia. Female heterozygous null mice, Mecp2(Null/+), show an age-dependent prolongation of QTc associated with ventricular tachycardia and cardiac-related death. Genetic deletion of MeCP2 function in only the nervous system was sufficient to cause long QTc and ventricular tachycardia, implicating neuronally mediated changes to cardiac electrical conduction as a potential cause of ventricular tachycardia in Rett syndrome. The standard therapy for prolonged QTc in Rett syndrome, β-adrenergic receptor blockers, did not prevent ventricular tachycardia in Mecp2(Null/Y) mice. To determine whether an alternative therapy would be more appropriate, we characterized cardiomyocytes from Mecp2(Null/Y) mice and found increased persistent sodium current, which was normalized when cells were treated with the sodium channel-blocking anti-seizure drug phenytoin. Treatment with phenytoin reduced both QTc and sustained ventricular tachycardia in Mecp2(Null/Y) mice. These results demonstrate that cardiac abnormalities in Rett syndrome are secondary to abnormal nervous system control, which leads to increased persistent sodium current. Our findings suggest that treatment in people with Rett syndrome would be more effective if it targeted the increased persistent sodium current to prevent lethal cardiac arrhythmias.
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Affiliation(s)
- Mark D McCauley
- Department of Molecular Physiology and Biophysics, Baylor College of Medicine, Houston, TX 77030, USA
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Cumming P, Borghammer P. Molecular imaging and the neuropathologies of Parkinson's disease. Curr Top Behav Neurosci 2011; 11:117-48. [PMID: 22034053 DOI: 10.1007/7854_2011_165] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The main motor symptoms of Parkinson's disease (PD) are linked to degeneration of the nigrostriatal dopamine (DA) fibers, especially those innervating the putamen. This degeneration can be assessed in molecular imaging studies with presynaptic tracers such as [(18)F]-fluoro-L-DOPA (FDOPA) and ligands for DA transporter ligands. However, the pathologies of PD are by no means limited to nigrostriatal loss. Results of post mortem and molecular imaging studies reveal parallel degenerations of cortical noradrenaline (NA) and serotonin (5-HT) innervations, which may contribute to affective and cognitive changes of PD. Especially in advanced PD, cognitive impairment can come to resemble that seen in Alzheimer's dementia, as can the degeneration of acetylcholine innervations arising in the basal forebrain. The density of striatal DA D(2) receptors increases in early untreated PD, consistent with denervation upregulation, but there is an accelerated rate of DA receptor loss as the disease advances. Animal studies and post mortem investigations reveal changes in brain opioid peptide systems, but these are poorly documented in imaging studies of PD. Relatively minor changes in the binding sites for GABA are reported in cortex and striatum of PD patients. There remains some controversy about the expression of the 18 kDa translocator protein (TSPO) in activated microglia as an indicator of an active inflammatory component of neurodegeneration in PD. A wide variety of autonomic disturbances contribute to the clinical syndrome of PD; the degeneration of myocardial sympathetic innervation can be revealed in SPECT studies of PD patients with autonomic failure. Considerable emphasis has been placed on investigations of cerebral blood flow and energy metabolism in PD. Due to the high variance of these physiological estimates, researchers have often employed normalization procedures for the sensitive detection of perturbations in relatively small patient groups. However, a widely used normalization to the global mean must be used with caution, as it can result in spurious findings of relative hypermetabolic changes in subcortical structures. A meta-analysis of the quantitative studies to date shows that there is in fact widespread hypometabolism and cerebral blood flow in the cerebral cortex, especially in frontal cortex and parietal association areas. These changes can bias the use of global mean normalization, and probably represent the pathophysiological basis of the cognitive impairment of PD.
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Affiliation(s)
- Paul Cumming
- Department of Nuclear Medicine, Ludwig-Maximilian's University of Munich, Munich, Germany,
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Leńska-Mieciek M, Derecka-Charzyńska I, Fiszer U, Królicki L, Kułakowski P. Syncope and autonomic cardiovascular dysfunction in Parkinson disease. Neurol Neurochir Pol 2011; 45:335-41. [DOI: 10.1016/s0028-3843(14)60104-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Cardiac repolarization and striatal dopamine transporter function are interrelated. Nucl Med Commun 2009; 30:713-7. [PMID: 19550362 DOI: 10.1097/mnm.0b013e32832bdc96] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Cardiac denervation and dysautonomia in Parkinson's disease: A review of screening techniques. Parkinsonism Relat Disord 2008; 14:524-31. [DOI: 10.1016/j.parkreldis.2008.03.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2008] [Revised: 03/20/2008] [Accepted: 03/26/2008] [Indexed: 11/19/2022]
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Schmidt C, Herting B, Prieur S, Junghanns S, Schweitzer K, Reichmann H, Berg D, Ziemssen T. Autonomic dysfunction in patients with progressive supranuclear palsy. Mov Disord 2008; 23:2083-9. [DOI: 10.1002/mds.22289] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Thorough QT/QTc study in patients with advanced Parkinson's disease: cardiac safety of rotigotine. Clin Pharmacol Ther 2008; 84:595-603. [PMID: 18650802 DOI: 10.1038/clpt.2008.143] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The potential effects of the dopamine agonist rotigotine on cardiac repolarization were studied in patients with Parkinson's disease, which affects electrocardiogram (ECG) quality. The parallel-group trial was double-blind and placebo- and positive (moxifloxacin 400 mg)-controlled. After two 24-h baseline ECGs, patients were randomized to rotigotine (n = 66) or placebo (n = 64). Twenty four-hour ECGs were recorded on days 14/15, 21/22, 28/29, 35/36, and 42/43 of a regimen involving weekly dose escalations of 4 mg/24 h (4 mg/24 h-24 mg/24 h). In 10-s ECGs (n = 357,948) selected from 24-h records, QT measurements were manually verified and individually rate-corrected (QTc). Assay sensitivity showed maximum mean 13.5 ms QTc prolongation after moxifloxacin with 95% confidence interval (CI) 11.8-15.2 ms. Rotigotine vs. placebo differences in time-matched changes from baseline (54 data points/24 h) showed mean effects close to zero with upper one-sided 95% CI <5 ms. Accurate, thorough QTc studies are possible even in patients with diseases that profoundly affect ECG quality. Rotigotine in supra- and therapeutic doses was shown not to affect cardiac repolarization.
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Papapetropoulos S, Mash DC. Insular pathology in Parkinson's disease patients with orthostatic hypotension. Parkinsonism Relat Disord 2007; 13:308-11. [PMID: 16962365 DOI: 10.1016/j.parkreldis.2006.06.009] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2006] [Revised: 06/21/2006] [Accepted: 06/27/2006] [Indexed: 10/24/2022]
Abstract
Orthostatic hypotension (OH) in Parkinson's disease (PD) patients may be a significant source of morbidity and discomfort. Although peripheral ANS components have been associated with its development, central mechanisms are probably involved. The insular cortex is a central site of autonomic and limbic integration and neuropathologic studies have indicated its involvement in the neurodegenerative process of PD. To this end, we studied the neuropathology of the insular, temporal and parietal cortices in PD patients with and without OH. Our results suggest an association between the severity of PD-related neuropathology in the insular cortex and OH. Further research into the subject is warranted.
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Affiliation(s)
- Spiridon Papapetropoulos
- Department of Neurology, University of Miami, Miller School of Medicine, Room 4004, 1501 NW 9th Avenue, Miami, FL 33136, USA.
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Kasten M, Chade A, Tanner CM. Epidemiology of Parkinson's disease. HANDBOOK OF CLINICAL NEUROLOGY 2007; 83:129-51. [PMID: 18808913 PMCID: PMC7112363 DOI: 10.1016/s0072-9752(07)83006-5] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
This chapter discusses the epidemiology of Parkinson's disease (PD). Classically, PD refers to progressive parkinsonism caused by loss of pigmented aminergic brainstem neurons without an identifiable cause, while parkinsonism refers simply to the syndrome of bradykinesia, resting tremor, rigidity and postural reflex impairment. Over nearly two centuries, Parkinson's clinical description has provided the framework for clinical investigations, including epidemiologic ones. Descriptions of PD were limited to selected clinical settings until the middle of the 20th century. Since then, epidemiologic approaches have been used not only to investigate the population distribution of PD, but also as a way to glean clues as to the cause of this “idiopathic” disorder. Because PD is relatively infrequent, a large base population must be surveyed to identify sufficient numbers of cases for a study. In some instances, PD cases can be identified through health service rosters within defined geographic areas or in enumerated populations. In others, cases of PD are sought independently of the health care system, such as through door-to-door surveys. While the latter approach is theoretically least likely to exclude cases, the time and cost involved are also greatest using this approach.
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Kocer A, Karakaya O, Barutcu I, Batukan Esen O, Kargin R, Mayda Domac F. Assessment of P wave duration and dispersion in Parkinson's disease. Prog Neuropsychopharmacol Biol Psychiatry 2006; 30:718-23. [PMID: 16600454 DOI: 10.1016/j.pnpbp.2006.02.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Cardiovascular disorders such as decreased heart rate variability, orthostatic hypotension, and arrhythmias have been frequently observed in Parkinson's disease (PD) patients. In this study, authors measured P wave duration and dispersion in PD patients and controls. Twenty-three consecutive patients with idiopathic PD and sex-age matched 23 control subjects were included to the study. A 12-lead surface ECG was obtained from each participant. Maximum-minimum P wave duration and P wave dispersion (PWD) were measured in both groups. Maximum P wave duration was found to be higher in PD patients than controls (117+/-12 vs. 105+/-9 ms p=0.001). Minimum P wave duration was similar in PD patients and controls (64+/-11 vs. 63+/-11 ms p=0.7). PWD in PD patients was also found to be higher than those of controls (53+/-11 vs. 43+/-10 ms p=0.0001). P wave duration and PWD did not significantly differ between PD patients taking anti-parkinsonian agents from those who were not (119+/-13 vs. 116+/-13 ms p=0.4 and 55+/-11 vs. 52+/-11 ms p=0.5, respectively). Moreover, when the PD patients taking anti-parkinsonian agents were excluded from the study, PD patients had still higher P wave duration and PWD compared to controls (119+/-11 vs. 105+/-9 ms p=0.004, 52+/-10 vs. 43+/-10 ms p=0.009, respectively). In conclusion, we found that P wave duration and PWD were greater in PD patients compared to control subjects.
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Affiliation(s)
- Abdulkadir Kocer
- Dr Lütfi Kirdar Kartal Education and Research Hospital, Department of Neurology, Istanbul, Turkey.
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Naschitz J, Fields M, Isseroff H, Sharif D, Sabo E, Rosner I. Shortened QT interval: a distinctive feature of the dysautonomia of chronic fatigue syndrome. J Electrocardiol 2006; 39:389-94. [PMID: 16895768 DOI: 10.1016/j.jelectrocard.2005.10.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2005] [Indexed: 12/20/2022]
Abstract
PURPOSE Because autonomic nervous functioning is frequently abnormal in chronic fatigue syndrome (CFS), we examined whether the corrected QT interval (QTc) in CFS differs from QTc in other populations. METHODS The QTc was calculated at the end of 10 minutes of recumbence and the end of 10 minutes of head-up tilt. In a pilot study, groups of 15 subjects, CFS, and controls, matched for age and sex, were investigated. In a second phase of the study, the QTc was measured in larger groups of CFS (n = 30) and control patients (n = 96) not matched for demographic features. RESULTS In the pilot study, the average supine QTc in CFS was 0.371 +/- 0.02 seconds and QTc on tilt, 0.385 +/- 0.02 seconds, significantly shorter than in controls (P = .0002 and .0003, respectively). Results of phase II confirmed this data. CONCLUSIONS Relative short QTc intervals are features of the CFS-related dysautonomia. The significance of this finding is discussed.
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Affiliation(s)
- Jochanan Naschitz
- Department of Internal Medicine A, Bnai Zion Medical Center and Rappaport Family Faculty of Medicine, Technion-Israel Institute of Technology, P.O. Box 4940, Haifa 31048, Israel.
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