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Correlations between cerebrospinal fluid homovanillic acid and dopamine transporter SPECT in degenerative parkinsonian syndromes. J Neural Transm (Vienna) 2023; 130:513-520. [PMID: 36871130 PMCID: PMC10050014 DOI: 10.1007/s00702-023-02611-y] [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: 12/15/2022] [Accepted: 02/21/2023] [Indexed: 03/06/2023]
Abstract
Both cerebrospinal fluid (CSF) homovanillic acid (HVA) and striatal dopamine transporter (DAT) binding on single-photon emission computed tomography (SPECT) reflect nigrostriatal dopaminergic function, but studies on the relationship between the two have been limited. It is also unknown whether the reported variance in striatal DAT binding among diseases reflects the pathophysiology or characteristics of the subjects. We included 70 patients with Parkinson's disease (PD), 12 with progressive supranuclear palsy (PSP), 12 with multiple system atrophy, six with corticobasal syndrome, and nine with Alzheimer's disease as disease control, who underwent both CSF analysis and 123I-N-ω-fluoropropyl-2β-carbomethoxy-3β-(4-iodophenyl)nortropane (123I-ioflupane) SPECT. We evaluated the correlation between CSF HVA concentration and the specific binding ratio (SBR) of striatal DAT binding. We also compared the SBR for each diagnosis, controlling for CSF HVA concentration. The correlations between the two were significant in patients with PD (r = 0.34, p = 0.004) and PSP (r = 0.77, p = 0.004). The mean SBR value was the lowest in patients with PSP and was significantly lower in patients with PSP than in those with PD (p = 0.037) after adjusting for CSF HVA concentration. Our study demonstrates that striatal DAT binding correlates with CSF HVA concentration in both PD and PSP, and striatal DAT reduction would be more advanced in PSP than in PD at an equivalent dopamine level. Striatal DAT binding may correlate with dopamine levels in the brain. The pathophysiology of each diagnosis may explain this difference.
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Willis GL, Boda J, Freelance CB. Polychromatic Light Exposure as a Therapeutic in the Treatment and Management of Parkinson's Disease: A Controlled Exploratory Trial. Front Neurol 2018; 9:741. [PMID: 30778331 PMCID: PMC6156259 DOI: 10.3389/fneur.2018.00741] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Accepted: 08/14/2018] [Indexed: 12/11/2022] Open
Abstract
Parkinson's disease (PD) is a disorder characterized by loss of dopamine (DA) in the nigro-striatal dopamine (NSD) system with the primary symptoms of bradykinaesia, rigidity, tremor, and altered gate. Secondary symptoms including depression, insomnia, involuntary movement, and psychiatric side effects are also commonly observed. While the treatment focus for the past 50 years has been aimed at replacing deficient DA, to relieve the primary symptoms, more recent studies have suggested that the circadian system plays a critical role in the etiology and treatment of this disorder. Several case studies and open label trials have implemented bright light therapy (BT) in an attempt to repair sleep, depression and even the primary motor symptoms of this disorder, however controlled studies are yet to be fully implemented. In this controlled trial, patients that had been maintained on BT daily for 4 months to 5 years previously were assigned to one of three groups: continued polychromatic light, continued with red light or discontinued polychromatic light for a 2 week period. The Movement Disorder Society-Unified Parkinson's Disease Rating Scale (MDSUPDRS), The Parkinson's Disease Questionnaire (PDQ-39), The Beck Depression Inventory II, The Beck Anxiety Inventory, The Epworth Sleep Scale (ESS) and a global rating scale were used to assess patients prior to and at 1 and 2 weeks after commencing the trial. Patients continuing polychromatic BT showed significant improvement on the MDSUPDRS Rating Scale (12 points; p = 0.028), the PDQ-39 (10 points; p = 0.011), ESS (4 points; p = 0.013), and numerous motor and secondary symptoms on a global rating scale. Performance on standardized motor tests also incrementally improved in this group while those exposed to red light and those that discontinued BT treatment deteriorated. These results demonstrate that strategically applied polychromatic light was beneficial in reducing many primary motor and secondary symptoms of PD. Further work investigating the role of light in mitigating PD symptoms and involvement of the circadian system will provide further advances in the treatment of PD. Clinical Trial Registration: http://www.anzctr.org.au, identifier ACTRN12617001309370.
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Affiliation(s)
- Gregory L Willis
- The Bronowski Institute of Behavioural Neuroscience, The Bronowski Clinic, Coliban Medical Centre, Kyneton, VIC, Australia
| | - Jamilee Boda
- The Bronowski Institute of Behavioural Neuroscience, The Bronowski Clinic, Coliban Medical Centre, Kyneton, VIC, Australia
| | - Christopher B Freelance
- The Bronowski Institute of Behavioural Neuroscience, The Bronowski Clinic, Coliban Medical Centre, Kyneton, VIC, Australia
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Sánchez MP, García-Cabrero AM, Sánchez-Elexpuru G, Burgos DF, Serratosa JM. Tau-Induced Pathology in Epilepsy and Dementia: Notions from Patients and Animal Models. Int J Mol Sci 2018; 19:ijms19041092. [PMID: 29621183 PMCID: PMC5979593 DOI: 10.3390/ijms19041092] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Revised: 03/23/2018] [Accepted: 04/03/2018] [Indexed: 12/24/2022] Open
Abstract
Patients with dementia present epilepsy more frequently than the general population. Seizures are more common in patients with Alzheimer’s disease (AD), dementia with Lewy bodies (LBD), frontotemporal dementia (FTD) and progressive supranuclear palsy (PSP) than in other dementias. Missense mutations in the microtubule associated protein tau (MAPT) gene have been found to cause familial FTD and PSP, while the P301S mutation in MAPT has been associated with early-onset fast progressive dementia and the presence of seizures. Brains of patients with AD, LBD, FTD and PSP show hyperphosphorylated tau aggregates, amyloid-β plaques and neuropil threads. Increasing evidence suggests the existence of overlapping mechanisms related to the generation of network hyperexcitability and cognitive decline. Neuronal overexpression of tau with various mutations found in FTD with parkinsonism-linked to chromosome 17 (FTDP-17) in mice produces epileptic activity. On the other hand, the use of certain antiepileptic drugs in animal models with AD prevents cognitive impairment. Further efforts should be made to search for plausible common targets for both conditions. Moreover, attempts should also be made to evaluate the use of drugs targeting tau and amyloid-β as suitable pharmacological interventions in epileptic disorders. The diagnosis of dementia and epilepsy in early stages of those diseases may be helpful for the initiation of treatments that could prevent the generation of epileptic activity and cognitive deterioration.
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Affiliation(s)
- Marina P Sánchez
- Laboratory of Neurology, IIS (Instituto Investigación Sanitaria/Health Research Institute)-Jiménez Díaz Foundation, UAM (Universidad Autonoma de Madrid/Autonomous University of Madrid) and Biomedical Research Network Center on Rare Diseases (CIBERER), 28045 Madrid, Spain.
| | - Ana M García-Cabrero
- Laboratory of Neurology, IIS (Instituto Investigación Sanitaria/Health Research Institute)-Jiménez Díaz Foundation, UAM (Universidad Autonoma de Madrid/Autonomous University of Madrid) and Biomedical Research Network Center on Rare Diseases (CIBERER), 28045 Madrid, Spain.
- Department of Immunology and Oncology and Protein Tools Unit, Biotechnology National Center (CNB/CSIC), 28049 Madrid, Spain.
| | - Gentzane Sánchez-Elexpuru
- Laboratory of Neurology, IIS (Instituto Investigación Sanitaria/Health Research Institute)-Jiménez Díaz Foundation, UAM (Universidad Autonoma de Madrid/Autonomous University of Madrid) and Biomedical Research Network Center on Rare Diseases (CIBERER), 28045 Madrid, Spain.
| | - Daniel F Burgos
- Laboratory of Neurology, IIS (Instituto Investigación Sanitaria/Health Research Institute)-Jiménez Díaz Foundation, UAM (Universidad Autonoma de Madrid/Autonomous University of Madrid) and Biomedical Research Network Center on Rare Diseases (CIBERER), 28045 Madrid, Spain.
| | - José M Serratosa
- Laboratory of Neurology, IIS (Instituto Investigación Sanitaria/Health Research Institute)-Jiménez Díaz Foundation, UAM (Universidad Autonoma de Madrid/Autonomous University of Madrid) and Biomedical Research Network Center on Rare Diseases (CIBERER), 28045 Madrid, Spain.
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Park S, Kim DE, Park SY, Gil HW, Hong SY. Seizures in patients with acute pesticide intoxication, with a focus on glufosinate ammonium. Hum Exp Toxicol 2017; 37:331-337. [PMID: 28421825 DOI: 10.1177/0960327117705427] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The incidence and clinical aspects of seizures remain to be elucidated in patients with acute pesticide intoxication. The present study included subjects who ingested pesticide with the intention of committing suicide and were treated at Soonchunhyang University Hospital (Cheonan, Korea) between January 2011 and December 2014. We analyzed the incidence and characterized the type and frequency of seizure, from the medical records of 464 patients with acute pesticide intoxication, according to the pesticide class. The effect of seizure on the clinical outcome was assessed. The incidence of seizure was 31.5% in patients who ingested glufosinate ammonium {2-amino-4-[hydroxyl (methyl) phosphinoyl] butyrate; ammonium DL-homoalanin-4-yl (methyl) phosphinate}, followed by those who ingested pyrethroid (5.9%) or glycine derivatives (5.4%). All of the seizures developed between 12 and 24 h of pesticide ingestion and had ceased by 72 h after seizure initiation, following treatment with antiseizure medication. Generalized tonic-clonic seizures were the most commonly observed (85.7% of the cases). Multivariable logistic regression analysis showed that the effect of seizure on mortality was not statistically significant. In conclusion, glufosinate ammonium herbicide is the most common seizurogenic pesticide class. Seizure itself was not a risk factor for mortality in patients with acute glufosinate ammonium intoxication.
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Affiliation(s)
- S Park
- 1 Department of Internal Medicine, Soonchunhyang University, College of Medicine, Cheonan, Korea
| | - D E Kim
- 2 Department of Neurology, Soonchunhyang University, College of Medicine, Cheonan, Korea
| | - S Y Park
- 3 Department of Biostatistics, Soonchunhyang University, College of Medicine, Seoul, Korea
| | - H W Gil
- 1 Department of Internal Medicine, Soonchunhyang University, College of Medicine, Cheonan, Korea
| | - S Y Hong
- 1 Department of Internal Medicine, Soonchunhyang University, College of Medicine, Cheonan, Korea
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Bron AJ, Yokoi N, Gaffney EA, Tiffany JM. A Solute Gradient in the Tear Meniscus. II. Implications for Lid Margin Disease, including Meibomian Gland Dysfunction. Ocul Surf 2011; 9:92-7. [DOI: 10.1016/s1542-0124(11)70015-5] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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Tolosa E, Valldeoriola F, Cruz-Sánchez F. Progressive supranuclear palsy: clinical and pathological diagnosis. Eur J Neurol 2011; 2:259-73. [DOI: 10.1111/j.1468-1331.1995.tb00129.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Liu GT, Volpe NJ, Galetta SL. Eye movement disorders. Neuroophthalmology 2010. [DOI: 10.1016/b978-1-4160-2311-1.00016-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Willis GL, Turner EJD. Primary and Secondary Features of Parkinson's Disease Improve with Strategic Exposure to Bright Light: A Case Series Study. Chronobiol Int 2009; 24:521-37. [PMID: 17612949 DOI: 10.1080/07420520701420717] [Citation(s) in RCA: 81] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The antagonism of melatonin in models of Parkinson's disease (PD) can reduce the severity of motor impairment associated with dopamine (DA) degeneration. In consideration of the potent antidepressant effects of bright light therapy (LT), that LT suppresses melatonin secretion, that depression is commonly observed in PD, and that exposure to constant light facilitates recovery from experimental PD, the object of the present study was to strategically administer LT to PD patients and observe the effects on depression, insomnia, and motor performance. Twelve patients diagnosed with PD were exposed to white fluorescent light for 1-1.5 h at an intensity of 1000 to 1500 lux once daily commencing 1 h prior to the usual time of sleep onset, approximately 22:00 h in most patients. All patients were assessed before LT commenced and at two weeks, five weeks, and regular intervals thereafter. Within two weeks after commencing LT, marked improvement in bradykinaesia and rigidity was observed in most patients. Tremor was not affected by LT treatment; however, agitation, dyskinaesia, and psychiatric side effects were reduced, as verified by decreased requirement for DA replacement therapy. Elevated mood, improved sleep, decreased seborrhea, reduced impotence, and increased appetite were observed after LT. LT permitted the reduction of the dose of L-dopa, bromocriptine, or deprenyl in some patients by up to 50% without loss of symptom control. Factors limiting the efficacy of LT included multiple disease states, treatment compliance, polypharmacy, emotional stress, advanced age, and predominance of positive symptoms. The results of this case series study confirms previous work describing light as efficacious in the treatment of PD and suggest that controlled trials may help to elucidate how LT might be used strategically as an adjunct therapy to improve the morbidity of PD patients.
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Affiliation(s)
- Gregory L Willis
- The Bronowski Institute of Behavioural Neuroscience, Coliban Medical Centre, Kyneton, Victoria, Australia.
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Zampieri C, Di Fabio RP. Improvement of gaze control after balance and eye movement training in patients with progressive supranuclear palsy: a quasi-randomized controlled trial. Arch Phys Med Rehabil 2009; 90:263-70. [PMID: 19236979 DOI: 10.1016/j.apmr.2008.07.024] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2008] [Revised: 06/24/2008] [Accepted: 07/24/2008] [Indexed: 10/21/2022]
Abstract
OBJECTIVE One of the main oculomotor findings in progressive supranuclear palsy (PSP) is the inability to saccade downward. In addition, people with PSP have difficulty suppressing fixation, which may contribute to vertical gaze palsy. The objective was to investigate the effectiveness of a rehabilitation intervention tailored to enhance suppression of fixation and gaze shift in participants with PSP. DESIGN Controlled trial with a quasi-randomized design. Measures occurred at week 1 and 5. Researchers assessing participants were blind to the group assignments. SETTING Movement disorders assessment laboratory. PARTICIPANTS Nineteen adults with possible or probable PSP who were ambulatory for short distances and had far visual acuity of 20/80 and a Folstein Mini-Mental State score of more than 23. INTERVENTIONS Balance training complemented with eye movement and visual awareness exercises was compared with balance training alone. MAIN OUTCOME MEASURES Gaze control was assessed using a vertical Gaze Fixation Score and a Gaze Error Index. RESULTS Gaze control after the balance plus eye exercise significantly improved, whereas no significant improvement was observed for the group that received balance training alone. CONCLUSIONS These preliminary findings support the use of balance and eye movement exercises to improve gaze control in PSP.
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Affiliation(s)
- Cris Zampieri
- Department of Physical Medicine and Rehabilitation, University of Minnesota, Minneapolis, MN, USA.
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10
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Balance and eye movement training to improve gait in people with progressive supranuclear palsy: quasi-randomized clinical trial. Phys Ther 2008; 88:1460-73. [PMID: 18948373 DOI: 10.2522/ptj.20070302] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND AND PURPOSE Although vertical gaze palsy and gait instability are cardinal features of progressive supranuclear palsy (PSP), little research has been done to address oculomotor and gait rehabilitation for PSP. The purpose of this study was to compare the benefits of a program of balance training complemented with eye movement and visual awareness training versus balance training alone to rehabilitate gait in people with PSP. PARTICIPANTS Nineteen people moderately affected by the disease were assigned to either a treatment group (balance plus eye movement exercises, n=10) or a comparison group (balance exercises only, n=9) in a quasi-random fashion. METHODS The baseline characteristics assessed were diagnosis (possible versus probable), sex, age, time of symptom onset, dementia, and severity of symptoms. Within-group, between-group, and effect size analyses were performed on kinematic gait parameters (stance time, swing time, and step length) and clinical tests (8-ft [2.4-m] walk test and Timed "Up & Go" Test). RESULTS The within-group analysis revealed significant improvements in stance time and walking speed for the treatment group, whereas the comparison group showed improvements in step length only. Moderate to large effects of the intervention were observed for the treatment group, and small effects were observed for the comparison group. The between-group analysis did not reveal significant changes for either group. DISCUSSION AND CONCLUSION These preliminary findings support the use of eye movement exercises as a complementary therapy for balance training in the rehabilitation of gait in people with PSP and moderate impairments. Additional studies powered at a higher level are needed to confirm these results.
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11
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Benamer HTS. Parkinsonism and Tremor Disorders: A Clinical Approach. Libyan J Med 2007. [DOI: 10.4176/061222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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12
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Benamer HTS. Parkinsonism and tremor disorders. A clinical approach. Libyan J Med 2007. [DOI: 10.3402/ljm.v2i2.4698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Hani TS Benamer
- New Cross Hospital, Wolverhampton and Queen Elizabeth Neuroscience Centre, University Hospital Birmingham, UK
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13
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Valls-Solé J. Chapter 20 Neurophysiological aids to the diagnosis of Progressive Supranuclear Palsy (PSP). ACTA ACUST UNITED AC 2006; 58:249-56. [PMID: 16623336 DOI: 10.1016/s1567-424x(09)70073-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Affiliation(s)
- Josep Valls-Solé
- Unitat d'EMG, Servei de Neurologia, Hospital Clínic, Villarroel 170, Barcelona 08036, Spain.
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14
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Papapetropoulos S, Gonzalez J, Mash DC. Natural History of Progressive Supranuclear Palsy: A Clinicopathologic Study from a Population of Brain Donors. Eur Neurol 2005; 54:1-9. [PMID: 16015014 DOI: 10.1159/000086754] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2004] [Accepted: 04/04/2005] [Indexed: 11/19/2022]
Abstract
Progressive supranuclear palsy (PSP) is the second most common parkinsonian syndrome, characterized by a 'diverse' clinical phenotype. Although several different diagnostic guidelines have been proposed, the early and accurate diagnosis of PSP remains problematic and neuropathology is still considered the 'gold standard'. In order to contribute to the better clinical characterization of PSP, we conducted a postmortem study in a cohort of 22 consecutive PSP brain donors and compared our results with those of previously published reports. Our results further demonstrate and expand the varied clinical picture of PSP. Furthermore, we report associations between older age at onset, early dementia, early falls and smoking with shorter PSP duration.
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Abstract
Richardson observed an unusual clinical syndrome in the 1950s, which he later designated progressive supranuclear palsy (PSP). Over the past 25 years, although knowledge of this disorder has gradually improved, its cause is still unknown, pathogenesis is unclear, and there is still no definitive treatment for this disorder. This article reviews the epidemiology, clinical features, diagnostic criteria, neuropathology, neuroimaging, and treatment of PSP.
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Affiliation(s)
- R Pahwa
- Department of Neurology, University of Kansas Medical Center, Kansas City, USA
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Abstract
A substantial portion of elderly people experience declines in mental capacities. While these changes are often attributable to serious dementing illnesses such as Alzheimer's disease, a surprising number result from apparently normal aging processes. The effects of senescence on cognition may be indirect (i.e., gait instability leading to falling and subsequent head trauma); however, they may have a more direct and subtle impact on the brain. The evidence available to date suggests that only a limited range of cognitive domains are susceptible to these aging effects. Perhaps the most important are short-term memory functions. The specific character of these and other age-related cognitive deficits are reviewed.
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Affiliation(s)
- R W Keefover
- Department of Neurology, West Virginia University School of Medicine, Morgantown, West Virginia 26506-9180, USA
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17
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Henneberg AE, Scholl I, Kogan E. Myoclonic astatic attacks in patients suffering from Parkinson's disease. Eur J Neurol 1998. [DOI: 10.1046/j.1468-1331.1998.540365.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Abstract
OBJECTIVES To document the nature, distribution, and frequency of dystonic symptoms in progressive supranuclear palsy (PSP). METHODS Charts and videotapes of all clinically diagnosed patients with PSP seen between 1983 and 1993 were reviewed and the occurrence, nature, and distribution of all dystonic symptoms were recorded. RESULTS Of 83 identified cases 38 had some dystonic features. Twenty (24%) had blepharospasm (one was induced by levodopa), 22 (27%) had limb dystonia (one was induced by electroconvulsive therapy and another by levodopa), 14 (17%) had axial dystonia in extension, one had oromandibular dystonia induced by levodopa, and two had other cranial dystonias. Six patients had limb dystonia as an early or presenting feature, sometimes leading to misdiagnosis of cortical-basal ganglionic degeneration. All three patients who had postmortem confirmation of the diagnosis had other concurrent disease. One patient with bilateral limb dystonia and blepharospasm had evidence of previous hydrocephalus and severe arteriosclerotic changes. One with arm dystonia also had cerebrovascular disease and one with hemidystonia also had rare swollen chromatolytic neurons in the frontotemporal cortex. CONCLUSIONS Dystonia is a common manifestation of PSP. Limb dystonia is particularly common and may indicate the presence of concurrent disease. When dystonia occurs in PSP, dopaminergic medication should be cautiously reduced or discontinued to rule out the possibility of treatment induced symptoms.
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Affiliation(s)
- C L Barclay
- University of Ottawa, Ottawa Civic Hospital, Ontario, Canada
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Rascol O, Sabatini U, Fabre N, Senard JM, Simonetta-Moreau M, Montastruc JL, Clanet M, Rascol A. Abnormal vestibuloocular reflex cancellation in multiple system atrophy and progressive supranuclear palsy but not in Parkinson's disease. Mov Disord 1995; 10:163-70. [PMID: 7753058 DOI: 10.1002/mds.870100206] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
We have measured the gain of the vestibuloocular reflex (VOR) in darkness and its cancellation by fixation in 37 patients with Parkinson's disease (PD), 26 patients with multiple system atrophy (MSA), 11 patients with progressive supranuclear palsy (PSP), and 19 normal volunteers. The capacity to cancel the VOR by fixation (VOR cancellation) was significantly reduced in the MSA and PSP patients compared with the PD and normal subjects (p < 10(-4)). A VOR cancellation < 90% (i.e., the mean VOR cancellation of the normals--2 SD) was present in four PD patients, 23 MSA patients, and 11 PSP patients. This criteria distinguished PD and MSA with a 89% sensitivity and a 89% specificity. Our results demonstrate that the VOR cancellation is impaired in most patients with MSA and PSP but not with PD. In MSA patients, the abnormal VOR cancellation is probably not related to the nigrostriatal dopaminergic deficit and more likely reflects a cerebellar dysfunction. Impaired VOR cancellation is a clinical criteria to differentiate MSA and PSP from PD.
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Affiliation(s)
- O Rascol
- Laboratory of Medical and Clinical Pharmacology (INSERM U 317), University Hospital of Toulouse, France
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20
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Abstract
Progressive supranuclear palsy (PSP) is characterized by supranuclear ophthalmoplegia mainly affecting vertical gaze, nuchal dystonia in extension, pseudobulbar palsy, and mental changes. The literature on PSP has been neurologically oriented whereas the psychiatric aspects have been relatively neglected. A review of the literature shows that psychiatric disturbance in PSP is common but with no characteristic pattern. Cognitive impairment, nonspecific affective and behavioral disturbances are commonly found, whereas frank psychosis or bipolar disorder are rare. Misdiagnoses with psychiatric disorders are common and a heightened awareness of the condition is necessary for early diagnosis.
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Affiliation(s)
- H F Chiu
- Department of Psychiatry, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin
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21
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Trevisol-Bittencourt PC. [Progressive supranuclear palsy (Steele-Richardson-Olszewski syndrome): report of a case and review of the literature]. ARQUIVOS DE NEURO-PSIQUIATRIA 1992; 50:369-74. [PMID: 1308417 DOI: 10.1590/s0004-282x1992000300018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Progressive supranuclear palsy (PSP) was first recognized as a distinct syndrome by Richardson, Steele and Olszewski roughly a quarter century ago. Subsequent clinical experience has corroborated and enlarged their original observations. PSP has become familiar as a chronic progressive disorder with extrapyramidal rigity, bradykinesia, gait impairment, bulbar palsy, dementia and a characteristic supranuclear ophthalmoplegia. It is a significant cause of parkinsonism and its etiology remains obscure. The case of a patient from Santa Catarina who presented definite clinical evidences of this syndrome is reported. This is the first description in this southern Brazilian State, where at least 50 more patients should exist, if we may extrapolate the prevalence rate of this condition in developed countries to this well developed area of Brazil. A review of the literature was undertaken with emphasis on recent clinical and therapeutic aspects of PSP.
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Gutrecht JA. Autonomic cardiovascular reflexes in progressive supranuclear palsy. JOURNAL OF THE AUTONOMIC NERVOUS SYSTEM 1992; 39:29-35. [PMID: 1629523 DOI: 10.1016/0165-1838(92)90248-f] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Assessment of possible autonomic nervous system dysfunction was performed by testing cardiovascular reflexes in nine patients with progressive supranuclear palsy (PSP). The patients were significantly different from 15 control age-matched subjects because of greater blood pressure drop on standing for 1 min, diminished rise of diastolic blood pressure during the sustained handgrip test, and lack of compensatory tachycardia measured by the 30:15 ratio on standing. The latter test abnormality was caused by a slow rise to erect posture. No differences were observed in the cold pressor test, Valsalva ratio, and heart rate response to deep breathing. The differences between patients and control subjects were usually small. Autonomic nervous system involvement in patients with PSP is minor and is caused by involvement of central brain stem sympathetic nuclei or efferent fibers.
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Affiliation(s)
- J A Gutrecht
- Department of Neurology, Lahey Clinic Medical Center, Burlington, Massachusetts 01805
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Colosimo C, Rossi P, Elia M, Bentivoglio AR, Altavista MC, Albanese A. Transient alternating hemichorea as presenting sign of progressive supranuclear palsy. ITALIAN JOURNAL OF NEUROLOGICAL SCIENCES 1991; 12:99-101. [PMID: 2013530 DOI: 10.1007/bf02337621] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
We report the case of a man who developed unilateral alternating chorea four years before presenting a typical clinical form of Steele-Richardson-Olszewski syndrome. It is known that choreic dyskinesias may occur during the course of this syndrome but this is the first account of choreas presenting sign of the syndrome.
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Affiliation(s)
- C Colosimo
- Istituto di Neurologia, Università Cattolica del Sacro Cuore, Roma
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Yamamoto T, Kawamura J, Hashimoto S, Nakamura M, Iwamoto H, Kobashi Y, Ichijima K. Pallido-nigro-luysian atrophy, progressive supranuclear palsy and adult onset Hallervorden-Spatz disease: a case of akinesia as a predominant feature of parkinsonism. J Neurol Sci 1991; 101:98-106. [PMID: 1709202 DOI: 10.1016/0022-510x(91)90023-z] [Citation(s) in RCA: 28] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Few parkinsonian patients present with 'pure akinesia' or with severe akinesia accompanied by only mild rigidity, tremor and other manifestations such as ophthalmoplegia. Pathological examinations of such cases have rarely been conducted and have revealed findings compatible with progressive supranuclear palsy (PSP), pallido-nigro-luysian atrophy (PNLA) or Parkinson's disease. We report a parkinsonian patient whose main clinical feature was akinesia. A postmortem study of this patient showed findings corresponding to PNLA and PSP. Histochemical properties of the pallidal pigment granules were equivalent to those of Hallervorden-Spatz disease (HSD) and striatonigral degeneration. In addition to iron-positive pigment granules, spheroids, severe neuronal loss and gliosis in the globus pallidus and substantia nigra, formation of Alzheimer's neurofibrillary tangle (NFT) in the brainstem shares characteristics with PSP, adult onset HSD and PNLA. We suggest that the underlying pathology of 'pure' akinesia is most often situated in the globus pallidus substantia nigra and subthalamus (Luys), and that PSP, PNLA and adult onset HSD may constitute a spectrum of one disease.
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Affiliation(s)
- T Yamamoto
- Department of Neurology, Tenri Hospital, Nara, Japan
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Bundza A. Experimental scrapie in white Swiss mice. ZENTRALBLATT FUR VETERINARMEDIZIN. REIHE B. JOURNAL OF VETERINARY MEDICINE. SERIES B 1990; 37:777-80. [PMID: 2082631 DOI: 10.1111/j.1439-0450.1990.tb01129.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
In order to confirm the clinical and histological diagnosis of scrapie and to determine the infectivity titer of the scrapie agent in the brain of a naturally infected Suffolk sheep, 123 white Swiss mice were inoculated intracerebrally. From about 13 to 20 months post-inoculation, 28 mice died, and 95 that were sick were killed. In the terminal stages of disease, the mice developed weakness, gradual emaciation, posterior ataxia, and occasionally alopecia. The average infection (83%) of mice affected with scrapie occurred in groups 1 to 4 inoculated with dilution 10(-1) to 10(-4) of scrapie sheep brain. Sixty-seven (54.5%) of the mice developed spongiform lesions and vacuolar degeneration of neurons. Similarities of scrapie with other subacute spongiform encephalopathies in animals and humans are discussed.
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Affiliation(s)
- A Bundza
- Agriculture Canada, Animal Diseases Research Institute, Nepean
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Takahashi H, Oyanagi K, Takeda S, Hinokuma K, Ikuta F. Occurrence of 15-nm-wide straight tubules in neocortical neurons in progressive supranuclear palsy. Acta Neuropathol 1989; 79:233-9. [PMID: 2609933 DOI: 10.1007/bf00294656] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Ultrastructural investigations were carried out on the cerebral neocortex in two cases of progressive supranuclear palsy. In both cases, characteristic 15-nm-wide straight tubules were observed in the neurons. The numbers of cells containing the straight tubules and of tubules in individual cells were small. However, the occurrence of the tubules strongly suggests that the cerebral neocortex is also exposed to the disease process in progressive supranuclear palsy.
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Affiliation(s)
- H Takahashi
- Department of Pathology, Niigata University, Japan
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Abstract
Recent research into the dementia of Parkinson's disease has exposed a complex area in which it has not always been possible to match clinical and pathological observations. Certain neuropsychological deficits result from a disruption of basal ganglia and frontal lobe interactions. These are unrelated to a global dementia, the prevalence of which exceeds twice that in the normal population. The associated pathological lesions comprise cortical pathology, either Alzheimer's disease or Lewy bodies, in combination with moderate degeneration of the subcortical, cholinergic, basal nucleus of Meynert.
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Affiliation(s)
- W R Gibb
- Department of Neurology, Guy's Hospital, London
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