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Menezes-Rodrigues FS, de Oliveira MP, Araújo EA, Ferraz HB, Finsterer J, Olszewer E, Taha MO, Scorza CA, Caricati-Neto A, Scorza FA. Role of cardiac β 1-adrenergic and A 1-adenosine receptors in severe arrhythmias related to Parkinson's disease. Clinics (Sao Paulo) 2023; 78:100243. [PMID: 37459671 PMCID: PMC10757299 DOI: 10.1016/j.clinsp.2023.100243] [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: 10/18/2022] [Revised: 06/02/2023] [Accepted: 06/19/2023] [Indexed: 07/27/2023] Open
Abstract
AIMS Although reduced life expectancy in Parkinson's Disease (PD) patients has been related to severe cardiac arrhythmias due to autonomic dysfunctions, its molecular mechanisms remain unclear. To investigate the role of cardiac β1-Adrenergic (β1AR) and A1-Adenosine (A1R) receptors in these dysfunctions, the pharmacological effects of stimulation of cardiac β1AR (isoproterenol, ISO), in the absence and presence of cardiac β1AR (atenolol, AT) or A1R (1,3-dipropyl-8-cyclopentyl xanthine, DPCPX) blockade, on the arrhythmias induced by Ischemia/Reperfusion (CIR) in an animal PD model were studied. METHODS PD was produced by dopaminergic lesions (confirmed by immunohistochemistry analysis) caused by the injection of 6-hydroxydopamine (6-OHDA, 6 μg) in rat striatum. CIR was produced by a surgical interruption for 10 min followed by reestablishment of blood circulation in the descendent left coronary artery. On the incidence of CIR-Induced Ventricular Arrhythmias (VA), Atrioventricular Block (AVB), and Lethality (LET), evaluated by Electrocardiogram (ECG) analysis, the effects of intravenous treatment with ISO, AT and DPCPX (before CIR) were studied. RESULTS VA, AVB and LET incidences were significantly higher in 6-OHDA (83%, 92%, 100%, respectively) than in control rats (58%, 67% and 67%, respectively). ISO treatment significantly reduced these incidences in 6-OHDA (33%, 33% and 42%, respectively) and control rats (25%, 25%, 33%, respectively), indicating that stimulation of cardiac β1AR induced cardioprotection. This response was prevented by pretreatment with AT and DPCPX, confirming the involvement of cardiac β1AR and A1R. CONCLUSION Pharmacological modulation of cardiac β1AR and A1R could be a potential therapeutic strategy to reduce severe arrhythmias and increase life expectancy in PD patients.
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Affiliation(s)
- Francisco Sandro Menezes-Rodrigues
- Laboratory of Autonomic and Cardiovascular Pharmacology, Department of Pharmacology, Escola Paulista de Medicina (EPM), Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil; Neuroscience Discipline, Escola Paulista de Medicina (EPM), Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil; PostGraduate Program in Cardiology, Escola Paulista de Medicina (EPM), Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - Marcelo Pires de Oliveira
- School of Medicine, Centro Universitário UNIFAS, União Metropolitana para a Educação e Cultura, Lauro de Freitas, BA, Brazil
| | - Erisvaldo Amarante Araújo
- Laboratory of Autonomic and Cardiovascular Pharmacology, Department of Pharmacology, Escola Paulista de Medicina (EPM), Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - Henrique Ballalai Ferraz
- Neuroscience Discipline, Escola Paulista de Medicina (EPM), Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| | | | - Efrain Olszewer
- Fundação de Apoio à Pesquisa e Estudo na Área de Saúde (FAPES), São Paulo, SP, Brazil
| | - Murched Omar Taha
- Department of Surgery, Escola Paulista de Medicina (EPM), Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - Carla Alessandra Scorza
- Neuroscience Discipline, Escola Paulista de Medicina (EPM), Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - Afonso Caricati-Neto
- Laboratory of Autonomic and Cardiovascular Pharmacology, Department of Pharmacology, Escola Paulista de Medicina (EPM), Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil.
| | - Fúlvio Alexandre Scorza
- Neuroscience Discipline, Escola Paulista de Medicina (EPM), Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
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Senapati LK, Patnaik S, Samanta P, Kar SP, Dash S, Mishra J. Comparison of Cardiac Autonomic Function in Type 2 Spinocerebellar Ataxia With Normal Control Using Heart Rate Variability as a Tool: A Cross-Sectional Study in Eastern India. Cureus 2021; 13:e20058. [PMID: 34873557 PMCID: PMC8632594 DOI: 10.7759/cureus.20058] [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] [Accepted: 11/30/2021] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Spinocerebellar ataxia (SCA) is a disease that refers to a category of inherited ataxias that are characterized by degenerative alterations in the cerebellum, pons, and spinocerebellar tracts. There are several different varieties of SCA and they are classified based on the mutant (altered) gene that causes the disease. OBJECTIVE To analyze the cardiovascular autonomic regulation in patients with type-2 spinocerebellar ataxia (SCA-2) from the heart rate variability (HRV) of 20 minutes resting electrocardiogram (ECG) and compare with the age and gender-matched controls. MATERIALS AND METHODS HRV of 27 type-2 spinocerebellar ataxia patients was calculated offline from the resting ECG recording and compared with 23 age and gender-matched controls. The HRV was analyzed by HRV software module MLS 310. The frequency and time domain parameters were computed and compared. RESULT Type-2 spinocerebellar ataxia patients have significantly low HRV and parasympathetic activity at rest compared to normal control. The total power in SCA-2 is 13491.63 ± 7660.77 ms2 and the normal control is 21784.76 ± 11008.67 ms2. High-frequency power (HF) which is a marker of parasympathetic activity in SCA-2 is 3823.1 ± 364 ms2 and in normal control is 9006.1 ± 920.64 ms2. The standard deviation of all NN intervals (SDNN), the square root of the mean-squared differences of successive intervals (RMSSD), spectral interval, and delta NN is significantly low in SCA-2. CONCLUSION There is decreased parasympathetic tone and low HRV in SCA-2 as compared to normal controls.
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Affiliation(s)
- Laxman K Senapati
- Department of Anesthesia, Kalinga Institute of Medical Sciences, Kalinga Institute of Industrial Technology (KIIT, deemed to be University), Bhubaneswar, IND
| | - Sudipta Patnaik
- Department of Physiology, Sriram Chandra Bhanja Medical College, Utkal University, Bhubaneswar, IND
| | - Priyadarsini Samanta
- Department of Physiology, Kalinga Institute of Medical Sciences, Kalinga Institute of Industrial Technology (KIIT, deemed to be University), Bhubaneswar, IND
| | - Sambit P Kar
- Research, School of Electronics Engineering, Kalinga Institute of Industrial Technology (KIIT, deemed to be University), Bhubaneswar, IND
| | - Santosh Dash
- Department of Neurology, Kalinga Institute of Medical Sciences, Kalinga Institute of Industrial Technology (KIIT, deemed to be University), Bhubaneswar, IND
| | - Jayanti Mishra
- Department of Physiology, Kalinga Institute of Medical Sciences, Kalinga Institute of Industrial Technology (KIIT, deemed to be University), Bhubaneswar, IND
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Yu Z, Li Y. Association of autonomic symptoms with cerebrospinal fluid biomarkers in Parkinson disease and scans without evidence of dopaminergic deficit. Medicine (Baltimore) 2021; 100:e24837. [PMID: 33607852 PMCID: PMC7899893 DOI: 10.1097/md.0000000000024837] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Accepted: 01/25/2021] [Indexed: 01/05/2023] Open
Abstract
Dysautonomia is common in patients with Parkinson disease (PD) since disease early phase. Scales for Outcomes in Parkinson's disease - Autonomic (SCOPA-AUT) is a well-designed scale assessing the autonomic dysfunctions of PD patients. Our objectives were to examine the autonomic dysfunction in PD and scan without evidence of dopaminergic deficit (SWEDD) patients and to assess the correlation of autonomic dysfunctions with cerebrospinal fluid (CSF) biomarkers.An analysis of the Parkinson's Progression Markers Initiative (PPMI) data including 414 PD patients, 60 SWEDD patients, and 170 healthy controls (HCs) with baseline CSF biomarker measurements and SCOPA-AUT assessments was presented. Autonomic symptoms including gastrointestinal, urinary, cardiovascular, pupillomotor, thermoregulatory and sexual dysfunctions were assessed by SCOPA-AUT scales. Spearman correlation test was used to examine the correlations between CSF measurements and each section of SCOPA-AUT scales in HCs and subjects with PD or SWEDD.More severe autonomic dysfunctions were observed in patients with SWEDD than those with PD (P < .001). Specifically, patients with PD have lower scores on the urinary scale [4 (0-17) vs 5 (1-18)], pupillomotor scale [0 (0-3) vs 0 (0-3)], thermoregulatory scale [0 (0-4) vs 1.5 (0-10)] and sexual scale [1 (0-6) vs 2 (0-6)] compared with SWEDD patients. Thermoregulatory dysfunction scores were found correlated with CSF α-syn levels in SWEDD group, and gastrointestinal dysfunction scores were correlated with CSF Abeta1-42 in PD group. Additionally, urinary dysfunction scores were correlated with CSF total tau and tau phosphorylated at threonine 181(p-tau181) levels in both HCs and PD patients.
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Affiliation(s)
- Zhenwei Yu
- Beijing Neurosurgical Institute, Capital Medical University
| | - Yang Li
- Institute of Systems Biomedicine, School of Basic Medical Sciences, Peking University Health Science Center, Beijing, China
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Winbo A, Ramanan S, Eugster E, Jovinge S, Skinner JR, Montgomery JM. Functional coculture of sympathetic neurons and cardiomyocytes derived from human-induced pluripotent stem cells. Am J Physiol Heart Circ Physiol 2020; 319:H927-H937. [DOI: 10.1152/ajpheart.00546.2020] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
We present data on a functional coculture between human-induced pluripotent stem cell-derived sympathetic neurons and cardiomyocytes. Moreover, this study adds significantly to the available data on the electrophysiological function of human-induced pluripotent stem cell-derived sympathetic neurons.
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Affiliation(s)
- Annika Winbo
- Department of Physiology, The University of Auckland, Auckland, New Zealand
- Manaaki Mānawa Centre for Heart Research, The University of Auckland, Auckland, New Zealand
- Department of Paediatric and Congenital Cardiac Services, Starship Children’s Hospital, Auckland, New Zealand
| | - Suganeya Ramanan
- Department of Physiology, The University of Auckland, Auckland, New Zealand
- Manaaki Mānawa Centre for Heart Research, The University of Auckland, Auckland, New Zealand
| | - Emily Eugster
- DeVos Cardiovascular Research Program, Spectrum Health and Van Andel Research Institute, Grand Rapids, Michigan
| | - Stefan Jovinge
- DeVos Cardiovascular Research Program, Spectrum Health and Van Andel Research Institute, Grand Rapids, Michigan
- Cardiovascular Institute, Stanford University, Palo Alto, California
| | - Jonathan R. Skinner
- Manaaki Mānawa Centre for Heart Research, The University of Auckland, Auckland, New Zealand
- Department of Paediatric and Congenital Cardiac Services, Starship Children’s Hospital, Auckland, New Zealand
| | - Johanna M. Montgomery
- Department of Physiology, The University of Auckland, Auckland, New Zealand
- Manaaki Mānawa Centre for Heart Research, The University of Auckland, Auckland, New Zealand
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Bodi I, Hagen EM, Ingle GT, Lunn MP. Fatal autonomic failure due to premanifesting Parkinson's disease only diagnosed at autopsy. Clin Case Rep 2020; 8:1997-1999. [PMID: 33088537 PMCID: PMC7562892 DOI: 10.1002/ccr3.3042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 04/30/2020] [Accepted: 05/28/2020] [Indexed: 11/08/2022] Open
Abstract
A 46-year-old male had 11-year history of cryptic autonomic dysfunction. He developed a fatal autonomic failure with diffuse hypoxic brain injury. Histology examination of medulla oblongata and the celiac ganglion revealed many α-synuclein immunoreactive Lewy bodies confirming the diagnosis of premanifesting Parkinson's disease (PD). PNS involvement in PD is underappreciated.
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Affiliation(s)
- Istvan Bodi
- Clinical NeuropathologyKing's College HospitalNHS Foundation TrustLondonUK
| | | | | | - Michael P Lunn
- Centre for Neuromuscular DiseaseNational Hospital for Neurology and NeurosurgeryLondonUK
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Rodrigues LD, Oliveira LF, Shinoda L, Scorza CA, Faber J, Ferraz HB, Britto LRG, Scorza FA. Cardiovascular alterations in rats with Parkinsonism induced by 6-OHDA and treated with Domperidone. Sci Rep 2019; 9:8965. [PMID: 31222185 PMCID: PMC6586896 DOI: 10.1038/s41598-019-45518-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Accepted: 06/10/2019] [Indexed: 01/10/2023] Open
Abstract
After Alzheimer, Parkinson disease (PD) is the most frequently occurring progressive, degenerative neurological disease. It affects both sympathetic and parasympathetic nervous systems in a variable fashion. Cardiovascular symptoms are present in almost all stages of PD and narrower heart rate variability is the earliest sign. Administration of Levodopa to PD patients has proven to provide some degree of neurological protection. This drug, however, causes side effects including nausea and vomiting, lessened by the administration of domperidone. Autopsies in PD patients led some researchers to suggest the involvement of the ventricular arrhythmia induced by domperidone. The aim of the present study was to determine the impact of the adjusted human maximal dose of domperidone, on cardiological features of Wistar rats. domperidone was administered to both 6-hydroxydopamine Parkinsonism models and regular Wistar rats. Quantitative analysis of ranges of heart beat variation showed significant abnormal distribution in both groups receiving domperidone as compared with respective sham counterparts. However, qualitative analysis of Poincaré plots showed that 6-hydroxydopamine Parkinsonism models receiving domperidone had the narrowest full range of heart beat and the worst distribution heart beat ranges as compared with all study groups corroborating with previous suggestion that domperidone administration to PD patients is likely to play a role in sudden unexpected death in this group of patients.
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Affiliation(s)
- Laís D Rodrigues
- Department of Neurology and Neurosurgery, UNIFESP/EPM, São Paulo, Brazil.
| | - Leandro F Oliveira
- Department of Neurology and Neurosurgery, UNIFESP/EPM, São Paulo, Brazil.
| | - Lucas Shinoda
- Department of Neurology and Neurosurgery, UNIFESP/EPM, São Paulo, Brazil
| | - Carla A Scorza
- Department of Neurology and Neurosurgery, UNIFESP/EPM, São Paulo, Brazil
| | - Jean Faber
- Department of Neurology and Neurosurgery, UNIFESP/EPM, São Paulo, Brazil
| | - Henrique B Ferraz
- Department of Neurology and Neurosurgery, UNIFESP/EPM, São Paulo, Brazil
| | - Luiz R G Britto
- Laboratory of Cellular Neurobiology, Department of Physiology and Biophysics -University of São Paulo, São Paulo, Brazil
| | - Fulvio A Scorza
- Department of Neurology and Neurosurgery, UNIFESP/EPM, São Paulo, Brazil
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Kim A, Kim HJ, Shin CW, Kim A, Kim Y, Jang M, Jung YJ, Lee WW, Park H, Jeon B. Emergence of non-motor fluctuations with reference to motor fluctuations in Parkinson's disease. Parkinsonism Relat Disord 2018; 54:79-83. [PMID: 29724602 DOI: 10.1016/j.parkreldis.2018.04.020] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Revised: 03/27/2018] [Accepted: 04/17/2018] [Indexed: 01/27/2023]
Abstract
INTRODUCTION Non-motor fluctuations (NMF) and motor fluctuations (MF) are frequent in patients with Parkinson's disease (PD) with long-term medical treatment. We aimed to examine the timing of the emergence of NMF with reference to MF in a prospective cohort of patients with PD without symptom fluctuations. METHODS A total of 334 patients with PD who had neither MF nor NMF were recruited. The exclusion criteria included a Mini-Mental State Examination score of less than 26 points at baseline and an alternative diagnosis or significant comorbidity during follow-up. The "SNUH-Fluctuation Questionnaire" consisting of 29 items (9 on MF and 20 on NMF) was administered on a semi-annually basis for 3 years. RESULTS Three hundred seven out of 334 patients were analyzed for symptom fluctuations with the Kaplan-Meier survival analysis. MF were observed in more patients and developed earlier than NMF (cumulative survival of 0.572 for MF and 0.619 for NMF at 36 months of follow-up). In 212 patients who finished the follow-up for 36 months, MF and NMF developed simultaneously in 58 (27.4%), MF developed first in 45 (21.2%), and NMF developed first in only 3 (1.4%). The remaining 106 patients (50.0%) did not develop either MF or NMF. CONCLUSION NMF developed simultaneously with or later than MF. From these data, we hypothesize that NMF develop in the disease state where the pathology in the brain has been severe enough to develop MF. Hence, pharmacologic management should consider targeting both dopaminergic and non-dopaminergic systems to treat NMF.
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Affiliation(s)
- Aryun Kim
- Department of Neurology, Movement Disorder Center, Seoul National University Hospital, Parkinson Study Group, Seoul National University College of Medicine, Seoul, South Korea
| | - Han-Joon Kim
- Department of Neurology, Movement Disorder Center, Seoul National University Hospital, Parkinson Study Group, Seoul National University College of Medicine, Seoul, South Korea
| | - Chae Won Shin
- Department of Neurology, Kyung Hee University Medical Center, Seoul, South Korea
| | - Ahro Kim
- Department of Neurology, Catholic University of Korea, Seoul, South Korea
| | - Yoon Kim
- Department of Neurology, Movement Disorder Center, Seoul National University Hospital, Parkinson Study Group, Seoul National University College of Medicine, Seoul, South Korea
| | - Mihee Jang
- Department of Neurology, Movement Disorder Center, Seoul National University Hospital, Parkinson Study Group, Seoul National University College of Medicine, Seoul, South Korea
| | - Yu Jin Jung
- Department of Neurology, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Daejeon, South Korea
| | - Woong-Woo Lee
- Department of Neurology, Nowon Eulji Medical Center, Eulji University, Seoul, South Korea
| | - Hyeyoung Park
- Department of Neurology, Hallym Hospital, Incheon, South Korea
| | - Beomseok Jeon
- Department of Neurology, Movement Disorder Center, Seoul National University Hospital, Parkinson Study Group, Seoul National University College of Medicine, Seoul, South Korea.
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Steventon JJ, Collett J, Furby H, Hamana K, Foster C, O'Callaghan P, Dennis A, Armstrong R, Németh AH, Rosser AE, Murphy K, Quinn L, Busse M, Dawes H. Alterations in the metabolic and cardiorespiratory response to exercise in Huntington's Disease. Parkinsonism Relat Disord 2018; 54:56-61. [PMID: 29705557 DOI: 10.1016/j.parkreldis.2018.04.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Revised: 04/04/2018] [Accepted: 04/12/2018] [Indexed: 01/01/2023]
Abstract
BACKGROUND Limited data suggests that an altered metabolic and cardiorespiratory exercise response may affect exercise performance in individuals with Huntington's disease (HD). There is no clear exploration of the response in individuals at different stages of the disease or in relation to genetic markers. This study aimed to examine the exercise response and recovery of HD participants, and the relationship to genetic and clinical markers. METHOD HD gene-positive participants (n = 31; 9 pre-manifest; 22 manifest HD) and a healthy control group (n = 29) performed an incremental exercise test until exhaustion. Performance, cardiorespiratory, metabolic and perceptual responses to exercise were determined from a maximal cycle ergometer test throughout the exercise test and during a recovery period. RESULTS During sub-maximal exercise, metabolic (lactate levels, oxygen uptake) and cardiorespiratory markers (heart rate) were elevated in HD participants compared to controls. Lactate elevation was specific to pre-manifest HD participants. Work capacity was reduced in both pre-manifest and manifest HD participants with tests terminated with no difference in metabolic, perceptual or cardiorespiratory markers. Submaximal oxygen uptake was correlated with motor score, whilst peak measures were unrelated to genetic or clinical markers. Heart rate recovery was attenuated in pre-manifest and manifest HD participants. CONCLUSIONS Our findings confirm metabolic and cardiorespiratory deficits reduce exercise performance and affect recovery from an early stage in HD, with submaximal deficits related to phenotypic expression. Exercise capacity appears to be limited by an altered movement economy, thus clinicians should consider an altered exercise response and recovery may affect prescription in HD.
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Affiliation(s)
- J J Steventon
- School of Physics and Astronomy, Cardiff University, UK; NMHRI, School of Medicine, Cardiff University, UK; CUBRIC, School of Psychology, Cardiff University, UK.
| | - J Collett
- Centre for Movement, Occupation and Rehabilitation Sciences, OxINMAHR, Oxford Brookes University, Oxford, UK; Faculty of Health and Life Sciences, Oxford Brookes University, Oxford, UK
| | - H Furby
- NMHRI, School of Medicine, Cardiff University, UK; CUBRIC, School of Psychology, Cardiff University, UK
| | - K Hamana
- School of Healthcare Sciences, Cardiff University, UK
| | - C Foster
- CUBRIC, School of Psychology, Cardiff University, UK
| | - P O'Callaghan
- Cardiology Department, University Hospital of Wales, Cardiff, UK
| | - A Dennis
- FMRIB Centre, Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, OX3 9DU, UK
| | - R Armstrong
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - A H Németh
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - A E Rosser
- IPMCN, School of Medicine, Cardiff University, UK
| | - K Murphy
- School of Physics and Astronomy, Cardiff University, UK; CUBRIC, School of Psychology, Cardiff University, UK
| | - L Quinn
- Department of Biobehavioral Sciences, Teachers College, Columbia University, USA
| | - M Busse
- Centre for Trials Research, Cardiff University, UK
| | - H Dawes
- Centre for Movement, Occupation and Rehabilitation Sciences, OxINMAHR, Oxford Brookes University, Oxford, UK; Department of Clinical Neurology, University of Oxford, Oxford, UK
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Sengoku A. Editorial Comment from Dr Sengoku to Case of possible multiple system atrophy with a characteristic imaging finding of open bladder neck during storage phase as an initial sign. Int J Urol 2017; 24:820. [DOI: 10.1111/iju.13467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Atsushi Sengoku
- Department of Urology; Hyogo Rehabilitation Center Hospital; Kobe Hyogo Japan
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Florczak-Wyspianska J, Rozycka A, Wolny L, Lianeri M, Kozubski W, Dorszewska J. Polymorphisms of COMT (c.649G>A), MAO-A (c.1460C>T), NET (c.1287G>A) Genes and the Level of Catecholamines, Serotonin in Patients with Parkinson's Disease. DNA Cell Biol 2017; 36:501-512. [PMID: 28418735 DOI: 10.1089/dna.2016.3569] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
The purpose of this study was to determine the concentration of plasma norepinephrine (NE), epinephrine (E), and serotonin (5-HT) in two collections, after a 30-min supine (I) and 5-min upright position (II), and polymorphisms of genes, COMT (c.649G>A), MAO-A (c.1460C>T), and NET (c.1287G>A), in patients with Parkinson's disease (PD) and other degenerative parkinsonism and controls. The study was performed in 49 PD patients, 19 parkinsonism patients, and 48 controls. The level of NE, E, and 5-HT was determined by HPLC/EC. PCR-RFLP was conducted to analyze the COMT, MAO-A, and NET polymorphisms. Genotypes of COMT, MAO-A, and NET genes occurred with different frequencies in patients with movement disorders and controls. NET AA occurred 4.8 times more frequently in patients with parkinsonism than in PD (p < 0.05). COMT AA genotype was associated with increased E levels [E (I) p < 0.01, E (II) p < 0.05] in PD compared to controls. Patients with parkinsonism with MAO-A TT genotype have a significantly higher level of 5-HT [5-HT (II), p < 0.05] compared to controls. Moreover, PD patients with NET GA genotype have the lowest level of NE (p < 0.05) compared to controls. It appears that COMT, MAO-A, and NET polymorphisms and levels of NE, E, and 5-HT are involved in pathogenesis of PD.
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Affiliation(s)
| | - Agata Rozycka
- 2 Laboratory of Molecular Biology, Division of Perinatology and Women's Diseases, Poznan University of Medical Sciences , Poznan, Poland .,3 Department of Biochemistry and Molecular Biology, Poznan University of Medical Sciences , Poznan, Poland
| | - Lukasz Wolny
- 4 Laboratory of Neurobiology, Department of Neurology, Poznan University of Medical Sciences , Poznan, Poland
| | - Margarita Lianeri
- 4 Laboratory of Neurobiology, Department of Neurology, Poznan University of Medical Sciences , Poznan, Poland
| | - Wojciech Kozubski
- 1 Chair and Department of Neurology, Poznan University of Medical Sciences , Poznan, Poland
| | - Jolanta Dorszewska
- 4 Laboratory of Neurobiology, Department of Neurology, Poznan University of Medical Sciences , Poznan, Poland
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11
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Petschow C, Scheef L, Paus S, Zimmermann N, Schild HH, Klockgether T, Boecker H. Central Pain Processing in Early-Stage Parkinson's Disease: A Laser Pain fMRI Study. PLoS One 2016; 11:e0164607. [PMID: 27776130 PMCID: PMC5077078 DOI: 10.1371/journal.pone.0164607] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Accepted: 09/28/2016] [Indexed: 01/08/2023] Open
Abstract
Background & Objective Pain is a common non-motor symptom in Parkinson’s disease. As dopaminergic dysfunction is suggested to affect intrinsic nociceptive processing, this study was designed to characterize laser-induced pain processing in early-stage Parkinson’s disease patients in the dopaminergic OFF state, using a multimodal experimental approach at behavioral, autonomic, imaging levels. Methods 13 right-handed early-stage Parkinson’s disease patients without cognitive or sensory impairment were investigated OFF medication, along with 13 age-matched healthy control subjects. Measurements included warmth perception thresholds, heat pain thresholds, and central pain processing with event-related functional magnetic resonance imaging (erfMRI) during laser-induced pain stimulation at lower (E = 440 mJ) and higher (E = 640 mJ) target energies. Additionally, electrodermal activity was characterized during delivery of 60 randomized pain stimuli ranging from 440 mJ to 640 mJ, along with evaluation of subjective pain ratings on a visual analogue scale. Results No significant differences in warmth perception thresholds, heat pain thresholds, electrodermal activity and subjective pain ratings were found between Parkinson’s disease patients and controls, and erfMRI revealed a generally comparable activation pattern induced by laser-pain stimuli in brain areas belonging to the central pain matrix. However, relatively reduced deactivation was found in Parkinson’s disease patients in posterior regions of the default mode network, notably the precuneus and the posterior cingulate cortex. Conclusion Our data during pain processing extend previous findings suggesting default mode network dysfunction in Parkinson’s disease. On the other hand, they argue against a genuine pain-specific processing abnormality in early-stage Parkinson’s disease. Future studies are now required using similar multimodal experimental designs to examine pain processing in more advanced stages of Parkinson’s disease.
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Affiliation(s)
- Christine Petschow
- Functional Neuroimaging Group, Department of Radiology, University of Bonn, Bonn, Germany
| | - Lukas Scheef
- Functional Neuroimaging Group, Department of Radiology, University of Bonn, Bonn, Germany
| | - Sebastian Paus
- Department of Neurology, University of Bonn, Bonn, Germany
| | | | - Hans H. Schild
- Department of Radiology, University of Bonn, Bonn, Germany
| | | | - Henning Boecker
- Functional Neuroimaging Group, Department of Radiology, University of Bonn, Bonn, Germany
- * E-mail:
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Oh Y, Cho GS, Li Z, Hong I, Zhu R, Kim MJ, Kim YJ, Tampakakis E, Tung L, Huganir R, Dong X, Kwon C, Lee G. Functional Coupling with Cardiac Muscle Promotes Maturation of hPSC-Derived Sympathetic Neurons. Cell Stem Cell 2016; 19:95-106. [PMID: 27320040 DOI: 10.1016/j.stem.2016.05.002] [Citation(s) in RCA: 81] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Revised: 03/14/2016] [Accepted: 05/05/2016] [Indexed: 11/27/2022]
Abstract
Neurons derived from human pluripotent stem cells (hPSCs) are powerful tools for studying human neural development and diseases. Robust functional coupling of hPSC-derived neurons with target tissues in vitro is essential for modeling intercellular physiology in a dish and to further translational studies, but it has proven difficult to achieve. Here, we derive sympathetic neurons from hPSCs and show that they can form physical and functional connections with cardiac muscle cells. Using multiple hPSC reporter lines, we recapitulated human autonomic neuron development in vitro and successfully isolated PHOX2B::eGFP+ neurons that exhibit sympathetic marker expression and electrophysiological properties and norepinephrine secretion. Upon pharmacologic and optogenetic manipulation, PHOX2B::eGFP+ neurons controlled beating rates of cardiomyocytes, and the physical interactions between these cells increased neuronal maturation. This study provides a foundation for human sympathetic neuron specification and for hPSC-based neuronal control of organs in a dish.
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Affiliation(s)
- Yohan Oh
- Institute for Cell Engineering, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA; Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA; Adrienne Helis Malvin Medical Research Foundation, New Orleans, LA 70130, USA
| | - Gun-Sik Cho
- Institute for Cell Engineering, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA; Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| | - Zhe Li
- The Solomon H. Snyder Department of Neuroscience, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| | - Ingie Hong
- The Solomon H. Snyder Department of Neuroscience, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| | - Renjun Zhu
- Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| | - Min-Jeong Kim
- Institute for Cell Engineering, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA; Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| | - Yong Jun Kim
- Institute for Cell Engineering, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA; Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| | - Emmanouil Tampakakis
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| | - Leslie Tung
- Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| | - Richard Huganir
- The Solomon H. Snyder Department of Neuroscience, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| | - Xinzhong Dong
- The Solomon H. Snyder Department of Neuroscience, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA; Center for Sensory Biology, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA; The Howard Hughes Medical Institute, Baltimore, MD 21205, USA
| | - Chulan Kwon
- Institute for Cell Engineering, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA; Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA.
| | - Gabsang Lee
- Institute for Cell Engineering, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA; Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA; Adrienne Helis Malvin Medical Research Foundation, New Orleans, LA 70130, USA; The Solomon H. Snyder Department of Neuroscience, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA.
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13
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Liu WM, Lin RJ, Yu RL, Tai CH, Lin CH, Wu RM. The impact of nonmotor symptoms on quality of life in patients with Parkinson's disease in Taiwan. Neuropsychiatr Dis Treat 2015; 11:2865-73. [PMID: 26635475 PMCID: PMC4646598 DOI: 10.2147/ndt.s88968] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE The nonmotor symptoms (NMS) of Parkinson's disease (PD) are important factors for quality of life (QoL). Few studies on NMS have been conducted in Asian PD patients. Additionally, effects of anti-PD drugs on risk of NMS are still controversial. We therefore conducted this hospital-based cross-sectional study to examine the clinical factors, including concomitant anti-PD medication use, on the occurrence of NMS and QoL in Taiwanese PD patients. PATIENTS AND METHODS PD patients who received long-term follow-up in the movement disorders clinics were enrolled and received NMS questionnaire (NMSQuest) and the 39-item Parkinson's Disease Questionnaire (PDQ-39). Spearman's rank correlation coefficient was checked for the correlation between clinical factors and NMSQT/PDQSI. Multiple linear regressions were applied to assess the influence of clinical factors on NMSQT/PDQSI. RESULTS A total of 210 PD patients (mean age 66.1±9.86 years, Hoehn and Yahr stage 2.2±0.9) were included in this study. Up to 98% of patients reported at least one symptom of NMS. The most prevalent symptom was urinary complaints (56%), followed by memory/apathy (30%) and depression/anxiety (28%). The correlation between NMSQT and PDQSI was strong (r s=0.667), especially the item of depression/anxiety (r s=0.607). The regression model for NMSQT indicated that disease duration and severity, but not pharmacological therapy, were major predictors of NMS. CONCLUSION Our data indicated a high prevalence rate of NMS in PD patients. Among symptoms of NMS, depression and anxiety had the greatest impact on QoL. Concomitant anti-PD medication use did not affect the occurrence of NMS and QoL.
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Affiliation(s)
- Weng-Ming Liu
- Department of Neurology, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan ; Department of Neurology, Buddhist Tzu Chi General Hospital, Hualien, Taiwan
| | - Ru-Jen Lin
- Department of Neurology, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Rwei-Ling Yu
- Institute of Behavioral Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chun-Hwei Tai
- Department of Neurology, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Chin-Hsien Lin
- Department of Neurology, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Ruey-Meei Wu
- Department of Neurology, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
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14
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Vegezzi G, Al Harraq Z, Levandis G, Cerri S, Blandini F, Gnudi G, Miduri F, Blandizzi C, Domenichini G, Bertoni S, Ballabeni V, Barocelli E. Radiological analysis of gastrointestinal dysmotility in a model of central nervous dopaminergic degeneration: Comparative study with conventional in vivo techniques in the rat. J Pharmacol Toxicol Methods 2014; 70:163-9. [DOI: 10.1016/j.vascn.2014.08.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2014] [Revised: 07/25/2014] [Accepted: 08/04/2014] [Indexed: 12/13/2022]
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15
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Peever J, Luppi PH, Montplaisir J. Breakdown in REM sleep circuitry underlies REM sleep behavior disorder. Trends Neurosci 2014; 37:279-88. [PMID: 24673896 DOI: 10.1016/j.tins.2014.02.009] [Citation(s) in RCA: 114] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2013] [Revised: 02/05/2014] [Accepted: 02/21/2014] [Indexed: 11/29/2022]
Abstract
During rapid eye movement (REM) sleep, skeletal muscles are almost paralyzed. However, in REM sleep behavior disorder (RBD), which is a rare neurological condition, muscle atonia is lost, leaving afflicted individuals free to enact their dreams. Although this may sound innocuous, it is not, given that patients with RBD often injure themselves or their bed-partner. A major concern in RBD is that it precedes, in 80% of cases, development of synucleinopathies, such as Parkinson's disease (PD). This link suggests that neurodegenerative processes initially target the circuits controlling REM sleep. Clinical and basic neuroscience evidence indicates that RBD results from breakdown of the network underlying REM sleep atonia. This finding is important because it opens new avenues for treating RBD and understanding its link to neurodegenerative disorders.
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Affiliation(s)
- John Peever
- Systems Neurobiology Laboratory, Departments of Cell and Systems Biology and Physiology, University of Toronto, Ontario, Canada.
| | - Pierre-Hervé Luppi
- Sleep Team, Center of Neuroscience of Lyon, UMR 5292 CNRS/U1028 INSERM, University of Lyon, Lyon, France
| | - Jacques Montplaisir
- Center for Advanced Research in Sleep Medicine, Hôpital du Sacré-Coeur de Montréal, Université de Montréal Québec, Montréal, QC Canada
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16
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Alexander GE. Biology of Parkinson's disease: pathogenesis and pathophysiology of a multisystem neurodegenerative disorder. DIALOGUES IN CLINICAL NEUROSCIENCE 2012. [PMID: 22033559 PMCID: PMC3181806 DOI: 10.31887/dcns.2004.6.3/galexander] [Citation(s) in RCA: 276] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Parkinson's disease (PD) is the second most common movement disorder. The characteristic motor impairments - bradykinesia, rigidity, and resting tremor - result from degenerative loss of midbrain dopamine (DA) neurons in the substantia nigra, and are responsive to symptomatic treatment with dopaminergic medications and functional neurosurgery. PD is also the second most common neurodegenerative disorder. Viewed from this perspective, PD is a disorder of multiple functional systems, not simply the motor system, and of multiple neurotransmitter systems, not merely that of DA. The characteristic pathology - intraneuronal Lewy body inclusions and reduced numbers of surviving neurons - is similar in each of the targeted neuron groups, suggesting a common neurodegenerative process. Pathological and experimental studies indicate that oxidative stress, proteolytic stress, and inflammation figure prominently in the pathogenesis of PD. Yet, whether any of these mechanisms plays a causal role in human PD is unknown, because to date we have no proven neuroprotective therapies that slow or reverse disease progression in patients with PD. We are beginning to understand the pathophysiology of motor dysfunction in PD, but its etiopathogenesis as a neurodegenerative disorder remains poorly understood.
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Affiliation(s)
- Garrett E Alexander
- Department of Neurology, Emory University School of Medicine, Atlanta, Ga, USA
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17
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Abstract
Parkinson's disease (PD) is the most common age-related motoric neurodegenerative disease initially described in the 1800's by James Parkinson as the 'Shaking Palsy'. Loss of the neurotransmitter dopamine was recognized as underlying the pathophysiology of the motor dysfunction; subsequently discovery of dopamine replacement therapies brought substantial symptomatic benefit to PD patients. However, these therapies do not fully treat the clinical syndrome nor do they alter the natural history of this disorder motivating clinicians and researchers to further investigate the clinical phenotype, pathophysiology/pathobiology and etiology of this devastating disease. Although the exact cause of sporadic PD remains enigmatic studies of familial and rare toxicant forms of this disorder have laid the foundation for genome wide explorations and environmental studies. The combination of methodical clinical evaluation, systematic pathological studies and detailed genetic analyses have revealed that PD is a multifaceted disorder with a wide-range of clinical symptoms and pathology that include regions outside the dopamine system. One common thread in PD is the presence of intracytoplasmic inclusions that contain the protein, α-synuclein. The presence of toxic aggregated forms of α-synuclein (e.g., amyloid structures) are purported to be a harbinger of subsequent pathology. In fact, PD is both a cerebral amyloid disease and the most common synucleinopathy, that is, diseases that display accumulations of α-synuclein. Here we present our current understanding of PD etiology, pathology, clinical symptoms and therapeutic approaches with an emphasis on misfolded α-synuclein.
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Affiliation(s)
- Timothy R. Mhyre
- Department of Neuroscience, Georgetown University Medical Center, NRB EP08, 3970 Reservoir Road NW, 20057, Washington, DC, USA,
| | - James T. Boyd
- University of Vermont College of Medicine, 1 South Prospect Street, DU-Arnold 4416-UHC, 05401, Burlington, VT, USA,
| | - Robert W. Hamill
- Department of Neurology, University of Vermont College of Medicine, 89 Beaumont Avenue, Given Hall Room C225, 05405, Burlington, VT, USA,
| | - Kathleen A. Maguire-Zeiss
- Department of Neuroscience, Center for Neural Injury and RecoveryGeorgetown University Medical Center, 3970 Reservoir Road, NW NRB EP08, 20057, Washington, DC, USA,
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18
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Berganzo K, Tijero B, Somme JH, Llorens V, Sánchez-Manso JC, Low D, Iodice V, Vichayanrat E, Mathias CJ, Lezcano E, Zarranz JJ, Gómez-Esteban JC. SCOPA-AUT scale in different parkinsonisms and its correlation with (123) I-MIBG cardiac scintigraphy. Parkinsonism Relat Disord 2012; 18:45-8. [DOI: 10.1016/j.parkreldis.2011.08.018] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2011] [Revised: 08/22/2011] [Accepted: 08/23/2011] [Indexed: 10/17/2022]
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19
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Vairetti M, Ferrigno A, Rizzo V, Ambrosi G, Bianchi A, Richelmi P, Blandini F, Armentero MT. Impaired hepatic function and central dopaminergic denervation in a rodent model of Parkinson's disease: a self-perpetuating crosstalk? Biochim Biophys Acta Mol Basis Dis 2011; 1822:176-84. [PMID: 22119596 DOI: 10.1016/j.bbadis.2011.11.008] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2011] [Revised: 11/07/2011] [Accepted: 11/09/2011] [Indexed: 12/12/2022]
Abstract
In Parkinson's disease (PD), aside from the central lesion, involvement of visceral organs has been proposed as part of the complex clinical picture of the disease. The issue is still poorly understood and relatively unexplored. In this study we used a classic rodent model of nigrostriatal degeneration, induced by the intrastriatal injection of 6-hydroxydopamine (6-OHDA), to investigate whether and how a PD-like central dopaminergic denervation may influence hepatic functions. Rats received an intrastriatal injection of 6-OHDA or saline (sham), and blood, cerebrospinal fluid, liver and brain samples were obtained for up to 8 weeks after surgery. Specimens were analyzed for changes in cytokine and thyroid hormone levels, as well as liver mitochondrial alterations. Hepatic mitochondria isolated from animals bearing extended nigrostriatal lesion displayed increased ROS production, while membrane potential (ΔΨ) and ATP production were significantly decreased. Reduced ATP production correlated with nigral neuronal loss. Thyroid hormone levels were significantly increased in serum of PD rats compared to sham animals while steady expression of selected cytokines was detected in all groups. Hepatic enzyme functions were comparable in all animals. Our study indicates for the first time that in a rodent model of PD, hepatic mitochondria dysfunctions arise as a consequence of nigrostriatal degeneration, and that thyroid hormone represents a key interface in this CNS-liver interaction. Liver plays a fundamental detoxifying function and a better understanding of PD-related hepatic mitochondrial alterations, which might further promote neurodegeneration, may represent an important step for the development of novel therapeutic strategies.
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Affiliation(s)
- Mariapia Vairetti
- Department of Internal Medicine and Therapeutics, University of Pavia, Italy.
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20
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Bajwa SK, Bajwa SJS, Kaur J, Singh A. Anesthesia implications in emergency oncologic surgery in a case of untreated Parkinsonism. Saudi J Anaesth 2011; 5:317-9. [PMID: 21957415 PMCID: PMC3168353 DOI: 10.4103/1658-354x.84110] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Oncologic surgery has made tremendous advancements in the last two decades. The prognosis of once thought to be irreversible and incurable diseases has improved dramatically with these advancements, which have given a fresh lease of hope to the general population. But there are certain factors that are still unfavorable for achieving improved outcome of surgery in various cancers. The associated comorbid diseases do determine to a large extent the actual outcome of all the interventions to treat oncologic disease. The untreated coexisting disease makes the task of the attending anesthesiologist very challenging as numerous complications are anticipated, especially during emergency surgery. We are describing a case of a patient with endometrial carcinoma who presented with unstoppable bleeding per-vaginum and was suffering from Parkinson disease since 1½ years, for which no treatment was ever sought. Vaginal hysterectomy was performed under graded epidural anesthesia; and after a smooth and uneventful postoperative period of 8 days, she was referred to radiotherapy unit for further management.
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Affiliation(s)
- Sukhwinder Kaur Bajwa
- Departments of Obstetrics & Gynaecology, Gian Sagar Medical College & Hospital, Banur, Punjab, India
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21
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Wishart S, Macphee GJA. Evaluation and management of the non-motor features of Parkinson's disease. Ther Adv Chronic Dis 2011; 2:69-85. [PMID: 23251743 PMCID: PMC3513877 DOI: 10.1177/2040622310387847] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Parkinson's disease (PD) is traditionally viewed as a motor disorder with a characteristic triad of tremor, rigidity and bradykinesia. There is now increasing awareness that PD is a complex systemic disorder with many nonmotor symptoms (NMS) which include autonomic dysfunction, sleep disorders, sensory and neuropsychiatric features. NMS become more common in severity and frequency with advancing disease when neuropsychiatric features such as cognitive impairment and psychosis dominate the clinical picture. NMS are strongly correlated with quality of life for patients and their families as well as institutional care placement. Despite their importance, NMS are poorly recognized by clinicians and often undeclared by patients. Use of a validated screening tool NMSQuest followed by specific symptom assessment instruments strengthens the recognition and holistic management of NMS in PD. Some NMS such as mood disturbance, anxiety, pain and insomnia may be improved by optimization of dopaminergic therapy. Conversely, psychosis, excess daytime somnolence or impulse control disorder (ICD) may be triggered by dopaminergic drugs. Other NMS such as dementia and severe depression may be unresponsive to dopaminergic treatment and may reflect perturbations in cholinergic, serotonergic or noradrenergic neurotransmitter function. These symptoms are more challenging to manage but may be ameliorated to some extent by agents such as acetylcholinesterase inhibitor or antidepressant drugs. This contribution reviews the evidence for the evaluation and management of key NMS in PD (apathy, anxiety, depression, psychosis, dementia, ICD, sleep disturbance, autonomic dysfunction, pain) and highlights the urgent need for both novel therapies and more controlled trials for current therapeutic strategies.
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Affiliation(s)
- Steven Wishart
- Medicine for the Elderly/Movement Disorders Clinic, Southern General Hospital, Glasgow, Scotland G51 4TF, UK
| | - Graeme J. A. Macphee
- Medicine for the Elderly/Movement Disorders Clinic, Southern General Hospital, Glasgow, Scotland G51 4TF, UK
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22
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Montplaisir J, Gagnon JF, Postuma RB, Vendette M. REM sleep parasomnias. HANDBOOK OF CLINICAL NEUROLOGY 2011; 99:869-82. [PMID: 21056233 DOI: 10.1016/b978-0-444-52007-4.00012-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/21/2023]
Affiliation(s)
- Jacques Montplaisir
- Hôpital du Sacré-Coeur de Montréal, Université de Montréal, Montreal, Canada.
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23
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Ceravolo R, Rossi C, Kiferle L, Bonuccelli U. Nonmotor symptoms in Parkinson’s disease: the dark side of the moon. FUTURE NEUROLOGY 2010. [DOI: 10.2217/fnl.10.69] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Nonmotor symptoms may appear during the course of Parkinson’s disease, complicating the advanced phase in particular, but are also common in the premotor phase of Parkinson’s disease. The appearance of nonmotor manifestations represents a milestone, determining a worse prognosis and lower quality of life; however, they are often misdiagnosed and untreated. The spectrum of nonmotor symptoms encompasses mood disorders, psychosis, dementia, sleep disorders, impulse-control disorders and autonomic dysfunctions. This article describes these nonmotor symptoms and their management.
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Affiliation(s)
- Roberto Ceravolo
- Department of Neurosciences, Section of Neurology, University of Pisa, via Roma 67, 56126 Pisa, Italy
| | - Carlo Rossi
- Department of Neurosciences, Section of Neurology, University of Pisa, via Roma 67, 56126 Pisa, Italy
| | - Lorenzo Kiferle
- Department of Neurosciences, Section of Neurology, University of Pisa, via Roma 67, 56126 Pisa, Italy
| | - Ubaldo Bonuccelli
- Department of Neurosciences, Section of Neurology, University of Pisa, via Roma 67, 56126 Pisa, Italy
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24
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Chaudhuri KR, Odin P. The challenge of non-motor symptoms in Parkinson's disease. PROGRESS IN BRAIN RESEARCH 2010; 184:325-41. [PMID: 20887883 DOI: 10.1016/s0079-6123(10)84017-8] [Citation(s) in RCA: 118] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
The non-motor symptoms (NMS) of Parkinson's disease (PD) are often poorly recognized and inadequately treated in contrast to motor symptoms and a modern holistic approach to treatment of PD should, therefore, include recognition and assessment of NMS. Certain aspects of the NMS complex of PD can be improved with currently available treatments, both dopaminergic and non-dopaminergic, but other features may be more refractory illustrating the importance of research into more effective drug therapies for the future. The American Academy of Neurology has recently published the first task force guidelines in relation to treatment of NMS of PD.
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Affiliation(s)
- K Ray Chaudhuri
- National Parkinson Foundation Centre of Excellence, Kings College Hospital and University Hospital Lewisham, London, UK.
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25
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Jubault T, Brambati SM, Degroot C, Kullmann B, Strafella AP, Lafontaine AL, Chouinard S, Monchi O. Regional brain stem atrophy in idiopathic Parkinson's disease detected by anatomical MRI. PLoS One 2009; 4:e8247. [PMID: 20011063 PMCID: PMC2784293 DOI: 10.1371/journal.pone.0008247] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2009] [Accepted: 11/12/2009] [Indexed: 11/18/2022] Open
Abstract
Idiopathic Parkinson's disease (PD) is a neurodegenerative disorder characterized by the dysfunction of dopaminergic dependent cortico-basal ganglia loops and diagnosed on the basis of motor symptoms (tremors and/or rigidity and bradykinesia). Post-mortem studies tend to show that the destruction of dopaminergic neurons in the substantia nigra constitutes an intermediate step in a broader neurodegenerative process rather than a unique feature of Parkinson's disease, as a consistent pattern of progression would exist, originating from the medulla oblongata/pontine tegmentum. To date, neuroimaging techniques have been unable to characterize the pre-symptomatic stages of PD. However, if such a regular neurodegenerative pattern were to exist, consistent damages would be found in the brain stem, even at early stages of the disease. We recruited 23 PD patients at Hoenn and Yahr stages I to II of the disease and 18 healthy controls (HC) matched for age. T1-weighted anatomical scans were acquired (MPRAGE, 1 mm3 resolution) and analyzed using an optimized VBM protocol to detect white and grey matter volume reduction without spatial a priori. When the HC group was compared to the PD group, a single cluster exhibited statistical difference (p<0.05 corrected for false detection rate, 4287 mm3) in the brain stem, between the pons and the medulla oblongata. The present study provides in-vivo evidence that brain stem damage may be the first identifiable stage of PD neuropathology, and that the identification of this consistent damage along with other factors could help with earlier diagnosis in the future. This damage could also explain some non-motor symptoms in PD that often precede diagnosis, such as autonomic dysfunction and sleep disorders.
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Affiliation(s)
- Thomas Jubault
- Unité de Neuroimagerie Fonctionelle, Institut Universitaire de Gériatrie de Montréal, Montreal, Quebec, Canada.
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26
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Ghebremedhin E, Del Tredici K, Langston JW, Braak H. Diminished tyrosine hydroxylase immunoreactivity in the cardiac conduction system and myocardium in Parkinson's disease: an anatomical study. Acta Neuropathol 2009; 118:777-84. [PMID: 19802627 DOI: 10.1007/s00401-009-0596-y] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2009] [Revised: 09/17/2009] [Accepted: 09/23/2009] [Indexed: 11/25/2022]
Abstract
Clinical and autopsy studies have consistently reported cardiac sympathetic dysfunction in the left ventricular wall in patients with Parkinson's disease (PD). Whether the nerve fibers of the cardiac conduction system or the atrial walls are equally affected in this disease process has not yet been well documented. Therefore, the aim of this study was to investigate sympathetic nerves in the cardiac conduction system as well as in the walls of all four heart chambers in patients with PD, in incidental Lewy body disease (iLBD), and in controls. Heart tissue from five PD patients, two iLBD cases, and seven controls were investigated immunohistochemically using antibodies directed against tyrosine hydroxylase (TH) and alpha-synuclein (syn-1). A marked diminution of TH immunoreactivity (IR) within nerve fibers was observed in four PD patients and in both individuals with iLBD. In contrast, all control subjects displayed dense TH-IR nerve structures. The depletion in TH-IR involved not only the ventricles, but also the conduction system and the atrium showing a global change within cardiac TH-IR nerve fibers in the course of PD. In conclusion, the alterations in cardiac sympathetic nerves of patients with PD or in individuals with iLBD are homogeneous and global within the heart. The clinical implications related to this complete cardiac sympathetic dysfunction, including clinical correlates, diagnostic implications, and treatment, however, remain to be determined in a larger autopsy-controlled cohort of prospectively followed individuals.
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Affiliation(s)
- Estifanos Ghebremedhin
- Institute of Clinical Neuroanatomy, Goethe University Frankfurt, 60590, Frankfurt am Main, Germany.
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27
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Abstract
Parkinson's disease (PD) is the second most common neurodegenerative disease after Alzheimer's disease. Traditionally, attention has focused on the motor symptomatology of PD, but it is now appreciated that the nonmotor symptoms affecting neuropsychiatric, sleep, autonomic, and sensory domains occur in up to 88% of PD patients and can be an important source of disability. Nonmotor manifestations of PD play a significant role in the impairment of disease-related quality of life. The cause of nonmotor manifestations of PD is multifactorial, but to a large extent, these manifestations are related to the nature of the neurodegenerative process and the widespread nondopaminergic neuropathological changes associated with the disease. Recognition of nonmotor disability is essential not only for ascertaining the functional status of patients but also for better appreciating the nature of the neurodegenerative process in PD. In addition, a number of nonmotor manifestations can precede the onset of motor symptoms in PD and can be used as screening tools allowing for early disease identification and for trials of possible disease-modifying interventions. This article reviews depression, sleep, and autonomic dysfunction in PD.
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Affiliation(s)
- Tanya Simuni
- Department of Neurology, Northwestern University, Chicago, IL, USA.
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28
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Vivacqua G, Yin JJ, Casini A, Li X, Li YH, D'Este L, Chan P, Renda TG, Yu S. Immunolocalization of alpha-synuclein in the rat spinal cord by two novel monoclonal antibodies. Neuroscience 2008; 158:1478-87. [PMID: 19118601 DOI: 10.1016/j.neuroscience.2008.12.001] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2008] [Revised: 11/26/2008] [Accepted: 12/01/2008] [Indexed: 01/22/2023]
Abstract
This study provides the first immunohistochemical evidence of the presence and distribution patterns in the rat spinal cord of alpha-synuclein (alpha-Syn), a soluble acidic protein, widely expressed in the CNS and closely associated to the pathogenesis of neurodegenerative conditions such as Parkinson's and Alzheimer's diseases. We used two novel homemade monoclonal antibodies (2E3 and 3D5) recognizing two different epitopes of alpha-Syn. Both antibodies localized alpha-Syn within the nerve terminals, whereas 3D5 alone also localized it within the neuronal nuclei. alpha-Syn-immunoreactive nervous elements were widely recognized throughout rat spinal cord and in almost all the gray matter laminae. However, they appeared particularly concentrated within laminae I, II, VII and X and more scattered in the others. Double immunofluorescent labeling showed that alpha-Syn colocalized with synaptophysin in the presynaptic nerve terminals, with neuropeptide Y (NPY) in lamina I, II, IX and X, and had close relationships with tyrosine hydroxylase (TH) immunoreactive neurons in laminae VII and X. Interestingly, the alpha-Syn-immunoreactive nerve elements, in lamina X, contained little of calbindin-28KD and calretinin-31KD. Our findings could help in understanding the genesis of some early clinical symptoms of Parkinson's disease (PD), such as pain and dysautonomic disorders, and indicate the spinal cord as their probable starting point, according to the ascending theory of PD, proposed by Braak.
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Affiliation(s)
- G Vivacqua
- Department of Neurobiology, Beijing Institute of Geriatrics, Beijing 100053, China
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Stiasny-Kolster K, Mayer G, Schäfer S, Möller JC, Heinzel-Gutenbrunner M, Oertel WH. The REM sleep behavior disorder screening questionnaire--a new diagnostic instrument. Mov Disord 2008; 22:2386-93. [PMID: 17894337 DOI: 10.1002/mds.21740] [Citation(s) in RCA: 664] [Impact Index Per Article: 41.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Many patients with assumed idiopathic REM sleep behavior disorder (RBD) may actually represent an early clinical manifestation of an evolving neurodegenerative disorder, such as the alpha-synucleinopathies, Parkinson's disease or multiple system atrophy. Early detection of these patients is clinically relevant for long-term prospective as well as future neuroprotective studies. For this purpose, we validated a 10-item patient self-rating questionnaire (maximum total score 13 points) covering the clinical features of RBD. The RBD screening questionnaire (RBDSQ) was applied to 54 patients with polysomnographically confirmed RBD (29 men; mean age 53.7 +/- 15.8 years), 160 control subjects (81 men; mean age 50.8 +/- 15.5 years) in whom RBD was excluded by history and polysomnography (PSG, control group 1) and 133 unselected healthy subjects (58 men; mean age 46.9 +/- 12.3 years; no PSG, control group 2). In most subjects (n = 153) of control group 1, other sleep-wake disturbances were present. The mean RBDSQ score in the RBD group was 9.5 +/- 2.8 points compared with 4.6 +/- 3.0 points in control group 1 (P < 0.0001). Considering an RBDSQ score of five points as a positive test result, we found a sensitivity of 0.96 and a specificity of 0.56. The RBDSQ poorly discriminated patients with the most challenging differential diagnoses such as sleepwalking or epilepsy. In control group 2, the mean RBDSQ score (2.02 +/- 1.78) was significantly lower than in the RBD group (P < 0.0005), revealing a specificity of 0.92. Due to its high sensitivity, the RBDSQ appears to be particularly useful as a screening tool.
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Affiliation(s)
- Karin Stiasny-Kolster
- Department of Neurology, Center of Nervous Diseases, Philipps-University, Marburg, Germany.
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Allan LM, Ballard CG, Allen J, Murray A, Davidson AW, McKeith IG, Kenny RA. Autonomic dysfunction in dementia. J Neurol Neurosurg Psychiatry 2007; 78:671-7. [PMID: 17178816 PMCID: PMC2117678 DOI: 10.1136/jnnp.2006.102343] [Citation(s) in RCA: 146] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND There are no studies of autonomic function comparing Alzheimer's disease (AD), vascular dementia (VAD), dementia with Lewy bodies (DLB) and Parkinson's disease dementia (PDD). AIMS To assess cardiovascular autonomic function in 39 patients with AD, 30 with VAD, 30 with DLB, 40 with PDD and 38 elderly controls by Ewing's battery of autonomic function tests and power spectral analysis of heart rate variability. To determine the prevalence of orthostatic hypotension and autonomic neuropathies by Ewing's classification. RESULTS There were significant differences in severity of cardiovascular autonomic dysfunction between the four types of dementia. PDD and DLB had considerable dysfunction. VAD showed limited evidence of autonomic dysfunction and in AD, apart from orthostatic hypotension, autonomic functions were relatively unimpaired. PDD showed consistent impairment of both parasympathetic and sympathetic function tests in comparison with controls (all p<0.001) and AD (all p<0.03). DLB showed impairment of parasympathetic function (all p<0.05) and one of the sympathetic tests in comparison with controls (orthostasis; p = 0.02). PDD had significantly more impairment than DLB in some autonomic parameters (Valsalva ratio: p = 0.024; response to isometric exercise: p = 0.002). Patients with VAD showed impairment in two parasympathetic tests (orthostasis: p = 0.02; Valsalva ratio: p = 0.08) and one sympathetic test (orthostasis: p = 0.04). These results were in contrast with AD patients who only showed impairment in one sympathetic response (orthostasis: p = 0.004). The prevalence of orthostatic hypotension and autonomic neuropathies was higher in all dementias than in controls (all p<0.05). CONCLUSION Autonomic dysfunction occurs in all common dementias but is especially prominent in PDD with important treatment implications.
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Affiliation(s)
- L M Allan
- Institute for Ageing and Health, Wolfson Research Centre, Newcastle General Hospital, Westgate Road, Newcastle upon Tyne NE4 6BE, UK.
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Hurt C, Angelotti T. Molecular insights into α2 adrenergic receptor function: clinical implications. ACTA ACUST UNITED AC 2007. [DOI: 10.1053/j.sane.2006.11.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Oka H, Morita M, Onouchi K, Yoshioka M, Mochio S, Inoue K. Cardiovascular autonomic dysfunction in dementia with Lewy bodies and Parkinson's disease. J Neurol Sci 2007; 254:72-7. [PMID: 17306830 DOI: 10.1016/j.jns.2007.01.002] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2006] [Revised: 10/15/2006] [Accepted: 01/03/2007] [Indexed: 10/23/2022]
Abstract
OBJECTIVE We estimated the extent and pattern of cardiovascular autonomic dysfunction in dementia with Lewy bodies (DLB) as compared with that in Parkinson's disease (PD). METHODS We performed meta-iodobenzylguanidine ((123)I-MIBG) scintigraphy of the heart and hemodynamic autonomic function testing using the Valsalva maneuver in 27 patients with DLB, 46 with PD, and 20 controls. RESULTS (123)I-MIBG uptakes in DLB were reduced as compared with those in control and PD. Hemodynamic studies revealed that DLB had decreased baroreceptor reflex and reduced responses of SBP in phases II and IV as compared with PD and control. SBP responses on standing and the difference in plasma norepinephrine (NE) concentrations between supine and standing positions were reduced in PD as compared with those in control. Furthermore, SBP responses on standing, plasma NE concentrations in supine and standing positions, and the difference in plasma NE concentrations between these positions were significantly lower in DLB than in PD and control. Plasma NE concentrations in DLB with orthostatic hypotension (OH) were lower than that in DLB without OH, although some patients who had DLB with orthostatic hypotension had relatively normal plasma NE levels. CONCLUSION Cardiovascular autonomic dysfunction is more severe in DLB than in PD and is usually caused by the loss of postganglionic sympathetic nervous function, although dysautonomia in some patients with DLB may result from preganglionic dysfunction.
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Affiliation(s)
- Hisayoshi Oka
- Department of Neurology, Jikei University School of Medicine, 3-25-8, Nishi-shinbashi, Tokyo, 105-8461, Japan.
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Pellicano C, Benincasa D, Pisani V, Buttarelli FR, Giovannelli M, Pontieri FE. Prodromal non-motor symptoms of Parkinson's disease. Neuropsychiatr Dis Treat 2007; 3:145-52. [PMID: 19300544 PMCID: PMC2654529 DOI: 10.2147/nedt.2007.3.1.145] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
The motor symptoms of Parkinson's disease (PD), bradykinesia, muscular rigidity, and tremor depend upon degeneration of the dopaminergic neurons in the substantia nigra pars compacta. Recent neuropathological studies show that the Lewy bodies, the intraneuronal landmark of PD, accumulate in several neuronal cell types in the brain. An ascending gradient of pathological involvement, from the medulla oblongata to neocortical areas has been reported. Thus the original view of PD as a disease characterized by selective damage of the dopaminergic neurons in the mesencephalon should be updated into the concept of a severe multisystemic neurodegenerative disorder. Additionally, the neuropathological alterations outside the substantia nigra are soundly correlated with the non-motor symptoms of PD. As a result of these findings, interest is growing in the identification of prodromal non-motor symptoms of PD. Indeed, data from the literature suggest that autonomic disturbances, olfactory dysfunctions, depression and sleep disorders (in particular REM-sleep behavior disorder) may represent prodromal non-motor symptoms of PD. Several tests are available to detect most of these symptoms. Thus, the identification of prodromal non-motor symptoms may contribute to the precocious diagnosis of PD, and might be useful in the future to test the efficacy of neuroprotective agents.
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Affiliation(s)
- Clelia Pellicano
- Dipartimento di Scienze, Neurologiche, II Facoltà di Medicina e Chirurgia; Università degli Studi di Roma "La Sapienza", Italy
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Muzerengi S, Lewis H, Edwards M, Kipps E, Bahl A, Martinez-Martin P, Chaudhuri KR. Non-motor symptoms in Parkinson's disease: an underdiagnosed problem. ACTA ACUST UNITED AC 2006. [DOI: 10.2217/1745509x.2.6.967] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Parkinson's disease results from degeneration of the substantia nigra pars compacta and the consequent dysfunction of the dopaminergic nigrostriatal pathway. Serotonergic and noradrenergic pathways are also affected. However, It has been recognized that nondopaminergic and non-motor symptoms are sometimes present prior to diagnosis and these inevitably emerge with disease progression, impacting on morbidity, quality of life and mortality. The non-motor symptoms of Parkinson's disease continue to be poorly recognized and inadequately treated in contrast with motor symptoms, and a modern holistic approach to treatment of Parkinson's disease should therefore include recognition and assessment of non-motor symptoms. Certain aspects of the non-motor symptoms complex of Parkinson's disease can be improved with currently available treatments, but other features may be more refractory and require research into effective nondopaminergic drug therapies for the future.
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Affiliation(s)
| | | | - Mark Edwards
- Movement Disorders Unit, Kings College Hospital, 9th Floor Ruskin Wing, Denmark hill, London, SE5 9RS UK
- Guy's King's St. Thomas’ School of Medicine and Kings College, London
| | - Emma Kipps
- Movement Disorders Unit, Kings College Hospital, 9th Floor Ruskin Wing, Denmark hill, London, SE5 9RS UK
- Guy's King's St. Thomas’ School of Medicine and Kings College, London
| | - Anuj Bahl
- Movement Disorders Unit, Kings College Hospital, 9th Floor Ruskin Wing, Denmark hill, London, SE5 9RS UK
- Guy's King's St. Thomas’ School of Medicine and Kings College, London
| | - Pablo Martinez-Martin
- Unit of Neuroepidemiology. National Center for Epidemiology, Carlos III Institute of Health, Madrid, Spain
| | - K Ray Chaudhuri
- University Hospital Lewisham, London, UK
- Movement Disorders Unit, Kings College Hospital, 9th Floor Ruskin Wing, Denmark hill, London, SE5 9RS UK
- Guy's King's St. Thomas’ School of Medicine and Kings College, London
- National Parkinson Foundation Centre of Excellence, Kings College London, UK
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Allan L, McKeith I, Ballard C, Kenny RA. The prevalence of autonomic symptoms in dementia and their association with physical activity, activities of daily living and quality of life. Dement Geriatr Cogn Disord 2006; 22:230-7. [PMID: 16902277 DOI: 10.1159/000094971] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/09/2006] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS There is little published data regarding autonomic symptoms in dementia. This study aimed to examine the prevalence and severity of autonomic symptoms in patients with different subtypes of dementia in comparison with healthy controls, and their association with levels of physical activity, depression, quality of life and ability to carry out activities of daily living. METHODS Prevalence and severity of autonomic symptoms in Parkinson's disease dementia (PDD, n = 46), dementia with Lewy bodies (DLB, n = 32), vascular dementia (VAD, n = 38), Alzheimer's disease (AD, n = 40) and healthy controls (n = 42) were assessed using a structured symptom scale. The associations between autonomic symptoms and physical activity, Bristol Activities of Daily Living Score, Geriatric and Cornell Depression Scores and quality of life (Medical Outcomes Study 36-Item Short Form Health Survey, SF-36) were examined by multiple linear regressions. RESULTS Total autonomic symptom scores, urinary symptoms, constipation and postural dizziness were significantly higher in PDD, DLB and VAD patients than either controls or AD patients (all p < 0.05). Higher autonomic symptom scores were associated with poorer outcomes in all measures of physical activity, activities of daily living, depression and quality of life. CONCLUSION The burden of autonomic symptoms is high in non-Alzheimer's dementias. The identification of such symptoms is of importance because of the detrimental effect of these symptoms upon physical activity, depression, activities of daily living and quality of life.
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Affiliation(s)
- Louise Allan
- Institute for Ageing and Health, Wolfson Research Centre, Newcastle General Hospital, Newcastle upon Tyne, UK.
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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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Gagnon JF, Postuma RB, Mazza S, Doyon J, Montplaisir J. Rapid-eye-movement sleep behaviour disorder and neurodegenerative diseases. Lancet Neurol 2006; 5:424-32. [PMID: 16632313 DOI: 10.1016/s1474-4422(06)70441-0] [Citation(s) in RCA: 242] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Rapid-eye-movement (REM) sleep behaviour disorder (RBD) is characterised by loss of muscular atonia and prominent motor behaviours during REM sleep. RBD can cause sleep disruption and severe injuries for the patient or bed partner. The disorder is strongly associated with neurodegenerative diseases, such as multiple-system atrophy, Parkinson's disease, dementia with Lewy bodies, and progressive supranuclear palsy. In many cases, the symptoms of RBD precede other symptoms of these neurodegenerative disorders by several years. Furthermore, several recent studies have shown that RBD is associated with abnormalities of electroencephalographic activity, cerebral blood flow, and cognitive, perceptual, and autonomic functions. RBD might be a stage in the development of neurodegenerative disorders and increased awareness of this could lead to substantial advances in knowledge of mechanisms, diagnosis, and treatment of neurodegenerative disorders.
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Affiliation(s)
- Jean-François Gagnon
- Centre d'étude du Sommeil et des Rythmes Biologiques, Hôpital du Sacré-Coeur de Montréal, Québec, Canada
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Chaudhuri KR, Healy DG, Schapira AHV. Non-motor symptoms of Parkinson's disease: diagnosis and management. Lancet Neurol 2006; 5:235-45. [PMID: 16488379 DOI: 10.1016/s1474-4422(06)70373-8] [Citation(s) in RCA: 1731] [Impact Index Per Article: 96.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
The clinical diagnosis of Parkinson's disease rests on the identification of the characteristics related to dopamine deficiency that are a consequence of degeneration of the substantia nigra pars compacta. However, non-dopaminergic and non-motor symptoms are sometimes present before diagnosis and almost inevitably emerge with disease progression. Indeed, non-motor symptoms dominate the clinical picture of advanced Parkinson's disease and contribute to severe disability, impaired quality of life, and shortened life expectancy. By contrast with the dopaminergic symptoms of the disease, for which treatment is available, non-motor symptoms are often poorly recognised and inadequately treated. However, attention is now being focused on the recognition and quantitation of non-motor symptoms, which will form the basis of improved treatments. Some non-motor symptoms, including depression, constipation, pain, genitourinary problems, and sleep disorders, can be improved with available treatments. Other non-motor symptoms can be more refractory and need the introduction of novel non-dopaminergic drugs. Inevitably, the development of treatments that can slow or prevent the progression of Parkinson's disease and its multicentric neurodegeneration provides the best hope of curing non-motor symptoms.
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Affiliation(s)
- K Ray Chaudhuri
- Movement Disorders Unit, Kings College Hospital, Guy's King's and St Thomas' School of Medicine, London, UK.
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Karita K, Nakao M, Nishikitani M, Iwata T, Murata K, Yano E. Effect of Overtime Work and Insufficient Sleep on Postural Sway in Information‐Technology Workers. J Occup Health 2006; 48:65-8. [PMID: 16484765 DOI: 10.1539/joh.48.65] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Kanae Karita
- Department of Hygiene and Public Health, Teikyo University School of Medicine, Kaga, Tokyo, Japan.
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Jiménez-Hoyuela García JM, Campos Arillo V, Rebollo Aguirre AC, Gómez Doblas JJ, Gutiérrez Hurtado A. Alteración precoz de la función adrenérgica cardíaca en los parkinsonismos con cuerpos de Lewy. ACTA ACUST UNITED AC 2005; 24:93-100. [PMID: 15745679 DOI: 10.1157/13071684] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
BACKGROUND 123I-metaiodobenzylguanidine (123I-MIBG) myocardial scintigraphy is clinically used to estimate myocardial sympathetic damage in some forms of heart disease, autonomic nerve disturbance in diabetic neuropathy, and disturbance of the autonomic nervous system in neurodegenerative disease. In the present study, examinations were performed to clarify the rate and characteristics of cardiac sympathetic disturbance in Parkinson's disease (PD) and usefulness of 123I-MIBG myocardial scintigraphy to differentiate PD from the Lewy Body Disease (LBD). MATERIAL AND METHODS 108 subjects were studied. There were 70 patients with PD, 21 patients with LBD, and 17 age-matched normal subjects without neurological disease. The clinical parameters evaluated were severity of the process (measured by Hoehn and Yahr Scale), vegetative manifestations, development time and use of medication taken. Myocardial adrenergic function was analyzed by imaging with 123I-MIBG. Early (15 min) and delayed (4 h) images of the thorax in the anterior view were obtained after injection of 123I-MIBG (111 MBq). The qualitative and semiquantitative 123I-MIBG uptake was quantified by calculating a heart-to-mediastinum ratio (HMR) and analyzed in a blind manner. RESULTS The mean H/M ratio in patients with PD and LBD was significantly lower than in controls (p < 0.05). This is independent of development time, process severity, use of medication or vegetative manifestations. The HMR obtained in LBD patients is less clear than in PD. CONCLUSION 123I-MIBG myocardial scintigraphy might detect early disturbances of the sympathetic nervous system in PD and LBD.
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Belforte JE, Pazo JH. Striatal Inhibition of Nociceptive Responses Evoked in Trigeminal Sensory Neurons by Tooth Pulp Stimulation. J Neurophysiol 2005; 93:1730-41. [PMID: 15738277 DOI: 10.1152/jn.00496.2004] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The noxious evoked response in trigeminal sensory neurons was studied to address the role of striatum in the control of nociceptive inputs. In urethane-anesthetized rats, the jaw opening reflex (JOR) was produced by suprathreshold stimulation of the tooth pulp and measured as electromyographic response in the digastric muscle, with simultaneous recording of noxious responses in single unit neurons of the spinal trigeminal nucleus pars caudalis (Sp5c). The microinjection of glutamate (80 ηmol/0.5 μl) into striatal JOR inhibitory sites significantly decreased the Aδ and C fiber–mediated–evoked response (53 ± 4.2 and 43.6 ± 6.4% of control value, P < 0.0001) in 92% (31/34) of nociceptive Sp5c neurons. The microinjection of the solvent was ineffective, as was microinjection of glutamate in sites out of the JOR inhibitory ones. In another series of experiments, simultaneous single unit recordings were performed in the motor trigeminal nucleus (Mo5) and the Sp5c nucleus. Microinjection of glutamate decreased the noxious-evoked response in Sp5c and Mo5 neurons in parallel with the JOR, without modifying spontaneous neuronal activity of trigeminal motoneurons ( n = 8 pairs). These results indicate that the striatum could be involved in the modulation of nociceptive inputs and confirm the role of the basal ganglia in the processing of nociceptive information.
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Affiliation(s)
- Juan E Belforte
- Laboratorio de Neurofisiología, Deptartamento de Fisiología, Facultad de Medicina, Universidad de Buenos Aires, Paraguay 2155, Buenos Aires 1121, Argentina
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Visser M, Marinus J, Stiggelbout AM, Van Hilten JJ. Assessment of autonomic dysfunction in Parkinson's disease: the SCOPA-AUT. Mov Disord 2005; 19:1306-12. [PMID: 15390007 DOI: 10.1002/mds.20153] [Citation(s) in RCA: 525] [Impact Index Per Article: 27.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
We developed a questionnaire to assess autonomic symptoms in patients with Parkinson's disease (PD) and evaluated its reliability and validity. Based on the results of a postal survey in 46 PD patients, 21 multiple system atrophy patients, and 8 movement disorders specialists, items were included according to their frequency, burden, and clinical relevance. The questionnaire was evaluated in 140 PD patients and 100 controls, and test-retest reliability was established in a sample of 55 PD patients. The SCOPA-AUT consists of 25 items assessing the following regions: gastrointestinal (7), urinary (6), cardiovascular (3), thermoregulatory (4), pupillomotor (1), and sexual (2 items for men and 2 items for women) dysfunction. Test-retest reliability was good. Autonomic problems increased significantly with increasing disease severity for all autonomic regions, except sexual dysfunction. We conclude that SCOPA-AUT is a reliable and valid questionnaire that evaluates autonomic dysfunction in PD.
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Affiliation(s)
- Martine Visser
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands.
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Lezcano E, Gómez-Esteban JC, Zarranz JJ, Alcaraz R, Atarés B, Bilbao G, Garibi J, Lambarri I. Parkinson's disease-like presentation of multiple system atrophy with poor response to STN stimulation: a clinicopathological case report. Mov Disord 2004; 19:973-7. [PMID: 15300669 DOI: 10.1002/mds.20108] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
We report on a clinicopathological case of multiple system atrophy with good response to levodopa and subsequent development of motor complications. Because the subject complied with all the inclusion criteria (Core Assessment Program for Surgical Interventional Therapies in Parkinson's Disease), bilateral subthalamic nucleus deep brain stimulation electrodes were implanted.
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Affiliation(s)
- Elena Lezcano
- Service of Neurology, Hospital of Cruces, Neurosciences Department, University of the Basque Country, Spain
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Singleton A, Gwinn-Hardy K, Sharabi Y, Li ST, Holmes C, Dendi R, Hardy J, Singleton A, Crawley A, Goldstein DS. Association between cardiac denervation and parkinsonism caused by alpha-synuclein gene triplication. ACTA ACUST UNITED AC 2004; 127:768-72. [PMID: 14736756 DOI: 10.1093/brain/awh081] [Citation(s) in RCA: 101] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Parkinson's disease patients frequently have symptoms and signs of autonomic nervous dysfunction that are the source of considerable disability. Recent studies have revealed that most patients with Parkinson's disease, and all with Parkinson's disease-associated orthostatic hypotension, have a loss of cardiac sympathetic innervation. Familial Parkinson's disease, caused by mutation of the gene encoding alpha-synuclein, also features orthostatic hypotension, sympathetic neurocirculatory failure and cardiac sympathetic denervation. We have recently described a whole-gene triplication of alpha-synuclein causing Lewy body parkinsonism in a large, well characterized family called the 'Iowa kindred'. Here we report the results of cardiac PET scanning using the sympathoneural imaging agent, 6-[18F]fluorodopamine in affected and unaffected members of this kindred. Four family members were studied, two with parkinsonism, one clinically normal and one with benign essential tremor alone. Both affected members had obvious loss of cardiac sympathetic innervation; the unaffected member had normal innervation, as did the member with isolated essential tremor. The results indicate that, in this family, where disease is caused by overexpression of normal alpha-synuclein, cardiac sympathetic denervation cosegregates with parkinsonism. Post-mortem studies have demonstrated synuclein-positive Lewy body formation in the brains of individuals with parkinsonism who were also in the family described here and who also carry this triplication. These results indicate that both parkinsonism and cardiac sympathetic denervation can result from an excess of normal synuclein.
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Affiliation(s)
- Amanda Singleton
- Parkinson's Unit, Neurogenetics Branch, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD 20892, USA
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Hurst RS, Higdon NR, Lawson JA, Clark MA, Rutherford-Root KL, McDonald WG, Haas JV, McGrath JP, Meglasson MD. Dopamine receptor agonists differ in their actions on cardiac ion channels. Eur J Pharmacol 2003; 482:31-7. [PMID: 14660002 DOI: 10.1016/j.ejphar.2003.09.054] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Four dopamine receptor agonists used for the treatment of Parkinson's disease (apomorphine, pergolide, ropinirole and sumanirole) were evaluated for the ability to block human ether-a-go-go related gene (hERG) K(+) channels and to modify the duration of canine Purkinje fiber action potentials. Apomorphine, pergolide and ropinirole blocked the hERG-mediated currents with IC(50) values of 2.4, 0.12 and 1.2 microM, respectively. When evaluated in an action potential duration assay, pergolide significantly shortened action potential duration at 90% repolarization (APD(90)) whereas apomorphine and ropinirole significantly prolonged repolarization. Sumanirole only partially blocked hERG K(+) channels at the highest tested concentration (10 microM) and did not modify action potential duration over the tested concentration range (0.65-65 microM). Taken together, these data provide evidence that dopamine receptor agonists developed for the treatment of Parkinson's disease differentially influence hERG K(+) channel function and cardiac action potential duration.
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Affiliation(s)
- Raymond S Hurst
- Department of Pharmacology, Pharmacia Corporation, Kalamazoo, MI 49007, USA.
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48
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Abstract
Movement disorders are commonly encountered in clinical practice. The diagnosis of movement disorders relies on a focused history and neurologic examination. Diagnostic steps include (1) identification of the phenomenology of the movements (eg, tremor); (2) characterization of appropriate clinical syndromes; and (3) differential diagnosis of specific disease entities. Accurate diagnosis is essential because symptomatic treatment exists for most movement disorders.
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Affiliation(s)
- Maria Graciela Cersosimo
- Movement Disorder Program, Hospital de Clinicas Jose de San Martin, University of Buenos Aires, Buenos Aires, Argentina
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Jiménez-Hoyuela JM, Rebollo AC, Campos V, Rius F. [123 I-MIBG myocardial sympathetic innervation scintigraphy and Parkinson's disease. Preliminary results]. REVISTA ESPANOLA DE MEDICINA NUCLEAR 2003; 22:229-37. [PMID: 12846947 DOI: 10.1016/s0212-6982(03)72191-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
OBJECTIVES Cardiac sympathetic function in patients with Parkinson's disease (PD) is significantly impaired. Cardiac scintigraphy with 123I-metaiodobenzylguanidine (123I-MIBG) is used to assess cardiac sympathetic function. METHODS A total of 29 consecutive patients with PD and 10 control subjects without neurological disease were studied. Myocardial imaging with 123I-MIBG was performed to evaluate cardiac sympathetic function. Early and delayed images of the anterior view were obtained at 15 min. and 4 h. after injection of 123I-MIBG, respectively. 123I-MIBG uptake was quantified qualitatively and semiquantitatively by calculating a heart-to-mediastinum (H/M) ratio. RESULTS The heart/mediastinum ratio was markedly reduced in patients with PD (I to IV on the Hoehn and Yahr scale) when compared to the control subjects (p < 0.05). This finding was independent of the length and severity of the disease or the pharmacological treatment of the patients. None of the control subjects showed decrease in myocardial 123I-MIBG uptake. CONCLUSIONS Our findings indicate that a decrease in myocardial accumulation of 123I-MIBG was observed in the early stages of PD. This suggests that the measurement of 123I-MIBG may help the early diagnosis of PD, and can be used to detect cardiac autonomic dysfunction, especially in patients without typical signs and symptoms.
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Affiliation(s)
- J M Jiménez-Hoyuela
- Servicios de Medicina Nuclear. Hospital Universitario Virgen de la Victoria. Málaga. Spain
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Rascol O, Payoux P, Ory F, Ferreira JJ, Brefel-Courbon C, Montastruc JL. Limitations of current Parkinson's disease therapy. Ann Neurol 2003; 53 Suppl 3:S3-12; discussion S12-5. [PMID: 12666094 DOI: 10.1002/ana.10513] [Citation(s) in RCA: 190] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Levodopa and other dopaminergic medications drastically improve the motor symptoms and quality of life of patients with Parkinson's disease in the early stages of the disease. However, once the "honeymoon" period has waned, usually after a few years of dopaminergic therapy, patients become progressively more disabled despite an ever more complex combination of available antiparkinsonian treatments. Sooner or later, they suffer from "dopa-resistant" motor symptoms (speech impairment, abnormal posture, gait and balance problems), "dopa-resistant" nonmotor signs (autonomic dysfunction, mood and cognitive impairment, sleep problems, pain) and/or drug-related side effects (especially psychosis, motor fluctuations, and dyskinesias). Therefore, the current antiparkinsonian therapy cannot be considered as ideal with regard to both efficacy and safety.
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Affiliation(s)
- Olivier Rascol
- Clinical Investigation Centre and Department of Clinical Pharmacology, Toulouse, University Hospital France
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