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Bruno MK, Dhall R, Duquette A, Haq IU, Honig LS, Lamotte G, Mari Z, McFarland NR, Montaser-Kousari L, Rodriguez-Porcel F, Shurer J, Siddiqui J, Spears CC, Wills AMA, Diaz K, Golbe LI. A General Neurologist's Practical Diagnostic Algorithm for Atypical Parkinsonian Disorders: A Consensus Statement. Neurol Clin Pract 2024; 14:e200345. [PMID: 39185098 PMCID: PMC11341009 DOI: 10.1212/cpj.0000000000200345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 04/16/2024] [Indexed: 08/27/2024]
Abstract
Purpose of Review The most common four neurodegenerative atypical parkinsonian disorders (APDs) are progressive supranuclear palsy (PSP), multiple system atrophy (MSA), corticobasal syndrome (CBS), and dementia with Lewy bodies (DLB). Their formal diagnostic criteria often require subspecialty experience to implement as designed and all require excluding competing diagnoses without clearly specifying how to do that. Validated diagnostic criteria are not available at all for many of the other common APDs, including normal pressure hydrocephalus (NPH), vascular parkinsonism (VP), or drug-induced parkinsonism (DIP). APDs also include conditions of structural, genetic, vascular, toxic/metabolic, infectious, and autoimmune origin. Their differential diagnosis can be challenging early in the course, if the presentation is atypical, or if a rare or non-neurodegenerative condition is present. This review equips community general neurologists to make an early provisional diagnosis before, or in place of, referral to a tertiary center. Early diagnosis would allay diagnostic uncertainty, allow prompt symptomatic management, provide disease-specific information and support resources, avoid further pointless testing and treatments, and create the possibility of trial referral. Recent Findings We address 64 APDs using one over-arching flow diagram and a series of detailed tables. Most instances of APDs can be diagnosed with a careful history and neurological exam, along with a non-contrast brain MRI. Additional diagnostic tests are rarely needed but are delineated where applicable. Our diagnostic algorithm encourages referral to a tertiary center whenever the general neurologist feels it would be in the patient's best interest. Our algorithm emphasizes that the diagnosis of APDs is an iterative process, refined with the appearance of new diagnostic features, availability of new technology, and advances in scientific understanding of the disorders. Clinicians' proposals for all diagnostic tests for the APDs, including repeat visits, should be discussed with patients and their families to ensure that the potential information to be gained aligns with their larger clinical goals. Summary We designed this differential diagnostic algorithm for the APDs to enhance general neurologists' diagnostic skills and confidence and to help them address the less common or more ambiguous cases.
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Affiliation(s)
- Michiko K Bruno
- Neuroscience Institute (MKB), The Queen's Medical Center; Medicine (MKB), University of Hawaii, John A Burns School of Medicine, Honolulu; Neurology (RD), University of Arkansas for Medical Sciences, Little Rock; Service de Neurologie (AD), Département de Médecine, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, Quebec, Canada; Neurology (IUH), University of Miami, FL; Neurology (LSH), Columbia University Irving Medical Center, New York; Neurology (GL), The University of Utah; Neurology (GL), George E. Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, UT; Neurology (NRM), University of Florida, Gainesville; Neurology (LM-K), Brigham and Women Hospital and Harvard Medical School, Boston, MA; Neurology (ZM), Johns Hopkins University, Baltimore, MD; Cleveland Clinic Lou Ruvo Center for Brain Health (ZM), Las Vegas, NV; Neurology (FR-P), Medical University of South Carolina, Charleston; CurePSP (J. Shurer, KD, LIG), New York; Neurological Institute (J. Siddiqui), Cleveland Clinic, OH; Neurology (CCS), University of Michigan, Ann Arbor; Neurology (AMW), Massachusetts General Hospital and Harvard Medical School, Boston; and Neurology (LIG), Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Rohit Dhall
- Neuroscience Institute (MKB), The Queen's Medical Center; Medicine (MKB), University of Hawaii, John A Burns School of Medicine, Honolulu; Neurology (RD), University of Arkansas for Medical Sciences, Little Rock; Service de Neurologie (AD), Département de Médecine, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, Quebec, Canada; Neurology (IUH), University of Miami, FL; Neurology (LSH), Columbia University Irving Medical Center, New York; Neurology (GL), The University of Utah; Neurology (GL), George E. Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, UT; Neurology (NRM), University of Florida, Gainesville; Neurology (LM-K), Brigham and Women Hospital and Harvard Medical School, Boston, MA; Neurology (ZM), Johns Hopkins University, Baltimore, MD; Cleveland Clinic Lou Ruvo Center for Brain Health (ZM), Las Vegas, NV; Neurology (FR-P), Medical University of South Carolina, Charleston; CurePSP (J. Shurer, KD, LIG), New York; Neurological Institute (J. Siddiqui), Cleveland Clinic, OH; Neurology (CCS), University of Michigan, Ann Arbor; Neurology (AMW), Massachusetts General Hospital and Harvard Medical School, Boston; and Neurology (LIG), Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Antoine Duquette
- Neuroscience Institute (MKB), The Queen's Medical Center; Medicine (MKB), University of Hawaii, John A Burns School of Medicine, Honolulu; Neurology (RD), University of Arkansas for Medical Sciences, Little Rock; Service de Neurologie (AD), Département de Médecine, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, Quebec, Canada; Neurology (IUH), University of Miami, FL; Neurology (LSH), Columbia University Irving Medical Center, New York; Neurology (GL), The University of Utah; Neurology (GL), George E. Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, UT; Neurology (NRM), University of Florida, Gainesville; Neurology (LM-K), Brigham and Women Hospital and Harvard Medical School, Boston, MA; Neurology (ZM), Johns Hopkins University, Baltimore, MD; Cleveland Clinic Lou Ruvo Center for Brain Health (ZM), Las Vegas, NV; Neurology (FR-P), Medical University of South Carolina, Charleston; CurePSP (J. Shurer, KD, LIG), New York; Neurological Institute (J. Siddiqui), Cleveland Clinic, OH; Neurology (CCS), University of Michigan, Ann Arbor; Neurology (AMW), Massachusetts General Hospital and Harvard Medical School, Boston; and Neurology (LIG), Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Ihtsham U Haq
- Neuroscience Institute (MKB), The Queen's Medical Center; Medicine (MKB), University of Hawaii, John A Burns School of Medicine, Honolulu; Neurology (RD), University of Arkansas for Medical Sciences, Little Rock; Service de Neurologie (AD), Département de Médecine, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, Quebec, Canada; Neurology (IUH), University of Miami, FL; Neurology (LSH), Columbia University Irving Medical Center, New York; Neurology (GL), The University of Utah; Neurology (GL), George E. Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, UT; Neurology (NRM), University of Florida, Gainesville; Neurology (LM-K), Brigham and Women Hospital and Harvard Medical School, Boston, MA; Neurology (ZM), Johns Hopkins University, Baltimore, MD; Cleveland Clinic Lou Ruvo Center for Brain Health (ZM), Las Vegas, NV; Neurology (FR-P), Medical University of South Carolina, Charleston; CurePSP (J. Shurer, KD, LIG), New York; Neurological Institute (J. Siddiqui), Cleveland Clinic, OH; Neurology (CCS), University of Michigan, Ann Arbor; Neurology (AMW), Massachusetts General Hospital and Harvard Medical School, Boston; and Neurology (LIG), Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Lawrence S Honig
- Neuroscience Institute (MKB), The Queen's Medical Center; Medicine (MKB), University of Hawaii, John A Burns School of Medicine, Honolulu; Neurology (RD), University of Arkansas for Medical Sciences, Little Rock; Service de Neurologie (AD), Département de Médecine, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, Quebec, Canada; Neurology (IUH), University of Miami, FL; Neurology (LSH), Columbia University Irving Medical Center, New York; Neurology (GL), The University of Utah; Neurology (GL), George E. Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, UT; Neurology (NRM), University of Florida, Gainesville; Neurology (LM-K), Brigham and Women Hospital and Harvard Medical School, Boston, MA; Neurology (ZM), Johns Hopkins University, Baltimore, MD; Cleveland Clinic Lou Ruvo Center for Brain Health (ZM), Las Vegas, NV; Neurology (FR-P), Medical University of South Carolina, Charleston; CurePSP (J. Shurer, KD, LIG), New York; Neurological Institute (J. Siddiqui), Cleveland Clinic, OH; Neurology (CCS), University of Michigan, Ann Arbor; Neurology (AMW), Massachusetts General Hospital and Harvard Medical School, Boston; and Neurology (LIG), Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Guillaume Lamotte
- Neuroscience Institute (MKB), The Queen's Medical Center; Medicine (MKB), University of Hawaii, John A Burns School of Medicine, Honolulu; Neurology (RD), University of Arkansas for Medical Sciences, Little Rock; Service de Neurologie (AD), Département de Médecine, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, Quebec, Canada; Neurology (IUH), University of Miami, FL; Neurology (LSH), Columbia University Irving Medical Center, New York; Neurology (GL), The University of Utah; Neurology (GL), George E. Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, UT; Neurology (NRM), University of Florida, Gainesville; Neurology (LM-K), Brigham and Women Hospital and Harvard Medical School, Boston, MA; Neurology (ZM), Johns Hopkins University, Baltimore, MD; Cleveland Clinic Lou Ruvo Center for Brain Health (ZM), Las Vegas, NV; Neurology (FR-P), Medical University of South Carolina, Charleston; CurePSP (J. Shurer, KD, LIG), New York; Neurological Institute (J. Siddiqui), Cleveland Clinic, OH; Neurology (CCS), University of Michigan, Ann Arbor; Neurology (AMW), Massachusetts General Hospital and Harvard Medical School, Boston; and Neurology (LIG), Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Zoltan Mari
- Neuroscience Institute (MKB), The Queen's Medical Center; Medicine (MKB), University of Hawaii, John A Burns School of Medicine, Honolulu; Neurology (RD), University of Arkansas for Medical Sciences, Little Rock; Service de Neurologie (AD), Département de Médecine, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, Quebec, Canada; Neurology (IUH), University of Miami, FL; Neurology (LSH), Columbia University Irving Medical Center, New York; Neurology (GL), The University of Utah; Neurology (GL), George E. Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, UT; Neurology (NRM), University of Florida, Gainesville; Neurology (LM-K), Brigham and Women Hospital and Harvard Medical School, Boston, MA; Neurology (ZM), Johns Hopkins University, Baltimore, MD; Cleveland Clinic Lou Ruvo Center for Brain Health (ZM), Las Vegas, NV; Neurology (FR-P), Medical University of South Carolina, Charleston; CurePSP (J. Shurer, KD, LIG), New York; Neurological Institute (J. Siddiqui), Cleveland Clinic, OH; Neurology (CCS), University of Michigan, Ann Arbor; Neurology (AMW), Massachusetts General Hospital and Harvard Medical School, Boston; and Neurology (LIG), Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Nikolaus R McFarland
- Neuroscience Institute (MKB), The Queen's Medical Center; Medicine (MKB), University of Hawaii, John A Burns School of Medicine, Honolulu; Neurology (RD), University of Arkansas for Medical Sciences, Little Rock; Service de Neurologie (AD), Département de Médecine, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, Quebec, Canada; Neurology (IUH), University of Miami, FL; Neurology (LSH), Columbia University Irving Medical Center, New York; Neurology (GL), The University of Utah; Neurology (GL), George E. Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, UT; Neurology (NRM), University of Florida, Gainesville; Neurology (LM-K), Brigham and Women Hospital and Harvard Medical School, Boston, MA; Neurology (ZM), Johns Hopkins University, Baltimore, MD; Cleveland Clinic Lou Ruvo Center for Brain Health (ZM), Las Vegas, NV; Neurology (FR-P), Medical University of South Carolina, Charleston; CurePSP (J. Shurer, KD, LIG), New York; Neurological Institute (J. Siddiqui), Cleveland Clinic, OH; Neurology (CCS), University of Michigan, Ann Arbor; Neurology (AMW), Massachusetts General Hospital and Harvard Medical School, Boston; and Neurology (LIG), Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Leila Montaser-Kousari
- Neuroscience Institute (MKB), The Queen's Medical Center; Medicine (MKB), University of Hawaii, John A Burns School of Medicine, Honolulu; Neurology (RD), University of Arkansas for Medical Sciences, Little Rock; Service de Neurologie (AD), Département de Médecine, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, Quebec, Canada; Neurology (IUH), University of Miami, FL; Neurology (LSH), Columbia University Irving Medical Center, New York; Neurology (GL), The University of Utah; Neurology (GL), George E. Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, UT; Neurology (NRM), University of Florida, Gainesville; Neurology (LM-K), Brigham and Women Hospital and Harvard Medical School, Boston, MA; Neurology (ZM), Johns Hopkins University, Baltimore, MD; Cleveland Clinic Lou Ruvo Center for Brain Health (ZM), Las Vegas, NV; Neurology (FR-P), Medical University of South Carolina, Charleston; CurePSP (J. Shurer, KD, LIG), New York; Neurological Institute (J. Siddiqui), Cleveland Clinic, OH; Neurology (CCS), University of Michigan, Ann Arbor; Neurology (AMW), Massachusetts General Hospital and Harvard Medical School, Boston; and Neurology (LIG), Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Federico Rodriguez-Porcel
- Neuroscience Institute (MKB), The Queen's Medical Center; Medicine (MKB), University of Hawaii, John A Burns School of Medicine, Honolulu; Neurology (RD), University of Arkansas for Medical Sciences, Little Rock; Service de Neurologie (AD), Département de Médecine, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, Quebec, Canada; Neurology (IUH), University of Miami, FL; Neurology (LSH), Columbia University Irving Medical Center, New York; Neurology (GL), The University of Utah; Neurology (GL), George E. Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, UT; Neurology (NRM), University of Florida, Gainesville; Neurology (LM-K), Brigham and Women Hospital and Harvard Medical School, Boston, MA; Neurology (ZM), Johns Hopkins University, Baltimore, MD; Cleveland Clinic Lou Ruvo Center for Brain Health (ZM), Las Vegas, NV; Neurology (FR-P), Medical University of South Carolina, Charleston; CurePSP (J. Shurer, KD, LIG), New York; Neurological Institute (J. Siddiqui), Cleveland Clinic, OH; Neurology (CCS), University of Michigan, Ann Arbor; Neurology (AMW), Massachusetts General Hospital and Harvard Medical School, Boston; and Neurology (LIG), Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Jessica Shurer
- Neuroscience Institute (MKB), The Queen's Medical Center; Medicine (MKB), University of Hawaii, John A Burns School of Medicine, Honolulu; Neurology (RD), University of Arkansas for Medical Sciences, Little Rock; Service de Neurologie (AD), Département de Médecine, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, Quebec, Canada; Neurology (IUH), University of Miami, FL; Neurology (LSH), Columbia University Irving Medical Center, New York; Neurology (GL), The University of Utah; Neurology (GL), George E. Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, UT; Neurology (NRM), University of Florida, Gainesville; Neurology (LM-K), Brigham and Women Hospital and Harvard Medical School, Boston, MA; Neurology (ZM), Johns Hopkins University, Baltimore, MD; Cleveland Clinic Lou Ruvo Center for Brain Health (ZM), Las Vegas, NV; Neurology (FR-P), Medical University of South Carolina, Charleston; CurePSP (J. Shurer, KD, LIG), New York; Neurological Institute (J. Siddiqui), Cleveland Clinic, OH; Neurology (CCS), University of Michigan, Ann Arbor; Neurology (AMW), Massachusetts General Hospital and Harvard Medical School, Boston; and Neurology (LIG), Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Junaid Siddiqui
- Neuroscience Institute (MKB), The Queen's Medical Center; Medicine (MKB), University of Hawaii, John A Burns School of Medicine, Honolulu; Neurology (RD), University of Arkansas for Medical Sciences, Little Rock; Service de Neurologie (AD), Département de Médecine, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, Quebec, Canada; Neurology (IUH), University of Miami, FL; Neurology (LSH), Columbia University Irving Medical Center, New York; Neurology (GL), The University of Utah; Neurology (GL), George E. Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, UT; Neurology (NRM), University of Florida, Gainesville; Neurology (LM-K), Brigham and Women Hospital and Harvard Medical School, Boston, MA; Neurology (ZM), Johns Hopkins University, Baltimore, MD; Cleveland Clinic Lou Ruvo Center for Brain Health (ZM), Las Vegas, NV; Neurology (FR-P), Medical University of South Carolina, Charleston; CurePSP (J. Shurer, KD, LIG), New York; Neurological Institute (J. Siddiqui), Cleveland Clinic, OH; Neurology (CCS), University of Michigan, Ann Arbor; Neurology (AMW), Massachusetts General Hospital and Harvard Medical School, Boston; and Neurology (LIG), Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Christopher C Spears
- Neuroscience Institute (MKB), The Queen's Medical Center; Medicine (MKB), University of Hawaii, John A Burns School of Medicine, Honolulu; Neurology (RD), University of Arkansas for Medical Sciences, Little Rock; Service de Neurologie (AD), Département de Médecine, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, Quebec, Canada; Neurology (IUH), University of Miami, FL; Neurology (LSH), Columbia University Irving Medical Center, New York; Neurology (GL), The University of Utah; Neurology (GL), George E. Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, UT; Neurology (NRM), University of Florida, Gainesville; Neurology (LM-K), Brigham and Women Hospital and Harvard Medical School, Boston, MA; Neurology (ZM), Johns Hopkins University, Baltimore, MD; Cleveland Clinic Lou Ruvo Center for Brain Health (ZM), Las Vegas, NV; Neurology (FR-P), Medical University of South Carolina, Charleston; CurePSP (J. Shurer, KD, LIG), New York; Neurological Institute (J. Siddiqui), Cleveland Clinic, OH; Neurology (CCS), University of Michigan, Ann Arbor; Neurology (AMW), Massachusetts General Hospital and Harvard Medical School, Boston; and Neurology (LIG), Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Anne-Marie A Wills
- Neuroscience Institute (MKB), The Queen's Medical Center; Medicine (MKB), University of Hawaii, John A Burns School of Medicine, Honolulu; Neurology (RD), University of Arkansas for Medical Sciences, Little Rock; Service de Neurologie (AD), Département de Médecine, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, Quebec, Canada; Neurology (IUH), University of Miami, FL; Neurology (LSH), Columbia University Irving Medical Center, New York; Neurology (GL), The University of Utah; Neurology (GL), George E. Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, UT; Neurology (NRM), University of Florida, Gainesville; Neurology (LM-K), Brigham and Women Hospital and Harvard Medical School, Boston, MA; Neurology (ZM), Johns Hopkins University, Baltimore, MD; Cleveland Clinic Lou Ruvo Center for Brain Health (ZM), Las Vegas, NV; Neurology (FR-P), Medical University of South Carolina, Charleston; CurePSP (J. Shurer, KD, LIG), New York; Neurological Institute (J. Siddiqui), Cleveland Clinic, OH; Neurology (CCS), University of Michigan, Ann Arbor; Neurology (AMW), Massachusetts General Hospital and Harvard Medical School, Boston; and Neurology (LIG), Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Kristophe Diaz
- Neuroscience Institute (MKB), The Queen's Medical Center; Medicine (MKB), University of Hawaii, John A Burns School of Medicine, Honolulu; Neurology (RD), University of Arkansas for Medical Sciences, Little Rock; Service de Neurologie (AD), Département de Médecine, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, Quebec, Canada; Neurology (IUH), University of Miami, FL; Neurology (LSH), Columbia University Irving Medical Center, New York; Neurology (GL), The University of Utah; Neurology (GL), George E. Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, UT; Neurology (NRM), University of Florida, Gainesville; Neurology (LM-K), Brigham and Women Hospital and Harvard Medical School, Boston, MA; Neurology (ZM), Johns Hopkins University, Baltimore, MD; Cleveland Clinic Lou Ruvo Center for Brain Health (ZM), Las Vegas, NV; Neurology (FR-P), Medical University of South Carolina, Charleston; CurePSP (J. Shurer, KD, LIG), New York; Neurological Institute (J. Siddiqui), Cleveland Clinic, OH; Neurology (CCS), University of Michigan, Ann Arbor; Neurology (AMW), Massachusetts General Hospital and Harvard Medical School, Boston; and Neurology (LIG), Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Lawrence I Golbe
- Neuroscience Institute (MKB), The Queen's Medical Center; Medicine (MKB), University of Hawaii, John A Burns School of Medicine, Honolulu; Neurology (RD), University of Arkansas for Medical Sciences, Little Rock; Service de Neurologie (AD), Département de Médecine, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, Quebec, Canada; Neurology (IUH), University of Miami, FL; Neurology (LSH), Columbia University Irving Medical Center, New York; Neurology (GL), The University of Utah; Neurology (GL), George E. Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, UT; Neurology (NRM), University of Florida, Gainesville; Neurology (LM-K), Brigham and Women Hospital and Harvard Medical School, Boston, MA; Neurology (ZM), Johns Hopkins University, Baltimore, MD; Cleveland Clinic Lou Ruvo Center for Brain Health (ZM), Las Vegas, NV; Neurology (FR-P), Medical University of South Carolina, Charleston; CurePSP (J. Shurer, KD, LIG), New York; Neurological Institute (J. Siddiqui), Cleveland Clinic, OH; Neurology (CCS), University of Michigan, Ann Arbor; Neurology (AMW), Massachusetts General Hospital and Harvard Medical School, Boston; and Neurology (LIG), Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
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Garcia-Guaqueta DP, Stephens YC, Ali F, Utianski RL, Duffy JR, Clark HM, Thu Pham NT, Machulda MM, Lowe VJ, Dickson DW, Whitwell JL, Josephs KA. Comparing classic-onset corticobasal syndrome to speech/language-onset corticobasal syndrome. Parkinsonism Relat Disord 2024; 125:107025. [PMID: 38875956 PMCID: PMC11283966 DOI: 10.1016/j.parkreldis.2024.107025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Revised: 05/17/2024] [Accepted: 06/02/2024] [Indexed: 06/16/2024]
Abstract
INTRODUCTION Patients with classic-onset corticobasal syndrome (CBS) present with asymmetric limb apraxia and parkinsonism. We have, however, observed patients who initially present with speech and/or language (SL) problems and several years later develop CBS (i.e., SL-onset CBS). We aimed to compare clinical, neuroimaging and pathological characteristics of classic-onset CBS with SL-onset CBS. METHODS We conducted a retrospective cohort study of 62 patients who met criteria for CBS (17 presented with classic-onset CBS and 45 had SL-onset CBS). We compared demographics, clinical characteristics, and grey and white matter volume loss with SPM12 between groups and assessed pathology and corticobasal degeneration (CBD) pathological lesion counts in patients who had died and undergone autopsy. RESULTS Median age at CBS diagnosis was 66.4 years in classic-onset CBS and 73.6 years in SL-onset CBS. Classic-onset CBS had higher frequencies of dystonia, myoclonus, and alien limb phenomenon, while SL-onset CBS had a higher frequency of vertical supranuclear gaze palsy. Both groups showed smaller frontoparietal volumes than controls, with SL-onset CBS having greater volume loss in the left supplementary motor area than classic-onset CBS. All three classic-onset CBS cases with autopsy (100 %) had CBD pathology while 8/21 of SL-onset CBS cases (38 %) had CBD. Pathological lesion burden (including astrocytic plaques) did not differ between classic-onset and SL-onset CBS. CONCLUSION Classic-onset and SL-onset CBS appear to be different syndromes, with the former being a more profuse motor syndrome. The more widespread volume loss in SL-onset CBS likely reflects longer disease course.
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Affiliation(s)
| | | | - Farwa Ali
- Department of Neurology, Mayo Clinic, Rochester, MN, 55905, USA
| | - Rene L Utianski
- Department of Neurology, Mayo Clinic, Rochester, MN, 55905, USA
| | - Joseph R Duffy
- Department of Neurology, Mayo Clinic, Rochester, MN, 55905, USA
| | - Heather M Clark
- Department of Neurology, Mayo Clinic, Rochester, MN, 55905, USA
| | | | - Mary M Machulda
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, 55905, USA
| | - Val J Lowe
- Department of Radiology, Mayo Clinic, Rochester, MN, 55905, USA
| | - Dennis W Dickson
- Department of Neuroscience (Neuropathology), Mayo Clinic, Florida, 32224, USA
| | | | - Keith A Josephs
- Department of Neurology, Mayo Clinic, Rochester, MN, 55905, USA.
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Piramide N, De Micco R, Siciliano M, Silvestro M, Tessitore A. Resting-State Functional MRI Approaches to Parkinsonisms and Related Dementia. Curr Neurol Neurosci Rep 2024:10.1007/s11910-024-01365-8. [PMID: 39046642 DOI: 10.1007/s11910-024-01365-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/12/2024] [Indexed: 07/25/2024]
Abstract
PURPOSE OF THE REVIEW In this review, we attempt to summarize the most updated studies that applied resting-state functional magnetic resonance imaging (rs-fMRI) in the field of Parkinsonisms and related dementia. RECENT FINDINGS Over the past decades, increasing interest has emerged on investigating the presence and pathophysiology of cognitive symptoms in Parkinsonisms and their possible role as predictive biomarkers of neurodegenerative brain processes. In recent years, evidence has been provided, applying mainly three methodological approaches (i.e. seed-based, network-based and graph-analysis) on rs-fMRI data, with promising results. Neural correlates of cognitive impairment and dementia have been detected in patients with Parkinsonisms along the diseases course. Interestingly, early functional connectivity signatures were proposed to track and predict future progression of neurodegenerative processes. However, longitudinal studies are still sparce and further investigations are needed to overcome this knowledge gap.
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Affiliation(s)
- Noemi Piramide
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Napoli, Italy
| | - Rosa De Micco
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Napoli, Italy
| | - Mattia Siciliano
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Napoli, Italy
- Neuropsychology Laboratory, Department of Psychology, University of Campania "Luigi Vanvitelli", Caserta, Italy
| | - Marcello Silvestro
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Napoli, Italy
| | - Alessandro Tessitore
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Napoli, Italy.
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Garcia-Guaqueta DP, Botha H, Utianski RL, Duffy JR, Clark HM, Goodrich AW, Pham NTT, Machulda MM, Baker M, Rademakers R, Whitwell JL, Josephs KA. Progression to corticobasal syndrome: a longitudinal study of patients with nonfluent primary progressive aphasia and primary progressive apraxia of speech. J Neurol 2024; 271:4168-4179. [PMID: 38583104 PMCID: PMC11233233 DOI: 10.1007/s00415-024-12344-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 01/23/2024] [Accepted: 01/24/2024] [Indexed: 04/08/2024]
Abstract
BACKGROUND AND OBJECTIVES Nonfluent variant primary progressive aphasia (nfvPPA) and primary progressive apraxia of speech (PPAOS) can be precursors to corticobasal syndrome (CBS). Details on their progression remain unclear. We aimed to examine the clinical and neuroimaging evolution of nfvPPA and PPAOS into CBS. METHODS We conducted a retrospective longitudinal study in 140 nfvPPA or PPAOS patients and applied the consensus criteria for possible and probable CBS for every visit, evaluating limb rigidity, akinesia, limb dystonia, myoclonus, ideomotor apraxia, alien limb phenomenon, and nonverbal oral apraxia (NVOA). Given the association of NVOA with AOS, we also modified the CBS criteria by excluding NVOA and assigned every patient to either a progressors or non-progressors group. We evaluated the frequency of every CBS feature by year from disease onset, and assessed gray and white matter volume loss using SPM12. RESULTS Asymmetric akinesia, NVOA, and limb apraxia were the most common CBS features that developed; while limb dystonia, myoclonus, and alien limb were rare. Eighty-two patients progressed to possible CBS; only four to probable CBS. nfvPPA and PPAOS had a similar proportion of progressors, although nfvPPA progressed to CBS earlier (p-value = 0.046), driven by an early appearance of limb apraxia (p-value = 0.0041). The non-progressors and progressors both showed premotor/motor cortex involvement at baseline, with spread into prefrontal cortex over time. DISCUSSION An important proportion of patients with nfvPPA and PPAOS progress to possible CBS, while they rarely develop features of probable CBS even after long follow-up.
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Affiliation(s)
- Danna P Garcia-Guaqueta
- Department of Neurology, Behavioral Neurology & Movement Disorders, Mayo Clinic, College of Medicine and Science, Rochester, MN, 55905, USA
| | - Hugo Botha
- Department of Neurology, Behavioral Neurology & Movement Disorders, Mayo Clinic, College of Medicine and Science, Rochester, MN, 55905, USA
| | - Rene L Utianski
- Department of Neurology, Behavioral Neurology & Movement Disorders, Mayo Clinic, College of Medicine and Science, Rochester, MN, 55905, USA
| | - Joseph R Duffy
- Department of Neurology, Behavioral Neurology & Movement Disorders, Mayo Clinic, College of Medicine and Science, Rochester, MN, 55905, USA
| | - Heather M Clark
- Department of Neurology, Behavioral Neurology & Movement Disorders, Mayo Clinic, College of Medicine and Science, Rochester, MN, 55905, USA
| | - Austin W Goodrich
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, 55905, USA
| | | | - Mary M Machulda
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, 55905, USA
| | - Matt Baker
- Department of Neuroscience, Mayo Clinic, Jacksonville, FL, USA
| | - Rosa Rademakers
- Department of Neuroscience, Mayo Clinic, Jacksonville, FL, USA
- VIB Center for Molecular Neurology, University of Antwerp, Antwerp, Belgium
| | | | - Keith A Josephs
- Department of Neurology, Behavioral Neurology & Movement Disorders, Mayo Clinic, College of Medicine and Science, Rochester, MN, 55905, USA.
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5
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Jellinger KA. Pathomechanisms of cognitive and behavioral impairment in corticobasal degeneration. J Neural Transm (Vienna) 2023; 130:1509-1522. [PMID: 37659990 DOI: 10.1007/s00702-023-02691-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 08/23/2023] [Indexed: 09/04/2023]
Abstract
Corticobasal degeneration (CBD) is a rare, sporadic, late-onset progressive neurodegenerative disorder of unknown etiology, clinically characterized by an akinetic-rigid syndrome, behavior and personality disorders, language problems (aphasias), apraxia, executive and cognitive abnormalities and limb dystonia. The syndrome is not specific, as clinical features of pathologically proven CBD include several phenotypes. This 4-repeat (4R) tauopathy is morphologically featured by often asymmetric frontoparietal atrophy, ballooned/achromatic neurons containing filamentous 4R-tau aggregates in cortex and striatum, thread-like processes that are more widespread than in progressive supranuclear palsy (PSP), pathognomonic "astroglial plaques", and numerous inclusions in both astrocytes and oligodendroglia ("coiled bodies") in the white matter. Cognitive deficits in CBD are frequent initial presentations before onset of motor symptoms, depending on the phenotypic variant. They predominantly include executive and visuospatial dysfunction, sleep disorders and language deficits with usually preserved memory domains. Neuroimaging studies showed heterogenous locations of brain atrophy, particularly contralateral to the dominant symptoms, with disruption of striatal connections to prefrontal cortex and basal ganglia circuitry. Asymmetric hypometabolism, mainly involving frontal and parietal regions, is associated with brain cholinergic deficits, and dopaminergic nigrostriatal degeneration. Widespread alteration of cortical and subcortical structures causing heterogenous changes in various brain functional networks support the concept that CBD, similar to PSP, is a brain network disruption disorder. Putative pathogenic factors are hyperphosphorylated tau-pathology, neuroinflammation and oxidative injury, but the basic mechanisms of cognitive impairment in CBD, as in other degenerative movement disorders, are complex and deserve further elucidation as a basis for early diagnosis and adequate treatment of this fatal disorder.
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Affiliation(s)
- Kurt A Jellinger
- Institute of Clinical Neurobiology, Alberichgasse 5/13, 1150, Vienna, Austria.
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6
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El Ouartassi A, Giordana C, Schiazza A, Chardin D, Darcourt J. [ 18F]-FDopa positron emission tomography imaging in corticobasal syndrome. Brain Imaging Behav 2023; 17:619-627. [PMID: 37474673 DOI: 10.1007/s11682-023-00789-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/30/2023] [Indexed: 07/22/2023]
Abstract
PURPOSE First, to investigate the patterns of [18F]-FDOPA positron emission tomography imaging in corticobasal syndrome using visual and semi-quantitative analysis and to compare them with patterns found in Parkinson's disease and progressive supranuclear palsy. Then, to search for correlations with clinical features and [18F]-FDG positron emission tomography imaging. METHODS 27 corticobasal syndrome patients who underwent [18F]-FDOPA positron emission tomography imaging were retrospectively studied. They were compared to 27 matched Parkinson's disease patients, 12 progressive supranuclear palsy patients and 53 normal controls. Scans were visually assigned to one of the following patterns: normal; unilateral homogeneous striatal uptake reduction; putamen uptake reduction with putamen-caudate gradient. A semi-quantitative analysis of striatal regional uptake and asymmetry was performed and correlated to clinical features and [18F]-FDG positron emission tomography patterns. RESULTS [18F]-FDOPA positron emission tomography appeared visually abnormal in only 33.5% of corticobasal syndrome patients. However, semi-quantitative analysis found putaminal asymmetry in 63%. Striatal uptake was homogeneously reduced in both putamen and caudate nucleus in corticobasal syndrome patients unlike in Parkinson's disease and progressive supranuclear palsy. No correlation was found between [18F]-FDOPA positron emission tomography and clinical features. Half of corticobasal syndrome patients presented a corticobasal degeneration pattern on [18F]-FDG positron emission tomography. CONCLUSION: [18F]-FDOPA positron emission tomography can often be normal in corticobasal syndrome patients. Semi-quantitative analysis is useful to unmask a significant asymmetry in many of them. Homogeneous striatal uptake reduction contralateral to the clinical signs is highly suggestive of corticobasal syndrome. This finding can be helpful to better characterize this syndrome with respect to Parkinson's disease and progressive supranuclear palsy.
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Affiliation(s)
- Anaïs El Ouartassi
- Movement Disorders Unit, Centre Hospitalier Universitaire de Nice, Université Côte d'Azur, Nice, France.
- Neurology Department, Centre Hospitalier d'Antibes, 107 Avenue de Nice, Antibes, France.
| | - Caroline Giordana
- Movement Disorders Unit, Centre Hospitalier Universitaire de Nice, Université Côte d'Azur, Nice, France
| | - Aurélie Schiazza
- Nuclear Medicine Department, Centre Antoine Lacassagne, Université Côte d'Azur, Nice, France
- Research Group, UMR 4320, CEA-Université Côte d'Azur, Nice, France
| | - David Chardin
- Nuclear Medicine Department, Centre Antoine Lacassagne, Université Côte d'Azur, Nice, France
- Research Group, UMR 4320, CEA-Université Côte d'Azur, Nice, France
| | - Jacques Darcourt
- Nuclear Medicine Department, Centre Antoine Lacassagne, Université Côte d'Azur, Nice, France
- Research Group, UMR 4320, CEA-Université Côte d'Azur, Nice, France
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7
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Aloisio S, Satolli S, Bellini G, Lopriore P. Parkinsonism in complex neurogenetic disorders: lessons from hereditary dementias, adult-onset ataxias and spastic paraplegias. Neurol Sci 2023; 44:3379-3388. [PMID: 37648940 PMCID: PMC10495519 DOI: 10.1007/s10072-023-07044-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 08/22/2023] [Indexed: 09/01/2023]
Abstract
Parkinsonism is a syndrome characterized by bradykinesia in combination with either rest tremor, rigidity, or both. These features are the cardinal manifestations of Parkinson's disease, the most common cause of parkinsonism, and atypical parkinsonian disorders. However, parkinsonism can be a manifestation of complex neurological and neurodegenerative genetically determined disorders, which have a vast and heterogeneous motor and non-motor phenotypic features. Hereditary dementias, adult-onset ataxias and spastic paraplegias represent only few of this vast group of neurogenetic diseases. This review will provide an overview of parkinsonism's clinical features within adult-onset neurogenetic diseases which a neurologist could face with. Understanding parkinsonism and its characteristics in the context of the aforementioned neurological conditions may provide insights into pathophysiological mechanisms and have important clinical implications, including diagnostic and therapeutic aspects.
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Affiliation(s)
- Simone Aloisio
- Department of Advanced Medical and Surgical Sciences (DAMSS), University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Sara Satolli
- Molecular Medicine for Neurodegenerative and Neuromuscular Diseases Unit, IRCCS Fondazione Stella Maris, Pisa, Italy
| | - Gabriele Bellini
- Department of Clinical and Experimental Medicine, Neurological Institute, University of Pisa, Pisa, Italy
| | - Piervito Lopriore
- Department of Clinical and Experimental Medicine, Neurological Institute, University of Pisa, Pisa, Italy.
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8
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Lu J, Zhang Z, Wu P, Liang X, Zhang H, Hong J, Clement C, Yen TC, Ding S, Wang M, Xiao Z, Rominger A, Shi K, Guan Y, Zuo C, Zhao Q. The heterogeneity of asymmetric tau distribution is associated with an early age at onset and poor prognosis in Alzheimer's disease. Neuroimage Clin 2023; 38:103416. [PMID: 37137254 PMCID: PMC10176076 DOI: 10.1016/j.nicl.2023.103416] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 04/13/2023] [Accepted: 04/22/2023] [Indexed: 05/05/2023]
Abstract
PURPOSE Left-right asymmetry, an important feature of brain development, has been implicated in neurodegenerative diseases, although it's less discussed in typical Alzheimer's disease (AD). We sought to investigate whether asymmetric tau deposition plays a potential role in AD heterogeneity. METHODS Two independent cohorts consisting of patients with mild cognitive impairment due to AD and AD dementia with tau PET imaging were enrolled [the Alzheimer's Disease Neuroimaging Initiative (ADNI) cohort with 18F-Flortaucipir, the Shanghai Memory Study (SMS) cohort with 18F-Florzolotau]. Based on the absolute global tau interhemispheric differences, each cohort was divided into two groups (asymmetric versus symmetric tau distribution). The two groups were cross-sectionally compared in terms of demographic, cognitive characteristics, and pathological burden. The cognitive decline trajectories were analyzed longitudinally. RESULTS Fourteen (23.3%) and 42 (48.3%) patients in the ADNI and SMS cohorts showed an asymmetric tau distribution, respectively. An asymmetric tau distribution was associated with an earlier age at disease onset (proportion of early-onset AD: ADNI/SMS/combined cohorts, p = 0.093/0.026/0.001) and more severe pathological burden (i.e., global tau burden: ADNI/SMS cohorts, p < 0.001/= 0.007). And patients with an asymmetric tau distribution were characterized by a steeper cognitive decline longitudinally (i.e., the annual decline of Mini-Mental Status Examination score: ADNI/SMS/combined cohorts, p = 0.053 / 0.035 / < 0.001). CONCLUSIONS Asymmetry in tau deposition, which may be associated with an earlier age at onset, more severe pathological burden, and a steeper cognitive decline, is potentially an important characteristic of AD heterogeneity.
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Affiliation(s)
- Jiaying Lu
- Department of Nuclear Medicine & PET Center, Huashan Hospital, Fudan University, Shanghai, China; Department of Nuclear Medicine, Inselspital Bern, University Hospital, University of Bern, Bern, Switzerland
| | - Zhengwei Zhang
- Department of Nuclear Medicine & PET Center, Huashan Hospital, Fudan University, Shanghai, China
| | - Ping Wu
- Department of Nuclear Medicine & PET Center, Huashan Hospital, Fudan University, Shanghai, China
| | - Xiaoniu Liang
- Department of Neurology, Huashan Hospital, Fudan University, Shanghai, China
| | - Huiwei Zhang
- Department of Nuclear Medicine & PET Center, Huashan Hospital, Fudan University, Shanghai, China
| | - Jimin Hong
- Department of Nuclear Medicine, Inselspital Bern, University Hospital, University of Bern, Bern, Switzerland
| | - Christoph Clement
- Department of Nuclear Medicine, Inselspital Bern, University Hospital, University of Bern, Bern, Switzerland
| | | | - Saineng Ding
- Department of Neurology, Huashan Hospital, Fudan University, Shanghai, China
| | - Min Wang
- Shanghai Institute for Advanced Communication and Data Science, Shanghai University, Shanghai, China; Department of Informatics, Technische Universität München, Munich, Germany
| | - Zhenxu Xiao
- Department of Neurology, Huashan Hospital, Fudan University, Shanghai, China
| | - Axel Rominger
- Department of Nuclear Medicine, Inselspital Bern, University Hospital, University of Bern, Bern, Switzerland
| | - Kuangyu Shi
- Department of Nuclear Medicine, Inselspital Bern, University Hospital, University of Bern, Bern, Switzerland; Department of Informatics, Technische Universität München, Munich, Germany
| | - Yihui Guan
- Department of Nuclear Medicine & PET Center, Huashan Hospital, Fudan University, Shanghai, China; National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, China; National Center for Neurological Disorders, Huashan Hospital, Fudan University, Shanghai, China.
| | - Chuantao Zuo
- Department of Nuclear Medicine & PET Center, Huashan Hospital, Fudan University, Shanghai, China; National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, China; National Center for Neurological Disorders, Huashan Hospital, Fudan University, Shanghai, China.
| | - Qianhua Zhao
- Department of Neurology, Huashan Hospital, Fudan University, Shanghai, China; National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, China; National Center for Neurological Disorders, Huashan Hospital, Fudan University, Shanghai, China; MOE Frontiers Center for Brain Science, Fudan University, Shanghai, China.
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9
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Chen R, Berardelli A, Bhattacharya A, Bologna M, Chen KHS, Fasano A, Helmich RC, Hutchison WD, Kamble N, Kühn AA, Macerollo A, Neumann WJ, Pal PK, Paparella G, Suppa A, Udupa K. Clinical neurophysiology of Parkinson's disease and parkinsonism. Clin Neurophysiol Pract 2022; 7:201-227. [PMID: 35899019 PMCID: PMC9309229 DOI: 10.1016/j.cnp.2022.06.002] [Citation(s) in RCA: 33] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Revised: 06/11/2022] [Accepted: 06/22/2022] [Indexed: 01/01/2023] Open
Abstract
This review is part of the series on the clinical neurophysiology of movement disorders and focuses on Parkinson’s disease and parkinsonism. The pathophysiology of cardinal parkinsonian motor symptoms and myoclonus are reviewed. The recordings from microelectrode and deep brain stimulation electrodes are reported in detail.
This review is part of the series on the clinical neurophysiology of movement disorders. It focuses on Parkinson’s disease and parkinsonism. The topics covered include the pathophysiology of tremor, rigidity and bradykinesia, balance and gait disturbance and myoclonus in Parkinson’s disease. The use of electroencephalography, electromyography, long latency reflexes, cutaneous silent period, studies of cortical excitability with single and paired transcranial magnetic stimulation, studies of plasticity, intraoperative microelectrode recordings and recording of local field potentials from deep brain stimulation, and electrocorticography are also reviewed. In addition to advancing knowledge of pathophysiology, neurophysiological studies can be useful in refining the diagnosis, localization of surgical targets, and help to develop novel therapies for Parkinson’s disease.
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Affiliation(s)
- Robert Chen
- Krembil Research Institute, University Health Network, Toronto, Ontario, Canada.,Division of Neurology, Department of Medicine, University of Toronto, Ontario, Canada.,Edmond J. Safra Program in Parkinson's Disease, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| | - Alfredo Berardelli
- Department of Human Neurosciences, Sapienza University of Rome, Italy.,IRCCS Neuromed Pozzilli (IS), Italy
| | - Amitabh Bhattacharya
- Department of Neurology, National Institute of Mental Health & Neurosciences (NIMHANS), Bangalore, India
| | - Matteo Bologna
- Department of Human Neurosciences, Sapienza University of Rome, Italy.,IRCCS Neuromed Pozzilli (IS), Italy
| | - Kai-Hsiang Stanley Chen
- Department of Neurology, National Taiwan University Hospital Hsinchu Branch, Hsinchu, Taiwan
| | - Alfonso Fasano
- Krembil Research Institute, University Health Network, Toronto, Ontario, Canada.,Division of Neurology, Department of Medicine, University of Toronto, Ontario, Canada.,Edmond J. Safra Program in Parkinson's Disease, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| | - Rick C Helmich
- Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology and Centre of Expertise for Parkinson & Movement Disorders, Nijmegen, the Netherlands
| | - William D Hutchison
- Krembil Research Institute, University Health Network, Toronto, Ontario, Canada.,Departments of Surgery and Physiology, University of Toronto, Toronto, Ontario, Canada
| | - Nitish Kamble
- Department of Neurology, National Institute of Mental Health & Neurosciences (NIMHANS), Bangalore, India
| | - Andrea A Kühn
- Department of Neurology, Movement Disorder and Neuromodulation Unit, Charité - Universitätsmedizin Berlin, Germany
| | - Antonella Macerollo
- Institute of Systems, Molecular and Integrative Biology, University of Liverpool, United Kingdom.,The Walton Centre NHS Foundation Trust for Neurology and Neurosurgery, Liverpool, United Kingdom
| | - Wolf-Julian Neumann
- Department of Neurology, Movement Disorder and Neuromodulation Unit, Charité - Universitätsmedizin Berlin, Germany
| | - Pramod Kumar Pal
- Department of Neurology, National Institute of Mental Health & Neurosciences (NIMHANS), Bangalore, India
| | | | - Antonio Suppa
- Department of Human Neurosciences, Sapienza University of Rome, Italy.,IRCCS Neuromed Pozzilli (IS), Italy
| | - Kaviraja Udupa
- Department of Neurophysiology National Institute of Mental Health & Neurosciences (NIMHANS), Bangalore, India
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10
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Chen P, Yao H, Tijms BM, Wang P, Wang D, Song C, Yang H, Zhang Z, Zhao K, Qu Y, Kang X, Du K, Fan L, Han T, Yu C, Zhang X, Jiang T, Zhou Y, Lu J, Han Y, Liu B, Zhou B, Liu Y. Four Distinct Subtypes of Alzheimer's Disease Based on Resting-State Connectivity Biomarkers. Biol Psychiatry 2022; 93:759-769. [PMID: 36137824 DOI: 10.1016/j.biopsych.2022.06.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 05/19/2022] [Accepted: 06/13/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Alzheimer's disease (AD) is a neurodegenerative disorder with significant heterogeneity. Different AD phenotypes may be associated with specific brain network changes. Uncovering disease heterogeneity by using functional networks could provide insights into precise diagnoses. METHODS We investigated the subtypes of AD using nonnegative matrix factorization clustering on the previously identified 216 resting-state functional connectivities that differed between AD and normal control subjects. We conducted the analysis using a discovery dataset (n = 809) and a validated dataset (n = 291). Next, we grouped individuals with mild cognitive impairment according to the model obtained in the AD groups. Finally, the clinical measures and brain structural characteristics were compared among the subtypes to assess their relationship with differences in the functional network. RESULTS Individuals with AD were clustered into 4 subtypes reproducibly, which included those with 1) diffuse and mild functional connectivity disruption (subtype 1), 2) predominantly decreased connectivity in the default mode network accompanied by an increase in the prefrontal circuit (subtype 2), 3) predominantly decreased connectivity in the anterior cingulate cortex accompanied by an increase in prefrontal cortex connectivity (subtype 3), and 4) predominantly decreased connectivity in the basal ganglia accompanied by an increase in prefrontal cortex connectivity (subtype 4). In addition to these differences in functional connectivity, differences between the AD subtypes were found in cognition, structural measures, and cognitive decline patterns. CONCLUSIONS These comprehensive results offer new insights that may advance precision medicine for AD and facilitate strategies for future clinical trials.
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Affiliation(s)
- Pindong Chen
- Brainnetome Center & National Laboratory of Pattern Recognition, Institute of Automation, Chinese Academy of Sciences, Beijing, China; School of Artificial Intelligence, University of Chinese Academy of Sciences, Beijing, China
| | - Hongxiang Yao
- Department of Radiology, the Second Medical Centre, National Clinical Research Centre for Geriatric Diseases, Chinese PLA General Hospital, Beijing, China
| | - Betty M Tijms
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC - Location VUmc, The Netherlands
| | - Pan Wang
- Department of Neurology, Tianjin Huanhu Hospital, Tianjin University, Tianjin, China
| | - Dawei Wang
- Department of Radiology, Qilu Hospital of Shandong University, Ji'nan, China
| | - Chengyuan Song
- Department of Neurology, Qilu Hospital of Shandong University, Ji'nan, China
| | - Hongwei Yang
- Department of Radiology, Xuanwu Hospital of Capital Medical University, Beijing, China
| | | | - Kun Zhao
- Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science & Medical Engineering, Beihang University, Beijing, China
| | - Yida Qu
- Brainnetome Center & National Laboratory of Pattern Recognition, Institute of Automation, Chinese Academy of Sciences, Beijing, China; School of Artificial Intelligence, University of Chinese Academy of Sciences, Beijing, China
| | - Xiaopeng Kang
- Brainnetome Center & National Laboratory of Pattern Recognition, Institute of Automation, Chinese Academy of Sciences, Beijing, China; School of Artificial Intelligence, University of Chinese Academy of Sciences, Beijing, China
| | - Kai Du
- Brainnetome Center & National Laboratory of Pattern Recognition, Institute of Automation, Chinese Academy of Sciences, Beijing, China; School of Artificial Intelligence, University of Chinese Academy of Sciences, Beijing, China
| | - Lingzhong Fan
- Brainnetome Center & National Laboratory of Pattern Recognition, Institute of Automation, Chinese Academy of Sciences, Beijing, China
| | - Tong Han
- Department of Radiology, Tianjin Huanhu Hospital, Tianjin University, Tianjin, China
| | - Chunshui Yu
- Department of Radiology, Tianjin Medical University General Hospital, Tianjin, China
| | - Xi Zhang
- Department of Neurology, the Second Medical Centre, National Clinical Research Centre for Geriatric Diseases, Chinese PLA General Hospital, Beijing, China
| | - Tianzi Jiang
- Brainnetome Center & National Laboratory of Pattern Recognition, Institute of Automation, Chinese Academy of Sciences, Beijing, China; School of Artificial Intelligence, University of Chinese Academy of Sciences, Beijing, China
| | - Yuying Zhou
- Department of Neurology, Tianjin Huanhu Hospital, Tianjin University, Tianjin, China
| | - Jie Lu
- Department of Radiology, Xuanwu Hospital of Capital Medical University, Beijing, China
| | - Ying Han
- Department of Neurology, Xuanwu Hospital of Capital Medical University, Beijing, China; Beijing Institute of Geriatrics, Beijing, China; National Clinical Research Center for Geriatric Disorders, Beijing, China
| | - Bing Liu
- State Key Laboratory of Cognition Neuroscience & Learning, Beijing Normal University, Beijing, China
| | - Bo Zhou
- Department of Neurology, the Second Medical Centre, National Clinical Research Centre for Geriatric Diseases, Chinese PLA General Hospital, Beijing, China.
| | - Yong Liu
- Brainnetome Center & National Laboratory of Pattern Recognition, Institute of Automation, Chinese Academy of Sciences, Beijing, China; School of Artificial Intelligence, University of Chinese Academy of Sciences, Beijing, China; School of Artificial Intelligence, Beijing University of Posts and Telecommunications, Beijing, China.
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11
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Liang M, Jia C, Yen TC, Liu L, Li M, Cui R. Complementary value of metabolic and tau PET imaging in the diagnosis of corticobasal degeneration. Eur J Nucl Med Mol Imaging 2022; 49:4286-4288. [PMID: 35723696 DOI: 10.1007/s00259-022-05859-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 05/30/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Menglin Liang
- Department of Nuclear Medicine, DongchengDistrict, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 1 Shuaifuyuan, WangfujingBeijing, 100730, China.,Beijing Key Laboratory of Molecular Targeted Diagnosis and Therapy in Nuclear Medicine, Beijing, China
| | - Chenhao Jia
- Department of Nuclear Medicine, DongchengDistrict, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 1 Shuaifuyuan, WangfujingBeijing, 100730, China.,Beijing Key Laboratory of Molecular Targeted Diagnosis and Therapy in Nuclear Medicine, Beijing, China
| | | | - Linwen Liu
- Medical Research Center, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Mingli Li
- Department of Radiology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ruixue Cui
- Department of Nuclear Medicine, DongchengDistrict, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 1 Shuaifuyuan, WangfujingBeijing, 100730, China. .,Beijing Key Laboratory of Molecular Targeted Diagnosis and Therapy in Nuclear Medicine, Beijing, China.
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12
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Arterial spin labeling imaging for the detection of cerebral blood flow asymmetry in patients with corticobasal syndrome. Neuroradiology 2022; 64:1829-1837. [DOI: 10.1007/s00234-022-02942-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 04/01/2022] [Indexed: 10/18/2022]
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13
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Di Lazzaro V, Bella R, Benussi A, Bologna M, Borroni B, Capone F, Chen KHS, Chen R, Chistyakov AV, Classen J, Kiernan MC, Koch G, Lanza G, Lefaucheur JP, Matsumoto H, Nguyen JP, Orth M, Pascual-Leone A, Rektorova I, Simko P, Taylor JP, Tremblay S, Ugawa Y, Dubbioso R, Ranieri F. Diagnostic contribution and therapeutic perspectives of transcranial magnetic stimulation in dementia. Clin Neurophysiol 2021; 132:2568-2607. [PMID: 34482205 DOI: 10.1016/j.clinph.2021.05.035] [Citation(s) in RCA: 86] [Impact Index Per Article: 28.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 04/22/2021] [Accepted: 05/28/2021] [Indexed: 02/07/2023]
Abstract
Transcranial magnetic stimulation (TMS) is a powerful tool to probe in vivo brain circuits, as it allows to assess several cortical properties such asexcitability, plasticity and connectivity in humans. In the last 20 years, TMS has been applied to patients with dementia, enabling the identification of potential markers of thepathophysiology and predictors of cognitive decline; moreover, applied repetitively, TMS holds promise as a potential therapeutic intervention. The objective of this paper is to present a comprehensive review of studies that have employed TMS in dementia and to discuss potential clinical applications, from the diagnosis to the treatment. To provide a technical and theoretical framework, we first present an overview of the basic physiological mechanisms of the application of TMS to assess cortical excitability, excitation and inhibition balance, mechanisms of plasticity and cortico-cortical connectivity in the human brain. We then review the insights gained by TMS techniques into the pathophysiology and predictors of progression and response to treatment in dementias, including Alzheimer's disease (AD)-related dementias and secondary dementias. We show that while a single TMS measure offers low specificity, the use of a panel of measures and/or neurophysiological index can support the clinical diagnosis and predict progression. In the last part of the article, we discuss the therapeutic uses of TMS. So far, only repetitive TMS (rTMS) over the left dorsolateral prefrontal cortex and multisite rTMS associated with cognitive training have been shown to be, respectively, possibly (Level C of evidence) and probably (Level B of evidence) effective to improve cognition, apathy, memory, and language in AD patients, especially at a mild/early stage of the disease. The clinical use of this type of treatment warrants the combination of brain imaging techniques and/or electrophysiological tools to elucidate neurobiological effects of neurostimulation and to optimally tailor rTMS treatment protocols in individual patients or specific patient subgroups with dementia or mild cognitive impairment.
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Affiliation(s)
- Vincenzo Di Lazzaro
- Unit of Neurology, Neurophysiology, Neurobiology, Department of Medicine, Università Campus Bio-Medico di Roma, Rome, Italy.
| | - Rita Bella
- Department of Medical and Surgical Sciences and Advanced Technologies, Section of Neurosciences, University of Catania, Catania, Italy
| | - Alberto Benussi
- Centre for Neurodegenerative Disorders, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Matteo Bologna
- Department of Human Neurosciences, Sapienza University of Rome, Italy; IRCCS Neuromed, Pozzilli, IS, Italy
| | - Barbara Borroni
- Centre for Neurodegenerative Disorders, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Fioravante Capone
- Unit of Neurology, Neurophysiology, Neurobiology, Department of Medicine, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Kai-Hsiang S Chen
- Department of Neurology, National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu, Taiwan
| | - Robert Chen
- Division of Neurology, Department of Medicine, University of Toronto, Toronto, Canada; Division of Brain, Imaging& Behaviour, Krembil Brain Institute, Toronto, Canada
| | | | - Joseph Classen
- Department of Neurology, University Hospital Leipzig, Leipzig University Medical Center, Germany
| | - Matthew C Kiernan
- Department of Neurology, Royal Prince Alfred Hospital, Brain and Mind Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Giacomo Koch
- Non Invasive Brain Stimulation Unit/Department of Behavioral and Clinical Neurology, Santa Lucia Foundation IRCCS, Rome, Italy; Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy
| | - Giuseppe Lanza
- Department of Surgery and Medical-Surgical Specialties, University of Catania, Catania, Italy; Department of Neurology IC, Oasi Research Institute-IRCCS, Troina, Italy
| | - Jean-Pascal Lefaucheur
- ENT Team, EA4391, Faculty of Medicine, Paris Est Créteil University, Créteil, France; Clinical Neurophysiology Unit, Department of Physiology, Henri Mondor Hospital, Assistance Publique - Hôpitaux de Paris, Créteil, France
| | | | - Jean-Paul Nguyen
- Pain Center, clinique Bretéché, groupe ELSAN, Multidisciplinary Pain, Palliative and Supportive care Center, UIC 22/CAT2 and Laboratoire de Thérapeutique (EA3826), University Hospital, Nantes, France
| | - Michael Orth
- University Hospital of Old Age Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland; Swiss Huntington's Disease Centre, Siloah, Bern, Switzerland
| | - Alvaro Pascual-Leone
- Hinda and Arthur Marcus Institute for Aging Research, Center for Memory Health, Hebrew SeniorLife, USA; Department of Neurology, Harvard Medical School, Boston, MA, USA; Guttmann Brain Health Institute, Universitat Autonoma Barcelona, Spain
| | - Irena Rektorova
- Applied Neuroscience Research Group, Central European Institute of Technology, Masaryk University (CEITEC MU), Brno, Czech Republic; Department of Neurology, St. Anne's University Hospital and Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Patrik Simko
- Applied Neuroscience Research Group, Central European Institute of Technology, Masaryk University (CEITEC MU), Brno, Czech Republic; Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - John-Paul Taylor
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Sara Tremblay
- Department of Cellular and Molecular Medicine, Faculty of Medicine, University of Ottawa, ON, Canada; Royal Ottawa Institute of Mental Health Research, Ottawa, ON, Canada
| | - Yoshikazu Ugawa
- Department of Human Neurophysiology, School of Medicine, Fukushima Medical University, Fukushima, Japan
| | - Raffaele Dubbioso
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples "Federico II", Naples, Italy
| | - Federico Ranieri
- Unit of Neurology, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
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Wilson D, Le Heron C, Anderson T. Corticobasal syndrome: a practical guide. Pract Neurol 2021. [DOI: 10.1136/practneurol-2020-002835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Corticobasal syndrome is a disorder of movement, cognition and behaviour with several possible underlying pathologies, including corticobasal degeneration. It presents insidiously and is slowly progressive. Clinicians should consider the diagnosis in people presenting with any combination of extrapyramidal features (with poor response to levodopa), apraxia or other parietal signs, aphasia and alien-limb phenomena. Neuroimaging showing asymmetrical perirolandic cortical changes supports the diagnosis, while advanced neuroimaging may give insight into the underlying pathology. Identifying corticobasal syndrome carries some management implications (especially if protein-based treatments arise in the future) and prognostic significance. Its treatment is largely symptomatic and is best undertaken within a multidisciplinary setting, including a neurologist, physiotherapist, occupational therapist, speech language therapist, psychiatrist and, ultimately, a palliative care clinician. Corticobasal syndrome can be a confusing entity for neurologists, not least because it has over time evolved from being considered predominantly as a movement disorder to a condition spanning a wide range of cognitive and motor manifestations. In this practical review, we attempt to disentangle this syndrome and provide clarity around diagnosis, its underlying pathological substrates, key clinical features and potential treatments.
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15
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Dunalska A, Pikul J, Schok K, Wiejak KA, Alster P. The Significance of Vascular Pathogenesis in the Examination of Corticobasal Syndrome. Front Aging Neurosci 2021; 13:668614. [PMID: 34017244 PMCID: PMC8129188 DOI: 10.3389/fnagi.2021.668614] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 04/06/2021] [Indexed: 11/30/2022] Open
Abstract
Corticobasal syndrome (CBS) is a clinical entity, classified as an atypical Parkinsonism, characterized by both motor and higher cortical dysfunctions. The clinical manifestation of CBS is associated with several pathologies, among which corticobasal degeneration (CBD) is the most common. The aim of our study was to elaborate on the possible vascular pathogenesis of CBS and consider types of vascular lesions in these cases. Several cases of vascular CBS are described in the literature. The majority of presented patients were affected by internal carotid artery (ICA) stenosis and ischemic strokes; few cases were associated with vascular malformations or autoimmune diseases. Vascular CBS is preceded by an abrupt onset. The clinical manifestation does not significantly differ with non-vascular CBS. Patients with vascular CBS are usually elderly; often with coexistent hypertension, dyslipidemia and diabetes mellitus. Inferring from our observations, cerebral hypoperfusion can play a significant role in neuropathological changes in neurodegenerative diseases. To the best of our knowledge paper is the first comprehensive review of vascular CBS and we are positive that our observations show that further research concerning the vascular pathogenesis of tauopathy atypical Parkinsonism is required.
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Affiliation(s)
- Anna Dunalska
- Department of Neurology, Medical University of Warsaw, Warsaw, Poland
| | - Julia Pikul
- Students' Scientific Association of the Department of Neurology, Medical University of Warsaw, Warsaw, Poland
| | - Katarzyna Schok
- Students' Scientific Association of the Department of Neurology, Medical University of Warsaw, Warsaw, Poland
| | - Katarzyna Anna Wiejak
- Students' Scientific Association of the Department of Neurology, Medical University of Warsaw, Warsaw, Poland
| | - Piotr Alster
- Department of Neurology, Medical University of Warsaw, Warsaw, Poland
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16
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Fernández V. The Use of Motor-Evoked Potentials in Clinical Trials in Multiple Sclerosis. J Clin Neurophysiol 2021; 38:166-170. [PMID: 33958566 DOI: 10.1097/wnp.0000000000000734] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
SUMMARY Motor-evoked potentials (MEPs) can be used to assess the integrity of the descending corticospinal tract in the laboratory. Evoked potentials (EPs) have been widely used in the past for the diagnosis of multiple sclerosis (MS), but they are now becoming more useful in assessing the prognosis of the disease. Motor-evoked potentials have been included in EP scales that have demonstrated good correlations with clinical disability. Soon after the onset of MS, it is possible to detect an ongoing process of neurodegeneration and axonal loss. Axonal loss is probably responsible for the disability and disease progression that occurs in MS. Given the good correlations of EPs in detecting disease progression in MS, they have been used to monitor the effects of drugs used to treat the disease. Several clinical trials used MEPs as part of their EP evaluation, but MEPs have never been used as a measure of efficacy in clinical trials testing neuroprotective agents, although MEPs could be a very promising tool to measure neuroprotection and remyelination resulting from these drugs. To be used in multicenter clinical trials, MEP readings should be comparable between centers. Standardized multicenter EP assessment with central reading has been demonstrated to be feasible and reliable. Although MEP measurements have been correlated with clinical scores and other measures of neurodegeneration, further validation of MEP amplitude measurements is needed regarding their validity, reliability, and sensitivity before they can be routinely used in clinical drug trials in MS.
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Affiliation(s)
- Victoria Fernández
- Service of Clinical Neurophysiology, University Regional Hospital of Malaga, Malaga, Spain
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Effective Valproic Acid Treatment in a Patient With Delusional Parasitosis Due to Corticobasal Syndrome and Alzheimer Disease. J Clin Psychopharmacol 2021; 41:335-337. [PMID: 33734170 DOI: 10.1097/jcp.0000000000001378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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18
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Ferrazzoli D, Ortelli P, Volpe D, Cucca A, Versace V, Nardone R, Saltuari L, Sebastianelli L. The Ties That Bind: Aberrant Plasticity and Networks Dysfunction in Movement Disorders-Implications for Rehabilitation. Brain Connect 2021; 11:278-296. [PMID: 33403893 DOI: 10.1089/brain.2020.0971] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Background: Movement disorders encompass various conditions affecting the nervous system. The pathological processes underlying movement disorders lead to aberrant synaptic plastic changes, which in turn alter the functioning of large-scale brain networks. Therefore, clinical phenomenology does not only entail motor symptoms but also cognitive and motivational disturbances. The result is the disruption of motor learning and motor behavior. Due to this complexity, the responsiveness to standard therapies could be disappointing. Specific forms of rehabilitation entailing goal-based practice, aerobic training, and the use of noninvasive brain stimulation techniques could "restore" neuroplasticity at motor-cognitive circuitries, leading to clinical gains. This is probably associated with modulations occurring at both molecular (synaptic) and circuitry levels (networks). Several gaps remain in our understanding of the relationships among plasticity and neural networks and how neurorehabilitation could promote clinical gains is still unclear. Purposes: In this review, we outline first the networks involved in motor learning and behavior and analyze which mechanisms link the pathological synaptic plastic changes with these networks' disruption in movement disorders. Therefore, we provide theoretical and practical bases to be applied for treatment in rehabilitation.
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Affiliation(s)
- Davide Ferrazzoli
- Department of Neurorehabilitation, Hospital of Vipiteno (SABES-ASDAA), Vipiteno-Sterzing, Italy
| | - Paola Ortelli
- Department of Neurorehabilitation, Hospital of Vipiteno (SABES-ASDAA), Vipiteno-Sterzing, Italy
| | - Daniele Volpe
- Fresco Parkinson Center, Villa Margherita, S. Stefano Riabilitazione, Vicenza, Italy
| | - Alberto Cucca
- Fresco Parkinson Center, Villa Margherita, S. Stefano Riabilitazione, Vicenza, Italy.,Department of Neurology, The Marlene & Paolo Fresco Institute for Parkinson's & Movement Disorders, NYU School of Medicine, New York, New York, USA.,Department of Life Sciences, University of Trieste, Trieste, Italy
| | - Viviana Versace
- Department of Neurorehabilitation, Hospital of Vipiteno (SABES-ASDAA), Vipiteno-Sterzing, Italy
| | - Raffaele Nardone
- Department of Neurology, Franz Tappeiner Hospital (SABES-ASDAA), Merano-Meran, Italy.,Department of Neurology, Christian Doppler Medical Center, Paracelsus University Salzburg, Salzburg, Austria
| | - Leopold Saltuari
- Department of Neurorehabilitation, Hospital of Vipiteno (SABES-ASDAA), Vipiteno-Sterzing, Italy
| | - Luca Sebastianelli
- Department of Neurorehabilitation, Hospital of Vipiteno (SABES-ASDAA), Vipiteno-Sterzing, Italy
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Dentatorubrothalamic tract reduction using fixel-based analysis in corticobasal syndrome. Neuroradiology 2020; 63:529-538. [PMID: 32989557 DOI: 10.1007/s00234-020-02559-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 09/16/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE The word "fixel" refers to the specific fiber population within each voxel, and fixel-based analysis (FBA) is a recently developed technique that facilitates fiber tract-specific statistical analysis. The aim of the paper is to apply FBA to detect impaired fibers for corticobasal syndrome (CBS) especially in regions that contain multiple crossed fibers. METHODS FBA was performed in cohorts of participants clinically diagnosed with CBS (n = 10) and Parkinson's disease (n = 15) or in healthy controls (n = 9). The parameters of the diffusion weighted image were echo time, 83 ms; time, 8123.6 ms; flip angle, 90°; section thickness, 2 mm; b = 1000 s/mm2; and 32 axes. Diffusion tensor analysis was conducted using tract-based spatial statistics (TBSS), and white matter volume was estimated via voxel-based morphometry. RESULTS A comparison of PD or HC to CBS revealed a significant difference in the dentatorubrothalamic tract of the brainstem in FBA in addition to the affected regions in voxel-based morphometry and TBSS (family-wise error-corrected p < 0.05). Reduction of the white matter fibers crossing the brainstem could not be detected via microstructural changes identified using TBSS, but it was detected using FBA. CONCLUSION FBA has some advantages in determining the distribution of corticobasal syndrome lesions.
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20
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Schirinzi T, Canevelli M, Suppa A, Bologna M, Marsili L. The continuum between neurodegeneration, brain plasticity, and movement: a critical appraisal. Rev Neurosci 2020; 31:723-742. [DOI: 10.1515/revneuro-2020-0011] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2020] [Accepted: 05/08/2020] [Indexed: 01/09/2023]
Abstract
Abstract
While the “physiological” aging process is associated with declines in motor and cognitive features, these changes do not significantly impair functions and activities of daily living. Differently, motor and cognitive impairment constitute the most common phenotypic expressions of neurodegeneration. Both manifestations frequently coexist in the same disease, thus making difficult to detect “pure” motor or cognitive conditions. Movement disorders are often characterized by cognitive disturbances, and neurodegenerative dementias often exhibit the occurrence of movement disorders. Such a phenotypic overlap suggests approaching these conditions by highlighting the commonalities of entities traditionally considered distinct. In the present review, we critically reappraised the common clinical and pathophysiological aspects of neurodegeneration in both animal models and patients, looking at motricity as a trait d’union over the spectrum of neurodegeneration and focusing on synaptopathy and oscillopathy as the common pathogenic background. Finally, we discussed the possible role of movement as neuroprotective intervention in neurodegenerative conditions, regardless of the etiology. The identification of commonalities is critical to drive future research and develop novel possible disease-modifying interventions.
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Affiliation(s)
- Tommaso Schirinzi
- Department of Systems Medicine , University of Rome Tor Vergata , Rome , Italy
| | - Marco Canevelli
- Department of Human Neurosciences , Sapienza University of Rome , Rome , Italy
- National Center for Disease Prevention and Health Promotion, National Institute of Health , Rome , Italy
| | - Antonio Suppa
- Department of Human Neurosciences , Sapienza University of Rome , Rome , Italy
- IRCCS Neuromed , Pozzilli , IS , Italy
| | - Matteo Bologna
- Department of Human Neurosciences , Sapienza University of Rome , Rome , Italy
- IRCCS Neuromed , Pozzilli , IS , Italy
| | - Luca Marsili
- Department of Neurology, Gardner Family Center for Parkinson’s Disease and Movement Disorders , University of Cincinnati , 260 Stetson Street , Cincinnati , 45219, OH , USA
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Abstract
PURPOSE OF REVIEW Corticobasal degeneration (CBD) is a rapidly progressive neurodegenerative tauopathy diagnosed postmortem by pathological examination. The clinical presentation of corticobasal syndrome (CBS) is an apraxic, dystonic, and rigid limb with asymmetrical cortical signs and myoclonus. However, less than half of the patients with CBS receive a CBD diagnosis. As tau-lowering therapies have entered clinical trials, improved antemortem diagnosis of CBD is needed. Here, clinicopathological, neuroimaging, and biofluid data in CBS and/or CBD patients are briefly summarized and some knowledge gaps identified. RECENT FINDINGS Developments of MRI-based and nuclear medicine imaging modalities have increased pathophysiological insights of CBS and may improve diagnostic accuracy. In particular, several tau-PET ligands have been evaluated in CBS patients. Cerebrospinal fluid and plasma levels of neurofilament light chain can distinguish CBS from Parkinson's disease but not from other atypical forms of Parkinsonism. SUMMARY Structural and functional imaging approaches provide some aid in the diagnosis of CBD but have low-content validity. None of the currently available tau-PET ligands is suitable for detecting straight filament 4repeat tau disease in clinical routine. Biofluid markers reflecting the distinct tau and/or astrocyte disease of CBD are needed. Examining biosamples along with clinical parameters from longitudinally followed patients with autopsy-confirmed CBD diagnosis shall hopefully delineate improved biomarkers.
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