1
|
Wada T, Shimizu T, Asano Y, Kaneko T, Kawazoe T, Bokuda K, Nakata Y, Naito R, Tobisawa S, Nagaoka U, Sugaya K, Takahashi K. Early-onset dysphagia predicts short survival in multiple system atrophy. J Neurol 2024; 271:6715-6723. [PMID: 39158732 DOI: 10.1007/s00415-024-12623-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2024] [Revised: 07/29/2024] [Accepted: 08/01/2024] [Indexed: 08/20/2024]
Abstract
BACKGROUND The prognostic impact of dysphagia in multiple system atrophy (MSA) remains controversial. This study aimed to investigate the relationship between dysphagia severity and survival in MSA and to elucidate whether this impact differs between MSA-cerebellar ataxia (MSA-C) and MSA-parkinsonism (MSA-P). METHODS This retrospective study included 297 patients with MSA: 251 met criteria for clinically established MSA and 46 for clinically probable MSA. Among them, 171 had MSA-C and 126 had MSA-P. We evaluated symptomatic dysphagia within 3 years of onset and quantified dysphagia severity using the Hyodo score (0 to 12) through fibreoptic endoscopic evaluation of swallowing (FEES) and clinical features, including autonomic dysfunction and vocal cord paralysis. Patients were followed up until death or tracheostomy, and survival factors were analysed using the log-rank test and multivariate Cox proportional hazards model. RESULTS Ninety patients developed symptomatic dysphagia within 3 years of onset, and 75 were evaluated for dysphagia severity using FEES. Survival from onset was shorter in patients with dysphagia within 3 years compared to those without (median: 4.2 years vs. 7.3 years; p < 0.001). Symptomatic dysphagia within 3 years of onset was an independent predictor of shorter survival in the multivariate Cox analysis. While the Hyodo score was higher in MSA-P than in MSA-C patients (p = 0.048), the Hyodo score was associated with survival in both MSA-C and MSA-P patients (log-rank p < 0.001 and p = 0.046, respectively). CONCLUSION Symptomatic dysphagia within 3 years of onset predicts shorter survival in MSA-C and MSA-P patients.
Collapse
Affiliation(s)
- Takahide Wada
- Department of Neurology, Tokyo Metropolitan Neurological Hospital (TMNH), 2-6-1 Musashidai, Fuchu, Tokyo, 183-0042, Japan.
| | - Toshio Shimizu
- Department of Neurology, Tokyo Metropolitan Neurological Hospital (TMNH), 2-6-1 Musashidai, Fuchu, Tokyo, 183-0042, Japan
| | - Yuri Asano
- Department of Neurology, Tokyo Metropolitan Neurological Hospital (TMNH), 2-6-1 Musashidai, Fuchu, Tokyo, 183-0042, Japan
| | - Tetsuji Kaneko
- Department of Clinical Trial, Clinical Research Support Center, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan
| | - Tomoya Kawazoe
- Department of Neurology, Tokyo Metropolitan Neurological Hospital (TMNH), 2-6-1 Musashidai, Fuchu, Tokyo, 183-0042, Japan
| | - Kota Bokuda
- Department of Neurology, Tokyo Metropolitan Neurological Hospital (TMNH), 2-6-1 Musashidai, Fuchu, Tokyo, 183-0042, Japan
| | | | - Rie Naito
- Department of Neurotology, TMNH, Tokyo, Japan
| | - Shinsuke Tobisawa
- Department of Neurology, Tokyo Metropolitan Neurological Hospital (TMNH), 2-6-1 Musashidai, Fuchu, Tokyo, 183-0042, Japan
| | - Utako Nagaoka
- Department of Neurology, Tokyo Metropolitan Neurological Hospital (TMNH), 2-6-1 Musashidai, Fuchu, Tokyo, 183-0042, Japan
| | - Keizo Sugaya
- Department of Neurology, Tokyo Metropolitan Neurological Hospital (TMNH), 2-6-1 Musashidai, Fuchu, Tokyo, 183-0042, Japan
| | - Kazushi Takahashi
- Department of Neurology, Tokyo Metropolitan Neurological Hospital (TMNH), 2-6-1 Musashidai, Fuchu, Tokyo, 183-0042, Japan
| |
Collapse
|
2
|
Sghaier I, Nasri A, Atrous A, Abida Y, Gharbi A, Souissi A, Mrabet S, Ben Djebara M, Kacem I, Gargouri-Berrechid A, Gouider R. Clinical and molecular predictors of survival among atypical parkinsonian syndromes in a North African tertiary referral center. J Neurol Sci 2024; 464:123155. [PMID: 39106638 DOI: 10.1016/j.jns.2024.123155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Revised: 07/24/2024] [Accepted: 07/25/2024] [Indexed: 08/09/2024]
Abstract
INTRODUCTION Atypical Parkinsonian Syndromes(APS) are challenging neurodegenerative disorders due to their heterogeneous phenotypic overlaps.So far,there are no validated biomarkers that can accurately predict disease progression,and survival studies were highly different and contradictory. AIM To investigate clinical and molecular survival factors among Tunisian APS patients. METHODS A retrospective study included Tunisian APS-patients.Using clinical and molecular parameters,survival was explored by Kaplan-Meier analysis. RESULTS We included 409-APS patients divided into 166-DLB,112-PSP,81-MSA and 50-CBS.Survival rate was similar in synucleinopathies, while it differed in tauopathies,being shorter in PSP compared to CBS.Median survival in DLB was different according to gender(p = 0.0048),early parkinsonism and cognitive disorders. Among MSA, prognosis was worse in MSA-C-patients(p = 0.012) and those with stridor(p = 0.0049),oculomotor and neuropsychiatric disorders. For tauopathies, survival was shorter in PSP-RS(p = 0.027),cerebellar phenotype, those with tremor and swallowing problems at onset, early parkinsonism and memory impairment. For CBS,prognosis was worse in patients with tremor,swallowing and cognitive problems.Significant differences were noted in terms of survival across APS non-carriers of APOE-ε4(p < 0.001) as well APS patients carriers of MAPT-H1.PSP patients had lower survival rate according to MAPT haplotype carriage. Moreover, the number of copies had an influence as patients with H1/H2-MAPT profile had better prognosis than those with H1/H1. CONCLUSION This study determined survival rates in APS subgroups,which were comparable across synucleinopathies but shorter in PSP and longer in CBS.It also characterized demographic,phenotypic,and genetic profiles identifying more aggressive forms within APS subgroups.These findings address clinical gaps,aiding counseling for patients and families and guiding clinical management.Furthermore,they could facilitate patient stratification in clinical trials where mortality is an outcome measure.
Collapse
Affiliation(s)
- Ikram Sghaier
- Neurology Department, LR18SP03, Razi University Hospital, 1 Rue des Orangers Manouba, 2010 Tunis, Tunisia; Clinical Investigation Center (CIC) "Neurosciences and Mental Health", Razi University Hospital, 1 Rue des Orangers Manouba, 2010 Tunis, Tunisia
| | - Amina Nasri
- Neurology Department, LR18SP03, Razi University Hospital, 1 Rue des Orangers Manouba, 2010 Tunis, Tunisia; Clinical Investigation Center (CIC) "Neurosciences and Mental Health", Razi University Hospital, 1 Rue des Orangers Manouba, 2010 Tunis, Tunisia; Faculty of Medicine of Tunis, University of Tunis El Manar, 15, Rue Djebel Akhdhar, La Rabta, 1007 Tunis, Tunisia
| | - Amal Atrous
- Neurology Department, LR18SP03, Razi University Hospital, 1 Rue des Orangers Manouba, 2010 Tunis, Tunisia; Clinical Investigation Center (CIC) "Neurosciences and Mental Health", Razi University Hospital, 1 Rue des Orangers Manouba, 2010 Tunis, Tunisia
| | - Youssef Abida
- Neurology Department, LR18SP03, Razi University Hospital, 1 Rue des Orangers Manouba, 2010 Tunis, Tunisia; Clinical Investigation Center (CIC) "Neurosciences and Mental Health", Razi University Hospital, 1 Rue des Orangers Manouba, 2010 Tunis, Tunisia; Faculty of Medicine of Tunis, University of Tunis El Manar, 15, Rue Djebel Akhdhar, La Rabta, 1007 Tunis, Tunisia
| | - Alya Gharbi
- Neurology Department, LR18SP03, Razi University Hospital, 1 Rue des Orangers Manouba, 2010 Tunis, Tunisia; Clinical Investigation Center (CIC) "Neurosciences and Mental Health", Razi University Hospital, 1 Rue des Orangers Manouba, 2010 Tunis, Tunisia; Faculty of Medicine of Tunis, University of Tunis El Manar, 15, Rue Djebel Akhdhar, La Rabta, 1007 Tunis, Tunisia
| | - Amira Souissi
- Neurology Department, LR18SP03, Razi University Hospital, 1 Rue des Orangers Manouba, 2010 Tunis, Tunisia; Clinical Investigation Center (CIC) "Neurosciences and Mental Health", Razi University Hospital, 1 Rue des Orangers Manouba, 2010 Tunis, Tunisia; Faculty of Medicine of Tunis, University of Tunis El Manar, 15, Rue Djebel Akhdhar, La Rabta, 1007 Tunis, Tunisia
| | - Saloua Mrabet
- Neurology Department, LR18SP03, Razi University Hospital, 1 Rue des Orangers Manouba, 2010 Tunis, Tunisia; Clinical Investigation Center (CIC) "Neurosciences and Mental Health", Razi University Hospital, 1 Rue des Orangers Manouba, 2010 Tunis, Tunisia; Faculty of Medicine of Tunis, University of Tunis El Manar, 15, Rue Djebel Akhdhar, La Rabta, 1007 Tunis, Tunisia
| | - Mouna Ben Djebara
- Neurology Department, LR18SP03, Razi University Hospital, 1 Rue des Orangers Manouba, 2010 Tunis, Tunisia; Clinical Investigation Center (CIC) "Neurosciences and Mental Health", Razi University Hospital, 1 Rue des Orangers Manouba, 2010 Tunis, Tunisia; Faculty of Medicine of Tunis, University of Tunis El Manar, 15, Rue Djebel Akhdhar, La Rabta, 1007 Tunis, Tunisia
| | - Imen Kacem
- Neurology Department, LR18SP03, Razi University Hospital, 1 Rue des Orangers Manouba, 2010 Tunis, Tunisia; Clinical Investigation Center (CIC) "Neurosciences and Mental Health", Razi University Hospital, 1 Rue des Orangers Manouba, 2010 Tunis, Tunisia; Faculty of Medicine of Tunis, University of Tunis El Manar, 15, Rue Djebel Akhdhar, La Rabta, 1007 Tunis, Tunisia
| | - Amina Gargouri-Berrechid
- Neurology Department, LR18SP03, Razi University Hospital, 1 Rue des Orangers Manouba, 2010 Tunis, Tunisia; Clinical Investigation Center (CIC) "Neurosciences and Mental Health", Razi University Hospital, 1 Rue des Orangers Manouba, 2010 Tunis, Tunisia; Faculty of Medicine of Tunis, University of Tunis El Manar, 15, Rue Djebel Akhdhar, La Rabta, 1007 Tunis, Tunisia
| | - Riadh Gouider
- Neurology Department, LR18SP03, Razi University Hospital, 1 Rue des Orangers Manouba, 2010 Tunis, Tunisia; Clinical Investigation Center (CIC) "Neurosciences and Mental Health", Razi University Hospital, 1 Rue des Orangers Manouba, 2010 Tunis, Tunisia; Faculty of Medicine of Tunis, University of Tunis El Manar, 15, Rue Djebel Akhdhar, La Rabta, 1007 Tunis, Tunisia.
| |
Collapse
|
3
|
O'Shea N, Lyons S, Higgins S, O'Dowd S. Neurological update: the palliative care landscape for atypical parkinsonian syndromes. J Neurol 2023; 270:2333-2341. [PMID: 36688987 DOI: 10.1007/s00415-023-11574-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 01/12/2023] [Indexed: 01/24/2023]
Abstract
Atypical parkinsonian syndromes are neurodegenerative conditions, characterised by rapid disease progression and shorter life expectancy compared to idiopathic Parkinson's disease. These conditions inflict substantial physical and psychosocial burden on patients and their families; hence, there is a clear rationale for a palliative care approach from diagnosis. An interdisciplinary care model has been shown to improve symptom burden, quality of life and engagement with advance care planning, in a heterogeneous group of neurodegenerative conditions. In this update, we summarise how the landscape for treating these patients has changed and the questions that still need to be resolved.
Collapse
Affiliation(s)
- Noreen O'Shea
- Department of Neurology, Tallaght University Hospital, Tallaght, Dublin 24, D24NR0A, Ireland.
- Department of Palliative Medicine, Tallaght University Hospital, Tallaght, Dublin 24, D24NR0A, Ireland.
| | - Shane Lyons
- Department of Neurology, Tallaght University Hospital, Tallaght, Dublin 24, D24NR0A, Ireland
| | - Stephen Higgins
- Department of Palliative Medicine, Tallaght University Hospital, Tallaght, Dublin 24, D24NR0A, Ireland
- Our Lady's Hospice & Care Services, Harold's Cross, Dublin, D6WRY72, Ireland
| | - Sean O'Dowd
- Department of Neurology, Tallaght University Hospital, Tallaght, Dublin 24, D24NR0A, Ireland
| |
Collapse
|
5
|
Delamarre A, Meissner WG. Tracheostomy invasive ventilation for stridor in multiple system atrophy. Parkinsonism Relat Disord 2022; 97:105-106. [PMID: 35487827 DOI: 10.1016/j.parkreldis.2022.04.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Accepted: 04/21/2022] [Indexed: 10/18/2022]
Affiliation(s)
- Anna Delamarre
- CHU Bordeaux, Service de Neurologie - Maladies Neurodégénératives, CRMR AMS, IMNc, F-33000, Bordeaux, France
| | - Wassilios G Meissner
- CHU Bordeaux, Service de Neurologie - Maladies Neurodégénératives, CRMR AMS, IMNc, F-33000, Bordeaux, France; Univ. Bordeaux, CNRS, IMN, UMR 5293, F-33000, Bordeaux, France; Dept. Medicine, University of Otago, Christchurch, New Zealand; New Zealand Brain Research Institute, Christchurch, New Zealand.
| |
Collapse
|