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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 2024:10.1007/s00415-024-12623-7. [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] [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.
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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
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Toś M, Grażyńska A, Antoniuk S, Siuda J. Impulse Control Disorders in Parkinson's Disease and Atypical Parkinsonian Syndromes-Is There a Difference? Brain Sci 2024; 14:181. [PMID: 38391755 PMCID: PMC10886884 DOI: 10.3390/brainsci14020181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 02/10/2024] [Accepted: 02/14/2024] [Indexed: 02/24/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Impulse control disorders (ICDs) are characterized by potentially harmful actions resulting from disturbances in the self-control of emotions and behavior. ICDs include disorders such as gambling, hypersexuality, binge eating, and compulsive buying. ICDs are known non-motor symptoms in Parkinson's disease (PD) and are associated primarily with the use of dopaminergic treatment (DRT) and especially dopamine agonists (DA). However, in atypical parkinsonism (APS), such as progressive supranuclear palsy (PSP) or multiple system atrophy (MSA), there are only single case reports of ICDs without attempts to determine the risk factors for their occurrence. Moreover, numerous reports in the literature indicate increased impulsivity in PSP. Our study aimed to determine the frequency of individual ICDs in APS compared to PD and identify potential factors for developing ICDs in APS. MATERIALS AND METHODS Our prospective study included 185 patients with PD and 35 with APS (27 patients with PSP and 9 with MSA) hospitalized between 2020 and 2023 at the Neurological Department of University Central Hospital in Katowice. Each patient was examined using the Questionnaire for Impulsive-Compulsive Disorders in Parkinson's Disease (QUIP) to assess ICDs. Additionally, other scales were used to assess the advancement of the disease, the severity of depression, and cognitive impairment. Information on age, gender, age of onset, disease duration, and treatment used were collected from medical records and patient interviews. RESULTS ICDs were detected in 23.39% of patients with PD (including binge eating in 11.54%, compulsive buying in 10.44%, hypersexuality in 8.79%, and pathological gambling in 4.40%), in one patient with MSA (hypersexuality and pathological gambling), and in 18.52% of patients with PSP (binge eating in 3.70%, compulsive buying in 7.41%, and hypersexuality in 11.11%). We found no differences in the frequency of ICDs between individual diseases (p = 0.4696). We confirmed that the use of higher doses of DA and L-dopa in patients with PD, as well as a longer disease duration and the presence of motor complications, were associated with a higher incidence of ICDs. However, we did not find any treatment effect on the incidence of ICDs in APS. CONCLUSIONS ICDs are common and occur with a similar frequency in PD and APS. Well-described risk factors for ICDs in PD, such as the use of DRT or longer disease duration, are not fully reflected in the risk factors for ICDs in APS. This applies especially to PSP, which, unlike PD and MSA, is a tauopathy in which, in addition to the use of DRT, other mechanisms related to the disease, such as disorders in neuronal loops and neurotransmitter deficits, may influence the development of ICDs. Further prospective multicenter studies recruiting larger groups of patients are needed to fully determine the risk factors and mechanisms of ICD development in APS.
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Affiliation(s)
- Mateusz Toś
- Department of Neurology, Faculty of Medical Sciences in Katowice, Medical University of Silesia, 40-055 Katowice, Poland
| | - Anna Grażyńska
- Department of Imaging Diagnostics and Interventional Radiology, Kornel Gibiński Independent Public Central Clinical Hospital, Medical University of Silesia, 40-055 Katowice, Poland
| | - Sofija Antoniuk
- St. Barbara Regional Specialist Hospital No. 5, 41-200 Sosnowiec, Poland
| | - Joanna Siuda
- Department of Neurology, Faculty of Medical Sciences in Katowice, Medical University of Silesia, 40-055 Katowice, Poland
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Goolla M, Cheshire WP, Ross OA, Kondru N. Diagnosing multiple system atrophy: current clinical guidance and emerging molecular biomarkers. Front Neurol 2023; 14:1210220. [PMID: 37840912 PMCID: PMC10570409 DOI: 10.3389/fneur.2023.1210220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Accepted: 09/18/2023] [Indexed: 10/17/2023] Open
Abstract
Multiple system atrophy (MSA) is a rare and progressive neurodegenerative disorder characterized by motor and autonomic dysfunction. Accurate and early diagnosis of MSA is challenging due to its clinical similarity with other neurodegenerative disorders, such as Parkinson's disease and atypical parkinsonian disorders. Currently, MSA diagnosis is based on clinical criteria drawing from the patient's symptoms, lack of response to levodopa therapy, neuroimaging studies, and exclusion of other diseases. However, these methods have limitations in sensitivity and specificity. Recent advances in molecular biomarker research, such as α-synuclein protein amplification assays (RT-QuIC) and other biomarkers in cerebrospinal fluid and blood, have shown promise in improving the diagnosis of MSA. Additionally, these biomarkers could also serve as targets for developing disease-modifying therapies and monitoring treatment response. In this review, we provide an overview of the clinical syndrome of MSA and discuss the current diagnostic criteria, limitations of current diagnostic methods, and emerging molecular biomarkers that offer hope for improving the accuracy and early detection of MSA.
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Affiliation(s)
- Meghana Goolla
- Department of Neuroscience, Mayo Clinic, Jacksonville, FL, United States
- Department of Surgery, University of Illinois, Chicago, IL, United States
| | | | - Owen A. Ross
- Department of Neuroscience, Mayo Clinic, Jacksonville, FL, United States
- Department of Clinical Genomics, Mayo Clinic, Jacksonville, FL, United States
- Department of Biology, University of North Florida, Jacksonville, FL, United States
| | - Naveen Kondru
- Department of Neuroscience, Mayo Clinic, Jacksonville, FL, United States
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Eschlboeck S, Goebel G, Eckhardt C, Fanciulli A, Raccagni C, Boesch S, Djamshidian A, Heim B, Mahlknecht P, Mair K, Nachbauer W, Scherfler C, Stockner H, Poewe W, Seppi K, Kiechl S, Wenning G, Krismer F. Development and Validation of a Prognostic Model to Predict Overall Survival in Multiple System Atrophy. Mov Disord Clin Pract 2023; 10:1368-1376. [PMID: 37772304 PMCID: PMC10525072 DOI: 10.1002/mdc3.13822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 06/05/2023] [Accepted: 06/14/2023] [Indexed: 09/30/2023] Open
Abstract
Background Multiple system atrophy (MSA) is a devastating disease characterized by a variable combination of motor and autonomic symptoms. Previous studies identified numerous clinical factors to be associated with shorter survival. Objective To enable personalized patient counseling, we aimed at developing a risk model of survival based on baseline clinical symptoms. Methods MSA patients referred to the Movement Disorders Unit in Innsbruck, Austria, between 1999 and 2016 were retrospectively analyzed. Kaplan-Meier curves and multivariate Cox regression analysis with least absolute shrinkage and selection operator penalty for variable selection were performed to identify prognostic factors. A nomogram was developed to estimate the 7 years overall survival probability. The performance of the predictive model was validated and calibrated internally using bootstrap resampling and externally using data from the prospective European MSA Study Group Natural History Study. Results A total of 210 MSA patients were included in this analysis, of which 124 patients died. The median survival was 7 years. The following clinical variables were found to significantly affect overall survival and were included in the nomogram: age at symptom onset, falls within 3 years of onset, early autonomic failure including orthostatic hypotension and urogenital failure, and lacking levodopa response. The time-dependent area under curve for internal and external validation was >0.7 within the first 7 years of the disease course. The model was well calibrated showing good overlap between predicted and actual survival probability at 7 years. Conclusion The nomogram is a simple tool to predict survival on an individual basis and may help to improve counseling and treatment of MSA patients.
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Affiliation(s)
| | - Georg Goebel
- Department of Medical Statistics Informatics and Health EconomicsInnsbruck Medical UniversityInnsbruckAustria
| | - Christine Eckhardt
- Department of NeurologyInnsbruck Medical UniversityInnsbruckAustria
- Department of AnesthesiaInnsbruck Medical UniversityInnsbruckAustria
| | | | - Cecilia Raccagni
- Department of NeurologyInnsbruck Medical UniversityInnsbruckAustria
- Department of Neurology, Provincial Hospital of BolzanoTeaching hospital of Paracelsus Medical Private UniversityBolzano‐BozenItaly
| | - Sylvia Boesch
- Department of NeurologyInnsbruck Medical UniversityInnsbruckAustria
| | | | - Beatrice Heim
- Department of NeurologyInnsbruck Medical UniversityInnsbruckAustria
| | | | - Katherina Mair
- Department of NeurologyInnsbruck Medical UniversityInnsbruckAustria
| | | | | | - Heike Stockner
- Department of NeurologyInnsbruck Medical UniversityInnsbruckAustria
| | - Werner Poewe
- Department of NeurologyInnsbruck Medical UniversityInnsbruckAustria
| | - Klaus Seppi
- Department of NeurologyInnsbruck Medical UniversityInnsbruckAustria
- Department of NeurologyProvincial Hospital of KufsteinKufsteinAustria
| | - Stefan Kiechl
- Department of NeurologyInnsbruck Medical UniversityInnsbruckAustria
| | - Gregor Wenning
- Department of NeurologyInnsbruck Medical UniversityInnsbruckAustria
| | - Florian Krismer
- Department of NeurologyInnsbruck Medical UniversityInnsbruckAustria
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Ali N, Nesspor V, Bang J, Scholz SW, Pantelyat A. Factors impacting quality of life in multiple system atrophy. Front Neurol 2023; 14:1111605. [PMID: 36970533 PMCID: PMC10036583 DOI: 10.3389/fneur.2023.1111605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 02/13/2023] [Indexed: 03/12/2023] Open
Abstract
BackgroundMultiple system atrophy (MSA) is an atypical parkinsonian disorder marked by autonomic dysfunction, parkinsonism, cerebellar dysfunction, and poor response to dopaminergic medications such as levodopa. Patient-reported quality of life is an important benchmark for clinicians and clinical trials. The Unified Multiple System Atrophy Rating Scale (UMSARS) allows healthcare providers to rate and assess MSA progression. The MSA-QoL questionnaire is a health-related quality of life scale intended to provide patient-reported outcome measures. In this article, we investigated inter-scale correlations between the MSA-QoL and UMSARS to determine factors impacting the quality of life of patients with MSA.MethodsTwenty patients at the Johns Hopkins Atypical Parkinsonism Center's Multidisciplinary Clinic with a diagnosis of clinically probable MSA and who filled out the MSA-QoL and UMSARS questionnaires within 2 weeks of each other were included. Inter-scale correlations between MSA-QoL and UMSARS responses were examined. Linear regressions were also performed to examine relationships between both scales.ResultsSignificant inter-scale correlations were found between the MSA-QoL and UMSARS, both between MSA-QoL total score and UMSARS Part I subtotal scores and for individual scale items. There were no significant correlations between MSA-QoL life satisfaction rating and UMSARS subtotal scores or any specific UMSARS items. Linear regression analysis found significant associations between MSA-QoL total score and UMSARS Part I and total scores, and between MSA-QoL life satisfaction rating and UMSARS Part I, Part II, and total scores (after adjustment for age).ConclusionsOur study demonstrates significant inter-scale correlations between MSA-QoL and UMSARS, particularly relating to activities of daily living and hygiene. MSA-QoL total score and UMSARS Part I subtotal scores, which assess patients' functional status, were significantly correlated. The lack of significant associations between MSA-QoL life satisfaction rating and any UMSARS item suggests there may be aspects to quality of life that are not fully captured by this assessment. Larger cross-sectional and longitudinal analyses utilizing UMSARS and MSA-QoL are warranted and modification of the UMSARS should be considered.
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Affiliation(s)
- Nabila Ali
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Vanessa Nesspor
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Jee Bang
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Sonja W. Scholz
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
- Neurodegenerative Diseases Research Unit, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, United States
| | - Alexander Pantelyat
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
- *Correspondence: Alexander Pantelyat
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Oender D, Faber J, Wilke C, Schaprian T, Lakghomi A, Mengel D, Schöls L, Traschütz A, Fleszar Z, Dufke C, Vielhaber S, Machts J, Giordano I, Grobe-Einsler M, Klopstock T, Stendel C, Boesch S, Nachbauer W, Timmann-Braun D, Thieme AG, Kamm C, Dudesek A, Tallaksen C, Wedding I, Filla A, Schmid M, Synofzik M, Klockgether T. Evolution of Clinical Outcome Measures and Biomarkers in Sporadic Adult-Onset Degenerative Ataxia. Mov Disord 2023; 38:654-664. [PMID: 36695111 DOI: 10.1002/mds.29324] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 11/11/2022] [Accepted: 12/22/2022] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Sporadic adult-onset ataxias without known genetic or acquired cause are subdivided into multiple system atrophy of cerebellar type (MSA-C) and sporadic adult-onset ataxia of unknown etiology (SAOA). OBJECTIVES To study the differential evolution of both conditions including plasma neurofilament light chain (NfL) levels and magnetic resonance imaging (MRI) markers. METHODS SPORTAX is a prospective registry of sporadic ataxia patients with an onset >40 years. Scale for the Assessment and Rating of Ataxia was the primary outcome measure. In subgroups, blood samples were taken and MRIs performed. Plasma NfL was measured via a single molecule assay. Regional brain volumes were automatically measured. To assess signal changes, we defined the pons and middle cerebellar peduncle abnormality score (PMAS). Using mixed-effects models, we analyzed changes on a time scale starting with ataxia onset. RESULTS Of 404 patients without genetic diagnosis, 130 met criteria of probable MSA-C at baseline and 26 during follow-up suggesting clinical conversion to MSA-C. The remaining 248 were classified as SAOA. At baseline, NfL, cerebellar white matter (CWM) and pons volume, and PMAS separated MSA-C from SAOA. NfL decreased in MSA-C and did not change in SAOA. CWM and pons volume decreased faster, whereas PMAS increased faster in MSA-C. In MSA-C, pons volume had highest sensitivity to change, and PMAS was a predictor of faster progression. Fulfillment of possible MSA criteria, NfL and PMAS were risk factors, CWM and pons volume protective factors for conversion to MSA-C. CONCLUSIONS This study provides detailed information on differential evolution and prognostic relevance of biomarkers in MSA-C and SAOA. © 2023 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Demet Oender
- German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany.,Department of Neurology, University Hospital Bonn, Bonn, Germany
| | - Jennifer Faber
- German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany.,Department of Neurology, University Hospital Bonn, Bonn, Germany
| | - Carlo Wilke
- Department of Neurodegenerative Diseases and Hertie-Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
| | - Tamara Schaprian
- German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany
| | - Asadeh Lakghomi
- Department of Neuroradiology, University Hospital Bonn, Bonn, Germany
| | - David Mengel
- Department of Neurodegenerative Diseases and Hertie-Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
| | - Ludger Schöls
- Department of Neurodegenerative Diseases and Hertie-Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany.,German Centre for Neurodegenerative Diseases (DZNE), Tübingen, Germany
| | - Andreas Traschütz
- Department of Neurodegenerative Diseases and Hertie-Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany.,German Centre for Neurodegenerative Diseases (DZNE), Tübingen, Germany
| | - Zofia Fleszar
- Department of Neurodegenerative Diseases and Hertie-Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany.,German Centre for Neurodegenerative Diseases (DZNE), Tübingen, Germany
| | - Claudia Dufke
- Institute of Medical Genetics and Applied Genomics, University of Tübingen, Tübingen, Germany
| | - Stefan Vielhaber
- German Center for Neurodegenerative Diseases (DZNE), Magdeburg, Germany.,Department of Neurology, Otto-von-Guericke University, Magdeburg, Germany
| | - Judith Machts
- German Center for Neurodegenerative Diseases (DZNE), Magdeburg, Germany.,Department of Neurology, Otto-von-Guericke University, Magdeburg, Germany
| | - Ilaria Giordano
- German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany.,Department of Neurodegeneration and Geriatric Psychiatry, University Hospital Bonn, Bonn, Germany
| | - Marcus Grobe-Einsler
- German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany.,Department of Neurology, University Hospital Bonn, Bonn, Germany
| | - Thomas Klopstock
- German Center for Neurodegenerative Diseases (DZNE), Munich, Germany.,Department of Neurology, Friedrich-Baur-Institute, Ludwig-Maximilians-University, Munich, Germany.,Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
| | - Claudia Stendel
- German Center for Neurodegenerative Diseases (DZNE), Munich, Germany.,Department of Neurology, Friedrich-Baur-Institute, Ludwig-Maximilians-University, Munich, Germany
| | - Sylvia Boesch
- Department of Neurology and Center for Rare Movement Disorders, Medical University Innsbruck, Austria
| | - Wolfgang Nachbauer
- Department of Neurology and Center for Rare Movement Disorders, Medical University Innsbruck, Austria
| | - Dagmar Timmann-Braun
- Department of Neurology and Center for Translational Neuro- and Behavioral Sciences (C-TNBS), Essen University Hospital, Essen, Germany
| | - Andreas Gustafsson Thieme
- Department of Neurology and Center for Translational Neuro- and Behavioral Sciences (C-TNBS), Essen University Hospital, Essen, Germany
| | - Christoph Kamm
- German Center for Neurodegenerative Diseases (DZNE), Rostock, Germany.,Department of Neurology, University of Rostock, Germany
| | - Ales Dudesek
- German Center for Neurodegenerative Diseases (DZNE), Rostock, Germany.,Department of Neurology, University of Rostock, Germany
| | | | - Iselin Wedding
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Alessandro Filla
- Department of Neurosciences Reproductive and Odontostomatological Sciences, Federico II University, Naples, Italy
| | - Matthias Schmid
- German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany.,Department of Medical Biometry, Informatics and Epidemiology, University Hospital Bonn, Bonn, Germany
| | - Matthis Synofzik
- Department of Neurodegenerative Diseases and Hertie-Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany.,German Centre for Neurodegenerative Diseases (DZNE), Tübingen, Germany
| | - Thomas Klockgether
- German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany.,Department of Neurology, University Hospital Bonn, Bonn, Germany
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Naidoo AK, Wells CD, Rugbeer Y, Naidoo N. The "Hot Cross Bun Sign" in Spinocerebellar Ataxia Types 2 and 7-Case Reports and Review of Literature. Mov Disord Clin Pract 2022; 9:1105-1113. [PMID: 36339304 PMCID: PMC9631856 DOI: 10.1002/mdc3.13550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 07/25/2022] [Accepted: 07/26/2022] [Indexed: 09/19/2023] Open
Abstract
Background The "hot cross bun" sign is a cruciform hyperintensity is seen on T2 weighted imaging within the pons. The sign is considered to be pathognomic for Multiple system atrophy type C. The clinical and radiological features of Multiple system atrophy type C overlap with the autosomal dominant inherited ataxias. We present a case series of 3 African patients with genetically proven Spinocerebellar Ataxia presenting with the Hot cross bun sign and a scoping review of similar studies. Cases We described the phenotypic and radiological presentation of genetically confirmed SCA-2 in two, and SCA-7 in one patient, with the "hot cross bun" sign. Literature Review We performed a scoping review on the Hot Cross Bun Sign.A total of 66 articles were retrieved. We describe the diverse aetiologies of the sign and associated phenotypic and radiological features. We review the Spinocerebellar Ataxias described with a Hot cross bun sign and make comparisons to Multiple System Atrophy Type C [Ref. 1,2]. Conclusions To our knowledge this is the first description of an African cohort presenting with the Hot Cross Bun Sign. We expand the differential diagnosis of the Hot Cross Bun Sign.
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Affiliation(s)
- Ansuya Kasavelu Naidoo
- Greys Academic HospitalPietermaritzburgSouth Africa
- School of Clinical Medicine, Division NeurologyUniversity of KwaZulu NatalDurbanSouth Africa
| | - Cait‐Lynn Deanne Wells
- Greys Academic HospitalPietermaritzburgSouth Africa
- School of Clinical Medicine, Division NeurologyUniversity of KwaZulu NatalDurbanSouth Africa
| | | | - Neil Naidoo
- Greys Academic HospitalPietermaritzburgSouth Africa
- School of Clinical Medicine, Division NeurologyUniversity of KwaZulu NatalDurbanSouth Africa
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8
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Vichayanrat E, Valerio F, Koay S, De Pablo-Fernandez E, Panicker J, Morris H, Bhatia K, Chelban V, Houlden H, Quinn N, Navarro-Otano J, Miki Y, Holton J, Warner T, Mathias C, Iodice V. Diagnosing Premotor Multiple System Atrophy: Natural History and Autonomic Testing in an Autopsy-Confirmed Cohort. Neurology 2022; 99:e1168-e1177. [PMID: 35790426 PMCID: PMC9536739 DOI: 10.1212/wnl.0000000000200861] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Accepted: 05/02/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Nonmotor features precede motor symptoms in many patients with multiple system atrophy (MSA). However, little is known about differences between the natural history, progression, and prognostic factors for survival in patients with MSA with nonmotor vs motor presentations. We aimed to compare initial symptoms, disease progression, and clinical features at final evaluation and investigate differences in survival and natural history between patients with MSA with motor and nonmotor presentations. METHODS Medical records of autopsy-confirmed MSA cases at Queen Square Brain Bank who underwent both clinical examination and cardiovascular autonomic testing were identified. Clinical features, age at onset, sex, time from onset to diagnosis, disease duration, autonomic function tests, and plasma noradrenaline levels were evaluated. RESULTS Forty-seven patients with autopsy-confirmed MSA (age 60 ± 8 years; 28 men) were identified. Time from symptom onset to first autonomic evaluation was 4 ± 2 years, and the disease duration was 7.7 ± 2.2 years. Fifteen (32%) patients presented with nonmotor features including genitourinary dysfunction, orthostatic hypotension, or REM sleep behavior disorder before developing motor involvement (median delay 1-6 years). A third (5/15) were initially diagnosed with pure autonomic failure (PAF) before evolving into MSA. All these patients had normal supine plasma noradrenaline levels (332.0 ± 120.3 pg/mL) with no rise on head-up tilt (0.1 ± 0.3 pg/mL). Patients with MSA with early cardiovascular autonomic dysfunction (within 3 years of symptom onset) had shorter survival compared with those with later onset of cardiovascular autonomic impairment (6.8 years [5.6-7.9] vs 8.5 years [7.9-9.2]; p = 0.026). Patients with early urinary catheterization had shorter survival than those requiring catheterization later (6.2 years [4.6-7.8] vs 8.5 years [7.6-9.4]; p = 0.02). The survival of patients with MSA presenting with motor and nonmotor symptoms did not differ (p > 0.05). DISCUSSION Almost one-third of patients with MSA presented with nonmotor features, which could predate motor symptoms by up to 6 years. Cardiovascular autonomic failure and early urinary catheterization were predictors of poorer outcomes. A normal supine plasma noradrenaline level in patients presenting with PAF phenotype is a possible autonomic biomarker indicating later conversion to MSA.
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Affiliation(s)
- Ekawat Vichayanrat
- From the Autonomic Unit (E.V., F.V., S.K., J.N.-O., V.I.), National Hospital for Neurology and Neurosurgery, Queen Square; Department of Brain Repair and Rehabilitation (E.V., S.K., J.P., C.M., V.I.), Reta Lila Weston Institute for Neurological Studies (E.D.P.-F., N.Q., Y.M., J.H., T.W.), and Queen Square Brain Bank for Neurological Disorders (E.D.P.-F., N.Q., Y.M., J.H., T.W.), UCL Queen Square Institute of Neurology; Department of Uro Neurology (J.P.), National Hospital for Neurology and Neurosurgery; Department of Clinical and Movement Neuroscience (V.C., H.H.), and Department of Neuromuscular Diseases (Y.M.), UCL Institute of Neurology, Queen Square, London, United Kingdom; Service of Neurology (H.M., K.B.), Hospital Clinic, Barcelona, Spain and Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS); Department of Neuropathology (J.N.-O.), Institute of Brain Science, Hirosaki University Graduate School of Medicine, Japan; and The Lindo Wing (C.M.), Imperial College Healthcare NHS Trust, St Mary's Hospital, London, United Kingdom
| | - Fernanda Valerio
- From the Autonomic Unit (E.V., F.V., S.K., J.N.-O., V.I.), National Hospital for Neurology and Neurosurgery, Queen Square; Department of Brain Repair and Rehabilitation (E.V., S.K., J.P., C.M., V.I.), Reta Lila Weston Institute for Neurological Studies (E.D.P.-F., N.Q., Y.M., J.H., T.W.), and Queen Square Brain Bank for Neurological Disorders (E.D.P.-F., N.Q., Y.M., J.H., T.W.), UCL Queen Square Institute of Neurology; Department of Uro Neurology (J.P.), National Hospital for Neurology and Neurosurgery; Department of Clinical and Movement Neuroscience (V.C., H.H.), and Department of Neuromuscular Diseases (Y.M.), UCL Institute of Neurology, Queen Square, London, United Kingdom; Service of Neurology (H.M., K.B.), Hospital Clinic, Barcelona, Spain and Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS); Department of Neuropathology (J.N.-O.), Institute of Brain Science, Hirosaki University Graduate School of Medicine, Japan; and The Lindo Wing (C.M.), Imperial College Healthcare NHS Trust, St Mary's Hospital, London, United Kingdom
| | - Shiwen Koay
- From the Autonomic Unit (E.V., F.V., S.K., J.N.-O., V.I.), National Hospital for Neurology and Neurosurgery, Queen Square; Department of Brain Repair and Rehabilitation (E.V., S.K., J.P., C.M., V.I.), Reta Lila Weston Institute for Neurological Studies (E.D.P.-F., N.Q., Y.M., J.H., T.W.), and Queen Square Brain Bank for Neurological Disorders (E.D.P.-F., N.Q., Y.M., J.H., T.W.), UCL Queen Square Institute of Neurology; Department of Uro Neurology (J.P.), National Hospital for Neurology and Neurosurgery; Department of Clinical and Movement Neuroscience (V.C., H.H.), and Department of Neuromuscular Diseases (Y.M.), UCL Institute of Neurology, Queen Square, London, United Kingdom; Service of Neurology (H.M., K.B.), Hospital Clinic, Barcelona, Spain and Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS); Department of Neuropathology (J.N.-O.), Institute of Brain Science, Hirosaki University Graduate School of Medicine, Japan; and The Lindo Wing (C.M.), Imperial College Healthcare NHS Trust, St Mary's Hospital, London, United Kingdom
| | - Eduardo De Pablo-Fernandez
- From the Autonomic Unit (E.V., F.V., S.K., J.N.-O., V.I.), National Hospital for Neurology and Neurosurgery, Queen Square; Department of Brain Repair and Rehabilitation (E.V., S.K., J.P., C.M., V.I.), Reta Lila Weston Institute for Neurological Studies (E.D.P.-F., N.Q., Y.M., J.H., T.W.), and Queen Square Brain Bank for Neurological Disorders (E.D.P.-F., N.Q., Y.M., J.H., T.W.), UCL Queen Square Institute of Neurology; Department of Uro Neurology (J.P.), National Hospital for Neurology and Neurosurgery; Department of Clinical and Movement Neuroscience (V.C., H.H.), and Department of Neuromuscular Diseases (Y.M.), UCL Institute of Neurology, Queen Square, London, United Kingdom; Service of Neurology (H.M., K.B.), Hospital Clinic, Barcelona, Spain and Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS); Department of Neuropathology (J.N.-O.), Institute of Brain Science, Hirosaki University Graduate School of Medicine, Japan; and The Lindo Wing (C.M.), Imperial College Healthcare NHS Trust, St Mary's Hospital, London, United Kingdom
| | - Jalesh Panicker
- From the Autonomic Unit (E.V., F.V., S.K., J.N.-O., V.I.), National Hospital for Neurology and Neurosurgery, Queen Square; Department of Brain Repair and Rehabilitation (E.V., S.K., J.P., C.M., V.I.), Reta Lila Weston Institute for Neurological Studies (E.D.P.-F., N.Q., Y.M., J.H., T.W.), and Queen Square Brain Bank for Neurological Disorders (E.D.P.-F., N.Q., Y.M., J.H., T.W.), UCL Queen Square Institute of Neurology; Department of Uro Neurology (J.P.), National Hospital for Neurology and Neurosurgery; Department of Clinical and Movement Neuroscience (V.C., H.H.), and Department of Neuromuscular Diseases (Y.M.), UCL Institute of Neurology, Queen Square, London, United Kingdom; Service of Neurology (H.M., K.B.), Hospital Clinic, Barcelona, Spain and Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS); Department of Neuropathology (J.N.-O.), Institute of Brain Science, Hirosaki University Graduate School of Medicine, Japan; and The Lindo Wing (C.M.), Imperial College Healthcare NHS Trust, St Mary's Hospital, London, United Kingdom
| | - Huw Morris
- From the Autonomic Unit (E.V., F.V., S.K., J.N.-O., V.I.), National Hospital for Neurology and Neurosurgery, Queen Square; Department of Brain Repair and Rehabilitation (E.V., S.K., J.P., C.M., V.I.), Reta Lila Weston Institute for Neurological Studies (E.D.P.-F., N.Q., Y.M., J.H., T.W.), and Queen Square Brain Bank for Neurological Disorders (E.D.P.-F., N.Q., Y.M., J.H., T.W.), UCL Queen Square Institute of Neurology; Department of Uro Neurology (J.P.), National Hospital for Neurology and Neurosurgery; Department of Clinical and Movement Neuroscience (V.C., H.H.), and Department of Neuromuscular Diseases (Y.M.), UCL Institute of Neurology, Queen Square, London, United Kingdom; Service of Neurology (H.M., K.B.), Hospital Clinic, Barcelona, Spain and Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS); Department of Neuropathology (J.N.-O.), Institute of Brain Science, Hirosaki University Graduate School of Medicine, Japan; and The Lindo Wing (C.M.), Imperial College Healthcare NHS Trust, St Mary's Hospital, London, United Kingdom
| | - Kailash Bhatia
- From the Autonomic Unit (E.V., F.V., S.K., J.N.-O., V.I.), National Hospital for Neurology and Neurosurgery, Queen Square; Department of Brain Repair and Rehabilitation (E.V., S.K., J.P., C.M., V.I.), Reta Lila Weston Institute for Neurological Studies (E.D.P.-F., N.Q., Y.M., J.H., T.W.), and Queen Square Brain Bank for Neurological Disorders (E.D.P.-F., N.Q., Y.M., J.H., T.W.), UCL Queen Square Institute of Neurology; Department of Uro Neurology (J.P.), National Hospital for Neurology and Neurosurgery; Department of Clinical and Movement Neuroscience (V.C., H.H.), and Department of Neuromuscular Diseases (Y.M.), UCL Institute of Neurology, Queen Square, London, United Kingdom; Service of Neurology (H.M., K.B.), Hospital Clinic, Barcelona, Spain and Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS); Department of Neuropathology (J.N.-O.), Institute of Brain Science, Hirosaki University Graduate School of Medicine, Japan; and The Lindo Wing (C.M.), Imperial College Healthcare NHS Trust, St Mary's Hospital, London, United Kingdom
| | - Viorica Chelban
- From the Autonomic Unit (E.V., F.V., S.K., J.N.-O., V.I.), National Hospital for Neurology and Neurosurgery, Queen Square; Department of Brain Repair and Rehabilitation (E.V., S.K., J.P., C.M., V.I.), Reta Lila Weston Institute for Neurological Studies (E.D.P.-F., N.Q., Y.M., J.H., T.W.), and Queen Square Brain Bank for Neurological Disorders (E.D.P.-F., N.Q., Y.M., J.H., T.W.), UCL Queen Square Institute of Neurology; Department of Uro Neurology (J.P.), National Hospital for Neurology and Neurosurgery; Department of Clinical and Movement Neuroscience (V.C., H.H.), and Department of Neuromuscular Diseases (Y.M.), UCL Institute of Neurology, Queen Square, London, United Kingdom; Service of Neurology (H.M., K.B.), Hospital Clinic, Barcelona, Spain and Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS); Department of Neuropathology (J.N.-O.), Institute of Brain Science, Hirosaki University Graduate School of Medicine, Japan; and The Lindo Wing (C.M.), Imperial College Healthcare NHS Trust, St Mary's Hospital, London, United Kingdom
| | - Henry Houlden
- From the Autonomic Unit (E.V., F.V., S.K., J.N.-O., V.I.), National Hospital for Neurology and Neurosurgery, Queen Square; Department of Brain Repair and Rehabilitation (E.V., S.K., J.P., C.M., V.I.), Reta Lila Weston Institute for Neurological Studies (E.D.P.-F., N.Q., Y.M., J.H., T.W.), and Queen Square Brain Bank for Neurological Disorders (E.D.P.-F., N.Q., Y.M., J.H., T.W.), UCL Queen Square Institute of Neurology; Department of Uro Neurology (J.P.), National Hospital for Neurology and Neurosurgery; Department of Clinical and Movement Neuroscience (V.C., H.H.), and Department of Neuromuscular Diseases (Y.M.), UCL Institute of Neurology, Queen Square, London, United Kingdom; Service of Neurology (H.M., K.B.), Hospital Clinic, Barcelona, Spain and Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS); Department of Neuropathology (J.N.-O.), Institute of Brain Science, Hirosaki University Graduate School of Medicine, Japan; and The Lindo Wing (C.M.), Imperial College Healthcare NHS Trust, St Mary's Hospital, London, United Kingdom
| | - Niall Quinn
- From the Autonomic Unit (E.V., F.V., S.K., J.N.-O., V.I.), National Hospital for Neurology and Neurosurgery, Queen Square; Department of Brain Repair and Rehabilitation (E.V., S.K., J.P., C.M., V.I.), Reta Lila Weston Institute for Neurological Studies (E.D.P.-F., N.Q., Y.M., J.H., T.W.), and Queen Square Brain Bank for Neurological Disorders (E.D.P.-F., N.Q., Y.M., J.H., T.W.), UCL Queen Square Institute of Neurology; Department of Uro Neurology (J.P.), National Hospital for Neurology and Neurosurgery; Department of Clinical and Movement Neuroscience (V.C., H.H.), and Department of Neuromuscular Diseases (Y.M.), UCL Institute of Neurology, Queen Square, London, United Kingdom; Service of Neurology (H.M., K.B.), Hospital Clinic, Barcelona, Spain and Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS); Department of Neuropathology (J.N.-O.), Institute of Brain Science, Hirosaki University Graduate School of Medicine, Japan; and The Lindo Wing (C.M.), Imperial College Healthcare NHS Trust, St Mary's Hospital, London, United Kingdom
| | - Judith Navarro-Otano
- From the Autonomic Unit (E.V., F.V., S.K., J.N.-O., V.I.), National Hospital for Neurology and Neurosurgery, Queen Square; Department of Brain Repair and Rehabilitation (E.V., S.K., J.P., C.M., V.I.), Reta Lila Weston Institute for Neurological Studies (E.D.P.-F., N.Q., Y.M., J.H., T.W.), and Queen Square Brain Bank for Neurological Disorders (E.D.P.-F., N.Q., Y.M., J.H., T.W.), UCL Queen Square Institute of Neurology; Department of Uro Neurology (J.P.), National Hospital for Neurology and Neurosurgery; Department of Clinical and Movement Neuroscience (V.C., H.H.), and Department of Neuromuscular Diseases (Y.M.), UCL Institute of Neurology, Queen Square, London, United Kingdom; Service of Neurology (H.M., K.B.), Hospital Clinic, Barcelona, Spain and Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS); Department of Neuropathology (J.N.-O.), Institute of Brain Science, Hirosaki University Graduate School of Medicine, Japan; and The Lindo Wing (C.M.), Imperial College Healthcare NHS Trust, St Mary's Hospital, London, United Kingdom
| | - Yasuo Miki
- From the Autonomic Unit (E.V., F.V., S.K., J.N.-O., V.I.), National Hospital for Neurology and Neurosurgery, Queen Square; Department of Brain Repair and Rehabilitation (E.V., S.K., J.P., C.M., V.I.), Reta Lila Weston Institute for Neurological Studies (E.D.P.-F., N.Q., Y.M., J.H., T.W.), and Queen Square Brain Bank for Neurological Disorders (E.D.P.-F., N.Q., Y.M., J.H., T.W.), UCL Queen Square Institute of Neurology; Department of Uro Neurology (J.P.), National Hospital for Neurology and Neurosurgery; Department of Clinical and Movement Neuroscience (V.C., H.H.), and Department of Neuromuscular Diseases (Y.M.), UCL Institute of Neurology, Queen Square, London, United Kingdom; Service of Neurology (H.M., K.B.), Hospital Clinic, Barcelona, Spain and Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS); Department of Neuropathology (J.N.-O.), Institute of Brain Science, Hirosaki University Graduate School of Medicine, Japan; and The Lindo Wing (C.M.), Imperial College Healthcare NHS Trust, St Mary's Hospital, London, United Kingdom
| | - Janice Holton
- From the Autonomic Unit (E.V., F.V., S.K., J.N.-O., V.I.), National Hospital for Neurology and Neurosurgery, Queen Square; Department of Brain Repair and Rehabilitation (E.V., S.K., J.P., C.M., V.I.), Reta Lila Weston Institute for Neurological Studies (E.D.P.-F., N.Q., Y.M., J.H., T.W.), and Queen Square Brain Bank for Neurological Disorders (E.D.P.-F., N.Q., Y.M., J.H., T.W.), UCL Queen Square Institute of Neurology; Department of Uro Neurology (J.P.), National Hospital for Neurology and Neurosurgery; Department of Clinical and Movement Neuroscience (V.C., H.H.), and Department of Neuromuscular Diseases (Y.M.), UCL Institute of Neurology, Queen Square, London, United Kingdom; Service of Neurology (H.M., K.B.), Hospital Clinic, Barcelona, Spain and Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS); Department of Neuropathology (J.N.-O.), Institute of Brain Science, Hirosaki University Graduate School of Medicine, Japan; and The Lindo Wing (C.M.), Imperial College Healthcare NHS Trust, St Mary's Hospital, London, United Kingdom
| | - Thomas Warner
- From the Autonomic Unit (E.V., F.V., S.K., J.N.-O., V.I.), National Hospital for Neurology and Neurosurgery, Queen Square; Department of Brain Repair and Rehabilitation (E.V., S.K., J.P., C.M., V.I.), Reta Lila Weston Institute for Neurological Studies (E.D.P.-F., N.Q., Y.M., J.H., T.W.), and Queen Square Brain Bank for Neurological Disorders (E.D.P.-F., N.Q., Y.M., J.H., T.W.), UCL Queen Square Institute of Neurology; Department of Uro Neurology (J.P.), National Hospital for Neurology and Neurosurgery; Department of Clinical and Movement Neuroscience (V.C., H.H.), and Department of Neuromuscular Diseases (Y.M.), UCL Institute of Neurology, Queen Square, London, United Kingdom; Service of Neurology (H.M., K.B.), Hospital Clinic, Barcelona, Spain and Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS); Department of Neuropathology (J.N.-O.), Institute of Brain Science, Hirosaki University Graduate School of Medicine, Japan; and The Lindo Wing (C.M.), Imperial College Healthcare NHS Trust, St Mary's Hospital, London, United Kingdom
| | - Christopher Mathias
- From the Autonomic Unit (E.V., F.V., S.K., J.N.-O., V.I.), National Hospital for Neurology and Neurosurgery, Queen Square; Department of Brain Repair and Rehabilitation (E.V., S.K., J.P., C.M., V.I.), Reta Lila Weston Institute for Neurological Studies (E.D.P.-F., N.Q., Y.M., J.H., T.W.), and Queen Square Brain Bank for Neurological Disorders (E.D.P.-F., N.Q., Y.M., J.H., T.W.), UCL Queen Square Institute of Neurology; Department of Uro Neurology (J.P.), National Hospital for Neurology and Neurosurgery; Department of Clinical and Movement Neuroscience (V.C., H.H.), and Department of Neuromuscular Diseases (Y.M.), UCL Institute of Neurology, Queen Square, London, United Kingdom; Service of Neurology (H.M., K.B.), Hospital Clinic, Barcelona, Spain and Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS); Department of Neuropathology (J.N.-O.), Institute of Brain Science, Hirosaki University Graduate School of Medicine, Japan; and The Lindo Wing (C.M.), Imperial College Healthcare NHS Trust, St Mary's Hospital, London, United Kingdom
| | - Valeria Iodice
- From the Autonomic Unit (E.V., F.V., S.K., J.N.-O., V.I.), National Hospital for Neurology and Neurosurgery, Queen Square; Department of Brain Repair and Rehabilitation (E.V., S.K., J.P., C.M., V.I.), Reta Lila Weston Institute for Neurological Studies (E.D.P.-F., N.Q., Y.M., J.H., T.W.), and Queen Square Brain Bank for Neurological Disorders (E.D.P.-F., N.Q., Y.M., J.H., T.W.), UCL Queen Square Institute of Neurology; Department of Uro Neurology (J.P.), National Hospital for Neurology and Neurosurgery; Department of Clinical and Movement Neuroscience (V.C., H.H.), and Department of Neuromuscular Diseases (Y.M.), UCL Institute of Neurology, Queen Square, London, United Kingdom; Service of Neurology (H.M., K.B.), Hospital Clinic, Barcelona, Spain and Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS); Department of Neuropathology (J.N.-O.), Institute of Brain Science, Hirosaki University Graduate School of Medicine, Japan; and The Lindo Wing (C.M.), Imperial College Healthcare NHS Trust, St Mary's Hospital, London, United Kingdom.
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Hosapatna M, Aparna Verma, Antony Sylvan D’Souza, L. C. P. The role of width of pars compacta of substantia nigra and the midbrain area in patients with Parkinson’s disease and progressive supranuclear palsy with healthy aged individuals. Biomedicine (Taipei) 2022. [DOI: 10.51248/.v42i4.1180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Introduction and Aim: Though numerous image processing software exists to analyse the images, measurement of substantia nigra width and midbrain area are simple yet definite tools to distinguish and diagnose the Parkinson’s disease (PD) and progressive supranuclear palsy (PSP) when complimented with clinical findings. Comparing the brainstem parameters in healthy, (neurodegenerative) diseased, and during the treatment helps us to assess the disease monitoring i.e., severity and progress of the disease, and formulate the best treatment strategies. This study aimed at comparison of the thickness of substantia nigra (SN) in Parkinson's disease (PD) and progressive supranuclear palsy (PSP) with aged healthy individuals by magnetic resonance (MR) imaging.
Material and Methods: This observational study includes the evaluation of MR images of 50 aged healthy individuals with no obvious neurological diseases, 35 classical PD, and 15 PSP patients from the Department of Radiology. Quantitative planimetric evaluation of midbrain area was calculated and the width of substantia nigra (SN) was evaluated as per standard reference criteria with computer assisted image analysis and interpretation program.
Results: The parameters like means of midbrain area and the pars compacta thickness on both right and left sides were compared both in PD and PSP patients with healthy individuals. MR image analysis showed significant decrease in the thickness of pars compacta of SN in PD patients than in PSP patients when compared with age matched healthy aged individuals.
Conclusion: Parkinsonian diseases are always associated with the neuronal loss leading to volume alterations by causing midbrain atrophy. Magnetic resonance imaging of the thickness of SN is simple and reliable imaging markers to differentiate PD and PSP when combined with clinical symptomatology.
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Kühnel L, Raket LL, Åström DO, Berger A, Hansen IH, Krismer F, Wenning GK, Seppi K, Poewe W, Molinuevo J. Disease Progression in Multiple System Atrophy-Novel Modeling Framework and Predictive Factors. Mov Disord 2022; 37:1719-1727. [PMID: 35668573 PMCID: PMC9540561 DOI: 10.1002/mds.29077] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 04/21/2022] [Accepted: 05/02/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Multiple system atrophy (MSA) is a rare and aggressive neurodegenerative disease that typically leads to death 6 to 10 years after symptom onset. The rapid evolution renders it crucial to understand the general disease progression and factors affecting the disease course. OBJECTIVES The aims of this study were to develop a novel disease-progression model to estimate a population-level MSA progression trajectory and predict patient-specific continuous disease stages describing the degree of progress into the disease. METHODS The disease-progression model estimated a population-level progression trajectory of subscales of the Unified MSA Rating Scale and the Unified Parkinson's Disease Rating Scale using patients in the European MSA natural history study. The predicted disease continuum was validated via multiple analyses based on reported anchor points, and the effect of MSA subtype on the rate of disease progression was evaluated. RESULTS The predicted disease continuum spanned approximately 6 years, with an estimated average duration of 51 months for a patient with global disability score 0 to reach the highest level of 4. The predicted continuous disease stages were shown to be correlated with time of symptom onset and predictive of survival time. MSA motor subtype was found to significantly affect disease progression, with MSA-parkinsonian (MSA-P) type patients having an accelerated rate of progression. CONCLUSIONS The proposed modeling framework introduces a new method of analyzing and interpreting the progression of MSA. It can provide new insights and opportunities for investigating covariate effects on the rate of progression and provide well-founded predictions of patient-level future progressions. © 2022 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Line Kühnel
- H. Lundbeck A/SCopenhagenDenmark
- Department of Mathematical SciencesUniversity of CopenhagenCopenhagenDenmark
| | - Lars Lau Raket
- H. Lundbeck A/SCopenhagenDenmark
- Clinical Memory Research Unit, Department of Clinical SciencesLund UniversityLundSweden
| | | | | | | | - Florian Krismer
- Department of NeurologyMedical University InnsbruckInnsbruckAustria
| | | | - Klaus Seppi
- Department of NeurologyMedical University InnsbruckInnsbruckAustria
| | - Werner Poewe
- Department of NeurologyMedical University InnsbruckInnsbruckAustria
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Kaasinen V, Vahlberg T, Stoessl AJ, Strafella AP, Antonini A. Dopamine Receptors in Parkinson's Disease: A Meta-Analysis of Imaging Studies. Mov Disord 2021; 36:1781-1791. [PMID: 33955044 DOI: 10.1002/mds.28632] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 03/15/2021] [Accepted: 04/13/2021] [Indexed: 12/25/2022] Open
Abstract
Dopamine receptors are abundant along the central nigrostriatal tract and are expressed as 5 subtypes in two receptor families. In PD, compensatory changes in dopamine receptors emerge as a consequence of the loss of dopamine nerve terminals or dopaminergic pharmacotherapy. We performed a systematic review and meta-analysis of the available PET and single-photon emission computed tomography studies that have investigated dopamine receptors in PD, PSP and MSA. The inclusion criteria were studies including human PET or single-photon emission computed tomography imaging; dopamine receptor tracers (D1-like or D2-like) and idiopathic PD, PSP, or MSA patients compared with healthy controls. The 67 included D2-like studies had 1925 patients. Data were insufficient for an analysis of D1-like studies. PD patients had higher striatal binding early in the disease, but after a disease duration of 4.36 years, PD patients had lower binding values than healthy controls. Striatal D2R binding was highest in unmedicated early PD patients and in the striatum contralateral to the predominant motor symptoms. PSP and MSA-P patients had lower striatal D2R binding than PD patients (14.2% and 21.8%, respectively). There is initial upregulation of striatal D2Rs in PD, which downregulate on average 4 years after motor symptom onset, possibly because of agonist-induced effects. The consistent upregulation of D2Rs in the PD striatum contralateral to the predominant motor symptoms indicates that receptor changes are driven by neurodegeneration and loss of striatal neuropil. Both PSP and MSA patients have clearly lower striatal D2R binding values than PD patients, which offers an opportunity for differential diagnostics. © 2021 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Valtteri Kaasinen
- Clinical Neurosciences, Department of Clinical Medicine, Faculty of Medicine, University of Turku, Turku, Finland.,Neurocenter, Turku University Hospital, Turku, Finland
| | - Tero Vahlberg
- Biostatistics, Department of Clinical Medicine, Faculty of Medicine, University of Turku, Turku, Finland
| | - A Jon Stoessl
- Pacific Parkinson's Research Centre, Division of Neurology and Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Antonio P Strafella
- Division of Brain, Imaging and Behaviour-Systems Neuroscience, Krembil Research Institute, UHN, University of Toronto, Toronto, Ontario, Canada.,Research Imaging Centre, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, University of Toronto, Toronto, Ontario, Canada.,Morton and Gloria Shulman Movement Disorder Unit and E.J. Safra Parkinson Disease Program, Neurology Division, Department of Medicine, Toronto Western Hospital, UHN, University of Toronto, Toronto, Ontario, Canada
| | - Angelo Antonini
- Parkinson and Movement Disorders Unit, Department of Neuroscience, University of Padua, Padua, Italy
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Lin J, Xu X, Hou Y, Yang J, Shang H. Voxel-Based Meta-Analysis of Gray Matter Abnormalities in Multiple System Atrophy. Front Aging Neurosci 2020; 12:591666. [PMID: 33328969 PMCID: PMC7729009 DOI: 10.3389/fnagi.2020.591666] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 10/28/2020] [Indexed: 02/05/2023] Open
Abstract
Purpose: This study aimed to identify consistent gray matter volume (GMV) changes in the two subtypes of multiple system atrophy (MSA), including parkinsonism subtype (MSA-P), and cerebellar subtype (MSA-C), by conducting a voxel-wise meta-analysis of whole brain voxel-based morphometry (VBM) studies. Method: VBM studies comparing MSA-P or MSA-C and healthy controls (HCs) were systematically searched in the PubMed, Embase, and Web of Science published from 1974 to 20 October 2020. A quantitative meta-analysis of VBM studies on MSA-P or MSA-C was performed using the effect size-based signed differential mapping (ES-SDM) method separately. A complementary analysis was conducted using the Seed-based d Mapping with Permutation of Subject Images (SDM-PSI) method, which allows a familywise error rate (FWE) correction for multiple comparisons of the results, for further validation of the results. Results: Ten studies were included in the meta-analysis of MSA-P subtype, comprising 136 MSA-P patients and 211 HCs. Five studies were included in the meta-analysis of MSA-C subtype, comprising 89 MSA-C patients and 134 HCs. Cerebellum atrophy was detected in both MSA-P and MSA-C, whereas basal ganglia atrophy was only detected in MSA-P. Cerebral cortex atrophy was detected in both subtypes, with predominant impairment of the superior temporal gyrus, inferior frontal gyrus, temporal pole, insula, and amygdala in MSA-P and predominant impairment of the superior temporal gyrus, middle temporal gyrus, fusiform gyrus, and lingual gyrus in MSA-C. Most of these results survived the FWE correction in the complementary analysis, except for the bilateral amygdala and the left caudate nucleus in MSA-P, and the right superior temporal gyrus and the right middle temporal gyrus in MSA-C. These findings remained robust in the jackknife sensitivity analysis, and no significant heterogeneity was detected. Conclusion: A different pattern of brain atrophy between MSA-P and MSA-C detected in the current study was in line with clinical manifestations and provided the evidence of the pathophysiology of the two subtypes of MSA.
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Affiliation(s)
- Junyu Lin
- Laboratory of Neurodegenerative Disorders, Department of Neurology, Rare Diseases Center, West China Hospital, Sichuan University, Chengdu, China
| | - Xinran Xu
- Laboratory of Neurodegenerative Disorders, Department of Neurology, Rare Diseases Center, West China Hospital, Sichuan University, Chengdu, China
| | - Yanbing Hou
- Laboratory of Neurodegenerative Disorders, Department of Neurology, Rare Diseases Center, West China Hospital, Sichuan University, Chengdu, China
| | - Jing Yang
- Laboratory of Neurodegenerative Disorders, Department of Neurology, Rare Diseases Center, West China Hospital, Sichuan University, Chengdu, China
| | - Huifang Shang
- Laboratory of Neurodegenerative Disorders, Department of Neurology, Rare Diseases Center, West China Hospital, Sichuan University, Chengdu, China
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Santaella A, Kuiperij HB, van Rumund A, Esselink RAJ, Bloem BR, Verbeek MM. Cerebrospinal fluid myelin basic protein is elevated in multiple system atrophy. Parkinsonism Relat Disord 2020; 76:80-84. [PMID: 32576494 DOI: 10.1016/j.parkreldis.2020.06.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 05/13/2020] [Accepted: 06/05/2020] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Parkinson's disease (PD) and multiple system atrophy (MSA) have overlapping symptoms, challenging an early diagnosis. Diagnostic accuracy is important because PD and MSA have a different prognosis and response to treatment. Here, we aimed to evaluate the diagnostic value of brain-specific structural proteins in cerebrospinal fluid (CSF) of PD and MSA patients, as well as their association with cognitive decline. METHODS CSF samples were collected from patients with clear signs of parkinsonism, but with uncertain diagnosis at the time of inclusion. Clinical diagnoses of PD (n = 55) and MSA (n = 22) were established after 3 and 10 years of follow-up and re-evaluated after 12 years, according to the most updated clinical criteria. CSF from controls (n = 118) was studied for comparison. Neuron-specific enolase (NSE), glial fibrillary acidic protein (GFAP), S100 calcium-binding protein B (S100B) and myelin basic protein (MBP) levels in CSF were measured using ELISA. Protein levels were also correlated with cognitive decline, i.e. worsening of the mini mental state examination (MMSE) over a period of three years. RESULTS MBP concentrations were increased in MSA compared to PD and controls (p < 0.005) and could differentiate MSA and PD with high accuracy (AUC = 0.781; p < 0.001). Concentrations of MPB, GFAP and S100B, but not NSE, were significantly elevated in PD patients compared to controls (p = 0.05). None of the brain-specific structural proteins correlated with MMSE progression. CONCLUSIONS Our results demonstrate that MBP differentiates PD from MSA at early stages of the disease, indicating that demyelination and axonal damage may already occur in early stages of MSA.
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Affiliation(s)
- Anna Santaella
- Departments of Neurology, the Netherlands; Laboratory Medicine, Radboud university Medical Center and Donders Institute for Brain, Cognition and Behavior, the Netherlands; Center of Expertise for Parkinson & Movement Disorders, Nijmegen, the Netherlands
| | - H Bea Kuiperij
- Departments of Neurology, the Netherlands; Laboratory Medicine, Radboud university Medical Center and Donders Institute for Brain, Cognition and Behavior, the Netherlands
| | | | - Rianne A J Esselink
- Departments of Neurology, the Netherlands; Center of Expertise for Parkinson & Movement Disorders, Nijmegen, the Netherlands
| | - Bastiaan R Bloem
- Departments of Neurology, the Netherlands; Center of Expertise for Parkinson & Movement Disorders, Nijmegen, the Netherlands
| | - Marcel M Verbeek
- Departments of Neurology, the Netherlands; Laboratory Medicine, Radboud university Medical Center and Donders Institute for Brain, Cognition and Behavior, the Netherlands; Center of Expertise for Parkinson & Movement Disorders, Nijmegen, the Netherlands.
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14
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Harvey HB, Watson LC, Subramaniam RM, Burns J, Bykowski J, Chakraborty S, Ledbetter LN, Lee RK, Pannell JS, Pollock JM, Powers WJ, Rosenow JM, Shih RY, Slavin K, Utukuri PS, Corey AS. ACR Appropriateness Criteria® Movement Disorders and Neurodegenerative Diseases. J Am Coll Radiol 2020; 17:S175-S187. [PMID: 32370961 DOI: 10.1016/j.jacr.2020.01.042] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 01/25/2020] [Indexed: 12/12/2022]
Abstract
Movement disorders and neurodegenerative diseases are a variety of conditions that involve progressive neuronal degeneration, injury, or death. Establishing the correct diagnosis of a movement disorder or neurodegenerative process can be difficult due to the variable features of these conditions, unusual clinical presentations, and overlapping symptoms and characteristics. MRI has an important role in the initial assessment of these patients, although a combination of imaging and laboratory and genetic tests is often needed for complete evaluation and management. This document summarizes the imaging appropriateness data for rapidly progressive dementia, chorea, Parkinsonian syndromes, suspected neurodegeneration with brain iron accumulation, and suspected motor neuron disease. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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Affiliation(s)
| | - Laura C Watson
- Research Author, Massachusetts General Hospital, Boston, Massachusetts
| | | | - Judah Burns
- Panel Chair, Montefiore Medical Center, Bronx, New York
| | | | - Santanu Chakraborty
- Ottawa Hospital Research Institute and the Department of Radiology, The University of Ottawa, Ottawa, Ontario, Canada; Canadian Association of Radiologists
| | | | - Ryan K Lee
- Einstein Healthcare Network, Philadelphia, Pennsylvania
| | - Jeffrey S Pannell
- University of California San Diego Medical Center, San Diego, California
| | | | - William J Powers
- University of North Carolina School of Medicine, Chapel Hill, North Carolina; American Academy of Neurology
| | - Joshua M Rosenow
- Northwestern University Feinberg School of Medicine, Chicago, Illinois; Neurosurgery expert
| | - Robert Y Shih
- Walter Reed National Military Medical Center, Bethesda, Maryland
| | | | | | - Amanda S Corey
- Specialty Chair, Atlanta VA Health Care System and Emory University, Atlanta, Georgia
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15
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Cui X, Li L, Yu L, Xing H, Chang H, Zhao L, Qian J, Song Q, Zhou S, Dong C. Gray Matter Atrophy in Parkinson's Disease and the Parkinsonian Variant of Multiple System Atrophy: A Combined ROI- and Voxel-Based Morphometric Study. Clinics (Sao Paulo) 2020; 75:e1505. [PMID: 32555945 PMCID: PMC7279630 DOI: 10.6061/clinics/2020/e1505] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Accepted: 03/20/2020] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES Parkinson's disease (PD) and the parkinsonian variant of multiple system atrophy (MSA-P) are distinct neurodegenerative disorders that share similar clinical features of parkinsonism. The morphological alterations of these diseases have yet to be understood. The purpose of this study was to evaluate gray matter atrophy in PD and MSA-P using regions of interest (ROI)-based measurements and voxel-based morphometry (VBM). METHODS We studied 41 patients with PD, 20 patients with MSA-P, and 39 controls matched for age, sex, and handedness using an improved T1-weighted sequence that eased gray matter segmentation. The gray matter volumes were measured using ROI and VBM. RESULTS ROI volumetric measurements showed significantly reduced bilateral putamen volumes in MSA-P patients compared with those in PD patients and controls (p<0.05), and the volumes of the bilateral caudate nucleus were significantly reduced in both MSA-P and PD patients compared with those in the controls (p<0.05). VBM analysis revealed multifocal cortical and subcortical atrophy in both MSA-P and PD patients, and the volumes of the cerebellum and temporal lobes were remarkably reduced in MSA-P patients compared with the volumes in PD patients (p<0.05). CONCLUSIONS Both PD and MSA-P are associated with gray matter atrophy, which mainly involves the bilateral putamen, caudate nucleus, cerebellum, and temporal lobes. ROI and VBM can be used to identify these morphological alterations, and VBM is more sensitive and repeatable and less time-consuming, which may have potential diagnostic value.
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Affiliation(s)
- Xiaorui Cui
- Department of Neurology, Affiliated Hospital of Xiangnan University, Chenzhou, China
| | - Lan Li
- Department of Neurology, Second Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Lei Yu
- Department of Neurology, Dalian Friendship Hospital, Dalian, China
| | - Huijuan Xing
- Department of Neurology, The Third People’s Hospital of Dalian, Dalian, China
| | - Hong Chang
- Department of Neurology, The Third People’s Hospital of Dalian, Dalian, China
| | - Li Zhao
- Department of Neurology, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Jin Qian
- Department of Neurology, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Qingwei Song
- Department of Radiology, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Shiyu Zhou
- Department of Psychology, Dalian Medical University, Dalian, China
| | - Chunbo Dong
- Department of Neurology, First Affiliated Hospital of Dalian Medical University, Dalian, China
- *Corresponding author. E-mail:
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16
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Lee MJ, Kim TH, Kim SJ, Mun CW, Shin JH, Lee GH, Lee JH. Speculating the timing of iron deposition in the putamen in multiple system atrophy. Parkinsonism Relat Disord 2019; 63:106-110. [DOI: 10.1016/j.parkreldis.2019.02.030] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Revised: 02/17/2019] [Accepted: 02/19/2019] [Indexed: 01/26/2023]
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17
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Lieto M, Roca A, Bruzzese D, Antenora A, Alfieri G, Saccà F, Bellofatto M, Bilo L, Barbato S, De Michele G, Filla A. Longitudinal study of a cohort of MSA-C patients in South Italy: survival and clinical features. Neurol Sci 2019; 40:2105-2109. [DOI: 10.1007/s10072-019-03948-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Accepted: 05/23/2019] [Indexed: 12/20/2022]
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18
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Uwatoko H, Hama Y, Iwata IT, Shirai S, Matsushima M, Yabe I, Utsumi J, Sasaki H. Identification of plasma microRNA expression changes in multiple system atrophy and Parkinson's disease. Mol Brain 2019; 12:49. [PMID: 31088501 PMCID: PMC6518614 DOI: 10.1186/s13041-019-0471-2] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Accepted: 05/01/2019] [Indexed: 12/12/2022] Open
Abstract
MicroRNAs (miRNAs) are endogenous small (18–25 nt), single-stranded, non-coding RNAs that play key roles in post-transcriptional gene expression regulation. The expression profiles of miRNAs in biofluids and tissues change in various diseases. Multiple system atrophy (MSA) and Parkinson’s disease (PD) are both categorized as α-synucleinopathies and often present with similar clinical manifestations. This study aimed to identify miRNAs that are differently expressed in plasma samples of PD patients, MSA patients, and healthy controls. We used microarray analysis to screen for miRNAs that are up- and down-regulated in these patients and analyzed the relative-quantitative expression levels of the identified miRNAs by reverse transcription quantitative polymerase chain reaction (RT-qPCR). Hsa-miR-671-5p, hsa-miR-19b-3p, and hsa-miR-24-3p showed significantly different expression levels among patients with MSA-C, MSA-P, or PD, and healthy controls. Hsa-miR-671-5p levels were lower in the MSA-P and PD than the MSA-C and control groups, hsa-miR-19b-3p levels were higher in the PD than the other groups, and hsa-miR-24-3p levels were higher in the PD than the MSA-C group. Hsa-miR-671-5p was the first miRNA shown to be expressed differently between MSA-C and MSA-P in plasma. Interestingly, the expression levels of hsa-miR-19b-3p and hsa-miR-24-3p were positively correlated, indicating that these miRNAs may be involved in the same processes in PD pathogenesis. Our findings suggest that hsa-miR-671-5p, hsa-miR-19b-3p, and hsa-miR-24-3p may reflect the pathophysiology or symptoms of PD and MSA.
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Affiliation(s)
- Hisashi Uwatoko
- Department of Neurology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, North 15 West 7, Kita-Ku, Sapporo, Hokkaido, 060-8368, Japan.
| | - Yuka Hama
- Department of Neurology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, North 15 West 7, Kita-Ku, Sapporo, Hokkaido, 060-8368, Japan
| | - Ikuko Takahashi Iwata
- Department of Neurology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, North 15 West 7, Kita-Ku, Sapporo, Hokkaido, 060-8368, Japan
| | - Shinichi Shirai
- Department of Neurology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, North 15 West 7, Kita-Ku, Sapporo, Hokkaido, 060-8368, Japan
| | - Masaaki Matsushima
- Department of Neurology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, North 15 West 7, Kita-Ku, Sapporo, Hokkaido, 060-8368, Japan
| | - Ichiro Yabe
- Department of Neurology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, North 15 West 7, Kita-Ku, Sapporo, Hokkaido, 060-8368, Japan
| | - Jun Utsumi
- Department of Neurology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, North 15 West 7, Kita-Ku, Sapporo, Hokkaido, 060-8368, Japan
| | - Hidenao Sasaki
- Department of Neurology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, North 15 West 7, Kita-Ku, Sapporo, Hokkaido, 060-8368, Japan
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Mateos-Pérez JM, Dadar M, Lacalle-Aurioles M, Iturria-Medina Y, Zeighami Y, Evans AC. Structural neuroimaging as clinical predictor: A review of machine learning applications. NEUROIMAGE-CLINICAL 2018; 20:506-522. [PMID: 30167371 PMCID: PMC6108077 DOI: 10.1016/j.nicl.2018.08.019] [Citation(s) in RCA: 90] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/16/2017] [Revised: 01/22/2018] [Accepted: 08/09/2018] [Indexed: 11/26/2022]
Abstract
In this paper, we provide an extensive overview of machine learning techniques applied to structural magnetic resonance imaging (MRI) data to obtain clinical classifiers. We specifically address practical problems commonly encountered in the literature, with the aim of helping researchers improve the application of these techniques in future works. Additionally, we survey how these algorithms are applied to a wide range of diseases and disorders (e.g. Alzheimer's disease (AD), Parkinson's disease (PD), autism, multiple sclerosis, traumatic brain injury, etc.) in order to provide a comprehensive view of the state of the art in different fields.
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Affiliation(s)
| | - Mahsa Dadar
- Montreal Neurological Institute, McGill University, Montreal, Quebec, Canada
| | | | | | - Yashar Zeighami
- Montreal Neurological Institute, McGill University, Montreal, Quebec, Canada
| | - Alan C Evans
- Montreal Neurological Institute, McGill University, Montreal, Quebec, Canada
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20
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Xu Z, Arbizu J, Pavese N. PET Molecular Imaging in Atypical Parkinsonism. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2018; 142:3-36. [DOI: 10.1016/bs.irn.2018.09.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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21
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Brumberg J, Isaias IU. SPECT Molecular Imaging in Atypical Parkinsonism. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2018; 142:37-65. [DOI: 10.1016/bs.irn.2018.08.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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22
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Kaindlstorfer C, Jellinger KA, Eschlböck S, Stefanova N, Weiss G, Wenning GK. The Relevance of Iron in the Pathogenesis of Multiple System Atrophy: A Viewpoint. J Alzheimers Dis 2018; 61:1253-1273. [PMID: 29376857 PMCID: PMC5798525 DOI: 10.3233/jad-170601] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/09/2017] [Indexed: 12/16/2022]
Abstract
Iron is essential for cellular development and maintenance of multiple physiological processes in the central nervous system. The disturbance of its homeostasis leads to abnormal iron deposition in the brain and causes neurotoxicity via generation of free radicals and oxidative stress. Iron toxicity has been established in the pathogenesis of Parkinson's disease; however, its contribution to multiple system atrophy (MSA) remains elusive. MSA is characterized by cytoplasmic inclusions of misfolded α-synuclein (α-SYN) in oligodendrocytes referred to as glial cytoplasmic inclusions (GCIs). Remarkably, the oligodendrocytes possess high amounts of iron, which together with GCI pathology make a contribution toward MSA pathogenesis likely. Consistent with this observation, the GCI density is associated with neurodegeneration in central autonomic networks as well as olivopontocerebellar and striatonigral pathways. Iron converts native α-SYN into a β-sheet conformation and promotes its aggregation either directly or via increasing levels of oxidative stress. Interestingly, α-SYN possesses ferrireductase activity and α-SYN expression underlies iron mediated translational control via RNA stem loop structures. Despite a correlation between progressive putaminal atrophy and iron accumulation as well as clinical decline, it remains unclear whether pathologic iron accumulation in MSA is a secondary event in the cascade of neuronal degeneration rather than a primary cause. This review summarizes the current knowledge of iron in MSA and gives evidence for perturbed iron homeostasis as a potential pathogenic factor in MSA-associated neurodegeneration.
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Affiliation(s)
| | | | - Sabine Eschlböck
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Nadia Stefanova
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Günter Weiss
- Department of Internal Medicine, Medical University of Innsbruck, Innsbruck, Austria
| | - Gregor K. Wenning
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
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23
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Glasmacher SA, Leigh PN, Saha RA. Predictors of survival in progressive supranuclear palsy and multiple system atrophy: a systematic review and meta-analysis. J Neurol Neurosurg Psychiatry 2017; 88:402-411. [PMID: 28250027 DOI: 10.1136/jnnp-2016-314956] [Citation(s) in RCA: 75] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2016] [Revised: 12/27/2016] [Accepted: 01/08/2017] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To undertake a systematic review and meta-analysis of studies that investigated prognostic factors and survival in patients with progressive supranuclear palsy (PSP) and multiple system atrophy (MSA). METHODS Publications of at least 10 patients with a likely or confirmed diagnosis of PSP or MSA were eligible for inclusion. Methodological quality was rated using a modified version of the Quality in Prognostic Studies tool. For frequently examined prognostic factors, HRs derived by univariate and multivariate analysis were pooled in separate subgroups; other results were synthesised narratively and HRs could not be reported here. RESULTS Thirty-seven studies presenting findings on 6193 patients (1911 PSP, 4282 MSA) fulfilled the inclusion criteria. We identified the following variables as unfavourable predictors of survival. In PSP, PSP-Richardson's phenotype (univariate HR 2.53; 95% CI 1.69 to 3.78), early dysphagia and early cognitive symptoms. In MSA, severe dysautonomia and early development of combined autonomic and motor features but not MSA phenotype (multivariate HR 1.22; 95% CI 0.83 to 1.80).In PSP and MSA, survival was predicted by early falls (multivariate HR 2.32; 95% CI 1.94 to 2.77), the Neuroprotection and Natural History in Parkinson Plus Syndromes Parkinson Plus Score and the Clinical Global Impression Disease Severity Score but not sex (multivariate HR 0.93; 95% CI 0.67 to 1.28). There was conflicting evidence regarding the prognostic effect of age at onset and stridor. CONCLUSION Several clinical variables were strongly associated with shorter survival in PSP and MSA. Results on most prognostic factors were consistent across methodologically diverse studies; however, the lack of commonality of prognostic factors investigated is a significant limitation.
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Affiliation(s)
| | - Peter Nigel Leigh
- Department of Clinical Neuroscience, Brighton and Sussex Medical School, Brighton, UK
| | - Romi Anirban Saha
- Hurstwood Park Neurological Centre, Brighton and Sussex University Hospitals, Brighton, UK
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24
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Heller J, Brcina N, Dogan I, Holtbernd F, Romanzetti S, Schulz JB, Schiefer J, Reetz K. Brain imaging findings in idiopathic REM sleep behavior disorder (RBD) - A systematic review on potential biomarkers for neurodegeneration. Sleep Med Rev 2016; 34:23-33. [PMID: 27542516 DOI: 10.1016/j.smrv.2016.06.006] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Revised: 05/09/2016] [Accepted: 06/16/2016] [Indexed: 01/08/2023]
Abstract
Idiopathic rapid eye movement (REM) sleep behavior disorder (RBD) is a parasomnia characterized by the loss of physiological atonia of skeletal muscles with abnormal behavior during dream sleep. RBD may be the initial manifestation of neurodegenerative diseases, particularly of α-synucleinopathies such as Parkinson's disease (PD), dementia with Lewy bodies (DLB), and multiple system atrophy (MSA). However, gauging the individual risk of subsequent phenoconversion and making assumptions on the type of disease that may subsequently follow RBD is challenging. Over the past years, a growing number of studies have sought to establish reliable neuroimaging markers to detect neurodegenerative brain changes in RBD subjects at the earliest possible stage. The present review summarizes recent advances in brain imaging in RBD and provides recommendations for the application of currently available structural and functional neuroimaging modalities to monitor disease progression and risk of subsequent phenoconversion. Further imaging research applying multimodal approaches is encouraged to enhance accuracy of prognoses. Additionally, more longitudinal studies are warranted to validate findings from cross-sectional studies on RBD progression and risk of subsequent phenoconversion. Aside from enabling reliable prognoses on a single-subject-level in the near future, this might give further insight into RBD pathophysiology, and finally augment the development of intervention strategies and disease-modifying therapies.
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Affiliation(s)
- Julia Heller
- Department of Neurology, RWTH Aachen University, Pauwelsstraße 30, Aachen, Germany; JARA - Institute Molecular Neuroscience and Neuroimaging, Forschungszentrum Jülich GmbH, Jülich and RWTH Aachen University, Aachen, Germany
| | - Nikolina Brcina
- Department of Neurology, RWTH Aachen University, Pauwelsstraße 30, Aachen, Germany
| | - Imis Dogan
- Department of Neurology, RWTH Aachen University, Pauwelsstraße 30, Aachen, Germany; JARA - Institute Molecular Neuroscience and Neuroimaging, Forschungszentrum Jülich GmbH, Jülich and RWTH Aachen University, Aachen, Germany
| | - Florian Holtbernd
- Department of Neurology, RWTH Aachen University, Pauwelsstraße 30, Aachen, Germany
| | - Sandro Romanzetti
- Department of Neurology, RWTH Aachen University, Pauwelsstraße 30, Aachen, Germany; JARA - Institute Molecular Neuroscience and Neuroimaging, Forschungszentrum Jülich GmbH, Jülich and RWTH Aachen University, Aachen, Germany
| | - Jörg B Schulz
- Department of Neurology, RWTH Aachen University, Pauwelsstraße 30, Aachen, Germany; JARA - Institute Molecular Neuroscience and Neuroimaging, Forschungszentrum Jülich GmbH, Jülich and RWTH Aachen University, Aachen, Germany
| | - Johannes Schiefer
- Department of Neurology, RWTH Aachen University, Pauwelsstraße 30, Aachen, Germany
| | - Kathrin Reetz
- Department of Neurology, RWTH Aachen University, Pauwelsstraße 30, Aachen, Germany; JARA - Institute Molecular Neuroscience and Neuroimaging, Forschungszentrum Jülich GmbH, Jülich and RWTH Aachen University, Aachen, Germany.
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25
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Koo DL, Lee JY, Joo EY, Hong SB, Nam H. Acoustic Characteristics of Stridor in Multiple System Atrophy. PLoS One 2016; 11:e0153935. [PMID: 27093692 PMCID: PMC4836672 DOI: 10.1371/journal.pone.0153935] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Accepted: 04/06/2016] [Indexed: 11/18/2022] Open
Abstract
Nocturnal stridor is a breathing disorder prevalent in patients with multiple system atrophy (MSA). An improved understanding of this breathing disorder is essential since nocturnal stridor carries a poor prognosis (an increased risk of sudden death). In this study, we aimed to classify types of stridor by sound analysis and to reveal their clinical significance. Patients who met the criteria for probable MSA and had undergone polysomnography (PSG) were recruited. Patients were then assessed clinically with sleep questionnaires, including the Pittsburgh Sleep Quality Index, and the Hoehn and Yahr scale. Nocturnal stridor and snoring were analyzed with the Multi-Dimensional Voice Program. Nocturnal stridor was recorded in 22 patients and snoring in 18 patients using the PSG. Waveforms of stridors were classified into rhythmic or semirhythmic after analysis of the oscillogram. Formants and harmonics were observed in both types of stridor, but not in snoring. Of the 22 patients diagnosed with stridor during the present study, fifteen have subsequently died, with the time to death after the PSG study being 1.9 ± 1.4 years (range 0.8 to 5.0 years). The rhythmic waveform group presented higher scores on the Hoehn and Yahr scale and the survival outcome of this group was lower compared to the semirhythmic waveform group (p = 0.030, p = 0.014). In the Kaplan Meier's survival curve, the outcome of patients with rhythmic waveform was significantly less favorable than the outcome of patients with semirhythmic waveform (log-rank test, p < 0.001). Stridor in MSA can be classified into rhythmic and semirhythmic types and the rhythmic component signifies a poorer outcome.
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Affiliation(s)
- Dae Lim Koo
- Department of Neurology, Seoul National University Boramae Hospital, Seoul, South Korea
| | - Jee Young Lee
- Department of Neurology, Seoul National University Boramae Hospital, Seoul, South Korea
| | - Eun Yeon Joo
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Samsung Biomedical Research Institute, Seoul, South Korea
- Department of Health Sciences and Technology, SAIHST, Sungkyunkwan University, Seoul, South Korea
- * E-mail: (HWN); (EYJ)
| | - Seung Bong Hong
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Samsung Biomedical Research Institute, Seoul, South Korea
| | - Hyunwoo Nam
- Department of Neurology, Seoul National University Boramae Hospital, Seoul, South Korea
- * E-mail: (HWN); (EYJ)
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Affiliation(s)
- B Das
- Department of Neurology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - A Patil
- Department of Neurology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - M K Goyal
- Department of Neurology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - M Modi
- Department of Neurology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - V Lal
- Department of Neurology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - C Ahuja
- Department of Radiology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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27
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Baldarçara L, Currie S, Hadjivassiliou M, Hoggard N, Jack A, Jackowski AP, Mascalchi M, Parazzini C, Reetz K, Righini A, Schulz JB, Vella A, Webb SJ, Habas C. Consensus paper: radiological biomarkers of cerebellar diseases. THE CEREBELLUM 2015; 14:175-96. [PMID: 25382714 DOI: 10.1007/s12311-014-0610-3] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Hereditary and sporadic cerebellar ataxias represent a vast and still growing group of diseases whose diagnosis and differentiation cannot only rely on clinical evaluation. Brain imaging including magnetic resonance (MR) and nuclear medicine techniques allows for characterization of structural and functional abnormalities underlying symptomatic ataxias. These methods thus constitute a potential source of radiological biomarkers, which could be used to identify these diseases and differentiate subgroups of them, and to assess their severity and their evolution. Such biomarkers mainly comprise qualitative and quantitative data obtained from MR including proton spectroscopy, diffusion imaging, tractography, voxel-based morphometry, functional imaging during task execution or in a resting state, and from SPETC and PET with several radiotracers. In the current article, we aim to illustrate briefly some applications of these neuroimaging tools to evaluation of cerebellar disorders such as inherited cerebellar ataxia, fetal developmental malformations, and immune-mediated cerebellar diseases and of neurodegenerative or early-developing diseases, such as dementia and autism in which cerebellar involvement is an emerging feature. Although these radiological biomarkers appear promising and helpful to better understand ataxia-related anatomical and physiological impairments, to date, very few of them have turned out to be specific for a given ataxia with atrophy of the cerebellar system being the main and the most usual alteration being observed. Consequently, much remains to be done to establish sensitivity, specificity, and reproducibility of available MR and nuclear medicine features as diagnostic, progression and surrogate biomarkers in clinical routine.
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Structural and Functional Magnetic Resonance Imaging of the Cerebellum: Considerations for Assessing Cerebellar Ataxias. THE CEREBELLUM 2015; 15:21-25. [DOI: 10.1007/s12311-015-0738-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Ishibashi K, Nishina H, Ishiwata K, Ishii K. Individual time course of pre- and postsynaptic PET imaging may improve differential diagnosis of Parkinson's disease and multiple system atrophy: a case report. BMC Res Notes 2015; 8:496. [PMID: 26419749 PMCID: PMC4589095 DOI: 10.1186/s13104-015-1522-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2015] [Accepted: 09/21/2015] [Indexed: 11/26/2022] Open
Abstract
Background Many in vivo studies have shown a difference in pre- and/or postsynaptic imaging between Parkinson’s disease and multiple system atrophy; however, time course differences in pre- and postsynaptic imaging between Parkinson’s disease and multiple system atrophy have not been rigorously investigated. Case presentation We report serial positron emission tomography images of both dopamine transporters and dopamine D2 receptors, obtained from a Japanese patient with Parkinson’s disease who underwent positron emission tomography scanning at ages 71, 72, 74, and 75 years, and another Japanese patient with multiple system atrophy who underwent positron emission tomography scanning at ages 65, 66, and 67 years. Volumes-of-interest were placed on the striatal subregions. The percentage decreases between the first and last images showed that dopamine transporter availability decreased with disease progression in both patients, but that dopamine D2 receptor availability decreased only in the patient with multiple system atrophy. A partial correlation analysis between dopamine transporter and dopamine D2 receptor availability, controlling for the effects of striatal subregional differences, revealed a positive correlation in the patient with multiple system atrophy (r = 0.893, P = 0.0002), but no significant correlation in the patient with Parkinson’s disease (r = −0.036, P = 0.89). Conclusions The time course of pre- and postsynaptic imaging can be considerably different between Parkinson’s disease and multiple system atrophy, and may be useful in improving the accuracy of discrimination between Parkinson’s disease and multiple system atrophy.
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Affiliation(s)
- Kenji Ishibashi
- Research Team for Neuroimaging, Tokyo Metropolitan Institute of Gerontology, 35-2 Sakae-cho, Itabashi-ku, Tokyo, 173-0015, Japan.
| | - Hirofumi Nishina
- Department of Neurology, Tokyo Metropolitan Geriatric Hospital, Tokyo, 173-0015, Japan.
| | - Kiichi Ishiwata
- Research Team for Neuroimaging, Tokyo Metropolitan Institute of Gerontology, 35-2 Sakae-cho, Itabashi-ku, Tokyo, 173-0015, Japan.
| | - Kenji Ishii
- Research Team for Neuroimaging, Tokyo Metropolitan Institute of Gerontology, 35-2 Sakae-cho, Itabashi-ku, Tokyo, 173-0015, Japan.
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Coon EA, Sletten DM, Suarez MD, Mandrekar JN, Ahlskog JE, Bower JH, Matsumoto JY, Silber MH, Benarroch EE, Fealey RD, Sandroni P, Low PA, Singer W. Clinical features and autonomic testing predict survival in multiple system atrophy. Brain 2015; 138:3623-31. [PMID: 26369944 DOI: 10.1093/brain/awv274] [Citation(s) in RCA: 98] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Accepted: 07/26/2015] [Indexed: 11/12/2022] Open
Abstract
Multiple system atrophy is characterized by autonomic failure along with motor symptoms of parkinsonism and/or cerebellar ataxia. There are differing reports on the influence of certain clinical features, including motor subtype (multiple system atrophy-parkinsonism versus multiple system atrophy-cerebellar ataxia), age of onset, gender, and early autonomic symptoms, on the survival in patients with multiple system atrophy. We sought to evaluate overall survival and predictors of survival in a large cohort of patients with multiple system atrophy seen at a single referral centre where objective autonomic testing is routinely performed for this indication. All cases of multiple system atrophy evaluated at Mayo Clinic, Rochester and assessed with an autonomic reflex screen between January 1998 and December 2012 were retrospectively reviewed. A total of 685 patients were identified; 594 met criteria for probable multiple system atrophy, and 91 for possible multiple system atrophy. Multiple system atrophy-parkinsonism was the predominant subtype in 430 patients (63%). Average age of onset was earlier in multiple system atrophy-cerebellar ataxia (58.4 years) compared to multiple system atrophy-parkinsonism (62.3 years; P < 0.001). Median disease duration from symptom onset to death was 7.51 years (95% confidence interval 7.18-7.78) while time from diagnosis to death was 3.33 years (95% confidence interval 2.92-3.59). There was no difference in survival between motor subtypes of multiple system atrophy (P = 0.232). An initial motor symptom was most common (61%) followed by autonomic onset (28%) and combined motor and autonomic symptoms (11%). The initial onset of either motor or autonomic symptoms did not influence length of survival. However, a number of clinical and autonomic laboratory features predicted unfavourable survival in a univariate analysis. A multivariate model retained the following unfavourable predictors of survival: (i) falls within 3 years of onset (hazard ratio 2.31, P < 0.0001); (ii) bladder symptoms (hazard ratio 1.96, P < 0.0001); (iii) urinary catheterization within 3 years of symptom onset (hazard ratio 1.67, P < 0.003); (iv) orthostatic intolerance within 1 year of symptom onset (hazard ratio 1.28, P < 0.014); (v) older age of onset (hazard ratio 1.02, P = 0.001); and (vi) degree of autonomic failure as measured by a validated composite autonomic severity score (hazard ratio 1.07, P < 0.0023). We conclude that carefully selected clinical features can be used to predict survival in patients with multiple system atrophy. Autonomic testing adds an additional, independent predictor of survival, demonstrating its value not only in the diagnosis of multiple system atrophy but also as prognostic marker.
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Affiliation(s)
| | | | | | - Jay N Mandrekar
- 2 Department of Clinical Statistics, Mayo Clinic, Rochester, MN, USA
| | - J Eric Ahlskog
- 1 Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | - James H Bower
- 1 Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | | | | | | | | | - Paola Sandroni
- 1 Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | - Phillip A Low
- 1 Department of Neurology, Mayo Clinic, Rochester, MN, USA
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Schneeberger A, Tierney L, Mandler M. Active immunization therapies for Parkinson's disease and multiple system atrophy. Mov Disord 2015; 31:214-24. [PMID: 26260853 DOI: 10.1002/mds.26377] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Revised: 07/16/2015] [Accepted: 07/20/2015] [Indexed: 01/06/2023] Open
Abstract
Vaccination is increasingly being investigated as a potential treatment for synucleinopathies, a group of neurodegenerative diseases including Parkinson's disease, multiple system atrophy, and dementia with Lewy bodies associated with α-synuclein pathology. All lack a causal therapy. Development of novel, disease-altering treatment strategies is urgently needed. Vaccination has positioned itself as a prime strategy for addressing these diseases because it is broadly applicable, requires infrequent administration, and maintains low production costs for treating a large population or as a preventive measure. Current evidence points to a causal role of misfolded α-synuclein in the development and progression of synucleinopathies. In the past decade, significant progress in active immunization against α-synuclein has been shown both in preclinical animal models and in early clinical development. In this review, we describe the state-of-the-art in active immunization approaches to synucleinopathies, with a focus on advances in Parkinson's disease (PD) and multiple-system atrophy (MSA). We first review preclinical animal models, highlighting their progress in translation to the clinical setting. We then discuss current clinical applications, stressing different approaches taken to address α-synuclein pathology. Finally, we address challenges, trends, and future perspectives of current vaccination programs.
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Autonomic predominant multiple system atrophy in the context of Parkinsonian and cerebellar variants. Clin Neurol Neurosurg 2015; 130:110-3. [DOI: 10.1016/j.clineuro.2014.09.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2013] [Revised: 06/21/2014] [Accepted: 09/24/2014] [Indexed: 11/23/2022]
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Krismer F, Kuzdas D, Colosimo C, Stefanova N, Wenning GK. Animal Models of Multiple-System Atrophy. Mov Disord 2015. [DOI: 10.1016/b978-0-12-405195-9.00058-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Colloby SJ, O׳Brien JT, Taylor JP. Patterns of cerebellar volume loss in dementia with Lewy bodies and Alzheimer׳s disease: A VBM-DARTEL study. Psychiatry Res 2014; 223:187-91. [PMID: 25037902 PMCID: PMC4333903 DOI: 10.1016/j.pscychresns.2014.06.006] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2014] [Revised: 05/27/2014] [Accepted: 06/19/2014] [Indexed: 12/20/2022]
Abstract
Evidence suggests that the cerebellum contributes to cognition as well as motor function. We investigated cerebellar grey matter (GM) and white matter (WM) changes from magnetic resonance images in dementia with Lewy bodies (DLB), Alzheimer׳s disease (AD) and healthy older subjects using voxel-based morphometry (VBM). Subjects (39 controls, 41 DLB, and 48 AD) underwent magnetic resonance imaging as well as clinical and cognitive assessments. VBM used SPM8 with a cerebellar brain mask to define the subspace for voxel analysis. Statistical analyses were conducted using the general linear model. Relative to findings in controls, VBM analysis revealed cerebellar GM loss in lobule VI bilaterally in AD and in left Crus I and right Crus II regions in DLB. WM deficits were confined to AD in the bilateral middle cerebellar peduncles. DLB demonstrates a different pattern of cerebellar GM loss which, although not significantly different from that in AD, could be an important feature in understanding the neurobiology of DLB and warrants further investigation.
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Affiliation(s)
- Sean. J. Colloby
- Institute for Ageing and Health, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne NE4 5PL, UK,Corresponding author. Tel.: +44 191 208 1321; fax: +44 191 208 1301.
| | - John. T. O׳Brien
- Institute for Ageing and Health, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne NE4 5PL, UK,Department of Psychiatry, University of Cambridge, Cambridge CB2 0QC, UK
| | - John-Paul Taylor
- Institute for Ageing and Health, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne NE4 5PL, UK
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Figueroa JJ, Singer W, Parsaik A, Benarroch EE, Ahlskog JE, Fealey RD, Parisi JE, Sandroni P, Mandrekar J, Iodice V, Low PA, Bower JH. Multiple system atrophy: prognostic indicators of survival. Mov Disord 2014; 29:1151-7. [PMID: 24909319 DOI: 10.1002/mds.25927] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2014] [Revised: 04/24/2014] [Accepted: 05/04/2014] [Indexed: 12/19/2022] Open
Abstract
Neurological and autonomic presentation in multiple system atrophy (MSA) may predict early mortality. Quantification of early autonomic failure as a mortality predictor is lacking. Early neurological and autonomic clinical features were retrospectively reviewed in 49 MSA cases (median age at onset, 56.1 years; 16 women) confirmed by autopsy at Mayo Clinic. When available, the 10-point composite autonomic severity score derived from the autonomic reflex screen provided quantification of the degree of autonomic failure and thermoregulatory sweat test quantitated body surface anhidrosis. Symptoms at onset were autonomic in 50%, parkinsonian in 30%, and cerebellar in 20% of cases. Survival (median [95% confidence interval]) was 8.6 [6.7-10.2] years. Survival was shorter in patients with early laboratory evidence of generalized (composite autonomic severity score ≥ 6) autonomic failure (7.0 [3.9-9.8] vs. 9.8 [4.6-13.8] years; P = 0.036), and early requirement of bladder catheterization (7.3 [3.1-10.2] vs. 13.7 [8.5-14.9] years; P = 0.003) compared with those without these clinical features. On Cox proportional analysis, prognostic indicators of shorter survival were older age at onset (hazard ratio [95% confidence interval], 1.04 [1.01-1.08]; P = 0.03), early requirement of bladder catheterization (7.9 [1.88-38.63]; P = 0.004), and early generalized (composite autonomic severity score ≥ 6) autonomic failure (2.8 [1.01-9.26]; P = 0.047). Gender, phenotype, and early development of gait instability, aid-requiring ambulation, orthostatic symptoms, neurogenic bladder, or significant anhidrosis (thermoregulatory sweat test ≥ 40%) were not indicators of shorter survival. Our data suggest that early development of severe generalized autonomic failure more than triples the risk of shorter survival in patients with MSA.
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Affiliation(s)
- Juan J Figueroa
- Department of Neurology, Medical College of Wisconsin, Milwaukee, WI
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Jecmenica-Lukic M, Petrovic IN, Pekmezovic T, Kostic VS. Clinical outcomes of two main variants of progressive supranuclear palsy and multiple system atrophy: a prospective natural history study. J Neurol 2014; 261:1575-83. [PMID: 24888315 DOI: 10.1007/s00415-014-7384-x] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2014] [Revised: 04/22/2014] [Accepted: 05/15/2014] [Indexed: 01/31/2023]
Abstract
Progressive supranuclear palsy (PSP) and parkinsonian subtype of multiple system atrophy (MSA-P) are, after Parkinson's disease (PD), the most common forms of neurodegenerative parkinsonism. Clinical heterogeneity of PSP includes two main variants, Richardson syndrome (PSP-RS) and PSP-parkinsonism (PSP-P). Clinical differentiation between them may be impossible at least during the first 2 years of the disease. Little is known about the differences in natural course of PSP-RS and PSP-P and, therefore, in this study we prospectively followed the clinical outcomes of consecutive, pathologically unconfirmed patients with the clinical diagnoses of PSP-RS (51 patients), PSP-P (21 patients) and MSA-P (49 patients). Estimated mean survival time was 11.2 years for PSP-P, 6.8 years for PSP-RS, and 7.9 years for MSA-P, where a 5-year survival probabilities were 90, 66 and 78 %, respectively. More disabling course of PSP-RS compared to PSP-P was also highlighted through the higher number of milestones reached in the first 3 years of the disease, as well as in the trend to reach all clinical milestones earlier. We found that PSP-P variant had a more favorable course with longer survival, not only when compared to PSP-RS, but also when compared to another form of atypical parkinsonism, MSA-P.
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Affiliation(s)
- Milica Jecmenica-Lukic
- Clinic of Neurology, School of Medicine, University of Belgrade, Ul. Dr Subotića 6, 11000, Belgrade, Serbia,
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Pre- and postsynaptic dopamine SPECT in idiopathic Parkinsonian diseases: a follow-up study. BIOMED RESEARCH INTERNATIONAL 2013; 2013:143532. [PMID: 24163811 PMCID: PMC3791645 DOI: 10.1155/2013/143532] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/17/2013] [Revised: 08/02/2013] [Accepted: 08/08/2013] [Indexed: 11/18/2022]
Abstract
We prospectively evaluated the diagnostic contribution of (123)I-FP-Cit (DAT) and (123)I-IBZM (IBZM) SPECT in 29 patients with Parkinson's disease (PD) (74.4 ± 4.2 years) and 28 patients with atypical parkinsonian diseases (APD) (74.3 ± 9.2 years). Twelve had multiple system atrophy (MSA) and 16 progressive supranuclear palsy (PSP). Sixteen age-matched healthy controls (HC) were included. DAT and IBZM SPECTs were made at baseline and after 1 year in all PD patients and in 20 (DAT) and 18 (IBZM) of the APD patients, and after 3 years in 22 (DAT) and 17 (IBZM) of the PD patients and in 10 (DAT) and 10 (IBZM) of the APD patients. The relative DAT uptake decrease was faster in PD and PSP than in HC and MSA. In PSP the DAT uptake was lower than in MSA after 1 year but not after 3 years. Baseline IBZM uptake was not significantly different between patients and HC or between PD and APD. One year after initiated dopaminergic treatment the mean IBZM uptake in the MSA patients remained high compared to PSP and after 3 years compared to PD, PSP, and HC. Thus, the pattern of uptake of these ligands over time may be of value in discriminating between these diagnoses.
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Sinclair CF, Gurey LE, Brin MF, Stewart C, Blitzer A. Surgical management of airway dysfunction in Parkinson's disease compared with Parkinson-plus syndromes. Ann Otol Rhinol Laryngol 2013; 122:294-8. [PMID: 23815045 DOI: 10.1177/000348941312200502] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES We sought to compare the laryngeal symptoms of Parkinson's disease (PD) with those of multiple system atrophy (MSA), a Parkinson-plus syndrome; to review the differences in surgical management of upper airway dysfunction between patients with PD and those with MSA; and to present a treatment algorithm for management of upper airway disorders in patients with PD and MSA. METHODS We analyzed the airway manifestations of each disease, including clinical and physiological test results and management outcomes, in a case series of 30 patients (24 with PD and 6 with MSA). RESULTS Vocal fold atrophy causing bowing with a midfold glottic gap was common in patients with PD. One third of patients with PD underwent vocal fold augmentation with noticeable improvement in vocal volume and phonation time. Tracheostomy was required for life-threatening sleep apnea in 50% of the patients with MSA. Systemic medications and speech therapy were integral components of the management regimen. CONCLUSIONS Surgical management of laryngeal disorders in patients with PD should focus on restoring bulk to atrophic vocal folds to minimize glottic gaps, thus improving vocalization efficiency even in the presence of impaired respiratory effort. Conversely, the autonomic dysfunction that characterizes MSA results in upper airway obstruction, and thus surgical management focuses primarily on maintaining an adequate airway, which frequently necessitates tracheostomy.
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Affiliation(s)
- Catherine F Sinclair
- New York Center for Voice and Swallowing Disorders, St Luke's Roosevelt Medical Center, New York, NY 10019, USA
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Wenning GK, Geser F, Krismer F, Seppi K, Duerr S, Boesch S, Köllensperger M, Goebel G, Pfeiffer KP, Barone P, Pellecchia MT, Quinn NP, Koukouni V, Fowler CJ, Schrag A, Mathias CJ, Giladi N, Gurevich T, Dupont E, Ostergaard K, Nilsson CF, Widner H, Oertel W, Eggert KM, Albanese A, del Sorbo F, Tolosa E, Cardozo A, Deuschl G, Hellriegel H, Klockgether T, Dodel R, Sampaio C, Coelho M, Djaldetti R, Melamed E, Gasser T, Kamm C, Meco G, Colosimo C, Rascol O, Meissner WG, Tison F, Poewe W. The natural history of multiple system atrophy: a prospective European cohort study. Lancet Neurol 2013; 12:264-74. [PMID: 23391524 PMCID: PMC3581815 DOI: 10.1016/s1474-4422(12)70327-7] [Citation(s) in RCA: 350] [Impact Index Per Article: 31.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND Multiple system atrophy (MSA) is a fatal and still poorly understood degenerative movement disorder that is characterised by autonomic failure, cerebellar ataxia, and parkinsonism in various combinations. Here we present the final analysis of a prospective multicentre study by the European MSA Study Group to investigate the natural history of MSA. METHODS Patients with a clinical diagnosis of MSA were recruited and followed up clinically for 2 years. Vital status was ascertained 2 years after study completion. Disease progression was assessed using the unified MSA rating scale (UMSARS), a disease-specific questionnaire that enables the semiquantitative rating of autonomic and motor impairment in patients with MSA. Additional rating methods were applied to grade global disease severity, autonomic symptoms, and quality of life. Survival was calculated using a Kaplan-Meier analysis and predictors were identified in a Cox regression model. Group differences were analysed by parametric tests and non-parametric tests as appropriate. Sample size estimates were calculated using a paired two-group t test. FINDINGS 141 patients with moderately severe disease fulfilled the consensus criteria for MSA. Mean age at symptom onset was 56·2 (SD 8·4) years. Median survival from symptom onset as determined by Kaplan-Meier analysis was 9·8 years (95% CI 8·1-11·4). The parkinsonian variant of MSA (hazard ratio [HR] 2·08, 95% CI 1·09-3·97; p=0·026) and incomplete bladder emptying (HR 2·10, 1·02-4·30; p=0·044) predicted shorter survival. 24-month progression rates of UMSARS activities of daily living, motor examination, and total scores were 49% (9·4 [SD 5·9]), 74% (12·9 [8·5]), and 57% (21·9 [11·9]), respectively, relative to baseline scores. Autonomic symptom scores progressed throughout the follow-up. Shorter symptom duration at baseline (OR 0·68, 0·5-0·9; p=0·006) and absent levodopa response (OR 3·4, 1·1-10·2; p=0·03) predicted rapid UMSARS progression. Sample size estimation showed that an interventional trial with 258 patients (129 per group) would be able to detect a 30% effect size in 1-year UMSARS motor examination decline rates at 80% power. INTERPRETATION Our prospective dataset provides new insights into the evolution of MSA based on a follow-up period that exceeds that of previous studies. It also represents a useful resource for patient counselling and planning of multicentre trials.
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Affiliation(s)
- Gregor K Wenning
- Department of Neurology, Innsbruck Medical University, Innsbruck, Austria.
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Brain monoamine systems in multiple system atrophy: a positron emission tomography study. Neurobiol Dis 2012; 46:130-6. [PMID: 22266105 DOI: 10.1016/j.nbd.2011.12.053] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2011] [Revised: 11/21/2011] [Accepted: 12/31/2011] [Indexed: 11/22/2022] Open
Abstract
Post-mortem studies of multiple system atrophy (MSA) patients have shown widespread subcortical neurodegeneration. In this study, we have used 18F-dopa PET, a marker of monoaminergic nerve terminal function, to explore in vivo changes in striatal and extrastriatal dopamine, noradrenaline, and serotonin transmission for a cohort of patients with MSA with predominant parkinsonism. Fourteen patients with MSA, ten patients with idiopathic Parkinson's disease (PD) matched for disease duration, and ten healthy controls were studied with 18F-dopa PET. Regions of interest (ROIs) were placed to sample 18F-dopa uptake in thirteen structures and mean activity was compared between groups. The MSA patients showed significantly decreased 18F-dopa uptake in putamen, caudate nucleus, ventral striatum, globus pallidus externa and red nucleus compared to controls, whereas PD patients only had decreased 18F-dopa uptake in putamen, caudate nucleus, and ventral striatum. MSA cases with orthostatic hypotension had lower 18F-dopa uptake in the locus coeruleus than patients without this symptom. In conclusion, 18F-dopa PET showed more widespread basal ganglia dysfunction in MSA than in PD with similar disease duration, and extrastriatal loss of monoaminergic innervation could be detected in the red nucleus and locus coeruleus. In contrast to PD, there was no evidence of early compensatory increases in regional 18F-dopa uptake.
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Mascalchi M, Vella A. Magnetic resonance and nuclear medicine imaging in ataxias. HANDBOOK OF CLINICAL NEUROLOGY 2012; 103:85-110. [PMID: 21827882 DOI: 10.1016/b978-0-444-51892-7.00004-8] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Imaging techniques including computed tomography (CT), magnetic resonance imaging (MRI), single photon emission computed tomography (SPECT), and positron emission tomography (PET) have been widely applied to the investigation of patients with acute or chronic ataxias. Fundamentally, CT has a role in the emergency evaluation of the patient with acute ataxia to ascertain brainstem or cerebellar hemorrhage and to exclude a mass lesion in the posterior cranial fossa. Conventional MRI is the most frequently performed imaging investigation in patients with ataxia. It can support the diagnosis of acute cerebellitis and Wernicke encephalopathy by revealing T2 signal changes with a typical distribution. In patients with inherited or sporadic chronic ataxia it reveals three fundamental patterns of atrophy of the brainstem, cerebellum, and spinal cord which match the gross neuropathological descriptions. These are represented by olivopontocerebellar atrophy (OPCA), cortical cerebellar atrophy (CCA), and spinal atrophy (SA). A substantial correspondence exists among these patterns of atrophy shown by MRI and the etiological classification of inherited or acquired chronic ataxias. This, along with demonstration of T2 signal changes characteristic of some diseases, makes conventional MRI potentially useful for the diagnostic work-up of the single patient, especially in the case of a sporadic disease. Non-conventional MR techniques including diffusion MR, spectroscopy, and functional MR have been used in patients with acute or chronic ataxia, but their exact role in the evaluation of the single patient is not established yet. They are currently investigated as potential tools to monitor progression of neurodegeneration in chronic ataxia and to serve as "surrogate markers" in clinical trials. Several radiotracers have been utilized in combination with SPECT and PET in patients with ataxia. Perfusion SPECT can reveal cerebellar blood flow abnormalities early in the course of cerebellitis. It has also been utilized to investigate perfusion of the brain in several inherited or sporadic chronic ataxic diseases, contributing to improved understanding of the pathophysiology of these conditions. Recently, perfusion SPECT has been tested as a "surrogate marker" to verify the effects of newly developed therapies in patients with a variety of chronic ataxias. Whole-body FDG-PET is recommended in patients with suspected paraneoplastic cerebellar degeneration to detect the primary malignancy. Brain FDG-PET has provided important information on the pathophysiology of several acquired and inherited conditions. PET and SPECT with radiotracers able to assess the nigrostriatal system or the density of D2 dopamine receptors in the striatum are increasingly used in patients with adult-onset sporadic ataxia for the differential diagnosis between multiple system atrophy in which overt striatal abnormalities are found and idiopathic late-onset cerebellar ataxia in which no abnormality is detected.
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Affiliation(s)
- Mario Mascalchi
- Radiodiagnostic Section, Department of Clinical Physiopathology, University of Florence, Italy.
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Abstract
Sporadic adult-onset ataxia of unknown etiology (SAOA) denotes the non-hereditary degenerative adult-onset ataxia disorders that are distinct from multiple system atrophy (MSA). Rather than being a defined disease entity, SAOA has to be regarded as a group of disorders of unknown etiology that are defined by a common clinical syndrome and the exclusion of known disease causes. Epidemiological studies have revealed prevalence rates ranging from 2.2 to 8.4 per 100000, which are higher than those of hereditary ataxias. Clinically, SAOA is characterized by a slowly progressive cerebellar syndrome starting around the age of 50 years. About one-third of SAOA patients have either polyneuropathy or pyramidal tract involvement accompanying cerebellar ataxia. Cognitive impairment is not the rule, and, if present, is only mild. More than half of SAOA patients have signs of mild autonomic dysfunction that do not meet the criteria of severe autonomic failure required for a diagnosis of MSA. Neuropathological and imaging studies show an isolated cerebellar cortical degeneration with no or only mild brainstem involvement. There is no established therapy for SAOA.
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Wang Y, Butros SR, Shuai X, Dai Y, Chen C, Liu M, Haacke EM, Hu J, Xu H. Different iron-deposition patterns of multiple system atrophy with predominant parkinsonism and idiopathetic Parkinson diseases demonstrated by phase-corrected susceptibility-weighted imaging. AJNR Am J Neuroradiol 2011; 33:266-73. [PMID: 22051807 DOI: 10.3174/ajnr.a2765] [Citation(s) in RCA: 108] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND AND PURPOSE MSA-P and IPD have similar clinical presentations that may complicate accurate clinical diagnosis. Different iron-deposition patterns of those 2 diseases have been demonstrated in histopathology. The aim was to demonstrate the different iron-deposition patterns of MSA-P and IPD by using SWI phase images. MATERIALS AND METHODS Sixteen patients with IPD, 8 with MSA-P, and 44 age-matched healthy controls underwent SWI of brain. The different phase shifts as well as the high iron percentage of the area in several gray nuclei were statistically evaluated. The putamen was divided into 4 subregions for further analysis. RESULTS Patients with MSA-P had significantly higher iron deposition in the putamen and PT compared with those with IPD (P < .05). Moreover, ROC curves indicated slightly more sensitivity in differentiating MSA-P from IPD, by means of the high-iron-deposition-percentage area than the average phase shift (putamen: AUC = 0.88 versus 0.78; PT: AUC = 0.79 versus 0.62). Moreover, the lower inner region of the putamen was the most valuable subregion in differentiating MSA-P from IPD among the 4 subregions (AUC = 0.92 and 0.91 for high-iron-percentage area and average phase shift, respectively). CONCLUSIONS Higher iron deposition in the putamen and PT may differentiate MSA-P from IPD, but the lower inner region of the putamen may be better compared with the PT and other subregions of the putamen. Moreover, the high iron percentage makes it possible to detect smaller increases in iron content more confidently in comparison with average phase shift.
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Affiliation(s)
- Y Wang
- Department of Radiology, Union Hospital, Wuhan, China
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[Functional assessment of nigro-striatal pathway with FP-CIT in patients with multiple system atrophy subtype C]. Med Clin (Barc) 2011; 137:440-3. [PMID: 21396668 DOI: 10.1016/j.medcli.2010.11.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2010] [Revised: 11/10/2010] [Accepted: 11/11/2010] [Indexed: 11/21/2022]
Abstract
BACKGROUND AND OBJECTIVE To assess the functional state of nigro-striatal pathway using FP-CIT-I-123 in patients with clinical diagnosis of Multiple System Atrophy (MSA) subtype C. PATIENTS AND METHODS We included 10 patients with a clinical diagnosis of MSA-C and compared them with 10 patients diagnosed with essential tremor (controls) and 10 with Parkinson Disease (PD). The studies are evaluated by the striatum/occipital index (S/O). We calculated the diagnostic validity of the procedure by ROC curve analysis. RESULTS The average value of the S/O index showed a mean of 1.48 (0.23), 1.59 (0.17) and 1.22 (0.16) respectively for MSA-C, control group (p=0.25) and PD (p=0.00). ROC curve analysis: Az: 0.650; sensitivity: 0.50; specificity: 0.80. The comparison between the results of FP-CIT and clinical manifestations showed: 4 patients with parkinsonism (PK) and pathological study; 4 without PK and normal study; 1 with PK and normal study and 1 without PK and pathological study. CONCLUSIONS FP-CIT study does not exclude completely the existence of an MSA-C. From a functional point of view, there does not always seem to be a consistency between the state of the nigro-striatal pathway and the existence of parkinsonism.
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Minnerop M, Lüders E, Specht K, Ruhlmann J, Schimke N, Thompson PM, Chou YY, Toga AW, Abele M, Wüllner U, Klockgether T. Callosal tissue loss in multiple system atrophy--a one-year follow-up study. Mov Disord 2011; 25:2613-20. [PMID: 20623690 DOI: 10.1002/mds.23318] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Multiple system atrophy (MSA) is a neurodegenerative disease not only affecting the basal ganglia, brainstem, cerebellum, and intermediolateral cell columns of the spinal cord but also the cerebral cortex. Clinically, cerebellar (MSA-C) and parkinsonian variants of MSA (MSA-P) are distinguished. We investigated 14 MSA patients (10 MSA-C, 4 MSA-P, men: 7, women: 7; age: 61.1 ± 3.3 years) and 14 matched controls (men: 7, women: 7; age: 58.6 ± 5.1 years) with voxel-based morphometry (VBM) to analyze gray and white matter differences both at baseline and at follow-up, 1 year later. Baseline comparisons between patients and controls confirmed significantly less gray matter in MSA in the cerebellum and cerebral cortex, and significantly less white matter in the cerebellar peduncles and brainstem. Comparisons of tissue-loss profiles (i.e., baseline versus follow-up) between patients and controls, revealed white matter reduction in MSA along the middle cerebellar peduncles, reflecting degeneration of the ponto-cerebellar tract as a particularly prominent and progressive morphological alteration in MSA. Comparisons between baseline and follow-up, separately performed in patients and controls, revealed additional white matter reduction in MSA along the corpus callosum at follow-up. This was replicated through additional shape-based analyses indicating a reduced callosal thickness in the anterior and posterior midbody, extending posteriorly into the isthmus. Callosal atrophy may possibly reflect a disease-specific pattern of neurodegeneration and cortical atrophy, fitting well with the predominant impairment of motor functions in the MSA patients.
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Affiliation(s)
- Martina Minnerop
- Institute of Neurosciences and Medicine-1, Research Centre Jülich, Jülich, Germany.
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Kim HJ, Jeon BS, Lee JY, Yun JY. Survival of Korean patients with multiple system atrophy. Mov Disord 2011; 26:909-12. [PMID: 21287601 DOI: 10.1002/mds.23580] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2010] [Revised: 10/19/2010] [Accepted: 11/16/2010] [Indexed: 11/08/2022] Open
Abstract
METHODS We conducted a retrospective medical record review to determine the survival of 455 Korean multiple system atrophy (MSA) patients and examined the effect of clinical factors that could possibly influence survival. The patients comprised 222 men and 233 women. RESULTS Age at onset was 60.1 ± 8.8 years (mean ± SD) and did not differ between the sexes. Parkinsonism was the most prevalent initial symptom, followed by cerebellar dysfunction and dysautonomia. Age at onset was significantly older in patients with predominant parkinsonism at the last visit (MSA-P) than in the other patients. At the time of data collection, 107 patients had died. Median survival time was 10 years. The survival rate of women was slightly better than that of men, especially in MSA-P patients. CONCLUSIONS Survival was not affected by age at onset, initial symptom, or predominant symptom at the last visit or by the presence of autonomic symptoms or multiple symptoms at disease onset.
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Affiliation(s)
- Han-Joon Kim
- Departments of Neurology and Movement Disorder Center and Neuroscience Research Institute, BK21, College of Medicine, Seoul National University, Seoul, Korea
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Durif F, Albuisson E, Debilly B, Bas J, Pollak P. Comparison of cerebral atrophy evaluated by MRI in Parkinson's disease and multiple system atrophy. Eur J Neurol 2011. [DOI: 10.1111/j.1468-1331.1996.tb00244.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Watanabe H, Ito M, Fukatsu H, Senda J, Atsuta N, Kaga T, Kato S, Katsuno M, Tanaka F, Hirayama M, Naganawa S, Sobue G. Putaminal magnetic resonance imaging features at various magnetic field strengths in multiple system atrophy. Mov Disord 2010; 25:1916-23. [PMID: 20623769 DOI: 10.1002/mds.23196] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
We delineated the effects of magnetic field strength on signal intensities to facilitate the specific findings of multiple system atrophy (MSA). Fifteen patients with probable MSA were imaged by 0.35T fast spin-echo (FSE), 1.5T FSE, and 3.0T FSE using a consistent protocol, testing all field strengths on the same day. Sixty patients with probable Parkinson's disease (PD) also underwent imaging. Moderate or marked hyperintensity at the dorsolateral outer putaminal margin, hyperintensity of the putaminal body, hypointensity relative to the globus pallidus at the dorsolateral putaminal margin, and infratentorial signal changes were evaluated as specific findings for MSA. As the field strength increased, the occurrence of hyperintensity both at the dorsolateral outer putaminal margin and of the putaminal body decreased, while the occurrence of hypointensity at the dorsolateral putaminal margin increased in MSA. The occurrence of uniform mild hyperintensity of the outer putaminal margin was evident in 7% at 0.35T, 40% at 1.5T, and 47% at 3.0T in MSA and in 5% at 0.35T, 60% at 1.5T, and 75% at 3.0T in PD. However, no PD patients showed hyperintensity at the dorsolateral outer putaminal margin and that of the putaminal body. Putaminal magnetic resonance imaging (MRI) findings in MSA were altered considerably by magnetic field strength. The severity and distribution of signal changes are important for assessing putaminal MRI findings in MSA.
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Affiliation(s)
- Hirohisa Watanabe
- Department of Neurology, Nagoya University Graduate School of Medicine, Nagoya, Japan
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Van Laere K, Clerinx K, D'Hondt E, de Groot T, Vandenberghe W. Combined striatal binding and cerebral influx analysis of dynamic 11C-raclopride PET improves early differentiation between multiple-system atrophy and Parkinson disease. J Nucl Med 2010; 51:588-95. [PMID: 20237023 DOI: 10.2967/jnumed.109.070144] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
UNLABELLED Striatal dopamine D(2) receptor (D2R) PET has been proposed to differentiate between Parkinson disease (PD) and multiple-system atrophy with predominant parkinsonism (MSA-P). However, considerable overlap in striatal D(2) binding may exist between PD and MSA-P. It has been shown that imaging of neuronal activity, as determined by metabolism or perfusion, can also help distinguish PD from MSA-P. We investigated whether the differential diagnostic value of (11)C-raclopride PET could be improved by dynamic scan analysis combining D2R binding and regional tracer influx. METHODS (11)C-raclopride PET was performed in 9 MSA-P patients (mean age +/- SD, 56.2 +/- 10.2 y; disease duration, 2.9 +/- 0.8 y; median Hoehn-Yahr score, 3), 10 PD patients (mean age +/- SD, 65.7 +/- 8.1 y; disease duration, 3.3 +/- 1.5 y; median Hoehn-Yahr score, 1.5), and 10 healthy controls (mean age +/- SD, 61.6 +/- 6.5 y). Diagnosis was obtained after prolonged follow-up (MSA-P, 5.5 +/- 2.0 y; PD, 6.0 +/- 2.3 y) using validated clinical criteria. Spatially normalized parametric images of binding potential (BP) and local influx ratio (R(1) = K(1)/K'(1)) of (11)C-raclopride were obtained using a voxelwise reference tissue model with occipital cortex as reference region. Stepwise forward discriminant analysis with cross-validation, with and without the inclusion of regional R(1) values, was performed using a predefined volume-of-interest template. RESULTS Using conventional BP values, we correctly classified 65.5% (all values given with cross-validation) of 29 cases only. The combination of BP and R(1) information increased discrimination accuracy to 79.3%. When healthy controls were not included and patients only were considered, BP information alone discriminated PD and MSA-P in 84.2% of cases, but the combination with R(1) data increased accuracy to 100%. CONCLUSION Discriminant analysis using combined striatal D2R BP and cerebral influx ratio information of a single dynamic (11)C-raclopride PET scan distinguishes MSA-P and PD patients with high accuracy and is superior to conventional methods of striatal D2R binding analysis.
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Affiliation(s)
- Koen Van Laere
- Division of Nuclear Medicine, Leuven University Hospital and Katholieke Universiteit Leuven, Leuven, Belgium.
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