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Bologna M, Truong D, Jankovic J. The etiopathogenetic and pathophysiological spectrum of parkinsonism. J Neurol Sci 2021; 433:120012. [PMID: 34642022 DOI: 10.1016/j.jns.2021.120012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 09/05/2021] [Accepted: 09/29/2021] [Indexed: 12/12/2022]
Abstract
Parkinsonism is a syndrome characterized by bradykinesia, rigidity, and tremor. Parkinsonism is a common manifestation of Parkinson's disease and other neurodegenerative diseases referred to as atypical parkinsonism. However, a growing body of clinical and scientific evidence indicates that parkinsonism may be part of the phenomenological spectrum of various neurological conditions to a greater degree than expected by chance. These include neurodegenerative conditions not traditionally classified as movement disorders, e.g., dementia and motor neuron diseases. In addition, parkinsonism may characterize a wide range of central nervous system diseases, e.g., autoimmune diseases, infectious diseases, cerebrospinal fluid disorders (e.g., normal pressure hydrocephalus), cerebrovascular diseases, and other conditions. Several pathophysiological mechanisms have been identified in Parkinson's disease and atypical parkinsonism. Conversely, it is not entirely clear to what extent the same mechanisms and key brain areas are also involved in parkinsonism due to a broader etiopathogenetic spectrum. We aimed to provide a comprehensive and up-to-date overview of the various etiopathogenetic and pathophysiological mechanisms of parkinsonism in a wide spectrum of neurological conditions, with a particular focus on the role of the basal ganglia involvement. The paper also highlights potential implications in the diagnostic approach and therapeutic management of patients. This article is part of the Special Issue "Parkinsonism across the spectrum of movement disorders and beyond" edited by Joseph Jankovic, Daniel D. Truong and Matteo Bologna.
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Affiliation(s)
- Matteo Bologna
- Department of Human Neurosciences, Sapienza University of Rome, Italy; IRCCS Neuromed, Pozzilli, IS, Italy.
| | - Daniel Truong
- Truong Neuroscience Institute, Orange Coast Memorial Medical Center, Fountain Valley, CA, USA; Department of Neurosciences, UC Riverside, Riverside, CA, USA
| | - Joseph Jankovic
- Parkinson's Disease Center and Movement Disorders Clinic, Department of Neurology, Baylor College of Medicine, Houston, TX, USA
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Moreno-Gambín MI, Tembl JI, Mazón M, Cañada-Martínez AJ, Martí-Bonmatí L, Sevilla T, Vázquez-Costa JF. Role of the nigrosome 1 absence as a biomarker in amyotrophic lateral sclerosis. J Neurol 2021; 269:1631-1640. [PMID: 34379200 PMCID: PMC8857168 DOI: 10.1007/s00415-021-10729-w] [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: 04/29/2021] [Revised: 07/19/2021] [Accepted: 07/26/2021] [Indexed: 10/26/2022]
Abstract
INTRODUCTION The absence of nigrosome 1 on brain MRI and the hyperechogenicity of substantia nigra (SNh) by transcranial sonography are two useful biomarkers in the diagnosis of parkinsonisms. We aimed to evaluate the absence of nigrosome 1 in amyotrophic lateral sclerosis (ALS) and to address its meaning. METHODS 136 ALS patients were recruited, including 16 progressive muscular atrophy (PMA) and 22 primary lateral sclerosis (PLS) patients. The SNh area was measured planimetrically by standard protocols. The nigrosome 1 status was qualitatively assessed by two blind evaluators in susceptibility weight images of 3T MRI. Demographic and clinical data were collected and the C9ORF72 expansion was tested in all patients. RESULTS Nigrosome 1 was absent in 30% of ALS patients (36% of PLS, 29% of classical ALS and 19% of PMA patients). There was no relationship between radiological and clinical laterality, nor between nigrosome 1 and SNh area. Male sex (OR = 3.63 [1.51, 9.38], p = 0.005) and a higher upper motor neuron (UMN) score (OR = 1.10 [1.02, 1.2], p = 0.022) were independently associated to nigrosome 1 absence, which also was an independent marker of poor survival (HR = 1.79 [1.3, 2.8], p = 0.013). CONCLUSION In ALS patients, the absence of nigrosome 1 is associated with male sex, UMN impairment and shorter survival. This suggests that constitutional factors and the degree of pyramidal involvement are related to the substantia nigra involvement in ALS. Thus, nigrosome 1 could be a marker of a multisystem degeneration, which in turn associates to poor prognosis.
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Affiliation(s)
- María Isabel Moreno-Gambín
- Neurosonology Laboratory, Department of Neurology, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - José I Tembl
- Neurosonology Laboratory, Department of Neurology, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Miguel Mazón
- Radiology and Biomedical Imaging Research Group (GIBI230), Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | | | - Luis Martí-Bonmatí
- Radiology and Biomedical Imaging Research Group (GIBI230), Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Teresa Sevilla
- ALS Unit, Department of Neurology, Hospital Universitario y Politécnico La Fe, Valencia, Spain.,Neuromuscular Research Unit, Instituto de Investigación Sanitaria La Fe (IIS La Fe), Valencia, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Valencia, Spain.,Department of Medicine, University of Valencia, Valencia, Spain
| | - Juan F Vázquez-Costa
- ALS Unit, Department of Neurology, Hospital Universitario y Politécnico La Fe, Valencia, Spain. .,Neuromuscular Research Unit, Instituto de Investigación Sanitaria La Fe (IIS La Fe), Valencia, Spain. .,Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Valencia, Spain. .,Department of Medicine, University of Valencia, Valencia, Spain.
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Günther R, Schrempf W, Hähner A, Hummel T, Wolz M, Storch A, Hermann A. Impairment in Respiratory Function Contributes to Olfactory Impairment in Amyotrophic Lateral Sclerosis. Front Neurol 2018. [PMID: 29535673 PMCID: PMC5834512 DOI: 10.3389/fneur.2018.00079] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Background Nonmotor symptoms are very common in neurodegenerative diseases. In patients suffering from amyotrophic lateral sclerosis (ALS), olfactory dysfunction was first reported more than 20 years ago; however, its pathophysiological correlates and further implications remain elusive. Methods In this so far largest case-control study, we analyzed olfactory performance with the "Sniffin' Sticks," a validated olfactory testing kit used in clinical routine. This test kit was designed to investigate different qualities of olfaction including odor threshold, odor discrimination, and odor identification. Results ALS patients were mildly but significantly impaired in TDI score, the composite of the three subtests (ALS 27.7 ± 7.9, Controls 32.3 ± 5.8). In contrast to Parkinson's disease, ALS patients did not show impaired performance in the suprathreshold tests identification and discrimination. However, the odor threshold was markedly decreased (ALS 6.0 ± 3.4, Controls 8.77 ± 3.6). This pattern of olfactory loss resembles sinonasal diseases, where olfactory dysfunction results from impeded odorant transmission to the olfactory cleft. The evaluation of medical history and clinical data of ALS patients showed that patients with perception of dyspnea (TDI 25.7 ± 8.0) performed significantly worse in olfactory testing compared to those who did not (TDI 30.0 ± 7.4). In line with that, we found that in patients with preserved respiratory function (vital capacity >70% of index value), olfactory performance did not differ from healthy controls. Conclusion These findings suggest that the mild impairment of olfaction in patients suffering from ALS should at least partly be considered as a consequence of impaired respiratory function, and odor threshold might be a marker of respiratory dysfunction in ALS.
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Affiliation(s)
- René Günther
- Division for Neurodegenerative Diseases, Department of Neurology, Technische Universität Dresden, Dresden, Germany.,German Center for Neurodegenerative Diseases (DZNE) Dresden, Dresden, Germany
| | - Wiebke Schrempf
- Division for Neurodegenerative Diseases, Department of Neurology, Technische Universität Dresden, Dresden, Germany
| | - Antje Hähner
- Smell & Taste Clinic, Department of Otorhinolaryngology, Technische Universität Dresden, Dresden, Germany
| | - Thomas Hummel
- Smell & Taste Clinic, Department of Otorhinolaryngology, Technische Universität Dresden, Dresden, Germany
| | - Martin Wolz
- Department of Neurology, Elblandkliniken Meissen, Meissen, Germany
| | - Alexander Storch
- German Center for Neurodegenerative Diseases (DZNE) Dresden, Dresden, Germany.,Department of Neurology, University of Rostock, Rostock, Germany.,German Center for Neurodegenerative Diseases (DZNE) Rostock, Rostock, Germany
| | - Andreas Hermann
- Division for Neurodegenerative Diseases, Department of Neurology, Technische Universität Dresden, Dresden, Germany.,German Center for Neurodegenerative Diseases (DZNE) Dresden, Dresden, Germany
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Vázquez-Costa JF, Tembl JI, Fornés-Ferrer V, Cardona F, Morales-Caba L, Fortea G, Pérez-Tur J, Sevilla T. Genetic and constitutional factors are major contributors to substantia nigra hyperechogenicity. Sci Rep 2017; 7:7119. [PMID: 28769074 PMCID: PMC5541052 DOI: 10.1038/s41598-017-07835-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Accepted: 06/30/2017] [Indexed: 12/22/2022] Open
Abstract
Hyperechogenicity of substantia nigra (SNh) is a frequent finding in amyotrophic lateral sclerosis (ALS), Parkinson’s disease (PD) and other movement disorders (MD) patients, but its meaning is unclear. To ascertain the contribution of different factors to SNh area, we measured it in 108 ALS, 102 PD, 91 other MD patients and 91 healthy controls. Demographical data were collected in all patients and controls. In ALS patients, we also recorded clinical variables, performed genetic analysis and measured baseline levels of ferritin. After family history and genetic testing, ALS patients were classified as familial (15) or sporadic (93). ALS, PD and other MD patients had a larger SNh area than controls. Left SNh and male gender, but not age, associated with larger SNh area in both patients and controls. Familial ALS patients showed larger SNh area than sporadic ones and familial ALS was the only clinical variable in the multivariate analysis to be associated with larger SNh area in ALS patients. Our results suggest that SNh associates with genetic and constitutional factors (male gender, handedness), some of which predispose to certain neurodegenerative diseases. This evidence supports the idea of SNh as an inborn marker of unspecific neuronal vulnerability.
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Affiliation(s)
- Juan F Vázquez-Costa
- Neuromuscular Research Unit, Instituto de Investigación Sanitaria la Fe (IIS La Fe), Valencia, Spain. .,ALS Unit, Department of Neurology, Hospital Universitario y Politécnico La Fe, Valencia, Spain. .,Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Valencia, Spain.
| | - José I Tembl
- Neurosonology Laboratory, Department of Neurology, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Victoria Fornés-Ferrer
- Biostatistics Unit, Instituto de Investigación Sanitaria la Fe (IIS La Fe), Valencia, Spain
| | - Fernando Cardona
- Laboratory of Molecular Genetics, Institut de Biomedicina de València-CSIC, Valencia, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Neurodegenerativas (CIBERNED), Valencia, Spain
| | - Lluis Morales-Caba
- Neurosonology Laboratory, Department of Neurology, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Gerardo Fortea
- Neurosonology Laboratory, Department of Neurology, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Jordi Pérez-Tur
- Laboratory of Molecular Genetics, Institut de Biomedicina de València-CSIC, Valencia, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Neurodegenerativas (CIBERNED), Valencia, Spain.,Unidad mixta de Neurología y Genética, Instituto de Investigación Sanitaria la Fe (IIS La Fe), Valencia, Spain
| | - Teresa Sevilla
- Neuromuscular Research Unit, Instituto de Investigación Sanitaria la Fe (IIS La Fe), Valencia, Spain.,ALS Unit, Department of Neurology, Hospital Universitario y Politécnico La Fe, Valencia, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Valencia, Spain.,Department of Medicine, University of Valencia, Valencia, Spain
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Günther R, Richter N, Sauerbier A, Chaudhuri KR, Martinez-Martin P, Storch A, Hermann A. Non-Motor Symptoms in Patients Suffering from Motor Neuron Diseases. Front Neurol 2016; 7:117. [PMID: 27504105 PMCID: PMC4958907 DOI: 10.3389/fneur.2016.00117] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Accepted: 07/06/2016] [Indexed: 11/13/2022] Open
Abstract
Background The recently postulated “disease spreading hypothesis” has gained much attention, especially for Parkinson’s disease (PD). The various non-motor symptoms (NMS) in neurodegenerative diseases would be much better explained by this hypothesis than by the degeneration of disease-specific cell populations. Motor neuron disease (MND) is primarily known as a group of diseases with a selective loss of motor function. However, recent evidence suggests disease spreading into non-motor brain regions also in MND. The aim of this study was to comprehensively detect NMS in patients suffering from MND. Methods We used a self-rating questionnaire including 30 different items of gastrointestinal, autonomic, neuropsychiatric, and sleep complaints [NMS questionnaire (NMSQuest)], which is an established tool in PD patients. 90 MND patients were included and compared to 96 controls. Results In total, MND patients reported significantly higher NMS scores (median: 7 points) in comparison to controls (median: 4 points). Dribbling, impaired taste/smelling, impaired swallowing, weight loss, loss of interest, sad/blues, falling, and insomnia were significantly more prevalent in MND patients compared to controls. Interestingly, excessive sweating was more reported in the MND group. Correlation analysis revealed an increase of total NMS score with disease progression. Conclusion NMS in MND patients seemed to increase with disease progression, which would fit with the recently postulated “disease spreading hypothesis.” The total NMS score in the MND group significantly exceeded the score for the control group, but only 8 of the 30 single complaints of the NMSQuest were significantly more often reported by MND patients. Dribbling, impaired swallowing, weight loss, and falling could primarily be connected to motor neuron degeneration and declared as motor symptoms in MND.
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Affiliation(s)
- René Günther
- Department of Neurology, Division for Neurodegenerative Diseases, Technische Universität Dresden , Dresden , Germany
| | - Nicole Richter
- Department of Neurology, Division for Neurodegenerative Diseases, Technische Universität Dresden , Dresden , Germany
| | - Anna Sauerbier
- Department of Basic and Clinical Neuroscience, The Maurice Wohl Clinical Neuroscience Institute, King's College London , London , UK
| | - Kallol Ray Chaudhuri
- Department of Basic and Clinical Neuroscience, The Maurice Wohl Clinical Neuroscience Institute, King's College London , London , UK
| | - Pablo Martinez-Martin
- National Center of Epidemiology and CIBERNED, Carlos III Institute of Health , Madrid , Spain
| | - Alexander Storch
- Department of Neurology, Division for Neurodegenerative Diseases, Technische Universität Dresden, Dresden, Germany; Department of Neurology, University of Rostock, Rostock, Germany; German Center for Neurodegenerative Diseases (DZNE) Dresden, Dresden, Germany
| | - Andreas Hermann
- Department of Neurology, Division for Neurodegenerative Diseases, Technische Universität Dresden, Dresden, Germany; German Center for Neurodegenerative Diseases (DZNE) Dresden, Dresden, Germany
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