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Moran CH, Pietrzyk M, Sarangmat N, Gerard CS, Barua N, Ashida R, Whone A, Szewczyk-Krolikowski K, Mooney L, Gill SS. Clinical Outcome of “Asleep” Deep Brain Stimulation for Parkinson Disease Using Robot-Assisted Delivery and Anatomic Targeting of the Subthalamic Nucleus: A Series of 152 Patients. Neurosurgery 2021. [DOI: 10.1093/neuros/nyaa367_s070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Baig F, Boca M, Mooney L, Cheminais L, Selikhova M, Rolinski M, Szewczyk-Krolikowski K, Collin N, Whone A. Per-oral image guided gastrojejunostomy insertion for levodopa-carbidopa intestinal gel in Parkinson's disease is safe and may be advantageous. Parkinsonism Relat Disord 2021; 89:34-37. [PMID: 34218045 DOI: 10.1016/j.parkreldis.2021.06.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 06/16/2021] [Accepted: 06/26/2021] [Indexed: 01/16/2023]
Abstract
BACKGROUND Procedural aspects and complications of gastrojejunostomy insertion are important considerations in the use of levodopa-carbidopa intestinal gel therapy (LCIG) and may limit uptake. We describe our experience of using per-oral image guided gastrojejunostomy (PIG-J) which avoids the need for endoscopy and routine sedation in percutaneous endoscopic gastrojejunostomy (PEG-J) and allows more secure tube placement than radiologically inserted gastrojejunostomy techniques. METHODS We describe a case series of 32 patients undergoing PIG-J insertion for LCIG therapy in a single centre. Under local anaesthetic, a fluoroscopy-guided gastric puncture allows access for the guidewire which is then used to pull through the gastrostomy tube allowing for secure fixation, followed by placement of the gastrojejunal extension. RESULTS Between December 2015 to April 2020, 32/34 patients referred for PIG-J underwent this procedure successfully, 2 cases unsuccessful due to technical considerations. One patient developed delirium following successful implantation. Ten patients (31%) required a replacement tube due to blockage or displacement within the first 12 months of placement, including 2 patients who needed more than one replacement. Minor complications occurred in 10 other patients (31%), including infection (9 patients); a small haematoma not requiring intervention who later developed an infection (1 patient); and peri-stomal acid leakage (1 patient). CONCLUSION In summary, PIG-J insertion is safe with a similar complication rate to traditional PEG-J, well tolerated and effective for use in LCIG administration. This may widen access to LCIG for PD patients who may not be suitable or unable to tolerate PEG-J.
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Affiliation(s)
- Fahd Baig
- North Bristol NHS Trust, Bristol, United Kingdom; St. George's University, London, United Kingdom; University of Bristol, Bristol, United Kingdom.
| | - Mihaela Boca
- North Bristol NHS Trust, Bristol, United Kingdom
| | - Lucy Mooney
- North Bristol NHS Trust, Bristol, United Kingdom
| | | | | | - Michal Rolinski
- North Bristol NHS Trust, Bristol, United Kingdom; University of Bristol, Bristol, United Kingdom
| | | | - Neil Collin
- North Bristol NHS Trust, Bristol, United Kingdom
| | - Alan Whone
- North Bristol NHS Trust, Bristol, United Kingdom; University of Bristol, Bristol, United Kingdom
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Moran CH, Pietrzyk M, Sarangmat N, Gerard CS, Barua N, Ashida R, Whone A, Szewczyk-Krolikowski K, Mooney L, Gill SS. Clinical Outcome of "Asleep" Deep Brain Stimulation for Parkinson Disease Using Robot-Assisted Delivery and Anatomic Targeting of the Subthalamic Nucleus: A Series of 152 Patients. Neurosurgery 2021; 88:165-173. [PMID: 32985669 DOI: 10.1093/neuros/nyaa367] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Accepted: 06/08/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Recent advances in methods used for deep brain stimulation (DBS) include subthalamic nucleus electrode implantation in the "asleep" patient without the traditional use of microelectrode recordings or intraoperative test stimulation. OBJECTIVE To examine the clinical outcome of patients who have undergone "asleep" DBS for the treatment of Parkinson disease using robot-assisted electrode delivery. METHODS This is a retrospective review of clinical outcomes of 152 consecutive patients. Their outcomes at 1 yr postimplantation are reported; these include Unified Parkinson's Disease Rating Scale (UPDRS) assessment, Tinetti Mobility Test, Parkinson's Disease Questionnaire (PDQ)-39 quality of life assessment, Mattis Dementia Rating Scale, Beck Depression Inventory, and Beck Anxiety. We also report on a new parietal trajectory for electrode implantation. RESULTS A total of 152 patients underwent assessment at 1 yr. UPDRS III improved from 39 to 20.5 (47%, P < .001). The total UPDRS score improved from 67.6 to 36.4 (46%, P < .001). UPDRS II scores improved from 18.9 to 10.5 (44%, P < .001) and UPDRS IV scores improved from 7.1 to 3.6 (49%, P < .001). There was a significant reduction in levodopa equivalent daily dose after surgery (mean: 35%, P < .001). PDQ-39 summary index improved by a mean of 7.1 points. There was no significant difference found in clinical outcomes between the frontal and parietal approaches. CONCLUSION "Asleep" robot-assisted DBS of the subthalamic nucleus demonstrates comparable outcomes with traditional techniques in the treatment of Parkinson disease.
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Affiliation(s)
- Catherine H Moran
- Department of Neurosurgery, Tallaght University Hospital, Dublin, Ireland
| | - Mariusz Pietrzyk
- Neurological Applications Division, Renishaw PlC, Wooton-under-Edge, United Kinrgdom
| | - Nagaraja Sarangmat
- Department of Neurology, North Bristol NHS Trust, Southmead Hospital, Bristol, United Kingdom
| | - Carter S Gerard
- Department of Neurosurgery, Swedish Medical Center, Seattle, Washington
| | - Neil Barua
- Department of Neurosurgery, North Bristol NHS Trust, Southmead Hospital, Bristol, United Kingdom
| | - Reiko Ashida
- Department of Neurosurgery, North Bristol NHS Trust, Southmead Hospital, Bristol, United Kingdom
| | - Alan Whone
- Department of Neurology, North Bristol NHS Trust, Southmead Hospital, Bristol, United Kingdom
| | | | - Lucy Mooney
- Department of Neurology, North Bristol NHS Trust, Southmead Hospital, Bristol, United Kingdom
| | - Steven S Gill
- Department of Neurosurgery, North Bristol NHS Trust, Southmead Hospital, Bristol, United Kingdom
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Thompson A, Morgan C, Smith P, Jones C, Ball H, Coulthard EJ, Moran E, Szewczyk-Krolikowski K, Rice CM. Cerebral venous sinus thrombosis associated with COVID-19. Pract Neurol 2020:practneurol-2020-002678. [PMID: 33033161 DOI: 10.1136/practneurol-2020-002678] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/15/2020] [Indexed: 11/04/2022]
Affiliation(s)
- Ameeka Thompson
- Department of Infectious Disease, North Bristol NHS Trust, Bristol, UK
| | - Catherine Morgan
- Department of Neurology, North Bristol NHS Trust, Bristol, UK
- Clinical Neurosciences, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Paul Smith
- Department of Neuroradiology, North Bristol NHS Trust, Bristol, UK
| | - Christopher Jones
- Department of Infectious Disease, North Bristol NHS Trust, Bristol, UK
| | - Harriet Ball
- Department of Neurology, North Bristol NHS Trust, Bristol, UK
- Clinical Neurosciences, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Elizabeth J Coulthard
- Department of Neurology, North Bristol NHS Trust, Bristol, UK
- Clinical Neurosciences, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Ed Moran
- Department of Infectious Disease, North Bristol NHS Trust, Bristol, UK
| | | | - Claire M Rice
- Department of Neurology, North Bristol NHS Trust, Bristol, UK
- Clinical Neurosciences, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
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Griffanti L, Klein JC, Szewczyk-Krolikowski K, Menke RAL, Rolinski M, Barber TR, Lawton M, Evetts SG, Begeti F, Crabbe M, Rumbold J, Wade-Martins R, Hu MT, Mackay C. Cohort profile: the Oxford Parkinson's Disease Centre Discovery Cohort MRI substudy (OPDC-MRI). BMJ Open 2020; 10:e034110. [PMID: 32792423 PMCID: PMC7430482 DOI: 10.1136/bmjopen-2019-034110] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
PURPOSE The Oxford Parkinson's Disease Centre (OPDC) Discovery Cohort MRI substudy (OPDC-MRI) collects high-quality multimodal brain MRI together with deep longitudinal clinical phenotyping in patients with Parkinson's, at-risk individuals and healthy elderly participants. The primary aim is to detect pathological changes in brain structure and function, and develop, together with the clinical data, biomarkers to stratify, predict and chart progression in early-stage Parkinson's and at-risk individuals. PARTICIPANTS Participants are recruited from the OPDC Discovery Cohort, a prospective, longitudinal study. Baseline MRI data are currently available for 290 participants: 119 patients with early idiopathic Parkinson's, 15 Parkinson's patients with pathogenic mutations of the leucine-rich repeat kinase 2 or glucocerebrosidase (GBA) genes, 68 healthy controls and 87 individuals at risk of Parkinson's (asymptomatic carriers of GBA mutation and patients with idiopathic rapid eye movement sleep behaviour disorder-RBD). FINDINGS TO DATE Differences in brain structure in early Parkinson's were found to be subtle, with small changes in the shape of the globus pallidus and evidence of alterations in microstructural integrity in the prefrontal cortex that correlated with performance on executive function tests. Brain function, as assayed with resting fMRI yielded more substantial differences, with basal ganglia connectivity reduced in early Parkinson'sand RBD. Imaging of the substantia nigra with the more recent adoption of sequences sensitive to iron and neuromelanin content shows promising results in identifying early signs of Parkinsonian disease. FUTURE PLANS Ongoing studies include the integration of multimodal MRI measures to improve discrimination power. Follow-up clinical data are now accumulating and will allow us to correlate baseline imaging measures to clinical disease progression. Follow-up MRI scanning started in 2015 and is currently ongoing, providing the opportunity for future longitudinal imaging analyses with parallel clinical phenotyping.
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Affiliation(s)
- Ludovica Griffanti
- Wellcome Centre for Integrative Neuroimaging, Oxford Centre for Functional MRI of the Brain, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, Oxfordshire, UK
- Wellcome Centre for Integrative Neuroimaging, Oxford Centre for Human Brain Activity, Department of Psychiatry, University of Oxford, Oxford, Oxfordshire, UK
- Oxford Parkinson's Disease Centre, University of Oxford, Oxford, UK
| | - Johannes C Klein
- Wellcome Centre for Integrative Neuroimaging, Oxford Centre for Functional MRI of the Brain, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, Oxfordshire, UK
- Oxford Parkinson's Disease Centre, University of Oxford, Oxford, UK
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, Oxfordshire, UK
| | - Konrad Szewczyk-Krolikowski
- Oxford Parkinson's Disease Centre, University of Oxford, Oxford, UK
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, Oxfordshire, UK
| | - Ricarda A L Menke
- Wellcome Centre for Integrative Neuroimaging, Oxford Centre for Functional MRI of the Brain, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, Oxfordshire, UK
| | - Michal Rolinski
- Oxford Parkinson's Disease Centre, University of Oxford, Oxford, UK
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, Oxfordshire, UK
- Institute of Clinical Neurosciences, University of Bristol, Bristol, UK
| | - Thomas R Barber
- Wellcome Centre for Integrative Neuroimaging, Oxford Centre for Human Brain Activity, Department of Psychiatry, University of Oxford, Oxford, Oxfordshire, UK
- Oxford Parkinson's Disease Centre, University of Oxford, Oxford, UK
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, Oxfordshire, UK
| | - Michael Lawton
- Population Health Sciences, University of Bristol, Bristol, UK
| | - Samuel G Evetts
- Oxford Parkinson's Disease Centre, University of Oxford, Oxford, UK
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, Oxfordshire, UK
| | - Faye Begeti
- Oxford Parkinson's Disease Centre, University of Oxford, Oxford, UK
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, Oxfordshire, UK
| | - Marie Crabbe
- Oxford Parkinson's Disease Centre, University of Oxford, Oxford, UK
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, Oxfordshire, UK
| | - Jane Rumbold
- Oxford Parkinson's Disease Centre, University of Oxford, Oxford, UK
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, Oxfordshire, UK
| | - Richard Wade-Martins
- Oxford Parkinson's Disease Centre, University of Oxford, Oxford, UK
- Department of Physiology, Anatomy and Genetics, University of Oxford, Oxford, Oxfordshire, UK
| | - Michele T Hu
- Oxford Parkinson's Disease Centre, University of Oxford, Oxford, UK
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, Oxfordshire, UK
| | - Clare Mackay
- Wellcome Centre for Integrative Neuroimaging, Oxford Centre for Human Brain Activity, Department of Psychiatry, University of Oxford, Oxford, Oxfordshire, UK
- Oxford Parkinson's Disease Centre, University of Oxford, Oxford, UK
- Oxford Health, NHS Foundation Trust, Oxford, Oxfordshire, UK
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Baig F, Robb T, Mooney L, Robbins C, Norris C, Barua N, Szewczyk-Krolikowski K, Whone A. Deep brain stimulation: practical insights and common queries. Pract Neurol 2019; 19:502-507. [PMID: 31358573 DOI: 10.1136/practneurol-2019-002275] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/11/2019] [Indexed: 11/03/2022]
Abstract
The number of patients with deep brain stimulation (DBS) devices implanted is increasing. Although practices vary between centres, patients are typically given training and information from their DBS nurse or clinician, as well as a comprehensive device manual and contact details for their device manufacturer. However, for the lifetime of a patient with a DBS system, most of their secondary care often occurs in a centre without a co-located DBS service. The local neurologist is often asked pragmatic questions regarding the do's and don'ts for patients with DBS systems. While a DBS centre or device manufacturer can provide advice, we thought that it will be helpful to outline the overall management of DBS for movement disorders and the approach to commonly raised questions. We describe briefly the clinical application of DBS and discuss common scenarios where there are possible compatibility issues around the device.
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Affiliation(s)
- Fahd Baig
- Neurological and Musculoskeletal Sciences Division, Southmead Hospital, North Bristol NHS Trust, Bristol, UK.,Nuffield Department of Clinical Neuroscience, University of Oxford, Oxford, UK
| | - Thomas Robb
- Translational Health Sciences, University of Bristol, Bristol, UK
| | - Lucy Mooney
- Neurological and Musculoskeletal Sciences Division, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - Caroline Robbins
- Neurological and Musculoskeletal Sciences Division, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - Caroline Norris
- Neurological and Musculoskeletal Sciences Division, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - Neil Barua
- Neurological and Musculoskeletal Sciences Division, Southmead Hospital, North Bristol NHS Trust, Bristol, UK.,Translational Health Sciences, University of Bristol, Bristol, UK
| | - Konrad Szewczyk-Krolikowski
- Neurological and Musculoskeletal Sciences Division, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - Alan Whone
- Neurological and Musculoskeletal Sciences Division, Southmead Hospital, North Bristol NHS Trust, Bristol, UK .,Translational Health Sciences, University of Bristol, Bristol, UK
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Klein JC, Rolinski M, Griffanti L, Szewczyk-Krolikowski K, Baig F, Ruffmann C, Groves AR, Menke RAL, Hu MT, Mackay C. Cortical structural involvement and cognitive dysfunction in early Parkinson's disease. NMR Biomed 2018; 31:e3900. [PMID: 29436039 DOI: 10.1002/nbm.3900] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Revised: 12/13/2017] [Accepted: 01/03/2018] [Indexed: 06/08/2023]
Abstract
Magnetic resonance imaging (MRI) studies in early Parkinson's disease (PD) have shown promise in the detection of disease-related brain changes in the white and deep grey matter. We set out to establish whether intrinsic cortical involvement in early PD can be detected with quantitative MRI. We collected a rich, multi-modal dataset, including diffusion MRI, T1 relaxometry and cortical morphometry, in 20 patients with early PD (disease duration, 1.9 ± 0.97 years, Hoehn & Yahr 1-2) and in 19 matched controls. The cortex was reconstructed using FreeSurfer. Data analysis employed linked independent component analysis (ICA), a novel data-driven technique that allows for data fusion and extraction of multi-modal components before further analysis. For comparison, we performed standard uni-modal analysis with a general linear model (GLM). Linked ICA detected multi-modal cortical changes in early PD (p = 0.015). These comprised fractional anisotropy reduction in dorsolateral prefrontal, cingulate and premotor cortex and the superior parietal lobule, mean diffusivity increase in the mesolimbic, somatosensory and superior parietal cortex, sparse diffusivity decrease in lateral parietal and right prefrontal cortex, and sparse changes to the cortex area. In PD, the amount of cortical dysintegrity correlated with diminished cognitive performance. Importantly, uni-modal analysis detected no significant group difference on any imaging modality. We detected microstructural cortical pathology in early PD using a data-driven, multi-modal approach. This pathology is correlated with diminished cognitive performance. Our results indicate that early degenerative processes leave an MRI signature in the cortex of patients with early PD. The cortical imaging findings are behaviourally meaningful and provide a link between cognitive status and microstructural cortical pathology in patients with early PD.
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Affiliation(s)
- J C Klein
- Oxford Parkinson's Disease Centre, Nuffield Department of Clinical Neurosciences, Division of Clinical Neurology, University of Oxford, Oxford, UK
- Wellcome Centre for Integrative Neuroimaging (WIN), FMRIB Centre, University of Oxford, Oxford, UK
- Department of Clinical Neurology, John Radcliffe Hospital, Oxford, UK
| | - M Rolinski
- Oxford Parkinson's Disease Centre, Nuffield Department of Clinical Neurosciences, Division of Clinical Neurology, University of Oxford, Oxford, UK
- Department of Clinical Neurology, John Radcliffe Hospital, Oxford, UK
| | - L Griffanti
- Oxford Parkinson's Disease Centre, Nuffield Department of Clinical Neurosciences, Division of Clinical Neurology, University of Oxford, Oxford, UK
- Wellcome Centre for Integrative Neuroimaging (WIN), FMRIB Centre, University of Oxford, Oxford, UK
| | - K Szewczyk-Krolikowski
- Oxford Parkinson's Disease Centre, Nuffield Department of Clinical Neurosciences, Division of Clinical Neurology, University of Oxford, Oxford, UK
| | - F Baig
- Oxford Parkinson's Disease Centre, Nuffield Department of Clinical Neurosciences, Division of Clinical Neurology, University of Oxford, Oxford, UK
- Department of Clinical Neurology, John Radcliffe Hospital, Oxford, UK
| | - C Ruffmann
- Oxford Parkinson's Disease Centre, Nuffield Department of Clinical Neurosciences, Division of Clinical Neurology, University of Oxford, Oxford, UK
- Department of Clinical Neurology, John Radcliffe Hospital, Oxford, UK
| | - A R Groves
- Wellcome Centre for Integrative Neuroimaging (WIN), FMRIB Centre, University of Oxford, Oxford, UK
| | - R A L Menke
- Oxford Parkinson's Disease Centre, Nuffield Department of Clinical Neurosciences, Division of Clinical Neurology, University of Oxford, Oxford, UK
- Wellcome Centre for Integrative Neuroimaging (WIN), FMRIB Centre, University of Oxford, Oxford, UK
| | - M T Hu
- Oxford Parkinson's Disease Centre, Nuffield Department of Clinical Neurosciences, Division of Clinical Neurology, University of Oxford, Oxford, UK
- Department of Clinical Neurology, John Radcliffe Hospital, Oxford, UK
| | - C Mackay
- Oxford Parkinson's Disease Centre, Nuffield Department of Clinical Neurosciences, Division of Clinical Neurology, University of Oxford, Oxford, UK
- Department of Psychiatry, University of Oxford, Oxford, UK
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Rolinski M, Griffanti L, Piccini P, Roussakis AA, Szewczyk-Krolikowski K, Menke RA, Quinnell T, Zaiwalla Z, Klein JC, Mackay CE, Hu MTM. Basal ganglia dysfunction in idiopathic REM sleep behaviour disorder parallels that in early Parkinson's disease. Brain 2016; 139:2224-34. [PMID: 27297241 PMCID: PMC4958897 DOI: 10.1093/brain/aww124] [Citation(s) in RCA: 90] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Accepted: 04/05/2016] [Indexed: 12/02/2022] Open
Abstract
See Postuma (doi:10.1093/aww131) for a scientific commentary on this article. Resting state functional magnetic resonance imaging dysfunction within the basal ganglia network is a feature of early Parkinson’s disease and may be a diagnostic biomarker of basal ganglia dysfunction. Currently, it is unclear whether these changes are present in so-called idiopathic rapid eye movement sleep behaviour disorder, a condition associated with a high rate of future conversion to Parkinson’s disease. In this study, we explore the utility of resting state functional magnetic resonance imaging to detect basal ganglia network dysfunction in rapid eye movement sleep behaviour disorder. We compare these data to a set of healthy control subjects, and to a set of patients with established early Parkinson’s disease. Furthermore, we explore the relationship between resting state functional magnetic resonance imaging basal ganglia network dysfunction and loss of dopaminergic neurons assessed with dopamine transporter single photon emission computerized tomography, and perform morphometric analyses to assess grey matter loss. Twenty-six patients with polysomnographically-established rapid eye movement sleep behaviour disorder, 48 patients with Parkinson’s disease and 23 healthy control subjects were included in this study. Resting state networks were isolated from task-free functional magnetic resonance imaging data using dual regression with a template derived from a separate cohort of 80 elderly healthy control participants. Resting state functional magnetic resonance imaging parameter estimates were extracted from the study subjects in the basal ganglia network. In addition, eight patients with rapid eye movement sleep behaviour disorder, 10 with Parkinson’s disease and 10 control subjects received 123I-ioflupane single photon emission computerized tomography. We tested for reduction of basal ganglia network connectivity, and for loss of tracer uptake in rapid eye movement sleep behaviour disorder and Parkinson’s disease relative to each other and to controls. Connectivity measures of basal ganglia network dysfunction differentiated both rapid eye movement sleep behaviour disorder and Parkinson’s disease from controls with high sensitivity (96%) and specificity (74% for rapid eye movement sleep behaviour disorder, 78% for Parkinson’s disease), indicating its potential as an indicator of early basal ganglia dysfunction. Rapid eye movement sleep behaviour disorder was indistinguishable from Parkinson’s disease on resting state functional magnetic resonance imaging despite obvious differences on dopamine transported single photon emission computerized tomography. Basal ganglia connectivity is a promising biomarker for the detection of early basal ganglia network dysfunction, and may help to identify patients at risk of developing Parkinson’s disease in the future. Future risk stratification using a polymodal approach could combine basal ganglia network connectivity with clinical and other imaging measures, with important implications for future neuroprotective trials in rapid eye movement sleep behaviour disorder.
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Affiliation(s)
- Michal Rolinski
- 1 Oxford Parkinson's Disease Centre (OPDC), Oxford, UK 2 Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Ludovica Griffanti
- 3 Centre for the functional MRI of the Brain (FMRIB), University of Oxford, Oxford, UK
| | - Paola Piccini
- 4 Division of Clinical Neurosciences and MRC Clinical Sciences Centre, Faculty of Medicine, Hammersmith Hospital, Imperial College London, London, UK
| | - Andreas A Roussakis
- 4 Division of Clinical Neurosciences and MRC Clinical Sciences Centre, Faculty of Medicine, Hammersmith Hospital, Imperial College London, London, UK
| | - Konrad Szewczyk-Krolikowski
- 1 Oxford Parkinson's Disease Centre (OPDC), Oxford, UK 2 Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Ricarda A Menke
- 3 Centre for the functional MRI of the Brain (FMRIB), University of Oxford, Oxford, UK
| | - Timothy Quinnell
- 5 Respiratory Support and Sleep Centre, Papworth Hospital, Cambridge, UK
| | - Zenobia Zaiwalla
- 6 Department of Clinical Neurophysiology, John Radcliffe Hospital, Oxford, UK
| | - Johannes C Klein
- 1 Oxford Parkinson's Disease Centre (OPDC), Oxford, UK 2 Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK 3 Centre for the functional MRI of the Brain (FMRIB), University of Oxford, Oxford, UK
| | - Clare E Mackay
- 1 Oxford Parkinson's Disease Centre (OPDC), Oxford, UK 3 Centre for the functional MRI of the Brain (FMRIB), University of Oxford, Oxford, UK 7 Department of Psychiatry, University of Oxford, Oxford, UK
| | - Michele T M Hu
- 1 Oxford Parkinson's Disease Centre (OPDC), Oxford, UK 2 Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
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Rolinski M, Griffanti L, Szewczyk-Krolikowski K, Menke R, Quinnell T, Zaiwalla Z, Mackay C, Hu M. NEUROIMAGING OF IDIOPATHIC REM SLEEP BEHAVIOR DISORDER. J Neurol Neurosurg Psychiatry 2015. [DOI: 10.1136/jnnp-2015-312379.184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
IntroductionResting-state functional magnetic resonance imaging (rs-fMRI) studies have previously shown significantly impaired connectivity in patients within the early motor phase of Parkinson's disease. Is it possible to detect the same imaging signature of Parkinson's in RBD subjects, before a clinical diagnosis of Parkinson's disease is established?MethodsTwenty-six patients with polysomnography-proven RBD and twenty-two age- and sex-matched healthy controls were recruited into the study. All subjects underwent a comprehensive structural and resting-state MRI protocol.ResultsVoxel-based morphometry analysis did not yield any significant grey matter differences between the two groups. Similarly, no significant differences of fractional anisotropy were found using white matter tract analysis. Rs-fMRI revealed decreased coactivation within the basal ganglia network (involving the caudate, putamen, globus pallidus bilaterally) and the sensorimotor network (precentral gyrus) of patients with RBD. A small area of increased coactivation was found in the default mode network of patients with RBD.ConclusionsOur findings support the presence of basal ganglia dysfunction in patients with RBD, likely representing the prodromal stages of Parkinson's disease. Clinical and neuroimaging follow up is necessary to assess the clinical utility of resting state fMRI to predict the onset of Parkinson's disease in RBD subjects.
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Griffanti L, Rolinski M, Szewczyk-Krolikowski K, Menke RA, Filippini N, Zamboni G, Jenkinson M, Hu MTM, Mackay CE. Challenges in the reproducibility of clinical studies with resting state fMRI: An example in early Parkinson's disease. Neuroimage 2015; 124:704-713. [PMID: 26386348 PMCID: PMC4655939 DOI: 10.1016/j.neuroimage.2015.09.021] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Revised: 09/07/2015] [Accepted: 09/09/2015] [Indexed: 11/06/2022] Open
Abstract
Resting state fMRI (rfMRI) is gaining in popularity, being easy to acquire and with promising clinical applications. However, rfMRI studies, especially those involving clinical groups, still lack reproducibility, largely due to the different analysis settings. This is particularly important for the development of imaging biomarkers. The aim of this work was to evaluate the reproducibility of our recent study regarding the functional connectivity of the basal ganglia network in early Parkinson's disease (PD) (Szewczyk-Krolikowski et al., 2014). In particular, we systematically analysed the influence of two rfMRI analysis steps on the results: the individual cleaning (artefact removal) of fMRI data and the choice of the set of independent components (template) used for dual regression. Our experience suggests that the use of a cleaning approach based on single-subject independent component analysis, which removes non neural-related sources of inter-individual variability, can help to increase the reproducibility of clinical findings. A template generated using an independent set of healthy controls is recommended for studies where the aim is to detect differences from a “healthy” brain, rather than an “average” template, derived from an equal number of patients and controls. While, exploratory analyses (e.g. testing multiple resting state networks) should be used to formulate new hypotheses, careful validation is necessary before promising findings can be translated into useful biomarkers. Reproducibility of clinical findings is crucial for imaging biomarker development. We addressed the impact on reproducibility of different analysis settings in rfMRI. ICA-based cleaning of rfMRI data increases reproducibility. The effect of the template choice for dual regression is evaluated.
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Affiliation(s)
- Ludovica Griffanti
- Centre for the functional MRI of the Brain (FMRIB), University of Oxford, Oxford, UK
| | - Michal Rolinski
- Oxford Parkinson's Disease Centre (OPDC), University of Oxford, Oxford, UK; Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Konrad Szewczyk-Krolikowski
- Oxford Parkinson's Disease Centre (OPDC), University of Oxford, Oxford, UK; Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Ricarda A Menke
- Centre for the functional MRI of the Brain (FMRIB), University of Oxford, Oxford, UK
| | - Nicola Filippini
- Centre for the functional MRI of the Brain (FMRIB), University of Oxford, Oxford, UK; Department of Psychiatry, University of Oxford, Oxford, UK
| | - Giovanna Zamboni
- Centre for the functional MRI of the Brain (FMRIB), University of Oxford, Oxford, UK
| | - Mark Jenkinson
- Centre for the functional MRI of the Brain (FMRIB), University of Oxford, Oxford, UK
| | - Michele T M Hu
- Oxford Parkinson's Disease Centre (OPDC), University of Oxford, Oxford, UK; Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Clare E Mackay
- Centre for the functional MRI of the Brain (FMRIB), University of Oxford, Oxford, UK; Oxford Parkinson's Disease Centre (OPDC), University of Oxford, Oxford, UK; Department of Psychiatry, University of Oxford, Oxford, UK.
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Rolinski M, Griffanti L, Szewczyk-Krolikowski K, Menke RAL, Wilcock GK, Filippini N, Zamboni G, Hu MTM, Mackay CE. Aberrant functional connectivity within the basal ganglia of patients with Parkinson's disease. Neuroimage Clin 2015; 8:126-32. [PMID: 26106536 PMCID: PMC4473718 DOI: 10.1016/j.nicl.2015.04.003] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Revised: 04/02/2015] [Accepted: 04/03/2015] [Indexed: 11/06/2022]
Abstract
Resting state functional MRI (rs-fMRI) has been previously shown to be a promising tool for the assessment of early Parkinson's disease (PD). In order to assess whether changes within the basal ganglia network (BGN) are disease specific or relate to neurodegeneration generally, BGN connectivity was assessed in 32 patients with early PD, 19 healthy controls and 31 patients with Alzheimer's disease (AD). Voxel-wise comparisons demonstrated decreased connectivity within the basal ganglia of patients with PD, when compared to patients with AD and healthy controls. No significant changes within the BGN were seen in AD, when compared to healthy controls. Moreover, measures of functional connectivity extracted from regions within the basal ganglia were significantly lower in the PD group. Consistent with previous radiotracer studies, the greatest change when compared to the healthy control group was seen in the posterior putamen of PD subjects. When combined into a single component score, this method differentiated PD from AD and healthy control subjects, with a diagnostic accuracy of 81%. Rs-fMRI can be used to demonstrate the aberrant functional connectivity within the basal ganglia of patients with early PD. These changes are likely to be representative of patho-physiological basal ganglia dysfunction and are not associated with generalised neurodegeneration seen in AD. Further studies are necessary to ascertain whether this method is sensitive enough to detect basal ganglia dysfunction in prodromal PD, and its utility as a potential diagnostic biomarker for premotor and early motoric disease. We assess resting state connectivity within the basal ganglia network of patients with PD, AD and healthy controls. Connectivity within the basal ganglia is significantly lower in patients with PD, compared to the other two groups. Changes are likely to represent basal ganglia dysfunction and are not associated with generalised neurodegeneration. We differentiated patients with PD from those with AD and healthy control subjects with a diagnostic accuracy of 81%.
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Affiliation(s)
- Michal Rolinski
- Oxford Parkinson's Disease Centre (OPDC), Oxford, UK ; Nuffield Department of Clinical Neurosciences, Oxford, UK
| | - Ludovica Griffanti
- Nuffield Department of Clinical Neurosciences, Oxford, UK ; Centre for the Functional MRI of the Brain (FMRIB), Oxford, UK
| | - Konrad Szewczyk-Krolikowski
- Oxford Parkinson's Disease Centre (OPDC), Oxford, UK ; Nuffield Department of Clinical Neurosciences, Oxford, UK
| | - Ricarda A L Menke
- Oxford Parkinson's Disease Centre (OPDC), Oxford, UK ; Centre for the Functional MRI of the Brain (FMRIB), Oxford, UK ; Department of Psychiatry, University of Oxford, Oxford, UK
| | | | - Nicola Filippini
- Centre for the Functional MRI of the Brain (FMRIB), Oxford, UK ; Oxford Project to Investigate Memory and Ageing, Oxford, UK
| | - Giovanna Zamboni
- Nuffield Department of Clinical Neurosciences, Oxford, UK ; Centre for the Functional MRI of the Brain (FMRIB), Oxford, UK ; Oxford Project to Investigate Memory and Ageing, Oxford, UK
| | - Michele T M Hu
- Oxford Parkinson's Disease Centre (OPDC), Oxford, UK ; Nuffield Department of Clinical Neurosciences, Oxford, UK
| | - Clare E Mackay
- Oxford Parkinson's Disease Centre (OPDC), Oxford, UK ; Centre for the Functional MRI of the Brain (FMRIB), Oxford, UK ; Department of Psychiatry, University of Oxford, Oxford, UK
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Mackay CE, Szewczyk-Krolikowski K, Ben-Shlomo Y, Hu M. Author response. Neurology 2015; 84:546. [PMID: 25767851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023] Open
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Ben-Shlomo Y, Lawton M, Szewczyk-Krolikowski K, Hu M. Letter in response to Picillo et al., in relation to Szewczyk-Krolikowski et al.: The influence of age and gender on motor and non-motor features of early Parkinson's disease: Initial findings from the Oxford Parkinson disease Center (OPDC) discovery cohort. Parkinsonism Relat Disord 2014; 20:1321-2. [DOI: 10.1016/j.parkreldis.2014.06.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2014] [Accepted: 06/17/2014] [Indexed: 11/28/2022]
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Hu M, Lawton M, Baig F, Rolinski M, Ruffmann C, Nithi K, Tomlinson P, Szewczyk-Krolikowski K, May M, Ben-Shlomo Y. PARKINSON'S DISEASE: HOW MANY FORMS ARE THERE? J Neurol Neurosurg Psychiatry 2014. [DOI: 10.1136/jnnp-2014-309236.20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Rolinski M, Szewczyk-Krolikowski K, Menke RAL, Filippini N, Heise V, Zamboni G, Wilcock G, Talbot K, Hu M, Mackay C. RESTING STATE FMRI DISCERNS EARLY PARKINSON'S FROM CONTROLS. J Neurol Neurosurg Psychiatry 2014. [DOI: 10.1136/jnnp-2014-309236.204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Szewczyk-Krolikowski K, Menke RAL, Rolinski M, Duff E, Salimi-Khorshidi G, Filippini N, Zamboni G, Hu MTM, Mackay CE. Functional connectivity in the basal ganglia network differentiates PD patients from controls. Neurology 2014; 83:208-14. [PMID: 24920856 DOI: 10.1212/wnl.0000000000000592] [Citation(s) in RCA: 131] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
OBJECTIVE To examine functional connectivity within the basal ganglia network (BGN) in a group of cognitively normal patients with early Parkinson disease (PD) on and off medication compared to age- and sex-matched healthy controls (HC), and to validate the findings in a separate cohort of participants with PD. METHODS Participants were scanned with resting-state fMRI (RS-fMRI) at 3T field strength. Resting-state networks were isolated using independent component analysis. A BGN template was derived from 80 elderly HC participants. BGN maps were compared between 19 patients with PD on and off medication in the discovery group and 19 age- and sex-matched controls to identify a threshold for optimal group separation. The threshold was applied to 13 patients with PD (including 5 drug-naive) in the validation group to establish reproducibility of findings. RESULTS Participants with PD showed reduced functional connectivity with the BGN in a wide range of areas. Administration of medication significantly improved connectivity. Average BGN connectivity differentiated participants with PD from controls with 100% sensitivity and 89.5% specificity. The connectivity threshold was tested on the validation cohort and achieved 85% accuracy. CONCLUSIONS We demonstrate that resting functional connectivity, measured with MRI using an observer-independent method, is reproducibly reduced in the BGN in cognitively intact patients with PD, and increases upon administration of dopaminergic medication. Our results hold promise for RS-fMRI connectivity as a biomarker in early PD. CLASSIFICATION OF EVIDENCE This study provides Class III evidence that average connectivity in the BGN as measured by RS-fMRI distinguishes patients with PD from age- and sex-matched controls.
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Affiliation(s)
- Konrad Szewczyk-Krolikowski
- From the Nuffield Department of Clinical Neurosciences (K.S.-K., M.R., M.H.), Oxford Parkinson's Disease Centre (OPDC) (K.S.-K., R.A.L.M., M.R., M.T.M.H., C.E.M.), Department of Psychiatry (C.E.M.), and FMRIB Centre (R.A.L.M., E.D., G.S.-K., N.F., G.Z., C.E.M.), University of Oxford, UK
| | - Ricarda A L Menke
- From the Nuffield Department of Clinical Neurosciences (K.S.-K., M.R., M.H.), Oxford Parkinson's Disease Centre (OPDC) (K.S.-K., R.A.L.M., M.R., M.T.M.H., C.E.M.), Department of Psychiatry (C.E.M.), and FMRIB Centre (R.A.L.M., E.D., G.S.-K., N.F., G.Z., C.E.M.), University of Oxford, UK
| | - Michal Rolinski
- From the Nuffield Department of Clinical Neurosciences (K.S.-K., M.R., M.H.), Oxford Parkinson's Disease Centre (OPDC) (K.S.-K., R.A.L.M., M.R., M.T.M.H., C.E.M.), Department of Psychiatry (C.E.M.), and FMRIB Centre (R.A.L.M., E.D., G.S.-K., N.F., G.Z., C.E.M.), University of Oxford, UK
| | - Eugene Duff
- From the Nuffield Department of Clinical Neurosciences (K.S.-K., M.R., M.H.), Oxford Parkinson's Disease Centre (OPDC) (K.S.-K., R.A.L.M., M.R., M.T.M.H., C.E.M.), Department of Psychiatry (C.E.M.), and FMRIB Centre (R.A.L.M., E.D., G.S.-K., N.F., G.Z., C.E.M.), University of Oxford, UK
| | - Gholamreza Salimi-Khorshidi
- From the Nuffield Department of Clinical Neurosciences (K.S.-K., M.R., M.H.), Oxford Parkinson's Disease Centre (OPDC) (K.S.-K., R.A.L.M., M.R., M.T.M.H., C.E.M.), Department of Psychiatry (C.E.M.), and FMRIB Centre (R.A.L.M., E.D., G.S.-K., N.F., G.Z., C.E.M.), University of Oxford, UK
| | - Nicola Filippini
- From the Nuffield Department of Clinical Neurosciences (K.S.-K., M.R., M.H.), Oxford Parkinson's Disease Centre (OPDC) (K.S.-K., R.A.L.M., M.R., M.T.M.H., C.E.M.), Department of Psychiatry (C.E.M.), and FMRIB Centre (R.A.L.M., E.D., G.S.-K., N.F., G.Z., C.E.M.), University of Oxford, UK
| | - Giovanna Zamboni
- From the Nuffield Department of Clinical Neurosciences (K.S.-K., M.R., M.H.), Oxford Parkinson's Disease Centre (OPDC) (K.S.-K., R.A.L.M., M.R., M.T.M.H., C.E.M.), Department of Psychiatry (C.E.M.), and FMRIB Centre (R.A.L.M., E.D., G.S.-K., N.F., G.Z., C.E.M.), University of Oxford, UK
| | - Michele T M Hu
- From the Nuffield Department of Clinical Neurosciences (K.S.-K., M.R., M.H.), Oxford Parkinson's Disease Centre (OPDC) (K.S.-K., R.A.L.M., M.R., M.T.M.H., C.E.M.), Department of Psychiatry (C.E.M.), and FMRIB Centre (R.A.L.M., E.D., G.S.-K., N.F., G.Z., C.E.M.), University of Oxford, UK
| | - Clare E Mackay
- From the Nuffield Department of Clinical Neurosciences (K.S.-K., M.R., M.H.), Oxford Parkinson's Disease Centre (OPDC) (K.S.-K., R.A.L.M., M.R., M.T.M.H., C.E.M.), Department of Psychiatry (C.E.M.), and FMRIB Centre (R.A.L.M., E.D., G.S.-K., N.F., G.Z., C.E.M.), University of Oxford, UK.
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Rolinski M, Szewczyk-Krolikowski K, Tomlinson PR, Nithi K, Talbot K, Ben-Shlomo Y, Hu MT. REM sleep behaviour disorder is associated with worse quality of life and other non-motor features in early Parkinson's disease. J Neurol Neurosurg Psychiatry 2014; 85:560-6. [PMID: 24187013 PMCID: PMC3995329 DOI: 10.1136/jnnp-2013-306104] [Citation(s) in RCA: 131] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
BACKGROUND Concomitant REM sleep behaviour disorder (RBD) is commonly observed in patients with Parkinson's disease (PD). Although the brainstem structures responsible for the symptoms of RBD correspond to the premotor stages of PD, the association of RBD with motor and non-motor features in early PD remains unclear. METHODS The study evaluated 475 patients with PD within 3.5 years of diagnosis for the presence of probable RBD (pRBD) using the REM Sleep Behaviour Disorder Screening Questionnaire (RBDSQ). A neurologist and a trained research nurse carried out evaluation of each participant blinded to the results of the RBDSQ. Standardised rating scales for motor and non-motor features of PD, as well as health-related quality of life measures, were assessed. Multiple linear and logistic regression analyses were used to determine the relationship between pRBD and a variety of outcomes, controlling for confounding factors. RESULTS The overall frequency of pRBD was 47.2% (95% CI 42.7% to 51.9%). None of the patients had a previous diagnosis of RBD. Patients with PD and concomitant pRBD did not differ on motor phenotype and scored comparably on the objective motor scales, but reported problems with motor aspects of daily living more frequently. Adjusted for age, sex, disease duration and smoking history, pRBD was associated with greater sleepiness (p=0.001), depression (p=0.001) and cognitive impairment (p=0.006). CONCLUSIONS pRBD is common and under-recognised in early PD. It is associated with increased severity and frequency of non-motor features, poorer subjective motor performance and a greater impact on health-related quality of life.
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Affiliation(s)
- Michal Rolinski
- Department of Physiology, Anatomy and Genetics, Oxford Parkinson's Disease Centre, Oxford, UK
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Menke RAL, Szewczyk-Krolikowski K, Jbabdi S, Jenkinson M, Talbot K, Mackay CE, Hu M. Comprehensive morphometry of subcortical grey matter structures in early-stage Parkinson's disease. Hum Brain Mapp 2013; 35:1681-90. [PMID: 23861334 DOI: 10.1002/hbm.22282] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2012] [Revised: 01/01/2013] [Accepted: 02/13/2013] [Indexed: 12/16/2022] Open
Abstract
Previous imaging studies that investigated morphometric group differences of subcortical regions outside the substantia nigra between non-demented Parkinson's patients and controls either did not find any significant differences, or reported contradictory results. Here, we performed a comprehensive morphometric analysis of 20 cognitively normal, early-stage PD patients and 19 matched control subjects. In addition to relatively standard analyses of whole-brain grey matter volume and overall regional volumes, we examined subtle localized surface shape differences in striatal and limbic grey matter structures and tested their utility as a diagnostic marker. Voxel-based morphometry and volumetric comparisons did not reveal significant group differences. Shape analysis, on the other hand, demonstrated significant between-group shape differences for the right pallidum. Careful diffusion tractography analysis showed that the affected parts of the pallidum are connected subcortically with the subthalamic nucleus, the pedunculopontine nucleus, and the thalamus and cortically with the frontal lobe. Additionally, microstructural measurements along these pathways, but not along other pallidal connections, were significantly different between the two groups. Vertex-wise linear discriminant analysis, however, revealed limited accuracy of pallidal shape for the discrimination between patients and controls. We conclude that localized disease-related changes in the right pallidum in early Parkinson's disease, undetectable using standard voxel-based morphometry or volumetry, are evident using sensitive shape analysis. However, the subtle nature of these changes makes it unlikely that shape analysis alone will be useful for early diagnosis.
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Affiliation(s)
- Ricarda A L Menke
- FMRIB Centre, Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford, United Kingdom; Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, United Kingdom; Oxford Parkinson's Disease Centre (OPDC), University of Oxford, Oxford, United Kingdom
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