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Rajput AH, Rajput ML, Ferguson LW, Rajput A. Baseline motor findings and Parkinson disease prognostic subtypes. Neurology 2017; 89:138-143. [PMID: 28592451 PMCID: PMC5501934 DOI: 10.1212/wnl.0000000000004078] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Accepted: 04/11/2017] [Indexed: 11/15/2022] Open
Abstract
Objective: To identify the significance of baseline motor features to the lifelong prognostic motor subtypes in a Parkinson disease (PD) cohort. Methods: In a previous study of 166 PD cases, we observed different prognosis in tremor-dominant, akinetic-rigid, and mixed subtypes. This study includes the same cases, but we excluded 10 cases with symptoms of ≥15 years duration at baseline. Relative severity of tremor, bradykinesia/akinesia, and rigidity at baseline were evaluated as predictors of the motor subtypes, which are known to have different prognosis. Results: The most common motor subtype was mixed, followed by akinetic-rigid and then the tremor-dominant. Seventy cases were not receiving antiparkinsonian drugs at baseline. The prognostic subtypes could be predicted at baseline in 85% of all and in 91% of the treatment-naive cases. Sensitivity, specificity, and positive predictive values were strong for the mixed and the akinetic-rigid but weak for the tremor-dominant subtype. Conclusions: Our data show that motor profile at baseline can predict prognosis in most PD cases. These findings can be incorporated into clinical practice.
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Affiliation(s)
- Ali H Rajput
- From the Division of Neurology (A.H.R., A.R.), Saskatoon Health Region/University of Saskatchewan, Rosthern; and Movement Disorders Program (M.L.R.) and College of Medicine (L.W.F.), University of Saskatchewan, Saskatoon, Canada.
| | - Michele L Rajput
- From the Division of Neurology (A.H.R., A.R.), Saskatoon Health Region/University of Saskatchewan, Rosthern; and Movement Disorders Program (M.L.R.) and College of Medicine (L.W.F.), University of Saskatchewan, Saskatoon, Canada
| | - Leslie W Ferguson
- From the Division of Neurology (A.H.R., A.R.), Saskatoon Health Region/University of Saskatchewan, Rosthern; and Movement Disorders Program (M.L.R.) and College of Medicine (L.W.F.), University of Saskatchewan, Saskatoon, Canada
| | - Alex Rajput
- From the Division of Neurology (A.H.R., A.R.), Saskatoon Health Region/University of Saskatchewan, Rosthern; and Movement Disorders Program (M.L.R.) and College of Medicine (L.W.F.), University of Saskatchewan, Saskatoon, Canada
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Rajput AH, Rajput ML, Robinson CA, Rajput A. Normal substantia nigra patients treated with levodopa - Clinical, therapeutic and pathological observations. Parkinsonism Relat Disord 2015; 21:1232-7. [PMID: 26372624 DOI: 10.1016/j.parkreldis.2015.08.029] [Citation(s) in RCA: 3] [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: 05/21/2015] [Revised: 08/17/2015] [Accepted: 08/24/2015] [Indexed: 01/15/2023]
Abstract
BACKGROUND Definite diagnosis of idiopathic Parkinson's disease is based on histological findings of marked substantia nigra neuronal loss and Lewy body inclusions. Almost all cases with clinical diagnosis of idiopathic Parkinson's disease are treated with levodopa. Because there is no biological marker for the diagnosis, erroneous clinical diagnosis and treatment of such cases with levodopa are well known. There is very limited literature on levodopa treated cases that had normal substantia nigra at autopsy. METHODS Patients seen at Movement Disorders Clinic Saskatchewan are offered autopsy at no cost to the family/estate of the patient. Autopsy studies are performed by certified neuropathologists. Notation on the status of substantia nigra is made in every autopsied case. RESULTS Between 1968 and 2014, 21 cases treated with levodopa had normal substantia nigra at autopsy. Eleven patients continued levodopa until death and 9 received the drug for four years or longer. No objective motor symptom benefit, dyskinesia or motor response fluctuations on levodopa were observed in any case. The most common final diagnosis was essential tremor. CONCLUSION Individuals with normal substantia nigra do not benefit from levodopa and do not manifest motor response fluctuations or dyskinesia. Long-term use of levodopa is not toxic to normal human substantia nigra.
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Affiliation(s)
- Ali H Rajput
- Saskatchewan Movement Disorders Program, Department of Medicine, University of Saskatchewan/Saskatoon Health Region, Saskatoon, Saskatchewan, Canada.
| | - Michele L Rajput
- Saskatchewan Movement Disorders Program, Department of Medicine, University of Saskatchewan/Saskatoon Health Region, Saskatoon, Saskatchewan, Canada
| | - Christopher A Robinson
- Saskatchewan Movement Disorders Program, Department of Pathology, University of Saskatchewan/Saskatoon Health Region, Saskatoon, Saskatchewan, Canada
| | - Alex Rajput
- Saskatchewan Movement Disorders Program, Department of Medicine, University of Saskatchewan/Saskatoon Health Region, Saskatoon, Saskatchewan, Canada
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Ross JP, Rayaprolu S, Bernales CQ, Soto-Ortolaza AI, van Gerpen J, Uitti RJ, Wszolek ZK, Rajput A, Rajput AH, Rajput ML, Ross OA, Vilariño-Güell C. SLC1A2 rs3794087 does not associate with essential tremor. Neurobiol Aging 2013; 35:935.e9-10. [PMID: 24139280 DOI: 10.1016/j.neurobiolaging.2013.09.022] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2013] [Revised: 09/10/2013] [Accepted: 09/16/2013] [Indexed: 11/17/2022]
Abstract
A recent genome-wide association study of patients with essential tremor (ET) from Germany has nominated SLC1A2 rs3794087 as a novel risk factor for disease. This association was independently replicated in the Chinese population, albeit with an opposite direction of effect. To further define the role of SLC1A2 in ET, we genotyped rs3794087 in a North American series consisting of 1347 patients with ET and controls. Statistical analysis did not identify significant differences in genotype or allele frequencies between healthy controls and patients with ET (p > 0.36). These findings therefore do not support a role for SLC1A2 rs3794087 in susceptibility to ET in the North American population. Further studies in ethnically distinct populations of patients with ET are necessary to understand whether genetic variability in SLC1A2 affects disease risk for ET.
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Affiliation(s)
- Jay P Ross
- Department of Medical Genetics, University of British Columbia, Vancouver British Columbia, Canada
| | - Sruti Rayaprolu
- Department of Neuroscience, Mayo Clinic, Jacksonville, Florida, USA
| | - Cecily Q Bernales
- Department of Medical Genetics, University of British Columbia, Vancouver British Columbia, Canada
| | | | - Jay van Gerpen
- Department of Neurology, Mayo Clinic, Jacksonville, Florida, USA
| | - Ryan J Uitti
- Department of Neurology, Mayo Clinic, Jacksonville, Florida, USA
| | | | - Alex Rajput
- Division of Neurology, University of Saskatchewan and Saskatoon Health Region, Saskatoon Saskatchewan, Canada
| | - Ali H Rajput
- Division of Neurology, University of Saskatchewan and Saskatoon Health Region, Saskatoon Saskatchewan, Canada
| | - Michele L Rajput
- Division of Neurology, University of Saskatchewan and Saskatoon Health Region, Saskatoon Saskatchewan, Canada
| | - Owen A Ross
- Department of Neuroscience, Mayo Clinic, Jacksonville, Florida, USA
| | - Carles Vilariño-Güell
- Department of Medical Genetics, University of British Columbia, Vancouver British Columbia, Canada.
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Rajput A, Rajput AH, Rajput ML, Encarnacion M, Bernales CQ, Ross JP, Farrer MJ, Vilariño-Güell C. Identification of FUS p.R377W in essential tremor. Eur J Neurol 2013; 21:361-3. [PMID: 23834483 DOI: 10.1111/ene.12231] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [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: 05/07/2013] [Accepted: 06/05/2013] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND PURPOSE Exome sequencing analysis has recently identified a nonsense mutation in fused in sarcoma (FUS) segregating with essential tremor (ET) within a large French-Canadian family. Further characterization of FUS resulted in the identification of additional mutations in ET patients; however, their pathogenicity still remains to be confirmed. The role of FUS in an independent cohort of ET patients from Canada was evaluated. METHODS The entire coding sequence of FUS in 217 patients diagnosed with ET was analyzed and two missense variants in 219 healthy controls were genotyped by Sanger sequencing. RESULTS Sequencing of FUS identified a previously reported non-pathogenic mutation p.G174_G175del in one ET patient and two healthy controls, and a novel p.R377W in one patient with family history of disease. This mutation is highly conserved and strongly predicted to be damaging by in silico analysis. CONCLUSION This study has identified a novel FUS p.R377W substitution in ET patients. Additional genotyping studies in a large number of ET patients and controls are necessary to conclusively define its pathogenicity.
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Affiliation(s)
- A Rajput
- Division of Neurology, University of Saskatchewan and Saskatoon Health Region, Saskatoon, SK, Canada
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Abstract
OBJECT Investigators conducting the International Study of Unruptured Intracranial Aneurysms, sponsored by the National Institutes of Health, sought to evaluate predictors of future hemorrhage in patients who had unruptured mirror aneurysms. These paired aneurysms in bilateral arterial positions mirror each other; their natural history is unknown. METHODS Centers in the US, Canada, and Europe enrolled patients for prospective assessment of unruptured intracranial aneurysms. Central radiological review confirmed the presence or absence of mirror aneurysms in patients without a history of prior subarachnoid hemorrhage (SAH) (Group 1). Outcome at 1 and 5 years and aneurysm characteristics are compared. RESULTS Of 3120 patients with aneurysms treated in 61 centers, 376 (12%) had mirror aneurysms, which are more common in women than men (82% [n = 308] vs 73% [n = 1992], respectively; p <0.001) and in patients with a family history of aneurysm or SAH (p <0.001). Compared with patients with nonmirror saccular aneurysms, a greater percentage of patients with mirror aneurysms had larger (>10 mm) aneurysms (mean maximum diameter 11.7 vs 10.4 mm, respectively; p <0.001). The most common distribution for mirror aneurysms was the middle cerebral artery (34% [126 patients]) followed by noncavernous internal carotid artery (32% [121]), posterior communicating artery (16% [60]), cavernous internal carotid artery (13% [48]), anterior cerebral artery/anterior communicating artery (3% [13]), and vertebrobasilar circulation (2% [8]). When these patients were compared with patients without mirror aneurysms, no statistically significant differences were found in age (mean age 54 years in both groups), blood pressure, smoking history, or cardiac disease. Aneurysm rupture rates were similar (3.0% for patients with mirror aneurysms vs 2.8% for those without). CONCLUSIONS Overall, patients with mirror aneurysms were more likely to be women, to report a family history of aneurysmal SAH, and to have larger aneurysms. The presence of a mirror aneurysm was not an independent predictor of future SAHs.
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Affiliation(s)
- Irene Meissner
- Department of Neurology, Mayo Clinic, Rochester, Minnesota 55905, USA.
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Rajput A, Vilariño-Güell C, Rajput ML, Ross OA, Soto-Ortolaza AI, Lincoln SJ, Cobb SA, Heckman MG, Farrer MJ, Rajput A. Alpha-synuclein polymorphisms are associated with Parkinson's disease in a Saskatchewan population. Mov Disord 2010; 24:2411-4. [PMID: 19890971 DOI: 10.1002/mds.22795] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Alpha-synuclein gene (SNCA) mutations cause familial Parkinsonism but the role of SNCA variability in idiopathic Parkinson's disease (PD) remains incompletely defined. We report a study of SNCA genetic variation in 452 idiopathic PD cases and 245 controls. SNCA copy number mutations were not associated with early-onset disease in this population. The minor allele "G" at rs356165 was associated with increased odds of PD (P = 0.013) and genetic variation in D4S3481 (Rep1) was associated with age of disease onset (P = 0.007). There was a trend toward association between variation at rs2583988 and rapid PD progression.
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Affiliation(s)
- Alex Rajput
- Division of Neurology, University of Saskatchewan and Saskatoon Health Region, Saskatoon, Saskatchewan, Canada
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Abstract
BACKGROUND Individual variations in the course of Lewy body Parkinson disease (PD) are well known. Patients have been classified into different clinical subtypes to identify differences in the course among the subgroups. Several studies indicate that the outcome is more favorable in tremor dominant (TD) cases but others report no difference. A majority of progression studies are based on cross-sectional single point data or short-term clinical observations. The lack of longitudinally followed autopsy-confirmed PD cohort remains a major weakness in the literature. Biochemical studies of brain indicate most pronounced abnormalities in akinetic/rigid (AR) and the least in TD cases. We postulate that PD course in these subtypes is concordant with the biochemical findings. OBJECTIVE To compare the course in TD, mixed (MX), and AR subtypes of PD. METHODS Longitudinal clinical follow-up and autopsy studies were performed on 166 patients with PD over 39 years (1968-2006). Patients were classified into TD, AR, and MX based on the entire clinical course. Only the pathologically confirmed PD cases were included. RESULTS Sixty-six percent of cases had MX, 26% AR, and 8% TD profile. The age at onset was younger (p < 0.001) and progression to Hoehn & Yahr stage 4 was slower (p = 0.016) in the TD cases. Dementia was most common in AR (p = 0.039) and the least common in TD. In general, the course was most favorable in TD, followed by MX and AR subgroups. CONCLUSION The three subtypes of Parkinson disease have different courses which are concordant with the differences in brain biochemical abnormalities.
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Affiliation(s)
- A H Rajput
- Division of Neurology, Department of Pathology, Saskatoon Health Region/University of Saskatchewan, Canada
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Ferguson LW, Rajput ML, Rajput A. Comment on “Individualized Assessment of Quality of Life in Idiopathic Parkinson's Disease”. Mov Disord 2009; 24:630-2. [DOI: 10.1002/mds.22064] [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: 11/05/2022] Open
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Wider C, Lincoln SJ, Heckman MG, Diehl NN, Stone JT, Haugarvoll K, Aasly JO, Gibson JM, Lynch T, Rajput A, Rajput ML, Uitti RJ, Wszolek ZK, Farrer MJ, Ross OA. Phactr2 and Parkinson's disease. Neurosci Lett 2009; 453:9-11. [PMID: 19429005 DOI: 10.1016/j.neulet.2009.02.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2008] [Revised: 01/14/2009] [Accepted: 02/04/2009] [Indexed: 11/18/2022]
Abstract
Attempts at replicating the first genome-wide association study (GWAS) in Parkinson's disease (PD) have not successfully identified genetic risk factors. The present study reevaluates data from the first GWAS and focuses on the SNP (rs11155313, located in the Phactr2 gene) with the lowest P-value in the Tier 2 patient-control series. We employed four case-control series to examine the nominated SNP rs11155313 and identified association in US (OR: 1.39, P=0.032), Canadian (OR: 1.41, P=0.014) and Irish (OR: 1.44, P=0.034) patient-control series, but not in the Norwegian series (OR: 1.15, P=0.27). When combining all four series the observed trend was statistically significant (OR: 1.30, P<0.001). This study shows that reappraisal of publicly available results of GWAS may help nominate new risk factors for PD.
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Affiliation(s)
- Christian Wider
- Department of Neuroscience, Mayo Clinic, Jacksonville, FL, USA
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Ferguson LW, Rajput ML, Muhajarine N, Shah SM, Rajput A. Clinical features at first visit and rapid disease progression in Parkinson's disease. Parkinsonism Relat Disord 2008; 14:431-5. [DOI: 10.1016/j.parkreldis.2007.10.012] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2007] [Revised: 09/24/2007] [Accepted: 10/14/2007] [Indexed: 10/22/2022]
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Rajput A, Dickson DW, Robinson CA, Ross OA, Dächsel JC, Lincoln SJ, Cobb SA, Rajput ML, Farrer MJ. Parkinsonism, Lrrk2 G2019S, and tau neuropathology. Neurology 2006; 67:1506-8. [PMID: 17060589 DOI: 10.1212/01.wnl.0000240220.33950.0c] [Citation(s) in RCA: 164] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Lrrk2 G2019S is predominantly associated with alpha-synuclein-immunopositive Lewy body pathology. We have identified Family SK where Lrrk2 G2019S segregates with slowly progressive parkinsonism and the affected proband has tau-immunopositive neurofibrillary tangle pathology. Thus alpha-synucleinopathy and tauopathy, the predominant pathologies associated with parkinsonism, may be alternate outcomes of the same underlying genetic cause. Intriguingly, we observe no evidence of a direct interaction between either the tau or alpha-synuclein protein with Lrrk2.
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Affiliation(s)
- A Rajput
- Division of Neurology, University of Saskatchewan and Saskatoon Health Region, Saskatoon, Saskatchewan, Canada
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Abstract
BACKGROUND Previous open-label trials have shown iron to be efficacious in the treatment of restless legs syndrome. We performed a randomized, double-blind, placebo-controlled trial of iron sulfate. METHODS Twenty-eight patients were randomized to receive either ferrous sulfate 325 mg b.i.d. or placebo for 12 weeks. The primary outcome measure was the dichotomous variable of improvement or no improvement in average quality of sleep as recorded by a visual analog scale nightly over a 2-week period, comparing a pretreatment 2-week baseline to weeks 13-14. Secondary outcome measures included a comparison of the quality of sleep as measured by a visual analog scale, effect of restless legs syndrome on life as a whole as measured by a different visual analog scale, and the percentage of nights patients were symptomatic. RESULTS No significant differences were noted between iron and placebo groups for both primary and secondary outcome measures. Responders taking iron did have a significant increase in their iron saturation compared to nonresponders taking iron. CONCLUSIONS Iron sulfate does not appear to be an effective empiric treatment for restless legs syndrome.
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Affiliation(s)
- B J Davis
- Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA.
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