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Dale ML, Silva-Batista C, de Almeida FO, Horak FB. Balance and gait in progressive supranuclear palsy: a narrative review of objective metrics and exercise interventions. Front Neurol 2023; 14:1212185. [PMID: 37426438 PMCID: PMC10327556 DOI: 10.3389/fneur.2023.1212185] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 05/30/2023] [Indexed: 07/11/2023] Open
Abstract
Background The use of objective gait and balance metrics is rapidly expanding for evaluation of atypical parkinsonism, and these measures add to clinical observations. Evidence for rehabilitation interventions to improve objective measures of balance and gait in atypical parkinsonism is needed. Aim Our aim is to review, with a narrative approach, current evidence on objective metrics for gait and balance and exercise interventions in progressive supranuclear palsy (PSP). Methods Literature searches were conducted in four computerized databases from the earliest record up to April 2023: PubMed, ISI's Web of Knowledge, Cochrane's Library, and Embase. Data were extracted for study type (cross-sectional, longitudinal, and rehabilitation interventions), study design (e.g., experimental design and case series), sample characteristics, and gait and balance measurements. Results Eighteen gait and balance (16 cross-sectional and 4 longitudinal) and 14 rehabilitation intervention studies were included. Cross-sectional studies showed that people with PSP have impairments in gait initiation and steady-state gait using wearable sensors, and in static and dynamic balance assessed by posturography when compared to Parkinson's disease (PD) and healthy controls. Two longitudinal studies observed that wearable sensors can serve as objective measures of PSP progression, using relevant variables of change in turn velocity, stride length variability, toe off angle, cadence, and cycle duration. Rehabilitation studies investigated the effect of different interventions (e.g., balance training, body-weight supported treadmill gait, sensorimotor training, and cerebellar transcranial magnetic stimulation) on gait, clinical balance, and static and dynamic balance assessed by posturography measurements. No rehabilitation study in PSP used wearable sensors to evaluate gait and balance impairments. Although clinical balance was assessed in 6 rehabilitation studies, 3 of these studies used a quasi-experimental design, 2 used a case series, only 1 study used an experimental design, and sample sizes were relatively small. Conclusion Wearable sensors to quantify balance and gait impairments are emerging as a means of documenting progression of PSP. Robust evidence for improving balance and gait in PSP was not found for rehabilitation studies. Future powered, prospective and robust clinical trials are needed to investigate the effects of rehabilitation interventions on objective gait and balance outcomes in people with PSP.
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Affiliation(s)
- Marian L. Dale
- Balance Disorders Laboratory, Department of Neurology, Oregon Health and Science University, Portland, OR, United States
- Neurology Section, VA Portland Health Care System, Veterans Health Administration, Portland, OR, United States
| | - Carla Silva-Batista
- Balance Disorders Laboratory, Department of Neurology, Oregon Health and Science University, Portland, OR, United States
- Exercise Neuroscience Research Group, University of São Paulo, São Paulo, Brazil
| | | | - Fay B. Horak
- Balance Disorders Laboratory, Department of Neurology, Oregon Health and Science University, Portland, OR, United States
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Naito R, Watanabe Y, Naito A, Sugasawa K, Nakata Y, Kamiyama T, Okiyama R, Yokochi F, Isozaki E, Yamasoba T, Takahashi K. Visual fixation suppression of caloric nystagmus in progressive supranuclear palsy - A comparison with Parkinson's disease. J Vestib Res 2023; 33:385-401. [PMID: 37599554 DOI: 10.3233/ves-210147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/22/2023]
Abstract
BACKGROUND Impairment of visual fixation suppression (VS) in progressive supranuclear palsy (PSP) is not well documented. OBJECTIVE To evaluate the usefulness of impaired VS of caloric nystagmus as an index for differential diagnosis between PSP and Parkinson's disease (PD), which is often difficult, especially in the early stage. METHODS Subjects comprised 26 PSP patients and 26 PD patients clinically diagnosed at Tokyo Metropolitan Neurological Hospital. We retrospectively investigated VS of caloric nystagmus, horizontal pursuit, saccades, and horizontal optokinetic nystagmus recorded on direct-current-electronystagmography, and neuroradiological findings. RESULTS The median of the average VS% was 0% and 50.0% in PSP and PD patients, respectively. In PSP, VS was impaired even in the early stage of disease. We found a significant correlation between VS and velocity of saccades or maximum slow phase velocity of optokinetic nystagmus only in PSP patients. PSP patients with atrophy of the subthalamic nucleus or with decreased blood flow in the frontal lobe showed significantly more severe impairment of VS. CONCLUSIONS VS may be a useful biomarker to differentiate patients with PSP from those with PD. Cerebellar networks that connect with the cerebral cortex and basal ganglia may contribute to impaired VS of caloric nystagmus in PSP.
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Affiliation(s)
- Rie Naito
- Department of Neuro-Otology, Tokyo Metropolitan Neurological Hospital, Fuchu, Tokyo, Japan
| | - Yuki Watanabe
- Department of Neuro-Otology, Tokyo Metropolitan Neurological Hospital, Fuchu, Tokyo, Japan
| | - Akira Naito
- Department of Neuro-Otology, Tokyo Metropolitan Neurological Hospital, Fuchu, Tokyo, Japan
| | - Keiko Sugasawa
- Department of Neuro-Otology, Tokyo Metropolitan Neurological Hospital, Fuchu, Tokyo, Japan
| | - Yasuhiro Nakata
- Department of Neuro-Radiology, Tokyo Metropolitan Neurological Hospital, Fuchu, Tokyo, Japan
| | - Tsutomu Kamiyama
- Department of Neuro-Radiology, Tokyo Metropolitan Neurological Hospital, Fuchu, Tokyo, Japan
| | - Ryoichi Okiyama
- Department of Neurology, Tokyo Metropolitan Neurological Hospital, Fuchu, Tokyo, Japan
| | - Fusako Yokochi
- Department of Neurology, Tokyo Metropolitan Neurological Hospital, Fuchu, Tokyo, Japan
| | - Eiji Isozaki
- Department of Neurology, Tokyo Metropolitan Neurological Hospital, Fuchu, Tokyo, Japan
| | - Tatsuya Yamasoba
- Department of Otolaryngology and Head and Neck Surgery, Graduate School of Medicines, University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Kazushi Takahashi
- Department of Neurology, Tokyo Metropolitan Neurological Hospital, Fuchu, Tokyo, Japan
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Yoshida M, Akagi A, Miyahara H, Riku Y, Ando T, Ikeda T, Yabata H, Moriyoshi H, Koizumi R, Iwasaki Y. Macroscopic diagnostic clue for parkinsonism. Neuropathology 2022; 42:394-419. [PMID: 35996308 DOI: 10.1111/neup.12853] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 07/09/2022] [Accepted: 07/11/2022] [Indexed: 12/25/2022]
Abstract
The neuropathological background of parkinsonism includes various neurodegenerative disorders, including Lewy body disease (LBD), multiple system atrophy (MSA), progressive supranuclear palsy (PSP), and corticobasal degeneration (CBD). The pathological diagnostic procedure begins by assessing the macroscopic findings to evaluate the degenerative lesions in brains with the naked eye. Usually, degenerative lesions show variable atrophy and brownish discoloration in accordance with disease-specific profiles. These macroscopic appearances support neuropathologists in identifying the relevant regions for microscopic examination. The neuropathological diagnosis of parkinsonism is based on regional distribution and fundamental proteinopathies in neurons and glia cells. LBD and MSA are synucleinopathies, and PSP and CBD are tauopathies. Among them, glial-predominant proteinopathy (MSA, PSP, and CBD) may play a significant role in volume reduction. Therefore, macroscopic inspection provides the appropriate direction for assessment. The disease duration, the severity of lesions, and mixed pathologies make the validation of macroscopic observations more complicated. In this review, we outline the macroscopic diagnostic clues in LBD, MSA, PSP, and CBD that could help with pathological refinement.
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Affiliation(s)
- Mari Yoshida
- Department of Neuropathology, Institute for Medical Science of Aging, Aichi Medical University, Nagakute, Japan
| | - Akio Akagi
- Department of Neuropathology, Institute for Medical Science of Aging, Aichi Medical University, Nagakute, Japan
| | - Hiroaki Miyahara
- Department of Neuropathology, Institute for Medical Science of Aging, Aichi Medical University, Nagakute, Japan
| | - Yuichi Riku
- Department of Neuropathology, Institute for Medical Science of Aging, Aichi Medical University, Nagakute, Japan.,Department of Neurology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Takashi Ando
- Department of Neuropathology, Institute for Medical Science of Aging, Aichi Medical University, Nagakute, Japan.,Department of Neurology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Toshimasa Ikeda
- Department of Neuropathology, Institute for Medical Science of Aging, Aichi Medical University, Nagakute, Japan.,Department of Neurology and Neuroscience, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Hiroyuki Yabata
- Department of Neuropathology, Institute for Medical Science of Aging, Aichi Medical University, Nagakute, Japan.,Department of Neurology, Shiga University of Medical Science, Ohtsu
| | - Hideyuki Moriyoshi
- Department of Neuropathology, Institute for Medical Science of Aging, Aichi Medical University, Nagakute, Japan.,Department of Neurology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Ryuichi Koizumi
- Department of Neuropathology, Institute for Medical Science of Aging, Aichi Medical University, Nagakute, Japan.,Department of Neurology and Stroke Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Yasushi Iwasaki
- Department of Neuropathology, Institute for Medical Science of Aging, Aichi Medical University, Nagakute, Japan
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Jecmenica Lukic M, Respondek G, Kurz C, Compta Y, Gelpi E, Ferguson LW, Rajput A, Troakes C, van Swieten JC, Giese A, Roeber S, Herms J, Arzberger T, Höglinger G. Long-duration progressive supranuclear palsy: clinical course and pathological underpinnings. Ann Neurol 2022; 92:637-649. [PMID: 35872640 DOI: 10.1002/ana.26455] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 06/21/2022] [Accepted: 07/17/2022] [Indexed: 11/10/2022]
Abstract
OBJECTIVES To identify the clinical characteristics of the subgroup of benign progressive supranuclear palsy with particularly long disease duration; to define neuropathological determinants underlying variability in disease duration in progressive supranuclear palsy. METHODS Clinical and pathological features were compared among 186 autopsy-confirmed cases with progressive supranuclear palsy with ≥10 years and shorter survival times. RESULTS 45 cases (24.2%) had a disease duration of ≥10 years. The absence of ocular motor abnormalities within the first 3 years from disease onset was the only significant independent clinical predictor of longer survival. Histopathologically, the neurodegeneration parameters in each survival group were paralleled anatomically by the distribution of neuronal cytoplasmic inclusions, whereas the tufted astrocytes displayed anatomically an opposite severity pattern. Most interestingly, we found significantly less coiled bodies in those who survive longer, in contrast to patients with less favorable course. INTERPRETATIONS A considerable proportion of patients had a more 'benign' disease course with ≥10 years survival. They had a distinct pattern and evolution of core symptoms compared to patients with short survival. The inverted anatomical patterns of astrocytic tau distribution suggest distinct implications of these cell types in trans-cellular propagation. The tempo of disease progression appeared to be determined mostly by oligodendroglial tau, where high degree of oligodendroglial tau pathology might affect neuronal integrity and function on top of neuronal tau pathology. The relative contribution of glial tau should be further explored in cellular and animal models. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Milica Jecmenica Lukic
- German Center for Neurodegenerative Diseases (DZNE), Munich, Germany.,Clinic of Neurology, The University Clinical Center of Serbia, Belgrade, Republic of Serbia
| | - Gesine Respondek
- Department of Neurology, Hannover Medical School, Hannover, Germany
| | - Carolin Kurz
- German Center for Neurodegenerative Diseases (DZNE), Munich, Germany.,Department of Psychiatry and Psychotherapy, University Hospital, LMU, Munich, Germany
| | - Yaroslau Compta
- Parkinson's Disease & Movement Disorders Unit, Hospital Clínic de Barcelona / IDIBAPS / CIBERNED / (CB06/05/0018-ISCIII) / European Reference Network for Rare Neurological Diseases (ERN-RND) / Institut de Neurociències, Universitat de Barcelona, Catalonia, Spain
| | - Ellen Gelpi
- Neurological Tissue Bank and Neurology Department, Hospital Clínic de Barcelona, Universitat de Barcelona, IDIBAPS, Centres de Recerca de Catalunya (CERCA), Barcelona, Catalonia, Spain.,Institute of Neurology, Medical University of Vienna, Vienna, Austria
| | - Leslie W Ferguson
- Division of Neurology, Royal University Hospital, University of Saskatchewan, Canada
| | - Alex Rajput
- Division of Neurology, Royal University Hospital, University of Saskatchewan, Canada
| | - Claire Troakes
- London Neurodegenerative Diseases Brain Bank, Institute of Psychiatry, London, United Kingdom
| | | | - John C van Swieten
- Department of Neurology, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Armin Giese
- Center for Neuropathology and Prion Research, Munich, LMU, Munich, Germany
| | - Sigrun Roeber
- Center for Neuropathology and Prion Research, Munich, LMU, Munich, Germany
| | - Jochen Herms
- German Center for Neurodegenerative Diseases (DZNE), Munich, Germany.,Center for Neuropathology and Prion Research, Munich, LMU, Munich, Germany
| | - Thomas Arzberger
- German Center for Neurodegenerative Diseases (DZNE), Munich, Germany.,Department of Psychiatry and Psychotherapy, University Hospital, LMU, Munich, Germany.,Center for Neuropathology and Prion Research, Munich, LMU, Munich, Germany.,Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
| | - Günter Höglinger
- German Center for Neurodegenerative Diseases (DZNE), Munich, Germany.,Department of Neurology, Hannover Medical School, Hannover, Germany.,Department of Neurology, Klinikum rechts der Isar, Technical University of Munich, Germany
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Association of PSP phenotypes with survival: A brain-bank study. Parkinsonism Relat Disord 2021; 84:77-81. [PMID: 33581485 DOI: 10.1016/j.parkreldis.2021.01.015] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 12/18/2020] [Accepted: 01/20/2021] [Indexed: 11/22/2022]
Abstract
INTRODUCTION The MDS-PSP criteria expand the phenotypic spectrum of PSP by adding to Richardson's syndrome (PSP-RS) other presentations such as PSP-parkinsonism (PSP-P), PSP-pure-gait-freezing (PSP-PGF), PSP-speech-language (PSP-SL), PSP-frontal (PSP-F), PSP-postural-instability (PSP-PI) and PSP-corticobasal-syndrome (PSP-CBS). Evidence about the prognostic differences between PSP phenotypes is scarce and focused on PSP-RS vs. non-PSP-RS. Using a brain-bank cohort we assessed PSP survival not only in PSP-RS vs. non-PSP-RS, but also in PSP-RS + cortical vs. subcortical phenotypes. Besides, we assessed sensitivity and specificity of the MDS-PSP criteria in of PSP and other degenerative parkinsonisms. METHODS We retrospectively applied the MDS-PSP diagnostic criteria to 32 definite PSP cases and 30 cases with other degenerative parkinsonian syndromes (Parkinson's disease [PD; n = 11], multiple system atrophy [MSA; n = 11], corticobasal degeneration [CBD; n = 8]). We conducted survival statistics in neuropathologically confirmed PSP cases considering PSP-RS vs. non-PSP-RS and PSP-RS + PSP-cortical (PSP-F + PSP-SL + PSP-CBS) vs. PSP-subcortical (PSP-P + PSP-PGF) phenotypes. We also adjusted survival analyses for PSP tau scores. RESULTS Diagnostic sensitivity was 100% and specificity ranged from 47% to 87% when excluding cases that met the "suggestive of PSP" definition early in their disease course but with other clinical features better matching with a non-PSP pathological diagnosis. Survival was significantly shorter in PSP-RS vs. non-PSP-RS cases, but it was more markedly shorter in PSP-RS + PSP-cortical vs. PSP-subcortical, independently of PSP tau scores, which were not associated with survival. CONCLUSIONS PSP-subcortical phenotypes appear to have longer survival than PSP-RS and cortical phenotypes. This might be of prognostic relevance when informing patients upon clinical diagnosis.
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Mahale RR, Krishnan S, Divya KP, Jisha VT, Kishore A. Subtypes of PSP and Prognosis: A Retrospective Analysis. Ann Indian Acad Neurol 2021; 24:56-62. [PMID: 33911380 PMCID: PMC8061531 DOI: 10.4103/aian.aian_611_20] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 08/27/2020] [Accepted: 09/16/2020] [Indexed: 11/04/2022] Open
Abstract
Background Progressive supranuclear palsy (PSP) is a clinically heterogeneous disease characterized by supranuclear gaze palsy and varying combinations of Parkinsonism, gait disturbances, postural instability, and fronto-limbic cognitive dysfunction. A major challenge in clinical diagnosis is the existence of subtypes whose clinical features overlap with those of other Parkinsonian disorders. Objectives To categorize patients of PSP into its using the recently proposed movement disorder society criteria (2017) and to determine the prognosis of the PSP subtypes. Methods Demographic and clinical data of patients diagnosed with PSP over a 21 year period were collected by review of medical records and categorized into its subtypes. Subtype prognosis was assessed from the interval between disease onset and attainment of the first of 5 clinical disability milestones namely wheelchair dependency, unintelligible speech, severe dysphagia, severe cognitive impairment, and urinary catheterization. Results When categorized into subtypes, out of the 334 patients with PSP, PSP-RS predominated (72%), followed by PSP-parkinsonism (PSP-P) (13.5%), PSP-corticobasal syndrome (PSP-CBS) (5.1%), PSP-frontal (PSP-F) (4.2%), PSP-progressive gait freezing (PSP-PGF) (4.2%), PSP-postural instability (PSP-PI) (0.6%), and PSP-speech/language (PSP-SL) (0.3%). PSP-P reaches the milestones of wheelchair dependency, unintelligible speech, and dysphagia later than other subtypes. Conclusion PSP-RS was the commonest and PSP-OM the rarest PSP subtype in our retrospective PSP cohort analysis. PSP-P had a better prognosis than all other subtypes of PSP. A large proportion of these cases would remain unclassified using NINDS-SPSP (1996) criteria.
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Affiliation(s)
- Rohan R Mahale
- Department of Neurology, Sree Chitra Tirunal Institute of Medical Sciences and Technology (SCTIMST), Trivandrum, Kerala, India
| | - Syam Krishnan
- Department of Neurology, Sree Chitra Tirunal Institute of Medical Sciences and Technology (SCTIMST), Trivandrum, Kerala, India
| | - K P Divya
- Department of Neurology, Sree Chitra Tirunal Institute of Medical Sciences and Technology (SCTIMST), Trivandrum, Kerala, India
| | - V T Jisha
- Achutha Menon Centre for Health Science Studies (AMCHSS), Sree Chitra Tirunal Institute of Medical Sciences and Technology (SCTIMST), Trivandrum, Kerala, India
| | - Asha Kishore
- Department of Neurology, Sree Chitra Tirunal Institute of Medical Sciences and Technology (SCTIMST), Trivandrum, Kerala, India
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7
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Alausa A, Ogundepo S, Olaleke B, Adeyemi R, Olatinwo M, Ismail A. Chinese nutraceuticals and physical activity; their role in neurodegenerative tauopathies. Chin Med 2021; 16:1. [PMID: 33407732 PMCID: PMC7789572 DOI: 10.1186/s13020-020-00418-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 12/22/2020] [Indexed: 12/12/2022] Open
Abstract
The onset of neurodegenerative disease has not only been a major cause of scientific worry, but of economic burden to the health system. This condition has been further attributed to mis-stability, deletion or mutation of tau protein, causing the onset of Corticobasal degeneration, Pick's diseases, Progressive supranuclear palsy, Argyrophilic grains disease, Alzheimer's diseases etc. as scientifically renowned. This is mainly related to dysregulation of translational machinery, upregulation of proinflammatory cytokines and inhibition of several essential cascades such as ERK signaling cascade, GSK3β, CREB, and PKA/PKB (Akt) signaling cascades that enhances protein processing, normal protein folding, cognitive function, and microtubule associated tau stability. Administration of some nutrients and/or bioactive compounds has a high tendency to impede tau mediated inflammation at neuronal level. Furthermore, prevention and neutralization of protein misfolding through modulation of microtubule tau stability and prevention of protein misfolding is by virtue few of the numerous beneficial effects of physical activity. Of utmost important in this study is the exploration of promising bioactivities of nutraceuticals found in china and the ameliorating potential of physical activity on tauopathies, while highlighting animal and in vitro studies that have been investigated for comprehensive understanding of its potential and an insight into the effects on human highly probable to tau mediated neurodegeneration.
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Affiliation(s)
- Abdullahi Alausa
- Department of Biochemistry, Faculty of Basic Medical Sciences, Ladoke Akintola University of Technology, Ogbomoso, Oyo, Nigeria
| | - Sunday Ogundepo
- Department of Biochemistry, Faculty of Basic Medical Sciences, Ladoke Akintola University of Technology, Ogbomoso, Oyo, Nigeria
| | - Barakat Olaleke
- Department of Biochemistry, Faculty of Basic Medical Sciences, Ladoke Akintola University of Technology, Ogbomoso, Oyo, Nigeria
| | - Rofiat Adeyemi
- Department of Biochemistry, Faculty of Basic Medical Sciences, Ladoke Akintola University of Technology, Ogbomoso, Oyo, Nigeria.
| | - Mercy Olatinwo
- Department of Biochemistry, Faculty of Basic Medical Sciences, Ladoke Akintola University of Technology, Ogbomoso, Oyo, Nigeria
| | - Aminat Ismail
- Department of Science Laboratory Technology, Faculty of Pure & Applied Sciences, Ladoke Akintola University of Technology, Ogbomoso, Oyo, Nigeria
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Behari M. Commentary on PSP Subtypes in India. Ann Indian Acad Neurol 2021; 24:3-4. [PMID: 33911369 PMCID: PMC8061511 DOI: 10.4103/aian.aian_1047_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 10/12/2020] [Indexed: 11/17/2022] Open
Affiliation(s)
- Madhuri Behari
- Department of Neurology, Flt. Lt. Rajan Dhall Fortis Hospital, Vasant Kunj, New Delhi, India
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9
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Coughlin DG, Dickson DW, Josephs KA, Litvan I. Progressive Supranuclear Palsy and Corticobasal Degeneration. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2021; 1281:151-176. [PMID: 33433875 DOI: 10.1007/978-3-030-51140-1_11] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Progressive supranuclear palsy (PSP) and corticobasal degeneration (CBD) are neurodegenerative tauopathies with neuronal and glial lesions composed of tau that is composed predominantly of isomers with four repeats in the microtubule-binding domain (4R tau). The brain regions vulnerable to pathology in PSP and CBD overlap, but there are differences, particularly with respect to distribution of neuronal loss, the relative abundance of neuronal and glial lesions, the morphologic features of glial lesions, and the frequency of comorbid pathology. Both PSP and CBD have a wide spectrum of clinical manifestations, including disorders of movement and cognition. Recognition of phenotypic diversity in PSP and CBD may improve antemortem diagnostic accuracy, which tends to be very good for the most common presentation of PSP (Richardson syndrome), but poor for the most characteristic presentation of CBD (corticobasal syndrome: CBS). Development of molecular and imaging biomarkers may improve antemortem diagnostic accuracy. Currently, multidisciplinary symptomatic and supportive treatment with pharmacological and non-pharmacological strategies remains the standard of care. In the future, experimental therapeutic trials will be important to slow disease progression.
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Affiliation(s)
| | | | | | - Irene Litvan
- UC San Diego Department of Neurosciences, La Jolla, CA, USA.
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10
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Coughlin DG, Litvan I. Progressive supranuclear palsy: Advances in diagnosis and management. Parkinsonism Relat Disord 2020; 73:105-116. [PMID: 32487421 PMCID: PMC7462164 DOI: 10.1016/j.parkreldis.2020.04.014] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 04/28/2020] [Accepted: 04/29/2020] [Indexed: 02/07/2023]
Abstract
Progressive supranuclear palsy (PSP) is a complex clinicopathologic disease with no current cure or disease modulating therapies that can only be definitively confirmed at autopsy. Growing understanding of the phenotypic diversity of PSP has led to expanded clinical criteria and new insights into etiopathogenesis that coupled with improved in vivo biomarkers makes increased access to current clinical trials possible. Current standard-of-care treatment of PSP is multidisciplinary, supportive and symptomatic, and several trials of potentially disease modulating agents have already been completed with disappointing results. Current ongoing clinical trials target the abnormal aggregation of tau through a variety of mechanisms including immunotherapy and gene therapy offer a more direct method of treatment. Here we review PSP clinicopathologic correlations, in vivo biomarkers including MRI, PET, and CSF biomarkers. We additionally review current pharmacologic and non-pharmacologic methods of treatment, prior and ongoing clinical trials in PSP. Newly expanded clinical criteria and improved specific biomarkers will aid in identifying patients with PSP earlier and more accurately and expand access to these potentially beneficial clinical trials.
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Affiliation(s)
- David G Coughlin
- Department of Neurosciences, University of California San Diego, San Diego, CA, 92093, USA
| | - Irene Litvan
- Department of Neurosciences, University of California San Diego, San Diego, CA, 92093, USA.
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Abstract
Objectives: Recently, new criteria for sensitive and specific clinical diagnosis of progressive supranuclear palsy (PSP) have been addressed while distinct clinical phenotypes of the disorder have been increasingly described in the literature. This study aimed to describe past and present aspects of the disease as well as to highlight the cognitive and behavioral profile of PSP patients in relation to the underlying pathology, genetics and treatment procedures.Methods: A Medline and Scopus search was performed to identify articles published on this topic. Articles published solely in English were considered.Results: The most common clinical characteristics of PSP included early postural instability and falls, vertical supranuclear gaze palsy, parkinsonism with poor response to levodopa and pseudobulbar palsy. Frontal dysfunction and verbal fluency deficits were the most distinct cognitive impairments in PSP while memory, visuospatial and social cognition could also be affected. Apathy and impulsivity were also present in PSP patients and had significant impact on relatives and caregivers.Conclusions: PSP is a neurodegenerative disorder with prominent tau neuropathology. Movement, motivation and communication impairments in patients with PSP may limit participation in everyday living activities. Comprehensive neuropsychological assessments are of significant importance for PSP cognitive evaluation. Pharmacologic and non-pharmacologic approaches could be applied in order to relieve patients and improve quality of life.Clinical Implications: Executive dysfunction is the most notable cognitive impairment and dominates the neuropsychological profile of patients with PSP.
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Affiliation(s)
| | - Kleopatra H Schulpis
- Institute of Child Health, Research Center, "Aghia Sophia" Children's Hospital, Athens, Greece
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12
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Whitwell JL, Tosakulwong N, Botha H, Ali F, Clark HM, Duffy JR, Utianski RL, Stevens CA, Weigand SD, Schwarz CG, Senjem ML, Jack CR, Lowe VJ, Ahlskog JE, Dickson DW, Josephs KA. Brain volume and flortaucipir analysis of progressive supranuclear palsy clinical variants. NEUROIMAGE-CLINICAL 2019; 25:102152. [PMID: 31935638 PMCID: PMC6961761 DOI: 10.1016/j.nicl.2019.102152] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/05/2019] [Revised: 11/25/2019] [Accepted: 12/26/2019] [Indexed: 12/12/2022]
Abstract
All PSP variants showed atrophy or flortaucipir uptake in subcortical structures. Speech/language, frontal and corticobasal variants showed cortical involvement. Dentatorubrothalamic tract involvement was only seen in some variants. PSP variants show different patterns of damage to subcortical-cortical circuitry.
Background and purpose Progressive supranuclear palsy (PSP) is a neurodegenerative tauopathy that is associated with different clinical variants, including PSP-Richardson's syndrome (PSP-RS), PSP-parkinsonism (PSP-P), PSP-corticobasal syndrome (PSP-CBS), PSP-frontal (PSP-F), PSP-progressive gait freezing (PSP-PGF) and PSP-speech/language (PSP-SL). While PSP-RS has been well-characterized on neuroimaging, the characteristics of the other atypical variants are less well defined and it is unknown how they compare to each other or relate to neuropathology. We aimed to assess and compare regional atrophy on MRI and [18F]flortaucipir uptake on PET across PSP variants. Materials and methods 105 PSP patients (53 PSP-RS, 23 PSP-SL, 12 PSP-P, 8 PSP-CBS, 5 PSP-F and 4 PSP-PGF) underwent volumetric MRI, with 59 of these also undergoing flortaucipir PET. Voxel-level and region-level analyses were performed comparing PSP variants to 30 controls and to each other. Semi-quantitative tau burden measurements were also performed in 21 patients with autopsy-confirmed PSP. Results All variants showed evidence for atrophy or increased flortaucipir uptake in striatum, globus pallidus and thalamus. Superior cerebellar peduncle volume loss was only observed in PSP-RS, PSP-CBS and PSP-F. Volume loss in the frontal lobes was observed in PSP-SL, PSP-CBS and PSP-F, with these variants also showing highest cortical tau burden at autopsy. The PSP-P and PSP-PGF variants showed more restricted patterns of neurodegeneration predominantly involving striatum, globus pallidus, subthalamic nucleus and thalamus. The PSP-SL variant showed greater volume loss and flortaucipir uptake in supplementary motor area and motor cortex compared to all other variants, but showed less involvement of subthalamic nucleus and midbrain. Compared to PSP-RS, PSP-P had larger midbrain volume and greater flortaucipir uptake in putamen. Conclusion The PSP variants have different patterns of involvement of subcortical circuitry, perhaps suggesting different patterns of disease spread through the brain. These findings will be important in the development of appropriate neuroimaging biomarkers for the different PSP variants.
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Affiliation(s)
| | - Nirubol Tosakulwong
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, United States
| | - Hugo Botha
- Department of Neurology, Mayo Clinic, Rochester, MN, United States
| | - Farwa Ali
- Department of Neurology, Mayo Clinic, Rochester, MN, United States
| | - Heather M Clark
- Department of Neurology, Mayo Clinic, Rochester, MN, United States
| | - Joseph R Duffy
- Department of Neurology, Mayo Clinic, Rochester, MN, United States
| | - Rene L Utianski
- Department of Neurology, Mayo Clinic, Rochester, MN, United States
| | - Chase A Stevens
- Department of Neurology, Mayo Clinic, Rochester, MN, United States
| | - Stephen D Weigand
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, United States
| | | | - Matthew L Senjem
- Department of Radiology, Mayo Clinic, Rochester, MN, United States; Department of Information Technology, Mayo Clinic, Rochester, MN, United States
| | - Clifford R Jack
- Department of Radiology, Mayo Clinic, Rochester, MN, United States
| | - Val J Lowe
- Department of Radiology, Mayo Clinic, Rochester, MN, United States
| | - J Eric Ahlskog
- Department of Neurology, Mayo Clinic, Rochester, MN, United States
| | - Dennis W Dickson
- Department of Neuroscience, Mayo Clinic, Jacksonville, FL, United States
| | - Keith A Josephs
- Department of Neurology, Mayo Clinic, Rochester, MN, United States
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Giagkou N, Höglinger GU, Stamelou M. Progressive supranuclear palsy. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2019; 149:49-86. [PMID: 31779824 DOI: 10.1016/bs.irn.2019.10.013] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Progressive supranuclear palsy (PSP) is a neurodegenerative disease characterized pathologically by 4 repeat tau deposition in various cell types and anatomical regions. Richardson's syndrome (RS) is the initially described and one of the clinical phenotypes associated with PSP pathology, characterized by vertical supranuclear gaze paly in particular downwards, postural instability with early falls and subcortical frontal dementia. PSP can manifest as several other clinical phenotypes, including PSP-parkinsonism, -pure akinesia with gait freezing, -frontotemporal dementia, - corticobasal syndrome, - speech/language impairment. RS can also have a pathologic diagnosis other than PSP, including corticobasal degeneration, FTD-TDP-43 and others. New clinical diagnostic criteria take into account this phenotypic variability in an attempt to diagnose the disease earlier, given the current lack of a validated biomarker. At present, therapeutic options for PSP are symptomatic and insufficient. Recent large neuroprotective trials have failed to provide a positive clinical outcome, however, have led to the design of better studies that are ongoing and hold promise for a neuroprotective treatment for PSP.
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Affiliation(s)
- Nikolaos Giagkou
- Parkinson's Disease and Movement Disorders Department, HYGEIA Hospital, Athens, Greece
| | - Günter U Höglinger
- Department for Neurology Hannover Medical School (MHH), Hannover, Germany; German Center for Neurodegenerative Diseases (DZNE), Munich, Germany
| | - Maria Stamelou
- Parkinson's Disease and Movement Disorders Department, HYGEIA Hospital, Athens, Greece; Aiginiteion Hospital, First Department of Neurology, University of Athens, Greece; Clinic for Neurology, Philipps University, Marburg, Germany
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Picillo M, Erro R, Cuoco S, Tepedino MF, Manara R, Pellecchia MT, Barone P. MDS PSP criteria in real-life clinical setting: Motor and cognitive characterization of subtypes. Mov Disord 2018; 33:1361-1365. [PMID: 29984518 DOI: 10.1002/mds.27408] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Revised: 02/19/2018] [Accepted: 02/21/2018] [Indexed: 11/09/2022] Open
Affiliation(s)
- Marina Picillo
- Center for Neurodegenerative diseases (CEMAND), Department of Medicine and Surgery, Neuroscience section, University of Salerno, Salerno, Italy
| | - Roberto Erro
- Center for Neurodegenerative diseases (CEMAND), Department of Medicine and Surgery, Neuroscience section, University of Salerno, Salerno, Italy
| | - Sofia Cuoco
- Center for Neurodegenerative diseases (CEMAND), Department of Medicine and Surgery, Neuroscience section, University of Salerno, Salerno, Italy
| | - Maria Francesca Tepedino
- Center for Neurodegenerative diseases (CEMAND), Department of Medicine and Surgery, Neuroscience section, University of Salerno, Salerno, Italy
| | - Renzo Manara
- Radiology Unit, Department of Medicine and Surgery, Neuroscience section, University of Salerno, Salerno, Italy
| | - Maria Teresa Pellecchia
- Center for Neurodegenerative diseases (CEMAND), Department of Medicine and Surgery, Neuroscience section, University of Salerno, Salerno, Italy
| | - Paolo Barone
- Center for Neurodegenerative diseases (CEMAND), Department of Medicine and Surgery, Neuroscience section, University of Salerno, Salerno, Italy
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Levodopa-induced dystonia in a patient with possible progressive supranuclear palsy with progressive gait freezing. J Neurol Sci 2018; 388:139-140. [DOI: 10.1016/j.jns.2018.03.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2017] [Revised: 02/02/2018] [Accepted: 03/14/2018] [Indexed: 11/17/2022]
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16
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Erkkinen MG, Kim MO, Geschwind MD. Clinical Neurology and Epidemiology of the Major Neurodegenerative Diseases. Cold Spring Harb Perspect Biol 2018; 10:a033118. [PMID: 28716886 PMCID: PMC5880171 DOI: 10.1101/cshperspect.a033118] [Citation(s) in RCA: 504] [Impact Index Per Article: 84.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Neurodegenerative diseases are a common cause of morbidity and cognitive impairment in older adults. Most clinicians who care for the elderly are not trained to diagnose these conditions, perhaps other than typical Alzheimer's disease (AD). Each of these disorders has varied epidemiology, clinical symptomatology, laboratory and neuroimaging features, neuropathology, and management. Thus, it is important that clinicians be able to differentiate and diagnose these conditions accurately. This review summarizes and highlights clinical aspects of several of the most commonly encountered neurodegenerative diseases, including AD, frontotemporal dementia (FTD) and its variants, progressive supranuclear palsy (PSP), corticobasal degeneration (CBD), Parkinson's disease (PD), dementia with Lewy bodies (DLB), multiple system atrophy (MSA), and Huntington's disease (HD). For each condition, we provide a brief overview of the epidemiology, defining clinical symptoms and diagnostic criteria, relevant imaging and laboratory features, genetics, pathology, treatments, and differential diagnosis.
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Affiliation(s)
- Michael G Erkkinen
- Department of Neurology, Memory and Aging Center, University of California, San Francisco, San Francisco, California 94158
| | - Mee-Ohk Kim
- Department of Neurology, Memory and Aging Center, University of California, San Francisco, San Francisco, California 94158
| | - Michael D Geschwind
- Department of Neurology, Memory and Aging Center, University of California, San Francisco, San Francisco, California 94158
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17
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Abstract
PURPOSE OF REVIEW Progressive supranuclear palsy (PSP) is a 4R tau neuropathologic entity. While historically defined by the presence of a vertical supranuclear gaze palsy and falls in the first symptomatic year, clinicopathologic studies identify alternate presenting phenotypes. This article reviews the new PSP diagnostic criteria, diagnostic approaches, and treatment strategies. RECENT FINDINGS The 2017 International Parkinson and Movement Disorder Society PSP criteria outline 14 core clinical features and 4 clinical clues that combine to diagnose one of eight PSP phenotypes with probable, possible, or suggestive certainty. Evidence supports the use of select imaging approaches in the classic PSP-Richardson syndrome phenotype. Recent trials of putative disease-modifying agents showed no benefit. The new PSP diagnostic criteria incorporating the range of presenting phenotypes have important implications for diagnosis and research. More work is needed to understand how diagnostic evaluations inform phenotype assessment and identify expected progression. Current treatment is symptomatic, but tau-based therapeutics are in active clinical trials.
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18
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Elkouzi A, Bit-Ivan EN, Elble RJ. Pure akinesia with gait freezing: a clinicopathologic study. JOURNAL OF CLINICAL MOVEMENT DISORDERS 2017; 4:15. [PMID: 29051824 PMCID: PMC5644075 DOI: 10.1186/s40734-017-0063-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Accepted: 08/04/2017] [Indexed: 12/05/2022]
Abstract
Background Pure akinesia with gait freezing is a rare syndrome with few autopsied cases. Severe freezing of gait occurs in the absence of bradykinesia and rigidity. Most autopsies have revealed progressive supranuclear palsy. We report the clinical and postmortem findings of two patients with pure akinesia with gait freezing, provide video recordings of these patients, and review the literature describing similar cases. We also discuss bradykinesia, hypokinesia and akinesia in the context of this clinical syndrome. Case presentation Two patients with the syndrome of pure akinesia with gait freezing were examined by the same movement disorder specialist at least annually for 9 and 18 years. Both patients initially exhibited freezing, tachyphemia, micrographia and festination without bradykinesia and rigidity. Both autopsies revealed characteristic tau pathology of progressive supranuclear palsy, with nearly total neuronal loss and gliosis in the subthalamus and severe neuronal loss and gliosis in the globus pallidus and substantia nigra. Previously published postmortem studies revealed that most patients with this syndrome had progressive supranuclear palsy or pallidonigroluysian atrophy. Conclusions Pallidonigroluysian degeneration produces freezing and festination in the absence of generalized slowing (bradykinesia). Freezing and festination are commonly regarded as features of akinesia. Akinesia literally means absence of movement, and akinesia is commonly viewed as an extreme of bradykinesia. The pure akinesia with gait freezing phenotype illustrates that bradykinesia and akinesia should be viewed as separate phenomena. Electronic supplementary material The online version of this article (doi:10.1186/s40734-017-0063-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ahmad Elkouzi
- Department of Neurology, Southern Illinois University School of Medicine, PO Box 19645, Springfield, IL 62794-9645 USA
| | - Esther N Bit-Ivan
- Department of Neurology, Southern Illinois University School of Medicine, PO Box 19645, Springfield, IL 62794-9645 USA.,Department of Pathology, Southern Illinois University School of Medicine and Memorial Medical Center, Springfield, IL USA
| | - Rodger J Elble
- Department of Neurology, Southern Illinois University School of Medicine, PO Box 19645, Springfield, IL 62794-9645 USA
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Locomozione: fisiologia, metodi di analisi e classificazione dei principali disturbi. Neurologia 2017. [DOI: 10.1016/s1634-7072(17)85553-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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20
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Respondek G, Kurz C, Arzberger T, Compta Y, Englund E, Ferguson LW, Gelpi E, Giese A, Irwin DJ, Meissner WG, Nilsson C, Pantelyat A, Rajput A, van Swieten JC, Troakes C, Josephs KA, Lang AE, Mollenhauer B, Müller U, Whitwell JL, Antonini A, Bhatia KP, Bordelon Y, Corvol JC, Colosimo C, Dodel R, Grossman M, Kassubek J, Krismer F, Levin J, Lorenzl S, Morris H, Nestor P, Oertel WH, Rabinovici GD, Rowe JB, van Eimeren T, Wenning GK, Boxer A, Golbe LI, Litvan I, Stamelou M, Höglinger GU. Which ante mortem clinical features predict progressive supranuclear palsy pathology? Mov Disord 2017; 32:995-1005. [PMID: 28500752 PMCID: PMC5543934 DOI: 10.1002/mds.27034] [Citation(s) in RCA: 111] [Impact Index Per Article: 15.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Revised: 04/08/2017] [Accepted: 04/10/2017] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Progressive supranuclear palsy (PSP) is a neuropathologically defined disease presenting with a broad spectrum of clinical phenotypes. OBJECTIVE To identify clinical features and investigations that predict or exclude PSP pathology during life, aiming at an optimization of the clinical diagnostic criteria for PSP. METHODS We performed a systematic review of the literature published since 1996 to identify clinical features and investigations that may predict or exclude PSP pathology. We then extracted standardized data from clinical charts of patients with pathologically diagnosed PSP and relevant disease controls and calculated the sensitivity, specificity, and positive predictive value of key clinical features for PSP in this cohort. RESULTS Of 4166 articles identified by the database inquiry, 269 met predefined standards. The literature review identified clinical features predictive of PSP, including features of the following 4 functional domains: ocular motor dysfunction, postural instability, akinesia, and cognitive dysfunction. No biomarker or genetic feature was found reliably validated to predict definite PSP. High-quality original natural history data were available from 206 patients with pathologically diagnosed PSP and from 231 pathologically diagnosed disease controls (54 corticobasal degeneration, 51 multiple system atrophy with predominant parkinsonism, 53 Parkinson's disease, 73 behavioral variant frontotemporal dementia). We identified clinical features that predicted PSP pathology, including phenotypes other than Richardson's syndrome, with varying sensitivity and specificity. CONCLUSIONS Our results highlight the clinical variability of PSP and the high prevalence of phenotypes other than Richardson's syndrome. The features of variant phenotypes with high specificity and sensitivity should serve to optimize clinical diagnosis of PSP. © 2017 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Gesine Respondek
- Department of Neurology, Technische Universität München, Munich, Germany
- German Center for Neurodegenerative Diseases, Munich, Germany
| | - Carolin Kurz
- Department of Psychiatry, Ludwig-Maximilians-Universität, Munich, Germany
| | - Thomas Arzberger
- German Center for Neurodegenerative Diseases, Munich, Germany
- Department of Psychiatry, Ludwig-Maximilians-Universität, Munich, Germany
- Center for Neuropathology and Prion Research, Ludwig-Maximilians-University, Munich, Germany
| | - Yaroslau Compta
- Parkinson's Disease & Movement Disorders Unit, Neurology Service, Hospital Clinic/IDIBAPS/University of Barcelona/CIBERNED, Barcelona, Catalonia, Spain
| | - Elisabet Englund
- Department of Clinical Sciences, Division of Oncology and Pathology, Lund University, Lund, Sweden
| | - Leslie W Ferguson
- Division of Neurology, Royal University Hospital, University of Saskatchewan, Saskatchewan, Canada
| | - Ellen Gelpi
- Neurological Tissue Bank and Neurology Department, Hospital Clínic de Barcelona, Universitat de Barcelona, IDIBAPS, CERCA, Barcelona, Catalonia, Spain
| | - Armin Giese
- Center for Neuropathology and Prion Research, Ludwig-Maximilians-University, Munich, Germany
| | - David J Irwin
- Frontotemporal Degeneration Center, Department of Neurology, University of Pennsylvania, Pennsylvania, USA
| | - Wassilios G Meissner
- University of Bordeaux, Institut des Maladies Neurodégénératives, UMR 5293, Bordeaux, France
- Centre national de la recherche scientifique (CNRS), Institut des Maladies Neurodégénératives, UMR 5293, Bordeaux, France
- Service de Neurologie, Hôpital Pellegrin, CHU de Bordeaux, Bordeaux, France
| | - Christer Nilsson
- Department of Clinical Sciences, Division of Neurology, Lund University, Lund, Sweden
| | | | - Alex Rajput
- Division of Neurology, Royal University Hospital, University of Saskatchewan, Saskatchewan, Canada
| | - John C van Swieten
- Department of Neurology, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Claire Troakes
- London Neurodegenerative Diseases Brain Bank, Institute of Psychiatry, Psychology and Neuroscience, Kings College London, UK
| | - Keith A Josephs
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - Anthony E Lang
- Morton and Gloria Shulman Movement Disorders Clinic and the Edmond J Safra Program in Parkinson's Disease, Toronto Western Hospital, Toronto, Canada
| | - Brit Mollenhauer
- Paracelsus-Elena Klinik Kassel and University Medical Center Goettingen, Institute of Neuropathology, Goettingen, Germany
| | | | | | - Angelo Antonini
- Parkinson and Movement Disorders Unit, Istituto di ricovero e cura a carattere scientifico (IRCCS) Hospital San Camillo and Department of Neurosciences (DNS), Padova University, Padova, Italy
| | - Kailash P Bhatia
- Sobell Department of Motor Neuroscience and Movement Disorders, UCL Institute of Neurology, London, UK
| | - Yvette Bordelon
- Department of Neurology, University of California, Los Angeles, California, USA
| | - Jean-Christophe Corvol
- Sorbonne Universités, Université Pierre et Marie Curie (UPMC Univ) Paris 06; and INSERM UMRS_1127, CIC_1422; and CNRS UMR_7225; and Assistance publique - Hôpitaux de Paris (AP-HP); and Institut du Cerveau et de la Moelle Epinière (ICM), Hôpital Pitié-Salpêtrière, Département des maladies du système nerveux, F-75013, Paris, France
| | - Carlo Colosimo
- Department of Neurology, Santa Maria University Hospital of Terni, Terni, Italy
| | - Richard Dodel
- Department of Geriatric Medicine, University Hospital Essen, Essen, Germany
| | - Murray Grossman
- Frontotemporal Degeneration Center, Department of Neurology, University of Pennsylvania, Pennsylvania, USA
| | - Jan Kassubek
- Department of Neurology, University of Ulm, Ulm, Germany
| | - Florian Krismer
- Department of Neurology, Medical University Innsbruck, Innsbruck, Austria
| | - Johannes Levin
- Department of Neurology, Ludwig-Maximilians-Universität, Munich, Germany
| | - Stefan Lorenzl
- Department of Palliative Medicine, Munich University Hospital, Ludwig-Maximilians-Universität (LMU), Munich, Munich, Germany
- Institute of Nursing Science and Practice, Paracelsus Medical University, Salzburg, Austria
- Department of Neurology, Hospital Agatharied, Agatharied, Germany
| | - Huw Morris
- Department of Clinical Neuroscience, UCL Institute of Neurology, London, UK
| | - Peter Nestor
- German Center for Neurodegenerative Diseases, Magdeburg, Germany
| | | | - Gil D Rabinovici
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, California, USA
| | - James B Rowe
- Department of Clinical Neurosciences, Cambridge University, Cambridge, UK
| | - Thilo van Eimeren
- Department of Nuclear Medicine, University Hospital Cologne, Cologne, Germany
| | - Gregor K Wenning
- Department of Neurology, Medical University Innsbruck, Innsbruck, Austria
| | - Adam Boxer
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, California, USA
| | - Lawrence I Golbe
- Department of Neurology, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Irene Litvan
- Department of Neurology, University of California, San Diego, California, USA
| | - Maria Stamelou
- Department of Neurology, Philipps Universität, Marburg, Germany
- Second Department of Neurology, Attikon University Hospital, University of Athens, Greece
- HYGEIA Hospital, Athens, Greece
| | - Günter U Höglinger
- Department of Neurology, Technische Universität München, Munich, Germany
- German Center for Neurodegenerative Diseases, Munich, Germany
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21
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Hoglinger GU, Respondek G, Stamelou M, Kurz C, Josephs KA, Lang AE, Mollenhauer B, Muller U, Nilsson C, Whitwell JL, Arzberger T, Englund E, Gelpi E, Giese A, Irwin DJ, Meissner WG, Pantelyat A, Rajput A, van Swieten JC, Troakes C, Antonini A, Bhatia KP, Bordelon Y, Compta Y, Corvol JC, Colosimo C, Dickson DW, Dodel R, Ferguson L, Grossman M, Kassubek J, Krismer F, Levin J, Lorenzl S, Morris HR, Nestor P, Oertel WH, Poewe W, Rabinovici G, Rowe JB, Schellenberg GD, Seppi K, van Eimeren T, Wenning GK, Boxer AL, Golbe LI, Litvan I. Clinical diagnosis of progressive supranuclear palsy: The movement disorder society criteria. Mov Disord 2017; 32:853-864. [PMID: 28467028 PMCID: PMC5516529 DOI: 10.1002/mds.26987] [Citation(s) in RCA: 1254] [Impact Index Per Article: 179.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Revised: 02/09/2017] [Accepted: 02/16/2017] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND PSP is a neuropathologically defined disease entity. Clinical diagnostic criteria, published in 1996 by the National Institute of Neurological Disorders and Stroke/Society for PSP, have excellent specificity, but their sensitivity is limited for variant PSP syndromes with presentations other than Richardson's syndrome. OBJECTIVE We aimed to provide an evidence- and consensus-based revision of the clinical diagnostic criteria for PSP. METHODS We searched the PubMed, Cochrane, Medline, and PSYCInfo databases for articles published in English since 1996, using postmortem diagnosis or highly specific clinical criteria as the diagnostic standard. Second, we generated retrospective standardized clinical data from patients with autopsy-confirmed PSP and control diseases. On this basis, diagnostic criteria were drafted, optimized in two modified Delphi evaluations, submitted to structured discussions with consensus procedures during a 2-day meeting, and refined in three further Delphi rounds. RESULTS Defined clinical, imaging, laboratory, and genetic findings serve as mandatory basic features, mandatory exclusion criteria, or context-dependent exclusion criteria. We identified four functional domains (ocular motor dysfunction, postural instability, akinesia, and cognitive dysfunction) as clinical predictors of PSP. Within each of these domains, we propose three clinical features that contribute different levels of diagnostic certainty. Specific combinations of these features define the diagnostic criteria, stratified by three degrees of diagnostic certainty (probable PSP, possible PSP, and suggestive of PSP). Clinical clues and imaging findings represent supportive features. CONCLUSIONS Here, we present new criteria aimed to optimize early, sensitive, and specific clinical diagnosis of PSP on the basis of currently available evidence. © 2017 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Gunter U. Hoglinger
- Department of Neurology, Technische Universitat Munchen, Munich, Germany
- German Center for Neurodegenerative Diseases (DZNE), Munich, Germany
| | - Gesine Respondek
- Department of Neurology, Technische Universitat Munchen, Munich, Germany
- German Center for Neurodegenerative Diseases (DZNE), Munich, Germany
| | - Maria Stamelou
- Second Department of Neurology, Attikon University Hospital, University of Athens, Athens, Greece
| | - Carolin Kurz
- Department of Psychiatry, Ludwig-Maximilians-Universitat, Munich, Germany
| | | | - Anthony E. Lang
- Morton and Gloria Shulman Movement Disorders Clinic and the Edmond J. Safra Program in Parkinson’s Disease, Toronto Western Hospital, Toronto, Canada
| | - Brit Mollenhauer
- Paracelsus-Elena Klinik, Kassel, Germany, and University Medical Center Gottingen, Institute of Neuropathology, Gottingen, Germany
| | | | - Christer Nilsson
- Department of Clinical Sciences, Division of Neurology, Lund University, Lund, Sweden
| | | | - Thomas Arzberger
- German Center for Neurodegenerative Diseases (DZNE), Munich, Germany
- Department of Psychiatry, Ludwig-Maximilians-Universitat, Munich, Germany
- Center for Neuropathology and Prion Research, Ludwig-Maximilians-Universitat, Munich, Germany
| | - Elisabet Englund
- Department of Clinical Sciences, Division of Oncology and Pathology, Lund University, Lund, Sweden
| | - Ellen Gelpi
- Neurological Tissue Bank of the Biobank - Hospital Clínic de Barcelona, Universitat de Barcelona, IDIBAPS, Barcelona, Spain
| | - Armin Giese
- Center for Neuropathology and Prion Research, Ludwig-Maximilians-Universitat, Munich, Germany
| | - David J. Irwin
- Frontotemporal Degeneration Center, Department of Neurology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Wassilios G. Meissner
- Université de Bordeaux, Institut des Maladies Neurodégénératives, UMR 5293, Bordeaux, France
- CNRS, Institut des Maladies Neurodégénératives, UMR 5293, Bordeaux, France
- Service de Neurologie, Hôpital Pellegrin, CHU de Bordeaux, Bordeaux, France
| | | | - Alex Rajput
- Division of Neurology, Royal University Hospital, University of Saskatchewan, Saskatoon, SK, Canada
| | | | - Claire Troakes
- London Neurodegenerative Diseases Brain Bank, Institute of Psychiatry, Psychology and Neuroscience, Kings College London, London, United Kingdom
| | - Angelo Antonini
- Parkinson and Movement Disorders Unit, IRCCS Hospital San Camillo, Venice, and Department of Neurosciences, Padova University, Padova, Italy
| | - Kailash P. Bhatia
- Sobell Department of Motor Neuroscience and Movement Disorders, UCL Institute of Neurology, Queen Square, London, United Kingdom
| | - Yvette Bordelon
- Department of Neurology, University of California, Los Angeles, California, USA
| | - Yaroslau Compta
- Parkinson’s Disease & Movement Disorders Unit, Neurology Service, Hospital Clinic/IDIBAPS/University of Barcelona, Barcelona, Catalonia, Spain
| | - Jean-Christophe Corvol
- Sorbonne Universités, UPMC Univ Paris 06; and INSERM UMRS_1127, CIC_1422; and CNRS UMR_7225; and AP-HP; and ICM, Hôpital Pitié-Salpêtrière, Département des maladies du système nerveux, Paris, France
| | - Carlo Colosimo
- Department of Neurology, Santa Maria University Hospital of Terni, Terni, Italy
| | | | - Richard Dodel
- Department of Geriatric Medicine, University Hospital Essen, Essen, Germany
| | - Leslie Ferguson
- Division of Neurology, Royal University Hospital, University of Saskatchewan, Saskatoon, SK, Canada
| | - Murray Grossman
- Frontotemporal Degeneration Center, Department of Neurology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jan Kassubek
- Department of Neurology, University of Ulm, Ulm, Germany
| | - Florian Krismer
- Department of Neurology, Medical University Innsbruck, Innsbruck, Austria
| | - Johannes Levin
- German Center for Neurodegenerative Diseases (DZNE), Munich, Germany
- Department of Neurology, Ludwig-Maximilians-Universitat, Munich, Germany
| | - Stefan Lorenzl
- Institute of Nursing Science and Practice, Paracelsus Medical University, Salzburg, Austria
- Department of Neurology, Hospital Agatharied, Agatharied, Germany
- Department of Palliative Medicine, Munich University Hospital, LMU Munich, Munich, Germany
| | - Huw R. Morris
- Department of Clinical Neuroscience, UCL Institute of Neurology, London, United Kingdom
| | - Peter Nestor
- German Center for Neurodegenerative Diseases (DZNE), Magdeburg, Germany
| | | | - Werner Poewe
- Department of Neurology, Medical University Innsbruck, Innsbruck, Austria
| | - Gil Rabinovici
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, California, USA
| | - James B. Rowe
- Department of Clinical Neurosciences, Cambridge University, Cambridge, United Kingdom
| | - Gerard D. Schellenberg
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Klaus Seppi
- Department of Neurology, Medical University Innsbruck, Innsbruck, Austria
| | - Thilo van Eimeren
- Departments of Nuclear Medicine and Neurology, University of Cologne, Cologne, Germany
| | - Gregor K. Wenning
- Department of Neurology, Medical University Innsbruck, Innsbruck, Austria
| | - Adam L. Boxer
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, California, USA
| | - Lawrence I. Golbe
- Department of Neurology, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Irene Litvan
- Department of Neurology, University of California, San Diego, California, USA
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22
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Incipient progressive supranuclear palsy is more common than expected and may comprise clinicopathological subtypes: a forensic autopsy series. Acta Neuropathol 2017; 133:809-823. [PMID: 28064358 DOI: 10.1007/s00401-016-1665-7] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Revised: 12/30/2016] [Accepted: 12/30/2016] [Indexed: 12/14/2022]
Abstract
We investigated 998 serial Japanese forensic autopsy cases (0-101 years old, mean age 61.7 ± 21.9), with no case selection, using immunohistochemistry to detect cases with progressive supranuclear palsy (PSP). Twenty-nine cases (mean age 82.3 ± 7.2 years, 11 males, 18 females) fulfilled the National Institute of Neuronal Disorders and Stroke (NINDS)-PSP pathological criteria (2.9% of all cases, 4.6% of cases over 60). All had neuronal and glial inclusions in the basal ganglia and brainstem. However, 13 cases had low tau pathology and were categorized as atypical PSP. In addition to PSP pathology, multiple types of astrocytic inclusions and comorbid proteinopathies, particularly a high prevalence of argyrophilic grain disease, were found. All cases had not been diagnosed with PSP and had preserved daily functioning prior to death. However, 14 (48.3%), 11 (37.9%), and 16 (55.2%) cases showed signs of dementia, depressive state, and gait disturbance, respectively. Sixteen accidental death cases (55.2%), including from falls and getting lost, and 11 suicide cases (37.9%) appear to have a relationship with incipient PSP pathology. Cluster analysis using the distribution and amount of 4-repeat-tau pathology classified the cases into three subgroups: Group 1 (10 cases) had typical PSP pathology and seven cases (70.0%) had dementia as the most frequent symptom; Group 2 (7 cases) had significantly higher frequency of gait disorder (6 cases, 85.7%), and less neocortical tau pathology than Group 1; Group 3 (12 cases) had relatively mild PSP pathology and high argyrophilic grain burdens. Granular-shaped astrocytes were the dominant astrocytic inclusion in all cases. We conclude that in forensic cases incipient PSP occurs with a higher prevalence than expected. If these findings can be extrapolated to other population-based cohorts, PSP may be more common than previously thought.
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23
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Osaki Y, Morita Y, Miyamoto Y, Furuta K, Furuya H. Freezing of gait is an early clinical feature of progressive supranuclear palsy. ACTA ACUST UNITED AC 2017; 5:86-90. [PMID: 28702192 PMCID: PMC5484990 DOI: 10.1111/ncn3.12122] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/09/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND AIM Early clinical diagnosis of progressive supranuclear palsy (PSP) remains challenging. AIM We attempted to identify any sign or symptom to diagnose PSP earlier. METHODS A total of 401 patients, 40 with PSP and 361 with other neurodegenerative disorders, were included. We followed these patients for at least 1 year since 2009. We reviewed the signs and symptoms of patients with PSP in a standardized manner, and observed four manifestations: "vertical supranuclear gaze abnormality," "movement disorders," "pseudobulbar palsy" and "dementia of frontal type." Features, such as symmetric parkinsonism, freezing of gait, postural instability, dysarthria and/or dysphagia, or dementia of frontal type, were considered core clinical features. RESULTS In patients with PSP, "movement disorders" was the most common manifestation, whereas "vertical supranuclear gaze abnormality" was uncommon during the early disease course. A total of 16 patients fulfilled the National Institute for Neurological Disorders and Stroke and Society for PSP criteria for possible PSP at their first clinic visit. Of the remaining 24 patients, 15 presented with one or more core clinical features before fulfilling the criteria for possible PSP; nine patients had a clinical diagnosis of PSP but never fulfilled the criteria. A total of 49 of the 361 patients with other neurodegenerative disorders had core clinical features. A comparison showed that freezing of gait differentiated the groups the best over the disease course. CONCLUSION Freezing of gait is an early feature that might improve the clinical diagnosis of PSP, whereas vertical supranuclear gaze abnormality is not.
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Affiliation(s)
- Yasushi Osaki
- Department of Neurology Kochi Medical School Hospital Kochi Japan
| | - Yukari Morita
- Department of Neurology Kochi Medical School Hospital Kochi Japan
| | - Yuka Miyamoto
- Department of Neurology Kochi Medical School Hospital Kochi Japan
| | - Kounosuke Furuta
- Department of Emergency Medicine Kochi Medical School Hospital Kochi Japan
| | - Hirokazu Furuya
- Department of Neurology Kochi Medical School Hospital Kochi Japan
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24
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Owens E, Josephs KA, Savica R, Hassan A, Klassen B, Bower J, Maraganore D, Matsumoto J, Ahlskog JE. The clinical spectrum and natural history of pure akinesia with gait freezing. J Neurol 2016; 263:2419-2423. [PMID: 27624121 DOI: 10.1007/s00415-016-8278-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Revised: 08/28/2016] [Accepted: 08/29/2016] [Indexed: 11/24/2022]
Abstract
Gait freezing as a presenting and relatively restricted condition is uncommon but a distinctive disorder. This entity was initially defined as "pure akinesia with gait freezing", and later a neuropathological substrate of progressive supranuclear palsy has been recognized. Limited studies have reported the clinical evolution after presentation, which is important for patient counseling. The objective of this study was to assess the demographic and clinical features, treatment-response, neuroimaging, and evolution of pure akinesia with gait freezing. A retrospective review of patients with this phenotype as previously defined was performed. Patients included had no or minimal limb rigidity and/or bradykinesia and no resting tremor, and all underwent neuroimaging of the brain after onset. Inclusion criteria were met by 30 patients, who were followed up to 21 years after symptom onset. During their course, 28 patients had falls (93 %), 12 patients had dysarthria (40 %), and 13 had handwriting changes (43 %). All patients had progression of their gait disorder over time, but with a variable interval until falls occurred. None of the patients developed vertical gaze palsy or met diagnostic criteria for an alternative parkinsonian disorder. Pure akinesia with gait freezing is a distinctive disorder that can be recognized in the clinic. Despite the previously reported progressive supranuclear palsy-like neuropathology, the clinical course is much less aggressive and disabling than classic Richardson syndrome, although fall risk eventually develops in nearly all patients. Bradykinesia, tremor, and rigidity do not develop, distinguishing pure akinesia with gait freezing from Parkinson's disease and other parkinsonian disorders.
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Affiliation(s)
- Emily Owens
- Department of Neurology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
| | - Keith A Josephs
- Department of Neurology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Rodolfo Savica
- Department of Neurology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Anhar Hassan
- Department of Neurology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Bryan Klassen
- Department of Neurology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - James Bower
- Department of Neurology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Demetrius Maraganore
- Neurological Institute NorthShore University HealthSystem, Evanston, IL, 60201, USA
| | - Joseph Matsumoto
- Department of Neurology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - J E Ahlskog
- Department of Neurology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
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25
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Onder H. Letter regarding article 'Freezing of gait associated with a corpus callosum lesion'. JOURNAL OF CLINICAL MOVEMENT DISORDERS 2016; 3:13. [PMID: 27617107 PMCID: PMC5018163 DOI: 10.1186/s40734-016-0041-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/20/2016] [Accepted: 08/04/2016] [Indexed: 11/10/2022]
Abstract
Here, I discuss the report by Dale et al. and present some relevant comments, hoping that it will allow a better understanding of the patient's situation as well as freezing of gait phenomenon. I will also discuss other disorders for differential diagnosis those should be kept in mind.
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Affiliation(s)
- Halil Onder
- Department of Neurology, Hacettepe University Hospital, Sıhhıye, Ankara Post Code: 06010 Turkey
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26
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Fasano A, Herman T, Tessitore A, Strafella AP, Bohnen NI. Neuroimaging of Freezing of Gait. JOURNAL OF PARKINSONS DISEASE 2016; 5:241-54. [PMID: 25757831 PMCID: PMC4923721 DOI: 10.3233/jpd-150536] [Citation(s) in RCA: 77] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Functional brain imaging techniques appear ideally suited to explore the pathophysiology of freezing of gait (FOG). In the last two decades, techniques based on magnetic resonance or nuclear medicine imaging have found a number of structural changes and functional disconnections between subcortical and cortical regions of the locomotor network in patients with FOG. FOG seems to be related in part to disruptions in the "executive-attention" network along with regional tissue loss including the premotor area, inferior frontal gyrus, precentral gyrus, the parietal and occipital areas involved in visuospatial functions of the right hemisphere. Several subcortical structures have been also involved in the etiology of FOG, principally the caudate nucleus and the locomotor centers in the brainstem. Maladaptive neural compensation may present transiently in the presence of acute conflicting motor, cognitive or emotional stimulus processing, thus causing acute network overload and resulting in episodic impairment of stepping.In this review we will summarize the state of the art of neuroimaging research for FOG. We will also discuss the limitations of current approaches and delineate the next steps of neuroimaging research to unravel the pathophysiology of this mysterious motor phenomenon.
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Affiliation(s)
- Alfonso Fasano
- Morton and Gloria Shulman Movement Disorders Centre and the Edmond J. Safra Program in Parkinson's Disease, Toronto Western Hospital, University Health Network, Toronto, ON, Canada
| | - Talia Herman
- Center for the study of Movement, Cognition and Mobility, Department of Neurology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Alessandro Tessitore
- Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences, Second University of Naples, Naples, Italy
| | - Antonio P Strafella
- Morton and Gloria Shulman Movement Disorders Centre and the Edmond J. Safra Program in Parkinson's Disease, Toronto Western Hospital, University Health Network, Toronto, ON, Canada
| | - Nicolaas I Bohnen
- Departments of Radiology and Neurology, University of Michigan, and Neurology Service and GRECC, VAAAHS, Ann Arbor, MI, USA
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27
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Garrido A, Vilas D, Tolosa E. Update on the Diagnosis and Management of Progressive Supranuclear Palsy. CURRENT GERIATRICS REPORTS 2016. [DOI: 10.1007/s13670-016-0172-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Abstract
This chapter focuses on one of the most common types of neurologic disorders: altered walking. Walking impairment often reflects disease of the neurologic structures mediating gait, balance or, most often, both. These structures are distributed along the neuraxis. For this reason, this chapter is introduced by a brief description of the neurobiologic underpinning of walking, stressing information that is critical for imaging, namely, the anatomic representation of gait and balance mechanisms. This background is essential not only in order to direct the relevant imaging tools to the regions more likely to be affected but also to interpret correctly imaging findings that may not be related to the walking deficit object of clinical study. The chapter closes with a discussion on how to image some of the most frequent etiologies causing gait or balance impairment. However, it focuses on syndromes not already discussed in other chapters of this volume, such as Parkinson's disease and other movement disorders, already discussed in Chapter 48, or cerebellar ataxia, in Chapter 23, in the previous volume. As regards vascular disease, the spastic hemiplegia most characteristic of brain disease needs little discussion, while the less well-understood effects of microvascular disease are extensively reviewed here, together with the imaging approach.
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Affiliation(s)
- Joseph C Masdeu
- Department of Neurology, Houston Methodist Hospital, Houston, TX, USA.
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29
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Hong JY, Yun HJ, Sunwoo MK, Ham JH, Lee JM, Sohn YH, Lee PH. Comparison of regional brain atrophy and cognitive impairment between pure akinesia with gait freezing and Richardson's syndrome. Front Aging Neurosci 2015; 7:180. [PMID: 26483680 PMCID: PMC4586277 DOI: 10.3389/fnagi.2015.00180] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Accepted: 09/07/2015] [Indexed: 11/13/2022] Open
Abstract
Pure akinesia with gait freezing (PAGF) is considered a clinical phenotype of progressive supranuclear palsy. The brain atrophy and cognitive deficits in PAGF are expected to be less prominent than in classical Richardson's syndrome (RS), but this hypothesis has not been explored yet. We reviewed the medical records of 28 patients with probable RS, 19 with PAGF, and 29 healthy controls, and compared cortical thickness, subcortical gray matter volume, and neuropsychological performance among the three groups. Patients with PAGF had thinner cortices in frontal, inferior parietal, and temporal areas compared with controls; however, areas of cortical thinning in PAGF patients were less extensive than those in RS patients. In PAGF patients, hippocampal, and thalamic volumes were also smaller than controls, whereas subcortical gray matter volumes in PAGF and RS patients were comparable. In a comparison of neuropsychological tests, PAGF patients had better cognitive performance in executive function, visual memory, and visuospatial function than RS patients had. These results demonstrate that cognitive impairment, cortical thinning, and subcortical gray matter atrophy in PAGF patients resemble to those in RS patients, though the severity of cortical thinning and cognitive dysfunction is milder. Our results suggest that, PAGF and RS may share same pathology but that it appears to affect a smaller proportion of the cortex in PAGF.
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Affiliation(s)
- Jin Yong Hong
- Department of Neurology, Yonsei University Wonju College of Medicine Wonju, South Korea
| | - Hyuk Jin Yun
- Department of Biomedical Engineering, Hanyang University Seoul, South Korea
| | - Mun Kyung Sunwoo
- Department of Neurology, Bundang Jesaeng General Hospital Seongnam, South Korea
| | - Jee Hyun Ham
- Department of Neurology and Brain Research Institute, Yonsei University College of Medicine Seoul, South Korea
| | - Jong-Min Lee
- Department of Biomedical Engineering, Hanyang University Seoul, South Korea
| | - Young H Sohn
- Department of Neurology and Brain Research Institute, Yonsei University College of Medicine Seoul, South Korea
| | - Phil Hyu Lee
- Department of Neurology and Brain Research Institute, Yonsei University College of Medicine Seoul, South Korea ; Severance Biomedical Science Institute, Yonsei University College of Medicine Seoul, South Korea
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30
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Tomita S, Oeda T, Umemura A, Kohsaka M, Park K, Yamamoto K, Sugiyama H, Mori C, Inoue K, Fujimura H, Sawada H. Impact of Aspiration Pneumonia on the Clinical Course of Progressive Supranuclear Palsy: A Retrospective Cohort Study. PLoS One 2015; 10:e0135823. [PMID: 26270456 PMCID: PMC4536232 DOI: 10.1371/journal.pone.0135823] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Accepted: 07/27/2015] [Indexed: 11/18/2022] Open
Abstract
Introduction Although aspiration pneumonia is the most common complication of progressive supranuclear palsy (PSP), the clinical impact of aspiration pneumonia on disease course and survival has not been fully estimated. Thus, we retrospectively analyzed the prognostic factors and clinical consequences of pneumonia in PSP. Methods The clinical course of patients with aspiration pneumonia was surveyed. The association between baseline clinical features (2 years from disease onset) and latency to the initial development of pneumonia was investigated using survival time and Cox regression analyses. Results Ninety patients with a clinical diagnosis of PSP were observed for 5.1±3.8 years (mean±SD), and 22 had aspiration pneumonia. Subsequently, 20 patients (91%) had to discontinue oral feeding entirely and 13 (59%) died, whereas, of 68 patients without pneumonia, only three patients (4%) died. Time to initial development of pneumonia was strongly correlated with survival time (Spearman R = 0.92, P<0.001), with a mean latency of 2.3 years to death. Among baseline clinical features, early fall episodes and cognitive decline were significant predictors of pneumonia (P = 0.001 and P<0.001, respectively, log rank test). Cox regression analysis demonstrated that early fall episodes (adjusted hazard ratio: 3.9, 95% confidence interval: 1.2–12.5, P = 0.03) and cognitive decline (adjusted hazard ratio: 5.2, 95% confidence interval: 1.4–19.3, P = 0.02) independently predicted pneumonia. By contrast, dysphagia was not associated with pneumonia (P = 0.2, log rank test). Conclusion Initial development of pneumonia indicates an unfavorable clinical course and predicts survival time (mean survival time 2.3 years). Patients with early falls and cognitive decline were at high risk of early development of pneumonia.
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Affiliation(s)
- Satoshi Tomita
- Clinical Research Center, National Regional Center for Neurological Disorders and Utano National Hospital, Kyoto, Japan
- Department of Neurology, National Regional Center for Neurological Disorders and Utano National Hospital, Kyoto, Japan
| | - Tomoko Oeda
- Clinical Research Center, National Regional Center for Neurological Disorders and Utano National Hospital, Kyoto, Japan
- Department of Neurology, National Regional Center for Neurological Disorders and Utano National Hospital, Kyoto, Japan
| | - Atsushi Umemura
- Clinical Research Center, National Regional Center for Neurological Disorders and Utano National Hospital, Kyoto, Japan
- Department of Neurology, National Regional Center for Neurological Disorders and Utano National Hospital, Kyoto, Japan
| | - Masayuki Kohsaka
- Clinical Research Center, National Regional Center for Neurological Disorders and Utano National Hospital, Kyoto, Japan
- Department of Neurology, National Regional Center for Neurological Disorders and Utano National Hospital, Kyoto, Japan
| | - Kwiyoung Park
- Clinical Research Center, National Regional Center for Neurological Disorders and Utano National Hospital, Kyoto, Japan
- Department of Neurology, National Regional Center for Neurological Disorders and Utano National Hospital, Kyoto, Japan
| | - Kenji Yamamoto
- Clinical Research Center, National Regional Center for Neurological Disorders and Utano National Hospital, Kyoto, Japan
- Department of Neurology, National Regional Center for Neurological Disorders and Utano National Hospital, Kyoto, Japan
| | - Hiroshi Sugiyama
- Department of Neurology, National Regional Center for Neurological Disorders and Utano National Hospital, Kyoto, Japan
| | - Chiaki Mori
- Department of Neurology, Toneyama National Hospital, Osaka, Japan
| | - Kimiko Inoue
- Department of Neurology, Toneyama National Hospital, Osaka, Japan
| | | | - Hideyuki Sawada
- Clinical Research Center, National Regional Center for Neurological Disorders and Utano National Hospital, Kyoto, Japan
- Department of Neurology, National Regional Center for Neurological Disorders and Utano National Hospital, Kyoto, Japan
- * E-mail:
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31
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Kwon KY, Lee HM, Kim M, Kang SH, Koh SB. Long-lasting isolated freezing of gait with good response to methylphenidate: A patient with pantothenate kinase-associated neurodegeneration. Parkinsonism Relat Disord 2015; 21:671-2. [PMID: 25907032 DOI: 10.1016/j.parkreldis.2015.04.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Revised: 01/22/2015] [Accepted: 04/06/2015] [Indexed: 11/25/2022]
Affiliation(s)
- Kyum-Yil Kwon
- Department of Neurology and Parkinson's Disease Center, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Hye Mi Lee
- Department of Neurology and Parkinson's Disease Center, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Minjik Kim
- Department of Neurology and Parkinson's Disease Center, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Sung Hoon Kang
- Department of Neurology and Parkinson's Disease Center, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Seong-Beom Koh
- Department of Neurology and Parkinson's Disease Center, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea.
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32
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Respondek G, Stamelou M, Kurz C, Ferguson LW, Rajput A, Chiu WZ, van Swieten JC, Troakes C, Al Sarraj S, Gelpi E, Gaig C, Tolosa E, Oertel WH, Giese A, Roeber S, Arzberger T, Wagenpfeil S, Höglinger GU. The phenotypic spectrum of progressive supranuclear palsy: a retrospective multicenter study of 100 definite cases. Mov Disord 2014; 29:1758-66. [PMID: 25370486 DOI: 10.1002/mds.26054] [Citation(s) in RCA: 235] [Impact Index Per Article: 23.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2014] [Revised: 08/13/2014] [Accepted: 09/16/2014] [Indexed: 11/06/2022] Open
Abstract
The phenotypic variability of progressive supranuclear palsy (PSP) may account for its frequent misdiagnosis, in particular in early stages of the disease. However, large multicenter studies to define the frequency and natural history of PSP phenotypes are missing. In a cohort of 100 autopsy-confirmed patients we studied the phenotypic spectrum of PSP by retrospective chart review. Patients were derived from five brain banks with expertise in neurodegenerative disorders with referrals from multiple academic hospitals. The clinical characteristics of the 100 cases showed remarkable heterogeneity. Most strikingly, only 24% of cases presented as Richardson's Syndrome (RS), and more than half of the cases either showed overlapping features of several predescribed phenotypes, or features not fitting proposed classification criteria for PSP phenotypes. Classification of patients according to predominant clinical features in the first 2 years of the disease course allowed a more comprehensive description of the phenotypic spectrum. These predominance types differed significantly with regard to survival time and frequency of cognitive deficits. In summary, the phenotypic spectrum of PSP may be broader and more variable than previously described in single-center studies. Thus, too strict clinical criteria defining distinct phenotypes may not reflect this variability. A more pragmatic clinical approach using predominance types could potentially be more helpful in the early recognition of and for making prognostic predictions for these patients. Given the limitations arising from the retrospective nature of this analysis, a systematic validation in a prospective cohort study is imperative.
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Affiliation(s)
- Gesine Respondek
- Department of Neurology, Technische Universität München, Munich, Germany; German Center for Neurodegenerative Diseases (DZNE), Munich, Germany; Department of Neurology, Philipps Universität, Marburg, Germany
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Kızıltan ME, Gunduz A, Kızıltan G, Tekeoğlu A, Sohtaoğlu M. Brainstem and spinal reflex studies in patients with primary progressive freezing of gait. J Neurol Sci 2014; 343:51-5. [PMID: 24867166 DOI: 10.1016/j.jns.2014.05.018] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2014] [Revised: 04/12/2014] [Accepted: 05/07/2014] [Indexed: 11/29/2022]
Affiliation(s)
- Meral E Kızıltan
- Department of Neurology, Cerrahpasa School of Medicine, Istanbul University, Istanbul, Turkey
| | - Aysegul Gunduz
- Department of Neurology, Cerrahpasa School of Medicine, Istanbul University, Istanbul, Turkey.
| | - Gunes Kızıltan
- Department of Neurology, Cerrahpasa School of Medicine, Istanbul University, Istanbul, Turkey
| | - Anıl Tekeoğlu
- Department of Neurology, Cerrahpasa School of Medicine, Istanbul University, Istanbul, Turkey
| | - Melis Sohtaoğlu
- Department of Neurology, Cerrahpasa School of Medicine, Istanbul University, Istanbul, Turkey
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34
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Abstract
This chapter deals with the neuronal mechanisms underlying impaired gait. The aim is, first, a better understanding of the underlying pathophysiology and, second, the selection of an adequate treatment. One of the first symptoms of a lesion within the central motor system perceived by patients is a movement disorder, which is most characteristic during locomotion, e.g. in patients suffering spasticity after stroke or a spinal cord injury or Parkinson disease. By the recording and analysis of electrophysiological and biomechanical signals during a movement, the significance of impaired reflex behavior or muscle tone and its contribution to the movement disorder can reliably be assessed. Adequate treatment should not be restricted to the correction of an isolated clinical sign but should be based on the mechanisms underlying the movement disorder that impairs the patient. Therapy should be directed toward functional training, which takes advantage of the plasticity of the nervous system. In the future a combination of repair and functional training will further improve the mobility of disabled patients.
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Affiliation(s)
- V Dietz
- Balgrist University Hospital, Zürich, Switzerland.
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35
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Fasano A, Baldari S, Di Giuda D, Paratore R, Piano C, Bentivoglio AR, Girlanda P, Morgante F. Nigro-striatal involvement in primary progressive freezing gait: insights into a heterogeneous pathogenesis. Parkinsonism Relat Disord 2012; 18:578-84. [PMID: 22459564 DOI: 10.1016/j.parkreldis.2012.03.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2011] [Revised: 02/10/2012] [Accepted: 03/03/2012] [Indexed: 12/11/2022]
Abstract
Primary progressive freezing gait (PPFG) is a clinical syndrome underlain by diverse neurodegenerative diseases and characterized by early occurrence of gait freezing. Either degeneration or integrity of the nigrostriatal terminals have been found by SPECT and PET studies. In this retrospective study, we evaluated (123)I-FP-CIT SPECT findings in a consecutive series of 13 PPFG patients with detailed clinical evaluation over time (mean follow-up duration: 3.1 ± 1.2 years). In all patients, (123)I-FP-CIT SPECT has been performed at the time of first clinical evaluation (1.7 ± 1.4 years after disease onset) and was compared with data from 23 age- and sex-matched healthy subjects. PPFG patients were categorized as having abnormal (n = 8) or normal (n = 5) SPECT. At disease onset, PPFG with abnormal SPECT had more frequent hypophonia, higher UPDRS-III scores and partial levodopa responsiveness. By contrast, PPFG with normal SPECT had more frequent bilateral plantar responses and no response to levodopa. At latest follow-up, initial diagnosis in the abnormal SPECT group was revised (n = 5) to progressive supranuclear palsy (n = 4) and pure akinesia with gait freezing (n = 1). Among the five patients with normal SPECT, follow-up evaluation disclosed corticobasal syndrome (n = 2) and primary lateral sclerosis (n = 1). Dopamine transporter imaging can capture the clinical heterogeneity of PPFG and might have a value to predict possible disease progression.
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36
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Williams DR, Lee W. Clinical features and criteria for the diagnosis of progressive supranuclear palsy. Neurodegener Dis Manag 2012. [DOI: 10.2217/nmt.11.79] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
SUMMARY The neurofibrillary tau pathology of progressive supranuclear palsy (PSP) has been associated with a number of different clinical syndromes that all ultimately lead to death and disability within 6–10 years. In 1964, Steele, Richardson and Olszewski predicted that the classic clinical syndrome they had described was specific to the topographic distribution of PSP–tau neurodegeneration and that other clinical syndromes may occur if other brain regions were affected. The spectrum of clinical disease related to PSP–tau pathology is indeed broader than 40 years ago. In addition to the classic form of PSP (Richardson’s syndrome), a number of clinical variants caused by the same neurodegenerative process have been identified. These include PSP–Parkinsonism, PSP–corticobasal syndrome, PSP–pure akinesia with gait freezing and PSP–progressive nonfluent aphasia. Here we review the clinical pictures of these syndromes and propose practical diagnostic guidelines to aid the clinician in tackling the challenges presented by the multifaceted condition of PSP–tau pathology.
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Affiliation(s)
- David R Williams
- Neuroscience Department, Alfred Hospital, Melbourne, Victoria, Australia; Van Cleef Roet Center for Nervous Diseases, Monash University, Commercial Road, Melbourne 3004, Australia
| | - Will Lee
- Neuroscience Department, Alfred Hospital, Melbourne, Victoria, Australia; Van Cleef Roet Center for Nervous Diseases, Monash University, Commercial Road, Melbourne 3004, Australia
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Azulay JP, Cantiniaux S, Vacherot F, Vaugoyeau M, Assaiante C. Locomozione: fisiologia, tecniche di analisi e classificazione dei principali disturbi. Neurologia 2011. [DOI: 10.1016/s1634-7072(11)70696-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Diederich NJ, Zanini F, Untereiner M, Pilloy W, Kruger M, Metman LV. Freezing of gait as late-onset side effect of cerebral radiotherapy. Mov Disord 2010; 25:948-50. [DOI: 10.1002/mds.22945] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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Azulay JP, Vacherot F, Vaugoyeau M. Locomotion : physiologie et classification des principaux troubles. Rev Neurol (Paris) 2010; 166:142-8. [DOI: 10.1016/j.neurol.2009.10.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2009] [Revised: 09/11/2009] [Accepted: 10/28/2009] [Indexed: 11/16/2022]
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Welter ML, Westby G, Chastan N. Les troubles de la marche et de l’équilibre dans les syndromes parkinsoniens « plus ». Rev Neurol (Paris) 2010; 166:188-95. [DOI: 10.1016/j.neurol.2009.05.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2009] [Revised: 05/11/2009] [Accepted: 05/25/2009] [Indexed: 10/20/2022]
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41
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Sakamoto R, Tsuchiya K, Yoshida R, Itoh Y, Furuta N, Kosuga A, Sugai Y, Mimura M. Progressive supranuclear palsy combined with Alzheimer's disease: A clinicopathological study of two autopsy cases. Neuropathology 2009; 29:219-29. [DOI: 10.1111/j.1440-1789.2008.00968.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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42
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Cardiac MIBG scintigraphy in Primary Progressive Freezing Gait. Parkinsonism Relat Disord 2009; 15:365-9. [DOI: 10.1016/j.parkreldis.2008.08.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2008] [Accepted: 08/21/2008] [Indexed: 12/16/2022]
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Williams DR, Lees AJ. Progressive supranuclear palsy: clinicopathological concepts and diagnostic challenges. Lancet Neurol 2009; 8:270-9. [PMID: 19233037 DOI: 10.1016/s1474-4422(09)70042-0] [Citation(s) in RCA: 414] [Impact Index Per Article: 27.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Progressive supranuclear palsy (PSP) is a clinical syndrome comprising supranuclear palsy, postural instability, and mild dementia. Neuropathologically, PSP is defined by the accumulation of neurofibrillary tangles. Since the first description of PSP in 1963, several distinct clinical syndromes have been described that are associated with PSP; this discovery challenges the traditional clinicopathological definition and complicates diagnosis in the absence of a reliable, disease-specific biomarker. We review the emerging nosology in this field and contrast the clinical and pathological characteristics of the different disease subgroups. These new insights emphasise that the pathological events and processes that lead to the accumulation of phosphorylated tau protein in the brain are best considered as dynamic processes that can develop at different rates, leading to different clinical phenomena. Moreover, for patients for whom the diagnosis is unclear, clinicians must continue to describe accurately the clinical picture of each individual, rather than label them with inaccurate diagnostic categories, such as atypical parkinsonism or PSP mimics. In this way, the development of the clinical features can be informative in assigning less common nosological categories that give clues to the underlying pathology and an understanding of the expected clinical course.
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Affiliation(s)
- David R Williams
- Faculty of Medicine (Neurosciences), Monash University, Melbourne, Australia.
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Park HK, Kim JS, Im KC, Oh SJ, Kim MJ, Lee JH, Chung SJ, Lee MC. Functional brain imaging in pure akinesia with gait freezing: [18F] FDG PET and [18F] FP-CIT PET analyses. Mov Disord 2009; 24:237-45. [DOI: 10.1002/mds.22347] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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45
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Ahmed Z, Josephs KA, Gonzalez J, DelleDonne A, Dickson DW. Clinical and neuropathologic features of progressive supranuclear palsy with severe pallido-nigro-luysial degeneration and axonal dystrophy. ACTA ACUST UNITED AC 2007; 131:460-72. [PMID: 18158316 DOI: 10.1093/brain/awm301] [Citation(s) in RCA: 76] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Pallido-nigro-luysial atrophy (PNLA) is a rare disorder that in many cases has histopathological features similar to progressive supranuclear palsy (PSP). In a pathological series of over 400 cases of PSP, eight cases were noted to have features similar to those described in PNLA, including severe atrophy and neuronal loss in the globus pallidus, substantia nigra and subthalamic nucleus, in addition to many axonal spheroids in the globus pallidus and substantia nigra. These eight cases of PSP-PNLA were compared to 11 typical PSP cases with quantitative neuropathologic indices and assessment of demographics, clinical features and the timing of clinical features. PSP-PNLA cases were younger, had longer disease duration and more often were not initially diagnosed with PSP; in the end, they did not differ from PSP with respect to any major clinical feature. The clinical course of PSP-PNLA, however, was different, with earlier gait abnormalities and difficulty with handwriting, but later falls, rigidity and dysphagia than PSP. Pathologically, the same types of lesions were detected in both PSP and PSP-PNLA, but there were differences in the distribution and density of tau-pathology, with less tau-pathology in motor cortex, striatum, pontine nuclei and cerebellum in PSP-PNLA. These clinical and pathological findings suggest that PSP-PNLA should be considered a variant of PSP.
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Affiliation(s)
- Zeshan Ahmed
- Department of Neuroscience, Mayo Clinic College of Medicine, Jacksonville, FL, USA
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