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Habibi SAH, Aghavali S, Azad Z, Amini E, Falah M, Gholibeigian Z, Yazdi N, Emamikhah M, Rohani M. Transcranial sonography in neurodegeneration with brain iron accumulation disorders. Clin Neurol Neurosurg 2024; 236:108074. [PMID: 38091703 DOI: 10.1016/j.clineuro.2023.108074] [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] [Received: 05/28/2023] [Revised: 11/21/2023] [Accepted: 11/26/2023] [Indexed: 02/04/2024]
Abstract
BACKGROUND Transcranial Sonography is a non-invasive technique that has been used as a diagnostic tool for a variety of neurodegenerative disorders. However, the utility and potential application of this technique in NBIA disorders is scarce and inconclusive. METHODS In this cross-sectional retrospective case-control study, the echogenicity of Substantia Nigra (SN), Lentiform Nucleus (LN), and Diameter of the Third Ventricle (DTV) were assessed by TCS in genetically confirmed NBIA patients referring to the movement disorder clinic. The normal echogenicity area of SN was defined based on the 90th percentile of an age-and-gender-matched control group. NBIA patients underwent neurologic examination at each visit, but their brain magnetic resonance imaging and demographics were extracted from electronic records. RESULTS Thirty-five NBIA patients of four subtypes with a mean disease duration of 10.54 years and 35 controls were enrolled. The normally defined SN echogenicity in controls was 0.23 cm2. DTV and SN echogenicity areas were significantly higher in patients compared to the controls (P = 0.002 and < 0.001, respectively). Around 85% and 63% of the patients showed LN and SN hyperechogenicity at least on one side, respectively. Disease duration was positively correlated with DTV (r = 0.422, p = 0.015). Cases with Pantothenate Kinase Associated Neurodegeneration (n = 23) also had significantly higher DTV and SN echogenicity area compared to the controls. CONCLUSION Despite most NBIA patients displayed increased DVT and higher SN and LN hyperechogenicity than healthy controls, the discriminatory role of TCS on different NBIA subtypes remains to be determined.
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Affiliation(s)
- Seyed Amir Hassan Habibi
- Department of Neurology, Rasoul Akram Hospital, School of Medicine, Iran University of Medical Sciences, Tehran 1445613131, Iran
| | - Sharmin Aghavali
- Department of Neurology, Rasoul Akram Hospital, School of Medicine, Iran University of Medical Sciences, Tehran 1445613131, Iran
| | - Zahra Azad
- Skull Base Research Center, The Five Senses Health Institute, Rasoul Akram Hospital, School of Medicine, Iran University of Medical Sciences, Tehran 1445613131, Iran.
| | - Elahe Amini
- Department of Neurology, Rasoul Akram Hospital, School of Medicine, Iran University of Medical Sciences, Tehran 1445613131, Iran; Skull Base Research Center, The Five Senses Health Institute, Rasoul Akram Hospital, School of Medicine, Iran University of Medical Sciences, Tehran 1445613131, Iran
| | - Masoumeh Falah
- ENT and Head and Neck Research Center and Department, Rasoul Akram Hospital, The Five Senses Health Institute, School of Medicine, Iran University of Medical Sciences, Tehran 1445613131, Iran
| | - Zeinab Gholibeigian
- Skull Base Research Center, The Five Senses Health Institute, Rasoul Akram Hospital, School of Medicine, Iran University of Medical Sciences, Tehran 1445613131, Iran
| | - Narges Yazdi
- Department of Neurology, Rasoul Akram Hospital, School of Medicine, Iran University of Medical Sciences, Tehran 1445613131, Iran
| | - Maziar Emamikhah
- Department of Neurology, Rasoul Akram Hospital, School of Medicine, Iran University of Medical Sciences, Tehran 1445613131, Iran
| | - Mohammad Rohani
- Department of Neurology, Rasoul Akram Hospital, School of Medicine, Iran University of Medical Sciences, Tehran 1445613131, Iran; Skull Base Research Center, The Five Senses Health Institute, Rasoul Akram Hospital, School of Medicine, Iran University of Medical Sciences, Tehran 1445613131, Iran
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Khan MA, Haider N, Singh T, Bandopadhyay R, Ghoneim MM, Alshehri S, Taha M, Ahmad J, Mishra A. Promising biomarkers and therapeutic targets for the management of Parkinson's disease: recent advancements and contemporary research. Metab Brain Dis 2023; 38:873-919. [PMID: 36807081 DOI: 10.1007/s11011-023-01180-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 02/04/2023] [Indexed: 02/23/2023]
Abstract
Parkinson's disease (PD) is one of the progressive neurological diseases which affect around 10 million population worldwide. The clinical manifestation of motor symptoms in PD patients appears later when most dopaminergic neurons have degenerated. Thus, for better management of PD, the development of accurate biomarkers for the early prognosis of PD is imperative. The present work will discuss the potential biomarkers from various attributes covering biochemical, microRNA, and neuroimaging aspects (α-synuclein, DJ-1, UCH-L1, β-glucocerebrosidase, BDNF, etc.) for diagnosis, recent development in PD management, and major limitations with current and conventional anti-Parkinson therapy. This manuscript summarizes potential biomarkers and therapeutic targets, based on available preclinical and clinical evidence, for better management of PD.
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Affiliation(s)
- Mohammad Ahmed Khan
- Department of Pharmacology, School of Pharmaceutical Education and Research, Jamia Hamdard, New Delhi, 110062, India
| | - Nafis Haider
- Prince Sultan Military College of Health Sciences, Dhahran, 34313, Saudi Arabia
| | - Tanveer Singh
- Department of Neuroscience and Experimental Therapeutics, College of Medicine, Texas A&M University Health Science Center, Bryan, TX, 77807, USA
| | - Ritam Bandopadhyay
- Department of Pharmacology, School of Pharmaceutical Sciences, Lovely Professional University, Phagwara, 144411, Punjab, India
| | - Mohammed M Ghoneim
- Department of Pharmacy Practice, College of Pharmacy, AlMaarefa University, Ad Diriyah, 13713, Saudi Arabia
| | - Sultan Alshehri
- Department of Pharmaceutics, College of Pharmacy, King Saud University, Riyadh, 11451, Saudi Arabia
| | - Murtada Taha
- Prince Sultan Military College of Health Sciences, Dhahran, 34313, Saudi Arabia
| | - Javed Ahmad
- Department of Pharmaceutics, College of Pharmacy, Najran University, Najran, 11001, Saudi Arabia
| | - Awanish Mishra
- Department of Pharmacology and Toxicology, National Institute of Pharmaceutical Education and Research (NIPER) - Guwahati, Sila Katamur (Halugurisuk), Kamrup, Changsari, Assam, 781101, India.
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3
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The role of transcranial sonography in differentiation of dementia subtypes: an introduction of a new diagnostic method. Neurol Sci 2020; 42:275-283. [DOI: 10.1007/s10072-020-04566-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Accepted: 07/02/2020] [Indexed: 12/21/2022]
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Paramanandam V, Olszewska DA, Shakya B, Chalissery AJ, O'Connell M, Farrell M, Lynch T. Reply to Comment on: A 57-Year-Old Woman With Progressive Left Hand Clumsiness and Falls. Mov Disord Clin Pract 2020; 7:581-582. [PMID: 32626813 PMCID: PMC7328408 DOI: 10.1002/mdc3.12964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Accepted: 03/31/2020] [Indexed: 11/07/2022] Open
Affiliation(s)
- Vijayashankar Paramanandam
- Centre for Brain Health, Dublin Neurological Institute at the Mater MisericordiaeUniversity HospitalDublinIreland
| | - Diana Angelika Olszewska
- Centre for Brain Health, Dublin Neurological Institute at the Mater MisericordiaeUniversity HospitalDublinIreland
| | | | - Albi Jose Chalissery
- Centre for Brain Health, Dublin Neurological Institute at the Mater MisericordiaeUniversity HospitalDublinIreland
| | - Martin O'Connell
- Department of RadiologyMater Misericordiae University HospitalDublinIreland
| | | | - Tim Lynch
- Centre for Brain Health, Dublin Neurological Institute at the Mater MisericordiaeUniversity HospitalDublinIreland
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5
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Crespo-Cuevas AM, López-Cancio E, Cáceres C, González A, Ispierto L, Hernández-Pérez M, Mataró M, Planas A, Canento T, Martín L, Arenillas JF, Alvarez R, Vilas D. Third Ventricle Width Assessed by Transcranial Sonography as Predictor of Long-Term Cognitive Impairment. J Alzheimers Dis 2020; 73:741-749. [DOI: 10.3233/jad-190949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Ane Miren Crespo-Cuevas
- Department of Neurosciences, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Elena López-Cancio
- Department of Neurosciences, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
- Department of Neurology, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Cynthia Cáceres
- Department of Neurosciences, Neuropsychology Unit, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Anna González
- Department of Neurosciences, Neuropsychology Unit, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Lourdes Ispierto
- Department of Neurosciences, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - María Hernández-Pérez
- Department of Neurosciences, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - María Mataró
- Department of Clinical Psychology and Psychobiology, Universitat de Barcelona, Barcelona, Spain
- Institut de Neurociències, University of Barcelona, Barcelona, Spain
- Institut de Recerca Pediàtrica Hospital Sant Joan de Déu, Esplugues de Llobregat, Spain
| | - Anna Planas
- Department of Neurosciences, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Tamara Canento
- Department of Neurosciences, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Lorena Martín
- Department of Neurosciences, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | | | - Ramiro Alvarez
- Department of Neurosciences, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Dolores Vilas
- Department of Neurosciences, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
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Abstract
Parkinson's disease (PD) is a chronic, debilitating neurodegenerative disorder characterized clinically by a variety of progressive motor and nonmotor symptoms. Currently, there is a dearth of diagnostic tools available to predict, diagnose or mitigate disease risk or progression, leading to a challenging dilemma within the healthcare management system. The search for a reliable biomarker for PD that reflects underlying pathology is a high priority in PD research. Currently, there is no reliable single biomarker predictive of risk for motor and cognitive decline, and there have been few longitudinal studies of temporal progression. A combination of multiple biomarkers might facilitate earlier diagnosis and more accurate prognosis in PD. In this review, we focus on the recent developments of serial biomarkers for PD from a variety of clinical, biochemical, genetic and neuroimaging perspectives.
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Affiliation(s)
- Anastasia Bougea
- Neurochemistry Laboratory, 1st Department of Neurology and Movement Disorders, Medical School, Aeginition Hospital, National and Kapodistrian University of Athens, Athens, Greece; Neuroscience Laboratory, Center for Basic Research, Biomedical Research Foundation of the Academy of Athens, Athens, Greece.
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7
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Bor-Seng-Shu E, Paschoal FM, Almeida KJ, De Lima Oliveira M, Nogueira RC, Teixeira MJ, Walter U. Transcranial brain sonography for Parkinsonian syndromes. J Neurosurg Sci 2020; 63:441-449. [PMID: 31210040 DOI: 10.23736/s0390-5616.19.04696-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Substantia nigra (SN) hyperechogenicity has been proved to be a characteristic finding for idiopathic Parkinson's disease (PD), occurring in more than 90% of the patients. This echofeature is owed to increased amounts of iron in the SN region and reflects a functional impairment of the nigrostriatal dopaminergic system. In a prospective blinded study in which a group of patients with early mild signs and symptoms of unclear Parkinsonism were followed until a definite clinical diagnosis of PD, the hyperechogenicity of the SN was demonstrated to be highly predictive of a final diagnosis of PD. For the diagnosis of PD in individuals with early motor symptoms, both the sensitivity and positive predictive value of SN hyperechogenicity were higher than 90% and both the specificity and negative predictive value were higher than 80%. For early differential diagnosis between PD and atypical Parkinsonian syndromes, the sensitivity and positive predictive value of SN hyperechogenicity were higher than 90%, and both the specificity and negative predictive value were higher than 80%. The diagnostic specificity is increased if combining the TCS findings of SN, lenticular nucleus and third ventricle. In asymptomatic adult subjects, SN hyperechogenicity, at least unilaterally, indicates a subclinical functional insufficiency of the nigrostriatal dopaminergic system. Recent papers revealed that SN hyperechogenicity might suggest preclinical PD. Reduced echogenicity of midbrain raphe indicates increased risk of depression in PD patients. Caudate nucleus hyperechogenicity has been associated with drug-induced psychosis, and frontal horn dilatation >20 mm with dementia. Transcranial brain sonography can be a valuable tool for managing patients with Parkinsonian signs and symptoms.
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Affiliation(s)
- Edson Bor-Seng-Shu
- Division of Neurological Surgery, Hospital das Clinicas, School of Medicine, University of Sao Paulo, Sao Paulo, Brazil -
| | - Fernando M Paschoal
- Division of Neurological Surgery, Hospital das Clinicas, School of Medicine, University of Sao Paulo, Sao Paulo, Brazil
| | - Kelson J Almeida
- Division of Neurological Surgery, Hospital das Clinicas, School of Medicine, University of Sao Paulo, Sao Paulo, Brazil
| | - Marcelo De Lima Oliveira
- Division of Neurological Surgery, Hospital das Clinicas, School of Medicine, University of Sao Paulo, Sao Paulo, Brazil
| | - Ricardo C Nogueira
- Division of Neurological Surgery, Hospital das Clinicas, School of Medicine, University of Sao Paulo, Sao Paulo, Brazil
| | - Manoel J Teixeira
- Division of Neurological Surgery, Hospital das Clinicas, School of Medicine, University of Sao Paulo, Sao Paulo, Brazil
| | - Uwe Walter
- Department of Neurology, University of Rostock, Rostock, Germany
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Richter D, Katsanos AH, Schroeder C, Tsivgoulis G, Paraskevas GP, Müller T, Alexandrov AV, Gold R, Tönges L, Krogias C. Lentiform Nucleus Hyperechogenicity in Parkinsonian Syndromes: A Systematic Review and Meta-Analysis with Consideration of Molecular Pathology. Cells 2019; 9:cells9010002. [PMID: 31861253 PMCID: PMC7016776 DOI: 10.3390/cells9010002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 12/03/2019] [Accepted: 12/14/2019] [Indexed: 12/19/2022] Open
Abstract
The hyperechogenicity of the substania nigra (SN) has been established as a valid finding in patients with Parkinson’s disease (PD), probably caused by an increased tissue iron concentration in the SN. The application of transcranial sonography (TCS) has been investigated for further echogenic basal ganglia alterations in patients with extrapyramidal movement disorders. Compared to PD, a hyperechogenic nucleus lentiformis (LN) has been reported to appear more frequently in atypical parkinsonian syndromes (aPS) such as the parkinsonian phenotype of multiple system atrophy (MSA-P) or the progressive supranuclear palsy (PSP). As the evidence providing study sizes are small, we conduct the first meta-analysis of the prevalence of LN hyperechogenicity in PD and aPS. We search for available studies providing prevalence of LN hyperechogenicity in patients with PD and aPS (MSA-P and PSP) detected by TCS in MEDLINE and SCOPUS databases. We calculate the prevalence rates of LN hyperechogenicity detection in patients with clinical diagnosis of PD vs. aPS under the random-effects model. We include a total of 1330 patients, 1091 PD and 239 aPS (MSA-P and PSP). We find a significantly higher prevalence of LN hyperechogenicity in aPS (76%, 95% CI: 0.62-0.88) compared to PD (16%, 95% CI: 0.10-0.23). After proving a higher prevalence of LN hyperechogenicity in aPS compared to PD, its histopathological cause needs to be investigated. Furthermore, its full diagnostic accuracy and the qualification to serve as a risk factor for MSA-P and PSP should also be questioned in future studies.
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Affiliation(s)
- Daniel Richter
- Department of Neurology, St. Josef-Hospital, Ruhr-University Bochum, 44791 Bochum, Germany; (D.R.); (A.H.K.); (C.S.); (R.G.); (L.T.)
| | - Aristeidis H. Katsanos
- Department of Neurology, St. Josef-Hospital, Ruhr-University Bochum, 44791 Bochum, Germany; (D.R.); (A.H.K.); (C.S.); (R.G.); (L.T.)
- 2nd Department of Neurology, National and Kapodistrian University of Athens, 15344 Athens, Greece;
| | - Christoph Schroeder
- Department of Neurology, St. Josef-Hospital, Ruhr-University Bochum, 44791 Bochum, Germany; (D.R.); (A.H.K.); (C.S.); (R.G.); (L.T.)
| | - Georgios Tsivgoulis
- 2nd Department of Neurology, National and Kapodistrian University of Athens, 15344 Athens, Greece;
- Department of Neurology, The University of Tennessee Health Science Center, Memphis, TN 38163, USA;
| | - George P. Paraskevas
- 1st Department of Neurology, Cognitive and Movement Disorders Clinic and Unit of Neurochemistry and Biological Markers, School of Medicine, National and Kapodistrian University of Athens, Eginition Hospital, 11528 Athens, Greece;
| | - Thomas Müller
- Department of Neurology, Alexianer St. Joseph Berlin-Weißensee, 13088 Berlin, Germany;
| | - Andrei V. Alexandrov
- Department of Neurology, The University of Tennessee Health Science Center, Memphis, TN 38163, USA;
| | - Ralf Gold
- Department of Neurology, St. Josef-Hospital, Ruhr-University Bochum, 44791 Bochum, Germany; (D.R.); (A.H.K.); (C.S.); (R.G.); (L.T.)
- Neurodegeneration Research, Protein Research Unit Ruhr (PURE), Ruhr University Bochum, 44791 Bochum, Germany
| | - Lars Tönges
- Department of Neurology, St. Josef-Hospital, Ruhr-University Bochum, 44791 Bochum, Germany; (D.R.); (A.H.K.); (C.S.); (R.G.); (L.T.)
- Neurodegeneration Research, Protein Research Unit Ruhr (PURE), Ruhr University Bochum, 44791 Bochum, Germany
| | - Christos Krogias
- Department of Neurology, St. Josef-Hospital, Ruhr-University Bochum, 44791 Bochum, Germany; (D.R.); (A.H.K.); (C.S.); (R.G.); (L.T.)
- Correspondence: ; Tel.: +49-234-509-6410; Fax: +49-234-509-2414
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Li T, Shi J, Qin B, Fan D, Liu N, Ni J, Zhang T, Zhou H, Xu X, Wei M, Zhang X, Wang X, Liu J, Wang Y, Tian J. Increased substantia nigra echogenicity correlated with visual hallucinations in Parkinson's disease: a Chinese population-based study. Neurol Sci 2019; 41:661-667. [PMID: 31754876 PMCID: PMC7039836 DOI: 10.1007/s10072-019-04110-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Accepted: 10/15/2019] [Indexed: 01/03/2023]
Abstract
As a noninvasive technique, transcranial sonography (TCS) of substantia nigra (SN) has gradually showed its effectiveness not only in diagnosis but also in understanding clinical features of Parkinson’s Disease (PD). This study aimed to further evaluate TCS for clinical diagnosis of PD, and to explore the association between sonographic manifestations and visual hallucinations (VH). A total of 226 subjects including 141 PD patients and 85 controls were recruited. All participants received TCS. A series of rating scales to evaluate motor and non-motor symptoms were performed in PD patients. Results showed that 172 subjects were successfully assessed by TCS. The area of SN was greater in PD patients than that in controls (P < 0.001). As receiver-operating characteristic (ROC) curve analysis showed, the best cutoff value for the larger SN echogenicity size was 23.5 mm2 (sensitivity 70.3%, specificity 77.0%). Patients with VH had larger SN area (P = 0.019), as well as higher Non-Motor Symptoms Scale (NMSS) scores (P = 0.018). Moreover, binary logistic regression analysis indicated that SN hyperechogenicity (odds ratio = 4.227, P = 0.012) and NMSS scores (odds ratio = 0.027, P = 0.042) could be the independent predictors for VH. In conclusion, TCS can be used as an auxiliary diagnostic tool for Parkinson’s disease. Increased SN echogenicity is correlated with VH in Parkinson’s disease, possibly because the brain stem is involved in the mechanism in the onset of VH. Further studies are needed to confirm these findings.
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Affiliation(s)
- Ting Li
- The Neurology Center, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, 100700, China
| | - Jing Shi
- The Neurology Center, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, 100700, China
| | - Bin Qin
- Beijing Hospital, Beijing, 100730, China
| | - Dongsheng Fan
- Peking University Third Hospital, Beijing, 100191, China
| | - Na Liu
- Peking University Third Hospital, Beijing, 100191, China
| | - Jingnian Ni
- The Neurology Center, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, 100700, China
| | - Tianqing Zhang
- The Neurology Center, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, 100700, China
| | - Hufang Zhou
- The Neurology Center, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, 100700, China
| | - Xiaoqing Xu
- The Neurology Center, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, 100700, China
| | - Mingqing Wei
- The Neurology Center, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, 100700, China
| | - Xuekai Zhang
- The Neurology Center, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, 100700, China
| | - Xiangzhu Wang
- The Neurology Center, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, 100700, China
| | - Jianping Liu
- Center for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, 100029, China
| | - Yongyan Wang
- Institute of Clinical Medicine, China Academy of Chinese Medical Sciences, Beijing, 100700, China
| | - Jinzhou Tian
- The Neurology Center, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, 100700, China.
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Alonso-Canovas A, Tembl Ferrairó JI, Martínez-Torres I, Lopez-Sendon Moreno JL, Parees-Moreno I, Monreal-Laguillo E, Pérez-Torre P, Toledano Delgado R, García Ribas G, Sastre Bataller I, Masjuan J, Martinez-Castrillo JC, Walter U. Transcranial sonography in atypical parkinsonism: How reliable is it in real clinical practice? A multicentre comprehensive study. Parkinsonism Relat Disord 2019; 68:40-45. [DOI: 10.1016/j.parkreldis.2019.09.032] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 07/12/2019] [Accepted: 09/30/2019] [Indexed: 12/13/2022]
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