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Mijajlovic M, Bozovic I, Pavlovic A, Rakocevic-Stojanovic V, Gluscevic S, Stojanovic A, Basta I, Meola G, Peric S. Transcranial brain parenchyma sonographic findings in patients with myotonic dystrophy type 1 and 2. Heliyon 2024; 10:e26856. [PMID: 38434309 PMCID: PMC10907768 DOI: 10.1016/j.heliyon.2024.e26856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Revised: 02/06/2024] [Accepted: 02/21/2024] [Indexed: 03/05/2024] Open
Abstract
Introduction Myotonic dystrophy type 1 (DM1) and 2 (DM2) are genetically determined progressive muscular disorders with multisystemic affection, including brain involvement. Transcranial sonography (TCS) is a reliable diagnostic tool for the investigation of deep brain structures. We sought to evaluate TCS findings in genetically confirmed DM1 and DM2 patients, and further correlate these results with patients' clinical features. Methods This cross-sectional study included 163 patients (102 DM1, 61 DM2). Echogenicity of the brainstem raphe (BR) and substantia nigra (SN) as well as the diameter of the third ventricle (DTV) were assessed by TCS. Patients were evaluated using the Hamilton Depression Rating Scale, Fatigue Severity Scale and Daytime Sleepiness Scale. Results SN hyperechogenicity was observed in 40% of DM1 and 34% of DM2 patients. SN hypoechogenicity was detected in 17% of DM1 and 7% of DM2 patients. BR hypoechogenicity was found in 36% of DM1 and 47% of DM2 subjects. Enlarged DTV was noted in 19% of DM1 and 15% of DM2 patients. Older, weaker, depressive, and fatigued DM1 patients were more likely to have BR hypoechogenicity (p < 0.05). DTV correlated with age and disease duration in DM1 (p < 0.01). In DM2 patients SN hyperechogenicity correlated with fatigue. Excessive daytime sleepiness was associated with hypoechogenic BR (p < 0.05) and enlarged DVT (p < 0.01) in DM2 patients. Conclusions TCS is an easy applicable and sensitive neuroimaging technique that could offer new information regarding several brainstem structures in DM1 and DM2. This may lead to better understanding of the pathogenesis of the brain involvement in DM with possible clinical implications.
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Affiliation(s)
- Milija Mijajlovic
- Neurology Clinic, University Clinical Center of Serbia, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Ivo Bozovic
- Neurology Clinic, University Clinical Center of Serbia, Belgrade, Serbia
| | - Aleksandra Pavlovic
- Neurology Clinic, University Clinical Center of Serbia, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
- Faculty of Special Education and Rehabilitation, University of Belgrade, Belgrade, Serbia
| | - Vidosava Rakocevic-Stojanovic
- Neurology Clinic, University Clinical Center of Serbia, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Sanja Gluscevic
- Neurology Clinic, Clinical Center of Montenegro, Podgorica, Montenegro
| | | | - Ivana Basta
- Neurology Clinic, University Clinical Center of Serbia, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Giovanni Meola
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
- Department of Neurorehabilitation Sciences, Casa Di Cura del Policlinico, Milan, Italy
| | - Stojan Peric
- Neurology Clinic, University Clinical Center of Serbia, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
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Liepelt-Scarfone I, Ophey A, Kalbe E. Cognition in prodromal Parkinson's disease. PROGRESS IN BRAIN RESEARCH 2022; 269:93-111. [PMID: 35248208 DOI: 10.1016/bs.pbr.2022.01.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
One characteristic of Parkinson's disease (PD) is a prodromal phase, lasting many years during which both pre-clinical motor and non-motor symptoms occur. Around one-fifth of patients with PD manifest mild cognitive impairment at time of clinical diagnosis. Thus, important challenges are to define the time of onset of cognitive dysfunction in the prodromal phase of PD, and to define its co-occurrence with other specific characteristics. Evidence for cognitive change in prodromal PD comes from various study designs, including both longitudinal and cross-sectional approaches with different target groups. These studies support the concept that changes in global cognitive function and alterations in executive functions occur, and that these changes may be present up to 6 years before clinical PD diagnosis. Notably, this evidence led to including global cognitive impairment as an independent prodromal marker in the recently updated research criteria of the Movement Disorder Society for prodromal PD. Knowledge in this field, however, is still at its beginning, and evidence is sparse about many aspects of this topic. Further longitudinal studies including standardized assessments of global and domain-specific cognitive functions are needed to gain further knowledge about the first appearance, the course, and the interaction of cognitive deficits with other non-motor symptoms in prodromal stage PD. Treatment approaches, including non-pharmacological interventions, in individuals with prodromal PD might help to prevent or delay cognitive dysfunction in early PD.
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Affiliation(s)
- Inga Liepelt-Scarfone
- German Center for Neurodegenerative Diseases (DZNE) and Hertie Institute for Clinical Brain Research, Department of Neurodegenerative Diseases, University of Tübingen, Tübingen, Germany; IB-Hochschule, Stuttgart, Germany.
| | - Anja Ophey
- Medical Psychology, Neuropsychology and Gender Studies, Center for Neuropsychological Diagnostics and Intervention (CeNDI), University Hospital Cologne and Medical Faculty of the University of Cologne, Cologne, Germany
| | - Elke Kalbe
- Medical Psychology, Neuropsychology and Gender Studies, Center for Neuropsychological Diagnostics and Intervention (CeNDI), University Hospital Cologne and Medical Faculty of the University of Cologne, Cologne, Germany
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3
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Li K, Ge YL, Gu CC, Zhang JR, Jin H, Li J, Cheng XY, Yang YP, Wang F, Zhang YC, Chen J, Mao CJ, Liu CF. Substantia nigra echogenicity is associated with serum ferritin, gender and iron-related genes in Parkinson's disease. Sci Rep 2020; 10:8660. [PMID: 32457446 PMCID: PMC7250839 DOI: 10.1038/s41598-020-65537-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2019] [Accepted: 04/29/2020] [Indexed: 01/17/2023] Open
Abstract
Substantia nigra (SN) hyperechogenicity is present in most Parkinson’s disease (PD) cases but is occasionally absent in some. To date, age, gender, disease severity, and other factors have been reported to be associated with SN hyperechogenicity in PD. Previous studies have discovered that excess iron deposition in the SN underlies its hyperechogenicity in PD, which may also indicate the involvement of genes associated with iron metabolism in hyperechogenicity. The objective of our study is to explore the potential associations between variants in iron metabolism-associated genes and SN echogenicity in Han Chinese PD. Demographic profiles, clinical data, SN echogenicity and genotypes were obtained from 221 Han Chinese PD individuals with a sufficient bone window. Serum ferritin levels were quantified in 92 of these individuals by immunochemical assay. We then compared factors between PD individuals with SN hyperechogenicity and those with SN hypoechogenicity to identify factors that predispose to SN hyperechogenicity. Of our 221 participants, 122 (55.2%) displayed SN hyperechogenicity, and 99 (44.8%) displayed SN hypoechogenicity. Gender and serum ferritin levels were found to be associated with SN hyperechogenicity. In total, 14 genes were included in the sequencing part. After data processing, 34 common single nucleotide polymorphisms were included in our further analyses. In our data, we also found a significantly higher frequency of PANK2 rs3737084 (genotype: OR = 2.07, P = 0.013; allele: OR = 2.51, P = 0.002) in the SN hyperechogenic group and a higher frequency of PLA2G6 rs731821 (genotype: OR = 0.45, P = 0.016; allele: OR = 0.44, P = 0.011) in the SN hypoechogenic group. However, neither of the two variants was found to be correlated with serum ferritin. This study demonstrated that genetic factors, serum ferritin level, and gender may explain the interindividual variability in SN echogenicity in PD. This is an explorative study, and further replication is warranted in larger samples and different populations.
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Affiliation(s)
- Kai Li
- Department of Neurology, the Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Yi-Lun Ge
- Department of Neurology, the Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Chen-Chen Gu
- Department of Neurology, the Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Jin-Ru Zhang
- Department of Neurology, the Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Hong Jin
- Department of Neurology, the Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Jiao Li
- Department of Neurology, the Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Xiao-Yu Cheng
- Department of Neurology, the Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Ya-Ping Yang
- Department of Neurology, the Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Fen Wang
- Institute of Neuroscience, Soochow University, Suzhou, Jiangsu, China
| | - Ying-Chun Zhang
- Department of Ultrasound, the Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Jing Chen
- Department of Neurology, the Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Cheng-Jie Mao
- Department of Neurology, the Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Chun-Feng Liu
- Department of Neurology, the Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China. .,Institute of Neuroscience, Soochow University, Suzhou, Jiangsu, China.
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Transcranial B-Mode Sonography in Movement Disorders. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2018; 143:179-212. [PMID: 30473195 DOI: 10.1016/bs.irn.2018.10.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Applying a 2-4MHz probe at the temporal bone window transcranial B-mode sonography (TCS) enables the depiction of the brain parenchyma through the intact skull. Meanwhile it has been applied for the diagnosis and the differential diagnosis of movement disorders for decades. In the first part of this chapter, we summarize the technical requirements and describe the ultrasound method for optimal TCS examination. Imaging planes and the relevant structures are explained in detail. In the second part of the chapter, we focus on the role of substantia nigra hyperechogenicity for the diagnosis of Parkinson's disease (PD) and prodromal PD. In this part, we also mention the role of TCS in atypical and secondary Parkinsonian syndromes and other movement disorders. Summarizing all these information we explain how TCS can be helpful for the differential diagnosis of movement disorders. The current data show that TCS is an easily applicable and economic imaging method which can be used as an additional tool for the diagnosis of PD with a high sensitivity (>85%), specificity (>80%) and inter-rater reliability (>84%) as well as for the differential diagnosis of movement disorders. Lately, TCS has also been utilized in further areas such as the detection of individuals at risk for PD or the determination of electrode localization in patients with deep brain stimulation. An insufficient temporal bone window especially in the elderly and the necessity of an experienced investigator are limitations of this method.
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Heldmann M, Heeren J, Klein C, Rauch L, Hagenah J, Münte TF, Kasten M, Brüggemann N. Neuroimaging abnormalities in individuals exhibiting Parkinson's disease risk markers. Mov Disord 2018; 33:1412-1422. [PMID: 29756356 DOI: 10.1002/mds.27313] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Revised: 12/23/2017] [Accepted: 12/31/2017] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND The concept of prodromal Parkinson's disease (PD) involves variable combinations of nonmotor features and subtle motor abnormalities as a result of ongoing neurodegeneration in the brain stem including substantia nigra (SN) and abnormal findings upon transcranial sonography and nuclear imaging. Except for nuclear imaging, the predictive value of risk markers for the conversion to overt PD is low. OBJECTIVE The objective of this study was to determine whether PD risk markers are associated with changes in brain structure and to what extent cognitive changes are risk markers for PD. METHODS Diffusion-weighted imaging, voxel-based morphometry, and cortical thickness analysis was performed in 29 individuals with hyposmia and/or an increased SN hyperechogenicity (SN+) upon transcranial sonography and 28 controls without these 2 risk markers. Classical parkinsonian signs were an exclusion criterion. All of the participants underwent a neuropsychological test battery addressing executive functions, learning ability, and verbal fluency. RESULTS In the PD risk group, diffusion-weighted imaging mean diffusivity was increased in 4 left hemisphere clusters (posterior thalamus, inferior longitudinal fasciculus, fornix, corticospinal tract). A negative relationship of mean diffusivity and smell function was present for the posterior thalamus and the corticospinal tract. There was a significant correlation of mean diffusivity values and SN+ in all clusters. Neither voxel-based morphometry nor cortical thickness analysis revealed any group differences. No relevant group differences were observed for cognitive tests included. CONCLUSION PD-free individuals with PD risk markers show microstructural changes of the white matter, including areas relevant for motor and limbic processes. In addition, our study provides for the first time a neuroanatomical correlate for SN hyperechogenicity. © 2018 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Marcus Heldmann
- Department of Neurology, University of Lübeck, Lübeck, Germany
| | - Janna Heeren
- Department of Neurology, University of Lübeck, Lübeck, Germany.,Institute of Neurogenetics, University of Lübeck, Lübeck, Germany
| | - Christine Klein
- Institute of Neurogenetics, University of Lübeck, Lübeck, Germany
| | - Linus Rauch
- Department of Neurology, University of Lübeck, Lübeck, Germany.,Institute of Neurogenetics, University of Lübeck, Lübeck, Germany
| | - Johann Hagenah
- Department of Neurology, Westküstenklinikum Heide, Heide, Germany
| | - Thomas F Münte
- Department of Neurology, University of Lübeck, Lübeck, Germany
| | - Meike Kasten
- Institute of Neurogenetics, University of Lübeck, Lübeck, Germany.,Department of Psychiatry and Psychotherapy, University of Lübeck, Lübeck, Germany
| | - Norbert Brüggemann
- Department of Neurology, University of Lübeck, Lübeck, Germany.,Institute of Neurogenetics, University of Lübeck, Lübeck, Germany
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Favaretto S, Walter U, Baracchini C, Cagnin A. Transcranial Sonography in Neurodegenerative Diseases with Cognitive Decline. J Alzheimers Dis 2017; 61:29-40. [DOI: 10.3233/jad-170382] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Silvia Favaretto
- Department of Neurosciences (DNS), University of Padova, Padova, Italy
| | - Uwe Walter
- Department of Neurology, University of Rostock, Rostock, Germany
| | | | - Annachiara Cagnin
- Department of Neurosciences (DNS), University of Padova, Padova, Italy
- San Camillo Hospital IRCCS, Venice, Italy
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7
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Fengler S, Liepelt-Scarfone I, Brockmann K, Schäffer E, Berg D, Kalbe E. Cognitive changes in prodromal Parkinson's disease: A review. Mov Disord 2017; 32:1655-1666. [PMID: 28980730 DOI: 10.1002/mds.27135] [Citation(s) in RCA: 77] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2017] [Revised: 06/22/2017] [Accepted: 06/26/2017] [Indexed: 12/31/2022] Open
Abstract
Although other nonmotor phenomena representing possible prodromal symptoms of Parkinson's disease have been described in some detail, the occurrence and characteristics of cognitive decline in this early phase of the disease are less well understood. The aim of this review is to summarize the current state of research on cognitive changes in prodromal PD. Only a small number of longitudinal studies have been conducted that examined cognitive function in individuals with a subsequent PD diagnosis. However, when we consider data from at-risk groups, the evidence suggests that cognitive decline may occur in a substantial number of individuals who have the potential for developing PD. In terms of specific cognitive domains, executive function in particular and, less frequently, memory scores are reduced. Prospective longitudinal studies are thus needed to clarify whether cognitive, and specifically executive, decline might be added to the prodromal nonmotor symptom complex that may precede motor manifestations of PD by years and may help to update the risk scores used for early identification of PD. © 2017 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Sophie Fengler
- Department of Medical Psychology ǀ Neuropsychology and Gender Studies & Center for Neuropsychological Diagnostics and Intervention (CeNDI), University Hospital Cologne, Cologne, Germany.,Psychological Gerontology, Institute of Gerontology, University of Vechta, Vechta, Germany
| | - Inga Liepelt-Scarfone
- Department of Neurodegenerative Diseases, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany.,German Center of Neurodegenerative Diseases (DZNE), University of Tübingen, Tübingen, Germany
| | - Kathrin Brockmann
- Department of Neurodegenerative Diseases, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany.,German Center of Neurodegenerative Diseases (DZNE), University of Tübingen, Tübingen, Germany
| | - Eva Schäffer
- Department of Neurology, Christian-Albrechts-University, Kiel, Kiel, Germany
| | - Daniela Berg
- Department of Neurodegenerative Diseases, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany.,Department of Neurology, Christian-Albrechts-University, Kiel, Kiel, Germany
| | - Elke Kalbe
- Department of Medical Psychology ǀ Neuropsychology and Gender Studies & Center for Neuropsychological Diagnostics and Intervention (CeNDI), University Hospital Cologne, Cologne, Germany.,Psychological Gerontology, Institute of Gerontology, University of Vechta, Vechta, Germany
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8
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Hayes M, Puhl P, Hagenah J, Russo R. A Brief Nonmotor Screen Combined with Transcranial Ultrasound may Improve Diagnostic Accuracy of Parkinson's Disease. Mov Disord Clin Pract 2016; 4:397-402. [PMID: 30363362 DOI: 10.1002/mdc3.12450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2016] [Revised: 08/18/2016] [Accepted: 09/06/2016] [Indexed: 11/10/2022] Open
Abstract
Background The addition of a simple nonmotor symptom (NMS) screen and transcranial sonography (TCS) to standard clinical assessment may improve the diagnostic accuracy of Parkinson's disease (PD). Methods Sixty-nine subjects (23 established PD group, 23 healthy controls, and 23 possible PD) were enrolled. All completed 3 "yes-no" NMS questions (score, 0-3) and had a transcranial ultrasound assessing nigral hyperechogenicity (score, 0-1). A combined PD risk score of 0 to 4 was obtained for each subject. A PD risk score of ≥2 was used as the diagnostic cutoff for PD. Results In the established PD group, there was an average of 2 NMSs per person or a group total of 46 of 69 possible NMSs, but only 4 of 69 NMSs in the healthy control group. Of the technically satisfactory TCS, 16 of 20 (80%) of the established PD group and 2 of 16 (12.5%) of the healthy control group were TCS positive. Using ≥2 NMSs alone as the cutoff identified 17 of 23 (74%) of the established PD and 100% of the healthy controls. The PD risk score of ≥2 identified 21 of 23 (91%) of the established PD as PD and 22 of 23 (96%) of the healthy control group as non-PD. In the possible PD group, the PD risk score identified 9 of 18 (50%) of those with a final clinical diagnosis of PD and 4 of 5 (80%) of non-PD. Conclusions The combination of a brief NMS screen and TCS discriminated well between normal healthy controls and established PD. A positive TCS and one NMS, or a negative TCS with two NMSs, indicated a likely diagnosis of PD.
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Affiliation(s)
- Michael Hayes
- Department of Neurology Concord Hospital Sydney Australia
| | - Peter Puhl
- Department of Neurology Concord Hospital Sydney Australia
| | - Johann Hagenah
- Department of Neurology Westküstenklinikum Heide Germany.,Department of Neurology University of Lübeck Lübeck Germany
| | - Robert Russo
- Department of Nuclear Medicine Concord Hospital Sydney Australia
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Pilotto A, Yilmaz R, Berg D. Developments in the role of transcranial sonography for the differential diagnosis of parkinsonism. Curr Neurol Neurosci Rep 2016; 15:43. [PMID: 26008814 DOI: 10.1007/s11910-015-0566-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
In the last two decades transcranial sonography (TCS) has developed as a valuable, supplementary tool in the diagnosis and differential diagnosis of movement disorders. In this review, we highlight recent evidence supporting TCS as a reliable method in the differential diagnosis of parkinsonism, combining substantia nigra (SN), basal ganglia and ventricular system findings. Moreover, several studies support SN hyperechogenicity as one of most important risk factors for Parkinson's disease (PD). The advantages of TCS include short investigation time, low cost and lack of radiation. Principal limitations are still the dependency on the bone window and operator experience. New automated algorithms may reduce the role of investigator skill in the assessment and interpretation, increasing TCS diagnostic reliability. Based on the convincing evidence available, the EFNS accredited the method of TCS a level A recommendation for supporting the diagnosis of PD and its differential diagnosis from secondary and atypical parkinsonism. An increasing number of training programmes is extending the use of this technique in clinical practice.
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Affiliation(s)
- Andrea Pilotto
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
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Yilmaz R, Behnke S, Liepelt-Scarfone I, Roeben B, Pausch C, Runkel A, Heinzel S, Niebler R, Suenkel U, Eschweiler GW, Maetzler W, Berg D. Substantia nigra hyperechogenicity is related to decline in verbal memory in healthy elderly adults. Eur J Neurol 2016; 23:973-8. [DOI: 10.1111/ene.12974] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Accepted: 01/18/2016] [Indexed: 11/27/2022]
Affiliation(s)
- R. Yilmaz
- Department of Neurodegeneration; Hertie Institute for Clinical Brain Research (HIH); University of Tübingen; Tübingen Germany
| | - S. Behnke
- Department of Neurology; University of Homburg/Saar; Homburg Germany
| | - I. Liepelt-Scarfone
- Department of Neurodegeneration; Hertie Institute for Clinical Brain Research (HIH); University of Tübingen; Tübingen Germany
- German Center for Neurodegenerative Diseases (DZNE); Tübingen Germany
| | - B. Roeben
- Department of Neurodegeneration; Hertie Institute for Clinical Brain Research (HIH); University of Tübingen; Tübingen Germany
- German Center for Neurodegenerative Diseases (DZNE); Tübingen Germany
| | - C. Pausch
- Department of Neurology; University of Homburg/Saar; Homburg Germany
| | - A. Runkel
- Department of Neurology; University of Homburg/Saar; Homburg Germany
| | - S. Heinzel
- Department of Neurodegeneration; Hertie Institute for Clinical Brain Research (HIH); University of Tübingen; Tübingen Germany
| | - R. Niebler
- Department of Psychiatry and Psychotherapy; University of Tübingen; Tübingen Germany
- Geriatric Center at the University Hospital Tübingen; Tübingen Germany
| | - U. Suenkel
- Department of Neurodegeneration; Hertie Institute for Clinical Brain Research (HIH); University of Tübingen; Tübingen Germany
| | - G. W. Eschweiler
- Department of Psychiatry and Psychotherapy; University of Tübingen; Tübingen Germany
- Geriatric Center at the University Hospital Tübingen; Tübingen Germany
| | - W. Maetzler
- Department of Neurodegeneration; Hertie Institute for Clinical Brain Research (HIH); University of Tübingen; Tübingen Germany
- German Center for Neurodegenerative Diseases (DZNE); Tübingen Germany
| | - D. Berg
- Department of Neurodegeneration; Hertie Institute for Clinical Brain Research (HIH); University of Tübingen; Tübingen Germany
- German Center for Neurodegenerative Diseases (DZNE); Tübingen Germany
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11
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Zhou HY, Sun Q, Tan YY, Hu YY, Zhan WW, Li DH, Wang Y, Xiao Q, Liu J, Chen SD. Substantia nigra echogenicity correlated with clinical features of Parkinson's disease. Parkinsonism Relat Disord 2016; 24:28-33. [PMID: 26842545 DOI: 10.1016/j.parkreldis.2016.01.021] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2015] [Revised: 01/21/2016] [Accepted: 01/21/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND Transcranial sonography can display structural alterations in the substantia nigra (SN) of patients with Parkinson's disease (PD), and is considered to be a potential useful tool for the diagnosis of PD. The aim of this study was to assess the correlation between SN echogenicity and clinical features in Chinese patients with PD. METHODS A total of 420 subjects including 290 patients with PD and 130 controls were recruited from the neurological clinic or the community. Transcranial sonographic evaluations of the SN were performed in all subjects, and motor and non-motor symptoms were thoroughly assessed by a series of rating scales in PD patients. RESULTS Two hundred and one patients were successfully assessed by transcranial sonography. SN hyperechogenicity was found to be associated with male sex (p = 0.004), higher scores on the Unified Parkinson's Disease Rating Scale (UPDRS) part II (p = 0.001) and autonomic symptoms scores (p = 0.003). Moreover, regression analysis revealed that UPDRS part II scores (odds ratio = 1.141, p < 0.001) and gender (odds ratio = 2.409, p = 0.007) could be the independent predictors for SN hyperechogenicity; in addition, among all items of UPDRS part II, speech, dressing, hygiene, and turning in bed and adjusting bed clothes significantly correlated with SN hyperechogenicity. CONCLUSIONS This is the first report suggesting the correlation between SN echogenicity and UPDRS part II, and we conclude that increased SN echogenicity might reflect more severe disease disability or poorer medical response.
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Affiliation(s)
- Hai-Yan Zhou
- Department of Neurology & Institute of Neurology, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qian Sun
- Department of Neurology & Institute of Neurology, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yu-Yan Tan
- Department of Neurology & Institute of Neurology, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yun-Yun Hu
- Department of Ultrasonography, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wei-Wei Zhan
- Department of Ultrasonography, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Dun-Hui Li
- Department of Neurology & Institute of Neurology, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ying Wang
- Department of Neurology & Institute of Neurology, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qin Xiao
- Department of Neurology & Institute of Neurology, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jun Liu
- Department of Neurology & Institute of Neurology, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Sheng-Di Chen
- Department of Neurology & Institute of Neurology, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.
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12
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Li K, Reichmann H. Role of iron in neurodegenerative diseases. J Neural Transm (Vienna) 2016; 123:389-99. [PMID: 26794939 DOI: 10.1007/s00702-016-1508-7] [Citation(s) in RCA: 81] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Accepted: 01/12/2016] [Indexed: 01/01/2023]
Abstract
Currently, we still lack effective measures to modify disease progression in neurodegenerative diseases. Iron-containing proteins play an essential role in many fundamental biological processes in the central nervous system. In addition, iron is a redox-active ion and can induce oxidative stress in the cell. Although the causes and pathology hallmarks of different neurodegenerative diseases vary, iron dyshomeostasis, oxidative stress and mitochondrial injury constitute a common pathway to cell death in several neurodegenerative diseases. MRI is capable of depicting iron content in the brain, and serves as a potential biomarker for early and differential diagnosis, tracking disease progression and evaluating the effectiveness of neuroprotective therapy. Iron chelators have shown their efficacy against neurodegeneration in a series of animal models, and been applied in several clinical trials. In this review, we summarize recent developments on iron dyshomeostasis in Parkinson's disease, Alzheimer's disease, Friedreich ataxia, and Huntington's disease.
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Affiliation(s)
- Kai Li
- Center of Clinical Neuroscience, University Hospital Carl Gustav Carus, Dresden University of Technology, Fetscherstr. 74, 01307, Dresden, Germany.
| | - Heinz Reichmann
- Department of Neurology, University Hospital Carl Gustav Carus, Dresden University of Technology, Fetscherstr. 74, 01307, Dresden, Germany
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Abnormal Echogenicity of the Substantia Nigra, Raphe Nuclei, and Third-Ventricle Width as Markers of Cognitive Impairment in Parkinsonian Disorders: A Cross-Sectional Study. PARKINSONS DISEASE 2016; 2016:4058580. [PMID: 26881179 PMCID: PMC4737005 DOI: 10.1155/2016/4058580] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Revised: 12/04/2015] [Accepted: 12/09/2015] [Indexed: 02/05/2023]
Abstract
Background. Patients with Parkinson's disease (PD) have a high risk of cognitive problems. Objective. This study assesses whether abnormal echogenicity of the substantia nigra (SN) and raphe nuclei (RN) and the diameter of third ventricle are markers of cognitive impairment in patients with PD and other forms of parkinsonism. Methods. 126 outpatients with early signs of parkinsonism underwent transcranial sonography (TCS). The scales for the outcome of Parkinson's disease cognition (SCOPA-COG) were used as cognitive measure. Definite neurological diagnosis was established after two-year follow-up. Results. One-third of the patients with PD and half of those with APS had signs of cognitive impairment. The echogenicity of the SN was not related to cognitive impairment. The diameter of the third ventricle was significantly larger in PD patients with cognitive impairment compared to those without. In patients with APS we found a significantly higher frequency of hypoechogenic RN in patients with cognitive problems. Conclusions. Cognitive impairment is already present in a substantial proportion of patients with PD and APS at first referral. In patients with APS the frequency of hypoechogenic RN points to the direction of other pathophysiology with more emphasis on deficits in the serotonergic neurotransmitter system. The larger diameter of the third ventricle in PD patients with cognitive impairment may reflect Alzheimer like brain atrophy, as has been reported in earlier studies.
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Li DH, Zhang LY, Hu YY, Jiang XF, Zhou HY, Yang Q, Kang WY, Liu J, Chen SD. Transcranial sonography of the substantia nigra and its correlation with DAT-SPECT in the diagnosis of Parkinson's disease. Parkinsonism Relat Disord 2015; 21:923-8. [PMID: 26066091 DOI: 10.1016/j.parkreldis.2015.05.024] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Revised: 04/17/2015] [Accepted: 05/31/2015] [Indexed: 11/24/2022]
Abstract
INTRODUCTIONS Transcranial sonography (TCS) of the substantia nigra is a new and promising method to diagnose Parkinson's disease (PD) but its effectiveness is controversial. METHODS All 55 PD patients involved in the study underwent single photon emission computed tomography (SPECT) imaging using the labeled dopamine transporter radiotracer (99m)Tc-TRODAT-1 to assess nigrostriatal dopaminergic function. The echogenicity of the substantia nigra was measured by TCS in all patients who received DAT-SPECT scanning. Finally, statistical analysis was carried out to determine the diagnostic accuracy of TCS as well as its correlation with (99m)Tc-TRODAT-1 SPECT, its positive predictive value (PPV), and negative predictive value (NPV). RESULTS Contralateral striatal (99m)Tc-TRODAT-1 uptake was significantly reduced compared to ipsilateral striatal uptake, and had a negative correlation with UPDRS-Ⅲ(r = -0.334, p = 0.013), disease duration (r = -0.393, p = 0.003) and H-Y stage (r = -0.330, p = 0.014). After TCS measurement, the contralateral SN echogenic area was similar to the ipsilateral SN echogenic area (27.77 ± 13.19 vs 25.98 ± 11.94 mm(2), p = 0.402, n = 24). No correlation was identified between TCS and UPDRS-Ⅲ (r = 0.383, p = 0.065), disease duration (r = 0.371, p = 0.075) or H-Y stage (r = 0.259, p = 0.222). The sensitivity and specificity of SN TCS for the diagnosis of PD were calculated as 64.70% and 60% according to DAT-SPECT, respectively, while the positive predictive value and negative predictive value was calculated as 91.67% and 20%, respectively. CONCLUSIONS Compared to DAT-SPECT, TCS is a non-radioactive and convenient procedure to perform. In our investigation, TCS had no correlation with DAT-SPECT. However, the high positive predictive value of TCS highlights its possible utility as a routine diagnostic test.
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Affiliation(s)
- Dun-hui Li
- Department of Neurology & Institute of Neurology, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Lin-yuan Zhang
- Department of Neurology & Institute of Neurology, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Yun-yun Hu
- Department of Ultrasound, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Xu-feng Jiang
- Department of Nuclear Medicine, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Hai-yan Zhou
- Department of Neurology & Institute of Neurology, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Qiong Yang
- Department of Neurology & Institute of Neurology, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Wen-yan Kang
- Department of Neurology & Institute of Neurology, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Jun Liu
- Department of Neurology & Institute of Neurology, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China.
| | - Sheng-Di Chen
- Department of Neurology & Institute of Neurology, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China.
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Liepelt-Scarfone I, Lerche S, Behnke S, Godau J, Gaenslen A, Pausch C, Fassbender K, Brockmann K, Srulijes K, Huber H, Wurster I, Berg D. Clinical characteristics related to worsening of motor function assessed by the Unified Parkinson's Disease Rating Scale in the elderly population. J Neurol 2014; 262:451-8. [PMID: 25451854 DOI: 10.1007/s00415-014-7584-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Revised: 11/11/2014] [Accepted: 11/13/2014] [Indexed: 11/29/2022]
Abstract
There is evidence that nigrostriatal pathology may at least partly underlie mild Parkinsonian signs. We evaluated whether an increase in the Unified Parkinson's Disease Rating Scale part III (UPDRS-III) could be predicted by the presence of risk and prodromal markers for neurodegenerative diseases in elderly individuals without those diseases. Therefore, we analyzed the UPDRS-III score and various risk and prodromal markers known to antecede neurodegenerative diseases in a population-based cohort comprising 807 individuals free of neurodegenerative diseases at baseline. After 5 years, eight persons (1.0 %) were diagnosed with Parkinson's Disease (PD). Of those, seven (87.5 %) had motor worsening ≥3 points on the UPDRS-III from baseline to follow-up, one had two points increase. Of the 788 people without PD, 568 (72.1 %) showed no increase in the UPDRS-III scale, 220 (27.9 %) had ≥1 point increase and out of these 104 (13.2 %) had an increase of ≥3 points in the UPDRS-III score after 5 years. We identified an age >60 years (relative risk, RR = 1.7; confidence interval, CI 1.3-2.1) and the occurrence of ≥2 risk factors (RR = 1.5; CI 1.2-1.9) as possible predictors of motor progression. After 5 years, individuals with an increase in the UPDRS-III score had more often a one-sided reduced arm swing (p < 0.001) and identified less odors in the Sniffin' sticks test (p < 0.041) than persons with stable motor performance. Our data support the assumption that progression of Parkinsonian signs assessed by the UPDRS-III parallels the development of prodromal markers for neurodegenerative diseases in the elderly population.
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Affiliation(s)
- Inga Liepelt-Scarfone
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research, Hoppe-Seyler Str. 3, 72076, Tübingen, Germany,
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Alonso-Cánovas A, López-Sendón JL, Buisán J, deFelipe-Mimbrera A, Guillán M, García-Barragán N, Corral I, Matute-Lozano MC, Masjuan J, Martínez-Castrillo JC, Walter U. Sonography for diagnosis of Parkinson disease-from theory to practice: a study on 300 participants. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2014; 33:2069-2074. [PMID: 25425362 DOI: 10.7863/ultra.33.12.2069] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
OBJECTIVES Hyperechogenicity of the substantia nigra on transcranial sonography is used for diagnosing Parkinson disease (PD). Cutoff values for the substantia nigra echogenic area, defining substantia nigra hyperechogenicity, vary among ultrasound systems from different manufacturers. In this study we wanted to determine the cutoff criterion for a Toshiba (Tokyo, Japan) system and to assess its diagnostic value. METHODS Three hundred participants (controls, n = 138; patients with PD, n = 105; and patients with essential tremor, n = 57) underwent transcranial sonography following a standardized protocol. RESULTS The substantia nigra was assessable in 92.7% of all participants. The substantia nigra echogenic area (larger of bilateral measurements) was larger in patients with PD (mean ± SD, 0.24 ± 0.05 cm(2)) than controls (0.14 ± 0.05 cm(2); P < .001) and patients with essential tremor (0.14 ± 0.04 cm(2); P < .001). Substantia nigra echogenicity was larger in male participants (0.20 ± 0.07 cm(2)) than female participants (0.15 ± 0.06 cm(2); P< .001). Age did not correlate with substantia nigra echogenicity in any group. Frontal horn width was larger and lenticular nucleus hyperechogenicity and a discontinuous raphe were more frequent in the PD group than the other groups. On multivariate analysis, only substantia nigra hyperechogenicity was associated with the diagnosis of PD. The 90th-percentile substantia nigra echogenic area in the control group, which defined marked substantia nigra hyperechogenicity, also represented the optimum cutoff value for discrimination of PD from non-PD participants on receiver operating characteristic curve analysis (area under the curve, 0.913; Youden index, 0.73). This cutoff value (≥0.21 cm(2), larger of bilateral measurements) yielded sensitivity of 83% and specificity of 90% for the diagnosis of PD. CONCLUSIONS Transcranial sonography shows good diagnostic validity for diagnosis of PD when implemented according to a strictly standardized protocol.
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Affiliation(s)
- Araceli Alonso-Cánovas
- Department of Neurology, Ramón y Cajal University Hospital, Madrid, Spain (A.A.-C., J.L.L.-S., J.B., A.d.-M., M.G., N.G.-B., I.C., M.C.M.-L., J.M., J.C.M.-C.); and Department of Neurology, University of Rostock, Rostock, Germany (U.W.).
| | - José Luis López-Sendón
- Department of Neurology, Ramón y Cajal University Hospital, Madrid, Spain (A.A.-C., J.L.L.-S., J.B., A.d.-M., M.G., N.G.-B., I.C., M.C.M.-L., J.M., J.C.M.-C.); and Department of Neurology, University of Rostock, Rostock, Germany (U.W.)
| | - Javier Buisán
- Department of Neurology, Ramón y Cajal University Hospital, Madrid, Spain (A.A.-C., J.L.L.-S., J.B., A.d.-M., M.G., N.G.-B., I.C., M.C.M.-L., J.M., J.C.M.-C.); and Department of Neurology, University of Rostock, Rostock, Germany (U.W.)
| | - Alicia deFelipe-Mimbrera
- Department of Neurology, Ramón y Cajal University Hospital, Madrid, Spain (A.A.-C., J.L.L.-S., J.B., A.d.-M., M.G., N.G.-B., I.C., M.C.M.-L., J.M., J.C.M.-C.); and Department of Neurology, University of Rostock, Rostock, Germany (U.W.)
| | - Marta Guillán
- Department of Neurology, Ramón y Cajal University Hospital, Madrid, Spain (A.A.-C., J.L.L.-S., J.B., A.d.-M., M.G., N.G.-B., I.C., M.C.M.-L., J.M., J.C.M.-C.); and Department of Neurology, University of Rostock, Rostock, Germany (U.W.)
| | - Nuria García-Barragán
- Department of Neurology, Ramón y Cajal University Hospital, Madrid, Spain (A.A.-C., J.L.L.-S., J.B., A.d.-M., M.G., N.G.-B., I.C., M.C.M.-L., J.M., J.C.M.-C.); and Department of Neurology, University of Rostock, Rostock, Germany (U.W.)
| | - Iñigo Corral
- Department of Neurology, Ramón y Cajal University Hospital, Madrid, Spain (A.A.-C., J.L.L.-S., J.B., A.d.-M., M.G., N.G.-B., I.C., M.C.M.-L., J.M., J.C.M.-C.); and Department of Neurology, University of Rostock, Rostock, Germany (U.W.)
| | - María Consuelo Matute-Lozano
- Department of Neurology, Ramón y Cajal University Hospital, Madrid, Spain (A.A.-C., J.L.L.-S., J.B., A.d.-M., M.G., N.G.-B., I.C., M.C.M.-L., J.M., J.C.M.-C.); and Department of Neurology, University of Rostock, Rostock, Germany (U.W.)
| | - Jaime Masjuan
- Department of Neurology, Ramón y Cajal University Hospital, Madrid, Spain (A.A.-C., J.L.L.-S., J.B., A.d.-M., M.G., N.G.-B., I.C., M.C.M.-L., J.M., J.C.M.-C.); and Department of Neurology, University of Rostock, Rostock, Germany (U.W.)
| | - Juan Carlos Martínez-Castrillo
- Department of Neurology, Ramón y Cajal University Hospital, Madrid, Spain (A.A.-C., J.L.L.-S., J.B., A.d.-M., M.G., N.G.-B., I.C., M.C.M.-L., J.M., J.C.M.-C.); and Department of Neurology, University of Rostock, Rostock, Germany (U.W.)
| | - Uwe Walter
- Department of Neurology, Ramón y Cajal University Hospital, Madrid, Spain (A.A.-C., J.L.L.-S., J.B., A.d.-M., M.G., N.G.-B., I.C., M.C.M.-L., J.M., J.C.M.-C.); and Department of Neurology, University of Rostock, Rostock, Germany (U.W.)
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Peric S, Pavlovic A, Ralic V, Dobricic V, Basta I, Lavrnic D, Rakocevic Stojanovic V. Transcranial sonography in patients with myotonic dystrophy type 1. Muscle Nerve 2014; 50:278-82. [PMID: 24395217 DOI: 10.1002/mus.24162] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2013] [Revised: 12/16/2013] [Accepted: 12/31/2013] [Indexed: 12/16/2022]
Abstract
INTRODUCTION In this study we analyzed transcranial sonography (TCS) in patients with myotonic dystrophy type 1 (DM1). METHODS This cross-sectional study included 66 DM1 patients and 55 matched healthy controls (HCs). Echogenicity of the brainstem raphe (BR) and substantia nigra (SN) and third ventricle width (DTV) were assessed by TCS. RESULTS BR hypoechogenicity was more common in DM1 patients than in HCs (37.7% vs. 7.8%, P < 0.01). Patients with depression or fatigue were more likely to have BR hypoechogenicity (80.0% vs. 29.4%, P < 0.01 and 51.9% vs. 24.2%, P < 0.05, respectively). Both hypoechogenicity and hyperechogenicity of SN were more frequent in DM1 patients than in controls (26.2% vs. 10.9% and 13.1% vs. 1.8%, respectively, P < 0.01). DTV was increased in DM1 patients compared with HCs (6.0 ± 1.4 vs. 4.9 ± 0.9 mm, P < 0.01). CONCLUSION TCS can offer new insight into structural changes of several cerebral areas in patients with DM1.
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Affiliation(s)
- Stojan Peric
- Neurology Clinic, Clinical Center of Serbia, School of Medicine, University of Belgrade, 6 Dr Subotica Street, 11000, Belgrade, Serbia
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Bor-Seng-Shu E, Pedroso JL, Felicio AC, Ciampi de Andrade D, Teixeira MJ, Braga-Neto P, Batista IR, Barsottini OGP, Borges V, Ferraz HB, Shih MC, Bressan RA, de Andrade LAF, Walter U. Substantia nigra echogenicity and imaging of striatal dopamine transporters in Parkinson's disease: A cross-sectional study. Parkinsonism Relat Disord 2014; 20:477-81. [DOI: 10.1016/j.parkreldis.2014.01.015] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2013] [Revised: 01/03/2014] [Accepted: 01/11/2014] [Indexed: 10/25/2022]
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Walter U. Transcranial brain sonography findings in Parkinson’s disease: implications for pathogenesis, early diagnosis and therapy. Expert Rev Neurother 2014; 9:835-46. [DOI: 10.1586/ern.09.41] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Berardelli A, Wenning GK, Antonini A, Berg D, Bloem BR, Bonifati V, Brooks D, Burn DJ, Colosimo C, Fanciulli A, Ferreira J, Gasser T, Grandas F, Kanovsky P, Kostic V, Kulisevsky J, Oertel W, Poewe W, Reese JP, Relja M, Ruzicka E, Schrag A, Seppi K, Taba P, Vidailhet M. EFNS/MDS-ES/ENS [corrected] recommendations for the diagnosis of Parkinson's disease. Eur J Neurol 2013; 20:16-34. [PMID: 23279440 DOI: 10.1111/ene.12022] [Citation(s) in RCA: 330] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2012] [Accepted: 09/18/2012] [Indexed: 01/24/2023]
Abstract
BACKGROUND A Task Force was convened by the EFNS/MDS-ES Scientist Panel on Parkinson's disease (PD) and other movement disorders to systemically review relevant publications on the diagnosis of PD. METHODS Following the EFNS instruction for the preparation of neurological diagnostic guidelines, recommendation levels have been generated for diagnostic criteria and investigations. RESULTS For the clinical diagnosis, we recommend the use of the Queen Square Brain Bank criteria (Level B). Genetic testing for specific mutations is recommended on an individual basis (Level B), taking into account specific features (i.e. family history and age of onset). We recommend olfactory testing to differentiate PD from other parkinsonian disorders including recessive forms (Level A). Screening for pre-motor PD with olfactory testing requires additional tests due to limited specificity. Drug challenge tests are not recommended for the diagnosis in de novo parkinsonian patients. There is an insufficient evidence to support their role in the differential diagnosis between PD and other parkinsonian syndromes. We recommend an assessment of cognition and a screening for REM sleep behaviour disorder, psychotic manifestations and severe depression in the initial evaluation of suspected PD cases (Level A). Transcranial sonography is recommended for the differentiation of PD from atypical and secondary parkinsonian disorders (Level A), for the early diagnosis of PD and in the detection of subjects at risk for PD (Level A), although the technique is so far not universally used and requires some expertise. Because specificity of TCS for the development of PD is limited, TCS should be used in conjunction with other screening tests. Conventional magnetic resonance imaging and diffusion-weighted imaging at 1.5 T are recommended as neuroimaging tools that can support a diagnosis of multiple system atrophy (MSA) or progressive supranuclear palsy versus PD on the basis of regional atrophy and signal change as well as diffusivity patterns (Level A). DaTscan SPECT is registered in Europe and the United States for the differential diagnosis between degenerative parkinsonisms and essential tremor (Level A). More specifically, DaTscan is indicated in the presence of significant diagnostic uncertainty such as parkinsonism associated with neuroleptic exposure and atypical tremor manifestations such as isolated unilateral postural tremor. Studies of [(123) I]MIBG/SPECT cardiac uptake may be used to identify patients with PD versus controls and MSA patients (Level A). All other SPECT imaging studies do not fulfil registration standards and cannot be recommended for routine clinical use. At the moment, no conclusion can be drawn as to diagnostic efficacy of autonomic function tests, neurophysiological tests and positron emission tomography imaging in PD. CONCLUSIONS The diagnosis of PD is still largely based on the correct identification of its clinical features. Selected investigations (genetic, olfactory, and neuroimaging studies) have an ancillary role in confirming the diagnosis, and some of them could be possibly used in the near future to identify subjects in a pre-symptomatic phase of the disease.
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Affiliation(s)
- A Berardelli
- Dipartimento di Neurologia e Psichiatria and IRCCS NEUROMED Institute, Sapienza, Università di Roma, Rome, Italy.
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Mahlknecht P, Seppi K, Stockner H, Nocker M, Scherfler C, Kiechl S, Willeit J, Schmidauer C, Gasperi A, Rungger G, Poewe W. Substantia nigra hyperechogenicity as a marker for Parkinson's disease: a population-based study. NEURODEGENER DIS 2013; 12:212-8. [PMID: 23689066 DOI: 10.1159/000348595] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2012] [Accepted: 01/31/2013] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The clinical diagnosis of Parkinson's disease (PD) is currently anchored in its cardinal motor symptoms. According to hospital-based studies, an enlarged echogenicity in the area of the substantia nigra (SN) assessed with transcranial sonography (TCS) may represent a useful biomarker in the diagnosis of PD. OBJECTIVE To evaluate SN hyperechogenicity as a marker for PD in the Bruneck Study cohort, which is representative of the general elderly community. METHODS The diagnostic accuracy of TCS in distinguishing clinically diagnosed PD from nonparkinsonian subjects was assessed in 574 subjects from this cohort. RESULTS There was a good diagnostic accuracy of TCS in distinguishing PD subjects from nonparkinsonian subjects with an area under the curve value of 0.82. At a receiver-operating characteristic curve analysis-based cutoff value for SN hyperechogenicity of 0.18 cm(2), TCS had a sensitivity of 88.2% (95% confidence interval, CI, 64.4-98.0), a specificity of 77.0% (95% CI 72.8-80.6), a positive predictive value of 12.7% (95% CI 7.8-20.0) and a negative predictive value of 99.4% (95% CI 97.8-100.0) for subjects with clinically definite PD at baseline. When analyzing the same population after 5 years with regard to the presence of known and newly diagnosed PD cases, baseline TCS yielded very similar diagnostic accuracy values. CONCLUSION SN hyperechogenicity may represent a useful biomarker for PD not only in a hospital-based setting but also in the general community.
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Affiliation(s)
- Philipp Mahlknecht
- Department of Neurology, Medical University Innsbruck, Innsbruck, Austria
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Olivares Romero J, Arjona Padillo A, Barrero Hernández FJ, Martín González M, Gil Extremera B. Utility of transcranial sonography in the diagnosis of drug-induced parkinsonism: a prospective study. Eur J Neurol 2013; 20:1451-8. [DOI: 10.1111/ene.12131] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2012] [Accepted: 01/30/2013] [Indexed: 12/19/2022]
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Godau J, Hussl A, Lolekha P, Stoessl AJ, Seppi K. Neuroimaging: current role in detecting pre-motor Parkinson's disease. Mov Disord 2012; 27:634-43. [PMID: 22508281 DOI: 10.1002/mds.24976] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Convergent evidence suggests a pre-motor period in Parkinson's disease (PD) during which typical motor symptoms have not yet developed although dopaminergic neurons in the substantia nigra have started to degenerate. Advances in different neuroimaging techniques have allowed the detection of functional and structural changes in early PD. This review summarizes the state of the art knowledge concerning structural neuroimaging techniques including magnetic resonance imaging (MRI) and transcranial B-mode-Doppler-sonography (TCS) as well as functional neuroimaging techniques using radiotracer imaging (RTI) with different radioligands in detecting pre-motor PD.
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Affiliation(s)
- Jana Godau
- Center of Neurology, Hertie Institute for Clinical Brain Research, Department of Neurodegeneration and German Center of Neurodegenerative Diseases (DZNE), University of Tübingen, Tübingen, Germany
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Laučkaitė K, Rastenytė D, Šurkienė D, Vaitkus A, Sakalauskas A, Lukoševičius A, Gleiznienė R. Specificity of transcranial sonography in parkinson spectrum disorders in comparison to degenerative cognitive syndromes. BMC Neurol 2012; 12:12. [PMID: 22400906 PMCID: PMC3317847 DOI: 10.1186/1471-2377-12-12] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2011] [Accepted: 03/08/2012] [Indexed: 12/16/2022] Open
Abstract
Background Hyperechogenicity of the substantia nigra (SN+), detected by transcranial sonography (TCS), was reported as a characteristic finding in Parkinson's disease (PD), with high diagnostic accuracy values, when compared mainly to healthy controls or essential tremor (ET) group. However, some data is accumulating that the SN + could be detected in other neurodegenerative and even in non-neurodegenerative disorders too. Our aim was to estimate the diagnostic accuracy of TCS, mainly focusing on the specificity point, when applied to a range of the parkinsonian disorders, and comparing to the degenerative cognitive syndromes. Methods A prospective study was carried out at the Hospital of Lithuanian University of Health Sciences from January until September 2011. Initially, a TCS and clinical examination were performed on 258 patients and 76 controls. The General Electric Voluson 730 Expert ultrasound system was used. There were 12.8% of cases excluded with insufficient temporal bones, and 4.3% excluded with an unclear diagnosis. The studied sample consisted of the groups: PD (n = 71, 33.2%), ET (n = 58, 27.1%), PD and ET (n = 10, 4.7%), atypical parkinsonian syndromes (APS) (n = 3, 1.4%), hereditary neurodegenerative parkinsonism (HDP) (n = 3, 1.4%), secondary parkinsonism (SP) (n = 23, 10.8%), mild cognitive impairment (MCI) (n = 33, 15.4%), dementia (n = 13, 6.1%), and control (n = 71). Results There were 80.3% of PD patients at stages 1 & 2 according to Hoehn and Yahr. At the cut-off value of 0.20 cm2 of the SN+, the sensitivity for PD was 94.3% and the specificity - 63.3% (ROC analysis, AUC 0.891), in comparison to the rest of the cohort. At the cut-off value of 0.26 cm2, the sensitivity was 90% and the specificity 82.4%. The estimations for the lowest specificity for PD, in comparison to the latter subgroups (at the cut-off values of 0.20 cm2 and 0.26 cm2, respectively) were: 0% and 33.3% to APS, 33.3% and 66.7% to HDP, 34.8% and 69.6% to SP, 55.2% and 82.8% to ET, 75% and 91.7% to dementia. Conclusions The high sensitivity of the test could be employed as a valuable screening tool. But TCS is more useful as a supplementary diagnostic method, due to the specificity values not being comprehensive.
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Affiliation(s)
- Kristina Laučkaitė
- Department of Neurology, Lithuanian University of Health Sciences, Academy of Medicine, Mickevičiaus street 9, Kaunas, Lithuania.
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Liepelt I, Behnke S, Schweitzer K, Wolf B, Godau J, Wollenweber F, Dillmann U, Gaenslen A, Di Santo A, Maetzler W, Berg D. Pre-motor signs of PD are related to SN hyperechogenicity assessed by TCS in an elderly population. Neurobiol Aging 2011; 32:1599-606. [DOI: 10.1016/j.neurobiolaging.2009.10.004] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2009] [Revised: 09/23/2009] [Accepted: 10/06/2009] [Indexed: 10/20/2022]
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Berg D, Steinberger JD, Warren Olanow C, Naidich TP, Yousry TA. Milestones in magnetic resonance imaging and transcranial sonography of movement disorders. Mov Disord 2011; 26:979-92. [DOI: 10.1002/mds.23766] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
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Brüggemann N, Hagenah J, Stanley K, Klein C, Wang C, Raymond D, Ozelius L, Bressman S, Saunders-Pullman R. Substantia nigra hyperechogenicity with LRRK2 G2019S mutations. Mov Disord 2011; 26:885-8. [PMID: 21312285 PMCID: PMC3082617 DOI: 10.1002/mds.23644] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2010] [Revised: 12/17/2010] [Accepted: 12/28/2010] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Transcranial sonography (TCS) area of hyperechogenicity in the substantia nigra (aSN) is increased in idiopathic and genetic Parkinson's disease (PD). METHODS We performed TCS in 34 LRRK2 G2019S mutation carriers manifesting PD, 24 non-manifesting mutation carriers, and 28 idiopathic PD patients and compared them with 40 healthy controls (total, n = 126). RESULTS Compared with the controls (mean 0.15 cm(2) ), the aSN values in all other groups were increased. The mean aSN was 0.23 cm(2) in nonmanifesting mutation carriers (P = .015), 0.34 cm(2) in idiopathic PD patients (P < .0001), 0.32 cm(2) in LRRK2-associated PD patients (P < .0001), and 0.33 cm(2) in the overall PD group (P < .0001). LRRK2-associated PD patients had a higher aSN than did nonmanifesting carriers (P = .011), but there was no significant difference in aSN between patients with idiopathic and LRRK2-associated PD (P = .439). CONCLUSIONS Our results suggest that SN pathoanatomical alterations may not be substantially different between idiopathic and LRRK2-associated PD. The findings in the nonmanifesting mutation carriers suggest the presence of intermediate nigrostriatal pathology consistent with the age-dependent reduced penetrance of this mutation.
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Affiliation(s)
- Norbert Brüggemann
- Section of Clinical and Molecular Neurogenetics, University of Lübeck, Ratzeburger Allee 160, 23538 Lübeck, Germany
- Department of Neurology, University of Lübeck, Ratzeburger Allee 160, 23538 Lübeck, Germany
| | - Johann Hagenah
- Section of Clinical and Molecular Neurogenetics, University of Lübeck, Ratzeburger Allee 160, 23538 Lübeck, Germany
- Department of Neurology, University of Lübeck, Ratzeburger Allee 160, 23538 Lübeck, Germany
| | - Kaili Stanley
- Department of Neurology, Beth Israel Medical Center, New York, NY
| | - Christine Klein
- Section of Clinical and Molecular Neurogenetics, University of Lübeck, Ratzeburger Allee 160, 23538 Lübeck, Germany
- Department of Neurology, University of Lübeck, Ratzeburger Allee 160, 23538 Lübeck, Germany
| | - Cuiling Wang
- Department of Neurology, Albert Einstein College of Medicine, Bronx, NY
| | - Deborah Raymond
- Department of Neurology, Beth Israel Medical Center, New York, NY
| | - Laurie Ozelius
- Department of Genetics, Mount Sinai School of Medicine, New York, NY
| | - Susan Bressman
- Department of Neurology, Beth Israel Medical Center, New York, NY
- Department of Neurology, Albert Einstein College of Medicine, Bronx, NY
| | - Rachel Saunders-Pullman
- Department of Neurology, Beth Israel Medical Center, New York, NY
- Department of Genetics, Mount Sinai School of Medicine, New York, NY
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Relation of risk factors and putative premotor markers for Parkinson’s disease. J Neural Transm (Vienna) 2011; 118:579-85. [DOI: 10.1007/s00702-010-0553-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2010] [Accepted: 11/30/2010] [Indexed: 11/26/2022]
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Substantia nigra hyperechogenicity is a risk marker of Parkinson’s disease: yes. J Neural Transm (Vienna) 2011; 118:613-9. [DOI: 10.1007/s00702-010-0565-6] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2010] [Accepted: 12/12/2010] [Indexed: 11/26/2022]
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30
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Walter U. Substantia nigra hyperechogenicity is a risk marker of Parkinson's disease: no. J Neural Transm (Vienna) 2010; 118:607-12. [PMID: 21190047 DOI: 10.1007/s00702-010-0564-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2010] [Accepted: 12/08/2010] [Indexed: 12/25/2022]
Abstract
During the past two decades, transcranial sonography (TCS) has developed to an increasingly used brain imaging method that visualizes characteristic patterns of basal ganglia alterations in distinct movement disorders. Since the discovery of a characteristic abnormal hyperechogenic appearance of substantia nigra (SN) on TCS in Parkinson's disease (PD), which is stable during the course of the disease and probably present already in preclinical disease stages, the results of several studies have promoted the idea that this TCS finding in healthy subjects might be a risk marker of PD. The present view summarizes current scientific evidence favouring the idea that the TCS finding of SN hyperechogenicity alone may not be a (strong) risk marker of PD. Especially, it is discussed how reliable this TCS finding is, whether this TCS finding can be regarded as a progression marker or a risk marker of PD, how strongly it may indicate a risk of PD, what else if not an increased risk of PD could be indicated, and which role TCS of SN may finally play in the detection of subjects at risk of PD.
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Affiliation(s)
- Uwe Walter
- Department of Neurology, University of Rostock, Gehlsheimer Str. 20, 18147, Rostock, Germany.
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Basal ganglia hyperechogenicity does not distinguish between patients with primary dystonia and healthy individuals. J Neurol 2010; 258:590-5. [PMID: 21042808 DOI: 10.1007/s00415-010-5795-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2010] [Revised: 09/30/2010] [Accepted: 10/05/2010] [Indexed: 09/29/2022]
Abstract
Transcranial sonography (TCS) of the basal ganglia is a non-invasive tool to study movement disorders. Very few studies have addressed the question of whether TCS may detect specific echofeatures in patients with primary dystonia. The basal ganglia including the substantia nigra (SN) and the ventricular system were investigated by TCS in 84 primary dystonia patients and 43 neurologically healthy controls. Any hyperechogenicity of the lenticular nucleus was present in 57.5% of the patients and in 50.0% of the controls (p = 0.453). While marked hyperechogenicity was more frequently present in the patients (17.8 vs. 7.9%), this difference was not significant (p = 0.227). No differences in the occurrence of hyperechogenicity were detectable either in the caudate nucleus (21.6 vs. 39.5%, p = 0.122) or the thalamus (4.1 vs. 0%, p = 0.199). Marked hyperechogenicity of the caudate nucleus was rare in dystonia (4.1%) and absent in controls. There was no relationship between the side of basal ganglia hyperechogenicity and the clinically affected side of cervical dystonia. The area of SN echogenicity was similar in patients and controls (0.19 ± 0.14 vs. 0.20 ± 0.13 cm(2)), but correlated negatively with increasing disease duration in the dystonia patients (ρ = -0.257, p = 0.028). Width of the third ventricle correlated with increasing age (ρ = 0.511, p = 0.000) and, in patients, with disease duration (ρ = 0.244, p = 0.034) and severity of cervical dystonia (ρ = 0.281, p = 0.038). No characteristic abnormalities were found in the basal ganglia of primary dystonia patients. It remains to be explored whether this is due to a true absence of signal alterations in the basal ganglia of dystonia patients or to limitations of the current technology used.
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Berg D. Hyperechogenicity of the substantia nigra: pitfalls in assessment and specificity for Parkinson’s disease. J Neural Transm (Vienna) 2010; 118:453-61. [DOI: 10.1007/s00702-010-0469-5] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2010] [Accepted: 08/16/2010] [Indexed: 10/19/2022]
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Diagnosis of Parkinson's disease--transcranial sonography in relation to MRI. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2010. [PMID: 20692494 DOI: 10.1016/s0074-7742(10)90005-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register]
Abstract
Displaying the echo pattern (echogenicity) of brain tissue transcranial sonography (TCS) may provide new and complementary information to other neuroimaging methods. In contrast to conventional magnetic resonance imaging (MRI), TCS is able to detect highly characteristic changes in signal brightness of the substantia nigra (SN) in patients with idiopathic Parkinson's disease. In this review, TCS findings are related to conventional and advanced high-field brain MRI findings. On the basis of the MRI findings, especially with T2-relaxometry, the possible role of trace metals in the genesis of altered echogenicity on TCS of brain parenchyma, especially of the SN, are discussed.
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Hagenah J, König IR, Sperner J, Wessel L, Seidel G, Condefer K, Saunders-Pullman R, Klein C, Brüggemann N. Life-long increase of substantia nigra hyperechogenicity in transcranial sonography. Neuroimage 2010; 51:28-32. [DOI: 10.1016/j.neuroimage.2010.01.112] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2009] [Revised: 12/06/2009] [Accepted: 01/29/2010] [Indexed: 12/23/2022] Open
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Godau J, Berg D. Role of Transcranial Ultrasound in the Diagnosis of Movement Disorders. Neuroimaging Clin N Am 2010; 20:87-101. [DOI: 10.1016/j.nic.2009.08.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Substantia nigra echomorphology and motor cortex excitability. Neuroimage 2010; 50:1351-6. [PMID: 20117219 DOI: 10.1016/j.neuroimage.2010.01.088] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2009] [Revised: 12/22/2009] [Accepted: 01/25/2010] [Indexed: 11/22/2022] Open
Abstract
The aim of our study was to investigate the relation between substantia nigra (SN) echomorphology and indices of motor cortex excitability. Nigral hyperechogenicity in healthy individuals is thought to represent an SN abnormality or predisposition to Parkinson's disease (PD) and its prevalence is greater in the very old. Our study involved 20 old healthy subjects (aged 72-84 years) known to have normal (n=10) or abnormal (n=10) SN echomorphology. All were in good health with no overt neurological signs. SN morphology was assessed with transcranial sonography through the pre-auricular bone window. Motor cortical excitability and intracortical inhibition were assessed with transcranial magnetic stimulation (TMS) over the first dorsal interosseus motor area. Single stimuli were delivered during relaxation and voluntary contraction and paired stimuli were delivered during relaxation. Each cortical hemisphere was analysed separately. The response to single-pulse TMS (in motor cortex ipsilateral to the target SN) did not differ between groups. However, a significant difference between groups was observed in the paired pulse paradigm (conditioning stimulus intensity: 70% resting motor threshold; interstimulus interval: 2 ms). The conditioned motor evoked potential amplitude was significantly larger ipsilateral to the hyperechogenic SN than in controls (P=0.014). Thus, healthy subjects with SN hyperechogenicity exhibit significantly less intracortical inhibition within the motor cortex than subjects with normal echomorphology. Decreased intracortical inhibition is also observed in PD patients. This study provides further evidence that SN hyperechogenicity in healthy individuals is associated with changes characteristic of PD supporting a role for this feature as a vulnerability marker or state marker for subtle nigral dopaminergic dysfunction.
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Gaenslen A, Berg D. Early Diagnosis of Parkinson’s Disease. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2010; 90:81-92. [DOI: 10.1016/s0074-7742(10)90006-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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38
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Pathophysiology of Transcranial Sonography Signal Changes in the Human Substantia Nigra. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2010. [DOI: 10.1016/s0074-7742(10)90008-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register]
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39
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Behnke S, Schröder U, Berg D. Transcranial Sonography in the Premotor Diagnosis of Parkinson’s Disease. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2010; 90:93-106. [DOI: 10.1016/s0074-7742(10)90007-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Školoudík D, Walter U. Method and Validity of Transcranial Sonography in Movement Disorders. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2010; 90:7-34. [DOI: 10.1016/s0074-7742(10)90002-0] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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41
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Behnke S, Schroeder U, Dillmann U, Buchholz HG, Schreckenberger M, Fuss G, Reith W, Berg D, Krick CM. Hyperechogenicity of the substantia nigra in healthy controls is related to MRI changes and to neuronal loss as determined by F-Dopa PET. Neuroimage 2009; 47:1237-43. [PMID: 19497378 DOI: 10.1016/j.neuroimage.2009.05.072] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2009] [Revised: 04/23/2009] [Accepted: 05/27/2009] [Indexed: 11/30/2022] Open
Abstract
Transcranial ultrasound (TCS) has been shown to reveal hyperechogenicity of the substantia nigra (SN) in Parkinsonian patients and in about 10% of healthy controls. It is hypothesized that SN hyperechogenicity in healthy subjects is a vulnerability marker for idiopathic Parkinson's disease (IPD). Although there is strong evidence that the echomarker results from increased local iron content, the exact pathophysiological mechanisms remain incompletely understood. Thus, prognostic impact can only be estimated. We examined 14 subjects with SN hyperechogenicity (SN+) (7 IPD patients and 7 controls) and 7 healthy controls without the echomarker (SN-) by a magnetic resonance imaging method (MRI; T2 relaxation times) known to reveal tissue inhomogeneity following abnormal iron content and by F-Dopa PET to assess nigrostriatal function.
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Affiliation(s)
- S Behnke
- Department of Neurology, University Hospital of the Saarland, Homburg Saar, Germany.
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42
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Obermann M, Küper M, Kastrup O, Yaldizli O, Esser S, Thiermann J, Koutsilieri E, Arendt G, Diener HC, Maschke M. Substantia nigra hyperechogenicity and CSF dopamine depletion in HIV. J Neurol 2009; 256:948-53. [PMID: 19240951 DOI: 10.1007/s00415-009-5052-3] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2008] [Revised: 12/19/2008] [Accepted: 01/13/2009] [Indexed: 10/21/2022]
Abstract
Dopaminergic dysfunction is thought to play a pivotal role in human immunodeficiency virus (HIV)-related dementia. Decreased dopamine (DA) levels in the cerebrospinal fluid (CSF) and neuronal loss in the substantia nigra (SN) have been reported in HIV-infected patients, suggesting nigrostriatal damage. Structural changes detectable as hyperechogenicity in transcranial ultrasound (TCS) scans of the SN have been reported in patients with Parkinson's disease (PD) and other neurological conditions. In this study, we assessed the echomorphology of the SN in 40 HIV-positive patients compared to 40 age- and sex-matched healthy controls and correlated these findings with CSF levels of DA and the metabolites homovanillic acid (HVA) and 3,4-dihydroxy phenylacetic acid (DOPAC) and with neuropsychologic performance. We observed that the SN of HIV-infected patients was hyperechogenic relative to that of controls (0.07 +/- 0.05 vs. 0.04 +/- 0.07 cm(2); mean +/- SEM; P < 0.001) and that this SN hyperechogenicity was correlated with decreased DA levels in the CSF, decreased CD4 cell count, and an impaired performance in the psychopathology assessment scale (AMDP) subtest for drive and psychomobility. An association to CDC stage, duration of HIV infection, or presence of HIV dementia was not observed. Our results indicate changes in the nigrostriatal system in HIV-infected patients that are detectable as hyperechogenic SN precede prominent extrapyramidal symptoms and cognitive dysfunction.
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Affiliation(s)
- Mark Obermann
- Department of Neurology, University of Duisburg-Essen, Hufelandstr. 55, 45122, Essen, Germany.
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Kumakura Y, Vernaleken I, Buchholz HG, Borghammer P, Danielsen E, Gründer G, Heinz A, Bartenstein P, Cumming P. Age-dependent decline of steady state dopamine storage capacity of human brain: an FDOPA PET study. Neurobiol Aging 2008; 31:447-63. [PMID: 18541344 DOI: 10.1016/j.neurobiolaging.2008.05.005] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2008] [Revised: 04/23/2008] [Accepted: 05/01/2008] [Indexed: 01/17/2023]
Abstract
Conventional indices of the utilization of FDOPA in living human brain have not consistently revealed important declines in dopamine function with normal aging. However, most methods of kinetic analysis have assumed irreversible trapping of decarboxylated FDOPA metabolites in brain, an assumption that is violated even in PET recordings of short duration. Therefore, we have developed methods for the calculation of steady-state storage of FDOPA together with its decarboxylated metabolites (V(d), mlg(-1)), based upon improved kinetic analysis of 120-min emission recordings. In a group of 28 normal male subjects, of age ranging from 23 to 73 years, the magnitude of V(d) in the striatum and in extrastriatal regions declined by approximately 10% with each decade. The utilization of FDOPA was also calculated by several conventional methods assuming irreversible trapping, i.e. the net blood brain clearance (K(in)(app), mlg(-1)min(-1)), the DOPA decarboxylase activity relative to a reference tissue input (k(3)(S), min(-1)), and relative to the arterial input (k(3)(D), min(-1)). None of these methods revealed an age-related decline in FDOPA utilization in the extended striatum, although the magnitude of K(in)(app) did decline in cerebral cortex. Thus, the capacity to synthesize [(18)F]fluorodopamine remained largely intact in striatum of the elderly subjects, but in the presence of a substantially increased rate of washout (k(loss)), which was evident in all brain regions examined. Consequently, the magnitude of V(d) declined with healthy aging, possibly reflecting impaired vesicular storage capacity, resulting in enhanced exposure of cytosolic [(18)F]fluorodopamine to monoamine oxidase.
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Affiliation(s)
- Yoshitaka Kumakura
- Centre for Functionally Integrative Neuroscience, Aarhus University, Aarhus C. 8000, Denmark.
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Liepelt I, Wendt A, Schweitzer KJ, Wolf B, Godau J, Gaenslen A, Bruessel T, Berg D. Substantia nigra hyperechogenicity assessed by transcranial sonography is related to neuropsychological impairment in the elderly population. J Neural Transm (Vienna) 2008; 115:993-9. [PMID: 18368284 DOI: 10.1007/s00702-008-0043-6] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2007] [Accepted: 03/09/2008] [Indexed: 11/25/2022]
Abstract
Transcranial sonography (TCS) is a valuable tool in the diagnosis of Parkinson's disease (PD). However, substantia nigra hyperechogenicity (SN+) in TCS has been shown to be also evident in about 8-10% of healthy persons. Neuroimaging studies and slight motor deficits in subjects with SN+ indicate functional impairment of the nigrostriatal system associated with the ultrasound sign. We questioned, whether SN+ may also be associated with neuropsychological deficits and whether there is a relation to other PD premotor markers. Thirty-six subjects with SN+ and 34 control persons (SN-) older than 50 years were investigated. The delayed verbal memory recall (LogII) of subjects with SN+ was significantly reduced compared to the performance of the control group (P=0.02). Binary logistic regression analysis revealed that, besides UPDRS-III (P<0.001) and positive family history for PD (P<0.01), LogII (P<0.05) seems to be independently associated with SN+.
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Affiliation(s)
- Inga Liepelt
- Center of Neurology, Department of Neurodegeneration, Hertie Institute of Clinical Brain Research, University of Tübingen, Hoppe-Seyler Str. 3, 72076 Tübingen, Germany.
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Schweitzer KJ, Behnke S, Liepelt I, Wolf B, Grosser C, Godau J, Gaenslen A, Bruessel T, Wendt A, Abel F, Müller A, Gasser T, Berg D. Cross-sectional study discloses a positive family history for Parkinson’s disease and male gender as epidemiological risk factors for substantia nigra hyperechogenicity. J Neural Transm (Vienna) 2007; 114:1167-71. [PMID: 17446999 DOI: 10.1007/s00702-007-0725-5] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2006] [Accepted: 03/11/2007] [Indexed: 11/28/2022]
Abstract
Hyperechogenicity of the substantia nigra (SN) has been proposed to be a typical finding in Parkinson's disease (PD) and a marker of vulnerability to nigrostriatal dysfunction in healthy subjects. This large cross-sectional study including 1120 subjects older than 50 years without any signs of PD was performed to evaluate the association of SN hyperechogenicity and other proposed epidemiological risk factors for PD. Among all variables assessed only family history of PD and male gender proved to be significantly associated with SN hyperechogenicity, indicating a genetic predisposition for the ultrasound marker.
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Affiliation(s)
- K J Schweitzer
- Center of Neurology, Department of Neurodegeneration, Hertie Institute of Clinical Brain Research, University of Tübingen, Tübingen, Germany
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