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Shetty N, Koteshwar P, Priyanka. Identification of optimal value of magnetic resonance planimetry and the parkinsonism index for the diagnosis of Parkinson's disease and progressive supranuclear palsy. J Taibah Univ Med Sci 2023; 18:1577-1585. [PMID: 37701844 PMCID: PMC10494174 DOI: 10.1016/j.jtumed.2023.07.004] [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: 04/24/2023] [Revised: 05/30/2023] [Accepted: 07/10/2023] [Indexed: 09/14/2023] Open
Abstract
Objectives Parkinson's disease (PD) and progressive supranuclear palsy (PSP) are neurodegenerative conditions that have overlapping clinical and imaging features, thus making it difficult to distinguish and diagnose PSP from PD. Therefore, in this study, we aimed to investigate the optimal value of magnetic resonance planimetry and the parkinsonism index to differentiate between PSP and PD. Methods In this retrospective study, we recruited a total of 84 patients (27 patients with PSP, 27 patients with PD and 27 normal controls) who underwent MRI brain examinations. For each subject, we calculated the corpus callosum area, midbrain area, pons area, middle cerebellar peduncle (MCP) width and superior cerebellar peduncle (SCP) width on MRI brain images. We also calculated the pons to midbrain area (P/M) ratio, MCP/SCP ratio and magnetic resonance parkinsonism index (MRPI). Results Receiver operating characteristic curve (ROC) analysis was used to identify the diagnostic value of each biomarker. MRPI had a sensitivity of 70.4%, a specificity of 88.9%, and a diagnostic accuracy of 79.6% with an optimum cut off of 24.3 for differentiating PSP from PD. P/M ratio had a sensitivity of 74.1%, a specificity of 77.8%, and a diagnostic accuracy of 75.9% with an optimal cutoff of 24.3 for differentiating PSP from PD. The MCP/SCP ratio had a sensitivity of 66.7%, a specificity of 77.8%, and an accuracy of 72.2% with an optimal cut off of 4.65 for differentiating PSP from PD. Conclusions The study revealed that MRPI and P/M ratio are accurate markers for differentiating PSP from PD. The optimal cut-off values derived from our study can help in the early diagnosis of PD.
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Affiliation(s)
- Nikhitha Shetty
- Department of Medical Imaging Technology, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, Karnataka, India
- Department of Medical Imaging Sciences, College of Health Sciences, Gulf Medical University, Ajman, UAE
| | - Prakashini Koteshwar
- Department of Radiodiagnosis and Imaging, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Priyanka
- Department of Medical Imaging Technology, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, Karnataka, India
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Wang Y, Xuan H, Zhao T, Li X, Li S, Hu W. A study of linear measurement and clinical correlation of brain atrophy in Wilson's disease. Front Hum Neurosci 2023; 17:1142082. [PMID: 37056963 PMCID: PMC10086176 DOI: 10.3389/fnhum.2023.1142082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 02/14/2023] [Indexed: 03/30/2023] Open
Abstract
Background The aim of this study was to explore the clinical relevance of linear measures of Wilson's disease (WD). Methods Relative values of brain atrophy in 30 patients with WD and 30 healthy volunteers were measured and compared using a manual measurement method. Linear measurement indicators of brain atrophy in patients with and without mental disorders were also compared. In addition, correlations of patients' age, disease duration, and Unified Wilson's Disease Rating Scale (UWDRS) scores with brain atrophy indicators were determined. Results The results showed that the e-value, Huckman number, Evans index, and lateral ventricular body index were higher in the WD group compared with the control group. The age of patients with WD was negatively correlated with the k-value and significantly positively correlated with the brainstem index. WD duration was prominently positively correlated with the d-value and negatively correlated with the j-value. In addition, neurological function scores were significantly positively correlated with the c-value, e-value, caudate nucleus index, Huckman number, Evans index, and lateral ventricular body index. By contrast, patients with psychiatric symptoms had a higher a-value and fourth ventricular index than those without psychiatric symptoms. Conclusion Therefore, it can be concluded that patients with WD and those with psychiatric symptoms have more severe brain atrophy compared to normal subjects. The patient's age, disease duration, and neurological function scores were positively correlated with the severity of brain atrophy.
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Affiliation(s)
- Yun Wang
- Department of Neurology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Hongxia Xuan
- Department of Neurology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
- Department of Neurology, Hongda Hospital, Jiamusi University, Jiamusi, China
| | - Tun Zhao
- Department of Neurology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Xiaodong Li
- Department of Neurology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Shujuan Li
- Department of Neurology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Wenli Hu
- Department of Neurology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
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Kalita J, Tripathi A, Jadhav M, Thakur RS, Patel DK. A Study of Dopaminergic Pathway in Neurologic Wilson Disease with Movement Disorder. Mol Neurobiol 2023; 60:3496-3506. [PMID: 36879138 DOI: 10.1007/s12035-023-03276-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 02/16/2023] [Indexed: 03/08/2023]
Abstract
Movement disorder (MD) is an important manifestation of neurologic Wilson disease (NWD), but there is a paucity of information on dopaminergic pathways. We evaluate dopamine and its receptors in patients with NWD and correlate the changes with MD and MRI changes. Twenty patients with NWD having MD were included. The severity of dystonia was assessed using BFM (Burke-Fahn-Marsden) score. The neurological severity of NWD was categorized as grades I to III based on the sum score of 5 neurological signs and activity of daily living. Dopamine concentration in plasma and CSF was measured using liquid chromatography-mass spectrometry, and D1 and D2 receptor expression at mRNA by reverse transcriptase polymerase chain reaction in patients and 20 matched controls. The median age of the patients was 15 years and 7 (35%) were females. Eighteen (90%) patients had dystonia and 2 (10%) had chorea. The CSF dopamine concentration (0.08 ± 0.02 vs 0.09 ± 0.017 pg/ml; p = 0.42) in the patients and controls was comparable, but D2 receptor expression was reduced in the patients (0.41 ± 0.13 vs 1.39 ± 1.04; p = 0.01). Plasma dopamine level correlated with BFM score (r = 0.592, p < 0.01) and D2 receptor expression with the severity of chorea (r = 0.447, p < 0.05). The neurological severity of WD correlated with plasma dopamine concentration (p = 0.006). Dopamine and its receptors were not related to MRI changes. The central nervous system dopaminergic pathway is not enhanced in NWD, which may be due to structural damage to the corpus striatum and/or substantia nigra.
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Affiliation(s)
- Jayantee Kalita
- Department of Neurology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Raebareli Road, Lucknow, 226014, Uttar Pradesh, India.
| | - Abhilasha Tripathi
- Department of Neurology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Raebareli Road, Lucknow, 226014, Uttar Pradesh, India
| | - Mahesh Jadhav
- Department of Neurology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Raebareli Road, Lucknow, 226014, Uttar Pradesh, India
| | - Ravindra S Thakur
- CSIR, Indian Institute of Toxicology Research Institute, Lucknow, Uttar Pradesh, India
| | - Devendra K Patel
- CSIR, Indian Institute of Toxicology Research Institute, Lucknow, Uttar Pradesh, India
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Thankappan B, Bhattacharya K. Wilson's disease update: An Indian perspective. Ann Indian Acad Neurol 2022; 25:43-53. [PMID: 35342245 PMCID: PMC8954307 DOI: 10.4103/aian.aian_1070_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 01/22/2022] [Indexed: 11/10/2022] Open
Abstract
Wilson's disease (WD) is an autosomal recessive disorder due to ATP7B gene mutation, resulting in defective copper metabolism, with liver and brain being primarily affected. Being a treatable disorder, early diagnosis and proper management of WD may result in near complete recovery. It has received significant attention over the past 50 years, with several Indian contributions. This study collates published Indian studies on WD in Pubmed and Embase databases and puts them in perspective. Several Indian case series suggest that WD may be more prevalent than thought. Commonly detected ATP7B mutation in India is p.C271X. Although initial Indian series reported significant osseomuscular presentation, neuropsychiatric and hepatic manifestations dominated the later reports. A significant male predominance is observed in Indian series. Pure hepatic presentation starts earlier than neurological or osseomuscular WD. A positive family history may be seen in nearly 50% of Indian WD cases with a high rate of consanguinity. Up to two-third of Indian cases may be initially misdiagnosed, with a mean diagnostic delay of up to 2 years. Abnormalities in serum ceruloplasmin and 24-hour urinary copper has been reported in more than four-fifth cases. Brain MRI is abnormal in nearly all neurological WD cases. Copper chelation remains the mainstay of therapy, with D-penicillamine being the most widely used chelator in India. Global Assessment Scale for WD is a comprehensive tool for clinical monitoring. Hepatic presentation carries a five-time higher mortality risk than neurological, with up to 90% Indian neurological WD cases recovering to pre-morbid functionality with adequate therapy.
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Song Y, Zou L, Zhao J, Zhou X, Huang Y, Qiu H, Han H, Yang Z, Li X, Tang X, Chu J. Whole brain volume and cortical thickness abnormalities in Wilson's disease: a clinical correlation study. Brain Imaging Behav 2020; 15:1778-1787. [PMID: 33052506 DOI: 10.1007/s11682-020-00373-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Wilson's disease (WD) is an inherited autosomal recessive disorder of copper metabolism, and its neurological and neuropsychiatric manifestations are associated with copper accumulation in brain. A few neuroimaging studies have shown that gray matter atrophy in WD affects both subcortical structures and cortex. This study aims to quantitatively evaluate the morphometric brain abnormalities in patients with WD in terms of whole brain volume and cortical thickness and their associations with clinical severity of WD. Thirty patients clinically diagnosed as WD with neurological manifestations and 25 healthy controls (HC) were recruited. 3D T1-weighted images were segmented into 276 whole-brain regions of interest (ROIs) and 68 cortical ROIs. WD-vs-HC group comparisons were then conducted for each ROI. The associations between those morphometric measurements and the Global Assessment Scale (GAS) score for WD were analyzed. Compared with HC, significant WD-related volumetric decreases were found in the bilateral subcortical nuclei (putamen, globus pallidus, caudate nucleus, substantia nigra, red nucleus and thalamus), diffuse white matter and several gray matter regions. WD patients showed reduced cortical thickness in the left precentral gyrus and the left insula. Further, the volumes of the right globus pallidus, bilateral putamen, right external capsule and left superior longitudinal fasciculus were negatively correlated with GAS. Our results indicated that significant WD-related morphometric abnormalities were quantified in terms of whole-brain volumes and cortical thicknesses, some of which correlated significantly to the clinical severity of WD. Those morphometrics may provide a potentially effective biomarker of WD.
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Affiliation(s)
- Yukun Song
- Department of Radiology, The First Affiliated Hospital of Xiamen University, Xiamen, 361001, Fujian Province, China
| | - Lin Zou
- Department of Electrical and Electronic Engineering, Southern University of Science and Technology, Shenzhen, 518052, Guangdong Province, China
| | - Jing Zhao
- Department of Radiology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510080, Guangdong Province, China
| | - Xiangxue Zhou
- Department of Neurology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510080, Guangdong Province, China
| | - Yingqian Huang
- Department of Radiology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510080, Guangdong Province, China
| | - Haishan Qiu
- Department of Radiology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510080, Guangdong Province, China
| | - Haiwei Han
- Department of Radiology, The First Affiliated Hospital of Xiamen University, Xiamen, 361001, Fujian Province, China
| | - Zhiyun Yang
- Department of Radiology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510080, Guangdong Province, China
| | - Xunhua Li
- Department of Neurology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510080, Guangdong Province, China
| | - Xiaoying Tang
- Department of Electrical and Electronic Engineering, Southern University of Science and Technology, Shenzhen, 518052, Guangdong Province, China.
| | - Jianping Chu
- Department of Radiology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510080, Guangdong Province, China.
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Yu XE, Gao S, Yang RM, Han YZ. MR Imaging of the Brain in Neurologic Wilson Disease. AJNR Am J Neuroradiol 2020; 40:178-183. [PMID: 30635331 DOI: 10.3174/ajnr.a5936] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Accepted: 10/30/2018] [Indexed: 12/16/2022]
Abstract
BACKGROUND AND PURPOSE Neurologic Wilson disease is an inherited disease characterized by a copper metabolic disorder that causes damage to many organs, especially the brain. Few studies report the relationships between these neurologic symptoms and MR imaging of the brain. Therefore, we investigated the correlation of brain abnormalities in patients with neurologic Wilson disease with their clinical symptoms, age of onset, and lag time to diagnosis. MATERIALS AND METHODS A cohort of 364 patients was recruited in China between January 2003 and December 2017. Age of onset, lag time until diagnosis, and neurologic symptoms were recorded, and cranial MR imaging was performed. Patients were divided into groups within each of these factors for correlation analysis with the MR imaging brain scans. RESULTS Abnormal signals in the MR imaging brain scans were seen in all 364 cases. Affected regions included the putamen, pons, midbrain, and thalamus, while the medulla and occipital lobe were unaffected. The putamen was the most frequently damaged brain region in this study. With the age of onset younger than 10 years, cranial MR imaging scans showed only impairment in the putamen. Patients with a longer lag time before diagnosis were more likely to have impairment in the pons, midbrain, and cortex. Among neurologic symptoms of Wilson disease, torsion spasm is associated with the midbrain and cortex, and choreoathetosis is related to the caudate nucleus. CONCLUSIONS Abnormalities in the putamen, pons, midbrain, and thalamus are part of the neuroimaging spectrum of Wilson disease. There is a significant correlation between the site of brain injury and diagnosis lag time.
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Affiliation(s)
- X-E Yu
- From the Department of Pharmacology (Y.X.-E., S.G.), Basic Medical College, Anhui Medical University, Hefei, China.,Hospital of the Institute of Neurology (X.-E.Y., R.-M.Y., Y.-Z.H.), Anhui University of Chinese Medicine, Hefei, China
| | - S Gao
- From the Department of Pharmacology (Y.X.-E., S.G.), Basic Medical College, Anhui Medical University, Hefei, China
| | - R-M Yang
- Hospital of the Institute of Neurology (X.-E.Y., R.-M.Y., Y.-Z.H.), Anhui University of Chinese Medicine, Hefei, China
| | - Y-Z Han
- Hospital of the Institute of Neurology (X.-E.Y., R.-M.Y., Y.-Z.H.), Anhui University of Chinese Medicine, Hefei, China
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The effect of docosahexaenoic acid on apelin distribution of nervous system in the experimental mouse model of Parkinson’s disease. Tissue Cell 2019; 56:41-51. [DOI: 10.1016/j.tice.2018.12.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Revised: 11/19/2018] [Accepted: 12/05/2018] [Indexed: 12/21/2022]
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