Serum vitamin levels in multiple system atrophy: A case-control study

Cortical Ribboning as a Key MRI Finding in Wernicke's Encephalopathy With Altered Mental Status

Wernicke's encephalopathy (WE) is associated with thiamine (vitamin B1) deficiency and may lead to mental status changes, ophthalmoplegia, and ataxia. While treatment is simple, delayed diagnosis can have serious consequences, making early detection essential. However, the complete triad of symptoms is rarely seen. When mental status changes occur, physical examination may be limited, making WE harder to identify without other characteristic signs. Furthermore, measuring blood thiamine levels is not always immediately possible, adding to the challenge of diagnosis. We encountered a case of WE presenting with mental status changes, where cortical ribboning appeared as a significant MRI finding. A 77-year-old male had experienced slowness of movement for approximately one year and was diagnosed with multiple system atrophy (MSA). He had difficulty eating; thus, he preferred soft rice porridge. He developed acute mental status changes, and a brain MRI revealed prominent cortical ribboning in both frontal cortices along with subtle medial thalami. The patient received intravenous thiamine, leading to dramatic recovery of mental status, and subsequent MRI follow-up showed near-complete resolution of both cortical and thalamic lesions. Cortical ribboning, which played a key role in this patient, is recognized as an atypical MRI finding of thiamine deficiency and is suggested to be associated with altered mental status in WE. However, to the best of our knowledge, no literature clearly lists thiamine deficiency as a differential diagnosis for cortical ribboning in patients with mental status changes. Recognizing this key imaging finding is crucial in differentiating WE in patients with mental status changes. Preventing the potentially fatal outcome of WE is of paramount importance. Patients with dysphagia tend to prefer soft foods, which may result in reduced thiamine intake. Our experience reaffirms the importance of a well-balanced diet in MSA patients with dysphagia.

Parkinson's disease and vitamins: a focus on vitamin B12

Parkinson's disease (PD) has been linked to a vast array of vitamins among which vitamin B12 (Vit B12) is the most relevant and often investigated specially in the context of intrajejunal levodopa infusion therapy. Vit B12 deficiency, itself, has been reported to cause acute parkinsonism. Nevertheless, concrete mechanisms through which B12 deficiency interacts with PD in terms of pathophysiology, clinical manifestation and progression remains unclear. Recent studies have suggested that Vit B12 deficiency along with the induced hyperhomocysteinemia are correlated with specific PD phenotypes characterized with early postural instability and falls and more rapid motor progression, cognitive impairment, visual hallucinations and autonomic dysfunction. Specific clinical features such as polyneuropathy have also been linked to Vit B12 deficiency specifically in context of intrajejunal levodopa therapy. In this review, we explore the link between Vit B12 and PD in terms of physiopathology regarding dysfunctional neural pathways, neuropathological processes as well as reviewing the major clinical traits of Vit B12 deficiency in PD and Levodopa-mediated neuropathy. Finally, we provide an overview of the therapeutic effect of Vit B12 supplementation in PD and posit a practical guideline for Vit B12 testing and supplementation.

The Imbalance of Homocysteine, Vitamin B12 and Folic Acid in Parkinson Plus Syndromes: A Review beyond Parkinson Disease

While there is a link between homocysteine (Hcy), B12 and folic acid and neurodegeneration, especially in disorders like Parkinson's and Alzheimer's diseases, its role in Parkinson plus syndromes (PPS) has only been partially investigated. It appears that elevated Hcy, along with an imbalance of its essential vitamin cofactors, are both implicated in the development and progression of parkinsonian syndromes, which represent different disease pathologies, namely alpha-synucleinopathies and tauopathies. Attributing a potential pathogenetic role in hyperhomocysteinemia would be crucial in terms of improving the diagnostic and prognostic accuracy of these syndromes and also for providing a new target for possible therapeutic intervention. The scope of this review is to focus on vitamin imbalance in PPS, with a special emphasis on the role of Hcy, B12 and folic acid in the neurodegenerative process and their implication in the therapeutic approach of these disorders.

No Correlation between Plasma GPNMB Levels and Multiple System Atrophy in Chinese Cohorts

BACKGROUND

Glycoprotein nonmetastatic melanoma protein B (GPNMB) has been demonstrated to mediate pathogenicity in Parkinson's disease (PD) through interactions with α-synuclein, and plasma GPNMB tended to be a novel biomarker for PD.

OBJECTIVE

The goal of this study was to investigate whether plasma GPNMB could act as a potential biomarker for the clinical diagnosis and severity monitoring of multiple system atrophy (MSA), another typical synucleinopathy.

METHODS

Plasma GPNMB levels in patients with MSA, patients with PD, and healthy control subjects (HCs) were quantified using enzyme-linked immunosorbent assays.

RESULTS

A total of 204 patients with MSA, 65 patients with PD, and 207 HCs were enrolled. The plasma GPNMB levels in patients with MSA were similar to those in HCs (P = 0.251) but were significantly lower than those in patients with PD (P = 0.003). Moreover, there was no significant correlation detected between the plasma GPNMB levels and disease severity scores of patients with MSA.

CONCLUSIONS

No evidence was detected for the biomarker potential of plasma GPNMB in MSA. © 2023 International Parkinson and Movement Disorder Society.