Electrophysiological and clinical assessment of dysautonomia in multiple system atrophy (MSA) and progressive supranuclear palsy (PSP): a comparative study

Autonomic dysfunction in progressive supranuclear palsy

BACKGROUND

The degree of involvement of the autonomic nervous system in progressive supranuclear palsy (PSP) has been investigated in several studies, often providing conflicting results. There is a need for a better characterization of autonomic dysfunction in PSP, to enhance our understanding of this highly disabling neurodegenerative disease including patients' needs and possibly be of value for clinicians in the differential diagnosis among Parkinsonian syndromes.

METHODS

We applied a systematic methodology to review existing literature on Pubmed regarding autonomic nervous system involvement in PSP.

RESULTS

PSP reported quite frequently symptoms suggestive of autonomic dysfunction in all domains. Cardiovascular autonomic testing showed in some cases a certain degree of impairment (never severe). There was some evidence suggesting bladder dysfunction particularly in the storage phase. Dysphagia and constipation were the most common gastrointestinal symptoms. Instrumental tests seemed to confirm sudomotor and pupillomotor disturbances.

CONCLUSIONS

PSP patients frequently reported visceral symptoms, however objective testing showed that not always these reflected actual autonomic impairment. Further studies are needed to better delineate autonomic profile and its prognostic role in PSP.

A Preliminary Study on Sympathetic Skin Response in Acute Ischemic Cerebrovascular Disease

Purpose

The study aims to identify the characteristics of SSR in patients with AICVD and their correlation with clinical presentations.

Methods

SSR of the upper limbs, the National Institute of Health stroke scale (NIHSS), the Barthel index (BI), the Essen stroke risk score (ESRS), and imaging examinations, was evaluated in 30 healthy subjects and 66 patients with AICVD. All results were recorded and analyzed via Statistical Package for the Social Sciences (SPSS 22.0) software. t-test and Spearman rank correlation were used.

Results

Compared to the control group, SSR of upper limbs in patients with AICVD showed prolonged latency, reduced amplitude, and disappeared waveform (p=0.000, p=0.015, p=0.004), No statistically significant difference was observed between the affected side and the healthy side (p=0.068, p=0.661). In the case group, the higher the abnormal rate of SSR, the more severe the neurological impairment (NIHSS and ADL scores) and the worse the long-term prognosis. Specific results are as follows: Firstly, the total abnormality rate of SSR, prolonged SSR latency were positively related to the NIHSS, also the ESRS (r=0.347, p=0.004; r=0.437, p<0.001), (r=0.371, p=0.005; r=0.433, p=0.001), the reduced amplitude was positively related to the NIHSS (r=0.341, p=0.012) while the disappeared waveform was positively related to the ESRS (r=0.299, p=0.015); Secondly, the total abnormality rate of SSR, prolonged SSR latency and reduced amplitude were negatively related to the BI (r=-0.346, p=0.004) (r=-0.426, p=0.001) (r=-0.316, p=0.020).

Conclusion

There may be inhibition of sympathetic reflex activity in patients with AICVD, SSR abnormality rate in patients with AICVD may be correlated with the degree of neurological impairment and long-term prognosis.

Differences in Motor Features of C9orf72, MAPT, or GRN Variant Carriers With Familial Frontotemporal Lobar Degeneration

BACKGROUND AND OBJECTIVES

Familial frontotemporal lobar degeneration (f-FTLD) is a phenotypically heterogeneous spectrum of neurodegenerative disorders most often caused by variants within chromosome 9 open reading frame 72 (C9orf72), microtubule-associated protein tau (MAPT), or granulin (GRN). The phenotypic association with each of these genes is incompletely understood. We hypothesized that the frequency of specific clinical features would correspond with different genes.

METHODS

We screened the Advancing Research and Treatment in Frontotemporal Lobar Degeneration (ARTFL)/Longitudinal Evaluation of Familial Frontotemporal Dementia Subjects (LEFFTDS)/ARTFL LEFFTDS Longitudinal Frontotemporal Lobar Degeneration Consortium for symptomatic carriers of pathogenic variants in C9orf72, MAPT, or GRN. We assessed for clinical differences among these 3 groups based on data recorded as part of a detailed neurologic examination, the Progressive Supranuclear Palsy Rating Scale, Progressive Supranuclear Palsy-Quality of Life Rating Scale, Unified Parkinson's Disease Rating Scale Part III (motor items), and the Amyotrophic Lateral Sclerosis Functional Rating Scale, revised version. Data were analyzed using Kruskal-Wallis and Wilcoxon rank-sum tests and Fisher exact test.

RESULTS

We identified 184 symptomatic participants who had a single pathogenic variant in C9orf72 (n = 88), MAPT (n = 53), or GRN (n = 43). Motor symptom age at onset was earliest in the MAPT participants followed by C9orf72, whereas the GRN pathogenic variant carriers developed symptoms later. C9orf72 participants more often had fasciculations, muscle atrophy, and weakness, whereas parkinsonism was less frequent. Vertical oculomotor abnormalities were more common in the MAPT cohort, whereas apraxia and focal limb dystonia occurred more often in participants with GRN variants.

DISCUSSION

We present a large comparative study of motor features in C9orf72, MAPT, and GRN pathogenic variant carriers with symptomatic f-FTLD. Our findings demonstrate characteristic phenotypic differences corresponding with specific gene variants that increase our understanding of the genotype-phenotype relationship in this complex spectrum of neurodegenerative disorders.

TRIAL REGISTRATION INFORMATION

NCT02365922, NCT02372773, and NCT04363684.