1
|
Hutyra M, Sanak D, Kral M, Dornak T, Precek J, Hudec S, Navratil K, Kocianova E, Koubek F, Kanovsky P, Taborsky M. Transoesophageal echocardiography findings in young patients with cryptogenic ischemic stroke. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background and purpose
The cause of ischemic stroke (IS) remains often unclear in young patients. Relevant structural heart abnormities with known embolic potential may represent cause of IS also in young population. The use of transoesophageal echocardiography (TEE) allows reliable detection of most relevant structural pathologies. The aim was to assess frequency and spectrum of relevant cardiac abnormities in young IS patients.
Subjects and methods
The study set consisted of young acute IS patients <50 years enrolled in the prospective HISTORY (Heart and Ischemic STrOke Relationship studY) study, registered on ClinicalTrials.gov NCT01541163). In all patients, the brain ischemia was confirmed on CT or MRI. Admission ECG, serum specific cardiac markers, TEE, 24-hour and 3-week ECG-Holter were performed in all patients.
Results
Out of 1284 patients enrolled in the HISTORY study, 135 (73 males, mean age 40.2±8.1 years) were <40 years. In total, the relevant TEE abnormities were present in 47 (35%) of these patients. Patent foramen ovale (PFO) with evident left to right shunt was detected in 38 (28%) patients, with significant right to left shunt in 25 (19%) patients, and other atrial septal defect with clinically significant bidirectional flow in 4 (3%) patients. Significant valvular heart disease was present in 2 (1%) patients (1 bicuspid aortic valve with moderate aortic regurgitation, 1 chronic severe mitral regurgitation), and 4 (3%) patients severe left ventricular systolic dysfunction (left ventricular ejection fraction ≤35%) due to idiopathic dilated cardiomyopathy. Left atrial myxoma was detected in one patient.
Conclusion
The relevant structural abnormities with embolic potential were detected using TEE in 35% of young IS patients. Routine use of TEE to elucidate the causes of stroke, has a role especially in young patients who present with cryptogenic stroke and no cardiovascular risk factors, as well as in the setting of a PFO associated with a deep venous thrombosis.
Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): IGA LF UP, MH CZ - DRO
Collapse
Affiliation(s)
- M Hutyra
- Palacky University, Faculty of Medicine and Dentistry, 1st Dept of Internal Medicine-Cardiology , Olomouc , Czechia
| | - D Sanak
- Palacky University, Faculty of Medicine and Dentistry, Department of Neurology , Olomouc , Czechia
| | - M Kral
- Palacky University, Faculty of Medicine and Dentistry, Department of Neurology , Olomouc , Czechia
| | - T Dornak
- Palacky University, Faculty of Medicine and Dentistry, Department of Neurology , Olomouc , Czechia
| | - J Precek
- Palacky University, Faculty of Medicine and Dentistry, Department of Neurology , Olomouc , Czechia
| | - S Hudec
- Palacky University, Faculty of Medicine and Dentistry, 1st Dept of Internal Medicine-Cardiology , Olomouc , Czechia
| | - K Navratil
- Palacky University, Faculty of Medicine and Dentistry, 1st Dept of Internal Medicine-Cardiology , Olomouc , Czechia
| | - E Kocianova
- Palacky University, Faculty of Medicine and Dentistry, 1st Dept of Internal Medicine-Cardiology , Olomouc , Czechia
| | - F Koubek
- Palacky University, Faculty of Medicine and Dentistry, 1st Dept of Internal Medicine-Cardiology , Olomouc , Czechia
| | - P Kanovsky
- Palacky University, Faculty of Medicine and Dentistry, Department of Neurology , Olomouc , Czechia
| | - M Taborsky
- Palacky University, Faculty of Medicine and Dentistry, 1st Dept of Internal Medicine-Cardiology , Olomouc , Czechia
| |
Collapse
|
2
|
Sanak D, Divisova P, Hutyra M, Kral M, Bartkova A, Latal J, Zapletalova J, Veverka T, Hudec S, Franc D, Dornak T, Kanovsky P. Risk of recurrent ischemic stroke in young cryptogenic patients with embolic stroke of undetermined source. J Neurol Sci 2019. [DOI: 10.1016/j.jns.2019.10.495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
|
3
|
Cerník D, Sanak D, Divisova P, Köcher M, Cihlar F, Zapletalova J, Veverka T, Ospalik D, Cerna M, Janousova P, Belinova K, Kral M, Dornak T, Franc D, Prasil V, Kanovsky P. Levels of glycemia within the first 48 hours after mechanical thrombectomy for acute ischemic stroke may affect clinical outcome. J Neurol Sci 2019. [DOI: 10.1016/j.jns.2019.10.506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
4
|
Hutyra M, Sanak D, Kral M, Veverka T, Dornak T, Divisova P, Precek J, Spacek M, Latal J, Kanovsky P, Taborsky M. P3709Risk of recurrent cerebral ischemia in young patients with cryptogenic ischemic stroke and patent foramen ovale. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
The cause of ischemic stroke (IS) remains often unclear in young patients. Relevant structural heart abnormities with known embolic potential may represent cause of IS also in young population. A persistent foramen ovale (PFO) is a known risk factor for paradoxical embolism, including ischemic stroke (IS).
Aims
The aims of our prospective study were to assess the rates of recurrent ischemic stroke events in young IS patients with PFO during a 35-month follow-up period (FUP) on effective antiplatelet therapy (OAT) and to evaluate a potential relationship with the presence of PFO on transesophageal echocardiography (TEE).
Methods
The study set consisted of young acute IS patients <50 years enrolled in the prospective HISTORY (Heart and Ischemic STrOke Relationship studY) study, NCT01541163). In all patients, the brain ischemia was confirmed on CT or MRI. Admission ECG, serum specific cardiac markers, transesophageal echocardiography, 24-hour and 3-week ECG-Holter were performed in all patients.
Results
Out of 980 patients enrolled in the HISTORY study, 260 patients were younger than 50 years and 185 (56% males, mean age 41±8 years) patients were classified as cryptogenic IS in ASCOD classification. PFO was diagnosed in 60 patients (32%). Six new clinically apparent recurrent ischemic brain events were recorded during a 35-month FUP. No significant difference was found in the presence of IS recurrence between patient group with PFO and without PFO (2 [3.2% patients with PFO] versus 4 [3.2% without PFO] of young IS patients, P=0.99).
Conclusion
The presence of PFO was not associated with a higher risk of new brain ischemic lesions in young patients with with cryptogenic ischemic stroke during a 35-month follow-up period. Number of recurrent clinical IS is relatively small, thus achieved results may be not so robust.
Acknowledgement/Funding
Grant support IGA MZ CR NT/14288-3, AZV MZ CR 17-30101A, IGA LF UP Olomouc (2016-2018), FNOL SUG No. 87-85
Collapse
Affiliation(s)
- M Hutyra
- Palacky University, Faculty of Medicine and Dentistry, 1st Dept of Internal Medicine-Cardiology, Olomouc, Czechia
| | - D Sanak
- Palacky University, Faculty of Medicine and Dentistry, Department of Neurology, Olomouc, Czechia
| | - M Kral
- Palacky University, Faculty of Medicine and Dentistry, Department of Neurology, Olomouc, Czechia
| | - T Veverka
- Palacky University, Faculty of Medicine and Dentistry, Department of Neurology, Olomouc, Czechia
| | - T Dornak
- Palacky University, Faculty of Medicine and Dentistry, Department of Neurology, Olomouc, Czechia
| | - P Divisova
- Palacky University, Faculty of Medicine and Dentistry, Department of Neurology, Olomouc, Czechia
| | - J Precek
- Palacky University, Faculty of Medicine and Dentistry, 1st Dept of Internal Medicine-Cardiology, Olomouc, Czechia
| | - M Spacek
- Palacky University, Faculty of Medicine and Dentistry, 1st Dept of Internal Medicine-Cardiology, Olomouc, Czechia
| | - J Latal
- Palacky University, Faculty of Medicine and Dentistry, 1st Dept of Internal Medicine-Cardiology, Olomouc, Czechia
| | - P Kanovsky
- Palacky University, Faculty of Medicine and Dentistry, Department of Neurology, Olomouc, Czechia
| | - M Taborsky
- Palacky University, Faculty of Medicine and Dentistry, Department of Neurology, Olomouc, Czechia
| |
Collapse
|
5
|
Frolova M, Hvizdosova L, Mensikova K, Langova K, Bucilova K, Kanovsky P, Mares J. CSF biological markers of neurodegeneration in patients with Lewy body disease (LBD) and progressive supranuclear palsy (PSP). Parkinsonism Relat Disord 2018. [DOI: 10.1016/j.parkreldis.2017.11.105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
6
|
Mensikova K, Vodicka R, Kolarikova K, Bartonikova T, Mikulicova L, Kaiserova M, Vastik M, Vrtel R, Otruba P, Bares M, Janout V, Kanovsky P. The identification of molecular-genetic background of familial atypical parkinsonism in “Hornacko”, a specific region of the South-Eastern Moravia, Czech Republic. Parkinsonism Relat Disord 2018. [DOI: 10.1016/j.parkreldis.2017.11.316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
7
|
Kurcova S, Bardon J, Vecerkova M, Vastik M, Nevrly M, Mensikova K, Otruba P, Krahulik D, Kurca E, Sivak S, Kanovsky P. The mutual relationship of bilateral subthalamic stimulation initial impact on the non-motor and motor symptoms in Parkinson’s disease - an open prospective study. Parkinsonism Relat Disord 2018. [DOI: 10.1016/j.parkreldis.2017.11.286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
8
|
Bartkova A, Sanak D, Kral M, Hutyra M, Veverka T, Divisova P, Zapletalova J, Kanovsky P. Etiology of ischemic stroke and frequency of risk factors in young patients. J Neurol Sci 2017. [DOI: 10.1016/j.jns.2017.08.3337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
9
|
Kanovsky P, Dornak T, Justanova M, Jech R, Bares M, Dusek L, Hoskovcova M, Riha M, Navratilova D, Otruba P. Epidemiology of spastic dystonia in stroke patients – Pilot results of sonar study. J Neurol Sci 2017. [DOI: 10.1016/j.jns.2017.08.1059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
10
|
Nevrly M, Hlustik P, Otruba P, Hok P, Kaiserova M, Tudos Z, Kanovsky P. Long-term changes in sensorimotor cortical modulation in response to botulinum toxin therapy in cervival dystonia. The functional MRI study. J Neurol Sci 2017. [DOI: 10.1016/j.jns.2017.08.1662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
11
|
Kaiserova M, Grambalova Z, Otruba P, Stejskal D, Prikrylova Vranova H, Mares J, Mensikova K, Kanovsky P. Cerebrospinal fluid levels of chromogranin A and phosphorylated neurofilament heavy chain are elevated in amyotrophic lateral sclerosis. Acta Neurol Scand 2017; 136:360-364. [PMID: 28185258 DOI: 10.1111/ane.12735] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/16/2017] [Indexed: 12/18/2022]
Abstract
BACKGROUND Various cerebrospinal fluid (CSF) biomarkers are being studied to improve the sensitivity and specificity of the diagnostic methods for amyotrophic lateral sclerosis (ALS). AIMS OF THE STUDY The aim of our study was to establish the CSF levels of chromogranin A (CgA) and phosphorylated neurofilament heavy chain (pNF-H) in patients with ALS in order to assess these proteins as possible biomarkers of ALS. METHODS Cerebrospinal fluid levels of CgA and pNF-H were examined and mutually compared in 15 patients with sporadic ALS and 16 gender- and age-matched controls. RESULTS Lumbar CSF CgA levels were increased in the patients with ALS compared to the controls (median 235 vs 138, P=.031). Lumbar CSF pNF-H levels were significantly increased in the patients with ALS compared to the control group (median 3091 vs 213, P<.0001). CONCLUSIONS Identifying CSF biomarkers in ALS is important in order to establish the diagnosis in the early stages of the disease. pNF-H seems to be a good biomarker for the diagnosis of ALS. If confirmed on a larger group of patients, CgA may also become useful in the diagnosis of sporadic ALS.
Collapse
Affiliation(s)
- M. Kaiserova
- Department of Neurology; Faculty of Medicine and Dentistry; Palacky University and University Hospital; Olomouc Czech Republic
| | - Z. Grambalova
- Department of Neurology; Faculty of Medicine and Dentistry; Palacky University and University Hospital; Olomouc Czech Republic
| | - P. Otruba
- Department of Neurology; Faculty of Medicine and Dentistry; Palacky University and University Hospital; Olomouc Czech Republic
| | - D. Stejskal
- AGEL Research and Training Institute; Prostejov Czech Republic
- Institute of Medical Chemistry and Biochemistry; Faculty of Medicine and Dentistry; Palacky University and University Hospital; Olomouc Czech Republic
- Department of Biochemical Sciences; Faculty of Medicine; Ostrava University; Ostrava Czech Republic
| | - H. Prikrylova Vranova
- Department of Neurology; Faculty of Medicine and Dentistry; Palacky University and University Hospital; Olomouc Czech Republic
| | - J. Mares
- Department of Neurology; Faculty of Medicine and Dentistry; Palacky University and University Hospital; Olomouc Czech Republic
| | - K. Mensikova
- Department of Neurology; Faculty of Medicine and Dentistry; Palacky University and University Hospital; Olomouc Czech Republic
| | - P. Kanovsky
- Department of Neurology; Faculty of Medicine and Dentistry; Palacky University and University Hospital; Olomouc Czech Republic
| |
Collapse
|
12
|
Sanak D, Hutyra M, Kral M, Precek J, Divisova P, Veverka T, Dornak T, Latal J, Franc D, Bartkova A, Taborsky M, Kanovsky P. Relevant structural and functional heart abnormities in young ischemic stroke patients: Tee findings from the history study. J Neurol Sci 2017. [DOI: 10.1016/j.jns.2017.08.2792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
|
13
|
Mensikova K, Vodicka R, Vrtel R, Kolarikova K, Otruba P, Kaiserova M, Vastik M, Bartonikova T, Kanovsky P. The identification of molecular-genetic background of familial atypical parkinsonism in "Hornacko", a specific region of the South-Eastern Moravia, Czech Republic. J Neurol Sci 2017. [DOI: 10.1016/j.jns.2017.08.1637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
14
|
Hlustik P, Vyslouzilova J, Hok P, Sladkova V, Prikrylova-Vranova H, Mares J, Otruba P, Kanovsky P. Sensorimotor plasticity due to botulinum-toxin treatment of leg spasticity in multiple sclerosis: A functional MRI study. J Neurol Sci 2017. [DOI: 10.1016/j.jns.2017.08.3455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
|
15
|
Hok P, Veverka T, Hlustik P, Krobot A, Kanovsky P. ID 312 – Sensorimotor modulation by botulinum Toxin A in post-stroke arm spasticity: Passive hand movement. Clin Neurophysiol 2016. [DOI: 10.1016/j.clinph.2015.11.257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
|
16
|
|
17
|
Matejcikova Z, Mares J, Klosova J, Sladkova V, Skalska S, Svrcinova T, Zapletalova J, Kanovsky P. CSF and serum levels of inflammatory markers at the time of first clinical symptoms in MS patients. J Neurol Sci 2015. [DOI: 10.1016/j.jns.2015.08.1099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
|
18
|
Mares J, Sladkova V, Matejcikova Z, Skalska S, Svrcinova T, Klosova J, Dolakova J, Kanovsky P. Biological markers of neurodegenerative and inflammatory processes in multiple sclerosis. J Neurol Sci 2015. [DOI: 10.1016/j.jns.2015.08.1096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
|
19
|
Kanovsky P, Prikrylova Vranova H, Mares J, Mensikova K, Henykova E, Amakorova P, Strnad M. UHPLC-MS/MS quantitative profiling of tryptophane-related neuroactive substances in cerebrospinal fluid in Parkinson's disease patients. J Neurol Sci 2015. [DOI: 10.1016/j.jns.2015.08.955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
|
20
|
Sanak D, Kral M, Hutyra M, Veverka T, Dornak T, Vindis D, Bartkova A, Skoloudik D, Taborsky M, Kanovsky P. Cardioembolic etiology of acute ischemic stroke in patients indicated to revascularization. J Neurol Sci 2015. [DOI: 10.1016/j.jns.2015.08.1444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
|
21
|
Bares M, Gescheidt T, Ibarburu Lorenzo Y Losada V, Mensikova K, Dusek L, Czekoova K, Menclova P, Kanovsky P, Roth J. Impulse control disorders in young-onset patients with Parkinson’s disease: cross-sectional study seeking associated factors with regard of personal characteristics. J Neurol Sci 2015. [DOI: 10.1016/j.jns.2015.08.956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
|
22
|
Nevrly M, Hlustik P, Otruba P, Opavsky R, Hok P, Kanovsky P. 28. Modulation of cerebral sensorimotor circuits during botulinum toxin treatment of cervical dystonia. Clin Neurophysiol 2014. [DOI: 10.1016/j.clinph.2013.12.066] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
|
23
|
Mensikova K, Kanovsky P, Kaiserova M, Vastik M, Mikulicova L, Otruba P, Jugas P, Ovecka J, Sachova L, Dvorsky F, Krsa J, Janout V. An epidemiological study of neurodegenerative parkinsonism prevalence in the population of “Upper Land” /INS;in the south-eastern Moravia, Czech Republic. J Neurol Sci 2013. [DOI: 10.1016/j.jns.2013.07.617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
|
24
|
Sanak D, Skoloudik D, Veverka T, Kuliha M, Kral M, Kocher M, Roubec M, Langova K, Prochazka V, Nevrly M, Franc D, Mensikova K, Marak R, Otruba P, Kanovsky P. Impact of prior IV thrombolysis on early recanalization and clinical outcome after endovascular treatment in acute ischemic stroke. J Neurol Sci 2013. [DOI: 10.1016/j.jns.2013.07.890] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
25
|
Ferreira JJ, Katzenschlager R, Bloem BR, Bonuccelli U, Burn D, Deuschl G, Dietrichs E, Fabbrini G, Friedman A, Kanovsky P, Kostic V, Nieuwboer A, Odin P, Poewe W, Rascol O, Sampaio C, Schüpbach M, Tolosa E, Trenkwalder C, Schapira A, Berardelli A, Oertel WH. Summary of the recommendations of the EFNS/MDS-ES review on therapeutic management of Parkinson's disease. Eur J Neurol 2013; 20:5-15. [PMID: 23279439 DOI: 10.1111/j.1468-1331.2012.03866.x] [Citation(s) in RCA: 216] [Impact Index Per Article: 19.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2012] [Accepted: 08/06/2012] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To summarize the 2010 EFNS/MDS-ES evidence-based treatment recommendations for the management of Parkinson's disease (PD). This summary includes the treatment recommendations for early and late PD. METHODS For the 2010 publication, a literature search was undertaken for articles published up to September 2009. For this summary, an additional literature search was undertaken up to December 2010. Classification of scientific evidence and the rating of recommendations were made according to the EFNS guidance. In cases where there was insufficient scientific evidence, a consensus statement ('good practice point') is made. RESULTS AND CONCLUSIONS For each clinical indication, a list of therapeutic interventions is provided, including classification of evidence.
Collapse
Affiliation(s)
- J J Ferreira
- Laboratory of Clinical Pharmacology and Therapeutics and Instituto de Medicina Molecular, Faculty of Medicine, University of Lisbon, Lisbon, Portugal
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
26
|
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: 323] [Impact Index Per Article: 29.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [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.
Collapse
Affiliation(s)
- A Berardelli
- Dipartimento di Neurologia e Psichiatria and IRCCS NEUROMED Institute, Sapienza, Università di Roma, Rome, Italy.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
27
|
Kanovsky P, Pulte I, Grafe S, Barnes M. Significant and sustained efficacy of incobotulinumtoxinA in upper limb spasticity. Toxicon 2013. [DOI: 10.1016/j.toxicon.2012.07.151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
28
|
Prikrylova Vranova H, Nevrly M, Hlustik P, Mares J, Obereigneru R, Kanovsky P. From Parkinson's Disease to Alzheimer Disease (P06.080). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.p06.080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
|
29
|
Farnikova K, Jugas P, Mikulicova L, Ovecka J, Kanovsky P. Prevalence of Neurodegenerative Parkinsonism in the Isolated Population of South-Eastern Moravia, Czech Republic (P07.124). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.p07.124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
|
30
|
Hlustik P, Veverka T, Tomasova Z, Otruba P, Kral M, Tudos Z, Herzig R, Kanovsky P. BoNT-Related Changes of Cortical Activity in Patients Suffering from Severe Hand Paralysis and Arm Spasticity Following Ischemic Stroke (P01.016). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.p01.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
|
31
|
Farnikova K, Obereigneru R, Prasko J, Kanovsky P. Parkinson's disease and predictors of impulse control disorders in MMPI-2. Eur Psychiatry 2011. [DOI: 10.1016/s0924-9338(11)72903-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
This was a case control study involving 46 patients suffering from Parkinson disease (PD); 13 with impulse control disorder (ICD) and 33 without ICD; and 56 controls. The personality traits in these groups were analyzed using the Minnesota Multiphasic Personality Inventory-2 (MMPI-2). 46 patients with PD and 56 control group subjects were included into study. ICD were identified in 13 patients from PD group. There were higher scores than pathological threshold (65) in four domains of MMPI-2 Clinical scales: D (Depression), Pt (Psychastenia), Sc (Schizophrenia) and SI (Social introversion) in PD patients with ICD; but there were not statistical difference in any of these scales in comparison with the group of PD patients without ICD. In the case of MMPI-2 Subscales and Content scales there were higher scores than pathological threshold in eight domains of MMPI-2: SOD (Social Discomfort), PD4 (Psychopatic deviate - social alienation), PA1 (Paranoia - persecutory ideas), SC1 (Schizophrenia), PA_O (Paranoia - subtle), MA_O (Hypomania - obvious), SI1 (Syness/Self-Consciousness), SI3 (Alienation self and others) and Ho (Hostility), but there were statistical differences only in one of these domains in comparison with the PD patients without ICD: SI3 (alienation self and others). There was earlier onset of the disease and higher dose of levodopa in PD patients with ICD than in PD patients without ICD.Supported by project IGA MZ ČR NS 10301-3/2009
Collapse
|
32
|
Skoloudik D, Herzig R, Fadrna T, Bar M, Hradilek P, Roubec M, Jelinkova M, Sanak D, Kral M, Chmelova J, Herman M, Langova K, Kanovsky P. Distal enlargement of the optic nerve sheath in the hyperacute stage of intracerebral haemorrhage. Br J Ophthalmol 2010; 95:217-21. [DOI: 10.1136/bjo.2009.172890] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
33
|
Skoloudík D, Král M, Sanák D, Vlachová I, Hlustík P, Michálková K, Herzig R, Kanovsky P. Thrombolytic treatment of ischaemic stroke occurring during a migrainous attack: a case report. Cephalalgia 2010; 30:368-72. [PMID: 19438912 DOI: 10.1111/j.1468-2982.2009.01891.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Authors report a case of young female suffering from the acute ischaemic stroke with right-sided hemiplegia, hemianopsia and hemihypoaesthesia during a migrainous attack without aura. Magnetic resonance imaging detected infarction in the left occipital lobe and occlusion of branches of the posterior cerebral artery (PCA). Combined treatment with systemic thrombolysis and sonothrombolysis was used, leading to the early PCA recanalization, and to a favourable clinical outcome after 1 month. Intravenous thrombolytic treatment administered within the therapeutic window may be useful in cerebral ischaemia associated with migraine when an arterial occlusion is documented.
Collapse
Affiliation(s)
- D Skoloudík
- Department of Neurology, Palacký University and University Hospital Olomouc, Stroke Centre, Czech Republic.
| | | | | | | | | | | | | | | |
Collapse
|
34
|
Farnikova K, Oberreigneru R, Kanovsky P. P1.103 Predictors of impulse control disorders in MMPI-2 in patients suffering from Parkinson's disease: a pilot study. Parkinsonism Relat Disord 2009. [DOI: 10.1016/s1353-8020(09)70225-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
35
|
Bares M, Rektorova I, Jech R, Farnikova K, Roth J, Ruzicka E, Kanovsky P, Rektor I, Pavlik T, Chroust K. FP44-TH-01 Epidemiology of wearing-off symptoms among the population of Parkinson's disease patients on l-dopa in the Czech Republic: the results of E.W.O. study. J Neurol Sci 2009. [DOI: 10.1016/s0022-510x(09)70500-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
36
|
Axmanova K, Roubec M, Vaclavik D, Skoloudik D, Kubosova M, Kucera D, Valka M, Cizek V, Kratky J, Prochazka V, Zapletalova J, Kanovsky P, Herzig R. FP05-MO-02 Acute ischemic stroke due to MCA occlusion: effectiveness of intracranial percutaneous transluminal angioplasty in patients without improvement of neurological deficit after intravenous thrombolysis. J Neurol Sci 2009. [DOI: 10.1016/s0022-510x(09)70285-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
37
|
Mares J, Herzig R, Stejskal D, Vavrouskova J, Hlustik P, Vranova H, Burval S, Zapletalova J, Pidrman V, Obereingeru R, Suchy A, Vesely J, Podivinsky J, Kanovsky P. FP43-TH-01 The assessment of beta amyloid, tau protein and cystatin C in the cerebrospinal fluid – laboratory markers of neurodegenerative diseases. J Neurol Sci 2009. [DOI: 10.1016/s0022-510x(09)70495-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
38
|
Farnikova K, Kanovsky P. PO24-TH-07 Prodromal non-motor symptoms of Parkinson's disease, long-term uneffective nondopaminergic treatment and subsequent response to dopaminergic medication: a retrospective study. J Neurol Sci 2009. [DOI: 10.1016/s0022-510x(09)71092-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
39
|
Bartkova A, Kral M, Herzig R, Sanak D, Vlachova I, Zapletalova J, Kanovsky P. PO01-MO-05 Subtypes of ischemic stroke and vascular risk factors in young adults. J Neurol Sci 2009. [DOI: 10.1016/s0022-510x(09)70597-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
40
|
Skoloudik D, Herzig R, Fadrna T, Bar M, Zapletal O, Blatny J, Langova K, Kanovsky P, Kral M. FP19-TU-01 Sono-thrombolytic activation of the fibrinolytic system in acute stroke patients using a diagnostic 1–4MHz transcranial probe. J Neurol Sci 2009. [DOI: 10.1016/s0022-510x(09)70362-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
41
|
Sanak D, Kral M, Herzig R, Zapletalova J, Hutyra M, Bartkova A, Vlachova I, Veverka T, Skoloudik D, Kanovsky P. PO13-TU-08 Is atrial fibrillation associated with poor outcome after thrombolysis? J Neurol Sci 2009. [DOI: 10.1016/s0022-510x(09)70870-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
|
42
|
Rektorova I, Bares M, Jech R, Farnikova K, Rektor I, Roth J, Ruzicka E, Kanovsky P, Chroust K, Pavlik T. PO24-TH-10 Gender differences in motor and non-motor clinical manifestation of Parkinson's disease: analysis of the E.W.O study. J Neurol Sci 2009. [DOI: 10.1016/s0022-510x(09)71095-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
|
43
|
Bartova P, Skoloudik D, Fadrna T, Herzig R, Kanovsky P. PO06-MO-04 Parkinson's disease detected by transcranial sonography. J Neurol Sci 2009. [DOI: 10.1016/s0022-510x(09)70695-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
44
|
Mares J, Kanovsky P, Herzig R, Stejskal D, Vavrouskova J, Hlustik P, Vranova H, Burval S, Zapletalova J, Pidrman V, Obereigneru R, Suchy A, Vesely J, Podivinsky J, Urbanek K. New laboratory markers in diagnosis of alzheimer dementia. Neurol Res 2009; 31:1056-9. [PMID: 19589198 DOI: 10.1179/174313209x385536] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
OBJECTIVES The aim of our work was to assess the role of tau protein, beta amyloid and cystatin C in diagnosis of Alzheimer dementia (AD) and other neurodegenerative diseases (NDs). METHODS The levels of tau protein, beta amyloid and cystatin C were assessed in a set of 79 patients with ND (38 men and 41 women; aged 22-90 years; mean, 61.6 +/- 15.6 years) and in a control group of 79 subjects with a healthy central nervous system (38 men and 41 women; aged 20-91 years; mean, 61.5 +/- 15.1 years). RESULTS When compared with the subjects in the control group, a statistically significant decrease in tau protein levels was found in patients with ND, an increase in tau protein levels in patients with AD and an increase in cystatin C cerebrospinal fluid/serum index in the ND + AD group. DISCUSSION Our work only confirmed the previously reported results in part. Although tau protein seems to be a quite reliable marker of AD, the role of beta amyloid in AD diagnosis remains at the least questionable. In the case of cystatin C, our results would seem to confirm the views of certain authors that cystatin C will probably not become a new 'revolutionary' marker contributing to differential diagnostics.
Collapse
Affiliation(s)
- J Mares
- Department of Neurology, University Hospital, Olomouc, Czech Republic.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
45
|
Nevrly M, Kanovsky P, Vranova H, Langova K, Hlustik P. Effect of levodopa and entacapone treatment on plasma homocysteine levels in Parkinson's disease patients. Parkinsonism Relat Disord 2009; 15:477-8. [DOI: 10.1016/j.parkreldis.2008.10.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2008] [Revised: 09/17/2008] [Accepted: 10/16/2008] [Indexed: 12/01/2022]
|
46
|
Mares J, Kanovsky P, Herzig R, Stejskal D, Vavrouskova J, Hlustik P, Vranova H, Burval S, Zapletalova J, Pidrman V, Obereigneru R, Suchy A, Vesely J, Podivinsky J, Urbanek K. The assessment of beta amyloid, tau protein and cystatin C in the cerebrospinal fluid: laboratory markers of neurodegenerative diseases. Neurol Sci 2009; 30:1-7. [PMID: 19153649 DOI: 10.1007/s10072-008-0005-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2008] [Accepted: 10/07/2008] [Indexed: 10/21/2022]
Abstract
To assess the role of tau protein, beta-amyloid(1-42) and cystatin C in the diagnostics of Alzheimer dementia (AD) and other neurodegenerative diseases (ND) by comparing to the control groups (CG). The levels of tau protein, beta-amyloid(1-42) and cystatin C were assessed in the set of 69 patients (AD + ND, 33 males, 36 females, aged 22-90, mean 60.5 + 16.1 years), and in a control group of 69 subjects without the affection of the central nervous system (CGAD + CGND, 33 males, 36 females, aged 20-91, mean 60.5 + 16.0 years). Statistically significant increased tau protein levels (P = 0.0001) and index tau/beta-amyloid(1-42) levels (P = 0.0002) were shown in the group of AD patients, compared to the group of ND patients. One-way ANOVA analysis with Bonferonni post hoc test did not show any significant differences of the cystatin C values between any of the compared groups. ROC analysis showed at least one tie between the positive actual state group (AD) and the negative actual state group (ND) by CSF cystatin C and at least one tie between the positive actual state group and the negative actual state group by CSF tau protein. Our study confirmed previously reported results only in part. While tau protein seems to be quite a reliable marker of AD, the role of beta-amyloid(1-42) and cystatin C in AD diagnosis remains at least questionable.
Collapse
Affiliation(s)
- Jan Mares
- Clinic of Neurology, University Hospital, Olomouc, Czech Republic.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
47
|
Kanovsky P, Sassin I, Comes G, Grafe S. NT201 (Xeomin) in upper limb post-stroke spasticity: results of a double-blind, placebo-controlled, randomised, multi-centre trial. Akt Neurol 2008. [DOI: 10.1055/s-0028-1086854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
48
|
Kanovsky P, Obereigneru R, Steckova T, Farnikova K. P1.130 Complex cognitive and behavioral dysfunction in Parkinson's disease: pilot study. Parkinsonism Relat Disord 2008. [DOI: 10.1016/s1353-8020(08)70227-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
|
49
|
Nevrly M, Vranova H, Chovancova Z, Nestrasil I, Otruba P, Dufek J, Kanovsky P. 1.161 Plasma homocysteine concentration and peripheral neuropathy in Parkinson's disease patients: A pilot study. Parkinsonism Relat Disord 2007. [DOI: 10.1016/s1353-8020(08)70433-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
|
50
|
Farnikova K, Micenkova M, Nestrasil I, Kanovsky P. 1.149 Autonomic dysfunction in Parkinson's disease and spinocerebellar ataxia: A pilot study. Parkinsonism Relat Disord 2007. [DOI: 10.1016/s1353-8020(08)70421-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|