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Zhou W, Tang M, Sun L, Lin H, Tan Y, Fan Y, Fan S, Zhang S. Subcortical structure alteration in patients with drug-induced parkinsonism: Evidence from neuroimaging. IBRO Neurosci Rep 2024; 16:436-442. [PMID: 38510074 PMCID: PMC10951636 DOI: 10.1016/j.ibneur.2024.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 02/22/2024] [Accepted: 03/03/2024] [Indexed: 03/22/2024] Open
Abstract
Parkinson's Disease (PD) and Drug-induced parkinsonism (DIP) are the most common subtypes of parkinsonism, yet no studies have reported that the subcortical volume alterations in DIP patients. This study aimed to identify specific alterations of subcortical structures volume in DIP patients, and investigate association between the subcortical structure modifications and clinical symptoms. We recruited 27 PD patients, 25 DIP patients and 30 healthy controls (HCs). The clinical symptom-related parameters (Unified Parkinson's Disease Rating Scale, UPDRS) were evaluated. Structural imaging was performed on a 3.0 T scanner, and volumes of subcortical structures were obtained using FreeSurfer software. Analysis of covariance (ANCOVA) and partial correlation analysis were performed. DIP group had significantly smaller volume of the thalamus, pallidum, hippocampus and amygdala compared to HCs. ROC curve analysis demonstrated that the highest area under curve (AUC) value was in the right pallidum (AUC = 0.831) for evaluating the diagnostic efficacy in DIP from HCs. Moreover, the volumes of the putamen, hippocampus and amygdala were negatively correlated with UPDRSII in the DIP patients. The volume of the amygdala was negatively correlated with UPDRSIII. The present study provides novel information regarding neuroanatomical alteration of subcortical nuclei in DIP patients, suggesting that these methods might provide the basis for early diagnosis and differential diagnosis of DIP.
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Affiliation(s)
- Wei Zhou
- Department of Neurology, Affiliated Hospital of North Sichuan Medical College, Maoyuan South Street 1, Nanchong, Sichuan 637000, PR China
| | - MengYue Tang
- Sichuan Key Laboratory of Medical Imaging, Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Maoyuan South Street 1, Nanchong, Sichuan 637000, PR China
| | - Ling Sun
- Department of Geriatrics, Nanchong Central Hospital, Renmin South Street 97, Nanchong, Sichuan 637000, PR China
| | - HongYu Lin
- Department of Neurology, Affiliated Hospital of North Sichuan Medical College, Maoyuan South Street 1, Nanchong, Sichuan 637000, PR China
| | - Ying Tan
- Department of Internal Medicine, The Second Affiliated Hospital of North Sichuan Medical College, Dongshun Road 55, Nanchong, Sichuan 637000, PR China
| | - Yang Fan
- Department of Neurology, Affiliated Hospital of North Sichuan Medical College, Maoyuan South Street 1, Nanchong, Sichuan 637000, PR China
| | - Si Fan
- Department of Neurology, Gaoping District Peolpe's Hospital, 21, Bajiao Street 21, Section 7, Jiangdong Middle Road, Nanchong, Sichuan 637000, PR China
| | - ShuShan Zhang
- Department of Neurology, Affiliated Hospital of North Sichuan Medical College, Maoyuan South Street 1, Nanchong, Sichuan 637000, PR China
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Politis A, Kokras N, Souvatzoglou M, Siarkos K, Toulas P, Potagas C, Hatzipanagiotou T, Limouris G, Alexopoulos P. Differences in cause and 12-month follow-up outcome of parkinsonian symptoms in depressed older adults treated with antipsychotics: a case series. BMC Psychiatry 2021; 21:289. [PMID: 34082747 PMCID: PMC8173873 DOI: 10.1186/s12888-021-03298-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 05/20/2021] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Parkinsonian symptoms are common adverse effects of antipsychotics. Older adults are particularly vulnerable to drug-induced parkinsonism. Nonetheless, parkinsonian symptoms in seniors treated with antipsychotics cannot be straightforwardly attributed to antipsychotic medication. A comprehensive diagnostic workup is necessary in many cases in order to shed light on the cause of such symptoms in this patient population. CASE SERIES Eight cases of hospitalized depressed older adults with parkinsonian symptoms, who were treated for at least one year with antipsychotics, are reported. Based on neurological consultation, structural brain imaging and Ioflupane (I-123) dopamine transporter (DAT) single photon emission computerized tomography (SPECT), Parkinson's disease was diagnosed in one case, idiopathic tremor in another, vascular parkinsonism in another one, while in another individual parkinsonian symptoms persisted at 12-month post-discharge follow-up even though his/her symptoms were classified as drug-induced on discharge. In four patients, parkinsonian symptoms were definitely drug-induced and no movement disturbances were reported at follow-up. CONCLUSIONS Differences in the cause and outcome of parkinsonian symptoms in seniors treated with antipsychotics merit systematic and in-depth study considering the therapeutic and prognostic implications of an accurate detection of the cause of such symptoms. Familiarizing clinical psychiatrists with these differences could pave the way towards approaching seniors with severe, atypical and/or persistent parkinsonian symptoms in a more individualized diagnostic and therapeutic manner, and towards more cautious prescribing of antipsychotics in this age group.
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Affiliation(s)
- Anastasios Politis
- grid.7445.20000 0001 2113 8111Charing Cross Hospital, Department of Neurosurgery, Imperial College London, London, UK
| | - Nikolaos Kokras
- grid.5216.00000 0001 2155 0800First Department of Psychiatry, Eginition Hospital; Department of Pharmacology, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Michael Souvatzoglou
- grid.5216.00000 0001 2155 0800Nuclear Medicine Division, Radiology First Department, “Aretaieion” Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Kostas Siarkos
- grid.5216.00000 0001 2155 0800First Department of Psychiatry, Eginition Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Panagiotis Toulas
- grid.5216.00000 0001 2155 0800Research Unit of Radiology, Second Department of Radiology, National and Kapodistrian University of Athens and Bioiatriki, Athens, Greece
| | - Constantin Potagas
- grid.5216.00000 0001 2155 0800First Department of Neurology, Eginition Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Theodoros Hatzipanagiotou
- grid.415451.00000 0004 0622 6078Department of Nuclear Medicine, Metropolitan Hospital, Neo Faliro, Pireas, Greece
| | - Georgios Limouris
- grid.5216.00000 0001 2155 0800Nuclear Medicine Division, Radiology First Department, “Aretaieion” Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Panagiotis Alexopoulos
- Department of Psychiatry, Patras University Hospital, Faculty of Medicine, School of Health Sciences, University of Patras, 26504 Rion, Patras, Greece. .,Department of Psychiatry and Psychotherapy, Klinikum rechts der Isar, Faculty of Medicine, Technical University of Munich, Munich, Germany.
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Abstract
We report 2 cases of drug induced Parkinsonism followed longitudinally that remained symptomatic 22 and 27 months after stopping causative agents with normal dopamine ioflupane iodine-123 (DaT) single-photon emission computed tomography (SPECT) scans at 8 and 16 months.
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Affiliation(s)
- Jaskaren Randhawa
- UT MOVE, Department of Neurology, University of Texas Health Science at Houston, Houston, TX, USA
| | - Raja Mehanna
- UT MOVE, Department of Neurology, University of Texas Health Science at Houston, Houston, TX, USA.
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Ham JH, Cha J, Lee JJ, Baek GM, Sunwoo MK, Hong JY, Shin NY, Sohn YH, Lee JM, Lee PH. Nigrostriatal dopamine-independent resting-state functional networks in Parkinson's disease. Neuroimage 2015; 119:296-304. [PMID: 26143204 DOI: 10.1016/j.neuroimage.2015.06.077] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2015] [Revised: 05/26/2015] [Accepted: 06/26/2015] [Indexed: 10/23/2022] Open
Abstract
As an indicator of synchronous neural activity, resting-state functional networks are influenced by neuropathological and neurochemical changes in degenerative diseases. To further advance understanding about neurochemical and neuropathological basis for resting-state functional maps, we performed a comparative analysis of resting-state functional connectivity in patients with Parkinson's disease (PD) and drug induced parkinsonism (DIP). Resting-state neuroimaging data were analyzed with a seed-based approach to investigate striatocortical functional connectivity and cortical functional connectivity within the default mode network, executive control network, and the dorsal attention network. The striatal subregions were divided into the more or less affected sides in terms of dopamine transporter uptake. Compared with DIP, PD exhibited an increased cerebellar connectivity from the more affected side of the caudate and the less affected sides of the anterior and the posterior putamen. Additionally, PD showed increased functional connectivity in the anterior prefrontal areas from the more affected side of the anterior putamen and from the less affected side of the posterior putamen. However, PD exhibited decreased cortical functional connectivity from the posterior cingulate cortex in the left temporal area. Finally, DIP patients showed decreased cortical functional connectivity from the dorsolateral prefrontal cortex in frontal and parietal areas compared with PD patients. In summary, the present study demonstrates that PD patients exhibited a unique resting state functional connectivity that may be associated with PD-related pathological changes beyond the dopaminergic system, whereas DIP patients showed altered functional connectivity within executive control network.
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Affiliation(s)
- Jee Hyun Ham
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - Jungho Cha
- Department of Biomedical Engineering, Hanyang University, Seoul, South Korea
| | - Jae Jung Lee
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - Gwang-Min Baek
- Department of Biomedical Engineering, Hanyang University, Seoul, South Korea
| | - Mun Kyung Sunwoo
- Department of Neurology, Bundang Jesaeng General Hospital, Seongnam, South Korea
| | - Jin Yong Hong
- Department of Neurology, Yonsei University Wonju College of Medicine, Wonju, South Korea
| | - Na-Young Shin
- Department of Radiology, Ewha Womans University, Seoul, South Korea
| | - Young Ho Sohn
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - Jong-Min Lee
- Department of Biomedical Engineering, Hanyang University, Seoul, South Korea
| | - Phil Hyu Lee
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea; Severance Biomedical Science Institute, Yonsei University College of Medicine, Seoul, South Korea.
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Abstract
Serotonin specific reuptake inhibitors (SSRI) are widely used antidepressants for variety of clinical conditions and have found popularity. They are sometimes associated with extrapyramidal side effects including Parkinsonism. We report a case of generalized anxiety disorder on treatment with SSRI (fluoxetine / sertraline) who developed irreversible Parkinsonism. SSRI are known to cause reversible or irreversible motor disturbances through pathophysiological changes in basal ganglion motor system by altering the dopamine receptors postsynaptically. Clinician should keep risk benefit ratio in mind and change of antidepressant of different class may be considered. Case is reported to alert physicians to possibility of motor system damage while treating with SSRI.
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Affiliation(s)
- Siddharth Dixit
- Classified Specialist, Department of Psychiatry,Base Hospital Delhi Cantt, New Delhi, India
| | - Shahbaj A Khan
- Classified Specialist, Department of Psychiatry,Base Hospital Delhi Cantt, New Delhi, India
| | - Sudip Azad
- Resident, Department of Psychiatry,Base Hospital Delhi Cantt, New Delhi, India
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