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14 "Multiple system atrophy"
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Original Articles
Semiautomated Algorithm for the Diagnosis of Multiple System Atrophy With Predominant Parkinsonism
Woong-Woo Lee, Han-Joon Kim, Hong Ji Lee, Han Byul Kim, Kwang Suk Park, Chul-Ho Sohn, Beomseok Jeon
J Mov Disord. 2022;15(3):232-240.   Published online July 26, 2022
DOI: https://doi.org/10.14802/jmd.21178
  • 723 View
  • 54 Download
AbstractAbstract PDFSupplementary Material
Objective
Putaminal iron deposition is an important feature that helps differentiate multiple system atrophy with predominant parkinsonism (MSA-p) from Parkinson’s disease (PD). Most previous studies used visual inspection or quantitative methods with manual manipulation to perform this differentiation. We investigated the value of a new semiautomated diagnostic algorithm using 3T-MR susceptibility-weighted imaging for MSA-p.
Methods
This study included 26 MSA-p, 68 PD, and 41 normal control (NC) subjects. The algorithm was developed in 2 steps: 1) determine the image containing the remarkable putaminal margin and 2) calculate the phase-shift values, which reflect the iron concentration. The next step was to identify the best differentiating conditions among several combinations. The highest phaseshift value of each subject was used to assess the most effective diagnostic set.
Results
The raw phase-shift values were present along the lateral margin of the putamen in each group. It demonstrates an anterior- to-posterior gradient that was identified most frequently in MSA-p. The average of anterior 5 phase shift values were used for normalization. The highest area under the receiver operating characteristic curve (0.874, 80.8% sensitivity, and 86.7% specificity) of MSA-p versus PD was obtained under the combination of 3 or 4 vertical pixels and one dominant side when the normalization methods were applied. In the subanalysis for the MSA-p patients with a longer disease duration, the performance of the algorithm improved.
Conclusion
This algorithm detected the putaminal lateral margin well, provided insight into the iron distribution of the putaminal rim of MSA-p, and demonstrated good performance in differentiating MSA-p from PD.
Fecal Calprotectin in Parkinson’s Disease and Multiple System Atrophy
Jia Wei Hor, Shen-Yang Lim, Eng Soon Khor, Kah Kian Chong, Sze Looi Song, Norlinah Mohamed Ibrahim, Cindy Shuan Ju Teh, Chun Wie Chong, Ida Normiha Hilmi, Ai Huey Tan
J Mov Disord. 2022;15(2):106-114.   Published online December 24, 2021
DOI: https://doi.org/10.14802/jmd.21085
  • 2,375 View
  • 292 Download
  • 3 Citations
AbstractAbstract PDFSupplementary Material
Objective
Converging evidence suggests that intestinal inflammation is involved in the pathogenesis of neurodegenerative diseases. Previous studies on fecal calprotectin in Parkinson’s disease (PD) were limited by small sample sizes, and literature regarding intestinal inflammation in multiple system atrophy (MSA) is very scarce. We investigated the levels of fecal calprotectin, a marker of intestinal inflammation, in PD and MSA.
Methods
We recruited 169 subjects (71 PD, 38 MSA, and 60 age-similar nonneurological controls). Clinico-demographic data were collected. PD and MSA were subtyped and the severity assessed using the MDS-UPDRS and UMSARS, respectively. Fecal calprotectin and blood immune markers were analyzed.
Results
Compared to controls (median: 35.7 [IQR: 114.2] μg/g), fecal calprotectin was significantly elevated in PD (median: 95.6 [IQR: 162.1] μg/g, p = 0.003) and even higher in MSA (median: 129.5 [IQR: 373.8] μg/g, p = 0.002). A significant interaction effect with age was observed; between-group differences were significant only in older subjects (i.e., ≥ 61 years) and became more apparent with increasing age. A total of 28.9% of MSA and 18.3% of PD patients had highly abnormal fecal calprotectin levels (≥ 250 μg/g); however, this difference was only significant for MSA compared to controls. Fecal calprotectin correlated moderately with selected blood immune markers in PD, but not with clinical features of PD or MSA.
Conclusions
Elevated fecal calprotectin suggests a role for intestinal inflammation in PD and MSA. A more complete understanding of gut immune alterations could open up new avenues of research and treatment for these debilitating diseases.

Citations

Citations to this article as recorded by  
  • The microbiome–gut–brain axis in Parkinson disease — from basic research to the clinic
    Ai Huey Tan, Shen Yang Lim, Anthony E. Lang
    Nature Reviews Neurology.2022; 18(8): 476.     CrossRef
  • The Gut Microbiome–Brain Crosstalk in Neurodegenerative Diseases
    Laura Ghezzi, Claudia Cantoni, Emanuela Rotondo, Daniela Galimberti
    Biomedicines.2022; 10(7): 1486.     CrossRef
  • Gastrointestinal Involvement in Extra-Digestive Disease: Which Is the Role of Fecal Calprotectin?
    Angela Saviano, Marcello Candelli, Christian Zanza, Andrea Piccioni, Alessio Migneco, Veronica Ojetti
    Medicina.2022; 58(10): 1384.     CrossRef
Review Article
Progressive Supranuclear Palsy with Predominant Cerebellar Ataxia
Shoichiro Ando, Masato Kanazawa, Osamu Onodera
J Mov Disord. 2020;13(1):20-26.   Published online December 19, 2019
DOI: https://doi.org/10.14802/jmd.19061
  • 6,867 View
  • 353 Download
  • 12 Citations
AbstractAbstract PDF
Progressive supranuclear palsy (PSP) is characterized by supranuclear gaze palsy, dystonic rigidity of the neck and upper trunk, frequent falls and mild cognitive impairment. Cerebellar ataxia is one of the exclusion criteria given by the National Institute of Neurological Disorders and Stroke and the Society for Progressive Supranuclear Palsy. As a result, pathologically proven PSP patients exhibiting cerebellar ataxia have often been misdiagnosed with spinocerebellar degeneration, specifically multiple system atrophy with predominant cerebellar ataxia (MSA-C). However, more recently, it has been recognized that patients with PSP can present with truncal and limb ataxia as their initial symptom and/or main manifestation. These patients can be classified as having PSP with predominant cerebellar ataxia (PSP-C), a new subtype of PSP. Since the development of this classification, patients with PSP-C have been identified primarily in Asian countries, and it has been noted that this condition is very rare in Western communities. Furthermore, the clinical features of PSP-C have been identified, enabling it to be distinguished from other subtypes of PSP and MSA-C. In this review, we describe the clinical and neuropathological features of PSP-C. The hypothesized pathophysiology of cerebellar ataxia in PSP-C is also discussed.

Citations

Citations to this article as recorded by  
  • Deciphering the saccade velocity profile of progressive supranuclear palsy: A sign of latent cerebellar/brainstem dysfunction?
    Yasuo Terao, Shin-ichi Tokushige, Satomi Inomata-Terada, Hideki Fukuda, Akihiro Yugeta, Yoshikazu Ugawa
    Clinical Neurophysiology.2022; 141: 147.     CrossRef
  • Parkinsonism and ataxia
    Giulia Franco, Giulia Lazzeri, Alessio Di Fonzo
    Journal of the Neurological Sciences.2022; 433: 120020.     CrossRef
  • Differential Diagnosis of Rare Subtypes of Progressive Supranuclear Palsy and PSP-Like Syndromes—Infrequent Manifestations of the Most Common Form of Atypical Parkinsonism
    Patrycja Krzosek, Natalia Madetko, Anna Migda, Bartosz Migda, Dominika Jaguś, Piotr Alster
    Frontiers in Aging Neuroscience.2022;[Epub]     CrossRef
  • Clinical Aspects of the Differential Diagnosis of Parkinson’s Disease and Parkinsonism
    Hae-Won Shin, Sang-Wook Hong, Young Chul Youn
    Journal of Clinical Neurology.2022; 18(3): 259.     CrossRef
  • Clinical Spectrum of Tauopathies
    Nahid Olfati, Ali Shoeibi, Irene Litvan
    Frontiers in Neurology.2022;[Epub]     CrossRef
  • Toward More Accessible Fully Automated 3D Volumetric MRI Decision Trees for the Differential Diagnosis of Multiple System Atrophy, Related Disorders, and Age-Matched Healthy Subjects
    Jisoo Kim, Geoffrey S. Young, Andrew S. Willett, Ariana T. Pitaro, Grace F. Crotty, Merlyne Mesidor, Kristie A. Jones, Camden Bay, Min Zhang, Mel B. Feany, Xiaoyin Xu, Lei Qin, Vikram Khurana
    The Cerebellum.2022;[Epub]     CrossRef
  • The Role of the Cerebellum in Swallowing
    Ayodele Sasegbon, Shaheen Hamdy
    Dysphagia.2021;[Epub]     CrossRef
  • Cerebellar ataxia in progressive supranuclear palsy: a clinico-pathological case report
    David Crosiers, Anne Sieben, Sarah Ceyssens, Paul M. Parizel, Jonathan Baets
    Acta Neurologica Belgica.2021; 121(2): 599.     CrossRef
  • Progressive supranuclear palsy
    N.V. Fedorova, E.V. Bril, T.K. Kulua, A.D. Mikhaylova
    Zhurnal nevrologii i psikhiatrii im. S.S. Korsakova.2021; 121(5): 111.     CrossRef
  • Case 20-2021: A 69-Year-Old Man with Ataxia
    Richard C. Cabot, Eric S. Rosenberg, David M. Dudzinski, Meridale V. Baggett, Kathy M. Tran, Dennis C. Sgroi, Jo-Anne O. Shepard, Emily K. McDonald, Tara Corpuz, Vikram Khurana, Claudio M. de Gusmao, McKinley Glover, Jeffrey Helgager
    New England Journal of Medicine.2021; 385(2): 165.     CrossRef
  • Evolving concepts in progressive supranuclear palsy and other 4-repeat tauopathies
    Maria Stamelou, Gesine Respondek, Nikolaos Giagkou, Jennifer L. Whitwell, Gabor G. Kovacs, Günter U. Höglinger
    Nature Reviews Neurology.2021; 17(10): 601.     CrossRef
  • Tauopathy and Movement Disorders—Unveiling the Chameleons and Mimics
    Jacky Ganguly, Mandar Jog
    Frontiers in Neurology.2020;[Epub]     CrossRef
Original Articles
Clinical Milestones Preceding the Diagnosis of Multiple System Atrophy and Progressive Supranuclear Palsy: A Retrospective Cohort Study
Louise Wiblin, Rory Durcan, Brook Galna, Mark Lee, David Burn
J Mov Disord. 2019;12(3):177-183.   Published online August 9, 2019
DOI: https://doi.org/10.14802/jmd.19015
  • 5,281 View
  • 189 Download
  • 4 Citations
AbstractAbstract PDF
Objective
Multiple System Atrophy (MSA) and progressive supranuclear palsy (PSP) are rapidly progressive forms of degenerative Parkinsonism. The difficulties of diagnosing MSA and PSP in their early stages may lead to delayed referral to appropriate specialists and distress to patients, as well as delaying symptomatic treatment and participation in clinical trials. This work aimed to describe the symptoms that patients with MSA and PSP developed and plot their emergence relative to final diagnosis using a median onset in months.
Methods
Forty-seven patients from the United Kingdom with MSA or PSP diagnosed by a movement disorder specialist were interviewed with carers or relatives to establish milestone onset. This was corroborated using clinical notes and letters.
Results
In the MSA cohort (n = 23), autonomic symptoms (median 5.5 months before diagnosis) and falls (median 1 month before diagnosis) were the two clinical milestones which occurred before diagnosis. In the PSP cohort (n = 24), falling was the only milestone which occurred before diagnosis (median of 18.5 months).
Conclusion
This Study Shows That Psp Patients Experience Falling More Than A Year And A Half An Average Before Receiving A Diagnosis And Although Msa Patients Also Tended To Fall, This Was Much Closer To The Time Of Diagnosis. Further Work With Larger Cohorts May Illustrate Whether These Preliminary Findings Can Be Generalised To Guide Diagnosis And Management.

Citations

Citations to this article as recorded by  
  • Toward More Accessible Fully Automated 3D Volumetric MRI Decision Trees for the Differential Diagnosis of Multiple System Atrophy, Related Disorders, and Age-Matched Healthy Subjects
    Jisoo Kim, Geoffrey S. Young, Andrew S. Willett, Ariana T. Pitaro, Grace F. Crotty, Merlyne Mesidor, Kristie A. Jones, Camden Bay, Min Zhang, Mel B. Feany, Xiaoyin Xu, Lei Qin, Vikram Khurana
    The Cerebellum.2022;[Epub]     CrossRef
  • Disease course and treatment patterns in progressive supranuclear palsy: A real-world study
    John C. Morgan, Xiaolan Ye, Jennifer A. Mellor, Keisha J. Golden, Jorge Zamudio, Louis A. Chiodo, Yanjun Bao, Tao Xie
    Journal of the Neurological Sciences.2021; 421: 117293.     CrossRef
  • Patient and care partner views on exercise and structured physical activity for people with Progressive Supranuclear Palsy
    Susan C. Slade, Christopher Bruce, Jennifer L. McGinley, Bastiaan R. Bloem, Meg E. Morris, John Duda
    PLOS ONE.2020; 15(6): e0234265.     CrossRef
  • Effect of cold oral stimulation on orthostatic hypotension in multiple system atrophy: a case study
    Hironobu Uzawa, Shinta Takeuchi, Yusuke Nishida
    Journal of Physical Therapy Science.2020; 32(7): 473.     CrossRef
The ‘Hot Cross Bun’ Sign Is Not Always Multiple System Atrophy: Etiologies of 11 Cases
Christopher Way, David Pettersson, Amie Hiller
J Mov Disord. 2019;12(1):27-30.   Published online December 19, 2018
DOI: https://doi.org/10.14802/jmd.18031
  • 6,684 View
  • 276 Download
  • 10 Citations
AbstractAbstract PDF
Objective
To clarify the specificity of the ‘hot cross bun’ sign (HCBS) for multiple system atrophy (MSA) in adult cerebellar ataxia or parkinsonism.
Methods
The radiologic information systems at an academic center and affiliated veterans’ hospital were queried using the keywords ‘hot cross bun,’ ‘pontocerebellar,’ ‘cruciate,’ ‘cruciform,’ ‘MSA,’ ‘multiple system atrophy,’ and ‘multisystem atrophy.’ Scans were reviewed by a neurologist and neuroradiologist to identify the HCBS. Subjects with the HCBS were reviewed by 2 neurologists to identify the most likely etiology of the patient’s neurologic symptoms.
Results
Eleven cases were identified. Etiologies included MSA (4 probable, 2 possible), hereditary cerebellar ataxia (3/11), probable dementia with Lewy bodies (1/11), and uncertain despite autopsy (1/11).
Conclusion
MSA was the most common etiology. However, 5 of the 11 patients did not have MSA. The most common alternate etiology was an undefined hereditary cerebellar ataxia (3/11).

Citations

Citations to this article as recorded by  
  • Mapping cortical disease-burden at individual-level in frontotemporal dementia: implications for clinical care and pharmacological trials
    Mary Clare McKenna, Marlene Tahedl, Jasmin Lope, Rangariroyashe H. Chipika, Stacey Li Hi Shing, Mark A. Doherty, Jennifer C. Hengeveld, Alice Vajda, Russell L. McLaughlin, Orla Hardiman, Siobhan Hutchinson, Peter Bede
    Brain Imaging and Behavior.2022; 16(3): 1196.     CrossRef
  • The “Black Straight-Line Sign” in the Putamen in Diffusion-Weighted Imaging: A Potential Diagnostic MRI Marker for Multiple System Atrophy
    Yiming Zheng, Xiwen Wang, Huajian Zhao, Yanyan Jiang, Ying Zhu, Jing Chen, Wei Sun, Zhaoxia Wang, Yunchuang Sun
    Frontiers in Neurology.2022;[Epub]     CrossRef
  • Radiological hints for differentiation of cerebellar multiple system atrophy from spinocerebellar ataxia
    Hung-Chieh Chen, Li-Hua Lee, Jiing-Feng Lirng, Bing-wen Soong
    Scientific Reports.2022;[Epub]     CrossRef
  • The “Hot Cross Bun Sign” in Spinocerebellar Ataxia Types 2 and 7–Case Reports and Review of Literature
    Ansuya Kasavelu Naidoo, Cait‐Lynn Deanne Wells, Yashvir Rugbeer, Neil Naidoo
    Movement Disorders Clinical Practice.2022; 9(8): 1105.     CrossRef
  • Magnetic resonance imaging abnormalities as a marker of multiple system atrophy in isolated rapid eye movement sleep behavior disorder
    Amaia Muñoz-Lopetegi, Joan Berenguer, Alex Iranzo, Monica Serradell, Teresa Pujol, Carles Gaig, Esteban Muñoz, Eduard Tolosa, Joan Santamaría
    Sleep.2021;[Epub]     CrossRef
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    Inna Page, Frank Gaillard
    Practical Neurology.2020; 20(6): 463.     CrossRef
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    Shuzhen Zhu, Hualing Li, Bin Deng, Jialing Zheng, Zifeng Huang, Zihan Chang, Yanjun Huang, Zhibo Wen, Yanran Liang, Mengjue Yu, Ling-Ling Chan, Eng-King Tan, Qing Wang
    Frontiers in Aging Neuroscience.2020;[Epub]     CrossRef
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    M. Portet, M. Filyridou, D. C. Howlett
    Journal of Neurology.2019; 266(10): 2573.     CrossRef
  • Progressive Supranuclear Palsy, Corticobasal Degeneration, and Multiple System Atrophy
    Paul Greene
    CONTINUUM: Lifelong Learning in Neurology.2019; 25(4): 919.     CrossRef
  • Differential value of brain magnetic resonance imaging in multiple system atrophy cerebellar phenotype and spinocerebellar ataxias
    Minkyeong Kim, Jong Hyeon Ahn, Yoonsu Cho, Ji Sun Kim, Jinyoung Youn, Jin Whan Cho
    Scientific Reports.2019;[Epub]     CrossRef
Case Report
A Case of Multiple System Atrophy-Cerebellar Type Preceded by Dementia
Eun Hye Jang, Joo Kyung Lee, Hyun Jung Jang, Mi-Jung Kim, Sun Ju Chung
J Mov Disord. 2012;5(2):48-52.
DOI: https://doi.org/10.14802/jmd.12011
  • 14,943 View
  • 88 Download
  • 3 Citations
AbstractAbstract PDF

Multiple system atrophy (MSA) is a sporadic, adult-onset disease characterized by progressive degeneration of nervous systems including cerebellar, pyramidal, extrapyramidal, and autonomic system. Although a few recent studies reported that cognitive impairments could occur in patients with MSA, prominent dementia with progressive decline is not a typical clinical manifestation of MSA. In particular, dementia with MSA-cerebellar type is very rare. We have experienced a patient with 2-year history of severe cognitive impairment, who was finally diagnosed as MSA-cerebellar type.

Citations

Citations to this article as recorded by  
  • Mitochondrial dysfunction and altered ribostasis in hippocampal neurons with cytoplasmic inclusions of multiple system atrophy
    Norihisa Maeda, Hiroyuki Honda, Satoshi O. Suzuki, Naoki Fujii, Jun-ichi Kira, Toru Iwaki
    Neuropathology.2018; 38(4): 361.     CrossRef
  • Mechanisms and prevention of sudden death in multiple system atrophy
    Takayoshi Shimohata, Naotaka Aizawa, Hideaki Nakayama, Hiroshige Taniguchi, Yasuyoshi Ohshima, Hitoshi Okumura, Tetsuya Takahashi, Akio Yokoseki, Makoto Inoue, Masatoyo Nishizawa
    Parkinsonism & Related Disorders.2016;[Epub]     CrossRef
  • Fragile X-associated tremor/ataxia syndrome: phenotypic comparisons with other movement disorders
    Erin E. Robertson, Deborah A. Hall, Andrew R. McAsey, Joan A. O’Keefe
    The Clinical Neuropsychologist.2016; 30(6): 849.     CrossRef
Original Articles
Clinical Features and Disability Milestones in Multiple System Atrophy and Progressive Supranuclear Palsy
Sang-Wook Lee, Seong-Beom Koh
J Mov Disord. 2012;5(2):42-47.
DOI: https://doi.org/10.14802/jmd.12010
  • 12,557 View
  • 121 Download
  • 12 Citations
AbstractAbstract PDF

Multiple system atrophy (MSA) and progressive supranuclear palsy (PSP) are an adult-onset progressive neurodegenerative disorder that are known to display diverse clinical features and disease progression. We aim to characterize the clinical features and disease progression in patients with MSA and PSP by using a number of relevant disability milestones in Koreans. Forty-one patients with MSA and 14 patients with PSP had been enrolled. The mean age at onset of MSA-C, MSA-P and PSP was 56.7 ± 7.8, 62.5 ± 8.0, 68.9 ± 6.1 years respectively. The most commonly reported symptom at disease onset is disequilibrium/dizziness in MSA-C, tremor in MSA-P and frequent falling in PSP. The mean duration of reaching milestones after disease onset in MSA-C were as followings: 20.8 (urinary incontinence), 22.9 (frequent falling), 27.8 (wheelchair bound), 31.8 (dysarthria) and 35.8 months (diagnosis). The mean duration of reaching milestones after disease onset were 22.0 (urinary incontinence), 32.6 (frequent falling and diagnosis), 41.2 (dysarthria), 61.4 months (wheelchair bound) in MSA-P and 16.8 (dysarthria), 21.6 (diagnosis), 21.7 (frequent falling), 24.0 months (wheel chair bound) in PSP. In the case of MSA, dizziness may occur for the first time. Thus, when the patient complains of non-specific dizziness, a follow-up examination to distinguish it from MSA can be helpful. There was a trend for patients with MSA-C to reach more disability milestones than in MSA-P and PSP before diagnosis. It may explain why patients with MSA-C are required more detail history taking and neurologic examination at an earlier stage.

Citations

Citations to this article as recorded by  
  • Disease course and treatment patterns in progressive supranuclear palsy: A real-world study
    John C. Morgan, Xiaolan Ye, Jennifer A. Mellor, Keisha J. Golden, Jorge Zamudio, Louis A. Chiodo, Yanjun Bao, Tao Xie
    Journal of the Neurological Sciences.2021; 421: 117293.     CrossRef
  • Progression of Oropharyngeal Dysphagia in Patients with Multiple System Atrophy
    Hui Jae Do, Han Gil Seo, Hyun Haeng Lee, Byung-Mo Oh, Yoon Kim, Aryun Kim, Han-Joon Kim, Beomseok Jeon, Tai Ryoon Han
    Dysphagia.2020; 35(1): 24.     CrossRef
  • Is There a Difference in Autonomic Dysfunction Between Multiple System Atrophy Subtypes?
    Divyani Garg, Achal Kumar Srivastava, Ashok Kumar Jaryal, Roopa Rajan, Akanksha Singh, Awadh Kishor Pandit, Deepti Vibha, Garima Shukla, Ajay Garg, Ravindra Mohan Pandey, Kameshwar Prasad
    Movement Disorders Clinical Practice.2020; 7(4): 405.     CrossRef
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    He-Jin Lee, Diadem Ricarte, Darlene Ortiz, Seung-Jae Lee
    Experimental & Molecular Medicine.2019; 51(11): 1.     CrossRef
  • Multiple System Atrophy: An Oligodendroglioneural Synucleinopathy1
    Kurt A. Jellinger, George Perry, Jesus Avila, Massimo Tabaton, Xiongwei Zhu
    Journal of Alzheimer's Disease.2018; 62(3): 1141.     CrossRef
  • Present and future of disease-modifying therapies in multiple system atrophy
    Miguel Lopez-Cuina, Alexandra Foubert-Samier, François Tison, Wassilios G. Meissner
    Autonomic Neuroscience.2018; 211: 31.     CrossRef
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    Minyoung Oh, Jae Seung Kim, Jungsu S. Oh, Chong Sik Lee, Sun Ju Chung, Byeong-Cheol Ahn
    PLOS ONE.2017; 12(3): e0173275.     CrossRef
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    Thomas Cronin, Qadeer Arshad, Barry M. Seemungal
    Frontiers in Neurology.2017;[Epub]     CrossRef
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    Julieta E. Arena, Stephen D. Weigand, Jennifer L. Whitwell, Anhar Hassan, Scott D. Eggers, Günter U. Höglinger, Irene Litvan, Keith A. Josephs
    Journal of Neurology.2016; 263(2): 380.     CrossRef
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    Kurt A. Jellinger, Gregor K. Wenning
    Journal of Neural Transmission.2016; 123(6): 555.     CrossRef
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    Tatsuya Yamamoto, Fuyuki Tateno, Ryuji Sakakibara, Shogo Furukawa, Masato Asahina, Tomoyuki Uchiyama, Shigeki Hirano, Yoshitaka Yamanaka, Miki Fuse, Yasuko Koga, Mitsuru Yanagisawa, Satoshi Kuwabara, Jong-Ling Fuh
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Preliminary Study of Intravenous Amantadine Treatment for Ataxia Management in Patients with Probable Multiple System Atrophy with Predominant Cerebellar Ataxia
Jinyoung Youn, Hyeeun Shin, Ji Sun Kim, Jin Whan Cho
J Mov Disord. 2012;5(1):1-4.
DOI: https://doi.org/10.14802/jmd.12001
  • 7,646 View
  • 86 Download
  • 4 Citations
AbstractAbstract PDF
Background and Purpose:

Multiple system atrophy with predominant cerebellar ataxia is a disabling neurologic disease. However, effective management has not yet been established. We conducted a short-term, open-label preliminary study to assess the benefits of intravenous amantadine treatment in patients with probable multiple system atrophy with predominant cerebellar ataxia.

Methods:

Twenty patients (10 male, 10 female) with probable multiple system atrophy with predominant cerebellar ataxia received 400 mg of amantadine by intravenous per day for 5 days. Ataxia severity was evaluated by the International Cooperative Ataxia Rating Scale before and after intravenous amantadine therapy and all subjects reported subjective improvement after intravenous amantadine treatment using a patient global impression scale. We analyzed the total and subscale scores by the ataxia scale and patient global impression scale.

Results:

The mean age was 57.4 years (range: 47–72) and the mean disease duration was 30.8 months (range: 11–79). The ataxia severity significantly decreased after intravenous amantadine therapy from 42.5 to 37.3 (p < 0.001). The mean patient global impression scale for improvement was 2.9 and there were no side effects of intravenous amantadine treatment observed. When we assessed responders, the duration of intravenous amantadine effect was more than 1 month in 4 subjects of 7 responders.

Conclusions:

Our findings suggest that intravenous amantadine treatment can be a safe management option in cerebellar ataxia, although the mechanism is unclear. Thus, further double-blind, long-term studies with a larger sample size are needed.

Citations

Citations to this article as recorded by  
  • M1 and Cerebellar tDCS for MSA-C: a Double-Blind, Randomized, Sham-Controlled, Crossover Study
    Jong Hyeon Ahn, Dongyeong Lee, Minkyeong Kim, Jin Whan Cho, Won Hyuk Chang, Jinyoung Youn
    The Cerebellum.2022;[Epub]     CrossRef
  • Effects of preoperative intravenous amantadine sulfate infusion on wake up test duration and postoperative opioid consumption in adolescents undergoing spine corrective surgery
    Ghada M. Aboelfadl, Saeid Elsawy, Belal O. Elnady, Rasha Hamed
    Perioperative Care and Operating Room Management.2021; 24: 100166.     CrossRef
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    E.A. Katunina
    Zhurnal nevrologii i psikhiatrii im. S.S. Korsakova.2021; 121(4): 101.     CrossRef
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    Adit Friedberg, Ilana Erikh, Maria Nassar, Elliot Sprecher, Ilana Schlesinger
    Clinical Neuropharmacology.2018; 41(5): 160.     CrossRef
Putaminal Hypointensity in the Parkinsonian Variant of Multiple System Atrophy: Simple Visual Assessment Using Susceptibility-Weighted Imaging
Jae-Hyeok Lee, Seung-Kug Baik
J Mov Disord. 2011;4(2):60-63.
DOI: https://doi.org/10.14802/jmd.11012
  • 15,225 View
  • 181 Download
  • 16 Citations
AbstractAbstract PDF
Background and Purpose

Susceptibility-weighted imaging (SWI) has been shown to be superior in its ability to demonstrate brain mineralization than other conventional MR imaging. The goal of our study was therefore to assess the frequency and extent of putaminal hypointensity in parkinsonian variant MSA using SWI.

Methods

11 patients with multiple system atrophy-parkinsonian type (MSA-p), 30 patients with Parkinson’s disease (PD), and age matched 30 controls were investigated using 3 Tesla MRI. The pattern of putaminal hypointensity was measured using a visual grading scale and scored from 0 to 3.

Results

Hemi- or bilateral putaminal hypointensity (a score of ≥ 2) and hyperintense rim were recognized in 81.8% and 54.5% of 11 MSA-p, respectively. The scores of putaminal hypointensity of MSA-p were significantly higher than other groups (p < 0.001), a score of ≥ 2 differentiated MSA-p from other groups. And all five patients with early disease stage also showed these characteristic findings.

Conclusions

SWI appears to be useful for depicting putaminal hypointensity even in early stage of MSA-p. This finding suggests that iron deposition associated putaminal degeneration can occur early in the disease process.

Citations

Citations to this article as recorded by  
  • Diagnostic performance of T2* gradient echo, susceptibility-weighted imaging, and quantitative susceptibility mapping for patients with multiple system atrophy–parkinsonian type: a systematic review and meta-analysis
    Su Jin Lim, Chong Hyun Suh, Woo Hyun Shim, Sang Joon Kim
    European Radiology.2022; 32(1): 308.     CrossRef
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Cognitive Impairments in Multiple System Atrophy of the Cerebellar Type
Hyun J. Hong, Sook Keun. Song, Phil Hyu Lee, Young Ho Sohn, Ji E. Lee
J Mov Disord. 2011;4(1):41-45.
DOI: https://doi.org/10.14802/jmd.11007
  • 10,933 View
  • 68 Download
  • 10 Citations
AbstractAbstract PDF
Background and Purpose

We investigated the cognitive profiles in a large sample of patients with multiple system atrophy-cerebellar ataxia (MSA-C) and compared directly them in patients with clinical diagnosis of probable MSA-C without dementia and control subjects with intact cognition.

Methods

We prospectively enrolled 26 patients with clinical diagnosis of probable MSA-C. All patients underwent a standardized neuropsychological test of the Seoul Neuropsychological Screening Battery.

Results

The score of Korean version of the Mini- Mental State Examination was significantly lower in patients with MSA-C (27.2 ± 2.5) than in control subjects (28.9 ± 1.0, p = 0.003). Patients with MSA-C showed a significantly worse performance in visuospatial function, 3 words recall, verbal immediate, delayed and recognition memory, visual delayed memory, phonemic and sementic Controlled Oral Word Association Test, and ideomotor praxis (p < 0.05).

Conclusions

Patients with MSA-C show more severe and more widespread cognitive dysfunctions than controls. Our results also indicate that cognitive dysfunction in patients with MCA-C is suggestive of disruption of the cerebellocortical circuits.

Citations

Citations to this article as recorded by  
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Case Report
Preserved Glucose Metabolism of Deep Cerebellar Nuclei in a Case of Multiple System Atrophy with Predominant Cerebellar Ataxia: F-18 Fluorodeoxyglucose Positron Emission Tomography Study
Oh Dae Kwon, Chang-Seok Ki
J Mov Disord. 2010;3(2):51-53.
DOI: https://doi.org/10.14802/jmd.10014
  • 19,135 View
  • 34 Download
AbstractAbstract PDF

The cerebellar glucose metabolism of multiple system atrophy with predominant cerebellar ataxia (MSA-C) is known to be decreased but is not defined among areas of cerebellum. We encountered a 54-year-old man who developed dizziness and progressive ataxia followed by urinary incontinence and orthostatic hypotension, all of those symptoms progressed relentlessly and the symptoms responded poorly to levodopa therapy. Visual analysis and statistical parametric mapping analysis of F-18 fluorodeoxyglucose positron emission tomography showed hypometabolism of both cerebellar hemisphere, severe at cortical area, and pons. There was clear sparing of deep cerebellar nuclei. Our report, as we know, shows the first case of preserved glucose metabolism of deep cerebellar nuclei relative to cerebellar cortex in an MSA-C patient.

Original Articles
Usefulness of Diffusion-Weighted MRI for Differentiation between Parkinson’s Disease and Parkinson Variant of Multiple System Atrophy
Eun Joo Chung, Eung Gyu Kim, Jong Seok Bae, Choong Ki Eun, Kwang Sig Lee, Minkyung Oh, Sang Jin Kim
J Mov Disord. 2009;2(2):64-68.
DOI: https://doi.org/10.14802/jmd.09017
  • 10,495 View
  • 63 Download
  • 14 Citations
AbstractAbstract PDF
Background and Purpose:

Several studies have reported that diffusion-weighted imaging (DWI) is able to help discriminate a Parkinson variant of multiple system atrophy (MSA-p) from Parkinson’s disease (PD) on the basis of the increased regional apparent diffusion coefficient (rADC). We analyzed the usefulness of DWI by using the rADC for differential diagnosis between MSA-p and PD and investigated the correlation between the rADC value and clinical features of MSA-p and PD.

Methods:

Twelve patients with PD and 10 with MSA-p were studied. The rADC value was determined in different brain regions, including the dorsal putamen (DP) and middle cerebellar peduncles (MCP).

Results:

The rADC values of the DP showed a greater increase in MSA-p patients than in PD patients (p=0.03). MSA-p patients also presented increased rADC values of the MCP compared with PD patients (p=0.0001). In particular, the sensitivity, specificity and positive predictive values of the MCP rADC were higher than those of the DP rADC. However, DP and MCP rADC values were not correlated with clinical features in either MSA or PD patients.

Conclusions:

DWI discriminated between PD and MSA-p based on rADC values in DP and MCP. The MCP rADC value, in particular, could better discriminate MSA-p from PD.

Citations

Citations to this article as recorded by  
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    Jacopo Pasquini, Michael J. Firbank, Roberto Ceravolo, Vincenzo Silani, Nicola Pavese
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    Germain Arribarat, Patrice Péran
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    Beatrice Heim, Florian Krismer, Roberto De Marzi, Klaus Seppi
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    Peggy J. Planetta, Edward Ofori, Ofer Pasternak, Roxana G. Burciu, Priyank Shukla, Jesse C. DeSimone, Michael S. Okun, Nikolaus R. McFarland, David E. Vaillancourt
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Comparison of Cerebral Glucose Metabolism between Possible and Probable Multiple System Atrophy
Kyum-Yil Kwon, Jae Seung Kim, Ki Chun Im, Myoung Chong Lee, Sun Ju Chung
J Mov Disord. 2009;2(1):22-28.
DOI: https://doi.org/10.14802/jmd.09006
  • 8,852 View
  • 82 Download
  • 2 Citations
AbstractAbstract PDF
Background:

To investigate the relationship between presenting clinical manifestations and imaging features of multisystem neuronal dysfunction in MSA patients, using 18F-fluorodeoxyglucose positron emission tomography (18F-FDG PET).

Methods:

We studied 50 consecutive MSA patients with characteristic brain MRI findings of MSA, including 34 patients with early MSA-parkinsonian (MSA-P) and 16 with early MSA-cerebellar (MSA-C). The cerebral glucose metabolism of all MSA patients was evaluated in comparison with 25 age-matched controls. 18F-FDG PET results were assessed by the Statistic Parametric Mapping (SPM) analysis and the regions of interest (ROI) method.

Results:

The mean time from disease onset to 18F-FDG PET was 25.9±13.0 months in 34 MSA-P patients and 20.1±11.1 months in 16 MSA-C patients. Glucose metabolism of the putamen showed a greater decrease in possible MSA-P than in probable MSA-P (p=0.031). Although the Unified Multiple System Atrophy Rating Scale (UMSARS) score did not differ between possible MSA-P and probable MSA-P, the subscores of rigidity (p=0.04) and bradykinesia (p= 0.008) were significantly higher in possible MSA-P than in probable MSA-P. Possible MSA-C showed a greater decrease in glucose metabolism of the cerebellum than probable MSA-C (p=0.016).

Conclusions:

Our results may suggest that the early neuropathological pattern of possible MSA with a predilection for the striatonigral or olivopontocerebellar system differs from that of probable MSA, which has prominent involvement of the autonomic nervous system in addition to the striatonigral or olivopontocerebellar system.

Citations

Citations to this article as recorded by  
  • F-18 FP-CIT PET in Multiple System Atrophy of the Cerebellar Type: Additional Role in Treatment
    Young Jin Jeong, Sang-Myung Cheon, Do-Young Kang, Jae Woo Kim
    Contrast Media & Molecular Imaging.2017; 2017: 1.     CrossRef
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    Flavia Niccolini, Marios Politis
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Relationship Between the Striatal and Cerebellar Glucose Metabolism and the Response to Levodopa Treatment in Patients With Multiple System Atrophy
Chul Hyoung Lyoo, Seung Hun Oh, Ki Ook Lee, Seung Yeob Lee, Young Hoon Ryu, Myung Sik Lee
J Mov Disord. 2008;1(1):26-32.
DOI: https://doi.org/10.14802/jmd.08005
  • 9,535 View
  • 53 Download
AbstractAbstract PDF
Introduction:

About two thirds of the patients with multiple system atrophy (MSA) do not respond to levodopa treatment. Postmortem pathological studies and one retrospective [18F]-deoxyglucose positron emission tomography (FDGPET) study attributed such poor response to the striatal degeneration. We prospectively investigated the relationship between levodopa responsiveness and the metabolic activities of the striatum and cerebellum in MSA patients.

Methods:

In 39 patients with MSA, the UPDRS motor score was assessed and two sets of timed motor tests were perform ed before and after the levodopa treatment. After quantitative FDG PET and baseline evaluation, treatment w as started with 3 tablets of Sinemet® 25/250 mg a day. Clinical assessments were performed monthly for three months. Metabolic activities of the caudate, anterior putamen, posterior putamen, cerebellar cortex and cerebellar vermis were measured. We compared the measurements with mean percentage changes of motor function. Also, using statistical parametric mapping (SPM) analysis, we tried to find brain areas in which metabolism correlated with the clinical changes.

Results:

Mean percentage improvements of UPDRS motor scores w ere correlated with glucose metabolism in the posterior putamen and cerebellar vermis. The mean percentage improvements of performance in Purdue peg board test correlated with the glucose metabolism in the cerebellar cortex and vermis. In SPM analysis, cerebellar glucose metabolism correlated with the improvement of UPDRS motor score and the performance of two timed motor tests.

Conclusion:

The integrity of cerebellum, as well as posterior putamen, may be an important factor for showing the response to levodopa.


JMD : Journal of Movement Disorders