Search

Background The clinical differentiation between Parkinson disease (PD) and multiple system atrophy (MSA) is difficult. Objectives Arterial spin labeling (ASL) is an advanced MRI technique that obviates the use of an exogenous contrast agent for the estimation of cerebral perfusion. We explored the value of ASL in combination with structural MRI for the differentiation between PD and MSA. Methods Ninety-four subjects (30 PD, 30 MSA and 34 healthy controls) performed a morphometric and ASL-MRI to measure volume and perfusion values within basal ganglia and cerebellum. A region-of-interest analysis was performed to test for structural atrophy and regional blood flow differences between groups. Results MSA patients showed higher subcortical atrophy than both PD patients and HC, while no differences were observed between the latter. MSA and PD showed lower volume-corrected perfusion values than HC in several cerebellar areas (Crus I, Crus II, right VIIb, right VIIIa, right VIIIb), right caudate and both thalami. MSA and PD patients displayed similar perfusion values in all aforementioned areas, but the right cerebellar area VIIIb (lower in MSA) and right caudate and both thalami (lower in PD). Similar results were obtained when comparing PD and MSA patients with the parkinsonian variant. Conclusions A perfusion reduction was equally observed in both MSA and PD patients in cerebellar areas that are putatively linked to cognitive (i.e., executive) rather than motor functions. The observed hypo-perfusion could not be explained by atrophy, suggesting the involvement of the cerebellum in the pathophysiology of both MSA and PD.

Objective\ud We aimed to describe the prevalence and clinical-demographical features of patients with functional gait disorders (FGDs) and to compare them to patients with functional motor disorders (FMDs) without FGDs (No-FGDs).\ud \ud Methods\ud In this multicenter observational study, we enrolled patients with a clinically definite diagnosis of FMDs in 25 tertiary movement disorders centers in Italy. Each subject with FMDs underwent a comprehensive clinical assessment, including screening for different subtypes of functional gait disorders. Multivariate regression models were implemented in order to estimate the adjusted odds ratio (OR; 95% confidence interval) of having FGDs in relation to sociodemographic and clinical characteristics.\ud \ud Results\ud Out of 410 FMDs, 26.6% (n = 109) of patients exhibited FGDs. The most frequent FGDs were slow gait (n = 43, 39.4%), astasia-abasia (n = 26, 23.8%), and knee buckling (n = 24, 22%). They exhibited single FGDs in 51.4% (n = 56) or complex FGDs (more than one type of FGDs) in 48.6% (n = 53) of cases. On multivariate regression analysis, the presence of FGDs was more likely associated with older age (OR 1.03, 95% CI 1.01–1.04), functional visual symptoms (OR 2.19, 95% CI 1.08–4.45), and the diagnosis of somatic symptoms disorder (OR 2.97, 95% CI 1.08–8.17). FGDs were also more likely to undergo physiotherapy (OR 1.81, 95% CI 1.08–3.03).\ud \ud Conclusions\ud People with FMDs may present with different and overlapping types of FGDs, which may occur in older age. The association of FGDs with functional visual symptoms and somatic symptoms disorder opens up to new avenues to the understanding of the neural mechanisms of these disorders.

Background There is evidence from animal studies, post-mortem pathology, functional imaging and neurophysiological studies to suggest that the cerebellum may be involved in the pathophysiology of dystonia. We sought to explore further the association of clinical and radiological abnormalities of the cerebellum in patients with dystonia. Methods We retrospectively reviewed patients from our movement disorders research database, with predominant cervical dystonia who have been seen within last 6 months and had available routine magnetic resonance imaging (MRI). The clinical details including presence of cerebellar signs, imaging findings and results of investigations were recorded on a proforma. The results were analysed using percentages and means with standard deviation. Results Out of 188 patients included 26 had evidence of cerebellar abnormality on neuroimaging. 17 patients showed cerebellar atrophy and 10 of these had cerebellar signs on examination. These patients were tested negative for common inherited ataxias. 9 patients had cerebellar lesions on MRI, reported as low grade tumour (n = 2), cerebellar infarct (n = 3), cyst (n = 2), white matter hyperintensity (n = 1) and ectopia (n = 1) out of these 4 had cerebellar signs. Conclusion The findings from our study suggest that there may be overt clinical or radiological cerebellar involvement in 14% of cases with cervical/segmental dystonia. However, larger prospective studies are needed in this context.

non available