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Distinct clinical features of predominant pre-synaptic and trans-synaptic nigrostriatal dysfunction in multiple system atrophy
- Source :
- Journal of the neurological sciences. 402
- Publication Year :
- 2019
-
Abstract
- Background The severity of parkinsonism and response to levodopa vary in patients with multiple system atrophy (MSA) because of the heterogeneity of nigrostriatal neuropathology. Objective To investigate the difference in clinical features between MSA patients with predominantly pre-synaptic nigrostriatal dysfunction and those with trans-synaptic nigrostriatal dysfunction. Methods We retrospectively analyzed clinical data of 61 patients with MSA who underwent both [18F]FP-CIT-PET and [18F]FDG-PET within 3 months of clinical evaluation, and who had ≤3 years of disease duration. Tracer uptake of the striatum on [18F]FP-CIT-PET and glucose metabolism of the striatum on [18F]FDG-PET were analyzed using eight striatal subregional volumes-of-interest templates. The patients were classified into two subgroups according to the predominant pre-synaptic tracer uptake loss of the posterior putamen on [18F]FP-CIT-PET (MSA-SNpc, n = 21) and trans-synaptic dopaminergic dysfunction reflected by both [18F]FP-CIT-PET and [18F]FDG-PET (MSA-STR, n = 40). Results Parkinsonian features were significantly more severe in the MSA-STR group than in the MSA-SNpc group (P = .005) and cerebellar ataxia was significantly more severe in the MSA-SNpc group (P = .036). The cerebellar type of MSA was significantly more common in the MSA-SNpc group (P = .001). There was no difference in age at onset, disease duration at the time of study, or Mini-Mental Status Examination scores between the groups. Conclusions Patients with MSA showed distinct clinical features depending on whether the pattern of nigrostriatal dysfunction was predominantly pre-synaptic or trans-synaptic.
- Subjects :
- Adult
Male
Levodopa
Pathology
medicine.medical_specialty
Cerebellar Ataxia
Presynaptic Terminals
Neuropathology
Striatum
03 medical and health sciences
0302 clinical medicine
Atrophy
stomatognathic system
Parkinsonian Disorders
Fluorodeoxyglucose F18
mental disorders
Neural Pathways
medicine
Humans
030212 general & internal medicine
Aged
Cerebellar ataxia
business.industry
Putamen
Parkinsonism
Functional Neuroimaging
Dopaminergic
Middle Aged
Multiple System Atrophy
medicine.disease
Corpus Striatum
nervous system diseases
Substantia Nigra
nervous system
Neurology
Case-Control Studies
Positron-Emission Tomography
Female
Neurology (clinical)
medicine.symptom
business
030217 neurology & neurosurgery
medicine.drug
Tropanes
Subjects
Details
- ISSN :
- 18785883
- Volume :
- 402
- Database :
- OpenAIRE
- Journal :
- Journal of the neurological sciences
- Accession number :
- edsair.doi.dedup.....3b8b7a6429e821ef47583104c5634963