Background. Autonomic dysfunctions occur in the early stage of Parkinson’s disease (PD) and impact the quality of life during the progression of the disease. In this study, we evaluated the serial progression of autonomic dysfunctions between different subtypes of a prospective PD cohort. Materials and Methods. From the Parkinson’s Progression Markers Initiative (PPMI) database, 325 PD patients (age: 61.2 ± 9.7, M : F = 215 : 110) were enrolled. Patients were subgrouped into tremor-dominant (TD), indeterminate, and postural instability and gait disorder (PIGD) subtypes. The progression of autonomic dysfunctions and dopaminergic denervation from I-123 FP-CIT SPECT images of each group were analyzed and compared at baseline, 12 months, 24 months, and 48 months of follow-up periods. Results. The SCOPA-AUT score of the indeterminate subtype was significantly higher than that of the TD subtype ( P < 0.05 ) at baseline and was significantly higher than that of both TD and PIGD subtypes ( P < 0.05 ) at 48 months. The indeterminate subtype had the most significant correlation between the aggravation of dopaminergic denervation in I-123 FP-CIT SPECT images and the increase of SCOPA-AUT scores during 48 months of follow-up (r = 0.56, P < 0.01 ). Conclusions. Autonomic dysfunctions were most severe in the indeterminate subtype throughout the 48 months of the follow-up period, with a significant correlation with dopaminergic denervation. We suggest a positive relationship between dopaminergic denervation and autonomic dysfunctions of the indeterminate subtype, beginning from the early stage of PD.
BackgroundDopaminergic denervation and motor symptoms are usually asymmetric at the onset of Parkinson's disease (PD). In this study, we estimated the asymmetry of specific binding ratio (SBR) of I-123 FP-CIT SPECT images during 4-years of follow up, to demonstrate the pattern of serial changes of asymmetry.MethodsClinical and I-123 FP-CIT SPECT image data of 301 PD patients and 141 normal controls were reviewed from the Parkinson's Progression Markers Initiative cohort. I-123 FP-CIT SPECT images were taken at baseline, 1-, 2-, and 4-year follow up periods for PD patients, and at baseline for normal controls. Asymmetry index were calculated by two methods. Method 1, by using the ratio of absolute difference of right and left SBRs to the average SBR. Method 2, by using the ratio of absolute difference of right and left SBRs to the SBR values of age-matched normal controls.ResultsAsymmetry index by method 2 revealed a more significant decrease during the 4-year follow up period, compared with method 1. The baseline asymmetry index of the putamen by method 2 showed significant correlation with the non-dominant putamen SBRs. However, there were no significant correlation with the baseline asymmetry index by method 2 and motor symptoms, cognition, nor autonomic symptoms.ConclusionWe suggest a novel asymmetry index in association to age-matched normal SBR values. This novel index could be adopted in predicting and evaluating the natural course of PD.
Background: Myokymia consists of involuntary, fine, continuous contraction that spread across the affected striated muscle. Eyelid myokymia, unlike other dystonic facial contracture such as blepharospasm and hemifacial spasm, is assumed to be a benign, self-limited disorder. Eyelid myokymia is associated with stress, fatigue, excercise, and exccessive caffeine use. The pathophysiology is not well understood, but some drugs or brain structural lesions are the cause of the eyelid myokymia. Especially in Korea hypomagnesemia is generally known the main cause of eyelid myokymia, however there are no evidences so far. This study investigated the relation between eyelid myokymia and serum magnesium level.Methods: We performed a cross sectional study on 72 patients with myokymia and 197 controls. We investigated fatigue, sleep quality, alcohol, smoking, caffeine use, and exercise datas by interview. We analyzed laboratory datas including magnesium, calcium, phosphate, thyroid hormone in serum.Results: Demographic characteristics between the patients with myokymia and controls showed no significant differences in age, gender, smoking, and alcohol history. Fatigue and poor sleep quality were significantly higher in the myokymia group than control group. However, any laboratory results including magnesium showed no significant differences between two groups.Conclusions: These data suggested that the eyelid myokymia is not related to the serum magnesium level as well as calcium and phosphate. Only fatigue and sleep quality were shown the relationship with eyelid myokymia.
Neurocysticercosis is the most common parasitic infection of the nervous system. However, the improvement in public health made the prevalence of neurocysticercosis low. Neurocysticercosis may have symptoms such as seizures, headache, and hydrocephalus, and calcified neurocysticercosis is generally known to be asymptomatic and inert. Also, status epilepticus associated with neurocysticercosis has been rarely reported. Therefore, we report a case of focal status epilepticus caused by calcified neurocysticercosis that invaded the subarachnoid space, which is uncommon pathophysiology of neurocysticercosis.
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