Urodynamic and neurophysiological evaluation in Parkinson's disease and multiple system atrophy.

Abstract

Aims-To determine whether Parkinson's disease and multiple system atrophy each has a distinct pattern of micturition abnormalities and whether a urodynamic evaluation could be useful in the differential diagnosis between the two diseases. Methods-Sixty two patients (30 with Parkinson's disease and 32 with multiple system atrophy) underwent a complete urodynamic evaluation and neurophysiological testing. Results-Of the parkinsonian patients 36-6% had normal micturition findings with normal bladder sensitivity; 26-7% had delayed or incomplete pelvic floor relaxation; 26-7% had hyperreflexia with vesicosphincteric synergy; and 10% had hyperreflexia with vesicosphincteric synergy associated with incomplete pelvic floor relaxation. Parkinsonian patients with a normal urodynamic pattern had significantly less severe disease and a shorter duration of disease in years than those who had abnormal patterns. Patients with hyperreflexia had significantly higher severity of disease. All the patients with multiple system atrophy had hyperreflexia with synergy. Two urodynamic patterns were identified: hyperreflexia with vesicosphincteric synergy (90-6% of patients), and hyperreflexia with vesicosphincteric synergy and incomplete pelvic floor relaxation (in 9.4%). Hyperreflexia with synergy correlated neither with the severity nor with the duration of disease. Sphincter EMG analysis showed that all the parkinsonian patients had normal sphincter EMG whereas 24 of the 32 patients with multiple system atrophy had neurogenic signs.

The value of external anal sphincter electromyography for the diagnosis of multiple system atrophy

“…1 Subsequently, smaller series confirmed the high sensitivity of the technique (75-100% of patients with denervation profiles), 12,19-21 even in the absence of urinary symptoms. 21 Conversely, several recent studies raised suspicions on the specificity of the procedure, 18,19,23 particularly for the differential diagnosis between PD 18,23 or PSP. 19 As far as we are aware from our practice, many neurologists hesitate to refer their patients suspected of having MSA for ASEMG, not only because of the aforementioned unsolved questions regarding the specificity of the procedure, 18,19,23 but also because of its embarrassing and uncomfortable reputation, its accessibility, and its interpretation difficulties caused by poor standardization of the technique, 17 variations in quantitative motor unit analysis, 18 and confounding factors such as age, gender, and parity.…”

Anorectal function in multiple system atrophy and Parkinson's disease

“…15 Moreover, all these patients showed denervation and chronic neurogenic signs with electromyographic evidence of a normal bulbocavernous reflex at the external anal sphincter. 1,5,6 Patients who had Mini Mental State Examination scores below 28 or who had undergone previous pelvic surgery were excluded. In all subjects, anticholinergic drugs were withdrawn 1 month before the study and dopaminergic drugs were stopped the night before the study.…”

“…The involvement of the autonomic sacral nuclei 5 manifests at electromyography with the finding of chronic neurogenic denervation of the striated urethral and anal sphincters. [6][7][8] We therefore investigated whether anorectal dysfunction might explain the symptoms of altered defecation reported by patients with MSA and whether their symptoms differ from those reported by patients with PD who have no chronic neurogenic lesions of the sphincter muscles. 9,10 …”

Urinary dysfunction in Parkinson’s disease

“…Происходящее вследствие ИБП нарушение функции множества структур нервной системы приводит к расстройствам моче- испускания. Распространенность нарушений моче-испускания у больных с ИБП оценивают в весьма широком диапазоне -от 20 до 77 % [7][8][9][10][11]. Ряд авторов указывают, что данные о частоте нару-шений мочеиспускания при ИБП зачастую завы-шены, поскольку исследования были проведены либо до выделения других заболеваний, сопрово-ждающихся синдромом паркинсонизма (например, мультисистемной атрофии) в отдельные нозологи-ческие единицы, либо в исследование включали также пациентов с другими формами паркинсониз-ма (например, сосудистый паркинсонизм) [12,13].…”

“…Среди больных с детрузорной гипер-активностью у 75 % наблюдали нормальную уретральную функцию и отсутствие признаков детрузорно-сфинктерной диссинергии, у 7 % -псевдодиссинергию, у 11 % -брадикинезию сфинктера [7]. По данным F. Stocchi et al (1997), од-ной из причин обструктивных симптомов у пациен-тов с болезнью Паркинсона может быть нарушение сократительной способности детрузора вследствие развития в нем миодистрофического процесса в ус-ловиях длительной гиперактивности [8]. В иссле-довании I.…”