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Article ; Online: Post-traumatic tics and tetrabenazine treatment: a blinded video assessment.

Poulopoulos, Markos / Hajjar, Mirna

BMJ case reports

2013 Volume 2013

Abstract: Traumatic head injury is a very rare cause of secondary tic disorders. We add another case by describing, for the first time, the response to tetrabenazine in a blinded video assessment. Our patient had a severe traumatic head injury and subsequently ... ...

Abstract	Traumatic head injury is a very rare cause of secondary tic disorders. We add another case by describing, for the first time, the response to tetrabenazine in a blinded video assessment. Our patient had a severe traumatic head injury and subsequently developed tics refractory to various agents including neuroleptics. We assessed tetrabenazine treatment by virtue of patient's impression, the treating neurologist's non-blinded (Yale Global Tic Severity Scale) and a second neurologist's blinded assessment (modified Rush Video Scale). The Yale Global Tic Severity Score improved by 24% on 12.5 mg twice daily and 45% on 12.5 mg thrice daily. Subjective improvement was 50% and 70%, respectively. The modified Rush Video scores improved by 21% and 28.5%, respectively. Post-traumatic tourettism can respond to tetrabenazine. The magnitude of benefit though, may be overestimated with open-label observations, thus there is a need for studies examining objectively the effect of tetrabenazine in tic disorders.
MeSH term(s)	Accidents, Traffic ; Adrenergic Uptake Inhibitors/therapeutic use ; Craniocerebral Trauma/complications ; Humans ; Male ; Severity of Illness Index ; Tetrabenazine/therapeutic use ; Tourette Syndrome/drug therapy ; Tourette Syndrome/etiology
Chemical Substances	Adrenergic Uptake Inhibitors ; Tetrabenazine (Z9O08YRN8O)
Language	English
Publishing date	2013-12-05
Publishing country	England
Document type	Case Reports ; Journal Article ; Video-Audio Media
ISSN	1757-790X
ISSN (online)	1757-790X
DOI	10.1136/bcr-2013-201676
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Article ; Online: Carbidopa/levodopa/entacapone: the evidence for its place in the treatment of Parkinson's disease.

Poulopoulos, Markos / Waters, Cheryl

Core evidence

2010 Volume 5, Page(s) 1–10

Abstract: Introduction: Parkinson's disease (PD) is a common neurodegenerative disease. In the 1960s, it was shown that the degeneration of dopamine producing neurons in the substantia nigra (SN) caused the motor features of PD. Dopamine replacement with levodopa, ...

Abstract	Introduction: Parkinson's disease (PD) is a common neurodegenerative disease. In the 1960s, it was shown that the degeneration of dopamine producing neurons in the substantia nigra (SN) caused the motor features of PD. Dopamine replacement with levodopa, a dopamine precursor, resulted in remarkable benefit. Yet, the intermittent administration of levodopa is a major cause of motor complications, such as "wearing-off" of levodopa's benefit and involuntary movements, known as dyskinesia. Therefore, agents that prolong levodopa's half-life were employed, such as carbidopa, an aromatic amino acid decarboxylase (AADC) inhibitor, and entacapone, a catechol-O-methyltransferase (COMT) inhibitor. The combination product carbidopa/levodopa/entacapone (CLE) was approved in 2003 for the treatment of PD patients. Aims: To assess the evidence for the place of CLE in the treatment of PD. Evidence review: CLE has a good efficacy, safety and tolerability profile, similar to that of entacapone taken separately with carbidopa/levodopa (CL). Compared to CL alone, it prolongs levodopa's benefit, and improves the quality of life but not the motor performance in PD patients with nondebilitating "wearing-off" or dyskinesia. However, it increases the dyskinesia rate in early PD patients, and has adverse events in advanced patients with significant motor complications. There is insufficient evidence regarding cost-effectiveness. Place in therapy: CLE is an attractive alternative for patients with nondisabling "wearing-off" or dyskinesia taking CL with or without entacapone. It cannot be recommended for early PD patients, as it can induce more dyskinesia than CL alone, or in any patients who seem to have more adverse events.
Language	English
Publishing date	2010-07-27
Publishing country	New Zealand
Document type	Journal Article
ZDB-ID	2520695-3
ISSN	1555-175X ; 1555-175X
ISSN (online)	1555-175X
ISSN	1555-175X
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Article ; Online: Clinical reasoning: a video analysis of eye and limb movement abnormalities in a Parkinsonian syndrome.

Poulopoulos, Markos / Silvers, David

Neurology

2009 Volume 73, Issue 5, Page(s) e20–3

MeSH term(s)	Aged ; Apraxias/diagnosis ; Apraxias/etiology ; Apraxias/physiopathology ; Brain/metabolism ; Brain/pathology ; Brain/physiopathology ; Diagnosis, Differential ; Disease Progression ; Dystonia/diagnosis ; Dystonia/etiology ; Dystonia/physiopathology ; Extremities/innervation ; Extremities/physiopathology ; Functional Laterality/physiology ; Humans ; Hypokinesia/diagnosis ; Hypokinesia/etiology ; Hypokinesia/physiopathology ; Male ; Movement Disorders/diagnosis ; Movement Disorders/etiology ; Movement Disorders/physiopathology ; Neural Pathways/metabolism ; Neural Pathways/pathology ; Neural Pathways/physiopathology ; Neurologic Examination/methods ; Ocular Motility Disorders/diagnosis ; Ocular Motility Disorders/etiology ; Ocular Motility Disorders/physiopathology ; Parkinsonian Disorders/diagnosis ; Parkinsonian Disorders/etiology ; Parkinsonian Disorders/physiopathology ; Pyramidal Tracts/metabolism ; Pyramidal Tracts/pathology ; Pyramidal Tracts/physiopathology ; Somatosensory Disorders/diagnosis ; Somatosensory Disorders/etiology ; Somatosensory Disorders/physiopathology ; Tauopathies/diagnosis ; Tauopathies/etiology ; Tauopathies/physiopathology ; Video Recording/methods
Language	English
Publishing date	2009-08-04
Publishing country	United States
Document type	Case Reports ; Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	207147-2
ISSN	1526-632X ; 0028-3878
ISSN (online)	1526-632X
ISSN	0028-3878
DOI	10.1212/WNL.0b013e3181b04ab7
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Article: A Novel Approach to Differentiating Erosive and Reticular Lichen Planus Based on the Percentage of Dental Surfaces With Metal Restorations.

Zisis, Vasileios / Giannakopoulos, Nikolaos N / Schmitter, Marc / Poulopoulos, Athanasios / Andreadis, Dimitrios

Cureus

2023 Volume 15, Issue 9, Page(s) e44782

Abstract: Introduction Oral lichen planus (OLP) and oral lichenoid reaction (OLR) constitute clinical entities with strong but unclear etiologic relation to dental materials. The aim of this study was to evaluate a correlation between the clinical form of OLP/OLR ... ...

Abstract	Introduction Oral lichen planus (OLP) and oral lichenoid reaction (OLR) constitute clinical entities with strong but unclear etiologic relation to dental materials. The aim of this study was to evaluate a correlation between the clinical form of OLP/OLR and the number of dental metal restorations in the oral cavity thus utilizing an exposure to metal (EM) index. Material and methods The study type is experimental, and the study design is characterized as semiquantitative research that belongs to the branch of experimental research. Twenty-nine patients were chosen based on clinical (either reticular or erosive clinical forms) and histologic findings suggestive of OLP/OLR. The files of patients were retrieved from the archives of the Department of Oral Medicine/Pathology, School of Dentistry, Aristotle University of Thessaloniki, Greece, during the period 2009-2019. The medical history of the patients did not include any disorder or medication associated with lichenoid lesions and the measurements took place concurrently with the establishment of the diagnosis, thus no treatment for the lichen planus had been administered prior to the measurements. Quantitative measurement of the percentage of dental surfaces restored through metal restorations and correlation with the clinical and histologic findings of OLP/OLR was evaluated. The EM index was evaluated on a scale of 1-3, which corresponds to the percentage of dental surfaces restored through metal restorations. The statistical analysis was performed with the Pearson chi-square test and the significance level was set at
Language	English
Publishing date	2023-09-06
Publishing country	United States
Document type	Journal Article
ZDB-ID	2747273-5
ISSN	2168-8184
ISSN	2168-8184
DOI	10.7759/cureus.44782
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Article: Cancer Stem Cells' Biomarker ALDH1&2 Increased Expression in Erosive Oral Lichen Planus Compared to Oral Leukoplakia.

Zisis, Vasileios / Giannakopoulos, Nikolaos N / Schmitter, Marc / Poulopoulos, Athanasios / Andreadis, Dimitrios

Cureus

2023 Volume 15, Issue 8, Page(s) e44278

Abstract: Introduction: ALDH1&2 has been considered an oral cancer stem cell (CSC) marker. Oral carcinogenesis is a process that usually passes through oral potentially malignant disorders (OPMD). Oral lichen planus (OLP) consists of immune-related chronic ... ...

Abstract	Introduction: ALDH1&2 has been considered an oral cancer stem cell (CSC) marker. Oral carcinogenesis is a process that usually passes through oral potentially malignant disorders (OPMD). Oral lichen planus (OLP) consists of immune-related chronic disorders that have been included in the OPMDs due to their possible transformation into oral cancer. The aim of this study was to investigate the early presence of ALDH1&2 in OLP compared to early oral leukoplakias (OL), especially mildly and non-dysplastic OL. Materials and methods: The study type is experimental, and the study design is characterized as semiquantitative research which belongs to the branch of experimental research. The study sample consisted of paraffin-embedded OLP biopsy samples from the archives of the Department of Oral Medicine/Pathology, School of Dentistry, Aristotle University of Thessaloniki, Greece, during the period 2009-2019. The study sample contained 24 cases of OLP (14 erosive and 10 reticular) and 30 cases of OL (16 cases of moderately and severely dysplastic OL and 14 cases of mildly and non-dysplastic OL). The CSC-related biomarker ALDH1&2 was examined using semiquantitative immunohistochemistry (monoclonal antibody sc-166362, Santa Cruz Biotechnology, Dallas, Texas, USA, 1:100). ALDH1&2 expression was evaluated through a scale of 1 to 3 depending on the percentage of positive epithelial cells and was compared to normal epithelium as well as cases of OL (the most prominent OPMD). The statistical analysis was performed with the Pearson chi-square test and the significance level was set at p≤0.05. Results: The cytoplasmic staining of ALDH1&2 was observed mostly in the epithelial cells of the basal layer of the epithelium of OLP. Overall, this expression was significantly increased compared to normal epithelium. In addition, statistically significantly higher expression of ALDH1&2 was observed in the erosive form of OLP. Interestingly, this OLP positivity was higher compared to mild and non-dysplastic leukoplakias (p<0.001). Conclusions: ALDH1&2 is a confirmed CSC marker that was found to be clearly increased in OLP and characteristically in erosive OLP epithelium for the first time. Noteworthy, it was more prominent in erosive OLP rather than in mildly and non-dysplastic OL. Whether this pattern of expression raises the red flag of an early epithelial "CSC" phenotype in OLP or that ALDH1&2 expression indicates a response to the OLP inflammatory process requires further investigation.
Language	English
Publishing date	2023-08-28
Publishing country	United States
Document type	Journal Article
ZDB-ID	2747273-5
ISSN	2168-8184
ISSN	2168-8184
DOI	10.7759/cureus.44278
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Article ; Online: The neuropathology of genetic Parkinson's disease.

Poulopoulos, Markos / Levy, Oren A / Alcalay, Roy N

Movement disorders : official journal of the Movement Disorder Society

2012 Volume 27, Issue 7, Page(s) 831–842

Abstract: ... was a marked variability in pathological findings, even among carriers of identical mutations ...

Abstract	Pathological data from autopsies genotyped for Parkinson's disease (PD)-related mutations in alpha-synuclein, Parkin, PINK1, DJ1, LRRK2, and glucocerebrosidase have accumulated in recent years. The aim of this review is to systematically review all pathological reports of mutation carriers and to identify pathological patterns and gaps in the currently available data. A systematic review of the English literature was done using the terms "Parkinson's disease," "brain pathology," "autopsy," the specific gene nomenclature, and any combination of the above. Most studies included reports of convenience samples: either cases that were preidentified as mutation carriers before autopsy or screens of Lewy body brain banks. Nineteen autopsies of alpha-synuclein mutation carriers, 49 of LRRK2 mutation carriers, nine of Parkin mutation carriers, one of a PINK1 mutation carrier, and 86 of glucocerebrosidase mutation carriers were identified. Most autopsies of alpha-synuclein, LRRK2 G2019S, and glucocerebrosidase mutation carriers demonstrated Lewy body pathology, as opposed to Parkin and LRRK2 non-G2019S mutation carriers. However, there was a marked variability in pathological findings, even among carriers of identical mutations. Pathological data from DJ1 mutation carriers, nonmanifesting mutation carriers (e.g., of LRRK2 mutations), and carriers of a single Parkin mutation were lacking. In gathering together all studies of PD autopsies with an identified genetic risk, this review highlights the wealth of information generated as well as shortcomings in the available data. In particular, there is a need for larger, unbiased pathological studies. Differential association of Lewy pathology with specific mutations may reflect heterogeneity in pathogenic mechanisms among the different PD-related genes.
MeSH term(s)	Animals ; Brain/pathology ; Genetic Predisposition to Disease/genetics ; Humans ; Mutation/genetics ; Nerve Tissue Proteins/genetics ; Parkinson Disease/genetics ; Parkinson Disease/pathology
Chemical Substances	Nerve Tissue Proteins
Language	English
Publishing date	2012-03-26
Publishing country	United States
Document type	Journal Article ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't ; Review ; Systematic Review
ZDB-ID	607633-6
ISSN	1531-8257 ; 0885-3185
ISSN (online)	1531-8257
ISSN	0885-3185
DOI	10.1002/mds.24962
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Article ; Online: Thoracic disc herniation leads to anterior spinal artery syndrome demonstrated by diffusion-weighted magnetic resonance imaging (DWI): a case report and literature review.

Reynolds, Jacques M / Belvadi, Yeshaswi S / Kane, Arthur G / Poulopoulos, Markos

The spine journal : official journal of the North American Spine Society

2014 Volume 14, Issue 6, Page(s) e17–22

Abstract: Background: Thoracic disc herniation rarely causes acute ischemic events involving the spinal cord. Few reports have suggested this as a mechanism leading to anterior spinal artery syndrome, and none with illustration through diffusion-weighted magnetic ...

Abstract	Background: Thoracic disc herniation rarely causes acute ischemic events involving the spinal cord. Few reports have suggested this as a mechanism leading to anterior spinal artery syndrome, and none with illustration through diffusion-weighted magnetic resonance imaging (DWI). Purpose: The purpose of this study was to report a case of anterior spinal artery syndrome secondary to thoracic disc herniation and demonstrate the first use of DWI to aid in diagnosis of this rare myelopathy. Study design: Case report. Methods: A 36-year-old woman developed sudden onset of back pain followed by evolving paraparesis and sensory loss consistent with anterior spinal artery distribution ischemia. T2-weighted magnetic resonance imaging (MRI) demonstrated an acute herniated nucleus pulposus at the T7-T8 disc, which produced a focal indentation of the adjacent anterior spinal cord without cord displacement or canal stenosis. T2-weighted hyperintensities were seen at T4-T7 levels with corresponding brightness on DWI and reduction of the apparent diffusion coefficient, consistent with cord ischemia. Results: Remarkably, within just a few days and following conservative treatment, including heparin and steroids, this patient's neurologic status began to show improvement. Within 3 weeks, she was ambulating with assisted devices, and at the 10-month follow-up, the patient had nearly complete neurological improvement. A follow-up MRI at 10 months showed normal T2-weighted imaging except for a 1×2-mm area of anterior-left lateral cord myelomalacia at T4-T5. Conclusions: Acute thoracic disc herniation with cord contact but without canal stenosis is able to disrupt blood flow to the cord leading to anterior spinal artery distribution ischemia. This case represents the first demonstrated use of DWI in diagnosing this rare cause of anterior spinal artery ischemia.
MeSH term(s)	Adult ; Anterior Spinal Artery Syndrome/etiology ; Anterior Spinal Artery Syndrome/physiopathology ; Diffusion Magnetic Resonance Imaging ; Female ; Humans ; Intervertebral Disc Displacement/complications ; Intervertebral Disc Displacement/physiopathology ; Paraparesis/etiology ; Paraparesis/physiopathology ; Thoracic Vertebrae
Language	English
Publishing date	2014-06-01
Publishing country	United States
Document type	Case Reports ; Journal Article ; Review
ZDB-ID	2037072-6
ISSN	1878-1632 ; 1529-9430
ISSN (online)	1878-1632
ISSN	1529-9430
DOI	10.1016/j.spinee.2013.10.050
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Article ; Online: Carbidopa/levodopa/entacapone

Markos Poulopoulos / Cheryl Waters

Core Evidence, Vol 2010, Iss default, Pp 1-

the evidence for its place in the treatment of Parkinson’s disease

2009 Volume 10

Abstract: Markos Poulopoulos, Cheryl WatersDepartment of Neurology, Division of Movement Disorders, Columbia ...

Abstract	Markos Poulopoulos, Cheryl WatersDepartment of Neurology, Division of Movement Disorders, Columbia University Medical Center, Neurological Institute of New York, Center of Parkinson’s Disease and Other Movement Disorders, New York, NY, USAIntroduction: Parkinson’s disease (PD) is a common neurodegenerative disease. In the 1960s, it was shown that the degeneration of dopamine producing neurons in the substantia nigra (SN) caused the motor features of PD. Dopamine replacement with levodopa, a dopamine precursor, resulted in remarkable benefit. Yet, the intermittent administration of levodopa is a major cause of motor complications, such as “wearing-off ” of levodopa’s benefit and involuntary movements, known as dyskinesia. Therefore, agents that prolong levodopa’s half-life were employed, such as carbidopa, an aromatic amino acid decarboxylase (AADC) inhibitor, and entacapone, a catechol-O-methyltransferase (COMT) inhibitor. The combination product carbidopa/levodopa/entacapone (CLE) was approved in 2003 for the treatment of PD patients.Aims: To assess the evidence for the place of CLE in the treatment of PD.Evidence review: CLE has a good efficacy, safety and tolerability profile, similar to that of entacapone taken separately with carbidopa/levodopa (CL). Compared to CL alone, it prolongs levodopa’s benefit, and improves the quality of life but not the motor performance in PD patients with nondebilitating “wearing-off ” or dyskinesia. However, it increases the dyskinesia rate in early PD patients, and has adverse events in advanced patients with significant motor complications. There is insufficient evidence regarding cost-effectiveness.Place in therapy: CLE is an attractive alternative for patients with nondisabling “wearing-off ” or dyskinesia taking CL with or without entacapone. It cannot be recommended for early PD patients, as it can induce more dyskinesia than CL alone, or in any patients who seem to have more adverse events.Keywords: Parkinson’s disease, levodopa, entacapone, carbidopa, treatment
Keywords	Medicine (General) ; R5-920 ; Medicine ; R ; DOAJ:Medicine (General) ; DOAJ:Health Sciences ; Therapeutics. Pharmacology ; RM1-950 ; DOAJ:Therapeutics
Subject code	610
Language	English
Publishing date	2009-12-01T00:00:00Z
Publisher	Dove Medical Press
Document type	Article ; Online
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Article: Neurological complications with acute sphenoid sinusitis a surgical emergency?

Poulopoulos, Markos / Finelli, Pasquale F

Neurocritical care

2007 Volume 7, Issue 2, Page(s) 169–171

Abstract: Background: Isolated acute sphenoid sinusitis is an uncommon sinus infection, frequently misdiagnosed and not usually considered in the differential diagnosis of acute severe headache, with the potential of serious neurologic complications.: ... ...

Abstract	Background: Isolated acute sphenoid sinusitis is an uncommon sinus infection, frequently misdiagnosed and not usually considered in the differential diagnosis of acute severe headache, with the potential of serious neurologic complications. Objectives: To describe two patients with acute sphenoid sinusitis who presented with acute onset of severe headache and consider the role of surgical management. Design: Case report. Setting: Tertiary care hospital. Results: Patient 1 developed right cavernous sinus thrombosis and permanent visual loss in one eye, requiring sphenoidotomy following failure of medical treatment. Patient 2 experienced failure of the medical treatment. However, sphenoidotomy abated all his symptoms without any neurologic sequelae. Conclusion: It is important to be aware of acute sphenoid sinusitis in the setting of new onset severe headache, when imaging studies are unrevealing for intracranial pathology. Considering the serious consequences of failed medical treatment vis-à-vis the safety and efficacy of sphenoidotomy we propose surgical intervention at the time of diagnosis.
MeSH term(s)	Acute Disease ; Adult ; Diagnosis, Differential ; Drainage ; Emergency Medical Services ; Female ; Headache/diagnosis ; Headache/etiology ; Headache/surgery ; Humans ; Male ; Middle Aged ; Pregnancy ; Pregnancy Complications, Infectious/diagnosis ; Pregnancy Complications, Infectious/surgery ; Sphenoid Sinusitis/complications ; Sphenoid Sinusitis/diagnosis ; Sphenoid Sinusitis/surgery
Language	English
Publishing date	2007
Publishing country	United States
Document type	Case Reports ; Journal Article
ZDB-ID	2381896-7
ISSN	1556-0961 ; 1541-6933
ISSN (online)	1556-0961
ISSN	1541-6933
DOI	10.1007/s12028-007-0036-6
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Article: Comparison of clinical features in pathologically confirmed PSP and MSA patients followed at a tertiary center.

Xie, Tao / Kang, Un J / Kuo, Sheng-Han / Poulopoulos, Markos / Greene, Paul / Fahn, Stanley

NPJ Parkinson's disease

2015 Volume 1, Page(s) 15007

Abstract: Background/objectives: The clinical diagnosis of progressive supranuclear palsy (PSP) and multiple system atrophy (MSA) remains challenging due to heterogeneity of the diseases.: Aims: Here we compared the clinical features of PSP and MSA to gain ... ...

Abstract	Background/objectives: The clinical diagnosis of progressive supranuclear palsy (PSP) and multiple system atrophy (MSA) remains challenging due to heterogeneity of the diseases. Aims: Here we compared the clinical features of PSP and MSA to gain insight into their diagnosis and prognosis, particularly the prognostic value of down-gaze palsy latency in PSP progression. Methods: We reviewed clinical features of pathologically confirmed 10 PSP and 13 MSA patients, incidentally matched in age-at-onset, gender, and disease duration, followed at Columbia University Medical Center during 1994-2009. Results: The final antemortem diagnosis was incorrect in 30% of PSP (all lacking down-gaze palsy) and 23% of MSA patients. Falls in the first year of the disease, pyramidal involvement and freezing of gait during the course were similar between PSP and MSA. Ataxia and apraxia were in 50% of the PSP patients. Parkinsonism responsive to levodopa treatment was in 30% of the PSP (all with resting tremor) and 50% of the MSA patients. Dysautonomia in MSA could occur as early as 3 years preceding the motor symptoms, with 46% within the first year of the motor onset, but 15% did not have dysautonomia in life. The latency of down-gaze palsy and urogenital dysfunction and MMSE scores at first visit in PSP, and the latency of falls and wheelchair confinement in MSA were all associated with the disease progression. Conclusions: We confirmed most of the previously published characterizations, and identified for the first time the prognostic value of down-gaze palsy latency in PSP progression.
Language	English
Publishing date	2015-05-21
Publishing country	United States
Document type	Journal Article
ZDB-ID	2819218-7
ISSN	2373-8057
ISSN	2373-8057
DOI	10.1038/npjparkd.2015.7
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