Abstract
Background
Differential diagnosis between Parkinson’s disease (PD) and atypical Parkinsonian syndromes (APS), such as multiple system atrophy (MSA) and progressive supranuclear palsy (PSP), is often difficult because of overlap of common clinical features. We evaluated R2 Blink Reflex Recovery Cycle (R2BRRC) in drug-naive PD patients and in MSA and PSP patients to differentiate early PD from APS.
Methods
We investigated 43 patients: 15 drug-naive PD patients, 16 MSA patients, and 12 PSP patients. R2BRRC was evaluated bilaterally at interstimulus intervals (ISIs) of 100, 150, 200, 300, 400, 500, and 750 ms. An asymmetry index (AI) of R2BRRC for each ISI was computed.
Results
R2BRRC of PD patients showed an increased brainstem excitability for less affected side (LAS) stimulation at ISIs of 100, 150, 200 (p < 0.001), and 300 ms (p = 0.03) compared to more affected side (MAS) stimulation, whereas no differences between LAS and MAS stimulation were found in APS. AI of 0.87 at ISI of 100 ms differentiated PD from MSA with a sensitivity of 86.7% and a specificity of 100%, whereas AI of 0.78 at ISI of 100 ms permitted to discriminate PD from PSP with a sensitivity of 86.7% and a specificity of 91.7%.
Conclusion
AI of R2BRRC may represent a reliable tool in differentiating PD from APS, especially at the early stage of the disease.
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Data and material of the study are available to be examined.
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The research did not have any financial support.
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Contributions
GS: Research project: conception, organization, execution; Statistical analysis: execution; Manuscript: writing of the first draft, review, and critique. GM: Research project: conception; Statistical analysis: design, review, and critique; Manuscript: review and critique. ID: Research project: execution. GD: Research project: Execution. RM: Research project: execution. GP: Research project: execution. CR: Research project: execution. SS: Statistical analysis: review and critique, Manuscript: Review and critique. FD: Statistical analysis: review and critique, Manuscript: review and critique. AN: Statistical analysis: review and critique, Manuscript: review and critique. MZ: Research project: conception, organization; Statistical analysis: design, execution, review, and critique; Manuscript: review and critique.
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The study was approved by the Local Ethics Committee and patients were enrolled after signing the written informed consent.
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415_2020_9900_MOESM1_ESM.tif
Supplementary file1 (TIF 27 kb) Asymmetry indexes for drug-naïve PD, MSA and PSP patients. Asymmetry indexes are shown as mean + standard error (S.E.). X-axis: asymmetry indexes at interstimulus intervals (ISIs) of 100, 150, 200, 300, 400, 500, 750 milliseconds (ms). Y-axis: absolute value of asymmetry index; ANOVA test: *p<0.001 when comparing PD, MSA and PSP; Tukey post-hoc test: p<0.001, when comparing PD vs. MSA and PD vs. PSP at AI of 100 ms; p<0.01 when comparing PD vs. MSA and PD vs. PSP at AI of 150 ms. AI= asymmetry index, PD= Parkinson’s Disease, MSA= Multiple System Atrophy, PSP= Progressive Supranuclear Palsy
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Sciacca, G., Mostile, G., Disilvestro, I. et al. Asymmetry index of Blink Reflex Recovery Cycle differentiates Parkinson’s disease from atypical Parkinsonian syndromes. J Neurol 267, 1859–1863 (2020). https://doi.org/10.1007/s00415-020-09900-6
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DOI: https://doi.org/10.1007/s00415-020-09900-6