Parkinson Disease: Benamer HT

Benamer HT, Grosset DG. · Department of Neurology, Queen Elizabeth Neuroscience Centre, Queen Elizabeth University Hospital, Birmingham, UK. · Eur Neurol. · Pubmed #18948694 links to  free full text

Abstract: Over the last 75 years there has been continuous debate about the existence of vascular parkinsonism (VP). The condition has been named and renamed several times, with terms such as arteriosclerotic parkinsonism, arteriosclerotic pseudo-parkinsonism and lower-body parkinsonism. Despite the progress in our understanding of other parkinsonian syndromes, such as progressive supranuclear palsy and multiple-system atrophy, and significant developments in neuroimaging techniques, the concept of VP is still unclear and the clinical diagnosis is often difficult. There are no widely agreed diagnostic criteria. This article reviews the current literature relating to VP in particular to identify the different clinical presentations that have been described.

Benamer HT, de Silva R, Siddiqui KA, Grosset DG. · Department of Neurology, Queen Elizabeth Neuroscience Centre, Queen Elizabeth University Hospital, Birmingham, United Kingdom. · Mov Disord. · Pubmed #18442138 No free full text.

Abstract: Studies of specific populations have provided invaluable knowledge about Parkinson's disease (PD), especially in the field of genetics. The present report systematically reviews the medical literature on PD in Arabs. Medline and Embase were searched, and 24 article were identified: genetic (n = 17), epidemiological (n = 3), and clinical series (n = 5). Both autosomal dominant and recessive forms of inherited PD are described, associated with four genes (Parkin, PINK1, LRRK2, and PARK9). The G2019S LRRK2 mutation is more common in both familial (37-42%) and apparently sporadic PD (41%) in North African Arabs than in Europeans and North Americans (2-3%). The incidence of PD is reported at 4.5 per 100,000 person-years and reported prevalence at 27 to 43 per 100,000 persons. Hospital-based clinical series suggest that parkinsonism is the commonest movement disorder. Clinical features of PD in Arabs are not significantly different from those reported elsewhere. PD was reported as the cause of dementia in around 7% of Arabs. The majority of studies relate to the role of genes in the etiology of PD in North African Arabs. Further genetic, epidemiological and clinical studies from the majority of Arabic countries may enhance our understanding of PD.

Benamer HT, Oertel WH, Patterson J, Hadley DM, Pogarell O, Höffken H, Gerstner A, Grosset DG. · Neurology Department, New Cross Hospital, Wolverhampton, United Kingdom. · Mov Disord. · Pubmed #14502664 No free full text.

Abstract: To record prospectively, from early presentation, the clinical features of parkinsonism and tremor disorders, in relation to evidence of dopaminergic deficit shown with [(123)I]-FP-CIT (DaTSCAN, Amersham Health) single photon emission computerised tomography (SPECT). Clinical signs were recorded in 62 patients, of whom 24 failed standard Parkinson's disease (PD) and essential tremor criteria, and 38 fulfilled UK Brain Bank step 1 PD criteria. Striatal radioligand uptake was graded visually as normal or abnormal, and specific:nonspecific ratios were calculated. Bradykinesia and rigidity showed significant overall association with abnormal scans (P < or = 0.003), but rest tremor did not (P = NS). In the 24 patients not fulfilling specific criteria (mean age 63 [SD 9] years, disease duration 3 [SD 4] years), 10 (42%) had abnormal visual SPECT assessment and 14 (58%) had normal scans. Of 38 patients with early PD by clinical criteria (mean age 60 [SD 9] years, disease duration 3 [SD 1.7] years), 33 (87%) were visually abnormal. Baseline clinical diagnosis corresponded with SPECT imaging results in 51 of 62 cases (82%), which increased to 56 of 62 cases (90%) with amendment of seven clinical diagnoses at 3 months (blind to SPECT results). Akinetic-rigid cardinal diagnostic features of parkinsonism associate well with dopaminergic deficit in patients with early and mild clinical features. When these clinical features are uncertain, or the patient fails clinical diagnostic criteria, testing for dopaminergic deficit with [(123)I]-FP-CIT SPECT may assist the diagnostic process.

Benamer HT, Patterson J, Wyper DJ, Hadley DM, Macphee GJ, Grosset DG. · Department of Neurology, Institute of Neurological Sciences, Southern General Hospital NHS Trust, Glasgow, Scotland, UK. · Mov Disord. · Pubmed #10928580 No free full text.

Abstract: The variability in clinical features and the masking effects of drug therapy in Parkinson's disease (PD) can affect clinical assessment of disease severity. The aim of this study was to assess the imaging of dopamine transporters using 123I-FP-CIT SPECT and its correlation with disease staging, severity, and duration. Differences between the clinical severity of the onset and non-onset side and the corresponding striatal uptake ratios were also examined. Forty-one patients with PD (nine unilateral, 32 bilateral clinical features) were studied. Clinical severity was determined by using the Unified Parkinson's Disease Rating Score (UPDRS). Unilateral UPDRS was calculated from unilateral arm and leg resting and action tremor, rigidity, finger taps, hand movements, alternating movements, and leg agility. 123I-FP-CIT striatal uptake was expressed as the ratio of specific:nonspecific (SP:NS) uptake for defined brain areas. Patients with PD who had unilateral symptoms showed a significant difference between the ipsilateral and contralateral SP:NS ratios in both the caudate and putamen, but there was a considerable overlap between between the two sides. This result was repeated in patients with bilateral symptoms and there was overlap of SP:NS ratios between the two groups. For the whole group of patients with PD, striatum, caudate, and putamen SP:NS ratios correlated with disease severity assessed by UPDRS and duration of disease. The SP:NS ratios correlated with the bradykinesia subscore but not with rigidity or tremor subscore. In conclusion, this study provides further evidence that the SP:NS ratio is a robust measure of disease severity correlating with duration of PD. However, variability in uptake values suggest that factors other than nigrostriatal degeneration may contribute to disease severity. Correlation with bradykinesia but not with tremor may indicate an origin for tremor outwith the dopamine transporter system. 123I-FP-CIT SPECT offers significant potential in defining the nigrostriatal changes in PD.

Benamer HT. · No affiliation provided · Lancet Neurol. · Pubmed #18702998 No free full text.

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