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Anal sphincter electromyography in patients with newly diagnosed idiopathic parkinsonism
Umeå universitet, Medicinska fakulteten, Institutionen för farmakologi och klinisk neurovetenskap, Klinisk neurovetenskap.
Umeå universitet, Medicinska fakulteten, Institutionen för farmakologi och klinisk neurovetenskap, Klinisk neurovetenskap.
Umeå universitet, Medicinska fakulteten, Institutionen för farmakologi och klinisk neurovetenskap, Klinisk neurovetenskap.
Institute of Neuroscience and Physiology/Neurology Göteborg University, Göteborg, Sweden..
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2012 (Engelska)Ingår i: Acta Neurologica Scandinavica, ISSN 0001-6314, E-ISSN 1600-0404, Vol. 126, nr 4, s. 248-255Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

Objectives The differential diagnosis of patients with idiopathic parkinsonism is difficult, especially early in the course of the disease. External anal sphincter electromyography has been reported to be of value in the differential diagnosis between Parkinson’s disease and multiple system atrophy. Patients with multiple system atrophy are reported to have pathological external anal sphincter electromyography and patients with Parkinson’s disease are reported to have significantly less pathological external anal sphincter electromyography results. Comparisons between patients with parkinsonian disorders have usually been made many years into the disease, and thus it is largely unknown if the results of external anal sphincter electromyography can be used to distinguish the different diagnoses in the early phase of the disease.

Material and methods We investigated 148 newly diagnosed patients with idiopathic parkinsonism from a population-based incidence cohort (100 definite Parkinson’s disease, 21 probable Parkinson’s disease, 16 multiple system atrophy, eleven progressive supranuclear palsy, and 40 controls) with external anal sphincter electromyography within three months of their first visit and, in the majority of patients, before start of treatment with dopaminergic drugs. The clinical diagnoses were made using established clinical diagnostic criteria after a median follow-up of three years.

Results All patient groups had more pathological external anal sphincter electromyography results than controls. No external anal sphincter electromyography differences were found between the patient groups, especially not between Parkinson’s disease and multiple system atrophy.

Conclusions External anal sphincter electromyography examination cannot separate the different parkinsonian subgroups from each other in early course of the diseases.

Ort, förlag, år, upplaga, sidor
Hoboken, NJ: Wiley-Blackwell, 2012. Vol. 126, nr 4, s. 248-255
Nyckelord [en]
Electromyography, Multiple system atrophy, Parkinson’s disease.
Nationell ämneskategori
Neurologi
Identifikatorer
URN: urn:nbn:se:umu:diva-50975DOI: 10.1111/j.1600-0404.2011.01633.xISI: 000308205500006OAI: oai:DiVA.org:umu-50975DiVA, id: diva2:471759
Tillgänglig från: 2012-01-04 Skapad: 2012-01-02 Senast uppdaterad: 2018-06-08Bibliografiskt granskad
Ingår i avhandling
1. Idiopathic parkinsonism: epidemiology and clinical characteristics of a population-based incidence cohort
Öppna denna publikation i ny flik eller fönster >>Idiopathic parkinsonism: epidemiology and clinical characteristics of a population-based incidence cohort
2012 (Engelska)Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
Abstract [en]

Background: Idiopathic parkinsonism is a neurodegenerative syndrome of unknown cause and includes Parkinson’s disease (PD) and atypical parkinsonian disorders. The atypical parkinsonian disorders are: Multiple system atrophy (MSA), progressive supranuclear palsy (PSP) and corticobasal degeneration (CBD). The incidence rates of these diseases in Sweden are largely unknown. The diagnosis of each disease relies mainly on clinical examination although several imaging and laboratory parameters may show changes. A diagnosis based on clinical examination is especially difficult early in the course of each disease; diagnosis is easier later on when disease-charactersistic signs have evolved and become more prominent. However, even in later stages it is not uncommon that patients are misdiagnosed. PD can be divided into subgroups based on the main clinical symptoms, i. e. tremor dominant, postural instability and gait difficulty (PIGD), and indeterminate. The PIGD subtype has worse prognosis including higher risk of dementia. The aims were to study the incidence of idiopathic parkinsonism and the different specific parkinsonian disorders in the Umeåregion and to investigate the patients early in the course of the disease with brainmagnetic resonance tomography (MRI), external anal sphincterelectromyography (EAS-EMG) and oculomotor examination. Can these methods improve the differential diagnostic work-up and/or differentiate between the subtypes of PD?

Methods: We examined all patients in our catchment area (142,000 inhabitants) who were referred to us due to a suspected parkinsonian syndrome. Our clinic is the only clinic in the area receiving referrals regarding movement disorders. During the period (January 1, 2004 through April 30,2009) 190 patients fulfilled the inclusion criteria and were included in the study. Healthy volunteers served as controls. 

Results: Incidence: We found the highest incidences reported in the literature: PD (22.5/100,000/year), MSA(2.4/100,000/year), and PSP (1.2/100,000/year). No CBD patients were encountered. Brain MRI: Degenerative changes were common both in controls and PD. There were no differences between the PD subtypes. EAS-EMG: Pathological changes in EAS-EMG examination were common in PD, MSA and PSP. It was not possible to separate PD, MSA and PSP by the EAS-EMG examination. Oculomotor examination: Pathological results were common in all diagnosis groups compared to controls. It was not possible to separate PD, MSA and PSP or the PD subtypes with the help of oculomotor examination.

Conclusions: The incidences of idiopathic parkinsonism, PD, MSA and PSP were higher than previously reported in the literature. It is not clear weather this is due to a true higher incidence in the Umeå region or a more effective casefinding than in other studies. MRI, EAS-EMG and oculomotor examination could not contribute to the differential diagnostic work-up between PD, MSA and PSP nor differentiate between PD subtypes early in the course of the disease.

Ort, förlag, år, upplaga, sidor
Umeå: Umeå universitet, 2012. s. 51
Serie
Umeå University medical dissertations, ISSN 0346-6612 ; 1436
Nyckelord
Parkinsonism, Parkinson's disease, Multiple system atrophy, Progressive supranuclear palsy, Incidence, Magnetic resonance tomography, Electromyography, Oculomotor
Nationell ämneskategori
Neurologi
Identifikatorer
urn:nbn:se:umu:diva-50976 (URN)978-91-7459-251-1 (ISBN)
Disputation
2012-01-27, Hörsal E04, byggnad 6E, Norrlands Universitetssjukhus, Umeå, 13:00 (Svenska)
Opponent
Handledare
Tillgänglig från: 2012-01-05 Skapad: 2012-01-02 Senast uppdaterad: 2018-06-08Bibliografiskt granskad

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Linder, JanLibelius, RolfNordh, ErikStenlund, HansForsgren, Lars

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