A new MRI rating scale for progressive supranuclear palsy and multiple system atrophy: validity and reliability

AIM To evaluate a standardised MRI acquisition protocol and a new image rating scale for disease severity in patients with progressive supranuclear palsy (PSP) and multiple systems atrophy (MSA) in a large multicentre study. METHODS The MRI protocol consisted of two-dimensional sagittal and axial T1, axial PD, and axial and coronal T2 weighted acquisitions. The 32 item ordinal scale evaluated abnormalities within the basal ganglia and posterior fossa, blind to diagnosis. Among 760 patients in the study population (PSP = 362, MSA = 398), 627 had per protocol images (PSP = 297, MSA = 330). Intra-rater (n = 60) and inter-rater (n = 555) reliability were assessed through Cohen's statistic, and scale structure through principal component analysis (PCA) (n = 441). Internal consistency and reliability were checked. Discriminant and predictive validity of extracted factors and total scores were tested for disease severity as per clinical diagnosis. RESULTS Intra-rater and inter-rater reliability were acceptable for 25 (78%) of the items scored (≥ 0.41). PCA revealed four meaningful clusters of covarying parameters (factor (F) F1: brainstem and cerebellum; F2: midbrain; F3: putamen; F4: other basal ganglia) with good to excellent internal consistency (Cronbach α 0.75-0.93) and moderate to excellent reliability (intraclass coefficient: F1: 0.92; F2: 0.79; F3: 0.71; F4: 0.49). The total score significantly discriminated for disease severity or diagnosis; factorial scores differentially discriminated for disease severity according to diagnosis (PSP: F1-F2; MSA: F2-F3). The total score was significantly related to survival in PSP (p<0.0007) or MSA (p<0.0005), indicating good predictive validity. CONCLUSIONS The scale is suitable for use in the context of multicentre studies and can reliably and consistently measure MRI abnormalities in PSP and MSA. Clinical Trial Registration Number The study protocol was filed in the open clinical trial registry (http://www.clinicaltrials.gov) with ID No NCT00211224

La maladie de Parkinson idiopathique : une maladie métabolique ?

International audienceParkinson's disease is a neurodegenerative disorder clinically characterized by motor impairments (tremor, bradykinesia, rigidity and postural instability) associated or not with non-motor complications (cognitive disorders, dysautonomia) Most of patients loose weight during evolution of their disease Dysregulations of hypothalamus, which is considered as the regulatory center of satiety and energy metabolism, could play a major role in this phenomenon Deep brain stimulation of the subthalamic nucleus (NST) is an effective method to treat patients with advanced Parkinson's disease providing marked improvement of motor impairments. This chirurgical procedure also induces a rapid and strong body weight gain and sometimes obesity. This post-operative weight gain, which exceeds largely weight lost recorded in non-operated patient, could be responsible of metabolic disorders (such as diabetes) and cardiovascular diseases. This review describes body weight variations generated by Parkinson' disease and deep brain stimulation of the NST, and focuses on metabolic disorders capable to explain them: Finally, this review emphasizes on the importance of an adequate nutritional follow up care for parkinsonian patient (C) 2010 Elsevier Masson SAS All rights reserve

Impact of localisation of deep brain stimulation electrodes on motor and neurobehavioural outcomes in Parkinson's disease

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Screening hypersexuality in Parkinson's disease in everyday practice

International audienceObjective: The purpose of this study was to develop a short and reliable measure of hypersexuality that could be used in everyday practice in patients with Parkinson's disease (PD).Design: The original questionnaire containing twenty-five-items, the Sexual Addiction Screening Test (SAST), was shortened and tested in a PD population. Methods: Successive reductions were performed until a final set of items satisfied the model fit requirements. The testing phase consisted of administering the SAST questionnaire to 159 PD patients. It included i) acceptability, ii) dimensionality construct validity, and iii) a complete general correlation structure of data. Finally, criterion validity of the final version of the instrument was assessed.Results: The initial questionnaire was reduced to five items (PD-SAST) with a cutoff score of 2. Psychometric analysis revealed three factors corresponding to "Preoccupation", "Cannot stop" and "Relationship disturbance". The discriminant validity of the PD-SAST was high (ROC area under the curve: 0.96).Conclusions: The PD-SAST performs well as a screening instrument. It has been found to be acceptable to patients and is ready for use. Moreover, it tests multidimensional aspects of hypersexuality

Parkinson's disease: A risk factor for osteoporosis

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