Zhuangzi: Ein kleiner Spaziergang in der Bilderwelt des Daoismus

Wer ist Zhuangzi? Was ist sein Denken? Wie ist sein Stil? Wie verhält er sich zu anderen philosophischen Denkrichtungen des antiken Chinas

Preface – Special issue: Multiple system atrophy

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/41652/1/702_2005_Article_376.pd

Drug-Induced Parkinsonism

Drug-induced parkinsonism (DIP) is the second-most-common etiology of parkinsonism in the elderly after Parkinson's disease (PD). Many patients with DIP may be misdiagnosed with PD because the clinical features of these two conditions are indistinguishable. Moreover, neurological deficits in patients with DIP may be severe enough to affect daily activities and may persist for long periods of time after the cessation of drug taking. In addition to typical antipsychotics, DIP may be caused by gastrointestinal prokinetics, calcium channel blockers, atypical antipsychotics, and antiepileptic drugs. The clinical manifestations of DIP are classically described as bilateral and symmetric parkinsonism without tremor at rest. However, about half of DIP patients show asymmetrical parkinsonism and tremor at rest, making it difficult to differentiate DIP from PD. The pathophysiology of DIP is related to drug-induced changes in the basal ganglia motor circuit secondary to dopaminergic receptor blockade. Since these effects are limited to postsynaptic dopaminergic receptors, it is expected that presynaptic dopaminergic neurons in the striatum will be intact. Dopamine transporter (DAT) imaging is useful for diagnosing presynaptic parkinsonism. DAT uptake in the striatum is significantly decreased even in the early stage of PD, and this characteristic may help in differentiating PD from DIP. DIP may have a significant and longstanding effect on patients' daily lives, and so physicians should be cautious when prescribing dopaminergic receptor blockers and should monitor patients' neurological signs, especially for parkinsonism and other movement disorders

Riluzole treatment, survival and diagnostic criteria in Parkinson plus disorders: The NNIPPS Study

Parkinson plus diseases, comprising mainly progressive supranuclear palsy (PSP) and multiple system atrophy (MSA) are rare neurodegenerative conditions. We designed a double-blind randomized placebo-controlled trial of riluzole as a potential disease-modifying agent in Parkinson plus disorders (NNIPPS: Neuroprotection and Natural History in Parkinson Plus Syndromes). We analysed the accuracy of our clinical diagnostic criteria, and studied prognostic factors for survival. Patients with an akinetic-rigid syndrome diagnosed as having PSP or MSA according to modified consensus diagnostic criteria were considered for inclusion. The psychometric validity (convergent and predictive) of the NNIPPS diagnostic criteria were tested prospectively by clinical and pathological assessments. The study was powered to detect a 40% decrease in relative risk of death within PSP or MSA strata. Patients were randomized to riluzole or matched placebo daily and followed up to 36 months. The primary endpoint was survival. Secondary efficacy outcomes were rates of disease progression assessed by functional measures. A total of 767 patients were randomized and 760 qualified for the Intent to Treat (ITT) analysis, stratified at entry as PSP (362 patients) or MSA (398 patients). Median follow-up was 1095 days (range 249–1095). During the study, 342 patients died and 112 brains were examined for pathology. NNIPPS diagnostic criteria showed for both PSP and MSA excellent convergent validity with the investigators’ assessment of diagnostic probability (point-biserial correlation: MSA rpb = 0.93, P < 0.0001; PSP, rpb = 0.95, P < 0.0001), and excellent predictive validity against histopathology [sensitivity and specificity (95% CI) for PSP 0.95 (0.88–0.98) and 0.84 (0.77–0.87); and for MSA 0.96 (0.88–0.99) and 0.91 (0.86–0.93)]. There was no evidence of a drug effect on survival in the PSP or MSA strata (3 year Kaplan–Meier estimates PSP-riluzole: 0.51, PSP-placebo: 0.50; MSA-riluzole: 0.53, MSA-placebo: 0.58; P = 0.66 and P = 0.48 by the log-rank test, respectively), or in the population as a whole (P = 0.42, by the stratified-log-rank test). Likewise, rate of progression was similar in both treatment groups. There were no unexpected adverse effects of riluzole, and no significant safety concerns. Riluzole did not have a significant effect on survival or rate of functional deterioration in PSP or MSA, although the study reached over 80% power to detect the hypothesized drug effect within strata. The NNIPPS diagnostic criteria were consistent and valid. They can be used to distinguish between PSP and MSA with high accuracy, and should facilitate research into these conditions relatively early in their evolution

Brainstem and Spinal Cord Circuitry Regulating REM Sleep and Muscle Atonia

Previous work has suggested, but not demonstrated directly, a critical role for both glutamatergic and GABAergic neurons of the pontine tegmentum in the regulation of rapid eye movement (REM) sleep.To determine the in vivo roles of these fast-acting neurotransmitters in putative REM pontine circuits, we injected an adeno-associated viral vector expressing Cre recombinase (AAV-Cre) into mice harboring lox-P modified alleles of either the vesicular glutamate transporter 2 (VGLUT2) or vesicular GABA-glycine transporter (VGAT) genes. Our results show that glutamatergic neurons of the sublaterodorsal nucleus (SLD) and glycinergic/GABAergic interneurons of the spinal ventral horn contribute to REM atonia, whereas a separate population of glutamatergic neurons in the caudal laterodorsal tegmental nucleus (cLDT) and SLD are important for REM sleep generation. Our results further suggest that presynaptic GABA release in the cLDT-SLD, ventrolateral periaqueductal gray matter (vlPAG) and lateral pontine tegmentum (LPT) are not critically involved in REM sleep control.These findings reveal the critical and divergent in vivo role of pontine glutamate and spinal cord GABA/glycine in the regulation of REM sleep and atonia and suggest a possible etiological basis for REM sleep behavior disorder (RBD)

Brain Structure and Degeneration Staging in Friedreich Ataxia: Magnetic Resonance Imaging Volumetrics from the ENIGMA-Ataxia Working Group

open48siThe method harmonization and multisite data analysis elements of this work were supported by the NIH BD2K (Big Data to Knowledge) program (grant U54 EB020403) and the Australian National Health and Medical Research Council (fellowship 1106533, grant 1184403).Objective: Friedreich ataxia (FRDA) is an inherited neurological disease defined by progressive movement incoordination. We undertook a comprehensive characterization of the spatial profile and progressive evolution of structural brain abnormalities in people with FRDA. Methods: A coordinated international analysis of regional brain volume using magnetic resonance imaging data charted the whole-brain profile, interindividual variability, and temporal staging of structural brain differences in 248 individuals with FRDA and 262 healthy controls. Results: The brainstem, dentate nucleus region, and superior and inferior cerebellar peduncles showed the greatest reductions in volume relative to controls (Cohen d&nbsp;= 1.5–2.6). Cerebellar gray matter alterations were most pronounced in lobules I–VI (d&nbsp;= 0.8), whereas cerebral differences occurred most prominently in precentral gyri (d&nbsp;= 0.6) and corticospinal tracts (d&nbsp;= 1.4). Earlier onset age predicted less volume in the motor cerebellum (rmax&nbsp;= 0.35) and peduncles (rmax&nbsp;= 0.36). Disease duration and severity correlated with volume deficits in the dentate nucleus region, brainstem, and superior/inferior cerebellar peduncles (rmax&nbsp;= −0.49); subgrouping showed these to be robust and early features of FRDA, and strong candidates for further biomarker validation. Cerebral white matter abnormalities, particularly in corticospinal pathways, emerge as intermediate disease features. Cerebellar and cerebral gray matter loss, principally targeting motor and sensory systems, preferentially manifests later in the disease course. Interpretation: FRDA is defined by an evolving spatial profile of neuroanatomical changes beyond primary pathology in the cerebellum and spinal cord, in line with its progressive clinical course. The design, interpretation, and generalization of research studies and clinical trials must consider neuroanatomical staging and associated interindividual variability in brain measures. ANN NEUROL 2021;90:570–583.openHarding I.H.; Chopra S.; Arrigoni F.; Boesch S.; Brunetti A.; Cocozza S.; Corben L.A.; Deistung A.; Delatycki M.; Diciotti S.; Dogan I.; Evangelisti S.; Franca M.C.; Goricke S.L.; Georgiou-Karistianis N.; Gramegna L.L.; Henry P.-G.; Hernandez-Castillo C.R.; Hutter D.; Jahanshad N.; Joers J.M.; Lenglet C.; Lodi R.; Manners D.N.; Martinez A.R.M.; Martinuzzi A.; Marzi C.; Mascalchi M.; Nachbauer W.; Pane C.; Peruzzo D.; Pisharady P.K.; Pontillo G.; Reetz K.; Rezende T.J.R.; Romanzetti S.; Sacca F.; Scherfler C.; Schulz J.B.; Stefani A.; Testa C.; Thomopoulos S.I.; Timmann D.; Tirelli S.; Tonon C.; Vavla M.; Egan G.F.; Thompson P.M.Harding I.H.; Chopra S.; Arrigoni F.; Boesch S.; Brunetti A.; Cocozza S.; Corben L.A.; Deistung A.; Delatycki M.; Diciotti S.; Dogan I.; Evangelisti S.; Franca M.C.; Goricke S.L.; Georgiou-Karistianis N.; Gramegna L.L.; Henry P.-G.; Hernandez-Castillo C.R.; Hutter D.; Jahanshad N.; Joers J.M.; Lenglet C.; Lodi R.; Manners D.N.; Martinez A.R.M.; Martinuzzi A.; Marzi C.; Mascalchi M.; Nachbauer W.; Pane C.; Peruzzo D.; Pisharady P.K.; Pontillo G.; Reetz K.; Rezende T.J.R.; Romanzetti S.; Sacca F.; Scherfler C.; Schulz J.B.; Stefani A.; Testa C.; Thomopoulos S.I.; Timmann D.; Tirelli S.; Tonon C.; Vavla M.; Egan G.F.; Thompson P.M