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MR parkinsonism index predicts vertical supranuclear gaze palsy in patients with PSP – parkinsonism

View Article: PubMed Central - PubMed

ABSTRACT

Objective:: To identify a biomarker for predicting the appearance of vertical supranuclear gaze palsy (VSGP) in patients affected by progressive supranuclear palsy–parkinsonism (PSP-P).

Methods:: Twenty-four patients with PSP-P were enrolled in the current study. Patients were clinically followed up every 6 months until the appearance of VSGP or the end of the follow-up (4 years). Participants underwent MRI at baseline and at the end of follow-up. Magnetic resonance parkinsonism index (MRPI), an imaging measure useful for diagnosing PSP, was calculated.

Results:: Twenty-one patients with PSP-P completed follow-up, and 3 patients dropped out. Eleven of 21 patients with PSP-P developed VSGP after a mean follow-up period of 28.5 months (range 6–48 months), while the remaining 10 patients with PSP-P did not develop VSGP during the 4-year follow-up period. At baseline, patients with PSP-P who later developed VSGP had MRPI values significantly higher than those of patients not developing VSGP without overlapping values between the 2 groups. MRPI showed a higher accuracy (100%) in predicting VSGP than vertical ocular slowness (accuracy 33.3%) or postural instability with or without vertical ocular slowness (accuracy 71.4% and 42.9%, respectively).

Conclusions:: Our study demonstrates that MRPI accurately predicted, on an individual basis, the appearance of VSGP in patients with PSP-P, thus confirming clinical diagnosis in vivo.

No MeSH data available.


Related in: MedlinePlus

Box plots of baseline and follow-up magnetic resonance parkinsonism index measurements in patients with progressive supranuclear palsy–parkinsonism (PSP-P) developing (A) or not developing (B) vertical supranuclear gaze palsy (VSGP)Box plots show an increase of MRPI value in patients with PSP-P developing VSGP in comparison with those not developing VSGP (mixed-model analysis of variance, p = 0.045). Vertical solid lines (whiskers) show lower and upper values. Box stretches from lower hinge (25th percentile) to upper hinge (75th percentile). Median is shown as a line across each box.
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Figure 2: Box plots of baseline and follow-up magnetic resonance parkinsonism index measurements in patients with progressive supranuclear palsy–parkinsonism (PSP-P) developing (A) or not developing (B) vertical supranuclear gaze palsy (VSGP)Box plots show an increase of MRPI value in patients with PSP-P developing VSGP in comparison with those not developing VSGP (mixed-model analysis of variance, p = 0.045). Vertical solid lines (whiskers) show lower and upper values. Box stretches from lower hinge (25th percentile) to upper hinge (75th percentile). Median is shown as a line across each box.

Mentions: Eleven of 21 patients (52.3%) with PSP-P developed VSGP during the follow-up. The mean ± SD duration of clinical follow-up period for these patients was 28.5 ± 13.6 months (range 6–48 months). None of the remaining 10 patients with PSP-P developed VSGP within 48 months of the clinical observational period. Baseline comparisons of clinicoradiologic data between patients with PSP-P developing and not developing VSGP are shown in table 1 and figure 1. More than 50% of patients in both groups showed levodopa responsiveness. It is noteworthy that the patients with PSP-P who developed VSGP showed baseline MRPI values (mean 14.77; range 12.52–20.24) that were significantly higher (p < 0.001) than those detected in patients who did not develop VSGP (mean 9.77; range 7.90–11.34) without overlapping values between the 2 groups (table 1). Follow-up comparisons of clinicoradiologic data between these 2 patient groups are shown in table 2. Of note, most patients in both groups lost levodopa responsiveness, with this result being more evident in those patients who developed VSGP. Comparisons between MRPI values in patients with PSP-P developing and not developing VSGP at baseline and follow-up are shown in figure 2. The mixed-model analysis of variance showed a significant effect of status (developing, not developing; p < 0.001) and no significant effect of time (baseline, follow-up; p = 0.38), while the interaction of status and time was shown to be slightly significant (p = 0.045), thus suggesting that the change in MRPI values from baseline to follow-up evaluation was higher in patients with PSP-P developing VSGP than in those not developing VSGP.


MR parkinsonism index predicts vertical supranuclear gaze palsy in patients with PSP – parkinsonism
Box plots of baseline and follow-up magnetic resonance parkinsonism index measurements in patients with progressive supranuclear palsy–parkinsonism (PSP-P) developing (A) or not developing (B) vertical supranuclear gaze palsy (VSGP)Box plots show an increase of MRPI value in patients with PSP-P developing VSGP in comparison with those not developing VSGP (mixed-model analysis of variance, p = 0.045). Vertical solid lines (whiskers) show lower and upper values. Box stretches from lower hinge (25th percentile) to upper hinge (75th percentile). Median is shown as a line across each box.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC5035983&req=5

Figure 2: Box plots of baseline and follow-up magnetic resonance parkinsonism index measurements in patients with progressive supranuclear palsy–parkinsonism (PSP-P) developing (A) or not developing (B) vertical supranuclear gaze palsy (VSGP)Box plots show an increase of MRPI value in patients with PSP-P developing VSGP in comparison with those not developing VSGP (mixed-model analysis of variance, p = 0.045). Vertical solid lines (whiskers) show lower and upper values. Box stretches from lower hinge (25th percentile) to upper hinge (75th percentile). Median is shown as a line across each box.
Mentions: Eleven of 21 patients (52.3%) with PSP-P developed VSGP during the follow-up. The mean ± SD duration of clinical follow-up period for these patients was 28.5 ± 13.6 months (range 6–48 months). None of the remaining 10 patients with PSP-P developed VSGP within 48 months of the clinical observational period. Baseline comparisons of clinicoradiologic data between patients with PSP-P developing and not developing VSGP are shown in table 1 and figure 1. More than 50% of patients in both groups showed levodopa responsiveness. It is noteworthy that the patients with PSP-P who developed VSGP showed baseline MRPI values (mean 14.77; range 12.52–20.24) that were significantly higher (p < 0.001) than those detected in patients who did not develop VSGP (mean 9.77; range 7.90–11.34) without overlapping values between the 2 groups (table 1). Follow-up comparisons of clinicoradiologic data between these 2 patient groups are shown in table 2. Of note, most patients in both groups lost levodopa responsiveness, with this result being more evident in those patients who developed VSGP. Comparisons between MRPI values in patients with PSP-P developing and not developing VSGP at baseline and follow-up are shown in figure 2. The mixed-model analysis of variance showed a significant effect of status (developing, not developing; p < 0.001) and no significant effect of time (baseline, follow-up; p = 0.38), while the interaction of status and time was shown to be slightly significant (p = 0.045), thus suggesting that the change in MRPI values from baseline to follow-up evaluation was higher in patients with PSP-P developing VSGP than in those not developing VSGP.

View Article: PubMed Central - PubMed

ABSTRACT

Objective:: To identify a biomarker for predicting the appearance of vertical supranuclear gaze palsy (VSGP) in patients affected by progressive supranuclear palsy&ndash;parkinsonism (PSP-P).

Methods:: Twenty-four patients with PSP-P were enrolled in the current study. Patients were clinically followed up every 6 months until the appearance of VSGP or the end of the follow-up (4 years). Participants underwent MRI at baseline and at the end of follow-up. Magnetic resonance parkinsonism index (MRPI), an imaging measure useful for diagnosing PSP, was calculated.

Results:: Twenty-one patients with PSP-P completed follow-up, and 3 patients dropped out. Eleven of 21 patients with PSP-P developed VSGP after a mean follow-up period of 28.5 months (range 6&ndash;48 months), while the remaining 10 patients with PSP-P did not develop VSGP during the 4-year follow-up period. At baseline, patients with PSP-P who later developed VSGP had MRPI values significantly higher than those of patients not developing VSGP without overlapping values between the 2 groups. MRPI showed a higher accuracy (100%) in predicting VSGP than vertical ocular slowness (accuracy 33.3%) or postural instability with or without vertical ocular slowness (accuracy 71.4% and 42.9%, respectively).

Conclusions:: Our study demonstrates that MRPI accurately predicted, on an individual basis, the appearance of VSGP in patients with PSP-P, thus confirming clinical diagnosis in vivo.

No MeSH data available.


Related in: MedlinePlus