Factors influencing the symmetry of Parkinson's disease symptoms

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Abstract

Introduction

The presence of asymmetry in symptoms and clinical signs favours the diagnosis of Parkinson's disease (PD). The aim of this study is to analyse this symptom asymmetry as a function of different variables and compare it with other parkinsonisms.

Materials and methods

201 Patients with PD were studied. The sample was supplemented with 29 patients diagnosed with MSA-P (according to the criteria established by the American Academy of Neurology) and 17 with PSP (according to the criteria established by the NINDS-SPSP International Workshop). The symmetry was evaluated, based on items 20–23, 25 and 26 of the Unified Parkinson's Disease Rating Scale, by subtracting the motor score for the left side from that for the right side. Those patients with a difference of one point or more were designated as being asymmetric.

Results

Around 16.4% of patients presented symmetrical clinical symptoms. There were no differences between those patients with or without family history of the disease. Those patients with symmetric symptoms were found to have longer symptomatic disease duration (10.8 vs. 7.9 years), a worse mental state (UPDRS I: 3.9 vs. 3.2), a higher incidence of complications (UPDRS IV: 4.5 vs. 3.2) and had their activities of daily living (ADL) affected to a greater degree (UPDRS II: 13.0 vs. 11.0). Around 48.3% of the MSA-P patients and 52.9% of the PSP patients showed symmetric symptoms.

Conclusions

The degree of symmetry is not useful in differentiating between sporadic and familial PD. However, the observation of highly symmetrical symptoms in a patient with short evolution time indicates that an atypical parkinsonism should be suspected.

Introduction

The diagnosis of Parkinson's disease (PD) is essentially clinical in the absence of a biological marker. Brain imaging SPECT and PET studies have shown significantly fewer striatal functional binding measures contralateral to the clinically more affected side [1]. The features that correlate best with autopsy-confirmed Parkinson's disease include unilateral/asymmetrical onset of signs, classic resting tremor and a beneficial, sustained response to levodopa [2]. A significant asymmetry in the symptoms and signs would assist in the diagnosis of this disease, especially in early stages, and is associated with better prognosis and increased survival rates [3].

The degree of asymmetry is similar in sporadic and hereditary forms of PD [4]. Other parkinsonisms, such as multiple system atrophy (MSA) and progressive supranuclear palsy (PSP), can also show asymmetric clinical symptoms [3], as reflected on presynaptic markers such as (123I)beta-CIT SPECT [5]. However, the symmetry of symptoms in MSA and PSP is more pronounced than in patients with PD [6], [7].

This study has two main aims: (1) to analyse the asymmetry of the clinical symptoms of a group of patients with different parkinsonisms (PD, MSA-P, PSP), and (2) to analyse the effect of gender, duration of PD and family history on the symptom asymmetry of those patients diagnosed with PD.

Section snippets

Patients and methods

A total of 201 consecutive patients diagnosed with PD (according to the criteria established by the UK Parkinson's Disease Society Brain Bank)[2] were analysed. The sample was diagnosed with PD by two physicians (J.C.G and B.T.) at the Movement Disorders Unit (Hospital of Cruces) between January 2004 and December 2007. After a complete description of the study, informed consent was obtained from each patient prior to enrolment in the study.

The presence of first- or second-degree family history,

Results

A total of 201 patients with PD, of which 34 (17%) had a first- and 29 (14%) a second-degree family history of the disease, were registered. Only 11 patients with PD (5.5%) had history of consanguinity. In those PD patients with a family history of the disease, the frequency amongst men was higher than in the sporadic form of the disease, with an odds ratio of 1.7 (sporadic PD: 54.9% women, 45.1% men (not statistically significant); PD with family history: 64.9% men, 35.1% women (p = 0.01)).

The

Discussion

Epidemiological studies have shown a greater incidence of PD in men, with an increased frequency between 1.6 and 2.0 with respect to women [12]. Among the theories proposed to explain the prevalence of this disease in men are the suggestion of a protective role played by oestrogens in women and a greater incidence of head injuries or exposure to toxins in men [13], [14]. Our sample shows that the relative frequency of PD among men declines when removing patients with familial PD. Although this

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