Factors influencing the symmetry of Parkinson's disease symptoms
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.
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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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