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PubMed1997

The distribution and dynamic density of oligodendroglial cytoplasmic inclusions (GCIs) in multiple system atrophy: a correlation between the density of GCIs and the degree of involvement of striatonigral and olivopontocerebellar systems.

The distribution and dynamic density of oligodendroglial cytoplasmic inclusions (GCIs) were studied based on 30 cases of multiple system atrophy (MSA), including striatonigral degeneration (SND), olivopontocerebellar atrophy (OPCA) and Shy-Drager syndrome. GCIs were widely spread throughout the central nervous system, including the striatonigral and olivopontocerebellar systems. Inclusion-bearing cells appeared to be oligodendrocytes which usually had larger and lighter nuclei than those of normal-looking oligodendrocytes. The distribution of GCIs was similar in all cases, irrespective of the degrees of OPCA and SND, but the frequency of GCIs varied from case to case. We classified all the cases into two categories based on the degree of neuropathological changes of SND (mild and severe) and, independently, into three groups based on that of OPCA (minimal, moderate and severe), i.e., a total of six groups. An association between the frequency of GCIs and the severity of the lesions was obtained. For example, many GCIs were seen the cerebellar white matter in the cases in which OPCA was not histologically confirmed. More GCIs were seen in the cases with moderate OPCA. In the cases with severe OPCA, GCIs were rarer and smaller, in proportion to the devastation of fibers; no GCIs were seen in the cases with more severe OPCA. The incidence of GCIs showed a positive correlation to the severity of OPCA but not that of SND in the corticopontine tracts, of both OPCA and SND in the pyramidal tracts, and of SND but not of OPCA in the pencil fibers of the putamen. It is suggested that GCIs may represent either a change synchronous with neuronal degeneration or a phenomenon preceding neuronal changes, especially in the cerebellar white matter. Thus, they may represent the early changes in MSA and may be a useful neuropathological hallmark for diagnosis of MSA, even in cases with minimal OPCA and SND.

Aged↗
PubMed1996

[Peptidergic sweating in multiple system atrophy and hereditary spinocerebellar ataxia with special reference to calcitonin gene-related peptide].

Calcitonin gene-related peptide (CGRP)-like immunoreactivity has been demonstrated to be present in nerve terminals around the sweat glands. We have previously demonstrated that CGRP modulates the cholinergic sweating activity. The present study was designed to evaluate the locally administrated CGRP on sweating of patients with multiple system atrophy (MSA) and hereditary spinocerebellar ataxia (HSCA) consisting of 10 males and 11 females. Among 9 HSCA, 3 was diagnosed as Machado-Joseph disease by clinical and DNA diagnostic assessment. CGRP and methacholine chloride (MCH) was dissolved in saline solution to specified concentration, and 0.1ml of which was injected intradermally at the center of a forearm test area. The sweat rate was recorded continuously by the capacitance hygrometry in a relatively cool environment in which the spontaneous sweating was absent. CGRP significantly increased the sweat rate when it was administrated with MCH on normal subjects. There was a clear dose-dependent relationship between the dose of CGRP and its enhancement. This enhancement was significantly reduced in patients with MSA as compared with controls. On the other hand, most of HSCA showed no remarkable impairment of CGRP enhancement. These results suggest that peptidergic sweating is extensively affected in patients with MSA but is not in patients with HSCA, which may be the consequence of peptidergic sweating dysfunction in MSA.

Adult↗
PubMed1998

Cerebral blood flow and metabolism in multiple system atrophy of the Shy-Drager syndrome type: a PET study.

To investigate the role of the autonomic nervous system in cerebral blood flow (CBF) and metabolism, CBF and oxygen metabolism in patients with multiple system atrophy of the Shy-Drager syndrome type were examined. Seven patients with Shy-Drager syndrome were imaged using positron emission tomography and 15O-labeled gases. There was excellent local coupling between CBF and the cerebral metabolic rate of oxygen in the resting state. Elevation of blood pressure induced by leg raising increased CBF. The inhalation of CO2 also increased CBF in the Shy-Drager patients. These results showed that autoregulation is impaired in Shy-Drager syndrome, but local metabolic-flow coupling in the resting state and the CBF response to CO2 inhalation are spared. We conclude that the autonomic nervous system plays an important role in autoregulation, but not in local metabolic-flow coupling in the resting state. We suggest that metabolic mechanisms may mediate resting metabolic-flow coupling.

Aged↗
PubMed1996

Atrial natriuretic peptide in multiple system atrophy.

Central nervous system feedback loops centered on hypothalamic neurons control atrial natriuretic peptide (ANP). We evaluated the ANP response to arterial hypotension, isotonic blood volume expansion, and increase in plasma osmolality in 14 patients with multiple system atrophy (MSA). Seven of the patients were characterized by a lack of vasopressin response to hypotension (MSA type B), suggesting chronic sinoaortic denervation, and seven by a preserved response (MSA type A). Orthostatic hypotension decreased ANP in controls and type A patients, whereas ANP in type B was not affected. Isotonic saline infusion increased ANP and diuresis in controls and type A patients, whereas it did not affect ANP in type B. Osmotic load increased plasma osmolality and vasopressin in controls and MSA patients and ANP in controls and type A but not in type B patients. In MSA patients with altered afferent control of vasopressin, ANP secretion is not stimulated by blood volume expansion, osmotic load, or blood pressure, suggesting that afferent excitatory control plays a role in the release of ANP.

Atrial Natriuretic Factor↗
PubMed1996

[MRI of degenerative extrapyramidal syndromes. Parkinson disease, progressive supranuclear palsy and multiple system atrophy].

MR imaging of the brain, particularly with high field MR imagers, may demonstrate signal abnormalities consistent with deposits of iron or other paramagnetic substances in extrapyramidal disorders. The diagnosis of Parkinson's disease and progressive supranuclear palsy can be made on clinical grounds in most of the cases and MR signs are of little help in the diagnosis of these diseases. In patients with parkinsonian disorders poorly responding to therapy, MR imaging may be useful in demonstrating signal abnormalities in the putamen that may help to establish the diagnosis of striatonigral degeneration (component of multiple system atrophy) with a poorer prognosis than Parkinson's disease. Finally, MR imaging may be useful in the exclusion of other disease processes.

Basal Ganglia Diseases↗
PubMed1993

Whole blood monoamine oxidase activity in Parkinson's disease and multiple system atrophy patients.

Monoamine oxidase type B (MAO-B), which catalyses the breakdown of dopamine (DA) in human brain, is said to be involved in the pathophysiology of Parkinson's disease (PD). Activity of MAO-B in PD has been measured in platelets isolated from blood samples in different studies, with contradictory results, possibly due to the differences in substrate used or to differences in platelet isolation. Therefore we measured MAO activity in whole blood, which is almost identical to MAO-B activity in platelets, in 25 drug-naive PD patients, 25 treated PD patients, 9 multiple system atrophy (MSA) patients and 20 controls, using a spectrofluorimetric method with kynuramin as a substrate. No statistically significant differences between groups were found, nor any correlation with the severity or duration of the disease.

Aged↗
PubMed1995

CYP2D6-debrisoquine hydroxylase gene polymorphism in multiple system atrophy.

Molecular genetic studies of the cytochrome P450 system enzyme CYP2D6, which hydroxylates debrisoquine, have indicated an excess of mutant alleles in large series of patients with Parkinson's disease (PD) when compared with controls. We have investigated CYP2D6 polymorphism in 91 patients with multiple system atrophy (MSA) in order to determine if this finding is specific to PD or if there is similar evidence of genetic susceptibility to neurotoxicity in MSA. The distribution of CYP2D6 alleles was not significantly different between MSA patients and controls, and there were fewer poor metabolisers in the MSA group than in the control group.

Alleles↗
PubMedDate not supplied

Further characterization of autonomic involvement in multiple system atrophy: a pupillometric study.

Pupillometry is a simple non-invasive technique which allows early detection of an altered functioning of both branches of the Autonomic Nervous System (ANS). In the present study, the pupillometric findings (dark and light diameters and light reflex) obtained in 14 Multiple System Atrophy (MSA) patients (5 with the striatonigral degeneration (SND) type and 9 with the olivopontocerebellar (OPCA) type were compared with those of a sex- and age-matched control group and with a group patients suffering from idiopathic parkinsonism who had never undergone treatment previously. MSA patients showed larger pupils after dark and light adaptation, high degrees of anisocoria after light adaptation and a complex impairment of pupil response to light (mainly occurring in the OPCA-type of MSA) represented by an increase in latency, contraction time and a reduction in contraction amplitude. These data point to the existence in MSA (particularly of OPCA-type) of a pupillary imbalance, mainly involving the parasympathetic branch of the ANS, which is likely to be due to an impairment of the central pathways subserving pupil response to light and is probably detectable in the early stages of the disease by means of dynamic pupillometric evaluation.

Adult↗
PubMed1979

Multiple system atrophy with autonomic failure: clinical, histological and neurochemical observations on four cases.

Four cases of progressive autonomic failure are described, in all of which there were additional non-autonomic neurological abnormalities, including pyramidal, extra-pyramidal and cerebellar features. Histological examination revealed cell degeneration in the substantia nigra, putamen and intermediolateral columns of the spinal cord as a common pathological finding. In addition, 3 cases showed loss of Purkinje cells in the cerebellum and degeneration of pontine nuclei and inferior olivary nuclei. In one case there was cell loss from the locus coeruleus, caudate nucleus, vestibular nuclei and dorsal vagal nuclei. These were, therefore, cases of multiple system atrophy. Neurochemically, a common feature was a profound depletion in dopamine and noradrenaline from brain regions which are normally rich in these catecholamines. Central cholinergic systems appeared to be involved also, but to a variable degree.

Aged↗
PubMed1995

[Pseudotransitory ischemic attacks as the initial symptom of multiple system atrophy].

A 59-year-old man presented with an 18-month history of episodes of visual disturbance and dysphagia in association with gait unsteadiness and leg weakness lasting between 45 and 120 min. These episodes were interpreted as vertebrobasilar transitory ischemic attacks. However, they had been preceded by impotence for 6 months. Autonomic function tests remained normal until the age of 62 years when the patient developed documented orthostatic hypotension. Parkinsonism was precipitated by neuroleptic treatment at the age of 59 years, at which time pyramidal signs were evident. The patient was unable to tolerate levodopa preparations and subsequently developed the full clinical picture of pathologically proven multiple system atrophy, dying at age 65, 7 years after his first symptom.

Aged↗
PubMed1992

Cerebrospinal fluid norepinephrine, 3-methoxy-4-hydroxyphenylglycol and neuropeptide Y levels in Parkinson's disease, multiple system atrophy and dementia of the Alzheimer type.

Neuropeptide Y, one of the most abundant polypeptides within the nervous system, is co-stored with catecholamines, especially norepinephrine (NE), thus suggesting its possible involvement in pathologies characterized by a noradrenergic impairment. In Parkinson's disease (PD), as well as in multiple system atrophy (MSA), a central noradrenergic deficit has been demonstrated, and in the dementia of Alzheimer type (DAT) an impaired noradrenergic transmission has been postulated. In this study we determined CSF NE and MHPG levels in 29 PD, 15 MSA, 22 DAT patients and in 36 controls, while CSF NPY-immunoreactivity (NPY-ir) levels were measured in 10 PD, 7 MSA, 10 DAT patients and 20 controls. PD, MSA, and DAT patients showed a significant reduction in CSF NPY-ir and NE levels compared with controls, while CSF MHPG levels resulted in a reduction in only the MSA group. Furthermore, an inverse correlation between either NE or MHPG levels and the duration of the orthostatic hypotension was found in MSA patients while for DAT patients the MHPG levels were directly correlated to the severity of cognitive impairment, and inversely to the duration of illness.

Adult↗