Since anatomic MRI is presently not able to directly discern neuronal loss in Parkinson's Disease (PD), studying the associated functional connectivity (FC) changes seems a promising approach toward ...developing non-invasive and non-radioactive neuroimaging markers for this disease. While several groups have reported such FC changes in PD, there are also significant discrepancies between studies. Investigating the reproducibility of PD-related FC changes on independent datasets is therefore of crucial importance. We acquired resting-state fMRI scans for 43 subjects (27 patients and 16 normal controls, with 2 replicate scans per subject) and compared the observed FC changes with those obtained in two independent datasets, one made available by the PPMI consortium (91 patients, 18 controls) and a second one by the group of Tao Wu (20 patients, 20 controls). Unfortunately, PD-related functional connectivity changes turned out to be non-reproducible across datasets. This could be due to disease heterogeneity, but also to technical differences. To distinguish between the two, we devised a method to directly check for disease heterogeneity using random splits of a single dataset. Since we still observe non-reproducibility in a large fraction of random splits of the same dataset, we conclude that functional heterogeneity may be a dominating factor behind the lack of reproducibility of FC alterations in different rs-fMRI studies of PD. While global PD-related functional connectivity changes were non-reproducible across datasets, we identified a few individual brain region pairs with marginally consistent FC changes across all three datasets. However, training classifiers on each one of the three datasets to discriminate PD scans from controls produced only low accuracies on the remaining two test datasets. Moreover, classifiers trained and tested on random splits of the same dataset (which are technically homogeneous) also had low test accuracies, directly substantiating disease heterogeneity.
Body awareness is the result of sensory integration in the posterior parietal cortex; however, other brain structures are part of this process. Our goal is to determine how the cingulate cortex is ...involved in the representation of our body. We retrospectively selected patients with drug‐resistant epilepsy, explored by stereo‐electroencephalography, that had the cingulate cortex sampled outside the epileptogenic zone. The clinical effects of high‐frequency electrical stimulation were reviewed and only those sites that elicited changes related to body perception were included. Connectivity of the cingulate cortex and other cortical structures was assessed using the h2 coefficient, following a nonlinear regression analysis of the broadband EEG signal. Poststimulation changes in connectivity were compared between two sets of stimulations eliciting or not eliciting symptoms related to body awareness (interest and control groups). We included 17 stimulations from 12 patients that reported different types of body perception changes such as sensation of being pushed toward right/left/up, one limb becoming heavier/lighter, illusory sensation of movement, sensation of pressure, sensation of floating or detachment of one hemi‐body. High‐frequency stimulation in the cingulate cortex (1 anterior, 15 middle, 1 posterior part) elicits body perception changes, associated with a decreased connectivity of the dominant posterior insula and increased coupling between other structures, located particularly in the nondominant hemisphere.
Hypertrophic osteoarthropathy, also named Pierre Marie-Bamberger syndrome, represents a rare medical condition that may be considered either a primary or a secondary disease, and lung malignancies ...are responsible for more than two-thirds of the cases with secondary forms of the disease.
We present the case of a 41-year-old man referred to our Neurology Department for pain that was considered secondary to cervical disc protrusions. The neurologic examination was normal. However, the general examination showed digital clubbing, right lateral cervical adenopathy, and pachydermia. The radiographic examinations of the upper and lower limbs depicted osseous abnormalities typical for periostosis, and the computed tomography of the thorax showed the presence of a mass lesion in the right upper pulmonary lobe. High values of vascular endothelial growth factor were also found. The patient was admitted to the Pneumology Clinic, where biopsy was performed from the lateral cervical adenopathy.
The anatomopathological examination revealed multiple neoplastic infiltrates suggestive of adenocarcinoma metastasis. Based on the clinical examination and radiological and histologic findings, the diagnosis of pulmonary adenocarcinoma with lymph nodes metastases and paraneoplastic hypertrophic osteoarthropathy was established.
The patient received treatment with nonsteroidal antiinflammatory drugs and opiate analgesics that relieved the pain.
The patient was referred to the Oncology Department for further treatment of the primary pathology. He received different types of chemotherapeutics, immunotherapy, and radiotherapy. However, despite all therapeutic measures, the disease rapidly progressed and the patient died 9 months later.
This is an interesting case of a patient with an overlooked pathology, which was refereed to our clinic for further investigations of a pain that was considered neuropathic, secondary to small cervical protrusions. Conversely, the pain proved to be nociceptive and Pierre Marie-Bamberger syndrome was the positive diagnosis in our patient, as it can be associated with numerous diseases, especially of neoplastic origin.
Management of Parkinson’s disease (PD) is complicated due to its progressive nature, the individual patient heterogeneity, and the wide range of signs, symptoms, and daily activities that are ...increasingly affected over its course. The last 10–15 years have seen great progress in the identification, evaluation, and management of PD, particularly in the advanced stages. Highly specialized information can be found in the scientific literature, but updates do not always reach general neurologists in a practical and useful way, potentially creating gaps in knowledge of PD between them and neurologists subspecialized in movement disorders, resulting in several unmet patient needs. However, general neurologists remain instrumental in diagnosis and routine management of PD. This review provides updated practical information to identify problems and resolve common issues, particularly when the advanced stage is suspected. Some tips are provided for efficient communication with the members of a healthcare team specialized in movement disorders, in order to find support at any stage of the disease in a given patient, and especially for a well-timed decision on referral.
Introduction
Our study is using Independent Component Analysis (ICA) to evaluate functional connectivity changes in Parkinson’s disease (PD) in an unbiased manner.
Methods
Resting-state functional ...magnetic resonance imaging (rs-fMRI) data was collected for 27 PD patients and 16 healthy subjects. Differences for intra- and inter-network connectivity between healthy subjects and patients were investigated using FMRIB Software Library (FSL) tools (Melodic ICA, dual regression, FSLNets).
Results
Twenty-three ICA maps were identified as components of neuronal origin. For
intra
-
network connectivity changes
, eight components showed a significant connectivity increase in patients (
p
< 0.05); these were correlated with clinical scores and were largest for (sensori)motor networks. For
inter
-
network connectivity changes
, we found higher connectivity between the sensorimotor network and the spatial attention network (
p
= 0.0098) and lower connectivity between anterior and posterior default mode networks (DMN) (
p
= 0.024), anterior DMN and visual recognition networks (
p
= 0.026), as well as between visual attention and main dorsal attention networks (
p
= 0.03), for patients as compared to healthy subjects. The area under the Receiver Operating Characteristics (ROC) curve for the best predictor (partial correlation between sensorimotor and spatial attention networks) was 0.772. These functional alterations were not associated with any gray or white matter structural changes.
Conclusion
Our results show higher connectivity between sensorimotor and spatial attention areas in patients that may be related to the reduced movement automaticity in PD.
The cingulate cortex is part of the limbic system. Its function and connectivity are organized in a rostro-caudal and ventral-dorsal manner which was addressed by various other studies using rather ...coarse cortical parcellations. In this study, we aim at describing its function and connectivity using invasive recordings from patients explored for focal drug-resistant epilepsy.
We included patients that underwent stereo-electroencephalographic recordings using intracranial electrodes in the University Emergency Hospital Bucharest between 2012 and 2019. We reviewed all high frequency stimulations (50 Hz) performed for functional mapping of the cingulate cortex. We used two methods to characterize brain connectivity. Effective connectivity was inferred based on the analysis of cortico-cortical potentials (CCEPs) evoked by single pulse electrical stimulation (SPES) (15 s inter-pulse interval). Functional connectivity was estimated using the non-linear regression method applied to 60 s spontaneous electrical brain signal intervals. The effective (stimulation-evoked) and functional (non-evoked) connectivity analyses highlight brain networks in a different way. While non-evoked connectivity evidences areas having related activity, often in close proximity to each other, evoked connectivity highlights spatially extended networks. To highlight in a comprehensive way the cingulate cortex’s network, we have performed a bi-modal connectivity analysis that combines the resting-state broadband h2 non-linear correlation with cortico-cortical evoked potentials. We co-registered the patient’s anatomy with the fsaverage FreeSurfer template to perform the automatic labeling based on HCP-MMP parcellation. At a group level, connectivity was estimated by averaging responses over stimulated/recorded or recorded sites in each pair of parcels. Finally, for multiple regions that evoked a clinical response during high frequency stimulation, we combined the connectivity of individual pairs using maximum intensity projection.
Connectivity was assessed by applying SPES on 2094 contact pairs and recording CCEPs on 3580 contacts out of 8582 contacts of 660 electrodes implanted in 47 patients. Clinical responses elicited by high frequency stimulations in 107 sites (pairs of contacts) located in the cingulate cortex were divided in 10 groups: affective, motor behavior, motor elementary, versive, speech, vestibular, autonomic, somatosensory, visual and changes in body perception. Anterior cingulate cortex was shown to be connected to the mesial temporal, orbitofrontal and prefrontal cortex. In the middle cingulate cortex, we located affective, motor behavior in the anterior region, and elementary motor and somatosensory in the posterior part. This region is connected to the prefrontal, premotor and primary motor network. Finally, the posterior cingulate was shown to be connected with the visual areas, mesial and lateral parietal and temporal cortex.
Display omitted
•Multi-modal (effective, functional) connectivity evidences cingulate cortex network.•Connectivity maps for cingulate subregions highlight a rostro-caudal organization.•High-frequency stimulation of 107 sites elicited clinical responses.•Bi-modal connectivity maps for regions evoking specific clinical effects are created.
In this paper we present the case of a 91 years-old male patient who was admitted for motor weakness accompanied by neuropathic pain suggestive for a femoral mononeuropathy which onset and evolution ...was subacute – chronic. The clinical examination and laboratory investigations confirmed the diagnosis of femoral nerve mononeuropathy, but also showed others signs and symptoms suggestive for a disorder in the area in the lower digestive and urinary tracts, which finally allowed us the etiologic diagnosis of recto-sigmoid colon cancer. This case raises some problems related to the etiological differential diagnosis of a femoral nerve neuropathy which most often is not the consequence of a disco-vertebral pathology but, of other lesions located inside the pelvis as long as this nerve has its initial trajectory in the intra-abdominal region having different neighboring reports on the left and on the right side, which are also different according to the patient’s sex in particular with different segments of the lower digestive tract and in women also with the salpingian-ovarian structures. Comorbidities, in particular diabetes mellitus and also the particularities related to the patient’s age increase the complexity of the problem related to the etiological differential diagnosis.
Recent studies emphasize an increased prevalence of non-motor symptoms in idiopathic dystonia with focal onset (IDFO), but their pathophysiological relationship is not clear.
We aimed to identify the ...prevalence of depression and neurocognitive impairment in a group of patients with idiopathic dystonia with focal onset and their impact on the patients’ quality of life.
This study represents a component of an ongoing research project – GENDYS. From the database of this project, we selected 48 patients 56.62+/-14.16 years old who have been examined clinically and using specific scales: Patient Health Questionnaire-9 (for depression), Montreal Cognitive Assessment - MoCA (for cognitive impairment), and a 5-degree analog scale for subjective perception of the severity of the disease. We conducted a descriptive cross-sectional study on patients with depression and cognition evaluated by the above-mentioned scales. We also performed a nested case-control analysis on 20 IDFO patients with and without at least moderate depression matched for age and gender; the cut-offs for depression were PHQ-9 score ≥10 and PHQ9 <5, for the depression group and the control group, respectively. The cut-off for MoCA was 26 points. 22 IDFO patients (46%) had depression; 54.5% of IDFO patients with depression had cognitive impairment, indicating a slight trend of increased cognitive impairment in those with depression compared to those without; the perception of the severity of disease was the greatest in patients with depression.
Depression is more prevalent in patients with IDFO and is associated with a worse perception of the disease severity.
Objectives. Transient ischemic attacks (TIAs) can present with a large variety of clinical features that impose an extensive differential diagnosis. We report this case due to its particularities of ...clinical presentation and diagnosis algorithm. Material and methods. A 72-year old male patient presented to our Neurology Department for recurrent episodes of numbness felt in the right upper limb. The initial patient history deemed the episodes as consistent with simple focal seizures. The cerebral computed tomography scan showed no recent lesions. Furthermore, video-electroencephalography was performed, but revealed no abnormalities. A second, more thorough anamnesis revealed that paresthesia was also present in the left part of the upper and lower lips and that the numbness episodes were being accompanied by blurred vision, loss of balance and difficulties coordinating his right upper limb. Results. The time-of-flight magnetic resonance angiography revealed dolichoectasia of the left vertebral and basilar arteries. Furthermore, the basilar artery grooved and displaced the pons with respect to the midline. The angio-computed tomography scan of the supra-aortic trunks showed multiple stenoses located in the V4 segment of both vertebral arteries, in the intracavernous segment of the right internal carotid artery and in the proximal segment (90%) and the middle third part (80%) of the basilar artery. The patient was diagnosed with vertebrobasilar TIAs and started treatment with Clopidogrel with no recurrence of the TIAs. Conclusions. This case was chosen to be presented in order to highlight another facet of the clinical polymorphism exhibited by transient ischemic attacks.
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