Norbert Kovács

Morphometric changes of gray matter in Parkinson's disease with depression: a voxel-based morphometry study.

The origin of the high rate of depression in idiopathic Parkinsons disease (PD) is unknown. We applied voxel‐based morphometry (VBM), as a sensitive tool in detection of gray matter MR density alterations, to find differences in depressed and nondepressed PD patients. Patients with idiopathic PD were classified into depressed (DPD) and nondepressed (NDPD) groups based on the Montgomery‐Åsberg Depression Rating Scale (MADRS). Subsequently, a group comparisons were performed between depressed PD (n = 23), nondepressed PD (n = 27) and normal healthy controls (NC, n = 16). There was no difference in gray matter density comparing healthy controls to any PD groups. However, when NDPD and DPD cohorts were compared, density alteration of the bilateral orbitofrontal, bilateral rectal gyrus, and also the right superior temporal pole was detected in the depressed subgroup. Exploratory analyses revealed an inverse correlation of MADRS scores and severity of VBM alteration in these regions beside the right medial temporal gyrus, anterior and medial cingular gyrus, and parahippocampal gyrus. These results suggest that depression in PD is related to gray matter decrease in the bilateral orbitofrontal and right temporal regions as well as the limbic system.

The Impact of Left Prefrontal Repetitive Transcranial Magnetic Stimulation on Depression in Parkinson's Disease: a Randomized, Double-Blind, Placebo-Controlled Study

Based on several open‐label and case studies, repetitive transcranial magnetic stimulation (rTMS) seems to have an antidepressive effect on patients with Parkinsons disease (PD). However, this hypothesis requires further confirmation. We conducted a randomized, double‐blind placebo‐controlled study to evaluate the effect of rTMS over the left dorsolateral prefrontal cortex (DLPFC) on depression and various motor and nonmotor features of PD. Twenty‐two PD patients with mild or moderate depressive episodes were assigned into two groups, one receiving real‐rTMS (90% of resting motor threshold, 5 Hz, 600 pulses‐a‐day for 10 days) over the left DLPFC, and another group receiving sham‐rTMS. An investigator blinded to the treatment performed three video‐taped examinations on each patient: before stimulation (baseline), 1 day (short term), and 30 days after treatment session ended (long‐term effect). Mini‐Mental State Examination, Unified Parkinsons Disease Rating Scale (UPDRS), Hoehn‐Yahr, Epworth Sleepiness, Visual Analog and Montgomery‐Asberg Depression Rating Scales (MADRS), Beck Depression Inventory (BDI), and Trail making and Stroop tests were applied. In the actively treated group, not only depression rating scales showed significant improvement 30 days after treatment ended (BDI by 44.4% and MADRS by 26.1%), but also the accuracy of Stroop test (by 16%). We could also demonstrate an insignificant improvement in UPDRS‐III by 7.5 points (31.9%, P = 0.06). In the sham‐treated group none of the examined tests and scales improved significantly after sham stimulation. Our study demonstrated the beneficial effect of the left DLPFC rTMS on depression in PD lasting at least 30 days after treatment. However, this result should be confirmed in patients with severe depression by further clinical trials.

Sensitivity and specificity of Addenbrooke's Cognitive Examination, Mattis Dementia Rating Scale, Frontal Assessment Battery and Mini Mental State Examination for diagnosing dementia in Parkinson's disease

INTRODUCTION Among the non-motor features of Parkinsons disease (PD), cognitive impairment is one of the most troublesome problems. Highly sensitive and specific screening instruments for detecting dementia in PD (PDD) are required in the clinical practice. METHODS In our study we evaluated the sensitivity and specificity of different neuropsychological tests (Addenbrookes Cognitive Examination, ACE; Frontal Assessment Battery, FAB and Mattis Dementia Rating Scale, MDRS) in 73 Parkinsons disease patients without depression. By receiver operating characteristic curve analysis, these screening instruments were tested against the recently established clinical diagnostic criteria of PDD. RESULTS Best cut-off score for ACE to identify PDD was 80 points (sensitivity = 74.0%, specificity = 78.1%). For FAB the most optimal cut-off value was 12 points (sensitivity = 66.3%, specificity = 72.2%); whereas for MDRS it was 125 points (sensitivity = 89.8%, specificity = 98.3%). Among the examined test batteries, MDRS had the best clinicometric profile for detecting PDD. CONCLUSION Although the types of applied screening instruments might differ from movement disorder clinic to clinic within a country, determination of the most specific and sensitive test for the given population remains to be an important task. Our results demonstrated that the specificity and sensitivity of MDRS was better than those of ACE, FAB and MMSE in Hungary. However, further studies with larger sample size and more uniform criteria for participation are required to determine the most suitable screening instrument for cognitive impairment.

Status dystonicus: Predictors of outcome and progression patterns of underlying disease

Status dystonicus (SD) is a rare, life‐threatening disorder characterized by acute worsening of generalized dystonia.

MRI-assessed volume of left and right hippocampi in females correlates with the relative length of the second and fourth fingers (the 2D: 4D ratio)

Atrophy of the left or right side of the hippocampus has been related to cognitive deficits and psychiatric disease. In this study, we examined the correlation between the hippocampal volume laterality index and the relative lengths of the second (index finger) and fourth (ring finger) digits (2D:4D) in healthy female subjects. The 2D:4D ratio is fixed in utero, and the ratio is higher in women than in men. There is evidence that this ratio is an indicator of the intrauterine concentration of testosterone, which influences the development of different regions of the brain. Assessing the volume of different parts of the brain of 40 healthy adult female students by magnetic resonance imaging (MRI), we found that the 2D:4D ratio was associated with an asymmetry in the hippocampal sub-regions. Smaller volume on the left side was found in the posterior part of the hippocampus in females with a low (masculine type) 2D:4D ratio. On the other hand, smaller volume on the left side was found in the middle part of the hippocampus in females with a high (female type) 2D:4D ratio. Thus, the development of the middle and posterior regions of the hippocampal formation may respond in opposite ways to prenatal levels of testosterone. Other brain regions such as the amygdala, the cerebral cortex, the total volume hippocampus, and the head of the hippocampus did not show such a difference.

Staged bilateral stereotactic pallidothalamotomy for life-threatening dystonia in a child with Hallervorden–Spatz disease

Hallervorden–Spatz disease (HSD) is a rare disorder characterized by progressive motor dysfunction and dementia. Dystonia is the most prominent and disabling symptom, responding only to a modest extent to pharmacological therapy. At the moment, only a few cases have been reported to improve dystonia and even fewer to resolve status dystonicus for a longer period in children. The authors present the case of a 10‐year‐old boy who had progressive generalized dystonia, resulting in spontaneous femur fracture and life‐threatening swallowing and respiratory disability. As a rescue solution, staged bilateral pallidothalamotomy was performed. Postoperatively, Burke–Fahn–Marsden Dystonia Rating Scale and Dystonia Disability Rating Scale improved (from 116 and 30 points to 41 and 18 points, respectively) and painful dystonia was resolved, which was still continuous 4 years later (47 and 20 points). Stereotactic staged bilateral pallidothalamotomy should be considered as a potential treatment in the management of life‐threatening generalized dystonia related to HSD.

History of simple febrile seizures is associated with hippocampal abnormalities in adults

Background: It is unclear whether the hippocampal abnormality in temporal lobe epilepsy (TLE) is a consequence or the cause of afebrile or febrile seizures (FSs). We investigated whether hippocampal abnormalities are present in healthy adults > 15 years after a simple FS.

Peri-ictal vegetative symptoms in temporal lobe epilepsy

We investigated peri-ictal vegetative symptoms (PIVS) in 141 patients with adult temporal lobe epilepsy (TLE) and assessed frequency, gender effect, and lateralizing value of peri-ictal autonomic signs. We recorded abdominal auras in 62%, goosebumps in 3%, hypersalivation in 12%, spitting in 1%, cold shivering in 3%, urinary urge in 3%, water drinking in 7%, postictal nose wiping (PNW) in 44%, and postictal coughing in 16%. At least one vegetative sign appeared in 86% of the patients. The presence of PIVS did not have a significant lateralizing value. PNW occurred in 52% of women and in 33% of men, whereas any PIVS was present in 93% of women and 77% of men. In summary, contradictory to previous studies, the presence of PIVS has no lateralizing value, which may be linked to a low frequency of occurrence of PIVS. PIVS, especially PNW, occurred more frequently in women, supporting the gender differences in epilepsy.

Are there any gender differences in the hippocampus volume after head-size correction? A volumetric and voxel-based morphometric study

Previous findings on normal sexual dimorphism in hippocampal volume have not always been consistent. This study investigated gender differences in hippocampal volume using different head-size correction strategies. T1-weighted MR images were collected in 99 healthy, Caucasian, university students (66 female subjects; mean age: 23.1 ± 2.3, range: 19-31 years). Sexual dimorphism in hippocampus was investigated by automated MRI volumetry and voxel-based morphometry (VBM) using both general linear model (GLM) and proportion head-size correction strategies. Absolute hippocampal volumes were larger in men than women. After adjusting for head-size, the proportion method indicated larger hippocampi in women than men, while no gender differences were found using the GLM approach. Investigating absolute hippocampal volumes in 15 head-size matched pairs of males and females indicated no gender differences. We suggest that there is no sexual dimorphism in hippocampal size and the apparent gender differences found by the proportion method may have more to do with head-size than with sex. The GLM and proportion head-size correction strategies are not interchangeable and may yield different results. The importance of the present findings is mostly related to scientific reproducibility across MRI volumetry or VBM studies.

Changes of Migraine‐Related White Matter Hyperintensities After 3 Years: A Longitudinal MRI Study

The aim of this longitudinal study was to investigate changes of migraine‐related brain white matter hyperintensities 3 years after an initial study. Baseline quantitative magnetic resonance imaging (MRI) studies of migraine patients with hemispheric white matter hyperintensities performed in 2009 demonstrated signs of tissue damage within the hyperintensities. The hyperintensities appeared most frequently in the deep white matter of the frontal lobe with a similar average hyperintensity size in all hemispheric lobes. Since in this patient group the repeated migraine attacks were the only known risk factors for the development of white matter hyperintensities, the remeasurements of migraineurs after a 3‐year long follow‐up may show changes in the status of these structural abnormalities as the effects of the repeated headaches.