Tsuyoshi Ogata

Sensitivity and specificity of metaiodobenzylguanidine (MIBG) myocardial accumulation in the diagnosis of Lewy body diseases in a movement disorder clinic

Cardiac scintigraphy with metaiodobenzylguanidine (MIBG), an analog of norepinephrine (NE), is now widely performed in Lewy body diseases (Parkinson’s disease (PD), dementia with Lewy bodies (DLB), pure autonomic failure (PAF), and REM sleep-related behavioral disorder (RBD)) to assess function of the sympathetic nerve endings in the heart. Monitoring of this function is considered important because cardiac sympathetic denervation has been documented in Lewy body diseases by scintigraphy as well as by pathology [1]. However, sensitivity and specificity of MIBG myocardial scintigraphy in the diagnosis of Lewy body diseases has not fully been established. The objective of this study was to determine sensitivity and specificity of MIBG myocardial scintigraphy in the diagnosis of Lewy body diseases in a movement disorder clinic. The study enrolled 182 new patients who visited our movement disorder clinic in a period of 15 months, most of whom were referred patients. They comprised Lewy body diseases in 127 (90 PD, 34 DLB, one PAF, and 2 RBD; 53 men, 74 women; mean age 73 years (range 51–85 years); mean disease duration 6.0 years (range 1–18 years); median Hohen Yahr stage 3 (range 1–4) in PD, DLB), and neurologic diseases control in 62 (parkinsonian gait disorder, cognitive decline, or autonomic dysfunction; including 21 Alzheimer’s disease [AD], 9 progressive supranuclear palsy [PSP], etc.) (Fig. 1). All patients fulfilled the ‘probable’ diagnostic consensus criteria for degenerative neurological disorders, which were confirmed again during a 3-year follow-up period. In order to confirm the diagnosis, in addition to standard neurological and cognitive examination, we performed brain magnetic resonance imaging (MRI) and brain single-photon emission computed tomography (SPECT) imaging using 99mTclabeled L,L-ethyl cysteinate dimer (ECD) in all patients. The methods of MIBG scintigraphy are based on evidence that NE and MIBG have the same mechanisms for uptake, storage, and release. The cut-off value of delayed images of the heart versus mediastinum (HM) ratio was 2.0. Statistical analysis was

Dietary Herb Extract Rikkunshi-To Ameliorates Gastroparesis in Parkinson's Disease: A Pilot Study

Objective: To perform an open trial on the effects of the extract of the dietary herb Rikkunshi-to (RKT) on gastroparesis in Parkinsons disease (PD) patients, using objective parameters given by the 13C-sodium acetate expiration breath test (gastric emptying study). Methods: Twenty patients with PD were enrolled into this study. Eleven patients were male and 9 were female, with the following characteristics (mean ± SD): age, 69.4 ± 8.17 years; disease duration, 4.34 ± 4.03 years; modified Hoehn and Yahr stage, 2.37 ± 0.98, and Unified Parkinsons Disease Rating Scale Part 3 motor score, 16.6 ± 7.37. Fourteen patients came to the clinic due to constipation; 16 patients were taking 288 ± 72 mg/day levodopa/carbidopa, 2 were taking dopamine agonists, and the others were not treated yet. All patients underwent the breath test. Statistical analysis was performed using Students t test. Results: RKT was well tolerated by all patients and none experienced abdominal pain or other adverse effects, except for its bitter taste. RKT significantly reduced the peak time of the 13C-dose-excess curve (p < 0.05). Conclusion: In this pilot trial, we found a significant shortening of the gastric emptying time after administration of the dietary herb extract RKT in PD patients. Further studies examining both gastric emptying and delayed-on in PD are warranted.

Lower urinary tract function in dementia with Lewy bodies (DLB)

Dementia with Lewy bodies (DLB) is the second most common degenerative cause of dementia, whereas lower urinary tract (LUT) function in DLB patients has not been fully delineated. We investigated LUT function in DLB by clinical‐urodynamic observations.

Nizatidine ameliorates gastroparesis in Parkinson's disease: a pilot study.

The objective of this work was to perform an open trial of the effects of nizatidine (NZT), a selective histamine H2‐receptor antagonist and a cholinomimetic, on gastroparesis in Parkinsons disease (PD) patients, using objective parameters given by a gastric emptying study using a 13C‐sodium acetate expiration breath test.

Nizatidine Ameliorates Slow Transit Constipation in Parkinson's Disease

To the Editor: Constipation (slow transit and anorectal types) is one of the most common nonmotor disorders in Parkinson’s disease (PD). Neuronal degeneration with alpha-synuclein-positive Lewy bodies appears in the myenteric plexus. Constipation leads to emergency intestinal pseudoobstruction, interferes with levodopa absorption, triggers malignant syndrome, and can appear earlier than motor disorder. Because slow-transit constipation is not responsive to levodopa, add-on therapies have been tried, with variable benefits. The results of a colonic transit time (CTT) test before and after administration of nizatidine, which acts on histamine H2 receptors, is presented. Inclusion criteria were PD and gastrointestinal tract (GIT) symptoms (upper: nausea, postprandial bloating; lower: bowel movement <3 times a week, difficult defecation) (12 participants complained of constipation). Individ-

Levodopa Does Not Worsen Gastric Emptying in Parkinson's Disease.

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DEHYDRATION ENCEPHALOPATHY: A NEUROLOGICAL EMERGENCY IN THE OLDER ADULTS

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Myasthenia Gravis Manifesting As Head Drop in an Elderly Adult with Parkinson's Disease.

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Transdermal Dopamine Agonist Ameliorates Gastric Emptying in Parkinson's Disease.

This research is supported by Grant T15LM007442 from the National Library of Medicine. Conflict of Interest: The editor in chief has reviewed the conflict of interest checklist provided by the authors and has determined that the authors have no financial or any other kind of personal conflicts with this paper. Author Contributions: Chaudhuri: study design, recruitment, data collection, preparation of manuscript. Oudejans: data analysis and interpretation. Thompson, Demiris: study design, assisting primary author throughout the study, data interpretation, preparation of final manuscript. Sponsor’s Role: None.

Amyotrophic Lateral Sclerosis Presenting Respiratory Failure as the Sole Initial Manifestation

It is rare that amyotrophic lateral sclerosis (ALS) presents with respiratory failure as the sole initial manifestation. A 72-year-old man with mild chronic obstructive pulmonary disease developed exertional dyspnea for 13 months. He then progressed to limb weakness that led to the diagnosis of ALS. Although rare, ALS can present with respiratory failure as the sole initial manifestation more than 1 year prior to limb weakness.