The Mesolimbic Dopamine Reward Circuit in Depression

Objective
To present the International Parkinson and Movement Disorder Society (MDS) Clinical Diagnostic Criteria for Parkinson9s disease.
Background
Although several diagnostic criteria for Parkinson9s disease have been proposed, none have been officially adopted by an official Parkinson society. Moreover, the commonest-used criteria, the UK brain bank, were created more than 25 years ago. In recognition of the lack of standard criteria, the MDS initiated a task force to design new diagnostic criteria for clinical Parkinson9s disease.
Methods/Results
The MDS-PD Criteria are intended for use in clinical research, but may also be used to guide clinical diagnosis. The benchmark is expert clinical diagnosis; the criteria aim to systematize the diagnostic process, to make it reproducible across centers and applicable by clinicians with less expertise. Although motor abnormalities remain central, there is increasing recognition of non-motor manifestations; these are incorporated into both the current criteria and particularly into separate criteria for prodromal PD. Similar to previous criteria, the MDS-PD Criteria retain motor parkinsonism as the core disease feature, defined as bradykinesia plus rest tremor and/or rigidity. Explicit instructions for defining these cardinal features are included. After documentation of parkinsonism, determination of PD as the cause of parkinsonism relies upon three categories of diagnostic features; absolute exclusion criteria (which rule out PD), red flags (which must be counterbalanced by additional supportive criteria to allow diagnosis of PD), and supportive criteria (positive features that increase confidence of PD diagnosis). Two levels of certainty are delineated: Clinically-established PD (maximizing specificity at the expense of reduced sensitivity), and Probable PD (which balances sensitivity and specificity).
Conclusion
The MDS criteria retain elements proven valuable in previous criteria and omit aspects that are no longer justified, thereby encapsulating diagnosis according to current knowledge. As understanding of PD expands, criteria will need continuous revision to accommodate these advances. Disclosure: Dr. Postuma has received personal compensation for activities with Roche Diagnostics Corporation and Biotie Therapies. Dr. Berg has received research support from Michael J. Fox Foundation, the Bundesministerium fur Bildung und Forschung (BMBF), the German Parkinson Association and Novartis GmbH.

MDS Clinical Diagnostic Criteria for Parkinson's Disease (S19.001)

There is no clear consensus regarding the frequency (and hence, the risk), of dyskinesias or motor fluctuations during chronic levodopa therapy for Parkinson's disease (PD). Multiple clinical series have tabulated these frequencies since the advent of levodopa over 30 years ago. We were interested in determining: (1) the aggregate frequency figures in the existing literature; and (2) how clinical series from the early levodopa era, which included patients with longer durations of parkinsonism, compare to more recent (modern era) series. We searched MEDLINE for all English language publications reporting the cumulative frequency of levodopa-induced dyskinesias or motor fluctuations during discrete intervals of treatment. This generated 2,478 publications spanning 1966 through September 2000. Papers with appropriate titles or abstracts were reviewed; reference lists from published clinical series were a source of additional papers for review. This ultimately yielded 74 publications with adequate data, relating to 112 intervals of levodopa treatment. Series that included patients with PD-onset well before levodopa availability (pre-levodopa era) were separately analyzed from all subsequent series. Series were grouped by duration of levodopa therapy and the median frequencies of dyskinesias and motor fluctuations were tabulated for each group. The data were analyzed both with and without adjustment for the number (N) in each series. Among series containing pre-levodopa era patients, the median dyskinesia frequency was already 50% by 5-6 months of treatment. This contrasts with the modern era series where dyskinesias were reported later in treatment. The median dyskinesia frequency was slightly less than 40% by 4-6 years of levodopa therapy among modern era patients. Motor fluctuations (wearing-off) were not tabulated in most of the early levodopa series. Among modern era reports, motor fluctuations were nil during the first year of levodopa therapy but were experienced by approximately 40% of patients by 4-6 years of treatment. Similar results were found when the analyses were restricted to only prospective studies where levodopa motor complications were targeted outcome measures. The conclusions reached were: (1) patients from the pre-levodopa era experienced dyskinesias much earlier during levodopa treatment than modern era patients, perhaps because of longer durations of pre-existing PD; (2) in the present era, patients treated with levodopa therapy for 4-6 years have approximately a 40% likelihood of experiencing motor fluctuations and a risk of dyskinesias just short of 40%; and (3) these findings represent incident data and the prevalence of clinically important morbidity may be substantially less.

Frequency of levodopa-related dyskinesias and motor fluctuations as estimated from the cumulative literature

https://digital.csic.es/bitstream/10261/72251/1/GarciaSegura%2c2001%2cProgressNeurobiol.%2c63%2c29-.pdf

Neuroprotection by estradiol.

The neurobiology and control of anxious states

Previous work from our laboratory showed prevention of 1-methyl-4-phenyl-1,2,3,6 tetrahydropyridine (MPTP) induced dopamine depletion in striatum of C57Bl/6 mice by 17β-estradiol, progesterone, and raloxifene, whereas 17α-estradiol had no effect. The present study investigated the mechanism by which these compounds exert their neuroprotective activity. The hormonal effect on the dopamine transporter (DAT) was examined to probe the integrity of dopamine neurons and glutamate receptors in order to find a possible excitotoxic mechanism. Drugs were injected daily for 5 days before MPTP (four injections, 15 mg/kg ip at 2-h intervals) and drug treatment continued for 5 more days. MPTP induced a decrease of striatal DAT-specific binding (50% of control) and DAT mRNA in the substantia nigra (20% of control), suggesting that loss of neuronal nerve terminals was more extensive than cell bodies. This MPTP-induced decrease of striatal [125I]RTI-121 specific binding was prevented by 17β-estradiol (2 μg/day), progesterone (2 μg/day), or raloxifene (5 mg/kg/day) but not by 17α-estradiol (2 μg/day) or raloxifene (1 mg/kg/day). No treatment completely reversed the decreased levels of DAT mRNA in the substantia nigra. Striatal [125I]RTI-121 specific binding was positively correlated with dopamine concentrations in intact, saline, or hormone-treated MPTP mice. Striatal NMDA-sensitive [3H]glutamate or [3H]AMPA specific binding remained unchanged in intact, saline, or hormone-treated MPTP mice, suggesting the unlikely implication of changes of glutamate receptors in an excitotoxic mechanism. These results show a stereospecific neuroprotection by 17β-estradiol of MPTP neurotoxicity, which is also observed with progesterone or raloxifene treatment. The present paradigm modeled early DA nerve cell damage and was responsive to hormones. Synapse 41:131–138, 2001. © 2001 Wiley-Liss, Inc.

Neuroprotective properties of 17beta-estradiol, progesterone, and raloxifene in MPTP C57Bl/6 mice.

Phytoestrogens, and particularly resveratrol, a red wine polyphenol, are currently under study for their therapeutic antioxidant properties. Administration of the dopaminergic neurotoxin 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP) to C57BL/6 mice targets nigrostriatal dopaminergic neurons, leading to cell death and striatal dopamine (DA) depletion. The aim of the present study was to analyze the protective effect of a diet rich in resveratrol against MPTP-induced neuronal death. Male mice were kept on a phytoestrogen-free diet, supplemented or not with 50 or 100 mg/kg/day of resveratrol for 1 or 2 weeks, after which MPTP was injected intraperitoneally. We observed that daily administration of resveratrol prevented MPTP-induced depletion of striatal DA, and maintained striatal tyrosine hydroxylase (TH) protein levels. Our results also demonstrated that mice treated with resveratrol prior to MPTP administration showed more abundant TH-immunopositive neurons than mice given only MPTP, indicating that resveratrol protects nigral neurons from MPTP insults. Altogether, these data revealed that resveratrol can counteract the toxic effects of the neurotoxin MPTP and, as such, it may be regarded as a powerful molecule for complementary neuroprotective therapy.

Resveratrol, a red wine polyphenol, protects dopaminergic neurons in MPTP-treated mice

Contribution of estrogen receptors alpha and beta to the effects of estradiol in the brain.

The reuptake of dopamine into nerve terminals is the primary mechanism of inactivation of this neurotransmitter in the synaptic cleft. We report sex differences and estrous cycle variations of rat striatal dopamine uptake sites. During the estrous cycle, peak density of striatal dopamine uptake sites labelled with [3H]GBR-12935 occurred in the morning of proestrus in coincidence with peak dopamine, serotonin, dihydroxyphenylacetic acid and 5-hydroxytryptophan levels pointing to a presynaptic effect of gonadal hormones. Striatal homovanillic acid and 5-hydroxyindoleacetic acid levels as well as [3H]GBR-12935 binding affinity remained unchanged throughout the estrous cycle. The density of [3H]GBR-12935 striatal binding sites was lower in ovariectomized rats compared to intact female rats during the estrous cycle, whereas it was similar in gonadectomized male rats, intact male rats and ovariectomized rats. Binding affinity was in general similar for all the groups of rats examined. The affinity of dopamine for striatal [3H]GBR-12935 binding sites was similar in males and ovariectomized females, and did not change during the female estrous cycle. In summary, striatal dopamine uptake site density was lower in male compared to intact female rats and was shown to fluctuate during the female estrous cycle. These results suggest that gonadal hormones could influence the activity of psychoactive drugs acting on neuronal dopamine uptake sites.

Marc Morissette

Papers

Neuroprotective properties of 17beta-estradiol, progesterone, and raloxifene in MPTP C57Bl/6 mice.

Resveratrol, a red wine polyphenol, protects dopaminergic neurons in MPTP-treated mice

Contribution of estrogen receptors alpha and beta to the effects of estradiol in the brain.

Sex and estrous cycle variations of rat striatal dopamine uptake sites.

Ovarian steroids and selective estrogen receptor modulators activity on rat brain NMDA and AMPA receptors.