Co-Planar Stereotaxic Atlas of the Human Brain—3-Dimensional Proportional System: An Approach to Cerebral Imaging, J. Talairach, P. Tournoux. Georg Thieme Verlag, New York (1988), 122 pp., 130 figs. DM 268

Prospective Cohort Study

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)

Two decades of clinical experience with immunomodulatory treatments for multiple sclerosis point to distinct immunological pathways that drive disease relapses and progression. In light of this, we discuss our current understanding of multiple sclerosis immunopathology, evaluate long-standing hypotheses regarding the role of the immune system in the disease and delineate key questions that are still unanswered. Recent and anticipated advances in the field of immunology, and the increasing recognition of inflammation as an important component of neurodegeneration, are shaping our conceptualization of disease pathophysiology, and we explore the potential implications for improved healthcare provision to patients in the future.

Immunopathology of multiple sclerosis

Several studies, including work from the Parkinson's disease (PD) non-motor group and others, have established that the non-motor symptoms of PD are common, occur across all stages of PD, are under-reported, and are a key determinant of quality of life. Research suggests that the non-motor symptoms of the disease are frequently unrecognised by clinicians and remain untreated. Even when identified, there is a common perception that many of these symptoms are untreatable. The role of dopaminergic drugs in treating the various non-motor problems of PD, although clinically recognised, has received little attention. In this Review, we investigate the dopaminergic basis of the range of non-motor symptoms that occur in PD such as depression, apathy, sleep disorders (including rapid-eye movement sleep behaviour disorder), and erectile dysfunction. We discuss the evidence that these symptoms are treatable, at least in part, with various dopaminergic strategies and, where relevant, we also refer to the use of deep-brain stimulation of appropriate targets in the brain. This Review provides a comprehensive overview of the management of this challenging aspect of PD.

https://www.thelancet.com/pdfs/journals/laneur/PIIS1474-4422%2809%2970068-7.pdf

Non-motor symptoms of Parkinson's disease: dopaminergic pathophysiology and treatment

Introduction Dopaminergic neuron loss in substantia nigra (SN) in patients with PD is associated with deposits of iron. Susceptibility weighted imaging (SWI) is a high-resolution MR-based imaging technique for quantifying iron depositions in vivo. SWI may be a robust biomarker for clinical characterization of PD. Methods Forty-two patients with PD were studied with SWI imaging. Average phase shift (radians) and percentage iron deposition of the SN were analysed using SPIN software. SWI data were also compared between PD patients with early (4.0±0.5 PD duration) vs. established PD (7.7±1.9), and according to low (21.2±4.5) vs. high (41.3±8.7) UPDRS-III-assessed motor symptoms severity. Data were interrogated using analysis of covariance (age), relative to healthy controls, and using post hoc univariate tests. Results PD patients had higher phase shift values (p Conclusions PD patients show higher levels of deposits of iron in SN compared to healthy controls, and increased iron levels in SN are associated with prolonged disease and increased motor disability

https://jnnp.bmj.com/content/jnnp/86/11/e4.91.full.pdf

Susceptibility Weighted Imaging to Detect Nigral Iron Accumulation in Parkinson's Disease

Microglial cell activation is visualised with [11C]-PK11195 Positron Emission Tomography (PET) in neuro-asymptomatic HIV infected subjects on effective antiretroviral therapy

The development of Impulse Control Disorders (ICDs) in Parkinson’s disease (PD) is a recognised iatrogeniccomplication associated with the use of dopamine agonists. The prevalence of ICDs has been reported to be as high as14% in studies conducted in Europe and North America. Early case reports and recent large-scale studies have shown thatclinical features associated with the development of PD-related ICDs include novelty-seeking personality traits, earlyonset PD and a past history of psychiatric conditions. More recent studies have also suggested that ICDs may beassociated with deep brain stimulation and dyskinesias. Moreover, there is heterogeneity in the clinical features associatedwith the range of ICDs, with studies pointing out that compulsive sexual behaviours and binge eating have fewer clinicalfeatures in common than compulsive buying and pathological gambling.The recent increase in the number of functional neuroimaging studies on patients with PD and ICDs, particularly thosewith pathological gambling, has provided a unique opportunity to understand the neurobiology of the disorder, and hasindicated an abnormality in the meso-limbic dopaminergic pathways. Further studies directly comparing ICD suffererswith and without PD will provide valuable knowledge to aid in the management of both patient groups.This review will provide a clinical overview of impulse control behaviours in PD, including both commonly reportedICDs and other related impulsive-compulsive behaviours observed in PD.

Impulse Control Disorders in Parkinson’s Disease: A Review

Dear Editor, RE: BA systematic review of lessons learned from PET molecular imaging research in atypical parkinsonism | EJNM-D-16-00995 [25]^ Reply to Jean-Claude Baron Letter to Editor We are most grateful for the comments and criticism. D’Antona et al. [6] is indeed the first [F]FDG PET report demonstrating glucose hypometabolism in the frontal lobe of six patients with progressive supranuclear palsy (PSP) but has some methodological limitations. The authors used an autoradiographic paradigm to measure the cerebral metabolic rate of glucose (CMR Glu) and only four out of six PSP patients showed reliable images due to difficulties related to neck stiffness. When the authors tried to overcome this issue by using CMR Glu values generated by means of the kinetic method only three PSP patients and five control subjects could be analysed [6]. Additionally, no reliable volumetric brain measures have been reported, thus cortical atrophy could have affected the results. The other studies mentioned (i.e. [11, 20, 21]) were conducted before the establishment of PSP diagnostic criteria [National Institute of Neurological Disorders and Stroke and the Society for PSP (NINDS-SPSP) criteria; [22]]. As such, one of the patients clinically diagnosed with PSP and included in the analysis, revealed to have multiple system atrophy (MSA) at postmortem examination [11]. In our study, we have limited our review to the findings from studies using more reliable methodology, larger sample size and more selective inclusion criteria for the diagnosis of PSP (please see [8, 14, 15, 19, 24, 33]). With regards to correlation between frontal lobe hypometabolism and severity of cognitive dysfunction in PSP patients, we have discussed in our review the findings from Takahashi et al. [31] that used well-established measures of cognitive impairment for both groups of PSP patients and healthy controls, together with voxel-based analysis of [F]FDG uptakes. We have not reported findings from previous studies investigating striatal dopamine D2 receptors availability using [Br]bromospiperone PET in PSP patients ([2, 3]). [Br]Bromospiperone PET has similar kinetics and affinity as [C]methylspiperone PET [34]. [C]Methylspiperone has shown to have lower affinity for dopamine D2 receptors compared to [C]raclopride and to be unsuitable for evaluating the degeneration of dopamine D2 receptors in the rat striatum following injection of excitotoxin quinolinic acid by PET and ex vivo and in vitro autoradiography [16, 17]. Moreover, in contrast to [C]raclopride, [C]methylspiperone PET failed to detect D2 receptor occupancy by quetiapine in schizophrenic patients [13]. As stated in the inclusion criteria in the Methods section, we only reported findings from PET studies using the [C]raclopride PET radioligand with regards to dopamine D2 receptor availability in atypical parkinsonism. Bhatt et al. [4] showed decreased [F]Fdopa uptake in large striatal regions of interest (12 cm) of six PSP patients. In our study, we reported the results fromBrooks et al. [5] who used more reliable methods of analysis [28] and quantified [F]Fdopa uptake in specific striatal regions such as the caudate and the putamen. This Editorial Commentary refers to the article http://dx.doi.org/10.1007 /s00259-016-3596-x.

A systematic review of lessons learned from PET molecular imaging research in atypical parkinsonism (Niccolini and Politis, 2016) : Reply to Jean-Claude Baron Letter to Editor.

Marios Politis

Papers

Susceptibility Weighted Imaging to Detect Nigral Iron Accumulation in Parkinson's Disease

Microglial cell activation is visualised with [11C]-PK11195 Positron Emission Tomography (PET) in neuro-asymptomatic HIV infected subjects on effective antiretroviral therapy

Impulse Control Disorders in Parkinson’s Disease: A Review

A systematic review of lessons learned from PET molecular imaging research in atypical parkinsonism (Niccolini and Politis, 2016) : Reply to Jean-Claude Baron Letter to Editor.

Imaging in Huntington’s