The segmental progression of early untreated Parkinson disease: a novel approach to clinical rating.

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J Neurol Neurosurg Psychiatry 2009 Jul;

Authors: Michael W M Schüpbach, Jean-Christophe Corvol, Virginie Czernecki, Mouna Ben Djebara, Jean-Louis Golmard, Yves Agid, Andreas Hartmann

CIC, Fédération des Maladies du Système Nerveux, Groupe Hospitalier Pitié-Salpêtrière, Paris, France.

OBJECTIVE: To assess the ability of potentially neuroprotective compounds to slow the progression of Parkinson's disease (PD), sensitive rating scales are needed to detect clinically meaningful effects. We evaluated the topographical progression of motor signs in early untreated PD to complement current clinical ratings and enhance the sensitivity to detect disease progression. METHODS: Twelve patients referred for diagnostic evaluation of so far untreated de novo PD underwent detailed clinical assessment of motor parkinsonian signs at baseline, 6, and 12 months' follow-up using the Unified Parkinson's Disease Rating Scale, motor part (UPDRS-III), and a newly developed approach of detailed segmental rating taking into account the localization of motor signs in all the major joints and muscle groups in the body. The progression of PD as measured with the UPDRS-III was compared to the segmental ratings. RESULTS: UPDRS-III scores and segmental ratings for rigidity and rest and postural tremor, but not bradykinesia, progressed significantly during the observation period. Progression of normalized segmental ratings for rigidity and tremor was significantly larger than the UPDRS-III ratings over one year. The segmental ratings for rigidity and tremor as well as their combination with the UPDRS-III bradykinesia rating were more sensitive a measure for progression of PD than the UPDRS-III. CONCLUSIONS: Taking into account the segmental evolution of parkinsonian signs may be a useful adjunct to UPDRS-III evaluations to measure clinical disease progression of PD. If validated in subsequent, larger cohorts, this may be useful in trials of neuroprotective agents.

PMID: 19622523 [PubMed - as supplied by publisher]

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