Premium
Motor Onset Topography and Progression in Parkinson's Disease: the Upper Limb Is First
Author(s) -
Monje Mariana H.G.,
SánchezFerro Álvaro,
PinedaPardo José A.,
VelaDesojo Lydia,
AlonsoFrech Fernando,
Obeso José A.
Publication year - 2021
Publication title -
movement disorders
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.352
H-Index - 198
eISSN - 1531-8257
pISSN - 0885-3185
DOI - 10.1002/mds.28462
Subject(s) - parkinson's disease , upper limb , cohort , physical medicine and rehabilitation , medicine , dopaminergic , prospective cohort study , movement disorders , psychology , rating scale , disease , neuroscience , dopamine , developmental psychology
Objective To define the motor onset and progression of Parkinson's disease (PD) in a prospective cohort of early unmedicated patients. Methods We enrolled a consecutive cohort of recently diagnosed (<18 months) PD patients with unilateral manifestations using age and gender‐matched controls. The most affected body region was determined using various clinical standard metrics and objective quantitative kinematic measurements. Parkinson's Progression Markers Initiative data were used for external validation of the results. Results Twenty‐five drug‐naive patients and 21 controls were studied. Upper limbs were (92%) the most affected body region at onset as ascertained by patients' self‐assessment, neurologists' impression, and Movement Disorders Society Unified Parkinson's Disease Rating Scale score. The upper limb (ie, hand) was the site of onset in 80% of patients. Motor features progressed to involve the lower limb but remained limited to the initially affected body side over a 2‐year follow‐up. Agreement among the different metrics (96%) confirmed focal upper limb predominant motor impairment at onset. The findings were confirmed by quantitative kinematic analyses and from a cohort of 34 similar patients from the Parkinson's Progression Markers Initiative database. Conclusions Motor manifestations in PD start distally in one upper limb. The complexity of the motor repertoire and, consequently, the presumed larger dopaminergic striatal demand for maintaining skillful motor function in the upper limb, may contribute to greater vulnerability of dopaminergic striatal terminals. Recognition of this motor pattern could be used to monitor the evolution of nigrostriatal degeneration and the putative impact of therapies. © 2021 International Parkinson and Movement Disorder Society