Neurology Clinic, University of Perugia, Perugia, Italy.
IRCCS, Fondazione Santa Lucia, Rome, Italy.
Eur J Neurol. 2019 Nov;26(11):1370-1376. doi: 10.1111/ene.13988. Epub 2019 Jun 27.
Essential tremor (ET) and Parkinson's disease (PD) sometimes overlap in their clinical expression with ET preceding PD onset, often leading to misdiagnosis. Transcranial sonography (TCS) has been shown to be a valid and non-invasive diagnostic tool to identify early idiopathic PD and to differentiate it from ET. The purpose of this study was to investigate the relevance of substantia nigra hyperechogenicity in patients with ET.
A total of 138 patients (79 with PD, 59 with ET) and 50 matched controls underwent TCS examination at baseline. All patients were followed in a 3-year longitudinal assessment.
A total of 10 subjects were excluded from the analysis due to the bilateral absence of a temporal acoustic window. During the follow-up period, 11 of the patients with ET developed new-onset parkinsonian features, without fulfilling criteria for PD diagnosis (ET+). Nine patients developed clinical features meeting diagnostic criteria for probable PD (ET-PD). Patients with ET- did not develop parkinsonian features. For each group, the maximum size of the substantia nigra hyperechogenicity was as follows: 5.62 ± 5.40 mm in the control group, 19.02 ± 14.27 mm in patients with PD, 9.15 ± 11.26 mm in patients with ET-, 20.05 ± 13.78 mm in patients with ET+ and 20.13 ± 13.51 mm in patients with ET-PD. ET-PD maximum values were significantly different from controls. Maximum values in patients with ET+ were different from both controls and patients with ET-.
Substantia nigra hyperechogenicity in ET seems to represent a risk marker for developing early parkinsonian symptoms or signs in the 3 years following TCS assessment.
特发性震颤（ET）和帕金森病（PD）在临床表达上有时会重叠，ET 先于 PD 发病，这常常导致误诊。经颅超声（TCS）已被证明是一种有效的、非侵入性的诊断工具，可用于识别早期特发性 PD，并将其与 ET 区分开来。本研究旨在探讨 ET 患者黑质回声增高的相关性。
共纳入 138 例患者（79 例 PD，59 例 ET）和 50 名匹配对照者，所有患者均在基线时进行 TCS 检查。所有患者均进行了 3 年的纵向评估。
由于双侧颞窗缺失，共有 10 例患者被排除在分析之外。在随访期间，11 例 ET 患者出现新的帕金森特征，但不符合 PD 诊断标准（ET+）。9 例患者出现符合可能 PD 诊断标准的临床特征（ET-PD）。ET-患者未出现帕金森特征。对于每个组，黑质回声增高的最大尺寸如下：对照组为 5.62±5.40mm，PD 患者为 19.02±14.27mm，ET-患者为 9.15±11.26mm，ET+患者为 20.05±13.78mm，ET-PD 患者为 20.13±13.51mm。ET-PD 的最大数值与对照组有显著差异。ET+患者的最大数值与对照组和 ET-患者均有差异。
ET 中的黑质回声增高似乎是 TCS 评估后 3 年内出现早期帕金森症状或体征的风险标志物。
