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journal article Jan 20, 2021

Motor Onset Topography and Progression in Parkinson's Disease: the Upper Limb Is First

Mariana H.G. Monje ORCID Álvaro Sánchez‐Ferro ORCID José A. Pineda‐Pardo Lydia Vela‐Desojo Fernando Alonso‐Frech José A. Obeso
Movement Disorders Vol. 36 No. 4 pp. 905-915 · Wiley
View at Publisher Save 10.1002/mds.28462
Abstract
ABSTRACTObjectiveTo define the motor onset and progression of Parkinson's disease (PD) in a prospective cohort of early unmedicated patients.MethodsWe 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.ResultsTwenty‐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.ConclusionsMotor 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
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Metrics
48
Citations
46
References
Details
Published
Jan 20, 2021
Vol/Issue
36(4)
Pages
905-915
License
View
Authors
M
Mariana H.G. Monje

HM‐CINAC. HM Puerta del Sur University Hospital, Móstoles, and CEU‐San Pablo University Madrid Spain; Department of Anatomy, Histology and Neuroscience Universidad Autónoma Madrid Madrid Spain

�
Álvaro Sánchez‐Ferro

HM‐CINAC. HM Puerta del Sur University Hospital, Móstoles, and CEU‐San Pablo University Madrid Spain

J
José A. Pineda‐Pardo

HM‐CINAC. HM Puerta del Sur University Hospital, Móstoles, and CEU‐San Pablo University Madrid Spain; CIBERNED (Center for Networked Biomedical Research on Neurodegenerative Diseases) Instituto Carlos III Madrid Spain

L
Lydia Vela‐Desojo

HM‐CINAC. HM Puerta del Sur University Hospital, Móstoles, and CEU‐San Pablo University Madrid Spain; Department of Neurology Hospital Universitario Fundación Alcorcón Alcorcón Madrid Spain

F
Fernando Alonso‐Frech

HM‐CINAC. HM Puerta del Sur University Hospital, Móstoles, and CEU‐San Pablo University Madrid Spain

J
José A. Obeso

HM‐CINAC. HM Puerta del Sur University Hospital, Móstoles, and CEU‐San Pablo University Madrid Spain; CIBERNED (Center for Networked Biomedical Research on Neurodegenerative Diseases) Instituto Carlos III Madrid Spain

Cite This Article
Mariana H.G. Monje, Álvaro Sánchez‐Ferro, José A. Pineda‐Pardo, et al. (2021). Motor Onset Topography and Progression in Parkinson's Disease: the Upper Limb Is First. Movement Disorders, 36(4), 905-915. https://doi.org/10.1002/mds.28462
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