Could tonic chin electromyogram density be a potential marker for differentiating atypical Parkinsonian syndromes from Parkinson's disease among alpha-synucleinopathies?

Y. Wang, K.P. Xiong, Y. Shen, P.C. He, C.J. Mao, J. Li, J.Y. Huang, C.F. Liu (Suzhou, People's Republic of China)

Meeting: 2016 International Congress

Abstract Number: 168

Keywords: Parkinsonism

Session Information

Date: Monday, June 20, 2016

Session Title: Parkinsonism, MSA, PSP (secondary and parkinsonism-plus)

Session Time: 12:30pm-2:00pm

Location: Exhibit Hall located in Hall B, Level 2

Objective: The study aimed to examine whether the video-polysomnography (vPSG) could provide some clues for differentiating atypical Parkinsonian syndromes (APS) from Parkinson’s disease (PD) among alpha-synucleinopathies (SPs).

Background: REM sleep without atonia (RSWA) is an essential diagnostic feature of RBD on PSG. It has been reported that the higher surface EMG activity were associated with longer PD disease duration and greater disease severity and suggest it as a PD biomarker. However, little is known about the clinical correlates of RSWA in APS. One study suggests that a higher RSWA percentage was found in MSA than PD. And whether the amount of RSWA could be a potential marker for differentiating APS from PD hasn’t been well understood.

Methods: The study group comprised 24 APS patients (4 dementia of lewy bodies, 20 multiple system atrophy), 32 patients with PD matched for age, sex, and the percentage of rapid eye movement (REM) sleep behavior disorder (RBD) were selected for comparison. All patients were evaluated by Mini Mental Status Examination (MMSE), the Montreal Cognitive Assessment (MoCA, Beijing Version), Epworth Sleepiness Scale (ESS) and Pittsburgh Sleep Quality Index (PSQI), and underwent a whole night vPSG and clinical evaluation. We manually quantified the tonic and phasic chin electromyogram (EMG) activity during REM sleep of each patient. Then, we compared the clinical characteristics and vPSG parameters between the two groups.

Results: There were no significant differences between the two groups in clinical characteristics and sleep architecture.

Demographics and clinical features in patients with APS and PD
	before ajustment for AHI			after ajustment for AHI
	APS (n=24)	PD (n=32)	P	APS (n=18)	PD (n=25)	P
Age (year)	67.875±7.146	65.781±5.586	0.224a	68.111±7.888	65.800±5.958	0.280a
Gender male (%)	12(50)	16(50)	1.000b	9 (50)	13(52)	0.897b
RBD percentage (%)	62.5	56.3	0.638b	72.2	68.0	0.766b
BMI (kg/m2)	21.917±3.624	22.866±3.056	0.293a	21.922±3.970	22.452±3.145	0.628a
Disease duration (month)	33.833±17.512	44.188±28.522	0.123a	34.333±18.787	45.240±29.466	0.175a
Hoehn-Yahr stage	–	2.016±0.767	–	–	2.060±0.726	–
UPDRS total score	–	34.219±13.229	–	–	36.440±13.141	–
LEDs (mg/day)	433.771±251.382	360.906±152.037	0.217a	443.028±239.607	376.960±135.644	0.257a
ESS score	7.333±4.815	6.406±3.917	0.431a	7.111±4.739	7.160±4.007	0.971a
PSQI score	6.792±4.354	7.938±4.048	0.315a	6.222±4.110	8.520±4.124	0.078a
MMSE score	24.875±4.523	26.000±3.455	0.296a	24.722±4.787	25.600±3.640	0.498a
MOCA score	21.125±5.245	23.375±4.851	0.103a	20.667±5.531	23.040±4.895	0.145a
Education (year)	8.750±4.954	8.531±3.379	0.845a	7.889±4.676	8.360±3.650	0.712a

a t test b chi-square test All these Parkinsonian patients can manifest lower sleep efficiency, RBD, and sleep apnea hypopnea syndrome (SAHS). But when compared to PD patients, the APS patients showed higher prevalence of SAHS (41.667% VS 9.375%) (p=0.011), higher tonic chin EMG density (%) (35.055±27.950 VS 11.825±13.412) (p=0.001)

Polysomnographic parameters in patients with APS and PD
	before ajustment for AHI			after ajustment for AHI
	APS (n=24)	PD (n=32)	P	APS (n=18)	PD (n=25)	P
Awakenings (n)	17.667±7.394	22.344±9.213	0.046a	17.444±5.953	22.000±9.730	0.086a
TST (min)	333.667±80.581	356.625±98.363	0.355a	319.028±74.922	361.940±100.683	0.134a
SE (%)	62.233±14.888	68.738±15.351	0.118a	58.628±13.792	70.128±14.334	0.012a
SL (min)	16.000(9.500,32.500)	5.250(0.625,15.875)	0.005b	16.750(9.500,31.500)	4.500(0.500,12.500)	0.002b
REML (min)	148.729±99.823	132.406±91.832	0.529a	147.389±104.295	123.200±91.875	0.426a
W (min)	120.167±53.859	114.781±79.380	0.776a	131.889±48.150	112.360±84.698	0.384a
REM (%)	16.679±11.543	15.844±7.513	0.744a	17.589±12.331	15.436±7.890	0.489a
NREM1 (%)	23.954±13.330	21.340±16.817	0.533a	23.344±11.408	22.284±18.170	0.828a
NREM2 (%)	44.367±15.514	45.734±14.789	0.739a	43.294±14.498	44.268±16.043	0.839a
NREM3 (%)	14.988±12.150	17.084±10.181	0.486a	15.761±13.203	18.016±10.735	0.541a
Arousal index	8.413±7.197	7.675±7.385	0.710a	6.322±4.410	6.148±6.382	0.921a
AHI (/h)	2.450(0.000,16.600)	0.000(0.000,0.650)	0.031b	0.000(0.000,4.730)	0.000(0.000,1.350)	0.475b
Minimal SaO2 (%)	88.875±4.712	91.406±3.004	0.027a	90.722±3.196	91.760±2.773	0.263a
Mean SaO2 (%)	94.792±1.865	95.625±1.699	0.087a	94.889±1.967	95.800±1.555	0.097a
Time (SaO2<90%) during sleep (%)	0.050(0.000,3.975)	0.000(0.000,0.000)	0.013b	0.000(0.000,1.200)	0.000(0.000,0.000)	0.069b
Tonic EMG density (%)	35.055±27.950	11.825±13.412	0.001a	37.017±27.539	14.315±14.072	0.004a
Phasic EMG density (%)	9.994±13.518	7.306±9.310	0.382a	9.840±12.298	7.873±9.393	0.555a

a t test b Mann-Whitney test“.

Conclusions: Tonic chin EMG density could be a potential marker for differentiating APS from PD among SPs.

To cite this abstract in AMA style:

Y. Wang, K.P. Xiong, Y. Shen, P.C. He, C.J. Mao, J. Li, J.Y. Huang, C.F. Liu. Could tonic chin electromyogram density be a potential marker for differentiating atypical Parkinsonian syndromes from Parkinson’s disease among alpha-synucleinopathies? [abstract]. Mov Disord. 2016; 31 (suppl 2). https://www.mdsabstracts.org/abstract/could-tonic-chin-electromyogram-density-be-a-potential-marker-for-differentiating-atypical-parkinsonian-syndromes-from-parkinsons-disease-among-alpha-synucleinopathies/. Accessed November 22, 2024.

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