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| ORIGINAL ARTICLE
|Year : 2016 | Volume
| Issue : 4 | Page : 633--639
Correlation between qualitative balance indices, dynamic posturography and structural brain imaging in patients with progressive supranuclear palsy and its subtypes
Shaik Afsar Pasha1, Ravi Yadav1, Mohan Ganeshan2, Jitender Saini3, Anupam Gupta2, M Sandhya3, Pramod Kumar Pal1
1 Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
2 Department of Neurological Rehabilitation, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
3 Department of Neuroimaging and Interventional Radiology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
Objectives: To compare the clinical, balance, and radiological profile of progressive supranuclear palsy (PSP) of Richardson type (PSP-R) and Parkinsonian type (PSP-P).
Materials and Methods: Twenty-nine patients with PSP (PSP-R: 17, PSP-P: 12) satisfying the probable/possible National Institute of Neurological Disorders and Stroke-PSP criteria were recruited and assessed with Unified Parkinson's Disease Rating Scale-III, PSP rating scale (PSPRS), Berg balance scale (BBS), Tinetti performance-oriented mobility assessment gait and total (TPG and TPT) score, dynamic posturography (DP), and magnetic resonance imaging. Data were compared with 30 age- and gender-matched healthy controls.
Results: The mean ages of PSP-R, PSP-P, and controls were comparable (62.5 ± 6.6, 59 ± 8.9, and 59.8 ± 7.6 years). The PSP group had significantly poor DP scores and more radiological abnormalities than controls. The PSPRS, TPG, and TPT scores were significantly more impaired in PSP-R compared to PSP-P (P = 0.045, P = 0.031, and P = 0.037, respectively). In DP, the limits of overall stability were most significant (P < 0.001) and PSP-R had lower scores. PSP-R compared to PSP-P had more often “Humming Bird” sign (P < 0.001), “Morning Glory” sign (P < 0.008), and generalized cortical atrophy (P < 0.001). The area of midbrain (P < 0.002) and midbrain/pons ratio (P < 0.013) was significantly lower in PSP-R. In PSP-P, the overall balance index significantly correlated with BBS, TPG, and TPT (r = −0.79, P = 0.002; r = −0.772, P = 0.003; and r = −0.688, P = 0.013) and the midbrain axial anterior–posterior diameter significantly correlated with the TPG and TPT (r = 0.74, P = 0.01; r = 0.66, P = 0.018).
Conclusions: While balance and radiological abnormalities were more severe in PSP-R, the qualitative and quantitative measurements of severity of balance in PSP-P rather than PSP-R was a better reflection of the pathology of the midbrain.
Dr. Pramod Kumar Pal
Department of Neurology, National Institute of Mental Health and Neurosciences, Hosur Road, Bengaluru - 560 029, Karnataka
Source of Support: None, Conflict of Interest: None
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