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Introduction: Alexithymia is a neuropsychiatric symptom conceptualized as difficulty iden-tifying and describing feelings. Although associated with other non-motor symptoms, mainlyneuropsychiatric, alexithymia may present as an isolated symptom in persons with Parkinson’sDisease (PwP). The objective of the study is to identify determinants of alexithymia and itsassociation with quality of life (QoL) in Parkinson’s disease. Methods: Subjects with Parkinson’s disease were recruited. The following instruments wereapplied: Movement Disorders Society Unified Parkinson’s Disease Rating Scale (MDS-UPDRS),Non-Motor Symptoms Scale (NMSS), Montreal Cognitive Assessment (MoCA), Toronto alexithymiascale (TAS-20) and Parkinson’s Disease Questionnaire (PDQ-8). Matched healthy controls werescreened using TAS-20. Clinical and demographical variables were compared between alex-ithymic and non-alexithymic. Regression models were used to find determinants of alexithymia.Impact of alexithymia on QoL was estimated with a linear regression model.Results: 98 patients were included. 56.1% PwP and 28.8% controls were alexithymic (p < 0.001).Education level (OR 0.86) and NMSS urinary score (OR 1.09) determined alexithymia as well asTAS-20 score. Alexithymia was an independent determinant of QoL. Conclusions: Alexithymia is a prevalent independent non-motor symptom in PwP with impacton QoL. Low education level and urinary symptoms are important determinants of alexithymia.(AU)

Introducción: La alexitimia es un rasgo neuropsiquiátrico conceptualizado como la dificul-tad para identificar y describir sentimientos. Aunque está asociado con otros síntomas nomotores, principalmente neuropsiquiátricos, sigue siendo una característica independiente delas personas con enfermedad de Parkinson (PcP). El objetivo del estudio es identificar losdeterminantes de la alexitimia y su asociación con la calidad de vida en la enfermedad deParkinson. Métodos: Se reclutaron sujetos con enfermedad de Parkinson. Se aplicaron los siguientesinstrumentos: escala unificada de la enfermedad de Parkinson de la Sociedad de Trastornosdel Movimiento (MDS-UPDRS), escala de síntomas no motores (NMSS), evaluación cognitiva deMontreal (MoCA), escala de alexitimia de Toronto (TAS-20) y cuestionario de la enfermedadde Parkinson (PDQ-8). Se incluyeron controles sanos pareados, los cuales se evaluaron usandola TAS-20. Las variables clínicas y demográficas se compararon entre pacientes alexitímicos yno alexitímicos. Se utilizaron modelos de regresión para estimar los predictores de alexitimia.El impacto de este rasgo neuropsiquiátrico en la calidad de vida se estimó con un modelo deregresión lineal. Resultados: Se incluyeron 98 pacientes. El 56,1% de PcP y el 28,8% de los controles fueronalexitímicos (p < 0,001). El nivel educativo (OR 0,86) y la puntuación urinaria del NMSS (OR1,09) determinaron la alexitimia, así como la puntuación del TAS-20. La alexitimia fue undeterminante independiente de calidad de vida. Conclusiones: La alexitimia es un síntoma independiente no motor prevalente con impactoen la calidad de vida. El bajo nivel educativo y los síntomas urinarios son determinantesimportantes de esta condición. (AU)

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INTRODUCTION: Alexithymia is a neuropsychiatric symptom conceptualized as difficulty identifying and describing feelings. Although associated with other non-motor symptoms, mainly neuropsychiatric, alexithymia may present as an isolated symptom in persons with Parkinson's Disease (PwP). The objective of the study is to identify determinants of alexithymia and its association with quality of life (QoL) in Parkinson's disease. METHODS: Subjects with Parkinson's disease were recruited. The following instruments were applied: Movement Disorders Society Unified Parkinson's Disease Rating Scale (MDS-UPDRS), Non-Motor Symptoms Scale (NMSS), Montreal Cognitive Assessment (MoCA), Toronto alexithymia scale (TAS-20) and Parkinson's Disease Questionnaire (PDQ-8). Matched healthy controls were screened using TAS-20. Clinical and demographical variables were compared between alexithymic and non-alexithymic. Regression models were used to find determinants of alexithymia. Impact of alexithymia on QoL was estimated with a linear regression model. RESULTS: 98 patients were included. 56.1% PwP and 28.8% controls were alexithymic (p<0.001). Education level (OR 0.86) and NMSS urinary score (OR 1.09) determined alexithymia as well as TAS-20 score. Alexithymia was an independent determinant of QoL. CONCLUSIONS: Alexithymia is a prevalent independent non-motor symptom in PwP with impact on QoL. Low education level and urinary symptoms are important determinants of alexithymia.

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INTRODUCTION: Alexithymia is a neuropsychiatric symptom conceptualized as difficulty identifying and describing feelings. Although associated with other non-motor symptoms, mainly neuropsychiatric, alexithymia may present as an isolated symptom in persons with Parkinson's Disease (PwP). The objective of the study is to identify determinants of alexithymia and its association with quality of life (QoL) in Parkinson's disease. METHODS: Subjects with Parkinson's disease were recruited. The following instruments were applied: Movement Disorders Society Unified Parkinson's Disease Rating Scale (MDS-UPDRS), Non-Motor Symptoms Scale (NMSS), Montreal Cognitive Assessment (MoCA), Toronto alexithymia scale (TAS-20) and Parkinson's Disease Questionnaire (PDQ-8). Matched healthy controls were screened using TAS-20. Clinical and demographical variables were compared between alexithymic and non-alexithymic. Regression models were used to find determinants of alexithymia. Impact of alexithymia on QoL was estimated with a linear regression model. RESULTS: 98 patients were included. 56.1% PwP and 28.8% controls were alexithymic (p<0.001). Education level (OR 0.86) and NMSS urinary score (OR 1.09) determined alexithymia as well as TAS-20 score. Alexithymia was an independent determinant of QoL. CONCLUSIONS: Alexithymia is a prevalent independent non-motor symptom in PwP with impact on QoL. Low education level and urinary symptoms are important determinants of alexithymia.

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This article reviews and summarizes 200 years of Parkinson's disease. It comprises a relevant history of Dr. James Parkinson's himself and what he described accurately and what he missed from today's perspective. Parkinson's disease today is understood as a multietiological condition with uncertain etiopathogenesis. Many advances have occurred regarding pathophysiology and symptomatic treatments, but critically important issues are still pending resolution. Among the latter, the need to modify disease progression is undoubtedly a priority. In sum, this multiple-author article, prepared to commemorate the bicentenary of the shaking palsy, provides a historical state-of-the-art account of what has been achieved, the current situation, and how to progress toward resolving Parkinson's disease. © 2017 International Parkinson and Movement Disorder Society.

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INTRODUCTION: Parkinson's disease (PD) is a common neurodegenerative disease which begins in adulthood. Its incidence in Mexico is estimated to be 40-50 cases per 100,000 inhabitants/year and is the fourth reason for medical care in the National Institute of Neurology and Neurosurgery. The protein alpha-synuclein, SNCA, plays a key role in the pathology of PD, and its polymorphisms have been associated with an increased risk of developing the disease. AIM: To evaluate the risk of PD represented by the polymorphisms rs2619364, rs2619363, rs2736990, rs7684318, rs17016074, rs356219, rs356220 and rs356203 of SNCA in a sample of Mexican subjects. SUBJECTS AND METHODS: Altogether 171 patients diagnosed with PD and 171 gender- and age-paired controls were assessed by means of real-time polymerase chain reaction, and a statistical analysis was performed to determine the association between the polymorphisms and the disease. RESULTS: The SNCA variants rs356220, rs356203, rs7684318 and rs2736990 were associated with the disease and form two haplotypes with a high risk of developing sporadic PD in the Mexican population. CONCLUSIONS: Variations in SNCA are a risk factor for the development of PD and can act as specific genetic biomarkers as a diagnostic support tool in sporadic PD for Mexican mestizo patients.

TITLE: Frecuencia de polimorfismos de nucleotido unico y haplotipos de alfa-sinucleina asociados con la enfermedad de Parkinson esporadica en poblacion mexicana.Introduccion. La enfermedad de Parkinson (EP) es una entidad neurodegenerativa comun de inicio en la etapa adulta. Su incidencia en Mexico se estima en 40-50 casos por 100.000 habitantes/año y constituye la cuarta causa de atencion medica en el Instituto Nacional de Neurologia y Neurocirugia. La proteina alfa-sinucleina, SNCA, es clave en la patologia de la EP y sus polimorfismos se han asociado a un riesgo aumentado de desarrollarla. Objetivo. Evaluar el riesgo que representan los polimorfismos rs2619364, rs2619363, rs2736990, rs7684318, rs17016074, rs356219, rs356220 y rs356203 de SNCA en una muestra de sujetos mexicanos para la EP. Sujetos y metodos. Se evaluaron 171 pacientes con diagnostico de EP y 171 controles pareados por sexo y edad mediante reaccion en cadena de la polimerasa en tiempo real, y se realizo un analisis estadistico para determinar la asociacion de los polimorfismos con la enfermedad. Resultados. Las variantes rs356220, rs356203, rs7684318 y rs2736990 de SNCA estan asociadas a la enfermedad y forman dos haplotipos de riesgo elevado para desarrollar EP esporadica en la poblacion mexicana. Conclusiones. Las variaciones en SNCA son un factor de riesgo para desarrollar EP y pueden ser biomarcadores geneticos especificos para pacientes mestizos mexicanos como herramienta de apoyo diagnostico en la EP esporadica.

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Introducción: La enfermedad de Parkinson impacta en la calidad de vida del sujeto que la presenta, pero también ocasiona una carga para el cuidador. Los factores relacionados con estos efectos incluyen aspectos motores y no motores de la enfermedad, así como características inherentes al cuidador. Métodos: Se evaluó a sujetos con enfermedad de Parkinson mediante los siguientes instrumentos: cuestionario de calidad de vida PDQ-8, escala unificada de la enfermedad de Parkinson de la Sociedad de Trastornos del Movimiento parte i a iv (MDS-UPDRS) y estadio de Hoehn y Yahr (HY). A los cuidadores primarios, se les aplicó el inventario de carga del cuidador de Zarit. Adicionalmente, se registraron las principales variables demográficas y clínicas. Resultados: Se incluyó a 250 sujetos con enfermedad de Parkinson, de los cuales 201 contaban con un cuidador primario. En el análisis multivariado los factores predictores de una peor calidad de vida del sujeto con enfermedad de Parkinson fueron la puntuación de la MDS-UPDRS I (β = 0,39, p < 0,001), puntuación de la MDS-UPDRS II (β = 0,21, p < 0,001) y puntuación de la MDS-UPDRS III (β = 0,07, p = 0,004). En lo que respecta a la carga en el cuidador, la puntuación de la MDS-UPDRS II (β = 0,54, p = 0,007) fue el que más influyó. Conclusiones: El presente estudio muestra una relación entre la calidad de vida del sujeto con enfermedad de Parkinson y la percepción de carga del cuidador. No obstante, los factores que determinan cada una de estas parecen ser distintos

Introduction: Parkinson's disease affects the quality of life of the individual with the disease in addition to creating a burden on the caregiver. Factors related to these effects include motor and non-motor aspects of the disease, as well as traits inherent to the caregiver. Methods: We evaluated subjects with Parkinson's disease using the following instruments: Quality of Life Questionnaire PDQ-8, Movement Disorders Society Unified Parkinson's disease Rating Scale part i to iv (MDS-UPDRS), and Hoehn and Yahr staging. The Zarit Burden Inventory was used to assess all primary caregivers. Major demographic and clinical variables were also recorded. Results: A total of 250 subjects with Parkinson's disease were included, of whom 201 had a primary caregiver. In the multivariate analysis, predictors of poor quality of life for a subject with Parkinson's disease were the MDS-UPDRS I score (β = .39, P < .001), MDS-UPDRS II score (β = .21, P < .001), and MDS-UPDRS III score (β = .07, P = .004). Regarding caregiver burden, the MDS-UPDRS II score (β = .54, P = .007) was the most influential factor. Conclusions: The present study shows a relationship between quality of life for the subject with Parkinson's disease and the caregiver's perceived burden. However, the factors that determine each situation appear to be distinct

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BACKGROUND AND PURPOSE: Although Parkinson's disease (PD) is characterized by typical motor manifestations, non-motor symptoms (NMS) are an outstanding part of the disease. At present, several specific instruments for assessment of NMS are available. The objective of our study was to determine the performance of the Movement Disorder Society-Unified Parkinson's Disease Rating Scale (MDS-UPDRS): Part I - Non-Motor Aspects of Experiences of Daily Living (nM-EDL) compared with the Non-Motor Symptoms Scale (NMSS). METHODS: To this purpose, 434 consecutive patients with PD were included in an international, observational, cross-sectional study. The association between scores of both scales was determined by the Spearman rank correlation coefficient. Equations for transformation of total score of a scale to the other were constructed from weighted regression models and both, transformed and observed score, contrasted by means of the Lin's Concordance Correlation Coefficient (LCCC) and Bland-Altman plot. RESULTS: As a whole, the prevalence of the NMS according to each scale was quite similar, and most of the correlations between their corresponding components were high (r(S) > 0.60). The total score correlation of the MDS-UPDRS Part I with the NMSS was high (r(S) = 0.81). Concerning the transformed scores, estimated scores only partially approach the observed ones (sharing about 60-64% of the variance) because residual variance increased with increasing magnitudes of the scores, i.e. the most severe patients (Bland-Altman plot; LCCC < 0.60 for severe patients). CONCLUSIONS: (i) MDS-UPDRS Part I (nM-EDL) and NMSS showed a strong convergent validity; (ii) however, transformed scores using the equations from weighted regression models showed that for patients with the most severe NMS they are not concordant.

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INTRODUCTION: Parkinson's disease affects the quality of life of the individual with the disease in addition to creating a burden on the caregiver. Factors related to these effects include motor and non-motor aspects of the disease, as well as traits inherent to the caregiver. METHODS: We evaluated subjects with Parkinson's disease using the following instruments: Quality of Life Questionnaire PDQ-8, Movement Disorders Society Unified Parkinson's disease Rating Scale part i to iv (MDS-UPDRS), and Hoehn and Yahr staging. The Zarit Burden Inventory was used to assess all primary caregivers. Major demographic and clinical variables were also recorded. RESULTS: A total of 250 subjects with Parkinson's disease were included, of whom 201 had a primary caregiver. In the multivariate analysis, predictors of poor quality of life for a subject with Parkinson's disease were the MDS-UPDRS I score (ß=.39, P<.001), MDS-UPDRS II score (ß=.21, P<.001), and MDS-UPDRS III score (ß=.07, P=.004). Regarding caregiver burden, the MDS-UPDRS II score (ß=.54, P=.007) was the most influential factor. CONCLUSIONS: The present study shows a relationship between quality of life for the subject with Parkinson's disease and the caregiver's perceived burden. However, the factors that determine each situation appear to be distinct.

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Pantothenate kinase-associated neurodegeneration (PKAN) is an autosomal recessive disorder characterized by iron accumulation in the brain, because of mutations in the PANK2 gene. Phenotypic and genotypic characteristics of 11 patients from five Mexican families with PKAN disease are reported. Sequencing of PANK2 confirmed the diagnosis. The 11 patients had dysarthria associated with dystonia and Parkinsonism in six. Brain magnetic resonance imaging (MRI) showed the 'eye-of-the-tiger' sign in all patients. Three different mutations were identified, a novel one (p.A469P) and two (p.G219V and p.N404I) very rare. Homozygous sibs for the p.G219V mutation had a severe disease progression with early death. Dystonia predominated in the p.A469P/p.N404I compound heterozygous patients. Homozygous for p.N404I showed Parkinsonism, tics and personality and speech disorders. Early and late disease onset and variable expression was present in carriers of the different identified mutations. The 'eye-of-the-tiger' is an excellent neuroimaging hallmark to predict PANK2 mutations. We detected a 'cluster' of patients harboring the p.N404I mutation, strongly suggesting a founder effect for this mutation. This is the first familial clinical-genetic PKAN disease study accomplished in Mexico.

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BACKGROUND AND PURPOSE: The Movement Disorder Society sponsored version of the Unified Parkinson's Disease Rating Scale (MDS-UPDRS) is a comprehensive instrument for assessing Parkinson's disease (PD). The present study was aimed at determining the relationships between MDS-UPDRS components and health-related quality of life (HRQoL) evaluations in PD patients. METHODS: An international, multicenter, cross-sectional study was carried out of 435 PD patients assessed with the MDS-UPDRS, Hoehn and Yahr (HY), Clinical Impression Severity for PD, EQ-5D and PD Questionnaire - eight items (PDQ-8). Spearman's rank correlation coefficients, exploratory factor analysis and multiple linear regression models (dependent variables EQ-5D and PDQ-8) were performed. RESULTS: The participants' age was 66.71 ± 10.32 years (51.5% men). PD duration was 8.52 ± 6.14, and median HY was 2 (range 1-5). The correlation between the EQ-5D index and the MDS-UPDRS ranged from -0.46 (Part IV) to -0.72 (Part II) and for the PDQ-8 index from 0.47 (Part III) to 0.74 (Part II). In multiple regression models with the MDS-UPDRS domains as independent variables, the main determinant for both the EQ-5D index and the PDQ-8 was Part II followed by Part I. After factorial grouping of the cardinal PD manifestations embedded in the MDS-UPDRS Parts III and IV for inclusion into multiple regression models, a factor formed by M-EDL, nM-EDL and fluctuations was the main determinant for both the EQ-5D and PDQ-8 indexes. CONCLUSIONS: The MDS-UPDRS component most tightly related with the HRQoL measures was a combination of motor and non-motor experiences of daily living.

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Introducción: la relación de la lateralidad y asimetría de la enfermedad de Parkinson con la sintomatología de disfunción no motora ha sido abordada principalmente desde el punto de vista de las funciones cognitivas, y los escasos estudios que han involucrado otros síntomas han sido contradictorios. La asociación de los síntomas no motores con el tipo de inicio de la enfermedad no ha sido estudiada profundamente. Objetivo: analizar la asociación entre el lado de inicio de la sintomatología motora, así como del tipo de inicio termorígeno y rígido-bradicinético y la prevalencia de síntomas no motores. Pacientes y métodos: se incluyeron 232 pacientes con diagnóstico de enfermedad de Parkinson. Se documentó el tipo de inicio y el hemicuerpo afectado inicialmente. La presencia de síntomas no motores se determinó mediante la aplicación del cuestionario de síntomas no motores (NMSQuest). Resultados: al analizar el lado de inicio y la presencia de los síntomas no motores explorados se encontraron diferencias estadísticamente significativas en la frecuencia de alucinaciones (p=0,04) y del trastorno conductual del sueño (p<0,01) en los sujetos de inicio del lado derecho. En el caso del tipo de inicio no se encontraron diferencias con significación estadística. Conclusiones: los sujetos con inicio en el hemicuerpo derecho parecen tener un mayor riesgo de presentar tanto alucinaciones como trastorno conductual del sueño. El médico tratante debe buscar de forma intencionada estos síntomas en estos pacientes, y de esta manera otorgar un tratamiento adecuado que impacte en la calidad de vida de los mismos (AU)

Introduction: The relationship between laterality and asymmetry of Parkinson's disease and non-motor dysfunction has been studied mainly from the perspective of cognitive functions, and the few studies that have included other symptoms have mixed reports. The relationship between non-motor symptoms and the type of onset of the disease has not been studied in detail. Objective: to analyse the association between the side and type of motor onset and the prevalence of non-motor symptoms. Patients and methods: we included 232 patients diagnosed with Parkinson's disease. Type of onset and the side initially affected were documented. The presence of non-motor symptoms was determined by applying the non-motor symptom questionnaire (NMSQuest). Results: when analysing the side of onset and presence of each non-motor symptom explored, statistically significant differences were found in the frequency of hallucinations (P=0.04) and sleep behaviour disorder (P<0.01) in subjects with right side onset. The motor type of onset differences were not statistically significant. Conclusions: subjects with right side onset seem to have a higher risk of having hallucinations and sleep behaviour disorders. These symptoms should be intentionally sought in order to provide treatment and improve the patient's quality of life (AU)

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INTRODUCTION: the relationship between laterality and asymmetry of Parkinson's disease and non-motor dysfunction has been studied mainly from the perspective of cognitive functions, and the few studies that have included other symptoms have mixed reports. The relationship between non-motor symptoms and the type of onset of the disease has not been studied in detail. OBJECTIVE: to analyse the association between the side and type of motor onset and the prevalence of non-motor symptoms. PATIENTS AND METHODS: we included 232 patients diagnosed with Parkinson's disease. Type of onset and the side initially affected were documented. The presence of non-motor symptoms was determined by applying the non-motor symptom questionnaire (NMSQuest). RESULTS: when analysing the side of onset and presence of each non-motor symptom explored, statistically significant differences were found in the frequency of hallucinations (P=0.04) and sleep behaviour disorder (P<0.01) in subjects with right side onset. The motor type of onset differences were not statistically significant. CONCLUSIONS: subjects with right side onset seem to have a higher risk of having hallucinations and sleep behaviour disorders. These symptoms should be intentionally sought in order to provide treatment and improve the patient's quality of life.

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INTRODUCTION: Auto-antibody determinations are very important in current clinical practice, not only in immunology or rheumatology but also in the neurosciences. These antibodies have both diagnostic and prognostic implications which, unfortunately, are often overused or are granted undue importance when it comes to interpreting them. On requesting their determination it is therefore necessary to know their indications, utility and application. AIM: To present a series of auto-antibodies that are relatively commonly used in neurology and which have primary and secondary effects on both the central and the peripheral nervous system, including the neuromuscular junction and muscle tissue. DEVELOPMENT: In this review we cover a series of different conditions, including diseases such as vasculitis, cerebrovascular disease, neurological paraneoplastic syndromes, dysimmune polyneuropathies and inflammatory myopathies. Special attention is given, when relevant, to the indications and, particularly, to the value and weight that should be granted to both positive and negative results. CONCLUSIONS: Appropriate interpretation and knowledge of the scope and limitations of auto-antibodies are essential, because otherwise they will lead to mistaken diagnoses and, consequently, erroneous treatment.

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Las determinaciones de autoanticuerpos son de gran relevancia en la práctica clínica actual, no sóloen las áreas de inmunología o reumatología, sino también en las neurociencias. Estos anticuerpos poseen implicaciones tanto diagnósticas como pronósticas, que desafortunadamente se sobreutilizan con gran frecuencia o se les da un valor inapropiado en la interpretación; por lo anterior, es necesario al solicitarlos conocer sus indicaciones, utilidad y aplicación.Objetivo. Presentar una serie de autoanticuerpos de uso relativamente frecuente en neurología y que afectan tanto de manera primaria como secundaria al sistema nervioso central y periférico, incluidos también la placa neuromuscular y el músculo.Desarrollo. A lo largo de esta revisión se cubre una serie de entidades diversas, entre las que se incluyen enfermedades como vasculitis, enfermedad vascular cerebral, síndromes paraneoplásicos neurológicos, polineuropatías disinmunes y miopatías inflamatorias. Se hace hincapié, cuando es pertinente, en las indicaciones y, particularmente, en el valor y peso que a suresultado, tanto positivo como negativo, se le debe otorgar. Conclusiones. La interpretación adecuada y el conocimiento del alcance y limitaciones de los autoanticuerpos son indispensables, ya que de lo contrario conducirán a errores en el diagnósticoy, como consecuencia, en el tratamiento

Introduction. Auto-antibody determinations are very important in current clinical practice, not only in immunology or rheumatology but also in the neurosciences. These antibodies have both diagnostic and prognostic implications which, unfortunately, are often overused or are granted undue importance when it comes to interpreting them. On requesting their determination it is therefore necessary to know their indications, utility and application. Aim. To present a series of autoantibodies that are relatively commonly used in neurology and which have primary and secondary effects on both the central and the peripheral nervous system, including the neuromuscular junction and muscle tissue. Development. In this review we cover a series of different conditions, including diseases such as vasculitis, cerebrovascular disease, neurological paraneoplastic syndromes, dysimmune polyneuropathies and inflammatory myopathies. Special attention is given, when relevant, to the indications and, particularly, to the value and weight that should be granted to both positive and negative results.Conclusions. Appropriate interpretation and knowledge of the scope and limitations of auto-antibodies are essential, because otherwise they will lead to mistaken diagnoses and, consequently, erroneous treatment

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