Diagnosing multiple system atrophy with greater accuracy: combined analysis of the clonidine-growth hormone test and external anal sphincter electromyography.
Identifieur interne : 000935 ( Ncbi/Checkpoint ); précédent : 000934; suivant : 000936Diagnosing multiple system atrophy with greater accuracy: combined analysis of the clonidine-growth hormone test and external anal sphincter electromyography.
Auteurs : Eun Ah Lee [Corée du Sud] ; B Joon Kim ; Won Yong LeeSource :
- Movement disorders : official journal of the Movement Disorder Society [ 0885-3185 ] ; 2002.
English descriptors
- KwdEn :
- Aged, Anal Canal (innervation), Clonidine (diagnostic use), Diagnosis, Differential, Electromyography, Female, Human Growth Hormone (blood), Humans, Male, Middle Aged, Multiple System Atrophy (diagnosis), Multiple System Atrophy (physiopathology), Parkinson Disease (diagnosis), Parkinson Disease (physiopathology), Predictive Value of Tests.
- MESH :
- chemical , blood : Human Growth Hormone.
- chemical , diagnostic use : Clonidine.
- diagnosis : Multiple System Atrophy, Parkinson Disease.
- innervation : Anal Canal.
- physiopathology : Multiple System Atrophy, Parkinson Disease.
- Aged, Diagnosis, Differential, Electromyography, Female, Humans, Male, Middle Aged, Predictive Value of Tests.
Abstract
The clonidine-growth hormone test (CGHT) has been proposed as a means of differentiating multiple system atrophy (MSA) from idiopathic Parkinson's disease (PD). However, it is controversial whether the CGHT is valid. We sought to confirm the validity of the CGHT and to compare the diagnostic accuracy of the CGHT with that of external anal sphincter electromyelography (Sph-EMG) for MSA. We performed the CGHT and the Sph-EMG on 21 PD patients, 23 patients with probable MSA of parkinsonian type (MSA-p), and 22 patients with probable MSA of cerebellar type (MSA-c). We compared the sensitivity, specificity, and positive and negative predictive values (PPV and NPV) of CGHT, Sph-EMG, and a combination of the two tests. We also evaluated the correlations of Unified Parkinson's Disease Rating Scale (UPDRS) scores with the results of the two tests. There was no significant difference between the UPDRS scores for the PD and MSA-p groups. Serum growth hormone concentrations after clonidine significantly increased in PD (mean increase +/- SEM, 4.19 +/- 0.92 ng/ml; P < 0.0001), but remained unchanged in both MSA-p (0.83 +/- 0.61 ng/ml) and MSA-c (1.45 +/- 0.58 ng/ml). The growth hormone responses to clonidine in MSA-p were significantly different from those in PD (P < 0.05). Abnormal, denervated Sph-EMG was observed in 95.7% of MSA-p, 86.4% of MSA-c, and 33.3% of PD patients. Compared to Sph-EMG, the CGHT was less sensitive but more specific in both MSA-p and MSA-c. The result of neither test correlated with the severity of parkinsonism. Interestingly, combining the results of the CGHT and Sph-EMG markedly increased the specificity (85.7% in the CGHT and 66.7% in Sph-EMG vs. 95.2% in the combination study) and the PPV in both MSA-p (85.7% and 75.9% vs. 94.4%) and MSA-c (82.4% and 73.1% vs. 91.7%). We confirm that the CGHT can distinguish MSA-p from PD. Its sensitivity is lower and its specificity higher than Sph-EMG. Compared to either test alone, combined testing with the CGHT and Sph-EMG increased specificity and PPV, thereby enhancing accuracy in the diagnosis of MSA.
DOI: 10.1002/mds.10225
PubMed: 12465063
Affiliations:
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pubmed:12465063Le document en format XML
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<author><name sortKey="Lee, Eun Ah" sort="Lee, Eun Ah" uniqKey="Lee E" first="Eun Ah" last="Lee">Eun Ah Lee</name>
<affiliation wicri:level="3"><nlm:affiliation>Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.</nlm:affiliation>
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<author><name sortKey="Kim, B Joon" sort="Kim, B Joon" uniqKey="Kim B" first="B Joon" last="Kim">B Joon Kim</name>
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<author><name sortKey="Lee, Won Yong" sort="Lee, Won Yong" uniqKey="Lee W" first="Won Yong" last="Lee">Won Yong Lee</name>
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<sourceDesc><biblStruct><analytic><title xml:lang="en">Diagnosing multiple system atrophy with greater accuracy: combined analysis of the clonidine-growth hormone test and external anal sphincter electromyography.</title>
<author><name sortKey="Lee, Eun Ah" sort="Lee, Eun Ah" uniqKey="Lee E" first="Eun Ah" last="Lee">Eun Ah Lee</name>
<affiliation wicri:level="3"><nlm:affiliation>Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.</nlm:affiliation>
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<series><title level="j">Movement disorders : official journal of the Movement Disorder Society</title>
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<term>Diagnosis, Differential</term>
<term>Electromyography</term>
<term>Female</term>
<term>Human Growth Hormone (blood)</term>
<term>Humans</term>
<term>Male</term>
<term>Middle Aged</term>
<term>Multiple System Atrophy (diagnosis)</term>
<term>Multiple System Atrophy (physiopathology)</term>
<term>Parkinson Disease (diagnosis)</term>
<term>Parkinson Disease (physiopathology)</term>
<term>Predictive Value of Tests</term>
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<front><div type="abstract" xml:lang="en">The clonidine-growth hormone test (CGHT) has been proposed as a means of differentiating multiple system atrophy (MSA) from idiopathic Parkinson's disease (PD). However, it is controversial whether the CGHT is valid. We sought to confirm the validity of the CGHT and to compare the diagnostic accuracy of the CGHT with that of external anal sphincter electromyelography (Sph-EMG) for MSA. We performed the CGHT and the Sph-EMG on 21 PD patients, 23 patients with probable MSA of parkinsonian type (MSA-p), and 22 patients with probable MSA of cerebellar type (MSA-c). We compared the sensitivity, specificity, and positive and negative predictive values (PPV and NPV) of CGHT, Sph-EMG, and a combination of the two tests. We also evaluated the correlations of Unified Parkinson's Disease Rating Scale (UPDRS) scores with the results of the two tests. There was no significant difference between the UPDRS scores for the PD and MSA-p groups. Serum growth hormone concentrations after clonidine significantly increased in PD (mean increase +/- SEM, 4.19 +/- 0.92 ng/ml; P < 0.0001), but remained unchanged in both MSA-p (0.83 +/- 0.61 ng/ml) and MSA-c (1.45 +/- 0.58 ng/ml). The growth hormone responses to clonidine in MSA-p were significantly different from those in PD (P < 0.05). Abnormal, denervated Sph-EMG was observed in 95.7% of MSA-p, 86.4% of MSA-c, and 33.3% of PD patients. Compared to Sph-EMG, the CGHT was less sensitive but more specific in both MSA-p and MSA-c. The result of neither test correlated with the severity of parkinsonism. Interestingly, combining the results of the CGHT and Sph-EMG markedly increased the specificity (85.7% in the CGHT and 66.7% in Sph-EMG vs. 95.2% in the combination study) and the PPV in both MSA-p (85.7% and 75.9% vs. 94.4%) and MSA-c (82.4% and 73.1% vs. 91.7%). We confirm that the CGHT can distinguish MSA-p from PD. Its sensitivity is lower and its specificity higher than Sph-EMG. Compared to either test alone, combined testing with the CGHT and Sph-EMG increased specificity and PPV, thereby enhancing accuracy in the diagnosis of MSA.</div>
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<tree><noCountry><name sortKey="Kim, B Joon" sort="Kim, B Joon" uniqKey="Kim B" first="B Joon" last="Kim">B Joon Kim</name>
<name sortKey="Lee, Won Yong" sort="Lee, Won Yong" uniqKey="Lee W" first="Won Yong" last="Lee">Won Yong Lee</name>
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