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Letter to the editor
Comments on “Absence of Alpha-Synuclein Aggregation in Patients With Parkinson’s Disease Complicated by Sigmoid Volvulus”
Sabri Selcuk Atamanalp1corresp_iconorcid, Refik Selim Atamanalp2orcid
Journal of Movement Disorders 2024;17(2):248-249.
Published online: March 29, 2024

1Department of General Surgery, Faculty of Medicine, Ataturk University, Erzurum, Türkiye

2Department of Medical Pathology, Prof. Dr. Cemil Tascioglu City Hospital, Istanbul, Türkiye

Corresponding author: Sabri Selcuk Atamanalp, MD Department of General Surgery, Faculty of Medicine, Ataturk University, Erzurum 25040, Türkiye / Tel: +90-442-3447560 / Fax: +90-442-3446528 / E-mail:
• Received: March 27, 2024   • Revised: March 28, 2024   • Accepted: March 29, 2024

Copyright © 2024 The Korean Movement Disorder Society

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Dear Editor,
We read with interest the paper written by Yoo et al. [1] on the role of alpha-synuclein (aSyn) in the pathogenesis of sigmoid volvulus (SV) complicated by Parkinson’s disease (PD). SV, the twisting of the sigmoid colon around itself causing a colonic obstruction, is an uncommon disease in western populations. Similarly, ileosigmoid knotting (ISK), the wrapping of the ileum or sigmoid colon around the other stricture causing a double-segment bowel obstruction, is a rare clinical entity over the world. However, both SV and ISK are relatively common in Türkiye [2]. Ataturk University, the biggest health centre of western Anatolia, has 57.5-year (from July 1966 to January 2024) experience with SV and ISK. In this period, 1,076-case SV series is the largest and 81-case ISK series is the third largest monocenter data over the world [3]. Based on this experience, our comments relate to the pathogenesis of PD complicating SV and ISK.
First, according to an electronic search of the last 79-years’ literature (between 1945 and 2024) in Web of Science database [3], among 1,373 reports on SV or ISK, there are only 15 publications on PD complicating SV. For this reason, the prevelance of PD complicating SV is not clear enough [1,4]. When limited number of case reports or small case series are excluded, the unique universal data on this comorbidity was reported by us as 0.8% in 2021 [5]. Our current data provides this rate as 0.9% (10 of 1,076 cases), which is relatively higher than that of overall PD prevelance in Türkiye, which is 0.6% [5]. This rate makes PD and SV relation interesting. On the other hand, there is no paper on PD complicating ISK in above-mentioned electronic search and when our one-case data is excluded, there is no data on the prevelance of this comorbidity.
Second, most likely due to the rarity of above-mentioned comorbidities, the pathogenesis is not clearly identified. In PD, the presence of neuronal destruction in myenteric plexus is not a mystery. Additionally, some anti-PD drugs provokes an ileus-like delay in colonic transportation. Moreover, some laxatives and enemas frequently needed to treat constipation may wreak damage on myenteric neurons. In the end, chronic increase in intraluminal pressure worsens the elastogenesis of the colonic wall resulting in dolichosigmoid, the most known anatomic prerequisite for SV and ISK [4,5].
Third, we have no recorded data on immunostaining of aSyn in resected colon materials of four cases with PD complicating SV, some of which were treated before the usage of immunostaining technique. Additionally, we have no similar documentation on 379 SV and 54 ISK cases treated with sigmoid colectomy among surgically treated total 488 SV and 81 ISK patients. For this reason, despite contradictory results, we value the innovative presentation of the authors on immunostaining of aSyn in the surgical specimens of the patients with PD complicating SV. As the authors mentioned, further studies are needed with a larger number of cases. However, sigmoid resection is needed in only some SV cases, while some others are treated with endoscopic detorsion or with other surgical techniques [6]. Similarly, although ISK requires emergency surgical treatment, sigmoid resection is not the sole option in most cases [7]. In the end, a colonic specimen is not obtained in most SV and ISK cases. For this reason, large series-prospective studies on PD complicating SV or ISK, which are relatively rare clinical entities, appear like difficult or impossible at least in the near future.
We congratulate the authors and wait for their reply to our comments.

Ethics Statement

This study has been approved by Ethics Committee of Ataturk University Faculty of Medicine (68-69/24). Informed consent was obtained from all patients.

Conflicts of Interest

The authors have no financial conflicts of interest.

Funding Statement


Author Contributions

Conceptualization: Sabri Selcuk Atamanalp. Data curation: Sabri Selcuk Atamanalp. Formal analysis: Sabri Selcuk Atamanalp. Investigation: Sabri Selcuk Atamanalp. Methodology: Sabri Selcuk Atamanalp. Project administration: Sabri Selcuk Atamanalp. Visualization: Sabri Selcuk Atamanalp. Writing—original draft: Sabri Selcuk Atamanalp. Writing—review & editing: Refik Selim Atamanalp.

  • 1. Yoo D, Joo JY, Park SH, Park SJ, Ahn TB. Absence of alpha-synuclein aggregation in patients with Parkinson’s disease complicated by sigmoid volvulus. J Mov Disord 2024;17:118–119.ArticlePubMedPDF
  • 2. Atamanalp SS, Peksöz R, Dişçi E. Sigmoid volvulus and ileosigmoid knotting: an update. Eurasian J Med 2022;54(Suppl1):S91–S96.Article
  • 3. Web of Science. Sigmoid volvulus or ileosigmoid knot [Internet]. London: Clarivate [accessed on 2024 March 27]. Available at:
  • 4. Blackley S, Maguire C, Daniels T. Seven cases of sigmoid volvulus in Parkinson’s disease. J R Coll Physicians Edinb 2016;46:157–159.ArticlePubMedPDF
  • 5. Atamanalp SS. Sigmoid volvulus: coincidence with neurological diseases. Cukurova Med J 2021;46:1725–1726.
  • 6. Atamanalp SS. Endoscopic decompression of sigmoid volvulus: review of 748 patients. J Laparoendosc Adv Surg Tech A 2022;32:763–767.ArticlePubMed
  • 7. Atamanalp SS. Treatment for ileosigmoid knotting: a single-center experience of 74 patients. Tech Coloproctol 2014;18:233–237.ArticlePubMedPDF

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