1Neurotology and Neuro-ophthalmology Laboratory, Korea University Medical Center, Seoul, Korea
2Department of Neurology, Korea University Medical Center, Seoul, Korea
3Department of Otorhinolaryngology-Head and Neck Surgery, Korea University College of Medicine, Seoul, Korea
4Department of Neurology, Seoul National University College of Medicine, Seoul, Korea
5Dizziness Center, Clinical Neuroscience Center, Seoul National University Bundang Hospital, Seongnam, Korea
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 (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Conflicts of Interest
Drs. K.T. Kim, K. Baik, S.U. Lee, E. Park, C.N. Lee, D. Woo, Y. Kim, S. Kwag, and H. Park report no disclosures.
JS Kim serves as an Associate Editor of Frontiers in Neuro-otology and on the editorial boards of Frontiers in Neuro-ophthalmology, Journal of Neuroophthalmology, Journal of Vestibular Research, and Clinical and Translational Neuroscience.
Funding Statement
This study was supported by the Basic Research Program through the National Research Foundation of Korea (NRF) funded by the MSIT (2022 R1A4A1018869).
Author Contributions
Conceptualization: Sun-Uk Lee. Data curation: Kyoungwon Baik, Sun-Uk Lee, Euyhyun Park, Chan-Nyoung Lee, Yukang Kim, Seoui Kwag, Hyunsoh Park. Formal analysis: Keun-Tae Kim, Sun-Uk Lee, Donghoon Woo, Yukang Kim. Funding acquisition: Sun-Uk Lee. Investigation: Kyoungwon Baik, Sun-Uk Lee, Euyhyun Park. Methodology: Kyoungwon Baik, Sun-Uk Lee, Chan-Nyoung Lee. Project administration: Sun-Uk Lee. Resources: Sun-Uk Lee. Supervision: Kyoungwon Baik, Sun-Uk Lee, Chan-Nyoung Lee. Validation: Sun-Uk Lee, Donghoon Woo, Ji-Soo Kim. Visualization: Sun-Uk Lee, Yukang Kim, Seoui Kwag, Hyunsoh Park. Writing—original draft: Keun-Tae Kim, Sun-Uk Lee. Writing—review & editing: Keun-Tae Kim, Sun-Uk Lee, Ji-Soo Kim.
Characteristics | MSA (n = 24) | PD (n = 52) | p value |
---|---|---|---|
Age (yr) | 65 ± 10 | 69 ± 12 | 0.194 |
Female sex | 9 (38) | 25 (48) | 0.389 |
Disease duration (yr) | 1.0 [0.5–2.0] | 1.0 [0.5–3.0] | 0.996 |
Body weight (kg) | 62 ± 12 | 63 ± 10 | 0.902 |
MDS-UPDRS-III | 38 (27–53) | 27 (22–33) | 0.079 |
H&Y stage | 2.5 (2.5–3.0) | 2.0 (2.0–2.5) | 0.002 |
UMSARS I-II | 36 (25–53) | - | - |
SARA | 14 (9–21) | - | - |
CASS | 4 (3–5) | 4 (2–6) | 0.796 |
COMPASS-31 | 22 (12–29) | 19 (9–31) | 0.973 |
RBD | 11 (46) | 16 (31) | 0.224 |
Comorbidities | |||
Benign prostate hyperplasia | 3/16 (19) | 4/27 (15) | >0.999 |
Diabetes mellitus | 0/24 (0) | 10/52 (19) | 0.026* |
Hypertension | 5/24 (21) | 27/52 (52) | 0.011* |
Dyslipidemia | 4/24 (17) | 18/52 (35) | 0.173 |
Congestive heart failure | 0/24 (0) | 1/52 (2) | >0.999 |
Chronic kidney disease | 1/24 (4) | 7/52 (14) | 0.423 |
Anemia | 6/24 (25) | 9/52 (17) | 0.434 |
Data are presented as mean ± standard deviation, median [interquartile range], or n (%).
* indicates statistically significant values.
MSA, multiple system atrophy; PD, Parkinson’s disease; MDS-UPDRSIII, Movement Disorder Society-Unified Parkinson’s Disease Rating Scale motor part; H&Y, Hoehn and Yahr; UMSARS, Unified Multiple System Atrophy Rating Scale; SARA, Scale for the Assessment and Rating of Ataxia; CASS, The Composite Autonomic Severity Scores; COMPASS-31, The Korean version of Composite Autonomic Symptom Score 31; RBD, REM sleep behavior disorder.
MSA (n = 24) | PD (n = 52) | p value | |
---|---|---|---|
oVEMP | 0.127 | ||
Normal | 9 (38) | 30 (58) | |
Unilaterally abnormal | 6 (25) | 13 (25) | |
Bilaterally abnormal | 9 (38) | 9 (17) | |
n1 latency (ms) | 7.0 ± 1.6 | 7.0 ± 1.3 | >0.999 |
n1–p1 amplitude (μV) | 7.7 ± 6.3 | 8.2 ± 6.4 | 0.733 |
IAD (%) | 7.2 [2.4–38.9] | 10.0 [3.5–15.5] | 0.717 |
cVEMP* | 0.510 | ||
Normal | 11 (55) | 34 (69) | |
Unilaterally abnormal | 4 (20) | 6 (12) | |
Bilaterally abnormal | 5 (25) | 9 (18) | |
p13 latency (ms) | 15.1 ± 3.8 | 15.9 ± 2.3 | 0.321 |
Normalized p13–n23 amplitude (μV) | 1.7 ± 1.5 | 2.1 ± 1.2 | 0.219 |
IAD (%) | 7.1 [2.1–39.4] | 10.0 [3.5–15.5] | 0.142 |
Data are presented as mean ± standard deviation, median [interquartile range], or n (%).
* after excluding seven patients whose cVEMP data cannot be assessed due to poor sternocleidomastoid contraction.
MSA, multiple system atrophy; PD, Parkinson’s disease; VEMP, vestibularevoked myogenic potential; oVEMP, ocular VEMP; cVEMP, cervical VEMP; IAD, interaural difference ratio of the amplitudes.
MSA (n = 24) | PD (n = 52) | p value | |
---|---|---|---|
Neurogenic OH | 15/24 (63) | 24/52 (46) | 0.185 |
Initial | 1 | 0 | |
Classic | 14 | 22 | |
Delayed | 0 | 2 | |
Baseline SBP (mmHg) | 139 ± 22 | 138 ± 26 | 0.824 |
Baseline DBP (mmHg) | 74 ± 15 | 66 ± 11 | 0.015* |
Baseline heart rate (beat/min) | 69 ± 8 | 65 ± 9 | 0.081 |
ΔSBP15s (mmHg) | -8 [-19– -1] | -7 [-15–1] | 0.750 |
ΔSBP3min (mmHg) | -21 [-30– -5] | -11 [-31– -1] | 0.118 |
ΔSBP10min (mmHg) | -26 [-37– -7] | -13 [-37– -3] | 0.194 |
ΔDBP15s (mmHg) | 1 [-1–3] | 1 [-4–5] | 0.382 |
ΔDBP3min (mmHg) | -2 [-9–1] | -2 [-6–2] | 0.601 |
ΔDBP10min (mmHg) | -2 [-10–1] | -2 [-8–2] | 0.387 |
ΔHR15s (beat/min) | 4 [2–6] | 4 [1–6] | 0.900 |
ΔHR3min (beat/min) | 10 [7–18] | 8 [4–14] | 0.635 |
ΔHR10min (beat/min) | 13 [8–19] | 10 [7–18] | 0.520 |
Data are presented as mean ± standard deviation, median [interquartile range], n (%), or numbers only.
* indicates statistically significant values.
MSA, multiple system atrophy; PD, Parkinson’s disease; OH, orthostatic hypotension; SBP, systolic blood pressure; DBP, diastolic blood pressure; HR, heart rate.
Variables |
Univariate analysis |
Multivariable analysis |
||
---|---|---|---|---|
OR (95% CI) | p value | OR (95% CI) | p value | |
Age | 0.97 (0.93–1.02) | 0.193 | 0.94 (0.87–1.00) | 0.065 |
Female sex | 0.65 (0.24–1.74) | 0.648 | 0.91 (0.25–3.40) | 0.894 |
Diabetes mellitus | 0.999* | |||
Hypertension | 0.24 (0.08–0.75) | 0.014‡ | 0.34 (0.08–1.41) | 0.340 |
oVEMP abnormality | 0.138† | 0.029†‡ | ||
Unilateral | 1.54 (0.45–5.22) | 0.489 | 1.85 (0.38–8.98) | 0.443 |
Bilateral | 3.33 (1.02–10.92) | 0.047* | 9.19 (1.77–47.76) | 0.008‡ |
cVEMP abnormality | 0.515† | 0.513† | ||
Unilateral | 2.06 (0.49–8.67) | 0.324 | 2.39 (0.42–13.52) | 0.325 |
Bilateral | 1.72 (0.47–6.22) | 0.410 | 1.90 (0.41–8.67) | 0.410 |
Neurogenic OH | 1.47 (0.54–4.00) | 0.448 | 0.92 (0.21–4.13) | 0.913 |
* there are insufficient data to estimate a difference (null incidence);
† p value for type 3 analysis for assessment of the significance of the complete categorical variable;
‡ indicates statistically significant values.
MSA, multiple system atrophy; PD, Parkinson’s disease; OR, odds ratio; CI, confidence interval; oVEMP, ocular vestibular-evoked myogenic potential; cVEMP, cervical vestibular-evoked myogenic potential; OH, orthostatic hypotension.
Variables |
Univariate analysis |
Multivariable analysis |
||
---|---|---|---|---|
OR (95% CI) | p value | OR (95% CI) | p value | |
MSA-cerebellar type (n = 16) | ||||
Age | 0.94 (0.89–0.99) | 0.027‡ | 0.90 (0.83–0.99) | 0.025‡ |
Female sex | 0.84 (0.27–2.59) | 0.762 | 1.37 (0.29–6.40) | 0.691 |
Diabetes mellitus | 0.999* | |||
Hypertension | 0.21 (0.05–0.84) | 0.027‡ | ||
oVEMP abnormality | 0.034† | 0.021†‡ | ||
Unilateral | 0.33 (0.04–2.96) | 0.322 | 0.53 (0.04–6.64) | 0.618 |
Bilateral | 3.81 (1.08–13.41) | 0.037‡ | 11.12 (1.76–70.04) | 0.010‡ |
cVEMP abnormality | 0.520† | 0.480† | ||
Unilateral | 2.13 (0.44–10.37) | 0.351 | 2.80 (0.37–21.16) | 0.318 |
Bilateral | 1.89 (0.46–7.72) | 0.376 | 2.21 (0.39–12.61) | 0.371 |
Neurogenic OH | 1.24 (0.39–3.97) | 0.722 | 1.11 (0.19–6.37) | 0.909 |
MSA-parkinsonian type (n = 8) | ||||
Age | 1.03 (0.96–1.10) | 0.393 | 1.00 (0.90–1.11) | 0.993 |
Female sex | 0.36 (0.07–1.95) | 0.236 | 0.15 (0.01–3.54) | 0.151 |
Diabetes mellitus | 0.999* | |||
Hypertension | 0.31 (0.06–1.67) | 0.173 | 0.60 (0.07–5.07) | 0.638 |
oVEMP abnormality | 0.128† | 0.201† | ||
Unilateral | 5.77 (0.99–33.68) | 0.052 | 10.12 (0.81–127.24) | 0.073 |
Bilateral | 1.67 (0.14–20.58) | 0.690 | 3.31 (0.13–84.71) | 0.470 |
cVEMP abnormality | 0.874† | 0.845† | ||
Unilateral | 1.89 (0.17–21.33) | 0.607 | 1.55 (0.07–32.84) | 0.779 |
Bilateral | 1.26 (0.12–13.60) | 0.849 | 2.33 (0.10–53.24) | 0.596 |
Neurogenic OH | 2.06 (0.46–9.25) | 0.346 | 1.12 (0.07–17.96) | 0.935 |
* there are insufficient data to estimate a difference (null incidence);
† p value for type 3 analysis for assessment of the significance of the complete categorical variable;
‡ indicates statistically significant values.
MSA, multiple system atrophy; PD, Parkinson’s disease; OR, odds ratio; CI, confidence interval; cVEMP, cervical vestibular-evoked myogenic potential; oVEMP, ocular vestibular-evoked myogenic potential; OH, orthostatic hypotension.
Comments on this article
Characteristics | MSA (n = 24) | PD (n = 52) | p value |
---|---|---|---|
Age (yr) | 65 ± 10 | 69 ± 12 | 0.194 |
Female sex | 9 (38) | 25 (48) | 0.389 |
Disease duration (yr) | 1.0 [0.5–2.0] | 1.0 [0.5–3.0] | 0.996 |
Body weight (kg) | 62 ± 12 | 63 ± 10 | 0.902 |
MDS-UPDRS-III | 38 (27–53) | 27 (22–33) | 0.079 |
H&Y stage | 2.5 (2.5–3.0) | 2.0 (2.0–2.5) | 0.002 |
UMSARS I-II | 36 (25–53) | - | - |
SARA | 14 (9–21) | - | - |
CASS | 4 (3–5) | 4 (2–6) | 0.796 |
COMPASS-31 | 22 (12–29) | 19 (9–31) | 0.973 |
RBD | 11 (46) | 16 (31) | 0.224 |
Comorbidities | |||
Benign prostate hyperplasia | 3/16 (19) | 4/27 (15) | >0.999 |
Diabetes mellitus | 0/24 (0) | 10/52 (19) | 0.026 |
Hypertension | 5/24 (21) | 27/52 (52) | 0.011 |
Dyslipidemia | 4/24 (17) | 18/52 (35) | 0.173 |
Congestive heart failure | 0/24 (0) | 1/52 (2) | >0.999 |
Chronic kidney disease | 1/24 (4) | 7/52 (14) | 0.423 |
Anemia | 6/24 (25) | 9/52 (17) | 0.434 |
MSA (n = 24) | PD (n = 52) | p value | |
---|---|---|---|
oVEMP | 0.127 | ||
Normal | 9 (38) | 30 (58) | |
Unilaterally abnormal | 6 (25) | 13 (25) | |
Bilaterally abnormal | 9 (38) | 9 (17) | |
n1 latency (ms) | 7.0 ± 1.6 | 7.0 ± 1.3 | >0.999 |
n1–p1 amplitude (μV) | 7.7 ± 6.3 | 8.2 ± 6.4 | 0.733 |
IAD (%) | 7.2 [2.4–38.9] | 10.0 [3.5–15.5] | 0.717 |
cVEMP |
0.510 | ||
Normal | 11 (55) | 34 (69) | |
Unilaterally abnormal | 4 (20) | 6 (12) | |
Bilaterally abnormal | 5 (25) | 9 (18) | |
p13 latency (ms) | 15.1 ± 3.8 | 15.9 ± 2.3 | 0.321 |
Normalized p13–n23 amplitude (μV) | 1.7 ± 1.5 | 2.1 ± 1.2 | 0.219 |
IAD (%) | 7.1 [2.1–39.4] | 10.0 [3.5–15.5] | 0.142 |
MSA (n = 24) | PD (n = 52) | p value | |
---|---|---|---|
Neurogenic OH | 15/24 (63) | 24/52 (46) | 0.185 |
Initial | 1 | 0 | |
Classic | 14 | 22 | |
Delayed | 0 | 2 | |
Baseline SBP (mmHg) | 139 ± 22 | 138 ± 26 | 0.824 |
Baseline DBP (mmHg) | 74 ± 15 | 66 ± 11 | 0.015 |
Baseline heart rate (beat/min) | 69 ± 8 | 65 ± 9 | 0.081 |
ΔSBP15s (mmHg) | -8 [-19– -1] | -7 [-15–1] | 0.750 |
ΔSBP3min (mmHg) | -21 [-30– -5] | -11 [-31– -1] | 0.118 |
ΔSBP10min (mmHg) | -26 [-37– -7] | -13 [-37– -3] | 0.194 |
ΔDBP15s (mmHg) | 1 [-1–3] | 1 [-4–5] | 0.382 |
ΔDBP3min (mmHg) | -2 [-9–1] | -2 [-6–2] | 0.601 |
ΔDBP10min (mmHg) | -2 [-10–1] | -2 [-8–2] | 0.387 |
ΔHR15s (beat/min) | 4 [2–6] | 4 [1–6] | 0.900 |
ΔHR3min (beat/min) | 10 [7–18] | 8 [4–14] | 0.635 |
ΔHR10min (beat/min) | 13 [8–19] | 10 [7–18] | 0.520 |
Variables | Univariate analysis |
Multivariable analysis |
||
---|---|---|---|---|
OR (95% CI) | p value | OR (95% CI) | p value | |
Age | 0.97 (0.93–1.02) | 0.193 | 0.94 (0.87–1.00) | 0.065 |
Female sex | 0.65 (0.24–1.74) | 0.648 | 0.91 (0.25–3.40) | 0.894 |
Diabetes mellitus | 0.999 |
|||
Hypertension | 0.24 (0.08–0.75) | 0.014 |
0.34 (0.08–1.41) | 0.340 |
oVEMP abnormality | 0.138 |
0.029 |
||
Unilateral | 1.54 (0.45–5.22) | 0.489 | 1.85 (0.38–8.98) | 0.443 |
Bilateral | 3.33 (1.02–10.92) | 0.047 |
9.19 (1.77–47.76) | 0.008 |
cVEMP abnormality | 0.515 |
0.513 |
||
Unilateral | 2.06 (0.49–8.67) | 0.324 | 2.39 (0.42–13.52) | 0.325 |
Bilateral | 1.72 (0.47–6.22) | 0.410 | 1.90 (0.41–8.67) | 0.410 |
Neurogenic OH | 1.47 (0.54–4.00) | 0.448 | 0.92 (0.21–4.13) | 0.913 |
Variables | Univariate analysis |
Multivariable analysis |
||
---|---|---|---|---|
OR (95% CI) | p value | OR (95% CI) | p value | |
MSA-cerebellar type (n = 16) | ||||
Age | 0.94 (0.89–0.99) | 0.027 |
0.90 (0.83–0.99) | 0.025 |
Female sex | 0.84 (0.27–2.59) | 0.762 | 1.37 (0.29–6.40) | 0.691 |
Diabetes mellitus | 0.999 |
|||
Hypertension | 0.21 (0.05–0.84) | 0.027 |
||
oVEMP abnormality | 0.034 |
0.021 |
||
Unilateral | 0.33 (0.04–2.96) | 0.322 | 0.53 (0.04–6.64) | 0.618 |
Bilateral | 3.81 (1.08–13.41) | 0.037 |
11.12 (1.76–70.04) | 0.010 |
cVEMP abnormality | 0.520 |
0.480 |
||
Unilateral | 2.13 (0.44–10.37) | 0.351 | 2.80 (0.37–21.16) | 0.318 |
Bilateral | 1.89 (0.46–7.72) | 0.376 | 2.21 (0.39–12.61) | 0.371 |
Neurogenic OH | 1.24 (0.39–3.97) | 0.722 | 1.11 (0.19–6.37) | 0.909 |
MSA-parkinsonian type (n = 8) | ||||
Age | 1.03 (0.96–1.10) | 0.393 | 1.00 (0.90–1.11) | 0.993 |
Female sex | 0.36 (0.07–1.95) | 0.236 | 0.15 (0.01–3.54) | 0.151 |
Diabetes mellitus | 0.999 |
|||
Hypertension | 0.31 (0.06–1.67) | 0.173 | 0.60 (0.07–5.07) | 0.638 |
oVEMP abnormality | 0.128 |
0.201 |
||
Unilateral | 5.77 (0.99–33.68) | 0.052 | 10.12 (0.81–127.24) | 0.073 |
Bilateral | 1.67 (0.14–20.58) | 0.690 | 3.31 (0.13–84.71) | 0.470 |
cVEMP abnormality | 0.874 |
0.845 |
||
Unilateral | 1.89 (0.17–21.33) | 0.607 | 1.55 (0.07–32.84) | 0.779 |
Bilateral | 1.26 (0.12–13.60) | 0.849 | 2.33 (0.10–53.24) | 0.596 |
Neurogenic OH | 2.06 (0.46–9.25) | 0.346 | 1.12 (0.07–17.96) | 0.935 |
Data are presented as mean ± standard deviation, median [interquartile range], or indicates statistically significant values. MSA, multiple system atrophy; PD, Parkinson’s disease; MDS-UPDRSIII, Movement Disorder Society-Unified Parkinson’s Disease Rating Scale motor part; H&Y, Hoehn and Yahr; UMSARS, Unified Multiple System Atrophy Rating Scale; SARA, Scale for the Assessment and Rating of Ataxia; CASS, The Composite Autonomic Severity Scores; COMPASS-31, The Korean version of Composite Autonomic Symptom Score 31; RBD, REM sleep behavior disorder.
Data are presented as mean ± standard deviation, median [interquartile range], or after excluding seven patients whose cVEMP data cannot be assessed due to poor sternocleidomastoid contraction. MSA, multiple system atrophy; PD, Parkinson’s disease; VEMP, vestibularevoked myogenic potential; oVEMP, ocular VEMP; cVEMP, cervical VEMP; IAD, interaural difference ratio of the amplitudes.
Data are presented as mean ± standard deviation, median [interquartile range], indicates statistically significant values. MSA, multiple system atrophy; PD, Parkinson’s disease; OH, orthostatic hypotension; SBP, systolic blood pressure; DBP, diastolic blood pressure; HR, heart rate.
there are insufficient data to estimate a difference (null incidence); indicates statistically significant values. MSA, multiple system atrophy; PD, Parkinson’s disease; OR, odds ratio; CI, confidence interval; oVEMP, ocular vestibular-evoked myogenic potential;
cVEMP, cervical vestibular-evoked myogenic potential; OH, orthostatic hypotension.
there are insufficient data to estimate a difference (null incidence); indicates statistically significant values. MSA, multiple system atrophy; PD, Parkinson’s disease; OR, odds ratio; CI, confidence interval; cVEMP, cervical vestibular-evoked myogenic potential; oVEMP, ocular vestibular-evoked myogenic potential; OH, orthostatic hypotension.
JEE YOUNG LEE
October 03, 2024