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MALDI Imaging Mass Spectrometry of Neuropeptides in Parkinson's Disease

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Pallidopyramidal disease: a misnomer?

Martin W I M Horstink¹, Marieke C Dekker, Pasquale Montagna

¹Department of Neurology, Donders Centre for Brain, Cognition, and Behaviour, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.

Movement Disorders : Official Journal of the Movement Disorder Society

|July 15, 2010

Summary

This summary is machine-generated.

Pallidopyramidal disease (PPD/S) is doubtful as a distinct neurological entity. Reported cases likely represent early-onset parkinsonism or dopa-responsive dystonia, not true pallidal degeneration.

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Area of Science:

Neurology
Neurodegenerative Diseases

Background:

Pallidopyramidal disease (PPD/S) is characterized by early-onset parkinsonism and pyramidal tract signs attributed to pallidopyramidal degeneration.
Davison's original description proposed PPD/S as a distinct clinico-pathological entity.

Observation:

Investigated 15 reported cases of PPD/S post-Davison's description.
None of the reported cases showed definitive proof of pyramidal or pallidal degeneration.
Patients exhibited dopa-responsiveness, a characteristic not typical of primary pallidal parkinsonism.

Findings:

The clinical presentation and dopa-responsiveness suggest these cases are more likely early-onset nigral parkinsonism or dopa-responsive dystonia.
The observed Babinski sign may be a 'pseudobabinski' or 'striatal toe', not indicative of pyramidal tract involvement.
Secondary pallidopyramidal syndromes exist but present with additional features distinct from Davison's PPD/S.

Implications:

The existence of PPD/S as a distinct nosological entity, as defined by Davison, is questionable.
The term 'pallidopyramidal' may be a misnomer for the described clinical presentations.
Re-evaluation of reported PPD/S cases is necessary to clarify their actual diagnoses and underlying pathologies.