Esansiyel tremoru ve Parkinson hastalığı olan hastalarda retina sinir lifi tabaka kalınlığı

Öz

Amaç: Esansiyel tremor (ET) ve Parkinson hastalığı (PH) yaygın hareket bozukluklarındandır. PH’de renkli görmede bozulma ve görme keskinliğinde azalma gibi görme sorunları bildirilmiştir. Çalışmalar, optik koherens tomografi (OKT) ile ölçülebilen retina sinir lifi tabaka (RSLT) kalınlığının PH ve bazı nörodejeneratif hastalıklarda azaldığını göstermiştir. ET ve PH hastalığının benzer özellikleri olması nedeniyle, ET ve PH hastalarında OKT kullanarak RSLT'yi değerlendirmeyi amaçladık.

Yöntemler: Bu prospektif vaka-kontrol çalışmasında PH, ET ve kontrol grupları oluşturuldu. Her grupta 30 kişi mevcuttu ve 180 göz incelendi. Bu gruplarda, RSLT kadranları, makula ve fovea OKT ile değerlendirildi. ET grubunda titreme şiddeti analizlere dahil edildi. PH'de hastalığın şiddeti Birleşik Parkinson Hastalığı Değerlendirme Ölçeği ve Hoehn ve Yahr ölçeği ile değerlendirildi.

Bulgular: Kontrol, ET ve PH gruplarında sağ gözün ortalama RSLT kalınlığı sırasıyla 93,2 (8,1), 86,7 (9,7), 86,8 (10,2) μm idi. PH ve ET gruplarında bu değerler kontrol grubuna göre daha düşüktü (P=0,026, P=0,025). ET'de hastalık şiddeti ile RSLT kalınlığı arasında ilişki bulunmadı.

Sonuç: ET'de azalmış RSLT kalınlığı, ET'nin PH gibi bir nörodejeneratif hastalık olduğunu gösterebilir. ET'de subklinik retinal bir etkilenme olabilir.

Anahtar Kelimeler

• Esansiyel tremor,Optik koherens tomografi,Parkinson hastalığı,Retinal sinir lifi tabakası

Retinal nerve fiber layer thickness in patients with essential tremor and Parkinson’s disease

Öz

Aim: Essential tremor (ET) and Parkinson’s disease (PD) are common movement disorders. In PD, visual problems such as impaired color vision and decreased visual acuity have been reported. Studies have shown that retinal nerve fiber layer (RNFL) thickness measured by optical coherence tomography (OCT) is decreased in PD and some neurodegenerative diseases. Due to the similarities of ET and PD, we aimed to evaluate RNFL measured by OCT in ET and PD patients. 

Methods: PD, ET and control groups were formed in this prospective case-control study. Each group included 30 individuals, and 180 eyes were examined. In these groups, RNFL quadrants, macula and fovea were evaluated with OCT. In the ET group, tremor severity was included in the analyses. The severity of disease in PD was assessed with the Unified Parkinson's Disease Rating scale and the Hoehn and Yahr scale. 

Results: In the control, ET and PD groups, the mean RNFL thicknesses of the right eye were 93.2 (8.1), 86.7 (9.7), 86.8 (10.2) μm, respectively. These values were lower in the PD and ET groups compared to the control group (P=0.026, P=0.025). There was no correlation between disease severity and RNFL thickness in ET. 

Conclusion: Decreased RNFL thickness in ET may indicate that ET is a neurodegenerative disease, such as PD. There may be subclinical retinal impairment in ET.

Anahtar Kelimeler

• Parkinson’s disease,Essential tremor,Optical coherence tomography,Retinal nerve fiber layer

Kaynakça

1. 1. Biousse V, Skibell BC, Watts RL, Loupe DN, Drews-Botsch C, Newman NJ. Ophthalmologic features of Parkinson’s disease. Neurology. 2004;62:177–80.
2. 2. Bodis-Wollner I. Retinopathy in Parkinson disease. J Neural Transm. 2009;116(11):1493-501.
3. 3. Bodis-Wollner I. Visual deficits related to dopamine deficiency in experimental animals and Parkinson’s disease patients. Trends Neurosci. 1990;13:296–302.
4. 4. Witkovsky P. Dopamine and retinal function. Doc Pohthalmol 2004;108(1):17-40.
5. 5. Harnois C., Di Paolo T. Decreased dopamine in the retinas of patients with Parkinson’s disease. Investigative Ophthalmology&Visual Science. 1990;31(11):2473–75.
6. 6. Satue M, Seral M, Otin S, Alarcia R, Herrero R, Bambo MP, et al. Retinal thinning and correlation with functional disability in patients with Parkinson’s disease. British Journal of Ophthalmology. 2014;98(3):350–5.
7. 7. Satue M, Obis J, Rodrigo MJ, Otin S, Fuertes MI, Vilades E, et al. Optical Coherence Tomography as a Biomarker for Diagnosis, Progression and Prognosis of Neurodegenerative Diseases. J Ophtalmol. 2016;2016:8503859.
8. 8. Inzelberg R, Ramirez JA, Nisipeanu P, Ophir A. Retinal nerve fiber layer thinning in Parkinson disease. Vision Res. 2004;44:2793–7.

9. 9. Kirbas S, Turkyilmaz K, Tufekci A, Durmus M. Retinal nerve fiber layer thickness in Parkinson disease. J Neuroophthalmol. 2013;33:62–5.
10. 10. Louis ED, Honig LS, Vonsattel JP, Maraganore DM, Borden S, Moscowitz CB. Essential tremor associated with focal nonnigral Lewy bodies: a clinicopathologic study. Arch Neurol. 2005;62(6):1004-7.
11. 11. Louis ED, Faust PL, Vonsattel JP, Honig LS, Rajput A, Robinson CA, et al. Neuropathological changes in essential tremor: 33 cases compared with 21 controls. Brain. 2007;130(12):3297-307.
12. 12. Louis ED. Essential Tremor: From Bedside to Bench and Back to Bedside. Curr Opin Neurol. 2014;27(4):461-7.
13. 13. Jankovic J. Essential tremor: a heterogenous disorder. Mov Disord. 2002;17:638.
14. 14. Louis ED, Benito-León J, Bermejo-Pareja F. Self-reported depression and anti-depressant medication use in essential tremor: cross-sectional and prospective analyses in a population-based study. Eur J Neurol. 2007;14(10):1138–46.
15. 15. Lee SM, Kim M, Lee HM, Kwon KY, Koh SB. Nonmotor symptoms in essential tremor: Comparison with Parkinson’s disease and normal control. J Neurol Sci 2015;349(1-2):168-73
16. 16. Oh YS, Kim JS, Chung SW, Song IU, Kim YD, Kim YI, et al. Color vision in Parkinson’s disease and essential tremor. Eur J Neurol. 2011;18(4):577-83.
17. 17. Louis ED, Gerbin M, Viner AS. Color vision: a study of essential tremor cases versus controls. Eur J Neurol. 2012;19 (8):1136-9.
18. 18. Cubo E, Tedejo RP, Rodriguez Mendez V, Lopez Pena MJ, Trejo Gabriel Y Galan JM. Retina Thickness in Parkinson's Disease and Essential Tremor. Movement Disorders. 2010;25(14):2461-2.
19. 19. Tak AZA, Şengül Y, Karadağ AS. Evaluation of thickness of retinal nerve fiber layer, ganglion cell layer, and choroidal thickness in essential tremor: can eyes be a clue for neurodegeneration. Acta Neurol Belg. 2018;118(2):235-41.
20. 20. Turkel Y, Ornek N, Dag E, Ornek K, Alpua M, Ogurel T, et al. Retinal nerve fiber layer thickness in patients with essential tremor. Neurology Asia. 2017;20(4):363-6.
21. 21. Shrier EM, Adam CR, Spund B, Glazman S, Bodis-Wollner I. Intraocular asymmetry of foveal thickness in Parkinson’s disease. J Ophtalmol. 2012;728457
22. 22. Altintas O, Iseri P, Ozkan B, Caglar Y. Correlation between retinal morphological and functional findings and clinical severity in Parkinson’s disease. Doc Ophthalmol. 2008;116:137–46.
23. 23. Rohani M, Langroodi AS, Ghourchian S, Falavarjani KG, SoUdi R, Shahidi G. Retinal nerve changes in patients with tremor dominant and akinetic rigid Parkinson’s disease. Neurol Sci. 2013;34(5):689-93.
24. 24. Archibald NK, Clarke MP, Mosimann UP, Burn DJ. Retinal thickness in Parkinson’s disease. Parkinsonism Relat Disord. 2011;17:431–6.
25. 25. Yu JG, Feng YF, Xiang Y, Huang JH, Savini G, Parisi V, et al. Retinal Nerve Fiber Layer Thickness Changes in Parkinson Disease: A Meta-Analysis. PLoS One. 2014:9(1);e85718.
26. 26. Moschos MM, Tagaris G, Markopoulos I, Margetis I, Tsapakis S, Kanakis M, et al. Morphologic Changes and Functional Retinal Impairment in Patients with Parkinson Disease without Visual Loss. Eur J Ophthalmol. 2011;21(1):24-9.
27. 27. Garcia-Martin E, Pueyo V, Ara JR, Almarcegui C, Martin J, Pablo L, et al. Effect of optic neuritis on progressive axonal damage in multiple sclerosis patients. Mult Scler. 2011;17(7):830-7.
28. 28. Frederick JM, Rayborn ME, Laties AM, Lam DM, Hollyfield JG. Dopaminergic neurons in the human retina. J Comp Neurol. 1982;210:65–79.
29. 29. Peppe A, Stanzione P, Pierelli F, De Angelis D, Pierantozzi M, Bernardi G. Visual alterations in de novo Parkinson’s disease: pattern electroretinogram latencies are more delayed and more reversible by levodopa than are visual evoked potentials. Neurology. 1995;45:1144–8.
30. 30. Büttner T, Kuhn W, Patzold T, Przuntek H. L-Dopa improves colour vision in Parkinson’s disease. J NeuralTransm Park Dis Dement Sect. 1994;7:13–9.
31. 31. Braak H, Del Tredici K, Rüb U, de Vos RA, Jansen Steur EN, Braak E. Staging of the brain pathology related to sporadic Parkinson’s disease. Neurobiol Aging. 2003;24:197-211.
32. 32. Ortuño-Lizarán I, Beach TG, Serrano GE, Walker DG, Adler CH, Cuenca N. Phosphorylated α-synuclein in the retina is a biomarker of Parkinson’s disease pathology severity. Mov Disord. 2018; 33(8):1315-24.
33. 33. Beach TG, Carew J, Serrano G, Adler CH, Shill HA, Sue LI, et al. Phosphorylated α-synuclein-immunoreactive retinal neuronal elements in Parkinson's disease subjects. Neurosci Lett. 2014;571:34-8.
34. 34. Jiménez B, Ascaso FJ, Cristobal JA, Lopez del Val J. Development of a prediction formula of Parkinson disease severity by optical coherence tomography. Mov Disord. 2004;29(1):68-74.
35. 35. Benito-Leon J, Louis ED, Bermejo-Pareja F. Risk of incident parkinson's disease and parkinsonism in essential tremor: a population based study. J Neurol Neurosurg Psychiatry. 2009;80(4):423-5.
36. 36. Louis ED, Hernandez N, Michalec M. Prevalence and correlates of rest tremor in essential tremor: cross-sectional survey of 831 patients across four distinct cohorts. Eur J Neurol. 2015;22(6):927-32.
37. 37. Thenganatt MA, Louis ED. Distinguishing essential tremor from Parkinson’s disease: bedside tests and laboratory evaluations. Expert Rev Neurother. 2012;12(6):687-96.