Transcranial sonographic features of Parkinson′s disease patients with musculoskeletal pain

Abstract

Objective To investigate the substantia nigra(SN) and brainstem raphe(BR) echogenic features of Parkinson′s disease (PD) patients with musculoskeletal pain. Methods A total of 115 PD patients recruited in the Second Affiliated Hospital of Soochow University from October 2014 to May 2016 were assessed with the following rating scales: Unified Parkinson′s Disease Rating Scale(UPDRS), Hoehn and Yahr Staging Scale (H/Y), Hamilton Rating Scale for Depression (HRSD), Beck Depression Inventory Ⅱ(BDI-Ⅱ) and Visual Analogue Scale (VAS). All the subjects underwent transcranial sonography during the clinical evaluation. And the patients were divided into PD with musculoskeletal pain(n=54) and PD without musculoskeletal pain(n=61) groups, or PD with depression(n=74) and PD without depression(n=41) groups. Results Compared with PD patients without pain, PD patients with musculoskeletal pain had higher scores of UPDRS-Ⅱ, -Ⅲ, HRSD, BDI, NMSQ and H/Y (UPDRS-Ⅱ score: 12.56±6.01 vs 8.79±4.38, t=-3.801, P<0.01; UPDRS-Ⅲ score: 24.43±12.43 vs 20.07±11.12, t=-1.986, P=0.049; HRSD score: 11.65±6.94 vs 8.38±5.36, t=-2.844, P=0.005; BDI score: 14.09±6.20 vs 9.74±6.00, t=-3.826, P<0.01; NMSQ score: 8.57±4.06 vs 5.60±3.38, t=-4.193, P<0.01; H/Y: 2.0(1.5, 2.6) vs 1.5(1.0, 2.0), Z=-3.011, P=0.003). Positive BR was more frequent in depressed than in non-depressed PD patients without pain(63.6% vs 14.3%; χ2=15.25, P<0.01). Positive BR was positively associated with sex(r=0.228, P=0.014), age(r=0.184, P=0.049), disease duration(r=0.196, P=0.035), and depression(r=0.396, P<0.01). However, positive BR did not correlate with musculoskeletal pain. No correlation was found between positive SN and clinical characteristics of PD patients. Conclusions PD patients with musculoskeletal pain have worse activity of daily living, more severe motor symptoms, more non-motor symptoms, and are more depressed. SN and BR echogenecity do not correlate with musculoskeletal pain, however, hypoechogenic or interrupted BR is associated with depression in PD patients. Key words: Ultrasonography, Doppler, transcranial; Parkinson disease; Muscle, skeletal; Pain; Depression