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Vagus nerve ultrasonography in Parkinson's disease: A systematic review and meta-analysis

      Abstract

      Objectives

      Vagus nerve (VN) has been suggested as one of the major routes of Parkinson's disease (PD) progression from enteric nervous system to brain. Therefore, the recent studies have investigated the VN structurally, with a focus on the changes in its size in PD patients using high-frequency ultrasonography. This systematic review and meta-analysis aims to evaluate VN size via ultrasound in PD compared to controls.

      Methods

      Totally, five studies were included with a total of 238 participants (128 PD patients and 111 controls).

      Results

      The estimate mean difference in four studies showed that the VN CSA was smaller in PD patients with 0.29 mm2 (95% CI, −0.52 to −0.06) and 0.23 mm2 (95% CI, −0.42 to −0.05) for right and left VNs respectively. The test for overall effect was significant for both measurements (p = 0.01).

      Conclusions

      This review reveals that there is a degree of vagus nerve atrophy in PD which could be detected sonographically with high confidence, thus can be used as a marker for vagus neuronal lesion or neuropathy. Further studies are needed to examine its clinical correlation thoroughly.

      Abbreviations:

      CSA (cross sectional area), dmX (dorsal motor nucleus of the vagus), MDS-UPDRS (Movement Disorder Society-Unified Parkinson's Disease Rating Scale), PD (Parkinson's disease), SN (substantia nigra), VN (vagus nerve)

      Keywords

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      References

        • Al-Kureischi K.
        Verlauf und Nervenfaserarten des Truncus vagalis des Menschen [Topographic anatomy and fiber diameter of the human vagal trunk].
        Acta Anat. 1979; 103: 252-258
        • Braak H.
        • Rüb U.
        • Gai W.P.
        • Del Tredici K.
        Idiopathic Parkinson’s disease: possible routes by which vulnerable neuronal types may be subject to neuroinvasion by an unknown pathogen.
        J. Neural Transm. 2003; 110: 517-536https://doi.org/10.1007/s00702-002-0808-2
        • Cheng Z.
        • Powley T.L.
        • Schwaber J.S.
        • Doyle F.J.
        Projections of the dorsal motor nucleus of the vagus to cardiac ganglia of rat atria: an anterograde tracing study.
        J. Comp. Neurol. 1999; 410: 320-341https://doi.org/10.1002/(SICI)1096-9861(19990726)410:2<320::AID-CNE12>3.0.CO;2-5
        • Clarke C.E.
        Parkinson’s disease.
        Br. Med. J. 2007; 335 (September 1): 441-445https://doi.org/10.1136/bmj.39289.437454.AD
        • Del Tredici K.
        • Braak H.
        Sporadic Parkinson’s disease: development and distribution of α-synuclein pathology.
        Neuropathol. Appl. Neurobiol. 2016; 42 (February 1): 33-50https://doi.org/10.1111/nan.12298
        • Fedtke N.
        • Witte O.W.
        • Prell T.
        Ultrasonography of the vagus nerve in Parkinson’s disease.
        Front. Neurol. 2018; 9: 1-3https://doi.org/10.3389/fneur.2018.00525
        • Grimm A.
        • Décard B.F.
        • Bischof A.
        • Axer H.
        Ultrasound of the peripheral nerves in systemic vasculitic neuropathies.
        J. Neurol. Sci. 2014; 347: 44-49https://doi.org/10.1016/j.jns.2014.09.017
        • Grimm A.
        • Rasenack M.
        • Athanasopoulou I.
        • Peters N.
        • Fuhr P.
        Long-term observations in asymmetric immune-mediated neuropathy with vagus hypertrophy using ultrasound of the nerves.
        J. Neurol. Sci. 2015, September 15; 356: 205-208https://doi.org/10.1016/j.jns.2015.06.018
        • Holmqvist S.
        • Chutna O.
        • Bousset L.
        • Aldrin-Kirk P.
        • Li W.
        • Björklund T.
        • Li J.Y.
        Direct evidence of Parkinson pathology spread from the gastrointestinal tract to the brain in rats.
        Acta Neuropathol. 2014; 128: 805-820https://doi.org/10.1007/s00401-014-1343-6
        • Klingelhoefer L.
        • Reichmann H.
        Pathogenesis of Parkinson disease - the gut-brain axis and environmental factors.
        Nat. Rev. Neurol. 2015; 11 (November 1): 625-636https://doi.org/10.1038/nrneurol.2015.197
        • Laucius O.
        • Balnyte R.
        • Petrikonis K.
        • Matijošaitis V.
        • Jucevičiute N.
        • Vanagas T.
        • Danielius V.
        Ultrasonography of the vagus nerve in the diagnosis of Parkinson’s disease.
        Parkinsons Dis. 2020; 2020https://doi.org/10.1155/2020/2627471
        • Liu B.
        • Fang F.
        • Pedersen N.L.
        • Tillander A.
        • Ludvigsson J.F.
        • Ekbom A.
        • Karin W.
        Vagotomy and Parkinson disease a Swedish register-based matched-cohort study.
        Neurology. 2017; 88: 1996-2002https://doi.org/10.1212/WNL.0000000000003961
        • McGrath S.
        • Zhao X.
        • Steele R.
        • Thombs B.D.
        • Benedetti A.
        Estimating the sample mean and standard deviation from commonly reported quantiles in meta-analysis.
        Stat. Methods Med. Res. 2020; 29: 2520-2537https://doi.org/10.1177/0962280219889080
        • Moher D.
        • Liberati A.
        • Tetzlaff J.
        • et al.
        Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement.
        Ann. Intern. Med. 2009; 151: 264-269https://doi.org/10.7326/0003-4819-151-4-200908180-00135
        • Pakkenberg B.
        • Gundersen H.J.
        • Mouritzen Dam A.
        • Pakkenberg H.
        The absolute number of nerve cells in substantia nigra in normal subjects and in patients with Parkinson’s disease estimated with an unbiased stereological method.
        Neurosurg. Psychiatry. 1991; 54
        • Pelz J.O.
        • Belau E.
        • Fricke C.
        • Classen J.
        • Weise D.
        Axonal degeneration of the vagus nerve in Parkinson’s disease-a high-resolution ultrasound study.
        Front. Neurol. 2018; 9: 1-4https://doi.org/10.3389/fneur.2018.00951
        • Poewe W.
        • Seppi K.
        • Tanner C.M.
        • Halliday G.M.
        • Brundin P.
        • Volkmann J.
        • Schrag A.E.
        • Lang A.E.
        Parkinson disease.
        Nat. Rev. Dis. Primers. 2017; 3: 1-21https://doi.org/10.1038/nrdp.2017.13
      1. Review Manager (RevMan). Version 5.3. The Cochrane Collaboration, 2020 (computer program)
        • Svensson E.
        • Horváth-Puhó E.
        • Thomsen R.W.
        • Djurhuus J.C.
        • Pedersen L.
        • Borghammer P.
        • Sørensen H.T.
        Vagotomy and subsequent risk of Parkinson’s disease.
        Ann. Neurol. 2015; 78: 522-529https://doi.org/10.1002/ana.24448
        • Tawfik E.A.
        • Walker F.O.
        • Cartwright M.S.
        • El-Hilaly R.A.
        Diagnostic ultrasound of the vagus nerve in patients with diabetes.
        J. Neuroimaging. 2017; 27: 589-593https://doi.org/10.1111/jon.12452
        • Tsukita K.
        • Taguchi T.
        • Sakamaki-Tsukita H.
        • Tanaka K.
        • Suenaga T.
        The vagus nerve becomes smaller in patients with Parkinson’s disease: a preliminary cross-sectional study using ultrasonography.
        Parkinsonism Relat. Disord. 2018; 55: 148-149https://doi.org/10.1016/j.parkreldis.2018.06.002
        • Walter U.
        • Tsiberidou P.
        • Kersten M.
        • Storch A.
        • Löhle M.
        Atrophy of the vagus nerve in Parkinson’s disease revealed by high-resolution ultrasonography.
        Front. Neurol. 2018; 9: 1-6https://doi.org/10.3389/fneur.2018.00805
        • Wells G.
        • Shea B.
        • O’connell D.
        • Peterson J.
        • Welch V.
        • Losos M.
        • Tugwell P.
        The Newcastle-Ottawa Scale (Nos) for Assessing the Quality of Nonrandomised Studies in Meta-Analyses.
        Ottawa Hospital Research Institute, Ottawa, ON, Canada2000
        • Xu L.
        • Pu J.
        Alpha-synuclein in Parkinson’s disease: from pathogenetic dysfunction to potential clinical application.
        Parkinsons Dis. 2016; 2016https://doi.org/10.1155/2016/1720621