**6.2. Lewy body diseases**

#### *6.2.1. Idiopathic Parkinson's disease (IPD)*

Several reports of "supposed IPD" have shown severe bladder dysfunctions, e.g., large post-void residuals or neurogenic change in the EAS-EMG. However, some of these reports were published before a definition of MSA was established. Recent studies have reported almost normal EAS-EMG in patients with typical IPD38,47,53,67. Stocchi's study (1997) is important, since EMG in patients with IPD and MSA was performed by researchers blinded to the diagnosis.67 Pathological studies of IPD have shown a degenerative lesion in the spinal parasympathetic PGN75, although the lesions are much less developed than those in MSA. No Lewy bodies were found in Onuf's nucleus innervating the anal sphincter in IPD.75 In contrast, Libelius and Johansson (2000) described neurogenic change in EAS-EMG in PD after a disease duration of more than 5 years.30 This remains a matter of controversy; on the other hand, some patients with DLB may show abnormal EAS-EMG, as described below.

#### *6.2.2. Dementia with Lewy bodies (DLB)*

DLB is characterized as dementia with fluctuating cognition and visual hallucination, with (sometimes atypical) parkinsonism. Cardiovascular and urinary autonomic failure is another feature. We performed urodynamic studies in 7 patients with DLB, and performed EAS-EMG in 3. Two of those 3 patients exhibited neurogenic changes in MUPs.55

#### *6.2.3. Autonomic failure with Parkinson's disease (AFPD)*

AFPD is an intermediate entity that describes a combination of autonomic failure and IPD, but without dementia. We performed urodynamic studies in 7 patients with AFPD and performed EAS-EMG in 4. Three of those 4 patients exhibited neurogenic changes in MUPs55.

#### *6.2.4. Pure autonomic failure (PAF)*

Computational Intelligence in Electromyography Analysis – 298 A Perspective on Current Applications and Future Challenges

DSD: detrusor-sphincter dyssynergia

**6.2. Lewy body diseases** 

*6.2.1. Idiopathic Parkinson's disease (IPD)* 

may show abnormal EAS-EMG, as described below.

*6.2.2. Dementia with Lewy bodies (DLB)* 

(cited from ref. 74)

MSA: multiple system atrophy, RU: residual urine volume, UD: underactive detrusor, AD: acontractile detrusor

Several reports of "supposed IPD" have shown severe bladder dysfunctions, e.g., large post-void residuals or neurogenic change in the EAS-EMG. However, some of these reports were published before a definition of MSA was established. Recent studies have reported almost normal EAS-EMG in patients with typical IPD38,47,53,67. Stocchi's study (1997) is important, since EMG in patients with IPD and MSA was performed by researchers blinded to the diagnosis.67 Pathological studies of IPD have shown a degenerative lesion in the spinal parasympathetic PGN75, although the lesions are much less developed than those in MSA. No Lewy bodies were found in Onuf's nucleus innervating the anal sphincter in IPD.75 In contrast, Libelius and Johansson (2000) described neurogenic change in EAS-EMG in PD after a disease duration of more than 5 years.30 This remains a matter of controversy; on the other hand, some patients with DLB

DLB is characterized as dementia with fluctuating cognition and visual hallucination, with (sometimes atypical) parkinsonism. Cardiovascular and urinary autonomic failure is

**Table 1.** Neurogenic sphincter EMG and clinical variables other than duration of illness.

\*: International Cooperative Ataxia Rating Scale, walking capacities subscale

Earlier studies reported normal EAS-EMG in small groups of patients with PAF. However, Ravits et al. (1996)46 found abnormal EAS-EMG in 2 of 7 patients with PAF, although both of them were multiparous women. Sakakibara et al. performed urodynamic studies in 6 patients with PAF and EAS-EMG in 4. Three of those 4 patients exhibited neurogenic changes in MUPs.51 In PAF, parkinsonism may appear after a 10-year interval.81 Therefore PAF can be listed in the differential diagnosis of degenerative parkinsonism. To sum up, in all three Lewy body diseases (DLB, AFPD, PAF), the frequency of neurogenic changes seemed higher in EAS-EMG than in IPD but lower than in MSA. This suggests the involvement of the sacral Onuf's nucleus or its fibers in the external sphincter in these diseases. The prevalence of neurogenic changes in EAS-EMG seems to be: **MSA >> DLB = AFPD = PAF >> PD (Table 2)**. However, these assumptions require confirmation with a larger study. The results seem to be in accordance with the fact that 29% of the DLB patients undergoing EMG-cystometry had a low-compliance detrusor, indicating a pre-ganglionic lesion of the pelvic nerves. The bethanechol test showed that both of these patients had denervation supersensitivity of the detrusor, indicating a post-ganglionic lesion of the pelvic nerves. The results of physiological studies and metaiodobenzylguanidine (MIBG) cardiac scintigraphy suggested postganglionic abnormalities in DLB.


MSA: multiple system atrophy, DLB: Dementia with Lewy bodies, AFPD: Autonomic failure with Parkinson's disease PAF: Pure autonomic failure, PD: Parkinson's disease, GGL: ganglionic (cited from ref. 78)

**Table 2.** Comparison of lower urinary tract function in DLB, AFPD, PAF, PD and MSA. See text.
