Sudden Unexpected Death in Parkinson’s Disease (SUDPAR): a fatal event that James Parkinson did not address

Sudden Unexpected Death in Parkinson’s Disease (SUDPAR): a fatal event that James Parkinson did... Age and Ageing 2018; 47: 627 © The Author(s) 2018. Published by Oxford University Press on behalf of the British Geriatrics Society. All rights reserved. For permissions, please email: journals.permissions@oup.com Letter to the Editor routine ECG, stress tests, long-term ECG recordings, echo- Sudden Unexpected Death in Parkinson’s cardiography, cardiac MRI and myocardial scintigraphy. The Disease (SUDPAR): a fatal event that goal of all these measures should be the reduction of the fre- James Parkinson did not address quency of SUDPAR. 1 2 1 FULVIO A. SCORZA ,ANA C. FIORINI ,CARLA A. SCORZA , Dear Sir, JOSEF FINSTERER We read with interest the stimulating article by McDonald Disciplina de Neurociência. Escola Paulista de Medicina/ et al. who have elegantly reviewed the scientific advances of Universidade Federal de São Paulo/. (EPM/UNIFESP) Parkinson’s Disease (PD) since James Parkinson’soriginal Programa de Estudos Pós-Graduado em Fonoaudiologia. Pontifícia Universidade Católica de São Paulo (PUC-SP). Departamento de description [1]. In the last decades, significant advances have Fonoaudiologia. Escola Paulista de Medicina/Universidade Federal been achieved regarding pathophysiology and symptomatic de São Paulo (EPM/UNIFESP) treatments, but critically important issues are still under dis- Krankenanstalt Rudolfstiftung cussion, such as the need to modify disease progression [1, 2]. Address correspondence to: Josef Finsterer, Postfach 20, 1180 Vienna, Austria, Europe. Tel: +43-1-71165-92085; Another important aspect, not frequently discussed in the lit- Fax: +43-1-4781711. Email: fifigs1@yahoo.de erature, that should also be addressed, is the mortality in PD [3]. Mortality rates among patients with PD are higher when compared with the general population [3]. Interestingly, mor- Funding tality is not increased in the first decade after disease onset, Our studies are supported by the following grants: FAPESP but increases only thereafter [4]. It is well established that the (Fundação de Amparo à Pesquisa do Estado de São Paulo); leading causes of death in PD are pneumonia, cerebrovascular CNPq (Conselho Nacional de Desenvolvimento Científico e complications and cardiovascular diseases [3, 4]. However, Tecnológico); Coordenação de Aperfeiçoamento de Pessoal neuroscientists are recognising the increasing number of PD de Nível Superior (CAPES) and FAPESP/CNPq/MCT patients who die suddenly and unexplained, referred as (Instituto Nacional de Neurociência Translacional). Sudden Unexpected Death in Pakinson’sDisease (SUDPAR) [3]. Didactically, SUDPAR could be defined as an unexpected death in a patient with PD without any satisfactory explan- Conflicts of interest ation of death as determined by autopsy studies [3]. From the epidemiological point of view, there are still only few studies The authors report no conflicts of interest. providing figures about the prevalence and incidence of SUDPAR in the main research centres of PD. Accordingly, an References interesting study by Matsumoto et al. [5] evaluated the causes of death in16patientswithPDinanautopsy study. The 1. McDonald C, Gordon G, Hand A, Walker RW, Fisher JM. authors found that 25% of the individuals with PD had died 200 years of Parkinson’s disease: what have we learnt from suddenly, suggesting that a non-negligible number of PD James Parkinson? Age Ageing 2018; 47: 209–14. doi:10. patients diefromsuddendeath[5]. SUDPAR does not have a 1093/ageing/afx196. definite cause, but cardiovascular events may play an import- 2. Obeso JA, Stamelou M, Goetz CG et al. Past, present, and future ant pathogenetic role [3]. Despite being considered a rare of Parkinson’s disease: a special essay on the 200th Anniversary event, much still needs to be discovered about SUDPAR and of the Shaking Palsy. Mov Disord 2017; 32: 1264–1310. 3. Scorza FA, do Carmo AC, Fiorini AC et al. Sudden unex- a number of questions remain unanswered. How to define pected death in Parkinson’s disease (SUDPAR): a review of sudden death of patients with PD? How many individuals publications since the decade of the brain. Clinics 2017; 72: with PD die annually? What is the main cause or causes of 649–51. SUDPAR? Are there specificriskfactors forSUDPAR? In 4. Pinter B, Diem-Zangerl A, Wenning GK et al. Mortality in case specificriskfactors forSUDPARcan be identified, pre- Parkinson’s disease: a 38-year follow-up study. Mov Disord ventive actions need to be taken by neurologists. While 2015; 30: 266–9. answers to these questions are not extensively discussed in the 5. Matsumoto H, Sengoku R, Saito Y, Kakuta Y, Murayama S, literature, caution with PD patients is necessary. Therefore, a Imafuku I. Sudden death in Parkinson’s disease: a retrospect- close cooperation between neurologists and cardiologists ive autopsy study. J Neurol Sci 2014; 343: 149–52. should be pursued in PD research centres. Cardiac surveil- lance of PD patients considered at high risk, should follow doi: 10.1093/ageing/afy064 comprehensive cardiovascular screening protocols, including Published electronically 25 April 2018 Downloaded from https://academic.oup.com/ageing/article-abstract/47/4/627/4985485 by Ed 'DeepDyve' Gillespie user on 26 June 2018 http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Age and Ageing Oxford University Press

Sudden Unexpected Death in Parkinson’s Disease (SUDPAR): a fatal event that James Parkinson did not address

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Oxford University Press
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© The Author(s) 2018. Published by Oxford University Press on behalf of the British Geriatrics Society. All rights reserved. For permissions, please email: journals.permissions@oup.com
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0002-0729
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1468-2834
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10.1093/ageing/afy064
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Abstract

Age and Ageing 2018; 47: 627 © The Author(s) 2018. Published by Oxford University Press on behalf of the British Geriatrics Society. All rights reserved. For permissions, please email: journals.permissions@oup.com Letter to the Editor routine ECG, stress tests, long-term ECG recordings, echo- Sudden Unexpected Death in Parkinson’s cardiography, cardiac MRI and myocardial scintigraphy. The Disease (SUDPAR): a fatal event that goal of all these measures should be the reduction of the fre- James Parkinson did not address quency of SUDPAR. 1 2 1 FULVIO A. SCORZA ,ANA C. FIORINI ,CARLA A. SCORZA , Dear Sir, JOSEF FINSTERER We read with interest the stimulating article by McDonald Disciplina de Neurociência. Escola Paulista de Medicina/ et al. who have elegantly reviewed the scientific advances of Universidade Federal de São Paulo/. (EPM/UNIFESP) Parkinson’s Disease (PD) since James Parkinson’soriginal Programa de Estudos Pós-Graduado em Fonoaudiologia. Pontifícia Universidade Católica de São Paulo (PUC-SP). Departamento de description [1]. In the last decades, significant advances have Fonoaudiologia. Escola Paulista de Medicina/Universidade Federal been achieved regarding pathophysiology and symptomatic de São Paulo (EPM/UNIFESP) treatments, but critically important issues are still under dis- Krankenanstalt Rudolfstiftung cussion, such as the need to modify disease progression [1, 2]. Address correspondence to: Josef Finsterer, Postfach 20, 1180 Vienna, Austria, Europe. Tel: +43-1-71165-92085; Another important aspect, not frequently discussed in the lit- Fax: +43-1-4781711. Email: fifigs1@yahoo.de erature, that should also be addressed, is the mortality in PD [3]. Mortality rates among patients with PD are higher when compared with the general population [3]. Interestingly, mor- Funding tality is not increased in the first decade after disease onset, Our studies are supported by the following grants: FAPESP but increases only thereafter [4]. It is well established that the (Fundação de Amparo à Pesquisa do Estado de São Paulo); leading causes of death in PD are pneumonia, cerebrovascular CNPq (Conselho Nacional de Desenvolvimento Científico e complications and cardiovascular diseases [3, 4]. However, Tecnológico); Coordenação de Aperfeiçoamento de Pessoal neuroscientists are recognising the increasing number of PD de Nível Superior (CAPES) and FAPESP/CNPq/MCT patients who die suddenly and unexplained, referred as (Instituto Nacional de Neurociência Translacional). Sudden Unexpected Death in Pakinson’sDisease (SUDPAR) [3]. Didactically, SUDPAR could be defined as an unexpected death in a patient with PD without any satisfactory explan- Conflicts of interest ation of death as determined by autopsy studies [3]. From the epidemiological point of view, there are still only few studies The authors report no conflicts of interest. providing figures about the prevalence and incidence of SUDPAR in the main research centres of PD. Accordingly, an References interesting study by Matsumoto et al. [5] evaluated the causes of death in16patientswithPDinanautopsy study. The 1. McDonald C, Gordon G, Hand A, Walker RW, Fisher JM. authors found that 25% of the individuals with PD had died 200 years of Parkinson’s disease: what have we learnt from suddenly, suggesting that a non-negligible number of PD James Parkinson? Age Ageing 2018; 47: 209–14. doi:10. patients diefromsuddendeath[5]. SUDPAR does not have a 1093/ageing/afx196. definite cause, but cardiovascular events may play an import- 2. Obeso JA, Stamelou M, Goetz CG et al. Past, present, and future ant pathogenetic role [3]. Despite being considered a rare of Parkinson’s disease: a special essay on the 200th Anniversary event, much still needs to be discovered about SUDPAR and of the Shaking Palsy. Mov Disord 2017; 32: 1264–1310. 3. Scorza FA, do Carmo AC, Fiorini AC et al. Sudden unex- a number of questions remain unanswered. How to define pected death in Parkinson’s disease (SUDPAR): a review of sudden death of patients with PD? How many individuals publications since the decade of the brain. Clinics 2017; 72: with PD die annually? What is the main cause or causes of 649–51. SUDPAR? Are there specificriskfactors forSUDPAR? In 4. Pinter B, Diem-Zangerl A, Wenning GK et al. Mortality in case specificriskfactors forSUDPARcan be identified, pre- Parkinson’s disease: a 38-year follow-up study. Mov Disord ventive actions need to be taken by neurologists. While 2015; 30: 266–9. answers to these questions are not extensively discussed in the 5. Matsumoto H, Sengoku R, Saito Y, Kakuta Y, Murayama S, literature, caution with PD patients is necessary. Therefore, a Imafuku I. Sudden death in Parkinson’s disease: a retrospect- close cooperation between neurologists and cardiologists ive autopsy study. J Neurol Sci 2014; 343: 149–52. should be pursued in PD research centres. Cardiac surveil- lance of PD patients considered at high risk, should follow doi: 10.1093/ageing/afy064 comprehensive cardiovascular screening protocols, including Published electronically 25 April 2018 Downloaded from https://academic.oup.com/ageing/article-abstract/47/4/627/4985485 by Ed 'DeepDyve' Gillespie user on 26 June 2018

Journal

Age and AgeingOxford University Press

Published: Apr 25, 2018

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