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Segmental progression of early untreated Parkinson’s disease: a novel approach to clinical rating
  1. W M M Schüpbach1,2,3,4,
  2. J-C Corvol1,3,5,
  3. V Czernecki1,3,6,
  4. M B Djebara1,2,3,7,
  5. J-L Golmard8,
  6. Y Agid1,2,3,7,
  7. A Hartmann1,2,3,7
  1. 1
    Centre d’Investigation Clinique, Fédération des Maladies du Système Nerveux, Paris, France
  2. 2
    INSERM, UMR 679, Neurology and Experimental Therapeutics, Paris, France
  3. 3
    AP-HP, Pitié-Salpêtrière Group, Fédération de Neurologie, Paris, France
  4. 4
    Department of Neurology, Bern University Hospital and University of Bern, Switzerland
  5. 5
    Service de Pharmacologie, Pitié-Salpêtrière Group, Paris, France
  6. 6
    INSERM UMR 610, Functional Neuroanatomy of Normal and Pathological Behaviour, Paris, France
  7. 7
    Université Pierre et Marie Curie, Faculté de Médecine, Paris, France
  8. 8
    AP-HP, Pitié-Salpêtrière Group, Biostatistics Unit, Paris, France
  1. Correspondence to Dr A Hartmann, Centre d’Investigation Clinique, Pitié-Salpêtrière Group, 47, Boulevard de l’Hôpital, F-75651 Paris Cedex 13, France; andreas.hartmann{at}


Objective: To assess the ability of potentially neuroprotective compounds to slow the progression of Parkinson’s disease (PD), sensitive rating scales are needed to detect clinically meaningful effects. The topographical progression of motor signs in early untreated PD was evaluated to complement current clinical ratings and enhance the sensitivity to detect disease progression.

Methods: 12 patients referred for diagnostic evaluation of untreated de novo PD underwent detailed clinical assessment of motor parkinsonian signs at baseline and after 6 and 12 months of follow-up using the Unified Parkinson’s Disease Rating Scale, motor part (UPDRS-III), and a newly developed approach of detailed segmental rating taking into account the localisation of motor signs in all of the major joints and muscle groups in the body. The progression of PD, as measured with the UPDRS-III, was compared with the segmental ratings.

Results: UPDRS-III scores and segmental ratings for rigidity and rest and postural tremor, but not bradykinesia, progressed significantly during the observation period. Progression of normalised segmental ratings for rigidity and tremor was significantly larger than the UPDRS-III ratings over 1 year. The segmental ratings for rigidity and tremor as well as their combination with the UPDRS-III bradykinesia rating were more sensitive a measure for progression of PD than the UPDRS-III.

Conclusions: Taking into account the segmental evolution of parkinsonian signs may be a useful adjunct to UPDRS-III evaluations to measure clinical disease progression of PD. If validated in subsequent larger cohorts, this may be useful in trials of neuroprotective agents.

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  • Funding WMMS was supported by grants from the Swiss National Science Foundation and the Swiss Parkinson’s Disease Association.

  • Competing interests None.

  • Provenance and Peer review Not commissioned; externally peer reviewed.