Woong-Woo Lee

Koo Y, et al. J Clin Neurol. 2025 Jan;21(1):21-30. https://doi.org/10.3988/jcn.2024.0175

Parkinson’s disease (PD) has undergone significant advancements in diagnosis and treatment over the past century, with apparent dopaminergic cell degeneration on dopamine transporter scans and a strong response to medication being key features. However, the etiology remains complex, involving various pathogenic mechanisms beyond alpha-synuclein accumulation. The recent brain-first versus body-first hypothesis, emerging from advances in functional imaging and clinical symptom clustering, suggests distinct starting points of alpha-synuclein pathology-either in the brain or the body, with subsequent spread via neural connections. This theory, exemplified by the alpha-synuclein origin site and connectome (SOC) model, proposes that body-first PD may originate in the enteric nervous system and spread to the brain, while brain-first PD starts within the central nervous system, such as the olfactory bulb or amygdala. While the SOC model offers valuable insights into the progression of PD, it raises several controversies. Critics argue that the model may oversimplify the disease’s complexity, failing to account for overlapping symptoms and the varying progression rates observed in different subtypes. Furthermore, there are concerns about the lack of longitudinal data and the potential for reclassification of PD subtypes over time. Despite these challenges, the ongoing development of imaging techniques that reflect in-vivo pathology holds promise for resolving these controversies and advancing the selection of patients for disease-modifying therapies.

Objective Parkinson’s disease (PD) patients often find it difficult to visit hospitals because of motor symptoms, distance to the hospital, or the absence of caregivers. Telemedicine is one way to solve this problem.Methods We surveyed 554 PD patients from eight university hospitals in Korea. The questionnaire consisted of the clinical characteristics of the participants, possible teleconferencing methods, and preferences for telemedicine.Results A total of 385 patients (70%) expressed interest in receiving telemedicine. Among them, 174 preferred telemedicine whereas 211 preferred in-person visits. The longer the duration of disease, and the longer the time required to visit the hospital, the more patients were interested in receiving telemedicine.Conclusion This is the first study on PD patients’ preferences regarding telemedicine in Korea. Although the majority of patients with PD have a positive view of telemedicine, their interest in receiving telemedicine depends on their different circumstances.

동결(freezing)은 일시적으로 움직임이 중단되어 멈칫거리는 현상을 의미하며, 운동 차단(motor block)이라고 부르기도 한다. 말할 때나 팔을 사용할 때도 나타날 수 있으나 주로 보행할 때 나타나므로 실제로는 동결보행(freezing of gait)이 동결 의 대부분을 차지한다. 보행을 담당하는 척수위영역(supraspinal region)에는 다리뇌숨뇌그물체(pontomedullary reticular formation), 중뇌보행영역(mesencephalic locomotor region), 기저핵, 소뇌, 대뇌피질 등이 포함되는데,

Mitochondrial encephalopathy, lactic acidosis, and stroke-like episodes (MELAS) syndrome is a maternally inherited mitochondrial disorder. MELAS syndrome manifests different clinical symptoms due to mitochondrial heteroplasmy and individual susceptibility and tends to be aggravated by metabolic events. It presents various clinical manifestations including hearing impairment, diabetes mellitus, and stroke like episodes. However, to date, only a few cases of MELAS syndrome accompanied with cerebellar ataxia have been reported in Korea. We hereby present an unusual case of a patient diagnosed with MELAS syndrome involving diabetes mellitus, cerebellar ataxia and sensorineural hearing loss, which were aggravated by metabolic stresses such as pregnancy and hypoglycemic shock.

Lee WW, et al. J Clin Neurol. 2023 Sep;19(5):498-500. https://doi.org/10.3988/jcn.2023.0154

오하윤, et al. J Korean Soc Radiol. 2023 May;84:e51. https://doi.org/10.3348/jksr.2021.0015

Yoon S, et al. J Clin Neurol. 2023 Jan;19:e7. https://doi.org/10.3988/jcn.2022.0160

Neurodegenerative diseases are caused by the interaction of genetic susceptibility and environmental factors. Although it has been revealed that α-synuclein and tau protein are the key players in neurodegeneration, the process of where they originate and how they make the disease is still unclear. The gut must coexist with various bacteria and inevitably affect the body. Recent studies have revealed that the nervous system and the gut interact, bringing one step closer to the mystery of how neurodegenerative disorders occur. The most common prodromal symptom of Parkinson disease is constipation. Several studies have confirmed that intestinal alpha-synuclein deposition is prominent in patients with Parkinson disease and rapid eye movement sleep behavior disorder, and pathological changes can be transmitted through the vagus nerve. In this sense, there has been a hypothesis to divide the process into two types, brain-first versus body-first, but it is still controversial. It is unclear whether Alzheimer disease is the starting point for pathological changes in the gut like Parkinson disease. However, common pathomechanisms could be applied to both diseases: disrupting the gut and blood-brain barriers, facilitating inflammations, and engaging hormones. Further studies on the gut-brain axis are required to predict and prevent neurodegenerative diseases.