Objective: To compare the self-perception of symptoms lateralization with clinical evaluation, and explore associations with symptoms severity, onset side, and handedness.

Background: Symptoms lateralization is a key feature of PD, indicated by the onset side [1]. It is caused by asymmetric dysregulation in the cortico-striatal circuits [2]. Research has shown differences in left- and right-onset individuals in terms of motor and non-motor impairments [3]. However, little has been discussed on the subject’s perception of that lateralization. Empirically, some individuals did not seem to be aware of the bi-lateralization of the symptoms, which moved us to confirm that observation. We hypothesized that for those individuals unaware of the bi-lateralization we would find an association between the onset side and the motor severity of the contralateral upper and/or lower limbs.

Method: Preliminary data from an ongoing clinical trial were analysed [4]. Demographic data were collected for sample characterization. Data on motor symptom severity (rigidity, tremor, and bradykinesia) were assessed through the UPDRS III for the upper/lower limbs of the onset and contralateral sides. A descriptive analysis of the subject’s perception and clinical assessment was conducted. A nonparametric correlation was used to test our hypothesis and the associations of related variables (lateralization perception, symptoms severity, onset side, and handedness).

Results: Sample main characteristics are displayed [table1]. Fourteen participants (60.9%) perceived symptoms unilaterally, diverging from the clinical assessment (H&Y ≥ 2). Only 1 participant with unilateral symptoms was convergent with the clinical assessment (H&Y = 1) [table2]. As can be seen [table3], no associations were observed between subjects’ perception and severity of symptoms, onset side, or handedness. Interestingly, left-side onset was positively associated with contralateral upper limb motor severity (rho = .514, p = .017), which may indicate that the left-side onset plays a more detrimental role in disease severity than the right-side onset, as discussed elsewhere [5].

Conclusion: The unawareness of the bi-lateralization of symptoms was observed in a relevant range of our sample; yet, it was not associated with contralateral symptoms severity, onset side, or handedness. The reasons underpinning this phenomenon warrant further investigation.

References: [1] Modestino, E. J., Amenechi, C., Reinhofer, A., & O’Toole, P. (2016). Side-of-onset of Parkinson’s disease in relation to neuropsychological measures. Brain and behavior, 7(1), e00590. https://doi.org/10.1002/brb3.590
[2] Riederer, P., Jellinger, K. A., Kolber, P., Hipp, G., Sian-Hülsmann, J., & Krüger, R. (2018). Lateralisation in Parkinson disease. Cell and tissue research, 373(1), 297–312. https://doi.org/10.1007/s00441-018-2832-z
[3] Cubo, E., Martín, P. M., Martin-Gonzalez, J. A., Rodríguez-Blázquez, C., Kulisevsky, J., & ELEP Group Members (2010). Motor laterality asymmetry and nonmotor symptoms in Parkinson’s disease. Movement disorders: official journal of the Movement Disorder Society, 25(1), 70–75. https://doi.org/10.1002/mds.22896
[4] RBR-7zjgnrx (2022). Effects of Physical Exercise in movements, manual ability and brain plasticity in individuals with Parkinson’s disease. https://ensaiosclinicos.gov.br/rg/RBR-7zjgnrx
[5] Su, W., Li, K., Li, C. M., Ma, X. X., Zhao, H., Chen, M., Li, S. H., Wang, R., Lou, B. H., Chen, H. B., & Yan, C. Z. (2021). Motor Symptom Lateralization Influences Cortico-Striatal Functional Connectivity in Parkinson’s Disease. Frontiers in neurology, 12, 619631. https://doi.org/10.3389/fneur.2021.619631

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MDS Abstracts - https://www.mdsabstracts.org/abstract/self-perception-of-symptoms-lateralization-and-association-with-symptoms-severity-in-parkinsons-disease/