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Guadeloupe syndromes

In the island of Guadeloupe in the French West Indies (FWI), an unexpectedly high frequency of parkinsonism with features atypical for classical Parkinson’s Disease (PD) has been reported (1).  Eighty percents respond poorly to levodopa.  The remaining 20% present with the clinical picture of classical PD.  Such distribution is opposite to the one encountered in Europe and North America where classical PD is by far the commonest diagnosis among patients with idiopathic parkinsonism (2, 3). 

The characteristic spectrum of guadeloupean parkinsonism includes symmetric symptoms, predominantly axial rigidity, early postural imbalance, cognitive decline with prominent features of frontal lobe dysfunction and is associated with a poor prognosis.  Guadeloupe has 435 000 inhabitants, in whom approximately 80% have African or admixed origins, 15% have Indian background and 5% are Caucasian. 

Several cultural traditions are characteristic of the Island and other West Indies islands, such as language, dietary habits and a frequent use of herbal medicine.  The unusual distribution of IPD and atypical parkinsonism could be related to genetic as well as to environmental factors.  The possibility of an environmental origin has emerged as a reasonable cause since most patients reported a daily or weekly use of herbal tea and/or fruits of tropical plants that are known to contain several alkaloid toxins.  Few younger patients improved after the consumption of these plants was stopped.  These alkaloid toxins are benzyl-tetra-hydro-isoquinolines [BeTIQ], tetra-hydro-protoberberines (4) and acetogenins (5).  They are potent mitochondrial complex I inhibitors.  Some of these toxins have also an affinity for dopaminergic receptors and inhibit dopamine reuptake (6).

We report here additional results on the demographic and clinical characteristics of guadeloupean parkinsonism that confirms the high prevalence of atypical parkinsonism on the island.  We report also the results of pathologic and biochemical studies performed in the brains of three patients, all three included in our initial report of guadeloupean parkinsonism (1) and who subsequently died.  They had been categorized clinically during life as probable supranuclear palsy.  This report indicates that guadeloupean parkinsonism is a tauopathy with some unusual features, possibly different from those currently known.

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