151
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Verdura E, Fons C, Schlüter A, Ruiz M, Fourcade S, Casasnovas C, Castellano A, Pujol A. Complete loss of KCNA1 activity causes neonatal epileptic encephalopathy and dyskinesia. J Med Genet 2019; 57:132-137. [PMID: 31586945 PMCID: PMC7029237 DOI: 10.1136/jmedgenet-2019-106373] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Revised: 09/12/2019] [Accepted: 09/15/2019] [Indexed: 11/29/2022]
Abstract
Background Since 1994, over 50 families affected by the episodic ataxia type 1 disease spectrum have been described with mutations in KCNA1, encoding the voltage-gated K+ channel subunit Kv1.1. All of these mutations are either transmitted in an autosomal-dominant mode or found as de novo events. Methods A patient presenting with a severe combination of dyskinesia and neonatal epileptic encephalopathy was sequenced by whole-exome sequencing (WES). A candidate variant was tested using cellular assays and patch-clamp recordings. Results WES revealed a homozygous variant (p.Val368Leu) in KCNA1, involving a conserved residue in the pore domain, close to the selectivity signature sequence for K+ ions (TVGYG). Functional analysis showed that mutant protein alone failed to produce functional channels in homozygous state, while coexpression with wild-type produced no effects on K+ currents, similar to wild-type protein alone. Treatment with oxcarbazepine, a sodium channel blocker, proved effective in controlling seizures. Conclusion This newly identified variant is the first to be reported to act in a recessive mode of inheritance in KCNA1. These findings serve as a cautionary tale for the diagnosis of channelopathies, in which an unreported phenotypic presentation or mode of inheritance for the variant of interest can hinder the identification of causative variants and adequate treatment choice.
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Affiliation(s)
- Edgard Verdura
- Neurometabolic Diseases Laboratory, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Catalunya, Spain.,Centre for Biomedical Research on Rare Diseases (CIBERER), Instituto de Salud Carlos III, Barcelona, Spain
| | - Carme Fons
- Centre for Biomedical Research on Rare Diseases (CIBERER), Instituto de Salud Carlos III, Barcelona, Spain.,Pediatric Neurology Department, Hospital Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Catalunya, Spain.,Sant Joan de Déu Research Institute (IRSJD), Esplugues de Llobregat, Barcelona, Catalunya, Spain
| | - Agatha Schlüter
- Neurometabolic Diseases Laboratory, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Catalunya, Spain.,Centre for Biomedical Research on Rare Diseases (CIBERER), Instituto de Salud Carlos III, Barcelona, Spain
| | - Montserrat Ruiz
- Neurometabolic Diseases Laboratory, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Catalunya, Spain.,Centre for Biomedical Research on Rare Diseases (CIBERER), Instituto de Salud Carlos III, Barcelona, Spain
| | - Stéphane Fourcade
- Neurometabolic Diseases Laboratory, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Catalunya, Spain.,Centre for Biomedical Research on Rare Diseases (CIBERER), Instituto de Salud Carlos III, Barcelona, Spain
| | - Carlos Casasnovas
- Neurometabolic Diseases Laboratory, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Catalunya, Spain.,Centre for Biomedical Research on Rare Diseases (CIBERER), Instituto de Salud Carlos III, Barcelona, Spain.,Neuromuscular Unit, Neurology Department, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Catalunya, Spain
| | - Antonio Castellano
- Institute of Biomedicine of Seville (IBiS), Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Sevilla, Spain.,Medical Physiology and Biophysics Departament, Universidad de Sevilla, Sevilla, Spain
| | - Aurora Pujol
- Neurometabolic Diseases Laboratory, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Catalunya, Spain .,Centre for Biomedical Research on Rare Diseases (CIBERER), Instituto de Salud Carlos III, Barcelona, Spain.,Catalan Institution of Research and Advanced Studies (ICREA), Barcelona, Catalunya, Spain
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152
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Einspieler C, Bos AF, Krieber-Tomantschger M, Alvarado E, Barbosa VM, Bertoncelli N, Burger M, Chorna O, Del Secco S, DeRegnier RA, Hüning B, Ko J, Lucaccioni L, Maeda T, Marchi V, Martín E, Morgan C, Mutlu A, Nogolová A, Pansy J, Peyton C, Pokorny FB, Prinsloo LR, Ricci E, Saini L, Scheuchenegger A, Silva CRD, Soloveichick M, Spittle AJ, Toldo M, Utsch F, van Zyl J, Viñals C, Wang J, Yang H, Yardımcı-Lokmanoğlu BN, Cioni G, Ferrari F, Guzzetta A, Marschik PB. Cerebral Palsy: Early Markers of Clinical Phenotype and Functional Outcome. J Clin Med 2019; 8:E1616. [PMID: 31590221 PMCID: PMC6833082 DOI: 10.3390/jcm8101616] [Citation(s) in RCA: 99] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 09/21/2019] [Accepted: 09/25/2019] [Indexed: 11/17/2022] Open
Abstract
The Prechtl General Movement Assessment (GMA) has become a cornerstone assessment in early identification of cerebral palsy (CP), particularly during the fidgety movement period at 3-5 months of age. Additionally, assessment of motor repertoire, such as antigravity movements and postural patterns, which form the Motor Optimality Score (MOS), may provide insight into an infant's later motor function. This study aimed to identify early specific markers for ambulation, gross motor function (using the Gross Motor Function Classification System, GMFCS), topography (unilateral, bilateral), and type (spastic, dyskinetic, ataxic, and hypotonic) of CP in a large worldwide cohort of 468 infants. We found that 95% of children with CP did not have fidgety movements, with 100% having non-optimal MOS. GMFCS level was strongly correlated to MOS. An MOS > 14 was most likely associated with GMFCS outcomes I or II, whereas GMFCS outcomes IV or V were hardly ever associated with an MOS > 8. A number of different movement patterns were associated with more severe functional impairment (GMFCS III-V), including atypical arching and persistent cramped-synchronized movements. Asymmetrical segmental movements were strongly associated with unilateral CP. Circular arm movements were associated with dyskinetic CP. This study demonstrated that use of the MOS contributes to understanding later CP prognosis, including early markers for type and severity.
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Affiliation(s)
- Christa Einspieler
- Research Unit iDN, Division of Phoniatrics, Medical University of Graz, 8036 Graz, Austria.
| | - Arend F Bos
- University of Groningen, University Medical Center Groningen, Beatrix Children's Hospital, Division of Neonatology, 9713 GZ Groningen, The Netherlands.
| | | | - Elsa Alvarado
- National Rehabilitation Institute, Cerebral Palsy Department, 14389 Mexico City, Mexico.
| | - Vanessa M Barbosa
- University of Illinois at Chicago, UI Health, Department of Occupational and Physical Therapy, Chicago, IL 60612, USA.
| | - Natascia Bertoncelli
- University of Modena and Reggio Emilia, Department of Clinical and Surgical Sciences for Mothers, Children and Adults, Neonatal Intensive Care Unit, 41124 Modena, Italy.
| | - Marlette Burger
- Stellenbosch University, Faculty of Medicine and Health Sciences, Department of Health and Rehabilitation Sciences, Cape Town 8000, South Africa.
| | - Olena Chorna
- IRCCS Fondazione Stella Maris, Department of Developmental Neuroscience, 56128 Pisa, Italy.
| | - Sabrina Del Secco
- IRCCS Fondazione Stella Maris, Department of Developmental Neuroscience, 56128 Pisa, Italy.
| | - Raye-Ann DeRegnier
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL 60611, USA.
| | - Britta Hüning
- University Hospital Essen, Department of Pediatrics I, 45122 Essen, Germany.
| | - Jooyeon Ko
- Daegu Health College, Department of Physical Therapy, 41453 Daegu, Korea.
| | - Laura Lucaccioni
- University of Modena and Reggio Emilia, Department of Clinical and Surgical Sciences for Mothers, Children and Adults, Neonatal Intensive Care Unit, 41124 Modena, Italy.
| | - Tomoki Maeda
- Oita University Faculty of Medicine, Department of Pediatrics, 879-5593 Oita, Japan.
| | - Viviana Marchi
- IRCCS Fondazione Stella Maris, Department of Developmental Neuroscience, 56128 Pisa, Italy.
- Institute of Life Sciences, Scuola Superiore Sant'Anna, 56127 Pisa, Italy.
| | - Erika Martín
- Children's Rehabilitation Institute Teleton, 72825 Puebla, Mexico.
| | - Catherine Morgan
- The University of Sydney Medical School, Children's Hospital at Westmead Clinical School, The Discipline of Child and Adolescent Health, Sydney 2050, NSW, Australia.
- The University of Sydney, Cerebral Palsy Alliance Research Institute, Sydney 2050, NSW, Australia.
| | - Akmer Mutlu
- Hacettepe University, Faculty of Physical Therapy and Rehabilitation, Developmental and Early Physiotherapy Unit, 06100 Ankara, Turkey.
| | - Alice Nogolová
- Municipal Hospital of Ostrava, Children 's Department, 72880 Ostrava, Czech Republic.
- Masaryk University, Faculty of Medicine, 62500 Brno, Czech Republic.
| | - Jasmin Pansy
- Medical University of Graz, Department of Pediatrics and Adolescent Medicine, Division of Neonatology, 8036 Graz, Austria.
| | - Colleen Peyton
- Northwestern University, Department of Physical Therapy and Human Movement Science, Chicago, IL 60611, USA.
| | - Florian B Pokorny
- Research Unit iDN, Division of Phoniatrics, Medical University of Graz, 8036 Graz, Austria.
| | - Lucia R Prinsloo
- Cerebral Palsy Association Eastern Cape, Port Elizabeth 6001, South Africa.
| | - Eileen Ricci
- University of New England/Maine LEND Program, Portland, ME 04103, USA.
| | - Lokesh Saini
- Post Graduate Institute of Medical Education and Research, Department of Pediatrics, Pediatric Neurology Division, Chandigarh 160012, India.
| | - Anna Scheuchenegger
- Medical University of Graz, Department of Pediatrics and Adolescent Medicine, Division of Neonatology, 8036 Graz, Austria.
| | - Cinthia R D Silva
- Rede SARAH de Hospitais de Reabilitação, Reabilitação Infantil, 30510-000 Belo Horizonte, Brazil.
| | - Marina Soloveichick
- Lady Davis Carmel Medical Center, NICU Developmental Follow-up Clinic, 34362 Haifa, Israel.
| | - Alicia J Spittle
- University of Melbourne, School of Health Sciences, Department of Physiotherapy, Parkville 3052, Australia.
- Murdoch Children's Research Institute, Parkville 3052, Victoria, Australia.
| | - Moreno Toldo
- Kiran Society for Rehabilitation and Education of Children with Disabilities, Varanasi 221011, India.
| | - Fabiana Utsch
- Rede SARAH de Hospitais de Reabilitação, Reabilitação Infantil, 30510-000 Belo Horizonte, Brazil.
| | - Jeanetta van Zyl
- Stellenbosch University, Faculty of Medicine and Health Sciences, Department of Paediatrics and Child Health, Cape Town 8000, South Africa.
| | - Carlos Viñals
- National Rehabilitation Institute, Cerebral Palsy Department, 14389 Mexico City, Mexico.
| | - Jun Wang
- Children's Hospital of Fudan University, Department of Rehabilitation, Shanghai 201102, China.
| | - Hong Yang
- Children's Hospital of Fudan University, Department of Rehabilitation, Shanghai 201102, China.
| | - Bilge N Yardımcı-Lokmanoğlu
- Hacettepe University, Faculty of Physical Therapy and Rehabilitation, Developmental and Early Physiotherapy Unit, 06100 Ankara, Turkey.
| | - Giovanni Cioni
- IRCCS Fondazione Stella Maris, Department of Developmental Neuroscience, 56128 Pisa, Italy.
| | - Fabrizio Ferrari
- University of Modena and Reggio Emilia, Department of Clinical and Surgical Sciences for Mothers, Children and Adults, Neonatal Intensive Care Unit, 41124 Modena, Italy.
| | - Andrea Guzzetta
- IRCCS Fondazione Stella Maris, Department of Developmental Neuroscience, 56128 Pisa, Italy.
| | - Peter B Marschik
- Research Unit iDN, Division of Phoniatrics, Medical University of Graz, 8036 Graz, Austria.
- University Medical Center Göttingen, Child and Adolescent Psychiatry and Psychotherapy, 37075 Göttingen, Germany.
- Karolinska Institutet, Department of Women's and Children's Health, Center of Neurodevelopmental Disorders (KIND), 11330 Stockholm, Sweden.
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153
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Martini ML, Ray C, Yu X, Liu J, Pogorelov VM, Wetsel WC, Huang XP, McCorvy JD, Caron MG, Jin J. Designing Functionally Selective Noncatechol Dopamine D 1 Receptor Agonists with Potent In Vivo Antiparkinsonian Activity. ACS Chem Neurosci 2019; 10:4160-4182. [PMID: 31387346 DOI: 10.1021/acschemneuro.9b00410] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Dopamine receptors are important G protein-coupled receptors (GPCRs) with therapeutic opportunities for treating Parkinson's Disease (PD) motor and cognitive deficits. Biased D1 dopamine ligands that differentially activate G protein over β-arrestin recruitment pathways are valuable chemical tools for dissecting positive versus negative effects in drugs for PD. Here, we reveal an iterative approach toward modification of a D1-selective noncatechol scaffold critical for G protein-biased agonism. This approach provided enhanced understanding of the structural components critical for activity and signaling bias and led to the discovery of several novel compounds with useful pharmacological properties, including three highly GS-biased partial agonists. Administration of a potent, balanced, and brain-penetrant lead compound from this series results in robust antiparkinsonian effects in a rodent model of PD. This study suggests that the noncatechol ligands developed through this approach are valuable tools for probing D1 receptor signaling biology and biased agonism in models of neurologic disease.
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Affiliation(s)
- Michael L. Martini
- Mount Sinai Center for Therapeutics Discovery, Departments of Pharmacological Sciences and Oncological Sciences, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, New York 10029, United States
- Medical Scientist Training Program, Icahn School of Medicine at Mount Sinai, New York, New York 10029, United States
| | - Caroline Ray
- Department of Cell Biology, Duke University Medical Center, Durham, North Carolina 27710, United States
| | - Xufen Yu
- Mount Sinai Center for Therapeutics Discovery, Departments of Pharmacological Sciences and Oncological Sciences, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, New York 10029, United States
| | - Jing Liu
- Mount Sinai Center for Therapeutics Discovery, Departments of Pharmacological Sciences and Oncological Sciences, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, New York 10029, United States
| | - Vladimir M. Pogorelov
- Department of Cell Biology, Duke University Medical Center, Durham, North Carolina 27710, United States
- Departments of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina 27710, United States
- Department of Medicine and Neurobiology, Duke University Medical Center, Durham, North Carolina 27710, United States
| | - William C. Wetsel
- Department of Cell Biology, Duke University Medical Center, Durham, North Carolina 27710, United States
- Departments of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina 27710, United States
- Department of Medicine and Neurobiology, Duke University Medical Center, Durham, North Carolina 27710, United States
| | - Xi-Ping Huang
- Department of Pharmacology and National Institute of Mental Health Psychoactive Drug Screening Program, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599, United States
| | - John D. McCorvy
- Department of Cell Biology, Neurobiology and Anatomy, Medical College of Wisconsin, Milwaukee, Wisconsin 53226, United States
| | - Marc G. Caron
- Department of Cell Biology, Duke University Medical Center, Durham, North Carolina 27710, United States
- Department of Medicine and Neurobiology, Duke University Medical Center, Durham, North Carolina 27710, United States
| | - Jian Jin
- Mount Sinai Center for Therapeutics Discovery, Departments of Pharmacological Sciences and Oncological Sciences, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, New York 10029, United States
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154
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Meadows SM, Conti MM, Gross L, Chambers NE, Avnor Y, Ostock CY, Lanza K, Bishop C. Diverse serotonin actions of vilazodone reduce l-3,4-dihidroxyphenylalanine-induced dyskinesia in hemi-parkinsonian rats. Mov Disord 2019; 33:1740-1749. [PMID: 30485908 DOI: 10.1002/mds.100] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Revised: 06/08/2018] [Accepted: 06/28/2018] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND The serotonergic system is a well-established modulator of l-dopa-induced dyskinesia. To date, targeting serotonin transporters or serotonin receptor subtype 1A (5-HT1A ) reduces l-dopa-induced dyskinesia in animal models; however, these strategies have failed to translate clinically. Ideally, a compound acting at both known antidyskinetic sites could optimize serotonin-mediated approaches. Vilazodone is a selective serotonin reuptake inhibitor and a partial 5-HT1A agonist approved by the U.S. Food and Drug Administration, situating Vilazodone in a unique position to reduce l-dopa-induced dyskinesia without compromising l-dopa-mediated motor improvements. OBJECTIVES The goal of the present study was to characterize Vilazodone's effects on l-dopa-induced behaviors, neurochemistry and gene expression in unilateral 6-hydroxydopamine-lesioned hemi-parkinsonian rats. METHODS In experiments 1 and 2, l-dopa-naïve and l-dopa-primed animals were coadministered Vilazodone and l-dopa daily for 3 weeks to model subchronic use, and behavioral, neurochemical, and messenger RNA (mRNA) expression changes were measured. In experiment 3, dyskinetic behavior was assessed following 5-HT1A or serotonin receptor subtype 1B blockade prior to Vilazodone-l-dopa coadministration. RESULTS Vilazodone significantly suppressed developing and established l-dopa-induced dyskinesia without compromising the promotor effects of l-dopa therapy. In the dopamine-depleted striatum, Vilazodone-l-dopa cotreatment increased dopamine content, suggesting a normalization of dopamine kinetics in dyskinetic brain, and reduced l-dopa-induced c-Fos and preprodynorphin mRNA overexpression, indicative of attenuated dopamine D1 receptor-mediated direct pathway overactivity. Only 5-HT1A antagonism partially attenuated Vilazodone's antidyskinetic efficacy, suggesting both serotonin transporter-dependent effects and 5-HT1A receptors in Vilazodone's actions. CONCLUSIONS Our findings show Vilazodone has a serotonin-dependent effect on rodent l-dopa-induced dyskinesia and implicate the potential for repositioning Vilazodone against l-dopa-induced dyskinesia development and expression in Parkinson's disease patients. © 2018 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Samantha M Meadows
- Behavioral Neuroscience Program, Department of Psychology, Binghamton University, Binghamton, New York, USA
| | - Melissa M Conti
- Behavioral Neuroscience Program, Department of Psychology, Binghamton University, Binghamton, New York, USA
| | - Libby Gross
- Behavioral Neuroscience Program, Department of Psychology, Binghamton University, Binghamton, New York, USA
| | - Nicole E Chambers
- Behavioral Neuroscience Program, Department of Psychology, Binghamton University, Binghamton, New York, USA
| | - Yarden Avnor
- Behavioral Neuroscience Program, Department of Psychology, Binghamton University, Binghamton, New York, USA
| | - Corinne Y Ostock
- Behavioral Neuroscience Program, Department of Psychology, Binghamton University, Binghamton, New York, USA
| | - Kathryn Lanza
- Behavioral Neuroscience Program, Department of Psychology, Binghamton University, Binghamton, New York, USA
| | - Christopher Bishop
- Behavioral Neuroscience Program, Department of Psychology, Binghamton University, Binghamton, New York, USA
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Pajo AT, Espiritu AI, Jamora RDG. Efficacy and safety of extended-release amantadine in levodopa-induced dyskinesias: a meta-analysis. Neurodegener Dis Manag 2019; 9:205-215. [PMID: 31392922 DOI: 10.2217/nmt-2019-0011] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Aim: To determine the effectiveness and safety of extended-release amantadine (ADS-5102) for levodopa-induced dyskinesias (LID) in patients with Parkinson disease (PD) by conducting a meta-analysis of relevant trials. Methods: The electronic databases were searched on or before March 1, 2019 for relevant trials. Only randomized, double-blind, parallel-group, placebo-controlled trials using ADS-5102 for LID in PD were included. Results: The ADS-5102 showed a reduction in the dyskinesia scores (mean difference: -9.56: CI: -10.05 to -9.07; p < 0.00001) and in the on time without troublesome dyskinesia (mean difference 2.50: CI 2.38 to 2.63; p < 0.00001). The adverse events identified in ADS-5102 were visual hallucinations, constipation, dry mouth and fall. Conclusion: ADS-5102 can be used as an adjunct therapy for LID.
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Affiliation(s)
- Azalea T Pajo
- Department of Neurosciences, Philippine General Hospital, University of the Philippines Manila, Manila, Philippines
| | - Adrian I Espiritu
- Department of Neurosciences, Philippine General Hospital, University of the Philippines Manila, Manila, Philippines
| | - Roland Dominic G Jamora
- Movement Disorders Service, Institute for Neurosciences, St Luke's Medical Center, Quezon City & Global City, Philippines
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156
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Kelly MJ, Lawton MA, Baig F, Ruffmann C, Barber TR, Lo C, Klein JC, Ben‐Shlomo Y, Hu MT. Predictors of motor complications in early Parkinson's disease: A prospective cohort study. Mov Disord 2019; 34:1174-1183. [PMID: 31283854 PMCID: PMC6771533 DOI: 10.1002/mds.27783] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 05/21/2019] [Accepted: 06/12/2019] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVE The objective of this study was to identify clinical predictors of motor complications (dyskinesia and motor fluctuations) of levodopa in a prospectively recruited PD cohort using longitudinal analysis. METHODS An inception cohort (Oxford Discovery) of 734 patients was followed to a maximum of 10 years from diagnosis using a discrete-time survival analysis. A subset analysis was used to validate an online dyskinesia-risk calculator developed from the results of the Stalevo Reduction in Dyskinesia Evaluation PD trial. RESULTS A total of 186 cases of dyskinesia and 254 cases of motor fluctuations were observed. Dyskinesia incidence increased with time (risk per 100 participants [95% confidence interval] 13 [11-16] <3.5 years, 16 [13-21] 3.5-5.0 years, 19 [14-26] 5-6.5 years, and 23 [16-33] >6.5 years from diagnosis). Motor complication predictors were grouped as medication predictors, disease predictors and patient predictors. Baseline nonmotor feature severity, low mood, anxiety, and age at symptom onset were associated with motor complications among a number of previously identified predictors. Replication of the Stalevo Reduction in Dyskinesia Evaluation PD calculator was reasonable with the area under the curve for dyskinesia risk score as a predictor of dyskinesia being 0.68 (95% confidence interval, 0.55-0.81). CONCLUSIONS This study quantifies risk of motor complications, finds consistent predictors, and demonstrates the novel finding that nonmotor features of PD, particularly low mood and anxiety, are significant risk factors for motor complications. Further validation of dyskinesia risk scores are required as well as evidence to determine if the routine use of such scores can be clinically valuable in enhancing patient care and quality of life. © 2019 The Authors. Movement Disorders published by Wiley Periodicals, Inc. on behalf of International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Mark J. Kelly
- Oxford Parkinson's Disease CentreUniversity of OxfordOxfordUK
- Nuffield Department of Clinical NeurosciencesUniversity of OxfordOxfordUK
| | | | - Fahd Baig
- Oxford Parkinson's Disease CentreUniversity of OxfordOxfordUK
- Nuffield Department of Clinical NeurosciencesUniversity of OxfordOxfordUK
| | - Claudio Ruffmann
- Oxford Parkinson's Disease CentreUniversity of OxfordOxfordUK
- Nuffield Department of Clinical NeurosciencesUniversity of OxfordOxfordUK
- Neurology DepartmentHampshire Hospitals National Health Service (NHS) Foundation TrustBasingstokeUK
| | - Thomas R. Barber
- Oxford Parkinson's Disease CentreUniversity of OxfordOxfordUK
- Nuffield Department of Clinical NeurosciencesUniversity of OxfordOxfordUK
| | - Christine Lo
- Oxford Parkinson's Disease CentreUniversity of OxfordOxfordUK
- Nuffield Department of Clinical NeurosciencesUniversity of OxfordOxfordUK
| | - Johannes C. Klein
- Oxford Parkinson's Disease CentreUniversity of OxfordOxfordUK
- Nuffield Department of Clinical NeurosciencesUniversity of OxfordOxfordUK
| | | | - Michele T. Hu
- Oxford Parkinson's Disease CentreUniversity of OxfordOxfordUK
- Nuffield Department of Clinical NeurosciencesUniversity of OxfordOxfordUK
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157
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Boi L, Pisanu A, Greig NH, Scerba MT, Tweedie D, Mulas G, Fenu S, Carboni E, Spiga S, Carta AR. Immunomodulatory drugs alleviate l-dopa-induced dyskinesia in a rat model of Parkinson's disease. Mov Disord 2019; 34:1818-1830. [PMID: 31335998 DOI: 10.1002/mds.27799] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Revised: 06/05/2019] [Accepted: 06/14/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Thalidomide and closely related analogues are used clinically for their immunomodulatory and antiangiogenic properties mediated by the inhibition of the proinflammatory cytokine tumor necrosis factor α. Neuroinflammation and angiogenesis contribute to classical neuronal mechanisms underpinning the pathophysiology of l-dopa-induced dyskinesia, a motor complication associated with l-dopa therapy in Parkinson's disease. The efficacy of thalidomide and the more potent derivative 3,6'-dithiothalidomide on dyskinesia was tested in the 6-hydroxydopamine Parkinson's disease model. METHODS Three weeks after 6-hydroxydopamine infusion, rats received 10 days of treatment with l-dopa plus benserazide (6 mg/kg each) and thalidomide (70 mg/kg) or 3,6'-dithiothalidomide (56 mg/kg), and dyskinesia and contralateral turning were recorded daily. Rats were euthanized 1 hour after the last l-dopa injection, and levels of tumor necrosis factor-α, interleukin-10, OX-42, vimentin, and vascular endothelial growth factor immunoreactivity were measured in their striatum and substantia nigra reticulata to evaluate neuroinflammation and angiogenesis. Striatal levels of GLUR1 were measured as a l-dopa-induced postsynaptic change that is under tumor necrosis factor-α control. RESULTS Thalidomide and 3,6'-dithiothalidomide significantly attenuated the severity of l-dopa-induced dyskinesia while not affecting contralateral turning. Moreover, both compounds inhibited the l-dopa-induced microgliosis and excessive tumor necrosis factor-α in the striatum and substantia nigra reticulata, while restoring physiological levels of the anti-inflammatory cytokine interleukin-10. l-Dopa-induced angiogenesis was inhibited in both basal ganglia nuclei, and l-dopa-induced GLUR1 overexpression in the dorsolateral striatum was restored to normal levels. CONCLUSIONS These data suggest that decreasing tumor necrosis factor-α levels may be useful to reduce the appearance of dyskinesia, and thalidomide, and more potent derivatives may provide an effective therapeutic approach to dyskinesia. © 2019 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Laura Boi
- Department of Biomedical Sciences, University of Cagliari, Cagliari, Italy
| | - Augusta Pisanu
- CNR Institute of Neuroscience, Cagliari, Cagliari, Italy
| | - Nigel H Greig
- Drug Design & Development Section, Translational Gerontology Branch, National Institute of Aging, Baltimore, Maryland, USA
| | - Michael T Scerba
- Drug Design & Development Section, Translational Gerontology Branch, National Institute of Aging, Baltimore, Maryland, USA
| | - David Tweedie
- Drug Design & Development Section, Translational Gerontology Branch, National Institute of Aging, Baltimore, Maryland, USA
| | - Giovanna Mulas
- Department of Life and Environmental Sciences, University of Cagliari, Cagliari, Italy
| | - Sandro Fenu
- Department of Biomedical Sciences, University of Cagliari, Cagliari, Italy
| | - Ezio Carboni
- Department of Biomedical Sciences, University of Cagliari, Cagliari, Italy
| | - Saturnino Spiga
- Department of Life and Environmental Sciences, University of Cagliari, Cagliari, Italy
| | - Anna R Carta
- Department of Biomedical Sciences, University of Cagliari, Cagliari, Italy.,National Institute of Neuroscience (INN), University of Cagliari, Cagliari, Italy
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158
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Méneret A, Roze E, Maranci JB, Dodet P, Doummar D, Riant F, Tranchant C, Fraix V, Anheim M, Ekmen A, McGovern E, Vidailhet M, Arnulf I, Leu-Semenescu S. Sleep in ADCY5-Related Dyskinesia: Prolonged Awakenings Caused by Abnormal Movements. J Clin Sleep Med 2019; 15:1021-1029. [PMID: 31383240 DOI: 10.5664/jcsm.7886] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Accepted: 03/18/2019] [Indexed: 12/15/2022]
Abstract
STUDY OBJECTIVES ADCY5 mutations cause early-onset hyperkinetic movement disorders comprising diurnal and nocturnal paroxysmal dyskinesia, and patient-reported sleep fragmentation. We aimed to characterize all movements occurring during sleep and in the transition from sleep to awakening, to ascertain if there is a primary sleep disorder, or if the sleep disturbance is rather a consequence of the dyskinesia. METHODS Using video polysomnography, we evaluated the nocturnal motor events and abnormal movements in 7 patients with ADCY5-related dyskinesia and compared their sleep measures with those of 14 age- and sex-matched healthy controls. RESULTS We observed an increased occurrence of abnormal movements during wake periods compared to sleep in patients with ADCY5-related dyskinesia. While asleep, abnormal movements occurred more frequently during stage N2 and REM sleep, in contrast with stage N3 sleep. Abnormal movements were also more frequent during morning awakenings compared to wake periods before falling asleep. The pattern of the nocturnal abnormal movements mirrored those observed during waking hours. Compared to controls, patients with ADCY5-related dyskinesia had lower sleep efficiencies due to prolonged awakenings secondary to the abnormal movements, but no other differences in sleep measures. Notably, sleep onset latency was short and devoid of violent abnormal movements. CONCLUSIONS In this series of patients with ADCY5-related dyskinesia, nocturnal paroxysmal dyskinesia were not associated with drowsiness or delayed sleep onset, but emerged during nighttime awakenings with subsequent delayed sleep, whereas sleep architecture was normal.
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Affiliation(s)
- Aurélie Méneret
- Department of Neurology, Pitié-Salpêtrière Hospital, Paris, France.,Faculty of Medicine of Sorbonne University, Institut du Cerveau et de la Moelle épinière, Paris, France
| | - Emmanuel Roze
- Department of Neurology, Pitié-Salpêtrière Hospital, Paris, France.,Faculty of Medicine of Sorbonne University, Institut du Cerveau et de la Moelle épinière, Paris, France
| | - Jean-Baptiste Maranci
- Sleep Disorders (Department "R3S"), Pitié-Salpêtrière Hospital, Sorbonne University, Paris, France
| | - Pauline Dodet
- Sleep Disorders (Department "R3S"), Pitié-Salpêtrière Hospital, Sorbonne University, Paris, France
| | - Diane Doummar
- Department of Pediatric Neurology, Hôpital Armand-Trousseau, Paris, France
| | - Florence Riant
- Groupe hospitalier Lariboisière-Fernand Widal, Laboratoire de Génétique, Paris, France.,Université Paris, Paris, France
| | - Christine Tranchant
- Department of Neurology, Hautepierre Hospital, University Hospitals of Strasbourg, Strasbourg, France.,Institute of Genetics and Molecular and Cellular Biology, University of Strasbourg, Illkirch, France.,Strasbourg Federation of Translational Medicine, University of Strasbourg, Strasbourg, France
| | - Valérie Fraix
- Service de Neurologie, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble Institut des Neurosciences, Université Grenoble Alpes, Grenoble, France
| | - Mathieu Anheim
- Department of Neurology, Hautepierre Hospital, University Hospitals of Strasbourg, Strasbourg, France.,Institute of Genetics and Molecular and Cellular Biology, University of Strasbourg, Illkirch, France.,Strasbourg Federation of Translational Medicine, University of Strasbourg, Strasbourg, France
| | - Asya Ekmen
- Faculty of Medicine of Sorbonne University, Institut du Cerveau et de la Moelle épinière, Paris, France
| | - Eavan McGovern
- Department of Neurology, Pitié-Salpêtrière Hospital, Paris, France
| | - Marie Vidailhet
- Department of Neurology, Pitié-Salpêtrière Hospital, Paris, France.,Faculty of Medicine of Sorbonne University, Institut du Cerveau et de la Moelle épinière, Paris, France
| | - Isabelle Arnulf
- Faculty of Medicine of Sorbonne University, Institut du Cerveau et de la Moelle épinière, Paris, France.,Sleep Disorders (Department "R3S"), Pitié-Salpêtrière Hospital, Sorbonne University, Paris, France
| | - Smaranda Leu-Semenescu
- Sleep Disorders (Department "R3S"), Pitié-Salpêtrière Hospital, Sorbonne University, Paris, France
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159
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Vasconcellos LF, Nassif D, Spitz M. Parkinsonism and Belly Dancer Syndrome in a Patient with Schizophrenia. Tremor Other Hyperkinet Mov (N Y) 2019; 9:654. [PMID: 31498333 PMCID: PMC6691608 DOI: 10.7916/tohm.v0.654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2019] [Accepted: 06/14/2019] [Indexed: 12/01/2022] Open
Abstract
Background Belly dancer syndrome (BDS) and parkinsonian features are rarely described in association as a drug-induced movement disorder. Phenomenology shown A 62-year-old woman with paranoid schizophrenia presented with bradykinesia, rigidity, rest, and postural tremor, as well as dyskinetic abdominal movements. Educational value Our case highlights that drug-induced parkinsonism can be associated with other rare movement disorders, such as BDS, with subsequent greater morbidity.
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Affiliation(s)
- Luiz Felipe Vasconcellos
- Institute of Neurology, Federal University of Rio de Janeiro, Rio de Janeiro, BR,Neurology Department, Hospital dos Servidores do Estado, Rio de Janeiro, BR,To whom correspondence should be addressed. E-mail:
| | - Daniel Nassif
- Neurology Department, Hospital dos Servidores do Estado, Rio de Janeiro, BR
| | - Mariana Spitz
- Neurology Department, Hospital dos Servidores do Estado, Rio de Janeiro, BR,Neurology Service, State University of Rio de Janeiro, Rio de Janeiro, BR
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160
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Lindholm B, Eek F, Skogar Ö, Hansson EE. Dyskinesia and FAB score predict future falling in Parkinson's disease. Acta Neurol Scand 2019; 139:512-518. [PMID: 30820932 DOI: 10.1111/ane.13084] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2018] [Revised: 02/09/2019] [Accepted: 02/26/2019] [Indexed: 12/11/2022]
Abstract
A growing body of research highlights the importance of cognition for prediction of falls in Parkinson's disease (PD). However, a previously proposed prediction model for future near falls and falls in PD, which includes history of near falls, tandem gait, and retropulsion, was developed without considering cognitive impairment. Therefore, by using a sample of 64 individuals with relatively mild PD and not excluding those with impaired cognition we aimed to externally validate the previously proposed model as well as to explore the value of additional predictors that also consider cognitive impairment. Since this validation study failed to support the proposed model in a PD sample including individuals with impaired global cognition, extended analyses generated a new model including dyskinesia (item 32 of Unified PD Rating Scale) and frontal lobe impairment (Frontal Assessment Battery-FAB) as significant independent predictors for future near falls and falls in PD. The discriminant ability of this new model was acceptable (AUC, 0. 80; 95% CI 0.68-0.91). Replacing the continuous FAB scores by a dichotomized version of FAB with a cut-off score ≤14 yielded slightly lower but still acceptable discriminant ability (AUC, 0. 79; 95% CI 0.68-0.91). Further studies are needed to test our new model and the proposed cut-off score of FAB in additional samples. Taken together, our observations suggest potentially important additions to the evidence base for clinical fall prediction in PD with concomitant cognitive impairment.
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Affiliation(s)
- Beata Lindholm
- Clinical Memory Research Unit, Department of Clinical Sciences, Malmö Lund University Lund Sweden
- Department of Neurology and Rehabilitation Medicine Skåne University Hospital Malmö Sweden
| | - Frida Eek
- Department of Health Sciences Lund University Lund Sweden
| | - Örjan Skogar
- Department of Neurobiology, Care Sciences and Society Karolinska Institutet Stockholm Sweden
- Institute of Gerontology and Aging Research Network – Jönköping (ARN‐J), School of Health and Welfare Jönköping University Jönköping Sweden
| | - Eva E. Hansson
- Department of Health Sciences Lund University Lund Sweden
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161
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Redenšek S, Jenko Bizjan B, Trošt M, Dolžan V. Clinical-Pharmacogenetic Predictive Models for Time to Occurrence of Levodopa Related Motor Complications in Parkinson's Disease. Front Genet 2019; 10:461. [PMID: 31156712 PMCID: PMC6532453 DOI: 10.3389/fgene.2019.00461] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2019] [Accepted: 04/30/2019] [Indexed: 12/25/2022] Open
Abstract
The response to dopaminergic treatment in Parkinson's disease depends on many clinical and genetic factors. The very common motor fluctuations (MF) and dyskinesia affect approximately half of patients after 5 years of treatment with levodopa. We did an evaluation of a combined effect of 16 clinical parameters and 34 single nucleotide polymorphisms to build clinical and clinical-pharmacogenetic models for prediction of time to occurrence of motor complications and to compare their predictive abilities. In total, 220 Parkinson's disease patients were included in the analysis. Their demographic, clinical, and genotype data were obtained. The combined effect of clinical and genetic factors was assessed using The Least Absolute Shrinkage and Selection Operator penalized regression in the Cox proportional hazards model. Clinical and clinical-pharmacogenetic models were constructed. The predictive capacity of the models was evaluated with the cross-validated area under time-dependent receiver operating characteristic curve. Clinical-pharmacogenetic model included age at diagnosis (HR = 0.99), time from diagnosis to initiation of levodopa treatment (HR = 1.24), COMT rs165815 (HR = 0.90), DRD3 rs6280 (HR = 1.03), and BIRC5 rs9904341 (HR = 0.95) as predictive factors for time to occurrence of MF. Furthermore, clinical-pharmacogenetic model for prediction of time to occurrence of dyskinesia included female sex (HR = 1.07), age at diagnosis (HR = 0.97), tremor-predominant Parkinson's disease (HR = 0.88), beta-blockers (HR = 0.95), alcohol consumption (HR = 0.99), time from diagnosis to initiation of levodopa treatment (HR = 1.15), CAT rs1001179 (HR = 1.27), SOD2 rs4880 (HR = 0.95), NOS1 rs2293054 (HR = 0.99), COMT rs165815 (HR = 0.92), and SLC22A1 rs628031 (HR = 0.80). Areas under the curves for clinical and clinical-pharmacogenetic models for MF after 5 years of levodopa treatment were 0.68 and 0.70, respectively. Areas under the curves for clinical and clinical-pharmacogenetic models for dyskinesia after 5 years of levodopa treatment were 0.71 and 0.68, respectively. These results show that clinical-pharmacogenetic models do not have better ability to predict time to occurrence of motor complications in comparison to the clinical ones despite the significance of several polymorphisms. Models could be improved by a larger sample size and by additional polymorphisms, epigenetic predictors or serum biomarkers.
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Affiliation(s)
- Sara Redenšek
- Pharmacogenetics Laboratory, Institute of Biochemistry, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Barbara Jenko Bizjan
- Pharmacogenetics Laboratory, Institute of Biochemistry, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Maja Trošt
- Department of Neurology, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Vita Dolžan
- Pharmacogenetics Laboratory, Institute of Biochemistry, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
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162
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Khodakarami H, Farzanehfar P, Horne M. The Use of Data from the Parkinson's KinetiGraph to Identify Potential Candidates for Device Assisted Therapies. Sensors (Basel) 2019; 19:E2241. [PMID: 31096576 DOI: 10.3390/s19102241] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Revised: 05/08/2019] [Accepted: 05/12/2019] [Indexed: 01/29/2023]
Abstract
Device-assisted therapies (DAT) benefit people with Parkinsons Disease (PwP) but many referrals for DAT are unsuitable or too late, and a screening tool to aid in identifying candidates would be helpful. This study aimed to produce such a screening tool by building a classifier that models specialist identification of suitable DAT candidates. To our knowledge, this is the first objective decision tool for managing DAT referral. Subjects were randomly assigned to either a construction set (n = 112, to train, develop, cross validate, and then evaluate the classifier’s performance) or to a test set (n = 60 to test the fully specified classifier), resulting in a sensitivity and specificity of 89% and 86.6%, respectively. The classifier’s performance was then assessed in PwP who underwent deep brain stimulation (n = 31), were managed in a non-specialist clinic (n = 81) or in PwP in the first five years from diagnosis (n = 22). The classifier identified 87%, 92%, and 100% of the candidates referred for DAT in each of the above clinical settings, respectively. Furthermore, the classifier score changed appropriately when therapeutic intervention resolved troublesome fluctuations or dyskinesia that would otherwise have required DAT. This study suggests that information from objective measurement could improve timely referral for DAT.
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163
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Zhou X, Guo J, Sun Q, Xu Q, Pan H, Yu R, Tan J, Yan X, Tang B, Fang L. Factors Associated With Dyskinesia in Parkinson's Disease in Mainland China. Front Neurol 2019; 10:477. [PMID: 31164859 PMCID: PMC6536088 DOI: 10.3389/fneur.2019.00477] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Accepted: 04/23/2019] [Indexed: 11/22/2022] Open
Abstract
Background and Objectives: Studies examining the risk factors for dyskinesia in Parkinson's disease (PD) have been inconsistent, and racial differences exist. Since there have been no systematic studies of the characteristics of dyskinesia in the Mainland Chinese population, we sought to elucidate the risk factors for dyskinesia. Methods: A total of 1974 PD patients from Mainland China were systematically investigated by univariable and multivariable analyses. PD patients with and without dyskinesia were stratified into 4 groups according to levodopa equivalent daily dose (LEDD) and analyzed by a Cox proportional hazards model. A longitudinal study of 87 patients with dyskinesia was classified into 3 groups according to the duration from onset of PD to the initiation of levodopa, and comparisons among groups were analyzed by the Mann-Whitney test. Results: Early age of onset, long disease duration, being female, high LEDD, low UPDRS III scores (ON-state) and high Hoehn-Yahr stage (ON-state) were predictors of dyskinesia. Dyskinesia was levodopa dosage-dependent, and the incidence increased remarkably when LEDD exceeded 300 mg/d (p < 0.05). The emergence of dyskinesia had no association with the initiation time of levodopa, and if the latter was more than 4 years, the duration of time on chronic levodopa free of motor complications was significantly shortened. Conclusions: We found risk factors for the prediction of dyskinesia. Our data shows that physicians should be cautious if the LEDD exceeds 300 mg/d. The development of dyskinesia was not correlated with the time of levodopa initiation.
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Affiliation(s)
- Xun Zhou
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
| | - Jifeng Guo
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China.,Laboratory of Medical Genetics, Central South University, Changsha, China.,National Clinical Research Center for Geriatric Disorders, Changsha, China.,Key Laboratory of Hunan Province in Neurodegenerative Disorders, Central South University, Changsha, China.,Center for Brain Disorders Research, Beijing Institute for Brain Disorders, Capital Medical University, Beijing, China
| | - Qiying Sun
- National Clinical Research Center for Geriatric Disorders, Changsha, China.,Key Laboratory of Hunan Province in Neurodegenerative Disorders, Central South University, Changsha, China.,Department of Geriatric Neurology, Xiangya Hospital, Central South University, Changsha, China
| | - Qian Xu
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China.,National Clinical Research Center for Geriatric Disorders, Changsha, China.,Key Laboratory of Hunan Province in Neurodegenerative Disorders, Central South University, Changsha, China
| | - Hongxu Pan
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
| | - Renhe Yu
- School of Public Health, Central South University, Changsha, China
| | - Jieqiong Tan
- Laboratory of Medical Genetics, Central South University, Changsha, China
| | - Xinxiang Yan
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China.,National Clinical Research Center for Geriatric Disorders, Changsha, China.,Key Laboratory of Hunan Province in Neurodegenerative Disorders, Central South University, Changsha, China
| | - Beisha Tang
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China.,Laboratory of Medical Genetics, Central South University, Changsha, China.,National Clinical Research Center for Geriatric Disorders, Changsha, China.,Key Laboratory of Hunan Province in Neurodegenerative Disorders, Central South University, Changsha, China.,Center for Brain Disorders Research, Beijing Institute for Brain Disorders, Capital Medical University, Beijing, China.,Department of Geriatric Neurology, Xiangya Hospital, Central South University, Changsha, China
| | - Liangjuan Fang
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China.,National Clinical Research Center for Geriatric Disorders, Changsha, China.,Key Laboratory of Hunan Province in Neurodegenerative Disorders, Central South University, Changsha, China
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164
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Johnston TH, Geva M, Steiner L, Orbach A, Papapetropoulos S, Savola JM, Reynolds IJ, Ravenscroft P, Hill M, Fox SH, Brotchie JM, Laufer R, Hayden MR. Pridopidine, a clinic-ready compound, reduces 3,4-dihydroxyphenylalanine-induced dyskinesia in Parkinsonian macaques. Mov Disord 2019; 34:708-716. [PMID: 30575996 DOI: 10.1002/mds.27565] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Accepted: 10/24/2018] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Pridopidine, in development for Huntington's disease, may modulate aberrant l-dopa-induced effects including l-dopa-induced dyskinesia (LID). OBJECTIVE This study investigated whether pridopidine could reduce LID in the MPTP macaque model of Parkinson's disease and characterized the observed behavioral effects in terms of receptor occupancy. METHODS The pharmacokinetic profile and effects of pridopidine (15-30 mg/kg) on parkinsonism, dyskinesia, and quality of on-time, in combination with l-dopa, were assessed in MPTP macaques with LID. Pridopidine receptor occupancy was estimated using known in vitro binding affinities to σ1 and dopamine D2 receptors, in vivo PET imaging, and pharmacokinetic profiling across different species. RESULTS Pridopidine produced a dose-dependent reduction in dyskinesia (up to 71%, 30 mg/kg) and decreased the duration of on-time with disabling dyskinesia evoked by l-dopa by 37% (20 mg/kg) and 60% (30 mg/kg). Pridopidine did not compromise the anti-parkinsonian benefit of l-dopa. Plasma exposures following the ineffective dose (15 mg/kg) were associated with full σ1 occupancy (>80%), suggesting that σ1 engagement alone is unlikely to account for the antidyskinetic benefits of pridopidine. Exposures following effective doses (20-30 mg/kg), while providing full σ1 occupancy, provide only modest dopamine D2 occupancy (<40%). However, effective pridopidine doses clearly engage a range of receptors (including adrenergic-α2C , dopamine-D3 , and serotoninergic-5-HT1A sites) to a higher degree than D2 and might contribute to the antidyskinetic actions. CONCLUSIONS In MPTP macaques, pridopidine produced a significant decrease in LID without compromising the antiparkinsonian benefit of l-dopa. Although the actions of pridopidine were associated with full σ1 occupancy, effective exposures are more likely associated with occupancy of additional, non-sigma receptors. This complex pharmacology may underlie the effectiveness of pridopidine against LID. © 2018 International Parkinson and Movement Disorder Society.
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MESH Headings
- 1-Methyl-4-phenyl-1,2,3,6-tetrahydropyridine
- Animals
- Antiparkinson Agents/adverse effects
- Brain/diagnostic imaging
- Brain/metabolism
- Dyskinesia, Drug-Induced/drug therapy
- Dyskinesia, Drug-Induced/etiology
- Levodopa/adverse effects
- MPTP Poisoning/drug therapy
- Macaca fascicularis
- Movement/drug effects
- Parkinsonian Disorders/chemically induced
- Parkinsonian Disorders/drug therapy
- Piperidines/pharmacology
- Positron-Emission Tomography
- Receptor, Muscarinic M2/metabolism
- Receptor, Serotonin, 5-HT1A/metabolism
- Receptor, Serotonin, 5-HT2A/metabolism
- Receptors, Adrenergic, alpha-2/metabolism
- Receptors, Dopamine D2/metabolism
- Receptors, Dopamine D3/metabolism
- Receptors, Histamine H3/metabolism
- Receptors, sigma/metabolism
- Sigma-1 Receptor
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Affiliation(s)
- Tom H Johnston
- Atuka Inc, Toronto, Ontario, Canada
- Krembil Research Institute, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| | - Michal Geva
- Prilenia Therapeutics Development Ltd., Herzliya, Israel (formerly 4)
| | - Lilach Steiner
- Global Research and Development, Teva Pharmaceutical Industries, Ltd., Netanya, Israel
| | - Aric Orbach
- Global Research and Development, Teva Pharmaceutical Industries, Ltd., Netanya, Israel
| | | | | | | | - Paula Ravenscroft
- Atuka Inc, Toronto, Ontario, Canada
- Krembil Research Institute, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| | - Michael Hill
- Atuka Inc, Toronto, Ontario, Canada
- Krembil Research Institute, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| | - Susan H Fox
- Movement Disorders Clinic, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| | - Jonathan M Brotchie
- Atuka Inc, Toronto, Ontario, Canada
- Krembil Research Institute, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| | - Ralph Laufer
- Lysogene S.A., Neuilly sur Seine, France (formerly 4)
| | - Michael R Hayden
- Prilenia Therapeutics Development Ltd., Herzliya, Israel (formerly 4)
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165
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Steece‐Collier K, Stancati JA, Collier NJ, Sandoval IM, Mercado NM, Sortwell CE, Collier TJ, Manfredsson FP. Genetic silencing of striatal CaV1.3 prevents and ameliorates levodopa dyskinesia. Mov Disord 2019; 34:697-707. [PMID: 31002755 PMCID: PMC6563183 DOI: 10.1002/mds.27695] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Revised: 03/19/2019] [Accepted: 03/21/2019] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Levodopa-induced dyskinesias are an often debilitating side effect of levodopa therapy in Parkinson's disease. Although up to 90% of individuals with PD develop this side effect, uniformly effective and well-tolerated antidyskinetic treatment remains a significant unmet need. The pathognomonic loss of striatal dopamine in PD results in dysregulation and disinhibition of striatal CaV1.3 calcium channels, leading to synaptopathology that appears to be involved in levodopa-induced dyskinesias. Although there are clinically available drugs that can inhibit CaV1.3 channels, they are not adequately potent and have only partial and transient impact on levodopa-induced dyskinesias. METHODS To provide unequivocal target validation, free of pharmacological limitations, we developed a CaV1.3 shRNA to provide high-potency, target-selective, mRNA-level silencing of striatal CaV1.3 channels and examined its ability to impact levodopa-induced dyskinesias in severely parkinsonian rats. RESULTS We demonstrate that vector-mediated silencing of striatal CaV1.3 expression in severely parkinsonian rats prior to the introduction of levodopa can uniformly and completely prevent induction of levodopa-induced dyskinesias, and this antidyskinetic benefit persists long term and with high-dose levodopa. In addition, this approach is capable of ameliorating preexisting severe levodopa-induced dyskinesias. Importantly, motoric responses to low-dose levodopa remained intact in the presence of striatal CaV1.3 silencing, indicating preservation of levodopa benefit without dyskinesia liability. DISCUSSION The current data provide some of the most profound antidyskinetic benefit reported to date and suggest that genetic silencing of striatal CaV1.3 channels has the potential to transform treatment of individuals with PD by allowing maintenance of motor benefit of levodopa in the absence of the debilitating levodopa-induced dyskinesia side effect. © 2019 The Authors. Movement Disorders published by Wiley Periodicals, Inc. on behalf of International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Kathy Steece‐Collier
- Department of Translational Science & Molecular MedicineCollege of Human Medicine, Michigan State UniversityGrand RapidsMIUSA
- Hauenstein Neuroscience CenterMercy Health Saint Mary's, Grand RapidsMichiganUSA
| | - Jennifer A. Stancati
- Department of Translational Science & Molecular MedicineCollege of Human Medicine, Michigan State UniversityGrand RapidsMIUSA
| | - Nicholas J. Collier
- Department of Translational Science & Molecular MedicineCollege of Human Medicine, Michigan State UniversityGrand RapidsMIUSA
| | - Ivette M. Sandoval
- Department of Translational Science & Molecular MedicineCollege of Human Medicine, Michigan State UniversityGrand RapidsMIUSA
- Hauenstein Neuroscience CenterMercy Health Saint Mary's, Grand RapidsMichiganUSA
| | - Natosha M. Mercado
- Department of Translational Science & Molecular MedicineCollege of Human Medicine, Michigan State UniversityGrand RapidsMIUSA
| | - Caryl E. Sortwell
- Department of Translational Science & Molecular MedicineCollege of Human Medicine, Michigan State UniversityGrand RapidsMIUSA
- Hauenstein Neuroscience CenterMercy Health Saint Mary's, Grand RapidsMichiganUSA
| | - Timothy J. Collier
- Department of Translational Science & Molecular MedicineCollege of Human Medicine, Michigan State UniversityGrand RapidsMIUSA
- Hauenstein Neuroscience CenterMercy Health Saint Mary's, Grand RapidsMichiganUSA
| | - Fredric P. Manfredsson
- Department of Translational Science & Molecular MedicineCollege of Human Medicine, Michigan State UniversityGrand RapidsMIUSA
- Hauenstein Neuroscience CenterMercy Health Saint Mary's, Grand RapidsMichiganUSA
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166
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Caraballo RH, Valenzuela GR, Pociecha J, Princich JP, Gutierrez R, Beltran L, Lubieniecki F, Bartuluchi M. Rasmussen syndrome: an atypical presentation in ten patients. Epileptic Disord 2018; 20:468-78. [PMID: 30530407 DOI: 10.1684/epd.2018.1007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The aim of this study was to analyse the electroclinical and imaging findings and outcome of patients with Rasmussen syndrome (RS) with atypical manifestations. We conducted a retrospective, descriptive study of 10 of 44 consecutive patients with RS with atypical features, followed between 1999 and 2017. Six patients were boys and four were girls. The mean and median ages at onset of the seizures were 8.8 and 6.5 years, respectively (range: 4.6-13 years). All of the patients except one had seizures. Eight patients (80%) had epilepsia partialis continua that started at a mean age of 7.5 years (range: 7-15 years). In our series, hemiparesis without seizures was the first manifestation in three patients, one of whom had dual pathology. In two patients, the first manifestation was dyskinetic movements, followed by delayed-onset seizures associated with unilateral caudate atrophy. Two patients had a focal lesion mimicking focal cortical dysplasia as the first MRI abnormality; one of these two patients had epileptic spasms in clusters. Bilateral cerebral hemisphere involvement was observed in three patients during the course of the disease. Six of eight patients responded well to surgical treatment. Progressive hemiparesis alone or with delayed-onset seizures, dyskinetic movements associated with seizures, a focal lesion mimicking focal cortical dysplasia, and bilateral brain involvement were the atypical features recognized. Our series of patients responded well to surgery. Clinical, video-EEG, and neuroradiological follow-up is important for early confirmation of RS in order to initiate adequate management of the condition.
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167
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Sassone J, Valtorta F, Ciammola A. Early Dyskinesias in Parkinson's Disease Patients With Parkin Mutation: A Primary Corticostriatal Synaptopathy? Front Neurosci 2019; 13:273. [PMID: 30971883 PMCID: PMC6443894 DOI: 10.3389/fnins.2019.00273] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Accepted: 03/07/2019] [Indexed: 12/18/2022] Open
Abstract
Mutations in the PARKIN gene cause early-onset Parkinson’s disease (PD). Despite the high proportion of still missing phenotyping data in the literature devoted to early-onset PD, studies suggest that, as compared with late-onset PD, PARKIN patients show dystonia at onset and extremely dose-sensitive levodopa-induced dyskinesia (LID). What pathophysiological mechanisms underpin such early and atypical dyskinesia in patients with PARKIN mutations? Though the precise mechanisms underlying dystonia and LID are still unclear, evidence suggests that hyperkinetic disorders in PD are a behavioral expression of maladaptive functional and morphological changes at corticostriatal synapses induced by long-term dopamine (DA) depletion. However, since the dyskinesia in PARKIN patients can also be present at onset, other mechanisms beside the well-established DA depletion may play a role in the development of dyskinesia in these patients. Because cortical and striatal neurons express parkin protein, and parkin modulates the function of ionotropic glutamatergic receptors (iGluRs), an intriguing explanation may rest on the potential role of parkin in directly controlling the glutamatergic corticostriatal synapse transmission. We discuss the novel theory that loss of parkin function can dysregulate transmission at the corticostriatal synapses where they cause early maladaptive changes that co-occur with the changes stemming from DA loss. This hypothesis suggests an early striatal synaptopathy; it could lay the groundwork for pharmacological treatment of dyskinesias and LID in patients with PARKIN mutations.
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Affiliation(s)
- Jenny Sassone
- Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
| | - Flavia Valtorta
- Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
| | - Andrea Ciammola
- Department of Neurology, IRCCS Istituto Auxologico Italiano, Milan, Italy
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168
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Liu Y, Li F, Luo H, He Q, Chen L, Cheng Y, Zhang W, Xie Z. Improvement of Deep Brain Stimulation in Dyskinesia in Parkinson's Disease: A Meta-Analysis. Front Neurol 2019; 10:151. [PMID: 30858823 PMCID: PMC6397831 DOI: 10.3389/fneur.2019.00151] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Accepted: 02/05/2019] [Indexed: 01/26/2023] Open
Abstract
Background: Deep brain stimulation (DBS) of the subthalamic nucleus (STN) or globus pallidus internus (GPi) have been proven to be equally effective in improving motor-symptoms for advanced Parkinson's disease (PD) patients. However, it is unclear that which target stimulation is more effective in reducing dyskinesia. We conducted the meta-analysis to evaluate the efficacy of STN and GPi-DBS in the dyskinesia. Methods: A systematic search was performed in PubMed, Embase, and the Cochrane Library databases. Controlled trials about the dyskinesia comparing the efficacy of GPi and STN DBS were included. Clinical data of dyskinesia and levodopa equivalent doses (LED) were collected for the meta-analysis. Results: Eight eligible trials containing a total of 822 patients were included in this meta-analysis. Our results showed that GPi DBS offered a greater reduction of dyskinesia than STN DBS at 12 months after surgery, with an overall pooled SMD of 0.32 (95% CI = 0.06 to 0.59, P = 0.02). Treatment of STN DBS was associated with a greater reduction of LED compared with GPi DBS, with a change score of −320.55 (95% CI = −401.36 to −239.73, P < 0.00001). Conclusion: GPi DBS is superior to reduce dyskinesia than STN DBS at 12 months after surgery for advanced PD patients. Further studies should focus on the different mechanism for dyskinesia reduction by GPi or STN DBS.
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Affiliation(s)
- Yun Liu
- Department of Neurosurgery, The Second Affiliated Hospital, Chongqing Medical University, Chongqing, China
| | - Feng Li
- Department of Neurosurgery, The Second Affiliated Hospital, Chongqing Medical University, Chongqing, China
| | - Hansheng Luo
- Department of Neurosurgery, The Second Affiliated Hospital, Chongqing Medical University, Chongqing, China
| | - Qiuguang He
- Department of Neurosurgery, The Second Affiliated Hospital, Chongqing Medical University, Chongqing, China
| | - Lifen Chen
- Department of Neurology, The Second Affiliated Hospital, Chongqing Medical University, Chongqing, China
| | - Yuan Cheng
- Department of Neurosurgery, The Second Affiliated Hospital, Chongqing Medical University, Chongqing, China
| | - Wenbin Zhang
- Department of Functional Neurosurgery, Nanjing Brain Hospital Affiliated to Nanjing Medical University, Nanjing, China
| | - Zongyi Xie
- Department of Neurosurgery, The Second Affiliated Hospital, Chongqing Medical University, Chongqing, China
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169
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Poewe W, Chaudhuri KR, Bergmann L, Antonini A. Levodopa-carbidopa intestinal gel in a subgroup of patients with dyskinesia at baseline from the GLORIA Registry. Neurodegener Dis Manag 2018; 9:39-46. [PMID: 30547712 PMCID: PMC6360350 DOI: 10.2217/nmt-2018-0034] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Aim: To evaluate long-term effects of levodopa–carbidopa intestinal gel on dyskinesia burden. Patients & methods: Posthoc analysis of the GLORIA registry assessed subgroups of advanced Parkinson's disease patients with <4 and ≥4 h/day of levodopa-induced dyskinesia at baseline. Results & conclusions: Mean dyskinesia duration significantly (p < 0.0001) decreased by 3.5 h in patients with ≥4 h baseline dyskinesia; conversely, dyskinesia duration increased by 1.6 h in patients with <4 h baseline dyskinesia. Quality of life improved in both subgroups. Adverse drug reactions occurred at similar rates in both subgroups. Despite increases in levodopa dose, levodopa–carbidopa intestinal gel treatment led to significant and sustained reductions in dyskinesia time, severity and associated pain in advanced Parkinson's disease patients with high baseline dyskinesia burden.
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Affiliation(s)
- Werner Poewe
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - K Ray Chaudhuri
- Institute of Psychiatry, Psychology & Neuroscience at King's College London & King's College Hospital (KCH) NHS Foundation Trust, London, UK
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170
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Thorp JE, Adamczyk PG, Ploeg HL, Pickett KA. Monitoring Motor Symptoms During Activities of Daily Living in Individuals With Parkinson's Disease. Front Neurol 2018; 9:1036. [PMID: 30619024 PMCID: PMC6299017 DOI: 10.3389/fneur.2018.01036] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2018] [Accepted: 11/16/2018] [Indexed: 01/23/2023] Open
Abstract
This literature review addressed wearable sensor systems to monitor motor symptoms in individuals with Parkinson's disease (PD) during activities of daily living (ADLs). Specifically, progress in monitoring tremor, freezing of gait, dyskinesia, bradykinesia, and hypokinesia was reviewed. Twenty-seven studies were found that met the criteria of measuring symptoms in a home or home-like setting, with some studies examining multiple motor disorders. Accelerometers, gyroscopes, and electromyography sensors were included, with some studies using more than one type of sensor. Five studies measured tremor, five studies examined bradykinesia or hypokinesia, thirteen studies included devices to measure dyskinesia or motor fluctuations, and ten studies measured akinesia or freezing of gait. Current sensor technology can detect the presence and severity of each of these symptoms; however, most systems require sensors on multiple body parts, which is challenging for remote or ecologically valid observation. Different symptoms are detected by different sensor placement, suggesting that the goal of detecting all symptoms with a reduced set of sensors may not be achievable. For the goal of monitoring motor symptoms during ADLs in a home setting, the measurement system should be simple to use, unobtrusive to the wearer and easy for an individual with PD to put on and take off. Machine learning algorithms such as neural networks appear to be the most promising way to detect symptoms using a small number of sensors. More work should be done validating the systems during unscripted and unconstrained ADLs rather than in scripted motions.
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Affiliation(s)
- Jenna E. Thorp
- Department of Mechanical Engineering, College of Engineering, University of Wisconsin-Madison, Madison, WI, United States
| | - Peter Gabriel Adamczyk
- Department of Mechanical Engineering, College of Engineering, University of Wisconsin-Madison, Madison, WI, United States
- Department of Biomedical Engineering, College of Engineering, University of Wisconsin-Madison, Madison, WI, United States
| | - Heidi-Lynn Ploeg
- Department of Mechanical Engineering, College of Engineering, University of Wisconsin-Madison, Madison, WI, United States
- Department of Biomedical Engineering, College of Engineering, University of Wisconsin-Madison, Madison, WI, United States
| | - Kristen A. Pickett
- Department of Biomedical Engineering, College of Engineering, University of Wisconsin-Madison, Madison, WI, United States
- Occupational Therapy Program, Department of Kinesiology, University of Wisconsin-Madison, Madison, WI, United States
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171
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Sarchioto M, Ricchi V, Melis M, Deriu M, Arca R, Melis M, Morgante F, Cossu G. Dyskinesia-Hyperpyrexia Syndrome in Parkinson's Disease: A Heat Shock-Related Emergency? Mov Disord Clin Pract 2018; 5:534-537. [PMID: 30515444 DOI: 10.1002/mdc3.12663] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Revised: 07/09/2018] [Accepted: 07/12/2018] [Indexed: 11/07/2022] Open
Affiliation(s)
- Marianna Sarchioto
- Neurology Service and Stroke Unit, AO Brotzu Hospital Cagliari Italy
- Department of Medical Sciences and Public Health University of Cagliari Cagliari Italy
| | | | - Marta Melis
- Neurology Service and Stroke Unit, AO Brotzu Hospital Cagliari Italy
- Department of Medical Sciences and Public Health University of Cagliari Cagliari Italy
| | - Marcello Deriu
- Neurology Service, Nostra Signora della Mercede Hospital S. Gavino Monreale Italy
| | - Roberta Arca
- Neurology Service and Stroke Unit, AO Brotzu Hospital Cagliari Italy
| | - Maurizio Melis
- Neurology Service and Stroke Unit, AO Brotzu Hospital Cagliari Italy
| | - Francesca Morgante
- Institute of Molecular and Clinical Sciences St George's University of London London United Kingdom
| | - Giovanni Cossu
- Neurology Service and Stroke Unit, AO Brotzu Hospital Cagliari Italy
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172
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Bette S, Shpiner DS, Singer C, Moore H. Safinamide in the management of patients with Parkinson's disease not stabilized on levodopa: a review of the current clinical evidence. Ther Clin Risk Manag 2018; 14:1737-1745. [PMID: 30271159 PMCID: PMC6152599 DOI: 10.2147/tcrm.s139545] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Safinamide (Xadago®) is a novel medication with both dopaminergic and non-dopaminergic effects, approved first by the European Commission and more recently by the US Food and Drug Administration (FDA) as an adjunctive treatment to carbidopa/levodopa in patients with mid- to late-stage Parkinson’s disease (PD) and motor fluctuations. It works through multiple mechanisms, namely as a reversible selective monoamine oxidase-B inhibitor and through modulation of glutamate release. Safinamide is extensively metabolized via oxidation to several inactive metabolites that are excreted primarily through the urine. Several large Phase III clinical trials of patients with advanced PD with motor fluctuations have shown that safinamide, administered orally at doses of 50–100 mg daily, increased ON time with no or non-troublesome dyskinesia, decreased daily OFF time, improved overall motor function (as measured by Unified Parkinson’s Disease Rating Scale [UPDRS] part III total score), and quality of life (as measured by Clinical Global Impression-Change and 39-item Parkinson’s Disease Questionnaire). In large clinical trials of patients with early PD on a single dopamine agonist, safinamide administered orally at a dose of 100 mg daily improved overall motor function as measured by UPDRS part III total score; however, some of the results reported were exploratory. Safinamide is generally well-tolerated and safe, with few to no treatment-related adverse events. Safinamide does not cause new or worsening dyskinesia and may be able to reduce this symptom in patients reporting it at baseline. Evidence suggests that safinamide is a good option for add-on therapy to carbidopa/levodopa in patients with advanced PD with motor complications, but there is still insufficient evidence to recommend it as monotherapy or add-on therapy in patients with early PD.
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Affiliation(s)
- Sagari Bette
- Department of Neurology, Division of Parkinson's Disease and Movement Disorders, University of Miami - Miller School of Medicine, Miami, FL, USA,
| | - Danielle S Shpiner
- Department of Neurology, Division of Parkinson's Disease and Movement Disorders, University of Miami - Miller School of Medicine, Miami, FL, USA,
| | - Carlos Singer
- Department of Neurology, Division of Parkinson's Disease and Movement Disorders, University of Miami - Miller School of Medicine, Miami, FL, USA,
| | - Henry Moore
- Department of Neurology, Division of Parkinson's Disease and Movement Disorders, University of Miami - Miller School of Medicine, Miami, FL, USA,
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173
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Jung NY, Park CK, Kim M, Lee PH, Sohn YH, Chang JW. The efficacy and limits of magnetic resonance-guided focused ultrasound pallidotomy for Parkinson's disease: a Phase I clinical trial. J Neurosurg 2018; 130:1-9. [PMID: 30095337 DOI: 10.3171/2018.2.jns172514] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Accepted: 02/23/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVERecently, MR-guided focused ultrasound (MRgFUS) has emerged as an innovative treatment for numerous neurological disorders, including essential tremor, Parkinson's disease (PD), and some psychiatric disorders. Thus, clinical applications with this modality have been tried using various targets. The purpose of this study was to determine the feasibility, initial effectiveness, and potential side effects of unilateral MRgFUS pallidotomy for the treatment of parkinsonian dyskinesia.METHODSA prospective, nonrandomized, single-arm clinical trial was conducted between December 2013 and May 2016 at a single tertiary medical center. Ten patients with medication-refractory, dyskinesia-dominant PD were enrolled. Participants underwent unilateral MRgFUS pallidotomy using the Exablate 4000 device (InSightec) after providing written informed consent. Patients were serially evaluated for motor improvement, neuropsychological effects, and adverse events according to the 1-year follow-up protocol. Primary measures included the changes in the Unified Parkinson's Disease Rating Scale (UPDRS) and Unified Dyskinesia Rating Scale (UDysRS) scores from baseline to 1 week, 1 month, 3 months, 6 months, and 1 year. Secondary measures consisted of neuropsychological batteries and quality of life questionnaire (SF-36). Technical failure and safety issues were also carefully assessed by monitoring all events during the study period.RESULTSUnilateral MRgFUS pallidotomy was successfully performed in 8 of 10 patients (80%), and patients were followed up for more than 6 months. Clinical outcomes showed significant improvements of 32.2% in the "medication-off" UPDRS part III score (p = 0.018) and 52.7% in UDysRS (p = 0.017) at the 6-month follow-up, as well as 39.1% (p = 0.046) and 42.7% (p = 0.046) at the 1-year follow-up, respectively. These results were accompanied by improvement in quality of life. Among 8 cases, 1 patient suffered an unusual side effect of sonication; however, no patient experienced persistent aftereffects.CONCLUSIONSIn the present study, which marks the first Phase I pilot study of unilateral MRgFUS pallidotomy for parkinsonian dyskinesia, the authors demonstrated the efficacy of pallidal lesioning using MRgFUS and certain limitations that are unavoidably associated with incomplete thermal lesioning due to technical issues. Further investigation and long-term follow-up are necessary to validate the use of MRgFUS in clinical practice.Clinical trial registration no.: NCT02003248 (clinicaltrials.gov).
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Affiliation(s)
| | - Chang Kyu Park
- 3Department of Neurosurgery, Kyung Hee University College of Medicine, Seoul, Republic of Korea
| | | | - Phil Hyu Lee
- 2Neurology, Brain Research Institute, Yonsei University College of Medicine, Seoul; and
| | - Young Ho Sohn
- 2Neurology, Brain Research Institute, Yonsei University College of Medicine, Seoul; and
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174
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Kashiura M, Taira H, Amagasa S, Moriya T. Hyperglycemia and chorea. J Gen Fam Med 2018; 19:141-142. [PMID: 29998046 PMCID: PMC6030040 DOI: 10.1002/jgf2.174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Accepted: 04/10/2018] [Indexed: 11/07/2022] Open
Abstract
(A) Computed tomography of the brain showing no abnormal finding. (B) Magnetic resonance imaging of the brain showing a T1-weighted area of hyperintensity in the left putamen, caudate nucleus, and globus pallidum with sparing of the internal capsule (arrow). (C) T2*-weighted image showing hypointensity in the left putamen, caudate nucleus, and globus pallidum (arrowhead). (D) T2-weighted image showing no abnormal finding.
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Affiliation(s)
- Masahiro Kashiura
- Department of Emergency and Critical Care MedicineSaitama Medical CenterJichi Medical UniversitySaitamaJapan
| | - Haruka Taira
- Department of Emergency and Critical Care MedicineSaitama Medical CenterJichi Medical UniversitySaitamaJapan
| | - Shunsuke Amagasa
- Department of Emergency and Critical Care MedicineSaitama Medical CenterJichi Medical UniversitySaitamaJapan
| | - Takashi Moriya
- Department of Emergency and Critical Care MedicineSaitama Medical CenterJichi Medical UniversitySaitamaJapan
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175
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Montagna M, Amir R, De Volder I, Lammens M, Huyskens J, Willekens B. IgLON5-Associated Encephalitis With Atypical Brain Magnetic Resonance Imaging and Cerebrospinal Fluid Changes. Front Neurol 2018; 9:329. [PMID: 29867738 PMCID: PMC5966542 DOI: 10.3389/fneur.2018.00329] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2018] [Accepted: 04/25/2018] [Indexed: 11/13/2022] Open
Abstract
IgLON5-associated encephalitis is a syndrome with different clinical presentations consisting of sleep dysfunction, bulbar dysfunction, chorea, and progressive supranuclear palsy-like symptoms whereas dysautonomy and cognitive decline usually appear in later stages of the disease. We report a case of a patient with IgLON5-associated encephalitis presenting with rapidly progressive cognitive decline and atypical inflammatory lesions on brain magnetic resonance imaging, oligoclonal bands on cerebrospinal fluid, anti-IgLON5 antibodies exclusively of the IgG1 class, and a fierce inflammatory reaction on brain biopsy, who responded favorably to immunotherapy.
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Affiliation(s)
- Massimiliano Montagna
- Department of Neurology, Antwerp University Hospital, Antwerp, Belgium.,Master After Master in Medicine, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Rizvana Amir
- Department of Neurology, Sint Maarten General Hospital, Mechelen, Belgium
| | - Ilse De Volder
- Department of Neurology, Antwerp University Hospital, Antwerp, Belgium.,Multidisciplinary Sleep Disorders Centre, Antwerp University Hospital, Antwerp, Belgium
| | - Martin Lammens
- Department of Pathology, Antwerp University Hospital, University of Antwerp, Antwerp, Belgium
| | - Jef Huyskens
- Department of Radiology, Antwerp University Hospital, Antwerp, Belgium
| | - Barbara Willekens
- Department of Neurology, Antwerp University Hospital, Antwerp, Belgium.,Laboratory of Experimental Hematology, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
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176
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Lu DS, Chen C, Zheng YX, Li DD, Wang GQ, Liu J, Shi J, Zhang F. Combination Treatment of Icariin and L-DOPA Against 6-OHDA-Lesioned Dopamine Neurotoxicity. Front Mol Neurosci 2018; 11:155. [PMID: 29867347 PMCID: PMC5964195 DOI: 10.3389/fnmol.2018.00155] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Accepted: 04/24/2018] [Indexed: 12/16/2022] Open
Abstract
Until now, the dopamine (DA) precursor, L-3,4-dihydroxyphenylalanine (L-DOPA), remains the gold standard effective drug therapy for Parkinson’s disease (PD) patients. Nevertheless, long-term chronic L-DOPA administration leads to the drug efficacy loss and severe adverse effects, such as L-DOPA-induced dyskinesia (LID). Icariin (ICA), a flavonoid that is extracted from Epimedium, has been proved to evoke neuroprotection against DA neuronal loss in PD animal models. Here, the present study detected the effects of ICA combined with L-DOPA on 6-hydroxydopamine (6-OHDA)-elicited DA neurotoxicity and L-DOPA-induced motor dysfunction as well. PC12 cells were applied to investigate the combination treatment of ICA and L-DOPA against 6-OHDA-lesioned neurotoxicity. In addition, rat substantia nigral stereotaxic injection of 6-OHDA-induced DA neuronal injury was performed to explore the neuroprotective effects mediated by ICA combined with L-DOPA. The pathological movement triggered by L-DOPA was determined by the abnormal involuntary movements (AIM) scores analysis. In PC12 cells, ICA combined with L-DOPA produced better neuroprotection from 6-OHDA-induced neurotoxicity than ICA or L-DOPA alone treatment. In parkinsonian 6-OHDA lesioned rats, ICA conferred DA neuroprotection as monotherapy and an enhancement benefit of L-DOPA treatment after daily administration of L-DOPA and ICA for 21 days. Moreover, ICA ameliorated the development of LID as evidenced by the lowered AIM scores without affecting L-DOPA-mediated efficacy. Furtherly, ICA attenuated neuroinflammation in 6-OHDA-induced DA neuronal loss and the development of LID in vivo. In conclusion, these findings suggest ICA might be a potential promising adjuvant to enhance L-DOPA efficacy and attenuate L-DOPA-produced adverse effects in PD.
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Affiliation(s)
- Di-Sheng Lu
- Key Laboratory of Basic Pharmacology of Ministry of Education and Joint International Research Laboratory of Ethnomedicine of Ministry of Education, Zunyi Medical University, Zunyi, China
| | - Ce Chen
- Key Laboratory of Basic Pharmacology of Ministry of Education and Joint International Research Laboratory of Ethnomedicine of Ministry of Education, Zunyi Medical University, Zunyi, China
| | - Ya-Xin Zheng
- Key Laboratory of Basic Pharmacology of Ministry of Education and Joint International Research Laboratory of Ethnomedicine of Ministry of Education, Zunyi Medical University, Zunyi, China
| | - Dai-Di Li
- Key Laboratory of Basic Pharmacology of Ministry of Education and Joint International Research Laboratory of Ethnomedicine of Ministry of Education, Zunyi Medical University, Zunyi, China
| | - Guo-Qing Wang
- Key Laboratory of Basic Pharmacology of Ministry of Education and Joint International Research Laboratory of Ethnomedicine of Ministry of Education, Zunyi Medical University, Zunyi, China
| | - Jie Liu
- Key Laboratory of Basic Pharmacology of Ministry of Education and Joint International Research Laboratory of Ethnomedicine of Ministry of Education, Zunyi Medical University, Zunyi, China
| | - Jingshan Shi
- Key Laboratory of Basic Pharmacology of Ministry of Education and Joint International Research Laboratory of Ethnomedicine of Ministry of Education, Zunyi Medical University, Zunyi, China
| | - Feng Zhang
- Key Laboratory of Basic Pharmacology of Ministry of Education and Joint International Research Laboratory of Ethnomedicine of Ministry of Education, Zunyi Medical University, Zunyi, China
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177
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Tanimura A, Pancani T, Lim SAO, Tubert C, Melendez AE, Shen W, Surmeier DJ. Striatal cholinergic interneurons and Parkinson's disease. Eur J Neurosci 2018; 47:1148-1158. [PMID: 28677242 PMCID: PMC6074051 DOI: 10.1111/ejn.13638] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2017] [Revised: 06/27/2017] [Accepted: 06/30/2017] [Indexed: 11/27/2022]
Abstract
Giant, aspiny cholinergic interneurons (ChIs) have long been known to be key nodes in the striatal circuitry controlling goal-directed actions and habits. In recent years, new experimental approaches, like optogenetics and monosynaptic rabies virus mapping, have expanded our understanding of how ChIs contribute to the striatal activity underlying action selection and the interplay of dopaminergic and cholinergic signaling. These approaches also have begun to reveal how ChI function is distorted in disease states affecting the basal ganglia, like Parkinson's disease (PD). This review gives a brief overview of our current understanding of the functional role played by ChIs in striatal physiology and how this changes in PD. The translational implications of these discoveries, as well as the gaps that remain to be bridged, are discussed as well.
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Affiliation(s)
- Asami Tanimura
- Department of Physiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, 60611, USA
| | - Tristano Pancani
- Department of Physiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, 60611, USA
| | - Sean Austin O Lim
- Department of Physiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, 60611, USA
| | - Cecilia Tubert
- Department of Physiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, 60611, USA
| | - Alexandra E Melendez
- Department of Physiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, 60611, USA
| | - Weixing Shen
- Department of Physiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, 60611, USA
| | - Dalton James Surmeier
- Department of Physiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, 60611, USA
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178
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Hauser RA, Pahwa R, Tanner CM, Oertel W, Isaacson SH, Johnson R, Felt L, Stempien MJ. ADS-5102 (Amantadine) Extended-Release Capsules for Levodopa-Induced Dyskinesia in Parkinson's Disease (EASE LID 2 Study): Interim Results of an Open-Label Safety Study. J Parkinsons Dis 2018; 7:511-522. [PMID: 28777755 PMCID: PMC5611804 DOI: 10.3233/jpd-171134] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Background: Medical treatment of levodopa-induced dyskinesia (LID) in Parkinson’s disease (PD) is an unmet need. ADS-5102 (amantadine) extended-release capsules is being developed for the treatment of LID in patients with PD. Objective: Evaluate the long-term safety and tolerability of 274 mg ADS-5102 for LID in PD. Methods: In an ongoing, open-label safety study (NCT02202551), PD patients with LID received 274 mg of ADS-5102 once daily at bedtime. Patients were recruited from previous ADS-5102 trials. In addition, patients were enrolled who were ineligible for previous ADS-5102 trials due to previous implantation of deep-brain stimulation (DBS) devices. The primary outcome measure was safety assessed through adverse events (AEs). Efficacy was assessed using the Movement Disorder Society–Unified Parkinson’s Disease Rating Scale (MDS-UPDRS), Part IV and its subparts. Results: For this interim analysis, 223 patients received ADS-5102 for a mean duration of 348 (SD 182) days. The most common AEs included falls (25.1%), visual hallucinations (19.3%), peripheral edema (13.0%), and constipation (12.6%). Overall, 32 patients (14.3%) discontinued due to an AE. In patients receiving placebo in previous studies, the mean MDS-UPDRS, Part IV scores decreased by 3.4 points from baseline (n = 78) to week 8 and remained stable through week 64 (n = 21). In patients receiving ADS-5102 in previous studies, the mean baseline (n = 61) MDS-UPDRS, Part IV score was low due to the response to ADS-5102 in previous studies and remained stable through week 64 (total of 88 weeks; n = 21). The effect was primarily due to reduction in item 4.2 (functional impact of dyskinesia) and item 4.4 (functional impact of motor fluctuations). Conclusions: ADS-5102 was generally well tolerated in all groups, including DBS patients, and the safety profile was consistent with previous controlled studies. Long-term durability and tolerability were shown from the double-blind studies through participation in the open-label study up to 88 weeks.
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Affiliation(s)
| | - Rajesh Pahwa
- University of Kansas Medical Center, Kansas City, KS, USA
| | - Caroline M Tanner
- University of California San Francisco and San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA
| | | | - Stuart H Isaacson
- Parkinson's Disease and Movement Disorders Center of Boca Raton, Boca Raton, FL, USA
| | - Reed Johnson
- Adamas Pharmaceuticals, Inc., Emeryville, CA, USA
| | - Larissa Felt
- Adamas Pharmaceuticals, Inc., Emeryville, CA, USA
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179
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Loiodice S, Denibaud AS, Deffains W, Alix M, Montagne P, Seffals M, Drieu La Rochelle C. Validation of a New Scoring Scale for Behavioral Assessment of L-Dopa-Induced Dyskinesia in the Rat: A New Tool for Early Decision-Making in Drug Development. ACS Chem Neurosci 2018; 9:762-772. [PMID: 29226687 DOI: 10.1021/acschemneuro.7b00426] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
The 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP)-treated nonhuman primate (NHP) has been described as the most translatable model for experimental reproduction of L-dopa-induced dyskinesia (LID). However, from a drug discovery perspective, the risk associated with investment in this type of model is high due to the time and cost. The 6-hydroxydopamine (6-OHDA) rat dyskinesia model is recommended for testing compounds but relies on onerous, and nonstandard behavioral rating scales. We sought to develop a simplified and sensitive method aiming at assessing LID in the rat. The purpose was to validate a reliable tool providing earlier insight into the antidyskinetic potential of compounds in a time/cost-effective manner before further investigation in NHP models. Unilaterally 6-OHDA-lesioned rats were administered L-dopa (20 mg/kg) and benserazide (5 mg/kg) daily for 3 weeks starting 4 weeks postlesion, then coadministered with amantadine (20-30-40 mg/kg). An adapted rating scale was used to score LID frequency and a severity coefficient was applied depending on the features of the observed behavior. A gradual increase (about 3-fold) in LID score was observed over the 3 weeks of L-dopa treatment. The rating scale was sensitive enough to highlight a dose-dependent amantadine-mediated decrease (about 2.2-fold) in LID score. We validated a simplified method, able to reflect different levels of severity in the assessment of LID and, thus, provide a reliable tool for drug discovery.
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Affiliation(s)
- Simon Loiodice
- Non-Clinical Department, Biotrial Pharmacology, 7-9 rue Jean-Louis Bertrand, 35042 Rennes, France
| | - Anne-Sophie Denibaud
- Non-Clinical Department, Biotrial Pharmacology, 7-9 rue Jean-Louis Bertrand, 35042 Rennes, France
| | - Wendy Deffains
- Non-Clinical Department, Biotrial Pharmacology, 7-9 rue Jean-Louis Bertrand, 35042 Rennes, France
| | - Magali Alix
- Non-Clinical Department, Biotrial Pharmacology, 7-9 rue Jean-Louis Bertrand, 35042 Rennes, France
| | - Pierre Montagne
- Non-Clinical Department, Biotrial Pharmacology, 7-9 rue Jean-Louis Bertrand, 35042 Rennes, France
| | - Marine Seffals
- Plate-Forme H2P2, Université de Rennes 1, Biosit, 2 Av. du Prof. Léon Bernard, 35043 Rennes, France
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180
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Sampaio TF, Dos Santos EUD, de Lima GDC, Dos Anjos RSG, da Silva RC, Asano AGC, Asano NMJ, Crovella S, de Souza PRE. MAO-B and COMT Genetic Variations Associated With Levodopa Treatment Response in Patients With Parkinson's Disease. J Clin Pharmacol 2018; 58:920-926. [PMID: 29578580 DOI: 10.1002/jcph.1096] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Accepted: 01/16/2018] [Indexed: 12/19/2022]
Abstract
The most commonly used Parkinson's disease (PD) treatment is the replacement of dopamine by its levodopa precursor (l-dopa). Monoamine oxidase-B (MAO-B) and catechol-o-methyl transferase (COMT) are enzymes involved in the metabolism and regulation of dopamine availability. In our study we investigated the possible relation among selected single-nucleotide polymorphisms (SNPs) in the MAO-B (rs1799836) and COMT (rs4680) genes and the therapeutic response to levodopa (l-dopa). A total of 162 Brazilian patients from the Pro-Parkinson service of Clinics Hospital of Pernambuco diagnosed with sporadic PD and treated with levodopa were enrolled. PD patients were stratified into 2 groups according to the daily levodopa dose. MAO-B and COMT SNP genotyping was conducted by polymerase chain reaction-restriction fragment length polymorphism. After multivariate analysis, we observed a significant difference between PD groups for the following variables: sex (P = .02), longer duration of disease (P = .02), longer levodopa therapy duration (P = .01), younger onset of PD (P = .01), and use of COMT inhibitor (P = .02). We observed that patients carrying MAO-B (rs1799836) A and AA genotypes and COMT (rs4680) LL genotype suffered more frequently from levodopa-induced-dyskinesia. In addition, we found an increased risk of 2.84-fold for male individuals carrying the MAO-B G allele to be treated with higher doses of levodopa (P = .04). We concluded that before beginning PD pharmacological treatment, it is important to consider the genetic variants of the MAO-B and COMT genes and the sex, reinforcing the evidence that sexual dimorphism in the genes related to dopamine metabolism might affect PD treatment.
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Affiliation(s)
- Tiago Furtado Sampaio
- Postgraduate Program of Biology Applied to Health, Federal University of Pernambuco (UFPE), Recife, Brazil
| | | | | | | | - Ronaldo Celerino da Silva
- Postgraduate Program of Biology Applied to Health, Federal University of Pernambuco (UFPE), Recife, Brazil
| | - Amdore Guescel C Asano
- Department of Clinical Medicine, Faculty of Medicine, Federal University of Pernambuco (UFPE), Recife, Brazil.,Pro-Parkinson Program of Clinical Hospital of Federal University of Pernambuco e Recife (HC/UFPE), Recife, Brazil
| | - Nadja Maria Jorge Asano
- Department of Clinical Medicine, Faculty of Medicine, Federal University of Pernambuco (UFPE), Recife, Brazil.,Pro-Parkinson Program of Clinical Hospital of Federal University of Pernambuco e Recife (HC/UFPE), Recife, Brazil
| | - Sergio Crovella
- Department of Genetics, Federal University of Pernambuco (UFPE), Recife, Brazil
| | - Paulo Roberto Eleutério de Souza
- Postgraduate Program of Biology Applied to Health, Federal University of Pernambuco (UFPE), Recife, Brazil.,Postgraduate Program of Applied Cellular and Molecular Biology, University of Pernambuco (UPE), Recife, Brazil.,Department of Biology, Federal Rural University of Pernambuco (UFRPE), Recife, Brazil
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181
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Chung KA, Lobb BM, Murchison CF, Mancini M, Hogarth P, Nutt JG. Assessment of an Objective Method of Dyskinesia Measurement in Parkinson's Disease. Mov Disord Clin Pract 2018; 5:160-164. [PMID: 30363374 DOI: 10.1002/mdc3.12583] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Revised: 10/17/2017] [Accepted: 12/05/2017] [Indexed: 11/06/2022] Open
Abstract
Background The goal of this study was to validate an objective method of measuring levodopa induced dyskinesia in Parkinson's disease (PD). Methods To characterize agreement between the clinician-based measure and a force plate, we assessed dyskinesia in PD subjects participating in a randomized and blinded clinical trial of an adenosine A2A anatagonist. Convergent validity and intra-class correlations were evaluated between the objective force plate measure and clinician assessments. Results All measures correlated across time and detected differences in treatments. Conclusion Our results indicate that objective measure from a force plate is in scale agreement with clinical ratings of dyskinesia severity, indicating it as a reliable method to measure LID objectively but with greater resolution to detect changes in LID.
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Affiliation(s)
- Kathryn A Chung
- VA Portland Health Care System Portland Oregon USA.,Oregon Health & Science University Portland Oregon USA
| | | | | | | | | | - John G Nutt
- Oregon Health & Science University Portland Oregon USA
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182
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Isaacson SH, Fahn S, Pahwa R, Tanner CM, Espay AJ, Trenkwalder C, Adler CH, Patni R, Johnson R. Parkinson's Patients with Dyskinesia Switched from Immediate Release Amantadine to Open-label ADS-5102. Mov Disord Clin Pract 2018; 5:183-190. [PMID: 29780852 PMCID: PMC5947645 DOI: 10.1002/mdc3.12595] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Revised: 01/09/2018] [Accepted: 01/20/2018] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND ADS-5102 (amantadine) extended release capsules (GOCOVRI™) are a treatment for dyskinesia in patients with Parkinson's disease (PD). ADS-5102 reduced dyskinesia and OFF time in phase 3 controlled trials of up to six months. Amantadine immediate release (IR) is used for dyskinesia, but suboptimal durability and tolerability limit its clinical utility. METHODS In an ongoing, open-label, phase 3 study in the US and Western Europe (NCT02202551), patients with PD received 274 mg of ADS-5102 (equivalent to 340 mg amantadine HCl) once daily at bedtime for up to two years. Study outcomes included safety and assessment of motor complications, as measured by the Movement Disorder Society Unified Parkinson's Disease Rating Scale (MDS-UPDRS) Part IV. This manuscript focuses on those patients switched to ADS-5102 from amantadine IR. Results in two groups of patients who previously completed a randomized controlled trial (EASE LID or EASE LID 3) are also presented according to use of ADS-5102 or placebo in that study before enrollment in the open-label study. RESULTS Change in MDS-UPDRS Part IV at week 8 was -0.3 in the previous ADS-5102 subgroup (n = 61), -3.4 in the previous placebo subgroup (n = 79), and -3.4 in the previous amantadine IR subgroup (n = 32). Effects were maintained to week 64. In the previous amantadine IR subgroup (mean treatment duration, 2.5 years), mean amantadine IR dose was 221 mg. Safety data were consistent with previous randomized controlled trials of ADS-5102. CONCLUSION These open-label data suggest ADS-5102 provides incremental reduction from baseline in MDS-UDPRS Part IV score in patients switched directly from amantadine IR, without exacerbating adverse events.
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Affiliation(s)
- Stuart H. Isaacson
- Parkinson's Disease and Movement Disorders Center of Boca RatonBoca RatonFLUSA
| | | | - Rajesh Pahwa
- University of Kansas Medical CenterKansas CityKSUSA
| | - Caroline M. Tanner
- University of California, San Francisco and San Francisco Veterans Affairs Medical CenterSan FranciscoCAUSA
| | - Alberto J. Espay
- Gardner Center for Parkinson's Disease and Movement DisordersUniversity of CincinnatiCincinnatiOHUSA
| | - Claudia Trenkwalder
- Paracelsus‐Elena‐Klinik, Kassel and Clinic NeurosurgeryUniversity Medical CenterGoettingenGermany
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183
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Suarez LM, Alberquilla S, García-Montes JR, Moratalla R. Differential Synaptic Remodeling by Dopamine in Direct and Indirect Striatal Projection Neurons in Pitx3 -/- Mice, a Genetic Model of Parkinson's Disease. J Neurosci 2018; 38:3619-30. [PMID: 29483281 DOI: 10.1523/JNEUROSCI.3184-17.2018] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Revised: 12/23/2017] [Accepted: 01/18/2018] [Indexed: 02/06/2023] Open
Abstract
In toxin-based models of Parkinson's disease (PD), striatal projection neurons (SPNs) exhibit dendritic atrophy and spine loss concurrent with an increase in excitability. Chronic l-DOPA treatment that induces dyskinesia selectively restores spine density and excitability in indirect pathway SPNs (iSPNs), whereas spine loss and hyperexcitability persist in direct pathway SPNs (dSPNs). These alterations have only been characterized in toxin-based models of PD, raising the possibility that they are an artifact of exposure to the toxin, which may engage compensatory mechanisms independent of the PD-like pathology or due to the loss of dopaminergic afferents. To test all these, we studied the synaptic remodeling in Pitx3-/- or aphakia mice, a genetic model of PD, in which most of the dopamine neurons in the substantia nigra fail to fully differentiate and to innervate the striatum. We made 3D reconstructions of the dendritic arbor and measured excitability in identified SPNs located in dorsal striatum of BAC-Pitx3-/- mice treated with saline or l-DOPA. Both dSPNs and iSPNs from BAC-Pitx3-/- mice had shorter dendritic trees, lower spine density, and more action potentials than their counterparts from WT mice. Chronic l-DOPA treatment restored spine density and firing rate in iSPNs. By contrast, in dSPNs, spine loss and hyperexcitability persisted following l-DOPA treatment, which is similar to what happens in 6-OHDA WT mice. This indicates that dopamine-mediated synaptic remodeling and plasticity is independent of dopamine innervation during SPN development and that Pitx3-/- mice are a good model because they develop the same pathology described in the toxins-based models and in human postmortem studies of advanced PD.SIGNIFICANCE STATEMENT As the only genetic model of Parkinson's disease (PD) that develops dyskinesia, Pitx3-/- mice reproduce the behavioral effects seen in humans and are a good system for studying dopamine-induced synaptic remodeling. The studies we present here establish that the structural and functional synaptic plasticity that occur in striatal projection neurons in PD and in l-DOPA-induced dyskinesia are specifically due to modulation of the neurotransmitter dopamine and are not artifacts of the use of chemical toxins in PD models. In addition, our findings provide evidence that synaptic plasticity in the Pitx3-/- mouse is similar to that seen in toxin models despite its lack of dopaminergic innervation of the striatum during development. Pitx3-/- mice reproduced the alterations described in patients with advanced PD and in well accepted toxin-based models of PD and dyskinesia. These results further consolidate the fidelity of the Pitx3-/- mouse as a PD model in which to study the morphological and physiological remodeling of striatal projection neurons by administration of l-DOPA and other drugs.
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184
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Zheng F, Ye X, Shi X, Poonit ND, Lin Z. Management of Refractory Orofacial Dyskinesia Caused by Anti- N-methyl-d-aspartate Receptor Encephalitis Using Botulinum Toxin. Front Neurol 2018. [PMID: 29520252 PMCID: PMC5827093 DOI: 10.3389/fneur.2018.00081] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The use of botulinum neurotoxin serotype A (BoNT-A) injections for the treatment of orofacial dyskinesia secondary to anti-N-methyl-d-aspartate receptor (NMDAR) encephalitis is rarely reported. Here, we report a case of an urgent, successful management of severe orofacial dyskinesia in an 8-year-old girl with anti-NMDAR encephalitis using BoNT-A injection. The patient presented with de novo unilateral paroxysmal movement disorder progressing to generalized dystonia and repetitive orofacial dyskinesia. Diagnosis was confirmed by the presence of NMDAR antibodies in serum and cerebrospinal fluid. The orofacial dyskinesia worsened despite the aggressive use of first-line immunotherapy and second-line immunotherapy (rituximab), and resulted in a potentially fatal self-inflicted oral injury. We urgently attempted symptomatic management using BoNT-A injections in the masseter, and induced muscle paralysis using vecuronium. The patient’s severe orofacial dyskinesia was controlled. We observed the effects of the BoNT-A injections and a tapering off of the effects of vecuronium 10 days after the treatment. The movement disorder had improved significantly 4 weeks after the first administration of rituximab. The injection of BoNT-A into the masseter may be an effective treatment for medically refractory orofacial dyskinesia in pediatric patients with anti-NMDAR encephalitis. We propose that the use of BoNT-A injections should be considered early to avoid self-inflicted oral injury due to severe refractory orofacial dyskinesia in patients with anti-NMDAR encephalitis.
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Affiliation(s)
- Feixia Zheng
- Department of Pediatric Neurology, The Second Affiliated Hospital & Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Xiuyun Ye
- Department of Pediatric Neurology, The Second Affiliated Hospital & Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Xulai Shi
- Department of Pediatric Neurology, The Second Affiliated Hospital & Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Neha Devi Poonit
- Department of Pediatrics, The Second Affiliated Hospital & Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Zhongdong Lin
- Department of Pediatric Neurology, The Second Affiliated Hospital & Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
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185
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Hamadjida A, Nuara SG, Gourdon JC, Huot P. The effect of mianserin on the severity of psychosis and dyskinesia in the parkinsonian marmoset. Prog Neuropsychopharmacol Biol Psychiatry 2018; 81:367-371. [PMID: 28882428 DOI: 10.1016/j.pnpbp.2017.09.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Revised: 08/28/2017] [Accepted: 09/03/2017] [Indexed: 11/25/2022]
Affiliation(s)
- Adjia Hamadjida
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada
| | - Stephen G Nuara
- Comparative Medicine & Animal Resource Centre, McGill University, Montreal, QC, Canada
| | - Jim C Gourdon
- Comparative Medicine & Animal Resource Centre, McGill University, Montreal, QC, Canada
| | - Philippe Huot
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada; Department of Pharmacology, Université de Montréal, Montreal, QC, Canada; Unité des Troubles du Mouvement André Barbeau, Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada; Division of Neurology, Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada.
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186
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Ba M, Kong M, Guan L, Yi M, Zhang H. Repetitive transcranial magnetic stimulation (rTMS) improves behavioral and biochemical deficits in levodopa-induced dyskinetic rats model. Oncotarget 2016; 7:58802-12. [PMID: 27613848 DOI: 10.18632/oncotarget.11587] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2016] [Accepted: 08/21/2016] [Indexed: 11/25/2022] Open
Abstract
Fluctuations of dopamine levels and upregulations of NR2B tyrosine phosphorylation in the striatum have been connected with levodopa (L-dopa)-induced dyskinesia (LID) in Parkinson's disease (PD). Repetitive transcranial magnetic stimulation (rTMS) is one of the noninvasive and potential method treating dyskinesia. Yet, the effect of rTMS on the above key pathological events remains unclear. In this study, we gave L-dopa treatment intraperitoneally for 22 days to 6-hydroxydopamine-lesioned PD rats to prepare LID rats model, and subsequently applied rTMS daily for 3 weeks to LID rats model. The effect of rTMS on abnormal involuntary movements (AIMs) was assessed. After ending the experiments, we further determined tyrosine hydroxylase (TH)-positive dopaminergic neurons number by immunohistochemistry, dopamine levels by HPLC, glial cell line-derived neurotrophic factor (GDNF) levels by ELISA, NR2B tyrosine phosphorylation and interactions of NR2B with Fyn by immunoblotting and immunoprecipitation. The results demonstrated that rTMS obviously attenuated AIMs scores, reduced the loss of nigral dopaminergic neurons and the fluctuations of striatal dopamine levels. Meanwhile, rTMS significantly increased the expression of GDNF, which couldrestore the damage of dopaminergic neurons. Additionally, rTMS also reduced the levels of the NR2B tyrosine phosphorylation andits interactions with Fyn in the lesioned striatum of LID rats model. Thus, these data indicate that rTMS can provide benefit for the therapy of LID by improving the key biochemical deficits related to dyskinesia.
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187
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Singh A, Jenkins MA, Burke KJ, Beck G, Jenkins A, Scimemi A, Traynelis SF, Papa SM. Glutamatergic Tuning of Hyperactive Striatal Projection Neurons Controls the Motor Response to Dopamine Replacement in Parkinsonian Primates. Cell Rep 2018; 22:941-952. [PMID: 29386136 DOI: 10.1016/j.celrep.2017.12.095] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Revised: 09/09/2017] [Accepted: 12/26/2017] [Indexed: 12/25/2022] Open
Abstract
Dopamine (DA) loss in Parkinson's disease (PD) alters the function of striatal projection neurons (SPNs) and causes motor deficits, but DA replacement can induce further abnormalities. A key pathological change in animal models and patients is SPN hyperactivity; however, the role of glutamate in altered DA responses remains elusive. We tested the effect of locally applied AMPAR or NMDAR antagonists on glutamatergic signaling in SPNs of parkinsonian primates. Following a reduction in basal hyperactivity by antagonists at either receptor, DA inputs induced SPN firing changes that were stable during the entire motor response, in clear contrast with the typically unstable effects. The SPN activity reduction over an extended putamenal area controlled the release of involuntary movements in the "on" state and therefore improved motor responses to DA replacement. These results demonstrate the pathophysiological role of upregulated SPN activity and support strategies to reduce striatal glutamate signaling for PD therapy.
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Affiliation(s)
- Arun Singh
- Yerkes National Primate Research Center, Emory University School of Medicine, Atlanta, GA 30329, USA
| | - Meagan A Jenkins
- Department of Pharmacology, Emory University School of Medicine, Atlanta, GA 30322, USA
| | - Kenneth J Burke
- Yerkes National Primate Research Center, Emory University School of Medicine, Atlanta, GA 30329, USA
| | - Goichi Beck
- Yerkes National Primate Research Center, Emory University School of Medicine, Atlanta, GA 30329, USA
| | - Andrew Jenkins
- Department of Pharmacology, Emory University School of Medicine, Atlanta, GA 30322, USA; Department of Anesthesiology, Emory University School of Medicine, Atlanta, GA 30322, USA
| | - Annalisa Scimemi
- Department of Biology, State University of New York, Albany, NY 12222, USA
| | - Stephen F Traynelis
- Department of Pharmacology, Emory University School of Medicine, Atlanta, GA 30322, USA
| | - Stella M Papa
- Yerkes National Primate Research Center, Emory University School of Medicine, Atlanta, GA 30329, USA; Department of Neurology, Emory University School of Medicine, Atlanta, GA 30329, USA.
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188
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Dams J, Balzer-Geldsetzer M, Siebert U, Deuschl G, Schuepbach WMM, Krack P, Timmermann L, Schnitzler A, Reese JP, Dodel R. Cost-effectiveness of neurostimulation in Parkinson's disease with early motor complications. Mov Disord 2018; 31:1183-91. [PMID: 27506638 DOI: 10.1002/mds.26740] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Revised: 06/13/2016] [Accepted: 06/26/2016] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Recent research efforts have focused on the effects of deep brain stimulation of the subthalamic nucleus (STN DBS) for selected patients with mild-to-moderate PD experiencing motor complications. OBJECTIVES We assessed the cost utility of subthalamic DBS compared with the best medical treatment for German patients below the age of 61 with early motor complications of PD. METHODS We applied a previously published Markov model that integrated health utilities based on EuroQoL and direct costs over patients' lifetime adjusted to the German health care payer perspective (year of costing: 2013). Effectiveness was evaluated using the Parkinson's Disease Questionnaire 39 summary index. We performed sensitivity analyses to assess uncertainty. RESULTS In the base-case analysis, the incremental cost-utility ratio for STN DBS compared to best medical treatment was 22,700 Euros per quality-adjusted life year gained. The time to, and costs for, battery exchange had a major effect on the incremental cost-utility ratios, but never exceeded a threshold of 50,000 Euros per quality-adjusted life year. CONCLUSIONS Our decision analysis supports the fact that STN DBS at earlier stages of the disease is cost-effective in patients below the age of 61 when compared with the best medical treatment in the German health care system. This finding was supported by detailed sensitivity analyses reporting robust results. Whereas the EARLYSTIM study has shown STN DBS to be superior to medical therapy with respect to quality of life for patients with early motor complications, this further analysis has shown its cost-effectiveness. © 2016 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Judith Dams
- Department of Neurology, Philipps-University Marburg, Marburg, Germany
| | | | - Uwe Siebert
- Department of Public Health, Health Services Research and HealthTechnology Assessment, UMIT-University for Health Sciences, Medical Informatics and Technology, Hall i.T., Austria.,Institute for Technology Assessment and Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.,Department of Health Policy and Management, Harvard Chan School of Public Health, Boston, Massachusetts, USA
| | - Günther Deuschl
- Department of Neurology, Christian-Albrechts-University Kiel, Kiel, Germany
| | - W M Michael Schuepbach
- Assistance-Publique Hôpitaux de Paris; Centre d'Investigation Clinique 9503, Institut du Cerveau et de la Moelle épinière; Département de Neurologie, Université Pierre et Marie Curie-Paris 6 et INSERM, CHU Pitié-Salpêtrière, Paris, France, and Movement Disorders Center, Department of Neurology, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Paul Krack
- Department of Neurology, University Hospital INSERM Unite 836, Grenoble Alpes University, Saint-Martin-d'Hères, France
| | - Lars Timmermann
- Department of Neurology, University Hospital Cologne, Cologne, Germany
| | - Alfons Schnitzler
- Institute of Clinical Neuroscience and Medical Psychology, Heinrich-Heine University Duesseldorf, Duesseldorf, Germany
| | - Jens-Peter Reese
- Department of Medical Sociology and Social Medicine, Philipps-University Marburg, Marburg, Germany
| | - Richard Dodel
- Department of Neurology, Philipps-University Marburg, Marburg, Germany.,Department of Geriatrics, University Duisburg-Essen, Essen, Germany
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Packer ME. A review of the outcome of dental implant provision in individuals with movement disorders. Eur J Oral Implantol 2018; 11 Suppl 1:S47-S63. [PMID: 30109299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
UNLABELLED Movement disorders encompass a wide range of medical conditions that demonstrate changes to muscle function and tone which present with orofacial dyskinesia and dystonia. The most common conditions exhibiting these features are Parkinson's disease, Down syndrome, chorea and epilepsy. AIM To establish whether implant success in patients suffering from movement disorders is similar to the general population, identifying risk factors and noting recommendations that may aid maintenance programmes. METHOD PubMed and Medline searches, combined with a manual search of the reference lists of identified full text studies. In total, 19 patient case reports and 11 patient case series were identified for inclusion in the review. RESULTS Implant survival in patients may be less than expected in patients with movement disorders, but evidence points to early rather than late failures. Oral hygiene control was widely reported as an issue, although there was insufficient evidence to imply that a lack of oral care will cause more rapid deterioration in implant patients with movement disorders. Maintenance requirements were low for fixed restorations, but more frequently reported in patients treated with overdentures, with the attachment mechanism and the prostheses requiring replacement. Chewing and quality of life in relation to prosthesis wear were improved. CONCLUSION Provision of implant-supported prostheses improves chewing and quality of life for patients with movement disorders and should be considered as an option in the treatment planning for tooth loss in this group of patients. However, straightforward designs that lend themselves to easier long-term maintenance should be adopted.
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190
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Abstract
Inhaled levodopa is a newly emerging therapeutic option in the treatment of "off " symptoms associated with Parkinson's disease (PD). Its mode of delivery offers more rapid absorption of levodopa and shorter onset of clinical benefit compared to oral formulations, and has been shown to be feasible for use in patients with PD experiencing worse motor function due to declining plasma levodopa levels. Clinical development of this compound is supported by preclinical, Phase I-III, long-term-safety studies and studies in special populations, including otherwise-healthy asthmatics and smokers. These investigations demonstrated that the drug is well tolerated without risk of long-term (up to 1 year) changes in pulmonary function or spirometry measures. The most common side effects among PD patients were a mild cough, upper respiratory tract infection, nausea, sputum discoloration, and dyskinesia. Inhaled levodopa offers a different administration method and side-effect profile from the currently available options for rescue therapy for Off periods in PD, though comparative studies have not been performed. The drug is presently under review by the US Food and Drug Administration.
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Affiliation(s)
- Ami B Patel
- Department of Neurology, Baylor College of Medicine, Houston, TX, USA,
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191
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Wu N, Wan Y, Song L, Qi C, Liu Z, Gan J. The abnormal activation of D1R/Shp-2 complex involved in levodopa-induced dyskinesia in 6-hydroxydopamine-lesioned Parkinson's rats. Neuropsychiatr Dis Treat 2018; 14:1779-1786. [PMID: 30013350 PMCID: PMC6038854 DOI: 10.2147/ndt.s162562] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Levodopa-induced dyskinesia (LID) is a troublesome problem in the treatment of Parkinson's disease (PD). The mechanisms of LID are still mysterious. Recently, the interaction between Shp-2 and D1 dopamine receptor (D1R) has been identified to be indispensable in the D1R-mediated extracellular signal-regulated kinases 1 and 2 (ERK1/2) activation and the occurrence of LID. However, the role of Shp-2 in the D1R-mediated signaling pathway of dyskinetic rat models is not fully clear. We designed this study with the purpose of exploring the role of D1R/Shp-2 complex in the D1R-mediated signaling pathway in the occurrence of LID. MATERIALS AND METHODS The 6-hydroxydopamine (6-OHDA) was injected unilaterally to produce the rat models of PD. Successful PD rat models were randomly divided into three groups to receive the treatment with L-3,4-dihydroxyphenylalanine (l-DOPA) + benserazide, l-DOPA + benserazide + D1R antagonist (SCH23390) or D1R agonist (SKF38393). Abnormal involuntary movements were assessed in different groups during the treatment. The interaction between D1R and Shp-2 was confirmed in the sham and LID rats through the methods of coimmunoprecipitation. In addition, the levels of p-Shp-2, p-ERK1/2 and p-mTOR were determined by Western blot in different groups. RESULTS After the treatment with l-DOPA + benserazide for 22 days, PD rats presented with dyskinesia. D1R agonist, SKF38393, induced similar involuntary movements in PD rats. In contrast, the dyskinetic movements were not induced by coadministration of l-DOPA + D1R antagonist (SCH23390). The interaction between D1R and Shp-2 in the normal rats was kept stable after the long-term use of l-DOPA. Moreover, we found that the pulsatile levodopa administration induced hyperphosphorylation of Shp-2, ERK1/2 and mTOR, while the coadministration of l-DOPA and D1R antagonist, SCH23390, did not induce the hyperphosphorylation of these proteins. CONCLUSION These data verified the existence of D1R/Shp-2 complex and its crucial role in the D1R-mediated signaling pathway in dyskinetic rats. Focus on the D1R/Shp-2 complex might be a potential treatment of LID in the future.
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Affiliation(s)
- Na Wu
- Department of Neurology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China, ;
| | - Ying Wan
- Department of Neurology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China, ;
| | - Lu Song
- Department of Neurology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China, ;
| | - Chen Qi
- Department of Neurology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China, ;
| | - Zhenguo Liu
- Department of Neurology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China, ;
| | - Jing Gan
- Department of Neurology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China, ;
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192
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Abstract
To highlight the association between amisulpride and onset of tardive dyskinesia (TD) in patient suffering with psychosis not otherwise specified (NOS), who has already been treated with amisulpride for many years. A 40-year-old female suffering with psychosis NOS since 19 years presented with recurrence of positive symptoms in the form of delusion of persecution, ideas of grandiosity since last 3 months. She was treated with amisulpride up to 400 mg/day and developed involuntary oro-buccal-lingual movement within 2 months of amisulpride therapy. Amisulpride an atypical antipsychotic can lead to the development of TD in patient who already received amisulpride for many years in the past. Reexposure with amisulpride can lead to early onset of TD due to blockade of already unregulated postsynaptic supersensitive dopamine receptors.
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Affiliation(s)
- Ajeet Sidana
- Department of Psychiatry, Government Medical College and Hospital, Chandigarh, India
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193
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Abstract
Background Despite being the most commonly performed operations, sometimes cholecystectomy fails to relieve symptoms; this is now a well-recognised clinical entity termed 'post-cholecystectomy syndrome' (PCS). Very few studies from India deal with PCS, and the present study was carried out to find the incidence and risk factors for PCS in patients undergoing elective laparoscopic cholecystectomy (LC). Materials and Methods The records of 207 patients undergoing elective LC were prospectively maintained for 6 months after surgery. Persistence or appearance of new symptoms after surgery was documented and investigated only when they persisted beyond 30 days of surgery. Results There were 185 (89.4%) female patients and 22 (10.6%) male patients with a mean age of 44.4 years (age range: 12-79 years). Conversion to open cholecystectomy was done in 18 patients (8.69%), mainly due to adhesions and unclear anatomy. The incidence of symptoms was found to be 13% at 6 months follow-up, showing a reducing trend from 58% in the 1st week after LC; the most common symptom in symptomatic patients was dyspepsia (55.56%). On investigation, a cause for symptoms could be detected in only 0.97%. Conclusion Symptoms are common after LC, but they settle over time. Very few patients have a detectable cause for symptoms after LC, and it is difficult to predict which patients will become symptomatic after LC; in the present series, previous attacks of cholecystitis and presence of co-morbid conditions were the only consistent risk factors for symptoms after LC.
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Affiliation(s)
- Divya Arora
- Department of Surgery, Government Medical College and Hospital, Chandigarh, India
| | - Robin Kaushik
- Department of Surgery, Government Medical College and Hospital, Chandigarh, India
| | - Ravinder Kaur
- Department of Radiodiagnosis, Government Medical College and Hospital, Chandigarh, India
| | - Atul Sachdev
- Department of Medicine, Government Medical College and Hospital, Chandigarh, India
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Abstract
INTRODUCTION Chorea is defined as jerk-like movements that move randomly from one body part to another. It is due to a variety of disorders and although current symptomatic therapy is quite effective there are few etiology- or pathogenesis-targeted therapies. The aim of this review is to summarize our own experience and published evidence in the treatment of chorea. Areas covered: After evaluating current guidelines and clinical practices for chorea of all etiologies, PubMed was searched for the most recent clinical trials and reviews using the term 'chorea' cross referenced with specific drug names. Expert commentary: Inhibitors of presynaptic vesicular monoamine transporter type 2 (VMAT2) that cause striatal dopamine depletion, such as tetrabenazine, deutetrabenazine, and valbenazine, are considered the treatment of choice in patients with chorea. Some clinicians also use dopamine receptor blockers (e.g. antipsychotics) and other drugs, including anti-epileptics and anti-glutamatargics. 'Dopamine stabilizers' such as pridopidine and other experimental drugs are currently being investigated in the treatment of chorea. Deep brain stimulation is usually reserved for patients with disabling chorea despite optimal medical therapy.
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Affiliation(s)
- H Bashir
- a Parkinson's Disease Center and Movement Disorders Clinic, Department of Neurology , Baylor College of Medicine , Houston , TX , USA
| | - J Jankovic
- a Parkinson's Disease Center and Movement Disorders Clinic, Department of Neurology , Baylor College of Medicine , Houston , TX , USA
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Cortés M, Malave L, Castello J, Flajolet M, Cenci MA, Friedman E, Rebholz H. CK2 Oppositely Modulates l-DOPA-Induced Dyskinesia via Striatal Projection Neurons Expressing D1 or D2 Receptors. J Neurosci 2017; 37:11930-46. [PMID: 29097596 DOI: 10.1523/JNEUROSCI.0443-17.2017] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Revised: 07/14/2017] [Accepted: 07/19/2017] [Indexed: 01/23/2023] Open
Abstract
We have previously shown that casein kinase 2 (CK2) negatively regulates dopamine D1 and adenosine A2A receptor signaling in the striatum. Ablation of CK2 in D1 receptor-positive striatal neurons caused enhanced locomotion and exploration at baseline, whereas CK2 ablation in D2 receptor-positive neurons caused increased locomotion after treatment with A2A antagonist, caffeine. Because both, D1 and A2A receptors, play major roles in the cellular responses to l-DOPA in the striatum, these findings prompted us to examine the impact of CK2 ablation on the effects of l-DOPA treatment in the unilateral 6-OHDA lesioned mouse model of Parkinson's disease. We report here that knock-out of CK2 in striatonigral neurons reduces the severity of l-DOPA-induced dyskinesia (LID), a finding that correlates with lowered pERK but unchanged pPKA substrate levels in D1 medium spiny neurons as well as in cholinergic interneurons. In contrast, lack of CK2 in striatopallidal neurons enhances LID and ERK phosphorylation. Coadministration of caffeine with a low dose of l-DOPA reduces dyskinesia in animals with striatopallidal knock-out to wild-type levels, suggesting a dependence on adenosine receptor activity. We also detect reduced Golf levels in the striatonigral but not in the striatopallidal knock-out in response to l-DOPA treatment.Our work shows, in a rodent model of PD, that treatment-induced dyskinesia and striatal ERK activation are bidirectionally modulated by ablating CK2 in D1- or D2-positive projection neurons, in male and female mice. The results reveal that CK2 regulates signaling events critical to LID in each of the two main populations of striatal neurons.SIGNIFICANCE STATEMENT To date, l-DOPA is the most effective treatment for PD. Over time, however, its efficacy decreases, and side effects including l-DOPA-induced dyskinesia (LID) increase, affecting up to 78% of patients within 10 years of therapy (Hauser et al., 2007). It is understood that supersensitivity of the striatonigral pathway underlies LID, however, D2 agonists were also shown to induce LID (Bezard et al., 2001; Delfino et al., 2004). Our work implicates a novel player in the expression of LID, the kinase CK2: knock-out of CK2 in striatonigral and striatopallidal neurons has opposing effects on LID. The bidirectional modulation of dyskinesia reveals a central role for CK2 in striatal physiology and indicates that both pathways contribute to LID.
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196
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Lenka A, Thota N, Stezin A, Pal PK, Yadav R. Orofacial Involuntary Movements in Neurosyphilis: Beyond the Candy Sign. Tremor Other Hyperkinet Mov (N Y) 2017; 7:507. [PMID: 29090106 PMCID: PMC5662534 DOI: 10.7916/d8000dkm] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Accepted: 09/15/2017] [Indexed: 12/12/2022]
Abstract
Background Involvement of the central nervous system in patients with syphilis (neurosyphilis) may result in several neuropsychiatric symptoms. Rarely, patients with neurosyphillis may develop movement disorders with different phenomenology. Subtle orofacial dyskinesias have been reported in patients with neurosyphilis, known as the candy sign. Case Report We describe a patient with neurosyphilis who presented with severe orofacial involuntary movements. Discussion Our patient had orofacial movements at presentation and severity of the movements was much higher than the candy sign that has been reported in patients with neurosyphilis. This report contributes towards the ever-expanding clinical spectrum of neurosyphilis.
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Affiliation(s)
- Abhishek Lenka
- Department of Clinical Neurosciences, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore-560029, Karnataka, India.,Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore-560029, Karnataka, India
| | - Naveen Thota
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore-560029, Karnataka, India
| | - Albert Stezin
- Department of Clinical Neurosciences, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore-560029, Karnataka, India.,Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore-560029, Karnataka, India
| | - Pramod Kumar Pal
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore-560029, Karnataka, India
| | - Ravi Yadav
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore-560029, Karnataka, India
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Chotibut T, Meadows S, Kasanga E, McInnis T, Cantu MA, Bishop C, Salvatore MF. Ceftriaxone reduces L-dopa-induced dyskinesia severity in 6-hydroxydopamine parkinson's disease model. Mov Disord 2017; 32:1547-1556. [PMID: 28631864 PMCID: PMC5681381 DOI: 10.1002/mds.27077] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Revised: 05/15/2017] [Accepted: 05/26/2017] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Increased extracellular glutamate may contribute to l-dopa induced dyskinesia, a debilitating side effect faced by Parkinson's disease patients 5 to 10 years after l-dopa treatment. Therapeutic strategies targeting postsynaptic glutamate receptors to mitigate dyskinesia may have limited success because of significant side effects. Increasing glutamate uptake may be another approach to attenuate excess glutamatergic neurotransmission to mitigate dyskinesia severity or prolong the time prior to onset. Initiation of a ceftriaxone regimen at the time of nigrostriatal lesion can attenuate tyrosine hydroxylase loss in conjunction with increased glutamate uptake and glutamate transporter GLT-1 expression in a rat 6-hydroxydopamine model. In this article, we examined if a ceftriaxone regimen initiated 1 week after nigrostriatal lesion, but prior to l-dopa, could reduce l-dopa-induced dyskinesia in an established dyskinesia model. METHODS Ceftriaxone (200 mg/kg, intraperitoneal, once daily, 7 consecutive days) was initiated 7 days post-6-hydroxydopamine lesion (days 7-13) and continued every other week (days 21-27, 35-39) until the end of the study (day 39 postlesion, 20 days of l-dopa). RESULTS Ceftriaxone significantly reduced abnormal involuntary movements at 5 time points examined during chronic l-dopa treatment. Partial recovery of motor impairment from nigrostriatal lesion by l-dopa was unaffected by ceftriaxone. The ceftriaxone-treated l-dopa group had significantly increased striatal GLT-1 expression and glutamate uptake. Striatal tyrosine hydroxylase loss in this group was not significantly different when compared with the l-dopa alone group. CONCLUSIONS Initiation of ceftriaxone after nigrostriatal lesion, but prior to and during l-dopa, may reduce dyskinesia severity without affecting l-dopa efficacy or the reduction of striatal tyrosine hydroxylase loss. © 2017 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Tanya Chotibut
- Department of Pharmacology, Toxicology, & Neuroscience, Louisiana State University Health Sciences Center, Shreveport, LA 71130
| | - Samantha Meadows
- Behavioral Neuroscience Program, Department of Psychology, Binghamton University, Binghamton, NY 13902-6000
| | - Ella Kasanga
- Institute for Healthy Aging & Center for Neuroscience Discovery, University of North Texas Health Science Center, 3500 Camp Bowie, Fort Worth, TX 76107
| | - Tamara McInnis
- Institute for Healthy Aging & Center for Neuroscience Discovery, University of North Texas Health Science Center, 3500 Camp Bowie, Fort Worth, TX 76107
| | - Mark A. Cantu
- Institute for Healthy Aging & Center for Neuroscience Discovery, University of North Texas Health Science Center, 3500 Camp Bowie, Fort Worth, TX 76107
| | - Christopher Bishop
- Behavioral Neuroscience Program, Department of Psychology, Binghamton University, Binghamton, NY 13902-6000
| | - Michael F. Salvatore
- Institute for Healthy Aging & Center for Neuroscience Discovery, University of North Texas Health Science Center, 3500 Camp Bowie, Fort Worth, TX 76107
- Department of Pharmacology, Toxicology, & Neuroscience, Louisiana State University Health Sciences Center, Shreveport, LA 71130
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Massari CM, López-Cano M, Núñez F, Fernández-Dueñas V, Tasca CI, Ciruela F. Antiparkinsonian Efficacy of Guanosine in Rodent Models of Movement Disorder. Front Pharmacol 2017; 8:700. [PMID: 29046640 PMCID: PMC5632808 DOI: 10.3389/fphar.2017.00700] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Accepted: 09/20/2017] [Indexed: 11/18/2022] Open
Abstract
Guanosine (GUO) is a guanine-based purine nucleoside with important trophic functions and promising neuroprotective properties. Although the neuroprotective effects of GUO have been corroborated in cellular models of Parkinson’s disease (PD), its efficacy as an antiparkinsonian agent has not been fully explored in PD animal models. Accordingly, we evaluated the effectiveness of GUO in reversing motor impairments in several rodent movement disorder models, including catalepsy, tremor, and hemiparkinsonism. Our results showed that orally administered GUO antagonized reserpine-mediated catalepsy, reduced reserpine-induced tremulous jaw movements, and potentiated the number of contralateral rotations induced by L-3,4-dihydroxyphenylalanine in unilaterally 6-hydroxidopamine-lesioned rats. In addition, at 5 and 7.5 mg/kg, GUO inhibited L-DOPA-induced dyskinesia in rats chronically treated with a pro-dopaminergic agent. Overall, we describe the therapeutic potential of GUO, which may be effective not only for reversing parkinsonian motor impairments but also for reducing dyskinesia induced by treatment for PD.
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Affiliation(s)
- Caio M Massari
- Programa de Pós-graduação em Bioquímica, Centro de Ciências Biológicas, Universidade Federal de Santa Catarina, Florianópolis, Brazil
| | - Marc López-Cano
- Unitat de Farmacologia, Departament de Patologia i Terapèutica Experimental, Facultat de Medicina, Bellvitge Institute for Biomedical Research, Universitat de Barcelona, Barcelona, Spain.,Institut de Neurociències, Universitat de Barcelona, Barcelona, Spain
| | - Fabiana Núñez
- Unitat de Farmacologia, Departament de Patologia i Terapèutica Experimental, Facultat de Medicina, Bellvitge Institute for Biomedical Research, Universitat de Barcelona, Barcelona, Spain.,Institut de Neurociències, Universitat de Barcelona, Barcelona, Spain
| | - Víctor Fernández-Dueñas
- Unitat de Farmacologia, Departament de Patologia i Terapèutica Experimental, Facultat de Medicina, Bellvitge Institute for Biomedical Research, Universitat de Barcelona, Barcelona, Spain.,Institut de Neurociències, Universitat de Barcelona, Barcelona, Spain
| | - Carla I Tasca
- Programa de Pós-graduação em Bioquímica, Centro de Ciências Biológicas, Universidade Federal de Santa Catarina, Florianópolis, Brazil.,Departamento de Bioquímica, Centro de Ciências Biológicas, Universidade Federal de Santa Catarina, Florianópolis, Brazil
| | - Francisco Ciruela
- Unitat de Farmacologia, Departament de Patologia i Terapèutica Experimental, Facultat de Medicina, Bellvitge Institute for Biomedical Research, Universitat de Barcelona, Barcelona, Spain.,Institut de Neurociències, Universitat de Barcelona, Barcelona, Spain
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199
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Choudhury S, Chatterjee K, Singh R, Shubham S, Trivedi S, Chatterjee S, Kumar H. Levosulpiride-induced Movement Disorders. J Pharmacol Pharmacother 2017; 8:177-181. [PMID: 29472751 PMCID: PMC5820749 DOI: 10.4103/jpp.jpp_32_17] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Revised: 05/13/2017] [Accepted: 07/10/2017] [Indexed: 11/04/2022] Open
Abstract
We reported a series of patients who presented with LSP-induced movement disorders specifically, dyskinetic movements. We have presented one case of LSP-induced parkinsonism and summarized ten cases of LSP-induced dyskinesia. The causality of the adverse drug reaction was assessed systematically using a validated rating system, and we extensively qualified the clinical presentation of each case of dyskinesia using a clinical rating scale. We described an unusual case of acute onset LSP-induced parkinsonism in a 56-year-aged female. The mean age of ten patients of LSP-induced dyskinesia was 65.3 years (standard deviation 10.4), and 25% of patients were female. They were consuming suspected medication for a median duration of 13 months (range 1-60 months). We noted LSP-induced dyskinesia was challenging to treat as its resolution is often incomplete even with adequate treatment.
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Affiliation(s)
- Supriyo Choudhury
- Department of Neurology, RGC Research Centre, Institute of Neurosciences, Kolkata, West Bengal, India
| | - Koustav Chatterjee
- Department of Neurology, RGC Research Centre, Institute of Neurosciences, Kolkata, West Bengal, India
| | - Ravi Singh
- Department of Neurology, RGC Research Centre, Institute of Neurosciences, Kolkata, West Bengal, India
| | - Shantanu Shubham
- Department of Neurology, RGC Research Centre, Institute of Neurosciences, Kolkata, West Bengal, India
| | - Santosh Trivedi
- Department of Neurology, RGC Research Centre, Institute of Neurosciences, Kolkata, West Bengal, India
| | - Suparna Chatterjee
- Department of Pharmacology, Institute of Post Graduate Medical Education and Research, Kolkata, West Bengal, India
| | - Hrishikesh Kumar
- Department of Neurology, RGC Research Centre, Institute of Neurosciences, Kolkata, West Bengal, India
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Biundo R, Weis L, Abbruzzese G, Calandra-Buonaura G, Cortelli P, Jori MC, Lopiano L, Marconi R, Matinella A, Morgante F, Nicoletti A, Tamburini T, Tinazzi M, Zappia M, Vorovenci RJ, Antonini A. Impulse control disorders in advanced Parkinson's disease with dyskinesia: The ALTHEA study. Mov Disord 2017; 32:1557-1565. [PMID: 28960475 DOI: 10.1002/mds.27181] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Revised: 08/17/2017] [Accepted: 08/23/2017] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Impulse control disorders and dyskinesia are common and disabling complications of dopaminergic treatment in Parkinson's disease. They may coexist and are possibly related. The objectives of this study were to assess the frequency and severity of impulse control disorders in Parkinson's disease patients with dyskinesia. METHODS The ALTHEA study enrolled 251 Parkinson's disease patients with various degrees of dyskinesia severity from 11 movement disorders centers in Italy. Each patient underwent a comprehensive assessment including Unified Dyskinesia Rating Scale and the Questionnaire for Impulsive Compulsive Disorders in Parkinson Disease-Rating Scale. RESULTS There was an overall 55% frequency of impulse control disorder and related behaviors (36% were clinically significant). The positive patients were younger at disease diagnosis and onset and had higher Unified Dyskinesia Rating Scale historical and total score (P = 0.001 and P = 0.02, respectively, vs negative). There was an increased frequency of clinically significant impulse control disorders in patients with severe dyskinesia (P = 0.013), a positive correlation between the questionnaire total score and dopamine agonist dose (P = 0.018), and a trend with levodopa dose. CONCLUSIONS More than half of Parkinson's disease patients with dyskinesia have impulse control disorders and related behaviors, which are frequently clinically significant. Dopaminergic therapy total dose is associated with their severity. Clinicians should carefully assess patients with maladaptive behaviors and dyskinesia because they do not properly evaluate their motor and nonmotor status. © 2017 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Roberta Biundo
- Parkinson and Movement Disorders Unit, IRCCS Hospital San Camillo, Venice, Italy
| | - Luca Weis
- Parkinson and Movement Disorders Unit, IRCCS Hospital San Camillo, Venice, Italy
| | - Giovanni Abbruzzese
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal Child Health, University of Genoa Genoa, Italy
| | - Giovanna Calandra-Buonaura
- Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy.,I.R.C.C.S. Institute of Neurological Sciences of Bologna, Bellaria Hospital, Bologna, Italy
| | - Pietro Cortelli
- Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy.,I.R.C.C.S. Institute of Neurological Sciences of Bologna, Bellaria Hospital, Bologna, Italy
| | | | - Leonardo Lopiano
- Department of Neuroscience "Rita Levi Montalcini", University of Turin, Torino, Italy
| | - Roberto Marconi
- Unità Operativa Complessa di Neurologia, Ospedale Misericordia, Grosseto, Italy
| | - Angela Matinella
- Department of Neurological, Neuropsychological, Morphological and Motor Sciences, University of Verona, Italy
| | - Francesca Morgante
- Dipartimento di Medicina Clinica e Sperimentale, Università di Messina, Messina, Italy
| | - Alessandra Nicoletti
- Section of Neurosciences, Department GF Ingrassia, University of Catania, Catania, Italy
| | | | - Michele Tinazzi
- Department of Neuroscience, Biomedicine and Motor Sciences, University of Verona, Italy
| | - Mario Zappia
- Clinica Neurologica I Policlinico Universitario, Catania, Italy
| | - Ruxandra Julia Vorovenci
- University of Medicine and Pharmacy "Victor Babes"; County Hospital, Department of Neurology, Timisoara, Romania
| | - Angelo Antonini
- Parkinson and Movement Disorders Unit, IRCCS Hospital San Camillo, Venice, Italy.,Department of Neuroscience (DNS), University of Padua, Padua, Italy
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