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Cerejo C, De Cleene N, Walser G, Djamshidian A, Seppi K, Heim B. Drug-induced parkinsonism in a patient with DiGeorge syndrome: a case report. Front Neurosci 2024; 18:1483587. [PMID: 39664449 PMCID: PMC11631938 DOI: 10.3389/fnins.2024.1483587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2024] [Accepted: 10/28/2024] [Indexed: 12/13/2024] Open
Abstract
DiGeorge syndrome, also referred as 22q11.2 deletion syndrome is a multisystem disorder associated with an increased risk of early-onset parkinsonism. In this case report, we present a case of a 47-year-old male patient with complex comorbidities and seizures. This patient presented with increased seizure frequency and on examination was found to have parkinsonism. Due to the symptoms constellation, a genetic analysis was done which revealed presence of DiGeorge syndrome. However, his DaTscan was normal and hence a possibility of medication induced parkinsonism was considered. Through this case report, we want to emphasize the fact that while it is important to consider genetic testing for young patients with parkinsonism especially in those with complex comorbidities, other possible causes of parkinsonism should not be ignored.
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Affiliation(s)
| | | | | | | | | | - Beatrice Heim
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
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Mathew T, Chadha AS, Jayalakshmi S, Garg S, Ravindranath AH, Murgod U, Bhardwaj S, Ektare P, John SK, Nadig R, Sarma GR. Levetiracetam-Induced Parkinsonism: A Short Case Series. Ann Indian Acad Neurol 2024; 27:742-744. [PMID: 39344257 DOI: 10.4103/aian.aian_430_24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2024] [Accepted: 09/01/2024] [Indexed: 10/01/2024] Open
Affiliation(s)
- Thomas Mathew
- Department of Neurology, St. John's Medical College Hospital, Bengaluru, Karnataka, India
| | - Amitoj S Chadha
- Department of Neurology, St. John's Medical College Hospital, Bengaluru, Karnataka, India
| | - Sita Jayalakshmi
- Department of Neurology, Krishna Institute of Medical Sciences, Secunderabad, Telangana, India
| | - Surabhi Garg
- Department of Neurology, St. John's Medical College Hospital, Bengaluru, Karnataka, India
| | - Aditya H Ravindranath
- Department of Neurology, St. John's Medical College Hospital, Bengaluru, Karnataka, India
| | - Uday Murgod
- Department of Neurology, Manipal Hospitals, Bengaluru, Karnataka, India
| | - Shagun Bhardwaj
- Department of Neurology, St. John's Medical College Hospital, Bengaluru, Karnataka, India
| | - Pranjali Ektare
- Department of Neurology, St. John's Medical College Hospital, Bengaluru, Karnataka, India
| | - Saji K John
- Department of Neurology, St. John's Medical College Hospital, Bengaluru, Karnataka, India
| | - Raghunandan Nadig
- Department of Neurology, St. John's Medical College Hospital, Bengaluru, Karnataka, India
| | - Gosala Rk Sarma
- Department of Neurology, St. John's Medical College Hospital, Bengaluru, Karnataka, India
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Kim HK, Biessels GJ, Yu MH, Hong N, Lee YH, Lee BW, Kang ES, Cha BS, Lee EJ, Lee M. SGLT2 Inhibitor Use and Risk of Dementia and Parkinson Disease Among Patients With Type 2 Diabetes. Neurology 2024; 103:e209805. [PMID: 39292986 DOI: 10.1212/wnl.0000000000209805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/20/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Despite the mechanistic potential of sodium-glucose cotransporter 2 inhibitor (SGLT2i) to improve neurologic outcomes, the efficacy of SGLT2i in neurodegenerative disorders among patients with type 2 diabetes is not well established. This population-based cohort study aimed to investigate the association of SGLT2i use with risks of incident dementia and Parkinson disease (PD) in patients with type 2 diabetes. METHODS This was a retrospective examination of data from a cohort of 1,348,362 participants with type 2 diabetes (≥40 years), who started antidiabetic drugs from 2014 to 2019, evaluated using the Korean National Health Insurance Service Database. Propensity score matching (1:1; SGLT2i to other oral antidiabetic drugs [OADs]) produced a cohort of 358,862 participants. Primary outcomes were the individual incidence of Alzheimer disease (AD), vascular dementia (VaD), and PD. Secondary outcomes were all-cause dementia (AD, VaD, and other dementia) and a composite of all-cause dementia and PD. Cox proportional hazards models were used to investigate the association between SGLT2i use and the risks of dementia and PD. RESULTS From the 358,862 participants analyzed (mean [SD] age, 57.8 [9.6] years; 58.0% male), 6,837 incident dementia or PD events occurred. Regarding the individual endpoints, SGLT2i use was associated with reduced risks of AD (adjusted hazard ratio [aHR] 0.81, 95% CI 0.76-0.87), VaD (aHR 0.69, 95% CI 0.60-0.78), and PD (aHR 0.80, 95% CI 0.69-0.91) with a 6-month drug use lag period. In addition, use of SGLT2i was associated with a 21% lower risk of all-cause dementia (aHR 0.79, 95% CI 0.69-0.90) and a 22% lower risk of all-cause dementia and PD than use of other OADs (aHR 0.78, 95% CI 0.73-0.83). The association between the use of SGLT2i and the lowered risk of these neurodegenerative disorders was not affected by sex, Charlson Comorbidity Index, diabetic complications, comorbidities, and medications. Sensitivity analysis further adjusting for bioclinical variables from health screening tests, including blood pressure, glucose, lipid profiles, and kidney function, yielded generally consistent results. DISCUSSION In this nationwide population-based study, SGLT2i use significantly reduced the risks of neurodegenerative disorders in patients with type 2 diabetes independent of various factors including comorbidities and bioclinical parameters. CLASSIFICATION OF EVIDENCE This study provides Class II evidence that SGLT2 antidiabetic drugs decrease the risk of dementia and PD in people with diabetes.
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Affiliation(s)
- Hae Kyung Kim
- From the Department of Internal Medicine (H.K.K., M.H.Y., N.H., Y.-h.L., B.-W.L., E.S.K., B.-S.C., E.J.L., M.L.), Institute of Endocrine Research (H.K.K., N.H., Y.-h.L., B.-W.L., E.S.K., B.-S.C., E.J.L., M.L.), Yonsei University College of Medicine, Seoul, South Korea; Department of Neurology (G.J.B.), University Medical Center (UMC) Utrecht Brain Center, UMC Utrecht, the Netherlands; and SENTINEL Team (M.H.Y.), Division of Endocrinology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | - Geert Jan Biessels
- From the Department of Internal Medicine (H.K.K., M.H.Y., N.H., Y.-h.L., B.-W.L., E.S.K., B.-S.C., E.J.L., M.L.), Institute of Endocrine Research (H.K.K., N.H., Y.-h.L., B.-W.L., E.S.K., B.-S.C., E.J.L., M.L.), Yonsei University College of Medicine, Seoul, South Korea; Department of Neurology (G.J.B.), University Medical Center (UMC) Utrecht Brain Center, UMC Utrecht, the Netherlands; and SENTINEL Team (M.H.Y.), Division of Endocrinology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | - Min Heui Yu
- From the Department of Internal Medicine (H.K.K., M.H.Y., N.H., Y.-h.L., B.-W.L., E.S.K., B.-S.C., E.J.L., M.L.), Institute of Endocrine Research (H.K.K., N.H., Y.-h.L., B.-W.L., E.S.K., B.-S.C., E.J.L., M.L.), Yonsei University College of Medicine, Seoul, South Korea; Department of Neurology (G.J.B.), University Medical Center (UMC) Utrecht Brain Center, UMC Utrecht, the Netherlands; and SENTINEL Team (M.H.Y.), Division of Endocrinology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | - Namki Hong
- From the Department of Internal Medicine (H.K.K., M.H.Y., N.H., Y.-h.L., B.-W.L., E.S.K., B.-S.C., E.J.L., M.L.), Institute of Endocrine Research (H.K.K., N.H., Y.-h.L., B.-W.L., E.S.K., B.-S.C., E.J.L., M.L.), Yonsei University College of Medicine, Seoul, South Korea; Department of Neurology (G.J.B.), University Medical Center (UMC) Utrecht Brain Center, UMC Utrecht, the Netherlands; and SENTINEL Team (M.H.Y.), Division of Endocrinology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | - Yong-Ho Lee
- From the Department of Internal Medicine (H.K.K., M.H.Y., N.H., Y.-h.L., B.-W.L., E.S.K., B.-S.C., E.J.L., M.L.), Institute of Endocrine Research (H.K.K., N.H., Y.-h.L., B.-W.L., E.S.K., B.-S.C., E.J.L., M.L.), Yonsei University College of Medicine, Seoul, South Korea; Department of Neurology (G.J.B.), University Medical Center (UMC) Utrecht Brain Center, UMC Utrecht, the Netherlands; and SENTINEL Team (M.H.Y.), Division of Endocrinology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | - Byung-Wan Lee
- From the Department of Internal Medicine (H.K.K., M.H.Y., N.H., Y.-h.L., B.-W.L., E.S.K., B.-S.C., E.J.L., M.L.), Institute of Endocrine Research (H.K.K., N.H., Y.-h.L., B.-W.L., E.S.K., B.-S.C., E.J.L., M.L.), Yonsei University College of Medicine, Seoul, South Korea; Department of Neurology (G.J.B.), University Medical Center (UMC) Utrecht Brain Center, UMC Utrecht, the Netherlands; and SENTINEL Team (M.H.Y.), Division of Endocrinology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | - Eun Seok Kang
- From the Department of Internal Medicine (H.K.K., M.H.Y., N.H., Y.-h.L., B.-W.L., E.S.K., B.-S.C., E.J.L., M.L.), Institute of Endocrine Research (H.K.K., N.H., Y.-h.L., B.-W.L., E.S.K., B.-S.C., E.J.L., M.L.), Yonsei University College of Medicine, Seoul, South Korea; Department of Neurology (G.J.B.), University Medical Center (UMC) Utrecht Brain Center, UMC Utrecht, the Netherlands; and SENTINEL Team (M.H.Y.), Division of Endocrinology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | - Bong-Soo Cha
- From the Department of Internal Medicine (H.K.K., M.H.Y., N.H., Y.-h.L., B.-W.L., E.S.K., B.-S.C., E.J.L., M.L.), Institute of Endocrine Research (H.K.K., N.H., Y.-h.L., B.-W.L., E.S.K., B.-S.C., E.J.L., M.L.), Yonsei University College of Medicine, Seoul, South Korea; Department of Neurology (G.J.B.), University Medical Center (UMC) Utrecht Brain Center, UMC Utrecht, the Netherlands; and SENTINEL Team (M.H.Y.), Division of Endocrinology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | - Eun Jig Lee
- From the Department of Internal Medicine (H.K.K., M.H.Y., N.H., Y.-h.L., B.-W.L., E.S.K., B.-S.C., E.J.L., M.L.), Institute of Endocrine Research (H.K.K., N.H., Y.-h.L., B.-W.L., E.S.K., B.-S.C., E.J.L., M.L.), Yonsei University College of Medicine, Seoul, South Korea; Department of Neurology (G.J.B.), University Medical Center (UMC) Utrecht Brain Center, UMC Utrecht, the Netherlands; and SENTINEL Team (M.H.Y.), Division of Endocrinology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | - Minyoung Lee
- From the Department of Internal Medicine (H.K.K., M.H.Y., N.H., Y.-h.L., B.-W.L., E.S.K., B.-S.C., E.J.L., M.L.), Institute of Endocrine Research (H.K.K., N.H., Y.-h.L., B.-W.L., E.S.K., B.-S.C., E.J.L., M.L.), Yonsei University College of Medicine, Seoul, South Korea; Department of Neurology (G.J.B.), University Medical Center (UMC) Utrecht Brain Center, UMC Utrecht, the Netherlands; and SENTINEL Team (M.H.Y.), Division of Endocrinology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea
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Xu X, Li Y, Lu H, Wang H, Guo Y, Dregan A, Sun L, Shen Y, Geng T, Gao X. Prospective study of bipolar disorder and neurodegenerative diseases. NPJ Parkinsons Dis 2024; 10:184. [PMID: 39362870 PMCID: PMC11450157 DOI: 10.1038/s41531-024-00794-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Accepted: 09/15/2024] [Indexed: 10/05/2024] Open
Abstract
Bipolar disorder (BD) is linked to an increased risk of neurodegenerative diseases such as dementia and Parkinson disease (PD), yet several uncertainties still remain and the extent to which the associations could be explained by BD-related medications (antipsychotics, lithium, and antiepileptics) was unknown. This study included 501,233 UK Biobank participants (mean [standard deviation] age, 56.5 [8.10] years; 54.4% women), free of dementia and PD at baseline. After a median 13.8 year follow-up, 9422 cases of dementia and 3457 PD cases were identified. Participants with BD had a significantly higher risk of dementia (adjusted hazard ratio [HR] 2.52, 95% CI 2.00-3.19) and PD (adjusted HR 2.88, 95% CI 2.03-4.08). Findings suggest that up to two-thirds of the association of neurodegenerative diseases with BD may be mediated by BD-related medications. Further research is needed to confirm these findings and explore the underlying mechanisms.
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Affiliation(s)
- Xinming Xu
- Department of Nutrition and Food Hygiene, Ministry of Education Key Laboratory of Public Health Safety, School of Public Health, Institute of Nutrition, Fudan University, Shanghai, 200030, China
| | - Yaqi Li
- Department of Nutrition and Food Hygiene, Ministry of Education Key Laboratory of Public Health Safety, School of Public Health, Institute of Nutrition, Fudan University, Shanghai, 200030, China
| | - Hanyu Lu
- Department of Nutrition and Food Hygiene, Ministry of Education Key Laboratory of Public Health Safety, School of Public Health, Institute of Nutrition, Fudan University, Shanghai, 200030, China
| | - Han Wang
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Yi Guo
- Department of Nutrition and Food Hygiene, Ministry of Education Key Laboratory of Public Health Safety, School of Public Health, Institute of Nutrition, Fudan University, Shanghai, 200030, China
| | - Alexandru Dregan
- Department of Psychological Medicine, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - Liang Sun
- Department of Nutrition and Food Hygiene, Ministry of Education Key Laboratory of Public Health Safety, School of Public Health, Institute of Nutrition, Fudan University, Shanghai, 200030, China
| | - Yun Shen
- Department of Neurology and Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University, Suzhou, 215004, China
| | - Tingting Geng
- Department of Nutrition and Food Hygiene, Ministry of Education Key Laboratory of Public Health Safety, School of Public Health, Institute of Nutrition, Fudan University, Shanghai, 200030, China.
| | - Xiang Gao
- Department of Nutrition and Food Hygiene, Ministry of Education Key Laboratory of Public Health Safety, School of Public Health, Institute of Nutrition, Fudan University, Shanghai, 200030, China.
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Ewens AN, Pilski A, Hastings SD, Krook-Magnuson C, Graves SM, Krook-Magnuson E, Thayer SA. Levetiracetam Prevents Neurophysiological Changes and Preserves Cognitive Function in the Human Immunodeficiency Virus (HIV)-1 Transactivator of Transcription Transgenic Mouse Model of HIV-Associated Neurocognitive Disorder. J Pharmacol Exp Ther 2024; 391:104-118. [PMID: 39060163 PMCID: PMC11413936 DOI: 10.1124/jpet.124.002272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Revised: 06/24/2024] [Accepted: 07/22/2024] [Indexed: 07/28/2024] Open
Abstract
Human immunodeficiency virus (HIV)-associated neurocognitive disorder (HAND) affects nearly half of the 39 million people living with HIV. HAND symptoms range from subclinical cognitive impairment to dementia; the mechanisms that underlie HAND remain unclear and there is no treatment. The HIV protein transactivator of transcription (TAT) is thought to contribute to HAND because it persists in the central nervous system and elicits neurotoxicity in animal models. Network hyperexcitability is associated with accelerated cognitive decline in neurodegenerative disorders. Here we show that the antiepileptic drug levetiracetam (LEV) attenuated aberrant excitatory synaptic transmission, protected synaptic plasticity, reduced seizure susceptibility, and preserved cognition in inducible TAT (iTAT) transgenic male mice. iTAT mice had an increased frequency of spontaneous excitatory postsynaptic currents in hippocampal slice recordings and impaired long-term potentiation, a form of synaptic plasticity that underlies learning and memory. Two-week administration of LEV by osmotic minipump prevented both impairments. Kainic acid administered to iTAT mice induced a higher maximum behavioral seizure score, longer seizure duration, and shorter latency to first seizure, consistent with a lower seizure threshold. LEV treatment prevented these in vivo signs of hyperexcitability. Lastly, in the Barnes maze, iTAT mice required more time to reach the goal, committed more errors, and received lower cognitive scores relative to iTAT mice treated with LEV. Thus, TAT expression drives functional deficits, suggesting a causative role in HAND. As LEV not only prevented aberrant synaptic activity in iTAT mice but also prevented cognitive dysfunction, it may provide a promising pharmacological approach to the treatment of HAND. SIGNIFICANCE STATEMENT: Approximately half of people living with human immunodeficiency virus (HIV) also suffer from HIV-associated neurocognitive disorder (HAND), for which there is no treatment. The HIV protein transactivator of transcription (TAT) causes toxicity that is thought to contribute to HAND. Here, the antiepileptic drug levetiracetam (LEV) prevented synaptic and cognitive impairments in a TAT-expressing mouse. LEV is widely used to treat seizures and is well-tolerated in humans, including those with HIV. This study supports further investigation of LEV-mediated neuroprotection in HAND.
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Affiliation(s)
- Ashley N Ewens
- Department of Pharmacology, University of Minnesota Medical School, Minneapolis, Minnesota (A.N.E., A.P., S.M.G., S.A.T.); and Department of Neuroscience, University of Minnesota, Minneapolis, Minnesota (S.D.H., C.K.-M., E.K.-M.)
| | - Alexander Pilski
- Department of Pharmacology, University of Minnesota Medical School, Minneapolis, Minnesota (A.N.E., A.P., S.M.G., S.A.T.); and Department of Neuroscience, University of Minnesota, Minneapolis, Minnesota (S.D.H., C.K.-M., E.K.-M.)
| | - Shayne D Hastings
- Department of Pharmacology, University of Minnesota Medical School, Minneapolis, Minnesota (A.N.E., A.P., S.M.G., S.A.T.); and Department of Neuroscience, University of Minnesota, Minneapolis, Minnesota (S.D.H., C.K.-M., E.K.-M.)
| | - Chris Krook-Magnuson
- Department of Pharmacology, University of Minnesota Medical School, Minneapolis, Minnesota (A.N.E., A.P., S.M.G., S.A.T.); and Department of Neuroscience, University of Minnesota, Minneapolis, Minnesota (S.D.H., C.K.-M., E.K.-M.)
| | - Steven M Graves
- Department of Pharmacology, University of Minnesota Medical School, Minneapolis, Minnesota (A.N.E., A.P., S.M.G., S.A.T.); and Department of Neuroscience, University of Minnesota, Minneapolis, Minnesota (S.D.H., C.K.-M., E.K.-M.)
| | - Esther Krook-Magnuson
- Department of Pharmacology, University of Minnesota Medical School, Minneapolis, Minnesota (A.N.E., A.P., S.M.G., S.A.T.); and Department of Neuroscience, University of Minnesota, Minneapolis, Minnesota (S.D.H., C.K.-M., E.K.-M.)
| | - Stanley A Thayer
- Department of Pharmacology, University of Minnesota Medical School, Minneapolis, Minnesota (A.N.E., A.P., S.M.G., S.A.T.); and Department of Neuroscience, University of Minnesota, Minneapolis, Minnesota (S.D.H., C.K.-M., E.K.-M.)
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O'Dwyer R, Leppik IE, Eads P, Long Y, Birnbaum AK. Overview of acute seizure management in US nursing homes. Epilepsy Behav 2024; 158:109913. [PMID: 38959744 DOI: 10.1016/j.yebeh.2024.109913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Revised: 06/17/2024] [Accepted: 06/19/2024] [Indexed: 07/05/2024]
Abstract
INTRODUCTION Residents in NH are more likely to be diagnosed with epilepsy or seizures, which are associated with higher mortality and complicate care. This setting provides unique challenges in the treatment of seizures however, little is known about current management practices in NH. Most studies in the literature concentrate on the use of antiseizure medications (ASMs) but little is known about the management of the acute seizure and clinical guidance is needed to ensure the safety of this vulnerable population. The objective of this study was to survey current practices, identifying knowledge deficits and inform future educational endeavors, including acute seizure action plans (ASAPs). METHODS A survey was developed pertaining to a broad spectrum of clinical aspects in the management of acute seizures in NH, distinguishing first time seizures from those in the setting of a known seizure disorder. It was sent to NH medical directors throughout the US and data was gathered from those who had at least one new case of new onset/epilepsy in the last 3 years. RESULTS Ninety-one NH directors responded with 52 % having a seizure protocol. Nurses are responsible in the majority of cases for protocol activation. Regardless of the patient's seizure history, rescue medications are given in the majority of cases, oral benzodiazepines, followed by intravenous and then rectal benzodiazepines. Newer intranasal and intramuscular formulations of benzodiazepines were less frequently prescribed. The most commonly prescribed ASM is levetiracetam, followed by lamotrigine, valproic acid and phenytoin. Staff training and in-service education occur infrequently. Respondents thought no-cost seizure education would be highly beneficial. CONCLUSIONS AND IMPLICATIONS Only approximately half of NH have protocols for the acute management of seizures. Rescue medications are given regardless of seizure history and often older ASMs are used for long-term management. Our study highlights areas of knowledge deficits and treatment areas for improvement, identifying the need and potential for ASAPs in NHs.
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Affiliation(s)
- Rebecca O'Dwyer
- Department of Neurological Science, Rush University Medical Center, Chicago, IL, USA.
| | - Ilo E Leppik
- Experimental and Clinical Pharmacology, College of Pharmacy, University of Minnesota, Minneapolis, MN, USA; Department of Neurology, University of Minnesota, Minneapolis, MN, USA
| | - Pam Eads
- UCB Pharmaceuticals, Smyrna, GA, USA
| | - Yuhan Long
- Experimental and Clinical Pharmacology, College of Pharmacy, University of Minnesota, Minneapolis, MN, USA
| | - Angela K Birnbaum
- Experimental and Clinical Pharmacology, College of Pharmacy, University of Minnesota, Minneapolis, MN, USA
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Wang Q, Liu F, Wang X, Zhong L, Cai B, Chen T. Identifying potential repurposable medications for Parkinson's disease through Mendelian randomization analysis. Sci Rep 2024; 14:19670. [PMID: 39181920 PMCID: PMC11344818 DOI: 10.1038/s41598-024-70758-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 08/21/2024] [Indexed: 08/27/2024] Open
Abstract
Observational studies have suggested the potential benefits of several medications for Parkinson's disease (PD) and their potential for repurposing. However, the conclusions drawn from these studies are not entirely consistent. To address this inconsistency, we used the two-sample Mendelian randomization (MR) method to explore the putative causal relationships between 23 medications and the risk and progression of PD. We applied inverse-variance weighted meta-analysis (IVW) to combine MR estimates. Additionally, sensitivity analyses were conducted to evaluate the robustness of the results. Our genetic evidence suggests that thyroid preparations and calcium channel blockers reduce the risk of PD, and salicylic acid and derivatives slow the progression of PD motor symptoms. Additionally, genetic evidence also suggests that four medications were associated with PD risk or progression, but the sensitivity analysis revealed that three of the medications may have interference caused by reverse causality. Our findings suggest that there are weak causal relationships between several medications and the risk or progression of PD. Though further replication studies are needed to verify these findings, these new insights may help in understanding the etiology of the disease, generate new clues related to drug discovery, and quantify the risk of future drug intake.
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Affiliation(s)
- Qitong Wang
- Department of Neurology, Hainan General Hospital, Hainan Affiliated Hospital of Hainan Medical University, Haikou, 570311, Hainan, China
| | - Fang Liu
- Department of Neurology, Hainan General Hospital, Hainan Affiliated Hospital of Hainan Medical University, Haikou, 570311, Hainan, China
| | - Xinyu Wang
- Department of Neurology, Hainan General Hospital, Hainan Affiliated Hospital of Hainan Medical University, Haikou, 570311, Hainan, China
| | - Lifan Zhong
- Department of Neurology, Hainan General Hospital, Hainan Affiliated Hospital of Hainan Medical University, Haikou, 570311, Hainan, China
| | - Benchi Cai
- Department of Neurology, Hainan General Hospital, Hainan Affiliated Hospital of Hainan Medical University, Haikou, 570311, Hainan, China.
| | - Tao Chen
- Department of Neurology, Hainan General Hospital, Hainan Affiliated Hospital of Hainan Medical University, Haikou, 570311, Hainan, China.
- Hainan Provincial Bureau of Disease Prevention and Control, Haikou, 570100, China.
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8
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Grotewold N, Albin RL. Update: Protective and risk factors for Parkinson disease. Parkinsonism Relat Disord 2024; 125:107026. [PMID: 38879999 DOI: 10.1016/j.parkreldis.2024.107026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Revised: 06/02/2024] [Accepted: 06/04/2024] [Indexed: 06/18/2024]
Abstract
We review the epidemiologic literature on potential protective and risk factors in Parkinson's Disease (PD). Prior research identified numerous possible protective and risk factors. Potential protective factors include tobacco abuse, physical activity, urate levels, NSAID use, calcium channel blocker use, statin use, and use of some α1-adrenergic antagonists. Some potential protective factors could be products of reverse causation, including increased serum urate, tobacco abuse, and coffee-tea-caffeine consumption. Potential risk factors include traumatic brain injury, pesticide exposure, organic solvent exposure, lead exposure, air pollution, Type 2 Diabetes, some dairy products, cardiovascular disease, and some infections including Hepatitis C, H. pylori, and COVID-19. Potential non-environmental risk factors include bipolar disorder, essential tremor, bullous pemphigoid, and inflammatory bowel disease. There is an inverse relationship with PD and risk of most cancers. Though many potential protective and risk factors for PD were identified, research has not yet led to unique, rigorous prevention trials or successful disease-modifying interventions. While efforts to reduce exposure to some industrial toxicants are well justified, PD incidence might be most effectively reduced by mitigation of risks, such as Type 2 Diabetes, air pollution, traumatic brain injury, or physical inactivity, that are general public health intervention targets.
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Affiliation(s)
- Nikolas Grotewold
- Dept. of Neurology, University of Michigan, Ann Arbor, MI, 48109, USA
| | - Roger L Albin
- Dept. of Neurology, University of Michigan, Ann Arbor, MI, 48109, USA; GRECC & Neurology Service, VAAAHS, Ann Arbor, MI, 48105, USA; University of Michigan Morris K. Udall Center of Excellence for Parkinson's Disease Research, Ann Arbor, MI, 48109, USA; University of Michigan Parkinson's Foundation Research Center of Excellence, USA.
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Schaper FLWVJ, Morton-Dutton M, Pacheco-Barrios N, Turner JI, Drew W, Khosravani S, Joutsa J, Fox MD. Brain lesions causing parkinsonism versus seizures map to opposite brain networks. Brain Commun 2024; 6:fcae196. [PMID: 38915927 PMCID: PMC11195636 DOI: 10.1093/braincomms/fcae196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Revised: 04/03/2024] [Accepted: 06/04/2024] [Indexed: 06/26/2024] Open
Abstract
Recent epidemiological studies propose an association between parkinsonism and seizures, but the direction of this association is unclear. Focal brain lesions causing new-onset parkinsonism versus seizures may provide a unique perspective on the causal relationship between the two symptoms and involved brain networks. We studied lesions causing parkinsonism versus lesions causing seizures and used the human connectome to identify their connected brain networks. Brain networks for parkinsonism and seizures were compared using spatial correlations on a group and individual lesion level. Lesions not associated with either symptom were used as controls. Lesion locations from 29 patients with parkinsonism were connected to a brain network with the opposite spatial topography (spatial r = -0.85) compared to 347 patients with lesions causing seizures. A similar inverse relationship was found when comparing the connections that were most specific on a group level (spatial r = -0.51) and on an individual lesion level (average spatial r = -0.042; P < 0.001). The substantia nigra was found to be most positively correlated to the parkinsonism network but most negatively correlated to the seizure network (spatial r > 0.8). Brain lesions causing parkinsonism versus seizures map to opposite brain networks, providing neuroanatomical insight into conflicting epidemiological evidence.
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Affiliation(s)
- Frederic L W V J Schaper
- Center for Brain Circuit Therapeutics, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA
- Department of Neurology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Mae Morton-Dutton
- Center for Brain Circuit Therapeutics, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA
- Department of Neurology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Niels Pacheco-Barrios
- Center for Brain Circuit Therapeutics, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA
- Department of Neurosurgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Joseph I Turner
- Center for Brain Circuit Therapeutics, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA
- Department of Neurology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - William Drew
- Center for Brain Circuit Therapeutics, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA
- Department of Neurology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Sanaz Khosravani
- Center for Brain Circuit Therapeutics, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA
- Department of Neurology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Juho Joutsa
- Turku Brain and Mind Center, Clinical Neurosciences, University of Turku, 20520 Turku, Finland
- Turku PET Centre, Neurocenter, Turku University Hospital, 20520 Turku, Finland
| | - Michael D Fox
- Center for Brain Circuit Therapeutics, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA
- Department of Neurology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA
- Athinoula A Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA 02129, USA
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10
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Lin F, Lin Y, Chen L, Huang T, Lin T, He J, Lu X, Chen X, Wang Y, Ye Q, Cai G. Association of physical activity pattern and risk of Parkinson's disease. NPJ Digit Med 2024; 7:137. [PMID: 38783073 PMCID: PMC11116521 DOI: 10.1038/s41746-024-01135-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 05/10/2024] [Indexed: 05/25/2024] Open
Abstract
Increasing evidence suggests an association between exercise duration and Parkinson's disease. However, no high-quality prospective evidence exists confirming whether differences exist between the two modes of exercise, weekend warrior and equal distribution of exercise duration, and Parkinson's risk. Hence, this study aimed to explore the association between different exercise patterns and Parkinson's risk using exercise data from the UK Biobank. The study analyzed data from 89,400 UK Biobank participants without Parkinson's disease. Exercise data were collected using the Axivity AX3 wrist-worn triaxial accelerometer. Participants were categorized into three groups: inactive, regularly active, and engaged in the weekend warrior (WW) pattern. The relationship between these exercise patterns and Parkinson's risk was assessed using a multifactorial Cox model. During a mean follow-up of 12.32 years, 329 individuals developed Parkinson's disease. In a multifactorial Cox model, using the World Health Organization-recommended threshold of 150 min of moderate-to-vigorous physical activity per week, both the active WW group [hazard ratio (HR) = 0.58; 95% confidence interval (CI) = 0.43-0.78; P < 0.001] and the active regular group (HR = 0.44; 95% CI = 0.34-0.57; P < 0.001) exhibited a lower risk of developing Parkinson's disease compared with the inactive group. Further, no statistically significant difference was observed between the active WW and the active regular groups (HR = 0.77; 95% CI = 0.56-1.05; P = 0.099). In conclusion, in this cohort study, both the WW exercise pattern and an equal distribution of exercise hours were equally effective in reducing Parkinson's risk.
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Affiliation(s)
- Fabin Lin
- Department of Neurology, Center for Cognitive Neurology, Institute of Clinical Neurology, Fujian Medical University Union Hospital, 29 Xinquan Road, Fuzhou, 350001, China
- Fujian Institute of Geriatrics, Fujian Medical University Union Hospital, 29 Xinquan Road, Fuzhou, 350001, China
- Fujian Key Laboratory of Molecular Neurology, Fujian Medical University, 88 Jiaotong Road, Fuzhou, 350001, China
- Department of Neurosurgery, Fujian Medical University Union Hospital, 29 Xinquan Road, Fuzhou, 350001, China
| | - Yixiang Lin
- Department of Neurology, Center for Cognitive Neurology, Institute of Clinical Neurology, Fujian Medical University Union Hospital, 29 Xinquan Road, Fuzhou, 350001, China
- Fujian Institute of Geriatrics, Fujian Medical University Union Hospital, 29 Xinquan Road, Fuzhou, 350001, China
- Fujian Key Laboratory of Molecular Neurology, Fujian Medical University, 88 Jiaotong Road, Fuzhou, 350001, China
| | - Lina Chen
- Department of Neurology, Center for Cognitive Neurology, Institute of Clinical Neurology, Fujian Medical University Union Hospital, 29 Xinquan Road, Fuzhou, 350001, China
- Fujian Institute of Geriatrics, Fujian Medical University Union Hospital, 29 Xinquan Road, Fuzhou, 350001, China
- Fujian Key Laboratory of Molecular Neurology, Fujian Medical University, 88 Jiaotong Road, Fuzhou, 350001, China
| | - Tingting Huang
- Department of Neurology, Center for Cognitive Neurology, Institute of Clinical Neurology, Fujian Medical University Union Hospital, 29 Xinquan Road, Fuzhou, 350001, China
- Fujian Institute of Geriatrics, Fujian Medical University Union Hospital, 29 Xinquan Road, Fuzhou, 350001, China
- Fujian Key Laboratory of Molecular Neurology, Fujian Medical University, 88 Jiaotong Road, Fuzhou, 350001, China
| | - Tianxin Lin
- Department of Neurology, Center for Cognitive Neurology, Institute of Clinical Neurology, Fujian Medical University Union Hospital, 29 Xinquan Road, Fuzhou, 350001, China
- Fujian Institute of Geriatrics, Fujian Medical University Union Hospital, 29 Xinquan Road, Fuzhou, 350001, China
- Fujian Key Laboratory of Molecular Neurology, Fujian Medical University, 88 Jiaotong Road, Fuzhou, 350001, China
| | - Jiarui He
- Department of Neurology, Center for Cognitive Neurology, Institute of Clinical Neurology, Fujian Medical University Union Hospital, 29 Xinquan Road, Fuzhou, 350001, China
- Fujian Institute of Geriatrics, Fujian Medical University Union Hospital, 29 Xinquan Road, Fuzhou, 350001, China
- Fujian Key Laboratory of Molecular Neurology, Fujian Medical University, 88 Jiaotong Road, Fuzhou, 350001, China
| | - Xiaoyang Lu
- Department of Neurology, Center for Cognitive Neurology, Institute of Clinical Neurology, Fujian Medical University Union Hospital, 29 Xinquan Road, Fuzhou, 350001, China
- Fujian Institute of Geriatrics, Fujian Medical University Union Hospital, 29 Xinquan Road, Fuzhou, 350001, China
- Fujian Key Laboratory of Molecular Neurology, Fujian Medical University, 88 Jiaotong Road, Fuzhou, 350001, China
| | - Xiaochun Chen
- Department of Neurology, Center for Cognitive Neurology, Institute of Clinical Neurology, Fujian Medical University Union Hospital, 29 Xinquan Road, Fuzhou, 350001, China
- Fujian Institute of Geriatrics, Fujian Medical University Union Hospital, 29 Xinquan Road, Fuzhou, 350001, China
- Fujian Key Laboratory of Molecular Neurology, Fujian Medical University, 88 Jiaotong Road, Fuzhou, 350001, China
| | - Yingqing Wang
- Department of Neurology, Center for Cognitive Neurology, Institute of Clinical Neurology, Fujian Medical University Union Hospital, 29 Xinquan Road, Fuzhou, 350001, China.
- Fujian Institute of Geriatrics, Fujian Medical University Union Hospital, 29 Xinquan Road, Fuzhou, 350001, China.
- Fujian Key Laboratory of Molecular Neurology, Fujian Medical University, 88 Jiaotong Road, Fuzhou, 350001, China.
| | - Qinyong Ye
- Department of Neurology, Center for Cognitive Neurology, Institute of Clinical Neurology, Fujian Medical University Union Hospital, 29 Xinquan Road, Fuzhou, 350001, China.
- Fujian Institute of Geriatrics, Fujian Medical University Union Hospital, 29 Xinquan Road, Fuzhou, 350001, China.
- Fujian Key Laboratory of Molecular Neurology, Fujian Medical University, 88 Jiaotong Road, Fuzhou, 350001, China.
| | - Guoen Cai
- Department of Neurology, Center for Cognitive Neurology, Institute of Clinical Neurology, Fujian Medical University Union Hospital, 29 Xinquan Road, Fuzhou, 350001, China.
- Fujian Institute of Geriatrics, Fujian Medical University Union Hospital, 29 Xinquan Road, Fuzhou, 350001, China.
- Fujian Key Laboratory of Molecular Neurology, Fujian Medical University, 88 Jiaotong Road, Fuzhou, 350001, China.
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11
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Schaper FLWVJ, Morton-Dutton M, Drew W, Khosravani S, Joutsa J, Fox MD. Brain lesions causing parkinsonism versus seizures map to opposite brain networks. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.05.02.24306764. [PMID: 38746381 PMCID: PMC11092727 DOI: 10.1101/2024.05.02.24306764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2024]
Abstract
Recent epidemiological studies propose an association between parkinsonism and seizures, but the direction of this association is unclear. Focal brain lesions causing new-onset parkinsonism versus seizures may provide a unique perspective on the causal relationship between the two symptoms and involved brain networks. We studied lesions causing parkinsonism versus lesions causing seizures and utilized human connectome data to identify their connected brain networks. Brain networks for parkinsonism and seizures were compared using spatial correlations on a group and individual lesion level. Lesions not associated with either symptom were used as controls. Lesion locations from 29 patients with parkinsonism were connected to a brain network with the opposite spatial topography (spatial r =-0.85) compared to 347 patients with lesions causing seizures. A similar inverse relationship was found when comparing the connections that were most specific for lesions causing parkinsonism versus seizures on a group level (spatial r =- 0.51) and on an individual lesion level (average spatial r =-0.042; p<0.001). The substantia nigra was found to be most positively correlated to the parkinsonism network but most negatively correlated to the seizure network (spatial r >0.8). Brain lesions causing parkinsonism versus seizures map to opposite brain networks, providing neuroanatomical insight into conflicting epidemiological evidence.
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12
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Li Y, Su S, Zhang M, Yu L, Miao X, Li H, Sun Y. Risk assessment of arrhythmias related to three antiseizure medications: a systematic review and single-arm meta-analysis. Front Neurol 2024; 15:1295368. [PMID: 38419702 PMCID: PMC10899418 DOI: 10.3389/fneur.2024.1295368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Accepted: 01/29/2024] [Indexed: 03/02/2024] Open
Abstract
Objective Antiseizure medications (ASMs) are first line therapy for seizure disorders. Their effects on arrhythmias, especially the risk of arrhythmias associated with lacosamide (LCM), levetiracetam (LEV), and perampanel (PER), have been intensely investigated. Methods We searched four databases (PubMed, EMBASE, Cochrane Library, and Web of Science) until August 6, 2023. We used a common effects model and reported data as pooled incidence with 95% CIs. Meta-analyses were conducted to elucidate the risk of arrhythmias with different drugs, and Egger's regression was performed to detect publication bias analysis. Results We included 11 clinical trials with 1,031 participants. The pooled incidence of arrhythmias in the LEV group was 0.005 (95% CI: 0.001-0.013), while it was 0.014 in the LCM group (95% CI: 0.003-0.030). Publication bias analyses indicated no significant bias in the LEV group (t = 0.02, df = 4, p-value = 0.9852) but a significant bias in the LCM group (t = 5.94, df = 3, p-value = 0.0095). We corrected for this bias in the LCM group using the trim-and-fill method, which yielded a similar pooled incidence of 0.0137 (95% CI: 0.0036-0.0280), indicating good reliability. Due to insufficient studies, we could not conduct a meta-analysis for PER, and we analyzed them in our systematic review. Conclusion The use of LCM significantly elevated the risk of arrhythmias, while LEV had non-significant arrhythmogenic effects. As for the arrhythmogenic effects of PER, more clinical trials are needed in the future.
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Affiliation(s)
- Yulong Li
- Department of Neurology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Shen Su
- Department of Gastroenterology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Mengwen Zhang
- Department of Neurology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Limin Yu
- Department of Neurology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Xinyuan Miao
- Department of Neurology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Hongjun Li
- Department of Neurology, Tai’an City Central Hospital, Tai’an, China
| | - Yanping Sun
- Department of Neurology, The Affiliated Hospital of Qingdao University, Qingdao, China
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13
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Romanowska J, Bjornevik K, Cortese M, Tuominen JA, Solheim M, Abolpour Mofrad A, Igland J, Scherzer CR, Riise T. Association Between Use of Any of the Drugs Prescribed in Norway and the Subsequent Risk of Parkinson Disease: A Drug-wide Association Study. Neurology 2023; 101:e2068-e2077. [PMID: 37816645 PMCID: PMC10663041 DOI: 10.1212/wnl.0000000000207899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 08/17/2023] [Indexed: 10/12/2023] Open
Abstract
BACKGROUND AND OBJECTIVES The incidence rate of Parkinson disease (PD) has been increasing rapidly during the past years. Yet, no treatments exist to prevent or slow the progression of the disease. Moreover, we are unable to detect early disease stages during which intervention with disease-modifying therapies is most likely to succeed. The objective of this study was to perform an agnostic drug-wide association study estimating the association between the use of any of the drugs prescribed in Norway and the subsequent risk of PD. METHODS This registry-based cohort study use data from the entire Norwegian population between 2004 and 2019 linked to the Norwegian Prescription Registry, with more than 600 million individual prescriptions. Drug classes were screened according to Anatomical Therapeutic Chemical codes at level 2, corresponding to therapeutic subgroups. We used Cox regression models to estimate hazard ratios (HRs) and 95% CIs for the associations between drug classes and PD risk. All p values were corrected for multiple testing using the false discovery rate. In addition, we conducted sensitivity analyses of exposure definition as well as time-lag and dose-response analyses. RESULTS The study population comprised 3,223,672 individuals, 15,849 of whom developed PD during the follow-up. We identified 31 drug classes that were statistically significantly associated with PD risk in Norway during the follow-up. Drugs acting on the renin-angiotensin system (HR 0.92, 95% CI 0.89-0.95), corticosteroids for systemic use (0.88, 95% CI 0.84-0.93), and vaccines (0.89, 95% CI 0.82-0.96) were associated with a decreased risk of PD even up to 10 years before PD onset. Drug classes used to treat symptoms related to prodromal signs of PD, such as constipation, urological issues, and depression, were associated with an increased risk of subsequent diagnosis of PD with HRs of 1.6 (95% CI 1.49-1.73), 1.48 (1.42-1.53), and 1.94 (1.87-2.01), respectively. DISCUSSION This drug-wide study identified 31 drug classes that were associated with the PD risk change. It reveals the links of renin-angiotensin system medications, vaccines, and corticosteroids with PD risk and suggests that monitoring drug usage using pharmacoepidemiology may allow identifying individuals with prodromal PD.
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Affiliation(s)
- Julia Romanowska
- From the Department of Global Public Health and Primary Care (J.R., K.B., M.C., J.A.T., M.S., A.A.M., J.I., T.R.), University of Bergen, Norway; Department of Nutrition (K.B., M.C.), and Department of Epidemiology (K.B.), Harvard T.H. Chan School of Public Health; and Precision Neurology Program (C.R.S., T.R.), and APDA Center for Advanced Parkinson Research (C.R.S.), Harvard Medical School, Brigham and Women's Hospital, Boston, MA.
| | - Kjetil Bjornevik
- From the Department of Global Public Health and Primary Care (J.R., K.B., M.C., J.A.T., M.S., A.A.M., J.I., T.R.), University of Bergen, Norway; Department of Nutrition (K.B., M.C.), and Department of Epidemiology (K.B.), Harvard T.H. Chan School of Public Health; and Precision Neurology Program (C.R.S., T.R.), and APDA Center for Advanced Parkinson Research (C.R.S.), Harvard Medical School, Brigham and Women's Hospital, Boston, MA
| | - Marianna Cortese
- From the Department of Global Public Health and Primary Care (J.R., K.B., M.C., J.A.T., M.S., A.A.M., J.I., T.R.), University of Bergen, Norway; Department of Nutrition (K.B., M.C.), and Department of Epidemiology (K.B.), Harvard T.H. Chan School of Public Health; and Precision Neurology Program (C.R.S., T.R.), and APDA Center for Advanced Parkinson Research (C.R.S.), Harvard Medical School, Brigham and Women's Hospital, Boston, MA
| | - Julia A Tuominen
- From the Department of Global Public Health and Primary Care (J.R., K.B., M.C., J.A.T., M.S., A.A.M., J.I., T.R.), University of Bergen, Norway; Department of Nutrition (K.B., M.C.), and Department of Epidemiology (K.B.), Harvard T.H. Chan School of Public Health; and Precision Neurology Program (C.R.S., T.R.), and APDA Center for Advanced Parkinson Research (C.R.S.), Harvard Medical School, Brigham and Women's Hospital, Boston, MA
| | - Magne Solheim
- From the Department of Global Public Health and Primary Care (J.R., K.B., M.C., J.A.T., M.S., A.A.M., J.I., T.R.), University of Bergen, Norway; Department of Nutrition (K.B., M.C.), and Department of Epidemiology (K.B.), Harvard T.H. Chan School of Public Health; and Precision Neurology Program (C.R.S., T.R.), and APDA Center for Advanced Parkinson Research (C.R.S.), Harvard Medical School, Brigham and Women's Hospital, Boston, MA
| | - Asieh Abolpour Mofrad
- From the Department of Global Public Health and Primary Care (J.R., K.B., M.C., J.A.T., M.S., A.A.M., J.I., T.R.), University of Bergen, Norway; Department of Nutrition (K.B., M.C.), and Department of Epidemiology (K.B.), Harvard T.H. Chan School of Public Health; and Precision Neurology Program (C.R.S., T.R.), and APDA Center for Advanced Parkinson Research (C.R.S.), Harvard Medical School, Brigham and Women's Hospital, Boston, MA
| | - Jannicke Igland
- From the Department of Global Public Health and Primary Care (J.R., K.B., M.C., J.A.T., M.S., A.A.M., J.I., T.R.), University of Bergen, Norway; Department of Nutrition (K.B., M.C.), and Department of Epidemiology (K.B.), Harvard T.H. Chan School of Public Health; and Precision Neurology Program (C.R.S., T.R.), and APDA Center for Advanced Parkinson Research (C.R.S.), Harvard Medical School, Brigham and Women's Hospital, Boston, MA
| | - Clemens R Scherzer
- From the Department of Global Public Health and Primary Care (J.R., K.B., M.C., J.A.T., M.S., A.A.M., J.I., T.R.), University of Bergen, Norway; Department of Nutrition (K.B., M.C.), and Department of Epidemiology (K.B.), Harvard T.H. Chan School of Public Health; and Precision Neurology Program (C.R.S., T.R.), and APDA Center for Advanced Parkinson Research (C.R.S.), Harvard Medical School, Brigham and Women's Hospital, Boston, MA
| | - Trond Riise
- From the Department of Global Public Health and Primary Care (J.R., K.B., M.C., J.A.T., M.S., A.A.M., J.I., T.R.), University of Bergen, Norway; Department of Nutrition (K.B., M.C.), and Department of Epidemiology (K.B.), Harvard T.H. Chan School of Public Health; and Precision Neurology Program (C.R.S., T.R.), and APDA Center for Advanced Parkinson Research (C.R.S.), Harvard Medical School, Brigham and Women's Hospital, Boston, MA
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14
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Zhou J, Wei Z, Chen S, Xie H, Huang W, Liu M, Wu X. Movement disorders associated with antiseizure medications: A real-world disproportionality analysis of the Food and Drug Administration Adverse Event Reporting System. Br J Clin Pharmacol 2023; 89:3389-3400. [PMID: 37353394 DOI: 10.1111/bcp.15836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 06/14/2023] [Accepted: 06/16/2023] [Indexed: 06/25/2023] Open
Abstract
AIMS Patients with epilepsy often require long-term use of antiseizure medications (ASMs) to control their seizures. However, movement disorders (MDs) related to ASMs can significantly impact their quality of life. This study aims to analyse MDs related to ASMs in the Food and Drug Administration Adverse Event Reporting System database to provide recommendations for safe medication. METHODS All adverse drug reactions associated with 26 marketed ASMs in Food and Drug Administration Adverse Event Reporting System were extracted for analysis. Disproportionality analyses were used to assess the association between ASMs and MDs, and signal colour scale maps were created to identify potential ASM-MD safety signals. RESULTS A total of 1921 cases experienced MDs while taking ASMs were included. A higher prevalence of MDs was observed in females compared to males. The association between specific MDs with ASMs was revealed, including known and unknown MDs such as tremors, Parkinson and paralysis. Lamotrigine and carbamazepine exhibited multiple significant MDs, while levetiracetam and pregabalin were linked to the earlier onset of MDs. Generally, higher doses were linked to a higher incidence of MDs. CONCLUSION MDs were the most obvious adverse drug reactions in the nervous system triggered by using ASMs. Fourteen drugs exhibited positive signals for MDs, including some not previously reported. Conversely, 12 ASMs were deemed to have a lower possibility of inducing MDs. The incidence of MDs can be mitigated by selecting appropriate ASMs for epileptic patients. These findings enhance our understanding of the relationship between ASMs and MDs.
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Affiliation(s)
- Jianxing Zhou
- School of Pharmacy, Fujian Medical University, Fuzhou, Fujian, China
- Department of Pharmacy, Fujian Medical University Union Hospital, Fuzhou, Fujian, China
- Fujian Medical University, Fuzhou, Fujian, China
| | - Zipeng Wei
- School of Pharmacy, Fujian Medical University, Fuzhou, Fujian, China
- Department of Pharmacy, Fujian Medical University Union Hospital, Fuzhou, Fujian, China
- Fujian Medical University, Fuzhou, Fujian, China
| | - Shengyang Chen
- School of Pharmacy, Fujian Medical University, Fuzhou, Fujian, China
- Department of Pharmacy, Fujian Medical University Union Hospital, Fuzhou, Fujian, China
- Fujian Medical University, Fuzhou, Fujian, China
| | - Helin Xie
- Department of Pharmacy, Fujian Medical University Union Hospital, Fuzhou, Fujian, China
| | - Wei Huang
- School of Pharmacy, Fujian Medical University, Fuzhou, Fujian, China
- Department of Pharmacy, Fujian Medical University Union Hospital, Fuzhou, Fujian, China
- Fujian Medical University, Fuzhou, Fujian, China
| | - Maobai Liu
- School of Pharmacy, Fujian Medical University, Fuzhou, Fujian, China
- Department of Pharmacy, Fujian Medical University Union Hospital, Fuzhou, Fujian, China
- Fujian Medical University, Fuzhou, Fujian, China
| | - Xuemei Wu
- School of Pharmacy, Fujian Medical University, Fuzhou, Fujian, China
- Department of Pharmacy, Fujian Medical University Union Hospital, Fuzhou, Fujian, China
- Fujian Medical University, Fuzhou, Fujian, China
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15
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Vogel JW, Corriveau-Lecavalier N, Franzmeier N, Pereira JB, Brown JA, Maass A, Botha H, Seeley WW, Bassett DS, Jones DT, Ewers M. Connectome-based modelling of neurodegenerative diseases: towards precision medicine and mechanistic insight. Nat Rev Neurosci 2023; 24:620-639. [PMID: 37620599 DOI: 10.1038/s41583-023-00731-8] [Citation(s) in RCA: 35] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/26/2023] [Indexed: 08/26/2023]
Abstract
Neurodegenerative diseases are the most common cause of dementia. Although their underlying molecular pathologies have been identified, there is substantial heterogeneity in the patterns of progressive brain alterations across and within these diseases. Recent advances in neuroimaging methods have revealed that pathological proteins accumulate along specific macroscale brain networks, implicating the network architecture of the brain in the system-level pathophysiology of neurodegenerative diseases. However, the extent to which 'network-based neurodegeneration' applies across the wide range of neurodegenerative disorders remains unclear. Here, we discuss the state-of-the-art of neuroimaging-based connectomics for the mapping and prediction of neurodegenerative processes. We review findings supporting brain networks as passive conduits through which pathological proteins spread. As an alternative view, we also discuss complementary work suggesting that network alterations actively modulate the spreading of pathological proteins between connected brain regions. We conclude this Perspective by proposing an integrative framework in which connectome-based models can be advanced along three dimensions of innovation: incorporating parameters that modulate propagation behaviour on the basis of measurable biological features; building patient-tailored models that use individual-level information and allowing model parameters to interact dynamically over time. We discuss promises and pitfalls of these strategies for improving disease insights and moving towards precision medicine.
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Affiliation(s)
- Jacob W Vogel
- Department of Clinical Sciences, SciLifeLab, Lund University, Lund, Sweden.
| | - Nick Corriveau-Lecavalier
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
| | - Nicolai Franzmeier
- Institute for Stroke and Dementia Research (ISD), University Hospital, LMU Munich, Munich, Germany
- Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Acadamy, University of Gothenburg, Mölndal and Gothenburg, Sweden
| | - Joana B Pereira
- Clinical Memory Research Unit, Department of Clinical Sciences, Lund University, Malmö, Sweden
- Neuro Division, Department of Clinical Neurosciences, Karolinska Institute, Stockholm, Sweden
| | - Jesse A Brown
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, CA, USA
| | - Anne Maass
- German Center for Neurodegenerative Diseases (DZNE), Magdeburg, Germany
| | - Hugo Botha
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | - William W Seeley
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, CA, USA
- Department of Pathology, University of California, San Francisco, CA, USA
| | - Dani S Bassett
- Departments of Bioengineering, Electrical and Systems Engineering, Physics and Astronomy, Neurology and Psychiatry, University of Pennsylvania, Philadelphia, PA, USA
- Santa Fe Institute, Santa Fe, NM, USA
| | - David T Jones
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | - Michael Ewers
- Institute for Stroke and Dementia Research (ISD), University Hospital, LMU Munich, Munich, Germany.
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Moos WH, Faller DV, Glavas IP, Kanara I, Kodukula K, Pernokas J, Pernokas M, Pinkert CA, Powers WR, Sampani K, Steliou K, Vavvas DG. Epilepsy: Mitochondrial connections to the 'Sacred' disease. Mitochondrion 2023; 72:84-101. [PMID: 37582467 DOI: 10.1016/j.mito.2023.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 08/03/2023] [Accepted: 08/12/2023] [Indexed: 08/17/2023]
Abstract
Over 65 million people suffer from recurrent, unprovoked seizures. The lack of validated biomarkers specific for myriad forms of epilepsy makes diagnosis challenging. Diagnosis and monitoring of childhood epilepsy add to the need for non-invasive biomarkers, especially when evaluating antiseizure medications. Although underlying mechanisms of epileptogenesis are not fully understood, evidence for mitochondrial involvement is substantial. Seizures affect 35%-60% of patients diagnosed with mitochondrial diseases. Mitochondrial dysfunction is pathophysiological in various epilepsies, including those of non-mitochondrial origin. Decreased ATP production caused by malfunctioning brain cell mitochondria leads to altered neuronal bioenergetics, metabolism and neurological complications, including seizures. Iron-dependent lipid peroxidation initiates ferroptosis, a cell death pathway that aligns with altered mitochondrial bioenergetics, metabolism and morphology found in neurodegenerative diseases (NDDs). Studies in mouse genetic models with seizure phenotypes where the function of an essential selenoprotein (GPX4) is targeted suggest roles for ferroptosis in epilepsy. GPX4 is pivotal in NDDs, where selenium protects interneurons from ferroptosis. Selenium is an essential central nervous system micronutrient and trace element. Low serum concentrations of selenium and other trace elements and minerals, including iron, are noted in diagnosing childhood epilepsy. Selenium supplements alleviate intractable seizures in children with reduced GPX activity. Copper and cuproptosis, like iron and ferroptosis, link to mitochondria and NDDs. Connecting these mechanistic pathways to selenoproteins provides new insights into treating seizures, pointing to using medicines including prodrugs of lipoic acid to treat epilepsy and to potential alternative therapeutic approaches including transcranial magnetic stimulation (transcranial), photobiomodulation and vagus nerve stimulation.
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Affiliation(s)
- Walter H Moos
- Department of Pharmaceutical Chemistry, School of Pharmacy, University of California San Francisco, San Francisco, CA, USA.
| | - Douglas V Faller
- Department of Medicine, Boston University School of Medicine, Boston, MA, USA; Cancer Research Center, Boston University School of Medicine, Boston, MA, USA
| | - Ioannis P Glavas
- Department of Ophthalmology, New York University School of Medicine, New York, NY, USA
| | | | | | - Julie Pernokas
- Advanced Dental Associates of New England, Woburn, MA, USA
| | - Mark Pernokas
- Advanced Dental Associates of New England, Woburn, MA, USA
| | - Carl A Pinkert
- Department of Pathobiology, College of Veterinary Medicine, Auburn University, Auburn, AL, USA
| | - Whitney R Powers
- Department of Health Sciences, Boston University, Boston, MA, USA; Department of Anatomy, Boston University School of Medicine, Boston, MA, USA
| | - Konstantina Sampani
- Beetham Eye Institute, Joslin Diabetes Center, Boston, MA, USA; Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Kosta Steliou
- Cancer Research Center, Boston University School of Medicine, Boston, MA, USA; PhenoMatriX, Inc., Natick, MA, USA
| | - Demetrios G Vavvas
- Department of Ophthalmology, Harvard Medical School, Boston, MA, USA; Retina Service, Angiogenesis Laboratory, Massachusetts Eye and Ear Infirmary, Boston, MA, USA
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Sarkis RA. Anti-Seizure Medications on Trial Again: Accused of Parkinson's Disease! Epilepsy Curr 2023; 23:277-279. [PMID: 37901782 PMCID: PMC10601026 DOI: 10.1177/15357597231180068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2023] Open
Abstract
Association Between Antiepileptic Drugs and Incident Parkinson Disease Belete D, Jacobs BM, Simonet C, Bestwick JP, Waters S, Marshall CR, Dobson R, Noyce AJ. JAMA Neurol. 2023;80(2):183-187. doi:10.1001/jamaneurol.2022.4699 Importance: Recent studies have highlighted an association between epilepsy and Parkinson disease (PD). The role of antiepileptic drugs (AEDs) has not been explored. Objective: To investigate the association between AEDs and incident PD. Design, setting, and participants: This nested case-control study started collecting data from the UK Biobank (UKB) in 2006, and data were extracted on June 30, 2021. Individuals with linked primary care prescription data were included. Cases were defined as individuals with a Hospital Episode Statistics (HES)–coded diagnosis of PD. Controls were matched 6:1 for age, sex, race and ethnicity, and socioeconomic status. Prescription records were searched for AEDs prescribed prior to diagnosis of PD. The UKB is a longitudinal cohort study with more than 500 000 participants; 45% of individuals in the UKB have linked primary care prescription data. Participants living in the UK aged between 40 and 69 years were recruited to the UKB between 2006 and 2010. All participants with UKB-linked primary care prescription data (n = 222 106) were eligible for enrollment in the study. Individuals with only a self-reported PD diagnosis or missing data for the matching variables were excluded. In total, 1477 individuals were excluded; 49 were excluded due to having only self-reported PD, and 1428 were excluded due to missing data. Exposures: Exposure to AEDs (carbamazepine, lamotrigine, levetiracetam, and sodium valproate) was defined using routinely collected prescription data derived from primary care. Main outcomes and measures: Odds ratios and 95% CIs were calculated using adjusted logistic regression models for individuals prescribed AEDs before the first date of HES-coded diagnosis of PD. Results: In this case-control study, there were 1433 individuals with an HES-coded PD diagnosis (cases) and 8598 controls in the analysis. Of the 1433 individuals, 873 (60.9%) were male, 1397 (97.5%) had their race and ethnicity recorded as White, and their median age was 71 years (IQR, 65-75 years). An association was found between AED prescriptions and incident PD (odds ratio, 1.80; 95% CI, 1.35-2.40). There was a trend for a greater number of prescription issues and multiple AEDs being associated with a greater risk of PD. Conclusions and relevance: This study, the first to systematically look at PD risk in individuals prescribed the most common AEDs, to our knowledge, found evidence of an association between AEDs and incident PD. With the recent literature demonstrating an association between epilepsy and PD, this study provides further insights.
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Association between Antiepileptic Drugs and Incident Parkinson’s Disease among Patients Followed in German Primary Care Practices. Brain Sci 2023; 13:brainsci13030450. [PMID: 36979260 PMCID: PMC10046339 DOI: 10.3390/brainsci13030450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 03/01/2023] [Accepted: 03/02/2023] [Indexed: 03/08/2023] Open
Abstract
Background: The aim of this study was to analyze whether prescriptions of antiepileptic drugs (AEDs) are significantly associated with an increased incidence of Parkinson’s disease (PD) in the German population. Methods: This study used data from German primary care practices found in the Disease Analyzer database (IQVIA) and included all patients aged ≥18 years who were diagnosed with PD between January 2010 and December 2021 (index date). The controls were patients without PD matched (1:1) by age, sex, and pre-diagnostic observation time in years. Associations between AED prescriptions (any AED as well as separate evaluations for carbamazepine, lamotrigine, levetiracetam, sodium valproate, gabapentin, and pregabalin) and subsequent diagnosis of PD were examined using a logistic regression model adjusted for epilepsy, restless legs syndrome, and neuropathy diagnoses. Results: We identified 24,950 cases that were matched with 24,950 controls (mean age 75.2 years, 47.3% women). Diagnoses of epilepsy, restless legs syndrome, and neuropathy as well as AED prescription were significantly associated with an increased incidence of PD. In the multivariate analysis, incidence of PD was significantly associated with epilepsy (OR: 1.91; 95% CI: 1.69–2.15), restless legs syndrome (OR: 3.02; 95% CI: 2.73–3.34), and neuropathy (OR: 1.53; 95% CI: 1.44–1.62)), as well as the prescription of any AED (OR: 1.43; 95% CI: 1.33–1.53), sodium valproate (OR: 2.39; 95% CI: 1.84–3.11), gabapentin (OR: 1.36; 95% CI: 1.22–1.52), and pregabalin (OR: 1.28; 95% CI: 1.15–1.41). Conclusion: Prescriptions of AEDs, including sodium valproate, gabapentin, and pregabalin, were associated with an increased risk of subsequent PD, even after adjustment for underlying diagnoses. Further studies are needed to confirm the present results.
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Error in Title. JAMA Neurol 2023; 80:216. [PMID: 36779984 PMCID: PMC9926320 DOI: 10.1001/jamaneurol.2022.5503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
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