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Rigon L, Genovese D, Piano C, Brunetti V, Guglielmi V, Cimmino AT, Scala I, Citro S, Bentivoglio AR, Rollo E, Di Iorio R, Broccolini A, Morosetti R, Monforte M, Frisullo G, Caliandro P, Pedicelli A, Caricato A, Masone G, Calabresi P, Marca GD. Movement disorders following mechanical thrombectomy resulting in ischemic lesions of the basal ganglia: An emerging clinical entity. Eur J Neurol 2024; 31:e16219. [PMID: 38299441 PMCID: PMC11235728 DOI: 10.1111/ene.16219] [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: 11/15/2023] [Revised: 12/20/2023] [Accepted: 01/04/2024] [Indexed: 02/02/2024]
Abstract
BACKGROUND AND PURPOSE Post-stroke movement disorders (PMDs) following ischemic lesions of the basal ganglia (BG) are a known entity, but data regarding their incidence are lacking. Ischemic strokes secondary to proximal middle cerebral artery (MCA) occlusion treated with thrombectomy represent a model of selective damage to the BG. The aim of this study was to assess the prevalence and features of movement disorders after selective BG ischemia in patients with successfully reperfused acute ischemic stroke (AIS). METHODS We enrolled 64 consecutive subjects with AIS due to proximal MCA occlusion treated with thrombectomy. Patients were clinically evaluated by a movement disorders specialist for PMDs onset at baseline, and after 6 and 12 months. RESULTS None of the patients showed an identifiable movement disorder in the subacute phase of the stroke. At 6 and 12 months, respectively, 7/25 (28%) and 7/13 (53.8%) evaluated patients developed PMDs. The clinical spectrum of PMDs encompassed parkinsonism, dystonia and chorea, either isolated or combined. In most patients, symptoms were contralateral to the lesion, although a subset of patients presented with bilateral involvement and prominent axial signs. CONCLUSION Post-stroke movement disorders are not uncommon in long-term follow-up of successfully reperfused AIS. Follow-up conducted by a multidisciplinary team is strongly advisable in patients with selective lesions of the BG after AIS, even if asymptomatic at discharge.
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Affiliation(s)
- Leonardo Rigon
- Dipartimento di NeuroscienzeUniversità Cattolica del Sacro CuoreRomeItaly
| | - Danilo Genovese
- Dipartimento di neuroscienze, Organi di Senso e ToraceFondazione Policlinico Universitario A. Gemelli IRCCS – UOC NeurologiaRomeItaly
- The Marlene and Paolo Fresco Institute for Parkinson's Disease and Movement DisordersNew York University Langone HealthNew YorkNew YorkUSA
| | - Carla Piano
- Dipartimento di neuroscienze, Organi di Senso e ToraceFondazione Policlinico Universitario A. Gemelli IRCCS – UOC NeurologiaRomeItaly
| | - Valerio Brunetti
- Dipartimento di neuroscienze, Organi di Senso e ToraceFondazione Policlinico Universitario A. Gemelli IRCCS – UOC NeurologiaRomeItaly
| | - Valeria Guglielmi
- Dipartimento di neuroscienze, Organi di Senso e ToraceFondazione Policlinico Universitario A. Gemelli IRCCS – UOC NeurologiaRomeItaly
| | | | - Irene Scala
- Dipartimento di NeuroscienzeUniversità Cattolica del Sacro CuoreRomeItaly
| | - Salvatore Citro
- Dipartimento di NeuroscienzeUniversità Cattolica del Sacro CuoreRomeItaly
| | - Anna Rita Bentivoglio
- Dipartimento di NeuroscienzeUniversità Cattolica del Sacro CuoreRomeItaly
- Dipartimento di neuroscienze, Organi di Senso e ToraceFondazione Policlinico Universitario A. Gemelli IRCCS – UOC NeurologiaRomeItaly
| | - Eleonora Rollo
- Dipartimento di NeuroscienzeUniversità Cattolica del Sacro CuoreRomeItaly
| | - Riccardo Di Iorio
- Dipartimento di neuroscienze, Organi di Senso e ToraceFondazione Policlinico Universitario A. Gemelli IRCCS – UOC NeurologiaRomeItaly
| | - Aldobrando Broccolini
- Dipartimento di NeuroscienzeUniversità Cattolica del Sacro CuoreRomeItaly
- Dipartimento di neuroscienze, Organi di Senso e ToraceFondazione Policlinico Universitario A. Gemelli IRCCS – UOC NeurologiaRomeItaly
| | - Roberta Morosetti
- Dipartimento di neuroscienze, Organi di Senso e ToraceFondazione Policlinico Universitario A. Gemelli IRCCS – UOC NeurologiaRomeItaly
| | - Mauro Monforte
- Dipartimento di neuroscienze, Organi di Senso e ToraceFondazione Policlinico Universitario A. Gemelli IRCCS – UOC NeurologiaRomeItaly
| | - Giovanni Frisullo
- Dipartimento di neuroscienze, Organi di Senso e ToraceFondazione Policlinico Universitario A. Gemelli IRCCS – UOC NeurologiaRomeItaly
| | - Pietro Caliandro
- Dipartimento di neuroscienze, Organi di Senso e ToraceFondazione Policlinico Universitario A. Gemelli IRCCS – UOC NeurologiaRomeItaly
| | - Alessandro Pedicelli
- UOC Radiologia e Neuroradiologia, Dipartimento di diagnostica per immagini, radioterapia oncologica ed ematologiaFondazione Policlinico Universitario A. Gemelli IRCCSRomaItaly
| | - Anselmo Caricato
- Neuro Intensive Care Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCSUniversità Cattolica del Sacro CuoreRomeItaly
| | - Giovanna Masone
- Dipartimento di neuroscienze, Organi di Senso e ToraceFondazione Policlinico Universitario A. Gemelli IRCCS – UOC NeurologiaRomeItaly
| | - Paolo Calabresi
- Dipartimento di NeuroscienzeUniversità Cattolica del Sacro CuoreRomeItaly
- Dipartimento di neuroscienze, Organi di Senso e ToraceFondazione Policlinico Universitario A. Gemelli IRCCS – UOC NeurologiaRomeItaly
| | - Giacomo Della Marca
- Dipartimento di NeuroscienzeUniversità Cattolica del Sacro CuoreRomeItaly
- Dipartimento di neuroscienze, Organi di Senso e ToraceFondazione Policlinico Universitario A. Gemelli IRCCS – UOC NeurologiaRomeItaly
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Wu J, Maurenbrecher H, Schaer A, Becsek B, Awai Easthope C, Chatzipirpiridis G, Ergeneman O, Pané S, Nelson BJ. Human gait-labeling uncertainty and a hybrid model for gait segmentation. Front Neurosci 2022; 16:976594. [PMID: 36570841 PMCID: PMC9773262 DOI: 10.3389/fnins.2022.976594] [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: 06/24/2022] [Accepted: 11/18/2022] [Indexed: 12/13/2022] Open
Abstract
Motion capture systems are widely accepted as ground-truth for gait analysis and are used for the validation of other gait analysis systems. To date, their reliability and limitations in manual labeling of gait events have not been studied. Objectives Evaluate manual labeling uncertainty and introduce a hybrid stride detection and gait-event estimation model for autonomous, long-term, and remote monitoring. Methods Estimate inter-labeler inconsistencies by computing the limits-of-agreement. Develop a hybrid model based on dynamic time warping and convolutional neural network to identify valid strides and eliminate non-stride data in inertial (walking) data collected by a wearable device. Finally, detect gait events within a valid stride region. Results The limits of inter-labeler agreement for key gait events heel off, toe off, heel strike, and flat foot are 72, 16, 24, and 80 ms, respectively; The hybrid model's classification accuracy for stride and non-stride are 95.16 and 84.48%, respectively; The mean absolute error for detected heel off, toe off, heel strike, and flat foot are 24, 5, 9, and 13 ms, respectively, when compared to the average human labels. Conclusions The results show the inherent labeling uncertainty and the limits of human gait labeling of motion capture data; The proposed hybrid-model's performance is comparable to that of human labelers, and it is a valid model to reliably detect strides and estimate the gait events in human gait data. Significance This work establishes the foundation for fully automated human gait analysis systems with performances comparable to human-labelers.
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Affiliation(s)
- Jiaen Wu
- Multi-Scale Robotics Lab, ETH Zurich, Zurich, Switzerland,Magnes AG, Zurich, Switzerland,*Correspondence: Jiaen Wu
| | | | | | | | - Chris Awai Easthope
- Cereneo Foundation, Center for Interdisciplinary Research (CEFIR), Vitznau, Switzerland
| | | | | | - Salvador Pané
- Multi-Scale Robotics Lab, ETH Zurich, Zurich, Switzerland
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3
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Sánchez-Rodríguez A, Tirnauca C, Salas-Gómez D, Fernández-Gorgojo M, Martínez-Rodríguez I, Sierra M, González-Aramburu I, Stan D, Gutierrez-González A, Meissner JM, Andrés-Pacheco J, Rivera-Sánchez M, Sánchez-Peláez MV, Sánchez-Juan P, Infante J. Sensor-based gait analysis in the premotor stage of LRRK2 G2019S-associated Parkinson's disease. Parkinsonism Relat Disord 2022; 98:21-26. [PMID: 35421781 DOI: 10.1016/j.parkreldis.2022.03.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 03/30/2022] [Accepted: 03/31/2022] [Indexed: 10/18/2022]
Abstract
INTRODUCTION There is a need for biomarkers to monitor the earliest phases of Parkinson's disease (PD), especially in premotor stages. Here, we studied whether there are early gait alterations in carriers of the G2019S mutation of LRRK2 that can be detected by means of an inertial sensor system. METHODS Twenty-one idiopathic PD patients, 20 LRRK2-G2019S PD, 27 asymptomatic carriers of LRRK2-G2019S mutation (AsG2019S) and 36 controls walked equipped with 16 lightweight inertial sensors in three different experiments: i/normal gait, ii/fast gait and iii/dual-task gait. In the AsG2019S group, DaT-SPECT (123I-ioflupane) with semi-quantitative analysis was carried out. Motor and cognitive performance were evaluated using MDS-UPDRS-III and MoCA scales. We employed neural network techniques to classify individuals based on their walking patterns. RESULTS PD patients and controls showed differences in speed, stride length and arm swing amplitude, variability and asymmetry in all three tasks (p < 0.01). In the AsG2019S group, the only differences were detected during fast walking, with greater step time on the non-dominant side (p < 0.05), lower step/stride time variability (p < 0.01) and lower step time asymmetry (p < 0.01). DaT uptake showed a significant correlation with step time during fast walking on the non-dominant side (r = -0.52; p < 0.01). The neural network was able to differentiate between AsG2019S and healthy controls with an accuracy rate of 82.5%. CONCLUSION Our sensor-based analysis did not detect substantial and robust changes in the gait of LRRK2-G2019S asymptomatic mutation carriers. Nonetheless, step or stride time during fast walking, supported by the observed correlation with striatal DaT binding deserves consideration as a potential biomarker in future studies.
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Affiliation(s)
- Antonio Sánchez-Rodríguez
- Neurology Service, Hospital Universitario de Cabueñes, Gijón, Spain; Centro de Investigación Biomédica en Red de Enfermedades Neurodegenerativas (CIBERNED), Spain
| | - Cristina Tirnauca
- Departamento de Matemáticas, Estadística y Computación. Universidad de Cantabria, Santander, Spain
| | - Diana Salas-Gómez
- Gimbernat-Cantabria Research Unit (SUIGC), University Schools Gimbernat-Cantabria, Attached to the University of Cantabria, Torrelavega, Spain
| | - Mario Fernández-Gorgojo
- Gimbernat-Cantabria Research Unit (SUIGC), University Schools Gimbernat-Cantabria, Attached to the University of Cantabria, Torrelavega, Spain
| | - Isabel Martínez-Rodríguez
- Nuclear Medicine Department, Molecular Imaging Group (IDIVAL). University Hospital Marqués de Valdecilla, Santander, Spain
| | - María Sierra
- Centro de Investigación Biomédica en Red de Enfermedades Neurodegenerativas (CIBERNED), Spain; Neurology Service, University Hospital Marqués de Valdecilla-IDIVAL, Santander, Spain
| | - Isabel González-Aramburu
- Centro de Investigación Biomédica en Red de Enfermedades Neurodegenerativas (CIBERNED), Spain; Neurology Service, University Hospital Marqués de Valdecilla-IDIVAL, Santander, Spain
| | - Diana Stan
- Departamento de Matemáticas, Estadística y Computación. Universidad de Cantabria, Santander, Spain
| | - Angela Gutierrez-González
- Nuclear Medicine Department, Molecular Imaging Group (IDIVAL). University Hospital Marqués de Valdecilla, Santander, Spain
| | - Johannes M Meissner
- Departamento de Matemáticas, Estadística y Computación. Universidad de Cantabria, Santander, Spain
| | - Javier Andrés-Pacheco
- Nuclear Medicine Department, Molecular Imaging Group (IDIVAL). University Hospital Marqués de Valdecilla, Santander, Spain
| | - María Rivera-Sánchez
- Neurology Service, University Hospital Marqués de Valdecilla-IDIVAL, Santander, Spain
| | | | - Pascual Sánchez-Juan
- Centro de Investigación Biomédica en Red de Enfermedades Neurodegenerativas (CIBERNED), Spain; Alzheimer's Centre Reina Sofia-CIEN Foundation, 28031, Madrid, Spain
| | - Jon Infante
- Centro de Investigación Biomédica en Red de Enfermedades Neurodegenerativas (CIBERNED), Spain; Neurology Service, University Hospital Marqués de Valdecilla-IDIVAL, Santander, Spain; Departamento de Medicina y Psiquiatría. Universidad de Cantabria, Santander, Spain.
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4
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Krohn L, Grenn FP, Makarious MB, Kim JJ, Bandres-Ciga S, Roosen DA, Gan-Or Z, Nalls MA, Singleton AB, Blauwendraat C. Comprehensive assessment of PINK1 variants in Parkinson's disease. Neurobiol Aging 2020; 91:168.e1-168.e5. [PMID: 32249012 PMCID: PMC7236133 DOI: 10.1016/j.neurobiolaging.2020.03.003] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 03/04/2020] [Accepted: 03/04/2020] [Indexed: 02/03/2023]
Abstract
Multiple genes have been associated with monogenic Parkinson's disease and Parkinsonism syndromes. Mutations in PINK1 (PARK6) have been shown to result in autosomal recessive early-onset Parkinson's disease. In the past decade, several studies have suggested that carrying a single heterozygous PINK1 mutation is associated with increased risk for Parkinson's disease. Here, we comprehensively assess the role of PINK1 variants in Parkinson's disease susceptibility using several large data sets totalling 376,558 individuals including 13,708 cases with Parkinson's disease and 362,850 control subjects. After combining these data, we did not find evidence to support a role for heterozygous PINK1 mutations as a robust risk factor for Parkinson's disease.
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Affiliation(s)
- Lynne Krohn
- Department of Human Genetics, McGill University, Montreal, Quebec, Canada; Montreal Neurological Institute, McGill University, Montreal, Quebec, Canada
| | - Francis P Grenn
- Laboratory of Neurogenetics, National Institute on Aging, National Institutes of Health, Bethesda, MD, USA
| | - Mary B Makarious
- Laboratory of Neurogenetics, National Institute on Aging, National Institutes of Health, Bethesda, MD, USA
| | - Jonggeol Jeffrey Kim
- Laboratory of Neurogenetics, National Institute on Aging, National Institutes of Health, Bethesda, MD, USA
| | - Sara Bandres-Ciga
- Laboratory of Neurogenetics, National Institute on Aging, National Institutes of Health, Bethesda, MD, USA
| | - Dorien A Roosen
- Laboratory of Neurogenetics, National Institute on Aging, National Institutes of Health, Bethesda, MD, USA
| | - Ziv Gan-Or
- Department of Human Genetics, McGill University, Montreal, Quebec, Canada; Montreal Neurological Institute, McGill University, Montreal, Quebec, Canada; Department of Neurology and Neurosurgery, McGill University, Montreal, Quebec, Canada
| | - Mike A Nalls
- Laboratory of Neurogenetics, National Institute on Aging, National Institutes of Health, Bethesda, MD, USA; Data Tecnica International, Glen Echo, MD, USA
| | - Andrew B Singleton
- Laboratory of Neurogenetics, National Institute on Aging, National Institutes of Health, Bethesda, MD, USA
| | - Cornelis Blauwendraat
- Laboratory of Neurogenetics, National Institute on Aging, National Institutes of Health, Bethesda, MD, USA.
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5
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Raccagni C, Nonnekes J, Bloem BR, Peball M, Boehme C, Seppi K, Wenning GK. Gait and postural disorders in parkinsonism: a clinical approach. J Neurol 2019; 267:3169-3176. [PMID: 31119450 PMCID: PMC7578144 DOI: 10.1007/s00415-019-09382-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 05/13/2019] [Accepted: 05/16/2019] [Indexed: 02/07/2023]
Abstract
Disturbances of balance, gait and posture are a hallmark of parkinsonian syndromes. Recognition of these axial features can provide important and often early clues to the nature of the underlying disorder, and, therefore, help to disentangle Parkinson’s disease from vascular parkinsonism and various forms of atypical parkinsonism, including multiple system atrophy, progressive supranuclear palsy, and corticobasal syndrome. Careful assessment of axial features is also essential for initiating appropriate treatment strategies and for documenting the outcome of such interventions. In this article, we provide an overview of balance, gait and postural impairment in parkinsonian disorders, focusing on differential diagnostic aspects.
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Affiliation(s)
- Cecilia Raccagni
- Department of Neurology, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Jorik Nonnekes
- Department of Rehabilitation, Donders Institute for Brain, Cognition and Behavior, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Bastiaan R Bloem
- Department of Neurology, Donders Institute for Brain, Cognition and Behavior, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Marina Peball
- Department of Neurology, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Christian Boehme
- Department of Neurology, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Klaus Seppi
- Department of Neurology, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Gregor K Wenning
- Department of Neurology, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria.
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6
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Chastan N, Decker LM. Posturo-locomotor markers of preclinical Parkinson's disease. Neurophysiol Clin 2019; 49:173-180. [PMID: 30686671 DOI: 10.1016/j.neucli.2019.01.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Revised: 01/02/2019] [Accepted: 01/02/2019] [Indexed: 11/18/2022] Open
Abstract
Parkinson's disease (PD) is known to have a long prodromal stage due to the degeneration of dopaminergic neurons of the substantia nigra pars compacta over the course of many years without clinical manifestations of PD. When the diagnosis is made, the neuropathological process is already well entrenched. Consequently, identifying individuals during this prodromal period could be very helpful for future trials of neuroprotective or disease-modifying therapies, which might slow or prevent the degeneration of dopaminergic neurons. Thus, efforts are needed to determine appropriate early markers of PD. Gait and balance disorders are frequent during the early stages of PD. This systematic review aims to determine if gait and balance disorders occur before the diagnosis of PD and if so, whether they could be used as markers of preclinical PD. Findings reveal that, at the presymptomatic stage of PD, impaired basal ganglia function leads to disorders in gait and balance. Both clinical and instrumental assessments allow early detection of these disorders, particularly when performed under challenging conditions (e.g. dual-task). Among all studied parameters, temporal gait variability and arm kinematics appear to be promising markers of preclinical PD.
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Affiliation(s)
- Nathalie Chastan
- Normandie University, UNICAEN, INSERM, COMETE, 14000 Caen, France; Rouen University Hospital, Department of Neurophysiology, 76000 Rouen, France.
| | - Leslie M Decker
- Normandie University, UNICAEN, INSERM, COMETE, 14000 Caen, France
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7
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Nonnekes J, Goselink RJM, Růžička E, Fasano A, Nutt JG, Bloem BR. Neurological disorders of gait, balance and posture: a sign-based approach. Nat Rev Neurol 2018; 14:183-189. [DOI: 10.1038/nrneurol.2017.178] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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8
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Mirelman A, Bernad-Elazari H, Thaler A, Giladi-Yacobi E, Gurevich T, Gana-Weisz M, Saunders-Pullman R, Raymond D, Doan N, Bressman SB, Marder KS, Alcalay RN, Rao AK, Berg D, Brockmann K, Aasly J, Waro BJ, Tolosa E, Vilas D, Pont-Sunyer C, Orr-Urtreger A, Hausdorff JM, Giladi N. Arm swing as a potential new prodromal marker of Parkinson's disease. Mov Disord 2017; 31:1527-1534. [PMID: 27430880 DOI: 10.1002/mds.26720] [Citation(s) in RCA: 110] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2016] [Revised: 06/01/2016] [Accepted: 06/06/2016] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Reduced arm swing is a well-known clinical feature of Parkinson's disease (PD), often observed early in the course of the disease. We hypothesized that subtle changes in arm swing and axial rotation may also be detectable in the prodromal phase. OBJECTIVE The purpose of this study was to evaluate the relationship between the LRRK2-G2019S mutation, arm swing, and axial rotation in healthy nonmanifesting carriers and noncarriers of the G2019S mutation and in patients with PD. METHODS A total of 380 participants (186 healthy nonmanifesting controls and 194 PD patients) from 6 clinical sites underwent gait analysis while wearing synchronized 3-axis body-fixed sensors on the lower back and bilateral wrists. Participants walked for 1 minute under the following 2 conditions: (1) usual walking and (2) dual-task walking. Arm swing amplitudes, asymmetry, variability, and smoothness were calculated for both arms along with measures of axial rotation. RESULTS A total of 122 nonmanifesting participants and 67 PD patients were carriers of the G2019S mutation. Nonmanifesting mutation carriers walked with greater arm swing asymmetry and variability and lower axial rotation smoothness under the dual task condition when compared with noncarriers (P < .04). In the nonmanifesting mutation carriers, arm swing asymmetry was associated with gait variability under dual task (P = .003). PD carriers showed greater asymmetry and variability of movement than PD noncarriers, even after controlling for disease severity (P < .009). CONCLUSIONS The G2019S mutation is associated with increased asymmetry and variability among nonmanifesting participants and patients with PD. Prospective studies should determine if arm swing asymmetry and axial rotation smoothness may be used as motor markers of prodromal PD. © 2016 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Anat Mirelman
- Laboratory for Early Markers of Neurodegeneration, Tel Aviv Medical Center, Tel Aviv, Israel. .,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel. .,Neurology Institute, Tel Aviv Medical Center, Tel Aviv, Israel. .,Center for the Study of Movement, Cognition and Mobility, Tel Aviv Medical Center, Tel Aviv, Israel.
| | - Hagar Bernad-Elazari
- Laboratory for Early Markers of Neurodegeneration, Tel Aviv Medical Center, Tel Aviv, Israel.,Center for the Study of Movement, Cognition and Mobility, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Avner Thaler
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,Neurology Institute, Tel Aviv Medical Center, Tel Aviv, Israel
| | | | - Tanya Gurevich
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,Neurology Institute, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Mali Gana-Weisz
- Genetic Institute, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Rachel Saunders-Pullman
- Departments of Neurology, Mount Sinai Beth Israel Medical Center, New York, New York, USA.,Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Deborah Raymond
- Departments of Neurology, Mount Sinai Beth Israel Medical Center, New York, New York, USA.,Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Nancy Doan
- Departments of Neurology, Mount Sinai Beth Israel Medical Center, New York, New York, USA.,Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Susan B Bressman
- Departments of Neurology, Mount Sinai Beth Israel Medical Center, New York, New York, USA.,Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Karen S Marder
- Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, New York, USA.,G. H. Sergievsky Center, College of Physicians and Surgeons, Columbia University, New York, New York, USA
| | - Roy N Alcalay
- Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, New York, USA
| | - Ashwini K Rao
- G. H. Sergievsky Center, College of Physicians and Surgeons, Columbia University, New York, New York, USA.,Department of Rehabilitation & Regenerative Medicine (Physical Therapy), New York, New York, USA
| | - Daniela Berg
- Hertie-Institut für klinische Hirnforschung, Tubingen, Germany
| | | | - Jan Aasly
- Norwegian University of Science and Technology, Trondheim, Norway
| | | | - Eduardo Tolosa
- Institut de Neurociències Hospital Clìnic, Barcelona, Spain
| | - Dolores Vilas
- Institut de Neurociències Hospital Clìnic, Barcelona, Spain
| | | | - Avi Orr-Urtreger
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,Genetic Institute, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Jeffrey M Hausdorff
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,Neurology Institute, Tel Aviv Medical Center, Tel Aviv, Israel.,Center for the Study of Movement, Cognition and Mobility, Tel Aviv Medical Center, Tel Aviv, Israel.,Department of Physical Therapy, Tel Aviv University, Tel Aviv, Israel.,Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
| | - Nir Giladi
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,Neurology Institute, Tel Aviv Medical Center, Tel Aviv, Israel.,Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
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9
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Steinlechner S, Hagenah J, Rumpf HJ, Meyer C, John U, Bäumer T, Brüggemann N, Kasten M, Münchau A, Klein C, Lencer R. Associations of specific psychiatric disorders with isolated focal dystonia, and monogenic and idiopathic Parkinson’s disease. J Neurol 2017; 264:1076-1084. [DOI: 10.1007/s00415-017-8488-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Revised: 04/04/2017] [Accepted: 04/06/2017] [Indexed: 02/07/2023]
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Abstract
OBJECTIVE To postulate a new possible cause of a unilaterally reduced arm swing in addition to the known medical conditions such as shoulder pathology, Erb's palsy, stroke, and Parkinson's disease. METHODS Analysis of YouTube videos depicting the gait of highly ranked Russian officials. RESULTS We found a similar walking pattern in President Vladimir Putin, Prime Minister Dmitry Medvedev and three other highly ranked Russian officials, all presenting with a consistently reduced right arm swing in the absence of other overt neurological abnormalities. CONCLUSIONS We propose that this new gait pattern, which we term "gunslinger's gait," may result from a behavioural adaptation, possibly triggered by KGB or other forms of weapons training where trainees are taught to keep their right hand close to the chest while walking, allowing them to quickly draw a gun when faced with a foe. This should be included in the differential diagnosis of a unilaterally reduced arm swing.
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Affiliation(s)
- Rui Araújo
- Department of Neurology, Coimbra Hospital and University Centre, Coimbra, Portugal
| | - Joaquim J Ferreira
- Clinical Pharmacology Unit, Institute of Molecular Medicine, Faculty of Medicine, University of Lisbon, Lisbon, Portugal
| | - Angelo Antonini
- Department for Parkinson's Disease, IRCCS San Camillo, Venice, Italy
| | - Bastiaan R Bloem
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen, the Netherlands
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