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Hopfner F, Buhmann C, Classen J, Holtbernd F, Klebe S, Koschel J, Kohl Z, Paus S, Pedrosa DJ. Tips and tricks in tremor treatment. J Neural Transm (Vienna) 2024:10.1007/s00702-024-02806-x. [PMID: 39043978 DOI: 10.1007/s00702-024-02806-x] [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: 04/09/2024] [Accepted: 07/04/2024] [Indexed: 07/25/2024]
Abstract
Tremor, whether arising from neurological diseases, other conditions, or medication side effects, significantly impacts patients' lives. Treatment complexities necessitate clear algorithms and strategies. Levodopa remains pivotal for Parkinson's tremor, though response variability exists. Some dopamine agonists offer notable tremor reduction targeting D2 receptors. Propranolol effectively manages essential tremor and essential tremor plus (ET/ET +), sometimes with primidone for added benefits, albeit dose-dependent side effects. As reserve medications anticholinergics and clozapine are used for treatment of parkinsonian tremor, 1-Octanol and certain anticonvulsant drugs for tremor of other orign, especially ET. Therapies such as invasive deep brain stimulation and lesional focused ultrasound serve for resistant cases. A medication review is crucial for all forms of tremor, but it is particularly important if medication may have triggered the tremor. Sensor-based detection and non-drug interventions like wristbands and physical therapy broaden diagnostic and therapeutic horizons, promising future tremor care enhancements. Understanding treatment nuances is a key for tailored tremor management respecting patient needs and tolerability. Successful strategies integrate pharmacological, non-invasive, and technological modalities, aiming for optimal symptom control and improved quality of life.
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Affiliation(s)
- Franziska Hopfner
- Department of Neurology, Neurologische Klinik und Poliklinik mit Friedrich Baur Institut, Ludwig-Maximilians University, Campus Großhadern, Marchioninistraße 15, 81377, Munich, Germany.
| | - Carsten Buhmann
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Joseph Classen
- Department of Neurology, Leipzig University Medical Center, Liebigstraße 20, 04103, Leipzig, Germany
| | - Florian Holtbernd
- Department of Neurology, RWTH Aachen University, Pauwelsstraße 30, Aachen, Germany
- JARA-BRAIN Institute Molecular Neuroscience and Neuroimaging, Juelich Research Center GmbH and RWTH Aachen University, Aachen, Germany
| | - Stephan Klebe
- Department of Neurology, Essen University Hospital, 45147, Essen, Germany
- Department of Neurology, Knappschaftskrankenhaus Recklinghausen, Recklinghausen, Germany
| | - Jiri Koschel
- Parkinson-Klinik Ortenau, GmbH & Co KG, Kreuzbergstraße 12-16, 77709, Wolfach, Germany
| | - Zacharias Kohl
- Department of Neurology, University of Regensburg, Regensburg, Germany
| | - Sebastian Paus
- Department of Neurology, GFO Clinics Troisdorf, Troisdorf, Germany
| | - David J Pedrosa
- Department of Neurology, Philipps University Marburg, Marburg, Germany
- Centre for Mind, Brain and Behaviour, Philipps University Marburg, Marburg, Germany
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Mestre TA, Stebbins GT, Stephenson D, Dexter D, Lee KK, Xiao Y, Dam T, Kopil CM, Simuni T. Patient-centered development of clinical outcome assessments in early Parkinson disease: key priorities and advances. NPJ Parkinsons Dis 2024; 10:101. [PMID: 38744872 PMCID: PMC11094181 DOI: 10.1038/s41531-024-00716-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 04/25/2024] [Indexed: 05/16/2024] Open
Affiliation(s)
- Tiago A Mestre
- Ottawa Hospital Research Institute; University of Ottawa Brain and Mind Research Institute; Division of Neurology, Department of Medicine, University of Ottawa, The Ottawa Hospital Ottawa, Ottawa, ON, Canada.
| | - Glenn T Stebbins
- Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, USA
| | | | | | | | - Yuge Xiao
- The Michael J. Fox Foundation for Parkinson's Research, New York, NY, USA
| | - Tien Dam
- Neumora Therapeutics, Cambridge, MA, USA
| | - Catherine M Kopil
- The Michael J. Fox Foundation for Parkinson's Research, New York, NY, USA
| | - Tanya Simuni
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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Zhou X, Zou H, Lutz MW, Arbeev K, Akushevich I, Yashin A, Welsh-Bohmer KA, Luo S. Assessing tilavonemab efficacy in early Alzheimer's disease via longitudinal item response theory modeling. ALZHEIMER'S & DEMENTIA (NEW YORK, N. Y.) 2024; 10:e12471. [PMID: 38835820 PMCID: PMC11148533 DOI: 10.1002/trc2.12471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 03/28/2024] [Accepted: 03/30/2024] [Indexed: 06/06/2024]
Abstract
INTRODUCTION Alzheimer's disease (AD) is a neurodegenerative disorder characterized by declines in cognitive and functional severities. This research utilized the Clinical Dementia Rating (CDR) to assess the influence of tilavonemab on these deteriorations. METHODS Longitudinal Item Response Theory (IRT) models were employed to analyze CDR domains in early-stage AD patients. Both unidimensional and multidimensional models were contrasted to elucidate the trajectories of cognitive and functional severities. RESULTS We observed significant temporal increases in both cognitive and functional severities, with the cognitive severity deteriorating at a quicker rate. Tilavonemab did not demonstrate a statistically significant effect on the progression in either severity. Furthermore, a significant positive association was identified between the baselines and progression rates of both severities. DISCUSSION While tilavonemab failed to mitigate impairment progression, our multidimensional IRT analysis illuminated the interconnected progression of cognitive and functional declines in AD, suggesting a comprehensive perspective on disease trajectories. Highlights Utilized longitudinal Item Response Theory (IRT) models to analyze the Clinical Dementia Rating (CDR) domains in early-stage Alzheimer's disease (AD) patients, comparing unidimensional and multidimensional models.Observed significant temporal increases in both cognitive and functional severities, with cognitive severity deteriorating at a faster rate, while tilavonemab showed no statistically significant effect on either domain's progression.Found a significant positive association between the baseline severities and their progression rates, indicating interconnected progression patterns of cognitive and functional declines in AD.Introduced the application of multidimensional longitudinal IRT models to provide a comprehensive perspective on the trajectories of cognitive and functional severities in early AD, suggesting new avenues for future research including the inclusion of time-dependent random effects and data-driven IRT models.
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Affiliation(s)
- Xiaoxiao Zhou
- Department of Biostatistics & Bioinformatics Duke University Durham North Carolina USA
| | - Haotian Zou
- Department of Biostatistics & Bioinformatics Duke University Durham North Carolina USA
| | - Michael W Lutz
- Division of Translational Brain Sciences Department of Neurology Duke University Medical Center Durham North Carolina USA
| | - Konstantin Arbeev
- Social Science Research Institute Duke University Durham North Carolina USA
| | - Igor Akushevich
- Social Science Research Institute Duke University Durham North Carolina USA
| | - Anatoli Yashin
- Social Science Research Institute Duke University Durham North Carolina USA
| | - Kathleen A Welsh-Bohmer
- Department of Psychiatry Duke University Durham North Carolina USA
- Duke Clinical Research Institute (DCRI) Duke University Durham North Carolina USA
| | - Sheng Luo
- Department of Biostatistics & Bioinformatics Duke University Durham North Carolina USA
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Zou H, Guo Y, Goetz CG, Mestre TA, Stebbins GT, Al‐Hajraf F, Lawton M, Hu M, Luo S. Co-Existent Probable RBD and PD: Disease Progression, Medication Response, and Clinical Trial Implications. Mov Disord Clin Pract 2024; 11:312-314. [PMID: 38468540 PMCID: PMC10928330 DOI: 10.1002/mdc3.13890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 08/04/2023] [Accepted: 09/18/2023] [Indexed: 03/13/2024] Open
Affiliation(s)
- Haotian Zou
- Department of BiostatisticsUniversity of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
| | - Yuanyuan Guo
- Department of Biostatistics and BioinformaticsDuke UniversityDurhamNorth CarolinaUSA
| | - Christopher G. Goetz
- Department of Neurological SciencesRush University Medical CenterChicagoIllinoisUSA
| | - Tiago A. Mestre
- Ottawa Hospital Research Institute, University of Ottawa Brain and Mind Research InstituteOttawaOntarioCanada
- Division of Neurology, Department of MedicineUniversity of OttawaOttawaOntarioCanada
| | - Glenn T. Stebbins
- Department of Neurological SciencesRush University Medical CenterChicagoIllinoisUSA
| | - Falah Al‐Hajraf
- Nuffield Department of Clinical Neurosciences, Division of Clinical NeurologyUniversity of OxfordOxfordUK
| | - Michael Lawton
- Department of Population Health SciencesUniversity of BristolBristolUK
| | - Michele Hu
- Nuffield Department of Clinical Neurosciences, Division of Clinical NeurologyUniversity of OxfordOxfordUK
| | - Sheng Luo
- Department of Biostatistics and BioinformaticsDuke UniversityDurhamNorth CarolinaUSA
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Woitalla D, Buhmann C, Hilker-Roggendorf R, Höglinger G, Koschel J, Müller T, Weise D. Role of dopamine agonists in Parkinson's disease therapy. J Neural Transm (Vienna) 2023; 130:863-873. [PMID: 37165120 DOI: 10.1007/s00702-023-02647-0] [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: 03/13/2023] [Accepted: 04/27/2023] [Indexed: 05/12/2023]
Abstract
Dopamine agonists are an important component of Parkinson's therapy. When weighing up the various therapy options, therapy with levodopa has recently been increasingly preferred due to its stronger efficacy and the ostensibly lower rate of side effects. The advantage of the lower incidence of motor complications during therapy with dopamine agonists was neglected. The occurrence of side effects can be explained by the different receptor affinity to the individual dopaminergic and non-dopaminergic receptors of the individual dopamine agonists. However, the different affinity to individual receptors also explains the different effect on individual Parkinson symptoms and can, therefore, contribute to a targeted use of the different dopamine agonists. Since comparative studies on the differential effect of dopamine agonists have only been conducted for individual substances, empirical knowledge of the differential effect is of great importance. Therefore, the guidelines for the treatment of Parkinson's disease do not consider the differential effect of the dopamine agonists. The historical consideration of dopamine agonists within Parkinson's therapy deserves special attention to be able to classify the current discussion about the significance of dopamine agonists.
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Affiliation(s)
- D Woitalla
- Department of Neurology, Katholische Kliniken Der Ruhrhalbinsel, Essen, Germany.
| | - C Buhmann
- Department of Neurology, Universitätsklinikum Hamburg, Hamburg, Germany
| | | | - G Höglinger
- Department of Neurology, Medizinische Hochschule Hannover, Hannover, Germany
| | - J Koschel
- Department of Neurology Parkinson-Klinik Ortenau, Wolfach, Germany
| | - T Müller
- Department of Neurology, Alexianer St. Joseph Krankenhaus, Berlin, Germany
| | - D Weise
- Department of Neurology, Asklepios Fachklinikum Stadtroda, Stadtroda, Germany
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Guo Y, Goetz CG, Stebbins GT, Mestre TA, Luo S. Using Movement Disorder Society Unified Parkinson's Disease Rating Scale Parts 2 and 3 Simultaneously: Combining the Patient Voice with Clinician Ratings. Mov Disord 2023; 38:453-463. [PMID: 36621935 PMCID: PMC10033355 DOI: 10.1002/mds.29308] [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: 08/18/2022] [Revised: 12/12/2022] [Accepted: 12/15/2022] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Regulatory recommendations favor outcomes combining objective and patient input. The Movement Disorder Society Unified Parkinson's Disease Rating Scale (MDS-UPDRS), the most commonly used scale in Parkinson's disease (PD), includes patient and investigator ratings in distinct parts, but original clinimetric analyses failed to confirm the validity of combining parts by simple summing. OBJECTIVES The aim was to develop clinimetrically valid constructs for combining patient-reported Part 2 and investigator-rated Part 3 MDS-UPDRS scores. METHODS Using 7888 MDS-UPDRS scores, we assessed construct validity of combined Part 2 and Part 3 items using exploratory factor analysis (EFA) and graded item response theory (IRT) with threshold criteria: comparative fit index ≥0.9 (EFA) and discrimination parameters ≥0.65 (IRT). RESULTS The direct sum of Parts 2 + 3 failed to meet the threshold for a valid outcome of PD severity (comparative fit index, CFI = 0.855). However, a two-domain construct combining item scores for tremor and non-tremor domains from Parts 2 and 3 confirmed validity, meeting both EFA and IRT criteria as distinct but correlated indices of disease severity (CFI = 0.923; discrimination mean 2.197 ± 0.480 [tremor] and 1.737 ± 0.344 [non-tremor] domains). CONCLUSIONS The sum of Parts 2 + 3 is not clinimetrically sound. However, considering tremor and non-tremor items of both Parts 2 and 3 as two outcomes results in a valid summary of PD motor severity that leverages simultaneous patient- and investigator-derived measures. This analytic application addresses regulatory prioritizations and retains the well-validated MDS-UPDRS items. In future interventional trials, we suggest that tremor and non-tremor components of PD motor severity from Parts 2 + 3 be monitored and analyzed to accurately detect objective changes that integrate the patient's voice. © 2023 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Yuanyuan Guo
- Department of Biostatistics & Bioinformatics, Duke University, Durham, North Carolina, USA
| | - Christopher G Goetz
- Department of Neurological Sciences, Rush University Medical Center, Chicago, Illinois, USA
| | - Glenn T Stebbins
- Department of Neurological Sciences, Rush University Medical Center, Chicago, Illinois, USA
| | - Tiago A Mestre
- Division of Neurology, Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa Brain and Mind Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Sheng Luo
- Department of Biostatistics & Bioinformatics, Duke University, Durham, North Carolina, USA
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Guo Y, Stebbins GT, Mestre TA, Goetz CG, Luo S. Movement Disorder Society Unified Parkinson's Disease Rating Scale Motor Examination Retains Its 2-Domain Profile in Both On and Off States. Mov Disord Clin Pract 2022; 9:1149-1151. [PMID: 36339308 PMCID: PMC9631834 DOI: 10.1002/mdc3.13566] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 08/23/2022] [Accepted: 08/30/2022] [Indexed: 10/01/2023] Open
Affiliation(s)
- Yuanyuan Guo
- Department of Biostatistics & BioinformaticsDuke UniversityDurhamNorth CarolinaUSA
| | - Glenn T. Stebbins
- Department of Neurological SciencesRush University Medical CenterChicagoIllinoisUSA
| | - Tiago A. Mestre
- Ottawa Hospital Research Institute; University of Ottawa Brain and Mind Research Institute; Division of Neurology, Department of MedicineUniversity of Ottawa, The Ottawa Hospital OttawaOttawaOntarioCanada
| | - Christopher G. Goetz
- Department of Neurological SciencesRush University Medical CenterChicagoIllinoisUSA
| | - Sheng Luo
- Department of Biostatistics & BioinformaticsDuke UniversityDurhamNorth CarolinaUSA
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