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Faggianelli F, Witjas T, Azulay JP, Benatru I, Hubsch C, Anheim M, Moreau C, Hainque E, Drapier S, Jarraya B, Laurencin C, Guehl D, Hopes L, Brefel-Courbon C, Tir M, Marques A, Rouaud T, Maltete D, Giordana C, Baumstarck K, Rascol O, Corvol JC, Rolland AS, Devos D, Eusebio A. ON/OFF non-motor evaluation: a new way to evaluate non-motor fluctuations in Parkinson's disease. J Neurol Neurosurg Psychiatry 2024; 95:656-662. [PMID: 38272656 DOI: 10.1136/jnnp-2023-332551] [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: 09/11/2023] [Accepted: 01/10/2024] [Indexed: 01/27/2024]
Abstract
BACKGROUND NMF are currently poorly evaluated in therapeutic decisions. A quantification of their severity would facilitate their integration. The objective of this study was to validate an autoquestionnaire evaluating the severity of non-motor fluctuations (NMF) in Parkinson's disease (PD). METHODS Patients with PD were included in presurgical situation for deep brain stimulation of subthalamic nuclei. They participated in the PREDISTIM cohort (a study evaluating the predictive factors for therapeutic response of subthalamic stimulation in PD) in 17 centres in France. Our questionnaire, resulting from previous phases of development, included 11 non-motor symptoms (NMS). Their severity ranged from 0 to 10 and was assessed in OFF and then ON-Dopa to study their fluctuations. RESULTS 310 patients were included, of whom 98.8% had NMS and 98.0% had NMF. Each NMS was significantly improved by L-Dopa (decrease in severity score ranging from 43.1% to 69.9%). Fatigue was the most frequent and most severe NMS. NMS were considered more bothersome than motor symptoms by 37.5% of patients in OFF-Dopa and 34.9% in ON-Dopa. CONCLUSIONS This is the first questionnaire allowing a real-time quantification of the severity of NMS and their fluctuation with levodopa. It was able to confirm and measure the effect of L-dopa and show differences according to the patients and the NMS. It differs from other questionnaires by its measurement at a precise moment of the severity of the NMS, allowing its use during pretherapeutic assessments.Our questionnaire has been validated to measure the severity of NMF. It will be able to quantify the non-motor effect of anti-parkinsonian treatments and could facilitate the integration of NMF in therapeutic decisions.
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Affiliation(s)
| | - Tatiana Witjas
- Department of Neurology, University Hospital Timone, Marseille, France
| | | | | | - Cécile Hubsch
- Neurology, Fondation Ophtalmologique Adolphe de Rothschild, Paris, France
| | - Mathieu Anheim
- Service de Neurologie, Hopital de Hautepierre, Strasbourg, France
| | - Caroline Moreau
- Neurology Expert Center for Parkinson's disease, University of Lille, Lille, France
| | | | | | - Béchir Jarraya
- Neuroscience, Hospital Foch, Suresnes, Île-de-France, France
| | - Chloé Laurencin
- CNRS UMR 5229, Bron, France
- Centre Expert Parkinson, Bron, France
| | - Dominique Guehl
- Pôle de Neurosciences Cliniques, CHU de Bordeaux, Bordeaux, France
- CNRS UMR 5293, Institut des Maladies Neurodegeneratives, Bordeaux, France
| | - Lucie Hopes
- Neurology, Centre Hospitalier Universitaire de Nancy, Nancy, Lorraine, France
| | - Christine Brefel-Courbon
- Clinical Pharmacology and Neurosciences, University Hospital Centre Toulouse, Toulouse, Occitanie, France
| | - Melissa Tir
- Neurology, CHU Amiens-Picardie, Amiens, Hauts-de-France, France
| | - Ana Marques
- EA7280, Université Clermont Auvergne, Clermont-Ferrand, France
- Neurology, University Hospital Centre Clermont-Ferrand, Clermont-Ferrand, France
| | - Tiphaine Rouaud
- Department of Neurology, Nantes University Hospital, Nantes, France
| | | | - Caroline Giordana
- Neurology, Centre Hospitalier Universitaire de Nancy, Nancy, Lorraine, France
| | - Karine Baumstarck
- Aix Marseille Université, EA 3279 Self-Perceived Health Assessment Research Unit, Marseille, France
| | | | | | - Anne-Sophie Rolland
- Department of Medical Pharmacology, Neurology and Movement Disorders Department, Referent Center of Parkinson's Disease, CHU of Lille, Univ. Lille Neuroscience & Cognition, Inserm, UMR-S1172, Lille, France
| | - David Devos
- Medical Pharmacology, Lille University Medical Center, Lille, France
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Schmitt E, Debu B, Castrioto A, Kistner A, Fraix V, Bouvard M, Moro E. Fluctuations in Parkinson's disease and personalized medicine: bridging the gap with the neuropsychiatric fluctuation scale. Front Neurol 2023; 14:1242484. [PMID: 37662035 PMCID: PMC10469620 DOI: 10.3389/fneur.2023.1242484] [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: 06/21/2023] [Accepted: 08/02/2023] [Indexed: 09/05/2023] Open
Abstract
Background Neuropsychiatric fluctuations (NpsyF) are frequent and disabling in people with Parkinson's disease (PD). In OFF-medication, NpsyF entail minus neuropsychiatric symptoms (NPS) like anxiety, apathy, sadness, and fatigue. In ON-medication, NpsyF consist in plus NPS, such as high mood, hypomania, and hyperactivity. Accurate identification of these NpsyF is essential to optimize the overall PD management. Due to lack of punctual scales, the neuropsychiatric fluctuation scale (NFS) has been recently designed to assess NpsyF in real time. The NFS comprises 20 items with two subscores for plus and minus NPS, and a total score. Objective To evaluate the psychometric properties of the NFS in PD. Methods PD patients with motor fluctuations and healthy controls (HC) were assessed. In PD patients, the NFS was administrated in both the ON-and OFF-medication conditions, together with the movement disorders society-unified Parkinson disease rating scale parts I-IV. Depression (Beck depression scale II), apathy (Starkstein apathy scale) and non-motor fluctuations items of the Ardouin scale of behaviour in PD (ASBPD OFF and ON items) were also assessed. NFS internal structure was evaluated with principal component analysis consistency (PCA) in both medication conditions in PD patients and before emotional induction in HC. NFS internal consistency was assessed using Cronbach's alpha coefficient. NFS convergent and divergent validity was measured through correlations with BDI-II, Starktein, and ASBPD OFF and ON non motor items. Specificity was assessed comparing NFS global score between the HC and PD populations. Sensitivity was evaluated with t-student test comparing the ON-and the OFF-medication conditions for NFS global score and for minus and plus subscores. Results In total, 101 consecutive PD patients and 181 HC were included. In PD patients and HC, PCA highlighted one component that explained 32-35 and 42% of the variance, respectively. Internal consistency was good for both the NFS-plus (alpha =0.88) and NFS-minus items (alpha =0.8). The NFS showed a good specifity for PD (p < 0.0001) and a good sensitivity to the medication condition (p < 0.0001). Conclusion The satisfactory properties of the NFS support its use to assess acute neuropsychiatric fluctuations in PD patients, adding to available tools.
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Affiliation(s)
- Emmanuelle Schmitt
- Division of Neurology, CHU Grenoble Alpes, Grenoble Institute of Neuroscience, INSERM U1216, Grenoble Alpes University, Grenoble, France
| | - Bettina Debu
- Division of Neurology, CHU Grenoble Alpes, Grenoble Institute of Neuroscience, INSERM U1216, Grenoble Alpes University, Grenoble, France
| | - Anna Castrioto
- Division of Neurology, CHU Grenoble Alpes, Grenoble Institute of Neuroscience, INSERM U1216, Grenoble Alpes University, Grenoble, France
| | - Andrea Kistner
- Division of Neurology, CHU Grenoble Alpes, Grenoble Institute of Neuroscience, INSERM U1216, Grenoble Alpes University, Grenoble, France
| | - Valerie Fraix
- Division of Neurology, CHU Grenoble Alpes, Grenoble Institute of Neuroscience, INSERM U1216, Grenoble Alpes University, Grenoble, France
| | - Martine Bouvard
- Psychology and Neurocognition Laboratory, Grenoble Alpes University, Université Savoie Mont Blanc, CNRS, LPNC, Grenoble, France
| | - Elena Moro
- Division of Neurology, CHU Grenoble Alpes, Grenoble Institute of Neuroscience, INSERM U1216, Grenoble Alpes University, Grenoble, France
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