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Witt K, Levin J, van Eimeren T, Hasan A, Ebersbach G. Diagnostics and treatment of impulse control disorders, psychosis and delirium: systemic review-based recommendations - guideline "Parkinson's disease" of the German Society of Neurology. J Neurol 2024:10.1007/s00415-024-12576-x. [PMID: 39046524 DOI: 10.1007/s00415-024-12576-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: 05/23/2024] [Revised: 07/05/2024] [Accepted: 07/07/2024] [Indexed: 07/25/2024]
Abstract
BACKGROUND AND OBJECTIVE Impulse control disorders (ICD), psychosis and delirium are part of the spectrum of behavioural changes associated with Parkinson's disease (PD). The diagnostic and therapeutic management of these rather complex neuropsychiatric conditions has been updated in the clinical guideline by the German Society of Neurology (DGN). METHODS Recommendations are based on a systematic literature reviews, other relevant guidelines and expert opinion. RESULTS Patients receiving dopamine agonists (DA) therapy should be informed about the symptoms and risks of an ICD and should be routinely screened for ICD symptoms. In the presence of an ICD, DA should be reduced or discontinued and psychotherapeutic treatment may be considered. Non-oral therapies (levodopa/carbidopa intestinal gel infusion or deep brain stimulation) may also be an option for appropriate candidates. Psychosis in PD often has a gradual onset. Cognitive and affective disorders, psychiatric and medical comorbidities as well as polypharmacy are risk factors for a psychosis. Non-pharmacological treatments should be implemented as soon as possible and anti-parkinsonian medications should be adjusted/reduced if feasible. For psychosis associated with PD, quetiapine or clozapine should be used on an as-needed basis and for as short a time as is necessary, with safety monitoring. Delirium in PD may be underdiagnosed due to an overlap with chronic neuropsychiatric features of PD. Although transient by definition, delirium in PD can lead to permanent cognitive decline, motor impairment and increased mortality. Management of delirium includes pharmacological and non-pharmacological interventions. CONCLUSION The updated guideline encompasses the evidence-based diagnostic, non-pharmacological and pharmacological management of ICD, psychosis and delirium in PD.
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Affiliation(s)
- Karsten Witt
- Department of Neurology, School of Medicine and Health Sciences, Carl von Ossietzky University of Oldenburg, Marienstrasse 15, 26121, Oldenburg, Germany.
- University Clinic of Neurology, Evangelical Hospital, Oldenburg, Germany.
- Center of Neurosensory Sciences, University of Oldenburg, Oldenburg, Germany.
| | - Johannes Levin
- Department of Neurology, LMU University Hospital, LMU Munich, Munich, Germany
- German Center for Neurodegenerative Diseases, Site Munich, Munich, Germany
- Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
| | | | - Alkomiet Hasan
- Department of Psychiatry, Psychotherapy and Psychosomatics, Faculty of Medicine, University of Augsburg, Augsburg, Germany
- DZPG (German Center for Mental Health), Partner Site München/Augsburg, Augsburg, Germany
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Lellis CDA, Herbas MAM, da Silva LJ. Psychiatric disorders after deep brain stimulation of the subthalamic nucleus in Parkinson's disease: a systematic review. EINSTEIN-SAO PAULO 2024; 22:eRW0182. [PMID: 39046070 PMCID: PMC11221831 DOI: 10.31744/einstein_journal/2024rw0182] [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: 05/18/2022] [Accepted: 11/06/2023] [Indexed: 07/25/2024] Open
Abstract
OBJECTIVE To evaluate the psychiatric alterations resulting from deep brain stimulation of the subthalamic nucleus in the management of Parkinson's disease. METHODS Articles were searched using three databases: Public/Publisher MEDLINE, Virtual Health Library, and Cochrane Library. RESULTS Eleven studies were included in the analysis. Manic syndrome alone was reported in two of the 11 studies analyzed. Psychosis alone was not reported in any of them, but it was found in association with other psychiatric alterations in two studies, not including manic syndrome. In one case report, hypersexuality was associated with depression and self-alienation. Depressive disorder was the most frequent psychiatric disorder after deep brain stimulation of the subthalamic nucleus, according to five of the reviewed articles, encompassing 26 patients. In four of these articles, depression was associated with other psychiatric disorders, such as psychosis, suicidal ideation, hypersexuality, and anxiety. Hypomanic syndrome was reported in two cases. CONCLUSION More common psychiatric disorders related to the neuroanatomy of the nucleus were observed, probably because of the microlesions caused by the implantation of deep brain stimulation and the regulation of the stimulation of the device. The most common disorders include depression, mania/hypomania, psychosis, anxiety, suicidal ideation, and hypersexuality.
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Affiliation(s)
- Caio de Almeida Lellis
- Escola de Ciências Médicas e da VidaPontifícia Universidade Católica de GoiásGoiâniaGOBrazilEscola de Ciências Médicas e da Vida, Pontifícia Universidade Católica de Goiás, Goiânia, GO, Brazil.
| | - Marco Alejandro Menacho Herbas
- Escola de Ciências Médicas e da VidaPontifícia Universidade Católica de GoiásGoiâniaGOBrazilEscola de Ciências Médicas e da Vida, Pontifícia Universidade Católica de Goiás, Goiânia, GO, Brazil.
| | - Ledismar José da Silva
- Escola de Ciências Médicas e da VidaPontifícia Universidade Católica de GoiásGoiâniaGOBrazilEscola de Ciências Médicas e da Vida, Pontifícia Universidade Católica de Goiás, Goiânia, GO, Brazil.
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Krugliakova E, Karpovich A, Stieglitz L, Huwiler S, Lustenberger C, Imbach L, Bujan B, Jedrysiak P, Jacomet M, Baumann CR, Fattinger S. Exploring the local field potential signal from the subthalamic nucleus for phase-targeted auditory stimulation in Parkinson's disease. Brain Stimul 2024; 17:769-779. [PMID: 38906529 DOI: 10.1016/j.brs.2024.06.007] [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: 11/13/2023] [Revised: 05/26/2024] [Accepted: 06/12/2024] [Indexed: 06/23/2024] Open
Abstract
BACKGROUND Enhancing slow waves, the electrophysiological (EEG) manifestation of non-rapid eye movement (NREM) sleep, could potentially benefit patients with Parkinson's disease (PD) by improving sleep quality and slowing disease progression. Phase-targeted auditory stimulation (PTAS) is an approach to enhance slow waves, which are detected in real-time in the surface EEG signal. OBJECTIVE We aimed to test whether the local-field potential of the subthalamic nucleus (STN-LFP) can be used to detect frontal slow waves and assess the electrophysiological changes related to PTAS. METHODS We recruited patients diagnosed with PD and undergoing Percept™ PC neurostimulator (Medtronic) implantation for deep brain stimulation of STN (STN-DBS) in a two-step surgery. Patients underwent three full-night recordings, including one between-surgeries recording and two during rehabilitation, one with DBS+ (on) and one with DBS- (off). Surface EEG and STN-LFP signals from Percept PC were recorded simultaneously, and PTAS was applied during sleep in all three recording sessions. RESULTS Our results show that during NREM sleep, slow waves of the cortex and STN are time-locked. PTAS application resulted in power and coherence changes, which can be detected in STN-LFP. CONCLUSION Our findings suggest the feasibility of implementing PTAS using solely STN-LFP signal for slow wave detection, thus without a need for an external EEG device alongside the implanted neurostimulator. Moreover, we propose options for more efficient STN-LFP signal preprocessing, including different referencing and filtering to enhance the reliability of cortical slow wave detection in STN-LFP recordings.
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Affiliation(s)
- Elena Krugliakova
- Department of Neurology, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Artyom Karpovich
- Department of Neurology, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Lennart Stieglitz
- Department of Neurosurgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Stephanie Huwiler
- Neural Control of Movement Lab, Institute of Human Movement Sciences and Sport, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
| | - Caroline Lustenberger
- Neural Control of Movement Lab, Institute of Human Movement Sciences and Sport, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
| | - Lukas Imbach
- Swiss Epilepsy Center, Clinic Lengg, Zurich, Switzerland
| | - Bartosz Bujan
- Neurorehabilitation, Clinic Lengg, Zurich, Switzerland
| | | | - Maria Jacomet
- Department of Neurology, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Christian R Baumann
- Department of Neurology, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Sara Fattinger
- Department of Neurology, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
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Barbosa RMG, Soares MC, Portela DMMC, Guimarães TG, Cury RG. New Perspectives of Deep Brain Stimulation Indications for Parkinson's Disease: A Critical Review. Brain Sci 2024; 14:638. [PMID: 39061379 PMCID: PMC11274985 DOI: 10.3390/brainsci14070638] [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: 06/04/2024] [Revised: 06/23/2024] [Accepted: 06/24/2024] [Indexed: 07/28/2024] Open
Abstract
Deep Brain Stimulation (DBS) is an effective treatment option for patients with dopaminergic complications of Parkinson's disease (PD) and drug-refractory PD tremor. However, DBS and its indications can be challenging, and they are not often debated in the medical community. Through a critical narrative review, the objective of this paper is to improve the comprehension of DBS indications and help to solve the puzzle that this process can be. Proper patient selection is the first step for a good surgical outcome. In this review, then, relevant considerations are discussed, involving PD genes, PD phenotypes, indications of early stages, non-motor symptoms, neuroimaging predictors, comorbidities, and age. Individualized approaches are encouraged, including clinical and radiological factors. Social support during the whole follow-up and expectations alignment are necessary through this process and are also debated.
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Affiliation(s)
- Renata Montes Garcia Barbosa
- Movement Disorders Center, Department of Neurology, School of Medicine, University of São Paulo, São Paulo 05403-010, Brazil; (R.M.G.B.); (M.C.S.); (T.G.G.)
| | - Miriam Carvalho Soares
- Movement Disorders Center, Department of Neurology, School of Medicine, University of São Paulo, São Paulo 05403-010, Brazil; (R.M.G.B.); (M.C.S.); (T.G.G.)
| | - Denise Maria Meneses Cury Portela
- Movement Disorders Center, Department of Neurology, School of Medicine, Centro Universitário Uninovafapi (UNINOVAFAPI), Teresina 64073505, Brazil;
| | - Thiago Gonçalves Guimarães
- Movement Disorders Center, Department of Neurology, School of Medicine, University of São Paulo, São Paulo 05403-010, Brazil; (R.M.G.B.); (M.C.S.); (T.G.G.)
| | - Rubens Gisbert Cury
- Movement Disorders Center, Department of Neurology, School of Medicine, University of São Paulo, São Paulo 05403-010, Brazil; (R.M.G.B.); (M.C.S.); (T.G.G.)
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Gronostay A, Jost ST, Silverdale M, Rizos A, Loehrer PA, Evans J, Sauerbier A, Indi D, Leta V, Reker P, Fink GR, Ashkan K, Antonini A, Nimsky C, Visser-Vandewalle V, Martinez-Martin P, Ray Chaudhuri K, Timmermann L, Dafsari HS. Stratifying quality of life outcome in subthalamic stimulation for Parkinson's disease. J Neurol Neurosurg Psychiatry 2024; 95:630-638. [PMID: 38124227 DOI: 10.1136/jnnp-2023-332272] [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: 07/24/2023] [Accepted: 12/03/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND Subthalamic nucleus deep brain stimulation (STN-DBS) for Parkinson's disease (PD) improves quality of life (QoL), motor and non-motor symptoms (NMS). However, in previous studies, 43%-49% of patients did not experience clinically relevant postoperative QoL improvement. To inform individualised prediction of postoperative QoL improvement, we developed a stratification analysis of QoL outcomes based on preoperative non-motor total burden, severity of motor progression and motor response in levodopa challenge tests. METHODS This was a prospective, open-label, multicentre, international study with a 6-month follow-up. A distribution-based threshold identified 'QoL responders' in the PDQuestionnaire-8 Summary Index (PDQ-8 SI). After baseline stratification based on the NMS Scale, Hoehn and Yahr Scale and levodopa response assessed with the Unified PD Rating Scale-III, we compared postoperative QoL response between these strata. To assess the clinical usefulness and statistical feasibility of stratifications, we compared cumulative distribution function curves, respectively PDQ-8 within-stratum variation. RESULTS All main outcomes improved postoperatively. Based on the 8.1 points threshold for clinically meaningful PDQ-8 SI improvement, only 80/161 patients were classified as 'QoL responders'. The absolute risk reductions for QoL non-response among respective non-motor, motor progression and levodopa response strata were 23%, 8% and 3%, respectively. Only non-motor stratification reduced PDQ-8 within-stratum variation compared with the overall cohort. CONCLUSIONS Non-motor stratification, but not motor progression or levodopa response stratification, is clinically useful and statistically feasible for personalised preoperative prediction of postoperative QoL outcome of STN-DBS for PD. Our findings highlight that non-motor assessments are necessary components of a case-based, holistic approach of DBS indication evaluations geared towards optimising postoperative QoL outcomes. TRIAL REGISTRATION NUMBER GermanClinicalTrialsRegister: #6735.
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Affiliation(s)
- Alexandra Gronostay
- Department of Neurology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Stefanie Theresa Jost
- Department of Neurology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Monty Silverdale
- Department of Neurology and Neurosurgery, Salford Royal NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, Greater Manchester, UK
| | - Alexandra Rizos
- Parkinson Foundation International Centre of Excellence, King's College Hospital, London, UK
| | | | - Julian Evans
- Department of Neurology and Neurosurgery, Salford Royal NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, Greater Manchester, UK
| | - Anna Sauerbier
- Department of Neurology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
- Parkinson Foundation International Centre of Excellence, King's College Hospital, London, UK
| | - Donya Indi
- Department of Neurology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Valentina Leta
- Parkinson Foundation International Centre of Excellence, King's College Hospital, London, UK
| | - Paul Reker
- Department of Neurology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Gereon Rudolf Fink
- Department of Neurology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
- Cognitive Neuroscience, Institute of Neuroscience and Medicine (INM-3), Research Center Jülich, Jülich, Germany
| | - Keyoumars Ashkan
- Parkinson Foundation International Centre of Excellence, King's College Hospital, London, UK
| | - Angelo Antonini
- Parkinson and Movement Disorders Unit, Department of Neurosciences (DNS), Padova University, Padova, Italy
| | - Christopher Nimsky
- Department of Neurosurgery, Philipps-University Marburg, Marburg, Germany
| | - Veerle Visser-Vandewalle
- Department of Stereotactic and Functional Neurosurgery, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Pablo Martinez-Martin
- Center for Networked Biomedical Research in Neurodegenerative Diseases (CIBERNED), Carlos III Institute of Health, Madrid, Spain
| | - K Ray Chaudhuri
- Parkinson Foundation International Centre of Excellence, King's College Hospital, London, UK
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Lars Timmermann
- Department of Neurology, Philipps-University Marburg, Marburg, Germany
| | - Haidar S Dafsari
- Department of Neurology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
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Turcano P, Jacobson J, Ghoniem K, Mullan A, Camerucci E, Stang C, Piat C, Bower JH, Savica R. Impulse control disorders and use of dopamine agonists in early onset Parkinson's disease. Front Neurol 2024; 15:1404904. [PMID: 38841693 PMCID: PMC11150809 DOI: 10.3389/fneur.2024.1404904] [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: 03/21/2024] [Accepted: 05/13/2024] [Indexed: 06/07/2024] Open
Abstract
Introduction Impulse control disorders (ICDs) are defined as excessive and repetitive behaviors that may affect Parkinson's disease (PD) patients exposed to dopamine agonists. Current data on ICDs in patients with early-onset Parkinson's disease (EOPD) is lacking. In this study we aim to assess the frequency of use of dopamine agonists, the prevalence of ICDs, and to explore potential factors associated with their development in patients with EOPD. Methods We used the Mayo Clinic Data Explorer system to investigate a population-based cohort of EOPD patients between 1990 and 2022 at Mayo Clinic, Rochester, MN. We used ICD coding for parkinsonism; then, we reviewed all the clinical records and included only those patients with a clinical diagnosis of PD with symptoms onset at or before the age of 50, and who developed ICDs after using therapeutic doses of dopamine agonists. Results A total of 831 (513 males and 318 females) patients with EOPD were included with a median age at symptom onset of 42 years of age (CI: 37-46). Dopamine agonists were used in 49.7% of all patients; of these, only 14.5% developed symptoms of one or more ICDs. Hypersexuality was the most commonly observed ICD (38.3%), and the only one having a statistically significant male predominance (p = 0.011). Conclusion ICDs are common in EOPD, particularly when associated with the use of dopamine agonists.
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Affiliation(s)
| | - Jessie Jacobson
- Department of Neurology, Mayo Clinic, Rochester, MN, United States
| | - Khaled Ghoniem
- Department of Neurology, Mayo Clinic, Rochester, MN, United States
| | - Aidan Mullan
- Department of Neurology, Mayo Clinic, Rochester, MN, United States
| | - Emanuele Camerucci
- Department of Neurology, University of Kansas Medical Center, Kansas City, KS, United States
| | - Cole Stang
- Department of Neurology, Mayo Clinic, Rochester, MN, United States
| | - Capucine Piat
- Department of Neurology, Mayo Clinic, Rochester, MN, United States
| | - James H. Bower
- Department of Neurology, Mayo Clinic, Rochester, MN, United States
| | - Rodolfo Savica
- Department of Neurology, Mayo Clinic, Rochester, MN, United States
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Cavallieri F, Mulroy E, Moro E. The history of deep brain stimulation. Parkinsonism Relat Disord 2024; 121:105980. [PMID: 38161106 DOI: 10.1016/j.parkreldis.2023.105980] [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: 12/19/2023] [Accepted: 12/23/2023] [Indexed: 01/03/2024]
Abstract
Deep brain stimulation (DBS) surgery is an established and effective treatment for several movement disorders (tremor, Parkinson's disease, and dystonia), and is under investigation in numerous other neurological and psychiatric disorders. However, the origins and development of this neurofunctional technique are not always well understood and recognized. In this mini-review, we review the history of DBS, highlighting important milestones and the most remarkable protagonists (neurosurgeons, neurologists, and neurophysiologists) who pioneered and fostered this therapy throughout the 20th and early 21st century. Alongside DBS historical markers, we also briefly discuss newer developments in the field, and the future challenges which accompany such progress.
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Affiliation(s)
- Francesco Cavallieri
- Neurology Unit, Neuromotor & Rehabilitation Department, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Eoin Mulroy
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, London, United Kingdom
| | - Elena Moro
- Grenoble Alpes University, Division of Neurology, Centre Hospitalier Universitaire de Grenoble, Grenoble Institute of Neuroscience, INSERM U1216, Grenoble, France.
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Brinker D, Smilowska K, Paschen S, Antonini A, Moro E, Deuschl G. How to Use the New European Academy of Neurology/Movement Disorder Society European Section Guideline for Invasive Therapies in Parkinson's Disease. Mov Disord Clin Pract 2024; 11:209-219. [PMID: 38214401 DOI: 10.1002/mdc3.13962] [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: 09/25/2023] [Revised: 11/28/2023] [Accepted: 12/13/2023] [Indexed: 01/13/2024] Open
Abstract
BACKGROUND The decision to choose invasive treatments for Parkinson's disease (PD) is complex and needs careful consideration. OBJECTIVES Although the recommendations of the European Academy of Neurology/Movement Disorder Society European Section guideline for invasive therapies of PD are useful, the different clinical profiles of people with PD who seek advice for possible invasive therapy need further attention. METHODS AND RESULTS Here we describe 8 clinical standard situations of people with PD unsatisfied with their current oral treatment where invasive therapies may be considered. These are PD patients presenting with the following symptoms: (1) severe motor fluctuations, (2) beginning of levodopa-responsive fluctuations, severe tremor at (3) young or (4) advanced age, (5) impulse control disorders and related behavioral disorders, (6) hallucinations and psychosis, (7) minimal cognitive impairment or mild dementia, and (8) patients in need of palliative care. For some of these conditions, evidence at lower level or simple clinical considerations exist. CONCLUSIONS There are no one-fits-all answers, but physician and patient should discuss each option carefully considering symptom profile, psychosocial context, availability of therapy alternatives, and many other factors. The current paper outlines our proposed approach to these circumstances.
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Affiliation(s)
- Dana Brinker
- Department of Neurology, UKSH, Christian-Albrechts-University Kiel, Kiel, Germany
| | - Katarzyna Smilowska
- Department of Neurology, UKSH, Christian-Albrechts-University Kiel, Kiel, Germany
- Department of Neurology, Regional Specialist Hospital im. Św. Barbary, Sonowiec, Poland
| | - Steffen Paschen
- Department of Neurology, UKSH, Christian-Albrechts-University Kiel, Kiel, Germany
| | - Angelo Antonini
- Parkinson and Movement Disorders Unit, Study Center for Neurodegenerative Diseases (CESNE), Department of Neuroscience, University of Padua, Padua, Italy
| | - Elena Moro
- Grenoble Alpes University, Chu of Grenoble, Division of Neurology, Grenoble Institute of Neurosciences, Grenoble, France
| | - Günther Deuschl
- Department of Neurology, UKSH, Christian-Albrechts-University Kiel, Kiel, Germany
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Mai AS, Lee YS, Yong JH, Teo DCYJ, Wan YM, Tan EK. Treatment of apathy in Parkinson's disease: A bayesian network meta-analysis of randomised controlled trials. Heliyon 2024; 10:e26107. [PMID: 38440294 PMCID: PMC10909723 DOI: 10.1016/j.heliyon.2024.e26107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 01/12/2024] [Accepted: 02/07/2024] [Indexed: 03/06/2024] Open
Abstract
Background Apathy is an important but unrecognised aspect of Parkinson's disease (PD). The optimal therapeutic options for apathy remain unclear. Early recognition and treatment of apathy can reduce the significant burden of disease for patients and their caregivers. Here we conducted a meta-analysis to evaluate the comparative efficacy of different treatment modalities of apathy in PD (CRD42021292099). Methods We screened Medline, Embase, and PsycINFO databases for articles on therapies for apathy in PD. The outcome of interest is the reduction in apathy scores post-intervention and is measured by standardised mean differences (SMD) with 95% credible intervals (CrI). We included only randomised controlled trials examining interventions targeted at reducing apathy. Results Nineteen studies involving 2372 patients were included in the quantitative analysis. The network meta-analysis found pharmacotherapy to be the most efficacious treatment, significantly better than brain stimulation (SMD -0.43, 95% CrI -0.78 to -0.07), exercise-based interventions (SMD -0.66, 95% CrI -1.25 to -0.08), supplements (SMD -0.33, 95% CrI -0.67 to 0), and placebo (SMD -0.38, 95% CrI -0.56 to -0.23). Subgroup analysis of pharmacotherapy versus placebo found similar efficacy of dopamine agonists (SMD -0.36, 95% CI -0.59 to -0.12, P = 0.003) and alternative medications (SMD -0.42, 95% CI -0.61 to -0.23, P < 0.001). The remaining comparisons and subgroup analyses did not demonstrate any significant treatment effects. Conclusion Our meta-analysis of randomised controlled trials showed that pharmacotherapy is the most efficacious treatment option, with dopamine agonists having similar efficacy as other medications. Further research is needed to determine the optimal management strategy.
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Affiliation(s)
- Aaron Shengting Mai
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Yi Siang Lee
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Jung Hahn Yong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | | | - Yi-Min Wan
- Department of Psychiatry, Ng Teng Fong General Hospital, Singapore
| | - Eng-King Tan
- Department of Neurology, Singapore General Hospital Campus, National Neuroscience Institute, Singapore
- Neuroscience and Behavioural Programme, Duke-NUS Medical School, Singapore
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Holewijn RA, Zoon TJC, Verbaan D, Bergfeld IO, Verwijk E, Geurtsen GJ, van Rooijen G, van den Munckhof P, Bot M, Denys DAJP, De Bie RMA, Schuurman PR. Cognitive and psychiatric outcomes in the GALAXY trial: effect of anaesthesia in deep brain stimulation. J Neurol Neurosurg Psychiatry 2024; 95:214-221. [PMID: 37679030 DOI: 10.1136/jnnp-2023-331791] [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: 05/04/2023] [Accepted: 08/23/2023] [Indexed: 09/09/2023]
Abstract
BACKGROUND This study aims: (1) To compare cognitive and psychiatric outcomes after bilateral awake versus asleep subthalamic nucleus (STN) deep brain stimulation (DBS) surgery for Parkinson's disease (PD). (2) To explore the occurrence of psychiatric diagnoses, cognitive impairment and quality of life after surgery in our whole sample. (3) To validate whether we can predict postoperative cognitive decline. METHODS 110 patients with PD were randomised to receive awake (n=56) or asleep (n=54) STN DBS surgery. At baseline and 6-month follow-up, all patients underwent standardised assessments testing several cognitive domains, psychiatric symptoms and quality of life. RESULTS There were no differences on neuropsychological composite scores and psychiatric symptoms between the groups, but we found small differences on individual tests and cognitive domains. The asleep group performed better on the Rey Auditory Verbal Learning Test delayed memory test (f=4.2, p=0.04), while the awake group improved on the Rivermead Behavioural Memory Test delayed memory test. (f=4.4, p=0.04). The Stroop III score was worse for the awake group (f=5.5, p=0.02). Worse scores were present for Stroop I (Stroop word card) (f=6.3, p=0.01), Stroop II (Stroop color card) (f=46.4, p<0.001), Stroop III (Stroop color-word card) (f=10.8, p=0.001) and Trailmaking B/A (f=4.5, p=0.04). Improvements were seen on quality of life: Parkinson's Disease Questionnaire-39 (f=24.8, p<0.001), and psychiatric scales: Hamilton Depression Rating Scale (f=6.2, p=0.01), and Hamilton Anxiety Rating Scale (f=5.5, p=0.02). CONCLUSIONS This study suggests that the choice between awake and asleep STN DBS does not affect cognitive, mood and behavioural adverse effects, despite a minor difference in memory. STN DBS has a beneficial effect on quality of life, mood and anxiety symptoms. TRIAL REGISTRATION NUMBER NTR5809.
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Affiliation(s)
- Rozemarije A Holewijn
- Department of Neurosurgery, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Thomas J C Zoon
- Department of Psychiatry, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Dagmar Verbaan
- Department of Neurosurgery, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Isidoor O Bergfeld
- Department of Psychiatry, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Esmée Verwijk
- Amsterdam Neuroscience, Amsterdam University Medical Centers, Amsterdam, The Netherlands
- Department of Medical Psychology, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Gert J Geurtsen
- Department of Medical Psychology, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Geeske van Rooijen
- Department of Psychiatry, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Pepijn van den Munckhof
- Department of Neurosurgery, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Maarten Bot
- Department of Neurosurgery, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Damiaan A J P Denys
- Department of Psychiatry, Amsterdam University Medical Centers, Amsterdam, The Netherlands
- Amsterdam Neuroscience, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Rob M A De Bie
- Department of Neurology, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - P Rick Schuurman
- Department of Neurosurgery, Amsterdam University Medical Centers, Amsterdam, The Netherlands
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11
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Zoon TJC, van Rooijen G, Contarino MF, van der Gaag S, Zutt R, van Asseldonk JT, van den Munckhof P, Schuurman PR, Denys DAJP, de Bie RMA. A multicenter double-blind randomized crossover study comparing the impact of dorsal subthalamic nucleus deep brain stimulation versus standard care on apathy in Parkinson's disease: a study protocol. Trials 2024; 25:104. [PMID: 38308317 PMCID: PMC10837902 DOI: 10.1186/s13063-024-07938-9] [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: 10/23/2023] [Accepted: 01/16/2024] [Indexed: 02/04/2024] Open
Abstract
BACKGROUND Neuroimaging studies suggest an association between apathy after deep brain stimulation (DBS) and stimulation of the ventral part of the subthalamic nucleus (STN) due to the associative fibers connected to the non-motor limbic circuits that are involved in emotion regulation and motivation. We have previously described three patients with severe apathy that could be fully treated after switching stimulation from a ventral electrode contact point to a more dorsal contact point. OBJECTIVES To determine whether more dorsal stimulation of the STN decreases apathy compared to standard care in a multicenter randomized controlled trial with a crossover design. METHODS We will include 26 patients with a Starkstein Apathy Scale (SAS) score of 14 or more after subthalamic nucleus (STN) deep brain stimulation (DBS) for refractory Parkinson's disease. This is a multicenter trial conducted in two teaching hospitals and one university medical center in the Netherlands after at least 3 months of STN DBS. Our intervention will consist of 1 month of unilateral dorsal STN stimulation compared to treatment as usual. The primary outcome is a change in SAS score following 1 month of DBS on the original contact compared to the SAS score following 1 month of DBS on the more dorsal contact. Secondary outcomes are symptom changes on the Movement Disorders Society-Unified Parkinson's Disease Rating Scale motor part III, Montgomery-Åsberg Depression Rating Scale, 39-item Parkinson's disease questionnaire, Parkinson's disease impulsive-compulsive disorders questionnaire, changes in levodopa-equivalent daily dosage, apathy rated by the caregiver, and burden and quality of life of the caregiver. TRIAL REGISTRATION ClinicalTrials.gov NL8279. Registered on January 10, 2020.
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Affiliation(s)
- T J C Zoon
- Department of Psychiatry, Amsterdam UMC, Location AMC, Amsterdam, the Netherlands.
| | - G van Rooijen
- Department of Psychiatry, Amsterdam UMC, Location AMC, Amsterdam, the Netherlands
| | | | | | - R Zutt
- HagaZiekenhuis, the Hague, the Netherlands
| | | | | | - P R Schuurman
- Department of Neurosurgery, Amsterdam UMC, Amsterdam, the Netherlands
| | - D A J P Denys
- Department of Psychiatry, Amsterdam UMC, Location AMC, Amsterdam, the Netherlands
| | - R M A de Bie
- Department of Neurology, Amsterdam UMC, Location AMC, Amsterdam, the Netherlands
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12
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Béreau M, Kibleur A, Servant M, Clément G, Dujardin K, Rolland AS, Wirth T, Lagha-Boukbiza O, Voirin J, Santin MDN, Hainque E, Grabli D, Comte A, Drapier S, Durif F, Marques A, Eusebio A, Azulay JP, Giordana C, Houeto JL, Jarraya B, Maltete D, Rascol O, Rouaud T, Tir M, Moreau C, Danaila T, Prange S, Tatu L, Tranchant C, Corvol JC, Devos D, Thobois S, Desmarets M, Anheim M. Motivational and cognitive predictors of apathy after subthalamic nucleus stimulation in Parkinson's disease. Brain 2024; 147:472-485. [PMID: 37787488 DOI: 10.1093/brain/awad324] [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: 03/23/2023] [Revised: 07/13/2023] [Accepted: 08/21/2023] [Indexed: 10/04/2023] Open
Abstract
Postoperative apathy is a frequent symptom in Parkinson's disease patients who have undergone bilateral deep brain stimulation of the subthalamic nucleus. Two main hypotheses for postoperative apathy have been suggested: (i) dopaminergic withdrawal syndrome relative to postoperative dopaminergic drug tapering; and (ii) direct effect of chronic stimulation of the subthalamic nucleus. The primary objective of our study was to describe preoperative and 1-year postoperative apathy in Parkinson's disease patients who underwent chronic bilateral deep brain stimulation of the subthalamic nucleus. We also aimed to identify factors associated with 1-year postoperative apathy considering: (i) preoperative clinical phenotype; (ii) dopaminergic drug management; and (iii) volume of tissue activated within the subthalamic nucleus and the surrounding structures. We investigated a prospective clinical cohort of 367 patients before and 1 year after chronic bilateral deep brain stimulation of the subthalamic nucleus. We assessed apathy using the Lille Apathy Rating Scale and carried out a systematic evaluation of motor, cognitive and behavioural signs. We modelled the volume of tissue activated in 161 patients using the Lead-DBS toolbox and analysed overlaps within motor, cognitive and limbic parts of the subthalamic nucleus. Of the 367 patients, 94 (25.6%) exhibited 1-year postoperative apathy: 67 (18.2%) with 'de novo apathy' and 27 (7.4%) with 'sustained apathy'. We observed disappearance of preoperative apathy in 22 (6.0%) patients, who were classified as having 'reversed apathy'. Lastly, 251 (68.4%) patients had neither preoperative nor postoperative apathy and were classified as having 'no apathy'. We identified preoperative apathy score [odds ratio (OR) 1.16; 95% confidence interval (CI) 1.10, 1.22; P < 0.001], preoperative episodic memory free recall score (OR 0.93; 95% CI 0.88, 0.97; P = 0.003) and 1-year postoperative motor responsiveness (OR 0.98; 95% CI 0.96, 0.99; P = 0.009) as the main factors associated with postoperative apathy. We showed that neither dopaminergic dose reduction nor subthalamic stimulation were associated with postoperative apathy. Patients with 'sustained apathy' had poorer preoperative fronto-striatal cognitive status and a higher preoperative action initiation apathy subscore. In these patients, apathy score and cognitive status worsened postoperatively despite significantly lower reduction in dopamine agonists (P = 0.023), suggesting cognitive dopa-resistant apathy. Patients with 'reversed apathy' benefited from the psychostimulant effect of chronic stimulation of the limbic part of the left subthalamic nucleus (P = 0.043), suggesting motivational apathy. Our results highlight the need for careful preoperative assessment of motivational and cognitive components of apathy as well as executive functions in order to better prevent or manage postoperative apathy.
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Affiliation(s)
- Matthieu Béreau
- Department of Neurology, NS-PARK/F-CRIN network, University Hospital of Besançon, 25030 Besançon Cedex, France
- UR LINC 481, Université de Franche-Comté, F-2500 Besançon, France
| | - Astrid Kibleur
- LIP/PC2S, Université Grenoble Alpes, Université Savoie Mont Blanc, 38040 Grenoble Cedex 9, France
| | - Mathieu Servant
- UR LINC 481, Université de Franche-Comté, F-2500 Besançon, France
| | - Gautier Clément
- Department of Neurology, NS-PARK/F-CRIN network, University Hospital of Besançon, 25030 Besançon Cedex, France
| | - Kathy Dujardin
- Lille Neurosciences and Cognition, CHU-Lille, Neurology and Movement Disorders department, NS-Park/F-CRIN network, Univ. Lille, 59037 Lille, France
| | - Anne-Sophie Rolland
- Lille Neurosciences and Cognition, CHU-Lille, Department of Medical Pharmacology, NS-Park/F-CRIN, Univ. Lille, Inserm, 59045 Lille, France
| | - Thomas Wirth
- Service de Neurologie, NS-Park/F-CRIN network, Hôpitaux Universitaires de Strasbourg et Fédération de Médecine Translationnelle de Médecine de Strasbourg, 67200 Strasbourg, France
- Institut de Génétique et de Biologie Moléculaire et Cellulaire, INSERM-U964/CNRS-UMR7104/Université de Strasbourg, 67400 Illkirch, France
| | - Ouhaid Lagha-Boukbiza
- Service de Neurologie, NS-Park/F-CRIN network, Hôpitaux Universitaires de Strasbourg et Fédération de Médecine Translationnelle de Médecine de Strasbourg, 67200 Strasbourg, France
| | - Jimmy Voirin
- Department of Neurosurgery, NS-PARK/F-CRIN network, Strasbourg University Hospital, 67200 Strasbourg, France
| | - Marie des Neiges Santin
- Department of Neurosurgery, NS-PARK/F-CRIN network, Strasbourg University Hospital, 67200 Strasbourg, France
| | - Elodie Hainque
- Assistance publique Hôpitaux de Paris, Inserm, CNRS, Hôpital Pitié-Salpêtrière, Department of Neurology, NS-Park/F-CRIN network, Sorbonne Université, Paris Brain Institute-ICM, 75014 Paris, France
| | - David Grabli
- Assistance publique Hôpitaux de Paris, Inserm, CNRS, Hôpital Pitié-Salpêtrière, Department of Neurology, NS-Park/F-CRIN network, Sorbonne Université, Paris Brain Institute-ICM, 75014 Paris, France
| | - Alexandre Comte
- UR LINC 481, Université de Franche-Comté, F-2500 Besançon, France
- Centre d'investigation clinique Inserm CIC 1431, CHU Besançon, F-25000 Besançon, France
| | - Sophie Drapier
- Department of Neurology, NS-PARK/F-CRIN network, University Hospital of Rennes, 35000 Rennes, France
| | - Franck Durif
- CNRS, Clermont Auvergne INP, Institut Pascal, Clermont-Ferrand University Hospital, Neurology department, NS-Park/F-CRIN network, Université Clermont Auvergne, 63000 Clermont-Ferrand, France
| | - Ana Marques
- CNRS, Clermont Auvergne INP, Institut Pascal, Clermont-Ferrand University Hospital, Neurology department, NS-Park/F-CRIN network, Université Clermont Auvergne, 63000 Clermont-Ferrand, France
| | - Alexandre Eusebio
- Department of Neurology and Movement Disorders, APHM, Hôpital Universitaire Timone, 13005 Marseille, France
- CNRS, Institut de Neurosciences de la Timone, Aix Marseille Univ., 13005 Marseille, France
| | - Jean-Philippe Azulay
- Department of Neurology and Movement Disorders, APHM, Hôpital Universitaire Timone, 13005 Marseille, France
- CNRS, Institut de Neurosciences de la Timone, Aix Marseille Univ., 13005 Marseille, France
| | - Caroline Giordana
- Department of Neurology, NS-Park/F-CRIN network, Centre Hospitalier Universitaire de Nice, 06002 Nice, France
| | - Jean-Luc Houeto
- Department of Neurology, NS-Park/F-CRIN network, Limoges University Hospital, Inserm, U1094, EpiMaCT-Epidemiology of chronic diseases in tropical zone, Limoges University Hospital,87042 Limoges, France
| | - Béchir Jarraya
- Neuroscience Pole, NS-Park/F-CRIN network, Hôpital Foch, Suresnes, University of Versailles Paris-Saclay, INSERM-CEA NeuroSpin, 91191 Gif-sur-Yvette, France
| | - David Maltete
- Department of Neurology, NS-Park/F-CRIN network, Rouen University Hospital and University of Rouen, 76000 Rouen, France
- INSERM U1239, Laboratory of Neuronal and Neuroendocrine Differentiation and Communication, 76130 Mont-Saint-Aignan, France
| | - Olivier Rascol
- Department of Clinical Pharmacology and Neuroscience, CIC1436, NS-Park/F-CRIN network, NeuroToul Center of Excellence, Toulouse University Hospital, INSERM, CHU of Toulouse, 31000 Toulouse, France
| | - Tiphaine Rouaud
- Department of Neurology, Centre Expert Parkinson, NS-Park/F-CRIN network, CHU Nantes, 44093 Nantes, France
| | - Mélissa Tir
- Department of Neurology, NS-Park/F-CRIN network, Amiens University Hospital, 80000 Amiens, France
| | - Caroline Moreau
- Lille Neurosciences and Cognition, CHU-Lille, Neurology and Movement Disorders department, NS-Park/F-CRIN network, Univ. Lille, 59037 Lille, France
| | - Teodor Danaila
- Department of Neurology, NS-Park/F-CRIN network, Amiens University Hospital, 80000 Amiens, France
| | - Stéphane Prange
- Department of Neurology, NS-Park/F-CRIN network, Amiens University Hospital, 80000 Amiens, France
- Service de Neurologie C, NS-Park/F-CRIN network, Hospices Civils de Lyon, Hôpital Neurologique Pierre Wertheimer, 69500 Bron, France
| | - Laurent Tatu
- Department of Neurology, NS-PARK/F-CRIN network, University Hospital of Besançon, 25030 Besançon Cedex, France
| | - Christine Tranchant
- Service de Neurologie, NS-Park/F-CRIN network, Hôpitaux Universitaires de Strasbourg et Fédération de Médecine Translationnelle de Médecine de Strasbourg, 67200 Strasbourg, France
| | - Jean-Christophe Corvol
- Assistance publique Hôpitaux de Paris, Inserm, CNRS, Hôpital Pitié-Salpêtrière, Department of Neurology, NS-Park/F-CRIN network, Sorbonne Université, Paris Brain Institute-ICM, 75014 Paris, France
| | - David Devos
- Lille Neurosciences and Cognition, CHU-Lille, Neurology and Movement Disorders department, NS-Park/F-CRIN network, Univ. Lille, 59037 Lille, France
- Lille Neurosciences and Cognition, CHU-Lille, Department of Medical Pharmacology, NS-Park/F-CRIN, Univ. Lille, Inserm, 59045 Lille, France
| | - Stephane Thobois
- Service de Neurologie C, NS-Park/F-CRIN network, Hospices Civils de Lyon, Hôpital Neurologique Pierre Wertheimer, 69500 Bron, France
- Institut des Sciences Cognitives Marc Jeannerot, CNRS, UMR5229, 69675 Bron, France
| | - Maxime Desmarets
- Centre d'investigation clinique Inserm CIC 1431, CHU Besançon, F-25000 Besançon, France
- Université de Franche-Comté, EFS, INSERM, UMR RIGHT, 25000 Besançon, France
| | - Mathieu Anheim
- Service de Neurologie, NS-Park/F-CRIN network, Hôpitaux Universitaires de Strasbourg et Fédération de Médecine Translationnelle de Médecine de Strasbourg, 67200 Strasbourg, France
- Institut de Génétique et de Biologie Moléculaire et Cellulaire, INSERM-U964/CNRS-UMR7104/Université de Strasbourg, 67400 Illkirch, France
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Debove I, Paschen S, Amstutz D, Cardoso F, Corvol JC, Fung VSC, Lang AE, Martinez Martin P, Rodríguez-Oroz MC, Weintraub D, Krack P, Deuschl G. Management of Impulse Control and Related Disorders in Parkinson's Disease: An Expert Consensus. Mov Disord 2024; 39:235-248. [PMID: 38234035 DOI: 10.1002/mds.29700] [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: 08/08/2023] [Revised: 10/23/2023] [Accepted: 12/13/2023] [Indexed: 01/19/2024] Open
Abstract
BACKGROUND Impulse-control and related behavioral disorders (ICBDs) significantly impact the lives of Parkinson's disease (PD) patients and caregivers, with lasting consequences if undiagnosed and untreated. While ICBD pathophysiology and risk factors are well-studied, a standardized severity definition and treatment evidence remain elusive. OBJECTIVE This work aimed to establish international expert consensus on ICBD treatment strategies. To comprehensively address diverse treatment availabilities, experts from various continents were included. METHODS From 2021 to 2023, global movement disorders specialists engaged in a Delphi process. A core expert group initiated surveys, involving a larger panel in three iterations, leading to refined severity definitions and treatment pathways. RESULTS Experts achieved consensus on defining ICBD severity, emphasizing regular PD patient screenings for early detection. General treatment recommendations focused on continuous monitoring, collaboration with significant others, and seeking specialist advice for legal or financial challenges. For mild to severe ICBDs, gradual reduction in dopamine agonists was endorsed, followed by reductions in other PD medications. Second-line treatment strategies included diverse approaches like reversing the last medication change, cognitive behavior therapy, subthalamic nucleus deep brain stimulation, and specific medications like quetiapine, clozapine, and antidepressants. The panel reached consensus on distinct treatment pathways for punding and dopamine dysregulation syndrome, formulating therapy recommendations. Comprehensive discussions addressed management strategies for the exacerbation of either motor or non-motor symptoms following the proposed treatments. CONCLUSION The consensus offers in-depth insights into ICBD management, presenting clear severity criteria and expert consensus treatment recommendations. The study highlights the critical need for further research to enhance ICBD management. © 2024 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Ines Debove
- Department of Neurology, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland
| | - Steffen Paschen
- Department of Neurology, University Hospital Schleswig-Holstein, Christian-Albrechts-University, Kiel, Germany
| | - Deborah Amstutz
- Department of Neurology, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland
| | - Francisco Cardoso
- Movement Disorders Unit, Neurology Service, Internal Medicine Department, The Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Jean-Christophe Corvol
- Department of Neurology, Sorbonne Université, Paris Brain Institute (ICM), Inserm, CNRS, Assistance Publique Hôpitaux de Paris, Hôpital Pitié-Salpêtrière, Paris, France
| | - Victor S C Fung
- Movement Disorders Unit, Department of Neurology, Westmead Hospital and Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - Anthony E Lang
- Division of Neurology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Edmond J. Safra Program in Parkinson's Disease and the Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| | - Pablo Martinez Martin
- Center for Networked Biomedical Research in Neurodegenerative Diseases (CIBERNED), Carlos III Institute of Health, Madrid, Spain
| | | | - Daniel Weintraub
- Departments of Psychiatry and Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Parkinson's Disease Research, Education and Clinical Center (PADRECC and MIRECC), Philadelphia Veterans Affairs Medical Center, Philadelphia, Pennsylvania, USA
| | - Paul Krack
- Department of Neurology, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland
| | - Günther Deuschl
- Department of Neurology, University Hospital Schleswig-Holstein, Christian-Albrechts-University, Kiel, Germany
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14
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Magalhães AD, Amstutz D, Petermann K, Debove I, Sousa M, Maradan-Gachet ME, Lachenmayer ML, Waskönig J, Murcia-Carretero S, Diamantaras AA, Tinkhauser G, Nowacki A, Pollo C, Rodriguez-Blazquez C, Martinez-Martin P, Krack P. Subthalamic stimulation has acute psychotropic effects and improves neuropsychiatric fluctuations in Parkinson's disease. BMJ Neurol Open 2024; 6:e000524. [PMID: 38196982 PMCID: PMC10773312 DOI: 10.1136/bmjno-2023-000524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/24/2023] [Indexed: 01/11/2024] Open
Abstract
Background Subthalamic nucleus deep brain stimulation (STN-DBS) is a well-established treatment for motor complications in Parkinson's disease (PD). However, its effects on neuropsychiatric symptoms remain disputed. The aim of this study was to evaluate the effects of STN-DBS on neuropsychiatric symptoms in PD. Methods We retrospectively assessed 26 patients with PD who underwent a preoperative levodopa challenge and postoperative levodopa and stimulation challenges 1 year after STN-DBS. Based on the Neuropsychiatric Fluctuations Scale, Neuropsychiatric State Scores and Neuropsychiatric Fluctuation Indices (NFIs) were calculated. Mixed-effects models with random effects for intercept were used to examine the association of Neuropsychiatric State Score and NFI with the different assessment conditions. Results In acute challenge conditions, there was an estimated increase of 15.9 points in the Neuropsychiatric State Score in stimulation ON conditions (95% CI 11.4 to 20.6, p<0.001) and 7.6 points in medication ON conditions (95% CI 3.3 to 11.9, p<0.001). Neuropsychiatric fluctuations induced by levodopa, quantified with NFI, decreased by 35.54% (95% CI 49.3 to 21.8, p<0.001) 1 year after STN-DBS. Conclusions Bilateral STN-DBS at therapeutic parameters has acute psychotropic effects similar to levodopa and can modulate and decrease levodopa-induced neuropsychiatric fluctuations.
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Affiliation(s)
- Andreia D Magalhães
- Department of Neurology, Inselspital University Hospital Bern, Bern, Switzerland
| | - Deborah Amstutz
- Department of Neurology, Inselspital University Hospital Bern, Bern, Switzerland
- Graduate School for Health Sciences, University of Bern, Bern, Switzerland
| | - Katrin Petermann
- Department of Neurology, Inselspital University Hospital Bern, Bern, Switzerland
| | - Ines Debove
- Department of Neurology, Inselspital University Hospital Bern, Bern, Switzerland
| | - Mário Sousa
- Department of Neurology, Inselspital University Hospital Bern, Bern, Switzerland
- Graduate School for Health Sciences, University of Bern, Bern, Switzerland
| | - Marie E Maradan-Gachet
- Department of Neurology, Inselspital University Hospital Bern, Bern, Switzerland
- Graduate School for Health Sciences, University of Bern, Bern, Switzerland
| | | | - Julia Waskönig
- Department of Neurology, Inselspital University Hospital Bern, Bern, Switzerland
| | | | | | - Gerd Tinkhauser
- Department of Neurology, Inselspital University Hospital Bern, Bern, Switzerland
| | - Andreas Nowacki
- Department of Neurosurgery, Inselspital University Hospital Bern, Bern, Switzerland
| | - Claudio Pollo
- Department of Neurosurgery, Inselspital University Hospital Bern, Bern, Switzerland
| | - Carmen Rodriguez-Blazquez
- National Epidemiology Center, Carlos III Health Institute, Madrid, Spain
- Center for Networked Biomedical Research in Neurodegenerative Diseases (CIBERNED), Carlos III Health Institute, Madrid, Spain
| | - Pablo Martinez-Martin
- Center for Networked Biomedical Research in Neurodegenerative Diseases (CIBERNED), Carlos III Health Institute, Madrid, Spain
| | - Paul Krack
- Department of Neurology, Inselspital University Hospital Bern, Bern, Switzerland
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El Ouadih Y, Marques A, Pereira B, Luisoni M, Claise B, Coste J, Sontheimer A, Chaix R, Debilly B, Derost P, Morand D, Durif F, Lemaire JJ. Deep brain stimulation of the subthalamic nucleus in severe Parkinson's disease: relationships between dual-contact topographic setting and 1-year worsening of speech and gait. Acta Neurochir (Wien) 2023; 165:3927-3941. [PMID: 37889334 DOI: 10.1007/s00701-023-05843-9] [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: 01/17/2023] [Accepted: 06/24/2023] [Indexed: 10/28/2023]
Abstract
BACKGROUND Subthalamic nucleus (STN) deep brain stimulation (DBS) alleviates severe motor fluctuations and dyskinesia in Parkinson's disease, but may result in speech and gait disorders. Among the suspected or demonstrated causes of these adverse effects, we focused on the topography of contact balance (CB; individual, right and left relative dual positions), a scantly studied topic, analyzing the relationships between symmetric or non-symmetric settings, and the worsening of these signs. METHOD An observational monocentric study was conducted on a series of 92 patients after ethical approval. CB was specified by longitudinal and transversal positions and relation to the STN (CB sub-aspects) and totalized at the patient level (patient CB). CB was deemed symmetric when the two contacts were at the same locations relative to the STN. CB was deemed asymmetric when at least one sub-aspect differed in the patient CB. Baseline and 1-year characteristics were routinely collected: (i) general, namely, Unified Parkinson's Disease Rating Scores (UPDRS), II, III motor and IV, daily levodopa equivalent doses, and Parkinson's Disease Questionnaire of Quality of Life (PDQ39) scores; (ii) specific, namely scores for speech (II-5 and III-18) and axial signs (II-14, III-28, III-29, and III-30). Only significant correlations were considered (p < 0.05). RESULTS Baseline characteristics were comparable (symmetric versus asymmetric). CB settings were related to deteriorations of speech and axial signs: communication PDQ39 and UPDRS speech and gait scores worsened exclusively with symmetric settings; the most influential CB sub-aspect was symmetric longitudinal position. CONCLUSION Our findings suggest that avoiding symmetric CB settings, whether by electrode positioning or shaping of electric fields, could reduce worsening of speech and gait.
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Affiliation(s)
- Youssef El Ouadih
- Université Clermont Auvergne, Clermont Auvergne INP, CHU Clermont-Ferrand, CNRS, Institut Pascal, 63000, Clermont-Ferrand, France
- Service de Neurochirurgie, CHU Clermont-Ferrand, 63000, Clermont-Ferrand, France
| | - Ana Marques
- Université Clermont Auvergne, Clermont Auvergne INP, CHU Clermont-Ferrand, CNRS, Institut Pascal, 63000, Clermont-Ferrand, France
- Service de Neurologie, CHU Clermont-Ferrand, 63000, Clermont-Ferrand, France
| | - Bruno Pereira
- Direction de La Recherche Clinique Et de L'Innovation, CHU Clermont-Ferrand, 63000, Clermont-Ferrand, France
| | - Maxime Luisoni
- Université Clermont Auvergne, Clermont Auvergne INP, CHU Clermont-Ferrand, CNRS, Institut Pascal, 63000, Clermont-Ferrand, France
| | - Béatrice Claise
- Service de Radiologie, Unité de Neuroradiologie, CHU Clermont-Ferrand, 63000, Clermont-Ferrand, France
| | - Jérôme Coste
- Université Clermont Auvergne, Clermont Auvergne INP, CHU Clermont-Ferrand, CNRS, Institut Pascal, 63000, Clermont-Ferrand, France
- Service de Neurochirurgie, CHU Clermont-Ferrand, 63000, Clermont-Ferrand, France
| | - Anna Sontheimer
- Université Clermont Auvergne, Clermont Auvergne INP, CHU Clermont-Ferrand, CNRS, Institut Pascal, 63000, Clermont-Ferrand, France
- Service de Neurochirurgie, CHU Clermont-Ferrand, 63000, Clermont-Ferrand, France
| | - Rémi Chaix
- Université Clermont Auvergne, Clermont Auvergne INP, CHU Clermont-Ferrand, CNRS, Institut Pascal, 63000, Clermont-Ferrand, France
- Service de Neurochirurgie, CHU Clermont-Ferrand, 63000, Clermont-Ferrand, France
| | - Bérangère Debilly
- Service de Neurologie, CHU Clermont-Ferrand, 63000, Clermont-Ferrand, France
| | - Philippe Derost
- Service de Neurologie, CHU Clermont-Ferrand, 63000, Clermont-Ferrand, France
| | - Dominique Morand
- Direction de La Recherche Clinique Et de L'Innovation, CHU Clermont-Ferrand, 63000, Clermont-Ferrand, France
| | - Franck Durif
- Université Clermont Auvergne, Clermont Auvergne INP, CHU Clermont-Ferrand, CNRS, Institut Pascal, 63000, Clermont-Ferrand, France
- Service de Neurologie, CHU Clermont-Ferrand, 63000, Clermont-Ferrand, France
| | - Jean-Jacques Lemaire
- Université Clermont Auvergne, Clermont Auvergne INP, CHU Clermont-Ferrand, CNRS, Institut Pascal, 63000, Clermont-Ferrand, France.
- Service de Neurochirurgie, CHU Clermont-Ferrand, 63000, Clermont-Ferrand, France.
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Marques A, Macias E, Pereira B, Durand E, Chassain C, Vidal T, Defebvre L, Carriere N, Fraix V, Moro E, Thobois S, Metereau E, Mangone G, Vidailhet M, Corvol JC, Lehéricy S, Menjot de Champfleur N, Geny C, Spampinato U, Meissner WG, Frismand S, Schmitt E, Doé de Maindreville A, Portefaix C, Remy P, Fénelon G, Houeto JL, Colin O, Rascol O, Peran P, Bonny JM, Fantini ML, Durif F. Volumetric changes and clinical trajectories in Parkinson's disease: a prospective multicentric study. J Neurol 2023; 270:6033-6043. [PMID: 37648911 DOI: 10.1007/s00415-023-11947-0] [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: 03/15/2023] [Revised: 05/15/2023] [Accepted: 08/16/2023] [Indexed: 09/01/2023]
Abstract
BACKGROUND Longitudinal measures of structural brain changes using MRI in relation to clinical features and progression patterns in PD have been assessed in previous studies, but few were conducted in well-defined and large cohorts, including prospective clinical assessments of both motor and non-motor symptoms. OBJECTIVE We aimed to identify brain volumetric changes characterizing PD patients, and determine whether regional brain volumetric characteristics at baseline can predict motor, psycho-behavioral and cognitive evolution at one year in a prospective cohort of PD patients. METHODS In this multicentric 1 year longitudinal study, PD patients and healthy controls from the MPI-R2* cohort were assessed for demographical, clinical and brain volumetric characteristics. Distinct subgroups of PD patients according to motor, cognitive and psycho-behavioral evolution were identified at the end of follow-up. RESULTS One hundred and fifty PD patients and 73 control subjects were included in our analysis. Over one year, there was no significant difference in volume variations between PD and control subjects, regardless of the brain region considered. However, we observed a reduction in posterior cingulate cortex volume at baseline in PD patients with motor deterioration at one year (p = 0.017). We also observed a bilateral reduction of the volume of the amygdala (p = 0.015 and p = 0.041) and hippocampus (p = 0.015 and p = 0.053) at baseline in patients with psycho-behavioral deterioration, regardless of age, dopaminergic treatment and center. CONCLUSION Brain volumetric characteristics at baseline may predict clinical trajectories at 1 year in PD as posterior cingulate cortex atrophy was associated with motor decline, while amygdala and hippocampus atrophy were associated with psycho-behavioral decline.
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Affiliation(s)
- Ana Marques
- University Clermont Auvergne, CNRS, Clermont Auvergne INP, IGCNC, Institute Pascal, Clermont-Ferrand, France.
- Neurology Department and NS-PARK/FCRIN Network, Clermont-Ferrand University Hospital, Clermont-Ferrand, France.
- Neurology Department, Parkinson Expert Center, CHRU Gabriel Montpied, 63000, Clermont-Ferrand, France.
| | - Elise Macias
- University Clermont Auvergne, CNRS, Clermont Auvergne INP, IGCNC, Institute Pascal, Clermont-Ferrand, France
- Neurology Department and NS-PARK/FCRIN Network, Clermont-Ferrand University Hospital, Clermont-Ferrand, France
| | - Bruno Pereira
- Clermont-Ferrand University Hospital, Biostatistics Unit (DRCI), Clermont-Ferrand, France
| | - Elodie Durand
- University Clermont Auvergne, CNRS, Clermont Auvergne INP, IGCNC, Institute Pascal, Clermont-Ferrand, France
- Neurology Department and NS-PARK/FCRIN Network, Clermont-Ferrand University Hospital, Clermont-Ferrand, France
| | - Carine Chassain
- University Clermont Auvergne, CNRS, Clermont Auvergne INP, IGCNC, Institute Pascal, Clermont-Ferrand, France
- Neurology Department and NS-PARK/FCRIN Network, Clermont-Ferrand University Hospital, Clermont-Ferrand, France
| | - Tiphaine Vidal
- University Clermont Auvergne, CNRS, Clermont Auvergne INP, IGCNC, Institute Pascal, Clermont-Ferrand, France
- Neurology Department and NS-PARK/FCRIN Network, Clermont-Ferrand University Hospital, Clermont-Ferrand, France
| | - Luc Defebvre
- Department of Movement Disorder and NS-PARK/FCRIN Network, Inserm 1172, University of Lille, Lille, France
| | - Nicolas Carriere
- Department of Movement Disorder and NS-PARK/FCRIN Network, Inserm 1172, University of Lille, Lille, France
| | - Valerie Fraix
- Université Grenoble Alpes, CHU de Grenoble, Service de Neurologie, Grenoble Institute of Neuroscience, and NS-PARK/FCRIN Network, Grenoble, France
| | - Elena Moro
- Université Grenoble Alpes, CHU de Grenoble, Service de Neurologie, Grenoble Institute of Neuroscience, and NS-PARK/FCRIN Network, Grenoble, France
| | - Stéphane Thobois
- CNRS, Institut des Sciences Cognitives Marc Jeannerod, UMR 5229 CNRS, Lyon, France
- Université Claude Bernard, Lyon I, Lyon, France
- Hospices Civils de Lyon, Hôpital Neurologique Pierre Wertheimer, Service de Neurologie C and NS-PARK/FCRIN Network, Lyon, France
| | - Elise Metereau
- CNRS, Institut des Sciences Cognitives Marc Jeannerod, UMR 5229 CNRS, Lyon, France
- Université Claude Bernard, Lyon I, Lyon, France
- Hospices Civils de Lyon, Hôpital Neurologique Pierre Wertheimer, Service de Neurologie C and NS-PARK/FCRIN Network, Lyon, France
| | - Graziella Mangone
- Département de Neurologie and NS-PARK/FCRIN Network, Sorbonne Université; Institut du Cerveau-ICM, Assistance Publique Hôpitaux de Paris; Inserm 1127, CNRS 7225, CIC Neurosciences, Hôpital Pitié-Salpêtrière, Paris, France
| | - Marie Vidailhet
- Département de Neurologie and NS-PARK/FCRIN Network, Sorbonne Université; Institut du Cerveau-ICM, Assistance Publique Hôpitaux de Paris; Inserm 1127, CNRS 7225, CIC Neurosciences, Hôpital Pitié-Salpêtrière, Paris, France
| | - Jean-Christophe Corvol
- Département de Neurologie and NS-PARK/FCRIN Network, Sorbonne Université; Institut du Cerveau-ICM, Assistance Publique Hôpitaux de Paris; Inserm 1127, CNRS 7225, CIC Neurosciences, Hôpital Pitié-Salpêtrière, Paris, France
| | - Stéphane Lehéricy
- Département de Neuroradiologie and NS-PARK/FCRIN Network, Sorbonne Université; Institut du Cerveau-ICM, Assistance Publique Hôpitaux de Paris; Inserm 1127, CNRS 7225; Hôpital Pitié-Salpêtrière, Paris, France
| | - Nicolas Menjot de Champfleur
- Department of Neuroradiology, Montpellier University Hospital Center, Gui de Chauliac Hospital, Montpellier, France
- I2FH, Institut d'Imagerie Fonctionnelle Humaine, Hôpital Gui de Chauliac, CHRU de Montpellier, Montpellier, France
| | - Christian Geny
- Department of Geriatrics and NS-PARK/FCRIN Network, Montpellier University Hospital, Montpellier University, Montpellier, France
| | - Umberto Spampinato
- Service de Neurologie-Maladies Neurodégénératives and NS-PARK/FCRIN Network, CHU Bordeaux, 33000, Bordeaux, France
- INCIA-UMR 5287, Team P3TN, CNRS/Université de Bordeaux, Bordeaux, France
| | - Wassilios G Meissner
- Service de Neurologie-Maladies Neurodégénératives and NS-PARK/FCRIN Network, CHU Bordeaux, 33000, Bordeaux, France
- Univ. Bordeaux, CNRS, IMN, UMR 5293, Bordeaux, 33000, Bordeaux, France
- Dept. Medicine, University of Otago, Christchurch, New Zealand
- New Zealand Brain Research Institute, Christchurch, New Zealand
| | - Solène Frismand
- Department of Neurology and NS-PARK/FCRIN Network, Nancy University Hospital Center, Nancy, France
| | - Emmanuelle Schmitt
- Department of Neuroradiology, Nancy University Hospital Center, Nancy, France
| | | | - Christophe Portefaix
- Department of Radiology, Hôpital Maison Blanche, Reims, France
- CReSTIC Laboratory, University of Reims Champagne-Ardenne, Reims, France
| | - Philippe Remy
- Centre Expert Parkinson and NS-PARK/FCRIN Network, CHU Henri Mondor; AP-HP et Equipe Neuropsychologie Interventionnelle, INSERM-IMRB, Faculté de Santé, Université Paris-Est Créteil et Ecole Normale Supérieure Paris Sorbonne Université, Créteil, France
| | - Gilles Fénelon
- Centre Expert Parkinson and NS-PARK/FCRIN Network, CHU Henri Mondor; AP-HP et Equipe Neuropsychologie Interventionnelle, INSERM-IMRB, Faculté de Santé, Université Paris-Est Créteil et Ecole Normale Supérieure Paris Sorbonne Université, Créteil, France
| | - Jean Luc Houeto
- INSERM, CHU de Poitiers, Université de Poitiers, Centre d'Investigation Clinique CIC1402; Service de Neurologie and NS-PARK/FCRIN Network, Poitiers, France
- CHU-Centre Expert Parkinson de Limoges, Limoges, France
| | - Olivier Colin
- INSERM, CHU de Poitiers, Université de Poitiers, Centre d'Investigation Clinique CIC1402; Service de Neurologie and NS-PARK/FCRIN Network, CH Brive la Gaillarde, Poitiers, France
| | - Olivier Rascol
- Centre Expert Parkinson, Départements de Pharmacologie Clinique et Neurosciences, Centre d'Investigation Clinique CIC 1436, UMR 1214 TONIC, NeuroToul and NS-PARK/FCRIN Network, INSERM, CHU de Toulouse et Université de Toulouse3, Toulouse, France
| | - Patrice Peran
- ToNIC, Toulouse NeuroImaging Center, Université de Toulouse, INSERM, UPS, Toulouse, France
| | - Jean-Marie Bonny
- INRAE, UR QuaPA, 63122, Saint-Genès-Champanelle, France
- Nuclear Magnetic Resonance Facility for Agronomy, Food and Health, AgroResonance, INRAE, 2018, Saint-Genès-Champanelle, France
| | - Maria Livia Fantini
- University Clermont Auvergne, CNRS, Clermont Auvergne INP, IGCNC, Institute Pascal, Clermont-Ferrand, France
- Neurology Department and NS-PARK/FCRIN Network, Clermont-Ferrand University Hospital, Clermont-Ferrand, France
| | - Franck Durif
- University Clermont Auvergne, CNRS, Clermont Auvergne INP, IGCNC, Institute Pascal, Clermont-Ferrand, France
- Neurology Department and NS-PARK/FCRIN Network, Clermont-Ferrand University Hospital, Clermont-Ferrand, France
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Hernandez‐Con P, Lin I, Mamikonyan E, Deeb W, Feldman R, Althouse A, Barmore R, Eisinger RS, Spindler M, Okun MS, Weintraub D, Chahine LM. Course of Impulse Control Disorder Symptoms in Parkinson's Disease: Deep Brain Stimulation Versus Medications. Mov Disord Clin Pract 2023; 10:903-913. [PMID: 37332637 PMCID: PMC10272921 DOI: 10.1002/mdc3.13738] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 02/22/2023] [Accepted: 03/18/2023] [Indexed: 06/20/2023] Open
Abstract
Background The effect of surgery on impulse control disorders (ICDs) remains unclear in Parkinson's disease (PD) patients undergoing deep brain stimulation (DBS). Objective To examine changes in ICD symptoms in PD patients undergoing DBS compared to a medication-only control group. Methods The study was a 2-center, 12-month, prospective, observational investigation of PD patients undergoing DBS and a control group matched on age, sex, dopamine agonist use, and baseline presence of ICDs. Questionnaire for Impulsive-Compulsive Disorders in Parkinson's Disease-Rating Scale (QUIP-RS) and total levodopa equivalent daily dose (LEDD) were collected at baseline, 3, 6, and 12 months. Linear mixed-effects models assessed changes in mean QUIP-RS score (sum of buying, eating, gambling, and hypersexuality items). Results The cohort included 54 participants (DBS = 26, controls = 28), mean (SD) age 64.3 (8.1) and PD duration 8.0 (5.2) years. Mean baseline QUIP-RS was higher in the DBS group at baseline (8.6 (10.7) vs. 5.3 (6.9), P = 0.18). However, scores at 12 months follow-up were nearly identical (6.6 (7.3) vs. 6.0 (6.9) P = 0.79). Predictors of change in QUIP-RS score were baseline QUIP-RS score (β = 0.483, P < 0.001) and time-varying LEDD (β = 0.003, P = 0.02). Eight patients (four in each group) developed de novo ICD symptoms during follow-up, although none met diagnostic criteria for an impulse control disorder. Conclusions ICD symptoms (including de novo symptoms) at 12 months follow-up were similar between PD patients undergoing DBS and patients treated with pharmacological therapy only. Monitoring for emergence of ICD symptoms is important in both surgically- and medication-only-treated PD patients.
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Affiliation(s)
- Pilar Hernandez‐Con
- Department of Pharmaceutical Outcomes and PolicyUniversity of FloridaGainesvilleFloridaUSA
| | - Iris Lin
- Department of NeurologyUniversity of CincinnatiCincinnatiOhioUSA
| | - Eugenia Mamikonyan
- Department of PsychiatryUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Wissam Deeb
- Department of NeurologyUniversity of MassachusettsAmherstMassachusettsUSA
| | - Robert Feldman
- Center for Research on Health Care Data CenterUniversity of PittsburghPittsburghPennsylvaniaUSA
| | - Andrew Althouse
- Center for Research on Health Care Data CenterUniversity of PittsburghPittsburghPennsylvaniaUSA
| | - Ryan Barmore
- Department of NeurologyBanner HealthPhoenixArizonaUSA
| | - Robert S. Eisinger
- Department of NeurologyUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
- Department of NeurologyNorman Fixel Institute for Neurological Diseases, University of FloridaGainesvilleFloridaUSA
| | - Meredith Spindler
- Department of NeurologyUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Michael S. Okun
- Department of NeurologyNorman Fixel Institute for Neurological Diseases, University of FloridaGainesvilleFloridaUSA
| | - Daniel Weintraub
- Department of PsychiatryUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
- Department of NeurologyUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Lana M. Chahine
- Department of NeurologyUniversity of PittsburghPittsburghPennsylvaniaUSA
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18
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Jost ST, Konitsioti A, Loehrer PA, Ashkan K, Rizos A, Sauerbier A, Dos Santos Ghilardi MG, Rosenkranz F, Strobel L, Gronostay A, Barbe MT, Evans J, Visser-Vandewalle V, Nimsky C, Fink GR, Silverdale M, Cury RG, Fonoff ET, Antonini A, Chaudhuri KR, Timmermann L, Martinez-Martin P, Dafsari HS. Non-motor effects of deep brain stimulation in Parkinson's disease motor subtypes. Parkinsonism Relat Disord 2023; 109:105318. [PMID: 36842866 DOI: 10.1016/j.parkreldis.2023.105318] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 01/20/2023] [Accepted: 02/05/2023] [Indexed: 02/11/2023]
Abstract
INTRODUCTION Deep brain stimulation (DBS) is a well-established treatment for patients with Parkinson's disease (PD) improving quality of life, motor, and non-motor symptoms. However, non-motor effects in PD subtypes are understudied. We hypothesized that patients with 'postural instability and gait difficulty' (PIGD) experience more beneficial non-motor effects than 'tremor-dominant' patients undergoing DBS for PD. METHODS In this prospective, observational, international multicentre study with a 6-month follow-up, we assessed the Non-Motor Symptom Scale (NMSS) as primary and the following secondary outcomes: Unified PD Rating Scale-motor examination (UPDRS-III), Scales for Outcomes in PD (SCOPA)-activities of daily living (ADL) and -motor complications, PDQuestionnaire-8 (PDQ-8), and levodopa-equivalent daily dose (LEDD). We analysed within-group longitudinal changes with Wilcoxon signed-rank test and Benjamini-Hochberg correction for multiple comparisons. Additionally, we explored outcome between-group differences of motor subtypes with Mann-Whitney U-tests. RESULTS In 82 PIGD and 33 tremor-dominant patients included in this study, baseline NMSS total scores were worse in PIGD patients, both groups experienced postoperative improvements of the NMSS sleep/fatigue domain, and between-group differences in postoperative outcomes were favourable in the PIGD group for the NMSS total and miscellaneous domain scores. CONCLUSIONS This study provides evidence of a favourable outcome of total non-motor burden in PIGD compared to tremor-dominant patients undergoing DBS for PD. These differences of clinical efficacy on non-motor aspects should be considered when advising and monitoring patients with PD undergoing DBS.
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Affiliation(s)
- Stefanie T Jost
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Neurology, Cologne, Germany.
| | - Agni Konitsioti
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Neurology, Cologne, Germany
| | - Philipp A Loehrer
- University Hospital Giessen and Marburg, Campus Marburg, Department of Neurology, Marburg, Germany
| | - Keyoumars Ashkan
- Parkinson Foundation International Centre of Excellence, King's College Hospital, London, United Kingdom
| | - Alexandra Rizos
- Parkinson Foundation International Centre of Excellence, King's College Hospital, London, United Kingdom
| | - Anna Sauerbier
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Neurology, Cologne, Germany
| | - Maria Gabriela Dos Santos Ghilardi
- Division of Functional Neurosurgery of Institute of Psychiatry, Department of Neurology, University of São Paulo Medical School, São Paulo, Brazil
| | - Franz Rosenkranz
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Neurology, Cologne, Germany
| | - Lena Strobel
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Neurology, Cologne, Germany
| | - Alexandra Gronostay
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Neurology, Cologne, Germany
| | - Michael T Barbe
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Neurology, Cologne, Germany
| | - Julian Evans
- Department of Neurology and Neurosurgery, Salford Royal NHS Foundation Trust, Manchester Academic Health Science Centre, Greater Manchester, UK
| | - Veerle Visser-Vandewalle
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Stereotactic and Functional Neurosurgery, Cologne, Germany
| | | | - Gereon R Fink
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Neurology, Cologne, Germany; Cognitive Neuroscience, Institute of Neuroscience and Medicine (INM-3), Research Centre Jülich, Jülich, Germany
| | - Monty Silverdale
- Department of Neurology and Neurosurgery, Salford Royal NHS Foundation Trust, Manchester Academic Health Science Centre, Greater Manchester, UK
| | - Rubens G Cury
- Division of Functional Neurosurgery of Institute of Psychiatry, Department of Neurology, University of São Paulo Medical School, São Paulo, Brazil
| | - Erich T Fonoff
- Division of Functional Neurosurgery of Institute of Psychiatry, Department of Neurology, University of São Paulo Medical School, São Paulo, Brazil
| | - Angelo Antonini
- Parkinson and Movement Disorders Unit, Department of Neurosciences (DNS), University of Padua, Padova, Italy
| | - K Ray Chaudhuri
- Parkinson Foundation International Centre of Excellence, King's College Hospital, London, United Kingdom; Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom; NIHR Mental Health Biomedical Research Centre and Dementia Biomedical Research Unit, South London and Maudsley NHS Foundation Trust and King's College London, United Kingdom
| | - Lars Timmermann
- University Hospital Giessen and Marburg, Campus Marburg, Department of Neurology, Marburg, Germany
| | - Pablo Martinez-Martin
- Center for Networked Biomedical Research in Neurodegenerative Diseases (CIBERNED), Carlos III Institute of Health, Madrid, Spain
| | - Haidar S Dafsari
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Neurology, Cologne, Germany.
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19
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Pinto S, Nebel A, Rau J, Espesser R, Maillochon P, Niebuhr O, Krack P, Witjas T, Ghio A, Cuartero MC, Timmermann L, Schnitzler A, Hesekamp H, Meier N, Müllner J, Hälbig TD, Möller B, Paschen S, Paschen L, Volkmann J, Barbe MT, Fink GR, Becker J, Reker P, Kühn AA, Schneider GH, Fraix V, Seigneuret E, Kistner A, Rascol O, Brefel-Courbon C, Ory-Magne F, Hartmann CJ, Wojtecki L, Fradet A, Maltête D, Damier P, Le Dily S, Sixel-Döring F, Benecke P, Weiss D, Wächter T, Pinsker MO, Régis J, Thobois S, Polo G, Houeto JL, Hartmann A, Knudsen K, Vidailhet M, Schüpbach M, Deuschl G. Results of a Randomized Clinical Trial of Speech After Early Neurostimulation in Parkinson's Disease. Mov Disord 2023; 38:212-222. [PMID: 36461899 DOI: 10.1002/mds.29282] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 11/03/2022] [Accepted: 11/06/2022] [Indexed: 12/07/2022] Open
Abstract
BACKGROUND The EARLYSTIM trial demonstrated for Parkinson's disease patients with early motor complications that deep brain stimulation of the subthalamic nucleus (STN-DBS) and best medical treatment (BMT) was superior to BMT alone. OBJECTIVE This prospective, ancillary study on EARLYSTIM compared changes in blinded speech intelligibility assessment between STN-DBS and BMT over 2 years, and secondary outcomes included non-speech oral movements (maximum phonation time [MPT], oral diadochokinesis), physician- and patient-reported assessments. METHODS STN-DBS (n = 102) and BMT (n = 99) groups underwent assessments on/off medication at baseline and 24 months (in four conditions: on/off medication, ON/OFF stimulation-for STN-DBS). Words and sentences were randomly presented to blinded listeners, and speech intelligibility rate was measured. Statistical analyses compared changes between the STN-DBS and BMT groups from baseline to 24 months. RESULTS Over the 2-year period, changes in speech intelligibility and MPT, as well as patient-reported outcomes, were not different between groups, either off or on medication or OFF or ON stimulation, but most outcomes showed a nonsignificant trend toward worsening in both groups. Change in oral diadochokinesis was significantly different between STN-DBS and BMT groups, on medication and OFF STN-DBS, with patients in the STN-DBS group performing slightly worse than patients under BMT only. A signal for clinical worsening with STN-DBS was found for the individual speech item of the Unified Parkinson's Disease Rating Scale, Part III. CONCLUSION At this early stage of the patients' disease, STN-DBS did not result in a consistent deterioration in blinded speech intelligibility assessment and patient-reported communication, as observed in studies of advanced Parkinson's Disease. © 2022 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Serge Pinto
- Aix-Marseille Univ, CNRS, LPL, Aix-en-Provence, France
| | - Adelheid Nebel
- Department of Neurology, University Medical Center Schleswig-Holstein, Christian-Albrechts-University, Kiel, Germany
| | - Jörn Rau
- Coordinating Centre for Clinical Trials of the Philipps-University of Marburg, Marburg, Germany
| | | | | | - Oliver Niebuhr
- Department of Scandinavian Studies, Frisian, and General Linguistics, Kiel University, Kiel, Germany
| | - Paul Krack
- Department of Neurology or Neurosurgery, Grenoble University Hospital, Grenoble Alpes University, Grenoble Institut des Neurosciences, Grenoble, France
| | - Tatiana Witjas
- Aix Marseille Univ, APHM, La Timone, Neurology Department or Department of Functional and Stereotactic Neurosurgery and Radiosurgery, Marseille, France
| | - Alain Ghio
- Aix-Marseille Univ, CNRS, LPL, Aix-en-Provence, France
| | | | - Lars Timmermann
- Department of Neurology, University Hospital Cologne, Cologne, Germany
| | - Alfons Schnitzler
- Department of Neurology and Institute of Clinical Neuroscience and Medical Psychology, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany
| | - Helke Hesekamp
- Department of Neurology, Pitié-Salpêtrière Hospital, Assistance Publique Hôpitaux de Paris (APHP), INSERM, Institut du Cerveau et de la Moelle Epinière, and Centre d'Investigation Clinique (CIC), Paris, France
| | - Niklaus Meier
- Department of Neurology, Pitié-Salpêtrière Hospital, Assistance Publique Hôpitaux de Paris (APHP), INSERM, Institut du Cerveau et de la Moelle Epinière, and Centre d'Investigation Clinique (CIC), Paris, France
| | - Julia Müllner
- Department of Neurology, Pitié-Salpêtrière Hospital, Assistance Publique Hôpitaux de Paris (APHP), INSERM, Institut du Cerveau et de la Moelle Epinière, and Centre d'Investigation Clinique (CIC), Paris, France
| | - Thomas D Hälbig
- Department of Neurology, Pitié-Salpêtrière Hospital, Assistance Publique Hôpitaux de Paris (APHP), INSERM, Institut du Cerveau et de la Moelle Epinière, and Centre d'Investigation Clinique (CIC), Paris, France
| | - Bettina Möller
- Department of Neurology, University Medical Center Schleswig-Holstein, Christian-Albrechts-University, Kiel, Germany
| | - Steffen Paschen
- Department of Neurology, University Medical Center Schleswig-Holstein, Christian-Albrechts-University, Kiel, Germany
| | - Laura Paschen
- Department of Neurology, University Medical Center Schleswig-Holstein, Christian-Albrechts-University, Kiel, Germany
| | - Jens Volkmann
- Department of Neurology, University Medical Center Schleswig-Holstein, Christian-Albrechts-University, Kiel, Germany
| | - Michael T Barbe
- Department of Neurology, University Hospital Cologne, Cologne, Germany
| | - Gereon R Fink
- Department of Neurology, University Hospital Cologne, Cologne, Germany
| | - Johannes Becker
- Department of Neurology, University Hospital Cologne, Cologne, Germany
| | - Paul Reker
- Department of Neurology, University Hospital Cologne, Cologne, Germany
| | - Andrea A Kühn
- Department of Neurology, Charité Hospital, Berlin University, Berlin, Germany
| | | | - Valérie Fraix
- Department of Neurology or Neurosurgery, Grenoble University Hospital, Grenoble Alpes University, Grenoble Institut des Neurosciences, Grenoble, France
| | - Eric Seigneuret
- Department of Neurology or Neurosurgery, Grenoble University Hospital, Grenoble Alpes University, Grenoble Institut des Neurosciences, Grenoble, France
| | - Andrea Kistner
- Department of Neurology or Neurosurgery, Grenoble University Hospital, Grenoble Alpes University, Grenoble Institut des Neurosciences, Grenoble, France
| | - Olivier Rascol
- Department of Neurology and Centre Expert Parkinson, and INSERM U1214, Toulouse University Hospital, Toulouse NeuroImaging Centre, Toulouse, France
| | - Christine Brefel-Courbon
- Department of Neurology and Centre Expert Parkinson, and INSERM U1214, Toulouse University Hospital, Toulouse NeuroImaging Centre, Toulouse, France
| | - Fabienne Ory-Magne
- Department of Neurology and Centre Expert Parkinson, and INSERM U1214, Toulouse University Hospital, Toulouse NeuroImaging Centre, Toulouse, France
| | - Christian J Hartmann
- Department of Neurology and Institute of Clinical Neuroscience and Medical Psychology, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany
| | - Lars Wojtecki
- Department of Neurology and Institute of Clinical Neuroscience and Medical Psychology, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany
| | - Anne Fradet
- Department of Neurology, CIC-INSERM 1402, CHU de Poitiers, Université de Poitiers, Poitiers, France
| | - David Maltête
- Department of Neurology, Rouen University Hospital, INSERM U1073, Rouen Faculty of Medicine, Rouen, France
| | - Philippe Damier
- CHU Nantes, INSERM, CIC1413, Hôpital Laënnec, Nantes, France
| | | | | | - Petra Benecke
- Department of Neurology, Paracelsus-Elena-Klinik, Kassel, Germany
| | - Daniel Weiss
- Department for Neurodegenerative Diseases, Centre for Neurology, and Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
| | - Tobias Wächter
- Department for Neurodegenerative Diseases, Centre for Neurology, and Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
| | - Marcus O Pinsker
- Department of Neurosurgery, University Hospital, Freiburg, Germany
| | - Jean Régis
- Aix Marseille Univ, APHM, La Timone, Neurology Department or Department of Functional and Stereotactic Neurosurgery and Radiosurgery, Marseille, France
| | - Stéphane Thobois
- Hôpital Neurologique Pierre Wertheimer, Centre Expert Parkinson, Hospices Civils de Lyon, Université Claude Bernard Lyon 1 Lyon, France, and Centre de Neurosciences Cognitives, Bron, France
| | - Gustavo Polo
- Hôpital Neurologique Pierre Wertheimer, Centre Expert Parkinson, Hospices Civils de Lyon, Université Claude Bernard Lyon 1 Lyon, France, and Centre de Neurosciences Cognitives, Bron, France
| | - Jean-Luc Houeto
- Department of Neurology, CIC-INSERM 1402, CHU de Poitiers, Université de Poitiers, Poitiers, France
| | - Andreas Hartmann
- Department of Neurology, Pitié-Salpêtrière Hospital, Assistance Publique Hôpitaux de Paris (APHP), INSERM, Institut du Cerveau et de la Moelle Epinière, and Centre d'Investigation Clinique (CIC), Paris, France
| | - Karina Knudsen
- Department of Neurology, University Medical Center Schleswig-Holstein, Christian-Albrechts-University, Kiel, Germany
| | - Marie Vidailhet
- Department of Neurology, Pitié-Salpêtrière Hospital, Assistance Publique Hôpitaux de Paris (APHP), INSERM, Institut du Cerveau et de la Moelle Epinière, and Centre d'Investigation Clinique (CIC), Paris, France
| | - Michael Schüpbach
- Department of Neurology, Pitié-Salpêtrière Hospital, Assistance Publique Hôpitaux de Paris (APHP), INSERM, Institut du Cerveau et de la Moelle Epinière, and Centre d'Investigation Clinique (CIC), Paris, France
| | - Günther Deuschl
- Department of Neurology, University Medical Center Schleswig-Holstein, Christian-Albrechts-University, Kiel, Germany
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van Wamelen DJ, Rukavina K, Podlewska AM, Chaudhuri KR. Advances in the Pharmacological and Non-pharmacological Management of Non-motor Symptoms in Parkinson's Disease: An Update Since 2017. Curr Neuropharmacol 2023; 21:1786-1805. [PMID: 35293295 PMCID: PMC10514535 DOI: 10.2174/1570159x20666220315163856] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 01/19/2022] [Accepted: 03/10/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Non-motor symptoms (NMS) are an important and ubiquitous determinant of quality of life in Parkinson's disease (PD). However, robust evidence for their treatment is still a major unmet need. OBJECTIVE This study aimed to provide an updated review on advances in pharmacological, nonpharmacological, and exercise-based interventions for NMS in PD, covering the period since the publication of the MDS Task Force Recommendations. METHODS We performed a literature search to identify pharmacological, non-pharmacological, and exercise-based interventions for NMS in PD. As there are recent reviews on the subject, we have only included studies from the 1st of January 2017 to the 1st of December 2021 and limited our search to randomised and non-randomised (including open-label) clinical trials. RESULTS We discuss new strategies to manage NMS based on data that have become available since 2017, for instance, on the treatment of orthostatic hypotension with droxidopa, several dopaminergic treatment options for insomnia, and a range of non-pharmacological and exercise-based interventions for cognitive and neuropsychiatric symptoms, pain, and insomnia and excessive sleepiness. CONCLUSION Recent evidence suggests that targeted non-pharmacological treatments, as well as some other NMS management options, may have a significant beneficial effect on the quality of life and need to be considered in the pathways of treatment of PD.
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Affiliation(s)
- Daniel J. van Wamelen
- Department of Basic & Clinical Neuroscience, Institute of Psychiatry, Psychology & Neuroscience, Division of Neuroscience, King’s College London, London, United Kingdom
- Parkinson Foundation Centre of Excellence at King’s College Hospital NHS Foundation Trust, London, United Kingdom
- Department of Neurology, Radboud University Medical Center, Donders Institute for Brain, Cognition, and Behaviour, Centre of Expertise for Parkinson & Movement Disorders, Nijmegen, the Netherlands
| | - Katarina Rukavina
- Department of Basic & Clinical Neuroscience, Institute of Psychiatry, Psychology & Neuroscience, Division of Neuroscience, King’s College London, London, United Kingdom
- Parkinson Foundation Centre of Excellence at King’s College Hospital NHS Foundation Trust, London, United Kingdom
| | - Aleksandra M. Podlewska
- Department of Basic & Clinical Neuroscience, Institute of Psychiatry, Psychology & Neuroscience, Division of Neuroscience, King’s College London, London, United Kingdom
- Parkinson Foundation Centre of Excellence at King’s College Hospital NHS Foundation Trust, London, United Kingdom
| | - K. Ray Chaudhuri
- Department of Basic & Clinical Neuroscience, Institute of Psychiatry, Psychology & Neuroscience, Division of Neuroscience, King’s College London, London, United Kingdom
- Parkinson Foundation Centre of Excellence at King’s College Hospital NHS Foundation Trust, London, United Kingdom
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21
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Albano L, Agosta F, Basaia S, Cividini C, Stojkovic T, Sarasso E, Stankovic I, Tomic A, Markovic V, Canu E, Stefanova E, Mortini P, Kostic VS, Filippi M. Altered Functional Connectivity of the Subthalamic Nucleus in Parkinson's Disease: Focus on Candidates for Deep Brain Stimulation. JOURNAL OF PARKINSON'S DISEASE 2023; 13:797-809. [PMID: 37270810 PMCID: PMC10473091 DOI: 10.3233/jpd-230005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/13/2023] [Indexed: 06/06/2023]
Abstract
BACKGROUND The hypothesis that the effectiveness of deep brain stimulation (DBS) in Parkinson's disease (PD) would be related to connectivity dysfunctions between the site of stimulation and other brain regions is growing. OBJECTIVE To investigate how the subthalamic nucleus (STN), the most frequently used DBS target for PD, is functionally linked to other brain regions in PD patients according to DBS eligibility. METHODS Clinical data and resting-state functional MRI were acquired from 60 PD patients and 60 age- and sex-matched healthy subjects within an ongoing longitudinal project. PD patients were divided into 19 patients eligible for DBS and 41 non-candidates. Bilateral STN were selected as regions of interest and a seed-based functional MRI connectivity analysis was performed. RESULTS A decreased functional connectivity between STN and sensorimotor cortex in both PD patient groups compared to controls was found. Whereas an increased functional connectivity between STN and thalamus was found in PD patient groups relative to controls. Candidates for DBS showed a decreased functional connectivity between bilateral STN and bilateral sensorimotor areas relative to non-candidates. In patients eligible for DBS, a weaker STN functional connectivity with left supramarginal and angular gyri was related with a more severe rigidity and bradykinesia whereas a higher connectivity between STN and cerebellum/pons was related to poorer tremor score. CONCLUSION Our results suggest that functional connectivity of STN varies among PD patients eligible or not for DBS. Future studies would confirm whether DBS modulates and restores functional connectivity between STN and sensorimotor areas in treated patients.
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Affiliation(s)
- Luigi Albano
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS Ospedale San Raffaele, Milan, Italy
- Neurosurgery and Gamma Knife Radiosurgery Unit, IRCCS Ospedale San Raffaele, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Federica Agosta
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS Ospedale San Raffaele, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
- Neurology Unit, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Silvia Basaia
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Camilla Cividini
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS Ospedale San Raffaele, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Tanja Stojkovic
- Clinic of Neurology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Elisabetta Sarasso
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Iva Stankovic
- Clinic of Neurology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Aleksandra Tomic
- Clinic of Neurology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Vladana Markovic
- Clinic of Neurology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Elisa Canu
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Elka Stefanova
- Clinic of Neurology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Pietro Mortini
- Neurosurgery and Gamma Knife Radiosurgery Unit, IRCCS Ospedale San Raffaele, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Vladimir S. Kostic
- Clinic of Neurology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Massimo Filippi
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS Ospedale San Raffaele, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
- Neurology Unit, IRCCS Ospedale San Raffaele, Milan, Italy
- Neurorehabilitation Unit, IRCCS Ospedale San Raffaele, Milan, Italy
- Neurophysiology Service, IRCCS Ospedale San Raffaele, Milan, Italy
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22
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Krause P, Reimer J, Kaplan J, Borngräber F, Schneider GH, Faust K, Kühn AA. Deep brain stimulation in Early Onset Parkinson's disease. Front Neurol 2022; 13:1041449. [PMID: 36468049 PMCID: PMC9713840 DOI: 10.3389/fneur.2022.1041449] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Accepted: 10/24/2022] [Indexed: 10/27/2023] Open
Abstract
INTRODUCTION Subthalamic Deep Brain Stimulation (STN-DBS) is a safe and well-established therapy for the management of motor symptoms refractory to best medical treatment in patients with Parkinson's disease (PD). Early intervention is discussed especially for Early-onset PD (EOPD) patients that present with an age of onset ≤ 45-50 years and see themselves often confronted with high psychosocial demands. METHODS We retrospectively assessed the effect of STN-DBS at 12 months follow-up (12-MFU) in 46 EOPD-patients. Effects of stimulation were evaluated by comparison of disease-specific scores for motor and non-motor symptoms including impulsiveness, apathy, mood, quality of life (QoL), cognition before surgery and in the stimulation ON-state without medication. Further, change in levodopa equivalent dosage (LEDD) after surgery, DBS parameter, lead localization, adverse and serious adverse events as well as and possible additional clinical features were assessed. RESULTS PD-associated gene mutations were found in 15% of our EOPD-cohort. At 12-MFU, mean motor scores had improved by 52.4 ± 17.6% in the STIM-ON/MED-OFF state compared to the MED-OFF state at baseline (p = 0.00; n = 42). These improvements were accompanied by a significant 59% LEDD reduction (p < 0.001), a significant 6.6 ± 16.1 points reduction of impulsivity (p = 0.02; n = 35) and a significant 30 ± 50% improvement of QoL (p = 0.01). At 12-MFU, 9 patients still worked full- and 6 part-time. Additionally documented motor and/or neuropsychiatric features decreased from n = 41 at baseline to n = 14 at 12-MFU. CONCLUSION The present study-results demonstrate that EOPD patients with and without known genetic background benefit from STN-DBS with significant improvement in motor as well as non-motor symptoms. In line with this, patients experienced a meaningful reduction of additional neuropsychiatric features. Physicians as well as patients have an utmost interest in possible predictors for the putative DBS outcome in a cohort with such a highly complex clinical profile. Longitudinal monitoring of DBS-EOPD-patients over long-term intervals with standardized comprehensive clinical assessment, accurate phenotypic characterization and documentation of clinical outcomes might help to gain insights into disease etiology, to contextualize genomic information and to identify predictors of optimal DBS candidates as well as those in danger of deterioration and/or non-response in the future.
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Affiliation(s)
- Patricia Krause
- Movement Disorder and Neuromodulation Unit, Charité University Medicine Berlin, Berlin, Germany
| | - Johanna Reimer
- Movement Disorder and Neuromodulation Unit, Charité University Medicine Berlin, Berlin, Germany
| | - Jonathan Kaplan
- Movement Disorder and Neuromodulation Unit, Charité University Medicine Berlin, Berlin, Germany
| | - Friederike Borngräber
- Movement Disorder and Neuromodulation Unit, Charité University Medicine Berlin, Berlin, Germany
| | | | - Katharina Faust
- Department of Neurosurgery, Charité University Medicine Berlin, Berlin, Germany
| | - Andrea A. Kühn
- Movement Disorder and Neuromodulation Unit, Charité University Medicine Berlin, Berlin, Germany
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Abstract
Parkinson's disease (PD) is a progressive neurodegenerative illness with both motor and nonmotor symptoms. Deep brain stimulation (DBS) is an established safe neurosurgical symptomatic therapy for eligible patients with advanced disease in whom medical treatment fails to provide adequate symptom control and good quality of life, or in whom dopaminergic medications induce severe side effects such as dyskinesias. DBS can be tailored to the patient's symptoms and targeted to various nodes along the basal ganglia-thalamus circuitry, which mediates the various symptoms of the illness; DBS in the thalamus is most efficient for tremors, and DBS in the pallidum most efficient for rigidity and dyskinesias, whereas DBS in the subthalamic nucleus (STN) can treat both tremors, akinesia, rigidity and dyskinesias, and allows for decrease in doses of medications even in patients with advanced stages of the disease, which makes it the preferred target for DBS. However, DBS in the STN assumes that the patient is not too old, with no cognitive decline or relevant depression, and does not exhibit severe and medically resistant axial symptoms such as balance and gait disturbances, and falls. Dysarthria is the most common side effect of DBS, regardless of the brain target. DBS has a long-lasting effect on appendicular symptoms, but with progression of disease, nondopaminergic axial features become less responsive to DBS. DBS for PD is highly specialised; to enable adequate selection and follow-up of patients, DBS requires dedicated multidisciplinary teams of movement disorder neurologists, functional neurosurgeons, specialised DBS nurses and neuropsychologists.
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Affiliation(s)
- Marwan Hariz
- Department of Clinical Neuroscience, University Hospital of Umeå, Umeå, Sweden.,UCL-Queen Square Institute of Neurology, London, UK
| | - Patric Blomstedt
- Department of Clinical Neuroscience, University Hospital of Umeå, Umeå, Sweden
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Weintraub D, Aarsland D, Biundo R, Dobkin R, Goldman J, Lewis S. Management of psychiatric and cognitive complications in Parkinson's disease. BMJ 2022; 379:e068718. [PMID: 36280256 DOI: 10.1136/bmj-2021-068718] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Neuropsychiatric symptoms (NPSs) such as affective disorders, psychosis, behavioral changes, and cognitive impairment are common in Parkinson's disease (PD). However, NPSs remain under-recognized and under-treated, often leading to adverse outcomes. Their epidemiology, presentation, risk factors, neural substrate, and management strategies are incompletely understood. While psychological and psychosocial factors may contribute, hallmark PD neuropathophysiological changes, plus the associations between exposure to dopaminergic medications and occurrence of some symptoms, suggest a neurobiological basis for many NPSs. A range of psychotropic medications, psychotherapeutic techniques, stimulation therapies, and other non-pharmacological treatments have been studied, are used clinically, and are beneficial for managing NPSs in PD. Appropriate management of NPSs is critical for comprehensive PD care, from recognizing their presentations and timing throughout the disease course, to the incorporation of different therapeutic strategies (ie, pharmacological and non-pharmacological) that utilize a multidisciplinary approach.
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Affiliation(s)
- Daniel Weintraub
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
- Parkinson's Disease Research, Education and Clinical Center (PADRECC), Philadelphia Veterans Affairs Medical Center, Philadelphia, PA
| | - Dag Aarsland
- Department of Old Age Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, England
- Centre for Age-Related Diseases, Stavanger University Hospital, Stavanger, Norway
| | - Roberta Biundo
- Department of General Psychology, University of Padua, Padua, Italy
- Study Center for Neurodegeneration (CESNE), Department of Neuroscience, University of Padua, Padua, Italy
| | - Roseanne Dobkin
- Department of Psychiatry, Rutgers-The State University of New Jersey, Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Jennifer Goldman
- Shirley Ryan AbilityLab, Parkinson's Disease and Movement Disorders, Chicago, IL
- Departments of Physical Medicine and Rehabilitation and Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Simon Lewis
- ForeFront Parkinson's Disease Research Clinic, Brain and Mind Centre, School of Medical Sciences, University of Sydney, Sydney, New South Wales, Australia
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25
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Lamy F, Lagha-Boukbiza O, Wirth T, Philipps C, Longato N, Gebus O, Montaut S, Mengin A, Voirin J, Proust F, Tuzin N, Anheim M, Tranchant C. Early hyperdopaminergic state following sub-thalamic nucleus deep brain stimulation in Parkinson disease. Rev Neurol (Paris) 2022; 178:896-906. [PMID: 36153257 DOI: 10.1016/j.neurol.2022.07.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 04/26/2022] [Accepted: 07/17/2022] [Indexed: 10/14/2022]
Abstract
BACKGROUND Hyperdopaminergic state (HS), especially impulse control behaviors (ICBs), are not rare in Parkinson's disease (PD). Controversial data regarding HS prevalence one year following sub-thalamic nucleus deep brain stimulation (STN-DBS) are reported. OBJECTIVE Our objectives were to describe early postoperative HS (PoOHS) including ICBs, hypomania and psychotic symptoms during the first 3 months following STN-DBS (V1) and their prognosis at 1 year (V2). METHODS This descriptive study included 24 PD patients treated successively with bilateral STN-DBS between 2017 and 2019. The primary endpoint was prevalence of PoOHS at V1 according to the Ardouin Scale of Behaviour in Parkinson's Disease. RESULTS Prior to STN-DBS (V0), 25% patients had HS (only ICBs) whereas at V1 (during the 3 first months), 10 patients (41.7%) had one or several HS (P=0.22) (de novo in 29.2%): 7 (29.2%) ICBs, 4 (16.7%) hypomanic mood, 1 (4.7%) psychotic symptoms. At V2, all V0 and V1 HS had disappeared, while 1 patient (4.2%) presented de novo HS (P<0.01). No correlation was found between the occurrence of PoOHS at V1 and any V0 data. Higher levodopa equivalent dose of dopamine agonists at V1 was correlated with ICB at V1 (P=0.04). CONCLUSION We found that early PoOHS are frequent in PD after STN-DBS, mostly de novo, with ICBs and hypomania being the most frequent. Despite a good prognosis of PoOHS at one year, our work emphasizes the importance of both a cautious adjustment of dopamine agonist doses and a close non-motor monitoring pre- and post-STN-DBS in PD.
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Affiliation(s)
- F Lamy
- Service de neurologie, département de neurologie, hôpitaux universitaires de Strasbourg, hôpital de Hautepierre, 1, avenue Molière, 67200 Strasbourg cedex, France; Département de neurologie fonctionnelle et d'épileptologie, hospices civils de Lyon, université de Lyon, Lyon, France
| | - O Lagha-Boukbiza
- Service de neurologie, département de neurologie, hôpitaux universitaires de Strasbourg, hôpital de Hautepierre, 1, avenue Molière, 67200 Strasbourg cedex, France
| | - T Wirth
- Service de neurologie, département de neurologie, hôpitaux universitaires de Strasbourg, hôpital de Hautepierre, 1, avenue Molière, 67200 Strasbourg cedex, France
| | - C Philipps
- Service de neurologie, département de neurologie, hôpitaux universitaires de Strasbourg, hôpital de Hautepierre, 1, avenue Molière, 67200 Strasbourg cedex, France
| | - N Longato
- Service de neurologie, département de neurologie, hôpitaux universitaires de Strasbourg, hôpital de Hautepierre, 1, avenue Molière, 67200 Strasbourg cedex, France
| | - O Gebus
- Service de neurologie, département de neurologie, hôpitaux universitaires de Strasbourg, hôpital de Hautepierre, 1, avenue Molière, 67200 Strasbourg cedex, France
| | - S Montaut
- Service de neurologie, département de neurologie, hôpitaux universitaires de Strasbourg, hôpital de Hautepierre, 1, avenue Molière, 67200 Strasbourg cedex, France
| | - A Mengin
- Clinique psychiatrique, hôpitaux universitaires de Strasbourg, 1, place de l'Hôpital, Strasbourg cedex, France
| | - J Voirin
- Service de neurochirurgie, hôpitaux universitaires de Strasbourg, hôpital de Hautepierre, 1, avenue Molière, 67200 Strasbourg cedex, France
| | - F Proust
- Service de neurochirurgie, hôpitaux universitaires de Strasbourg, hôpital de Hautepierre, 1, avenue Molière, 67200 Strasbourg cedex, France
| | - N Tuzin
- Département de santé publique, hôpitaux universitaires de Strasbourg, Strasbourg, France
| | - M Anheim
- Service de neurologie, département de neurologie, hôpitaux universitaires de Strasbourg, hôpital de Hautepierre, 1, avenue Molière, 67200 Strasbourg cedex, France; Inserm-U964/CNRS-UMR7104, institut de génétique et de biologie moléculaire et cellulaire (IGBMC), université de Strasbourg, Illkirch, France; Fédération de médecine translationnelle de Strasbourg (FMTS), université de Strasbourg, Strasbourg, France
| | - C Tranchant
- Service de neurologie, département de neurologie, hôpitaux universitaires de Strasbourg, hôpital de Hautepierre, 1, avenue Molière, 67200 Strasbourg cedex, France; Inserm-U964/CNRS-UMR7104, institut de génétique et de biologie moléculaire et cellulaire (IGBMC), université de Strasbourg, Illkirch, France; Fédération de médecine translationnelle de Strasbourg (FMTS), université de Strasbourg, Strasbourg, France.
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26
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Liu WY, Tung TH, Zhang C, Shi L. Systematic review for the prevention and management of falls and fear of falling in patients with Parkinson's disease. Brain Behav 2022; 12:e2690. [PMID: 35837986 PMCID: PMC9392538 DOI: 10.1002/brb3.2690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 03/17/2022] [Accepted: 04/24/2022] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVE To synthesize recent empirical evidence for the prevention and management of falls and fear of falling in patients with Parkinson's disease (PD). DATA SOURCE Database from PubMed, Cochrane Library, and EMBASE. STUDY DESIGN Systematic review. DATA COLLECTION We searched the PubMed, Cochrane Library, and EMBASE databases for studies published from inception to February 27, 2021. Inclusion criteria were nonreview articles on prevention and management measures related to falls and fall prevention in Parkinson's disease patients. PRINCIPAL FINDINGS We selected 45 articles and conducted in-depth research and discussion. According to the causes of falls in PD patients, they were divided into five directions, namely physical status, pre-existing conditions, environment, medical care, and cognition. In the cognitive domain, we focused on the fear of falling. On the above basis, we constructed a fall prevention model, which is a tertiary prevention health care network, based on The Johns Hopkins Fall Risk Assessment Tool to provide ideas for the prevention and management of falling and fear of falling in PD patients in clinical practice CONCLUSIONS: Falls and fear of falls in patients with Parkinson's disease can be reduced by effective clinical prevention and management. Future studies are needed to explore the efficacy of treatment and prevention of falls and fear of falls.
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Affiliation(s)
- Wen-Yi Liu
- Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA.,Shanghai Bluecross Medical Science Institute, Shanghai, China.,Institute for Hospital Management, Tsing Hua University, Shenzhen Campus, China
| | - Tao-Hsin Tung
- Evidence-based Medicine Center, Taizhou Hospital of Zhejiang Province, Wenzhou Medical University, Linhai, Zhejiang, China
| | - Chencheng Zhang
- Department of Neurosurgery, Center for Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Leiyu Shi
- Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
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27
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Weiss D, Ebersbach G, Möller JC, Schwarz J, Arlt C, Fritz B, Sensken SC, Eggert K. Do we start too late? Insights from the real-world non-interventional BALANCE study on the present use of levodopa/carbidopa intestinal gel in advanced Parkinson's disease in Germany and Switzerland. Parkinsonism Relat Disord 2022; 103:85-91. [DOI: 10.1016/j.parkreldis.2022.08.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 08/18/2022] [Accepted: 08/18/2022] [Indexed: 11/17/2022]
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28
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Potel SR, Marceglia S, Meoni S, Kalia SK, Cury RG, Moro E. Advances in DBS Technology and Novel Applications: Focus on Movement Disorders. Curr Neurol Neurosci Rep 2022; 22:577-588. [PMID: 35838898 DOI: 10.1007/s11910-022-01221-7] [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] [Accepted: 06/17/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE OF REVIEW Deep brain stimulation (DBS) is an established treatment in several movement disorders, including Parkinson's disease, dystonia, tremor, and Tourette syndrome. In this review, we will review and discuss the most recent findings including but not limited to clinical evidence. RECENT FINDINGS New DBS technologies include novel hardware design (electrodes, cables, implanted pulse generators) enabling new stimulation patterns and adaptive DBS which delivers potential stimulation tailored to moment-to-moment changes in the patient's condition. Better understanding of movement disorders pathophysiology and functional anatomy has been pivotal for studying the effects of DBS on the mesencephalic locomotor region, the nucleus basalis of Meynert, the substantia nigra, and the spinal cord. Eventually, neurosurgical practice has improved with more accurate target visualization or combined targeting. A rising research domain emphasizes bridging neuromodulation and neuroprotection. Recent advances in DBS therapy bring more possibilities to effectively treat people with movement disorders. Future research would focus on improving adaptive DBS, leading more clinical trials on novel targets, and exploring neuromodulation effects on neuroprotection.
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Affiliation(s)
- Sina R Potel
- Service de Neurologie, CHU Grenoble Alpes, Université Grenoble Alpes, Grenoble, France
| | - Sara Marceglia
- Dipartimento Di Ingegneria E Architettura, Università Degli Studi Di Trieste, Trieste, Italy
| | - Sara Meoni
- Service de Neurologie, CHU Grenoble Alpes, Université Grenoble Alpes, Grenoble, France
- Grenoble Institut Neurosciences, INSERM U1416, Grenoble, France
| | - Suneil K Kalia
- Division of Neurosurgery, University of Toronto, Toronto, Ontario, Canada
| | - Rubens G Cury
- Department of Neurology, Movement Disorders Center, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Elena Moro
- Service de Neurologie, CHU Grenoble Alpes, Université Grenoble Alpes, Grenoble, France.
- Grenoble Institut Neurosciences, INSERM U1416, Grenoble, France.
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Prange S, Lin Z, Nourredine M, Danaila T, Laurencin C, Lagha-Boukbiza O, Anheim M, Klinger H, Longato N, Phillipps C, Voirin J, Polo G, Simon E, Mertens P, Rolland AS, Devos D, Metereau E, Tranchant C, Thobois S. Limbic stimulation drives mania in STN-DBS in Parkinson disease: a prospective study. Ann Neurol 2022; 92:411-417. [PMID: 35703252 DOI: 10.1002/ana.26434] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 05/30/2022] [Accepted: 06/05/2022] [Indexed: 11/10/2022]
Abstract
In this one-year prospective study, Parkinson's disease (PD) patients with or without mania following STN-DBS were compared to investigate risk and etiological factors, clinical management and consequences. Eighteen (16.2%) out of 111 consecutive PD patients developed mania, of whom 17 were males. No preoperative risk factor was identified. Postoperative mania was related to ventral limbic subthalamic stimulation in 15 (83%) patients, and resolved as stimulation was relocated to the sensorimotor STN, besides discontinuation or reduction of dopamine agonists and use of low-dose clozapine in 12 patients, while motor and nonmotor outcomes were similar. These findings underpin the prominent role of limbic subthalamic stimulation in postoperative mania. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Stéphane Prange
- Univ Lyon, Institut des Sciences Cognitives Marc Jeannerod, CNRS, UMR 5229, Bron, France.,Hospices Civils de Lyon, Hôpital Neurologique Pierre Wertheimer, Service de Neurologie C, Centre Expert Parkinson NS-PARK/FCRIN network, Bron, France.,University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Nuclear Medicine, Cologne, Germany
| | - Zhengyu Lin
- Service de Neurochirurgie fonctionnelle, Hôpital Neurologique et Neurochirurgical Pierre Wertheimer, Hospices Civils de Lyon 59 Bd Pinel, 69500, Bron, France.,Department of Neurosurgery, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Center for Functional Neurosurgery, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | | | - Teodor Danaila
- Univ Lyon, Institut des Sciences Cognitives Marc Jeannerod, CNRS, UMR 5229, Bron, France.,Hospices Civils de Lyon, Hôpital Neurologique Pierre Wertheimer, Service de Neurologie C, Centre Expert Parkinson NS-PARK/FCRIN network, Bron, France
| | - Chloé Laurencin
- Univ Lyon, Institut des Sciences Cognitives Marc Jeannerod, CNRS, UMR 5229, Bron, France.,Hospices Civils de Lyon, Hôpital Neurologique Pierre Wertheimer, Service de Neurologie C, Centre Expert Parkinson NS-PARK/FCRIN network, Bron, France
| | - Ouhaid Lagha-Boukbiza
- Service de Neurologie, Hôpitaux Universitaires de Strasbourg, Strasbourg, France.,Fédération de Médecine Translationnelle de Strasbourg (FMTS), Université de Strasbourg, Strasbourg, France
| | - Mathieu Anheim
- Service de Neurologie, Hôpitaux Universitaires de Strasbourg, Strasbourg, France.,Fédération de Médecine Translationnelle de Strasbourg (FMTS), Université de Strasbourg, Strasbourg, France.,Institut de Génétique et de Biologie Moléculaire et Cellulaire (IGBMC), INSERM-U964/CNRS-UMR7104/Université de Strasbourg, Illkirch-Graffenstaden, France
| | - Hélène Klinger
- Hospices Civils de Lyon, Hôpital Neurologique Pierre Wertheimer, Service de Neurologie C, Centre Expert Parkinson NS-PARK/FCRIN network, Bron, France
| | - Nadine Longato
- Service de Neurologie, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Clelie Phillipps
- Service de Neurologie, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Jimmy Voirin
- Department of Neurosurgery, NS-PARK/F-CRIN, Strasbourg University Hospital, Strasbourg, France
| | - Gustavo Polo
- Service de Neurochirurgie fonctionnelle, Hôpital Neurologique et Neurochirurgical Pierre Wertheimer, Hospices Civils de Lyon 59 Bd Pinel, 69500, Bron, France
| | - Emile Simon
- Service de Neurochirurgie fonctionnelle, Hôpital Neurologique et Neurochirurgical Pierre Wertheimer, Hospices Civils de Lyon 59 Bd Pinel, 69500, Bron, France
| | - Patrick Mertens
- Service de Neurochirurgie fonctionnelle, Hôpital Neurologique et Neurochirurgical Pierre Wertheimer, Hospices Civils de Lyon 59 Bd Pinel, 69500, Bron, France
| | - Anne-Sophie Rolland
- Univ Lille, CHU-Lille, Medical Pharmacology & Neurology, Expert center for Parkinson, Lille Neuroscience & Cognition, Inserm, UMR-S1172, LICEND, NS-Park network, F-59000, Lille, France
| | - David Devos
- Univ Lille, CHU-Lille, Medical Pharmacology & Neurology, Expert center for Parkinson, Lille Neuroscience & Cognition, Inserm, UMR-S1172, LICEND, NS-Park network, F-59000, Lille, France
| | - Elise Metereau
- Univ Lyon, Institut des Sciences Cognitives Marc Jeannerod, CNRS, UMR 5229, Bron, France.,Hospices Civils de Lyon, Hôpital Neurologique Pierre Wertheimer, Service de Neurologie C, Centre Expert Parkinson NS-PARK/FCRIN network, Bron, France
| | - Christine Tranchant
- Service de Neurologie, Hôpitaux Universitaires de Strasbourg, Strasbourg, France.,Fédération de Médecine Translationnelle de Strasbourg (FMTS), Université de Strasbourg, Strasbourg, France.,Institut de Génétique et de Biologie Moléculaire et Cellulaire (IGBMC), INSERM-U964/CNRS-UMR7104/Université de Strasbourg, Illkirch-Graffenstaden, France
| | - Stéphane Thobois
- Univ Lyon, Institut des Sciences Cognitives Marc Jeannerod, CNRS, UMR 5229, Bron, France.,Hospices Civils de Lyon, Hôpital Neurologique Pierre Wertheimer, Service de Neurologie C, Centre Expert Parkinson NS-PARK/FCRIN network, Bron, France.,Univ Lyon, Université Claude Bernard Lyon 1, Faculté de Médecine et de Maïeutique Lyon Sud Charles Mérieux, Oullins, France
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Prange S, Klinger H, Laurencin C, Danaila T, Thobois S. Depression in Patients with Parkinson's Disease: Current Understanding of its Neurobiology and Implications for Treatment. Drugs Aging 2022; 39:417-439. [PMID: 35705848 PMCID: PMC9200562 DOI: 10.1007/s40266-022-00942-1] [Citation(s) in RCA: 41] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/09/2022] [Indexed: 12/11/2022]
Abstract
Depression is one of the most frequent and burdensome non-motor symptoms in Parkinson’s disease (PD), across all stages. Even when its severity is mild, PD depression has a great impact on quality of life for these patients and their caregivers. Accordingly, accurate diagnosis, supported by validated scales, identification of risk factors, and recognition of motor and non-motor symptoms comorbid to depression are critical to understanding the neurobiology of depression, which in turn determines the effectiveness of dopaminergic drugs, antidepressants and non-pharmacological interventions. Recent advances using in vivo functional and structural imaging demonstrate that PD depression is underpinned by dysfunction of limbic networks and monoaminergic systems, depending on the stage of PD and its associated symptoms, including apathy, anxiety, rapid eye movement sleep behavior disorder (RBD), cognitive impairment and dementia. In particular, the evolution of serotonergic, noradrenergic, and dopaminergic dysfunction and abnormalities of limbic circuits across time, involving the anterior cingulate and orbitofrontal cortices, amygdala, thalamus and ventral striatum, help to delineate the variable expression of depression in patients with prodromal, early and advanced PD. Evidence is accumulating to support the use of dual serotonin and noradrenaline reuptake inhibitors (desipramine, nortriptyline, venlafaxine) in patients with PD and moderate to severe depression, while selective serotonin reuptake inhibitors, repetitive transcranial magnetic stimulation and cognitive behavioral therapy may also be considered. In all patients, recent findings advocate that optimization of dopamine replacement therapy and evaluation of deep brain stimulation of the subthalamic nucleus to improve motor symptoms represents an important first step, in addition to physical activity. Overall, this review indicates that increasing understanding of neurobiological changes help to implement a roadmap of tailored interventions for patients with PD and depression, depending on the stage and comorbid symptoms underlying PD subtypes and their prognosis.
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Affiliation(s)
- Stéphane Prange
- Hospices Civils de Lyon, Hôpital Neurologique Pierre Wertheimer, Service de Neurologie C, Centre Expert Parkinson, NS-PARK/FCRIN Network, 59 Boulevard Pinel, 69500, Bron, France. .,Physiopathology of the Basal Ganglia Team, Univ Lyon, Institut des Sciences Cognitives Marc Jeannerod, CNRS, UMR 5229, 67 Boulevard Pinel, 69675, Bron, France. .,Department of Nuclear Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.
| | - Hélène Klinger
- Hospices Civils de Lyon, Hôpital Neurologique Pierre Wertheimer, Service de Neurologie C, Centre Expert Parkinson, NS-PARK/FCRIN Network, 59 Boulevard Pinel, 69500, Bron, France
| | - Chloé Laurencin
- Hospices Civils de Lyon, Hôpital Neurologique Pierre Wertheimer, Service de Neurologie C, Centre Expert Parkinson, NS-PARK/FCRIN Network, 59 Boulevard Pinel, 69500, Bron, France.,Physiopathology of the Basal Ganglia Team, Univ Lyon, Institut des Sciences Cognitives Marc Jeannerod, CNRS, UMR 5229, 67 Boulevard Pinel, 69675, Bron, France
| | - Teodor Danaila
- Hospices Civils de Lyon, Hôpital Neurologique Pierre Wertheimer, Service de Neurologie C, Centre Expert Parkinson, NS-PARK/FCRIN Network, 59 Boulevard Pinel, 69500, Bron, France.,Physiopathology of the Basal Ganglia Team, Univ Lyon, Institut des Sciences Cognitives Marc Jeannerod, CNRS, UMR 5229, 67 Boulevard Pinel, 69675, Bron, France
| | - Stéphane Thobois
- Hospices Civils de Lyon, Hôpital Neurologique Pierre Wertheimer, Service de Neurologie C, Centre Expert Parkinson, NS-PARK/FCRIN Network, 59 Boulevard Pinel, 69500, Bron, France. .,Physiopathology of the Basal Ganglia Team, Univ Lyon, Institut des Sciences Cognitives Marc Jeannerod, CNRS, UMR 5229, 67 Boulevard Pinel, 69675, Bron, France. .,Faculté de Médecine et de Maïeutique Lyon Sud Charles Mérieux, Univ Lyon, Université Claude Bernard Lyon 1, Oullins, France.
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Mahlknecht P, Foltynie T, Limousin P, Poewe W. How Does Deep Brain Stimulation Change the Course of Parkinson's Disease? Mov Disord 2022; 37:1581-1592. [PMID: 35560443 PMCID: PMC9545904 DOI: 10.1002/mds.29052] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 04/07/2022] [Accepted: 04/18/2022] [Indexed: 12/14/2022] Open
Abstract
A robust body of evidence from randomized controlled trials has established the efficacy of deep brain stimulation (DBS) in reducing off time and dyskinesias in levodopa‐treated patients with Parkinson's disease (PD). These effects go along with improvements in on period motor function, activities of daily living, and quality of life. In addition, subthalamic DBS is effective in controlling drug‐refractory PD tremor. Here, we review the available data from long‐term observational and controlled follow‐up studies in DBS‐treated patients to re‐examine the persistence of motor and quality of life benefits and evaluate the effects on disease progression, major disability milestones, and survival. Although there is consistent evidence from observational follow‐up studies in DBS‐treated patients over 5–10 years and beyond showing sustained improvement of motor control, the long‐term impact of DBS on overall progression of disability in PD is less clear. Whether DBS reduces or delays the development of later motor and non‐motor disability milestones in comparison to best medical management strategies is difficult to answer by uncontrolled observational follow‐up, but there are signals from controlled long‐term observational studies suggesting that subthalamic DBS may delay some of the late‐stage disability milestones including psychosis, falls, and institutionalization, and also slightly prolongs survival compared with matched medically managed patients. These observations could be attributable to the sustained improvements in motor function and reduction in medication‐induced side effects, whereas there is no clinical evidence of direct effects of DBS on the underlying disease progression. © 2022 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society
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Affiliation(s)
- Philipp Mahlknecht
- Department of Neurology, Innsbruck Medical University, Innsbruck, Austria
| | - Thomas Foltynie
- Department of Clinical and Movement Neurosciences, UCL Institute of Neurology, National Hospital for Neurology and Neurosurgery, London, United Kingdom
| | - Patricia Limousin
- Department of Clinical and Movement Neurosciences, UCL Institute of Neurology, National Hospital for Neurology and Neurosurgery, London, United Kingdom
| | - Werner Poewe
- Department of Neurology, Innsbruck Medical University, Innsbruck, Austria
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Saba RA, Maia DP, Cardoso FEC, Borges V, F. Andrade LA, Ferraz HB, Barbosa ER, Rieder CRDM, da Silva DJ, Chien HF, Capato T, Rosso AL, Souza Lima CF, Bezerra JMF, Nicaretta D, Povoas Barsottini OG, Godeiro-Júnior C, Broseghini Barcelos L, Gisbert Cury R, Spitz M, Azevedo Silva SMC, Della Colletta MV. Guidelines for Parkinson’s disease treatment: consensus from the Movement Disorders Scientific Department of the Brazilian Academy of Neurology - motor symptoms. ARQUIVOS DE NEURO-PSIQUIATRIA 2022; 80:316-329. [DOI: 10.1590/0004-282x-anp-2021-0219] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Accepted: 10/02/2021] [Indexed: 11/21/2022]
Abstract
ABSTRACT The treatment of Parkinson's disease (PD) is challenging, especially since it is considered highly individualized. The Brazilian Academy of Neurology has recognized the need to disseminate knowledge about the management of PD treatment, adapting the best evidence to the Brazilian reality. Thus, the main published treatment guidelines were reviewed based on the recommendations of group from the Movement Disorders Scientific Department of the Brazilian Academy of Neurology.
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Affiliation(s)
- Roberta Arb Saba
- Universidade Federal de São Paulo, Brazil; Hospital do Servidor Público Estadual, Brazil
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Functional connectivity in Parkinson's disease candidates for deep brain stimulation. NPJ Parkinsons Dis 2022; 8:4. [PMID: 35013326 PMCID: PMC8748462 DOI: 10.1038/s41531-021-00268-6] [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] [Received: 05/27/2021] [Accepted: 12/10/2021] [Indexed: 11/29/2022] Open
Abstract
This study aimed to identify functional neuroimaging patterns anticipating the clinical indication for deep brain stimulation (DBS) in patients with Parkinson’s disease (PD). A cohort of prospectively recruited patients with PD underwent neurological evaluations and resting-state functional MRI (RS-fMRI) at baseline and annually for 4 years. Patients were divided into two groups: 19 patients eligible for DBS over the follow-up and 41 patients who did not meet the criteria to undergo DBS. Patients selected as candidates for DBS did not undergo surgery at this stage. Sixty age- and sex-matched healthy controls performed baseline evaluations. Graph analysis and connectomics assessed global and local topological network properties and regional functional connectivity at baseline and at each time point. At baseline, network analysis showed a higher mean nodal strength, local efficiency, and clustering coefficient of the occipital areas in candidates for DBS over time relative to controls and patients not eligible for DBS. The occipital hyperconnectivity pattern was confirmed by regional analysis. At baseline, a decreased functional connectivity between basal ganglia and sensorimotor/frontal networks was found in candidates for DBS compared to patients not eligible for surgery. In the longitudinal analysis, patient candidate for DBS showed a progressively decreased topological brain organization and functional connectivity, mainly in the posterior brain networks, and a progressively increased connectivity of basal ganglia network compared to non-candidates for DBS. RS-fMRI may support the clinical indication to DBS and could be useful in predicting which patients would be eligible for DBS in the earlier stages of PD.
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Weintraub D, Aarsland D, Chaudhuri KR, Dobkin RD, Leentjens AF, Rodriguez-Violante M, Schrag A. The neuropsychiatry of Parkinson's disease: advances and challenges. Lancet Neurol 2022; 21:89-102. [PMID: 34942142 PMCID: PMC8800169 DOI: 10.1016/s1474-4422(21)00330-6] [Citation(s) in RCA: 136] [Impact Index Per Article: 68.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 08/21/2021] [Accepted: 09/20/2021] [Indexed: 01/03/2023]
Abstract
In people with Parkinson's disease, neuropsychiatric signs and symptoms are common throughout the disease course. These symptoms can be disabling and as clinically relevant as motor symptoms, and their presentation can be similar to, or distinct from, their counterparts in the general population. Correlates and risk factors for developing neuropsychiatric signs and symptoms include demographic, clinical, and psychosocial characteristics. The underlying neurobiology of these presentations is complex and not well understood, with the strongest evidence for neuropathological changes associated with Parkinson's disease, mechanisms linked to dopaminergic therapy, and effects not specific to Parkinson's disease. Assessment instruments and formal diagnostic criteria exist, but there is little routine screening of these signs and symptoms in clinical practice. Mounting evidence supports a range of pharmacological and non-pharmacological interventions, but relatively few efficacious treatment options exist. Optimising the management of neuropsychiatric presentations in people with Parkinson's disease will require additional research, raised awareness, specialised training, and development of innovative models of care.
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Affiliation(s)
- Daniel Weintraub
- Departments of Psychiatry and Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; Parkinson's Disease Research, Education and Clinical Center, Corporal Michael J Crescenz Philadelphia Veterans Affairs Medical Center, Philadelphia, PA, USA.
| | - Dag Aarsland
- Department of Neurosciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; Centre for Age-Related Disease, Stavanger University Hospital, Stavanger, Norway
| | - Kallol Ray Chaudhuri
- Department of Neurosciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; Parkinson's Foundation Centre of Excellence, King's College Hospital, King's College London, London, UK
| | - Roseanne D Dobkin
- Department of Psychiatry, Rutgers University, Robert Wood Johnson Medical School, Piscataway, NJ, USA
| | - Albert Fg Leentjens
- Department of Psychiatry, and School for Mental Health and Neuroscience, Maastricht University Hospital, Maastricht, Netherlands
| | - Mayela Rodriguez-Violante
- Clinical Neurodegenerative Diseases Research Unit, National Institute of Neurology and Neurosurgery, Mexico City, Mexico
| | - Anette Schrag
- Department of Clinical and Movement Neurosciences, Queen Square Institute of Neurology, UCL, London, UK
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Strelow JN, Baldermann JC, Dembek TA, Jergas H, Petry-Schmelzer JN, Schott F, Dafsari HS, Moll CKE, Hamel W, Gulberti A, Visser-Vandewalle V, Fink GR, Pötter-Nerger M, Barbe MT. Structural Connectivity of Subthalamic Nucleus Stimulation for Improving Freezing of Gait. JOURNAL OF PARKINSON'S DISEASE 2022; 12:1251-1267. [PMID: 35431262 DOI: 10.3233/jpd-212997] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
BACKGROUND Freezing of gait (FOG) is among the most common and disabling symptoms of Parkinson's disease (PD). Studies show that deep brain stimulation (DBS) of the subthalamic nucleus (STN) can reduce FOG severity. However, there is uncertainty about pathways that need to be modulated to improve FOG. OBJECTIVE To investigate whether STN-DBS effectively reduces FOG postoperatively and whether structural connectivity of the stimulated tissue explains variance of outcomes. METHODS We investigated 47 patients with PD and preoperative FOG. Freezing prevalence and severity was primarily assessed using the Freezing of Gait Questionnaire (FOG-Q). In a subset of 18 patients, provoked FOG during a standardized walking course was assessed. Using a publicly available model of basal-ganglia pathways we determined stimulation-dependent connectivity associated with postoperative changes in FOG. A region-of-interest analysis to a priori defined mesencephalic regions was performed using a disease-specific normative connectome. RESULTS Freezing of gait significantly improved six months postoperatively, marked by reduced frequency and duration of freezing episodes. Optimal stimulation volumes for improving FOG structurally connected to motor areas, the prefrontal cortex and to the globus pallidus. Stimulation of the lenticular fasciculus was associated with worsening of FOG. This connectivity profile was robust in a leave-one-out cross-validation. Subcortically, stimulation of fibers crossing the pedunculopontine nucleus and the substantia nigra correlated with postoperative improvement. CONCLUSION STN-DBS can alleviate FOG severity by modulating specific pathways structurally connected to prefrontal and motor cortices. More differentiated FOG assessments may allow to differentiate pathways for specific FOG subtypes in the future.
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Affiliation(s)
- Joshua N Strelow
- Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
- Department of Stereotactic and Functional Neurosurgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Juan C Baldermann
- Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Till A Dembek
- Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Hannah Jergas
- Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Jan N Petry-Schmelzer
- Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Frederik Schott
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Haidar S Dafsari
- Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Christian K E Moll
- Department of Neurophysiology and Pathophysiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Wolfgang Hamel
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Alessandro Gulberti
- Department of Neurophysiology and Pathophysiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Veerle Visser-Vandewalle
- Department of Stereotactic and Functional Neurosurgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Gereon R Fink
- Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
- Cognitive Neuroscience, Institute of Neuroscience and Medicine (INM-3), Jülich Research Center, Jülich, Germany
| | - Monika Pötter-Nerger
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Michael T Barbe
- Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
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Cabrera LY, Young Han C, Ostendorf T, Jimenez-Shahed J, Sarva H. Neurologists' Attitudes Toward Use and Timing of Deep Brain Stimulation. Neurol Clin Pract 2021; 11:506-516. [PMID: 34992957 PMCID: PMC8723941 DOI: 10.1212/cpj.0000000000001098] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 03/19/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVE We sought to explore current perspectives and attitudes of general neurologists and movement disorder specialists toward deep brain stimulation (DBS) for Parkinson disease (PD), focusing on perspectives on its earlier use in the clinical course of the disease. METHODS We designed a 30-question online survey comprised of Likert-type, multiple choice, and rank-order questions, which was distributed to 932 neurologist members of the American Academy of Neurology. We analyzed clinicians' sociodemographic information, treatment patterns used for patients with PD, reasons for and against patient referral for DBS, and general attitudes toward DBS. Data were analyzed using descriptive and inferential statistics. RESULTS We received 164/930 completed surveys (completion rate of 18%). Overall, most respondents agreed that DBS was more useful after the appearance of motor complications and that DBS utilization offered better management of PD than medication alone. However, respondents were divided on issues like minimum duration of disease needed to consider DBS as a treatment option and timing of DBS referral relative to disease progression. Specifically, differences between movement disorder specialists and general neurologists were seen in medication management of symptoms and dyskinesia. CONCLUSIONS There remains a lack of consensus on several aspects of DBS, including medical management before offering DBS and the appropriate timing of its consideration for patients. Given the effect of such lack of consensus on patients' outcomes and recent evidence on positive DBS results, it is essential to update DBS professional guidelines with a focus on medical management and the timely use of DBS.
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Affiliation(s)
- Laura Yenisa Cabrera
- Center for Ethics and Humanities in the Life Sciences (LYC), Department of Translational Neuroscience, Michigan State University, East Lansing, current affiliation: Center for Neural Engineering, Department of Engineering Science and Mechanics, Rock Ethics Institutes, Pennsylvania State University; Weill Cornell Medicine (CYH), New York; American Academy of Neurology (TO), Minneapolis, MN; Bonnie and Tom Strauss Movement Disorders Center (JJ-S), Icahn School of Medicine at Mount Sinai, New York; and Parkinson's Disease and Movement Disorders Institute (HS), Department of Neurology, Weill Cornell Medicine, New York
| | - Catherine Young Han
- Center for Ethics and Humanities in the Life Sciences (LYC), Department of Translational Neuroscience, Michigan State University, East Lansing, current affiliation: Center for Neural Engineering, Department of Engineering Science and Mechanics, Rock Ethics Institutes, Pennsylvania State University; Weill Cornell Medicine (CYH), New York; American Academy of Neurology (TO), Minneapolis, MN; Bonnie and Tom Strauss Movement Disorders Center (JJ-S), Icahn School of Medicine at Mount Sinai, New York; and Parkinson's Disease and Movement Disorders Institute (HS), Department of Neurology, Weill Cornell Medicine, New York
| | - Tasha Ostendorf
- Center for Ethics and Humanities in the Life Sciences (LYC), Department of Translational Neuroscience, Michigan State University, East Lansing, current affiliation: Center for Neural Engineering, Department of Engineering Science and Mechanics, Rock Ethics Institutes, Pennsylvania State University; Weill Cornell Medicine (CYH), New York; American Academy of Neurology (TO), Minneapolis, MN; Bonnie and Tom Strauss Movement Disorders Center (JJ-S), Icahn School of Medicine at Mount Sinai, New York; and Parkinson's Disease and Movement Disorders Institute (HS), Department of Neurology, Weill Cornell Medicine, New York
| | - Joohi Jimenez-Shahed
- Center for Ethics and Humanities in the Life Sciences (LYC), Department of Translational Neuroscience, Michigan State University, East Lansing, current affiliation: Center for Neural Engineering, Department of Engineering Science and Mechanics, Rock Ethics Institutes, Pennsylvania State University; Weill Cornell Medicine (CYH), New York; American Academy of Neurology (TO), Minneapolis, MN; Bonnie and Tom Strauss Movement Disorders Center (JJ-S), Icahn School of Medicine at Mount Sinai, New York; and Parkinson's Disease and Movement Disorders Institute (HS), Department of Neurology, Weill Cornell Medicine, New York
| | - Harini Sarva
- Center for Ethics and Humanities in the Life Sciences (LYC), Department of Translational Neuroscience, Michigan State University, East Lansing, current affiliation: Center for Neural Engineering, Department of Engineering Science and Mechanics, Rock Ethics Institutes, Pennsylvania State University; Weill Cornell Medicine (CYH), New York; American Academy of Neurology (TO), Minneapolis, MN; Bonnie and Tom Strauss Movement Disorders Center (JJ-S), Icahn School of Medicine at Mount Sinai, New York; and Parkinson's Disease and Movement Disorders Institute (HS), Department of Neurology, Weill Cornell Medicine, New York
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Weiss D, Höglinger G, Klostermann F, Weise D, Zeuner KE, Reichmann H. [Hallucinations in Patients with Idiopathic Parkinson's Disease]. FORTSCHRITTE DER NEUROLOGIE-PSYCHIATRIE 2021; 90:456-464. [PMID: 34844278 DOI: 10.1055/a-1670-7111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Patients with idiopathic Parkinson's disease develop symptoms of the hallucination-psychosis spectrum in more than 20%. Most common are visual hallucinations. The pathogenesis of hallucinations mainly depends on disease duration, the distribution and extent of alpha-synuclein pathology, and modulating effects of the dopaminergic therapy. When managing PD hallucinations both anti-delirogenic actions and medication management are important. However, decrease in dopaminergic medication may lead to critical worsening of akinesia. If appropriate neuroleptic medication - essentially quetiapin or clozapin - can be considered. Instead, anti-dopaminergic neuroleptics should not be used owing to their pro-akinetic side-effects. Here, we provide therapy recommendations to manage PD hallucinations based on an up-to-date targeted review of the literature and expert-based empirical evidence.
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Affiliation(s)
- Daniel Weiss
- Neurologische Klinik mit Schwerpunkt Neurodegenerative Erkrankungen und Hertie-Institut für Klinische Hirnforschung, Universitätsklinikum Tübingen, Deutschland
| | - Günter Höglinger
- Klinik für Neurologie mit Klinischer Neurophysiologie, Medizinisch Hochschule Hannover, Deutschland
| | - Fabian Klostermann
- Klinik für Neurologie mit Experimenteller Neurologie, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Deutschland
| | - David Weise
- Klinik für Neurologie, Schmerztherapie und Schlafmedizin, Asklepios Fachklinikum Stadtroda, Deutschland
| | - Kirsten E Zeuner
- Klinik für Neurologie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Deutschland
| | - Heinz Reichmann
- Klinik und Poliklinik für Neurologie, Universitätsklinikum Carl Gustav Carus Dresden, Deutschland
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Besse-Pinot E, Pereira B, Durif F, Fantini ML, Durand E, Debilly B, Derost P, Moreau C, Hainque E, Rouaud T, Eusebio A, Benatru I, Drapier S, Guehl D, Rascol O, Maltête D, Lagha-Boukbiza O, Giordana C, Tir M, Thobois S, Hopes L, Hubsch C, Jarraya B, Rolland AS, Corvol JC, Devos D, Marques A. Preoperative REM Sleep Behavior Disorder and Subthalamic Nucleus Deep Brain Stimulation Outcome in Parkinson Disease 1 Year After Surgery. Neurology 2021; 97:e1994-e2006. [PMID: 34667082 DOI: 10.1212/wnl.0000000000012862] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 09/20/2021] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVES To determine whether patients with Parkinson disease (PD) eligible for subthalamic nucleus deep brain stimulation (STN-DBS) with probable REM sleep behavior disorder (RBD) preoperatively could be more at risk of poorer motor, nonmotor, and quality of life outcomes 12 months after surgery compared to those without RBD. METHODS We analyzed the preoperative clinical profile of 448 patients with PD from a French multicentric prospective study (PREDISTIM) according to the presence or absence of probable RBD based on the RBD Single Question and RBD Screening Questionnaire. Among the 215 patients with PD with 12 months of follow-up after STN-DBS, we compared motor, cognitive, psycho-behavioral profile, and quality of life outcomes in patients with (pre-opRBD+) or without (pre-opRBD-) probable RBD preoperatively. RESULTS At preoperative evaluation, pre-opRBD+ patients were older (61 ± 7.2 vs 59.5 ± 7.7 years; p = 0.02), had less motor impairment (Movement Disorder Society-sponsored version of the Unified Parkinson's Disease Rating Scale [MDS-UPDRS] III "off": 38.7 ± 16.2 vs 43.4 ± 7.1; p = 0.03) but more nonmotor symptoms on daily living activities (MDS-UPDRS I: 12.6 ± 5.5 vs 10.7 ± 5.3; p < 0.001), had more psychobehavioral manifestations (Ardouin Scale of Behavior in Parkinson's Disease total: 7.7 ± 5.1 vs 5.1 ± 0.4; p = 0.003), and had worse quality of life (Parkinson's Disease Questionnaire-39: 33 ± 12 vs 29 ± 12; p = 0.03), as compared to pre-opRBD- patients. Both pre-opRBD+ and pre-opRBD- patients had significant MDS-UPDRS IV score decrease (-37% and -33%, respectively), MDS-UPDRS III "med 'off'/stim 'on'" score decrease (-52% and -54%), and dopaminergic treatment decrease (-52% and -49%) after surgery, with no between-group difference. There was no between-group difference for cognitive and global quality of life outcomes. CONCLUSIONS In patients with PD eligible for STN-DBS, the presence of probable RBD preoperatively is not associated with a different clinical outcome 1 year after neurosurgery. TRIAL REGISTRATION INFORMATION NCT02360683. CLASSIFICATION OF EVIDENCE This study provides Class II evidence that in patients with PD eligible for STN-DBS, the presence of probable RBD preoperatively is not associated with poorer outcomes 1 year post surgery.
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Affiliation(s)
- Elsa Besse-Pinot
- From the Neurology Department, Université Clermont Auvergne, EA7280 (E.B.-P., F.D., M.L.F., E.D., B.D., P.D., A.M.), and Biostatistics Department (B.P.), Clermont-Ferrand University Hospital, NS-Park/F-CRIN Network; Departments of Medical Pharmacology and Neurology and Movement Disorders, Referent Center of Parkinson's Disease, INSERM UMRS_1171, Licend, CHU of Lille (C.M.), and Department of Medical Pharmacology, University Hospital, Lille Neuroscience & Cognition, INSERM, UMR-S1172 (A.-S.R., D.D.), University of Lille, NS-Park/F-CRIN Network; Department of Neurology, Paris Brain Institute (ICM) (E.H., J.-C.C.), Institut Du Cerveau, INSERM CNRS, Assistance Publique Hôpitaux de Paris, Sorbonne Université, Hôpital Pitié-Salpêtrière, NS-Park/F-CRIN Network; Department of Neurology (T.R.), Nantes University Hospital, NS-Park/F-CRIN Network; Department of Neurology (A.E.), Assistance Publique Hôpitaux de Marseille, Timone University Hospital and Institut de Neurosciences de La Timone, NS-Park/F-CRIN Network; Department of Neurology (I.B.), University Poitiers, NS-Park/F-CRIN Network; Department of Neurology (S.D.), University Hospital of Rennes, NS-Park/F-CRIN Network; Institut des Maladies Neurodégénératives, Centre Expert Parkinson (D.G.), CHU de Bordeaux, NS-Park/F-CRIN Network; Parkinson Expert Center, Department of Clinical Pharmacology and Neuroscience (O.R.), Clinical Investigation Center CIC1436, NeuroToul COEN Center, Toulouse University Hospital, University of Toulouse 3, INSERM, NS-Park/F-CRIN Network; Department of Neurology (D.M.), Rouen University Hospital and University of Rouen; Laboratory of Neuronal and Neuroendocrine Differentiation and Communication (D.M.), INSERM U1239, NS-Park/F-CRIN Network, Mont-Saint-Aignan; Department of Neurology (O.L.-B.), Strasbourg University Hospital, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Université de Strasbourg, NS-Park/F-CRIN Network; Department of Neurology (C.G.), Centre Hospitalier Universitaire de Nice, NS-Park/F-CRIN Network; Departments of Neurology and Neurosurgery (M.T.), Expert Centre for Parkinson's Disease, EA 4559 Laboratoire de Neurosciences Fonctionnelles et Pathologie, Amiens University Hospital, Université de Picardie Jules Verne, NS-Park/F-CRIN Network, Amiens; Department of Neurology C (S.T.), Pierre Wertheimer Neurological Hospital, Hospices Civils de Lyon, University Hospital of Lyon, Université Claude Bernard Lyon 1, CNRS, Institut des Sciences Cognitives Marc Jeannerod, UMR 5229 CNRS, NS-PARK/F-CRIN Network; Department of Neurology (L.H.), University Hospital of Nancy, NS-PARK/F-CRIN Network; Department of Neurology (C.H.), Hospital Fondation Ophtalmologique Adolphe de Rothschild, NS-PARK/F-CRIN Network; and Neuroscience Pole (B.J.), Hôpital Foch, Université Paris-Saclay (UVSQ), INSERM-CEA NeuroSpin, NS-PARK/F-CRIN Network, Paris, France
| | - Bruno Pereira
- From the Neurology Department, Université Clermont Auvergne, EA7280 (E.B.-P., F.D., M.L.F., E.D., B.D., P.D., A.M.), and Biostatistics Department (B.P.), Clermont-Ferrand University Hospital, NS-Park/F-CRIN Network; Departments of Medical Pharmacology and Neurology and Movement Disorders, Referent Center of Parkinson's Disease, INSERM UMRS_1171, Licend, CHU of Lille (C.M.), and Department of Medical Pharmacology, University Hospital, Lille Neuroscience & Cognition, INSERM, UMR-S1172 (A.-S.R., D.D.), University of Lille, NS-Park/F-CRIN Network; Department of Neurology, Paris Brain Institute (ICM) (E.H., J.-C.C.), Institut Du Cerveau, INSERM CNRS, Assistance Publique Hôpitaux de Paris, Sorbonne Université, Hôpital Pitié-Salpêtrière, NS-Park/F-CRIN Network; Department of Neurology (T.R.), Nantes University Hospital, NS-Park/F-CRIN Network; Department of Neurology (A.E.), Assistance Publique Hôpitaux de Marseille, Timone University Hospital and Institut de Neurosciences de La Timone, NS-Park/F-CRIN Network; Department of Neurology (I.B.), University Poitiers, NS-Park/F-CRIN Network; Department of Neurology (S.D.), University Hospital of Rennes, NS-Park/F-CRIN Network; Institut des Maladies Neurodégénératives, Centre Expert Parkinson (D.G.), CHU de Bordeaux, NS-Park/F-CRIN Network; Parkinson Expert Center, Department of Clinical Pharmacology and Neuroscience (O.R.), Clinical Investigation Center CIC1436, NeuroToul COEN Center, Toulouse University Hospital, University of Toulouse 3, INSERM, NS-Park/F-CRIN Network; Department of Neurology (D.M.), Rouen University Hospital and University of Rouen; Laboratory of Neuronal and Neuroendocrine Differentiation and Communication (D.M.), INSERM U1239, NS-Park/F-CRIN Network, Mont-Saint-Aignan; Department of Neurology (O.L.-B.), Strasbourg University Hospital, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Université de Strasbourg, NS-Park/F-CRIN Network; Department of Neurology (C.G.), Centre Hospitalier Universitaire de Nice, NS-Park/F-CRIN Network; Departments of Neurology and Neurosurgery (M.T.), Expert Centre for Parkinson's Disease, EA 4559 Laboratoire de Neurosciences Fonctionnelles et Pathologie, Amiens University Hospital, Université de Picardie Jules Verne, NS-Park/F-CRIN Network, Amiens; Department of Neurology C (S.T.), Pierre Wertheimer Neurological Hospital, Hospices Civils de Lyon, University Hospital of Lyon, Université Claude Bernard Lyon 1, CNRS, Institut des Sciences Cognitives Marc Jeannerod, UMR 5229 CNRS, NS-PARK/F-CRIN Network; Department of Neurology (L.H.), University Hospital of Nancy, NS-PARK/F-CRIN Network; Department of Neurology (C.H.), Hospital Fondation Ophtalmologique Adolphe de Rothschild, NS-PARK/F-CRIN Network; and Neuroscience Pole (B.J.), Hôpital Foch, Université Paris-Saclay (UVSQ), INSERM-CEA NeuroSpin, NS-PARK/F-CRIN Network, Paris, France
| | - Franck Durif
- From the Neurology Department, Université Clermont Auvergne, EA7280 (E.B.-P., F.D., M.L.F., E.D., B.D., P.D., A.M.), and Biostatistics Department (B.P.), Clermont-Ferrand University Hospital, NS-Park/F-CRIN Network; Departments of Medical Pharmacology and Neurology and Movement Disorders, Referent Center of Parkinson's Disease, INSERM UMRS_1171, Licend, CHU of Lille (C.M.), and Department of Medical Pharmacology, University Hospital, Lille Neuroscience & Cognition, INSERM, UMR-S1172 (A.-S.R., D.D.), University of Lille, NS-Park/F-CRIN Network; Department of Neurology, Paris Brain Institute (ICM) (E.H., J.-C.C.), Institut Du Cerveau, INSERM CNRS, Assistance Publique Hôpitaux de Paris, Sorbonne Université, Hôpital Pitié-Salpêtrière, NS-Park/F-CRIN Network; Department of Neurology (T.R.), Nantes University Hospital, NS-Park/F-CRIN Network; Department of Neurology (A.E.), Assistance Publique Hôpitaux de Marseille, Timone University Hospital and Institut de Neurosciences de La Timone, NS-Park/F-CRIN Network; Department of Neurology (I.B.), University Poitiers, NS-Park/F-CRIN Network; Department of Neurology (S.D.), University Hospital of Rennes, NS-Park/F-CRIN Network; Institut des Maladies Neurodégénératives, Centre Expert Parkinson (D.G.), CHU de Bordeaux, NS-Park/F-CRIN Network; Parkinson Expert Center, Department of Clinical Pharmacology and Neuroscience (O.R.), Clinical Investigation Center CIC1436, NeuroToul COEN Center, Toulouse University Hospital, University of Toulouse 3, INSERM, NS-Park/F-CRIN Network; Department of Neurology (D.M.), Rouen University Hospital and University of Rouen; Laboratory of Neuronal and Neuroendocrine Differentiation and Communication (D.M.), INSERM U1239, NS-Park/F-CRIN Network, Mont-Saint-Aignan; Department of Neurology (O.L.-B.), Strasbourg University Hospital, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Université de Strasbourg, NS-Park/F-CRIN Network; Department of Neurology (C.G.), Centre Hospitalier Universitaire de Nice, NS-Park/F-CRIN Network; Departments of Neurology and Neurosurgery (M.T.), Expert Centre for Parkinson's Disease, EA 4559 Laboratoire de Neurosciences Fonctionnelles et Pathologie, Amiens University Hospital, Université de Picardie Jules Verne, NS-Park/F-CRIN Network, Amiens; Department of Neurology C (S.T.), Pierre Wertheimer Neurological Hospital, Hospices Civils de Lyon, University Hospital of Lyon, Université Claude Bernard Lyon 1, CNRS, Institut des Sciences Cognitives Marc Jeannerod, UMR 5229 CNRS, NS-PARK/F-CRIN Network; Department of Neurology (L.H.), University Hospital of Nancy, NS-PARK/F-CRIN Network; Department of Neurology (C.H.), Hospital Fondation Ophtalmologique Adolphe de Rothschild, NS-PARK/F-CRIN Network; and Neuroscience Pole (B.J.), Hôpital Foch, Université Paris-Saclay (UVSQ), INSERM-CEA NeuroSpin, NS-PARK/F-CRIN Network, Paris, France
| | - Maria Livia Fantini
- From the Neurology Department, Université Clermont Auvergne, EA7280 (E.B.-P., F.D., M.L.F., E.D., B.D., P.D., A.M.), and Biostatistics Department (B.P.), Clermont-Ferrand University Hospital, NS-Park/F-CRIN Network; Departments of Medical Pharmacology and Neurology and Movement Disorders, Referent Center of Parkinson's Disease, INSERM UMRS_1171, Licend, CHU of Lille (C.M.), and Department of Medical Pharmacology, University Hospital, Lille Neuroscience & Cognition, INSERM, UMR-S1172 (A.-S.R., D.D.), University of Lille, NS-Park/F-CRIN Network; Department of Neurology, Paris Brain Institute (ICM) (E.H., J.-C.C.), Institut Du Cerveau, INSERM CNRS, Assistance Publique Hôpitaux de Paris, Sorbonne Université, Hôpital Pitié-Salpêtrière, NS-Park/F-CRIN Network; Department of Neurology (T.R.), Nantes University Hospital, NS-Park/F-CRIN Network; Department of Neurology (A.E.), Assistance Publique Hôpitaux de Marseille, Timone University Hospital and Institut de Neurosciences de La Timone, NS-Park/F-CRIN Network; Department of Neurology (I.B.), University Poitiers, NS-Park/F-CRIN Network; Department of Neurology (S.D.), University Hospital of Rennes, NS-Park/F-CRIN Network; Institut des Maladies Neurodégénératives, Centre Expert Parkinson (D.G.), CHU de Bordeaux, NS-Park/F-CRIN Network; Parkinson Expert Center, Department of Clinical Pharmacology and Neuroscience (O.R.), Clinical Investigation Center CIC1436, NeuroToul COEN Center, Toulouse University Hospital, University of Toulouse 3, INSERM, NS-Park/F-CRIN Network; Department of Neurology (D.M.), Rouen University Hospital and University of Rouen; Laboratory of Neuronal and Neuroendocrine Differentiation and Communication (D.M.), INSERM U1239, NS-Park/F-CRIN Network, Mont-Saint-Aignan; Department of Neurology (O.L.-B.), Strasbourg University Hospital, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Université de Strasbourg, NS-Park/F-CRIN Network; Department of Neurology (C.G.), Centre Hospitalier Universitaire de Nice, NS-Park/F-CRIN Network; Departments of Neurology and Neurosurgery (M.T.), Expert Centre for Parkinson's Disease, EA 4559 Laboratoire de Neurosciences Fonctionnelles et Pathologie, Amiens University Hospital, Université de Picardie Jules Verne, NS-Park/F-CRIN Network, Amiens; Department of Neurology C (S.T.), Pierre Wertheimer Neurological Hospital, Hospices Civils de Lyon, University Hospital of Lyon, Université Claude Bernard Lyon 1, CNRS, Institut des Sciences Cognitives Marc Jeannerod, UMR 5229 CNRS, NS-PARK/F-CRIN Network; Department of Neurology (L.H.), University Hospital of Nancy, NS-PARK/F-CRIN Network; Department of Neurology (C.H.), Hospital Fondation Ophtalmologique Adolphe de Rothschild, NS-PARK/F-CRIN Network; and Neuroscience Pole (B.J.), Hôpital Foch, Université Paris-Saclay (UVSQ), INSERM-CEA NeuroSpin, NS-PARK/F-CRIN Network, Paris, France
| | - Elodie Durand
- From the Neurology Department, Université Clermont Auvergne, EA7280 (E.B.-P., F.D., M.L.F., E.D., B.D., P.D., A.M.), and Biostatistics Department (B.P.), Clermont-Ferrand University Hospital, NS-Park/F-CRIN Network; Departments of Medical Pharmacology and Neurology and Movement Disorders, Referent Center of Parkinson's Disease, INSERM UMRS_1171, Licend, CHU of Lille (C.M.), and Department of Medical Pharmacology, University Hospital, Lille Neuroscience & Cognition, INSERM, UMR-S1172 (A.-S.R., D.D.), University of Lille, NS-Park/F-CRIN Network; Department of Neurology, Paris Brain Institute (ICM) (E.H., J.-C.C.), Institut Du Cerveau, INSERM CNRS, Assistance Publique Hôpitaux de Paris, Sorbonne Université, Hôpital Pitié-Salpêtrière, NS-Park/F-CRIN Network; Department of Neurology (T.R.), Nantes University Hospital, NS-Park/F-CRIN Network; Department of Neurology (A.E.), Assistance Publique Hôpitaux de Marseille, Timone University Hospital and Institut de Neurosciences de La Timone, NS-Park/F-CRIN Network; Department of Neurology (I.B.), University Poitiers, NS-Park/F-CRIN Network; Department of Neurology (S.D.), University Hospital of Rennes, NS-Park/F-CRIN Network; Institut des Maladies Neurodégénératives, Centre Expert Parkinson (D.G.), CHU de Bordeaux, NS-Park/F-CRIN Network; Parkinson Expert Center, Department of Clinical Pharmacology and Neuroscience (O.R.), Clinical Investigation Center CIC1436, NeuroToul COEN Center, Toulouse University Hospital, University of Toulouse 3, INSERM, NS-Park/F-CRIN Network; Department of Neurology (D.M.), Rouen University Hospital and University of Rouen; Laboratory of Neuronal and Neuroendocrine Differentiation and Communication (D.M.), INSERM U1239, NS-Park/F-CRIN Network, Mont-Saint-Aignan; Department of Neurology (O.L.-B.), Strasbourg University Hospital, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Université de Strasbourg, NS-Park/F-CRIN Network; Department of Neurology (C.G.), Centre Hospitalier Universitaire de Nice, NS-Park/F-CRIN Network; Departments of Neurology and Neurosurgery (M.T.), Expert Centre for Parkinson's Disease, EA 4559 Laboratoire de Neurosciences Fonctionnelles et Pathologie, Amiens University Hospital, Université de Picardie Jules Verne, NS-Park/F-CRIN Network, Amiens; Department of Neurology C (S.T.), Pierre Wertheimer Neurological Hospital, Hospices Civils de Lyon, University Hospital of Lyon, Université Claude Bernard Lyon 1, CNRS, Institut des Sciences Cognitives Marc Jeannerod, UMR 5229 CNRS, NS-PARK/F-CRIN Network; Department of Neurology (L.H.), University Hospital of Nancy, NS-PARK/F-CRIN Network; Department of Neurology (C.H.), Hospital Fondation Ophtalmologique Adolphe de Rothschild, NS-PARK/F-CRIN Network; and Neuroscience Pole (B.J.), Hôpital Foch, Université Paris-Saclay (UVSQ), INSERM-CEA NeuroSpin, NS-PARK/F-CRIN Network, Paris, France
| | - Bérengère Debilly
- From the Neurology Department, Université Clermont Auvergne, EA7280 (E.B.-P., F.D., M.L.F., E.D., B.D., P.D., A.M.), and Biostatistics Department (B.P.), Clermont-Ferrand University Hospital, NS-Park/F-CRIN Network; Departments of Medical Pharmacology and Neurology and Movement Disorders, Referent Center of Parkinson's Disease, INSERM UMRS_1171, Licend, CHU of Lille (C.M.), and Department of Medical Pharmacology, University Hospital, Lille Neuroscience & Cognition, INSERM, UMR-S1172 (A.-S.R., D.D.), University of Lille, NS-Park/F-CRIN Network; Department of Neurology, Paris Brain Institute (ICM) (E.H., J.-C.C.), Institut Du Cerveau, INSERM CNRS, Assistance Publique Hôpitaux de Paris, Sorbonne Université, Hôpital Pitié-Salpêtrière, NS-Park/F-CRIN Network; Department of Neurology (T.R.), Nantes University Hospital, NS-Park/F-CRIN Network; Department of Neurology (A.E.), Assistance Publique Hôpitaux de Marseille, Timone University Hospital and Institut de Neurosciences de La Timone, NS-Park/F-CRIN Network; Department of Neurology (I.B.), University Poitiers, NS-Park/F-CRIN Network; Department of Neurology (S.D.), University Hospital of Rennes, NS-Park/F-CRIN Network; Institut des Maladies Neurodégénératives, Centre Expert Parkinson (D.G.), CHU de Bordeaux, NS-Park/F-CRIN Network; Parkinson Expert Center, Department of Clinical Pharmacology and Neuroscience (O.R.), Clinical Investigation Center CIC1436, NeuroToul COEN Center, Toulouse University Hospital, University of Toulouse 3, INSERM, NS-Park/F-CRIN Network; Department of Neurology (D.M.), Rouen University Hospital and University of Rouen; Laboratory of Neuronal and Neuroendocrine Differentiation and Communication (D.M.), INSERM U1239, NS-Park/F-CRIN Network, Mont-Saint-Aignan; Department of Neurology (O.L.-B.), Strasbourg University Hospital, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Université de Strasbourg, NS-Park/F-CRIN Network; Department of Neurology (C.G.), Centre Hospitalier Universitaire de Nice, NS-Park/F-CRIN Network; Departments of Neurology and Neurosurgery (M.T.), Expert Centre for Parkinson's Disease, EA 4559 Laboratoire de Neurosciences Fonctionnelles et Pathologie, Amiens University Hospital, Université de Picardie Jules Verne, NS-Park/F-CRIN Network, Amiens; Department of Neurology C (S.T.), Pierre Wertheimer Neurological Hospital, Hospices Civils de Lyon, University Hospital of Lyon, Université Claude Bernard Lyon 1, CNRS, Institut des Sciences Cognitives Marc Jeannerod, UMR 5229 CNRS, NS-PARK/F-CRIN Network; Department of Neurology (L.H.), University Hospital of Nancy, NS-PARK/F-CRIN Network; Department of Neurology (C.H.), Hospital Fondation Ophtalmologique Adolphe de Rothschild, NS-PARK/F-CRIN Network; and Neuroscience Pole (B.J.), Hôpital Foch, Université Paris-Saclay (UVSQ), INSERM-CEA NeuroSpin, NS-PARK/F-CRIN Network, Paris, France
| | - Philippe Derost
- From the Neurology Department, Université Clermont Auvergne, EA7280 (E.B.-P., F.D., M.L.F., E.D., B.D., P.D., A.M.), and Biostatistics Department (B.P.), Clermont-Ferrand University Hospital, NS-Park/F-CRIN Network; Departments of Medical Pharmacology and Neurology and Movement Disorders, Referent Center of Parkinson's Disease, INSERM UMRS_1171, Licend, CHU of Lille (C.M.), and Department of Medical Pharmacology, University Hospital, Lille Neuroscience & Cognition, INSERM, UMR-S1172 (A.-S.R., D.D.), University of Lille, NS-Park/F-CRIN Network; Department of Neurology, Paris Brain Institute (ICM) (E.H., J.-C.C.), Institut Du Cerveau, INSERM CNRS, Assistance Publique Hôpitaux de Paris, Sorbonne Université, Hôpital Pitié-Salpêtrière, NS-Park/F-CRIN Network; Department of Neurology (T.R.), Nantes University Hospital, NS-Park/F-CRIN Network; Department of Neurology (A.E.), Assistance Publique Hôpitaux de Marseille, Timone University Hospital and Institut de Neurosciences de La Timone, NS-Park/F-CRIN Network; Department of Neurology (I.B.), University Poitiers, NS-Park/F-CRIN Network; Department of Neurology (S.D.), University Hospital of Rennes, NS-Park/F-CRIN Network; Institut des Maladies Neurodégénératives, Centre Expert Parkinson (D.G.), CHU de Bordeaux, NS-Park/F-CRIN Network; Parkinson Expert Center, Department of Clinical Pharmacology and Neuroscience (O.R.), Clinical Investigation Center CIC1436, NeuroToul COEN Center, Toulouse University Hospital, University of Toulouse 3, INSERM, NS-Park/F-CRIN Network; Department of Neurology (D.M.), Rouen University Hospital and University of Rouen; Laboratory of Neuronal and Neuroendocrine Differentiation and Communication (D.M.), INSERM U1239, NS-Park/F-CRIN Network, Mont-Saint-Aignan; Department of Neurology (O.L.-B.), Strasbourg University Hospital, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Université de Strasbourg, NS-Park/F-CRIN Network; Department of Neurology (C.G.), Centre Hospitalier Universitaire de Nice, NS-Park/F-CRIN Network; Departments of Neurology and Neurosurgery (M.T.), Expert Centre for Parkinson's Disease, EA 4559 Laboratoire de Neurosciences Fonctionnelles et Pathologie, Amiens University Hospital, Université de Picardie Jules Verne, NS-Park/F-CRIN Network, Amiens; Department of Neurology C (S.T.), Pierre Wertheimer Neurological Hospital, Hospices Civils de Lyon, University Hospital of Lyon, Université Claude Bernard Lyon 1, CNRS, Institut des Sciences Cognitives Marc Jeannerod, UMR 5229 CNRS, NS-PARK/F-CRIN Network; Department of Neurology (L.H.), University Hospital of Nancy, NS-PARK/F-CRIN Network; Department of Neurology (C.H.), Hospital Fondation Ophtalmologique Adolphe de Rothschild, NS-PARK/F-CRIN Network; and Neuroscience Pole (B.J.), Hôpital Foch, Université Paris-Saclay (UVSQ), INSERM-CEA NeuroSpin, NS-PARK/F-CRIN Network, Paris, France
| | - Caroline Moreau
- From the Neurology Department, Université Clermont Auvergne, EA7280 (E.B.-P., F.D., M.L.F., E.D., B.D., P.D., A.M.), and Biostatistics Department (B.P.), Clermont-Ferrand University Hospital, NS-Park/F-CRIN Network; Departments of Medical Pharmacology and Neurology and Movement Disorders, Referent Center of Parkinson's Disease, INSERM UMRS_1171, Licend, CHU of Lille (C.M.), and Department of Medical Pharmacology, University Hospital, Lille Neuroscience & Cognition, INSERM, UMR-S1172 (A.-S.R., D.D.), University of Lille, NS-Park/F-CRIN Network; Department of Neurology, Paris Brain Institute (ICM) (E.H., J.-C.C.), Institut Du Cerveau, INSERM CNRS, Assistance Publique Hôpitaux de Paris, Sorbonne Université, Hôpital Pitié-Salpêtrière, NS-Park/F-CRIN Network; Department of Neurology (T.R.), Nantes University Hospital, NS-Park/F-CRIN Network; Department of Neurology (A.E.), Assistance Publique Hôpitaux de Marseille, Timone University Hospital and Institut de Neurosciences de La Timone, NS-Park/F-CRIN Network; Department of Neurology (I.B.), University Poitiers, NS-Park/F-CRIN Network; Department of Neurology (S.D.), University Hospital of Rennes, NS-Park/F-CRIN Network; Institut des Maladies Neurodégénératives, Centre Expert Parkinson (D.G.), CHU de Bordeaux, NS-Park/F-CRIN Network; Parkinson Expert Center, Department of Clinical Pharmacology and Neuroscience (O.R.), Clinical Investigation Center CIC1436, NeuroToul COEN Center, Toulouse University Hospital, University of Toulouse 3, INSERM, NS-Park/F-CRIN Network; Department of Neurology (D.M.), Rouen University Hospital and University of Rouen; Laboratory of Neuronal and Neuroendocrine Differentiation and Communication (D.M.), INSERM U1239, NS-Park/F-CRIN Network, Mont-Saint-Aignan; Department of Neurology (O.L.-B.), Strasbourg University Hospital, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Université de Strasbourg, NS-Park/F-CRIN Network; Department of Neurology (C.G.), Centre Hospitalier Universitaire de Nice, NS-Park/F-CRIN Network; Departments of Neurology and Neurosurgery (M.T.), Expert Centre for Parkinson's Disease, EA 4559 Laboratoire de Neurosciences Fonctionnelles et Pathologie, Amiens University Hospital, Université de Picardie Jules Verne, NS-Park/F-CRIN Network, Amiens; Department of Neurology C (S.T.), Pierre Wertheimer Neurological Hospital, Hospices Civils de Lyon, University Hospital of Lyon, Université Claude Bernard Lyon 1, CNRS, Institut des Sciences Cognitives Marc Jeannerod, UMR 5229 CNRS, NS-PARK/F-CRIN Network; Department of Neurology (L.H.), University Hospital of Nancy, NS-PARK/F-CRIN Network; Department of Neurology (C.H.), Hospital Fondation Ophtalmologique Adolphe de Rothschild, NS-PARK/F-CRIN Network; and Neuroscience Pole (B.J.), Hôpital Foch, Université Paris-Saclay (UVSQ), INSERM-CEA NeuroSpin, NS-PARK/F-CRIN Network, Paris, France
| | - Elodie Hainque
- From the Neurology Department, Université Clermont Auvergne, EA7280 (E.B.-P., F.D., M.L.F., E.D., B.D., P.D., A.M.), and Biostatistics Department (B.P.), Clermont-Ferrand University Hospital, NS-Park/F-CRIN Network; Departments of Medical Pharmacology and Neurology and Movement Disorders, Referent Center of Parkinson's Disease, INSERM UMRS_1171, Licend, CHU of Lille (C.M.), and Department of Medical Pharmacology, University Hospital, Lille Neuroscience & Cognition, INSERM, UMR-S1172 (A.-S.R., D.D.), University of Lille, NS-Park/F-CRIN Network; Department of Neurology, Paris Brain Institute (ICM) (E.H., J.-C.C.), Institut Du Cerveau, INSERM CNRS, Assistance Publique Hôpitaux de Paris, Sorbonne Université, Hôpital Pitié-Salpêtrière, NS-Park/F-CRIN Network; Department of Neurology (T.R.), Nantes University Hospital, NS-Park/F-CRIN Network; Department of Neurology (A.E.), Assistance Publique Hôpitaux de Marseille, Timone University Hospital and Institut de Neurosciences de La Timone, NS-Park/F-CRIN Network; Department of Neurology (I.B.), University Poitiers, NS-Park/F-CRIN Network; Department of Neurology (S.D.), University Hospital of Rennes, NS-Park/F-CRIN Network; Institut des Maladies Neurodégénératives, Centre Expert Parkinson (D.G.), CHU de Bordeaux, NS-Park/F-CRIN Network; Parkinson Expert Center, Department of Clinical Pharmacology and Neuroscience (O.R.), Clinical Investigation Center CIC1436, NeuroToul COEN Center, Toulouse University Hospital, University of Toulouse 3, INSERM, NS-Park/F-CRIN Network; Department of Neurology (D.M.), Rouen University Hospital and University of Rouen; Laboratory of Neuronal and Neuroendocrine Differentiation and Communication (D.M.), INSERM U1239, NS-Park/F-CRIN Network, Mont-Saint-Aignan; Department of Neurology (O.L.-B.), Strasbourg University Hospital, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Université de Strasbourg, NS-Park/F-CRIN Network; Department of Neurology (C.G.), Centre Hospitalier Universitaire de Nice, NS-Park/F-CRIN Network; Departments of Neurology and Neurosurgery (M.T.), Expert Centre for Parkinson's Disease, EA 4559 Laboratoire de Neurosciences Fonctionnelles et Pathologie, Amiens University Hospital, Université de Picardie Jules Verne, NS-Park/F-CRIN Network, Amiens; Department of Neurology C (S.T.), Pierre Wertheimer Neurological Hospital, Hospices Civils de Lyon, University Hospital of Lyon, Université Claude Bernard Lyon 1, CNRS, Institut des Sciences Cognitives Marc Jeannerod, UMR 5229 CNRS, NS-PARK/F-CRIN Network; Department of Neurology (L.H.), University Hospital of Nancy, NS-PARK/F-CRIN Network; Department of Neurology (C.H.), Hospital Fondation Ophtalmologique Adolphe de Rothschild, NS-PARK/F-CRIN Network; and Neuroscience Pole (B.J.), Hôpital Foch, Université Paris-Saclay (UVSQ), INSERM-CEA NeuroSpin, NS-PARK/F-CRIN Network, Paris, France
| | - Tiphaine Rouaud
- From the Neurology Department, Université Clermont Auvergne, EA7280 (E.B.-P., F.D., M.L.F., E.D., B.D., P.D., A.M.), and Biostatistics Department (B.P.), Clermont-Ferrand University Hospital, NS-Park/F-CRIN Network; Departments of Medical Pharmacology and Neurology and Movement Disorders, Referent Center of Parkinson's Disease, INSERM UMRS_1171, Licend, CHU of Lille (C.M.), and Department of Medical Pharmacology, University Hospital, Lille Neuroscience & Cognition, INSERM, UMR-S1172 (A.-S.R., D.D.), University of Lille, NS-Park/F-CRIN Network; Department of Neurology, Paris Brain Institute (ICM) (E.H., J.-C.C.), Institut Du Cerveau, INSERM CNRS, Assistance Publique Hôpitaux de Paris, Sorbonne Université, Hôpital Pitié-Salpêtrière, NS-Park/F-CRIN Network; Department of Neurology (T.R.), Nantes University Hospital, NS-Park/F-CRIN Network; Department of Neurology (A.E.), Assistance Publique Hôpitaux de Marseille, Timone University Hospital and Institut de Neurosciences de La Timone, NS-Park/F-CRIN Network; Department of Neurology (I.B.), University Poitiers, NS-Park/F-CRIN Network; Department of Neurology (S.D.), University Hospital of Rennes, NS-Park/F-CRIN Network; Institut des Maladies Neurodégénératives, Centre Expert Parkinson (D.G.), CHU de Bordeaux, NS-Park/F-CRIN Network; Parkinson Expert Center, Department of Clinical Pharmacology and Neuroscience (O.R.), Clinical Investigation Center CIC1436, NeuroToul COEN Center, Toulouse University Hospital, University of Toulouse 3, INSERM, NS-Park/F-CRIN Network; Department of Neurology (D.M.), Rouen University Hospital and University of Rouen; Laboratory of Neuronal and Neuroendocrine Differentiation and Communication (D.M.), INSERM U1239, NS-Park/F-CRIN Network, Mont-Saint-Aignan; Department of Neurology (O.L.-B.), Strasbourg University Hospital, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Université de Strasbourg, NS-Park/F-CRIN Network; Department of Neurology (C.G.), Centre Hospitalier Universitaire de Nice, NS-Park/F-CRIN Network; Departments of Neurology and Neurosurgery (M.T.), Expert Centre for Parkinson's Disease, EA 4559 Laboratoire de Neurosciences Fonctionnelles et Pathologie, Amiens University Hospital, Université de Picardie Jules Verne, NS-Park/F-CRIN Network, Amiens; Department of Neurology C (S.T.), Pierre Wertheimer Neurological Hospital, Hospices Civils de Lyon, University Hospital of Lyon, Université Claude Bernard Lyon 1, CNRS, Institut des Sciences Cognitives Marc Jeannerod, UMR 5229 CNRS, NS-PARK/F-CRIN Network; Department of Neurology (L.H.), University Hospital of Nancy, NS-PARK/F-CRIN Network; Department of Neurology (C.H.), Hospital Fondation Ophtalmologique Adolphe de Rothschild, NS-PARK/F-CRIN Network; and Neuroscience Pole (B.J.), Hôpital Foch, Université Paris-Saclay (UVSQ), INSERM-CEA NeuroSpin, NS-PARK/F-CRIN Network, Paris, France
| | - Alexandre Eusebio
- From the Neurology Department, Université Clermont Auvergne, EA7280 (E.B.-P., F.D., M.L.F., E.D., B.D., P.D., A.M.), and Biostatistics Department (B.P.), Clermont-Ferrand University Hospital, NS-Park/F-CRIN Network; Departments of Medical Pharmacology and Neurology and Movement Disorders, Referent Center of Parkinson's Disease, INSERM UMRS_1171, Licend, CHU of Lille (C.M.), and Department of Medical Pharmacology, University Hospital, Lille Neuroscience & Cognition, INSERM, UMR-S1172 (A.-S.R., D.D.), University of Lille, NS-Park/F-CRIN Network; Department of Neurology, Paris Brain Institute (ICM) (E.H., J.-C.C.), Institut Du Cerveau, INSERM CNRS, Assistance Publique Hôpitaux de Paris, Sorbonne Université, Hôpital Pitié-Salpêtrière, NS-Park/F-CRIN Network; Department of Neurology (T.R.), Nantes University Hospital, NS-Park/F-CRIN Network; Department of Neurology (A.E.), Assistance Publique Hôpitaux de Marseille, Timone University Hospital and Institut de Neurosciences de La Timone, NS-Park/F-CRIN Network; Department of Neurology (I.B.), University Poitiers, NS-Park/F-CRIN Network; Department of Neurology (S.D.), University Hospital of Rennes, NS-Park/F-CRIN Network; Institut des Maladies Neurodégénératives, Centre Expert Parkinson (D.G.), CHU de Bordeaux, NS-Park/F-CRIN Network; Parkinson Expert Center, Department of Clinical Pharmacology and Neuroscience (O.R.), Clinical Investigation Center CIC1436, NeuroToul COEN Center, Toulouse University Hospital, University of Toulouse 3, INSERM, NS-Park/F-CRIN Network; Department of Neurology (D.M.), Rouen University Hospital and University of Rouen; Laboratory of Neuronal and Neuroendocrine Differentiation and Communication (D.M.), INSERM U1239, NS-Park/F-CRIN Network, Mont-Saint-Aignan; Department of Neurology (O.L.-B.), Strasbourg University Hospital, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Université de Strasbourg, NS-Park/F-CRIN Network; Department of Neurology (C.G.), Centre Hospitalier Universitaire de Nice, NS-Park/F-CRIN Network; Departments of Neurology and Neurosurgery (M.T.), Expert Centre for Parkinson's Disease, EA 4559 Laboratoire de Neurosciences Fonctionnelles et Pathologie, Amiens University Hospital, Université de Picardie Jules Verne, NS-Park/F-CRIN Network, Amiens; Department of Neurology C (S.T.), Pierre Wertheimer Neurological Hospital, Hospices Civils de Lyon, University Hospital of Lyon, Université Claude Bernard Lyon 1, CNRS, Institut des Sciences Cognitives Marc Jeannerod, UMR 5229 CNRS, NS-PARK/F-CRIN Network; Department of Neurology (L.H.), University Hospital of Nancy, NS-PARK/F-CRIN Network; Department of Neurology (C.H.), Hospital Fondation Ophtalmologique Adolphe de Rothschild, NS-PARK/F-CRIN Network; and Neuroscience Pole (B.J.), Hôpital Foch, Université Paris-Saclay (UVSQ), INSERM-CEA NeuroSpin, NS-PARK/F-CRIN Network, Paris, France
| | - Isabelle Benatru
- From the Neurology Department, Université Clermont Auvergne, EA7280 (E.B.-P., F.D., M.L.F., E.D., B.D., P.D., A.M.), and Biostatistics Department (B.P.), Clermont-Ferrand University Hospital, NS-Park/F-CRIN Network; Departments of Medical Pharmacology and Neurology and Movement Disorders, Referent Center of Parkinson's Disease, INSERM UMRS_1171, Licend, CHU of Lille (C.M.), and Department of Medical Pharmacology, University Hospital, Lille Neuroscience & Cognition, INSERM, UMR-S1172 (A.-S.R., D.D.), University of Lille, NS-Park/F-CRIN Network; Department of Neurology, Paris Brain Institute (ICM) (E.H., J.-C.C.), Institut Du Cerveau, INSERM CNRS, Assistance Publique Hôpitaux de Paris, Sorbonne Université, Hôpital Pitié-Salpêtrière, NS-Park/F-CRIN Network; Department of Neurology (T.R.), Nantes University Hospital, NS-Park/F-CRIN Network; Department of Neurology (A.E.), Assistance Publique Hôpitaux de Marseille, Timone University Hospital and Institut de Neurosciences de La Timone, NS-Park/F-CRIN Network; Department of Neurology (I.B.), University Poitiers, NS-Park/F-CRIN Network; Department of Neurology (S.D.), University Hospital of Rennes, NS-Park/F-CRIN Network; Institut des Maladies Neurodégénératives, Centre Expert Parkinson (D.G.), CHU de Bordeaux, NS-Park/F-CRIN Network; Parkinson Expert Center, Department of Clinical Pharmacology and Neuroscience (O.R.), Clinical Investigation Center CIC1436, NeuroToul COEN Center, Toulouse University Hospital, University of Toulouse 3, INSERM, NS-Park/F-CRIN Network; Department of Neurology (D.M.), Rouen University Hospital and University of Rouen; Laboratory of Neuronal and Neuroendocrine Differentiation and Communication (D.M.), INSERM U1239, NS-Park/F-CRIN Network, Mont-Saint-Aignan; Department of Neurology (O.L.-B.), Strasbourg University Hospital, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Université de Strasbourg, NS-Park/F-CRIN Network; Department of Neurology (C.G.), Centre Hospitalier Universitaire de Nice, NS-Park/F-CRIN Network; Departments of Neurology and Neurosurgery (M.T.), Expert Centre for Parkinson's Disease, EA 4559 Laboratoire de Neurosciences Fonctionnelles et Pathologie, Amiens University Hospital, Université de Picardie Jules Verne, NS-Park/F-CRIN Network, Amiens; Department of Neurology C (S.T.), Pierre Wertheimer Neurological Hospital, Hospices Civils de Lyon, University Hospital of Lyon, Université Claude Bernard Lyon 1, CNRS, Institut des Sciences Cognitives Marc Jeannerod, UMR 5229 CNRS, NS-PARK/F-CRIN Network; Department of Neurology (L.H.), University Hospital of Nancy, NS-PARK/F-CRIN Network; Department of Neurology (C.H.), Hospital Fondation Ophtalmologique Adolphe de Rothschild, NS-PARK/F-CRIN Network; and Neuroscience Pole (B.J.), Hôpital Foch, Université Paris-Saclay (UVSQ), INSERM-CEA NeuroSpin, NS-PARK/F-CRIN Network, Paris, France
| | - Sophie Drapier
- From the Neurology Department, Université Clermont Auvergne, EA7280 (E.B.-P., F.D., M.L.F., E.D., B.D., P.D., A.M.), and Biostatistics Department (B.P.), Clermont-Ferrand University Hospital, NS-Park/F-CRIN Network; Departments of Medical Pharmacology and Neurology and Movement Disorders, Referent Center of Parkinson's Disease, INSERM UMRS_1171, Licend, CHU of Lille (C.M.), and Department of Medical Pharmacology, University Hospital, Lille Neuroscience & Cognition, INSERM, UMR-S1172 (A.-S.R., D.D.), University of Lille, NS-Park/F-CRIN Network; Department of Neurology, Paris Brain Institute (ICM) (E.H., J.-C.C.), Institut Du Cerveau, INSERM CNRS, Assistance Publique Hôpitaux de Paris, Sorbonne Université, Hôpital Pitié-Salpêtrière, NS-Park/F-CRIN Network; Department of Neurology (T.R.), Nantes University Hospital, NS-Park/F-CRIN Network; Department of Neurology (A.E.), Assistance Publique Hôpitaux de Marseille, Timone University Hospital and Institut de Neurosciences de La Timone, NS-Park/F-CRIN Network; Department of Neurology (I.B.), University Poitiers, NS-Park/F-CRIN Network; Department of Neurology (S.D.), University Hospital of Rennes, NS-Park/F-CRIN Network; Institut des Maladies Neurodégénératives, Centre Expert Parkinson (D.G.), CHU de Bordeaux, NS-Park/F-CRIN Network; Parkinson Expert Center, Department of Clinical Pharmacology and Neuroscience (O.R.), Clinical Investigation Center CIC1436, NeuroToul COEN Center, Toulouse University Hospital, University of Toulouse 3, INSERM, NS-Park/F-CRIN Network; Department of Neurology (D.M.), Rouen University Hospital and University of Rouen; Laboratory of Neuronal and Neuroendocrine Differentiation and Communication (D.M.), INSERM U1239, NS-Park/F-CRIN Network, Mont-Saint-Aignan; Department of Neurology (O.L.-B.), Strasbourg University Hospital, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Université de Strasbourg, NS-Park/F-CRIN Network; Department of Neurology (C.G.), Centre Hospitalier Universitaire de Nice, NS-Park/F-CRIN Network; Departments of Neurology and Neurosurgery (M.T.), Expert Centre for Parkinson's Disease, EA 4559 Laboratoire de Neurosciences Fonctionnelles et Pathologie, Amiens University Hospital, Université de Picardie Jules Verne, NS-Park/F-CRIN Network, Amiens; Department of Neurology C (S.T.), Pierre Wertheimer Neurological Hospital, Hospices Civils de Lyon, University Hospital of Lyon, Université Claude Bernard Lyon 1, CNRS, Institut des Sciences Cognitives Marc Jeannerod, UMR 5229 CNRS, NS-PARK/F-CRIN Network; Department of Neurology (L.H.), University Hospital of Nancy, NS-PARK/F-CRIN Network; Department of Neurology (C.H.), Hospital Fondation Ophtalmologique Adolphe de Rothschild, NS-PARK/F-CRIN Network; and Neuroscience Pole (B.J.), Hôpital Foch, Université Paris-Saclay (UVSQ), INSERM-CEA NeuroSpin, NS-PARK/F-CRIN Network, Paris, France
| | - Dominique Guehl
- From the Neurology Department, Université Clermont Auvergne, EA7280 (E.B.-P., F.D., M.L.F., E.D., B.D., P.D., A.M.), and Biostatistics Department (B.P.), Clermont-Ferrand University Hospital, NS-Park/F-CRIN Network; Departments of Medical Pharmacology and Neurology and Movement Disorders, Referent Center of Parkinson's Disease, INSERM UMRS_1171, Licend, CHU of Lille (C.M.), and Department of Medical Pharmacology, University Hospital, Lille Neuroscience & Cognition, INSERM, UMR-S1172 (A.-S.R., D.D.), University of Lille, NS-Park/F-CRIN Network; Department of Neurology, Paris Brain Institute (ICM) (E.H., J.-C.C.), Institut Du Cerveau, INSERM CNRS, Assistance Publique Hôpitaux de Paris, Sorbonne Université, Hôpital Pitié-Salpêtrière, NS-Park/F-CRIN Network; Department of Neurology (T.R.), Nantes University Hospital, NS-Park/F-CRIN Network; Department of Neurology (A.E.), Assistance Publique Hôpitaux de Marseille, Timone University Hospital and Institut de Neurosciences de La Timone, NS-Park/F-CRIN Network; Department of Neurology (I.B.), University Poitiers, NS-Park/F-CRIN Network; Department of Neurology (S.D.), University Hospital of Rennes, NS-Park/F-CRIN Network; Institut des Maladies Neurodégénératives, Centre Expert Parkinson (D.G.), CHU de Bordeaux, NS-Park/F-CRIN Network; Parkinson Expert Center, Department of Clinical Pharmacology and Neuroscience (O.R.), Clinical Investigation Center CIC1436, NeuroToul COEN Center, Toulouse University Hospital, University of Toulouse 3, INSERM, NS-Park/F-CRIN Network; Department of Neurology (D.M.), Rouen University Hospital and University of Rouen; Laboratory of Neuronal and Neuroendocrine Differentiation and Communication (D.M.), INSERM U1239, NS-Park/F-CRIN Network, Mont-Saint-Aignan; Department of Neurology (O.L.-B.), Strasbourg University Hospital, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Université de Strasbourg, NS-Park/F-CRIN Network; Department of Neurology (C.G.), Centre Hospitalier Universitaire de Nice, NS-Park/F-CRIN Network; Departments of Neurology and Neurosurgery (M.T.), Expert Centre for Parkinson's Disease, EA 4559 Laboratoire de Neurosciences Fonctionnelles et Pathologie, Amiens University Hospital, Université de Picardie Jules Verne, NS-Park/F-CRIN Network, Amiens; Department of Neurology C (S.T.), Pierre Wertheimer Neurological Hospital, Hospices Civils de Lyon, University Hospital of Lyon, Université Claude Bernard Lyon 1, CNRS, Institut des Sciences Cognitives Marc Jeannerod, UMR 5229 CNRS, NS-PARK/F-CRIN Network; Department of Neurology (L.H.), University Hospital of Nancy, NS-PARK/F-CRIN Network; Department of Neurology (C.H.), Hospital Fondation Ophtalmologique Adolphe de Rothschild, NS-PARK/F-CRIN Network; and Neuroscience Pole (B.J.), Hôpital Foch, Université Paris-Saclay (UVSQ), INSERM-CEA NeuroSpin, NS-PARK/F-CRIN Network, Paris, France
| | - Olivier Rascol
- From the Neurology Department, Université Clermont Auvergne, EA7280 (E.B.-P., F.D., M.L.F., E.D., B.D., P.D., A.M.), and Biostatistics Department (B.P.), Clermont-Ferrand University Hospital, NS-Park/F-CRIN Network; Departments of Medical Pharmacology and Neurology and Movement Disorders, Referent Center of Parkinson's Disease, INSERM UMRS_1171, Licend, CHU of Lille (C.M.), and Department of Medical Pharmacology, University Hospital, Lille Neuroscience & Cognition, INSERM, UMR-S1172 (A.-S.R., D.D.), University of Lille, NS-Park/F-CRIN Network; Department of Neurology, Paris Brain Institute (ICM) (E.H., J.-C.C.), Institut Du Cerveau, INSERM CNRS, Assistance Publique Hôpitaux de Paris, Sorbonne Université, Hôpital Pitié-Salpêtrière, NS-Park/F-CRIN Network; Department of Neurology (T.R.), Nantes University Hospital, NS-Park/F-CRIN Network; Department of Neurology (A.E.), Assistance Publique Hôpitaux de Marseille, Timone University Hospital and Institut de Neurosciences de La Timone, NS-Park/F-CRIN Network; Department of Neurology (I.B.), University Poitiers, NS-Park/F-CRIN Network; Department of Neurology (S.D.), University Hospital of Rennes, NS-Park/F-CRIN Network; Institut des Maladies Neurodégénératives, Centre Expert Parkinson (D.G.), CHU de Bordeaux, NS-Park/F-CRIN Network; Parkinson Expert Center, Department of Clinical Pharmacology and Neuroscience (O.R.), Clinical Investigation Center CIC1436, NeuroToul COEN Center, Toulouse University Hospital, University of Toulouse 3, INSERM, NS-Park/F-CRIN Network; Department of Neurology (D.M.), Rouen University Hospital and University of Rouen; Laboratory of Neuronal and Neuroendocrine Differentiation and Communication (D.M.), INSERM U1239, NS-Park/F-CRIN Network, Mont-Saint-Aignan; Department of Neurology (O.L.-B.), Strasbourg University Hospital, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Université de Strasbourg, NS-Park/F-CRIN Network; Department of Neurology (C.G.), Centre Hospitalier Universitaire de Nice, NS-Park/F-CRIN Network; Departments of Neurology and Neurosurgery (M.T.), Expert Centre for Parkinson's Disease, EA 4559 Laboratoire de Neurosciences Fonctionnelles et Pathologie, Amiens University Hospital, Université de Picardie Jules Verne, NS-Park/F-CRIN Network, Amiens; Department of Neurology C (S.T.), Pierre Wertheimer Neurological Hospital, Hospices Civils de Lyon, University Hospital of Lyon, Université Claude Bernard Lyon 1, CNRS, Institut des Sciences Cognitives Marc Jeannerod, UMR 5229 CNRS, NS-PARK/F-CRIN Network; Department of Neurology (L.H.), University Hospital of Nancy, NS-PARK/F-CRIN Network; Department of Neurology (C.H.), Hospital Fondation Ophtalmologique Adolphe de Rothschild, NS-PARK/F-CRIN Network; and Neuroscience Pole (B.J.), Hôpital Foch, Université Paris-Saclay (UVSQ), INSERM-CEA NeuroSpin, NS-PARK/F-CRIN Network, Paris, France
| | - David Maltête
- From the Neurology Department, Université Clermont Auvergne, EA7280 (E.B.-P., F.D., M.L.F., E.D., B.D., P.D., A.M.), and Biostatistics Department (B.P.), Clermont-Ferrand University Hospital, NS-Park/F-CRIN Network; Departments of Medical Pharmacology and Neurology and Movement Disorders, Referent Center of Parkinson's Disease, INSERM UMRS_1171, Licend, CHU of Lille (C.M.), and Department of Medical Pharmacology, University Hospital, Lille Neuroscience & Cognition, INSERM, UMR-S1172 (A.-S.R., D.D.), University of Lille, NS-Park/F-CRIN Network; Department of Neurology, Paris Brain Institute (ICM) (E.H., J.-C.C.), Institut Du Cerveau, INSERM CNRS, Assistance Publique Hôpitaux de Paris, Sorbonne Université, Hôpital Pitié-Salpêtrière, NS-Park/F-CRIN Network; Department of Neurology (T.R.), Nantes University Hospital, NS-Park/F-CRIN Network; Department of Neurology (A.E.), Assistance Publique Hôpitaux de Marseille, Timone University Hospital and Institut de Neurosciences de La Timone, NS-Park/F-CRIN Network; Department of Neurology (I.B.), University Poitiers, NS-Park/F-CRIN Network; Department of Neurology (S.D.), University Hospital of Rennes, NS-Park/F-CRIN Network; Institut des Maladies Neurodégénératives, Centre Expert Parkinson (D.G.), CHU de Bordeaux, NS-Park/F-CRIN Network; Parkinson Expert Center, Department of Clinical Pharmacology and Neuroscience (O.R.), Clinical Investigation Center CIC1436, NeuroToul COEN Center, Toulouse University Hospital, University of Toulouse 3, INSERM, NS-Park/F-CRIN Network; Department of Neurology (D.M.), Rouen University Hospital and University of Rouen; Laboratory of Neuronal and Neuroendocrine Differentiation and Communication (D.M.), INSERM U1239, NS-Park/F-CRIN Network, Mont-Saint-Aignan; Department of Neurology (O.L.-B.), Strasbourg University Hospital, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Université de Strasbourg, NS-Park/F-CRIN Network; Department of Neurology (C.G.), Centre Hospitalier Universitaire de Nice, NS-Park/F-CRIN Network; Departments of Neurology and Neurosurgery (M.T.), Expert Centre for Parkinson's Disease, EA 4559 Laboratoire de Neurosciences Fonctionnelles et Pathologie, Amiens University Hospital, Université de Picardie Jules Verne, NS-Park/F-CRIN Network, Amiens; Department of Neurology C (S.T.), Pierre Wertheimer Neurological Hospital, Hospices Civils de Lyon, University Hospital of Lyon, Université Claude Bernard Lyon 1, CNRS, Institut des Sciences Cognitives Marc Jeannerod, UMR 5229 CNRS, NS-PARK/F-CRIN Network; Department of Neurology (L.H.), University Hospital of Nancy, NS-PARK/F-CRIN Network; Department of Neurology (C.H.), Hospital Fondation Ophtalmologique Adolphe de Rothschild, NS-PARK/F-CRIN Network; and Neuroscience Pole (B.J.), Hôpital Foch, Université Paris-Saclay (UVSQ), INSERM-CEA NeuroSpin, NS-PARK/F-CRIN Network, Paris, France
| | - Ouhaïd Lagha-Boukbiza
- From the Neurology Department, Université Clermont Auvergne, EA7280 (E.B.-P., F.D., M.L.F., E.D., B.D., P.D., A.M.), and Biostatistics Department (B.P.), Clermont-Ferrand University Hospital, NS-Park/F-CRIN Network; Departments of Medical Pharmacology and Neurology and Movement Disorders, Referent Center of Parkinson's Disease, INSERM UMRS_1171, Licend, CHU of Lille (C.M.), and Department of Medical Pharmacology, University Hospital, Lille Neuroscience & Cognition, INSERM, UMR-S1172 (A.-S.R., D.D.), University of Lille, NS-Park/F-CRIN Network; Department of Neurology, Paris Brain Institute (ICM) (E.H., J.-C.C.), Institut Du Cerveau, INSERM CNRS, Assistance Publique Hôpitaux de Paris, Sorbonne Université, Hôpital Pitié-Salpêtrière, NS-Park/F-CRIN Network; Department of Neurology (T.R.), Nantes University Hospital, NS-Park/F-CRIN Network; Department of Neurology (A.E.), Assistance Publique Hôpitaux de Marseille, Timone University Hospital and Institut de Neurosciences de La Timone, NS-Park/F-CRIN Network; Department of Neurology (I.B.), University Poitiers, NS-Park/F-CRIN Network; Department of Neurology (S.D.), University Hospital of Rennes, NS-Park/F-CRIN Network; Institut des Maladies Neurodégénératives, Centre Expert Parkinson (D.G.), CHU de Bordeaux, NS-Park/F-CRIN Network; Parkinson Expert Center, Department of Clinical Pharmacology and Neuroscience (O.R.), Clinical Investigation Center CIC1436, NeuroToul COEN Center, Toulouse University Hospital, University of Toulouse 3, INSERM, NS-Park/F-CRIN Network; Department of Neurology (D.M.), Rouen University Hospital and University of Rouen; Laboratory of Neuronal and Neuroendocrine Differentiation and Communication (D.M.), INSERM U1239, NS-Park/F-CRIN Network, Mont-Saint-Aignan; Department of Neurology (O.L.-B.), Strasbourg University Hospital, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Université de Strasbourg, NS-Park/F-CRIN Network; Department of Neurology (C.G.), Centre Hospitalier Universitaire de Nice, NS-Park/F-CRIN Network; Departments of Neurology and Neurosurgery (M.T.), Expert Centre for Parkinson's Disease, EA 4559 Laboratoire de Neurosciences Fonctionnelles et Pathologie, Amiens University Hospital, Université de Picardie Jules Verne, NS-Park/F-CRIN Network, Amiens; Department of Neurology C (S.T.), Pierre Wertheimer Neurological Hospital, Hospices Civils de Lyon, University Hospital of Lyon, Université Claude Bernard Lyon 1, CNRS, Institut des Sciences Cognitives Marc Jeannerod, UMR 5229 CNRS, NS-PARK/F-CRIN Network; Department of Neurology (L.H.), University Hospital of Nancy, NS-PARK/F-CRIN Network; Department of Neurology (C.H.), Hospital Fondation Ophtalmologique Adolphe de Rothschild, NS-PARK/F-CRIN Network; and Neuroscience Pole (B.J.), Hôpital Foch, Université Paris-Saclay (UVSQ), INSERM-CEA NeuroSpin, NS-PARK/F-CRIN Network, Paris, France
| | - Caroline Giordana
- From the Neurology Department, Université Clermont Auvergne, EA7280 (E.B.-P., F.D., M.L.F., E.D., B.D., P.D., A.M.), and Biostatistics Department (B.P.), Clermont-Ferrand University Hospital, NS-Park/F-CRIN Network; Departments of Medical Pharmacology and Neurology and Movement Disorders, Referent Center of Parkinson's Disease, INSERM UMRS_1171, Licend, CHU of Lille (C.M.), and Department of Medical Pharmacology, University Hospital, Lille Neuroscience & Cognition, INSERM, UMR-S1172 (A.-S.R., D.D.), University of Lille, NS-Park/F-CRIN Network; Department of Neurology, Paris Brain Institute (ICM) (E.H., J.-C.C.), Institut Du Cerveau, INSERM CNRS, Assistance Publique Hôpitaux de Paris, Sorbonne Université, Hôpital Pitié-Salpêtrière, NS-Park/F-CRIN Network; Department of Neurology (T.R.), Nantes University Hospital, NS-Park/F-CRIN Network; Department of Neurology (A.E.), Assistance Publique Hôpitaux de Marseille, Timone University Hospital and Institut de Neurosciences de La Timone, NS-Park/F-CRIN Network; Department of Neurology (I.B.), University Poitiers, NS-Park/F-CRIN Network; Department of Neurology (S.D.), University Hospital of Rennes, NS-Park/F-CRIN Network; Institut des Maladies Neurodégénératives, Centre Expert Parkinson (D.G.), CHU de Bordeaux, NS-Park/F-CRIN Network; Parkinson Expert Center, Department of Clinical Pharmacology and Neuroscience (O.R.), Clinical Investigation Center CIC1436, NeuroToul COEN Center, Toulouse University Hospital, University of Toulouse 3, INSERM, NS-Park/F-CRIN Network; Department of Neurology (D.M.), Rouen University Hospital and University of Rouen; Laboratory of Neuronal and Neuroendocrine Differentiation and Communication (D.M.), INSERM U1239, NS-Park/F-CRIN Network, Mont-Saint-Aignan; Department of Neurology (O.L.-B.), Strasbourg University Hospital, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Université de Strasbourg, NS-Park/F-CRIN Network; Department of Neurology (C.G.), Centre Hospitalier Universitaire de Nice, NS-Park/F-CRIN Network; Departments of Neurology and Neurosurgery (M.T.), Expert Centre for Parkinson's Disease, EA 4559 Laboratoire de Neurosciences Fonctionnelles et Pathologie, Amiens University Hospital, Université de Picardie Jules Verne, NS-Park/F-CRIN Network, Amiens; Department of Neurology C (S.T.), Pierre Wertheimer Neurological Hospital, Hospices Civils de Lyon, University Hospital of Lyon, Université Claude Bernard Lyon 1, CNRS, Institut des Sciences Cognitives Marc Jeannerod, UMR 5229 CNRS, NS-PARK/F-CRIN Network; Department of Neurology (L.H.), University Hospital of Nancy, NS-PARK/F-CRIN Network; Department of Neurology (C.H.), Hospital Fondation Ophtalmologique Adolphe de Rothschild, NS-PARK/F-CRIN Network; and Neuroscience Pole (B.J.), Hôpital Foch, Université Paris-Saclay (UVSQ), INSERM-CEA NeuroSpin, NS-PARK/F-CRIN Network, Paris, France
| | - Melissa Tir
- From the Neurology Department, Université Clermont Auvergne, EA7280 (E.B.-P., F.D., M.L.F., E.D., B.D., P.D., A.M.), and Biostatistics Department (B.P.), Clermont-Ferrand University Hospital, NS-Park/F-CRIN Network; Departments of Medical Pharmacology and Neurology and Movement Disorders, Referent Center of Parkinson's Disease, INSERM UMRS_1171, Licend, CHU of Lille (C.M.), and Department of Medical Pharmacology, University Hospital, Lille Neuroscience & Cognition, INSERM, UMR-S1172 (A.-S.R., D.D.), University of Lille, NS-Park/F-CRIN Network; Department of Neurology, Paris Brain Institute (ICM) (E.H., J.-C.C.), Institut Du Cerveau, INSERM CNRS, Assistance Publique Hôpitaux de Paris, Sorbonne Université, Hôpital Pitié-Salpêtrière, NS-Park/F-CRIN Network; Department of Neurology (T.R.), Nantes University Hospital, NS-Park/F-CRIN Network; Department of Neurology (A.E.), Assistance Publique Hôpitaux de Marseille, Timone University Hospital and Institut de Neurosciences de La Timone, NS-Park/F-CRIN Network; Department of Neurology (I.B.), University Poitiers, NS-Park/F-CRIN Network; Department of Neurology (S.D.), University Hospital of Rennes, NS-Park/F-CRIN Network; Institut des Maladies Neurodégénératives, Centre Expert Parkinson (D.G.), CHU de Bordeaux, NS-Park/F-CRIN Network; Parkinson Expert Center, Department of Clinical Pharmacology and Neuroscience (O.R.), Clinical Investigation Center CIC1436, NeuroToul COEN Center, Toulouse University Hospital, University of Toulouse 3, INSERM, NS-Park/F-CRIN Network; Department of Neurology (D.M.), Rouen University Hospital and University of Rouen; Laboratory of Neuronal and Neuroendocrine Differentiation and Communication (D.M.), INSERM U1239, NS-Park/F-CRIN Network, Mont-Saint-Aignan; Department of Neurology (O.L.-B.), Strasbourg University Hospital, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Université de Strasbourg, NS-Park/F-CRIN Network; Department of Neurology (C.G.), Centre Hospitalier Universitaire de Nice, NS-Park/F-CRIN Network; Departments of Neurology and Neurosurgery (M.T.), Expert Centre for Parkinson's Disease, EA 4559 Laboratoire de Neurosciences Fonctionnelles et Pathologie, Amiens University Hospital, Université de Picardie Jules Verne, NS-Park/F-CRIN Network, Amiens; Department of Neurology C (S.T.), Pierre Wertheimer Neurological Hospital, Hospices Civils de Lyon, University Hospital of Lyon, Université Claude Bernard Lyon 1, CNRS, Institut des Sciences Cognitives Marc Jeannerod, UMR 5229 CNRS, NS-PARK/F-CRIN Network; Department of Neurology (L.H.), University Hospital of Nancy, NS-PARK/F-CRIN Network; Department of Neurology (C.H.), Hospital Fondation Ophtalmologique Adolphe de Rothschild, NS-PARK/F-CRIN Network; and Neuroscience Pole (B.J.), Hôpital Foch, Université Paris-Saclay (UVSQ), INSERM-CEA NeuroSpin, NS-PARK/F-CRIN Network, Paris, France
| | - Stéphane Thobois
- From the Neurology Department, Université Clermont Auvergne, EA7280 (E.B.-P., F.D., M.L.F., E.D., B.D., P.D., A.M.), and Biostatistics Department (B.P.), Clermont-Ferrand University Hospital, NS-Park/F-CRIN Network; Departments of Medical Pharmacology and Neurology and Movement Disorders, Referent Center of Parkinson's Disease, INSERM UMRS_1171, Licend, CHU of Lille (C.M.), and Department of Medical Pharmacology, University Hospital, Lille Neuroscience & Cognition, INSERM, UMR-S1172 (A.-S.R., D.D.), University of Lille, NS-Park/F-CRIN Network; Department of Neurology, Paris Brain Institute (ICM) (E.H., J.-C.C.), Institut Du Cerveau, INSERM CNRS, Assistance Publique Hôpitaux de Paris, Sorbonne Université, Hôpital Pitié-Salpêtrière, NS-Park/F-CRIN Network; Department of Neurology (T.R.), Nantes University Hospital, NS-Park/F-CRIN Network; Department of Neurology (A.E.), Assistance Publique Hôpitaux de Marseille, Timone University Hospital and Institut de Neurosciences de La Timone, NS-Park/F-CRIN Network; Department of Neurology (I.B.), University Poitiers, NS-Park/F-CRIN Network; Department of Neurology (S.D.), University Hospital of Rennes, NS-Park/F-CRIN Network; Institut des Maladies Neurodégénératives, Centre Expert Parkinson (D.G.), CHU de Bordeaux, NS-Park/F-CRIN Network; Parkinson Expert Center, Department of Clinical Pharmacology and Neuroscience (O.R.), Clinical Investigation Center CIC1436, NeuroToul COEN Center, Toulouse University Hospital, University of Toulouse 3, INSERM, NS-Park/F-CRIN Network; Department of Neurology (D.M.), Rouen University Hospital and University of Rouen; Laboratory of Neuronal and Neuroendocrine Differentiation and Communication (D.M.), INSERM U1239, NS-Park/F-CRIN Network, Mont-Saint-Aignan; Department of Neurology (O.L.-B.), Strasbourg University Hospital, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Université de Strasbourg, NS-Park/F-CRIN Network; Department of Neurology (C.G.), Centre Hospitalier Universitaire de Nice, NS-Park/F-CRIN Network; Departments of Neurology and Neurosurgery (M.T.), Expert Centre for Parkinson's Disease, EA 4559 Laboratoire de Neurosciences Fonctionnelles et Pathologie, Amiens University Hospital, Université de Picardie Jules Verne, NS-Park/F-CRIN Network, Amiens; Department of Neurology C (S.T.), Pierre Wertheimer Neurological Hospital, Hospices Civils de Lyon, University Hospital of Lyon, Université Claude Bernard Lyon 1, CNRS, Institut des Sciences Cognitives Marc Jeannerod, UMR 5229 CNRS, NS-PARK/F-CRIN Network; Department of Neurology (L.H.), University Hospital of Nancy, NS-PARK/F-CRIN Network; Department of Neurology (C.H.), Hospital Fondation Ophtalmologique Adolphe de Rothschild, NS-PARK/F-CRIN Network; and Neuroscience Pole (B.J.), Hôpital Foch, Université Paris-Saclay (UVSQ), INSERM-CEA NeuroSpin, NS-PARK/F-CRIN Network, Paris, France
| | - Lucie Hopes
- From the Neurology Department, Université Clermont Auvergne, EA7280 (E.B.-P., F.D., M.L.F., E.D., B.D., P.D., A.M.), and Biostatistics Department (B.P.), Clermont-Ferrand University Hospital, NS-Park/F-CRIN Network; Departments of Medical Pharmacology and Neurology and Movement Disorders, Referent Center of Parkinson's Disease, INSERM UMRS_1171, Licend, CHU of Lille (C.M.), and Department of Medical Pharmacology, University Hospital, Lille Neuroscience & Cognition, INSERM, UMR-S1172 (A.-S.R., D.D.), University of Lille, NS-Park/F-CRIN Network; Department of Neurology, Paris Brain Institute (ICM) (E.H., J.-C.C.), Institut Du Cerveau, INSERM CNRS, Assistance Publique Hôpitaux de Paris, Sorbonne Université, Hôpital Pitié-Salpêtrière, NS-Park/F-CRIN Network; Department of Neurology (T.R.), Nantes University Hospital, NS-Park/F-CRIN Network; Department of Neurology (A.E.), Assistance Publique Hôpitaux de Marseille, Timone University Hospital and Institut de Neurosciences de La Timone, NS-Park/F-CRIN Network; Department of Neurology (I.B.), University Poitiers, NS-Park/F-CRIN Network; Department of Neurology (S.D.), University Hospital of Rennes, NS-Park/F-CRIN Network; Institut des Maladies Neurodégénératives, Centre Expert Parkinson (D.G.), CHU de Bordeaux, NS-Park/F-CRIN Network; Parkinson Expert Center, Department of Clinical Pharmacology and Neuroscience (O.R.), Clinical Investigation Center CIC1436, NeuroToul COEN Center, Toulouse University Hospital, University of Toulouse 3, INSERM, NS-Park/F-CRIN Network; Department of Neurology (D.M.), Rouen University Hospital and University of Rouen; Laboratory of Neuronal and Neuroendocrine Differentiation and Communication (D.M.), INSERM U1239, NS-Park/F-CRIN Network, Mont-Saint-Aignan; Department of Neurology (O.L.-B.), Strasbourg University Hospital, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Université de Strasbourg, NS-Park/F-CRIN Network; Department of Neurology (C.G.), Centre Hospitalier Universitaire de Nice, NS-Park/F-CRIN Network; Departments of Neurology and Neurosurgery (M.T.), Expert Centre for Parkinson's Disease, EA 4559 Laboratoire de Neurosciences Fonctionnelles et Pathologie, Amiens University Hospital, Université de Picardie Jules Verne, NS-Park/F-CRIN Network, Amiens; Department of Neurology C (S.T.), Pierre Wertheimer Neurological Hospital, Hospices Civils de Lyon, University Hospital of Lyon, Université Claude Bernard Lyon 1, CNRS, Institut des Sciences Cognitives Marc Jeannerod, UMR 5229 CNRS, NS-PARK/F-CRIN Network; Department of Neurology (L.H.), University Hospital of Nancy, NS-PARK/F-CRIN Network; Department of Neurology (C.H.), Hospital Fondation Ophtalmologique Adolphe de Rothschild, NS-PARK/F-CRIN Network; and Neuroscience Pole (B.J.), Hôpital Foch, Université Paris-Saclay (UVSQ), INSERM-CEA NeuroSpin, NS-PARK/F-CRIN Network, Paris, France
| | - Cécile Hubsch
- From the Neurology Department, Université Clermont Auvergne, EA7280 (E.B.-P., F.D., M.L.F., E.D., B.D., P.D., A.M.), and Biostatistics Department (B.P.), Clermont-Ferrand University Hospital, NS-Park/F-CRIN Network; Departments of Medical Pharmacology and Neurology and Movement Disorders, Referent Center of Parkinson's Disease, INSERM UMRS_1171, Licend, CHU of Lille (C.M.), and Department of Medical Pharmacology, University Hospital, Lille Neuroscience & Cognition, INSERM, UMR-S1172 (A.-S.R., D.D.), University of Lille, NS-Park/F-CRIN Network; Department of Neurology, Paris Brain Institute (ICM) (E.H., J.-C.C.), Institut Du Cerveau, INSERM CNRS, Assistance Publique Hôpitaux de Paris, Sorbonne Université, Hôpital Pitié-Salpêtrière, NS-Park/F-CRIN Network; Department of Neurology (T.R.), Nantes University Hospital, NS-Park/F-CRIN Network; Department of Neurology (A.E.), Assistance Publique Hôpitaux de Marseille, Timone University Hospital and Institut de Neurosciences de La Timone, NS-Park/F-CRIN Network; Department of Neurology (I.B.), University Poitiers, NS-Park/F-CRIN Network; Department of Neurology (S.D.), University Hospital of Rennes, NS-Park/F-CRIN Network; Institut des Maladies Neurodégénératives, Centre Expert Parkinson (D.G.), CHU de Bordeaux, NS-Park/F-CRIN Network; Parkinson Expert Center, Department of Clinical Pharmacology and Neuroscience (O.R.), Clinical Investigation Center CIC1436, NeuroToul COEN Center, Toulouse University Hospital, University of Toulouse 3, INSERM, NS-Park/F-CRIN Network; Department of Neurology (D.M.), Rouen University Hospital and University of Rouen; Laboratory of Neuronal and Neuroendocrine Differentiation and Communication (D.M.), INSERM U1239, NS-Park/F-CRIN Network, Mont-Saint-Aignan; Department of Neurology (O.L.-B.), Strasbourg University Hospital, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Université de Strasbourg, NS-Park/F-CRIN Network; Department of Neurology (C.G.), Centre Hospitalier Universitaire de Nice, NS-Park/F-CRIN Network; Departments of Neurology and Neurosurgery (M.T.), Expert Centre for Parkinson's Disease, EA 4559 Laboratoire de Neurosciences Fonctionnelles et Pathologie, Amiens University Hospital, Université de Picardie Jules Verne, NS-Park/F-CRIN Network, Amiens; Department of Neurology C (S.T.), Pierre Wertheimer Neurological Hospital, Hospices Civils de Lyon, University Hospital of Lyon, Université Claude Bernard Lyon 1, CNRS, Institut des Sciences Cognitives Marc Jeannerod, UMR 5229 CNRS, NS-PARK/F-CRIN Network; Department of Neurology (L.H.), University Hospital of Nancy, NS-PARK/F-CRIN Network; Department of Neurology (C.H.), Hospital Fondation Ophtalmologique Adolphe de Rothschild, NS-PARK/F-CRIN Network; and Neuroscience Pole (B.J.), Hôpital Foch, Université Paris-Saclay (UVSQ), INSERM-CEA NeuroSpin, NS-PARK/F-CRIN Network, Paris, France
| | - Béchir Jarraya
- From the Neurology Department, Université Clermont Auvergne, EA7280 (E.B.-P., F.D., M.L.F., E.D., B.D., P.D., A.M.), and Biostatistics Department (B.P.), Clermont-Ferrand University Hospital, NS-Park/F-CRIN Network; Departments of Medical Pharmacology and Neurology and Movement Disorders, Referent Center of Parkinson's Disease, INSERM UMRS_1171, Licend, CHU of Lille (C.M.), and Department of Medical Pharmacology, University Hospital, Lille Neuroscience & Cognition, INSERM, UMR-S1172 (A.-S.R., D.D.), University of Lille, NS-Park/F-CRIN Network; Department of Neurology, Paris Brain Institute (ICM) (E.H., J.-C.C.), Institut Du Cerveau, INSERM CNRS, Assistance Publique Hôpitaux de Paris, Sorbonne Université, Hôpital Pitié-Salpêtrière, NS-Park/F-CRIN Network; Department of Neurology (T.R.), Nantes University Hospital, NS-Park/F-CRIN Network; Department of Neurology (A.E.), Assistance Publique Hôpitaux de Marseille, Timone University Hospital and Institut de Neurosciences de La Timone, NS-Park/F-CRIN Network; Department of Neurology (I.B.), University Poitiers, NS-Park/F-CRIN Network; Department of Neurology (S.D.), University Hospital of Rennes, NS-Park/F-CRIN Network; Institut des Maladies Neurodégénératives, Centre Expert Parkinson (D.G.), CHU de Bordeaux, NS-Park/F-CRIN Network; Parkinson Expert Center, Department of Clinical Pharmacology and Neuroscience (O.R.), Clinical Investigation Center CIC1436, NeuroToul COEN Center, Toulouse University Hospital, University of Toulouse 3, INSERM, NS-Park/F-CRIN Network; Department of Neurology (D.M.), Rouen University Hospital and University of Rouen; Laboratory of Neuronal and Neuroendocrine Differentiation and Communication (D.M.), INSERM U1239, NS-Park/F-CRIN Network, Mont-Saint-Aignan; Department of Neurology (O.L.-B.), Strasbourg University Hospital, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Université de Strasbourg, NS-Park/F-CRIN Network; Department of Neurology (C.G.), Centre Hospitalier Universitaire de Nice, NS-Park/F-CRIN Network; Departments of Neurology and Neurosurgery (M.T.), Expert Centre for Parkinson's Disease, EA 4559 Laboratoire de Neurosciences Fonctionnelles et Pathologie, Amiens University Hospital, Université de Picardie Jules Verne, NS-Park/F-CRIN Network, Amiens; Department of Neurology C (S.T.), Pierre Wertheimer Neurological Hospital, Hospices Civils de Lyon, University Hospital of Lyon, Université Claude Bernard Lyon 1, CNRS, Institut des Sciences Cognitives Marc Jeannerod, UMR 5229 CNRS, NS-PARK/F-CRIN Network; Department of Neurology (L.H.), University Hospital of Nancy, NS-PARK/F-CRIN Network; Department of Neurology (C.H.), Hospital Fondation Ophtalmologique Adolphe de Rothschild, NS-PARK/F-CRIN Network; and Neuroscience Pole (B.J.), Hôpital Foch, Université Paris-Saclay (UVSQ), INSERM-CEA NeuroSpin, NS-PARK/F-CRIN Network, Paris, France
| | - Anne-Sophie Rolland
- From the Neurology Department, Université Clermont Auvergne, EA7280 (E.B.-P., F.D., M.L.F., E.D., B.D., P.D., A.M.), and Biostatistics Department (B.P.), Clermont-Ferrand University Hospital, NS-Park/F-CRIN Network; Departments of Medical Pharmacology and Neurology and Movement Disorders, Referent Center of Parkinson's Disease, INSERM UMRS_1171, Licend, CHU of Lille (C.M.), and Department of Medical Pharmacology, University Hospital, Lille Neuroscience & Cognition, INSERM, UMR-S1172 (A.-S.R., D.D.), University of Lille, NS-Park/F-CRIN Network; Department of Neurology, Paris Brain Institute (ICM) (E.H., J.-C.C.), Institut Du Cerveau, INSERM CNRS, Assistance Publique Hôpitaux de Paris, Sorbonne Université, Hôpital Pitié-Salpêtrière, NS-Park/F-CRIN Network; Department of Neurology (T.R.), Nantes University Hospital, NS-Park/F-CRIN Network; Department of Neurology (A.E.), Assistance Publique Hôpitaux de Marseille, Timone University Hospital and Institut de Neurosciences de La Timone, NS-Park/F-CRIN Network; Department of Neurology (I.B.), University Poitiers, NS-Park/F-CRIN Network; Department of Neurology (S.D.), University Hospital of Rennes, NS-Park/F-CRIN Network; Institut des Maladies Neurodégénératives, Centre Expert Parkinson (D.G.), CHU de Bordeaux, NS-Park/F-CRIN Network; Parkinson Expert Center, Department of Clinical Pharmacology and Neuroscience (O.R.), Clinical Investigation Center CIC1436, NeuroToul COEN Center, Toulouse University Hospital, University of Toulouse 3, INSERM, NS-Park/F-CRIN Network; Department of Neurology (D.M.), Rouen University Hospital and University of Rouen; Laboratory of Neuronal and Neuroendocrine Differentiation and Communication (D.M.), INSERM U1239, NS-Park/F-CRIN Network, Mont-Saint-Aignan; Department of Neurology (O.L.-B.), Strasbourg University Hospital, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Université de Strasbourg, NS-Park/F-CRIN Network; Department of Neurology (C.G.), Centre Hospitalier Universitaire de Nice, NS-Park/F-CRIN Network; Departments of Neurology and Neurosurgery (M.T.), Expert Centre for Parkinson's Disease, EA 4559 Laboratoire de Neurosciences Fonctionnelles et Pathologie, Amiens University Hospital, Université de Picardie Jules Verne, NS-Park/F-CRIN Network, Amiens; Department of Neurology C (S.T.), Pierre Wertheimer Neurological Hospital, Hospices Civils de Lyon, University Hospital of Lyon, Université Claude Bernard Lyon 1, CNRS, Institut des Sciences Cognitives Marc Jeannerod, UMR 5229 CNRS, NS-PARK/F-CRIN Network; Department of Neurology (L.H.), University Hospital of Nancy, NS-PARK/F-CRIN Network; Department of Neurology (C.H.), Hospital Fondation Ophtalmologique Adolphe de Rothschild, NS-PARK/F-CRIN Network; and Neuroscience Pole (B.J.), Hôpital Foch, Université Paris-Saclay (UVSQ), INSERM-CEA NeuroSpin, NS-PARK/F-CRIN Network, Paris, France
| | - Jean-Christophe Corvol
- From the Neurology Department, Université Clermont Auvergne, EA7280 (E.B.-P., F.D., M.L.F., E.D., B.D., P.D., A.M.), and Biostatistics Department (B.P.), Clermont-Ferrand University Hospital, NS-Park/F-CRIN Network; Departments of Medical Pharmacology and Neurology and Movement Disorders, Referent Center of Parkinson's Disease, INSERM UMRS_1171, Licend, CHU of Lille (C.M.), and Department of Medical Pharmacology, University Hospital, Lille Neuroscience & Cognition, INSERM, UMR-S1172 (A.-S.R., D.D.), University of Lille, NS-Park/F-CRIN Network; Department of Neurology, Paris Brain Institute (ICM) (E.H., J.-C.C.), Institut Du Cerveau, INSERM CNRS, Assistance Publique Hôpitaux de Paris, Sorbonne Université, Hôpital Pitié-Salpêtrière, NS-Park/F-CRIN Network; Department of Neurology (T.R.), Nantes University Hospital, NS-Park/F-CRIN Network; Department of Neurology (A.E.), Assistance Publique Hôpitaux de Marseille, Timone University Hospital and Institut de Neurosciences de La Timone, NS-Park/F-CRIN Network; Department of Neurology (I.B.), University Poitiers, NS-Park/F-CRIN Network; Department of Neurology (S.D.), University Hospital of Rennes, NS-Park/F-CRIN Network; Institut des Maladies Neurodégénératives, Centre Expert Parkinson (D.G.), CHU de Bordeaux, NS-Park/F-CRIN Network; Parkinson Expert Center, Department of Clinical Pharmacology and Neuroscience (O.R.), Clinical Investigation Center CIC1436, NeuroToul COEN Center, Toulouse University Hospital, University of Toulouse 3, INSERM, NS-Park/F-CRIN Network; Department of Neurology (D.M.), Rouen University Hospital and University of Rouen; Laboratory of Neuronal and Neuroendocrine Differentiation and Communication (D.M.), INSERM U1239, NS-Park/F-CRIN Network, Mont-Saint-Aignan; Department of Neurology (O.L.-B.), Strasbourg University Hospital, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Université de Strasbourg, NS-Park/F-CRIN Network; Department of Neurology (C.G.), Centre Hospitalier Universitaire de Nice, NS-Park/F-CRIN Network; Departments of Neurology and Neurosurgery (M.T.), Expert Centre for Parkinson's Disease, EA 4559 Laboratoire de Neurosciences Fonctionnelles et Pathologie, Amiens University Hospital, Université de Picardie Jules Verne, NS-Park/F-CRIN Network, Amiens; Department of Neurology C (S.T.), Pierre Wertheimer Neurological Hospital, Hospices Civils de Lyon, University Hospital of Lyon, Université Claude Bernard Lyon 1, CNRS, Institut des Sciences Cognitives Marc Jeannerod, UMR 5229 CNRS, NS-PARK/F-CRIN Network; Department of Neurology (L.H.), University Hospital of Nancy, NS-PARK/F-CRIN Network; Department of Neurology (C.H.), Hospital Fondation Ophtalmologique Adolphe de Rothschild, NS-PARK/F-CRIN Network; and Neuroscience Pole (B.J.), Hôpital Foch, Université Paris-Saclay (UVSQ), INSERM-CEA NeuroSpin, NS-PARK/F-CRIN Network, Paris, France
| | - David Devos
- From the Neurology Department, Université Clermont Auvergne, EA7280 (E.B.-P., F.D., M.L.F., E.D., B.D., P.D., A.M.), and Biostatistics Department (B.P.), Clermont-Ferrand University Hospital, NS-Park/F-CRIN Network; Departments of Medical Pharmacology and Neurology and Movement Disorders, Referent Center of Parkinson's Disease, INSERM UMRS_1171, Licend, CHU of Lille (C.M.), and Department of Medical Pharmacology, University Hospital, Lille Neuroscience & Cognition, INSERM, UMR-S1172 (A.-S.R., D.D.), University of Lille, NS-Park/F-CRIN Network; Department of Neurology, Paris Brain Institute (ICM) (E.H., J.-C.C.), Institut Du Cerveau, INSERM CNRS, Assistance Publique Hôpitaux de Paris, Sorbonne Université, Hôpital Pitié-Salpêtrière, NS-Park/F-CRIN Network; Department of Neurology (T.R.), Nantes University Hospital, NS-Park/F-CRIN Network; Department of Neurology (A.E.), Assistance Publique Hôpitaux de Marseille, Timone University Hospital and Institut de Neurosciences de La Timone, NS-Park/F-CRIN Network; Department of Neurology (I.B.), University Poitiers, NS-Park/F-CRIN Network; Department of Neurology (S.D.), University Hospital of Rennes, NS-Park/F-CRIN Network; Institut des Maladies Neurodégénératives, Centre Expert Parkinson (D.G.), CHU de Bordeaux, NS-Park/F-CRIN Network; Parkinson Expert Center, Department of Clinical Pharmacology and Neuroscience (O.R.), Clinical Investigation Center CIC1436, NeuroToul COEN Center, Toulouse University Hospital, University of Toulouse 3, INSERM, NS-Park/F-CRIN Network; Department of Neurology (D.M.), Rouen University Hospital and University of Rouen; Laboratory of Neuronal and Neuroendocrine Differentiation and Communication (D.M.), INSERM U1239, NS-Park/F-CRIN Network, Mont-Saint-Aignan; Department of Neurology (O.L.-B.), Strasbourg University Hospital, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Université de Strasbourg, NS-Park/F-CRIN Network; Department of Neurology (C.G.), Centre Hospitalier Universitaire de Nice, NS-Park/F-CRIN Network; Departments of Neurology and Neurosurgery (M.T.), Expert Centre for Parkinson's Disease, EA 4559 Laboratoire de Neurosciences Fonctionnelles et Pathologie, Amiens University Hospital, Université de Picardie Jules Verne, NS-Park/F-CRIN Network, Amiens; Department of Neurology C (S.T.), Pierre Wertheimer Neurological Hospital, Hospices Civils de Lyon, University Hospital of Lyon, Université Claude Bernard Lyon 1, CNRS, Institut des Sciences Cognitives Marc Jeannerod, UMR 5229 CNRS, NS-PARK/F-CRIN Network; Department of Neurology (L.H.), University Hospital of Nancy, NS-PARK/F-CRIN Network; Department of Neurology (C.H.), Hospital Fondation Ophtalmologique Adolphe de Rothschild, NS-PARK/F-CRIN Network; and Neuroscience Pole (B.J.), Hôpital Foch, Université Paris-Saclay (UVSQ), INSERM-CEA NeuroSpin, NS-PARK/F-CRIN Network, Paris, France
| | - Ana Marques
- From the Neurology Department, Université Clermont Auvergne, EA7280 (E.B.-P., F.D., M.L.F., E.D., B.D., P.D., A.M.), and Biostatistics Department (B.P.), Clermont-Ferrand University Hospital, NS-Park/F-CRIN Network; Departments of Medical Pharmacology and Neurology and Movement Disorders, Referent Center of Parkinson's Disease, INSERM UMRS_1171, Licend, CHU of Lille (C.M.), and Department of Medical Pharmacology, University Hospital, Lille Neuroscience & Cognition, INSERM, UMR-S1172 (A.-S.R., D.D.), University of Lille, NS-Park/F-CRIN Network; Department of Neurology, Paris Brain Institute (ICM) (E.H., J.-C.C.), Institut Du Cerveau, INSERM CNRS, Assistance Publique Hôpitaux de Paris, Sorbonne Université, Hôpital Pitié-Salpêtrière, NS-Park/F-CRIN Network; Department of Neurology (T.R.), Nantes University Hospital, NS-Park/F-CRIN Network; Department of Neurology (A.E.), Assistance Publique Hôpitaux de Marseille, Timone University Hospital and Institut de Neurosciences de La Timone, NS-Park/F-CRIN Network; Department of Neurology (I.B.), University Poitiers, NS-Park/F-CRIN Network; Department of Neurology (S.D.), University Hospital of Rennes, NS-Park/F-CRIN Network; Institut des Maladies Neurodégénératives, Centre Expert Parkinson (D.G.), CHU de Bordeaux, NS-Park/F-CRIN Network; Parkinson Expert Center, Department of Clinical Pharmacology and Neuroscience (O.R.), Clinical Investigation Center CIC1436, NeuroToul COEN Center, Toulouse University Hospital, University of Toulouse 3, INSERM, NS-Park/F-CRIN Network; Department of Neurology (D.M.), Rouen University Hospital and University of Rouen; Laboratory of Neuronal and Neuroendocrine Differentiation and Communication (D.M.), INSERM U1239, NS-Park/F-CRIN Network, Mont-Saint-Aignan; Department of Neurology (O.L.-B.), Strasbourg University Hospital, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Université de Strasbourg, NS-Park/F-CRIN Network; Department of Neurology (C.G.), Centre Hospitalier Universitaire de Nice, NS-Park/F-CRIN Network; Departments of Neurology and Neurosurgery (M.T.), Expert Centre for Parkinson's Disease, EA 4559 Laboratoire de Neurosciences Fonctionnelles et Pathologie, Amiens University Hospital, Université de Picardie Jules Verne, NS-Park/F-CRIN Network, Amiens; Department of Neurology C (S.T.), Pierre Wertheimer Neurological Hospital, Hospices Civils de Lyon, University Hospital of Lyon, Université Claude Bernard Lyon 1, CNRS, Institut des Sciences Cognitives Marc Jeannerod, UMR 5229 CNRS, NS-PARK/F-CRIN Network; Department of Neurology (L.H.), University Hospital of Nancy, NS-PARK/F-CRIN Network; Department of Neurology (C.H.), Hospital Fondation Ophtalmologique Adolphe de Rothschild, NS-PARK/F-CRIN Network; and Neuroscience Pole (B.J.), Hôpital Foch, Université Paris-Saclay (UVSQ), INSERM-CEA NeuroSpin, NS-PARK/F-CRIN Network, Paris, France.
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Faggianelli F, Loundou A, Baumstarck K, Nathalie S, Auquier P, Eusebio A, Defebvre L, Brefel-Courbon C, Houeto JL, Maltete D, Tranchant C, Derkinderen P, Geny C, Krystkowiak P, Jean-Philippe B, Macia F, Durif F, Poujois A, Borg M, Azulay JP, Witjas T. Validation of a non-motor fluctuations questionnaire in Parkinson's disease. Rev Neurol (Paris) 2021; 178:347-354. [PMID: 34565624 DOI: 10.1016/j.neurol.2021.06.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 06/02/2021] [Accepted: 06/07/2021] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Non-motor fluctuations (NMF) in Parkinson's disease (PD) remain poorly recognized but have a high impact on patients' quality of life. The lack of assessment tools limits our understanding of NMF, compromising appropriate management. Our objective was to validate a hetero-questionnaire for NMF in PD patients at different stages of the disease: without treatment, without motor fluctuations, with motor fluctuations. METHODS We included patients in 15 centers in France. Our questionnaire, NMF-Park, resulted from previous studies, allowing us to identify the more pertinent NMF for evaluation. Patients reported the presence (yes or no) of 22 selected NMF, and their link with dopaminergic medications. The assessment was repeated at one and two years to study the progression of NMF. We performed a metrological validation of our questionnaire. RESULTS We included 255 patients (42 without treatment, 88 without motor fluctuations and 125 with motor fluctuations). After metrological validation, three dimensions of NMF were found: dysautonomic; cognitive; psychiatric. The sensory/pain dimension described in the literature was not statistically confirmed by our study. DISCUSSION Our questionnaire was validated according to clinimetric standards, for different stages of PD. It was clinically coherent with three homogeneous dimensions. It highlighted a link between fatigue, visual accommodation disorder, and cognitive fluctuations; and the integration of sensory/pain fluctuations as part of dysautonomic fluctuations. It focused exclusively on NMF, which is interesting considering the described differences between non-motor and motor fluctuations. CONCLUSION Our study validated a hetero-questionnaire of diagnosis for NMF for different stages of PD.
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Affiliation(s)
- F Faggianelli
- Service de Neurologie et Pathologies du Mouvement, CHU Timone, APHM, Marseille, France.
| | - A Loundou
- Centre D'Etudes et de Recherches sur les Services de Santé et Qualité, Faculté de Médecine, Aix-Marseille Université, Marseille, France.
| | - K Baumstarck
- Centre D'Etudes et de Recherches sur les Services de Santé et Qualité, Faculté de Médecine, Aix-Marseille Université, Marseille, France.
| | - S Nathalie
- Service de Neurologie et Pathologies du Mouvement, CHU Timone, APHM, Marseille, France
| | - P Auquier
- Centre D'Etudes et de Recherches sur les Services de Santé et Qualité, Faculté de Médecine, Aix-Marseille Université, Marseille, France.
| | - A Eusebio
- Service de Neurologie et Pathologies du Mouvement, CHU Timone, APHM, Marseille, France.
| | - L Defebvre
- Service de Neurologie A, CHRU de Lille, Hôpital Roger Salengro, Marseille, France.
| | - C Brefel-Courbon
- Unité Neurologie cognitive, épilepsie, sommeil et mouvements anormaux, Département de Neurologie, CHU de Toulouse - Hôpital Purpan, Marseille, France.
| | - J-L Houeto
- Service de Neurologie, CHU de Poitiers, Marseille, France.
| | - D Maltete
- Unité Neurologie polyvalente, Département de neurologie, CHU de Rouen, Marseille, France.
| | - C Tranchant
- Service de Pathologie du mouvement-Neurologie, CHU de Strasbourg, Hôpital de Hautepierre, Marseille, France.
| | - P Derkinderen
- Clinique neurologique, CHU de Nantes, Hôpital Nord Guillaume et René Laënnec, Marseille, France.
| | - C Geny
- Service de Neurologie, CHU de Montpellier, Marseille, France.
| | - P Krystkowiak
- Service de Neurologie, CHU Amiens-Picardie - Site Sud, Marseille, France.
| | - B Jean-Philippe
- Département de Neurologie, Hôpital Universitaire de la Pitié-Salpêtrière, APHP, Marseille, France.
| | - F Macia
- Service de Neurologie, Hôpital Sainte Musse, Toulon, France.
| | - F Durif
- Service de neurologie, CHU de Clermont-Ferrand, Hôpital Gabriel Montpied, Marseille, France.
| | - A Poujois
- Service de Neurologie, Hôpital Fondation Rothschild, Paris, France.
| | - M Borg
- Service de Neurologie, CHU de Nice, Marseille, France.
| | - J-P Azulay
- Service de Neurologie et Pathologies du Mouvement, CHU Timone, APHM, Marseille, France.
| | - T Witjas
- Service de Neurologie et Pathologies du Mouvement, CHU Timone, APHM, Marseille, France.
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Schedlich-Teufer C, Jost ST, Krack P, Witt K, Weintraub D, Baldermann JC, Sommerauer M, Amstutz D, van Eimeren T, Dafsari HS, Kalbe E, Visser-Vandewalle V, Fink GR, Kessler J, Barbe MT. Assessment of Affective-Behavioral States in Parkinson's Disease Patients: Towards a New Screening Tool. JOURNAL OF PARKINSONS DISEASE 2021; 11:1417-1430. [PMID: 33967055 DOI: 10.3233/jpd-202375] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Assessment of affective-behavioral states in patients with Parkinson's disease (PD) undergoing deep brain stimulation (DBS) is essential. OBJECTIVE To analyze well-established questionnaires as a pilot-study with the long term aim to develop a screening tool evaluating affective-behavioral dysfunction, including depression, anxiety, apathy, mania, and impulse control disorders, in PD patients screened for DBS. METHODS Two hundred ninety-seven inpatients with PD underwent standardized neuropsychiatric testing including German versions of Beck Depression Inventory-II, Hospital Anxiety and Depression Scale, Apathy Evaluation Scale, Self-Report Manic Inventory, and Questionnaire for Impulsive-Compulsive Disorders in PD-Rating Scale, to assess appropriateness for DBS. Statistical item reduction was based on exploratory factor analysis, Cronbach's alpha, item-total correlations, item difficulty, and inter-item correlations. Confirmatory factor analysis was conducted to assess factorial validity. An expert rating was performed to identify clinically relevant items in the context of PD and DBS, to maintain content validity. We compared the shortened subscales with the original questionnaires using correlations. To determine cutoff points, receiver operating characteristics analysis was performed. RESULTS The items of the initial questionnaires were reduced from 129 to 38 items. Results of confirmatory factor analyses supported the validity of the shortened pool. It demonstrated high internal consistency (Cronbach's alpha = 0.72-0.83 across subscales), and the individual subscales were correlated with the corresponding original scales (rs = 0.84-0.95). Sensitivities and specificities exceeded 0.7. CONCLUSION The shortened item pool, including 38 items, provides a good basis for the development of a screening tool, capturing affective-behavioral symptoms in PD patients before DBS implantation. Confirmation of the validity of such a screening tool in an independent sample of PD patients is warranted.
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Affiliation(s)
- Charlotte Schedlich-Teufer
- Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Stefanie Theresa Jost
- Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Paul Krack
- Department of Neurology, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Karsten Witt
- Department of Neurology, School of Medicine and Health Sciences, University of Oldenburg, Oldenburg, Germany.,Research Center Neurosensory Science, University of Oldenburg, Oldenburg, Germany
| | - Daniel Weintraub
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.,Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.,Parkinson's Disease Research, Education and Clinical Center, Philadelphia Veterans Affairs Medical Center, Philadelphia, PA, USA
| | - Juan Carlos Baldermann
- Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.,Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Michael Sommerauer
- Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Deborah Amstutz
- Department of Neurology, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Thilo van Eimeren
- Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.,Department of Nuclear Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.,German Center for Neurodegenerative Diseases (DZNE), Bonn-Cologne, Germany
| | - Haidar Salimi Dafsari
- Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Elke Kalbe
- Department of Medical Psychology, Neuropsychology and Gender Studies & Center for Neuropsychological Diagnostics and Intervention (CeNDI), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Veerle Visser-Vandewalle
- Department of Stereotactic and Functional Neurosurgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Gereon Rudolf Fink
- Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.,Cognitive Neuroscience, Institute of Neuroscience and Medicine (INM-3), Research Center Jülich, Jülich, Germany
| | - Josef Kessler
- Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Michael Thomas Barbe
- Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
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Weiss D, Volkmann J, Fasano A, Kühn A, Krack P, Deuschl G. Changing Gears - DBS For Dopaminergic Desensitization in Parkinson's Disease? Ann Neurol 2021; 90:699-710. [PMID: 34235776 DOI: 10.1002/ana.26164] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 07/06/2021] [Accepted: 07/06/2021] [Indexed: 12/19/2022]
Abstract
In Parkinson's disease, both motor and neuropsychiatric complications unfold as a consequence of both incremental striatal dopaminergic denervation and intensifying long-term dopaminergic treatment. Together, this leads to 'dopaminergic sensitization' steadily increasing motor and behavioral responses to dopaminergic medication that result in the detrimental sequalae of long-term dopaminergic treatment. We review the clinical presentations of 'dopaminergic sensitization', including rebound off and dyskinesia in the motor domain, and neuropsychiatric fluctuations and behavioral addictions with impulse control disorders and dopamine dysregulation syndrome in the neuropsychiatric domain. We summarize state-of-the-art deep brain stimulation, and show that STN-DBS allows dopaminergic medication to be tapered, thus supporting dopaminergic desensitization. In this framework, we develop our integrated debatable viewpoint of "changing gears", that is we suggest rethinking earlier use of subthalamic nucleus deep brain stimulation, when the first clinical signs of dopaminergic motor or neuropsychiatric complications emerge over the steadily progressive disease course. In this sense, subthalamic deep brain stimulation may help reduce longitudinal motor and neuropsychiatric symptom expression - importantly, not by neuroprotection but by supporting dopaminergic desensitization through postoperative medication reduction. Therefore, we suggest considering STN-DBS early enough before patients encounter potentially irreversible psychosocial consequences of dopaminergic complications, but importantly not before a patient shows first clinical signs of dopaminergic complications. We propose to consider neuropsychiatric dopaminergic complications as a new inclusion criterion in addition to established motor criteria, but this concept will require validation in future clinical trials. ANN NEUROL 2021.
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Affiliation(s)
- Daniel Weiss
- Centre for Neurology, Department for Neurodegenerative Diseases, and Hertie-Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
| | - Jens Volkmann
- Department of Neurology, University Hospital and Julius-Maximilian-University, Würzburg, Germany
| | - Alfonso Fasano
- Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, UHN, Toronto, ON, Canada.,Division of Neurology, University of Toronto, Toronto, ON, Canada.,Krembil Brain Institute, Toronto, ON, Canada.,Center for Advancing Neurotechnological Innovation to Application (CRANIA), Toronto, ON, Canada
| | - Andrea Kühn
- Department of Neurology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Paul Krack
- Department of Neurology, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Günther Deuschl
- Department of Neurology, University Hospital Schleswig Holstein (UKSH), Christian-Albrechts-University Kiel, Kiel, Germany
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Salles PA, Mata IF, Fernandez HH. Should we start integrating genetic data in decision-making on device-aided therapies in Parkinson disease? A point of view. Parkinsonism Relat Disord 2021; 88:51-57. [PMID: 34119931 DOI: 10.1016/j.parkreldis.2021.05.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 04/26/2021] [Accepted: 05/12/2021] [Indexed: 12/14/2022]
Abstract
Parkinson disease (PD) is a complex heterogeneous neurodegenerative disorder. Association studies have revealed numerous genetic risk loci and variants, and about 5-10% suffer from a monogenic form. Because the presentation and course of PD is unique to each patient, personalized symptomatic treatment should ideally be offered to treat the most disabling motor and non-motor symptoms. Indeed, clinical milestones and treatment complications that appear during disease progression are influenced by the genetic imprint. With recent advances in PD, more patients live longer to become eligible for device-aided therapies, such as apomorphine continuous subcutaneous infusion, levodopa duodenal gel infusion, and deep brain stimulation surgery, each with its own inclusion and exclusion criteria, advantages and disadvantages. Because genetic variants influence the expression of particular clinical profiles, factors for better or worse outcomes for device-aided therapies may then be proactively identified. For example, mutations in PRKN, LRRK2 and GBA express phenotypes that favor suitability for different device therapies, although with marked differences in the therapeutic window; whereas multiplications of SNCA express phenotypes that make them less desirable for device therapies.
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Affiliation(s)
- Philippe A Salles
- Center for Neurological Restoration, Cleveland Clinic Neurological Institute, OH, USA; Movement Disorders Center, CETRAM, Santiago, Chile.
| | - Ignacio F Mata
- Lerner Research Institute, Genomic Medicine, Cleveland Clinic Foundation, Cleveland, OH, USA.
| | - Hubert H Fernandez
- Center for Neurological Restoration, Cleveland Clinic Neurological Institute, OH, USA.
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Ribault S, Simon E, Berthiller J, Polo G, Nunes A, Brinzeu A, Mertens P, Danaila T, Thobois S, Laurencin C. Comparison of clinical outcomes and accuracy of electrode placement between robot-assisted and conventional deep brain stimulation of the subthalamic nucleus: a single-center study. Acta Neurochir (Wien) 2021; 163:1327-1333. [PMID: 33649878 DOI: 10.1007/s00701-021-04790-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Accepted: 02/23/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Several surgical methods are used for deep brain stimulation (DBS) of the subthalamic nucleus (STN) in Parkinson's disease (PD). This study aimed to compare clinical outcomes and electrode placement accuracy after robot-assisted (RAS) versus frame-based stereotactic (FSS) STN DBS in Parkinson's disease. METHODS In this single-center open-label study, we prospectively collected data from 48 consecutive PD patients who underwent RAS (Neuromate®; n = 20) or FSS (n = 28) STN DBS with the same MRI-based STN targeting between October 2016 and December 2018 in the university neurological hospital of Lyon, France. Clinical variables were assessed before and 1 year after surgery. The number of electrode contacts within the STN was determined by merging post-operative CT and pre-operative MRI using Brainlab® GUIDE™XT software. RESULTS One year after surgery, the improvement of motor manifestations (p = 0.18), motor complications (p = 0.80), and quality of life (p= 0.30) and the reduction of dopaminergic treatment (p = 0.94) and the rate of complications (p = 0.99) were similar in the two groups. Surgery duration was longer in the RAS group (p = 0.0001). There was no difference in the number of electrode contacts within the STN. CONCLUSION This study demonstrates that RAS and FSS STN DBS for PD provide similar clinical outcomes and accuracy of electrode placement.
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Affiliation(s)
- Shams Ribault
- Service de Neurologie C, Centre Expert Parkinson, Hôpital Neurologique et Neurochirurgical Pierre Wertheimer, Hospices Civils de Lyon, 69003, Lyon, France
- Service de Médecine Physique et de Réadaptation, Hôpital Henry Gabrielle, Hospices Civils de Lyon, 69230, Saint-Genis-Laval, France
| | - Emile Simon
- Service de Neurochirurgie Fonctionnelle, Hôpital Neurologique et Neurochirurgical Pierre Wertheimer, Hospices Civils de Lyon, 69003, Lyon, France
- Laboratoire d'Anatomie, Faculté de Médecine Lyon Est, Université de Lyon, Université Claude Bernard Lyon 1, 69003, Lyon, France
| | - Julien Berthiller
- Service de Recherche et d'Épidémiologie Clinique, Pôle de Santé Publique, Hospices Civils de Lyon, 69003, Lyon, France
| | - Gustavo Polo
- Service de Neurochirurgie Fonctionnelle, Hôpital Neurologique et Neurochirurgical Pierre Wertheimer, Hospices Civils de Lyon, 69003, Lyon, France
| | - Adélaïde Nunes
- Service de Neurologie C, Centre Expert Parkinson, Hôpital Neurologique et Neurochirurgical Pierre Wertheimer, Hospices Civils de Lyon, 69003, Lyon, France
| | - Andrei Brinzeu
- Service de Recherche et d'Épidémiologie Clinique, Pôle de Santé Publique, Hospices Civils de Lyon, 69003, Lyon, France
| | - Patrick Mertens
- Service de Neurochirurgie Fonctionnelle, Hôpital Neurologique et Neurochirurgical Pierre Wertheimer, Hospices Civils de Lyon, 69003, Lyon, France
- Laboratoire d'Anatomie, Faculté de Médecine Lyon Est, Université de Lyon, Université Claude Bernard Lyon 1, 69003, Lyon, France
| | - Teodor Danaila
- Service de Neurologie C, Centre Expert Parkinson, Hôpital Neurologique et Neurochirurgical Pierre Wertheimer, Hospices Civils de Lyon, 69003, Lyon, France
| | - Stéphane Thobois
- Service de Neurologie C, Centre Expert Parkinson, Hôpital Neurologique et Neurochirurgical Pierre Wertheimer, Hospices Civils de Lyon, 69003, Lyon, France
- CNRS, Institut des Sciences Cognitives Marc Jeannerod, UMR 5229, 69675, Lyon, France
- Faculté de Médecine et de Maïeutique Lyon Sud Charles Mérieux, Université de Lyon, Université Claude Bernard Lyon 1, 69373, Lyon, France
| | - Chloé Laurencin
- Service de Neurologie C, Centre Expert Parkinson, Hôpital Neurologique et Neurochirurgical Pierre Wertheimer, Hospices Civils de Lyon, 69003, Lyon, France.
- Centre de Recherche en Neuroscience de Lyon, INSERM U1028, UMR 5292, 69000, Lyon, France.
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Grassi G, Albani G, Terenzi F, Razzolini L, Ramat S. New pharmacological and neuromodulation approaches for impulsive-compulsive behaviors in Parkinson's disease. Neurol Sci 2021; 42:2673-2682. [PMID: 33852081 DOI: 10.1007/s10072-021-05237-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 04/07/2021] [Indexed: 12/15/2022]
Abstract
INTRODUCTION A significant proportion of patients with Parkinson's disease (PD) display a set of impulsive-compulsive behaviors at some point during the course of illness. These behaviors range from the so-called behavioral addictions to dopamine dysregulation syndrome, punding and hoarding disorders. These behaviors have been consistently linked to the use of dopaminergic medications used to treat PD motor symptoms (dopamine agonists, levodopa, and other agents) and less consistently to neuromodulation techniques such as deep brain stimulation (DBS). Since there are still no approved treatments for these conditions, their pharmacological management is still a big challenge for clinicians. METHODS We conducted an extensive review of current pharmacological and neuromodulation literature for the management of impulsive-compulsive disorders in PD patients. RESULTS Pharmacological treatment approaches for impulsive-compulsive behaviors and DDS in PD patients include reduction of levodopa (LD), reduction/cessation of dopamine agonist (DA), and initiation of infusion therapies (apomorphine infusion and duodopa). Also, atomoxetine, a noradrenergic agent approved for the treatment of attention deficit hyperactivity disorder, showed some interesting preliminary results but there is still a lack of controlled longitudinal studies. Finally, while DBS effects on impulsive-compulsive disorders are still controversial, non-invasive techniques (such as transcranial magnetic stimulation and transcranial direct current stimulation) could have a potential positive effect but, again, there is still a lack of controlled trials. CONCLUSION Managing impulsivity and compulsivity in PD patients is still a non-evidence-based challenge for clinicians. Controlled trials on promising approaches such as atomoxetine and non-invasive neuromodulation techniques are needed.
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Affiliation(s)
- Giacomo Grassi
- Brain Center Firenze, Viale Belfiore 36, 5014, Florence, Italy.
| | | | | | - Lorenzo Razzolini
- Brain Center Firenze, Viale Belfiore 36, 5014, Florence, Italy.,University of Florence, Florence, Italy
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Kardous R, Joly H, Giordana B, Stefanini L, Mulliez A, Giordana C, Lemaire JJ, Fontaine D. Functional and dysfunctional impulsivities changes after subthalamic nucleus-deep brain stimulation in Parkinson disease. Neurochirurgie 2021; 67:420-426. [PMID: 33845115 DOI: 10.1016/j.neuchi.2021.03.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 03/04/2021] [Accepted: 03/21/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVES We investigated changes of impulsivity after deep brain stimulation (DBS) of the subthalamic nucleus (STN) in Parkinson's disease (PD) patients, distinguishing functional from dysfunctional impulsivity and their contributing factors. METHODS Data of 33 PD patients treated by STN-DBS were studied before and 6 months after surgery: motor impairment, medication (dose and dopaminergic agonists), cognition, mood and occurrence of impulse control disorders. Impulsivity was assessed by the Dickman Impulsivity Inventory, which distinguishes functional impulsivity (FI), reflecting the potential for reasoning and rapid action when the situation requires it, and dysfunctional impulsivity (DI), reflecting the lack of prior reasoning, even when the situation demands it. The location of DBS leads was studied on postoperative MRI using a deformable histological atlas and by compartmentalization of the STN. RESULTS After STN-DBS, DI was significantly increased (mean pre- and postoperative DI scores 1.9±1.6 and 3.5±2.4, P<0.001) although FI was not modified (mean pre- and postoperative FI scores 6.2±2.7 and 5.8±2.6). Factors associated with a DI score's increase≥2 (multivariable logistic regression model) were: low preoperative Frontal Assessment Battery score and location of the left active contact in the ventral part of the STN. CONCLUSION Our study suggests that STN-DBS may have a different impact on both dimensions of impulsivity, worsening pathological impulsivity without altering physiological impulsivity. The increase in dysfunctional impulsivity may be favoured by the location of the electrode in the ventral part of the STN.
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Affiliation(s)
- R Kardous
- Department of Psychiatry, Université Côte d'Azur, CHU de Nice, Nice, France; Centre d'acceuil Psychiatrique, Université Côte d'Azur, CHU de Nice, Nice, France
| | - H Joly
- Department of Neurology, CRC SEP, UR2CA, URRIS, Université Côte d'Azur, CHU de Nice, Hôpital Pasteur 2, 30, avenue de la voie Romaine, 06000 Nice, France.
| | - B Giordana
- Department of Psychiatry, Université Côte d'Azur, CHU de Nice, Nice, France
| | - L Stefanini
- Department of Psychiatry, Université Côte d'Azur, CHU de Nice, Nice, France
| | - A Mulliez
- Unité de Biostatistiques (DRCI), CHU de Clermont-Ferrand, Clermont-Ferrand, France
| | - C Giordana
- Department of Neurology, Université Côte d'Azur, CHU de Nice, Nice, France
| | - J-J Lemaire
- CNRS, SIGMA Clermont, Institut Pascal, Université Clermont-Auvergne, Clermont-Ferrand, France
| | - D Fontaine
- Department of Neurosurgery, Université Côte d'Azur, CHU de Nice, Nice, France
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46
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Costanza A, Radomska M, Bondolfi G, Zenga F, Amerio A, Aguglia A, Serafini G, Amore M, Berardelli I, Pompili M, Nguyen KD. Suicidality Associated With Deep Brain Stimulation in Extrapyramidal Diseases: A Critical Review and Hypotheses on Neuroanatomical and Neuroimmune Mechanisms. Front Integr Neurosci 2021; 15:632249. [PMID: 33897384 PMCID: PMC8060445 DOI: 10.3389/fnint.2021.632249] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Accepted: 03/15/2021] [Indexed: 12/13/2022] Open
Abstract
Deep brain stimulation (DBS) is a very well-established and effective treatment for patients with extrapyramidal diseases. Despite its generally favorable clinical efficacy, some undesirable outcomes associated with DBS have been reported. Among such complications are incidences of suicidal ideation (SI) and behavior (SB) in patients undergoing this neurosurgical procedure. However, causal associations between DBS and increased suicide risk are not demonstrated and they constitute a debated issue. In light of these observations, the main objective of this work is to provide a comprehensive and unbiased overview of the literature on suicide risk in patients who received subthalamic nucleus (STN) and internal part of globus pallidum (GPi) DBS treatment. Additionally, putative mechanisms that might be involved in the development of SI and SB in these patients as well as caveats associated with these hypotheses are introduced. Finally, we briefly propose some clinical implications, including therapeutic strategies addressing these potential disease mechanisms. While a mechanistic connection between DBS and suicidality remains a controversial topic that requires further investigation, it is of critical importance to consider suicide risk as an integral component of candidate selection and post-operative care in DBS.
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Affiliation(s)
- Alessandra Costanza
- Department of Psychiatry, Faculty of Medicine, University of Geneva (UNIGE), Geneva, Switzerland.,Department of Psychiatry, ASO Santi Antonio e Biagio e Cesare Arrigo Hospital, Alessandria, Italy
| | - Michalina Radomska
- Faculty of Psychology, University of Geneva (UNIGE), Geneva, Switzerland
| | - Guido Bondolfi
- Department of Psychiatry, Faculty of Medicine, University of Geneva (UNIGE), Geneva, Switzerland.,Department of Psychiatry, Service of Liaison Psychiatry and Crisis Intervention (SPLIC), Geneva University Hospitals (HUG), Geneva, Switzerland
| | - Francesco Zenga
- Department of Neurosurgery, University and City of Health and Science Hospital, Turin, Italy
| | - Andrea Amerio
- Section of Psychiatry, Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genova, Genova, Italy.,Department of Psychiatry, IRCCS Ospedale Policlinico San Martino, Genoa, Italy.,Mood Disorders Program, Tufts Medical Center, Boston, MA, United States
| | - Andrea Aguglia
- Section of Psychiatry, Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genova, Genova, Italy.,Department of Psychiatry, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Gianluca Serafini
- Section of Psychiatry, Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genova, Genova, Italy.,Department of Psychiatry, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Mario Amore
- Section of Psychiatry, Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genova, Genova, Italy.,Department of Psychiatry, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Isabella Berardelli
- Department of Neurosciences, Mental Health and Sensory Organs, Suicide Prevention Center, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Maurizio Pompili
- Department of Neurosciences, Mental Health and Sensory Organs, Suicide Prevention Center, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Khoa D Nguyen
- Department of Microbiology and Immunology, Stanford University, Palo Alto, CA, United States.,Tranquis Therapeutics, Palo Alto, CA, United States.,Hong Kong University of Science and Technology, Hong Kong, China
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47
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Nijhuis FAP, Esselink R, de Bie RMA, Groenewoud H, Bloem BR, Post B, Meinders MJ. Translating Evidence to Advanced Parkinson's Disease Patients: A Systematic Review and Meta-Analysis. Mov Disord 2021; 36:1293-1307. [PMID: 33797786 PMCID: PMC8252410 DOI: 10.1002/mds.28599] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 02/02/2021] [Accepted: 03/01/2021] [Indexed: 12/19/2022] Open
Abstract
In the advanced stages of Parkinson's disease (PD), patients frequently experience disabling motor complications. Treatment options include deep brain stimulation (DBS), levodopa‐carbidopa intestinal gel (LCIG), and continuous subcutaneous apomorphine infusion (CSAI). Choosing among these treatments is influenced by scientific evidence, clinical expertise, and patient preferences. To foster patient engagement in decision‐making among the options, scientific evidence should be adjusted to their information needs. We conducted a systematic review from the patient perspective. First, patients selected outcomes for a treatment choice: quality of life, activities of daily living, ON and OFF time, and adverse events. Second, we conducted a systematic review and meta‐analysis for each treatment versus best medical treatment using Grading of Recommendations, Assessment, Development, and Evaluation (GRADE). Finally, the evidence was transformed into comprehensible and comparable information. We converted the meta‐analysis results into the number of patients (per 100) who benefit clinically from an advanced treatment per outcome, based on the minimal clinically important difference and the cumulative distribution function. Although this approach allows for a comparison of outcomes across the three device‐aided therapies, they have never been compared directly. The interpretation is hindered by the relatively short follow‐up time in the included studies, usually less than 12 months. These limitations should be clarified to patients during the decision‐making process. This review can help patients integrate the evidence with their own preferences, and with their clinician's expertise, to reach an informed decision. © 2021 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society
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Affiliation(s)
- Frouke A P Nijhuis
- Department of Neurology, Canisius Wilhelmina Hospital, Nijmegen, the Netherlands.,Department of Neurology, Radboud University Medical Center, Donders Institute for Brain, Cognition and Behavior, Nijmegen, the Netherlands
| | - Rianne Esselink
- Department of Neurology, Radboud University Medical Center, Donders Institute for Brain, Cognition and Behavior, Nijmegen, the Netherlands
| | - Rob M A de Bie
- Department of Neurology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam Neuroscience, Amsterdam, the Netherlands
| | - Hans Groenewoud
- Department for Health Evidence, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Bastiaan R Bloem
- Department of Neurology, Radboud University Medical Center, Donders Institute for Brain, Cognition and Behavior, Nijmegen, the Netherlands
| | - Bart Post
- Department of Neurology, Radboud University Medical Center, Donders Institute for Brain, Cognition and Behavior, Nijmegen, the Netherlands
| | - Marjan J Meinders
- Department of Neurology, Radboud University Medical Center, Donders Institute for Brain, Cognition and Behavior, Nijmegen, the Netherlands
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48
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Azevedo P, Aquino CC, Fasano A. Surgical Management of Parkinson's Disease in the Elderly. Mov Disord Clin Pract 2021; 8:500-509. [PMID: 33981782 DOI: 10.1002/mdc3.13161] [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: 10/23/2020] [Revised: 01/11/2021] [Accepted: 01/19/2021] [Indexed: 11/09/2022] Open
Abstract
Background Deep Brain Stimulation (DBS) is an increasingly popular therapy for Parkinson's Disease (PD). Despite the experience gained over time with DBS of either the subthalamus or the globus pallidus pars interna, there is still no consensus regarding the age limit for DBS indication. Objectives This narrative review of the literature discusses the issues of age and DBS, emphasizing the critical need for good quality evidence to support the surgical management of elderly patients with PD. Methods We searched PubMed using the terms Parkinson's Disease; Parkinson's Disease therapy; deep brain stimulation; antiparkinsonian agents therapeutic use; age factors; aged; aged, 80 and over; middle aged; treatment outcome; and risk assessments. Results We identified several limitations of the available evidence, such as under-representation of older patients in DBS studies, small sample sizes in studies with older participants, heterogeneity of outcomes, and conflicting results. Conclusions Despite preliminary suggestions that age might affect the outcomes of DBS, the evidence to support the hypothesis of age as an independent predictor of DBS outcomes is limited and results are controversial. Ultimately, finding an age-independent biomarker predicting DBS outcome is the final goal to expand this powerful treatment to all patients age in an effective and safe manner.
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Affiliation(s)
- Paula Azevedo
- Edmond J. Safra Program in Parkinson's Disease and Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, UHN, Division of Neurology University of Toronto Toronto Ontario Canada
| | - Camila C Aquino
- Department of Clinical Neurosciences University of Calgary Calgary Alberta Canada.,Hotchkiss Brain Institute, University of Calgary Calgary Alberta Canada
| | - Alfonso Fasano
- Edmond J. Safra Program in Parkinson's Disease and Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, UHN, Division of Neurology University of Toronto Toronto Ontario Canada.,Krembil Brain Institute Toronto Ontario Canada.,CenteR for Advancing Neurotechnological Innovation to Application (CRANIA) Toronto Ontario Canada
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49
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Klebe S, Coenen V. [Deep brain stimulation in neurological and psychiatric diseases]. DER NERVENARZT 2021; 92:1042-1051. [PMID: 33630100 PMCID: PMC8484136 DOI: 10.1007/s00115-021-01079-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 01/15/2021] [Indexed: 11/18/2022]
Abstract
Die invasive Hirnstimulation (tiefe Hirnstimulation [THS], „deep brain stimulation“ [DBS]) ist mittlerweile ein etabliertes Therapieverfahren bei einer Reihe neurologischer Erkrankungen insbesondere Bewegungsstörungen. Die Anzahl der mit einer THS versorgten Patienten steigt stetig, die technische Entwicklung der THS-Systeme schreitet voran und neue Indikationen werden aktuell in Studien überprüft. Im folgenden Beitrag soll ein Überblick über die aktuellen Indikationen und ein Ausblick auf zukünftige Entwicklungen der THS bei Bewegungsstörungen und psychiatrischen Erkrankungen gegeben werden.
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Affiliation(s)
- Stephan Klebe
- Klinik für Neurologie, Universitätsmedizin Essen, Hufelandstr. 55, 45147, Essen, Deutschland.
| | - Volker Coenen
- Abteilung Stereotaktische und Funktionelle Neurochirurgie, Klinik für Neurochirurgie, Neurozentrum, Universitätsklinikum Freiburg, Breisacher Str. 64, 79106, Freiburg, Deutschland
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50
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Zoon TJ, van Rooijen G, Balm GM, Bergfeld IO, Daams JG, Krack P, Denys DA, de Bie RM. Apathy Induced by Subthalamic Nucleus Deep Brain Stimulation in Parkinson's Disease: A Meta-Analysis. Mov Disord 2021; 36:317-326. [PMID: 33331023 PMCID: PMC7986158 DOI: 10.1002/mds.28390] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 10/15/2020] [Accepted: 10/26/2020] [Indexed: 12/12/2022] Open
Abstract
Apathy, the loss of motivation, is a common problem in Parkinson's disease (PD) and often observed following deep brain stimulation (DBS) of the subthalamic nucleus (STN). The aim of this meta-analysis was to determine the occurrence of apathy following STN DBS in literature. Relevant articles were searched in PubMed/Medline, SCOPUS, EMBASE, and Web of Sciences electronic databases. Studies were included if they reported apathy scores pre- and post-DBS or the cross-sectional difference between PD patients receiving STN DBS and patients receiving medication only. Thirty-three articles were included in the meta-analyses from 6,658 screened articles by two authors independently. A total of 1,286 patients were included with a mean age (±standard deviation [SD]) of 58.4 ± 8.5 years and a disease duration of 11.0 ± 5.8 years. The apathy score measured by means of the Apathy Evaluation Scale (AES), Starkstein Apathy Scale (SAS), and the Lille Apathy Rating Scale (LARS) was significantly higher after DBS than pre-operatively (g = 0.34, 95% confidence interval [CI] = 0.19-0.48, P < 0.001). An equal, significant difference in severity of apathy was found between STN DBS and medication only (g = 0.36, 95% CI = 0.03-0.65; P = 0.004). Statistical heterogeneity was moderately high, but the effects stood strong after multiple analyses and were independent of tapering off dopaminergic medication. The findings of this meta-analysis indicate that apathy is increased after STN DBS compared to the pre-operative state and to medication only (systematic review registration number: PROSPERO CRD42019133932). © 2020 Universiteit van Amsterdam. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Thomas J.C. Zoon
- Department of Psychiatry, Amsterdam NeuroscienceAmsterdam University Medical Centers, University of AmsterdamAmsterdamthe Netherlands
| | - Geeske van Rooijen
- Department of Psychiatry, Amsterdam NeuroscienceAmsterdam University Medical Centers, University of AmsterdamAmsterdamthe Netherlands
| | - Georgina M.F.C. Balm
- Department of Psychiatry, Amsterdam NeuroscienceAmsterdam University Medical Centers, University of AmsterdamAmsterdamthe Netherlands
| | - Isidoor O. Bergfeld
- Department of Psychiatry, Amsterdam NeuroscienceAmsterdam University Medical Centers, University of AmsterdamAmsterdamthe Netherlands
- Amsterdam Brain and CognitionAmsterdamthe Netherlands
| | - Joost G. Daams
- Department of Psychiatry, Amsterdam NeuroscienceAmsterdam University Medical Centers, University of AmsterdamAmsterdamthe Netherlands
| | - Paul Krack
- Division of Movement Disorder, Department of NeurologyInselspital, University Hospital BernBernSwitzerland
| | - Damiaan A.J.P. Denys
- Department of Psychiatry, Amsterdam NeuroscienceAmsterdam University Medical Centers, University of AmsterdamAmsterdamthe Netherlands
| | - Rob M.A. de Bie
- Department of NeurologyAmsterdam University Medical Centers, University of AmsterdamAmsterdamthe Netherlands
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