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Smith LJ, Callis J, Bridger‐Smart S, Guilfoyle O. Experiences of Living With the Nonmotor Symptoms of Parkinson's Disease: A Photovoice Study. Health Expect 2024; 27:e14124. [PMID: 38924637 PMCID: PMC11199325 DOI: 10.1111/hex.14124] [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: 09/04/2023] [Revised: 04/19/2024] [Accepted: 06/11/2024] [Indexed: 06/28/2024] Open
Abstract
BACKGROUND Nonmotor symptoms (NMSs) are frequently experienced by people with Parkinson's disease (PD) and are often perceived as their most bothersome symptoms. However, these remain poorly understood with suboptimal clinical management. These unmet needs are an important determinant of health-related quality of life (QoL) in PD. OBJECTIVE The aim of this study was to gain insights into the experience of living with the NMS of PD in real-time using participatory action methodology. METHOD Using the photovoice method, 14 people with PD took photographs to document their experiences of living with the NMS of PD. They composed corresponding written narratives to capture the impact of NMS on their daily activities and QoL. In total, 152 photographs and corresponding narratives were analysed using thematic analysis with an inductive approach. RESULTS Four interrelated themes were identified. Emotional well-being and sense of self encompassed a process of adjustment to living with PD. Engaging in valued activities, adopting a positive mindset and utilising coping strategies were thought to enhance confidence and self-esteem. Social support and societal awareness highlighted the importance of supportive relationships and socialising to aid participation and avoid isolation. Barriers to social engagement included the unpredictability of NMS and nonvisible NMS being neglected or misunderstood. CONCLUSION Findings demonstrated the far-reaching impact of nonmotor aspects of PD on emotional, occupational and social dimensions. These needs could be addressed through person-centred and comprehensive approaches to care. PATIENT OR PUBLIC CONTRIBUTION This study utilised a participatory research approach allowing participants to choose the subjects that mattered to them and how to present their results. Additionally, a group workshop was held with people with PD, their family members and healthcare professionals to guide theme development.
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Affiliation(s)
- Laura J. Smith
- Preventive Neurology Unit, Wolfson Institute of Population HealthQueen Mary University of LondonLondonUK
- School of Psychology, Keynes CollegeUniversity of KentCanterburyUK
| | - Jerri Callis
- School of Psychology, Keynes CollegeUniversity of KentCanterburyUK
- Salomons Institute for Applied PsychologyCanterbury Christ Church UniversityTunbridge WellsUK
| | | | - Olivia Guilfoyle
- School of Psychology, Keynes CollegeUniversity of KentCanterburyUK
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Mobasheri A, Spring-Charles A, Gamaleri FC, McSwan J, Garg M, Sethi VS. Evidence-Based Opinions from Multidisciplinary Experts on Use of Naturopathic Herbal Remedies in Pain Management. J Pain Res 2024; 17:599-608. [PMID: 38347854 PMCID: PMC10860847 DOI: 10.2147/jpr.s432090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 01/03/2024] [Indexed: 02/15/2024] Open
Abstract
Background Pharmacological approaches to acute and chronic pain management, including non-steroidal anti-inflammatory drugs (NSAIDs) and opioids, are respectively associated with adverse reactions (such as gastrointestinal, cardiovascular, and renal effects) that might limit their use in patients with comorbidities and controversy related to inappropriate use. Naturopathic remedies might offer patients alternative and integrative treatments with minimal side effects. Objective To explore the regional variation in the acceptance and use of naturopathic remedies in pain management. Methods Two expert panel discussions were held by GlaxoSmithKline Consumer Healthcare (now Haleon Pte. Ltd.) over 9 and 12 hours in 2020 and 2021, respectively, and attended by multidisciplinary experts in naturopathy, Ayurvedic medicine, community pharmacy, physiotherapy, clinical pharmacy, Western medicine, academics, and naturopathic pain relief. Experts shared and discussed their experiences of naturopathic treatments and relevant clinical evidence related to different types of pain (including joint and muscle pain, migraine, sleeplessness due to pain, and general pain) and examined barriers to providing support to patients. Results Experts agreed on the potential for curcumin (2020, 71.4% [5/7]; 2021, 91.7% [11/12]) and fish oil (2020, 100% [7/7]) for management of osteoarthritic joint pain although these are not uniformly recommended in osteoarthritis treatment guidelines. In treatment of migraines, coenzyme Q10 and magnesium were favored by experts (2021, 90.9% [10/11] and 63.6% [7/11], respectively). Conclusion The need was emphasized for more and higher quality clinical studies to support naturopathic remedies, which might not be reflected in the latest treatment guidelines. The expert panel also highlighted missed opportunities for physicians and pharmacists to recommend effective naturopathic treatments.
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Affiliation(s)
- Ali Mobasheri
- Research Unit of Health Sciences and Technology, Physics and Technology, University of Oulu, Oulu, Finland
- Department of Regenerative Medicine, State Research Institute Centre for Innovative Medicine, Vilnius, Lithuania
- Department of Joint Surgery, Sun Yat-sen University, Guangzhou, People’s Republic of China
- World Health Organization Collaborating Center for Public Health Aspects of Musculoskeletal Health and Aging, Université de Liège, Liège, Belgium
| | | | | | - Joyce McSwan
- PainWISE Pty Ltd, Gold Coast, Queensland, Australia
| | - Manohar Garg
- Nutraceuticals Research Program, University of Newcastle, Callaghan, Newcastle, NSW, Australia
| | - Vidhu Sood Sethi
- Medical Affairs, Haleon (Formerly GlaxoSmithKline Consumer Healthcare) Pte. Ltd., Singapore
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Wu Q, Wang J, Lin X, Han D, Hu H, Gao H. Determining the Efficacy and Safety of Acupuncture for the Preventive Treatment of Menstrual Migraine: A Protocol for a PRISMA-Compliant Systematic Review and Meta-Analysis. J Pain Res 2023; 16:101-109. [PMID: 36647433 PMCID: PMC9840396 DOI: 10.2147/jpr.s394446] [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: 10/24/2022] [Accepted: 12/17/2022] [Indexed: 01/11/2023] Open
Abstract
Background Menstrual migraine (MM), as a common type of headache related to women's menstrual cycle, currently available treatments do not produce sufficient effectiveness, making it remains difficult to manage. Although acupuncture may be an effective treatment for MM, there is a lack of convincing evidence to recommend acupuncture to patients with MM until more solid evidence is produced. Therefore, the purpose of our systematic review (SR) and meta-analysis protocol is to synthesize up-to-date evidence regarding the clinical efficacy and safety of acupuncture on MM. Methods To find qualifying RCTs, nine databases will be searched. RevMan 5.3 will be used to combine the retrieved data for meta-analyses. The Cochrane risk of bias instrument will be used to assess the methodological quality of each included trial. The strength and certainty of the evidence will be evaluated using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system. Additionally, we will undertake sensitivity analyses, publication bias, and subgroup analyses if available. Discussion Our SR and meta-analysis protocol will contribute to determining acupuncture's therapeutic effect and safety in the preventive treatment of MM. Based on the up-to-date evidence produced by the subsequent SR and meta-analysis, informed treatment decisions will be made by patients, physicians and policy makers.
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Affiliation(s)
- Qiqi Wu
- Department of Acupuncture, Moxibustion and Massage, Wenzhou Central Hospital, Wenzhou City, People’s Republic of China
| | - Jiawei Wang
- The Third School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou City, People’s Republic of China
| | - Xiaoqi Lin
- The Third School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou City, People’s Republic of China
| | - Dexiong Han
- Department of Acupuncture and Moxibustion, the Third Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou City, People’s Republic of China
| | - Hantong Hu
- Department of Acupuncture and Moxibustion, the Third Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou City, People’s Republic of China,Correspondence: Hantong Hu; Hong Gao, Department of Acupuncture and Moxibustion, the Third Affiliated Hospital of Zhejiang Chinese Medical University, No. 219 Moganshan Road, Xihu District, Hangzhou City, People’s Republic of China, Email ;
| | - Hong Gao
- Department of Acupuncture and Moxibustion, the Third Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou City, People’s Republic of China
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Ali MD, Gayasuddin Qur F, Alam MS, M Alotaibi N, Mujtaba MA. Global Epidemiology, Clinical Features, Diagnosis and Current Therapeutic Novelties in Migraine Therapy and their Prevention: A Narrative Review. Curr Pharm Des 2023; 29:3295-3311. [PMID: 38270151 DOI: 10.2174/0113816128266227231205114320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 09/21/2023] [Indexed: 01/26/2024]
Abstract
INTRODUCTION The current article reviews the latest information on epidemiology, clinical features, diagnosis, recent advancements in clinical management, current therapeutic novelties, and the prevention of migraines. In a narrative review, all studies as per developed MeSH terms published until February 2023, excluding those irrelevant, were identified through a PubMed literature search. METHODS Overall, migraine affects more than a billion people annually and is one of the most common neurological illnesses. A wide range of comorbidities is associated with migraines, including stress and sleep disturbances. To lower the worldwide burden of migraine, comprehensive efforts are required to develop and enhance migraine treatment, which is supported by informed healthcare policy. Numerous migraine therapies have been successful, but not all patients benefit from them. RESULTS CGRP pathway-targeted therapy demonstrates the importance of translating mechanistic understanding into effective treatment. In this review, we discuss clinical features, diagnosis, and recently approved drugs, as well as a number of potential therapeutic targets, including pituitary adenylate cyclase-activating polypeptide (PACAP), adenosine, opioid receptors, potassium channels, transient receptor potential ion channels (TRP), and acid-sensing ion channels (ASIC). CONCLUSION In addition to providing more treatment options for improved clinical care, a better understanding of these mechanisms facilitates the discovery of novel therapeutic targets.
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Affiliation(s)
- Mohammad Daud Ali
- Department of Pharmacy, Mohammed Al-Mana College for Medical Sciences, Abdulrazaq Bin Hammam Street, Al Safa, Dammam 34222, Saudi Arabia
| | - Fehmida Gayasuddin Qur
- Department of Obstetrics and Gynecology, Princess Royal Maternity Hospital, Glasgow, Scotland
| | - Md Sarfaraz Alam
- Department of Pharmaceutics, HIMT College of Pharmacy, Rajpura 8, Institutional Area, Knowledge Park I, Greater Noida, Uttar Pradesh 201301, India
| | - Nawaf M Alotaibi
- Department of Clinical Pharmacy, Faculty of Pharmacy, Northern Border University, Rafha Campus, Arar, Saudi Arabia
| | - Md Ali Mujtaba
- Department of Pharmaceutics, Faculty of Pharmacy, Northern Border University, Rafha Campus, Arar, Saudi Arabia
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Pozo-Rosich P, Dodick DW, Ettrup A, Hirman J, Cady R. Shift in diagnostic classification of migraine after initiation of preventive treatment with eptinezumab: post hoc analysis of the PROMISE studies. BMC Neurol 2022; 22:394. [PMID: 36284281 PMCID: PMC9594902 DOI: 10.1186/s12883-022-02914-9] [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: 06/09/2022] [Accepted: 10/11/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Monthly headache frequency directly correlates with personal/societal burden and impacts severity and preventive treatment decisions. This post hoc analysis identified shifts from higher to lower frequency headache categories over 6 months in patients with migraine participating in the PROMISE clinical trials receiving two eptinezumab doses. METHODS Headache frequency at baseline and over study months 1-6 was categorized into 4 groups: chronic migraine (CM; ≥ 15 monthly headache days [MHDs]), high-frequency episodic migraine (HFEM; 10-14 MHDs), low-frequency episodic migraine (LFEM; 4-9 MHDs), and ≤ 3 MHDs. Outcomes included the percentage of patients within each MHD category, the percentage of patients improving by ≥ 1 MHD category, and the number of months with reduction of ≥ 1 MHD category. Data from patients who received approved eptinezumab doses (100 mg or 300 mg) or placebo were included. RESULTS Mean headache frequency at baseline in PROMISE-1 was 10 MHDs; most patients were classified as having HFEM (48.6%) or LFEM (43.9%). At Month 1, 62/221 (28.1%), 75/222 (33.8%), and 45/222 (20.3%) patients who received eptinezumab 100 mg, 300 mg, and placebo had ≤ 3 MHDs, with 97/221 (43.9%), 108/222 (48.6%), and 84/222 (37.8%), respectively, falling below the diagnostic EM threshold at Month 6. More than one-third (79/221 [35.7%], 83/222 [37.4%], and 68/222 [30.6%] of patients in the eptinezumab 100 mg, 300 mg, and placebo groups, respectively), had 6 months of reduction of ≥ 1 frequency category. At baseline in PROMISE-2, mean headache frequency was 20.5 MHDs. All patients (100%) in the eptinezumab 100 mg and placebo groups had CM, as did 99.4% of patients receiving eptinezumab 300 mg. At Month 1, 209/356 (58.7%), 216/350 (61.7%), and 167/366 (45.6%) patients treated with eptinezumab 100 mg, 300 mg, and placebo had ≤ 14 MHDs, with 240/356 (67.4%), 249/350 (71.1%), and 221/366 (60.4%), respectively, falling below CM threshold at Month 6. Additionally, 153/356 (43.0%), 169/350 (48.3%), and 116/366 (31.7%) patients in the eptinezumab 100 mg, 300 mg, and placebo groups, respectively, had 6 months of reduction of ≥ 1 frequency category. CONCLUSION In the PROMISE studies, episodic and chronic migraine patients treated with eptinezumab were more likely to reduce their headache frequency versus placebo, which directly and in a sustained way improved their diagnostic category classification. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02559895, NCT02974153.
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Affiliation(s)
- Patricia Pozo-Rosich
- grid.7080.f0000 0001 2296 0625Neurology Department, Headache Unit, Vall d’Hebron, University Hospital and Research Institute, Universitat Autonoma de Barcelona, Barcelona, Spain ,grid.7080.f0000 0001 2296 0625Headache and Neurological Pain Research Group, Department de Medicina, Vall d’Hebron, University Hospital and Research Institute, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - David W. Dodick
- grid.417468.80000 0000 8875 6339Mayo Clinic, Scottsdale, AZ USA ,Atria Institute, New York, NY USA
| | - Anders Ettrup
- grid.424580.f0000 0004 0476 7612H. Lundbeck A/S, Copenhagen, Denmark
| | - Joe Hirman
- Pacific Northwest Statistical Consulting, Inc., Woodinville, WA USA
| | - Roger Cady
- grid.419796.4Lundbeck LLC, Deerfield, IL USA ,RK Consults, Ozark, MO USA ,grid.260126.10000 0001 0745 8995Missouri State University, Springfield, MO USA
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Abstract
Chronic migraine is a neurologic disorder associated with considerable disability, lost productivity, and a profound economic burden worldwide. The past five years have seen a dramatic expansion in new treatments for this often challenging condition, among them calcitonin gene related peptide antagonists and neuromodulatory devices. This review outlines the epidemiology of and diagnostic criteria and risk factors for chronic migraine. It discusses evidence based drug and non-drug treatments, their advantages and disadvantages, and the principles of patient centered care for adults with chronic migraine, with attention to differential diagnosis and comorbidities, clinical reasoning, initiation and monitoring, cost, and availability. It discusses the international guidelines on drug treatment for chronic migraine and evaluates non-drug treatments including behavioral and complementary therapies and lifestyle modifications. Finally, it discusses the management of chronic migraine in special populations, including pediatrics, pregnancy, and older people, and considers future questions and emerging research in the field.
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Affiliation(s)
| | - Julie Roth
- Warren Alpert Medical School of Brown University, Brown University, Providence, RI, USA
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Zhou C, Bao J, Hu H, Ye S, Shao X, Liang Y, Fang J. Letter to the Editor: Acupuncture Based on Regulating Autonomic Nerves for the Prevention of Migraine without Aura: A Prospective, Double-Dummy, Randomized Controlled Clinical Trial [Response to Letter]. J Pain Res 2022; 15:2997-2998. [PMID: 36176964 PMCID: PMC9514281 DOI: 10.2147/jpr.s387388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 09/01/2022] [Indexed: 11/23/2022] Open
Affiliation(s)
- Chuanlong Zhou
- Department of Acupuncture, the Third Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, People's Republic of China
| | - Jie Bao
- School of Basic Medical Sciences, Zhejiang Chinese Medical University, Hangzhou, People's Republic of China
| | - Hantong Hu
- Department of Acupuncture, the Third Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, People's Republic of China
| | - Siting Ye
- Department of Tuina, the First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, People's Republic of China
| | - Xiaomei Shao
- Key Laboratory of Acupuncture and Neurology of Zhejiang Province, the Third Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou, People's Republic of China
| | - Yi Liang
- Key Laboratory of Acupuncture and Neurology of Zhejiang Province, the Third Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou, People's Republic of China
| | - Jianqiao Fang
- Key Laboratory of Acupuncture and Neurology of Zhejiang Province, the Third Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou, People's Republic of China
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Graves EB, Gerber BR, Berrigan PS, Shaw E, Cowling TM, Ladouceur MP, Bougie JK. Epidemiology and treatment utilization for Canadian patients with migraine: a literature review. J Int Med Res 2022; 50:3000605221126380. [PMID: 36173008 PMCID: PMC9528037 DOI: 10.1177/03000605221126380] [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] [Indexed: 11/16/2022] Open
Abstract
The objective of this narrative review was to identify real-world evidence regarding the burden of migraine in Canada. We conducted a literature search in MEDLINE, Embase, and the Cochrane Database of Systematic Reviews for studies published between August 2010 and August 2020. Of the 3269 publications identified, 29 studies were included. Prevalence estimates varied widely across Canada, and mental health comorbidities were common. Individuals with migraine have a lower quality of life, detrimental impact on workforce productivity, and higher rates of health care resource utilization (HCRU), with HCRU and costs highest among those with chronic migraine. We found inconsistencies in care, including underutilization of medications such as triptans, and varied utilization of over-the-counter and prescription medications. Increased medication use was identified among those with chronic migraine, and only a small number of patients used migraine preventive medications. The burden of migraine in Canada is substantial. Reduced quality of life and workforce productivity, increased HCRU and costs, and underutilization of triptans and migraine preventive medications highlight an important need for more effective management of individuals with migraine.
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Affiliation(s)
- Erin B Graves
- Medlior Health Outcomes Research Ltd., Calgary, AB, Canada
| | | | | | - Eileen Shaw
- Medlior Health Outcomes Research Ltd., Calgary, AB, Canada
| | - Tara M Cowling
- Medlior Health Outcomes Research Ltd., Calgary, AB, Canada
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Fitzek M, Raffaelli B, Reuter U. Advances in pharmacotherapy for the prophylactic treatment of resistant and refractory migraine. Expert Opin Pharmacother 2022; 23:1143-1153. [PMID: 35698795 DOI: 10.1080/14656566.2022.2088281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Refractory migraine is associated with low quality of life and great socioeconomic burden. Despite high need for effective, tolerable preventive therapies, there has been little research on potential therapeutic options. Monoclonal antibodies (mAbs) against Calcitonin Gene-Related Peptide (CGRP) are the first preventive therapeutic approach for migraine based on the underlying pathophysiology. AREAS COVERED Following a brief introduction into the term 'refractory migraine,' the authors reviewavailable treatment options, focusing on current phase III trials of substances acting on the CGRP pathway. EXPERT OPINION No uniform definition for refractory migraine is available. The vast majority of proposals recommend treatment failure of 2-4 drug classes as a key diagnostic criterion. Phase III studies on CGRP-(receptor) mAbs demonstrated excellent efficacy and tolerability in patients with chronic and episodic migraine including subjects with multiple unsuccessful conventional therapy attempts. However, more comparator trials showing superiority of mAbs versus oral preventatives, such as the HER-MEs study are needed. In summary, with the CGRP antibodies, a group of drugs has entered the market which will most likely not only significantly improve the quality of life of many individual migraine patients but could also reduce indirect health-care costs associated with migraine by reducing recurrent medical consultations.
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Affiliation(s)
- Mira Fitzek
- Department of Neurology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Bianca Raffaelli
- Department of Neurology, Charité Universitätsmedizin Berlin, Berlin, Germany.,Clinician Scientist Programm, Berlin Institute of Health (BIH), Berlin, Germany
| | - Uwe Reuter
- Department of Neurology, Charité Universitätsmedizin Berlin, Berlin, Germany.,Universitätsmedizin Greifswald, Greifswald, Germany
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Koponen M, Bell JS, Lalic S, Watson R, Koivisto AM, Ilomäki J. Treatment initiation for parkinson’s disease in Australia 2013–2018: a nation-wide study. BMC Geriatr 2022; 22:483. [PMID: 35658842 PMCID: PMC9166304 DOI: 10.1186/s12877-022-03095-3] [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: 12/09/2021] [Accepted: 04/19/2022] [Indexed: 11/10/2022] Open
Abstract
Background Guidelines highlight the importance of an individualized approach to treatment initiation for Parkinson’s disease. Our aim was to investigate initiation of anti-Parkinson medication in Australia from 2013–2018, and to determine factors predicting choice of initial treatment. Methods Cohort of new-users (N = 4,887) of anti-Parkinson medication aged ≥ 40 years were identified from a 10% random representative sample of national medication dispensing data from July-2013 to June-2018. Changes in treatment initiation were examined across the whole cohort and stratified by age and sex. Results Treatment initiation was most frequent with levodopa followed by non-ergot dopamine agonists (DAs) and anticholinergics. Two thirds initiated with levodopa across the study period. Initiation with non-ergot DAs increased from 22 to 27% (rate ratio, RR 1.23, 95% confidence interval, CI 1.02–1.47) and initiation with anticholinergics decreased from 6.9% to 2.4% (RR 0.34, 95% CI 0.21–0.55) from 2013–2018. Among persons aged ≥ 65 years, one third of women and one fourth of men initiated on levodopa. Among women aged < 65 years, rates of treatment initiation with DAs (37%) and levodopa (37%) were similar in 2013/2014 but initiation with DA exceeded levodopa thereafter. Among men aged < 65 years, treatment initiation with levodopa (44%-49%) remained more frequent than initiation with DAs (29%-32%) throughout the study period. Conclusions Treatment initiation with levodopa was most frequent among persons aged ≥ 65 years, consistent with current guidelines. Whilst the value of levodopa sparing strategies is unclear, treatment initiation with DA has become increasingly common relative to levodopa among women but not among men aged < 65 years. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-022-03095-3.
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Schwedt TJ, Hentz JG, Sahai-Srivastava S, Murinova N, Spare NM, Treppendahl C, Martin VT, Birlea M, Digre K, Watson D, Leonard M, Robert T, Dodick DW. Patient-Centered Treatment of Chronic Migraine With Medication Overuse: A Prospective, Randomized, Pragmatic Clinical Trial. Neurology 2022; 98:e1409-e1421. [PMID: 35169011 DOI: 10.1212/wnl.0000000000200117] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 01/11/2022] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Overuse of symptomatic (i.e., acute) medications is common among those with chronic migraine. It is associated with developing frequent headaches, medication side effects, and reduced quality of life. The optimal treatment strategy for patients who have chronic migraine with medication overuse (CMMO) has long been debated. The study objective was to determine whether migraine preventive therapy without switching or limiting the frequency of the overused medication was noninferior to migraine preventive therapy with switching from the overused medication to an alternative medication that could be used on ≤2 d/wk. METHODS The Medication Overuse Treatment Strategy (MOTS) trial was an open-label, pragmatic clinical trial, randomizing adult participants 1:1 to migraine preventive medication and (1) switching from the overused medication to an alternative used ≤2 d/wk or (2) continuation of the overused medication with no maximum limit. Participants were enrolled between February 2017 and December 2020 from 34 clinics in the United States, including headache specialty, general neurology, and primary care clinics. The primary outcome was moderate to severe headache day frequency during weeks 9 to 12 and subsequently during weeks 1 to 2 after randomization. RESULTS Seven hundred twenty participants were randomized; average age was 44 (SD 13) years; and 87.5% were female. At baseline, participants averaged 22.5 (SD 5.1) headache days over 4 weeks, including 12.8 (SD 6.7) moderate to severe headache days and 21.4 (SD 5.8) days of symptomatic medication use. Migraine preventive medication without switching of the overused medication was not inferior to preventive medication with switching for moderate to severe headache day frequency during weeks 9 to 12 (switching 9.3 [SD 7.2] vs no switching 9.1 [SD 6.8]; p = 0.75, 95% CI -1.0 to 1.3). The treatment strategies also provided similar outcomes during the first 2 weeks (switching 6.6 [SD 3.7] moderate to severe headaches days vs no switching 6.4 [SD 3.6]; p = 0.57, 95% CI -0.4 to 0.7). DISCUSSION When reduction in moderate to severe headache days was used as the outcome of interest for the management of CMMO, migraine preventive medication without switching or limiting symptomatic medication is not inferior to migraine preventive medication with switching to a different symptomatic medication with a maximum limit of 2 treatment days per week. TRIAL REGISTRATION INFORMATION ClinicalTrials.gov identifier NCT02764320. CLASSIFICATION OF EVIDENCE This study provides Class III evidence that, for patients who have CMMO, migraine preventive medication without switching or limiting the overused medication is noninferior to migraine preventive medication with switching and limiting symptomatic medication.
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Affiliation(s)
- Todd J Schwedt
- From the Department of Neurology (T.J.S., J.G.H., M.L., D.W.D.), Mayo Clinic, Phoenix, AZ; Department of Neurology (S.S.-S.), University of Southern California, Los Angeles; Department of Neurology (N.M.), University of Washington, Seattle; Department of Neurology (N.M.S.), Thomas Jefferson University, Philadelphia, PA; The Headache Center (C.T.), Ridgeland, MS; Department of Internal Medicine (V.T.M.), University of Cincinnati, OH; Department of Neurology (M.B.), University of Colorado, Denver; Department of Neurology (K.D.), University of Utah, Salt Lake City; Department of Neurology (D.W.), West Virginia University Rockefeller Neuroscience Institute, Morgantown; and patient advocate and educator (T.R.), Washington, WV.
| | - Joseph G Hentz
- From the Department of Neurology (T.J.S., J.G.H., M.L., D.W.D.), Mayo Clinic, Phoenix, AZ; Department of Neurology (S.S.-S.), University of Southern California, Los Angeles; Department of Neurology (N.M.), University of Washington, Seattle; Department of Neurology (N.M.S.), Thomas Jefferson University, Philadelphia, PA; The Headache Center (C.T.), Ridgeland, MS; Department of Internal Medicine (V.T.M.), University of Cincinnati, OH; Department of Neurology (M.B.), University of Colorado, Denver; Department of Neurology (K.D.), University of Utah, Salt Lake City; Department of Neurology (D.W.), West Virginia University Rockefeller Neuroscience Institute, Morgantown; and patient advocate and educator (T.R.), Washington, WV
| | - Soma Sahai-Srivastava
- From the Department of Neurology (T.J.S., J.G.H., M.L., D.W.D.), Mayo Clinic, Phoenix, AZ; Department of Neurology (S.S.-S.), University of Southern California, Los Angeles; Department of Neurology (N.M.), University of Washington, Seattle; Department of Neurology (N.M.S.), Thomas Jefferson University, Philadelphia, PA; The Headache Center (C.T.), Ridgeland, MS; Department of Internal Medicine (V.T.M.), University of Cincinnati, OH; Department of Neurology (M.B.), University of Colorado, Denver; Department of Neurology (K.D.), University of Utah, Salt Lake City; Department of Neurology (D.W.), West Virginia University Rockefeller Neuroscience Institute, Morgantown; and patient advocate and educator (T.R.), Washington, WV
| | - Natalia Murinova
- From the Department of Neurology (T.J.S., J.G.H., M.L., D.W.D.), Mayo Clinic, Phoenix, AZ; Department of Neurology (S.S.-S.), University of Southern California, Los Angeles; Department of Neurology (N.M.), University of Washington, Seattle; Department of Neurology (N.M.S.), Thomas Jefferson University, Philadelphia, PA; The Headache Center (C.T.), Ridgeland, MS; Department of Internal Medicine (V.T.M.), University of Cincinnati, OH; Department of Neurology (M.B.), University of Colorado, Denver; Department of Neurology (K.D.), University of Utah, Salt Lake City; Department of Neurology (D.W.), West Virginia University Rockefeller Neuroscience Institute, Morgantown; and patient advocate and educator (T.R.), Washington, WV
| | - Nicole M Spare
- From the Department of Neurology (T.J.S., J.G.H., M.L., D.W.D.), Mayo Clinic, Phoenix, AZ; Department of Neurology (S.S.-S.), University of Southern California, Los Angeles; Department of Neurology (N.M.), University of Washington, Seattle; Department of Neurology (N.M.S.), Thomas Jefferson University, Philadelphia, PA; The Headache Center (C.T.), Ridgeland, MS; Department of Internal Medicine (V.T.M.), University of Cincinnati, OH; Department of Neurology (M.B.), University of Colorado, Denver; Department of Neurology (K.D.), University of Utah, Salt Lake City; Department of Neurology (D.W.), West Virginia University Rockefeller Neuroscience Institute, Morgantown; and patient advocate and educator (T.R.), Washington, WV
| | - Christina Treppendahl
- From the Department of Neurology (T.J.S., J.G.H., M.L., D.W.D.), Mayo Clinic, Phoenix, AZ; Department of Neurology (S.S.-S.), University of Southern California, Los Angeles; Department of Neurology (N.M.), University of Washington, Seattle; Department of Neurology (N.M.S.), Thomas Jefferson University, Philadelphia, PA; The Headache Center (C.T.), Ridgeland, MS; Department of Internal Medicine (V.T.M.), University of Cincinnati, OH; Department of Neurology (M.B.), University of Colorado, Denver; Department of Neurology (K.D.), University of Utah, Salt Lake City; Department of Neurology (D.W.), West Virginia University Rockefeller Neuroscience Institute, Morgantown; and patient advocate and educator (T.R.), Washington, WV
| | - Vincent T Martin
- From the Department of Neurology (T.J.S., J.G.H., M.L., D.W.D.), Mayo Clinic, Phoenix, AZ; Department of Neurology (S.S.-S.), University of Southern California, Los Angeles; Department of Neurology (N.M.), University of Washington, Seattle; Department of Neurology (N.M.S.), Thomas Jefferson University, Philadelphia, PA; The Headache Center (C.T.), Ridgeland, MS; Department of Internal Medicine (V.T.M.), University of Cincinnati, OH; Department of Neurology (M.B.), University of Colorado, Denver; Department of Neurology (K.D.), University of Utah, Salt Lake City; Department of Neurology (D.W.), West Virginia University Rockefeller Neuroscience Institute, Morgantown; and patient advocate and educator (T.R.), Washington, WV
| | - Marius Birlea
- From the Department of Neurology (T.J.S., J.G.H., M.L., D.W.D.), Mayo Clinic, Phoenix, AZ; Department of Neurology (S.S.-S.), University of Southern California, Los Angeles; Department of Neurology (N.M.), University of Washington, Seattle; Department of Neurology (N.M.S.), Thomas Jefferson University, Philadelphia, PA; The Headache Center (C.T.), Ridgeland, MS; Department of Internal Medicine (V.T.M.), University of Cincinnati, OH; Department of Neurology (M.B.), University of Colorado, Denver; Department of Neurology (K.D.), University of Utah, Salt Lake City; Department of Neurology (D.W.), West Virginia University Rockefeller Neuroscience Institute, Morgantown; and patient advocate and educator (T.R.), Washington, WV
| | - Kathleen Digre
- From the Department of Neurology (T.J.S., J.G.H., M.L., D.W.D.), Mayo Clinic, Phoenix, AZ; Department of Neurology (S.S.-S.), University of Southern California, Los Angeles; Department of Neurology (N.M.), University of Washington, Seattle; Department of Neurology (N.M.S.), Thomas Jefferson University, Philadelphia, PA; The Headache Center (C.T.), Ridgeland, MS; Department of Internal Medicine (V.T.M.), University of Cincinnati, OH; Department of Neurology (M.B.), University of Colorado, Denver; Department of Neurology (K.D.), University of Utah, Salt Lake City; Department of Neurology (D.W.), West Virginia University Rockefeller Neuroscience Institute, Morgantown; and patient advocate and educator (T.R.), Washington, WV
| | - David Watson
- From the Department of Neurology (T.J.S., J.G.H., M.L., D.W.D.), Mayo Clinic, Phoenix, AZ; Department of Neurology (S.S.-S.), University of Southern California, Los Angeles; Department of Neurology (N.M.), University of Washington, Seattle; Department of Neurology (N.M.S.), Thomas Jefferson University, Philadelphia, PA; The Headache Center (C.T.), Ridgeland, MS; Department of Internal Medicine (V.T.M.), University of Cincinnati, OH; Department of Neurology (M.B.), University of Colorado, Denver; Department of Neurology (K.D.), University of Utah, Salt Lake City; Department of Neurology (D.W.), West Virginia University Rockefeller Neuroscience Institute, Morgantown; and patient advocate and educator (T.R.), Washington, WV
| | - Michael Leonard
- From the Department of Neurology (T.J.S., J.G.H., M.L., D.W.D.), Mayo Clinic, Phoenix, AZ; Department of Neurology (S.S.-S.), University of Southern California, Los Angeles; Department of Neurology (N.M.), University of Washington, Seattle; Department of Neurology (N.M.S.), Thomas Jefferson University, Philadelphia, PA; The Headache Center (C.T.), Ridgeland, MS; Department of Internal Medicine (V.T.M.), University of Cincinnati, OH; Department of Neurology (M.B.), University of Colorado, Denver; Department of Neurology (K.D.), University of Utah, Salt Lake City; Department of Neurology (D.W.), West Virginia University Rockefeller Neuroscience Institute, Morgantown; and patient advocate and educator (T.R.), Washington, WV
| | - Teri Robert
- From the Department of Neurology (T.J.S., J.G.H., M.L., D.W.D.), Mayo Clinic, Phoenix, AZ; Department of Neurology (S.S.-S.), University of Southern California, Los Angeles; Department of Neurology (N.M.), University of Washington, Seattle; Department of Neurology (N.M.S.), Thomas Jefferson University, Philadelphia, PA; The Headache Center (C.T.), Ridgeland, MS; Department of Internal Medicine (V.T.M.), University of Cincinnati, OH; Department of Neurology (M.B.), University of Colorado, Denver; Department of Neurology (K.D.), University of Utah, Salt Lake City; Department of Neurology (D.W.), West Virginia University Rockefeller Neuroscience Institute, Morgantown; and patient advocate and educator (T.R.), Washington, WV
| | - David W Dodick
- From the Department of Neurology (T.J.S., J.G.H., M.L., D.W.D.), Mayo Clinic, Phoenix, AZ; Department of Neurology (S.S.-S.), University of Southern California, Los Angeles; Department of Neurology (N.M.), University of Washington, Seattle; Department of Neurology (N.M.S.), Thomas Jefferson University, Philadelphia, PA; The Headache Center (C.T.), Ridgeland, MS; Department of Internal Medicine (V.T.M.), University of Cincinnati, OH; Department of Neurology (M.B.), University of Colorado, Denver; Department of Neurology (K.D.), University of Utah, Salt Lake City; Department of Neurology (D.W.), West Virginia University Rockefeller Neuroscience Institute, Morgantown; and patient advocate and educator (T.R.), Washington, WV
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Abstract
Migraine is a common, chronic, disorder that is typically characterized by recurrent disabling attacks of headache and accompanying symptoms, including aura. The aetiology is multifactorial with rare monogenic variants. Depression, epilepsy, stroke and myocardial infarction are comorbid diseases. Spreading depolarization probably causes aura and possibly also triggers trigeminal sensory activation, the underlying mechanism for the headache. Despite earlier beliefs, vasodilation is only a secondary phenomenon and vasoconstriction is not essential for antimigraine efficacy. Management includes analgesics or NSAIDs for mild attacks, and, for moderate or severe attacks, triptans or 5HT1B/1D receptor agonists. Because of cardiovascular safety concerns, unreliable efficacy and tolerability issues, use of ergots to abort attacks has nearly vanished in most countries. CGRP receptor antagonists (gepants) and lasmiditan, a selective 5HT1F receptor agonist, have emerged as effective acute treatments. Intramuscular onabotulinumtoxinA may be helpful in chronic migraine (migraine on ≥15 days per month) and monoclonal antibodies targeting CGRP or its receptor, as well as two gepants, have proven effective and well tolerated for the preventive treatment of migraine. Several neuromodulation modalities have been approved for acute and/or preventive migraine treatment. The emergence of new treatment targets and therapies illustrates the bright future for migraine management.
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13
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Zaman MS, Ghahari S, McColl MA. Barriers to Accessing Healthcare Services for People with Parkinson's Disease: A Scoping Review. JOURNAL OF PARKINSON'S DISEASE 2021; 11:1537-1553. [PMID: 34308913 PMCID: PMC8609702 DOI: 10.3233/jpd-212735] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 07/03/2021] [Indexed: 12/18/2022]
Abstract
Parkinson's disease is a complex condition that affects many different aspects of a person's health. Because of its complexity, people with Parkinson's disease require access to a variety of healthcare services. The aim of the present study was to identify the barriers to access healthcare services for people with Parkinson's disease. We conducted a scoping review according to guidelines posed by Arksey & O'Malley (2005). A search of MEDLINE, Embase, CINHAL, and PsycINFO databases was conducted, and 38 articles were selected based on the inclusion criteria. The review findings identified person-level and system-level barriers. The person-level barriers included skills required to seek healthcare services, ability to engage in healthcare and cost for services. The system-level barriers included the availability of appropriate healthcare resources. Based on the existing barriers elucidated in the scope review, we have discussed potential areas in healthcare that require improvement for people with Parkinson's disease to manage their healthcare needs more equitably.
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Affiliation(s)
| | - Setareh Ghahari
- School of Rehabilitation Therapy, Queen’s University, Kingston, Canada
| | - Mary Ann McColl
- School of Rehabilitation Therapy, Queen’s University, Kingston, Canada
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14
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Nicholas R, Nicholas E, Hannides M, Gautam V, Friede T, Koffman J. Influence of individual, illness and environmental factors on place of death among people with neurodegenerative diseases: a retrospective, observational, comparative cohort study. BMJ Support Palliat Care 2021:bmjspcare-2021-003105. [PMID: 34489324 DOI: 10.1136/bmjspcare-2021-003105] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 07/11/2021] [Indexed: 11/03/2022]
Abstract
BACKGROUND In long-term neurological conditions, location of death is poorly understood but is seen as a marker of quality of dying. OBJECTIVE To examine individual, illness and environmental factors on place of death among people with multiple sclerosis (MS) and Parkinson's disease (PD) in isolation or in combination and compare them with people without either condition. METHODS Retrospective, observational, comparative cohort study of 582 people with MS, 579 people with PD and 95 controls from UK Multiple Sclerosis and Parkinson's Disease Tissue Bank. A subset of people with MS and PD were selected for analysis of individual clinical encounters 2 years before death and further subset of all groups for analysis of impact of advance care planning (ACP) and recognition of dying. RESULTS People with MS died more often (50.8%) in hospital than those with PD (35.3%). Examining individual clinical encounters over 2 years (4931 encounters) identified increased contact with services 12 months before death (F(1, 58)=69.71, p<0.0001) but was not associated with non-hospital deaths (F(1, 58)=1.001, p=0.321). The presence of ACPs and recognition of dying were high among people with MS and PD and both associated with a non-hospital death. ACPs were more likely to prevent hospital deaths when initiated by general practitioners (GPs) compared with other professional groups (χ2=68.77, p=0.0007). CONCLUSIONS For people with MS and PD, ACPs contribute to reducing dying in hospital. ACPs appear to be most effective when facilitated by GPs underlining the importance of primary care involvement in delivering holistic care at the end of life.
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Affiliation(s)
- Richard Nicholas
- UK Multiple Sclerosis Tissue Bank, Imperial College London, London, UK
| | - Emma Nicholas
- UK Multiple Sclerosis Tissue Bank, Imperial College London, London, UK
| | - Mike Hannides
- UK Multiple Sclerosis Tissue Bank, Imperial College London, London, UK
| | - Vishal Gautam
- UK Multiple Sclerosis Tissue Bank, Imperial College London, London, UK
| | - Tim Friede
- Department of Medical Statistics, University Medical Center, University of Göttingen, Göttingen, Germany
| | - Jonathan Koffman
- Department of Palliative Care, Policy and Rehabiltation, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK
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15
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Zhao T, Guo J, Song Y, Chen H, Sun M, Chen L, Geng H, Pei L, Sun J. A Bibliometric Analysis of Research Trends of Acupuncture Therapy in the Treatment of Migraine from 2000 to 2020. J Pain Res 2021; 14:1399-1414. [PMID: 34079357 PMCID: PMC8164719 DOI: 10.2147/jpr.s306594] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 04/23/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Migraine is the second-leading cause of disability worldwide. It is often characterized by attacks of severe, mostly unilateral, pulsating headache associated with symptoms such as photophobia, phonophobia, nausea, vomiting, and cutaneous allodynia. Acupuncture therapy has been used worldwide for the treatment of migraine. However, no visual bibliometric analysis has been conducted on the effects of acupuncture on migraine over the past 20 years. Therefore, this study aimed to explore the current status and trends on the use of acupuncture in the treatment of migraine from 2000 to 2020. PURPOSE The objective of this study is to identify the current status and emerging trends of the global use of acupuncture on migraine from 2000 to 2020 using CiteSpace and VOSviewer. METHODS Web of Science databases were searched for publications related to acupuncture therapy for treating migraine between 2000 and 2020. CiteSpace and VOSviewer were used to analyze the number of publications per year, countries, institutions, authors, journals, references, and keywords. RESULTS A total of 572 publications were included in the final analysis. The total number of publications has continued to increase with some fluctuations over the past 20 years. The most productive country and institution in this field were the USA, and Chengdu University of Traditional Chinese Medicine, respectively. The most active and cited authors were Liang FR and Linde K, respectively. Cephalalgia was the most productive, cited, and co-cited journal. The Linde K (2005) had the highest co-citation, citation number and centrality. The keywords "migraine" ranked first in frequency. The common type of migraine (tension-type headache), research method (randomized controlled trial, multicenter, double-blind), acupuncture's role (prophylactic, quality of life, pain), and evaluation (meta-analysis, systematic review) were the hotspots and frontier trends of acupuncture therapy on migraine between 2000 and 2020. CONCLUSION The present study examined the research-related trend in acupuncture therapy on migraine using bibliometric methods and identified the statement and research frontiers over the past two decades. This may help researchers to identify potential hotspots and new directions for future research in this field.
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Affiliation(s)
- Tingting Zhao
- Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, Jiangsu Province, People’s Republic of China
| | - Jing Guo
- Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, Jiangsu Province, People’s Republic of China
| | - Yafang Song
- Nanjing University of Chinese Medicine, Nanjing, Jiangsu Province, People’s Republic of China
| | - Hao Chen
- Nanjing University of Chinese Medicine, Nanjing, Jiangsu Province, People’s Republic of China
| | - Mengzhu Sun
- Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, Jiangsu Province, People’s Republic of China
| | - Lu Chen
- Jiangsu Province Hospital of Chinese Medicine, Nanjing, Jiangsu Province, People’s Republic of China
| | - Hao Geng
- Jiangsu Province Hospital of Chinese Medicine, Nanjing, Jiangsu Province, People’s Republic of China
| | - Lixia Pei
- Jiangsu Province Hospital of Chinese Medicine, Nanjing, Jiangsu Province, People’s Republic of China
| | - Jianhua Sun
- Jiangsu Province Hospital of Chinese Medicine, Nanjing, Jiangsu Province, People’s Republic of China
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16
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Xu W, OuYang S, Chi Z, Wang Z, Zhu D, Chen R, Zhong G, Zhang F, Zhou G, Duan S, Jiao L. Effectiveness and safety of electroacupuncture in treating Parkinson disease: A protocol for systematic review and meta-analyses. Medicine (Baltimore) 2021; 100:e25095. [PMID: 33725902 PMCID: PMC7969292 DOI: 10.1097/md.0000000000025095] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Accepted: 02/18/2021] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Parkinson disease (PD) is an Extrapyramidal Disease mainly characterized by static tremor, myotonia, bradykinesia and postural gait disorder. As China's population ages, the number of people suffering from PD is increasing. Since there are many side effects of western medicine for Parkinson's patients, and the high price of the drugs make it difficult for many patients to adhere to treat. At present, many clinical studies have shown that electroacupuncture is effective in treating PD. Therefore, this systematic review aims to explore the effectiveness and safety of electroacupuncture in the treatment of PD. METHODS Comprehensive search of PubMed, Embase, Medline, Cochrane Database of Systematic Reviews, Chinese Biomedical Literatures Database, China National Knowledge Infrastructure, Chinese Scientific Journal Database, Wang Fang Database from inception to February 2021, the literature selected is not restricted by language. In addition, we will search for unpublished studies and the references that were originally included in the literature manually. There were two reviewers screened the data and cross-checked the information individually, the quality of the literature was assessed by reviewers independently. The outcomes of interest include:the scale of Unifified PD Rating Scales, the Webster scale, the Quality of Life Questionnaire, total effective rate, recurrence rate, adverse events. The laboratory inspection indicators include:the content of lipid peroxidase, Superoxide dismutase activity in plasma and erythrocyte. The relevant randomized controlled trials will be included in this study. And we will evaluate the quality of the selected literature according to the Cochrane Handbook. Meta-analysis will be performed using RevMan 5.4.0 software. The heterogeneity test will be implemented in the included literature, the tests' thresholds will be P < .1 and I2 > 50%. We will use either fixed effects model or random effects model according to the size of heterogeneity. RESULTS The results of this systematic review will provide a comprehensive evidence for the clinical treatment of PD, and we will report this result soon. CONCLUSION This paper will explore whether or not electroacupuncture can be used as a non-drug therapy for PD. ETHICS AND DISSEMINATION Ethical approval is not required for this paper, our plan will be published in the journal. TRIAL REGISTRATION NUMBER INPLASY202120031.
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Affiliation(s)
- Wei Xu
- The Affiliated Hospital of Jiangxi University of Traditional Chinese Medicine, Nanchang, China
| | - Sha OuYang
- Science and Technology college of Jiangxi University of Traditional Chinese Medicine
| | - Zhenhai Chi
- The Affiliated Hospital of Jiangxi University of Traditional Chinese Medicine, Nanchang, China
| | - ZhiQin Wang
- The Affiliated Hospital of Jiangxi University of Traditional Chinese Medicine, Nanchang, China
| | - DaoCheng Zhu
- The Affiliated Hospital of Jiangxi University of Traditional Chinese Medicine, Nanchang, China
| | - RiXin Chen
- The Affiliated Hospital of Jiangxi University of Traditional Chinese Medicine, Nanchang, China
| | - GenPing Zhong
- The Affiliated Hospital of Jiangxi University of Traditional Chinese Medicine, Nanchang, China
| | - FengTing Zhang
- The Affiliated Hospital of Jiangxi University of Traditional Chinese Medicine, Nanchang, China
| | - GuiQin Zhou
- The Affiliated Hospital of Jiangxi University of Traditional Chinese Medicine, Nanchang, China
| | - SiWei Duan
- The Affiliated Hospital of Jiangxi University of Traditional Chinese Medicine, Nanchang, China
| | - Lin Jiao
- The Affiliated Hospital of Jiangxi University of Traditional Chinese Medicine, Nanchang, China
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17
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Agüera-Ortiz L, García-Ramos R, Grandas Pérez FJ, López-Álvarez J, Montes Rodríguez JM, Olazarán Rodríguez FJ, Olivera Pueyo J, Pelegrín Valero C, Porta-Etessam J. Focus on Depression in Parkinson's Disease: A Delphi Consensus of Experts in Psychiatry, Neurology, and Geriatrics. PARKINSON'S DISEASE 2021; 2021:6621991. [PMID: 33628415 PMCID: PMC7884180 DOI: 10.1155/2021/6621991] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 01/07/2021] [Accepted: 01/22/2021] [Indexed: 12/26/2022]
Abstract
Major and minor forms of depression are significant contributors to Parkinson's disease morbidity and caregiver burden, affecting up to 50% of these patients. Nonetheless, symptoms of depression are still underrecognized and undertreated in this context due to scarcity of evidence and, consequently, consistent clinical guideline recommendations. Here, we carried out a prospective, multicentre, 2-round modified Delphi survey with 49 questions about the aetiopathological mechanisms of depression in Parkinson's disease (10), clinical features and connections with motor and nonmotor symptoms (10), diagnostic criteria (5), and therapeutic options (24). Items were assessed by a panel of 37 experts (neurologists, psychiatrists, and a geriatrist), and consensus was achieved in 81.6% of them. Depressive symptoms, enhanced by multiple patient circumstances, were considered Parkinson's disease risk factors but not clinical indicators of motor symptom and disease progression. These patients should be systematically screened for depression while ruling out both anhedonia and apathy symptoms as they are not necessarily linked to it. Clinical scales (mainly the Geriatric Depression Scale GDS-15) can help establishing the diagnosis of depression, the symptoms of which will require treatment regardless of severity. Efficacious and well-tolerated pharmacological options for Parkinson's comorbid depression were selective serotonin reuptake inhibitors (especially sertraline), dual-action serotonin and norepinephrine reuptake inhibitors (venlafaxine, desvenlafaxine, and duloxetine), multimodal (vortioxetine, bupropion, mirtazapine, and tianeptine), and anti-Parkinsonian dopamine agonists (pramipexole, ropinirole, and rotigotine). Tricyclic antidepressants and combining type B monoamine oxidase inhibitors with serotonergic drugs have serious side effects in these patients and therefore should not be prescribed. Electroconvulsive therapy was indicated for severe and drug-refractory cases. Cognitive behavioural therapy was recommended in cases of mild depression. Results presented here are useful diagnostic and patient management guidance for other physicians and important considerations to improve future drug trial design.
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Affiliation(s)
- Luis Agüera-Ortiz
- Servicio de Psiquiatría, Instituto de Investigación i+12, Hospital Universitario 12 de Octubre, Madrid, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
| | - Rocío García-Ramos
- Movement Disorders Unit, Servicio de Neurología, Hospital Clínico San Carlos, Complutense University, Madrid, Spain
| | | | - Jorge López-Álvarez
- Servicio de Psiquiatría, Instituto de Investigación i+12, Hospital Universitario 12 de Octubre, Madrid, Spain
| | | | | | | | | | - Jesús Porta-Etessam
- Service of Neurology, Instituto de Neurociencias, Hospital Clínico San Carlos, San Carlos, IdISSC, Madrid, Spain
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18
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Karimi N, Razian A, Heidari M. The efficacy of magnesium oxide and sodium valproate in prevention of migraine headache: a randomized, controlled, double-blind, crossover study. Acta Neurol Belg 2021; 121:167-173. [PMID: 30798472 DOI: 10.1007/s13760-019-01101-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2018] [Accepted: 02/19/2019] [Indexed: 01/03/2023]
Abstract
Migraine is a disabling disorder that affects the quality of life of patients. Different medications have been used in prevention of migraine headache. In this study, we evaluated the effectiveness of magnesium oxide in comparison with valproate sodium in preventing migraine headache attacks. This is a single-center, randomized, controlled, crossover trial which is double-blind, 24-week, 2-sequence, 2-period, 2-treatment. After patient randomization into two sequences, the intervention group received magnesium oxide 500 mg and the control group received valproate sodium 400 mg two tablets each day (every 12 h) for 8 weeks. The primary efficacy variable was reduction in the number of migraine attacks and number of days with moderate or severe headache and hours with headache (duration) per month in the final of 8 weeks in comparison with baseline. Seventy patients were randomized and seven dropped out, leaving 63 for analysis. In an intention-to-treat analysis, 31 patients were in group 1 (magnesium oxide-valproate) and 32 patients were in group 2 (valproate-magnesium oxide). The mean number of migraine attacks and days per month was 1.72 ± 1.18 and 2.09 ± 1.70, with a mean duration of 15.50 ± 21.80 h in magnesium group and 1.27 ± 1.27 and 2.22 ± 1.96, with a mean duration 13.38 ± 14.10 in valproate group. This study has shown that 500 mg magnesium oxide appears to be effective in migraine prophylaxis similar to valproate sodium without significant adverse effect.
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Affiliation(s)
- Narges Karimi
- School of Medicine, Immunogenetics Research Center, Clinical Research Development Unit of Bou Ali Sina Hospital, Mazandaran University of Medical Sciences, Pasdaran boulevard, Sari, Mazandaran Province, Iran.
| | - Azadeh Razian
- Mazandarn University of Medical Sciences, Sari, Iran
| | - Mohammad Heidari
- Department of Epidemiology and Biostatistics, School Of Medicine, Urmia University of Medical Sciences, Urmia, Iran
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19
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Diener HC, Ashina M, Durand-Zaleski I, Kurth T, Lantéri-Minet M, Lipton RB, Ollendorf DA, Pozo-Rosich P, Tassorelli C, Terwindt G. Health technology assessment for the acute and preventive treatment of migraine: A position statement of the International Headache Society. Cephalalgia 2021; 41:279-293. [PMID: 33472427 PMCID: PMC7961634 DOI: 10.1177/0333102421989247] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The Clinical Trials Subcommittee of the International Headache Society presents the first Health Technology Assessment for the Acute Treatment of Migraine Attacks and Prevention of Migraine. Health technology assessments are systematic evaluations of the properties, effects, and consequences of healthcare technologies; this position statement is designed to inform decision makers about access to and reimbursement for medications and devices for the acute and preventive treatment of migraine. This position statement extends beyond the already available guidelines on randomized controlled trials for migraine to incorporate real-world evidence and a synthetic approach for considering multiple data sources and modelling methods when assessing the value of migraine treatments.
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Affiliation(s)
- Hans Christoph Diener
- Institute for Medical Informatics, Biometry and Epidemiology, University Duisburg-Essen, Essen, Berlin, Germany
| | - Messoud Ashina
- Danish Headache Center, Department of Neurology, Rigshospitalet Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Glostrup, Denmark
| | - Isabelle Durand-Zaleski
- Université de Paris, CRESS, INSERM, INRA, URCEco, AP-HP, Hôpital de l'Hôtel Dieu, Paris, France.,Santé Publique Hôpital Henri Mondor, Créteil, France
| | - Tobias Kurth
- Institute of Public Health, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Michel Lantéri-Minet
- Départment d'Evaluation et Traitement de la Douleur, CHU de Nice, FHU InovPain, Universite Cete Azur, Nice, France
| | | | - Daniel A Ollendorf
- Value Measurement and Global Health Initiatives, Center for the Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies, 1867Tufts Medical Center, Boston, MA, USA
| | - Patricia Pozo-Rosich
- Headache Unit, Neurology Department, Vall d'Hebron University Hospital, Barcelona, Spain.,Headache Research Group, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Cristina Tassorelli
- Headache Science Center, IRCCS Mondino Foundation, Pavia, Italy.,Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Gisela Terwindt
- Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands
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Im HJ, Cho SJ. Pharmacotherapy of migraine prevention based on the assessment of headache. JOURNAL OF THE KOREAN MEDICAL ASSOCIATION 2020. [DOI: 10.5124/jkma.2020.63.10.644] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Migraine as a recurrent, relapsing, and chronic disease is one of the most disabling disorders globally. Most patients are women in their reproductive age and their migraines are classified as episodic migraine. Although less than half of the episodic and most chronic migraineurs require preventive intervention, early discontinuation rates are high, owing to poor tolerability and insufficient awareness about migraine. This article aims to review the recent update of migraine prevention based on the practice guidelines for the prevention of episodic migraine published by the Korea Headache Society and the position statement of the American Headache Society in 2019. The goal of migraine prevention is to reduce migraine attack frequency by at least 50 %, the number of migraine days, and the attack severity to ultimately improve quality of life. The guidelines recommend considering the initiation of preventive medication when recurring migraines significantly interfere with daily life or when acute treatment is contraindicated or inappropriate. Preventive medications should be determined based on various qualified assessments. Pharmacologic treatments are recommended for migraine prophylaxis include antidepressant (amitriptyline), anti-epileptic drugs (topiramate, divalproex sodium), beta-blockers (propranolol, metoprolol), calcium channel blocker (flunarizine), and intramuscular injection of onabotulinumtoxin A. Furthermore subcutaneous or intravenous injection of calcitonin gene-related peptide monoclonal antibodies was recently approved as a new therapy for migraine prevention. Migraine is a chronic debilitating disorder. The initiation of evidence-based preventive management is necessary and management methods should be individually selected to improve quality of life.
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A Customized Next-Generation Sequencing-Based Panel to Identify Novel Genetic Variants in Dementing Disorders: A Pilot Study. Neural Plast 2020. [PMID: 32908482 DOI: 10.1155/2020/8078103.] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Purpose The advancements in the next-generation sequencing (NGS) techniques have allowed for rapid, efficient, and cost-time-effective genetic variant detection. However, in both clinical practice and research setting, sequencing is still often limited to the use of gene panels clinically targeted on the genes underlying the disease of interest. Methods We performed a neurogenetic study through an ad hoc NGS-based custom sequencing gene panel in order to screen 16 genes in 8 patients with different types of degenerative cognitive disorders (Alzheimer's disease, mild cognitive impairment, frontotemporal dementia, and dementia associated with Parkinson's disease). The study protocol was based on previous evidence showing a high sensitivity and specificity of the technique even when the panel is limited to some hotspot exons. Results We found variants of the TREM2 and APP genes in three patients; these have been previously identified as pathogenic or likely pathogenic and, therefore, considered "disease causing." In the remaining subjects, the pathogenicity was evaluated according to the guidelines of the American College of Medical Genetics (ACMG). In one patient, the p.R205W variant in the CHMP2B gene was found to be likely pathogenic of the disease. A variant in the CSF1R and SERPINI1 genes found in two patients was classified as benign, whereas the other two (in the GRN and APP genes) were classified as likely pathogenic according to the ACMG. Conclusions Notwithstanding the preliminary value of this study, some rare genetic variants with a probable disease association were detected. Although future application of NGS-based sensors and further replication of these experimental data are needed, this approach seems to offer promising translational perspectives in the diagnosis and management of a wide range of neurodegenerative disorders.
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Khan U, Stoff L, Yahuaca JD, Bhagavat B, Toledo S, Goldman JG, Simuni T, Rafferty M. Evaluation of an Interdisciplinary Screening Program for People With Parkinson Disease and Movement Disorders. Arch Rehabil Res Clin Transl 2020; 2:100067. [PMID: 33543093 PMCID: PMC7853386 DOI: 10.1016/j.arrct.2020.100067] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To describe the characteristics of people with Parkinson disease and movement disorders (PDMDs) referred by neurologist to a physiatrist-led interdisciplinary rehabilitation screening program. DESIGN Retrospective data analysis of electronic health records (EMRs). SETTING Outpatient PDMD neurology clinic and an interdisciplinary rehabilitation hospital's PDMD screening program. PARTICIPANTS People with PDMDs referred by neurologists to the interdisciplinary rehabilitation screening program from 2009-2017 (n=934), with early referrals from 2009-2015 (n=449) and recently referred from 2015-2017 (n=485), and patients who had new interdisciplinary rehabilitation screening program evaluations from 2015-2017 (n=183). INTERVENTION Participation in the physiatrist-led PDMD screening clinic. MAIN OUTCOME MEASURES Demographics, disease-related features, timed Up and Go, conversational voice volume, recommended therapy services, and number of therapies completed 90 days following interdisciplinary rehabilitation screening program. RESULTS People referred from the neurologists to the interdisciplinary rehabilitation screening program from 2009-2017 were 72±12.9 years old, male (56%), white (65%), and with 1 or more comorbidities (62%). Compared with early referrals from 2009-2015, more recently referred participants from 2015-2017 were younger (P<.001) and earlier in disease duration (P=.036). The interdisciplinary rehabilitation screening program participants from 2015-2017 had mean timed Up and Go time of 15.4±10.1 seconds and a mean conversational voice volume of 68.98±4.7 dB. CONCLUSIONS The interdisciplinary rehabilitation screening program was sustained with increased number of referrals over time, occurring earlier in the disease in more recent years. Key strategies used to sustain the program over time include development of a unique referral order set for the neurologists, implementation of a comprehensive screen tool in the rehabilitation hospital EMR, and centralized communication through social workers at both facilities.
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Affiliation(s)
- Uzma Khan
- Shirley Ryan AbilityLab, Chicago, Illinois
| | | | - J. Diego Yahuaca
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Bavna Bhagavat
- Shirley Ryan AbilityLab, Chicago, Illinois
- Chicago Medical School at Rosalind Franklin University of Medicine and Science, North Chicago, Illinois
| | - Santiago Toledo
- Shirley Ryan AbilityLab, Chicago, Illinois
- Northwestern University Department of Physical Medicine and Rehabilitation, Chicago, Illinois
| | - Jennifer G. Goldman
- Shirley Ryan AbilityLab, Chicago, Illinois
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Northwestern University Department of Physical Medicine and Rehabilitation, Chicago, Illinois
- Northwestern University Department of Neurology, Chicago, Illinois
| | - Tanya Simuni
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Northwestern University Department of Neurology, Chicago, Illinois
| | - Miriam Rafferty
- Shirley Ryan AbilityLab, Chicago, Illinois
- Northwestern University Department of Physical Medicine and Rehabilitation, Chicago, Illinois
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23
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Fan SQ, Jin S, Tang TC, Chen M, Zheng H. Efficacy of acupuncture for migraine prophylaxis: a trial sequential meta-analysis. J Neurol 2020; 268:4128-4137. [PMID: 32839839 DOI: 10.1007/s00415-020-10178-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Revised: 08/14/2020] [Accepted: 08/18/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND Acupuncture is commonly used for migraine prophylaxis; however, evidence of its efficacy was equivocal. AIM We aimed to evaluated the efficacy of acupuncture in migraine prophylaxis and calculated the required information size (RIS) to determine whether further clinical studies are required. METHODS We searched Cochrane library, EMBASE and PubMed from inception to April 23th, 2020. Randomized trials that compared acupuncture with conventional drug therapy or sham acupuncture were included. The primary outcome was migraine episodes. Secondary outcomes were responder rate and adverse event. RESULTS Twenty studies (n = 3380) met the inclusion criteria. When it comes to migraine episodes, Acupuncture was superior over sham acupuncture [SMD = - 0.29, 95% CI (- 0.47 to - 0.11), P = 0.002] after treatment, while the difference between acupuncture and prophylactic drugs was not significant [SMD = - 0.21, 95% CI (- 0.42 to 0.00), P = 0.06].Both TSA graphs indicated that more RCTs are needed. As for responder rate, the results after treatment showed that acupuncture was statistically significantly better than sham acupuncture [RR 1.30, 95% CI (1.09-1.55), P = 0.003] as well as conventional drugs [RR 1.24, 95% CI (1.04-1.48), P = 0.01]. Both of their cumulative Z-curves intersected with the trial sequential monitoring boundaries favoring acupuncture. Compared to prophylactic medication, acupuncture can cause less adverse events [RR 0.34, 95% CI (0.14-0.81), P = 0.01]. CONCLUSION Acupuncture can reduce migraine episodes compared to sham one and can be an alternative and safe prophylactic treatment for conventional drugs therapy, but it should be further verified through more RCTs. Available studies suggested acupuncture was superior to sham acupuncture and conventional drugs in terms of responder rate as verified by TSA.
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Affiliation(s)
- Shi-Qi Fan
- The Third Hospital/Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, No. 1166 Liutai Avenue, Wenjiang District, Chengdu, Sichuan, China
| | - Song Jin
- Clinical Medicine College, Hospital of Chengdu University of Traditional Chinese Medicine, 39 Shi-er-qiao Road, Chengdu, Sichuan, China
| | - Tai-Chun Tang
- Clinical Medicine College, Hospital of Chengdu University of Traditional Chinese Medicine, 39 Shi-er-qiao Road, Chengdu, Sichuan, China
| | - Min Chen
- Clinical Medicine College, Hospital of Chengdu University of Traditional Chinese Medicine, 39 Shi-er-qiao Road, Chengdu, Sichuan, China.
| | - Hui Zheng
- The Third Hospital/Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, No. 1166 Liutai Avenue, Wenjiang District, Chengdu, Sichuan, China.
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24
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Abraham DS, Pham Nguyen TP, Hennessy S, Weintraub D, Gray SL, Xie D, Willis AW. Frequency of and risk factors for potentially inappropriate medication use in Parkinson's disease. Age Ageing 2020; 49:786-792. [PMID: 32255485 DOI: 10.1093/ageing/afaa033] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Revised: 12/16/2019] [Accepted: 01/01/2020] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND impairments in neurotransmitter pathways put Parkinson's disease (PD) patients at risk for drug-disease interactions and adverse medication events. OBJECTIVE to determine the prevalence and risk factors for potentially inappropriate medication (PIM) prescriptions, as defined by the 2015 Beers List, in PD. METHODS cross-sectional analysis was conducted on 2014 Medicare beneficiaries with PD who had parts A, B and D coverage. The prevalence of PIM prescriptions for older adults was determined overall, and specifically for medications that can exacerbate motor symptoms or cognitive impairment in PD. Logistic regression models were constructed to determine the association between age, sex, race, geography and poverty with PIM prescriptions. RESULTS the final sample included 458,086 beneficiaries. In 2014, 35.8% of beneficiaries with PD filled a prescription for at least one PIM for older adults. In total, 8.7% of beneficiaries received a PIM that could exacerbate motor symptoms and 29.0% received a PIM that could worsen cognitive impairment. After adjustment, in all models, beneficiaries who were younger, female, white, urban-dwelling and eligible for Medicaid benefits were more likely to receive a PIM. CONCLUSION PIM prescriptions are not uncommon in PD, particularly for medications that can exacerbate cognitive impairment. Future research will examine underlying drivers of sex and other disparities in PIM prescribing. Additional studies are needed to understand the impact of PIMs on disease symptoms, healthcare utilisation and patient outcomes.
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Affiliation(s)
- Danielle S Abraham
- Department of Neurology, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
- Department of Neurology Translational Center for Excellence for Neuroepidemiology and Neurological Outcomes Research, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
- Department of Biostatics, Epidemiology, and Informatics, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
| | - Thanh Phuong Pham Nguyen
- Department of Neurology, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
- Department of Neurology Translational Center for Excellence for Neuroepidemiology and Neurological Outcomes Research, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
- Department of Biostatics, Epidemiology, and Informatics, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
| | - Sean Hennessy
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
- Department of Biostatics, Epidemiology, and Informatics, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
| | - Daniel Weintraub
- Department of Neurology, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
- Parkinson’s Disease Research, Education and Clinical Center, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, USA
- Department of Psychiatry, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
| | - Shelly L Gray
- Department of Pharmacy, University of Washington School of Pharmacy, Seattle, WA, USA
| | - Dawei Xie
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
- Department of Biostatics, Epidemiology, and Informatics, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
| | - Allison W Willis
- Department of Neurology, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
- Department of Neurology Translational Center for Excellence for Neuroepidemiology and Neurological Outcomes Research, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
- Department of Biostatics, Epidemiology, and Informatics, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
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Grimes D, Fitzpatrick M, Gordon J, Miyasaki J, Fon EA, Schlossmacher M, Suchowersky O, Rajput A, Lafontaine AL, Mestre T, Appel-Cresswell S, Kalia SK, Schoffer K, Zurowski M, Postuma RB, Udow S, Fox S, Barbeau P, Hutton B. Canadian guideline for Parkinson disease. CMAJ 2020; 191:E989-E1004. [PMID: 31501181 DOI: 10.1503/cmaj.181504] [Citation(s) in RCA: 79] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Affiliation(s)
- David Grimes
- The Ottawa Hospital, University of Ottawa Brain and Mind Research Institute (Grimes, Fitzpatrick, Schlossmacher, Mestre), Ottawa, Ont.; Parkinson Canada (Gordon), Toronto, Ont.; University of Alberta Hospital (Miyasaki), Edmonton, Alta.; Montreal Neurological Institute (Fon), McGill University, Montréal, Que.; University of Alberta (Suchowersky), Edmonton, Alta.; Royal University Hospital (Rajput), University of Saskatchewan, Saskatoon, Sask.; Montreal General Hospital (Lafontaine, Postuma), McGill University, Montréal, Que.; Pacific Parkinson's Research Centre, Djavad Mowafaghian Centre for Brain Health (Appel-Cresswell), University of British Columbia, Vancouver, BC; Toronto Western Hospital (Kalia, Zurowski, Fox), University of Toronto, Toronto, Ont.; Dalhousie University (Schoffer), Halifax, NS; University of Manitoba Rady Faculty of Health Sciences (Udow), Winnipeg, Man.; Knowledge Synthesis Group (Barbeau, Hutton), Ottawa Hospital Research Institute, Ottawa, Ont.
| | - Megan Fitzpatrick
- The Ottawa Hospital, University of Ottawa Brain and Mind Research Institute (Grimes, Fitzpatrick, Schlossmacher, Mestre), Ottawa, Ont.; Parkinson Canada (Gordon), Toronto, Ont.; University of Alberta Hospital (Miyasaki), Edmonton, Alta.; Montreal Neurological Institute (Fon), McGill University, Montréal, Que.; University of Alberta (Suchowersky), Edmonton, Alta.; Royal University Hospital (Rajput), University of Saskatchewan, Saskatoon, Sask.; Montreal General Hospital (Lafontaine, Postuma), McGill University, Montréal, Que.; Pacific Parkinson's Research Centre, Djavad Mowafaghian Centre for Brain Health (Appel-Cresswell), University of British Columbia, Vancouver, BC; Toronto Western Hospital (Kalia, Zurowski, Fox), University of Toronto, Toronto, Ont.; Dalhousie University (Schoffer), Halifax, NS; University of Manitoba Rady Faculty of Health Sciences (Udow), Winnipeg, Man.; Knowledge Synthesis Group (Barbeau, Hutton), Ottawa Hospital Research Institute, Ottawa, Ont
| | - Joyce Gordon
- The Ottawa Hospital, University of Ottawa Brain and Mind Research Institute (Grimes, Fitzpatrick, Schlossmacher, Mestre), Ottawa, Ont.; Parkinson Canada (Gordon), Toronto, Ont.; University of Alberta Hospital (Miyasaki), Edmonton, Alta.; Montreal Neurological Institute (Fon), McGill University, Montréal, Que.; University of Alberta (Suchowersky), Edmonton, Alta.; Royal University Hospital (Rajput), University of Saskatchewan, Saskatoon, Sask.; Montreal General Hospital (Lafontaine, Postuma), McGill University, Montréal, Que.; Pacific Parkinson's Research Centre, Djavad Mowafaghian Centre for Brain Health (Appel-Cresswell), University of British Columbia, Vancouver, BC; Toronto Western Hospital (Kalia, Zurowski, Fox), University of Toronto, Toronto, Ont.; Dalhousie University (Schoffer), Halifax, NS; University of Manitoba Rady Faculty of Health Sciences (Udow), Winnipeg, Man.; Knowledge Synthesis Group (Barbeau, Hutton), Ottawa Hospital Research Institute, Ottawa, Ont
| | - Janis Miyasaki
- The Ottawa Hospital, University of Ottawa Brain and Mind Research Institute (Grimes, Fitzpatrick, Schlossmacher, Mestre), Ottawa, Ont.; Parkinson Canada (Gordon), Toronto, Ont.; University of Alberta Hospital (Miyasaki), Edmonton, Alta.; Montreal Neurological Institute (Fon), McGill University, Montréal, Que.; University of Alberta (Suchowersky), Edmonton, Alta.; Royal University Hospital (Rajput), University of Saskatchewan, Saskatoon, Sask.; Montreal General Hospital (Lafontaine, Postuma), McGill University, Montréal, Que.; Pacific Parkinson's Research Centre, Djavad Mowafaghian Centre for Brain Health (Appel-Cresswell), University of British Columbia, Vancouver, BC; Toronto Western Hospital (Kalia, Zurowski, Fox), University of Toronto, Toronto, Ont.; Dalhousie University (Schoffer), Halifax, NS; University of Manitoba Rady Faculty of Health Sciences (Udow), Winnipeg, Man.; Knowledge Synthesis Group (Barbeau, Hutton), Ottawa Hospital Research Institute, Ottawa, Ont
| | - Edward A Fon
- The Ottawa Hospital, University of Ottawa Brain and Mind Research Institute (Grimes, Fitzpatrick, Schlossmacher, Mestre), Ottawa, Ont.; Parkinson Canada (Gordon), Toronto, Ont.; University of Alberta Hospital (Miyasaki), Edmonton, Alta.; Montreal Neurological Institute (Fon), McGill University, Montréal, Que.; University of Alberta (Suchowersky), Edmonton, Alta.; Royal University Hospital (Rajput), University of Saskatchewan, Saskatoon, Sask.; Montreal General Hospital (Lafontaine, Postuma), McGill University, Montréal, Que.; Pacific Parkinson's Research Centre, Djavad Mowafaghian Centre for Brain Health (Appel-Cresswell), University of British Columbia, Vancouver, BC; Toronto Western Hospital (Kalia, Zurowski, Fox), University of Toronto, Toronto, Ont.; Dalhousie University (Schoffer), Halifax, NS; University of Manitoba Rady Faculty of Health Sciences (Udow), Winnipeg, Man.; Knowledge Synthesis Group (Barbeau, Hutton), Ottawa Hospital Research Institute, Ottawa, Ont
| | - Michael Schlossmacher
- The Ottawa Hospital, University of Ottawa Brain and Mind Research Institute (Grimes, Fitzpatrick, Schlossmacher, Mestre), Ottawa, Ont.; Parkinson Canada (Gordon), Toronto, Ont.; University of Alberta Hospital (Miyasaki), Edmonton, Alta.; Montreal Neurological Institute (Fon), McGill University, Montréal, Que.; University of Alberta (Suchowersky), Edmonton, Alta.; Royal University Hospital (Rajput), University of Saskatchewan, Saskatoon, Sask.; Montreal General Hospital (Lafontaine, Postuma), McGill University, Montréal, Que.; Pacific Parkinson's Research Centre, Djavad Mowafaghian Centre for Brain Health (Appel-Cresswell), University of British Columbia, Vancouver, BC; Toronto Western Hospital (Kalia, Zurowski, Fox), University of Toronto, Toronto, Ont.; Dalhousie University (Schoffer), Halifax, NS; University of Manitoba Rady Faculty of Health Sciences (Udow), Winnipeg, Man.; Knowledge Synthesis Group (Barbeau, Hutton), Ottawa Hospital Research Institute, Ottawa, Ont
| | - Oksana Suchowersky
- The Ottawa Hospital, University of Ottawa Brain and Mind Research Institute (Grimes, Fitzpatrick, Schlossmacher, Mestre), Ottawa, Ont.; Parkinson Canada (Gordon), Toronto, Ont.; University of Alberta Hospital (Miyasaki), Edmonton, Alta.; Montreal Neurological Institute (Fon), McGill University, Montréal, Que.; University of Alberta (Suchowersky), Edmonton, Alta.; Royal University Hospital (Rajput), University of Saskatchewan, Saskatoon, Sask.; Montreal General Hospital (Lafontaine, Postuma), McGill University, Montréal, Que.; Pacific Parkinson's Research Centre, Djavad Mowafaghian Centre for Brain Health (Appel-Cresswell), University of British Columbia, Vancouver, BC; Toronto Western Hospital (Kalia, Zurowski, Fox), University of Toronto, Toronto, Ont.; Dalhousie University (Schoffer), Halifax, NS; University of Manitoba Rady Faculty of Health Sciences (Udow), Winnipeg, Man.; Knowledge Synthesis Group (Barbeau, Hutton), Ottawa Hospital Research Institute, Ottawa, Ont
| | - Alexander Rajput
- The Ottawa Hospital, University of Ottawa Brain and Mind Research Institute (Grimes, Fitzpatrick, Schlossmacher, Mestre), Ottawa, Ont.; Parkinson Canada (Gordon), Toronto, Ont.; University of Alberta Hospital (Miyasaki), Edmonton, Alta.; Montreal Neurological Institute (Fon), McGill University, Montréal, Que.; University of Alberta (Suchowersky), Edmonton, Alta.; Royal University Hospital (Rajput), University of Saskatchewan, Saskatoon, Sask.; Montreal General Hospital (Lafontaine, Postuma), McGill University, Montréal, Que.; Pacific Parkinson's Research Centre, Djavad Mowafaghian Centre for Brain Health (Appel-Cresswell), University of British Columbia, Vancouver, BC; Toronto Western Hospital (Kalia, Zurowski, Fox), University of Toronto, Toronto, Ont.; Dalhousie University (Schoffer), Halifax, NS; University of Manitoba Rady Faculty of Health Sciences (Udow), Winnipeg, Man.; Knowledge Synthesis Group (Barbeau, Hutton), Ottawa Hospital Research Institute, Ottawa, Ont
| | - Anne Louise Lafontaine
- The Ottawa Hospital, University of Ottawa Brain and Mind Research Institute (Grimes, Fitzpatrick, Schlossmacher, Mestre), Ottawa, Ont.; Parkinson Canada (Gordon), Toronto, Ont.; University of Alberta Hospital (Miyasaki), Edmonton, Alta.; Montreal Neurological Institute (Fon), McGill University, Montréal, Que.; University of Alberta (Suchowersky), Edmonton, Alta.; Royal University Hospital (Rajput), University of Saskatchewan, Saskatoon, Sask.; Montreal General Hospital (Lafontaine, Postuma), McGill University, Montréal, Que.; Pacific Parkinson's Research Centre, Djavad Mowafaghian Centre for Brain Health (Appel-Cresswell), University of British Columbia, Vancouver, BC; Toronto Western Hospital (Kalia, Zurowski, Fox), University of Toronto, Toronto, Ont.; Dalhousie University (Schoffer), Halifax, NS; University of Manitoba Rady Faculty of Health Sciences (Udow), Winnipeg, Man.; Knowledge Synthesis Group (Barbeau, Hutton), Ottawa Hospital Research Institute, Ottawa, Ont
| | - Tiago Mestre
- The Ottawa Hospital, University of Ottawa Brain and Mind Research Institute (Grimes, Fitzpatrick, Schlossmacher, Mestre), Ottawa, Ont.; Parkinson Canada (Gordon), Toronto, Ont.; University of Alberta Hospital (Miyasaki), Edmonton, Alta.; Montreal Neurological Institute (Fon), McGill University, Montréal, Que.; University of Alberta (Suchowersky), Edmonton, Alta.; Royal University Hospital (Rajput), University of Saskatchewan, Saskatoon, Sask.; Montreal General Hospital (Lafontaine, Postuma), McGill University, Montréal, Que.; Pacific Parkinson's Research Centre, Djavad Mowafaghian Centre for Brain Health (Appel-Cresswell), University of British Columbia, Vancouver, BC; Toronto Western Hospital (Kalia, Zurowski, Fox), University of Toronto, Toronto, Ont.; Dalhousie University (Schoffer), Halifax, NS; University of Manitoba Rady Faculty of Health Sciences (Udow), Winnipeg, Man.; Knowledge Synthesis Group (Barbeau, Hutton), Ottawa Hospital Research Institute, Ottawa, Ont
| | - Silke Appel-Cresswell
- The Ottawa Hospital, University of Ottawa Brain and Mind Research Institute (Grimes, Fitzpatrick, Schlossmacher, Mestre), Ottawa, Ont.; Parkinson Canada (Gordon), Toronto, Ont.; University of Alberta Hospital (Miyasaki), Edmonton, Alta.; Montreal Neurological Institute (Fon), McGill University, Montréal, Que.; University of Alberta (Suchowersky), Edmonton, Alta.; Royal University Hospital (Rajput), University of Saskatchewan, Saskatoon, Sask.; Montreal General Hospital (Lafontaine, Postuma), McGill University, Montréal, Que.; Pacific Parkinson's Research Centre, Djavad Mowafaghian Centre for Brain Health (Appel-Cresswell), University of British Columbia, Vancouver, BC; Toronto Western Hospital (Kalia, Zurowski, Fox), University of Toronto, Toronto, Ont.; Dalhousie University (Schoffer), Halifax, NS; University of Manitoba Rady Faculty of Health Sciences (Udow), Winnipeg, Man.; Knowledge Synthesis Group (Barbeau, Hutton), Ottawa Hospital Research Institute, Ottawa, Ont
| | - Suneil K Kalia
- The Ottawa Hospital, University of Ottawa Brain and Mind Research Institute (Grimes, Fitzpatrick, Schlossmacher, Mestre), Ottawa, Ont.; Parkinson Canada (Gordon), Toronto, Ont.; University of Alberta Hospital (Miyasaki), Edmonton, Alta.; Montreal Neurological Institute (Fon), McGill University, Montréal, Que.; University of Alberta (Suchowersky), Edmonton, Alta.; Royal University Hospital (Rajput), University of Saskatchewan, Saskatoon, Sask.; Montreal General Hospital (Lafontaine, Postuma), McGill University, Montréal, Que.; Pacific Parkinson's Research Centre, Djavad Mowafaghian Centre for Brain Health (Appel-Cresswell), University of British Columbia, Vancouver, BC; Toronto Western Hospital (Kalia, Zurowski, Fox), University of Toronto, Toronto, Ont.; Dalhousie University (Schoffer), Halifax, NS; University of Manitoba Rady Faculty of Health Sciences (Udow), Winnipeg, Man.; Knowledge Synthesis Group (Barbeau, Hutton), Ottawa Hospital Research Institute, Ottawa, Ont
| | - Kerrie Schoffer
- The Ottawa Hospital, University of Ottawa Brain and Mind Research Institute (Grimes, Fitzpatrick, Schlossmacher, Mestre), Ottawa, Ont.; Parkinson Canada (Gordon), Toronto, Ont.; University of Alberta Hospital (Miyasaki), Edmonton, Alta.; Montreal Neurological Institute (Fon), McGill University, Montréal, Que.; University of Alberta (Suchowersky), Edmonton, Alta.; Royal University Hospital (Rajput), University of Saskatchewan, Saskatoon, Sask.; Montreal General Hospital (Lafontaine, Postuma), McGill University, Montréal, Que.; Pacific Parkinson's Research Centre, Djavad Mowafaghian Centre for Brain Health (Appel-Cresswell), University of British Columbia, Vancouver, BC; Toronto Western Hospital (Kalia, Zurowski, Fox), University of Toronto, Toronto, Ont.; Dalhousie University (Schoffer), Halifax, NS; University of Manitoba Rady Faculty of Health Sciences (Udow), Winnipeg, Man.; Knowledge Synthesis Group (Barbeau, Hutton), Ottawa Hospital Research Institute, Ottawa, Ont
| | - Mateusz Zurowski
- The Ottawa Hospital, University of Ottawa Brain and Mind Research Institute (Grimes, Fitzpatrick, Schlossmacher, Mestre), Ottawa, Ont.; Parkinson Canada (Gordon), Toronto, Ont.; University of Alberta Hospital (Miyasaki), Edmonton, Alta.; Montreal Neurological Institute (Fon), McGill University, Montréal, Que.; University of Alberta (Suchowersky), Edmonton, Alta.; Royal University Hospital (Rajput), University of Saskatchewan, Saskatoon, Sask.; Montreal General Hospital (Lafontaine, Postuma), McGill University, Montréal, Que.; Pacific Parkinson's Research Centre, Djavad Mowafaghian Centre for Brain Health (Appel-Cresswell), University of British Columbia, Vancouver, BC; Toronto Western Hospital (Kalia, Zurowski, Fox), University of Toronto, Toronto, Ont.; Dalhousie University (Schoffer), Halifax, NS; University of Manitoba Rady Faculty of Health Sciences (Udow), Winnipeg, Man.; Knowledge Synthesis Group (Barbeau, Hutton), Ottawa Hospital Research Institute, Ottawa, Ont
| | - Ronald B Postuma
- The Ottawa Hospital, University of Ottawa Brain and Mind Research Institute (Grimes, Fitzpatrick, Schlossmacher, Mestre), Ottawa, Ont.; Parkinson Canada (Gordon), Toronto, Ont.; University of Alberta Hospital (Miyasaki), Edmonton, Alta.; Montreal Neurological Institute (Fon), McGill University, Montréal, Que.; University of Alberta (Suchowersky), Edmonton, Alta.; Royal University Hospital (Rajput), University of Saskatchewan, Saskatoon, Sask.; Montreal General Hospital (Lafontaine, Postuma), McGill University, Montréal, Que.; Pacific Parkinson's Research Centre, Djavad Mowafaghian Centre for Brain Health (Appel-Cresswell), University of British Columbia, Vancouver, BC; Toronto Western Hospital (Kalia, Zurowski, Fox), University of Toronto, Toronto, Ont.; Dalhousie University (Schoffer), Halifax, NS; University of Manitoba Rady Faculty of Health Sciences (Udow), Winnipeg, Man.; Knowledge Synthesis Group (Barbeau, Hutton), Ottawa Hospital Research Institute, Ottawa, Ont
| | - Sean Udow
- The Ottawa Hospital, University of Ottawa Brain and Mind Research Institute (Grimes, Fitzpatrick, Schlossmacher, Mestre), Ottawa, Ont.; Parkinson Canada (Gordon), Toronto, Ont.; University of Alberta Hospital (Miyasaki), Edmonton, Alta.; Montreal Neurological Institute (Fon), McGill University, Montréal, Que.; University of Alberta (Suchowersky), Edmonton, Alta.; Royal University Hospital (Rajput), University of Saskatchewan, Saskatoon, Sask.; Montreal General Hospital (Lafontaine, Postuma), McGill University, Montréal, Que.; Pacific Parkinson's Research Centre, Djavad Mowafaghian Centre for Brain Health (Appel-Cresswell), University of British Columbia, Vancouver, BC; Toronto Western Hospital (Kalia, Zurowski, Fox), University of Toronto, Toronto, Ont.; Dalhousie University (Schoffer), Halifax, NS; University of Manitoba Rady Faculty of Health Sciences (Udow), Winnipeg, Man.; Knowledge Synthesis Group (Barbeau, Hutton), Ottawa Hospital Research Institute, Ottawa, Ont
| | - Susan Fox
- The Ottawa Hospital, University of Ottawa Brain and Mind Research Institute (Grimes, Fitzpatrick, Schlossmacher, Mestre), Ottawa, Ont.; Parkinson Canada (Gordon), Toronto, Ont.; University of Alberta Hospital (Miyasaki), Edmonton, Alta.; Montreal Neurological Institute (Fon), McGill University, Montréal, Que.; University of Alberta (Suchowersky), Edmonton, Alta.; Royal University Hospital (Rajput), University of Saskatchewan, Saskatoon, Sask.; Montreal General Hospital (Lafontaine, Postuma), McGill University, Montréal, Que.; Pacific Parkinson's Research Centre, Djavad Mowafaghian Centre for Brain Health (Appel-Cresswell), University of British Columbia, Vancouver, BC; Toronto Western Hospital (Kalia, Zurowski, Fox), University of Toronto, Toronto, Ont.; Dalhousie University (Schoffer), Halifax, NS; University of Manitoba Rady Faculty of Health Sciences (Udow), Winnipeg, Man.; Knowledge Synthesis Group (Barbeau, Hutton), Ottawa Hospital Research Institute, Ottawa, Ont
| | - Pauline Barbeau
- The Ottawa Hospital, University of Ottawa Brain and Mind Research Institute (Grimes, Fitzpatrick, Schlossmacher, Mestre), Ottawa, Ont.; Parkinson Canada (Gordon), Toronto, Ont.; University of Alberta Hospital (Miyasaki), Edmonton, Alta.; Montreal Neurological Institute (Fon), McGill University, Montréal, Que.; University of Alberta (Suchowersky), Edmonton, Alta.; Royal University Hospital (Rajput), University of Saskatchewan, Saskatoon, Sask.; Montreal General Hospital (Lafontaine, Postuma), McGill University, Montréal, Que.; Pacific Parkinson's Research Centre, Djavad Mowafaghian Centre for Brain Health (Appel-Cresswell), University of British Columbia, Vancouver, BC; Toronto Western Hospital (Kalia, Zurowski, Fox), University of Toronto, Toronto, Ont.; Dalhousie University (Schoffer), Halifax, NS; University of Manitoba Rady Faculty of Health Sciences (Udow), Winnipeg, Man.; Knowledge Synthesis Group (Barbeau, Hutton), Ottawa Hospital Research Institute, Ottawa, Ont
| | - Brian Hutton
- The Ottawa Hospital, University of Ottawa Brain and Mind Research Institute (Grimes, Fitzpatrick, Schlossmacher, Mestre), Ottawa, Ont.; Parkinson Canada (Gordon), Toronto, Ont.; University of Alberta Hospital (Miyasaki), Edmonton, Alta.; Montreal Neurological Institute (Fon), McGill University, Montréal, Que.; University of Alberta (Suchowersky), Edmonton, Alta.; Royal University Hospital (Rajput), University of Saskatchewan, Saskatoon, Sask.; Montreal General Hospital (Lafontaine, Postuma), McGill University, Montréal, Que.; Pacific Parkinson's Research Centre, Djavad Mowafaghian Centre for Brain Health (Appel-Cresswell), University of British Columbia, Vancouver, BC; Toronto Western Hospital (Kalia, Zurowski, Fox), University of Toronto, Toronto, Ont.; Dalhousie University (Schoffer), Halifax, NS; University of Manitoba Rady Faculty of Health Sciences (Udow), Winnipeg, Man.; Knowledge Synthesis Group (Barbeau, Hutton), Ottawa Hospital Research Institute, Ottawa, Ont
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Luedtke K, Starke W, Korn KV, Szikszay TM, Schwarz A, May A. Neck treatment compared to aerobic exercise in migraine: A preference-based clinical trial. CEPHALALGIA REPORTS 2020. [DOI: 10.1177/2515816320930681] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objectives: The main objective of this study was to compare the effectiveness of aerobic exercise with physiotherapy. A second objective was to evaluate whether patients with pain referred to the head during manual palpation will benefit more from physiotherapy than patients with local or no pain. Methods: A total of 103 patients with migraine received physiotherapy ( n = 79) or supervised aerobic exercise ( n = 24) according to their preference as an add-on treatment. Both groups had the same contact time with a specialized physiotherapist. The primary outcome measure was headache frequency during the 4 weeks after the intervention. Eighty-seven patients were analyzed at the primary end point ( n = 69 in the physiotherapy group; n = 18 in the aerobic exercise group). A follow-up assessment was conducted 3 months after the final intervention. Results: During the initial assessment of the upper cervical spine, 17 patients reported no pain, 45 local pain, and 25 referred pain to the head. Patients in the physiotherapy group had a mean reduction of 1.8 days (standard deviation (SD) 6.07), while patients in the aerobic exercise group had a mean reduction of 1.2 days (SD 4.27) at the primary end point. This difference was not statistically significant ( p = 0.8). The largest improvement was noted in the group that showed referred pain to the head and received physiotherapy (2.13 days (SD 7.82)). Only patients in the physiotherapy group reported a subjectively perceived general improvement. Conclusions: Patients had a strong preference for physiotherapy. Both groups showed small reductions in headache frequency. Effects were superior after physiotherapy but not statistically significant. Patients with pain referred to the head responded best to a physiotherapy intervention.
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Affiliation(s)
- Kerstin Luedtke
- Department of Systems Neuroscience, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Department of Health Sciences, Academic Physiotherapy, Pain and Exercise Research Luebeck (P.E.R.L), University of Luebeck, Luebeck, Germany
| | - Wiebke Starke
- Department of Systems Neuroscience, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | - Tibor Maximillian Szikszay
- Department of Health Sciences, Academic Physiotherapy, Pain and Exercise Research Luebeck (P.E.R.L), University of Luebeck, Luebeck, Germany
| | - Annika Schwarz
- Department of Systems Neuroscience, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Arne May
- Department of Systems Neuroscience, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Kim DY, Oh HM, Bok SK, Chang WH, Choi Y, Chun MH, Han SJ, Han TR, Jee S, Jung SH, Jung HY, Jung TD, Kim MW, Kim EJ, Kim HS, Kim YH, Kim Y, Kim DY, Kim DY, Kim DK, Ko SH, Ko MH, Lee JK, Lee J, Lee SJ, Lee SG, Lim SH, Oh BM, Paik NJ, Park KD, Park SW, Park GY, Park JH, Park YG, Pyun SB, Ryu B, Seo HG, Shin YI, Sohn MK, Yang SN, Don Yoo S, Yoo WK. KSNR Clinical Consensus Statements: Rehabilitation of Patients with Parkinson's Disease. BRAIN & NEUROREHABILITATION 2020; 13:e17. [PMID: 36744191 PMCID: PMC9879460 DOI: 10.12786/bn.2020.13.e17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 04/09/2020] [Accepted: 05/18/2020] [Indexed: 11/08/2022] Open
Abstract
Clinical consensus statements (CCSs) aim to improve care for patients with Parkinson's disease (PD) and reduce the variability of rehabilitation methods in clinical practice. A literature search was conducted to find available evidence on the rehabilitation of patients with PD and to determine the scope of CCSs. The selection of PD rehabilitation domains and key questions was done using the modified Delphi method in 43 expert panels. These panels achieved a consensus on 11 key questions regarding rehabilitation assessment and goal setting, gait and balance, activities of daily living, and swallowing and communication disorders. After the completion of an agreement procedure, 11 key consensus statements were developed by the consensus panel. These statements addressed the needs of rehabilitation as a continuum in patients with PD. They included the appropriate rehabilitation initiation time, assessment items, rehabilitation contents, and complication management. This agreement can be used by physiatrists, rehabilitation therapists, and other practitioners who take care of patients with PD. The consensus panel also highlighted areas where a consensus could not be reached. The development of more focused CCS or clinical practice guidelines that target specific rehabilitation approaches is considered the next needed step.
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Affiliation(s)
| | - Doo Young Kim
- Department of Rehabilitation Medicine, International St. Mary's Hospital, Catholic Kwandong University, Incheon, Korea
| | - Hyun Mi Oh
- Department of Rehabilitation Medicine, National Traffic Injury Rehabilitation Hospital, Yangpyeong, Korea
| | - Soo-Kyung Bok
- Department of Rehabilitation Medicine, College of Medicine, Chungnam National University, Daejeon, Korea
| | - Won Hyuk Chang
- Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yongmin Choi
- Department of Rehabilitation Medicine, School of Medicine, Keimyung University Dongsan Hospital, Daegu, Korea
| | - Min Ho Chun
- Department of Rehabilitation Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Soo Jeong Han
- Department of Rehabilitation, Ewha Womans University, College of Medicine, Seoul, Korea
| | - Tai-Ryoon Han
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Sungju Jee
- Department of Rehabilitation Medicine, College of Medicine, Chungnam National University, Daejeon, Korea
| | - Se Hee Jung
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea
| | - Han Young Jung
- Department of Rehabilitation Medicine, Inha University School of Medicine, Incheon, Korea
| | - Tae-Du Jung
- Department of Rehabilitation Medicine, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Min Wook Kim
- Department of Rehabilitation Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, Korea
| | - Eun Joo Kim
- Department of Rehabilitation Medicine, National Rehabilitation Center, Seoul, Korea
| | - Hyoung Seop Kim
- Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yun-Hee Kim
- Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yongwook Kim
- Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Deog Young Kim
- Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Dae Yul Kim
- Department of Rehabilitation Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Don-Kyu Kim
- Department of Physical Medicine & Rehabilitation, College of Medicine, Chung-Ang University, Seoul, Korea
| | - Sung-Hwa Ko
- Department of Rehabilitation Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Myoung-Hwan Ko
- Department of Physical Medicine & Rehabilitation, Jeonbuk National University Medical School, Jeonju, Korea
| | - Ju Kang Lee
- Department of Rehabilitation Medicine, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
| | - Jongmin Lee
- Department of Rehabilitation Medicine, Konkuk University School of Medicine, Seoul, Korea
| | - Seong Jae Lee
- Department of Rehabilitation Medicine, College of Medicine, Dankook University, Cheonan, Korea
| | - Sam-Gyu Lee
- Department of Physical & Rehabilitation Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Seong Hoon Lim
- Department of Rehabilitation Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea
| | - Byung-Mo Oh
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea
| | - Nam-Jong Paik
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Ki Deok Park
- Department of Rehabilitation Medicine, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
| | - Si-Woon Park
- Department of Rehabilitation Medicine, International St. Mary's Hospital, Catholic Kwandong University, Incheon, Korea
| | - Geun-Young Park
- Department of Rehabilitation Medicine, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Bucheon, Korea
| | - Joo Hyun Park
- Department of Rehabilitation Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Yoon Ghil Park
- Department of Rehabilitation Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Sung-Bom Pyun
- Department of Physical Medicine and Rehabilitation, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Byungju Ryu
- Department of Physical Medicine and Rehabilitation, Sahmyook Medical Center, Seoul, Korea
| | - Han Gil Seo
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea
| | - Yong-Il Shin
- Department of Rehabilitation Medicine, Pusan National University School of Medicine, Busan, Korea
| | - Min Kyun Sohn
- Department of Rehabilitation Medicine, College of Medicine, Chungnam National University, Daejeon, Korea
| | - Seung Nam Yang
- Department of Physical Medicine and Rehabilitation, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Seung Don Yoo
- Department of Rehabilitation Medicine, Kyung Hee University, College of Medicine, Seoul, Korea
| | - Woo-Kyoung Yoo
- Department of Physical Medicine & Rehabilitation, Hallym University College of Medicine, Chuncheon, Korea
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Olmstead AJ, Lee J, Viswanathan N. The Role of the Speaker, the Listener, and Their Joint Contributions During Communicative Interactions: A Tripartite View of Intelligibility in Individuals With Dysarthria. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2020; 63:1106-1114. [PMID: 32302251 DOI: 10.1044/2020_jslhr-19-00233] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Purpose We present a tripartite view of intelligibility in which the contributions of both the speaker and listener, as well as their joint effort during interaction, are considered. While considerable research has examined communicative interactions in situ, there is a critical gap in current knowledge on how speech intelligibility unfolds during such interactions. Here, we argue that research examining speech intelligibility in communicative interactions may provide important groundwork for advancement in clinical interventions for individuals with dysarthria. Method First, we describe the view and argue for its consideration as a powerful way of thinking about speech intelligibility. We then briefly situate the view in the relevant literature on speech intelligibility and existing theoretical frameworks. We then identify suitable methodological paradigms for studying joint contributions to intelligibility and, lastly, discuss the clinical application and potential impact of this tripartite view. Conclusions Speech communication occurs through interaction; however, in the laboratory and clinic, emphasis is usually placed on individual speakers and listeners. We have proposed that it is critical to consider how the joint contributions of speakers and listeners affect speech intelligibility in communicative interaction. This conceptualization is well aligned with the International Classification of Functioning, Disability and Health, and the findings from such an approach will allow us to better understand how to maximize available resources to enhance speech intelligibility.
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Affiliation(s)
- Annie J Olmstead
- Department of Communication Sciences and Disorders, Pennsylvania State University, University Park
| | - Jimin Lee
- Department of Communication Sciences and Disorders, Pennsylvania State University, University Park
| | - Navin Viswanathan
- Department of Communication Sciences and Disorders, Pennsylvania State University, University Park
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Schini M, Vilaca T, Poku E, Harnan S, Sutton A, Allen IE, Cummings SR, Eastell R. The risk of hip and non-vertebral fractures in patients with Parkinson's disease and parkinsonism: A systematic review and meta-analysis. Bone 2020; 132:115173. [PMID: 31790846 DOI: 10.1016/j.bone.2019.115173] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 11/20/2019] [Accepted: 11/22/2019] [Indexed: 12/26/2022]
Abstract
Parkinson's disease (PD) is a neurodegenerative disorder that is common in older individuals. PD patients have an increased risk of fractures compared to the general population, perhaps due to multiple falls. However, the fracture risk has not been fully assessed. To assess the impact of PD on the risk of hip and non-vertebral fractures, we conducted a systematic review and meta-analysis. Comprehensive searches of three key bibliographic databases were conducted to identify reviews and primary studies relating to the risk of fractures in patients with PD. Search terms included all relevant terms for Parkinson's disease and for fractures. We selected observational studies with data on the risk of fractures in adults with PD compared to controls without the diagnosis. Study quality was assessed using the Newcastle Ottawa Scale. The random-effects model was used to pool the results. Eighteen studies were included in the review. Seventeen independent studies (14 cohort and 3 case-control studies) were included in the hip fracture analysis. Nine studies (all cohorts, no case-control studies) were included in the non-vertebral fracture analysis. Study quality was judged to be moderate to good. Overall, PD patients had an increased risk for both hip fractures (2.40, 95% CI 2.04 to 2.82) and non-vertebral fractures (1.80, 95% CI 1.60 to 2.01) compared to controls. The relative risk for hip fractures was higher in men (2.93, 95% CI 2.05 to 4.18) than in women (1.81, 95% CI 1.61 to 2.04). There were no effects of the study design, geographical region, or criteria for diagnosing Parkinson's disease on these estimates of fracture risk. There is an increase in the risk of hip and non-vertebral fractures in patients with Parkinson's disease and we recommend a re-evaluation of the clinical guidelines on bone health in patients with PD to address this.
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Affiliation(s)
- Marian Schini
- Department of Oncology and Metabolism, University of Sheffield, UK.
| | - Tatiane Vilaca
- Department of Oncology and Metabolism, University of Sheffield, UK
| | - Edith Poku
- School of Health and Related Research (ScHARR), University of Sheffield, UK
| | - Susan Harnan
- School of Health and Related Research (ScHARR), University of Sheffield, UK
| | - Anthea Sutton
- School of Health and Related Research (ScHARR), University of Sheffield, UK
| | | | | | - Richard Eastell
- Department of Oncology and Metabolism, University of Sheffield, UK
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Lanza G, Calì F, Vinci M, Cosentino FII, Tripodi M, Spada RS, Cantone M, Bella R, Mattina T, Ferri R. A Customized Next-Generation Sequencing-Based Panel to Identify Novel Genetic Variants in Dementing Disorders: A Pilot Study. Neural Plast 2020; 2020:8078103. [PMID: 32908482 PMCID: PMC7450320 DOI: 10.1155/2020/8078103] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 06/13/2020] [Accepted: 07/13/2020] [Indexed: 02/07/2023] Open
Abstract
PURPOSE The advancements in the next-generation sequencing (NGS) techniques have allowed for rapid, efficient, and cost-time-effective genetic variant detection. However, in both clinical practice and research setting, sequencing is still often limited to the use of gene panels clinically targeted on the genes underlying the disease of interest. METHODS We performed a neurogenetic study through an ad hoc NGS-based custom sequencing gene panel in order to screen 16 genes in 8 patients with different types of degenerative cognitive disorders (Alzheimer's disease, mild cognitive impairment, frontotemporal dementia, and dementia associated with Parkinson's disease). The study protocol was based on previous evidence showing a high sensitivity and specificity of the technique even when the panel is limited to some hotspot exons. RESULTS We found variants of the TREM2 and APP genes in three patients; these have been previously identified as pathogenic or likely pathogenic and, therefore, considered "disease causing." In the remaining subjects, the pathogenicity was evaluated according to the guidelines of the American College of Medical Genetics (ACMG). In one patient, the p.R205W variant in the CHMP2B gene was found to be likely pathogenic of the disease. A variant in the CSF1R and SERPINI1 genes found in two patients was classified as benign, whereas the other two (in the GRN and APP genes) were classified as likely pathogenic according to the ACMG. CONCLUSIONS Notwithstanding the preliminary value of this study, some rare genetic variants with a probable disease association were detected. Although future application of NGS-based sensors and further replication of these experimental data are needed, this approach seems to offer promising translational perspectives in the diagnosis and management of a wide range of neurodegenerative disorders.
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Affiliation(s)
- Giuseppe Lanza
- 1Department of Surgery and Medical-Surgical Specialties, University of Catania, Catania, Italy
- 2Oasi Research Institute–IRCCS, Troina, Italy
| | | | | | | | | | | | - Mariagiovanna Cantone
- 3Department of Neurology, Sant'Elia Hospital, ASP Caltanissetta, Caltanissetta, Italy
| | - Rita Bella
- 4Department of Medical and Surgical Sciences and Advanced Technologies, University of Catania, Catania, Italy
| | - Teresa Mattina
- 5Department of Biomedical and Biotechnological Sciences, University of Catania, Catania, Italy
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Ford JH, Schroeder K, Buse DC, Joshi S, Gelwicks S, Foster SA, Aurora SK. Predicting initiation of preventive migraine medications: exploratory study in a large U.S. medical claims database. Curr Med Res Opin 2020; 36:51-61. [PMID: 31422701 DOI: 10.1080/03007995.2019.1657716] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Objective: Despite guidelines that identify potential patients eligible for preventive migraine medications, their underutilization leaves patients at risk of acute medication overuse, disease progression, and higher healthcare resource utilization and disability. This exploratory, retrospective, observational study aimed to identify which factors predict preventive migraine medication initiation. Demographics and initiation of acute medication use were hypothesized to be predictive of initiation of preventive migraine medication.Methods: The Truven Health Analytics MarketScan1 U.S. Commercial and Medicare Supplemental claims database (2011-2013) was used to identify adults newly diagnosed with migraine. Patients were divided into 2 subgroups: initiated a preventive migraine medication (antidepressants, anti-epileptics, beta-blockers, or neurotoxins) within 1 year of migraine diagnosis and did not initiate a preventive migraine medication. Logistic regression models were constructed to identify factors associated with preventive migraine medication initiation.Results: Study population included 147,923 patients: 43,660 preventive migraine medication initiators and 104,263 non-preventive migraine medication patients. Best-fit model for predicting preventive migraine medication initiation included: female gender (odds ratio = 1.181 [95% CI = 1.144,1.218]; measured at date of first migraine diagnosis); headache diagnosis prior to migraine diagnosis (odds ratio = 1.538 [95% CI = 1.498,1.579]; measured 1-year before first migraine diagnosis); and sleep disorder (odds ratio = 1.206 [95% CI = 1.161,1.252]), headache/migraine-specific Emergency Department (ED) visit (odds ratio = 1.224 [95% CI = 1.168,1.283]), neurologist visit (odds ratio = 1.502 [95% CI = 1.459,1.547]), and acute medication refills with <90-day gap (odds ratio = 1.509 [95% CI = 1.470,1.549]) each measured at 1-year before first preventive migraine medication.Conclusions: In addition to consistent acute medication refills, specific comorbidity diagnoses, headache/migraine-specific ED utilization, and neurologist care are predictive of preventive migraine medication initiation in the 1-year post-incident migraine diagnosis.
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Affiliation(s)
| | | | - Dawn C Buse
- Albert Einstein College of Medicine, Bronx, NY, USA
| | - Shivang Joshi
- Dent Neurologic Institute, Amherst, NY, USA
- University of Buffalo School of Pharmacy, Buffalo, NY, USA
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Lee J, Fischer JC. Single Word–Based Acoustic Vowel Space in Individuals With Dysarthria Secondary to Amyotrophic Lateral Sclerosis. ACTA ACUST UNITED AC 2019. [DOI: 10.1044/2019_pers-sig19-2019-0011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Jimin Lee
- Department of Communication Sciences and Disorders, The Pennsylvania State University, University Park
| | - Julie C. Fischer
- Department of Communication Sciences and Disorders, The Pennsylvania State University, University Park
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The metabolic face of migraine - from pathophysiology to treatment. Nat Rev Neurol 2019; 15:627-643. [PMID: 31586135 DOI: 10.1038/s41582-019-0255-4] [Citation(s) in RCA: 127] [Impact Index Per Article: 25.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/12/2019] [Indexed: 12/11/2022]
Abstract
Migraine can be regarded as a conserved, adaptive response that occurs in genetically predisposed individuals with a mismatch between the brain's energy reserve and workload. Given the high prevalence of migraine, genotypes associated with the condition seem likely to have conferred an evolutionary advantage. Technological advances have enabled the examination of different aspects of cerebral metabolism in patients with migraine, and complementary animal research has highlighted possible metabolic mechanisms in migraine pathophysiology. An increasing amount of evidence - much of it clinical - suggests that migraine is a response to cerebral energy deficiency or oxidative stress levels that exceed antioxidant capacity and that the attack itself helps to restore brain energy homeostasis and reduces harmful oxidative stress levels. Greater understanding of metabolism in migraine offers novel therapeutic opportunities. In this Review, we describe the evidence for abnormalities in energy metabolism and mitochondrial function in migraine, with a focus on clinical data (including neuroimaging, biochemical, genetic and therapeutic studies), and consider the relationship of these abnormalities with the abnormal sensory processing and cerebral hyper-responsivity observed in migraine. We discuss experimental data to consider potential mechanisms by which metabolic abnormalities could generate attacks. Finally, we highlight potential treatments that target cerebral metabolism, such as nutraceuticals, ketone bodies and dietary interventions.
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Abstract
PURPOSE OF REVIEW This article reviews the preventive therapy of migraine, including indications, strategies for use, and available treatments. RECENT FINDINGS Lifestyle modifications and migraine trigger avoidance are recommended as preventive measures for all individuals with migraine. The decision to recommend additional migraine preventive therapy should consider the frequency of migraine attacks and headaches, extent of migraine-associated disability, frequency of using acute migraine treatments and the responsiveness to such treatments, and patient preferences. Additional therapies include prescription medications, nutraceuticals, neurostimulation, and behavioral therapy. Considering evidence for efficacy and the risk of potential side effects and adverse events, treatments with the most favorable profiles include (in alphabetical order): amitriptyline, beta-blockers (several), biofeedback, candesartan, coenzyme Q10, cognitive-behavioral therapy, magnesium citrate, onabotulinumtoxinA (for chronic migraine only), relaxation therapy, riboflavin, and topiramate. In addition, erenumab, a calcitonin gene-related peptide (CGRP) receptor monoclonal antibody, received approval from the US Food and Drug Administration (FDA) for the prevention of migraine in May 2018. SUMMARY Successful migraine preventive therapy reduces the frequency and burden of attacks while causing limited side effects. Individual treatment recommendations are determined based upon evidence for efficacy, side effect and adverse event profiles, medication interactions, patient comorbidity, costs, and patient preferences. Patients must be counseled on reasonable expectations for their preventive therapy and the importance of adhering to the recommended treatment plan for a period of time that is sufficient to determine outcomes.
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Huang M, Rathore SS, Lindau M. Drug testing complementary metal-oxide-semiconductor chip reveals drug modulation of transmitter release for potential therapeutic applications. J Neurochem 2019; 151:38-49. [PMID: 31274190 PMCID: PMC6837173 DOI: 10.1111/jnc.14815] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Revised: 06/05/2019] [Accepted: 07/02/2019] [Indexed: 01/01/2023]
Abstract
Neurodegenerative diseases, such as Parkinson’s disease, Alzheimer’s disease, and Huntington’s disease, are considered incurable and significantly reduce the quality of life of the patients. A variety of drugs that modulate neurotransmitter levels have been used for the treatment of the neurodegenerative diseases but with limited efficacy. In this work, an amperometric complementary metal‐oxide‐semiconductor (CMOS) chip is used for high‐throughput drug testing with respect to the modulation of transmitter release from single vesicles using chromaffin cells prepared from bovine adrenal glands as a model system. Single chromaffin cell amperometry was performed with high efficiency on the surface‐modified CMOS chip and follow‐up whole‐cell patch‐clamp experiments were performed to determine the readily releasable pool sizes. We show that the antidepressant drug bupropion significantly increases the amount of neurotransmitter released in individual quantal release events. The antidepressant drug citalopram accelerates rapid neurotransmitter release following stimulation and follow‐up patch‐clamp experiments reveal that this is because of the increase in the pool of readily releasable vesicles. These results shed light on the mechanisms by which bupropion and citalopram may be potentially effective in the treatment of neurodegenerative diseases. These results demonstrate that the CMOS amperometry chip technology is an excellent tool for drug testing to determine the specific mechanisms by which they modulate neurotransmitter release. ![]()
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Affiliation(s)
- Meng Huang
- Department of Materials Science and Engineering, Cornell University, Ithaca, New York, USA.,School of Applied and Engineering Physics, Cornell University, Ithaca, New York, USA
| | - Shailendra S Rathore
- School of Applied and Engineering Physics, Cornell University, Ithaca, New York, USA
| | - Manfred Lindau
- School of Applied and Engineering Physics, Cornell University, Ithaca, New York, USA
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Abstract
Migraine is a disabling neurovascular disorder with few targeted, tolerable and effective treatments. Phytomedicines, or plant-based medicinal formulations, hold great promise in the identification of novel therapeutic targets in migraine. Many patients also turn toward herbal and plant-based therapies for the treatment of their migraines as clinical and preclinical evidence of efficacy increases. Patients seek effective and tolerable treatments instead of or in addition to current conventional pharmacologic therapies. We review some phytomedicines potentially useful for migraine treatment-feverfew (Tanacetum parthenium), butterbur (Petasites hybridus), marijuana (Cannabis spp.), Saint John's Wort (Hypericum perforatum) and the Damask rose (Rosa × damascena)-with respect to their mechanisms of action and evidence for treatment of migraine. The evidence for feverfew is mixed; butterbur is effective with potential risks of hepatotoxicity related to preparation; marijuana has not been shown to be effective in migraine treatment, and data are scant; Saint John's Wort shows relevant physiological activity but is a hepatic enzyme inducer and lacks clinical studies for this purpose; the Damask rose when used in topical preparations did not show efficacy in one clinical trial. Other plant preparations have been considered for migraine treatment but most without blinded randomized, placebo-controlled trial evidence.
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Affiliation(s)
- Thilinie Rajapakse
- Division of Neurology, Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada. .,Women and Children's Research Institute, Edmonton Clinic Health Academy, University of Alberta, Edmonton, AB, Canada.
| | - William Jeptha Davenport
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Department of Medical Genetics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
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Abstract
ABSTRACT:Objectives:We assessed trends in the incidence, prevalence, and post-diagnosis mortality of parkinsonism in Ontario, Canada over 18 years. We also explored the influence of a range of risk factors for brain health on the trend of incident parkinsonism.Methods:We established an open cohort by linking population-based health administrative databases from 1996 to 2014 in Ontario. The study population comprised residents aged 20–100 years with an incident diagnosis of parkinsonism ascertained using a validated algorithm. We calculated age- and sex-standardized incidence, prevalence, and mortality of parkinsonism, stratified by young onset (20–39 years) and mid/late onset (≥40 years). We assessed trends in incidence using Poisson regression, mortality using negative binomial regression, and prevalence of parkinsonism and pre-existing conditions (e.g., head injury) using the Cochran–Armitage trend test. To better understand trends in the incidence of mid/late-onset parkinsonism, we adjusted for various pre-existing conditions in the Poisson regression model.Results:From 1996 to 2014, we identified 73,129 incident cases of parkinsonism (source population of ∼10.5 million), of whom 56% were male, mean age at diagnosis was 72.6 years, and 99% had mid/late-onset parkinsonism. Over 18 years, the age- and sex-standardized incidence decreased by 13.0% for mid/late-onset parkinsonism but remained unchanged for young-onset parkinsonism. The age- and sex-standardized prevalence increased by 22.8%, while post-diagnosis mortality decreased by 5.5%. Adjustment for pre-existing conditions did not appreciably explain the declining incidence of mid/late-onset parkinsonism.Conclusion:Young-onset and mid/late-onset parkinsonism exhibited differing trends in incidence over 18 years in Ontario. Further research to identify other factors that may appreciably explain trends in incident parkinsonism is warranted.
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McLean A, Becker WJ, Vujadinovic Z. Making a new-patient headache education session more patient-centered: what participants want to know. Disabil Rehabil 2019; 42:1462-1473. [PMID: 30689453 DOI: 10.1080/09638288.2018.1526337] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Purpose: To describe the new-patient Education Session provided by the Calgary Headache Assessment and Management Program, analyze patient evaluations, and generate potential patient-centered improvements based on themes in patient feedback.Materials and Methods: Between 2008 and 2012, 1873 new patients attended the Education Session, and 913 evaluations were completed. Session objectives ratings were analyzed. Open-ended questions regarding most- and least-helpful components and suggestions for improvement were examined using thematic analysis.Results: Eighty-seven percent of respondents indicated they would recommend the session to others with headache. Median objectives ratings ranged from 9.0-10.0 out of 10 and were stable over time. Most-helpful themes included medication, types of headache, our program's multi-faceted management approach, medication overuse, triggers, and not feeling alone. Most respondents left the least-useful and suggestions sections blank or commented "nothing" or "not applicable". Least-useful themes included migraine overemphasis, insufficient or excessive medication content, participant over-disclosure, and lack of practical trigger management strategies.Conclusion: Most attendees found the Education Session useful. Those who did not provided valuable input that will allow us to modify the content. Our findings may benefit other headache programs seeking to implement or improve patient education programing. Implications for RehabilitationHeadache is a common and debilitating condition.Education is an important part of headache treatment, and has been associated with decreases in headache frequency, intensity, and disability, as well as increases in self-efficacy.A new-patient Education Session is a practical and inexpensive way to provide evidence-based medical and behavioral headache information.Quantitative and qualitative analysis of patient evaluations can help gauge relevance and direct content changes.
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Affiliation(s)
- Allison McLean
- Calgary Headache Assessment and Management Program, Alberta Health Services, Calgary Canada
| | - Werner J Becker
- Department of Clinical Neurosciences, University of Calgary, Calgary, Canada
| | - Zorana Vujadinovic
- Department of Clinical Neurosciences, University of Calgary, Calgary, Canada
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Johansson IL, Samuelsson C, Müller N. Patients’ and communication partners’ experiences of communicative changes in Parkinson’s disease. Disabil Rehabil 2019; 42:1835-1843. [DOI: 10.1080/09638288.2018.1539875] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Inga-Lena Johansson
- Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Christina Samuelsson
- Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Nicole Müller
- Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
- Department Speech and Hearing Sciences, University College Cork, Cork, Ireland
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Dodick DW. CGRP ligand and receptor monoclonal antibodies for migraine prevention: Evidence review and clinical implications. Cephalalgia 2019; 39:445-458. [DOI: 10.1177/0333102418821662] [Citation(s) in RCA: 91] [Impact Index Per Article: 18.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: Monoclonal antibodies that target calcitonin gene-related peptide or the canonical calcitonin gene-related peptide receptor have emerged as effective and well tolerated for the preventive treatment of migraine. These large molecules appear ideally suited for migraine prevention. They have an extended biological half-life, are administered either monthly or quarterly either by subcutaneous injection or intravenous infusion, require minimal or no dose-titration and have the potential for a rapid onset of effect compared to conventional oral preventive drugs. There is high selectivity and they target an important mediator in the pathogenesis of migraine. Investigation: Phase II and pivotal phase III studies have all yielded positive results with a favorable adverse event profile. No serious treatment-related adverse outcomes have thus far been reported in controlled or long-term open-label extension studies. This tolerability profile promises to improve adherence and, possibly, long-term outcomes. Conclusions: Calcitonin gene-related peptide monoclonal antibodies are effective and well tolerated for the preventive treatment of migraine. They have distinct advantages over currently available oral preventive drugs. While treatment-related serious adverse events have not been observed in open-label extension studies, long-term outcomes and safety will require broad exposure in heterogeneous patient populations in clinical practice. In addition, their safety in women, especially during pregnancy, will require longitudinal surveillance. Given the overlapping mechanism(s), the effectiveness of existing (triptans) and emerging (calcitonin gene-related peptide receptor antagonists) acute therapies in those using a calcitonin gene-related peptide mAb will require further study.
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Affiliation(s)
- David W Dodick
- Department of Neurology, Mayo Clinic, Scottsdale, AZ, USA
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Moore C, Leaver A, Sibbritt D, Adams J. The management of common recurrent headaches by chiropractors: a descriptive analysis of a nationally representative survey. BMC Neurol 2018; 18:171. [PMID: 30332996 PMCID: PMC6192187 DOI: 10.1186/s12883-018-1173-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2018] [Accepted: 10/04/2018] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Headache management is common within chiropractic clinical settings; however, little is yet known about how this provider group manage headache sufferers. The aim of this study is to report on the prevalence of headache patients found within routine chiropractic practice and to assess how chiropractors approach key aspects of headache management applicable to primary care settings. METHODS A 31-item cross-sectional survey was distributed to a national sample of chiropractors (n = 1050) to report on practitioner approach to headache diagnosis, interdisciplinary collaboration, treatment and outcome assessment of headache patients who present with recurrent headache disorders. RESULTS The survey attracted a response rate of 36% (n = 381). One in five new patients present to chiropractors with a chief complaint of headache. The majority of chiropractors provide headache diagnosis for common primary (84.6%) and secondary (90.4%) headaches using formal headache classification criteria. Interdisciplinary referral for headache management was most often with CAM providers followed by GPs. Advice on headache triggers, stress management, spinal manipulation, soft tissue therapies and prescriptive neck exercises were the most common therapeutic approaches to headache management. CONCLUSION Headache patients make up a substantial proportion of chiropractic caseload. The majority of chiropractors managing headache engage in headache diagnosis and interdisciplinary patient management. More research information is needed to understand the headache types and level of headache chronicity and disability common to chiropractic patient populations to further assess the healthcare needs of this patient population.
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Affiliation(s)
- Craig Moore
- Faculty of Health, University of Technology Sydney, Level 8, Building 10, 235-253 Jones Street Ultimo, Sydney, NSW 2007 Australia
| | - Andrew Leaver
- Faculty of Health Science, University of Sydney, Sydney, Australia
| | - David Sibbritt
- Faculty of Health, University of Technology Sydney, Level 8, Building 10, 235-253 Jones Street Ultimo, Sydney, NSW 2007 Australia
| | - Jon Adams
- Faculty of Health, University of Technology Sydney, Level 8, Building 10, 235-253 Jones Street Ultimo, Sydney, NSW 2007 Australia
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Cho KH, Kim TH, Kwon S, Jung WS, Moon SK, Ko CN, Cho SY, Jeon CY, Lee SH, Choi TY, Jun JH, Choi J, Lee MS, Chung EK. Complementary and Alternative Medicine for Idiopathic Parkinson's Disease: An Evidence-Based Clinical Practice Guideline. Front Aging Neurosci 2018; 10:323. [PMID: 30374299 PMCID: PMC6196228 DOI: 10.3389/fnagi.2018.00323] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Accepted: 09/24/2018] [Indexed: 11/23/2022] Open
Abstract
Patients with idiopathic Parkinson's disease (IPD) require long-term care and are reported to use complementary and alternative medicine (CAM) interventions frequently. This CAM-specific clinical practice guideline (CPG) makes recommendations for the use of CAM, including herbal medicines, acupuncture, moxibustion, pharmaco-acupuncture, and qigong (with Tai chi) in patients with IPD. This guideline was developed using an evidence-based approach with randomized controlled trials currently available. Even though this CPG had some limitations, mainly originating from the bias inherent in the research on which it is based, it would be helpful when assessing the value of the CAM interventions frequently used in patients with IPD.
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Affiliation(s)
- Ki-Ho Cho
- Department of Cardiology and Neurology, College of Korean Medicine, Kyung Hee University, Seoul, South Korea
| | - Tae-Hun Kim
- Korean Medicine Clinical Trial Center, Korean Medicine Hospital, Kyung Hee University, Seoul, South Korea
| | - Seungwon Kwon
- Department of Cardiology and Neurology, College of Korean Medicine, Kyung Hee University, Seoul, South Korea
| | - Woo-Sang Jung
- Department of Cardiology and Neurology, College of Korean Medicine, Kyung Hee University, Seoul, South Korea
| | - Sang-Kwan Moon
- Department of Cardiology and Neurology, College of Korean Medicine, Kyung Hee University, Seoul, South Korea
| | - Chang-Nam Ko
- Department of Cardiology and Neurology, College of Korean Medicine, Kyung Hee University, Seoul, South Korea
- Stroke and Neurological Disorders Center, Kyung Hee University Hospital at Gangdong, Seoul, South Korea
| | - Seung-Yeon Cho
- Department of Cardiology and Neurology, College of Korean Medicine, Kyung Hee University, Seoul, South Korea
- Stroke and Neurological Disorders Center, Kyung Hee University Hospital at Gangdong, Seoul, South Korea
| | - Chan-Yong Jeon
- Department of Korean Internal Medicine, College of Korean Medicine, Gachon University, Seongnam, South Korea
| | - Sang-Ho Lee
- Gangdong Mokhuri Oriental Medical Hospital, Seoul, South Korea
| | - Tae Young Choi
- Clinical Medicine Division, Korea Institute of Oriental Medicine, Daejeon, South Korea
| | - Ji Hee Jun
- Clinical Medicine Division, Korea Institute of Oriental Medicine, Daejeon, South Korea
| | - Jiae Choi
- Integrative Health Promotion Team, Korea Health Promotion Institute, Seoul, South Korea
| | - Myeong Soo Lee
- Clinical Medicine Division, Korea Institute of Oriental Medicine, Daejeon, South Korea
| | - Eun Kyoung Chung
- Division of Clinical Pharmacy, Department of Pharmacy, College of Pharmacy, Kyung Hee University, Seoul, South Korea
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Sussman M, Benner J, Neumann P, Menzin J. Cost-effectiveness analysis of erenumab for the preventive treatment of episodic and chronic migraine: Results from the US societal and payer perspectives. Cephalalgia 2018; 38:1644-1657. [DOI: 10.1177/0333102418796842] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Objectives To assess the cost-effectiveness of erenumab 140 mg (“erenumab”) for the prophylactic treatment of episodic migraine and chronic migraine. Study design A hybrid Monte Carlo patient simulation and Markov cohort model was constructed to compare erenumab to no preventive treatment or onabotulinumtoxinA among adult ( ≥ 18 years) patients with episodic migraine and chronic migraine who failed prior preventive therapy from the US societal and payer perspectives. Methods Patients entered the model one at a time and were assigned to a post-treatment monthly migraine day category based on baseline monthly migraine days and treatment effect. Using monthly cycles, patients were followed for 2 years and accumulated costs and utilities associated with their post-treatment monthly migraine days. The primary outcome included the incremental cost-effectiveness ratio presented as cost per quality-adjusted life year gained. Results With an annual drug price of erenumab of $6900, treatment with erenumab in the societal perspective ranges from a dominant strategy versus no preventive treatment among chronic migraine patients to an incremental cost-effectiveness ratio of $122,167 versus no preventive treatment among episodic migraine patients. When excluding indirect costs (i.e. payer perspective), the incremental cost-effectiveness ratios are cost-effective among chronic migraine patients ($23,079 and $65,720 versus no preventive treatment and onabotulinumtoxinA, respectively), but not among episodic migraine patients ($180,012 versus no preventive treatment). Model results were sensitive to changes in monthly migraine days, health utilities, and treatment costs. Conclusion The use of erenumab may be a cost-effective approach to preventing monthly migraine days among patients with chronic migraine versus onabotulinumtoxinA and no preventive treatment in the societal and payer perspectives, but is less likely to offer good value for money for those with episodic migraine, unless lost productivity costs are considered.
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Affiliation(s)
| | | | - Peter Neumann
- Center for the Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies at Tufts Medical Center, Boston, MA, USA
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Dodick D, Edvinsson L, Makino T, Grisold W, Sakai F, Jensen R, Balch A, Ruiz de la Torre E, Henscheid-Lorenz D, Craven A, Ashina M. Vancouver Declaration on Global Headache Patient Advocacy 2018. Cephalalgia 2018; 38:1899-1909. [PMID: 29882695 DOI: 10.1177/0333102418781644] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Headache disorders comprise the three most prevalent medical disorders globally and contribute almost 20% to the total burden of neurologic illness. Although the experience of a recurrent headache disorder tends to be highly individualized, patient preferences tend to be a low priority in guidelines for the management of patients with headache. METHODS In September 2017, the first Global Patient Advocacy Summit was convened, bringing together patients, patient advocates, patient advocacy organizations, healthcare professionals, pharmaceutical manufacturers, scientists, and regulatory agencies to advance issues of importance to patients affected by headache worldwide. RESULTS Presentations and discussion covered multiple issues, such as improving access to appropriate medical care; incorporating the insights of independent patient advocates and advocacy organizations; leveraging the insights, experience and influence of leading health and neurological organizations; and raising awareness of the role of regulatory agencies in disease advocacy. Attendees agreed that it is important to understand and promote the global, regional, and local interests of people with headache disorders, as well as challenge the pervasive stigma associated with headache. They also agreed that those with severe, recurrent, or disabling headache disorders should have reliable access to competent medical care; healthcare professionals should have access to adequate training in Headache Medicine; global benchmarks should be established for accurate diagnosis and the use of evidence-based treatments in patients with headache; and that information is needed about consultation, diagnosis, and treatment of headache, particularly in regard to patient preferences. CONCLUSION Based on the group's consensus around these issues, a series of statements was developed, and they are collectively presented herein as the Vancouver Declaration on Global Headache Patient Advocacy 2018.
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Affiliation(s)
| | | | - Tomohiko Makino
- 3 World Health Organization, Regional Office for the Western Pacific, Manila, Philippines
| | | | | | - Rigmor Jensen
- 6 Danish Headache Center, University of Copenhagen, Rigshopitalet, Glostrup, Denmark
| | - Alan Balch
- 7 Patient Advocate Foundation, Hampton, VA, USA
| | | | | | | | - Messoud Ashina
- 6 Danish Headache Center, University of Copenhagen, Rigshopitalet, Glostrup, Denmark
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Williams DR, Evans AH, Fung VSC, Hayes M, Iansek R, Kimber T, O'Sullivan JD, Sue CM. Practical approaches to commencing device-assisted therapies for Parkinson disease in Australia. Intern Med J 2018; 47:1107-1113. [PMID: 28195385 DOI: 10.1111/imj.13398] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Accepted: 01/29/2017] [Indexed: 11/28/2022]
Abstract
In Australia 1% of individuals aged over 50 years have Parkinson disease (PD). Guidance for commencing device-assisted therapies (DAT) for PD in Australia was developed based on a review of European recommendations and their relevance to the local clinical setting. An online survey and teleconference discussions were held by a group of eight local movement disorder experts to develop consensus. Referral to a movement disorder specialist and consideration of DAT is appropriate when motor fluctuations cause disability or reduced quality of life, response to treatment is inconsistent or motor fluctuations and dyskinesias require frequent treatment adjustment without apparent benefit and levodopa is required four or more times daily. Three types of DAT are available in Australia for patients with PD: continuous subcutaneous apomorphine; continuous levodopa-carbidopa intestinal gel infusion; and deep brain stimulation. All improve consistency of motor response. The most important aspects when considering which DAT to use are the preferences of the patient and their carers, patient comorbidities, age, cognitive function and neuropsychiatric status. Patients and their families need to be provided with treatment options that are suitable to them, with adequate explanations regarding the recommendations and comparison of potential device-related complications. DAT are best managed, where possible, in a specialist centre with experience in all three types of therapy. Proactive and early management of symptoms during disease progression is essential to maintain optimally motor responses and quality of life in patients with PD.
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Affiliation(s)
- David R Williams
- Faculty of Medicine Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Andrew H Evans
- Neurology Department, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Victor S C Fung
- Movement Disorders Unit, Department of Neurology, Westmead Hospital and Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - Michael Hayes
- Department of Neuroscience, Concord Hospital, Sydney, New South Wales, Australia
| | - Robert Iansek
- CRC for Movement Disorders and Gait Kingston Centre Monash Health, School of Clinical Sciences, Monash University, Melbourne, Victoria, Australia
| | - Thomas Kimber
- Neurology Unit, Royal Adelaide Hospital, Department of Medicine, University of Adelaide, Adelaide, South Australia, Australia
| | - John D O'Sullivan
- School of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Carolyn M Sue
- Department of Neurology, Royal North Shore Hospital, University of Sydney, Sydney, New South Wales, Australia
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Effects of Antiparkinson Medication on Cognition in Parkinson's Disease: A Systematic Review. Can J Neurol Sci 2018; 45:375-404. [PMID: 29747716 DOI: 10.1017/cjn.2018.21] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE This study aimed to systematically review the effects of currently prescribed antiparkinson medication on cognition in patients with mild-to-moderate Parkinson's disease (PD) who were either cognitively intact or mildly impaired. METHODS English- and French-language studies published between 1969 and 2017 were accessed via MedLine, PsychNET, EMBASE and EBSCO databases. Methodological quality (MQ) was evaluated with the quality assessment instrument of the Cochrane Collaboration Depression, Anxiety and Neurosis Review (scores from 0% to 44% indicate very low quality; scores from 45% to 64% indicate low quality; scores from 65% to 84% indicate medium quality; and scores from 85% to 100% indicate high quality). Hedges' g and Student's t-test were performed on all cognitive outcome measures reported. RESULTS In total, 14 studies assessed the cognitive effects of levodopa (L-D), pramipexole (PRX), selegiline (SEL) and rasagiline (RAS) in mild-to-moderate non-demented PD patients. The MQ was overall low, with an average score of 49.1%. Results for L-D showed deleterious effects on a test of cognitive inhibition, as well as benefits on tests of attention/processing speed/working memory, executive functions and episodic memory. Pramipexole was associated with a worsening of episodic memory and impulse control. Results on SEL indicated a deterioration of global cognition over time and of concept formation. Rasagiline had some benefits on working memory and verbal fluency. CONCLUSION Antiparkinson medications can have deleterious (L-D; PRX; SEL) and beneficial (L-D; RAS) effects on cognition. However, randomized double-blind placebo-controlled trials with larger sample sizes are required to better elucidate this issue.
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Williams U, Bandmann O, Walker R. Parkinson's Disease in Sub-Saharan Africa: A Review of Epidemiology, Genetics and Access to Care. J Mov Disord 2018; 11:53-64. [PMID: 29860783 PMCID: PMC5990907 DOI: 10.14802/jmd.17028] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Revised: 10/02/2017] [Accepted: 12/11/2017] [Indexed: 12/20/2022] Open
Abstract
A low prevalence of Parkinson's disease (PD) has been reported in the Sub-Saharan Africa (SSA) region. The genetic causes and clinical features of PD in this region have been poorly described. Very few reports have examined the availability and access to evidence-based quality care for people living with PD in this region. We reviewed all publications focusing on idiopathic PD from SSA published up to May 2016 and observed a prevalence of PD ranging from 7/100,000 in Ethiopia to 67/100,000 in Nigeria. The most recent community-based study reported a mean age at onset of 69.4 years. The infrequent occurrence of mutations in established PD genes was also observed in the region. Treatments were non-existent or at best irregular. Additionally, there is a lack of well-trained medical personnel and multidisciplinary teams in most countries in this region. Drugs for treating PD are either not available or unaffordable. Large-scale genetic and epidemiological studies are therefore needed in SSA to provide further insights into the roles of genetics and other etiological factors in the pathogenesis of PD. The quality of care also requires urgent improvement to meet the basic level of care required by PD patients.
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Affiliation(s)
- Uduak Williams
- Neurology Unit, Internal Medicine Department, University of Calabar Teaching Hospital, Calabar, Nigeria
- Department of Neuroscience, Sheffield Institute for Translational Neuroscience (SITraN), University of Sheffield, Sheffield, UK
| | - Oliver Bandmann
- Department of Neuroscience, Sheffield Institute for Translational Neuroscience (SITraN), University of Sheffield, Sheffield, UK
| | - Richard Walker
- Department of Elderly Medicine, North Tyneside General Hospital, Newcastle, UK
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Aboukarr A, Giudice M. Interaction between Monoamine Oxidase B Inhibitors and Selective Serotonin Reuptake Inhibitors. Can J Hosp Pharm 2018; 71:196-207. [PMID: 29955193 PMCID: PMC6019085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
BACKGROUND Monoamine oxidase B (MAO-B) inhibitors are used to treat the motor symptoms of Parkinson disease. Depression is commonly associated with Parkinson disease, and selective serotonin reuptake inhibitors (SSRIs) are often used for its management. Tertiary sources warn that the combination of MAO-B inhibitors and SSRIs can result in increased serotonergic effects, leading to serotonin syndrome. OBJECTIVE To explore the mechanism, clinical significance, and management of this potential drug interaction through a review of the supporting evidence. DATA SOURCES PubMed, MEDLINE (1946 forward), Embase (1947 forward), PsycINFO (1806 forward), and International Pharmaceutical Abstracts (1970 forward) were searched on February 4, 2017. STUDY SELECTION AND DATA EXTRACTION Studies and case reports describing aspects of the potential interaction between MAO-B inhibitors and SSRIs in patients with Parkinson disease and published in English were identified by both title and abstract. DATA SYNTHESIS The search identified 8 studies evaluating the potential interaction between SSRIs and the MAO-B inhibitors selegiline and rasagiline. The largest, a retrospective cohort study of 1504 patients with Parkinson disease, found no cases of serotonin syndrome with coadministration of rasagiline and an SSRI. A survey of 63 investigators in the Parkinson Study Group identified 11 potential cases of serotonin syndrome among 4568 patients treated with the combination of selegiline and antidepressants (including SSRIs). In addition, 17 case reports describing the onset of serotonin syndrome with coadministration of an SSRI and either selegiline or rasagiline were identified. Following discontinuation or dose reduction of one or both of the agents, the symptoms of serotonin syndrome gradually resolved in most cases, with none being fatal. CONCLUSIONS According to the literature, serotonin syndrome occurs rarely, and the combination of SSRI and MAO-B inhibitor is well tolerated. Therefore, SSRIs and MAO-B inhibitors can be coadministered, provided that their recommended doses are not exceeded and the SSRI dose is kept at the lower end of the therapeutic range. Among the SSRIs, citalopram and sertraline may be preferred.
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Affiliation(s)
- Abdullah Aboukarr
- , PharmD, was, at the time this review was performed, a PharmD student in the Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario. He is now with Medical Affairs, Purdue Pharma (Canada), Pickering, Ontario
| | - Mirella Giudice
- , BScPharm, is with the Ottawa Valley Regional Drug Information Service, The Ottawa Hospital, Ottawa, Ontario
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Yi ZM, Qiu TT, Zhang Y, Liu N, Zhai SD. Levodopa/carbidopa/entacapone versus levodopa/dopa-decarboxyiase inhibitor for the treatment of Parkinson's disease: systematic review, meta-analysis, and economic evaluation. Ther Clin Risk Manag 2018; 14:709-719. [PMID: 29713179 PMCID: PMC5907888 DOI: 10.2147/tcrm.s163190] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Aims To review the evidence for efficacy, safety, and cost-effectiveness of levodopa/carbidopa/entacapone (LCE) compared with levodopa/dopa-decarboxyiase inhibitor (DDCI) for Parkinson’s disease (PD). Methods PubMed, Embase, the Cochrane Library, and Chinese databases WangFang Data, Chinese Sci-tech Journals Database and China National Knowledge Infrastructure, as well as ClinicalTrials.gov, were searched for randomized controlled trials with “levodopa/carbidopa/entacapone” as keywords. The search period was from inception to August 2017. We conducted meta-analyses to synthesize the evidence quantitatively. Results A total of 5,693 records were obtained. We included seven randomized controlled trials and one cost-effectiveness study after the screening process. Compared with levodopa–DDCI, LCE improved patient Unified Parkinson’s Disease Rating Scale (UPDRS) II score (mean difference [MD] −1.17, 95% CI −1.64 to −0.71), UPDRS III score (MD −1.55, 95% CI −2.29 to −0.81), and Schwab and England daily activity rating (MD 2.05, 95% CI 0.85–3.26). There was no statistically significant difference in the risk of serious adverse events (AEs) or discontinuation due to AEs in patients with LCE, and the risk of total AEs was higher in the LCE group (risk ratio [RR] 1.33, 95% CI 1.05–1.70). The incremental cost-effectiveness ratio of LCE was £3,105 per quality-adjusted life-year (QALY) gained in the UK. Conclusion LCE can improve PD patients’ motor symptoms and daily living functioning when compared with levodopa/DDCI.
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Affiliation(s)
- Zhan-Miao Yi
- Department of Pharmacy, Peking University Third Hospital.,Department of Pharmacy Administration and Clinical Pharmacy, Peking University School of Pharmaceutical Science.,Institute for Drug Evaluation, Peking University Health Science Center, Beijing, China
| | - Ting-Ting Qiu
- Department of Pharmacy, Peking University Third Hospital.,Public Health Department, Aix-Marseille University, Marseille, France
| | - Yuan Zhang
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Na Liu
- Department of Neurology, Peking University Third Hospital, Beijing, China
| | - Suo-Di Zhai
- Department of Pharmacy, Peking University Third Hospital.,Institute for Drug Evaluation, Peking University Health Science Center, Beijing, China
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Fox SH, Katzenschlager R, Lim SY, Barton B, de Bie RMA, Seppi K, Coelho M, Sampaio C. International Parkinson and movement disorder society evidence-based medicine review: Update on treatments for the motor symptoms of Parkinson's disease. Mov Disord 2018; 33:1248-1266. [DOI: 10.1002/mds.27372] [Citation(s) in RCA: 406] [Impact Index Per Article: 67.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Revised: 01/26/2018] [Accepted: 02/05/2018] [Indexed: 01/05/2023] Open
Affiliation(s)
- Susan H. Fox
- Edmund J. Safra Program, Movement Disorder Clinic; Toronto Western Hospital; Toronto Ontario Canada
- University of Toronto Department of Medicine; Toronto Ontario Canada
| | - Regina Katzenschlager
- Department of Neurology and Karl Landsteiner Institute for Neuroimmunological and Neurodegenerative Disorders; Danube Hospital; Vienna Austria
| | - Shen-Yang Lim
- Division of Neurology and the Mah Pooi Soo & Tan Chin Nam Centre for Parkinson's & Related Disorders; University of Malaya; Kuala Lumpur Malaysia
| | - Brandon Barton
- Rush University Medical Center; Chicago Illinois USA
- Jesse Brown VA Medical Center; Chicago Illinois USA
| | - Rob M. A. de Bie
- Department of Neurology, Academic Medical Center; University of Amsterdam; Amsterdam The Netherlands
| | - Klaus Seppi
- Department of Neurology; Medical University Innsbruck; Innsbruck Austria
| | - Miguel Coelho
- Department of Neurology, Santa Maria Hospital, Instituto de Medicina Molecular; University of Lisbon; Lisbon Portugal
| | - Cristina Sampaio
- Cure Huntington's Disease Initiative (CHDI) Management/CHDI Foundation, Princeton, NJ; USA
- Instituto de Medicina Molecular; University of Lisbon; Lisbon Portugal
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