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Stocchi F, Barone P, Ceravolo R, De Pandis MF, Lopiano L, Modugno N, Padovani A, Pilleri M, Tessitore A, Zappia M. Advanced Parkinson's disease treatment patterns in Italy: an observational study interim analysis. Ann Med 2024; 56:2315226. [PMID: 38381654 PMCID: PMC10883087 DOI: 10.1080/07853890.2024.2315226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 02/01/2024] [Indexed: 02/23/2024] Open
Abstract
BACKGROUND Oral levodopa remains the mainstay of treatment for Parkinson's disease (PD). However, as PD progresses, response to treatment may fluctuate. Managing fluctuations can be demanding for clinicians and patients. There is a paucity of real-world studies reporting on PD management in patients with fluctuations in treatment response, especially in patients with advanced stages of PD. The multicentre, observational Parkinson's Disease Fluctuations treatment PAthway (PD-FPA) study describes the real-life management of response fluctuations in Italian patients with advanced PD. PATIENTS AND METHODS PD-FPA had a retrospective and prospective phase; herein, retrospective results are presented. Ten Italian centres enrolled patients with a PD diagnosis from 10-15 years prior to study entry (T0) and who had ≥2-year history of fluctuations. Data on patient demographics, medical history, PD stage, fluctuation characteristics, symptoms, and prescribed treatments were collected at T0 and retrospectively (2 years prior to T0) via patient chart review/interview. RESULTS Overall, 296 patients (60% male, mean age 68 years, 84% with Hoehn and Yahr scores 2-3) were enrolled. At T0, most patients (99.3%) were on oral levodopa therapy. All patients used dopaminergic medications; adjunctive medications included dopamine agonists (56%) and monoamine oxidase B (60%) and catechol-O-methyltransferase enzyme inhibitors (41%). At T0, 51% of patients had changed therapy, with response fluctuations being the most common reason (74%); wearing-off was the most common fluctuation (83%). CONCLUSION This interim analysis of PD-FPA suggests that adequate levodopa dosing and adjunctive medications can stabilize advanced PD and provide patients with a good quality of life.
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Affiliation(s)
- Fabrizio Stocchi
- Department of Neurology, University San Raffaele Roma and IRCCS San Raffaele, Rome, Italy
| | - Paolo Barone
- Centro per le Malattie Neurodegenerative, Dipartimento di Medicina, Università di Salerno, Baronissi, Salerno, Italy
| | - Roberto Ceravolo
- Neurodegenerative Disease Center, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Maria Francesca De Pandis
- Department of Human Sciences and Promotion of Quality of Life, San Raffaele University, Roma, Italy
- San Raffaele Cassino Hospital, Cassino, Italy
| | - Leonardo Lopiano
- Department of Neuroscience Rita Levi-Montalcini, University of Turin AOU Città della Salute e della Scienza, Turin, Italy
| | | | - Alessandro Padovani
- Unità di Neurologia, Dipartimento Scienze Cliniche e Sperimentali, Università degli Studi di Brescia, Brescia, Italy
| | - Manuela Pilleri
- UO Neurologia Casa di Cura Villa Margherita, Arcugnano Vicenza, Italy and Centro Parkinson e Parkinsonismi, ASST Gaetano Pini CTO, Milano, Italy
| | - Alessandro Tessitore
- Department of Advanced Medical and Surgical Sciences, University of Campania "L. Vanvitelli", Naples, Italy
| | - Mario Zappia
- Department "G.F. Ingrassia", University of Catania, Catania, Italy
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Tibbitts DC, Stoyles SA, Mancini M, El-Gohary M, Horak FB, Dieckmann NF, Winters-Stone KM. The Use of Novel Instrumented Socks to Detect Changes in Daily Life Mobility During an Exercise Intervention in Prostate Cancer Survivors Treated with Androgen Deprivation Therapy. Semin Oncol Nurs 2024; 40:151658. [PMID: 38902183 DOI: 10.1016/j.soncn.2024.151658] [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: 03/15/2024] [Revised: 05/07/2024] [Accepted: 05/13/2024] [Indexed: 06/22/2024]
Abstract
OBJECTIVES To describe changes in daily life mobility in prostate cancer survivors treated with androgen deprivation therapy (ADT) after a 6-month exercise intervention using novel instrumented socks and to identify characteristics of participants who exhibited changes in daily life mobility. METHODS A subset of participants in a fall prevention exercise trial completed objective tests and patient-reported surveys of physical functioning, and wore instrumented socks for up to 7 days to measure daily life mobility. Changes in cadence, double support proportion, and pitch angle of the foot at toe-off were selected as measures of daily life mobility previously found to be different in men exposed to ADT for prostate cancer versus controls. Daily life mobility was compared from baseline to 6 months using paired t-tests. Characteristics of responders who improved their daily life mobility were compared to nonresponders using two-sample t-tests, Chi-squared proportion tests, or Fisher's Exact Tests. RESULTS Our sample included 35 prostate cancer survivors (mean age 71.6 ± 7.8 years). Mean cadence, double support proportion, and pitch angle at toe-off did not change significantly over 6 months of exercise, but 14 participants (40%) improved in at least two of three daily life mobility measures ("responders"). Responders were characterized by lower physical functioning, lower cadence in daily life, fewer comorbidities, and better social and mental/emotional functioning. CONCLUSIONS Certain daily life mobility measures potentially impacted by ADT could be measured with instrumented socks and improved by exercise. Men who start with lower physical functioning and better social and mental/emotional functioning appear most likely to benefit, possibly because they have more to gain from exercise and are able to engage in a 6-month intervention. IMPLICATIONS FOR NURSING PRACTICE Technology-based approaches could provide nurses with an objective measure of daily life mobility for patients with chronic illness and detect who is responding to rehabilitation.
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Affiliation(s)
- Deanne C Tibbitts
- Knight Cancer Institute, Oregon Health & Science University, Portland, OR, USA; Division of Oncological Sciences, Oregon Health & Science University, Portland, OR, USA
| | - Sydnee A Stoyles
- School of Nursing, Oregon Health & Science University, Portland, OR, USA
| | - Martina Mancini
- Department of Neurology, Oregon Health & Science University, Portland, OR, USA
| | | | - Fay B Horak
- Department of Neurology, Oregon Health & Science University, Portland, OR, USA
| | - Nathan F Dieckmann
- School of Nursing, Oregon Health & Science University, Portland, OR, USA
| | - Kerri M Winters-Stone
- Knight Cancer Institute, Oregon Health & Science University, Portland, OR, USA; Division of Oncological Sciences, Oregon Health & Science University, Portland, OR, USA.
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Frouni I, Kwan C, Bédard D, Hamadjida A, Kang W, Belliveau S, Nuara SG, Gourdon JC, Huot P. Effect of mGluR 2 and mGluR 2/3 activators on parkinsonism in the MPTP-lesioned non-human primate. NAUNYN-SCHMIEDEBERG'S ARCHIVES OF PHARMACOLOGY 2024:10.1007/s00210-024-03216-2. [PMID: 38900249 DOI: 10.1007/s00210-024-03216-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Accepted: 06/03/2024] [Indexed: 06/21/2024]
Abstract
We have previously discovered that the selective activation of metabotropic glutamate type 2 receptors (mGluR2) and concurrent stimulation of metabotropic glutamate types 2 and 3 receptors (mGluR2/3) enhance the anti-parkinsonian action of L-3,4-dihydroxyphenylalanine (L-DOPA). Here, we sought to determine the effects of the mGluR2/3 orthosteric agonists LY-354,740 and LY-404,039, as well as the effects of the mGluR2 positive allosteric modulators LY-487,379 and CBiPES on the range of movement, bradykinesia, posture and alertness as adjuncts to L-DOPA. Ten 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP)-lesioned marmosets entered 4 experimental streams: L-DOPA + LY-354,740 (vehicle, 0.1, 0.3 and 1 mg/kg), L-DOPA + LY-404,039 (vehicle, 0.1, 1 and 10 mg/kg), L-DOPA + LY-487,379 (vehicle, 0.1, 1 and 10 mg/kg), L-DOPA + CBiPES (vehicle, 0.1, 1 and 10 mg/kg). For each molecule, treatments were randomised, and the range of movement, bradykinesia, posture and alertness were assessed by a blinded rater. None of the tested compounds significantly altered the global range of movement. LY-404,039 and CBiPES both reduced global bradykinesia, by up to 46% (both P < 0.05). LY-354,740, LY-404,039 and CBiPES each improved global posture by 35%, 44% and 39% (each P < 0.05), respectively. LY-404,039 and CBiPES both enhanced alertness by 54% (P < 0.05) and 79% (P < 0.01), respectively. LY-487,379 did not improve any of the parameters. Our results suggest that selective mGluR2 positive allosteric modulation and combined mGluR2/3 orthosteric stimulation might benefit bradykinesia, posture and alertness in PD when added to L-DOPA, which potentially represent novel therapeutic indications for molecules acting via these mechanisms.
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Affiliation(s)
- Imane Frouni
- Neurodegenerative Disease Group, Montreal Neurological Institute-Hospital (The Neuro), 3801 University St, Montreal, Quebec, H3A 2B4, Canada
| | - Cynthia Kwan
- Neurodegenerative Disease Group, Montreal Neurological Institute-Hospital (The Neuro), 3801 University St, Montreal, Quebec, H3A 2B4, Canada
| | - Dominique Bédard
- Neurodegenerative Disease Group, Montreal Neurological Institute-Hospital (The Neuro), 3801 University St, Montreal, Quebec, H3A 2B4, Canada
| | - Adjia Hamadjida
- Neurodegenerative Disease Group, Montreal Neurological Institute-Hospital (The Neuro), 3801 University St, Montreal, Quebec, H3A 2B4, Canada
| | - Woojin Kang
- Neurodegenerative Disease Group, Montreal Neurological Institute-Hospital (The Neuro), 3801 University St, Montreal, Quebec, H3A 2B4, Canada
| | - Sébastien Belliveau
- Neurodegenerative Disease Group, Montreal Neurological Institute-Hospital (The Neuro), 3801 University St, Montreal, Quebec, H3A 2B4, Canada
| | - Stephen G Nuara
- Comparative Medicine & Animal Resource Centre, McGill University, Montreal, Quebec, Canada
| | - Jim C Gourdon
- Comparative Medicine & Animal Resource Centre, McGill University, Montreal, Quebec, Canada
| | - Philippe Huot
- Neurodegenerative Disease Group, Montreal Neurological Institute-Hospital (The Neuro), 3801 University St, Montreal, Quebec, H3A 2B4, Canada.
- Department of Neurology and Neurosurgery, McGill University, Montreal, Quebec, Canada.
- Movement Disorder Clinic, Division of Neurology, Department of Neurosciences, McGill University Health Centre, Montreal, Quebec, Canada.
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Lyu S, Zhang CS, Mao Z, Guo X, Li Z, Luo X, Sun J, Su Q. Real-world Chinese herbal medicine for Parkinson's disease: a hospital-based retrospective analysis of electronic medical records. Front Aging Neurosci 2024; 16:1362948. [PMID: 38756536 PMCID: PMC11096516 DOI: 10.3389/fnagi.2024.1362948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Accepted: 04/22/2024] [Indexed: 05/18/2024] Open
Abstract
Background Parkinson's disease (PD) is a progressive neurodegenerative condition. Chinese medicine therapies have demonstrated effectiveness for PD in controlled settings. However, the utilization of Chinese medicine therapies for PD in real-world clinical practice and the characteristics of patients seeking these therapies have not been thoroughly summarized. Method The study retrospectively analyzed initial patient encounters (PEs) with a first-listed diagnosis of PD, based on electronic medical records from Guangdong Provincial Hospital of Chinese Medicine between July 2018 and July 2023. Results A total of 3,206 PEs, each corresponding to an individual patient, were eligible for analyses. Approximately 60% of patients made initial visits to the Chinese medicine hospital after receiving a PD diagnosis, around 4.59 years after the onset of motor symptoms. Over 75% of the patients visited the Internal Medicine Outpatient Clinic at their initial visits, while a mere 13.85% visited PD Chronic Care Clinic. Rest tremor (61.98%) and bradykinesia (52.34%) are the most commonly reported motor symptoms, followed by rigidity (40.70%). The most commonly recorded non-motor symptoms included constipation (31.88%) and sleep disturbance (25.27%). Integration of Chinese medicine and conventional medicine therapies was the most common treatment method (39.15%), followed by single use of Chinese herbal medicine (27.14%). The most frequently prescribed herbs for PD included Glycyrrhiza uralensis Fisch. (gan cao), Astragalus mongholicus Bunge (huang qi), Atractylodes macrocephala Koidz. (bai zhu), Angelica sinensis (Oliv.) Diels (dang gui), Rehmannia glutinosa (Gaertn.) DC. (di huang), Paeonia lactiflora Pall. (bai shao), Bupleurum chinense DC. (chai hu), Citrus aurantium L. (zhi qiao/zhi shi/chen pi), Panax ginseng C. A. Mey. (ren shen), and Poria cocos (Schw.) Wolf (fu ling). These herbs contribute to formulation of Bu zhong yi qi tang (BZYQT). Conclusion Patients typically initiated Chinese medical care after the establishment of PD diagnosis, ~4.59 years post-onset of motor symptoms. The prevalent utilization of CHM decoctions and patented Chinese herbal medicine products, underscores its potential in addressing both motor and non-motor symptoms. Despite available evidence, rigorous clinical trials are needed to validate and optimize the integration of CHM, particularly BZYQT, into therapeutic strategies for PD.
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Affiliation(s)
- Shaohua Lyu
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangdong Provincial Hospital of Chinese Medicine, Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, China
| | - Claire Shuiqing Zhang
- School of Health and Biomedical Sciences, STEM College, RMIT University, Bundoora, VIC, Australia
| | - Zhenhui Mao
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangdong Provincial Hospital of Chinese Medicine, Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, China
| | - Xinfeng Guo
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangdong Provincial Hospital of Chinese Medicine, Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, China
| | - Zhe Li
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangdong Provincial Hospital of Chinese Medicine, Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, China
| | - Xiaodong Luo
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangdong Provincial Hospital of Chinese Medicine, Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, China
| | - Jingbo Sun
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangdong Provincial Hospital of Chinese Medicine, Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, China
| | - Qiaozhen Su
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangdong Provincial Hospital of Chinese Medicine, Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, China
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Phokaewvarangkul O, Kantachadvanich N, Buranasrikul V, Sanyawut K, Phumphid S, Anan C, Bhidayasiri R. Integrating technology into a successful apomorphine delivery program in Thailand: a 10-year journey of achievements with a five-motto concept. Front Neurol 2024; 15:1379459. [PMID: 38645746 PMCID: PMC11026563 DOI: 10.3389/fneur.2024.1379459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 03/18/2024] [Indexed: 04/23/2024] Open
Abstract
Introduction Apomorphine, a potent dopamine agonist, is a therapeutic option for patients with Parkinson's disease and motor fluctuations. However, the adoption of and adherence to this therapy have been limited by the need for complex delivery devices and specialized care as well as resource consumption, posing challenges for new physicians. Thailand is a unique example of a developing nation that has successfully implemented and continued the use of this therapy by employing cooperative technology that has dramatically enhanced apomorphine delivery services. Methods Establishing apomorphine delivery services requires significant resources and step-by-step solutions. We began our services by implementing various strategies in three chronological stages: the initial stage (2013-2015), intermediate stage (2016-2019), and current stage (2020-present), each presenting unique challenges. Together, we also implemented a proposed set of five mottos to strengthen our apomorphine delivery service. Using additive technology, we developed a patient registry platform that combined electronic data acquisition, video and remote monitoring using wearable sensors, and in-house mobile applications to support our service. Results At the initial stage, we assembled a team to enhance the efficacy and confirm the safety of apomorphine treatment in our hospital. At the intermediate stage, we expanded our apomorphine delivery services beyond just the patients at our hospital. We supported other hospitals in Thailand in setting up their own apomorphine services by educating both physicians and nurses regarding apomorphine therapy. With this educational undertaking, increased apomorphine-related knowledge among medical professionals, and a greater number of hospitals providing apomorphine services, an increasing number of patients were administered apomorphine in subsequent years. Currently, we are providing effective apomorphine delivery to improve patient outcomes and are seamlessly integrating technology into clinical practice. Incorporating integrative technologies in our apomorphine delivery program yielded positive results in data collection and support throughout patient care, in tracking patients' statuses, in the long-term use of this treatment, and in increasing medication adherence rates. Conclusion This perspective paper describes how technology can help provide supportive healthcare services in resource-constrained environments, such as in Thailand, offering a step-by-step approach to overcoming several limitations. The valuable insights from our 10-year journey in successfully integrating technology into apomorphine delivery services can benefit new physicians seeking to replicate our success.
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Affiliation(s)
- Onanong Phokaewvarangkul
- Chulalongkorn Centre of Excellence for Parkinson’s Disease & Related Disorders, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Nithinan Kantachadvanich
- Chulalongkorn Centre of Excellence for Parkinson’s Disease & Related Disorders, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Vijittra Buranasrikul
- Chulalongkorn Centre of Excellence for Parkinson’s Disease & Related Disorders, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Kanyawat Sanyawut
- Chulalongkorn Centre of Excellence for Parkinson’s Disease & Related Disorders, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Saisamorn Phumphid
- Chulalongkorn Centre of Excellence for Parkinson’s Disease & Related Disorders, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Chanawat Anan
- Chulalongkorn Centre of Excellence for Parkinson’s Disease & Related Disorders, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Roongroj Bhidayasiri
- Chulalongkorn Centre of Excellence for Parkinson’s Disease & Related Disorders, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
- The Academy of Science, The Royal Science of Thailand, Bangkok, Thailand
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Zhu F, Wang B, Qin D, Su X, Yu L, Wu J, Law BY, Guo M, Yu C, Zhou X, Wu A. Carpesii fructus extract exhibits neuroprotective effects in cellular and Caenorhabditis elegans models of Parkinson's disease. CNS Neurosci Ther 2024; 30:e14515. [PMID: 37905594 PMCID: PMC11017466 DOI: 10.1111/cns.14515] [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: 07/27/2023] [Revised: 10/05/2023] [Accepted: 10/14/2023] [Indexed: 11/02/2023] Open
Abstract
OBJECTIVE Parkinson's disease (PD) is a debilitating neurodegenerative disorder characterized by the progressive loss of dopaminergic neurons in the substantia nigra. Despite extensive research, no definitive cure or effective disease-modifying treatment for PD exists to date. Therefore, the identification of novel therapeutic agents with neuroprotective properties is of utmost importance. Here, we aimed to investigate the potential neuroprotective effects of Carpesii fructus extract (CFE) in both cellular and Caenorhabditis elegans (C. elegans) models of PD. METHODS The neuroprotective effect of CFE in H2O2- or 6-OHDA-induced PC-12 cells and α-synuclein-overexpressing PC-12 cells were investigated by determining the cell viability, mitochondrial damage, reactive oxygen species (ROS) production, apoptosis, and α-synuclein expression. In NL5901, BZ555, and N2 worms, the expression of α-synuclein, motive ability, the viability of dopaminergic neurons, lifespan, and aging-related phenotypes were investigated. The signaling pathway was detected by Western blotting and validated by employing small inhibitors and RNAi bacteria. RESULTS In cellular models of PD, CFE significantly attenuated H2O2- or 6-OHDA-induced toxicity, as evidenced by increased cell viability and reduced apoptosis rate. In addition, CFE treatment suppressed ROS generation and restored mitochondrial membrane potential, highlighting its potential as a mitochondrial protective agent. Furthermore, CFE reduced the expression of α-synuclein in wide type (WT)-, A53T-, A30P-, or E46K-α-synuclein-overexpressing PC-12 cells. Our further findings reveal that CFE administration reduced α-synuclein expression and improved its induced locomotor deficits in NL5901 worms, protected dopaminergic neurons against 6-OHDA-induced degeneration in BZ555 worms, extended lifespan, delayed aging-related phenotypes, and enhanced the ability of stress resistance in N2 worms. Mechanistic studies suggest that the neuroprotective effects of CFE may involve the modulation of the MAPK signaling pathway, including ERK, JNK, and p38, whereas the interference of these pathways attenuated the neuroprotective effect of CFE in vitro and in vivo. CONCLUSION Overall, our study highlights the potential therapeutic value of CFE as a neuroprotective agent in the context of PD. Furthermore, elucidation of the active compounds of CFE will provide valuable insights for the development of novel therapeutic strategies for PD.
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Affiliation(s)
- Feng‐Dan Zhu
- Sichuan Key Medical Laboratory of New Drug Discovery and Drugability Evaluation, Luzhou Key Laboratory of Activity Screening and Druggability Evaluation for Chinese Materia Medica, Key Laboratory of Medical Electrophysiology of Ministry of EducationSchool of Pharmacy, Southwest Medical UniversityLuzhouChina
| | - Bin‐Ding Wang
- Sichuan Key Medical Laboratory of New Drug Discovery and Drugability Evaluation, Luzhou Key Laboratory of Activity Screening and Druggability Evaluation for Chinese Materia Medica, Key Laboratory of Medical Electrophysiology of Ministry of EducationSchool of Pharmacy, Southwest Medical UniversityLuzhouChina
| | - Da‐Lian Qin
- Sichuan Key Medical Laboratory of New Drug Discovery and Drugability Evaluation, Luzhou Key Laboratory of Activity Screening and Druggability Evaluation for Chinese Materia Medica, Key Laboratory of Medical Electrophysiology of Ministry of EducationSchool of Pharmacy, Southwest Medical UniversityLuzhouChina
| | - Xiao‐Hui Su
- Institute of Chinese Materia Medica, China Academy of Chinese Medical SciencesBeijingChina
| | - Lu Yu
- Sichuan Key Medical Laboratory of New Drug Discovery and Drugability Evaluation, Luzhou Key Laboratory of Activity Screening and Druggability Evaluation for Chinese Materia Medica, Key Laboratory of Medical Electrophysiology of Ministry of EducationSchool of Pharmacy, Southwest Medical UniversityLuzhouChina
| | - Jian‐Ming Wu
- Sichuan Key Medical Laboratory of New Drug Discovery and Drugability Evaluation, Luzhou Key Laboratory of Activity Screening and Druggability Evaluation for Chinese Materia Medica, Key Laboratory of Medical Electrophysiology of Ministry of EducationSchool of Pharmacy, Southwest Medical UniversityLuzhouChina
| | - Betty Yuen‐Kwan Law
- State Key Laboratory of Quality Research in Chinese Medicine, Macau University of Science and TechnologyTaipaChina
| | - Min‐Song Guo
- Sichuan Key Medical Laboratory of New Drug Discovery and Drugability Evaluation, Luzhou Key Laboratory of Activity Screening and Druggability Evaluation for Chinese Materia Medica, Key Laboratory of Medical Electrophysiology of Ministry of EducationSchool of Pharmacy, Southwest Medical UniversityLuzhouChina
| | - Chong‐Lin Yu
- Sichuan Key Medical Laboratory of New Drug Discovery and Drugability Evaluation, Luzhou Key Laboratory of Activity Screening and Druggability Evaluation for Chinese Materia Medica, Key Laboratory of Medical Electrophysiology of Ministry of EducationSchool of Pharmacy, Southwest Medical UniversityLuzhouChina
| | - Xiao‐Gang Zhou
- Sichuan Key Medical Laboratory of New Drug Discovery and Drugability Evaluation, Luzhou Key Laboratory of Activity Screening and Druggability Evaluation for Chinese Materia Medica, Key Laboratory of Medical Electrophysiology of Ministry of EducationSchool of Pharmacy, Southwest Medical UniversityLuzhouChina
| | - An‐Guo Wu
- Sichuan Key Medical Laboratory of New Drug Discovery and Drugability Evaluation, Luzhou Key Laboratory of Activity Screening and Druggability Evaluation for Chinese Materia Medica, Key Laboratory of Medical Electrophysiology of Ministry of EducationSchool of Pharmacy, Southwest Medical UniversityLuzhouChina
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Evans A, Waterhouse BJ. Levodopa use in Australia: an analysis of Pharmaceutical Benefits Scheme 10% data. BMJ Neurol Open 2024; 6:e000484. [PMID: 38268755 PMCID: PMC10806810 DOI: 10.1136/bmjno-2023-000484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 11/23/2023] [Indexed: 01/26/2024] Open
Abstract
Background Levodopa remains the mainstay of treatment of Parkinson's disease, however, over time motor fluctuations and levodopa-induced dyskinesia develop, requiring add-on therapies to control emerging symptoms. To date, however, there is no clear consensus in Australia, or elsewhere, at which dose of levodopa that add-on therapies should be considered. Objectives The purpose of this study was to examine the treatment patterns of patients with Parkinson's disease in Australia, with particular focus on levodopa doses at the time of first add-on. Methods This was a retrospective, observational, non-interventional study of patients with Parkinson's disease within the Australian Department of Human Services Pharmaceutical Benefits Scheme (PBS) 10% sample. Data on all reimbursed prescriptions (both general and concession), prescriber type and item code were extracted for patients who were dispensed at least three PBS reimbursed prescriptions for levodopa in the previous 12 months prescription from 1 January 2007 to 31 December 2021. Results 154 850 unique patients were included, of whom 42 330 (27%) commenced add-on therapy during the period. In the 12 months prior to add-on therapy, levodopa doses ranged from 100 mg/day to 1000 mg/day. The majority of patients were prescribed add-on therapy by a neurologist and approximately 40% of patients were prescribed levodopa doses of 600 mg/day or more prior to the first add-on therapy being initiated. Conclusions A large proportion of patients in Australia are managed with levodopa monotherapy doses that are considered high and many of these patients may benefit from the addition of add-on therapy to their regimen.
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Affiliation(s)
- Andrew Evans
- The Royal Melbourne Hospital, Parkville, Victoria, Australia
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Noyes E, Rajput AH, Bocking S, Rajput A. Effect of Levodopa on Heat Hypersensitivity and Complex Motor Parkinsonism. Clin Neuropharmacol 2024; 47:29-32. [PMID: 38154069 DOI: 10.1097/wnf.0000000000000580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2023]
Abstract
OBJECTIVES The aim of the study is to report a case with heat intolerance, complex motor fluctuations, and parkinsonism. MATERIALS AND METHODS A male with onset of heat intolerance at the age of 46 years developed left upper limb tremor at the age of 58 years. He was diagnosed with Parkinson disease at the age of 62 years and presented to Movement Disorders Clinic Saskatchewan at the age of 65 years. He reported motor response fluctuations, including WO and dyskinesias. There was no history of dizziness on standing, bladder, or sexual dysfunction. We recorded an asymptomatic drop of orthostatic blood pressure. He reported loss of smell sensation for 5 years and REM behavior disorder characterized by talking in his sleep. He was assessed at the age of 65 years over the course of a day with 4 video recordings of his evolving findings and symptoms with his informed consent. RESULTS Initial assessment after levodopa was withheld more than 14 hours revealed him to be 'off' with severe dystonic neck flexion and with bradykinesia and rigidity in the limbs. He was anhidrotic, felt hot, and needed a wet towel over his neck. Over the course of 4 hours, he turns "on" with improvement in heat intolerance, neck hypertonicity, and parkinsonian findings and develops evolving dyskinetic movements before turning "off" again. His overall clinical picture was most consistent with multiple system atrophy. CONCLUSIONS Heat intolerance can precede onset of motor symptoms of parkinsonism by several years and supports a diagnosis of multiple system atrophy. To our knowledge, this is the first documented case of improvement in heat intolerance with levodopa.
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Affiliation(s)
- Eric Noyes
- Saskatchewan Movement Disorders Program, Saskatchewan Health Authority/University of Saskatchewan, Saskatoon, Canada
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Zhai H, Fan W, Xiao Y, Zhu Z, Ding Y, He C, Zhang W, Xu Y, Zhang Y. Convergent and divergent intra- and internetwork connectivity in Parkinson's disease with wearing-off. Neurol Sci 2024; 45:155-169. [PMID: 37578631 PMCID: PMC10761410 DOI: 10.1007/s10072-023-07005-2] [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: 02/24/2023] [Accepted: 08/06/2023] [Indexed: 08/15/2023]
Abstract
OBJECTIVE Our study aimed to explore the functional connectivity alterations between cortical nodes of resting-state networks in Parkinson's disease (PD) patients with wearing-off (WO) at different levels. METHODS Resting-state functional magnetic resonance imaging was performed on 36 PD patients without wearing-off (PD-nWO), 30 PD patients with wearing-off (PD-WO), and 35 healthy controls (HCs) to extract functional networks. Integrity, network, and edge levels were calculated for comparison between groups. UPDRS-III, MMSE, MOCA, HAMA, and HAMD scores were collected for further regression analysis. RESULTS We observed significantly reduced connectivity strength in the dorsal attention network and limbic network in the PD-WO group compared with the HC group. The PD-WO group showed a decreased degree of functional connectivity at 12 nodes, including the bilateral orbital part of the superior frontal gyrus, right olfactory cortex, left medial orbital part of the superior frontal gyrus, bilateral gyrus rectus, right parahippocampal gyrus, right thalamus, left Heschl's gyrus, right superior temporal gyrus part of the temporal pole, left middle temporal gyrus part of the temporal pole, and right inferior temporal gyrus. Furthermore, the PD-WO group showed a significantly lower degree of functional connectivity in the left orbital part of the superior frontal gyrus and right gyrus rectus than the PD-nWO group. Internetwork analysis indicated reduced functional connectivity in five pairs of resting-state networks. CONCLUSION Our results demonstrated altered intra- and internetwork connections in PD patients with WO. These findings will facilitate a better understanding of the distinction between the network changes in PD pathophysiology.
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Affiliation(s)
- Heng Zhai
- Department of Neurology, Guangdong Neuroscience Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangdong Province, Guangzhou, 510080, China
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, Hubei Province, China
| | - Wenliang Fan
- Department of Radiology, Union hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, Hubei Province, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, 430022, Hubei Province, China
| | - Yan Xiao
- Department of Radiology, Union hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, Hubei Province, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, 430022, Hubei Province, China
| | - Zhipeng Zhu
- Department of Radiology, Union hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, Hubei Province, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, 430022, Hubei Province, China
| | - Ying Ding
- Department of Radiology, Union hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, Hubei Province, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, 430022, Hubei Province, China
| | - Chentao He
- Department of Neurology, Guangdong Neuroscience Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangdong Province, Guangzhou, 510080, China
| | - Wei Zhang
- Department of Radiology, Union hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, Hubei Province, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, 430022, Hubei Province, China
| | - Yan Xu
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, Hubei Province, China.
| | - Yuhu Zhang
- Department of Neurology, Guangdong Neuroscience Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangdong Province, Guangzhou, 510080, China.
- Guangzhou Key Laboratory of Diagnosis and Treatment for Neurodegenerative Diseases, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, China.
- Guangdong Provincial Key Laboratory of Artificial Intelligence in Medical Image Analysis and Application, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, China.
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Zhai H, Fan W, Xiao Y, Zhu Z, Ding Y, He C, Zhang W, Xu Y, Zhang Y. Voxel-based morphometry of grey matter structures in Parkinson's Disease with wearing-off. Brain Imaging Behav 2023; 17:725-737. [PMID: 37735325 PMCID: PMC10733201 DOI: 10.1007/s11682-023-00793-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/28/2023] [Indexed: 09/23/2023]
Abstract
Our study aimed to investigate the grey matter (GM) changes using voxel-based morphometry (VBM) in Parkinson's disease (PD) patients with wearing-off (WO). 3D-T1-weighted imaging was performed on 48 PD patients without wearing-off (PD-nWO), 39 PD patients with wearing-off (PD-WO) and 47 age and sex-matched healthy controls (HCs). 3D structural images were analyzed by VBM procedure with Statistical Parametric Mapping (SPM12) to detect grey matter volume. Widespread areas of grey matter changes were found in patients among three groups (in bilateral frontal, temporal lobes, lingual gyrus, inferior occipital gyrus, right precuneus, right superior parietal gyrus and right cerebellum). Grey matter reductions were found in frontal lobe (right middle frontal gyrus, superior frontal gyrus and precentral gyrus), right parietal lobe (precuneus, superior parietal gyrus, postcentral gyrus), right temporal lobe (superior temporal gyrus, middle temporal gyrus), bilateral lingual gyrus and inferior occipital gyrus in PD-WO group compared with the PD-nWO group. Our results suggesting that wearing-off may be associated with grey matter atrophy in the cortical areas. These findings may aid in a better understanding of the brain degeneration process in PD with wearing-off.
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Affiliation(s)
- Heng Zhai
- Department of Neurology, Guangdong Neuroscience Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, No. 106 Zhongshan Er Road, Guangzhou, 510080, Guangdong Province, China
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, Hubei Province, China
| | - Wenliang Fan
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, Hubei Province, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, 430022, Hubei Province, China
| | - Yan Xiao
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, Hubei Province, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, 430022, Hubei Province, China
| | - Zhipeng Zhu
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, Hubei Province, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, 430022, Hubei Province, China
| | - Ying Ding
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, Hubei Province, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, 430022, Hubei Province, China
| | - Chentao He
- Department of Neurology, Guangdong Neuroscience Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, No. 106 Zhongshan Er Road, Guangzhou, 510080, Guangdong Province, China
| | - Wei Zhang
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, Hubei Province, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, 430022, Hubei Province, China
| | - Yan Xu
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, Hubei Province, China
| | - Yuhu Zhang
- Department of Neurology, Guangdong Neuroscience Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, No. 106 Zhongshan Er Road, Guangzhou, 510080, Guangdong Province, China.
- Guangzhou Key Laboratory of Diagnosis and Treatment for Neurodegenerative Diseases, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, China.
- Guangdong Provincial Key Laboratory of Artificial Intelligence in Medical Image Analysis and Application, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, China.
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11
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Koch J. Management of OFF condition in Parkinson disease. Ment Health Clin 2023; 13:289-297. [PMID: 38058599 PMCID: PMC10696172 DOI: 10.9740/mhc.2023.12.289] [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: 03/21/2023] [Accepted: 08/31/2023] [Indexed: 12/08/2023] Open
Abstract
Parkinson disease (PD) impacts nearly 1 million individuals in the United States. Nearly every patient with PD will require therapy with dopamine in the form of levodopa as the disease progresses. In more advanced stages of the disease, patients will experience motor fluctuations and require adjustment to their medication regimens to maintain good control of their symptoms. During the last 10 years, several new therapeutic treatment options have come to the market to treat motor fluctuations and improve patient quality of life. Some of these agents represent additional options to previously available drug classes, such as the catechol-O-methyl transferase (COMT) inhibitor, opicapone, and monoamine-oxidase B-inhibitor (MAO-B inhibitor), safinamide, as well as new dosage forms for available therapeutics. One new agent, istradefylline, has a novel mechanism in the treatment of PD. The place in therapy for these newer therapeutic options will be explored through a series of patient cases. This article focuses on evidence-based recommendations for the use of these newer options in the management of patients experiencing OFF episodes.
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12
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Nomoto Y, Furihata M, Hagiwara H, Ishino H, Yano S, Okawa H, Nakatsu Y, Noda K, Nishi S, Ogiwara S, Kitamura T, Osada T. Transgastric Jejunostomy (PEG-J) for Continuous Infusion of Levodopa-Carbidopa Intestinal Gel: An Approach for Parkinson's Disease Treatment. Med Sci Monit 2023; 29:e941285. [PMID: 37571821 PMCID: PMC10429380 DOI: 10.12659/msm.941285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 06/28/2023] [Indexed: 08/13/2023] Open
Abstract
BACKGROUND Parkinson's disease (PD) is a neurodegenerative disorder that often requires long-term management of motor symptoms. Continuous infusion of levodopa-carbidopa intestinal gel (LCIG) has shown promising results in alleviating motor fluctuations and improving quality of life. This study aimed to evaluate the efficacy and safety of transgastric jejunostomy (PEG-J) as a delivery method for LCIG in a cohort of 43 PD patients. MATERIAL AND METHODS Forty-three PD patients who were candidates for LCIG therapy underwent transgastric jejunostomy to facilitate continuous infusion of LCIG. The primary outcomes assessed were motor symptom improvement, reduction in motor fluctuations, and medication-related adverse events. Secondary outcomes included changes in quality of life, dyskinesia severity, and healthcare resource utilization. RESULTS The results of this study demonstrated significant improvements in motor symptoms, reduction in motor fluctuations, and enhanced quality of life following PEG-J for LCIG infusion. The treatment was generally well-tolerated, with a low incidence of procedure-related complications. Notably, the use of PEG-J allowed for precise and continuous delivery of LCIG, minimizing variations in drug absorption and ensuring consistent therapeutic levels. CONCLUSIONS Transgastric jejunostomy (PEG-J) offers an effective approach for the continuous infusion of LCIG in Parkinson's disease treatment. This method provides a stable and reliable delivery system, leading to improved symptom control and enhanced quality of life for PD patients.
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Doggrell SA. Continuous subcutaneous levodopa-carbidopa for the treatment of advanced Parkinson's disease: is it an improvement on other delivery? Expert Opin Drug Deliv 2023; 20:1189-1199. [PMID: 37634938 DOI: 10.1080/17425247.2023.2253146] [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: 02/19/2023] [Revised: 08/06/2023] [Accepted: 08/25/2023] [Indexed: 08/29/2023]
Abstract
INTRODUCTION Parkinson's disease (PD) is the second most common neurodegenerative disease and is growing in prevalence and disability. The standard treatment for PD is oral levo-dopa (LD) with carbidopa (CD). As PD progresses, despite higher doses of LD/CD, plasma levels of LD fluctuate, and may be associated with motor fluctuations and dyskinesia. AREAS COVERED The development of two new subcutaneous preparations of LD/CD (ND0612 and ABBV-951) for the treatment of motor fluctuations in PD is described in detail. Both reduce motor fluctuations and dyskinesia with minor infusion site adverse events. A third subcutaneous preparation, DIZ102, is in early-stage development. EXPERT OPINION The premise for using continuous release LD in advanced PD is that steady state levels of LD will prevent motor fluctuations/dyskinesia, but this is not the whole story, and will limit the benefits of subcutaneous continuous release LD. With its present pump system ND0612 cannot be used as monotherapy, whereas ABBV-951 can be. Having to combine with oral LD/CD will complicate the use of ND0612. Both ND0612 and ABBV-951 only cause modest reductions in OFF time. It is not clear whether these subcutaneous preparations will have more benefits than the intestinal gel, which also reduces OFF time and dyskinesia.
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Affiliation(s)
- Sheila A Doggrell
- School of Pharmacy and Medical Sciences, Griffith University, Gold Coast Campus, Gold Coast, Queensland, Australia
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14
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Wu C, Zhao L, Guo Y, Hao X, Fan Y, Wu P, Han J, Li Q, Wang X, Wang Q, Luo X, Zhu M. Moxibustion treatment for Parkinson's disease: study protocol for a randomized controlled trial. BMC Complement Med Ther 2023; 23:193. [PMID: 37303044 DOI: 10.1186/s12906-023-03995-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Accepted: 05/09/2023] [Indexed: 06/13/2023] Open
Abstract
BACKGROUND Parkinson's disease (PD) is the second most common neurodegenerative disorder and seriously affects quality of life globally. Moxibustion is widely used to treat neurodegenerative diseases in the clinic and has achieved a beneficial clinical effect. However, strict control and high-quality randomized controlled trials are still lacking. Therefore, this trial aims to evaluate the clinical efficacy and safety of moxibustion in patients with PD and preliminarily explore the underlying mechanism. METHODS This is a randomized, single-blind and placebo-controlled trial design in which 70 eligible participants will be randomly divided into a moxibustion group and a sham moxibustion group. Baihui (DU20) and Sishenchong (EX-HN1) are selected for both groups. The treatment will be performed for 30 min per session, two sessions a week for 8 weeks. The mean change in MDS-UPDRS scores (including MDS-UPDRS II, III subscale scores and total scores) from baseline to the observation points will be the primary outcome. The secondary outcomes will include scores on the Parkinson's Disease Questionnaire-39 (PDQ-39), Fatigue Severity Scale (FSS), Parkinson Disease Sleep Scale (PDSS), Montreal Cognitive Assessment (MoCA), and Self-Rating Depression Scale (SDS) as well as the Wexner constipation score. All the above outcomes will be assessed at 4 and 8 weeks. Laboratory blood biochemical analysis and functional magnetic resonance imaging (fMRI) will be conducted at baseline and at the end of treatment to explore the potential mechanisms of moxibustion in regulating PD. DISCUSSION In conclusion, the results of this trial will reveal whether moxibustion is effective for treating motor and nonmotor symptoms in PD. This trial will also preliminarily explore the underlying mechanism of the regulatory effect of moxibustion in PD, which will contribute to providing a theoretical basis for the treatment of PD. TRIAL REGISTRATION ClinicalTrials.gov ChiCTR2000029745. Registered on 9 August 2021.
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Affiliation(s)
- Chunxiao Wu
- Shenzhen Hospital of Integrated Traditional Chinese and Western Medicine, Shenzhen, People's Republic of China
- The Research Center of Basic Integrative Medicine, Guangzhou University of Chinese Medicine, Guangzhou, 510405, Guangdong Province, People's Republic of China
| | - Lijun Zhao
- Shenzhen Hospital of Integrated Traditional Chinese and Western Medicine, Shenzhen, People's Republic of China
| | - Yuelin Guo
- Shenzhen Hospital of Integrated Traditional Chinese and Western Medicine, Shenzhen, People's Republic of China
| | - Xiaoqian Hao
- Shenzhen Hospital of Integrated Traditional Chinese and Western Medicine, Shenzhen, People's Republic of China
| | - Yaohua Fan
- Shenzhen Hospital of Integrated Traditional Chinese and Western Medicine, Shenzhen, People's Republic of China
| | - Peipei Wu
- Shenzhen Hospital of Integrated Traditional Chinese and Western Medicine, Shenzhen, People's Republic of China
| | - Jiajun Han
- Shenzhen Hospital of Integrated Traditional Chinese and Western Medicine, Shenzhen, People's Republic of China
| | - Qinglian Li
- Shenzhen Hospital of Integrated Traditional Chinese and Western Medicine, Shenzhen, People's Republic of China
| | - Xiaoling Wang
- Shenzhen Hospital of Integrated Traditional Chinese and Western Medicine, Shenzhen, People's Republic of China
| | - Qizhang Wang
- Shenzhen Hospital of Integrated Traditional Chinese and Western Medicine, Shenzhen, People's Republic of China
| | - Xiaodong Luo
- Department of Neurology, The Second Affiliated Hospital, Guangzhou University of Chinese Medicine, Guangzhou, China.
| | - Meiling Zhu
- Shenzhen Hospital of Integrated Traditional Chinese and Western Medicine, Shenzhen, People's Republic of China.
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Mishima T, Chiu SW, Saiki H, Yamaguchi T, Shimo Y, Maeda T, Watanabe H, Kashihara K, Nomoto M, Hattori N, Tsuboi Y. Risk factors for developing dyskinesia among Parkinson's disease patients with wearing-off: J-FIRST. J Neurol Sci 2023; 448:120619. [PMID: 37023638 DOI: 10.1016/j.jns.2023.120619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 02/08/2023] [Accepted: 03/20/2023] [Indexed: 04/03/2023]
Abstract
BACKGROUND Dyskinesia frequently occurs during long-term treatment with levodopa in patients with Parkinson's disease (PD) and impacts quality of life. Few studies have examined risk factors for developing dyskinesia in PD patients exhibiting wearing-off. Therefore, we investigated the risk factors and impact of dyskinesia in PD patients exhibiting wearing-off. METHODS We investigated the risk factors and impact of dyskinesia in a 1-year observational study of Japanese PD patients exhibiting wearing-off (J-FIRST). Risk factors were assessed by logistic regression analyses in patients without dyskinesia at study entry. Mixed-effect models were used to evaluate the impact of dyskinesia on changes in Movement Disorder Society-Unified PD Rating Scale (MDS-UPDRS) Part I and PD Questionnaire (PDQ)-8 scores from one timepoint before dyskinesia was observed. RESULTS Of 996 patients analyzed, 450 had dyskinesia at baseline, 133 developed dyskinesia within 1 year, and 413 did not develop dyskinesia. Female sex (odds ratio [95% confidence interval]: 2.636 [1.645-4.223]) and administration of a dopamine agonist (1.840 [1.083-3.126]), a catechol-O-methyltransferase inhibitor (2.044 [1.285-3.250]), or zonisamide (1.869 [1.184-2.950]) were independent risk factors for dyskinesia onset. MDS-UPDRS Part I and PDQ-8 scores increased significantly after the onset of dyskinesia (least-squares mean change [standard error] at 52 weeks: 1.11 [0.52], P = 0.0336; 1.53 [0.48], P = 0.0014; respectively). CONCLUSION Female sex and administration of a dopamine agonist, a catechol-O-methyltransferase inhibitor, or zonisamide were risk factors for dyskinesia onset within 1 year in PD patients exhibiting wearing-off. Nonmotor symptoms and quality of life deteriorated after dyskinesia onset.
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Masood N, Jimenez-Shahed J. Effective Management of "OFF" Episodes in Parkinson's Disease: Emerging Treatment Strategies and Unmet Clinical Needs. Neuropsychiatr Dis Treat 2023; 19:247-266. [PMID: 36721795 PMCID: PMC9884436 DOI: 10.2147/ndt.s273121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 01/05/2023] [Indexed: 01/26/2023] Open
Abstract
Motor complications related to the chronic administration of levodopa and failure to prevent the neurodegenerative disease process counterbalance the pivotal discovery of levodopa as the cornerstone of PD treatment. Excellent motor control is offered early during the course of treatment, but this diminishes as pathological changes in the striatum lead to synaptic dopamine levels becoming completely dependent on exogenous dopamine. This non-physiologic stimulation of dopamine receptors eventually manifests as OFF episodes. As no disease modifying therapy exists for PD that can disrupt these pathological changes, most research and treatment focuses on optimization of dopaminergic stimulation of striatal receptors so that they mimic tonic, physiologic stimulation as closely as possible. Strategies focusing on these challenges have included non-pharmacologic approaches, optimizing levodopa pharmacokinetics, using adjunctive treatments including those with non-dopaminergic mechanisms, and implementing rescue therapies. Device aided therapies, including surgery, are also available. In this review, we will focus on effective management of motor symptoms related to OFF periods, including emerging strategies. Unmet clinical needs will be discussed, including non-motor symptoms, targeted molecular therapies and disease modifying therapy.
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Affiliation(s)
- Nbaa Masood
- Department of Neurology, Icahn School of Medicine at Mount Sinai, Mount Sinai West, New York, NY, USA
| | - Joohi Jimenez-Shahed
- Department of Neurology, Icahn School of Medicine at Mount Sinai, Mount Sinai West, New York, NY, USA
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LeWitt P, Ellenbogen A, Burdick D, Gunzler S, Gil R, Dhall R, Banisadr G, D'Souza R. Improving levodopa delivery: IPX203, a novel extended-release carbidopa-levodopa formulation. Clin Park Relat Disord 2023; 8:100197. [PMID: 37181100 PMCID: PMC10172697 DOI: 10.1016/j.prdoa.2023.100197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 04/05/2023] [Accepted: 04/17/2023] [Indexed: 05/16/2023] Open
Abstract
Introduction IPX203 is a novel oral extended-release (ER) formulation of carbidopa (CD) and levodopa (LD) developed to address the short half-life and limited area for absorption of LD in the gastrointestinal tract. This paper presents the formulation strategy of IPX203 and its relationship to the pharmacokinetics (PK) and pharmacodynamic profile of IPX203 in Parkinson's disease (PD) patients. Methods IPX203 was developed with an innovative technology containing immediate-release (IR) granules and ER beads that provides rapid LD absorption to achieve desired plasma concentration and maintaining it within the therapeutic range for longer than can be achieved with current oral LD formulations. The PK and pharmacodynamics of IPX203 were compared with IR CD-LD in a Phase 2, open-label, rater-blinded, multicenter, crossover study in patients with advanced PD. Results Pharmacokinetic data showed that on Day 15, LD concentrations were sustained above 50% of peak for 6.2 h with IPX203 vs. 3.9 h with IR CD-LD (P = 0.0002). Pharmacodynamic analysis demonstrated that mean MDS-UPDRS Part III scores prior to administration of the first daily dose were significantly lower among patients receiving IPX203 than IR CD-LD (LS mean difference -8.1 [25.0], P = 0.0255). In a study conducted in healthy volunteers, a high-fat, high-calorie meal delayed plasma LD Tmax by 2 h, and increased Cmax and AUCtau by approximately 20% compared with a fasted state. Sprinkling capsule contents on applesauce did not affect PK parameters. Conclusion These data confirm that the unique design of IPX203 addresses some of the limitations of oral LD delivery.
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Affiliation(s)
- Peter LeWitt
- Departments of Neurology, Wayne State University School of Medicine and Henry Ford Hospital, Sastry Foundation Endowed Chair in Neurology, 4201 St. Antoine, Detroit, MI 48201, United States
| | - Aaron Ellenbogen
- Michigan Institute for Neurological Disorders and Quest Research Institute, 28595 Orchard Lake Road, #200, Farmington Hills, MI 48334, United States
| | - Daniel Burdick
- Booth Gardner Parkinson’s Care Center, EvergreenHealth Medical Center, 12039 NE 128th Street #300, Kirkland, WA 98034, United States
| | - Steven Gunzler
- Parkinson’s and Movement Disorders Center, University Hospitals Cleveland Medical Center and Case Western Reserve University School of Medicine, 11100 Euclid Avenue, Cleveland, OH 44106, United States
| | - Ramon Gil
- Parkinson’s Disease Treatment Center of Southwest Florida, 4235 Kings Highway, #102, Port Charlotte, FL 33980, United States
| | - Rohit Dhall
- University of Arkansas for Medical Sciences, 4301 W Markham Street, Little Rock, AR 72205, United States
| | - Ghazal Banisadr
- Amneal Pharmaceuticals, LLC, 400 Crossing Boulevard, Bridgewater, NJ 08807, United States
- Corresponding author at: Amneal Pharmaceuticals, 400 Crossing Boulevard, 3rd Floor, Bridgewater, NJ 08807, United States.
| | - Richard D'Souza
- Amneal Pharmaceuticals, LLC, 400 Crossing Boulevard, Bridgewater, NJ 08807, United States
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Mata-Marín D, Pineda-Pardo JÁ, Michiels M, Pagge C, Ammann C, Martínez-Fernández R, Molina JA, Vela-Desojo L, Alonso-Frech F, Obeso I. A circuit-based approach to modulate hypersexuality in Parkinson's disease. Psychiatry Clin Neurosci 2022; 77:223-232. [PMID: 36579893 DOI: 10.1111/pcn.13523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 12/17/2022] [Accepted: 12/20/2022] [Indexed: 12/30/2022]
Abstract
AIM Impulse-control disorder is a common neuropsychiatric complication in Parkinson's disease (PD) under dopamine replacement therapy. Prior studies tested the balance between enhanced desire towards reward and cognitive control deficits, hypothesized to be biased towards the former in impulse control disorders. We provide evidence for this hypothesis by measuring behavioral and neural patterns behind the influence of sexual desire over response inhibition and tools towards functional restoration using repetitive transcranial stimulation in patients with hypersexuality as predominant impulsive disorder. METHODS The effect of sexual cues on inhibition was measured with a novel erotic stop-signal task under on and off dopaminergic medication. Task-related functional and anatomical connectivity models were estimated in 16 hypersexual and 17 nonhypersexual patients with PD as well as in 17 healthy controls. Additionally, excitatory neuromodulation using intermittent theta-burst stimulation (sham-controlled) was applied over the pre-supplementary motor area in 20 additional hypersexual patients with PD aiming to improve response inhibition. RESULTS Compared with their nonhypersexual peers, patients with hypersexuality recruited caudate, pre-supplementary motor area, ventral tegmental area, and anterior cingulate cortex while on medication. Reduced connectivity was found between pre-supplementary motor area and caudate nucleus in hypersexual compared with nonhypersexual patients (while medicated), a result paralleled by compensatory enhanced anatomical connectivity. Furthermore, stimulation over the pre-supplementary motor area improved response inhibition in hypersexual patients with PD when exposed to sexual cues. CONCLUSION This study, therefore, has identified a specific fronto-striatal and mesolimbic circuitry underlying uncontrolled sexual responses in medicated patients with PD where cortical neuromodulation halts its expression.
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Affiliation(s)
- David Mata-Marín
- Centro Integral de Neurociencias Abarca Campal (HM CINAC), Hospital Universitario HM Puerta del Sur. HM Hospitales, Madrid, Spain.,Network Center for Biomedical Research on Neurodegenerative Diseases (CIBERNED), Instituto Carlos III, Madrid, Spain.,PhD program in Neuroscience, Autonoma University of Madrid, Madrid, Spain
| | - José Ángel Pineda-Pardo
- Centro Integral de Neurociencias Abarca Campal (HM CINAC), Hospital Universitario HM Puerta del Sur. HM Hospitales, Madrid, Spain.,Network Center for Biomedical Research on Neurodegenerative Diseases (CIBERNED), Instituto Carlos III, Madrid, Spain
| | - Mario Michiels
- Centro Integral de Neurociencias Abarca Campal (HM CINAC), Hospital Universitario HM Puerta del Sur. HM Hospitales, Madrid, Spain.,Network Center for Biomedical Research on Neurodegenerative Diseases (CIBERNED), Instituto Carlos III, Madrid, Spain.,PhD program in Neuroscience, Autonoma University of Madrid, Madrid, Spain
| | - Cristina Pagge
- Centro Integral de Neurociencias Abarca Campal (HM CINAC), Hospital Universitario HM Puerta del Sur. HM Hospitales, Madrid, Spain.,PhD program in Neuroscience, Autonoma University of Madrid, Madrid, Spain
| | - Claudia Ammann
- Centro Integral de Neurociencias Abarca Campal (HM CINAC), Hospital Universitario HM Puerta del Sur. HM Hospitales, Madrid, Spain
| | - Raúl Martínez-Fernández
- Centro Integral de Neurociencias Abarca Campal (HM CINAC), Hospital Universitario HM Puerta del Sur. HM Hospitales, Madrid, Spain.,Network Center for Biomedical Research on Neurodegenerative Diseases (CIBERNED), Instituto Carlos III, Madrid, Spain
| | | | | | | | - Ignacio Obeso
- Centro Integral de Neurociencias Abarca Campal (HM CINAC), Hospital Universitario HM Puerta del Sur. HM Hospitales, Madrid, Spain.,Network Center for Biomedical Research on Neurodegenerative Diseases (CIBERNED), Instituto Carlos III, Madrid, Spain.,Department of Psychobiology & Methods for the Behavioral Sciences Department, Complutense University of Madrid, Madrid, Spain
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19
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Sriram S, Root K, Chacko K, Patel A, Lucke-Wold B. Surgical Management of Synucleinopathies. Biomedicines 2022; 10:biomedicines10102657. [PMID: 36289920 PMCID: PMC9599076 DOI: 10.3390/biomedicines10102657] [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: 09/20/2022] [Revised: 10/19/2022] [Accepted: 10/19/2022] [Indexed: 12/03/2022] Open
Abstract
Synucleinopathies represent a diverse set of pathologies with significant morbidity and mortality. In this review, we highlight the surgical management of three synucleinopathies: Parkinson’s disease (PD), dementia with Lewy bodies (DLB), and multiple system atrophy (MSA). After examining underlying molecular mechanisms and the medical management of these diseases, we explore the role of deep brain stimulation (DBS) in the treatment of synuclein pathophysiology. Further, we examine the utility of focused ultrasound (FUS) in the treatment of synucleinopathies such as PD, including its role in blood–brain barrier (BBB) opening for the delivery of novel drug therapeutics and gene therapy vectors. We also discuss other recent advances in the surgical management of MSA and DLB. Together, we give a diverse overview of current techniques in the neurosurgical management of these pathologies.
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20
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Rota S, Urso D, van Wamelen DJ, Leta V, Boura I, Odin P, Espay AJ, Jenner P, Chaudhuri KR. Why do 'OFF' periods still occur during continuous drug delivery in Parkinson's disease? Transl Neurodegener 2022; 11:43. [PMID: 36229860 PMCID: PMC9558383 DOI: 10.1186/s40035-022-00317-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 09/19/2022] [Indexed: 11/10/2022] Open
Abstract
Continuous drug delivery (CDD) is used in moderately advanced and late-stage Parkinson’s disease (PD) to control motor and non-motor fluctuations (‘OFF’ periods). Transdermal rotigotine is indicated for early fluctuations, while subcutaneous apomorphine infusion and levodopa-carbidopa intestinal gel are utilised in advanced PD. All three strategies are considered examples of continuous dopaminergic stimulation achieved through CDD. A central premise of the CDD is to achieve stable control of the parkinsonian motor and non-motor states and avoid emergence of ‘OFF’ periods. However, data suggest that despite their efficacy in reducing the number and duration of ‘OFF’ periods, these strategies still do not prevent ‘OFF’ periods in the middle to late stages of PD, thus contradicting the widely held concepts of continuous drug delivery and continuous dopaminergic stimulation. Why these emergent ‘OFF’ periods still occur is unknown. In this review, we analyse the potential reasons for their persistence. The contribution of drug- and device-related involvement, and the problems related to site-specific drug delivery are analysed. We propose that changes in dopaminergic and non-dopaminergic mechanisms in the basal ganglia might render these persistent ‘OFF’ periods unresponsive to dopaminergic therapy delivered via CDD.
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Affiliation(s)
- Silvia Rota
- Department of Basic and Clinical Neurosciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK. .,Parkinson's Foundation Centre of Excellence, King's College Hospital, London, UK. .,Department of Neuroimaging, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
| | - Daniele Urso
- Department of Basic and Clinical Neurosciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,Centre for Neurodegenerative Diseases and the Aging Brain, Department of Clinical Research in Neurology, University of Bari 'Aldo Moro, "Pia Fondazione Cardinale G. Panico", 73039, Tricase, Italy
| | - Daniel J van Wamelen
- Department of Basic and Clinical Neurosciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,Parkinson's Foundation Centre of Excellence, King's College Hospital, London, UK.,Department of Neuroimaging, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Valentina Leta
- Department of Basic and Clinical Neurosciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,Parkinson's Foundation Centre of Excellence, King's College Hospital, London, UK
| | - Iro Boura
- Department of Basic and Clinical Neurosciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,School of Medicine, University of Crete, Crete, Greece.,Department of Neurology, University Hospital of Heraklion, Crete, Greece
| | - Per Odin
- Division of Neurology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Alberto J Espay
- University of Cincinnati Gardner Neuroscience Institute, Gardner Family Center for Parkinson's Disease and Movement Disorders, Department of Neurology, University of Cincinnati, Cincinnati, OH, USA
| | - Peter Jenner
- Institute of Pharmaceutical Sciences, Faculty of Life Science and Medicine, King's College London, London, UK.
| | - K Ray Chaudhuri
- Department of Basic and Clinical Neurosciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,Parkinson's Foundation Centre of Excellence, King's College Hospital, London, UK
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21
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Effectiveness and safety of safinamide in routine clinical practice in a Belgian Parkinson's disease population: an open-label, levodopa add-on study. Acta Neurol Belg 2022:10.1007/s13760-022-02100-1. [PMID: 36201116 DOI: 10.1007/s13760-022-02100-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 09/15/2022] [Indexed: 11/01/2022]
Abstract
BACKGROUND Safinamide is a recent multimodal antiparkinsonian drug that inhibits monoamine oxidase B and modulates the glutamatergic system with positive effects on motor and nonmotor symptoms of Parkinson's disease (PD). This post-hoc analysis of the European SYNAPSES study provides first-time data on the use of safinamide in routine clinical practice in Belgium. OBJECTIVE To describe the efficacy and safety of safinamide in Belgian PD patients in real-life conditions. METHODS Post-hoc analysis of the Belgian cohort from the European SYNAPSES trial, which was an observational, multicenter, retrospective-prospective cohort study. Patients were followed up to 12 months. Analyses were performed in the overall population and according to different criteria such as the age limit (> 75 years), presence or absence of relevant comorbidities, presence or absence of psychiatric conditions such as depression and anxiety, patients on levodopa monotherapy or levodopa in combination with other treatments, patients on rasagiline before inclusion or not. RESULTS Of the 172 patients included, 29.2% were > 75 years, 58.9% had relevant comorbidities and 32.7% had psychiatric conditions. Almost all the patients reported motor (98.8%) or non-motor (86.3%) symptoms. During the study, 36.3% of patients reported drug-related reactions. The adverse drug reactions were those already described in the patients' information leaflet. The majority were mild or moderate and completely resolved and no differences were detected between the subgroups of patients. Almost 35% of the patients demonstrated a clinically significant improvement in the UPDRS and 50% of the patients with wearing-off at baseline, did not report wearing-off anymore after one year of treatment. Patients under levodopa monotherapy compared to patients receiving levodopa combined with other antiparkinsonian treatments benefit more from safinamide treatment. Patients switched from rasagiline to safinamide seemed also to benefit more from safinamide treatment. CONCLUSION The study confirms the excellent safety and efficacy profile of safinamide, particularly in more vulnerable groups of patients such as the elderly and patients with significant comorbidities or psychiatric conditions such as depression or anxiety.
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22
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GÜNEŞ M, KARAVANA SY. Non-Oral Drug Delivery in Parkinson’s Disease: Current Applications and Future. Turk J Pharm Sci 2022; 19:343-352. [DOI: 10.4274/tjps.galenos.2021.95226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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23
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Barra ME, Edlow BL, Brophy GM. Pharmacologic Therapies to Promote Recovery of Consciousness. Semin Neurol 2022; 42:335-347. [PMID: 36100228 DOI: 10.1055/s-0042-1755271] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
Pharmacologic interventions are commonly used to support rehabilitation efforts of patients with disorders of consciousness (DoC). The 2018 practice guidelines recommend amantadine in adults with traumatic DoC to promote functional recovery, though several other stimulants are used off-label in clinical practice and trials, such as methylphenidate, bromocriptine, levodopa, and zolpidem. Differences in the mechanisms of action, adverse effects, pharmacokinetics, and drug-drug interactions should be considered when selecting the best agent for each individual patient. Overall, pharmacologic stimulants may provide a safe and inexpensive pathway to increased functionality and participation in rehabilitation. This article provides a concise summary of scientific evidence supporting the use of pharmacologic therapies to stimulate recovery of consciousness in patients with DoC.
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Affiliation(s)
- Megan E Barra
- Department of Pharmacy, Massachusetts General Hospital, Boston, Massachusetts.,Department of Neurology, Center for Neurotechnology and Neurorecovery (CNTR), Massachusetts General Hospital, Boston, Massachusetts
| | - Brian L Edlow
- Department of Neurology, Center for Neurotechnology and Neurorecovery (CNTR), Massachusetts General Hospital, Boston, Massachusetts.,Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, Massachusetts
| | - Gretchen M Brophy
- Department of Pharmacotherapy and Outcomes Science and Neurosurgery, Virginia Commonwealth University, Medical College of Virginia, Richmond, Virginia
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24
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Jaramillo-Jimenez A, Ying Y, Ren P, Xiao Z, Zhang Q, Wang J, Rong H, Borda MG, Bonanni L, Aarsland D, Wu D. Prodromal Dementia With Lewy Bodies and Recurrent Panic Attacks as the First Symptom: A Case Report. Front Neurol 2022; 13:839539. [PMID: 35493812 PMCID: PMC9043811 DOI: 10.3389/fneur.2022.839539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 03/03/2022] [Indexed: 11/13/2022] Open
Abstract
Psychiatric-onset dementia with Lewy bodies (DLB) might include symptoms of depression, hallucinations, anxiety, and apathy. Here, we report a patient with DLB with recurrent panic attacks as her first symptom 5 years before a biological-based diagnosis of probable DLB. We provide an extended description of the clinical presentation and course from psychiatric-onset DLB to dementia in an 83-year-old woman. This case illustrates the common misdiagnosis of DLB and the delay of having a detailed clinical and biomarker assessment for structured diagnosis. With a detailed description of the clinical presentation of this case, the empirical treatment strategies, and the patient perspectives, we aim to make clinicians aware of panic attacks within the psychiatric-onset DLB.
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Affiliation(s)
- Alberto Jaramillo-Jimenez
- Centre for Age-Related Medicine (SESAM), Stavanger University Hospital, Stavanger, Norway
- Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
- Grupo de Neurociencias de Antioquia, School of Medicine Medellín, Universidad de Antioquia, Medellín, Colombia
- Grupo Neuropsicología y Conducta, School of Medicine Medellín, Universidad de Antioquia, Medellín, Colombia
- *Correspondence: Alberto Jaramillo-Jimenez
| | - Yinbing Ying
- Shenzhen Kangning Hospital, Shenzhen Mental Health Center, Shenzhen, China
| | - Ping Ren
- Shenzhen Kangning Hospital, Shenzhen Mental Health Center, Shenzhen, China
| | - Zhan Xiao
- Shenzhen Kangning Hospital, Shenzhen Mental Health Center, Shenzhen, China
| | - Qian Zhang
- Shenzhen Kangning Hospital, Shenzhen Mental Health Center, Shenzhen, China
| | - Jian Wang
- Shenzhen Kangning Hospital, Shenzhen Mental Health Center, Shenzhen, China
| | - Han Rong
- Shenzhen Kangning Hospital, Shenzhen Mental Health Center, Shenzhen, China
| | - Miguel Germán Borda
- Centre for Age-Related Medicine (SESAM), Stavanger University Hospital, Stavanger, Norway
- Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
- Semillero de Neurociencias y Envejecimiento, Ageing Institute, Medical School, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Laura Bonanni
- Department of Medicine and Aging Sciences, University G. D'Annunzio of Chieti-Pescara, Chieti, Italy
| | - Dag Aarsland
- Centre for Age-Related Medicine (SESAM), Stavanger University Hospital, Stavanger, Norway
- Department of Old Age Psychiatry, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, United Kingdom
- Dag Aarsland
| | - Donghui Wu
- Shenzhen Kangning Hospital, Shenzhen Mental Health Center, Shenzhen, China
- Donghui Wu
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25
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Saba RA, Maia DP, Cardoso FEC, Borges V, F. Andrade LA, Ferraz HB, Barbosa ER, Rieder CRDM, da Silva DJ, Chien HF, Capato T, Rosso AL, Souza Lima CF, Bezerra JMF, Nicaretta D, Povoas Barsottini OG, Godeiro-Júnior C, Broseghini Barcelos L, Gisbert Cury R, Spitz M, Azevedo Silva SMC, Della Colletta MV. Guidelines for Parkinson’s disease treatment: consensus from the Movement Disorders Scientific Department of the Brazilian Academy of Neurology - motor symptoms. ARQUIVOS DE NEURO-PSIQUIATRIA 2022; 80:316-329. [DOI: 10.1590/0004-282x-anp-2021-0219] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Accepted: 10/02/2021] [Indexed: 11/21/2022]
Abstract
ABSTRACT The treatment of Parkinson's disease (PD) is challenging, especially since it is considered highly individualized. The Brazilian Academy of Neurology has recognized the need to disseminate knowledge about the management of PD treatment, adapting the best evidence to the Brazilian reality. Thus, the main published treatment guidelines were reviewed based on the recommendations of group from the Movement Disorders Scientific Department of the Brazilian Academy of Neurology.
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Affiliation(s)
- Roberta Arb Saba
- Universidade Federal de São Paulo, Brazil; Hospital do Servidor Público Estadual, Brazil
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26
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Hatano T, Kano O, Sengoku R, Yoritaka A, Suzuki K, Nishikawa N, Mukai Y, Nomura K, Yoshida N, Seki M, Matsukawa MK, Terashi H, Kimura K, Tashiro J, Hirano S, Murakami H, Joki H, Uchiyama T, Shimura H, Ogaki K, Fukae J, Tsuboi Y, Takahashi K, Yamamoto T, Yanagisawa N, Nagayama H. Evaluating the impact of adjunctive istradefylline on the cumulative dose of levodopa-containing medications in Parkinson's disease: study protocol for the ISTRA ADJUST PD randomized, controlled study. BMC Neurol 2022; 22:71. [PMID: 35241003 PMCID: PMC8892732 DOI: 10.1186/s12883-022-02600-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 02/23/2022] [Indexed: 12/02/2022] Open
Abstract
Background Levodopa remains the most effective symptomatic treatment for Parkinson’s disease (PD) more than 50 years after its clinical introduction. However, the onset of motor complications can limit pharmacological intervention with levodopa, which can be a challenge when treating PD patients. Clinical data suggest using the lowest possible levodopa dose to balance the risk/benefit. Istradefylline, an adenosine A2A receptor antagonist indicated as an adjunctive treatment to levodopa-containing preparations in PD patients experiencing wearing off, is currently available in Japan and the US. Preclinical and preliminary clinical data suggested that adjunctive istradefylline may provide sustained antiparkinsonian benefits without a levodopa dose increase; however, available data on the impact of istradefylline on levodopa dose titration are limited. The ISTRA ADJUST PD study will evaluate the effect of adjunctive istradefylline on levodopa dosage titration in PD patients. Methods This 37-week, multicenter, randomized, open-label, parallel-group controlled study in PD patients aged 30–84 years who are experiencing the wearing-off phenomenon despite receiving levodopa-containing medications ≥ 3 times daily (daily dose 300–400 mg) began in February 2019 and will continue until February 2022. Enrollment is planned to attain 100 evaluable patients for the efficacy analyses. Patients will receive adjunctive istradefylline (20 mg/day, increasing to 40 mg/day) or the control in a 1:1 ratio, stratified by age, levodopa equivalent dose, and presence/absence of dyskinesia. During the study, the levodopa dose will be increased according to symptom severity. The primary study endpoint is the comparison of the cumulative additional dose of levodopa-containing medications during the treatment period between the adjunctive istradefylline and control groups. Secondary endpoints include changes in efficacy rating scales and safety outcomes. Discussion This study aims to clarify whether adjunctive istradefylline can reduce the cumulative additional dose of levodopa-containing medications in PD patients experiencing the wearing-off phenomenon, and lower the risk of levodopa-associated complications. It is anticipated that data from ISTRA ADJUST PD will help inform future clinical decision-making for patients with PD in the real-world setting. Trial registration Japan Registry of Clinical Trials, jRCTs031180248; registered 12 March 2019.
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Affiliation(s)
- Taku Hatano
- Department of Neurology, Faculty of Medicine, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, 113-8421, Tokyo, Japan.
| | - Osamu Kano
- Department of Neurology, Faculty of Medicine, Toho University, 6-11-1 Omorinishi, Ota-ku, Tokyo, 143-8541, Japan
| | - Renpei Sengoku
- Department of Neurology, Jikei University Daisan Hospital, 4-11-1 Izumihoncho, Komae, Tokyo, 201-0003, Japan
| | - Asako Yoritaka
- Department of Neurology, Juntendo University Koshigaya Hospital, 560 Fukuroyama, Koshigaya-shi, Saitama, 343-0032, Japan
| | - Keisuke Suzuki
- Department of Neurology, Dokkyo Medical University Hospital, 880 Oaza Kitakobayashi, Mibu-machi, Shimotsuga-gun, Tochigi, 321-0293, Japan
| | - Noriko Nishikawa
- Department of Neurology, Faculty of Medicine, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, 113-8421, Tokyo, Japan.,Department of Neurology, National Center of Neurology and Psychiatry, 4-1-1 Ogawahigashi-cho, Kodaira-shi, Tokyo, 187-8551, Japan
| | - Yohei Mukai
- Department of Neurology, National Center of Neurology and Psychiatry, 4-1-1 Ogawahigashi-cho, Kodaira-shi, Tokyo, 187-8551, Japan
| | - Kyoichi Nomura
- Department of Neurology, Saitama Medical Center, Kawagoe-shi, Saitama, 350-8550, Japan
| | - Norihito Yoshida
- Department of Neurology, Saitama Medical Center, Kawagoe-shi, Saitama, 350-8550, Japan
| | - Morinobu Seki
- Department of Neurology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Miho Kawabe Matsukawa
- Department of Neurology, Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology, 35-2 Sakae-cho, Itabashi-ku, Tokyo, 173-0015, Japan
| | - Hiroo Terashi
- Department of Neurology, Tokyo Medical University Hospital, 6-7-1 Nishi-shinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan
| | - Katsuo Kimura
- Department of Neurology, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama-shi, Kanagawa, 232-0024, Japan
| | - Jun Tashiro
- Sapporo Parkinson MS Neurological Clinic, Dai 27 Big Sapporo-kita Sky Building 12F, 7-6 Kita-7 jo Nishi-5 chome, Kita-ku, Sapporo-shi, Hokkaido, 060-0807, Japan
| | - Shigeki Hirano
- Department of Neurology, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba-shi, Chiba, 260-8670, Japan
| | - Hidetomo Murakami
- Department of Neurology, The Jikei University Hospital, 3-19-18 Nishishinbashi, Minato-ku, Tokyo, 105-8471, Japan
| | - Hideto Joki
- Department of Neurology and Stroke Medicine, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan
| | - Tsuyoshi Uchiyama
- Department of Neurology, Seirei Hamamatsu General Hospital, 2-12-12 Sumiyoshi, Naka-ku, Hamamatsu-shi, Shizuoka, 430-8558, Japan
| | - Hideki Shimura
- Department of Neurology, Juntendo Tokyo Koto Geriatric Medical Center, 3-3-20 Shinsuna, Koto-ku, Tokyo, 136-0075, Japan
| | - Kotaro Ogaki
- Department of Neurology, Juntendo University Urayasu Hospital, 2-1-1 Tomioka, Urayasu-shi, Chiba, 279-0021, Japan
| | - Jiro Fukae
- Department of Neurology, Juntendo University Nerima Hospital, 3-1-10 Takano-dai, Nerima-ku, Tokyo, 177-8521, Japan
| | - Yoshio Tsuboi
- Department of Neurology, Fukuoka University School of Medicine, 7-45-1 Nanakuma, Johnan-ku, Fukuoka, 814-0180, Japan
| | - Kazushi Takahashi
- Department of Neurology, Tokyo Metropolitan Neurological Hospital, Musashidai 2-6-1, Fuchu-shi, Tokyo, 183-0042, Japan
| | - Toshimasa Yamamoto
- Department of Neurology, Saitama Medical University Hospital, Saitama Medical University, 38 Morohongo, Moroyama-machi, Iruma-gun, Saitama, 350-0495, Japan
| | - Naotake Yanagisawa
- Medical Technology Innovation Center, Juntendo University and Juntendo Clinical Research and Trial Center, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Hiroshi Nagayama
- Department of Neurology, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8602, Japan
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Kwok JYY, Lee JJ, Choi EPH, Chau PH, Auyeung M. Stay mindfully active during the coronavirus pandemic: a feasibility study of mHealth-delivered mindfulness yoga program for people with Parkinson's disease. BMC Complement Med Ther 2022; 22:37. [PMID: 35130894 PMCID: PMC8818838 DOI: 10.1186/s12906-022-03519-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 01/20/2022] [Indexed: 11/10/2022] Open
Abstract
Importance Patients with long-term neurological conditions, such as Parkinson’s disease (PD), are particularly vulnerable to the public health measures taken to combat the COVID-19 pandemic. The inaccessibility of center-based rehabilitation further aggravated their motor dysfunctions as well as mental distress, leading to exacerbation of motor and non-motor symptoms, high healthcare utilization and worsened health-related quality of life (HRQOL). Objective This study aimed to evaluate the feasibility, safety, and preliminary effects of the mHealth-delivered home-based mindfulness yoga program on functional balance, motor symptoms, mental health and HRQOL in patients with PD. Design, setting and participants This prospective, single-arm, non-randomized feasibility study adopted a sequential explanatory mixed-method design. Adults (aged ≥ 18) with a clinical diagnosis of idiopathic Parkinson’s disease (Hoehn and Yahr stage I to III) who were able to stand unaided and walk with or without an assistive device were enrolled via convenience sampling. Intervention Home-based mindfulness yoga training were delivered via video-conferencing software (Zoom) in eight bi-weekly 90-min sessions. Main outcomes and measures This current study measured functional balance, motor symptoms, perceived balance confidence, perceived freezing of gait symptoms, anxiety and depression, mindfulness and HRQOL using a tele-assessment approach at baseline and 1-week post-intervention. All participants were invited to attend qualitative individual interviews to explore their experience of using online mindfulness yoga program as a lifestyle intervention for PD rehabilitation. Results Among the ten patients, 80% completed the program with an adherence rate of 98.4%. All participants were able to learn and practice mindfulness yoga following the eight bi-weekly online mindfulness yoga training sessions, without any significant adverse events. Tele-assessment of outcomes were feasible and uneventful. Qualitative feedback revealed participants had a high preference of using the tele-rehabilitation approach to stay mindful and being active, both physically and socially, while confronting the changes brought by COVID-19 pandemic. Conclusions and relevance The mHealth-delivered home-based mindfulness yoga intervention was feasible, safe, and well-accepted among people with PD to relieve the burden brought by COVID-19 pandemic. Future studies should adopt a design with enhanced rigor, a comparison group, and enlarged sample size to evaluate the efficacy of the program in patients with long-term neurological conditions and/or physical impairments. We recommend a longer intervention duration of at least 8 weeks to enhance the psychophysiological effects.
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Affiliation(s)
- Jojo Yan Yan Kwok
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong 4/F, William MW Mong Block, 21 Sassoon Road, Pokfulam, Hong Kong SAR, China.
| | - Jung Jae Lee
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong 4/F, William MW Mong Block, 21 Sassoon Road, Pokfulam, Hong Kong SAR, China
| | - Edmond Pui Hang Choi
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong 4/F, William MW Mong Block, 21 Sassoon Road, Pokfulam, Hong Kong SAR, China
| | - Pui Hing Chau
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong 4/F, William MW Mong Block, 21 Sassoon Road, Pokfulam, Hong Kong SAR, China
| | - Man Auyeung
- Department of Medicine, Pamela Youde Nethersole Eastern Hospital, Chai Wan, Hong Kong SAR, China
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Craft BM, Baker DE, Levien TL. Opicapone: Once-Daily COMT Inhibitor for the Treatment of Wearing Off in Parkinson's Disease. Sr Care Pharm 2022; 37:55-61. [PMID: 35082010 DOI: 10.4140/tcp.n.2022.55] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Objective To provide a review of opicapone as a treatment for end-of-dose wearing off associated with long-term levodopa therapy in patients with Parkinson's disease (PD). Data Sources PubMed, Web of Science, and Google Scholar were searched for relevant literature using the following terms: management, treatment, opicapone, BIA 9-1067, entacapone, and tolcapone. Current guidelines and the manufacturer's package inserts were also reviewed. Study Selection/Data Extraction Recent literature and published studies of opicapone in the management of wearing off. Data Synthesis Long-term use of levodopa is associated with known complications of motor fluctuations and dyskinesia. The addition of a drug with fewer daily administrations may reduce the complexity of the current medication regimen, improve adherence, and reduce the risk of adverse events in older people with PD. The Food and Drug Administration (FDA) approved a new catechol-O-methyltransferase (COMT) inhibitor opicapone in combination with levodopa/carbidopa to treat wearing off in PD patients on April 24, 2020. Conclusion Opicapone offers patients with PD a once-daily option with a favorable side effect profile, increased exposure to levodopa, and reduction in "off" time. It may be an appropriate second line option in patients who are intolerant or do not respond with entacapone.
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Kwon M, Cheong MJ, Leem J, Kim TH. Effect of Acupuncture on Movement Function in Patients with Parkinson's Disease: Network Meta-Analysis of Randomized Controlled Trials. Healthcare (Basel) 2021; 9:healthcare9111502. [PMID: 34828548 PMCID: PMC8619200 DOI: 10.3390/healthcare9111502] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 11/01/2021] [Accepted: 11/02/2021] [Indexed: 11/17/2022] Open
Abstract
We aimed to compare the effectiveness of some different acupuncture modalities on motor function using the unified Parkinson disease rating scale (UPDRS)-III scores of idiopathic Parkinson’s disease (PD) via pairwise and network meta-analyses (NMA) of randomized controlled trials (RCTs). The Cochrane risk of bias assessment tool was used to assess the methodological quality of the included RCTs. A frequentist approach-based random effect model NMA was performed. Seventeen RCTs with 1071 participants were included. The five following modalities were identified: combination of conventional medication (levodopa) with (1) electroacupuncture (ELEC), (2) manual acupuncture (MANU), (3) bee venom acupuncture (BEEV), (4) sham acupuncture (SHAM), and (5) conventional medication alone (CONV). In NMA on UPDRS-III, BEEV was the best modality compared to CONV (mean difference [MD]) −7.37, 95% confidence interval [−11.97, −2.77]). The comparative ranking assessed through NMA was suggested to be BEEV, MANU, ELEC, SHAM, and CONV. Regarding daily activity assessment (UPDRS-II), the magnitude of effectiveness was in the order of BEEV, ELEC, MANU, SHAM, and CONV. Combination treatment with BEEV (MANU or ELEC) and CONV can be recommended to improve motor function in PD patients. Due to the limited number of included RCTs, further NMA with more rigorous RCTs are warranted.
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Affiliation(s)
- Miri Kwon
- Department of Clinical Korean Medicine, College of Korean Medicine, Graduate School, Kyung Hee University, Seoul 02447, Korea;
| | - Moon Joo Cheong
- Rare Diseases Integrative Treatment Research Institute, Wonkwang University, Jangheung Integrative Medical Hospital, Iksan 59338, Korea;
| | - Jungtae Leem
- Research Center of Traditional Korean Medicine, Wonkwang University, Iksan 54538, Korea
- Correspondence: (J.L.); (T.-h.K.); Tel.: +82-063-850-5114 (J.L.); +82-02-958-9194 (T.-h.K.)
| | - Tae-hun Kim
- Department of Clinical Korean Medicine, College of Korean Medicine, Graduate School, Kyung Hee University, Seoul 02447, Korea;
- Korean Medicine Clinical Trial Center, Korean Medicine Hospital, Kyung Hee University Medical Center, Seoul 02447, Korea
- Correspondence: (J.L.); (T.-h.K.); Tel.: +82-063-850-5114 (J.L.); +82-02-958-9194 (T.-h.K.)
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El-Battari A, Rodriguez L, Chahinian H, Delézay O, Fantini J, Yahi N, Di Scala C. Gene Therapy Strategy for Alzheimer's and Parkinson's Diseases Aimed at Preventing the Formation of Neurotoxic Oligomers in SH-SY5Y Cells. Int J Mol Sci 2021; 22:11550. [PMID: 34768981 PMCID: PMC8583875 DOI: 10.3390/ijms222111550] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 10/21/2021] [Accepted: 10/22/2021] [Indexed: 01/17/2023] Open
Abstract
We present here a gene therapy approach aimed at preventing the formation of Ca2+-permeable amyloid pore oligomers that are considered as the most neurotoxic structures in both Alzheimer's and Parkinson's diseases. Our study is based on the design of a small peptide inhibitor (AmyP53) that combines the ganglioside recognition properties of the β-amyloid peptide (Aβ, Alzheimer) and α-synuclein (α-syn, Parkinson). As gangliosides mediate the initial binding step of these amyloid proteins to lipid rafts of the brain cell membranes, AmyP53 blocks, at the earliest step, the Ca2+ cascade that leads to neurodegeneration. Using a lentivirus vector, we genetically modified brain cells to express the therapeutic coding sequence of AmyP53 in a secreted form, rendering these cells totally resistant to oligomer formation by either Aβ or α-syn. This protection was specific, as control mCherry-transfected cells remained fully sensitive to these oligomers. AmyP53 was secreted at therapeutic concentrations in the supernatant of cultured cells, so that the therapy was effective for both transfected cells and their neighbors. This study is the first to demonstrate that a unique gene therapy approach aimed at preventing the formation of neurotoxic oligomers by targeting brain gangliosides may be considered for the treatment of two major neurodegenerative disorders, Alzheimer's and Parkinson's diseases.
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Affiliation(s)
- Assou El-Battari
- INSERM UMR_S 1072, Aix-Marseille Université, 13015 Marseille, France; (A.E.-B.); (H.C.); (J.F.); (N.Y.)
| | - Léa Rodriguez
- CUO-Recherche, Département d’ophtalmologie, Faculté de Médecine, Université Laval and Centre de recherche du CHU de Québec-Université Laval, Québec, QC G1V 0A6, Canada;
| | - Henri Chahinian
- INSERM UMR_S 1072, Aix-Marseille Université, 13015 Marseille, France; (A.E.-B.); (H.C.); (J.F.); (N.Y.)
| | - Olivier Delézay
- Faculté de Médecine, SAINBIOSE INSERM U1059, Campus Santé Innovations, 42270 St. Priest en Jarez, France;
| | - Jacques Fantini
- INSERM UMR_S 1072, Aix-Marseille Université, 13015 Marseille, France; (A.E.-B.); (H.C.); (J.F.); (N.Y.)
| | - Nouara Yahi
- INSERM UMR_S 1072, Aix-Marseille Université, 13015 Marseille, France; (A.E.-B.); (H.C.); (J.F.); (N.Y.)
| | - Coralie Di Scala
- Neuroscience Center—HiLIFE, Helsinki Institute of Life Science, University of Helsinki, 00014 Helsinki, Finland
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Yoshida K, Takano K, Tani H, Nobuhara S, Maruyama Y, Marumoto K. ΔHR/ΔWR derived from CPET; A novel predictor of 'off' symptom in Parkinson's disease. Parkinsonism Relat Disord 2021; 92:101-104. [PMID: 34739978 DOI: 10.1016/j.parkreldis.2021.10.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 09/28/2021] [Accepted: 10/16/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Chronotropic incompetence (CI) is broadly defined as the inability of the heart to increase its rate commensurate with increased activity. In this study, we tried to clarify the link between CI and UPDRS part II (off-on), which was calculated by subtracting part II (on) from part II (off), in patients with Parkinson's disease (PD). METHODS Thirty-six hospitalized patients were examined by using cardiopulmonary exercise testing (CPET) for exercise tolerance (ΔVO2/ΔWR and peak VO2/W) and the presence of CI (ΔHR/ΔWR), and using electrocardiogram for heart rate variability. RESULTS We originally divided the patients into three groups; Group I (ΔHR/ΔWR x100 <15) (N = 3), Group II (15≥, <60) (N = 28), Group III (>60) (N = 5). Since Group I and III were significantly smaller and older than Group II, we focused and divided into two groups; Group II CI (+), the PD patients with CI (15≤ ΔHR/ΔWR x100 <35), and Group II CI (-), those patients without that (35≤ ΔHR/ΔWR x100 <60). ΔVO2/ΔWR and peak VO2/W in CI (+) patients was lower than CI (-) (P = 0.022 and P = 0.096, respectively). HF power (parasympathetic activity) tends to be decreased, whereas LF/HF ratio (sympathetic activity) was increased in CI (+) patients as compared with CI (-). The UPDRS part II (off-on) of CI (+) patients was significantly higher than CI (-) (P = 0.023). CONCLUSIONS In PD patients, the difference between 'on' and 'off' in activities of daily living might be predicted by using ΔHR/ΔWR x100 obtained from CPET as an index.
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Affiliation(s)
- Kohsuke Yoshida
- Department of Clinical Laboratory, Hyogo Prefectural Rehabilitation Hospital at Nishi-Harima, 1-7-1 Kouto, Shingu-cho, Tatsuno, Hyogo, 679-5165, Japan; Department of Public Health, Kobe University Graduate School of Health Sciences, 7-10-2, Tomogaoka, Suma-ku, Kobe, Hyogo, 654-0142, Japan.
| | - Kazuki Takano
- Department of Clinical Laboratory, Hyogo Prefectural Rehabilitation Hospital at Nishi-Harima, 1-7-1 Kouto, Shingu-cho, Tatsuno, Hyogo, 679-5165, Japan
| | - Hiromi Tani
- Department of Clinical Laboratory, Hyogo Prefectural Rehabilitation Hospital at Nishi-Harima, 1-7-1 Kouto, Shingu-cho, Tatsuno, Hyogo, 679-5165, Japan
| | - Sae Nobuhara
- Department of Clinical Laboratory, Hyogo Prefectural Rehabilitation Hospital at Nishi-Harima, 1-7-1 Kouto, Shingu-cho, Tatsuno, Hyogo, 679-5165, Japan
| | - Yuki Maruyama
- Department of Pharmacy, Hyogo Prefectural Rehabilitation Hospital at Nishi-Harima, 1-7-1 Kouto, Shingu-cho, Tatsuno, Hyogo, 679-5165, Japan
| | - Kohei Marumoto
- Department of Physical Medicine and Rehabilitation, Hyogo Prefectural Rehabilitation Hospital at Nishi-Harima, 1-7-1 Kouto, Shingu-cho, Tatsuno, Hyogo, 679-5165, Japan
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Shoshan-Barmatz V, Anand U, Nahon-Crystal E, Di Carlo M, Shteinfer-Kuzmine A. Adverse Effects of Metformin From Diabetes to COVID-19, Cancer, Neurodegenerative Diseases, and Aging: Is VDAC1 a Common Target? Front Physiol 2021; 12:730048. [PMID: 34671273 PMCID: PMC8521008 DOI: 10.3389/fphys.2021.730048] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 08/24/2021] [Indexed: 12/13/2022] Open
Abstract
Metformin has been used for treating diabetes mellitus since the late 1950s. In addition to its antihyperglycemic activity, it was shown to be a potential drug candidate for treating a range of other diseases that include various cancers, cardiovascular diseases, diabetic kidney disease, neurodegenerative diseases, renal diseases, obesity, inflammation, COVID-19 in diabetic patients, and aging. In this review, we focus on the important aspects of mitochondrial dysfunction in energy metabolism and cell death with their gatekeeper VDAC1 (voltage-dependent anion channel 1) as a possible metformin target, and summarize metformin’s effects in several diseases and gut microbiota. We question how the same drug can act on diseases with opposite characteristics, such as increasing apoptotic cell death in cancer, while inhibiting it in neurodegenerative diseases. Interestingly, metformin’s adverse effects in many diseases all show VDAC1 involvement, suggesting that it is a common factor in metformin-affecting diseases. The findings that metformin has an opposite effect on various diseases are consistent with the fact that VDAC1 controls cell life and death, supporting the idea that it is a target for metformin.
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Affiliation(s)
- Varda Shoshan-Barmatz
- Department of Life Sciences, Ben-Gurion University of the Negev, Beersheba, Israel.,National Institute for Biotechnology in the Negev, Ben-Gurion University of the Negev, Beersheba, Israel
| | - Uttpal Anand
- Department of Life Sciences, Ben-Gurion University of the Negev, Beersheba, Israel
| | | | - Marta Di Carlo
- Institute for Biomedical Research and Innovation, National Research Council, Palermo, Italy
| | - Anna Shteinfer-Kuzmine
- National Institute for Biotechnology in the Negev, Ben-Gurion University of the Negev, Beersheba, Israel
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Levodopa-Induced Ocular Dyskinesia in an Early-Onset Parkinson Disease Patient With GBA Mutation. Clin Neuropharmacol 2021; 44:201-204. [PMID: 34654015 PMCID: PMC8594500 DOI: 10.1097/wnf.0000000000000484] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Supplemental digital content is available in the text. Objectives The aim of this study was to report a case of levodopa-induced ocular dyskinesia in an early-onset Parkinson disease patient and to investigate the pathogenic gene. Methods We report the case of a 49-year-old male patient with a 13-year history of Parkinson disease. Involuntary eye movements were noticed after treatment with amantadine for limb dyskinesias. Levodopa-induced ocular dyskinesias involving repetitive, transient, and stereotyped rightward deviations of gaze appeared after intake of an antiparkinsonian drug. Limb dyskinesias also occurred simultaneously. We used a next-generation sequencing targeted gene panel and found a heterozygous missense mutation (p.R535H) in GBA. Direct Sanger sequencing verified the missense mutation. Conclusions We report the case of an uncommon early-onset PD patient carrying a GBA mutation presenting ocular dyskinesia. Genetic screening may provide a better mechanistic insight into dyskinesias.
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Could New Generations of Sensors Reshape the Management of Parkinson’s Disease? CLINICAL AND TRANSLATIONAL NEUROSCIENCE 2021. [DOI: 10.3390/ctn5020018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Parkinson's disease (PD) is a chronic neurologic disease that has a great impact on the patient’s quality of life. The natural course of the disease is characterized by an insidious onset of symptoms, such as rest tremor, shuffling gait, bradykinesia, followed by improvement with the initiation of dopaminergic therapy. However, this “honeymoon period” gradually comes to an end with the emergence of motor fluctuations and dyskinesia. PD patients need long-term treatments and monitoring throughout the day; however, clinical examinations in hospitals are often not sufficient for optimal management of the disease. Technology-based devices are a new comprehensive assessment method of PD patient’s symptoms that are easy to use and give unbiased measurements. This review article provides an exhaustive overview of motor complications of advanced PD and new approaches to the management of the disease using sensors.
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Testini P, Sarva H, Schwalb J, Barkan S, Cabrera LY. Neurosurgeons perspective on the shift towards earlier use of deep brain stimulation for Parkinson disease. INTERDISCIPLINARY NEUROSURGERY 2021. [DOI: 10.1016/j.inat.2021.101224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Abstract
Advanced Parkinson disease (PD) is associated with treatment-related motor fluctuations and reduced ability to perform activities of daily living. Progression of non-motor symptoms and medication-induced adverse effects complicate focused approach to motor symptom management, frequently accelerating reduced quality of life. It is thus critical for clinicians to consider disease progression versus therapeutic contributions when balancing management decisions. Such an approach requires careful recognition of inflection points resulting from therapeutic decisions and should prompt consideration of reduced pharmacologic burden and increased reliance on non-pharmacologic strategies in advanced disease. The successful approach to advanced PD requires a multidisciplinary effort focused on improving the patient's and family's quality of life, sometimes requiring sacrifice of motor symptom benefit. Here, we emphasize management strategies in advanced PD, focusing on the need to balance the therapeutic approach across advancing motor symptoms, progressive non-motor features, and potential pharmacologic adverse effects.
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Affiliation(s)
- Helen Hwang
- Department of Neurology, 7548Washington University School of Medicine, St Louis, MO, USA
| | - Scott A Norris
- Department of Neurology, 7548Washington University School of Medicine, St Louis, MO, USA
- Department of Radiology, 7548Washington University School of Medicine, St Louis, MO, USA
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Omoruyi SI, Ibrakaw AS, Ekpo OE, Boatwright JS, Cupido CN, Hussein AA. Neuroprotective Activities of Crossyne flava Bulbs and Amaryllidaceae Alkaloids: Implications for Parkinson's Disease. Molecules 2021; 26:molecules26133990. [PMID: 34208814 PMCID: PMC8272225 DOI: 10.3390/molecules26133990] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 06/13/2021] [Accepted: 06/24/2021] [Indexed: 02/07/2023] Open
Abstract
Parkinson’s disease (PD) is one of the most common neurodegenerative diseases and affects approximately 6.3 million people worldwide. To date, the treatment of PD remains a challenge, as available treatment options are known to be associated with serious side effects; hence, the search for new treatment strategies is critical. Extracts from the Amaryllidaceae plant family as well as their alkaloids have been reported to have neuroprotective potentials. This study, therefore, investigated the biological activities of Crossyne flava and its isolated alkaloids in an in vitro MPP+ (1-methyl-4-phenylpyridinium) PD model using SH-SY5Y cells. The effects of the total extract as well as the four compounds isolated from Crossyne flava (i.e., pancratinine B (1), bufanidrine (2), buphanisine (3), and epibuphanisine (4)) were evaluated for cell viability, neuroprotection, levels of reactive oxygen species (ROS), adenosine triphosphate activity (ATP), and caspase 3/7 activity in SH-SY5Y cells. The results obtained showed that pre-treatment with both the extract and the isolated compounds was effective in protecting the SH-SY5Y cells from MPP+-induced neurotoxicity and inhibited ROS generation, ATP depletion as well as apoptosis induction in the SH-SY5Y cells. The results of this study show that the Amaryllidaceae plant family may be a source of novel compounds for the treatment of neurodegenerative diseases, which validates the reported traditional uses.
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Affiliation(s)
- Sylvester I. Omoruyi
- Department of Chemistry, Cape Peninsula University of Technology, Symphony Road, Bellville 7535, South Africa;
| | - Abobaker S. Ibrakaw
- Department of Biodiversity and Conservation Biology, University of the Western Cape, Cape Town, Robert Sobukwe Road, Bellville 7535, South Africa; (A.S.I.); (J.S.B.)
| | - Okobi E. Ekpo
- Department of Anatomy and Cellular Biology, College of Medicine and Health Sciences, Khalifa University, Abu Dhabi P.O. Box 127788, United Arab Emirates;
| | - James S. Boatwright
- Department of Biodiversity and Conservation Biology, University of the Western Cape, Cape Town, Robert Sobukwe Road, Bellville 7535, South Africa; (A.S.I.); (J.S.B.)
| | - Christopher N. Cupido
- Department of Botany, University of Fort Hare, Private Bag X1314, Alice 5700, South Africa;
| | - Ahmed A. Hussein
- Department of Chemistry, Cape Peninsula University of Technology, Symphony Road, Bellville 7535, South Africa;
- Correspondence: ; Tel.: +27-21-959-6193; Fax: +27-21-959-3055
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Kleiner G, Fernandez HH, Chou KL, Fasano A, Duque KR, Hengartner D, Law A, Margolius A, Poon Y, Sáenz Farret M, Saleh P, Vizcarra JA, Stebbins GT, Espay AJ. Non‐Motor Fluctuations in Parkinson's Disease: Validation of the Non‐Motor Fluctuation Assessment Questionnaire. Mov Disord 2021; 36:1392-1400. [DOI: 10.1002/mds.28507] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 12/29/2020] [Accepted: 01/03/2021] [Indexed: 12/16/2022] Open
Affiliation(s)
- Galit Kleiner
- Jeff and Diane Ross Movement Disorders Clinic/ATC Baycrest Center for Geriatric Health Toronto Toronto Ontario Canada
- Division of Neurology University of Toronto Toronto Ontario Canada
| | - Hubert H. Fernandez
- Department of Neurology and Center for Neurological Restoration Neurological Institute, Cleveland Clinic Lerner College of Medicine Cleveland Ohio USA
| | - Kelvin L. Chou
- Department of Neurology and Neurosurgery University of Michigan Medical School Ann Arbor Michigan USA
| | - Alfonso Fasano
- Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic Toronto Western Hospital, UHN Toronto Ontario Canada
- Krembil Brain Institute Toronto Ontario Canada
| | - Kevin R. Duque
- James J. and Joan A. Gardner Center for Parkinson's Disease and Movement Disorders Department of Neurology University of Cincinnati Cincinnati Ohio USA
| | - Diana Hengartner
- Department of Neurology and Center for Neurological Restoration Neurological Institute, Cleveland Clinic Lerner College of Medicine Cleveland Ohio USA
| | - Albie Law
- Jeff and Diane Ross Movement Disorders Clinic/ATC Baycrest Center for Geriatric Health Toronto Toronto Ontario Canada
- Division of Neurology University of Toronto Toronto Ontario Canada
| | - Adam Margolius
- Department of Neurology and Center for Neurological Restoration Neurological Institute, Cleveland Clinic Lerner College of Medicine Cleveland Ohio USA
| | - Yu‐Yan Poon
- Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic Toronto Western Hospital, UHN Toronto Ontario Canada
| | - Michel Sáenz Farret
- Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic Toronto Western Hospital, UHN Toronto Ontario Canada
| | - Philip Saleh
- Jeff and Diane Ross Movement Disorders Clinic/ATC Baycrest Center for Geriatric Health Toronto Toronto Ontario Canada
- Division of Neurology University of Toronto Toronto Ontario Canada
| | - Joaquin A. Vizcarra
- James J. and Joan A. Gardner Center for Parkinson's Disease and Movement Disorders Department of Neurology University of Cincinnati Cincinnati Ohio USA
| | - Glenn T. Stebbins
- Department of Neurological Sciences Rush University Medical Center Chicago Illinois USA
| | - Alberto J. Espay
- James J. and Joan A. Gardner Center for Parkinson's Disease and Movement Disorders Department of Neurology University of Cincinnati Cincinnati Ohio USA
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Sica M, Tedesco S, Crowe C, Kenny L, Moore K, Timmons S, Barton J, O’Flynn B, Komaris DS. Continuous home monitoring of Parkinson's disease using inertial sensors: A systematic review. PLoS One 2021; 16:e0246528. [PMID: 33539481 PMCID: PMC7861548 DOI: 10.1371/journal.pone.0246528] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 01/20/2021] [Indexed: 02/01/2023] Open
Abstract
Parkinson’s disease (PD) is a progressive neurological disorder of the central nervous system that deteriorates motor functions, while it is also accompanied by a large diversity of non-motor symptoms such as cognitive impairment and mood changes, hallucinations, and sleep disturbance. Parkinsonism is evaluated during clinical examinations and appropriate medical treatments are directed towards alleviating symptoms. Tri-axial accelerometers, gyroscopes, and magnetometers could be adopted to support clinicians in the decision-making process by objectively quantifying the patient’s condition. In this context, at-home data collections aim to capture motor function during daily living and unobstructedly assess the patients’ status and the disease’s symptoms for prolonged time periods. This review aims to collate existing literature on PD monitoring using inertial sensors while it focuses on papers with at least one free-living data capture unsupervised either directly or via videotapes. Twenty-four papers were selected at the end of the process: fourteen investigated gait impairments, eight of which focused on walking, three on turning, two on falls, and one on physical activity; ten articles on the other hand examined symptoms, including bradykinesia, tremor, dyskinesia, and motor state fluctuations in the on/off phenomenon. In summary, inertial sensors are capable of gathering data over a long period of time and have the potential to facilitate the monitoring of people with Parkinson’s, providing relevant information about their motor status. Concerning gait impairments, kinematic parameters (such as duration of gait cycle, step length, and velocity) were typically used to discern PD from healthy subjects, whereas for symptoms’ assessment, researchers were capable of achieving accuracies of over 90% in a free-living environment. Further investigations should be focused on the development of ad-hoc hardware and software capable of providing real-time feedback to clinicians and patients. In addition, features such as the wearability of the system and user comfort, set-up process, and instructions for use, need to be strongly considered in the development of wearable sensors for PD monitoring.
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Affiliation(s)
- Marco Sica
- Tyndall National Institute, University College Cork, Cork, Ireland
- * E-mail:
| | | | - Colum Crowe
- Tyndall National Institute, University College Cork, Cork, Ireland
| | - Lorna Kenny
- Centre for Gerontology and Rehabilitation, University College Cork, Cork, Ireland
| | - Kevin Moore
- Centre for Gerontology and Rehabilitation, University College Cork, Cork, Ireland
| | - Suzanne Timmons
- Centre for Gerontology and Rehabilitation, University College Cork, Cork, Ireland
| | - John Barton
- Tyndall National Institute, University College Cork, Cork, Ireland
| | - Brendan O’Flynn
- Tyndall National Institute, University College Cork, Cork, Ireland
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Thach A, Jones E, Pappert E, Pike J, Wright J, Gillespie A. Real-world assessment of the impact of "OFF" episodes on health-related quality of life among patients with Parkinson's disease in the United States. BMC Neurol 2021; 21:46. [PMID: 33516182 PMCID: PMC7846980 DOI: 10.1186/s12883-021-02074-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 01/24/2021] [Indexed: 01/13/2023] Open
Abstract
Background Many patients with Parkinson’s disease (PD) who receive carbidopa/levodopa experience symptom reemergence or worsening, or “OFF” episodes. This study assessed the association of “OFF” episodes with health-related quality of life (HRQoL). Methods US-specific data from the 2017 and 2019 Adelphi Real World Disease Specific Programme for PD, a real-world cross-sectional survey, were used. Neurologists provided data for 10–12 consecutive patients with PD who completed the 39-item Parkinson’s Disease Questionnaire (PDQ-39) and the EuroQol 5-Dimension (EQ-5D). Data were grouped by patients who experienced “OFF” episodes versus those who did not and by average hours of daily “OFF” time. Differences between patient groups were assessed for demographics and clinical characteristics; regression analyses were used to model the relationship between HRQoL and “OFF” episodes with age, sex, body mass index, current PD stage on the Hoehn and Yahr scale, and number of concomitant conditions related and unrelated to mobility as covariates. Results Data from 722 patients were analyzed. Overall, 321 patients (44%) had “OFF” episodes (mean of 2.9 h of daily “OFF” time). Patients who experienced “OFF” episodes were less likely to work full-time and more likely to live with family members other than their spouse/partner or reside in a long-term care facility than those without “OFF” episodes. The presence of “OFF” episodes, regardless of the average hours of daily “OFF” time, was significantly associated with high scores (reflecting poor HRQoL) on most PDQ-39 dimensions and the summary index and low scores (reflecting poor health status) on the EQ-5D health utility index, visual analog scale (VAS), and all dimensions. Furthermore, increased average hours of daily “OFF” time was significantly correlated with higher scores for all PDQ-39 dimensions and the summary index, as well as with the EQ-5D health utility index and VAS scores. Patients with “OFF” episodes experienced reduced HRQoL even after correcting for potentially confounding variables. Conclusions This study demonstrated that the occurrence of “OFF” episodes in patients with PD is associated with reduced HRQoL and that the impact on HRQoL increased incrementally with increasing average hours of daily “OFF” time. Supplementary Information The online version contains supplementary material available at 10.1186/s12883-021-02074-2.
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Affiliation(s)
- Andrew Thach
- Sunovion Pharmaceuticals Inc., 84 Waterford Dr, Marlborough, MA, 01752, USA.
| | | | - Eric Pappert
- Sunovion Pharmaceuticals Inc., 84 Waterford Dr, Marlborough, MA, 01752, USA
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Qian Y, Zhang Y, He X, Xu S, Yang X, Mo C, Lu X, Qiu M, Xiao Q. Findings in Chinese Patients With Parkinson's Disease: A Content Analysis From the SML Study. Front Psychiatry 2021; 12:615743. [PMID: 33603686 PMCID: PMC7884465 DOI: 10.3389/fpsyt.2021.615743] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 01/08/2021] [Indexed: 11/13/2022] Open
Abstract
Social media listening (SML) is a new process for obtaining information from social media platforms to generate insights into users' experiences and has been used to analyze discussions about a multitude of diseases. To understand Parkinson's disease patients' unmet needs and optimize communication between doctors and patients, social media listening was performed to investigate concerns in Chinese patients. A comprehensive search of publicly available social media platforms with Chinese-language content posted between January 2005 and April 2019 in mainland China was performed using defined Parkinson's disease-related terms. After multiple steps of machine screening were performed, a series of posts were derived. The content was summarized and classified manually to analyze and map psychological insights, and descriptive statistics were applied to aggregate findings. A total of 101,899 patient-related posts formed the basis of this study. The topics mainly focused on motor symptoms (n = 54,983), choice of pharmaceutical drugs (n = 45,203) and non-motor symptoms (n = 44,855). The most common symptoms mentioned were tremor (54.5%), pain (22.9%), and rigidity (22.1%). Psychological burden (51%) and work/social burden (48%) were the most concerning burdens for patients and their families. The compound levodopa (43%) and dopamine agonists (23%) were the most common options for the patients, while concerns about new-generation anti-Parkinson's disease medication increased. The portraits of patients suggested varying characteristics across different periods and advocate for personalized service from doctors. In the management of patients, it is imperative to plan individualized therapy and education strategies as well as strategies for social support.
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Affiliation(s)
- Yiwei Qian
- Department of Neurology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yi Zhang
- Department of Neurology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiaoqin He
- Department of Neurology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Shaoqing Xu
- Department of Neurology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiaodong Yang
- Department of Neurology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chengjun Mo
- Department of Neurology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiaomeng Lu
- Department of Digital, Huimei Digital Tech (Beijing) Co., Ltd, Beijing, China
| | - Mengjuan Qiu
- Department of Digital, Huimei Digital Tech (Beijing) Co., Ltd, Beijing, China
| | - Qin Xiao
- Department of Neurology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Abbruzzese G, Kulisevsky J, Bergmans B, Gomez-Esteban JC, Kägi G, Raw J, Stefani A, Warnecke T, Jost WH. A European Observational Study to Evaluate the Safety and the Effectiveness of Safinamide in Routine Clinical Practice: The SYNAPSES Trial. JOURNAL OF PARKINSON'S DISEASE 2021; 11:187-198. [PMID: 33104040 PMCID: PMC7990425 DOI: 10.3233/jpd-202224] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 10/01/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND Safinamide modulates both dopaminergic and glutamatergic systems with positive effects on motor and non-motor symptoms of Parkinson's disease (PD). The drug utilization study SYNAPSES was designed to investigate the use of safinamide in routine clinical practice, as recommended by the European Medicines Agency. OBJECTIVE To describe the occurrence of adverse events in PD patients treated with safinamide in real-life conditions. METHODS The SYNAPSES trial is an observational, European, multicenter, retrospective-prospective cohort study. Patients were followed up to 12 months with analyses performed in the overall population and in patients aged >75 years, with relevant comorbidities and with psychiatric conditions. RESULTS Of the 1610 patients included, 82.4% were evaluable after 12 months with 25.1% of patients >75 years, 70.8% with relevant comorbidities and 42.4% with psychiatric conditions. During observation 45.8% patients experienced adverse events, 27.7% patients had adverse drug reactions and 9.2% patients had serious adverse events. The adverse events were those already described in the patients' information leaflet. The majority were mild or moderate and completely resolved and no differences were detected between the subgroup of patients. Clinically significant improvements were seen in the UPDRS motor score and in the UPDRS total score in ≥40% of patients, according to the criteria developed by Shulman et al.Conclusion:The SYNAPSES study confirms the good safety profile of safinamide even in special groups of patients. Motor complications and motor scores improved with clinically significant results in the UPDRS scale maintained in the long-term.
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Affiliation(s)
| | - Jaime Kulisevsky
- Sant Pau Hospital, Universitat Autònoma de Barcelona, CIBERNED, Barcelona, Spain
| | - Bruno Bergmans
- Department of Neurology, AZ St-Jan Brugge-Oostende AV, Campus Brugge, Brugge & Ghent University Hospital, Ghent, Belgium
| | | | - Georg Kägi
- Department of Neurology, Cantonal Hospital St.Gallen, Switzerland
| | - Jason Raw
- Fairfield General Hospital, Bury, Greater Manchester, UK
| | | | - Tobias Warnecke
- Department of Neurology, University of Muenster, Muenster, Germany
| | - Wolfgang H. Jost
- Parkinson-Klinik Ortenau, University of Freiburg, Wolfach, Germany
| | - the SYNAPSES Study Investigators Group
- DINOGMI, University of Genoa, Genova, Italy
- Sant Pau Hospital, Universitat Autònoma de Barcelona, CIBERNED, Barcelona, Spain
- Department of Neurology, AZ St-Jan Brugge-Oostende AV, Campus Brugge, Brugge & Ghent University Hospital, Ghent, Belgium
- Biocruces Research Institute, Barakaldo, Spain
- Department of Neurology, Cantonal Hospital St.Gallen, Switzerland
- Fairfield General Hospital, Bury, Greater Manchester, UK
- Parkinson Center, University Policlinico Tor Vergata, Roma, Italy
- Department of Neurology, University of Muenster, Muenster, Germany
- Parkinson-Klinik Ortenau, University of Freiburg, Wolfach, Germany
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Jhuo CF, Hsieh SK, Chen CJ, Chen WY, Tzen JT. Teaghrelin Protects SH-SY5Y Cells against MPP +-Induced Neurotoxicity through Activation of AMPK/SIRT1/PGC-1α and ERK1/2 Pathways. Nutrients 2020; 12:nu12123665. [PMID: 33260513 PMCID: PMC7759814 DOI: 10.3390/nu12123665] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 11/19/2020] [Accepted: 11/26/2020] [Indexed: 12/13/2022] Open
Abstract
The prevalence and incidence of Parkinson’s disease (PD), an age-related neurodegenerative disease, are higher among elderly people. Independent of etiology, dysfunction and loss of dopaminergic neurons are common pathophysiological changes in PD patients with impaired motor and non-motor function. Currently, preventive or therapeutic treatment for combating PD is limited. The ghrelin axis and ghrelin receptor have been implicated in the preservation of dopaminergic neurons and have potential implications in PD treatment. Teaghrelin, a compound originating from Chin-Shin Oolong tea, exhibits ghrelin agonist activity. In this study, the neuroprotective potential of teaghrelin against PD was explored in a cell model in which human neuroblastoma SH-SY5Y cells were treated with the mitochondrial toxin 1-methyl-4-phenylpyridinium (MPP+). Upon MPP+ exposure, SH-SY5Y cells exhibited decreased mitochondrial complex I activity and apoptotic cell death. Teaghrelin activated AMP-activated protein kinase (AMPK)/sirtuin 1(SIRT1)/peroxisome proliferator-activated receptor gamma (PPARγ) coactivator-1α (PGC-1α) and extracellular signal–regulated kinases 1 and 2 (ERK1/2) pathways to antagonize MPP+-induced cell death. Herein, we propose that teaghrelin is a potential candidate for the therapeutic treatment of PD.
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Affiliation(s)
- Cian-Fen Jhuo
- Graduate Institute of Biotechnology, National Chung Hsing University, Taichung 402, Taiwan; (C.-F.J.); (S.-K.H.)
| | - Sheng-Kuo Hsieh
- Graduate Institute of Biotechnology, National Chung Hsing University, Taichung 402, Taiwan; (C.-F.J.); (S.-K.H.)
| | - Chun-Jung Chen
- Department of Medical Research, Taichung Veterans General Hospital, Taichung 40705, Taiwan;
| | - Wen-Ying Chen
- Department of Veterinary Medicine, National Chung Hsing University, Taichung 402, Taiwan
- Correspondence: (W.-Y.C.); (J.T.C.T.); Tel.: +886-4-2284-0368 (W.-Y.C.); +886-4-2284-0328 (J.T.C.T.)
| | - Jason T.C. Tzen
- Graduate Institute of Biotechnology, National Chung Hsing University, Taichung 402, Taiwan; (C.-F.J.); (S.-K.H.)
- Correspondence: (W.-Y.C.); (J.T.C.T.); Tel.: +886-4-2284-0368 (W.-Y.C.); +886-4-2284-0328 (J.T.C.T.)
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Abraham ME, Gold J, Dondapati A, Gendreau J, Mammis A, Herschman Y. Intrathecal and intracerebroventricular dopamine for Parkinson's disease. Clin Neurol Neurosurg 2020; 200:106374. [PMID: 33290887 DOI: 10.1016/j.clineuro.2020.106374] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 10/12/2020] [Accepted: 11/14/2020] [Indexed: 10/22/2022]
Abstract
While CDD directly to the CSF can provide a constant delivery of the dopaminergic drug resulting in a more stable treatment effect without the limitations of traditional oral therapy without peripheral effects, it is still young and longitudinal data is lacking. These experimental therapies show promise and further investigation into their efficacy and safety could extend the frontiers for management of PD.
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Affiliation(s)
- Mickey E Abraham
- Department of Neurological Surgery, Doctor's Office Center, Rutgers New Jersey Medical School, 90 Bergen Street, 07101-1709, Newark, NJ, United States
| | - Justin Gold
- Department of Neurological Surgery, Doctor's Office Center, Rutgers New Jersey Medical School, 90 Bergen Street, 07101-1709, Newark, NJ, United States.
| | - Akhil Dondapati
- Department of Neurological Surgery, Doctor's Office Center, Rutgers New Jersey Medical School, 90 Bergen Street, 07101-1709, Newark, NJ, United States
| | - Julian Gendreau
- Department of Neurological Surgery, Doctor's Office Center, Rutgers New Jersey Medical School, 90 Bergen Street, 07101-1709, Newark, NJ, United States
| | - Antonios Mammis
- Department of Neurological Surgery, Doctor's Office Center, Rutgers New Jersey Medical School, 90 Bergen Street, 07101-1709, Newark, NJ, United States
| | - Yehuda Herschman
- Department of Neurological Surgery, Doctor's Office Center, Rutgers New Jersey Medical School, 90 Bergen Street, 07101-1709, Newark, NJ, United States
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Dos Santos EUD, da Silva IIFG, Asano AGC, Asano NMJ, De Mascena Diniz Maia M, de Souza PRE. Pharmacogenetic profile and the development of the dyskinesia induced by levodopa-therapy in Parkinson's disease patients: a population-based cohort study. Mol Biol Rep 2020; 47:8997-9004. [PMID: 33151475 DOI: 10.1007/s11033-020-05956-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 10/28/2020] [Indexed: 12/21/2022]
Abstract
Levodopa-induced dyskinesia (LID) is an adverse effect that negatively impacts the quality of life of patients with Parkinson's disease (PD). Studies report that genetic variations in the genes of the pharmacogenetic pathway of the levodopa (L-DOPA) might be associated with LID development. The goal of the present study was to investigate a possible influence of functional genetic variants in the DRD1 (rs4532), DRD2 (rs1800497), DAT1 (rs28363170), and COMT (rs4680) genes with LID development. A total of 220 patients with idiopathic PD were enrolled. The genotyping for DRD1 (rs4532), DRD2 (rs1800497), DAT1 (rs28363170), and COMT (rs4680) polymorphisms were performed using Restriction Fragment Length Polymorphism (PCR-RFLP). Univariate and multivariate analyses were performed to assess the association of these polymorphisms and risk factors with LID development. Multivariate Cox regression analysis showed increased risk to LID development for both Levodopa Dose Equivalency (LED) (Hazard ratios (HR) = 1.001; 95% CI 1.00-1.01; p = 0.009) and individuals carrying the COMT L/L genotype (HR = 2.974; 95% CI 1.12-7.83; p = 0.010). Furthermore, when performed a Cox regression analysis adjusted for a total LED, we observed that the genotype COMT L/L had a 3.84-fold increased risk for LID development (HR = 3.841; 95% CI 1.29-11.37; p = 0.012). Our results suggest that before treating LID in PD patients, it is important to take into consideration genetic variant in the COMT gene, since COMT LL genotype may increase the risk for LID development.
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Affiliation(s)
- Erinaldo Ubirajara Damasceno Dos Santos
- Graduate Program in Applied Cellular and Molecular Biology, University of Pernambuco (UPE), Rua Dom Manuel de Medeiros, S/N -Dois Irmãos, CEP:52171-900, Recife, PE, Brazil
| | | | - Amdore Guescel C Asano
- Department of Clinical Medicine, Faculty of Medicine, Federal University of Pernambuco (UFPE), Recife, PE, Brazil.,Pro-Parkinson Program of the Clinical Hospital of the Federal University of Pernambuco Recife (HC/UFPE), Recife, PE, Brazil
| | - Nadja Maria Jorge Asano
- Department of Clinical Medicine, Faculty of Medicine, Federal University of Pernambuco (UFPE), Recife, PE, Brazil.,Pro-Parkinson Program of the Clinical Hospital of the Federal University of Pernambuco Recife (HC/UFPE), Recife, PE, Brazil
| | | | - Paulo Roberto Eleutério de Souza
- Graduate Program in Applied Cellular and Molecular Biology, University of Pernambuco (UPE), Rua Dom Manuel de Medeiros, S/N -Dois Irmãos, CEP:52171-900, Recife, PE, Brazil. .,Graduate Program in Genetics, Federal University of Pernambuco (UFPE), Recife, PE, Brazil. .,Department of Biology, Federal Rural University of Pernambuco (UFRPE), Recife, PE, Brazil.
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Affiliation(s)
- Yogesh Bhattarai
- Enteric Neuroscience Program, Mayo Clinic, Rochester, Minnesota
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota
| | - Purna C. Kashyap
- Enteric Neuroscience Program, Mayo Clinic, Rochester, Minnesota
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota
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47
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Aich S, Youn J, Chakraborty S, Pradhan PM, Park JH, Park S, Park J. A Supervised Machine Learning Approach to Detect the On/Off State in Parkinson's Disease Using Wearable Based Gait Signals. Diagnostics (Basel) 2020; 10:diagnostics10060421. [PMID: 32575764 PMCID: PMC7344560 DOI: 10.3390/diagnostics10060421] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 06/12/2020] [Accepted: 06/18/2020] [Indexed: 01/07/2023] Open
Abstract
Fluctuations in motor symptoms are mostly observed in Parkinson's disease (PD) patients. This characteristic is inevitable, and can affect the quality of life of the patients. However, it is difficult to collect precise data on the fluctuation characteristics using self-reported data from PD patients. Therefore, it is necessary to develop a suitable technology that can detect the medication state, also termed the "On"/"Off" state, automatically using wearable devices; at the same time, this could be used in the home environment. Recently, wearable devices, in combination with powerful machine learning techniques, have shown the potential to be effectively used in critical healthcare applications. In this study, an algorithm is proposed that can detect the medication state automatically using wearable gait signals. A combination of features that include statistical features and spatiotemporal gait features are used as inputs to four different classifiers such as random forest, support vector machine, K nearest neighbour, and Naïve Bayes. In total, 20 PD subjects with definite motor fluctuations have been evaluated by comparing the performance of the proposed algorithm in association with the four aforementioned classifiers. It was found that random forest outperformed the other classifiers with an accuracy of 96.72%, a recall of 97.35%, and a precision of 96.92%.
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Affiliation(s)
| | - Jinyoung Youn
- Department of Neurology, Samsung Medical Center, School of medicine Sungkyunkwan University, Seoul 06351, Korea
- Correspondence: (J.Y.); (J.P.); Tel.:+82-51-797-2448 (J.P.)
| | | | - Pyari Mohan Pradhan
- Department of Electronics and Communication Engineering, IIT Roorkee 247667, India;
| | - Jin-han Park
- Department of Respiratory Medicine, Haeundae Paik Hospital, Inje University, Busan 48108, Korea;
| | - Seongho Park
- Department of Neurology, Haeundae Paik Hospital, Inje University, Busan 48108 Korea;
| | - Jinse Park
- Department of Neurology, Haeundae Paik Hospital, Inje University, Busan 48108 Korea;
- Correspondence: (J.Y.); (J.P.); Tel.:+82-51-797-2448 (J.P.)
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Tunur T, DeBlois A, Yates-Horton E, Rickford K, Columna LA. Augmented reality-based dance intervention for individuals with Parkinson's disease: A pilot study. Disabil Health J 2019; 13:100848. [PMID: 31679951 DOI: 10.1016/j.dhjo.2019.100848] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 10/10/2019] [Accepted: 10/19/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND The effects of dance on improving the symptoms of individuals with Parkinson's disease (PD) is well documented. Augmented reality devices, such as Google Glass, may be used to implement dance interventions to improve mobility and balance. OBJECTIVE To evaluate the feasibility, safety, and acceptability of a mobile dance intervention and obtain preliminary efficacy estimates for assessment of the research protocol. METHODS Seven participants with PD were asked to use Google Glass preloaded with Moving Through Dance modules for three weeks. Changes in motor functions (balance, mobility) and non-motor functions (mood, quality of life) were evaluated before and after completion of the intervention. RESULTS Recruitment rate was 50%, retention rate was 100%, and adherence to usage was 95%. The intervention was safe and accepted by participants. Use of Moving Through Glass improved mobility with a cognitive load (F(1, 5) = 10.76; p < 0.05). However, there were no significant changes to the participants' balance scores, quality of life or mood. CONCLUSIONS The outcomes of this pilot study suggest that Moving Through Glass, as a mobile dance intervention, may be a safe way to increase physical activity through dance in individuals with PD. Its efficacy should be investigated in a properly powered randomized controlled trial.
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Affiliation(s)
- Tumay Tunur
- Department of Kinesiology, California State University San Marcos, San Marcos, CA, USA.
| | - Amy DeBlois
- Department of Physical Therapy Education, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Elizabeth Yates-Horton
- Department of Physical Therapy Education, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Kara Rickford
- Department of Exercise Science, Syracuse University, Syracuse, NY, USA
| | - Luis A Columna
- Department of Kinesiology, University of Wisconsin at Madison, Madison, WI, USA
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Carrarini C, Russo M, Dono F, Di Pietro M, Rispoli MG, Di Stefano V, Ferri L, Barbone F, Vitale M, Thomas A, Sensi SL, Onofrj M, Bonanni L. A Stage-Based Approach to Therapy in Parkinson's Disease. Biomolecules 2019; 9:biom9080388. [PMID: 31434341 PMCID: PMC6723065 DOI: 10.3390/biom9080388] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 07/31/2019] [Accepted: 08/14/2019] [Indexed: 12/11/2022] Open
Abstract
Parkinson’s disease (PD) is a neurodegenerative disorder that features progressive, disabling motor symptoms, such as bradykinesia, rigidity, and resting tremor. Nevertheless, some non-motor symptoms, including depression, REM sleep behavior disorder, and olfactive impairment, are even earlier features of PD. At later stages, apathy, impulse control disorder, neuropsychiatric disturbances, and cognitive impairment can present, and they often become a heavy burden for both patients and caregivers. Indeed, PD increasingly compromises activities of daily life, even though a high variability in clinical presentation can be observed among people affected. Nowadays, symptomatic drugs and non-pharmaceutical treatments represent the best therapeutic options to improve quality of life in PD patients. The aim of the present review is to provide a practical, stage-based guide to pharmacological management of both motor and non-motor symptoms of PD. Furthermore, warning about drug side effects, contraindications, as well as dosage and methods of administration, are highlighted here, to help the physician in yielding the best therapeutic strategies for each symptom and condition in patients with PD.
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Affiliation(s)
- Claudia Carrarini
- Department of Neuroscience, Imaging and Clinical Sciences, University G. d'Annunzio of Chieti-Pescara, 66100 Chieti, Italy
| | - Mirella Russo
- Department of Neuroscience, Imaging and Clinical Sciences, University G. d'Annunzio of Chieti-Pescara, 66100 Chieti, Italy
| | - Fedele Dono
- Department of Neuroscience, Imaging and Clinical Sciences, University G. d'Annunzio of Chieti-Pescara, 66100 Chieti, Italy
| | - Martina Di Pietro
- Department of Neuroscience, Imaging and Clinical Sciences, University G. d'Annunzio of Chieti-Pescara, 66100 Chieti, Italy
| | - Marianna G Rispoli
- Department of Neuroscience, Imaging and Clinical Sciences, University G. d'Annunzio of Chieti-Pescara, 66100 Chieti, Italy
| | - Vincenzo Di Stefano
- Department of Neuroscience, Imaging and Clinical Sciences, University G. d'Annunzio of Chieti-Pescara, 66100 Chieti, Italy
| | - Laura Ferri
- Department of Neuroscience, Imaging and Clinical Sciences, University G. d'Annunzio of Chieti-Pescara, 66100 Chieti, Italy
| | - Filomena Barbone
- Department of Neuroscience, Imaging and Clinical Sciences, University G. d'Annunzio of Chieti-Pescara, 66100 Chieti, Italy
| | - Michela Vitale
- Department of Neuroscience, Imaging and Clinical Sciences, University G. d'Annunzio of Chieti-Pescara, 66100 Chieti, Italy
| | - Astrid Thomas
- Department of Neuroscience, Imaging and Clinical Sciences, University G. d'Annunzio of Chieti-Pescara, 66100 Chieti, Italy
| | - Stefano Luca Sensi
- Department of Neuroscience, Imaging and Clinical Sciences, University G. d'Annunzio of Chieti-Pescara, 66100 Chieti, Italy
| | - Marco Onofrj
- Department of Neuroscience, Imaging and Clinical Sciences, University G. d'Annunzio of Chieti-Pescara, 66100 Chieti, Italy
| | - Laura Bonanni
- Department of Neuroscience, Imaging and Clinical Sciences, University G. d'Annunzio of Chieti-Pescara, 66100 Chieti, Italy.
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Abstract
Rotigotine (Neupro®), a non-ergolinic dopamine agonist (DA), is administered once daily via a transdermal patch (TP) that delivers the drug over a 24-h period. In the EU, the rotigotine TP is approved as monotherapy for the treatment of early Parkinson's disease (PD) and as combination therapy with levodopa throughout the course of the disease. It is also approved for the treatment of PD in numerous other countries, including Australia, the USA, China and Japan. Rotigotine TP effectively improved motor and overall functioning in clinical trials in Caucasian and Asian patients with early PD (as monotherapy) or advanced PD (in combination with levodopa); treatment benefits appeared to be maintained in open-label extensions that followed patients for up to 6 years. Rotigotine TP was not consistently non-inferior to ropinirole and pramipexole in studies that included these oral non-ergolinic DAs as active comparators. Rotigotine TP variously improved some non-motor symptoms of PD, in particular sleep disturbances and health-related quality of life (HRQOL), based on findings from individual studies and/or a meta-analysis. Rotigotine TP was generally well tolerated, with an adverse event profile characterized by adverse events typical of dopaminergic stimulation and transdermal patch application. Available for more than a decade, rotigotine TP is a well-established, once-daily DA formulation for use in the short- and longer-term treatment of PD. It offers a convenient alternative when non-oral administration of medication is preferred and may be particularly useful in patients with gastrointestinal disturbances that reduce the suitability of oral medication.
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Affiliation(s)
- James E Frampton
- Springer Nature, Private Bag 65901, Mairangi Bay, Auckland, 0754, New Zealand.
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