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Wilhelm E, Derosiere G, Quoilin C, Cakiroglu I, Paço S, Raftopoulos C, Nuttin B, Duque J. Subthalamic DBS does not restore deficits in corticospinal suppression during movement preparation in Parkinson's disease. Clin Neurophysiol 2024; 165:107-116. [PMID: 38996612 DOI: 10.1016/j.clinph.2024.06.002] [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: 10/02/2023] [Revised: 03/27/2024] [Accepted: 06/03/2024] [Indexed: 07/14/2024]
Abstract
OBJECTIVE Parkinson's disease (PD) patients exhibit changes in mechanisms underlying movement preparation, particularly the suppression of corticospinal excitability - termed "preparatory suppression" - which is thought to facilitate movement execution in healthy individuals. Deep brain stimulation (DBS) of the subthalamic nucleus (STN) being an attractive treatment for advanced PD, we aimed to study the potential contribution of this nucleus to PD-related changes in such corticospinal dynamics. METHODS On two consecutive days, we applied single-pulse transcranial magnetic stimulation to the primary motor cortex of 20 advanced PD patients treated with bilateral STN-DBS (ON vs. OFF), as well as 20 healthy control subjects. Motor-evoked potentials (MEPs) were elicited at rest or during movement preparation in an instructed-delay choice reaction time task including left- or right-hand responses. Preparatory suppression was assessed by expressing MEPs during movement preparation relative to rest. RESULTS PD patients exhibited a deficit in preparatory suppression when it was probed on the responding hand side, particularly when this corresponded to their most-affected hand, regardless of their STN-DBS status. CONCLUSIONS Advanced PD patients displayed a reduction in preparatory suppression which was not restored by STN-DBS. SIGNIFICANCE The current findings confirm that PD patients lack preparatory suppression, as previously reported. Yet, the fact that this deficit was not responsive to STN-DBS calls for future studies on the neural source of this regulatory mechanism during movement preparation.
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Affiliation(s)
- Emmanuelle Wilhelm
- Institute of Neuroscience, Catholic University of Louvain, 1200 Brussels, Belgium; Department of Adult Neurology, Saint-Luc University Hospital, 1200 Brussels, Belgium.
| | - Gerard Derosiere
- Institute of Neuroscience, Catholic University of Louvain, 1200 Brussels, Belgium
| | - Caroline Quoilin
- Institute of Neuroscience, Catholic University of Louvain, 1200 Brussels, Belgium
| | - Inci Cakiroglu
- Institute of Neuroscience, Catholic University of Louvain, 1200 Brussels, Belgium
| | - Susana Paço
- NOVA IMS, Universidade Nova de Lisboa, 1070-312 Lisbon, Portugal
| | | | - Bart Nuttin
- Department of Neurosurgery, UZ Leuven, 3000 Leuven, Belgium
| | - Julie Duque
- Institute of Neuroscience, Catholic University of Louvain, 1200 Brussels, Belgium
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Lee MJ, Park J, Ryu DW, Yoo D, Cheon SM. Survey of the Knowledge, Attitudes, and Practices of Neurologists Regarding Exercise in Parkinson's Disease. J Clin Neurol 2024; 20:385-393. [PMID: 38627229 PMCID: PMC11220353 DOI: 10.3988/jcn.2023.0344] [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: 09/04/2023] [Revised: 10/23/2023] [Accepted: 11/28/2023] [Indexed: 07/03/2024] Open
Abstract
BACKGROUND AND PURPOSE Exercise and physiotherapy can exert potentially beneficial effects on the motor and nonmotor features of Parkinson's disease (PD). We conducted an e-mail survey to assess the knowledge, attitudes, and practices of neurologists regarding exercise among patients with PD. METHODS A total of 222 neurologists from the Korean Movement Disorder Society and the Korean Society of Neurologists completed the survey and were classified into 4 clusters using the k-means clustering algorithm based on their institute types, the proportions of PD patients in their clinics, and the number of years working as neurologists. RESULTS Specialists working at referral hospitals (Clusters 1 and 2) were more confident than general neurologists (Clusters 3 and 4) about exercise improving the general motor features of PD. Specialists recommended more-frequent intense exercise compared with physicians not working at referral hospitals. The specialists in Cluster 1, representing >50% of PD patients in the clinics at referral hospitals, recommended exercise regardless of the disease stage, whereas the general neurologists in Clusters 3 and 4 recommended low-intensity exercise at an early stage of disease. Although most of the respondents agreed with the need for PD patients to exercise, less than half had prescribed rehabilitation or physiotherapy. More than 90% of the respondents answered that developing an exercise/physiotherapy protocol for PD would be helpful. CONCLUSIONS Specialists were more confident than general neurologists about the effect of exercise and recommended more-intense activities regardless of the disease stage. These results highlight the need to develop clinical practice guidelines and PD-specialized exercise protocols to provide optimal care for PD patients.
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Affiliation(s)
- Myung Jun Lee
- Department of Neurology, Pusan National University Hospital, Pusan National University School of Medicine and Biomedical Research Institute, Busan, Korea
| | - Jinse Park
- Department of Neurology, Haeundae Paik Hospital, Inje University, Busan, Korea
| | - Dong-Woo Ryu
- Department of Neurology, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Dallah Yoo
- Department of Neurology, Kyung Hee University Hospital, Kyung Hee University College of Medicine, Seoul, Korea
| | - Sang-Myung Cheon
- Department of Neurology, Dong-A University College of Medicine, Busan, Korea.
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Muleiro Alvarez M, Cano-Herrera G, Osorio Martínez MF, Vega Gonzales-Portillo J, Monroy GR, Murguiondo Pérez R, Torres-Ríos JA, van Tienhoven XA, Garibaldi Bernot EM, Esparza Salazar F, Ibarra A. A Comprehensive Approach to Parkinson's Disease: Addressing Its Molecular, Clinical, and Therapeutic Aspects. Int J Mol Sci 2024; 25:7183. [PMID: 39000288 PMCID: PMC11241043 DOI: 10.3390/ijms25137183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2024] [Revised: 06/24/2024] [Accepted: 06/27/2024] [Indexed: 07/16/2024] Open
Abstract
Parkinson's disease (PD) is a gradually worsening neurodegenerative disorder affecting the nervous system, marked by a slow progression and varied symptoms. It is the second most common neurodegenerative disease, affecting over six million people in the world. Its multifactorial etiology includes environmental, genomic, and epigenetic factors. Clinical symptoms consist of non-motor and motor symptoms, with motor symptoms being the classic presentation. Therapeutic approaches encompass pharmacological, non-pharmacological, and surgical interventions. Traditional pharmacological treatment consists of administering drugs (MAOIs, DA, and levodopa), while emerging evidence explores the potential of antidiabetic agents for neuroprotection and gene therapy for attenuating parkinsonian symptoms. Non-pharmacological treatments, such as exercise, a calcium-rich diet, and adequate vitamin D supplementation, aim to slow disease progression and prevent complications. For those patients who have medically induced side effects and/or refractory symptoms, surgery is a therapeutic option. Deep brain stimulation is the primary surgical option, associated with motor symptom improvement. Levodopa/carbidopa intestinal gel infusion through percutaneous endoscopic gastrojejunostomy and a portable infusion pump succeeded in reducing "off" time, where non-motor and motor symptoms occur, and increasing "on" time. This article aims to address the general aspects of PD and to provide a comparative comprehensive review of the conventional and the latest therapeutic advancements and emerging treatments for PD. Nevertheless, further studies are required to optimize treatment and provide suitable alternatives.
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Affiliation(s)
- Mauricio Muleiro Alvarez
- Centro de Investigación en Ciencias de la Salud (CICSA), Facultad de Ciencias de la Salud, Universidad Anáhuac Campus México Norte, Huixquilucan 52786, Mexico
| | - Gabriela Cano-Herrera
- Centro de Investigación en Ciencias de la Salud (CICSA), Facultad de Ciencias de la Salud, Universidad Anáhuac Campus México Norte, Huixquilucan 52786, Mexico
| | - María Fernanda Osorio Martínez
- Centro de Investigación en Ciencias de la Salud (CICSA), Facultad de Ciencias de la Salud, Universidad Anáhuac Campus México Norte, Huixquilucan 52786, Mexico
| | | | - Germán Rivera Monroy
- Centro de Investigación en Ciencias de la Salud (CICSA), Facultad de Ciencias de la Salud, Universidad Anáhuac Campus México Norte, Huixquilucan 52786, Mexico
| | - Renata Murguiondo Pérez
- Centro de Investigación en Ciencias de la Salud (CICSA), Facultad de Ciencias de la Salud, Universidad Anáhuac Campus México Norte, Huixquilucan 52786, Mexico
| | - Jorge Alejandro Torres-Ríos
- Centro de Investigación en Ciencias de la Salud (CICSA), Facultad de Ciencias de la Salud, Universidad Anáhuac Campus México Norte, Huixquilucan 52786, Mexico
| | - Ximena A. van Tienhoven
- Centro de Investigación en Ciencias de la Salud (CICSA), Facultad de Ciencias de la Salud, Universidad Anáhuac Campus México Norte, Huixquilucan 52786, Mexico
| | - Ernesto Marcelo Garibaldi Bernot
- Centro de Investigación en Ciencias de la Salud (CICSA), Facultad de Ciencias de la Salud, Universidad Anáhuac Campus México Norte, Huixquilucan 52786, Mexico
| | - Felipe Esparza Salazar
- Centro de Investigación en Ciencias de la Salud (CICSA), Facultad de Ciencias de la Salud, Universidad Anáhuac Campus México Norte, Huixquilucan 52786, Mexico
| | - Antonio Ibarra
- Centro de Investigación en Ciencias de la Salud (CICSA), Facultad de Ciencias de la Salud, Universidad Anáhuac Campus México Norte, Huixquilucan 52786, Mexico
- Secretaria de la Defensa Nacional, Escuela Militar de Graduados en Sanidad, Ciudad de México 11200, Mexico
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Chen S, Wang L, Hu Y, Liu S, Geng L, Li Y. High Drug Capacity of Nano-Levodopa-Liposomes: Preparation, In Vitro Release and Brain-Targeted Research. Appl Biochem Biotechnol 2024; 196:3317-3330. [PMID: 37646886 DOI: 10.1007/s12010-023-04673-w] [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] [Accepted: 08/16/2023] [Indexed: 09/01/2023]
Abstract
In this work, nano-levodopa-liposomes (L-dopa-Lip) suspension was prepared by rotary-evaporated film-ultrasonic method, and freeze-drying powders of L-dopa-Lip were also obtained to improve the stability. The products were characterized by TEM, DLS, and TG-DSC, and the phase-transition temperature (Tm) and encapsulation efficiency were calculated. The brain-targeting and in vitro release of the drug was also studied. The results showed that L-dopa-Lip were well-formed spherical vesicles, and the sizes were about 100 nm, and the encapsulation efficiency was higher than 90%. The drug release temperature of L-dopa-Lip was 68 °C, and the in vitro release property and mathematical model were also studied. The brain targeting of L-dopa-Lip in vivo was explored by injecting the gold nanoparticles (AuNPs) labeled L-dopa-Lip (AuNPs-L-dopa-Lip) through the tail vein. ICP-MS and TEM showed that L-dopa-Lip had brain targeting, suggesting the potential treatment of L-dopa-Lip on brain dysfunction. The results of this work might be helpful for designing drug-loaded liposomes for the treatment of central nervous system (CNS) diseases and monitoring their distributions in vivo.
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Affiliation(s)
- Shenna Chen
- College of Chemistry and Material Science, Hebei Key Laboratory of Organic Functional Molecules, Hebei Normal University, Shijiazhuang, 050024, China
| | - Lin Wang
- College of Chemistry and Material Science, Hebei Key Laboratory of Organic Functional Molecules, Hebei Normal University, Shijiazhuang, 050024, China
| | - Yue Hu
- College of Chemistry and Material Science, Hebei Key Laboratory of Organic Functional Molecules, Hebei Normal University, Shijiazhuang, 050024, China
| | - Sha Liu
- College of Chemistry and Material Science, Hebei Key Laboratory of Organic Functional Molecules, Hebei Normal University, Shijiazhuang, 050024, China
| | - Lina Geng
- College of Chemistry and Material Science, Hebei Key Laboratory of Organic Functional Molecules, Hebei Normal University, Shijiazhuang, 050024, China.
| | - Yayong Li
- Department of Rehabilitation Medicine, Shijiazhuang People's Hospital, Shijiazhuang, 050000, China
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Costa EDC, Filho CAK, Esteves AM, Guelfi ÉTN, Vuillerme N, Barbieri FA. Sleep "ON", sleep better! Positive effects of levodopa on sleep behaviour in people with Parkinson's disease. J Sleep Res 2024:e14240. [PMID: 38764179 DOI: 10.1111/jsr.14240] [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: 10/25/2023] [Revised: 04/21/2024] [Accepted: 05/05/2024] [Indexed: 05/21/2024]
Abstract
People with Parkinson's disease experience reduced sleep quality compared with their peers. Levodopa may have a direct effect on sleep macrostructure or may improve sleep by enhancing nocturnal motor performance. Therefore, it is important to understand the acute effects of withdrawing levodopa on sleep measures in Parkinson's disease. The purpose of this study was to compare the estimated objective and subjective sleep measures of people with Parkinson's disease sleeping under (ON-night) versus without (OFF-night) the effects of the last daily dopaminergic medication before going to bed. A total of 23 people with Parkinson's disease were instructed to wear an actigraphy device for 4 consecutive nights to objectively measure the sleep behaviour. Subjective sleep measure was assessed each morning using a Likert scale. Participants slept for 3 nights on ON-night and 1 night on OFF-night. They were instructed not to take their last dose of levodopa before going to bed in OFF-night. Sleeping in ON- versus OFF-night increased total sleep time (7.8%, p = 0.032) and sleep efficiency (3.7%, p = 0.019), and decreased duration and number of wakes after sleep onset (22.3%, p = 0.050; and 29.2%, p = 0.013, respectively). However, subjective sleep analysis indicated no significant differences between the two conditions. From a clinical point of view, our results suggest that sleeping on ON-night resulted in an improvement in estimated objective sleep measures compared with sleeping on OFF-night. From a methodological point of view, our findings emphasize the importance of relying on objective sleep measurements to accurately assess OFF-night sleep behaviour in people with Parkinson's disease.
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Affiliation(s)
- Elisa de Carvalho Costa
- School of Sciences, Department of Physical Education, Human Movement Research Laboratory (MOVI-LAB), São Paulo State University (UNESP), Bauru, Brazil
| | - Carlos Augusto Kalva Filho
- School of Sciences, Department of Physical Education, Human Movement Research Laboratory (MOVI-LAB), São Paulo State University (UNESP), Bauru, Brazil
| | | | | | - Nicolas Vuillerme
- Université Grenoble Alpes, AGEIS, Grenoble, France
- Institut Universitaire de France, Paris, France
| | - Fabio Augusto Barbieri
- School of Sciences, Department of Physical Education, Human Movement Research Laboratory (MOVI-LAB), São Paulo State University (UNESP), Bauru, Brazil
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Hermann MG, Schröter N, Rau A, Reisert M, Jarc N, Rijntjes M, Hosp JA, Reinacher PC, Jost WH, Urbach H, Weiller C, Coenen VA, Sajonz BEA. The connection of motor improvement after deep brain stimulation in Parkinson's disease and microstructural integrity of the substantia nigra and subthalamic nucleus. Neuroimage Clin 2024; 42:103607. [PMID: 38643635 PMCID: PMC11046219 DOI: 10.1016/j.nicl.2024.103607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Revised: 04/15/2024] [Accepted: 04/15/2024] [Indexed: 04/23/2024]
Abstract
BACKGROUND Nigrostriatal microstructural integrity has been suggested as a biomarker for levodopa response in Parkinson's disease (PD), which is a strong predictor for motor response to deep brain stimulation (DBS) of the subthalamic nucleus (STN). This study aimed to explore the impact of microstructural integrity of the substantia nigra (SN), STN, and putamen on motor response to STN-DBS using diffusion microstructure imaging. METHODS Data was collected from 23 PD patients (mean age 63 ± 7, 6 females) who underwent STN-DBS, had preoperative 3 T diffusion magnetic resonance imaging including multishell diffusion-weighted MRI with b-values of 1000 and 2000 s/mm2 and records of motor improvement available. RESULTS The association between a poorer DBS-response and increased free interstitial fluid showed notable effect sizes (rho > |0.4|) in SN and STN, but not in putamen. However, this did not reach significance after Bonferroni correction and controlling for sex and age. CONCLUSION Microstructural integrity of SN and STN are potential biomarkers for the prediction of therapy efficacy following STN-DBS, but further studies are required to confirm these associations.
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Affiliation(s)
- Marco G Hermann
- Department of Stereotactic and Functional Neurosurgery, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Nils Schröter
- Department of Neurology and Clinical Neuroscience, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Alexander Rau
- Department of Neuroradiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany; Department of Diagnostic and Interventional Radiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Marco Reisert
- Department of Stereotactic and Functional Neurosurgery, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany; Medical Physics, Department of Radiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | - Nadja Jarc
- Department of Stereotactic and Functional Neurosurgery, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Michel Rijntjes
- Department of Neurology and Clinical Neuroscience, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Jonas A Hosp
- Department of Neurology and Clinical Neuroscience, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Peter C Reinacher
- Department of Stereotactic and Functional Neurosurgery, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany; Fraunhofer Institute for Laser Technology (ILT), Aachen, Germany
| | | | - Horst Urbach
- Department of Neuroradiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Cornelius Weiller
- Department of Neurology and Clinical Neuroscience, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Volker A Coenen
- Department of Stereotactic and Functional Neurosurgery, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany; Center for Deep Brain Stimulation, University of Freiburg, Germany
| | - Bastian E A Sajonz
- Department of Stereotactic and Functional Neurosurgery, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
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Yeo MS, Hwang J, Lee HK, Kim SJ, Cho SR. Therapeutic singing-induced swallowing exercise for dysphagia in advanced-stage Parkinson's disease. Front Neurol 2024; 15:1323703. [PMID: 38628693 PMCID: PMC11018993 DOI: 10.3389/fneur.2024.1323703] [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: 10/25/2023] [Accepted: 03/18/2024] [Indexed: 04/19/2024] Open
Abstract
Background With longer life spans and medical advancements, the rising number of patients with advanced-stage Parkinson's disease (PD) warrants attention. Current literature predominantly addresses dementia and fall management in these patients. However, exploring the impact of swallowing function on patients with advanced PD is crucial. Previous research has demonstrated notable enhancements in the quality of life related to voice for participants following a group singing-intervention program. To further elucidate the effect of individual singing-induced swallowing exercises, our study aimed to investigate the quantitative and qualitative effects of therapeutic singing on swallowing function in patients with advanced PD in comparison to a matched usual care control group. The hypothesis of this study is that therapeutic singing-induced swallowing exercises can assist to maintain swallowing function in patients with advanced PD. Methods This prospective matched control study compared the effects of a 6-week therapeutic singing-based swallowing intervention on swallowing function and quality of life in patients with advanced PD. The intervention group received individual sessions with a music therapist and conventional individual physical therapy. The control group received the same standard physical therapy for 6 weeks without music intervention. The primary outcome measure was Video Fluoroscopic Dysphagia Scale (VDS). Results The study revealed that the intervention group maintained swallowing function, whereas the control group experienced deterioration, indicating significant time-dependent changes in Penetration-Aspiration Scale (PAS), National Institutes of Health-Swallowing Safety Scale (NIH-SSS), and VDS. Analysis of PAS and NIH-SSS liquid food scores in both groups showed significant time effects. However, the intervention group exhibited no significant differences between the pre- and post-tests, indicating preservation of the swallowing function. VDS of liquid food indicated an interaction effect between time and group in the pharyngeal phase and total scores. The Swallowing-Quality of Life showed significant time-effect improvement in the intervention group. Conclusion Therapeutic singing exercises may help maintain swallowing function in advanced PD patients, potentially enhancing quality of life related to swallowing in those with advanced-stage diseases. Clinical trial registration https://cris.nih.go.kr/cris/search/listDetail.do, identifier KCT0008644.
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Affiliation(s)
- Myung Sun Yeo
- Music Therapy Education, Graduate School of Education, Ewha Womans University, Seoul, Republic of Korea
| | - Jihye Hwang
- Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
- Graduate Program of Biomedical Engineering, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hye Kyoung Lee
- Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
- Graduate Program of Biomedical Engineering, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Soo Ji Kim
- Music Therapy Education, Graduate School of Education, Ewha Womans University, Seoul, Republic of Korea
| | - Sung-Rae Cho
- Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
- Graduate Program of Biomedical Engineering, Yonsei University College of Medicine, Seoul, Republic of Korea
- Brain Korea 21 Plus Project for Medical Science, Yonsei University College of Medicine, Seoul, Republic of Korea
- Rehabilitation Institute of Neuromuscular Disease, Yonsei University College of Medicine, Seoul, Republic of Korea
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Ahlskog JE. Parkinson's disease progression is multifaceted: Evidence for the underlying benchmarks. Parkinsonism Relat Disord 2024; 121:106037. [PMID: 38360506 DOI: 10.1016/j.parkreldis.2024.106037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 02/05/2024] [Accepted: 02/09/2024] [Indexed: 02/17/2024]
Abstract
Long-term Parkinson's disease (PD) progression is not a homogeneous process and manifests in diverse ways over the lifetime. Recognition of progression benchmarks and their substrates is important for treatment and addressing the expectations of patients, as well as for PD research planning.
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Affiliation(s)
- J Eric Ahlskog
- Department of Neurology, Mayo Clinic, Rochester, MN, 55905, USA.
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Mailankody P, Kamble N, Bhattacharya A, Shubha Bhat GS, Arumugam T, Thennarasu K, Arasappa R, Varambally S, Yadav R, Pal PK. Yoga as an Add-on Therapy in Parkinson's Disease: A Single Group Open-label Trial. Can J Neurol Sci 2024:1-8. [PMID: 38525880 DOI: 10.1017/cjn.2024.43] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/26/2024]
Abstract
OBJECTIVE We aimed to evaluate the effect of yoga on motor and non-motor symptoms and cortical excitability in patients with Parkinson's disease (PD). METHODS We prospectively evaluated 17 patients with PD at baseline, after one month of conventional care, and after one month of supervised yoga sessions. The motor and non-motor symptoms were evaluated using the Unified Parkinson's disease Rating Scale (motor part III), Hoehn and Yahr stage, Montreal Cognitive Assessment, Hamilton depression rating scale, Hamilton anxiety rating scale, non-motor symptoms questionnaire and World Health Organization quality of life questionnaire. Transcranial magnetic stimulation was used to record resting motor threshold, central motor conduction time, ipsilateral silent period (iSP), contralateral silent period (cSP), short interval intracortical inhibition (SICI), and intracortical facilitation. RESULTS The mean age of the patients was 55.5 ± 10.8 years, with a mean duration of illness of 4.0 ± 2.5 years. The postural stability of the patients significantly improved following yoga (0.59 ± 0.5 to 0.18 ± 0.4, p = 0.039). There was a significant reduction in the cSP from baseline (138.07 ± 27.5 ms) to 4 weeks of yoga therapy (116.94 ± 18.2 ms, p = 0.004). In addition, a significant reduction in SICI was observed after four weeks of yoga therapy (0.22 ± 0.10) to (0.46 ± 0.23), p = 0.004). CONCLUSION Yoga intervention can significantly improve postural stability in patients with PD. A significant reduction of cSP and SICI suggests a reduction in GABAergic neurotransmission following yoga therapy that may underlie the improvement observed in postural stability. CLINICALTRIALSGOV IDENTIFIER CTRI/2019/02/017564.
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Affiliation(s)
- Pooja Mailankody
- Department of Neurology, National Institute of Mental Health & Neuro Sciences, Bangalore, Karnataka, India
| | - Nitish Kamble
- Department of Neurology, National Institute of Mental Health & Neuro Sciences, Bangalore, Karnataka, India
| | - Amitabh Bhattacharya
- Department of Neurology, National Institute of Mental Health & Neuro Sciences, Bangalore, Karnataka, India
| | - G S Shubha Bhat
- Department of Neurology, National Institute of Mental Health & Neuro Sciences, Bangalore, Karnataka, India
| | - Thamodharan Arumugam
- Department of Neurology, National Institute of Mental Health & Neuro Sciences, Bangalore, Karnataka, India
| | - K Thennarasu
- Department of Biostatistics, National Institute of Mental Health & Neuro Sciences, Bangalore, Karnataka, India
| | - Rashmi Arasappa
- Department of Psychiatry, National Institute of Mental Health & Neuro Sciences, Bangalore, Karnataka, India
| | - Shivarama Varambally
- Department of Psychiatry, National Institute of Mental Health & Neuro Sciences, Bangalore, Karnataka, India
| | - Ravi Yadav
- Department of Neurology, National Institute of Mental Health & Neuro Sciences, Bangalore, Karnataka, India
| | - Pramod Kumar Pal
- Department of Neurology, National Institute of Mental Health & Neuro Sciences, Bangalore, Karnataka, India
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Gan QX, Peng MY, Wei HB, Chen LL, Chen XY, Li ZH, An GQ, Ma YT. Gastrodia elata polysaccharide alleviates Parkinson's disease via inhibiting apoptotic and inflammatory signaling pathways and modulating the gut microbiota. Food Funct 2024; 15:2920-2938. [PMID: 38385354 DOI: 10.1039/d3fo05169b] [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: 02/23/2024]
Abstract
Parkinson's disease (PD) is a common, chronic, and progressive degenerative disease of the central nervous system for which there is no effective treatment. Gastrodia elata is a well-known food and medicine homologous resource with neuroprotective potential. Gastrodia elata polysaccharide (GEP), which is a highly active and safe component in Gastrodia elata, is an important ingredient in the development of functional products. In this study, GEP was administered to 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP)-induced mice over 3 weeks to investigate its neuroprotective effects. The results showed that GEP significantly alleviated the motor dysfunction of PD mice, inhibited the accumulation of α-synuclein, and reduced the loss of dopaminergic neurons in the brain. Moreover, GEP increased the Bcl-2/Bax ratio and decreased the cleaved-caspase-3 level, suggesting that GEP may ameliorate PD by preventing MPTP-induced mitochondrial apoptosis. GEP also significantly inhibited the increase of GFAP and decreased the levels of TNF-α, IL-1β, and IL-6 in the brain of PD mice, which may be the result of the inhibition of neuroinflammation by the inactivation of the TLR4/NF-κB pathway. Furthermore, the neuroprotective effects of GEP involve the gut-brain axis, as it has been shown that GEP regulated the dysbiosis of PD-related gut microbiota such as Akkermansia, Lactobacillus, Bacteroides, Prevotella, and Faecalibacterium, increased the content of microbial metabolites SCFAs in the colon and increased the level of occludin that repairs the intestinal barrier of PD mice. In conclusion, this study is expected to provide a theoretical basis for the development and application of functional products with GEP from the perspective of neuroprotective effects.
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Affiliation(s)
- Qing-Xia Gan
- College of Pharmacy, Chengdu University of Traditional Chinese, Medicine, No.1166, Liutai Road, Wenjiang District, Chengdu, 611137, China.
- State Key Laboratory of Traditional Chinese Medicine Processing Technology, State Administration of Traditional Chinese Medicine, No.1166, Liutai Road, Wenjiang District, Chengdu, 611137, China
| | - Mao-Yao Peng
- College of Pharmacy, Chengdu University of Traditional Chinese, Medicine, No.1166, Liutai Road, Wenjiang District, Chengdu, 611137, China.
- State Key Laboratory of Traditional Chinese Medicine Processing Technology, State Administration of Traditional Chinese Medicine, No.1166, Liutai Road, Wenjiang District, Chengdu, 611137, China
| | - Hao-Bo Wei
- College of Pharmacy, Chengdu University of Traditional Chinese, Medicine, No.1166, Liutai Road, Wenjiang District, Chengdu, 611137, China.
- State Key Laboratory of Traditional Chinese Medicine Processing Technology, State Administration of Traditional Chinese Medicine, No.1166, Liutai Road, Wenjiang District, Chengdu, 611137, China
| | - Lin-Lin Chen
- College of Pharmacy, Chengdu University of Traditional Chinese, Medicine, No.1166, Liutai Road, Wenjiang District, Chengdu, 611137, China.
- State Key Laboratory of Traditional Chinese Medicine Processing Technology, State Administration of Traditional Chinese Medicine, No.1166, Liutai Road, Wenjiang District, Chengdu, 611137, China
| | - Xiao-Yan Chen
- College of Pharmacy, Chengdu University of Traditional Chinese, Medicine, No.1166, Liutai Road, Wenjiang District, Chengdu, 611137, China.
- State Key Laboratory of Traditional Chinese Medicine Processing Technology, State Administration of Traditional Chinese Medicine, No.1166, Liutai Road, Wenjiang District, Chengdu, 611137, China
| | - Zi-Han Li
- College of Pharmacy, Chengdu University of Traditional Chinese, Medicine, No.1166, Liutai Road, Wenjiang District, Chengdu, 611137, China.
- State Key Laboratory of Traditional Chinese Medicine Processing Technology, State Administration of Traditional Chinese Medicine, No.1166, Liutai Road, Wenjiang District, Chengdu, 611137, China
| | - Guang-Qin An
- College of Pharmacy, Chengdu University of Traditional Chinese, Medicine, No.1166, Liutai Road, Wenjiang District, Chengdu, 611137, China.
- State Key Laboratory of Traditional Chinese Medicine Processing Technology, State Administration of Traditional Chinese Medicine, No.1166, Liutai Road, Wenjiang District, Chengdu, 611137, China
| | - Yun-Tong Ma
- College of Pharmacy, Chengdu University of Traditional Chinese, Medicine, No.1166, Liutai Road, Wenjiang District, Chengdu, 611137, China.
- State Key Laboratory of Traditional Chinese Medicine Processing Technology, State Administration of Traditional Chinese Medicine, No.1166, Liutai Road, Wenjiang District, Chengdu, 611137, China
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11
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Johansson ME, Toni I, Kessels RPC, Bloem BR, Helmich RC. Clinical severity in Parkinson's disease is determined by decline in cortical compensation. Brain 2024; 147:871-886. [PMID: 37757883 PMCID: PMC10907095 DOI: 10.1093/brain/awad325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 08/02/2023] [Accepted: 09/07/2023] [Indexed: 09/29/2023] Open
Abstract
Dopaminergic dysfunction in the basal ganglia, particularly in the posterior putamen, is often viewed as the primary pathological mechanism behind motor slowing (i.e. bradykinesia) in Parkinson's disease. However, striatal dopamine loss fails to account for interindividual differences in motor phenotype and rate of decline, implying that the expression of motor symptoms depends on additional mechanisms, some of which may be compensatory in nature. Building on observations of increased motor-related activity in the parieto-premotor cortex of Parkinson patients, we tested the hypothesis that interindividual differences in clinical severity are determined by compensatory cortical mechanisms and not just by basal ganglia dysfunction. Using functional MRI, we measured variability in motor- and selection-related brain activity during a visuomotor task in 353 patients with Parkinson's disease (≤5 years disease duration) and 60 healthy controls. In this task, we manipulated action selection demand by varying the number of possible actions that individuals could choose from. Clinical variability was characterized in two ways. First, patients were categorized into three previously validated, discrete clinical subtypes that are hypothesized to reflect distinct routes of α-synuclein propagation: diffuse-malignant (n = 42), intermediate (n = 128) or mild motor-predominant (n = 150). Second, we used the scores of bradykinesia severity and cognitive performance across the entire sample as continuous measures. Patients showed motor slowing (longer response times) and reduced motor-related activity in the basal ganglia compared with controls. However, basal ganglia activity did not differ between clinical subtypes and was not associated with clinical scores. This indicates a limited role for striatal dysfunction in shaping interindividual differences in clinical severity. Consistent with our hypothesis, we observed enhanced action selection-related activity in the parieto-premotor cortex of patients with a mild-motor predominant subtype, both compared to patients with a diffuse-malignant subtype and controls. Furthermore, increased parieto-premotor activity was related to lower bradykinesia severity and better cognitive performance, which points to a compensatory role. We conclude that parieto-premotor compensation, rather than basal ganglia dysfunction, shapes interindividual variability in symptom severity in Parkinson's disease. Future interventions may focus on maintaining and enhancing compensatory cortical mechanisms, rather than only attempting to normalize basal ganglia dysfunction.
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Affiliation(s)
- Martin E Johansson
- Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Centre of Expertise for Parkinson & Movement Disorders, 6525 EN Nijmegen, The Netherlands
| | - Ivan Toni
- Donders Institute for Brain, Cognition and Behaviour, Radboud University, 6525 EN Nijmegen, The Netherlands
| | - Roy P C Kessels
- Department of Medical Psychology, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands
- Radboudumc Alzheimer Center, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands
- Vincent van Gogh Institute for Psychiatry, 5803 AC Venray, The Netherlands
| | - Bastiaan R Bloem
- Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Centre of Expertise for Parkinson & Movement Disorders, 6525 EN Nijmegen, The Netherlands
| | - Rick C Helmich
- Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Centre of Expertise for Parkinson & Movement Disorders, 6525 EN Nijmegen, The Netherlands
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12
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Gonzalez-Robles C, Bartlett M, Burnell M, Clarke CS, Haar S, Hu MT, Huxford B, Jha A, Lawton M, Noyce A, Piccini P, Pushparatnam K, Rochester L, Siu C, van Wamelen D, Williams-Gray CH, Zeissler ML, Zetterberg H, Carroll CB, Foltynie T, Weil RS, Schrag A. Embedding Patient Input in Outcome Measures for Long-Term Disease-Modifying Parkinson Disease Trials. Mov Disord 2024; 39:433-438. [PMID: 38140767 DOI: 10.1002/mds.29691] [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: 06/22/2023] [Revised: 10/30/2023] [Accepted: 11/30/2023] [Indexed: 12/24/2023] Open
Abstract
BACKGROUND Clinical trials of disease-modifying therapies in PD require valid and responsive primary outcome measures that are relevant to patients. OBJECTIVES The objective is to select a patient-centered primary outcome measure for disease-modification trials over three or more years. METHODS Experts in Parkinson's disease (PD), statistics, and health economics and patient and public involvement and engagement (PPIE) representatives reviewed and discussed potential outcome measures. A larger PPIE group provided input on their key considerations for such an endpoint. Feasibility, clinimetric properties, and relevance to patients were assessed and synthesized. RESULTS Although initial considerations favored the Movement Disorder Society-sponsored revision of the Unified Parkinson's Disease Rating Scale (MDS-UPDRS) Part III in Off, feasibility, PPIE input, and clinimetric properties supported the MDS-UPDRS Part II. However, PPIE input also highlighted the importance of nonmotor symptoms, especially in the longer term, leading to the selection of the MDS-UPDRS Parts I + II sum score. CONCLUSIONS The MDS-UPDRS Parts I + II sum score was chosen as the primary outcome for large 3-year disease-modification trials. © 2023 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Cristina Gonzalez-Robles
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
| | | | - Matthew Burnell
- Medical Research Council Clinical Trials Unit, University College London, London, United Kingdom
| | - Caroline S Clarke
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Shlomi Haar
- Department of Brain Sciences, Imperial College London, London, United Kingdom
| | - Michele T Hu
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
| | - Brook Huxford
- Preventive Neurology Unit, Wolfson Institute of Population Health, Queen Mary University of London, London, United Kingdom
| | - Ashwani Jha
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Michael Lawton
- Population Health Sciences, University of Bristol, Bristol, United Kingdom
| | - Alastair Noyce
- Preventive Neurology Unit, Wolfson Institute of Population Health, Queen Mary University of London, London, United Kingdom
| | - Paola Piccini
- Department of Brain Sciences, Imperial College London, London, United Kingdom
| | | | - Lynn Rochester
- Translational and Clinical Research Institute Clinical Ageing Research Unit, Newcastle University, Newcastle, United Kingdom
| | - Carroll Siu
- Expert by experience, Canterbury, United Kingdom
| | - Daniel van Wamelen
- Department of Neurology, Centre of Expertise for Parkinson and Movement Disorders, King's College London, London, United Kingdom
| | | | | | - Henrik Zetterberg
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Mölndal, Sweden
| | - Camille B Carroll
- Translational and Clinical Research Institute Clinical Ageing Research Unit, Newcastle University, Newcastle, United Kingdom
- Faculty of Health, University of Plymouth, Plymouth, United Kingdom
| | - Thomas Foltynie
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Rimona S Weil
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
- Dementia Research Centre, Movement Disorders Centre, University College London, London, United Kingdom
| | - Anette Schrag
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
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13
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Nishijima H, Tomiyama M. GABA storage and release from direct pathway neurons account for the enhanced short-duration response of L-dopa in Parkinson's disease. J Neurol Sci 2024; 456:122844. [PMID: 38142158 DOI: 10.1016/j.jns.2023.122844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Revised: 12/07/2023] [Accepted: 12/13/2023] [Indexed: 12/25/2023]
Affiliation(s)
- Haruo Nishijima
- Department of Neurology, Institute of Brain Science, Hirosaki University Graduate School of Medicine, Hirosaki City, Aomori, Japan; Department of Neurology, Hirosaki University Hospital, Hirosaki City, Aomori, Japan.
| | - Masahiko Tomiyama
- Department of Neurology, Institute of Brain Science, Hirosaki University Graduate School of Medicine, Hirosaki City, Aomori, Japan
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14
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Dong W, Qiu C, Lu Y, Luo B, Jiang X, Chang L, Yan J, Sun J, Liu W, Zhang L, Zhang W. Effect of deep brain stimulation compared with drug therapy alone on the progression of Parkinson's disease. Front Neurosci 2024; 17:1330752. [PMID: 38260017 PMCID: PMC10800581 DOI: 10.3389/fnins.2023.1330752] [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: 10/31/2023] [Accepted: 12/14/2023] [Indexed: 01/24/2024] Open
Abstract
Background Parkinson's disease (PD) symptoms deteriorate with disease progression. Although deep brain stimulation (DBS) can effectively improve the motor signs of PD patients, it is not yet known whether DBS surgery, which is an invasive treatment modality, may change the progression of PD. Objective The aim of this work was to compare the effect of DBS with that of drug treatment on the progression of PD. Methods A total of 77 patients with PD with the Hoehn and Yahr scale (HY) stage of 2.5 or 3 were included, and were divided into 34 in the drug therapy alone group (Drug-G) and 43 in the DBS therapy group (DBS-G). All patients were subjected to a follow-up of 2 years, and disease severity was assessed by the Unified Parkinson's Disease Rating Scale part III (UPDRS-III), the Montreal Cognitive Assessment (MOCA), the Hamilton Anxiety Scale (HAMA), and the Hamilton Depression Scale (HAMD) scores. In addition, the quality of life of patients and the burden on their family were assessed by the 39-item PD questionnaire (PDQ-39) scores, daily levodopa equivalent dose (LED), patient's annual treatment-related costs, and the Zarit Caregiver Burden Scale (ZCBS) score. The changes in relevant scale scores between the two groups were compared at each follow-up stage. Results The UPDRS-III score of the patients in the "off" state increased from year to year in both groups, and the degree of increase of this score was greater in the DBS-G than in the Drug-G group. The MOCA score in both groups began to decline in the 2nd year of follow-up, and the decline was greater in the Drug-G than in the DBS-G group. DBS treatment did not affect patients' psychiatric disorders. The PDQ39, LED, costs, and ZCBS were negatively correlated with the follow-up time in patients in the DBS-G group, and positively correlated with the follow-up time in patients in the Drug-G. Conclusion PD is progressive regardless of treatment. The findings from this follow-up study suggest that the disease progression of patients in DBS-G may be slightly faster compared to the drug-G, but the advantages of DBS are also evident. Indeed, DBS better improves patient's motor signs and quality of life and reduces the family burden. In addition, DBS has less impact on patients in terms of cognitive and mental effects.
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Affiliation(s)
- Wenwen Dong
- Department of Functional Neurosurgery, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Chang Qiu
- Department of Functional Neurosurgery, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Yue Lu
- Department of Functional Neurosurgery, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Bei Luo
- Department of Functional Neurosurgery, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Xu Jiang
- Department of Geriatric Medicine, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Lei Chang
- Department of Functional Neurosurgery, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Jiuqi Yan
- Department of Functional Neurosurgery, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Jian Sun
- Department of Functional Neurosurgery, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Weiguo Liu
- Department of Neurology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Li Zhang
- Department of Geriatric Medicine, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Wenbin Zhang
- Department of Functional Neurosurgery, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
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15
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Di Folco C, Couronné R, Arnulf I, Mangone G, Leu-Semenescu S, Dodet P, Vidailhet M, Corvol JC, Lehéricy S, Durrleman S. Charting Disease Trajectories from Isolated REM Sleep Behavior Disorder to Parkinson's Disease. Mov Disord 2024; 39:64-75. [PMID: 38006282 DOI: 10.1002/mds.29662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 10/03/2023] [Accepted: 10/30/2023] [Indexed: 11/26/2023] Open
Abstract
BACKGROUND Clinical presentation and progression dynamics are variable in patients with Parkinson's disease (PD). Disease course mapping is an innovative disease modelling technique that summarizes the range of possible disease trajectories and estimates dimensions related to onset, sequence, and speed of progression of disease markers. OBJECTIVE To propose a disease course map for PD and investigate progression profiles in patients with or without rapid eye movement sleep behavioral disorders (RBD). METHODS Data of 919 PD patients and 88 isolated RBD patients from three independent longitudinal cohorts were analyzed (follow-up duration = 5.1; 95% confidence interval, 1.1-8.1] years). Disease course map was estimated by using eight clinical markers (motor and non-motor symptoms) and four imaging markers (dopaminergic denervation). RESULTS PD course map showed that the first changes occurred in the contralateral putamen 13 years before diagnosis, followed by changes in motor symptoms, dysautonomia, sleep-all before diagnosis-and finally cognitive decline at the time of diagnosis. The model showed earlier disease onset, earlier non-motor and later motor symptoms, more rapid progression of cognitive decline in PD patients with RBD than PD patients without RBD. This pattern was even more pronounced in patients with isolated RBD with early changes in sleep, followed by cognition and non-motor symptoms and later changes in motor symptoms. CONCLUSIONS Our findings are consistent with the presence of distinct patterns of progression between patients with and without RBD. Understanding heterogeneity of PD progression is key to decipher the underlying pathophysiology and select homogeneous subgroups of patients for precision medicine. © 2023 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Cécile Di Folco
- Inria, Centre de Paris, Paris, France
- Paris Brain Institute-ICM, Paris, France
- Inserm, Paris, France
- CNRS, Paris, France
- Sorbonne Université, Paris, France
- AP-HP, Hôpital de la Pitié Salpêtrière, Paris, France
| | - Raphaël Couronné
- Inria, Centre de Paris, Paris, France
- Paris Brain Institute-ICM, Paris, France
- Inserm, Paris, France
- CNRS, Paris, France
- Sorbonne Université, Paris, France
- AP-HP, Hôpital de la Pitié Salpêtrière, Paris, France
| | - Isabelle Arnulf
- Paris Brain Institute-ICM, Paris, France
- Inserm, Paris, France
- CNRS, Paris, France
- Sorbonne Université, Paris, France
- AP-HP, Hôpital de la Pitié Salpêtrière, Paris, France
| | - Graziella Mangone
- Paris Brain Institute-ICM, Paris, France
- Inserm, Paris, France
- CNRS, Paris, France
- Sorbonne Université, Paris, France
- AP-HP, Hôpital de la Pitié Salpêtrière, Paris, France
| | - Smaranda Leu-Semenescu
- Paris Brain Institute-ICM, Paris, France
- Inserm, Paris, France
- CNRS, Paris, France
- Sorbonne Université, Paris, France
- AP-HP, Hôpital de la Pitié Salpêtrière, Paris, France
| | - Pauline Dodet
- Paris Brain Institute-ICM, Paris, France
- Inserm, Paris, France
- CNRS, Paris, France
- Sorbonne Université, Paris, France
- AP-HP, Hôpital de la Pitié Salpêtrière, Paris, France
| | - Marie Vidailhet
- Paris Brain Institute-ICM, Paris, France
- Inserm, Paris, France
- CNRS, Paris, France
- Sorbonne Université, Paris, France
- AP-HP, Hôpital de la Pitié Salpêtrière, Paris, France
| | - Jean-Christophe Corvol
- Paris Brain Institute-ICM, Paris, France
- Inserm, Paris, France
- CNRS, Paris, France
- Sorbonne Université, Paris, France
- AP-HP, Hôpital de la Pitié Salpêtrière, Paris, France
| | - Stéphane Lehéricy
- Paris Brain Institute-ICM, Paris, France
- Inserm, Paris, France
- CNRS, Paris, France
- Sorbonne Université, Paris, France
- AP-HP, Hôpital de la Pitié Salpêtrière, Paris, France
| | - Stanley Durrleman
- Inria, Centre de Paris, Paris, France
- Paris Brain Institute-ICM, Paris, France
- Inserm, Paris, France
- CNRS, Paris, France
- Sorbonne Université, Paris, France
- AP-HP, Hôpital de la Pitié Salpêtrière, Paris, France
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16
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Brissenden JA, Scerbak T, Albin RL, Lee TG. Motivational Vigor in Parkinson's Disease Requires the Short and Long Duration Response to Levodopa. Mov Disord 2024; 39:76-84. [PMID: 38062630 PMCID: PMC10842158 DOI: 10.1002/mds.29659] [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: 07/21/2023] [Revised: 09/27/2023] [Accepted: 10/26/2023] [Indexed: 02/01/2024] Open
Abstract
BACKGROUND Impaired movement vigor (bradykinesia) is a cardinal feature of Parkinson's disease (PD) and hypothesized to result from abnormal motivational processes-impaired motivation-vigor coupling. Dopamine replacement therapy (DRT) improves bradykinesia, but the response to DRT is multifaceted, comprising a short-duration response (SDR) and a long-duration response (LDR) only manifesting with chronic treatment. Prior experiments assessing motivation-vigor coupling in PD used chronically treated subjects, obscuring the roles of the SDR and LDR. METHODS To disambiguate the SDR and LDR, 11 de novo PD subjects (6 male [M]:5 female [F]; mean age, 67) were studied before treatment, after an acute levodopa (l-dopa) dose, and in both the practical "off" (LDR) and "on" (LDR + SDR) states after chronic stable treatment. At each visit, subjects were characterized with a standard battery including the Movement Disorder Society-Sponsored Revision of the Unified Parkinson's Disease Rating Scale (MDS-UPDRS) and an incentivized joystick task to assess motor performance in response to varying rewards. RESULTS l-Dopa induced a robust SDR and LDR, with further improvement in the combined SDR + LDR state. At baseline, after acute treatment (SDR), and after LDR induction, subjects did not exhibit the normal increase in movement speed with increasing reward. Only in the combined SDR + LDR state was there restoration of motivation-vigor coupling. CONCLUSIONS Although consistent with prior results in chronically treated PD subjects, the significant improvement in motor performance observed with the SDR and LDR suggests that bradykinesia is not solely secondary to deficient modulation of motivational processes. © 2023 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
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Affiliation(s)
- James A Brissenden
- Department of Psychology, University of Michigan, Ann Arbor, Michigan, USA
| | - Teresa Scerbak
- Department of Neurology, University of Michigan, Ann Arbor, Michigan, USA
| | - Roger L Albin
- Department of Neurology, University of Michigan, Ann Arbor, Michigan, USA
- Neurology Service and Geriatric Research Education and Clinical Center, Veteran Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
| | - Taraz G Lee
- Department of Psychology, University of Michigan, Ann Arbor, Michigan, USA
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Duanmu X, Wen J, Tan S, Guo T, Zhou C, Wu H, Wu J, Cao Z, Liu X, Chen J, Wu C, Qin J, Gu L, Yan Y, Zhang B, Zhang M, Guan X, Xu X. Aberrant dentato-rubro-thalamic pathway in action tremor but not rest tremor: A multi-modality magnetic resonance imaging study. CNS Neurosci Ther 2023; 29:4160-4171. [PMID: 37408389 PMCID: PMC10651946 DOI: 10.1111/cns.14339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 05/14/2023] [Accepted: 06/24/2023] [Indexed: 07/07/2023] Open
Abstract
AIMS The purpose of this study was to clarify the dentato-rubro-thalamic (DRT) pathway in action tremor in comparison to normal controls (NC) and disease controls (i.e., rest tremor) by using multi-modality magnetic resonance imaging (MRI). METHODS This study included 40 essential tremor (ET) patients, 57 Parkinson's disease (PD) patients (29 with rest tremor, 28 without rest tremor), and 41 NC. We used multi-modality MRI to comprehensively assess major nuclei and fiber tracts of the DRT pathway, which included decussating DRT tract (d-DRTT) and non-decussating DRT tract (nd-DRTT), and compared the differences in DRT pathway components between action and rest tremor. RESULTS Bilateral dentate nucleus (DN) in the ET group had excessive iron deposition compared with the NC group. Compared with the NC group, significantly decreased mean diffusivity and radial diffusivity were observed in the left nd-DRTT in the ET group, which were negatively correlated with tremor severity. No significant difference in each component of the DRT pathway was observed between the PD subgroup or the PD and NC. CONCLUSION Aberrant changes in the DRT pathway may be specific to action tremor and were indicating that action tremor may be related to pathological overactivation of the DRT pathway.
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Affiliation(s)
- Xiaojie Duanmu
- Department of Radiology, The Second Affiliated HospitalZhejiang University School of MedicineHangzhouChina
| | - Jiaqi Wen
- Department of Radiology, The Second Affiliated HospitalZhejiang University School of MedicineHangzhouChina
| | - Sijia Tan
- Department of Radiology, The Second Affiliated HospitalZhejiang University School of MedicineHangzhouChina
| | - Tao Guo
- Department of Radiology, The Second Affiliated HospitalZhejiang University School of MedicineHangzhouChina
| | - Cheng Zhou
- Department of Radiology, The Second Affiliated HospitalZhejiang University School of MedicineHangzhouChina
| | - Haoting Wu
- Department of Radiology, The Second Affiliated HospitalZhejiang University School of MedicineHangzhouChina
| | - Jingjing Wu
- Department of Radiology, The Second Affiliated HospitalZhejiang University School of MedicineHangzhouChina
| | - Zhengye Cao
- Department of Radiology, The Second Affiliated HospitalZhejiang University School of MedicineHangzhouChina
| | - Xiaocao Liu
- Department of Radiology, The Second Affiliated HospitalZhejiang University School of MedicineHangzhouChina
| | - Jingwen Chen
- Department of Radiology, The Second Affiliated HospitalZhejiang University School of MedicineHangzhouChina
| | - Chenqing Wu
- Department of Radiology, The Second Affiliated HospitalZhejiang University School of MedicineHangzhouChina
| | - Jianmei Qin
- Department of Radiology, The Second Affiliated HospitalZhejiang University School of MedicineHangzhouChina
| | - Luyan Gu
- Department of Neurology, The Second Affiliated HospitalZhejiang University School of MedicineHangzhouChina
| | - Yaping Yan
- Department of Neurology, The Second Affiliated HospitalZhejiang University School of MedicineHangzhouChina
| | - Baorong Zhang
- Department of Neurology, The Second Affiliated HospitalZhejiang University School of MedicineHangzhouChina
| | - Minming Zhang
- Department of Radiology, The Second Affiliated HospitalZhejiang University School of MedicineHangzhouChina
| | - Xiaojun Guan
- Department of Radiology, The Second Affiliated HospitalZhejiang University School of MedicineHangzhouChina
| | - Xiaojun Xu
- Department of Radiology, The Second Affiliated HospitalZhejiang University School of MedicineHangzhouChina
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18
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Colucci F, Avenali M, De Micco R, Fusar Poli M, Cerri S, Stanziano M, Bacila A, Cuconato G, Franco V, Franciotta D, Ghezzi C, Gastaldi M, Elia AE, Romito L, Devigili G, Leta V, Garavaglia B, Golfrè Andreasi N, Cazzaniga F, Reale C, Galandra C, Germani G, Mitrotti P, Ongari G, Palmieri I, Picascia M, Pichiecchio A, Verri M, Esposito F, Cirillo M, Di Nardo F, Aloisio S, Siciliano M, Prioni S, Amami P, Piacentini S, Bruzzone MG, Grisoli M, Moda F, Eleopra R, Tessitore A, Valente EM, Cilia R. Ambroxol as a disease-modifying treatment to reduce the risk of cognitive impairment in GBA-associated Parkinson's disease: a multicentre, randomised, double-blind, placebo-controlled, phase II trial. The AMBITIOUS study protocol. BMJ Neurol Open 2023; 5:e000535. [PMID: 38027469 PMCID: PMC10679992 DOI: 10.1136/bmjno-2023-000535] [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: 09/12/2023] [Accepted: 10/10/2023] [Indexed: 12/01/2023] Open
Abstract
Background Heterozygous mutations in the GBA gene, encoding the lysosomal enzyme β-glucocerebrosidase (GCase), are the most frequent genetic risk factor for Parkinson's disease (PD). GBA-related PD (GBA-PD) patients have higher risk of dementia and reduced survival than non-carriers. Preclinical studies and one open-label trial in humans demonstrated that the chaperone ambroxol (ABX) increases GCase levels and modulates α-synuclein levels in the blood and cerebrospinal fluid (CSF). Methods and analysis In this multicentre, double-blind, placebo-controlled, phase II clinical trial, we randomise patients with GBA-PD in a 1:1 ratio to either oral ABX 1.2 g/day or placebo. The duration of treatment is 52 weeks. Each participant is assessed at baseline and weeks 12, 26, 38, 52 and 78. Changes in the Montreal Cognitive Assessment score and the frequency of mild cognitive impairment and dementia between baseline and weeks 52 are the primary outcome measures. Secondary outcome measures include changes in validated scales/questionnaires assessing motor and non-motor symptoms. Neuroimaging features and CSF neurodegeneration markers are used as surrogate markers of disease progression. GCase activity, ABX and α-synuclein levels are also analysed in blood and CSF. A repeated-measures analysis of variance will be used for elaborating results. The primary analysis will be by intention to treat. Ethics and dissemination The study and protocols have been approved by the ethics committee of centres. The study is conducted according to good clinical practice and the Declaration of Helsinki. The trial findings will be published in peer-reviewed journals and presented at conferences. Trial registration numbers NCT05287503, EudraCT 2021-004565-13.
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Affiliation(s)
- Fabiana Colucci
- Department of Clinical Neurosciences, Parkinson and Movement Disorders Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
- Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy
| | - Micol Avenali
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
- IRCCS Mondino Foundation, Pavia, Italy
| | - Rosita De Micco
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Marco Fusar Poli
- Neuropsychology Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
| | | | - Mario Stanziano
- Neuroradiology Unit, Foundation IRCCS Carlo Besta Neurological Institute, Milano, Italy
| | | | - Giada Cuconato
- Department of Molecular Medicine, University of Pavia, Pavia, Italy
| | - Valentina Franco
- IRCCS Mondino Foundation, Pavia, Italy
- Division of Clinical and Experimental Pharmacology, Department of Internal Medicine and Therapeutics, University of Pavia, Pavia, Italy
| | | | | | | | - Antonio Emanuele Elia
- Department of Clinical Neurosciences, Parkinson and Movement Disorders Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
| | - Luigi Romito
- Department of Clinical Neurosciences, Parkinson and Movement Disorders Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
| | - Grazia Devigili
- Department of Clinical Neurosciences, Parkinson and Movement Disorders Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
| | - Valentina Leta
- Department of Clinical Neurosciences, Parkinson and Movement Disorders Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
- Parkinson's Centre of Excellence, King's College London, London, UK
| | - Barbara Garavaglia
- Unit of Medical Genetics and Neurogenetics, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
| | - Nico Golfrè Andreasi
- Department of Clinical Neurosciences, Parkinson and Movement Disorders Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
| | - Federico Cazzaniga
- Unit of Neurology 5 and Neuropathology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
| | - Chiara Reale
- Unit of Medical Genetics and Neurogenetics, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
| | | | | | | | | | | | | | - Anna Pichiecchio
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
- IRCCS Mondino Foundation, Pavia, Italy
| | - Mattia Verri
- Neuroradiology Unit, Foundation IRCCS Carlo Besta Neurological Institute, Milano, Italy
| | - Fabrizio Esposito
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Mario Cirillo
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Federica Di Nardo
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Simone Aloisio
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Mattia Siciliano
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
- Department of Psychology, University of Campania Luigi Vanvitelli, Caserta, Italy
| | - Sara Prioni
- Neuropsychology Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
| | - Paolo Amami
- Neuropsychology Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
| | - Sylvie Piacentini
- Neuropsychology Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
| | - Maria Grazia Bruzzone
- Neuroradiology Unit, Foundation IRCCS Carlo Besta Neurological Institute, Milano, Italy
| | - Marina Grisoli
- Neuroradiology Unit, Foundation IRCCS Carlo Besta Neurological Institute, Milano, Italy
| | - Fabio Moda
- Unit of Neurology 5 and Neuropathology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
| | - Roberto Eleopra
- Department of Clinical Neurosciences, Parkinson and Movement Disorders Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
| | - Alessandro Tessitore
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Enza Maria Valente
- IRCCS Mondino Foundation, Pavia, Italy
- Department of Molecular Medicine, University of Pavia, Pavia, Italy
| | - Roberto Cilia
- Department of Clinical Neurosciences, Parkinson and Movement Disorders Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
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19
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Wu H, Zhou C, Guan X, Bai X, Guo T, Wu J, Chen J, Wen J, Wu C, Cao Z, Liu X, Gao T, Gu L, Huang P, Xu X, Zhang B, Zhang M. Functional connectomes of akinetic-rigid and tremor within drug-naïve Parkinson's disease. CNS Neurosci Ther 2023; 29:3507-3517. [PMID: 37305965 PMCID: PMC10580330 DOI: 10.1111/cns.14284] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 03/26/2023] [Accepted: 05/22/2023] [Indexed: 06/13/2023] Open
Abstract
AIMS To detect functional connectomes of akinetic-rigid (AR) and tremor and compare their connection pattern. METHODS Resting-state functional MRI data of 78 drug-naïve PD patients were enrolled to construct connectomes of AR and tremor via connectome-based predictive modeling (CPM). The connectomes were further validated with 17 drug-naïve patients to verify their replication. RESULTS The connectomes related to AR and tremor were identified via CPM method and successfully validated in the independent set. Additional regional-based CPM demonstrated neither AR nor tremor could be simplified to functional changes within a single brain region. Computational lesion version of CPM revealed that parietal lobe and limbic system were the most important regions among AR-related connectome, and motor strip and cerebellum were the most important regions among tremor-related connectome. Comparing two connectomes found that the patterns of connection between them were largely distinct, with only four overlapped connections identified. CONCLUSION AR and tremor were found to be associated with functional changes in multiple brain regions. Distinct connection patterns of AR-related and tremor-related connectomes suggest different neural mechanisms underlying the two symptoms.
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Affiliation(s)
- Haoting Wu
- Department of Radiology, The Second Affiliated HospitalZhejiang University School of MedicineHangzhouChina
| | - Cheng Zhou
- Department of Radiology, The Second Affiliated HospitalZhejiang University School of MedicineHangzhouChina
| | - Xiaojun Guan
- Department of Radiology, The Second Affiliated HospitalZhejiang University School of MedicineHangzhouChina
| | - Xueqin Bai
- Department of Radiology, The Second Affiliated HospitalZhejiang University School of MedicineHangzhouChina
| | - Tao Guo
- Department of Radiology, The Second Affiliated HospitalZhejiang University School of MedicineHangzhouChina
| | - Jingjing Wu
- Department of Radiology, The Second Affiliated HospitalZhejiang University School of MedicineHangzhouChina
| | - Jingwen Chen
- Department of Radiology, The Second Affiliated HospitalZhejiang University School of MedicineHangzhouChina
| | - Jiaqi Wen
- Department of Radiology, The Second Affiliated HospitalZhejiang University School of MedicineHangzhouChina
| | - Chenqing Wu
- Department of Radiology, The Second Affiliated HospitalZhejiang University School of MedicineHangzhouChina
| | - Zhengye Cao
- Department of Radiology, The Second Affiliated HospitalZhejiang University School of MedicineHangzhouChina
| | - Xiaocao Liu
- Department of Radiology, The Second Affiliated HospitalZhejiang University School of MedicineHangzhouChina
| | - Ting Gao
- Department of Neurology, The Second Affiliated HospitalZhejiang University School of MedicineHangzhouChina
| | - Luyan Gu
- Department of Neurology, The Second Affiliated HospitalZhejiang University School of MedicineHangzhouChina
| | - Peiyu Huang
- Department of Radiology, The Second Affiliated HospitalZhejiang University School of MedicineHangzhouChina
| | - Xiaojun Xu
- Department of Radiology, The Second Affiliated HospitalZhejiang University School of MedicineHangzhouChina
| | - Baorong Zhang
- Department of Neurology, The Second Affiliated HospitalZhejiang University School of MedicineHangzhouChina
| | - Minming Zhang
- Department of Radiology, The Second Affiliated HospitalZhejiang University School of MedicineHangzhouChina
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20
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Jenner P, Falup-Pecurariu C, Leta V, Verin M, Auffret M, Bhidayasiri R, Weiss D, Borovečki F, Jost WH. Adopting the Rumsfeld approach to understanding the action of levodopa and apomorphine in Parkinson's disease. J Neural Transm (Vienna) 2023; 130:1337-1347. [PMID: 37210460 PMCID: PMC10645644 DOI: 10.1007/s00702-023-02655-0] [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: 04/04/2023] [Accepted: 05/14/2023] [Indexed: 05/22/2023]
Abstract
Dopaminergic therapies dominate the treatment of the motor and non-motor symptoms of Parkinson's disease (PD) but there have been no major advances in therapy in many decades. Two of the oldest drugs used appear more effective than others-levodopa and apomorphine-but the reasons for this are seldom discussed and this may be one cause for a lack of progress. This short review questions current thinking on drug action and looks at whether adopting the philosophy of ex-US Secretary of State Donald Rumsfeld reveals 'unknown' aspects of the actions of levodopa and apomorphine that provide clues for a way forward. It appears that both levodopa and apomorphine have a more complex pharmacology than classical views would suggest. In addition, there are unexpected facets to the mechanisms through which levodopa acts that are either forgotten as 'known unknowns' or ignored as 'unknown unknowns'. The conclusion reached is that we may not know as much as we think about drug action in PD and there is a case for looking beyond the obvious.
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Affiliation(s)
- P Jenner
- Faculty of Life Sciences and Medicine, Institute of Pharmaceutical Sciences, King's College London, London, SE1 1UL, UK.
| | - C Falup-Pecurariu
- Department of Neurology, Transylvania University, 500036, Brasov, Romania
| | - V Leta
- Parkinson's Foundation Center of Excellence at King's College Hospital; Department of Basic and Clinical Neuroscience, The Maurice Wohl Clinical Neuroscience Institute, King's College London and National Institute for Health Research (NIHR) Mental Health Biomedical Research Centre, Institute of Psychology, Psychiatry and Neurosciences, King's College London, London, UK
| | - M Verin
- Institut des Neurosciences Cliniques de Rennes (INCR); Behavior and Basal Ganglia Research Unit, CIC-IT, CIC1414, Pontchaillou University Hospital and University of Rennes, Rennes, France
| | - M Auffret
- Institut des Neurosciences Cliniques de Rennes (INCR); Behavior and Basal Ganglia Research Unit, CIC-IT, CIC1414, Pontchaillou University Hospital and University of Rennes, Rennes, France
- France Développement Electronique (FDE), Monswiller, France
| | - Roongroj Bhidayasiri
- Department of Medicine, Faculty of Medicine, Chulalongkorn Centre of Excellence for Parkinson's Disease and Related Disorders, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, 10330, Thailand
- The Academy of Science, The Royal Society of Thailand, Bangkok, 10330, Thailand
| | - D Weiss
- Department for Neurodegenerative Diseases, Centre for Neurology, Hertie-Institute for Clinical Brain Research, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany
| | - F Borovečki
- Division for Neurodegenerative Diseases and Neurogenomics, Department of Neurology, University Hospital Centre Zagreb, 10000, Zagreb, Croatia
| | - W H Jost
- Parkinson-Klinik Ortenau, Kreuzbergstr. 12-16, 77709, Wolfach, Germany
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21
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Walker R, Fothergill-Misbah N, Kariuki S, Ojo O, Cilia R, Dekker MCJ, Agabi O, Akpalu A, Amod F, Breckons M, Cham M, Del Din S, Dotchin C, Guggsa S, Kwasa J, Mushi D, Nwaokorie FO, Park T, Rochester L, Rogathi J, Sarfo FS, Shalash A, Ternent L, Urasa S, Okubadejo N. Transforming Parkinson's Care in Africa (TraPCAf): protocol for a multimethodology National Institute for Health and Care Research Global Health Research Group project. BMC Neurol 2023; 23:373. [PMID: 37858118 PMCID: PMC10585779 DOI: 10.1186/s12883-023-03414-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 09/29/2023] [Indexed: 10/21/2023] Open
Abstract
BACKGROUND Parkinson's disease (PD) is the second most common neurodegenerative disorder and, according to the Global Burden of Disease estimates in 2015, was the fastest growing neurological disorder globally with respect to associated prevalence, disability, and deaths. Information regarding the awareness, diagnosis, phenotypic characteristics, epidemiology, prevalence, risk factors, treatment, economic impact and lived experiences of people with PD from the African perspective is relatively sparse in contrast to the developed world, and much remains to be learned from, and about, the continent. METHODS Transforming Parkinson's Care in Africa (TraPCAf) is a multi-faceted, mixed-methods, multi-national research grant. The study design includes multiple sub-studies, combining observational (qualitative and quantitative) approaches for the epidemiological, clinical, risk factor and lived experience components, as appropriate, and interventional methods (clinical trial component). The aim of TraPCAf is to describe and gain a better understanding of the current situation of PD in Africa. The countries included in this National Institute for Health and Care Research (NIHR) Global Health Research Group (Egypt, Ethiopia, Ghana, Kenya, Nigeria, South Africa and Tanzania) represent diverse African geographies and genetic profiles, with differing resources, healthcare systems, health and social protection schemes, and policies. The research team is composed of experts in the field with vast experience in PD, jointly led by a UK-based and Africa-based investigator. DISCUSSION Despite the increasing prevalence of PD globally, robust data on the disease from Africa are lacking. Existing data point towards the poor awareness of PD and other neurological disorders on the continent and subsequent challenges with stigma, and limited access to affordable services and medication. This multi-site study will be the first of its kind in Africa. The data collected across the proposed sub-studies will provide novel and conclusive insights into the situation of PD. The selected country sites will allow for useful comparisons and make results relevant to other low- and middle-income countries. This grant is timely, as global recognition of PD and the public health challenge it poses builds. The work will contribute to broader initiatives, including the World Health Organization's Intersectoral global action plan on epilepsy and other neurological disorders. TRIAL REGISTRATION https://doi.org/10.1186/ISRCTN77014546 .
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Affiliation(s)
- R Walker
- Northumbria Healthcare NHS Foundation Trust, Newcastle upon Tyne, UK
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - N Fothergill-Misbah
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK.
| | - S Kariuki
- Neuroscience Unit, KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | - O Ojo
- College of Medicine, University of Lagos, Lagos, Nigeria
- Lagos University Teaching Hospital, Lagos, Nigeria
| | - R Cilia
- Parkinson and Movement Disorders Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - M C J Dekker
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - O Agabi
- College of Medicine, University of Lagos, Lagos, Nigeria
| | - A Akpalu
- University of Ghana Medical School, Korle Bu Teaching Hospital, Accra, Ghana
| | - F Amod
- University of KwaZulu-Natal, Durban, South Africa
| | - M Breckons
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - M Cham
- Richard Novati Catholic Hospital, Sogakope, Ghana
| | - S Del Din
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
- National Institute for Health and Care Research (NIHR) Newcastle Biomedical Research Centre (BRC), Newcastle University and Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - C Dotchin
- Northumbria Healthcare NHS Foundation Trust, Newcastle upon Tyne, UK
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - S Guggsa
- Addis Ababa University, Addis Ababa, Ethiopia
| | - J Kwasa
- Department of Clinical Medicine and Therapeutics, University of Nairobi, Nairobi, Kenya
| | - D Mushi
- Institute of Public Health, Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - F O Nwaokorie
- Department of Medical Laboratory Science, Faculty of Basic Medical Sciences, College of Medicine, University of Lagos, Lagos, Nigeria
| | - T Park
- Parkinson's Africa, Kingston upon Thames, UK
| | - L Rochester
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
- National Institute for Health and Care Research (NIHR) Newcastle Biomedical Research Centre (BRC), Newcastle University and Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - J Rogathi
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - F S Sarfo
- Kwame Nkrumah University of Science & Technology, Kumasi, Ghana
| | - A Shalash
- Department of Neurology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - L Ternent
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - S Urasa
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - N Okubadejo
- College of Medicine, University of Lagos, Lagos, Nigeria
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22
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Ortega-Vázquez A, Sánchez-Badajos S, Ramírez-García MÁ, Alvarez-Luquín D, López-López M, Adalid-Peralta LV, Monroy-Jaramillo N. Longitudinal Changes in Mitochondrial DNA Copy Number and Telomere Length in Patients with Parkinson's Disease. Genes (Basel) 2023; 14:1913. [PMID: 37895262 PMCID: PMC10606744 DOI: 10.3390/genes14101913] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 09/30/2023] [Accepted: 10/05/2023] [Indexed: 10/29/2023] Open
Abstract
Parkinson's disease (PD) pathophysiology includes mitochondrial dysfunction, neuroinflammation, and aging as its biggest risk factors. Mitochondrial DNA copy number (mtDNA-CN) and telomere length (TL) are biological aging markers with inconclusive results regarding their association with PD. A case-control study was used to measure TL and mtDNA-CN using qPCR in PBMCs. PD patients were naive at baseline (T0) and followed-up at one (T1) and two (T2) years after the dopaminergic treatment (DRT). Plasmatic cytokines were determined by ELISA in all participants, along with clinical parameters of patients at T0. While TL was shorter in patients vs. controls at all time points evaluated (p < 0.01), mtDNA-CN showed no differences. An increase in mtDNA-CN and TL was observed in treated patients vs. naive ones (p < 0.001). Our statistical model analyzed both aging markers with covariates, showing a strong correlation between them (r = 0.57, p < 0.01), and IL-17A levels positively correlating with mtDNA-CN only in untreated patients (r = 0.45, p < 0.05). TL and mtDNA-CN could be useful markers for monitoring inflammation progression or treatment response in PD. DRT might modulate TL and mtDNA-CN, reflecting a compensatory mechanism to counteract mitochondrial dysfunction in PD, but this needs further investigation.
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Affiliation(s)
- Alberto Ortega-Vázquez
- Departamento de Sistemas Biológicos, Universidad Autónoma Metropolitana, Unidad Xochimilco, Mexico City 04960, Mexico; (A.O.-V.); (M.L.-L.)
| | - Salvador Sánchez-Badajos
- Doctorado en Ciencias Biológicas y de la Salud, Universidad Autónoma Metropolitana, Unidad Xochimilco, Mexico City 04960, Mexico;
| | | | - Diana Alvarez-Luquín
- Laboratorio de Reprogramación Celular del Instituto de Fisiología Celular UNAM en el Instituto Nacional de Neurología y Neurocirugía, Mexico City 14269, Mexico; (D.A.-L.); (L.V.A.-P.)
| | - Marisol López-López
- Departamento de Sistemas Biológicos, Universidad Autónoma Metropolitana, Unidad Xochimilco, Mexico City 04960, Mexico; (A.O.-V.); (M.L.-L.)
| | - Laura Virginia Adalid-Peralta
- Laboratorio de Reprogramación Celular del Instituto de Fisiología Celular UNAM en el Instituto Nacional de Neurología y Neurocirugía, Mexico City 14269, Mexico; (D.A.-L.); (L.V.A.-P.)
| | - Nancy Monroy-Jaramillo
- Departamento de Genética, Instituto Nacional de Neurología y Neurocirugía, Mexico City 14269, Mexico;
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23
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Eguchi K, Takigawa I, Shirai S, Takahashi-Iwata I, Matsushima M, Kano T, Yaguchi H, Yabe I. Gait video-based prediction of unified Parkinson's disease rating scale score: a retrospective study. BMC Neurol 2023; 23:358. [PMID: 37798685 PMCID: PMC10552271 DOI: 10.1186/s12883-023-03385-2] [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: 03/15/2023] [Accepted: 09/11/2023] [Indexed: 10/07/2023] Open
Abstract
BACKGROUND The diagnosis of Parkinson's disease (PD) and evaluation of its symptoms require in-person clinical examination. Remote evaluation of PD symptoms is desirable, especially during a pandemic such as the coronavirus disease 2019 pandemic. One potential method to remotely evaluate PD motor impairments is video-based analysis. In this study, we aimed to assess the feasibility of predicting the Unified Parkinson's Disease Rating Scale (UPDRS) score from gait videos using a convolutional neural network (CNN) model. METHODS We retrospectively obtained 737 consecutive gait videos of 74 patients with PD and their corresponding neurologist-rated UPDRS scores. We utilized a CNN model for predicting the total UPDRS part III score and four subscores of axial symptoms (items 27, 28, 29, and 30), bradykinesia (items 23, 24, 25, 26, and 31), rigidity (item 22) and tremor (items 20 and 21). We trained the model on 80% of the gait videos and used 10% of the videos as a validation dataset. We evaluated the predictive performance of the trained model by comparing the model-predicted score with the neurologist-rated score for the remaining 10% of videos (test dataset). We calculated the coefficient of determination (R2) between those scores to evaluate the model's goodness of fit. RESULTS In the test dataset, the R2 values between the model-predicted and neurologist-rated values for the total UPDRS part III score and subscores of axial symptoms, bradykinesia, rigidity, and tremor were 0.59, 0.77, 0.56, 0.46, and 0.0, respectively. The performance was relatively low for videos from patients with severe symptoms. CONCLUSIONS Despite the low predictive performance of the model for the total UPDRS part III score, it demonstrated relatively high performance in predicting subscores of axial symptoms. The model approximately predicted the total UPDRS part III scores of patients with moderate symptoms, but the performance was low for patients with severe symptoms owing to limited data. A larger dataset is needed to improve the model's performance in clinical settings.
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Affiliation(s)
- Katsuki Eguchi
- Department of Neurology, Faculty of Medicine, Graduate School of Medicine, Hokkaido University, Kita 15, Nishi 7, Kita-ku, Sapporo, 060-8638, Hokkaido, Japan.
| | - Ichigaku Takigawa
- RIKEN Center for Advanced Intelligence Project, 1-4-1 Nihonbashi, Chuo-ku, Tokyo, 103- 0027, Japan
- Institute for Chemical Reaction Design and Discovery (WPI-ICReDD), Hokkaido University, Kita 21 Nishi 10, Kita-ku, Sapporo, 001-0021, Hokkaido, Japan
| | - Shinichi Shirai
- Department of Neurology, Faculty of Medicine, Graduate School of Medicine, Hokkaido University, Kita 15, Nishi 7, Kita-ku, Sapporo, 060-8638, Hokkaido, Japan
| | - Ikuko Takahashi-Iwata
- Department of Neurology, Faculty of Medicine, Graduate School of Medicine, Hokkaido University, Kita 15, Nishi 7, Kita-ku, Sapporo, 060-8638, Hokkaido, Japan
| | - Masaaki Matsushima
- Department of Neurology, Faculty of Medicine, Graduate School of Medicine, Hokkaido University, Kita 15, Nishi 7, Kita-ku, Sapporo, 060-8638, Hokkaido, Japan
| | - Takahiro Kano
- Department of Neurology, Faculty of Medicine, Graduate School of Medicine, Hokkaido University, Kita 15, Nishi 7, Kita-ku, Sapporo, 060-8638, Hokkaido, Japan
| | - Hiroaki Yaguchi
- Department of Neurology, Faculty of Medicine, Graduate School of Medicine, Hokkaido University, Kita 15, Nishi 7, Kita-ku, Sapporo, 060-8638, Hokkaido, Japan
| | - Ichiro Yabe
- Department of Neurology, Faculty of Medicine, Graduate School of Medicine, Hokkaido University, Kita 15, Nishi 7, Kita-ku, Sapporo, 060-8638, Hokkaido, Japan
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24
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Liu Z, Su D, Zhou J, Wang X, Wang Z, Yang Y, Ma H, Feng T. Acute effect of levodopa on orthostatic hypotension and its association with motor responsiveness in Parkinson's disease: Results of acute levodopa challenge test. Parkinsonism Relat Disord 2023; 115:105860. [PMID: 37742502 DOI: 10.1016/j.parkreldis.2023.105860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Revised: 09/15/2023] [Accepted: 09/17/2023] [Indexed: 09/26/2023]
Abstract
OBJECTIVE Levodopa administration can induce or worsen orthostatic hypotension (OH) in patients with Parkinson's disease (PD). Understanding of acute OH post levodopa (AOHPL) is important for rational drug use in PD patients. Primary objective of this study was to investigate the incidence of AOHPL in PD patients. The secondary objectives were a) hemodynamic character of AOHPL; b) risk factors of AOHPL; c) relationship between motor responsiveness and blood pressure (BP) change. METHODS 490 PD inpatients underwent acute levodopa challenge test (LCT). Supine-to-standing test (STS) was done 4 times during LCT, including before levodopa and every hour post levodopa intake within 3 h. Patients were classified into two groups, AOHPL and non-AOHPL. A comprehensive set of clinical features scales was assessed, including both motor (e.g., motor response, wearing-off) and nonmotor symptoms (e.g., autonomic dysfunction, neuropsychology). RESULTS 33.1% PD patients had OH before drug, 50.8% the same subjects had AOHPL during levodopa effectiveness. PD patients who had better response to levodopa likely to have lower standing mean artery pressure (MAP) and severer systolic BP drop after levodopa intake. BP increased when the motor performance worsened and vice versa. Beneficial response was a risk factors of AOHPL (OR = 1.624, P = 0.017). CONCLUSIONS AOHPL was very common in PD patients. We suggested that PD patients with risk factors should monitor hemodynamic change during LCT to avoid AOHPL following the introduction or increase of oral levodopa. The fluctuations of BP were complicated and multifactorial, likely caused by the process of PD and levodopa both.
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Affiliation(s)
- Zhu Liu
- Center for Movement Disorders, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Dongning Su
- Center for Movement Disorders, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Junhong Zhou
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Roslindale, MA, United States; Harvard Medical School, Boston, MA, United States
| | - Xuemei Wang
- Center for Movement Disorders, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Zhan Wang
- Center for Movement Disorders, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Yaqin Yang
- Center for Movement Disorders, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Huizi Ma
- Center for Movement Disorders, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Tao Feng
- Center for Movement Disorders, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; China National Clinical Research Center for Neurological Diseases, Beijing, China.
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Jansen JAF, Capato TTC, Darweesh SKL, Barbosa ER, Donders R, Bloem BR, Nonnekes J. Exploring the levodopa-paradox of freezing of gait in dopaminergic medication-naïve Parkinson's disease populations. NPJ Parkinsons Dis 2023; 9:130. [PMID: 37689706 PMCID: PMC10492797 DOI: 10.1038/s41531-023-00575-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 08/25/2023] [Indexed: 09/11/2023] Open
Abstract
The relationship between dopaminergic treatment and freezing of gait (FOG) in Parkinson's disease (PD) is complex: levodopa is the most effective symptomatic treatment for FOG, but long-term pulsatile levodopa treatment has also been linked to an increase in the occurrence of FOG. This concept, however, continues to be debated. Here, we compared the occurrence of FOG between a levodopa-naive PD cohort and a levodopa-treated cohort. Forty-nine treatment-naive patients and 150 levodopa-treated patients were included. The time since first motor symptoms was at least 5 years. Disease severity was assessed using the MDS-UPDRS part III. Occurrence of FOG was assessed subjectively (new freezing-of-gait-questionnaire) and objectively (rapid turns test and Timed Up-and-Go test). The presence of FOG was compared between the levodopa-treated and levodopa-naive groups using a chi-square test of homogeneity. We also performed a binomial Firth logistic regression with disease duration, disease severity, country of inclusion, location of measurement, and executive function as covariates. Subjective FOG was more common in the levodopa-treated cohort (n = 41, 27%) compared to the levodopa-naive cohort (n = 2, 4%, p < 0.001). The association between FOG and levodopa treatment remained after adjustment for covariates (OR = 6.04, 95%Cl [1.60, 33.44], p = 0.006). Objectively verified FOG was more common in the levodopa-treated cohort (n = 21, 14%) compared to the levodopa-naive cohort (n = 1, 2%, p = 0.02). We found an association between long-term pulsatile levodopa treatment and an increased occurrence of FOG. Future studies should further explore the role of nonphysiological stimulation of dopamine receptors in generating FOG, as a basis for possible prevention studies.
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Affiliation(s)
- Jamie A F Jansen
- Radboud University Medical Center, Donders Institute for Brain, Cognition and Behavior, Department of Rehabilitation, Center of Expertise for Parkinson & Movement Disorders, Nijmegen, The Netherlands
| | - Tamine T C Capato
- University of São Paulo, Department of Neurology, Movement Disorders Center, São Paulo, Brazil
- Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, Centre of Expertise for Parkinson & Movement Disorders, Nijmegen, The Netherlands
| | - Sirwan K L Darweesh
- Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, Centre of Expertise for Parkinson & Movement Disorders, Nijmegen, The Netherlands
| | - Egberto R Barbosa
- University of São Paulo, Department of Neurology, Movement Disorders Center, São Paulo, Brazil
| | - Rogier Donders
- Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | - Bastiaan R Bloem
- Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, Centre of Expertise for Parkinson & Movement Disorders, Nijmegen, The Netherlands
| | - Jorik Nonnekes
- Radboud University Medical Center, Donders Institute for Brain, Cognition and Behavior, Department of Rehabilitation, Center of Expertise for Parkinson & Movement Disorders, Nijmegen, The Netherlands.
- Department of Rehabilitation, Sint Maartenskliniek, Ubbergen, The Netherlands.
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Wu H, Hong H, Wu C, Qin J, Zhou C, Tan S, DuanMu X, Guan X, Bai X, Guo T, Wu J, Chen J, Wen J, Cao Z, Gao T, Gu L, Huang P, Xu X, Zhang B, Zhang M. Regional white matter hyperintensity volume in Parkinson's disease and associations with the motor signs. Ann Clin Transl Neurol 2023; 10:1502-1512. [PMID: 37353980 PMCID: PMC10502622 DOI: 10.1002/acn3.51839] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 06/08/2023] [Accepted: 06/09/2023] [Indexed: 06/25/2023] Open
Abstract
OBJECTIVE To determine whether white matter hyperintensity (WMH) volumes in specific regions are associated with Parkinson's disease (PD) compared to non-PD controls, and to assess their impact on motor signs through cross-sectional and longitudinal analyses. METHODS A total of 50 PD participants and 47 age- and gender-matched controls were enrolled. All PD participants were followed up for at least 2 years. To detect regions of greater WMH in the PD, the WMH volume of each region was compared with the corresponding region in the control group. Linear regression and linear mixed effects models were respectively used for cross-sectional and longitudinal analyses of the impact of increases in WMH volume on motor signs. RESULTS The PD group had greater WMH volume in the occipital region compared with the control group. Cross-sectional analyses only detected a significant correlation between occipital WMH volume and motor function in PD. Occipital WMH volume positively correlated with the severity of tremor, and gait and posture impairments, in the PD group. During the follow-up period, the participants' motor signs progressed and the WMH volumes remained stable, no longitudinal association was detected between them. The baseline occipital WMH volume cannot predict the progression of signs after adjustment for baseline disease duration and the presence of vascular risk factors. INTERPRETATION PD participants in this study were characterized by greater WMH at the occipital region, and greater occipital WMH volume had cross-sectional associations with worse motor signs, while its longitudinal impact on motor signs progression was limited.
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Affiliation(s)
- Haoting Wu
- Department of RadiologyThe Second Affiliated HospitalZhejiang University School of MedicineHangzhou310009China
| | - Hui Hong
- Department of RadiologyThe Second Affiliated HospitalZhejiang University School of MedicineHangzhou310009China
| | - Chenqing Wu
- Department of RadiologyThe Second Affiliated HospitalZhejiang University School of MedicineHangzhou310009China
| | - Jianmei Qin
- Department of RadiologyThe Second Affiliated HospitalZhejiang University School of MedicineHangzhou310009China
| | - Cheng Zhou
- Department of RadiologyThe Second Affiliated HospitalZhejiang University School of MedicineHangzhou310009China
| | - Sijia Tan
- Department of RadiologyThe Second Affiliated HospitalZhejiang University School of MedicineHangzhou310009China
| | - Xiaojie DuanMu
- Department of RadiologyThe Second Affiliated HospitalZhejiang University School of MedicineHangzhou310009China
| | - Xiaojun Guan
- Department of RadiologyThe Second Affiliated HospitalZhejiang University School of MedicineHangzhou310009China
| | - Xueqin Bai
- Department of RadiologyThe Second Affiliated HospitalZhejiang University School of MedicineHangzhou310009China
| | - Tao Guo
- Department of RadiologyThe Second Affiliated HospitalZhejiang University School of MedicineHangzhou310009China
| | - Jingjing Wu
- Department of RadiologyThe Second Affiliated HospitalZhejiang University School of MedicineHangzhou310009China
| | - Jingwen Chen
- Department of RadiologyThe Second Affiliated HospitalZhejiang University School of MedicineHangzhou310009China
| | - Jiaqi Wen
- Department of RadiologyThe Second Affiliated HospitalZhejiang University School of MedicineHangzhou310009China
| | - Zhengye Cao
- Department of RadiologyThe Second Affiliated HospitalZhejiang University School of MedicineHangzhou310009China
| | - Ting Gao
- Department of NeurologyThe Second Affiliated HospitalZhejiang University School of MedicineHangzhou310009China
| | - Luyan Gu
- Department of NeurologyThe Second Affiliated HospitalZhejiang University School of MedicineHangzhou310009China
| | - Peiyu Huang
- Department of RadiologyThe Second Affiliated HospitalZhejiang University School of MedicineHangzhou310009China
| | - Xiaojun Xu
- Department of RadiologyThe Second Affiliated HospitalZhejiang University School of MedicineHangzhou310009China
| | - Baorong Zhang
- Department of NeurologyThe Second Affiliated HospitalZhejiang University School of MedicineHangzhou310009China
| | - Minming Zhang
- Department of RadiologyThe Second Affiliated HospitalZhejiang University School of MedicineHangzhou310009China
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Wang Z, Song Z, Zhou C, Fang Y, Gu L, Yang W, Gao T, Si X, Liu Y, Chen Y, Guan X, Guo T, Wu J, Bai X, Zhang M, Zhang B, Pu J. Reduced coupling of global brain function and cerebrospinal fluid dynamics in Parkinson's disease. J Cereb Blood Flow Metab 2023; 43:1328-1339. [PMID: 36927139 PMCID: PMC10369155 DOI: 10.1177/0271678x231164337] [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: 08/13/2022] [Revised: 01/18/2023] [Accepted: 01/23/2023] [Indexed: 03/18/2023]
Abstract
Dysfunction of the glymphatic system, an intracranial clearance pathway that drains misfolded proteins, has been implicated in the onset of Parkinson's disease (PD). Recently, the coupling strength of global blood-oxygen-level-dependent (gBOLD) signals and cerebrospinal fluid (CSF) inflow dynamics have been suggested to be an indicator of glymphatic function. Using resting-state functional magnetic resonance imaging (MRI), we quantified gBOLD-CSF coupling strength as the cross-correlation between baseline gBOLD and CSF inflow signals to evaluate glymphatic function and its association with the clinical manifestations of PD. We found that gBOLD-CSF coupling in drug-naïve PD patients was significantly weaker than that in normal controls, but significantly stronger in patients less affected by sleep disturbances than in those more affected by sleep disturbances, based on the PD sleep scale. Furthermore, we collected longitudinal data from patients and found that baseline gBOLD-CSF coupling negatively correlated with the rate of change over time, but positively correlated with the rate of change in UPDRS-III scores. In conclusion, severe gBOLD-CSF decoupling in PD patients may reflect longitudinal motor impairment, thereby providing a potential marker of glymphatic dysfunction in PD.
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Affiliation(s)
- Zhiyun Wang
- Department of Neurology, Second Affiliated Hospital, School of Medicine, Zhejiang University, China
| | - Zhe Song
- Department of Neurology, Second Affiliated Hospital, School of Medicine, Zhejiang University, China
| | - Cheng Zhou
- Department of Radiology, Second Affiliated Hospital, School of Medicine, Zhejiang University, China
| | - Yi Fang
- Department of Neurology, Second Affiliated Hospital, School of Medicine, Zhejiang University, China
| | - Luyan Gu
- Department of Neurology, Second Affiliated Hospital, School of Medicine, Zhejiang University, China
| | - Wenyi Yang
- Department of Neurology, Second Affiliated Hospital, School of Medicine, Zhejiang University, China
| | - Ting Gao
- Department of Neurology, Second Affiliated Hospital, School of Medicine, Zhejiang University, China
| | - Xiaoli Si
- Department of Neurology, Second Affiliated Hospital, School of Medicine, Zhejiang University, China
| | - Yi Liu
- Department of Neurology, Second Affiliated Hospital, School of Medicine, Zhejiang University, China
| | - Ying Chen
- Department of Neurology, Second Affiliated Hospital, School of Medicine, Zhejiang University, China
| | - Xiaojun Guan
- Department of Radiology, Second Affiliated Hospital, School of Medicine, Zhejiang University, China
| | - Tao Guo
- Department of Radiology, Second Affiliated Hospital, School of Medicine, Zhejiang University, China
| | - Jingjing Wu
- Department of Radiology, Second Affiliated Hospital, School of Medicine, Zhejiang University, China
| | - Xueqing Bai
- Department of Radiology, Second Affiliated Hospital, School of Medicine, Zhejiang University, China
| | - Minming Zhang
- Department of Radiology, Second Affiliated Hospital, School of Medicine, Zhejiang University, China
| | - Baorong Zhang
- Department of Neurology, Second Affiliated Hospital, School of Medicine, Zhejiang University, China
| | - Jiali Pu
- Department of Neurology, Second Affiliated Hospital, School of Medicine, Zhejiang University, China
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28
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Rocha E, Chamoli M, Chinta SJ, Andersen JK, Wallis R, Bezard E, Goldberg M, Greenamyre T, Hirst W, Kuan WL, Kirik D, Niedernhofer L, Rappley I, Padmanabhan S, Trudeau LE, Spillantini M, Scott S, Studer L, Bellantuono I, Mortiboys H. Aging, Parkinson's Disease, and Models: What Are the Challenges? AGING BIOLOGY 2023; 1:e20230010. [PMID: 38978807 PMCID: PMC11230631 DOI: 10.59368/agingbio.20230010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 07/10/2024]
Abstract
Parkinson's disease (PD) is a chronic, neurodegenerative condition characterized by motor symptoms such as bradykinesia, rigidity, and tremor, alongside multiple nonmotor symptoms. The appearance of motor symptoms is linked to progressive dopaminergic neuron loss within the substantia nigra. PD incidence increases sharply with age, suggesting a strong association between mechanisms driving biological aging and the development and progression of PD. However, the role of aging in the pathogenesis of PD remains understudied. Numerous models of PD, including cell models, toxin-induced models, and genetic models in rodents and nonhuman primates (NHPs), reproduce different aspects of PD, but preclinical studies of PD rarely incorporate age as a factor. Studies using patient neurons derived from stem cells via reprogramming methods retain some aging features, but their characterization, particularly of aging markers and reproducibility of neuron type, is suboptimal. Investigation of age-related changes in PD using animal models indicates an association, but this is likely in conjunction with other disease drivers. The biggest barrier to drawing firm conclusions is that each model lacks full characterization and appropriate time-course assessments. There is a need to systematically investigate whether aging increases the susceptibility of mouse, rat, and NHP models to develop PD and understand the role of cell models. We propose that a significant investment in time and resources, together with the coordination and sharing of resources, knowledge, and data, is required to accelerate progress in understanding the role of biological aging in PD development and improve the reliability of models to test interventions.
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Affiliation(s)
- Emily Rocha
- Pittsburgh Institute for Neurodegenerative Diseases and Department of Neurology, University of Pittsburgh School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | | | - Shankar J Chinta
- Buck Institute for Research on Aging, Novato, CA, USA
- Touro University California, College of Pharmacy, Vallejo, CA, USA
| | | | - Ruby Wallis
- The Healthy Lifespan Institute, Sheffield, United Kingdom
| | | | | | - Tim Greenamyre
- Pittsburgh Institute for Neurodegenerative Diseases and Department of Neurology, University of Pittsburgh School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | | | - We-Li Kuan
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom
| | - Deniz Kirik
- Brain Repair and Imaging in Neural Systems (BRAINS), Lund, Sweden
| | - Laura Niedernhofer
- Institute on the Biology of Aging and Metabolism, University of Minnesota, Minneapolis, MN, USA
| | - Irit Rappley
- Recursion pharmaceuticals, Salt Lake City, UT, USA
| | | | - Louis-Eric Trudeau
- Department of pharmacology and physiology, Faculty of Medicine, Université de Montréal, Montreal, QC, Canada
| | - Maria Spillantini
- Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom
| | | | - Lorenz Studer
- The Center for Stem Cell Biology and Developmental Biology Program, Sloan-Kettering Institute for Cancer Research, New York, NY, USA
| | - Ilaria Bellantuono
- The Healthy Lifespan Institute, Sheffield, United Kingdom
- Department of Oncology and Metabolism, The Medical School, Sheffield, United Kingdom
| | - Heather Mortiboys
- The Healthy Lifespan Institute, Sheffield, United Kingdom
- Department of Neuroscience, Sheffield Institute of Translational Neuroscience (SITraN), University of Sheffield, Sheffield, United Kindgom
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29
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Steel D, Reid KM, Pisani A, Hess EJ, Fox S, Kurian MA. Advances in targeting neurotransmitter systems in dystonia. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2023; 169:217-258. [PMID: 37482394 DOI: 10.1016/bs.irn.2023.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/25/2023]
Abstract
Dystonia is characterised as uncontrolled, often painful involuntary muscle contractions that cause abnormal postures and repetitive or twisting movements. These movements can be continuous or sporadic and affect different parts of the body and range in severity. Dystonia and its related conditions present a huge cause of neurological morbidity worldwide. Although therapies are available, achieving optimal symptom control without major unwanted effects remains a challenge. Most pharmacological treatments for dystonia aim to modulate the effects of one or more neurotransmitters in the central nervous system, but doing so effectively and with precision is far from straightforward. In this chapter we discuss the physiology of key neurotransmitters, including dopamine, noradrenaline, serotonin (5-hydroxytryptamine), acetylcholine, GABA, glutamate, adenosine and cannabinoids, and their role in dystonia. We explore the ways in which existing pharmaceuticals as well as novel agents, currently in clinical trial or preclinical development, target dystonia, and their respective advantages and disadvantages. Finally, we discuss current and emerging genetic therapies which may be used to treat genetic forms of dystonia.
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Affiliation(s)
- Dora Steel
- UCL GOS Institute of Child Health (Zayed Centre for Research into Rare Diseases in Children), London, United Kingdom; Great Ormond Street Hospital for Children, London, United Kingdom
| | - Kimberley M Reid
- UCL GOS Institute of Child Health (Zayed Centre for Research into Rare Diseases in Children), London, United Kingdom
| | - Antonio Pisani
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy; IRCCS Mondino Foundation, Pavia, Italy
| | - Ellen J Hess
- Emory University School of Medicine, CA, United States
| | - Susan Fox
- Movement Disorders Clinic, Toronto Western Hospital, University of Toronto, ON, Canada
| | - Manju A Kurian
- UCL GOS Institute of Child Health (Zayed Centre for Research into Rare Diseases in Children), London, United Kingdom; Great Ormond Street Hospital for Children, London, United Kingdom.
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30
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Zhang Q, Chen XT, Chen FF, Wen SY, Zhou CQ. Dopamine agonists versus levodopa monotherapy in early Parkinson's disease for the potential risks of motor complications: A network meta-analysis. Eur J Pharmacol 2023:175884. [PMID: 37385577 DOI: 10.1016/j.ejphar.2023.175884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Revised: 06/25/2023] [Accepted: 06/26/2023] [Indexed: 07/01/2023]
Abstract
BACKGROUND Compared with levodopa, dopamine agonists (DAs) as initial treatment are associated with lower incidences of motor complications in early Parkinson's disease (PD). There is no strong evidence that a given DA is more potent in lower incidences of motor complications than another. OBJECTIVE We performed a network meta-analysis of levodopa versus DAs as monotherapy in early PD to access the risk of motor complications. METHODS Databases were searched up to June 2022 for eligible RCTs. Levodopa and four DAs (pramipexole, ropinirole, bromocriptine and pergolide) were investigated. The incidences of motor complications and efficacy, tolerability and safety outcomes were analyzed. RESULTS Nine RCTs (2112 patients) were included in the current study. The surface under the cumulative ranking curve (SUCRA) indicated that levodopa ranked first in the incidence of dyskinesia (0.988), followed by pergolide, pramipexole, ropinirole, and bromocriptine (0.704, 0.408, 0.240, 0.160). Pramipexole was least prone to wearing-off (0.109) and on-off fluctuation (0.041). Levodopa performed best in improvements of UPDRS-II, UPDRS-III, and UPDRS-II + III (0.925, 0.952, 0.934). Bromocriptine ranked first in total withdrawals and withdrawals due to adverse events (0.736, 0.751). Four DAs showed different adverse events profiles. CONCLUSION In the two non-ergot DAs, ropinirole is associated with a lower risk of dyskinesia while pramipexole is associated with lower risks of wearing-off and on-off fluctuations. Our research may facilitate head-to-head research, larger sample sizes, long following-up time RCTs to confirm the findings of this network meta-analysis.
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Affiliation(s)
- Qian Zhang
- Department of Neurology, Bishan Hospital of Chongqing Medical University, Chongqing, 402760, China.
| | - Xiang-Ting Chen
- Department of Neurology, Bishan Hospital of Chongqing Medical University, Chongqing, 402760, China.
| | - Fei-Fei Chen
- Department of Neurology, Bishan Hospital of Chongqing Medical University, Chongqing, 402760, China.
| | - Si-Yuan Wen
- Department of Neurology, Bishan Hospital of Chongqing Medical University, Chongqing, 402760, China.
| | - Chang-Qing Zhou
- Department of Neurology, Bishan Hospital of Chongqing Medical University, Chongqing, 402760, China.
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31
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Shih YC, Ooi LQR, Li HH, Allen JC, Hartono S, Welton T, Tan EK, Chan LL. Serial deep gray nuclear DTI changes in Parkinson's disease over twelve years. Front Aging Neurosci 2023; 15:1169254. [PMID: 37409008 PMCID: PMC10318173 DOI: 10.3389/fnagi.2023.1169254] [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: 02/19/2023] [Accepted: 05/30/2023] [Indexed: 07/07/2023] Open
Abstract
Background Deep gray nuclear pathology relates to motor deterioration in idiopathic Parkinson's disease (PD). Inconsistent deep nuclear diffusion tensor imaging (DTI) findings in cross-sectional or short-term longitudinal studies have been reported. Long-term studies in PD are clinically challenging; decade-long deep nuclear DTI data are nonexistent. We investigated serial DTI changes and clinical utility in a case-control PD cohort of 149 subjects (72 patients/77 controls) over 12 years. Methods Participating subjects underwent brain MRI at 1.5T; DTI metrics from segmented masks of caudate, putamen, globus pallidus and thalamus were extracted from three timepoints with 6-year gaps. Patients underwent clinical assessment, including Unified Parkinson Disease Rating Scale Part 3 (UPDRS-III) and Hoehn and Yahr (H&Y) staging. A multivariate linear mixed-effects regression model with adjustments for age and gender was used to assess between-group differences in DTI metrics at each timepoint. Partial Pearson correlation analysis was used to correlate clinical motor scores with DTI metrics over time. Results MD progressively increased over time and was higher in the putamen (p < 0.001) and globus pallidus (p = 0.002). FA increased (p < 0.05) in the thalamus at year six, and decreased in the putamen and globus pallidus at year 12. Putaminal (p = 0.0210), pallidal (p = 0.0066) and caudate MD (p < 0.0001) correlated with disease duration. Caudate MD (p < 0.05) also correlated with UPDRS-III and H&Y scores. Conclusion Pallido-putaminal MD showed differential neurodegeneration in PD over 12 years on longitudinal DTI; putaminal and thalamic FA changes were complex. Caudate MD could serve as a surrogate marker to track late PD progression.
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Affiliation(s)
- Yao-Chia Shih
- Department of Diagnostic Radiology, Singapore General Hospital, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
- Graduate Institute of Medicine, Yuan Ze University, Taoyuan City, Taiwan
| | - Leon Qi Rong Ooi
- Department of Neurology, National Neuroscience Institute, Singapore, Singapore
| | - Hui-Hua Li
- Duke-NUS Medical School, Singapore, Singapore
- Health Services Research Unit, Singapore General Hospital, Singapore, Singapore
| | | | - Septian Hartono
- Duke-NUS Medical School, Singapore, Singapore
- Department of Neurology, National Neuroscience Institute, Singapore, Singapore
| | - Thomas Welton
- Duke-NUS Medical School, Singapore, Singapore
- Department of Neurology, National Neuroscience Institute, Singapore, Singapore
| | - Eng-King Tan
- Duke-NUS Medical School, Singapore, Singapore
- Department of Neurology, National Neuroscience Institute, Singapore, Singapore
| | - Ling Ling Chan
- Department of Diagnostic Radiology, Singapore General Hospital, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
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32
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Broeder S, Roussos G, De Vleeschhauwer J, D'Cruz N, de Xivry JJO, Nieuwboer A. A smartphone-based tapping task as a marker of medication response in Parkinson's disease: a proof of concept study. J Neural Transm (Vienna) 2023:10.1007/s00702-023-02659-w. [PMID: 37268772 DOI: 10.1007/s00702-023-02659-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 05/24/2023] [Indexed: 06/04/2023]
Abstract
Tapping tasks have the potential to distinguish between ON-OFF fluctuations in Parkinson's disease (PD) possibly aiding assessment of medication status in e-diaries and research. This proof of concept study aims to assess the feasibility and accuracy of a smartphone-based tapping task (developed as part of the cloudUPDRS-project) to discriminate between ON-OFF used in the home setting without supervision. 32 PD patients performed the task before their first medication intake, followed by two test sessions after 1 and 3 h. Testing was repeated for 7 days. Index finger tapping between two targets was performed as fast as possible with each hand. Self-reported ON-OFF status was also indicated. Reminders were sent for testing and medication intake. We studied task compliance, objective performance (frequency and inter-tap distance), classification accuracy and repeatability of tapping. Average compliance was 97.0% (± 3.3%), but 16 patients (50%) needed remote assistance. Self-reported ON-OFF scores and objective tapping were worse pre versus post medication intake (p < 0.0005). Repeated tests showed good to excellent test-retest reliability in ON (0.707 ≤ ICC ≤ 0.975). Although 7 days learning effects were apparent, ON-OFF differences remained. Discriminative accuracy for ON-OFF was particularly good for right-hand tapping (0.72 ≤ AUC ≤ 0.80). Medication dose was associated with ON-OFF tapping changes. Unsupervised tapping tests performed on a smartphone have the potential to classify ON-OFF fluctuations in the home setting, despite some learning and time effects. Replication of these results are needed in a wider sample of patients.
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Affiliation(s)
- Sanne Broeder
- KU Leuven, Department of Rehabilitation Sciences, Neurorehabilitation Research Group (eNRGy), Tervuursevest 101, 3001, Leuven, Belgium.
| | - George Roussos
- Department of Computer Science and Information Systems, Birkbeck College, University of London, Malet Street, London, WC1E 7HX, UK
| | - Joni De Vleeschhauwer
- KU Leuven, Department of Rehabilitation Sciences, Neurorehabilitation Research Group (eNRGy), Tervuursevest 101, 3001, Leuven, Belgium
| | - Nicholas D'Cruz
- KU Leuven, Department of Rehabilitation Sciences, Neurorehabilitation Research Group (eNRGy), Tervuursevest 101, 3001, Leuven, Belgium
| | - Jean-Jacques Orban de Xivry
- KU Leuven, Department of Kinesiology, Movement Control and Neuroplasticity Research Group, Tervuursevest 101, 3001, Leuven, Belgium
- KU Leuven, KU Leuven Brain Institute, Leuven, Belgium
| | - Alice Nieuwboer
- KU Leuven, Department of Rehabilitation Sciences, Neurorehabilitation Research Group (eNRGy), Tervuursevest 101, 3001, Leuven, Belgium
- KU Leuven, KU Leuven Brain Institute, Leuven, Belgium
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Trinh I, Muralidhar A, Yang J, Phielipp N. Quantified Striatal Dopaminergic Denervation as Predictor for Motor Outcomes in Parkinson's Disease. Mov Disord Clin Pract 2023; 10:896-902. [PMID: 37332639 PMCID: PMC10272916 DOI: 10.1002/mdc3.13726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 02/15/2023] [Accepted: 03/05/2023] [Indexed: 06/20/2023] Open
Abstract
Background A hallmark of Parkinson's disease (PD) is progressive loss of dopamine terminals in the basal ganglia, with clinical symptoms including motor and non-motor manifestations such as bradykinesia, rigidity, and cognitive impairment. Dopamine transporter single-photon emission computed tomography (DaT-SPECT) can be used to assess dopaminergic denervation by detecting loss of striatal dopamine transporters (DaT). Objective We examined DaT binding scores' (DaTbs) association with motor outcomes in PD and explored its usefulness as a predictor of disease progression. Faster dopaminergic denervation in the basal ganglia was hypothesized to have stronger correlation and predictive value for poor motor outcomes. Methods Data was analyzed from the Parkinson's Progression Markers Initiative. DaTbs in the putamen and caudate nucleus were correlated with Movement Disorders Society Unified Parkinson's Disease Rating Scale (MDS-UPDRS) scores for walking and balance difficulties, gait difficulties, and presence of dyskinesias. A predictive model using baseline speed of drop in DaT binding score was performed for each motor outcome. Results All motor outcomes had mild, significantly negative correlation with DaTbs in the putamen and caudate nucleus, with similar degree of correlation per region. Speed of drop was predictive of only substantial gait difficulties when evaluated in the putamen but not the caudate. Conclusions These findings suggest that analyzing speed of drop in DaTbs, which occurs early in the motor phase of the disease, may be helpful for predicting clinical outcomes in PD. Longer observation of this cohort may provide further data to investigate DaTbs as a prognostic marker in PD.
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Affiliation(s)
- Ilene Trinh
- Department of NeurologySchool of Medicine, University of California IrvineIrvineCaliforniaUSA
| | - Angeni Muralidhar
- Department of NeurologySchool of Medicine, University of California IrvineIrvineCaliforniaUSA
| | - Justin Yang
- Department of NeurologySchool of Medicine, University of California IrvineIrvineCaliforniaUSA
| | - Nicolás Phielipp
- Department of NeurologySchool of Medicine, University of California IrvineIrvineCaliforniaUSA
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Molteni L, Charlier B, Izzo V, Coglianese A, Conti V, Eleopra R, Cilia R, Capelli C, D'Urso A, de Grazia U. Development and Validation of a New LC-MS/MS Bioanalytical Method for the Simultaneous Determination of Levodopa, Levodopa Methyl Ester, and Carbidopa in Human Plasma Samples. Molecules 2023; 28:molecules28114264. [PMID: 37298741 DOI: 10.3390/molecules28114264] [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: 03/22/2023] [Revised: 05/09/2023] [Accepted: 05/19/2023] [Indexed: 06/12/2023] Open
Abstract
Levodopa (L-DOPA) treatment, combined with the administration of dopa-decarboxylase inhibitors (DDCIs), is still the most effective symptomatic treatment of Parkinson's disease (PD). Although its efficacy in the early stage of the disease has been confirmed, its complex pharmacokinetics (PK) increases the variability of the intra-individual motor response, thus amplifying the risk of motor/non-motor fluctuations and dyskinesia. Moreover, it has been demonstrated that L-DOPA PK is strongly influenced by several clinical, therapeutic, and lifestyle variables (e.g., dietary proteins). L-DOPA therapeutic monitoring is therefore crucial to provide personalized therapy, hence improving drug efficacy and safety. To this aim, we have developed and validated an ultra-high performance liquid chromatography-tandem mass spectrometry (UHPLC-MS/MS) method to quantify L-DOPA, levodopa methyl ester (LDME), and the DDCI carbidopa in human plasma. The compounds were extracted by protein precipitation and samples were analyzed with a triple quadrupole mass spectrometer. The method showed good selectivity and specificity for all compounds. No carryover was observed, and dilution integrity was demonstrated. No matrix effect could be retrieved; intra-day and inter-day precision and accuracy values met the acceptance criteria. Reinjection reproducibility was assessed. The described method was successfully applied to a 45-year-old male patient to compare the pharmacokinetic behavior of an L-DOPA-based medical treatment involving commercially available Mucuna pruriens extracts and an LDME/carbidopa (100/25 mg) formulation.
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Affiliation(s)
- Linda Molteni
- Laboratory of Neurological Biochemistry and Neuropharmacology, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milano, Italy
| | - Bruno Charlier
- Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", University of Salerno, Baronissi, 84081 Salerno, Italy
- University Hospital "San Giovanni di Dio e Ruggi d'Aragona", 84131 Salerno, Italy
| | - Viviana Izzo
- Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", University of Salerno, Baronissi, 84081 Salerno, Italy
- University Hospital "San Giovanni di Dio e Ruggi d'Aragona", 84131 Salerno, Italy
| | - Albino Coglianese
- Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", University of Salerno, Baronissi, 84081 Salerno, Italy
- Graduate School in Clinical Pathology and Clinical Biochemistry, University of Salerno, Baronissi, 84081 Salerno, Italy
| | - Valeria Conti
- Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", University of Salerno, Baronissi, 84081 Salerno, Italy
- University Hospital "San Giovanni di Dio e Ruggi d'Aragona", 84131 Salerno, Italy
| | - Roberto Eleopra
- Parkinson and Movement Disorders Unit, Department of Clinical Neurosciences, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milano, Italy
| | - Roberto Cilia
- Parkinson and Movement Disorders Unit, Department of Clinical Neurosciences, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milano, Italy
| | - Chiara Capelli
- Laboratory of Neurological Biochemistry and Neuropharmacology, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milano, Italy
| | - Annachiara D'Urso
- Laboratory of Neurological Biochemistry and Neuropharmacology, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milano, Italy
| | - Ugo de Grazia
- Laboratory of Neurological Biochemistry and Neuropharmacology, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milano, Italy
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Wu C, Wu H, Zhou C, Guan X, Guo T, Cao Z, Wu J, Liu X, Chen J, Wen J, Qin J, Tan S, Duanmu X, Zhang B, Huang P, Xu X, Zhang M. Normalization effect of dopamine replacement therapy on brain functional connectome in Parkinson's disease. Hum Brain Mapp 2023; 44:3845-3858. [PMID: 37126590 DOI: 10.1002/hbm.26316] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 04/06/2023] [Accepted: 04/09/2023] [Indexed: 05/03/2023] Open
Abstract
Dopamine replacement therapy (DRT) represents the standard treatment for Parkinson's disease (PD), however, instant and long-term medication influence on patients' brain function have not been delineated. Here, a total of 97 drug-naïve patients, 43 patients under long-term DRT, and 94 normal control (NC) were, retrospectively, enrolled. Resting-state functional magnetic resonance imaging data and motor symptom assessments were conducted before and after levodopa challenge test. Whole-brain functional connectivity (FC) matrices were constructed. Network-based statistics were performed to assess FC difference between drug-naïve patients and NC, and these significant FCs were defined as disease-related connectomes, which were used for further statistical analyses. Patients showed better motor performances after both long-term DRT and levodopa challenge test. Two disease-related connectomes were observed with distinct patterns. The FC of the increased connectome, which mainly consisted of the motor, visual, subcortical, and cerebellum networks, was higher in drug-naïve patients than that in NC and was normalized after long-term DRT (p-value <.050). The decreased connectome was mainly composed of the motor, medial frontal, and salience networks and showed significantly lower FC in all patients than NC (p-value <.050). The global FC of both increased and decreased connectome was significantly enhanced after levodopa challenge test (q-value <0.050, false discovery rate-corrected). The global FC of increased connectome in ON-state was negatively associated with levodopa equivalency dose (r = -.496, q-value = 0.007). Higher global FC of the decreased connectome was related to better motor performances (r = -.310, q-value = 0.022). Our findings provided insights into brain functional alterations under dopaminergic medication and its benefit on motor symptoms.
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Affiliation(s)
- Chenqing Wu
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Haoting Wu
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Cheng Zhou
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xiaojun Guan
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Tao Guo
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Zhengye Cao
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jingjing Wu
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xiaocao Liu
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jingwen Chen
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jiaqi Wen
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jianmei Qin
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Sijia Tan
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xiaojie Duanmu
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Baorong Zhang
- Department of Neurology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Peiyu Huang
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xiaojun Xu
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Minming Zhang
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
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Sun YM, Yang WL, Rogaeva E, Lang AE, Wang J, Zhang M. Genetic and Epigenetic Study of Monozygotic Twins Affected by Parkinson’s Disease. CLINICAL AND TRANSLATIONAL NEUROSCIENCE 2023. [DOI: 10.3390/ctn7020011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/09/2023] Open
Abstract
Background: Genetic and epigenetic modifiers of age at onset of Parkinson’s disease (PD) are largely unknown. It remains unclear whether DNA methylation (DNAm) age acceleration is linked to age at onset in PD patients of different ethnicities with a similar genetic background. We aim to characterize the clinical, genomic and epigenomic features of three pairs of Chinese monozygotic twins discordant for PD onset by up to 10 years. Methods: We conducted whole genome sequencing, multiplex ligation-dependent probe amplification and genome-wide DNAm array to evaluate the three pairs of Chinese monozygotic twins discordant for age at onset of PD (families A–C). Results: We identified two heterozygous PRKN mutations (exon 2–4 deletion and p.Met1Thr) in PD affected members of one family. Somatic mutation analyses of investigated families did not reveal any variants that could explain the phenotypic discordance in the twin pairs. Of note, our epigenetic study revealed that the twins with earlier-onset had a trend of faster DNAm age acceleration than the later-onset/asymptomatic twins, but without statistical significance. Conclusion: The link between DNAm age acceleration and PD onset in Chinese patients should be interpreted with cautious, and need to be further verified in an extended PD cohort with similar genetic background.
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Affiliation(s)
- Yi-Min Sun
- Department of Neurology and National Research Center for Aging and Medicine & National Center for Neurological Disorders, Huashan Hospital, Fudan University, Shanghai 200040, China
| | - Wan-Li Yang
- Department of Medical Genetics, The First Rehabilitation Hospital of Shanghai, School of Medicine, Tongji University, Shanghai 200090, China
| | - Ekaterina Rogaeva
- Tanz Centre for Research in Neurodegenerative Diseases, University of Toronto, 60 Leonard Ave., Toronto, ON M5T 2S8, Canada
- Division of Neurology, University of Toronto, Toronto, ON M5R 0A3, Canada
| | - Anthony E. Lang
- Division of Neurology, University of Toronto, Toronto, ON M5R 0A3, Canada
- Edmond J. Safra Program in Parkinson’s Disease and Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, Toronto, ON M5T 2S8, Canada
- Krembil Brain Institute, Toronto, ON M5G 2C4, Canada
| | - Jian Wang
- Department of Neurology and National Research Center for Aging and Medicine & National Center for Neurological Disorders, Huashan Hospital, Fudan University, Shanghai 200040, China
| | - Ming Zhang
- Department of Medical Genetics, The First Rehabilitation Hospital of Shanghai, School of Medicine, Tongji University, Shanghai 200090, China
- Clinical Center for Brain and Spinal Cord Research, Tongji University, Shanghai 200092, China
- Institute for Advanced Study, Tongji University, Shanghai 200092, China
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Zhou X, Xiang Y, Song T, Zhao Y, Pan H, Xu Q, Chen Y, Sun Q, Wu X, Yan X, Guo J, Tang B, Lei L, Liu Z. Characteristics of fatigue in Parkinson’s disease: A longitudinal cohort study. Front Aging Neurosci 2023; 15:1133705. [PMID: 36967819 PMCID: PMC10036570 DOI: 10.3389/fnagi.2023.1133705] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Accepted: 02/20/2023] [Indexed: 03/12/2023] Open
Abstract
ObjectiveTo assess the prevalence, evolution, clinical characteristics, correlates and predictors of fatigue as well as to investigate the influence of comorbid fatigue on the longitudinal changes in motor and non-motor symptoms over a 2-year longitudinal follow-up period in a large cohort of patients with Parkinson’s disease (PD).Materials and methodsA total of 2,100 PD patients were enrolled from the Parkinson’s Disease & Movement Disorders Multicenter Database and Collaborative Network in China (PD-MDCNC), and their motor and non-motor symptoms were assessed biennially using comprehensive scales, including the 16-item Parkinson Fatigue Scale (PFS-16). Each PD patient was categorized as PD with or without fatigue on the basis of a cut-off mean PFS-16 score of 3.3.ResultsThe prevalence of fatigue in our cohort was 36.8%. Compared to PD patients without fatigue, PD patients with fatigue were more likely to be older, have a longer disease duration, and higher baseline levodopa equivalent daily dose (all p < 0.05). Moreover, PD patients with fatigue showed more severe motor and non-motor phenotypes than those without fatigue. Overall, high total Unified Parkinson’s Disease Rating Scale (UPDRS) score (odds ratio [OR] = 1.016, 95% confidence interval [CI]: 1.009–1.024), Non-Motor Symptoms Scale score (OR = 1.022, 95% CI: 1.015–1.029), postural instability and gait difficulty (PIGD) subtype (OR = 1.586, 95% CI: 1.211–2.079), presence of excessive daytime sleepiness (EDS; OR = 1.343, 95% CI: 1.083–1.666), and wearing-off (OR = 1.282, 95% CI: 1.023–1.607) were significantly associated with fatigue in PD patients (all p < 0.05). High total UPDRS score at baseline (OR = 1.014, 95% CI: 1.002–1.027, p = 0.028) increased the risk of developing fatigue during follow-up. Although significant, the odds ratios were low and confidence intervals were narrow. Analysis of disease progression showed significant group differences in motor and non-motor symptoms. In comparison with the never-fatigue group, the persistent-fatigue group showed significantly greater progression in motor, autonomic dysfunction, sleep, depression and cognitive symptoms (all p < 0.05).ConclusionIncreased disease severity, presence of the PIGD subtype, EDS, and wearing-off were associated with fatigue in PD patients. Significant subgroup-level differences were observed in the progression of motor and non-motor symptoms across different fatigue subgroups of PD patients.
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Affiliation(s)
- Xiaoxia Zhou
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
| | - Yaqin Xiang
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
| | - Tingwei Song
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
| | - Yuwen Zhao
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
| | - Hongxu Pan
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
| | - Qian Xu
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
| | - Yase Chen
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
| | - Qiying Sun
- Department of Geriatrics, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Xinyin Wu
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, China
| | - Xinxiang Yan
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Jifeng Guo
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
- Key Laboratory of Hunan Province in Neurodegenerative Disorders, Central South University, Changsha, China
| | - Beisha Tang
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
- Key Laboratory of Hunan Province in Neurodegenerative Disorders, Central South University, Changsha, China
| | - Lifang Lei
- Department of Neurology, The Third Xiangya Hospital, Central South University, Changsha, China
- Lifang Lei,
| | - Zhenhua Liu
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
- Key Laboratory of Hunan Province in Neurodegenerative Disorders, Central South University, Changsha, China
- *Correspondence: Zhenhua Liu,
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Ohara M, Hirata K, Hallett M, Matsubayashi T, Chen Q, Kina S, Shimano K, Hirakawa A, Yokota T, Hattori T. Long-term levodopa ameliorates sequence effect in simple, but not complex walking in early Parkinson's disease patients. Parkinsonism Relat Disord 2023; 108:105322. [PMID: 36822140 PMCID: PMC10082924 DOI: 10.1016/j.parkreldis.2023.105322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 01/28/2023] [Accepted: 02/09/2023] [Indexed: 02/11/2023]
Abstract
BACKGROUND The sequence effect (SE) is characterized by the progressive decrement of movements and is often observed in Parkinson's disease (PD) patients. While acute effect of levodopa does not ameliorate the SE, the effect of long-term levodopa treatment for the SE remains unknown. OBJECTIVE We aimed to elucidate the SEs during various gait conditions and their response to long-term levodopa treatment in drug-naïve PD patients. METHODS Nineteen drug-naïve PD patients and 21 healthy controls were enrolled. Gait parameters were measured via wearable inertial sensors in the following conditions:1) straight walking, 2) circular walking: walking a circle of 1 m diameter in a clock-wise direction for 3 laps, 3) straight or circular walking under cognitive-motor dual-task (serial 7s subtractions). PD patients were evaluated at baseline, within 1 h after intravenous administration of levodopa, and after one, three, and six months treatment with levodopa. The SE was measured by a linear regression slope by plotting consecutive stride lengths over steps. Patients were also separately analyzed depending on laterality of symptoms. RESULTS Long-term levodopa treatment ameliorated the SE only during single-task straight walking. The SE during circular walking was exacerbated after long-term levodopa treatment for right-side dominant patients. During dual-task straight walking, the SE at baseline was greater in right-side dominant PD patients. CONCLUSIONS The SE only during single-task straight walking can be ameliorated by long-term levodopa treatment. However, the SE may be exaggerated by cognitive motor interference or by asymmetrical stride length with/without long-term levodopa treatment, depending on the laterality of symptoms.
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Affiliation(s)
- Masahiro Ohara
- Department of Neurology and Neurological Science, Graduate School of Medical and Dental Science, Tokyo Medical and Dental University, Tokyo, Japan
| | - Kosei Hirata
- Department of Neurology and Neurological Science, Graduate School of Medical and Dental Science, Tokyo Medical and Dental University, Tokyo, Japan
| | - Mark Hallett
- Human Motor Control Section, Medical Neurology Branch, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - Taiki Matsubayashi
- Department of Neurology and Neurological Science, Graduate School of Medical and Dental Science, Tokyo Medical and Dental University, Tokyo, Japan
| | - Qingmeng Chen
- Department of Neurology and Neurological Science, Graduate School of Medical and Dental Science, Tokyo Medical and Dental University, Tokyo, Japan
| | - Satoko Kina
- Department of Neurology and Neurological Science, Graduate School of Medical and Dental Science, Tokyo Medical and Dental University, Tokyo, Japan
| | - Kaoru Shimano
- Department of Neurology and Neurological Science, Graduate School of Medical and Dental Science, Tokyo Medical and Dental University, Tokyo, Japan
| | - Akihiro Hirakawa
- Department of Clinical Biostatistics, Graduate School of Medical and Dental Science, Tokyo Medical and Dental University, Tokyo, Japan
| | - Takanori Yokota
- Department of Neurology and Neurological Science, Graduate School of Medical and Dental Science, Tokyo Medical and Dental University, Tokyo, Japan
| | - Takaaki Hattori
- Department of Neurology and Neurological Science, Graduate School of Medical and Dental Science, Tokyo Medical and Dental University, Tokyo, Japan.
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Leroy T, Baggen RJ, Lefeber N, Herssens N, Santens P, De Letter M, Maes L, Bouche K, Van Bladel A. Effects of Oral Levodopa on Balance in People with Idiopathic Parkinson's Disease. JOURNAL OF PARKINSON'S DISEASE 2023; 13:3-23. [PMID: 36617752 PMCID: PMC9912739 DOI: 10.3233/jpd-223536] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND Balance impairment is a frequent cause of morbidity and mortality in people with Parkinson's disease (PD). As opposed to the effects of appendicular motor symptoms, the effects of Levodopa on balance impairment in idiopathic PD are less clear. OBJECTIVE To review the literature on the effects of oral Levodopa on clinical balance test performance, posturography, step initiation, and responses to perturbation in people with idiopathic PD (PwPD). METHODS A systematic search of three scientific databases (Pubmed, Embase, and Web of Science) was conducted in accordance with PRISMA guidelines. For the pilot meta-analysis, standardized mean differences with 95% confidence intervals were calculated using an inverse variance random effects model. Data not suitable for implementation in the meta-analysis (missing means or standard deviations, and non-independent outcomes) were analyzed narratively. RESULTS A total of 2772 unique studies were retrieved, of which 18 met the eligibility criteria and were analyzed, including data of 710 idiopathic PwPD. Levodopa had a significant positive effect on the Berg Balance Scale, the Push and Release test, and jerk and frequency parameters during posturography. In contrast, some significant negative effects on velocity-based sway parameters were found during posturography and step initiation. However, Levodopa had no significant effect on most step initiation- and all perturbation parameters. CONCLUSION The effects of Levodopa on balance in PwPD vary depending on the outcome parameters and patient inclusion criteria. A systematic approach with well-defined outcome parameters, and prespecified, sensitive and reliable tests is needed in future studies to unravel the effects of oral Levodopa on balance.
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Affiliation(s)
- Tim Leroy
- Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Remco J. Baggen
- Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium,Correspondence to: Dr. Remco Baggen, Department of Rehabilitation Sciences, Ghent University, Campus UZ Gent, Corneel Heymanslaan 10, 9000 Gent, Belgium. E-mail:
| | - Nina Lefeber
- Rehabilitation Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Vrije Universiteit Brussel, Brussels, Belgium
| | - Nolan Herssens
- Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium,Space Medicine Team, European Astronaut Centre, European Space Agency, Cologne, Germany
| | - Patrick Santens
- Department of Neurology, Ghent University Hospital, Ghent, Belgium,Research Group BrainComm, Ghent University, Ghent, Belgium
| | - Miet De Letter
- Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium,Research Group BrainComm, Ghent University, Ghent, Belgium
| | - Leen Maes
- Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium,Department of Otorhinolaryngology, Ghent University Hospital, Ghent, Belgium
| | - Katie Bouche
- Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium,Department of Physical and Rehabilitation Medicine, Ghent University Hospital, Ghent, Belgium
| | - Anke Van Bladel
- Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium,Department of Physical and Rehabilitation Medicine, Ghent University Hospital, Ghent, Belgium
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Sheng S, Li X, Zhao S, Zheng C, Zhang F. Effects of levodopa on gut bacterial antibiotic resistance in Parkinson's disease rat. Front Aging Neurosci 2023; 15:1122712. [PMID: 36824263 PMCID: PMC9941341 DOI: 10.3389/fnagi.2023.1122712] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 01/23/2023] [Indexed: 02/10/2023] Open
Abstract
The second most prevalent neurodegenerative ailment, Parkinson's disease (PD), is characterized by both motor and non-motor symptoms. Levodopa is the backbone of treatment for PD at the moment. However, levodopa-induced side effects, such as dyskinesia, are commonly seen in PD patients. Recently, several antibiotics were found to present neuroprotective properties against neurodegenerative and neuro-inflammatory processes, which might be developed to effective therapies against PD. In this study, we aimed to identify if levodopa treatment could influence the gut bacterial antibiotic resistance in PD rat. Fecal samples were collected from healthy rats and 6-OHDA induced PD rats treated with different doses of levodopa, metagenomic sequencing data showed that levodopa resulted in gut bacteria composition change, the biomarkers of gut bacteria analyzed by LEfSe changed as well. More interestingly, compared with levodopa (5 mg/kg)-treated or no levodopa-treated PD rats, levodopa (10 mg/kg) caused a significant decrease in the abundance of tetW and vanTG genes in intestinal bacteria, which were related to tetracycline and vancomycin resistance, while the abundance of AAC6-lb-Suzhou gene increased apparently, which was related to aminoglycosides resistance, even though the total quantity of Antibiotic Resistance Gene (ARG) and Antibiotic Resistance Ontology (ARO) among all groups did not significantly differ. Consequently, our results imply that the combination of levodopa and antibiotics, such as tetracycline and vancomycin, in the treatment of PD may decrease the amount of corresponding antibiotic resistance genes in gut bacteria, which would give a theoretical basis for treating PD with levodopa combined with tetracycline and vancomycin in the future.
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Affiliation(s)
- Shuo Sheng
- Key Laboratory of Basic Pharmacology of the Ministry of Education, Joint International Research Laboratory of Ethnomedicine of the Ministry of Education and Key Laboratory of Basic Pharmacology of Guizhou Province, Zunyi Medical University, Zunyi, Guizhou, China
| | - Xianwei Li
- Key Laboratory of Basic Pharmacology of the Ministry of Education, Joint International Research Laboratory of Ethnomedicine of the Ministry of Education and Key Laboratory of Basic Pharmacology of Guizhou Province, Zunyi Medical University, Zunyi, Guizhou, China
| | - Shuo Zhao
- Electron Microscopy Room of School of Basic Medicine, Zunyi Medical University, Zunyi, Guizhou, China
| | - Changqing Zheng
- Key Laboratory of Basic Pharmacology of the Ministry of Education, Joint International Research Laboratory of Ethnomedicine of the Ministry of Education and Key Laboratory of Basic Pharmacology of Guizhou Province, Zunyi Medical University, Zunyi, Guizhou, China
| | - Feng Zhang
- Key Laboratory of Basic Pharmacology of the Ministry of Education, Joint International Research Laboratory of Ethnomedicine of the Ministry of Education and Key Laboratory of Basic Pharmacology of Guizhou Province, Zunyi Medical University, Zunyi, Guizhou, China,Laboratory Animal Center, Zunyi Medical University, Zunyi, Guizhou, China,The Collaborative Innovation Center of Tissue Damage Repair and Regeneration Medicine of Zunyi Medical University, Zunyi, Guizhou, China,*Correspondence: Feng Zhang, ✉
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Sun Y, Sheng J, Liu T, Yang G, He M, Huang Y, Luo Z, Zhu J, Jin X. Combination treatment of acupoint therapy and conventional medication for motor function of Parkinson's disease: A systematic review and meta-analysis. Complement Ther Clin Pract 2023; 50:101677. [PMID: 36402061 DOI: 10.1016/j.ctcp.2022.101677] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 09/29/2022] [Accepted: 10/29/2022] [Indexed: 11/11/2022]
Abstract
BACKGROUND Combination treatment with acupoint therapy and conventional medication (CM) has been proposed as a strategy that could improve motor dysfunction in Parkinson's disease (PD). We performed this systematic review and meta-analysis to assess the effects of this combination treatment on motor function in patients with PD. METHODS We searched randomized controlled trials (RCTs) from eight databases, comparing combined acupoint therapy and CM and CM (alone or with sham interventions). The quality of the trials was evaluated according to the Cochrane risk of bias. Subgroup and sensitivity analyses were performed on different types of acupoint interventions. RESULTS Forty-seven trials of 2929 participants were included, with 45 studies used for the meta-analyses. Combination treatment yielded an improved reduction in United Parkinson's disease rating scale (UPDRS) III of -3.85 [95% CI, -4.83 to -2.86] and Webster scale score of -3.17 [95% CI, -4.07 to -2.27]. Further analyses demonstrated that real (compared with sham) intervention was linked to a decreased UPDRS III of -2.02 ([95% CI, -3.60 to -0.44], I2 = 40%), and beneficial effects were observed when combination intervention was used for patients with Hoehn-Yahr (H-Y) stages >3 with mild to moderate stimulation for 4-12-week treatment. CONCLUSIONS Acupoint therapy and CM treatment may improve motor function of patients with PD. Patients with H-Y stage >3 could tolerate real acupoint intervention with mild to moderate stimulation for 4-12-week treatment and showed improvement. However, this was demonstrated with low to moderate levels of evidence in statistical description.
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Affiliation(s)
- Yingying Sun
- Department of Rehabilitation, Ningbo Zhenhai Longsai Hospital, Ningbo, 315299, China
| | - Jili Sheng
- The Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, 310053, China; Department of Acupuncture, Zhejiang Hospital, Hangzhou, 310013, China
| | - Tao Liu
- Department of Acupuncture, Zhejiang Hospital, Hangzhou, 310013, China
| | - Geyao Yang
- Department of Acupuncture, Hangzhou Geriatric Hospital, Hangzhou, 310000, China
| | - Meiling He
- Rehabilitation Department, Mianyang Hospital of TCM, Sichuan, 621063, China
| | - Yuanan Huang
- Department of Manipulation, Zhejiang Hospital, Hangzhou, 310030, China
| | - Zhouxiao Luo
- Department of Acupuncture, Tonglu Hospital of TCM, Hangzhou, 311599, China
| | - Jianfang Zhu
- Department of Acupuncture, Zhejiang Hospital, Hangzhou, 310013, China
| | - Xiaoqing Jin
- Department of Acupuncture, Zhejiang Hospital, Hangzhou, 310013, China.
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Frequin HL, Schouten J, Verschuur CVM, Suwijn SR, Boel JA, Post B, Bloem BR, van Hilten JJ, van Laar T, Tissingh G, Munts AG, Dijk JM, Deuschl G, Lang A, Dijkgraaf MGW, de Haan RJ, de Bie RMA. Levodopa Response in Patients With Early Parkinson Disease: Further Observations of the LEAP Study. Neurology 2023; 100:e367-e376. [PMID: 36253105 DOI: 10.1212/wnl.0000000000201448] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 09/08/2022] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND AND OBJECTIVES The Levodopa in EArly Parkinson's Disease (LEAP) study enabled us to conduct post hoc analyses concerning the effects of levodopa in patients with early Parkinson disease. METHODS The LEAP study was a double-blind, placebo-controlled, randomized, delayed-start trial in which patients with early Parkinson disease were randomized to receive levodopa/carbidopa 300/75 mg daily for 80 weeks (early-start group) or to placebo for 40 weeks followed by levodopa/carbidopa 300/75 mg daily for 40 weeks (delayed-start group). We analyzed the effect of levodopa with the Unified Parkinson's Disease Rating Scale on bradykinesia, rigidity, and tremor. At week 80, participants answered 3 questions regarding motor response fluctuations. RESULTS A total of 222 patients were randomized to the early-start group (mean ± SD age at baseline 64.8 ± 8.7 years; 71% male) and 223 to the delayed-start group (mean ± SD age at baseline 65.5 ± 8.8 years; 69% male). The difference between the early- and delayed-start groups in mean change from baseline to week 4, expressed as Hedges g effect size, was -0.33 for bradykinesia, -0.29 for rigidity, and -0.25 for tremor (for all symptoms indicating a small effect in favor of the early-start group); from baseline to week 22, respectively, -0.49, -0.36, and -0.44 (small to medium effect); and from baseline to week 40, respectively, -0.32, -0.19, and -0.27 (small effect). At 80 weeks, fewer patients in the early-start group (46 of 205 patients, 23%) experienced motor response fluctuations than patients in the delayed-start group (81 of 211, 38%; p < 0.01). DISCUSSION In patients with early Parkinson disease, levodopa improves bradykinesia, rigidity, and tremor to the same order of magnitude. For all 3 symptoms, effects were larger at 22 weeks compared with 4 weeks. At 80 weeks, there were fewer patients with motor response fluctuations in the group that had started levodopa earlier. CLASSIFICATION OF EVIDENCE This study provides Class II evidence that the effect of levodopa on bradykinesia, rigidity, and tremor is larger after 22 weeks compared with 4 weeks of treatment. TRIAL REGISTRATION INFORMATION ISRCTN30518857, EudraCT number 2011-000678-72.
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Affiliation(s)
- Henrieke L Frequin
- From the Department of Neurology (H.L.F., J.S., C.V.M.V., S.R.S., J.M.D., R.M.A.d.B.) and Department of Medical Psychology (J.A.B.), Amsterdam University Medical Centers; Radboud University Medical Center (B.P., B.R.B.), Department of Neurology; Leiden University Medical Center (J.J.H.), Department of Neurology; University Medical Center Groningen (T.L.), Department of Neurology; Zuyderland Medical Center (G.T.), Department of Neurology; Excellent Klinieken (A.G.M.), Dordrecht, Department of Neurology; University Medical Center Schleswig-Holstein (G.D.), Department of Neurology; Toronto Western Hospital (A.L.), University of Toronto, Department of Neurology; Amsterdam University Medical Centers (M.G.W.D.), Department of Epidemiology and Data Science; and Amsterdam University Medical Centers (R.J.H.), Clinical Research Unit
| | - Jason Schouten
- From the Department of Neurology (H.L.F., J.S., C.V.M.V., S.R.S., J.M.D., R.M.A.d.B.) and Department of Medical Psychology (J.A.B.), Amsterdam University Medical Centers; Radboud University Medical Center (B.P., B.R.B.), Department of Neurology; Leiden University Medical Center (J.J.H.), Department of Neurology; University Medical Center Groningen (T.L.), Department of Neurology; Zuyderland Medical Center (G.T.), Department of Neurology; Excellent Klinieken (A.G.M.), Dordrecht, Department of Neurology; University Medical Center Schleswig-Holstein (G.D.), Department of Neurology; Toronto Western Hospital (A.L.), University of Toronto, Department of Neurology; Amsterdam University Medical Centers (M.G.W.D.), Department of Epidemiology and Data Science; and Amsterdam University Medical Centers (R.J.H.), Clinical Research Unit
| | - Constant V M Verschuur
- From the Department of Neurology (H.L.F., J.S., C.V.M.V., S.R.S., J.M.D., R.M.A.d.B.) and Department of Medical Psychology (J.A.B.), Amsterdam University Medical Centers; Radboud University Medical Center (B.P., B.R.B.), Department of Neurology; Leiden University Medical Center (J.J.H.), Department of Neurology; University Medical Center Groningen (T.L.), Department of Neurology; Zuyderland Medical Center (G.T.), Department of Neurology; Excellent Klinieken (A.G.M.), Dordrecht, Department of Neurology; University Medical Center Schleswig-Holstein (G.D.), Department of Neurology; Toronto Western Hospital (A.L.), University of Toronto, Department of Neurology; Amsterdam University Medical Centers (M.G.W.D.), Department of Epidemiology and Data Science; and Amsterdam University Medical Centers (R.J.H.), Clinical Research Unit
| | - Sven R Suwijn
- From the Department of Neurology (H.L.F., J.S., C.V.M.V., S.R.S., J.M.D., R.M.A.d.B.) and Department of Medical Psychology (J.A.B.), Amsterdam University Medical Centers; Radboud University Medical Center (B.P., B.R.B.), Department of Neurology; Leiden University Medical Center (J.J.H.), Department of Neurology; University Medical Center Groningen (T.L.), Department of Neurology; Zuyderland Medical Center (G.T.), Department of Neurology; Excellent Klinieken (A.G.M.), Dordrecht, Department of Neurology; University Medical Center Schleswig-Holstein (G.D.), Department of Neurology; Toronto Western Hospital (A.L.), University of Toronto, Department of Neurology; Amsterdam University Medical Centers (M.G.W.D.), Department of Epidemiology and Data Science; and Amsterdam University Medical Centers (R.J.H.), Clinical Research Unit
| | - Judith A Boel
- From the Department of Neurology (H.L.F., J.S., C.V.M.V., S.R.S., J.M.D., R.M.A.d.B.) and Department of Medical Psychology (J.A.B.), Amsterdam University Medical Centers; Radboud University Medical Center (B.P., B.R.B.), Department of Neurology; Leiden University Medical Center (J.J.H.), Department of Neurology; University Medical Center Groningen (T.L.), Department of Neurology; Zuyderland Medical Center (G.T.), Department of Neurology; Excellent Klinieken (A.G.M.), Dordrecht, Department of Neurology; University Medical Center Schleswig-Holstein (G.D.), Department of Neurology; Toronto Western Hospital (A.L.), University of Toronto, Department of Neurology; Amsterdam University Medical Centers (M.G.W.D.), Department of Epidemiology and Data Science; and Amsterdam University Medical Centers (R.J.H.), Clinical Research Unit
| | - Bart Post
- From the Department of Neurology (H.L.F., J.S., C.V.M.V., S.R.S., J.M.D., R.M.A.d.B.) and Department of Medical Psychology (J.A.B.), Amsterdam University Medical Centers; Radboud University Medical Center (B.P., B.R.B.), Department of Neurology; Leiden University Medical Center (J.J.H.), Department of Neurology; University Medical Center Groningen (T.L.), Department of Neurology; Zuyderland Medical Center (G.T.), Department of Neurology; Excellent Klinieken (A.G.M.), Dordrecht, Department of Neurology; University Medical Center Schleswig-Holstein (G.D.), Department of Neurology; Toronto Western Hospital (A.L.), University of Toronto, Department of Neurology; Amsterdam University Medical Centers (M.G.W.D.), Department of Epidemiology and Data Science; and Amsterdam University Medical Centers (R.J.H.), Clinical Research Unit
| | - Bastiaan R Bloem
- From the Department of Neurology (H.L.F., J.S., C.V.M.V., S.R.S., J.M.D., R.M.A.d.B.) and Department of Medical Psychology (J.A.B.), Amsterdam University Medical Centers; Radboud University Medical Center (B.P., B.R.B.), Department of Neurology; Leiden University Medical Center (J.J.H.), Department of Neurology; University Medical Center Groningen (T.L.), Department of Neurology; Zuyderland Medical Center (G.T.), Department of Neurology; Excellent Klinieken (A.G.M.), Dordrecht, Department of Neurology; University Medical Center Schleswig-Holstein (G.D.), Department of Neurology; Toronto Western Hospital (A.L.), University of Toronto, Department of Neurology; Amsterdam University Medical Centers (M.G.W.D.), Department of Epidemiology and Data Science; and Amsterdam University Medical Centers (R.J.H.), Clinical Research Unit
| | - Johannes J van Hilten
- From the Department of Neurology (H.L.F., J.S., C.V.M.V., S.R.S., J.M.D., R.M.A.d.B.) and Department of Medical Psychology (J.A.B.), Amsterdam University Medical Centers; Radboud University Medical Center (B.P., B.R.B.), Department of Neurology; Leiden University Medical Center (J.J.H.), Department of Neurology; University Medical Center Groningen (T.L.), Department of Neurology; Zuyderland Medical Center (G.T.), Department of Neurology; Excellent Klinieken (A.G.M.), Dordrecht, Department of Neurology; University Medical Center Schleswig-Holstein (G.D.), Department of Neurology; Toronto Western Hospital (A.L.), University of Toronto, Department of Neurology; Amsterdam University Medical Centers (M.G.W.D.), Department of Epidemiology and Data Science; and Amsterdam University Medical Centers (R.J.H.), Clinical Research Unit
| | - Teus van Laar
- From the Department of Neurology (H.L.F., J.S., C.V.M.V., S.R.S., J.M.D., R.M.A.d.B.) and Department of Medical Psychology (J.A.B.), Amsterdam University Medical Centers; Radboud University Medical Center (B.P., B.R.B.), Department of Neurology; Leiden University Medical Center (J.J.H.), Department of Neurology; University Medical Center Groningen (T.L.), Department of Neurology; Zuyderland Medical Center (G.T.), Department of Neurology; Excellent Klinieken (A.G.M.), Dordrecht, Department of Neurology; University Medical Center Schleswig-Holstein (G.D.), Department of Neurology; Toronto Western Hospital (A.L.), University of Toronto, Department of Neurology; Amsterdam University Medical Centers (M.G.W.D.), Department of Epidemiology and Data Science; and Amsterdam University Medical Centers (R.J.H.), Clinical Research Unit
| | - Gerrit Tissingh
- From the Department of Neurology (H.L.F., J.S., C.V.M.V., S.R.S., J.M.D., R.M.A.d.B.) and Department of Medical Psychology (J.A.B.), Amsterdam University Medical Centers; Radboud University Medical Center (B.P., B.R.B.), Department of Neurology; Leiden University Medical Center (J.J.H.), Department of Neurology; University Medical Center Groningen (T.L.), Department of Neurology; Zuyderland Medical Center (G.T.), Department of Neurology; Excellent Klinieken (A.G.M.), Dordrecht, Department of Neurology; University Medical Center Schleswig-Holstein (G.D.), Department of Neurology; Toronto Western Hospital (A.L.), University of Toronto, Department of Neurology; Amsterdam University Medical Centers (M.G.W.D.), Department of Epidemiology and Data Science; and Amsterdam University Medical Centers (R.J.H.), Clinical Research Unit
| | - Alexander G Munts
- From the Department of Neurology (H.L.F., J.S., C.V.M.V., S.R.S., J.M.D., R.M.A.d.B.) and Department of Medical Psychology (J.A.B.), Amsterdam University Medical Centers; Radboud University Medical Center (B.P., B.R.B.), Department of Neurology; Leiden University Medical Center (J.J.H.), Department of Neurology; University Medical Center Groningen (T.L.), Department of Neurology; Zuyderland Medical Center (G.T.), Department of Neurology; Excellent Klinieken (A.G.M.), Dordrecht, Department of Neurology; University Medical Center Schleswig-Holstein (G.D.), Department of Neurology; Toronto Western Hospital (A.L.), University of Toronto, Department of Neurology; Amsterdam University Medical Centers (M.G.W.D.), Department of Epidemiology and Data Science; and Amsterdam University Medical Centers (R.J.H.), Clinical Research Unit
| | - Joke M Dijk
- From the Department of Neurology (H.L.F., J.S., C.V.M.V., S.R.S., J.M.D., R.M.A.d.B.) and Department of Medical Psychology (J.A.B.), Amsterdam University Medical Centers; Radboud University Medical Center (B.P., B.R.B.), Department of Neurology; Leiden University Medical Center (J.J.H.), Department of Neurology; University Medical Center Groningen (T.L.), Department of Neurology; Zuyderland Medical Center (G.T.), Department of Neurology; Excellent Klinieken (A.G.M.), Dordrecht, Department of Neurology; University Medical Center Schleswig-Holstein (G.D.), Department of Neurology; Toronto Western Hospital (A.L.), University of Toronto, Department of Neurology; Amsterdam University Medical Centers (M.G.W.D.), Department of Epidemiology and Data Science; and Amsterdam University Medical Centers (R.J.H.), Clinical Research Unit
| | - Günther Deuschl
- From the Department of Neurology (H.L.F., J.S., C.V.M.V., S.R.S., J.M.D., R.M.A.d.B.) and Department of Medical Psychology (J.A.B.), Amsterdam University Medical Centers; Radboud University Medical Center (B.P., B.R.B.), Department of Neurology; Leiden University Medical Center (J.J.H.), Department of Neurology; University Medical Center Groningen (T.L.), Department of Neurology; Zuyderland Medical Center (G.T.), Department of Neurology; Excellent Klinieken (A.G.M.), Dordrecht, Department of Neurology; University Medical Center Schleswig-Holstein (G.D.), Department of Neurology; Toronto Western Hospital (A.L.), University of Toronto, Department of Neurology; Amsterdam University Medical Centers (M.G.W.D.), Department of Epidemiology and Data Science; and Amsterdam University Medical Centers (R.J.H.), Clinical Research Unit
| | - Anthony Lang
- From the Department of Neurology (H.L.F., J.S., C.V.M.V., S.R.S., J.M.D., R.M.A.d.B.) and Department of Medical Psychology (J.A.B.), Amsterdam University Medical Centers; Radboud University Medical Center (B.P., B.R.B.), Department of Neurology; Leiden University Medical Center (J.J.H.), Department of Neurology; University Medical Center Groningen (T.L.), Department of Neurology; Zuyderland Medical Center (G.T.), Department of Neurology; Excellent Klinieken (A.G.M.), Dordrecht, Department of Neurology; University Medical Center Schleswig-Holstein (G.D.), Department of Neurology; Toronto Western Hospital (A.L.), University of Toronto, Department of Neurology; Amsterdam University Medical Centers (M.G.W.D.), Department of Epidemiology and Data Science; and Amsterdam University Medical Centers (R.J.H.), Clinical Research Unit
| | - Marcel G W Dijkgraaf
- From the Department of Neurology (H.L.F., J.S., C.V.M.V., S.R.S., J.M.D., R.M.A.d.B.) and Department of Medical Psychology (J.A.B.), Amsterdam University Medical Centers; Radboud University Medical Center (B.P., B.R.B.), Department of Neurology; Leiden University Medical Center (J.J.H.), Department of Neurology; University Medical Center Groningen (T.L.), Department of Neurology; Zuyderland Medical Center (G.T.), Department of Neurology; Excellent Klinieken (A.G.M.), Dordrecht, Department of Neurology; University Medical Center Schleswig-Holstein (G.D.), Department of Neurology; Toronto Western Hospital (A.L.), University of Toronto, Department of Neurology; Amsterdam University Medical Centers (M.G.W.D.), Department of Epidemiology and Data Science; and Amsterdam University Medical Centers (R.J.H.), Clinical Research Unit
| | - Rob J de Haan
- From the Department of Neurology (H.L.F., J.S., C.V.M.V., S.R.S., J.M.D., R.M.A.d.B.) and Department of Medical Psychology (J.A.B.), Amsterdam University Medical Centers; Radboud University Medical Center (B.P., B.R.B.), Department of Neurology; Leiden University Medical Center (J.J.H.), Department of Neurology; University Medical Center Groningen (T.L.), Department of Neurology; Zuyderland Medical Center (G.T.), Department of Neurology; Excellent Klinieken (A.G.M.), Dordrecht, Department of Neurology; University Medical Center Schleswig-Holstein (G.D.), Department of Neurology; Toronto Western Hospital (A.L.), University of Toronto, Department of Neurology; Amsterdam University Medical Centers (M.G.W.D.), Department of Epidemiology and Data Science; and Amsterdam University Medical Centers (R.J.H.), Clinical Research Unit
| | - Rob M A de Bie
- From the Department of Neurology (H.L.F., J.S., C.V.M.V., S.R.S., J.M.D., R.M.A.d.B.) and Department of Medical Psychology (J.A.B.), Amsterdam University Medical Centers; Radboud University Medical Center (B.P., B.R.B.), Department of Neurology; Leiden University Medical Center (J.J.H.), Department of Neurology; University Medical Center Groningen (T.L.), Department of Neurology; Zuyderland Medical Center (G.T.), Department of Neurology; Excellent Klinieken (A.G.M.), Dordrecht, Department of Neurology; University Medical Center Schleswig-Holstein (G.D.), Department of Neurology; Toronto Western Hospital (A.L.), University of Toronto, Department of Neurology; Amsterdam University Medical Centers (M.G.W.D.), Department of Epidemiology and Data Science; and Amsterdam University Medical Centers (R.J.H.), Clinical Research Unit
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Rinaldi D, Alborghetti M, Bianchini E, Sforza M, Galli S, Pontieri FE. Monoamine-oxidase Type B Inhibitors and Cognitive Functions in Parkinson's Disease: Beyond the Primary Mechanism of Action. Curr Neuropharmacol 2023; 21:1214-1223. [PMID: 36065929 PMCID: PMC10286595 DOI: 10.2174/1570159x20666220905102144] [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: 03/02/2022] [Revised: 03/23/2022] [Accepted: 04/24/2022] [Indexed: 11/22/2022] Open
Abstract
Symptoms of cognitive impairment are rather common since the early stage of Parkinson's disease (PD); they aggravate with disease progression and may lead to dementia in a significant proportion of cases. Worsening of cognitive symptoms in PD patients depends on the progression of subcortical dopaminergic damage as well as the involvement of other brain neurotransmitter systems in cortical and subcortical regions. Beyond the negative impact on disability and quality of life, the presence and severity of cognitive symptoms may limit adjustments of dopamine replacement therapy along the disease course. This review focuses on the consequences of the administration of monoamine-oxidase type Binhibitors (MAOB-I) on cognition in PD patients. Two drugs (selegiline and rasagiline) are available for the treatment of motor symptoms of PD as monotherapy or in combination with L-DOPA or dopamine agonists in stable and fluctuating patients; a further drug (safinamide) is usable in fluctuating subjects solely. The results of available studies indicate differential effects according to disease stage and drug features. In early, non-fluctuating patients, selegiline and rasagiline ameliorated prefrontal executive functions, similarly to other dopaminergic drugs. Benefit on some executive functions was maintained in more advanced, fluctuating patients, despite the tendency of worsening prefrontal inhibitory control activity. Interestingly, high-dose safinamide improved inhibitory control in fluctuating patients. The benefit of high-dose safinamide on prefrontal inhibitory control mechanisms may stem from its dual mechanism of action, allowing reduction of excessive glutamatergic transmission, in turn secondary to increased cortical dopaminergic input.
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Affiliation(s)
- Domiziana Rinaldi
- Dipartimento di Neuroscienze, Salute Mentale e Organi di Senso, Sapienza Università di Roma, Italy
- IRCCS Fondazione Santa Lucia, Roma, Italy
| | - Marika Alborghetti
- Dipartimento di Neuroscienze, Salute Mentale e Organi di Senso, Sapienza Università di Roma, Italy
- IRCCS Fondazione Santa Lucia, Roma, Italy
| | - Edoardo Bianchini
- Dipartimento di Neuroscienze, Salute Mentale e Organi di Senso, Sapienza Università di Roma, Italy
| | - Michela Sforza
- Dipartimento di Neuroscienze, Salute Mentale e Organi di Senso, Sapienza Università di Roma, Italy
- IRCCS Fondazione Santa Lucia, Roma, Italy
| | - Silvia Galli
- Dipartimento di Neuroscienze, Salute Mentale e Organi di Senso, Sapienza Università di Roma, Italy
| | - Francesco E. Pontieri
- Dipartimento di Neuroscienze, Salute Mentale e Organi di Senso, Sapienza Università di Roma, Italy
- IRCCS Fondazione Santa Lucia, Roma, Italy
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Zhu GY, Zhang JG, Yuan TS, Chen YC, Liu DF, Ma RY, Zhang X, Du TT. Sex modulates the outcome of subthalamic nucleus deep brain stimulation in patients with Parkinson’s disease. Neural Regen Res 2023; 18:901-907. [DOI: 10.4103/1673-5374.353506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Lees A, Tolosa E, Stocchi F, Ferreira JJ, Rascol O, Antonini A, Poewe W. Optimizing levodopa therapy, when and how? Perspectives on the importance of delivery and the potential for an early combination approach. Expert Rev Neurother 2023; 23:15-24. [PMID: 36729395 DOI: 10.1080/14737175.2023.2176220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
INTRODUCTION There is currently a resurgence of levodopa as the initial treatment of choice for most patients with Parkinson's disease, albeit at lower doses than previously used. The addition of adjuvant treatments (including MAO-B inhibitors, COMT inhibitors and dopamine agonists) is an established strategy to reduce motor complications that develop with sustained levodopa therapy. AREAS COVERED In this narrative review, the authors discuss the evidence underpinning current levodopa optimization strategies, during early disease and once motor complications occur. To support the discussion, the authors performed a broad PubMed search with the terms 'levodopa/L-dopa/L-Dopa, and Parkinson's disease,' restricted to clinical trials. There is now a wealth of evidence that improving levodopa delivery to the brain improves outcomes and we discuss how agents can be combined earlier in the course of disease to leverage the full potential of this strategy. EXPERT OPINION Levodopa remains the cornerstone of antiparkinsonian therapy. Several promising advances in formulation have been made and include novel extended-release oral drugs as well as non-oral delivery systems. However, evidence has long suggested that anti-parkinsonian medications may be better used in combination earlier in the disease, and consequently patients will benefit from low doses of several agents rather than ever larger levodopa doses.
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Affiliation(s)
- Andrew Lees
- University College London, Reta Lila Weston Institute, London, UK
| | - Eduardo Tolosa
- Parkinson disease and Movement Disorders Unit, Neurology Service, Hospital Clinic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED: CB06/05/0018-ISCIII) Barcelona, Barcelona, Spain
| | - Fabrizio Stocchi
- Department of Neurology, University San Raffaele and IRCCS San Raffaele Pisana, Rome, Italy
| | - Joaquim J Ferreira
- Laboratory of Clinical Pharmacology and Therapeutics, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal.,CNS - Campus Neurológico, Torres Vedras, Portugal
| | - Olivier Rascol
- Department of Neurosciences and Clinical Pharmacology, Clinical Investigation center CIC1436 and NS-Park/FCRIN network; University Hospital of Toulouse, INSERM and University of Toulouse 3, Toulouse, France
| | - Angelo Antonini
- Movement Disorders Unit, Study Center for Neurodegenerative Diseases (CESNE), Department of Neuroscience, University of Padova
| | - Werner Poewe
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
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Yu Z, Tang D. Artificial Neural Network-Assisted Wearable Flexible Sweat Patch for Drug Management in Parkinson's Patients Based on Vacancy-Engineered Processing of g-C 3N 4. Anal Chem 2022; 94:18000-18008. [PMID: 36524711 DOI: 10.1021/acs.analchem.2c04291] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Herein, we developed a flexible, low-cost non-enzymatic sweat sensing chip for in situ acquisition of bioinformation in sweat of individuals under exercise conditions to advance personal health monitoring and medication management for patients with Parkinson's disease. This low-cost, flexible, wearable sweat sensor consists of a printed screen electrode modified with g-C3N4 material and an external MSME element. The doping strategy and surface activation strategy of the g-C3N4-based exhibited efficient glucose oxidase-like activity and electrochemical activity when testing l-dopa and glucose in sweat. The optimized signal was transmitted to a smartphone for processing 12 individuals with simulated dosing, enabling continuous monitoring of l-dopa metabolism in sweat and management of dosing. The generalization ability and robustness of models constructed by methods such as multiple linear regression, artificial neural networks, and convolutional neural networks were compared cross-sectionally. Deep learning models based on artificial neural networks help develop a user-personalized medication administration reminder system, which provides a promising paradigm for reliable medication supervision for Parkinson's patients in the Internet of Things era.
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Affiliation(s)
- Zhichao Yu
- Key Laboratory for Analytical Science of Food Safety and Biology (MOE & Fujian Province), Department of Chemistry, Fuzhou University, Fuzhou 350108, People Republic of China
| | - Dianping Tang
- Key Laboratory for Analytical Science of Food Safety and Biology (MOE & Fujian Province), Department of Chemistry, Fuzhou University, Fuzhou 350108, People Republic of China
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Wen J, Guo T, Wu J, Bai X, Zhou C, Wu H, Liu X, Chen J, Cao Z, Gu L, Pu J, Zhang B, Zhang M, Guan X, Xu X. Nigral Iron Deposition Influences Disease Severity by Modulating the Effect of Parkinson's Disease on Brain Networks. JOURNAL OF PARKINSON'S DISEASE 2022; 12:2479-2492. [PMID: 36336939 PMCID: PMC9837680 DOI: 10.3233/jpd-223372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND In Parkinson's disease (PD), excessive iron deposition in the substantia nigra may exacerbate α-synuclein aggregation, facilitating the degeneration of dopaminergic neurons and their neural projection. OBJECTIVE To investigate the interaction effect between nigral iron deposition and PD status on brain networks. METHODS Eighty-five PD patients and 140 normal controls (NC) were included. Network function and nigral iron were measured using multi-modality magnetic resonance imaging. According to the median of nigral magnetic susceptibility of NC (0.095 ppm), PD and NC were respectively divided into high and low nigral iron group. The main and interaction effects were investigated by mixed effect analysis. RESULTS The main effect of disease was observed in basal ganglia network (BGN) and visual network (VN). The interaction effect between nigral iron and PD status was observed in left inferior frontal gyrus and left insular lobe in BGN, as well as right middle occipital gyrus, right superior temporal gyrus, and bilateral cuneus in VN. Furthermore, multiple mediation analysis revealed that the functional connectivity of interaction effect clusters in BGN and medial VN partially mediated the relationship between nigral iron and Unified Parkinson's Disease Rating Scale II score. CONCLUSION Our study demonstrates an interaction of nigral iron deposition and PD status on brain networks, that is, nigral iron deposition is associated with the change of brain network configuration exclusively when in PD. We identified a potential causal mediation pathway for iron to affect disease severity that was mediated by both BGN dysfunction and VN hyperfunction in PD.
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Affiliation(s)
- Jiaqi Wen
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Tao Guo
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jingjing Wu
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xueqin Bai
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Cheng Zhou
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Haoting Wu
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xiaocao Liu
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jingwen Chen
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Zhengye Cao
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Luyan Gu
- Department of Neurology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jiali Pu
- Department of Neurology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Baorong Zhang
- Department of Neurology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Minming Zhang
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xiaojun Guan
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China,Correspondence to: Xiaojun Xu, MD, Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, No.88 Jiefang Road, Shangcheng District, Hangzhou 310009, China. Tel.: +86 0571 87315255; Fax: +86 0571 87315255; E-mail: and Xiaojun Guan, PhD, Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, No. 88 Jiefang Road, Shangcheng District, Hangzhou 310009, China. Tel.: +86 0571 87315255; Fax: +86 0571 87315255;
| | - Xiaojun Xu
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China,Correspondence to: Xiaojun Xu, MD, Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, No.88 Jiefang Road, Shangcheng District, Hangzhou 310009, China. Tel.: +86 0571 87315255; Fax: +86 0571 87315255; E-mail: and Xiaojun Guan, PhD, Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, No. 88 Jiefang Road, Shangcheng District, Hangzhou 310009, China. Tel.: +86 0571 87315255; Fax: +86 0571 87315255;
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Golfrè Andreasi N, Cilia R, Romito LM, Bonvegna S, Straccia G, Elia AE, Novelli A, Messina G, Tringali G, Levi V, Devigili G, Rinaldo S, Gasparini V, Grisoli M, Stanziano M, Ghielmetti F, Prioni S, Bocchi E, Amami P, Piacentini SHMJ, Ciceri EFM, Bruzzone MG, Eleopra R. Magnetic Resonance-Guided Focused Ultrasound Thalamotomy May Spare Dopaminergic Therapy in Early-Stage Tremor-Dominant Parkinson's Disease: A Pilot Study. Mov Disord 2022; 37:2289-2295. [PMID: 36036203 DOI: 10.1002/mds.29200] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Revised: 05/10/2022] [Accepted: 06/06/2022] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Magnetic resonance-guided focused ultrasound (MRgFUS) thalamotomy is a safe and effective procedure for drug-resistant tremor in Parkinson's disease (PD). OBJECTIVE The aim of this study was to demonstrate that MRgFUS ventralis intermedius thalamotomy in early-stage tremor-dominant PD may prevent an increase in dopaminergic medication 6 months after treatment compared with matched PD control subjects on standard medical therapy. METHODS We prospectively enrolled patients with early-stage PD who underwent MRgFUS ventralis intermedius thalamotomy (PD-FUS) and patients treated with oral dopaminergic therapy (PD-ODT) with a 1:2 ratio. We collected demographic and clinical data at baseline and 6 and 12 months after thalamotomy. RESULTS We included 10 patients in the PD-FUS group and 20 patients in the PD-ODT group. We found a significant increase in total levodopa equivalent daily dose and levodopa plus monoamine oxidase B inhibitors dose in the PD-ODT group 6 months after thalamotomy. CONCLUSIONS In early-stage tremor-dominant PD, MRgFUS thalamotomy may be useful to reduce tremor and avoid the need to increase dopaminergic medications. © 2022 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Nico Golfrè Andreasi
- Fondazione IRCCS Istituto Neurologico Carlo Besta, Department of Clinical Neurosciences, Parkinson and Movement Disorders Unit, Milan, Italy
| | - Roberto Cilia
- Fondazione IRCCS Istituto Neurologico Carlo Besta, Department of Clinical Neurosciences, Parkinson and Movement Disorders Unit, Milan, Italy
| | - Luigi Michele Romito
- Fondazione IRCCS Istituto Neurologico Carlo Besta, Department of Clinical Neurosciences, Parkinson and Movement Disorders Unit, Milan, Italy
| | - Salvatore Bonvegna
- Fondazione IRCCS Istituto Neurologico Carlo Besta, Department of Clinical Neurosciences, Parkinson and Movement Disorders Unit, Milan, Italy
| | - Giulia Straccia
- Fondazione IRCCS Istituto Neurologico Carlo Besta, Department of Clinical Neurosciences, Parkinson and Movement Disorders Unit, Milan, Italy
| | - Antonio Emanuele Elia
- Fondazione IRCCS Istituto Neurologico Carlo Besta, Department of Clinical Neurosciences, Parkinson and Movement Disorders Unit, Milan, Italy
| | - Alessio Novelli
- Fondazione IRCCS Istituto Neurologico Carlo Besta, Department of Clinical Neurosciences, Parkinson and Movement Disorders Unit, Milan, Italy
| | - Giuseppe Messina
- Fondazione IRCCS Istituto Neurologico Carlo Besta, Neurosurgery Department, Functional Neurosurgery Unit, Milan, Italy
| | - Giovanni Tringali
- Fondazione IRCCS Istituto Neurologico Carlo Besta, Neurosurgery Department, Functional Neurosurgery Unit, Milan, Italy
| | - Vincenzo Levi
- Fondazione IRCCS Istituto Neurologico Carlo Besta, Neurosurgery Department, Functional Neurosurgery Unit, Milan, Italy
| | - Grazia Devigili
- Fondazione IRCCS Istituto Neurologico Carlo Besta, Department of Clinical Neurosciences, Parkinson and Movement Disorders Unit, Milan, Italy
| | - Sara Rinaldo
- Fondazione IRCCS Istituto Neurologico Carlo Besta, Department of Clinical Neurosciences, Parkinson and Movement Disorders Unit, Milan, Italy
| | - Valentina Gasparini
- Fondazione IRCCS Istituto Neurologico Carlo Besta, Department of Clinical Neurosciences, Parkinson and Movement Disorders Unit, Milan, Italy
| | - Marina Grisoli
- Fondazione IRCCS Istituto Neurologico Carlo Besta, Neuroradiology Unit, Milan, Italy
| | - Mario Stanziano
- Fondazione IRCCS Istituto Neurologico Carlo Besta, Neuroradiology Unit, Milan, Italy.,Neuroscience Department "Rita Levi Montalcini", University of Turin, Turin, Italy
| | - Francesco Ghielmetti
- Fondazione IRCCS Istituto Neurologico Carlo Besta, Health Department, Milan, Italy
| | - Sara Prioni
- Fondazione IRCCS Istituto Neurologico Carlo Besta, Clinical Neuropsychology Unit, Milan, Italy
| | - Elisa Bocchi
- Fondazione IRCCS Istituto Neurologico Carlo Besta, Clinical Neuropsychology Unit, Milan, Italy
| | - Paolo Amami
- Fondazione IRCCS Istituto Neurologico Carlo Besta, Clinical Neuropsychology Unit, Milan, Italy
| | | | - Elisa Francesca Maria Ciceri
- Fondazione IRCCS Istituto Neurologico Carlo Besta, Diagnostic Radiology and Interventional Neuroradiology, Milan, Italy
| | - Maria Grazia Bruzzone
- Fondazione IRCCS Istituto Neurologico Carlo Besta, Neuroradiology Unit, Milan, Italy
| | - Roberto Eleopra
- Fondazione IRCCS Istituto Neurologico Carlo Besta, Department of Clinical Neurosciences, Parkinson and Movement Disorders Unit, Milan, Italy
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Interactions of dopamine, iron, and alpha-synuclein linked to dopaminergic neuron vulnerability in Parkinson's disease and neurodegeneration with brain iron accumulation disorders. Neurobiol Dis 2022; 175:105920. [DOI: 10.1016/j.nbd.2022.105920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 10/21/2022] [Accepted: 11/04/2022] [Indexed: 11/08/2022] Open
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50
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Zhen K, Zhang S, Tao X, Li G, Lv Y, Yu L. A systematic review and meta-analysis on effects of aerobic exercise in people with Parkinson's disease. NPJ Parkinsons Dis 2022; 8:146. [PMID: 36316416 PMCID: PMC9622812 DOI: 10.1038/s41531-022-00418-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 10/19/2022] [Indexed: 11/05/2022] Open
Abstract
Previous studies have shown that aerobic exercise is an effective way to improve symptoms of Parkinson's disease (PD). The aim of this study [PROSPERO CRD42022340730] was to explore the effects of aerobic exercises on balance, gait, motor function, and quality of life in PD patients. Searches were performed in PubMed, Web of Science, and EBSCO electronic databases. The Cochrane risk assessment tool was used to evaluate the methodological quality of the included literature. From 1287 search records initially identified, 20 studies were considered eligible for systematic review and meta-analysis. There was a significant effect of aerobic exercise on improving timed up and go test [standardized mean difference (SMD), -0.41 (95% CI, -0.61 to -0.22), p < 0.00001], Berg Balance Scale [0.99 (95% CI, 0.76 to 1.23), p < 0.00001], stride/step length [0.32 (95% CI, 0.03 to 0.61), p = 0.03], gait velocity [0.49 (95% CI, 0.20 to 0.78), p = 0.0009], Unified Parkinson's Disease Rating Scale Part-III [-0.40 (95% CI, -0.55 to -0.24), p < 0.00001], and 6-minute walking test [0.35 (95% CI, 0.13 to 0.56), p = 0.002] in people with PD, but not in step cadence [-0.08 (95% CI, -0.43 to 0.27), p = 0.65] and Parkinson's Disease Questionnaire-39 [-0.113 (95% CI, -0.39 to 0.13), p = 0.32]. Aerobic exercise had beneficial effects in improving balance, gait (velocity and stride/step length), and motor function in PD patients. However, aerobic exercise had no significant associations with the step cadence and quality of life in PD patients.
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Affiliation(s)
- Kai Zhen
- grid.411614.70000 0001 2223 5394Key Laboratory of Physical Fitness and Exercise, Ministry of Education, Beijing Sport University, Beijing, China ,grid.411614.70000 0001 2223 5394Department of Sports Performance, Beijing Sport University, Beijing, China
| | - Shiyan Zhang
- grid.411614.70000 0001 2223 5394Key Laboratory of Physical Fitness and Exercise, Ministry of Education, Beijing Sport University, Beijing, China ,grid.411614.70000 0001 2223 5394Department of Sports Performance, Beijing Sport University, Beijing, China
| | - Xifeng Tao
- grid.411614.70000 0001 2223 5394Department of Sports Performance, Beijing Sport University, Beijing, China
| | - Gen Li
- grid.411614.70000 0001 2223 5394Department of Sports Performance, Beijing Sport University, Beijing, China
| | - Yuanyuan Lv
- grid.411614.70000 0001 2223 5394Key Laboratory of Physical Fitness and Exercise, Ministry of Education, Beijing Sport University, Beijing, China ,grid.411614.70000 0001 2223 5394China Institute of Sport and Health Science, Beijing Sport University, Beijing, China
| | - Laikang Yu
- grid.411614.70000 0001 2223 5394Key Laboratory of Physical Fitness and Exercise, Ministry of Education, Beijing Sport University, Beijing, China ,grid.411614.70000 0001 2223 5394Department of Sports Performance, Beijing Sport University, Beijing, China
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