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Sarasso E, Gardoni A, Zenere L, Emedoli D, Balestrino R, Grassi A, Basaia S, Tripodi C, Canu E, Malcangi M, Pelosin E, Volontè MA, Corbetta D, Filippi M, Agosta F. Neural correlates of bradykinesia in Parkinson's disease: a kinematic and functional MRI study. NPJ Parkinsons Dis 2024; 10:167. [PMID: 39242570 PMCID: PMC11379907 DOI: 10.1038/s41531-024-00783-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Accepted: 08/20/2024] [Indexed: 09/09/2024] Open
Abstract
Bradykinesia is defined as a "complex" of motor alterations including decreased movement amplitude and/or speed and tendency to reduce them with movement repetition (sequence effect). This study aimed at investigating the neural and kinematic correlates of bradykinesia during hand-tapping in people with Parkinson's disease (pwPD) relative to healthy controls. Twenty-five pwPD and 25 age- and sex-matched healthy controls underwent brain functional MRI (fMRI) during a hand-tapping task: subjects alternatively opened and closed their right hand as fully and quickly as possible. Hand-tapping kinematic parameters were objectively measured during the fMRI task using an optical fibre glove. During the fMRI task, pwPD showed reduced hand-tapping amplitude (hypokinesia) and a greater sequence effect. PwPD relative to healthy controls showed a reduced activity of fronto-parietal areas, middle cingulum/supplementary motor area (SMA), parahippocampus, pallidum/thalamus and motor cerebellar areas. Moreover, pwPD showed an increased activity of brain cognitive areas such as superior temporal gyrus, posterior cingulum, and cerebellum crus I. The decreased activity of cerebellum IV-V-VI, vermis IV-V, inferior frontal gyrus, and cingulum/SMA correlated with hypokinesia and with the sequence effect. Interestingly, a reduced activity of areas involved in motor planning and timing correlated both with hypokinesia and with the sequence effect in pwPD. This study has the major strength of collecting objective motor parameters and brain activity simultaneously, providing a unique opportunity to investigate the neural correlates of the "bradykinesia complex".
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Affiliation(s)
- Elisabetta Sarasso
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal Child Health, University of Genoa, Genoa, Italy
| | - Andrea Gardoni
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Lucia Zenere
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Daniele Emedoli
- Department of Rehabilitation and Functional Recovery, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Roberta Balestrino
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Neurorehabilitation Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Andrea Grassi
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Silvia Basaia
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Chiara Tripodi
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Elisa Canu
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Massimo Malcangi
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Neurorehabilitation Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Elisa Pelosin
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal Child Health, University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | | | - Davide Corbetta
- Department of Rehabilitation and Functional Recovery, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Massimo Filippi
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Neurorehabilitation Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Neurophysiology Service, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Federica Agosta
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy.
- Vita-Salute San Raffaele University, Milan, Italy.
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.
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2
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Ohara M, Hirata K, Matsubayashi T, Chen Q, Shimano K, Hanazawa R, Hirakawa A, Yokota T, Hattori T. Circular walking is useful for assessing the risk of falls in early progressive supranuclear palsy. J Neurol 2024; 271:6349-6358. [PMID: 39009736 DOI: 10.1007/s00415-024-12551-6] [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: 04/12/2024] [Revised: 06/26/2024] [Accepted: 06/27/2024] [Indexed: 07/17/2024]
Abstract
BACKGROUND Progressive supranuclear palsy (PSP) is characterized by early onset postural instability and frequent falls. Circular walking necessitates dynamic postural control, which is impaired in patients with PSP. We aimed to explore gait parameters associated with the risk of falls in patients with PSP, focusing on circular walking. METHODS Sixteen drug-naïve patients with PSP, 22 drug-naïve patients with Parkinson's disease (PD), and 23 healthy controls were enrolled. Stride lengths/velocities and their coefficients of variation (CV) during straight and circular walking (walking around a circle of 1-m diameter) were measured under single-task and cognitive dual-task conditions. Correlation analysis was performed between gait parameters and postural instability and gait difficulty (PIGD) motor subscores, representing the risk of falls. RESULTS Patients with PSP had significantly higher CVs of stride lengths/velocities during circular walking than those during straight walking, and the extent of exacerbation of CVs in patients with PSP was larger than that in patients with PD under single-task conditions. Stride lengths/velocities and their CVs were significantly correlated with PIGD motor subscores in patients with PSP only during single-task circular walking. In addition, patients with PSP showed progressive decrements of stride lengths/velocities over steps only during single-task circular walking. CONCLUSIONS Worse gait parameters during circular walking are associated with an increased risk of falls in patients with PSP. Circular walking is a challenging task to demand the compromised motor functions of patients with PSP, unmasking impaired postural control and manifesting sequence effect. Assessing circular walking is useful for evaluating the risk of falls in patients with early PSP.
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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, 1-5-45, Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
| | - Kosei Hirata
- Department of Neurology and Neurological Science, Graduate School of Medical and Dental Science, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
| | - Taiki Matsubayashi
- Department of Neurology and Neurological Science, Graduate School of Medical and Dental Science, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
| | - Qingmeng Chen
- Department of Neurology and Neurological Science, Graduate School of Medical and Dental Science, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
| | - Kaoru Shimano
- Department of Neurology and Neurological Science, Graduate School of Medical and Dental Science, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
| | - Ryoichi Hanazawa
- Department of Clinical Biostatistics, 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, 1-5-45, Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
| | - Takaaki Hattori
- Department of Neurology and Neurological Science, Graduate School of Medical and Dental Science, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan.
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Passaretti M, Cilia R, Rinaldo S, Rossi Sebastiano D, Orunesu E, Devigili G, Braccia A, Paparella G, De Riggi M, van Eimeren T, Strafella AP, Lanteri P, Berardelli A, Bologna M, Eleopra R. Neurophysiological markers of motor compensatory mechanisms in early Parkinson's disease. Brain 2024:awae210. [PMID: 39189320 DOI: 10.1093/brain/awae210] [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: 03/01/2024] [Revised: 05/20/2024] [Accepted: 06/13/2024] [Indexed: 08/28/2024] Open
Abstract
Compensatory mechanisms in Parkinson's disease are defined as the changes that the brain uses to adapt to neurodegeneration and progressive dopamine reduction. Motor compensation in early Parkinson's disease could, in part, be responsible for a unilateral onset of clinical motor signs despite the presence of bilateral nigrostriatal degeneration. Although several mechanisms have been proposed for compensatory adaptations in Parkinson's disease, the underlying pathophysiology is unclear. Here, we investigate motor compensation in Parkinson's disease by investigating the relationship between clinical signs, dopamine transporter imaging data and neurophysiological measures of the primary motor cortex (M1), using transcranial magnetic stimulation in presymptomatic and symptomatic hemispheres of patients. In this cross-sectional, multicentre study, we screened 82 individuals with Parkinson's disease. Patients were evaluated clinically in their medication OFF state using standardized scales. Sixteen Parkinson's disease patients with bilateral dopamine transporter deficit in the putamina but unilateral symptoms were included. Twenty-eight sex- and age-matched healthy controls were also investigated. In all participants, we tested cortical excitability using single- and paired-pulse techniques, interhemispheric inhibition and cortical plasticity with paired associative stimulation. Data were analysed with ANOVAs, multiple linear regression and logistic regression models. Individual coefficients of motor compensation were defined in patients based on clinical and imaging data, i.e. the motor compensation coefficient. The motor compensation coefficient includes an asymmetry score to balance motor and dopamine transporter data between the two hemispheres, in addition to a hemispheric ratio accounting for the relative mismatch between the magnitude of motor signs and dopaminergic deficit. In patients, corticospinal excitability and plasticity were higher in the presymptomatic compared with the symptomatic M1. Also, interhemispheric inhibition from the presymptomatic to the symptomatic M1 was reduced. Lower putamen binding was associated with higher plasticity and reduced interhemispheric inhibition in the presymptomatic hemisphere. The motor compensation coefficient distinguished the presymptomatic from the symptomatic hemisphere. Finally, in the presymptomatic hemisphere, a higher motor compensation coefficient was associated with lower corticospinal excitability and interhemispheric inhibition and with higher plasticity. In conclusion, the present study suggests that motor compensation involves M1-striatal networks and intercortical connections becoming more effective with progressive loss of dopaminergic terminals in the putamen. The balance between these motor networks seems to be driven by cortical plasticity.
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Affiliation(s)
- Massimiliano Passaretti
- Parkinson and Movement Disorders Unit, Department of Clinical Neurosciences, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy
- Department of Human Neurosciences, Sapienza University of Rome, 00185 Rome, Italy
- Department of Clinical Neuroscience, Karolinska Institutet, 17165 Solna, Sweden
| | - Roberto Cilia
- Parkinson and Movement Disorders Unit, Department of Clinical Neurosciences, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy
| | - Sara Rinaldo
- Parkinson and Movement Disorders Unit, Department of Clinical Neurosciences, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy
| | - Davide Rossi Sebastiano
- Neurophysiology Unit, Department of Clinical Neurosciences, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy
| | - Eva Orunesu
- Nuclear Medicine Unit, Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Grazia Devigili
- Parkinson and Movement Disorders Unit, Department of Clinical Neurosciences, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy
| | - Arianna Braccia
- Parkinson and Movement Disorders Unit, Department of Clinical Neurosciences, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy
| | - Giulia Paparella
- Department of Human Neurosciences, Sapienza University of Rome, 00185 Rome, Italy
- IRCCS Neuromed, 86077 Pozzilli (IS), Italy
| | - Martina De Riggi
- Department of Human Neurosciences, Sapienza University of Rome, 00185 Rome, Italy
| | - Thilo van Eimeren
- Department of Nuclear Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50937 Cologne, Germany
| | - Antonio Paolo Strafella
- Krembil Brain Institute, University Health Network, Toronto, ON M5R 1E8, Canada
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON M5S 2S1, Canada
| | - Paola Lanteri
- Neurophysiology Unit, Department of Clinical Neurosciences, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy
| | - Alfredo Berardelli
- Department of Human Neurosciences, Sapienza University of Rome, 00185 Rome, Italy
- IRCCS Neuromed, 86077 Pozzilli (IS), Italy
| | - Matteo Bologna
- Department of Human Neurosciences, Sapienza University of Rome, 00185 Rome, Italy
- IRCCS Neuromed, 86077 Pozzilli (IS), Italy
| | - Roberto Eleopra
- Parkinson and Movement Disorders Unit, Department of Clinical Neurosciences, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy
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Fortunati M, Febbi M, Negro M, Gennaro F, D’Antona G, Crisafulli O. Lower-Limb Exoskeletons for Gait Training in Parkinson's Disease: The State of the Art and Future Perspectives. Healthcare (Basel) 2024; 12:1636. [PMID: 39201194 PMCID: PMC11353983 DOI: 10.3390/healthcare12161636] [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: 07/08/2024] [Revised: 08/07/2024] [Accepted: 08/14/2024] [Indexed: 09/02/2024] Open
Abstract
Gait dysfunction (GD) is a common impairment of Parkinson's disease (PD), which negatively impacts patients' quality of life. Among the most recent rehabilitation technologies, a lower-limb powered exoskeleton (LLEXO) arises as a useful instrument for gait training in several neurological conditions, including PD. However, some questions relating to methods of use, achievable results, and usefulness compared to traditional rehabilitation methodologies still require clear answers. Therefore, in this review, we aim to summarise and analyse all the studies that have applied an LLEXO to train gait in PD patients. Literature research on PubMed and Scopus retrieved five articles, comprising 46 PD participants stable on medications (age: 71.7 ± 3.7 years, 24 males, Hoehn and Yahr: 2.1 ± 0.6). Compared to traditional rehabilitation, low-profile lower-limb exoskeleton (lp-LLEXO) training brought major improvements towards walking capacity and gait speed, while there are no clear major benefits regarding the dual-task gait cost index and freezing of gait symptoms. Importantly, the results suggest that lp-LLEXO training is more beneficial for patients with an intermediate-to-severe level of disease severity (Hoehn and Yahr > 2.5). This review could provide a novel framework for implementing LLEXO in clinical practise, highlighting its benefits and limitations towards gait training.
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Affiliation(s)
- Matteo Fortunati
- Department of Industrial Engineering, University of Tor Vergata, 00133 Rome, Italy
- CRIAMS-Sport Medicine Centre Voghera, University of Pavia, 27058 Voghera, Italy
| | - Massimiliano Febbi
- Department of Industrial Engineering, University of Tor Vergata, 00133 Rome, Italy
- Laboratory for Rehabilitation, Medicine and Sport (LARM), 00133 Rome, Italy
| | - Massimo Negro
- CRIAMS-Sport Medicine Centre Voghera, University of Pavia, 27058 Voghera, Italy
| | - Federico Gennaro
- Department of Biomedical Sciences, University of Padua, 35131 Padua, Italy
| | - Giuseppe D’Antona
- CRIAMS-Sport Medicine Centre Voghera, University of Pavia, 27058 Voghera, Italy
- Department of Public Health, Experimental and Forensic Medicine, University of Pavia, 27100 Pavia, Italy
| | - Oscar Crisafulli
- CRIAMS-Sport Medicine Centre Voghera, University of Pavia, 27058 Voghera, Italy
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Marsili L, Abanto J, Mahajan A, Duque KR, Chinchihualpa Paredes NO, Deraz HA, Espay AJ, Bologna M. Dysrhythmia as a prominent feature of Parkinson's disease: An app-based tapping test. J Neurol Sci 2024; 463:123144. [PMID: 39033737 DOI: 10.1016/j.jns.2024.123144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2024] [Revised: 07/08/2024] [Accepted: 07/15/2024] [Indexed: 07/23/2024]
Abstract
INTRODUCTION Smartphone applications (apps) are instruments that assist with objective measurements during the clinical assessment of patients with movement disorders. We aim to test the hypothesis that Parkinson's disease (PD) patients will exhibit an increase in tapping variability and a decrease in tapping speed over a one-year period, compared to healthy controls (HC). METHODS Data was prospectively collected from participants enrolled in our Cincinnati Cohort Biomarker Program, in 2021-2023. Participants diagnosed with PD and age-matched HC were examined over a one-year-interval with a tapping test performed with customized smartphone app. Tapping speed (taps/s), inter-tap intervals and variability (movement regularity), and sequence effect were measured. RESULTS We included 295 PD patients and 62 HC. At baseline, PD subjects showed higher inter-tap variability than HC (coefficient-of-variation-CV, 37 ms [22-64] vs 26 ms [8-51]) (p = 0.007). Conversely, there was no difference in inter-tap intervals (411 ms [199-593] in PD versus 478 ms [243-618] in HC) and tapping speed (3.42[2.70-4.76] taps/s in PD versus 3.21 taps/s [2.57-4.54] in HC) (p > 0.05). Only PD subjects (n = 135), at the one-year follow-up, showed a decreased tapping speed vs baseline (3.44 taps/s [2.86-4.81] versus 3.39 taps/s [2.58,4.30]) (p = 0.036), without significant changes in inter-tap variability (CV, 32 ms [18,55] baseline versus 34 ms [22,59] follow-up) (p = 0.142). No changes were found in HC at the one-year follow up (all p values>0.05). CONCLUSIONS Inter-tap variability (dysrhythmia) but no inter-tap intervals or tapping speed are reliably distinctive feature of an app-based bradykinesia assessment in PD.
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Affiliation(s)
- Luca Marsili
- Gardner Family Center for Parkinson's Disease and Movement Disorders, Department of Neurology, University of Cincinnati, Cincinnati, OH, USA.
| | - Jesus Abanto
- Gardner Family Center for Parkinson's Disease and Movement Disorders, Department of Neurology, University of Cincinnati, Cincinnati, OH, USA.
| | - Abhimanyu Mahajan
- Gardner Family Center for Parkinson's Disease and Movement Disorders, Department of Neurology, University of Cincinnati, Cincinnati, OH, USA.
| | - Kevin R Duque
- Gardner Family Center for Parkinson's Disease and Movement Disorders, Department of Neurology, University of Cincinnati, Cincinnati, OH, USA.
| | - Nathaly O Chinchihualpa Paredes
- Gardner Family Center for Parkinson's Disease and Movement Disorders, Department of Neurology, University of Cincinnati, Cincinnati, OH, USA.
| | - Heba A Deraz
- Gardner Family Center for Parkinson's Disease and Movement Disorders, Department of Neurology, University of Cincinnati, Cincinnati, OH, USA; Department of Neurology, Cairo University Hospitals, Cairo, Egypt.
| | - Alberto J Espay
- Gardner Family Center for Parkinson's Disease and Movement Disorders, Department of Neurology, University of Cincinnati, Cincinnati, OH, USA.
| | - Matteo Bologna
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy; IRCCS Neuromed, Pozzilli, IS, Italy.
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6
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Williams D. Why so slow? Models of parkinsonian bradykinesia. Nat Rev Neurosci 2024; 25:573-586. [PMID: 38937655 DOI: 10.1038/s41583-024-00830-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/20/2024] [Indexed: 06/29/2024]
Abstract
Bradykinesia, or slowness of movement, is a defining feature of Parkinson disease (PD) and a major contributor to the negative effects on quality of life associated with this disorder and related conditions. A dominant pathophysiological model of bradykinesia in PD has existed for approximately 30 years and has been the basis for the development of several therapeutic interventions, but accumulating evidence has made this model increasingly untenable. Although more recent models have been proposed, they also appear to be flawed. In this Perspective, I consider the leading prior models of bradykinesia in PD and argue that a more functionally related model is required, one that considers changes that disrupt the fundamental process of accurate information transmission. In doing so, I review emerging evidence of network level functional connectivity changes, information transfer dysfunction and potential motor code transmission error and present a novel model of bradykinesia in PD that incorporates this evidence. I hope that this model may reconcile inconsistencies in its predecessors and encourage further development of therapeutic interventions.
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Affiliation(s)
- David Williams
- Department of Internal Medicine, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates.
- Department of Neurology, Whipps Cross University Hospital, Barts Health NHS Trust, London, UK.
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7
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DeRosier F, Hibbs C, Alessi K, Padda I, Rodriguez J, Pradeep S, Parmar MS. Progressive supranuclear palsy: Neuropathology, clinical presentation, diagnostic challenges, management, and emerging therapies. Dis Mon 2024; 70:101753. [PMID: 38908985 DOI: 10.1016/j.disamonth.2024.101753] [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] [Indexed: 06/24/2024]
Abstract
Progressive supranuclear palsy (PSP) is a neurodegenerative disease characterized by the accumulation of 4R-tau protein aggregates in various brain regions. PSP leads to neuronal loss, gliosis, and tau-positive inclusions, such as neurofibrillary tangles, tufted astrocytes, and coiled bodies. These pathological changes mainly affect the brainstem and the basal ganglia, resulting in distinctive MRI features, such as the hummingbird and morning glory signs. PSP shows clinical heterogeneity and presents as different phenotypes, the most classical of which is Richardson's syndrome (PSP-RS). The region of involvement and the mode of atrophy spread can further distinguish subtypes of PSP. PSP patients can experience various signs and symptoms, such as postural instability, supranuclear ophthalmoplegia, low amplitude fast finger tapping, and irregular sleep patterns. The most common symptoms of PSP are postural instability, falls, vertical gaze palsy, bradykinesia, and cognitive impairment. These features often overlap with those of Parkinson's disease (PD) and other Parkinsonian syndromes, making the diagnosis challenging. PSP is an essential clinical topic to research because it is a devastating and incurable disease. However, there are still many gaps in knowledge about its pathophysiology, diagnosis, and treatment. Several clinical trials are underway to test noveltherapies that target tau in various ways, such as modulating its post-translational modifications, stabilizing its interaction with microtubules, or enhancing its clearance by immunotherapy. These approaches may offer new hope for slowing down the progression of PSP. In this review, we aim to provide an overview of the current knowledge on PSP, from its pathogenesis to its management. We also discuss the latest advances and future directions in PSP research.
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Affiliation(s)
- Frederick DeRosier
- Department of Foundational Sciences, Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Clearwater, FL, United States of America
| | - Cody Hibbs
- Department of Foundational Sciences, Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Clearwater, FL, United States of America
| | - Kaitlyn Alessi
- Department of Family Medicine, University of Florida, Gainesville, United States of America
| | - Inderbir Padda
- Department of Internal Medicine, Richmond University Medical Center, Staten Island, New York, United States of America
| | - Jeanette Rodriguez
- Department of Family Medicine, Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Clearwater, Florida, United States of America
| | - Swati Pradeep
- Department of Movement Disorders, UTHealth Houston Neurosciences Neurology - Texas Medical Center, Texas, United States of America
| | - Mayur S Parmar
- Department of Foundational Sciences, Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Clearwater, FL, United States of America.
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8
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Grippe T, Shamli-Oghli Y, Darmani G, Nankoo JF, Raies N, Sarica C, Arora T, Gunraj C, Ding MYR, Rinchon C, DiLuca DG, Pichardo S, Cardoso F, Lozano AM, Chen R. Plasticity-Induced Effects of Theta Burst Transcranial Ultrasound Stimulation in Parkinson's Disease. Mov Disord 2024; 39:1364-1374. [PMID: 38787806 DOI: 10.1002/mds.29836] [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: 01/24/2024] [Revised: 04/29/2024] [Accepted: 05/02/2024] [Indexed: 05/26/2024] Open
Abstract
BACKGROUND Low-intensity transcranial ultrasound stimulation (TUS) is a noninvasive brain stimulation (NIBS) technique with high spatial specificity. Previous studies showed that TUS delivered in a theta burst pattern (tbTUS) increased motor cortex (MI) excitability up to 30 minutes due to long-term potentiation (LTP)-like plasticity. Studies using other forms of NIBS suggested that cortical plasticity may be impaired in patients with Parkinson's disease (PD). OBJECTIVE The aim was to investigate the neurophysiological effects of tbTUS in PD patients off and on dopaminergic medications compared to healthy controls. METHODS We studied 20 moderately affected PD patients in on and off dopaminergic medication states (7 with and 13 without dyskinesia) and 17 age-matched healthy controls in a case-controlled study. tbTUS was applied for 80 seconds to the MI. Motor-evoked potentials (MEP), short-interval intracortical inhibition (SICI), and short-interval intracortical facilitation (SICF) were recorded at baseline, and at 5 minutes (T5), T30, and T60 after tbTUS. Motor Unified Parkinson's Disease Rating Scale (mUPDRS) was measured at baseline and T60. RESULTS tbTUS significantly increased MEP amplitude at T30 compared to baseline in controls and in PD patients on but not in PD patients off medications. SICI was reduced in PD off medications compared to controls. tbTUS did not change in SICI or SICF. The bradykinesia subscore of mUPDRS was reduced at T60 compared to baseline in PD on but not in the off medication state. The presence of dyskinesia did not affect tbTUS-induced plasticity. CONCLUSIONS tbTUS-induced LTP plasticity is impaired in PD patients off medications and is restored by dopaminergic medications. © 2024 The Author(s). Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Talyta Grippe
- Department of Neurology, Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, UHN, Toronto, Canada
- Neuroscience Graduate Program, Federal University of Minas Gerais, Belo Horizonte, Brazil
- University Health Network, Toronto, Canada
- Division of Neurology, Department of Medicine, University of Toronto, Toronto, Canada
| | | | | | | | | | - Can Sarica
- University Health Network, Toronto, Canada
- Institute of Medical Science, University of Toronto, Toronto, Canada
| | - Tarun Arora
- University Health Network, Toronto, Canada
- Division of Clinical Neuroscience, Department of Neurology, Oslo University Hospital, Oslo, Norway
| | | | - Mandy Yi Rong Ding
- University Health Network, Toronto, Canada
- Institute of Medical Science, University of Toronto, Toronto, Canada
| | - Cricia Rinchon
- University Health Network, Toronto, Canada
- Institute of Medical Science, University of Toronto, Toronto, Canada
| | - Daniel G DiLuca
- Department of Neurology, Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, UHN, Toronto, Canada
- University Health Network, Toronto, Canada
- Division of Neurology, Department of Medicine, University of Toronto, Toronto, Canada
- Department of Neurology, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Samuel Pichardo
- Cumming School of Medicine, Department of Radiology and Clinical Neurosciences, University of Calgary, Calgary, Canada
| | - Francisco Cardoso
- Neuroscience Graduate Program, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Andres M Lozano
- University Health Network, Toronto, Canada
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Canada
| | - Robert Chen
- Department of Neurology, Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, UHN, Toronto, Canada
- University Health Network, Toronto, Canada
- Division of Neurology, Department of Medicine, University of Toronto, Toronto, Canada
- Institute of Medical Science, University of Toronto, Toronto, Canada
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9
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Angelini L, Paparella G, Bologna M. Distinguishing essential tremor from Parkinson's disease: clinical and experimental tools. Expert Rev Neurother 2024; 24:799-814. [PMID: 39016323 DOI: 10.1080/14737175.2024.2372339] [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: 04/25/2024] [Accepted: 06/20/2024] [Indexed: 07/18/2024]
Abstract
INTRODUCTION Essential tremor (ET) and Parkinson's disease (PD) are the most common causes of tremor and the most prevalent movement disorders, with overlapping clinical features that can lead to diagnostic challenges, especially in the early stages. AREAS COVERED In the present paper, the authors review the clinical and experimental studies and emphasized the major aspects to differentiate between ET and PD, with particular attention to cardinal phenomenological features of these two conditions. Ancillary and experimental techniques, including neurophysiology, neuroimaging, fluid biomarker evaluation, and innovative methods, are also discussed for their role in differential diagnosis between ET and PD. Special attention is given to investigations and tools applicable in the early stages of the diseases, when the differential diagnosis between the two conditions is more challenging. Furthermore, the authors discuss knowledge gaps and unsolved issues in the field. EXPERT OPINION Distinguishing ET and PD is crucial for prognostic purposes and appropriate treatment. Additionally, accurate diagnosis is critical for optimizing clinical and experimental research on pathophysiology and innovative therapies. In a few years, integrated technologies could enable accurate, reliable diagnosis from early disease stages or prodromal stages in at-risk populations, but further research combining different techniques is needed.
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Affiliation(s)
| | - Giulia Paparella
- IRCCS Neuromed, Pozzilli, (IS), Italy
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Matteo Bologna
- IRCCS Neuromed, Pozzilli, (IS), Italy
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
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10
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Ali F, Clark H, Machulda M, Senjem ML, Lowe VJ, Jack CR, Josephs KA, Whitwell J, Botha H. Patterns of brain volume and metabolism predict clinical features in the progressive supranuclear palsy spectrum. Brain Commun 2024; 6:fcae233. [PMID: 39056025 PMCID: PMC11272075 DOI: 10.1093/braincomms/fcae233] [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: 04/20/2023] [Revised: 03/26/2024] [Accepted: 07/14/2024] [Indexed: 07/28/2024] Open
Abstract
Progressive supranuclear palsy (PSP) is a neurodegenerative tauopathy that presents with highly heterogenous clinical syndromes. We perform cross-sectional data-driven discovery of independent patterns of brain atrophy and hypometabolism across the entire PSP spectrum. We then use these patterns to predict specific clinical features and to assess their relationship to phenotypic heterogeneity. We included 111 patients with PSP (60 with Richardson syndrome and 51 with cortical and subcortical variant subtypes). Ninety-one were used as the training set and 20 as a test set. The presence and severity of granular clinical variables such as postural instability, parkinsonism, apraxia and supranuclear gaze palsy were noted. Domains of akinesia, ocular motor impairment, postural instability and cognitive dysfunction as defined by the Movement Disorders Society criteria for PSP were also recorded. Non-negative matrix factorization was used on cross-sectional MRI and fluorodeoxyglucose-positron emission tomography (FDG-PET) scans. Independent models for each as well as a combined model for MRI and FDG-PET were developed and used to predict the granular clinical variables. Both MRI and FDG-PET were better at predicting presence of a symptom than severity, suggesting identification of disease state may be more robust than disease stage. FDG-PET predicted predominantly cortical abnormalities better than MRI such as ideomotor apraxia, apraxia of speech and frontal dysexecutive syndrome. MRI demonstrated prediction of cortical and more so sub-cortical abnormalities, such as parkinsonism. Distinct neuroanatomical foci were predictive in MRI- and FDG-PET-based models. For example, vertical gaze palsy was predicted by midbrain atrophy on MRI, but frontal eye field hypometabolism on FDG-PET. Findings also differed by scale or instrument used. For example, prediction of ocular motor abnormalities using the PSP Saccadic Impairment Scale was stronger than with the Movement Disorders Society Diagnostic criteria for PSP oculomotor impairment designation. Combination of MRI and FDG-PET demonstrated enhanced detection of parkinsonism and frontal syndrome presence and apraxia, cognitive impairment and bradykinesia severity. Both MRI and FDG-PET patterns were able to predict some measures in the test set; however, prediction of global cognition measured by Montreal Cognitive Assessment was the strongest. MRI predictions generalized more robustly to the test set. PSP leads to neurodegeneration in motor, cognitive and ocular motor networks at cortical and subcortical foci, leading to diverse yet overlapping clinical syndromes. To advance understanding of phenotypic heterogeneity in PSP, it is essential to consider data-driven approaches to clinical neuroimaging analyses.
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Affiliation(s)
- Farwa Ali
- Department of Neurology, Mayo Clinic, Rochester, MN 55905, USA
| | - Heather Clark
- Department of Neurology, Mayo Clinic, Rochester, MN 55905, USA
| | - Mary Machulda
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN 55905, USA
| | | | - Val J Lowe
- Department of Radiology, Mayo Clinic, Rochester, MN 55905, USA
| | - Clifford R Jack
- Department of Radiology, Mayo Clinic, Rochester, MN 55905, USA
| | - Keith A Josephs
- Department of Neurology, Mayo Clinic, Rochester, MN 55905, USA
| | | | - Hugo Botha
- Department of Neurology, Mayo Clinic, Rochester, MN 55905, USA
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Mishra A, Bajaj V, Fitzpatrick T, Watts J, Khojandi A, Ramdhani RA. Differential Responses to Low- and High-Frequency Subthalamic Nucleus Deep Brain Stimulation on Sensor-Measured Components of Bradykinesia in Parkinson's Disease. SENSORS (BASEL, SWITZERLAND) 2024; 24:4296. [PMID: 39001075 PMCID: PMC11244034 DOI: 10.3390/s24134296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/10/2024] [Revised: 05/30/2024] [Accepted: 07/01/2024] [Indexed: 07/16/2024]
Abstract
INTRODUCTION The current approach to assessing bradykinesia in Parkinson's Disease relies on the Unified Parkinson's Disease Rating Scale (UPDRS), which is a numeric scale. Inertial sensors offer the ability to probe subcomponents of bradykinesia: motor speed, amplitude, and rhythm. Thus, we sought to investigate the differential effects of high-frequency compared to low-frequency subthalamic nucleus (STN) deep brain stimulation (DBS) on these quantified facets of bradykinesia. METHODS We recruited advanced Parkinson's Disease subjects with a chronic bilateral subthalamic nucleus (STN) DBS implantation to a single-blind stimulation trial where each combination of medication state (OFF/ON), electrode contacts, and stimulation frequency (60 Hz/180 Hz) was assessed. The Kinesia One sensor system was used to measure upper limb bradykinesia. For each stimulation trial, subjects performed extremity motor tasks. Sensor data were recorded continuously. We identified STN DBS parameters that were associated with improved upper extremity bradykinesia symptoms using a mixed linear regression model. RESULTS We recruited 22 subjects (6 females) for this study. The 180 Hz STN DBS (compared to the 60 Hz STN DBS) and dopaminergic medications improved all subcomponents of upper extremity bradykinesia (motor speed, amplitude, and rhythm). For the motor rhythm subcomponent of bradykinesia, ventral contacts yielded improved symptom improvement compared to dorsal contacts. CONCLUSION The differential impact of high- and low-frequency STN DBS on the symptoms of bradykinesia may advise programming for these patients but warrants further investigation. Wearable sensors represent a valuable addition to the armamentarium that furthers our ability to conduct objective, quantitative clinical assessments.
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Affiliation(s)
- Akash Mishra
- Department of Neurology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, 300 Community Drive, Manhasset, NY 11030, USA
| | - Vikram Bajaj
- Department of Neurology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, 300 Community Drive, Manhasset, NY 11030, USA
| | - Toni Fitzpatrick
- Department of Neurology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, 300 Community Drive, Manhasset, NY 11030, USA
| | - Jeremy Watts
- Department of Industrial and Systems Engineering, University of Tennessee, Knoxville, TN 37996, USA
| | - Anahita Khojandi
- Department of Industrial and Systems Engineering, University of Tennessee, Knoxville, TN 37996, USA
| | - Ritesh A. Ramdhani
- Department of Neurology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, 300 Community Drive, Manhasset, NY 11030, USA
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12
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Lenka A, Perera VM, Espay AJ, Pontone GM, Okun MS. Gaps and Controversies in Catatonia as a Movement Disorder. Mov Disord 2024. [PMID: 38924566 DOI: 10.1002/mds.29906] [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: 02/20/2024] [Revised: 06/09/2024] [Accepted: 06/12/2024] [Indexed: 06/28/2024] Open
Abstract
The term "catatonia" was introduced by German psychiatrist Karl Kahlbaum in 1874. Although historically tied to schizophrenia, catatonia exhibits a diverse range of phenotypes and has been observed in various medical and neuropsychiatric conditions. Its intrinsic movement characteristics and association with hypokinetic and hyperkinetic phenomenologies place catatonia within the purview of movement disorders. Despite the presence of catatonia in psychiatry literature for over 150 years, many gaps and controversies persist regarding its etiopathogenesis, phenomenology, diagnostic criteria, and treatment. The current versions of the International Classification of Diseases (ICD-11) and the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) require clinicians to identify any three signs of 15 (ICD-11) or 12 (DSM-5) for the diagnosis of catatonia. Catalepsy and waxy flexibility are the only motor features with high specificity for the diagnosis. We highlight the gaps and controversies in catatonia as a movement disorder, emphasize the lack of a clear definition, and discuss the inconsistencies in the description of various catatonic signs. We propose the exploration of a bi-axial classification framework similar to that used for dystonia and tremor to encourage the evaluation of underlying etiologies and to guide therapeutic decisions to improve the outcome of these patients. © 2024 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Abhishek Lenka
- Parkinson's Disease Center and Movement Disorders Clinic, Department of Neurology, Baylor College of Medicine, Houston, Texas, USA
| | - Vishal M Perera
- Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, Florida, USA
| | - Alberto J Espay
- Department of Neurology, James J. and Joan A. Gardner Family Center for Parkinson's Disease and Movement Disorders, University of Cincinnati, Cincinnati, Ohio, USA
| | - Gregory M Pontone
- Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, Florida, USA
| | - Michael S Okun
- Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, Florida, USA
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13
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Leodori G, De Bartolo MI, Piervincenzi C, Mancuso M, Ojha A, Costanzo M, Aiello F, Vivacqua G, Fabbrini G, Conte A, Pantano P, Berardelli A, Belvisi D. Mapping Motor Cortical Network Excitability and Connectivity Changes in De Novo Parkinson's Disease. Mov Disord 2024. [PMID: 38924157 DOI: 10.1002/mds.29901] [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: 02/28/2024] [Revised: 05/07/2024] [Accepted: 06/10/2024] [Indexed: 06/28/2024] Open
Abstract
BACKGROUND Transcranial magnetic stimulation-electroencephalography (TMS-EEG) has demonstrated decreased excitability in the primary motor cortex (M1) and increased excitability in the pre-supplementary motor area (pre-SMA) in moderate-advanced Parkinson's disease (PD). OBJECTIVES The aim was to investigate whether these abnormalities are evident from the early stages of the disease, their behavioral correlates, and relationship to cortico-subcortical connections. METHODS Twenty-eight early, drug-naive (de novo) PD patients and 28 healthy controls (HCs) underwent TMS-EEG to record TMS-evoked potentials (TEPs) from the primary motor cortex (M1) and the pre-SMA, kinematic recording of finger-tapping movements, and a 3T-MRI (magnetic resonance imaging) scan to obtain diffusion tensor imaging (DTI) reconstruction of white matter (WM) tracts connecting M1 to the ventral lateral anterior thalamic nucleus and pre-SMA to the anterior putamen. RESULTS We found reduced M1 TEP P30 amplitude in de novo PD patients compared to HCs and similar pre-SMA TEP N40 amplitude between groups. PD patients exhibited smaller amplitude and slower velocity in finger-tapping movements and altered structural integrity in WM tracts of interest, although these changes did not correlate with TEPs. CONCLUSIONS M1 hypoexcitability is a characteristic of PD from early phases and may be a marker of the parkinsonian state. Pre-SMA hyperexcitability is not evident in early PD and possibly emerges at later stages of the disease. © 2024 The Author(s). Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Giorgio Leodori
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
- IRCCS Neuromed, Pozzilli, Italy
| | | | | | - Marco Mancuso
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Abhineet Ojha
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Matteo Costanzo
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Flavia Aiello
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Giorgio Vivacqua
- Unit of Microscopic and Ultrastructural Anatomy, Campus Bio-Medico University of Rome, Rome, Italy
| | - Giovanni Fabbrini
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
- IRCCS Neuromed, Pozzilli, Italy
| | - Antonella Conte
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
- IRCCS Neuromed, Pozzilli, Italy
| | - Patrizia Pantano
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
- IRCCS Neuromed, Pozzilli, Italy
| | - Alfredo Berardelli
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
- IRCCS Neuromed, Pozzilli, Italy
| | - Daniele Belvisi
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
- IRCCS Neuromed, Pozzilli, Italy
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14
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Pietracupa S, Ojha A, Belvisi D, Piervincenzi C, Tommasin S, Petsas N, De Bartolo MI, Costanzo M, Fabbrini A, Conte A, Berardelli A, Pantano P. Understanding the role of cerebellum in early Parkinson's disease: a structural and functional MRI study. NPJ Parkinsons Dis 2024; 10:119. [PMID: 38898032 PMCID: PMC11187155 DOI: 10.1038/s41531-024-00727-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 05/24/2024] [Indexed: 06/21/2024] Open
Abstract
Increasing evidence suggests that the cerebellum may have a role in the pathophysiology of Parkinson's disease (PD). Hence, the scope of this study was to investigate whether there are structural and functional alterations of the cerebellum and whether they correlate with motor and non-motor symptoms in early PD patients. Seventy-six patients with early PD and thirty-one age and sex-matched healthy subjects (HS) were enrolled and underwent a 3 T magnetic resonance imaging (MRI) protocol. The following MRI analyses were performed: (1) volumes of 5 cerebellar regions of interest (sensorimotor and cognitive cerebellum, dentate, interposed, and fastigial nuclei); (2) microstructural integrity of the cerebellar white matter connections (inferior, middle, and superior cerebellar peduncles); (3) functional connectivity at rest of the 5 regions of interest already described in point 1 with the rest of brain. Compared to controls, early PD patients showed a significant decrease in gray matter volume of the dentate, interposed and fastigial nuclei, bilaterally. They also showed abnormal, bilateral white matter microstructural integrity in all 3 cerebellar peduncles. Functional connectivity of the 5 cerebellar regions of interest with several areas in the midbrain, basal ganglia and cerebral cortex was altered. Finally, there was a positive correlation between abnormal functional connectivity of the fastigial nucleus with the volume of the nucleus itself and a negative correlation with axial symptoms severity. Our results showed that structural and functional alterations of the cerebellum are present in PD patients and these changes contribute to the pathophysiology of PD in the early phase.
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Affiliation(s)
- S Pietracupa
- IRCCS Neuromed, Pozzilli, IS, Italy
- Department of Human Neuroscience, Sapienza University of Rome, Rome, Italy
| | - A Ojha
- Department of Human Neuroscience, Sapienza University of Rome, Rome, Italy
| | - D Belvisi
- IRCCS Neuromed, Pozzilli, IS, Italy
- Department of Human Neuroscience, Sapienza University of Rome, Rome, Italy
| | - C Piervincenzi
- Department of Human Neuroscience, Sapienza University of Rome, Rome, Italy.
| | - S Tommasin
- Department of Human Neuroscience, Sapienza University of Rome, Rome, Italy
| | - N Petsas
- Department of Public Health and Infectious Disease, Sapienza University of Rome, Rome, Italy
| | | | | | - A Fabbrini
- Department of Human Neuroscience, Sapienza University of Rome, Rome, Italy
| | - A Conte
- IRCCS Neuromed, Pozzilli, IS, Italy
- Department of Human Neuroscience, Sapienza University of Rome, Rome, Italy
| | - A Berardelli
- IRCCS Neuromed, Pozzilli, IS, Italy
- Department of Human Neuroscience, Sapienza University of Rome, Rome, Italy
| | - P Pantano
- IRCCS Neuromed, Pozzilli, IS, Italy
- Department of Human Neuroscience, Sapienza University of Rome, Rome, Italy
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15
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Bocci T, Ferrara R, Albizzati T, Averna A, Guidetti M, Marceglia S, Priori A. Asymmetries of the subthalamic activity in Parkinson's disease: phase-amplitude coupling among local field potentials. Brain Commun 2024; 6:fcae201. [PMID: 38894949 PMCID: PMC11184348 DOI: 10.1093/braincomms/fcae201] [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: 07/30/2023] [Revised: 01/22/2024] [Accepted: 06/07/2024] [Indexed: 06/21/2024] Open
Abstract
The role of brain asymmetries of dopaminergic neurons in motor symptoms of Parkinson's disease is still undefined. Local field recordings from the subthalamic nucleus revealed some neurophysiological biomarkers of the disease: increased beta activity, increased low-frequency activity and high-frequency oscillations. Phase-amplitude coupling coordinates the timing of neuronal activity and allows determining the mechanism for communication within distinct regions of the brain. In this study, we discuss the use of phase-amplitude coupling to assess the differences between the two hemispheres in a cohort of 24 patients with Parkinson's disease before and after levodopa administration. Subthalamic low- (12-20 Hz) and high-beta (20-30 Hz) oscillations were compared with low- (30-45 Hz), medium- (70-100 Hz) and high-frequency (260-360 Hz) bands. We found a significant beta-phase-amplitude coupling asymmetry between left and right and an opposite-side-dependent effect of the pharmacological treatment, which is associated with the reduction of motor symptoms. In particular, high coupling between high frequencies and high-beta oscillations was found during the OFF condition (P < 0.01) and a low coupling during the ON state (P < 0.0001) when the right subthalamus was assessed; exactly the opposite happened when the left subthalamus was considered in the analysis, showing a lower coupling between high frequencies and high-beta oscillations during the OFF condition (P < 0.01), followed by a higher one during the ON state (P < 0.01). Interestingly, these asymmetries are independent of the motor onset side, either left or right. These findings have important implications for neural signals that may be used to trigger adaptive deep brain stimulation in Parkinson's and could provide more exhaustive insights into subthalamic dynamics.
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Affiliation(s)
- Tommaso Bocci
- ‘Aldo Ravelli’ Research Center for Neurotechnology and Experimental Neurotherapeutics, Department of Health Sciences, University of Milan, 20142 Milan, Italy
- III Neurology Clinic, ASST-Santi Paolo e Carlo University Hospital, 20142 Milan, Italy
| | - Rosanna Ferrara
- ‘Aldo Ravelli’ Research Center for Neurotechnology and Experimental Neurotherapeutics, Department of Health Sciences, University of Milan, 20142 Milan, Italy
| | - Tommaso Albizzati
- Department of Engineering and Architecture, University of Trieste, Trieste, 34127 Friuli-Venezia Giulia, Italy
| | - Alberto Averna
- Department of Neurology, Bern University Hospital and University of Bern, 3010 Bern, Switzerland
| | - Matteo Guidetti
- ‘Aldo Ravelli’ Research Center for Neurotechnology and Experimental Neurotherapeutics, Department of Health Sciences, University of Milan, 20142 Milan, Italy
| | - Sara Marceglia
- Department of Engineering and Architecture, University of Trieste, Trieste, 34127 Friuli-Venezia Giulia, Italy
- Newronika S.r.l., 20093 Cologno Monzese, Italy
| | - Alberto Priori
- ‘Aldo Ravelli’ Research Center for Neurotechnology and Experimental Neurotherapeutics, Department of Health Sciences, University of Milan, 20142 Milan, Italy
- III Neurology Clinic, ASST-Santi Paolo e Carlo University Hospital, 20142 Milan, Italy
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Passaretti M, Piervincenzi C, Baione V, Pasqua G, Colella D, Pietracupa S, Petsas N, Angelini L, Cannavacciuolo A, Paparella G, Berardelli A, Pantano P, Bologna M. The Role of Cerebellum and Basal Ganglia Functional Connectivity in Altered Voluntary Movement Execution in Essential Tremor. CEREBELLUM (LONDON, ENGLAND) 2024:10.1007/s12311-024-01699-6. [PMID: 38761352 DOI: 10.1007/s12311-024-01699-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/25/2024] [Indexed: 05/20/2024]
Abstract
Substantial evidence highlights the role of the cerebellum in the pathophysiology of tremor in essential tremor (ET), although its potential involvement in altered movement execution in this condition remains unclear. This study aims to explore potential correlations between the cerebellum and basal ganglia functional connectivity and voluntary movement execution abnormalities in ET, objectively assessed with kinematic techniques. A total of 20 patients diagnosed with ET and 18 healthy subjects were enrolled in this study. Tremor and repetitive finger tapping were recorded using an optoelectronic kinematic system. All participants underwent comprehensive 3T-MRI examinations, including 3D-T1 and blood-oxygen-level dependent (BOLD) sequences during resting state. Morphometric analysis was conducted on the 3D-T1 images, while a seed-based analysis was performed to investigate the resting-state functional connectivity (rsFC) of dorsal and ventral portions of the dentate nucleus and the external and internal segments of the globus pallidus. Finally, potential correlations between rsFC alterations in patients and clinical as well as kinematic scores were assessed. Finger tapping movements were slower in ET than in healthy subjects. Compared to healthy subjects, patients with ET exhibited altered FC of both dentate and globus pallidus with cerebellar, basal ganglia, and cortical areas. Interestingly, both dentate and pallidal FC exhibited positive correlations with movement velocity in patients, differently from that we observed in healthy subjects, indicating the higher the FC, the faster the finger tapping. The findings of this study indicate the possible role of both cerebellum and basal ganglia in the pathophysiology of altered voluntary movement execution in patients with ET.
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Affiliation(s)
- Massimiliano Passaretti
- Department of Human Neurosciences, Sapienza University of Rome, Viale dell'Università, 30, 00185, Rome, Italy
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Claudia Piervincenzi
- Department of Human Neurosciences, Sapienza University of Rome, Viale dell'Università, 30, 00185, Rome, Italy
| | - Viola Baione
- Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Gabriele Pasqua
- Department of Human Neurosciences, Sapienza University of Rome, Viale dell'Università, 30, 00185, Rome, Italy
| | - Donato Colella
- Department of Human Neurosciences, Sapienza University of Rome, Viale dell'Università, 30, 00185, Rome, Italy
| | - Sara Pietracupa
- Department of Human Neurosciences, Sapienza University of Rome, Viale dell'Università, 30, 00185, Rome, Italy
- IRCCS Neuromed, Pozzilli, IS, Italy
| | - Nikolaos Petsas
- Department of Public Health and Infectious Disease, Sapienza University of Rome, Rome, Italy
| | | | | | - Giulia Paparella
- Department of Human Neurosciences, Sapienza University of Rome, Viale dell'Università, 30, 00185, Rome, Italy
- IRCCS Neuromed, Pozzilli, IS, Italy
| | - Alfredo Berardelli
- Department of Human Neurosciences, Sapienza University of Rome, Viale dell'Università, 30, 00185, Rome, Italy
- IRCCS Neuromed, Pozzilli, IS, Italy
| | - Patrizia Pantano
- Department of Human Neurosciences, Sapienza University of Rome, Viale dell'Università, 30, 00185, Rome, Italy
- IRCCS Neuromed, Pozzilli, IS, Italy
| | - Matteo Bologna
- Department of Human Neurosciences, Sapienza University of Rome, Viale dell'Università, 30, 00185, Rome, Italy.
- IRCCS Neuromed, Pozzilli, IS, Italy.
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Paparella G, Galosi E, Irelli EC, Angelini L, Birreci D, Costa D, De Riggi M, Cannavacciuolo A, Truini A, Bologna M. A Novel KCNQ2 Variant in a Patient with a Combined Tremor Syndrome. Tremor Other Hyperkinet Mov (N Y) 2024; 14:24. [PMID: 38737299 PMCID: PMC11086586 DOI: 10.5334/tohm.887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Accepted: 04/26/2024] [Indexed: 05/14/2024] Open
Abstract
Background Tremor disorders have various genetic causes. Case report A 60-year-old female with a family history of tremor presented a combined tremor syndrome, transient episodes of loss of contact and speech disturbances, as well as distal painful symptoms. Genetic screening revealed a novel heterozygous missense variant in the KCNQ2 gene. Discussion The KCNQ2 protein regulates action potential firing, and mutations in its gene are associated with epilepsy and neuropathic pain. The identified variant, although of uncertain significance, may disrupt KCNQ2 function and also play a role in tremor pathogenesis. This case highlights the importance of genetic screening in combined tremor disorders.
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Affiliation(s)
- Giulia Paparella
- IRCCS Neuromed, Pozzilli (IS), Italy
- Department of Human Neurosciences, Sapienza University of Rome, Italy
| | - Eleonora Galosi
- Department of Human Neurosciences, Sapienza University of Rome, Italy
| | | | | | - Daniele Birreci
- Department of Human Neurosciences, Sapienza University of Rome, Italy
| | | | - Martina De Riggi
- Department of Human Neurosciences, Sapienza University of Rome, Italy
| | | | - Andrea Truini
- Department of Human Neurosciences, Sapienza University of Rome, Italy
| | - Matteo Bologna
- IRCCS Neuromed, Pozzilli (IS), Italy
- Department of Human Neurosciences, Sapienza University of Rome, Italy
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18
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Mifsud J, Embry KR, Macaluso R, Lonini L, Cotton RJ, Simuni T, Jayaraman A. Detecting the symptoms of Parkinson's disease with non-standard video. J Neuroeng Rehabil 2024; 21:72. [PMID: 38702705 PMCID: PMC11067123 DOI: 10.1186/s12984-024-01362-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 04/20/2024] [Indexed: 05/06/2024] Open
Abstract
BACKGROUND Neurodegenerative diseases, such as Parkinson's disease (PD), necessitate frequent clinical visits and monitoring to identify changes in motor symptoms and provide appropriate care. By applying machine learning techniques to video data, automated video analysis has emerged as a promising approach to track and analyze motor symptoms, which could facilitate more timely intervention. However, existing solutions often rely on specialized equipment and recording procedures, which limits their usability in unstructured settings like the home. In this study, we developed a method to detect PD symptoms from unstructured videos of clinical assessments, without the need for specialized equipment or recording procedures. METHODS Twenty-eight individuals with Parkinson's disease completed a video-recorded motor examination that included the finger-to-nose and hand pronation-supination tasks. Clinical staff provided ground truth scores for the level of Parkinsonian symptoms present. For each video, we used a pre-existing model called PIXIE to measure the location of several joints on the person's body and quantify how they were moving. Features derived from the joint angles and trajectories, designed to be robust to recording angle, were then used to train two types of machine-learning classifiers (random forests and support vector machines) to detect the presence of PD symptoms. RESULTS The support vector machine trained on the finger-to-nose task had an F1 score of 0.93 while the random forest trained on the same task yielded an F1 score of 0.85. The support vector machine and random forest trained on the hand pronation-supination task had F1 scores of 0.20 and 0.33, respectively. CONCLUSION These results demonstrate the feasibility of developing video analysis tools to track motor symptoms across variable perspectives. These tools do not work equally well for all tasks, however. This technology has the potential to overcome barriers to access for many individuals with degenerative neurological diseases like PD, providing them with a more convenient and timely method to monitor symptom progression, without requiring a structured video recording procedure. Ultimately, more frequent and objective home assessments of motor function could enable more precise telehealth optimization of interventions to improve clinical outcomes inside and outside of the clinic.
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Affiliation(s)
- Joseph Mifsud
- Max Näder Center for Rehabilitation Technologies and Outcomes Research, Shirley Ryan AbilityLab, Chicago, IL, USA
| | - Kyle R Embry
- Max Näder Center for Rehabilitation Technologies and Outcomes Research, Shirley Ryan AbilityLab, Chicago, IL, USA
- Northwestern University, Chicago, IL, USA
| | - Rebecca Macaluso
- Max Näder Center for Rehabilitation Technologies and Outcomes Research, Shirley Ryan AbilityLab, Chicago, IL, USA
| | - Luca Lonini
- Max Näder Center for Rehabilitation Technologies and Outcomes Research, Shirley Ryan AbilityLab, Chicago, IL, USA
- Northwestern University, Chicago, IL, USA
| | - R James Cotton
- Northwestern University, Chicago, IL, USA
- Center for Bionic Medicine, Shirley Ryan AbilityLab, Chicago, IL, USA
| | | | - Arun Jayaraman
- Max Näder Center for Rehabilitation Technologies and Outcomes Research, Shirley Ryan AbilityLab, Chicago, IL, USA.
- Northwestern University, Chicago, IL, USA.
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19
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Bologna M, Guerra A, Colella D, Birreci D, Costa D, Cannavacciuolo A, Angelini L, Paparella G, Antonini A, Berardelli A, Fabbrini G. Objective assessment of the effects of opicapone in Parkinson's disease through kinematic analysis. Neurol Sci 2024; 45:2035-2046. [PMID: 38091213 PMCID: PMC11021230 DOI: 10.1007/s10072-023-07233-6] [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: 10/10/2023] [Accepted: 11/27/2023] [Indexed: 12/29/2023]
Abstract
BACKGROUND Opicapone (OPC) is a third-generation, selective peripheral COMT inhibitor that improves peripheral L-DOPA bioavailability and reduces OFF time and end-of-dose motor fluctuations in Parkinson's disease (PD) patients. OBJECTIVES In this study, we objectively assessed the effects of adding OPC to L-DOPA on bradykinesia in PD through kinematic analysis of finger movements. METHODS We enrolled 20 treated patients with PD and motor fluctuations. Patients underwent two experimental sessions (L-DOPA, L-DOPA + OPC), separated by at least 1 week. In each session, patients were clinically evaluated and underwent kinematic movement analysis of repetitive finger movements at four time points: (i) before their usual morning dose of L-DOPA (T0), (ii) 30 min (T1), (iii) 1 h and 30 min (T2), and (iv) 3 h and 30 min after the L-DOPA intake (T3). RESULTS Movement velocity and amplitude of finger movements were higher in PD patients during the session with OPC compared to the session without OPC at all the time points tested. Importantly, the variability of finger movement velocity and amplitude across T0-T3 was significantly lower in the L-DOPA + OPC than L-DOPA session. CONCLUSIONS This study is the first objective assessment of the effects of adding OPC to L-DOPA on bradykinesia in patients with PD and motor fluctuations. OPC, in addition to the standard dopaminergic therapy, leads to significant improvements in bradykinesia during clinically relevant periods associated with peripheral L-DOPA dynamics, i.e., the OFF state in the morning, delayed-ON, and wearing-OFF periods.
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Affiliation(s)
- Matteo Bologna
- Department of Human Neurosciences, Sapienza University of Rome, Viale Dell'Università 30, 00185, Rome, Italy.
- IRCCS Neuromed, 86077, Pozzilli, IS, Italy.
| | - Andrea Guerra
- Parkinson and Movement Disorder Unit, Study Center On Neurodegeneration (CESNE), Department of Neuroscience, University of Padua, Padua, Italy
- Padua Neuroscience Center, University of Padua, Padua, Italy
| | - Donato Colella
- Department of Human Neurosciences, Sapienza University of Rome, Viale Dell'Università 30, 00185, Rome, Italy
| | - Daniele Birreci
- Department of Human Neurosciences, Sapienza University of Rome, Viale Dell'Università 30, 00185, Rome, Italy
| | - Davide Costa
- Department of Human Neurosciences, Sapienza University of Rome, Viale Dell'Università 30, 00185, Rome, Italy
| | | | - Luca Angelini
- Department of Human Neurosciences, Sapienza University of Rome, Viale Dell'Università 30, 00185, Rome, Italy
| | - Giulia Paparella
- Department of Human Neurosciences, Sapienza University of Rome, Viale Dell'Università 30, 00185, Rome, Italy
- IRCCS Neuromed, 86077, Pozzilli, IS, Italy
| | - Angelo Antonini
- Parkinson and Movement Disorder Unit, Study Center On Neurodegeneration (CESNE), Department of Neuroscience, University of Padua, Padua, Italy
- Padua Neuroscience Center, University of Padua, Padua, Italy
| | - Alfredo Berardelli
- Department of Human Neurosciences, Sapienza University of Rome, Viale Dell'Università 30, 00185, Rome, Italy
- IRCCS Neuromed, 86077, Pozzilli, IS, Italy
| | - Giovanni Fabbrini
- Department of Human Neurosciences, Sapienza University of Rome, Viale Dell'Università 30, 00185, Rome, Italy
- IRCCS Neuromed, 86077, Pozzilli, IS, Italy
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20
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Chen H, Wang X, Zhang J, Xie D. Effect of high-frequency repetitive transcranial magnetic stimulation on cognitive impairment in WD patients based on inverse probability weighting of propensity scores. Front Neurosci 2024; 18:1375234. [PMID: 38660222 PMCID: PMC11039870 DOI: 10.3389/fnins.2024.1375234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Accepted: 03/26/2024] [Indexed: 04/26/2024] Open
Abstract
Background Hepatolenticular degeneration [Wilson disease (WD)] is an autosomal recessive metabolic disease characterized by copper metabolism disorder. Cognitive impairment is a key neuropsychiatric symptom of WD. At present, there is no effective treatment for WD-related cognitive impairment. Methods In this study, high-frequency repetitive transcranial magnetic stimulation (rTMS) was used to treat WD-related cognitive impairment, and inverse probability weighting of propensity scores was used to correct for confounding factors. The Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA), Auditory Verbal Learning Test (AVLT), Boston Naming Test (BNT), Clock Drawing Test (CDT) and Trail Making Test (TMT) were used to evaluate overall cognition and specific cognitive domains. Results The MMSE, MoCA and CDT scores after treatment were significantly different from those before treatment (MMSE: before adjustment: OR = 1.404, 95% CI: 1.271-1.537; after adjustment: OR = 1.381, 95% CI: 1.265-1.497, p < 0.001; MoCA: before adjustment: OR = 1.306, 95% CI: 1.122-1.490; after adjustment: OR = 1.286, 95% CI: 1.104; AVLT: OR = 1.161, 95% CI: 1.074-1.248; after adjustment: OR = 1.145, 95% CI: 1.068-1.222, p < 0.05; CDT: OR = 1.524, 95% CI: 1.303-1.745; after adjustment: OR = 1.518, 95% CI: 1.294-1.742, p < 0.001). The BNT and TMT scores after adjustment were not significantly different from those before adjustment (BNT: before adjustment: OR = 1.048, 95% CI: 0.877-1.219; after adjustment: OR = 1.026, 95% CI: 0.863-1.189, p > 0.05; TMT: before adjustment: OR = 0.816, 95% CI: 1.122-1.490; after adjustment: OR = 0.791, 95% CI: 0.406-1.176, p > 0.05). Conclusion High-frequency rTMS can effectively improve cognitive impairment, especially memory and visuospatial ability, in WD patients. The incidence of side effects is low, and the safety is good.
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Affiliation(s)
- Hong Chen
- The First Clinical Mdical College of Anhui University of Chinese Medicine, Hefei, China
| | - Xie Wang
- The First Clinical Mdical College of Anhui University of Chinese Medicine, Hefei, China
| | - Juan Zhang
- Department of Neurology, The First Affiliated Hospital of Anhui University of Traditional Chinese Medicine, Hefei, China
| | - Daojun Xie
- Department of Neurology, The First Affiliated Hospital of Anhui University of Traditional Chinese Medicine, Hefei, China
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21
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Laurencin C, Lancelot S, Brosse S, Mérida I, Redouté J, Greusard E, Lamberet L, Liotier V, Le Bars D, Costes N, Thobois S, Boulinguez P, Ballanger B. Noradrenergic alterations in Parkinson's disease: a combined 11C-yohimbine PET/neuromelanin MRI study. Brain 2024; 147:1377-1388. [PMID: 37787503 PMCID: PMC10994534 DOI: 10.1093/brain/awad338] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 09/05/2023] [Accepted: 09/19/2023] [Indexed: 10/04/2023] Open
Abstract
Degeneration of the noradrenergic system is now considered a pathological hallmark of Parkinson's disease, but little is known about its consequences in terms of parkinsonian manifestations. Here, we evaluated two aspects of the noradrenergic system using multimodal in vivo imaging in patients with Parkinson's disease and healthy controls: the pigmented cell bodies of the locus coeruleus with neuromelanin sensitive MRI; and the density of α2-adrenergic receptors (ARs) with PET using 11C-yohimbine. Thirty patients with Parkinson's disease and 30 age- and sex-matched healthy control subjects were included. The characteristics of the patients' symptoms were assessed using the Movement Disorder Society Unified Parkinson's Disease Rating Scale (MDS-UPDRS). Patients showed reduced neuromelanin signal intensity in the locus coeruleus compared with controls and diminished 11C-yohimbine binding in widespread cortical regions, including the motor cortex, as well as in the insula, thalamus and putamen. Clinically, locus coeruleus neuronal loss was correlated with motor (bradykinesia, motor fluctuations, tremor) and non-motor (fatigue, apathy, constipation) symptoms. A reduction of α2-AR availability in the thalamus was associated with tremor, while a reduction in the putamen, the insula and the superior temporal gyrus was associated with anxiety. These results highlight a multifaceted alteration of the noradrenergic system in Parkinson's disease since locus coeruleus and α2-AR degeneration were found to be partly uncoupled. These findings raise important issues about noradrenergic dysfunction that may encourage the search for new drugs targeting this system, including α2-ARs, for the treatment of Parkinson's disease.
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Affiliation(s)
- Chloé Laurencin
- Lyon Neuroscience Research Center (CRNL), INSERM U1028, CNRS UMR5292, University Lyon 1, F-69000 Lyon, France
- Department of Neurology C, Expert Parkinson Centre, Hospices Civils de Lyon, Pierre Wertheimer Neurological Hospital, NS-Park/F-CRIN, 69500 Bron, France
| | - Sophie Lancelot
- Lyon Neuroscience Research Center (CRNL), INSERM U1028, CNRS UMR5292, University Lyon 1, F-69000 Lyon, France
- CERMEP-Imagerie du Vivant, PET-MRI Department, 69500 Bron, France
| | - Sarah Brosse
- Lyon Neuroscience Research Center (CRNL), INSERM U1028, CNRS UMR5292, University Lyon 1, F-69000 Lyon, France
| | - Inés Mérida
- CERMEP-Imagerie du Vivant, PET-MRI Department, 69500 Bron, France
| | - Jérôme Redouté
- CERMEP-Imagerie du Vivant, PET-MRI Department, 69500 Bron, France
| | - Elise Greusard
- CERMEP-Imagerie du Vivant, PET-MRI Department, 69500 Bron, France
| | - Ludovic Lamberet
- CERMEP-Imagerie du Vivant, PET-MRI Department, 69500 Bron, France
| | | | - Didier Le Bars
- CERMEP-Imagerie du Vivant, PET-MRI Department, 69500 Bron, France
| | - Nicolas Costes
- CERMEP-Imagerie du Vivant, PET-MRI Department, 69500 Bron, France
| | - Stéphane Thobois
- Department of Neurology C, Expert Parkinson Centre, Hospices Civils de Lyon, Pierre Wertheimer Neurological Hospital, NS-Park/F-CRIN, 69500 Bron, France
- Institut des Sciences Cognitives Marc Jeannerod, UMR 5229, CNRS, 69500 Bron, France
| | - Philippe Boulinguez
- Lyon Neuroscience Research Center (CRNL), INSERM U1028, CNRS UMR5292, University Lyon 1, F-69000 Lyon, France
| | - Bénédicte Ballanger
- Lyon Neuroscience Research Center (CRNL), INSERM U1028, CNRS UMR5292, University Lyon 1, F-69000 Lyon, France
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22
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Jiang X, Yang J, Wang Z, Jia J, Wang G. Functional interaction of abnormal beta and gamma oscillations on bradykinesia in parkinsonian rats. Brain Res Bull 2024; 209:110911. [PMID: 38432496 DOI: 10.1016/j.brainresbull.2024.110911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 02/21/2024] [Accepted: 02/26/2024] [Indexed: 03/05/2024]
Abstract
Bradykinesia, a debilitating symptom characterized by impaired movement initiation and reduced speed in Parkinson's disease (PD), is associated with abnormal oscillatory activity in the motor cortex-basal ganglia circuit. We investigated the interplay between abnormal beta and gamma oscillations in relation to bradykinesia in parkinsonian rats. Our findings showed reduced movement activities in parkinsonian rats, accompanied by enhanced high beta oscillations in the motor cortex, which are closely associated with movement transitional difficulties. Additionally, gamma oscillations correlated with movement velocity in control rats but not in parkinsonian rats. We observed selective coupling between high beta oscillation phase and gamma oscillation amplitude in PD, as well as cortical high beta-broadband gamma phase-amplitude coupling (PAC) negatively influencing locomotor activities in control and PD rats. These findings suggest a collaborative role of cortical beta and gamma oscillations in facilitating movement execution, with beta oscillations being linked to movement initiation and gamma oscillations associated with movement speed. Importantly, the aberrant alterations of these oscillations are closely related to the development of bradykinesia. Furthermore, PAC hold promise as a biomarker for comprehensive assessment of movement performance in PD.
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Affiliation(s)
- Xinxin Jiang
- Beijing Key Laboratory of Mental Disorders, National Clinical Research Center for Mental Disorders & National Center for Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing 100088, China; Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing 100069, China; Department of physiology and pathophysiology, School of Basic Medical Science, Capital Medical University, Beijing 100069, China
| | - Jian Yang
- Beijing Key Laboratory of Mental Disorders, National Clinical Research Center for Mental Disorders & National Center for Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing 100088, China; Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing 100069, China
| | - Zirui Wang
- Department of physiology and pathophysiology, School of Basic Medical Science, Capital Medical University, Beijing 100069, China
| | - Jun Jia
- Department of physiology and pathophysiology, School of Basic Medical Science, Capital Medical University, Beijing 100069, China.
| | - Gang Wang
- Beijing Key Laboratory of Mental Disorders, National Clinical Research Center for Mental Disorders & National Center for Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing 100088, China; Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing 100069, China.
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23
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de Graaf D, Araújo R, Derksen M, Zwinderman K, de Vries NM, IntHout J, Bloem BR. The sound of Parkinson's disease: A model of audible bradykinesia. Parkinsonism Relat Disord 2024; 120:106003. [PMID: 38219529 DOI: 10.1016/j.parkreldis.2024.106003] [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: 11/13/2023] [Revised: 01/08/2024] [Accepted: 01/08/2024] [Indexed: 01/16/2024]
Abstract
INTRODUCTION Evaluation of bradykinesia is based on five motor tasks from the MDS-UPDRS. Visually scoring these motor tasks is subjective, resulting in significant interrater variability. Recent observations suggest that it may be easier to hear the characteristic features of bradykinesia, such as the decrement in sound intensity or force of repetitive movements. The objective is to evaluate whether audio signals derived during four MDS-UPDRS tasks can be used to detect and grade bradykinesia, using two machine learning models. METHODS 54 patients with Parkinson's disease and 28 healthy controls were filmed while executing the bradykinesia motor tasks. Several features were extracted from the audio signal, including number of taps, speed, sound intensity, decrement and freezes. For each motor task, two supervised machine learning models were trained, Logistic Regression (LR) and Support Vector Machine (SVM). RESULTS Both classifiers were able to separate patients from controls reasonably well for the leg agility task, area under the receiver operating characteristic curve (AUC): 0.92 (95%CI: 0.78-0.99) for LR and 0.93 (0.81-1.00) for SVM. Also, models were able to differentiate less severe bradykinesia from severe bradykinesia, particularly for the pronation-supination motor task, with AUC: 0.90 (0.62-1.00) for LR and 0.82 (0.45-0.97) for SVM. CONCLUSION This audio-based approach discriminates PD from healthy controls with moderate-high accuracy and separated individuals with less severe bradykinesia from those with severe bradykinesia. Sound analysis may contribute to the identification and monitoring of bradykinesia.
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Affiliation(s)
- Debbie de Graaf
- Radboud University Medical Center, Donders Institute for Brain, Cognition and Behavior, Department of Neurology, Center of Expertise for Parkinson & Movement Disorders, Nijmegen, the Netherlands.
| | - Rui Araújo
- Department of Neurology, Centro Hospitalar Universitário São João, Department of Clinical Neurosciences and Mental Health, Faculty of Medicine, University of Porto, Porto, Portugal
| | | | - Koos Zwinderman
- Academic Medical Center, Department of Cardiology, P.O. Box 22660, 1100 DD, Amsterdam, the Netherlands
| | - Nienke M de Vries
- Radboud University Medical Center, Donders Institute for Brain, Cognition and Behavior, Department of Neurology, Center of Expertise for Parkinson & Movement Disorders, Nijmegen, the Netherlands
| | - Joanna IntHout
- Radboud University Medical Center, Department for Health Evidence Nijmegen, the Netherlands
| | - Bastiaan R Bloem
- Radboud University Medical Center, Donders Institute for Brain, Cognition and Behavior, Department of Neurology, Center of Expertise for Parkinson & Movement Disorders, Nijmegen, the Netherlands
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24
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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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25
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Hayasaka S, Hatori K, Nojiri S, Hatano T, Urabe T, Hayashi A, Hattori N, Fujiwara T. Novel characteristics of the temporal transition to maximum tongue pressure in Parkinson's disease: A pilot study. Clin Park Relat Disord 2024; 10:100244. [PMID: 38440206 PMCID: PMC10909619 DOI: 10.1016/j.prdoa.2024.100244] [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: 12/09/2022] [Revised: 07/31/2023] [Accepted: 11/19/2023] [Indexed: 03/06/2024] Open
Abstract
Introduction The reason why maximum tongue pressure (MTP) decreases in patients with Parkinson's disease (PD) remains unclear. Repeated measurements of isometric force and MTP may be useful for analyzing muscle wasting and force generation. The purpose of this pilot study was to evaluate the clinical characteristics and temporal transition of MTP in PD and normal control (NC) groups. Methods There were 18 participants in this study: 10 with PD and 8 NCs. The MTP was measured 20 times at regular intervals. The area under the curve of MTP temporal transitions, time to reach MTP, and total transition time of the tongue pressure (time to return to baseline) were compared between the groups. Results MTP decreased from baseline in PD subjects. Unlike NCs, PD subjects showed diverse and inconsistent temporal transitions. The decrease in MTP and delays in time to reach MTP and time to return to baseline were significantly greater in PD subjects (p < 0.05), while there was no group difference in area under the curve values. According to repeated-measures ANOVA, MTP was not different over time between PD subjects and NCs. Conclusion In this study, muscle fatigue did not affect the decrease in MTP seen in PD subjects, or the diversity and inconsistency of the temporal transition in MTP in that group. These findings indicate that the motor control needed for the repeated, identical movements associated with MTP generation may be impaired in PD patients.
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Affiliation(s)
- Sachi Hayasaka
- Department of Rehabilitation Medicine, Juntendo University Urayasu Hospital, Tomioka 2-1-1, Urayasu-shi, Chiba 279-0021, Japan
| | - Kozo Hatori
- Department of Rehabilitation Medicine, Juntendo University Urayasu Hospital, Tomioka 2-1-1, Urayasu-shi, Chiba 279-0021, Japan
- Department of Rehabilitation Medicine, Juntendo University Graduate School, Hongo 3-1-3, Bunkyo-ku, Tokyo 113-8431, Japan
| | - Shuko Nojiri
- Medical Technology Innovation Center, Juntendo University, Hongo 3-1-3, Bunkyo-ku, Tokyo 113-8431, Japan
| | - Taku Hatano
- Department of Neurology, Juntendo University Faculty of Medicine, Hongo 3-1-3, Bunkyo-ku, Tokyo 113-8431, Japan
| | - Takao Urabe
- Department of Neurology, Juntendo University Urayasu Hospital, Hongo 3-1-3, Bunkyo-ku, Tokyo 113-8431, Japan
| | - Akito Hayashi
- Department of Rehabilitation Medicine, Juntendo University Urayasu Hospital, Tomioka 2-1-1, Urayasu-shi, Chiba 279-0021, Japan
| | - Nobutaka Hattori
- Department of Neurology, Juntendo University Faculty of Medicine, Hongo 3-1-3, Bunkyo-ku, Tokyo 113-8431, Japan
| | - Toshiyuki Fujiwara
- Department of Rehabilitation Medicine, Juntendo University Graduate School, Hongo 3-1-3, Bunkyo-ku, Tokyo 113-8431, Japan
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Reinshagen A. Grid cells: the missing link in understanding Parkinson's disease? Front Neurosci 2024; 18:1276714. [PMID: 38389787 PMCID: PMC10881698 DOI: 10.3389/fnins.2024.1276714] [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: 08/12/2023] [Accepted: 01/24/2024] [Indexed: 02/24/2024] Open
Abstract
The mechanisms underlying Parkinson's disease (PD) are complex and not fully understood, and the box-and-arrow model among other current models present significant challenges. This paper explores the potential role of the allocentric brain and especially its grid cells in several PD motor symptoms, including bradykinesia, kinesia paradoxa, freezing of gait, the bottleneck phenomenon, and their dependency on cueing. It is argued that central hubs, like the locus coeruleus and the pedunculopontine nucleus, often narrowly interpreted in the context of PD, play an equally important role in governing the allocentric brain as the basal ganglia. Consequently, the motor and secondary motor (e.g., spatially related) symptoms of PD linked with dopamine depletion may be more closely tied to erroneous computation by grid cells than to the basal ganglia alone. Because grid cells and their associated central hubs introduce both spatial and temporal information to the brain influencing velocity perception they may cause bradykinesia or hyperkinesia as well. In summary, PD motor symptoms may primarily be an allocentric disturbance resulting from virtual faulty computation by grid cells revealed by dopamine depletion in PD.
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Dominik T, Mele A, Schurger A, Maoz U. Libet's legacy: A primer to the neuroscience of volition. Neurosci Biobehav Rev 2024; 157:105503. [PMID: 38072144 DOI: 10.1016/j.neubiorev.2023.105503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 11/09/2023] [Accepted: 12/04/2023] [Indexed: 12/23/2023]
Abstract
The neuroscience of volition is an emerging subfield of the brain sciences, with hundreds of papers on the role of consciousness in action formation published each year. This makes the state-of-the-art in the discipline poorly accessible to newcomers and difficult to follow even for experts in the field. Here we provide a comprehensive summary of research in this field since its inception that will be useful to both groups. We also discuss important ideas that have received little coverage in the literature so far. We systematically reviewed a set of 2220 publications, with detailed consideration of almost 500 of the most relevant papers. We provide a thorough introduction to the seminal work of Benjamin Libet from the 1960s to 1980s. We also discuss common criticisms of Libet's method, including temporal introspection, the interpretation of the assumed physiological correlates of volition, and various conceptual issues. We conclude with recent advances and potential future directions in the field, highlighting modern methodological approaches to volition, as well as important recent findings.
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Affiliation(s)
| | - Alfred Mele
- Department of Philosophy, Florida State University, FL, USA
| | | | - Uri Maoz
- Brain Institute, Chapman University, CA, USA
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Rahayel S, Postuma R, Baril AA, Misic B, Pelletier A, Soucy JP, Montplaisir J, Dagher A, Gagnon JF. 99mTc-HMPAO SPECT Perfusion Signatures Associated With Clinical Progression in Patients With Isolated REM Sleep Behavior Disorder. Neurology 2024; 102:e208015. [PMID: 38315966 PMCID: PMC10890831 DOI: 10.1212/wnl.0000000000208015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 10/03/2023] [Indexed: 02/07/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Idiopathic/isolated REM sleep behavior disorder (iRBD) is associated with dementia with Lewy bodies and Parkinson disease. Despite evidence of abnormal cerebral perfusion in iRBD, there is currently no pattern that can predict whether an individual will develop dementia with Lewy bodies or Parkinson disease. The objective was to identify a perfusion signature associated with conversion to dementia with Lewy bodies in iRBD. METHODS Patients with iRBD underwent video-polysomnography, neurologic and neuropsychological assessments, and baseline 99mTc-HMPAO SPECT to assess relative cerebral blood flow. Partial least squares correlation was used to identify latent variables that maximized covariance between 27 clinical features and relative gray matter perfusion. Patient-specific scores on the latent variables were used to test the association with conversion to dementia with Lewy bodies compared with that with Parkinson disease. The signature's expression was also assessed in 24 patients with iRBD who underwent a second perfusion scan, 22 healthy controls, and 19 individuals with Parkinson disease. RESULTS Of the 137 participants, 93 underwent SPECT processing, namely 52 patients with iRBD (67.9 years, 73% men), 19 patients with Parkinson disease (67.3 years, 37% men), and 22 controls (67.0 years, 73% men). Of the 47 patients with iRBD followed up longitudinally (4.5 years), 12 (26%) developed a manifest synucleinopathy (4 dementia with Lewy bodies and 8 Parkinson disease). Analysis revealed 2 latent variables between relative blood flow and clinical features: the first was associated with a broad set of features that included motor, cognitive, and perceptual variables, age, and sex; the second was mostly associated with cognitive features and RBD duration. When brought back into the patient's space, the expression of the first variable was associated with conversion to a manifest synucleinopathy, whereas the second was associated with conversion to dementia with Lewy bodies. The expression of the patterns changed over time and was associated with worse motor features. DISCUSSION This study identified a brain perfusion signature associated with cognitive impairment in iRBD and transition to dementia with Lewy bodies. This signature, which can be derived from individual scans, has the potential to be developed into a biomarker that predicts dementia with Lewy bodies in at-risk individuals.
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Affiliation(s)
- Shady Rahayel
- From the Department of Medicine (S.R., A.-A.B.), University of Montreal; Centre for Advanced Research in Sleep Medicine (S.R., R.P., A.-A.B., A.P., J.M., J.-F.G.), CIUSSS-NÎM - Hôpital du Sacré-Cœur de Montréal; Department of Neurology (R.P., A.P.), Montreal General Hospital; The Neuro (Montreal Neurological Institute-Hospital) (B.M., J.-P.S., A.D.), McGill University; Department of Psychiatry (J.M.), University of Montreal; and Department of Psychology (J.-F.G.), Université du Québec à Montréal, Canada
| | - Ronald Postuma
- From the Department of Medicine (S.R., A.-A.B.), University of Montreal; Centre for Advanced Research in Sleep Medicine (S.R., R.P., A.-A.B., A.P., J.M., J.-F.G.), CIUSSS-NÎM - Hôpital du Sacré-Cœur de Montréal; Department of Neurology (R.P., A.P.), Montreal General Hospital; The Neuro (Montreal Neurological Institute-Hospital) (B.M., J.-P.S., A.D.), McGill University; Department of Psychiatry (J.M.), University of Montreal; and Department of Psychology (J.-F.G.), Université du Québec à Montréal, Canada
| | - Andrée-Ann Baril
- From the Department of Medicine (S.R., A.-A.B.), University of Montreal; Centre for Advanced Research in Sleep Medicine (S.R., R.P., A.-A.B., A.P., J.M., J.-F.G.), CIUSSS-NÎM - Hôpital du Sacré-Cœur de Montréal; Department of Neurology (R.P., A.P.), Montreal General Hospital; The Neuro (Montreal Neurological Institute-Hospital) (B.M., J.-P.S., A.D.), McGill University; Department of Psychiatry (J.M.), University of Montreal; and Department of Psychology (J.-F.G.), Université du Québec à Montréal, Canada
| | - Bratislav Misic
- From the Department of Medicine (S.R., A.-A.B.), University of Montreal; Centre for Advanced Research in Sleep Medicine (S.R., R.P., A.-A.B., A.P., J.M., J.-F.G.), CIUSSS-NÎM - Hôpital du Sacré-Cœur de Montréal; Department of Neurology (R.P., A.P.), Montreal General Hospital; The Neuro (Montreal Neurological Institute-Hospital) (B.M., J.-P.S., A.D.), McGill University; Department of Psychiatry (J.M.), University of Montreal; and Department of Psychology (J.-F.G.), Université du Québec à Montréal, Canada
| | - Amélie Pelletier
- From the Department of Medicine (S.R., A.-A.B.), University of Montreal; Centre for Advanced Research in Sleep Medicine (S.R., R.P., A.-A.B., A.P., J.M., J.-F.G.), CIUSSS-NÎM - Hôpital du Sacré-Cœur de Montréal; Department of Neurology (R.P., A.P.), Montreal General Hospital; The Neuro (Montreal Neurological Institute-Hospital) (B.M., J.-P.S., A.D.), McGill University; Department of Psychiatry (J.M.), University of Montreal; and Department of Psychology (J.-F.G.), Université du Québec à Montréal, Canada
| | - Jean-Paul Soucy
- From the Department of Medicine (S.R., A.-A.B.), University of Montreal; Centre for Advanced Research in Sleep Medicine (S.R., R.P., A.-A.B., A.P., J.M., J.-F.G.), CIUSSS-NÎM - Hôpital du Sacré-Cœur de Montréal; Department of Neurology (R.P., A.P.), Montreal General Hospital; The Neuro (Montreal Neurological Institute-Hospital) (B.M., J.-P.S., A.D.), McGill University; Department of Psychiatry (J.M.), University of Montreal; and Department of Psychology (J.-F.G.), Université du Québec à Montréal, Canada
| | - Jacques Montplaisir
- From the Department of Medicine (S.R., A.-A.B.), University of Montreal; Centre for Advanced Research in Sleep Medicine (S.R., R.P., A.-A.B., A.P., J.M., J.-F.G.), CIUSSS-NÎM - Hôpital du Sacré-Cœur de Montréal; Department of Neurology (R.P., A.P.), Montreal General Hospital; The Neuro (Montreal Neurological Institute-Hospital) (B.M., J.-P.S., A.D.), McGill University; Department of Psychiatry (J.M.), University of Montreal; and Department of Psychology (J.-F.G.), Université du Québec à Montréal, Canada
| | - Alain Dagher
- From the Department of Medicine (S.R., A.-A.B.), University of Montreal; Centre for Advanced Research in Sleep Medicine (S.R., R.P., A.-A.B., A.P., J.M., J.-F.G.), CIUSSS-NÎM - Hôpital du Sacré-Cœur de Montréal; Department of Neurology (R.P., A.P.), Montreal General Hospital; The Neuro (Montreal Neurological Institute-Hospital) (B.M., J.-P.S., A.D.), McGill University; Department of Psychiatry (J.M.), University of Montreal; and Department of Psychology (J.-F.G.), Université du Québec à Montréal, Canada
| | - Jean-François Gagnon
- From the Department of Medicine (S.R., A.-A.B.), University of Montreal; Centre for Advanced Research in Sleep Medicine (S.R., R.P., A.-A.B., A.P., J.M., J.-F.G.), CIUSSS-NÎM - Hôpital du Sacré-Cœur de Montréal; Department of Neurology (R.P., A.P.), Montreal General Hospital; The Neuro (Montreal Neurological Institute-Hospital) (B.M., J.-P.S., A.D.), McGill University; Department of Psychiatry (J.M.), University of Montreal; and Department of Psychology (J.-F.G.), Université du Québec à Montréal, Canada
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Gelman K, Melott J, Thakur V, Tarabishy AR, Brandt A, Konrad P, Ranjan M, Memon AA. MR-guided focused ultrasound thalamotomy for lithium-induced tremor: a case report and literature review. Front Neurol 2024; 14:1331241. [PMID: 38362012 PMCID: PMC10867204 DOI: 10.3389/fneur.2023.1331241] [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: 12/19/2023] [Indexed: 02/17/2024] Open
Abstract
Drug-induced tremor is a common side effect of lithium with an occurrence of approximately 25% of patients. Cessation of the offending drug can be difficult, and many medical treatments for drug-induced tremor are ineffective. Deep brain stimulation (DBS) has been shown in a limited number of case reports to effectively reduce drug-induced tremor, however, which remains an invasive therapeutic option. MR-guided focused ultrasound (MRgFUS) thalamotomy is an FDA-approved non-invasive treatment for essential tremor (ET). To the best of our knowledge, MRgFUS thalamotomy has never been reported to treat drug-induced tremor. Here, we present a case of a left-handed 55-year-old man with a progressive, medically refractory lithium-induced tremor of the bilateral upper extremities. The patient underwent MRgFUS thalamotomy targeting the right ventral intermediate nucleus (VIM) of the thalamus to treat the left hand. There was almost complete resolution of his left-hand tremor immediately following MRgFUS. There were no side effects. The patient continues to show excellent tremor control at 90-day follow-up and remains free from side effects. This case demonstrates MRgFUS thalamotomy as a possible novel treatment option to treat drug-induced tremor.
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Affiliation(s)
- Kate Gelman
- School of Medicine, West Virginia University, Morgantown, WV, United States
| | - Joseph Melott
- School of Medicine, West Virginia University, Morgantown, WV, United States
| | - Vishal Thakur
- Department of Neurosurgery, Rockefeller Neuroscience Institute, West Virginia University, Morgantown, WV, United States
| | - Abdul R. Tarabishy
- School of Medicine, West Virginia University, Morgantown, WV, United States
- Department of Neuroradiology, Rockefeller Neuroscience Institute, West Virginia University, Morgantown, WV, United States
| | - Ana Brandt
- Department of Neurosurgery, Rockefeller Neuroscience Institute, West Virginia University, Morgantown, WV, United States
| | - Peter Konrad
- Department of Neurosurgery, Rockefeller Neuroscience Institute, West Virginia University, Morgantown, WV, United States
| | - Manish Ranjan
- Department of Neurosurgery, Rockefeller Neuroscience Institute, West Virginia University, Morgantown, WV, United States
| | - Adeel A. Memon
- Department of Neurology, Rockefeller Neuroscience Institute, West Virginia University, Morgantown, WV, United States
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Paparella G, De Riggi M, Cannavacciuolo A, Costa D, Birreci D, Passaretti M, Angelini L, Colella D, Guerra A, Berardelli A, Bologna M. Interhemispheric imbalance and bradykinesia features in Parkinson's disease. Brain Commun 2024; 6:fcae020. [PMID: 38370448 PMCID: PMC10873583 DOI: 10.1093/braincomms/fcae020] [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: 09/12/2023] [Revised: 12/14/2023] [Accepted: 01/25/2024] [Indexed: 02/20/2024] Open
Abstract
In patients with Parkinson's disease, the connectivity between the two primary motor cortices may be altered. However, the correlation between asymmetries of abnormal interhemispheric connections and bradykinesia features has not been investigated. Furthermore, the potential effects of dopaminergic medications on this issue remain largely unclear. The aim of the present study is to investigate the interhemispheric connections in Parkinson's disease by transcranial magnetic stimulation and explore the potential relationship between interhemispheric inhibition and bradykinesia feature asymmetry in patients. Additionally, we examined the impact of dopaminergic therapy on neurophysiological and motor characteristics. Short- and long-latency interhemispheric inhibition was measured in 18 Parkinson's disease patients and 18 healthy controls, bilaterally. We also assessed the corticospinal and intracortical excitability of both primary motor cortices. We conducted an objective analysis of finger-tapping from both hands. Correlation analyses were performed to explore potential relationships among clinical, transcranial magnetic stimulation and kinematic data in patients. We found that short- and long-latency interhemispheric inhibition was reduced (less inhibition) from both hemispheres in patients than controls. Compared to controls, finger-tapping movements in patients were slower, more irregular, of smaller amplitudes and characterized by a progressive amplitude reduction during movement repetition (sequence effect). Among Parkinson's disease patients, the degree of short-latency interhemispheric inhibition imbalance towards the less affected primary motor cortex correlated with the global clinical motor scores, as well as with the sequence effect on the most affected hand. The greater the interhemispheric inhibition imbalance towards the less affected hemisphere (i.e. less inhibition from the less to the most affected primary motor cortex than that measured from the most to the less affected primary motor cortex), the more severe the bradykinesia in patients. In conclusion, the inhibitory connections between the two primary motor cortices in Parkinson's disease are reduced. The interhemispheric disinhibition of the primary motor cortex may have a role in the pathophysiology of specific bradykinesia features in patients, i.e. the sequence effect.
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Affiliation(s)
- Giulia Paparella
- IRCCS Neuromed, Pozzilli, IS 86077, Italy
- Department of Human Neurosciences, Sapienza, University of Rome, Rome 00185, Italy
| | - Martina De Riggi
- Department of Human Neurosciences, Sapienza, University of Rome, Rome 00185, Italy
| | | | - Davide Costa
- Department of Human Neurosciences, Sapienza, University of Rome, Rome 00185, Italy
| | - Daniele Birreci
- Department of Human Neurosciences, Sapienza, University of Rome, Rome 00185, Italy
| | | | | | - Donato Colella
- Department of Human Neurosciences, Sapienza, University of Rome, Rome 00185, Italy
| | - Andrea Guerra
- Parkinson and Movement Disorders Unit, Study Center for Neurodegeneration (CESNE), Department of Neuroscience, University of Padua, Padua 35121, Italy
- Padova Neuroscience Center (PNC), University of Padua, Padua 35131, Italy
| | - Alfredo Berardelli
- IRCCS Neuromed, Pozzilli, IS 86077, Italy
- Department of Human Neurosciences, Sapienza, University of Rome, Rome 00185, Italy
| | - Matteo Bologna
- IRCCS Neuromed, Pozzilli, IS 86077, Italy
- Department of Human Neurosciences, Sapienza, University of Rome, Rome 00185, Italy
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Bianchini E, Rinaldi D, Alborghetti M, Simonelli M, D’Audino F, Onelli C, Pegolo E, Pontieri FE. The Story behind the Mask: A Narrative Review on Hypomimia in Parkinson's Disease. Brain Sci 2024; 14:109. [PMID: 38275529 PMCID: PMC10814039 DOI: 10.3390/brainsci14010109] [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: 12/04/2023] [Revised: 01/18/2024] [Accepted: 01/19/2024] [Indexed: 01/27/2024] Open
Abstract
Facial movements are crucial for social and emotional interaction and well-being. Reduced facial expressions (i.e., hypomimia) is a common feature in patients with Parkinson's disease (PD) and previous studies linked this manifestation to both motor symptoms of the disease and altered emotion recognition and processing. Nevertheless, research on facial motor impairment in PD has been rather scarce and only a limited number of clinical evaluation tools are available, often suffering from poor validation processes and high inter- and intra-rater variability. In recent years, the availability of technology-enhanced quantification methods of facial movements, such as automated video analysis and machine learning application, led to increasing interest in studying hypomimia in PD. In this narrative review, we summarize the current knowledge on pathophysiological hypotheses at the basis of hypomimia in PD, with particular focus on the association between reduced facial expressions and emotional processing and analyze the current evaluation tools and management strategies for this symptom, as well as future research perspectives.
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Affiliation(s)
- Edoardo Bianchini
- Department of Neuroscience, Mental Health and Sensory Organs (NESMOS), Sapienza University of Rome, 00189 Rome, Italy; (E.B.); (D.R.); (M.A.); (M.S.)
- AGEIS, Université Grenoble Alpes, 38000 Grenoble, France
- Sant’Andrea University Hospital, 00189 Rome, Italy;
| | - Domiziana Rinaldi
- Department of Neuroscience, Mental Health and Sensory Organs (NESMOS), Sapienza University of Rome, 00189 Rome, Italy; (E.B.); (D.R.); (M.A.); (M.S.)
- Sant’Andrea University Hospital, 00189 Rome, Italy;
| | - Marika Alborghetti
- Department of Neuroscience, Mental Health and Sensory Organs (NESMOS), Sapienza University of Rome, 00189 Rome, Italy; (E.B.); (D.R.); (M.A.); (M.S.)
- Sant’Andrea University Hospital, 00189 Rome, Italy;
| | - Marta Simonelli
- Department of Neuroscience, Mental Health and Sensory Organs (NESMOS), Sapienza University of Rome, 00189 Rome, Italy; (E.B.); (D.R.); (M.A.); (M.S.)
- Ospedale dei Castelli, ASL Rome 6, 00040 Ariccia, Italy
| | | | - Camilla Onelli
- Department of Molecular Medicine, University of Padova, 35121 Padova, Italy;
| | - Elena Pegolo
- Department of Information Engineering, University of Padova, 35131 Padova, Italy;
| | - Francesco E. Pontieri
- Department of Neuroscience, Mental Health and Sensory Organs (NESMOS), Sapienza University of Rome, 00189 Rome, Italy; (E.B.); (D.R.); (M.A.); (M.S.)
- Sant’Andrea University Hospital, 00189 Rome, Italy;
- Fondazione Santa Lucia IRCCS, 00179 Rome, Italy
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Yu X, Jia Y, Dong Y. Research progress on the cannabinoid type-2 receptor and Parkinson's disease. Front Aging Neurosci 2024; 15:1298166. [PMID: 38264546 PMCID: PMC10804458 DOI: 10.3389/fnagi.2023.1298166] [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: 09/21/2023] [Accepted: 12/18/2023] [Indexed: 01/25/2024] Open
Abstract
Parkinson's disease (PD) is featured by movement impairments, including tremors, bradykinesia, muscle stiffness, and imbalance. PD is also associated with many non-motor symptoms, such as cognitive impairments, dementia, and mental disorders. Previous studies identify the associations between PD progression and factors such as α-synuclein aggregation, mitochondrial dysfunction, inflammation, and cell death. The cannabinoid type-2 receptor (CB2 receptor) is a transmembrane G-protein-coupled receptor and has been extensively studied as part of the endocannabinoid system. CB2 receptor is recently emerged as a promising target for anti-inflammatory treatment for neurodegenerative diseases. It is reported to modulate mitochondrial function, oxidative stress, iron transport, and neuroinflammation that contribute to neuronal cell death. Additionally, CB2 receptor possesses the potential to provide feedback on electrophysiological processes, offering new possibilities for PD treatment. This review summarized the mechanisms underlying PD pathogenesis. We also discussed the potential regulatory role played by CB2 receptor in PD.
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Affiliation(s)
- Xiaoqi Yu
- Neuropsychiatry Research Institute, The Affiliated Hospital of Qingdao University, Qingdao University, Qingdao, China
- School of Basic Medical Sciences, Qingdao University, Qingdao, China
| | - Yi Jia
- School of Basic Medical Sciences, Qingdao University, Qingdao, China
| | - Yuan Dong
- Neuropsychiatry Research Institute, The Affiliated Hospital of Qingdao University, Qingdao University, Qingdao, China
- School of Basic Medical Sciences, Qingdao University, Qingdao, China
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Wikeley S, Bacon I, Greer O, Evans M, Hasan R, Pathak S. New-onset movement disorder in the immediate postpartum period. BMJ Case Rep 2023; 16:e254132. [PMID: 38154870 PMCID: PMC10759129 DOI: 10.1136/bcr-2022-254132] [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] [Indexed: 12/30/2023] Open
Abstract
This case report describes a woman who developed involuntary, uncoordinated movements of her face and limbs following a spontaneous vaginal delivery, complicated by postpartum haemorrhage. Using systematic assessment with multidisciplinary team input, a differential diagnosis was proposed and relevant investigations were undertaken. Atypical eclamptic or generalised seizures were excluded clinically and neuroimaging ruled out an intracranial vascular event such as stroke or venous sinus thrombosis. Local anaesthetic systemic toxicity was managed empirically with intravenous lipid emulsion and intravenous fluids. A diagnosis of drug-induced dyskinesia was made, most likely secondary to ondansetron, with which dystonias and myoclonus have been described. This woman's symptoms were transient and resolved within 2 hours.This case presented a complex differential diagnosis, highlighting the paucity of guidance available. We propose a diagnostic algorithm to aid in the identification of acute involuntary movements in pregnancy and the puerperium.
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Affiliation(s)
- Sarah Wikeley
- Rookery Medical Centre, Royal College of General Practitioners, Newmarket, Suffolk, UK
| | - Imogen Bacon
- Department of Obstetrics & Gynaecology, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Orene Greer
- Department of Obstetrics & Gynaecology, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
- Division of Reproductive and Developmental Biology, Department of Metabolism, Digestion and Reproduction, Faculty of Medicine, Imperial College London, London, UK
| | - Matthew Evans
- Department of Neurology, Imperial College Healthcare NHS Trust, London, UK
| | - Rizwan Hasan
- Department of Anaesthetics, Hinchingbrooke Hospital, North West Anglia NHS Foundation Trust, Hinchingbrooke Park, Huntingdon, Cambridgeshire, UK
| | - Sangeeta Pathak
- Department of Obstetrics & Gynaecology, Hinchingbrooke Hospital, North West Anglia NHS Foundation Trust, Hinchingbrooke Park, Huntingdon, Cambridgeshire, UK
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Conti M, Guerra A, Pierantozzi M, Bovenzi R, D'Onofrio V, Simonetta C, Cerroni R, Liguori C, Placidi F, Mercuri NB, Di Giuliano F, Schirinzi T, Stefani A. Band-Specific Altered Cortical Connectivity in Early Parkinson's Disease and its Clinical Correlates. Mov Disord 2023; 38:2197-2208. [PMID: 37860930 DOI: 10.1002/mds.29615] [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: 05/03/2023] [Revised: 08/25/2023] [Accepted: 09/11/2023] [Indexed: 10/21/2023] Open
Abstract
BACKGROUND Functional connectivity (FC) has shown promising results in assessing the pathophysiology and identifying early biomarkers of neurodegenerative disorders, such as Parkinson's disease (PD). OBJECTIVES In this study, we aimed to assess possible resting-state FC abnormalities in early-stage PD patients using high-density electroencephalography (EEG) and to detect their clinical relationship with motor and non-motor PD symptoms. METHODS We enrolled 26 early-stage levodopa naïve PD patients and a group of 20 healthy controls (HC). Data were recorded with 64-channels EEG system and a source-reconstruction method was used to identify brain-region activity. FC was calculated using the weighted phase-lag index in θ, α, and β bands. Additionally, we quantified the unbalancing between β and lower frequencies through a novel index (β-functional ratio [FR]). Statistical analysis was conducted using a network-based statistical approach. RESULTS PD patients showed hypoconnected networks in θ and α band, involving prefrontal-limbic-temporal and frontoparietal areas, respectively, and a hyperconnected network in the β frequency band, involving sensorimotor-frontal areas. The θ FC network was negatively related to Non-Motor Symptoms Scale scores and α FC to the Movement Disorder Society-Sponsored Revision of the Unified Parkinson's Disease Rating Scale part III gait subscore, whereas β FC and β-FR network were positively linked to the bradykinesia subscore. Changes in θ FC and β-FR showed substantial reliability and high accuracy, precision, sensitivity, and specificity in discriminating PD and HC. CONCLUSIONS Frequency-specific FC changes in PD likely reflect the dysfunction of distinct cortical networks, which occur from the early stage of the disease. These abnormalities are involved in the pathophysiology of specific motor and non-motor PD symptoms, including gait, bradykinesia, mood, and cognition. © 2023 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Matteo Conti
- Parkinson Centre, Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy
| | - Andrea Guerra
- Parkinson and Movement Disorders Unit, Study Centre on Neurodegeneration (CESNE), Department of Neuroscience, University of Padova, Padua, Italy
| | - Mariangela Pierantozzi
- Parkinson Centre, Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy
- Neurology Unit, Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy
| | - Roberta Bovenzi
- Parkinson Centre, Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy
| | - Valentina D'Onofrio
- Parkinson and Movement Disorders Unit, Study Centre on Neurodegeneration (CESNE), Department of Neuroscience, University of Padova, Padua, Italy
| | - Clara Simonetta
- Neurology Unit, Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy
| | - Rocco Cerroni
- Parkinson Centre, Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy
| | - Claudio Liguori
- Neurology Unit, Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy
| | - Fabio Placidi
- Neurology Unit, Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy
| | - Nicola Biagio Mercuri
- Neurology Unit, Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy
| | - Francesca Di Giuliano
- Neuroradiology Unit, Department of Biomedicine and Prevention, University of Rome "Tor Vergata", Rome, Italy
| | - Tommaso Schirinzi
- Neurology Unit, Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy
| | - Alessandro Stefani
- Parkinson Centre, Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy
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Bologna M, Guerra A. Further insight into the role of primary motor cortex in bradykinesia pathophysiology. Clin Neurophysiol 2023; 155:94-96. [PMID: 37679198 DOI: 10.1016/j.clinph.2023.08.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Accepted: 08/24/2023] [Indexed: 09/09/2023]
Affiliation(s)
- Matteo Bologna
- Department of Human Neurosciences, Sapienza University of Rome, Italy IRCCS Neuromed Pozzilli (IS), Italy.
| | - Andrea Guerra
- Parkinson and Movement Disorder Unit, Study Center on Neurodegeneration (CESNE), Department of Neuroscience, University of Padua, Padua, Italy
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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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Xie L, Hong R, Wu Z, Yue L, Peng K, Li S, Zhang J, Wang X, Jin L, Guan Q. Kinect-based objective assessment for early frailty identification in patients with Parkinson's disease. Aging Clin Exp Res 2023; 35:2507-2516. [PMID: 37639172 DOI: 10.1007/s40520-023-02525-5] [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: 04/09/2023] [Accepted: 07/31/2023] [Indexed: 08/29/2023]
Abstract
BACKGROUND Frailty is common in Parkinson's disease (PD) and increases vulnerability to adverse outcomes. Early detection of this syndrome aids in early intervention. AIMS To objectively identify frailty at an early stage during routine motor tasks in PD patients using a Kinect-based system. METHODS PD patients were recruited and assessed with the Fried criteria to determine their frailty status. Each participant was recorded performing the Movement Disorder Society-Sponsored Revision of the Unified Parkinson's Disease Rating Scale part III (MDS-UPDRS III) extremity tasks with a Kinect-based system. Statistically significant kinematic parameters were selected to discriminate the pre-frail from the non-frail group. RESULTS Of the fifty-two participants, twenty were non-frail and thirty-two were pre-frail. Decreased frequency in finger tapping (P = 0.005), hand grasping (P = 0.002), toe tapping (P = 0.002), and leg agility (P = 0.019) alongside reduced hand grasping speed (P = 0.030), lifting (P < 0.001) and falling speed (P < 0.001) in leg agility were observed in the pre-frail group. Amplitude in leg agility (P = 0.048) and amplitude decrement rate (P = 0.046) in hand grasping showed marginally significant differences between two groups. Moderate discriminative values were found in frequency and speed of the extremity tasks to identify pre-frailty with sensitivity, specificity, and area under the curve (AUC) in the range of 45.00-85.00%, 68.75-100%, and 0.701-0.836, respectively. The combination of frequency and speed in extremity tasks showed moderate to high discriminatory ability, with AUC of 0.775 (95% CI 0.637-0.913, P < 0.001) for upper limb tasks and 0.909 (95% CI 0.832-0.987, P < 0.001) for lower limb tasks. When combining these features in both upper and lower limb tasks, the AUC increased to 0.942 (95% CI 0.886-0.999, P < 0.001). CONCLUSIONS Our findings demonstrated the promise of utilizing Kinect-based kinematic data from MDS-UPDRS III tasks as early indicators of frailty in PD patients.
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Affiliation(s)
- Ludi Xie
- Department of Neurology, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Ronghua Hong
- Department of Neurology, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China
- Department of Neurology and Neurological Rehabilitation, Shanghai Yangzhi Rehabilitation Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Zhuang Wu
- Department of Neurology, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Lei Yue
- Department of Neurology, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Kangwen Peng
- Department of Neurology, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Shuangfang Li
- Department of Neurology, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Jingxing Zhang
- Department of Neurology, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Xijin Wang
- Department of Neurology, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Lingjing Jin
- Department of Neurology, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China.
- Department of Neurology and Neurological Rehabilitation, Shanghai Yangzhi Rehabilitation Hospital, School of Medicine, Tongji University, Shanghai, China.
- Shanghai Clinical Research Center for Aging and Medicine, Shanghai, China.
| | - Qiang Guan
- Department of Neurology, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China.
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Colella D, Passaretti M, Frantellizzi V, Silvia De Feo M, Cannavacciuolo A, Angelini L, Birreci D, Costa D, Paparella G, Guerra A, De Vincentis G, Berardelli A, Bologna M. Subtle changes in central dopaminergic tone underlie bradykinesia in essential tremor. Neuroimage Clin 2023; 40:103526. [PMID: 37847966 PMCID: PMC10587600 DOI: 10.1016/j.nicl.2023.103526] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Revised: 09/25/2023] [Accepted: 10/09/2023] [Indexed: 10/19/2023]
Abstract
INTRODUCTION In this research, our primary objective was to explore the correlation between basal ganglia dopaminergic neurotransmission, assessed using 123I-FP-CIT (DAT-SPECT), and finger movements abnormalities in patients with essential tremor (ET) and Parkinson's disease (PD). METHODS We enrolled 16 patients with ET, 17 with PD, and 18 healthy controls (HC). Each participant underwent comprehensive clinical evaluations, kinematic assessments of finger tapping. ET and PD patients underwent DAT-SPECT imaging. The DAT-SPECT scans were subjected to both visual and semi-quantitative analysis using DaTQUANT®. We then investigated the correlations between the clinical, kinematic, and DAT-SPECT data, in patients. RESULTS Our findings confirm that individuals with ET exhibited slower finger tapping than HC. Visual evaluation of radiotracer uptake in both striata demonstrated normal levels within the ET patient cohort, while PD patients displayed reduced uptake. However, there was notable heterogeneity in the quantification of uptake within the striata among ET patients. Additionally, we found a correlation between the amount of radiotracer uptake in the striatum and movement velocity during finger tapping in patients. Specifically, lower radioligand uptake corresponded to decreased movement velocity (ET: coef. = 0.53, p-adj = 0.03; PD: coef. = 0.59, p-adj = 0.01). CONCLUSION The study's findings suggest a potential link between subtle changes in central dopaminergic tone and altered voluntary movement execution, in ET. These results provide further insights into the pathophysiology of ET. However, longitudinal studies are essential to determine whether the slight reduction in dopaminergic tone observed in ET patients represents a distinct subtype of the disease or could serve as a predictor for the clinical progression into PD.
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Affiliation(s)
- Donato Colella
- Department of Human Neurosciences, Sapienza University of Rome, Italy
| | - Massimiliano Passaretti
- Department of Human Neurosciences, Sapienza University of Rome, Italy; Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Viviana Frantellizzi
- Department of Radiological Sciences, Oncology and Anatomical Pathology, Sapienza University of Rome, Italy
| | - Maria Silvia De Feo
- Department of Radiological Sciences, Oncology and Anatomical Pathology, Sapienza University of Rome, Italy
| | | | - Luca Angelini
- Department of Human Neurosciences, Sapienza University of Rome, Italy
| | - Daniele Birreci
- Department of Human Neurosciences, Sapienza University of Rome, Italy
| | - Davide Costa
- Department of Human Neurosciences, Sapienza University of Rome, Italy
| | - Giulia Paparella
- Department of Human Neurosciences, Sapienza University of Rome, Italy; IRCCS Neuromed Pozzilli (IS), Italy
| | - Andrea Guerra
- Parkinson and Movement Disorder Unit, Study Center on Neurodegeneration (CESNE), Department of Neuroscience, University of Padua, Padua, Italy
| | - Giuseppe De Vincentis
- Department of Radiological Sciences, Oncology and Anatomical Pathology, Sapienza University of Rome, Italy
| | - Alfredo Berardelli
- Department of Human Neurosciences, Sapienza University of Rome, Italy; IRCCS Neuromed Pozzilli (IS), Italy
| | - Matteo Bologna
- Department of Human Neurosciences, Sapienza University of Rome, Italy; IRCCS Neuromed Pozzilli (IS), Italy.
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Munoz MJ, Arora R, Rivera YM, Drane QH, Pal GD, Verhagen Metman L, Sani SB, Rosenow JM, Goelz LC, Corcos DM, David FJ. Medication only improves limb movements while deep brain stimulation improves eye and limb movements during visually-guided reaching in Parkinson's disease. Front Hum Neurosci 2023; 17:1224611. [PMID: 37850040 PMCID: PMC10577235 DOI: 10.3389/fnhum.2023.1224611] [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: 05/17/2023] [Accepted: 09/18/2023] [Indexed: 10/19/2023] Open
Abstract
Background Antiparkinson medication and subthalamic nucleus deep brain stimulation (STN-DBS), two common treatments of Parkinson's disease (PD), effectively improve skeletomotor movements. However, evidence suggests that these treatments may have differential effects on eye and limb movements, although both movement types are controlled through the parallel basal ganglia loops. Objective Using a task that requires both eye and upper limb movements, we aimed to determine the effects of medication and STN-DBS on eye and upper limb movement performance. Methods Participants performed a visually-guided reaching task. We collected eye and upper limb movement data from participants with PD who were tested both OFF and ON medication (n = 34) or both OFF and ON bilateral STN-DBS while OFF medication (n = 11). We also collected data from older adult healthy controls (n = 14). Results We found that medication increased saccade latency, while having no effect on reach reaction time (RT). Medication significantly decreased saccade peak velocity, while increasing reach peak velocity. We also found that bilateral STN-DBS significantly decreased saccade latency while having no effect on reach RT, and increased saccade and reach peak velocity. Finally, we found that there was a positive relationship between saccade latency and reach RT, which was unaffected by either treatment. Conclusion These findings show that medication worsens saccade performance and benefits reaching performance, while STN-DBS benefits both saccade and reaching performance. We explore what the differential beneficial and detrimental effects on eye and limb movements suggest about the potential physiological changes occurring due to treatment.
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Affiliation(s)
- Miranda J. Munoz
- Department of Physical Therapy and Human Movement Sciences, Northwestern University, Chicago, IL, United States
| | - Rishabh Arora
- Department of Physical Therapy and Human Movement Sciences, Northwestern University, Chicago, IL, United States
- USF Health Morsani College of Medicine, University of South Florida, Tampa, FL, United States
| | - Yessenia M. Rivera
- Department of Physical Therapy and Human Movement Sciences, Northwestern University, Chicago, IL, United States
| | - Quentin H. Drane
- Department of Physical Therapy and Human Movement Sciences, Northwestern University, Chicago, IL, United States
| | - Gian D. Pal
- Department of Neurology, Rutgers-Robert Wood Johnson Medical School, New Brunswick, NJ, United States
- Department of Neurological Sciences, Section of Parkinson Disease and Movement Disorders, Rush University Medical Center, Chicago, IL, United States
| | - Leo Verhagen Metman
- Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Sepehr B. Sani
- Department of Neurosurgery, Rush University Medical Center, Chicago, IL, United States
| | - Joshua M. Rosenow
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Lisa C. Goelz
- Department of Kinesiology and Nutrition, University of Illinois at Chicago, Chicago, IL, United States
| | - Daniel M. Corcos
- Department of Physical Therapy and Human Movement Sciences, Northwestern University, Chicago, IL, United States
| | - Fabian J. David
- Department of Physical Therapy and Human Movement Sciences, Northwestern University, Chicago, IL, United States
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Herz DM, Brown P. Moving, fast and slow: behavioural insights into bradykinesia in Parkinson's disease. Brain 2023; 146:3576-3586. [PMID: 36864683 PMCID: PMC10473574 DOI: 10.1093/brain/awad069] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 02/10/2023] [Accepted: 02/21/2023] [Indexed: 03/04/2023] Open
Abstract
The debilitating symptoms of Parkinson's disease, including the hallmark slowness of movement, termed bradykinesia, were described more than 100 years ago. Despite significant advances in elucidating the genetic, molecular and neurobiological changes in Parkinson's disease, it remains conceptually unclear exactly why patients with Parkinson's disease move slowly. To address this, we summarize behavioural observations of movement slowness in Parkinson's disease and discuss these findings in a behavioural framework of optimal control. In this framework, agents optimize the time it takes to gather and harvest rewards by adapting their movement vigour according to the reward that is at stake and the effort that needs to be expended. Thus, slow movements can be favourable when the reward is deemed unappealing or the movement very costly. While reduced reward sensitivity, which makes patients less inclined to work for reward, has been reported in Parkinson's disease, this appears to be related mainly to motivational deficits (apathy) rather than bradykinesia. Increased effort sensitivity has been proposed to underlie movement slowness in Parkinson's disease. However, careful behavioural observations of bradykinesia are inconsistent with abnormal computations of effort costs due to accuracy constraints or movement energetic expenditure. These inconsistencies can be resolved when considering that a general disability to switch between stable and dynamic movement states can contribute to an abnormal composite effort cost related to movement in Parkinson's disease. This can account for paradoxical observations such as the abnormally slow relaxation of isometric contractions or difficulties in halting a movement in Parkinson's disease, both of which increase movement energy expenditure. A sound understanding of the abnormal behavioural computations mediating motor impairment in Parkinson's disease will be vital for linking them to their underlying neural dynamics in distributed brain networks and for grounding future experimental studies in well-defined behavioural frameworks.
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Affiliation(s)
- Damian M Herz
- MRC Brain Network Dynamics Unit at the University of Oxford, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford OX1 3TH, UK
- Movement Disorders and Neurostimulation, Department of Neurology, Focus Program Translational Neuroscience (FTN), University Medical Center of the Johannes Gutenberg-University Mainz, 55131 Mainz, Germany
| | - Peter Brown
- MRC Brain Network Dynamics Unit at the University of Oxford, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford OX1 3TH, UK
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Bernardinis M, Atashzar SF, Jog MS, Patel RV. Visual velocity perception dysfunction in Parkinson's disease. Behav Brain Res 2023; 452:114490. [PMID: 37172741 DOI: 10.1016/j.bbr.2023.114490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 04/21/2023] [Accepted: 05/08/2023] [Indexed: 05/15/2023]
Abstract
OBJECTIVE Compared with motor deficits, sensory information processing in Parkinson's disease (PD) is relatively unexplored. While there is increasing interest in understanding the sensory manifestations of PD, the extent of sensory abnormality in PD has remained relatively unexplored. Furthermore, most investigations on the sensory aspects of PD involve motor aspects, causing confounding results. As sensory deficits often arise in early PD development stages, they present a potential technological target for diagnosis and disease monitoring that is affordable and accessible. Considering this, the current study's aim is to assess visual spatiotemporal perception independent of goal directed movements in PD by designing and using a scalable computational tool. METHODS A flexible 2-D virtual reality environment was created to evaluate various cases of visual perception. Using the tool, an experimental task quantifying the visual perception of velocity was tested on 37 individuals with PD and 17 age-matched control participants. RESULTS PD patients, both ON and OFF PD therapy, displayed perceptual impairments (p = 0.001 and p = 0.008, respectively) at slower tested velocity magnitudes. These impairments were even observed in early stages of PD (p = 0.015). CONCLUSION Visual velocity perception is impaired in PD patients, which suggests impairments in visual spatiotemporal processing occur in PD and provides a promising modality to be used with disease monitoring software. SIGNIFICANCE Visual velocity perception shows high sensitivity to PD at all stages of the disease. Dysfunction in visual velocity perception may contribute to observed motor dysfunction in PD.
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Affiliation(s)
- Matthew Bernardinis
- School of Biomedical Engineering, University of Western Ontario, 1151 Richmond Street North, London, Ontario N6A 5B9, Canada; Canadian Surgical Technologies & Advanced Robotics, 339 Windermere Road, London, Ontario N6A 5A5, Canada; London Movement Disorders Centre, 339 Windermere Road, London, Ontario N6A 5A5, Canada.
| | - S Farokh Atashzar
- Canadian Surgical Technologies & Advanced Robotics, 339 Windermere Road, London, Ontario N6A 5A5, Canada; Electrical & Computer Engineering, Mechanical and Aerospace Engineering, New York University, New York 10003, NY, United States
| | - Mandar S Jog
- School of Biomedical Engineering, University of Western Ontario, 1151 Richmond Street North, London, Ontario N6A 5B9, Canada; London Movement Disorders Centre, 339 Windermere Road, London, Ontario N6A 5A5, Canada; Department of Clinical Neurological Sciences, University of Western Ontario, 1151 Richmond Street, London, Ontario N6A 3K7, Canada; Department of Electrical & Computer Engineering, University of Western Ontario, 1151 Richmond Street North, London, Ontario N6A 5B9, Canada
| | - Rajni V Patel
- School of Biomedical Engineering, University of Western Ontario, 1151 Richmond Street North, London, Ontario N6A 5B9, Canada; Canadian Surgical Technologies & Advanced Robotics, 339 Windermere Road, London, Ontario N6A 5A5, Canada; Department of Clinical Neurological Sciences, University of Western Ontario, 1151 Richmond Street, London, Ontario N6A 3K7, Canada; Department of Electrical & Computer Engineering, University of Western Ontario, 1151 Richmond Street North, London, Ontario N6A 5B9, Canada
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Guerra A, D'Onofrio V, Ferreri F, Bologna M, Antonini A. Objective measurement versus clinician-based assessment for Parkinson's disease. Expert Rev Neurother 2023; 23:689-702. [PMID: 37366316 DOI: 10.1080/14737175.2023.2229954] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 06/18/2023] [Accepted: 06/22/2023] [Indexed: 06/28/2023]
Abstract
INTRODUCTION Although clinician-based assessment through standardized clinical rating scales is currently the gold standard for quantifying motor impairment in Parkinson's disease (PD), it is not without limitations, including intra- and inter-rater variability and a degree of approximation. There is increasing evidence supporting the use of objective motion analyses to complement clinician-based assessment. Objective measurement tools hold significant potential for improving the accuracy of clinical and research-based evaluations of patients. AREAS COVERED The authors provide several examples from the literature demonstrating how different motion measurement tools, including optoelectronics, contactless and wearable systems allow for both the objective quantification and monitoring of key motor symptoms (such as bradykinesia, rigidity, tremor, and gait disturbances), and the identification of motor fluctuations in PD patients. Furthermore, they discuss how, from a clinician's perspective, objective measurements can help in various stages of PD management. EXPERT OPINION In our opinion, sufficient evidence supports the assertion that objective monitoring systems enable accurate evaluation of motor symptoms and complications in PD. A range of devices can be utilized not only to support diagnosis but also to monitor motor symptom during the disease progression and can become relevant in the therapeutic decision-making process.
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Affiliation(s)
- Andrea Guerra
- Parkinson and Movement Disorder Unit, Study Center on Neurodegeneration (CESNE), Department of Neuroscience, University of Padua, Padua, Italy
| | | | - Florinda Ferreri
- Unit of Neurology, Unit of Clinical Neurophysiology, Study Center of Neurodegeneration (CESNE), Department of Neuroscience, University of Padua, Padua, Italy
- Department of Clinical Neurophysiology, Kuopio University Hospital, University of Eastern Finland, Kuopio, Finland
| | - Matteo Bologna
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
- IRCCS Neuromed, Pozzilli, Italy
| | - Angelo Antonini
- Parkinson and Movement Disorder Unit, Study Center on Neurodegeneration (CESNE), Department of Neuroscience, University of Padua, Padua, Italy
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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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Wilkins KB, Kehnemouyi YM, Petrucci MN, Anderson RW, Parker JE, Trager MH, Neuville RS, Koop MM, Velisar A, Blumenfeld Z, Quinn EJ, Bronte-Stewart HM. Bradykinesia and Its Progression Are Related to Interhemispheric Beta Coherence. Ann Neurol 2023; 93:1029-1039. [PMID: 36641645 PMCID: PMC10191890 DOI: 10.1002/ana.26605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 12/05/2022] [Accepted: 01/09/2023] [Indexed: 01/16/2023]
Abstract
OBJECTIVE Bradykinesia is the major cardinal motor sign of Parkinson disease (PD), but its neural underpinnings are unclear. The goal of this study was to examine whether changes in bradykinesia following long-term subthalamic nucleus (STN) deep brain stimulation (DBS) are linked to local STN beta (13-30 Hz) dynamics or a wider bilateral network dysfunction. METHODS Twenty-one individuals with PD implanted with sensing neurostimulators (Activa® PC + S, Medtronic, PLC) in the STN participated in a longitudinal 'washout' therapy study every three to 6 months for an average of 3 years. At each visit, participants were withdrawn from medication (12/24/48 hours) and had DBS turned off (>60 minutes) before completing a repetitive wrist-flexion extension task, a validated quantitative assessment of bradykinesia, while local field potentials were recorded. Local STN beta dynamics were investigated via beta power and burst duration, while interhemispheric beta synchrony was assessed with STN-STN beta coherence. RESULTS Higher interhemispheric STN beta coherence, but not contralateral beta power or burst duration, was significantly associated with worse bradykinesia. Bradykinesia worsened off therapy over time. Interhemispheric STN-STN beta coherence also increased over time, whereas beta power and burst duration remained stable. The observed change in bradykinesia was related to the change in interhemispheric beta coherence, with greater increases in synchrony associated with further worsening of bradykinesia. INTERPRETATION Together, these findings implicate interhemispheric beta synchrony as a neural correlate of the progression of bradykinesia following chronic STN DBS. This could imply the existence of a pathological bilateral network contributing to bradykinesia in PD. ANN NEUROL 2023;93:1029-1039.
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Affiliation(s)
- Kevin B Wilkins
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA, United States
| | - Yasmine M Kehnemouyi
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA, United States
- Department of Bioengineering, Stanford Schools of Engineering & Medicine, Stanford, CA, United States
| | - Matthew N Petrucci
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA, United States
- Department of Bioengineering, Stanford Schools of Engineering & Medicine, Stanford, CA, United States
| | - Ross W Anderson
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA, United States
- Department of Neurosurgery, Kaiser Permanente, Redwood City, CA, United States
| | - Jordan E Parker
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA, United States
- Department of Psychology, University of California, Los Angeles, CA, United States
| | - Megan H Trager
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA, United States
- Columbia University Irving Medical Center, New York, NY, United States
| | - Raumin S Neuville
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA, United States
- The University of California School of Medicine, Irvine, CA, United States
| | - Mandy M Koop
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA, United States
- Cleveland Clinic, Cleveland, OH, United States
| | - Anca Velisar
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA, United States
- The Smith-Kettlewell Eye Research Institute, San Francisco, CA, United States
| | - Zack Blumenfeld
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA, United States
- Division of Biology and Biological Engineering, California Institute of Technology, Pasadena, CA, United States
- University of Southern California, Keck School of Medicine, Los Angeles, CA, United States
| | - Emma J Quinn
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA, United States
- Credit Karma, San Francisco, CA, United States
| | - Helen M Bronte-Stewart
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA, United States
- Department of Bioengineering, Stanford Schools of Engineering & Medicine, Stanford, CA, United States
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA, United States
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45
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Li Y, Zeng Y, Lin M, Wang Y, Ye Q, Meng F, Cai G, Cai G. β Oscillations of Dorsal STN as a Potential Biomarker in Parkinson's Disease Motor Subtypes: An Exploratory Study. Brain Sci 2023; 13:737. [PMID: 37239209 PMCID: PMC10216185 DOI: 10.3390/brainsci13050737] [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: 03/17/2023] [Revised: 04/21/2023] [Accepted: 04/26/2023] [Indexed: 05/28/2023] Open
Abstract
Parkinson's disease (PD) can be divided into postural instability and difficult gait (PIGD) and tremor dominance (TD) subtypes. However, potential neural markers located in the dorsal ventral side of the subthalamic nucleus (STN) for delineating the two subtypes of PIGD and TD have not been demonstrated. Therefore, this study aimed to investigate the spectral characteristics of PD on the dorsal ventral side. The differences in the β oscillation spectrum of the spike signal on the dorsal and ventral sides of the STN during deep brain stimulation (DBS) were investigated in 23 patients with PD, and coherence analysis was performed for both subtypes. Finally, each feature was associated with the Unified Parkinson's Disease Rating Scale (UPDRS). The β power spectral density (PSD) in the dorsal STN was found to be the best predictor of the PD subtype, with 82.6% accuracy. The PSD of dorsal STN β oscillations was greater in the PIGD group than in the TD group (22.17% vs. 18.22%; p < 0.001). Compared with the PIGD group, the TD group showed greater consistency in the β and γ bands. In conclusion, dorsal STN β oscillations could be used as a biomarker to classify PIGD and TD subtypes, guide STN-DBS treatment, and relate to some motor symptoms.
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Affiliation(s)
- Yongjie Li
- College of Information Engineering, Guangdong University of Technology, Guangzhou 510006, China
| | - Yuqi Zeng
- Department of Neurology, Fujian Medical University Union Hospital, Fuzhou 350001, China; (Y.Z.)
- Fujian Key Laboratory of Molecular Neurology, Institute of Clinical Neurology, Institute of Neuroscience, Fujian Medical University, Fuzhou 350001, China
| | - Mangui Lin
- College of Information Engineering, Guangdong University of Technology, Guangzhou 510006, China
| | - Yingqing Wang
- Department of Neurology, Fujian Medical University Union Hospital, Fuzhou 350001, China; (Y.Z.)
- Fujian Key Laboratory of Molecular Neurology, Institute of Clinical Neurology, Institute of Neuroscience, Fujian Medical University, Fuzhou 350001, China
| | - Qinyong Ye
- Department of Neurology, Fujian Medical University Union Hospital, Fuzhou 350001, China; (Y.Z.)
- Fujian Key Laboratory of Molecular Neurology, Institute of Clinical Neurology, Institute of Neuroscience, Fujian Medical University, Fuzhou 350001, China
| | - Fangang Meng
- Beijing Neurosurgical Institute, Capital Medical University, Beijing 100070, China;
| | - Guofa Cai
- College of Information Engineering, Guangdong University of Technology, Guangzhou 510006, China
| | - Guoen Cai
- Department of Neurology, Fujian Medical University Union Hospital, Fuzhou 350001, China; (Y.Z.)
- Fujian Key Laboratory of Molecular Neurology, Institute of Clinical Neurology, Institute of Neuroscience, Fujian Medical University, Fuzhou 350001, China
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46
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Guerra A, Colella D, Cannavacciuolo A, Giangrosso M, Paparella G, Fabbrini G, Berardelli A, Bologna M. Short-term plasticity of the motor cortex compensates for bradykinesia in Parkinson's disease. Neurobiol Dis 2023; 182:106137. [PMID: 37120094 DOI: 10.1016/j.nbd.2023.106137] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 04/14/2023] [Accepted: 04/24/2023] [Indexed: 05/01/2023] Open
Abstract
Patients with Parkinson's disease (PD) show impaired short-term potentiation (STP) mechanisms in the primary motor cortex (M1). However, the role played by this neurophysiological abnormality in bradykinesia pathophysiology is unknown. In this study, we used a multimodal neuromodulation approach to test whether defective STP contributes to bradykinesia. We evaluated STP by measuring motor-evoked potential facilitation during 5 Hz-repetitive transcranial magnetic stimulation (rTMS) and assessed repetitive finger tapping movements through kinematic techniques. Also, we used transcranial alternating current stimulation (tACS) to drive M1 oscillations and experimentally modulate bradykinesia. STP was assessed during tACS delivered at beta (β) and gamma (γ) frequency, and during sham-tACS. Data were compared to those recorded in a group of healthy subjects. In PD, we found that STP was impaired during sham- and γ-tACS, while it was restored during β-tACS. Importantly, the degree of STP impairment was associated with the severity of movement slowness and amplitude reduction. Moreover, β-tACS-related improvements in STP were linked to changes in movement slowness and intracortical GABA-A-ergic inhibition during stimulation, as assessed by short-interval intracortical inhibition (SICI). Patients with prominent STP amelioration had greater SICI reduction (cortical disinhibition) and less slowness worsening during β-tACS. Dopaminergic medications did not modify β-tACS effects. These data demonstrate that abnormal STP processes are involved in bradykinesia pathophysiology and return to normal levels when β oscillations increase. STP changes are likely mediated by modifications in GABA-A-ergic intracortical circuits and may represent a compensatory mechanism against β-induced bradykinesia in PD.
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Affiliation(s)
- Andrea Guerra
- IRCCS Neuromed, Pozzilli, IS 86077, Italy; Department of Human Neurosciences, Sapienza University of Rome, Rome 00185, Italy
| | - Donato Colella
- Department of Human Neurosciences, Sapienza University of Rome, Rome 00185, Italy
| | | | | | | | - Giovanni Fabbrini
- IRCCS Neuromed, Pozzilli, IS 86077, Italy; Department of Human Neurosciences, Sapienza University of Rome, Rome 00185, Italy
| | - Alfredo Berardelli
- IRCCS Neuromed, Pozzilli, IS 86077, Italy; Department of Human Neurosciences, Sapienza University of Rome, Rome 00185, Italy
| | - Matteo Bologna
- IRCCS Neuromed, Pozzilli, IS 86077, Italy; Department of Human Neurosciences, Sapienza University of Rome, Rome 00185, Italy.
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47
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Kehnemouyi YM, Petrucci MN, Wilkins KB, Melbourne JA, Bronte-Stewart HM. The Sequence Effect Worsens Over Time in Parkinson's Disease and Responds to Open and Closed-Loop Subthalamic Nucleus Deep Brain Stimulation. JOURNAL OF PARKINSON'S DISEASE 2023:JPD223368. [PMID: 37125563 DOI: 10.3233/jpd-223368] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
BACKGROUND The sequence effect is the progressive deterioration in speech, limb movement, and gait that leads to an inability to communicate, manipulate objects, or walk without freezing of gait. Many studies have demonstrated a lack of improvement of the sequence effect from dopaminergic medication, however few studies have studied the metric over time or investigated the effect of open-loop deep brain stimulation in people with Parkinson's disease (PD). OBJECTIVE To investigate whether the sequence effect worsens over time and/or is improved on clinical (open-loop) deep brain stimulation (DBS). METHODS Twenty-one people with PD with bilateral subthalamic nucleus (STN) DBS performed thirty seconds of instrumented repetitive wrist flexion extension and the MDS-UPDRS III off therapy, prior to activation of DBS and every six months for up to three years. A sub-cohort of ten people performed the task during randomized presentations of different intensities of STN DBS. RESULTS The sequence effect was highly correlated with the overall MDS-UPDRS III score and the bradykinesia sub-score and worsened over three years. Increasing intensities of STN open-loop DBS improved the sequence effect and one subject demonstrated improvement on both open-loop and closed-loop DBS. CONCLUSION Sequence effect in limb bradykinesia worsened over time off therapy due to disease progression but improved on open-loop DBS. These results demonstrate that DBS is a useful treatment of the debilitating effects of the sequence effect in limb bradykinesia and upon further investigation closed-loop DBS may offer added improvement.
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Affiliation(s)
- Yasmine M Kehnemouyi
- Stanford University School of Medicine, Department of Neurology and Neurological Sciences, Stanford, CA, USA
- Stanford University School of Engineering, Department of Bioengineering, Stanford, CA, USA
| | - Matthew N Petrucci
- Stanford University School of Medicine, Department of Neurology and Neurological Sciences, Stanford, CA, USA
- Stanford University School of Engineering, Department of Bioengineering, Stanford, CA, USA
| | - Kevin B Wilkins
- Stanford University School of Medicine, Department of Neurology and Neurological Sciences, Stanford, CA, USA
| | - Jillian A Melbourne
- Stanford University School of Medicine, Department of Neurology and Neurological Sciences, Stanford, CA, USA
| | - Helen M Bronte-Stewart
- Stanford University School of Medicine, Department of Neurology and Neurological Sciences, Stanford, CA, USA
- Stanford University School of Medicine, Department of Neurosurgery, Stanford, CA, USA
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48
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Williams S, Wong D, Alty JE, Relton SD. Parkinsonian Hand or Clinician's Eye? Finger Tap Bradykinesia Interrater Reliability for 21 Movement Disorder Experts. JOURNAL OF PARKINSON'S DISEASE 2023:JPD223256. [PMID: 37092233 DOI: 10.3233/jpd-223256] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/25/2023]
Abstract
BACKGROUND Bradykinesia is considered the fundamental motor feature of Parkinson's disease (PD). It is central to diagnosis, monitoring, and research outcomes. However, as a clinical sign determined purely by visual judgement, the reliability of humans to detect and measure bradykinesia remains unclear. OBJECTIVE To establish interrater reliability for expert neurologists assessing bradykinesia during the finger tapping test, without cues from additional examination or history. METHODS 21 movement disorder neurologists rated finger tapping bradykinesia, by Unified Parkinson's Disease Rating Scale (MDS-UPDRS) and Modified Bradykinesia Rating Scale (MBRS), in 133 videos of hands: 73 from 39 people with idiopathic PD, 60 from 30 healthy controls. Each neurologist rated 30 randomly-selected videos. 19 neurologists were also asked to judge whether the hand was PD or control. We calculated intraclass correlation coefficients (ICC) for absolute agreement and consistency of MDS-UPDRS ratings, using standard linear and cumulative linked mixed models. RESULTS There was only moderate agreement for finger tapping MDS-UPDRS between neurologists, ICC 0.53 (standard linear model) and 0.65 (cumulative linked mixed model). Among control videos, 53% were rated > 0 by MDS-UPDRS, and 24% were rated as bradykinesia by MBRS subscore combination. Neurologists correctly identified PD/control status in 70% of videos, without strictly following bradykinesia presence/absence. CONCLUSION Even experts show considerable disagreement about the level of bradykinesia on finger tapping, and frequently see bradykinesia in the hands of those without neurological disease. Bradykinesia is to some extent a phenomenon in the eye of the clinician rather than simply the hand of the person with PD.
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Affiliation(s)
- Stefan Williams
- Leeds Institute of Health Science, University of Leeds, Leeds, UK
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - David Wong
- Centre for Health Informatics, University of Manchester, Manchester, UK
| | - Jane E Alty
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
- Wicking Dementia Research and Education Centre, University of Tasmania, Hobart, Tasmania, Australia
| | - Samuel D Relton
- Leeds Institute of Health Science, University of Leeds, Leeds, UK
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49
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McGee C, Liebert A, Bicknell B, Pang V, Isaac V, McLachlan CS, Kiat H, Herkes G. A Randomized Placebo-Controlled Study of a Transcranial Photobiomodulation Helmet in Parkinson's Disease: Post-Hoc Analysis of Motor Outcomes. J Clin Med 2023; 12:jcm12082846. [PMID: 37109183 PMCID: PMC10146323 DOI: 10.3390/jcm12082846] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 04/06/2023] [Accepted: 04/11/2023] [Indexed: 04/29/2023] Open
Abstract
Emerging evidence is increasingly supporting the use of transcranial photobiomodulation (tPBM) to improve symptoms of neurodegenerative diseases, including Parkinson's disease (PD). The objective of this study was to analyse the safety and efficacy of tPBM for PD motor symptoms. The study was a triple blind, randomized placebo-controlled trial with 40 idiopathic PD patients receiving either active tPBM (635 nm plus 810 nm LEDs) or sham tPBM for 24 min per day (56.88J), six days per week, for 12 weeks. The primary outcome measures were treatment safety and a 37-item MDS-UPDRS-III (motor domain) assessed at baseline and 12 weeks. Individual MDS-UPDRS-III items were clustered into sub-score domains (facial, upper-limb, lower-limb, gait, and tremor). The treatment produced no safety concerns or adverse events, apart from occasional temporary and minor dizziness. There was no significant difference in total MDS-UPDRS-III scores between groups, presumably due to the placebo effect. Additional analyses demonstrated that facial and lower-limb sub-scores significantly improved with active treatment, while gait and lower-limb sub-scores significantly improved with sham treatment. Approximately 70% of participants responded to active treatment (≥5 decrease in MDS-UPDRS-III score) and improved in all sub-scores, while sham responders improved in lower-limb sub-scores only. tPBM appears to be a safe treatment and improved several PD motor symptoms in patients that responded to treatment. tPBM is proving to be increasingly attractive as a possible non-pharmaceutical adjunct therapy.
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Affiliation(s)
- Claire McGee
- Faculty of Health Sciences, Torrens University Australia, Sydney, NSW 2000, Australia
| | - Ann Liebert
- School of Medical Sciences, University of Sydney, Camperdown, NSW 2050, Australia
- Department of Research and Governance, Sydney Adventist Hospital, Wahroonga, NSW 2076, Australia
- NICM Health Research Institute, University of Western Sydney, Westmead, NSW 2145, Australia
| | - Brian Bicknell
- NICM Health Research Institute, University of Western Sydney, Westmead, NSW 2145, Australia
| | - Vincent Pang
- NICM Health Research Institute, University of Western Sydney, Westmead, NSW 2145, Australia
| | - Vivian Isaac
- School of Allied Health, Exercise & Sports Sciences, Faculty of Science & Health, Charles Sturt University, Albury Campus, Albury, NSW 2640, Australia
| | - Craig S McLachlan
- Centre for Healthy Futures, Torrens University Australia, Sydney, NSW 2000, Australia
| | - Hosen Kiat
- NICM Health Research Institute, University of Western Sydney, Westmead, NSW 2145, Australia
- Centre for Healthy Futures, Torrens University Australia, Sydney, NSW 2000, Australia
- Faculty of Medicine, Human and Health Sciences, Macquarie University, Sydney, NSW 2109, Australia
- College of Health and Medicine, Australian National University, Canberra, ACT 2601, Australia
- Cardiac Health Institute, Sydney, NSW 2000, Australia
| | - Geoffrey Herkes
- College of Health and Medicine, Australian National University, Canberra, ACT 2601, Australia
- Department of Neurology, Sydney Adventist Hospital, Wahroonga, NSW 2076, Australia
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50
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Bologna M, Espay AJ, Fasano A, Paparella G, Hallett M, Berardelli A. Redefining Bradykinesia. Mov Disord 2023; 38:551-557. [PMID: 36847357 PMCID: PMC10387192 DOI: 10.1002/mds.29362] [Citation(s) in RCA: 22] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 01/31/2023] [Accepted: 02/06/2023] [Indexed: 03/01/2023] Open
Affiliation(s)
- Matteo Bologna
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
- IRCCS Neuromed, Pozzilli, Italy
| | - Alberto J. Espay
- Gardner Family Center for Parkinson’s Disease and Movement Disorders, Department of Neurology, University of Cincinnati, Cincinnati, Ohio, USA
| | - Alfonso Fasano
- Edmond J. Safra Program in Parkinson’s Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, UHN, Toronto, Ontario, Canada
- Division of Neurology, University of Toronto, Toronto, Ontario, Canada
- Krembil Brain Institute, Toronto, Ontario, Canada
| | | | - Mark Hallett
- Human Motor Control Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland, USA
| | - Alfredo Berardelli
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
- IRCCS Neuromed, Pozzilli, Italy
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