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Rožanković PB, Johansson A, Péter K, Milanov I, Odin P. Monotherapy with infusion therapies - useful or not? J Neural Transm (Vienna) 2024:10.1007/s00702-024-02801-2. [PMID: 38967810 DOI: 10.1007/s00702-024-02801-2] [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: 04/30/2024] [Accepted: 06/24/2024] [Indexed: 07/06/2024]
Abstract
Infusion pump-based therapies are an effective treatment option for patients with advanced Parkinson´s disease. Achieving monotherapy with infusion-based therapies could simplify the treatment regimen, provide better medication adherence, reduce adverse events and drug interactions. This review presents the literature data on the efficacy, safety, and achievability of monotherapy with all available infusion-based therapies, including apomorphine, levodopa-carbidopa-intestinal gel (LCIG), levodopa-entacapone-carbidopa intestinal gel (LECIG), and foslevodopa-foscarbidopa (LDp/CDp). In summary, monotherapy is achievable and effective in most patients on intestinal levodopa infusion therapy and in some patients on apomorphine infusion. There is a need for further investigation of monotherapy compared to polytherapy, especially in new pump treatment options (LECIG and LDp/CDp). Future research should reveal which patients on infusion-based therapies could benefit from monotherapy, including identification of potential baseline predictors of achieving monotherapy in patients treated with specific infusion-based therapies.
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Affiliation(s)
- Petra Bago Rožanković
- Department of Neurology, Clinical Hospital Dubrava, Avenija Gojka Šuška 6, Zagreb, 10000, Croatia.
- School of Medicine, Catholic University of Croatia, Ilica 242, Zagreb, 10000, Croatia.
| | - Anders Johansson
- Medical Unit Neurology, Karolinska University Hospital, Stockholm, Sweden
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Klivényi Péter
- Department of Neurology, Albert Szent-Gyorgyi Medical School, University of Szeged, Szeged, Hungary
| | - Ivan Milanov
- Department of Neurology, Medical University of Sofia, Sofia, Bulgaria
| | - Per Odin
- Division of Neurology, Department of Clinical Sciences, Lund University, Lund, Sweden
- Department of Neurology, Rehabilitation medicine, Memory and Geriatrics, Skane University Hospital, Lund, Sweden
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2
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Kwon CY. Exploring Novel Meridian-Based Therapeutic Approaches in Parkinson's Disease. J Acupunct Meridian Stud 2024; 17:45-46. [PMID: 38686427 DOI: 10.51507/j.jams.2024.17.2.45] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Revised: 03/26/2024] [Accepted: 03/31/2024] [Indexed: 05/02/2024] Open
Affiliation(s)
- Chan-Young Kwon
- Department of Oriental Neuropsychiatry, Dong-Eui University College of Korean Medicine, Busan, Korea
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3
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Polgar S, Finkelstein DI, Karimi L. Overcoming Methodological Challenges for Advancing Stem Cell Therapies in Parkinson's Disease. Cell Transplant 2024; 33:9636897241246355. [PMID: 38634440 PMCID: PMC11027592 DOI: 10.1177/09636897241246355] [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: 12/20/2023] [Revised: 03/19/2024] [Accepted: 03/20/2024] [Indexed: 04/19/2024] Open
Abstract
The quest for new and improved therapies for Parkinson's disease (PD) remains of paramount importance, despite previous trial failures. There is a current debate regarding the potential of stem cell research as a therapeutic approach for PD. The studies of dopaminergic fetal stem cells for PD treatment, their design, and the results of the initial surgical placebo-controlled trials were reviewed in this study. Some of the fundamental methodological challenges and possible strategies to resolve them were proposed. In this article, we argue that the most important impact lies in the proof-of-principle demonstrated by clinical trials for cell replacement strategies in reconstructing the human brain. While some researchers argue that the considerable technical challenges associated with cell therapies for PD warrant the discontinuation of further development using stem cells, we believe that the opposing viewpoints are instrumental in identifying a series of methodological misunderstandings. Here, we propose to expose key challenges to ensure the advancement of the field and unlock the potential of stem cell therapies in PD treatment. Overall, this review underscores the need for further research and innovation to overcome the hurdles in realizing the potential of stem cell-based therapies for PD.
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Affiliation(s)
- Stephen Polgar
- School of Health and Biomedical Sciences, RMIT University, Melbourne, VIC, Australia
| | - David I. Finkelstein
- University of Melbourne, Florey Institute of Neuroscience and Mental Health, Parkville, VIC, Australia
| | - Leila Karimi
- School of Health and Biomedical Sciences, RMIT University, Melbourne, VIC, Australia
- School of Medicine and Healthcare Management, Caucasus University, Tbilisi, Georgia
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Moes HR, Henriksen T, Sławek J, Phokaewvarangkul O, Buskens E, van Laar T. Tools and criteria to select patients with advanced Parkinson's disease for device-aided therapies: a narrative review. J Neural Transm (Vienna) 2023; 130:1359-1377. [PMID: 37500937 PMCID: PMC10645650 DOI: 10.1007/s00702-023-02656-z] [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: 02/28/2023] [Accepted: 05/16/2023] [Indexed: 07/29/2023]
Abstract
This article provides an overview of the various screening and selection tools which have been developed over the past 25 years to identify patients with Parkinson's disease (PD) possibly eligible for device-aided therapies (DATs). For the available screening tools, we describe the target therapies (subtypes of DAT), development methods, validation data, and their use in clinical practice. In addition, the historical background and potential utility of these screening tools are discussed. The challenges in developing and validating these tools are also addressed, taking into account the differences in population, the local health care organization, and resource availability.
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Affiliation(s)
- Harmen R Moes
- Department of Neurology, University of Groningen, University Medical Center Groningen, 9713 GZ, Groningen, The Netherlands
| | - Tove Henriksen
- Department of Neurology, Movement Disorder Clinic, Bispebjerg Hospital, Copenhagen, Denmark
| | - Jarosław Sławek
- Department of Neurology, St Adalbert Hospital Copernicus, Gdansk, Poland
- Department of Neurological and Psychiatric Nursing, Faculty of Health Sciences, Medical University of Gdansk, Gdansk, Poland
| | - Onanong Phokaewvarangkul
- Chulalongkorn Center of Excellence for Parkinson Disease & Related Disorders, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | - Erik Buskens
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Teus van Laar
- Department of Neurology, University of Groningen, University Medical Center Groningen, 9713 GZ, Groningen, The Netherlands.
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5
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Löhle M, Timpka J, Bremer A, Khodakarami H, Gandor F, Horne M, Ebersbach G, Odin P, Storch A. Application of single wrist-wearable accelerometry for objective motor diary assessment in fluctuating Parkinson's disease. NPJ Digit Med 2023; 6:194. [PMID: 37848531 PMCID: PMC10582031 DOI: 10.1038/s41746-023-00937-1] [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: 03/30/2023] [Accepted: 09/29/2023] [Indexed: 10/19/2023] Open
Abstract
Advanced Parkinson's disease (PD) is characterized by motor fluctuations including unpredictable oscillations remarkably impairing quality of life. Effective management and development of novel therapies for these response fluctuations largely depend on clinical rating instruments such as the widely-used PD home diary, which are associated with biases and errors. Recent advancements in digital health technologies provide user-friendly wearables that can be tailored for continuous monitoring of motor fluctuations. Their criterion validity under real-world conditions using clinical examination as the gold standard remains to be determined. We prospectively examined this validity of a wearable accelerometer-based digital Parkinson's Motor Diary (adPMD) using the Parkinson's Kinetigraph (PKG®) in an alternative application by converting its continuous data into one of the three motor categories of the PD home diary (Off, On and Dyskinetic state). Sixty-three out of 91 eligible participants with fluctuating PD (46% men, average age 66) had predefined sufficient adPMD datasets (>70% of half-hour periods) from 2 consecutive days. 92% of per-protocol assessments were completed. adPMD monitoring of daily times in motor states showed moderate validity for Off and Dyskinetic state (ICC = 0.43-0.51), while inter-rating methods agreements on half-hour-level can be characterized as poor (median Cohen's κ = 0.13-0.21). Individualization of adPMD thresholds for transferring accelerometer data into diary categories improved temporal agreements up to moderate level for Dyskinetic state detection (median Cohen's κ = 0.25-0.41). Here we report that adPMD real-world-monitoring captures daily times in Off and Dyskinetic state in advanced PD with moderate validities, while temporal agreement of adPMD and clinical observer diary data is limited.
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Affiliation(s)
- Matthias Löhle
- Department of Neurology, University Medical Center Rostock, Rostock, Germany.
- German Center for Neurodegenerative Diseases (DZNE) Rostock-Greifswald, Rostock, Germany.
| | - Jonathan Timpka
- Division of Neurology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
- Department of Neurology, Skåne University Hospital, Lund, Sweden
| | - Alexander Bremer
- Department of Neurology, University Medical Center Rostock, Rostock, Germany
| | | | - Florin Gandor
- Movement Disorders Hospital, Beelitz-Heilstätten, Beelitz, Germany
- Department of Neurology, Otto-von-Guericke University, Magdeburg, Germany
| | - Malcom Horne
- Bionics Institute, Melbourne, VIC, Australia
- The Department of Medicine, The University of Melbourne, St Vincent's Hospital, Fitzroy, VIC, 3010, Australia
| | - Georg Ebersbach
- Movement Disorders Hospital, Beelitz-Heilstätten, Beelitz, Germany
| | - Per Odin
- Division of Neurology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
- Department of Neurology, Skåne University Hospital, Lund, Sweden
| | - Alexander Storch
- Department of Neurology, University Medical Center Rostock, Rostock, Germany.
- German Center for Neurodegenerative Diseases (DZNE) Rostock-Greifswald, Rostock, Germany.
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Kang Q, Chai W, Min J, Qu X. Yin Yang 1 suppresses apoptosis and oxidative stress injury in SH-SY5Y cells by facilitating NR4A1 expression. J Neurogenet 2023; 37:115-123. [PMID: 37922205 DOI: 10.1080/01677063.2023.2270745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Accepted: 09/06/2023] [Indexed: 11/05/2023]
Abstract
Oxidative stress plays a significant role in the development of Parkinson's disease (PD). Previous studies implicate nuclear receptor subfamily 4 group A member 1 (NR4A1) in oxidative stress associated with PD. However, the molecular mechanism underlying the regulation of NR4A1 expression remains incompletely understood. In the present study, a PD cell model was established by using 1-methyl-4-phenylpyridinium (MPP+) in SH-SY5Y cells. Cell viability and apoptosis were assessed by using CCK-8 assay and flow cytometry, respectively. The activities of LDH and SOD, and ROS generation were used as an indicators of oxidative stress. ChIP-PCR was performed to detect the interaction between Yin Yang 1 (YY1) and the NR4A1 promoter. MPP+ treatment inhibited SH-SY5Y cell viability in a dose- and time-dependent manner. NR4A1 and YY1 expression were decreased in MPP+-treated SH-SY5Y cells. Increasing NR4A1 or YY1 alleviated MPP+-induced apoptosis and oxidative stress in SH-SY5Y cells, whereas reduction of NR4A1 aggravated MPP+-induced cell injury. Transcription factor YY1 facilitated NR4A1 expression by binding with NR4A1 promoter. In addition, in MPP+-treated SH-SY5Y cells, the inhibition of NR4A1 to apoptosis and oxidative stress was further enhanced by overexpression of YY1. The reduction of NR4A1 led to an elevation of apoptosis and oxidative stress in MPP+-induced SH-SY5Y cells, and this effect was partially reversed by the overexpression of YY1. In conclusion, YY1 suppresses MPP+-induced apoptosis and oxidative stress in SH-SY5Y cells by binding with NR4A1 promoter and boosting NR4A1 expression. Our findings suggest that NR4A1 may be a candidate target for PD treatment.HIGHLIGHTSNR4A1 and YY1 are decreased in MPP+-treated SH-SY5Y cells.NR4A1 prevents oxidative stress and apoptosis in MPP+-treated SH-SY5Y cells.YY1 binds with NR4A1 promoter and increases NR4A1 expression.YY1 enhances the inhibition of NR4A1 to SH-SY5Y cell apoptosis and oxidative stress.
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Affiliation(s)
- Qin Kang
- Department of Neurology, Jiangxi Provincial People's Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, Jiangxi Province, P.R. China
| | - Wen Chai
- Department of Neurology, Jiangxi Provincial People's Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, Jiangxi Province, P.R. China
| | - Jun Min
- Department of Neurology, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi Province, P.R. China
| | - Xinhui Qu
- Department of Neurology, Jiangxi Provincial People's Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, Jiangxi Province, P.R. China
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7
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Mari Z. Start the Late-Stage PD Wellness Prescription Early. Am J Geriatr Psychiatry 2023; 31:748-750. [PMID: 37414671 DOI: 10.1016/j.jagp.2023.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 06/07/2023] [Indexed: 07/08/2023]
Affiliation(s)
- Zoltan Mari
- Department of Neurology, Johns Hopkins University (ZM), Baltimore, MD; Lou Ruvo Center for Brain Health (ZM), Cleveland Clinic Nevada, Las Vegas, NV.
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8
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Pahwa R, Pagan FL, Kremens DE, Saint-Hilaire M. Clinical Use of On-Demand Therapies for Patients with Parkinson's Disease and OFF Periods. Neurol Ther 2023; 12:1033-1049. [PMID: 37221354 PMCID: PMC10310675 DOI: 10.1007/s40120-023-00486-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 04/19/2023] [Indexed: 05/25/2023] Open
Abstract
On-demand therapies for Parkinson's disease (PD) provide rapid, reliable relief for patients experiencing OFF periods; however, practical guidelines on the use of these therapies are not generally available. This paper reviews the use of on-demand treatments. Motor fluctuations occur in nearly all patients with PD after long-term use of levodopa. As the goal of PD treatment is to provide good ON time, on-demand treatments that have a more rapid reliable onset than the slower-acting oral medications provide rapid relief for OFF periods. All current on-demand treatments bypass the gastrointestinal tract, providing dopaminergic therapy directly into the blood stream by subcutaneous injection, through the buccal mucosa, or by inhalation into the pulmonary circulation. On-demand treatments are fast acting (10- to 20-min onset), with maximum, reliable, and significant responses reached within 30 min after administration. Oral medications pass through the gastrointestinal tract and thus have slower absorption owing to gastroparesis and competition with food. On-demand therapies, by providing fast-acting relief, can have a positive impact on a patient's quality of life when patients are experiencing OFF periods.
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Affiliation(s)
- Rajesh Pahwa
- Department of Neurology, University of Kansas Medical Center, 3599 Rainbow Blvd, Mailstop 2012, Kansas City, KS, 66160, USA.
| | - Fernando L Pagan
- Department of Neurology, Georgetown University Hospital, Washington, DC, USA
| | - Daniel E Kremens
- Department of Neurology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Marie Saint-Hilaire
- Department of Neurology, Parkinson's Disease and Movement Disorders Center, Boston University School of Medicine, Boston, MA, USA
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9
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Santos García D, Pagonabarraga Mora J, Escamilla Sevilla F, García Ruiz PJ, Infante Ceberio J, Kulisevsky Bojarski J, Linazasoro Cristóbal G, Luquín Piudo MR, Martínez Castrillo JC, Jesús Maestre S, Vela Desojo L, Campos Lucas FJ, Caballero Martínez F, Mir P. Dopamine agonist therapy in Parkinson's disease: Spanish expert consensus on its use in different clinical situations. Neurologia 2023:S2173-5808(23)00037-8. [PMID: 37419211 DOI: 10.1016/j.nrleng.2023.04.008] [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: 03/28/2023] [Accepted: 04/01/2023] [Indexed: 07/09/2023] Open
Abstract
BACKGROUND Different types of therapies were proven effective for the medical management of motor and non-motor symptoms in Parkinson's disease (PD). We aimed to gain consensus on the Dopamine agonist (DA) therapy use in different clinical scenarios of Parkinson's disease (PD) patients. METHODS This consensus study was based on the nominal group technique. Initially, a Consensus Group comprising 12 expert neurologists in the PD field identified the topics to be addressed and elaborated different evidence-based preliminary statements. Next, a panel of 48 Spanish neurologists expressed their opinion on an internet-based systematic voting program. Finally, initial ideas were reviewed and rewritten according to panel contribution and were ranked by the Consensus group using a Likert-type scale. The analysis of data was carried out by using a combination of both qualitative and quantitative methods. The consensus was achieved if the statement reached ≥3,5 points on the voting process. RESULTS The Consensus Group produced 76 real-world recommendations. The topics addressed included 12 statements related to DA therapy in early PD, 20 statements concerning DA treatment strategy in patients with motor complications, 11 statements associated with DA drugs and their side effects, and 33 statements regarding DA therapy in specific clinical scenarios. The Consensus Group did not reach a consensus on 15 statements. CONCLUSION The findings from this consensus method represent an exploratory step to help clinicians and patients in the appropriate use of DA in different stages and clinical situations of PD.
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Affiliation(s)
- Diego Santos García
- Servicio de Neurología, CHUAC (Complejo Hospitalario Universitario de A Coruña), As Xubias 84, 15006 A Coruña, Spain.
| | | | - Francisco Escamilla Sevilla
- Unidad de Trastornos del Movimiento, Servicio de Neurología, Hospital Universitario Virgen de las Nieves, Av. de las Fuerzas Armadas, 2, 18014 Granada, Spain; Instituto de Investigación Biosanitaria (ibs.Granada), Granada, Spain
| | - Pedro J García Ruiz
- Hospital Universitario Fundación Jiménez Díaz, Av. de los Reyes Católicos, 2, 28040 Madrid, Spain
| | - Jon Infante Ceberio
- Servicio de Neurología, Hospital Universitario de Marqués de Valdecilla-IDIVAL, Calle Cardenal Herrera Oria, 39011 Santander, Cantabria, Spain; Centro de Investigación Biomédica en Red en Enfermedades Neurodegenerativas (CIBERNED), Universidad de Cantabria, Santander, Spain
| | | | | | | | | | - Silvia Jesús Maestre
- Unidad de Trastornos del Movimiento, Servicio de Neurología y Neurofisiología Clínica, Hospital Universitario Virgen del Rocío, Instituto de Biomedicina de Sevilla, Av. Manuel Siurot, S/n, 41013 Sevilla, Spain
| | - Lydia Vela Desojo
- Hospital Universitario Fundación Alcorcón, C/ Budapest, 1, 28922 Alcorcón, Madrid, Spain
| | - Francisco J Campos Lucas
- Facultad de Medicina, Universidad Francisco de Vitoria, Carretera Pozuelo, km 1800, 28223 Majadahonda, Madrid, Spain
| | - Fernando Caballero Martínez
- Facultad de Medicina, Universidad Francisco de Vitoria, Carretera Pozuelo, km 1800, 28223 Majadahonda, Madrid, Spain
| | - Pablo Mir
- Unidad de Trastornos del Movimiento, Servicio de Neurología y Neurofisiología Clínica, Instituto de Biomedicina de Sevilla, (IBiS), Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Av. Manuel Siurot, S/n, 41013 Sevilla, Spain; Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Calle Valderrebollo, 5, 28031 Madrid, Spain; Departamento de Medicina, Facultad de Medicina, Universidad de Sevilla, Av. de Sánchez Pizjuán, s/n, 41009 Sevilla, Spain
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10
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Dietrichs E, Alves G, Benjaminsen E, Johansen KK, Tysnes OB. Treatment of motor symptoms in Parkinson's disease. TIDSSKRIFT FOR DEN NORSKE LEGEFORENING 2023; 143:22-0804. [PMID: 37158528 DOI: 10.4045/tidsskr.22.0804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/10/2023] Open
Abstract
In recent years, the development of new therapies and improvements in our understanding of older therapies have led to changes in the management of Parkinson's disease. However, current Norwegian and international therapy recommendations present a range of different options as being equally viable. In this clinical review, we propose an updated algorithm for the medical treatment of motor symptoms in Parkinson's disease, based on evidence-based recommendations and our own personal experience and opinions.
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Affiliation(s)
- Espen Dietrichs
- Nevrologisk avdeling, Oslo universitetssykehus, og, Institutt for klinisk medisin, Universitetet i Oslo
| | - Guido Alves
- Nasjonal kompetansetjeneste for bevegelsesforstyrrelser, Stavanger universitetssjukehus, og, Institutt for kjemi, biovitenskap og miljøteknologi, Universitetet i Stavanger
| | - Espen Benjaminsen
- Nevrologisk avdeling, Nordlandssykehuset, Bodø, og, Det helsevitenskapelige fakultet, UiT - Norges arktiske universitet
| | | | - Ole-Bjørn Tysnes
- Nevrologisk avdeling og Neuro-SysMed, Haukeland universitetssjukehus, og, Det medisinske fakultet, Universitetet i Bergen
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11
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Martinez-Nunez AE, LeWitt PA. Drugs to the Rescue: Comparison of On-Demand Therapies for OFF Symptoms in Parkinson's Disease. JOURNAL OF PARKINSON'S DISEASE 2023:JPD230055. [PMID: 37182902 DOI: 10.3233/jpd-230055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
Patients with Parkinson's disease often suffer from OFF symptoms disrupting their daily routines and adding to disabilities. Despite polypharmacy and adjustments to medication schedules, they often do not experience consistent relief from their motor symptoms. As the disease progresses, impaired gastric emptying may evolve, making it even more challenging for dopaminergic drugs to provide consistent results. This review focuses on a group of drugs that have the pharmacokinetic advantage of a much earlier onset of action by virtue of their non-oral routes of absorption. We compare the current marketed options: subcutaneous apomorphine, sublingual apomorphine, and inhaled levodopa. Subcutaneous apomorphine is the speediest to take effect, whereas sublingual apomorphine offers the longest clinical effect. Inhaled levodopa has the most favorable side effect profile among the three options. An inhaled form of apomorphine is currently under development, having passed safety and efficacy studies. Each of these drugs has unique characteristics for the user, including different side effect profiles and onset of action. The best choice for a patient will depend on individual needs and circumstances. In this review, we explore those nuances to allow clinicians to select the best option for their patients.
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Affiliation(s)
| | - Peter A LeWitt
- Department of Neurology, Henry Ford Hospital, Detroit, MI, USA
- Department of Neurology and Sastry Foundation Endowed Chair In Neurology, Wayne State University School of Medicine, Detroit, MI, USA
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12
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Attia MS, Yahya A, Monaem NA, Sabry SA. Mesoporous silica nanoparticles: Their potential as drug delivery carriers and nanoscavengers in Alzheimer's and Parkinson's diseases. Saudi Pharm J 2023; 31:417-432. [PMID: 37026045 PMCID: PMC10071366 DOI: 10.1016/j.jsps.2023.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 01/25/2023] [Indexed: 02/04/2023] Open
Abstract
Worldwide, populations face significant burdens from neurodegenerative disorders (NDDs), especially Alzheimer's and Parkinson's diseases. Although there are many proposed etiologies for neurodegenerative disorders, including genetic and environmental factors, the exact pathogenesis for these disorders is not fully understood. Most patients with NDDs are given lifelong treatment to improve their quality of life. There are myriad treatments for NDDs; however, these agents are limited by their side effects and difficulty in passing the blood-brain barrier (BBB). Furthermore, the central nervous system (CNS) active pharmaceuticals could offer symptomatic relief for the patient's condition without providing a complete cure or prevention by targeting the disease's cause. Recently, Mesoporous silica nanoparticles (MSNs) have gained interest in treating NDDs since their physicochemical properties and inherent ability to pass BBB make them possible drug carriers for several drugs for NDDs treatment. This paper provides insight into the pathogenesis and treatment of NDDs, along with the recent advances in applying MSNs as fibril scavengers. Moreover, the application of MSNs-based formulations in enhancing or sustaining drug release rate, and brain targeting via their responsive release properties, besides the neurotoxicity of MSNs, have been reviewed.
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Affiliation(s)
- Mohamed S. Attia
- Department of Pharmaceutics, Faculty of Pharmacy, Zagazig University, Zagazig 44519, Egypt
- Corresponding author.
| | - Ahmed Yahya
- Egypt-Japan University of Science and Technology, New Borg El Arab, Alexandria 21934, Egypt
| | - Nada Abdel Monaem
- Department of chemistry, Faculty of Science, Zagazig University, Zagazig 44519, Egypt
| | - Shereen A. Sabry
- Department of Pharmaceutics, Faculty of Pharmacy, Zagazig University, Zagazig 44519, Egypt
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13
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Sun Y, Sheng J, Liu T, Yang G, He M, Huang Y, Luo Z, Zhu J, Jin X. Combination treatment of acupoint therapy and conventional medication for motor function of Parkinson's disease: A systematic review and meta-analysis. Complement Ther Clin Pract 2023; 50:101677. [PMID: 36402061 DOI: 10.1016/j.ctcp.2022.101677] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 09/29/2022] [Accepted: 10/29/2022] [Indexed: 11/11/2022]
Abstract
BACKGROUND Combination treatment with acupoint therapy and conventional medication (CM) has been proposed as a strategy that could improve motor dysfunction in Parkinson's disease (PD). We performed this systematic review and meta-analysis to assess the effects of this combination treatment on motor function in patients with PD. METHODS We searched randomized controlled trials (RCTs) from eight databases, comparing combined acupoint therapy and CM and CM (alone or with sham interventions). The quality of the trials was evaluated according to the Cochrane risk of bias. Subgroup and sensitivity analyses were performed on different types of acupoint interventions. RESULTS Forty-seven trials of 2929 participants were included, with 45 studies used for the meta-analyses. Combination treatment yielded an improved reduction in United Parkinson's disease rating scale (UPDRS) III of -3.85 [95% CI, -4.83 to -2.86] and Webster scale score of -3.17 [95% CI, -4.07 to -2.27]. Further analyses demonstrated that real (compared with sham) intervention was linked to a decreased UPDRS III of -2.02 ([95% CI, -3.60 to -0.44], I2 = 40%), and beneficial effects were observed when combination intervention was used for patients with Hoehn-Yahr (H-Y) stages >3 with mild to moderate stimulation for 4-12-week treatment. CONCLUSIONS Acupoint therapy and CM treatment may improve motor function of patients with PD. Patients with H-Y stage >3 could tolerate real acupoint intervention with mild to moderate stimulation for 4-12-week treatment and showed improvement. However, this was demonstrated with low to moderate levels of evidence in statistical description.
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Affiliation(s)
- Yingying Sun
- Department of Rehabilitation, Ningbo Zhenhai Longsai Hospital, Ningbo, 315299, China
| | - Jili Sheng
- The Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, 310053, China; Department of Acupuncture, Zhejiang Hospital, Hangzhou, 310013, China
| | - Tao Liu
- Department of Acupuncture, Zhejiang Hospital, Hangzhou, 310013, China
| | - Geyao Yang
- Department of Acupuncture, Hangzhou Geriatric Hospital, Hangzhou, 310000, China
| | - Meiling He
- Rehabilitation Department, Mianyang Hospital of TCM, Sichuan, 621063, China
| | - Yuanan Huang
- Department of Manipulation, Zhejiang Hospital, Hangzhou, 310030, China
| | - Zhouxiao Luo
- Department of Acupuncture, Tonglu Hospital of TCM, Hangzhou, 311599, China
| | - Jianfang Zhu
- Department of Acupuncture, Zhejiang Hospital, Hangzhou, 310013, China
| | - Xiaoqing Jin
- Department of Acupuncture, Zhejiang Hospital, Hangzhou, 310013, China.
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Geritz J, Welzel J, Hansen C, Maetzler C, Hobert MA, Elshehabi M, Knacke H, Aleknonytė-Resch M, Kudelka J, Bunzeck N, Maetzler W. Cognitive parameters can predict change of walking performance in advanced Parkinson's disease - Chances and limits of early rehabilitation. Front Aging Neurosci 2022; 14:1070093. [PMID: 36620765 PMCID: PMC9813446 DOI: 10.3389/fnagi.2022.1070093] [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: 10/14/2022] [Accepted: 12/01/2022] [Indexed: 12/24/2022] Open
Abstract
Introduction Links between cognition and walking performance in patients with Parkinson's disease (PD), which both decline with disease progression, are well known. There is lack of knowledge regarding the predictive value of cognition for changes in walking performance after individualized therapy. The aim of this study is to identify relevant predictive cognitive and affective parameters, measurable in daily clinical routines, for change in quantitative walking performance after early geriatric rehabilitation. Methods Forty-seven acutely hospitalized patients with advanced PD were assessed at baseline (T1) and at the end (T2) of a 2-week early rehabilitative geriatric complex treatment (ERGCT). Global cognitive performance (Montreal Cognitive Assessment, MoCA), EF and divided attention (Trail Making Test B minus A, delta TMT), depressive symptoms, and fear of falling were assessed at T1. Change in walking performance was determined by the difference in quantitative walking parameters extracted from a sensor-based movement analysis over 20 m straight walking in single (ST, fast and normal pace) and dual task (DT, with secondary cognitive, respectively, motor task) conditions between T1 and T2. Bayesian regression (using Bayes Factor BF10) and multiple linear regression models were used to determine the association of non-motor characteristics for change in walking performance. Results Under ST, there was moderate evidence (BF10 = 7.8, respectively, BF10 = 4.4) that lower performance in the ∆TMT at baseline is associated with lower reduction of step time asymmetry after treatment (R 2 adj = 0.26, p ≤ 0.008, respectively, R 2 adj = 0.18, p ≤ 0.009). Under DT walking-cognitive, there was strong evidence (BF10 = 29.9, respectively, BF10 = 27.9) that lower performance in the ∆TMT is associated with more reduced stride time and double limb support (R 2 adj = 0.62, p ≤ 0.002, respectively, R 2 adj = 0.51, p ≤ 0.009). There was moderate evidence (BF10 = 5.1) that a higher MoCA total score was associated with increased gait speed after treatment (R 2 adj = 0.30, p ≤ 0.02). Discussion Our results indicate that the effect of ERGT on change in walking performance is limited for patients with deficits in EF and divided attention. However, these patients also seem to walk more cautiously after treatment in walking situations with additional cognitive demand. Therefore, future development of individualized treatment algorithms is required, which address individual needs of these vulnerable patients.
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Affiliation(s)
- Johanna Geritz
- Department of Neurology, University Hospital Schleswig-Holstein, Kiel, Germany,Department of Psychology, University of Lübeck, Lübeck, Germany,*Correspondence: Johanna Geritz,
| | - Julius Welzel
- Department of Neurology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Clint Hansen
- Department of Neurology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Corina Maetzler
- Department of Neurology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Markus A. Hobert
- Department of Neurology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Morad Elshehabi
- Department of Neurology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Henrike Knacke
- Department of Neurology, University Hospital Schleswig-Holstein, Kiel, Germany
| | | | - Jennifer Kudelka
- Department of Neurology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Nico Bunzeck
- Department of Psychology, University of Lübeck, Lübeck, Germany,Center of Brain, Behavior and Metabolism (CBBM), University of Lübeck, Lübeck, Germany
| | - Walter Maetzler
- Department of Neurology, University Hospital Schleswig-Holstein, Kiel, Germany
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15
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Abstract
Parkinson's disease (PD) is a progressive neurodegenerative illness with both motor and nonmotor symptoms. Deep brain stimulation (DBS) is an established safe neurosurgical symptomatic therapy for eligible patients with advanced disease in whom medical treatment fails to provide adequate symptom control and good quality of life, or in whom dopaminergic medications induce severe side effects such as dyskinesias. DBS can be tailored to the patient's symptoms and targeted to various nodes along the basal ganglia-thalamus circuitry, which mediates the various symptoms of the illness; DBS in the thalamus is most efficient for tremors, and DBS in the pallidum most efficient for rigidity and dyskinesias, whereas DBS in the subthalamic nucleus (STN) can treat both tremors, akinesia, rigidity and dyskinesias, and allows for decrease in doses of medications even in patients with advanced stages of the disease, which makes it the preferred target for DBS. However, DBS in the STN assumes that the patient is not too old, with no cognitive decline or relevant depression, and does not exhibit severe and medically resistant axial symptoms such as balance and gait disturbances, and falls. Dysarthria is the most common side effect of DBS, regardless of the brain target. DBS has a long-lasting effect on appendicular symptoms, but with progression of disease, nondopaminergic axial features become less responsive to DBS. DBS for PD is highly specialised; to enable adequate selection and follow-up of patients, DBS requires dedicated multidisciplinary teams of movement disorder neurologists, functional neurosurgeons, specialised DBS nurses and neuropsychologists.
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Affiliation(s)
- Marwan Hariz
- Department of Clinical Neuroscience, University Hospital of Umeå, Umeå, Sweden.,UCL-Queen Square Institute of Neurology, London, UK
| | - Patric Blomstedt
- Department of Clinical Neuroscience, University Hospital of Umeå, Umeå, Sweden
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16
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Bán EG, Dho-Nagy EA, Brassai AM. Effect of ractopamine on the release of dopamine from the striatum dissected from mice. Physiol Int 2022. [PMID: 36057103 DOI: 10.1556/2060.2022.00042] [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: 02/24/2022] [Revised: 04/04/2022] [Accepted: 05/16/2022] [Indexed: 02/18/2024]
Abstract
In the past two decades, ractopamine has been used as a feed additive to increase protein synthesis in farmed animals (swine, cattle, and turkeys) and to produce high-quality meat. However, the excessive feeding of animals with ractopamine may result in its accumulation in animal and human tissues after consuming the meat. Ractopamine is a trace amine-associated receptor1 and β-adrenoceptor agonist banned in the EU but approved in the USA, and it may pose a potential risk to human health. In this paper, the authors, for the first time, provide neurochemical evidence that ractopamine leads to the release of dopamine from nerve terminals of the nigrostriatal pathway in the striatum.
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Affiliation(s)
- Erika G Bán
- Department ME1, Faculty of Medicine in English, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Targu-Mures, Romania
| | - Eszter A Dho-Nagy
- Department ME1, Faculty of Medicine in English, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Targu-Mures, Romania
| | - Attila M Brassai
- Department ME1, Faculty of Medicine in English, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Targu-Mures, Romania
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17
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Treatment Satisfaction and Its Influencing Factors in Parkinson’s Disease: A Web-Based Survey of Patients and Physicians in Clinical Practice in Japan. PARKINSON'S DISEASE 2022; 2022:2732021. [PMID: 35251589 PMCID: PMC8890898 DOI: 10.1155/2022/2732021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 12/24/2021] [Indexed: 11/17/2022]
Abstract
Objective This study aimed to gain an understanding of patient and physician satisfaction with overall treatment and routine consultations for Parkinson's disease in clinical practice. Methods This observational, cross-sectional, web-based survey was conducted in Japan from February to March 2019. Eligible patients with Parkinson's disease (N = 186) and physicians who treat patients with Parkinson's disease (N = 331) were asked to evaluate their satisfaction with treatment, consultation, symptom control, and use of a symptom diary. Results Patients had a mean age of 62.7 years, 54.8% were male, and most (75.8%) had Hoehn and Yahr stage ≥3 symptoms. Physicians were mostly male (93.1%) and had treated 52 patients with Parkinson's disease in the last 6 months, and 34.1% were certified neurologists. There were significant gaps between patient and physician satisfaction with treatment and consultations. Patient and physician satisfaction with overall treatment was significantly lower for patients with Hoehn and Yahr stage ≥3 symptoms than stage 1-2 symptoms (patients: 53.9% vs. 71.1%; physicians: 43.2% vs. 69.7%, respectively). The proportion of patients who were satisfied with symptom control was lower than that of physicians (26.4% vs. 51.5%). Influencing factors for patient satisfaction with treatment were nonmotor symptoms (e.g., insomnia and depression). Satisfaction tended to be higher for patients and physicians when symptom diaries were used. Conclusion Significant gaps in perceptions of treatment and consultation exist between patients and physicians in Parkinson's disease. Physicians should participate in shared decision making with their patients and consider strategies for management of nonmotor symptoms and nonpharmacological therapies and encourage the use of symptom diaries.
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18
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Stefani A, Tessitore A, Tambasco N, Cossu G, Ceravolo MG, Defazio G, Morgante F, Ramat S, Melzi G, Gualberti G, Merolla R, Onuk K, Lopiano L. Criteria for identification of advanced Parkinson’s disease: the results of the Italian subgroup of OBSERVE-PD observational study. BMC Neurol 2022; 22:41. [PMID: 35090406 PMCID: PMC8796340 DOI: 10.1186/s12883-022-02554-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 11/09/2021] [Indexed: 02/05/2023] Open
Abstract
Background Frequency of Advanced Parkinson’s Disease (APD) and its clinical characteristics are still not well defined. Here, we aimed to assess APD prevalence in the Italian OBSERVE-PD cohort, as well as treatment eligibility to device-aided therapies (DAT), and to compare the APD clinical judgment with the established Delphi criteria. Methods This sub-group analysis of the OBSERVE-PD study was performed on patients enrolled by 9 Movement Disorders centers in Italy. Motor and non-motor symptoms, PD characteristics, activities of daily living, and quality of life were assessed. Patient eligibility for DAT, response to current PD treatments, referral process, and the concordance between APD physician’s judgment and Delphi criteria were also assessed. Results According to physician’s judgment, 60 out of 140 patients (43%) had APD. The correlation between physician’s judgment and the overall APD Delphi criteria was substantial (K = 0.743; 95%CI 0.633–0.853), mainly driven by a discrete concordance found for the presence of ≥ 2 h of daily OFF time, presence of troublesome dyskinesia, ≥ 5 times daily oral levodopa dosing, and activities of daily living limitation. Forty-four (73%) APD patients were considered eligible to DAT but only 18 of them (41%) used these therapies, while most patients, independently from their eligibility, continued to use 3–5 oral daily medications, due to fear of invasive solutions and need to have a longer time to decide. Conclusion APD was frequent in the Italian OBSERVE-PD population. DAT in the eligible APD population proved to be underused, in spite of unsatisfactory symptoms control with oral medications in 67% of patients.
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19
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Malaty IA, Martinez-Martin P, Chaudhuri KR, Odin P, Skorvanek M, Jimenez-Shahed J, Soileau MJ, Lindvall S, Domingos J, Jones S, Alobaidi A, Jalundhwala YJ, Kandukuri PL, Onuk K, Bergmann L, Femia S, Lee MY, Wright J, Antonini A. Does the 5-2-1 criteria identify patients with advanced Parkinson's disease? Real-world screening accuracy and burden of 5-2-1-positive patients in 7 countries. BMC Neurol 2022; 22:35. [PMID: 35073872 PMCID: PMC8785442 DOI: 10.1186/s12883-022-02560-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 01/19/2022] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND The burden of Parkinson's disease (PD) worsens with disease progression. However, the lack of objective and uniform disease classification challenges our understanding of the incremental burden in patients with advanced Parkinson's disease (APD) and suboptimal medication control. The 5-2-1 criteria was proposed by clinical consensus to identify patients with advancing PD. Our objective was to evaluate the screening accuracy and incremental clinical burden, healthcare resource utilization (HCRU), and humanistic burden in PD patients meeting the 5-2-1 screening criteria. METHODS Data were drawn from the Adelphi Parkinson's Disease Specific Program (DSP™), a multi-country point-in-time survey (2017-2020). People with PD who were naive to device-aided therapy and on oral PD therapy were included. Patients meeting the 5-2-1 screening criteria had one or more of the three clinical indicators of APD: (i) ≥5 doses of oral levodopa/day, OR (ii) "off" symptoms for ≥2 h of waking day, OR (iii) ≥1 h of troublesome dyskinesia. Clinician assessment of PD stage was used as the reference in this study. Clinical screening accuracy of the 5-2-1 criteria was assessed using area under the curve and multivariable logistic regression models. Incremental clinical, HCRU, and humanistic burden were assessed by known-group comparisons between 5 and 2-1-positive and negative patients. RESULTS From the analytic sample (n = 4714), 33% of patients met the 5-2-1 screening criteria. Among physician-classified APD patients, 78.6% were 5-2-1 positive. Concordance between clinician judgment and 5-2-1 screening criteria was > 75%. 5-2-1-positive patients were nearly 7-times more likely to be classified as APD by physician judgment. Compared with the 5-2-1-negative group, 5-2-1-positive patients had significantly higher clinical, HCRU, and humanistic burden across all measures. In particular, 5-2-1-positive patients had 3.8-times more falls, 3.6-times higher annual hospitalization rate, and 3.4-times greater dissatisfaction with PD treatment. 5-2-1-positive patients also had significantly lower quality of life and worse caregiver burden. CONCLUSIONS 5-2-1 criteria demonstrated potential as a screening tool for identifying people with APD with considerable clinical, humanistic, and HCRU burden. The 5-2-1 screening criteria is an objective and reliable tool that may aid the timely identification and treatment optimization of patients inadequately controlled on oral PD medications.
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Affiliation(s)
- Irene A. Malaty
- University of Florida, Fixel Institute for Neurological Diseases, Gainesville, FL USA
| | - Pablo Martinez-Martin
- Center for Networked Biomedical Research in Neurodegenerative Diseases (CIBERNED), Carlos III Institute of Health, Madrid, Spain
| | - K. Ray Chaudhuri
- Parkinson Foundation Centre of Excellence, King’s College Hospital and King’s College, London, UK
| | - Per Odin
- University of Lund, Lund, Sweden
| | - Matej Skorvanek
- Department of Neurology, P. J. Šafárik University, Košice, Slovakia
- Department of Neurology, University Hospital of L. Pasteur, Košice, Slovakia
| | - Joohi Jimenez-Shahed
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY USA
| | | | | | - Josefa Domingos
- European Parkinson’s Disease Association (EPDA), Sevenoaks, UK
- Grupo de patologia médica, nutrição e exercício clínico (PaMNEC) do CiiEM, Almada, Portugal
| | - Sarah Jones
- Parkinson & Movement Disorder Alliance, Tucson, USA
| | - Ali Alobaidi
- AbbVie Inc., North Chicago, IL USA
- University of Illinois at Chicago, Chicago, IL USA
| | | | | | | | | | | | | | | | - Angelo Antonini
- Parkinson and Movement Disorders Unit, Department of Neuroscience, University of Padua, Padova, Italy
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20
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Sakamaki T, Furusawa Y, Hayashi A, Otsuka M, Fernandez J. Remote Patient Monitoring for Neuropsychiatric Disorders: A Scoping Review of Current Trends and Future Perspectives from Recent Publications and Upcoming Clinical Trials. Telemed J E Health 2022; 28:1235-1250. [PMID: 35073206 PMCID: PMC9508442 DOI: 10.1089/tmj.2021.0489] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Introduction: Telemedicine and remote patient monitoring are rapidly growing fields. This scoping review provides an update on remote patient monitoring for neuropsychiatric disorders from recent publications and upcoming clinical trials. Methods: Publications (PubMed and ICHUSHI; published January 2010 to February 2021) and trials (ClinicalTrials.gov and Japanese registries; active or recruiting by March 2021) that assessed wearable devices for remote management and/or monitoring of patients with neuropsychiatric disorders were searched. The review focuses on disorders with ≥3 publications. Results: We identified 44 publications and 51 active or recruiting trials, mostly from 2019 or 2020. Research on digital devices was most common for Parkinson's disease (11 publications and 19 trials), primarily for monitoring motor symptoms and/or preventing falls. Other disorders (3–5 publications each) included epilepsy (electroencephalogram [EEG] and seizure prediction), sleep disorder (sleep outcomes and behavioral therapies), multiple sclerosis (physical activity and symptoms), depression (physical activity, symptoms, and behavioral therapies), and amyotrophic lateral sclerosis (symptoms). Very few studies focused on newly emerging technologies (e.g., in-ear EEG and portable oximeters), and few studies integrated remote symptom monitoring with telemedicine. Discussion: Currently, development of digital devices for daily symptom monitoring is focused on Parkinson's disease. For the diseases reviewed, studies mostly focused on physical activity rather than psychiatric or nonmotor symptoms. Although the validity and usefulness of many devices are established, models for implementing remote patient monitoring in telehealth settings have not been established. Conclusions: Verification of the clinical effectiveness of digital devices combined with telemedicine is needed to further advance remote patient care for neuropsychiatric disorders.
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Affiliation(s)
- Tetsuo Sakamaki
- Medical Informatics and Decision Sciences, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Yoshihiko Furusawa
- Japan Medical Office, Takeda Pharmaceutical Company Limited, Tokyo, Japan
| | - Ayako Hayashi
- Japan Medical Office, Takeda Pharmaceutical Company Limited, Tokyo, Japan
| | - Masaru Otsuka
- Enterprise Digital Lead, Takeda Pharmaceutical Company Limited, Tokyo, Japan
| | - Jovelle Fernandez
- Japan Medical Office, Takeda Pharmaceutical Company Limited, Tokyo, Japan
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21
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Thijssen E, den Heijer J, Puibert D, Moss L, Lei M, Hasegawa D, Keum K, Mochel K, Ezzeldin Sharaf M, Alfredson T, Zeng W, van Brummelen E, Naranda T, Groeneveld GJ. A Randomized Trial Assessing the Safety, Pharmacokinetics, and Efficacy During Morning Off of AZ-009. Mov Disord 2022; 37:790-798. [PMID: 35048423 PMCID: PMC9306836 DOI: 10.1002/mds.28926] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 12/23/2021] [Accepted: 12/27/2021] [Indexed: 01/23/2023] Open
Abstract
Background Inhalation of apomorphine could be a faster‐acting and more user‐friendly alternative to subcutaneous injection for treating off periods in Parkinson's disease (PD). Objective The aim of this study was to compare the safety and pharmacokinetics of inhaled apomorphine (AZ‐009) with subcutaneous apomorphine (APO‐go PEN) in healthy volunteers (HVs) and to examine the safety, pharmacokinetics, and efficacy of AZ‐009 in patients with PD. Methods In part A of this study, eight HVs received 1 mg AZ‐009 and 2 mg subcutaneous apomorphine in a randomized crossover manner. In the subsequent single ascending dose parts in HVs (part B, n = 16) and patients with PD (part C, n = 25), participants were randomized to placebo or AZ‐009 up to 4 mg. In patients, after medication withdrawal, Movement Disorder Society‐Unified Parkinson's Disease Rating Scale part III and on/off states were assessed predose and postdose. Results AZ‐009 was rapidly absorbed with peak plasma concentrations at 2 minutes, as compared to 30 minutes for subcutaneous apomorphine. Adverse events for AZ‐009 were comparable to subcutaneous apomorphine, except for mild and transient throat irritation. Adverse events limited AZ‐009 dose escalation in HVs to 3 mg. Patients tolerated up to 4 mg. In patients with PD, 2, 3, and 4 mg AZ‐009 reduced mean Movement Disorder Society‐Unified Parkinson's Disease Rating Scale part III score (standard deviation) by 10.7 (13.6), 12.8 (7.9), and 10.3 (3.7) points, respectively, compared to 4.8 (4.9) after placebo at 10 minutes postdose. The percentage of patients achieving full on within 45 minutes postdose increased dose dependently: 0% (placebo), 17% (2 mg), 50% (3 mg), and 83% (4 mg). Conclusions AZ‐009 appears to be a rapid‐acting and reasonably well‐tolerated formulation for treating off periods. © 2022 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society
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Affiliation(s)
- Eva Thijssen
- Centre for Human Drug Research (CHDR), Leiden, the Netherlands.,Leiden University Medical Centre (LUMC), Leiden, the Netherlands
| | - Jonas den Heijer
- Centre for Human Drug Research (CHDR), Leiden, the Netherlands.,Leiden University Medical Centre (LUMC), Leiden, the Netherlands
| | | | - Laurence Moss
- Centre for Human Drug Research (CHDR), Leiden, the Netherlands.,Leiden University Medical Centre (LUMC), Leiden, the Netherlands
| | - Mingzu Lei
- Alexza Pharmaceuticals, Mountain View, California, USA
| | | | - Kyo Keum
- Alexza Pharmaceuticals, Mountain View, California, USA
| | - Ken Mochel
- Alexza Pharmaceuticals, Mountain View, California, USA
| | | | - Tom Alfredson
- Alexza Pharmaceuticals, Mountain View, California, USA
| | - Wenxiang Zeng
- Alexza Pharmaceuticals, Mountain View, California, USA
| | | | | | - Geert Jan Groeneveld
- Centre for Human Drug Research (CHDR), Leiden, the Netherlands.,Leiden University Medical Centre (LUMC), Leiden, the Netherlands
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22
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Isaacson SH, Pagan FL, Lew MF, Pahwa R. Should “on-demand” treatments for Parkinson’s disease OFF episodes be used earlier? Clin Park Relat Disord 2022; 7:100161. [PMID: 36033905 PMCID: PMC9405081 DOI: 10.1016/j.prdoa.2022.100161] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 07/18/2022] [Accepted: 08/04/2022] [Indexed: 02/07/2023] Open
Abstract
OFF episodes are common in patients as Parkinson’s disease progresses. OFF episodes are typically managed with “ON-extenders” and changes in levodopa dosing. OFF episodes persist despite conventional treatment. “On-demand” therapies can rapidly improve OFF symptoms. A shift to earlier complementary use of “on-demand” therapies should be considered.
We discuss a shift in the treatment paradigm for OFF episode management in patients with Parkinson’s disease, based on clinical experience in the United States (US). Three “on-demand” treatments are currently available in the US as follows: subcutaneous apomorphine, levodopa inhalation powder, and sublingual apomorphine. We empirically propose that “on-demand” treatments can be utilized as a complementary treatment when OFF episodes emerge and can be utilized when needed rather than reserving these treatments only until other treatment approaches (adjustment of baseline treatment and/or addition of adjunctive treatment with “ON-extenders”) have failed. Current treatment approaches combine “ON-extenders” with increasing levodopa dosing and/or frequency to treat OFF episodes. Yet, OFF episodes often persist, with a substantial amount of daily OFF time. OFF episode treatment is hindered by variable gastrointestinal (GI) absorption of oral levodopa, reflecting GI dysmotility and protein competition. Novel “on-demand” treatments bypass the gut and can improve OFF symptoms more rapidly and reliably than oral levodopa. With the emergence of novel “on-demand” treatments, we conclude that a shift in treatment paradigm to the earlier, complementary use of these medications be considered.
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23
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Noncoding RNA Roles in Pharmacogenomic Responses to Aspirin: New Molecular Mechanisms for an Old Drug. BIOMED RESEARCH INTERNATIONAL 2021; 2021:6830560. [PMID: 34926688 PMCID: PMC8677408 DOI: 10.1155/2021/6830560] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 11/25/2021] [Indexed: 12/13/2022]
Abstract
Aspirin, as one of the most frequently prescribed drugs, can have therapeutic effects on different conditions such as cardiovascular and metabolic disorders and malignancies. The effects of this common cardiovascular drug are exerted through different molecular and cellular pathways. Altered noncoding RNA (ncRNA) expression profiles during aspirin treatments indicate a close relationship between these regulatory molecules and aspirin effects through regulating gene expressions. A better understanding of the molecular networks contributing to aspirin efficacy would help optimize efficient therapies for this very popular drug. This review is aimed at discussing and highlighting the identified interactions between aspirin and ncRNAs and their targeting pathways and better understanding pharmacogenetic responses to aspirin.
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24
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Pirooznia SK, Rosenthal LS, Dawson VL, Dawson TM. Parkinson Disease: Translating Insights from Molecular Mechanisms to Neuroprotection. Pharmacol Rev 2021; 73:33-97. [PMID: 34663684 DOI: 10.1124/pharmrev.120.000189] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Parkinson disease (PD) used to be considered a nongenetic condition. However, the identification of several autosomal dominant and recessive mutations linked to monogenic PD has changed this view. Clinically manifest PD is then thought to occur through a complex interplay between genetic mutations, many of which have incomplete penetrance, and environmental factors, both neuroprotective and increasing susceptibility, which variably interact to reach a threshold over which PD becomes clinically manifested. Functional studies of PD gene products have identified many cellular and molecular pathways, providing crucial insights into the nature and causes of PD. PD originates from multiple causes and a range of pathogenic processes at play, ultimately culminating in nigral dopaminergic loss and motor dysfunction. An in-depth understanding of these complex and possibly convergent pathways will pave the way for therapeutic approaches to alleviate the disease symptoms and neuroprotective strategies to prevent disease manifestations. This review is aimed at providing a comprehensive understanding of advances made in PD research based on leveraging genetic insights into the pathogenesis of PD. It further discusses novel perspectives to facilitate identification of critical molecular pathways that are central to neurodegeneration that hold the potential to develop neuroprotective and/or neurorestorative therapeutic strategies for PD. SIGNIFICANCE STATEMENT: A comprehensive review of PD pathophysiology is provided on the complex interplay of genetic and environmental factors and biologic processes that contribute to PD pathogenesis. This knowledge identifies new targets that could be leveraged into disease-modifying therapies to prevent or slow neurodegeneration in PD.
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Affiliation(s)
- Sheila K Pirooznia
- Neuroregeneration and Stem Cell Programs, Institute for Cell Engineering (S.K.P., V.L.D., T.M.D.), Departments of Neurology (S.K.P., L.S.R., V.L.D., T.M.D.), Departments of Physiology (V.L.D.), Solomon H. Snyder Department of Neuroscience (V.L.D., T.M.D.), Department of Pharmacology and Molecular Sciences (T.M.D.), Johns Hopkins University School of Medicine, Baltimore, Maryland; Adrienne Helis Malvin Medical Research Foundation, New Orleans, Louisiana (S.K.P., V.L.D., T.M.D.); and Diana Helis Henry Medical Research Foundation, New Orleans, Louisiana (S.K.P., V.L.D., T.M.D.)
| | - Liana S Rosenthal
- Neuroregeneration and Stem Cell Programs, Institute for Cell Engineering (S.K.P., V.L.D., T.M.D.), Departments of Neurology (S.K.P., L.S.R., V.L.D., T.M.D.), Departments of Physiology (V.L.D.), Solomon H. Snyder Department of Neuroscience (V.L.D., T.M.D.), Department of Pharmacology and Molecular Sciences (T.M.D.), Johns Hopkins University School of Medicine, Baltimore, Maryland; Adrienne Helis Malvin Medical Research Foundation, New Orleans, Louisiana (S.K.P., V.L.D., T.M.D.); and Diana Helis Henry Medical Research Foundation, New Orleans, Louisiana (S.K.P., V.L.D., T.M.D.)
| | - Valina L Dawson
- Neuroregeneration and Stem Cell Programs, Institute for Cell Engineering (S.K.P., V.L.D., T.M.D.), Departments of Neurology (S.K.P., L.S.R., V.L.D., T.M.D.), Departments of Physiology (V.L.D.), Solomon H. Snyder Department of Neuroscience (V.L.D., T.M.D.), Department of Pharmacology and Molecular Sciences (T.M.D.), Johns Hopkins University School of Medicine, Baltimore, Maryland; Adrienne Helis Malvin Medical Research Foundation, New Orleans, Louisiana (S.K.P., V.L.D., T.M.D.); and Diana Helis Henry Medical Research Foundation, New Orleans, Louisiana (S.K.P., V.L.D., T.M.D.)
| | - Ted M Dawson
- Neuroregeneration and Stem Cell Programs, Institute for Cell Engineering (S.K.P., V.L.D., T.M.D.), Departments of Neurology (S.K.P., L.S.R., V.L.D., T.M.D.), Departments of Physiology (V.L.D.), Solomon H. Snyder Department of Neuroscience (V.L.D., T.M.D.), Department of Pharmacology and Molecular Sciences (T.M.D.), Johns Hopkins University School of Medicine, Baltimore, Maryland; Adrienne Helis Malvin Medical Research Foundation, New Orleans, Louisiana (S.K.P., V.L.D., T.M.D.); and Diana Helis Henry Medical Research Foundation, New Orleans, Louisiana (S.K.P., V.L.D., T.M.D.)
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Hellmers N, Barkan S, Auerbach G, Hanineva A, Popa P, Sarva H, Henchcliffe C. Tablet-based patient educational interventions in care and management of complex movement disorders. Disabil Rehabil Assist Technol 2021:1-8. [PMID: 33784918 DOI: 10.1080/17483107.2021.1900934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Patient education is an essential part of management of complex, disabling neurological disorders. Mobile web-based educational materials provide a novel and potentially valuable means to communicate clinical information that can aid in both medical management and rehabilitation. AIMS We, therefore, evaluated an educational tablet-based intervention in three patient cohorts regarding the following topics: Parkinson's disease (PD) medications, dystonia and botulinum toxin treatment. METHODS A total of 50 subjects with PD, 32 with dystonia and 61 receiving botulinum toxin treatment for movement disorders or sialorrhoea were enrolled. Participants in each cohort completed a specific educational module at the time of their regularly scheduled clinic visit, comprising slides, in addition to pre- and post-module quizzes and a satisfaction survey. Additionally, participants in the dystonia and botulinum toxin modules were given a follow-up test at their 3- or 6-month clinical treatment visit. RESULTS There were 143 participants with 50 completing the PD module, 32 completing the dystonia module and 61 completing the botulinum toxin module. All three groups demonstrated significant improvement in knowledge of module content between their pre- and post-module test scores (PD: p=.0001, dystonia: p<.0001 and botulinum toxin: p=.008), and those who took the dystonia module maintained significant improvement at either a 3- or 6-month follow up compared to pre-module (p <.0001). CONCLUSIONS Tablet-based teaching modules are an effective means of communicating key concepts to patients. This study supports their use for improving patient understanding that can support lifelong approaches to managing disabling, neurological conditions.Implication for RehabilitationTablet-based modules are relatively easy to use for enhancing education during clinic visits and can possibly help reduce and maintain disability with chronic conditions like Parkinson's disease and dystonia.Improvements in post-test scores suggested that patient participants were able to retain information from the tablets about their complex and challenging conditions and treatments.Adding patients who are fluent in another language would have made this study more generalizable and future studies exploring educational interventions are warranted to help better tailor interventions to patients with chronic neurologic illnesses to help understand the complex aspects of their medical and rehabilitation therapy.The effect of cognitive changes in neurological conditions and understanding of educational information needs to be further tested.This positive result is especially meaningful during the COVID-19 pandemic when in-person access to both medical and rehabilitative care has been curtailed.
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Affiliation(s)
- Natalie Hellmers
- Department of Neurology, Weill Cornell Medicine, Parkinson's Disease and Movement Disorders Institute, New York, NY, USA
| | - Samantha Barkan
- Department of Neurology, Weill Cornell Medicine, Parkinson's Disease and Movement Disorders Institute, New York, NY, USA
| | - Gabrielle Auerbach
- Department of Neurology, Weill Cornell Medicine, Parkinson's Disease and Movement Disorders Institute, New York, NY, USA
| | - Aneliya Hanineva
- Department of Neurology, Weill Cornell Medicine, Parkinson's Disease and Movement Disorders Institute, New York, NY, USA
| | - Paul Popa
- Department of Neurology, Weill Cornell Medicine, Parkinson's Disease and Movement Disorders Institute, New York, NY, USA
| | - Harini Sarva
- Department of Neurology, Weill Cornell Medicine, Parkinson's Disease and Movement Disorders Institute, New York, NY, USA
| | - Claire Henchcliffe
- Department of Neurology, Weill Cornell Medicine, Parkinson's Disease and Movement Disorders Institute, New York, NY, USA
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Ghoraani B, Galvin JE, Jimenez-Shahed J. Point of view: Wearable systems for at-home monitoring of motor complications in Parkinson's disease should deliver clinically actionable information. Parkinsonism Relat Disord 2021; 84:35-39. [PMID: 33549914 PMCID: PMC8324321 DOI: 10.1016/j.parkreldis.2021.01.022] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 12/18/2020] [Accepted: 01/26/2021] [Indexed: 01/05/2023]
Affiliation(s)
- Behnaz Ghoraani
- Department of Computer and Electrical Engineering and Computer Science, Florida Atlantic University, Boca Raton, FL, 33431, USA.
| | - James E Galvin
- Comprehensive Center for Brain Health, Department of Neurology, University of Miami, Miami, FL, 33136, USA
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Szasz JA, Jianu DC, Simu MA, Constantin VA, Dulamea AO, Onuk K, Popescu D, Vasile MT, Popescu BO, Fasano A, Bajenaru OA. Characterizing Advanced Parkinson's Disease: Romanian Subanalysis from the OBSERVE-PD Study. PARKINSON'S DISEASE 2021; 2021:6635618. [PMID: 33564391 PMCID: PMC7850828 DOI: 10.1155/2021/6635618] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 12/22/2020] [Accepted: 01/12/2021] [Indexed: 01/10/2023]
Abstract
OBSERVE-PD was a cross-sectional, multicountry, observational study conducted in 128 Movement Disorders Centers (MDCs) in 18 countries. Overall, the study enrolled 2615 patients. The aim was to determine the proportion of patients with advanced Parkinson's disease (APD) versus non-APD from MDCs and to uncover the clinical burden of APD, as well as a correlation between overall assessment of APD and several indicators of APD. The advanced stage of the disease and severity were assessed by investigators using their clinical judgement. Data were collected during a single visit between February 2015 and January 2016. Agreement on physician judgement of APD diagnosis and fulfillment of at least one previously established APD indicator was calculated. Motor and nonmotor symptoms (NMSs), activities of daily living, treatment complications, quality of life (QoL), conventional treatments, and device-aided therapy (DAT) eligibility were assessed. Here, country-specific results of 161 Romanian patients with PD are presented. In total, 59.0% of patients were diagnosed with APD and 78.8% met at least one APD indicator. There was only moderate agreement between clinical judgement of APD and overall fulfillment of APD indicators. All scores related to motor symptoms, NMSs, and treatment complications, as well as to QoL, showed a higher disease burden for patients with APD versus non-APD. Physicians considered 73.7% of patients with APD eligible for DAT. The majority of patients eligible for DAT (54.3%) did not receive such treatment. Our results highlight the importance of earlier recognition of APD, by combining clinical judgement with more standardized clinical tools, such as generally recognized APD criteria. However, timely diagnosis of APD alone is not enough to improve patient outcomes. Other critical factors include patient acceptance and access to appropriate treatment.
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Affiliation(s)
- Jozsef Attila Szasz
- Department of Neurology, Mureș Emergency Clinical County Hospital, “George Emil Palade” University of Medicine, Pharmacy, Science and Technology, Târgu Mureș 540139, Romania
| | - Dragos Catalin Jianu
- Department of Neurology, “Victor Babes” University of Medicine and Pharmacy, Timisoara 300041, Romania
| | - Mihaela Adriana Simu
- Department of Neurology, “Victor Babes” University of Medicine and Pharmacy, Timisoara 300041, Romania
| | - Viorelia Adelina Constantin
- Department of Neurology, Mureș Emergency Clinical County Hospital, “George Emil Palade” University of Medicine, Pharmacy, Science and Technology, Târgu Mureș 540139, Romania
| | - Adriana Octaviana Dulamea
- Fundeni Clinical Institute, “Carol Davila” University of Medicine and Pharmacy, Bucharest 020021, Romania
| | - Koray Onuk
- AbbVie Inc., North Chicago, Chicago, IL 60064, USA
| | | | - Mihai-Titus Vasile
- Department of Neurology, University Emergency Hospital, “Carol Davila” University of Medicine and Pharmacy, Bucharest 020021, Romania
| | - Bogdan Ovidiu Popescu
- Department of Neurology, Colentina Clinical Hospital, “Carol Davila” University of Medicine and Pharmacy, Bucharest 020021, Romania
| | - Alfonso Fasano
- Edmond J. Safra Program in Parkinson's Disease and Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital and Division of Neurology, UHN, Division of Neurology, University of Toronto, Toronto, ON, Canada 7MCL-402
- Krembil Research Institute, Toronto, ON, Canada M5T0S8
| | - Ovidiu Alexandru Bajenaru
- Department of Neurology, University Emergency Hospital, “Carol Davila” University of Medicine and Pharmacy, Bucharest 020021, Romania
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Hamadjida A, Nuara SG, Frouni I, Kwan C, Bédard D, Gourdon JC, Huot P. Monoamine oxidase A inhibition as monotherapy reverses parkinsonism in the MPTP-lesioned marmoset. Naunyn Schmiedebergs Arch Pharmacol 2020; 393:2139-2144. [DOI: 10.1007/s00210-020-01927-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 06/17/2020] [Indexed: 11/30/2022]
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29
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Evans A, Fung VSC, O'Sullivan JD, Stell R, White R, Williams DR, Femia S, Onuk K. Characteristics of advanced Parkinson's disease patients seen in movement disorder clinics - Australian results from the cross-sectional OBSERVE study. Clin Park Relat Disord 2020; 4:100075. [PMID: 34316660 PMCID: PMC8299979 DOI: 10.1016/j.prdoa.2020.100075] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 10/13/2020] [Indexed: 11/25/2022] Open
Abstract
Objectives To evaluate the proportion of Parkinson's disease (PD) patients identified as having advanced Parkinson's disease (APD) according to physician's judgement in Australia. Methods This cross-sectional, non-interventional observational study was performed in movement disorder clinics from 18 countries. Results from Australia are presented. Participants included consecutive adults with PD attending routine clinical visits, or inpatients, who could speak English. The primary outcome was the proportion of patients diagnosed with APD via physician judgement. Results 100 patients were recruited in Australia: 61.0% (95% CI 51.4–70.6%) diagnosed with APD by physician judgement. Patients were 66.6 ± 8.5 years, 65% were male, were living at home (97%), and diagnosed with PD for median 10.7 years (0–30.5 years). Motor fluctuations were present in 68%. For those with APD, referral was predominantly to enable access to device assisted therapies (DAT) (49%), while for non-APD, referral was largely for diagnostic purposes (41%). Patients had a median follow-up at the movement disorder clinic of 4.8 years for those with APD, or 3.6 years for non-APD. While 62% were eligible for DAT, only two-thirds of these received them. The most commonly used DAT was deep brain stimulation (64.3%). There was fair agreement between physician's judgement and the APD criteria by Delphi method (Cohen's kappa) 0.325 (95% CI 0.150–0.500) in the Australian subset. Conclusions The definition of APD requires refinement in order to facilitate greater agreement among movement disorder specialists. A third of APD patients eligible for DAT remain untreated. Better referral and education of patients with APD is needed. The definition of advanced Parkinson's disease requires refinement. Device assisted therapy is recommended in advanced Parkinson's disease. A third of eligible patients are not receiving device assisted therapy. Better referral and education of advanced Parkinson's disease patients is needed.
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Affiliation(s)
- Andrew Evans
- Movement Disorders Program, Royal Melbourne Hospital, Australia
| | - Victor S C Fung
- Movement Disorders Unit, Department of Neurology, Westmead Hospital, Australia.,Sydney Medical School, University of Sydney, Australia
| | - John D O'Sullivan
- UQ Centre for Clinical Research, The University of Queensland, Australia.,Senior Visiting Neurologist Royal Brisbane & Women's Hospital, Australia
| | - Rick Stell
- Movement Disorders Clinic, Perron Institute, Australia
| | - Richard White
- Department of Neurology, Townsville Hospital, Australia
| | | | - Samira Femia
- Therapeutic Area Lead, AbbVie, United States of America
| | - Koray Onuk
- Study Designated Physician, AbbVie, United States of America
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Salamon A, Zádori D, Szpisjak L, Klivényi P, Vécsei L. Fixed-dose combination therapy for Parkinson’s disease with a spotlight on entacapone in the past 20 years: a reduced pill burden and a simplified dosing regime. Expert Opin Pharmacother 2020; 21:2265-2278. [DOI: 10.1080/14656566.2020.1806237] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- András Salamon
- Department of Neurology, Faculty of Medicine, Albert Szent-Györgyi Clinical Center, University of Szeged, Szeged, Hungary
| | - Dénes Zádori
- Department of Neurology, Faculty of Medicine, Albert Szent-Györgyi Clinical Center, University of Szeged, Szeged, Hungary
| | - László Szpisjak
- Department of Neurology, Faculty of Medicine, Albert Szent-Györgyi Clinical Center, University of Szeged, Szeged, Hungary
| | - Péter Klivényi
- Department of Neurology, Faculty of Medicine, Albert Szent-Györgyi Clinical Center, University of Szeged, Szeged, Hungary
| | - László Vécsei
- Department of Neurology, Faculty of Medicine, Albert Szent-Györgyi Clinical Center, University of Szeged, Szeged, Hungary
- Department of Neurology and Interdisciplinary Excellence Centre, Faculty of Medicine, MTA-SZTE Neuroscience Research Group, Szeged, Hungary
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31
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Maheshwary A, Mohite D, Omole JA, Bhatti KS, Khan S. Is Deep Brain Stimulation Associated With Detrimental Effects on Cognitive Functions in Patients of Parkinson's Disease? A Systematic Review. Cureus 2020; 12:e9688. [PMID: 32923280 PMCID: PMC7486084 DOI: 10.7759/cureus.9688] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 08/12/2020] [Indexed: 11/21/2022] Open
Abstract
Deep brain stimulation (DBS) is a rapidly evolving procedure with its application in multiple fields of neurology, but it is most prominent in Parkinson's disease (PD). Through electrode implantation in different areas of the brain, it brings a favorable change to the motor symptoms to the magnitude that none of the medications have been able to, but the effect on cognition of the patients is still unknown. We did a comprehensive search through PubMed and Cochrane databases and conducted a systematic review by following the PRISMA guidelines. Inclusion criteria were studies conducted only in PD patients, after the year 2008. The studies published in languages other than English were excluded. Thirteen studies, including randomized and non-randomized controlled trials, observational studies, and meta-analysis, were analyzed in detail. The results showed a declining trend in verbal fluency and attention domains of cognition, while other functions remained unchanged. The decline was significant but not enough to impact the quality index in patients. DBS is associated with worse performance in verbal fluency and attention, and there is a further need for studies focusing on these domains with long-term follow-up. The overall cognitive profile was not affected significantly.
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Affiliation(s)
- Ankush Maheshwary
- Neurology, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA
- Medicine, Mrs. Khushbir Kalra's Memorial Hospital, Amritsar, IND
| | - Divya Mohite
- Neurology, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA
| | - Janet A Omole
- Internal Medicine, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA
| | - Karandeep S Bhatti
- Neurology, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA
- Medicine, Mrs. Khushbir Kalra's Memorial Hospital, Amritsar, IND
| | - Safeera Khan
- Internal Medicine, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA
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Parkinsonian Symptoms, Not Dyskinesia, Negatively Affect Active Life Participation of Dyskinetic Patients with Parkinson's Disease. Tremor Other Hyperkinet Mov (N Y) 2020; 10:20. [PMID: 32775034 PMCID: PMC7394214 DOI: 10.5334/tohm.403] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Background: The impact of slight-to-moderate levodopa-induced dyskinesia (LID) on the level of participation in active life in patients with Parkinson’s disease (PD) has never been objectively determined. Methods: Levels of LID, tremor and bradykinesia were measured during best-ON state in 121 patients diagnosed with PD and having peak-dose LID using inertial sensors positioned on each body limb. Rigidity and postural instability were assessed using clinical evaluations. Cognition and depression were assessed using the MMSE and the GDS-15. Participation in active life was assessed in patients and in 69 healthy controls using the Activity Card Sort (ACS), which measures levels of activity engagement and activities affected by the symptomatology. Outcome measures were compared between patients and controls using ANCOVA, controlling for age or Wilcoxon-Mann-Whitney tests. Spearman correlations and multivariate analyses were then performed between symptomatology and ACS scores. Results: Patients had significantly lower activity engagement than controls and had significantly affected activities. LID was neither associated with activity engagement nor affected activities. Higher levels of tremor, postural instability, cognitive decline and depression were associated with lower activity engagement and higher affected activities. Multivariate analyses revealed that only tremor, postural instability and depression accounted significantly in the variances of these variables. Discussion: Slight-to-moderate LID had little impact compared to other symptoms on the level of participation in active life, suggesting that other symptoms should remain the treatment priority to maintain the level of participation of patients in an active lifestyle.
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Santos-García D, de Deus Fonticoba T, Suárez Castro E, Aneiros Díaz A, McAfee D. 5-2-1 Criteria: A Simple Screening Tool for Identifying Advanced PD Patients Who Need an Optimization of Parkinson's Treatment. PARKINSON'S DISEASE 2020; 2020:7537924. [PMID: 32269748 PMCID: PMC7128051 DOI: 10.1155/2020/7537924] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/16/2019] [Accepted: 03/02/2020] [Indexed: 01/10/2023]
Abstract
OBJECTIVE 5- (5 times oral levodopa tablet taken/day) 2- (2 hours of OFF time/day) 1- (1 hour/day of troublesome dyskinesia) criteria have been proposed by a Delphi expert consensus panel for diagnosing advanced Parkinson's disease (PD). The aim of the present study is to compare quality of life (QoL) in PD patients with "5-2-1 positive criteria" vs QoL in PD patients without "5-2-1 positive criteria" (defined as meeting ≥1 of the criteria). METHODS This is a cross-sectional, observational, monocenter study. Three different instruments were used to assess QoL: the 39-Item Parkinson's Disease Quality of Life Questionnaire Summary Index Score (PDQ-39SI); a subjective rating of perceived QoL (PQ-10); and the EUROHIS-QOL 8-Item Index (EUROHIS-QOL8). RESULTS From a cohort of 102 PD patients (65.4 ± 8.2 years old, 53.9% males; disease duration 4.7 ± 4.5 years), 20 (19.6%) presented positive 5-2-1 criteria: 6.9% for 5, 17.6% for 2, and 4.9% for 1. 37.5% (12/32) and 25% (5/20) of patients with motor complications and dyskinesia, respectively, presented 5-2-1 negative criteria. Both health-related (PDQ-39SI, 25.6 ± 14 vs 12.1 ± 9.2; p < 0.0001) and global QoL (PQ-10, 6.1 ± 2 vs 7.1 ± 1.3; p=0.007; EUROHIS-QOL8, 3.5 ± 0.5 vs 3.7 ± 0.4; p=0.034) were worse in patients with 5-2-1 positive criteria. Moreover, nonmotor symptoms burden (Non-Motor Symptoms Scale total score, 64.8 ± 44.8 vs 39.4 ± 35.1; p < 0.0001) and autonomy for activities of daily living (ADLS scale, 73.5 ± 13.1 vs 89.2 ± 9.3; p < 0.0001) were worse in patients with 5-2-1 positive criteria. Patient's principal caregiver's strain (Caregiver Stain Index, 4.3 ± 3 vs 1.5 ± 1.6; p < 0.0001), burden (Zarit Caregiver Burden Inventory, 28.4 ± 12.5 vs 10.9 ± 9.8; p < 0.0001), and mood (Beck Depression Inventory II, 12.2 ± 7.2 vs 6.2 ± 6.1; p < 0.0001) were worse in patients with 5-2-1 positive criteria as well. CONCLUSIONS QoL is worse in patients meeting ≥1 of the 5-2-1 criteria. This group of patients and their caregivers are more affected as a whole. These criteria could be useful for identifying patients in which it is necessary to optimize Parkinson's treatment.
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Affiliation(s)
- D. Santos-García
- Complejo Hospitalario Universitario de A Coruña (CHUAC), A Coruña, Spain
| | | | - E. Suárez Castro
- Complejo Hospitalario Universitario de Ferrol (CHUF), Ferrol, A Coruña, Spain
| | - A. Aneiros Díaz
- Complejo Hospitalario Universitario de Ferrol (CHUF), Ferrol, A Coruña, Spain
| | - D. McAfee
- University of Pennsylvania, Philadelphia, PA, USA
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Riesenberg R, Werth J, Zhang Y, Duvvuri S, Gray D. PF-06649751 efficacy and safety in early Parkinson's disease: a randomized, placebo-controlled trial. Ther Adv Neurol Disord 2020; 13:1756286420911296. [PMID: 32201505 PMCID: PMC7066585 DOI: 10.1177/1756286420911296] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Accepted: 12/02/2019] [Indexed: 11/03/2022] Open
Abstract
Background: PF-06649751 is a novel, oral, non-catechol-based, D1/D5 dopamine receptor partial agonist under investigation for the treatment of motor symptoms associated with Parkinson’s disease. Methods: A 15-week, phase II, double-blind, placebo-controlled clinical trial was conducted to assess the efficacy and safety of flexible-dose PF-06649751 in subjects with early stage Parkinson’s disease (ClinicalTrials.gov identifier: NCT02847650). Results: Enrollment was terminated early for reasons unrelated to the trial. Overall, 57 subjects received study medication (PF-06649751 = 29; placebo = 28) and 47 completed the study (PF-06649751 = 25; placebo = 22). Despite early termination, the study met its primary endpoint with the PF-06649751 group showing statistically significant improvement from baseline in the Movement Disorder Society-Unified Parkinson’s Disease Rating Scale (MDS-UPDRS) Part III score at week 15 compared with placebo. Mean (SE) change in MDS-UPDRS Part III score was −9.0 (1.54) for PF-06649751 and −4.3 (1.65) for placebo. This corresponds to an improvement versus placebo of 4.8 for the PF-06649751 group (two-sided p = 0.0407; 90% CI = 1.0, 8.6). Statistically significant improvement in MDS-UPDRS-III score was also observed at all assessment time points prior to week 15. The safety profile of PF-06649751 was similar to that observed in prior studies, with the majority of adverse events (AEs) reported as mild or moderate. The most common AEs in the PF-06649751 group were nausea, headache, dry mouth, somnolence, and tremor. Conclusions: Once-daily dosing of oral PF-06649751 resulted in significant improvement of motor symptoms and was generally well tolerated in subjects with early stage Parkinson’s disease.
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Affiliation(s)
| | - John Werth
- Pfizer Inc., 500 Arcola Road, Collegeville, PA 19426, USA
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Cabreira V, Soares-da-Silva P, Massano J. Contemporary Options for the Management of Motor Complications in Parkinson's Disease: Updated Clinical Review. Drugs 2019; 79:593-608. [PMID: 30905034 DOI: 10.1007/s40265-019-01098-w] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Parkinson's disease (PD) is a chronic, progressive condition affecting around 1% of the population older than 60 years. Upon long-term treatment with levodopa, the mainstay of treatment in PD, most patients, especially younger ones exposed to higher doses, will experience symptoms related to end-of-dose deterioration, peak-dose dyskinesias, and other motor fluctuations. Therapeutic strategies are grounded on modification of oral levodopa pharmacokinetics to extend levodopa benefit and development of new routes of drug delivery (e.g., levodopa/carbidopa intestinal gel infusion) or long-acting formulations of existing dopaminergic drugs to prolong the duration of striatal dopamine receptors stimulation. As our understanding of the pathophysiology of motor complications evolves, our therapeutic armamentarium is actively expanding and the focus of research is now actively pointing to the new non-dopaminergic agents acting both within the basal ganglia and in other brain regions (e.g., drugs acting on glutamate, GABA, serotonin, and calcium channels). Despite the fact that trials comparing the different therapeutic strategies are lacking, we aimed at devising practical evidence- and experience-guided suggestions for the clinical management of motor complications, emphasizing that this should always be an individualized endeavor. This review summarizes the pharmacological management of motor complications in PD, including new formulations and routes of delivery, and the newer released drugs such as istradefylline, opicapone, safinamide, and zonisamide. Advanced therapeutic strategies for selected cases such as treatment with apomorphine and surgical techniques (deep brain stimulation) are also discussed. A comprehensive knowledge of the available options and evidence is fundamental for the successful management of these challenging complications.
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Affiliation(s)
- Verónica Cabreira
- Department of Neurology, Centro Hospitalar Universitário de S. João, Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal.,Department of Clinical Neurosciences and Mental Health, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Patrício Soares-da-Silva
- Department of Biomedicine, Pharmacology and Therapeutics Unit, Faculty of Medicine, University of Porto, Porto, Portugal.,MedInUP, Center for Drug Discovery and Innovative Medicines, University of Porto, Porto, Portugal.,Department of Research and Development, BIAL, Portela & Cª S.A., S. Mamede do Coronado, Portugal
| | - João Massano
- Department of Neurology, Centro Hospitalar Universitário de S. João, Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal. .,Department of Clinical Neurosciences and Mental Health, Faculty of Medicine, University of Porto, Porto, Portugal.
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McKay JL, Hackney ME, Factor SA, Ting LH. Lower Limb Rigidity Is Associated with Frequent Falls in Parkinson's Disease. Mov Disord Clin Pract 2019; 6:446-451. [PMID: 31392245 PMCID: PMC6660233 DOI: 10.1002/mdc3.12784] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Revised: 05/03/2019] [Accepted: 05/12/2019] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND AND OBJECTIVE The role of muscle rigidity as an etiological factor of falls in Parkinson's disease (PD) is poorly understood. Our objective was to determine whether lower leg rigidity was differentially associated with frequent falls in PD compared to upper limb, neck, and total rigidity measures. METHODS We examined the associations between Unified Parkinson's Disease Rating Scale-Part III (motor) rigidity subscores and the history of monthly or more frequent falls in 216 individuals with PD (age, 66 ± 10 years; 36% female; disease duration, 7 ± 5 years) with logistic regression. RESULTS A total of 35 individuals were frequent fallers. Significant associations were identified between lower limb rigidity and frequent falls (P = 0.01) after controlling for age, sex, PD duration, total Unified Parkinson's Disease Rating Scale- Part III score, and presence of freezing of gait. No significant associations (P ≥ 0.14) were identified for total, arm, or neck rigidity. CONCLUSION Lower limb rigidity is related to frequent falls in people with PD. Further investigation may be warranted into how parkinsonian rigidity could cause falls.
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Affiliation(s)
- J. Lucas McKay
- The Wallace H. Coulter Department of Biomedical Engineering at Emory University and Georgia TechAtlantaGeorgiaUSA
| | - Madeleine E. Hackney
- Department of Medicine, Division of General Medicine and GeriatricsEmory University School of MedicineAtlantaGeorgiaUSA
- Rehabilitation R&D CenterAtlanta Veterans Affairs Medical CenterAtlantaGeorgiaUSA
| | - Stewart A. Factor
- Department of NeurologyEmory University School of MedicineAtlantaGeorgiaUSA
| | - Lena H. Ting
- The Wallace H. Coulter Department of Biomedical Engineering at Emory University and Georgia TechAtlantaGeorgiaUSA
- Department of Rehabilitation Medicine, Division of Physical TherapyEmory University School of MedicineAtlantaGeorgiaUSA
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Auto-sondages intermittents et rétentions urinaires des syndromes parkinsoniens. Prog Urol 2018; 28:987-992. [DOI: 10.1016/j.purol.2017.11.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Revised: 11/22/2017] [Accepted: 11/25/2017] [Indexed: 11/20/2022]
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Ahmed MR, Shaikh MA, Ul Haq SHI, Nazir S. Neuroprotective role of chrysin in attenuating loss of dopaminergic neurons and improving motor, learning and memory functions in rats. Int J Health Sci (Qassim) 2018; 12:35-43. [PMID: 29896070 PMCID: PMC5969782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Selective degeneration of dopaminergic neurons is the pathological hallmark of Parkinson disease (PD). Enhanced oxidative stress, lipid peroxidation and susceptibility of dopaminergic neurons to apoptotic cellular death are the leading pathogenetic mechanisms. Chrysin is an active flavonoid. Its neuroprotective effects have been reported. This study examined the neuroprotective effects of chrysin in ameliorating the dopaminergic neuronal degeneration and motor behavioral changes in rotenone model of PD. METHODS Thirty Sprague-Dawley rats were assigned into three groups: Control, rotenone-treated, and rotenone+chrysin treated groups. Rotenone was given at a dose of 3 mg/kg daily intraperitoneally, and chrysin was given at a dose of 50 mg/kg daily intraperitoneally for 4 weeks. Using five neurobehavioral assessment tests, evaluation was done weekly to record the motor behavioral changes. After 4 weeks, animals were sacrificed, brains were removed, and section from striatum and substantia nigra were stained using hematoxylin and eosin and cresyl violet stains. Immunohistochemical sections were also prepared using anti-tyrosine hydroxylase (TH) antibody. RESULTS Rotenone-induced Parkinson like changes were evident from deteriorating motor behavior. These animals showed extensive loss of dopaminergic neurons, decreased immunoreactivity against anti-TH antibodies and number of TH positive dopaminergic neurons in the nigrostriatal region. Chrysin treated animals showed a significant reduction in motor behavioral changes, degeneration and loss of nigrostriatal dopaminergic neurons and increased immunoreactivity to anti-TH antibody. CONCLUSION This study concludes that chrysin confers neuroprotection in rat model of PD. It attenuates the degeneration of the nigrostriatal dopaminergic neurons and motor behavioral abnormalities.
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Affiliation(s)
| | - Masood Ahmed Shaikh
- Department of Anatomy and Histology, College of Medicine, Qassim University, KSA,Address for correspondence: Masood Ahmed Shaikh, Department of Anatomy and Histology, College of Medicine, Qassim University, KSA. E-mail:
| | | | - Shakila Nazir
- Department of Biology, Baqai Dental College, Baqai Medical University, Karachi, Pakistan
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Dietrichs E, Odin P. Algorithms for the treatment of motor problems in Parkinson's disease. Acta Neurol Scand 2017; 136:378-385. [PMID: 28133726 PMCID: PMC5655734 DOI: 10.1111/ane.12733] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/05/2017] [Indexed: 12/17/2022]
Abstract
Several different strategies are effective for medical treatment of motor problems in Parkinson's disease (PD). Many guidelines and evidence-based reviews are available, but there is no documentation or consensus in favor of just one treatment strategy. This review presents two algorithms that may be helpful when deciding how to treat a PD patient at various stages of the disease. The first algorithm suggests one way to treat PD from the first onset of motor symptoms. It is largely based on treatment recommendations from the Scandinavian countries and Germany. The other algorithm is meant as assistance for choosing among the different device-aided treatments for advanced PD. There is not sufficient comparative data to recommend one particular line of treatment, neither in early PD nor in advanced disease with motor complications. Individualized treatment is needed for each patient. The current algorithms only represent an alternative for aiding treatment decisions.
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Affiliation(s)
- E. Dietrichs
- Department of NeurologyOslo University Hospital and University of OsloOsloNorway
| | - P. Odin
- Department of NeurologySkåne University HospitalUniversity of LundLundSweden
- Department of NeurologyKlinikum‐BremerhavenBremerhavenGermany
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Rocha PA, Slade SC, McClelland J, Morris ME. Dance is more than therapy: Qualitative analysis on therapeutic dancing classes for Parkinson's. Complement Ther Med 2017; 34:1-9. [PMID: 28917359 DOI: 10.1016/j.ctim.2017.07.006] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Revised: 07/17/2017] [Accepted: 07/18/2017] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVES To understand the benefits and limitations of therapeutic dancing classes for people with Parkinson's disease (PD) and how best to design and implement classes. DESIGN A stakeholder forum explored the opinions of 18 allied health clinicians, dance instructors, people with PD and caregivers. Data were thematically analysed and interpreted within a grounded theory framework. RESULTS Four main themes were identified: (1) the need to consider the stage of disease progression when designing classes; (2) recognition that dance is more than just therapy; (3) the benefits of carefully selecting music to move by; (4) ways to design classes that are both feasible and engaging. These themes give rise to the theory that dancing classes can provide more than just therapeutic benefits. Dance affords creative expression and enables people to immerse themselves in the art-form, rather than focussing on the disease. The results highlight the benefits of enabling individuals with PD to be able to express themselves in a supportive environment that does not see them solely through the lens of Parkinson's. The feasibility of dance programs can be increased by educating dancing teachers about PD and the unique needs of people living with this condition. CONCLUSION Well-structured dance classes can promote social-connectedness and joy, in addition to facilitating movement to music and physical activity. Consumers advised that careful planning of the classes and tailoring them to participant needs optimizes outcomes.
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Affiliation(s)
- Priscila A Rocha
- La Trobe Centre for Sport and Exercise Medicine Research, School Allied Health, College Science, Health & Engineering, La Trobe University, 3086, Australia; CAPES Foundation, Ministry of Education of Brazil, Brasília, DF 70040-020, Brazil.
| | - Susan C Slade
- La Trobe Centre for Sport and Exercise Medicine Research, School Allied Health, College Science, Health & Engineering, La Trobe University, 3086, Australia
| | - Jodie McClelland
- La Trobe Centre for Sport and Exercise Medicine Research, School Allied Health, College Science, Health & Engineering, La Trobe University, 3086, Australia
| | - Meg E Morris
- La Trobe Centre for Sport and Exercise Medicine Research, School Allied Health, College Science, Health & Engineering, La Trobe University, 3086, Australia; Healthscope, Northpark Private Hospital, Plenty Road Bundoora, 3083, Australia
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