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Südmeyer M, Pedrosa DJ, Siebecker F, Arlt C, Kopra JJ, Jost WH. Utilization of MANAGE-PD Tool in a Real-World Setting in Germany: A Cross-Sectional Study. Brain Sci 2024; 14:630. [PMID: 39061371 PMCID: PMC11275059 DOI: 10.3390/brainsci14070630] [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: 05/06/2024] [Revised: 06/18/2024] [Accepted: 06/19/2024] [Indexed: 07/28/2024] Open
Abstract
MANAGE-PD is a validated, web-based tool to assist physicians in identifying patients with Parkinson's disease (PD) whose symptoms are inadequately controlled by oral medication. Also, a modified patient version of MANAGE-PD (Parkinson Check) is available in Germany. However, prospective research into the clinical utility of MANAGE-PD is lacking. This non-interventional study aimed to assess the real-world clinical utility of the MANAGE-PD and Parkinson Check in PD patients attending a single visit at specialist clinics and neurologist practices in Germany in 2022. Participants' disease control was rated by the physicians using their own judgment, and by completing the MANAGE-PD, and by the patients completing the Parkinson Check. Concordance was calculated between the unassisted physician's assessment and the outcome of MANAGE-PD, as well as the Parkinson Check. A total of 278 patients from 19 sites were included in the analyses, of whom 160 patients (57.6%) were assigned to the same category of disease control by physicians' judgment and the MANAGE-PD. Concordance was higher in patients treated in specialist clinics (63.9%) than in neurologist practices (43.7%). Concordance between physicians' and patients' responses was high (>80%) for each question in the Parkinson Check. MANAGE-PD proved to be especially valuable for general neurologists in identifying patients who should be referred to specialist clinics. The Parkinson Check self-assessment generated promising outcomes that merit its more widespread use.
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Affiliation(s)
- Martin Südmeyer
- Department of Neurology, Ernst-von-Bergmann Klinikum, 14467 Potsdam, Germany
- Department of Neurology, Medical Faculty, University Düsseldorf, 40225 Düsseldorf, Germany
| | - David J. Pedrosa
- Department of Neurology, Philipps-University Marburg, 35037 Marburg, Germany;
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Singh L, Kaur H, Chandra Arya G, Bhatti R. Neuroprotective potential of formononetin, a naturally occurring isoflavone phytoestrogen. Chem Biol Drug Des 2024; 103:e14353. [PMID: 37722967 DOI: 10.1111/cbdd.14353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 08/17/2023] [Accepted: 09/04/2023] [Indexed: 09/20/2023]
Abstract
The increased prevalence of neurological illnesses is a burgeoning challenge to the public healthcare system and presents greater financial pressure. Formononetin, an O-methylated isoflavone, has gained a lot of attention due to its neuroprotective potential explored in several investigations. Formononetin is widely found in legumes and several types of clovers including Trifolium pratense L., Astragalus membranaceus, Sophora tomentosa, etc. Formononetin modulates various endogenous mediators to confer neuroprotection. It prevents RAGE activation that results in the inhibition of neuronal damage via downregulating the level of ROS and proinflammatory cytokines. Furthermore, formononetin also increases the expression of ADAM-10, which affects the pathology of neurodegenerative disease by lowering tau phosphorylation, maintaining synaptic plasticity, and boosting hippocampus neurogenesis. Besides these, formononetin also increases the expression of antioxidants, Nrf-2, PI3K, ApoJ, and LRP1. Whereas, reduces the expression of p65-NF-κB and proinflammatory cytokines. It also inhibits the deposition of Aβ and MAO-B activity. An inhibition of Aβ/RAGE-induced activation of MAPK and NOX governs the protection elicited by formononetin against inflammatory and oxidative stress-induced neuronal damage. Besides this, PI3K/Akt and ER-α-mediated activation of ADAM10, ApoJ/LRP1-mediated clearance of Aβ, and MAO-B inhibition-mediated preservation of dopaminergic neurons integrity are the major modulations produced by formononetin. This review covers the biosynthesis of formononetin and key molecular pathways modulated by formononetin to confer neuroprotection.
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Affiliation(s)
- Lovedeep Singh
- Department of Pharmaceutical Sciences, Guru Nanak Dev University, Amritsar, India
- University Institute of Pharma Sciences, Chandigarh University, Mohali, India
| | - Harpreet Kaur
- Department of Pharmaceutical Sciences, Guru Nanak Dev University, Amritsar, India
| | - Girish Chandra Arya
- University Institute of Pharma Sciences, Chandigarh University, Mohali, India
| | - Rajbir Bhatti
- Department of Pharmaceutical Sciences, Guru Nanak Dev University, Amritsar, India
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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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Auffret M, Weiss D, Stocchi F, Vérin M, Jost WH. Access to device-aided therapies in advanced Parkinson's disease: navigating clinician biases, patient preference, and prognostic uncertainty. J Neural Transm (Vienna) 2023; 130:1411-1432. [PMID: 37436446 PMCID: PMC10645670 DOI: 10.1007/s00702-023-02668-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 06/24/2023] [Indexed: 07/13/2023]
Abstract
Device-aided therapies (DAT), which include deep brain stimulation and pump-based continuous dopaminergic stimulation with either levodopa or apomorphine, are among the major advances in the clinical management of Parkinson's disease (PD). Although DAT are being increasingly offered earlier in the disease course, their classical indication remains advanced PD. Theoretically, every patient should be offered transition to DAT when faced with refractory motor and nonmotor fluctuations and functional decline. Worldwide clinical reality is far from these ideal, and, therefore, question the "real-world" equal opportunity of access to DAT for PD patients with advanced PD-even within a single health care system. Differences in access to care, referral pattern (timing and frequency), as well as physician biases (unconscious/implicit or conscious/explicit bias), and patients' preferences or health-seeking behaviour are to be considered. Compared to DBS, little information is available concerning infusion therapies, as well as neurologists' and patients' attitudes towards them. This viewpoint aims to be thought-provoking and to assist clinicians in moving through the process of DAT selection, by including in their decision algorithm their own biases, patient perspective, ethical concerns as well as the current unknowns surrounding PD prognosis and DAT-related long-term side effects for a given patient.
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Affiliation(s)
- Manon Auffret
- France Développement Electronique (FDE), Monswiller, France.
- Institut des Neurosciences Cliniques de Rennes (INCR), Rennes, France.
- Behavior and Basal Ganglia Research Unit, CIC-IT, CIC1414, Pontchaillou University Hospital and University of Rennes, Rennes, France.
| | - Daniel Weiss
- Centre for Neurology, Department for Neurodegenerative Diseases, Hertie-Institute for Clinical Brain Research, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany
| | - Fabrizio Stocchi
- University San Raffaele Roma and Institute of Research and Medical Care IRCCS San Raffaele Roma, Rome, Italy
| | - Marc Vérin
- Institut des Neurosciences Cliniques de Rennes (INCR), Rennes, France
- Behavior and Basal Ganglia Research Unit, CIC-IT, CIC1414, Pontchaillou University Hospital and University of Rennes, Rennes, France
- Neurology Department, Pontchaillou University Hospital, rue Henri Le Guilloux, 35000, Rennes, France
| | - Wolfgang H Jost
- Parkinson-Klinik Ortenau, Kreuzbergstr. 12-16, 77709, Wolfach, Germany
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Cabo-Lopez I, Puy-Nuñez A, Redondo-Rafales N, Teixeira Baltazar S, Calderón-Cruz B. Holter STAT-ON™ against other tools for detecting MF in advanced Parkinson's disease: an observational study. Front Neurol 2023; 14:1249385. [PMID: 37662044 PMCID: PMC10472943 DOI: 10.3389/fneur.2023.1249385] [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: 06/28/2023] [Accepted: 08/07/2023] [Indexed: 09/05/2023] Open
Abstract
Background Different screening tools to identify advanced Parkinson's disease (APD) have emerged in recent years. Among them, wearable medical devices, such as STAT-ON™, have been proposed to help to objectively detect APD. Objectives To analyze the correlation between STAT-ON™ reports and other assessment tools to identify APD and to assess the accuracy of screening tools in APD patients, using the STAT-ON™ as the gold standard. Methods In this retrospective, observational study, data from the University Hospital Complex of Pontevedra database on 44 patients with potential APD who wore STAT-ON™ were extracted. Data were collected according to different sources of tools for identifying APD: (1) STAT-ON™, (2) information provided by the patient, (3) questionnaire for advanced Parkinson's disease (CDEPA), (4) 5-2-1 Criteria, and (5) Making Informed Decisions to Aid Timely Management of Parkinson's Disease (MANAGE-PD). Considering STAT-ON™ recordings as a reference, the sensitivity, specificity, and positive and negative predictive values for each tool were calculated. The kappa index assessed the degree of agreement between the gold standard and the other instruments. Results Although no statistically significant association was found between STAT-ON™ recordings and any screening methods evaluated, the CDEPA questionnaire demonstrated the highest sensitivity and VPN values to detect patients with APD candidates for second-line therapy (SLT). According to the correlation analyses, MANAGE-PD demonstrated the highest degree of concordance with STAT-ON™ recordings to identify the SLT indication and to predict the SLT decision. Conclusion STAT-ON™ device may be a helpful tool to detect APD and to guide treatment decisions.
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Affiliation(s)
- Iria Cabo-Lopez
- Neurology Department, University Hospital Complex of Pontevedra, Galicia, Spain
| | - Alfredo Puy-Nuñez
- Neurology Department, University Hospital Complex of Pontevedra, Galicia, Spain
| | | | | | - Beatriz Calderón-Cruz
- Methodology and Statistics Unit, Galicia Sur Health Research Institute, Galicia, Spain
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Máñez‐Miró JU, Vivancos‐Matellano F, Alonso‐Frech F, Vela‐Desojo L, López‐Ariztegui N, López‐Manzanares L, Balaguer E, Martínez‐Castrillo JC, Herrero‐Infante Y, Gasca‐Salas C, Morales‐Casado MI, Casas E, Hernández A, Pareés I, Tegel‐Ayuela I, Martínez‐Fernández R, Martinez‐Martin P. Validation of the OPTIMIPARK Questionnaire: A Tool to Optimize Treatment in Parkinson's Disease. Mov Disord Clin Pract 2022; 9:1085-1093. [PMID: 36339297 PMCID: PMC9631843 DOI: 10.1002/mdc3.13581] [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: 05/17/2022] [Revised: 08/01/2022] [Accepted: 08/28/2022] [Indexed: 11/10/2022] Open
Abstract
Background Dopamine replacement therapy reduces most motor and nonmotor features of Parkinson's disease. However, with disease progression, adjustments of dopaminergics and the application of advanced therapies must be considered. Objectives To validate the OPTIMIPARK questionnaire as a tool to help clinicians make therapeutic decisions on patients treated with levodopa. Methods We tested a questionnaire including 9 items encompassing motor and nonmotor signs, complications, and disability in a multicenter, observational, cross-sectional study. A neurologist (neurologist 1 [N1]) assessed patients according to regular clinical practice and blinded to the OPTIMIPARK questionnaire score. Therapeutic decisions were classified as "no changes," "adjustment of conventional treatment," and "advanced therapy indicated." External neurologists (neurologist 3 [N3] and neurologist 4 [N4]), who only knew the patient age, years of disease, and current treatment, made their therapeutic decisions based on the OPTIMIPARK score. Concordance between the criterion of the N1 versus the OPTIMIPARK-based N3-N4 consensus was analyzed applying weighted κ. The area under Receiving Operating Characteristic (ROC) curves was calculated for OPTIMIPARK scores. Results A total of 113 patients with Parkinson's disease were included. The OPTIMIPARK-based decision led to a higher proportion of patients requiring therapeutic modification than N1 assessment (74% vs. 60%; P = 0.002). Concordance between the N1 and N3-N4 decisions was moderate, whereas interobserver agreement among N3 and N4 was high. Area Under the Curve(AUC) values of 0.83 and 0.82 were found for "no changes" and "advanced therapy indicated" decisions by the N1 neurologist. Conclusions OPTIMIPARK might be more sensitive than regular clinical practice in suggesting the need for a therapeutic change. Furthermore, the low and high scores identify with high accuracy well-adjusted patients and candidates for advanced therapy, respectively.
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Affiliation(s)
| | - Francisco Vivancos‐Matellano
- Department of Neurology, Movement Disorders Unit, Hospital Universitario La PazUniversidad Autónoma de MadridMadridSpain
| | - Fernando Alonso‐Frech
- Department of Neurology, Movement Disorders Unit, Hospital Clínico San Carlos, San Carlos Research Health Institute (IdISSC)Universidad ComplutenseMadridSpain
| | - Lydia Vela‐Desojo
- Department of NeurologyHospital Universitario Fundación AlcorcónMadridSpain
| | - Nuria López‐Ariztegui
- Department of Neurology, Movement Disorders UnitHospital Universitario de ToledoToledoSpain
| | - Lydia López‐Manzanares
- Department of Neurology, Movement Disorders UnitHospital Universitario La PrincesaMadridSpain
| | - Ernest Balaguer
- Department of NeurologyHospital General de Catalunya, Sant Cugat del Vallés Research Director, Hospital Universitari General de Catalunya, Hospital Universitari Sagrat Cor, Hospital Quirónsalud del VallèsBarcelonaSpain
| | | | - Yolanda Herrero‐Infante
- Department of Neurology, Movement Disorders Unit, Hospital Universitario La PazUniversidad Autónoma de MadridMadridSpain
| | - Carmen Gasca‐Salas
- HM CINAC Madrid (Centro Integral de Neurociencias Abarca Campal)Hospital Universitario HM Puerta del Sur, HM HospitalesMadridSpain
| | | | - Elena Casas
- Department of Neurology, Movement Disorders UnitHospital Universitario La PrincesaMadridSpain
| | - Antonio Hernández
- Department of NeurologyHospital General de Catalunya, Sant Cugat del Vallés Research Director, Hospital Universitari General de Catalunya, Hospital Universitari Sagrat Cor, Hospital Quirónsalud del VallèsBarcelonaSpain
| | - Isabel Pareés
- Movement Disorders and Neurodegenerative Diseases Unit, IRYCISHospital Ramón y CajalMadridSpain
| | | | - Raul Martínez‐Fernández
- HM CINAC Madrid (Centro Integral de Neurociencias Abarca Campal)Hospital Universitario HM Puerta del Sur, HM HospitalesMadridSpain
| | - Pablo Martinez‐Martin
- Centre for Networked Biomedical Research in Neurodegenerative DiseasesCarlos III Institute of HealthMadridSpain
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Gurevich T, Arkadir D, Badarny S, Benizri S, Cohen O, Djaldetti R, Hassin-Baer S, Kestenbaum M, Nitsan Z, Zlotnik Y, Yahalom G. Management of advanced Parkinson’s disease in Israel: Clinicians viewpoint and action items. Front Aging Neurosci 2022; 14:1029824. [DOI: 10.3389/fnagi.2022.1029824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Accepted: 09/12/2022] [Indexed: 11/13/2022] Open
Abstract
Parkinson’s disease (PD) is taking a staggering toll on healthcare systems worldwide, with the bulk of the expenditures invested in the late stages of the disease. Considering the rising life expectancy and the increasing prevalence of PD across the globe, a clear understanding of the early signs and treatment options available for advanced PD (APD), will facilitate tailoring management programs and support services. This task is complicated by the lack of both global consensus in defining APD and standardized care guidelines. This perspective prepared by a panel of movement disorder specialists, proposes to extend and optimize currently accepted PD coding to better reflect the diverse disease manifestations, with emphasis on non-motor features. The panel seeks to promote timely diagnosis by adjustment of evaluation tools for use by community neurologists and suggests modification of eligibility criteria for advanced therapy. Moreover, it advocates multidisciplinary assessments of APD patients to drive personalized, patient-centered and holistic management. Overall, earlier and more targeted intervention is expected to markedly improve patient quality of life.
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Chaudhuri KR, Pickard AS, Alobaidi A, Jalundhwala YJ, Kandukuri PL, Bao Y, Sus J, Jones G, Ridley C, Oddsdottir J, Najle-Rahim S, Madin-Warburton M, Xu W, Schrag A. The Cost Effectiveness of Levodopa-Carbidopa Intestinal Gel in the Treatment of Advanced Parkinson's Disease in England. PHARMACOECONOMICS 2022; 40:559-574. [PMID: 35307793 PMCID: PMC9095547 DOI: 10.1007/s40273-022-01132-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 01/23/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Parkinson's disease is a progressive neurodegenerative disease, which significantly impacts patients' quality of life and is associated with high treatment and direct healthcare costs. In England, levodopa/carbidopa intestinal gel (LCIG) is indicated for the treatment of levodopa-responsive advanced Parkinson's disease with troublesome motor fluctuations when available combinations of medicinal products are unsatisfactory. OBJECTIVE We aimed to determine the cost effectiveness of LCIG compared to the standard of care for patients with advanced Parkinson's disease in England, using real-world data. METHODS A Markov model was adapted from previous published studies, using the perspective of the English National Health System and Personal and Social Services to evaluate the cost effectiveness of LCIG compared to standard of care in patients with advanced Parkinson's disease over a 20-year time horizon. The model comprised 25 health states, defined by a combination of the Hoehn and Yahr scale, and waking time spent in OFF-time. The base case considered an initial cohort of patients with an Hoehn and Yahr score of ≥ 3, and > 4 h OFF-time. Standard of care comprised standard oral therapies, and a proportion of patients were assumed to be treated with subcutaneous apomorphine infusion or injection in addition to oral therapies. Efficacy inputs were based on LCIG clinical trials where possible. Resource use and utility values were based on results of a large-scale observational study, and costs were derived from the latest published UK data, valued at 2017 prices. The EuroQol five-dimensions-3-level (EQ-5D-3L) instrument was used to measure utilities. Costs and quality-adjusted life-years were discounted at 3.5%. Both deterministic and probabilistic sensitivity analyses were conducted. RESULTS Total costs and quality-adjusted life-years gained for LCIG vs standard of care were £586,832 vs £554,022, and 2.82 vs 1.43, respectively. The incremental cost-effectiveness ratio for LCIG compared to standard of care was £23,649/quality-adjusted life-year. Results were sensitive to the healthcare resource utilisation based on real-world data, and long-term efficacy of LCIG. CONCLUSIONS The base-case incremental cost-effectiveness ratio was estimated to be within the acceptable thresholds for cost effectiveness considered for England.
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Affiliation(s)
- K. Ray Chaudhuri
- Department of Basic and Clinical Neuroscience, The Maurice Wohl Clinical Neuroscience Institute, King’s College London, Cutcombe Road, London, SE5 9RT UK
| | | | - Ali Alobaidi
- University of Illinois at Chicago, Chicago, IL USA
- AbbVie Inc., North Chicago, IL USA
| | | | | | | | - Julia Sus
- AbbVie Ltd, Maidenhead, Berkshire UK
| | | | | | | | | | | | | | - Anette Schrag
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, University College London, London, UK
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Thaler A, Barer Y, Gross R, Cohen R, Bergmann L, Jalundhwala YJ, Giladi N, Chodick G, Shalev V, Gurevich T. Long-Term Persistence and Monotherapy with Device-Aided Therapies: A Retrospective Analysis of an Israeli Cohort of Patients with Advanced Parkinson's Disease. Adv Ther 2022; 39:2009-2024. [PMID: 35247187 PMCID: PMC9056469 DOI: 10.1007/s12325-022-02072-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 02/02/2022] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Patients with advanced Parkinson's disease (PD) may require device-aided therapies (DAT) for adequate symptom control. However, long-term, real-world efficacy and safety data are limited. This study aims to describe real-world, long-term treatment persistence for patients with PD treated with levodopa-carbidopa intestinal gel (LCIG). The study also aims to describe patient profiles, treatment discontinuation rates, co-medication patterns, monotherapy rates, and rates of healthcare visits and their associated costs for patients receiving all forms of DAT (deep brain stimulation [DBS], continuous subcutaneous apomorphine infusion [CSAI], or LCIG). METHODS In this retrospective analysis of the Israeli Maccabi Healthcare Services database, adult patients with PD were analyzed in three cohorts, based on DAT (DBS, CSAI, or LCIG). The primary endpoint was LCIG treatment persistence 12 months after initiation. RESULTS This analysis included 161 DAT-treated patients (LCIG, n = 62; DBS, n = 76; CSAI, n = 23). Among those who discontinued, the mean time to discontinuation was 86.4 months for LCIG and 42.4 months for CSAI (p = 0.046). Twelve months after initiation, 14.3% LCIG, 10.7% DBS, and 5.9% CSAI patients were not receiving any additional anti-parkinsonian therapy. At the last recorded visit, 28.6% LCIG, 13.3% DBS, and 5.9% CSAI patients received DAT as monotherapy. During the first 12 months after initiation, 45.2% LCIG, 65.2% CSAI, and 1.3% DBS patients had no reported hospitalization days. Annual healthcare visit costs decreased following LCIG initiation (US$9491 vs. $8146) and increased following DBS ($4113 vs. $7677) and CSAI ($6378 vs. $8277). CONCLUSION DAT are well maintained in patients with advanced PD. These retrospective data suggest that patients receiving LCIG may have higher long-term persistence rates compared with patients receiving CSAI. A subgroup of patients was treated with DAT as monotherapy without additional oral anti-parkinsonian therapy, with LCIG showing the highest rates.
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Affiliation(s)
- Avner Thaler
- Movement Disorders Unit, Neurological Institute, Tel Aviv Sourasky Medical Center, 6 Weizmann St, 64239, Tel Aviv, Israel.
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
- Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel.
| | - Yael Barer
- MaccabiTech, Maccabi Institute for Research and Innovation, Tel Aviv, Israel
| | | | | | | | | | - Nir Giladi
- Movement Disorders Unit, Neurological Institute, Tel Aviv Sourasky Medical Center, 6 Weizmann St, 64239, Tel Aviv, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
| | - Gabriel Chodick
- MaccabiTech, Maccabi Institute for Research and Innovation, Tel Aviv, Israel
- School of Public Health, Tel Aviv University, Tel Aviv, Israel
| | - Varda Shalev
- MaccabiTech, Maccabi Institute for Research and Innovation, Tel Aviv, Israel
| | - Tanya Gurevich
- Movement Disorders Unit, Neurological Institute, Tel Aviv Sourasky Medical Center, 6 Weizmann St, 64239, Tel Aviv, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
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Barer Y, Gurevich T, Chodick G, Giladi N, Gross R, Cohen R, Bergmann L, Jalundhwala YJ, Shalev V, Grabarnik‐John M, Thaler A. Advanced‐Stage
Parkinson's disease: From Identification to Characterization Using a Nationwide Database. Mov Disord Clin Pract 2022; 9:458-467. [PMID: 35586537 PMCID: PMC9092754 DOI: 10.1002/mdc3.13458] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 02/13/2022] [Accepted: 04/05/2022] [Indexed: 11/06/2022] Open
Abstract
Background As Parkinson's disease (PD) progresses, response to oral medications decreases and motor complications appear. Timely intervention has been demonstrated as effective in reducing symptoms. However, current instruments for the identification of these patients are often complicated and inadequate. It has been suggested that anti-PD intensified therapy (IT) can serve as a proxy for increased burden of disease. Objective To explore whether IT aligns with events reflecting advanced PD (APD) burden. Methods This was a retrospective analysis of PD beneficiaries in the second-largest healthcare provider in Israel. Patients with PD diagnosed between January 2000 and June 2018 and treated with levodopa (l-dopa) ≥5 times/day and/or ≥1000 mg l-dopa equivalent daily dose were defined as the IT cohort (n = 2037). Treated patients with PD not fulfilling this criterion were defined as the nonintensified therapy (NIT) cohort (n = 3402). Point prevalence and 5- and 10-year cumulative incidence of IT were assessed. Baseline demographic and comorbidities, 1-year healthcare resource use, health costs, and time to clinical events were assessed and compared between cohorts. Results IT was associated with significantly (P < 0.05) higher healthcare resource use compared with NIT. In turn, IT patients incurred higher healthcare costs (P < 0.001) and were at greater risk for mortality, hospitalization, disability, and device-aided therapy use (P < 0.001, for all comparisons). Conclusions Treatment intensity can serve as an objective and robust indicator of more APD. This readily extractable marker can be easily integrated into electronic medical record alerts to actively target more advanced patients and to guide risk-appropriate care.
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Affiliation(s)
- Yael Barer
- Maccabitech Maccabi Institute for Research and Innovation Israel
| | - Tanya Gurevich
- Tel Aviv Sourasky Medical Center Israel
- Sackler School of Medicine Tel Aviv University
- Sagol School of Neuroscience Tel Aviv University
| | - Gabriel Chodick
- Maccabitech Maccabi Institute for Research and Innovation Israel
- Sackler School of Medicine Tel Aviv University
| | - Nir Giladi
- Tel Aviv Sourasky Medical Center Israel
- Sackler School of Medicine Tel Aviv University
- Sagol School of Neuroscience Tel Aviv University
| | | | | | | | | | | | | | - Avner Thaler
- Tel Aviv Sourasky Medical Center Israel
- Sackler School of Medicine Tel Aviv University
- Sagol School of Neuroscience Tel Aviv University
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Antonini A, Pahwa R, Odin P, Henriksen T, Soileau MJ, Rodriguez-Cruz R, Isaacson SH, Merola A, Lindvall S, Domingos J, Alobaidi A, Jalundhwala YJ, Kandukuri PL, Parra JC, Kukreja PK, Onuk K, Bergmann L, Pike J, Ray Chaudhuri K. Psychometric Properties of Clinical Indicators for Identification and Management of Advanced Parkinson's Disease: Real-World Evidence From G7 Countries. Neurol Ther 2022; 11:303-318. [PMID: 35015215 PMCID: PMC8857339 DOI: 10.1007/s40120-021-00313-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 12/08/2021] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Standardized and validated criteria to define advanced Parkinson's disease (PD) or identify patient eligibility for device-aided therapy are needed. This study assessed the psychometric properties of clinical indicators of advanced PD and eligibility for device-aided therapy in a large population. METHODS This retrospective analysis of the Adelphi Parkinson's Disease Specific Programme collected data from device-aided therapy-naïve people with PD in G7 countries. We assessed the presence of 15 clinical indicators of advancing PD and seven indicators of eligibility for device-aided therapy in patients classified with advanced PD or as eligible for device-aided therapy by the treating physician. Accuracy was assessed using area under the curve (AUC) and multivariable logistic regression models. Construct validity was examined via known-group comparisons of disease severity and burden among patients with and without each clinical indicator. RESULTS Of 4714 PD patients, 14.9% were classified with advanced PD and 17.5% as eligible for device-aided therapy by physician judgment. The presence of each clinical indicator was 1.9- to 7.3-fold more likely in patients classified with advanced PD. Similarly, the presence of device-aided therapy eligibility indicators was 1.8- to 5.5-fold more likely in patients considered eligible for device-aided therapy. All indicators demonstrated high clinical screening accuracy for identifying advanced PD (AUC range 0.84-0.89) and patients eligible for device-aided therapy (AUC range 0.73-0.80). The Unified Parkinson's Disease Rating Scale (UPDRS) score, cognitive function, quality of life, and caregiver burden were significantly worse in indicator-positive patients. CONCLUSION Specific clinical indicators of advanced PD and eligibility for device-aided therapy demonstrated excellent psychometric properties in a large sample, and thus may provide an objective and reliable approach for patient identification and treatment optimization.
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Affiliation(s)
- Angelo Antonini
- Parkinson and Movement Disorders Unit, Study Centre for Neurodegeneration, Department of Neuroscience, University of Padova, Padova, Italy
| | - Rajesh Pahwa
- Medical Center, University of Kansas, Kansas, KS, USA
| | - Per Odin
- University of Lund, Lund, Sweden
| | - Tove Henriksen
- Movement Disorder Clinic, University Hospital of Bispebjerg, Copenhagen, Denmark
| | | | | | - Stuart H Isaacson
- Parkinson's Disease and Movement Disorders Center, Boca Raton, FL, USA
| | - Aristide Merola
- Madden Center for Parkinson Disease and Other Movement Disorders, Department of Neurology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | | | - Josefa Domingos
- European Parkinson's Disease Association, Sevenoaks, UK
- Grupo de Patologia Médica, Nutrição e Exercício Clínico (PaMNEC) do CiiEM, Almada, Portugal
| | - Ali Alobaidi
- AbbVie Inc., North Chicago, IL, USA
- University of Illinois at Chicago, Chicago, IL, USA
| | | | | | | | | | | | | | - James Pike
- Adelphi Real World, Adelphi Mill, Bollington, UK
| | - K Ray Chaudhuri
- King's College and Parkinson Foundation Centre of Excellence, Kings College Hospital London, London, UK.
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12
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Antonini A, Pahwa R, Odin P, Isaacson SH, Merola A, Wang L, Kandukuri PL, Alobaidi A, Yan CH, Bao Y, Zadikoff C, Parra JC, Bergmann L, Chaudhuri KR. Comparative Effectiveness of Device-Aided Therapies on Quality of Life and Off-Time in Advanced Parkinson's Disease: A Systematic Review and Bayesian Network Meta-analysis. CNS Drugs 2022; 36:1269-1283. [PMID: 36414908 PMCID: PMC9712309 DOI: 10.1007/s40263-022-00963-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/29/2022] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Research comparing levodopa/carbidopa intestinal gel (LCIG), deep brain stimulation (DBS), and continuous subcutaneous apomorphine infusion (CSAI) for advanced Parkinson's disease (PD) is lacking. This network meta-analysis (NMA) assessed the comparative effectiveness of LCIG, DBS, CSAI and best medical therapy (BMT) in reducing off-time and improving quality of life (QoL) in patients with advanced PD. METHODS A systematic literature review was conducted for randomized controlled trials (RCTs), observational and interventional studies from January 2003 to September 2019. Data extracted at baseline and 6 months were off-time, as reported by diary or Unified Parkinson's Disease Rating Scale Part IV item 39, and QoL, as reported by Parkinson's Disease Questionnaire (PDQ-39/PDQ-8). Bayesian NMA was performed to estimate pooled treatment effect sizes and to rank treatments in order of effectiveness. RESULTS A total of 22 studies fulfilled the inclusion criteria (n = 2063 patients): four RCTs, and 16 single-armed, one 2-armed and one 3-armed prospective studies. Baseline mean age was between 55.5-70.9 years, duration of PD was 9.1-15.3 years, off-time ranged from 5.4 to 8.7 h/day in 9 studies, and PDQ scores ranged from 28.8 to 67.0 in 19 studies. Levodopa/carbidopa intestinal gel and DBS demonstrated significantly greater improvement in off-time and QoL at 6 months compared with CSAI and BMT (p < 0.05). There was no significant difference in the effects of LCIG and DBS, but DBS was ranked first for reduction in off-time, and LCIG was ranked first for improvement in QoL. CONCLUSIONS This NMA found that LCIG and DBS were associated with superior improvement in off-time and PD-related QoL compared with CSAI and BMT at 6 months after treatment initiation. This comparative effectiveness research may assist providers, patients, and caregivers in the selection of the optimal device-aided therapy.
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Affiliation(s)
- Angelo Antonini
- Parkinson and Movement Disorders Unit, Department of Neuroscience, Study Center for Neurodegeneration (CESNE), University of Padova, 35128, Padua, Italy.
| | - Rajesh Pahwa
- Medical Center, University of Kansas, Kansas City, KS USA
| | - Per Odin
- University of Lund, Lund, Sweden
| | | | - Aristide Merola
- Department of Neurology, The Ohio State University Wexner Medical Center, Columbus, OH USA
| | - Lin Wang
- AbbVie Inc., North Chicago, IL USA ,Johns Hopkins School of Public Health, Baltimore, MD USA
| | | | - Ali Alobaidi
- AbbVie Inc., North Chicago, IL USA ,University of Illinois at Chicago, Chicago, IL USA
| | - Connie H. Yan
- AbbVie Inc., North Chicago, IL USA ,University of Illinois at Chicago, Chicago, IL USA
| | | | | | | | | | - K. Ray Chaudhuri
- King’s College and Parkinson Foundation Centre of Excellence, Kings College Hospital London, London, UK
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13
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Santos García D, Álvarez Sauco M, Calopa M, Carrillo F, Escamilla Sevilla F, Freire E, García Ramos R, Kulisevsky J, Gómez Esteban JC, Legarda I, Luquín MRI, Castrillo JCM, Martínez-Martin P, Martínez-Torres I, Mir P, Ignacio ÁS. MNCD: A New Tool for Classifying Parkinson’s Disease in Daily Clinical Practice. Diagnostics (Basel) 2021; 12:diagnostics12010055. [PMID: 35054222 PMCID: PMC8774369 DOI: 10.3390/diagnostics12010055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Revised: 12/19/2021] [Accepted: 12/23/2021] [Indexed: 11/16/2022] Open
Abstract
Background and objective: Parkinson’s disease (PD) is a clinically heterogeneous disorder in which the symptoms and prognosis can be very different among patients. We propose a new simple classification to identify key symptoms and staging in PD. Patients and Methods: Sixteen movement disorders specialists from Spain participated in this project. The classification was consensually approved after a discussion and review process from June to October 2021. The TNM classification and the National Institutes of Health Stroke Scale (NIHSS) were considered as models in the design. Results: The classification was named MNCD and included 4 major axes: (1) motor symptoms; (2) non-motor symptoms; (3) cognition; (4) dependency for activities of daily living (ADL). Motor axis included 4 sub-axes: (1) motor fluctuations; (2) dyskinesia; (3) axial symptoms; (4) tremor. Four other sub-axes were included in the non-motor axis: (1) neuropsychiatric symptoms; (2) autonomic dysfunction; (3) sleep disturbances and fatigue; (4) pain and sensory disorders. According to the MNCD, 5 stages were considered, from stage 1 (no disabling motor or non-motor symptoms with normal cognition and independency for ADL) to 5 (dementia and dependency for basic ADL). Conclusions: A new simple classification of PD is proposed. The MNCD classification includes 4 major axes and 5 stages to identify key symptoms and monitor the evolution of the disease in patients with PD. It is necessary to apply this proof of concept in a properly designed study.
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Affiliation(s)
- Diego Santos García
- Unidad de Trastornos de Movimiento, Servicio de Neurología, CHUAC, Complejo Hospitalario Universitario de A Coruña, 15009 A Coruña, Spain
- Neurología, Hospital San Rafael, 15009 A Coruña, Spain
- Correspondence: ; Tel.: +34-646173341
| | - María Álvarez Sauco
- Departamento de Neurología, Hospital General Universitario de Elche, 03203 Elche, Spain; (M.Á.S.); (E.F.)
| | - Matilde Calopa
- Unidad de Trastornos del Movimiento, Servicio de Neurología, Hospital Universitari de Bellvitge, 08907 Barcelona, Spain;
| | - Fátima Carrillo
- Unidad de Trastornos del Movimiento, Servicio de Neurología y Neurofisiología Clínica, Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío, 41013 Sevilla, Spain; (F.C.); (P.M.)
- Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas CIBERNED, 28031 Madrid, Spain; (J.K.); (P.M.-M.)
| | - Francisco Escamilla Sevilla
- Unidad de Trastornos del Movimiento, Servicio de Neurología, Hospital Universitario Virgen de las Nieves, Instituto de Investigación Biosanitaria (ibs.Granada), 18013 Granada, Spain;
| | - Eric Freire
- Departamento de Neurología, Hospital General Universitario de Elche, 03203 Elche, Spain; (M.Á.S.); (E.F.)
- Departamento de Neurología, Hospital IMED Elche, 03203 Elche, Spain
| | - Rocío García Ramos
- Instituto de Investigación Sanitaria San Carlos (IdISCC), Hospital Clínico San Carlos, 28040 Madrid, Spain;
| | - Jaime Kulisevsky
- Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas CIBERNED, 28031 Madrid, Spain; (J.K.); (P.M.-M.)
- Departamento de Neurología, Unidad de Trastornos del Movimiento, Hospital de la Santa Creu i Sant Pau, 08041 Barcelona, Spain
| | | | - Inés Legarda
- Hospital Universitario Son Espases, 07120 Palma, Spain;
| | - María Rosario Isabel Luquín
- Departamento de Neurología, Clínica Universidad de Navarra, Instituto de Investigación Sanitaria de Navarra, 31008 Pamplona, Spain;
| | | | - Pablo Martínez-Martin
- Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas CIBERNED, 28031 Madrid, Spain; (J.K.); (P.M.-M.)
| | - Irene Martínez-Torres
- Unidad de Trastornos del Movimiento, Servicio de Neurología, Hospital Universitario y Politècnico La Fe, 46026 Valencia, Spain;
| | - Pablo Mir
- Unidad de Trastornos del Movimiento, Servicio de Neurología y Neurofisiología Clínica, Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío, 41013 Sevilla, Spain; (F.C.); (P.M.)
- Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas CIBERNED, 28031 Madrid, Spain; (J.K.); (P.M.-M.)
| | - Ángel Sesar Ignacio
- Unidad de Trastornos del Movimiento, Servicio de Neurología, CHUS (Complejo Hospitalario Universitario de Santiago de Compostela), 15706 A Coruña, Spain;
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Hayashi Y, Nakagawa R, Ishido M, Yoshinaga Y, Watanabe J, Kurihara K, Nagaki K, Ogura H, Mishima T, Fujioka S, Tsuboi Y. Off Time Independently Affects Quality of Life in Advanced Parkinson's Disease (APD) Patients but Not in Non-APD Patients: Results from the Self-Reported Japanese Quality-of-Life Survey of Parkinson's Disease (JAQPAD) Study. PARKINSON'S DISEASE 2021; 2021:9917539. [PMID: 34676064 PMCID: PMC8526216 DOI: 10.1155/2021/9917539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 08/10/2021] [Accepted: 09/09/2021] [Indexed: 12/01/2022]
Abstract
INTRODUCTION Parkinson's disease (PD) is characterized by a triad of motor symptoms and several nonmotor symptoms (NMS). Identifying the most appropriate treatment is essential for improving patient quality of life (QoL). However, it is still not known which PD symptoms more commonly affect patients with advanced PD (APD) versus non-APD. This study examined the factors that most affected the QoL of patients with APD (defined using the 5-2-1 criteria: ≥5 oral levodopa doses a day, off time ≥2 hours a day, or troublesome dyskinesia ≥1 hour a day) versus non-APD in a large Japanese population using the Japanese Quality-of-Life Survey of Parkinson's Disease (JAQPAD) study. METHODS Participants in this self-reported survey-based study included all members of the Japan Parkinson's Disease Association. Questionnaires assessing NMS and QoL (e.g., the 8-item PD Questionnaire [PDQ-8]) were included. Univariate and multivariate regression analyses were conducted to identify clinical factors impacting QoL using the PDQ-8 Summary Index (PDQ-8 SI). RESULTS Of the 3022 eligible patients, 864 were classified as having non-APD and 1599 as having APD. QoL as assessed by the PDQ-8 SI was notably worse in patients with APD versus non-APD (39.2 vs. 26.9, p < 0.0001). Although off time affected QoL only in patients with APD, PD duration and the NMS Questionnaire score significantly contributed to the QoL in both patients with APD and non-APD. CONCLUSIONS This study identified the factors more commonly associated with worse QoL in patients with APD versus non-APD. Our findings offer new insights for providing optimal treatment and improving treatment satisfaction in patients with PD.
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Affiliation(s)
- Yuka Hayashi
- Department of Neurology, Faculty of Medicine, Fukuoka University, 7-45-1 Nanakuma, Johnan-ku, Fukuoka 814-0180, Japan
| | - Ryoko Nakagawa
- Medical, AbbVie GK, 3-1-21 Shibaura, Minato-ku, Tokyo 108-0023, Japan
| | - Miwako Ishido
- Medical, AbbVie GK, 3-1-21 Shibaura, Minato-ku, Tokyo 108-0023, Japan
| | - Yoko Yoshinaga
- Medical, AbbVie GK, 3-1-21 Shibaura, Minato-ku, Tokyo 108-0023, Japan
| | - Jun Watanabe
- Medical, AbbVie GK, 3-1-21 Shibaura, Minato-ku, Tokyo 108-0023, Japan
| | - Kanako Kurihara
- Department of Neurology, Faculty of Medicine, Fukuoka University, 7-45-1 Nanakuma, Johnan-ku, Fukuoka 814-0180, Japan
| | - Koichi Nagaki
- Department of Neurology, Faculty of Medicine, Fukuoka University, 7-45-1 Nanakuma, Johnan-ku, Fukuoka 814-0180, Japan
| | - Hiromu Ogura
- Department of Neurology, Faculty of Medicine, Fukuoka University, 7-45-1 Nanakuma, Johnan-ku, Fukuoka 814-0180, Japan
| | - Takayasu Mishima
- Department of Neurology, Faculty of Medicine, Fukuoka University, 7-45-1 Nanakuma, Johnan-ku, Fukuoka 814-0180, Japan
| | - Shinsuke Fujioka
- Department of Neurology, Faculty of Medicine, Fukuoka University, 7-45-1 Nanakuma, Johnan-ku, Fukuoka 814-0180, Japan
| | - Yoshio Tsuboi
- Department of Neurology, Faculty of Medicine, Fukuoka University, 7-45-1 Nanakuma, Johnan-ku, Fukuoka 814-0180, Japan
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