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Diao Y, Xie H, Wang Y, Zhao B, Yang A, Zhang J. Individual Structural Covariance Network Predicts Long-Term Motor Improvement in Parkinson Disease with Subthalamic Nucleus Deep Brain Stimulation. AJNR Am J Neuroradiol 2024:ajnr.A8245. [PMID: 38471785 DOI: 10.3174/ajnr.a8245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 03/10/2024] [Indexed: 03/14/2024]
Abstract
BACKGROUND AND PURPOSE The efficacy of long-term chronic subthalamic nucleus deep brain stimulation (STN-DBS) in treating Parkinson disease (PD) exhibits substantial variability among individuals. The preoperative identification of suitable deep brain stimulation (DBS) candidates through predictive means becomes crucial. Our study aims to investigate the predictive value of characterizing individualized structural covariance networks for long-term efficacy of DBS, offering patients a precise and cost-effective preoperative screening tool. MATERIALS AND METHODS We included 138 patients with PD and 40 healthy controls. We developed individualized structural covariance networks from T1-weighted images utilizing network template perturbation, and computed the networks' topological characteristics. Patients were categorized according to their long-term motor improvement following STN-DBS. Intergroup analyses were conducted on individual network edges and topological indices, alongside correlation analyses with long-term outcomes for the entire patient cohort. Finally, machine learning algorithms were employed for regression and classification to predict post-DBS motor improvement. RESULTS Among the patients with PD, 6 edges (left middle frontal and left caudate nucleus, right olfactory and right insula, left superior medial frontal gyrus and right insula, right middle frontal and left paracentral lobule, right middle frontal and cerebellum, left lobule VIIb of the cerebellum and the vermis of the cerebellum) exhibited significant results in intergroup comparisons and correlation analyses. Increased degree centrality and local efficiency of the cerebellum, parahippocampal gyrus, and postcentral gyrus were associated with DBS improvement. A regression model constructed from these 6 edges revealed a significant correlation between predicted and observed changes in the unified PD rating scale (R = 0.671, P < .001) and receiver operating characteristic analysis demonstrated an area under the curve of 0.802, effectively distinguishing between patients with good and moderate improvement post-DBS. CONCLUSIONS Our findings reveal the link between individual structural covariance network fingerprints in patients with PD and long-term motor outcome following STN-DBS. Additionally, binary and continuous cerebellum-basal ganglia-frontal structural covariance network edges have emerged as potential predictive biomarkers for DBS motor outcome.
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Affiliation(s)
- Yu Diao
- From the Department of Neurosurgery (Y.D., H.X., Y.W., B.Z., A.Y., J.Z.), Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Hutao Xie
- From the Department of Neurosurgery (Y.D., H.X., Y.W., B.Z., A.Y., J.Z.), Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yanwen Wang
- From the Department of Neurosurgery (Y.D., H.X., Y.W., B.Z., A.Y., J.Z.), Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Baotian Zhao
- From the Department of Neurosurgery (Y.D., H.X., Y.W., B.Z., A.Y., J.Z.), Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Anchao Yang
- From the Department of Neurosurgery (Y.D., H.X., Y.W., B.Z., A.Y., J.Z.), Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Beijing Key Laboratory of Neurostimulation (A.Y., J.Z.), Beijing, China
| | - Jianguo Zhang
- From the Department of Neurosurgery (Y.D., H.X., Y.W., B.Z., A.Y., J.Z.), Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Beijing Key Laboratory of Neurostimulation (A.Y., J.Z.), Beijing, China
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Hong R, Wu Z, Peng K, Zhang J, He Y, Zhang Z, Gao Y, Jin Y, Su X, Zhi H, Guan Q, Pan L, Jin L. Kinect-based objective assessment of the acute levodopa challenge test in parkinsonism: a feasibility study. Neurol Sci 2024; 45:2661-2670. [PMID: 38183553 DOI: 10.1007/s10072-023-07296-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Accepted: 12/28/2023] [Indexed: 01/08/2024]
Abstract
INTRODUCTION The acute levodopa challenge test (ALCT) is an important and valuable examination but there are still some shortcomings with it. We aimed to objectively assess ALCT based on a depth camera and filter out the best indicators. METHODS Fifty-nine individuals with parkinsonism completed ALCT and the improvement rate (IR, which indicates the change in value before and after levodopa administration) of the Movement Disorder Society-Sponsored Revision of the Unified Parkinson's Disease Rating Scale part III (MDS-UPDRS III) was calculated. The kinematic features of the patients' movements in both the OFF and ON states were collected with an Azure Kinect depth camera. RESULTS The IR of MDS-UPDRS III was significantly correlated with the IRs of many kinematic features for arising from a chair, pronation-supination movements of the hand, finger tapping, toe tapping, leg agility, and gait (rs = - 0.277 ~ - 0.672, P < 0.05). Moderate to high discriminative values were found in the selected features in identifying a clinically significant response to levodopa with sensitivity, specificity, and area under the curve (AUC) in the range of 50-100%, 47.22%-97.22%, and 0.673-0.915, respectively. The resulting classifier combining kinematic features of toe tapping showed an excellent performance with an AUC of 0.966 (95% CI = 0.922-1.000, P < 0.001). The optimal cut-off value was 21.24% with sensitivity and specificity of 94.44% and 87.18%, respectively. CONCLUSION This study demonstrated the feasibility of measuring the effect of levodopa and objectively assessing ALCT based on kinematic data derived from an Azure Kinect-based system.
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Affiliation(s)
- Ronghua Hong
- Department of Neurology and Neurological Rehabilitation, Shanghai Disabled Persons' Federation Key Laboratory of Intelligent Rehabilitation Assistive Devices and Technologies, School of Medicine, Shanghai Yangzhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), Tongji University, Shanghai, China
- Key Laboratory of Spine and Spinal Cord Injury Repair and Regeneration of Ministry of Education, Department of Neurology, School of Medicine, Neurotoxin Research CenterTongji HospitalTongji University, Shanghai, China
| | - Zhuang Wu
- Department of Neurology and Neurological Rehabilitation, Shanghai Disabled Persons' Federation Key Laboratory of Intelligent Rehabilitation Assistive Devices and Technologies, School of Medicine, Shanghai Yangzhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), Tongji University, Shanghai, China
- Key Laboratory of Spine and Spinal Cord Injury Repair and Regeneration of Ministry of Education, Department of Neurology, School of Medicine, Neurotoxin Research CenterTongji HospitalTongji University, Shanghai, China
| | - Kangwen Peng
- Key Laboratory of Spine and Spinal Cord Injury Repair and Regeneration of Ministry of Education, Department of Neurology, School of Medicine, Neurotoxin Research CenterTongji HospitalTongji University, Shanghai, China
| | - Jingxing Zhang
- Key Laboratory of Spine and Spinal Cord Injury Repair and Regeneration of Ministry of Education, Department of Neurology, School of Medicine, Neurotoxin Research CenterTongji HospitalTongji University, Shanghai, China
| | - Yijing He
- Key Laboratory of Spine and Spinal Cord Injury Repair and Regeneration of Ministry of Education, Department of Neurology, School of Medicine, Neurotoxin Research CenterTongji HospitalTongji University, Shanghai, China
| | - Zhuoyu Zhang
- Key Laboratory of Spine and Spinal Cord Injury Repair and Regeneration of Ministry of Education, Department of Neurology, School of Medicine, Neurotoxin Research CenterTongji HospitalTongji University, Shanghai, China
| | - Yichen Gao
- IFLYTEK Suzhou Research Institute, Suzhou, China
| | - Yue Jin
- IFLYTEK Suzhou Research Institute, Suzhou, China
| | - Xiaoyun Su
- IFLYTEK Suzhou Research Institute, Suzhou, China
| | - Hongping Zhi
- IFLYTEK Suzhou Research Institute, Suzhou, China
| | - Qiang Guan
- Key Laboratory of Spine and Spinal Cord Injury Repair and Regeneration of Ministry of Education, Department of Neurology, School of Medicine, Neurotoxin Research CenterTongji HospitalTongji University, Shanghai, China
| | - Lizhen Pan
- Key Laboratory of Spine and Spinal Cord Injury Repair and Regeneration of Ministry of Education, Department of Neurology, School of Medicine, Neurotoxin Research CenterTongji HospitalTongji University, Shanghai, China.
| | - Lingjing Jin
- Department of Neurology and Neurological Rehabilitation, Shanghai Disabled Persons' Federation Key Laboratory of Intelligent Rehabilitation Assistive Devices and Technologies, School of Medicine, Shanghai Yangzhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), Tongji University, Shanghai, China.
- Key Laboratory of Spine and Spinal Cord Injury Repair and Regeneration of Ministry of Education, Department of Neurology, School of Medicine, Neurotoxin Research CenterTongji HospitalTongji University, Shanghai, China.
- Collaborative Innovation Center for Brain Science, Tongji University, Shanghai, China.
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Wu X, Ma L, Wei P, Shan Y, Chan P, Wang K, Zhao G. Wearable sensor devices can automatically identify the ON-OFF status of patients with Parkinson's disease through an interpretable machine learning model. Front Neurol 2024; 15:1387477. [PMID: 38751881 PMCID: PMC11094303 DOI: 10.3389/fneur.2024.1387477] [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: 02/17/2024] [Accepted: 04/12/2024] [Indexed: 05/18/2024] Open
Abstract
Introduction Accurately and objectively quantifying the clinical features of Parkinson's disease (PD) is crucial for assisting in diagnosis and guiding the formulation of treatment plans. Therefore, based on the data on multi-site motor features, this study aimed to develop an interpretable machine learning (ML) model for classifying the "OFF" and "ON" status of patients with PD, as well as to explore the motor features that are most associated with changes in clinical symptoms. Methods We employed a support vector machine with a recursive feature elimination (SVM-RFE) algorithm to select promising motion features. Subsequently, 12 ML models were constructed based on these features, and we identified the model with the best classification performance. Then, we used the SHapley Additive exPlanations (SHAP) and the Local Interpretable Model agnostic Explanations (LIME) methods to explain the model and rank the importance of those motor features. Results A total of 96 patients were finally included in this study. The naive Bayes (NB) model had the highest classification performance (AUC = 0.956; sensitivity = 0.8947, 95% CI 0.6686-0.9870; accuracy = 0.8421, 95% CI 0.6875-0.9398). Based on the NB model, we analyzed the importance of eight motor features toward the classification results using the SHAP algorithm. The Gait: range of motion (RoM) Shank left (L) (degrees) [Mean] might be the most important motor feature for all classification horizons. Conclusion The symptoms of PD could be objectively quantified. By utilizing suitable motor features to construct ML models, it became possible to intelligently identify whether patients with PD were in the "ON" or "OFF" status. The variations in these motor features were significantly correlated with improvement rates in patients' quality of life. In the future, they might act as objective digital biomarkers to elucidate the changes in symptoms observed in patients with PD and might be used to assist in the diagnosis and treatment of patients with PD.
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Affiliation(s)
- Xiaolong Wu
- Department of Neurosurgery, Xuanwu Hospital of Capital Medical University, Beijing, China
- International Neuroscience Institute (China-INI), Beijing, China
| | - Lin Ma
- Department of Neurorehabilitation, Rehabilitation Medicine of Capital Medical University, China Rehabilitation Research Centre, Beijing, China
| | - Penghu Wei
- Department of Neurosurgery, Xuanwu Hospital of Capital Medical University, Beijing, China
- International Neuroscience Institute (China-INI), Beijing, China
| | - Yongzhi Shan
- Department of Neurosurgery, Xuanwu Hospital of Capital Medical University, Beijing, China
- International Neuroscience Institute (China-INI), Beijing, China
| | - Piu Chan
- Department of Neurology and Neurobiology, Xuanwu Hospital of Capital Medical University, Beijing, China
| | - Kailiang Wang
- Department of Neurosurgery, Xuanwu Hospital of Capital Medical University, Beijing, China
- International Neuroscience Institute (China-INI), Beijing, China
| | - Guoguang Zhao
- Department of Neurosurgery, Xuanwu Hospital of Capital Medical University, Beijing, China
- International Neuroscience Institute (China-INI), Beijing, China
- Beijing Municipal Geriatric Medical Research Center, Beijing, China
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Liu W, Shen Y, Zhong Y, Sun Y, Yang J, Zhang W, Yan L, Liu W, Yu M. Levodopa improved different motor symptoms in patients with Parkinson's disease by reducing the functional connectivity of specific thalamic subregions. CNS Neurosci Ther 2024; 30:e14354. [PMID: 37452488 PMCID: PMC10848087 DOI: 10.1111/cns.14354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 05/15/2023] [Accepted: 07/01/2023] [Indexed: 07/18/2023] Open
Abstract
BACKGROUND The thalamus is an important relay station for the motor circuit of human. Levodopa can reverse the clinical manifestations by modulating the function of motor circuits, but its detailed mechanisms are still not fully understood. We aimed to explore (1) the mechanism by which levodopa modulates the functional connectivity (FC) in the subregions of the thalamus; (2) the relationship between the changed FC and the improvement of motor symptoms in Parkinson's disease (PD) patients. METHODS Resting-state functional MRI was used to scan 36 PD patients and 37 healthy controls. The FC between the subregions in the thalamus and the whole brain was measured and compared under different medication states of PD patients. The correlation between the improvement of motor symptoms and changes in FC in the thalamus subregions was examined. RESULTS The PD on state exhibited decreased FC between the right pre-motor thalamus and the right postcentral gyrus, as well as the right lateral pre-frontal thalamus and the right postcentral gyrus. These decreases were positively correlated with the improvement of resting tremor. The PD on state also exhibited decreased FC between the left lateral pre-frontal thalamus and right paracentral lobule, which was positively correlated with the improvement of bradykinesia. CONCLUSIONS This study demonstrates that levodopa treats PD by decreasing the FC between the thalamus subregions and pre/post-central cortex. Our results provide a basis for further exploration of the functional activity of thalamic subregions and offer new insights into the precision treatment in PD patients.
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Affiliation(s)
- Wan Liu
- Department of RehabilitationThe Affiliated Brain Hospital of Nanjing Medical UniversityNanjingChina
- Department of NeurologyThe Affiliated Brain Hospital of Nanjing Medical UniversityNanjingChina
| | - Yang Shen
- Department of NeurologyThe Affiliated Brain Hospital of Nanjing Medical UniversityNanjingChina
- Department of NeurologyXiaogan Hospital Affiliated to Wuhan University of Science and Technology, The Central Hospital of XiaoganXiaoganChina
| | - Yuan Zhong
- School of PsychologyNanjing Normal UniversityNanjingChina
- Jiangsu Key Laboratory of Mental Health and Cognitive ScienceNanjing Normal UniversityNanjingChina
| | - Yu Sun
- International Laboratory for Children's Medical Imaging Research, School of Biological Sciences and Medical EngineeringSoutheast UniversityNanjingChina
- Director of Joint Research Centre for University of Birmingham and Southeast UniversitySoutheast UniversityNanjingChina
| | - Jiaying Yang
- Department of Public Health, School of Medicine and Holistic Integrative MedicineNanjing University of Chinese MedicineNanjingChina
| | - Wenbin Zhang
- Department of Functional NeurosurgeryThe Affiliated Brain Hospital of Nanjing Medical UniversityNanjingChina
| | - Lei Yan
- Department of NeurologyThe Affiliated Brain Hospital of Nanjing Medical UniversityNanjingChina
| | - Weiguo Liu
- Department of NeurologyThe Affiliated Brain Hospital of Nanjing Medical UniversityNanjingChina
| | - Miao Yu
- Department of NeurologyThe Affiliated Brain Hospital of Nanjing Medical UniversityNanjingChina
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Geraedts VJ, van Vugt JPP, Marinus J, Kuiper R, Middelkoop HAM, Zutt R, van der Gaag NA, Hoffmann CFE, Dorresteijn LDA, van Hilten JJ, Contarino MF. Predicting Motor Outcome and Quality of Life After Subthalamic Deep Brain Stimulation for Parkinson's Disease: The Role of Standard Screening Measures and Wearable-Data. JOURNAL OF PARKINSON'S DISEASE 2023:JPD225101. [PMID: 37182900 DOI: 10.3233/jpd-225101] [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
BACKGROUND Standardized screening for subthalamic deep brain stimulation (STN DBS) in Parkinson's disease (PD) patients is crucial to determine eligibility, but its utility to predict postoperative outcomes in eligible patients is inconclusive. It is unknown whether wearable data can contribute to this aim. OBJECTIVE To evaluate the utility of universal components incorporated in the DBS screening, complemented by a wearable sensor, to predict motor outcomes and Quality of life (QoL) one year after STN DBS surgery. METHODS Consecutive patients were included in the OPTIMIST cohort study from two DBS centers. Standardized assessments included a preoperative Levodopa Challenge Test (LCT), and questionnaires on QoL and non-motor symptoms including cognition, psychiatric symptoms, impulsiveness, autonomic symptoms, and sleeping problems. Moreover, an ambulatory wearable sensor (Parkinson Kinetigraph (PKG)) was used. Postoperative assessments were similar and also included a Stimulation Challenge Test to determine DBS effects on motor function. RESULTS Eighty-three patients were included (median (interquartile range) age 63 (56-68) years, 36% female). Med-OFF (Stim-OFF) motor severity deteriorated indicating disease progression, but patients significantly improved in terms of Med-ON (Stim-ON) motor function, motor fluctuations, QoL, and most non-motor domains. Motor outcomes were not predicted by preoperative tests, including covariates of either LCT or PKG. Postoperative QoL was predicted by better preoperative QoL, lower age, and more preoperative impulsiveness scores in multivariate models. CONCLUSION Data from the DBS screening including wearable data do not predict postoperative motor outcome at one year. Post-DBS QoL appears primarily driven by non-motor symptoms, rather than by motor improvement.
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Affiliation(s)
- Victor J Geraedts
- Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
| | | | - Johan Marinus
- Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands
| | - Roy Kuiper
- Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands
- Department of Neurology, HAGA Teaching Hospital, Den Haag, the Netherlands
| | - Huub A M Middelkoop
- Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands
| | - Rodi Zutt
- Department of Neurology, HAGA Teaching Hospital, Den Haag, the Netherlands
| | - Niels A van der Gaag
- Department of Neurosurgery, HAGA Teaching Hospital, Den Haag, the Netherlands
- Department of Neurosurgery, Leiden University Medical Center, Leiden, the Netherlands
| | - Carel F E Hoffmann
- Department of Neurosurgery, HAGA Teaching Hospital, Den Haag, the Netherlands
| | | | - Jacobus J van Hilten
- Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands
| | - Maria Fiorella Contarino
- Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands
- Department of Neurology, HAGA Teaching Hospital, Den Haag, the Netherlands
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Shen Y, Hu J, Chen Y, Liu W, Li Y, Yan L, Xie C, Zhang W, Yu M, Liu W. Levodopa Changes Functional Connectivity Patterns in Subregions of the Primary Motor Cortex in Patients With Parkinson's Disease. Front Neurosci 2020; 14:647. [PMID: 32733186 PMCID: PMC7360730 DOI: 10.3389/fnins.2020.00647] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Accepted: 05/25/2020] [Indexed: 12/12/2022] Open
Abstract
Background The primary motor cortex (M1) is a critical node in Parkinson’s disease (PD)-related motor circuitry; however, the functional roles of its subregions are poorly understood. In this study, we investigated changes in the functional connectivity patterns of M1 subregions and their relationships to improved clinical symptoms following levodopa administration. Methods Thirty-six PD patients and 37 healthy controls (HCs) were enrolled. A formal levodopa challenge test was conducted in the PD group, and the Unified Parkinson’s Disease Rating Scale motor section (UPDRS-III) was assessed before (off state) and 1 h after administration of levodopa (on state). The PD group underwent resting-state functional magnetic resonance imaging in both off and on states, whereas the HC group was scanned once. We used the Human Brainnetome Atlas template to subdivide M1 into twelve regions of interest (ROIs). Functional connectivity (FC) was compared between PD on and off states [paired t-test, voxel-level p < 0.001, cluster-level p < 0.05, Gaussian random field (GRF) correction] and between patients and HC (two-sample t-test voxel-level p < 0.001, cluster-level p < 0.05). Correlations between ΔFC (differences in FC between PD off and on states) and clinical symptom improvements were examined. Results There was decreased FC between the right caudal dorsolateral area 6 and the anterior cingulate gyrus (ACC), the right upper limb region and the left medial dorsal thalamus (mdTHA), as well as increased FC between the left tongue and larynx region and the left medial frontal gyrus. ΔFC between the right caudal dorsolateral area 6 and ACC was positively correlated with improvements in UPDRS-III total scores as well as the rigidity (item 22) and bradykinesia (items 23–26 and 31) subscores. ΔFC between the right upper limb region and left thalamus was positively correlated with improvements in the left upper limb tremor (items 20c and 21b) and postural tremor (item 21b) subscores. Conclusions Our results reveal novel information regarding the underlying mechanisms in the motor circuits in the M1 and a promising way to explore the internal function of the M1 in PD patients. Notably, M1 is a potential therapeutic target in PD, and the exploration of its subregions provides a basis and a source of new insights for clinical intervention and precise drug treatment.
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Affiliation(s)
- Yang Shen
- Department of Neurology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Jun Hu
- Department of Radiology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Yong Chen
- Department of Laboratory Medicine, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Wan Liu
- Department of Rehabilitation, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Yuqian Li
- Department of Neurology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Lei Yan
- Department of Neurology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Chunming Xie
- Department of Neurology, Affiliated ZhongDa Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Wenbin Zhang
- Department of Functional Neurosurgery, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Miao Yu
- Department of Neurology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Weiguo Liu
- Department of Neurology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
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Wearable Sensors Measure Ankle Joint Changes of Patients with Parkinson's Disease before and after Acute Levodopa Challenge. PARKINSON'S DISEASE 2020; 2020:2976535. [PMID: 32351681 PMCID: PMC7171676 DOI: 10.1155/2020/2976535] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/20/2019] [Revised: 01/13/2020] [Accepted: 02/22/2020] [Indexed: 11/17/2022]
Abstract
Background Previous studies found levodopa could improve the activity of the ankle joints of patients with Parkinson's disease (PD). But ankle joint movement is composed of four motion ranges. The specific changes of four motion ranges in PD remain unknown. Objective The purpose of this study was to decompose the complex ankle joint movement, measure ankle joint changes before and after the acute levodopa challenge test (ALCT), and investigate the effects of these parameters on gait performance. Methods 29 PD patients and 30 healthy control subjects (HC) completed the Instrumented Stand and Walk (ISAW) test and gait parameters were collected by the JiBuEn gait analysis system. The percentage of improvement of gait data and the UPDRS III in the on-drug condition (ON) were determined with respect to the off-drug condition (OFF). Results We observed a reduction in the heel strike angle (HS), 3-plantarflexion (3-PF) angle, and 4-dorsiflexion (4-DF) angle of ankle joints. We did not find significant difference in the toe-off angle (TO), 1-plantarflexion (1-PF) angle, and 2-dorsiflexion (2-DF) angle among three groups. Stride length improvement rate was significantly correlated with HS (r s = 0.616, P < 0.001) and 3-PF (r s = 0.639, P < 0.001) improvement rates. The improvement in the sum of rigidity items (UPDRS motor subsection item 22) was also correlated with HS (r s = 0.389, P=0.037) and 3-PF (r s = 0.373, P=0.046) improvement rates. Conclusions Exogenous levodopa supplementation can significantly reduce the rigidity of patients with PD, improve their 3-PF and 4-DF of ankle joint kinematic parameters, and ultimately enhance their gait.
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Saranza G, Lang AE. Levodopa challenge test: indications, protocol, and guide. J Neurol 2020; 268:3135-3143. [PMID: 32333167 DOI: 10.1007/s00415-020-09810-7] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 03/20/2020] [Accepted: 03/24/2020] [Indexed: 12/21/2022]
Abstract
A drug challenge test in Parkinson's disease, such as the levodopa challenge test (LCT), is an easy and generally safe procedure, which has been used by clinicians for various indications. The results of the test have significant implications in the management of patients, from preoperative evaluation for deep brain stimulation to providing the basis for medication adjustments to address motor or non-motor fluctuations and dyskinesias. This paper reviews the different indications and protocols commonly used in an acute LCT. Potential complications of the procedure and an overview of levodopa responsiveness and unresponsiveness are also discussed.
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Affiliation(s)
- Gerard Saranza
- Edmond J. Safra Program in Parkinson's Disease and the Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, Toronto, ON, Canada
| | - Anthony E Lang
- Edmond J. Safra Program in Parkinson's Disease and the Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, Toronto, ON, Canada. .,Division of Neurology, Department of Medicine, University of Toronto, Toronto, ON, Canada. .,Movement Disorders Clinic, Toronto Western Hospital, 399 Bathurst Street, Toronto, ON, M5T 2S8, Canada.
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Draak THP, Faber CG, Merkies ISJ. Quality of life in inflammatory neuropathies: the IN-QoL. J Neurol Neurosurg Psychiatry 2018; 89:256-262. [PMID: 28986470 DOI: 10.1136/jnnp-2017-316634] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2017] [Revised: 08/21/2017] [Accepted: 09/17/2017] [Indexed: 11/04/2022]
Abstract
BACKGROUND No consensus exists which quality of life (QoL) measure should be used in patients with inflammatory neuropathies. Moreover, most QoL measures are ordinal-based scales with their known deficiencies. OBJECTIVES To establish a new disease-specific interval-based QoL questionnaire in inflammatory neuropathies (IN-QoL) using the Rasch model and evaluate its scientific properties (validity, reliability and responsiveness). METHODS 264 patients with inflammatory neuropathies completed six commonly used QoL questionnaires. The obtained data were stacked and subjected to Rasch analysis. Responsiveness was determined by using the concept of minimum clinically important differences related to varying individually obtained SEs (responsiveness definition: MCID-SE≥1.96 after 1-year follow-up compared with baseline). RESULTS The IN-QoL fulfilled all Rasch's model requirements with high internal reliability values (patient separation index of 0.94), except being multidimensional. Additional factor analysis resulted in two (functional and mental) subsets that were unidimensional on their own. The IN-QoL showed good correlation with the EuroQol-health quality visual analogue scale (EQ-VAS) (Spearman's rho 0.72). It demonstrated acceptable responsiveness in patients with Guillain-Barré syndrome (GBS) and chronic inflammatory demyelinating polyradiculoneuropathy (CIDP), as did the EQ-VAS. In patients with monoclonal gammopathy-related neuropathy and multifocal motor neuropathy, hardly any changes were seen over time. CONCLUSION The IN-QoL questionnaire fulfils modern clinimetric requirements and correlates strongly with a patient's self-assessment of their own quality of health, while also showing responsiveness in patients with GBS and CIDP. We propose using the IN-QoL and the EQ-VAS for assessing the QoL of patients with inflammatory neuropathies in future studies.
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Affiliation(s)
- Thomas H P Draak
- Department of Neurology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Catharina G Faber
- Department of Neurology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Ingemar S J Merkies
- Department of Neurology, Maastricht University Medical Centre, Maastricht, The Netherlands.,Department of Neurology, St. Elisabeth hospital, Willemstad, Curaçao
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