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Niemrungruang K, Thanakamchokchai J, Pongmala C, Khobkhun F. The effects of combining repetitive transcranial magnetic stimulation with task-specific training on gait performance in individuals with Parkinson's disease: A review article. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2024; 29:e2105. [PMID: 38864408 DOI: 10.1002/pri.2105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Revised: 04/11/2024] [Accepted: 05/28/2024] [Indexed: 06/13/2024]
Abstract
BACKGROUND Parkinson's disease (PD) is a neurodegenerative disorder characterized by motor impairments, especially in the area of gait disturbances. Physiotherapy, with a focus on task-specific training, has demonstrated a level of efficacy as regards alleviating symptoms and enhancing functional capabilities in individuals with PD. Repetitive Transcranial Magnetic Stimulation (rTMS) has emerged as a potential therapeutic intervention for improving motor functions in individuals with PD. AIMS This review article aims to investigate the effects of combining rTMS with task-specific training on gait performance in individuals with PD. MATERIALS AND METHODS PubMed, Physiotherapy Evidence Database (PEDro), and Scopus were all searched for relevant studies. The focus of the search was on studies that investigated the efficacy of combining rTMS with task-specific training to improve gait performance in individuals with PD. RESULTS Four studies were identified as fulfilling the eligibility criteria and were included in the study. The combination of rTMS with specific treadmill training and weight-bearing exercises can significantly enhance walking efficiency, including improvements in walking speed, self-mobility, and step rate. In addition, the combination of rTMS and task-specific training, such as treadmill-based training, shows promise in enhancing gait performance in individuals with PD. DISCUSSION AND CONCLUSION High-frequency rTMS targeting the primary motor cortex (or M1) can result in improved walking speed, self-mobility, and step rate. However, limited research exists regarding low-frequency stimulation of the supplementary motor area (SMA) in individuals with gait issues. Further research is required to determine the optimal parameters of rTMS, such as strength, frequency, and duration of stimulation and it is worth considering the incorporation of additional training modalities, including cognitive exercises.
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Affiliation(s)
- Kanjana Niemrungruang
- Physical Therapy Center, Faculty of Physical Therapy, Mahidol University, Bangkok, Thailand
| | - Jenjira Thanakamchokchai
- Parkinson Movement and Research Collaboration Laboratory, Faculty of Physical Therapy, Mahidol University, Nakhon Pathom, Thailand
| | - Chatkaew Pongmala
- Functional Neuroimaging, Cognitive and Mobility Laboratory, Department of Radiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Fuengfa Khobkhun
- Parkinson Movement and Research Collaboration Laboratory, Faculty of Physical Therapy, Mahidol University, Nakhon Pathom, Thailand
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So MG, Lee SU, Lee CN, Kim JS. Ocular Flutter Evoked by Vestibular Stimulation in Multiple System Atrophy with Predominant Cerebellar Ataxia. CEREBELLUM (LONDON, ENGLAND) 2024:10.1007/s12311-024-01713-x. [PMID: 38910230 DOI: 10.1007/s12311-024-01713-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/16/2024] [Indexed: 06/25/2024]
Affiliation(s)
- Min-Ggyung So
- Department of Neurology, Korea University Medical Center, 73 Goryeodae-ro, Seongbuk-gu, Seoul, 02841, South Korea
| | - Sun-Uk Lee
- Department of Neurology, Korea University Medical Center, 73 Goryeodae-ro, Seongbuk-gu, Seoul, 02841, South Korea.
- Neurotology and Neuro-ophthalmology Laboratory, Korea University Anam Hospital, Seoul, South Korea.
| | - Chan-Nyoung Lee
- Department of Neurology, Korea University Medical Center, 73 Goryeodae-ro, Seongbuk-gu, Seoul, 02841, South Korea
| | - Ji-Soo Kim
- Department of Neurology, Seoul National University College of Medicine, Seoul, South Korea
- Dizziness Center, Clinical Neuroscience Center, Seoul National University Bundang Hospital, Seongnam, South Korea
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Ueha R, Miura C, Matsumoto N, Sato T, Goto T, Kondo K. Vocal Fold Motion Impairment in Neurodegenerative Diseases. J Clin Med 2024; 13:2507. [PMID: 38731036 PMCID: PMC11084971 DOI: 10.3390/jcm13092507] [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: 03/30/2024] [Revised: 04/20/2024] [Accepted: 04/24/2024] [Indexed: 05/13/2024] Open
Abstract
Vocal fold motion impairment (VFMI) is the inappropriate movement of the vocal folds during respiration, leading to vocal fold adduction and/or abduction problems and causing respiratory and vocal impairments. Neurodegenerative diseases (NDDs) are a wide range of disorders characterized by progressive loss of neurons and deposition of altered proteins in the brain and peripheral organs. VFMI may be unrecognized in patients with NDDs. VFMI in NDDs is caused by the following: laryngeal muscle weakness due to muscular atrophy, caused by brainstem and motor neuron degeneration in amyotrophic lateral sclerosis; hyperactivity of laryngeal adductors in Parkinson's disease; and varying degrees of laryngeal adductor hypertonia and abductor paralysis in multiple system atrophy. Management of VFMI depends on whether there is a presence of glottic insufficiency or insufficient glottic opening with/without severe dysphagia. VFMI treatment options for glottic insufficiency range from surgical interventions, including injection laryngoplasty and medialization thyroplasty, to behavioral therapies; for insufficient glottic opening, various options are available based on the severity and underlying cause of the condition, including continuous positive airway pressure therapy, botulinum toxin injection, tracheostomy, vocal fold surgery, or a combination of interventions. In this review, we outline the mechanisms, clinical features, and management of VFMI in NDDs and provide a guide for physicians who may encounter these clinical features in their patients. NDDs are always progressive; hence, timely evaluation, proper diagnosis, and appropriate management of the patient will greatly affect their vocal, respiratory, and swallowing functions as well as their quality of life.
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Affiliation(s)
- Rumi Ueha
- Swallowing Center, The University of Tokyo Hospital, Tokyo 113-8655, Japan
- Department of Otolaryngology and Head and Neck Surgery, Faculty of Medicine, The University of Tokyo, Tokyo 113-8655, Japan; (C.M.); (N.M.); (T.S.); (T.G.); (K.K.)
| | - Cathrine Miura
- Department of Otolaryngology and Head and Neck Surgery, Faculty of Medicine, The University of Tokyo, Tokyo 113-8655, Japan; (C.M.); (N.M.); (T.S.); (T.G.); (K.K.)
| | - Naoyuki Matsumoto
- Department of Otolaryngology and Head and Neck Surgery, Faculty of Medicine, The University of Tokyo, Tokyo 113-8655, Japan; (C.M.); (N.M.); (T.S.); (T.G.); (K.K.)
| | - Taku Sato
- Department of Otolaryngology and Head and Neck Surgery, Faculty of Medicine, The University of Tokyo, Tokyo 113-8655, Japan; (C.M.); (N.M.); (T.S.); (T.G.); (K.K.)
| | - Takao Goto
- Department of Otolaryngology and Head and Neck Surgery, Faculty of Medicine, The University of Tokyo, Tokyo 113-8655, Japan; (C.M.); (N.M.); (T.S.); (T.G.); (K.K.)
| | - Kenji Kondo
- Department of Otolaryngology and Head and Neck Surgery, Faculty of Medicine, The University of Tokyo, Tokyo 113-8655, Japan; (C.M.); (N.M.); (T.S.); (T.G.); (K.K.)
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Mohammadi S, Ghaderi S. Parkinson's disease and Parkinsonism syndromes: Evaluating iron deposition in the putamen using magnetic susceptibility MRI techniques - A systematic review and literature analysis. Heliyon 2024; 10:e27950. [PMID: 38689949 PMCID: PMC11059419 DOI: 10.1016/j.heliyon.2024.e27950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Revised: 02/29/2024] [Accepted: 03/08/2024] [Indexed: 05/02/2024] Open
Abstract
Magnetic resonance imaging (MRI) techniques, such as quantitative susceptibility mapping (QSM) and susceptibility-weighted imaging (SWI), can detect iron deposition in the brain. Iron accumulation in the putamen (PUT) can contribute to the pathogenesis of Parkinson's disease (PD) and atypical Parkinsonian disorders. This systematic review aimed to synthesize evidence on iron deposition in the PUT assessed by MRI susceptibility techniques in PD and Parkinsonism syndromes. The PubMed and Scopus databases were searched for relevant studies. Thirty-four studies from January 2007 to October 2023 that used QSM, SWI, or other MRI susceptibility methods to measure putaminal iron in PD, progressive supranuclear palsy (PSP), multiple system atrophy (MSA), and healthy controls (HCs) were included. Most studies have found increased putaminal iron levels in PD patients versus HCs based on higher quantitative susceptibility. Putaminal iron accumulation correlates with worse motor scores and cognitive decline in patients with PD. Evidence regarding differences in susceptibility between PD and atypical Parkinsonism is emerging, with several studies showing greater putaminal iron deposition in PSP and MSA than in PD patients. Alterations in putaminal iron levels help to distinguish these disorders from PD. Increased putaminal iron levels appear to be associated with increased disease severity and progression. Thus, magnetic susceptibility MRI techniques can detect abnormal iron accumulation in the PUT of patients with Parkinsonism. Moreover, quantifying putaminal susceptibility may serve as an MRI biomarker to monitor motor and cognitive changes in PD and aid in the differential diagnosis of Parkinsonian disorders.
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Affiliation(s)
- Sana Mohammadi
- Department of Medical Sciences, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Sadegh Ghaderi
- Department of Neuroscience and Addiction Studies, School of Advanced Technologies in Medicine, Tehran University of Medical Sciences, Tehran, Iran
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Choi JY. Decoding Movement Disorders: The Role of Eye Movements in Distinguishing Multisystem Atrophy From Parkinson's Disease. J Clin Neurol 2024; 20:115-116. [PMID: 38433482 PMCID: PMC10921049 DOI: 10.3988/jcn.2024.0017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 01/09/2024] [Indexed: 03/05/2024] Open
Affiliation(s)
- Jeong-Yoon Choi
- Department of Neurology, Dizziness Center, Clinical Neuroscience Center, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Neurology, Seoul National University College of Medicine, Seoul, Korea.
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Wang Q, Bu C, Wang H, Zhang B, Chen Q, Shi D, Chi L. Distinct mechanisms underlying the therapeutic effects of low-molecular-weight heparin and chondroitin sulfate on Parkinson's disease. Int J Biol Macromol 2024; 262:129846. [PMID: 38296150 DOI: 10.1016/j.ijbiomac.2024.129846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 01/26/2024] [Accepted: 01/28/2024] [Indexed: 02/09/2024]
Abstract
Parkinson's disease (PD) is a neurodegenerative disorder influenced by various factors, including age, genetics, and the environment. Current treatments provide symptomatic relief without impeding disease progression. Previous studies have demonstrated the therapeutic potential of exogenous heparin and chondroitin sulfate in PD. However, their therapeutic mechanisms and structure-activity relationships remain poorly understood. In this study, low-molecular-weight heparin (L-HP) and chondroitin sulfate (L-CS) exhibited favorable therapeutic effects in a mouse model of PD. Proteomics revealed that L-HP attenuated mitochondrial dysfunction through its antioxidant properties, whereas L-CS suppressed neuroinflammation by inhibiting platelet activation. Two glycosaminoglycan (GAG)-binding proteins, manganese superoxide dismutase (MnSOD2) and fibrinogen beta chain (FGB), were identified as potential targets of L-HP and L-CS, and we investigated their structure-activity relationships. The IdoA2S-GlcNS6S/GlcNAc6S unit in HP bound to SOD2, whereas the GlcA-GalNAc4S and GlcA-GalNAc4S6S units in CS preferred FGB. Furthermore, N-S and 2-O-S in L-HP, and 4-O-S, 6-O-S, and -COOH in L-CS contributed significantly to the binding process. These findings provide new insights and evidence for the development and use of glycosaminoglycan-based therapeutics for PD.
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Affiliation(s)
- Qingchi Wang
- National Glycoengineering Research Center and Shandong Key Laboratory of Carbohydrate Chemistry and Glycobiology, Shandong University, 72 Binhai Rd, Qingdao 266200, China; Xianghu Laboratory, Hangzhou 311231, China
| | - Changkai Bu
- National Glycoengineering Research Center and Shandong Key Laboratory of Carbohydrate Chemistry and Glycobiology, Shandong University, 72 Binhai Rd, Qingdao 266200, China
| | - Haoran Wang
- National Glycoengineering Research Center and Shandong Key Laboratory of Carbohydrate Chemistry and Glycobiology, Shandong University, 72 Binhai Rd, Qingdao 266200, China
| | - Bin Zhang
- National Glycoengineering Research Center and Shandong Key Laboratory of Carbohydrate Chemistry and Glycobiology, Shandong University, 72 Binhai Rd, Qingdao 266200, China
| | - Qingqing Chen
- National Glycoengineering Research Center and Shandong Key Laboratory of Carbohydrate Chemistry and Glycobiology, Shandong University, 72 Binhai Rd, Qingdao 266200, China
| | - Deling Shi
- National Glycoengineering Research Center and Shandong Key Laboratory of Carbohydrate Chemistry and Glycobiology, Shandong University, 72 Binhai Rd, Qingdao 266200, China
| | - Lianli Chi
- National Glycoengineering Research Center and Shandong Key Laboratory of Carbohydrate Chemistry and Glycobiology, Shandong University, 72 Binhai Rd, Qingdao 266200, China.
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Mercer MK, Revels JW, Blacklock LC, Banks KP, Johnson LS, Lewis DH, Kuo PH, Wilson S, Elojeimy S. Practical Overview of 123I-Ioflupane Imaging in Parkinsonian Syndromes. Radiographics 2024; 44:e230133. [PMID: 38236751 DOI: 10.1148/rg.230133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2024]
Abstract
Parkinsonian syndromes are a heterogeneous group of progressive neurodegenerative disorders involving the nigrostriatal dopaminergic pathway and are characterized by a wide spectrum of motor and nonmotor symptoms. These syndromes are quite common and can profoundly impact the lives of patients and their families. In addition to classic Parkinson disease, parkinsonian syndromes include multiple additional disorders known collectively as Parkinson-plus syndromes or atypical parkinsonism. These are characterized by the classic parkinsonian motor symptoms with additional distinguishing clinical features. Dopamine transporter SPECT has been developed as a diagnostic tool to assess the levels of dopamine transporters in the striatum. This imaging assessment, which uses iodine 123 (123I) ioflupane, can be useful to differentiate parkinsonian syndromes caused by nigrostriatal degeneration from other clinical mimics such as essential tremor or psychogenic tremor. Dopamine transporter imaging plays a crucial role in diagnosing parkinsonian syndromes, particularly in patients who do not clearly fulfill the clinical criteria for diagnosis. Diagnostic clarification can allow early treatment in appropriate patients and avoid misdiagnosis. At present, only the qualitative interpretation of dopamine transporter SPECT is approved by the U.S. Food and Drug Administration, but quantitative interpretation is often used to supplement qualitative interpretation. The authors provide an overview of patient preparation, common imaging findings, and potential pitfalls that radiologists and nuclear medicine physicians should know when performing and interpreting dopamine transporter examinations. Alternatives to 123I-ioflupane imaging for the evaluation of nigrostriatal degeneration are also briefly discussed. ©RSNA, 2024 Test Your Knowledge questions for this article are available in the supplemental material. See the invited commentary by Intenzo and Colarossi in this issue.
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Affiliation(s)
- Megan K Mercer
- From the Department of Radiology and Radiological Science, Medical University of South Carolina, 96 Jonathan Lucas St, CSB 211N, MSC 323, Charleston, SC 29425 (M.K.M., S.E.); Department of Radiology, New York University Langone Health Long Island, New York, NY (J.W.R.); Department of Radiology, University of New Mexico, Albuquerque, NM (L.C.B.); Department of Radiology, Brooke Army Medical Center, San Antonio, Tex (K.P.B.); Department of Radiology, Eastern Virginia Medical School, Norfolk, Va (L.S.J., S.W.); Department of Radiology, University of Washington, Seattle, Wash (D.H.L.); and Departments of Medical Imaging, Medicine, and Biomedical Engineering, University of Arizona, Tucson, Ariz (P.H.K.)
| | - Jonathan W Revels
- From the Department of Radiology and Radiological Science, Medical University of South Carolina, 96 Jonathan Lucas St, CSB 211N, MSC 323, Charleston, SC 29425 (M.K.M., S.E.); Department of Radiology, New York University Langone Health Long Island, New York, NY (J.W.R.); Department of Radiology, University of New Mexico, Albuquerque, NM (L.C.B.); Department of Radiology, Brooke Army Medical Center, San Antonio, Tex (K.P.B.); Department of Radiology, Eastern Virginia Medical School, Norfolk, Va (L.S.J., S.W.); Department of Radiology, University of Washington, Seattle, Wash (D.H.L.); and Departments of Medical Imaging, Medicine, and Biomedical Engineering, University of Arizona, Tucson, Ariz (P.H.K.)
| | - Lisa C Blacklock
- From the Department of Radiology and Radiological Science, Medical University of South Carolina, 96 Jonathan Lucas St, CSB 211N, MSC 323, Charleston, SC 29425 (M.K.M., S.E.); Department of Radiology, New York University Langone Health Long Island, New York, NY (J.W.R.); Department of Radiology, University of New Mexico, Albuquerque, NM (L.C.B.); Department of Radiology, Brooke Army Medical Center, San Antonio, Tex (K.P.B.); Department of Radiology, Eastern Virginia Medical School, Norfolk, Va (L.S.J., S.W.); Department of Radiology, University of Washington, Seattle, Wash (D.H.L.); and Departments of Medical Imaging, Medicine, and Biomedical Engineering, University of Arizona, Tucson, Ariz (P.H.K.)
| | - Kevin P Banks
- From the Department of Radiology and Radiological Science, Medical University of South Carolina, 96 Jonathan Lucas St, CSB 211N, MSC 323, Charleston, SC 29425 (M.K.M., S.E.); Department of Radiology, New York University Langone Health Long Island, New York, NY (J.W.R.); Department of Radiology, University of New Mexico, Albuquerque, NM (L.C.B.); Department of Radiology, Brooke Army Medical Center, San Antonio, Tex (K.P.B.); Department of Radiology, Eastern Virginia Medical School, Norfolk, Va (L.S.J., S.W.); Department of Radiology, University of Washington, Seattle, Wash (D.H.L.); and Departments of Medical Imaging, Medicine, and Biomedical Engineering, University of Arizona, Tucson, Ariz (P.H.K.)
| | - Lester S Johnson
- From the Department of Radiology and Radiological Science, Medical University of South Carolina, 96 Jonathan Lucas St, CSB 211N, MSC 323, Charleston, SC 29425 (M.K.M., S.E.); Department of Radiology, New York University Langone Health Long Island, New York, NY (J.W.R.); Department of Radiology, University of New Mexico, Albuquerque, NM (L.C.B.); Department of Radiology, Brooke Army Medical Center, San Antonio, Tex (K.P.B.); Department of Radiology, Eastern Virginia Medical School, Norfolk, Va (L.S.J., S.W.); Department of Radiology, University of Washington, Seattle, Wash (D.H.L.); and Departments of Medical Imaging, Medicine, and Biomedical Engineering, University of Arizona, Tucson, Ariz (P.H.K.)
| | - David H Lewis
- From the Department of Radiology and Radiological Science, Medical University of South Carolina, 96 Jonathan Lucas St, CSB 211N, MSC 323, Charleston, SC 29425 (M.K.M., S.E.); Department of Radiology, New York University Langone Health Long Island, New York, NY (J.W.R.); Department of Radiology, University of New Mexico, Albuquerque, NM (L.C.B.); Department of Radiology, Brooke Army Medical Center, San Antonio, Tex (K.P.B.); Department of Radiology, Eastern Virginia Medical School, Norfolk, Va (L.S.J., S.W.); Department of Radiology, University of Washington, Seattle, Wash (D.H.L.); and Departments of Medical Imaging, Medicine, and Biomedical Engineering, University of Arizona, Tucson, Ariz (P.H.K.)
| | - Phillip H Kuo
- From the Department of Radiology and Radiological Science, Medical University of South Carolina, 96 Jonathan Lucas St, CSB 211N, MSC 323, Charleston, SC 29425 (M.K.M., S.E.); Department of Radiology, New York University Langone Health Long Island, New York, NY (J.W.R.); Department of Radiology, University of New Mexico, Albuquerque, NM (L.C.B.); Department of Radiology, Brooke Army Medical Center, San Antonio, Tex (K.P.B.); Department of Radiology, Eastern Virginia Medical School, Norfolk, Va (L.S.J., S.W.); Department of Radiology, University of Washington, Seattle, Wash (D.H.L.); and Departments of Medical Imaging, Medicine, and Biomedical Engineering, University of Arizona, Tucson, Ariz (P.H.K.)
| | - Shannon Wilson
- From the Department of Radiology and Radiological Science, Medical University of South Carolina, 96 Jonathan Lucas St, CSB 211N, MSC 323, Charleston, SC 29425 (M.K.M., S.E.); Department of Radiology, New York University Langone Health Long Island, New York, NY (J.W.R.); Department of Radiology, University of New Mexico, Albuquerque, NM (L.C.B.); Department of Radiology, Brooke Army Medical Center, San Antonio, Tex (K.P.B.); Department of Radiology, Eastern Virginia Medical School, Norfolk, Va (L.S.J., S.W.); Department of Radiology, University of Washington, Seattle, Wash (D.H.L.); and Departments of Medical Imaging, Medicine, and Biomedical Engineering, University of Arizona, Tucson, Ariz (P.H.K.)
| | - Saeed Elojeimy
- From the Department of Radiology and Radiological Science, Medical University of South Carolina, 96 Jonathan Lucas St, CSB 211N, MSC 323, Charleston, SC 29425 (M.K.M., S.E.); Department of Radiology, New York University Langone Health Long Island, New York, NY (J.W.R.); Department of Radiology, University of New Mexico, Albuquerque, NM (L.C.B.); Department of Radiology, Brooke Army Medical Center, San Antonio, Tex (K.P.B.); Department of Radiology, Eastern Virginia Medical School, Norfolk, Va (L.S.J., S.W.); Department of Radiology, University of Washington, Seattle, Wash (D.H.L.); and Departments of Medical Imaging, Medicine, and Biomedical Engineering, University of Arizona, Tucson, Ariz (P.H.K.)
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Anandan C, Jankovic J. Botulinum toxin treatment in parkinsonism. J Neurol Sci 2024; 456:122810. [PMID: 38056063 DOI: 10.1016/j.jns.2023.122810] [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: 10/30/2023] [Accepted: 11/22/2023] [Indexed: 12/08/2023]
Abstract
Botulinum toxin (BoNT) was approved by the United States Food and Drug Administration (FDA) in 1989 for facial movement disorders and strabismus, but since that time its indications have been expanding beyond neurologic and ophthalmologic disorders. This article is a narrative review of the therapeutic use of BoNT in tremors, dystonia, sialorrhea, bladder and other autonomic symptoms, levodopa-induced dyskinesia and other problems occuring in the setting of parkinsonism. Though FDA approval is lacking for some of these indications, expert experiences have shown that BoNT is often beneficial in this group of patients.
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Affiliation(s)
- Charenya Anandan
- Parkinson's Disease Center and Movement Disorders Clinic, Department of Neurology, Baylor College of Medicine, Houston, TX, United States of America; Neurology Care Line, Michael E DeBakey VA Medical Center, Houston, TX, United States of America
| | - Joseph Jankovic
- Parkinson's Disease Center and Movement Disorders Clinic, Department of Neurology, Baylor College of Medicine, Houston, TX, United States of America.
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Hong JP, Kwon H, Park E, Lee SU, Lee CN, Kim BJ, Kim JS, Park KW. The semicircular canal function is preserved with little impact on falls in patients with mild Parkinson's disease. Parkinsonism Relat Disord 2024; 118:105933. [PMID: 38007917 DOI: 10.1016/j.parkreldis.2023.105933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 10/27/2023] [Accepted: 11/13/2023] [Indexed: 11/28/2023]
Abstract
INTRODUCTION Postural instability is a cardinal symptom of Parkinson's disease (PD), which suggests the vestibular system may be affected in PD. This study aimed to determine whether vestibular dysfunction is associated with the risk of falls in PD. METHODS We prospectively recruited patients with de-novo PD at a tertiary medical center between December 2019 and March 2023. During initial assessment, each patient was queried about falls within the preceding year. All patients underwent evaluation of video head-impulse tests (video-HITs), motion analysis, mini-mental state examination (MMSE), and Montreal Cognitive Assessment (MOCA). We determined whether head impulse gain of the vestibulo-ocular reflex (VOR) was associated with clinical severity of PD or risk of falls. RESULTS Overall, 133 patients (mean age ± SD = 68 ± 10, 59 men) were recruited. The median Movement Disorder Society-Unified Parkinson's Disease Rating Scale motor part (MDS-UPDRS-III) was 23 (interquartile range = 16-31), and 81 patients (61 %) scored 2 or less on the Hoehn and Yahr scale. Fallers were older (p = 0.001), had longer disease duration (p = 0.001), slower gait velocity (p = 0.009), higher MDS-UPDRS-III (p < 0.001) and H&Y scale (p < 0.001), lower MMSE (p = 0.018) and MOCA scores (p = 0.001) than non-fallers. Multiple logistic regression showed that MDS-UPDRS-III had a positive association with falling (p = 0.004). Falling was not associated with VOR gain (p = 0.405). The VOR gain for each semicircular canal showed no correlation with the MDS-UPDRS-III or disease duration. CONCLUSIONS The semicircular canal function, as determined by video-HITs, is relatively spared and has little effect on the risk of falls in patients with mild-to-moderate PD.
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Affiliation(s)
- Jun-Pyo Hong
- Department of Neurology, Korea University Medical Center, Seoul, South Korea
| | - Hanim Kwon
- Department of Neurology, Korea University Ansan Hospital, Ansan, South Korea
| | - Euyhyun Park
- Department of Otorhinolaryngology-Head and Neck Surgery, Korea University College of Medicine, Seoul, South Korea; Neurotology and Neuro-ophthalmology Laboratory, Korea University Anam Hospital, Seoul, South Korea
| | - Sun-Uk Lee
- Department of Neurology, Korea University Medical Center, Seoul, South Korea; Neurotology and Neuro-ophthalmology Laboratory, Korea University Anam Hospital, Seoul, South Korea.
| | - Chan-Nyoung Lee
- Department of Neurology, Korea University Medical Center, Seoul, South Korea.
| | - Byung-Jo Kim
- Department of Neurology, Korea University Medical Center, Seoul, South Korea; BK21 FOUR Program in Learning Health Systems, Korea University, Seoul, South Korea
| | - Ji-Soo Kim
- Department of Neurology, Seoul National University College of Medicine, Seoul, South Korea; Dizziness Center, Clinical Neuroscience Center, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Kun-Woo Park
- Department of Neurology, Korea University Medical Center, Seoul, South Korea
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Shin JH, Shin DA, Lee CY, Chang HJ, Woo KA, Kim HJ, Lee JC, Jeon B. Inability to suppress head rotation during the saccade test as a clinical biomarker for cognitive dysfunction in Parkinson's disease. Neurosci Lett 2023; 812:137356. [PMID: 37355157 DOI: 10.1016/j.neulet.2023.137356] [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: 04/03/2023] [Revised: 06/03/2023] [Accepted: 06/18/2023] [Indexed: 06/26/2023]
Abstract
BACKGROUND There is a need for development of reliable and accessible clinical biomarker for detecting cognitive dysfunction in PD. This study aimed to investigate whether involuntary head rotation during the saccade test could serve as a potential biomarker for screening cognitive dysfunction in PD. METHODS A total of 27 PD patients and nine age- and sex-matched healthy controls were prospectively enrolled in this study. A custom-designed gyroscope was attached to the forehead of each participant, and a saccade test consisting of 20 trials was conducted. The entire test was recorded on video, and two movement disorder experts independently rated the degree of head rotation, blinded to the patients' clinical information. The peak angular velocity of head rotation was derived from the gyroscope data. Participants underwent Montreal Cognitive Assessment (MoCA) as the cognitive evaluation. Correlation analysis was performed to assess the relationship between head rotation and MoCA scores. RESULTS The mean peak angular velocity of head rotation significantly correlated with the MoCA scores (R = -0.52, p = 0.0023) including age, sex, disease duration, and education duration as cofactors. The optimal peak angular velocity thresholds for head rotation, which aligned with the manual ratings, were determined to be 5°/s and 10°/s for raters 1 and 2, respectively. The MoCA scores exhibited significant correlations with the number of head rotations, using both the 5°/s (R = -0.36, p = 0.042) and 10°/s (R = -0.49, p = 0.0048) thresholds. Furthermore, the mean angular velocity of the head demonstrated a 100% positive predictive value and specificity for the detection of cognitive impairment (MoCA < 26), based on the cut-offs of 5°/s and 10°/s. CONCLUSION Inability to suppress head rotation during saccades may serve as a potential clinical biomarker for screening cognitive dysfunction in PD.
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Affiliation(s)
- Jung Hwan Shin
- Department of Neurology, Seoul National University Hospital & Seoul National University College of Medicine, Seoul, South Korea
| | - Dong Ah Shin
- Institute of Medical and Biological Engineering, Medical Research Center, Seoul National University, Seoul 03080, Republic of Korea
| | - Chan Young Lee
- Department of Neurology, Seoul National University Hospital & Seoul National University College of Medicine, Seoul, South Korea
| | - Hee Jin Chang
- Department of Neurology, Chungnam National University Hospital & Chungnam National University College of Medicine, Seoul, South Korea
| | - Kyung Ah Woo
- Department of Neurology, Seoul National University Hospital & Seoul National University College of Medicine, Seoul, South Korea
| | - Han-Joon Kim
- Department of Neurology, Seoul National University Hospital & Seoul National University College of Medicine, Seoul, South Korea
| | - Jung Chan Lee
- Institute of Medical and Biological Engineering, Medical Research Center, Seoul National University, Seoul 03080, Republic of Korea; Department of Biomedical Engineering, Seoul National University College of Medicine and Seoul National University Hospital, Seoul 03080, Republic of Korea.
| | - Beomseok Jeon
- Department of Neurology, Seoul National University Hospital & Seoul National University College of Medicine, Seoul, South Korea.
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Head-to-Head Comparison Between Rabbit Sign and EANM/SNMMI Criteria for the 18F-DOPA Visual Assessment of Parkinsonian Syndromes in PET/MRI: A Multiple Expert-Based and Blinded Controlled Study. Clin Nucl Med 2023; 48:112-118. [PMID: 36607361 DOI: 10.1097/rlu.0000000000004481] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
PURPOSE The aim of this study was to compare the diagnostic performance of the rabbit visual pattern versus the one endorsed by the EANM/SNMMI for the diagnosis of parkinsonian syndromes in PET/MRI. PATIENTS AND METHODS The 18F-DOPA PET images of 129 consecutive patients (65 Park+ and 64 controls) with 1 year of clinical follow-up were reviewed independently by 5 experienced readers on the same imaging workstation, blinded to the final clinical diagnosis. Two visual methods were assessed independently, with several days to months of interval: the criteria endorsed by EANM/SNMMI and the "rabbit" shape of the striate assessed on 3D MIP images. The sensitivities, specificities, likelihood ratios, and predictive values of the 2 diagnostic tests were estimated simultaneously by using the "comparison of 2 binary diagnostic tests to a paired design" method. RESULTS The estimated 95% confidence interval (CI) of sensitivities and specificities ranged from 49.4% to 76.5% and from 83.2% to 97.7%, respectively. The 95% CI estimates of positive and negative likelihood ratios ranged from 3.8 to 26.7 and from 0.26 to 0.56, respectively. The 95% CI estimates of the positive and negative predictive values ranged from 78.1% to 96.7% and from 60.3% to 81.4%, respectively. For all the parameters, no statistical difference was observed between the 2 methods (P > 0.05). The rabbit sign reduced the readers' discrepancies by 25%, while maintaining the same performance. CONCLUSIONS The rabbit visual pattern appears at least comparable to the current EANM/SNMMI reference procedure for the assessment of parkinsonian syndromes in daily clinical practice, without the need of any image postprocessing. Further multicenter prospective studies would be of relevance to validate these findings.
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Jeong SH, Park CW, Lee HS, Kim YJ, Yun M, Lee PH, Sohn YH, Chung SJ. Patterns of striatal dopamine depletion and motor deficits in de novo Parkinson's disease. J Neural Transm (Vienna) 2023; 130:19-28. [PMID: 36462096 DOI: 10.1007/s00702-022-02571-9] [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: 10/10/2022] [Accepted: 11/24/2022] [Indexed: 12/07/2022]
Abstract
The background of this study is to investigate whether striatal dopamine depletion patterns (selective involvement in the sensorimotor striatum or asymmetry) are associated with motor deficits in Parkinson's disease (PD). We enrolled 404 drug-naïve patients with early stage PD who underwent dopamine transporter (DAT) imaging. After quantifying DAT availability in each striatal sub-region, principal component (PC) analysis was conducted to yield PCs representing the spatial patterns of striatal dopamine depletion. Subsequently, multivariate linear regression analysis was conducted to investigate the relationship between striatal dopamine depletion patterns and motor deficits assessed using the Unified PD Rating Scale Part III (UPDRS-III). Mediation analyses were used to evaluate whether dopamine deficiency in the posterior putamen mediated the association between striatal dopamine depletion patterns and parkinsonian motor deficits. Three PCs indicated patterns of striatal dopamine depletion: PC1 (overall striatal dopamine deficiency), PC2 (selective dopamine loss in the sensorimotor striatum), and PC3 (symmetric dopamine loss in the striatum). Multivariate linear regression analysis revealed that PC1 (β = - 1.605, p < 0.001) and PC2 (β = 3.201, p < 0.001) were associated with motor deficits (i.e., higher UPDRS-III scores in subjects with severe dopamine depletion throughout the whole striatum or more selective dopamine loss in the sensorimotor striatum), whereas PC3 was not (β = - 0.016, p = 0.992). Mediation analyses demonstrated that the effects of PC1 and PC2 on UPDRS-III scores were indirectly mediated by DAT availability in the posterior putamen, with a non-significant direct effect. Dopamine deficiency in the posterior putamen was most relevant to the severity of motor deficits in patients with PD, while the spatial patterns of striatal dopamine depletion were not a key determinant.
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Affiliation(s)
- Seong Ho Jeong
- Department of Neurology, Inje University Sanggye Paik Hospital, Seoul, South Korea.,Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - Chan Wook Park
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea.,Department of Physiology, Yonsei University College of Medicine, Seoul, South Korea
| | - Hye Sun Lee
- Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul, South Korea
| | - Yun Joong Kim
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea.,Department of Neurology, Yongin Severance Hospital, Yonsei University Health System, 363 Dongbaekjukjeon-daero Giheung-gu, Yongin-si, Gyeonggi-do, 16995, South Korea.,YONSEI BEYOND LAB, Yongin, South Korea
| | - Mijin Yun
- Department of Nuclear Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | - Phil Hyu Lee
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - Young H Sohn
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - Seok Jong Chung
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea. .,Department of Neurology, Yongin Severance Hospital, Yonsei University Health System, 363 Dongbaekjukjeon-daero Giheung-gu, Yongin-si, Gyeonggi-do, 16995, South Korea. .,YONSEI BEYOND LAB, Yongin, South Korea.
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