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Lim KB, Lim SY, Hor JW, Krishnan H, Mortadza F, Lim JL, Chinna K, Saedon NI, Tan AH. Orthostatic hypotension in Parkinson's disease: Sit-to-stand vs. supine-to-stand protocol and clinical correlates. Parkinsonism Relat Disord 2024; 123:106980. [PMID: 38657381 DOI: 10.1016/j.parkreldis.2024.106980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Revised: 04/14/2024] [Accepted: 04/21/2024] [Indexed: 04/26/2024]
Abstract
BACKGROUND Screening for orthostatic hypotension (OH) is integral in Parkinson's disease (PD) management, yet evidence-based guidelines on best practice methods for diagnosing OH in PD are lacking. METHODS We investigated the frequency and correlates of OH, symptomatic OH, and neurogenic OH, in a large consecutively recruited PD cohort (n = 318), and compared the diagnostic performance of the sit-to-stand vs. the supine-to-stand blood pressure (BP) test. We evaluated the utility of continuous BP monitoring and tilt table testing in patients with postural symptoms or falls who were undetected to have OH with clinic-based BP measurements. Disease severity, fluid intake, orthostatic and overactive bladder symptoms, falls, comorbidities and medication history were evaluated. RESULTS Patients' mean age was 66.1 ± 9.5years, with mean disease duration 7.8 ± 5.5years. OH frequency was 35.8 % based on the supine-to-stand test. OH in PD was significantly associated with older age, lower body mass index, longer disease duration, worse motor, cognitive and overactive bladder symptoms and functional disabilities, falls, and lower fluid intake. A similar profile was seen with asymptomatic OH. Three quarters of OH were neurogenic, with the majority also having supine hypertension. The sit-to-stand test had a sensitivity of only 0.39. One quarter of patients were additionally diagnosed with OH during continuous BP monitoring. CONCLUSIONS The sit-to-stand test substantially underdiagnoses OH in PD, with the important practice implication that supine-to-stand measurements may be preferred. Screening for OH is warranted even in asymptomatic patients. Adequate fluid intake, treatment of urinary dysfunction and falls prevention are important strategies in managing PD patients with OH.
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Affiliation(s)
- Kai Bin Lim
- Division of Neurology, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia; The Mah Pooi Soo & Tan Chin Nam Centre for Parkinson's & Related Disorders, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Shen-Yang Lim
- Division of Neurology, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia; The Mah Pooi Soo & Tan Chin Nam Centre for Parkinson's & Related Disorders, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Jia Wei Hor
- Division of Neurology, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia; The Mah Pooi Soo & Tan Chin Nam Centre for Parkinson's & Related Disorders, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Heamah Krishnan
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Firdaus Mortadza
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Jia Lun Lim
- Department of Biomedical Science, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Karuthan Chinna
- Faculty of Business and Management, UCSI University, Cheras, Kuala Lumpur, Malaysia
| | - Nor Izzati Saedon
- Division of Geriatric Medicine, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Ai Huey Tan
- Division of Neurology, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia; The Mah Pooi Soo & Tan Chin Nam Centre for Parkinson's & Related Disorders, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
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Lim SY, Tan AH, Foo JN, Tan YJ, Chew EG, Annuar AA, Closas AMD, Pajo A, Lim JL, Tay YW, Nadhirah A, Hor JW, Toh TS, Lit LC, Zulkefli J, Ngim SJ, Lim WK, Morris HR, Tan EK, Ng AS. Loss-of-function SMPD1 gene variant in Progressive Supranuclear Palsy-Richardson Syndrome patients of Chinese ancestry. J Mov Disord 2024:jmd.24009. [PMID: 38291878 DOI: 10.14802/jmd.24009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Accepted: 01/30/2024] [Indexed: 02/01/2024] Open
Abstract
Lysosomal dysfunction plays an important role in neurodegenerative diseases, including Parkinson's disease (PD) and possibly also Parkinson-plus syndromes such as progressive supranuclear palsy (PSP). This is exemplified by the involvement of the GBA1 gene, which results in a deficiency of the lysosomal enzyme glucocerebrosidase, and is currently the most frequently identified genetic factor underlying PD worldwide. Pathogenic variants in the SMPD1 gene are a recessive cause of Niemann-Pick disease type A and B. Here, we provide the first report on an association between a loss-of-function SMPD1 gene variant present in heterozygous state (p.Pro332Arg/p.P332R, which is known to result in reduced lysosomal acid sphingomyelinase activity), with PSP-Richardson syndrome in three unrelated patients of Chinese ancestry.
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Affiliation(s)
- Shen-Yang Lim
- Division of Neurology, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
- The Mah Pooi Soo & Tan Chin Nam Centre for Parkinson's & Related Disorders, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Ai Huey Tan
- Division of Neurology, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
- The Mah Pooi Soo & Tan Chin Nam Centre for Parkinson's & Related Disorders, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Jia Nee Foo
- Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore
- Laboratory of Neurogenetics, Genome Institute of Singapore, A*STAR, Singapore
| | - Yi Jayne Tan
- Department of Neurology, National Neuroscience Institute, Singapore
| | - Elaine Gy Chew
- Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore
- Laboratory of Neurogenetics, Genome Institute of Singapore, A*STAR, Singapore
| | - Azlina Ahmad Annuar
- Department of Biomedical Science, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Alfand Marl Dy Closas
- Metro Davao Medical and Research Center, Health Science and Wellness Center, Davao City, Philippines
| | - Azalea Pajo
- University of the Philippines - College of Medicine, Department of Clinical Epidemiology, Manila, Philippines
| | - Jia Lun Lim
- Department of Biomedical Science, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Yi Wen Tay
- Department of Biomedical Science, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Anis Nadhirah
- Department of Physiology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Jia Wei Hor
- The Mah Pooi Soo & Tan Chin Nam Centre for Parkinson's & Related Disorders, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Tzi Shin Toh
- The Mah Pooi Soo & Tan Chin Nam Centre for Parkinson's & Related Disorders, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Lei Cheng Lit
- Department of Physiology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Jannah Zulkefli
- The Mah Pooi Soo & Tan Chin Nam Centre for Parkinson's & Related Disorders, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Su Juen Ngim
- Division of Neurology, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Weng Khong Lim
- SingHealth Duke-NUS Institute of Precision Medicine, Singapore
- SingHealth Duke-NUS Genomic Medicine Centre, Singapore
- Cancer & Stem Cell Biology Program, Duke-NUS Medical School, Singapore
- Laboratory of Genome Variation Analytics, Genome Institute of Singapore, Agency for Science, Technology and Research, Singapore
| | - Huw R Morris
- Department of Clinical and Movement Neurosciences, University College London, Institute of Neurology, London, United Kingdom
| | - Eng-King Tan
- Department of Neurology, National Neuroscience Institute, Singapore
| | - Adeline Sl Ng
- Department of Neurology, National Neuroscience Institute, Singapore
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Tan AH, Cornejo‐Olivas M, Okubadejo N, Pal PK, Saranza G, Saffie‐Awad P, Ahmad‐Annuar A, Schumacher‐Schuh AF, Okeng'o K, Mata IF, Gatto EM, Lim S. Genetic Testing for Parkinson's Disease and Movement Disorders in Less Privileged Areas: Barriers and Opportunities. Mov Disord Clin Pract 2024; 11:14-20. [PMID: 38291851 PMCID: PMC10828609 DOI: 10.1002/mdc3.13903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 07/14/2023] [Accepted: 07/30/2023] [Indexed: 02/01/2024] Open
Affiliation(s)
- Ai Huey Tan
- Division of Neurology, Department of Medicine, Faculty of MedicineUniversity of MalayaKuala LumpurMalaysia
| | - Mario Cornejo‐Olivas
- Neurogenetics Working GroupUniversidad Científica del SurLimaPeru
- Neurogenetics Research Center, Instituto Nacional de Ciencias NeurológicasLimaPeru
| | - Njideka Okubadejo
- Department of Medicine, College of MedicineUniversity of LagosLagosNigeria
| | - Pramod Kumar Pal
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS)BengaluruIndia
| | - Gerard Saranza
- Movement Disorders Service, Section of Neurology, Department of Internal Medicine, Chong Hua Hospital and Vicente Sotto Memorial Medical CenterCebuPhilippines
| | - Paula Saffie‐Awad
- CETRAM‐Centro de Estudios de Transtornos del Movimiento, Clínica Santa MaríaSantiagoChile
| | - Azlina Ahmad‐Annuar
- Department of Biomedical Science, Faculty of MedicineUniversity of MalayaKuala LumpurMalaysia
| | - Artur F. Schumacher‐Schuh
- Departamento de FarmacologiaUniversidade Federal do Rio Grande do SulPorto AlegreBrazil
- Serviço de Neurologia, Hospital de Clínicas de Porto AlegrePorto AlegreBrazil
| | | | - Ignacio F. Mata
- Genomic Medicine Institute, Lerner Research Institute, Genomic Medicine, Cleveland Clinic FoundationClevelandOhioUSA
| | - Emilia M. Gatto
- Department of Neurology, Hospital Sanatorio de la Trinidad Mitre, Instituto de Neurociencias Buenos Aires, School of MedicineBuenos Aires UniversityBuenos AiresArgentina
| | - Shen‐Yang Lim
- Division of Neurology, Department of Medicine, Faculty of MedicineUniversity of MalayaKuala LumpurMalaysia
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4
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Vollstedt EJ, Madoev H, Aasly A, Ahmad-Annuar A, Al-Mubarak B, Alcalay RN, Alvarez V, Amorin I, Annesi G, Arkadir D, Bardien S, Barker RA, Barkhuizen M, Basak AN, Bonifati V, Boon A, Brighina L, Brockmann K, Carmine Belin A, Carr J, Clarimon J, Cornejo-Olivas M, Correia Guedes L, Corvol JC, Crosiers D, Damásio J, Das P, de Carvalho Aguiar P, De Rosa A, Dorszewska J, Ertan S, Ferese R, Ferreira J, Gatto E, Genç G, Giladi N, Gómez-Garre P, Hanagasi H, Hattori N, Hentati F, Hoffman-Zacharska D, Illarioshkin SN, Jankovic J, Jesús S, Kaasinen V, Kievit A, Klivenyi P, Kostic V, Koziorowski D, Kühn AA, Lang AE, Lim SY, Lin CH, Lohmann K, Markovic V, Martikainen MH, Mellick G, Merello M, Milanowski L, Mir P, Öztop-Çakmak Ö, Pimentel MMG, Pulkes T, Puschmann A, Rogaeva E, Sammler EM, Skaalum Petersen M, Skorvanek M, Spitz M, Suchowersky O, Tan AH, Termsarasab P, Thaler A, Tumas V, Valente EM, van de Warrenburg B, Williams-Gray CH, Wu RM, Zhang B, Zimprich A, Solle J, Padmanabhan S, Klein C. Establishing an online resource to facilitate global collaboration and inclusion of underrepresented populations: Experience from the MJFF Global Genetic Parkinson's Disease Project. PLoS One 2023; 18:e0292180. [PMID: 37788254 PMCID: PMC10547150 DOI: 10.1371/journal.pone.0292180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 09/14/2023] [Indexed: 10/05/2023] Open
Abstract
Parkinson's disease (PD) is the fastest-growing neurodegenerative disorder, currently affecting ~7 million people worldwide. PD is clinically and genetically heterogeneous, with at least 10% of all cases explained by a monogenic cause or strong genetic risk factor. However, the vast majority of our present data on monogenic PD is based on the investigation of patients of European White ancestry, leaving a large knowledge gap on monogenic PD in underrepresented populations. Gene-targeted therapies are being developed at a fast pace and have started entering clinical trials. In light of these developments, building a global network of centers working on monogenic PD, fostering collaborative research, and establishing a clinical trial-ready cohort is imperative. Based on a systematic review of the English literature on monogenic PD and a successful team science approach, we have built up a network of 59 sites worldwide and have collected information on the availability of data, biomaterials, and facilities. To enable access to this resource and to foster collaboration across centers, as well as between academia and industry, we have developed an interactive map and online tool allowing for a quick overview of available resources, along with an option to filter for specific items of interest. This initiative is currently being merged with the Global Parkinson's Genetics Program (GP2), which will attract additional centers with a focus on underrepresented sites. This growing resource and tool will facilitate collaborative research and impact the development and testing of new therapies for monogenic and potentially for idiopathic PD patients.
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Affiliation(s)
| | - Harutyun Madoev
- Institute of Neurogenetics, University of Luebeck, Luebeck, Germany
| | - Anna Aasly
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway
| | - Azlina Ahmad-Annuar
- Department of Biomedical Science, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Bashayer Al-Mubarak
- Center for Genomic Medicine, Research Centre, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Roy N. Alcalay
- Department of Neurology, Columbia University, New York, New York, United States of America
- Neurological Institute, Tel-Aviv Medical Center, Tel-Aviv, Israel; Sackler School of Medicine, Sagol School of Neuroscience, Tel-Aviv University, Tel-Aviv, Israel
| | - Victoria Alvarez
- Laboratório de Genética, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain
- Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain
| | - Ignacio Amorin
- Universidad de la Republica Uruguay, Montevideo, Uruguay
| | - Grazia Annesi
- Institute of Biomedical Research and Innovation, National Research Council, Cosenza, Italy
| | - David Arkadir
- Department of Neurology, Hadassah Medical Center and the Hebrew University, Jerusalem, Israel
| | - Soraya Bardien
- Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
- South African Medical Research Council/Stellenbosch University Genomics of Brain Disorders Research Unit, Stellenbosch University, Cape Town, South Africa
| | - Roger A. Barker
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom
| | - Melinda Barkhuizen
- DST/NWU Preclinical Drug Development Platform, North-West University, Potchefstroom, North-West, South Africa
| | - A. Nazli Basak
- Suna and Inan Kiraç Foundation, Neurodegeneration Research Laboratory, KUTTAM, School of Medicine, Koç University, Istanbul, Turkey
| | - Vincenzo Bonifati
- Department of Clinical Genetics, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Agnita Boon
- Department of Neurology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Laura Brighina
- Department of Neurology, Milan Center for Neuroscience, University of Milano-Bicocca/San Gerardo Hospital, Monza, Monza Brianza, Italy
| | - Kathrin Brockmann
- Department of Neurodegenerative Diseases, University of Tuebingen, Tuebingen, Baden Wuerttemberg, Germany
- Hertie Institute for Clinical Brain Research and German Centre for Neurodegenerative Diseases, Tuebingen, Baden Wuerttemberg, Germany
| | | | - Jonathan Carr
- South African Medical Research Council/Stellenbosch University Genomics of Brain Disorders Research Unit, Stellenbosch University, Cape Town, South Africa
- Division of Neurology, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Jordi Clarimon
- Department of Neurology, Biomedical Research Institute IIB-Sant Pau, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain
| | - Mario Cornejo-Olivas
- Neurogenetics Research Center, Instituto Nacional de Ciencias Neurologicas, Lima, Peru
- Center for Global Health, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Leonor Correia Guedes
- Centro de Estudos Egas Moniz, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
- Instituto de Medicina Molecular João Lobo Antunes, Faculty of Medicine, University of Lisbon, Lisbon, Portugal
| | - Jean-Christophe Corvol
- Paris Brain Institute—ICM, Inserm, CNRS, Assistance Publique Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Department of Neurology, Sorbonne University, Paris, France
| | - David Crosiers
- Department of Neurology, Antwerp University Hospital, Edegem, Belgium
- Translational Neurosciences, Born Bunge Institute, Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Antwerp, Belgium
- Center for Molecular Neurology, VIB, Wilrijk, Antwerp, Belgium
| | - Joana Damásio
- Department of Neurology, Hospital de Santo António—Centro Hospitalar Universitário do Porto, Porto, Portugal
- UnIGENe, Instituto de Biologia Molecular e Celular (IBMC), Instituto de Investigação e Inovação em Saúde (i3S), Universidade do Porto, Porto, Portugal
| | - Parimal Das
- Centre for Genetic Disorders, Institute of Science, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Patricia de Carvalho Aguiar
- Hospital Israelita Albert Einstein, São Paulo, Brazil
- Department of Neurology and Neurosurgery, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Anna De Rosa
- Department of Neurosciences and Reproductive and Odontostomatological Sciences, Federico II University, Naples, Italy
| | - Jolanta Dorszewska
- Laboratory of Neurobiology, Department of Neurology, Poznan University of Medical Sciences, Poznan, Poland
| | - Sibel Ertan
- Department of Neurology, School of Medicine, Koç University, Istanbul, Turkey
| | | | - Joaquim Ferreira
- Translational Neurosciences, Born Bunge Institute, Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Antwerp, Belgium
- Laboratory of Clinical Pharmacology and Therapeutics, University of Lisbon, Lisbon, Portugal
| | - Emilia Gatto
- Movement Disorders, Department of Neurology, Instituto de Neurosciencias Buenos Aires, Buenos Aires, Argentina
| | - Gençer Genç
- Department of Neurology, University of Health Sciences, Şişli Hamidiye Etfal Training and Research Hospital, İstanbul, Turkey
| | - Nir Giladi
- Neurological Institute, Tel-Aviv Medical Center, Tel-Aviv, Israel; Sackler School of Medicine, Sagol School of Neuroscience, Tel-Aviv University, Tel-Aviv, Israel
| | - Pilar Gómez-Garre
- Unidad de Trastornos del Movimiento, Servicio de Neurología y Neurofisiología Clínica, Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Seville, Spain
- Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain
| | - Hasmet Hanagasi
- Department of Neurology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Nobutaka Hattori
- Department of Neurology, Juntendo University School of Medicine, Bunkyo, Tokyo, Japan
| | - Faycal Hentati
- Mongi Ben Hmida National Institute of Neurology, Tunis, Tunisia
| | - Dorota Hoffman-Zacharska
- Institute of Genetics and Biotechnology, Faculty of Biology, University of Warsaw, Warsaw, Poland
| | | | - Joseph Jankovic
- Parkinson’s Disease Center and Movement Disorders Clinic, Department of Neurology, Baylor College of Medicine, Houston, Texas, United States of America
| | - Silvia Jesús
- Unidad de Trastornos del Movimiento, Servicio de Neurología y Neurofisiología Clínica, Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Seville, Spain
- Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain
| | - Valtteri Kaasinen
- Neurocenter, Turku University Hospital, Turku, Finland
- Department of Neurology, Satasairaala Hospital, Pori, Finland
- Clinical Neurosciences, Faculty of Medicine, University of Turku, Turku, Finland
| | - Anneke Kievit
- Department of Clinical Genetics, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Peter Klivenyi
- Department of Neurology, University of Szeged, Szeged, Hungary
| | - Vladimir Kostic
- Department for Neurodegeneration, Clinic for Neurology UCCS, Medical Faculty, University of Belgrade, Belgrade, Serbia
| | - Dariusz Koziorowski
- Department of Neurology, Faculty of Health Science, Medical University in Warsaw, Warsaw, Poland
| | - Andrea A. Kühn
- Movement Disorder and Neuromodulation Unit, Charité, Department of Neurology, Campus Mitte, Universitätsmedizin Berlin, Berlin, Germany
| | - Anthony E. Lang
- Edmond J. Safra Program in Parkinson’s Disease, Division of Neurology, Department of Medicine, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Shen-Yang Lim
- Division of Neurology, Department of Medicine, and the Mah Pooi Soo & Tan Chin Nam Centre for Parkinson’s & Related Disorders, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Chin-Hsien Lin
- Department of Neurology, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Katja Lohmann
- Institute of Neurogenetics, University of Luebeck, Luebeck, Germany
| | - Vladana Markovic
- Department for Neurodegeneration, Clinic for Neurology UCCS, Medical Faculty, University of Belgrade, Belgrade, Serbia
| | - Mika Henrik Martikainen
- Neurocenter, Turku University Hospital, Turku, Finland
- Clinical Neurosciences, Faculty of Medicine, University of Turku, Turku, Finland
- Pontificia Universidad Católica Argentina (UCA), Buenos Aires, Argentina
| | - George Mellick
- Griffith Institute for Drug Discovery (GRIDD), School of Environment and Science, Griffith University, Brisbane, Queensland, Australia
| | - Marcelo Merello
- Pontificia Universidad Católica Argentina (UCA), Buenos Aires, Argentina
- Sección Movimientos Anormales, Departamento de Neurociencias, Fleni, Buenos Aires, Argentina
- Argentine National Scientific and Technological Research Council (CONICET), Buenos Aires, Argentina
| | - Lukasz Milanowski
- Department of Neurology, Faculty of Health Science, Medical University in Warsaw, Warsaw, Poland
| | - Pablo Mir
- Unidad de Trastornos del Movimiento, Servicio de Neurología y Neurofisiología Clínica, Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Seville, Spain
- Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain
| | - Özgür Öztop-Çakmak
- Department of Neurology, School of Medicine, Koç University, Istanbul, Turkey
| | - Márcia Mattos Gonçalves Pimentel
- Department of Genetics, Institute of Biology Roberto Alcantara Gomes, State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Teeratorn Pulkes
- Division of Neurology, Department of Medicine, Ramathibodi Hospital, Mahidol University, Rajthevi, Bangkok, Thailand
| | - Andreas Puschmann
- Department of Neurology, Lund University, Lund, Sweden
- Department of Neurology, Skåne University Hospital, Lund, Sweden
| | - Ekaterina Rogaeva
- Tanz Centre for Research in Neurodegenerative Diseases, University of Toronto, Toronto, ON, Canada
| | - Esther M. Sammler
- Medical Research Council Protein Phosphorylation and Ubiquitylation Unit, University of Dundee, Dundee, United Kingdom
- Molecular and Clinical Medicine, Ninewells Hospital and Medical School, University of Dundee, Dundee, United Kingdom
| | - Maria Skaalum Petersen
- Centre of Health Science, University of the Faroe Islands, Tórshavn, Faroe Islands
- Department of Occupational Medicine and Public Health, The Faroese Hospital System, Tórshavn, Faroe Islands
| | - Matej Skorvanek
- Pavol Jozef Šafárik University in Košice, Košice, Slovakia
- Department of Neurology, University Hospital L. Pasteur, Kosice, Slovakia
| | - Mariana Spitz
- Neurology Service, State University of Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Oksana Suchowersky
- Department of Medicine, Medical Genetics and Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Ai Huey Tan
- Division of Neurology, Department of Medicine, and the Mah Pooi Soo & Tan Chin Nam Centre for Parkinson’s & Related Disorders, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Pichet Termsarasab
- Division of Neurology, Department of Medicine, Ramathibodi Hospital, Mahidol University, Rajthevi, Bangkok, Thailand
| | - Avner Thaler
- Neurological Institute, Tel-Aviv Medical Center, Tel-Aviv, Israel; Sackler School of Medicine, Sagol School of Neuroscience, Tel-Aviv University, Tel-Aviv, Israel
| | - Vitor Tumas
- Behavioral and Movement Disorders Section, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
| | - Enza Maria Valente
- Department of Molecular Medicine, University of Pavia, Pavia, Italy
- Neurogenetics Research Centre, IRCCS Mondino Foundation, Pavia, Italy
| | - Bart van de Warrenburg
- Department of Neurology, Donders Institute for Brain, Cognition, and Behavior, Radboud University Medical Centre, Nijmegen, The Netherlands
| | | | - Ruey-Mei Wu
- Department of Neurology, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Baorong Zhang
- Department of Neurology, Second Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | | | - Justin Solle
- The Michael J. Fox Foundation for Parkinson’s Research, New York, NY, United States of America
| | - Shalini Padmanabhan
- The Michael J. Fox Foundation for Parkinson’s Research, New York, NY, United States of America
| | - Christine Klein
- Institute of Neurogenetics, University of Luebeck, Luebeck, Germany
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Lim TT, Por CY, Beh YY, Schee JP, Tan AH. Treatment of startle and related disorders. Clin Park Relat Disord 2023; 9:100218. [PMID: 37808566 PMCID: PMC10556813 DOI: 10.1016/j.prdoa.2023.100218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 08/04/2023] [Accepted: 09/15/2023] [Indexed: 10/10/2023] Open
Affiliation(s)
| | - Chia Yin Por
- Department of Medicine, Penang General Hospital, Penang, Malaysia
| | - Yuan Ye Beh
- Department of Medicine, Penang General Hospital, Penang, Malaysia
| | - Jie Ping Schee
- Faculty of Medicine (Divisions of Neurology), University of Malaya, Malaysia
| | - Ai Huey Tan
- Faculty of Medicine (Divisions of Neurology), University of Malaya, Malaysia
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Müller-Nedebock AC, Dekker MCJ, Farrer MJ, Hattori N, Lim SY, Mellick GD, Rektorová I, Salama M, Schuh AFS, Stoessl AJ, Sue CM, Tan AH, Vidal RL, Klein C, Bardien S. Different pieces of the same puzzle: a multifaceted perspective on the complex biological basis of Parkinson's disease. NPJ Parkinsons Dis 2023; 9:110. [PMID: 37443150 DOI: 10.1038/s41531-023-00535-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 05/22/2023] [Indexed: 07/15/2023] Open
Abstract
The biological basis of the neurodegenerative movement disorder, Parkinson's disease (PD), is still unclear despite it being 'discovered' over 200 years ago in Western Medicine. Based on current PD knowledge, there are widely varying theories as to its pathobiology. The aim of this article was to explore some of these different theories by summarizing the viewpoints of laboratory and clinician scientists in the PD field, on the biological basis of the disease. To achieve this aim, we posed this question to thirteen "PD experts" from six continents (for global representation) and collated their personal opinions into this article. The views were varied, ranging from toxin exposure as a PD trigger, to LRRK2 as a potential root cause, to toxic alpha-synuclein being the most important etiological contributor. Notably, there was also growing recognition that the definition of PD as a single disease should be reconsidered, perhaps each with its own unique pathobiology and treatment regimen.
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Affiliation(s)
- Amica C Müller-Nedebock
- Division of Molecular Biology and Human Genetics, Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
- South African Medical Research Council/Stellenbosch University Genomics of Brain Disorders Research Unit, Stellenbosch University, Cape Town, South Africa
| | - Marieke C J Dekker
- Department of Internal Medicine, Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - Matthew J Farrer
- Norman Fixel Institute for Neurological Diseases, McKnight Brain Institute, University of Florida, Gainesville, FL, USA
| | - Nobutaka Hattori
- Research Institute of Disease of Old Age, Graduate School of Medicine, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
- Department of Neurology, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
- Neurodegenerative Disorders Collaborative Laboratory, RIKEN Center for Brain Science, 2-1 Hirosawa, Wako, Saitama, 351-0106, Japan
| | - Shen-Yang Lim
- Division of Neurology, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
- The Mah Pooi Soo & Tan Chin Nam Centre for Parkinson's & Related Disorders, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - George D Mellick
- Griffith Institute of Drug Discovery (GRIDD), Griffith University, Brisbane, QLD, Australia
| | - Irena Rektorová
- First Department of Neurology and International Clinical Research Center, St. Anne's University Hospital and Faculty of Medicine, Masaryk University, Brno, Czech Republic
- Applied Neuroscience Research Group, CEITEC, Masaryk University, Brno, Czech Republic
| | - Mohamed Salama
- Institute of Global Health and Human Ecology (I-GHHE), The American University in Cairo (AUC), New Cairo, 11835, Egypt
- Faculty of Medicine, Mansoura University, Dakahleya, Egypt
- Atlantic Senior Fellow for Equity in Brain Health at the Global Brain Health Institute (GBHI), Trinity College Dublin (TCD), Dublin, Ireland
| | - Artur F S Schuh
- Departamento de Farmacologia, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
- Serviço de Neurologia, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - A Jon Stoessl
- Pacific Parkinson's Research Centre, Department of Medicine (Division of Neurology), Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, BC, Canada
| | - Carolyn M Sue
- Neuroscience Research Australia; Faculty of Medicine, University of New South Wales; Kinghorn Centre for Clinical Genomics, Garvan Institute of Medical Research, Darlinghurst; Department of Neurology, Prince of Wales Hospital, South Eastern Sydney Local Health District, Randwick, NSW, Australia
| | - Ai Huey Tan
- Division of Neurology, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
- The Mah Pooi Soo & Tan Chin Nam Centre for Parkinson's & Related Disorders, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Rene L Vidal
- Instituto de Neurociencia Biomédica (BNI), Facultad de Medicina, Universidad de Chile, Santiago, Chile
- Centro FONDAP de Gerociencia, Salud Mental y Metabolismo (GERO), Santiago, Chile
- Centro de Biología Integrativa, Facultad de Ciencias, Universidad Mayor, Santiago, Chile
| | - Christine Klein
- Institute of Neurogenetics, University of Lübeck and University Hospital Schleswig-Holstein, Lübeck, Germany.
| | - Soraya Bardien
- Division of Molecular Biology and Human Genetics, Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
- South African Medical Research Council/Stellenbosch University Genomics of Brain Disorders Research Unit, Stellenbosch University, Cape Town, South Africa.
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Tan AH, Chuah KH, Beh YY, Schee JP, Mahadeva S, Lim SY. Gastrointestinal Dysfunction in Parkinson's Disease: Neuro-Gastroenterology Perspectives on a Multifaceted Problem. J Mov Disord 2023; 16:138-151. [PMID: 37258277 DOI: 10.14802/jmd.22220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 02/21/2023] [Indexed: 06/02/2023] Open
Abstract
Patients with Parkinson's disease (PD) face a multitude of gastrointestinal (GI) symptoms, including nausea, bloating, reduced bowel movements, and difficulties with defecation. These symptoms are common and may accumulate during the course of PD but are often under-recognized and challenging to manage. Objective testing can be burdensome to patients and does not correlate well with symptoms. Effective treatment options are limited. Evidence is often based on studies in the general population, and specific evidence in PD is scarce. Upper GI dysfunction may also interfere with the pharmacological treatment of PD motor symptoms, which poses significant management challenges. Several new less invasive assessment tools and novel treatment options have emerged in recent years. The current review provides an overview and a practical approach to recognizing and diagnosing common upper and lower GI problems in PD, e.g., dyspepsia, gastroparesis, small bowel dysfunction, chronic constipation, and defecatory dysfunction. Management aspects are discussed based on the latest evidence from the PD and general populations, with insights for future research pertaining to GI dysfunction in PD.
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Affiliation(s)
- Ai Huey Tan
- Division of Neurology, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
- Mah Pooi Soo & Tan Chin Nam Centre for Parkinson's & Related Disorders, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Kee Huat Chuah
- Division of Gastroenterology, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Yuan Ye Beh
- Department of Medicine, Hospital Pulau Pinang, Penang, Malaysia
| | - Jie Ping Schee
- Division of Neurology, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
- Mah Pooi Soo & Tan Chin Nam Centre for Parkinson's & Related Disorders, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Sanjiv Mahadeva
- Division of Gastroenterology, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Shen-Yang Lim
- Division of Neurology, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
- Mah Pooi Soo & Tan Chin Nam Centre for Parkinson's & Related Disorders, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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Tay YW, Tan AH, Lim JL, Lohmann K, Ibrahim KA, Abdul Aziz Z, Chin YT, Mawardi AS, Lim TT, Looi I, Chia YK, Ooi JCE, Cheah WK, Dy Closas AMF, Lit LC, Hor JW, Toh TS, Muthusamy KA, Bauer P, Skrahin V, Rolfs A, Klein C, Ahmad-Annuar A, Lim SY. Genetic study of early-onset Parkinson's disease in the Malaysian population. Parkinsonism Relat Disord 2023; 111:105399. [PMID: 37209484 DOI: 10.1016/j.parkreldis.2023.105399] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 03/17/2023] [Accepted: 04/11/2023] [Indexed: 05/22/2023]
Abstract
BACKGROUND About 5-10% of Parkinson's disease (PD) cases are early onset (EOPD), with several genes implicated, including GBA1, PRKN, PINK1, and SNCA. The spectrum and frequency of mutations vary across populations and globally diverse studies are crucial to comprehensively understand the genetic architecture of PD. The ancestral diversity of Southeast Asians offers opportunities to uncover a rich PD genetics landscape, and identify common regional mutations and new pathogenic variants. OBJECTIVES This study aimed to investigate the genetic architecture of EOPD in a multi-ethnic Malaysian cohort. METHODS 161 index patients with PD onset ≤50 years were recruited from multiple centers across Malaysia. A two-step approach to genetic testing was used, combining a next-generation sequencing-based PD gene panel and multiplex ligation-dependent probe amplification (MLPA). RESULTS Thirty-five patients (21.7%) carried pathogenic or likely pathogenic variants involving (in decreasing order of frequency): GBA1, PRKN, PINK1, DJ-1, LRRK2, and ATP13A2. Pathogenic/likely pathogenic variants in GBA1 were identified in thirteen patients (8.1%), and were also commonly found in PRKN and PINK1 (11/161 = 6.8% and 6/161 = 3.7%, respectively). The overall detection rate was even higher in those with familial history (48.5%) or age of diagnosis ≤40 years (34.8%). PRKN exon 7 deletion and the PINK1 p.Leu347Pro variant appear to be common among Malay patients. Many novel variants were found across the PD-related genes. CONCLUSIONS This study provides novel insights into the genetic architecture of EOPD in Southeast Asians, expands the genetic spectrum in PD-related genes, and highlights the importance of diversifying PD genetic research to include under-represented populations.
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Affiliation(s)
- Yi Wen Tay
- Department of Biomedical Science, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Ai Huey Tan
- The Mah Pooi Soo & Tan Chin Nam Centre for Parkinson's & Related Disorders, University of Malaya, Kuala Lumpur, Malaysia; Division of Neurology, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Jia Lun Lim
- Department of Biomedical Science, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Katja Lohmann
- Institute of Neurogenetics, University of Luebeck, Luebeck, Germany
| | - Khairul Azmi Ibrahim
- Department of Medicine, Hospital Sultanah Nur Zahirah, Kuala Terengganu, Malaysia
| | - Zariah Abdul Aziz
- Department of Medicine, Hospital Sultanah Nur Zahirah, Kuala Terengganu, Malaysia
| | - Yen Theng Chin
- Department of Medicine, Hospital Sultanah Nur Zahirah, Kuala Terengganu, Malaysia
| | | | | | - Irene Looi
- Department of Neurology, Seberang Jaya Hospital, Penang, Malaysia
| | - Yuen Kang Chia
- Department of Neurology, Queen Elizabeth Hospital, Kota Kinabalu, Sabah, Malaysia
| | - Joshua Chin Ern Ooi
- Department of Neurology, Queen Elizabeth Hospital, Kota Kinabalu, Sabah, Malaysia
| | - Wee Kooi Cheah
- Department of Geriatrics, Taiping Hospital, Taiping, Malaysia
| | - Alfand Marl F Dy Closas
- The Mah Pooi Soo & Tan Chin Nam Centre for Parkinson's & Related Disorders, University of Malaya, Kuala Lumpur, Malaysia; Division of Neurology, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Lei Cheng Lit
- Department of Physiology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Jia Wei Hor
- The Mah Pooi Soo & Tan Chin Nam Centre for Parkinson's & Related Disorders, University of Malaya, Kuala Lumpur, Malaysia; Division of Neurology, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Tzi Shin Toh
- The Mah Pooi Soo & Tan Chin Nam Centre for Parkinson's & Related Disorders, University of Malaya, Kuala Lumpur, Malaysia; Division of Neurology, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Kalai Arasu Muthusamy
- Division of Neurosurgery, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Peter Bauer
- Centogene GmbH, Am Strande 7, 18057, Rostock, Germany
| | - Volha Skrahin
- Centogene GmbH, Am Strande 7, 18057, Rostock, Germany; Arcensus, Goethestrasse 20, 18055, Rostock, Germany
| | - Arndt Rolfs
- Centogene GmbH, Am Strande 7, 18057, Rostock, Germany; Arcensus, Goethestrasse 20, 18055, Rostock, Germany
| | - Christine Klein
- Institute of Neurogenetics, University of Luebeck, Luebeck, Germany.
| | - Azlina Ahmad-Annuar
- Department of Biomedical Science, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
| | - Shen-Yang Lim
- The Mah Pooi Soo & Tan Chin Nam Centre for Parkinson's & Related Disorders, University of Malaya, Kuala Lumpur, Malaysia; Division of Neurology, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
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Tan AH, Gatto EM. Movement Disorder Rounds: Learning through observation, Building on collective experiences. Parkinsonism Relat Disord 2023; 110:105396. [PMID: 37045676 DOI: 10.1016/j.parkreldis.2023.105396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/07/2023]
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Fong SL, Dy Closas AMF, Lim TT, Lean PL, Loh EC, Lim SY, Tan AH. From parasomnia to agrypnia excitata - An illustrative case on diagnostic approach. Parkinsonism Relat Disord 2023; 109:105332. [PMID: 36948111 DOI: 10.1016/j.parkreldis.2023.105332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Revised: 02/10/2023] [Accepted: 02/17/2023] [Indexed: 03/06/2023]
Abstract
The diagnostic approach to sleep-related movements disorders is seldom discussed. We report a case of fatal familial insomnia who initially presented with persistent limb movements in sleep, which later progressed to a state of agrypnia excitata. Here, the evaluation of abnormal movements in sleep is discussed using a step-by-step diagnostic approach. Although no cure is available for fatal familial insomnia, prompt recognition of this condition is important to facilitate proper management, including the involvement of interdisciplinary neuropalliative care.
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Affiliation(s)
- Si-Lei Fong
- Division of Neurology, Department of Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Alfand Marl F Dy Closas
- Division of Neurology, Department of Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | | | - Phooi Leng Lean
- Department of Medicine, Seberang Jaya Hospital, Penang, Malaysia
| | - Ee Chin Loh
- Division of Palliative Medicine, Department of Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Shen-Yang Lim
- Division of Neurology, Department of Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Ai Huey Tan
- Division of Neurology, Department of Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia.
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Tan AH, Ng ASL, Ramli NM, Lim WK, Cheah PL, Teo JX, Kuan JL, Tan YJ, Lim JL, Chew EGY, Foo JN, Goh KJ, Tan EK, Lim SY. Expanding the DARS phenotype: Late-adult onset myelopathy and leukoencephalopathy. NeuroAsia 2023. [DOI: 10.54029/2023vkd] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/30/2023]
Abstract
A significant proportion of adult-onset neurological disorders remain diagnostic odysseys despite extensive evaluation. Hypomyelination with Brainstem and Spinal Cord Involvement and Leg Spasticity (HBSL) is an autosomal recessive disorder caused by mutations in the cytoplasmic aspartyl-tRNA synthetase (DARS) gene involved in mRNA translation. Clinical features of patients with DARS mutations include developmental delay, leg spasticity, cerebellar dysfunction, cognitive impairment and epilepsy. Most reported cases have been infantile-onset with severe neurological disability and neuroimaging abnormalities. To our knowledge, late- or adult-onset cases have never been reported in the literature. Here, we report for the first time, with video documentation and six-year clinical follow-up, an ethnic Malay patient with onset of spasticity and ataxia in late-adulthood, carrying a pathogenic DARS mutation discovered via whole-genome sequencing. His clinical and radiological findings were consistent with HBSL, but this diagnosis was not considered as, up until now, HBSL has only been reported with childhood/adolescent-onset. This case highlights that HBSL/DARS mutations should now be considered in the differential diagnosis of adult-onset spastic paraplegia and/or leukoencephalopathy.
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Vollstedt EJ, Schaake S, Lohmann K, Padmanabhan S, Brice A, Lesage S, Tesson C, Vidailhet M, Wurster I, Hentati F, Mirelman A, Giladi N, Marder K, Waters C, Fahn S, Kasten M, Brüggemann N, Borsche M, Foroud T, Tolosa E, Garrido A, Annesi G, Gagliardi M, Bozi M, Stefanis L, Ferreira JJ, Correia Guedes L, Avenali M, Petrucci S, Clark L, Fedotova EY, Abramycheva NY, Alvarez V, Menéndez-González M, Jesús Maestre S, Gómez-Garre P, Mir P, Belin AC, Ran C, Lin CH, Kuo MC, Crosiers D, Wszolek ZK, Ross OA, Jankovic J, Nishioka K, Funayama M, Clarimon J, Williams-Gray CH, Camacho M, Cornejo-Olivas M, Torres-Ramirez L, Wu YR, Lee-Chen GJ, Morgadinho A, Pulkes T, Termsarasab P, Berg D, Kuhlenbäumer G, Kühn AA, Borngräber F, de Michele G, De Rosa A, Zimprich A, Puschmann A, Mellick GD, Dorszewska J, Carr J, Ferese R, Gambardella S, Chase B, Markopoulou K, Satake W, Toda T, Rossi M, Merello M, Lynch T, Olszewska DA, Lim SY, Ahmad-Annuar A, Tan AH, Al-Mubarak B, Hanagasi H, Koziorowski D, Ertan S, Genç G, de Carvalho Aguiar P, Barkhuizen M, Pimentel MMG, Saunders-Pullman R, van de Warrenburg B, Bressman S, Toft M, Appel-Cresswell S, Lang AE, Skorvanek M, Boon AJW, Krüger R, Sammler EM, Tumas V, Zhang BR, Garraux G, Chung SJ, Kim YJ, Winkelmann J, Sue CM, Tan EK, Damásio J, Klivényi P, Kostic VS, Arkadir D, Martikainen M, Borges V, Hertz JM, Brighina L, Spitz M, Suchowersky O, Riess O, Das P, Mollenhauer B, Gatto EM, Petersen MS, Hattori N, Wu RM, Illarioshkin SN, Valente EM, Aasly JO, Aasly A, Alcalay RN, Thaler A, Farrer MJ, Brockmann K, Corvol JC, Klein C. Embracing Monogenic Parkinson's Disease: The MJFF Global Genetic PD Cohort. Mov Disord 2023; 38:286-303. [PMID: 36692014 DOI: 10.1002/mds.29288] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 07/20/2022] [Accepted: 07/27/2022] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND As gene-targeted therapies are increasingly being developed for Parkinson's disease (PD), identifying and characterizing carriers of specific genetic pathogenic variants is imperative. Only a small fraction of the estimated number of subjects with monogenic PD worldwide are currently represented in the literature and availability of clinical data and clinical trial-ready cohorts is limited. OBJECTIVE The objectives are to (1) establish an international cohort of affected and unaffected individuals with PD-linked variants; (2) provide harmonized and quality-controlled clinical characterization data for each included individual; and (3) further promote collaboration of researchers in the field of monogenic PD. METHODS We conducted a worldwide, systematic online survey to collect individual-level data on individuals with PD-linked variants in SNCA, LRRK2, VPS35, PRKN, PINK1, DJ-1, as well as selected pathogenic and risk variants in GBA and corresponding demographic, clinical, and genetic data. All registered cases underwent thorough quality checks, and pathogenicity scoring of the variants and genotype-phenotype relationships were analyzed. RESULTS We collected 3888 variant carriers for our analyses, reported by 92 centers (42 countries) worldwide. Of the included individuals, 3185 had a diagnosis of PD (ie, 1306 LRRK2, 115 SNCA, 23 VPS35, 429 PRKN, 75 PINK1, 13 DJ-1, and 1224 GBA) and 703 were unaffected (ie, 328 LRRK2, 32 SNCA, 3 VPS35, 1 PRKN, 1 PINK1, and 338 GBA). In total, we identified 269 different pathogenic variants; 1322 individuals in our cohort (34%) were indicated as not previously published. CONCLUSIONS Within the MJFF Global Genetic PD Study Group, we (1) established the largest international cohort of affected and unaffected individuals carrying PD-linked variants; (2) provide harmonized and quality-controlled clinical and genetic data for each included individual; (3) promote collaboration in the field of genetic PD with a view toward clinical and genetic stratification of patients for gene-targeted clinical trials. © 2023 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
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Affiliation(s)
| | - Susen Schaake
- Institute of Neurogenetics, University of Lübeck, Lübeck, Germany
| | - Katja Lohmann
- Institute of Neurogenetics, University of Lübeck, Lübeck, Germany
| | - Shalini Padmanabhan
- Research Programs, The Michael J. Fox Foundation for Parkinson's Research, New York, New York, USA
| | - Alexis Brice
- Department of Neurology, Sorbonne University, Paris Brain Institute - ICM, Inserm, CNRS, Assistance Publique Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Paris, France
| | - Suzanne Lesage
- Sorbonne University, Paris Brain Institute - ICM, Inserm, CNRS, Paris, France
| | - Christelle Tesson
- Sorbonne University, Paris Brain Institute - ICM, Inserm, CNRS, Paris, France
| | - Marie Vidailhet
- Department of Neurology, Sorbonne University, Paris Brain Institute - ICM, Inserm, CNRS, Assistance Publique Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Paris, France
| | - Isabel Wurster
- Department of Neurodegenerative Diseases, University of Tuebingen, Tuebingen, Baden Wuerttemberg, Germany, Hertie Institute for Clinical Brain Research and German Centre for Neurodegenerative Diseases, Tuebingen, Germany
| | - Faycel Hentati
- Mongi Ben Hmida National Institute of Neurology, Tunis, Tunisia
| | - Anat Mirelman
- Laboratory of Early Markers of Neurodegeneration, Neurological Institute, Tel-Aviv Medical Center, Tel-Aviv, Israel; Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel; Sagol School of Neuroscience, Tel-Aviv University, Tel-Aviv, Israel
| | - Nir Giladi
- Neurological Institute, Tel-Aviv Medical Center, Tel-Aviv, Israel; Sackler School of Medicine, Sagol School of Neuroscience, Tel-Aviv University, Tel-Aviv, Israel
| | - Karen Marder
- Department of Neurology, Taub Institute for Alzheimer's Disease and the Aging Brain, Columbia University, New York, New York, USA
| | - Cheryl Waters
- Department of Neurology, Columbia University, New York, New York, USA
| | - Stanley Fahn
- Department of Neurology, Columbia University, New York, New York, USA
| | - Meike Kasten
- Department of Psychiatry and Psychotherapy and Institute of Neurogenetics, University of Lübeck, Lübeck, Germany
| | - Norbert Brüggemann
- Department of Neurology and Institute of Neurogenetics, University of Lübeck, Lübeck, Germany
| | - Max Borsche
- Department of Neurology and Institute of Neurogenetics, University of Lübeck, Lübeck, Germany
| | - Tatiana Foroud
- Department of Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Eduardo Tolosa
- Parkinson Disease and Movement Disorders Unit, Neurology Service, Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona (UB), Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED:CB06/05/0018-ISCIII), Barcelona, Spain
| | - Alicia Garrido
- Parkinson Disease and Movement Disorders Unit, Neurology Service, Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona (UB), Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED:CB06/05/0018-ISCIII), Barcelona, Spain
| | - Grazia Annesi
- Institute of Biomedical Research and Innovation, National Research Council, Cosenza, Italy
| | - Monica Gagliardi
- Institute of Biomedical Research and Innovation, National Research Council, Cosenza, Italy
| | - Maria Bozi
- Parkinson's and Movement Disorders Unit, 2nd Department of Neurology of the University of Athens, Attikon Hospital, Haidari, Athens, Greece; Psychiatry Hospital of Attica "Dafni," Neurology Department, Haidari, Athens, Greece
| | - Leonidas Stefanis
- First Department of Neurology, Medical School of the National and Kapodistrian University of Athens, Eginition Hospital, Athens, Greece
| | - Joaquim J Ferreira
- Laboratory of Clinical Pharmacology and Therapeutics, University of Lisbon, Lisbon, Portugal; Instituto de Medicina Molecular João Lobo Antunes, Faculty of Medicine, University of Lisbon, Lisbon, Portugal
| | - Leonor Correia Guedes
- Department of Neuroscience and Mental Health, Neurology Department, Hospital de Santa Maria, CHULN, Lisbon, Portugal; Instituto de Medicina Molecular João Lobo Antunes, Faculty of Medicine, University of Lisbon, Lisbon, Portugal
| | - Micol Avenali
- Neurorehabilitation Unit, IRCCS Mondino Foundation, Pavia, Italy; Department of Brain and Behavioural Sciences, University of Pavia, Pavia, Italy
| | - Simona Petrucci
- Department of Clinical and Molecular Medicine, Sapienza University of Rome, Rome, Italy; Sant' Andrea University Hospital, Rome, Italy
| | - Lorraine Clark
- Department of Pathology and Cell Biology, Vagelos College of Physicians & Surgeons, Columbia University Irving Medical Center, New York, New York, USA; Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University Irving Medical Center, New York, New York, USA; Laboratory of Personalized Genomic Medicine, Vagelos College of Physicians & Surgeons, Columbia University Irving Medical Center, New York, New York, USA
| | | | | | - Victoria Alvarez
- Laboratório de Genética, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain
| | - Manuel Menéndez-González
- Servicio Neurología, Hospital Universitario Central de Asturias, Oviedo, Spain; Instituto de Investigación; Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain
| | - Silvia Jesús Maestre
- Unidad de Trastornos del Movimiento, Servicio de Neurología y Neurofisiología Clínica, Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Seville, Spain; Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain
| | - Pilar Gómez-Garre
- Unidad de Trastornos del Movimiento, Servicio de Neurología y Neurofisiología Clínica, Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Seville, Spain; Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain
| | - Pablo Mir
- Unidad de Trastornos del Movimiento, Servicio de Neurología y Neurofisiología Clínica, Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Seville, Spain; Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain
| | | | - Caroline Ran
- Department of Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Chin-Hsien Lin
- Department of Neurology, National Taiwan University Hospital, Taipei, Taiwan; Department of Neurology, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Ming-Che Kuo
- Department of Neurology, National Taiwan University Hospital, Taipei, Taiwan; Department of Neurology, National Taiwan University College of Medicine, Taipei, Taiwan
| | - David Crosiers
- Department of Neurology, Antwerp University Hospital, Edegem, Belgium; Born Bunge Institute, Department of Neurology, University of Antwerp, Wilrijk, Belgium; Center for Molecular Neurology, VIB, Wilrijk, Belgium
| | | | - Owen A Ross
- Department of Neuroscience, Mayo Clinic, Jacksonville, Florida, USA
| | - Joseph Jankovic
- Parkinson's Disease Center and Movement Disorders Clinic, Department of Neurology, Baylor College of Medicine, Houston, Texas, USA
| | - Kenya Nishioka
- Department of Neurology, Juntendo University School of Medicine, Bunkyo, Tokyo, Japan
| | - Manabu Funayama
- Research Institute for Diseases of Old Age, Graduate School of Medicine, Juntendo University, Bunkyo, Tokyo, Japan
| | - Jordi Clarimon
- Department of Neurology, Biomedical Research Institute IIB-Sant Pau, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain
| | | | - Marta Camacho
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - Mario Cornejo-Olivas
- Neurogenetics Research Center, Instituto Nacional de Ciencias Neurologicas, Lima, Peru; Center for Global Health, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Luis Torres-Ramirez
- Movement Disorders Unit, Instituto Nacional de Ciencias Neurologicas, Lima, Peru
| | - Yih-Ru Wu
- Department of Neurology, Chang Gung University, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan
| | - Guey-Jen Lee-Chen
- Department of Life Science, National Taiwan Normal University, Taipei, Taiwan
| | - Ana Morgadinho
- Movement Disorders Clinic, Department of Neurology, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Teeratorn Pulkes
- Division of Neurology, Department of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Pichet Termsarasab
- Division of Neurology, Department of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Daniela Berg
- Department of Neurology, Christian-Albrechts-Universität, Kiel, Germany
| | | | - Andrea A Kühn
- Movement Disorder and Neuromodulation Unit, Charité, Universitätsmedizin Berlin, Department of Neurology, Berlin, Germany
| | - Friederike Borngräber
- Movement Disorder and Neuromodulation Unit, Charité, Universitätsmedizin Berlin, Department of Neurology, Berlin, Germany
| | - Giuseppe de Michele
- Department of Neurosciences and Reproductive and Odontostomatological Sciences, Federico II University, Naples, Italy
| | - Anna De Rosa
- Department of Neurosciences and Reproductive and Odontostomatological Sciences, Federico II University, Naples, Italy
| | | | - Andreas Puschmann
- Department of Neurology, Clinical Sciences, Lund University, Lund, Sweden; Department of Neurology, Skåne University, Lund, Sweden
| | - George D Mellick
- Griffith Institute for Drug Discovery (GRIDD), School of Environment and Science, Griffith University, Brisbane, Queensland, Australia
| | - Jolanta Dorszewska
- Laboratory of Neurobiology, Department of Neurology, Poznan University of Medical Sciences, Poznan, Poland
| | - Jonathan Carr
- Division of Neurology, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Rosangela Ferese
- IRCCS Neuromed, Localita' Camerelle, Pozzilli, Isernia, Italy; Department of Biomolecular Sciences, University of Urbino "Carlo Bo", Urbino, Italy
| | - Stefano Gambardella
- IRCCS Neuromed, Localita' Camerelle, Pozzilli, Isernia, Italy; Department of Biomolecular Sciences, University of Urbino "Carlo Bo", Urbino, Italy
| | - Bruce Chase
- Department of Neurology, NorthShore University HealthSystem, Evanston, Illinois, USA
| | - Katerina Markopoulou
- Department of Neurology, NorthShore University HealthSystem, Evanston Illinois and Department of Neurology, University of Chicago, Chicago, Illinois, USA
| | - Wataru Satake
- Sección Movimientos Anormales, Departamento de Neurociencias, Fleni, Buenos Aires, Argentina; Argentine National Scientific and Technological Research Council (CONICET), Buenos Aires, Argentina
| | - Tatsushi Toda
- Department of Neurology, The University of Tokyo, Tokyo, Japan
| | - Malco Rossi
- Sección Movimientos Anormales, Departamento de Neurociencias, Fleni, Buenos Aires, Argentina; Argentine National Scientific and Technological Research Council (CONICET), Buenos Aires, Argentina
| | - Marcelo Merello
- Sección Movimientos Anormales, Departamento de Neurociencias, Fleni, Buenos Aires, Argentina; Argentine National Scientific and Technological Research Council (CONICET), Argentina; Pontificia Universidad Católica Argentina (UCA), Buenos Aires, Argentina
| | - Timothy Lynch
- Department of Neurology, The Dublin Neurological Institute at the Mater Misericordiae University Hospital, Dublin, Ireland; School of Medicine and Medical Sciences, University College Dublin, Dublin, Ireland
| | - Diana A Olszewska
- Department of Neurology, The Dublin Neurological Institute at the Mater Misericordiae University Hospital, Dublin, Ireland; School of Medicine and Medical Sciences, University College Dublin, Dublin, Ireland
| | - Shen-Yang Lim
- Division of Neurology and the Mah Pooi Soo & Tan Chin Nam Centre for Parkinson's & Related Disorders, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Azlina Ahmad-Annuar
- Department of Biomedical Science, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Ai Huey Tan
- Division of Neurology and the Mah Pooi Soo & Tan Chin Nam Centre for Parkinson's & Related Disorders, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Bashayer Al-Mubarak
- Behavioural Genetics Unit, Department of Genetics, Research Centre, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Hasmet Hanagasi
- Department of Neurology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | | | - Sibel Ertan
- Department of Neurology, School of Medicine, Koç University, Istanbul, Turkey
| | - Gençer Genç
- Department of Neurology, University of Health Sciences, Şişli Hamidiye Etfal Training and Research Hospital, İstanbul, Turkey
| | - Patricia de Carvalho Aguiar
- Hospital Israelita Albert Einstein, São Paulo, Brazil; Department of Neurology and Neurosurgery, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Melinda Barkhuizen
- DST/NWU Preclinical Drug Development Platform, North-West University, Potchefstroom, North-West, South Africa
| | - Marcia M G Pimentel
- Department of Genetics, Institute of Biology Roberto Alcantara Gomes, State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Bart van de Warrenburg
- Department of Neurology, Donders Institute for Brain, Cognition, and Behavior, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Susan Bressman
- Department of Neurology, Beth Israel Medical Center, New York, New York, USA; Department of Neurology at Albert Einstein College of Medicine, New York, New York, USA
| | - Mathias Toft
- Department of Neurology, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Silke Appel-Cresswell
- Pacific Parkinson's Research Centre, Division of Neurology, Department of Medicine, Vancouver, British Columbia, Canada
| | - Anthony E Lang
- Edmond J. Safra Program in Parkinson's Disease, Division of Neurology, Department of Medicine, University of Toronto, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Matej Skorvanek
- Department of Neurology, Pavol Jozef Šafárik University in Košice, Košice, Slovakia; Department of Neurology, University Hospital L. Pasteur, Kosice, Slovakia
| | - Agnita J W Boon
- Department of Clinical Genetics, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Rejko Krüger
- Luxembourg Centre for Systems Biomedicine (LCSB), University of Luxembourg, Esch-sur-Alzette, Luxembourg; Transversal Translational Medicine, Luxembourg Institute of Health (LIH), Strassen, Luxembourg; Parkinson Research Clinic, Centre Hospitalier de Luxembourg (CHL), Luxembourg, Luxembourg
| | - Esther M Sammler
- Neurology Department, Ninewells Hospital and Medical School, Dundee, United Kingdom; MRC Protein Phosphorylation and Ubiquitylation Unit, University of Dundee, Dundee, UK
| | - Vitor Tumas
- Behavioral and Movement Disorders Section, Ribeirão Preto Medical School, University of São Paulo, Brazil
| | - Bao-Rong Zhang
- Department of Neurology, Second Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Gaetan Garraux
- Department of Neurology, Centre Hospitalier Universitaire (CHU) de Liège, Liège, Belgium; MoVeRe Group, GIGA-CRC In Vivo Imaging, University of Liege, Liège, Belgium
| | - Sun Ju Chung
- Medical Genetic Center, Department of Neurology, Asan Medical Center, University of Ulsan 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, Yongin, South Korea
| | - Juliane Winkelmann
- Institute of Neurogenomics, Helmholtz Zentrum Muenchen, Neuherberg, Germany; Neurogenetics, Technische Universitaet Muenchen, Munich, Germany; Institute of Human Genetics, Klinikum rechts der Isar der TUM, Munich, Germany; Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
| | - Carolyn M Sue
- Department of Neurogenetics, Kolling Institute, University of Sydney, Sydney, New South Wales, Australia; Department of Neurology, Royal North Shore Hospital, St Leonards, New South Wales, Australia
| | - Eng-King Tan
- Department of Neurology, National Neuroscience Institute, Duke NUS Medical School, Singapore General Hospital, Singapore, Singapore
| | - Joana Damásio
- Department of Neurology, Hospital de Santo António - Centro Hospitalar Universitário do Porto, Porto, Portugal; UnIGENe, Instituto de Biologia Molecular e Celular (IBMC), Instituto de Investigação e Inovação em Saúde (i3S), Universidade do Porto, Portugal
| | - Péter Klivényi
- Department of Neurology, University of Szeged, Szeged, Hungary
| | - Vladimir S Kostic
- Department for Neurodegeneration, Clinic for Neurology CCS, Belgrade, Serbia
| | - David Arkadir
- Department of Neurology, Hadassah Medical Center and the Hebrew University, Jerusalem, Israel
| | - Mika Martikainen
- Neurocenter, Turku University Hospital, Turku, Finland; Clinical Neurosciences, Faculty of Medicine, University of Turku, Turku, Finland
| | - Vanderci Borges
- Department of Neurology and Neurosurgery, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Jens Michael Hertz
- Department of Clinical Genetics, Odense University Hospital, Odense C, Denmark
| | - Laura Brighina
- Department of Neurology, Milan Center for Neuroscience, University of Milano-Bicocca/San Gerardo Hospital, Monza, Italy
| | - Mariana Spitz
- Neurology Service, State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Oksana Suchowersky
- Department of Medicine, Medical Genetics and Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Olaf Riess
- Institute of Medical Genetics and Applied Genomics, University of Tuebingen, Tuebingen, Germany
| | - Parimal Das
- Centre for Genetic Disorders, Institute of Science, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Brit Mollenhauer
- Movement Disorder Paracelsus-Elena-Klinik, Kassel, Germany; Department of Neurology, University Medical Center Göttingen, Göttingen, Germany
| | - Emilia M Gatto
- Movement Disorders, Department of Neurology, Instituto de Neurosciencias Buenos Aires, Buenos Aires, Argentina
| | - Maria Skaalum Petersen
- Centre of Health Science, University of the Faroe Islands, Tórshavn, Faroe Islands; Department of Occupational Medicine and Public Health, The Faroese Hospital System, Tórshavn, Faroe Islands
| | - Nobutaka Hattori
- Research Institute for Diseases of Old Age, Graduate School of Medicine, Juntendo University, Bunkyo, Tokyo, Japan
| | - Ruey-Meei Wu
- Department of Neurology, National Taiwan University Hospital, Taipei, Taiwan; Department of Neurology, National Taiwan University College of Medicine, Taipei, Taiwan
| | | | - Enza Maria Valente
- Neurogenetics Research Centre, IRCCS Mondino Foundation, Pavia; Department of Molecular Medicine, University of Pavia, Pavia, Italy
| | - Jan O Aasly
- Department of Neurology, St. Olavs Hospital, Trondheim, Norway
- Department of Neuroscience, Norwegian University of Science and Technology, Trondheim, Norway
| | - Anna Aasly
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway
| | - Roy N Alcalay
- Department of Neurology, Columbia University, New York, New York, USA
| | - Avner Thaler
- Movement Disorders, Neurological Institute, Tel-Aviv Medical Center, Tel-Aviv, Israel; Sagol School of Neuroscience, Tel-Aviv University, Tel-Aviv, Israel; Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Matthew J Farrer
- Fixel Institute, Department of Neurology, University of Florida, Gainesville, Florida, USA
| | - Kathrin Brockmann
- Department of Neurodegenerative Diseases, University of Tuebingen, Tuebingen, Baden Wuerttemberg, Germany, Hertie Institute for Clinical Brain Research and German Centre for Neurodegenerative Diseases, Tuebingen, Germany
| | - Jean-Christophe Corvol
- Sorbonne University, Paris Brain Institute - ICM, Inserm, CNRS, Assistance Publique Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Department of Neurology, Paris, France
| | - Christine Klein
- Institute of Neurogenetics, University of Lübeck, Lübeck, Germany
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Lim SY, Tan AH, Tay YW. Deep brain stimulation in Dopa-Responsive Parkinsonism - Look out for red flags: Expert commentary. Parkinsonism Relat Disord 2023; 110:105276. [PMID: 36641339 DOI: 10.1016/j.parkreldis.2022.105276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Accepted: 12/31/2022] [Indexed: 01/12/2023]
Affiliation(s)
- Shen-Yang Lim
- Division of Neurology, Department of Medicine, Faculty of Medicine, University of Malaya, The Mah Pooi Soo & Tan Chin Nam Centre for Parkinson's & Related Disorders, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
| | - Ai Huey Tan
- Division of Neurology, Department of Medicine, Faculty of Medicine, University of Malaya, The Mah Pooi Soo & Tan Chin Nam Centre for Parkinson's & Related Disorders, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Yi Wen Tay
- Department of Biomedical Science, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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Closas AMFD, Lohmann K, Tan AH, Ibrahim NM, Lim JL, Tay YW, Muthusamy KA, Ahmad-Annuar AB, Klein C, Lim SY. A KMT2B Frameshift Variant Causing Focal Dystonia Restricted to the Oromandibular Region After Long-Term Follow-up. J Mov Disord 2023; 16:91-94. [PMID: 36537064 PMCID: PMC9978264 DOI: 10.14802/jmd.22109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 09/14/2022] [Indexed: 12/28/2022] Open
Abstract
KMT2B-linked dystonia (DYT-KMT2B) is a childhood-onset dystonia syndrome typically beginning in the lower limbs and progressing caudocranially to affect the upper limbs with eventual prominent craniocervical involvement. Despite its recent recognition, it now appears to be one of the more common monogenic causes of dystonia syndromes. Here, we present an atypical case of DYT-KMT2B with oromandibular dystonia as the presenting feature, which remained restricted to this region three decades after symptom onset. This appears to be the first reported case of DYT-KMT2B from Southeast Asia and provides further supporting evidence for the pathogenic impact of the KMT2B c.6210_6213delTGAG variant.
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Affiliation(s)
- Alfand Marl F. Dy Closas
- Division of Neurology, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia,The Mah Pooi Soo and Tan Chin Nam Centre for Parkinson’s and Related Disorders, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Katja Lohmann
- Institute of Neurogenetics, University of Luebeck, Luebeck, Germany
| | - Ai Huey Tan
- Division of Neurology, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia,The Mah Pooi Soo and Tan Chin Nam Centre for Parkinson’s and Related Disorders, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Norlinah Mohamed Ibrahim
- Neurology Unit, Department of Medicine, Faculty of Medicine, The National University of Malaysia, Kuala Lumpur, Malaysia
| | - Jia Lun Lim
- The Mah Pooi Soo and Tan Chin Nam Centre for Parkinson’s and Related Disorders, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia,Department of Biomedical Science, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Yi Wen Tay
- The Mah Pooi Soo and Tan Chin Nam Centre for Parkinson’s and Related Disorders, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia,Department of Biomedical Science, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Kalai Arasu Muthusamy
- Division of Neurosurgery, Department of Surgery, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | | | - Christine Klein
- Institute of Neurogenetics, University of Luebeck, Luebeck, Germany
| | - Shen-Yang Lim
- Division of Neurology, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia,The Mah Pooi Soo and Tan Chin Nam Centre for Parkinson’s and Related Disorders, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia,Corresponding author: Shen-Yang Lim, MD, FRACP, FASc Division of Neurology, Department of Medicine, Faculty of Medicine, Neurology Laboratory, Level 6 South Block, University of Malaya Medical Centre, Kuala Lumpur 50603, Malaysia / Tel: +603-7949-2891 / E-mail:
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15
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Bhidayasiri R, Phuenpathom W, Tan AH, Leta V, Phumphid S, Chaudhuri KR, Pal PK. Management of dysphagia and gastroparesis in Parkinson’s disease in real-world clinical practice – Balancing pharmacological and non-pharmacological approaches. Front Aging Neurosci 2022; 14:979826. [PMID: 36034128 PMCID: PMC9403060 DOI: 10.3389/fnagi.2022.979826] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 07/18/2022] [Indexed: 12/23/2022] Open
Abstract
Gastrointestinal (GI) issues are commonly experienced by patients with Parkinson’s disease (PD). Those that affect the lower GI tract, such as constipation, are the most frequently reported GI problems among patients with PD. Upper GI issues, such as swallowing dysfunction (dysphagia) and delayed gastric emptying (gastroparesis), are also common in PD but are less well recognized by both patients and clinicians and, therefore, often overlooked. These GI issues may also be perceived by the healthcare team as less of a priority than management of PD motor symptoms. However, if left untreated, both dysphagia and gastroparesis can have a significant impact on the quality of life of patients with PD and on the effectiveness on oral PD medications, with negative consequences for motor control. Holistic management of PD should therefore include timely and effective management of upper GI issues by utilizing both non-pharmacological and pharmacological approaches. This dual approach is key as many pharmacological strategies have limited efficacy in this setting, so non-pharmacological approaches are often the best option. Although a multidisciplinary approach to the management of GI issues in PD is ideal, resource constraints may mean this is not always feasible. In ‘real-world’ practice, neurologists and PD care teams often need to make initial assessments and treatment or referral recommendations for their patients with PD who are experiencing these problems. To provide guidance in these cases, this article reviews the published evidence for diagnostic and therapeutic management of dysphagia and gastroparesis, including recommendations for timely and appropriate referral to GI specialists when needed and guidance on the development of an effective management plan.
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Affiliation(s)
- Roongroj Bhidayasiri
- Chulalongkorn Centre of Excellence for Parkinson’s Disease and Related Disorders, Department of Medicine, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
- Academy of Science, Royal Society of Thailand, Bangkok, Thailand
- *Correspondence: Roongroj Bhidayasiri,
| | - Warongporn Phuenpathom
- Chulalongkorn Centre of Excellence for Parkinson’s Disease and Related Disorders, Department of Medicine, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | - Ai Huey Tan
- Division of Neurology, Department of Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Valentina Leta
- Department of Basic and Clinical Neurosciences, The Maurice Wohl Clinical Neuroscience Institute, Institute of Psychiatry, Psychology & Neuroscience, Parkinson’s Foundation Centre of Excellence, King’s College London, London, United Kingdom
| | - Saisamorn Phumphid
- Chulalongkorn Centre of Excellence for Parkinson’s Disease and Related Disorders, Department of Medicine, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | - K. Ray Chaudhuri
- Department of Basic and Clinical Neurosciences, The Maurice Wohl Clinical Neuroscience Institute, Institute of Psychiatry, Psychology & Neuroscience, Parkinson’s Foundation Centre of Excellence, King’s College London, London, United Kingdom
| | - Pramod Kumar Pal
- National Institute of Mental Health and Neurosciences, Bengaluru, India
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Abstract
Evidence for a close bidirectional link between the brain and the gut has led to a paradigm shift in neurology, especially in the case of Parkinson disease (PD), in which gastrointestinal dysfunction is a prominent feature. Over the past decade, numerous high-quality preclinical and clinical publications have shed light on the highly complex relationship between the gut and the brain in PD, providing potential for the development of new biomarkers and therapeutics. With the advent of high-throughput sequencing, the role of the gut microbiome has been specifically highlighted. Here, we provide a critical review of the literature on the microbiome-gut-brain axis in PD and present perspectives that will be useful for clinical practice. We begin with an overview of the gut-brain axis in PD, including the potential roles and interrelationships of the vagus nerve, α-synuclein in the enteric nervous system, altered intestinal permeability and inflammation, and gut microbes and their metabolic activities. The sections that follow synthesize the proposed roles of gut-related factors in the development and progression of, in responses to PD treatment, and as therapeutic targets. Finally, we summarize current knowledge gaps and challenges and delineate future directions for the field.
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Affiliation(s)
- Ai Huey Tan
- Division of Neurology, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia. .,Mah Pooi Soo & Tan Chin Nam Centre for Parkinson's & Related Disorders, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
| | - Shen Yang Lim
- Division of Neurology, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.,Mah Pooi Soo & Tan Chin Nam Centre for Parkinson's & Related Disorders, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Anthony E Lang
- Edmond J. Safra Program in Parkinson's Disease, Toronto Western Hospital, Toronto, Ontario, Canada.,Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, Toronto, Ontario, Canada
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17
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Agarwal V, Rajan J, Ramli N, Santiago C, Jasti DB, Tan AH, Lim SY. OFF-Period Purposeless Groaning in Parkinsonism. Neurol India 2022; 70:1232-1234. [PMID: 35864675 DOI: 10.4103/0028-3886.349581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
BACKGROUND Purposeless groaning is primarily encountered in patients with progressive supranuclear palsy and has also been reported to occur in advanced Parkinson's disease (PD). OBJECTIVE We describe a case of pronounced purposeless groaning occurring as a medication OFF-period nonmotor phenomenon in PD. To our knowledge, this has not been previously reported in the literature. METHODS AND MATERIALS We describe and provide video documentation of a patient with moderately advanced PD and motor fluctuations, in whom OFF-period groaning was reported by the family and observed during clinic consultations to be a prominent feature, occupying approximately 40% of his OFF periods as calculated from his PD diary. CONCLUSIONS Although rare, OFF-period purposeless groaning in PD can be very disruptive and add significantly to caregiver burden. It is postulated to be a disinhibitory and perseverative behavior related to overactivation of the cingulo-periaqueductal circuit; further study is needed to delineate the underlying pathophysiological mechanisms.
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Affiliation(s)
- Vikash Agarwal
- Division of Neurology and the Mah Pooi Soo and Tan Chin Nam Centre for Parkinson's and Related Disorders, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia; Department of Neurology, Gleneagles Global Health City, Chennai, Tamil Nadu, India
| | - Jeyalakshmi Rajan
- Division of Neurology and the Mah Pooi Soo and Tan Chin Nam Centre for Parkinson's and Related Disorders, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Norlisah Ramli
- Division of Neuroradiology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Cecilia Santiago
- Speech-Language Therapist, Sunway Medical Centre, Petaling Jaya, Selangor, Malaysia
| | - Dushyanth B Jasti
- Division of Neurology and the Mah Pooi Soo and Tan Chin Nam Centre for Parkinson's and Related Disorders, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia; Department of Neurology, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Ai Huey Tan
- Division of Neurology and the Mah Pooi Soo and Tan Chin Nam Centre for Parkinson's and Related Disorders, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Shen-Yang Lim
- Division of Neurology and the Mah Pooi Soo and Tan Chin Nam Centre for Parkinson's and Related Disorders, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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18
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Hor JW, Lim SY, Khor ES, Chong KK, Song SL, Ibrahim NM, Teh CSJ, Chong CW, Hilmi IN, Tan AH. Fecal Calprotectin in Parkinson's Disease and Multiple System Atrophy. J Mov Disord 2021; 15:106-114. [PMID: 34937162 PMCID: PMC9171316 DOI: 10.14802/jmd.21085] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 10/04/2021] [Indexed: 11/24/2022] Open
Abstract
Objective Converging evidence suggests that intestinal inflammation is involved in the pathogenesis of neurodegenerative diseases. Previous studies on fecal calprotectin in Parkinson’s disease (PD) were limited by small sample sizes, and literature regarding intestinal inflammation in multiple system atrophy (MSA) is very scarce. We investigated the levels of fecal calprotectin, a marker of intestinal inflammation, in PD and MSA. Methods We recruited 169 subjects (71 PD, 38 MSA, and 60 age-similar nonneurological controls). Clinico-demographic data were collected. PD and MSA were subtyped and the severity assessed using the MDS-UPDRS and UMSARS, respectively. Fecal calprotectin and blood immune markers were analyzed. Results Compared to controls (median: 35.7 [IQR: 114.2] μg/g), fecal calprotectin was significantly elevated in PD (median: 95.6 [IQR: 162.1] μg/g, p = 0.003) and even higher in MSA (median: 129.5 [IQR: 373.8] μg/g, p = 0.002). A significant interaction effect with age was observed; between-group differences were significant only in older subjects (i.e., ≥ 61 years) and became more apparent with increasing age. A total of 28.9% of MSA and 18.3% of PD patients had highly abnormal fecal calprotectin levels (≥ 250 μg/g); however, this difference was only significant for MSA compared to controls. Fecal calprotectin correlated moderately with selected blood immune markers in PD, but not with clinical features of PD or MSA. Conclusions Elevated fecal calprotectin suggests a role for intestinal inflammation in PD and MSA. A more complete understanding of gut immune alterations could open up new avenues of research and treatment for these debilitating diseases.
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Affiliation(s)
- Jia Wei Hor
- Division of Neurology, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.,The Mah Pooi Soo & Tan Chin Nam Centre for Parkinson's Disease and Related Disorders, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Shen-Yang Lim
- Division of Neurology, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.,The Mah Pooi Soo & Tan Chin Nam Centre for Parkinson's Disease and Related Disorders, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Eng Soon Khor
- Aab Cardiovascular Research Institute (CVRI), University of Rochester Medical Center, Rochester, NY, USA
| | - Kah Kian Chong
- Division of Neurology, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Sze Looi Song
- Institute for Advanced Studies, University of Malaya, Kuala Lumpur, Malaysia
| | - Norlinah Mohamed Ibrahim
- Neurology Unit, Department of Medicine, Faculty of Medicine, The National University of Malaysia, Kuala Lumpur, Malaysia
| | - Cindy Shuan Ju Teh
- Department of Medical Microbiology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Chun Wie Chong
- School of Pharmacy, Monash University Malaysia, Selangor, Malaysia
| | - Ida Normiha Hilmi
- Division Gasteroenterology, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Ai Huey Tan
- Division of Neurology, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.,The Mah Pooi Soo & Tan Chin Nam Centre for Parkinson's Disease and Related Disorders, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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19
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Toh TS, Chong CW, Lim SY, Bowman J, Cirstea M, Lin CH, Chen CC, Appel-Cresswell S, Finlay BB, Tan AH. Gut microbiome in Parkinson's disease: New insights from meta-analysis. Parkinsonism Relat Disord 2021; 94:1-9. [PMID: 34844021 DOI: 10.1016/j.parkreldis.2021.11.017] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Revised: 11/05/2021] [Accepted: 11/13/2021] [Indexed: 12/22/2022]
Abstract
BACKGROUND Gut microbiome alterations have been reported in Parkinson's disease (PD), but with heterogenous findings, likely due to differences in study methodology and population. We investigated the main microbiome alterations in PD, their correlations with disease severity, and the impact of study and geographical differences. METHODS After systematic screening, raw 16S rRNA gene sequences were obtained from ten case-control studies totaling 1703 subjects (969 PD, 734 non-PD controls; seven predominantly Caucasian and three predominantly non-Caucasian cohorts). Quality-filtered gene sequences were analyzed using a phylogenetic placement approach, which precludes the need for the sequences to be sourced from similar regions in the 16S rRNA gene, thus allowing a direct comparison between studies. Differences in microbiome composition and correlations with clinical variables were analyzed using multivariate statistics. RESULTS Study and geography accounted for the largest variations in gut microbiome composition. Microbiome composition was more similar for subjects from the same study than those from different studies with the same disease status. Microbiome composition significantly differed between Caucasian and non-Caucasian populations. After accounting for study differences, microbiome composition was significantly different in PD vs. controls (albeit with a marginal effect size), with several distinctive features including increased abundances of Megasphaera and Akkermansia, and reduced Roseburia. Several bacterial genera correlated with PD motor severity, motor response complications and cognitive function. CONCLUSION Consistent microbial features in PD merit further investigation. The large variations in microbiome findings of PD patients underscore the need for greater harmonization of future research, and personalized approaches in designing microbial-directed therapeutics.
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Affiliation(s)
- Tzi Shin Toh
- Division of Neurology, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia; Mah Pooi Soo & Tan Chin Nam Centre for Parkinson's & Related Disorders, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Chun Wie Chong
- School of Pharmacy, Monash University Malaysia, Selangor, Malaysia.
| | - Shen-Yang Lim
- Division of Neurology, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia; Mah Pooi Soo & Tan Chin Nam Centre for Parkinson's & Related Disorders, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Jeff Bowman
- Integrative Oceanography Division, Scripps Institution of Oceanography, University of California, California, USA; Center for Microbiome Innovation, UC San Diego, California, USA
| | - Mihai Cirstea
- Department of Microbiology and Immunology, University of British Columbia, Vancouver, British Columbia, Canada; Michael Smith Laboratories, UBC, Vancouver, British Columbia, Canada
| | - Chin-Hsien Lin
- Department of Neurology, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Chieh-Chang Chen
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan; Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Silke Appel-Cresswell
- Pacific Parkinson's Research Centre and Djavad Mowafaghian Centre for Brain Health, UBC, Vancouver, British Columbia, Canada; Division of Neurology, Faculty of Medicine, UBC, Vancouver, British Columbia, Canada
| | - B Brett Finlay
- Department of Microbiology and Immunology, University of British Columbia, Vancouver, British Columbia, Canada; Michael Smith Laboratories, UBC, Vancouver, British Columbia, Canada; Department of Biochemistry and Molecular Biology, UBC, Vancouver, British Columbia, Canada
| | - Ai Huey Tan
- Division of Neurology, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia; Mah Pooi Soo & Tan Chin Nam Centre for Parkinson's & Related Disorders, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
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20
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Lim JL, Lohmann K, Tan AH, Tay YW, Ibrahim KA, Abdul Aziz Z, Mawardi AS, Puvanarajah SD, Lim TT, Looi I, Ooi JCE, Chia YK, Muthusamy KA, Bauer P, Rolfs A, Klein C, Ahmad-Annuar A, Lim SY. Glucocerebrosidase (GBA) gene variants in a multi-ethnic Asian cohort with Parkinson's disease: mutational spectrum and clinical features. J Neural Transm (Vienna) 2021; 129:37-48. [PMID: 34779914 DOI: 10.1007/s00702-021-02421-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 09/17/2021] [Indexed: 02/07/2023]
Abstract
GBA variants are associated with increased risk and earlier onset of Parkinson's disease (PD), and more rapid disease progression especially with "severe" variants typified by p.L483P. GBA mutation screening studies from South-East Asia, with > 650 million inhabitants of diverse ancestries, are very limited. We investigated the spectrum of GBA variants, and associated clinico-demographic features, in a multi-ethnic PD cohort in Malaysia. Patients (n = 496) were recruited from seven centres, primarily of Chinese (45%), Malay (37%), and Indian (13%) ethnicities. All GBA coding exons were screened using a next-generation sequencing-based PD gene panel and verified with Sanger sequencing. We identified 14 heterozygous GBA alleles consisting of altogether 17 missense variants (8 classified as pathogenic or likely pathogenic for PD) in 25 (5.0%) patients, with a substantially higher yield among early (< 50 years) vs. late-onset patients across all three ethnicities (9.1-13.2% vs. 1.0-3.2%). The most common variant was p.L483P (including RecNciI, n = 11, 2.2%), detected in all three ethnicities. Three novel variants/recombinant alleles of uncertain significance were found; p.P71L, p.L411P, and p.L15S(;)S16G(;)I20V. The common European risk variants, p.E365K, p.T408M, and p.N409S, were not detected. A severe disease course was noted in the majority of GBA-variant carriers, across a range of detected variants. We report a potentially novel observation of spine posture abnormalities in GBA-variant carriers. This represents the largest study on GBA variation from South-East Asia, and highlights that these populations, especially those with EOPD, would be relevant for studies including clinical trials targeting GBA pathways.
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Affiliation(s)
- Jia Lun Lim
- Department of Biomedical Science, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.,The Mah Pooi Soo and Tan Chin Nam Centre for Parkinson's and Related Disorders, University of Malaya, Kuala Lumpur, Malaysia
| | - Katja Lohmann
- Institute of Neurogenetics, University of Luebeck, Luebeck, Germany
| | - Ai Huey Tan
- The Mah Pooi Soo and Tan Chin Nam Centre for Parkinson's and Related Disorders, University of Malaya, Kuala Lumpur, Malaysia.,Division of Neurology, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Yi Wen Tay
- Department of Biomedical Science, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.,The Mah Pooi Soo and Tan Chin Nam Centre for Parkinson's and Related Disorders, University of Malaya, Kuala Lumpur, Malaysia
| | - Khairul Azmi Ibrahim
- Department of Medicine, Hospital Sultanah Nur Zahirah, Kuala Terengganu, Malaysia
| | - Zariah Abdul Aziz
- Department of Medicine, Hospital Sultanah Nur Zahirah, Kuala Terengganu, Malaysia
| | | | | | - Thien Thien Lim
- Island Hospital, Penang, Malaysia.,Penang General Hospital, Penang, Malaysia
| | - Irene Looi
- Department of Medicine and Clinical Research Centre, Hospital Seberang Jaya, Penang, Malaysia
| | - Joshua Chin Ern Ooi
- Department of Neurology, Queen Elizabeth Hospital, Kota Kinabalu, Sabah, Malaysia
| | - Yuen Kang Chia
- Department of Neurology, Queen Elizabeth Hospital, Kota Kinabalu, Sabah, Malaysia
| | - Kalai Arasu Muthusamy
- Division of Neurosurgery, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Peter Bauer
- Centogene AG, Am Strande 7, 18057, Rostock, Germany
| | - Arndt Rolfs
- Centogene AG, Am Strande 7, 18057, Rostock, Germany
| | - Christine Klein
- Institute of Neurogenetics, University of Luebeck, Luebeck, Germany
| | - Azlina Ahmad-Annuar
- Department of Biomedical Science, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
| | - Shen-Yang Lim
- The Mah Pooi Soo and Tan Chin Nam Centre for Parkinson's and Related Disorders, University of Malaya, Kuala Lumpur, Malaysia. .,Division of Neurology, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
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21
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Lim JL, Ng EY, Lim SY, Tan AH, Abdul-Aziz Z, Ibrahim KA, Gopalai AA, Tay YW, Vijayanathan Y, Toh TS, Lim SK, Bee PC, Puvanarajah SD, Viswanathan S, Looi I, Lim TT, Eow GB, Cheah WK, Tan EK, Ahmad-Annuar A. Association study of MCCC1/LAMP3 and DGKQ variants with Parkinson's disease in patients of Malay ancestry. Neurol Sci 2021; 42:4203-4207. [PMID: 33559030 DOI: 10.1007/s10072-021-05056-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 01/11/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Genome-wide association studies (GWAS) have shown that variants in the 3-methylcrotonyl-CoA carboxylase (MCCC1)/lysosome-associated membrane protein 3 (LAMP3) loci (rs10513789, rs12637471, rs12493050) reduce the risk of Parkinson's disease (PD) in Caucasians, Chinese and Ashkenazi-Jews while the rs11248060 variant in the diacylglycerol kinase theta (DGKQ) gene increases the risk of PD in Caucasian and Han Chinese cohorts. However, their roles in Malays are unknown. Therefore, this study aims to investigate the association of these variants with the risk of PD in individuals of Malay ancestry. METHODS A total of 1114 subjects comprising of 536 PD patients and 578 healthy controls of Malay ancestry were recruited and genotyped using Taqman® allelic discrimination assays. RESULTS The G allele of rs10513789 (OR = 0.83, p = 0.001) and A allele of rs12637471 (OR = 0.79, p = 0.007) in the MCCC1/LAMP3 locus were associated with a protective effect against developing PD in the Malay population. A recessive model of penetrance showed a protective effect of the GG genotype for rs10513789 and the AA genotype for rs12637471. No association with PD was found with the other MCCC1/LAMP3 rs12493050 variant or with the DGKQ (rs11248060) variant. No significant associations were found between the four variants with the age at PD diagnosis. CONCLUSION MCCC1/LAMP3 variants rs10513789 and rs12637471 protect against PD in the Malay population.
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Affiliation(s)
- Jia Lun Lim
- Department of Biomedical Science, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia
| | - Ebonne Yulin Ng
- Department of Neurology, National Neuroscience Institute, Singapore General Hospital, Singapore, Singapore
| | - Shen-Yang Lim
- Division of Neurology, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
- The Mah Pooi Soo & Tan Chin Nam Centre for Parkinson's & Related Disorders, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Ai Huey Tan
- Division of Neurology, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
- The Mah Pooi Soo & Tan Chin Nam Centre for Parkinson's & Related Disorders, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Zariah Abdul-Aziz
- Department of Medicine, Hospital Sultanah Nur Zahirah, Kuala Terengganu, Malaysia
| | - Khairul Azmi Ibrahim
- Department of Medicine, Hospital Sultanah Nur Zahirah, Kuala Terengganu, Malaysia
| | - Aroma Agape Gopalai
- Department of Biomedical Science, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia
| | - Yi Wen Tay
- Department of Biomedical Science, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia
| | | | - Tzi Shin Toh
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Soo Kun Lim
- Division of Nephrology, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Ping-Chong Bee
- Division of Haematology, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | | | | | - Irene Looi
- Department of Medicine and Clinical Research Centre, Hospital Seberang Jaya, Penang, Malaysia
| | | | - Gaik Bee Eow
- Department of Neurology, Hospital Pulau Pinang, Penang, Malaysia
| | - Wee Kooi Cheah
- Department of Medicine, Hospital Taiping, Taiping, Perak, Malaysia
| | - Eng-King Tan
- Department of Neurology, National Neuroscience Institute, Academia, 20 College Road, Level 4, Singapore, 169856, Singapore.
- Duke-NUS Graduate Medical School, Singapore, Singapore.
| | - Azlina Ahmad-Annuar
- Department of Biomedical Science, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia.
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22
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Lange L, Lohmann K, Valente EM, Lim SY, Tan AH, Vollstedt EJ, Avenali M, Madoev H, Heutink P, Kumar K, Mencacci N, Klein C. The global Parkinson's Genetics Program (GP2): The Monogenic Hub 500-genomes pilot project. J Neurol Sci 2021. [DOI: 10.1016/j.jns.2021.118257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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23
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Avenali M, Lim SY, Lange L, Madoev H, Kumar K, Tan AH, Heutink P, Vollstedt EJ, Lohmann K, Mencacci N, Klein C, Valente EM. Monogenic portal of the global Parkinson's Genetics Program (GP2). J Neurol Sci 2021. [DOI: 10.1016/j.jns.2021.118256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Theng Chin Y, Abdul Aziz Z, Azmi Ibrahim K, Lun Lim J, Ahmad- Annuar A, Lim SY, Huey Tan A. P-MD010. Early-onset parkinson’s disease in malaysian malays. Clin Neurophysiol 2021. [DOI: 10.1016/j.clinph.2021.02.230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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25
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Tan YJ, Lim SY, Yong VW, Choo XY, Ng YD, Sugumaran K, Md Shah MN, Raja Aman RRA, Paramasivam SS, Mohd Ramli N, Grossmann M, Tan AH. Osteoporosis in Parkinson's Disease: Relevance of Distal Radius Dual-Energy X-Ray Absorptiometry (DXA) and Sarcopenia. J Clin Densitom 2021; 24:351-361. [PMID: 32888777 DOI: 10.1016/j.jocd.2020.07.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Revised: 07/27/2020] [Accepted: 07/27/2020] [Indexed: 12/28/2022]
Abstract
Osteoporotic fractures are common in Parkinson's disease (PD). Standard dual-energy X-ray absorptiometry (DXA) measuring bone mineral density (BMD) at the femoral neck and lumbar spine (central sites) has suboptimal sensitivity in predicting fracture risk in the general population. An association between sarcopenia and osteoporosis in PD has not been studied. We compared BMD and osteoporosis prevalence in PD patients vs controls; determined the osteoporosis detection rates using central alone vs central plus distal radius DXA; and analyzed factors (in particular, sarcopenia) associated with osteoporosis. One hundred and fifty-six subjects (102 patients with PD, 54 spousal/sibling controls) underwent femoral neck-lumbar spine-distal radius DXA. Seventy-three patients and 46 controls were assessed for sarcopenia using whole-body DXA and handgrip strength. Patients underwent clinical and serum biochemical evaluations. PD patients had significantly lower body mass index compared to controls. After adjustment for possible confounders, distal radius BMD and T-scores were significantly lower in PD patients compared to controls, but not at the femoral neck/lumbar spine. With distal radius DXA, an additional 11.0% of patients were diagnosed with osteoporosis (32.0% to 43.0%), vs 3.7% in controls (33.3% to 37.0%) additionally diagnosed; this increase was largely driven by the markedly higher detection rate in female PD patients. Female gender (adjusted odds ratio [ORadjusted] = 11.3, 95% confidence interval [CI]: 2.6-48.6) and sarcopenia (ORadjusted = 8.4, 95% CI: 1.1-64.9) were independent predictors for osteoporosis in PD. Distal radius DXA increased osteoporosis detection, especially in female PD patients, suggesting that diagnostic protocols for osteoporosis in PD could be optimized. A close association between osteoporosis and sarcopenia was documented for the first time in PD, which has important implications for clinical management and future research.
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Affiliation(s)
- Yan Jing Tan
- Division of Neurology, Department of Medicine; and the Mah Pooi Soo & Tan Chin Nam Centre for Parkinson's & Related Disorders, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Shen-Yang Lim
- Division of Neurology, Department of Medicine; and the Mah Pooi Soo & Tan Chin Nam Centre for Parkinson's & Related Disorders, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Voon Wei Yong
- Division of Neurology, Department of Medicine; and the Mah Pooi Soo & Tan Chin Nam Centre for Parkinson's & Related Disorders, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Xing Yan Choo
- Division of Neurology, Department of Medicine; and the Mah Pooi Soo & Tan Chin Nam Centre for Parkinson's & Related Disorders, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Yi-De Ng
- Department of Biomedical Imaging, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Kavita Sugumaran
- Department of Biomedical Imaging, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Mohammad Nazri Md Shah
- Department of Biomedical Imaging, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | | | - Sharmila Sunita Paramasivam
- Division of Endocrinology, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Norlisah Mohd Ramli
- Department of Biomedical Imaging, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Mathis Grossmann
- Department of Endocrinology, Austin Health, University of Melbourne, Melbourne, Australia
| | - Ai Huey Tan
- Division of Neurology, Department of Medicine; and the Mah Pooi Soo & Tan Chin Nam Centre for Parkinson's & Related Disorders, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
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Tay YW, Lim JL, Tan AH, Annuar AA, Lim SY. Rare homozygous PRKN exon 8 and 9 deletion in Malay familial early-onset Parkinson's disease. Ann Acad Med Singap 2021; 50:353-355. [PMID: 33990826 DOI: 10.47102/annals-acadmedsg.2020508] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Affiliation(s)
- Yi Wen Tay
- Department of Biomedical Science, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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Tan AH, Hor JW, Chong CW, Lim S. Probiotics for Parkinson's disease: Current evidence and future directions. JGH Open 2021; 5:414-419. [PMID: 33860090 PMCID: PMC8035463 DOI: 10.1002/jgh3.12450] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Accepted: 10/27/2020] [Indexed: 12/12/2022]
Abstract
The gut-brain axis is a hot topic in Parkinson's disease (PD). It has been postulated that gut pathogens and dysbiosis can contribute to peripheral inflammatory states or trigger downstream metabolic effects that exacerbate the neurodegenerative process in PD. Several preclinical and clinical studies have demonstrated disrupted intestinal permeability, intestinal inflammation, altered gut microbiome, and reduced fecal short-chain fatty acids in PD. In this regard, microbial-directed therapies such as probiotics are emerging as potential therapeutic options. Probiotic supplementation is postulated to confer a variety of health benefits due to the diverse functions of these live microorganisms, including inhibition of pathogen colonization, modulation/"normalization" of the microbiome and/or its function, immunomodulatory effects (e.g. reducing inflammation), and improved host epithelial barrier function. Interestingly, several PD animal model studies have demonstrated the potential neuroprotective effects of probiotics in reducing dopaminergic neuronal degeneration. Notably, two randomized placebo-controlled trials have provided class I evidence for probiotics as a treatment for constipation in PD. However, the effects of probiotics on other PD aspects, such as motor disability and cognitive function, and its long-term efficacy (including effects on PD drug absorption in the gut) have not been investigated adequately. Further targeted animal and human studies are also warranted to understand the mechanisms of actions of probiotics in PD and to tailor probiotic therapy based on individual host profiles to improve patient outcomes in this disabling disorder.
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Affiliation(s)
- Ai Huey Tan
- Division of Neurology and the Mah Pooi Soo and Tan Chin Nam Centre for Parkinson's and Related Disorders, Faculty of MedicineUniversity of MalayaKuala LumpurMalaysia
| | - Jia Wei Hor
- Division of Neurology and the Mah Pooi Soo and Tan Chin Nam Centre for Parkinson's and Related Disorders, Faculty of MedicineUniversity of MalayaKuala LumpurMalaysia
| | - Chun Wie Chong
- School of PharmacyMonash University MalaysiaSelangorMalaysia
| | - Shen‐Yang Lim
- Division of Neurology and the Mah Pooi Soo and Tan Chin Nam Centre for Parkinson's and Related Disorders, Faculty of MedicineUniversity of MalayaKuala LumpurMalaysia
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Tan AH, Chong CW, Lim SY, Yap IKS, Teh CSJ, Loke MF, Song SL, Tan JY, Ang BH, Tan YQ, Kho MT, Bowman J, Mahadeva S, Yong HS, Lang AE. Gut Microbial Ecosystem in Parkinson Disease: New Clinicobiological Insights from Multi-Omics. Ann Neurol 2021; 89:546-559. [PMID: 33274480 DOI: 10.1002/ana.25982] [Citation(s) in RCA: 90] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Revised: 11/26/2020] [Accepted: 11/29/2020] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Gut microbiome alterations in Parkinson disease (PD) have been reported repeatedly, but their functional relevance remains unclear. Fecal metabolomics, which provide a functional readout of microbial activity, have scarcely been investigated. We investigated fecal microbiome and metabolome alterations in PD, and their clinical relevance. METHODS Two hundred subjects (104 patients, 96 controls) underwent extensive clinical phenotyping. Stool samples were analyzed using 16S rRNA gene sequencing. Fecal metabolomics were performed using two platforms, nuclear magnetic resonance (NMR) spectroscopy and liquid chromatography-mass spectrometry. RESULTS Fecal microbiome and metabolome composition in PD was significantly different from controls, with the largest effect size seen in NMR-based metabolome. Microbiome and NMR-based metabolome compositional differences remained significant after comprehensive confounder analyses. Differentially abundant fecal metabolite features and predicted functional changes in PD versus controls included bioactive molecules with putative neuroprotective effects (eg, short chain fatty acids [SCFAs], ubiquinones, and salicylate) and other compounds increasingly implicated in neurodegeneration (eg, ceramides, sphingosine, and trimethylamine N-oxide). In the PD group, cognitive impairment, low body mass index (BMI), frailty, constipation, and low physical activity were associated with fecal metabolome compositional differences. Notably, low SCFAs in PD were significantly associated with poorer cognition and low BMI. Lower butyrate levels correlated with worse postural instability-gait disorder scores. INTERPRETATION Gut microbial function is altered in PD, characterized by differentially abundant metabolic features that provide important biological insights into gut-brain pathophysiology. Their clinical relevance further supports a role for microbial metabolites as potential targets for the development of new biomarkers and therapies in PD. ANN NEUROL 2021;89:546-559.
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Affiliation(s)
- Ai Huey Tan
- Division of Neurology, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.,Mah Pooi Soo and Tan Chin Nam Center for Parkinson's and Related Disorders, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Chun Wie Chong
- School of Pharmacy, Monash University Malaysia, Subang Jaya, Malaysia.,Center of Translational Research, Institute of Research, Development, and Innovation, International Medical University, Kuala Lumpur, Malaysia
| | - Shen-Yang Lim
- Division of Neurology, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.,Mah Pooi Soo and Tan Chin Nam Center for Parkinson's and Related Disorders, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | | | - Cindy Shuan Ju Teh
- Department of Medical Microbiology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Mun Fai Loke
- Department of Medical Microbiology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Sze-Looi Song
- China-ASEAN College of Marine Sciences, Xiamen University Malaysia, Sepang, Malaysia
| | - Jiun Yan Tan
- Mah Pooi Soo and Tan Chin Nam Center for Parkinson's and Related Disorders, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Ban Hong Ang
- Mah Pooi Soo and Tan Chin Nam Center for Parkinson's and Related Disorders, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Yong Qi Tan
- Mah Pooi Soo and Tan Chin Nam Center for Parkinson's and Related Disorders, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Mee Teck Kho
- School of Postgraduate Studies, International Medical University, Kuala Lumpur, Malaysia
| | - Jeff Bowman
- Integrative Oceanography Division, Scripps Institution of Oceanography, University of California, La Jolla, CA, USA.,Center for Microbiome Innovation, University of California, San Diego, San Diego, CA, USA
| | - Sanjiv Mahadeva
- Division of Gastroenterology, Department of Medicine, Faculty of Medicine, University Malaya, Kuala Lumpur, Malaysia
| | - Hoi Sen Yong
- Institute of Biological Sciences, University of Malaya, Kuala Lumpur, Malaysia
| | - 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
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Monje MHG, Fuller RLM, Cubo E, Mestre TA, Tan AH, Stout JC, Ali S, Chahine L, Dujardin K, Fitzer-Attas CJ, Youn J, Bloem BR, Horak FB, Merola A, Reilmann R, Paul SS, Dorsey ER, Maetzler W, Espay AJ, Martinez-Martin P, Stebbins GT, Sánchez-Ferro Á. Toward e-Scales: Digital Administration of the International Parkinson and Movement Disorder Society Rating Scales. Mov Disord Clin Pract 2020; 8:208-214. [PMID: 33553489 DOI: 10.1002/mdc3.13135] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 09/30/2020] [Accepted: 11/14/2020] [Indexed: 12/17/2022] Open
Affiliation(s)
- Mariana H G Monje
- HM CINAC, Hospital Universitario HM Puerta del Sur Madrid Spain.,Department of Anatomy, Histology and Neuroscience, School of Medicine Universidad Autónoma de Madrid Madrid Spain
| | | | - Esther Cubo
- Neurology Department Hospital Universitario Burgos Burgos Spain
| | - Tiago A Mestre
- Parkinson's Disease and Movement Disorders Center, Division of Neurology, Department of Medicine The Ottawa Hospital Research Institute, University of Ottawa Ottawa Ontario Canada
| | - Ai Huey Tan
- Division of Neurology and the Mah Pooi Soo & Tan Chin Nam Centre for Parkinson's & Related Disorders, Faculty of Medicine University of Malaya Kuala Lumpur Malaysia
| | - Julie C Stout
- Turner Institute for Brain and Mental Health, School of Psychological Sciences Monash University Clayton Victoria Australia
| | - Shazia Ali
- International Movement Disorders Society Milwaukee Illinois USA
| | - Lana Chahine
- Neurology Department, School of Medicine University of Pittsburgh Pittsburgh Pennsylvania USA
| | - Kathy Dujardin
- Movement Disorders Department Lille University Medical Center Lille France
| | | | - Jinyoung Youn
- Neurology Department Samsung Medical Center School of Medicine Seoul South Korea
| | - Bastiaan R Bloem
- Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology Centre of Expertise for Parkinson & Movement Disorders Nijmegen The Netherlands
| | - Fay B Horak
- Department of Neurology Oregon Health and Science University Portland Oregon USA
| | - Aristide Merola
- Department of Neurology Ohio State Wexner Medical Center Columbus Ohio USA
| | - Ralf Reilmann
- George-Huntingon-Institute & Department of Clinical Radiology University of Muenster Münster Germany.,Department of Neurodegeneration, Hertie Institute for Clinical Brain Research University of Tuebingen Tübingen Germany
| | - Serene S Paul
- Discipline of Physiotherapy, Sydney School of Health Sciences, Faculty of Medicine and Health University of Sydney Sydney New South Wales Australia
| | - Earl Ray Dorsey
- Center for Health + Technology and Department of Neurology University of Rochester Medical Center Rochester New York USA
| | - Walter Maetzler
- Department of Neurology University Hospital Schleswig-Holstein, Kiel University Kiel Germany
| | - Alberto J Espay
- Gardner Family Center for Parkinson's Disease and Movement Disorders and Neurology Department University of Cincinnati Cincinnati Ohio USA
| | - Pablo Martinez-Martin
- Center for Networked Biomedical Research in Neurodegenerative Diseases (CIBERNED) Carlos III Institute of Health Madrid Spain
| | - Glenn T Stebbins
- Department of Neurological Sciences Rush University Medical Center Chicago Illinois USA
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Lim SY, Lim KB, Hor JW, Tan AH. Brief Clinical Rating Scales Should Not Be Overlooked. Mov Disord 2020; 35:1884-1885. [PMID: 33068479 DOI: 10.1002/mds.28274] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 06/10/2020] [Accepted: 06/15/2020] [Indexed: 11/07/2022] Open
Affiliation(s)
- Shen-Yang Lim
- Division of Neurology and the Mah Pooi Soo & Tan Chin Nam Centre for Parkinson's & Related Disorders, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Kai Bin Lim
- Division of Neurology and the Mah Pooi Soo & Tan Chin Nam Centre for Parkinson's & Related Disorders, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Jia Wei Hor
- Division of Neurology and the Mah Pooi Soo & Tan Chin Nam Centre for Parkinson's & Related Disorders, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Ai Huey Tan
- Division of Neurology and the Mah Pooi Soo & Tan Chin Nam Centre for Parkinson's & Related Disorders, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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Tan AH, Lim SY, Chong KK, A Manap MAA, Hor JW, Lim JL, Low SC, Chong CW, Mahadeva S, Lang AE. Probiotics for Constipation in Parkinson Disease: A Randomized Placebo-Controlled Study. Neurology 2020; 96:e772-e782. [PMID: 33046607 DOI: 10.1212/wnl.0000000000010998] [Citation(s) in RCA: 67] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Accepted: 08/12/2020] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To determine whether probiotics are effective for constipation, a common and often difficult-to-treat problem, in Parkinson disease (PD). METHODS In this double-blind, randomized, placebo-controlled, single-center trial, 280 patients with PD were screened, and 72 eligible patients were block-randomized (1:1) to receive either multistrain probiotics capsules (n = 34) or identical-appearing placebo (n = 38), for 4 weeks. The primary endpoint was the change in the average number of spontaneous bowel movements (SBM) per week during the last 2 weeks of intervention compared with the 2-week preintervention phase, recorded by daily stool diary. Secondary outcome measures included changes in stool consistency, constipation severity score, and quality of life related to constipation. Satisfaction with intervention received was assessed. Change in levels of fecal calprotectin, a marker of intestinal inflammation, was an exploratory outcome. RESULTS SBM increased by 1.0 ± 1.2 per week after treatment with probiotics and decreased by 0.3 ± 1.0 per week in the placebo group (mean difference 1.3, 95% confidence interval 0.8-1.8, p < 0.001). Significant improvements were also seen for secondary outcomes after correction for multiple comparisons, including stool consistency (p = 0.009) and quality of life related to constipation (p = 0.001). In the treatment group, 65.6% reported satisfaction with the intervention vs only 21.6% in the placebo group (p < 0.001). One patient (2.9%) in the treatment group withdrew due to a nonserious adverse event. Fecal calprotectin did not change significantly during the study. CONCLUSIONS Multistrain probiotics treatment was effective for constipation in PD. Further studies are needed to investigate the long-term efficacy and safety of probiotics in PD, as well as their mechanisms of action. CLINICALTRIALSGOV IDENTIFIER NCT03377322. CLASSIFICATION OF EVIDENCE This study provides Class I evidence that, for people with PD, multistrain probiotics significantly increased the average number of SBM per week.
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Affiliation(s)
- Ai Huey Tan
- From the Division of Neurology (A.H.T., S.-Y.L., K.K.C., M.A.A.A.M., J.W.H., J.L.L., S.C.L.), Department of Medicine, and the Mah Pooi Soo & Tan Chin Nam Centre for Parkinson's & Related Disorders (A.H.T., S.-Y.L., K.K.C., M.A.A.A.M., J.W.H., J.L.L., S.C.L.), Faculty of Medicine, University of Malaya, Kuala Lumpur; School of Pharmacy (C.W.C.), Monash University Malaysia, Selangor; Division of Gastroenterology (S.M.), Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia; and Edmond J. Safra Program in Parkinson's Disease and the Morton and Gloria Shulman Movement Disorders Clinic (A.E.L.), Toronto Western Hospital, Toronto, Canada
| | - Shen-Yang Lim
- From the Division of Neurology (A.H.T., S.-Y.L., K.K.C., M.A.A.A.M., J.W.H., J.L.L., S.C.L.), Department of Medicine, and the Mah Pooi Soo & Tan Chin Nam Centre for Parkinson's & Related Disorders (A.H.T., S.-Y.L., K.K.C., M.A.A.A.M., J.W.H., J.L.L., S.C.L.), Faculty of Medicine, University of Malaya, Kuala Lumpur; School of Pharmacy (C.W.C.), Monash University Malaysia, Selangor; Division of Gastroenterology (S.M.), Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia; and Edmond J. Safra Program in Parkinson's Disease and the Morton and Gloria Shulman Movement Disorders Clinic (A.E.L.), Toronto Western Hospital, Toronto, Canada
| | - Kah Kian Chong
- From the Division of Neurology (A.H.T., S.-Y.L., K.K.C., M.A.A.A.M., J.W.H., J.L.L., S.C.L.), Department of Medicine, and the Mah Pooi Soo & Tan Chin Nam Centre for Parkinson's & Related Disorders (A.H.T., S.-Y.L., K.K.C., M.A.A.A.M., J.W.H., J.L.L., S.C.L.), Faculty of Medicine, University of Malaya, Kuala Lumpur; School of Pharmacy (C.W.C.), Monash University Malaysia, Selangor; Division of Gastroenterology (S.M.), Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia; and Edmond J. Safra Program in Parkinson's Disease and the Morton and Gloria Shulman Movement Disorders Clinic (A.E.L.), Toronto Western Hospital, Toronto, Canada
| | - Mohammad Addin Azhan A Manap
- From the Division of Neurology (A.H.T., S.-Y.L., K.K.C., M.A.A.A.M., J.W.H., J.L.L., S.C.L.), Department of Medicine, and the Mah Pooi Soo & Tan Chin Nam Centre for Parkinson's & Related Disorders (A.H.T., S.-Y.L., K.K.C., M.A.A.A.M., J.W.H., J.L.L., S.C.L.), Faculty of Medicine, University of Malaya, Kuala Lumpur; School of Pharmacy (C.W.C.), Monash University Malaysia, Selangor; Division of Gastroenterology (S.M.), Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia; and Edmond J. Safra Program in Parkinson's Disease and the Morton and Gloria Shulman Movement Disorders Clinic (A.E.L.), Toronto Western Hospital, Toronto, Canada
| | - Jia Wei Hor
- From the Division of Neurology (A.H.T., S.-Y.L., K.K.C., M.A.A.A.M., J.W.H., J.L.L., S.C.L.), Department of Medicine, and the Mah Pooi Soo & Tan Chin Nam Centre for Parkinson's & Related Disorders (A.H.T., S.-Y.L., K.K.C., M.A.A.A.M., J.W.H., J.L.L., S.C.L.), Faculty of Medicine, University of Malaya, Kuala Lumpur; School of Pharmacy (C.W.C.), Monash University Malaysia, Selangor; Division of Gastroenterology (S.M.), Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia; and Edmond J. Safra Program in Parkinson's Disease and the Morton and Gloria Shulman Movement Disorders Clinic (A.E.L.), Toronto Western Hospital, Toronto, Canada
| | - Jia Lun Lim
- From the Division of Neurology (A.H.T., S.-Y.L., K.K.C., M.A.A.A.M., J.W.H., J.L.L., S.C.L.), Department of Medicine, and the Mah Pooi Soo & Tan Chin Nam Centre for Parkinson's & Related Disorders (A.H.T., S.-Y.L., K.K.C., M.A.A.A.M., J.W.H., J.L.L., S.C.L.), Faculty of Medicine, University of Malaya, Kuala Lumpur; School of Pharmacy (C.W.C.), Monash University Malaysia, Selangor; Division of Gastroenterology (S.M.), Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia; and Edmond J. Safra Program in Parkinson's Disease and the Morton and Gloria Shulman Movement Disorders Clinic (A.E.L.), Toronto Western Hospital, Toronto, Canada
| | - Soon Chai Low
- From the Division of Neurology (A.H.T., S.-Y.L., K.K.C., M.A.A.A.M., J.W.H., J.L.L., S.C.L.), Department of Medicine, and the Mah Pooi Soo & Tan Chin Nam Centre for Parkinson's & Related Disorders (A.H.T., S.-Y.L., K.K.C., M.A.A.A.M., J.W.H., J.L.L., S.C.L.), Faculty of Medicine, University of Malaya, Kuala Lumpur; School of Pharmacy (C.W.C.), Monash University Malaysia, Selangor; Division of Gastroenterology (S.M.), Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia; and Edmond J. Safra Program in Parkinson's Disease and the Morton and Gloria Shulman Movement Disorders Clinic (A.E.L.), Toronto Western Hospital, Toronto, Canada
| | - Chun Wie Chong
- From the Division of Neurology (A.H.T., S.-Y.L., K.K.C., M.A.A.A.M., J.W.H., J.L.L., S.C.L.), Department of Medicine, and the Mah Pooi Soo & Tan Chin Nam Centre for Parkinson's & Related Disorders (A.H.T., S.-Y.L., K.K.C., M.A.A.A.M., J.W.H., J.L.L., S.C.L.), Faculty of Medicine, University of Malaya, Kuala Lumpur; School of Pharmacy (C.W.C.), Monash University Malaysia, Selangor; Division of Gastroenterology (S.M.), Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia; and Edmond J. Safra Program in Parkinson's Disease and the Morton and Gloria Shulman Movement Disorders Clinic (A.E.L.), Toronto Western Hospital, Toronto, Canada
| | - Sanjiv Mahadeva
- From the Division of Neurology (A.H.T., S.-Y.L., K.K.C., M.A.A.A.M., J.W.H., J.L.L., S.C.L.), Department of Medicine, and the Mah Pooi Soo & Tan Chin Nam Centre for Parkinson's & Related Disorders (A.H.T., S.-Y.L., K.K.C., M.A.A.A.M., J.W.H., J.L.L., S.C.L.), Faculty of Medicine, University of Malaya, Kuala Lumpur; School of Pharmacy (C.W.C.), Monash University Malaysia, Selangor; Division of Gastroenterology (S.M.), Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia; and Edmond J. Safra Program in Parkinson's Disease and the Morton and Gloria Shulman Movement Disorders Clinic (A.E.L.), Toronto Western Hospital, Toronto, Canada
| | - Anthony E Lang
- From the Division of Neurology (A.H.T., S.-Y.L., K.K.C., M.A.A.A.M., J.W.H., J.L.L., S.C.L.), Department of Medicine, and the Mah Pooi Soo & Tan Chin Nam Centre for Parkinson's & Related Disorders (A.H.T., S.-Y.L., K.K.C., M.A.A.A.M., J.W.H., J.L.L., S.C.L.), Faculty of Medicine, University of Malaya, Kuala Lumpur; School of Pharmacy (C.W.C.), Monash University Malaysia, Selangor; Division of Gastroenterology (S.M.), Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia; and Edmond J. Safra Program in Parkinson's Disease and the Morton and Gloria Shulman Movement Disorders Clinic (A.E.L.), Toronto Western Hospital, Toronto, Canada
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Tan AH, Lohmann K, Tay YW, Lim JL, Ahmad-Annuar A, Ramli N, Chin YT, Mawardi AS, Azmi K, Aziz ZA, Puvanarajah SD, Bauer P, Klein C, Rolfs A, Lim SY. PINK1 p.Leu347Pro mutations in Malays: Prevalence and illustrative cases. Parkinsonism Relat Disord 2020; 79:34-39. [DOI: 10.1016/j.parkreldis.2020.08.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 07/30/2020] [Accepted: 08/10/2020] [Indexed: 12/12/2022]
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Tan AH, Lim S, Mahadeva S, Loke MF, Tan JY, Ang BH, Chin KP, Mohammad Adnan AF, Ong SMC, Ibrahim AI, Zulkifli N, Lee JK, Lim WT, Teo YT, Kok YL, Ng TY, Tan AGS, Zulkifle IM, Ng CK, Ee SS, Arafin S, Mohamad Shukori K, Vadivelu JS, Marras C, Fox SH, Lang AE. Helicobacter pylori
Eradication in Parkinson's Disease: A Randomized Placebo‐Controlled Trial. Mov Disord 2020; 35:2250-2260. [DOI: 10.1002/mds.28248] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 06/22/2020] [Accepted: 07/27/2020] [Indexed: 01/03/2023] Open
Affiliation(s)
- Ai Huey Tan
- Division of Neurology, Department of Medicine, and the Mah Pooi Soo and Tan Chin Nam Centre for Parkinson's and Related Disorders, Faculty of Medicine University of Malaya Kuala Lumpur Malaysia
| | - Shen‐Yang Lim
- Division of Neurology, Department of Medicine, and the Mah Pooi Soo and Tan Chin Nam Centre for Parkinson's and Related Disorders, Faculty of Medicine University of Malaya Kuala Lumpur Malaysia
| | - Sanjiv Mahadeva
- Division of Gastroenterology, Department of Medicine, Faculty of Medicine University of Malaya Kuala Lumpur Malaysia
| | - Mun Fai Loke
- Department of Medical Microbiology University of Malaya Kuala Lumpur Malaysia
| | - Jiun Yan Tan
- Division of Neurology, Department of Medicine, and the Mah Pooi Soo and Tan Chin Nam Centre for Parkinson's and Related Disorders, Faculty of Medicine University of Malaya Kuala Lumpur Malaysia
| | - Ban Hong Ang
- Division of Neurology, Department of Medicine, and the Mah Pooi Soo and Tan Chin Nam Centre for Parkinson's and Related Disorders, Faculty of Medicine University of Malaya Kuala Lumpur Malaysia
| | - Kok Ping Chin
- Division of Neurology, Department of Medicine, and the Mah Pooi Soo and Tan Chin Nam Centre for Parkinson's and Related Disorders, Faculty of Medicine University of Malaya Kuala Lumpur Malaysia
| | - Amni Fatihah Mohammad Adnan
- Division of Neurology, Department of Medicine, and the Mah Pooi Soo and Tan Chin Nam Centre for Parkinson's and Related Disorders, Faculty of Medicine University of Malaya Kuala Lumpur Malaysia
| | - Shawna Mei Chien Ong
- Division of Neurology, Department of Medicine, and the Mah Pooi Soo and Tan Chin Nam Centre for Parkinson's and Related Disorders, Faculty of Medicine University of Malaya Kuala Lumpur Malaysia
| | - Aimi Izzah Ibrahim
- Division of Neurology, Department of Medicine, and the Mah Pooi Soo and Tan Chin Nam Centre for Parkinson's and Related Disorders, Faculty of Medicine University of Malaya Kuala Lumpur Malaysia
| | - Nusyaibah Zulkifli
- Division of Neurology, Department of Medicine, and the Mah Pooi Soo and Tan Chin Nam Centre for Parkinson's and Related Disorders, Faculty of Medicine University of Malaya Kuala Lumpur Malaysia
| | - Jing Kun Lee
- Division of Neurology, Department of Medicine, and the Mah Pooi Soo and Tan Chin Nam Centre for Parkinson's and Related Disorders, Faculty of Medicine University of Malaya Kuala Lumpur Malaysia
| | - Wan Ting Lim
- Division of Neurology, Department of Medicine, and the Mah Pooi Soo and Tan Chin Nam Centre for Parkinson's and Related Disorders, Faculty of Medicine University of Malaya Kuala Lumpur Malaysia
| | - Yong Teck Teo
- Division of Neurology, Department of Medicine, and the Mah Pooi Soo and Tan Chin Nam Centre for Parkinson's and Related Disorders, Faculty of Medicine University of Malaya Kuala Lumpur Malaysia
| | - Yong Leng Kok
- Division of Neurology, Department of Medicine, and the Mah Pooi Soo and Tan Chin Nam Centre for Parkinson's and Related Disorders, Faculty of Medicine University of Malaya Kuala Lumpur Malaysia
| | - Tze Ying Ng
- Division of Neurology, Department of Medicine, and the Mah Pooi Soo and Tan Chin Nam Centre for Parkinson's and Related Disorders, Faculty of Medicine University of Malaya Kuala Lumpur Malaysia
| | - Aaron Guan Siang Tan
- Division of Neurology, Department of Medicine, and the Mah Pooi Soo and Tan Chin Nam Centre for Parkinson's and Related Disorders, Faculty of Medicine University of Malaya Kuala Lumpur Malaysia
| | - Intan Maisara Zulkifle
- Division of Neurology, Department of Medicine, and the Mah Pooi Soo and Tan Chin Nam Centre for Parkinson's and Related Disorders, Faculty of Medicine University of Malaya Kuala Lumpur Malaysia
| | - Chin Khoon Ng
- Division of Neurology, Department of Medicine, and the Mah Pooi Soo and Tan Chin Nam Centre for Parkinson's and Related Disorders, Faculty of Medicine University of Malaya Kuala Lumpur Malaysia
| | - Soon Sean Ee
- Division of Neurology, Department of Medicine, and the Mah Pooi Soo and Tan Chin Nam Centre for Parkinson's and Related Disorders, Faculty of Medicine University of Malaya Kuala Lumpur Malaysia
| | - Shuhaina Arafin
- Division of Neurology, Department of Medicine, and the Mah Pooi Soo and Tan Chin Nam Centre for Parkinson's and Related Disorders, Faculty of Medicine University of Malaya Kuala Lumpur Malaysia
| | - Khairunnisa Mohamad Shukori
- Division of Neurology, Department of Medicine, and the Mah Pooi Soo and Tan Chin Nam Centre for Parkinson's and Related Disorders, Faculty of Medicine University of Malaya Kuala Lumpur Malaysia
| | | | - Connie Marras
- Division of Neurology, Edmond J. Safra Program in Parkinson's Disease and the Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital University of Toronto Toronto Ontario Canada
| | - Susan H. Fox
- Division of Neurology, Edmond J. Safra Program in Parkinson's Disease and the Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital University of Toronto Toronto Ontario Canada
| | - Anthony E. Lang
- Division of Neurology, Edmond J. Safra Program in Parkinson's Disease and the Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital University of Toronto Toronto Ontario Canada
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Lim SY, Lim JL, Ahmad-Annuar A, Lohmann K, Tan AH, Lim KB, Tay YW, Shing YL, Muthusamy KA, Bauer P, Rolfs A, Klein C. Clinical Phenotype of LRRK2 R1441C in 2 Chinese Sisters. NEURODEGENER DIS 2020; 20:39-45. [PMID: 32580205 DOI: 10.1159/000508131] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 04/23/2020] [Indexed: 11/19/2022] Open
Abstract
Pathogenic and risk variants in the LRRK2 gene are among the main genetic contributors to Parkinson's disease (PD) worldwide, and LRRK2-targeted therapies for patients with PARK-LRRK2are now entering clinical trials. However, in contrast to the LRRK2 G2019S mutation commonly found in Caucasians, North-African Arabs, and Ashkenazi Jews, relatively little is known about other causative LRRK2 mutations, and data on genotype-phenotype correlations are largely lacking. This report is from an ongoing multicentre study in which next-generation sequencing-based PD gene panel testing has so far been conducted on 499 PD patients of various ethnicities from Malaysia. We describe 2 sisters of Chinese ancestry with PD who carry the R1441C mutation in LRRK2 (which in Asians has been reported in only 2 Chinese patients previously), and highlight interesting clinical observations made over a decade of close follow-up. We further explored the feasibility of using a brief, expert-administered rating scale (the Clinical Impression of Severity Index; CISI-PD) to capture data on global disease severity in a large (n = 820) unselected cohort of PD patients, including severely disabled individuals typically excluded from research studies. All patients in this study were managed and evaluated by the same PD neurologist, and these data were used to make broad comparisons between the monogenic PD cases versus the overall "real world" PD cohort. This report contributes to the scarce literature on R1441C PARK-LRRK2, offering insights into natural history and epidemiological aspects, and provides support for the application of a simple and reliable clinical tool that can improve the inclusion of under-represented patient groups in PD research.
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Affiliation(s)
- Shen-Yang Lim
- Division of Neurology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia, .,The Mah Pooi Soo and Tan Chin Nam Centre for Parkinson's and Related Disorders, University of Malaya, Kuala Lumpur, Malaysia,
| | - Jia Lun Lim
- The Mah Pooi Soo and Tan Chin Nam Centre for Parkinson's and Related Disorders, University of Malaya, Kuala Lumpur, Malaysia.,Department of Biomedical Science, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Azlina Ahmad-Annuar
- Department of Biomedical Science, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Katja Lohmann
- Institute of Neurogenetics, University of Lubeck, Lubeck, Germany
| | - Ai Huey Tan
- Division of Neurology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.,The Mah Pooi Soo and Tan Chin Nam Centre for Parkinson's and Related Disorders, University of Malaya, Kuala Lumpur, Malaysia
| | - Kai Bin Lim
- Division of Neurology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.,The Mah Pooi Soo and Tan Chin Nam Centre for Parkinson's and Related Disorders, University of Malaya, Kuala Lumpur, Malaysia
| | - Yi Wen Tay
- Department of Biomedical Science, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Yee Lee Shing
- Department of Psychology, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Kalai Arasu Muthusamy
- Division of Neurosurgery, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | | | | | - Christine Klein
- Institute of Neurogenetics, University of Lubeck, Lubeck, Germany
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Foo JN, Chew EGY, Chung SJ, Peng R, Blauwendraat C, Nalls MA, Mok KY, Satake W, Toda T, Chao Y, Tan LCS, Tandiono M, Lian MM, Ng EY, Prakash KM, Au WL, Meah WY, Mok SQ, Annuar AA, Chan AYY, Chen L, Chen Y, Jeon BS, Jiang L, Lim JL, Lin JJ, Liu C, Mao C, Mok V, Pei Z, Shang HF, Shi CH, Song K, Tan AH, Wu YR, Xu YM, Xu R, Yan Y, Yang J, Zhang B, Koh WP, Lim SY, Khor CC, Liu J, Tan EK. Identification of Risk Loci for Parkinson Disease in Asians and Comparison of Risk Between Asians and Europeans: A Genome-Wide Association Study. JAMA Neurol 2020; 77:746-754. [PMID: 32310270 PMCID: PMC7171584 DOI: 10.1001/jamaneurol.2020.0428] [Citation(s) in RCA: 138] [Impact Index Per Article: 34.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Accepted: 01/03/2020] [Indexed: 02/05/2023]
Abstract
Importance Large-scale genome-wide association studies in the European population have identified 90 risk variants associated with Parkinson disease (PD); however, there are limited studies in the largest population worldwide (ie, Asian). Objectives To identify novel genome-wide significant loci for PD in Asian individuals and to compare genetic risk between Asian and European cohorts. Design Setting, and Participants Genome-wide association data generated from PD cases and controls in an Asian population (ie, Singapore/Malaysia, Hong Kong, Taiwan, mainland China, and South Korea) were collected from January 1, 2016, to December 31, 2018, as part of an ongoing study. Results were combined with inverse variance meta-analysis, and replication of top loci in European and Japanese samples was performed. Discovery samples of 31 575 individuals passing quality control of 35 994 recruited were used, with a greater than 90% participation rate. A replication cohort of 1 926 361 European-ancestry and 3509 Japanese samples was analyzed. Parkinson disease was diagnosed using UK Parkinson's Disease Society Brain Bank Criteria. Main Outcomes and Measures Genotypes of common variants, association with disease status, and polygenic risk scores. Results Of 31 575 samples identified, 6724 PD cases (mean [SD] age, 64.3 [10] years; age at onset, 58.8 [10.6] years; 3472 [53.2%] men) and 24 851 controls (age, 59.4 [11.4] years; 11 030 [45.0%] men) were analyzed in the discovery study. Eleven genome-wide significant loci were identified; 2 of these loci were novel (SV2C and WBSCR17) and 9 were previously found in Europeans. Replication in European-ancestry and Japanese samples showed robust association for SV2C (rs246814; odds ratio, 1.16; 95% CI, 1.11-1.21; P = 1.17 × 10-10 in meta-analysis of discovery and replication samples) but showed potential genetic heterogeneity at WBSCR17 (rs9638616; I2=67.1%; P = 3.40 × 10-3 for hetereogeneity). Polygenic risk score models including variants at these 11 loci were associated with a significant improvement in area under the curve over the model based on 78 European loci alone (63.1% vs 60.2%; P = 6.81 × 10-12). Conclusions and Relevance This study identified 2 apparently novel gene loci and found 9 previously identified European loci to be associated with PD in this large, meta-genome-wide association study in a worldwide population of Asian individuals and reports similarities and differences in genetic risk factors between Asian and European individuals in the risk for PD. These findings may lead to improved stratification of Asian patients and controls based on polygenic risk scores. Our findings have potential academic and clinical importance for risk stratification and precision medicine in Asia.
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Affiliation(s)
- Jia Nee Foo
- Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore, Singapore
- Human Genetics, Genome Institute of Singapore, A*STAR, Singapore, Singapore
| | - Elaine Guo Yan Chew
- Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore, Singapore
- Human Genetics, Genome Institute of Singapore, A*STAR, Singapore, Singapore
| | - Sun Ju Chung
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Rong Peng
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, PR China
| | - Cornelis Blauwendraat
- Laboratory of Neurogenetics, National Institute on Aging, National Institutes of Health, Bethesda, Maryland
| | - Mike A. Nalls
- Laboratory of Neurogenetics, National Institute on Aging, National Institutes of Health, Bethesda, Maryland
- Data Tecnica International LLC, Glen Echo, Maryland
| | - Kin Y. Mok
- Department of Neurodegenerative Disease, Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Wataru Satake
- Division of Neurology/Molecular Brain Science, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
- Department of Neurology, The University of Tokyo Graduate School of Medicine, Bunkyo, Tokyo, Japan
| | - Tatsushi Toda
- Department of Neurology, The University of Tokyo Graduate School of Medicine, Bunkyo, Tokyo, Japan
| | - Yinxia Chao
- Department of Neurology, National Neuroscience Institute, Singapore General Hospital, Singapore, Singapore
- Duke-National University of Singapore Medical School, Singapore, Singapore
| | - Louis C. S. Tan
- Duke-National University of Singapore Medical School, Singapore, Singapore
- Department of Neurology, National Neuroscience Institute, Singapore, Singapore
| | - Moses Tandiono
- Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore, Singapore
- Human Genetics, Genome Institute of Singapore, A*STAR, Singapore, Singapore
| | - Michelle M. Lian
- Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore, Singapore
- Human Genetics, Genome Institute of Singapore, A*STAR, Singapore, Singapore
| | - Ebonne Y. Ng
- Department of Neurology, National Neuroscience Institute, Singapore General Hospital, Singapore, Singapore
| | - Kumar-M. Prakash
- Department of Neurology, National Neuroscience Institute, Singapore General Hospital, Singapore, Singapore
| | - Wing-Lok Au
- Department of Neurology, National Neuroscience Institute, Singapore, Singapore
| | - Wee-Yang Meah
- Human Genetics, Genome Institute of Singapore, A*STAR, Singapore, Singapore
| | - Shi Qi Mok
- Human Genetics, Genome Institute of Singapore, A*STAR, Singapore, Singapore
| | - Azlina Ahmad Annuar
- Department of Biomedical Science, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Anne Y. Y. Chan
- Margaret K. L. Cheung Research Centre for Management of Parkinsonism, Gerald Choa Neuroscience Centre, Lui Che Woo Institute of Innovative Medicine, Prince of Wales Hospital, Division of Neurology, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, PR China
| | - Ling Chen
- Department of Neurology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, PR China
| | - Yongping Chen
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, PR China
| | - Beom S. Jeon
- Department of Neurology, Seoul National University Hospital, Jongno-gu, Seoul, South Korea
| | - Lulu Jiang
- Department of Neurology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, PR China
| | - Jia Lun Lim
- Department of Biomedical Science, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
- Mah Pooi Soo and Tan Chin Nam Centre for Parkinson's and Related Disorders, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Juei-Jueng Lin
- Department of Neurology, Chushang Show-Chwan Hospital, Zhushan District, Nantou, Taiwan
| | - Chunfeng Liu
- Department of Neurology, Second Affiliated Hospital of Soochow University, Suzhou, PR China
| | - Chengjie Mao
- Department of Neurology, Second Affiliated Hospital of Soochow University, Suzhou, PR China
| | - Vincent Mok
- Margaret K. L. Cheung Research Centre for Management of Parkinsonism, Gerald Choa Neuroscience Centre, Lui Che Woo Institute of Innovative Medicine, Prince of Wales Hospital, Division of Neurology, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, PR China
| | - Zhong Pei
- Department of Neurology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, PR China
| | - Hui-Fang Shang
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, PR China
| | - Chang-He Shi
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, PR China
| | - Kyuyoung Song
- Department of Biochemistry and Molecular Biology, University of Ulsan College of Medicine, Seoul, South Korea
| | - Ai Huey Tan
- Mah Pooi Soo and Tan Chin Nam Centre for Parkinson's and Related Disorders, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Yih-Ru Wu
- Department of Neurology, Chang Gung Memorial Hospital, Chang Gung University, Taipei, Taiwan
| | - Yu-ming Xu
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, PR China
| | - Renshi Xu
- Department of Neurology, Jiangxi Provincial People's Hospital, Affiliated People's Hospital of Nanchang University, Nanchang, Jiangxi, PR China
| | - Yaping Yan
- Second Affiliated Hospital, Department of Neurology, Zhejiang University College of Medicine, Hangzhou, Zhejiang Province, PR China
| | - Jing Yang
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, PR China
| | - BaoRong Zhang
- Second Affiliated Hospital, Department of Neurology, Zhejiang University College of Medicine, Hangzhou, Zhejiang Province, PR China
| | - Woon-Puay Koh
- Duke-National University of Singapore Medical School, Singapore, Singapore
| | - Shen-Yang Lim
- Mah Pooi Soo and Tan Chin Nam Centre for Parkinson's and Related Disorders, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Chiea Chuen Khor
- Human Genetics, Genome Institute of Singapore, A*STAR, Singapore, Singapore
- Singapore Eye Research Institute, Singapore, Singapore
| | - Jianjun Liu
- Human Genetics, Genome Institute of Singapore, A*STAR, Singapore, Singapore
| | - Eng-King Tan
- Department of Neurology, National Neuroscience Institute, Singapore General Hospital, Singapore, Singapore
- Duke-National University of Singapore Medical School, Singapore, Singapore
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Choo XY, Lim SY, Chinna K, Tan YJ, Yong VW, Lim JL, Lau KF, Chung JY, Em JM, Tan HT, Lim JH, Tan SB, Tan CT, Tan AH. Understanding patients’ and caregivers’ perspectives and educational needs in Parkinson’s disease: a multi-ethnic Asian study. Neurol Sci 2020; 41:2831-2842. [DOI: 10.1007/s10072-020-04396-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 04/03/2020] [Indexed: 12/28/2022]
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Lim SY, Ishiura H, Ramli N, Shibata S, Almansour MA, Tan AH, Houlden H, Lang AE, Tsuji S. Adult-onset neuronal intranuclear inclusion disease mimicking Fragile X-associated tremor-ataxia syndrome in ethnic Chinese patients. Parkinsonism Relat Disord 2020; 74:25-27. [PMID: 32289521 DOI: 10.1016/j.parkreldis.2020.03.025] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 03/22/2020] [Accepted: 03/23/2020] [Indexed: 10/24/2022]
Abstract
Two ethnic Chinese men with clinico-radiologic features of Fragile X-associated tremor-ataxia syndrome (FXTAS) were found on genetic testing to have neuronal intranuclear inclusion disease (NIID), highlighting that NIID should be considered in the differential diagnosis of FXTAS. NIID may also be much more common than FXTAS in certain Asian populations.
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Affiliation(s)
- Shen-Yang Lim
- Division of Neurology and the Mah Pooi Soo & Tan Chin Nam Centre for Parkinson's & Related Disorders, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
| | - Hiroyuki Ishiura
- Department of Neurology, The University of Tokyo Hospital, Tokyo, Japan
| | - Norlisah Ramli
- Division of Neuroradiology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Shota Shibata
- Department of Neurology, The University of Tokyo Hospital, Tokyo, Japan
| | - M Asem Almansour
- Department of Neurology, The University of Tokyo Hospital, Tokyo, Japan
| | - Ai Huey Tan
- Division of Neurology and the Mah Pooi Soo & Tan Chin Nam Centre for Parkinson's & Related Disorders, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Henry Houlden
- Neurogenetics Laboratory, National Hospital for Neurology and Neurosurgery, Queen Square, London, United Kingdom
| | - Anthony E Lang
- Edmond J Safra Program in Parkinson's Disease and the Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, Toronto, Canada
| | - Shoji Tsuji
- Department of Molecular Neurology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan; Institute of Medical Genomics, International University of Health and Welfare, Chiba, Japan
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Abstract
Lance-Adams syndrome (LAS) is chronic post-hypoxic myoclonus that is often associated with sudden lapses in muscle tone (negative myoclonus) in the legs, causing a disabling "bouncy gait." Given its relative rarity, there are no controlled treatment studies of LAS. The majority of cases require polypharmacy management, with an incomplete response. "Bouncy gait," in particular, is notoriously medication-refractory. Here, we report a patient with long-standing LAS who improved markedly when low-dose perampanel was added to his existing treatment regime consisting of clonazepam, levetiracetam, sodium valproate, and acetazolamide.
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Affiliation(s)
- Shen-Yang Lim
- Division of Neurology and the Mah Pooi Soo & Tan Chin Nam Centre for Parkinson's & Related Disorders, Faculty of Medicine, University of Malaya, Kuala Lumpur, MYS
| | | | - Ai Huey Tan
- Division of Neurology and the Mah Pooi Soo & Tan Chin Nam Centre for Parkinson's & Related Disorders, Faculty of Medicine, University of Malaya, Kuala Lumpur, MYS
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Gopalai AA, Lim JL, Li H, Zhao Y, Lim TT, Eow GB, Puvanarajah S, Viswanathan S, Norlinah MI, Abdul Aziz Z, Lim SK, Tan CT, Tan AH, Lim S, Tan E, Ahmad Annuar A. LRRK2 N551K and R1398H variants are protective in Malays and Chinese in Malaysia: A case-control association study for Parkinson's disease. Mol Genet Genomic Med 2019; 7:e604. [PMID: 31487119 PMCID: PMC6825847 DOI: 10.1002/mgg3.604] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Revised: 01/06/2019] [Accepted: 01/09/2019] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND The LRRK2 gene is associated with Parkinson's disease (PD) as a number of mutations within the gene have been shown to be susceptibility factors. Studies on various global populations have determined that mutations such as G2019S, G2385R, and R1628P in LRRK2 increase the risk of developing PD while the N551K-R1398H haplotype is associated with conferring protection against developing PD. Here we report a study looking at the N551K and R1398H variants for the first time in the Malaysian population. METHODS Cases (523) which conformed to the United Kingdom PD Brain Bank Criteria for PD were recruited through trained neurologists and age- and ethnically matched controls (491) were individuals free of any neurological disorder. The N551K and R1398H mutations were genotyped using the Taqman SNP genotyping assay. RESULTS A significant protective association for N551K was found in those of Malay ancestry, with a protective trend seen for R1398H. A meta-analysis of Chinese individuals in this cohort with other published cohorts of Chinese ancestry indicated a significant protective role for N551K and R1398H. CONCLUSION This study reports that the N551K-R1398H haplotype is also relevant to the Malaysian population, with a significant protective effect found in those of Malay and Chinese ancestries.
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Affiliation(s)
- Aroma Agape Gopalai
- Faculty of Medicine, Department of Biomedical ScienceUniversity of MalayaKuala LumpurMalaysia
| | - Jia Lun Lim
- Faculty of Medicine, Department of Biomedical ScienceUniversity of MalayaKuala LumpurMalaysia
| | - Hui‐Hua Li
- Health Services ResearchSingapore General HospitalSingaporeSingapore
- Centre for Quantitative MedicineDuke‐NUS Medical SchoolSingaporeSingapore
| | - Yi Zhao
- Department of Clinical Translational ResearchSingapore General HospitalSingaporeSingapore
| | | | - Gaik B. Eow
- Department of NeurologyHospital Pulau PinangPenangMalaysia
| | | | | | | | - Zariah Abdul Aziz
- Department of MedicineHospital Sultanah Nur ZahirahKuala TerengganuMalaysia
| | - Soo Kun Lim
- Faculty of Medicine, Department of MedicineUniversity of MalayaKuala LumpurMalaysia
| | - Chong Tin Tan
- Faculty of Medicine, Division of Neurology and the Mah Pooi Soo & Tan Chin Nam Centre for Parkinson's & Related DisordersUniversity of MalayaKuala LumpurMalaysia
| | - Ai Huey Tan
- Faculty of Medicine, Division of Neurology and the Mah Pooi Soo & Tan Chin Nam Centre for Parkinson's & Related DisordersUniversity of MalayaKuala LumpurMalaysia
| | - Shen‐Yang Lim
- Faculty of Medicine, Division of Neurology and the Mah Pooi Soo & Tan Chin Nam Centre for Parkinson's & Related DisordersUniversity of MalayaKuala LumpurMalaysia
| | - Eng‐King Tan
- Department of NeurologySingapore General HospitalSingaporeSingapore
- National Neuroscience Institute and Duke‐NUS Graduate Medical SchoolSingaporeSingapore
| | - Azlina Ahmad Annuar
- Faculty of Medicine, Department of Biomedical ScienceUniversity of MalayaKuala LumpurMalaysia
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40
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Affiliation(s)
- Ai Huey Tan
- Division of Neurology and the Mah Pooi Soo and Tan Chin Nam Centre for Parkinson's and Related Disorders, University of Malaya, Kuala Lumpur, Malaysia
| | - Shen-Yang Lim
- Division of Neurology and the Mah Pooi Soo and Tan Chin Nam Centre for Parkinson's and Related Disorders, University of Malaya, Kuala Lumpur, Malaysia
| | - Rong Xiang Ng
- Department of Medicine, University of Malaya Medical Centre, Kuala Lumpur, Malaysia
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Fong SL, Tan AH, Lau KF, Ramli N, Lim SY. Hyperglycemia-Associated Hemichorea-Hemiballismus with Predominant Ipsilateral Putaminal Abnormality on Neuroimaging. J Mov Disord 2019; 12:187-189. [PMID: 31390855 PMCID: PMC6763712 DOI: 10.14802/jmd.19014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Accepted: 06/24/2019] [Indexed: 12/14/2022] Open
Affiliation(s)
- Si Lei Fong
- Division of Neurology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Ai Huey Tan
- Division of Neurology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.,The Mah Pooi Soo & Tan Chin Nam Centre for Parkinson's & Related Disorders, University of Malaya, Kuala Lumpur, Malaysia
| | - Kar Foo Lau
- Faculty of Medicine and Health Sciences, University Tunku Abdul Rahman, Kuala Lumpur, Malaysia
| | - Norlisah Ramli
- Division of Neuroradiology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Shen-Yang Lim
- Division of Neurology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.,The Mah Pooi Soo & Tan Chin Nam Centre for Parkinson's & Related Disorders, University of Malaya, Kuala Lumpur, Malaysia
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Lubomski M, Tan AH, Lim SY, Holmes A, Davis RL, Sue CM. 064 Parkinson’s disease and the gastrointestinal microbiome: clinicopathological correlations and controversies. J Neurol Neurosurg Psychiatry 2019. [DOI: 10.1136/jnnp-2019-anzan.56] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
IntroductionThere has been a recent surge in interest around the gastrointestinal microbiome (GM) and its association with Parkinson’s disease (PD). The GM mediates interactions between the brain and the gut via the ‘microbiota-gut-brain-axis’. Compelling studies suggest that a shift in GM composition may play an important role in the pathogenesis and progression of PD.MethodsWe conducted a literature review exploring the pathological association between the GM, α-synuclein spread and intestinal inflammation in PD. We also summarised patterns and correlations of gut microflora seen in clinical studies of the GM in PD.ResultsTo date 14 mainly cross-sectional studies from 7 countries have reported GM alterations in PD. All studies described significant alterations between PD and healthy control groups across multiple bacterial families, genera and species. Several studies suggested that putative ‘pro-inflammatory’ bacteria were significantly more abundant, while putative beneficial bacteria were less abundant in PD. Various complex microbiota-gut-brain-axis interactions have been proposed due to alterations in the GM, inferred by changes in gut mucosal integrity and permeability, short-chain-fatty-acid metabolism, oxidative stress and inflammation.ConclusionsAcross the recent GM studies in PD, alterations in bacterial taxa have been repeatedly associated with various clinicopathological features, endorsing a plausible biological link between the GM and PD. Mechanisms involved in the pathogenesis of PD due to GM changes are complex and require ongoing study.
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Ishiura H, Shibata S, Yoshimura J, Suzuki Y, Qu W, Doi K, Almansour MA, Kikuchi JK, Taira M, Mitsui J, Takahashi Y, Ichikawa Y, Mano T, Iwata A, Harigaya Y, Matsukawa MK, Matsukawa T, Tanaka M, Shirota Y, Ohtomo R, Kowa H, Date H, Mitsue A, Hatsuta H, Morimoto S, Murayama S, Shiio Y, Saito Y, Mitsutake A, Kawai M, Sasaki T, Sugiyama Y, Hamada M, Ohtomo G, Terao Y, Nakazato Y, Takeda A, Sakiyama Y, Umeda-Kameyama Y, Shinmi J, Ogata K, Kohno Y, Lim SY, Tan AH, Shimizu J, Goto J, Nishino I, Toda T, Morishita S, Tsuji S. Noncoding CGG repeat expansions in neuronal intranuclear inclusion disease, oculopharyngodistal myopathy and an overlapping disease. Nat Genet 2019; 51:1222-1232. [DOI: 10.1038/s41588-019-0458-z] [Citation(s) in RCA: 178] [Impact Index Per Article: 35.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Accepted: 05/29/2019] [Indexed: 11/09/2022]
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Lubomski M, Tan AH, Lim SY, Holmes A, Davis RL, Sue CM. 082 The gastrointestinal microbiome in parkinson’s disease: impacts of motor and non-motor features, medications, lifestyle and diet. J Neurol Neurosurg Psychiatry 2019. [DOI: 10.1136/jnnp-2019-anzan.70] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
IntroductionThe human gastrointestinal microbiome (GM) has been proposed to be integral in the pathogenesis of Parkinson’s disease (PD). Evidence supports a bidirectional interaction between the brain and the gut that is mediated by the GM. Dysbiosis of the GM is believed to negatively influence vital physiological functions in many diseases.MethodsWe reviewed the literature on changes in human physiological function associated with gut microbial community states in PD. In particular, we evaluated the literature for effects of GM dysbiosis on motor and non-motor features, dietary and lifestyle factors and medication use in PD.ResultsAltered GM profiles in PD have been suggested to disrupt vital signalling pathways within the microbiota-gut-brain axis, integral to regulating physiological digestive function and metabolic homeostasis. Unfavourable variations in the GM have been shown to perturb mood (anxiety/depression), cognition, perception (hallucinations/delusions), gastrointestinal motility, including constipation in PD. Further, varied clinical motor phenotypes, including postural instability and gait disturbance have been attributed to alterations in the GM, in addition to the use of catechol-O-methyltransferase inhibitors, anticholinergics and levodopa. Variations in dietary and lifestyle factors have also been inferred to cause alterations in GM profiles, including caffeine consumption, macronutrient intake, smoking and the effects of ageing and exercise.ConclusionsIt is apparent from the mounting evidence that alterations in the GM are intimately involved in PD pathogenesis. However, the GM can also be modulated by dietary, lifestyle and treatment factors that may influence motor and non-motor features as well as disease progression.
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Tan AH, Ong TL, Ramli N, Tan LK, Lim JL, Azhan MA, Ahmad-Annuar A, Ibrahim KA, Abdul-Aziz Z, Ozelius LJ, Brashear A, Lim SY. Alternating Hemiplegia of Childhood in a Person of Malay Ethnicity with Diffusion Tensor Imaging Abnormalities. J Mov Disord 2019; 12:132-134. [PMID: 31158946 PMCID: PMC6547042 DOI: 10.14802/jmd.18063] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Accepted: 03/18/2019] [Indexed: 12/23/2022] Open
Affiliation(s)
- Ai Huey Tan
- Division of Neurology and the Mah Pooi Soo & Tan Chin Nam Centre for Parkinson's & Related Disorders, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Tien Lee Ong
- Department of Medicine, Hospital Sultanah Nur Zahirah, Kuala Terengganu, Malaysia
| | - Norlisah Ramli
- Department of Biomedical Imaging, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Li Kuo Tan
- Department of Biomedical Imaging, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Jia Lun Lim
- Department of Biomedical Science, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Mohamad Addin Azhan
- Division of Neurology and the Mah Pooi Soo & Tan Chin Nam Centre for Parkinson's & Related Disorders, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Azlina Ahmad-Annuar
- Department of Biomedical Science, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Khairul Azmi Ibrahim
- Department of Medicine, Hospital Sultanah Nur Zahirah, Kuala Terengganu, Malaysia
| | - Zariah Abdul-Aziz
- Department of Medicine, Hospital Sultanah Nur Zahirah, Kuala Terengganu, Malaysia
| | - Laurie J Ozelius
- Departments of Genetics and Genomic Sciences and Neurology, Mount Sinai School of Medicine, New York, NY, USA
| | - Allison Brashear
- Department of Neurology, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Shen-Yang Lim
- Division of Neurology and the Mah Pooi Soo & Tan Chin Nam Centre for Parkinson's & Related Disorders, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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Vizcarra JA, Sánchez-Ferro Á, Maetzler W, Marsili L, Zavala L, Lang AE, Martinez-Martin P, Mestre TA, Reilmann R, Hausdorff JM, Dorsey ER, Paul SS, Dexheimer JW, Wissel BD, Fuller RLM, Bonato P, Tan AH, Bloem BR, Kopil C, Daeschler M, Bataille L, Kleiner G, Cedarbaum JM, Klucken J, Merola A, Goetz CG, Stebbins GT, Espay AJ. The Parkinson's disease e-diary: Developing a clinical and research tool for the digital age. Mov Disord 2019; 34:676-681. [PMID: 30901492 DOI: 10.1002/mds.27673] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Revised: 02/07/2019] [Accepted: 02/22/2019] [Indexed: 01/22/2023] Open
Affiliation(s)
- Joaquin A Vizcarra
- Gardner Family Center for Parkinson's Disease and Movement Disorders, Department of Neurology, University of Cincinnati, Cincinnati, Ohio, USA
| | | | | | - Luca Marsili
- Gardner Family Center for Parkinson's Disease and Movement Disorders, Department of Neurology, University of Cincinnati, Cincinnati, Ohio, USA
| | - Lucia Zavala
- Hospital General de Agudos Jose Maria Ramos Mejia, Departamento de Neurología, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Anthony E Lang
- The Edmond J. Safra Program in Parkinson's Disease and the Morton and Gloria Shulman Movement Disorders Clinic, University of Toronto, Toronto, Ontario, Canada
| | - Pablo Martinez-Martin
- National Center of Epidemiology and CIBERNED, Carlos III Institute of Health, Madrid, Spain
| | - Tiago A Mestre
- Parkinson's Disease and Movement Disorders Center, Division of Neurology, Department of Medicine, The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Ralf Reilmann
- George Huntington Institute and Dept. of Clinical Radiology, University of Muenster, Muenster, and Dept. of Neurodegenerative Diseases and Hertie Institute for Clinical Brain Research, University of Tuebingen, Tuebingen, Germany
| | - Jeffrey M Hausdorff
- Center for the Study of Movement, Cognition, and Mobility, Tel Aviv Sourasky Medical Center; Department of Physical Therapy, Sackler Faculty of Medicine and Sagol School of Neuroscience, Tel Aviv University, Israel; Rush Alzheimer's Disease Center and Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - E Ray Dorsey
- Department of Neurology and Center for Health + Technology, University of Rochester Medical Center, Rochester, New York, USA
| | - Serene S Paul
- Discipline of Physiotherapy, Faculty of Health Sciences, University of Sydney, Sydney, Australia
| | - Judith W Dexheimer
- Department of Biomedical Informatics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Benjamin D Wissel
- Gardner Family Center for Parkinson's Disease and Movement Disorders, Department of Neurology, University of Cincinnati, Cincinnati, Ohio, USA
| | | | - Paolo Bonato
- Department of Physical Medicine & Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Charlestown, Massachusetts, USA
| | - Ai Huey Tan
- Division of Neurology and the Mah Pooi Soo & Tan Chin Nam Centre for Parkinson's & Related Disorders, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Bastiaan R Bloem
- Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, Nijmegen, The Netherlands
| | - Catherine Kopil
- The Michael J. Fox Foundation for Parkinson's Research, New York, New York, USA
| | - Margaret Daeschler
- The Michael J. Fox Foundation for Parkinson's Research, New York, New York, USA
| | - Lauren Bataille
- The Michael J. Fox Foundation for Parkinson's Research, New York, New York, USA
| | - Galit Kleiner
- Jeff and Diane Ross Movement Disorders Clinic at ATC/Baycrest Health Sciences, Division of Neurology Department of Medicine University of Toronto, Toronto, Ontario, Canada
| | | | - Jochen Klucken
- Department of Molecular Neurology, Movement Disorder Unit, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - Aristide Merola
- Gardner Family Center for Parkinson's Disease and Movement Disorders, Department of Neurology, University of Cincinnati, Cincinnati, Ohio, USA
| | - Christopher G Goetz
- Department of Neurological Sciences, Rush University Medical Center, Chicago, Illinois, USA
| | - Glenn T Stebbins
- Department of Neurological Sciences, Rush University Medical Center, Chicago, Illinois, USA
| | - Alberto J Espay
- Gardner Family Center for Parkinson's Disease and Movement Disorders, Department of Neurology, University of Cincinnati, Cincinnati, Ohio, USA
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Mohd Fauzi NA, Abdullah S, Tan AH, Mohd Ramli N, Tan CY, Lim SY. Relapsing encephalopathy with dancing eyes and jerky limbs. Parkinsonism Relat Disord 2019; 75:110-113. [PMID: 30846242 DOI: 10.1016/j.parkreldis.2019.02.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Revised: 02/17/2019] [Accepted: 02/18/2019] [Indexed: 10/27/2022]
Abstract
We report a case of relapsing-remitting opsoclonus-myoclonus-ataxia syndrome (OMAS) in a patient with Hashimoto's encephalopathy, diagnosed after comprehensive evaluation. OMAS as a manifestation of Hashimoto's encephalopathy has been reported once previously. It is hoped that recognition of this entity and early initiation of immunotherapy will improve clinical outcomes for patients.
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Affiliation(s)
- Nor Amelia Mohd Fauzi
- Department of Medicine, Faculty of Medicine, Universiti Teknologi MARA Sungai Buloh Campus, Selangor, Malaysia
| | - Suhailah Abdullah
- Division of Neurology, Department of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Ai Huey Tan
- Division of Neurology, Department of Medicine, University of Malaya, Kuala Lumpur, Malaysia; The Mah Pooi Soo and Tan Chin Nam Centre for Parkinson's and Related Disorders, University of Malaya, Kuala Lumpur, Malaysia
| | - Norlisah Mohd Ramli
- Department of Biomedical Imaging, University of Malaya, Kuala Lumpur, Malaysia
| | - Cheng Yin Tan
- Division of Neurology, Department of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Shen-Yang Lim
- Division of Neurology, Department of Medicine, University of Malaya, Kuala Lumpur, Malaysia; The Mah Pooi Soo and Tan Chin Nam Centre for Parkinson's and Related Disorders, University of Malaya, Kuala Lumpur, Malaysia.
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Tan AH, Toh TH, Low SC, Fong SL, Chong KK, Lee KW, Goh KJ, Lim SY. Chorea in Sporadic Creutzfeldt-Jakob Disease. J Mov Disord 2018; 11:149-151. [PMID: 30086616 PMCID: PMC6182307 DOI: 10.14802/jmd.18017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2018] [Accepted: 04/24/2018] [Indexed: 11/25/2022] Open
Affiliation(s)
- Ai Huey Tan
- Division of Neurology, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.,The Mah Pooi Soo & Tan Chin Nam Centre for Parkinson’s & Related Disorders, University of Malaya, Kuala Lumpur, Malaysia
| | - Tsun Haw Toh
- Division of Neurology, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Soon Chai Low
- Division of Neurology, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Si Lei Fong
- Division of Neurology, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Kah Kian Chong
- Division of Neurology, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Kee Wei Lee
- Division of Neurology, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Khean Jin Goh
- Division of Neurology, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Shen-Yang Lim
- Division of Neurology, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.,The Mah Pooi Soo & Tan Chin Nam Centre for Parkinson’s & Related Disorders, University of Malaya, Kuala Lumpur, Malaysia
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Tan AH, Hew YC, Lim SY, Ramli NM, Kamaruzzaman SB, Tan MP, Grossmann M, Ang BH, Tan JY, Manap MAAA, Tay TK, Tan SL, New RP, Fadzli F, Yee EJ, Moy FM, Mahadeva S, Lang AE. Altered body composition, sarcopenia, frailty, and their clinico-biological correlates, in Parkinson's disease. Parkinsonism Relat Disord 2018; 56:58-64. [PMID: 29914840 DOI: 10.1016/j.parkreldis.2018.06.020] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2018] [Revised: 06/03/2018] [Accepted: 06/12/2018] [Indexed: 01/11/2023]
Abstract
INTRODUCTION Low body weight in Parkinson's disease (PD) is poorly understood despite the associated risks of malnutrition, fractures, and death. Sarcopenia (loss of muscle bulk and strength) and frailty are geriatric syndromes that are likewise associated with adverse health outcomes, yet have received scant attention in PD. We studied body composition, sarcopenia, frailty, and their clinico-biological correlates in PD. METHODS 93 patients and 78 spousal/sibling controls underwent comprehensive assessment of diet, clinical status, muscle strength/performance, frailty, body composition (using dual-energy X-ray absorptiometry), and serum levels of neurogastrointestinal hormones and inflammatory markers. RESULTS PD patients were older than controls (66.0 ± 8.5 vs. 62.4 ± 8.4years, P = 0.003). Mean body mass index (24.0 ± 0.4 vs. 25.6 ± 0.5kg/m2, Padjusted = 0.016), fat mass index (7.4 ± 0.3 vs. 9.0 ± 0.3kg/m2, Padjusted<0.001), and whole-body fat percentage (30.7 ± 0.8 vs. 35.7 ± 0.9%, Padjusted<0.001) were lower in patients, even after controlling for age and gender. There were no between-group differences in skeletal muscle mass index and whole-body bone mineral density. Body composition parameters did not correlate with disease duration or motor severity. Reduced whole-body fat percentage was associated with higher risk of motor response complications as well as higher levels of insulin-growth factor-1 and inflammatory markers. PD patients had a higher prevalence of sarcopenia (17.2% vs. 10.3%, Padjusted = 0.340) and frailty (69.4% vs. 24.2%, Padjusted = 0.010). Older age and worse PD motor severity were predictors of frailty in PD. CONCLUSIONS We found reduced body fat with relatively preserved skeletal muscle mass, and a high prevalence of frailty, in PD. Further studies are needed to understand the patho-mechanisms underlying these alterations.
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Affiliation(s)
- Ai Huey Tan
- Division of Neurology and the Mah Pooi Soo & Tan Chin Nam Centre for Parkinson's & Related Disorders, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
| | - Yin Cheng Hew
- Department of Biomedical Imaging, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Shen-Yang Lim
- Division of Neurology and the Mah Pooi Soo & Tan Chin Nam Centre for Parkinson's & Related Disorders, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Norlisah Mohd Ramli
- Department of Biomedical Imaging, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Shahrul Bahyah Kamaruzzaman
- Division of Geriatrics, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Maw Pin Tan
- Division of Geriatrics, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Mathis Grossmann
- Department of Endocrinology, Austin Health, University of Melbourne, Melbourne, Australia
| | - Ban Hong Ang
- Division of Neurology and the Mah Pooi Soo & Tan Chin Nam Centre for Parkinson's & Related Disorders, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Jiun Yan Tan
- Division of Neurology and the Mah Pooi Soo & Tan Chin Nam Centre for Parkinson's & Related Disorders, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Mohamad Addin Azhan A Manap
- Division of Neurology and the Mah Pooi Soo & Tan Chin Nam Centre for Parkinson's & Related Disorders, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Tun Khong Tay
- Division of Neurology and the Mah Pooi Soo & Tan Chin Nam Centre for Parkinson's & Related Disorders, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Siang Lyn Tan
- Division of Neurology and the Mah Pooi Soo & Tan Chin Nam Centre for Parkinson's & Related Disorders, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Ru Peng New
- Division of Neurology and the Mah Pooi Soo & Tan Chin Nam Centre for Parkinson's & Related Disorders, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Farhana Fadzli
- Department of Biomedical Imaging, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Eng Jui Yee
- Julius Centre University of Malaya, Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Foong Ming Moy
- Julius Centre University of Malaya, Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Sanjiv Mahadeva
- Division of Gastroenterology, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Anthony E Lang
- Edmond J. Safra Program in Parkinson's Disease and the Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, Toronto, Canada
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Lim SY, Tan AH, Lim JL, Ahmad-Annuar A. Purposeless Groaning in Parkinson's Disease. J Mov Disord 2018; 11:87-88. [PMID: 29860787 PMCID: PMC5990904 DOI: 10.14802/jmd.18004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2018] [Revised: 02/23/2018] [Accepted: 03/20/2018] [Indexed: 11/24/2022] Open
Abstract
Purposeless groaning has been reported in advanced progressive supranuclear palsy. We present a case of purposeless groaning occurring as a primary complaint in a patient with advanced Parkinson’s disease. Purposeless groaning is thought to be a manifestation of disinhibition and perseveration due to frontal-subcortical dysfunction. Proper recognition of this phenomenon will help clinicians to avoid unnecessary investigations and treatment (e.g., prescription of opioid medications).
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Affiliation(s)
- Shen-Yang Lim
- Division of Neurology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.,Mah Pooi Soo & Tan Chin Nam Centre for Parkinson's & Related Disorders, University of Malaya, Kuala Lumpur, Malaysia
| | - Ai Huey Tan
- Division of Neurology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.,Mah Pooi Soo & Tan Chin Nam Centre for Parkinson's & Related Disorders, University of Malaya, Kuala Lumpur, Malaysia
| | - Jia Lun Lim
- Mah Pooi Soo & Tan Chin Nam Centre for Parkinson's & Related Disorders, University of Malaya, Kuala Lumpur, Malaysia.,Department of Biomedical Science, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Azlina Ahmad-Annuar
- Department of Biomedical Science, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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