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Gabb VG, Blackman J, Morrison HD, Biswas B, Li H, Turner N, Russell GM, Greenwood R, Jolly A, Trender W, Hampshire A, Whone A, Coulthard E. Remote Evaluation of Sleep and Circadian Rhythms in Older Adults With Mild Cognitive Impairment and Dementia: Protocol for a Feasibility and Acceptability Mixed Methods Study. JMIR Res Protoc 2024; 13:e52652. [PMID: 38517469 PMCID: PMC10998181 DOI: 10.2196/52652] [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: 09/19/2023] [Revised: 02/12/2024] [Accepted: 02/13/2024] [Indexed: 03/23/2024] Open
Abstract
BACKGROUND Sleep disturbances are a potentially modifiable risk factor for neurodegenerative dementia secondary to Alzheimer disease (AD) and Lewy body disease (LBD). Therefore, we need to identify the best methods to study sleep in this population. OBJECTIVE This study will assess the feasibility and acceptability of various wearable devices, smart devices, and remote study tasks in sleep and cognition research for people with AD and LBD. METHODS We will deliver a feasibility and acceptability study alongside a prospective observational cohort study assessing sleep and cognition longitudinally in the home environment. Adults aged older than 50 years who were diagnosed with mild to moderate dementia or mild cognitive impairment (MCI) due to probable AD or LBD and age-matched controls will be eligible. Exclusion criteria include lack of capacity to consent to research, other causes of MCI or dementia, and clinically significant sleep disorders. Participants will complete a cognitive assessment and questionnaires with a researcher and receive training and instructions for at-home study tasks across 8 weeks. At-home study tasks include remote sleep assessments using wearable devices (electroencephalography headband and actigraphy watch), app-based sleep diaries, online cognitive assessments, and saliva samples for melatonin- and cortisol-derived circadian markers. Feasibility outcomes will be assessed relating to recruitment and retention, data completeness, data quality, and support required. Feedback on acceptability and usability will be collected throughout the study period and end-of-study interviews will be analyzed using thematic analysis. RESULTS Recruitment started in February 2022. Data collection is ongoing, with final data expected in February 2024 and data analysis and publication of findings scheduled for the summer of 2024. CONCLUSIONS This study will allow us to assess if remote testing using smart devices and wearable technology is a viable alternative to traditional sleep measurements, such as polysomnography and questionnaires, in older adults with and without MCI or dementia due to AD or LBD. Understanding participant experience and the barriers and facilitators to technology use for research purposes and remote research in this population will assist with the development of, recruitment to, and retention within future research projects studying sleep and cognition outside of the clinic or laboratory. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/52652.
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Affiliation(s)
- Victoria Grace Gabb
- Bristol Medical School, University of Bristol, Bristol, United Kingdom
- Neurology Department, Bristol Brain Centre, North Bristol NHS Trust, Bristol, United Kingdom
| | - Jonathan Blackman
- Bristol Medical School, University of Bristol, Bristol, United Kingdom
- Neurology Department, Bristol Brain Centre, North Bristol NHS Trust, Bristol, United Kingdom
| | - Hamish Duncan Morrison
- Bristol Medical School, University of Bristol, Bristol, United Kingdom
- Neurology Department, Bristol Brain Centre, North Bristol NHS Trust, Bristol, United Kingdom
| | - Bijetri Biswas
- Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Haoxuan Li
- Bristol Medical School, University of Bristol, Bristol, United Kingdom
- Neurology Department, Bristol Brain Centre, North Bristol NHS Trust, Bristol, United Kingdom
- King's College Hospital, King's College Hospital NHS Foundation Trust, London, United Kingdom
- Bristol Royal Infirmary, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, United Kingdom
| | - Nicholas Turner
- Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | | | - Rosemary Greenwood
- Bristol Medical School, University of Bristol, Bristol, United Kingdom
- Research & Innovation, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, United Kingdom
| | - Amy Jolly
- Department of Brain Sciences, Faculty of Medicine, Imperial College London, London, United Kingdom
- UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, United Kingdom
| | - William Trender
- Department of Brain Sciences, Faculty of Medicine, Imperial College London, London, United Kingdom
| | - Adam Hampshire
- Department of Brain Sciences, Faculty of Medicine, Imperial College London, London, United Kingdom
| | - Alan Whone
- Bristol Medical School, University of Bristol, Bristol, United Kingdom
- Neurology Department, Bristol Brain Centre, North Bristol NHS Trust, Bristol, United Kingdom
| | - Elizabeth Coulthard
- Bristol Medical School, University of Bristol, Bristol, United Kingdom
- Neurology Department, Bristol Brain Centre, North Bristol NHS Trust, Bristol, United Kingdom
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Morgan C, Tonkin EL, Masullo A, Jovan F, Sikdar A, Khaire P, Mirmehdi M, McConville R, Tourte GJL, Whone A, Craddock I. A multimodal dataset of real world mobility activities in Parkinson's disease. Sci Data 2023; 10:918. [PMID: 38123584 PMCID: PMC10733419 DOI: 10.1038/s41597-023-02663-5] [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: 04/21/2023] [Accepted: 10/19/2023] [Indexed: 12/23/2023] Open
Abstract
Parkinson's disease (PD) is a neurodegenerative disorder characterised by motor symptoms such as gait dysfunction and postural instability. Technological tools to continuously monitor outcomes could capture the hour-by-hour symptom fluctuations of PD. Development of such tools is hampered by the lack of labelled datasets from home settings. To this end, we propose REMAP (REal-world Mobility Activities in Parkinson's disease), a human rater-labelled dataset collected in a home-like setting. It includes people with and without PD doing sit-to-stand transitions and turns in gait. These discrete activities are captured from periods of free-living (unobserved, unstructured) and during clinical assessments. The PD participants withheld their dopaminergic medications for a time (causing increased symptoms), so their activities are labelled as being "on" or "off" medications. Accelerometry from wrist-worn wearables and skeleton pose video data is included. We present an open dataset, where the data is coarsened to reduce re-identifiability, and a controlled dataset available on application which contains more refined data. A use-case for the data to estimate sit-to-stand speed and duration is illustrated.
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Affiliation(s)
- Catherine Morgan
- Movement Disorders Group, Bristol Brain Centre, North Bristol NHS Trust, Southmead Hospital, Southmead Road, Bristol, BS10 5NB, UK
- Translational Health Sciences, University of Bristol, 5 Tyndall Ave, Bristol, BS8 1UD, UK
| | - Emma L Tonkin
- Faculty of Engineering, University of Bristol, Digital Health Offices, 1 Cathedral Square, Bristol, BS1 5DD, UK.
| | - Alessandro Masullo
- Faculty of Engineering, University of Bristol, Digital Health Offices, 1 Cathedral Square, Bristol, BS1 5DD, UK
| | - Ferdian Jovan
- Faculty of Engineering, University of Bristol, Digital Health Offices, 1 Cathedral Square, Bristol, BS1 5DD, UK
- School of Natural and Computing Sciences, University of Aberdeen, Aberdeen, UK
| | - Arindam Sikdar
- Faculty of Engineering, University of Bristol, Digital Health Offices, 1 Cathedral Square, Bristol, BS1 5DD, UK
- Edge Hill University, Ormskirk, UK
| | - Pushpajit Khaire
- Faculty of Engineering, University of Bristol, Digital Health Offices, 1 Cathedral Square, Bristol, BS1 5DD, UK
- Datta Meghe Institute of Higher Education and Research, Wardha, India
| | - Majid Mirmehdi
- Faculty of Engineering, University of Bristol, Digital Health Offices, 1 Cathedral Square, Bristol, BS1 5DD, UK
| | - Ryan McConville
- Faculty of Engineering, University of Bristol, Digital Health Offices, 1 Cathedral Square, Bristol, BS1 5DD, UK
| | - Gregory J L Tourte
- Faculty of Engineering, University of Bristol, Digital Health Offices, 1 Cathedral Square, Bristol, BS1 5DD, UK
- Advanced Research Computing, University of Oxford, Oxford, UK
| | - Alan Whone
- Movement Disorders Group, Bristol Brain Centre, North Bristol NHS Trust, Southmead Hospital, Southmead Road, Bristol, BS10 5NB, UK
- Translational Health Sciences, University of Bristol, 5 Tyndall Ave, Bristol, BS8 1UD, UK
| | - Ian Craddock
- Faculty of Engineering, University of Bristol, Digital Health Offices, 1 Cathedral Square, Bristol, BS1 5DD, UK
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Blackman J, Morrison HD, Gabb V, Biswas B, Li H, Turner N, Jolly A, Trender W, Hampshire A, Whone A, Coulthard E. Remote evaluation of sleep to enhance understanding of early dementia due to Alzheimer's Disease (RESTED-AD): an observational cohort study protocol. BMC Geriatr 2023; 23:590. [PMID: 37742001 PMCID: PMC10518099 DOI: 10.1186/s12877-023-04288-0] [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: 01/11/2023] [Accepted: 09/06/2023] [Indexed: 09/25/2023] Open
Abstract
BACKGROUND Sleep and circadian rhythm disorders are well recognised in both AD (Alzheimer's Disease) dementia and MCI-AD (Mild Cognitive Impairment due to Alzheimer's Disease). Such abnormalities include insomnia, excessive daytime sleepiness, decreased sleep efficiency, increased sleep fragmentation and sundowning. Enhancing understanding of sleep abnormalities may unveil targets for intervention in sleep, a promising approach given hypotheses that sleep disorders may exacerbate AD pathological progression and represent a contributory factor toward impaired cognitive performance and worse quality of life. This may also permit early diagnosis of AD pathology, widely acknowledged as a pre-requisite for future disease-modifying therapies. This study aims to bridge the divide between in-laboratory polysomnographic studies which allow for rich characterisation of sleep but in an unnatural setting, and naturalistic studies typically approximating sleep through use of non-EEG wearable devices. It is also designed to record sleep patterns over a 2 month duration sufficient to capture both infradian rhythm and compensatory responses following suboptimal sleep. Finally, it harnesses an extensively phenotyped population including with AD blood biomarkers. Its principal aims are to improve characterisation of sleep and biological rhythms in individuals with AD, particularly focusing on micro-architectural measures of sleep, compensatory responses to suboptimal sleep and the relationship between sleep parameters, biological rhythms and cognitive performance. METHODS/DESIGN This observational cohort study has two arms (AD-MCI / mild AD dementia and aged-matched healthy adults). Each participant undergoes a baseline visit for collection of demographic, physiological and neuropsychological information utilising validated questionnaires. The main study period involves 7 nights of home-based multi-channel EEG sleep recording nested within an 8-week study period involving continuous wrist-worn actigraphy, sleep diaries and regular brief cognitive tests. Measurement of sleep parameters will be at home thereby obtaining a real-world, naturalistic dataset. Cognitive testing will be repeated at 6 months to stratify participants by longitudinal disease progression. DISCUSSION This study will generate new insights particularly in micro-architectural measures of sleep, circadian patterns and compensatory sleep responses in a population with and without AD neurodegenerative change. It aims to enhance standards of remotely based sleep research through use of a well-phenotyped population and advanced sleep measurement technology.
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Affiliation(s)
- Jonathan Blackman
- Bristol Medical School, University of Bristol, Bristol, BS2 8DZ UK
- Bristol Brain Centre, North Bristol NHS Trust, Bristol, BS10 5NB UK
| | - Hamish Duncan Morrison
- Bristol Medical School, University of Bristol, Bristol, BS2 8DZ UK
- Bristol Brain Centre, North Bristol NHS Trust, Bristol, BS10 5NB UK
| | - Victoria Gabb
- Bristol Medical School, University of Bristol, Bristol, BS2 8DZ UK
- Bristol Brain Centre, North Bristol NHS Trust, Bristol, BS10 5NB UK
| | - Bijetri Biswas
- Bristol Medical School, University of Bristol, Bristol, BS2 8DZ UK
| | - Haoxuan Li
- Bristol Medical School, University of Bristol, Bristol, BS2 8DZ UK
- Bristol Brain Centre, North Bristol NHS Trust, Bristol, BS10 5NB UK
| | - Nicholas Turner
- Bristol Medical School, University of Bristol, Bristol, BS2 8DZ UK
| | - Amy Jolly
- Faculty of Medicine, Imperial College London, London, SW7 2AZ UK
| | - William Trender
- Faculty of Medicine, Imperial College London, London, SW7 2AZ UK
| | - Adam Hampshire
- Faculty of Medicine, Imperial College London, London, SW7 2AZ UK
| | - Alan Whone
- Bristol Brain Centre, North Bristol NHS Trust, Bristol, BS10 5NB UK
| | - Elizabeth Coulthard
- Bristol Medical School, University of Bristol, Bristol, BS2 8DZ UK
- Bristol Brain Centre, North Bristol NHS Trust, Bristol, BS10 5NB UK
- Bristol Medical School, Learning & Research Building, Southmead Hospital, University of Bristol, Bristol, BS10 5NB UK
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Whone A. Reply to: "Bioinformatics and Immunohistochemistry Show Preserved Expression of GDNF Receptor RET in Parkinson's". Mov Disord 2023; 38:1117-1118. [PMID: 37475613 DOI: 10.1002/mds.29438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Accepted: 04/26/2023] [Indexed: 07/22/2023] Open
Affiliation(s)
- Alan Whone
- School of Translational Health Sciences, University of Bristol, Bristol, United Kingdom
- Department of Neurology, Southmead Hospital, Bristol, United Kingdom
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Lloyd K, Lawton M, Whone A. Practically Defined Off-State Dyskinesia Following Repeated Intraputamenal Glial Cell Line-Derived Neurotrophic Factor Administration. Mov Disord 2023; 38:104-112. [PMID: 36444971 DOI: 10.1002/mds.29262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Revised: 09/09/2022] [Accepted: 10/07/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND We recently showed that by employing an enhanced drug-delivery approach, repeated administration of glial cell line-derived neurotrophic factor (GDNF) can produce a spatially distributed increased 18 F-DOPA positron emission tomography (PET) uptake, suggesting sprouting of dopaminergic terminals throughout the putamen structure. Despite this, we failed to prove a significant measurable clinical response. Since, however, we have identified a subject demonstrating a temporal relationship between repeated GDNF infusions and dyskinesia arising in the practically defined off (pracoff) state. OBJECTIVES To describe the development of pracoff dyskinesia across our study population and consider its utility as an indicator that trophic factor-induced terminal sprouting can affect enhanced endogenous dopamine levels. METHODS This was a blinded retrospective analysis of videotaped motor assessments at eight weekly study visits. Dyskinesia in the pracoff and supramaximal on state were rated using the Clinical Dyskinesia Rating Scale. Logistic regression was employed to explore the predictors of pracoff dyskinesia. Generalized estimated equations were used to estimate the cumulative effect of repeated GDNF infusions. RESULTS Mild-moderate choreiform dyskinesia in the pracoff state were seen in 47 assessments in 17 (n = 41) subjects. During the 18-month timeframe, each subsequent 8-week period of receiving GDNF increased the risk of demonstrating pracoff state dyskinesia by 34% (odds ratio [OR], 1.34 (95% confidence interval [CI], 1.20, 1.50); P < 0.001). An increasing supramaximal on dyskinesia score (OR, 1.17 [95% CI, 1.07, 1.30]; P = 0.001) also increased the likelihood of pracoff dyskinesia at that visit. CONCLUSIONS We report the first description of increasingly prevalent pracoff-state dyskinesia developing during the course of a trophic factor study. This may provide a surrogate marker that GDNF can enable recovery of endogenous dopamine release even in advanced Parkinson's disease. © 2022 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Katherine Lloyd
- Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom.,Department of Neurology, North Bristol National Health Service (NHS) Trust, Bristol, United Kingdom
| | - Michael Lawton
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Alan Whone
- Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom.,Department of Neurology, North Bristol National Health Service (NHS) Trust, Bristol, United Kingdom
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Morgan C, Masullo A, Mirmehdi M, Isotalus HK, Jovan F, McConville R, Tonkin EL, Whone A, Craddock I. Automated Real-World Video Analysis of Sit-to-Stand Transitions Predicts Parkinson's Disease Severity. Digit Biomark 2023; 7:92-103. [PMID: 37588481 PMCID: PMC10425718 DOI: 10.1159/000530953] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 04/24/2023] [Indexed: 08/18/2023] Open
Abstract
Introduction Technology holds the potential to track disease progression and response to neuroprotective therapies in Parkinson's disease (PD). The sit-to-stand (STS) transition is a frequently occurring event which is important to people with PD. The aim of this study was to demonstrate an automatic approach to quantify STS duration and speed using a real-world free-living dataset and look at clinical correlations of the outcomes, including whether STS parameters change when someone withholds PD medications. Methods Eighty-five hours of video data were collected from 24 participants staying in pairs for 5-day periods in a naturalistic setting. Skeleton joints were extracted from the video data; the head trajectory was estimated and used to estimate the STS parameters of duration and speed. Results 3.14 STS transitions were seen per hour per person on average. Significant correlations were seen between automatic and manual STS duration (Pearson rho - 0.419, p = 0.042) and between automatic STS speed and manual STS duration (Pearson rho - 0.780, p < 0.001). Significant and strong correlations were seen between the gold-standard clinical rating scale scores and both STS duration and STS speed; these correlations were not seen in the STS transitions when the participants were carrying something in their hand(s). Significant differences were seen at the cohort level between control and PD participants' ON medications' STS duration (U = 6,263, p = 0.018) and speed (U = 9,965, p < 0.001). At an individual level, only two participants with PD became significantly slower to STS when they were OFF medications; withholding medications did not significantly change STS duration at an individual level in any participant. Conclusion We demonstrate a novel approach to automatically quantify and ecologically validate two STS parameters which correlate with gold-standard clinical tools measuring disease severity in PD.
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Affiliation(s)
- Catherine Morgan
- Translational Health Sciences, University of Bristol, Bristol, UK
- Movement Disorders Group, Bristol Brain Centre, North Bristol NHS Trust, Southmead Hospital, Bristol, UK
| | - Alessandro Masullo
- Faculty of Engineering, University of Bristol, Digital Health Offices, 1 Cathedral Square, Bristol, UK
| | - Majid Mirmehdi
- Faculty of Engineering, University of Bristol, Digital Health Offices, 1 Cathedral Square, Bristol, UK
| | - Hanna Kristiina Isotalus
- Faculty of Engineering, University of Bristol, Digital Health Offices, 1 Cathedral Square, Bristol, UK
| | - Ferdian Jovan
- Faculty of Engineering, University of Bristol, Digital Health Offices, 1 Cathedral Square, Bristol, UK
| | - Ryan McConville
- Faculty of Engineering, University of Bristol, Digital Health Offices, 1 Cathedral Square, Bristol, UK
| | - Emma L. Tonkin
- Faculty of Engineering, University of Bristol, Digital Health Offices, 1 Cathedral Square, Bristol, UK
| | - Alan Whone
- Translational Health Sciences, University of Bristol, Bristol, UK
- Movement Disorders Group, Bristol Brain Centre, North Bristol NHS Trust, Southmead Hospital, Bristol, UK
| | - Ian Craddock
- Faculty of Engineering, University of Bristol, Digital Health Offices, 1 Cathedral Square, Bristol, UK
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Roguski A, Rolinski M, Jones MW, Whone A. Inaccurate self-report of olfactory dysfunction in REM Sleep Behaviour Disorder and implications for prognosis. Clin Park Relat Disord 2022; 8:100176. [PMID: 36594073 PMCID: PMC9804136 DOI: 10.1016/j.prdoa.2022.100176] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 10/31/2022] [Accepted: 12/06/2022] [Indexed: 12/23/2022] Open
Abstract
Introduction The earliest stages of alpha-synucleinopathies are accompanied by non-specific prodromal symptoms such as diminished sense of smell, constipation and depression, as well as more specific prodromal conditions including REM Sleep Behaviour Disorder (RBD). While the majority of RBD patients will develop an alpha-synucleinopathy, one of the greatest clinical challenges is determining whether and when individual patients will phenoconvert. Clinical evaluation of a patient presenting with RBD should therefore include robust and objective assessments of known alpha-synucleinopathy prodromes. Methods This study compared olfactory function self-report measures with psychophysical 'Sniffin' Stick 16-item Identification' test scores in Control (n = 19), RBD (n = 16) and PD (n = 17) participants. Results We confirm that olfactory test scores are significantly diminished in RBD and PD groups compared to Controls (p < 0.001, One-Way ANOVA with Tukey-Kramer Post-Hoc, effect size = 0.401). However, RBD participants were only 56 % accurate when self-reporting olfactory dysfunction, hence markedly less likely to perceive or acknowledge their own hyposmia compared to Controls (p = 0.045, Fisher's Exact Test, effect-size = 0.35). Conclusion When isolated RBD presents with hyposmia, there is an increased likelihood of phenoconversion to Parkinson's Disease (PD) or Dementia with Lewy Bodies (DLB); unawareness of olfactory dysfunction in an individual with isolated RBD may therefore confound differential diagnosis and prognosis. Our results evidence the fallibility of olfactory function self-report in the context of RBD prognosis, indicating that clinical assessments of RBD patients should include more reliable measures of olfactory status.
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Affiliation(s)
- Amber Roguski
- School of Physiology, Pharmacology and Neuroscience, University of Bristol, Bristol, United Kingdom,Corresponding author.
| | - Michal Rolinski
- Department of Neurology, Torbay Hospital, Torquay, United Kingdom
| | - Matt W. Jones
- School of Physiology, Pharmacology and Neuroscience, University of Bristol, Bristol, United Kingdom
| | - Alan Whone
- Department of Neurology, Southmead Hospital, Bristol, United Kingdom,Translational Health Sciences, University of Bristol, Bristol, United Kingdom
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Morgan C, Jameson J, Craddock I, Tonkin EL, Oikonomou G, Isotalus HK, Heidarivincheh F, McConville R, Tourte GJL, Kinnunen KM, Whone A. Understanding how people with Parkinson's disease turn in gait from a real-world in-home dataset. Parkinsonism Relat Disord 2022; 105:114-122. [PMID: 36413901 PMCID: PMC10391706 DOI: 10.1016/j.parkreldis.2022.11.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 11/02/2022] [Accepted: 11/07/2022] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Turning in gait digital parameters may be useful in measuring disease progression in Parkinson's disease (PD), however challenges remain over algorithm validation in real-world settings. The influence of clinician observation on turning outcomes is poorly understood. Our objective is to describe a unique in-home video dataset and explore the use of turning parameters as biomarkers in PD. METHODS 11 participants with PD, 11 control participants stayed in a home-like setting living freely for 5 days (with two sessions of clinical assessment), during which high-resolution video was captured. Clinicians watched the videos, identified turns and documented turning parameters. RESULTS From 85 hours of video 3869 turns were evaluated, averaging at 22.7 turns per hour per person. 6 participants had significantly different numbers of turning steps and/or turn duration between "ON" and "OFF" medication states. Positive Spearman correlations were seen between the Movement Disorders Society-sponsored revision of the Unified Parkinson's Disease Rating Scale III score with a) number of turning steps (rho = 0.893, p < 0.001), and b) duration of turn (rho = 0.744, p = 0.009) "OFF" medications. A positive correlation was seen "ON" medications between number of turning steps and clinical rating scale score (rho = 0.618, p = 0.048). Both cohorts took more steps and shorter durations of turn during observed clinical assessments than when free-living. CONCLUSION This study shows proof of concept that real-world free-living turn duration and number of turning steps recorded can distinguish between PD medication states and correlate with gold-standard clinical rating scale scores. It illustrates a methodology for ecological validation of real-world digital outcomes.
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Affiliation(s)
- Catherine Morgan
- Translational Health Sciences, University of Bristol, 5 Tyndall Ave, Bristol, BS8 1UD, UK; Movement Disorders Group, Bristol Brain Centre, North Bristol NHS Trust, Southmead Hospital, Southmead Road, Bristol, BS10 5NB, UK.
| | - Jack Jameson
- Movement Disorders Group, Bristol Brain Centre, North Bristol NHS Trust, Southmead Hospital, Southmead Road, Bristol, BS10 5NB, UK.
| | - Ian Craddock
- Faculty of Engineering, University of Bristol, Digital Health Offices, 1 Cathedral Square, Bristol, BS1 5DD, UK.
| | - Emma L Tonkin
- Faculty of Engineering, University of Bristol, Digital Health Offices, 1 Cathedral Square, Bristol, BS1 5DD, UK.
| | - George Oikonomou
- Faculty of Engineering, University of Bristol, Digital Health Offices, 1 Cathedral Square, Bristol, BS1 5DD, UK.
| | - Hanna Kristiina Isotalus
- Faculty of Engineering, University of Bristol, Digital Health Offices, 1 Cathedral Square, Bristol, BS1 5DD, UK.
| | - Farnoosh Heidarivincheh
- Faculty of Engineering, University of Bristol, Digital Health Offices, 1 Cathedral Square, Bristol, BS1 5DD, UK.
| | - Ryan McConville
- Faculty of Engineering, University of Bristol, Digital Health Offices, 1 Cathedral Square, Bristol, BS1 5DD, UK.
| | - Gregory J L Tourte
- Faculty of Engineering, University of Bristol, Digital Health Offices, 1 Cathedral Square, Bristol, BS1 5DD, UK.
| | - Kirsi M Kinnunen
- Research and Development, IXICO, 4th Floor, Griffin Court, 15 Long Ln, Barbican, London, EC1A 9PN, UK.
| | - Alan Whone
- Translational Health Sciences, University of Bristol, 5 Tyndall Ave, Bristol, BS8 1UD, UK; Movement Disorders Group, Bristol Brain Centre, North Bristol NHS Trust, Southmead Hospital, Southmead Road, Bristol, BS10 5NB, UK.
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Stevens KN, Creanor S, Jeffery A, Whone A, Zajicek J, Foggo A, Jones B, Chapman R, Cocking L, Wilks J, Webb D, Carroll C, Inches J, Underwood D, Frost J, James A, Schofield C, James R, O’Reilly C, Sheridan R, Statton S, Goff A, Russell T, Whitcher A, Craw S, Lewis A, Sophia R, Amar K, Hernandez R, Pitcher A, Carvey S, Hamlin R, Lyell V, Aubry L, Carey G, Coebergh J, Mojela I, Molloy S, Berceruelo Bergaz Y, Camera B, Campbell P, Morris H, Samakomva T, Schrag A, Fuller S, Misbahuddin A, Parker L, Visentin E, Gallehawk S, Rudd J, Singh S, Wilson S, Creven J, Croucher Y, Tluk S, Watts P, Hargreaves S, Johnson D, Worboys L, Worth P, Brooke J, Kobylecki C, Parker V, Johnson L, Joseph R, Melville J, Raw J, Birt J, Hare M, Shaik S, Alty J, Cosgrove J, Burn D, Green A, McNichol A, Pavese N, Pilkington H, Price M, Walker K, Chaudhuri R, Podlewska A, Reddy P, Trivedi D, Bandmann O, Clegg R, Cole G, Emery A, Dostal V, Graham J, Keshet-Price J, Mamutse G, Miller-Fik A, Wiltshire A, Wright C, Dixon K, Abdelhafiz A, Rose J. Evaluation of Simvastatin as a Disease-Modifying Treatment for Patients With Parkinson Disease: A Randomized Clinical Trial. JAMA Neurol 2022; 79:1232-1241. [PMID: 36315128 PMCID: PMC9623477 DOI: 10.1001/jamaneurol.2022.3718] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Importance Current treatments manage symptoms of Parkinson disease (PD), but no known treatment slows disease progression. Preclinical and epidemiological studies support the potential use of statins as disease-modifying therapy. Objective To determine whether simvastatin has potential as a disease-modifying treatment for patients with moderate PD. Design, Setting, and Participants This randomized clinical trial, a double-blind, parallel-group, placebo-controlled futility trial, was conducted between March 2016 and May 2020 within 23 National Health Service Trusts in England. Participants aged 40 to 90 years with a diagnosis of idiopathic PD, with a modified Hoehn and Yahr stage of 3.0 or less while taking medication, and taking dopaminergic medication with wearing-off phenomenon were included. Data were analyzed from May 2020 to September 2020, with additional analysis in February 2021. Interventions Participants were allocated 1:1 to simvastatin or matched placebo via a computer-generated random sequence, stratified by site and Hoehn and Yahr stage. In the simvastatin arm, participants entered a 1-month phase of simvastatin, 40 mg daily, followed by 23 months of simvastatin, 80 mg daily, before a 2-month washout period. Main Outcomes and Measures The prespecified primary outcome was 24-month change in Movement Disorder Society Unified Parkinson Disease Rating Scale (MDS-UPDRS) part III score measured while not taking medication (high scores indicate worse outcome). The primary futility analysis included participants who commenced the 80-mg phase and had valid primary outcome data. The safety analysis included all participants who commenced trial treatment and is reported by dose at time of event. Results Of 332 patients assessed for eligibility, 32 declined and 65 were ineligible. Of 235 recruited participants, 97 (41%) were female, 233 (99%) were White, and the mean (SD) age was 65.4 (9.4) years. A total of 216 patients progressed to the 80-mg dose. Primary outcome analysis (n = 178) indicated the simvastatin group had an additional deterioration in MDS-UPDRS III score while not taking medication at 24 months compared with the placebo group (1.52 points; 2-sided 80% CI, -0.77 to 3.80; 1-sided futility test P = .006). A total of 37 serious adverse events (AEs), including 3 deaths, and 171 AEs were reported for participants receiving 0-mg simvastatin; 37 serious AEs and 150 AEs were reported for participants taking 40 mg or 80 mg of simvastatin. Four participants withdrew from the trial because of an AE. Conclusions and Relevance In this randomized clinical trial, simvastatin was futile as a disease-modifying therapy in patients with PD of moderate severity, providing no evidence to support proceeding to a phase 3 trial. Trial Registration ISRCTN Identifier: 16108482.
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Affiliation(s)
- Kara N. Stevens
- Faculty of Health, University of Plymouth, Plymouth, United Kingdom,Exploristics Ltd, Belfast, United Kingdom
| | - Siobhan Creanor
- College of Medicine and Health, University of Exeter, Exeter, United Kingdom
| | - Alison Jeffery
- Faculty of Health, University of Plymouth, Plymouth, United Kingdom
| | - Alan Whone
- Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - John Zajicek
- School of Medicine, Medical and Biological Sciences, University of St Andrews, St Andrews, United Kingdom
| | - Andy Foggo
- School of Biological and Marine Sciences, Faculty of Science and Engineering, University of Plymouth, Plymouth, United Kingdom
| | - Ben Jones
- College of Medicine and Health, University of Exeter, Exeter, United Kingdom
| | - Rebecca Chapman
- Faculty of Health, University of Plymouth, Plymouth, United Kingdom
| | - Laura Cocking
- NIHR BioResource, University of Cambridge, Cambridge, United Kingdom
| | - Jonny Wilks
- MAC Clinical Research, Blackpool, United Kingdom
| | - Doug Webb
- Bristol Trials Centre, University of Bristol, Bristol, United Kingdom
| | - Camille Carroll
- Faculty of Health, University of Plymouth, Plymouth, United Kingdom
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Affiliation(s)
- Alan Whone
- From Translational Health Sciences, Bristol Medical School, University of Bristol, and the Movement Disorders Group, Bristol Brain Centre, Southmead Hospital, North Bristol NHS Trust - both in Bristol, United Kingdom
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11
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Moran CH, Pietrzyk M, Sarangmat N, Gerard CS, Barua N, Ashida R, Whone A, Szewczyk-Krolikowski K, Mooney L, Gill SS. Clinical Outcome of “Asleep” Deep Brain Stimulation for Parkinson Disease Using Robot-Assisted Delivery and Anatomic Targeting of the Subthalamic Nucleus: A Series of 152 Patients. Neurosurgery 2021. [DOI: 10.1093/neuros/nyaa367_s070] [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: 11/12/2022] Open
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Neumann S, Taylor J, Bamford A, Metcalfe C, Gaunt DM, Whone A, Steeds D, Emmett SR, Hollingworth W, Ben-Shlomo Y, Henderson EJ. Cholinesterase inhibitor to prevent falls in Parkinson's disease (CHIEF-PD) trial: a phase 3 randomised, double-blind placebo-controlled trial of rivastigmine to prevent falls in Parkinson's disease. BMC Neurol 2021; 21:422. [PMID: 34715821 PMCID: PMC8556953 DOI: 10.1186/s12883-021-02430-2] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 10/04/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Falls are a common complication of Parkinson's disease. There is a need for new therapeutic options to target this debilitating aspect of the disease. Cholinergic deficit has been shown to contribute to both gait and cognitive dysfunction seen in the condition. Potential benefits of using cholinesterase inhibitors were shown during a single centre phase 2 trial. The aim of this trial is to evaluate the effectiveness of a cholinesterase inhibitor on fall rate in people with idiopathic Parkinson's disease. METHODS This is a multi-centre, double-blind, randomised placebo-controlled trial in 600 people with idiopathic Parkinson's disease (Hoehn and Yahr stages 1 to 4) with a history of a fall in the past year. Participants will be randomised to two groups, receiving either transdermal rivastigmine or identical placebo for 12 months. The primary outcome is the fall rate over 12 months follow-up. Secondary outcome measures, collected at baseline and 12 months either face-to-face or via remote video/telephone assessments, include gait and balance measures, neuropsychiatric indices, Parkinson's motor and non-motor symptoms, quality of life and cost-effectiveness. DISCUSSION This trial will establish whether cholinesterase inhibitor therapy is effective in preventing falls in Parkinson's disease. If cost-effective, it will alter current management guidelines by offering a new therapeutic option in this high-risk population. TRIAL REGISTRATION REC reference: 19/SW/0043. EudraCT: 2018-003219-23. ISCRTN 41639809 (registered 16/04/2019). ClinicalTrials.gov Identifier: NCT04226248 PROTOCOL AT TIME OF PUBLICATION: Version 7.0, 20th January 2021.
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Affiliation(s)
- S Neumann
- University of Bristol, Population Health Sciences, Bristol Medical School, Faculty of Health Sciences, Bristol, UK
| | - J Taylor
- University of Bristol, Population Health Sciences, Bristol Medical School, Faculty of Health Sciences, Bristol, UK
| | - A Bamford
- University of Bristol, Population Health Sciences, Bristol Medical School, Faculty of Health Sciences, Bristol, UK
| | - C Metcalfe
- University of Bristol, Population Health Sciences, Bristol Medical School, Faculty of Health Sciences, Bristol, UK
| | - D M Gaunt
- University of Bristol, Population Health Sciences, Bristol Medical School, Faculty of Health Sciences, Bristol, UK
| | - A Whone
- University of Bristol, Population Health Sciences, Bristol Medical School, Faculty of Health Sciences, Bristol, UK
- North Bristol NHS Trust, Bristol, UK
| | - D Steeds
- University of Bristol, Population Health Sciences, Bristol Medical School, Faculty of Health Sciences, Bristol, UK
| | - S R Emmett
- University of Bristol, Population Health Sciences, Bristol Medical School, Faculty of Health Sciences, Bristol, UK
- Royal United Hospitals Bath NHS Foundation Trust, Bath, UK
| | - W Hollingworth
- University of Bristol, Population Health Sciences, Bristol Medical School, Faculty of Health Sciences, Bristol, UK
| | - Y Ben-Shlomo
- University of Bristol, Population Health Sciences, Bristol Medical School, Faculty of Health Sciences, Bristol, UK
| | - E J Henderson
- University of Bristol, Population Health Sciences, Bristol Medical School, Faculty of Health Sciences, Bristol, UK.
- Royal United Hospitals Bath NHS Foundation Trust, Bath, UK.
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Baig F, Boca M, Mooney L, Cheminais L, Selikhova M, Rolinski M, Szewczyk-Krolikowski K, Collin N, Whone A. Per-oral image guided gastrojejunostomy insertion for levodopa-carbidopa intestinal gel in Parkinson's disease is safe and may be advantageous. Parkinsonism Relat Disord 2021; 89:34-37. [PMID: 34218045 DOI: 10.1016/j.parkreldis.2021.06.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 03/01/2021] [Revised: 06/16/2021] [Accepted: 06/26/2021] [Indexed: 01/16/2023]
Abstract
BACKGROUND Procedural aspects and complications of gastrojejunostomy insertion are important considerations in the use of levodopa-carbidopa intestinal gel therapy (LCIG) and may limit uptake. We describe our experience of using per-oral image guided gastrojejunostomy (PIG-J) which avoids the need for endoscopy and routine sedation in percutaneous endoscopic gastrojejunostomy (PEG-J) and allows more secure tube placement than radiologically inserted gastrojejunostomy techniques. METHODS We describe a case series of 32 patients undergoing PIG-J insertion for LCIG therapy in a single centre. Under local anaesthetic, a fluoroscopy-guided gastric puncture allows access for the guidewire which is then used to pull through the gastrostomy tube allowing for secure fixation, followed by placement of the gastrojejunal extension. RESULTS Between December 2015 to April 2020, 32/34 patients referred for PIG-J underwent this procedure successfully, 2 cases unsuccessful due to technical considerations. One patient developed delirium following successful implantation. Ten patients (31%) required a replacement tube due to blockage or displacement within the first 12 months of placement, including 2 patients who needed more than one replacement. Minor complications occurred in 10 other patients (31%), including infection (9 patients); a small haematoma not requiring intervention who later developed an infection (1 patient); and peri-stomal acid leakage (1 patient). CONCLUSION In summary, PIG-J insertion is safe with a similar complication rate to traditional PEG-J, well tolerated and effective for use in LCIG administration. This may widen access to LCIG for PD patients who may not be suitable or unable to tolerate PEG-J.
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Affiliation(s)
- Fahd Baig
- North Bristol NHS Trust, Bristol, United Kingdom; St. George's University, London, United Kingdom; University of Bristol, Bristol, United Kingdom.
| | - Mihaela Boca
- North Bristol NHS Trust, Bristol, United Kingdom
| | - Lucy Mooney
- North Bristol NHS Trust, Bristol, United Kingdom
| | | | | | - Michal Rolinski
- North Bristol NHS Trust, Bristol, United Kingdom; University of Bristol, Bristol, United Kingdom
| | | | - Neil Collin
- North Bristol NHS Trust, Bristol, United Kingdom
| | - Alan Whone
- North Bristol NHS Trust, Bristol, United Kingdom; University of Bristol, Bristol, United Kingdom
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Whone A. Reply: Growth differentiation factor 5 exerts neuroprotection in an α-synuclein rat model of Parkinson's disease and BMP5/7 protect dopaminergic neurons in an α-synuclein mouse model of Parkinson's disease. Brain 2021; 144:e16. [PMID: 33257974 DOI: 10.1093/brain/awaa369] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Alan Whone
- Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.,Neurological and Musculoskeletal Sciences Division, North Bristol NHS Trust, Bristol, UK
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Moran CH, Pietrzyk M, Sarangmat N, Gerard CS, Barua N, Ashida R, Whone A, Szewczyk-Krolikowski K, Mooney L, Gill SS. Clinical Outcome of "Asleep" Deep Brain Stimulation for Parkinson Disease Using Robot-Assisted Delivery and Anatomic Targeting of the Subthalamic Nucleus: A Series of 152 Patients. Neurosurgery 2021; 88:165-173. [PMID: 32985669 DOI: 10.1093/neuros/nyaa367] [Citation(s) in RCA: 6] [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] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Accepted: 06/08/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Recent advances in methods used for deep brain stimulation (DBS) include subthalamic nucleus electrode implantation in the "asleep" patient without the traditional use of microelectrode recordings or intraoperative test stimulation. OBJECTIVE To examine the clinical outcome of patients who have undergone "asleep" DBS for the treatment of Parkinson disease using robot-assisted electrode delivery. METHODS This is a retrospective review of clinical outcomes of 152 consecutive patients. Their outcomes at 1 yr postimplantation are reported; these include Unified Parkinson's Disease Rating Scale (UPDRS) assessment, Tinetti Mobility Test, Parkinson's Disease Questionnaire (PDQ)-39 quality of life assessment, Mattis Dementia Rating Scale, Beck Depression Inventory, and Beck Anxiety. We also report on a new parietal trajectory for electrode implantation. RESULTS A total of 152 patients underwent assessment at 1 yr. UPDRS III improved from 39 to 20.5 (47%, P < .001). The total UPDRS score improved from 67.6 to 36.4 (46%, P < .001). UPDRS II scores improved from 18.9 to 10.5 (44%, P < .001) and UPDRS IV scores improved from 7.1 to 3.6 (49%, P < .001). There was a significant reduction in levodopa equivalent daily dose after surgery (mean: 35%, P < .001). PDQ-39 summary index improved by a mean of 7.1 points. There was no significant difference found in clinical outcomes between the frontal and parietal approaches. CONCLUSION "Asleep" robot-assisted DBS of the subthalamic nucleus demonstrates comparable outcomes with traditional techniques in the treatment of Parkinson disease.
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Affiliation(s)
- Catherine H Moran
- Department of Neurosurgery, Tallaght University Hospital, Dublin, Ireland
| | - Mariusz Pietrzyk
- Neurological Applications Division, Renishaw PlC, Wooton-under-Edge, United Kinrgdom
| | - Nagaraja Sarangmat
- Department of Neurology, North Bristol NHS Trust, Southmead Hospital, Bristol, United Kingdom
| | - Carter S Gerard
- Department of Neurosurgery, Swedish Medical Center, Seattle, Washington
| | - Neil Barua
- Department of Neurosurgery, North Bristol NHS Trust, Southmead Hospital, Bristol, United Kingdom
| | - Reiko Ashida
- Department of Neurosurgery, North Bristol NHS Trust, Southmead Hospital, Bristol, United Kingdom
| | - Alan Whone
- Department of Neurology, North Bristol NHS Trust, Southmead Hospital, Bristol, United Kingdom
| | | | - Lucy Mooney
- Department of Neurology, North Bristol NHS Trust, Southmead Hospital, Bristol, United Kingdom
| | - Steven S Gill
- Department of Neurosurgery, North Bristol NHS Trust, Southmead Hospital, Bristol, United Kingdom
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Abstract
Background Frailty and Parkinson’s disease (PD) are both highly prevalent in older people, but few studies have studied frailty in people with Parkinson’s. Identifying frailty in this population is vital, to target new interventions to those who would most benefit. Methods Data were collected as part of the double-blind randomised controlled rivastigmine to stabilise gait ReSPonD trial in 130 people with Hoehn and Yahr 2–3, idiopathic PD who had fallen in the year prior to enrolment. Individuals were assessed at baseline and followed up at eight months, including determination of frailty status. Results 120 patients attended for follow-up. At follow-up, the mean (SD) age was 70.2 years (8.0), MDS-UPDRS total score 91.5 (29.1), and MDS-UPDRS motor score (Part III) 42.7 (14.8). Median disease duration was 9.2 years (IQR 4.6 to 13.1), Geriatric Depression Score 4 (IQR 2 to 6). Using the Fried frailty criteria, 31 (26%) were frail and 70 (58%) pre-frail. In univariable analysis, being female, higher depression score, and MDS-UPDRS score were associated with greater frailty. Using ordinal regression, in the multivariable model, being female (odds ratio [OR] 3.10, 95%CI 1.53 to 6.26, p=.002), higher total MDS-UPDRS score (OR 2.02, 95%CI 1.42 to 2.87, p<.0001) and higher depression (OR 1.47, 95%CI 1.05 to 2.06, p=.03) were associated with higher number of frailty markers. Conclusion There was a high prevalence (84%) of pre-frail and frail individuals in patients participating in this RCT. Future research should determine the optimum tool to assess frailty in this at-risk population, and delineate the association between Parkinson’s, frailty, and health outcomes.
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Affiliation(s)
| | - Daisy M Gaunt
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Alan Whone
- Movement Disorders Group, Bristol Brain Centre, Southmead Hospital, Bristol, UK
| | - Yoav Ben-Shlomo
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Emily J Henderson
- Royal United Hospitals Bath NHS Trust, Bath, UK.,Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
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Luz M, Whone A, Bassani N, Wyse RK, Stebbins GT, Mohr E. The Parkinson's Disease Comprehensive Response (PDCORE): a composite approach integrating three standard outcome measures. Brain Commun 2020; 2:fcaa046. [PMID: 33392501 PMCID: PMC7759656 DOI: 10.1093/braincomms/fcaa046] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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: 12/13/2019] [Revised: 12/13/2019] [Accepted: 12/19/2019] [Indexed: 11/12/2022] Open
Abstract
There is an increasing need for improved endpoints to assess clinical trial effects in Parkinson's disease. We propose the Parkinson's Disease Comprehensive Response as a novel weighted composite endpoint integrating changes measured in three established Parkinson's outcomes, including: OFF state Movement Disorder Society Unified Parkinson's Disease Rating Scale Motor Examination scores; Motor Experiences of Daily Living scores; and total good-quality ON time per day. The data source for the initial development of the composite described herein was a recent Phase II trial of glial cell line-derived neurotrophic factor. A wide range of clinically derived relative weights was assessed to normalize for differentially scoring base rates with each endpoint component. The Parkinson's disease comprehensive response, in contrast to examining practically defined OFF state Unified Parkinson's Disease Rating Scale Motor Examination scores alone, showed stability over 40 weeks in placebo patients, and all 432 analyses in this permutation exercise yielded significant differences in favour of glial cell line-derived neurotrophic factor. The findings were consistent with results obtained employing three different global statistical test methodologies and with patterns of intra-patient change. Based on our detailed analyses, we conclude it worth prospectively evaluating the clinical utility, validity and regulatory feasibility of using clinically supported final Parkinson's disease comprehensive response formulas (for both the Unified Parkinson's Disease Rating Scale-based and Movement Disorders Society-Unified Parkinson's Disease Rating Scale-based versions) in future disease-modifying Parkinson's trials. Whilst the data source employed in the initial development of this weighted composite score is from a recent Phase II trial of glial cell line-derived neurotrophic factor, we wish to stress that the results are not described to provide post hoc evidence of the efficacy of glial cell line-derived neurotrophic factor but rather are presented to further the debate of how current regulatory approved rating scales may be combined to address some of the recognized limitations of using individual scales in isolation.
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Affiliation(s)
- Matthias Luz
- MedGenesis Therapeutix Inc., Victoria, British Columbia V8R 3T1, Canada
| | - Alan Whone
- Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol BS105NB, UK.,Neurological and Musculoskeletal Sciences Division, North Bristol NHS Trust, Bristol BS105NB, UK
| | - Niccolò Bassani
- Quanticate International Ltd, Hitchin, Hertfordshire SG51LH, UK
| | | | - Glenn T Stebbins
- Department of Neurological Sciences, Rush University Medical Center, Chicago, IL 60612, USA
| | - Erich Mohr
- MedGenesis Therapeutix Inc., Victoria, British Columbia V8R 3T1, Canada
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Whone A, Luz M, Boca M, Woolley M, Mooney L, Dharia S, Broadfoot J, Cronin D, Schroers C, Barua NU, Longpre L, Barclay CL, Boiko C, Johnson GA, Fibiger HC, Harrison R, Lewis O, Pritchard G, Howell M, Irving C, Johnson D, Kinch S, Marshall C, Lawrence AD, Blinder S, Sossi V, Stoessl AJ, Skinner P, Mohr E, Gill SS. Randomized trial of intermittent intraputamenal glial cell line-derived neurotrophic factor in Parkinson's disease. Brain 2020; 142:512-525. [PMID: 30808022 PMCID: PMC6391602 DOI: 10.1093/brain/awz023] [Citation(s) in RCA: 174] [Impact Index Per Article: 43.5] [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: 08/12/2018] [Revised: 11/24/2018] [Accepted: 12/12/2018] [Indexed: 01/12/2023] Open
Abstract
We investigated the effects of glial cell line-derived neurotrophic factor (GDNF) in Parkinson’s disease, using intermittent intraputamenal convection-enhanced delivery via a skull-mounted transcutaneous port as a novel administration paradigm to potentially afford putamen-wide therapeutic delivery. This was a single-centre, randomized, double-blind, placebo-controlled trial. Patients were 35–75 years old, had motor symptoms for 5 or more years, and presented with moderate disease severity in the OFF state [Hoehn and Yahr stage 2–3 and Unified Parkinson’s Disease Rating Scale motor score (part III) (UPDRS-III) between 25 and 45] and motor fluctuations. Drug delivery devices were implanted and putamenal volume coverage was required to exceed a predefined threshold at a test infusion prior to randomization. Six pilot stage patients (randomization 2:1) and 35 primary stage patients (randomization 1:1) received bilateral intraputamenal infusions of GDNF (120 µg per putamen) or placebo every 4 weeks for 40 weeks. Efficacy analyses were based on the intention-to-treat principle and included all patients randomized. The primary outcome was the percentage change from baseline to Week 40 in the OFF state (UPDRS-III). The primary analysis was limited to primary stage patients, while further analyses included all patients from both study stages. The mean OFF state UPDRS motor score decreased by 17.3 ± 17.6% in the active group and 11.8 ± 15.8% in the placebo group (least squares mean difference: −4.9%, 95% CI: −16.9, 7.1, P = 0.41). Secondary endpoints did not show significant differences between the groups either. A post hoc analysis found nine (43%) patients in the active group but no placebo patients with a large clinically important motor improvement (≥10 points) in the OFF state (P = 0.0008). 18F-DOPA PET imaging demonstrated a significantly increased uptake throughout the putamen only in the active group, ranging from 25% (left anterior putamen; P = 0.0009) to 100% (both posterior putamina; P < 0.0001). GDNF appeared to be well tolerated and safe, and no drug-related serious adverse events were reported. The study did not meet its primary endpoint. 18F-DOPA imaging, however, suggested that intermittent convection-enhanced delivery of GDNF produced a putamen-wide tissue engagement effect, overcoming prior delivery limitations. Potential reasons for not proving clinical benefit at 40 weeks are discussed.
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Affiliation(s)
- Alan Whone
- Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- Neurological and Musculoskeletal Sciences Division, North Bristol NHS Trust, Bristol, UK
| | - Matthias Luz
- MedGenesis Therapeutix Inc., Victoria, BC, Canada
| | - Mihaela Boca
- Neurological and Musculoskeletal Sciences Division, North Bristol NHS Trust, Bristol, UK
| | - Max Woolley
- Renishaw plc, New Mills, Wotton-under-Edge, Gloucestershire, UK
| | - Lucy Mooney
- Neurological and Musculoskeletal Sciences Division, North Bristol NHS Trust, Bristol, UK
| | - Sonali Dharia
- Neurological and Musculoskeletal Sciences Division, North Bristol NHS Trust, Bristol, UK
| | - Jack Broadfoot
- Neurological and Musculoskeletal Sciences Division, North Bristol NHS Trust, Bristol, UK
| | - David Cronin
- Neurological and Musculoskeletal Sciences Division, North Bristol NHS Trust, Bristol, UK
| | - Christian Schroers
- Neurological and Musculoskeletal Sciences Division, North Bristol NHS Trust, Bristol, UK
| | - Neil U Barua
- Neurological and Musculoskeletal Sciences Division, North Bristol NHS Trust, Bristol, UK
| | - Lara Longpre
- MedGenesis Therapeutix Inc., Victoria, BC, Canada
| | | | - Chris Boiko
- MedGenesis Therapeutix Inc., Victoria, BC, Canada
| | | | | | - Rob Harrison
- Renishaw plc, New Mills, Wotton-under-Edge, Gloucestershire, UK
| | - Owen Lewis
- Renishaw plc, New Mills, Wotton-under-Edge, Gloucestershire, UK
| | - Gemma Pritchard
- Renishaw plc, New Mills, Wotton-under-Edge, Gloucestershire, UK
| | - Mike Howell
- Renishaw plc, New Mills, Wotton-under-Edge, Gloucestershire, UK
| | - Charlie Irving
- Renishaw plc, New Mills, Wotton-under-Edge, Gloucestershire, UK
| | - David Johnson
- Renishaw plc, New Mills, Wotton-under-Edge, Gloucestershire, UK
| | - Suk Kinch
- Renishaw plc, New Mills, Wotton-under-Edge, Gloucestershire, UK
| | - Christopher Marshall
- The Wales Research and Diagnostic Positron Emission Tomography Imaging Centre (PETIC), Cardiff University, Cardiff, UK
| | | | - Stephan Blinder
- Department of Physics and Astronomy, The University of British Columbia, Vancouver, BC, Canada
| | - Vesna Sossi
- Department of Physics and Astronomy, The University of British Columbia, Vancouver, BC, Canada
| | - A Jon Stoessl
- Djavad Mowafaghian Centre for Brain Health, Faculty of Medicine, The University of British Columbia, Vancouver, BC, Canada
| | - Paul Skinner
- Renishaw plc, New Mills, Wotton-under-Edge, Gloucestershire, UK
| | - Erich Mohr
- MedGenesis Therapeutix Inc., Victoria, BC, Canada
| | - Steven S Gill
- Neurological and Musculoskeletal Sciences Division, North Bristol NHS Trust, Bristol, UK
- Renishaw plc, New Mills, Wotton-under-Edge, Gloucestershire, UK
- Correspondence regarding study concept, drug-delivery device and surgical implantation to: Professor Steven S. Gill, FRCS Consultant Neurosurgeon, Department of Neurosurgery, Southmead Hospital, North Bristol NHS Trust, Bristol BS10 5NB, UK E-mail: Correspondence regarding trial oversight/execution and study data to: Dr Alan Whone, PhD, FRCP Movement Disorders Group, Bristol Brain Centre, Southmead Hospital, Bristol, BS10 5NB, UK E-mail:
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Barker RA, Björklund A, Gash DM, Whone A, Van Laar A, Kordower JH, Bankiewicz K, Kieburtz K, Saarma M, Booms S, Huttunen HJ, Kells AP, Fiandaca MS, Stoessl AJ, Eidelberg D, Federoff H, Voutilainen MH, Dexter DT, Eberling J, Brundin P, Isaacs L, Mursaleen L, Bresolin E, Carroll C, Coles A, Fiske B, Matthews H, Lungu C, Wyse RK, Stott S, Lang AE. GDNF and Parkinson's Disease: Where Next? A Summary from a Recent Workshop. J Parkinsons Dis 2020; 10:875-891. [PMID: 32508331 PMCID: PMC7458523 DOI: 10.3233/jpd-202004] [Citation(s) in RCA: 54] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 05/18/2020] [Indexed: 12/22/2022]
Abstract
The concept of repairing the brain with growth factors has been pursued for many years in a variety of neurodegenerative diseases including primarily Parkinson's disease (PD) using glial cell line-derived neurotrophic factor (GDNF). This neurotrophic factor was discovered in 1993 and shown to have selective effects on promoting survival and regeneration of certain populations of neurons including the dopaminergic nigrostriatal pathway. These observations led to a series of clinical trials in PD patients including using infusions or gene delivery of GDNF or the related growth factor, neurturin (NRTN). Initial studies, some of which were open label, suggested that this approach could be of value in PD when the agent was injected into the putamen rather than the cerebral ventricles. In subsequent double-blind, placebo-controlled trials, the most recent reporting in 2019, treatment with GDNF did not achieve its primary end point. As a result, there has been uncertainty as to whether GDNF (and by extrapolation, related GDNF family neurotrophic factors) has merit in the future treatment of PD. To critically appraise the existing work and its future, a special workshop was held to discuss and debate this issue. This paper is a summary of that meeting with recommendations on whether there is a future for this therapeutic approach and also what any future PD trial involving GDNF and other GDNF family neurotrophic factors should consider in its design.
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Affiliation(s)
- Roger A. Barker
- Cambridge Centre for Brain Repair, Department of Clinical Neuroscience and WT-MRC Cambridge Stem Cell Institute, Cambridge, UK
| | | | - Don M. Gash
- Professor Emeritus of Neuroscience, University of Kentucky, Lexington, KY, USA
| | - Alan Whone
- Translational Health Sciences, Bristol Medical School, University of Bristol and Neurological and Musculoskeletal Sciences Division, North Bristol NHS Trust, Bristol, UK
| | | | - Jeffrey H. Kordower
- Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, USA
| | - Krystof Bankiewicz
- Neurological Surgery, Gilbert and Kathryn Mitchell Endowed Chair, Director, Brain Health and Performance Center, The Ohio State University, Department of Neurological Surgery, Columbus, OH, USA
| | - Karl Kieburtz
- Center for Health & Technology, and the Department of Neurology, University of Rochester Medical Center, Rochester, NY, USA
| | - Mart Saarma
- Institute of Biotechnology, HiLIFE, University of Helsinki, Helsinki, Finland
| | | | - Henri J. Huttunen
- Herantis Pharma Plc, Finland
- Neuroscience Center, HiLIFE, University of Helsinki, Finland
| | | | | | - A. Jon Stoessl
- Pacific Parkinson’s Research Centre & Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Canada
| | - David Eidelberg
- Center for Neurosciences, The Feinstein Institutes for Medical Research, Manhasset, NY, USA
| | - Howard Federoff
- School of Medicine, Susan and Henry College of Health Sciences, University of California, Irvine and CEO, Aspen Neuroscience, San Diego, CA, USA
| | | | | | - Jamie Eberling
- The Michael J. Fox Foundation for Parkinson’s Research, New York, NY, USA
| | - Patrik Brundin
- Center for Neurodegenerative Science, Van Andel Institute, Grand Rapids, MI, USA
| | | | - Leah Mursaleen
- The Cure Parkinson’s Trust, London, UK
- School of Life Sciences, University of Westminster, UK and School of Pharmacy, University College London, UK
| | | | | | - Alasdair Coles
- Department of Clinical Neuroscience, University of Cambridge, Addenbrooke’s Hospital, Cambridge, UK
| | - Brian Fiske
- The Michael J. Fox Foundation for Parkinson’s Research, New York, NY, USA
| | | | - Codrin Lungu
- Division of Clinical Research, National Institute of Neurological Disorders and Stroke, Rockville, MD, USA
| | | | | | - Anthony E. Lang
- The Edmond J Safra Program in Parkinson’s Disease and the Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, and the Department of Medicine, University of Toronto, Toronto, Ontario, Canada
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20
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Carroll CB, Webb D, Stevens KN, Vickery J, Eyre V, Ball S, Wyse R, Webber M, Foggo A, Zajicek J, Whone A, Creanor S. Simvastatin as a neuroprotective treatment for Parkinson's disease (PD STAT): protocol for a double-blind, randomised, placebo-controlled futility study. BMJ Open 2019; 9:e029740. [PMID: 31594876 PMCID: PMC6797358 DOI: 10.1136/bmjopen-2019-029740] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION Parkinson's disease (PD) is a progressive neurodegenerative condition affecting approximately 185,000 people in the UK. No drug has been proven to slow disease progression. Epidemiological and pre-clinical data support simvastatin, a widely used cholesterol-lowering drug with a well-established safety profile, having neuroprotective properties. The aim of this study (Simvastatin as a neuroprotective treatment for PD (PD STAT)) is to determine whether simvastatin has the potential to slow PD progression. The study is part of the International Linked Clinical Trials initiative coordinated by The Cure Parkinson's Trust. This paper describes the protocol for the PD STAT study. METHODS AND ANALYSIS PD STAT is a double-blind, randomised, placebo-controlled, multi-centre, parallel group, futility trial in patients with PD of mild-moderate severity. 235 participants have been recruited and randomly allocated in a 1:1 ratio to receive either oral simvastatin or matched placebo. Treatment involves a 1-month low-dose phase (40 mg daily), followed by a 23-month high-dose phase (80 mg daily) and ends with a 2-month washout period. Participants are reviewed at clinic visits at 1 month, 6, 12, 18, 24 and 26 months post-baseline, with interim telephone follow-up to monitor for adverse events.The primary outcome is the change in the Movement Disorder Society Unified Parkinson's Disease Rating Scale part III motor subscale score in the practically defined OFF medication state (OFF state) between baseline and 24 months. Primary analysis will be on a modified intention to treat basis and will include only those participants who progress to the high-dose phase of the study. ETHICS AND DISSEMINATION The protocol has been approved by the North East-Newcastle and North Tyneside 2 Research Ethics Committee. The results will be disseminated via research articles in peer-reviewed journals and presentations at local, national and international scientific meetings, as well as disseminated via patient groups, websites and networks. A summary of the study findings will be posted to participants at the end of the study. TRIAL REGISTRATION ISRCTN16108482 (prospectively registered); EudraCT 2015-000148-40; ClinicalTrials.gov NCT02787590; Pre-results.
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Affiliation(s)
- Camille B Carroll
- Faculty of Medicine and Dentistry, University of Plymouth, Plymouth, UK
| | - Douglas Webb
- Peninsula Clinical Trials Unit, University of Plymouth, Plymouth, UK
| | | | - Jane Vickery
- Peninsula Clinical Trials Unit, University of Plymouth, Plymouth, UK
| | - Vicky Eyre
- Peninsula Clinical Trials Unit, University of Plymouth, Plymouth, UK
| | - Susan Ball
- NIHR CLAHRC South West Peninsula (PenCLAHRC), University of Exeter Medical School, Exeter, UK
| | | | - Mike Webber
- PPI Representative, University of Plymouth, Plymouth, UK
| | - Andy Foggo
- PPI Representative, University of Plymouth, Plymouth, UK
| | - John Zajicek
- School of Medicine, University of St Andrews, St Andrews, UK
| | - Alan Whone
- School of Translational Health Sciences, University of Bristol, Bristol, UK
| | - Siobhan Creanor
- Medical Statistics Group, University of Plymouth, Plymouth, UK
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21
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Baig F, Robb T, Mooney L, Robbins C, Norris C, Barua N, Szewczyk-Krolikowski K, Whone A. Deep brain stimulation: practical insights and common queries. Pract Neurol 2019; 19:502-507. [PMID: 31358573 DOI: 10.1136/practneurol-2019-002275] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/11/2019] [Indexed: 11/03/2022]
Abstract
The number of patients with deep brain stimulation (DBS) devices implanted is increasing. Although practices vary between centres, patients are typically given training and information from their DBS nurse or clinician, as well as a comprehensive device manual and contact details for their device manufacturer. However, for the lifetime of a patient with a DBS system, most of their secondary care often occurs in a centre without a co-located DBS service. The local neurologist is often asked pragmatic questions regarding the do's and don'ts for patients with DBS systems. While a DBS centre or device manufacturer can provide advice, we thought that it will be helpful to outline the overall management of DBS for movement disorders and the approach to commonly raised questions. We describe briefly the clinical application of DBS and discuss common scenarios where there are possible compatibility issues around the device.
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Affiliation(s)
- Fahd Baig
- Neurological and Musculoskeletal Sciences Division, Southmead Hospital, North Bristol NHS Trust, Bristol, UK.,Nuffield Department of Clinical Neuroscience, University of Oxford, Oxford, UK
| | - Thomas Robb
- Translational Health Sciences, University of Bristol, Bristol, UK
| | - Lucy Mooney
- Neurological and Musculoskeletal Sciences Division, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - Caroline Robbins
- Neurological and Musculoskeletal Sciences Division, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - Caroline Norris
- Neurological and Musculoskeletal Sciences Division, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - Neil Barua
- Neurological and Musculoskeletal Sciences Division, Southmead Hospital, North Bristol NHS Trust, Bristol, UK.,Translational Health Sciences, University of Bristol, Bristol, UK
| | - Konrad Szewczyk-Krolikowski
- Neurological and Musculoskeletal Sciences Division, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - Alan Whone
- Neurological and Musculoskeletal Sciences Division, Southmead Hospital, North Bristol NHS Trust, Bristol, UK .,Translational Health Sciences, University of Bristol, Bristol, UK
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22
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Barbe MT, Barthel C, Chen L, Van Dyck N, Brücke T, Seijo F, San Martin ES, Haegelen C, Verin M, Amarell M, Gill S, Whone A, Porta M, Servello D, Fink GR, Alesch F, Bloem BR, Timmermann L. Subthalamic nucleus deep brain stimulation reduces freezing of gait subtypes and patterns in Parkinson's disease. Brain Stimul 2018; 11:1404-1406. [PMID: 30174201 DOI: 10.1016/j.brs.2018.08.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Accepted: 08/20/2018] [Indexed: 10/28/2022] Open
Affiliation(s)
| | - Claudia Barthel
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Lilly Chen
- Boston Scientific Corporation, Valencia, CA, United States
| | - Nic Van Dyck
- Boston Scientific Corporation, Valencia, CA, United States
| | | | | | | | | | - Marc Verin
- CHU de Rennes-Pontchaillou, Rennes, France
| | | | - Steve Gill
- Frenchay Hospital, Bristol, United Kingdom
| | - Alan Whone
- Frenchay Hospital, Bristol, United Kingdom
| | | | | | | | | | - Bastiaan R Bloem
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
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23
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Brücke T, Jain R, Van Dyck N, Chen L, Thun P, Seijo F, Suarez San Martin E, Visser-Vandewalle V, Barbe M, Gill S, Whone A, Porta M, Servello D, Timmermann L, Alesch F. Long term results of the VANTAGE study: A prospective multicenter trial evaluating deep brain stimulation with a multiple source, constant current system in Parkinson’s disease. Parkinsonism Relat Disord 2018. [DOI: 10.1016/j.parkreldis.2017.11.082] [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: 11/26/2022]
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24
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Boca M, Whone A. Letter to the editor on "Evidence for dopaminergic denervation in classical galactosemia". Mov Disord 2017; 32:1797. [PMID: 29082548 DOI: 10.1002/mds.27187] [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] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Revised: 08/29/2017] [Accepted: 08/30/2017] [Indexed: 11/10/2022] Open
Affiliation(s)
- Mihaela Boca
- Movement Disorders Group, Bristol Brain Centre, Southmead Hospital, Bristol, UK
| | - Alan Whone
- Movement Disorders Group, Bristol Brain Centre, Southmead Hospital, Bristol, UK
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25
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Grogan JP, Tsivos D, Smith L, Knight BE, Bogacz R, Whone A, Coulthard EJ. Effects of dopamine on reinforcement learning and consolidation in Parkinson's disease. eLife 2017; 6. [PMID: 28691905 PMCID: PMC5531832 DOI: 10.7554/elife.26801] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [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: 03/14/2017] [Accepted: 07/07/2017] [Indexed: 01/24/2023] Open
Abstract
Emerging evidence suggests that dopamine may modulate learning and memory with important implications for understanding the neurobiology of memory and future therapeutic targeting. An influential hypothesis posits that dopamine biases reinforcement learning. More recent data also suggest an influence during both consolidation and retrieval. Eighteen Parkinson's disease patients learned through feedback ON or OFF medication, with memory tested 24 hr later ON or OFF medication (4 conditions, within-subjects design with matched healthy control group). Patients OFF medication during learning decreased in memory accuracy over the following 24 hr. In contrast to previous studies, however, dopaminergic medication during learning and testing did not affect expression of positive or negative reinforcement. Two further experiments were run without the 24 hr delay, but they too failed to reproduce effects of dopaminergic medication on reinforcement learning. While supportive of a dopaminergic role in consolidation, this study failed to replicate previous findings on reinforcement learning.
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Affiliation(s)
- John P Grogan
- Institute of Clinical Neurosciences, School of Clinical Sciences, University of Bristol, Bristol, United Kingdom
| | - Demitra Tsivos
- Clinical Neurosciences, North Bristol NHS Trust, Bristol, United Kingdom
| | - Laura Smith
- Institute of Clinical Neurosciences, School of Clinical Sciences, University of Bristol, Bristol, United Kingdom
| | - Brogan E Knight
- Clinical Neurosciences, North Bristol NHS Trust, Bristol, United Kingdom
| | - Rafal Bogacz
- MRC Brain Network Dynamics Unit, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
| | - Alan Whone
- Institute of Clinical Neurosciences, School of Clinical Sciences, University of Bristol, Bristol, United Kingdom
| | - Elizabeth J Coulthard
- Institute of Clinical Neurosciences, School of Clinical Sciences, University of Bristol, Bristol, United Kingdom.,Clinical Neurosciences, North Bristol NHS Trust, Bristol, United Kingdom
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26
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Volkmann J, Reich M, Kirsch AD, Timmermann L, Barbe M, Kühn A, van Riesen C, Whone A, Bigfoot J, Mooney L, Schnitzler A, Jun Groiss S, Moldovan A, Eleopra R, Belgrado E, Rinaldo S, Pavese N, Garmizo J, Carcieri S. EP 37. Impedance changes occur during threshold measurements in subthalamic nucleus (STN) deep brain stimulation patients. Clin Neurophysiol 2016. [DOI: 10.1016/j.clinph.2016.05.230] [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: 10/21/2022]
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27
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Boca M, Lloyd K, Likeman M, Jardine P, Whone A. Basal ganglia necrosis: a 'best-fit' approach. Pract Neurol 2016; 16:458-461. [PMID: 27503951 DOI: 10.1136/practneurol-2016-001410] [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] [Accepted: 07/17/2016] [Indexed: 11/04/2022]
Abstract
A previously well 16-year-old boy developed a rapid-onset hypokinetic syndrome, coupled with a radiological appearance of extensive and highly symmetrical basal ganglia and white matter change. The diagnostic process was challenging and we systematically considered potential causes. After excluding common causes of this clinico-radiological picture, we considered common disorders with this unusual radiological picture and vice versa, before finally concluding that this was a rare presentation of a rare disease. We considered the broad categories of: metabolic; toxic; infective; inflammatory, postinfective and immune-mediated; neoplastic; paraneoplastic and heredodegenerative. Long-term follow-up gave insight into the nature of the insult, confirming the monophasic course. During recovery, and following presumed secondary aberrant reinnervation, his disorder evolved from predominantly hypokinetic to hyperkinetic. Here, we explore the process of finding a 'best-fit' diagnosis: in this case, acute necrotising encephalopathy.
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Affiliation(s)
- Mihaela Boca
- Bristol Brain Centre, Southmead Hospital, Bristol, UK
| | - Katie Lloyd
- Faculty of Medicine and Dentistry, University of Bristol, Bristol, UK
| | - Marcus Likeman
- Department of Neuroradiology, Southmead Hospital, Bristol, UK
| | - Philip Jardine
- Institute of Child Health, Bristol Royal Hospital for Children, Bristol, UK
| | - Alan Whone
- Department of Clinical Neurosciences, University of Bristol, Bristol, UK
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28
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Alesch F, Jain R, Chen L, Brucke T, Seijo F, San Martin ES, Haegelen C, Verin M, Maarouf M, Barbe MT, Gill S, Whone A, Porta M, Servello D, Timmermann L. 135 A Comparison of Outcomes Between Deep Brain Stimulation Under General Anesthesia Versus Conscious Sedation With Awake Evaluation. Neurosurgery 2016. [DOI: 10.1227/01.neu.0000489705.76089.c2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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29
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Timmermann L, Jain R, Chen L, Brucke T, Seijo F, San Martin ES, Haegelen C, Verin M, Visser-Vandewalle V, Barbe MT, Gill S, Whone A, Porta M, Servello D, Alesch F. 134 VANTAGE Trial. Neurosurgery 2016. [DOI: 10.1227/01.neu.0000489704.68466.0a] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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30
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Moro E, Schüpbach M, Wächter T, Allert N, Eleopra R, Honey CR, Rueda M, Schiess MC, Shimo Y, Valkovic P, Whone A, Stoevelaar H. Referring Parkinson's disease patients for deep brain stimulation: a RAND/UCLA appropriateness study. J Neurol 2015; 263:112-9. [PMID: 26530503 PMCID: PMC4723622 DOI: 10.1007/s00415-015-7942-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Revised: 10/04/2015] [Accepted: 10/13/2015] [Indexed: 02/03/2023]
Abstract
In 2005, a European expert panel developed and validated an electronic tool to support the appropriate referral of patients with Parkinson’s disease (PD) for the consideration of deep brain stimulation (DBS). Since new evidence has become available over the last decade an update of the tool is necessary. A world-wide expert panel (71 neurologists and 11 neurosurgeons) used the RAND/UCLA Appropriateness Method to assess the appropriateness of referral for 1296 scenarios (9-point scale). Scenarios were permutations of 8 clinical variables relevant to the decision of referral. Appropriateness of referral was calculated on the basis of the median score and the extent of agreement. Compared to 2005, the impact of clinical variables on the appropriateness of referral was similar for severity of on–off fluctuations, dyskinesias and refractory tremor (positive association, p < 0.001), and cognitive impairment (negative association, p < 0.001). A relatively stronger negative impact was seen for levodopa-unresponsive gait and balance disturbances as well as older age, the latter most likely due to a higher cut-off value (75 versus 70 years in the previous study). The impact of PD duration on the appropriateness of referral was less pronounced than in 2005. The contribution of the newly included variable ‘non-motor side effects of anti-PD medication’ was very modest. Based on these results the panel produced new recommendations on the appropriateness of referral for the evaluation of DBS in PD patients. Differences from the previous study reflect the new clinical evidence, particularly related to the use of DBS in an earlier stage of PD. The validation of the updated recommendations is in progress.
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Affiliation(s)
- Elena Moro
- Division of Neurology, CHU of Grenoble, Joseph Fourier University, INSERM U836, Grenoble, France
| | - Michael Schüpbach
- Department of Neurology, Movement Disorders Center, Bern University Hospital and University of Bern, Bern, Switzerland
- Assistance-Publique Hôpitaux de Paris; Centre d'Investigation Clinique 9503, Institut du Cerveau et de la Moelle épinière; Département de Neurologie, Université Pierre et Marie Curie, Paris 6 et INSERM, CHU Pitié-Salpêtrière, Paris, France
| | - Tobias Wächter
- Department of Neurology and Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
- Center of Rehabilitation, Bad Gögging, Germany
| | - Niels Allert
- Neurological Rehabilitation Center Godeshoehe, Bonn, Germany
| | - Roberto Eleopra
- Department of Neurology, Santa Maria della Misericordia University Hospital, Udine, Italy
| | | | - Mauricio Rueda
- Departamento de Neurociencias, Fundación Cardiovascular de Colombia, Bucaramanga, Colombia
| | - Mya C Schiess
- Department of Neurology, University of Texas Medical School at Houston, Texas, USA
| | - Yasushi Shimo
- Department of Neurology, Juntendo University School of Medicine, Tokyo, Japan
| | - Peter Valkovic
- 2nd Department of Neurology, Comenius University Faculty of Medicine and University Hospital Bratislava, Bratislava, Slovakia
| | - Alan Whone
- Department of Neurology, Frenchay Hospital, Bristol, UK
| | - Herman Stoevelaar
- Centre for Decision Analysis and Support, Ismar Healthcare, Lier, Belgium.
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31
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Abstract
Memory consolidation underpins adaptive behavior and dopaminergic networks may be critical for prolonged, selective information storage. To understand the time course of the dopaminergic contribution to memory consolidation in humans, here we investigate the effect of dopaminergic medication on recall and recognition in the short and longer term in Parkinson disease (PD). Fifteen people with PD were each tested on or off dopaminergic medication during learning/early consolidation (Day 1) and/or late consolidation (Day 2). Fifteen age-matched healthy participants were tested only once. On Day 1 participants learned new information, and early episodic memory was tested after 30 min. Then on Day 2, recall and recognition were retested after a 24-hr delay. Participants on medication on Day 1 recalled less information at 30 min and 24 hr. In contrast, patients on medication on Day 2 (8-24 hr after learning) recalled more information at 24 hr than those off medication. Although recognition sensitivity was unaffected by medication, response bias was dependent on dopaminergic state: Medication during learning induced a more liberal bias 24 hr later, whereas patients off medication during learning were more conservative responders 24 hr later. We use computational modeling to propose possible mechanisms for this change in response bias. In summary, dopaminergic medication in PD patients during learning impairs early consolidation of episodic memory and makes delayed responses more liberal, but enhances late memory consolidation presumably through a dopamine-dependent consolidation pathway that may be active during sleep.
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Affiliation(s)
| | | | | | - Alan Whone
- University of Bristol
- North Bristol NHS Trust
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32
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Timmermann L, Jain R, Chen L, Maarouf M, Barbe MT, Allert N, Brücke T, Kaiser I, Beirer S, Sejio F, Suarez E, Lozano B, Haegelen C, Vérin M, Porta M, Servello D, Gill S, Whone A, Van Dyck N, Alesch F. Multiple-source current steering in subthalamic nucleus deep brain stimulation for Parkinson's disease (the VANTAGE study): a non-randomised, prospective, multicentre, open-label study. Lancet Neurol 2015; 14:693-701. [PMID: 26027940 DOI: 10.1016/s1474-4422(15)00087-3] [Citation(s) in RCA: 116] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Revised: 04/14/2015] [Accepted: 05/08/2015] [Indexed: 10/23/2022]
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33
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Hyam JA, Pereira EAC, McCulloch P, Javed S, Plaha P, Mooney L, Forrow BA, Joint C, Whone A, Gill S, Glasziou P, Aziz TZ, Green AL. Implementing novel trial methods to evaluate surgery for essential tremor. Br J Neurosurg 2015; 29:334-9. [DOI: 10.3109/02688697.2014.997670] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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34
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Alesch F, Jain R, Chen L, Brücke T, Seijo F, Martin ESS, Haegelen C, Verin M, Maarouf M, Barbe M, Gill S, Whone A, Porta M, Servello D, Timmermann L. Essai VANTAGE : suivi de douze (12) mois d’une étude prospective multicentrique évaluant la stimulation cérébrale profonde avec un nouveau système rechargeable à sources de courant multiples indépendantes (Vercise™) dans la maladie de Parkinson. Neurochirurgie 2014. [DOI: 10.1016/j.neuchi.2014.10.054] [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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35
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Henderson EJ, Lord SR, Close JCT, Lawrence AD, Whone A, Ben-Shlomo Y. The ReSPonD trial--rivastigmine to stabilise gait in Parkinson's disease a phase II, randomised, double blind, placebo controlled trial to evaluate the effect of rivastigmine on gait in patients with Parkinson's disease who have fallen. BMC Neurol 2013; 13:188. [PMID: 24299497 PMCID: PMC3880104 DOI: 10.1186/1471-2377-13-188] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2013] [Accepted: 11/11/2013] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Gait impairment is common in people with Parkinson's disease. There is a lack of effective interventions to target this debilitating complication and therefore a need to identify new therapeutic options. An underlying cholinergic deficit contributes to both the gait and cognitive dysfunction seen in Parkinson's disease. The combined impact of both impairments can be assessed in gait tasks performed with concomitant cognitive tasks. The aim of this trial is to evaluate the impact of a cholinesterase inhibitor on cognitive function and gait performance in people with established Parkinson's disease. METHODS/DESIGN This is a single centre, double-blind, randomised placebo-controlled trial in 130 people with Hoehn and Yahr stage 2-3 idiopathic Parkinson's disease who have fallen in the past year. Participants will be randomised to two groups, receiving either rivastigmine capsules or identical placebo capsules for 8 months. Assessment will be undertaken at baseline and at the end of medication prescription (i.e. 8 months) with participants remaining enrolled in the trial for a further 4 months to monitor for falls and adverse events. The primary outcome is step time variability, assessed with and without the addition of concurrent cognitive tasks. Secondary outcomes will include other gait parameters, sensorimotor and balance performances, cognitive indices, falls and fall related injury, fear of falling, Parkinson's symptoms and data pertaining to possible harms. DISCUSSION This randomised controlled trial will examine the effect of cholinesterase inhibitor therapy on gait, balance and falls in Parkinson's disease. If effective, it would offer a new therapeutic option to ameliorating gait and cognitive deficits in a population at high risk of falls. TRIAL REGISTRATION ISRCTN19880883, UTN U1111-1124-0244.
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Affiliation(s)
- Emily J Henderson
- Department of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, BS8 2PS Bristol, UK.
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Peall K, Smith D, Kurian M, Wardle M, Waite A, Hedderly T, Lin J, Smith M, Whone A, Pall H, White C, Lux A, Jardine P, Bajaj N, Lynch B, Kirov G, O'Riordan S, Samuel M, Lynch T, King M, Chinnery P, Warner T, Blake D, Owen M, Morris H. ARE PSYCHIATRIC SYMPTOMS A CORE PHENOTYPE OF MYOCLONUS DYSTONIA SYNDROME CAUSED BY SGCE MUTATIONS? J Neurol Psychiatry 2013. [DOI: 10.1136/jnnp-2013-306103.24] [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: 11/04/2022]
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Peall KJ, Smith DJ, Kurian MA, Wardle M, Waite AJ, Hedderly T, Lin JP, Smith M, Whone A, Pall H, White C, Lux A, Jardine P, Bajaj N, Lynch B, Kirov G, O'Riordan S, Samuel M, Lynch T, King MD, Chinnery PF, Warner TT, Blake DJ, Owen MJ, Morris HR. SGCE mutations cause psychiatric disorders: clinical and genetic characterization. ACTA ACUST UNITED AC 2013; 136:294-303. [PMID: 23365103 DOI: 10.1093/brain/aws308] [Citation(s) in RCA: 81] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Myoclonus dystonia syndrome is a childhood onset hyperkinetic movement disorder characterized by predominant alcohol responsive upper body myoclonus and dystonia. A proportion of cases are due to mutations in the maternally imprinted SGCE gene. Previous studies have suggested that patients with SGCE mutations may have an increased rate of psychiatric disorders. We established a cohort of patients with myoclonus dystonia syndrome and SGCE mutations to determine the extent to which psychiatric disorders form part of the disease phenotype. In all, 89 patients with clinically suspected myoclonus dystonia syndrome were recruited from the UK and Ireland. SGCE was analysed using direct sequencing and for copy number variants. In those patients where no mutation was found TOR1A (GAG deletion), GCH1, THAP1 and NKX2-1 were also sequenced. SGCE mutation positive cases were systematically assessed using standardized psychiatric interviews and questionnaires and compared with a disability-matched control group of patients with alcohol responsive tremor. Nineteen (21%) probands had a SGCE mutation, five of which were novel. Recruitment of family members increased the affected SGCE mutation positive group to 27 of whom 21 (77%) had psychiatric symptoms. Obsessive-compulsive disorder was eight times more likely (P < 0.001) in mutation positive cases, compulsivity being the predominant feature (P < 0.001). Generalized anxiety disorder (P = 0.003) and alcohol dependence (P = 0.02) were five times more likely in mutation positive cases than tremor controls. SGCE mutations are associated with a specific psychiatric phenotype consisting of compulsivity, anxiety and alcoholism in addition to the characteristic motor phenotype. SGCE mutations are likely to have a pleiotropic effect in causing both motor and specific psychiatric symptoms.
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Affiliation(s)
- Kathryn J Peall
- MRC Centre for Neuropsychiatric Genetics and Genomics, Institute of Psychological Medicine and Clinical Neurosciences, Henry Wellcome Building, Heath Park, Cardiff, UK.
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Khan S, Javed S, Mooney L, White P, Plaha P, Whone A, Gill SS. Clinical outcomes from bilateral versus unilateral stimulation of the pedunculopontine nucleus with and without concomitant caudal zona incerta region stimulation in Parkinson's disease. Br J Neurosurg 2012; 26:722-5. [PMID: 22404735 DOI: 10.3109/02688697.2012.659297] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
INTRODUCTION The Pedunculopontine nucleus is a novel target for deep brain stimulation and this may improve postural instability and gait dysfunction in Parkinson's disease. If unilateral Pedunculopontine nucleus stimulation is as efficacious as bilateral stimulation this would lead to less surgical risk. METHODS 5 Parkinson's disease patients with bilateral caudal Zona Incerta region and Pedunculopontine nucleus electrodes were assessed using the motor component of the Unified Parkinson's Disease Rating Scale. Patients were assessed in the on-medication state to determine the optimal combination of stimulation setting for axial symptom control. RESULTS The on-medication composite axial-subscore only showed a statistically significant improvement when bilateral Pedunculopontine nucleus and caudal Zona Incerta region stimulation was used. CONCLUSIONS In the on-medication state bilateral Pedunculopontine nucleus and caudal Zona Incerta region stimulation is required in order to produce a significant change in the motor Unified Parkinson's Disease Rating Scale axial-subscore from baseline.
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Affiliation(s)
- Sadaquate Khan
- Department of Neurosurgery, Institute of Neurosciences, Frenchay Hospital, Bristol
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Abstract
OBJECTIVE To assess the effect of deep brain stimulation (DBS) in the pedunculopontine nucleus (PPN) and caudal zona incerta (cZi)-both separately and in combination-on motor symptoms and regional cerebral blood flow (rCBF) in patients with Parkinson disease (PD). METHODS Four patients with bilateral cZi and PPN DBS electrodes were rated with the Unified Parkinson's Disease Rating Scale motor subscale (UPDRS-III) when taking and withdrawn from medication. A block of 16 [(15)O]-H(2)O PET resting measurements of rCBF were performed in 4 different states with patients withdrawn from medication: 1) no stimulation, 2) cZi stimulation alone, 3) PPN stimulation alone, 4) combined PPN/cZi stimulation. RESULTS When patients were medicated, combined PPN/cZi stimulation produced a statistically significant improvement in UPDRS-III score compared to cZi stimulation alone. In the "off" medication state, the clinical effect of combined stimulation was not significantly different from that induced by cZi stimulation alone. Concomitant PPN/cZi stimulation had a cumulative effect on levels of rCBF, effectively combining subcortical and cortical changes induced by stimulation of either target in isolation. CONCLUSIONS These findings suggest that concomitant low frequency stimulation of PPN and cZi regions induces additive brain activation changes and provides improved control of PD symptoms when medicated. CLASSIFICATION OF EVIDENCE This study provides Class IV evidence that concomitant low frequency stimulation of PPN and cZI improves motor symptoms in patients with PD on dopamine replacement. It provides Class III evidence that concomitant low frequency stimulation of PPN and cZi induces additive rCBF changes in motor areas of brain.
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Affiliation(s)
- S Khan
- Department of Neurosurgery, Institute of Neurosciences, Frenchay Hospital, Bristol, UK
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Peall K, Waite AJ, Kurian MA, Hedderly T, Smith M, Lin JP, Warner TT, Pall H, Chinnery P, Whone A, Owen MJ, Blake DJ, Morris HR. 1624 Myoclonus dystonia: a clinical and genetic description: Table 1. J Neurol Psychiatry 2012. [DOI: 10.1136/jnnp-2011-301993.29] [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: 11/04/2022]
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Plaha P, Javed S, Agombar D, O' Farrell G, Khan S, Whone A, Gill S. Bilateral caudal zona incerta nucleus stimulation for essential tremor: outcome and quality of life. J Neurol Neurosurg Psychiatry 2011; 82:899-904. [PMID: 21285454 DOI: 10.1136/jnnp.2010.222992] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.0] [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] [Indexed: 12/17/2022]
Abstract
BACKGROUND Over the past few years, bilateral stimulation of the caudal or motor part of the zona incerta nucleus (cZI) has been performed by the authors in patients with essential tremor (ET). Outcomes including quality of life data in 15 patients with a follow-up period of up to 84 months (mean 31.7 ± 28.6 months) are presented. METHODS 15 consecutive ET patients underwent MRI guided bilateral cZI deep brain stimulation implantation. Patients were assessed by applying the Fahn-Tolosa-Marin Tremor Rating Scale and the Short Form Health Survey-36 (SF-36) to assess quality of life. RESULTS The total tremor score improved by 73.8% (p<0.0001). The part A score (items 1-9) improved by 86.6% (p<0.0001). Postural tremor improved by 88.2% (p<0.0001) and action tremor by 82.2% (p<0.0001). The part B score, which evaluates the functional activities of the upper limbs, improved by 60.1% (p<0.0001). Part C score, which evaluates the activities of daily living, improved by 80.0% (p<0.0001). The SF-36 physical component score improved by 23.7% (p<0.0001) and the mental component score by 22.4% (p<0.0001). There was one wound infection and three patients developed stimulation related transient dysarthria. None developed any disequilibrium or tolerance to stimulation. CONCLUSION Bilateral cZI stimulation is safe and effective in suppressing the postural and action component of ET. It is associated with a low incidence of stimulation related complications and patients do not develop tolerance to stimulation with maintained clinical benefit over a follow-up period of up to 7 years.
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Affiliation(s)
- Puneet Plaha
- Department of Neurosurgery, Frenchay Hospital, Bristol BS16 1LE, UK
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Khan S, Javed S, Plaha P, Whone A, Gill S. Deep Brain Stimulation of the Pedunculopontine Nucleus in Combination with the Caudal Zona Incerta for the Treatment of Axial Symptoms in Parkinson's Disease. Neurosurgery 2009. [DOI: 10.1227/01.neu.0000358741.38249.8b] [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: 11/19/2022] Open
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Abstract
The accurate diagnosis of idiopathic Parkinson's disease (IPD) is not only important for deciding on treatment strategies and providing a prognosis, but also crucial for studies designed to investigate the aetiology and pathogenesis of parkinsonian disorders. Over recent decades, improvements in the characterisation of the parkinsonian syndromes have led to improvements in clinical diagnostic accuracy; however, clinical criteria alone are not always sufficient to distinguish between IPD and other parkinsonian syndromes, particularly in the early stages of disease and in atypical presentations. Therefore, in addition to the development and implementation of diagnostic clinical assessments, there is a need for available objective markers to aid the physician in the differential diagnosis of IPD. Functional neuroimaging holds the promise of improved diagnosis and allows assessment in early disease. In this review, the use of PET and single photon emission CT in the differential diagnosis of IPD are discussed.
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Affiliation(s)
- Paola Piccini
- MRC Clinical Sciences Centre and Division of Neuroscience, Faculty of Medicine, Imperial College, Hammersmith Hospital, London, UK.
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Mack TG, Dayanandan R, Van Slegtenhorst M, Whone A, Hutton M, Lovestone S, Anderton BH. Tau proteins with frontotemporal dementia-17 mutations have both altered expression levels and phosphorylation profiles in differentiated neuroblastoma cells. Neuroscience 2002; 108:701-12. [PMID: 11738505 DOI: 10.1016/s0306-4522(01)00434-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The inherited form of frontotemporal dementia with Parkinsonism linked to chromosome 17 (FTDP-17) has been attributed to mutations in the tau gene. Pathologically, affected FTDP-17 brains share tau aggregates with other tauopathies, the most common being Alzheimer's disease. FTDP-17 mutations may therefore affect tau function leading to tau aggregation and cell loss. Interaction of tau with microtubules is thought to be regulated by phosphorylation. Investigating FTDP-17 mutations transiently expressed as enhanced green fluorescent protein (EGFP)-tagged proteins for the first time in differentiated neuronal cells, we found that two out of three missense mutations showed surprisingly decreased phosphorylation at the pathologically relevant S202/T205 site, mutant EGFP-tau being completely dephosphorylated in most cells. Moreover, phosphorylation at the S396/S404 site was moderately decreased for all mutant isoforms. Although microtubule integrity was not affected, with all mutants tested we demonstrated an increase in cellular tau protein level, some of which is microtubule-bound. Further enhancing this EGFP-tau accumulation by inhibition of tau degradation resulted in the previously less phosphorylated mutant EGFP-tau becoming highly phosphorylated. We conclude that the missense tau mutations primarily result in an excess of neuronal tau, which may interfere with important cellular functions such as axonal transport.
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Affiliation(s)
- T G Mack
- Department of Neuroscience and Old Age Psychiatry, Institute of Psychiatry, De Crespigny Park, London, UK.
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