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Boogers A, Fasano A, Lang A. An Apple a Day Will Not Keep the (Parkinson Disease) Doctor at Bay! Ann Neurol 2024; 95:1012-1013. [PMID: 38553985 DOI: 10.1002/ana.26936] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Accepted: 02/03/2024] [Indexed: 05/01/2024]
Affiliation(s)
- Alexandra Boogers
- Edmond J. Safra Program in Parkinson's Disease and Morton and Gloria Shulman Movement Disorders Centre, Toronto Western Hospital, University Health Network, and Division of Neurology, University of Toronto, Toronto, Ontario, Canada
| | - Alfonso Fasano
- Edmond J. Safra Program in Parkinson's Disease and Morton and Gloria Shulman Movement Disorders Centre, Toronto Western Hospital, University Health Network, and Division of Neurology, University of Toronto, Toronto, Ontario, Canada
- Krembil Brain Institute, Toronto, Ontario, Canada
- Center for Advancing Neurotechnological Innovation to Application, Toronto, Ontario, Canada
| | - Anthony Lang
- Edmond J. Safra Program in Parkinson's Disease and Morton and Gloria Shulman Movement Disorders Centre, Toronto Western Hospital, University Health Network, and Division of Neurology, University of Toronto, Toronto, Ontario, Canada
- Krembil Brain Institute, Toronto, Ontario, Canada
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2
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Vogt LM, Yang K, Tse G, Quiroz V, Zaman Z, Wang L, Srouji R, Tam A, Estrella E, Manzi S, Fasano A, Northam WT, Stone S, Moharir M, Gonorazky H, McAlvin B, Kleinman M, LaRovere KL, Gorodetsky C, Ebrahimi-Fakhari D. Recommendations for the Management of Initial and Refractory Pediatric Status Dystonicus. Mov Disord 2024. [PMID: 38619077 DOI: 10.1002/mds.29794] [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: 11/03/2023] [Revised: 03/07/2024] [Accepted: 03/11/2024] [Indexed: 04/16/2024] Open
Abstract
Status dystonicus is the most severe form of dystonia with life-threatening complications if not treated promptly. We present consensus recommendations for the initial management of acutely worsening dystonia (including pre-status dystonicus and status dystonicus), as well as refractory status dystonicus in children. This guideline provides a stepwise approach to assessment, triage, interdisciplinary treatment, and monitoring of status dystonicus. The clinical pathways aim to: (1) facilitate timely recognition/triage of worsening dystonia, (2) standardize supportive and dystonia-directed therapies, (3) provide structure for interdisciplinary cooperation, (4) integrate advances in genomics and neuromodulation, (5) enable multicenter quality improvement and research, and (6) improve outcomes. © 2024 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Lindsey M Vogt
- Division of Neurology, Department of Pediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Kathryn Yang
- Division of Neurology, Department of Pediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
- Movement Disorders Program, Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Gabriel Tse
- Division of Pediatric Hospital Medicine, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California, USA
| | - Vicente Quiroz
- Movement Disorders Program, Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Zainab Zaman
- Movement Disorders Program, Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Laura Wang
- Division of Neurology, Department of Pediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Rasha Srouji
- Movement Disorders Program, Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Amy Tam
- Movement Disorders Program, Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Elicia Estrella
- Movement Disorders Program, Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Shannon Manzi
- Department of Pharmacy, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Alfonso Fasano
- Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
- Krembil Brain Institute, University of Toronto, Toronto, Ontario, Canada
| | - Weston T Northam
- Department of Neurosurgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Scellig Stone
- Department of Neurosurgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Mahendranath Moharir
- Division of Neurology, Department of Pediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Hernan Gonorazky
- Division of Neurology, Department of Pediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Brian McAlvin
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Monica Kleinman
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Kerri L LaRovere
- Neurocritical Care Consult Service, Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Carolina Gorodetsky
- Division of Neurology, Department of Pediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
- Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| | - Darius Ebrahimi-Fakhari
- Movement Disorders Program, Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Neurocritical Care Consult Service, Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Steiner LA, Crompton D, Sumarac S, Vetkas A, Germann J, Scherer M, Justich M, Boutet A, Popovic MR, Hodaie M, Kalia SK, Fasano A, Hutchison Wd WD, Lozano AM, Lankarany M, Kühn AA, Milosevic L. Neural signatures of indirect pathway activity during subthalamic stimulation in Parkinson's disease. Nat Commun 2024; 15:3130. [PMID: 38605039 PMCID: PMC11009243 DOI: 10.1038/s41467-024-47552-6] [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: 06/15/2023] [Accepted: 04/02/2024] [Indexed: 04/13/2024] Open
Abstract
Deep brain stimulation (DBS) of the subthalamic nucleus (STN) produces an electrophysiological signature called evoked resonant neural activity (ERNA); a high-frequency oscillation that has been linked to treatment efficacy. However, the single-neuron and synaptic bases of ERNA are unsubstantiated. This study proposes that ERNA is a subcortical neuronal circuit signature of DBS-mediated engagement of the basal ganglia indirect pathway network. In people with Parkinson's disease, we: (i) showed that each peak of the ERNA waveform is associated with temporally-locked neuronal inhibition in the STN; (ii) characterized the temporal dynamics of ERNA; (iii) identified a putative mesocircuit architecture, embedded with empirically-derived synaptic dynamics, that is necessary for the emergence of ERNA in silico; (iv) localized ERNA to the dorsal STN in electrophysiological and normative anatomical space; (v) used patient-wise hotspot locations to assess spatial relevance of ERNA with respect to DBS outcome; and (vi) characterized the local fiber activation profile associated with the derived group-level ERNA hotspot.
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Affiliation(s)
- Leon A Steiner
- Krembil Brain Institute, University Health Network, Toronto, ON, M5T 1M8, Canada
- Department of Neurology, Charité-Universitätsmedizin Berlin, Berlin, 10117, Germany
- Berlin Institute of Health (BIH), Berlin, 10178, Germany
| | - David Crompton
- Krembil Brain Institute, University Health Network, Toronto, ON, M5T 1M8, Canada
- Institute of Biomedical Engineering, University of Toronto, Toronto, ON, M5S 3G9, Canada
| | - Srdjan Sumarac
- Krembil Brain Institute, University Health Network, Toronto, ON, M5T 1M8, Canada
- Institute of Biomedical Engineering, University of Toronto, Toronto, ON, M5S 3G9, Canada
| | - Artur Vetkas
- Krembil Brain Institute, University Health Network, Toronto, ON, M5T 1M8, Canada
- Division of Neurosurgery, Toronto Western Hospital, Toronto, ON, M5T 2S8, Canada
| | - Jürgen Germann
- Krembil Brain Institute, University Health Network, Toronto, ON, M5T 1M8, Canada
- Division of Neurosurgery, Toronto Western Hospital, Toronto, ON, M5T 2S8, Canada
- Department of Surgery, University of Toronto, Toronto, ON, M5G 2C4, Canada
| | - Maximilian Scherer
- Krembil Brain Institute, University Health Network, Toronto, ON, M5T 1M8, Canada
- Institute of Biomedical Engineering, University of Toronto, Toronto, ON, M5S 3G9, Canada
| | - Maria Justich
- Krembil Brain Institute, University Health Network, Toronto, ON, M5T 1M8, Canada
- Department of Neurology, University of Toronto, Toronto, ON, M5S 3H2, Canada
- Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, Toronto, ON, M5T 2S8, Canada
| | - Alexandre Boutet
- Joint Department of Medical Imaging, University of Toronto, Toronto, ON, M5G 1×6, Canada
| | - Milos R Popovic
- Institute of Biomedical Engineering, University of Toronto, Toronto, ON, M5S 3G9, Canada
- KITE Research Institute, University Health Network, Toronto, ON, M5G 2A2, Canada
- Center for Advancing Neurotechnological Innovation to Application (CRANIA), Toronto, ON, M5T 2S8, Canada
| | - Mojgan Hodaie
- Krembil Brain Institute, University Health Network, Toronto, ON, M5T 1M8, Canada
- Division of Neurosurgery, Toronto Western Hospital, Toronto, ON, M5T 2S8, Canada
- Department of Surgery, University of Toronto, Toronto, ON, M5G 2C4, Canada
- Center for Advancing Neurotechnological Innovation to Application (CRANIA), Toronto, ON, M5T 2S8, Canada
- Institute of Medical Sciences, University of Toronto, Toronto, ON, M5S 1A8, Canada
| | - Suneil K Kalia
- Krembil Brain Institute, University Health Network, Toronto, ON, M5T 1M8, Canada
- Division of Neurosurgery, Toronto Western Hospital, Toronto, ON, M5T 2S8, Canada
- Department of Surgery, University of Toronto, Toronto, ON, M5G 2C4, Canada
- KITE Research Institute, University Health Network, Toronto, ON, M5G 2A2, Canada
- Center for Advancing Neurotechnological Innovation to Application (CRANIA), Toronto, ON, M5T 2S8, Canada
- Institute of Medical Sciences, University of Toronto, Toronto, ON, M5S 1A8, Canada
| | - Alfonso Fasano
- Krembil Brain Institute, University Health Network, Toronto, ON, M5T 1M8, Canada
- Department of Neurology, University of Toronto, Toronto, ON, M5S 3H2, Canada
- Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, Toronto, ON, M5T 2S8, Canada
- Center for Advancing Neurotechnological Innovation to Application (CRANIA), Toronto, ON, M5T 2S8, Canada
- Institute of Medical Sciences, University of Toronto, Toronto, ON, M5S 1A8, Canada
| | - William D Hutchison Wd
- Krembil Brain Institute, University Health Network, Toronto, ON, M5T 1M8, Canada
- Department of Surgery, University of Toronto, Toronto, ON, M5G 2C4, Canada
- Center for Advancing Neurotechnological Innovation to Application (CRANIA), Toronto, ON, M5T 2S8, Canada
- Department of Physiology, University of Toronto, Toronto, ON, M5S 1A8, Canada
| | - Andres M Lozano
- Krembil Brain Institute, University Health Network, Toronto, ON, M5T 1M8, Canada
- Division of Neurosurgery, Toronto Western Hospital, Toronto, ON, M5T 2S8, Canada
- Department of Surgery, University of Toronto, Toronto, ON, M5G 2C4, Canada
- Center for Advancing Neurotechnological Innovation to Application (CRANIA), Toronto, ON, M5T 2S8, Canada
- Institute of Medical Sciences, University of Toronto, Toronto, ON, M5S 1A8, Canada
| | - Milad Lankarany
- Krembil Brain Institute, University Health Network, Toronto, ON, M5T 1M8, Canada
- Institute of Biomedical Engineering, University of Toronto, Toronto, ON, M5S 3G9, Canada
- Center for Advancing Neurotechnological Innovation to Application (CRANIA), Toronto, ON, M5T 2S8, Canada
| | - Andrea A Kühn
- Department of Neurology, Charité-Universitätsmedizin Berlin, Berlin, 10117, Germany
| | - Luka Milosevic
- Krembil Brain Institute, University Health Network, Toronto, ON, M5T 1M8, Canada.
- Institute of Biomedical Engineering, University of Toronto, Toronto, ON, M5S 3G9, Canada.
- KITE Research Institute, University Health Network, Toronto, ON, M5G 2A2, Canada.
- Center for Advancing Neurotechnological Innovation to Application (CRANIA), Toronto, ON, M5T 2S8, Canada.
- Institute of Medical Sciences, University of Toronto, Toronto, ON, M5S 1A8, Canada.
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Boogers A, Fasano A. Reply to: Comment on: A Transatlantic Viewpoint on the Role of Pallidal Stimulation for Parkinson's Disease. Mov Disord 2024; 39:761. [PMID: 38661042 DOI: 10.1002/mds.29780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Accepted: 02/23/2024] [Indexed: 04/26/2024] Open
Affiliation(s)
- Alexandra Boogers
- Edmond J. Safra Program in Parkinson's Disease and Morton and Gloria Shulman Movement Disorders Centre, Toronto Western Hospital, UHN, and Division of Neurology, University of Toronto, Toronto, Ontario, Canada
| | - Alfonso Fasano
- Edmond J. Safra Program in Parkinson's Disease and Morton and Gloria Shulman Movement Disorders Centre, Toronto Western Hospital, UHN, and Division of Neurology, University of Toronto, Toronto, Ontario, Canada
- Krembil Brain Institute, Toronto, Ontario, Canada
- Center for Advancing Neurotechnological Innovation to Application (CRANIA), Toronto, Ontario, Canada
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Bartolo M, Castelli A, Calabrese M, Buttacchio G, Zucchella C, Tamburin S, Fontana A, Copetti M, Fasano A, Intiso D. A wearable system for visual cueing gait rehabilitation in Parkinson's disease: a randomized non-inferiority trial. Eur J Phys Rehabil Med 2024; 60:245-256. [PMID: 38483335 DOI: 10.23736/s1973-9087.24.08381-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/13/2024]
Abstract
BACKGROUND Gait disturbances represent one of the most disabling features of Parkinson's disease (PD). AIM The aim of this study was to evaluate the non-inferiority of a new wearable visual cueing system (Q-Walk) for gait rehabilitation in PD subjects, compared to traditional visual cues (stripes on the floor). DESIGN Open-label, monocentric, randomized controlled non-inferiority trial. SETTING Outpatients. POPULATION Patients affected by idiopathic PD without cognitive impairment, Hoehn and Yahr stage II-IV, Unified Parkinson's Disease Rating Scale motor section III ≥2, stable drug usage since at least 3 weeks. METHODS At the enrollment (T0), all subjects underwent a clinical/functional evaluation and the instrumental gait and postural analysis; then they were randomly assigned to the Study Group (SG) or Control Group (CG). Rehabilitation program consisted in 10 consecutive individual sessions (5 sessions/week for 2 consecutive weeks). Each session included 60 minutes of conventional physiotherapy plus 30 minutes of gait training by Q-Walk (SG) or by traditional visual cues (CG). Follow-up visits were scheduled at the end of the treatment (T1) and after 3 months (T2). RESULTS Fifty-two subjects were enrolled in the study, 26 in each group. The within-groups analysis showed a significant improvement in clinical scales and instrumental data at T1 and at T2, compared to baseline, in both groups. According to the between-group analysis, Q-Walk cueing system was not-inferior to the traditional cues for gait rehabilitation. The satisfaction questionnaire revealed that most subjects described the Q-Walk cueing system as simple, motivating and easily usable, possibly suitable for home use. CONCLUSIONS Data showed that motor rehabilitation of PD subjects performed by means of the new wearable Q-Walk cueing system was feasible and as effective as traditional cues in improving gait parameters and balance. CLINICAL REHABILITATION IMPACT Wearable devices can act as an additional rehabilitation strategy for long-term and continuous care, allowing patients to train intensively and extensively in household settings, favoring a tailor-made and personalized approach as well as remote monitoring.
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Affiliation(s)
- Michelangelo Bartolo
- Neurorehabilitation Unit, Rehabilitation Department, HABILITA Zingonia, Zingonia, Bergamo, Italy -
| | - Alberto Castelli
- Neurorehabilitation Unit, Rehabilitation Department, HABILITA Zingonia, Zingonia, Bergamo, Italy
| | - Marzia Calabrese
- Neurorehabilitation Unit, Rehabilitation Department, HABILITA Zingonia, Zingonia, Bergamo, Italy
| | - Giampiero Buttacchio
- Neurorehabilitation Unit, Rehabilitation Department, HABILITA Zingonia, Zingonia, Bergamo, Italy
| | | | - Stefano Tamburin
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Andrea Fontana
- Unit of Biostatistics, Fondazione IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Foggia, Italy
| | - Massimiliano Copetti
- Unit of Biostatistics, Fondazione IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Foggia, Italy
| | - Alfonso Fasano
- Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, UHN, Toronto, ON, Canada
- Division of Neurology, University of Toronto, Toronto, ON, Canada
- Krembil Brain Institute, Toronto, ON, Canada
- Department of Parkinson's Disease and Movement Disorders Rehabilitation, Moriggia-Pelascini Hospital, Gravedona ed Uniti, Como, Italy
| | - Domenico Intiso
- Unit of Neurorehabilitation and Rehabilitation Medicine, Fondazione IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Foggia, Italy
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Ebden M, Elkaim LM, Breitbart S, Yan H, Warsi N, Huynh M, Mithani K, Venetucci Gouveia F, Fasano A, Ibrahim GM, Gorodetsky C. Chronic Pallidal Local Field Potentials Are Associated With Dystonic Symptoms in Children. Neuromodulation 2024; 27:551-556. [PMID: 37768258 DOI: 10.1016/j.neurom.2023.08.003] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Revised: 08/07/2023] [Accepted: 08/18/2023] [Indexed: 09/29/2023]
Abstract
BACKGROUND Novel deep brain stimulation devices can record local field potentials (LFPs), which represent the synchronous synaptic activity of neuronal populations. The clinical relevance of LFPs in patients with dystonia remains unclear. OBJECTIVES We sought to determine whether chronic LFPs recorded from the globus pallidus internus (GPi) were associated with symptoms of dystonia in children. MATERIALS AND METHODS Ten patients with heterogeneous forms of dystonia (genetic and acquired) were implanted with neurostimulators that recorded LFP spectral snapshots. Spectra were compared across parent-reported asymptomatic and symptomatic periods, with daily narrowband data superimposed in 24 one-hour bins. RESULTS Spectral power increased during periods of registered dystonic symptoms: mean increase = 102%, CI: (76.7, 132). Circadian rhythms within the LFP narrowband time series correlated with dystonic symptoms: for delta/theta-waves, correlation = 0.33, CI: (0.18, 0.47) and for alpha waves, correlation = 0.27, CI: (0.14, 0.40). CONCLUSIONS LFP spectra recorded in the GPi indicate a circadian pattern and are associated with the manifestation of dystonic symptoms.
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Affiliation(s)
- Mark Ebden
- Neurosciences and Mental Health Program, the Hospital for Sick Children, Toronto, Ontario, Canada
| | - Lior M Elkaim
- Division of Neurology and Neurosurgery, McGill University, McGill University Health Centre, Montreal, Quebec, Canada
| | - Sara Breitbart
- Division of Neurosurgery, the Hospital for Sick Children, Toronto, Ontario, Canada
| | - Han Yan
- Division of Neurosurgery, the Hospital for Sick Children, Toronto, Ontario, Canada
| | - Nebras Warsi
- Division of Neurosurgery, the Hospital for Sick Children, Toronto, Ontario, Canada; Institute of Biomedical Engineering, University of Toronto, Toronto, Ontario, Canada
| | - MyLoi Huynh
- Neurosciences and Mental Health Program, the Hospital for Sick Children, Toronto, Ontario, Canada
| | - Karim Mithani
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Flavia Venetucci Gouveia
- Neurosciences and Mental Health Program, the Hospital for Sick Children, Toronto, Ontario, Canada
| | - Alfonso Fasano
- Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada; Division of Neurology, University of Toronto, Toronto, Ontario, Canada; Krembil Brain Institute, Toronto, Ontario, Canada; CenteR for Advancing Neurotechnological Innovation to Application, Toronto, Ontario, Canada
| | - George M Ibrahim
- Division of Neurosurgery, the Hospital for Sick Children, Toronto, Ontario, Canada; Department of Surgery, University of Toronto, Toronto, Ontario, Canada; Institute of Biomedical Engineering, University of Toronto, Toronto, Ontario, Canada
| | - Carolina Gorodetsky
- Division of Neurology, the Hospital for Sick Children, Toronto, Ontario, Canada; Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada.
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Gupta HV, Lenka A, Dhamija RK, Fasano A. A video-atlas of levodopa-induced dyskinesia in Parkinson's disease: terminology matters. Neurol Sci 2024; 45:1389-1397. [PMID: 37987930 DOI: 10.1007/s10072-023-07209-6] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Accepted: 11/15/2023] [Indexed: 11/22/2023]
Abstract
Dyskinesia is a common complication of long-term levodopa therapy in patients with Parkinson's disease (PD), which often worsens the quality of life. It is usually dose-dependent and emerges possibly due to pulsatile stimulation of dopamine receptors. Delineating the pattern of dyskinesia is crucial for determining the most effective therapeutic approach, a task that often presents challenges for numerous neurologists. This article comprehensively describes various patterns of dyskinesia in PD patients and features video demonstration of some of the common forms of dyskinesia. We have used a real case scenario as an example to lead the discussion on the phenomenology, distinguishing features, and management of various types of dyskinesia. A comprehensive literature search was conducted in PubMed using "dyskinesia" as a keyword. The prototype case with videos highlights the differentiating features of dyskinesia along with the treatment strategies. A wide range of descriptive rubrics have been used for certain dyskinesia which are described in detail in this article. The newer types of dyskinesia associated with continuous dopaminergic stimulation in patients with advanced PD and their implications have been described. As there are distinct ways of managing various types of dyskinesia, understanding the phenomenology and chronology of dyskinesia is vital for the optimal management of dyskinetic PD patients. We suggest that dyskinesia should be classified broadly into peak-dose dyskinesia (PDD), biphasic dyskinesia (BD), and OFF-period dystonia. The occurrence of low-dose dyskinesia and complex dyskinesia of continuous dopaminergic treatments should be known to specialists and will require additional studies.
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Affiliation(s)
- Harsh V Gupta
- Department of Neurology, Memorial Healthcare System, Hollywood, FL, USA.
| | - Abhishek Lenka
- Department of Neurology, Baylor College of Medicine, Houston, TX, USA
| | - Rajinder K Dhamija
- Department of Neurology, Institute of Human Behaviour and Allied Sciences, New Delhi, India
| | - Alfonso Fasano
- Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, UHN, Toronto, ON, Canada
- Division of Neurology, University of Toronto, Toronto, ON, Canada
- Krembil Brain Institute, Toronto, ON, Canada
- Center for Advancing Neurotechnological Innovation to Application (CRANIA), Toronto, Canada
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8
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Kihlstedt CJ, Malm J, Fasano A, Bäckström D. Freezing of gait in idiopathic normal pressure hydrocephalus. Fluids Barriers CNS 2024; 21:22. [PMID: 38454478 PMCID: PMC10921745 DOI: 10.1186/s12987-024-00522-y] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 02/14/2024] [Indexed: 03/09/2024] Open
Abstract
BACKGROUND Reports of freezing of gait (FoG) in idiopathic normal pressure hydrocephalus (iNPH) are few and results are variable. This study's objective was to evaluate the frequency of FoG in a large cohort of iNPH patients, identify FoG-associated factors, and assess FoG's responsiveness to shunt surgery. METHODS Videotaped standardized gait protocols with iNPH patients pre- and post-shunt surgery (n = 139; median age 75 (71-79) years; 48 women) were evaluated for FoG episodes by two observers (Cohens kappa = 0.9, p < 0.001). FoG episodes were categorized. Mini-mental state examination (MMSE) and MRI white matter hyperintensities (WMH) assessment using the Fazekas scale were performed. CSF was analyzed for Beta-amyloid, Tau, and Phospho-tau. Patients with and without FoG were compared. RESULTS Twenty-two patients (16%) displayed FoG at baseline, decreasing to seven (8%) after CSF shunt surgery (p = 0.039). The symptom was most frequently exhibited during turning (n = 16, 73%). Patients displaying FoG were older (77.5 vs. 74.6 years; p = 0.029), had a slower walking speed (0.59 vs. 0.89 m/s; p < 0.001), a lower Tinetti POMA score (6.8 vs. 10.8; p < 0.001), lower MMSE score (21.3 vs. 24.0; p = 0.031), and longer disease duration (4.2 vs. 2.3 years; p < 0.001) compared to patients not displaying FoG. WMH or CSF biomarkers did not differ between the groups. CONCLUSIONS FoG is occurring frequently in iNPH patients and may be considered a typical feature of iNPH. FoG in iNPH was associated with higher age, longer disease duration, worse cognitive function, and a more unstable gait. Shunt surgery seems to improve the symptom.
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Affiliation(s)
| | - Jan Malm
- Department of Clinical Science, Neurosciences, Umeå University, Umeå, Sweden
| | - Alfonso Fasano
- Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, UHN, Toronto, ON, Canada
- Division of Neurology, University of Toronto, Toronto, ON, Canada
- Krembil Brain Institute, Toronto, ON, Canada
- Center for Advancing Neurotechnological Innovation to Application (CRANIA), Toronto, ON, Canada
| | - David Bäckström
- Department of Clinical Science, Neurosciences, Umeå University, Umeå, Sweden.
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9
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Vetkas A, Boutet A, Sarica C, Germann J, Gwun D, Yamamoto K, Jung HH, Alkhotani A, Samuel N, Lang S, Conner CR, Elias GJB, Cheyuo C, Chow C, Santyr B, Iorio-Morin C, Yang AZ, Candeias da Silva C, Fasano A, Kalia SK, Lozano AM. Successful magnetic resonance-guided focused ultrasound treatment of tremor in patients with a skull density ratio of 0.4 or less. J Neurosurg 2024; 140:639-647. [PMID: 37657095 DOI: 10.3171/2023.6.jns23171] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 06/28/2023] [Indexed: 09/03/2023]
Abstract
OBJECTIVE The use of magnetic resonance-guided focused ultrasound (MRgFUS) for the treatment of tremor-related disorders and other novel indications has been limited by guidelines advocating treatment of patients with a skull density ratio (SDR) above 0.45 ± 0.05 despite reports of successful outcomes in patients with a low SDR (LSDR). The authors' goal was to retrospectively analyze the sonication strategies, adverse effects, and clinical and imaging outcomes in patients with SDR ≤ 0.4 treated for tremor using MRgFUS. METHODS Clinical outcomes and adverse effects were assessed at 3 and 12 months after MRgFUS. Outcomes and lesion location, volume, and shape characteristics (elongation and eccentricity) were compared between the SDR groups. RESULTS A total of 102 consecutive patients were included in the analysis, of whom 39 had SDRs ≤ 0.4. No patient was excluded from treatment because of an LSDR, with the lowest being 0.22. Lesioning temperatures (> 52°C) and therapeutic ablations were achieved in all patients. There were no significant differences in clinical outcome, adverse effects, lesion location, and volume between the high SDR group and the LSDR group. SDR was significantly associated with total energy (rho = -0.459, p < 0.001), heating efficiency (rho = 0.605, p < 0.001), and peak temperature (rho = 0.222, p = 0.025). CONCLUSIONS The authors' results show that treatment of tremor in patients with an LSDR using MRgFUS is technically possible, leading to a safe and lasting therapeutic effect. Limiting the number of sonications and adjusting the energy and duration to achieve the required temperature early during the treatment are suitable strategies in LSDR patients.
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Affiliation(s)
- Artur Vetkas
- 1Department of Surgery, Division of Neurosurgery, University Health Network and University of Toronto
| | - Alexandre Boutet
- 1Department of Surgery, Division of Neurosurgery, University Health Network and University of Toronto
- 2Joint Department of Medical Imaging, University of Toronto, Ontario, Canada
| | - Can Sarica
- 1Department of Surgery, Division of Neurosurgery, University Health Network and University of Toronto
| | - Jurgen Germann
- 1Department of Surgery, Division of Neurosurgery, University Health Network and University of Toronto
| | - Dave Gwun
- 1Department of Surgery, Division of Neurosurgery, University Health Network and University of Toronto
| | - Kazuaki Yamamoto
- 1Department of Surgery, Division of Neurosurgery, University Health Network and University of Toronto
| | - Hyun Ho Jung
- 3Center for Innovative Functional Neurosurgery, Brain Research Institute, Seoul
- 4Graduate School of Medical Science, Brain Korea 21 Project, Yonsei University College of Medicine, Seoul, South Korea
| | - Afnan Alkhotani
- 1Department of Surgery, Division of Neurosurgery, University Health Network and University of Toronto
| | - Nardin Samuel
- 1Department of Surgery, Division of Neurosurgery, University Health Network and University of Toronto
| | - Stefan Lang
- 1Department of Surgery, Division of Neurosurgery, University Health Network and University of Toronto
| | - Christopher R Conner
- 1Department of Surgery, Division of Neurosurgery, University Health Network and University of Toronto
| | - Gavin J B Elias
- 1Department of Surgery, Division of Neurosurgery, University Health Network and University of Toronto
| | - Cletus Cheyuo
- 1Department of Surgery, Division of Neurosurgery, University Health Network and University of Toronto
| | - Clement Chow
- 1Department of Surgery, Division of Neurosurgery, University Health Network and University of Toronto
| | - Brendan Santyr
- 1Department of Surgery, Division of Neurosurgery, University Health Network and University of Toronto
- 5Schulich School of Medicine and Dentistry, Western University, London, Ontario
| | | | - Andrew Z Yang
- 1Department of Surgery, Division of Neurosurgery, University Health Network and University of Toronto
| | | | - Alfonso Fasano
- 7Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, University Health Network, Toronto
- 8Department of Medicine, Division of Neurology, University of Toronto
- 9Krembil Research Institute, Toronto
- 10CRANIA, University Health Network and University of Toronto; and
- 11The KITE Research Institute, University Health Network, Toronto, Ontario, Canada
| | - Suneil K Kalia
- 1Department of Surgery, Division of Neurosurgery, University Health Network and University of Toronto
- 9Krembil Research Institute, Toronto
- 10CRANIA, University Health Network and University of Toronto; and
- 11The KITE Research Institute, University Health Network, Toronto, Ontario, Canada
| | - Andres M Lozano
- 1Department of Surgery, Division of Neurosurgery, University Health Network and University of Toronto
- 9Krembil Research Institute, Toronto
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10
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AlGethami HJ, Breitbart S, Warsi NM, Fasano A, Ibrahim GM, Gorodetsky C. Severe Pediatric Dystonia Responding to Deep Brain Stimulation in 22q11.2 Microduplication Syndrome: Rare Clinical Presentation. Mov Disord Clin Pract 2024; 11:309-311. [PMID: 38196101 PMCID: PMC10928346 DOI: 10.1002/mdc3.13955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 10/22/2023] [Accepted: 11/29/2023] [Indexed: 01/11/2024] Open
Affiliation(s)
- Hanin Jaber AlGethami
- Division of NeurologyThe Hospital for Sick ChildrenTorontoOntarioCanada
- Department of PediatricsUniversity of TorontoTorontoOntarioCanada
| | - Sara Breitbart
- Division of NeurosurgeryThe Hospital for Sick ChildrenTorontoOntarioCanada
| | - Nebras M. Warsi
- Division of NeurosurgeryThe Hospital for Sick ChildrenTorontoOntarioCanada
- Department of SurgeryUniversity of TorontoTorontoOntarioCanada
| | - Alfonso Fasano
- Division of NeurologyThe Hospital for Sick ChildrenTorontoOntarioCanada
- Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, UHNTorontoOntarioCanada
- Division of NeurologyUniversity of TorontoTorontoOntarioCanada
- Krembil Brain InstituteTorontoOntarioCanada
- CenteR for Advancing Neurotechnological Innovation to Application (CRANIA)TorontoOntarioCanada
| | - George M. Ibrahim
- Division of NeurosurgeryThe Hospital for Sick ChildrenTorontoOntarioCanada
- Department of SurgeryUniversity of TorontoTorontoOntarioCanada
- Institute of Biomedical Engineering, University of TorontoTorontoOntarioCanada
| | - Carolina Gorodetsky
- Division of NeurologyThe Hospital for Sick ChildrenTorontoOntarioCanada
- Department of PediatricsUniversity of TorontoTorontoOntarioCanada
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11
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Johnson KA, Dosenbach NUF, Gordon EM, Welle CG, Wilkins KB, Bronte-Stewart HM, Voon V, Morishita T, Sakai Y, Merner AR, Lázaro-Muñoz G, Williamson T, Horn A, Gilron R, O'Keeffe J, Gittis AH, Neumann WJ, Little S, Provenza NR, Sheth SA, Fasano A, Holt-Becker AB, Raike RS, Moore L, Pathak YJ, Greene D, Marceglia S, Krinke L, Tan H, Bergman H, Pötter-Nerger M, Sun B, Cabrera LY, McIntyre CC, Harel N, Mayberg HS, Krystal AD, Pouratian N, Starr PA, Foote KD, Okun MS, Wong JK. Proceedings of the 11th Annual Deep Brain Stimulation Think Tank: pushing the forefront of neuromodulation with functional network mapping, biomarkers for adaptive DBS, bioethical dilemmas, AI-guided neuromodulation, and translational advancements. Front Hum Neurosci 2024; 18:1320806. [PMID: 38450221 PMCID: PMC10915873 DOI: 10.3389/fnhum.2024.1320806] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 02/05/2024] [Indexed: 03/08/2024] Open
Abstract
The Deep Brain Stimulation (DBS) Think Tank XI was held on August 9-11, 2023 in Gainesville, Florida with the theme of "Pushing the Forefront of Neuromodulation". The keynote speaker was Dr. Nico Dosenbach from Washington University in St. Louis, Missouri. He presented his research recently published in Nature inn a collaboration with Dr. Evan Gordon to identify and characterize the somato-cognitive action network (SCAN), which has redefined the motor homunculus and has led to new hypotheses about the integrative networks underpinning therapeutic DBS. The DBS Think Tank was founded in 2012 and provides an open platform where clinicians, engineers, and researchers (from industry and academia) can freely discuss current and emerging DBS technologies, as well as logistical and ethical issues facing the field. The group estimated that globally more than 263,000 DBS devices have been implanted for neurological and neuropsychiatric disorders. This year's meeting was focused on advances in the following areas: cutting-edge translational neuromodulation, cutting-edge physiology, advances in neuromodulation from Europe and Asia, neuroethical dilemmas, artificial intelligence and computational modeling, time scales in DBS for mood disorders, and advances in future neuromodulation devices.
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Affiliation(s)
- Kara A. Johnson
- Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, United States
- Department of Neurology, University of Florida, Gainesville, FL, United States
| | - Nico U. F. Dosenbach
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, United States
| | - Evan M. Gordon
- Department of Radiology, Washington University School of Medicine, St. Louis, MO, United States
| | - Cristin G. Welle
- Department of Physiology and Biophysics, University of Colorado School of Medicine, Aurora, CO, United States
- Department of Neurosurgery, University of Colorado School of Medicine, Aurora, CO, United States
| | - Kevin B. Wilkins
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA, United States
| | - Helen M. Bronte-Stewart
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA, United States
| | - Valerie Voon
- Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
| | - Takashi Morishita
- Department of Neurosurgery, Fukuoka University Faculty of Medicine, Fukuoka, Japan
| | - Yuki Sakai
- ATR Brain Information Communication Research Laboratory Group, Kyoto, Japan
- Department of Psychiatry, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Amanda R. Merner
- Center for Bioethics, Harvard Medical School, Boston, MA, United States
| | - Gabriel Lázaro-Muñoz
- Center for Bioethics, Harvard Medical School, Boston, MA, United States
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States
| | - Theresa Williamson
- Department of Neurosurgery, Massachusetts General Hospital, Boston, MA, United States
| | - Andreas Horn
- Department of Neurology, Center for Brain Circuit Therapeutics, Harvard Medical School, Brigham & Women's Hospital, Boston, MA, United States
- MGH Neurosurgery and Center for Neurotechnology and Neurorecovery (CNTR) at MGH Neurology Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
- Movement Disorder and Neuromodulation Unit, Department of Neurology, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt- Universität zu Berlin, Berlin, Germany
| | | | | | - Aryn H. Gittis
- Biological Sciences and Center for Neural Basis of Cognition, Carnegie Mellon University, Pittsburgh, PA, United States
| | - Wolf-Julian Neumann
- Movement Disorder and Neuromodulation Unit, Department of Neurology, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt- Universität zu Berlin, Berlin, Germany
| | - Simon Little
- Department of Neurological Surgery, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, United States
| | - Nicole R. Provenza
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, United States
| | - Sameer A. Sheth
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, United States
| | - Alfonso Fasano
- Edmond J. Safra Program in Parkinson's Disease, Division of Neurology, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, University Health Network (UHN), University of Toronto, Toronto, ON, Canada
- Krembil Brain Institute, Toronto, ON, Canada
| | - Abbey B. Holt-Becker
- Restorative Therapies Group Implantables, Research, and Core Technology, Medtronic Inc., Minneapolis, MN, United States
| | - Robert S. Raike
- Restorative Therapies Group Implantables, Research, and Core Technology, Medtronic Inc., Minneapolis, MN, United States
| | - Lisa Moore
- Boston Scientific Neuromodulation Corporation, Valencia, CA, United States
| | | | - David Greene
- NeuroPace, Inc., Mountain View, CA, United States
| | - Sara Marceglia
- Department of Engineering and Architecture, University of Trieste, Trieste, Italy
| | - Lothar Krinke
- Newronika SPA, Milan, Italy
- Department of Neuroscience, West Virginia University, Morgantown, WV, United States
| | - Huiling Tan
- Medical Research Council Brain Network Dynamics Unit, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
| | - Hagai Bergman
- Edmond and Lily Safar Center (ELSC) for Brain Research and Department of Medical Neurobiology (Physiology), Institute of Medical Research Israel-Canada, Hebrew University of Jerusalem, Jerusalem, Israel
- Department of Neurosurgery, Hadassah Medical Center, Jerusalem, Israel
| | - Monika Pötter-Nerger
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Bomin Sun
- Department of Neurosurgery, Center for Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Laura Y. Cabrera
- Neuroethics, Department of Engineering Science and Mechanics, Philosophy, and Bioethics, and the Rock Ethics Institute, Pennsylvania State University, State College, PA, United States
| | - Cameron C. McIntyre
- Department of Biomedical Engineering, Duke University, Durham, NC, United States
- Department of Neurosurgery, Duke University, Durham, NC, United States
| | - Noam Harel
- Department of Radiology, Center for Magnetic Resonance Research, University of Minnesota, Minneapolis, MN, United States
| | - Helen S. Mayberg
- Department of Neurology, Neurosurgery, Psychiatry, and Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Andrew D. Krystal
- Departments of Psychiatry and Behavioral Science and Neurology, University of California, San Francisco, San Francisco, CA, United States
| | - Nader Pouratian
- Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Philip A. Starr
- Department of Neurological Surgery, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, United States
| | - Kelly D. Foote
- Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, United States
- Department of Neurosurgery, University of Florida, Gainesville, FL, United States
| | - Michael S. Okun
- Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, United States
- Department of Neurology, University of Florida, Gainesville, FL, United States
| | - Joshua K. Wong
- Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, United States
- Department of Neurology, University of Florida, Gainesville, FL, United States
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12
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Fung WKW, Justich MB, Hamani M, Munhoz RP, Kalia SK, Lozano AM, Fasano A. Remote Deep Brain Stimulation Programming in Canada. Mov Disord Clin Pract 2024. [PMID: 38369588 DOI: 10.1002/mdc3.13999] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 12/21/2023] [Accepted: 01/18/2024] [Indexed: 02/20/2024] Open
Affiliation(s)
- Wilson K W Fung
- Edmond J. Safra Program in Parkinson's Disease and Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, UHN, Toronto, Ontario, Canada
| | - Maria Belen Justich
- Edmond J. Safra Program in Parkinson's Disease and Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, UHN, Toronto, Ontario, Canada
| | - Michelle Hamani
- Edmond J. Safra Program in Parkinson's Disease and Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, UHN, Toronto, Ontario, Canada
| | - Renato P Munhoz
- Edmond J. Safra Program in Parkinson's Disease and Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, UHN, Toronto, Ontario, Canada
- Division of Neurology, University of Toronto, Toronto, Ontario, Canada
| | - Suneil K Kalia
- Division of Neurosurgery, University of Toronto, Toronto, Ontario, Canada
- Krembil Research Institute, Toronto, Ontario, Canada
| | - Andres M Lozano
- Division of Neurosurgery, University of Toronto, Toronto, Ontario, Canada
- Krembil Research Institute, Toronto, Ontario, Canada
| | - Alfonso Fasano
- Edmond J. Safra Program in Parkinson's Disease and Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, UHN, Toronto, Ontario, Canada
- Division of Neurology, University of Toronto, Toronto, Ontario, Canada
- Krembil Research Institute, Toronto, Ontario, Canada
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13
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Amini E, Rohani M, Fasano A, Azad Z, Miri S, Habibi SAH, Emamikhah M, Mirshahi R, Joghataei MT, Gholibeigian Z, Ghasemi Falavarjani K. Neurodegeneration with Brain Iron Accumulation Disorders and Retinal Neurovascular Structure. Mov Disord 2024; 39:411-423. [PMID: 37947042 DOI: 10.1002/mds.29644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 10/07/2023] [Accepted: 10/10/2023] [Indexed: 11/12/2023] Open
Abstract
BACKGROUND The unique neurovascular structure of the retina has provided an opportunity to observe brain pathology in many neurological disorders. However, such studies on neurodegeneration with brain iron accumulation (NBIA) disorders are lacking. OBJECTIVES To investigate NBIA's neurological and ophthalmological manifestations. METHODS This cross-sectional study was conducted on genetically confirmed NBIA patients and an age-gender-matched control group. The thickness of retinal layers, central choroidal thickness (CCT), and capillary plexus densities were measured by spectral domain-optical coherence tomography (SD-OCT) and OCT angiography, respectively. The patients also underwent funduscopy, electroretinography (ERG), visual evoked potential (VEP), and neurological examination (Pantothenate-Kinase Associated Neurodegeneration-Disease Rating Scale [PKAN-DRS]). The generalized estimating equation model was used to consider inter-eye correlations. RESULTS Seventy-four patients' and 80 controls' eyes were analyzed. Patients had significantly decreased visual acuity, reduced inner or outer sectors of almost all evaluated layers, increased CCT, and decreased vessel densities, with abnormal VEP and ERG in 32.4% and 45.9%, respectively. There were correlations between visual acuity and temporal peripapillary nerve fiber layer (positive) and between PKAN-DRS score and disease duration (negative), and scotopic b-wave amplitudes (positive). When considering only the PKAN eyes, ONL was among the significantly decreased retinal layers, with no differences in retinal vessel densities. Evidence of pachychoroid was only seen in patients with Kufor Rakeb syndrome. CONCLUSION Observing pathologic structural and functional neurovascular changes in NBIA patients may provide an opportunity to elucidate the underlying mechanisms and differential retinal biomarkers in NBIA subtypes in further investigations. © 2023 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Elahe Amini
- ENT and Head and Neck Research Center, The Five Senses Health Institute, Iran University of Medical Sciences, Tehran, Iran
- Department of Neurology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammad Rohani
- Department of Neurology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
- Skull Base Research Center, The Five Senses Health Institute, Iran University of Medical Sciences, Tehran, Iran
| | - Alfonso Fasano
- University Health Network University of Toronto, Toronto, Ontario, Canada
| | - Zahra Azad
- Skull Base Research Center, The Five Senses Health Institute, Iran University of Medical Sciences, Tehran, Iran
| | - Shahnaz Miri
- Vision Neurology Center, San Francisco, California, USA
| | - Seyed Amir Hassan Habibi
- Department of Neurology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
- Skull Base Research Center, The Five Senses Health Institute, Iran University of Medical Sciences, Tehran, Iran
| | - Maziar Emamikhah
- Department of Neurology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
- Skull Base Research Center, The Five Senses Health Institute, Iran University of Medical Sciences, Tehran, Iran
| | - Reza Mirshahi
- Eye Research Center, The Five Senses Health Institute, Iran University of Medical Sciences, Tehran, Iran
| | | | - Zeinab Gholibeigian
- Skull Base Research Center, The Five Senses Health Institute, Iran University of Medical Sciences, Tehran, Iran
| | - Khalil Ghasemi Falavarjani
- Eye Research Center, The Five Senses Health Institute, Iran University of Medical Sciences, Tehran, Iran
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14
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Montiel M, Fasano A. Dystonia and parkinsonism: Not an easy combo. Parkinsonism Relat Disord 2024:106009. [PMID: 38233325 DOI: 10.1016/j.parkreldis.2024.106009] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 01/11/2024] [Indexed: 01/19/2024]
Affiliation(s)
- Marcela Montiel
- Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada; Division of Neurology, University of Toronto, Toronto, Ontario, Canada
| | - Alfonso Fasano
- Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada; Division of Neurology, University of Toronto, Toronto, Ontario, Canada; Krembil Brain Institute, Neuroscience, Toronto, Ontario, Canada.
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15
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Santyr B, Loh A, Vetkas A, Gwun D, Fung WK, Qazi S, Germann J, Boutet A, Sarica C, Yang A, Elias G, Kalia SK, Fasano A, Lozano AM. Uncovering neuroanatomical correlates of impaired coordinated movement after pallidal deep brain stimulation. J Neurol Neurosurg Psychiatry 2024; 95:167-170. [PMID: 37438098 DOI: 10.1136/jnnp-2022-330734] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 05/30/2023] [Indexed: 07/14/2023]
Abstract
BACKGROUND The loss of the ability to swim following deep brain stimulation (DBS), although rare, poses a worrisome risk of drowning. It is unclear what anatomic substrate and neural circuitry underlie this phenomenon. We report a case of cervical dystonia with lost ability to swim and dance during active stimulation of globus pallidus internus. We investigated the anatomical underpinning of this phenomenon using unique functional and structural imaging analysis. METHODS Tesla (3T) functional MRI (fMRI) of the patient was used during active DBS and compared with a cohort of four matched patients without this side effect. Structural connectivity mapping was used to identify brain network engagement by stimulation. RESULTS fMRI during stimulation revealed significant (Pbonferroni<0.0001) stimulation-evoked responses (DBS ON CONCLUSIONS These stimulation-induced impairments are likely a manifestation of a broader deficit in interlimb coordination mediated by stimulation effects on the SMA. This neuroanatomical underpinning can help inform future patient-specific stimulation and targeting.
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Affiliation(s)
- Brendan Santyr
- Division of Neurosurgery, University of Toronto, Toronto, Ontario, Canada
| | - Aaron Loh
- Division of Neurosurgery, University of Toronto, Toronto, Ontario, Canada
| | - Artur Vetkas
- Division of Neurosurgery, University of Toronto, Toronto, Ontario, Canada
| | - Dave Gwun
- Division of Neurosurgery, University of Toronto, Toronto, Ontario, Canada
| | - Wilson Kw Fung
- Edmond J. Safra Program in Parkinson's Disease and Morton and Gloria Shulman Movement Disorders Centre, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Shakeel Qazi
- Division of Neurosurgery, University of Toronto, Toronto, Ontario, Canada
| | - Jurgen Germann
- Division of Neurosurgery, University of Toronto, Toronto, Ontario, Canada
| | - Alexandre Boutet
- Division of Neurosurgery, University of Toronto, Toronto, Ontario, Canada
- Joint Department of Medical Imaging, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Can Sarica
- Division of Neurosurgery, University of Toronto, Toronto, Ontario, Canada
| | - Andrew Yang
- Division of Neurosurgery, University of Toronto, Toronto, Ontario, Canada
| | - Gavin Elias
- Division of Neurosurgery, University of Toronto, Toronto, Ontario, Canada
| | - Suneil K Kalia
- Division of Neurosurgery, University of Toronto, Toronto, Ontario, Canada
- Krembil Brain Institute, University Health Network, Toronto, Ontario, Canada
- Center for Advancing Neurotechnological Innovation to Application (CRANIA), University Health Network, Toronto, Ontario, Canada
| | - Alfonso Fasano
- Edmond J. Safra Program in Parkinson's Disease and Morton and Gloria Shulman Movement Disorders Centre, Toronto Western Hospital, Toronto, Ontario, Canada
- Krembil Brain Institute, University Health Network, Toronto, Ontario, Canada
- Center for Advancing Neurotechnological Innovation to Application (CRANIA), University Health Network, Toronto, Ontario, Canada
- Division of Neurology, University of Toronto, Toronto, Ontario, Canada
| | - Andres M Lozano
- Division of Neurosurgery, University of Toronto, Toronto, Ontario, Canada
- Krembil Brain Institute, University Health Network, Toronto, Ontario, Canada
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16
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Germann J, Santyr B, Boutet A, Sarica C, Chow CT, Elias GJB, Vetkas A, Yang A, Hodaie M, Fasano A, Kalia SK, Schwartz ML, Lozano AM. Comparative neural correlates of DBS and MRgFUS lesioning for tremor control in essential tremor. J Neurol Neurosurg Psychiatry 2024; 95:180-183. [PMID: 37722831 PMCID: PMC10866130 DOI: 10.1136/jnnp-2022-330795] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 08/23/2023] [Indexed: 09/20/2023]
Abstract
BACKGROUND Given high rates of early complications and non-reversibility, refined targeting is necessitated for magnetic resonance-guided focused ultrasound (MRgFUS) thalamotomy for essential tremor (ET). Selection of lesion location can be informed by considering optimal stimulation area from deep brain stimulation (DBS). METHODS 118 patients with ET who received DBS (39) or MRgFUS (79) of the ventral intermediate nucleus (VIM) underwent stimulation/lesion mapping, probabilistic mapping of clinical efficacy and normative structural connectivity analysis. The efficacy maps were compared, which depict the relationship between stimulation/lesion location and clinical outcome. RESULTS Efficacy maps overlap around the VIM ventral border and encompass the dentato-rubro-thalamic tract. While the MRgFUS map extends inferiorly into the posterior subthalamic area, the DBS map spreads inside the VIM antero-superiorly. CONCLUSION Comparing the efficacy maps of DBS and MRgFUS suggests a potential alternative location for lesioning, more antero-superiorly. This may reduce complications, without sacrificing efficacy, and individualise targeting. TRIAL REGISTRATION NUMBER NCT02252380.
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Affiliation(s)
- Jurgen Germann
- Division of Neurosurgery, University of Toronto, Toronto, Ontario, Canada
- Krembil Brain Institute, Toronto, Ontario, Canada
- Center for Advancing Neurotechnological Innovation to Application (CRANIA), Toronto, Ontario, Canada
| | - Brendan Santyr
- Division of Neurosurgery, University of Toronto, Toronto, Ontario, Canada
| | - Alexandre Boutet
- Joint Department of Medical Imaging, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Can Sarica
- Division of Neurosurgery, University of Toronto, Toronto, Ontario, Canada
| | - Clement T Chow
- Division of Neurosurgery, University of Toronto, Toronto, Ontario, Canada
| | - Gavin J B Elias
- Division of Neurosurgery, University of Toronto, Toronto, Ontario, Canada
| | - Artur Vetkas
- Division of Neurosurgery, University of Toronto, Toronto, Ontario, Canada
| | - Andrew Yang
- Division of Neurosurgery, University of Toronto, Toronto, Ontario, Canada
| | - Mojgan Hodaie
- Division of Neurosurgery, University of Toronto, Toronto, Ontario, Canada
- Krembil Brain Institute, Toronto, Ontario, Canada
| | - Alfonso Fasano
- Krembil Brain Institute, Toronto, Ontario, Canada
- Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto WesternHospital, Toronto, Ontario, Canada
- Division of Neurology, University of Toronto, Toronto, Ontario, Canada
| | - Suneil K Kalia
- Division of Neurosurgery, University of Toronto, Toronto, Ontario, Canada
- Krembil Brain Institute, Toronto, Ontario, Canada
| | - Michael L Schwartz
- Division of Neurosurgery, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Andres M Lozano
- Division of Neurosurgery, University of Toronto, Toronto, Ontario, Canada
- Krembil Brain Institute, Toronto, Ontario, Canada
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Fomenko A, Fasano A, Kalia SK. Another Step Forward for Freezing of Gait in Parkinson's Disease. J Parkinsons Dis 2024; 14:353-355. [PMID: 38251064 DOI: 10.3233/jpd-230412] [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] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/23/2024]
Abstract
The study "A spinal cord neuroprosthesis for locomotor deficits due to Parkinson's disease" by Milekovic et al. introduces a novel neuroprosthesis for treating locomotor deficits in late-stage Parkinson's disease (PD). This approach employs an epidural spinal array targeting dorsal roots and electromyography to create a spatiotemporal map of muscle activation, aiming to restore natural gait patterns. Significant improvements in gait freezing and balance were observed in both non-human primate models and a human patient, resulting in improved mobility and quality of life. This innovative method, integrating real-time feedback and non-invasive motor intention decoding, marks a significant advancement in PD treatment.
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Affiliation(s)
- Anton Fomenko
- Department of Surgery, Division of Neurosurgery, University of Toronto, Toronto, ON, Canada
- Krembil Research Institute, University Health Network, Toronto, ON, Canada
- Center for Advancing Neurotechnological Innovation to Application (CRANIA), University of Toronto, Toronto, ON, Canada
| | - Alfonso Fasano
- Krembil Research Institute, University Health Network, Toronto, ON, Canada
- Center for Advancing Neurotechnological Innovation to Application (CRANIA), University of Toronto, Toronto, ON, Canada
- KITE, University Health Network, Toronto, ON, Canada
- Division of Neurology, Edmond J. Safra Program in Parkinson's Disease Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, University of Toronto, Toronto, ON, Canada
| | - Suneil K Kalia
- Department of Surgery, Division of Neurosurgery, University of Toronto, Toronto, ON, Canada
- Krembil Research Institute, University Health Network, Toronto, ON, Canada
- Center for Advancing Neurotechnological Innovation to Application (CRANIA), University of Toronto, Toronto, ON, Canada
- KITE, University Health Network, Toronto, ON, Canada
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Boogers A, Fasano A. A Transatlantic Viewpoint on the Role of Pallidal Stimulation for Parkinson's Disease. Mov Disord 2024; 39:36-39. [PMID: 37965914 DOI: 10.1002/mds.29656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 10/18/2023] [Accepted: 10/24/2023] [Indexed: 11/16/2023] Open
Affiliation(s)
- Alexandra Boogers
- Edmond J. Safra Program in Parkinson's Disease and Morton and Gloria Shulman Movement Disorders Centre, Toronto Western Hospital, UHN, and Division of Neurology, University of Toronto, Toronto, Canada
| | - Alfonso Fasano
- Edmond J. Safra Program in Parkinson's Disease and Morton and Gloria Shulman Movement Disorders Centre, Toronto Western Hospital, UHN, and Division of Neurology, University of Toronto, Toronto, Canada
- Krembil Brain Institute, Toronto, Canada
- Center for Advancing Neurotechnological Innovation to Application (CRANIA), Toronto, Canada
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Sabo A, Iaboni A, Taati B, Fasano A, Gorodetsky C. Evaluating the ability of a predictive vision-based machine learning model to measure changes in gait in response to medication and DBS within individuals with Parkinson's disease. Biomed Eng Online 2023; 22:120. [PMID: 38082277 PMCID: PMC10714555 DOI: 10.1186/s12938-023-01175-y] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 11/19/2023] [Indexed: 12/18/2023] Open
Abstract
INTRODUCTION Gait impairments in Parkinson's disease (PD) are treated with dopaminergic medication or deep-brain stimulation (DBS), although the magnitude of the response is variable between individuals. Computer vision-based approaches have previously been evaluated for measuring the severity of parkinsonian gait in videos, but have not been evaluated for their ability to identify changes within individuals in response to treatment. This pilot study examines whether a vision-based model, trained on videos of parkinsonism, is able to detect improvement in parkinsonian gait in people with PD in response to medication and DBS use. METHODS A spatial-temporal graph convolutional model was trained to predict MDS-UPDRS-gait scores in 362 videos from 14 older adults with drug-induced parkinsonism. This model was then used to predict MDS-UPDRS-gait scores on a different dataset of 42 paired videos from 13 individuals with PD, recorded while ON and OFF medication and DBS treatment during the same clinical visit. Statistical methods were used to assess whether the model was responsive to changes in gait in the ON and OFF states. RESULTS The MDS-UPDRS-gait scores predicted by the model were lower on average (representing improved gait; p = 0.017, Cohen's d = 0.495) during the ON medication and DBS treatment conditions. The magnitude of the differences between ON and OFF state was significantly correlated between model predictions and clinician annotations (p = 0.004). The predicted scores were significantly correlated with the clinician scores (Kendall's tau-b = 0.301, p = 0.010), but were distributed in a smaller range as compared to the clinician scores. CONCLUSION A vision-based model trained on parkinsonian gait did not accurately predict MDS-UPDRS-gait scores in a different PD cohort, but detected weak, but statistically significant proportional changes in response to medication and DBS use. Large, clinically validated datasets of videos captured in many different settings and treatment conditions are required to develop accurate vision-based models of parkinsonian gait.
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Affiliation(s)
- Andrea Sabo
- KITE, Toronto Rehabilitation Institute, University Health Network, 550 University Avenue, Toronto, ON, M5G 2A2, Canada
| | - Andrea Iaboni
- KITE, Toronto Rehabilitation Institute, University Health Network, 550 University Avenue, Toronto, ON, M5G 2A2, Canada
- Department of Psychiatry, University of Toronto, 250 College Street, 8th Floor, Toronto, ON, M5T 1R8, Canada
- Centre for Mental Health, University Health Network, 33 Russell Street, Toronto, ON, M5S 2S1, Canada
| | - Babak Taati
- KITE, Toronto Rehabilitation Institute, University Health Network, 550 University Avenue, Toronto, ON, M5G 2A2, Canada
- Department of Computer Science, University of Toronto, 10 King's College Road, Room 3302, Toronto, ON, M5S 3G4, Canada
- Institute of Biomedical Engineering, University of Toronto, 164 College Street. Room 407, Toronto, ON, M2S 3G9, Canada
- Vector Institute, 661 University Ave Suite 710, Toronto, ON, M5G 1M1, Canada
| | - Alfonso Fasano
- KITE, Toronto Rehabilitation Institute, University Health Network, 550 University Avenue, Toronto, ON, M5G 2A2, Canada
- Division of Neurology, The Hospital for Sick Children, University of Toronto, 555 University Avenue, Toronto, ON, M5G 1X8, Canada
- Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, UHN, Toronto, ON, Canada
- Krembil Brain Institute, Toronto, ON, Canada
- CenteR for Advancing Neurotechnological Innovation to Application (CRANIA), Toronto, ON, Canada
| | - Carolina Gorodetsky
- Division of Neurology, The Hospital for Sick Children, University of Toronto, 555 University Avenue, Toronto, ON, M5G 1X8, Canada.
- Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, UHN, Toronto, ON, Canada.
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20
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Lang S, Dimond D, Isaacs AM, Dronyk J, Vetkas A, Conner CR, Germann J, Fasano A, Kalia S, Lozano A, Hamilton MG. Use of cortical volume to predict response to temporary CSF drainage in patients with idiopathic normal pressure hydrocephalus. J Neurosurg 2023; 139:1776-1783. [PMID: 37148227 DOI: 10.3171/2023.3.jns222787] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 03/23/2023] [Indexed: 05/08/2023]
Abstract
OBJECTIVE Temporary drainage of CSF with lumbar puncture or lumbar drainage has a high predictive value for identifying patients with suspected idiopathic normal pressure hydrocephalus (iNPH) who may benefit from ventriculoperitoneal shunt insertion. However, it is unclear what differentiates responders from nonresponders. The authors hypothesized that nonresponders to temporary CSF drainage would have patterns of reduced regional gray matter volume (GMV) as compared with those of responders. The objective of the current investigation was to compare regional GMV between temporary CSF drainage responders and nonresponders. Machine learning using extracted GMV was then used to predict outcomes. METHODS This retrospective cohort study included 132 patients with iNPH who underwent temporary CSF drainage and structural MRI. Demographic and clinical variables were examined between groups. Voxel-based morphometry was used to calculate GMV across the brain. Group differences in regional GMV were assessed and correlated with change in results on the Montreal Cognitive Assessment (MoCA) and gait velocity. A support vector machine (SVM) model that used extracted GMV values and was validated with leave-one-out cross-validation was used to predict clinical outcome. RESULTS There were 87 responders and 45 nonresponders. There were no group differences in terms of age, sex, baseline MoCA score, Evans index, presence of disproportionately enlarged subarachnoid space hydrocephalus, baseline total CSF volume, or baseline white matter T2-weighted hyperintensity volume (p > 0.05). Nonresponders demonstrated decreased GMV in the right supplementary motor area (SMA) and right posterior parietal cortex as compared with responders (p < 0.001, p < 0.05 with false discovery rate cluster correction). GMV in the posterior parietal cortex was associated with change in MoCA (r2 = 0.075, p < 0.05) and gait velocity (r2 = 0.076, p < 0.05). Response status was classified by the SVM with 75.8% accuracy. CONCLUSIONS Decreased GMV in the SMA and posterior parietal cortex may help identify patients with iNPH who are unlikely to benefit from temporary CSF drainage. These patients may have limited capacity for recovery due to atrophy in these regions that are known to be important for motor and cognitive integration. This study represents an important step toward improving patient selection and predicting clinical outcomes in the treatment of iNPH.
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Affiliation(s)
- Stefan Lang
- 1Department of Neurosurgery, University of Toronto, Ontario, Canada
| | - Dennis Dimond
- 3Department of Clinical Neurosciences, Division of Neurosurgery, University of Calgary, Cumming School of Medicine, Calgary, Alberta, Canada
| | - Albert M Isaacs
- 2Department of Neurosurgery, Vanderbilt University, Nashville, Tennessee
| | - Jarred Dronyk
- 3Department of Clinical Neurosciences, Division of Neurosurgery, University of Calgary, Cumming School of Medicine, Calgary, Alberta, Canada
| | - Artur Vetkas
- 1Department of Neurosurgery, University of Toronto, Ontario, Canada
| | | | - Jurgen Germann
- 1Department of Neurosurgery, University of Toronto, Ontario, Canada
| | - Alfonso Fasano
- 4Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, UHN, Toronto, Ontario, Canada
- 6Krembil Brain Institute, Toronto, Ontario, Canada
| | - Suneil Kalia
- 1Department of Neurosurgery, University of Toronto, Ontario, Canada
- 6Krembil Brain Institute, Toronto, Ontario, Canada
| | - Andres Lozano
- 1Department of Neurosurgery, University of Toronto, Ontario, Canada
- 6Krembil Brain Institute, Toronto, Ontario, Canada
| | - Mark G Hamilton
- 3Department of Clinical Neurosciences, Division of Neurosurgery, University of Calgary, Cumming School of Medicine, Calgary, Alberta, Canada
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21
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Rong M, Benke T, Zulfiqar Ali Q, Aledo-Serrano Á, Bayat A, Rossi A, Devinsky O, Qaiser F, Ali AS, Fasano A, Bassett AS, Andrade DM. Adult Phenotype of SYNGAP1-DEE. Neurol Genet 2023; 9:e200105. [PMID: 38045990 PMCID: PMC10692795 DOI: 10.1212/nxg.0000000000200105] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 09/20/2023] [Indexed: 12/05/2023]
Abstract
Background and Objectives SYNGAP1 variants are associated with rare developmental and epileptic encephalopathies (DEEs). Although SYNGAP1-related childhood phenotypes are well characterized, the adult phenotype remains ill-defined. We sought to investigate phenotypes and outcomes in adults with SYNGAP1 variants and epilepsy. Methods Patients 18 years or older with DEE carrying likely pathogenic and pathogenic (LP/P) SYNGAP1 variants were recruited through physicians' practices and patient organization groups. We used standardized questionnaires to evaluate current seizures, medication use, sleep, gastrointestinal symptoms, pain response, gait, social communication disorder and adaptive skills of patients. We also assessed caregiver burden. Results Fourteen unrelated adult patients (median: 21 years, range: 18-65 years) with SYNGAP1-DEE were identified, 11 with novel and 3 with known LP/P SYNGAP1 de novo variants. One patient with a partial exon 3 deletion had greater daily living skills and social skills than others with single-nucleotide variants. Ten of 14 (71%) patients had drug-resistant seizures, treated with a median of 2 antiseizure medications. All patients (100%) had abnormal pain processing. Sleep disturbances, social communication disorders, and aggressive/self-injurious behaviors were each reported in 86% of patients. Only half of adults could walk with minimal or no assistance. Toileting was normal in 29%, and 71% had constipation. No adult patients could read or understand verbal material at a sixth-grade level or higher. Aggressive/self-injurious behaviors were leading cause of caregiver burden. The oldest patient was aged 65 years; although nonambulant, she had walked independently when younger. Discussion Seventy-one percent of patients with SYNGAP1-DEEs continue to have seizures when adults. Nonseizure comorbidities, especially aggression and self-injurious behaviors, are major management challenges in adults with SYNGAP1-DEE. Only 50% of adults can ambulate with minimal or no assistance. Almost all adult patients depend on caregivers for many activities of daily living. Prompt diagnostic genetic testing of adults with DEE can inform clinical care and guide outcomes of precision therapies.
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Affiliation(s)
- Marlene Rong
- From the Institute of Medical Science (M.R.), University of Toronto; Adult Genetic Epilepsy (AGE) Program (M.R., Q.Z.A., F.Q., A.S.A., D.M.A.), Krembil Neurosciences Institute, Toronto Western Hospital, University Health Network, Ontario, Canada; Department of Pediatrics, Neurology, Pharmacology and Otolaryngology (T.B.), University of Colorado School of Medicine and Children's Hospital Colorado, Aurora; Epilepsy and Neurogenetics Program (A.A.-S.), Neurology Department, Ruber Internacional Hospital, and Initiative for Neuroscience (INCE) Foundation, Madrid, Spain; Department of Drug Design and Pharmacology (A. Bayat), University of Copenhagen; Department for Genetics and Personalized Medicine (A. Bayat), Danish Epilepsy Centre, Dianalund; Institute for Regional Health Services (A. Bayat), University of Southern Denmark, Odense; Department of Epilepsy Genetics and Personalized Medicine (A.R.), Danish Epilepsy Centre, Dianalund, Denmark; Pediatric Clinic (A.R.), IRCCS San Matteo Hospital Foundation, University of Pavia, Italy; NYU Langone Epilepsy Center (O.D.), NY; Edmond J. Safra Program in Parkinson's Disease (A.F.), Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital; Division of Neurology (A.F.), University of Toronto; Krembil Brain Institute (A.F.); Clinical Genetics Research Program (A.S.B.), Centre for Addiction and Mental Health; The Dalglish Family 22q Clinic (A.S.B.), Toronto General Hospital, University Health Network; Department of Psychiatry (A.S.B.), University of Toronto; Toronto Congenital Cardiac Centre for Adults (A.S.B.), Division of Cardiology, Department of Medicine, and Department of Psychiatry, University Health Network; Toronto General Hospital Research Institute and Campbell Family Mental Health Research Institute (A.S.B.); Division of Neurology (D.M.A.), Department of Medicine, University of Toronto, Ontario, Canada
| | - Tim Benke
- From the Institute of Medical Science (M.R.), University of Toronto; Adult Genetic Epilepsy (AGE) Program (M.R., Q.Z.A., F.Q., A.S.A., D.M.A.), Krembil Neurosciences Institute, Toronto Western Hospital, University Health Network, Ontario, Canada; Department of Pediatrics, Neurology, Pharmacology and Otolaryngology (T.B.), University of Colorado School of Medicine and Children's Hospital Colorado, Aurora; Epilepsy and Neurogenetics Program (A.A.-S.), Neurology Department, Ruber Internacional Hospital, and Initiative for Neuroscience (INCE) Foundation, Madrid, Spain; Department of Drug Design and Pharmacology (A. Bayat), University of Copenhagen; Department for Genetics and Personalized Medicine (A. Bayat), Danish Epilepsy Centre, Dianalund; Institute for Regional Health Services (A. Bayat), University of Southern Denmark, Odense; Department of Epilepsy Genetics and Personalized Medicine (A.R.), Danish Epilepsy Centre, Dianalund, Denmark; Pediatric Clinic (A.R.), IRCCS San Matteo Hospital Foundation, University of Pavia, Italy; NYU Langone Epilepsy Center (O.D.), NY; Edmond J. Safra Program in Parkinson's Disease (A.F.), Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital; Division of Neurology (A.F.), University of Toronto; Krembil Brain Institute (A.F.); Clinical Genetics Research Program (A.S.B.), Centre for Addiction and Mental Health; The Dalglish Family 22q Clinic (A.S.B.), Toronto General Hospital, University Health Network; Department of Psychiatry (A.S.B.), University of Toronto; Toronto Congenital Cardiac Centre for Adults (A.S.B.), Division of Cardiology, Department of Medicine, and Department of Psychiatry, University Health Network; Toronto General Hospital Research Institute and Campbell Family Mental Health Research Institute (A.S.B.); Division of Neurology (D.M.A.), Department of Medicine, University of Toronto, Ontario, Canada
| | - Quratulain Zulfiqar Ali
- From the Institute of Medical Science (M.R.), University of Toronto; Adult Genetic Epilepsy (AGE) Program (M.R., Q.Z.A., F.Q., A.S.A., D.M.A.), Krembil Neurosciences Institute, Toronto Western Hospital, University Health Network, Ontario, Canada; Department of Pediatrics, Neurology, Pharmacology and Otolaryngology (T.B.), University of Colorado School of Medicine and Children's Hospital Colorado, Aurora; Epilepsy and Neurogenetics Program (A.A.-S.), Neurology Department, Ruber Internacional Hospital, and Initiative for Neuroscience (INCE) Foundation, Madrid, Spain; Department of Drug Design and Pharmacology (A. Bayat), University of Copenhagen; Department for Genetics and Personalized Medicine (A. Bayat), Danish Epilepsy Centre, Dianalund; Institute for Regional Health Services (A. Bayat), University of Southern Denmark, Odense; Department of Epilepsy Genetics and Personalized Medicine (A.R.), Danish Epilepsy Centre, Dianalund, Denmark; Pediatric Clinic (A.R.), IRCCS San Matteo Hospital Foundation, University of Pavia, Italy; NYU Langone Epilepsy Center (O.D.), NY; Edmond J. Safra Program in Parkinson's Disease (A.F.), Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital; Division of Neurology (A.F.), University of Toronto; Krembil Brain Institute (A.F.); Clinical Genetics Research Program (A.S.B.), Centre for Addiction and Mental Health; The Dalglish Family 22q Clinic (A.S.B.), Toronto General Hospital, University Health Network; Department of Psychiatry (A.S.B.), University of Toronto; Toronto Congenital Cardiac Centre for Adults (A.S.B.), Division of Cardiology, Department of Medicine, and Department of Psychiatry, University Health Network; Toronto General Hospital Research Institute and Campbell Family Mental Health Research Institute (A.S.B.); Division of Neurology (D.M.A.), Department of Medicine, University of Toronto, Ontario, Canada
| | - Ángel Aledo-Serrano
- From the Institute of Medical Science (M.R.), University of Toronto; Adult Genetic Epilepsy (AGE) Program (M.R., Q.Z.A., F.Q., A.S.A., D.M.A.), Krembil Neurosciences Institute, Toronto Western Hospital, University Health Network, Ontario, Canada; Department of Pediatrics, Neurology, Pharmacology and Otolaryngology (T.B.), University of Colorado School of Medicine and Children's Hospital Colorado, Aurora; Epilepsy and Neurogenetics Program (A.A.-S.), Neurology Department, Ruber Internacional Hospital, and Initiative for Neuroscience (INCE) Foundation, Madrid, Spain; Department of Drug Design and Pharmacology (A. Bayat), University of Copenhagen; Department for Genetics and Personalized Medicine (A. Bayat), Danish Epilepsy Centre, Dianalund; Institute for Regional Health Services (A. Bayat), University of Southern Denmark, Odense; Department of Epilepsy Genetics and Personalized Medicine (A.R.), Danish Epilepsy Centre, Dianalund, Denmark; Pediatric Clinic (A.R.), IRCCS San Matteo Hospital Foundation, University of Pavia, Italy; NYU Langone Epilepsy Center (O.D.), NY; Edmond J. Safra Program in Parkinson's Disease (A.F.), Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital; Division of Neurology (A.F.), University of Toronto; Krembil Brain Institute (A.F.); Clinical Genetics Research Program (A.S.B.), Centre for Addiction and Mental Health; The Dalglish Family 22q Clinic (A.S.B.), Toronto General Hospital, University Health Network; Department of Psychiatry (A.S.B.), University of Toronto; Toronto Congenital Cardiac Centre for Adults (A.S.B.), Division of Cardiology, Department of Medicine, and Department of Psychiatry, University Health Network; Toronto General Hospital Research Institute and Campbell Family Mental Health Research Institute (A.S.B.); Division of Neurology (D.M.A.), Department of Medicine, University of Toronto, Ontario, Canada
| | - Allan Bayat
- From the Institute of Medical Science (M.R.), University of Toronto; Adult Genetic Epilepsy (AGE) Program (M.R., Q.Z.A., F.Q., A.S.A., D.M.A.), Krembil Neurosciences Institute, Toronto Western Hospital, University Health Network, Ontario, Canada; Department of Pediatrics, Neurology, Pharmacology and Otolaryngology (T.B.), University of Colorado School of Medicine and Children's Hospital Colorado, Aurora; Epilepsy and Neurogenetics Program (A.A.-S.), Neurology Department, Ruber Internacional Hospital, and Initiative for Neuroscience (INCE) Foundation, Madrid, Spain; Department of Drug Design and Pharmacology (A. Bayat), University of Copenhagen; Department for Genetics and Personalized Medicine (A. Bayat), Danish Epilepsy Centre, Dianalund; Institute for Regional Health Services (A. Bayat), University of Southern Denmark, Odense; Department of Epilepsy Genetics and Personalized Medicine (A.R.), Danish Epilepsy Centre, Dianalund, Denmark; Pediatric Clinic (A.R.), IRCCS San Matteo Hospital Foundation, University of Pavia, Italy; NYU Langone Epilepsy Center (O.D.), NY; Edmond J. Safra Program in Parkinson's Disease (A.F.), Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital; Division of Neurology (A.F.), University of Toronto; Krembil Brain Institute (A.F.); Clinical Genetics Research Program (A.S.B.), Centre for Addiction and Mental Health; The Dalglish Family 22q Clinic (A.S.B.), Toronto General Hospital, University Health Network; Department of Psychiatry (A.S.B.), University of Toronto; Toronto Congenital Cardiac Centre for Adults (A.S.B.), Division of Cardiology, Department of Medicine, and Department of Psychiatry, University Health Network; Toronto General Hospital Research Institute and Campbell Family Mental Health Research Institute (A.S.B.); Division of Neurology (D.M.A.), Department of Medicine, University of Toronto, Ontario, Canada
| | - Alessandra Rossi
- From the Institute of Medical Science (M.R.), University of Toronto; Adult Genetic Epilepsy (AGE) Program (M.R., Q.Z.A., F.Q., A.S.A., D.M.A.), Krembil Neurosciences Institute, Toronto Western Hospital, University Health Network, Ontario, Canada; Department of Pediatrics, Neurology, Pharmacology and Otolaryngology (T.B.), University of Colorado School of Medicine and Children's Hospital Colorado, Aurora; Epilepsy and Neurogenetics Program (A.A.-S.), Neurology Department, Ruber Internacional Hospital, and Initiative for Neuroscience (INCE) Foundation, Madrid, Spain; Department of Drug Design and Pharmacology (A. Bayat), University of Copenhagen; Department for Genetics and Personalized Medicine (A. Bayat), Danish Epilepsy Centre, Dianalund; Institute for Regional Health Services (A. Bayat), University of Southern Denmark, Odense; Department of Epilepsy Genetics and Personalized Medicine (A.R.), Danish Epilepsy Centre, Dianalund, Denmark; Pediatric Clinic (A.R.), IRCCS San Matteo Hospital Foundation, University of Pavia, Italy; NYU Langone Epilepsy Center (O.D.), NY; Edmond J. Safra Program in Parkinson's Disease (A.F.), Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital; Division of Neurology (A.F.), University of Toronto; Krembil Brain Institute (A.F.); Clinical Genetics Research Program (A.S.B.), Centre for Addiction and Mental Health; The Dalglish Family 22q Clinic (A.S.B.), Toronto General Hospital, University Health Network; Department of Psychiatry (A.S.B.), University of Toronto; Toronto Congenital Cardiac Centre for Adults (A.S.B.), Division of Cardiology, Department of Medicine, and Department of Psychiatry, University Health Network; Toronto General Hospital Research Institute and Campbell Family Mental Health Research Institute (A.S.B.); Division of Neurology (D.M.A.), Department of Medicine, University of Toronto, Ontario, Canada
| | - Orrin Devinsky
- From the Institute of Medical Science (M.R.), University of Toronto; Adult Genetic Epilepsy (AGE) Program (M.R., Q.Z.A., F.Q., A.S.A., D.M.A.), Krembil Neurosciences Institute, Toronto Western Hospital, University Health Network, Ontario, Canada; Department of Pediatrics, Neurology, Pharmacology and Otolaryngology (T.B.), University of Colorado School of Medicine and Children's Hospital Colorado, Aurora; Epilepsy and Neurogenetics Program (A.A.-S.), Neurology Department, Ruber Internacional Hospital, and Initiative for Neuroscience (INCE) Foundation, Madrid, Spain; Department of Drug Design and Pharmacology (A. Bayat), University of Copenhagen; Department for Genetics and Personalized Medicine (A. Bayat), Danish Epilepsy Centre, Dianalund; Institute for Regional Health Services (A. Bayat), University of Southern Denmark, Odense; Department of Epilepsy Genetics and Personalized Medicine (A.R.), Danish Epilepsy Centre, Dianalund, Denmark; Pediatric Clinic (A.R.), IRCCS San Matteo Hospital Foundation, University of Pavia, Italy; NYU Langone Epilepsy Center (O.D.), NY; Edmond J. Safra Program in Parkinson's Disease (A.F.), Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital; Division of Neurology (A.F.), University of Toronto; Krembil Brain Institute (A.F.); Clinical Genetics Research Program (A.S.B.), Centre for Addiction and Mental Health; The Dalglish Family 22q Clinic (A.S.B.), Toronto General Hospital, University Health Network; Department of Psychiatry (A.S.B.), University of Toronto; Toronto Congenital Cardiac Centre for Adults (A.S.B.), Division of Cardiology, Department of Medicine, and Department of Psychiatry, University Health Network; Toronto General Hospital Research Institute and Campbell Family Mental Health Research Institute (A.S.B.); Division of Neurology (D.M.A.), Department of Medicine, University of Toronto, Ontario, Canada
| | - Farah Qaiser
- From the Institute of Medical Science (M.R.), University of Toronto; Adult Genetic Epilepsy (AGE) Program (M.R., Q.Z.A., F.Q., A.S.A., D.M.A.), Krembil Neurosciences Institute, Toronto Western Hospital, University Health Network, Ontario, Canada; Department of Pediatrics, Neurology, Pharmacology and Otolaryngology (T.B.), University of Colorado School of Medicine and Children's Hospital Colorado, Aurora; Epilepsy and Neurogenetics Program (A.A.-S.), Neurology Department, Ruber Internacional Hospital, and Initiative for Neuroscience (INCE) Foundation, Madrid, Spain; Department of Drug Design and Pharmacology (A. Bayat), University of Copenhagen; Department for Genetics and Personalized Medicine (A. Bayat), Danish Epilepsy Centre, Dianalund; Institute for Regional Health Services (A. Bayat), University of Southern Denmark, Odense; Department of Epilepsy Genetics and Personalized Medicine (A.R.), Danish Epilepsy Centre, Dianalund, Denmark; Pediatric Clinic (A.R.), IRCCS San Matteo Hospital Foundation, University of Pavia, Italy; NYU Langone Epilepsy Center (O.D.), NY; Edmond J. Safra Program in Parkinson's Disease (A.F.), Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital; Division of Neurology (A.F.), University of Toronto; Krembil Brain Institute (A.F.); Clinical Genetics Research Program (A.S.B.), Centre for Addiction and Mental Health; The Dalglish Family 22q Clinic (A.S.B.), Toronto General Hospital, University Health Network; Department of Psychiatry (A.S.B.), University of Toronto; Toronto Congenital Cardiac Centre for Adults (A.S.B.), Division of Cardiology, Department of Medicine, and Department of Psychiatry, University Health Network; Toronto General Hospital Research Institute and Campbell Family Mental Health Research Institute (A.S.B.); Division of Neurology (D.M.A.), Department of Medicine, University of Toronto, Ontario, Canada
| | - Anum S Ali
- From the Institute of Medical Science (M.R.), University of Toronto; Adult Genetic Epilepsy (AGE) Program (M.R., Q.Z.A., F.Q., A.S.A., D.M.A.), Krembil Neurosciences Institute, Toronto Western Hospital, University Health Network, Ontario, Canada; Department of Pediatrics, Neurology, Pharmacology and Otolaryngology (T.B.), University of Colorado School of Medicine and Children's Hospital Colorado, Aurora; Epilepsy and Neurogenetics Program (A.A.-S.), Neurology Department, Ruber Internacional Hospital, and Initiative for Neuroscience (INCE) Foundation, Madrid, Spain; Department of Drug Design and Pharmacology (A. Bayat), University of Copenhagen; Department for Genetics and Personalized Medicine (A. Bayat), Danish Epilepsy Centre, Dianalund; Institute for Regional Health Services (A. Bayat), University of Southern Denmark, Odense; Department of Epilepsy Genetics and Personalized Medicine (A.R.), Danish Epilepsy Centre, Dianalund, Denmark; Pediatric Clinic (A.R.), IRCCS San Matteo Hospital Foundation, University of Pavia, Italy; NYU Langone Epilepsy Center (O.D.), NY; Edmond J. Safra Program in Parkinson's Disease (A.F.), Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital; Division of Neurology (A.F.), University of Toronto; Krembil Brain Institute (A.F.); Clinical Genetics Research Program (A.S.B.), Centre for Addiction and Mental Health; The Dalglish Family 22q Clinic (A.S.B.), Toronto General Hospital, University Health Network; Department of Psychiatry (A.S.B.), University of Toronto; Toronto Congenital Cardiac Centre for Adults (A.S.B.), Division of Cardiology, Department of Medicine, and Department of Psychiatry, University Health Network; Toronto General Hospital Research Institute and Campbell Family Mental Health Research Institute (A.S.B.); Division of Neurology (D.M.A.), Department of Medicine, University of Toronto, Ontario, Canada
| | - Alfonso Fasano
- From the Institute of Medical Science (M.R.), University of Toronto; Adult Genetic Epilepsy (AGE) Program (M.R., Q.Z.A., F.Q., A.S.A., D.M.A.), Krembil Neurosciences Institute, Toronto Western Hospital, University Health Network, Ontario, Canada; Department of Pediatrics, Neurology, Pharmacology and Otolaryngology (T.B.), University of Colorado School of Medicine and Children's Hospital Colorado, Aurora; Epilepsy and Neurogenetics Program (A.A.-S.), Neurology Department, Ruber Internacional Hospital, and Initiative for Neuroscience (INCE) Foundation, Madrid, Spain; Department of Drug Design and Pharmacology (A. Bayat), University of Copenhagen; Department for Genetics and Personalized Medicine (A. Bayat), Danish Epilepsy Centre, Dianalund; Institute for Regional Health Services (A. Bayat), University of Southern Denmark, Odense; Department of Epilepsy Genetics and Personalized Medicine (A.R.), Danish Epilepsy Centre, Dianalund, Denmark; Pediatric Clinic (A.R.), IRCCS San Matteo Hospital Foundation, University of Pavia, Italy; NYU Langone Epilepsy Center (O.D.), NY; Edmond J. Safra Program in Parkinson's Disease (A.F.), Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital; Division of Neurology (A.F.), University of Toronto; Krembil Brain Institute (A.F.); Clinical Genetics Research Program (A.S.B.), Centre for Addiction and Mental Health; The Dalglish Family 22q Clinic (A.S.B.), Toronto General Hospital, University Health Network; Department of Psychiatry (A.S.B.), University of Toronto; Toronto Congenital Cardiac Centre for Adults (A.S.B.), Division of Cardiology, Department of Medicine, and Department of Psychiatry, University Health Network; Toronto General Hospital Research Institute and Campbell Family Mental Health Research Institute (A.S.B.); Division of Neurology (D.M.A.), Department of Medicine, University of Toronto, Ontario, Canada
| | - Anne S Bassett
- From the Institute of Medical Science (M.R.), University of Toronto; Adult Genetic Epilepsy (AGE) Program (M.R., Q.Z.A., F.Q., A.S.A., D.M.A.), Krembil Neurosciences Institute, Toronto Western Hospital, University Health Network, Ontario, Canada; Department of Pediatrics, Neurology, Pharmacology and Otolaryngology (T.B.), University of Colorado School of Medicine and Children's Hospital Colorado, Aurora; Epilepsy and Neurogenetics Program (A.A.-S.), Neurology Department, Ruber Internacional Hospital, and Initiative for Neuroscience (INCE) Foundation, Madrid, Spain; Department of Drug Design and Pharmacology (A. Bayat), University of Copenhagen; Department for Genetics and Personalized Medicine (A. Bayat), Danish Epilepsy Centre, Dianalund; Institute for Regional Health Services (A. Bayat), University of Southern Denmark, Odense; Department of Epilepsy Genetics and Personalized Medicine (A.R.), Danish Epilepsy Centre, Dianalund, Denmark; Pediatric Clinic (A.R.), IRCCS San Matteo Hospital Foundation, University of Pavia, Italy; NYU Langone Epilepsy Center (O.D.), NY; Edmond J. Safra Program in Parkinson's Disease (A.F.), Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital; Division of Neurology (A.F.), University of Toronto; Krembil Brain Institute (A.F.); Clinical Genetics Research Program (A.S.B.), Centre for Addiction and Mental Health; The Dalglish Family 22q Clinic (A.S.B.), Toronto General Hospital, University Health Network; Department of Psychiatry (A.S.B.), University of Toronto; Toronto Congenital Cardiac Centre for Adults (A.S.B.), Division of Cardiology, Department of Medicine, and Department of Psychiatry, University Health Network; Toronto General Hospital Research Institute and Campbell Family Mental Health Research Institute (A.S.B.); Division of Neurology (D.M.A.), Department of Medicine, University of Toronto, Ontario, Canada
| | - Danielle M Andrade
- From the Institute of Medical Science (M.R.), University of Toronto; Adult Genetic Epilepsy (AGE) Program (M.R., Q.Z.A., F.Q., A.S.A., D.M.A.), Krembil Neurosciences Institute, Toronto Western Hospital, University Health Network, Ontario, Canada; Department of Pediatrics, Neurology, Pharmacology and Otolaryngology (T.B.), University of Colorado School of Medicine and Children's Hospital Colorado, Aurora; Epilepsy and Neurogenetics Program (A.A.-S.), Neurology Department, Ruber Internacional Hospital, and Initiative for Neuroscience (INCE) Foundation, Madrid, Spain; Department of Drug Design and Pharmacology (A. Bayat), University of Copenhagen; Department for Genetics and Personalized Medicine (A. Bayat), Danish Epilepsy Centre, Dianalund; Institute for Regional Health Services (A. Bayat), University of Southern Denmark, Odense; Department of Epilepsy Genetics and Personalized Medicine (A.R.), Danish Epilepsy Centre, Dianalund, Denmark; Pediatric Clinic (A.R.), IRCCS San Matteo Hospital Foundation, University of Pavia, Italy; NYU Langone Epilepsy Center (O.D.), NY; Edmond J. Safra Program in Parkinson's Disease (A.F.), Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital; Division of Neurology (A.F.), University of Toronto; Krembil Brain Institute (A.F.); Clinical Genetics Research Program (A.S.B.), Centre for Addiction and Mental Health; The Dalglish Family 22q Clinic (A.S.B.), Toronto General Hospital, University Health Network; Department of Psychiatry (A.S.B.), University of Toronto; Toronto Congenital Cardiac Centre for Adults (A.S.B.), Division of Cardiology, Department of Medicine, and Department of Psychiatry, University Health Network; Toronto General Hospital Research Institute and Campbell Family Mental Health Research Institute (A.S.B.); Division of Neurology (D.M.A.), Department of Medicine, University of Toronto, Ontario, Canada
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22
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Fearon C, Sundaram AE, Munhoz RP, Fasano A, Tyndel F. Downbeat Nystagmus in Metronidazole Neurotoxicity. Can J Neurol Sci 2023; 50:941-943. [PMID: 36451594 DOI: 10.1017/cjn.2022.330] [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] [Indexed: 12/05/2022]
Affiliation(s)
- Conor Fearon
- Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, UHN-Toronto Western Hospital, Canada
- Department of Medicine, Division of Neurology, University of Toronto, Toronto, Ontario, Canada
- Mater Misericordiae University Hospital, University College Dublin, Ireland
| | - Arun E Sundaram
- Department of Medicine, Division of Neurology, University of Toronto, Toronto, Ontario, Canada
| | - Renato P Munhoz
- Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, UHN-Toronto Western Hospital, Canada
- Department of Medicine, Division of Neurology, University of Toronto, Toronto, Ontario, Canada
- Neuromodulation Unit and Ataxia Clinic, Edmond J. Safra Program in Parkinson's Disease and the Morton and Gloria Shulman Movement Disorders Clinic, UHN-Toronto Western Hospital, Canada
- Krembil Brain Institute, Toronto, Ontario, Canada
| | - Alfonso Fasano
- Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, UHN-Toronto Western Hospital, Canada
- Department of Medicine, Division of Neurology, University of Toronto, Toronto, Ontario, Canada
- Krembil Brain Institute, Toronto, Ontario, Canada
| | - Felix Tyndel
- Department of Medicine, Division of Neurology, University of Toronto, Toronto, Ontario, Canada
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23
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Di Luca DG, Ramirez-Gomez C, Germann J, Santyr B, Boutet A, Milosevic L, Lang AE, Kalia SK, Lozano AM, Fasano A. Deep Brain Stimulation of the Globus Pallidus Internus and Externus in Multiple System Atrophy. Mov Disord 2023; 38:2121-2125. [PMID: 37544011 DOI: 10.1002/mds.29573] [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: 03/24/2023] [Revised: 06/17/2023] [Accepted: 07/20/2023] [Indexed: 08/08/2023] Open
Abstract
BACKGROUND Multiple system atrophy with parkinsonism (MSA-P) is a progressive condition with no effective treatment. OBJECTIVE The aim of this study was to describe the safety and efficacy of deep brain stimulation (DBS) of globus pallidus pars interna and externa in a cohort of patients with MSA-P. METHODS Six patients were included. Changes in Movement Disorders Society Unified Parkinson's Disease Rating Scale Part III (MDS-UPDRS III), Parkinson's Disease Questionnaire (PDQ-39) scores, and levodopa equivalent daily dose were compared before and after DBS. Electrode localization and volume tissue activation were calculated. RESULTS DBS surgery did not result in any major adverse events or intraoperative complications. Overall, no differences in MDS-UPDRS III scores were demonstrated (55.2 ± 17.6 preoperatively compared with 67.3 ± 19.2 at 1 year after surgery), although transient improvement in mobility and dyskinesia was reported in some subjects. CONCLUSIONS Globus pallidus pars interna and externa DBS for patients with MSA-P did not result in major complications, although it did not provide significant clinical benefit as measured by MDS-UPDRS III. © 2023 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Daniel G Di Luca
- Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, UHN, Toronto, Ontario, Canada
- Division of Neurology, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Department of Neurology, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Carolina Ramirez-Gomez
- Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, UHN, Toronto, Ontario, Canada
- Division of Neurology, University of Toronto, Toronto, Ontario, Canada
| | - Jurgen Germann
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Brendan Santyr
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Alexandre Boutet
- Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
| | - Luka Milosevic
- Institute of Biomedical Engineering, University of Toronto, Toronto, Ontario, Canada
- Institute of Medical Sciences, University of Toronto, Toronto, Ontario, Canada
- Krembil Brain Institute, Toronto, Ontario, Canada
- Center for Advancing Neurotechnological Innovation to Application, Toronto, Ontario, Canada
| | - Anthony E Lang
- Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, UHN, Toronto, Ontario, Canada
- Krembil Brain Institute, Toronto, Ontario, Canada
| | - Suneil K Kalia
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
- Krembil Brain Institute, Toronto, Ontario, Canada
- Center for Advancing Neurotechnological Innovation to Application, Toronto, Ontario, Canada
| | - Andres M Lozano
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
- Krembil Brain Institute, Toronto, Ontario, Canada
- Center for Advancing Neurotechnological Innovation to Application, Toronto, Ontario, Canada
| | - Alfonso Fasano
- Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, UHN, Toronto, Ontario, Canada
- Division of Neurology, University of Toronto, Toronto, Ontario, Canada
- Krembil Brain Institute, Toronto, Ontario, Canada
- Center for Advancing Neurotechnological Innovation to Application, Toronto, Ontario, Canada
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24
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Mithani K, Breitbart S, Fasano A, Gorodetsky C, Ibrahim GM. Deep brain stimulation for status dystonicus in a toddler with SCN2A-related disorder. Childs Nerv Syst 2023; 39:3033-3035. [PMID: 37642686 DOI: 10.1007/s00381-023-06136-3] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 08/17/2023] [Indexed: 08/31/2023]
Affiliation(s)
- Karim Mithani
- Division of Neurosurgery, Hospital for Sick Children, Toronto, ON, Canada.
| | - Sara Breitbart
- Division of Neurosurgery, Hospital for Sick Children, Toronto, ON, Canada
| | - Alfonso Fasano
- Division of Neurology, Toronto Western Hospital, Toronto, ON, Canada
| | | | - George M Ibrahim
- Division of Neurosurgery, Hospital for Sick Children, Toronto, ON, Canada
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25
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Sasikumar S, Cohn M, Youm A, Duncan K, Boogers A, Strafella AP, Blake DT, Fasano A. Rethinking NBM DBS: Intermittent stimulation improves sustained attention in Parkinson's disease. Brain Stimul 2023; 16:1643-1645. [PMID: 37935282 DOI: 10.1016/j.brs.2023.10.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 10/21/2023] [Accepted: 10/24/2023] [Indexed: 11/09/2023] Open
Affiliation(s)
- Sanskriti Sasikumar
- Division of Neurology, University of Toronto, Toronto, Ontario, Canada; Edmond J. Safra Program in Parkinson's Disease and Morton and Gloria Shulman Movement Disorders Centre, Toronto Western Hospital, UHN, Toronto, Ontario, Canada.
| | - Melanie Cohn
- Department of Psychology, University of Toronto, Toronto, Ontario, Canada; Krembil Brain Institute, Toronto, ON, Canada
| | - Ariana Youm
- Department of Psychology, University of Toronto, Toronto, Ontario, Canada; Krembil Brain Institute, Toronto, ON, Canada
| | - Katherine Duncan
- Department of Psychology, University of Toronto, Toronto, Ontario, Canada
| | - Alexandra Boogers
- Division of Neurology, University of Toronto, Toronto, Ontario, Canada; Edmond J. Safra Program in Parkinson's Disease and Morton and Gloria Shulman Movement Disorders Centre, Toronto Western Hospital, UHN, Toronto, Ontario, Canada
| | - Antonio P Strafella
- Division of Neurology, University of Toronto, Toronto, Ontario, Canada; Edmond J. Safra Program in Parkinson's Disease and Morton and Gloria Shulman Movement Disorders Centre, Toronto Western Hospital, UHN, Toronto, Ontario, Canada; Division of Brain, Imaging and Behaviour - Systems Neuroscience, Krembil Brain Institute, UHN, University of Toronto, Ontario, M5T 2S8, Canada; Brain Health Imaging Centre, Campbell Family Mental Health Research Institute, CAMH, University of Toronto, Ontario, Canada
| | - David T Blake
- Dept. Neuroscience and Regenerative Medicine, Medical College of Georgia, Augusta University, Augusta, GA, 30912, USA
| | - Alfonso Fasano
- Division of Neurology, University of Toronto, Toronto, Ontario, Canada; Edmond J. Safra Program in Parkinson's Disease and Morton and Gloria Shulman Movement Disorders Centre, Toronto Western Hospital, UHN, Toronto, Ontario, Canada; Krembil Brain Institute, Toronto, ON, Canada; CenteR for Advancing Neurotechnological Innovation to Application (CRANIA), Toronto, ON, Canada.
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26
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Passaretti M, Maranzano A, Bluett B, Rajalingam R, Fasano A. Gait Analysis in Idiopathic Normal Pressure Hydrocephalus: A Meta-Analysis. Mov Disord Clin Pract 2023; 10:1574-1584. [PMID: 38026510 PMCID: PMC10654838 DOI: 10.1002/mdc3.13816] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 04/19/2023] [Accepted: 05/30/2023] [Indexed: 12/01/2023] Open
Abstract
Background Gait analysis objectively quantifies gait impairment in idiopathic normal pressure hydrocephalus (iNPH), may improve diagnosis and evaluation for surgical candidacy. Objectives This meta-analysis aims to understand which objective gait parameters improve after tap-test (TT) and CSF shunt surgery (CSS), also comparing responders (R) with non-responders (NR) and to assess if gait restores within the range of healthy controls after procedures. Methods Studies enrolling iNPH with at least one instrumented gait measure were selected. Three time points of gait assessment were defined: PRE, POST-TT, and POST-CSS. Gait velocity, cadence, step length, stride length, and double limb support time were evaluated. Patients were categorized based on responsiveness to CSF diversion procedures. Results Seventeen studies including 527 patients were selected. iNPH improved significantly in almost all gait parameters POST-TT, and to a greater extent POST-CSS. Gait parameters consistently discriminated iNPH from healthy controls. Despite the aforementioned improvements, iNPH's gait did not completely normalize after CSF diversion procedures. Meta-regression analysis also revealed that TT's effect on gait velocity plateaus after 24-48 hr and returns to baseline in 90-100 hr. Conclusions Gait analysis is a reliable quantitative instrument to assess gait impairment in iNPH, demarking a net differentiation from healthy controls, according to the notion that the iNPH CSF dynamic alteration also leads to an irreversible damage. Specific gait parameters improve among TT-R, providing an opportunity to select patients that will respond to CSS. Future studies validating a standardized reporting method including criteria of responsiveness, specific gait parameters, and timeframe of assessment are needed.
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Affiliation(s)
| | - Alessio Maranzano
- Department of Neurology and Laboratory of NeuroscienceIstituto Auxologico Italiano IRCCSMilanItaly
| | - Brent Bluett
- Central California Movement DisordersPismo BeachCaliforniaUSA
| | - Rajasumi Rajalingam
- Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital–UHN, Division of NeurologyUniversity of TorontoTorontoOntarioCanada
| | - Alfonso Fasano
- Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital–UHN, Division of NeurologyUniversity of TorontoTorontoOntarioCanada
- Krembil Brain InstituteTorontoOntarioCanada
- Department of Parkinson's Disease and Movement Disorders RehabilitationMoriggia‐Pelascini Hospital–Gravedona ed UnitiComoItaly
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27
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Artusi CA, Geroin C, Nonnekes J, Aquino C, Garg D, Dale ML, Schlosser D, Lai Y, Al‐Wardat M, Salari M, Wolke R, Labou VT, Imbalzano G, Camozzi S, Merello M, Bloem BR, Capato T, Djaldetti R, Doherty K, Fasano A, Tibar H, Lopiano L, Margraf NG, Moreau C, Ugawa Y, Bhidayasiri R, Tinazzi M. Predictors and Pathophysiology of Axial Postural Abnormalities in Parkinsonism: A Scoping Review. Mov Disord Clin Pract 2023; 10:1585-1596. [PMID: 38026508 PMCID: PMC10654876 DOI: 10.1002/mdc3.13879] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 08/09/2023] [Accepted: 08/20/2023] [Indexed: 12/01/2023] Open
Abstract
Background Postural abnormalities involving the trunk are referred to as axial postural abnormalities and can be observed in over 20% of patients with Parkinson's disease (PD) and in atypical parkinsonism. These symptoms are highly disabling and frequently associated with back pain and a worse quality of life in PD. Despite their frequency, little is known about the pathophysiology of these symptoms and scant data are reported about their clinical predictors, making it difficult to prompt prevention strategies. Objectives We conducted a scoping literature review of clinical predictors and pathophysiology of axial postural abnormalities in patients with parkinsonism to identify key concepts, theories and evidence on this topic. Methods We applied a systematic approach to identify studies, appraise quality of evidence, summarize main findings, and highlight knowledge gaps. Results Ninety-two articles were reviewed: 25% reported on clinical predictors and 75% on pathophysiology. Most studies identified advanced disease stage and greater motor symptoms severity as independent clinical predictors in both PD and multiple system atrophy. Discrepant pathophysiology data suggested different potential central and peripheral pathogenic mechanisms. Conclusions The recognition of clinical predictors and pathophysiology of axial postural abnormalities in parkinsonism is far from being elucidated due to literature bias, encompassing different inclusion criteria and measurement tools and heterogeneity of patient samples. Most studies identified advanced disease stage and higher burden of motor symptoms as possible clinical predictors. Pathophysiology data point toward many different (possibly non-mutually exclusive) mechanisms, including dystonia, rigidity, proprioceptive and vestibular impairment, and higher cognitive deficits.
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Affiliation(s)
| | - Christian Geroin
- Neurology Unit, Movement Disorders Division, Department of Neurosciences Biomedicine and Movement SciencesUniversity of VeronaVeronaItaly
| | - Jorik Nonnekes
- Radboud University Medical Centre, Donders Institute for Brain, Cognition and BehaviourDepartment of RehabilitationNijmegenThe Netherlands
| | - Camila Aquino
- Hotchkiss Brain Institute, Department of Clinical Neurosciences, and Department of Community Health SciencesUniversity of CalgaryCalgaryABCanada
| | - Divyani Garg
- Department of Neurology, Lady Hardinge Medical College, New Delhi, India. Department of NeurologyVardhman Mahavir Medical College and Safdarjung HospitalNew DelhiIndia
| | - Marian L. Dale
- Oregon Health & Science UniversityDepartment of NeurologyPortlandORUSA
| | - Darbe Schlosser
- Graduate Student in the Motor Learning Program at Teachers CollegeColumbia UniversityNew YorkNYUSA
| | - Yijie Lai
- Department of Neurosurgery, Center for Functional NeurosurgeryRuijin Hospital, Shanghai Jiao Tong University School of MedicineShanghaiChina
| | - Mohammad Al‐Wardat
- Department of Rehabilitation Sciences, Faculty of Applied Medical SciencesJordan University of Science and TechnologyIrbidJordan
| | - Mehri Salari
- Department of NeurologyShahid Beheshti University of Medical SciencesTehranIran
| | - Robin Wolke
- Department of NeurologyUKSH, Christian‐Albrechts‐UniversityKielGermany
| | | | - Gabriele Imbalzano
- Department of Neuroscience Rita Levi MontalciniUniversity of TurinTorinoItaly
| | - Serena Camozzi
- Neurology Unit, Movement Disorders Division, Department of Neurosciences Biomedicine and Movement SciencesUniversity of VeronaVeronaItaly
| | - Marcelo Merello
- Movement Disorders ServiceFLENI, CONICETBuenos AiresArgentina
| | - Bastiaan R. Bloem
- Department of NeurologyRadboud University Medical Centre, Donders Institute for Brain, Cognition and BehaviourNijmegenThe Netherlands
| | - Tamine Capato
- Department of NeurologyRadboud University Medical Centre, Donders Institute for Brain, Cognition and BehaviourNijmegenThe Netherlands
- University of São PauloDepartment of Neurology, Movement Disorders CenterSão PauloBrazil
| | - Ruth Djaldetti
- Department of Neurology, Rabin Medical Center, Petah Tikva; Sackler Faculty of MedicineTel Aviv UniversityTel AvivIsrael
| | - Karen Doherty
- Department of NeurologyRoyal Victoria HospitalBelfastUnited Kingdom
- Centre for Medical EducationQueens University BelfastBelfastUnited Kingdom
| | - Alfonso Fasano
- Division of NeurologyUniversity of TorontoTorontoONCanada
- Krembil Brain InstituteTorontoONCanada
- Edmond J. Safra Program in Parkinson's Disease and Morton and Gloria ShulmanMovement Disorders Clinic, Toronto Western Hospital, UHNTorontoONCanada
| | - Houyam Tibar
- Service de Neurologie B et de Neurogénétique Hôpital des Spécialités OTO‐Neuro‐OphtalmologiqueIbn Sina University Hospital, Medical School of Rabat, Mohamed 5 University of RabatRabatMorocco
| | - Leonardo Lopiano
- Department of Neuroscience Rita Levi MontalciniUniversity of TurinTorinoItaly
| | - Nils G. Margraf
- Department of NeurologyUKSH, Christian‐Albrechts‐UniversityKielGermany
| | - Caroline Moreau
- Expert Center for Parkinson's Disease, Neurological Department, Inserm UMR 1172Lille University HospitalLilleFrance
| | - Yoshikazu Ugawa
- Department of Human Neurophysiology, School of MedicineFukushima Medical UniversityFukushimaJapan
| | - Roongroj Bhidayasiri
- Chulalongkorn Centre of Excellence for Parkinson's Disease & Related Disorders, Department of Medicine, Faculty of MedicineChulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross SocietyBangkokThailand
- The Academy of ScienceThe Royal Society of ThailandBangkokThailand
| | - Michele Tinazzi
- Neurology Unit, Movement Disorders Division, Department of Neurosciences Biomedicine and Movement SciencesUniversity of VeronaVeronaItaly
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Rodriguez-Quiroga S, Aldecoa M, Morera N, Gatti C, Gil C, Garretto N, Fasano A. Ataxia Myoclonus Syndrome in Mild Acute COVID-19 Infection. Cerebellum 2023; 22:1026-1028. [PMID: 35976551 PMCID: PMC9382621 DOI: 10.1007/s12311-022-01460-x] [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] [Download PDF] [Subscribe] [Scholar Register] [Accepted: 08/11/2022] [Indexed: 10/25/2022]
Affiliation(s)
- Sergio Rodriguez-Quiroga
- Movement Disorders Section, Division of Neurology, Hospital J.M. Ramos Mejia, Buenos-Aires, Argentina
- Faculty of Medicine, University Center of Neurology "Jose Maria Ramos Mejia," Buenos Aires University, Buenos Aires, Argentina
| | - Mayra Aldecoa
- Movement Disorders Section, Division of Neurology, Hospital J.M. Ramos Mejia, Buenos-Aires, Argentina
- Faculty of Medicine, University Center of Neurology "Jose Maria Ramos Mejia," Buenos Aires University, Buenos Aires, Argentina
| | - Nicolas Morera
- Division of Neurology, Hospital Británico, Buenos Aires, Argentina
| | - Carolina Gatti
- Clínica Privada Dr. Pedro García Salinas, Trenque Lauquen, Buenos Aires, Argentina
| | - Cesar Gil
- Hospital HIGA Eva Perón, Buenos Aires, Argentina
| | - Nélida Garretto
- Movement Disorders Section, Division of Neurology, Hospital J.M. Ramos Mejia, Buenos-Aires, Argentina
- Faculty of Medicine, University Center of Neurology "Jose Maria Ramos Mejia," Buenos Aires University, Buenos Aires, Argentina
| | - Alfonso Fasano
- Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, UHN, 399 Bathurst St, 7McL412, Toronto, ON, M5T 2S8, Canada.
- Division of Neurology, University of Toronto, Toronto, ON, Canada.
- Krembil Brain Institute, Toronto, ON, Canada.
- Department of Parkinson's Disease & Movement Disorders Rehabilitation, Moriggia-Pelascini Hospital - Gravedona ed Uniti, 22015, Como, Italy.
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Sarica C, Conner CR, Yamamoto K, Yang A, Germann J, Lannon MM, Samuel N, Colditz M, Santyr B, Chow CT, Iorio-Morin C, Aguirre-Padilla DH, Lang ST, Vetkas A, Cheyuo C, Loh A, Darmani G, Flouty O, Milano V, Paff M, Hodaie M, Kalia SK, Munhoz RP, Fasano A, Lozano AM. Trends and disparities in deep brain stimulation utilization in the United States: a Nationwide Inpatient Sample analysis from 1993 to 2017. Lancet Reg Health Am 2023; 26:100599. [PMID: 37876670 PMCID: PMC10593574 DOI: 10.1016/j.lana.2023.100599] [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] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 09/08/2023] [Accepted: 09/08/2023] [Indexed: 10/26/2023]
Abstract
Background Deep brain stimulation (DBS) is an approved treatment option for Parkinson's Disease (PD), essential tremor (ET), dystonia, obsessive-compulsive disorder and epilepsy in the United States. There are disparities in access to DBS, and clear understanding of the contextual factors driving them is important. Previous studies aimed at understanding these factors have been limited by single indications or small cohort sizes. The aim of this study is to provide an updated and comprehensive analysis of DBS utilization for multiple indications to better understand the factors driving disparities in access. Methods The United States based National Inpatient Sample (NIS) database was utilized to analyze the surgical volume and trends of procedures based on indication, using relevant ICD codes. Predictors of DBS use were analyzed using a logistic regression model. DBS-implanted patients in each indication were compared based on the patient-, hospital-, and outcome-related variables. Findings Our analysis of 104,356 DBS discharges from 1993 to 2017 revealed that the most frequent indications for DBS were PD (67%), ET (24%), and dystonia (4%). Although the number of DBS procedures has consistently increased over the years, radiofrequency ablation utilization has significantly decreased to only a few patients per year since 2003. Negative predictors for DBS utilization in PD and ET cohorts included age increase and female sex, while African American status was a negative predictor across all cohorts. Significant differences in patient-, hospital-, and outcome-related variables between DBS indications were also determined. Interpretation Demographic and socioeconomic-based disparities in DBS use are evident. Although racial disparities are present across all indications, other disparities such as age, sex, wealth, and insurance status are only relevant in certain indications. Funding This work was supported by Alan & Susan Hudson Cornerstone Chair in Neurosurgery at University Health Network.
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Affiliation(s)
- Can Sarica
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
- Krembil Research Institute, University Health Network, Toronto, ON, Canada
| | - Christopher R. Conner
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Kazuaki Yamamoto
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Andrew Yang
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
- Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Jürgen Germann
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Melissa M. Lannon
- Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Nardin Samuel
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Michael Colditz
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Brendan Santyr
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Clement T. Chow
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Christian Iorio-Morin
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
- Division of Neurosurgery, Department of Surgery, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - David H. Aguirre-Padilla
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
- Department of Neurosurgery, Medical School, Universidad de Chile, Santiago, Chile
| | - Stefan Thomas Lang
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Artur Vetkas
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
- Department of Neurosurgery, Tartu University Hospital, University of Tartu, Tartu, Estonia
| | - Cletus Cheyuo
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Aaron Loh
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Ghazaleh Darmani
- Krembil Research Institute, University Health Network, Toronto, ON, Canada
| | - Oliver Flouty
- Department of Neurosurgery, University of South Florida, Tampa, FL, United States
| | - Vanessa Milano
- Department of Neurosurgery, Rutgers New Jersey Medical School, Newark, NJ, United States
| | - Michelle Paff
- Department of Neurosurgery, University of California Irvine, Orange, CA, United States
| | - Mojgan Hodaie
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
- Krembil Research Institute, University Health Network, Toronto, ON, Canada
- CRANIA Center for Advancing Neurotechnological Innovation to Application, University of Toronto, ON, Canada
| | - Suneil K. Kalia
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
- Krembil Research Institute, University Health Network, Toronto, ON, Canada
- CRANIA Center for Advancing Neurotechnological Innovation to Application, University of Toronto, ON, Canada
- KITE, University Health Network, Toronto, ON, Canada
| | - Renato P. Munhoz
- Krembil Research Institute, University Health Network, Toronto, ON, Canada
- Division of Neurology, Edmond J. Safra Program in Parkinson's Disease Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, University of Toronto, Toronto, ON, Canada
| | - Alfonso Fasano
- Krembil Research Institute, University Health Network, Toronto, ON, Canada
- CRANIA Center for Advancing Neurotechnological Innovation to Application, University of Toronto, ON, Canada
- KITE, University Health Network, Toronto, ON, Canada
- Division of Neurology, Edmond J. Safra Program in Parkinson's Disease Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, University of Toronto, Toronto, ON, Canada
| | - Andres M. Lozano
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
- Krembil Research Institute, University Health Network, Toronto, ON, Canada
- CRANIA Center for Advancing Neurotechnological Innovation to Application, University of Toronto, ON, Canada
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Vogt LM, Yan H, Santyr B, Breitbart S, Anderson M, Germann J, Lizarraga KJ, Hewitt AL, Fasano A, Ibrahim GM, Gorodetsky C. Deep Brain Stimulation for Refractory Status Dystonicus in Children: Multicenter Case Series and Systematic Review. Ann Neurol 2023. [PMID: 37714824 DOI: 10.1002/ana.26799] [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: 04/27/2023] [Revised: 09/14/2023] [Accepted: 09/14/2023] [Indexed: 09/17/2023]
Abstract
OBJECTIVE We sought to better understand the workflow, outcomes, and complications of deep brain stimulation (DBS) for pediatric status dystonicus (SD). We present a systematic review, alongside a multicenter case series of pediatric patients with SD treated with DBS. METHODS We collected individual data regarding treatment, stimulation parameters, and dystonia severity for a multicenter case series (n = 8) and all previously published cases (n = 77). Data for case series were used to create probabilistic voxelwise maps of stimulated tissue associated with dystonia improvement. RESULTS In our institutional series, DBS was implanted a mean of 25 days after SD onset. Programming began a mean of 1.6 days after surgery. All 8 patients in our case series and 73 of 74 reported patients in the systematic review had resolution of their SD with DBS, most within 2 to 4 weeks of surgery. Mean follow-up for patients in the case series was 16 months. DBS target for all patients in the case series and 68 of 77 in our systematic review was the globus pallidus pars interna (GPi). In our case series, stimulation of the posterior-ventrolateral GPi was associated with improved dystonia. Mean dystonia improvement was 32% and 51% in our institutional series and systematic review, respectively. Mortality was 4% in the review, which is lower than reported for treatment with pharmacotherapy alone (10-12.5%). INTERPRETATION DBS is a feasible intervention with potential to reverse refractory pediatric SD and improve survival. More work is needed to increase awareness of DBS in this setting, so that it can be implemented in a timely manner. ANN NEUROL 2023.
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Affiliation(s)
- Lindsey M Vogt
- Division of Neurology, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Han Yan
- Division of Neurology, Hospital for Sick Children, Toronto, Ontario, Canada
- Division of Neurosurgery, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Brendan Santyr
- Krembil Brain Institute, Toronto, Ontario, Canada
- Center for Advancing Neurotechnological Innovation to Application, Toronto, Ontario, Canada
| | - Sara Breitbart
- Division of Neurosurgery, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Melanie Anderson
- Library Services, University Health Network, Toronto, Ontario, Canada
| | - Jürgen Germann
- Krembil Brain Institute, Toronto, Ontario, Canada
- Center for Advancing Neurotechnological Innovation to Application, Toronto, Ontario, Canada
| | - Karlo J Lizarraga
- Motor Physiology and Neuromodulation Program, Division of Movement Disorders, Department of Neurology, University of Rochester Medical Center, Rochester, NY, USA
| | - Angela L Hewitt
- Motor Physiology and Neuromodulation Program, Division of Movement Disorders, Department of Neurology, University of Rochester Medical Center, Rochester, NY, USA
- Division of Child Neurology, Department of Neurology, University of Rochester Medical Center, Rochester, NY, USA
| | - Alfonso Fasano
- Krembil Brain Institute, Toronto, Ontario, Canada
- Center for Advancing Neurotechnological Innovation to Application, Toronto, Ontario, Canada
- Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
- Division of Neurology, University of Toronto, Toronto, Ontario, Canada
| | - George M Ibrahim
- Division of Neurosurgery, Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
- Institute of Biomedical Engineering, University of Toronto, Toronto, Ontario, Canada
| | - Carolina Gorodetsky
- Division of Neurology, Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
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Youn J, Slow E, Chen R, Lozano AM, Fasano A. Pallidal Deep Brain Stimulation for Refractory Celiac-Related Myoclonus. J Mov Disord 2023; 16:325-327. [PMID: 37291831 PMCID: PMC10548079 DOI: 10.14802/jmd.23006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Revised: 03/01/2023] [Accepted: 04/15/2023] [Indexed: 06/10/2023] Open
Affiliation(s)
- Jinyoung Youn
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Neuroscience Center, Samsung Medical Center, Seoul, Korea
- Edmond J. Safra Program in Parkinson’s Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, University Health Network, Toronto, ON, Canada
- Division of Neurology, University of Toronto, Toronto, ON, Canada
| | - Elizabeth Slow
- Edmond J. Safra Program in Parkinson’s Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, University Health Network, Toronto, ON, Canada
- Division of Neurology, University of Toronto, Toronto, ON, Canada
| | - Robert Chen
- Edmond J. Safra Program in Parkinson’s Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, University Health Network, Toronto, ON, Canada
- Division of Neurology, University of Toronto, Toronto, ON, Canada
- Division of Brain, Imaging and Behavior, Systems Neuroscience, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Andres M. Lozano
- Krembil Brain Institute, Toronto, ON, Canada
- Division of Neurosurgery, University of Toronto, Toronto, ON, Canada
| | - Alfonso Fasano
- Edmond J. Safra Program in Parkinson’s Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, University Health Network, Toronto, ON, Canada
- Division of Neurology, University of Toronto, Toronto, ON, Canada
- Krembil Brain Institute, Toronto, ON, Canada
- Center for Advancing Neurotechnological Innovation to Application (CRANIA), Toronto, ON, Canada
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Di Luca DG, Grippe TC, Adams J, Chen R, Fasano A, Lozano A, Lang AE. Generalized Dystonia With Tremor and Myoclonus Associated With ANO3 Variant. Can J Neurol Sci 2023:1-3. [PMID: 37641940 DOI: 10.1017/cjn.2023.282] [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] [Indexed: 08/31/2023]
Affiliation(s)
- Daniel G Di Luca
- Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, UHN, Toronto, ON, Canada
- Division of Neurology, University of Toronto, Toronto, ON, Canada
- Krembil Brain Institute, Toronto, ON, Canada
- Department of Neurology, Washington University in St. Louis, St. Louis, MO, USA
| | - Talyta C Grippe
- Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, UHN, Toronto, ON, Canada
- Division of Neurology, University of Toronto, Toronto, ON, Canada
- Krembil Brain Institute, Toronto, ON, Canada
| | - John Adams
- Ashgrove Medical Centre, Markham, ON, Canada
| | - Robert Chen
- Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, UHN, Toronto, ON, Canada
- Division of Neurology, University of Toronto, Toronto, ON, Canada
- Krembil Brain Institute, Toronto, ON, Canada
| | - Alfonso Fasano
- Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, UHN, Toronto, ON, Canada
- Division of Neurology, University of Toronto, Toronto, ON, Canada
- Krembil Brain Institute, Toronto, ON, Canada
| | - Andres Lozano
- Krembil Brain Institute, Toronto, ON, Canada
- Department of Neurosurgery, Toronto Western Hospital, University of Toronto, Toronto, ON, Canada
| | - Anthony E Lang
- Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, UHN, Toronto, ON, Canada
- Division of Neurology, University of Toronto, Toronto, ON, Canada
- Krembil Brain Institute, Toronto, ON, Canada
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33
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Wolke R, Becktepe JS, Paschen S, Helmers A, Kübler‐Weller D, Youn J, Brinker D, Bergman H, Kühn AA, Fasano A, Deuschl G. The Role of Levodopa Challenge in Predicting the Outcome of Subthalamic Deep Brain Stimulation. Mov Disord Clin Pract 2023; 10:1181-1191. [PMID: 37635781 PMCID: PMC10450242 DOI: 10.1002/mdc3.13825] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 05/14/2023] [Accepted: 06/14/2023] [Indexed: 08/29/2023] Open
Abstract
Background Deep brain stimulation of the subthalamic nucleus (STN-DBS) is an effective and evidence-based treatment for idiopathic Parkinson's disease (iPD). A minority of patients does not sufficiently benefit from STN-DBS. Objective The predictive validity of the levodopa challenge for individual patients is analyzed. Methods Data from patients assessed with a preoperative Levodopa-test and a follow-up examination (mean ± standard deviation: 9.15 months ±3.39) from Kiel (n = 253), Berlin (n = 78) and Toronto (n = 98) were studied. Insufficient DBS outcome was defined as an overall UPDRS-III reduction <33% compared to UPDRS-III in med-off at baseline or alternatively if the minimal clinically important improvement of 5 points was not reached. Single UPDRS-items and sub-scores were dichotomized. Following exploratory analysis, we trained supervised regression- and classification models for outcome prediction. Results Data analysis confirmed significant correlation between the absolute UPDRS-III reduction during Levodopa challenge and after stimulation. But individual improvement was inaccurately predicted with a large range of up to 30 UPDRS III points. Further analysis identified preoperative UPDRS-III/med-off-scores and preoperative Levodopa-improvement as most influential factors. The models for UPDRS-III and sub-scores improvement achieved comparably low accuracy. Conclusions With large prediction intervals, the Levodopa challenge use for patient counseling is limited, though remains important for excluding non-responders to Levodopa. Despite these deficiencies, the current practice of patient selection is highly successful and builds not only on the Levodopa challenge. However, more specific motor tasks and further paraclinical tools for prediction need to be developed.
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Affiliation(s)
- Robin Wolke
- Department of NeurologyUKSH, Christian‐Albrechts University KielKielGermany
| | | | - Steffen Paschen
- Department of NeurologyUKSH, Christian‐Albrechts University KielKielGermany
| | - Ann‐Kristin Helmers
- Department of NeurosurgeryUKSH, Christian‐Albrechts University KielKielGermany
| | - Dorothee Kübler‐Weller
- Movement Disorder and Neuromodulation Unit, Department of NeurologyCharité–UniversitätsmedizinBerlinGermany
| | - Jinyoung Youn
- Department of Neurology, Samsung Medical CenterSchool of medicine Sungkyunkwan UniversitySeoulSouth Korea
| | - Dana Brinker
- Department of NeurologyUKSH, Christian‐Albrechts University KielKielGermany
| | - Hagai Bergman
- The Edmond andLily Safra Center for Brain Sciences (ELSC)The Hebrew UniversityJerusalemIsrael
- Department of Medical Neurobiology (Physiology), Institute of Medical Research‐Israel Canada (IMRIC), Faculty of MedicineThe Hebrew UniversityJerusalemIsrael
- Department of Neurosurgery, Hadassah Medical CenterThe Hebrew UniversityJerusalemIsrael
| | - Andrea A. Kühn
- Movement Disorder and Neuromodulation Unit, Department of NeurologyCharité–UniversitätsmedizinBerlinGermany
| | - Alfonso Fasano
- Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders ClinicToronto Western Hospital, UHNTorontoOntarioCanada
- Division of NeurologyUniversity of TorontoTorontoOntarioCanada
- Krembil Brain InstituteTorontoOntarioCanada
- Center for Advancing Neurotechnological Innovation to Application (CRANIA)TorontoOntarioCanada
| | - Günther Deuschl
- Department of NeurologyUKSH, Christian‐Albrechts University KielKielGermany
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Espay AJ, Fasano A. The Existential Essentialism in Tremor Nosology - 7 Pitfalls, 2 Remedies, and a Path Ahead. Mov Disord Clin Pract 2023; 10:S36-S41. [PMID: 37637985 PMCID: PMC10448133 DOI: 10.1002/mdc3.13622] [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: 04/22/2022] [Revised: 05/23/2022] [Accepted: 06/02/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
- Alberto J. Espay
- James J and Joan A Gardner Family Center for Parkinson's Disease and Movement Disorders, Department of NeurologyUniversity of CincinnatiCincinnatiOhioUSA
| | - Alfonso Fasano
- Edmond J. Safra Program in Parkinson's DiseaseMorton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, UHN, Division of Neurology, University of TorontoTorontoOntarioCanada
- Krembil Research InstituteTorontoOntarioCanada
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35
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Justich MB, Rojas OL, Fasano A. The Role of Helicobacter pylori and Small Intestinal Bacterial Overgrowth in Parkinson's Disease. Semin Neurol 2023; 43:553-561. [PMID: 37562451 DOI: 10.1055/s-0043-1771468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/12/2023]
Abstract
Parkinson's disease (PD) is a common neurodegenerative disorder whose etiology remains largely unexplained. Several studies have aimed to describe a causative effect in the interactions between the gastrointestinal tract and the brain, for both PD pathogenesis and disease course. However, the results have been controversial. Helicobacter pylori and small intestinal bacterial overgrowth (SIBO) are theorized to be agents capable of triggering chronic proinflammatory changes with a possible neurotoxic effect, as well as a cause of erratic L-dopa response in PD patients. This review evaluates the individual and possibly synergistic influence of H. pylori and SIBO on PD, to provide an opportunity to consider prospective therapeutic approaches.
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Affiliation(s)
- Maria Belen Justich
- Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
- Division of Neurology, University of Toronto, Toronto, Ontario, Canada
| | - Olga L Rojas
- Krembil Brain Institute, University Health Network, Toronto, Ontario, Canada
- Department of Immunology, University of Toronto, Ontario, Canada
| | - Alfonso Fasano
- Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
- Division of Neurology, University of Toronto, Toronto, Ontario, Canada
- Department of Parkinson's Disease and Movement Disorders Rehabilitation, Moriggia-Pelascini Hospital - Gravedona ed Uniti, Como, Italy
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36
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Fung WK, Fasano A, Fearon C. Movement Disorders and SARS-CoV-2. Mov Disord Clin Pract 2023; 10:S9-S17. [PMID: 37637980 PMCID: PMC10448146 DOI: 10.1002/mdc3.13615] [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: 04/23/2022] [Accepted: 05/02/2022] [Indexed: 11/16/2022] Open
Affiliation(s)
- Wilson K.W. Fung
- Division of Neurology, Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital – UHNUniversity of TorontoTorontoOntarioCanada
| | - Alfonso Fasano
- Division of Neurology, Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital – UHNUniversity of TorontoTorontoOntarioCanada
- Krembil Research InstituteTorontoOntarioCanada
- Center for Advancing Neurotechnological Innovation to Application (CRANIA)TorontoOntarioCanada
- Department of Parkinson's Disease and Movement Disorders Rehabilitation‘Moriggia‐Pelascini’ Hospital – Gravedona ed UnitiComoItaly
| | - Conor Fearon
- Division of Neurology, Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital – UHNUniversity of TorontoTorontoOntarioCanada
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Abstract
Background Punding is a stereotyped behavior characterized by an intense fascination with a complex, excessive, non-goal oriented, repetitive activity affecting individuals with Parkinson's disease (PD) on dopamine replacement therapy (DRT). Objectives In 2010, we published the first review focused on the pathophysiology of punding. This study aims to systematically review the literature of the past decade on punding in PD, particularly focusing on the clinical features, underlying pathophysiological mechanisms, and treatment. Methods Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, we searched PubMed, Embase, and APA PsycInfo for articles published between July 1, 2010 and March 19, 2022. The search strategy included: (punding) AND (parkinson*). Results Of 256 studies identified, 29 were eligible for inclusion with 19 original research articles and 10 case reports. This review confirmed that predictors of punding in PD are higher doses of DRT, younger age, male sex, and increasing disease severity. We also found an association between punding and psychiatric and/or cognitive symptoms. Neuroimaging studies have showed that punding in PD is associated with a disconnection between midbrain, limbic and white matter tracts projecting to the frontal cortices and a breakdown of the connectivity among the crucial nodes of the reward circuit. Low-frequency repetitive transcranial magnetic stimulation on the dorsolateral prefrontal cortex has been shown to produce a transient beneficial effect in PD patients with punding. Conclusion In conclusion, although the clinical features of punding have been established, in the past 12 years, we gained a better understanding of the pathophysiological mechanisms of punding, mainly thanks to magnetic resonance imaging techniques.
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Affiliation(s)
- Rajasumi Rajalingam
- Edmond J. Safra Program in Parkinson's Disease and Morton and Gloria Shulman Movement Disorders ClinicToronto Western Hospital, UHNTorontoOntarioCanada
- Institute of Medical ScienceUniversity of TorontoTorontoOntarioCanada
| | - Alfonso Fasano
- Edmond J. Safra Program in Parkinson's Disease and Morton and Gloria Shulman Movement Disorders ClinicToronto Western Hospital, UHNTorontoOntarioCanada
- Division of NeurologyUniversity of TorontoTorontoOntarioCanada
- Krembil Research InstituteTorontoOntarioCanada
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Ferreira Felloni Borges Y, Cheyuo C, Lozano AM, Fasano A. Essential Tremor - Deep Brain Stimulation vs. Focused Ultrasound. Expert Rev Neurother 2023; 23:603-619. [PMID: 37288812 DOI: 10.1080/14737175.2023.2221789] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 06/01/2023] [Indexed: 06/09/2023]
Abstract
INTRODUCTION Essential Tremor (ET) is one of the most common tremor syndromes typically presented as action tremor, affecting mainly the upper limbs. In at least 30-50% of patients, tremor interferes with quality of life, does not respond to first-line therapies and/or intolerable adverse effects may occur. Therefore, surgery may be considered. AREAS COVERED In this review, the authors discuss and compare unilateral ventral intermedius nucleus deep brain stimulation (VIM DBS) and bilateral DBS with Magnetic Resonance-guided Focused Ultrasound (MRgFUS) thalamotomy, which comprises focused acoustic energy generating ablation under real-time MRI guidance. Discussion includes their impact on tremor reduction and their potential complications. Finally, the authors provide their expert opinion. EXPERT OPINION DBS is adjustable, potentially reversible and allows bilateral treatments; however, it is invasive requires hardware implantation, and has higher surgical risks. Instead, MRgFUS is less invasive, less expensive, and requires no hardware maintenance. Beyond these technical differences, the decision should also involve the patient, family, and caregivers.
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Affiliation(s)
- Yuri Ferreira Felloni Borges
- Edmond J. Safra Program in Parkinson's Disease, Division of Neurology, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, UHN, University of Toronto, Toronto, ON, Canada
| | - Cletus Cheyuo
- Division of Neurosurgery, Toronto Western Hospital, University Health Network, Toronto, ON, Canada
| | - Andres M Lozano
- Division of Neurosurgery, Toronto Western Hospital, University Health Network, Toronto, ON, Canada
- Krembil Brain Institute, Toronto, ON, Canada
| | - Alfonso Fasano
- Edmond J. Safra Program in Parkinson's Disease, Division of Neurology, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, UHN, University of Toronto, Toronto, ON, Canada
- Krembil Brain Institute, Toronto, ON, Canada
- Center for Advancing Neurotechnological Innovation to Application (CRANIA), Toronto, ON, Canada
- Department of Parkinson's Disease & Movement Disorders Rehabilitation, Moriggia-Pelascini Hospital, Gravedona Ed Uniti, Como, Italy
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Thompson JA, Hirt L, David‐Gerecht P, Fasano A, Kramer DR, Ojemann SG, Kern DS. Comparison of Monopolar Review to Fixed Parameter Fractionation in Deep Brain Stimulation. Mov Disord Clin Pract 2023; 10:987-991. [PMID: 37332654 PMCID: PMC10272899 DOI: 10.1002/mdc3.13750] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 02/21/2023] [Accepted: 03/29/2023] [Indexed: 06/20/2023] Open
Abstract
Background Technological advancements in deep brain stimulation (DBS) require methodological changes in programming. Fractionalization poses significant practical challenges for the most common approach for assessing DBS efficacy, monopolar review (MR). Objectives Two DBS programming methods: MR and fixed parameter vertical and horizontal fractionalization (FPF) were compared. Methods A two-phase process of vertical and horizontal FPF was performed. MR was conducted thereafter. After a short wash-out period, both optimal configurations determined by MR and FPF were tested in a double-blind randomized manner. Results Seven PD patients were enrolled, providing 11 hemispheres to compare the two conditions. In all subjects, the blinded examiner selected a directional or fractionalization configuration. There was no significant difference in clinical benefits between MR and FPF. FPF was the preferred method for initial programming as selected by subject and clinician. Conclusions FPF programming is a viable and efficient methodology that may be incorporated into clinical practice.
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Affiliation(s)
- John A. Thompson
- Department of NeurologyUniversity of Colorado School of MedicineAuroraColoradoUSA
- Department of NeurosurgeryUniversity of Colorado School of MedicineAuroraColoradoUSA
| | - Lisa Hirt
- Department of NeurosurgeryUniversity of Colorado School of MedicineAuroraColoradoUSA
| | - Pamela David‐Gerecht
- Department of NeurosurgeryUniversity of Colorado School of MedicineAuroraColoradoUSA
| | - Alfonso Fasano
- Department of NeurologyUniversity of TorontoTorontoOntarioUSA
| | - Daniel R. Kramer
- Department of NeurosurgeryUniversity of Colorado School of MedicineAuroraColoradoUSA
| | - Steven G. Ojemann
- Department of NeurologyUniversity of Colorado School of MedicineAuroraColoradoUSA
- Department of NeurosurgeryUniversity of Colorado School of MedicineAuroraColoradoUSA
| | - Drew S. Kern
- Department of NeurologyUniversity of Colorado School of MedicineAuroraColoradoUSA
- Department of NeurosurgeryUniversity of Colorado School of MedicineAuroraColoradoUSA
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Grippe T, Fasano A, Chen R. Different types of tremor and myoclonus in an atypical case of shaking upon standing. Parkinsonism Relat Disord 2023; 111:105175. [PMID: 37271568 DOI: 10.1016/j.parkreldis.2022.09.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 08/22/2022] [Accepted: 09/21/2022] [Indexed: 06/06/2023]
Abstract
Shaking upon standing is associated with a spectrum of different conditions. We describe an unusual case with a combination of slow orthostatic tremor, orthostatic myoclonus, and parkinsonism. The case illustrates the utility of electrophysiology for precise characterization of physical findings to establish the diagnosis.
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Affiliation(s)
- Talyta Grippe
- Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, UHN, Toronto, Ontario, Canada; Neuroscience Graduate Program, Federal University of Minas Gerais, Belo Horizonte, Brazil; Division of Neurology, University of Toronto, Toronto, Ontario, Canada
| | - Alfonso Fasano
- Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, UHN, Toronto, Ontario, Canada; Krembil Brain Institute, Toronto, Ontario, Canada; Center for Advancing Neurotechnological Innovation to Application (CRANIA), Canada; Department of Parkinson's Disease & Movement Disorders Rehabilitation, Moriggia-Pelascini Hospital - Gravedona ed Uniti, Como, 22015, Italy; Division of Neurology, University of Toronto, Toronto, Ontario, Canada
| | - Robert Chen
- Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, UHN, Toronto, Ontario, Canada; Krembil Brain Institute, Toronto, Ontario, Canada; Center for Advancing Neurotechnological Innovation to Application (CRANIA), Canada; Division of Neurology, University of Toronto, Toronto, Ontario, Canada.
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Schlienger S, Yam PT, Balekoglu N, Ducuing H, Michaud JF, Makihara S, Kramer DK, Chen B, Fasano A, Berardelli A, Hamdan FF, Rouleau GA, Srour M, Charron F. Genetics of mirror movements identifies a multifunctional complex required for Netrin-1 guidance and lateralization of motor control. Sci Adv 2023; 9:eadd5501. [PMID: 37172092 PMCID: PMC10181192 DOI: 10.1126/sciadv.add5501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 04/06/2023] [Indexed: 05/14/2023]
Abstract
Mirror movements (MM) disorder is characterized by involuntary movements on one side of the body that mirror intentional movements on the opposite side. We performed genetic characterization of a family with autosomal dominant MM and identified ARHGEF7, a RhoGEF, as a candidate MM gene. We found that Arhgef7 and its partner Git1 bind directly to Dcc. Dcc is the receptor for Netrin-1, an axon guidance cue that attracts commissural axons to the midline, promoting the midline crossing of axon tracts. We show that Arhgef7 and Git1 are required for Netrin-1-mediated axon guidance and act as a multifunctional effector complex. Arhgef7/Git1 activates Rac1 and Cdc42 and inhibits Arf1 downstream of Netrin-1. Furthermore, Arhgef7/Git1, via Arf1, mediates the Netrin-1-induced increase in cell surface Dcc. Mice heterozygous for Arhgef7 have defects in commissural axon trajectories and increased symmetrical paw placements during skilled walking, a MM-like phenotype. Thus, we have delineated how ARHGEF7 mutation causes MM.
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Affiliation(s)
- Sabrina Schlienger
- Montreal Clinical Research Institute (IRCM), 110 Pine Avenue West, Montreal, QC H2W 1R7, Canada
- Department of Anatomy and Cell Biology, Division of Experimental Medicine, McGill University, Montreal, QC H3A 0G4, Canada
| | - Patricia T. Yam
- Montreal Clinical Research Institute (IRCM), 110 Pine Avenue West, Montreal, QC H2W 1R7, Canada
| | - Nursen Balekoglu
- Montreal Clinical Research Institute (IRCM), 110 Pine Avenue West, Montreal, QC H2W 1R7, Canada
- Integrated Program in Neuroscience, McGill University, Montreal, QC H3A 2B4, Canada
| | - Hugo Ducuing
- Montreal Clinical Research Institute (IRCM), 110 Pine Avenue West, Montreal, QC H2W 1R7, Canada
| | - Jean-Francois Michaud
- Montreal Clinical Research Institute (IRCM), 110 Pine Avenue West, Montreal, QC H2W 1R7, Canada
| | - Shirin Makihara
- Montreal Clinical Research Institute (IRCM), 110 Pine Avenue West, Montreal, QC H2W 1R7, Canada
- Integrated Program in Neuroscience, McGill University, Montreal, QC H3A 2B4, Canada
| | - Daniel K. Kramer
- Roy J. Carver Department of Biochemistry, Biophysics and Molecular Biology, Iowa State University, Ames, IA 50011, USA
| | - Baoyu Chen
- Roy J. Carver Department of Biochemistry, Biophysics and Molecular Biology, Iowa State University, Ames, IA 50011, USA
| | - Alfonso Fasano
- Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, UHN, Toronto, ON, Canada
- Division of Neurology, University of Toronto, Toronto, ON, Canada
- Krembil Brain Institute, Toronto, ON, Canada
| | - Alfredo Berardelli
- IRCCS Neuromed, Pozzilli (IS), Italy
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Fadi F. Hamdan
- Division of Medical Genetics, Department of Pediatrics, CHU Sainte-Justine and University of Montreal, Montreal, QC H3T1C5, Canada
| | - Guy A. Rouleau
- Division of Medical Genetics, Department of Pediatrics, CHU Sainte-Justine and University of Montreal, Montreal, QC H3T1C5, Canada
- Department of Human Genetics, Montreal Neurological Institute and Hospital, McGill University, Montreal, QC, Canada
| | - Myriam Srour
- Department of Neurology and Neurosurgery, McGill University, Montreal, QC H3A 2B4, Canada
- Department of Pediatrics, Division of Pediatric Neurology, McGill University, Montreal, QC H4A 3J1, Canada
- McGill University Health Center Research Institute, Montreal, QC H4A 3J1, Canada
| | - Frederic Charron
- Montreal Clinical Research Institute (IRCM), 110 Pine Avenue West, Montreal, QC H2W 1R7, Canada
- Department of Anatomy and Cell Biology, Division of Experimental Medicine, McGill University, Montreal, QC H3A 0G4, Canada
- Integrated Program in Neuroscience, McGill University, Montreal, QC H3A 2B4, Canada
- Department of Medicine, University of Montreal, Montreal, QC H3T 1J4, Canada
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Jost ST, Kaldenbach MA, Antonini A, Martinez-Martin P, Timmermann L, Odin P, Katzenschlager R, Borgohain R, Fasano A, Stocchi F, Hattori N, Kukkle PL, Rodríguez-Violante M, Falup-Pecurariu C, Schade S, Petry-Schmelzer JN, Metta V, Weintraub D, Deuschl G, Espay AJ, Tan EK, Bhidayasiri R, Fung VSC, Cardoso F, Trenkwalder C, Jenner P, Ray Chaudhuri K, Dafsari HS. Levodopa Dose Equivalency in Parkinson's Disease: Updated Systematic Review and Proposals. Mov Disord 2023. [PMID: 37147135 DOI: 10.1002/mds.29410] [Citation(s) in RCA: 24] [Impact Index Per Article: 24.0] [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: 10/28/2022] [Revised: 03/07/2023] [Accepted: 03/29/2023] [Indexed: 05/07/2023] Open
Abstract
BACKGROUND To compare drug regimens across clinical trials in Parkinson's disease (PD) conversion formulae between antiparkinsonian drugs have been developed. These are reported in relation to levodopa as the benchmark drug in PD pharmacotherapy as 'levodopa equivalent dose' (LED). Currently, the LED conversion formulae proposed in 2010 by Tomlinson et al. based on a systematic review are predominantly used. However, new drugs with established and novel mechanisms of action and novel formulations of longstanding drugs have been developed since 2010. Therefore, consensus proposals for updated LED conversion formulae are needed. OBJECTIVES To update LED conversion formulae based on a systematic review. METHODS The MEDLINE, CENTRAL, and Embase databases were searched from January 2010 to July 2021. Additionally, in a standardized process according to the GRADE grid method, consensus proposals were issued for drugs with scarce data on levodopa dose equivalency. RESULTS The systematic database search yielded 3076 articles of which 682 were eligible for inclusion in the systematic review. Based on these data and the standardized consensus process, we present proposals for LED conversion formulae for a wide range of drugs that are currently available for the pharmacotherapy of PD or are expected to be introduced soon. CONCLUSIONS The LED conversion formulae issued in this Position Paper will serve as a research tool to compare the equivalence of antiparkinsonian medication across PD study cohorts and facilitate research on the clinical efficacy of pharmacological and surgical treatments as well as other non-pharmacological interventions in PD. © 2023 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Stefanie T Jost
- Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Marie-Ann Kaldenbach
- Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Angelo Antonini
- Parkinson and Movement Disorders Unit, Department of Neurosciences (DNS), University of Padua, Padova, Italy
| | - Pablo Martinez-Martin
- Center for Networked Biomedical Research in Neurodegenerative Diseases (CIBERNED), Carlos III Institute of Health, Madrid, Spain
| | - Lars Timmermann
- Department of Neurology, University Hospital Giessen and Marburg, Marburg, Germany
| | - Per Odin
- Division of Neurology, Lund University, Lund, Sweden
- Department of Neurology, Skåne University Hospital, Lund, Sweden
| | - Regina Katzenschlager
- Department of Neurology, Karl Landsteiner Institute for Neuroimmunological and Neurodegenerative Disorders at Klinik Donaustadt, Vienna, Austria
| | - Rupam Borgohain
- Department of Neurology, Nizam's Institute of Medical Sciences, Hyderabad, India
| | - Alfonso Fasano
- Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital-University Health Network (UHN), Toronto, Ontario, Canada
- Division of Neurology, University of Toronto, Toronto, Ontario, Canada
- Krembil Research Institute, Toronto, Ontario, Canada
- Department of Parkinson's Disease & Movement Disorders Rehabilitation, Moriggia-Pelascini Hospital-Gravedona ed Uniti, Como, Italy
| | - Fabrizio Stocchi
- University and Institute for Research and Medical Care IRCCS San Raffaele, Rome, Italy
| | - Nobutaka Hattori
- Department of Neurology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Prashanth Lingappa Kukkle
- Center for Parkinson's Disease and Movement Disorders, Manipal Hospital, Bangalore, India
- Parkinson's Disease and Movement Disorders Clinic, Bangalore, India
| | - Mayela Rodríguez-Violante
- Insituto Nacional de Neurologia y Neurocirugia, Movement Disorders Clinic, Mexico City, Mexico
- Movement Disorder Clinic, National Institute of Neurology and Neurosurgery, Mexico City, Mexico
| | - Cristian Falup-Pecurariu
- Department of Neurology, Faculty of Medicine, Transilvania University of Brașov, Brașov, Romania
- Department of Neurology, County Emergency Clinic Hospital, Brașov, Romania
| | - Sebastian Schade
- Department of Clinical Neurophysiology, University Medical Center Göttingen, Göttingen, Germany
| | - Jan Niklas Petry-Schmelzer
- Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Vinod Metta
- Parkinson Foundation International Centre of Excellence, King's College Hospital, London, United Kingdom
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Daniel Weintraub
- Departments of Psychiatry and Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Parkinson's Disease Research, Education and Clinical Center (PADRECC), Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania, USA
| | - Guenther Deuschl
- Department of Neurology, University Hospital Schleswig-Holstein (UKSH), Christian-Albrechts-University Kiel, Kiel, Germany
| | - Alberto J Espay
- University of Cincinnati Gardner Neuroscience Institute, Gardner Family Center for Parkinson's Disease and Movement Disorders, Department of Neurology, University of Cincinnati, Cincinnati, Ohio, USA
| | - Eng-King Tan
- Department of Neurology, National Neuroscience Institute, Singapore General Hospital, Singapore, Singapore
- Neuroscience and Behavioral Disorders (NBD) Department, Duke-NUS Medical School, Singapore, Singapore
| | - Roongroj Bhidayasiri
- Chulalongkorn Centre of Excellence for Parkinson's Disease & Related Disorders, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
- The Academy of Science, The Royal Society of Thailand, Bangkok, Thailand
| | - Victor S C Fung
- Movement Disorder Unit, Department of Neurology, Westmead Hospital, Westmead, Australia
| | - Francisco Cardoso
- Movement Disorders Unit, Internal Medicine Department, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Claudia Trenkwalder
- Paracelsus-Elena-Klinik, Kassel, Germany
- Department of Neurosurgery, University Medical Center Göttingen, Göttingen, Germany
| | - Peter Jenner
- Institute of Pharmaceutical Sciences, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom
| | - K Ray Chaudhuri
- Department of Neurology, County Emergency Clinic Hospital, Brașov, Romania
- Department of Clinical Neurophysiology, University Medical Center Göttingen, Göttingen, Germany
- NIHR Mental Health Biomedical Research Centre and Dementia Biomedical Research Unit, South London and Maudsley NHS Foundation Trust and King's College London, London, United Kingdom
| | - Haidar S Dafsari
- Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
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Geroin C, Artusi CA, Nonnekes J, Aquino C, Garg D, Dale ML, Schlosser D, Lai Y, Al-Wardat M, Salari M, Wolke R, Labou VT, Imbalzano G, Camozzi S, Merello M, Bloem BR, Capato T, Djaldetti R, Doherty K, Fasano A, Tibar H, Lopiano L, Margraf NG, Moreau C, Ugawa Y, Bhidayasiri R, Tinazzi M. Axial Postural Abnormalities in Parkinsonism: Gaps in Predictors, Pathophysiology, and Management. Mov Disord 2023; 38:732-739. [PMID: 37081741 DOI: 10.1002/mds.29377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 02/14/2023] [Accepted: 02/17/2023] [Indexed: 04/22/2023] Open
Affiliation(s)
- Christian Geroin
- Neurology Unit, Movement Disorders Division, Department of Neurosciences Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Carlo Alberto Artusi
- Department of Neuroscience Rita Levi Montalcini, University of Turin, Torino, Italy
| | - Jorik Nonnekes
- Department of Rehabilitation, Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands
| | - Camila Aquino
- Department of Clinical Neurosciences, and Department of Community Health Sciences, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Divyani Garg
- Department of Neurology, Lady Hardinge Medical College, New Delhi, India
- Department of Neurology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Marian L Dale
- Department of Neurology, Oregon Health and Science University, Portland, Oregon, USA
| | - Darbe Schlosser
- Motor Learning Program, Teachers College, Columbia University, New York, New York, USA
| | - Yijie Lai
- Department of Neurosurgery, Center for Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Mohammad Al-Wardat
- Department of Rehabilitation Sciences, Faculty of Applied Medical Sciences, Jordan University of Science and Technology, Irbid, Jordan
| | - Mehri Salari
- Department of Neurology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Robin Wolke
- Department of Neurology, UKSH, Christian-Albrechts-University, Kiel, Germany
| | | | - Gabriele Imbalzano
- Department of Neuroscience Rita Levi Montalcini, University of Turin, Torino, Italy
| | - Serena Camozzi
- Neurology Unit, Movement Disorders Division, Department of Neurosciences Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Marcelo Merello
- Movement Disorders Service, FLENI, CONICET, Buenos Aires, Argentina
| | - Bastiaan R Bloem
- Department of Neurology, Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands
| | - Tamine Capato
- Department of Neurology, Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands
- Department of Neurology, Movement Disorders Center, University of São Paulo, São Paulo, Brazil
| | - Ruth Djaldetti
- Department of Neurology, Rabin Medical Center, Petah Tikva Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Karen Doherty
- Department of Neurology, Royal Victoria Hospital, Belfast, UK
- Centre for Medical Education, Queens University Belfast, Belfast, UK
| | - Alfonso Fasano
- Krembil Brain Institute, Toronto, Ontario, Canada
- Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, UHN, Toronto, Ontario, Canada
- Division of Neurology, University of Toronto, Toronto, Ontario, Canada
| | - Houyam Tibar
- Service de Neurologie B et de Neurogénétique Hôpital des Spécialités OTO-Neuro-Ophtalmologique, Ibn Sina University Hospital, Medical School of Rabat, Mohamed 5 University of Rabat, Rabat, Morocco
| | - Leonardo Lopiano
- Department of Neuroscience Rita Levi Montalcini, University of Turin, Torino, Italy
- Neurology 2 Unit, A.O.U. Città della Salute e della Scienza di Torino, Torino, Italy
| | - Nils G Margraf
- Department of Neurology, UKSH, Christian-Albrechts-University, Kiel, Germany
| | - Caroline Moreau
- Neurological Department, Expert Center for Parkinson's Disease, Inserm UMR 1172, Lille University Hospital, Lille, France
| | - Yoshikazu Ugawa
- Department of Human Neurophysiology, School of Medicine, Fukushima Medical University, Fukushima, Japan
| | - Roongroj Bhidayasiri
- Department of Medicine, Faculty of Medicine, Chulalongkorn Centre of Excellence for Parkinson's Disease and Related Disorders, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
- The Academy of Science, The Royal Society of Thailand, Bangkok, Thailand
| | - Michele Tinazzi
- Neurology Unit, Movement Disorders Division, Department of Neurosciences Biomedicine and Movement Sciences, University of Verona, Verona, Italy
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Youn J, Gorodetsky C, Lozano AM, Lang AE, Fasano A. Hemiatrophy-hemiparkinsonism and Poland syndrome: A causative or coincidental association? Parkinsonism Relat Disord 2023; 110:105402. [PMID: 37084521 DOI: 10.1016/j.parkreldis.2023.105402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Revised: 04/10/2023] [Accepted: 04/14/2023] [Indexed: 04/23/2023]
Abstract
Despite various neurologic symptoms of Poland syndrome (PS), parkinsonism was never reported in PS, and the response to the treatment of parkinsonism was not studied before. We report a case of ipsilateral parkinsonism in PS, similar to hemiatrophy-hemiparkinsonism, with a good response to levodopa and subthalamic deep brain stimulation.
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Affiliation(s)
- Jinyoung Youn
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea; Neuroscience Center, Samsung Medical Center, Seoul, South Korea; Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, UHN, Toronto, Ontario, Canada; Division of Neurology, University of Toronto, Toronto, Ontario, Canada
| | - Carolina Gorodetsky
- Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, UHN, Toronto, Ontario, Canada; Division of Neurology, University of Toronto, Toronto, Ontario, Canada; Department of Pediatrics, Division of Neurology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Andres M Lozano
- Krembil Brain Institute, Toronto, Ontario, Canada; Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Anthony E Lang
- Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, UHN, Toronto, Ontario, Canada; Division of Neurology, University of Toronto, Toronto, Ontario, Canada; Krembil Brain Institute, Toronto, Ontario, Canada
| | - Alfonso Fasano
- Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, UHN, Toronto, Ontario, Canada; Division of Neurology, University of Toronto, Toronto, Ontario, Canada; Krembil Brain Institute, Toronto, Ontario, Canada.
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Sasikumar S, Sorrento G, Lang AE, Strafella AP, Fasano A. Cognition affects gait adaptation after split-belt treadmill training in Parkinson's disease. Neurobiol Dis 2023; 181:106109. [PMID: 37019221 DOI: 10.1016/j.nbd.2023.106109] [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: 02/21/2023] [Revised: 03/20/2023] [Accepted: 03/27/2023] [Indexed: 04/05/2023] Open
Abstract
BACKGROUND Split-belt treadmill (SBTM) training has been proposed to improve gait symmetry and overall gait performance of patients with Parkinson's disease (PD). OBJECTIVES To determine whether patient's baseline features affect gait adaptation to SBTM in PD with freezing of gait (FOG). METHODS Twenty participants with idiopathic PD and treatment-resistant FOG underwent several clinical assessments including the Toronto Cognitive Assessment (TorCA) prior to treadmill training. Velocity of the treadmill was adjusted to over-ground walking speed. During SBTM training, the belt velocity on the least-affected side was reduced by 25%. RESULTS Participants who adapted to SBTM training demonstrated cognitively intact TorCA scores (p < 0.001), particularly intact working memory (p < 0.001). After-effects correlated with normal total TorCA (p = 0.02), working memory and visuospatial (p < 0.001) function. CONCLUSIONS Cognitive impairment, particularly impaired working memory, reduces gait adaptation and after-effects in PD with FOG. This is informative for trials studying prolonged effects of SBTM training in FOG.
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Affiliation(s)
- Sanskriti Sasikumar
- Division of Neurology, University of Toronto, Toronto, Ontario, Canada; Edmond J. Safra Program in Parkinson's Disease and Morton and Gloria Shulman Movement Disorders Centre, Toronto Western Hospital, UHN, Toronto, Ontario, Canada.
| | - Gianluca Sorrento
- Edmond J. Safra Program in Parkinson's Disease and Morton and Gloria Shulman Movement Disorders Centre, Toronto Western Hospital, UHN, Toronto, Ontario, Canada
| | - Anthony E Lang
- Division of Neurology, University of Toronto, Toronto, Ontario, Canada; Edmond J. Safra Program in Parkinson's Disease and Morton and Gloria Shulman Movement Disorders Centre, Toronto Western Hospital, UHN, Toronto, Ontario, Canada
| | - Antonio P Strafella
- Division of Neurology, University of Toronto, Toronto, Ontario, Canada; Edmond J. Safra Program in Parkinson's Disease and Morton and Gloria Shulman Movement Disorders Centre, Toronto Western Hospital, UHN, Toronto, Ontario, Canada; Division of Brain, Imaging and Behaviour - Systems Neuroscience, Krembil Brain Institute, UHN, University of Toronto, Ontario M5T 2S8, Canada.; Brain Health Imaging Centre, Campbell Family Mental Health Research Institute, CAMH, University of Toronto, Ontario, Canada
| | - Alfonso Fasano
- Division of Neurology, University of Toronto, Toronto, Ontario, Canada; Edmond J. Safra Program in Parkinson's Disease and Morton and Gloria Shulman Movement Disorders Centre, Toronto Western Hospital, UHN, Toronto, Ontario, Canada; Krembil Brain Institute, Toronto, ON, Canada; CenteR for Advancing Neurotechnological Innovation to Application (CRANIA), Toronto, ON, Canada.
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46
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Bologna M, Espay AJ, Fasano A, Paparella G, Hallett M, Berardelli A. Redefining Bradykinesia. Mov Disord 2023; 38:551-557. [PMID: 36847357 PMCID: PMC10387192 DOI: 10.1002/mds.29362] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 01/31/2023] [Accepted: 02/06/2023] [Indexed: 03/01/2023] Open
Affiliation(s)
- Matteo Bologna
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
- IRCCS Neuromed, Pozzilli, Italy
| | - Alberto J. Espay
- Gardner Family Center for Parkinson’s Disease and Movement Disorders, Department of Neurology, University of Cincinnati, Cincinnati, Ohio, USA
| | - Alfonso Fasano
- Edmond J. Safra Program in Parkinson’s Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, UHN, Toronto, Ontario, Canada
- Division of Neurology, University of Toronto, Toronto, Ontario, Canada
- Krembil Brain Institute, Toronto, Ontario, Canada
| | | | - Mark Hallett
- Human Motor Control Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland, USA
| | - Alfredo Berardelli
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
- IRCCS Neuromed, Pozzilli, Italy
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Balachandar A, Boutet A, Vetkas A, Germann J, Chan IY, Mikulis D, Munhoz RP, Fasano A, Kalia SK, Lozano AM. Reply to: Glioblastoma, IDH-Wildtype, CNS WHO Grade 4, Associated with Deep Brain Stimulation in a Patient with Essential Tremor: Report of a Case with Molecular Characterization and Review of the Literature. Mov Disord Clin Pract 2023; 10:529-530. [PMID: 36949794 PMCID: PMC10026296 DOI: 10.1002/mdc3.13673] [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: 01/15/2023] [Accepted: 01/19/2023] [Indexed: 01/28/2023] Open
Affiliation(s)
- Arjun Balachandar
- Division of Neurology, Department of MedicineUniversity of TorontoTorontoOntarioCanada
| | - Alexandre Boutet
- Joint Department of Medical ImagingUniversity of TorontoTorontoOntarioCanada
| | - Artur Vetkas
- Department of Neurosurgery, Toronto Western Hospital, UHNUniversity of TorontoTorontoOntarioCanada
| | - Jurgen Germann
- Department of Neurosurgery, Toronto Western Hospital, UHNUniversity of TorontoTorontoOntarioCanada
| | - Ian Y.M. Chan
- Department of Diagnostic ImagingTrillium Health PartnersMississaugaOntarioCanada
| | - David Mikulis
- Joint Department of Medical ImagingUniversity of TorontoTorontoOntarioCanada
| | - Renato P. Munhoz
- Krembil Research InstituteTorontoOntarioCanada
- Edmond J. Safra Program in Parkinson's Disease and Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, UHN, Division of NeurologyUniversity of TorontoTorontoOntarioCanada
| | - Alfonso Fasano
- Krembil Research InstituteTorontoOntarioCanada
- Edmond J. Safra Program in Parkinson's Disease and Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, UHN, Division of NeurologyUniversity of TorontoTorontoOntarioCanada
| | - Suneil K. Kalia
- Department of Neurosurgery, Toronto Western Hospital, UHNUniversity of TorontoTorontoOntarioCanada
- Krembil Research InstituteTorontoOntarioCanada
| | - Andres M. Lozano
- Department of Neurosurgery, Toronto Western Hospital, UHNUniversity of TorontoTorontoOntarioCanada
- Krembil Research InstituteTorontoOntarioCanada
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Fung WKW, Sa'di Q, Katzberg H, Chen R, Lang A, Cheung AM, Fasano A. Functional disorders as a common motor manifestation of COVID-19 infection or vaccination. Eur J Neurol 2023; 30:678-691. [PMID: 36366936 PMCID: PMC9878181 DOI: 10.1111/ene.15630] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Revised: 10/16/2022] [Accepted: 11/03/2022] [Indexed: 11/13/2022]
Abstract
BACKGROUND AND PURPOSE There have been over 500 million confirmed cases of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), also known as coronavirus disease 2019 (COVID-19), across the globe. To date, a broad spectrum of neurological manifestations following acute infections as well as COVID-19 vaccines have been reported. The aim of this study was to describe the spectrum of neurological manifestations seen in the 'COVID-19 clinic' established in a tertiary Movement Disorders clinic. METHODS In this consecutive case-series study over the period March 2020-January 2022, clinical information regarding demographic data, clinical history and examination findings, investigation results and video recordings of outpatients with motor manifestations associated with COVID-19 infection or vaccination were reviewed. RESULTS Twenty-one adult patients were reviewed in this ad hoc clinic at Toronto Western Hospital. The majority of the patients were female (76%) and the mean (range) age was 50.7 ± 17.2 (21-80) years. Nine patients (43%) presented with motor manifestations following COVID-19 infection. Twelve patients (57%) developed neurological symptoms following at least one dose of the mRNA or viral vector-based COVID-19 vaccine. The most common manifestation observed was a functional movement disorder (43%). The vaccine group demonstrated a higher number of functional disorders compared to the infection group (58% vs. 22%; p = 0.08). CONCLUSION Functional motor manifestations can be associated with COVID-19 and are likely to be under-reported. In view of the co-existence of functional symptoms, movement disorders and mental health conditions observed in this study, we would advocate the use of dedicated COVID-19 Neurology clinics with full access to an experienced multidisciplinary team.
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Affiliation(s)
- Wilson K. W. Fung
- Edmond J. Safra Program in Parkinson's Disease and Morton and Gloria Shulman Movement Disorders ClinicToronto Western Hospital, UHNTorontoOntarioCanada
| | - Qais Sa'di
- Edmond J. Safra Program in Parkinson's Disease and Morton and Gloria Shulman Movement Disorders ClinicToronto Western Hospital, UHNTorontoOntarioCanada
| | - Hans Katzberg
- Division of NeurologyUniversity of TorontoTorontoOntarioCanada
- Krembil Research InstituteTorontoOntarioCanada
| | - Robert Chen
- Edmond J. Safra Program in Parkinson's Disease and Morton and Gloria Shulman Movement Disorders ClinicToronto Western Hospital, UHNTorontoOntarioCanada
- Division of NeurologyUniversity of TorontoTorontoOntarioCanada
- Krembil Research InstituteTorontoOntarioCanada
| | - Anthony E. Lang
- Edmond J. Safra Program in Parkinson's Disease and Morton and Gloria Shulman Movement Disorders ClinicToronto Western Hospital, UHNTorontoOntarioCanada
- Division of NeurologyUniversity of TorontoTorontoOntarioCanada
- Krembil Research InstituteTorontoOntarioCanada
| | - Angela M. Cheung
- Department of MedicineUHNTorontoOntarioCanada
- Faculty of MedicineUniversity of TorontoTorontoOntarioCanada
| | - Alfonso Fasano
- Edmond J. Safra Program in Parkinson's Disease and Morton and Gloria Shulman Movement Disorders ClinicToronto Western Hospital, UHNTorontoOntarioCanada
- Division of NeurologyUniversity of TorontoTorontoOntarioCanada
- Krembil Research InstituteTorontoOntarioCanada
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Krishna V, Fishman PS, Eisenberg HM, Kaplitt M, Baltuch G, Chang JW, Chang WC, Martinez Fernandez R, Del Alamo M, Halpern CH, Ghanouni P, Eleopra R, Cosgrove R, Guridi J, Gwinn R, Khemani P, Lozano AM, McDannold N, Fasano A, Constantinescu M, Schlesinger I, Dalvi A, Elias WJ. Trial of Globus Pallidus Focused Ultrasound Ablation in Parkinson's Disease. N Engl J Med 2023; 388:683-693. [PMID: 36812432 DOI: 10.1056/nejmoa2202721] [Citation(s) in RCA: 21] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
BACKGROUND Unilateral focused ultrasound ablation of the internal segment of globus pallidus has reduced motor symptoms of Parkinson's disease in open-label studies. METHODS We randomly assigned, in a 3:1 ratio, patients with Parkinson's disease and dyskinesias or motor fluctuations and motor impairment in the off-medication state to undergo either focused ultrasound ablation opposite the most symptomatic side of the body or a sham procedure. The primary outcome was a response at 3 months, defined as a decrease of at least 3 points from baseline either in the score on the Movement Disorders Society-Unified Parkinson's Disease Rating Scale, part III (MDS-UPDRS III), for the treated side in the off-medication state or in the score on the Unified Dyskinesia Rating Scale (UDysRS) in the on-medication state. Secondary outcomes included changes from baseline to month 3 in the scores on various parts of the MDS-UPDRS. After the 3-month blinded phase, an open-label phase lasted until 12 months. RESULTS Of 94 patients, 69 were assigned to undergo ultrasound ablation (active treatment) and 25 to undergo the sham procedure (control); 65 patients and 22 patients, respectively, completed the primary-outcome assessment. In the active-treatment group, 45 patients (69%) had a response, as compared with 7 (32%) in the control group (difference, 37 percentage points; 95% confidence interval, 15 to 60; P = 0.003). Of the patients in the active-treatment group who had a response, 19 met the MDS-UPDRS III criterion only, 8 met the UDysRS criterion only, and 18 met both criteria. Results for secondary outcomes were generally in the same direction as those for the primary outcome. Of the 39 patients in the active-treatment group who had had a response at 3 months and who were assessed at 12 months, 30 continued to have a response. Pallidotomy-related adverse events in the active-treatment group included dysarthria, gait disturbance, loss of taste, visual disturbance, and facial weakness. CONCLUSIONS Unilateral pallidal ultrasound ablation resulted in a higher percentage of patients who had improved motor function or reduced dyskinesia than a sham procedure over a period of 3 months but was associated with adverse events. Longer and larger trials are required to determine the effect and safety of this technique in persons with Parkinson's disease. (Funded by Insightec; ClinicalTrials.gov number, NCT03319485.).
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Affiliation(s)
- Vibhor Krishna
- From the University of North Carolina, Chapel Hill (V.K.); University of Maryland, Baltimore (P.S.F., H.M.E.); Cornell University (M.K.) and Columbia University (G.B.) - both in New York; Yonsei University, Seoul (J.W.C.); Chang Bing Show Chwan Memorial Hospital, Lukang, Taiwan (W.-C.C.); Centro Integral de Neurociencias Abarca Campal-HM Puerta Del Sur, Madrid (R.M.F., M.A.), and Clínica Universidad de Navarra, Pamplona (J.G.) - both in Spain; University of Pennsylvania, Philadelphia (C.H.H.); Stanford University, Stanford, CA (P.G.); Foundation IRCCS Neurological Institute Carlo Besta, Milan, Italy (R.E.); Harvard University, Boston (R.C., N.M.); Swedish Hospital, Seattle (R.G., P.K.); University of Toronto, Toronto (A.M.L., A.F.); Rambam Health Care Campus, Haifa, Israel (M.C., I.S.); Palm Beach Neuroscience Institute, Boynton Beach, FL (A.D.); and University of Virginia, Charlottesville (W.J.E.)
| | - Paul S Fishman
- From the University of North Carolina, Chapel Hill (V.K.); University of Maryland, Baltimore (P.S.F., H.M.E.); Cornell University (M.K.) and Columbia University (G.B.) - both in New York; Yonsei University, Seoul (J.W.C.); Chang Bing Show Chwan Memorial Hospital, Lukang, Taiwan (W.-C.C.); Centro Integral de Neurociencias Abarca Campal-HM Puerta Del Sur, Madrid (R.M.F., M.A.), and Clínica Universidad de Navarra, Pamplona (J.G.) - both in Spain; University of Pennsylvania, Philadelphia (C.H.H.); Stanford University, Stanford, CA (P.G.); Foundation IRCCS Neurological Institute Carlo Besta, Milan, Italy (R.E.); Harvard University, Boston (R.C., N.M.); Swedish Hospital, Seattle (R.G., P.K.); University of Toronto, Toronto (A.M.L., A.F.); Rambam Health Care Campus, Haifa, Israel (M.C., I.S.); Palm Beach Neuroscience Institute, Boynton Beach, FL (A.D.); and University of Virginia, Charlottesville (W.J.E.)
| | - Howard M Eisenberg
- From the University of North Carolina, Chapel Hill (V.K.); University of Maryland, Baltimore (P.S.F., H.M.E.); Cornell University (M.K.) and Columbia University (G.B.) - both in New York; Yonsei University, Seoul (J.W.C.); Chang Bing Show Chwan Memorial Hospital, Lukang, Taiwan (W.-C.C.); Centro Integral de Neurociencias Abarca Campal-HM Puerta Del Sur, Madrid (R.M.F., M.A.), and Clínica Universidad de Navarra, Pamplona (J.G.) - both in Spain; University of Pennsylvania, Philadelphia (C.H.H.); Stanford University, Stanford, CA (P.G.); Foundation IRCCS Neurological Institute Carlo Besta, Milan, Italy (R.E.); Harvard University, Boston (R.C., N.M.); Swedish Hospital, Seattle (R.G., P.K.); University of Toronto, Toronto (A.M.L., A.F.); Rambam Health Care Campus, Haifa, Israel (M.C., I.S.); Palm Beach Neuroscience Institute, Boynton Beach, FL (A.D.); and University of Virginia, Charlottesville (W.J.E.)
| | - Michael Kaplitt
- From the University of North Carolina, Chapel Hill (V.K.); University of Maryland, Baltimore (P.S.F., H.M.E.); Cornell University (M.K.) and Columbia University (G.B.) - both in New York; Yonsei University, Seoul (J.W.C.); Chang Bing Show Chwan Memorial Hospital, Lukang, Taiwan (W.-C.C.); Centro Integral de Neurociencias Abarca Campal-HM Puerta Del Sur, Madrid (R.M.F., M.A.), and Clínica Universidad de Navarra, Pamplona (J.G.) - both in Spain; University of Pennsylvania, Philadelphia (C.H.H.); Stanford University, Stanford, CA (P.G.); Foundation IRCCS Neurological Institute Carlo Besta, Milan, Italy (R.E.); Harvard University, Boston (R.C., N.M.); Swedish Hospital, Seattle (R.G., P.K.); University of Toronto, Toronto (A.M.L., A.F.); Rambam Health Care Campus, Haifa, Israel (M.C., I.S.); Palm Beach Neuroscience Institute, Boynton Beach, FL (A.D.); and University of Virginia, Charlottesville (W.J.E.)
| | - Gordon Baltuch
- From the University of North Carolina, Chapel Hill (V.K.); University of Maryland, Baltimore (P.S.F., H.M.E.); Cornell University (M.K.) and Columbia University (G.B.) - both in New York; Yonsei University, Seoul (J.W.C.); Chang Bing Show Chwan Memorial Hospital, Lukang, Taiwan (W.-C.C.); Centro Integral de Neurociencias Abarca Campal-HM Puerta Del Sur, Madrid (R.M.F., M.A.), and Clínica Universidad de Navarra, Pamplona (J.G.) - both in Spain; University of Pennsylvania, Philadelphia (C.H.H.); Stanford University, Stanford, CA (P.G.); Foundation IRCCS Neurological Institute Carlo Besta, Milan, Italy (R.E.); Harvard University, Boston (R.C., N.M.); Swedish Hospital, Seattle (R.G., P.K.); University of Toronto, Toronto (A.M.L., A.F.); Rambam Health Care Campus, Haifa, Israel (M.C., I.S.); Palm Beach Neuroscience Institute, Boynton Beach, FL (A.D.); and University of Virginia, Charlottesville (W.J.E.)
| | - Jin Woo Chang
- From the University of North Carolina, Chapel Hill (V.K.); University of Maryland, Baltimore (P.S.F., H.M.E.); Cornell University (M.K.) and Columbia University (G.B.) - both in New York; Yonsei University, Seoul (J.W.C.); Chang Bing Show Chwan Memorial Hospital, Lukang, Taiwan (W.-C.C.); Centro Integral de Neurociencias Abarca Campal-HM Puerta Del Sur, Madrid (R.M.F., M.A.), and Clínica Universidad de Navarra, Pamplona (J.G.) - both in Spain; University of Pennsylvania, Philadelphia (C.H.H.); Stanford University, Stanford, CA (P.G.); Foundation IRCCS Neurological Institute Carlo Besta, Milan, Italy (R.E.); Harvard University, Boston (R.C., N.M.); Swedish Hospital, Seattle (R.G., P.K.); University of Toronto, Toronto (A.M.L., A.F.); Rambam Health Care Campus, Haifa, Israel (M.C., I.S.); Palm Beach Neuroscience Institute, Boynton Beach, FL (A.D.); and University of Virginia, Charlottesville (W.J.E.)
| | - Wei-Chieh Chang
- From the University of North Carolina, Chapel Hill (V.K.); University of Maryland, Baltimore (P.S.F., H.M.E.); Cornell University (M.K.) and Columbia University (G.B.) - both in New York; Yonsei University, Seoul (J.W.C.); Chang Bing Show Chwan Memorial Hospital, Lukang, Taiwan (W.-C.C.); Centro Integral de Neurociencias Abarca Campal-HM Puerta Del Sur, Madrid (R.M.F., M.A.), and Clínica Universidad de Navarra, Pamplona (J.G.) - both in Spain; University of Pennsylvania, Philadelphia (C.H.H.); Stanford University, Stanford, CA (P.G.); Foundation IRCCS Neurological Institute Carlo Besta, Milan, Italy (R.E.); Harvard University, Boston (R.C., N.M.); Swedish Hospital, Seattle (R.G., P.K.); University of Toronto, Toronto (A.M.L., A.F.); Rambam Health Care Campus, Haifa, Israel (M.C., I.S.); Palm Beach Neuroscience Institute, Boynton Beach, FL (A.D.); and University of Virginia, Charlottesville (W.J.E.)
| | - Raul Martinez Fernandez
- From the University of North Carolina, Chapel Hill (V.K.); University of Maryland, Baltimore (P.S.F., H.M.E.); Cornell University (M.K.) and Columbia University (G.B.) - both in New York; Yonsei University, Seoul (J.W.C.); Chang Bing Show Chwan Memorial Hospital, Lukang, Taiwan (W.-C.C.); Centro Integral de Neurociencias Abarca Campal-HM Puerta Del Sur, Madrid (R.M.F., M.A.), and Clínica Universidad de Navarra, Pamplona (J.G.) - both in Spain; University of Pennsylvania, Philadelphia (C.H.H.); Stanford University, Stanford, CA (P.G.); Foundation IRCCS Neurological Institute Carlo Besta, Milan, Italy (R.E.); Harvard University, Boston (R.C., N.M.); Swedish Hospital, Seattle (R.G., P.K.); University of Toronto, Toronto (A.M.L., A.F.); Rambam Health Care Campus, Haifa, Israel (M.C., I.S.); Palm Beach Neuroscience Institute, Boynton Beach, FL (A.D.); and University of Virginia, Charlottesville (W.J.E.)
| | - Marta Del Alamo
- From the University of North Carolina, Chapel Hill (V.K.); University of Maryland, Baltimore (P.S.F., H.M.E.); Cornell University (M.K.) and Columbia University (G.B.) - both in New York; Yonsei University, Seoul (J.W.C.); Chang Bing Show Chwan Memorial Hospital, Lukang, Taiwan (W.-C.C.); Centro Integral de Neurociencias Abarca Campal-HM Puerta Del Sur, Madrid (R.M.F., M.A.), and Clínica Universidad de Navarra, Pamplona (J.G.) - both in Spain; University of Pennsylvania, Philadelphia (C.H.H.); Stanford University, Stanford, CA (P.G.); Foundation IRCCS Neurological Institute Carlo Besta, Milan, Italy (R.E.); Harvard University, Boston (R.C., N.M.); Swedish Hospital, Seattle (R.G., P.K.); University of Toronto, Toronto (A.M.L., A.F.); Rambam Health Care Campus, Haifa, Israel (M.C., I.S.); Palm Beach Neuroscience Institute, Boynton Beach, FL (A.D.); and University of Virginia, Charlottesville (W.J.E.)
| | - Casey H Halpern
- From the University of North Carolina, Chapel Hill (V.K.); University of Maryland, Baltimore (P.S.F., H.M.E.); Cornell University (M.K.) and Columbia University (G.B.) - both in New York; Yonsei University, Seoul (J.W.C.); Chang Bing Show Chwan Memorial Hospital, Lukang, Taiwan (W.-C.C.); Centro Integral de Neurociencias Abarca Campal-HM Puerta Del Sur, Madrid (R.M.F., M.A.), and Clínica Universidad de Navarra, Pamplona (J.G.) - both in Spain; University of Pennsylvania, Philadelphia (C.H.H.); Stanford University, Stanford, CA (P.G.); Foundation IRCCS Neurological Institute Carlo Besta, Milan, Italy (R.E.); Harvard University, Boston (R.C., N.M.); Swedish Hospital, Seattle (R.G., P.K.); University of Toronto, Toronto (A.M.L., A.F.); Rambam Health Care Campus, Haifa, Israel (M.C., I.S.); Palm Beach Neuroscience Institute, Boynton Beach, FL (A.D.); and University of Virginia, Charlottesville (W.J.E.)
| | - Pejman Ghanouni
- From the University of North Carolina, Chapel Hill (V.K.); University of Maryland, Baltimore (P.S.F., H.M.E.); Cornell University (M.K.) and Columbia University (G.B.) - both in New York; Yonsei University, Seoul (J.W.C.); Chang Bing Show Chwan Memorial Hospital, Lukang, Taiwan (W.-C.C.); Centro Integral de Neurociencias Abarca Campal-HM Puerta Del Sur, Madrid (R.M.F., M.A.), and Clínica Universidad de Navarra, Pamplona (J.G.) - both in Spain; University of Pennsylvania, Philadelphia (C.H.H.); Stanford University, Stanford, CA (P.G.); Foundation IRCCS Neurological Institute Carlo Besta, Milan, Italy (R.E.); Harvard University, Boston (R.C., N.M.); Swedish Hospital, Seattle (R.G., P.K.); University of Toronto, Toronto (A.M.L., A.F.); Rambam Health Care Campus, Haifa, Israel (M.C., I.S.); Palm Beach Neuroscience Institute, Boynton Beach, FL (A.D.); and University of Virginia, Charlottesville (W.J.E.)
| | - Roberto Eleopra
- From the University of North Carolina, Chapel Hill (V.K.); University of Maryland, Baltimore (P.S.F., H.M.E.); Cornell University (M.K.) and Columbia University (G.B.) - both in New York; Yonsei University, Seoul (J.W.C.); Chang Bing Show Chwan Memorial Hospital, Lukang, Taiwan (W.-C.C.); Centro Integral de Neurociencias Abarca Campal-HM Puerta Del Sur, Madrid (R.M.F., M.A.), and Clínica Universidad de Navarra, Pamplona (J.G.) - both in Spain; University of Pennsylvania, Philadelphia (C.H.H.); Stanford University, Stanford, CA (P.G.); Foundation IRCCS Neurological Institute Carlo Besta, Milan, Italy (R.E.); Harvard University, Boston (R.C., N.M.); Swedish Hospital, Seattle (R.G., P.K.); University of Toronto, Toronto (A.M.L., A.F.); Rambam Health Care Campus, Haifa, Israel (M.C., I.S.); Palm Beach Neuroscience Institute, Boynton Beach, FL (A.D.); and University of Virginia, Charlottesville (W.J.E.)
| | - Rees Cosgrove
- From the University of North Carolina, Chapel Hill (V.K.); University of Maryland, Baltimore (P.S.F., H.M.E.); Cornell University (M.K.) and Columbia University (G.B.) - both in New York; Yonsei University, Seoul (J.W.C.); Chang Bing Show Chwan Memorial Hospital, Lukang, Taiwan (W.-C.C.); Centro Integral de Neurociencias Abarca Campal-HM Puerta Del Sur, Madrid (R.M.F., M.A.), and Clínica Universidad de Navarra, Pamplona (J.G.) - both in Spain; University of Pennsylvania, Philadelphia (C.H.H.); Stanford University, Stanford, CA (P.G.); Foundation IRCCS Neurological Institute Carlo Besta, Milan, Italy (R.E.); Harvard University, Boston (R.C., N.M.); Swedish Hospital, Seattle (R.G., P.K.); University of Toronto, Toronto (A.M.L., A.F.); Rambam Health Care Campus, Haifa, Israel (M.C., I.S.); Palm Beach Neuroscience Institute, Boynton Beach, FL (A.D.); and University of Virginia, Charlottesville (W.J.E.)
| | - Jorge Guridi
- From the University of North Carolina, Chapel Hill (V.K.); University of Maryland, Baltimore (P.S.F., H.M.E.); Cornell University (M.K.) and Columbia University (G.B.) - both in New York; Yonsei University, Seoul (J.W.C.); Chang Bing Show Chwan Memorial Hospital, Lukang, Taiwan (W.-C.C.); Centro Integral de Neurociencias Abarca Campal-HM Puerta Del Sur, Madrid (R.M.F., M.A.), and Clínica Universidad de Navarra, Pamplona (J.G.) - both in Spain; University of Pennsylvania, Philadelphia (C.H.H.); Stanford University, Stanford, CA (P.G.); Foundation IRCCS Neurological Institute Carlo Besta, Milan, Italy (R.E.); Harvard University, Boston (R.C., N.M.); Swedish Hospital, Seattle (R.G., P.K.); University of Toronto, Toronto (A.M.L., A.F.); Rambam Health Care Campus, Haifa, Israel (M.C., I.S.); Palm Beach Neuroscience Institute, Boynton Beach, FL (A.D.); and University of Virginia, Charlottesville (W.J.E.)
| | - Ryder Gwinn
- From the University of North Carolina, Chapel Hill (V.K.); University of Maryland, Baltimore (P.S.F., H.M.E.); Cornell University (M.K.) and Columbia University (G.B.) - both in New York; Yonsei University, Seoul (J.W.C.); Chang Bing Show Chwan Memorial Hospital, Lukang, Taiwan (W.-C.C.); Centro Integral de Neurociencias Abarca Campal-HM Puerta Del Sur, Madrid (R.M.F., M.A.), and Clínica Universidad de Navarra, Pamplona (J.G.) - both in Spain; University of Pennsylvania, Philadelphia (C.H.H.); Stanford University, Stanford, CA (P.G.); Foundation IRCCS Neurological Institute Carlo Besta, Milan, Italy (R.E.); Harvard University, Boston (R.C., N.M.); Swedish Hospital, Seattle (R.G., P.K.); University of Toronto, Toronto (A.M.L., A.F.); Rambam Health Care Campus, Haifa, Israel (M.C., I.S.); Palm Beach Neuroscience Institute, Boynton Beach, FL (A.D.); and University of Virginia, Charlottesville (W.J.E.)
| | - Pravin Khemani
- From the University of North Carolina, Chapel Hill (V.K.); University of Maryland, Baltimore (P.S.F., H.M.E.); Cornell University (M.K.) and Columbia University (G.B.) - both in New York; Yonsei University, Seoul (J.W.C.); Chang Bing Show Chwan Memorial Hospital, Lukang, Taiwan (W.-C.C.); Centro Integral de Neurociencias Abarca Campal-HM Puerta Del Sur, Madrid (R.M.F., M.A.), and Clínica Universidad de Navarra, Pamplona (J.G.) - both in Spain; University of Pennsylvania, Philadelphia (C.H.H.); Stanford University, Stanford, CA (P.G.); Foundation IRCCS Neurological Institute Carlo Besta, Milan, Italy (R.E.); Harvard University, Boston (R.C., N.M.); Swedish Hospital, Seattle (R.G., P.K.); University of Toronto, Toronto (A.M.L., A.F.); Rambam Health Care Campus, Haifa, Israel (M.C., I.S.); Palm Beach Neuroscience Institute, Boynton Beach, FL (A.D.); and University of Virginia, Charlottesville (W.J.E.)
| | - Andres M Lozano
- From the University of North Carolina, Chapel Hill (V.K.); University of Maryland, Baltimore (P.S.F., H.M.E.); Cornell University (M.K.) and Columbia University (G.B.) - both in New York; Yonsei University, Seoul (J.W.C.); Chang Bing Show Chwan Memorial Hospital, Lukang, Taiwan (W.-C.C.); Centro Integral de Neurociencias Abarca Campal-HM Puerta Del Sur, Madrid (R.M.F., M.A.), and Clínica Universidad de Navarra, Pamplona (J.G.) - both in Spain; University of Pennsylvania, Philadelphia (C.H.H.); Stanford University, Stanford, CA (P.G.); Foundation IRCCS Neurological Institute Carlo Besta, Milan, Italy (R.E.); Harvard University, Boston (R.C., N.M.); Swedish Hospital, Seattle (R.G., P.K.); University of Toronto, Toronto (A.M.L., A.F.); Rambam Health Care Campus, Haifa, Israel (M.C., I.S.); Palm Beach Neuroscience Institute, Boynton Beach, FL (A.D.); and University of Virginia, Charlottesville (W.J.E.)
| | - Nathan McDannold
- From the University of North Carolina, Chapel Hill (V.K.); University of Maryland, Baltimore (P.S.F., H.M.E.); Cornell University (M.K.) and Columbia University (G.B.) - both in New York; Yonsei University, Seoul (J.W.C.); Chang Bing Show Chwan Memorial Hospital, Lukang, Taiwan (W.-C.C.); Centro Integral de Neurociencias Abarca Campal-HM Puerta Del Sur, Madrid (R.M.F., M.A.), and Clínica Universidad de Navarra, Pamplona (J.G.) - both in Spain; University of Pennsylvania, Philadelphia (C.H.H.); Stanford University, Stanford, CA (P.G.); Foundation IRCCS Neurological Institute Carlo Besta, Milan, Italy (R.E.); Harvard University, Boston (R.C., N.M.); Swedish Hospital, Seattle (R.G., P.K.); University of Toronto, Toronto (A.M.L., A.F.); Rambam Health Care Campus, Haifa, Israel (M.C., I.S.); Palm Beach Neuroscience Institute, Boynton Beach, FL (A.D.); and University of Virginia, Charlottesville (W.J.E.)
| | - Alfonso Fasano
- From the University of North Carolina, Chapel Hill (V.K.); University of Maryland, Baltimore (P.S.F., H.M.E.); Cornell University (M.K.) and Columbia University (G.B.) - both in New York; Yonsei University, Seoul (J.W.C.); Chang Bing Show Chwan Memorial Hospital, Lukang, Taiwan (W.-C.C.); Centro Integral de Neurociencias Abarca Campal-HM Puerta Del Sur, Madrid (R.M.F., M.A.), and Clínica Universidad de Navarra, Pamplona (J.G.) - both in Spain; University of Pennsylvania, Philadelphia (C.H.H.); Stanford University, Stanford, CA (P.G.); Foundation IRCCS Neurological Institute Carlo Besta, Milan, Italy (R.E.); Harvard University, Boston (R.C., N.M.); Swedish Hospital, Seattle (R.G., P.K.); University of Toronto, Toronto (A.M.L., A.F.); Rambam Health Care Campus, Haifa, Israel (M.C., I.S.); Palm Beach Neuroscience Institute, Boynton Beach, FL (A.D.); and University of Virginia, Charlottesville (W.J.E.)
| | - Marius Constantinescu
- From the University of North Carolina, Chapel Hill (V.K.); University of Maryland, Baltimore (P.S.F., H.M.E.); Cornell University (M.K.) and Columbia University (G.B.) - both in New York; Yonsei University, Seoul (J.W.C.); Chang Bing Show Chwan Memorial Hospital, Lukang, Taiwan (W.-C.C.); Centro Integral de Neurociencias Abarca Campal-HM Puerta Del Sur, Madrid (R.M.F., M.A.), and Clínica Universidad de Navarra, Pamplona (J.G.) - both in Spain; University of Pennsylvania, Philadelphia (C.H.H.); Stanford University, Stanford, CA (P.G.); Foundation IRCCS Neurological Institute Carlo Besta, Milan, Italy (R.E.); Harvard University, Boston (R.C., N.M.); Swedish Hospital, Seattle (R.G., P.K.); University of Toronto, Toronto (A.M.L., A.F.); Rambam Health Care Campus, Haifa, Israel (M.C., I.S.); Palm Beach Neuroscience Institute, Boynton Beach, FL (A.D.); and University of Virginia, Charlottesville (W.J.E.)
| | - Ilana Schlesinger
- From the University of North Carolina, Chapel Hill (V.K.); University of Maryland, Baltimore (P.S.F., H.M.E.); Cornell University (M.K.) and Columbia University (G.B.) - both in New York; Yonsei University, Seoul (J.W.C.); Chang Bing Show Chwan Memorial Hospital, Lukang, Taiwan (W.-C.C.); Centro Integral de Neurociencias Abarca Campal-HM Puerta Del Sur, Madrid (R.M.F., M.A.), and Clínica Universidad de Navarra, Pamplona (J.G.) - both in Spain; University of Pennsylvania, Philadelphia (C.H.H.); Stanford University, Stanford, CA (P.G.); Foundation IRCCS Neurological Institute Carlo Besta, Milan, Italy (R.E.); Harvard University, Boston (R.C., N.M.); Swedish Hospital, Seattle (R.G., P.K.); University of Toronto, Toronto (A.M.L., A.F.); Rambam Health Care Campus, Haifa, Israel (M.C., I.S.); Palm Beach Neuroscience Institute, Boynton Beach, FL (A.D.); and University of Virginia, Charlottesville (W.J.E.)
| | - Arif Dalvi
- From the University of North Carolina, Chapel Hill (V.K.); University of Maryland, Baltimore (P.S.F., H.M.E.); Cornell University (M.K.) and Columbia University (G.B.) - both in New York; Yonsei University, Seoul (J.W.C.); Chang Bing Show Chwan Memorial Hospital, Lukang, Taiwan (W.-C.C.); Centro Integral de Neurociencias Abarca Campal-HM Puerta Del Sur, Madrid (R.M.F., M.A.), and Clínica Universidad de Navarra, Pamplona (J.G.) - both in Spain; University of Pennsylvania, Philadelphia (C.H.H.); Stanford University, Stanford, CA (P.G.); Foundation IRCCS Neurological Institute Carlo Besta, Milan, Italy (R.E.); Harvard University, Boston (R.C., N.M.); Swedish Hospital, Seattle (R.G., P.K.); University of Toronto, Toronto (A.M.L., A.F.); Rambam Health Care Campus, Haifa, Israel (M.C., I.S.); Palm Beach Neuroscience Institute, Boynton Beach, FL (A.D.); and University of Virginia, Charlottesville (W.J.E.)
| | - W Jeff Elias
- From the University of North Carolina, Chapel Hill (V.K.); University of Maryland, Baltimore (P.S.F., H.M.E.); Cornell University (M.K.) and Columbia University (G.B.) - both in New York; Yonsei University, Seoul (J.W.C.); Chang Bing Show Chwan Memorial Hospital, Lukang, Taiwan (W.-C.C.); Centro Integral de Neurociencias Abarca Campal-HM Puerta Del Sur, Madrid (R.M.F., M.A.), and Clínica Universidad de Navarra, Pamplona (J.G.) - both in Spain; University of Pennsylvania, Philadelphia (C.H.H.); Stanford University, Stanford, CA (P.G.); Foundation IRCCS Neurological Institute Carlo Besta, Milan, Italy (R.E.); Harvard University, Boston (R.C., N.M.); Swedish Hospital, Seattle (R.G., P.K.); University of Toronto, Toronto (A.M.L., A.F.); Rambam Health Care Campus, Haifa, Israel (M.C., I.S.); Palm Beach Neuroscience Institute, Boynton Beach, FL (A.D.); and University of Virginia, Charlottesville (W.J.E.)
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Bonizzato M, Fasano A. Implementing automation in deep brain stimulation: has the time come? Lancet Digit Health 2023; 5:e52-e53. [PMID: 36528542 DOI: 10.1016/s2589-7500(22)00229-1] [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: 11/14/2022] [Accepted: 11/15/2022] [Indexed: 12/23/2022]
Affiliation(s)
- Marco Bonizzato
- Department of Electrical Engineering and Institute of Biomedical Engineering, Polytechnique Montréal, Montréal, QC, Canada; Department of Neurosciences and Centre interdisciplinaire sur le cerveau et l'apprentissage (CIRCA), Université de Montréal, Montréal, QC, Canada
| | - Alfonso Fasano
- Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, UHN, Toronto, ON M5T 2S8, Canada; Division of Neurology, University of Toronto, Toronto, ON, Canada; Krembil Brain Institute, Toronto, ON, Canada; CenteR for Advancing Neurotechnological Innovation to Application (CRANIA), Toronto, ON, Canada.
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