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Stampanoni Bassi M, Gilio L, Galifi G, Buttari F, Dolcetti E, Bruno A, Belli L, Modugno N, Furlan R, Finardi A, Mandolesi G, Musella A, Centonze D, Olivola E. Mood disturbances in newly diagnosed Parkinson's Disease patients reflect intrathecal inflammation. Parkinsonism Relat Disord 2024; 122:106071. [PMID: 38432021 DOI: 10.1016/j.parkreldis.2024.106071] [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: 12/01/2023] [Revised: 02/16/2024] [Accepted: 02/25/2024] [Indexed: 03/05/2024]
Abstract
In Parkinson's disease (PD), neuroinflammation may be involved in the pathogenesis of mood disorders, contributing to the clinical heterogeneity of the disease. The cerebrospinal fluid (CSF) levels of interleukin (IL)-1β, IL-2, IL-6, IL-7, IL-8, IL-9, IL-12, IL-17, interferon (IFN)γ, macrophage inflammatory protein 1-alpha (MIP-1a), MIP-1b, granulocyte colony stimulating factor (GCSF), eotaxin, tumor necrosis factor (TNF), and monocyte chemoattractant protein 1 (MCP-1), were assessed in 45 newly diagnosed and untreated PD patients and in 44 control patients. Spearman's correlations were used to explore possible associations between CSF cytokines and clinical variables including mood. Benjamini-Hochberg (B-H) correction for multiple comparisons was applied. Linear regression was used to test significant associations correcting for other clinical variables. In PD patients, higher CSF concentrations of the inflammatory molecules IL-6, IL-9, IFNγ, and GCSF were found (all B-H corrected p < 0.02). Significant associations were found between BDI-II and the levels of IL-6 (Beta = 0.438; 95%CI 1.313-5.889; p = 0.003) and IL-8 (Beta = 0.471; 95%CI 0.185-0.743; p = 0.002). Positive associations were also observed between STAI-Y state and both IL-6 (Beta = 0.452; 95%CI 1.649-7.366; p = 0.003), and IL-12 (Beta = 0.417; 95%CI 2.238-13.379; p = 0.007), and between STAI-Y trait and IL-2 (Beta = 0.354; 95%CI 1.923-14.796; p = 0.012), IL-6 (Beta = 0.362; 95%CI 0.990-6.734; p = 0.01), IL-8 (Beta = 0.341; 95%CI 0.076-0.796; p = 0.019), IL-12 (Beta = 0.328; 95%CI 0.975-12.135; p = 0.023), and IL-17 (Beta = 0.334; 95CI 0.315-4.455; p = 0.025). An inflammatory CSF milieu may be associated with depression and anxiety in the early phases of PD, supporting a role of neuroinflammation in the pathogenesis of mood disturbances.
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Affiliation(s)
| | - Luana Gilio
- Unit of Neurology, IRCCS Neuromed, Pozzilli, IS, Italy; Faculty of Psychology, Uninettuno Telematic International University, Rome, Italy
| | | | - Fabio Buttari
- Unit of Neurology, IRCCS Neuromed, Pozzilli, IS, Italy
| | | | - Antonio Bruno
- Unit of Neurology, IRCCS Neuromed, Pozzilli, IS, Italy
| | - Lorena Belli
- Unit of Neurology, IRCCS Neuromed, Pozzilli, IS, Italy
| | | | - Roberto Furlan
- Clinical Neuroimmunology Unit, Institute of Experimental Neurology (INSpe), Division of Neuroscience, San Raffaele Scientific Institute, Milan, Italy
| | - Annamaria Finardi
- Clinical Neuroimmunology Unit, Institute of Experimental Neurology (INSpe), Division of Neuroscience, San Raffaele Scientific Institute, Milan, Italy
| | - Georgia Mandolesi
- Synaptic Immunopathology Lab, IRCCS San Raffaele Roma, Italy; Department of Human Sciences and Quality of Life Promotion, University of Rome San Raffaele, Italy
| | - Alessandra Musella
- Synaptic Immunopathology Lab, IRCCS San Raffaele Roma, Italy; Department of Human Sciences and Quality of Life Promotion, University of Rome San Raffaele, Italy
| | - Diego Centonze
- Unit of Neurology, IRCCS Neuromed, Pozzilli, IS, Italy; Laboratory of Synaptic Immunopathology, Department of Systems Medicine, Tor Vergata University, Rome, Italy.
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2
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Erro R, Lazzeri G, Terranova C, Paparella G, Gigante AF, De Micco R, Magistrelli L, Di Biasio F, Valentino F, Moschella V, Pilotto A, Esposito M, Olivola E, Malaguti MC, Ceravolo R, Dallocchio C, Spagnolo F, Nicoletti A, De Rosa A, Di Giacopo R, Sorrentino C, Padovani A, Altavista MC, Pacchetti C, Marchese R, Contaldi E, Tessitore A, Misceo S, Bologna M, Rizzo V, Franco G, Barone P. Comparing Essential Tremor with and without Soft Dystonic Signs and Tremor Combined with Dystonia: The TITAN Study. Mov Disord Clin Pract 2024. [PMID: 38594807 DOI: 10.1002/mdc3.14026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Accepted: 02/28/2024] [Indexed: 04/11/2024] Open
Abstract
BACKGROUND Tremor disorders remain as clinical diagnoses and the rate of misdiagnosis between the commonest non-parkinsonian tremors is relatively high. OBJECTIVES To compare the clinical features of Essential Tremor without other features (pure ET), ET plus soft dystonic signs (ET + DS), and tremor combined with dystonia (TwD). METHODS We compared the clinical features of patients with pure ET, ET + DS, and TwD enrolled in The ITAlian tremor Network (TITAN). Linear regression models were performed to determine factors associated with health status and quality of life. RESULTS Three-hundred-eighty-three patients were included. Sex distribution was significantly different between the groups with males being more represented in pure ET and females in TwD. The initial site of tremor was different between the groups with about 40% of TwD having head tremor and ET + DS unilateral upper limb tremor at onset. This pattern mirrored the distribution of overt dystonia and soft dystonic signs at examination. Sensory trick, task-specificity, and position-dependence were more common, but not exclusive, to TwD. Pure ET patients showed the lowest degree of alcohol responsiveness and ET + DS the highest. Midline tremor was more commonly encountered and more severe in TwD than in the other groups. Regression analyses demonstrated that tremor severity, sex, age, and to a lesser degree the variable "group", independently predicted health status and quality of life, suggesting the existence of other determinants beyond tremor. CONCLUSIONS Pure ET and TwD manifest with a phenotypic overlap, which calls for the identification of diagnostic biomarkers. ET + DS shared features with both syndromes, suggesting intra-group heterogeneity.
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Affiliation(s)
- Roberto Erro
- Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", Neuroscience Section, University of Salerno, Baronissi, Italy
| | - Giulia Lazzeri
- Neurology Unit, Department of Neuroscience, Dino Ferrari Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Carmen Terranova
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Giulia Paparella
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
- Neuromed Institute IRCCS, Pozzilli, Italy
| | - Angelo Fabio Gigante
- Neurosensory Department, Neurology Unit, San Paolo Hospital, ASL Bari, Bari, Italy
| | - Rosa De Micco
- Department of Advanced Medical and Surgical Sciences, Università della Campania "Luigi Vanvitelli", Napoli, Italy
| | - Luca Magistrelli
- Department of Translational Medicine, Section of Neurology, University of Piemonte Orientale, Novara, Italy
- "Maggiore della Carità" University Hospital, Novara, Italy
| | | | - Francesca Valentino
- Parkinson's Disease and Movement Disorders Unit, IRCCS Mondino Foundation, Pavia, Italy
| | | | - Andrea Pilotto
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | | | | | - Maria Chiara Malaguti
- Clinical Unit of Neurology, Department of Emergency, Santa Chiara Hospital, Azienda Provinciale per i Servizi Sanitari (APSS), Trento, Italy
| | - Roberto Ceravolo
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Carlo Dallocchio
- Neurology Unit, Department of Medical Specialist Area, ASST Pavia, Voghera, Italy
| | | | - Alessandra Nicoletti
- Department "G.F. Ingrassia", Section of Neurosciences, University of Catania, Catania, Italy
| | - Anna De Rosa
- Department of Neurosciences and Reproductive and Odontostomatological Sciences, Federico II University, Naples, Italy
| | | | - Cristiano Sorrentino
- Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", Neuroscience Section, University of Salerno, Baronissi, Italy
| | - Alessandro Padovani
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | | | - Claudio Pacchetti
- Parkinson's Disease and Movement Disorders Unit, IRCCS Mondino Foundation, Pavia, Italy
| | | | - Elena Contaldi
- Department of Translational Medicine, Section of Neurology, University of Piemonte Orientale, Novara, Italy
| | - Alessandro Tessitore
- Department of Advanced Medical and Surgical Sciences, Università della Campania "Luigi Vanvitelli", Napoli, Italy
| | - Salvatore Misceo
- Neurosensory Department, Neurology Unit, San Paolo Hospital, ASL Bari, Bari, Italy
| | - Matteo Bologna
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
- Neuromed Institute IRCCS, Pozzilli, Italy
| | - Vincenzo Rizzo
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Giulia Franco
- Neurology Unit, Department of Neuroscience, Dino Ferrari Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Paolo Barone
- Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", Neuroscience Section, University of Salerno, Baronissi, Italy
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3
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Geroin C, Petracca M, Di Tella S, Marcuzzo E, Erro R, Cuoco S, Ceravolo R, Mazzucchi S, Pilotto A, Padovani A, Romito LM, Eleopra R, Zappia M, Nicoletti A, Dallocchio C, Arbasino C, Bono F, Laterza V, Demartini B, Gambini O, Modugno N, Olivola E, Bonanni L, Albanese A, Ferrazzano G, Tessitore A, Lopiano L, Calandra‐Buonaura G, Morgante F, Esposito M, Pisani A, Manganotti P, Tesolin L, Teatini F, Camozzi S, Ercoli T, Stocchi F, Coletti Moja M, Defazio G, Tinazzi M. Elderly Onset of Functional Motor Disorders: Clinical Correlates from the Italian Registry. Mov Disord Clin Pract 2024; 11:38-44. [PMID: 38291844 PMCID: PMC10828615 DOI: 10.1002/mdc3.13916] [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: 07/11/2023] [Revised: 10/06/2023] [Accepted: 10/13/2023] [Indexed: 02/01/2024] Open
Abstract
BACKGROUND Functional motor disorders (FMD) are a frequent neurological condition affecting patients with movement disorders. Commonly described in younger adults, their manifestation can be also associated to an elderly onset. OBJECTIVE To assess the prevalence and describe the clinical manifestations of FMD with elderly and younger onset and their relationship with demographical and clinical variables. METHODS We recruited patients with a "clinically definite" diagnosis of FMD from the Italian Registry of FMD. Patients underwent extensive clinical assessments. For elderly onset, we set a chronological cut-off at 65 years or older according to WHO definition. Multivariate regression models were implemented to estimate adjusted odds ratio of elderly FMD onset related to clinical characteristics. RESULTS Among the 410 patients, 34 (8.2%) experienced elderly-onset FMD, with a mean age at onset of 70.9 years. The most common phenotype was tremor (47.1%), followed by gait disorders, weakness, and dystonia (29.4%, 23.5%, 14.7%, respectively). Eleven elderly patients had a combined phenomenology: 9 exhibited two phenotypes, 2 had three phenotypes. Weakness was isolated in 3/8 patients and combined with another phenotype in 5/8, manifesting as paraplegia (n = 4); upper limb diplegia (n = 2), hemiparesis/hemiplegia (n = 1), and tetraparesis/tetraplegia (n= 1). Non-motor and other functional neurological disorders occurred more frequently in the younger group (89.1%) than the elderly (73.5%). Neurological and non-neurological comorbidities were more prevalent in the elderly group (82.4%) as opposed to the younger (32.7%). In a multivariate regression analysis, elderly-onset FMD was significantly associated with neurological comorbidities, including parkinsonism (OR 6.73) and cerebrovascular diseases (OR 5.48). CONCLUSIONS These results highlight the importance of achieving an accurate diagnosis of FMD in the elderly, as it is crucial for effectively managing FMD symptoms and addressing neurological comorbidities.
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Affiliation(s)
- Christian Geroin
- Neurology Unit, Movement Disorders Division, Department of Neurosciences, Biomedicine and Movement Sciences, University of VeronaVeronaItaly
| | - Martina Petracca
- Movement Disorder Unit, Fondazione Policlinico Universitario A. Gemelli IRCCSRomeItaly
| | - Sonia Di Tella
- Department of PsychologyUniversità Cattolica del Sacro CuoreMilanItaly
| | - Enrico Marcuzzo
- Neurology Unit, Movement Disorders Division, Department of Neurosciences, Biomedicine and Movement Sciences, University of VeronaVeronaItaly
| | - Roberto Erro
- Center for Neurodegenerative Diseases (CEMAND), Department of Medicine, Surgery and Dentistry‐Scuola Medica Salernitana, University of SalernoBaronissiItaly
| | - Sofia Cuoco
- Center for Neurodegenerative Diseases (CEMAND), Department of Medicine, Surgery and Dentistry‐Scuola Medica Salernitana, University of SalernoBaronissiItaly
| | - Roberto Ceravolo
- Center for NeuroDegenerative Diseases Parkinson and Movement Disorders, Department of Clinical and Experimental MedicineUniversity of PisaPisaItaly
| | - Sonia Mazzucchi
- Center for NeuroDegenerative Diseases Parkinson and Movement Disorders, Department of Clinical and Experimental MedicineUniversity of PisaPisaItaly
| | - Andrea Pilotto
- Neurology Unit, Department of Clinical and Experimental SciencesUniversity of BresciaBresciaItaly
- FERB Onlus, Ospedale S. Isidoro, Trescore BalnearioBergamoItaly
| | - Alessandro Padovani
- Neurology Unit, Department of Clinical and Experimental SciencesUniversity of BresciaBresciaItaly
| | - Luigi Michele Romito
- Parkinson and Movement Disorders Unit, Fondazione IRCCS Istituto Neurologico Carlo BestaMilanItaly
| | - Roberto Eleopra
- Parkinson and Movement Disorders Unit, Fondazione IRCCS Istituto Neurologico Carlo BestaMilanItaly
| | - Mario Zappia
- Department G.F. Ingrassia, Section of NeurosciencesUniversity of CataniaCataniaItaly
| | - Alessandra Nicoletti
- Department G.F. Ingrassia, Section of NeurosciencesUniversity of CataniaCataniaItaly
| | | | - Carla Arbasino
- Department of Medical AreaNeurology Unit, ASST PaviaPaviaItaly
| | - Francesco Bono
- Botulinum Toxin Center, Neurology Unit A.O.U. Mater DominiCatanzaroItaly
| | - Vincenzo Laterza
- Botulinum Toxin Center, Neurology Unit A.O.U. Mater DominiCatanzaroItaly
| | - Benedetta Demartini
- Aldo Ravelli Research Center for Neurotechnology and Experimental Brain Therapeutics, Department of Health SciencesUniversity of MilanMilanItaly
| | - Orsola Gambini
- Aldo Ravelli Research Center for Neurotechnology and Experimental Brain Therapeutics, Department of Health SciencesUniversity of MilanMilanItaly
| | | | | | - Laura Bonanni
- Department of Medicine and Aging Sciences, University G. d'AnnunzioChieti‐PescaraItaly
| | - Alberto Albanese
- Department of NeurologyIRCCS Humanitas Research HospitalRozzanoItaly
| | - Gina Ferrazzano
- Department of Human NeurosciencesUniversità La SapienzaRomeItaly
| | - Alessandro Tessitore
- Department of Advanced Medical and Surgery SciencesUniversity of Campania—Luigi VanvitelliNaplesItaly
| | - Leonardo Lopiano
- Department of Neuroscience—Rita Levi MontalciniUniversity of TurinTurinItaly
| | - Giovanna Calandra‐Buonaura
- Department of Biomedical and Neuromotor SciencesUniversity of BolognaBolognaItaly
- IRCCS Istituto delle Scienze Neurologiche di BolognaBolognaItaly
| | - Francesca Morgante
- Neurosciences Research Centre, Molecular and Clinical Sciences Neurosciences Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of LondonLondonUnited Kingdom
- Department of Experimental and Clinical MedicineUniversity of MessinaMessinaItaly
| | | | - Antonio Pisani
- Department of Brain and Behavioral SciencesUniversity of PaviaPaviaItaly
- IRCCS Mondino FoundationPaviaItaly
| | - Paolo Manganotti
- Clinical Neurology Unit, Department of Medical, Surgical and Health Services, University of TriesteTriesteItaly
| | - Lucia Tesolin
- Functional Movement Disorders Outpt.Clinic, Clinical Neurology and Stroke Unit Dep.Central Country HospitalBolzanoItaly
| | - Francesco Teatini
- Functional Movement Disorders Outpt.Clinic, Clinical Neurology and Stroke Unit Dep.Central Country HospitalBolzanoItaly
| | - Serena Camozzi
- Neurology Unit, Movement Disorders Division, Department of Neurosciences, Biomedicine and Movement Sciences, University of VeronaVeronaItaly
| | - Tommaso Ercoli
- Department of Medical Sciences and Public HealthUniversity of CagliariCagliariItaly
| | - Fabrizio Stocchi
- University and Institute of Research and Medical Care San Raffaele RomaRomeItaly
| | | | - Giovanni Defazio
- Department of Medical Sciences and Public HealthUniversity of CagliariCagliariItaly
| | - Michele Tinazzi
- Neurology Unit, Movement Disorders Division, Department of Neurosciences, Biomedicine and Movement Sciences, University of VeronaVeronaItaly
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Mirabella G, Pilotto A, Rizzardi A, Montalti M, Olivola E, Zatti C, Di Caprio V, Ferrari E, Modugno N, Padovani A. Effects of dopaminergic treatment on inhibitory control differ across Hoehn and Yahr stages of Parkinson's disease. Brain Commun 2023; 6:fcad350. [PMID: 38162902 PMCID: PMC10757450 DOI: 10.1093/braincomms/fcad350] [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: 07/28/2023] [Revised: 11/23/2023] [Accepted: 12/19/2023] [Indexed: 01/03/2024] Open
Abstract
Motor inhibitory control, a core component of cognitive control, is impaired in Parkinson's disease, dramatically impacting patients' abilities to implement goal-oriented adaptive strategies. A progressive loss of the midbrain's dopamine neurons characterizes Parkinson's disease and causes motor features responsive to dopaminergic treatments. Although such treatments restore motor symptoms, their impact on response inhibition is controversial. Most studies failed to show any effect of dopaminergic medicaments, although three studies found that these drugs selectively improved inhibitory control in early-stage patients. Importantly, all previous studies assessed only one domain of motor inhibition, i.e. reactive inhibition (the ability to react to a stop signal). The other domain, i.e. proactive inhibition (the ability to modulate reactive inhibition pre-emptively according to the current context), was utterly neglected. To re-examine this issue, we recruited cognitively unimpaired Parkinson's patients under dopaminergic treatment in the early (Hoehn and Yahr, 1-1.5, n = 20), intermediate (Hoehn and Yahr 2, n = 20), and moderate/advanced (Hoehn and Yahr, 2.5-3, n = 20) stages of the disease. Using a cross-sectional study design, we compared their performance on a simple reaction-time task and a stop-signal task randomly performed twice on dopaminergic medication (ON) and after medication withdrawal (OFF). Normative data were collected on 30 healthy controls. Results suggest that medication effects are stage-dependent. In Hoehn and Yahr 1-1.5 patients, drugs selectively impair reactive inhibition, leaving proactive inhibition unaffected. In the ON state, Hoehn and Yahr two patients experienced impaired proactive inhibition, whereas reactive inhibition is no longer affected, as it deteriorates even during the OFF state. By contrast, Hoehn and Yahr 2.5-3 patients exhibited less efficient reactive and proactive inhibition in the OFF state, and medication slightly improved proactive inhibition. This evidence aligns with the dopamine overdose hypothesis, indicating that drug administration may overdose intact dopamine circuitry in the earliest stages, impairing associated cognitive functions. In later stages, the progressive degeneration of dopaminergic neurons prevents the overdose and can exert some beneficial effects. Thus, our findings suggest that inhibitory control assessment might help tailor pharmacological therapy across the disease stage to enhance Parkinson's disease patients' quality of life by minimizing the hampering of inhibitory control and maximizing the reduction of motor symptoms.
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Affiliation(s)
- Giovanni Mirabella
- Department of Clinical and Experimental Sciences, University of Brescia, 25123 Brescia, BS, Italy
- IRCCS Neuromed, 86077 Pozzilli, IS, Italy
| | - Andrea Pilotto
- Department of Clinical and Experimental Sciences, Neurology Unit, University of Brescia, 25123 Brescia, BS, Italy
- Laboratory of Digital Neurology and Biosensors, University of Brescia, 25123 Brescia, BS, Italy
- Department of Continuity of Care and Frailty, Neurology Unit, ASST Spedali Civili Brescia Hospital, 25123 Brescia, BS, Italy
| | - Andrea Rizzardi
- Department of Clinical and Experimental Sciences, Neurology Unit, University of Brescia, 25123 Brescia, BS, Italy
- Laboratory of Digital Neurology and Biosensors, University of Brescia, 25123 Brescia, BS, Italy
| | - Martina Montalti
- Department of Clinical and Experimental Sciences, University of Brescia, 25123 Brescia, BS, Italy
| | | | - Cinzia Zatti
- Department of Clinical and Experimental Sciences, Neurology Unit, University of Brescia, 25123 Brescia, BS, Italy
- Laboratory of Digital Neurology and Biosensors, University of Brescia, 25123 Brescia, BS, Italy
- Department of Continuity of Care and Frailty, Neurology Unit, ASST Spedali Civili Brescia Hospital, 25123 Brescia, BS, Italy
| | | | - Elisabetta Ferrari
- Department of Clinical and Experimental Sciences, Neurology Unit, University of Brescia, 25123 Brescia, BS, Italy
| | | | - Alessandro Padovani
- Department of Clinical and Experimental Sciences, Neurology Unit, University of Brescia, 25123 Brescia, BS, Italy
- Laboratory of Digital Neurology and Biosensors, University of Brescia, 25123 Brescia, BS, Italy
- Department of Continuity of Care and Frailty, Neurology Unit, ASST Spedali Civili Brescia Hospital, 25123 Brescia, BS, Italy
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5
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Erro R, Lazzeri G, Gigante AF, Pilotto A, Magistrelli L, Bologna M, Terranova C, Olivola E, Dallocchio C, Moschella V, Valentino F, Di Biasio F, Nicoletti A, De Micco R, Brusa L, Sorrentino C, Matinella A, Bertino S, Paparella G, Modugno N, Contaldi E, Padovani A, Di Fonzo A, Restaino M, Barone P. Clinical correlates of "pure" essential tremor: the TITAN study. Front Neurol 2023; 14:1233524. [PMID: 37681007 PMCID: PMC10481166 DOI: 10.3389/fneur.2023.1233524] [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: 06/02/2023] [Accepted: 07/24/2023] [Indexed: 09/09/2023] Open
Abstract
Background To date, there are no large studies delineating the clinical correlates of "pure" essential tremor (ET) according to its new definition. Methods From the ITAlian tremor Network (TITAN) database, we extracted data from patients with a diagnosis of "pure" ET and excluded those with other tremor classifications, including ET-plus, focal, and task-specific tremor, which were formerly considered parts of the ET spectrum. Results Out of 653 subjects recruited in the TITAN study by January 2022, the data of 208 (31.8%) "pure" ET patients (86M/122F) were analyzed. The distribution of age at onset was found to be bimodal. The proportion of familial cases by the age-at-onset class of 20 years showed significant differences, with sporadic cases representing the large majority of the class with an age at onset above 60 years. Patients with a positive family history of tremor had a younger onset and were more likely to have leg involvement than sporadic patients despite a similar disease duration. Early-onset and late-onset cases were different in terms of tremor distribution at onset and tremor severity, likely as a function of longer disease duration, yet without differences in terms of quality of life, which suggests a relatively benign progression. Treatment patterns and outcomes revealed that up to 40% of the sample was unsatisfied with the current pharmacological options. Discussion The findings reported in the study provide new insights, especially with regard to a possible inversed sex distribution, and to the genetic backgrounds of "pure" ET, given that familial cases were evenly distributed across age-at-onset classes of 20 years. Deep clinical profiling of "pure" ET, for instance, according to age at onset, might increase the clinical value of this syndrome in identifying pathogenetic hypotheses and therapeutic strategies.
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Affiliation(s)
- Roberto Erro
- Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana”, Neuroscience Section, University of Salerno, Baronissi, SA, Italy
| | - Giulia Lazzeri
- Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Neurology Unit, Milan, Italy
| | - Angelo Fabio Gigante
- Department of Medical Sciences and Public Health, Section of Neurology, San Paolo Hospital, Bari, Italy
| | - Andrea Pilotto
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Luca Magistrelli
- Department of Translational Medicine, Movement Disorders Centre, Neurology Unit, University of Piemonte Orientale, Novara, Italy
| | - Matteo Bologna
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
- Neuromed Institute IRCCS, Pozzilli, IS, Italy
| | - Carmen Terranova
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | | | - Carlo Dallocchio
- Neurology Unit, Department of Medical Area, ASST Pavia, Voghera, PV, Italy
| | | | - Francesca Valentino
- Parkinson's Disease and Movement Disorders Unit, IRCCS Mondino Foundation, Pavia, Italy
| | | | - Alessandra Nicoletti
- Department “G.F. Ingrassia”, Section of Neurosciences, University of Catania, Catania, Italy
| | - Rosa De Micco
- Department of Advanced Medical and Surgical Sciences, Università della Campania “Luigi Vanvitelli”, Naples, Italy
| | - Livia Brusa
- Neurology Department, S.Eugenio Hospital, Rome, Italy
| | - Cristiano Sorrentino
- Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana”, Neuroscience Section, University of Salerno, Baronissi, SA, Italy
| | - Angela Matinella
- Neurology Unit, Department of Medical Area, ASST Pavia, Voghera, PV, Italy
| | - Salvatore Bertino
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | | | | | - Elena Contaldi
- Department of Translational Medicine, Movement Disorders Centre, Neurology Unit, University of Piemonte Orientale, Novara, Italy
| | - Alessandro Padovani
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Alessio Di Fonzo
- Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Neurology Unit, Milan, Italy
| | - Marialuisa Restaino
- Department of Economics and Statistics, University of Salerno, Fisciano, SA, Italy
| | - Paolo Barone
- Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana”, Neuroscience Section, University of Salerno, Baronissi, SA, Italy
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Cilia R, Cereda E, Piatti M, Pilotto A, Magistrelli L, Andreasi NG, Bonvegna S, Contaldi E, Mancini F, Imbalzano G, De Micco R, Colucci F, Braccia A, Bellini G, Brovelli F, Zangaglia R, Lazzeri G, Russillo MC, Olivola E, Sorbera C, Cereda V, Pinto P, Sucapane P, Gelosa G, Meloni M, Pistoria F, Sessa M, Canesi M, Modugno N, Pacchetti C, Brighina L, Pellecchia MT, Ceravolo R, Sensi MC, Zibetti M, Comi C, Padovani A, Zecchinelli AL, Di Fonzo A, Tessitore A, Morgante F, Eleopra R. Levodopa Equivalent Dose of Safinamide: a multicenter, longitudinal, case‐control study. Mov Disord Clin Pract 2023; 10:625-635. [PMID: 37070060 PMCID: PMC10105110 DOI: 10.1002/mdc3.13681] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 01/21/2023] [Indexed: 02/09/2023] Open
Abstract
Background Effects of dopaminergic medications used to treat Parkinson's disease (PD) may be compared with each other by using conversion factors, calculated as Levodopa equivalent dose (LED). However, current LED proposals on MAO-B inhibitors (iMAO-B) safinamide and rasagiline are still based on empirical approaches. Objectives To estimate LED of safinamide 50 and 100 mg. Methods In this multicenter, longitudinal, case-control study, we retrospectively reviewed clinical charts of 500 consecutive PD patients with motor complications and treated with (i) safinamide 100 mg (N = 130), safinamide 50 mg (N = 144), or rasagiline 1 mg (N = 97) for 9 ± 3 months and a control group of patients never treated with any iMAO-B (N = 129). Results Major baseline features (age, sex, disease duration and stage, severity of motor signs and motor complications) were similar among the groups. Patients on rasagiline had lower UPDRS-II scores and Levodopa dose than control subjects. After a mean follow-up of 8.8-to-10.1 months, patients on Safinamide 50 mg and 100 mg had lower UPDRS-III and OFF-related UPDRS-IV scores than control subjects, who in turn had larger increase in total LED than the three iMAO-B groups. After adjusting for age, disease duration, duration of follow-up, baseline values and taking change in UPDRS-III scores into account (sensitivity analysis), safinamide 100 mg corresponded to 125 mg LED, whereas safinamide 50 mg and rasagiline 1 mg equally corresponded to 100 mg LED. Conclusions We used a rigorous approach to calculate LED of safinamide 50 and 100 mg. Large prospective pragmatic trials are needed to replicate our findings.
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Affiliation(s)
- Roberto Cilia
- Fondazione IRCCS Istituto Neurologico Carlo Besta, Department of Clinical Neurosciences Parkinson and Movement Disorders Unit Milano Italy
| | - Emanuele Cereda
- Clinical Nutrition and Dietetics Unit Fondazione IRCCS Policlinico San Matteo Pavia Italy
| | - Marco Piatti
- Neurology Unit, Department of Neurology, Milan Center for Neuroscience San Gerardo Hospital Monza Italy
- Centro Parkinson e Parkinsonismi ASST Gaetano Pini‐CTO Milan Italy
| | - Andrea Pilotto
- Neurology Unit, Department of Clinical and Experimental Sciences University of Brescia Brescia Italy
| | - Luca Magistrelli
- Department of Translational Medicine Movement Disorders Centre, Neurology Unit, University of Piemonte Orientale Novara Italy
| | - Nico Golfrè Andreasi
- Fondazione IRCCS Istituto Neurologico Carlo Besta, Department of Clinical Neurosciences Parkinson and Movement Disorders Unit Milano Italy
| | | | - Elena Contaldi
- Department of Translational Medicine Movement Disorders Centre, Neurology Unit, University of Piemonte Orientale Novara Italy
| | - Francesca Mancini
- Istituto Auxologico Italiano IRCCS, Department of Neurology‐Stroke Unit and Laboratory of Neuroscience – Milan Italy
| | - Gabriele Imbalzano
- Department of Neuroscience "Rita Levi Montalcini" University of Torino Turin Italy
- SC Neurologia 2U AOU Città della Salute e della Scienza Turin Italy
| | - Rosa De Micco
- Department of Advanced Medical and Surgical Sciences University of Campania “Luigi Vanvitelli” Napoli Italy
| | - Fabiana Colucci
- Azienda Ospedaliera Univerisitaria S. Anna, U.O. Neurologia Ferrara Italy
- University of Ferrara Ferrara Italy
| | - Arianna Braccia
- Azienda Ospedaliera Univerisitaria S. Anna, U.O. Neurologia Ferrara Italy
- University of Ferrara Ferrara Italy
| | - Gabriele Bellini
- Unit of Neurology, Department of Clinical and Experimental Medicine University of Pisa Pisa Italy
| | - Francesco Brovelli
- Neurology Unit, Department of Neurology, Milan Center for Neuroscience San Gerardo Hospital Monza Italy
| | - Roberta Zangaglia
- Parkinson's Disease and Movement Disorders Unit IRCCS Mondino Foundation Pavia Italy
| | - Giulia Lazzeri
- Neurology Unit, Department of Neuroscience Dino Ferrari Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico Milan Italy
| | - Maria Chiara Russillo
- Department of Medicine Surgery and Dentistry "Scuola Medica Salernitana", Neuroscience Section, University of Salerno Italy
| | - Enrica Olivola
- Parkinson and Movement Disorders Unit IRCCS Neuromed Pozzilli Italy
| | | | - Viviana Cereda
- Department of Neurological Rehabilitation Parkinson's Disease and Movement Disorders Center, Moriggia‐Pelascini Hospital, Gravedona ed Uniti Gravedona Italy
| | | | | | - Giorgio Gelosa
- Neurology Unit ASST “Grande Ospedale Metropolitano” Niguarda Milano Italy
| | - Mario Meloni
- IRCCS Fondazione Don Carlo Gnocchi ONLUS 20148 Milan Italy
| | - Francesca Pistoria
- Neurology Unit San Salvatore Hospital 67100 L'Aquila Italy
- Department of Biotechnological and Applied Clinical Sciences University of L'Aquila L'Aquila Italy
| | - Maria Sessa
- Neurology Unit ASST Papa Giovanni XXIII Bergamo Italy
| | - Margherita Canesi
- Department of Neurological Rehabilitation Parkinson's Disease and Movement Disorders Center, Moriggia‐Pelascini Hospital, Gravedona ed Uniti Gravedona Italy
| | - Nicola Modugno
- Parkinson and Movement Disorders Unit IRCCS Neuromed Pozzilli Italy
| | - Claudio Pacchetti
- Parkinson's Disease and Movement Disorders Unit IRCCS Mondino Foundation Pavia Italy
| | - Laura Brighina
- Neurology Unit, Department of Neurology, Milan Center for Neuroscience San Gerardo Hospital Monza Italy
| | - Maria Teresa Pellecchia
- Department of Medicine Surgery and Dentistry "Scuola Medica Salernitana", Neuroscience Section, University of Salerno Italy
| | - Roberto Ceravolo
- Unit of Neurology, Department of Clinical and Experimental Medicine University of Pisa Pisa Italy
| | - Maria Chiara Sensi
- Azienda Ospedaliera Univerisitaria S. Anna, U.O. Neurologia Ferrara Italy
- University of Ferrara Ferrara Italy
| | - Maurizio Zibetti
- Department of Neuroscience "Rita Levi Montalcini" University of Torino Turin Italy
- SC Neurologia 2U AOU Città della Salute e della Scienza Turin Italy
| | - Cristoforo Comi
- Department of Translational Medicine Movement Disorders Centre, Neurology Unit, University of Piemonte Orientale Novara Italy
| | - Alessandro Padovani
- Neurology Unit, Department of Clinical and Experimental Sciences University of Brescia Brescia Italy
| | | | - Alessio Di Fonzo
- Neurology Unit, Department of Neuroscience Dino Ferrari Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico Milan Italy
| | - Alessandro Tessitore
- Department of Advanced Medical and Surgical Sciences University of Campania “Luigi Vanvitelli” Napoli Italy
| | - Francesca Morgante
- Neuroscience Research Centre Molecular and Clinical Sciences Institute, St. George's, University of London London UK
- Department of Clinical and Experimental Medicine University of Messina Messina Italy
| | - Roberto Eleopra
- Fondazione IRCCS Istituto Neurologico Carlo Besta, Department of Clinical Neurosciences Parkinson and Movement Disorders Unit Milano Italy
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7
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Mostile G, Geroin C, Erro R, Luca A, Marcuzzo E, Barone P, Ceravolo R, Mazzucchi S, Pilotto A, Padovani A, Romito LM, Eleopra R, Dallocchio C, Arbasino C, Bono F, Bruno PA, Demartini B, Gambini O, Modugno N, Olivola E, Bonanni L, Albanese A, Ferrazzano G, De Micco R, Zibetti M, Calandra-Buonaura G, Petracca M, Morgante F, Esposito M, Pisani A, Manganotti P, Stocchi F, Coletti Moja M, Di Vico IA, Tesolin L, De Bertoldi F, Ercoli T, Defazio G, Zappia M, Nicoletti A, Tinazzi M. Data-driven clustering of combined Functional Motor Disorders based on the Italian registry. Front Neurol 2022; 13:987593. [PMID: 36518193 PMCID: PMC9742245 DOI: 10.3389/fneur.2022.987593] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 10/17/2022] [Indexed: 11/29/2022] Open
Abstract
IntroductionFunctional Motor Disorders (FMDs) represent nosological entities with no clear phenotypic characterization, especially in patients with multiple (combined FMDs) motor manifestations. A data-driven approach using cluster analysis of clinical data has been proposed as an analytic method to obtain non-hierarchical unbiased classifications. The study aimed to identify clinical subtypes of combined FMDs using a data-driven approach to overcome possible limits related to “a priori” classifications and clinical overlapping.MethodsData were obtained by the Italian Registry of Functional Motor Disorders. Patients identified with multiple or “combined” FMDs by standardized clinical assessments were selected to be analyzed. Non-hierarchical cluster analysis was performed based on FMDs phenomenology. Multivariate analysis was then performed after adjustment for principal confounding variables.ResultsFrom a study population of n = 410 subjects with FMDs, we selected n = 188 subjects [women: 133 (70.7%); age: 47.9 ± 14.4 years; disease duration: 6.4 ± 7.7 years] presenting combined FMDs to be analyzed. Based on motor phenotype, two independent clusters were identified: Cluster C1 (n = 82; 43.6%) and Cluster C2 (n = 106; 56.4%). Cluster C1 was characterized by functional tremor plus parkinsonism as the main clinical phenotype. Cluster C2 mainly included subjects with functional weakness. Cluster C1 included older subjects suffering from anxiety who were more treated with botulinum toxin and antiepileptics. Cluster C2 included younger subjects referring to different associated symptoms, such as pain, headache, and visual disturbances, who were more treated with antidepressants.ConclusionUsing a data-driven approach of clinical data from the Italian registry, we differentiated clinical subtypes among combined FMDs to be validated by prospective studies.
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Affiliation(s)
- Giovanni Mostile
- Section of Neurosciences, Department “G.F. Ingrassia”, University of Catania, Catania, Italy
- Oasi Research Institute—IRCCS, Troina, Italy
| | - Christian Geroin
- Neurology Unit, Movement Disorders Division, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
- Christian Geroin
| | - Roberto Erro
- Center for Neurodegenerative Diseases (CEMAND), Department of Medicine, Surgery and Dentistry—Scuola Medica Salernitana, University of Salerno, Baronissi, Italy
| | - Antonina Luca
- Section of Neurosciences, Department “G.F. Ingrassia”, University of Catania, Catania, Italy
| | - Enrico Marcuzzo
- Neurology Unit, Movement Disorders Division, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Paolo Barone
- Center for Neurodegenerative Diseases (CEMAND), Department of Medicine, Surgery and Dentistry—Scuola Medica Salernitana, University of Salerno, Baronissi, Italy
| | - Roberto Ceravolo
- Neurology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Sonia Mazzucchi
- Neurology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Andrea Pilotto
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
- FERB Onlus, Ospedale S. Isidoro, Bergamo, Italy
| | - Alessandro Padovani
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Luigi Michele Romito
- Parkinson and Movement Disorders Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Roberto Eleopra
- Parkinson and Movement Disorders Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Carlo Dallocchio
- Department of Medical Area, Neurology Unit, ASST Pavia, Pavia, Italy
| | - Carla Arbasino
- Department of Medical Area, Neurology Unit, ASST Pavia, Pavia, Italy
| | - Francesco Bono
- Botulinum Toxin Center, Neurology Unit A.O.U. Mater Domini, Catanzaro, Italy
| | | | - Benedetta Demartini
- Aldo Ravelli Research Center for Neurotechnology and Experimental Brain Therapeutics, Department of Health Sciences, University of Milan, Milan, Italy
| | - Orsola Gambini
- Aldo Ravelli Research Center for Neurotechnology and Experimental Brain Therapeutics, Department of Health Sciences, University of Milan, Milan, Italy
| | | | | | - Laura Bonanni
- Department of Medicine and Aging Sciences, University G. d'Annunzio, Chieti, Italy
- Department of Medicine and Aging Sciences, University G. d'Annunzio, Pescara, Italy
| | | | - Gina Ferrazzano
- Department of Human Neurosciences, Università La Sapienza, Rome, Italy
| | - Rosa De Micco
- Department of Advanced Medical and Surgery Sciences, University of Campania—Luigi Vanvitelli, Naples, Italy
| | - Maurizio Zibetti
- Department of Neuroscience—Rita Levi Montalcini, University of Turin, Turin, Italy
| | - Giovanna Calandra-Buonaura
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
- IRCCS, Institute of Neurological Sciences of Bologna, Bologna, Italy
| | - Martina Petracca
- Movement Disorder Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Francesca Morgante
- Neurosciences Research Centre, Molecular and Clinical Sciences Neurosciences Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, London, United Kingdom
- Department of Experimental and Clinical Medicine, University of Messina, Messina, Italy
| | - Marcello Esposito
- Clinical Neurophysiology Unit, Cardarelli Hospital, Naples, Italy
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples—Federico II, Naples, Italy
| | - Antonio Pisani
- IRCCS Mondino Foundation, Pavia, Italy
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Paolo Manganotti
- Clinical Neurology Unit, Department of Medical, Surgical and Health Services, University of Trieste, Trieste, Italy
| | - Fabrizio Stocchi
- University and Institute of Research and Medical Care San Raffaele, Rome, Italy
| | | | - Ilaria Antonella Di Vico
- Neurology Unit, Movement Disorders Division, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | | | | | - Tommaso Ercoli
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Giovanni Defazio
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Mario Zappia
- Section of Neurosciences, Department “G.F. Ingrassia”, University of Catania, Catania, Italy
| | - Alessandra Nicoletti
- Section of Neurosciences, Department “G.F. Ingrassia”, University of Catania, Catania, Italy
| | - Michele Tinazzi
- Neurology Unit, Movement Disorders Division, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
- *Correspondence: Michele Tinazzi
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8
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Erro R, Pilotto A, Magistrelli L, Olivola E, Nicoletti A, Di Fonzo A, Dallocchio C, Di Biasio F, Bologna M, Tessitore A, De Rosa A, Gigante AF, Esposito M, Moschella V, di Biase L, Valentino F, Russo M, Contaldi E, Modugno N, Padovani A, Barone P, Angela Matinella, Sciarretta M, Perillo S, Giglio A, Raglione LM, Terranova C, Altavista MC, Spagnolo F, Pecoraro PM, Malaguti MC, Misceo S, Zoccolella S, Marchese R, Benzi T, Gallo S, Paparella G, Angelini L, Lazzeri G, Franco G, Di Giacopo R, De Micco R, Aramini S, Ceravolo R, Mostile G, Morgante F, Brusa L. A Bayesian approach to Essential Tremor plus: A preliminary analysis of the TITAN cohort. Parkinsonism Relat Disord 2022; 103:73-76. [DOI: 10.1016/j.parkreldis.2022.08.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 07/20/2022] [Accepted: 08/19/2022] [Indexed: 11/29/2022]
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9
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Ercoli T, Tinazzi M, Geroin C, Marcuzzo E, Erro R, Cuoco S, Ceravolo R, Mazzucchi S, Pilotto A, Padovani A, Romito LM, Eleopra R, Zappia M, Nicoletti A, Dallocchio C, Arbasino C, Bono F, Spano G, Demartini B, Gambini O, Modugno N, Olivola E, Bonanni L, Albanese A, Ferrazzano G, Tessitore A, Lopiano L, Calandra-Buonaura G, Petracca M, Morgante F, Esposito M, Pisani A, Manganotti P, Tesolin L, Teatini F, Stocchi F, Defazio G. Do demographic and clinical features and comorbidities affect the risk of spread to an additional body site in functional motor disorders? J Neural Transm (Vienna) 2022; 129:1271-1276. [PMID: 35972697 PMCID: PMC9468120 DOI: 10.1007/s00702-022-02537-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 08/06/2022] [Indexed: 11/30/2022]
Abstract
The aim of this study is to assess changes in the body distribution and the semeiology of functional motor disorder (FMD) in patients who reported only one or more than one body site affected at FMD onset. Data were obtained from the Italian Registry of Functional Motor Disorders, which included patients with a diagnosis of clinically definite FMDs. The relationship between FMD features and spread to other body sites was estimated by multivariate Cox regression analysis. We identified 201 (49%) patients who reported only one body site affected at FMD onset and 209 (51%) who reported multiple body sites affected at onset. FMD spread from the initial site to another site in 43/201 (21.4%) patients over 5.7 ± 7.1 years in those with only one site affected at FMD onset; FMD spread to an another body site in 29/209 (13.8%) over 5.5 ± 6.5 years. The spread of FMD was associated with non-motor functional symptoms and psychiatric comorbidities only in the patients with one body site affected at FMD onset. Our findings provide novel insight into the natural history of FMD. The number of body sites affected at onset does not seem to have a consistent influence on the risk of spread. Furthermore, our findings suggest that psychiatric comorbidities and non-motor functional symptoms may predict the spread of FMD symptoms, at least in patients with one body site affected at onset.
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Affiliation(s)
- Tommaso Ercoli
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Michele Tinazzi
- Neurology Unit, Movement Disorders Division, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, P.le Scuro 10, 37134, Verona, Italy.
| | - Christian Geroin
- Neurology Unit, Movement Disorders Division, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, P.le Scuro 10, 37134, Verona, Italy.
| | - Enrico Marcuzzo
- Neurology Unit, Movement Disorders Division, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, P.le Scuro 10, 37134, Verona, Italy
| | - Roberto Erro
- Center for Neurodegenerative Diseases (CEMAND), Department of Medicine, Surgery and Dentistry, Scuola Medica Salernitana, University of Salerno, Baronissi, SA, Italy
| | - Sofia Cuoco
- Center for Neurodegenerative Diseases (CEMAND), Department of Medicine, Surgery and Dentistry, Scuola Medica Salernitana, University of Salerno, Baronissi, SA, Italy
| | - Roberto Ceravolo
- Center for NeuroDegenerative Diseases Parkinson and Movement Disorders, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Sonia Mazzucchi
- Center for NeuroDegenerative Diseases Parkinson and Movement Disorders, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Andrea Pilotto
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy.,FERB Onlus, Ospedale S. Isidoro, Trescore Balneario, Bergamo, Italy
| | - Alessandro Padovani
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Luigi Michele Romito
- Parkinson and Movement Disorders Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Roberto Eleopra
- Parkinson and Movement Disorders Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Mario Zappia
- Department G.F. Ingrassia, Section of Neurosciences, University of Catania, Catania, Italy
| | - Alessandra Nicoletti
- Department G.F. Ingrassia, Section of Neurosciences, University of Catania, Catania, Italy
| | - Carlo Dallocchio
- Department of Medical Area, Neurology Unit, ASST Pavia, Pavia, Italy
| | - Carla Arbasino
- Department of Medical Area, Neurology Unit, ASST Pavia, Pavia, Italy
| | - Francesco Bono
- Botulinum Toxin Center, Neurology Unit A.O.U. Mater Domini, Catanzaro, Italy
| | - Giorgio Spano
- Botulinum Toxin Center, Neurology Unit A.O.U. Mater Domini, Catanzaro, Italy
| | - Benedetta Demartini
- Aldo Ravelli Research Center for Neurotechnology and Experimental Brain Therapeutics, Department of Health Sciences, University of Milan, Milan, Italy
| | - Orsola Gambini
- Aldo Ravelli Research Center for Neurotechnology and Experimental Brain Therapeutics, Department of Health Sciences, University of Milan, Milan, Italy
| | | | | | - Laura Bonanni
- Department of Neuroscience, Imaging and Clinical Sciences, University G. d'Annunzio, Chieti-Pescara, Italy
| | - Alberto Albanese
- Department of Neurology, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Gina Ferrazzano
- Department of Human Neurosciences, Sapienza, University of Rome, Rome, Italy
| | - Alessandro Tessitore
- Department of Advanced Medical and Surgery Sciences, University of Campania-Luigi Vanvitelli, Naples, Italy
| | - Leonardo Lopiano
- Department of Neuroscience-Rita Levi Montalcini, University of Turin, Turin, Italy
| | - Giovanna Calandra-Buonaura
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy.,IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Martina Petracca
- Movement Disorder Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Francesca Morgante
- Neurosciences Research Centre, Molecular and Clinical Sciences Neurosciences Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, London, UK.,Department of Experimental and Clinical Medicine, University of Messina, Messina, Italy
| | | | - Antonio Pisani
- IRCCS Mondino Foundation, Pavia, Italy.,Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Paolo Manganotti
- Clinical Neurology Unit, Department of Medical, Surgical and Health Services, University of Trieste, Trieste, Italy
| | - Lucia Tesolin
- Functional Movement Disorders Outpatient Clinic, Clinical Neurology and Stroke Unit, Central Country Hospital, Bolzano, Italy
| | - Francesco Teatini
- Functional Movement Disorders Outpatient Clinic, Clinical Neurology and Stroke Unit, Central Country Hospital, Bolzano, Italy
| | - Fabrizio Stocchi
- University and Institute of Research and Medical Care San Raffaele Roma, Rome, Italy
| | - Giovanni Defazio
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
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10
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Erro R, Pilotto A, Esposito M, Olivola E, Nicoletti A, Lazzeri G, Magistrelli L, Dallocchio C, Marchese R, Bologna M, Tessitore A, Misceo S, Gigante AF, Terranova C, Moschella V, di Biase L, Di Giacopo R, Morgante F, Valentino F, De Rosa A, Trinchillo A, Malaguti MC, Brusa L, Matinella A, Di Biasio F, Paparella G, De Micco R, Contaldi E, Modugno N, Di Fonzo A, Padovani A, Barone P. The Italian tremor Network (TITAN): rationale, design and preliminary findings. Neurol Sci 2022; 43:5369-5376. [PMID: 35608737 PMCID: PMC9385818 DOI: 10.1007/s10072-022-06104-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 04/29/2022] [Indexed: 11/01/2022]
Abstract
INTRODUCTION The recently released classification has revised the nosology of tremor, defining essential tremor (ET) as a syndrome and fueling an enlightened debate about some newly conceptualized entities such as ET-plus. As a result, precise information of demographics, clinical features, and about the natural history of these conditions are lacking. METHODS The ITAlian tremor Network (TITAN) is a multicenter data collection platform, the aim of which is to prospectively assess, according to a standardized protocol, the phenomenology and natural history of tremor syndromes. RESULTS In the first year of activity, 679 patients have been recruited. The frequency of tremor syndromes varied from 32% of ET and 41% of ET-plus to less than 3% of rare forms, including focal tremors (2.30%), task-specific tremors (1.38%), isolated rest tremor (0.61%), and orthostatic tremor (0.61%). Patients with ET-plus were older and had a higher age at onset than ET, but a shorter disease duration, which might suggest that ET-plus is not a disease stage of ET. Familial aggregation of tremor and movement disorders was present in up to 60% of ET cases and in about 40% of patients with tremor combined with dystonia. The body site of tremor onset was different between tremor syndromes, with head tremor being most commonly, but not uniquely, associated with dystonia. CONCLUSIONS The TITAN study is anticipated to provide clinically relevant prospective information about the clinical correlates of different tremor syndromes and their specific outcomes and might serve as a basis for future etiological, pathophysiological, and therapeutic research.
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Affiliation(s)
- Roberto Erro
- Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", Neuroscience Section, University of Salerno, Via Allende 43, 84081, Baronissi, SA, Italy.
| | - Andrea Pilotto
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | | | | | - Alessandra Nicoletti
- Department "G.F. Ingrassia", Section of Neurosciences, University of Catania, Catania, Italy
| | - Giulia Lazzeri
- Neurology Unit, Department of Neuroscience, Dino Ferrari Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Luca Magistrelli
- Department of Translational Medicine, Movement Disorders Centre, Neurology Unit, University of Piemonte Orientale, Novara, Italy
| | - Carlo Dallocchio
- Neurology Unit, Department of Medical Area, ASST Pavia, Voghera, PV, Italy
| | | | - Matteo Bologna
- Neuromed Institute IRCCS, Pozzilli, IS, Italy.,Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Alessandro Tessitore
- Department of Advanced Medical and Surgical Sciences, Università Della Campania "Luigi Vanvitelli", Naples, Italy
| | - Salvatore Misceo
- Neurosensory Department, Neurology Unit, San Paolo Hospital, ASL Bari, Bari, Italy
| | - Angelo Fabio Gigante
- Neurosensory Department, Neurology Unit, San Paolo Hospital, ASL Bari, Bari, Italy
| | - Carmen Terranova
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | | | - Lazzaro di Biase
- Neurology Unit, Campus Bio-Medico University Hospital Foundation, Rome, Italy.,Unit of Neurology, Neurophysiology, Neurobiology, Department of Medicine, Università Campus Bio-Medico Di Roma, Rome, Italy.,Brain Innovations Lab, Università Campus Bio-Medico Di Roma, Rome, Italy
| | | | - Francesca Morgante
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy.,Neurosciences Research Centre, Molecular and Clinical Sciences Institute, St. George's, University of London, London, UK
| | - Francesca Valentino
- Parkinson's Disease and Movement Disorders Unit, IRCCS Mondino Foundation, Pavia, Italy
| | - Anna De Rosa
- Department of Neurosciences and Reproductive and Odontostomatological Sciences, Federico II University, Naples, Italy
| | - Assunta Trinchillo
- Department of Neurosciences and Reproductive and Odontostomatological Sciences, Federico II University, Naples, Italy
| | | | - Livia Brusa
- Neurology Department, S.Eugenio Hospital, Rome, Italy
| | - Angela Matinella
- Neurology Unit, Department of Medical Area, ASST Pavia, Voghera, PV, Italy
| | | | | | - Rosa De Micco
- Department of Advanced Medical and Surgical Sciences, Università Della Campania "Luigi Vanvitelli", Naples, Italy
| | - Elena Contaldi
- Department of Translational Medicine, Movement Disorders Centre, Neurology Unit, University of Piemonte Orientale, Novara, Italy
| | | | - Alessio Di Fonzo
- Neurology Unit, Department of Neuroscience, Dino Ferrari Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Alessandro Padovani
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Paolo Barone
- Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", Neuroscience Section, University of Salerno, Via Allende 43, 84081, Baronissi, SA, Italy
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Tinazzi M, Pilotto A, Morgante F, Marcuzzo E, Cuoco S, Ceravolo R, Mazzucchi S, Padovani A, Romito LM, Eleopra R, Nicoletti A, Dallocchio C, Arbasino C, Bono F, Magro G, Demartini B, Gambini O, Modugno N, Olivola E, Bonanni L, Zanolin E, Albanese A, Ferrazzano G, Tessitore A, Lopiano L, Calandra-Buonaura G, Petracca M, Esposito M, Pisani A, Manganotti P, Tesolin L, Teatini F, Defazio G, Ercoli T, Stocchi F, Erro R, Zappia M, Geroin C. Functional gait disorders: Demographic and clinical correlations. Parkinsonism Relat Disord 2021; 91:32-36. [PMID: 34479056 DOI: 10.1016/j.parkreldis.2021.08.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 07/23/2021] [Accepted: 08/22/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE We aimed to describe the prevalence and clinical-demographical features of patients with functional gait disorders (FGDs) and to compare them to patients with functional motor disorders (FMDs) without FGDs (No-FGDs). METHODS In this multicenter observational study, we enrolled patients with a clinically definite diagnosis of FMDs in 25 tertiary movement disorders centers in Italy. Each subject with FMDs underwent a comprehensive clinical assessment, including screening for different subtypes of functional gait disorders. Multivariate regression models were implemented in order to estimate the adjusted odds ratio (OR; 95% confidence interval) of having FGDs in relation to sociodemographic and clinical characteristics. RESULTS Out of 410 FMDs, 26.6% (n = 109) of patients exhibited FGDs. The most frequent FGDs were slow gait (n = 43, 39.4%), astasia-abasia (n = 26, 23.8%), and knee buckling (n = 24, 22%). They exhibited single FGDs in 51.4% (n = 56) or complex FGDs (more than one type of FGDs) in 48.6% (n = 53) of cases. On multivariate regression analysis, the presence of FGDs was more likely associated with older age (OR 1.03, 95% CI 1.01-1.04), functional visual symptoms (OR 2.19, 95% CI 1.08-4.45), and the diagnosis of somatic symptoms disorder (OR 2.97, 95% CI 1.08-8.17). FGDs were also more likely to undergo physiotherapy (OR 1.81, 95% CI 1.08-3.03). CONCLUSIONS People with FMDs may present with different and overlapping types of FGDs, which may occur in older age. The association of FGDs with functional visual symptoms and somatic symptoms disorder opens up to new avenues to the understanding of the neural mechanisms of these disorders.
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Affiliation(s)
- Michele Tinazzi
- Neurology Unit, Movement Disorders Division, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy.
| | - Andrea Pilotto
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Italy; FERB Onlus, Ospedale S. Isidoro, Trescore Balneario, Bergamo, Italy
| | - Francesca Morgante
- Neurosciences Research Centre, Molecular and Clinical Sciences Neurosciences Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, London, United Kingdom; Department of Experimental and Clinical Medicine, University of Messina, Messina, Italy
| | - Enrico Marcuzzo
- Neurology Unit, Movement Disorders Division, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Sofia Cuoco
- Center for Neurodegenerative Diseases (CEMAND), Department of Medicine, Surgery and Dentistry -Scuola Medica Salernitana, University of Salerno, Baronissi, SA, Italy
| | - Roberto Ceravolo
- Center for NeuroDegenerative Diseases Parkinson and Movement Disorders, Department of Clinical and Experimental Medicine, University of Pisa, Italy
| | - Sonia Mazzucchi
- Center for NeuroDegenerative Diseases Parkinson and Movement Disorders, Department of Clinical and Experimental Medicine, University of Pisa, Italy
| | - Alessandro Padovani
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Italy
| | - Luigi Michele Romito
- Parkinson and Movement Disorders Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Roberto Eleopra
- Parkinson and Movement Disorders Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Alessandra Nicoletti
- Department G.F. Ingrassia, Section of Neurosciences, University of Catania, Catania, Italy
| | | | - Carla Arbasino
- Department of Medical Area, Neurology Unit, ASST Pavia, Italy
| | - Francesco Bono
- Botulinum Toxin Center, Neurology Unit A.O.U. Mater Domini, Catanzaro, Italy
| | - Giuseppe Magro
- Botulinum Toxin Center, Neurology Unit A.O.U. Mater Domini, Catanzaro, Italy
| | - Benedetta Demartini
- Aldo Ravelli Research Center for Neurotechnology and Experimental Brain Therapeutics, Department of Health Sciences, University of Milan, Milan, Italy
| | - Orsola Gambini
- Aldo Ravelli Research Center for Neurotechnology and Experimental Brain Therapeutics, Department of Health Sciences, University of Milan, Milan, Italy
| | | | | | - Laura Bonanni
- Department of Neuroscience, Imaging and Clinical Sciences, University G. D'Annunzio, Chieti-Pescara, Italy
| | - Elisabetta Zanolin
- Unit of Epidemiology and Medical Statistics, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Alberto Albanese
- Department of Neurology, IRCCS Humanitas Research Hospital, Rozzano Milan, Italy
| | - Gina Ferrazzano
- Department of Human Neurosciences, Università La Sapienza, Rome, Italy
| | - Alessandro Tessitore
- Department of Advanced Medical and Surgery Sciences, University of Campania - Luigi Vanvitelli, Naples, Italy
| | - Leonardo Lopiano
- Department of Neuroscience - Rita Levi Montalcini, University of Turin, Turin, Italy
| | - Giovanna Calandra-Buonaura
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy; IRCCS Istituto Delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Martina Petracca
- Movement Disorder Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | | | - Antonio Pisani
- IRCCS Mondino Foundation, Pavia, Italy; Department of Brain and Behavioral Sciences, University of Pavia, Italy
| | - Paolo Manganotti
- Clinical Neurology Unit, Department of Medical, Surgical and Health Services, University of Trieste, Trieste, Italy
| | - Lucia Tesolin
- Functional Movement Disorders Outpt.Clinic, Clinical Neurology and Stroke Unit Dep., Central Country Hospital, Bolzano, Italy
| | - Francesco Teatini
- Functional Movement Disorders Outpt.Clinic, Clinical Neurology and Stroke Unit Dep., Central Country Hospital, Bolzano, Italy
| | - Giovanni Defazio
- Department of Medical Sciences and Public Health, University of Cagliari, Italy
| | - Tommaso Ercoli
- Department of Medical Sciences and Public Health, University of Cagliari, Italy
| | - Fabrizio Stocchi
- University and Institute of Research and Medical Care San Raffaele Roma, Rome, Italy
| | - Roberto Erro
- Center for Neurodegenerative Diseases (CEMAND), Department of Medicine, Surgery and Dentistry -Scuola Medica Salernitana, University of Salerno, Baronissi, SA, Italy
| | - Mario Zappia
- Department G.F. Ingrassia, Section of Neurosciences, University of Catania, Catania, Italy
| | - Christian Geroin
- Neurology Unit, Movement Disorders Division, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy.
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Tinazzi M, Geroin C, Marcuzzo E, Cuoco S, Ceravolo R, Mazzucchi S, Pilotto A, Padovani A, Romito LM, Eleopra R, Zappia M, Nicoletti A, Dallocchio C, Arbasino C, Bono F, Magro G, Demartini B, Gambini O, Modugno N, Olivola E, Bonanni L, Zanolin E, Albanese A, Ferrazzano G, De Micco R, Lopiano L, Calandra-Buonaura G, Petracca M, Esposito M, Pisani A, Manganotti P, Tesolin L, Teatini F, Ercoli T, Morgante F, Erro R. Functional motor phenotypes: to lump or to split? J Neurol 2021; 268:4737-4743. [PMID: 33961091 PMCID: PMC8563631 DOI: 10.1007/s00415-021-10583-w] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 04/22/2021] [Accepted: 04/24/2021] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Functional motor disorders (FMDs) are usually categorized according to the predominant phenomenology; however, it is unclear whether this phenotypic classification mirrors the underlying pathophysiologic mechanisms. OBJECTIVE To compare the characteristics of patients with different FMDs phenotypes and without co-morbid neurological disorders, aiming to answer the question of whether they represent different expressions of the same disorder or reflect distinct entities. METHODS Consecutive outpatients with a clinically definite diagnosis of FMDs were included in the Italian registry of functional motor disorders (IRFMD), a multicenter data collection platform gathering several clinical and demographic variables. To the aim of the current work, data of patients with isolated FMDs were extracted. RESULTS A total of 176 patients were included: 58 with weakness, 40 with tremor, 38 with dystonia, 23 with jerks/facial FMDs, and 17 with gait disorders. Patients with tremor and gait disorders were older than the others. Patients with functional weakness had more commonly an acute onset (87.9%) than patients with tremor and gait disorders, a shorter time lag from symptoms onset and FMDs diagnosis (2.9 ± 3.5 years) than patients with dystonia, and had more frequently associated functional sensory symptoms (51.7%) than patients with tremor, dystonia and gait disorders. Patients with dystonia complained more often of associated pain (47.4%) than patients with tremor. No other differences were noted between groups in terms of other variables including associated functional neurological symptoms, psychiatric comorbidities, and predisposing or precipitating factors. CONCLUSIONS Our data support the evidence of a large overlap between FMD phenotypes.
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Affiliation(s)
- Michele Tinazzi
- Neurology Unit, Movement Disorders Division, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, P.le Scuro 10, 37134, Verona, Italy.
| | - Christian Geroin
- Neurology Unit, Movement Disorders Division, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, P.le Scuro 10, 37134, Verona, Italy.
| | - Enrico Marcuzzo
- Neurology Unit, Movement Disorders Division, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, P.le Scuro 10, 37134, Verona, Italy
| | - Sofia Cuoco
- Center for Neurodegenerative Diseases (CEMAND), Department of Medicine, Surgery and Dentistry-Scuola Medica Salernitana, University of Salerno, Baronissi, SA, Italy
| | - Roberto Ceravolo
- Neurology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Sonia Mazzucchi
- Neurology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Andrea Pilotto
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy.,FERB Onlus, Ospedale S. Isidoro, Trescore Balneario, Bergamo, Italy
| | - Alessandro Padovani
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Luigi Michele Romito
- Parkinson and Movement Disorders Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Roberto Eleopra
- Parkinson and Movement Disorders Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Mario Zappia
- Department G.F. Ingrassia, Section of Neurosciences, University of Catania, Catania, Italy
| | - Alessandra Nicoletti
- Department G.F. Ingrassia, Section of Neurosciences, University of Catania, Catania, Italy
| | - Carlo Dallocchio
- Department of Medical Area, Neurology Unit, ASST Pavia, Pavia, Italy
| | - Carla Arbasino
- Department of Medical Area, Neurology Unit, ASST Pavia, Pavia, Italy
| | - Francesco Bono
- Botulinum Toxin Center, Neurology Unit A.O.U. Mater Domini, Catanzaro, Italy
| | - Giuseppe Magro
- Botulinum Toxin Center, Neurology Unit A.O.U. Mater Domini, Catanzaro, Italy
| | - Benedetta Demartini
- Aldo Ravelli Research Center for Neurotechnology and Experimental Brain Therapeutics, Department of Health Sciences, University of Milan, Milan, Italy
| | - Orsola Gambini
- Aldo Ravelli Research Center for Neurotechnology and Experimental Brain Therapeutics, Department of Health Sciences, University of Milan, Milan, Italy
| | | | | | - Laura Bonanni
- Department of Neuroscience, Imaging and Clinical Sciences, University G. D'Annunzio, Chieti-Pescara, Italy
| | - Elisabetta Zanolin
- Unit of Epidemiology and Medical Statistics, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Alberto Albanese
- Department of Neurology, IRCCS Humanitas Research Hospital, Rozzano Milan, Italy
| | - Gina Ferrazzano
- Department of Human Neurosciences, Università La Sapienza, Rome, Italy
| | - Rosa De Micco
- Department of Advanced Medical and Surgery Sciences, University of Campania-Luigi Vanvitelli, Naples, Italy
| | - Leonardo Lopiano
- Department of Neuroscience-Rita Levi Montalcini, University of Turin, Turin, Italy
| | - Giovanna Calandra-Buonaura
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy.,IRCCS, Institute of Neurological Sciences of Bologna, Bologna, Italy
| | - Martina Petracca
- Movement Disorder Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | | | - Antonio Pisani
- IRCCS Mondino Foundation, Pavia, Italy.,Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Paolo Manganotti
- Clinical Neurology Unit, Department of Medical, Surgical and Health Services, University of Trieste, Trieste, Italy
| | - Lucia Tesolin
- Functional Movement Disorders Outpt. Clinic, Clinical Neurology and Stroke Unit Department, Central Country Hospital, Bolzano, Italy
| | - Francesco Teatini
- Functional Movement Disorders Outpt. Clinic, Clinical Neurology and Stroke Unit Department, Central Country Hospital, Bolzano, Italy
| | - Tommaso Ercoli
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Francesca Morgante
- Neurosciences Research Centre, Molecular and Clinical Sciences Neurosciences Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, London, UK.,Department of Experimental and Clinical Medicine, University of Messina, Messina, Italy
| | - Roberto Erro
- Center for Neurodegenerative Diseases (CEMAND), Department of Medicine, Surgery and Dentistry-Scuola Medica Salernitana, University of Salerno, Baronissi, SA, Italy
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Tirozzi A, Modugno N, Palomba NP, Ferese R, Lombardi A, Olivola E, Gialluisi A, Esposito T. Analysis of Genetic and Non-genetic Predictors of Levodopa Induced Dyskinesia in Parkinson's Disease. Front Pharmacol 2021; 12:640603. [PMID: 33995045 PMCID: PMC8118664 DOI: 10.3389/fphar.2021.640603] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 04/14/2021] [Indexed: 12/26/2022] Open
Abstract
Background: Levodopa (L-Dopa), representing the therapeutic gold standard for the treatment of Parkinson disease (PD), is associated with side effects like L-Dopa induced dyskinesia (LID). Although several non-genetic and genetic factors have been investigated for association with LID risk, contrasting results were reported and its genetic basis remain largely unexplored. Methods: In an Italian PD cohort (N = 460), we first performed stepwise multivariable Cox Proportional Hazard regressions modeling LID risk as a function of gender, PD familiarity, clinical subtype, weight, age-at-onset (AAO) and years-of-disease (YOD), L-Dopa dosage, severity scores, and scales assessing motor (UPDRS-III), cognitive (MoCA), and non-motor symptoms (NMS). Then we enriched the resulting model testing two variants—rs356219 and D4S3481—increasing the expression of the SNCA gene, previously suggested as a potential mechanism of LID onset. To account for more complex (non-linear) relations of these variables with LID risk, we built a survival random forest (SRF) algorithm including all the covariates mentioned above. Results: Among tested variables (N = 460 case-complete, 211 LID events; total follow-up 31,361 person-months, median 61 months), disease duration showed significant association (p < 0.005), with 6 (3–8)% decrease of LID risk per additional YOD. Other nominally significant associations were observed for gender—with women showing a 39 (5–82)% higher risk of LID—and AAO, with 2 (0.3–3)% decrease of risk for each year increase of PD onset. The SRF algorithm confirmed YOD as the most prominent feature influencing LID risk, with a variable importance of about 8% in the model. In genetic models, no statistically significant effects on incident LID risk was observed. Conclusions: This evidence supports a protective effect of late PD onset and gender (men) against LID risk and suggests a new independent protective factor, YOD. Moreover, it underlines the importance of personalized therapeutic protocols for PD patients in the future.
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Affiliation(s)
| | | | | | | | | | | | | | - Teresa Esposito
- IRCCS Neuromed, Pozzilli, Italy.,Institute of Genetics and Biophysics, CNR, Naples, Italy
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14
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Tinazzi M, Geroin C, Erro R, Marcuzzo E, Cuoco S, Ceravolo R, Mazzucchi S, Pilotto A, Padovani A, Romito LM, Eleopra R, Zappia M, Nicoletti A, Dallocchio C, Arbasino C, Bono F, Pascarella A, Demartini B, Gambini O, Modugno N, Olivola E, Bonanni L, Antelmi E, Zanolin E, Albanese A, Ferrazzano G, de Micco R, Lopiano L, Calandra-Buonaura G, Petracca M, Esposito M, Pisani A, Manganotti P, Stocchi F, Coletti Moja M, Antonini A, Ercoli T, Morgante F. Functional motor disorders associated with other neurological diseases: Beyond the boundaries of "organic" neurology. Eur J Neurol 2021; 28:1752-1758. [PMID: 33300269 DOI: 10.1111/ene.14674] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [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: 10/31/2020] [Revised: 12/03/2020] [Accepted: 12/06/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND AND PURPOSE The aims of this study were to describe the clinical manifestations of functional motor disorders (FMDs) coexisting with other neurological diseases ("comorbid FMDs"), and to compare comorbid FMDs with FMDs not overlapping with other neurological diseases ("pure FMDs"). METHODS For this multicenter observational study, we enrolled outpatients with a definite FMD diagnosis attending 25 tertiary movement disorder centers in Italy. Each patient with FMDs underwent a detailed clinical assessment including screening for other associated neurological conditions. Group comparisons (comorbid FMDs vs. pure FMDs) were performed in order to compare demographic and clinical variables. Logistic regression models were created to estimate the adjusted odds ratios (95% confidence intervals) of comorbid FMDs (dependent variable) in relation to sociodemographic and clinical characteristics (independent variables). RESULTS Out of 410 FMDs, 21.7% of patients (n = 89) had comorbid FMDs. The most frequent coexisting neurological diseases were migraine, cerebrovascular disease and parkinsonism. In the majority of cases (86.5%), FMDs appeared after the diagnosis of a neurological disease. Patients with comorbid FMDs were older, and more frequently had tremor, non-neurological comorbidities, paroxysmal non-epileptic seizures, major depressive disorders, and benzodiazepine intake. Multivariate regression analysis showed that diagnosis of comorbid FMDs was more likely associated with longer time lag until the final diagnosis of FMD, presence of tremor and non-neurological comorbidities. CONCLUSIONS Our findings highlight the need for prompt diagnosis of FMDs, given the relatively high frequency of associated neurological and non-neurological diseases.
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Affiliation(s)
- Michele Tinazzi
- Neurology Unit, Movement Disorders Division, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Christian Geroin
- Neurology Unit, Movement Disorders Division, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Roberto Erro
- Department of Medicine, Surgery and Dentistry -Scuola Medica Salernitana, Center for Neurodegenerative Diseases (CEMAND), University of Salerno, Baronissi, SA, Italy
| | - Enrico Marcuzzo
- Neurology Unit, Movement Disorders Division, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Sofia Cuoco
- Department of Medicine, Surgery and Dentistry -Scuola Medica Salernitana, Center for Neurodegenerative Diseases (CEMAND), University of Salerno, Baronissi, SA, Italy
| | - Roberto Ceravolo
- Neurology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Sonia Mazzucchi
- Neurology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Andrea Pilotto
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy.,FERB Onlus, Ospedale S. Isidoro, Trescore Balneario, Bergamo, Italy
| | - Alessandro Padovani
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Luigi Michele Romito
- Parkinson and Movement Disorders Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Roberto Eleopra
- Parkinson and Movement Disorders Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Mario Zappia
- Section of Neurosciences, Department G.F. Ingrassia, University of Catania, Catania, Italy
| | - Alessandra Nicoletti
- Section of Neurosciences, Department G.F. Ingrassia, University of Catania, Catania, Italy
| | - Carlo Dallocchio
- Neurology Unit, Department of Medical Area, ASST Pavia, Pavia, Italy
| | - Carla Arbasino
- Neurology Unit, Department of Medical Area, ASST Pavia, Pavia, Italy
| | - Francesco Bono
- Botulinum Toxin Center, Neurology Unit, A.O.U. Mater Domini, Catanzaro, Italy
| | - Angelo Pascarella
- Botulinum Toxin Center, Neurology Unit, A.O.U. Mater Domini, Catanzaro, Italy
| | - Benedetta Demartini
- Aldo Ravelli Research Center for Neurotechnology and Experimental Brain Therapeutics - Department of Health Sciences, University of Milan, Milan, Italy
| | - Orsola Gambini
- Aldo Ravelli Research Center for Neurotechnology and Experimental Brain Therapeutics - Department of Health Sciences, University of Milan, Milan, Italy
| | | | | | - Laura Bonanni
- Department of Neuroscience, Imaging and Clinical Sciences, University G. d'Annunzio, Chieti-Pescara, Italy
| | - Elena Antelmi
- Neurology Unit, Movement Disorders Division, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Elisabetta Zanolin
- Unit of Epidemiology and Medical Statistics, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Alberto Albanese
- Department of Neurology, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Gina Ferrazzano
- Department of Human Neurosciences, Università La Sapienza, Rome, Italy
| | - Rosa de Micco
- Department of Advanced Medical and Surgery Sciences, University of Campania - Luigi Vanvitelli, Naples, Italy
| | - Leonardo Lopiano
- Department of Neuroscience - Rita Levi Montalcini, University of Turin, Turin, Italy
| | - Giovanna Calandra-Buonaura
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy.,Institute of Neurological Sciences of Bologna, IRCCS, Bologna, Italy
| | - Martina Petracca
- Movement Disorder Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | | | | | - Paolo Manganotti
- Clinical Neurology Unit, Department of Medical, Surgical and Health Services, University of Trieste, Trieste, Italy
| | - Fabrizio Stocchi
- University and Institute of Research and Medical Care San Raffaele, Roma, Italy
| | | | - Angelo Antonini
- Movement Disorders Unit, Department of Neuroscience, University of Padua, Padua, Italy
| | - Tommaso Ercoli
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Francesca Morgante
- Neurosciences Research Centre, Molecular and Clinical Sciences Neurosciences Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, London, UK.,Department of Experimental and Clinical Medicine, University of Messina, Messina, Italy
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15
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Meglio M, Olivola E, Santilli M, Lena F, Centonze D, Bologna M, Modugno N. Effects of Prismatic Lenses on Lateral Axial Dystonia in Parkinson's Disease: A Pilot Study. Innov Clin Neurosci 2021; 18:39-42. [PMID: 34150363 PMCID: PMC8213334] [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] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
OBJECTIVE: In Parkinson's disease (PD), postural abnormalities such as lateral axial dystonia (LAD) are relatively common. Evidence suggests that both peripheral and central mechanisms contribute to these postural abnormalities. We previously reported an improvement in LAD following the use of prisms in two PD patients. Here, we further investigate the effects of prismatic lenses in a case series of nine patients with PD and LAD. METHODS: Nine patients underwent an orthoptic evaluation and were provided with prismatic lenses. Patients were evaluated at baseline and after one and three months of permanent prismatic lens use and again re-evaluated one month after the discontinuation of prismatic lens use. RESULTS: We found a linear relationship between disease duration and LAD severity. Compared to basal measurements, we observed a slight improvement in LAD. Furthermore, we found a significant reduction in self-perceived back pain due to the use of prismatic lenses. There was no significant association between the individual effects of prismatic lenses in patients with PD and their baseline LAD or other clinical and demographic features (all P>0.05). CONCLUSION: The present pilot study provides novel data on the possible effectiveness of prismatic lenses for LAD treatment in PD patients.
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Affiliation(s)
- Michele Meglio
- Dr. Meglio is with IRCCS Neuromed in the Unit of Neuro-Ophthalmology in Pozzilli, Italy; he's a PhD student in Neuroscience at University of Rome Tor Vergata in Rome, Italy
- Drs. Olivola, Santilli, Lena, Centonze, Bologna, and Modugno are with the IRCCS Neuromed in their Department of Neurology
- Dr. Modugno is the head of the Parkinson Center in the same Institute. Prof. Centonze is Full Professor of Neurology at the University of Rome Tor Vergata and Director of the Department of Neurology at the IRCCS Neuromed
- Dr. Bologna is with the Department of Human Neurosciences at Sapienza University in Rome, Italy
| | - Enrica Olivola
- Dr. Meglio is with IRCCS Neuromed in the Unit of Neuro-Ophthalmology in Pozzilli, Italy; he's a PhD student in Neuroscience at University of Rome Tor Vergata in Rome, Italy
- Drs. Olivola, Santilli, Lena, Centonze, Bologna, and Modugno are with the IRCCS Neuromed in their Department of Neurology
- Dr. Modugno is the head of the Parkinson Center in the same Institute. Prof. Centonze is Full Professor of Neurology at the University of Rome Tor Vergata and Director of the Department of Neurology at the IRCCS Neuromed
- Dr. Bologna is with the Department of Human Neurosciences at Sapienza University in Rome, Italy
| | - Marco Santilli
- Dr. Meglio is with IRCCS Neuromed in the Unit of Neuro-Ophthalmology in Pozzilli, Italy; he's a PhD student in Neuroscience at University of Rome Tor Vergata in Rome, Italy
- Drs. Olivola, Santilli, Lena, Centonze, Bologna, and Modugno are with the IRCCS Neuromed in their Department of Neurology
- Dr. Modugno is the head of the Parkinson Center in the same Institute. Prof. Centonze is Full Professor of Neurology at the University of Rome Tor Vergata and Director of the Department of Neurology at the IRCCS Neuromed
- Dr. Bologna is with the Department of Human Neurosciences at Sapienza University in Rome, Italy
| | - Francesco Lena
- Dr. Meglio is with IRCCS Neuromed in the Unit of Neuro-Ophthalmology in Pozzilli, Italy; he's a PhD student in Neuroscience at University of Rome Tor Vergata in Rome, Italy
- Drs. Olivola, Santilli, Lena, Centonze, Bologna, and Modugno are with the IRCCS Neuromed in their Department of Neurology
- Dr. Modugno is the head of the Parkinson Center in the same Institute. Prof. Centonze is Full Professor of Neurology at the University of Rome Tor Vergata and Director of the Department of Neurology at the IRCCS Neuromed
- Dr. Bologna is with the Department of Human Neurosciences at Sapienza University in Rome, Italy
| | - Diego Centonze
- Dr. Meglio is with IRCCS Neuromed in the Unit of Neuro-Ophthalmology in Pozzilli, Italy; he's a PhD student in Neuroscience at University of Rome Tor Vergata in Rome, Italy
- Drs. Olivola, Santilli, Lena, Centonze, Bologna, and Modugno are with the IRCCS Neuromed in their Department of Neurology
- Dr. Modugno is the head of the Parkinson Center in the same Institute. Prof. Centonze is Full Professor of Neurology at the University of Rome Tor Vergata and Director of the Department of Neurology at the IRCCS Neuromed
- Dr. Bologna is with the Department of Human Neurosciences at Sapienza University in Rome, Italy
| | - Matteo Bologna
- Dr. Meglio is with IRCCS Neuromed in the Unit of Neuro-Ophthalmology in Pozzilli, Italy; he's a PhD student in Neuroscience at University of Rome Tor Vergata in Rome, Italy
- Drs. Olivola, Santilli, Lena, Centonze, Bologna, and Modugno are with the IRCCS Neuromed in their Department of Neurology
- Dr. Modugno is the head of the Parkinson Center in the same Institute. Prof. Centonze is Full Professor of Neurology at the University of Rome Tor Vergata and Director of the Department of Neurology at the IRCCS Neuromed
- Dr. Bologna is with the Department of Human Neurosciences at Sapienza University in Rome, Italy
| | - Nicola Modugno
- Dr. Meglio is with IRCCS Neuromed in the Unit of Neuro-Ophthalmology in Pozzilli, Italy; he's a PhD student in Neuroscience at University of Rome Tor Vergata in Rome, Italy
- Drs. Olivola, Santilli, Lena, Centonze, Bologna, and Modugno are with the IRCCS Neuromed in their Department of Neurology
- Dr. Modugno is the head of the Parkinson Center in the same Institute. Prof. Centonze is Full Professor of Neurology at the University of Rome Tor Vergata and Director of the Department of Neurology at the IRCCS Neuromed
- Dr. Bologna is with the Department of Human Neurosciences at Sapienza University in Rome, Italy
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16
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Morgante F, Oppo V, Fabbri M, Olivola E, Sorbera C, De Micco R, Ielo GC, Colucci F, Bonvegna S, Novelli A, Modugno N, Sensi M, Zibetti M, Lopiano L, Tessitore A, Pilleri M, Cilia R, Elia AE, Eleopra R, Ricciardi L, Cossu G. Levodopa-carbidopa intrajejunal infusion in Parkinson's disease: untangling the role of age. J Neurol 2020; 268:1728-1737. [PMID: 33354739 PMCID: PMC8068706 DOI: 10.1007/s00415-020-10356-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Revised: 11/22/2020] [Accepted: 12/04/2020] [Indexed: 01/01/2023]
Abstract
OBJECTIVES Levodopa-Carbidopa Intrajejunal gel (LCIG) infusion is an effective intervention for people with advanced Parkinson's disease (PD). Although age may not be a limiting factor for LCIG implant, no data are available on late elderly PD (LE-PD) subjects. In this cross-sectional, we aimed to demonstrate if older age may impact on quality of life (QoL), motor and non-motor symptoms severity, and profile of side effects in PD treated with LCIG. METHODS Out of 512 PD subjects treated with LCIG at 9 Italian PD centers, we selected 25 LE-PD defined as age ≥ 80 years at last follow-up who were available to attend the study visit. Twenty-five PD patients (Control-PD, defined as age < 75 years at last follow-up) matched to LE-PD by disease and LCIG duration served as control group. The following motor and non-motor variables were ascertained: quality of life (PDQ-8), time spent in ON, wearing-off Questionnaire, Unified PD Rating Scale, freezing of gait questionnaire, Parkinson's disease sleep scale-2, Non Motor Symptoms Scale (NMSS), and MOCA. RESULTS No statistically significant differences were found between LE-PD and Control-PD on PDQ-8 and several motor and non-motor variables. LE-PD had less frequent and milder impulsive-compulsive behaviors and milder dyskinesia. At multivariable regression, worse quality of life was associated with UPDRS-III and NMSS scores but not to age at study visit and age at LICG implant. Rate of adverse effects was similar in both groups. Drop-out rate calculated in the whole PD cohort was comparable between the two groups. CONCLUSION Our data provide evidence that valuable LCIG infusion might be achieved in late elderly PD.
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Affiliation(s)
- Francesca Morgante
- Neurosciences Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, Cranmer Terrace, London, SW17 0RE, United Kingdom. .,Department of Experimental and Clinical Medicine, University of Messina, Messina, Italy.
| | - Valentina Oppo
- Movement Disorders and Neurophysiology Unit, Department of Neuroscience, AO Brotzu, Piazzale Ricchi 1, Cagliari, 09134, Italy
| | - Margherita Fabbri
- Department of Neurosciences, Clinical Investigation Center CIC 1436, Parkinson Toulouse expert center, NS-Park/FCRIN network and NeuroToul COEN center, TOULOUSE University Hospital, INSERM, University of Toulouse 3, Toulouse, France
| | | | - Chiara Sorbera
- Neurorehabilitation Unit, IRCCS Centro Neurolesi "Bonino Pulejo,", Messina, Italy
| | - Rosa De Micco
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Giovanna Chiara Ielo
- Service of Neurology, Private Hospital, Villa Margherita-Santo Stefano, Arcugnano, Italy
| | - Fabiana Colucci
- Department of Neuroscience and Rehabilitation, Azienda Ospedaliera-Universitaria S. Anna, Ferrara, Italy
| | - Salvatore Bonvegna
- Movement Disorder Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Alessio Novelli
- Movement Disorder Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | | | - Mariachiara Sensi
- Department of Neuroscience and Rehabilitation, Azienda Ospedaliera-Universitaria S. Anna, Ferrara, Italy
| | - Maurizio Zibetti
- Department of Neuroscience "Rita Levi Montalcini", University of Torino, Turin, Italy
| | - Leonardo Lopiano
- Department of Neuroscience "Rita Levi Montalcini", University of Torino, Turin, Italy
| | - Alessandro Tessitore
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Manuela Pilleri
- Service of Neurology, Private Hospital, Villa Margherita-Santo Stefano, Arcugnano, Italy
| | - Roberto Cilia
- Movement Disorder Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Antonio E Elia
- Movement Disorder Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Roberto Eleopra
- Movement Disorder Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Lucia Ricciardi
- Neurosciences Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, Cranmer Terrace, London, SW17 0RE, United Kingdom.,MRC Brain Network Dynamics Unit, Nuffield Department of Clinical Neurosciences, Oxford, UK
| | - Giovanni Cossu
- Movement Disorders and Neurophysiology Unit, Department of Neuroscience, AO Brotzu, Piazzale Ricchi 1, Cagliari, 09134, Italy.
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17
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Tinazzi M, Morgante F, Marcuzzo E, Erro R, Barone P, Ceravolo R, Mazzucchi S, Pilotto A, Padovani A, Romito LM, Eleopra R, Zappia M, Nicoletti A, Dallocchio C, Arbasino C, Bono F, Pascarella A, Demartini B, Gambini O, Modugno N, Olivola E, Di Stefano V, Albanese A, Ferrazzano G, Tessitore A, Zibetti M, Calandra-Buonaura G, Petracca M, Esposito M, Pisani A, Manganotti P, Stocchi F, Coletti Moja M, Antonini A, Defazio G, Geroin C. Clinical Correlates of Functional Motor Disorders: An Italian Multicenter Study. Mov Disord Clin Pract 2020; 7:920-929. [PMID: 33163563 DOI: 10.1002/mdc3.13077] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 08/04/2020] [Indexed: 12/21/2022] Open
Abstract
Background Functional motor disorders (FMDs) are abnormal movements that are significantly altered by distractive maneuvers and are incongruent with movement disorders seen in typical neurological diseases. Objective The objectives of this article are to (1) describe the clinical manifestations of FMDs, including nonmotor symptoms and occurrence of other functional neurological disorders (FND); and (2) to report the frequency of isolated and combined FMDs and their relationship with demographic and clinical variables. Methods For this multicenter, observational study, we enrolled consecutive outpatients with a definite diagnosis of FMDs attending 25 tertiary movement disorders centers in Italy. Each patient underwent a detailed clinical evaluation with a definition of the phenotype and number of FMDs (isolated, combined) and an assessment of associated neurological and psychiatric symptoms. Results Of 410 FMDs (71% females; mean age, 47 ± 16.1 years) the most common phenotypes were weakness and tremor. People with FMDs had higher educational levels than the general population and frequent nonmotor symptoms, especially anxiety, fatigue, and pain. Almost half of the patients with FMDs had other FNDs, such as sensory symptoms, nonepileptic seizures, and visual symptoms. Patients with combined FMDs showed a higher burden of nonmotor symptoms and more frequent FNDs. Multivariate regression analysis showed that a diagnosis of combined FMDs was more likely to be delivered by a movement disorders neurologist. Also, FMD duration, pain, insomnia, diagnosis of somatoform disease, and treatment with antipsychotics were all significantly associated with combined FMDs. Conclusions Our findings highlight the need for multidimensional assessments in patients with FMDs given the high frequency of nonmotor symptoms and other FNDs, especially in patients with combined FMDs.
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Affiliation(s)
- Michele Tinazzi
- Neurology Unit, Movement Disorders Division, Department of Neurosciences Biomedicine and Movement Sciences University of Verona Verona Italy
| | - Francesca Morgante
- Neurosciences Research Centre, Molecular and Clinical Sciences Neurosciences Research Centre Molecular and Clinical Sciences Research Institute, St George's University of London London United Kingdom.,Department of Experimental and Clinical Medicine University of Messina Messina Italy
| | - Enrico Marcuzzo
- Neurology Unit, Movement Disorders Division, Department of Neurosciences Biomedicine and Movement Sciences University of Verona Verona Italy
| | - Roberto Erro
- Center for Neurodegenerative Diseases, Department of Medicine, Surgery and Dentistry-Scuola Medica Salernitana University of Salerno Baronissi Italy
| | - Paolo Barone
- Center for Neurodegenerative Diseases, Department of Medicine, Surgery and Dentistry-Scuola Medica Salernitana University of Salerno Baronissi Italy
| | - Roberto Ceravolo
- Neurology Unit, Department of Clinical and Experimental Medicine University of Pisa Pisa Italy
| | - Sonia Mazzucchi
- Neurology Unit, Department of Clinical and Experimental Medicine University of Pisa Pisa Italy
| | - Andrea Pilotto
- Department of Clinical and Experimental Sciences University of Brescia Brescia Italy.,FERB Onlus, Ospedale S. Isidoro, Trescore Balneario Bergamo Italy
| | - Alessandro Padovani
- Department of Clinical and Experimental Sciences University of Brescia Brescia Italy
| | - Luigi M Romito
- Parkinson and Movement Disorders Unit Fondazione IRCCS Istituto Neurologico Carlo Besta Milan Italy
| | - Roberto Eleopra
- Parkinson and Movement Disorders Unit Fondazione IRCCS Istituto Neurologico Carlo Besta Milan Italy
| | - Mario Zappia
- Department G.F. Ingrassia, Section of Neurosciences University of Catania Catania Italy
| | - Alessandra Nicoletti
- Department G.F. Ingrassia, Section of Neurosciences University of Catania Catania Italy
| | - Carlo Dallocchio
- Department of Medical Area Neurology Unit, ASST Pavia Pavia Italy
| | - Carla Arbasino
- Department of Medical Area Neurology Unit, ASST Pavia Pavia Italy
| | - Francesco Bono
- Botulinum Toxin Center Neurology Unit A.O.U. Mater Domini Catanzaro Italy
| | - Angelo Pascarella
- Botulinum Toxin Center Neurology Unit A.O.U. Mater Domini Catanzaro Italy
| | - Benedetta Demartini
- Aldo Ravelli Research Center for Neurotechnology and Experimental Brain Therapeutics, Department of Health Sciences University of Milan Milan Italy
| | - Orsola Gambini
- Aldo Ravelli Research Center for Neurotechnology and Experimental Brain Therapeutics, Department of Health Sciences University of Milan Milan Italy
| | | | | | - Vincenzo Di Stefano
- Department of Neuroscience, Imaging and Clinical Sciences University G. d'Annunzio Chieti-Pescara Italy
| | - Alberto Albanese
- Department of Neurology IRCCS Humanitas Research Hospital Rozzano Italy
| | - Gina Ferrazzano
- Department of Human Neurosciences Università La Sapienza Rome Italy
| | - Alessandro Tessitore
- Department of Advanced Medical and Surgery Sciences University of Campania - Luigi Vanvitelli Naples Italy
| | - Maurizio Zibetti
- Department of Neuroscience-Rita Levi Montalcini University of Turin Turin Italy
| | - Giovanna Calandra-Buonaura
- Department of Biomedical and Neuromotor Sciences University of Bologna Bologna Italy.,IRCCS, Institute of Neurological Sciences of Bologna Bologna Italy
| | - Martina Petracca
- Movement Disorder Unit Fondazione Policlinico Universitario A. Gemelli IRCCS Rome Italy
| | - Marcello Esposito
- Clinical Neurophysiology Unit Cardarelli Hospital Naples Italy.,Department of Neurosciences Reproductive and Odontostomatological Sciences, University of Naples-Federico II Naples Italy
| | - Antonio Pisani
- Department of Systems Medicine University of Rome Tor Vergata Rome Italy
| | - Paolo Manganotti
- Clinical Neurology Unit, Department of Medical Surgical and Health Services, University of Trieste Trieste Italy
| | - Fabrizio Stocchi
- University and Institute of Research and Medical Care San Raffaele Roma Rome Italy
| | | | - Angelo Antonini
- Movement Disorders Unit, Department of Neuroscience University of Padua Padua Italy
| | - Giovanni Defazio
- Department of Medical Sciences and Public Health University of Cagliari Cagliari Italy
| | - Christian Geroin
- Neurology Unit, Movement Disorders Division, Department of Neurosciences Biomedicine and Movement Sciences University of Verona Verona Italy
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18
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Olivola S, Xodo S, Olivola E, Cecchini F, Londero AP, Driul L. Parkinson's Disease in Pregnancy: A Case Report and Review of the Literature. Front Neurol 2020; 10:1349. [PMID: 32140133 PMCID: PMC7042376 DOI: 10.3389/fneur.2019.01349] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Accepted: 12/09/2019] [Indexed: 11/13/2022] Open
Abstract
Background: Pregnancy in Parkinson's disease is a rare occurrence, and to date, clinical experience with its management is rather limited. In clinical practice, doubts concern mainly the impact of PD on gestation, labor, and delivery as well as the safety of dopaminergic drugs. Case and review of the literature: We report the case of a 40-year-old woman with an 8-year history of PD. In the first trimester of her pregnancy, her motor status was similar to the pre-conceptional period. In gestation week 16, her motor status dramatically worsened and she complained of predictable "off" periods in the afternoon. For this reason, her dose of L-DOPA/carbidopa was increased up to 500/125 mg per day. At 39 gestational weeks, she gave birth to a healthy girl with an Apgar score of 9 by an uncomplicated cesarean delivery. The child was not breast fed to avoid exposure to antiparkinsonian drugs. The L-DOPA/carbidopa dosage remained constant during the postpartum period. We performed a systematic review of the literature using Ovid Medline, Scopus, and PubMed (including Cochrane database). We used the search terms "Parkinson disease" AND "pregnancy." We identified 20 studies of PD in pregnancy with a total of 37 pregnant women with PD. The most important available data concern the safety of L-DOPA therapy during pregnancy. There seems to be some risk of worsening of the condition or upcoming of new PD symptoms during or shortly after pregnancy. Conclusion: More data concerning the safety of antiparkinsonian drugs in PD treatment, as well as the effect of pregnancy on parkinsonian symptoms are needed. According to the current state of the art, L-DOPA therapy should be considered preferable to other drugs during pregnancy.
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Affiliation(s)
- Sara Olivola
- Department of Gynaecology and Obstetrics, School of Medicine of Udine, Udine, Italy
| | - Serena Xodo
- Department of Gynaecology and Obstetrics, School of Medicine of Udine, Udine, Italy
| | - Enrica Olivola
- IRCCS Istituto Neurologico Mediterraneo (INM) Neuromed, Pozzilli, Italy
| | - Fabiana Cecchini
- Department of Gynaecology and Obstetrics, School of Medicine of Udine, Udine, Italy
| | | | - Lorenza Driul
- Department of Gynaecology and Obstetrics, School of Medicine of Udine, Udine, Italy
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19
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Di Caprio V, Modugno N, Mancini C, Olivola E, Mirabella G. Early‐Stage Parkinson's Patients Show Selective Impairment in Reactive But Not Proactive Inhibition. Mov Disord 2019; 35:409-418. [DOI: 10.1002/mds.27920] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Revised: 09/27/2019] [Accepted: 10/23/2019] [Indexed: 11/08/2022] Open
Affiliation(s)
- Veronica Di Caprio
- Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Neuromed, Pozzilli (IS) Italy
| | - Nicola Modugno
- Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Neuromed, Pozzilli (IS) Italy
| | - Christian Mancini
- Department of Anatomy, Histology, Forensic Medicine & OrthopedicsSapienza University Rome Italy
| | - Enrica Olivola
- Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Neuromed, Pozzilli (IS) Italy
| | - Giovanni Mirabella
- Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Neuromed, Pozzilli (IS) Italy
- Department of Anatomy, Histology, Forensic Medicine & OrthopedicsSapienza University Rome Italy
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20
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Picillo M, Cuoco S, Amboni M, Bonifacio FP, Bruschi F, Carotenuto I, De Micco R, De Rosa A, Del Prete E, Di Biasio F, Elifani F, Erro R, Fabbri M, Falla M, Franco G, Frosini D, Galantucci S, Lazzeri G, Magistrelli L, Malaguti MC, Milner AV, Minafra B, Olivola E, Pilotto A, Rascunà C, Rizzetti MC, Schirinzi T, Borroni B, Ceravolo R, Di Fonzo A, Marchese R, Mercuri NB, Modugno N, Nicoletti A, Padovani A, Santangelo G, Stefani A, Tessitore A, Volontè MA, Zangaglia R, Zappia M, Zibetti M, Barone P. Validation of the Italian version of the PSP Quality of Life questionnaire. Neurol Sci 2019; 40:2587-2594. [PMID: 31350659 DOI: 10.1007/s10072-019-04010-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 03/29/2019] [Accepted: 07/10/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND Progressive supranuclear palsy (PSP) is a rare rapidly progressive, neurodegenerative disease characterized by falls and ocular movement disturbances. The use of health-related quality of life (HR-QoL) measures allows assessing changes in health status induced by therapeutic interventions or disease progress in neurodegenerative diseases. The PSP-QoL is a 45-item, self-administered questionnaire designed to evaluate HR-QoL in PSP. METHODS AND RESULTS Here, the PSP-QoL was translated into Italian and validated in 190 PSP (96 women and 94 men; mean age ± standard deviation, 72 ± 6.5; mean disease duration, 4.2 ± 2.3) patients diagnosed according to the Movement Disorder Society criteria and recruited in 16 third level movement disorders centers participating in the Neurecanet project. The mean PSP-QoL total score was 77.8 ± 37 (physical subscore, 46.5 ± 18.7; mental subscore, 33.6 ± 19.2). The internal consistency was high (Cronbach's alpha = 0.954); corrected item-total correlation was > 0.40 for the majority of items. The significant and moderate correlation of the PSP-QoL with other HR-QoL measures as well as with motor and disability assessments indicated adequate convergent validity of the scale. Gender and geographic location presented a significant impact on the PSP-QoL in our sample with women and patients from the South of Italy scoring higher than their counterparts. CONCLUSION In conclusion, the Italian version of the PSP-QoL is an easy, reliable and valid tool for assessment of HR-QoL in PSP.
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Affiliation(s)
- Marina Picillo
- Center for Neurodegenerative Diseases (CEMAND), Department of Medicine, Surgery and Odontoiatry, University of Salerno, 84131, Salerno, Italy
| | - Sofia Cuoco
- Center for Neurodegenerative Diseases (CEMAND), Department of Medicine, Surgery and Odontoiatry, University of Salerno, 84131, Salerno, Italy
| | - Marianna Amboni
- Center for Neurodegenerative Diseases (CEMAND), Department of Medicine, Surgery and Odontoiatry, University of Salerno, 84131, Salerno, Italy
| | - Francesco Paolo Bonifacio
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Fabio Bruschi
- Parkinson's Disease and Movement Disorders Unit, IRCCS Mondino Foundation, Pavia, Italy
| | - Immacolata Carotenuto
- Center for Neurodegenerative Diseases (CEMAND), Department of Medicine, Surgery and Odontoiatry, University of Salerno, 84131, Salerno, Italy
| | - Rosa De Micco
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Anna De Rosa
- Department of Neurosciences and Reproductive and Odontostomatological Sciences, Federico II University, Naples, Italy
| | - Eleonora Del Prete
- Dipartimento di Medicina Clinica e Sperimentale, Università di Pisa, Pisa, Italy
| | | | | | - Roberto Erro
- Center for Neurodegenerative Diseases (CEMAND), Department of Medicine, Surgery and Odontoiatry, University of Salerno, 84131, Salerno, Italy
| | - Margherita Fabbri
- Department of Neuroscience "Rita Levi Montalcini", University of Turin, via Cherasco 15, 10124, Torino, Italy
| | - Marika Falla
- Department of Neurology, General Hospital of Bolzano, Bolzano, Italy
- CIMec and CeRIN, University of Trento, Rovereto, Italy
| | - Giulia Franco
- IRCCS Foundation Ca' Granda Ospedale Maggiore Policlinico, Dino Ferrari Center, Neuroscience Section, Department of Pathophysiology and Transplantation, University of Milan, 20122, Milan, Italy
| | - Daniela Frosini
- Dipartimento di Medicina Clinica e Sperimentale, Università di Pisa, Pisa, Italy
| | | | - Giulia Lazzeri
- IRCCS Foundation Ca' Granda Ospedale Maggiore Policlinico, Dino Ferrari Center, Neuroscience Section, Department of Pathophysiology and Transplantation, University of Milan, 20122, Milan, Italy
| | - Luca Magistrelli
- Movement Disorders Centre, Neurology Unit, Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy
- PhD Program in Clinical and Experimental Medicine and Medical Humanities, University of Insubria, Varese, Italy
| | - Maria Chiara Malaguti
- UO Neurologia, Ospedale Santa Chiara Trento, Azienda provinciale per i servizi sanitari provincia autonoma di Trento, Trento, Italy
| | - Anna Vera Milner
- Movement Disorders Centre, Neurology Unit, Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy
| | - Brigida Minafra
- Parkinson's Disease and Movement Disorders Unit, IRCCS Mondino Foundation, Pavia, Italy
| | | | - Andrea Pilotto
- Centre for Neurodegenerative Disorders, Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Cristina Rascunà
- Department G.F. Ingrassia, Section of Neurosciences, University of Catania, Catania, Italy
| | | | - Tommaso Schirinzi
- Centro Parkinson, Dip. Medicina dei Sistemi, Policlinico Tor Vergata, Rome, Italy
| | - Barbara Borroni
- Centre for Neurodegenerative Disorders, Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Roberto Ceravolo
- Dipartimento di Medicina Clinica e Sperimentale, Università di Pisa, Pisa, Italy
| | - Alessio Di Fonzo
- IRCCS Foundation Ca' Granda Ospedale Maggiore Policlinico, Dino Ferrari Center, Neuroscience Section, Department of Pathophysiology and Transplantation, University of Milan, 20122, Milan, Italy
| | | | - Nicola B Mercuri
- Centro Parkinson, Dip. Medicina dei Sistemi, Policlinico Tor Vergata, Rome, Italy
| | | | - Alessandra Nicoletti
- Department G.F. Ingrassia, Section of Neurosciences, University of Catania, Catania, Italy
| | - Alessandro Padovani
- Centre for Neurodegenerative Disorders, Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Gabriella Santangelo
- Department of Psychology, University of Campania "Luigi Vanvitelli", Viale Ellittico 31, 81100, Caserta, Italy
| | - Alessandro Stefani
- Centro Parkinson, Dip. Medicina dei Sistemi, Policlinico Tor Vergata, Rome, Italy
| | - Alessandro Tessitore
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | | | - Roberta Zangaglia
- Parkinson's Disease and Movement Disorders Unit, IRCCS Mondino Foundation, Pavia, Italy
| | - Mario Zappia
- Department G.F. Ingrassia, Section of Neurosciences, University of Catania, Catania, Italy
| | - Maurizio Zibetti
- Department of Neuroscience "Rita Levi Montalcini", University of Turin, via Cherasco 15, 10124, Torino, Italy
| | - Paolo Barone
- Center for Neurodegenerative Diseases (CEMAND), Department of Medicine, Surgery and Odontoiatry, University of Salerno, 84131, Salerno, Italy.
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21
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Liguori C, Ruffini R, Olivola E, Chiaravalloti A, Izzi F, Stefani A, Pierantozzi M, Mercuri NB, Modugno N, Centonze D, Schillaci O, Placidi F. Cerebral glucose metabolism in idiopathic REM sleep behavior disorder is different from tau-related and α-synuclein-related neurodegenerative disorders: A brain [18F]FDG PET study. Parkinsonism Relat Disord 2019; 64:97-105. [DOI: 10.1016/j.parkreldis.2019.03.017] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 03/16/2019] [Accepted: 03/19/2019] [Indexed: 10/27/2022]
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22
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Picillo M, Cuoco S, Amboni M, Bonifacio FP, Bruno A, Bruschi F, Cappiello A, De Micco R, De Rosa A, Di Biasio F, Elifani F, Erro R, Fabbri M, Falla M, Franco G, Frosini D, Galantucci S, Lazzeri G, Magistrelli L, Malaguti MC, Milner AV, Minafra B, Olivola E, Pilotto A, Rascunà C, Rizzetti MC, Schirinzi T, Borroni B, Ceravolo R, Di Fonzo A, Lopiano L, Marchese R, Mercuri NB, Modugno N, Nicoletti A, Padovani A, Santangelo G, Stefani A, Tessitore A, Volontè MA, Zangaglia R, Zappia M, Barone P. Validation of the Italian version of carers' quality-of-life questionnaire for parkinsonism (PQoL Carer) in progressive supranuclear palsy. Neurol Sci 2019; 40:2163-2169. [PMID: 31190253 DOI: 10.1007/s10072-019-03944-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 04/01/2019] [Accepted: 05/20/2019] [Indexed: 11/25/2022]
Abstract
Progressive supranuclear palsy (PSP) is a rare, rapidly progressive, neurodegenerative disease characterized by falls and ocular movement disturbances. Caring for a partner or relative who suffers from PSP entails a strenuous and demanding task, usually lasting for years that affects carers' everyday life routines and emotional and social well-being. The 26-item Parkinsonism Carers QoL (PQoL Carer) is a self-administered, concise instrument evaluating the quality of life of caregivers of patients with atypical parkinsonism (both PSP and multiple system atrophy). Here, the PQoL Carer was translated into Italian and validated in 162 carers of PSP patients (54.3% women; mean age (standard deviation), 62.4 (15.4)) diagnosed according to the Movement Disorder Society criteria and recruited in 16 third-level movement disorders centers participating in the Neurecanet project. The mean PQoL total score was 40.66 ± 19.46. The internal consistency was excellent (Cronbach's alpha = 0.941); corrected item-total correlation was > 0.40 for all the items. A correlation with other health-related quality of life measures as well as with behavioral assessments was shown suggesting adequate convergent validity of the scale. PQoL also correlated with patients' severity of disease. The discriminant validity of the scale was evidenced by its capacity to differentiate between carers with varying levels of self-reported health (p < 0.001). In conclusion, the Italian version of the PQoL Carer is an easy, consistent, and valid tool for the assessment of the quality of life in carers of PSP patients.
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Affiliation(s)
- Marina Picillo
- Center for Neurodegenerative Diseases (CEMAND), Department of Medicine, Surgery and Odontoiatry, University of Salerno, 84131, Salerno, Italy
| | - Sofia Cuoco
- Center for Neurodegenerative Diseases (CEMAND), Department of Medicine, Surgery and Odontoiatry, University of Salerno, 84131, Salerno, Italy
| | - Marianna Amboni
- Center for Neurodegenerative Diseases (CEMAND), Department of Medicine, Surgery and Odontoiatry, University of Salerno, 84131, Salerno, Italy
| | - Francesco Paolo Bonifacio
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Antonino Bruno
- Dipartimento di Medicina Clinica e Sperimentale, Università di Pisa, Pisa, Italy
| | - Fabio Bruschi
- Parkinson's Disease and Movement Disorders Unit, IRCCS Mondino Foundation, Pavia, Italy
| | - Arianna Cappiello
- Center for Neurodegenerative Diseases (CEMAND), Department of Medicine, Surgery and Odontoiatry, University of Salerno, 84131, Salerno, Italy
| | - Rosa De Micco
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Anna De Rosa
- Department of Neurosciences and Reproductive and Odontostomatological Sciences, Federico II University, Naples, Italy
| | | | | | - Roberto Erro
- Center for Neurodegenerative Diseases (CEMAND), Department of Medicine, Surgery and Odontoiatry, University of Salerno, 84131, Salerno, Italy
| | - Margherita Fabbri
- Department of Neuroscience "Rita Levi Montalcini", University of Turin, Via Cherasco 15, 10124, Torino, Italy
| | - Marika Falla
- Department of Neurology, General Hospital of Bolzano, Bolzano, Italy
- CIMec and CeRIN, University of Trento, Rovereto, Italy
| | - Giulia Franco
- IRCCS Foundation Ca' Granda Ospedale Maggiore Policlinico, Dino Ferrari Center, Neuroscience Section, Department of Pathophysiology and Transplantation, University of Milan, 20122, Milan, Italy
| | - Daniela Frosini
- Dipartimento di Medicina Clinica e Sperimentale, Università di Pisa, Pisa, Italy
| | | | - Giulia Lazzeri
- IRCCS Foundation Ca' Granda Ospedale Maggiore Policlinico, Dino Ferrari Center, Neuroscience Section, Department of Pathophysiology and Transplantation, University of Milan, 20122, Milan, Italy
| | - Luca Magistrelli
- Movement Disorders Centre, Neurology Unit, Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy
- PhD Program in Clinical and Experimental Medicine and Medical Humanities, University of Insubria, Varese, Italy
| | - Maria Chiara Malaguti
- UO Neurologia, Ospedale Santa Chiara Trento, Azienda Provinciale per i Servizi Sanitari Provincia Autonoma di Trento, Trento, Italy
| | - Anna Vera Milner
- Movement Disorders Centre, Neurology Unit, Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy
| | - Brigida Minafra
- Parkinson's Disease and Movement Disorders Unit, IRCCS Mondino Foundation, Pavia, Italy
| | | | - Andrea Pilotto
- Centre for Neurodegenerative Disorders, Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Cristina Rascunà
- Department G.F. Ingrassia, Section of Neurosciences, University of Catania, Catania, Italy
| | | | - Tommaso Schirinzi
- Centro Parkinson, Dip. Medicina dei Sistemi, Policlinico Tor Vergata, Rome, Italy
| | - Barbara Borroni
- Centre for Neurodegenerative Disorders, Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Roberto Ceravolo
- Dipartimento di Medicina Clinica e Sperimentale, Università di Pisa, Pisa, Italy
| | - Alessio Di Fonzo
- IRCCS Foundation Ca' Granda Ospedale Maggiore Policlinico, Dino Ferrari Center, Neuroscience Section, Department of Pathophysiology and Transplantation, University of Milan, 20122, Milan, Italy
| | - Leonardo Lopiano
- Department of Neuroscience "Rita Levi Montalcini", University of Turin, Via Cherasco 15, 10124, Torino, Italy
| | | | - Nicola B Mercuri
- Centro Parkinson, Dip. Medicina dei Sistemi, Policlinico Tor Vergata, Rome, Italy
| | | | - Alessandra Nicoletti
- Department G.F. Ingrassia, Section of Neurosciences, University of Catania, Catania, Italy
| | - Alessandro Padovani
- Centre for Neurodegenerative Disorders, Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Gabriella Santangelo
- Department of Psychology, University of Campania "Luigi Vanvitelli", Viale Ellittico 31, 81100, Caserta, Italy
| | - Alessandro Stefani
- Centro Parkinson, Dip. Medicina dei Sistemi, Policlinico Tor Vergata, Rome, Italy
| | - Alessandro Tessitore
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | | | - Roberta Zangaglia
- Parkinson's Disease and Movement Disorders Unit, IRCCS Mondino Foundation, Pavia, Italy
| | - Mario Zappia
- Department G.F. Ingrassia, Section of Neurosciences, University of Catania, Catania, Italy
| | - Paolo Barone
- Center for Neurodegenerative Diseases (CEMAND), Department of Medicine, Surgery and Odontoiatry, University of Salerno, 84131, Salerno, Italy.
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Liguori C, Mercuri NB, Albanese M, Olivola E, Stefani A, Pierantozzi M. Daytime sleepiness may be an independent symptom unrelated to sleep quality in Parkinson's disease. J Neurol 2019; 266:636-641. [PMID: 30607535 DOI: 10.1007/s00415-018-09179-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [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: 11/14/2018] [Revised: 12/28/2018] [Accepted: 12/31/2018] [Indexed: 12/31/2022]
Abstract
Excessive daytime sleepiness (EDS) may represent a disabling non-motor symptom in patients affected by Parkinson's disease (PD). This is a secondary analysis of a previous study documenting the improvement of nocturnal sleep in PD patients treated by rotigotine vs placebo. Here we tested the supposition that EDS may represent a distinct PD non-motor symptom occurring independently of other sleep-wake disorders; moreover, we verified whether EDS can be influenced by the improvement of nocturnal sleep in PD. In the present study, we evaluated the daytime sleepiness of PD patients treated with nocturnal administration of rotigotine (PD-Rot) vs placebo (PD-Pla), as measured by both subjective (Epworth Sleepiness Scale-ESS) and objective (Multiple Sleep Latency Test-MSLT) tools. We included 21 PD-Rot compared to 21 PD-Pla patients and documented no significant changes of both ESS and MSLT data between baseline and follow-up visits in both groups. Moreover, we found no correlations between nocturnal sleep improvement and diurnal sleepiness. Therefore, these data suggest that the improvement of nocturnal sleep in PD patients does not modify the daytime sleepiness, thus suggesting that diurnal sleepiness may occur independently of nocturnal sleep disturbances in PD patients.
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Affiliation(s)
- Claudio Liguori
- Department of Systems Medicine, Sleep Medicine Centre, University of Rome "Tor Vergata", Viale Oxford 81, 00133, Rome, Italy. .,UOSD Parkinson, University Hospital of Rome "Tor Vergata", Rome, Italy. .,Neurology Unit, Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy.
| | - Nicola Biagio Mercuri
- Neurology Unit, Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy.,Fondazione Santa Lucia IRCCS, Rome, Italy
| | - Maria Albanese
- Neurology Unit, Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy
| | - Enrica Olivola
- Parkinson and Movement Disorders Unit, Neurology Department, IRCCS Neuromed, Pozzilli, IS, Italy
| | - Alessandro Stefani
- UOSD Parkinson, University Hospital of Rome "Tor Vergata", Rome, Italy.,Neurology Unit, Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy
| | - Mariangela Pierantozzi
- UOSD Parkinson, University Hospital of Rome "Tor Vergata", Rome, Italy.,Neurology Unit, Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy
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Olivola E, Brusa L, Rocchi C, Schillaci O, Liguori C, Cerroni R, Pierantozzi M, Chiaravalloti A, Stefani A, Stocchi F. Does fatigue in Parkinson's disease correlate with autonomic nervous system dysfunction? Neurol Sci 2018; 39:2169-2174. [PMID: 30255487 DOI: 10.1007/s10072-018-3569-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2018] [Accepted: 09/10/2018] [Indexed: 11/25/2022]
Abstract
BACKGROUND Despite its negative impact on quality of life, fatigue in Parkinson's disease (PD) remains an under-recognized issue and the underlying pathology is undetermined. OBJECTIVE To contribute at understanding the pathogenesis of fatigue in a naturalistic cohort of cognitively intact PD patients. METHODS In a Caucasian population of PD patients (n = 27), we evaluated to what extent fatigue (quantified as PFS-16 score) is associated with PD duration and with autonomic dysfunction, studied by both MIBG scintigraphy and autonomic nervous system testing. The latter included the head-up tilt test, Valsalva maneuver, deep breathing, and handgrip tests. RESULTS PFS-16 score correlated with disease duration (R = 0.57, p = 0.002). Fatigue showed a clear correlation with deep breathing test (R = - 0.53, p = 0.004) but not with the MIBG H/M ratios. CONCLUSIONS Our data are consistent with a multifactorial pathogenesis of fatigue and with effects of dopamine depletion in PD-related fatigue; on the other hand, our findings do not support a role for sympathetic denervation in PD-related fatigue.
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Affiliation(s)
- Enrica Olivola
- UOSD Parkinson's Center, Department of Systems Medicine, University of Rome "Tor Vergata", Viale Oxford, 81, 00133, Rome, Italy.,IRCCS Istituto Neurologico Mediterraneo (INM) Neuromed, Pozzilli, Italy
| | | | - Camilla Rocchi
- UOSD Parkinson's Center, Department of Systems Medicine, University of Rome "Tor Vergata", Viale Oxford, 81, 00133, Rome, Italy
| | - Orazio Schillaci
- IRCCS Istituto Neurologico Mediterraneo (INM) Neuromed, Pozzilli, Italy.,Department of Biomedicine and Prevention, University Tor Vergata, Rome, Italy
| | - Claudio Liguori
- UOSD Parkinson's Center, Department of Systems Medicine, University of Rome "Tor Vergata", Viale Oxford, 81, 00133, Rome, Italy
| | - Rocco Cerroni
- UOSD Parkinson's Center, Department of Systems Medicine, University of Rome "Tor Vergata", Viale Oxford, 81, 00133, Rome, Italy
| | - Mariangela Pierantozzi
- UOSD Parkinson's Center, Department of Systems Medicine, University of Rome "Tor Vergata", Viale Oxford, 81, 00133, Rome, Italy
| | - Agostino Chiaravalloti
- IRCCS Istituto Neurologico Mediterraneo (INM) Neuromed, Pozzilli, Italy.,Department of Biomedicine and Prevention, University Tor Vergata, Rome, Italy
| | - Alessandro Stefani
- UOSD Parkinson's Center, Department of Systems Medicine, University of Rome "Tor Vergata", Viale Oxford, 81, 00133, Rome, Italy.
| | - Fabrizio Stocchi
- Department of Neurology, Institute for Research and Medical Care, IRCCS San Raffaele, Rome, Italy
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25
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Liguori C, Olivola E, Pierantozzi M, Cerroni R, Galati S, Saviozzi V, Mercuri NB, Stefani A. Cerebrospinal-fluid Alzheimer's Disease Biomarkers and Blood-Brain Barrier Integrity in a Natural Population of Cognitive Intact Parkinson's Disease Patients. CNS Neurol Disord Drug Targets 2018; 16:339-345. [PMID: 27934563 DOI: 10.2174/1871527316666161205123123] [Citation(s) in RCA: 12] [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] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Revised: 11/03/2016] [Accepted: 11/21/2016] [Indexed: 11/22/2022]
Abstract
BACKGROUND Cerebrospinal-fluid (CSF) Alzheimer's Disease (AD) biomarkers have been extensively studied in Parkinson's Disease (PD). Although reduced CSF beta-amyloid1-42 (Aβ42) levels have been associated with cognitive decline in PD, the alteration of CSF tau proteins remains controversial. In addition, the impairment of the blood-brain barrier (BBB) has been previously demonstrated along the PD progression. OBJECTIVE The aim of the present study was to assess CSF AD biomarkers and BBB integrity in a natural cohort of cognitive intact PD patients compared to matched controls. METHOD We measured and correlated CSF AD biomarkers and CSF/serum albumin ratio (expression of BBB integrity) in 124 PD patients and 46 controls. We distributed PD patients in three subgroups based on the Hoehn and Yahr (H&Y) staging: mild PD (1-1.5, n=40); moderate PD (2-2.5, n=58); advanced PD (3-5, n=26). PD patients were also distinguished as tremor dominant (TD, n=44) and non-tremor dominant (NTD, n=80). RESULTS PD patients showed lower CSF Aβ42 levels and higher CSF/serum albumin ratio compared to controls. CSF total tau (t-tau) concentrations as well as the CSF/serum albumin ratio gradually increased among H&Y stages. Conversely, we did not find differences between TD and NTD patients. Significantly, we documented the positive correlation between CSF t-tau levels and both CSF/serum albumin ratio and motor impairment in PD patients. CONCLUSION This study performed in cognitive intact PD patients confirms the progressive increase of CSF tau proteins levels and BBB impairment along with the evolution of PD pathology. Since the BBB ensures the clearance of tau proteins from brain, we hypothesize that the dysfunction of the BBB throughout the disease progression may possibly cause the concurrent increase of CSF tau proteins levels in PD, which could be irrespective of cognitive decline.
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Affiliation(s)
- Claudio Liguori
- Department of Systems Medicine, Neurophysiopathology Unit, University of Rome "Tor Vergata", Rome. Italy
| | - Enrica Olivola
- Department of Systems Medicine, Movement Disorders Centre, University of Rome "Tor Vergata", Rome. Italy
| | - Mariangela Pierantozzi
- Department of Systems Medicine, Movement Disorders Centre, University of Rome "Tor Vergata", Rome. Italy
| | - Rocco Cerroni
- Department of Systems Medicine, Movement Disorders Centre, University of Rome "Tor Vergata", Rome. Italy
| | | | - Valentina Saviozzi
- Department of Systems Medicine, Movement Disorders Centre, University of Rome "Tor Vergata", Rome. Italy
| | | | - Alessandro Stefani
- Movement Disorders Centre, Department of Systems Medicine, University of Rome "Tor Vergata", Viale Oxford, 81, 00133, Rome. Italy
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Stefani A, Pierantozzi M, Olivola E, Galati S, Cerroni R, D'Angelo V, Hainsworth AH, Saviozzi V, Fedele E, Liguori C. Homovanillic acid in CSF of mild stage Parkinson's disease patients correlates with motor impairment. Neurochem Int 2017; 105:58-63. [PMID: 28108196 DOI: 10.1016/j.neuint.2017.01.007] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2016] [Revised: 12/31/2016] [Accepted: 01/16/2017] [Indexed: 01/22/2023]
Abstract
In Parkinson's disease (PD), several efforts have been spent in order to find biochemical parameters able to identify the progression of the pathological processes at the basis of the disease. It is already known that advanced PD patients manifesting dyskinesia are featured by the high homovanillic acid (HVA)/dopamine (DA) ratio, suggesting the increased turnover of DA in these patients. Less clear is whether similar changes affect mild and moderate stages of the disease (between 1 and 2.5 of Hoehn & Yahr -H&Y- stage). Hence, here we tested whether cerebrospinal fluid (CSF) concentrations of DA and its major metabolites, either 3,4-dihydroxyphenylacetic acid (DOPAC) or HVA, correlate with motor performance in mild and moderate PD patients. CSF samples were collected after 2 days of anti-PD drugs washout, via lumbar puncture (LP) performed 130 min following administration of oral levodopa (LD) dose (200 mg). LP timing was determined in light of our previous tests clarifying that 2 h after oral LD administration CSF DA concentration reaches a plateau, which was un-respective of PD stage or duration. DA, DOPAC and HVA were assayed by high performance liquid chromatography in a group of 19 patients, distributed in two groups on the basis of the H&Y stage with a cut-off of 1.5. In these PD patients, HVA was correlated with DOPAC (R = 0,56, p < 0,01) and both HVA and DOPAC CSF levels increased in parallel with the motor impairment. More importantly, HVA correlated with motor impairment measured by the Unified Parkinson's Disease Score -III (UPDRS) (R = 0.61; p < 0.0001). The present findings showed the early alteration of the DA pre-synaptic machinery, as documented by the progressive increase of CSF HVA concentrations, which also correlated with PD motor impairment. Therefore, we suggest the potential use of measuring the CSF HVA level as a possible biomarker of PD stage changes in order to monitor the effectiveness of PD-modifying pharmacological therapies.
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Affiliation(s)
- Alessandro Stefani
- Movement Disorders Centre, Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy.
| | - Mariangela Pierantozzi
- Movement Disorders Centre, Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy
| | - Enrica Olivola
- Movement Disorders Centre, Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy
| | | | - Rocco Cerroni
- Movement Disorders Centre, Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy
| | - Vincenza D'Angelo
- Movement Disorders Centre, Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy
| | - Atticus H Hainsworth
- Stroke & Dementia Research Centre, St George's University of London, London, United Kingdom
| | - Valentina Saviozzi
- Movement Disorders Centre, Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy
| | | | - Claudio Liguori
- Movement Disorders Centre, Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy
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Liguori C, Pierantozzi M, Olivola E, Mercuri NB, Stefani A. Commentary: Clinical Correlates of Raphe Serotonergic Dysfunction in Early Parkinson's Disease. Front Neurol 2015; 6:261. [PMID: 26733935 PMCID: PMC4685319 DOI: 10.3389/fneur.2015.00261] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2015] [Accepted: 11/26/2015] [Indexed: 12/31/2022] Open
Affiliation(s)
- Claudio Liguori
- Neurophysiopathology Unit, Department of Systems Medicine, University of Rome "Tor Vergata" , Rome , Italy
| | - Mariangela Pierantozzi
- Department of Systems Medicine, Movement Disorders Centre, Fondazione Policlinico Tor Vergata , Rome , Italy
| | - Enrica Olivola
- Department of Systems Medicine, Movement Disorders Centre, Fondazione Policlinico Tor Vergata , Rome , Italy
| | - Nicola B Mercuri
- Neurophysiopathology Unit, Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy; Department of Systems Medicine, Movement Disorders Centre, Fondazione Policlinico Tor Vergata, Rome, Italy; IRCCS Fondazione Santa Lucia, Rome, Italy
| | - Alessandro Stefani
- Department of Systems Medicine, Movement Disorders Centre, Fondazione Policlinico Tor Vergata, Rome, Italy; IRCCS Fondazione Santa Lucia, Rome, Italy
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28
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Rocchi C, Pierantozzi M, Galati S, Chiaravalloti A, Pisani V, Prosperetti C, Lauretti B, Stampanoni Bassi M, Olivola E, Schillaci O, Stefani A. Autonomic Function Tests and MIBG in Parkinson's Disease: Correlation to Disease Duration and Motor Symptoms. CNS Neurosci Ther 2015. [PMID: 26205884 DOI: 10.1111/cns.12437] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
AIMS Disorders of the autonomic nervous system (ANS) have a variable degree of clinical relevance in patients with Parkinson's disease (PD). Here, we assessed whether subclinical autonomic dysfunction, as evaluated by a complete battery of autonomic function tests (AFTs), correlates with PD progression. METHODS A series of 27 consecutive patients with PD underwent extensive ANS investigations including the head-up tilt test (HUTT), Valsalva maneuver, deep-breathing test, and handgrip test (HG); further, they performed 123I-meta-iodobenzylguanidine (MIBG) scintigraphy. RESULTS Seven of the 27 patients showed orthostatic hypotension (OH) at HUTT and pathological responses to the deep-breathing and HG test and Valsalva maneuver. The majority of the remaining 20 patients with PD showed pathological responses to deep-breathing (n = 13) and/or HG (n = 11). Only 3 of 27 suffered relevant OH. MIBG uptake of myocardium was decreased in 19 patients with PD (H/M ratio 1.3 ± 0.2). Prolonged clinical observation (>3 years), persistent response to levodopa, and MIBG repetition allowed us to exclude negative MIBG as attributable to atypical Parkinsonism. MIBG uptake did not correlate with OH and other AFTs. Both HG test response and MIBG did correlate with the Unified Parkinson's Disease Rating Scale (UPDRS) motor score and disease duration. A positive correlation emerged between diastolic blood pressure (DBP) response to HG test and MIBG and with systolic blood pressure (SBP) response at tilt test. CONCLUSIONS Our investigation suggests that ANS impairment affects the majority of patients with PD, even those PD patients showing negative MIBG, irrespective of clinical neurovegetative symptoms. The strict correlation that has been revealed with disease progression supports the routine utilization of AFTs as a reliable and inexpensive tool for monitoring peripheral sympathetic dysfunction in PD and optimizing therapy.
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Affiliation(s)
- Camilla Rocchi
- Department of System Medicine, Neurology, University of Rome "Tor Vergata", Rome, Italy
| | | | | | | | | | | | - Benedetta Lauretti
- Department of System Medicine, Neurology, University of Rome "Tor Vergata", Rome, Italy
| | | | - Enrica Olivola
- Department of System Medicine, Neurology, University of Rome "Tor Vergata", Rome, Italy
| | - Orazio Schillaci
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Alessandro Stefani
- Department of System Medicine, Neurology, University of Rome "Tor Vergata", Rome, Italy.,IRCCS Fondazione S. Lucia, Rome, Italy
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29
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Stefani A, Olivola E, Liguori C, Hainsworth AH, Saviozzi V, Angileri G, D'Angelo V, Galati S, Pierantozzi M. Catecholamine-Based Treatment in AD Patients: Expectations and Delusions. Front Aging Neurosci 2015; 7:67. [PMID: 25999852 PMCID: PMC4418272 DOI: 10.3389/fnagi.2015.00067] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2015] [Accepted: 04/17/2015] [Indexed: 11/16/2022] Open
Abstract
In Alzheimer disease, the gap between excellence of diagnostics and efficacy of therapy is wide. Despite sophisticated imaging and biochemical markers, the efficacy of available therapeutic options is limited. Here we examine the possibility that assessment of endogenous catecholamine levels in cerebrospinal fluid (CSF) may fuel new therapeutic strategies. In reviewing the available literature, we consider the effects of levodopa, monoamine oxidase inhibitors, and noradrenaline (NE) modulators, showing disparate results. We present a preliminary assessment of CSF concentrations of dopamine (DA) and NE, determined by HPLC, in a small dementia cohort of either Alzheimer’s disease (AD) or frontotemporal dementia patients, compared to control subjects. Our data reveal detectable levels of DA, NE in CSF, though we found no significant alterations in the dementia population as a whole. AD patients exhibit a small impairment of the DA axis and a larger increase of NE concentration, likely to represent a compensatory mechanism. While waiting for preventive strategies, a pragmatic approach to AD may re-evaluate catecholamine modulation, possibly stratified to dementia subtypes, as part of the therapeutic armamentarium.
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Affiliation(s)
- Alessandro Stefani
- Department of System Medicine, Università di Roma Tor Vergata , Rome , Italy ; IRCCS Fondazione Santa Lucia , Rome , Italy
| | - Enrica Olivola
- Department of System Medicine, Università di Roma Tor Vergata , Rome , Italy
| | | | | | - Valentina Saviozzi
- Department of System Medicine, Università di Roma Tor Vergata , Rome , Italy
| | - Giacoma Angileri
- Department of System Medicine, Università di Roma Tor Vergata , Rome , Italy
| | - Vincenza D'Angelo
- Department of System Medicine, Università di Roma Tor Vergata , Rome , Italy
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Stefani A, Olivola E, Stampanoni Bassi M, Pisani V, Imbriani P, Pisani A, Pierantozzi M. Strength and weaknesses of cerebrospinal fluid biomarkers in Alzheimer's disease and possible detection of overlaps with frailty process. CNS Neurol Disord Drug Targets 2014; 12:538-46. [PMID: 23574170 DOI: 10.2174/1871527311312040016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2013] [Revised: 03/22/2013] [Accepted: 03/25/2013] [Indexed: 11/22/2022]
Abstract
With the increase of human lifespan and refinement of diagnostic techniques dementia, and Alzheimer's disease (AD) in particular, have become a multi-decade process with a complex pathogenesis. The prognosis of AD patients, especially in late stages, may be strongly influenced by factors that go far beyond the well-recognized cascades (tau deposition, amyloid plaques). In this context, AD and Frailty, a multidimensional process of the elderly, inevitably overlap. Not surprisingly, the routine biomarkers collectable in the cerebrospinal fluid, while highly relevant in allowing specific diagnoses, becoming limiting when used to define severity and rate of progression of cognitive impairment. In reviewing merits and pitfalls of routine cerebrospinal fluid profile for AD, this manuscript will examine the state-of-the-art related to a parallel field, the extrapyramidal disorders. For synucleinopathies, we will discuss the possibility to detect factors directly involved in earliest disease pathology (alpha-synuclein, tau-proteins) together with indexes of disease progression (i.e. dopamine-metabolite ratio and loss of blood-brain barrier integrity). This approach might guarantee the capability of monitoring putative disease-modifying strategies. However, we will show the likelihood that nonconventional approaches already proposed for Frail subjects (such as exercise-mediated neuro-protection) might prove to be a useful aid for an ageing brain already impaired by AD alterations. A crucial test for these hypotheses would be to apply this sort of interventional, and not merely pharmacological, therapy to homogeneous patient cohorts.
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Affiliation(s)
- Alessandro Stefani
- Department of Neuroscience, UOSD Parkinson, University of Rome Tor Vergata, Viale Oxford 81, Rome, Italy.
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Chiaravalloti A, Stefani A, Tavolozza M, Pierantozzi M, Di Biagio D, Olivola E, Di Pietro B, Stampanoni M, Danieli R, Simonetti G, Stanzione P, Schillaci O. Different patterns of cardiac sympathetic denervation in tremor-type compared to akinetic-rigid-type Parkinson's disease: molecular imaging with ¹²³I-MIBG. Mol Med Rep 2012; 6:1337-42. [PMID: 23023866 DOI: 10.3892/mmr.2012.1104] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2012] [Accepted: 08/21/2012] [Indexed: 11/06/2022] Open
Abstract
The aim of this study was to evaluate the correlation between the clinical motor phenotypes of Parkinson's disease (PD) and ¹²³I-MIBG myocardial uptake. In total, 53 patients with PD [31 males and 22 females, mean age 62±10 years; 19 Hoehn & Yahr (H&Y) stage 1, 9 stage 1.5, 15 stage 2 and 10 at stage 3] were examined and subdivided into different clinical forms on the basis of dominance of resting tremor (n=19, TDT) and bradykinesia plus rigidity (n=34, ART). This status was correlated with the semi-quantitative analysis of ¹²³I-MIBG myocardial uptake. An age-matched control group of 18 patients was recruited (8 males and 10 females, mean age 62.4±16.3 years). ¹²³I-MIBG myocardial uptake significantly correlated with disease duration in early (r²=0.1894; P=0.0028) and delayed images (r²=0.1795; P=0.0037) in PD patients, while no correlation was found when considering age at examination, UPDRS III motor examination section score and H&Y score. PD patients showed a reduced ¹²³I-MIBG myocardial uptake compared to the control group in early (P=0.0026) and delayed images (P=0.0040), and ¹²³I-MIBG myocardial uptake was significantly lower in delayed images in TDT patients compared with ART patients (P=0.0167). A decrease was detected in the heart-to-mediastinum (H/M) ratio in delayed images compared to that of the early images in TDT patients (P=0.0040) and in the whole PD population (P=0.0012), while no differences were found in ART patients (P=0.1043). The results of the present study revealed that the cardiac sympathetic system is more severely impaired in TDT than in ART patients and ¹²³I-MIBG molecular imaging has the potential help in improving therapeutic planning in these patients.
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Affiliation(s)
- A Chiaravalloti
- Department of Biopathology and Diagnostic Imaging, University Tor Vergata, Rome, Italy
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