1
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Chang PL, Goldstein FC, Burgio KL, Juncos JL, McGwin G, Muirhead L, Markland AD, Johnson TM, Vaughan CP. Exploratory evaluation of baseline cognition as a predictor of perceived benefit in a study of behavioral therapy for urinary incontinence in Parkinson disease. Neurourol Urodyn 2022; 41:841-846. [PMID: 35181928 PMCID: PMC8957523 DOI: 10.1002/nau.24891] [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: 10/04/2021] [Revised: 01/12/2022] [Accepted: 01/13/2022] [Indexed: 11/10/2022]
Abstract
AIMS While behavior-based pelvic floor muscle exercise therapy is an effective treatment for overactive bladder in Parkinson's disease (PD) patients, cognitive function may be a predictor of rehabilitation outcomes. METHODS In a planned exploratory analysis, participants who had a Montreal Cognitive Assessment (MoCA) with a score ≥18 who were randomized in a clinical trial to behavioral treatment were classified by perceived improvement (Benefit vs. No Benefit) as reported on a validated Satisfaction and Benefit Questionnaire. General cognition (MoCA), motor procedural learning (Serial reaction time task), verbal memory (Buschke delayed recall), spatial memory (Nonverbal/Spatial selective reminding test), and working memory (Wisconsin card sorting task) were compared between the two groups using Wilcoxon rank-sum test. RESULTS Of the 26 participants randomized to behavioral treatment (70% male, mean age 71 ± 6.1 years), 22 participants (85%) reported Benefit and four reported No Benefit. General cognition, motor procedural learning, verbal memory, spatial memory, and working memory did not differ between these groups. While the difference between the time to complete the final practiced series and the random series of the Serial Reaction Time Task (SRTT) was statistically similar between the groups, the Benefit group performed the random sequence more quickly (567.0 ± 136.5 ms) compared to the No Benefit group (959.4 ± 443.0 ms; p = 0.03) and trended toward faster performance in the final practiced series. CONCLUSIONS Perceived benefit from behavioral treatment for overactive bladder was not associated with measures of baseline cognition other than faster completion of the SRTT. This is noteworthy because many behavior-based therapy studies exclude participants with mild cognitive impairment. Additional studies may evaluate if domain-specific cognitive function, particularly the assessment of implicit memory, could lead to individualized behavioral therapy recommendations.
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Affiliation(s)
- PL Chang
- Division of Geriatrics and Gerontology, Department of Medicine, Emory University, Decatur, Georgia
| | - FC Goldstein
- Department of Neurology, Emory University, Atlanta, Georgia
| | - KL Burgio
- Birmingham/Atlanta VA Geriatric Research, Education, and Clinical Center, Birmingham VA Health System, Birmingham, Alabama,Division of Gerontology, Geriatrics, and Palliative Care, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - JL Juncos
- Department of Neurology, Emory University, Atlanta, Georgia
| | - G McGwin
- Birmingham/Atlanta VA Geriatric Research, Education, and Clinical Center, Birmingham VA Health System, Birmingham, Alabama,Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama
| | - L Muirhead
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia,Birmingham/Atlanta VA Geriatric Research, Education, and Clinical Center, Atlanta VA Health System, Atlanta, GA
| | - AD Markland
- Birmingham/Atlanta VA Geriatric Research, Education, and Clinical Center, Birmingham VA Health System, Birmingham, Alabama,Division of Gerontology, Geriatrics, and Palliative Care, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - TM Johnson
- Birmingham/Atlanta VA Geriatric Research, Education, and Clinical Center, Atlanta VA Health System, Atlanta, GA,Division of General Internal Medicine, Department of Medicine, Emory University, Atlanta, Georgia,Department of Family and Preventive Medicine, Emory University, Atlanta, Georgia
| | - CP Vaughan
- Division of Geriatrics and Gerontology, Department of Medicine, Emory University, Decatur, Georgia,Birmingham/Atlanta VA Geriatric Research, Education, and Clinical Center, Atlanta VA Health System, Atlanta, GA
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Sharma VD, Buetefisch CM, Kendall FD, Gross RE, DeLong MR, Juncos JL. Secondary Dystonia in a Novel Mitochondriopathy Responsive to Deep Brain Stimulation Therapy. Mov Disord Clin Pract 2021; 8:135-138. [PMID: 33426169 DOI: 10.1002/mdc3.13075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 07/07/2020] [Accepted: 08/10/2020] [Indexed: 11/09/2022] Open
Affiliation(s)
- Vibhash D Sharma
- Department of Neurology University of Kansas Medical Center Kansas City Kansas USA.,Department of Neurology Emory University School of Medicine Atlanta Georgia USA
| | - Cathrin M Buetefisch
- Department of Neurology Emory University School of Medicine Atlanta Georgia USA.,Department of Rehabilitation Medicine Emory University School of Medicine Atlanta Georgia USA
| | | | - Robert E Gross
- Department of Neurosurgery Emory University School of Medicine Atlanta Georgia USA
| | - Mahlon R DeLong
- Department of Neurology Emory University School of Medicine Atlanta Georgia USA
| | - Jorge L Juncos
- Department of Neurology Emory University School of Medicine Atlanta Georgia USA
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3
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Shoeibi A, Litvan I, Juncos JL, Bordelon Y, Riley D, Standaert D, Reich SG, Shprecher D, Hall D, Marras C, Kluger B, Olfati N, Jankovic J. Are the International Parkinson disease and Movement Disorder Society progressive supranuclear palsy (IPMDS-PSP) diagnostic criteria accurate enough to differentiate common PSP phenotypes? Parkinsonism Relat Disord 2019; 69:34-39. [PMID: 31665686 DOI: 10.1016/j.parkreldis.2019.10.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [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: 04/27/2019] [Revised: 07/26/2019] [Accepted: 10/10/2019] [Indexed: 10/25/2022]
Abstract
The International Parkinson Disease and Movement Disorder Society PSP study group (IPMDS-PSP) recently published new clinical diagnostic criteria for progressive supranuclear palsy (PSP). Currently, there is no data regarding the accuracy of these sets of criteria for differentiating various PSP phenotypes. We discuss the accuracy of the IPMDS-PSP criteria for differentiation of patients with the PSP- Richardson phenotype (PSP-RS) from those with the PSP-Parkinsonism (PSP-P) using data from a sample of 274 clinically diagnosed PSP patients participating in the Environmental Genetic PSP (ENGENE-PSP) case control study. Using National Institute of Neurological Disorders and Stroke and the Society for PSP (NINDS-SPSP) criteria and the Williams criteria we categorized 259 of these patients as probable PSP-RS and 15 as PSP-P. The IPD-MDS PSP-RS and PSP-P criteria were unable to distinguish the PSP-RS from the PSP-P phenotypes in this sample. Nearly all (92.6%; 240 out of 259) the PSP-RS patients and over half (60%; 9 out of 15) of the PSP-P patients fulfilled both the IPMDS criteria for PSP-RS and PSP-P. Applying the newly proposed multiple allocation extinction rules decreased the number of overlapping diagnoses among the NINDS-SPSP PSP-RS patients, however problems remained in the PSP-P group. Diagnostic accuracy might be improved by modification of timelines for development of falls and other parkinsonian features.
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Affiliation(s)
- Ali Shoeibi
- Department of Neurology, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Irene Litvan
- Parkinson and Other Movement Disorder Center, UC San Diego Department of Neurosciences, La Jolla, CA, 92037, USA.
| | - Jorge L Juncos
- Department of Neurology, Emory University, School of Medicine, Atlanta, GA, USA
| | - Yvette Bordelon
- Department of Neurology, David Geffen School of Medicine, Los Angeles, CA, USA
| | - David Riley
- Department of Neurology, Case Western Reserve University, Cleveland, OH, USA
| | - David Standaert
- Center for Neurodegeneration and Experimental Therapeutics, Department of Neurology, The University of Alabama at Birmingham, Birmingham, AL, 35294, USA
| | - Stephen G Reich
- Department of Neurology, University of Maryland, Baltimore, MD, USA
| | - David Shprecher
- Department of Neurology, University of Utah, Salt City, Utah, USA; Cleo Roberts Clinic, Banner Sun Health Research Institute, Sun City, AZ, USA; Department of Neurology, University of Arizona, Phoenix, AZ, USA
| | - Deborah Hall
- Department of Neurology, Rush University Medical Center, Chicago, IL, USA
| | - Connie Marras
- Morto and Gloria Shulman Movement Disorders Centre and the Edmond J. Safra Program in Parkinson's Research, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Benzi Kluger
- Department of Neurology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Nahid Olfati
- Department of Neurology, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Joseph Jankovic
- Parkinson's Disease Center and Movement Disorders Clinic, Department of Neurology, Baylor College of Medicine, Houston, TX, USA
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4
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Vaughan CP, Burgio KL, Goode PS, Juncos JL, McGwin G, Muirhead L, Markland AD, Johnson TM. Behavioral therapy for urinary symptoms in Parkinson's disease: A randomized clinical trial. Neurourol Urodyn 2019; 38:1737-1744. [PMID: 31187552 DOI: 10.1002/nau.24052] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [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: 03/15/2019] [Revised: 05/05/2019] [Accepted: 05/13/2019] [Indexed: 01/03/2023]
Abstract
AIM Determine the efficacy of behavioral therapy for urinary symptoms in Parkinson's disease. METHODS Randomized trial of behavioral therapy compared with control condition among adults (aged 54-85 years, 74% male, 10% Black/ 83% White) with Parkinson's and greater than or equal to 4 incontinence episodes weekly. Behavioral therapy included pelvic floor muscle exercises, bladder training, fluid and constipation management. Both groups completed bladder diary self-monitoring. Outcomes included diary-derived incontinence and ICIQ-overactive bladder (OAB) score (range, 0-16) with bother and quality of life questionnaires (higher scores = worse outcomes). RESULTS Fifty-three participants randomized and 47 reported 8-week outcomes including 26 behavioral therapy and 21 control. Behavioral vs control participants were similar with respect to age (71.0 ± 6.1 vs 69.7 ± 8.2 years), sex (70% vs 78% male), motor score, cognition, mean weekly incontinence episodes (13.9 ± 9.6 vs 15.1 ± 11.1) and OAB symptoms (8.9 ± 2.4 vs 8.3 ± 2.2). Weekly incontinence reduction was similar between behavioral (-6.2 ± 8.7) and control participants (-6.5 ± 13.8) (P = 0.89). After multiple imputation analysis, behavioral therapy participants reported statistically similar reduction in OAB symptoms compared to control (-3.1 ± 2.8 vs -1.9 ± 2.2, P = 0.19); however quality of life (-22.6 ± 19.1 vs -7.0 ± 18.4, P = 0.048) and bother (-12.6 ± 17.2 vs - 6.7 ± 8.8, P = 0.037) improved significantly more with behavioral therapy. CONCLUSION Self-monitoring resulted in fewer urinary symptoms; however, only multicomponent behavioral therapy was associated with reduced bother and improved quality of life. Providers should consider behavioral therapy as initial treatment for urinary symptoms in Parkinson's disease.
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Affiliation(s)
- Camille P Vaughan
- Birmingham/Atlanta VA Geriatric Research, Education, and Clinical Center, Atlanta VA Health System, Atlanta, Georgia.,Division of General Medicine & Geriatrics, Department of Medicine, Emory University, Decatur, Georgia
| | - Kathryn L Burgio
- Birmingham/Atlanta VA Geriatric Research, Education, and Clinical Center, Birmingham VA Health System, Birmingham, Alabama.,Division of Gerontology, Geriatrics, and Palliative Care, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Patricia S Goode
- Birmingham/Atlanta VA Geriatric Research, Education, and Clinical Center, Birmingham VA Health System, Birmingham, Alabama.,Division of Gerontology, Geriatrics, and Palliative Care, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Jorge L Juncos
- Department of Neurology, Emory University, Atlanta, Georgia
| | - Gerald McGwin
- Birmingham/Atlanta VA Geriatric Research, Education, and Clinical Center, Birmingham VA Health System, Birmingham, Alabama.,Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Lisa Muirhead
- Birmingham/Atlanta VA Geriatric Research, Education, and Clinical Center, Atlanta VA Health System, Atlanta, Georgia.,Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia
| | - Alayne D Markland
- Birmingham/Atlanta VA Geriatric Research, Education, and Clinical Center, Birmingham VA Health System, Birmingham, Alabama.,Division of Gerontology, Geriatrics, and Palliative Care, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Theodore M Johnson
- Birmingham/Atlanta VA Geriatric Research, Education, and Clinical Center, Atlanta VA Health System, Atlanta, Georgia.,Division of General Medicine & Geriatrics, Department of Medicine, Emory University, Decatur, Georgia
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Elmer LW, Juncos JL, Singer C, Truong DD, Criswell SR, Parashos S, Felt L, Johnson R, Patni R. Author Correction to: Pooled Analyses of Phase III Studies of ADS-5102 (Amantadine) Extended-Release Capsules for Dyskinesia in Parkinson's Disease. CNS Drugs 2018; 32:399-400. [PMID: 29637528 PMCID: PMC6828147 DOI: 10.1007/s40263-018-0510-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
An Online First version of this article was made available online at http://link.springer.com/journal/40263/onlineFirst/page/1 on 12 March 2018. An error was subsequently identified in the article, and the following correction should be noted.
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Affiliation(s)
- Lawrence W. Elmer
- Department of Neurology, University of Toledo College of Medicine, 3120 Glendale Avenue, Toledo, OH 43614 USA
| | - Jorge L. Juncos
- Department of Neurology and Movement Disorders, Emory University School of Medicine, Atlanta, GA USA
| | - Carlos Singer
- Department of Neurology, University of Miami, Miami, FL USA
| | - Daniel D. Truong
- The Parkinson’s and Movement Disorder Institute, Fountain Valley, CA USA
| | | | | | - Larissa Felt
- Adamas Pharmaceuticals, Inc., Emeryville, CA USA
| | - Reed Johnson
- Adamas Pharmaceuticals, Inc., Emeryville, CA USA
| | - Rajiv Patni
- Adamas Pharmaceuticals, Inc., Emeryville, CA USA
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6
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Elmer LW, Juncos JL, Singer C, Truong DD, Criswell SR, Parashos S, Felt L, Johnson R, Patni R. Pooled Analyses of Phase III Studies of ADS-5102 (Amantadine) Extended-Release Capsules for Dyskinesia in Parkinson's Disease. CNS Drugs 2018; 32. [PMID: 29532440 PMCID: PMC5934466 DOI: 10.1007/s40263-018-0498-4] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND Although levodopa is considered the most effective pharmacotherapy for motor symptoms of Parkinson's disease (PD), chronic use is associated with motor complications, including fluctuating response and unpredictable, involuntary movements called dyskinesia. ADS-5102 (amantadine) extended-release (ER) capsules (GOCOVRITM) is a recent US FDA-approved treatment for dyskinesia in PD patients. ADS-5102 is a high-dose, ER formulation of amantadine, administered orally once daily at bedtime, that achieves high plasma drug concentrations throughout the day. OBJECTIVE In this study, we present pooled results from two randomized, double-blind, placebo-controlled, phase III ADS-5102 trials. PATIENTS AND METHODS The two studies in PD patients with dyskinesia shared design and eligibility criteria, differing only in treatment duration. Results from common assessment time points were pooled. RESULTS At 12 weeks, the least squares (LS) mean change in total score on the Unified Dyskinesia Rating Scale among 100 patients randomized to ADS-5102 and 96 patients randomized to placebo was - 17.7 (standard error [SE] 1.3) vs. - 7.6 (1.3) points, respectively (- 10.1 points, 95% confidence interval [CI] - 13.8, - 6.5; p < 0.0001). The relative treatment difference between groups was 27.3% (p < 0.0001). At 12 weeks, the LS mean change in OFF time was - 0.59 (0.21) vs. +0.41 (0.20) h/day, a difference of - 1.00 h/day (95% CI - 1.57, - 0.44; p = 0.0006). For both efficacy measures, a significant difference from placebo was attained by two weeks, the first post-baseline assessment, and was maintained throughout 12 weeks. In the pooled ADS-5102 group, the most common adverse events were hallucination, dizziness, dry mouth, peripheral edema, constipation, falls, and orthostatic hypotension. CONCLUSIONS These analyses provide further evidence supporting ADS-5102 as an adjunct to levodopa for treating both dyskinesia and OFF time in PD patients with dyskinesia. Clinicaltrials.gov identifier: NCT02136914 and NCT02274766.
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Affiliation(s)
- Lawrence W. Elmer
- Department of Neurology, University of Toledo College of Medicine, 3120 Glendale Avenue, Toledo, OH 43614 USA
| | - Jorge L. Juncos
- Department of Neurology and Movement Disorders, Emory University School of Medicine, Atlanta, GA USA
| | - Carlos Singer
- Department of Neurology, University of Miami, Miami, FL USA
| | - Daniel D. Truong
- The Parkinson’s and Movement Disorder Institute, Fountain Valley, CA USA
| | | | | | - Larissa Felt
- Adamas Pharmaceuticals, Inc., Emeryville, CA USA
| | - Reed Johnson
- Adamas Pharmaceuticals, Inc., Emeryville, CA USA
| | - Rajiv Patni
- Adamas Pharmaceuticals, Inc., Emeryville, CA USA
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7
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Serra MC, Landry A, Juncos JL, Markland AD, Burgio KL, Goode PS, Johnson TM, Vaughan CP. Increased odds of bladder and bowel symptoms in early Parkinson's disease. Neurourol Urodyn 2017; 37:1344-1348. [PMID: 29095515 DOI: 10.1002/nau.23443] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [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: 06/19/2017] [Revised: 09/25/2017] [Accepted: 09/30/2017] [Indexed: 12/11/2022]
Abstract
AIMS To compare the prevalence of urinary and bowel symptoms in a sample of adults with early Parkinson's disease (PD) and healthy controls (HC). METHODS Data were obtained from the Michael J. Fox Parkinson's Progression Markers Initiative (PPMI). Prevalent bladder (urinary incontinence (UI) and nighttime voiding) and bowel (constipation and fecal incontinence (FI)) symptoms were defined as occurring at least sometimes when queried using the Scale for Outcomes in PD for Autonomic Symptoms. RESULTS The proportion of men (65% vs 64%) and the mean age (61.0 ± 9.7 vs 60.2 ± 11.2 years) was similar between early PD (n = 423) and HC (n = 195). UI and constipation were more prevalent among early PD versus HC (UI: 26.7% vs 8.2%, constipation: 32.4% vs 11.8%; P's < 0.0001). Prevalent nighttime voiding was high among both groups, but not significantly different (82.5% vs 84.1%, P = 0.62). FI was infrequent in both. The odds of UI and constipation were significantly higher in early PD even after adjustment for age, sex, cognition, and overactive bladder (UI model only), constipation (UI and constipation models only), depression, and anxiety medication usage (UI: OR: 4.39 [95% CI: 2.92, 5.87]; constipation: 3.34 [2.20, 4.42]; P's < 0.0001). CONCLUSIONS While constipation is known to precede PD diagnosis, these data suggest that the occurrence of UI is elevated in early PD compared to a well-matched HC population.
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Affiliation(s)
- Monica C Serra
- US Department of Veterans Affairs Geriatric Research, Education and Clinical Center, Atlanta, Georgia.,Division of General Medicine and Geriatrics, Department of Medicine, Emory University, Atlanta, Georgia
| | - Alexus Landry
- Department of Biology, Louisiana State University, Baton Rouge, Louisiana
| | - Jorge L Juncos
- Department of Neurology, Emory University, Atlanta, Georgia
| | - Alayne D Markland
- Department of Veterans Affairs Geriatric Research, Education and Clinical Center, Birmingham, Alabama.,Division of Geriatrics, Gerontology, Geriatrics, and Palliative Care, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Kathryn L Burgio
- Department of Veterans Affairs Geriatric Research, Education and Clinical Center, Birmingham, Alabama.,Division of Geriatrics, Gerontology, Geriatrics, and Palliative Care, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Patricia S Goode
- Department of Veterans Affairs Geriatric Research, Education and Clinical Center, Birmingham, Alabama.,Division of Geriatrics, Gerontology, Geriatrics, and Palliative Care, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Theodore M Johnson
- US Department of Veterans Affairs Geriatric Research, Education and Clinical Center, Atlanta, Georgia.,Division of General Medicine and Geriatrics, Department of Medicine, Emory University, Atlanta, Georgia
| | - Camille P Vaughan
- US Department of Veterans Affairs Geriatric Research, Education and Clinical Center, Atlanta, Georgia.,Division of General Medicine and Geriatrics, Department of Medicine, Emory University, Atlanta, Georgia
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8
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Shaikh AG, Factor SA, Juncos JL. Saccades in progressive supranuclear palsy - maladapted, irregular, curved, and slow. Mov Disord Clin Pract 2017; 4:671-681. [PMID: 29333474 PMCID: PMC5764187 DOI: 10.1002/mdc3.12491] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Revised: 02/02/2017] [Accepted: 02/07/2017] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Slowed and curved rapid eye movements, saccades, are the well-known features of progressive supranuclear palsy (PSP). We hypothesized that the saccades in PSP are not only slow and curved, but they are also irregular and have timing deficits. METHODS We tested this hypothesis in 12 patients with PSP by measuring vertical and horizontal visually guided saccades using a limbus tracker. RESULTS Both, horizontal and vertical saccades were slow and had irregular trajectory and velocity profiles, but deficits were much more robust in vertical saccades. The irregularity in the saccade velocity was due to premature interruptions that either completely stopped the eyes, or moved the eyes at much slower velocity along or in the opposite direction of the ongoing saccade. The direction of the eyes' trajectory was often changed after the interruption. We simulated a conductance based single-compartment model of the burst neurons embedded in local feedback circuit for saccade generation. This model mimicked anatomical and physiological realism, while allowing the liberty to selectively change the activation of individual burst neurons or the pause neurons. The PSP saccades were comparable to the simulations during reduced activity of the inhibitory and excitatory burst neurons. CONCLUSION PSP saccades are due to the paucity in burst generation at the excitatory and imprecise timing signal from the inhibitory burst neurons. Premature discharge of the inhibitory burst neuron further leads to breaks in the saccade trajectory, and maladaptive superior colliculus activity leading to aberrant saccades changing the intended trajectory of the ongoing saccade.
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Affiliation(s)
- Aasef G. Shaikh
- Department of NeurologyCase Western Reserve UniversityClevelandOhio
- Daroff‐Dell'Osso Ocular Motility Laboratory and Neurology ServiceLouis Stokes Cleveland Veterans Affairs Medical CenterClevelandOhio
| | - Stewart A. Factor
- Department of NeurologyMovement Disorders ProgramEmory UniversityAtlantaGeorgia
| | - Jorge L. Juncos
- Department of NeurologyMovement Disorders ProgramEmory UniversityAtlantaGeorgia
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9
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Shaikh AG, Finkelstein SR, Schuchard R, Ross G, Juncos JL. Fixational eye movements in Tourette syndrome. Neurol Sci 2017; 38:1977-1984. [PMID: 28815321 DOI: 10.1007/s10072-017-3069-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [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: 05/20/2017] [Accepted: 07/11/2017] [Indexed: 10/19/2022]
Abstract
Studies of saccadic eye movements in subjects with Tourette syndrome (TS) have provided additional evidence that there is a link between TS symptoms and deficits in fronto-striato-thalamic networks. These studies revealed impaired timing and inhibition of saccades. We compared fixational eye movements, such as microsaccades and ocular drifts, in subjects with TS and healthy controls.We measured horizontal and vertical eye positions with video-oculography in 14 subjects with Tourette syndrome. We found reduced microsaccade amplitude but increased time between adjacent microsaccades (intersaccadic interval). Hence, the rate of microsaccades was reduced in subjects with TS compared to controls. Measure of ocular stability during intersaccadic intervals revealed increased drift velocity and increased variance in eye position. We hypothesize that increased activity of the direct fronto-striatal pathway and the resulting reduction in basal ganglia outflow targeting the superior colliculus fixation zone affect the rate and amplitude of microsaccades in subjects with TS. The resulting impairment in frontal eye field fixation leads to increased drifts during intersaccadic interval in subjects with TS. Possible clinical implication for these results is that fixational eye movements can be objective biological markers of TS.
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Affiliation(s)
- Aasef G Shaikh
- Depatment of Neurology, Case Western Reserve University, Cleveland, OH, USA. .,Daroff-DelOsso Ocular Motility Laboratory and Neurology Service, Louis Stokes VA Medical Center, Cleveland, OH, USA. .,Department of Neurology, University Hospitals Case Medical Center, 11100 Euclid Avenue, Cleveland, OH, 44110, USA.
| | | | - Ronald Schuchard
- Department of Neurosurgery, Stanford University, Stanford, CA, USA
| | | | - Jorge L Juncos
- Depatment of Neurology, Emory University, Atlanta, GA, USA
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10
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Kouri N, Ross OA, Dombroski B, Younkin CS, Serie DJ, Soto-Ortolaza A, Baker M, Finch NCA, Yoon H, Kim J, Fujioka S, McLean CA, Ghetti B, Spina S, Cantwell LB, Farlow MR, Grafman J, Huey ED, Ryung Han M, Beecher S, Geller ET, Kretzschmar HA, Roeber S, Gearing M, Juncos JL, Vonsattel JPG, Van Deerlin VM, Grossman M, Hurtig HI, Gross RG, Arnold SE, Trojanowski JQ, Lee VM, Wenning GK, White CL, Höglinger GU, Müller U, Devlin B, Golbe LI, Crook J, Parisi JE, Boeve BF, Josephs KA, Wszolek ZK, Uitti RJ, Graff-Radford NR, Litvan I, Younkin SG, Wang LS, Ertekin-Taner N, Rademakers R, Hakonarsen H, Schellenberg GD, Dickson DW. Genome-wide association study of corticobasal degeneration identifies risk variants shared with progressive supranuclear palsy. Nat Commun 2015; 6:7247. [PMID: 26077951 PMCID: PMC4469997 DOI: 10.1038/ncomms8247] [Citation(s) in RCA: 136] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Accepted: 04/17/2015] [Indexed: 11/09/2022] Open
Abstract
Corticobasal degeneration (CBD) is a neurodegenerative disorder affecting movement and cognition, definitively diagnosed only at autopsy. Here, we conduct a genome-wide association study (GWAS) in CBD cases (n=152) and 3,311 controls, and 67 CBD cases and 439 controls in a replication stage. Associations with meta-analysis were 17q21 at MAPT (P=1.42 × 10(-12)), 8p12 at lnc-KIF13B-1, a long non-coding RNA (rs643472; P=3.41 × 10(-8)), and 2p22 at SOS1 (rs963731; P=1.76 × 10(-7)). Testing for association of CBD with top progressive supranuclear palsy (PSP) GWAS single-nucleotide polymorphisms (SNPs) identified associations at MOBP (3p22; rs1768208; P=2.07 × 10(-7)) and MAPT H1c (17q21; rs242557; P=7.91 × 10(-6)). We previously reported SNP/transcript level associations with rs8070723/MAPT, rs242557/MAPT, and rs1768208/MOBP and herein identified association with rs963731/SOS1. We identify new CBD susceptibility loci and show that CBD and PSP share a genetic risk factor other than MAPT at 3p22 MOBP (myelin-associated oligodendrocyte basic protein).
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Affiliation(s)
- Naomi Kouri
- Department of Neuroscience, Mayo Clinic College of Medicine, Jacksonville, Florida 32224, USA
| | - Owen A Ross
- Department of Neuroscience, Mayo Clinic College of Medicine, Jacksonville, Florida 32224, USA
| | - Beth Dombroski
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA
| | - Curtis S Younkin
- Department of Neuroscience, Mayo Clinic College of Medicine, Jacksonville, Florida 32224, USA.,Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic College of Medicine, Jacksonville, Florida 32224, USA
| | - Daniel J Serie
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic College of Medicine, Jacksonville, Florida 32224, USA
| | - Alexandra Soto-Ortolaza
- Department of Neuroscience, Mayo Clinic College of Medicine, Jacksonville, Florida 32224, USA
| | - Matthew Baker
- Department of Neuroscience, Mayo Clinic College of Medicine, Jacksonville, Florida 32224, USA
| | - Ni Cole A Finch
- Department of Neuroscience, Mayo Clinic College of Medicine, Jacksonville, Florida 32224, USA
| | - Hyejin Yoon
- Department of Neuroscience, Mayo Clinic College of Medicine, Jacksonville, Florida 32224, USA
| | - Jungsu Kim
- Department of Neuroscience, Mayo Clinic College of Medicine, Jacksonville, Florida 32224, USA
| | - Shinsuke Fujioka
- Department of Neuroscience, Mayo Clinic College of Medicine, Jacksonville, Florida 32224, USA
| | - Catriona A McLean
- Victorian Brain Bank Network, Mental Health Research Institute, Parksville, Victoria 3052, Australia
| | - Bernardino Ghetti
- Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, Indiana 46202, USA
| | - Salvatore Spina
- Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, Indiana 46202, USA
| | - Laura B Cantwell
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA
| | - Martin R Farlow
- Department of Neurology, Indiana University School of Medicine, Indianapolis, Indiana 46202, USA
| | - Jordan Grafman
- Cognitive Neuroscience Laboratory, Brain Injury Research, Rehabilitation Institute of Chicago, Chicago, Illinois 60611, USA.,Department of Physical Medicine and Rehabilitation, Northwestern University, Illinois 60208, USA
| | - Edward D Huey
- Departments of Psychiatry and Neurology, Columbia University, New York, New York10027, USA
| | - Mi Ryung Han
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA
| | - Sherry Beecher
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA
| | - Evan T Geller
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA
| | - Hans A Kretzschmar
- Department of Neuroscience, Mayo Clinic College of Medicine, Jacksonville, Florida 32224, USA
| | - Sigrun Roeber
- Institut for Neuropathology and Prion Research and Brain Net Germany, Ludwig-Maximilians-Universität, Munich 80539, Germany
| | - Marla Gearing
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Georgia 30307, USA
| | - Jorge L Juncos
- Department of Neurology, Emory University, Atlanta, Georgia 30307, USA
| | - Jean Paul G Vonsattel
- Department of Pathology and the Taub Institute for Research on Alzheimer's disease and the Aging Brain, Columbia University, New York, New York 10027, USA
| | - Vivianna M Van Deerlin
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA
| | - Murray Grossman
- Department of Neurology, University of Pennsylvania Health System, Philadelphia, Pennsylvania 19104, USA
| | - Howard I Hurtig
- Department of Neurology, University of Pennsylvania Health System, Philadelphia, Pennsylvania 19104, USA
| | - Rachel G Gross
- Department of Neurology, University of Pennsylvania Health System, Philadelphia, Pennsylvania 19104, USA
| | - Steven E Arnold
- Department of Psychiatry, Center for Neurobiology and Behavior, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania 19104, USA
| | - John Q Trojanowski
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA
| | - Virginia M Lee
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA
| | - Gregor K Wenning
- Department of Neurology, Innsbruck Medical University, Innsbruck 6020, Austria
| | - Charles L White
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, Texas 75235, USA
| | - Günter U Höglinger
- Department of Neurology, Technical University Munich, 81377 Munich, Germany.,Department of Translational Neurodegeneration, German Center for Neurodegenerative Diseases (DZNE), 81677 Munich, Germany.,Department of Neurology, Philipps University, 35033 Marburg, Germany
| | - Ulrich Müller
- Institut for Humangenetik, Justus-Liebig-Universität, Giessen 35390, Germany
| | - Bernie Devlin
- Department of Human Genetics, University of Pittsburgh, Pittsburg, Pennsylvania 15260, USA
| | - Lawrence I Golbe
- Department of Neurology, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey 08901, USA
| | - Julia Crook
- Department of Neuroscience, Mayo Clinic College of Medicine, Jacksonville, Florida 32224, USA.,Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic College of Medicine, Jacksonville, Florida 32224, USA
| | - Joseph E Parisi
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota 55905, USA
| | - Bradley F Boeve
- Department of Neurology, Mayo Clinic, Rochester, Minnesota 55905, USA
| | - Keith A Josephs
- Department of Neurology, Mayo Clinic, Rochester, Minnesota 55905, USA
| | | | - Ryan J Uitti
- Department of Neurology, Mayo Clinic, Jacksonville, Florida 32224, USA
| | | | - Irene Litvan
- Department of Neurosciences, University of California, San Diego, La Jolla, California 92093, USA
| | - Steven G Younkin
- Department of Neuroscience, Mayo Clinic College of Medicine, Jacksonville, Florida 32224, USA
| | - Li-San Wang
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA
| | - Nilüfer Ertekin-Taner
- Department of Neuroscience, Mayo Clinic College of Medicine, Jacksonville, Florida 32224, USA.,Department of Neurology, Mayo Clinic, Jacksonville, Florida 32224, USA
| | - Rosa Rademakers
- Department of Neuroscience, Mayo Clinic College of Medicine, Jacksonville, Florida 32224, USA
| | - Hakon Hakonarsen
- Center for Applied Genomics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania 19104, USA
| | - Gerard D Schellenberg
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA
| | - Dennis W Dickson
- Department of Neuroscience, Mayo Clinic College of Medicine, Jacksonville, Florida 32224, USA
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11
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Schrock LE, Mink JW, Woods DW, Porta M, Servello D, Visser-Vandewalle V, Silburn PA, Foltynie T, Walker HC, Shahed-Jimenez J, Savica R, Klassen BT, Machado AG, Foote KD, Zhang JG, Hu W, Ackermans L, Temel Y, Mari Z, Changizi BK, Lozano A, Auyeung M, Kaido T, Agid Y, Welter ML, Khandhar SM, Mogilner AY, Pourfar MH, Walter BL, Juncos JL, Gross RE, Kuhn J, Leckman JF, Neimat JA, Okun MS. Tourette syndrome deep brain stimulation: a review and updated recommendations. Mov Disord 2014; 30:448-71. [PMID: 25476818 DOI: 10.1002/mds.26094] [Citation(s) in RCA: 171] [Impact Index Per Article: 17.1] [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: 04/04/2014] [Revised: 10/06/2014] [Accepted: 10/08/2014] [Indexed: 12/16/2022] Open
Abstract
Deep brain stimulation (DBS) may improve disabling tics in severely affected medication and behaviorally resistant Tourette syndrome (TS). Here we review all reported cases of TS DBS and provide updated recommendations for selection, assessment, and management of potential TS DBS cases based on the literature and implantation experience. Candidates should have a Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM V) diagnosis of TS with severe motor and vocal tics, which despite exhaustive medical and behavioral treatment trials result in significant impairment. Deep brain stimulation should be offered to patients only by experienced DBS centers after evaluation by a multidisciplinary team. Rigorous preoperative and postoperative outcome measures of tics and associated comorbidities should be used. Tics and comorbid neuropsychiatric conditions should be optimally treated per current expert standards, and tics should be the major cause of disability. Psychogenic tics, embellishment, and malingering should be recognized and addressed. We have removed the previously suggested 25-year-old age limit, with the specification that a multidisciplinary team approach for screening is employed. A local ethics committee or institutional review board should be consulted for consideration of cases involving persons younger than 18 years of age, as well as in cases with urgent indications. Tourette syndrome patients represent a unique and complex population, and studies reveal a higher risk for post-DBS complications. Successes and failures have been reported for multiple brain targets; however, the optimal surgical approach remains unknown. Tourette syndrome DBS, though still evolving, is a promising approach for a subset of medication refractory and severely affected patients.
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Affiliation(s)
- Lauren E Schrock
- Department of Neurology, University of Utah, Salt Lake City, Utah, USA
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12
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Beal MF, Oakes D, Shoulson I, Henchcliffe C, Galpern WR, Haas R, Juncos JL, Nutt JG, Voss TS, Ravina B, Shults CM, Helles K, Snively V, Lew MF, Griebner B, Watts A, Gao S, Pourcher E, Bond L, Kompoliti K, Agarwal P, Sia C, Jog M, Cole L, Sultana M, Kurlan R, Richard I, Deeley C, Waters CH, Figueroa A, Arkun A, Brodsky M, Ondo WG, Hunter CB, Jimenez-Shahed J, Palao A, Miyasaki JM, So J, Tetrud J, Reys L, Smith K, Singer C, Blenke A, Russell DS, Cotto C, Friedman JH, Lannon M, Zhang L, Drasby E, Kumar R, Subramanian T, Ford DS, Grimes DA, Cote D, Conway J, Siderowf AD, Evatt ML, Sommerfeld B, Lieberman AN, Okun MS, Rodriguez RL, Merritt S, Swartz CL, Martin WRW, King P, Stover N, Guthrie S, Watts RL, Ahmed A, Fernandez HH, Winters A, Mari Z, Dawson TM, Dunlop B, Feigin AS, Shannon B, Nirenberg MJ, Ogg M, Ellias SA, Thomas CA, Frei K, Bodis-Wollner I, Glazman S, Mayer T, Hauser RA, Pahwa R, Langhammer A, Ranawaya R, Derwent L, Sethi KD, Farrow B, Prakash R, Litvan I, Robinson A, Sahay A, Gartner M, Hinson VK, Markind S, Pelikan M, Perlmutter JS, Hartlein J, Molho E, Evans S, Adler CH, Duffy A, Lind M, Elmer L, Davis K, Spears J, Wilson S, Leehey MA, Hermanowicz N, Niswonger S, Shill HA, Obradov S, Rajput A, Cowper M, Lessig S, Song D, Fontaine D, Zadikoff C, Williams K, Blindauer KA, Bergholte J, Propsom CS, Stacy MA, Field J, Mihaila D, Chilton M, Uc EY, Sieren J, Simon DK, Kraics L, Silver A, Boyd JT, Hamill RW, Ingvoldstad C, Young J, Thomas K, Kostyk SK, Wojcieszek J, Pfeiffer RF, Panisset M, Beland M, Reich SG, Cines M, Zappala N, Rivest J, Zweig R, Lumina LP, Hilliard CL, Grill S, Kellermann M, Tuite P, Rolandelli S, Kang UJ, Young J, Rao J, Cook MM, Severt L, Boyar K. A randomized clinical trial of high-dosage coenzyme Q10 in early Parkinson disease: no evidence of benefit. JAMA Neurol 2014; 71:543-52. [PMID: 24664227 DOI: 10.1001/jamaneurol.2014.131] [Citation(s) in RCA: 233] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
IMPORTANCE Coenzyme Q10 (CoQ10), an antioxidant that supports mitochondrial function, has been shown in preclinical Parkinson disease (PD) models to reduce the loss of dopamine neurons, and was safe and well tolerated in early-phase human studies. A previous phase II study suggested possible clinical benefit. OBJECTIVE To examine whether CoQ10 could slow disease progression in early PD. DESIGN, SETTING, AND PARTICIPANTS A phase III randomized, placebo-controlled, double-blind clinical trial at 67 North American sites consisting of participants 30 years of age or older who received a diagnosis of PD within 5 years and who had the following inclusion criteria: the presence of a rest tremor, bradykinesia, and rigidity; a modified Hoehn and Yahr stage of 2.5 or less; and no anticipated need for dopaminergic therapy within 3 months. Exclusion criteria included the use of any PD medication within 60 days, the use of any symptomatic PD medication for more than 90 days, atypical or drug-induced parkinsonism, a Unified Parkinson's Disease Rating Scale (UPDRS) rest tremor score of 3 or greater for any limb, a Mini-Mental State Examination score of 25 or less, a history of stroke, the use of certain supplements, and substantial recent exposure to CoQ10. Of 696 participants screened, 78 were found to be ineligible, and 18 declined participation. INTERVENTIONS The remaining 600 participants were randomly assigned to receive placebo, 1200 mg/d of CoQ10, or 2400 mg/d of CoQ10; all participants received 1200 IU/d of vitamin E. MAIN OUTCOMES AND MEASURES Participants were observed for 16 months or until a disability requiring dopaminergic treatment. The prospectively defined primary outcome measure was the change in total UPDRS score (Parts I-III) from baseline to final visit. The study was powered to detect a 3-point difference between an active treatment and placebo. RESULTS The baseline characteristics of the participants were well balanced, the mean age was 62.5 years, 66% of participants were male, and the mean baseline total UPDRS score was 22.7. A total of 267 participants required treatment (94 received placebo, 87 received 1200 mg/d of CoQ10, and 86 received 2400 mg/d of CoQ10), and 65 participants (29 who received placebo, 19 who received 1200 mg/d of CoQ10, and 17 who received 2400 mg/d of CoQ10) withdrew prematurely. Treatments were well tolerated with no safety concerns. The study was terminated after a prespecified futility criterion was reached. At study termination, both active treatment groups showed slight adverse trends relative to placebo. Adjusted mean changes (worsening) in total UPDRS scores from baseline to final visit were 6.9 points (placebo), 7.5 points (1200 mg/d of CoQ10; P = .49 relative to placebo), and 8.0 points (2400 mg/d of CoQ10; P = .21 relative to placebo). CONCLUSIONS AND RELEVANCE Coenzyme Q10 was safe and well tolerated in this population, but showed no evidence of clinical benefit. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00740714.
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Affiliation(s)
| | - M Flint Beal
- Department of Neurology, Weill Cornell Medical College, New York Hospital, New York
| | - David Oakes
- Department of Biostatistics, University of Rochester Medical Center, Rochester, New York
| | - Ira Shoulson
- Department of Neurology, Georgetown University, Washington, DC
| | - Claire Henchcliffe
- Department of Neurology, Weill Cornell Medical College, New York Hospital, New York
| | | | - Richard Haas
- Department of Neurosciences, University of California, San Diego, La Jolla
| | - Jorge L Juncos
- Department of Neurology, Emory University School of Medicine, Wesley Woods Center, Atlanta, Georgia
| | - John G Nutt
- Department of Neurology, Oregon Health and Science University, Portland
| | | | | | - Clifford M Shults
- Department of Neurosciences, University of California, San Diego, La Jolla10VA Medical Center, San Diego, California
| | - Karen Helles
- Department of Biostatistics, University of Rochester Medical Center, Rochester, New York
| | - Victoria Snively
- Department of Biostatistics, University of Rochester Medical Center, Rochester, New York
| | - Mark F Lew
- Department of Neurology, Keck School of Medicine, University of Southern California, Los Angeles
| | - Brian Griebner
- Department of Biostatistics, University of Rochester Medical Center, Rochester, New York
| | - Arthur Watts
- Department of Biostatistics, University of Rochester Medical Center, Rochester, New York12Department of Neurology, University of Rochester, Rochester, New York
| | - Shan Gao
- Department of Biostatistics, University of Rochester Medical Center, Rochester, New York
| | - Emmanuelle Pourcher
- Québec Memory and Motor Skills Disorders Research Center, Clinique Sainte-Anne, Québec, Canada
| | - Louisette Bond
- Québec Memory and Motor Skills Disorders Research Center, Clinique Sainte-Anne, Québec, Canada
| | | | - Pinky Agarwal
- Booth Gardner Parkinson's Care Center, EvergreenHealth, Kirkland, Washington
| | - Cherissa Sia
- Booth Gardner Parkinson's Care Center, EvergreenHealth, Kirkland, Washington
| | - Mandar Jog
- London Health Sciences Centre, London, Ontario, Canada
| | - Linda Cole
- London Health Sciences Centre, London, Ontario, Canada
| | | | - Roger Kurlan
- Overlook Medical Center, Atlantic Neuroscience Institute, Summit, New Jersey
| | - Irene Richard
- Department of Neurology, University of Rochester, Rochester, New York
| | - Cheryl Deeley
- Department of Neurology, University of Rochester, Rochester, New York
| | - Cheryl H Waters
- Columbia University Medical Center, Neurological Institute, New York, New York
| | - Angel Figueroa
- Columbia University Medical Center, Neurological Institute, New York, New York
| | - Ani Arkun
- Department of Neurology, Weill Cornell Medical College, New York Hospital, New York
| | - Matthew Brodsky
- Department of Neurology, Oregon Health and Science University, Portland
| | - William G Ondo
- Department of Neurology, University of Texas Health Science Center at Houston
| | | | | | - Alicia Palao
- Department of Neurology, Baylor College of Medicine, Houston, Texas
| | - Janis M Miyasaki
- Morton and Gloria Shulman Movement Disorders Centre, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Julie So
- Morton and Gloria Shulman Movement Disorders Centre, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada
| | - James Tetrud
- The Parkinson's Institute and Clinical Center, Sunnyvale, California
| | - Liza Reys
- The Parkinson's Institute and Clinical Center, Sunnyvale, California
| | - Katharine Smith
- The Parkinson's Institute and Clinical Center, Sunnyvale, California
| | - Carlos Singer
- Department of Neurology, University of Miami School of Medicine, Miami, Florida
| | - Anita Blenke
- Department of Neurology, University of Miami School of Medicine, Miami, Florida
| | - David S Russell
- Institute for Neurodegenerative Disorders, New Haven, Connecticut
| | - Candace Cotto
- Institute for Neurodegenerative Disorders, New Haven, Connecticut
| | - Joseph H Friedman
- Department of Neurology, Butler Hospital, Providence, Rhode Island26Alpert Medical School, Brown University, Providence, Rhode Island
| | - Margaret Lannon
- Department of Neurology, Butler Hospital, Providence, Rhode Island27Port City Neurology, Inc, Scarborough, Maine
| | - Lin Zhang
- Department of Neurology, University of California, Davis, School of Medicine and Sacramento VA Medical Center, Sacramento
| | | | | | - Thyagarajan Subramanian
- Milton S. Hershey Medical Center, Department of Neurology, Pennsylvania State Hershey College of Medicine, Hershey
| | - Donna Stuppy Ford
- Milton S. Hershey Medical Center, Department of Neurology, Pennsylvania State Hershey College of Medicine, Hershey
| | | | - Diane Cote
- Ottawa Hospital Civic Site, Ottawa, Ontario, Canada
| | | | | | - Marian Leslie Evatt
- Department of Neurology, Emory University School of Medicine, Wesley Woods Center, Atlanta, Georgia33Atlanta VA Medical Center, Atlanta, Georgia
| | - Barbara Sommerfeld
- Department of Neurology, Emory University School of Medicine, Wesley Woods Center, Atlanta, Georgia
| | - Abraham N Lieberman
- Muhammad Ali Parkinson Center, Barrow Neurological Institute, St Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Michael S Okun
- Department of Neurology, University of Florida Center for Movement Disorders and Neurorestoration, Gainesville
| | - Ramon L Rodriguez
- Department of Neurology, University of Florida Center for Movement Disorders and Neurorestoration, Gainesville
| | - Stacy Merritt
- Department of Neurology, University of Florida Center for Movement Disorders and Neurorestoration, Gainesville
| | - Camille Louise Swartz
- Department of Neurology, University of Florida Center for Movement Disorders and Neurorestoration, Gainesville
| | - W R Wayne Martin
- Glenrose Rehabilitation Hospital, University of Alberta, Edmonton, Alberta, Canada
| | - Pamela King
- Glenrose Rehabilitation Hospital, University of Alberta, Edmonton, Alberta, Canada
| | | | | | - Ray L Watts
- Department of Neurology, University of Alabama at Birmingham
| | - Anwar Ahmed
- Center for Neurological Restoration, Department of Neurology, Cleveland Clinic, Cleveland, Ohio
| | - Hubert H Fernandez
- Center for Neurological Restoration, Department of Neurology, Cleveland Clinic, Cleveland, Ohio
| | - Adrienna Winters
- Center for Neurological Restoration, Department of Neurology, Cleveland Clinic, Cleveland, Ohio
| | - Zoltan Mari
- Department of Neurology, Johns Hopkins University, Baltimore, Maryland
| | - Ted M Dawson
- Department of Neurology, Johns Hopkins University, Baltimore, Maryland
| | - Becky Dunlop
- Department of Neurology, Johns Hopkins University, Baltimore, Maryland
| | - Andrew S Feigin
- Feinstein Institute for Medical Research, Center for Neurosciences, Manhasset, New York
| | - Barbara Shannon
- Feinstein Institute for Medical Research, Center for Neurosciences, Manhasset, New York
| | | | - Mattson Ogg
- Department of Neurology, Weill Cornell Medical College, New York Hospital, New York
| | - Samuel A Ellias
- Department of Neurology, Boston University School of Medicine, Boston, Massachusetts
| | - Cathi-Ann Thomas
- Department of Neurology, Boston University School of Medicine, Boston, Massachusetts
| | - Karen Frei
- The Parkinson's and Movement Disorder Institute, Fountain Valley, California
| | - Ivan Bodis-Wollner
- State University of New York, Downstate Medical Center, Brooklyn, New York
| | - Sofya Glazman
- State University of New York, Downstate Medical Center, Brooklyn, New York
| | - Thomas Mayer
- State University of New York, Downstate Medical Center, Brooklyn, New York
| | | | - Rajesh Pahwa
- Department of Neurology, University of Kansas Medical Center, Kansas City
| | - April Langhammer
- Department of Neurology, University of Kansas Medical Center, Kansas City
| | - Ranjit Ranawaya
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
| | - Lorelei Derwent
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
| | - Kapil D Sethi
- Department of Neurology, Georgia Health Science University, Augusta
| | - Buff Farrow
- Department of Neurology, Georgia Health Science University, Augusta
| | - Rajan Prakash
- Department of Neurology, Georgia Health Science University, Augusta
| | - Irene Litvan
- Department of Neurosciences, University of California, San Diego, La Jolla
| | | | - Alok Sahay
- University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Maureen Gartner
- University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Vanessa K Hinson
- Department of Neurology, Medical University of South Carolina, Charleston
| | | | | | - Joel S Perlmutter
- Department of Neurology, Washington University in St Louis, Missouri
| | - Johanna Hartlein
- Department of Neurology, Washington University in St Louis, Missouri
| | - Eric Molho
- Movement Disorders Center, Albany Medical Center, Albany, New York
| | - Sharon Evans
- Movement Disorders Center, Albany Medical Center, Albany, New York
| | - Charles H Adler
- Parkinson's Disease and Movement Disorders Center, Department of Neurology, Mayo Clinic, Scottsdale, Arizona
| | - Amy Duffy
- Parkinson's Disease and Movement Disorders Center, Department of Neurology, Mayo Clinic, Scottsdale, Arizona
| | - Marlene Lind
- Parkinson's Disease and Movement Disorders Center, Department of Neurology, Mayo Clinic, Scottsdale, Arizona
| | - Lawrence Elmer
- Center for Neurological Health, University of Toledo, Toledo, Ohio
| | - Kathy Davis
- Department of Neurology, Medical University of Ohio at Toledo
| | - Julia Spears
- Department of Neurology, Medical University of Ohio at Toledo
| | | | - Maureen A Leehey
- Department of Neurology, University of Colorado Health Science Center, Denver
| | - Neal Hermanowicz
- Department of Neurology, University of California, Irvine Medical Center, Irvine
| | - Shari Niswonger
- Department of Neurology, University of California, Irvine Medical Center, Irvine
| | - Holly A Shill
- Banner Sun Health Research Institute, Sun City, Arizona
| | - Sanja Obradov
- Banner Sun Health Research Institute, Sun City, Arizona
| | - Alex Rajput
- Department of Neurology, University of Saskatchewan, Royal University Hospital, Saskatchewan, Canada
| | - Marilyn Cowper
- Department of Neurology, University of Saskatchewan, Royal University Hospital, Saskatchewan, Canada
| | - Stephanie Lessig
- Department of Neurology, University of California, San Diego, La Jolla
| | - David Song
- Department of Neurology, University of California, San Diego, La Jolla
| | - Deborah Fontaine
- Department of Neurology, University of California, San Diego, La Jolla
| | - Cindy Zadikoff
- Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Karen Williams
- Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | | | - Jo Bergholte
- Department of Neurology, Medical College of Wisconsin, Milwaukee
| | | | - Mark A Stacy
- Department of Neurology, Duke University, Durham, North Carolina
| | - Joanne Field
- Department of Neurology, Duke University, Durham, North Carolina
| | - Dragos Mihaila
- State University of New York Upstate Medical Center and Syracuse VA Medical Center, Syracuse
| | - Mark Chilton
- State University of New York Upstate Medical Center and Syracuse VA Medical Center, Syracuse
| | - Ergun Y Uc
- Department of Neurology, University of Iowa, Iowa City
| | - Jeri Sieren
- Department of Neurology, University of Iowa, Iowa City
| | - David K Simon
- Department of Neurology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts
| | - Lauren Kraics
- Department of Neurology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts
| | - Althea Silver
- Department of Neurology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts
| | - James T Boyd
- Department of Neurology, University of Vermont College of Medicine, Burlington
| | - Robert W Hamill
- Department of Neurology, University of Vermont College of Medicine, Burlington
| | | | - Jennifer Young
- Department of Neurology, University of Vermont College of Medicine, Burlington
| | - Karen Thomas
- Department of Neurology, Ohio State University, Columbus
| | | | - Joanne Wojcieszek
- Department of Neurology, Indiana University School of Medicine, Indianapolis
| | - Ronald F Pfeiffer
- Department of Neurology, University of Tennessee Health Science Center, Memphis
| | - Michel Panisset
- Department of Neurology, CHUM-Hôpital Notre-Dame, Montréal, Québec, Canada
| | - Monica Beland
- Department of Neurology, CHUM-Hôpital Notre-Dame, Montréal, Québec, Canada
| | - Stephen G Reich
- Department of Neurology, University of Maryland School of Science, Baltimore
| | - Michelle Cines
- Department of Neurology, University of Maryland School of Science, Baltimore
| | - Nancy Zappala
- Department of Neurology, University of Maryland School of Science, Baltimore
| | - Jean Rivest
- Department of Neurology, University of Sherbrooke, Québec, Canada
| | - Richard Zweig
- Department of Neurology, Louisiana State University Health Science Center, Shreveport
| | - L Pepper Lumina
- Department of Neurology, Louisiana State University Health Science Center, Shreveport
| | | | - Stephen Grill
- Department of Neurology, Johns Hopkins University, Baltimore, Maryland
| | | | - Paul Tuite
- Department of Neurology, University of Minnesota, Minneapolis
| | | | - Un Jung Kang
- Department of Neurology, University of Chicago, Chicago, Illinois
| | - Joan Young
- Department of Neurology, University of Chicago, Chicago, Illinois
| | - Jayaraman Rao
- Department of Neurology, Ochsner Clinic Foundation, New Orleans, Louisiana
| | - Maureen M Cook
- Department of Neurology, Ochsner Clinic Foundation, New Orleans, Louisiana
| | - Lawrence Severt
- Department of Neurology, Beth Israel Medical Center, New York, New York
| | - Karyn Boyar
- Department of Neurology, Beth Israel Medical Center, New York, New York
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13
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Wesseling C, Román N, Quirós I, Páez L, García V, Mora AM, Juncos JL, Steenland KN. Parkinson's and Alzheimer's diseases in Costa Rica: a feasibility study toward a national screening program. Glob Health Action 2013; 6:23061. [PMID: 24378195 PMCID: PMC3875350 DOI: 10.3402/gha.v6i0.23061] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [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: 10/12/2013] [Revised: 12/01/2013] [Accepted: 12/01/2013] [Indexed: 12/03/2022] Open
Abstract
Background The integration of mental and neurologic services in healthcare is a global priority. The universal Social Security of Costa Rica aspires to develop national screening of neurodegenerative disorders among the elderly, as part of the non-communicable disease agenda. Objective This study assessed the feasibility of routine screening for Parkinson's disease (PD) and Alzheimer's disease (AD) within the public healthcare system of Costa Rica. Design The population (aged ≥65) in the catchment areas of two primary healthcare clinics was targeted for motor and cognitive screening during routine annual health check-ups. The screening followed a tiered three-step approach, with increasing specificity. Step 1 involved a two-symptom questionnaire (tremor-at-rest; balance) and a spiral drawing test for motor assessment, as well as a three-word recall and animal category fluency test for cognitive assessment. Step 2 (for those failing Step 1) was a 10-item version of the Unified Parkinson Disease Rating Scale and the Mini-Mental State Examination. Step 3 (for those failing Step 2) was a comprehensive neurologic exam with definitive diagnosis of PD, AD, mild cognitive impairment (MCI), other disorders, or subjects who were healthy. Screening parameters and disease prevalence were calculated. Results Of the 401 screened subjects (80% of target population), 370 (92%), 163 (45%), and 81 (56%) failed in Step 1, Step 2, and Step 3, respectively. Thirty-three, 20, and 35 patients were diagnosed with PD, AD, and MCI, respectively (7 were PD with MCI/AD); 90% were new cases. Step 1 sensitivities of motor and cognitive assessments regarding Step 2 were both 93%, and Step 2 sensitivities regarding definitive diagnosis 100 and 96%, respectively. Specificities for Step 1 motor and cognitive tests were low (23% and 29%, respectively) and for Step 2 tests acceptable (76%, 94%). Based on international data, PD prevalence was 3.7 times higher than expected; AD prevalence was as expected. Conclusion Proposed protocol adjustments will increase test specificity and reduce administration time. A routine screening program is feasible within the public healthcare system of Costa Rica.
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Affiliation(s)
- Catharina Wesseling
- Central American Institute for Studies on Toxic Substances (IRET), Universidad Nacional, Heredia, Costa Rica; Institute of Environmental Medicine (IMM), Karolinska Institutet, Stockholm, Sweden;
| | - Norbel Román
- Hospital San Juan de Dios, Social Security of Costa Rica (CCSS), San José, Costa Rica
| | - Indiana Quirós
- Clínica de Santo Domingo de Heredia, Social Security of Costa Rica (CCSS), Santo Domingo de Heredia, Costa Rica
| | - Laura Páez
- Clínica de Santo Domingo de Heredia, Social Security of Costa Rica (CCSS), Santo Domingo de Heredia, Costa Rica
| | - Vilma García
- Development of Health Services, Social Security of Costa Rica (CCSS), San José, Costa Rica
| | - Ana María Mora
- Central American Institute for Studies on Toxic Substances (IRET), Universidad Nacional, Heredia, Costa Rica; School of Public Health, University of California at Berkeley, Berkeley, CA, USA
| | - Jorge L Juncos
- Department of Neurology, Emory University, Atlanta, GA, USA
| | - Kyle N Steenland
- Rollins School of Public Health, Emory University, Atlanta, GA, USA
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Amano S, Nocera JR, Vallabhajosula S, Juncos JL, Gregor RJ, Waddell DE, Wolf SL, Hass CJ. The effect of Tai Chi exercise on gait initiation and gait performance in persons with Parkinson's disease. Parkinsonism Relat Disord 2013; 19:955-60. [PMID: 23835431 DOI: 10.1016/j.parkreldis.2013.06.007] [Citation(s) in RCA: 76] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2012] [Revised: 06/10/2013] [Accepted: 06/13/2013] [Indexed: 10/26/2022]
Abstract
Gait dysfunction and postural instability are two debilitating symptoms in persons with Parkinson's disease (PD). Tai Chi exercise has recently gained attention as an attractive intervention for persons with PD because of its known potential to reduce falls and improve postural control, walking abilities, and safety at a low cost. The purpose of this report is to investigate the effect of Tai Chi exercise on dynamic postural control during gait initiation and gait performance in persons with idiopathic PD, and to determine whether these benefits could be replicated in two different environments, as complementary projects. In these two separate projects, a total of 45 participants with PD were randomly assigned to either a Tai Chi group or a control group. The Tai Chi groups in both projects completed a 16-week Tai Chi exercise session, while the control groups consisted of either a placebo (i.e., Qi-Gong) or non-exercise group. Tai Chi did not significantly improve Unified Parkinson's Disease Rating Scale Part III score, selected gait initiation parameters or gait performance in either project. Combined results from both projects suggest that 16 weeks of class-based Tai Chi were ineffective in improving either gait initiation, gait performance, or reducing parkinsonian disability in this subset of persons with PD. Thus the use of short-term Tai Chi exercise should require further study before being considered a valuable therapeutic intervention for these domains in PD.
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Affiliation(s)
- Shinichi Amano
- Department of Applied Physiology & Kinesiology, University of Florida, Gainesville, FL, USA
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15
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Vaughan CP, Juncos JL, Trotti LM, Johnson TM, Bliwise DL. Nocturia and overnight polysomnography in Parkinson disease. Neurourol Urodyn 2013; 32:1080-5. [PMID: 23359220 DOI: 10.1002/nau.22365] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2012] [Accepted: 12/03/2012] [Indexed: 01/26/2023]
Abstract
AIM Characterize clinical factors related to nocturia and sleep disruption in Parkinson disease (PD) using polysomnography (PSG). METHODS Sixty-three PD patients were recruited regardless of sleep or voiding complaints from a university-based movement disorders clinic for a 48 hr inpatient PSG protocol. Nocturia frequency and bother related to urinary symptoms were assessed using the International Prostate Symptom Score (IPSS) and were corroborated by measurements of PSG-defined sleep made immediately preceding and subsequent to each in-lab voiding episode. PSG measures included whole-night total sleep time (TST), sleep efficiency (SE), apnea/hypopnea index (AHI), and time to PSG-defined sleep following nocturia episodes. Differences between groups were assessed using Mantel-Haenszel chi-square, t-tests, or Wilcoxon signed rank tests. Linear regression was used to assess factors associated with reported nocturia frequency. RESULTS Sixty patients completed the IPSS. Thirty-seven (61%) reported at least two nocturia episodes nightly; those individuals demonstrated lower PSG-defined SE (P = 0.01) and TST (P = 0.02) than patients with 0-1 episodes. Participants reporting 2-3 episodes of nocturia with high bother on the IPSS (n = 12) demonstrated lower whole-night TST (280.5 ± 116.1 min vs. 372.5 ± 58.7 min, P = 0.03) and worse SE (59.2 ± 22.7% vs. 75.9 ± 11.2%, P = 0.04) when compared to participants with 2-3 episodes of nocturia with low bother (n = 13). CONCLUSIONS These results verify objectively that PD patients with nocturia have poor sleep. Furthermore, among individuals with comparable levels of reported nocturia, higher bother is associated with poorer sleep as defined on PSG. Neurourol. Urodynam. Published 2013. This article is a U.S. Government work and is in the public domain in the USA.
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Affiliation(s)
- Camille P Vaughan
- Department of Veterans Affairs Birmingham/Atlanta Geriatric Research Education and Clinical Center, Atlanta, Georgia; Division of General Medicine and Geriatrics, Department of Medicine, Emory University, Atlanta, Georgia
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16
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Steenland K, Wesseling C, Román N, Quirós I, Juncos JL. Occupational pesticide exposure and screening tests for neurodegenerative disease among an elderly population in Costa Rica. Environ Res 2013; 120:96-101. [PMID: 23092715 DOI: 10.1016/j.envres.2012.08.014] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/07/2012] [Revised: 07/31/2012] [Accepted: 08/02/2012] [Indexed: 06/01/2023]
Abstract
BACKGROUND Pesticides have been associated with Parkinson's disease (PD) in many studies, and with Alzheimer's disease (AD) in a few. METHODS We conducted screening tests for neurologic disease and occupational pesticide use in a population-based sample of 400 elderly subjects at two government-run clinics in Costa Rica; 361 subjects who failed the initial screen were given both the mini-mental states exam (MMSE) and a modified version of a 10-item united Parkinson's disease rating motor subscale (UPDRS). Among subjects who failed either test, 144 were then examined by a neurologist. RESULTS Past occupational pesticide exposure was reported by 18% of subjects. Exposed subjects performed worse on the MMSE than the non-exposed (mean 24.5 versus 25.9, p=0.01, adjusted for age, sex, and education). The exposed had significantly elevated risks of abnormal scores on two UPDRS items, tremor-at-rest (OR 2.58, 1.28-5.23), and finger-tapping (OR=2.94, 95% CI 1.03-8.41). Thirty-three (23%) of those examined by the neurologist were diagnosed with possible/probable PD, 3-4 times the expected based on international data; 85% of these cases had not been previously diagnosed. Among subjects who took the UPDRS, the exposed had an increased risk of PD (OR=2.57, 95% CI 0.91-7.26). No excess risk was found for a diagnosis of AD or mild cognitive impairment. CONCLUSIONS Elderly subjects with past occupational pesticide exposure performed significantly worse on screening tests for dementia and PD, and had an increased risk of an eventual PD diagnosis. Screening may be particularly appropriate among elderly subjects with past pesticide exposure.
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Affiliation(s)
- K Steenland
- Rollins School of Public Health, Emory University, 1518 Clifton Road, Atlanta, USA.
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17
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Elble R, Comella C, Fahn S, Hallett M, Jankovic J, Juncos JL, Lewitt P, Lyons K, Ondo W, Pahwa R, Sethi K, Stover N, Tarsy D, Testa C, Tintner R, Watts R, Zesiewicz T. Reliability of a new scale for essential tremor. Mov Disord 2012; 27:1567-9. [PMID: 23032792 DOI: 10.1002/mds.25162] [Citation(s) in RCA: 136] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2012] [Revised: 07/10/2012] [Accepted: 07/27/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The objective of this study was to determine the reliability of a new scale for the clinical assessment of essential tremor. The Essential Tremor Rating Assessment Scale contains 9 performance items that rate action tremor in the head, face, voice, limbs, and trunk from 0 to 4 in half-point intervals. Head and limb tremor ratings are defined by specific amplitude ranges in centimeters. METHODS Videos of 44 patients and 6 controls were rated by 10 specialists on 2 occasions 1-2 months apart. Inter- and intrarater reliability was assessed with a 2-way random-effects intraclass correlation, using an absolute agreement definition. RESULTS Inter- and intrarater intraclass correlations for head and upper-limb tremor ranged from 0.86 to 0.96, and intraclass correlations for total score were 0.94 and 0.96. The intraclass correlations for voice, face, trunk, and leg were less robust. CONCLUSIONS This scale is an exceptionally reliable tool for the clinical assessment of essential tremor.
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Affiliation(s)
- Rodger Elble
- Southern Illinois University School of Medicine, Springfield, Illinois 62794-9643, USA.
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18
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Juncos JL, Lazarus JT, Rohr J, Allen EG, Shubeck L, Hamilton D, Novak G, Sherman SL. Olfactory dysfunction in fragile X tremor ataxia syndrome. Mov Disord 2012; 27:1556-9. [PMID: 23079771 DOI: 10.1002/mds.25043] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2011] [Revised: 04/02/2012] [Accepted: 04/18/2012] [Indexed: 11/09/2022] Open
Abstract
INTRODUCTION We investigated olfactory defects in fragile X-associated tremor/ataxia syndrome (FXTAS), a finding reported on in other neurodegenerative disorders with clinical features that overlap those of FXTAS. METHODS We measured olfactory identification capacity in 41 FMR1 premutation carriers and 42 controls using the University of Pennsylvania Smell Identification Test (UPSIT). Carriers received neurologic evaluations using motor rating scales for tremor, ataxia, and parkinsonism. Cognitive function was measured using the Montreal Cognitive Assessment test. RESULTS Frequency of olfactory defects was higher in carriers, compared to controls (61% versus 29%; P = 0.003). There was no statistically significant group difference in severity of olfaction defects, after accounting for differences in age, and in rates of head injury and smoking. However, both the frequency (odds ratio = 3.9; 95% confidence interval: 0.81-19.1) and severity (28.6 versus 33.4; P = 0.01) of these defects were greater in cognitively impaired, compared to cognitively intact, carriers. There was no correlation between UPSIT scores and the above-mentioned motor rating scales. CONCLUSIONS FMR1 premutation carriers are susceptible to olfactory identification defects. The severity of these defects is comparable to that reported in hereditary ataxias, but less than that in PD and Alzheimer's disease. This concurrence across neurodegenerative disorders suggests a shared system vulnerability that correlates with, but is not limited to, cognitive impairment, because it is also found in cognitively intact carriers. These results need to be corroborated in a larger prospective study of FMR1 premutation carriers that extends beyond olfactory identification to include measures of smell thresholds.
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Affiliation(s)
- Jorge L Juncos
- Department of Neurology, Emory University School of Medicine, Atlanta, Georgia 30329, USA.
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19
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Coppola G, Chinnathambi S, Lee JJ, Dombroski BA, Baker MC, Soto-Ortolaza AI, Lee SE, Klein E, Huang AY, Sears R, Lane JR, Karydas AM, Kenet RO, Biernat J, Wang LS, Cotman CW, Decarli CS, Levey AI, Ringman JM, Mendez MF, Chui HC, Le Ber I, Brice A, Lupton MK, Preza E, Lovestone S, Powell J, Graff-Radford N, Petersen RC, Boeve BF, Lippa CF, Bigio EH, Mackenzie I, Finger E, Kertesz A, Caselli RJ, Gearing M, Juncos JL, Ghetti B, Spina S, Bordelon YM, Tourtellotte WW, Frosch MP, Vonsattel JPG, Zarow C, Beach TG, Albin RL, Lieberman AP, Lee VM, Trojanowski JQ, Van Deerlin VM, Bird TD, Galasko DR, Masliah E, White CL, Troncoso JC, Hannequin D, Boxer AL, Geschwind MD, Kumar S, Mandelkow EM, Wszolek ZK, Uitti RJ, Dickson DW, Haines JL, Mayeux R, Pericak-Vance MA, Farrer LA, Ross OA, Rademakers R, Schellenberg GD, Miller BL, Mandelkow E, Geschwind DH. Evidence for a role of the rare p.A152T variant in MAPT in increasing the risk for FTD-spectrum and Alzheimer's diseases. Hum Mol Genet 2012; 21:3500-12. [PMID: 22556362 DOI: 10.1093/hmg/dds161] [Citation(s) in RCA: 181] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Rare mutations in the gene encoding for tau (MAPT, microtubule-associated protein tau) cause frontotemporal dementia-spectrum (FTD-s) disorders, including FTD, progressive supranuclear palsy (PSP) and corticobasal syndrome, and a common extended haplotype spanning across the MAPT locus is associated with increased risk of PSP and Parkinson's disease. We identified a rare tau variant (p.A152T) in a patient with a clinical diagnosis of PSP and assessed its frequency in multiple independent series of patients with neurodegenerative conditions and controls, in a total of 15 369 subjects. Tau p.A152T significantly increases the risk for both FTD-s (n = 2139, OR = 3.0, CI: 1.6-5.6, P = 0.0005) and Alzheimer's disease (AD) (n = 3345, OR = 2.3, CI: 1.3-4.2, P = 0.004) compared with 9047 controls. Functionally, p.A152T (i) decreases the binding of tau to microtubules and therefore promotes microtubule assembly less efficiently; and (ii) reduces the tendency to form abnormal fibers. However, there is a pronounced increase in the formation of tau oligomers. Importantly, these findings suggest that other regions of the tau protein may be crucial in regulating normal function, as the p.A152 residue is distal to the domains considered responsible for microtubule interactions or aggregation. These data provide both the first genetic evidence and functional studies supporting the role of MAPT p.A152T as a rare risk factor for both FTD-s and AD and the concept that rare variants can increase the risk for relatively common, complex neurodegenerative diseases, but since no clear significance threshold for rare genetic variation has been established, some caution is warranted until the findings are further replicated.
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Affiliation(s)
- Giovanni Coppola
- Department of Neurology, University of California, Los Angeles, CA, USA
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Juncos JL, Lazarus JT, Graves-Allen E, Shubeck L, Rusin M, Novak G, Hamilton D, Rohr J, Sherman SL. New clinical findings in the fragile X-associated tremor ataxia syndrome (FXTAS). Neurogenetics 2011; 12:123-35. [PMID: 21279400 DOI: 10.1007/s10048-010-0270-5] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2010] [Accepted: 12/03/2010] [Indexed: 01/07/2023]
Abstract
The objective of this paper was to assess the phenotypic variance in patients with the Fragile X-associated Tremor Ataxia Syndrome (FXTAS) and to further elucidate genotype-phenotype correlations in the illness. A second goal was to generate hypotheses regarding symptom progression based on careful histories in our sample that can now be tested in ongoing longitudinal studies. The variability of clinical signs and symptom progression in FXTAS complicates our understanding of its phenotype and presents a series of problems in clinical trial design. Similarly, pre-motor and non-motor symptoms have not been adequately explored to answer outstanding questions regarding genotype-phenotype associations in FXTAS. This was a cross-sectional study of FMR1 premutation carriers from known fragile X syndrome pedigrees. We report on the first 50 subjects who have completed a full neurologic evaluation and a brain MRI. Subjects were selected on the basis of motor symptoms or abnormal results (>1 SD) on a quantitative instrument designed to detect mild tremor and ataxia (CATSYS 1994). A neuropsychological battery included the WAIS-III, COWA, and WCST. Statistical analysis used ANOVA and Fisher's exact test with p < 0.05. All FMR1 premutation carriers were men of mean age 65 ± 7 years. According to the diagnostic criteria of Jacquemont et al. (Am J Hum Genet 72(4):869-878, 2003), 21 subjects met criteria for definite FXTAS, 10 for probable, 9 for possible, and 10 were indeterminate. Duration of motor symptoms was significantly longer in the definitive group (8.6 ± 6) compared to the other groups (p < 0.01). The presentations in 40 subjects, excluding the indeterminate group, included: tremor 24, ataxia 5, memory symptoms 3, parkinsonism 2, and torticollis 1. The data suggest at least two dominant phenotypic presentations: (a) a tremor-dominant subtype in which the onset of ataxia is delayed; (b) a second in which ataxia is the dominant presentation from the outset. In both subtypes, once ataxia emerges it tends to track frontal cognitive changes (p < 0.01). The data support the view that FXTAS is a late-life neurodegenerative disorder with involvement of motor, non-motor, and cognitive systems. The results suggest at least two presentations with tremor- and ataxia-predominant phenotypes. In both, global cognitive decline appears to track ataxia. Prospective longitudinal studies are needed to validate this proposed evolution of FXTAS and its relevance to future clinical trials design.
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Affiliation(s)
- Jorge L Juncos
- Department of Neurology, Emory University, Atlanta, GA 30032, USA.
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Alvarez L, Macias R, Pavón N, López G, Rodríguez-Oroz MC, Rodríguez R, Alvarez M, Pedroso I, Teijeiro J, Fernández R, Casabona E, Salazar S, Maragoto C, Carballo M, García I, Guridi J, Juncos JL, DeLong MR, Obeso JA. Therapeutic efficacy of unilateral subthalamotomy in Parkinson's disease: results in 89 patients followed for up to 36 months. J Neurol Neurosurg Psychiatry 2009; 80:979-85. [PMID: 19204026 DOI: 10.1136/jnnp.2008.154948] [Citation(s) in RCA: 103] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Stereotactic thermocoagulative lesions of the subthalamic nucleus (STN) have been shown to induce significant motor improvement in patients with Parkinson's disease (PD). PATIENTS AND METHODS 89 patients with PD were treated with unilateral subthalamotomy. 68 patients were available for evaluations after 12 months, 36 at 24 months and 25 at 36 months. RESULTS The Unified Parkinson's Disease Rating Scale (UPDRS) motor scores improved significantly contralaterally to the lesion in the "off" and "on" states throughout the follow-up, except for the "on" state at the last evaluation. Axial features and signs ipsilateral to the lesion progressed steadily throughout the study. Levodopa daily doses were significantly reduced by 45%, 36% and 28% at 12, 24 and 36 months post-surgery. 14 patients (15%) developed postoperative hemichorea-ballism which required pallidotomy in eight. These 14 patients had significantly higher dyskinesia scores (levodopa induced) preoperatively than the entire cohort. CONCLUSION Unilateral subthalamotomy was associated with significant and sustained motor benefit contralateral to the lesion. Further work is needed to ascertain what factors led to severe, persistent chorea-ballism in a subset of patients. Subthalamotomy may be considered an option in circumstances when deep brain stimulation is not viable.
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Affiliation(s)
- L Alvarez
- Movement Disorders, Functional Neurosurgery and Neurophysiology Units, Centro Internacional de Restauración Neurológica (CIREN), La Habana, Cuba
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Zesiewicz TA, Sullivan KL, Freeman A, Juncos JL. Treatment of imbalance with varenicline Chantix(R): report of a patient with fragile X tremor/ataxia syndrome. Acta Neurol Scand 2009; 119:135-8. [PMID: 18771524 DOI: 10.1111/j.1600-0404.2008.01070.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
We describe the case of a man with Fragile X tremor/ataxia syndrome, whose ataxia and imbalance improved with the use of varenicline (Chantix) and reverted to baseline 10 days after varenicline was discontinued. Varenicline was started as part of a smoking cessation program.
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Affiliation(s)
- T A Zesiewicz
- Parkinson Research Foundation Center of Excellence at University of South Florida, University of South Florida, Tampa, FL 34677, USA.
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Hass CJ, Buckley T, Juncos JL. Subjective versus Objective Measures of Gait Function: Accuracy in Parkinson Disease. Med Sci Sports Exerc 2008. [DOI: 10.1249/01.mss.0000321530.74430.9c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Hass CJ, Collins MA, Juncos JL. Resistance training with creatine monohydrate improves upper-body strength in patients with Parkinson disease: a randomized trial. Neurorehabil Neural Repair 2007; 21:107-15. [PMID: 17312085 DOI: 10.1177/1545968306293449] [Citation(s) in RCA: 83] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Persons with Parkinson disease (PD) exhibit decreased muscular fitness including decreased muscle mass, muscle strength, bioenergetic capabilities and increased fatigability. OBJECTIVE This purpose of this investigation was to evaluate the therapeutic effects of resistance training with and without creatine supplementation in patients with mild to moderate PD. METHODS Twenty patients with idiopathic PD were randomized to receive creatine monohydrate supplementation plus resistance training (CRE) or placebo (lactose monohydrate) plus resistance training (PLA), using a double-blind procedure. Creatine and placebo supplementation consisted of 20 g/d for the first 5 days and 5 g/d thereafter. Both groups participated in progressive resistance training (24 sessions, 2 times per week, 1 set of 8-12 repetitions, 9 exercises). Participants performed 1-repetition maximum (1-RM) for chest press, leg extension, and biceps curl. Muscular endurance was evaluated for chest press and leg extension as the number of repetitions to failure using 60% of baseline 1-RM. Functional performance was evaluated as the time to perform 3 consecutive chair rises. RESULTS Statistical analyses (ANOVA) revealed significant Group x Time interactions for chest press strength and biceps curl strength, and post hoc testing revealed that the improvement was significantly greater for CRE. Chair rise performance significantly improved only for CRE (12%, P=.03). Both PLA and CRE significantly improved 1-RM for leg extension (PLA: 16%; CRE: 18%). Muscular endurance improved significantly for both groups. CONCLUSIONS These findings demonstrate that creatine supplementation can enhance the benefits of resistance training in patients with PD.
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Affiliation(s)
- Chris J Hass
- Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, NY, USA.
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Cairns NJ, Grossman M, Arnold SE, Burn DJ, Jaros E, Perry RH, Duyckaerts C, Stankoff B, Pillon B, Skullerud K, Cruz-Sanchez FF, Bigio EH, Mackenzie IRA, Gearing M, Juncos JL, Glass JD, Yokoo H, Nakazato Y, Mosaheb S, Thorpe JR, Uryu K, Lee VMY, Trojanowski JQ. Clinical and neuropathologic variation in neuronal intermediate filament inclusion disease. Neurology 2006; 63:1376-84. [PMID: 15505152 PMCID: PMC3516854 DOI: 10.1212/01.wnl.0000139809.16817.dd] [Citation(s) in RCA: 128] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Recently described neuronal intermediate filament inclusion disease (NIFID) shows considerable clinical heterogeneity. OBJECTIVE To assess the spectrum of the clinical and neuropathological features in 10 NIFID cases. METHODS Retrospective chart and comprehensive neuropathological review of these NIFID cases was conducted. RESULTS The mean age at onset was 40.8 (range 23 to 56) years, mean disease duration was 4.5 (range 2.7 to 13) years, and mean age at death was 45.3 (range 28 to 61) years. The most common presenting symptoms were behavioral and personality changes in 7 of 10 cases and, less often, memory loss, cognitive impairment, language deficits, and motor weakness. Extrapyramidal features were present in 8 of 10 patients. Language impairment, perseveration, executive dysfunction, hyperreflexia, and primitive reflexes were frequent signs, whereas a minority had buccofacial apraxia, supranuclear ophthalmoplegia, upper motor neuron disease (MND), and limb dystonia. Frontotemporal and caudate atrophy were common. Histologic changes were extensive in many cortical areas, deep gray matter, cerebellum, and spinal cord. The hallmark lesions of NIFID were unique neuronal IF inclusions detected most robustly by antibodies to neurofilament triplet proteins and alpha-internexin. CONCLUSION NIFID is a neuropathologically distinct, clinically heterogeneous variant of frontotemporal dementia (FTD) that may include parkinsonism or MND. Neuronal IF inclusions are the neuropathological signatures of NIFID that distinguish it from all other FTD variants including FTD with MND and FTD tauopathies.
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Affiliation(s)
- N J Cairns
- Center for Neurodegenerative Disease Research, Department University of Pennsylvania School of Medicine, Philadelphia, PA, USA.
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Craig LH, Svircev A, Haber M, Juncos JL. Controlled pilot study of the effects of neuromuscular therapy in patients with Parkinson's disease. Mov Disord 2006; 21:2127-33. [PMID: 17044088 DOI: 10.1002/mds.21132] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
The objectives of this study is to examine the effects of neuromuscular therapy (NMT) on motor and nonmotor symptoms in Parkinson's disease (PD). Thirty-six subjects with PD were randomly assigned to NMT or music relaxation (MR, or active control). Subjects received treatment twice a week for 4 weeks. Testing was conducted at baseline, after final treatment, and 8 days after final treatment. Primary outcome measures were the Motor subscale of the United Parkinson Disease Rating Scale (UPDRS) and the Clinical Global Impression scale (CGI-Change). Secondary outcome measures included a PD-specific quality of life scale (PDQ-39), quantitative measures of motor function, and severity scales for anxiety and depression symptoms. NMT resulted in a significant and sustained improvement in the Motor subscale of the UPDRS (P < or = 0.0001), most notable in the tremor scores. Also improved 1 week after the last treatment were the CGI scores (P = 0.007) and the finger-tapping speed (P = 0.001). The MR active control group had a slight improvement in tremor but evidenced no other change in motor function. Both groups exhibited a modest improvement in quality of life immediately after the last treatment. This effect was sustained for 8 days only in the MR group. In the nonmotor domains, the MR group evidenced improvements in mood (P = 0.001) and anxiety (P = 0.002), whereas NMT had no effect on mood (P = 0.09), and its initial effect on anxiety (P = 0.0009) dissipated after 8 days (P = 0.40). Group differences for UPDRS motor score and patient CGI-Change were superior in the NMT compared to the MR group. There was no group difference in PDQ-39 scores or in nonmotor measures. The findings suggest that NMT can improve motor and selected nonmotor symptoms in PD and that this effect is more durable for the motor symptoms. The results of this pilot study warrant larger controlled studies to examine dose range, durability, and mechanisms of NMT in PD function.
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Hass CJ, Waddell DE, Fleming RP, Juncos JL, Gregor RJ. Gait Initiation and Dynamic Balance Control in Parkinson’s Disease. Arch Phys Med Rehabil 2005; 86:2172-6. [PMID: 16271566 DOI: 10.1016/j.apmr.2005.05.013] [Citation(s) in RCA: 91] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2004] [Revised: 05/23/2005] [Accepted: 05/23/2005] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To determine whether the magnitude of the separation between the center of pressure (COP) and the whole-body center of mass (COM) during gait initiation can differentiate patients with varying severity of Parkinson's disease (PD) disability. DESIGN Cross-sectional, intact groups research design. SETTING Biomechanics research laboratory. PARTICIPANTS Forty-three patients were stratified into 2 groups based on the Hoehn and Yahr (H&Y) disability score, which heavily favors balance in determining disability. The 2 groups were: H&Y score of 2.0 or less (n=23; age, 61+/-10y) or H&Y score of 2.5 or higher (n=20; age, 70+/-9y). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES The peak COP-COM distance represents the maximum separation between the location of the whole-body COM and the ground reaction force's COP, and thus is an indicator of dynamic balance control. The peak COP-COM was evaluated during 3 phases of the COP trajectory during a gait initiation task. RESULTS The peak magnitude of the COP-COM distance was significantly greater during the end of the single-support phase in the less disabled patients (H&Y score <or=2.0) than in more balance disabled patients (H&Y score >or=2.5) (P=.004). CONCLUSIONS The differences in COP-COM distances between these H&Y groups suggest that patients with PD who have impaired postural control produce shorter COM-COP distances than do persons without clinically detectable balance impairment. This method of evaluation could prove a useful quantitative index to examine the impact of interventions designed to improve ambulation and balance in PD.
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Affiliation(s)
- Chris J Hass
- Department of Biobehavioral Sciences, Teachers College Columbia University, New York, NY 10027, USA.
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Hass CJ, Collins MA, Morris D, Juncos JL. Resistance Training Combined With Creatine Supplementation In Patients With Parkinsonʼs Disease. Med Sci Sports Exerc 2005. [DOI: 10.1249/00005768-200505001-01745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Collins MA, Hass CJ, Morris D, Juncos JL. The Effects Of Acute Creatine Supplementation On Muscle Strength In Patients With Parkinsonʼs Disease. Med Sci Sports Exerc 2005. [DOI: 10.1249/00005768-200505001-01898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Alvarez L, Macias R, Lopez G, Alvarez E, Pavon N, Rodriguez-Oroz MC, Juncos JL, Maragoto C, Guridi J, Litvan I, Tolosa ES, Koller W, Vitek J, DeLong MR, Obeso JA. Bilateral subthalamotomy in Parkinson's disease: initial and long-term response. Brain 2005; 128:570-83. [PMID: 15689366 DOI: 10.1093/brain/awh397] [Citation(s) in RCA: 127] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
We conducted an open label pilot study of the effect of bilateral subthalamotomy in 18 patients with advanced Parkinson's disease. In seven patients, the first subthalamotomy pre-dated the second by 12-24 months ('staged surgery'). Subsequently, a second group of 11 patients received bilateral subthalamotomy on the same day ('simultaneous surgery'). Patients were assessed according to the CAPIT (Core Assessment Program for Intracerebral Transplantation) protocol, a battery of timed motor tests and neuropsychological tests. Evaluations were performed in the 'off' and 'on' drug states before surgery and at 1 and 6 months and every year thereafter for a minimum of 3 years after bilateral subthalamotomy. Compared with baseline, bilateral subthalamotomy induced a significant (P < 0.001) reduction in the 'off' (49.5%) and 'on' (35.5%) Unified Parkinson's Disease Rating Scale (UPDRS) motor scores at the last assessment. A blind rating of videotape motor exams in the 'off' and 'on' medication states preoperatively and at 2 years postoperatively also revealed a significant improvement. All of the cardinal features of Parkinson's disease as well as activities of daily living (ADL) scores significantly improved (P < 0.01). Levodopa-induced dyskinesias were reduced by 50% (P < 0.01), and the mean daily levodopa dose was reduced by 47% at the time of the last evaluation compared with baseline (P < 0.0001). Dyskinesias occurred intraoperatively or in the immediate postoperative hours in 13 patients, but were generally mild and short lasting. Three patients developed severe generalized chorea that gradually resolved within the next 3-6 months. Three patients experienced severe and persistent postoperative dysarthria. In two, this coincided with the patients exhibiting large bilateral lesions also suffering from severe dyskinesias. No patient exhibited permanent cognitive impairment. The motor benefit has persisted for a follow-up of 3-6 years. This study indicates that bilateral subthalamotomy may induce a significant and long-lasting improvement of advanced Parkinson's disease, but the clinical outcome was variable. This variability may depend in large part on the precise location and volume of the lesions. Further refinement of the surgical procedure is mandatory.
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Affiliation(s)
- L Alvarez
- Movement Disorders and Neurophysiology Units, Centro Internacional de Restauracion Neurologica (CIREN), La Habana, Cuba
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Svircev A, Craig LH, Juncos JL. A pilot study examining the effects of neuromuscular therapy on patients with Parkinson's disease. J Am Osteopath Assoc 2005; 105:26. [PMID: 15710675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Affiliation(s)
- Anna Svircev
- Atlantas School of Massage and Department of Neurology, Emory University Medical School, Atlanta, GA, USA
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Okun MS, Raju DV, Walter BL, Juncos JL, DeLong MR, Heilman K, McDonald WM, Vitek JL. Pseudobulbar crying induced by stimulation in the region of the subthalamic nucleus. J Neurol Neurosurg Psychiatry 2004; 75:921-3. [PMID: 15146017 PMCID: PMC1739063 DOI: 10.1136/jnnp.2003.016485] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
We describe a case of pseudobulbar crying associated with deep brain stimulation (DBS) in the region of the subthalamic nucleus (STN). Patients with pseudobulbar crying show no other evidence of subjective feelings of depression such as dysphoria, anhedonia, or vegetative signs. This may be accompanied by other symptoms of pseudobulbar palsy and has been reported to occur with ischaemic or structural lesions in both cortical and subcortical regions of the brain. Although depression has been observed to result from DBS in the region of the STN, pseudobulbar crying has not been reported. A single patient who reported the symptoms of pseudobulbar crying after placement of an STN DBS was tested in the off DBS and on DBS conditions. The patient was tested using all four DBS lead contacts and the observations and results of the examiners were recorded. The Geriatric Depression Scale was used to evaluate for depression in all of the conditions. The patient exhibited pseudobulbar crying when on monopolar stimulation at all four lead contacts. The pseudobulbar crying resolved off stimulation. This case describes another type of affective change that may be associated with stimulation in the region of or within the STN. Clinicians should be aware of this potential complication, the importance of differentiating it from stimulation induced depression, and its response to a serotonin reuptake inhibitor, such as sertraline.
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Affiliation(s)
- M S Okun
- Department of Neurology, University of Florida McKnight Brain Institute, Gainesville, FL 32610, USA.
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Juncos JL, Roberts VJ, Evatt ML, Jewart RD, Wood CD, Potter LS, Jou HC, Yeung PP. Quetiapine improves psychotic symptoms and cognition in Parkinson's disease. Mov Disord 2003; 19:29-35. [PMID: 14743357 DOI: 10.1002/mds.10620] [Citation(s) in RCA: 84] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Twenty-nine elderly patients who failed treatment with clozapine, risperidone, or olanzapine entered this 24-week, single-center, open-label trial to assess the efficacy of quetiapine (12.5-400 mg/day) for psychosis in patients with Parkinson's disease (PD). Psychiatric, motor, and cognitive assessments were administered at baseline and at periodic intervals for 24 weeks. These included the Brief Psychiatric Rating Scale (BPRS), Neuropsychiatric Inventory (NPI), Unified Parkinson's Disease Rating Scale (UPDRS) and tests of intellectual functioning, attention, and memory. Repeated measures statistical analysis was used to assess change from baseline. The results revealed significant improvements in the 24-week BPRS total score and NPI psychosis subscale scores, with no decline in UPDRS total or motor subscale scores. There was also significant improvement in recall scores on cognitive measures. These results indicate that quetiapine may treat psychotic symptoms and improve cognition without worsening motor function in patients with PD, suggesting that quetiapine is an effective and well-tolerated antipsychotic in this population.
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Affiliation(s)
- Jorge L Juncos
- Neurology Department, Emory University, Atlanta, Georgia 30329, USA.
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Lyons KE, Pahwa R, Comella CL, Eisa MS, Elble RJ, Fahn S, Jankovic J, Juncos JL, Koller WC, Ondo WG, Sethi KD, Stern MB, Tanner CM, Tintner R, Watts RL. Benefits and risks of pharmacological treatments for essential tremor. Drug Saf 2003; 26:461-81. [PMID: 12735785 DOI: 10.2165/00002018-200326070-00003] [Citation(s) in RCA: 82] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Essential tremor can cause significant functional disability in some patients. The arms are the most common body part affected and cause the most functional disability. The treatment of essential tremor includes medications, surgical options and other forms of therapy. Presently there is no cure for essential tremor nor are there any medications that can slow the progression of tremor. Treatment for essential tremor is recommended if the tremor causes functional disability. If the tremor is disabling only during periods of stress and anxiety, propranolol and benzodiazepines can be used during those periods when the tremor causes functional disability. The currently available medications can improve tremor in approximately 50% of the patients. If the tremor is disabling, treatment should be initiated with either primidone or propranolol. If either primidone or propranolol do not provide adequate control of the tremor, then the medications can be used in combination. If patients experience adverse effects with propranolol, occasionally other beta-adrenoceptor antagonists (such as atenolol or metoprolol) can be used. If primidone and propranolol do not provide adequate control of tremor, occasionally the use of benzodiazepines (such as clonazepam) can provide benefit. Other medications that may be helpful include gabapentin or topiramate. If a patient has disabling head or voice tremor, botulinum toxin injections into the muscles may provide relief from the tremor. Botulinum toxin in the hand muscles for hand tremor can result in bothersome hand weakness and is not widely used. There are other medications that have been tried in essential tremor and have questionable efficacy. These drugs include carbonic anhydrase inhibitors (e.g. methazolamide), phenobarbital, calcium channel antagonists (e.g. nimodipine), isoniazid, clonidine, clozapine and mirtazapine. If the patient still has disabling tremor after medication trials, surgical options are usually considered. Surgical options include thalamotomy and deep brain stimulation of the thalamus. These surgical options provide adequate tremor control in approximately 90% of the patients. Surgical morbidity and mortality for these procedures is low. Deep brain stimulation and thalamotomy have been shown to have comparable efficacy but fewer complications have been reported with deep brain stimulation. In patients undergoing bilateral procedures deep brain stimulation of the thalamus is the procedure of choice to avoid adverse effects seen with bilateral ablative procedures. The use of medication and/or surgery can provide adequate tremor control in the majority of the patients.
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Affiliation(s)
- Kelly E Lyons
- University of Kansas Medical Center, Kansas City, Kansas 66160, USA
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Okun MS, Walter BL, McDonald WM, Tenover JL, Green J, Juncos JL, DeLong MR. Beneficial effects of testosterone replacement for the nonmotor symptoms of Parkinson disease. Arch Neurol 2002; 59:1750-3. [PMID: 12433262 DOI: 10.1001/archneur.59.11.1750] [Citation(s) in RCA: 74] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVE To investigate whether a single daily dose of testosterone replacement gel has beneficial effects on testosterone deficiency symptoms, cognitive function, nonmotor symptoms of Parkinson disease (PD), and motor symptoms of PD. BACKGROUND Recently it has been observed that testosterone replacement therapy improves refractory nonmotor symptoms in testosterone-deficient men with PD. Many of the symptoms of testosterone deficiency are nonspecific and overlap with the nonmotor symptoms of PD, such as decreased enjoyment of life, lack of energy, sexual dysfunction, and depression. Replacement therapy for men with PD and comorbid testosterone deficiency may be an important addition to antiparkinsonian management strategies. METHODS A prospective open-labeled pilot study of testosterone topical gel (5 g of AndroGel; Unimed Pharmaceutical Inc, Deerfield, Ill) administered daily to testosterone-deficient (free testosterone <80 pg/mL) men with PD. All 10 patients were followed up for 1 month and 6 patients were followed up for a total of 3 months. Patients were administered a battery of testosterone deficiency questionnaires, cognitive studies, and scales of PD nonmotor and motor function at baseline, 1, and 3 months. RESULTS With the daily transdermal testosterone gel, patients had an average increase in levels of free testosterone from baseline (53 pg/mL) to a 1-month follow-up visit (131 pg/mL; P =.06) and to a 3-month follow-up visit (98 pg/mL; P =.04). Testosterone deficiency symptoms improved in these patients (St Louis Testosterone Deficiency Questionnaire) from baseline (7.9 deficiency symptoms) to 1 month (5.6 deficiency symptoms, P =.04) and 3 months (5.8 deficiency symptoms, P =.08). The Unified Parkinson's Disease Rating Scale IV showed improvement at 1 month (P =.008). Additionally, there were trends toward improvement in the following scales: Unified Parkinson's Disease Rating Scale I at the 3-month follow-up (P =.09), Letter Fluency at the 3-month follow-up (P =.08), and the Hamilton Anxiety Scale at the 1-month follow-up (P =.09). CONCLUSIONS A daily dose of transdermal testosterone gel improved testosterone deficiency symptoms in men with PD. Although there were trends in improvement in other nonmotor and motor symptoms of PD, future placebo control studies will need to be powered to answer these important questions. Whether testosterone deficiency is simply a comorbidity in PD or whether it plays a role in the pathogenesis of disease also remains for future study.
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Affiliation(s)
- Michael S Okun
- Department of Neurology, Emory University, Atlanta, Ga., USA.
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Gearing M, Juncos JL, Procaccio V, Gutekunst CA, Marino-Rodriguez EM, Gyure KA, Ono S, Santoianni R, Krawiecki NS, Wallace DC, Wainer BH. Aggregation of actin and cofilin in identical twins with juvenile-onset dystonia. Ann Neurol 2002; 52:465-76. [PMID: 12325076 PMCID: PMC2821042 DOI: 10.1002/ana.10319] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The neuropathology of the primary dystonias is not well understood. We examined brains from identical twins with DYT1-negative, dopa-unresponsive dystonia. The twins exhibited mild developmental delays until age 12 years when they began developing rapidly progressive generalized dystonia. Genetic, metabolic, and imaging studies ruled out known causes of dystonia. Cognition was subnormal but stable until the last few years. Death occurred at ages 21 and 22 years. The brains were macroscopically unremarkable. Microscopic examination showed unusual glial fibrillary acidic protein-immunoreactive astrocytes in multiple regions and iron accumulation in pallidal and nigral neurons. However, the most striking findings were 1) eosinophilic, rod-like cytoplasmic inclusions in neocortical and thalamic neurons that were actin depolymerizing factor/cofilin-immunoreactive but only rarely actin-positive; and 2) abundant eosinophilic spherical structures in the striatum that were strongly actin- and actin depolymerizing factor/cofilin-positive. Electron microscopy suggested that these structures represent degenerating neurons and processes; the accumulating filaments had the same dimensions as actin microfilaments. To our knowledge, aggregation of actin has not been reported previously as the predominant feature in any neurodegenerative disease. Thus, our findings may shed light on a novel neuropathological change associated with dystonia that may represent a new degenerative mechanism involving actin, a ubiquitous constituent of the cytoskeletal system.
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Affiliation(s)
- Marla Gearing
- Department of Pathology and Laboratory Medicine, Emory University, Atlanta, GA, USA.
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Shults CW, Oakes D, Kieburtz K, Beal MF, Haas R, Plumb S, Juncos JL, Nutt J, Shoulson I, Carter J, Kompoliti K, Perlmutter JS, Reich S, Stern M, Watts RL, Kurlan R, Molho E, Harrison M, Lew M. Effects of coenzyme Q10 in early Parkinson disease: evidence of slowing of the functional decline. Arch Neurol 2002; 59:1541-50. [PMID: 12374491 DOI: 10.1001/archneur.59.10.1541] [Citation(s) in RCA: 627] [Impact Index Per Article: 28.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND Parkinson disease (PD) is a degenerative neurological disorder for which no treatment has been shown to slow the progression. OBJECTIVE To determine whether a range of dosages of coenzyme Q10 is safe and well tolerated and could slow the functional decline in PD. DESIGN Multicenter, randomized, parallel-group, placebo-controlled, double-blind, dosage-ranging trial. SETTING Academic movement disorders clinics. PATIENTS Eighty subjects with early PD who did not require treatment for their disability. INTERVENTIONS Random assignment to placebo or coenzyme Q10 at dosages of 300, 600, or 1200 mg/d. MAIN OUTCOME MEASURE The subjects underwent evaluation with the Unified Parkinson Disease Rating Scale (UPDRS) at the screening, baseline, and 1-, 4-, 8-, 12-, and 16-month visits. They were followed up for 16 months or until disability requiring treatment with levodopa had developed. The primary response variable was the change in the total score on the UPDRS from baseline to the last visit. RESULTS The adjusted mean total UPDRS changes were +11.99 for the placebo group, +8.81 for the 300-mg/d group, +10.82 for the 600-mg/d group, and +6.69 for the 1200-mg/d group. The P value for the primary analysis, a test for a linear trend between the dosage and the mean change in the total UPDRS score, was.09, which met our prespecified criteria for a positive trend for the trial. A prespecified, secondary analysis was the comparison of each treatment group with the placebo group, and the difference between the 1200-mg/d and placebo groups was significant (P =.04). CONCLUSIONS Coenzyme Q10 was safe and well tolerated at dosages of up to 1200 mg/d. Less disability developed in subjects assigned to coenzyme Q10 than in those assigned to placebo, and the benefit was greatest in subjects receiving the highest dosage. Coenzyme Q10 appears to slow the progressive deterioration of function in PD, but these results need to be confirmed in a larger study.
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Affiliation(s)
- Clifford W Shults
- Department of Neurosciences, Mail Code 0662, University of California-San Diego, 9500 Gilman Dr, La Jolla, CA 92093-0662, USA.
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Okun MS, Stover NP, Subramanian T, Gearing M, Wainer BH, Holder CA, Watts RL, Juncos JL, Freeman A, Evatt ML, Schuele SU, Vitek JL, DeLong MR. Complications of gamma knife surgery for Parkinson disease. Arch Neurol 2001; 58:1995-2002. [PMID: 11735773 DOI: 10.1001/archneur.58.12.1995] [Citation(s) in RCA: 83] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND Many medical centers throughout the world offer radiosurgery with the gamma knife (GK) for pallidotomy and thalamotomy as a safe and effective alternative to radiofrequency ablative surgery and deep brain stimulation for Parkinson disease (PD). The reported incidence of significant complications varies considerably, and the long-term complication rate remains unknown. DESIGN We describe 8 patients seen during an 8-month period referred for complications of GK surgery for PD. RESULTS Of the 8 patients, 1 died as a result of complications, including dysphagia and aspiration pneumonia. Other complications included hemiplegia, homonymous visual field deficit, hand weakness, dysarthria, hypophonia, aphasia, arm and face numbness, and pseudobulbar laughter. In all patients, lesions were significantly off target. CONCLUSIONS The 8 patients with PD seen in referral at our center for complications of GK surgery highlight a spectrum of potential problems associated with this procedure. These include lesion accuracy and size and the delayed development of neurological complications secondary to radiation necrosis. Gamma knife surgery may have a higher complication rate than has been previously appreciated due to delayed onset and underreporting. We believe that the risk-benefit ratio of the GK will require further scrutiny when considering pallidotomy or thalamotomy in patients with PD. Physicians using this technique should carefully follow up patients postoperatively for delayed complications, and fully inform patients of these potential risks.
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Affiliation(s)
- M S Okun
- Emory University, Wesley Wood Health Center Building, Third Floor Neurology, 1841 Clifton Rd NE, Atlanta, GA 30329, USA.
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Obeso JA, Rodriguez MC, Guridi J, Alvarez L, Alvarez E, Macias R, Juncos JL, DeLong M. Lesion of the basal ganglia and surgery for Parkinson disease. Arch Neurol 2001; 58:1165-6. [PMID: 11448310 DOI: 10.1001/archneur.58.7.1165] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Hutton JT, Metman LV, Chase TN, Juncos JL, Koller WC, Pahwa R, LeWitt PA, Samii A, Tsui JK, Calne DB, Waters CH, Calabrese VP, Bennett JP, Barrett R, Morris JL. Transdermal dopaminergic D(2) receptor agonist therapy in Parkinson's disease with N-0923 TDS: a double-blind, placebo-controlled study. Mov Disord 2001; 16:459-63. [PMID: 11391739 DOI: 10.1002/mds.1085] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
N-0923 is a non-ergot, dopaminergic D(2) agonist designed to be transdermally available. It has anti-parkinsonian effects when infused intravenously. An adhesive matrix patch was developed to deliver N-0923 transdermally (N-0923 TDS). In this phase II trial, we evaluated the effectiveness of various doses of N-0923 TDS at replacing levodopa. Eighty-five Parkinson's disease (PD) patients were randomized to placebo or one of four doses of N-0923 TDS for 21 days. Change in daily levodopa dose was the primary efficacy measure. Significantly greater reductions in levodopa dose were achieved as compared to placebo for the two highest doses of N-0923 TDS. Patients treated with 33.5 mg and 67 mg N-0923 TDS decreased levodopa use by 26% and 28%, vs. 7% for placebo. N-0923 TDS was safe and well tolerated.
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Affiliation(s)
- J T Hutton
- Neurology Research & Education Center, Covenant Medical Center-Lakeside, 4102 24th St., Lubbock, TX 79410, USA.
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Juncos JL. Management of psychotic aspects of Parkinson's disease. J Clin Psychiatry 1999; 60 Suppl 8:42-53. [PMID: 10335670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
Psychotic symptoms have become increasingly common in patients with idiopathic Parkinson's disease and other parkinsonian syndromes. This increased prevalence of psychoses is in part a reflection of the greater longevity of people with Parkinson's disease and, to a certain extent, is a consequence of our success in treating the motor symptoms of these syndromes. The psychotic symptoms associated with Parkinson's disease can be as varied as the motor symptoms. They stem from interactions between the underlying neuropathologies of the syndromes and the adverse effects associated with chronic antiparkinsonian drug administration. In patients with advanced Parkinson's disease, there is also a high prevalence of affective comorbidity. This increase in affective symptoms and the relatively high incidence of cognitive and affective side effects of the antiparkinsonian medications contribute to the increase in psychoses observed in these older patients. The most significant risk factors for developing psychosis in Parkinson's disease are (1) coexistence of dementia, (2) protracted sleep disturbances, and (3) nighttime use of long-acting dopaminomimetics. This article reviews the phenomenology, pathophysiology, and treatment of psychosis associated with parkinsonism and discusses how atypical antipsychotic medications have revolutionized the management of the symptoms and improved the quality of life of those affected.
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Affiliation(s)
- J L Juncos
- Emory University School of Medicine Movement Disorders Program and the Wesley Woods Center of Aging, Atlanta, GA 30329, USA.
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Abstract
The relationship between depression and disability in idiopathic Parkinson's disease (PD) was examined in 31 outpatients. Thirteen percent had current major depression (MD), 10% dysthymia, and 32% a lifetime history of MD. Depression was significantly related to both illness severity and functional impairment. Male patients with early-onset PD (before age 55) had more mood and anxiety disorders than late-onset male patients. Patients with right-sided PD had significantly more depressive symptoms than those with left-sided PD. On multiple regression analyses, depression predicted impaired social, role, and physical functioning for men (but not for women), independent of the impact of illness severity. The results suggest that treatment of depression may improve function; however, findings of gender differences will require replication.
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Affiliation(s)
- S A Cole
- Department of Psychiatry, Emory University School of Medicine, Atlanta, Georgia, USA
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Hooks MS, Jones DN, Holtzman SG, Juncos JL, Kalivas PW, Justice JB. Individual differences in behavior following amphetamine, GBR-12909, or apomorphine but not SKF-38393 or quinpirole. Psychopharmacology (Berl) 1994; 116:217-25. [PMID: 7862951 DOI: 10.1007/bf02245065] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Subjects that respond more to a novel environment show a greater locomotor response to drugs of abuse such as cocaine and amphetamine. The current study was performed to examine differences between high (HR) and low (LR) responding rats to a novel environment following administration of amphetamine, a selective dopamine uptake blocker (GBR-12909), a nonselective dopamine agonist (apomorphine), and selective dopamine D1 and D2/D3 agonists. A behavioral checklist and a rating scale were used to determine the behavioral arousal caused by administration of amphetamine (0, 0.5, 2.0, and 8.0 mg/kg), GBR-12909 (0, 1.25, 5.0, and 20.0 mg/kg), apomorphine (0, 0.1, 0.3, and 1 mg/kg), SKF 39393 (0, 2.5, 10, and 40 mg/kg), or quinpirole (0, 0.05, 0.5, and 5.0 mg/kg). The five drugs produced behavioral activation profiles distinct from each other. Following amphetamine administration, both HR and LR subjects showed dose dependent increases in behavioral arousal. The behaviors primarily affected were sniffing, locomotor activity, rearing, and oral activity. HR rats showed a greater overall behavioral response to amphetamine administration compared with LR rats and there were differences in specific behaviors between the two groups. Following GBR-12909 administration, all subjects showed dose dependent increases in sniffing, locomotor activity, and rearing. Differences between HR and LR were observed in sniffing, locomotor activity, and rearing behaviors. HR and LR both showed dose dependent increases in behavior following apomorphine administration. HR showed greater behavioral activation after apomorphine than LR.(ABSTRACT TRUNCATED AT 250 WORDS)
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MESH Headings
- 2,3,4,5-Tetrahydro-7,8-dihydroxy-1-phenyl-1H-3-benzazepine/pharmacology
- Amphetamine/pharmacology
- Animals
- Apomorphine/pharmacology
- Behavior, Animal/drug effects
- Dopamine Agonists/pharmacology
- Dopamine Antagonists/pharmacology
- Dopamine Uptake Inhibitors/pharmacology
- Dose-Response Relationship, Drug
- Environment
- Ergolines/pharmacology
- Individuality
- Male
- Piperazines/pharmacology
- Quinpirole
- Rats
- Rats, Sprague-Dawley
- Receptors, Dopamine/drug effects
- Receptors, Dopamine D1/agonists
- Receptors, Dopamine D2/agonists
- Receptors, Dopamine D3
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Affiliation(s)
- M S Hooks
- Department of Veterinary and Comparative Anatomy, Pharmacology, and Physiology, Washington State University, Pullman 99164-6520
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Hooks MS, Juncos JL, Justice JB, Meiergerd SM, Povlock SL, Schenk JO, Kalivas PW. Individual locomotor response to novelty predicts selective alterations in D1 and D2 receptors and mRNAs. J Neurosci 1994; 14:6144-52. [PMID: 7931568 PMCID: PMC6576994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Rats that have a greater locomotor response to novelty (high responders, HR) have differences in measures of presynaptic dopamine transmission compared to low responders (LR) to a novel environment, including altered dopamine release and behavioral response to indirect dopamine agonists. This study examined the role of three dopamine terminal fields, the nucleus accumbens, striatum, and medial prefrontal cortex, in differences between HR and LR. In the first experiment, dopamine was infused directly into the nucleus accumbens (0, 3, 10, and 30 micrograms/side) or the striatum (0, 10, 30, and 100 micrograms/side). HR showed a greater behavioral response to both the 3 and 30 micrograms/side doses infused into the nucleus accumbens compared to LR. No differences between HR and LR were revealed by dopamine infusion into the striatum. In the second experiment, radioligand binding assays were performed to determine if differences exist between high and low responder rats in the Bmax and/or KD of radiolabeled antagonist ligands for the dopamine D1 and/or D2 receptors. There were fewer D2 binding sites in the nucleus accumbens and fewer sites in the striatum in HR compared to LR. High responders showed a greater Bmax for D1 binding sites in the nucleus accumbens than LR. No differences in number of binding sites for D1 receptors were observed between HR and LR in the striatum. No differences between HR and LR in D2 or D1 receptor binding were observed in the medial prefrontal cortex. There were no differences in KD for any of the dopamine receptors in the regions examined.(ABSTRACT TRUNCATED AT 250 WORDS)
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MESH Headings
- Animals
- Binding Sites
- Blotting, Northern
- Carrier Proteins/metabolism
- Cocaine/pharmacology
- Corpus Striatum/chemistry
- Corpus Striatum/drug effects
- Corpus Striatum/physiology
- Dopamine/metabolism
- Dopamine/physiology
- Dopamine Antagonists/analysis
- Dopamine Plasma Membrane Transport Proteins
- Dose-Response Relationship, Drug
- Male
- Membrane Glycoproteins
- Membrane Transport Proteins
- Motor Activity/drug effects
- Motor Activity/physiology
- Nerve Tissue Proteins
- Nucleus Accumbens/chemistry
- Nucleus Accumbens/drug effects
- Nucleus Accumbens/physiology
- Prefrontal Cortex/chemistry
- Prefrontal Cortex/metabolism
- RNA, Messenger/analysis
- Rats
- Rats, Sprague-Dawley
- Receptors, Dopamine D1/analysis
- Receptors, Dopamine D1/genetics
- Receptors, Dopamine D1/metabolism
- Receptors, Dopamine D2/analysis
- Receptors, Dopamine D2/genetics
- Receptors, Dopamine D2/metabolism
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Affiliation(s)
- M S Hooks
- Department of VCAPP, Washington State University, Pullman 99164-6520
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Jones GH, Hooks MS, Juncos JL, Justice JB. Effects of cocaine microinjections into the nucleus accumbens and medial prefrontal cortex on schedule-induced behaviour: comparison with systemic cocaine administration. Psychopharmacology (Berl) 1994; 115:375-82. [PMID: 7871079 DOI: 10.1007/bf02245080] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
The effects of cocaine HCl infusions into either the nucleus accumbens (NACC) or medial prefrontal cortex (PFC) were compared on the performance of schedule-induced polydipsia (SIP) and related behaviours. Food-deprived rats were exposed to a fixed-time 60-s schedule of food delivery in daily 30-min sessions until stable levels of behaviour were obtained (14 days). Rats were then bilaterally infused with cocaine into either the NACC or PFC via chronically indwelling guide cannulae. Each subject received a sequence of five cocaine infusions (0, 12.5, 25, 50, 100 micrograms) according to a Latin Square design. For comparison, following these intracranial infusions each rat received a sequence of five IP injections of cocaine (0, 2.5, 5, 10, 20 mg/kg) also in a counterbalanced order. NACC and PFC infusions of cocaine and IP cocaine dose-dependently reduced SIP. Cocaine infusions into the NACC, but not the PFC, increased locomotor activity but the characteristic temporal profile of locomotor activity during SIP was retained. IP cocaine also increased locomotor activity in a dose-dependent manner, but the temporal profile of activity was flattened following 20 mg/kg cocaine. NACC and PFC infusions of cocaine had little effect on the total number of panel presses to gain access to the food pellets, but did slightly decrease the high rates of responding immediately prior to the pellet delivery. IP cocaine increased the total number of panel presses at the higher doses, mainly by increasing the low rates of responding. The effects of cocaine infusions into the PFC were behaviourally the most selective, as they reduced SIP without having substantial effects either on locomotor activity or panel pressing.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- G H Jones
- Department of Chemistry, Emory University, Atlanta, GA 30322
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Abstract
Previous experiments have shown that subjects which exhibit a high locomotor response to novelty (HR) also show a greater locomotor response to psychomotor stimulants than subjects which have a low locomotor response to a novel environment (LR). The current experiments were designed to examine in more detail the behavioral differences between HR and LR rats in non-drug paradigms. In the first experiment HR rats acquired schedule-induced polydipsia (SIP) more readily than LR rats. Panel pressing to gain access to the food pellets, however, was greater in LR rats compared to HR rats, especially after stable levels of SIP had been attained. In the second experiment one group of rats were fed daily after a 30-min period in photocell-cages (food conditioning; FC) while a control group was fed in the home-cage (non-conditioned; NC). FC subjects developed heightened locomotor activity in anticipation of feeding in the initial 30 min in the test-cage compared to NC rats. This anticipatory locomotor activity developed more rapidly and to a greater level in HR rats than in LR rats. The concentrations of dopamine, dihydroxyphenylacetic acid, homovanillic acid, serotonin, 5-hydroxyindoleacetic acid, and norepinephrine were determined at the completion of behavioral testing in both the food conditioned and non-conditioned rats. The food conditioned experiment showed that variations in both the dopaminergic and serotoninergic systems may underlie individual differences in behavioral responsiveness. However, no clear pattern of neurochemical differences emerged. The current set of experiments have demonstrated differences between HR and LR rats in non-drug related paradigms and that HR rats appear to show a greater motivational excitement induced by periodic food delivery than LR rats.
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Affiliation(s)
- M S Hooks
- Department of Chemistry, Emory University, Atlanta, GA 30322
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Hooks MS, Colvin AC, Juncos JL, Justice JB. Individual differences in basal and cocaine-stimulated extracellular dopamine in the nucleus accumbens using quantitative microdialysis. Brain Res 1992; 587:306-12. [PMID: 1525663 DOI: 10.1016/0006-8993(92)91012-4] [Citation(s) in RCA: 151] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The current experiment examined the role of nucleus accumbens (NACC) dopamine in individual differences. Subjects were divided into high responders (HR) and low responders (LR) based on their locomotor response to a novel environment. HR rats were subjects which had a locomotor response to novelty in the upper third of the population screened and LR rats in the bottom third of the population. A new method of microdialysis was then used that allowed determination of the extracellular dopamine concentration. This was accomplished by adding various dopamine concentrations (0.0, 5.0 and 20.0 nM) to the perfusate. The concentration of dopamine in the dialysate was subsequently determined. The difference in the dialysate and perfusate dopamine was regressed on the perfusate dopamine. The regression yielded the in vivo recovery and the extracellular concentration. HR rats exhibit a 250% higher basal dopamine concentration (6.45 +/- 1.01 nM, n = 6) than LR rats (2.58 +/- 0.16 nM, n = 7). The in vivo microdialysis recovery was used to estimate the extracellular dopamine following cocaine challenge (15 mg/kg) in the two groups. Following i.p. cocaine administration, HR rats had both a greater locomotor response and increase in absolute dopamine concentration compared to LR rats. The maximum dopamine concentration in the HR group was 23 +/- 2.9 nM, while that in the LR group was only 8.6 +/- 1.1 nM. The maximum in the LR group is comparable to the basal level in the HR group. However, there were no difference in percent change in dopamine following cocaine.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- M S Hooks
- Department of Chemistry, Emory University, Atlanta GA 30322
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