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Okelberry T, Lyons KE, Pahwa R. Updates in essential tremor. Parkinsonism Relat Disord 2024; 122:106086. [PMID: 38538475 DOI: 10.1016/j.parkreldis.2024.106086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Accepted: 03/02/2024] [Indexed: 05/05/2024]
Abstract
Essential tremor (ET) is one of the most common tremor disorders and can be disabling in its affect on daily activities. There have been major breakthroughs in the treatment of tremor and ET is the subject of important ongoing research. This review will present recent advancements in the epidemiology, genetics, pathophysiology, diagnosis, comorbidities, and imaging of ET. Current and future treatment options in the management of ET will also be reviewed. The need for continued innovation and scientific inquiry to address the unmet needs of persons of ET will be highlighted.
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Affiliation(s)
- Tyler Okelberry
- University of Kansas Medical Center, 3599 Rainbow Blvd, Kansas City, KS, 66160, USA.
| | - Kelly E Lyons
- University of Kansas Medical Center, 3599 Rainbow Blvd, Kansas City, KS, 66160, USA
| | - Rajesh Pahwa
- University of Kansas Medical Center, 3599 Rainbow Blvd, Kansas City, KS, 66160, USA
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Camerucci E, Lyons KE, Pahwa R. Predicting Depression in Parkinson's Disease Using Commonly Available PD Questionnaires. J Clin Med 2024; 13:2069. [PMID: 38610834 PMCID: PMC11012860 DOI: 10.3390/jcm13072069] [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: 02/05/2024] [Revised: 03/26/2024] [Accepted: 03/29/2024] [Indexed: 04/14/2024] Open
Abstract
Background: Depression is common in patients with Parkinson's disease (PD) and significantly impacts both the patients and their caregivers. The associations between depression and the responses from commonly used questionnaires for PD patients were assessed. New patients presenting to the Movement Disorder Center completed a number of questionnaires, including assessments of the motor and non-motor symptoms of PD, including depression. Methods: The PD patients were grouped according to severity of depression: none, mild, and moderate-severe, based on the Geriatric Depression Scale (GDS) scores. The mean scores of the Unified PD Rating Scale (UPDRS), Montreal Cognitive Assessment (MoCA), Epworth Sleepiness Scale (ESS), Non-motor Symptoms Scale (NMSS), PD Quality of life (PDQ-39), Hoehn and Yahr score (H&Y), levodopa equivalent daily dose (LEDD), and number of antidepressants used were collected. There were 1214 PD patients included. Results: Increasing depression scores were associated with worsening motor symptoms (according to the UPDRS and H&Y), non-motor symptoms (according to the NMSS), cognition (according to the MoCA), sleepiness (according to the ESS), and quality of life (according to the PDQ-39) (all p-values of p < 0.001). Only half of the patients with mild or moderate-severe depression were taking antidepressants, and the LEDD increased with depression severity. The risk of depression increased by 16% and 5% for every 1-point increase in the NMSS and PDQ-39 scores, respectively. Conclusions: Depression is often unrecognized and undertreated and should be assessed regularly in PD patients, especially in those who demonstrate changes in motor or non-motor symptoms.
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Affiliation(s)
- Emanuele Camerucci
- Department of Neurology, University of Kansas Medical Center, Kansas City, KS 66160, USA; (K.E.L.)
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Elble RJ, Ondo WG, Lyons KE, Qin M, Garafola S, Hersh B, Lieu T, Arkilo D, Chuang R, Bankole K, Pahwa R. A Randomized Phase 2 KINETIC Trial Evaluating SAGE-324/BIIB124 in Individuals with Essential Tremor. Mov Disord 2024; 39:733-738. [PMID: 38357797 DOI: 10.1002/mds.29731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 12/18/2023] [Accepted: 01/10/2024] [Indexed: 02/16/2024] Open
Abstract
BACKGROUND SAGE-324/BIIB124 is an investigational positive allosteric modulator of GABAA receptors. OBJECTIVE KINETIC (NCT04305275), a double-blind, randomized, placebo-controlled, phase 2 study, evaluated SAGE-324/BIIB124 in individuals with essential tremor (ET). METHODS Individuals aged 18 to 80 years were randomly assigned 1:1 to orally receive 60 mg of SAGE-324/BIIB124 or placebo once daily for 28 days. The primary endpoint was change from baseline in The Essential Tremor Rating Assessment Scale-Performance Subscale (TETRAS-PS) Item 4 (upper-limb tremor) at day 29 with SAGE-324/BIIB124 versus placebo. RESULTS Between May 2020 and February 2021, 69 U.S. participants were randomly assigned to receive SAGE-324/BIIB124 (n = 34) or placebo (n = 35). There was a significant reduction from baseline in TETRAS-PS Item 4 at day 29 with SAGE-324/BIIB124 versus placebo (least squares mean [standard error]: -2.31 [0.401] vs. -1.24 [0.349], P = 0.0491). The most common treatment-emergent adverse events included somnolence, dizziness, fatigue, and balance disorder. CONCLUSION These results support further development of SAGE-324/BIIB124 for potential ET treatment. © 2024 Sage Therapeutics, Inc and The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Rodger J Elble
- Department of Neurology, Southern Illinois University School of Medicine, Springfield, Illinois, USA
| | - William G Ondo
- Department of Neurology, Houston Methodist Hospital, Houston, Texas, USA
| | - Kelly E Lyons
- Department of Neurology, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Min Qin
- Sage Therapeutics, Inc, Cambridge, Massachusetts, USA
| | | | | | | | | | | | - Kemi Bankole
- Sage Therapeutics, Inc, Cambridge, Massachusetts, USA
| | - Rajesh Pahwa
- Department of Neurology, University of Kansas Medical Center, Kansas City, Kansas, USA
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Sadeghi M, Bristow T, Fakorede S, Liao K, Palmer JA, Lyons KE, Pahwa R, Huang CK, Akinwuntan A, Devos H. The Effect of Sensory Reweighting on Postural Control and Cortical Activity in Parkinson's Disease. medRxiv 2024:2024.01.26.24301687. [PMID: 38352617 PMCID: PMC10862999 DOI: 10.1101/2024.01.26.24301687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2024]
Abstract
Aims Balance requires the cortical control of visual, somatosensory, and vestibular inputs. The aim of this cross-sectional study was to compare the contributions of each of these systems on postural control and cortical activity using a sensory reweighting approach between participants with Parkinson's disease (PD) and controls. Methods Ten participants with PD (age: 72 ± 9; 3 women; Hoehn & Yahr: 2 [1.5 - 2.50]) and 11 controls (age: 70 ± 3; 4 women) completed a sensory organization test in virtual reality (VR-SOT) while cortical activity was being recorded using electroencephalography (EEG). Conditions 1 to 3 were completed on a stable platform; conditions 4 to 6 on a foam. Conditions 1 and 4 were done with eyes open; conditions 2 and 5 in a darkened VR environment; and conditions 3 and 6 in a moving VR environment. Linear mixed models were used to evaluate changes in center of pressure (COP) displacement and EEG alpha and theta/beta ratio power between the two groups across the postural control conditions. Condition 1 was used as reference in all analyses. Results Participants with PD showed greater COP displacement than controls in the anteroposterior (AP) direction when relying on vestibular input (condition 5; p<0.0001). The mediolateral (ML) COP sway was greater in PD than in controls when relying on the somatosensory (condition 2; p = 0.03), visual (condition 4; p = 0.002), and vestibular (condition 5; p < 0.0001) systems. Participants with PD exhibited greater alpha power compared to controls when relying on visual input (condition 2; p = 0.003) and greater theta/beta ratio power when relying on somatosensory input (condition 4; p = 0.001). Conclusions PD affects reweighting of postural control, exemplified by greater COP displacement and increased cortical activity. Further research is needed to establish the temporal dynamics between cortical activity and COP displacement.
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Richmond AM, Lyons KE, Pahwa R. Safety review of current pharmacotherapies for levodopa-treated patients with Parkinson's disease. Expert Opin Drug Saf 2023; 22:563-579. [PMID: 37401865 DOI: 10.1080/14740338.2023.2227096] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 06/15/2023] [Indexed: 07/05/2023]
Abstract
INTRODUCTION Levodopa remains the gold standard for treatment of Parkinson's disease (PD). Patients develop complications with disease progression, necessitating adjunctive therapy to control fluctuations in motor and non-motor symptoms and dyskinesia. Knowledge of medication safety and tolerability is critical to ascertain the benefit-risk ratio and select an adjunctive therapy that provides the highest chance for medication adherence. Posing a challenge are the sheer abundance of options, stemming from the development of several new drugs in recent years, as well as differences in commercial drug availability worldwide. AREAS COVERED This review evaluates the efficacy, safety, and tolerability of current US FDA-approved pharmacotherapies for levodopa-treated PD patients, including dopamine agonists, monoamine oxidase type-B inhibitors, catechol-O-methyltransferase inhibitors, the N-methyl-D-aspartate receptor antagonist amantadine, and the adenosine receptor antagonist istradefylline. Data were taken from pivotal phase III randomized controlled and post-surveillance studies, when available, that directly led to FDA-approval. EXPERT OPINION No strong evidence exists to support use of a specific adjunctive treatment for improving Off time. Only one medication has demonstrated improvement in dyskinesia in levodopa-treated PD patients; however, every patient cannot tolerate it and therefore adjunctive therapy should be tailored to an individual's symptoms and risk for specific adverse effects.
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Affiliation(s)
- Angela M Richmond
- Parkinson's and Movement Disorders Division, Department of Neurology, The University of Kansas Medical Center, Kansas, KS, United States of America
| | - Kelly E Lyons
- Research and Education, Parkinson's and Movement Disorders Division, Department of Neurology, The University of Kansas Medical Center, Kansas, KS, United States of America
| | - Rajesh Pahwa
- Laverne & Joyce Rider Professor of Neurology, Chief, Parkinson's and Movement Disorders Division Director, Parkinson's Foundation Center of Excellence, The University of Kansas Medical Center, Kansas, KS, United States of America
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Valentino RR, Scotton WJ, Roemer SF, Lashley T, Heckman MG, Shoai M, Martinez-Carrasco A, Tamvaka N, Walton RL, Baker MC, Macpherson HL, Real R, Soto-Beasley AI, Mok K, Revesz T, Warner TT, Jaunmuktane Z, Boeve BF, Christopher EA, DeTure M, Duara R, Graff-Radford NR, Josephs KA, Knopman DS, Koga S, Murray ME, Lyons KE, Pahwa R, Parisi JE, Petersen RC, Whitwell J, Grinberg LT, Miller B, Schlereth A, Seeley WW, Spina S, Grossman M, Irwin DJ, Lee EB, Suh E, Trojanowski JQ, Van Deerlin VM, Wolk DA, Connors TR, Dooley PM, Frosch MP, Oakley DH, Aldecoa I, Balasa M, Gelpi E, Borrego-Écija S, de Eugenio Huélamo RM, Gascon-Bayarri J, Sánchez-Valle R, Sanz-Cartagena P, Piñol-Ripoll G, Molina-Porcel L, Bigio EH, Flanagan ME, Gefen T, Rogalski EJ, Weintraub S, Redding-Ochoa J, Chang K, Troncoso JC, Prokop S, Newell KL, Ghetti B, Jones M, Richardson A, Robinson AC, Roncaroli F, Snowden J, Allinson K, Green O, Rowe JB, Singh P, Beach TG, Serrano GE, Flowers XE, Goldman JE, Heaps AC, Leskinen SP, Teich AF, Black SE, Keith JL, Masellis M, Bodi I, King A, Sarraj SA, Troakes C, Halliday GM, Hodges JR, Kril JJ, Kwok JB, Piguet O, Gearing M, Arzberger T, Roeber S, Attems J, Morris CM, Thomas AJ, Evers BM, White CL, Mechawar N, Sieben AA, Cras PP, De Vil BB, De Deyn PPP, Duyckaerts C, Le Ber I, Seihean D, Turbant-Leclere S, MacKenzie IR, McLean C, Cykowski MD, Ervin JF, Wang SHJ, Graff C, Nennesmo I, Nagra RM, Riehl J, Kovacs GG, Giaccone G, Nacmias B, Neumann M, Ang LC, Finger EC, Blauwendraat C, Nalls MA, Singleton AB, Vitale D, Cunha C, Carvalho A, Wszolek ZK, Morris HR, Rademakers R, Hardy JA, Dickson DW, Rohrer JD, Ross OA. Creating the Pick's disease International Consortium: Association study of MAPT H2 haplotype with risk of Pick's disease. medRxiv 2023:2023.04.17.23288471. [PMID: 37163045 PMCID: PMC10168402 DOI: 10.1101/2023.04.17.23288471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
Background Pick's disease (PiD) is a rare and predominantly sporadic form of frontotemporal dementia that is classified as a primary tauopathy. PiD is pathologically defined by argyrophilic inclusion Pick bodies and ballooned neurons in the frontal and temporal brain lobes. PiD is characterised by the presence of Pick bodies which are formed from aggregated, hyperphosphorylated, 3-repeat tau proteins, encoded by the MAPT gene. The MAPT H2 haplotype has consistently been associated with a decreased disease risk of the 4-repeat tauopathies of progressive supranuclear palsy and corticobasal degeneration, however its role in susceptibility to PiD is unclear. The primary aim of this study was to evaluate the association between MAPT H2 and risk of PiD. Methods We established the Pick's disease International Consortium (PIC) and collected 338 (60.7% male) pathologically confirmed PiD brains from 39 sites worldwide. 1,312 neurologically healthy clinical controls were recruited from Mayo Clinic Jacksonville, FL (N=881) or Rochester, MN (N=431). For the primary analysis, subjects were directly genotyped for MAPT H1-H2 haplotype-defining variant rs8070723. In secondary analysis, we genotyped and constructed the six-variant MAPT H1 subhaplotypes (rs1467967, rs242557, rs3785883, rs2471738, rs8070723, and rs7521). Findings Our primary analysis found that the MAPT H2 haplotype was associated with increased risk of PiD (OR: 1.35, 95% CI: 1.12-1.64 P=0.002). In secondary analysis involving H1 subhaplotypes, a protective association with PiD was observed for the H1f haplotype (0.0% vs. 1.2%, P=0.049), with a similar trend noted for H1b (OR: 0.76, 95% CI: 0.58-1.00, P=0.051). The 4-repeat tauopathy risk haplotype MAPT H1c was not associated with PiD susceptibility (OR: 0.93, 95% CI: 0.70-1.25, P=0.65). Interpretation The PIC represents the first opportunity to perform relatively large-scale studies to enhance our understanding of the pathobiology of PiD. This study demonstrates that in contrast to its protective role in 4R tauopathies, the MAPT H2 haplotype is associated with an increased risk of PiD. This finding is critical in directing isoform-related therapeutics for tauopathies.
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Affiliation(s)
| | - William J Scotton
- Dementia Research Centre, Department of Neurodegenerative Disease, University College London, Queen Square Institute of Neurology, London, UK
| | - Shanu F Roemer
- Department of Neuroscience, Mayo Clinic, Jacksonville, FL 32224, USA
| | - Tammaryn Lashley
- Queen Square Brain Bank for Neurological Disorders, University College London, Queen Square Institute of Neurology London, UK
- Department of Neurodegenerative Disease, University College London, Queen Square Institute of Neurology, London, UK
| | - Michael G Heckman
- Division of Clinical Trials and Biostatistics, Mayo Clinic, Jacksonville, FL 32224, USA
| | - Maryam Shoai
- Department of Neurodegenerative Disease, University College London, Queen Square Institute of Neurology, London, UK
| | - Alejandro Martinez-Carrasco
- Department of Clinical and Movement Neurosciences, University College London, Queen Square Institute of Neurology, London, UK
| | - Nicole Tamvaka
- Department of Neuroscience, Mayo Clinic, Jacksonville, FL 32224, USA
| | - Ronald L Walton
- Department of Neuroscience, Mayo Clinic, Jacksonville, FL 32224, USA
| | - Matthew C Baker
- Department of Neuroscience, Mayo Clinic, Jacksonville, FL 32224, USA
| | - Hannah L Macpherson
- Department of Neurodegenerative Disease, University College London, Queen Square Institute of Neurology, London, UK
| | - Raquel Real
- Department of Clinical and Movement Neurosciences, University College London, Queen Square Institute of Neurology, London, UK
| | | | - Kin Mok
- Department of Neurodegenerative Disease, University College London, Queen Square Institute of Neurology, London, UK
- UK Dementia Research Institute at UCL, London, UK
- Division of Life Science, State Key Laboratory of Molecular Neuroscience, Molecular Neuroscience Center, The Hong Kong University of Science and Technology, Clear Water Bay, Kowloon, Hong Kong, China
- Hong Kong Center for Neurodegenerative Diseases, Hong Kong Science Park, Hong Kong, China
| | - Tamas Revesz
- Queen Square Brain Bank for Neurological Disorders, University College London, Queen Square Institute of Neurology London, UK
- Department of Neurodegenerative Disease, University College London, Queen Square Institute of Neurology, London, UK
| | - Thomas T Warner
- Queen Square Brain Bank for Neurological Disorders, University College London, Queen Square Institute of Neurology London, UK
- Department of Clinical and Movement Neurosciences, University College London, Queen Square Institute of Neurology, London, UK
| | - Zane Jaunmuktane
- Queen Square Brain Bank for Neurological Disorders, University College London, Queen Square Institute of Neurology London, UK
- Department of Clinical and Movement Neurosciences, University College London, Queen Square Institute of Neurology, London, UK
| | - Bradley F Boeve
- Department of Neurology, Mayo Clinic, Rochester, MN 55905, USA
| | | | - Michael DeTure
- Department of Neuroscience, Mayo Clinic, Jacksonville, FL 32224, USA
| | - Ranjan Duara
- Wien Center for Alzheimer’s Disease and Memory Disorders, Mount Sinai Medical Center Miami Beach, FL
| | | | - Keith A Josephs
- Department of Neurology, Mayo Clinic, Rochester, MN 55905, USA
| | - David S Knopman
- Department of Neurology, Mayo Clinic, Rochester, MN 55905, USA
| | - Shunsuke Koga
- Department of Neuroscience, Mayo Clinic, Jacksonville, FL 32224, USA
| | - Melissa E Murray
- Department of Neuroscience, Mayo Clinic, Jacksonville, FL 32224, USA
| | - Kelly E Lyons
- University of Kansas Medical Center, Parkinson’s Disease & Movement Disorder Division, Kansas City, KS. 66160
| | - Rajesh Pahwa
- University of Kansas Medical Center, Parkinson’s Disease & Movement Disorder Division, Kansas City, KS. 66160
| | - Joseph E Parisi
- Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN 55905, USA
| | | | | | - Lea T Grinberg
- Department of Neurology, Memory and Aging Center, University of California San Francisco, San Francisco, CA, USA
| | - Bruce Miller
- Department of Neurology, Memory and Aging Center, University of California San Francisco, San Francisco, CA, USA
| | - Athena Schlereth
- Department of Neurology, Memory and Aging Center, University of California San Francisco, San Francisco, CA, USA
| | - William W Seeley
- Department of Neurology, Memory and Aging Center, University of California San Francisco, San Francisco, CA, USA
| | - Salvatore Spina
- Department of Neurology, Memory and Aging Center, University of California San Francisco, San Francisco, CA, USA
| | - Murray Grossman
- Department of Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA 19104, USA
| | - David J Irwin
- Department of Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Edward B Lee
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA 19104, USA
| | - EunRan Suh
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA 19104, USA
| | - John Q Trojanowski
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Vivianna M Van Deerlin
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA 19104, USA
| | - David A Wolk
- Department of Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Theresa R Connors
- Neuropathology Service, C.S. Kubik Laboratory for Neuropathology, Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA
| | - Patrick M Dooley
- Neuropathology Service, C.S. Kubik Laboratory for Neuropathology, Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA
| | - Matthew P Frosch
- Neuropathology Service, C.S. Kubik Laboratory for Neuropathology, Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA
| | - Derek H Oakley
- Neuropathology Service, C.S. Kubik Laboratory for Neuropathology, Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA
| | - Iban Aldecoa
- Pathology, BDC, Hospital Clinic de Barcelona, Barcelona, Spain
- University of Barcelona, Barcelona, Spain
- Neurological Tissue Bank, Biobanc-Hospital Clínic-FRCB-IDIBAPS, Barcelona, Spain
| | - Mircea Balasa
- Alzheimer’s Disease and other Cognitive Disorders Unit, Neurology Department, Hospital Clinic, Barcelona, Spain
- Barcelona Clinical Research Foundation-August Pi i Sunyer Biomedical Research Institute (FRCB-IDIBAPS), Barcelona, Spain
| | - Ellen Gelpi
- Division of Neuropathology and Neurochemistry, Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Sergi Borrego-Écija
- University of Barcelona, Barcelona, Spain
- Alzheimer’s Disease and other Cognitive Disorders Unit, Neurology Department, Hospital Clinic, Barcelona, Spain
- Barcelona Clinical Research Foundation-August Pi i Sunyer Biomedical Research Institute (FRCB-IDIBAPS), Barcelona, Spain
| | | | - Jordi Gascon-Bayarri
- Servei de Neurologia, Hospital Universitari de Bellvitge. Institut d’Investigació Biomèdica de Bellvitge (Idibell). L’Hospitalet de Llobregat, Spain
| | - Raquel Sánchez-Valle
- University of Barcelona, Barcelona, Spain
- Alzheimer’s Disease and other Cognitive Disorders Unit, Neurology Department, Hospital Clinic, Barcelona, Spain
- Barcelona Clinical Research Foundation-August Pi i Sunyer Biomedical Research Institute (FRCB-IDIBAPS), Barcelona, Spain
| | | | - Gerard Piñol-Ripoll
- Unitat Trastorns Cognitius (Cognitive Disorders Unit), Clinical Neuroscience Research, IRBLleida, Santa Maria University Hospital, Lleida, Spain
| | - Laura Molina-Porcel
- Neurological Tissue Bank, Biobanc-Hospital Clínic-FRCB-IDIBAPS, Barcelona, Spain
- Alzheimer’s Disease and other Cognitive Disorders Unit, Neurology Department, Hospital Clinic, Barcelona, Spain
- Barcelona Clinical Research Foundation-August Pi i Sunyer Biomedical Research Institute (FRCB-IDIBAPS), Barcelona, Spain
| | - Eileen H Bigio
- Mesulam Center for Cognitive Neurology & Alzheimer’s Disease, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Margaret E Flanagan
- Mesulam Center for Cognitive Neurology & Alzheimer’s Disease, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Tamar Gefen
- Mesulam Center for Cognitive Neurology & Alzheimer’s Disease, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Emily J Rogalski
- Mesulam Center for Cognitive Neurology & Alzheimer’s Disease, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Sandra Weintraub
- Mesulam Center for Cognitive Neurology & Alzheimer’s Disease, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | - Koping Chang
- Johns Hopkins School of Medicine, Baltimore, MD, USA
| | | | - Stefan Prokop
- Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, USA
| | - Kathy L Newell
- Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, Indiana 46202, USA
| | - Bernardino Ghetti
- Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, Indiana 46202, USA
| | - Matthew Jones
- Cerebral Function Unit, Manchester Centre for Clinical Neurosciences, Salford Royal NHS Foundation Trust, UK
- Division of Neuroscience, School of Biological Sciences, University of Manchester, UK
| | - Anna Richardson
- Cerebral Function Unit, Manchester Centre for Clinical Neurosciences, Salford Royal NHS Foundation Trust, UK
- Division of Neuroscience, School of Biological Sciences, University of Manchester, UK
| | - Andrew C Robinson
- Division of Neuroscience, Faculty of Biology, Medicine and Health, School of Biological Sciences, The University of Manchester, Salford Royal Hospital, Salford, M6 8HD, UK
- Geoffrey Jefferson Brain Research Centre, Manchester Academic Health Science Centre (MAHSC), Manchester, UK
| | - Federico Roncaroli
- Division of Neuroscience, Faculty of Biology, Medicine and Health, School of Biological Sciences, The University of Manchester, Salford Royal Hospital, Salford, M6 8HD, UK
- Geoffrey Jefferson Brain Research Centre, Manchester Academic Health Science Centre (MAHSC), Manchester, UK
| | - Julie Snowden
- Cerebral Function Unit, Manchester Centre for Clinical Neurosciences, Salford Royal NHS Foundation Trust, UK
- Division of Neuroscience, School of Biological Sciences, University of Manchester, UK
| | - Kieren Allinson
- Histopathology Box 235 Cambridge University Hospital NHS Foundation Trust, Cambridge Biomedical Campus, Hills Road, Cambridge, CB2 0QQ
| | - Oliver Green
- Histopathology Box 235 Cambridge University Hospital NHS Foundation Trust, Cambridge Biomedical Campus, Hills Road, Cambridge, CB2 0QQ
| | - James B Rowe
- Cambridge University Department of Clinical Neurosciences and Cambridge University Hospitals NHS Trust, Cambridge, UK
- Medical Research Council Cognition and Brain Sciences Unit, Cambridge, UK
| | - Poonam Singh
- Histopathology Box 235 Cambridge University Hospital NHS Foundation Trust, Cambridge Biomedical Campus, Hills Road, Cambridge, CB2 0QQ
| | - Thomas G Beach
- Civin Laboratory of Neuropathology, Banner Sun Health Research Institute, Sun City, AZ 85351, USA
| | - Geidy E Serrano
- Civin Laboratory of Neuropathology, Banner Sun Health Research Institute, Sun City, AZ 85351, USA
| | - Xena E Flowers
- Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, Columbia University, New York, NY, USA
| | - James E Goldman
- Department of Pathology and Cell Biology, Columbia University Irving Medical Center, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY 10032, USA
| | - Allison C Heaps
- Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, Columbia University, New York, NY, USA
| | - Sandra P Leskinen
- Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, Columbia University, New York, NY, USA
| | - Andrew F Teich
- Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, Columbia University, New York, NY, USA
- Department of Pathology and Cell Biology, Columbia University, New York, NY, USA
| | - Sandra E Black
- Department of Medicine, Division of Neurology, Sunnybrook Health Sciences Centre and University of Toronto, Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute
| | - Julia L Keith
- Laboratory Medicine and Molecular Diagnostics, Sunnybrook Health Sciences Centre, and Laboratory Medicine and Pathobiology, University of Toronto
| | - Mario Masellis
- Department of Medicine, Division of Neurology, Sunnybrook Health Sciences Centre and University of Toronto, Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute
| | - Istvan Bodi
- Clinical Neuropathology Department, King’s College Hospital NHS Foundation Trust, London, UK
- London Neurodegenerative Diseases Brain Bank, Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Andrew King
- Clinical Neuropathology Department, King’s College Hospital NHS Foundation Trust, London, UK
- London Neurodegenerative Diseases Brain Bank, Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Safa-Al Sarraj
- Clinical Neuropathology Department, King’s College Hospital NHS Foundation Trust, London, UK
- London Neurodegenerative Diseases Brain Bank, Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Claire Troakes
- London Neurodegenerative Diseases Brain Bank, Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Glenda M Halliday
- University of Sydney Brain and Mind Centre and Faculty of Medicine and Health School of Medical Sciences
| | - John R Hodges
- University of Sydney Brain and Mind Centre and Faculty of Medicine and Health School of Medical Sciences
| | - Jillian J Kril
- University of Sydney Faculty of Medicine and Health School of Medical Sciences
| | - John B Kwok
- University of Sydney Brain and Mind Centre and Faculty of Medicine and Health School of Medical Sciences
| | - Olivier Piguet
- University of Sydney Brain and Mind Centre and Faculty of Science School of Psychology
| | - Marla Gearing
- Dept. of Pathology and Laboratory Medicine, Dept. of Neurology, and Goizueta Alzheimer’s Disease Center Brain Bank; Emory University School of Medicine, Atlanta, GA USA
| | - Thomas Arzberger
- Department of Psychiatry and Psychotherapy, University Hospital, Ludwig-Maximilians-University Munich, Germany
| | - Sigrun Roeber
- Center for Neuropathology and Prion Research, Ludwig-Maximilians-University Munich, Germany
| | - Johannes Attems
- Newcastle Brain Tissue Resource, Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, NE4 5PL, UK
| | - Christopher M Morris
- Newcastle Brain Tissue Resource, Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, NE4 5PL, UK
| | - Alan J Thomas
- Newcastle Brain Tissue Resource, Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, NE4 5PL, UK
| | - Bret M. Evers
- University of Texas Southwestern Medical Center, Dallas, TX 75390
| | - Charles L White
- University of Texas Southwestern Medical Center, Dallas, TX 75390
| | | | - Anne A Sieben
- Laboratory of Neurology, Translational Neurosciences, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
- IBB-NeuroBiobank BB190113, Born Bunge Institute, Antwerp, Belgium
- Department of Pathology, Antwerp University Hospital, Antwerp, Belgium
- Department of Neurology, Ghent University Hospital, Ghent University, Belgium
| | - Patrick P Cras
- Laboratory of Neurology, Translational Neurosciences, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
- IBB-NeuroBiobank BB190113, Born Bunge Institute, Antwerp, Belgium
- Department of Neurology, Antwerp University Hospital - UZA, Antwerp, Belgium
| | - Bart B De Vil
- Laboratory of Neurology, Translational Neurosciences, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
- IBB-NeuroBiobank BB190113, Born Bunge Institute, Antwerp, Belgium
- Department of Neurology, Antwerp University Hospital - UZA, Antwerp, Belgium
| | - Peter Paul P.P. De Deyn
- Laboratory of Neurochemistry and Behavior, Experimental Neurobiology Unit, University of Antwerp, Universiteitsplein 1, 2610 Antwerpen, Belgium
| | - Charles Duyckaerts
- Laboratoire de Neuropathologie Escourolle, Hôpital de la Salpêtrière, AP-HP, & Alzheimer Prion Team, ICM, 47 Bd de l’Hôpital, 75651 CEDEX 13 Paris, France
| | - Isabelle Le Ber
- Inserm U1127, CNRS UMR 7225, Sorbonne Université, Paris Brain Institute (ICM), Hôpital Pitié-Salpêtrière, Paris, France
- Centre de référence des démences rares ou précoces, Hôpital Pitié-Salpêtrière, Paris, France
| | - Danielle Seihean
- Laboratoire de Neuropathologie Escourolle, Hôpital de la Salpêtrière, AP-HP, & ICM, 47 Bd de l’Hôpital, 75651 CEDEX 13 Paris, France
| | - Sabrina Turbant-Leclere
- Inserm U1127, CNRS UMR 7225, Sorbonne Université, Paris Brain Institute (ICM) Hôpital Pitié-Salpêtrière, Paris, France
| | - Ian R MacKenzie
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC Canada V6T 2B5
| | - Catriona McLean
- Department of Anatomical Pathology Alfred Heath, Melbourne, Victoria, 3004, Australia
- Victorian Brain Bank, The Florey Institute of Neuroscience of Mental Health, Parkville, Victoria, 3052, Australia
| | - Matthew D Cykowski
- Department of Pathology and Genomic Medicine, Houston Methodist Research Institute and Weill Cornell Medicine, Houston, TX
| | - John F Ervin
- Department of Neurology, Duke University Medical Center, Durham, USA
| | - Shih-Hsiu J Wang
- Department of Neurology, Duke University Medical Center, Durham, USA
| | - Caroline Graff
- Division for Neurogeriatrics, Centre for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
- Unit for Hereditary Dementias, Karolinska University Hospital Solna, Stockholm, Sweden
| | - Inger Nennesmo
- Dept of laboratory Medicine Huddinge Karolinska Institutet, Stockholm Sweden
- Dept of Pathology, Karolinska University Hospital Solna, Stockholm, Sweden
| | - Rashed M Nagra
- Human Brain and Spinal Fluid Resource Center, Brentwood Biomedical Research Institute, Los Angeles, CA, United States
| | | | - Gabor G Kovacs
- Tanz Centre for Research in Neurodegenerative Disease (CRND) and Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
- Laboratory Medicine Program and Krembil Brain Institute, University Health Network, Toronto, ON, Canada
| | | | - Benedetta Nacmias
- Department of Neuroscience, Psychology, Drug Research and Child Health University of Florence, Florence, Italy
- IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy
| | - Manuela Neumann
- Molecular Neuropathology of Neurodegenerative Diseases, German Center for Neurodegenerative Diseases (DZNE), Tübingen, Germany
- Department of Neuropathology, University Hospital of Tübingen, Tübingen, Germany
| | - Lee-Cyn Ang
- Department of Pathology and Laboratory Medicine, London Health Sciences Centre, London, ON, Canada
- Schulich School of Medicine and Dentistry, Western University, London. ON, Canada
| | - Elizabeth C Finger
- Department of Clinical Neurological Sciences, Western University, London, ON, Canada
- Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Cornelis Blauwendraat
- Laboratory of Neurogenetics, National Institute on Aging, National Institutes of Health, Bethesda, MD, USA
| | - Mike A Nalls
- Laboratory of Neurogenetics, National Institute on Aging, National Institutes of Health, Bethesda, MD, USA
- Center for Alzheimer’s and Related Dementias, National Institutes of Health, Bethesda, MD, USA
- Data Tecnica International LLC, Washington, DC, USA
| | - Andrew B Singleton
- Laboratory of Neurogenetics, National Institute on Aging, National Institutes of Health, Bethesda, MD, USA
| | - Dan Vitale
- Laboratory of Neurogenetics, National Institute on Aging, National Institutes of Health, Bethesda, MD, USA
- Center for Alzheimer’s and Related Dementias, National Institutes of Health, Bethesda, MD, USA
- Data Tecnica International LLC, Washington, DC, USA
| | - Cristina Cunha
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal
| | - Agostinho Carvalho
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal
- ICVS/3B’s - PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | | | - Huw R Morris
- Department of Clinical and Movement Neurosciences, University College London, Queen Square Institute of Neurology, London, UK
| | - Rosa Rademakers
- Department of Neuroscience, Mayo Clinic, Jacksonville, FL 32224, USA
- VIBUAntwerp Center for Molecular Neurology, University of Antwerp, Antwerp 2610, Belgium
| | - John A Hardy
- Department of Neurodegenerative Disease, University College London, Queen Square Institute of Neurology, London, UK
- UK Dementia Research Institute at UCL, London, UK
- Reta Lila Weston Institute, University College London, Queen Square Institute of Neurology, London, UK
- Institute for Advanced Study, The Hong Kong University of Science and Technology, Hong Kong, China
| | - Dennis W Dickson
- Department of Neuroscience, Mayo Clinic, Jacksonville, FL 32224, USA
| | - Jonathan D Rohrer
- Dementia Research Centre, Department of Neurodegenerative Disease, University College London, Queen Square Institute of Neurology, London, UK
| | - Owen A Ross
- Department of Neuroscience, Mayo Clinic, Jacksonville, FL 32224, USA
- Department of Clinical Genomics, Mayo Clinic, Jacksonville, FL 32224, USA
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Ghourchian S, Torres-Yaghi YA, Isaacson SH, Pagan F, Lyons KE, Nagle BJ, Patel S, Pahwa R. Movement Disorder Specialists Survey Regarding Use of Telemedicine During the COVID-19 Pandemic. Telemed J E Health 2022; 28:1651-1657. [PMID: 35297666 DOI: 10.1089/tmj.2021.0474] [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] [Indexed: 11/12/2022] Open
Abstract
Aim: To assess the overall satisfaction level of movement disorder specialists using a virtual platform during the COVID-19 pandemic. Methods: This was a multicenter cross-sectional survey for a 6-month period during the beginning of the COVID-19 pandemic. Movement disorder specialists, who utilized telehealth visits from March 2020 to August 2020, were included. The study surveys, including provider's satisfaction with the care that they were able to provide and visit quality, were completed by the provider after each visit. Results: A total of 206 visits, provided by movement disorder specialists, were analyzed. Zoom was the most popular platform used for remote visits (70, 34%). A backup platform was not needed in the majority of movement disorder visits (171, 83%). The majority of physicians were very satisfied or satisfied with the care provided (72.9%) and visit quality (61%). Conclusions: The satisfaction level of specialists using telemedicine during COVID-19 was high despite having encounters with elderly patients with cognitive impairment or lacking advanced skills with technology.
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Affiliation(s)
- Shadi Ghourchian
- Department of Neurology, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Yasar A Torres-Yaghi
- Department of Neurology, Georgetown University Hospital, Washington, District of Columbia, USA
| | - Stuart H Isaacson
- Parkinson's Disease and Movement Disorder Center of Boca Raton, Boca Raton, Florida, USA
| | - Fernando Pagan
- Department of Neurology, Georgetown University Hospital, Washington, District of Columbia, USA
| | - Kelly E Lyons
- Department of Neurology, Parkinson's Disease and Movement Disorder Center, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Brian James Nagle
- Department of Neurology, Georgetown University Hospital, Washington, District of Columbia, USA
| | - Sanskruti Patel
- Department of Neurology, Georgetown University Hospital, Washington, District of Columbia, USA
| | - Rajesh Pahwa
- Department of Neurology, Parkinson's Disease and Movement Disorder Center, University of Kansas Medical Center, Kansas City, Kansas, USA
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Vetterick C, Lyons KE, Matthews LG, Pendal R, Ravina B. The Hidden Burden of Disease and Treatment Experiences of Patients with Essential Tremor: A Retrospective Claims Data Analysis. Adv Ther 2022; 39:5546-5567. [PMID: 36239902 PMCID: PMC9618517 DOI: 10.1007/s12325-022-02318-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 09/06/2022] [Indexed: 01/30/2023]
Abstract
INTRODUCTION Essential tremor (ET) affects approximately 7 million people in the USA, yet public recognition of the disease and its impact remain low. METHODS A retrospective observational study examined US claims data from 2015 to 2019 using the Compile database. ET diagnoses were captured using longitudinal data from 2015 to 2019 and for the year 2019, with diagnosis estimates extrapolated to the general US population. Confirmed ET was identified by an ET diagnosis code with at least two relevant prescriptions or by two diagnosis codes for ET and unspecified tremor at least 90 days apart. Comorbidity and treatment use data were extracted, and medication compliance and 2-year treatment persistence were assessed as measures of treatment adherence. RESULTS A total of 1,336,183 patients with ET diagnoses codes were identified from 2015 through 2019, corresponding to 2,226,971 projected US diagnoses. In 2019, 128,263 patients had a confirmed ET diagnosis, corresponding to 213,772 projected US confirmed diagnoses. Of these, 96% had at least one comorbidity, and 64% received at least one pharmacologic treatment. Propranolol (24%) and primidone (20%) comprised the most common ET prescriptions. Two-year medication discontinuation rates were approximately 40%. CONCLUSION Our findings revealed that 1 million people were diagnosed and sought treatment for ET in the USA from 2015 to 2019. Projected population estimates of approximately 2 million people diagnosed suggest a further 1 million remain untreated. Our findings highlight the complexity of patient care in ET, complicated by delayed diagnoses, multiple comorbidities, and lack of effective and tolerable therapies that can mitigate treatment adherence limitations.
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Affiliation(s)
- Christine Vetterick
- Praxis Precision Medicines, 99 High Street, 30th Floor, Boston, MA, 02110, USA
| | - Kelly E Lyons
- University of Kansas Medical Center, Kansas City, KS, 66160, USA
| | - Lillian G Matthews
- Praxis Precision Medicines, 99 High Street, 30th Floor, Boston, MA, 02110, USA
| | - Robert Pendal
- Praxis Precision Medicines, 99 High Street, 30th Floor, Boston, MA, 02110, USA
| | - Bernard Ravina
- Praxis Precision Medicines, 99 High Street, 30th Floor, Boston, MA, 02110, USA.
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Hanna-Pladdy B, Pahwa R, Lyons KE. Dopaminergic Basis of Spatial Deficits in Early Parkinson's Disease. Cereb Cortex Commun 2021; 2:tgab042. [PMID: 34738086 DOI: 10.1093/texcom/tgab042] [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: 02/25/2021] [Revised: 06/06/2021] [Accepted: 06/07/2021] [Indexed: 11/14/2022] Open
Abstract
Dopaminergic mechanisms regulating cognitive and motor control were evaluated comparing visuoperceptual and perceptuomotor functions in Parkinson's disease (PD). The performance of PD patients (n = 40) was contrasted with healthy controls (n = 42) across two separate visits (on and off dopaminergic medications) on computerized tasks of perception and aiming to a target at variable stimulus lengths (4, 8, 12 cm). Novel visuoperceptual tasks of length equivalence and width interval estimations without motor demands were compared with tasks estimating spatial deviation in movement termination. The findings support the presence of spatial deficits in early PD, more pronounced with increased discrimination difficulty, and with shorter stimulus lengths of 4 cm for both visuoperceptual and perceptumotor functions. Dopaminergic medication had an adverse impact on visuoperceptual accuracy in particular for length equivalence estimations, in contrast with dopaminergic modulation of perceptuomotor functions that reduced angular displacements toward the target. The differential outcomes for spatial accuracy in perception versus movement termination in PD are consistent with involvement of the direct pathway and models of progressive loss of dopamine through corticostriatal loops. Future research should develop validated and sensitive standardized tests of perception and explore dopaminergic selective deficits in PD to optimize medication titration for motor and cognitive symptoms of the disease.
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Affiliation(s)
- B Hanna-Pladdy
- Center for Advanced Imaging Research (CAIR), Department of Diagnostic Radiology & Nuclear Medicine, University of Maryland School of Medicine, Baltimore, MD 21201, USA
| | - R Pahwa
- Parkinson's Disease and Movement Disorder Center, Department of Neurology, University of Kansas Medical Center, Kansas City, KS 66160, USA
| | - K E Lyons
- Parkinson's Disease and Movement Disorder Center, Department of Neurology, University of Kansas Medical Center, Kansas City, KS 66160, USA
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Kahya M, Lyons KE, Pahwa R, Akinwuntan AE, He J, Devos H. Pupillary Response to Postural Demand in Parkinson's Disease. Front Bioeng Biotechnol 2021; 9:617028. [PMID: 33987171 PMCID: PMC8111006 DOI: 10.3389/fbioe.2021.617028] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 03/09/2021] [Indexed: 12/11/2022] Open
Abstract
Background: Individuals with Parkinson’s disease (PD) may need to spend more mental and physical effort (i.e., cognitive workload) to maintain postural control. Pupillary response reflects cognitive workload during postural control tasks in healthy controls but has not been investigated as a measure of postural demand in PD. Objectives: To compare pupillary response during increased postural demand using vision occlusion and dual tasking between individuals with PD and healthy controls. Methods: Thirty-three individuals with PD and thirty-five healthy controls were recruited. The four conditions lasted 60 s and involved single balance task with eyes open; single balance task with eyes occluded; dual task with eyes open; dual task with eyes occluded. The dual task comprised the Auditory Stroop test. Pupillary response was recorded using an eye tracker. The balance was assessed by using a force plate. Two-way Repeated Measures ANOVA and LSD post-hoc tests were employed to compare pupillary response and Center of Pressure (CoP) displacement across the four conditions and between individuals with PD and healthy controls. Results: Pupillary response was higher in individuals with PD compared to healthy controls (p = 0.009) and increased with more challenging postural conditions in both groups (p < 0.001). The post-hoc analysis demonstrated increased pupillary response in the single balance eyes occluded (p < 0.001), dual task eyes open (p = 0.01), and dual task eyes occluded (p < 0.001) conditions compared to single task eyes open condition. Conclusion: Overall, the PD group had increased pupillary response with increased postural demand compared to the healthy controls. In the future, pupillary response can be a potential tool to understand the neurophysiological underpinnings of falls risk in the PD population.
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Affiliation(s)
- Melike Kahya
- Hinda and Arthur Marcus Institute for Aging Research, Harvard Medical School, Boston, MA, United States
| | - Kelly E Lyons
- Department of Neurology, School of Medicine, University of Kansas Medical Center, Kansas City, KS, United States
| | - Rajesh Pahwa
- Department of Neurology, School of Medicine, University of Kansas Medical Center, Kansas City, KS, United States
| | - Abiodun E Akinwuntan
- Office of the Dean, School of Health Professions, University of Kansas Medical Center, Kansas City, KS, United States.,Department of Physical Therapy and Rehabilitation Science, School of Health Professions, University of Kansas Medical Center, Kansas City, KS, United States
| | - Jianghua He
- Department of Biostatistics and Data Science, University of Kansas Medical Center, Kansas City, KS, United States
| | - Hannes Devos
- Department of Physical Therapy and Rehabilitation Science, School of Health Professions, University of Kansas Medical Center, Kansas City, KS, United States
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11
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Papapetropoulos S, Lee MS, Versavel S, Newbold E, Jinnah HA, Pahwa R, Lyons KE, Elble R, Ondo W, Zesiewicz T, Hedera P, Handforth A, Elder J, Versavel M. A Phase 2 Proof-of-Concept, Randomized, Placebo-Controlled Trial of CX-8998 in Essential Tremor. Mov Disord 2021; 36:1944-1949. [PMID: 33764619 PMCID: PMC8451783 DOI: 10.1002/mds.28584] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 01/29/2021] [Accepted: 03/02/2021] [Indexed: 11/26/2022] Open
Abstract
Background Available essential tremor (ET) therapies have limitations. Objectives The objective of this study was to evaluate CX‐8998, a selective T‐type calcium channel modulator, in essential tremor. Methods Patients 18–75 years old with moderate to severe essential tremor were randomized 1:1 to receive CX‐8998 (titrated to 10 mg twice daily) or placebo. The primary end point was change from baseline to day 28 in The Essential Tremor Rating Assessment Scale performance subscale scored by independent blinded video raters. Secondary outcomes included in‐person blinded investigator rating of The Essential Tremor Rating Assessment Scale performance subscale, The Essential Tremor Rating Assessment Scale activities of daily living subscale, and Kinesia ONE accelerometry. Results The video‐rated The Essential Tremor Rating Assessment Scale performance subscale was not different for CX‐8998 (n = 39) versus placebo (n = 44; P = 0.696). CX‐8998 improved investigator‐rated The Essential Tremor Rating Assessment Scale performance subscale (P = 0.017) and The Essential Tremor Rating Assessment Scale activities of daily living (P = 0.049) but not Kinesia ONE (P = 0.421). Adverse events with CX‐8998 included dizziness (21%), headache (8%), euphoric mood (6%), and insomnia (6%). Conclusions The primary efficacy end point was not met; however, CX‐8998 improved some assessments of essential tremor, supporting further clinical investigation. © 2021 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society. This article has been contributed to by US Government employees and their work is in the public domain in the USA.
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Affiliation(s)
| | | | | | - Evan Newbold
- Jazz Pharmaceuticals, Philadelphia, Pennsylvania, USA
| | - Hyder A Jinnah
- Emory University School of Medicine, Atlanta, Georgia, USA
| | - Rajesh Pahwa
- University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Kelly E Lyons
- University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Rodger Elble
- Southern Illinois University School of Medicine, Springfield, Illinois, USA
| | - William Ondo
- Houston Methodist Neurological Institute, Houston, Texas, USA
| | - Theresa Zesiewicz
- University of South Florida Ataxia Research Center, Tampa, Florida, USA
| | - Peter Hedera
- Department of Neurology, University of Louisville, Louisville, Kentucky, USA
| | - Adrian Handforth
- VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
| | - Jenna Elder
- PharPoint Research, Inc., Wilmington, North Carolina, USA
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Isaacson SH, Lyons KE, Amjad F, Pahwa R. Development, Efficacy and Safety of Once-daily, Bedtime, Extended-release Amantadine (Gocovri®) to Treat Dyskinesia and OFF Time in Parkinson’s Disease. Neurology 2021. [DOI: 10.17925/usn.2021.17.1.36] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
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Gupta HV, Pahwa R, Dowell P, Khosla S, Lyons KE. Exploring essential tremor: Results from a large online survey. Clin Park Relat Disord 2021; 5:100101. [PMID: 34988425 PMCID: PMC8710410 DOI: 10.1016/j.prdoa.2021.100101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 06/04/2021] [Accepted: 06/15/2021] [Indexed: 11/30/2022] Open
Abstract
2864 persons from the IETF database responded to the survey. 28% of respondents were not receiving medical care for their tremor. In 33% of respondents, tremor was not treated.
Introduction Essential tremor (ET) is one of the most common movement disorders; however, many patients are misdiagnosed and do not receive effective treatment. It is important to better understand the diagnosis, symptoms and treatment patterns to improve care for those with ET. Methods Persons in the International Essential Tremor Foundation database were invited to complete an online survey, focusing on symptoms, diagnosis, and treatment of ET. Results The survey was emailed to 19,206 persons, with 2864 (14.9%) respondents. Mean age was 65.4 years, median age of tremor onset was 36–40 years, 61% were women, and 64% had a known family history of tremor. Forty-five percent saw multiple physicians before a diagnosis of ET with 65% being diagnosed by a neurologist. Current care is provided by a neurologist in 42%, a family physician in 26% and 28% do not see a physician for ET. Tremor was most commonly reported in the hands/arms (95%). The most commonly affected daily activities included writing, eating, drinking and carrying. Beta-blockers were the most commonly used treatment (42%); however, 33% had no benefit and 35% discontinued due to side effects. Of note, 33% had never received treatment for their tremor. Conclusion This survey highlights the need for more effective treatments with greater tolerability. Increased awareness among physicians and patients in the diagnosis and treatment of ET is also warranted, with nearly half the respondents seeing multiple physicians before receiving an ET diagnosis and nearly 30% not seeing a physician and/or not receiving treatment for ET.
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Affiliation(s)
- Harsh V. Gupta
- University of Kansas Medical Center, 3901 Rainbow Blvd, Kansas City, KS 66160, United States
| | - Rajesh Pahwa
- Laverne & Joyce Rider Professor of Neurology, University of Kansas Medical Center, 3599 Rainbow Boulevard, Mailstop 3042, Kansas City, KS 66160, United States
| | - Phaedra Dowell
- Kansas City VA, 4801 Linwood Blvd, Kansas City, MO 64128, United States
| | - Shawn Khosla
- St. Lukes/Des Peres Hospital Family Medicine Residency, 2345 Dougherty Ferry Ave, St. Louis, MO 63139, United States
| | - Kelly E. Lyons
- University of Kansas Medical Center, 3599 Rainbow Boulevard, Mailstop 3042, Kansas City, KS 66160, United States
- Corresponding author at: Parkinson’s Disease and Movement Disorder Center, University of Kansas Medical Center, 3599 Rainbow Blvd, MS 3042, Kansas City, KS 66160, United States.
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14
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Moon S, Song HJ, Sharma VD, Lyons KE, Pahwa R, Akinwuntan AE, Devos H. Classification of Parkinson's disease and essential tremor based on balance and gait characteristics from wearable motion sensors via machine learning techniques: a data-driven approach. J Neuroeng Rehabil 2020; 17:125. [PMID: 32917244 PMCID: PMC7488406 DOI: 10.1186/s12984-020-00756-5] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 09/02/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Parkinson's disease (PD) and essential tremor (ET) are movement disorders that can have similar clinical characteristics including tremor and gait difficulty. These disorders can be misdiagnosed leading to delay in appropriate treatment. The aim of the study was to determine whether balance and gait variables obtained with wearable inertial motion sensors can be utilized to differentiate between PD and ET using machine learning. Additionally, we compared classification performances of several machine learning models. METHODS This retrospective study included balance and gait variables collected during the instrumented stand and walk test from people with PD (n = 524) and with ET (n = 43). Performance of several machine learning techniques including neural networks, support vector machine, k-nearest neighbor, decision tree, random forest, and gradient boosting, were compared with a dummy model or logistic regression using F1-scores. RESULTS Machine learning models classified PD and ET based on balance and gait characteristics better than the dummy model (F1-score = 0.48) or logistic regression (F1-score = 0.53). The highest F1-score was 0.61 of neural network, followed by 0.59 of gradient boosting, 0.56 of random forest, 0.55 of support vector machine, 0.53 of decision tree, and 0.49 of k-nearest neighbor. CONCLUSIONS This study demonstrated the utility of machine learning models to classify different movement disorders based on balance and gait characteristics collected from wearable sensors. Future studies using a well-balanced data set are needed to confirm the potential clinical utility of machine learning models to discern between PD and ET.
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Affiliation(s)
- Sanghee Moon
- Department of Physical Therapy, Ithaca College, Ithaca, NY, USA.
- Department of Physical Therapy and Rehabilitation Science, University of Kansas Medical Center, Kansas City, KS, USA.
| | - Hyun-Je Song
- Department of Information Technology, Jeonbuk National University, Jeonju, South Korea
| | - Vibhash D Sharma
- Department of Neurology, University of Kansas Medical Center, Kansas City, KS, USA
| | - Kelly E Lyons
- Department of Neurology, University of Kansas Medical Center, Kansas City, KS, USA
| | - Rajesh Pahwa
- Department of Neurology, University of Kansas Medical Center, Kansas City, KS, USA
| | - Abiodun E Akinwuntan
- Department of Physical Therapy and Rehabilitation Science, University of Kansas Medical Center, Kansas City, KS, USA
- Office of the Dean, School of Health Professions, University of Kansas Medical Center, Kansas City, KS, USA
| | - Hannes Devos
- Department of Physical Therapy and Rehabilitation Science, University of Kansas Medical Center, Kansas City, KS, USA
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Khodakarami H, Ricciardi L, Contarino MF, Pahwa R, Lyons KE, Geraedts VJ, Morgante F, Leake A, Paviour D, Angelis AD, Horne M. Khodakarami, H., et al., Prediction of the Levodopa Challenge Test in Parkinson's Disease Using Data from a Wrist-Worn Sensor. Sensors 2019, 19, 5153. Sensors (Basel) 2020; 20:s20154167. [PMID: 32727078 PMCID: PMC7435905 DOI: 10.3390/s20154167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 07/21/2020] [Indexed: 11/16/2022]
Affiliation(s)
| | - Lucia Ricciardi
- Neurosciences Research Centre, Molecular and Clinical Sciences Research Institute, St George’s University of London, Crammer Terrace, London SW18 0RE, UK; (L.R.); (F.M.); (A.L.); (D.P.); (A.D.A.)
| | - Maria Fiorella Contarino
- Department of Neurology, Leiden University Medical Center, K5-Q103 Albinusdreef 2, 2333 ZA Leiden, The Netherlands; (M.F.C.); (V.J.G.)
- Department of Neurology, Haga Teaching Hospital, Els Borst-Eilersplein 275, 2545 AA The Hague, The Netherlands
| | - Rajesh Pahwa
- Parkinson’s Disease and Movement Disorder Center, University of Kansas Medical Center, 3599 Rainbow Blvd, MS 3042, Kansas City, KS 66160, USA; (R.P.); (K.E.L.)
| | - Kelly E. Lyons
- Parkinson’s Disease and Movement Disorder Center, University of Kansas Medical Center, 3599 Rainbow Blvd, MS 3042, Kansas City, KS 66160, USA; (R.P.); (K.E.L.)
| | - Victor J. Geraedts
- Department of Neurology, Leiden University Medical Center, K5-Q103 Albinusdreef 2, 2333 ZA Leiden, The Netherlands; (M.F.C.); (V.J.G.)
| | - Francesca Morgante
- Neurosciences Research Centre, Molecular and Clinical Sciences Research Institute, St George’s University of London, Crammer Terrace, London SW18 0RE, UK; (L.R.); (F.M.); (A.L.); (D.P.); (A.D.A.)
- Department of Clinical and Experimental Medicine, University of Messina, 98122 Messina, Italy
| | - Alison Leake
- Neurosciences Research Centre, Molecular and Clinical Sciences Research Institute, St George’s University of London, Crammer Terrace, London SW18 0RE, UK; (L.R.); (F.M.); (A.L.); (D.P.); (A.D.A.)
| | - Dominic Paviour
- Neurosciences Research Centre, Molecular and Clinical Sciences Research Institute, St George’s University of London, Crammer Terrace, London SW18 0RE, UK; (L.R.); (F.M.); (A.L.); (D.P.); (A.D.A.)
| | - Andrea De Angelis
- Neurosciences Research Centre, Molecular and Clinical Sciences Research Institute, St George’s University of London, Crammer Terrace, London SW18 0RE, UK; (L.R.); (F.M.); (A.L.); (D.P.); (A.D.A.)
| | - Malcolm Horne
- Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, VIC 3010, Australia
- St Vincent’s Hospital, 3065 Fitzroy, Australia
- Correspondence: ; Tel.: +61-414-817-562
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Abstract
BACKGROUND Levodopa is the most efficacious medication in controlling the motor symptoms of Parkinson's disease (PD). There continues to be a controversy as to whether levodopa remains effective after years of therapy. OBJECTIVE To assess the long-term effectiveness of levodopa in PD patients. METHODS The response to levodopa in PD patients undergoing a levodopa challenge for deep brain stimulation (DBS) surgery evaluation from June 1997 through March 2017 were evaluated. The patients were broken into four groups based on disease duration (Group I: 0- 5 years, Group II: 6- 10 years, Group III: 11- 15 years, and Group IV:≥16 years). Levodopa response was calculated based on the changes in Unified Parkinson's Disease Rating Scale (UPDRS) motor and activities of daily living (ADL) scores in the medication ON and OFF states. RESULTS A total of 361 PD patients were included. The mean age in Group I was 59.4 years with a mean disease duration of 3.9 years (n = 29), Group II was 61 years with a mean disease duration of 8.1 years (n = 131), Group III was 64 years with a mean disease duration of 12.8 years (n = 143), and IV was 66.5 years with a mean disease duration of 18.5 years (n = 58). There was a significant improvement in UPDRS motor and ADL scores after the levodopa challenge for all groups. CONCLUSIONS In a subgroup of PD patients who were evaluated for DBS surgery, there was a marked improvement in UPDRS motor and ADL scores which did not decrease with disease progression.
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Affiliation(s)
- Harsh V Gupta
- Department of Neurology, Kansas University Medical Center, Kansas City, KS, USA
| | - Kelly E Lyons
- Department of Neurology, Kansas University Medical Center, Kansas City, KS, USA
| | - Nathaniel Wachter
- Department of Neurology, Kansas University Medical Center, Kansas City, KS, USA
| | - Rajesh Pahwa
- Department of Neurology, Kansas University Medical Center, Kansas City, KS, USA
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Moon S, Sarmento CVM, Steinbacher M, Smirnova IV, Colgrove Y, Lai SM, Lyons KE, Liu W. Can Qigong improve non-motor symptoms in people with Parkinson's disease - A pilot randomized controlled trial? Complement Ther Clin Pract 2020; 39:101169. [PMID: 32379638 PMCID: PMC7607921 DOI: 10.1016/j.ctcp.2020.101169] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Revised: 03/14/2020] [Accepted: 03/31/2020] [Indexed: 01/27/2023]
Abstract
Non-motor symptoms (NMS) including sleep disorders, anxiety, depression, fatigue, and cognitive decline can significantly impact quality of life in people with PD. Qigong exercise is a mind-body exercise that shows a wide range of benefits in various medical conditions. The purpose of this study was to investigate the effect of Qigong exercise on NMS with a focus on sleep quality. Seventeen participants completed a 12-week intervention of Qigong (n = 8) or sham Qigong (n = 9). Disease severity, anxiety and depression levels, fatigue, cognition, quality of life, and other NMS of the participants were evaluated prior to the intervention and at the end of the 12-week intervention. After the intervention, both Qigong and sham-Qigong group showed significant improvement in sleep quality (p < 0.05) and overall NMS (p < 0.05). No significant difference was found between groups. Qigong exercise has the potential as a rehabilitation method for people with PD, specifically alleviating NMS in PD. However, this finding needs to be carefully considered due to the small sample size and potentially low intervention fidelity of this study.
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Affiliation(s)
- Sanghee Moon
- Department of Physical Therapy and Rehabilitation Science, University of Kansas Medical Center, Kansas City, KS, USA.
| | - Caio V M Sarmento
- Department of Physical Therapy and Rehabilitation Science, University of Kansas Medical Center, Kansas City, KS, USA; Department of Physical Therapy, Department of Physical Therapy, California State University, Fresno, CA, USA.
| | - Michael Steinbacher
- Department of Physical Therapy and Rehabilitation Science, University of Kansas Medical Center, Kansas City, KS, USA.
| | - Irina V Smirnova
- Department of Physical Therapy and Rehabilitation Science, University of Kansas Medical Center, Kansas City, KS, USA.
| | - Yvonne Colgrove
- Department of Physical Therapy and Rehabilitation Science, University of Kansas Medical Center, Kansas City, KS, USA.
| | - Sue-Min Lai
- Department of Population Health, University of Kansas Medical Center, Kansas City, KS, USA.
| | - Kelly E Lyons
- Department of Neurology, University of Kansas Medical Center, Kansas City, KS, USA.
| | - Wen Liu
- Department of Physical Therapy and Rehabilitation Science, University of Kansas Medical Center, Kansas City, KS, USA.
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Moon S, Kahya M, Lyons KE, Pahwa R, Akinwuntan AE, Devos H. Cognitive workload during verbal abstract reasoning in Parkinson's disease: a pilot study. Int J Neurosci 2020; 131:504-510. [PMID: 32202180 DOI: 10.1080/00207454.2020.1746309] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Pupillary response reflects cognitive workload during processing speed, working memory, and arithmetic tasks in Parkinson's disease (PD). Abstract reasoning, a higher-order cognitive function that relates different objects, events, or thoughts in a similar manner, may also be compromised in PD. The aim of this study was to compare pupillary response as a measure of cognitive workload while completing a verbal abstract reasoning test between patients with PD and age-matched controls. METHODS Nineteen non-demented individuals with PD (66.6 ± 8.9 years) and 10 healthy controls (65.3 ± 7.3 years) were recruited. A remote eye tracker recorded the pupillary response at 60 Hz, while the participants were performing the Similarities test of Wechsler Adult Intelligence Scale-IV. Outcome measures included pupillary response, evaluated by the Index of Cognitive Activity (ICA), and behavioral responses of the Similarities test. RESULTS The PD group (scaled scores = 8.9 ± 2.2) did not show impairment in behavioral performance on Similarities test compared with healthy controls (scaled scores = 8.8 ± 2.3; p = .91). However, the PD group (ICA = .32 ± .09) demonstrated significantly greater cognitive workload during the Similarities test compared to controls (ICA = .24 ± .08; p = .03). CONCLUSIONS Non-demented individuals with PD exerted greater cognitive workload to complete a verbal abstract reasoning task despite similar behavioral performance compared to healthy controls. Clinical utilities of pupillary response to detect and monitor early impairment in higher-order executive function will be the subject of further study in the PD population.
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Affiliation(s)
- Sanghee Moon
- Department of Physical Therapy and Rehabilitation Science, School of Health Professions, University of Kansas Medical Center, Kansas City, KS, USA
| | - Melike Kahya
- Department of Physical Therapy and Rehabilitation Science, School of Health Professions, University of Kansas Medical Center, Kansas City, KS, USA
| | - Kelly E Lyons
- Department of Neurology, School of Medicine, University of Kansas Medical Center, Kansas City, KS, USA
| | - Rajesh Pahwa
- Department of Neurology, School of Medicine, University of Kansas Medical Center, Kansas City, KS, USA
| | - Abiodun E Akinwuntan
- Department of Physical Therapy and Rehabilitation Science, School of Health Professions, University of Kansas Medical Center, Kansas City, KS, USA.,Office of the Dean, School of Health Professions, University of Kansas Medical Center, Kansas City, KS, USA
| | - Hannes Devos
- Department of Physical Therapy and Rehabilitation Science, School of Health Professions, University of Kansas Medical Center, Kansas City, KS, USA
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Sharma VD, Lyons KE, Nazzaro JM, Pahwa R. Does post-operative symptomatic lead edema associated with subthalamic DBS implantation impact long-term clinical outcomes? J Neurol Sci 2019; 410:116647. [PMID: 31901593 DOI: 10.1016/j.jns.2019.116647] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2019] [Revised: 11/28/2019] [Accepted: 12/24/2019] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Post-operative, non-hemorrhagic, non-infectious symptomatic delayed edema around the DBS lead is an uncommon complication of DBS surgery. We investigated whether this complication impacts clinical outcomes or has long-term sequelae. METHODS All Parkinson's disease (PD) patients with subthalamic nucleus (STN) DBS implantation who developed delayed symptomatic lead edema were identified. UPDRS part III motor, Parkinson's Disease Questionnaire (PDQ-39) total and MoCA scores were analyzed to assess motor outcome, quality of life and cognitive status at 1 year. RESULTS A total of 260 patients underwent 482 STN lead placements. Of these, 16 patients (20 leads, 4.1% of total 482 leads) developed this delayed complication. None of the patients had edema on immediate post-operative scan. Patients presented with varied symptoms including speech difficulty (n = 8), mild confusion (n = 6), headaches (n = 4), gait difficulty (n = 4) and seizures (n = 3). The mean duration for the diagnosis was 5.8 days after lead implantation and the mean duration for which follow-up CT scans reported complete/near complete resolution or improvement of edema was 4.7 weeks (range 2-10 weeks). At 1-year post-DBS, UPDRS motor scores improved significantly (42.5%, p < .001); quality of life improved, but the change was not statistically significant (21.3%, p = .197). There was no decline in cognitive function at 1 year (26.6 vs 26.4, p = .567). No long-term complication related to lead edema occurred in these patients. CONCLUSION Symptomatic lead edema after DBS surgery is an uncommon complication which typically resolves over time. In our series, there were no long-term sequelae of this complication and clinical outcomes were comparable to that reported in the literature.
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Affiliation(s)
- Vibhash D Sharma
- Department of Neurology, University of Kansas Medical Center, Kansas City, KS, United States of America.
| | - Kelly E Lyons
- Department of Neurology, University of Kansas Medical Center, Kansas City, KS, United States of America
| | - Jules M Nazzaro
- Department of Neurosurgery, University of Kansas Medical Center, Kansas City, KS, United States of America
| | - Rajesh Pahwa
- Department of Neurology, University of Kansas Medical Center, Kansas City, KS, United States of America
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Kahya M, Moon S, Ranchet M, Vukas RR, Lyons KE, Pahwa R, Akinwuntan A, Devos H. Brain activity during dual task gait and balance in aging and age-related neurodegenerative conditions: A systematic review. Exp Gerontol 2019; 128:110756. [PMID: 31648005 PMCID: PMC6876748 DOI: 10.1016/j.exger.2019.110756] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 10/14/2019] [Accepted: 10/16/2019] [Indexed: 11/18/2022]
Abstract
The aims of this systematic review were to investigate (1) real-time brain activity during DT gait and balance, (2) whether changes in brain activity correlate with changes in behavioral outcomes in older adults and people with age-related neurodegenerative conditions. PubMed, PsycINFO, and Web of Science were searched from 2009 to 2019 using the keywords dual task, brain activity, gait, balance, aging, neurodegeneration, and other related search terms. A total of 15 articles were included in this review. Functional near-infrared spectroscopy and electroencephalogram measures demonstrated that older adults had higher brain activity, particularly in the prefrontal cortex (PFC), compared to young adults during dual task gait and balance. Similar neurophysiological results were observed in people with age-related neurodegenerative conditions. Few studies demonstrated a relationship between increased brain activity and better behavioral outcomes. This systematic review supports the notion that aging and age-related neurodegenerative conditions are associated with neuronal network changes, resulting in increased brain activity specifically in the PFC. Further studies are warranted to assess the relationship between increased PFC activation during dual task gait and balance and behavioral outcomes to better optimize the rehabilitation interventions.
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Affiliation(s)
- Melike Kahya
- Department of Physical Therapy and Rehabilitation Science, School of Health Professions, University of Kansas Medical Center, Kansas City, KS, USA.
| | - Sanghee Moon
- Department of Physical Therapy and Rehabilitation Science, School of Health Professions, University of Kansas Medical Center, Kansas City, KS, USA.
| | - Maud Ranchet
- University of Lyon, IFSTTAR, TS2 LESCOT, Lyon, France.
| | - Rachel R Vukas
- A.R. Dykes Library of the Health Sciences, University of Kansas Medical Center, Kansas City, KS, USA.
| | - Kelly E Lyons
- Department of Neurology, School of Medicine, University of Kansas Medical Center, Kansas City, KS, USA.
| | - Rajesh Pahwa
- Department of Neurology, School of Medicine, University of Kansas Medical Center, Kansas City, KS, USA.
| | - Abiodun Akinwuntan
- Department of Physical Therapy and Rehabilitation Science, School of Health Professions, University of Kansas Medical Center, Kansas City, KS, USA; Office of the Dean, School of Health Professions, University of Kansas Medical Center, Kansas City, KS, USA.
| | - Hannes Devos
- Department of Physical Therapy and Rehabilitation Science, School of Health Professions, University of Kansas Medical Center, Kansas City, KS, USA.
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Lyons KE, Pahwa R, Hermanowicz N, Davis T, Pagan F, Isaacson S. Changing the treatment paradigm for Parkinson’s disease psychosis with pimavanserin. Expert Rev Clin Pharmacol 2019; 12:681-691. [DOI: 10.1080/17512433.2019.1623669] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Kelly E. Lyons
- Department of Neurology, University of Kansas Medical Center, Kansas City, KS, USA
| | - Rajesh Pahwa
- Department of Neurology, University of Kansas Medical Center, Kansas City, KS, USA
| | - Neal Hermanowicz
- Department of Neurology, University of California Irvine, Irvine, CA, USA
| | - Thomas Davis
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Fernando Pagan
- Department of Neurology, Georgetown University Medical Center, Washington, DC, USA
| | - Stuart Isaacson
- Parkinson’s Disease and Movement Disorders Center of Boca Raton, Boca Raton, FL, USA
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Ferreira JJ, Mestre TA, Lyons KE, Benito-León J, Tan EK, Abbruzzese G, Hallett M, Haubenberger D, Elble R, Deuschl G. MDS evidence-based review of treatments for essential tremor. Mov Disord 2019; 34:950-958. [PMID: 31046186 DOI: 10.1002/mds.27700] [Citation(s) in RCA: 78] [Impact Index Per Article: 15.6] [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: 12/15/2018] [Revised: 03/25/2019] [Accepted: 03/27/2019] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Essential tremor is one of the most prevalent movement disorders. Many treatments for essential tremor have been reported in clinical practice, but it is uncertain which options have the most robust evidence. The International Parkinson and Movement Disorder Society commissioned a task force on tremor to review clinical studies of treatments for essential tremor. OBJECTIVES To conduct an evidence-based review of current pharmacological and surgical treatments for essential tremor, using standardized criteria defined a priori by the International Parkinson and Movement Disorder Society. METHODS We followed the recommendations of the International Parkinson and Movement Disorder Society Evidence Based Medicine Committee. RESULTS Sixty-four studies of pharmacological and surgical interventions were included in the review. Propranolol and primidone were classified as clinically useful, similar to Topiramate, but only for doses higher than 200 mg/day. Alprazolam and botulinum toxin type A were classified as possibly useful. Unilateral Ventralis intermedius thalamic DBS, radiofrequency thalamotomy, and MRI-guided focused ultrasound thalamotomy were considered possibly useful. All the above recommendations were made for limb tremor in essential tremor. There was insufficient evidence for voice and head tremor as well as for the remaining interventions. CONCLUSION Propranolol, primidone, and topiramate (>200 mg/day) are the pharmacological interventions in which the data reviewed robustly supported efficacy. Their safety profile and patient preference may guide the prioritization of these interventions in clinical practice. MRI-guided focused ultrasound thalamotomy was, for the first time, assessed and was considered to be possibly useful. There is a need to improve study design in essential tremor and overcome the limitation of small sample sizes, cross-over studies, short-term follow-up studies, and use of nonvalidated clinical scales. © 2019 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Joaquim J Ferreira
- Instituto de Medicina Molecular, Faculty of Medicine, University of Lisbon, Portugal.,CNS-Campus Neurológico Sénior, Torres Vedras, Portugal
| | - Tiago A Mestre
- Parkinson's Disease and Movement Disorders Center, Division of Neurology, Department of Medicine, The Ottawa Hospital Research Institute, Brain and Mind Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Kelly E Lyons
- Parkinson's Disease and Movement Disorder Center, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Julián Benito-León
- Department of Neurology, University Hospital 12 de Octubre; Center of Biomedical Network Research on Neurodegenerative diseases (CIBERNED), Department of Medicine, Faculty of Medicine, Complutense University, Madrid, Spain
| | - Eng-King Tan
- National Neuroscience Institute, Duke NUS Medical School, Singapore
| | - Giovanni Abbruzzese
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal Child Health, University of Genoa-IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Mark Hallett
- Motor Control Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland, USA
| | - Dietrich Haubenberger
- Clinical Trials Unit, Office of the Clinical Director, National Institutes of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland, USA
| | - Rodger Elble
- Department of Neurology, Southern Illinois University School of Medicine, Springfield, Illinois, USA
| | - Günther Deuschl
- Department of Neurology, Universitätsklinikum Schleswig-Holstein, Kiel Campus, Christian Albrechts University Kiel, Kiel, Germany
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Sharma VD, Lyons KE, Nazzaro JM, Pahwa R. Deep brain stimulation of the subthalamic nucleus in Parkinson's disease patients over 75 years of age. J Neurol Sci 2019; 399:57-60. [DOI: 10.1016/j.jns.2019.02.019] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2018] [Revised: 02/08/2019] [Accepted: 02/10/2019] [Indexed: 11/30/2022]
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Affiliation(s)
- Khashayar Dashtipour
- Department of Neurology, Loma Linda University School of Medicine, Loma Linda, CA, USA
| | - Ali R. Tafreshi
- Department of Neurology, Loma Linda University School of Medicine, Loma Linda, CA, USA
- Department of Neurological Surgery, Keck School of Medicine of USC, Los Angeles, CA, USA
| | - Rajesh Pahwa
- Department of Neurology, University of Kansas Medical Center, Kansas City, KS, USA
| | - Kelly E. Lyons
- Department of Neurology, University of Kansas Medical Center, Kansas City, KS, USA
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Parashos SA, Bloem BR, Browner NM, Giladi N, Gurevich T, Hausdorff JM, He Y, Lyons KE, Mari Z, Morgan JC, Post B, Schmidt PN, Wielinski CL. What predicts falls in Parkinson disease?: Observations from the Parkinson's Foundation registry. Neurol Clin Pract 2018; 8:214-222. [PMID: 30105161 PMCID: PMC6075989 DOI: 10.1212/cpj.0000000000000461] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Accepted: 03/27/2018] [Indexed: 12/20/2022]
Abstract
BACKGROUND We undertook this study to identify patients with Parkinson disease (PD) with no or rare falls who may progress to frequent falling by their next annual follow-up visit. METHODS We analyzed data in the National Parkinson Foundation Quality Improvement Initiative database to identify factors predicting which patients with PD with no or rare falls at the baseline visit will report at least monthly falls at the annual follow-up visit. Multivariable models were constructed using logistic regression. Variables were introduced in 4 blocks: in the 1st block, variables present at or before the baseline visit were entered; in the 2nd, baseline visit assessments; in the 3rd, interventions implemented during baseline visit; and, in the 4th block, changes in comorbidities, living situation, and treatment between visits. RESULTS Of 3,795 eligible participants, 3,276 (86.3%) reported no or rare falls at baseline visit, and of them, 382 (11.7%) reported at least monthly falls at follow-up visit. Predictors included female sex, <90% diagnostic certainty, motor fluctuations, levodopa treatment, antidepressant treatment, prior deep brain stimulation (DBS), worse quality of life, Hoehn & Yahr stage 2 or 3, worse semantic fluency, and, between visits, addition of amantadine, referral to occupational therapy, social services, or DBS, new diagnoses of cancer or osteoarthritis, and increased emergency visits. CONCLUSIONS This large-scale analysis identified several predictors of progression to falling in PD. Such identifiers may help target patient subgroups for falls prevention intervention. Some factors are modifiable, offering opportunities for developing such interventions.
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Affiliation(s)
- Sotirios A Parashos
- Struthers Parkinson's Center (SAP, CLW), HealthPartners, Golden Valley, MN; Parkinson Center Nijmegen (BRB, BP), Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Center, Department of Neurology, the Netherlands; Department of Neurology (NMB), University of North Carolina at Chapel Hill; Neurological Institute (NG, TG, JMH), Tel Aviv Sourasky Medical Center, Sackler School of Medicine, and Sagol School of Neuroscience, Tel-Aviv University, Israel; Department of Mathematics (YH), Clarkson University, Potsdam, NY; University of Kansas Medical Center Parkinson's Disease Center (KEL), Kansas City; Department of Neurology (ZM), Johns Hopkins University, Baltimore, MD, currently at Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas, NV; Movement Disorders Program (JCM), NPF Center of Excellence, Department of Neurology, Medical College of Georgia, Augusta University; Parkinson's Foundation (PNS), Miami, FL; and Department of Biostatistics (SSW), University of Florida, Gainesville
| | - Bastiaan R Bloem
- Struthers Parkinson's Center (SAP, CLW), HealthPartners, Golden Valley, MN; Parkinson Center Nijmegen (BRB, BP), Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Center, Department of Neurology, the Netherlands; Department of Neurology (NMB), University of North Carolina at Chapel Hill; Neurological Institute (NG, TG, JMH), Tel Aviv Sourasky Medical Center, Sackler School of Medicine, and Sagol School of Neuroscience, Tel-Aviv University, Israel; Department of Mathematics (YH), Clarkson University, Potsdam, NY; University of Kansas Medical Center Parkinson's Disease Center (KEL), Kansas City; Department of Neurology (ZM), Johns Hopkins University, Baltimore, MD, currently at Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas, NV; Movement Disorders Program (JCM), NPF Center of Excellence, Department of Neurology, Medical College of Georgia, Augusta University; Parkinson's Foundation (PNS), Miami, FL; and Department of Biostatistics (SSW), University of Florida, Gainesville
| | - Nina M Browner
- Struthers Parkinson's Center (SAP, CLW), HealthPartners, Golden Valley, MN; Parkinson Center Nijmegen (BRB, BP), Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Center, Department of Neurology, the Netherlands; Department of Neurology (NMB), University of North Carolina at Chapel Hill; Neurological Institute (NG, TG, JMH), Tel Aviv Sourasky Medical Center, Sackler School of Medicine, and Sagol School of Neuroscience, Tel-Aviv University, Israel; Department of Mathematics (YH), Clarkson University, Potsdam, NY; University of Kansas Medical Center Parkinson's Disease Center (KEL), Kansas City; Department of Neurology (ZM), Johns Hopkins University, Baltimore, MD, currently at Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas, NV; Movement Disorders Program (JCM), NPF Center of Excellence, Department of Neurology, Medical College of Georgia, Augusta University; Parkinson's Foundation (PNS), Miami, FL; and Department of Biostatistics (SSW), University of Florida, Gainesville
| | - Nir Giladi
- Struthers Parkinson's Center (SAP, CLW), HealthPartners, Golden Valley, MN; Parkinson Center Nijmegen (BRB, BP), Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Center, Department of Neurology, the Netherlands; Department of Neurology (NMB), University of North Carolina at Chapel Hill; Neurological Institute (NG, TG, JMH), Tel Aviv Sourasky Medical Center, Sackler School of Medicine, and Sagol School of Neuroscience, Tel-Aviv University, Israel; Department of Mathematics (YH), Clarkson University, Potsdam, NY; University of Kansas Medical Center Parkinson's Disease Center (KEL), Kansas City; Department of Neurology (ZM), Johns Hopkins University, Baltimore, MD, currently at Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas, NV; Movement Disorders Program (JCM), NPF Center of Excellence, Department of Neurology, Medical College of Georgia, Augusta University; Parkinson's Foundation (PNS), Miami, FL; and Department of Biostatistics (SSW), University of Florida, Gainesville
| | - Tanya Gurevich
- Struthers Parkinson's Center (SAP, CLW), HealthPartners, Golden Valley, MN; Parkinson Center Nijmegen (BRB, BP), Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Center, Department of Neurology, the Netherlands; Department of Neurology (NMB), University of North Carolina at Chapel Hill; Neurological Institute (NG, TG, JMH), Tel Aviv Sourasky Medical Center, Sackler School of Medicine, and Sagol School of Neuroscience, Tel-Aviv University, Israel; Department of Mathematics (YH), Clarkson University, Potsdam, NY; University of Kansas Medical Center Parkinson's Disease Center (KEL), Kansas City; Department of Neurology (ZM), Johns Hopkins University, Baltimore, MD, currently at Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas, NV; Movement Disorders Program (JCM), NPF Center of Excellence, Department of Neurology, Medical College of Georgia, Augusta University; Parkinson's Foundation (PNS), Miami, FL; and Department of Biostatistics (SSW), University of Florida, Gainesville
| | - Jeffrey M Hausdorff
- Struthers Parkinson's Center (SAP, CLW), HealthPartners, Golden Valley, MN; Parkinson Center Nijmegen (BRB, BP), Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Center, Department of Neurology, the Netherlands; Department of Neurology (NMB), University of North Carolina at Chapel Hill; Neurological Institute (NG, TG, JMH), Tel Aviv Sourasky Medical Center, Sackler School of Medicine, and Sagol School of Neuroscience, Tel-Aviv University, Israel; Department of Mathematics (YH), Clarkson University, Potsdam, NY; University of Kansas Medical Center Parkinson's Disease Center (KEL), Kansas City; Department of Neurology (ZM), Johns Hopkins University, Baltimore, MD, currently at Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas, NV; Movement Disorders Program (JCM), NPF Center of Excellence, Department of Neurology, Medical College of Georgia, Augusta University; Parkinson's Foundation (PNS), Miami, FL; and Department of Biostatistics (SSW), University of Florida, Gainesville
| | - Ying He
- Struthers Parkinson's Center (SAP, CLW), HealthPartners, Golden Valley, MN; Parkinson Center Nijmegen (BRB, BP), Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Center, Department of Neurology, the Netherlands; Department of Neurology (NMB), University of North Carolina at Chapel Hill; Neurological Institute (NG, TG, JMH), Tel Aviv Sourasky Medical Center, Sackler School of Medicine, and Sagol School of Neuroscience, Tel-Aviv University, Israel; Department of Mathematics (YH), Clarkson University, Potsdam, NY; University of Kansas Medical Center Parkinson's Disease Center (KEL), Kansas City; Department of Neurology (ZM), Johns Hopkins University, Baltimore, MD, currently at Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas, NV; Movement Disorders Program (JCM), NPF Center of Excellence, Department of Neurology, Medical College of Georgia, Augusta University; Parkinson's Foundation (PNS), Miami, FL; and Department of Biostatistics (SSW), University of Florida, Gainesville
| | - Kelly E Lyons
- Struthers Parkinson's Center (SAP, CLW), HealthPartners, Golden Valley, MN; Parkinson Center Nijmegen (BRB, BP), Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Center, Department of Neurology, the Netherlands; Department of Neurology (NMB), University of North Carolina at Chapel Hill; Neurological Institute (NG, TG, JMH), Tel Aviv Sourasky Medical Center, Sackler School of Medicine, and Sagol School of Neuroscience, Tel-Aviv University, Israel; Department of Mathematics (YH), Clarkson University, Potsdam, NY; University of Kansas Medical Center Parkinson's Disease Center (KEL), Kansas City; Department of Neurology (ZM), Johns Hopkins University, Baltimore, MD, currently at Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas, NV; Movement Disorders Program (JCM), NPF Center of Excellence, Department of Neurology, Medical College of Georgia, Augusta University; Parkinson's Foundation (PNS), Miami, FL; and Department of Biostatistics (SSW), University of Florida, Gainesville
| | - Zoltan Mari
- Struthers Parkinson's Center (SAP, CLW), HealthPartners, Golden Valley, MN; Parkinson Center Nijmegen (BRB, BP), Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Center, Department of Neurology, the Netherlands; Department of Neurology (NMB), University of North Carolina at Chapel Hill; Neurological Institute (NG, TG, JMH), Tel Aviv Sourasky Medical Center, Sackler School of Medicine, and Sagol School of Neuroscience, Tel-Aviv University, Israel; Department of Mathematics (YH), Clarkson University, Potsdam, NY; University of Kansas Medical Center Parkinson's Disease Center (KEL), Kansas City; Department of Neurology (ZM), Johns Hopkins University, Baltimore, MD, currently at Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas, NV; Movement Disorders Program (JCM), NPF Center of Excellence, Department of Neurology, Medical College of Georgia, Augusta University; Parkinson's Foundation (PNS), Miami, FL; and Department of Biostatistics (SSW), University of Florida, Gainesville
| | - John C Morgan
- Struthers Parkinson's Center (SAP, CLW), HealthPartners, Golden Valley, MN; Parkinson Center Nijmegen (BRB, BP), Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Center, Department of Neurology, the Netherlands; Department of Neurology (NMB), University of North Carolina at Chapel Hill; Neurological Institute (NG, TG, JMH), Tel Aviv Sourasky Medical Center, Sackler School of Medicine, and Sagol School of Neuroscience, Tel-Aviv University, Israel; Department of Mathematics (YH), Clarkson University, Potsdam, NY; University of Kansas Medical Center Parkinson's Disease Center (KEL), Kansas City; Department of Neurology (ZM), Johns Hopkins University, Baltimore, MD, currently at Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas, NV; Movement Disorders Program (JCM), NPF Center of Excellence, Department of Neurology, Medical College of Georgia, Augusta University; Parkinson's Foundation (PNS), Miami, FL; and Department of Biostatistics (SSW), University of Florida, Gainesville
| | - Bart Post
- Struthers Parkinson's Center (SAP, CLW), HealthPartners, Golden Valley, MN; Parkinson Center Nijmegen (BRB, BP), Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Center, Department of Neurology, the Netherlands; Department of Neurology (NMB), University of North Carolina at Chapel Hill; Neurological Institute (NG, TG, JMH), Tel Aviv Sourasky Medical Center, Sackler School of Medicine, and Sagol School of Neuroscience, Tel-Aviv University, Israel; Department of Mathematics (YH), Clarkson University, Potsdam, NY; University of Kansas Medical Center Parkinson's Disease Center (KEL), Kansas City; Department of Neurology (ZM), Johns Hopkins University, Baltimore, MD, currently at Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas, NV; Movement Disorders Program (JCM), NPF Center of Excellence, Department of Neurology, Medical College of Georgia, Augusta University; Parkinson's Foundation (PNS), Miami, FL; and Department of Biostatistics (SSW), University of Florida, Gainesville
| | - Peter N Schmidt
- Struthers Parkinson's Center (SAP, CLW), HealthPartners, Golden Valley, MN; Parkinson Center Nijmegen (BRB, BP), Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Center, Department of Neurology, the Netherlands; Department of Neurology (NMB), University of North Carolina at Chapel Hill; Neurological Institute (NG, TG, JMH), Tel Aviv Sourasky Medical Center, Sackler School of Medicine, and Sagol School of Neuroscience, Tel-Aviv University, Israel; Department of Mathematics (YH), Clarkson University, Potsdam, NY; University of Kansas Medical Center Parkinson's Disease Center (KEL), Kansas City; Department of Neurology (ZM), Johns Hopkins University, Baltimore, MD, currently at Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas, NV; Movement Disorders Program (JCM), NPF Center of Excellence, Department of Neurology, Medical College of Georgia, Augusta University; Parkinson's Foundation (PNS), Miami, FL; and Department of Biostatistics (SSW), University of Florida, Gainesville
| | - Catherine L Wielinski
- Struthers Parkinson's Center (SAP, CLW), HealthPartners, Golden Valley, MN; Parkinson Center Nijmegen (BRB, BP), Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Center, Department of Neurology, the Netherlands; Department of Neurology (NMB), University of North Carolina at Chapel Hill; Neurological Institute (NG, TG, JMH), Tel Aviv Sourasky Medical Center, Sackler School of Medicine, and Sagol School of Neuroscience, Tel-Aviv University, Israel; Department of Mathematics (YH), Clarkson University, Potsdam, NY; University of Kansas Medical Center Parkinson's Disease Center (KEL), Kansas City; Department of Neurology (ZM), Johns Hopkins University, Baltimore, MD, currently at Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas, NV; Movement Disorders Program (JCM), NPF Center of Excellence, Department of Neurology, Medical College of Georgia, Augusta University; Parkinson's Foundation (PNS), Miami, FL; and Department of Biostatistics (SSW), University of Florida, Gainesville
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27
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Abstract
Levodopa-induced dyskinesia (LID) is a common motor complication in patients with Parkinson's disease on chronic levodopa therapy. The management of LID is important as dyskinesia can be disabling and impair quality of life. Currently, there are limited treatment options for the medical management of LID. Amantadine extended-release capsules (Gocovri™) is the first medication that received US Food and Drug Administration approval for the treatment of LID. The following is a review of the pharmacodynamics, efficacy and safety profile, and current state of treatment of amantadine for LID.
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Affiliation(s)
- Vibhash D Sharma
- Department of Neurology, University of Kansas Medical Center, Kansas City, KS, USA
| | - Kelly E Lyons
- Department of Neurology, University of Kansas Medical Center, Kansas City, KS, USA
| | - Rajesh Pahwa
- Department of Neurology, University of Kansas Medical Center, Kansas City, KS, USA
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Kahya M, Moon S, Lyons KE, Pahwa R, Akinwuntan AE, Devos H. Pupillary Response to Cognitive Demand in Parkinson's Disease: A Pilot Study. Front Aging Neurosci 2018; 10:90. [PMID: 29692720 PMCID: PMC5902496 DOI: 10.3389/fnagi.2018.00090] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Accepted: 03/19/2018] [Indexed: 12/21/2022] Open
Abstract
Previous studies have shown that pupillary response, a physiological measure of cognitive workload, reflects cognitive demand in healthy younger and older adults. However, the relationship between cognitive workload and cognitive demand in Parkinson's disease (PD) remains unclear. The aim of this pilot study was to examine the pupillary response to cognitive demand in a letter-number sequencing (LNS) task between 16 non-demented individuals with PD (age, median (Q1-Q3): 68 (62-72); 10 males) and 10 control participants (age: 63 (59-67); 2 males), matched for age, education, and Montreal Cognitive Assessment (MOCA) scores. A mixed model analysis was employed to investigate cognitive workload changes as a result of incremental cognitive demand for both groups. As expected, no differences were found in cognitive scores on the LNS between groups. Cognitive workload, exemplified by greater pupil dilation, increased with incremental cognitive demand in both groups (p = 0.003). No significant between-group (p = 0.23) or interaction effects were found (p = 0.45). In addition, individuals who achieved to complete the task at higher letter-number (LN) load responded differently to increased cognitive demand compared with those who completed at lower LN load (p < 0.001), regardless of disease status. Overall, the findings indicated that pupillary response reflects incremental cognitive demand in non-demented people with PD and healthy controls. Further research is needed to investigate the pupillary response to incremental cognitive demand of PD patients with dementia compared to non-demented PD and healthy controls. Highlights -Pupillary response reflects cognitive demand in both non-demented people with PD and healthy controls-Although not significant due to insufficient power, non-demented individuals with PD had increased cognitive workload compared to the healthy controls throughout the testing-Pupillary response may be a valid measure of cognitive demand in non-demented individuals with PD-In future, pupillary response might be used to detect cognitive impairment in individuals with PD.
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Affiliation(s)
- Melike Kahya
- Laboratory for Advanced Rehabilitation Research in Simulation, Department of Physical Therapy and Rehabilitation Science, School of Health Professions, University of Kansas Medical Center, Kansas City, KS, United States
| | - Sanghee Moon
- Laboratory for Advanced Rehabilitation Research in Simulation, Department of Physical Therapy and Rehabilitation Science, School of Health Professions, University of Kansas Medical Center, Kansas City, KS, United States
| | - Kelly E Lyons
- Department of Neurology, School of Medicine, University of Kansas Medical Center, Kansas City, KS, United States
| | - Rajesh Pahwa
- Department of Neurology, School of Medicine, University of Kansas Medical Center, Kansas City, KS, United States
| | - Abiodun E Akinwuntan
- Laboratory for Advanced Rehabilitation Research in Simulation, Department of Physical Therapy and Rehabilitation Science, School of Health Professions, University of Kansas Medical Center, Kansas City, KS, United States.,Office of the Dean, School of Health Professions, University of Kansas Medical Center, Kansas City, KS, United States
| | - Hannes Devos
- Laboratory for Advanced Rehabilitation Research in Simulation, Department of Physical Therapy and Rehabilitation Science, School of Health Professions, University of Kansas Medical Center, Kansas City, KS, United States
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29
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Nazzaro JM, Pahwa R, Lyons KE. Symptomatic, non-infectious, non-hemorrhagic edema after subthalamic nucleus deep brain stimulation surgery for Parkinson's disease. J Neurol Sci 2017; 383:42-46. [PMID: 29246619 DOI: 10.1016/j.jns.2017.10.003] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2017] [Revised: 10/03/2017] [Accepted: 10/04/2017] [Indexed: 11/17/2022]
Abstract
OBJECT We review our experience with Parkinson's disease (PD) patients who underwent subthalamic nucleus (STN) deep brain stimulation (DBS) and then developed noninfectious, non-hemorrhagic, delayed, symptomatic brain edema associated with a DBS lead. METHODS All PD patients who underwent STN DBS lead implantation from 2007 to 2015 were included. The same neurosurgeon performed all surgeries, typically in staged fashion, utilizing single pass microelectrode recordings (MER) within a stereotactic frame. A brain CT was obtained in recovery and subsequently if indicated. RESULTS There were 189 patients who underwent 363 STN lead implantations among which 35 (9.6%) represent re-implantations of removed leads in 28 (14.8%) patients. Among the 363 STN leads implanted, there were 12 (3.3%) cases of delayed symptomatic edema associated with a DBS lead involving 10 (5.3%) of the patients studied. Of the 328 leads representing first-time operations, there were 9 (2.1%) cases of delayed symptomatic edema in 7 (3.7%) patients, one of whom (14.3%) presented with seizures. For lead re-implantations, there were 3 (8.6%) cases of the brain edema in 3 (10.7%) patients; all presenting with seizures. For the 35 re-implantations, the trajectory to target was the same or very similar via the same burr hole as prior surgery in 17 (48.6%); 3 (17.6%) of whom developed edema. There was no case of brain edema in the 18 re-operated cases using a different burr opening. Edema patients were treated with a course of anticonvulsant medication and dexamethasone. Lead-associated edema resolved over generally a 4 to 6-week course. CONCLUSIONS Noninfectious, non-hemorrhagic, delayed, symptomatic brain edema occurs in approximately 3% of implanted leads and is more common in re-implantations (9%) compared to new implantations (2%). In re-implantations, the edema is more common when the same trajectory is used (18%) compared to a new trajectory (0%). The edema generally occurs 3 to 8 days after implantation, although immediate post-op CT is normal and seizures are a common presenting feature.
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Affiliation(s)
- Jules M Nazzaro
- Department of Neurosurgery, University of Kansas Medical Center, Kansas City, KS, USA.
| | - Rajesh Pahwa
- Department of Neurology, University of Kansas Medical Center, Kansas City, KS, USA
| | - Kelly E Lyons
- Department of Neurology, University of Kansas Medical Center, Kansas City, KS, USA
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Pahwa R, Tanner CM, Hauser RA, Isaacson SH, Nausieda PA, Truong DD, Agarwal P, Hull KL, Lyons KE, Johnson R, Stempien MJ. ADS-5102 (Amantadine) Extended-Release Capsules for Levodopa-Induced Dyskinesia in Parkinson Disease (EASE LID Study): A Randomized Clinical Trial. JAMA Neurol 2017; 74:941-949. [PMID: 28604926 DOI: 10.1001/jamaneurol.2017.0943] [Citation(s) in RCA: 122] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Medical treatment of levodopa-induced dyskinesia (LID) in Parkinson disease (PD) is an unmet need. Objective To evaluate the efficacy and safety of ADS-5102 (amantadine) extended-release 274-mg capsules for treatment of LID in patients with PD. Design, Setting, and Participants A randomized, double-blind, placebo-controlled clinical trial was conducted between May 7, 2014, and July 22, 2015, at 44 North American sites among patients with PD treated with levodopa who experienced at least 1 hour of troublesome dyskinesia per day with at least mild functional impact. Interventions Patients were randomized to receive placebo or 274 mg of ADS-5102 administered orally at bedtime for up to 25 weeks. Main Outcomes and Measures The primary efficacy analysis was the change from baseline to week 12 in the Unified Dyskinesia Rating Scale total score for ADS-5102 vs placebo in the modified intent-to-treat population. OFF time (amount of time the PD medication is not controlling motor symptoms) was a key secondary end point. Safety analyses included all patients who received the study drug (ADS-5102 or placebo). Results A total of 189 patients were screened, and 126 were randomized; the modified intent-to-treat population included 121 patients (51 women and 70 men; mean [SD] age, 64.7 [9.1] years). At week 12, the least-squares mean (SE) change in the Unified Dyskinesia Rating Scale score was -15.9 (1.6) for ADS-5102 (n = 63) and -8.0 (1.6) for placebo (n = 58) (treatment difference, -7.9; 95% CI, -12.5 to -3.3; P < .001). OFF time decreased by a mean (SE) of 0.6 (0.3) hours for ADS-5102 and increased by 0.3 (0.3) hours for placebo (treatment difference, -0.9 hours; 95% CI, -1.6 to -0.2; P = .02). Common adverse events for ADS-5102 vs placebo included visual hallucinations (15 [23.8%] vs 1 [1.7%]), peripheral edema (15 [23.8%] vs 0), and dizziness (14 [22.2%] vs 0). Adverse events led to treatment discontinuation for 13 patients receiving ADS-5102 (20.6%) vs 4 patients receiving placebo (6.9%). Conclusions and Relevance ADS-5102, 274 mg at bedtime, may be an effective treatment for LID. An additional benefit is reduced OFF time. To our knowledge, this is the first demonstration of an oral treatment reducing both LID and OFF time in patients with PD with dyskinesia. Trial Registration clinicaltrials.gov Identifier: NCT02136914.
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Affiliation(s)
- Rajesh Pahwa
- Department of Neurology, University of Kansas Medical Center, Kansas City
| | - Caroline M Tanner
- Department of Neurology, University California-San Francisco.,Parkinson's Disease Research, Education and Clinic Center, San Francisco Veterans Affairs Medical Center, San Francisco, California
| | - Robert A Hauser
- Health Byrd Parkinson's Disease and Movement Disorders Center of Excellence, University of South Florida, Tampa
| | - Stuart H Isaacson
- Parkinson's Disease and Movement Disorders Center of Boca Raton, Boca Raton, Florida
| | - Paul A Nausieda
- Wisconsin Institute for Neurologic and Sleep Disorders, Milwaukee
| | - Daniel D Truong
- The Parkinson's and Movement Disorder Institute, Fountain Valley, California
| | - Pinky Agarwal
- Booth Gardner Parkinson's Care Center, Evergreen Health, Kirkland, Washington
| | - Keith L Hull
- Raleigh Neurology Associates, Raleigh, North Carolina
| | - Kelly E Lyons
- Department of Neurology, University of Kansas Medical Center, Kansas City
| | - Reed Johnson
- Adamas Pharmaceuticals Inc, Emeryville, California
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31
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Perez‐Lloret S, Ciampi de Andrade D, Lyons KE, Rodríguez‐Blázquez C, Chaudhuri KR, Deuschl G, Cruccu G, Sampaio C, Goetz CG, Schrag A, Martinez‐Martin P, Stebbins G. Rating Scales for Pain in Parkinson's Disease: Critique and Recommendations. Mov Disord Clin Pract 2016; 3:527-537. [PMID: 30363588 PMCID: PMC6178703 DOI: 10.1002/mdc3.12384] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Revised: 03/18/2016] [Accepted: 03/23/2016] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND We aimed at critically appraising the clinimetric properties of existing pain scales or questionnaires and to give recommendations for their use in Parkinson's disease (PD). METHODS Clinimetric properties of pain scales used in PD were systematically evaluated. A scale was classified as 'recommended' if was used in PD, showed adequate clinimetric properties, and had been used by investigators other than the original developers; as 'suggested' if it was used in PD and fulfilled only one other criterion; and as 'listed' if it was used in PD but did not meet the other criteria. Only scales rating pain intensity or for syndromic classification were assessed. RESULTS Eleven of the 34 scales initially considered fulfilled inclusion criteria. Among the scales rating pain intensity, the "Brief Pain Inventory short form," "McGill Pain Questionnaire short and long forms," "Neuropathic Pain Symptoms Inventory," "11-point Numeric Rating Scale," "10-cm Visual Analog Scale," and "Pain-O-Meter" were "recommended with caution" because of lack of clinimetric data in PD, whereas the "King's PD Pain Scale" was "recommended." Among scales for pain syndromic classification, the "DN4" was "recommended with caution" because of lack of clinimetric data in PD; the "Leeds Assessment of Neuropathic Symptoms and Signs," "Pain-DETECT," and the "King's PD Pain Scale" were "suggested." CONCLUSIONS King's PD pain scale can be recommended for the assessment of pain intensity in PD. Syndromic classification of pain in PD may be achieved by the DN4, but clinimetric data in PD are needed for this scale.
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Affiliation(s)
- Santiago Perez‐Lloret
- Institute of Cardiology ResearchUniversity of Buenos Aires, National Research Council (CONICET‐ININCA)Buenos AiresArgentina
| | - Daniel Ciampi de Andrade
- Centro de DorDepartamento de Neurologia da Faculdade de Medicina daUniversidade de São PauloSão PauloBrazil
- Instituto do Câncer de São Paulo Octavio Frias de OliveiraSão PauloBrazil
- Hospital das ClínicasUniversidade de São PauloSão PauloBrazil
| | | | - Carmen Rodríguez‐Blázquez
- Carlos III Institute of HealthNational Centre of Epidemiology and Centre for Networked Biomedical Research on Neurodegenerative Diseases (CIBERNED)MadridSpain
| | - Kallol Ray Chaudhuri
- National Parkinson Foundation International Center of ExcellenceKing's College Hospital NHS Foundation TrustLondonUnited Kingdom
- King's College LondonLondonUnited Kingdom
| | - Guenther Deuschl
- Department of NeurologyChristian‐Albrechts UniversityKielGermany
| | - Girgio Cruccu
- Department of Neurology and PsychiatrySapienza UniversityRomeItaly
| | | | - Christopher G. Goetz
- Department of Neurological SciencesRush University Medical CenterChicagoIllinoisUSA
| | - Anette Schrag
- Department of Clinical NeurosciencesUCL Institute of NeurologyLondonUnited Kingdom
| | - Pablo Martinez‐Martin
- Carlos III Institute of HealthNational Centre of Epidemiology and Centre for Networked Biomedical Research on Neurodegenerative Diseases (CIBERNED)MadridSpain
| | - Glenn Stebbins
- Department of Neurological SciencesRush University Medical CenterChicagoIllinoisUSA
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32
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Smith KA, Pahwa R, Lyons KE, Nazzaro JM. Deep brain stimulation for Parkinson's disease: current status and future outlook. Neurodegener Dis Manag 2016; 6:299-317. [DOI: 10.2217/nmt-2016-0012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Parkinson's disease is a neurodegenerative condition secondary to loss of dopaminergic neurons in the substantia nigra pars compacta. Surgical therapy serves as an adjunct when unwanted medication side effects become apparent or additional therapy is needed. Deep brain stimulation emerged into the forefront in the 1990s. Studies have demonstrated improvement in all of the cardinal parkinsonian signs with stimulation. Frameless and ‘mini-frame’ stereotactic systems, improved MRI for anatomic visualization, and intraoperative MRI-guided placement are a few of the surgical advances in deep brain stimulation. Other advances include rechargeable pulse generators, voltage- or current-based stimulation, and enhanced abilities to ‘steer’ stimulation. Work is ongoing investigating closed-loop ‘smart’ stimulation in which stimulation is predicated on neuronal feedback.
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Affiliation(s)
- Kyle A Smith
- Department of Neurosurgery, University of Kansas Medical Center, 3901 Rainbow Blvd, Mailstop 3021, Kansas City, KS 66160, USA
| | - Rajesh Pahwa
- Department of Neurology, University of Kansas Medical Center, Kansas City, KS 66160, USA
| | - Kelly E Lyons
- Department of Neurology, University of Kansas Medical Center, Kansas City, KS 66160, USA
| | - Jules M Nazzaro
- Department of Neurosurgery, University of Kansas Medical Center, 3901 Rainbow Blvd, Mailstop 3021, Kansas City, KS 66160, USA
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34
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Haubenberger D, Abbruzzese G, Bain PG, Bajaj N, Benito-León J, Bhatia KP, Deuschl G, Forjaz MJ, Hallett M, Louis ED, Lyons KE, Mestre TA, Raethjen J, Stamelou M, Tan EK, Testa CM, Elble RJ. Transducer-based evaluation of tremor. Mov Disord 2016; 31:1327-36. [PMID: 27273470 DOI: 10.1002/mds.26671] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Revised: 04/04/2016] [Accepted: 04/07/2016] [Indexed: 11/11/2022] Open
Abstract
The International Parkinson and Movement Disorder Society established a task force on tremor that reviewed the use of transducer-based measures in the quantification and characterization of tremor. Studies of accelerometry, electromyography, activity monitoring, gyroscopy, digitizing tablet-based measures, vocal acoustic analysis, and several other transducer-based methods were identified by searching PubMed.gov. The availability, use, acceptability, reliability, validity, and responsiveness were reviewed for each measure using the following criteria: (1) used in the assessment of tremor; (2) used in published studies by people other than the developers; and (3) adequate clinimetric testing. Accelerometry, gyroscopy, electromyography, and digitizing tablet-based measures fulfilled all three criteria. Compared to rating scales, transducers are far more sensitive to changes in tremor amplitude and frequency, but they do not appear to be more capable of detecting a change that exceeds random variability in tremor amplitude (minimum detectable change). The use of transducer-based measures requires careful attention to their limitations and validity in a particular clinical or research setting. © 2016 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Dietrich Haubenberger
- Clinical Trials Unit, Office of the Clinical Director, National Institutes of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland, USA.
| | | | - Peter G Bain
- Department of Neurology, Imperial College London, Charing Cross Hospital, London, United Kingdom
| | - Nin Bajaj
- Department of Neurology, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
| | - Julián Benito-León
- Department of Neurology, University Hospital "12 de Octubre", Madrid, Spain.,Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain.,Department of Medicine, Complutense University, Madrid, Spain
| | - Kailash P Bhatia
- Sobell Department for Movement Neuroscience, UCL, Institute of Neurology, Queen Square, London, United Kingdom
| | - Günther Deuschl
- Department of Neurology, Christian-Albrechts-University Kiel, Kiel, Germany
| | - Maria João Forjaz
- National School of Public Health and Red de Investigación en Servicios Sanitarios y Enfermedades Crónicas (REDISSEC), Carlos III Institute of Health, Madrid, Spain
| | - Mark Hallett
- Human Motor Control Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland, USA
| | - Elan D Louis
- Departments of Neurology and Chronic Disease Epidemiology, Yale School of Medicine and Yale School of Public Health, Yale University, New Haven, Connecticut, USA
| | - Kelly E Lyons
- University of Kansas Medical Center, Kansas City, Kansas
| | - Tiago A Mestre
- Parkinson's disease and Movement Disorders Center, Division of Neurology, Department of Medicine, University of Ottawa, The Ottawa Hospital Research Institute, Ottawa Brain and Mind Research Institute, Ottawa, Ontario, Canada
| | - Jan Raethjen
- Department of Neurology, Christian-Albrechts-University Kiel, Kiel, Germany
| | - Maria Stamelou
- Neurology Department, University of Athens, Greece and Neurology Department, Philipps University, Marburg, Germany
| | - Eng-King Tan
- Department of Neurology, National Neuroscience Institute (SGH campus), Duke NUS Medical School, Singapore General Hospital, Singapore
| | - Claudia M Testa
- Department of Neurology and Parkinson's and Movement Disorders Center, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Rodger J Elble
- Department of Neurology, Southern Illinois University School of Medicine, Springfield, Illinois, USA
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McVey MA, Barnds AN, Lyons KE, Pahwa R, Mahnken JD, Luchies CW. The characterization of a base-width neutral step as the first step for balance recovery in moderate Parkinson's disease. Int J Neurosci 2015; 126:713-22. [PMID: 26371386 DOI: 10.3109/00207454.2015.1094472] [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] [Indexed: 11/13/2022]
Abstract
PURPOSE The purpose of this study is to characterize the base-width neutral step (BNS) as the first step in a compensatory step response in persons with moderate Parkinson's disease (PD), and its effect on balance recovery. MATERIALS AND METHODS Ten PD and 10 healthy controls (HCs) responded to a posterior waist pull. A BNS was defined if the first step was less than 50 mm. The length, height, duration and velocity of the BNS and its effect on balance recovery time and center of mass location at recovery were compared to the first step within other stepping strategies (single step (SS), multiple step (MS)). A linear mixed model was used to compare across strategies. RESULTS Six of ten persons with PD compared to zero HC used a BNS. The BNS was shorter in length and duration compared to MS responses in HC, and shorter in duration compared to MS responses in PD. The BNS was slower in velocity compared to every other strategy. BNS use resulted in a longer recovery time compared to all strategies in HC and SS responses in PD, and trended toward a longer recovery time compared to MS responses in PD. CONCLUSIONS The BNS as the first step in a MS response may be an unreported strategy for compensatory stepping in PD. This study suggests that the cost of utilizing the BNS may be a longer time for recovery, but further work is necessary to understand the progression of the BNS as PD severity increases.
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Affiliation(s)
- Molly A McVey
- a 1 Department of Mechanical Engineering , University of Kansas , Lawrence, Kansas , KS , USA
| | - Annaria N Barnds
- b 2 Bioengineering, University of Kansas , Lawrence, Kansas , KS , USA
| | - Kelly E Lyons
- c 3 Department of Neurology , University of Kansas Medical Center , Kansas City , KS , USA
| | - Rajesh Pahwa
- c 3 Department of Neurology , University of Kansas Medical Center , Kansas City , KS , USA
| | - Jonathan D Mahnken
- d 4 Department of Biostatistics , University of Kansas Medical Center , Kansas City , KS , USA
| | - Carl W Luchies
- a 1 Department of Mechanical Engineering , University of Kansas , Lawrence, Kansas , KS , USA.,b 2 Bioengineering, University of Kansas , Lawrence, Kansas , KS , USA
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Hopfner F, Nebel A, Lyons KE, Tröster AI, Kuhlenbäumer G, Deuschl G, Martinez-Martin P. Validation of the QUEST for German-speaking countries. Int J Neurosci 2015; 126:127-34. [PMID: 26327253 DOI: 10.3109/00207454.2015.1077241] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To explore the clinimetric attributes of the German version of the quality of life in essential tremor (ET) questionnaire (QUEST) as a tremor-specific measure of quality of life. METHODS This was an observational, cross-sectional study. The QUEST German version was obtained by translation-back translation procedure. ET cases were diagnosed according to the tremor investigation group criteria. Assessments included Archimedes spirals rating, EQ-5D, Beck Depression Inventory (BDI-II) and QUEST German version. Missing data were imputed for those cases in which the loss of data for one domain of the QUEST was <30%. RESULTS Ninety three patients out of 138 (67.4%) with definite or probable ET had complete QUEST data after 43 item imputations and they constituted the sample for this study. The QUEST summary index (QSI) displayed no floor or ceiling effects. QUEST internal consistency (Cronbach's alpha) ranged between 0.50 and 0.89. Item-total domain correlations ranged from 0.26 to 0.82 and the item homogeneity indexes were satisfactory (range: 0.28-0.60). The QSI correlated weakly with the EQ-5D (rS=0.20) and moderately with the BDI-II (rS = 0.31) and the QUEST self-evaluation of tremor severity (rS = 0.44). CONCLUSIONS The QUEST German version has, despite recognized data quality problems, satisfactory acceptability and internal consistency as a whole. The correlation analysis showed that tremor in the head, voice and right hand was moderately associated with quality of life.
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Affiliation(s)
- Franziska Hopfner
- a Department of Neurology , University Hospital Schleswig-Holstein , Campus Kiel , Kiel , Germany
| | - Adelheid Nebel
- a Department of Neurology , University Hospital Schleswig-Holstein , Campus Kiel , Kiel , Germany
| | - Kelly E Lyons
- b Department of Neurology , University of Kansas Medical Center , Kansas City , MO , USA
| | - Alexander I Tröster
- c Department of Clinical Neuropsychology and Center for Neuromodulation , Barrow Neurological Institute , Phoenix , AZ , USA
| | - Gregor Kuhlenbäumer
- a Department of Neurology , University Hospital Schleswig-Holstein , Campus Kiel , Kiel , Germany
| | - Günther Deuschl
- a Department of Neurology , University Hospital Schleswig-Holstein , Campus Kiel , Kiel , Germany
| | - Pablo Martinez-Martin
- d Area of Applied Epidemiology, National Center for Epidemiology, and CIBERNED , Carlos III Institute of Health , Madrid , Spain
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Jafari N, Pahwa R, Nazzaro JM, Arnold PM, Lyons KE. MDS-UPDRS to assess non-motor symptoms after STN DBS for Parkinson's disease. Int J Neurosci 2015; 126:25-9. [DOI: 10.3109/00207454.2015.1065257] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Gunduz A, Morita H, Rossi PJ, Allen WL, Alterman RL, Bronte-Stewart H, Butson CR, Charles D, Deckers S, de Hemptinne C, DeLong M, Dougherty D, Ellrich J, Foote KD, Giordano J, Goodman W, Greenberg BD, Greene D, Gross R, Judy JW, Karst E, Kent A, Kopell B, Lang A, Lozano A, Lungu C, Lyons KE, Machado A, Martens H, McIntyre C, Min HK, Neimat J, Ostrem J, Pannu S, Ponce F, Pouratian N, Reymers D, Schrock L, Sheth S, Shih L, Stanslaski S, Steinke GK, Stypulkowski P, Tröster AI, Verhagen L, Walker H, Okun MS. Proceedings of the Second Annual Deep Brain Stimulation Think Tank: What's in the Pipeline. Int J Neurosci 2015; 125:475-85. [PMID: 25526555 PMCID: PMC4743588 DOI: 10.3109/00207454.2014.999268] [Citation(s) in RCA: 14] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The proceedings of the 2nd Annual Deep Brain Stimulation Think Tank summarize the most contemporary clinical, electrophysiological, and computational work on DBS for the treatment of neurological and neuropsychiatric disease and represent the insights of a unique multidisciplinary ensemble of expert neurologists, neurosurgeons, neuropsychologists, psychiatrists, scientists, engineers and members of industry. Presentations and discussions covered a broad range of topics, including advocacy for DBS, improving clinical outcomes, innovations in computational models of DBS, understanding of the neurophysiology of Parkinson's disease (PD) and Tourette syndrome (TS) and evolving sensor and device technologies.
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Abstract
PURPOSE Parkinson's disease (PD) involves a variety of motor and non-motor symptoms, several of which, including gait abnormalities and sleep disorders, are generally not adequately managed with standard therapy. This study aimed to determine the impact of Qigong as a potential complementary therapy in the management of gait and sleep-related symptoms in PD. METHODS Seven subjects (aged 66.9 ± 8.1 years) with PD participated in a six-week Qigong exercise intervention. Pre- and post-intervention testing was performed to assess sleep quality, cognitive function, fatigue, quality of life, gait performance (stride time, stride length, double support time, and velocity), and gait variability (stride time and length variability). RESULTS Following Qigong, subjects showed improvement in some aspects of sleep quality. Fatigue remained unchanged. Gait function was improved by a significant reduction of stride time and a slight increase in stride length. Together these changes resulted in significant improvements to gait velocity. In addition, time spent in double limb support was reduced following the intervention. Overall gait variability improved significantly, particularly in the reduction of stride time variability. CONCLUSIONS These results suggest that Qigong may provide benefit for gait performance and sleep quality in PD patients. However, larger, controlled studies are required to determine the immediate and long-term benefits of Qigong for PD sleep and gait problems as well as the impact on other aspects of the disease.
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Affiliation(s)
- Derek J Wassom
- 1Department of Physical Therapy & Rehabilitation Sciences; and
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Guthikonda LN, Lyons KE, Pahwa R. Continuous infusion of levodopa-carbidopa intestinal gel in Parkinson's disease. J Comp Eff Res 2014; 3:331-3. [PMID: 25275230 DOI: 10.2217/cer.14.33] [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] [Indexed: 11/21/2022] Open
Abstract
Evaluation of: Olanow CW, Kieburtz K, Odin P et al. Continuous intrajejunal infusion of levodopa-carbidopa intestinal gel for patients with advanced Parkinson's disease: a randomised, controlled, double-blind, double-dummy study. Lancet Neurol. 13(2), 141-149 (2014). Levodopa-induced motor complications, including motor fluctuations and dyskinesia, can be a major source of disability for Parkinson's disease patients. The development of levodopa-induced motor complications has been attributed to the pulsatile dopaminergic stimulation characteristic of conventional oral levodopa regimens. This is a review of a 12-week, randomized, controlled, double-blind, double-dummy study of continuous jejunal infusion of levodopa-carbidopa intestinal gel to determine if the continuous infusion of levodopa reduces motor complications in Parkinson's disease. Results demonstrated that levodopa-carbidopa intestinal gel significantly reduced off-time without increasing troublesome dyskinesia compared with standard oral levodopa therapy. Adverse effects were common in both the levodopa-carbidopa intestinal gel and placebo groups and were related primarily to the infusion hardware.
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Goldman SM, Kamel F, Ross GW, Jewell SA, Marras C, Hoppin JA, Umbach DM, Bhudhikanok GS, Meng C, Korell M, Comyns K, Hauser RA, Jankovic J, Factor SA, Bressman S, Lyons KE, Sandler DP, Langston JW, Tanner CM. Peptidoglycan recognition protein genes and risk of Parkinson's disease. Mov Disord 2014; 29:1171-80. [PMID: 24838182 DOI: 10.1002/mds.25895] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [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: 12/06/2013] [Revised: 03/12/2014] [Accepted: 03/25/2014] [Indexed: 12/26/2022] Open
Abstract
Increased gut permeability, inflammation, and colonic α-synuclein pathology are present in early Parkinson's disease (PD) and have been proposed to contribute to PD pathogenesis. Peptidoglycan is a structural component of the bacterial cell wall. Peptidoglycan recognition proteins (PGRPs) maintain healthy gut microbial flora by regulating the immune response to both commensal and harmful bacteria. We tested the hypothesis that variants in genes that encode PGRPs are associated with PD risk. Participants in two independent case-control studies were genotyped for 30 single-nucleotide polymorphisms (SNPs) in the four PGLYRP genes. Using logistic regression to estimate odds ratios (OR) and 95% confidence intervals (CI) adjusted for potential confounding variables, we conducted analyses in each study, separately and pooled. One SNP failed the assay, and three had little to no variation. The ORs were similar in both study populations. In pooled analyses, three of seven PGLYRP2 SNPs (rs3813135, rs733731, rs892145), one of five PGLYRP3 SNPs (rs2987763), and six of nine PGLYRP4 SNPs (rs10888557, rs12063091, rs3006440, rs3006448, rs3006458, and rs3014864) were significantly associated with PD risk. Association was strongest for PGLYRP4 5'untranslated region (UTR) SNP rs10888557 (GG reference, CG OR 0.6 [95%CI 0.4-0.9], CC OR 0.15 [95%CI 0.04-0.6]; log-additive P-trend, 0.0004). Common variants in PGLYRP genes are associated with PD risk in two independent studies. These results require replication, but they are consistent with hypotheses of a causative role for the gut microbiota and gastrointestinal immune response in PD.
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Affiliation(s)
- Samuel M Goldman
- San Francisco Veterans Affairs Medical Center, San Francisco, California, USA; University of California, San Francisco, San Francisco, California, USA; The Parkinson's Institute, Sunnyvale, California, USA
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Pahwa R, Lyons KE, Hauser RA, Fahn S, Jankovic J, Pourcher E, Hsu A, O'Connell M, Kell S, Gupta S. Randomized trial of IPX066, carbidopa/levodopa extended release, in early Parkinson's disease. Parkinsonism Relat Disord 2014; 20:142-8. [DOI: 10.1016/j.parkreldis.2013.08.017] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2013] [Revised: 08/15/2013] [Accepted: 08/27/2013] [Indexed: 10/26/2022]
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Nazzaro JM, Klemp JA, Brooks WM, Cook-Wiens G, Mayo MS, Van Acker III GM, Lyons KE, Cheney PD. Deep brain stimulation lead-contact heating during 3T MRI: single- versus dual-channel pulse generator configurations. Int J Neurosci 2013; 124:166-74. [DOI: 10.3109/00207454.2013.840303] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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McVey MA, Amundsen S, Barnds A, Lyons KE, Pahwa R, Mahnken JD, Luchies CW. The effect of moderate Parkinson's disease on compensatory backwards stepping. Gait Posture 2013; 38:800-5. [PMID: 23607994 DOI: 10.1016/j.gaitpost.2013.03.028] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2012] [Revised: 02/11/2013] [Accepted: 03/27/2013] [Indexed: 02/02/2023]
Abstract
Postural instability is a major unmet need in the treatment of Parkinson's disease (PD) and its progression is not well understood. This study examined compensatory stepping taken in response to a backwards waist pull in participants with moderate PD (H&Y III) compared to age-range matched healthy controls (HC). The first step in the response was quantified in terms of strategy, temporal, kinematic, and center of pressure (COP) parameters previously observed to be significantly different in mild PD (H&Y II) compared to HC. Patients with moderate PD, compared to HC, utilized more steps to regain balance, had a longer weight-shift-time, and utilized a base-width neutral step to regain balance. However, there were no differences in ankle angle or COP location at landing as observed in mild PD, possibly due to the use of the base-width neutral step. These results suggest that moderate PD significantly impairs the compensatory response to a backwards pull. Further study should examine the progression of impairment in compensatory responses across PD severity levels, and the correlation with fall risk.
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Affiliation(s)
- Molly A McVey
- The University of Kansas, 1530 West 15th Street, Room 3138, Lawrence, KS, 66045, United States
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Perea RD, Rada RC, Wilson J, Vidoni ED, Morris JK, Lyons KE, Pahwa R, Burns JM, Honea RA. A Comparative White Matter Study with Parkinson's disease, Parkinson's Disease with Dementia and Alzheimer's Disease. J Alzheimers Dis Parkinsonism 2013; 3:123. [PMID: 24724042 PMCID: PMC3979316 DOI: 10.4172/2161-0460.1000123] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Alzheimer's disease (AD) and Parkinson's disease (PD) are among the most common neurodegenerative disorders affecting older populations. AD is characterized by impaired memory and cognitive decline while the primary symptoms of PD include resting tremor, bradykinesia and rigidity. In PD, mild cognitive changes are frequently present, which could progress to dementia (PD dementia (PDD)). PDD and AD dementias are different in pathology although the difference in microstructural changes remains unknown. To further understand these diseases, it is essential to understand the distinct mechanism of their microstructural changes. We used diffusion tensor imaging (DTI) to investigate white matter tract differences between early stage individuals with AD (n=14), PD (n=12), PDD (n=9), and healthy non-demented controls (CON) (n=13). We used whole brain tract based spatial statistics (TBSS) and a region of interest (ROI) analysis focused on the substantia nigra (SN). We found that individuals with PDD had more widespread white matter degeneration compared to PD, AD, and CON. Individuals with AD had few regional abnormalities in the anterior and posterior projections of the corpus callosum while PD and CON did not appear to have significant white matter degeneration when compared to other groups. ROI analyses showed that PDD had the highest diffusivity in the SN and were significantly different from CON. There were no significant ROI differences between CON, PD, or AD. In conclusion, global white matter microstructural deterioration is evident in individuals with PDD, and DTI may provide a means with which to tease out pathological differences between AD and PD dementias.
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Affiliation(s)
- Rodrigo D Perea
- Department of Neurology, University of Kansas School of Medicine, Kansas City, KS, USA
- Alzheimer's Research Disease Center, University of Kansas School of Medicine, Kansas City, KS, USA
- Bioengineering Program, Department of Engineering, University of Kansas, Lawrence, KS, USA
| | - Rebecca C Rada
- Alzheimer's Research Disease Center, University of Kansas School of Medicine, Kansas City, KS, USA
| | - Jessica Wilson
- Department of Psychology, University of Kansas, Lawrence, KS, USA
| | - Eric D Vidoni
- Department of Neurology, University of Kansas School of Medicine, Kansas City, KS, USA
- Alzheimer's Research Disease Center, University of Kansas School of Medicine, Kansas City, KS, USA
| | - Jill K Morris
- Department of Neurology, University of Kansas School of Medicine, Kansas City, KS, USA
- Alzheimer's Research Disease Center, University of Kansas School of Medicine, Kansas City, KS, USA
| | - Kelly E Lyons
- Department of Neurology, University of Kansas School of Medicine, Kansas City, KS, USA
| | - Rajesh Pahwa
- Department of Neurology, University of Kansas School of Medicine, Kansas City, KS, USA
| | - Jeffrey M Burns
- Department of Neurology, University of Kansas School of Medicine, Kansas City, KS, USA
- Alzheimer's Research Disease Center, University of Kansas School of Medicine, Kansas City, KS, USA
| | - Robyn A Honea
- Department of Neurology, University of Kansas School of Medicine, Kansas City, KS, USA
- Alzheimer's Research Disease Center, University of Kansas School of Medicine, Kansas City, KS, USA
- Bioengineering Program, Department of Engineering, University of Kansas, Lawrence, KS, USA
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Lyons KE. Treatment of motor and NMS of Parkinson's disease with the rotigotine transdermal system. Neurol Clin 2013; 31:vii-ix. [PMID: 23931955 DOI: 10.1016/j.ncl.2013.04.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Abstract
Rotigotine transdermal system is a nonergot, 24-hour dopamine agonist approved for the treatment of early and advanced Parkinson's disease (PD). Recent studies have demonstrated significant improvements with rotigotine in motor function in early PD and significant improvements in daily off-time and motor function in advanced PD. In addition to motor improvements, nonmotor symptoms have been shown to be improved with rotigotine in both early and advanced PD. Rotigotine has been shown in large, controlled studies to be safe and efficacious for the treatment of motor and some nonmotor symptoms of early and advanced PD.
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Affiliation(s)
- Kelly E Lyons
- Department of Neurology, University of Kansas Medical Center, 3599 Rainbow Boulevard, Kansas City, KS 66160, USA.
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Hanna-Pladdy B, Jones K, Cabanban R, Pahwa R, Lyons KE. Predictors of mild cognitive impairment in early-stage Parkinson's disease. Dement Geriatr Cogn Dis Extra 2013; 3:168-78. [PMID: 23741229 PMCID: PMC3670639 DOI: 10.1159/000351421] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Aim The aim of this study was to identify mild cognitive deficits in Parkinson's disease (PD) prior to extensive neurodegeneration and to evaluate the extent to which dopamine depletion and other disease-related predictors can explain cognitive profiles. Methods Neuropsychological performances of 40 nondemented early-stage PD patients and 42 healthy controls were compared across on or off dopaminergic medications. Stepwise regression evaluated cognitive predictors of early-stage PD and disease-related predictors of PD cognition (levodopa dose, disease duration, Unified Parkinson's Disease Rating Scale score, sleep, quality of life, and mood) across on and off states. Results Neuropsychological performance was lower in PD patients across cognitive domains with significant memory, naming, visuomotor, and complex attention/executive deficits, but with intact visuospatial, simple attention, and phonemic fluency functions. However, medication effects were absent except for simple attention. Regression analyses revealed age, working memory, and memory recall to be the best cognitive predictors of PD, while age, quality of life, disease duration, and anxiety predicted PD cognition in the off state. Conclusion Nondemented early-stage PD patients presented with extensive mild cognitive deficits including prominent memory impairment. The profile was inconsistent with expected isolated frontostriatal dysfunction previously attributed to dopamine depletion and this highlights the need to further characterize extranigral sources of mild cognitive impairment in PD.
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Affiliation(s)
- Brenda Hanna-Pladdy
- Division of Neuropsychology, Department of Neurology, Emory University School of Medicine, Atlanta, Ga. ; Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Ga
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Abstract
Essential tremor is the most common tremor disorder and is characterized by a postural and kinetic tremor. Most commonly, the disease involves the upper extremities, although other body parts may be affected. Essential tremor is seen most often in adults and may markedly limit abilities to perform daily activities. Medications often fail to control the tremor adequately. In the past, ventral intermediate nucleus of the thalamus (VIM) thalamotomy was the surgery of choice for medication-resistant patients with disabling tremor. With technological advances, deep brain stimulation (DBS) to the VIM has replaced thalamotomy as the operation of choice for patients with essential tremor, given the heightened risk of permanent neurological deficits associated with ablative surgery. Multiple studies have demonstrated that unilateral VIM DBS has significant short- and long-term benefits for targeted tremor. Unilateral VIM DBS may also improve head and voice tremor, although most commonly bilateral stimulation is required for adequate control. However, bilateral thalamic stimulation is associated with a higher incidence of neurological deficits, particularly speech and gait problems. Investigations of DBS of other brain target areas for essential tremor, such as the posterior subthalamic area and the subthalamic nucleus, are ongoing.
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Affiliation(s)
- Jules M Nazzaro
- Department of Neurosurgery, University of Kansas Medical Center, Kansas City, KS, USA; Department of Neurology, University of Kansas Medical Center, Kansas City, KS, USA; Department of Molecular and Integrative Physiology, University of Kansas Medical Center, Kansas City, KS, USA
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Nazzaro JM, Pahwa R, Lyons KE. Erratum: Long-term benefits in quality of life after unilateral thalamic deep brain stimulation for essential tremor. J Neurosurg 2012. [DOI: 10.3171/2012.6.jns112316a] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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