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Lees AJ. The torment of needing to know for sure. Lancet Neurol 2024; 23:564. [PMID: 38760097 DOI: 10.1016/s1474-4422(24)00120-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Accepted: 03/11/2024] [Indexed: 05/19/2024]
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Espay AJ, Lees AJ. Loss of monomeric alpha-synuclein (synucleinopenia) and the origin of Parkinson's disease. Parkinsonism Relat Disord 2024; 122:106077. [PMID: 38461037 DOI: 10.1016/j.parkreldis.2024.106077] [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: 01/18/2024] [Revised: 02/26/2024] [Accepted: 02/27/2024] [Indexed: 03/11/2024]
Abstract
These facts argue against the gain-of-function synucleinopathy hypothesis, which proposes that Lewy pathology causes Parkinson's disease: (1) most brains from people without neurological symptoms have multiple pathologies; (2) neither pathology type nor distribution correlate with disease severity or progression in Parkinson's disease; (3) aggregated α-synuclein in the form of Lewy bodies is not a space-occupying lesion but the insoluble fraction of its precursor, soluble monomeric α-synuclein; (4) pathology spread is passive, occurring by irreversible nucleation, not active replication; and (5) low cerebrospinal fluid α-synuclein levels predict brain atrophy and clinical disease progression. The transformation of α-synuclein into Lewy pathology may occur as a response to biological, toxic, or infectious stressors whose persistence perpetuates the nucleation process, depleting normal α-synuclein and eventually leading to Parkinson's symptoms from neuronal death. We propose testing the loss-of-function synucleinopenia hypothesis by evaluating the clinical and neurodegenerative rescue effect of replenishing the levels of monomeric α-synuclein.
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Affiliation(s)
- Alberto J Espay
- James J. and Joan A. Gardner Family Center for Parkinson's Disease and Movement Disorders, Department of Neurology, University of Cincinnati, Cincinnati, OH, USA.
| | - Andrew J Lees
- The National Hospital, Queen Square and Reta Lila Weston Institute for Neurological Studies University College London, London, UK
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3
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Lees AJ, Lawson S. Earworms-A Narrative Review of Infectious Music. JAMA 2024; 331:1075-1076. [PMID: 38563845 DOI: 10.1001/jama.2024.2780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
This Arts and Medicine feature reviews the clinical and neurophysiologic features of earworms, music fragments heard in the mind that repeat over and over as if jammed in playback mode.
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Affiliation(s)
- A J Lees
- National Hospital, Queen Square, London, United Kingdom
| | - Sarah Lawson
- Head of Queen Square Library, UCL Queen Square Institute of Neurology, London, United Kingdom
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4
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Simonet C, Pérez-Carbonell L, Galmés-Ordinas MA, Huxford BFR, Chohan H, Gill A, Leschziner G, Lees AJ, Schrag A, Noyce AJ. The Motor Dysfunction Seen in Isolated REM Sleep Behavior Disorder. Mov Disord 2024. [PMID: 38470080 DOI: 10.1002/mds.29779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 02/16/2024] [Accepted: 02/22/2024] [Indexed: 03/13/2024] Open
Abstract
BACKGROUND Isolated Rapid Eye Movement (REM) sleep Behavior Disorder (iRBD) requires quantitative tools to detect incipient Parkinson's disease (PD). METHODS A motor battery was designed and compared with the Movement Disorder Society-Unified Parkinson's Disease Rating Scale part III (MDS-UPDRS-III) in people with iRBD and controls. This included two keyboard-based tests (BRadykinesia Akinesia INcoordination tap test and Distal Finger Tapping) and two dual tasking tests (walking and finger tapping). RESULTS We included 33 iRBD patients and 29 controls. The iRBD group performed both keyboard-based tapping tests more slowly (P < 0.001, P = 0.020) and less rhythmically (P < 0.001, P = 0.006) than controls. Unlike controls, the iRBD group increased their walking duration (P < 0.001) and had a smaller amplitude (P = 0.001) and slower (P = 0.007) finger tapping with dual task. The combination of the most salient motor markers showed 90.3% sensitivity for 89.3% specificity (area under the ROC curve [AUC], 0.94), which was higher than the MDS-UPDRS-III (minus action tremor) (69.7% sensitivity, 72.4% specificity; AUC, 0.81) for detecting motor dysfunction. CONCLUSION Speed, rhythm, and dual task motor deterioration might be accurate indicators of incipient PD in iRBD. © 2024 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Cristina Simonet
- Centre for Preventive Neurology, Wolfson Institute of Population Health, Queen Mary University of London, London, United Kingdom
| | - Laura Pérez-Carbonell
- Sleep Disorders Centre, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | | | - Brook F R Huxford
- Centre for Preventive Neurology, Wolfson Institute of Population Health, Queen Mary University of London, London, United Kingdom
| | - Harneek Chohan
- Centre for Preventive Neurology, Wolfson Institute of Population Health, Queen Mary University of London, London, United Kingdom
| | - Aneet Gill
- Centre for Preventive Neurology, Wolfson Institute of Population Health, Queen Mary University of London, London, United Kingdom
| | - Guy Leschziner
- Sleep Disorders Centre, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Andrew J Lees
- Reta Lila Weston Institute, Institute of Neurology, UCL and National Hospital, London, United Kingdom
| | - Anette Schrag
- Department of Clinical and Movement Neuroscience, UCL Institute of Neurology, London, United Kingdom
| | - Alastair J Noyce
- Centre for Preventive Neurology, Wolfson Institute of Population Health, Queen Mary University of London, London, United Kingdom
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Espay AJ, Lees AJ. Are we entering the 'Tau-lemaic' era of Parkinson's disease? Brain 2024; 147:330-332. [PMID: 38190424 DOI: 10.1093/brain/awae002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 12/21/2023] [Indexed: 01/10/2024] Open
Abstract
This scientific commentary refers to ‘Nigrostriatal tau pathology in parkinsonism and Parkinson’s disease’ by Chu et al. (https://doi.org/10.1093/brain/awad388).
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Affiliation(s)
- Alberto J Espay
- James J. and Joan A. Gardner Family Center for Parkinson's Disease and Movement Disorders, Department of Neurology, University of Cincinnati, Cincinnati, OH, USA
| | - Andrew J Lees
- The National Hospital, Queen Square and Reta Lila Weston Institute for Neurological Studies University College London, London, UK
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Foltynie T, Bruno V, Fox S, Kühn AA, Lindop F, Lees AJ. Medical, surgical, and physical treatments for Parkinson's disease. Lancet 2024; 403:305-324. [PMID: 38245250 DOI: 10.1016/s0140-6736(23)01429-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 05/09/2023] [Accepted: 07/06/2023] [Indexed: 01/22/2024]
Abstract
Although dopamine replacement therapy remains a core component of Parkinson's disease treatment, the onset of motor fluctuations and dyskinetic movements might require a range of medical and surgical approaches from a multidisciplinary team, and important new approaches in the delivery of dopamine replacement are becoming available. The more challenging, wide range of non-motor symptoms can also have a major impact on the quality of life of a patient with Parkinson's disease, and requires careful multidisciplinary management using evidence-based knowledge, as well as appropriately tailored strategies according to the individual patient's needs. Disease-modifying therapies are urgently needed to prevent the development of the most disabling refractory symptoms, including gait and balance difficulties, cognitive impairment and dementia, and speech and swallowing impairments. In the third paper in this Series, we present the latest evidence supporting the optimal treatment of Parkinson's disease, and describe an expert approach to many aspects of treatment choice where an evidence base is insufficient.
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Affiliation(s)
- Tom Foltynie
- Department of Clinical and Movement Neurosciences, UCL Institute of Neurology, National Hospital for Neurology and Neurosurgery, London, UK.
| | - Veronica Bruno
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Susan Fox
- Edmond J Safra Program in Parkinson Disease, Krembil Brain Institute, Toronto Western Hospital, Toronto, ON, Canada; Division of Neurology, University of Toronto, Toronto, ON, Canada
| | - Andrea A Kühn
- Berlin Institute of Health, Charité-Universitätsmedizin Berlin, Berlin, Germany; NeuroCure Cluster of Excellence, Charité-Universitätsmedizin Berlin, Berlin, Germany; Department of Neurology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Fiona Lindop
- University Hospitals of Derby and Burton NHS Foundation Trust, Specialist Rehabilitation, Florence Nightingale Community Hospital, Derby, UK
| | - Andrew J Lees
- Department of Clinical and Movement Neurosciences, UCL Institute of Neurology, National Hospital for Neurology and Neurosurgery, London, UK; Reta Lila Weston Institute of Neurological Studies, University College London, London, UK
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Luo H, Gustavsson EK, Macpherson H, Dominik N, Zhelcheska K, Montgomery K, Anderson C, Yau WY, Efthymiou S, Turner C, DeTure M, Dickson DW, Josephs KA, Revesz T, Lashley T, Halliday G, Rowe DB, McCann E, Blair I, Lees AJ, Tienari PJ, Suomalainen A, Molina-Porcel L, Kovacs GG, Gelpi E, Hardy J, Haltia MJ, Tucci A, Jaunmuktane Z, Ryten M, Houlden H, Chen Z. Letter to the editor on: Hornerin deposits in neuronal intranuclear inclusion disease: direct identification of proteins with compositionally biased regions in inclusions by Park et al. (2022). Acta Neuropathol Commun 2024; 12:2. [PMID: 38167323 PMCID: PMC10759526 DOI: 10.1186/s40478-023-01706-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 12/06/2023] [Indexed: 01/05/2024] Open
Affiliation(s)
- Huihui Luo
- Department of Neuromuscular Disease, Queen Square Institute of Neurology, University College London (UCL), London, UK
| | - Emil K Gustavsson
- Department of Genetics and Genomic Medicine, Great Ormond Street Institute of Child Health, University College London, London, UK
- NIHR Great Ormond Street Hospital Biomedical Research Centre, University College London, London, UK
| | - Hannah Macpherson
- Department of Genetics and Genomic Medicine, Great Ormond Street Institute of Child Health, University College London, London, UK
- Department of Neurodegenerative Disease, Queen Square Institute of Neurology, UCL, London, UK
| | - Natalia Dominik
- Department of Neuromuscular Disease, Queen Square Institute of Neurology, University College London (UCL), London, UK
| | - Kristina Zhelcheska
- Department of Neuromuscular Disease, Queen Square Institute of Neurology, University College London (UCL), London, UK
| | - Kylie Montgomery
- Department of Genetics and Genomic Medicine, Great Ormond Street Institute of Child Health, University College London, London, UK
- NIHR Great Ormond Street Hospital Biomedical Research Centre, University College London, London, UK
| | - Claire Anderson
- Department of Genetics and Genomic Medicine, Great Ormond Street Institute of Child Health, University College London, London, UK
- NIHR Great Ormond Street Hospital Biomedical Research Centre, University College London, London, UK
| | - Wai Yan Yau
- The Perron Institute for Neurological and Translational Science, Perth, Australia
| | - Stephanie Efthymiou
- Department of Neuromuscular Disease, Queen Square Institute of Neurology, University College London (UCL), London, UK
| | - Chris Turner
- The National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
| | - Michael DeTure
- Department of Neuroscience, Mayo Clinic, Jacksonville, FL, USA
| | | | - Keith A Josephs
- Neurodegenerative Research Group, Mayo Clinic, Rochester, MN, USA
| | - Tamas Revesz
- Queen Square Brain Bank, Department of Clinical and Movement Neurosciences, Queen Square Institute of Neurology, UCL, London, UK
| | - Tammaryn Lashley
- Queen Square Brain Bank, Department of Clinical and Movement Neurosciences, Queen Square Institute of Neurology, UCL, London, UK
| | - Glenda Halliday
- Neuroscience Research Australia, Sydney, Australia
- School of Medical Sciences, Faculty of Medicine, University of New South Wales, Sydney, Australia
- Brain and Mind Centre, Sydney Medical School, The University of Sydney, Sydney, Australia
| | - Dominic B Rowe
- Centre for Motor Neuron Disease Research, Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, NSW, Australia
| | - Emily McCann
- Centre for Motor Neuron Disease Research, Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, NSW, Australia
| | - Ian Blair
- Centre for Motor Neuron Disease Research, Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, NSW, Australia
| | - Andrew J Lees
- Queen Square Brain Bank, Department of Clinical and Movement Neurosciences, Queen Square Institute of Neurology, UCL, London, UK
- Reta Lila Weston Institute, UCL Queen Square Institute of Neurology, Wakefield Street, London, UK
| | - Pentti J Tienari
- Department of Neurology, Helsinki University Hospital, Helsinki, Finland
- Translational Immunology Research Program, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Anu Suomalainen
- Research Programs Unit, Stem Cells and Metabolism, University of Helsinki, 00290, Helsinki, Finland
- Neuroscience CenterHiLife, University of Helsinki, 00290, Helsinki, Finland
- HUSlab, Helsinki University Hospital, 00290, Helsinki, Finland
| | - Laura Molina-Porcel
- Alzheimer's Disease and Other Cognitive Disorders Unit. Neurology Service, Hospital ClínicFundació de Recerca Clínic Barcelona-Institut d'Investigacions Biomediques August Pi I Sunyer (FRCB-IDIBAPS), University of Barcelona, Barcelona, Spain
- Neurological Tissue Bank of the Hospital Clinic-IFRCB-IDIBAPS-Biobank, Barcelona, Spain
| | - Gabor G Kovacs
- Tanz Centre for Research in Neurodegenerative Disease, University of Toronto, Toronto, Canada
| | - Ellen Gelpi
- Division of Neuropathology and Neurochemistry, Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - John Hardy
- Department of Neurodegenerative Disease, Queen Square Institute of Neurology, UCL, London, UK
- Reta Lila Weston Institute, UCL Queen Square Institute of Neurology, Wakefield Street, London, UK
- Dementia Research Institute at UCL, Queen Square Institute of Neurology, UCL, London, UK
- NIHR University College London Hospitals Biomedical Research Centre, London, UK
- Institute for Advanced Study, The Hong Kong University of Science and Technology, Hong Kong SAR, China
| | - Matti J Haltia
- Department of Pathology, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Arianna Tucci
- William Harvey Research Institute, Queen Mary University of London, London, UK
| | - Zane Jaunmuktane
- Queen Square Brain Bank, Department of Clinical and Movement Neurosciences, Queen Square Institute of Neurology, UCL, London, UK
| | - Mina Ryten
- Department of Genetics and Genomic Medicine, Great Ormond Street Institute of Child Health, University College London, London, UK
- NIHR Great Ormond Street Hospital Biomedical Research Centre, University College London, London, UK
| | - Henry Houlden
- Department of Neuromuscular Disease, Queen Square Institute of Neurology, University College London (UCL), London, UK
| | - Zhongbo Chen
- Department of Genetics and Genomic Medicine, Great Ormond Street Institute of Child Health, University College London, London, UK.
- NIHR Great Ormond Street Hospital Biomedical Research Centre, University College London, London, UK.
- Department of Clinical and Movement Neuroscience, Queen Square Institute of Neurology, University College London, Queen Square House, London, WC1N 3BG, UK.
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8
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Lees AJ. Medical Nemesis 50 years on. Lancet Neurol 2023; 22:1111. [PMID: 37977710 DOI: 10.1016/s1474-4422(23)00426-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 10/30/2023] [Indexed: 11/19/2023]
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Lees AJ. Reduced to a number. Pract Neurol 2023; 23:536-538. [PMID: 37798108 DOI: 10.1136/pn-2023-003803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/17/2023] [Indexed: 10/07/2023]
Affiliation(s)
- A J Lees
- Reta Lila Weston Institute of Neurological Studies, University College London, London, UK
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10
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Simonet C, Mahlknecht P, Marini K, Seppi K, Gill A, Bestwick JP, Lees AJ, Giovannoni G, Schrag A, Noyce AJ. The Emergence and Progression of Motor Dysfunction in Individuals at Risk of Parkinson's Disease. Mov Disord 2023; 38:1636-1644. [PMID: 37317903 DOI: 10.1002/mds.29496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 05/22/2023] [Accepted: 05/24/2023] [Indexed: 06/16/2023] Open
Abstract
BACKGROUND PREDICT-PD is a United Kingdom population-based study aiming to stratify individuals for future Parkinson's disease (PD) using a risk algorithm. METHODS A randomly selected, representative sample of participants in PREDICT-PD were examined using several motor assessments, including the motor section of the Movement Disorder Society-Sponsored Revision of the Unified Parkinson's Disease Rating Scale (MDS-UPDRS)-III, at baseline (2012) and after an average of 6 years of follow-up. We checked for new PD diagnoses in participants seen at baseline and examined the association between risk scores and incident sub-threshold parkinsonism, motor decline (increasing ≥5 points in MDS-UPDRS-III) and single motor domains in the MDS-UPDRS-III. We replicated analyses in two independent datasets (Bruneck and Parkinson's Progression Markers Initiative [PPMI]). RESULTS After 6 years of follow-up, the PREDICT-PD higher-risk group (n = 33) had a greater motor decline compared with the lower-risk group (n = 95) (30% vs. 12.5%, P = 0.031). Two participants (both considered higher risk at baseline) were given a diagnosis of PD during follow-up, with motor signs emerging between 2 and 5 years before diagnosis. A meta-analysis of data from PREDICT-PD, Bruneck, and PPMI showed an association between PD risk estimates and incident sub-threshold parkinsonism (odds ratio [OR], 2.01 [95% confidence interval (CI), 1.55-2.61]), as well as new onset bradykinesia (OR, 1.69 [95% CI, 1.33-2.16]) and action tremor (OR, 1.61 [95% CI, 1.30-1.98]). CONCLUSIONS Risk estimates using the PREDICT-PD algorithm were associated with the occurrence of sub-threshold parkinsonism, including bradykinesia and action tremor. The algorithm could also identify individuals whose motor examination experience a decline over time. © 2023 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Cristina Simonet
- Preventive Neurology Unit, Wolfson Institute of Population Health, Queen Mary University of London, London, United Kingdom
| | - Philipp Mahlknecht
- Department of Neurology, Innsbruck Medical University, Innsbruck, Austria
| | - Kathrin Marini
- Department of Neurology, Innsbruck Medical University, Innsbruck, Austria
| | - Klaus Seppi
- Department of Neurology, Innsbruck Medical University, Innsbruck, Austria
| | - Aneet Gill
- Preventive Neurology Unit, Wolfson Institute of Population Health, Queen Mary University of London, London, United Kingdom
| | - Jonathan P Bestwick
- Preventive Neurology Unit, Wolfson Institute of Population Health, Queen Mary University of London, London, United Kingdom
| | - Andrew J Lees
- Reta Lila Weston Institute of Neurological Studies, University College London Queen Square Institute of Neurology, London, United Kingdom
| | - Gavin Giovannoni
- Preventive Neurology Unit, Wolfson Institute of Population Health, Queen Mary University of London, London, United Kingdom
- Blizard Institute, Queen Mary University, London, United Kingdom
| | - Anette Schrag
- Reta Lila Weston Institute of Neurological Studies, University College London Queen Square Institute of Neurology, London, United Kingdom
| | - Alastair J Noyce
- Preventive Neurology Unit, Wolfson Institute of Population Health, Queen Mary University of London, London, United Kingdom
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11
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Street D, Jabbari E, Costantini A, Jones PS, Holland N, Rittman T, Jensen MT, Chelban V, Goh YY, Guo T, Heslegrave AJ, Roncaroli F, Klein JC, Ansorge O, Allinson KSJ, Jaunmuktane Z, Revesz T, Warner TT, Lees AJ, Zetterberg H, Russell LL, Bocchetta M, Rohrer JD, Burn DJ, Pavese N, Gerhard A, Kobylecki C, Leigh PN, Church A, Hu MTM, Houlden H, Morris H, Rowe JB. Progression of atypical parkinsonian syndromes: PROSPECT-M-UK study implications for clinical trials. Brain 2023; 146:3232-3242. [PMID: 36975168 PMCID: PMC10393398 DOI: 10.1093/brain/awad105] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [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: 11/24/2022] [Revised: 02/11/2023] [Accepted: 02/21/2023] [Indexed: 03/29/2023] Open
Abstract
The advent of clinical trials of disease-modifying agents for neurodegenerative disease highlights the need for evidence-based end point selection. Here we report the longitudinal PROSPECT-M-UK study of progressive supranuclear palsy (PSP), corticobasal syndrome (CBS), multiple system atrophy (MSA) and related disorders, to compare candidate clinical trial end points. In this multicentre UK study, participants were assessed with serial questionnaires, motor examination, neuropsychiatric and MRI assessments at baseline, 6 and 12 months. Participants were classified by diagnosis at baseline and study end, into Richardson syndrome, PSP-subcortical (PSP-parkinsonism and progressive gait freezing subtypes), PSP-cortical (PSP-frontal, PSP-speech and language and PSP-CBS subtypes), MSA-parkinsonism, MSA-cerebellar, CBS with and without evidence of Alzheimer's disease pathology and indeterminate syndromes. We calculated annual rate of change, with linear mixed modelling and sample sizes for clinical trials of disease-modifying agents, according to group and assessment type. Two hundred forty-three people were recruited [117 PSP, 68 CBS, 42 MSA and 16 indeterminate; 138 (56.8%) male; age at recruitment 68.7 ± 8.61 years]. One hundred and fifty-nine completed the 6-month assessment (82 PSP, 27 CBS, 40 MSA and 10 indeterminate) and 153 completed the 12-month assessment (80 PSP, 29 CBS, 35 MSA and nine indeterminate). Questionnaire, motor examination, neuropsychiatric and neuroimaging measures declined in all groups, with differences in longitudinal change between groups. Neuroimaging metrics would enable lower sample sizes to achieve equivalent power for clinical trials than cognitive and functional measures, often achieving N < 100 required for 1-year two-arm trials (with 80% power to detect 50% slowing). However, optimal outcome measures were disease-specific. In conclusion, phenotypic variance within PSP, CBS and MSA is a major challenge to clinical trial design. Our findings provide an evidence base for selection of clinical trial end points, from potential functional, cognitive, clinical or neuroimaging measures of disease progression.
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Affiliation(s)
- Duncan Street
- University of Cambridge Department of Clinical Neurosciences and Cambridge University Hospitals NHS Trust, Cambridge, CB2 OQQ, UK
| | - Edwin Jabbari
- Department of Clinical and Movement Neurosciences, University College London, Queen Square Institute of Neurology, London, WC1N 3BG, UK
- Movement Disorders Centre, University College London, Queen Square Institute of Neurology, London, WC1N 3BG, UK
| | - Alyssa Costantini
- Department of Clinical and Movement Neurosciences, University College London, Queen Square Institute of Neurology, London, WC1N 3BG, UK
- Movement Disorders Centre, University College London, Queen Square Institute of Neurology, London, WC1N 3BG, UK
| | - P Simon Jones
- University of Cambridge Department of Clinical Neurosciences and Cambridge University Hospitals NHS Trust, Cambridge, CB2 OQQ, UK
| | - Negin Holland
- University of Cambridge Department of Clinical Neurosciences and Cambridge University Hospitals NHS Trust, Cambridge, CB2 OQQ, UK
| | - Timothy Rittman
- University of Cambridge Department of Clinical Neurosciences and Cambridge University Hospitals NHS Trust, Cambridge, CB2 OQQ, UK
| | - Marte T Jensen
- Department of Clinical and Movement Neurosciences, University College London, Queen Square Institute of Neurology, London, WC1N 3BG, UK
- Movement Disorders Centre, University College London, Queen Square Institute of Neurology, London, WC1N 3BG, UK
| | - Viorica Chelban
- Department of Neuromuscular Diseases, University College London, Queen Square Institute of Neurology, London, WC1N 3BG, UK
- Neurobiology and Medical Genetics Laboratory, ‘Nicolae Testemitanu’ State University of Medicine and Pharmacy, Chisinau 2004, Republic of Moldova
| | - Yen Y Goh
- Department of Neuromuscular Diseases, University College London, Queen Square Institute of Neurology, London, WC1N 3BG, UK
| | - Tong Guo
- Department of Clinical and Movement Neurosciences, University College London, Queen Square Institute of Neurology, London, WC1N 3BG, UK
| | - Amanda J Heslegrave
- Department of Neurodegenerative Disease, University College London, Queen Square Institute of Neurology, London, WC1N 3BG, UK
- UK Dementia Research Institute, University College London, London, W1T 7NF, UK
| | - Federico Roncaroli
- Geoffrey Jefferson Brain Research Centre, Division of Neuroscience, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, M6 8HD, UK
| | - Johannes C Klein
- Wellcome Centre for Integrative Neuroimaging, Oxford Centre for Functional MRI of the Brain, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, OX3 9DU, UK
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, OX3 9DU, UK
| | - Olaf Ansorge
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, OX3 9DU, UK
| | - Kieren S J Allinson
- University of Cambridge Department of Clinical Neurosciences and Cambridge University Hospitals NHS Trust, Cambridge, CB2 OQQ, UK
| | - Zane Jaunmuktane
- Department of Clinical and Movement Neurosciences, University College London, Queen Square Institute of Neurology, London, WC1N 3BG, UK
- Queen Square Brain Bank for Neurological Disorders, University College London, Queen Square Institute of Neurology, London, WC1N 3BG, UK
- Reta Lila Weston Institute, University College London, Queen Square Institute of Neurology, London, WC1N 3BG, UK
| | - Tamas Revesz
- Queen Square Brain Bank for Neurological Disorders, University College London, Queen Square Institute of Neurology, London, WC1N 3BG, UK
- Reta Lila Weston Institute, University College London, Queen Square Institute of Neurology, London, WC1N 3BG, UK
| | - Thomas T Warner
- Queen Square Brain Bank for Neurological Disorders, University College London, Queen Square Institute of Neurology, London, WC1N 3BG, UK
- Reta Lila Weston Institute, University College London, Queen Square Institute of Neurology, London, WC1N 3BG, UK
| | - Andrew J Lees
- Queen Square Brain Bank for Neurological Disorders, University College London, Queen Square Institute of Neurology, London, WC1N 3BG, UK
- Reta Lila Weston Institute, University College London, Queen Square Institute of Neurology, London, WC1N 3BG, UK
| | - Henrik Zetterberg
- Department of Neurodegenerative Disease, University College London, Queen Square Institute of Neurology, London, WC1N 3BG, UK
- UK Dementia Research Institute, University College London, London, W1T 7NF, UK
- Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, 431 30 Mölndal, Sweden
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Salhgrenska Academy at the University of Gothenburg, 413 45 Goteborg, Sweden
- Hong Kong Center for Neurodegenerative Diseases, Hong Kong Science Park, Shatin, N.T., Hong Kong, China
| | - Lucy L Russell
- Department of Neurodegenerative Disease, University College London, Queen Square Institute of Neurology, London, WC1N 3BG, UK
| | - Martina Bocchetta
- Centre for Cognitive and Clinical Neuroscience, Division of Psychology, Department of Life Sciences, College of Health, Medicine and Life Sciences, Brunel University London, London, UB8 3PH, UK
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, University College London, London, WC1N 3BG, UK
| | - Jonathan D Rohrer
- Department of Neurodegenerative Disease, University College London, Queen Square Institute of Neurology, London, WC1N 3BG, UK
| | - David J Burn
- Faculty of Medical Sciences, Newcastle University, Newcastle, NE2 4HH, UK
| | - Nicola Pavese
- Clinical Ageing Research Unit, Newcastle University, Newcastle, NE4 5PL, UK
| | - Alexander Gerhard
- Division of Neuroscience, Wolfson Molecular Imaging Centre, University of Manchester, Manchester, N20 3LJ, UK
- Departments of Geriatric Medicine and Nuclear Medicine, Center for Translational Neuro- and Behavioral Sciences, University Medicine Essen, 45356 Essen, Germany
| | - Christopher Kobylecki
- Division of Neuroscience, Wolfson Molecular Imaging Centre, University of Manchester, Manchester, N20 3LJ, UK
- Department of Neurology, Manchester Academic Health Science Centre, Northern Care Alliance NHS Foundation Trust, Salford, M13 9NQ, UK
| | - P Nigel Leigh
- Department of Neuroscience, Brighton and Sussex Medical School, Brighton, BN1 9PX, UK
| | - Alistair Church
- Department of Neurology, Royal Gwent Hospital, Newport, NP20 2UB, UK
| | - Michele T M Hu
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, OX3 9DU, UK
- Department of Physiology, Anatomy and Genetics, Oxford Parkinson’s Disease Centre, University of Oxford, Oxford, OX1 3QU, UK
| | - Henry Houlden
- Department of Clinical and Movement Neurosciences, University College London, Queen Square Institute of Neurology, London, WC1N 3BG, UK
- Movement Disorders Centre, University College London, Queen Square Institute of Neurology, London, WC1N 3BG, UK
- Department of Neuromuscular Diseases, University College London, Queen Square Institute of Neurology, London, WC1N 3BG, UK
| | - Huw Morris
- Department of Clinical and Movement Neurosciences, University College London, Queen Square Institute of Neurology, London, WC1N 3BG, UK
- Movement Disorders Centre, University College London, Queen Square Institute of Neurology, London, WC1N 3BG, UK
| | - James B Rowe
- University of Cambridge Department of Clinical Neurosciences and Cambridge University Hospitals NHS Trust, Cambridge, CB2 OQQ, UK
- Medical Research Council Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, CB2 7EF, UK
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12
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Jha A, Espay AJ, Lees AJ. Digital Biomarkers in Parkinson's Disease: Missing the Forest for the Trees? Mov Disord Clin Pract 2023; 10:S68-S72. [PMID: 37637991 PMCID: PMC10448130 DOI: 10.1002/mdc3.13746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 03/21/2023] [Accepted: 03/29/2023] [Indexed: 08/29/2023] Open
Affiliation(s)
- Ashwani Jha
- UCL Queen Square Institute of NeurologyLondonUnited Kingdom
| | - Alberto J. Espay
- James J. and Joan A. Gardner Family Center for Parkinson's Disease and Movement Disorders, Department of NeurologyUniversity of CincinnatiCincinnatiOhioUSA
| | - Andrew J. Lees
- Reta Lila Weston Institute of Neurological Studies, Department of Clinical Movement Disorder and Neuroscience, Institute of NeurologyUniversity College LondonLondonUnited Kingdom
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13
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14
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Hariz M, Bronstein JM, Cosgrove GR, de Bie RMA, DeLong MR, Gross RE, Krack P, Krauss JK, Lang AE, Lees AJ, Lozano AM, Obeso JA, Schuurman PR, Vitek JL. Concerns About the European Academy's Recommendations and Guidelines Regarding Pallidotomy for Parkinson's Disease. Mov Disord 2023; 38:509-511. [PMID: 36047463 DOI: 10.1002/mds.29210] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 08/12/2022] [Indexed: 11/09/2022] Open
Affiliation(s)
- Marwan Hariz
- Department of Clinical Neuroscience, Umeå University, Umeå, Sweden
- UCL Queen Square Institute of Neurology, London, United Kingdom
| | - Jeff M Bronstein
- Department of Neurology, UCLA David Geffen School of Medicine, Los Angeles, California, USA
| | - G Rees Cosgrove
- Neurosurgery Department at The Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Rob M A de Bie
- Department of Neurology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam Neuroscience, Amsterdam, the Netherlands
| | - Mahlon R DeLong
- Department of Neurology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Robert E Gross
- Department of Neurosurgery, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Paul Krack
- Department of Neurology, Inselspital, University Hospital Bern, Bern, Switzerland
| | - Joachim K Krauss
- Department of Neurosurgery, Medical School Hannover, Hannover, Germany
| | - Anthony E Lang
- The Edmond J. Safra Program in Parkinson's Disease and the Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital & University of Toronto, Toronto, Ontario, Canada
| | - Andrew J Lees
- UCL Queen Square Institute of Neurology, London, United Kingdom
| | - Andres M Lozano
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - José A Obeso
- HM CINAC (Centro Integral de Neurociencias Abarca Campal), Fundación Hospitales de Madrid, Hospital Universitario HM Puerta del Sur, HM Hospitales, Madrid, Spain
- Network Center for Biomedical Research on Neurodegenerative Diseases (CIBERNED), Instituto Carlos III, Madrid, Spain
- University CEU-San Pablo, Madrid, Spain
| | | | - Jerold L Vitek
- Department of Neurology, University of Minnesota, Minneapolis, Minnesota, USA
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15
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Alonso-Canovas A, Voeten J, Gifford L, Thomas O, Lees AJ, Bloem BR. The Early Treatment Phase in Parkinson's Disease: Not a Honeymoon for All, Not a Honeymoon at All? J Parkinsons Dis 2023; 13:323-328. [PMID: 36847018 DOI: 10.3233/jpd-225064] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
The discovery of levodopa in the late 60 s of twentieth century was a 'golden moment' for people with Parkinson's disease (PD). Unfortunately, clinical experience showed that some symptoms escaped from symptomatic control, and long-term complications developed. Back then, neurologists coined the term "honeymoon period" for the early phase of uncomplicated response to levodopa, and it continues to be used in scientific literature. However, medical terms are no longer restricted to professionals, and few people with PD relate to the notion of a "honeymoon". We examine the reasons why this term, once helpful, but inaccurate and inappropriate, should be abandoned.
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Affiliation(s)
- Araceli Alonso-Canovas
- Movement Disorders Unit, Neurology Department, Hospital Universitario Ramón y Cajal, Madrid, Spain.,Professor of Neurology, Faculty of Medicine, Universidad de Alcalá, Spain
| | | | | | | | - Andrew J Lees
- The National Hospital for Neurology and Neurosurgery, London, UK
| | - Bastiaan R Bloem
- Department of Neurology, Radboud University Medical Center, Donders Institute for Brain and Cognition, Center of Expertise for Parkinson & Movement Disorders, Nijmegen, The Netherlands
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16
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Lees AJ. John Michael Walshe - Born 24 April 1920, Died 14 October 2022. Mov Disord Clin Pract 2023; 10:211-212. [PMID: 38153387 PMCID: PMC9941921 DOI: 10.1002/mdc3.13634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 11/22/2022] [Indexed: 01/13/2023] Open
Affiliation(s)
- Andrew J. Lees
- Institute of Neurology, Department of Clinical Movement Disorder and Neuroscience, Reta Lila Weston Institute of Neurological StudiesUniversity College LondonLondonUK
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17
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Castillo‐Torres SA, Lees AJ, Merello M. Intermittent Apomorphine Use for off Period Rescue in Parkinson's Disease: A Pragmatic Review of over Three Decades of Clinical Experience. Mov Disord Clin Pract 2023; 10:190-208. [PMID: 36825043 PMCID: PMC9941929 DOI: 10.1002/mdc3.13593] [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: 05/22/2022] [Revised: 08/17/2022] [Accepted: 09/24/2022] [Indexed: 11/10/2022] Open
Abstract
Background Although proven very efficacious as treatment for Parkinson's disease by Schwab as far back as the 1950s, and later confirmed by Cotzias and colleagues in the early 1970s, use of intermittent subcutaneous injections of the dopamine agonist apomorphine remains limited worldwide. Objectives To review evidence regarding use of intermittent, on-demand apomorphine as a treatment for off-period disability in Parkinson's disease. Methods A PRISMA-compliant structured literature search was carried out with a focus on clinical effect (motor improvement, daily off time decrease; latency, duration), antiemetic prophylaxis, and adverse events. Results Fifty-eight studies were evaluated. Apomorphine administration route was subcutaneous in 29 (50%), sublingual in 14 (24.1%), intranasal in 6 (10.3%), inhaled in 5 (8.6%), rectal in 3 (5.2%) and transdermal in 1 (1.7%). Irrespective of the route, motor disability improved 19% to 74% and daily off time decreased 3% to 68%, with subcutaneous having the fastest onset of action ranging from 6 to 24 minutes and lasting 28 to 96 minutes. Antiemetic prophylaxis was used in almost all studies. Systemic side effects like nausea and yawning were mild and well tolerated, but sedation led to discontinuation of subcutaneous apomorphine in 5.5%. Local side effects to subcutaneous administration did not result in discontinuation. Stomatitis with the early sublingual formulations led to discontinuation in nearly half of patients and was reduced to 16.7% with novel film strips. Conclusions Intermittent subcutaneous injections remain the most reliable and safest route of apomorphine administration, with an efficacy for off period treatment supported by nearly four decades of clinical experience.
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Affiliation(s)
- Sergio A. Castillo‐Torres
- Edmond J. Safra Fellowship in Movement Disorders at Servicio de Movimientos Anormales, Departamento de NeurologíaFleniBuenos AiresArgentina
| | - Andrew J. Lees
- Department of Clinical Movement Disorder and NeuroscienceUniversity College London, Institute of Neurology, Reta Lila Weston Institute of Neurological StudiesLondonUK
| | - Marcelo Merello
- Edmond J. Safra Fellowship in Movement Disorders at Servicio de Movimientos Anormales, Departamento de NeurologíaFleniBuenos AiresArgentina
- Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET)Buenos AiresArgentina
- Faculty of MedicinePontifical Catholic University of ArgentinaBuenos AiresArgentina
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18
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Lees AJ. John Michael Walshe (April 24, 1920-October 14, 2022). Mov Disord 2023; 38:159-161. [PMID: 36627745 DOI: 10.1002/mds.29296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 11/29/2022] [Indexed: 01/12/2023] Open
Affiliation(s)
- Andrew J Lees
- Department of Clinical Movement Disorder and Neuroscience, University College London, Institute of Neurology, Reta Lila Weston Institute of Neurological Studies, London, United Kingdom
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19
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Morris HR, Lees AJ. Obituary for Dr. John C. Steele, 1934-2022. Mov Disord Clin Pract 2023; 10:7-8. [PMID: 38153384 PMCID: PMC9847287 DOI: 10.1002/mdc3.13628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 11/07/2022] [Indexed: 12/24/2022] Open
Affiliation(s)
- Huw R. Morris
- Department of Clinical and Movement Neurosciences, University College London Queen Square Institute of NeurologyUniversity College LondonLondonUnited Kingdom
| | - Andrew J. Lees
- Department of Clinical and Movement Neurosciences, University College London Queen Square Institute of NeurologyUniversity College LondonLondonUnited Kingdom
- Reta Lila Weston InstituteUniversity College London Queen Square Institute of NeurologyLondonUnited Kingdom
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20
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Morris HR, Lees AJ. Obituary for Dr. John C. Steele (1934-2022). Mov Disord 2023; 38:1-3. [PMID: 36542523 DOI: 10.1002/mds.29293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 11/21/2022] [Indexed: 12/24/2022] Open
Affiliation(s)
- Huw R Morris
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Andrew J Lees
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom.,Reta Lila Weston Institute, UCL Queen Square Institute of Neurology, London, United Kingdom
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21
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Hariz M, Lang AE, Bronstein JM, Cosgrove GR, de Bie RMA, DeLong MR, Gross RE, Krack P, Krauss JK, Lees AJ, Lozano AM, Obeso JA, Schuurman PR, Vitek JL. European Academy of Neurology/Movement Disorder Society European Section's guidelines on pallidotomy for Parkinson's disease: let's remain accurate. Eur J Neurol 2022. [PMID: 36583626 DOI: 10.1111/ene.15667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 12/09/2022] [Indexed: 12/31/2022]
Affiliation(s)
- Marwan Hariz
- Department of Clinical Neuroscience, Umeå University, Umeå, Sweden.,UCL Queen Square Institute of Neurology, London, UK
| | - Anthony E Lang
- Edmond J Safra Program in Parkinson's Disease and the Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital and University of Toronto, Toronto, Ontario, Canada
| | - Jeff M Bronstein
- Department of Neurology, UCLA David Geffen School of Medicine, Los Angeles, California, USA
| | - G Rees Cosgrove
- Neurosurgery Department, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Rob M A de Bie
- Department of Neurology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam Neuroscience, Amsterdam, The Netherlands
| | - Mahlon R DeLong
- Department of Neurology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Robert E Gross
- Department of Neurosurgery, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Paul Krack
- Department of Neurology, Inselspital, University Hospital Bern, Bern, Switzerland
| | - Joachim K Krauss
- Department of Neurosurgery, Medical School Hannover, Hannover, Germany
| | | | - Andres M Lozano
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - José A Obeso
- HM CINAC (Centro Integral de Neurociencias Abarca Campal), Fundación Hospitales de Madrid, Hospital Universitario HM Puerta del Sur, HM Hospitales, Madrid, Spain.,Network Center for Biomedical Research on Neurodegenerative Diseases (CIBERNED), Instituto Carlos III, Madrid, Spain.,University CEU-San Pablo, Madrid, Spain
| | | | - Jerrold L Vitek
- Department of Neurology, University of Minnesota, Minneapolis, Minnesota, USA
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22
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Wright IH, Sekar A, Jensen MT, Hodgson M, Bancroft MJ, Koohi N, Lees AJ, Morris HR, Kaski D. Reflexive and volitional saccadic eye movements and their changes in age and progressive supranuclear palsy. J Neurol Sci 2022; 443:120482. [PMID: 36356484 DOI: 10.1016/j.jns.2022.120482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 10/03/2022] [Accepted: 10/24/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND AND OBJECTIVES Saccades, rapid movements of the eyes towards a visual or remembered target, are useful in understanding the healthy brain and the pathology of neurological conditions such as progressive supranuclear palsy (PSP). We set out to investigate the parameters of horizontal reflexive and volitional saccades, both visually guided and memory-guided, over a 1 min epoch in healthy individuals and PSP patients. METHODS An experimental paradigm tested reflexive, volitional visually guided, and volitional memory-guided saccades in young healthy controls (n = 14; 20-31 years), PSP patients (n = 11; 46-75 years) and older age-matched healthy controls (n = 6; 56-71 years). The accuracy and velocity of saccades was recorded using an EyeBrain T2® video eye tracker and analyses performed using the MyEyeAnalysis® software. Two-way analysis of variance (ANOVA) was used to identify significant effects (p < 0.01) between young and older controls to investigate the effects of ageing upon saccades, and between PSP patients and age-matched controls to study the effects of PSP upon saccades. RESULTS In both healthy individuals and PSP patients, volitional saccades are slower and less accurate than reflexive saccades. In PSP patients, accuracy is lower across all saccade types compared to age-matched controls, but velocity is lower only for reflexive saccades. Crucially, there is no change in accuracy or velocity of consecutive saccades over short (one-minute) timescales in controls or PSP patients. CONCLUSIONS Velocity and accuracy of saccades in PSP does not decrease over one-minute timescales, contrary to that previously observed in Parkinson's Disease (PD), suggesting a potential clinical biomarker for the distinction of PSP from PD.
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Affiliation(s)
- Isaac Hempstead Wright
- Centre for Vestibular and Behavioural Neurosciences, Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, London, UK
| | - Akila Sekar
- Centre for Vestibular and Behavioural Neurosciences, Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, London, UK
| | - Marte Theilmann Jensen
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Megan Hodgson
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Matthew J Bancroft
- Centre for Vestibular and Behavioural Neurosciences, Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, London, UK
| | - Nehzat Koohi
- Centre for Vestibular and Behavioural Neurosciences, Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, London, UK; The Ear Institute, University College London, London, UK
| | - Andrew J Lees
- Reta Lila Weston Institute of Neurological Studies, University College London, London, UK
| | - Huw R Morris
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Diego Kaski
- Centre for Vestibular and Behavioural Neurosciences, Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, London, UK; The Ear Institute, University College London, London, UK.
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23
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Miki Y, Tanji K, Shinnai K, Tanaka MT, Altay F, Foti SC, Strand C, Sasaki T, Kon T, Shimoyama S, Furukawa T, Nishijima H, Yamazaki H, Asi YT, Bettencourt C, Jaunmuktane Z, Tada M, Mori F, Mizukami H, Tomiyama M, Lashuel HA, Lashley T, Kakita A, Ling H, Lees AJ, Holton JL, Warner TT, Wakabayashi K. Pathological substrate of memory impairment in multiple system atrophy. Neuropathol Appl Neurobiol 2022; 48:e12844. [PMID: 35906771 DOI: 10.1111/nan.12844] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 07/12/2022] [Accepted: 07/23/2022] [Indexed: 11/29/2022]
Abstract
AIMS Synaptic dysfunction in Parkinson's disease is caused by propagation of pathogenic α-synuclein between neurons. Previously, in multiple system atrophy (MSA), pathologically characterised by ectopic deposition of abnormal α-synuclein predominantly in oligodendrocytes, we demonstrated that the occurrence of memory impairment was associated with the number of α-synuclein-positive neuronal cytoplasmic inclusions (NCIs) in the hippocampus. In the present study, we aimed to investigate how abnormal α-synuclein in the hippocampus can lead to memory impairment. METHODS We performed pathological and biochemical analyses using a mouse model of adult-onset MSA and human cases (MSA, N = 25; Parkinson's disease, N = 3; Alzheimer's disease, N = 2; normal controls, N = 11). In addition, the MSA model mice were examined behaviourally and physiologically. RESULTS In the MSA model, inducible human α-synuclein was first expressed in oligodendrocytes and subsequently accumulated in the cytoplasm of excitatory hippocampal neurons (NCI-like structures) and their presynaptic nerve terminals with the development of memory impairment. α-Synuclein oligomers increased simultaneously in the hippocampus of the MSA model. Hippocampal dendritic spines also decreased in number, followed by suppression of long-term potentiation. Consistent with these findings obtained in the MSA model, post-mortem analysis of human MSA brain tissues showed that cases of MSA with memory impairment developed more NCIs in excitatory hippocampal neurons along with α-synuclein oligomers than those without. CONCLUSIONS Our results provide new insights into the role of α-synuclein oligomers as a possible pathological cause of memory impairment in MSA.
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Affiliation(s)
- Yasuo Miki
- Department of Neuropathology, Institute of Brain Science, Hirosaki University Graduate School of Medicine, Hirosaki, Japan.,Queen Square Brain Bank for Neurological Disorders, UCL Queen Square Institute of Neurology, London, UK
| | - Kunikazu Tanji
- Department of Neuropathology, Institute of Brain Science, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Kana Shinnai
- Department of Neuropathology, Institute of Brain Science, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Makoto T Tanaka
- Department of Neuropathology, Institute of Brain Science, Hirosaki University Graduate School of Medicine, Hirosaki, Japan.,Faculty of Science and Engineering, Graduate School of Science and Engineering, Iwate University, Morioka, Japan
| | - Firat Altay
- Laboratory of Molecular and Chemical Biology of Neurodegeneration, Faculty of Life Sciences, École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
| | - Sandrine C Foti
- Queen Square Brain Bank for Neurological Disorders, UCL Queen Square Institute of Neurology, London, UK
| | - Catherine Strand
- Queen Square Brain Bank for Neurological Disorders, UCL Queen Square Institute of Neurology, London, UK
| | - Takanori Sasaki
- Department of Pathology and Molecular Medicine, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Tomoya Kon
- Department of Neurology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Shuji Shimoyama
- Department of Neurophysiology, Institute of Brain Science, Graduate School of Medicine, Hirosaki University, Hirosaki, Japan
| | - Tomonori Furukawa
- Department of Neurophysiology, Institute of Brain Science, Graduate School of Medicine, Hirosaki University, Hirosaki, Japan
| | - Haruo Nishijima
- Department of Neurology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Hiromi Yamazaki
- Department of Stress Response Science, Center for Advanced Medical Research, Hirosaki University, Hirosaki, Japan.,Department of Hematology-Oncology, Institute of Biomedical Research and Innovation, Foundation for Biomedical Research and Innovation at Kobe, Kobe, Japan
| | - Yasmine T Asi
- Queen Square Brain Bank for Neurological Disorders, UCL Queen Square Institute of Neurology, London, UK
| | - Conceição Bettencourt
- Queen Square Brain Bank for Neurological Disorders, UCL Queen Square Institute of Neurology, London, UK.,Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Zane Jaunmuktane
- Queen Square Brain Bank for Neurological Disorders, UCL Queen Square Institute of Neurology, London, UK.,Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Mari Tada
- Department of Pathology, Brain Research Institute, Niigata University, Niigata, Japan
| | - Fumiaki Mori
- Department of Neuropathology, Institute of Brain Science, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Hiroki Mizukami
- Department of Pathology and Molecular Medicine, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Masahiko Tomiyama
- Department of Neurology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Hilal A Lashuel
- Laboratory of Molecular and Chemical Biology of Neurodegeneration, Faculty of Life Sciences, École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
| | - Tammaryn Lashley
- Queen Square Brain Bank for Neurological Disorders, UCL Queen Square Institute of Neurology, London, UK
| | - Akiyoshi Kakita
- Department of Pathology, Brain Research Institute, Niigata University, Niigata, Japan
| | - Helen Ling
- Queen Square Brain Bank for Neurological Disorders, UCL Queen Square Institute of Neurology, London, UK.,Reta Lila Weston Institute of Neurological Studies, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Andrew J Lees
- Queen Square Brain Bank for Neurological Disorders, UCL Queen Square Institute of Neurology, London, UK.,Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Janice L Holton
- Queen Square Brain Bank for Neurological Disorders, UCL Queen Square Institute of Neurology, London, UK
| | - Thomas T Warner
- Queen Square Brain Bank for Neurological Disorders, UCL Queen Square Institute of Neurology, London, UK.,Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, University College London, London, UK.,Reta Lila Weston Institute of Neurological Studies, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Koichi Wakabayashi
- Department of Neuropathology, Institute of Brain Science, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
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24
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Rajapakshe I, Menozzi E, Cunha I, Lees AJ, Bhatia KP, Mulroy E. Reply to Comment on "Patients' Postjudice of Tele-Neurology for Movement Disorders". Mov Disord Clin Pract 2022; 9:1010-1011. [PMID: 36247909 PMCID: PMC9547149 DOI: 10.1002/mdc3.13548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 08/06/2022] [Indexed: 11/09/2022] Open
Affiliation(s)
- Ishani Rajapakshe
- Department of Clinical and Movement NeurosciencesUniversity College London Queen Square Institute of NeurologyLondonUnited Kingdom
| | - Elisa Menozzi
- Department of Clinical and Movement NeurosciencesUniversity College London Queen Square Institute of NeurologyLondonUnited Kingdom
| | - Inês Cunha
- Department of Clinical and Movement NeurosciencesUniversity College London Queen Square Institute of NeurologyLondonUnited Kingdom
| | - Andrew J. Lees
- Reta Lila Weston Institute of Neurological Studies, Institute of NeurologyUniversity College LondonLondonUnited Kingdom
| | - Kailash P. Bhatia
- Department of Clinical and Movement NeurosciencesUniversity College London Queen Square Institute of NeurologyLondonUnited Kingdom
| | - Eoin Mulroy
- Department of Clinical and Movement NeurosciencesUniversity College London Queen Square Institute of NeurologyLondonUnited Kingdom
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Hariz M, Bronstein JM, Cosgrove GR, de Bie RMA, DeLong MR, Gross RE, Krack P, Krauss JK, Lang AE, Lees AJ, Lozano AM, Obeso JA, Schuurman PR, Vitek JL. Concerns about the European Academy's Recommendations and Guidelines Regarding Pallidotomy for Parkinson's Disease. Eur J Neurol 2022; 30:1831-1833. [PMID: 36128760 DOI: 10.1111/ene.15569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 09/08/2022] [Indexed: 11/26/2022]
Affiliation(s)
- Marwan Hariz
- Department of Clinical Neuroscience, Umeå University, Umeå, Sweden
- UCL Queen Square Institute of Neurology, London, UK
| | - Jeff M Bronstein
- Department of Neurology, UCLA David Geffen School of Medicine, Los Angeles, California, USA
| | - G Rees Cosgrove
- Neurosurgery Department, The Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Rob M A de Bie
- Department of Neurology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam Neuroscience, Amsterdam, The Netherlands
| | - Mahlon R DeLong
- Department of Neurology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Robert E Gross
- Department of Neurosurgery, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Paul Krack
- Department of Neurology, Inselspital, University Hospital Bern, Bern, Switzerland
| | - Joachim K Krauss
- Department of Neurosurgery, Medical School Hannover, Hannover, Germany
| | - Anthony E Lang
- The Edmond J. Safra Program in Parkinson's Disease and the Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital and University of Toronto, Toronto, Ontario, Canada
| | | | - Andres M Lozano
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - José A Obeso
- HM CINAC (Centro Integral de Neurociencias Abarca Campal), Fundación Hospitales de Madrid, HM Hospitales, Hospital Universitario HM Puerta del Sur, Madrid, Spain
- Network Center for Biomedical Research on Neurodegenerative Diseases (CIBERNED), Instituto Carlos III, Madrid, Spain
- University CEU-San Pablo, Madrid, Spain
| | | | - Jerold L Vitek
- Department of Neurology, University of Minnesota, Minneapolis, Minnesota, USA
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26
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Zarkali A, Luppi AI, Stamatakis EA, Reeves S, McColgan P, Leyland LA, Lees AJ, Weil RS. Changes in dynamic transitions between integrated and segregated states underlie visual hallucinations in Parkinson's disease. Commun Biol 2022; 5:928. [PMID: 36075964 PMCID: PMC9458713 DOI: 10.1038/s42003-022-03903-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [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: 03/31/2022] [Accepted: 08/25/2022] [Indexed: 11/09/2022] Open
Abstract
Hallucinations are a core feature of psychosis and common in Parkinson's. Their transient, unexpected nature suggests a change in dynamic brain states, but underlying causes are unknown. Here, we examine temporal dynamics and underlying structural connectivity in Parkinson's-hallucinations using a combination of functional and structural MRI, network control theory, neurotransmitter density and genetic analyses. We show that Parkinson's-hallucinators spent more time in a predominantly Segregated functional state with fewer between-state transitions. The transition from integrated-to-segregated state had lower energy cost in Parkinson's-hallucinators; and was therefore potentially preferable. The regional energy needed for this transition was correlated with regional neurotransmitter density and gene expression for serotoninergic, GABAergic, noradrenergic and cholinergic, but not dopaminergic, receptors. We show how the combination of neurochemistry and brain structure jointly shape functional brain dynamics leading to hallucinations and highlight potential therapeutic targets by linking these changes to neurotransmitter systems involved in early sensory and complex visual processing.
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Affiliation(s)
- Angeliki Zarkali
- Dementia Research Centre, University College London, 8-11 Queen Square, London, WC1N 3AR, UK.
| | - Andrea I Luppi
- Division of Anaesthesia, School of Clinical Medicine, University of Cambridge, Cambridge, CB2 0QQ, UK
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, CB2 0QQ, UK
| | - Emmanuel A Stamatakis
- Division of Anaesthesia, School of Clinical Medicine, University of Cambridge, Cambridge, CB2 0QQ, UK
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, CB2 0QQ, UK
| | - Suzanne Reeves
- Division of Psychiatry, University College London, 149 Tottenham Court Rd, London, W1T 7BN, UK
| | - Peter McColgan
- Huntington's Disease Centre, University College London, Russell Square House, London, WC1B 5EH, UK
| | - Louise-Ann Leyland
- Dementia Research Centre, University College London, 8-11 Queen Square, London, WC1N 3AR, UK
| | - Andrew J Lees
- Reta Lila Weston Institute of Neurological Studies, University College London, 1 Wakefield Street, London, WC1N 1PJ, UK
| | - Rimona S Weil
- Dementia Research Centre, University College London, 8-11 Queen Square, London, WC1N 3AR, UK
- Wellcome Centre for Human Neuroimaging, University College London, 12 Queen Square, London, WC1N 3AR, UK
- Movement Disorders Consortium, University College London, London, WC1N 3BG, UK
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27
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Lees AJ. Gabriel Garcia Marquez, the greatest of the amnesia writers. Brain 2022; 145:4144-4147. [PMID: 35993097 DOI: 10.1093/brain/awac303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 08/10/2022] [Indexed: 11/14/2022] Open
Affiliation(s)
- A J Lees
- Institute of Neurology, UCL, London, UK
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28
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Hariz M, Lees AJ, Blomstedt Y, Blomstedt P. Serendipity and Observations in Functional Neurosurgery: From James Parkinson's Stroke to Hamani's & Lozano's Flashbacks. Stereotact Funct Neurosurg 2022; 100:201-209. [PMID: 35882210 DOI: 10.1159/000525794] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 06/23/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND Serendipity and observations have a noble tradition in medicine, including neurology, and are responsible for many medical treatments (carbamazepine for tic douloureux, amantadine for Parkinson's disease, gabapentin for restless legs…). We aimed at examining the contribution of serendipity and observations to functional neurosurgery. Scholarly publications relevant to the history of functional neurosurgery for movement and psychiatric disorders were reviewed, starting from the pre-stereotactic era. The documents were scrutinized with respect to indications for surgery, surgical methods, and brain targets, in view of determining whether serendipitous discoveries and other observations contributed to various functional neurosurgical procedures. SUMMARY James Parkinson's observation that tremors disappeared in the arm of a person with shaking palsy after a hemiparetic stroke encouraged neurosurgeons in the first half of the 20th century to perform ablative procedures on central motor pathways. Following a lobotomy performed by Browder that extended too far medially in a psychiatric patient with coexisting Parkinson's disease (PD), it was noted that the Parkinsonian signs improved. This encouraged Russel Meyers to carry out open surgery on the caudate nucleus and basal ganglia in PD. Cooper introduced ligation of the anterior choroidal artery as a treatment for PD following a surgical accident during a pedunculotomy. Cooper later started to perform stereotactic surgery on the ventrolateral thalamus following the pathological finding that an intended pallidal lesion had in fact targeted the thalamus. Leksell discovered the ideal location of a pallidal lesion being in the posteroventral area empirically, long before the advent of the basal ganglia model of PD. Modern Deep Brain Stimulation (DBS) that started in the thalamus for tremor was the result of an observation by Benabid that intraoperative high-frequency stimulation during a thalamotomy reduced tremor. Both the discoveries of the anterior limbic subthalamic nucleus as a DBS target for OCD and the medial forebrain bundle as a DBS target for depression occurred by chance. Hamani and Lozano observed memory flashbacks in a patient who was undergoing DBS for obesity, which led to the discovery of the fornix as a potential DBS target for Alzheimer's disease. KEY MESSAGES In the history of functional neurosurgery, serendipity and observations have resulted in discoveries of several procedures, brain targets for lesioning or DBS as well as new clinical surgical indications. In this era of neuromodulation, this technology should be exquisite in allowing potential serendipitous discoveries, provided that clinicians remain both observant and prepared.
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Affiliation(s)
- Marwan Hariz
- Department of Clinical Neuroscience, Umeå University, Umeå, Sweden.,UCL Queen Square Institute of Neurology, London, United Kingdom
| | - Andrew J Lees
- UCL Queen Square Institute of Neurology, London, United Kingdom
| | | | - Patric Blomstedt
- Department of Clinical Neuroscience, Umeå University, Umeå, Sweden
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29
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Cardoso F, de Souza LC, Lees AJ. Parkinsonism before James Parkinson: The “Marília de Dirceu” Case. Mov Disord Clin Pract 2022; 9:741-743. [DOI: 10.1002/mdc3.13507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 04/24/2022] [Accepted: 04/26/2022] [Indexed: 11/10/2022] Open
Affiliation(s)
- Francisco Cardoso
- Movement Disorders Clinic, Neurology Service, Internal Medicine Department The Federal University of Minas Gerais Belo Horizonte Brazil
| | - Leonardo Cruz de Souza
- Cognitive Unit, Neurology Service, Internal Medicine Department The Federal University of Minas Gerais Belo Horizonte Brazil
| | - Andrew J. Lees
- The National Hospital for Neurology and Neurosurgery London UK
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30
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Zarkali A, McColgan P, Ryten M, Reynolds R, Leyland LA, Lees AJ, Rees G, Weil RS. 129 Network controllability and regional gene expression explain visual hallucinations in Parkinson’s. J Neurol Neurosurg Psychiatry 2022. [DOI: 10.1136/jnnp-2022-abn.162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Visual hallucinations are common in Parkinson’s (PD) and associated with poorer prognosis. Imaging studies have shown white matter and functional changes in PD-hallucinations1 2but the biological factors underlying selective vulnerability of brain regions are unknown.We performed diffusion-weighted imaging in 100 PD patients (81 without hallucinations [PD-non-VH], 19 with hallucinations [PD-VH]) and 34 controls. We used network-based statistics to identify structural con- nectivity changes in PD-VH and performed an analysis of controllability, an emerging technique that allows quantification of influence across the rest of the network. We used the Allen brain atlas to identify regional gene expression patterns associated with affected areas of the network.We identified a subnetwork of reduced connectivity in PD-VH. Within this network, PD-VH showed reduced controllability (influence over other brain regions), than PD-non-VH (U=526, p=0.014) and controls (U=176.5, p=0.003). This subnetwork appears to be critical for brain integration, as even in controls, nodes with high controllability were more likely to be within the subnetwork (U=572.5, p<0.001). Gene expression analysis revealed downregulated genes related to mRNA metabolism and upregulated genes related to membrane localisation.Our findings provide insights into how hallucinations are generated, with breakdown of a key structural subnetwork that exerts control across distributed brain regions.ReferenceShine,et al. The role of dysfunctional attentional control networks in visual misperceptions in Parkinson’s disease. HumBrainMapp;2014.a.zarkali@ucl.ac.uk
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31
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Cullinane PW, Jaunmuktane Z, Lees AJ, Warner TT. REM Sleep Behavior Disorder and Visual Hallucinations in a Pathologically Confirmed Case of Corticobasal Degeneration. Mov Disord Clin Pract 2022; 9:383-385. [PMID: 35402652 PMCID: PMC8974869 DOI: 10.1002/mdc3.13403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Revised: 11/29/2021] [Accepted: 12/09/2021] [Indexed: 01/09/2023] Open
Affiliation(s)
- Patrick W Cullinane
- Department of Clinical and Movement Neurosciences, Queen Square Brain Bank for Neurological Disorders UCL Queen Square Institute of Neurology London United Kingdom.,Reta Lila Weston Institute UCL Queen Square Institute of Neurology London United Kingdom
| | - Zane Jaunmuktane
- Department of Clinical and Movement Neurosciences, Queen Square Brain Bank for Neurological Disorders UCL Queen Square Institute of Neurology London United Kingdom.,Division of Neuropathology, National Hospital for Neurology and Neurosurgery University College London NHS Foundation Trust London United Kingdom
| | - Andrew J Lees
- Department of Clinical and Movement Neurosciences, Queen Square Brain Bank for Neurological Disorders UCL Queen Square Institute of Neurology London United Kingdom.,Reta Lila Weston Institute UCL Queen Square Institute of Neurology London United Kingdom
| | - Thomas T Warner
- Department of Clinical and Movement Neurosciences, Queen Square Brain Bank for Neurological Disorders UCL Queen Square Institute of Neurology London United Kingdom.,Reta Lila Weston Institute UCL Queen Square Institute of Neurology London United Kingdom
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32
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Simonet C, Bestwick J, Jitlal M, Waters S, Ben-Joseph A, Marshall CR, Dobson R, Marrium S, Robson J, Jacobs BM, Belete D, Lees AJ, Giovannoni G, Cuzick J, Schrag A, Noyce AJ. Assessment of Risk Factors and Early Presentations of Parkinson Disease in Primary Care in a Diverse UK Population. JAMA Neurol 2022; 79:359-369. [PMID: 35254398 PMCID: PMC8902684 DOI: 10.1001/jamaneurol.2022.0003] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
IMPORTANCE Early features of Parkinson disease (PD) have been described through population-based studies that overrepresent White, affluent groups and may not be generalizable. OBJECTIVE To investigate the association between risk factors and prediagnostic presentations of PD in an ethnically diverse UK population with high socioeconomic deprivation but universal access to health care. DESIGN, SETTING, AND PARTICIPANTS A nested case-control study was conducted using electronic health care records on 1 016 277 individuals from primary care practices in East London to extract clinical information recorded between 1990 and February 6, 2018. The data were analyzed between September 3, 2020, and September 3, 2021. Individuals with a diagnosis of PD were compared with controls without PD or other major neurological conditions. MAIN OUTCOMES AND MEASURES A matched analysis (10 controls matched for each patient with PD according to age and sex) and an unmatched analysis (adjusted for age and sex) were undertaken using multivariable logistic regression to determine associations between risk factors and prediagnostic presentations to primary care with subsequent diagnosis of PD. Three time periods (<2, 2-<5, and 5-10 years before diagnosis) were analyzed separately and together. RESULTS Of 1 016 277 individuals included in the data set, 5699 were excluded and 1055 patients with PD and 1 009 523 controls were included in the analysis. Patients with PD were older than controls (mean [SD], 72.9 [11.3] vs 40.3 [15.2] years), and more were male (632 [59.9%] vs 516 862 [51.2%]). In the matched analysis (1055 individuals with PD and 10 550 controls), associations were found for tremor (odds ratio [OR], 145.96; 95% CI, 90.55-235.28) and memory symptoms (OR, 8.60; 95% CI, 5.91-12.49) less than 2 years before the PD diagnosis. The associations were also found up to 10 years before PD diagnosis for tremor and 5 years for memory symptoms. Among midlife risk factors, hypertension (OR, 1.36; 95% CI, 1.19-1.55) and type 2 diabetes (OR, 1.39; 95% CI, 1.19-1.62) were associated with subsequent diagnosis of PD. Associations with early nonmotor features, including hypotension (OR, 6.84; 95% CI, 3.38-13.85), constipation (OR, 3.29; 95% CI, 2.32-4.66), and depression (OR, 4.69; 95% CI, 2.88-7.63), were also noted. Associations were found for epilepsy (OR, 2.5; 95% CI, 1.63-3.83) and hearing loss (OR, 1.66; 95% CI, 1.06-2.58), which have not previously been well reported. These findings were replicated using data from the UK Biobank. No association with future PD diagnosis was found for ethnicity or deprivation index level. CONCLUSIONS AND RELEVANCE This study provides data suggesting that a range of comorbidities and symptoms are encountered in primary care settings before PD diagnosis in an ethnically diverse and deprived population. Novel temporal associations were observed for epilepsy and hearing loss with subsequent development of PD. The prominence of memory symptoms suggests an excess of cognitive dysfunction in early PD in this population or difficulty in correctly ascertaining symptoms in traditionally underrepresented groups.
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Affiliation(s)
- Cristina Simonet
- Preventive Neurology Unit, Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom.,Department of Neurology, Royal London Hospital, London, United Kingdom
| | - Jonathan Bestwick
- Preventive Neurology Unit, Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Mark Jitlal
- Preventive Neurology Unit, Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom.,Food Standards Agency, London, United Kingdom
| | - Sheena Waters
- Preventive Neurology Unit, Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Aaron Ben-Joseph
- Preventive Neurology Unit, Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Charles R Marshall
- Preventive Neurology Unit, Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom.,Department of Neurology, Royal London Hospital, London, United Kingdom
| | - Ruth Dobson
- Preventive Neurology Unit, Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom.,Department of Neurology, Royal London Hospital, London, United Kingdom
| | - Soha Marrium
- Preventive Neurology Unit, Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - John Robson
- Centre for Primary Care, Wolfson Institute of Population Health, The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Benjamin M Jacobs
- Preventive Neurology Unit, Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom.,Department of Neurology, Royal London Hospital, London, United Kingdom
| | - Daniel Belete
- Preventive Neurology Unit, Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Andrew J Lees
- Reta Lila Weston Institute, Institute of Neurology, UCL and National Hospital, Queen Square, London, United Kingdom
| | - Gavin Giovannoni
- Preventive Neurology Unit, Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom.,Department of Neurology, Royal London Hospital, London, United Kingdom.,Blizard Institute, Queen Mary University of London, London, United Kingdom
| | - Jack Cuzick
- Centre for Cancer Prevention, Queen Mary University of London, London, United Kingdom
| | - Anette Schrag
- Preventive Neurology Unit, Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom.,Department of Clinical and Movement Neuroscience, University College London Queen Square Institute of Neurology, London, United Kingdom
| | - Alastair J Noyce
- Preventive Neurology Unit, Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom.,Department of Neurology, Royal London Hospital, London, United Kingdom.,Department of Clinical and Movement Neuroscience, University College London Queen Square Institute of Neurology, London, United Kingdom
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33
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Reichmann H, Eggert K, Oehlwein C, Warnecke T, Lees AJ, Kemmer M, Soares-da-Silva P. Opicapone Use in Clinical Practice across Germany: A Sub-Analysis of the OPTIPARK Study in Parkinson's Disease Patients with Motor Fluctuations. Eur Neurol 2022; 85:389-397. [PMID: 35350024 DOI: 10.1159/000523771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 02/16/2022] [Indexed: 11/19/2022]
Abstract
INTRODUCTION The OPTIPARK study confirmed the effectiveness and safety of opicapone as adjunct therapy to levodopa in patients with Parkinson's disease (PD) and motor fluctuations under real-world conditions. The aim of this sub-analysis was to evaluate opicapone in the German patient cohort of OPTIPARK in order to provide country-specific data. METHODS OPTIPARK was an open-label, single-arm study conducted in routine clinical practice across Germany and the UK. Patients with PD and motor fluctuations received once-daily opicapone 50 mg for 3 months in addition to levodopa. The primary endpoint was Clinicians' Global Impression of Change (CGI-C). Secondary assessments included Patients' Global Impressions of Change (PGI-C), Unified Parkinson's Disease Rating Scale (UPDRS) I-IV, Parkinson's Disease Questionnaire (PDQ-8), and Non-Motor Symptoms Scale (NMSS). This sub-analysis reports outcomes from the German patients only. RESULTS Overall, 363 (97.6%) of the 372 patients included in the German cohort received ≥1 dose of opicapone and 291 (80.2%) completed the study. Improvements on CGI-C and PGI-C were reported by 70.8% and 76.3% of patients, respectively. UPDRS scores improved for activities of daily living during OFF time by -3.3 ± 4.5 points and motor scores during ON time by -5.3 ± 7.9 points. PDQ-8 and NMSS scores also demonstrated improvements. Treatment emergent adverse events considered at least possibly related to opicapone occurred in 37.7% of patients, with most being of mild or moderate intensity. CONCLUSION Opicapone added to levodopa in patients with PD and motor fluctuations was effective and generally well tolerated in routine clinical practice across Germany.
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Affiliation(s)
- Heinz Reichmann
- Department of Neurology, University of Dresden, Dresden, Germany
| | - Karla Eggert
- Department of Neurology, Philipps-University of Marburg, Marburg, Germany
| | | | - Tobias Warnecke
- Department of Neurology, University of Münster, Münster, Germany
| | - Andrew J Lees
- University College London, Reta Lila Weston Institute, London, United Kingdom
| | | | - Patrício Soares-da-Silva
- BIAL - Portela & Ca S.A., Coronado, Portugal.,MedInUP, Center for Drug Discovery and Innovative Medicines, University of Porto, Porto, Portugal
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34
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Rajapakshe I, Menozzi E, Cunha I, Lees AJ, Bhatia KP, Mulroy E. Patients’ post‐judice of tele‐neurology for movement disorders. Mov Disord Clin Pract 2022; 9:446-451. [PMID: 35586530 PMCID: PMC9092759 DOI: 10.1002/mdc3.13434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 02/22/2022] [Accepted: 02/25/2022] [Indexed: 11/11/2022] Open
Affiliation(s)
- Ishani Rajapakshe
- Department of clinical and movement neurosciences UCL Queen Square Institute of Neurology London WC1N 3BG
| | - Elisa Menozzi
- Department of clinical and movement neurosciences UCL Queen Square Institute of Neurology London WC1N 3BG
| | - Inês Cunha
- Department of clinical and movement neurosciences UCL Queen Square Institute of Neurology London WC1N 3BG
| | - Andrew J. Lees
- Reta Lila Weston Institute of Neurological Studies, Institute of Neurology University College London London WC1N 1PJ UK
| | - Kailash P. Bhatia
- Department of clinical and movement neurosciences UCL Queen Square Institute of Neurology London WC1N 3BG
| | - Eoin Mulroy
- Department of clinical and movement neurosciences UCL Queen Square Institute of Neurology London WC1N 3BG
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35
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Coutinho L, Walusinski O, Lees AJ, Teive HAG. Charcot's Anglophilia. Eur Neurol 2022; 85:328-332. [PMID: 35235932 DOI: 10.1159/000522188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Accepted: 01/20/2022] [Indexed: 11/19/2022]
Abstract
Jean-Martin Charcot was one of the most influential physicians of the nineteenth century and is now rightly considered the father of Neurology. The aim of this paper was to review and describe Charcot's close relationships to Britain and the influence of this particular affinity on his career.
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Affiliation(s)
- Léo Coutinho
- Movement Disorders Unit, Neurology Service, Internal Medicine Department, Hospital de Clínicas, Federal University of Paraná, Curitiba, Brazil, .,Neurological Diseases Group, Graduate Program of Internal Medicine, Internal Medicine Department, Hospital de Clínicas, Federal University of Paraná, Curitiba, Brazil,
| | | | - Andrew J Lees
- The National Hospital, Queen Square, London, United Kingdom
| | - Hélio A G Teive
- Movement Disorders Unit, Neurology Service, Internal Medicine Department, Hospital de Clínicas, Federal University of Paraná, Curitiba, Brazil.,Neurological Diseases Group, Graduate Program of Internal Medicine, Internal Medicine Department, Hospital de Clínicas, Federal University of Paraná, Curitiba, Brazil
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36
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Barbosa P, O'Sullivan SS, Joyce E, Lees AJ, Warner TT, Djamshidian A. Neuropsychiatric Features of Punding and Hobbyism in Parkinson's Disease. Mov Disord Clin Pract 2022; 9:82-86. [PMID: 35005069 PMCID: PMC8721828 DOI: 10.1002/mdc3.13363] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Revised: 09/17/2021] [Accepted: 10/12/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Little is known about the cognitive and neuropsychiatric profile associated with punding and hobbyism in Parkinson's disease (PD). OBJECTIVE To compare the clinical and neuropsychological features of PD patients with punding and hobbyism to PD controls. METHODS The Questionnaire for Impulsive-Compulsive Disorders in Parkinson's Disease-Rating Scale (QUIP-RS) was used as a screening tool, and a structured interview was used to diagnose punding/hobbyism. Clinical and neuropsychological assessment was conducted with validated questionnaires/scales. RESULTS Twenty-one patients with PD and punding (PD + pu) were compared to 26 with hobbyism (PD + h) and 25 PD controls. PD + pu patients showed higher levels of anxiety, non-motor symptoms and motor symptoms, and lower Frontal Assessment Battery scores. The PD + h group exhibited similar levels of anxiety and motor fluctuations to the PD + pu group. CONCLUSION PD + pu showed increased anxiety and frontal lobe dysfunction, similar to PD + h. Hobbyism could be a prodromal phase with increased risk of leading to punding.
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Affiliation(s)
- Pedro Barbosa
- Reta Lila Weston Institute of Neurological Studies, Department of Clinical Movement Disorder and NeuroscienceInstitute of Neurology, University College LondonLondonUnited Kingdom
- The National Hospital for Neurology and NeurosurgeryLondonUnited Kingdom
| | | | - Eileen Joyce
- The National Hospital for Neurology and NeurosurgeryLondonUnited Kingdom
- Department of Clinical Movement Disorder and NeuroscienceInstitute of Neurology, University College LondonLondonUnited Kingdom
| | - Andrew J. Lees
- Reta Lila Weston Institute of Neurological Studies, Department of Clinical Movement Disorder and NeuroscienceInstitute of Neurology, University College LondonLondonUnited Kingdom
| | - Thomas T. Warner
- Reta Lila Weston Institute of Neurological Studies, Department of Clinical Movement Disorder and NeuroscienceInstitute of Neurology, University College LondonLondonUnited Kingdom
- The National Hospital for Neurology and NeurosurgeryLondonUnited Kingdom
| | - Atbin Djamshidian
- Reta Lila Weston Institute of Neurological Studies, Department of Clinical Movement Disorder and NeuroscienceInstitute of Neurology, University College LondonLondonUnited Kingdom
- Department of NeurologyInnsbruck Medical UniversityInnsbruckAustria
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Barbosa P, Hapuarachchi B, Djamshidian A, Strand K, Lees AJ, de Silva R, Holton JL, Warner TT. Reply to 'Impulse control disorders are associated with lower ventral striatum dopamine D3 receptor availability in Parkinson's disease: A [11C]-PHNO PET study.'. Parkinsonism Relat Disord 2021; 93:31-32. [PMID: 34775278 DOI: 10.1016/j.parkreldis.2021.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Accepted: 11/07/2021] [Indexed: 11/19/2022]
Abstract
Pagano and collaborators have recently reported lower ventral striatum D3 receptor availability in Parkinson's disease using PET scan. Our group conducted the first postmortem study of individuals with PD who had ICD and related behaviours in life and reported lower alpha-synuclein pathology and D3R levels in the nucleus accumbens of such individuals. The findings by Pagano and co-authors of low D3R binding in PD patients at baseline, when taken together with our findings of lower Lewy pathology and D3R in the nucleus accumbens, favour the hypothesis that D3R levels are downregulated because of excessive synaptic dopamine.
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Affiliation(s)
- Pedro Barbosa
- Reta Lila Weston Institute of Neurological Studies, Department of Clinical Movement Disorder and Neuroscience, UCL Queen Square Institute of Neurology, London, UK; Queen Square Brain Bank for Neurological Disorders, UCL Queen Square Institute of Neurology, London, UK.
| | - Bimali Hapuarachchi
- Reta Lila Weston Institute of Neurological Studies, Department of Clinical Movement Disorder and Neuroscience, UCL Queen Square Institute of Neurology, London, UK
| | - Atbin Djamshidian
- Reta Lila Weston Institute of Neurological Studies, Department of Clinical Movement Disorder and Neuroscience, UCL Queen Square Institute of Neurology, London, UK; Department of Neurology, Innsbruck Medical University, Innsbruck, Austria
| | - Kate Strand
- Queen Square Brain Bank for Neurological Disorders, UCL Queen Square Institute of Neurology, London, UK
| | - Andrew J Lees
- Reta Lila Weston Institute of Neurological Studies, Department of Clinical Movement Disorder and Neuroscience, UCL Queen Square Institute of Neurology, London, UK; Queen Square Brain Bank for Neurological Disorders, UCL Queen Square Institute of Neurology, London, UK
| | - Rohan de Silva
- Reta Lila Weston Institute of Neurological Studies, Department of Clinical Movement Disorder and Neuroscience, UCL Queen Square Institute of Neurology, London, UK
| | - Janice L Holton
- Queen Square Brain Bank for Neurological Disorders, UCL Queen Square Institute of Neurology, London, UK
| | - Thomas T Warner
- Reta Lila Weston Institute of Neurological Studies, Department of Clinical Movement Disorder and Neuroscience, UCL Queen Square Institute of Neurology, London, UK; Queen Square Brain Bank for Neurological Disorders, UCL Queen Square Institute of Neurology, London, UK
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38
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Affiliation(s)
- A J Lees
- Institute of Neurology, UCL, London, UK
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Bestwick JP, Auger SD, Schrag AE, Grosset DG, Kanavou S, Giovannoni G, Lees AJ, Cuzick J, Noyce AJ. Optimising classification of Parkinson's disease based on motor, olfactory, neuropsychiatric and sleep features. NPJ Parkinsons Dis 2021; 7:87. [PMID: 34561458 PMCID: PMC8463675 DOI: 10.1038/s41531-021-00226-2] [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] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 08/19/2021] [Indexed: 12/11/2022]
Abstract
Olfactory loss, motor impairment, anxiety/depression, and REM-sleep behaviour disorder (RBD) are prodromal Parkinson’s disease (PD) features. PD risk prediction models typically dichotomize test results and apply likelihood ratios (LRs) to scores above and below cut-offs. We investigate whether LRs for specific test values could enhance classification between PD and controls. PD patient data on smell (UPSIT), possible RBD (RBD Screening Questionnaire), and anxiety/depression (LADS) were taken from the Tracking Parkinson’s study (n = 1046). For motor impairment (BRAIN test) in PD cases, published data were supplemented (n = 87). Control data (HADS for anxiety/depression) were taken from the PREDICT-PD pilot study (n = 1314). UPSIT, RBDSQ, and anxiety/depression data were analysed using logistic regression to determine which items were associated with PD. Gaussian distributions were fitted to BRAIN test scores. LRs were calculated from logistic regression models or score distributions. False-positive rates (FPRs) for specified detection rates (DRs) were calculated. Sixteen odours were associated with PD; LRs for this set ranged from 0.005 to 5511. Six RBDSQ and seven anxiety/depression questions were associated with PD; LRs ranged from 0.35 to 69 and from 0.002 to 402, respectively. BRAIN test LRs ranged from 0.16 to 1311. For a 70% DR, the FPR was 2.4% for the 16 odours, 4.6% for anxiety/depression, 16.0% for the BRAIN test, and 20.0% for the RBDSQ. Specific selections of (prodromal) PD marker features rather than dichotomized marker test results optimize PD classification. Such optimized classification models could improve the ability of algorithms to detect prodromal PD; however, prospective studies are needed to investigate their value for PD-prediction models.
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Affiliation(s)
- Jonathan P Bestwick
- Preventive Neurology Unit, Wolfson Institute of Population Health, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK.
| | - Stephen D Auger
- Preventive Neurology Unit, Wolfson Institute of Population Health, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Anette E Schrag
- Department of Clinical and Movement Neuroscience, UCL Institute of Neurology, University College London, London, UK
| | - Donald G Grosset
- Department of Neurology, Institute of Neurological Sciences, Queen Elizabeth University Hospital, Glasgow, UK
| | - Sofia Kanavou
- Population Health Sciences, University of Bristol, Bristol, UK
| | - Gavin Giovannoni
- Preventive Neurology Unit, Wolfson Institute of Population Health, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK.,Centre for Neuroscience, Surgery and Trauma, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Andrew J Lees
- Department of Clinical and Movement Neuroscience, UCL Institute of Neurology, University College London, London, UK
| | - Jack Cuzick
- Preventive Neurology Unit, Wolfson Institute of Population Health, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Alastair J Noyce
- Preventive Neurology Unit, Wolfson Institute of Population Health, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK.,Department of Clinical and Movement Neuroscience, UCL Institute of Neurology, University College London, London, UK
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Beckers M, Lees AJ, Nutt JG, Bloem BR. Turning Back the Clock in Parkinson's Disease: Practical Recommendations for Managing Diurnal Symptom Worsening. J Parkinsons Dis 2021; 11:1471-1473. [PMID: 33967059 DOI: 10.3233/jpd-212711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Milan Beckers
- Donders Institute for Brain, Cognition and Behavior, Department of Neurology, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands
| | - Andrew J Lees
- Reta Lila Weston Institute of Neurological Studies, University College London, London, UK
| | - John G Nutt
- Department of Neurology, School of Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Bastiaan R Bloem
- Donders Institute for Brain, Cognition and Behavior, Department of Neurology, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands
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Thomas GEC, Zarkali A, Ryten M, Shmueli K, Gil-Martinez AL, Leyland LA, McColgan P, Acosta-Cabronero J, Lees AJ, Weil RS. Regional brain iron and gene expression provide insights into neurodegeneration in Parkinson's disease. Brain 2021; 144:1787-1798. [PMID: 33704443 PMCID: PMC8320305 DOI: 10.1093/brain/awab084] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [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: 08/19/2020] [Revised: 11/20/2020] [Accepted: 12/14/2020] [Indexed: 12/11/2022] Open
Abstract
The mechanisms responsible for the selective vulnerability of specific neuronal populations in Parkinson's disease are poorly understood. Oxidative stress secondary to brain iron accumulation is one postulated mechanism. We measured iron deposition in 180 cortical regions of 96 patients with Parkinson's disease and 35 control subjects using quantitative susceptibility mapping. We estimated the expression of 15 745 genes in the same regions using transcriptomic data from the Allen Human Brain Atlas. Using partial least squares regression, we then identified the profile of gene transcription in the healthy brain that underlies increased cortical iron in patients with Parkinson's disease relative to controls. Applying gene ontological tools, we investigated the biological processes and cell types associated with this transcriptomic profile and identified the sets of genes with spatial expression profiles in control brains that correlated significantly with the spatial pattern of cortical iron deposition in Parkinson's disease. Gene ontological analyses revealed that these genes were enriched for biological processes relating to heavy metal detoxification, synaptic function and nervous system development and were predominantly expressed in astrocytes and glutamatergic neurons. Furthermore, we demonstrated that the genes differentially expressed in Parkinson's disease are associated with the pattern of cortical expression identified in this study. Our findings provide mechanistic insights into regional selective vulnerabilities in Parkinson's disease, particularly the processes involving iron accumulation.
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Affiliation(s)
| | | | - Mina Ryten
- Department of Neurodegenerative Disease, UCL Institute of Neurology, London, WC1B 5EH, UK
- NIHR Great Ormond Street Hospital Biomedical Research Centre, UCL, London, WC1N 1EH, UK
- Genetics and Genomic Medicine, Great Ormond Street Institute of Child Health, UCL, London, WC1N 1EH, UK
| | - Karin Shmueli
- Department of Medical Physics and Biomedical Engineering, Malet Place Engineering Building, UCL, London, WC1E 6BT, UK
| | - Ana Luisa Gil-Martinez
- Department of Neurodegenerative Disease, UCL Institute of Neurology, London, WC1B 5EH, UK
- Genetics and Genomic Medicine, Great Ormond Street Institute of Child Health, UCL, London, WC1N 1EH, UK
| | | | - Peter McColgan
- Huntington’s Disease Centre, UCL Institute of Neurology, London, WC1B 5EH, UK
| | | | - Andrew J Lees
- Reta Lila Weston Institute of Neurological Studies, London, WC1N 1PJ, UK
| | - Rimona S Weil
- Dementia Research Centre, UCL, London, WC1N 3AR, UK
- Wellcome Centre for Human Neuroimaging, UCL, London, WC1N 3AR, UK
- Movement Disorders Consortium, UCL, London, WC1N 3BG, UK
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42
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Simonet C, Galmes MA, Lambert C, Rees RN, Haque T, Bestwick JP, Lees AJ, Schrag A, Noyce AJ. Slow Motion Analysis of Repetitive Tapping (SMART) Test: Measuring Bradykinesia in Recently Diagnosed Parkinson's Disease and Idiopathic Anosmia. J Parkinsons Dis 2021; 11:1901-1915. [PMID: 34180422 DOI: 10.3233/jpd-212683] [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] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Bradykinesia is the defining motor feature of Parkinson's disease (PD). There are limitations to its assessment using standard clinical rating scales, especially in the early stages of PD when a floor effect may be observed. OBJECTIVE To develop a quantitative method to track repetitive tapping movements and to compare people in the early stages of PD, healthy controls, and individuals with idiopathic anosmia. METHODS This was a cross-sectional study of 99 participants (early-stage PD = 26, controls = 64, idiopathic anosmia = 9). For each participant, repetitive finger tapping was recorded over 20 seconds using a smartphone at 240 frames per second. From each video, amplitude between fingers, frequency (number of taps per second), and velocity (distance travelled per second) was extracted. Clinical assessment was based on the motor section of the MDS-UPDRS. RESULTS People in the early stage of PD performed the task with slower velocity (p < 0.001) and with greater frequency slope than controls (p = 0.003). The combination of reduced velocity and greater frequency slope obtained the best accuracy to separate early-stage PD from controls based on metric thresholds alone (AUC = 0.88). Individuals with anosmia exhibited slower velocity (p = 0.001) and smaller amplitude (p < 0.001) compared with controls. CONCLUSION We present a simple, proof-of-concept method to detect early motor dysfunction in PD. Mean tap velocity appeared to be the best parameter to differentiate patients with PD from controls. Patients with anosmia also showed detectable differences in motor performance compared with controls which may suggest that some were in the prodromal phase of PD.
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Affiliation(s)
- Cristina Simonet
- Preventive Neurology Unit, Wolfson Institute of Preventive Medicine, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Miquel A Galmes
- Physical and Analytical Chemistry Department, Jaume I University, Castelló de la Plana, Spain
| | | | - Richard N Rees
- Department of Clinical and Movement Neuroscience, UCL Institute of Neurology, London, United Kingdom
| | - Tahrina Haque
- Preventive Neurology Unit, Wolfson Institute of Preventive Medicine, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Jonathan P Bestwick
- Preventive Neurology Unit, Wolfson Institute of Preventive Medicine, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Andrew J Lees
- Reta Lila Weston Institute of Neurological Studies, University College London Queen Square Institute of Neurology, London, United Kingdom
| | - Anette Schrag
- Preventive Neurology Unit, Wolfson Institute of Preventive Medicine, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom.,Department of Clinical and Movement Neuroscience, UCL Institute of Neurology, London, United Kingdom
| | - Alastair J Noyce
- Preventive Neurology Unit, Wolfson Institute of Preventive Medicine, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom.,Department of Clinical and Movement Neuroscience, UCL Institute of Neurology, London, United Kingdom
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43
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Lees AJ. In search of Charcot's second sight. Lancet Neurol 2021; 20:424-425. [PMID: 34022168 DOI: 10.1016/s1474-4422(21)00127-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Abstract
Visual hallucinations have intrigued neurologists and physicians for generations due to patients' vivid and fascinating descriptions. They are most commonly associated with Parkinson's disease and dementia with Lewy bodies, but also occur in people with visual loss, where they are known as Charles Bonnet syndrome. More rarely, they can develop in other neurological conditions, such as thalamic or midbrain lesions, when they are known as peduncular hallucinosis. This review considers the mechanisms underlying visual hallucinations across diagnoses, including visual loss, network dysfunction across the brain and changes in neurotransmitters. We propose a framework to explain why visual hallucinations occur most commonly in Parkinson's disease and dementia with Lewy bodies, and discuss treatment approaches to visual hallucinations in these conditions.
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Affiliation(s)
- Rimona S Weil
- Dementia Research Centre, University College London, London, UK
| | - A J Lees
- Reta Lila Weston Institute of Neurological Studies, University College London, London, UK
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Miki Y, Tsushima E, Foti SC, Strand KM, Asi YT, Yamamoto AK, Bettencourt C, Oliveira MCB, De Pablo-Fernández E, Jaunmuktane Z, Lees AJ, Wakabayashi K, Warner TT, Quinn N, Holton JL, Ling H. Identification of multiple system atrophy mimicking Parkinson's disease or progressive supranuclear palsy. Brain 2021; 144:1138-1151. [PMID: 33822892 PMCID: PMC8310424 DOI: 10.1093/brain/awab017] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [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: 08/31/2020] [Revised: 11/08/2020] [Accepted: 11/17/2020] [Indexed: 01/22/2023] Open
Abstract
We studied a subset of patients with autopsy-confirmed multiple system atrophy who presented a clinical picture that closely resembled either Parkinson's disease or progressive supranuclear palsy. These mimics are not captured by the current diagnostic criteria for multiple system atrophy. Among 218 autopsy-proven multiple system atrophy cases reviewed, 177 (81.2%) were clinically diagnosed and pathologically confirmed as multiple system atrophy (i.e. typical cases), while the remaining 41 (18.8%) had received an alternative clinical diagnosis, including Parkinson's disease (i.e. Parkinson's disease mimics; n = 16) and progressive supranuclear palsy (i.e. progressive supranuclear palsy mimics; n = 17). We also reviewed the clinical records of another 105 patients with pathologically confirmed Parkinson's disease or progressive supranuclear palsy, who had received a correct final clinical diagnosis (i.e. Parkinson's disease, n = 35; progressive supranuclear palsy-Richardson syndrome, n = 35; and progressive supranuclear palsy-parkinsonism, n = 35). We investigated 12 red flag features that would support a diagnosis of multiple system atrophy according to the current diagnostic criteria. Compared with typical multiple system atrophy, Parkinson's disease mimics more frequently had a good levodopa response and visual hallucinations. Vertical gaze palsy and apraxia of eyelid opening were more commonly observed in progressive supranuclear palsy mimics. Multiple logistic regression analysis revealed an increased likelihood of having multiple system atrophy [Parkinson's disease mimic versus typical Parkinson's disease, odds ratio (OR): 8.1; progressive supranuclear palsy mimic versus typical progressive supranuclear palsy, OR: 2.3] if a patient developed any one of seven selected red flag features in the first 10 years of disease. Severe autonomic dysfunction (orthostatic hypotension and/or urinary incontinence with the need for a urinary catheter) was more frequent in clinically atypical multiple system atrophy than other parkinsonian disorders (Parkinson's disease mimic versus typical Parkinson's disease, OR: 4.1; progressive supranuclear palsy mimic versus typical progressive supranuclear palsy, OR: 8.8). The atypical multiple system atrophy cases more frequently had autonomic dysfunction within 3 years of symptom onset than the pathologically confirmed patients with Parkinson's disease or progressive supranuclear palsy (Parkinson's disease mimic versus typical Parkinson's disease, OR: 4.7; progressive supranuclear palsy mimic versus typical progressive supranuclear palsy, OR: 2.7). Using all included clinical features and 21 early clinical features within 3 years of symptom onset, we developed decision tree algorithms with combinations of clinical pointers to differentiate clinically atypical cases of multiple system atrophy from Parkinson's disease or progressive supranuclear palsy.
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Affiliation(s)
- Yasuo Miki
- Queen Square Brain Bank for Neurological Disorders, UCL Queen Square Institute of Neurology, London WC1N 1PJ, UK
- Department of Neuropathology, Institute of Brain Science, Hirosaki University Graduate School of Medicine, Hirosaki 036-8562, Japan
| | - Eiki Tsushima
- Department of Comprehensive Rehabilitation Science, Hirosaki University Graduate School of Health Sciences, Hirosaki 036-8564, Japan
| | - Sandrine C Foti
- Queen Square Brain Bank for Neurological Disorders, UCL Queen Square Institute of Neurology, London WC1N 1PJ, UK
| | - Kate M Strand
- Queen Square Brain Bank for Neurological Disorders, UCL Queen Square Institute of Neurology, London WC1N 1PJ, UK
| | - Yasmine T Asi
- Queen Square Brain Bank for Neurological Disorders, UCL Queen Square Institute of Neurology, London WC1N 1PJ, UK
| | - Adam Kenji Yamamoto
- Lysholm Department of Neuroradiology, National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
- Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology, University College London, Queen Square, London, UK
| | - Conceição Bettencourt
- Queen Square Brain Bank for Neurological Disorders, UCL Queen Square Institute of Neurology, London WC1N 1PJ, UK
- Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Marcos C B Oliveira
- Department of Neurology, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, Brazil
- Neurology Unit, Instituto do Câncer do Estado de São Paulo (ICESP), Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, Brazil
| | - Eduardo De Pablo-Fernández
- Queen Square Brain Bank for Neurological Disorders, UCL Queen Square Institute of Neurology, London WC1N 1PJ, UK
- Reta Lila Weston Institute of Neurological Studies, UCL Queen Square Institute of Neurology, London WC1N 1PJ, UK
| | - Zane Jaunmuktane
- Queen Square Brain Bank for Neurological Disorders, UCL Queen Square Institute of Neurology, London WC1N 1PJ, UK
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Andrew J Lees
- Queen Square Brain Bank for Neurological Disorders, UCL Queen Square Institute of Neurology, London WC1N 1PJ, UK
- Reta Lila Weston Institute of Neurological Studies, UCL Queen Square Institute of Neurology, London WC1N 1PJ, UK
| | - Koichi Wakabayashi
- Department of Neuropathology, Institute of Brain Science, Hirosaki University Graduate School of Medicine, Hirosaki 036-8562, Japan
| | - Thomas T Warner
- Queen Square Brain Bank for Neurological Disorders, UCL Queen Square Institute of Neurology, London WC1N 1PJ, UK
- Reta Lila Weston Institute of Neurological Studies, UCL Queen Square Institute of Neurology, London WC1N 1PJ, UK
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Niall Quinn
- UCL Queen Square Institute of Neurology, London WC1N 3BG, UK
| | - Janice L Holton
- Queen Square Brain Bank for Neurological Disorders, UCL Queen Square Institute of Neurology, London WC1N 1PJ, UK
| | - Helen Ling
- Queen Square Brain Bank for Neurological Disorders, UCL Queen Square Institute of Neurology, London WC1N 1PJ, UK
- Reta Lila Weston Institute of Neurological Studies, UCL Queen Square Institute of Neurology, London WC1N 1PJ, UK
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Zarkali A, McColgan P, Leyland L, Lees AJ, Weil RS. Visual Dysfunction Predicts Cognitive Impairment and White Matter Degeneration in Parkinson's Disease. Mov Disord 2021; 36:1191-1202. [PMID: 33421201 PMCID: PMC8248368 DOI: 10.1002/mds.28477] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [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: 10/12/2020] [Revised: 11/23/2020] [Accepted: 12/14/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Visual dysfunction predicts dementia in Parkinson's disease (PD), but whether this translates to structural change is not known. The objectives of this study were to identify longitudinal white matter changes in patients with Parkinson's disease and low visual function and also in those who developed mild cognitive impairment. METHODS We used fixel-based analysis to examine longitudinal white matter change in PD. Diffusion MRI and clinical assessments were performed in 77 patients at baseline (22 low visual function/55 intact vision and 13 PD-mild cognitive impairment/51 normal cognition) and 25 controls and again after 18 months. We compared microstructural changes in fiber density, macrostructural changes in fiber bundle cross-section and combined fiber density and cross-section, across white matter, adjusting for age, sex, and intracranial volume. RESULTS Patients with PD and visual dysfunction showed worse cognitive performance at follow-up and were more likely to develop mild cognitive impairment compared with those with normal vision (P = 0.008). Parkinson's with poor visual function showed diffuse microstructural and macrostructural changes at baseline, whereas those with mild cognitive impairment showed fewer baseline changes. At follow-up, Parkinson's with low visual function showed widespread macrostructural changes, involving the fronto-occipital fasciculi, external capsules, and middle cerebellar peduncles bilaterally. No longitudinal change was seen in those with mild cognitive impairment at baseline or converters, even when the 2 groups were combined. CONCLUSION Parkinson's patients with poor visual function show increased white matter damage over time, providing further evidence for visual function as a marker of imminent cognitive decline. © 2021 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Angeliki Zarkali
- Dementia Research CentreUniversity College LondonLondonUnited Kingdom
| | - Peter McColgan
- Huntington's Disease CentreUniversity College LondonLondonUnited Kingdom
| | | | - Andrew J. Lees
- Reta Lila Weston Institute of Neurological StudiesLondonUnited Kingdom
| | - Rimona S. Weil
- Dementia Research CentreUniversity College LondonLondonUnited Kingdom,Wellcome Centre for Human NeuroimagingUniversity College LondonLondonUnited Kingdom,Movement Disorders ConsortiumNational Hospital for Neurology and NeurosurgeryLondonUnited Kingdom
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47
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Lees AJ. Bird watching on the asphalt. Brain 2021; 144:2-5. [PMID: 33454751 DOI: 10.1093/brain/awaa437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 11/25/2020] [Indexed: 11/12/2022] Open
Abstract
Attempting to make a diagnosis from a collection of baffling symptoms is comparable to the challenge of identifying an unusual bird that refuses to stay still. Andrew Lees describes how bird watching and a love of natural history helped turn him not only into a noticer, but ultimately into a neurologist.
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Abstract
The global prevalence of Parkinson's disease is increasing, yet the characteristics, risk factors and genetics of PD in Black, Asian and Hispanic populations is little understood. In this paper we review the published literature on clinical variation in the symptoms and signs of Parkinson's disease in different ethnic groups and responses to treatment. We included any study that sampled patients with Parkinson's disease from distinct ethnic backgrounds. We conclude that whilst there is little published evidence for ethnic variation in the clinical features of Parkinson's disease, there are substantial limitations and gaps in the current literature, which mean that the evidence does necessarily not fit with clinical observation. Possible explanations for expected differences in manifestation include genetic determinants, the co-existence of cerebrovascular disease and/or Alzheimer's disease pathology, healthcare inequalities and socio-cultural factors.
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Affiliation(s)
- Aaron Ben-Joseph
- Preventive Neurology Unit, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
| | - Charles R Marshall
- Preventive Neurology Unit, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
| | - Andrew J Lees
- Reta Lila Weston Institute of Neurological Studies and Department of Clinical and Movement Neurosciences, University College London, London, UK
| | - Alastair J Noyce
- Preventive Neurology Unit, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK.,Reta Lila Weston Institute of Neurological Studies and Department of Clinical and Movement Neurosciences, University College London, London, UK
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49
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Bestwick JP, Auger SD, Simonet C, Rees RN, Rack D, Jitlal M, Giovannoni G, Lees AJ, Cuzick J, Schrag AE, Noyce AJ. Improving estimation of Parkinson's disease risk-the enhanced PREDICT-PD algorithm. NPJ Parkinsons Dis 2021; 7:33. [PMID: 33795693 PMCID: PMC8017005 DOI: 10.1038/s41531-021-00176-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 02/22/2021] [Indexed: 12/01/2022]
Abstract
We previously reported a basic algorithm to identify the risk of Parkinson’s disease (PD) using published data on risk factors and prodromal features. Using this algorithm, the PREDICT-PD study identified individuals at increased risk of PD and used tapping speed, hyposmia and REM sleep behaviour disorder (RBD) as “intermediate” markers of prodromal PD in the absence of sufficient incident cases. We have now developed and tested an enhanced algorithm which incorporates the intermediate markers into the risk model. Risk estimates were compared using the enhanced and the basic algorithm in members of the PREDICT-PD pilot cohort. The enhanced PREDICT-PD algorithm yielded a much greater range of risk estimates than the basic algorithm (93–609-fold difference between the 10th and 90th centiles vs 10–13-fold respectively). There was a greater increase in the risk of PD with increasing risk scores for the enhanced algorithm than for the basic algorithm (hazard ratios per one standard deviation increase in log risk of 2.75 [95% CI 1.68–4.50; p < 0.001] versus 1.47 [95% CI 0.86–2.51; p = 0.16] respectively). Estimates from the enhanced algorithm also correlated more closely with subclinical striatal DaT-SPECT dopamine depletion (R2 = 0.164, p = 0.005 vs R2 = 0.043, p = 0.17). Incorporating the previous intermediate markers of prodromal PD and using likelihood ratios improved the accuracy of the PREDICT-PD prediction algorithm.
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Affiliation(s)
- Jonathan P Bestwick
- Preventive Neurology Unit, Wolfson Institute of Preventive Medicine, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Stephen D Auger
- Preventive Neurology Unit, Wolfson Institute of Preventive Medicine, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Cristina Simonet
- Preventive Neurology Unit, Wolfson Institute of Preventive Medicine, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Richard N Rees
- Department of Clinical and Movement Neuroscience, UCL Institute of Neurology, University College London, London, UK
| | - Daniel Rack
- Barts and The London School of Medicine and Dentistry, Queen Mary University, London, UK
| | - Mark Jitlal
- Preventive Neurology Unit, Wolfson Institute of Preventive Medicine, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Gavin Giovannoni
- Preventive Neurology Unit, Wolfson Institute of Preventive Medicine, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK.,Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University, London, UK
| | - Andrew J Lees
- Department of Clinical and Movement Neuroscience, UCL Institute of Neurology, University College London, London, UK
| | - Jack Cuzick
- Preventive Neurology Unit, Wolfson Institute of Preventive Medicine, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Anette E Schrag
- Department of Clinical and Movement Neuroscience, UCL Institute of Neurology, University College London, London, UK
| | - Alastair J Noyce
- Preventive Neurology Unit, Wolfson Institute of Preventive Medicine, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK. .,Department of Clinical and Movement Neuroscience, UCL Institute of Neurology, University College London, London, UK.
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Teive HAG, Camargo CHF, Walusinski O, Lees AJ. Charcot: Buddhist Leanings? Eur Neurol 2021; 84:135-138. [PMID: 33784690 DOI: 10.1159/000514430] [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: 12/12/2020] [Accepted: 01/07/2021] [Indexed: 11/19/2022]
Abstract
Jean-Martin Charcot, considered the father of modern neurology, had a complex personality featuring well-defined characteristics of introversion, competitiveness, irony, and skepticism. While biographers have described him as Republican, anticlerical, and agnostic, the literature also presents evidence that he came to admire Buddhism toward the end of his life; Charcot's involvement with numerous patients suffering from incurable and insidious neurological diseases may have contributed to this change in attitude.
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Affiliation(s)
- Hélio A G Teive
- Neurology Service, Internal Medicine Department, Hospital de Clínicas, Federal University of Paraná, Curitiba, Brazil.,Neurological Diseases Group, Postgraduate Program of Internal Medicine, Hospital de Clínicas, Federal University of Paraná, Curitiba, Brazil
| | - Carlos Henrique F Camargo
- Neurological Diseases Group, Postgraduate Program of Internal Medicine, Hospital de Clínicas, Federal University of Paraná, Curitiba, Brazil
| | | | - Andrew J Lees
- Reta Lila Weston Institute of Neurological Studies, London, United Kingdom
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