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Li D, Butala AA, Moro-Velazquez L, Meyer T, Oh ES, Motley C, Villalba J, Dehak N. Automating the analysis of eye movement for different neurodegenerative disorders. Comput Biol Med 2024; 170:107951. [PMID: 38219646 DOI: 10.1016/j.compbiomed.2024.107951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 12/08/2023] [Accepted: 01/01/2024] [Indexed: 01/16/2024]
Abstract
The clinical observation and assessment of extra-ocular movements is common practice in assessing neurodegenerative disorders but remains observer-dependent. In the present study, we propose an algorithm that can automatically identify saccades, fixation, smooth pursuit, and blinks using a non-invasive eye tracker. Subsequently, response-to-stimuli-derived interpretable features were elicited that objectively and quantitatively assess patient behaviors. The cohort analysis encompasses persons with mild cognitive impairment (MCI), Alzheimer's disease (AD), Parkinson's disease (PD), Parkinson's disease mimics (PDM), and controls (CTRL). Overall, results suggested that the AD/MCI and PD groups had significantly different saccade and pursuit characteristics compared to CTRL when the target moved faster or covered a larger visual angle during smooth pursuit. These two groups also displayed more omitted antisaccades and longer average antisaccade latency than CTRL. When reading a text passage silently, people with AD/MCI had more fixations. During visual exploration, people with PD demonstrated a more variable saccade duration than other groups. In the prosaccade task, the PD group showed a significantly smaller average hypometria gain and accuracy, with the most statistical significance and highest AUC scores of features studied. The minimum saccade gain was a PD-specific feature different from CTRL and PDM. These features, as oculographic biomarkers, can be potentially leveraged in distinguishing different types of NDs, yielding more objective and precise protocols to diagnose and monitor disease progression.
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Affiliation(s)
- Deming Li
- Department of Electrical and Computer Engineering, The Johns Hopkins University, Baltimore, 21218, MD, USA.
| | - Ankur A Butala
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, 21205, MD, USA
| | - Laureano Moro-Velazquez
- Department of Electrical and Computer Engineering, The Johns Hopkins University, Baltimore, 21218, MD, USA
| | - Trevor Meyer
- Department of Electrical and Computer Engineering, The Johns Hopkins University, Baltimore, 21218, MD, USA
| | - Esther S Oh
- Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, Baltimore, 21205, MD, USA
| | - Chelsey Motley
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, 21205, MD, USA
| | - Jesús Villalba
- Department of Electrical and Computer Engineering, The Johns Hopkins University, Baltimore, 21218, MD, USA
| | - Najim Dehak
- Department of Electrical and Computer Engineering, The Johns Hopkins University, Baltimore, 21218, MD, USA
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Miller DG, Yegya-Raman N, Friedes C, Cengel KA, Plastaras JP, Simone Ii CB, Cohen R, Langer C, Feigenberg SJ, Butala AA. Pneumonitis after Palliative Thoracic Radiotherapy +/- Immunotherapy: A Retrospective Propensity-Matched Cohort Study. Int J Radiat Oncol Biol Phys 2023; 117:e138. [PMID: 37784706 DOI: 10.1016/j.ijrobp.2023.06.945] [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] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Patients (pts) with advanced lung cancer often receive combined palliative thoracic radiotherapy (RT) and immune checkpoint inhibitors (ICI). There are limited data assessing the toxicities of combined ICI-RT in this setting. We sought to compare the rates of clinically significant pneumonitis among pts with lung cancer receiving palliative thoracic RT with or without recent or concomitant ICI. We hypothesized there would be a higher rate of grade 2+ pneumonitis among RT pts who received recent or concomitant ICI compared to those who did not. MATERIALS/METHODS We retrospectively identified consecutive pts with advanced/recurrent lung cancer from a tertiary academic center who received palliative thoracic RT with recent (defined as within 95 days of RT start) or concomitant ICI (ICI-RT group) between January 2014 and February 2020. Pts were propensity matched in a 1:1 manner (by age, sex, ECOG, RT modality, and RT dose) to lung cancer pts who received palliative thoracic RT without any history of ICI receipt (RT-only group). The presence and grade (CTCAE v5.0) of pneumonitis were independently assessed by two investigators. The primary endpoint was grade 2+ pneumonitis, estimated using the cumulative incidence function and compared between the ICI-RT and RT-only groups using Gray's test. The secondary endpoint was overall survival, estimated using the Kaplan-Meier method and compared between groups using the log-rank test. RESULTS A total of 146 pts were included in the study (73 in each group). There were no statistically significant differences between the ICI-RT and RT-only groups with respect to age (median 67.7 vs. 67.6, p = 0.97), sex (52% vs. 52% female, p = 1.00), pre-treatment ECOG 0-1 (74% vs 75%, p = 0.85), or biologically effective dose greater than 45 (48% vs. 48%, p = 1.00). The most common RT regimens were 30 Gy in 10 fractions (33 pts, 23%) and 20 Gy in 5 fractions (18 patients, 12%). A plurality of cases utilized 3DCRT (67 pts, 46%). In the ICI-RT group, the median time from last dose of ICI to the start of palliative RT was 16 days; three pts in this group-initiated ICI while receiving RT treatment. The most common ICI was pembrolizumab (36 pts, 49%). A total of eleven grade 2+ pneumonitis events (nine grade 2 and two grade 3 events) were observed. The ICI-RT group had a higher cumulative incidence of grade 2+ pneumonitis compared with the RT-only group (1-year rate, 12.3% vs. 2.7%, p = 0.029); grade 3 pneumonitis occurred in 1/73 (1.4%) in each group. There was no difference in overall survival between groups (median 239 vs. 218 days, p = 0.76). CONCLUSION In pts with advanced lung cancer treated with palliative thoracic RT, recent or concomitant ICI use was associated with a higher cumulative incidence of grade 2+ pneumonitis. However, the incidence of grade 3+ pneumonitis was low (1.4%) regardless of ICI receipt.
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Affiliation(s)
- D G Miller
- Department of Radiation Oncology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - N Yegya-Raman
- Department of Radiation Oncology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - C Friedes
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA
| | - K A Cengel
- Department of Radiation Oncology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - J P Plastaras
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA
| | | | - R Cohen
- Department of Hematology and Oncology, University of Pennsylvania, Philadelphia, PA
| | - C Langer
- Department of Hematology and Oncology, University of Pennsylvania, Philadelphia, PA
| | - S J Feigenberg
- Department of Radiation Oncology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - A A Butala
- Department of Radiation Oncology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
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Dulski J, Koga S, Liberski PP, Sitek EJ, Butala AA, Sławek J, Dickson DW, Wszolek ZK. Perry Disease: Expanding the Genetic Basis. Mov Disord Clin Pract 2023; 10:1136-1142. [PMID: 37476320 PMCID: PMC10354621 DOI: 10.1002/mdc3.13764] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 04/19/2023] [Accepted: 04/28/2023] [Indexed: 07/22/2023] Open
Abstract
Background Perry disease (or Perry syndrome [PS]) is a hereditary neurodegenerative disorder inevitably leading to death within few years from onset. All previous cases with pathological confirmation were caused by mutations within the cytoskeleton-associated protein glycine-rich (CAP-Gly) domain of the DCTN1 gene. Objectives This paper presents the first clinicopathological report of PS due to a novel DCTN1 mutation outside the CAP-Gly domain. Methods Clinical and pathological features of the new variant carrier are compared with another recently deceased PS case with a well-known pathogenic DCTN1 mutation and other reported cases. Results and Conclusions We report a novel DCTN1 mutation outside the CAP-Gly domain that we demonstrated to be pathogenic based on clinical and autopsy findings.
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Affiliation(s)
- Jarosław Dulski
- Department of NeurologyMayo ClinicJacksonvilleFloridaUSA
- Division of Neurological and Psychiatric NursingFaculty of Health Sciences, Medical University of GdanskGdanskPoland
- Neurology DepartmentSt Adalbert Hospital, Copernicus PLGdanskPoland
| | - Shunsuke Koga
- Department of NeuroscienceMayo ClinicJacksonvilleFloridaUSA
| | - Paweł P. Liberski
- Department of Molecular Pathology and NeuropathologyMedical University of LodzŁódźPoland
- Faculty of Health Science, The Mazovian State University in PłockPłockPoland
| | - Emilia J. Sitek
- Neurology DepartmentSt Adalbert Hospital, Copernicus PLGdanskPoland
- Laboratory of Clinical Neuropsychology, Neurolinguistics and Neuropsychotherapy, Division of Neurological and Psychiatric NursingFaculty of Health Sciences, Medical University of GdanskGdanskPoland
| | - Ankur A. Butala
- Neurology, Psychiatry and Behavioral SciencesJohns Hopkins University School of MedicineBaltimoreMarylandUSA
| | - Jarosław Sławek
- Division of Neurological and Psychiatric NursingFaculty of Health Sciences, Medical University of GdanskGdanskPoland
- Neurology DepartmentSt Adalbert Hospital, Copernicus PLGdanskPoland
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Hac NEF, Murphy OC, Butala AA, Newsome SD, Gold DR. Centripetal Nystagmus, Slow Saccades, Cerebellar Ataxia, and Parkinsonism in a Patient With Anti-GAD65-Associated Stiff Person Syndrome Spectrum Disorder. J Neuroophthalmol 2023; 43:273-276. [PMID: 36728609 DOI: 10.1097/wno.0000000000001774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
ABSTRACT A 68-year-old woman with positional dizziness and progressive imbalance presented for vestibular evaluation. Examination was notable for spontaneous downbeat nystagmus (DBN), horizontal and vertical gaze-evoked nystagmus (GEN) with centripetal and rebound nystagmus, and positional apogeotropic nystagmus. There was also mild-moderate slowing of saccades horizontally and vertically and poor fast phases with an optokinetic stimulus. Further consultation by a movement disorder specialist uncovered asymmetric decrementing bradykinesia and rigidity, masked facies, and a wide-based stance without camptocormia. Screening serum laboratory results for metabolic, rheumatologic, infectious, heavy metal, endocrine, or vitamin abnormalities was normal. Surveillance imaging for neoplasms was unremarkable, and cerebrospinal fluid (CSF) analysis was negative for 14-3-3 and real-time quaking-induced conversion (RT-QuIC). However, her anti-glutamic acid decarboxylase-65 (GAD65) immunoglobulin G (IgG) level was markedly elevated in serum to 426,202 IU/mL (reference range 0-5 IU/mL) and in CSF to 18.1 nmol/L (reference range <0.03 nmol/L). No other autoantibodies were identified on the expanded paraneoplastic panel. The patient was referred to neuroimmunology, where torso rigidity, spasticity, and significant paravertebral muscle spasms were noted. Overall, the clinical presentation, examination findings, and extensive workup were consistent with a diagnosis of anti-GAD65-associated stiff person syndrome-plus (musculoskeletal plus cerebellar and/or brainstem involvement). She was subsequently treated with intravenous immunoglobulin (IVIg) and has been stable since commencing this therapy. In patients with centripetal nystagmus, especially in association with other cerebellar findings, an autoimmune cerebellar workup should be considered.
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Affiliation(s)
- Nicholas E F Hac
- Department of Neurology (NEFH), Northwestern University, Chicago, Illinois; and Department of Neurology (OCM, AAB, SDN, DRG), The Johns Hopkins University School of Medicine, Baltimore, Maryland
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Cascella N, Butala AA, Mills K, Kim MJ, Salimpour Y, Wojtasievicz T, Hwang B, Cullen B, Figee M, Moran L, Lenz F, Sawa A, Schretlen DJ, Anderson W. Deep Brain Stimulation of the Substantia Nigra Pars Reticulata for Treatment-Resistant Schizophrenia: A Case Report. Biol Psychiatry 2021; 90:e57-e59. [PMID: 33906736 DOI: 10.1016/j.biopsych.2021.03.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 03/02/2021] [Indexed: 12/26/2022]
Affiliation(s)
- Nicola Cascella
- Johns Hopkins Schizophrenia Center, Johns Hopkins Hospital, the Johns Hopkins University School of Medicine and Bloomberg School of Public Health, Baltimore, Maryland; Department of Psychiatry, Johns Hopkins Hospital, the Johns Hopkins University School of Medicine and Bloomberg School of Public Health, Baltimore, Maryland.
| | - Ankur A Butala
- Department of Psychiatry, Johns Hopkins Hospital, the Johns Hopkins University School of Medicine and Bloomberg School of Public Health, Baltimore, Maryland; Department of Neurology, Johns Hopkins Hospital, the Johns Hopkins University School of Medicine and Bloomberg School of Public Health, Baltimore, Maryland
| | - Kelly Mills
- Department of Neurology, Johns Hopkins Hospital, the Johns Hopkins University School of Medicine and Bloomberg School of Public Health, Baltimore, Maryland
| | - Min Jae Kim
- Department of Neurology, Johns Hopkins Hospital, the Johns Hopkins University School of Medicine and Bloomberg School of Public Health, Baltimore, Maryland
| | - Yousef Salimpour
- Department of Neurology, Johns Hopkins Hospital, the Johns Hopkins University School of Medicine and Bloomberg School of Public Health, Baltimore, Maryland
| | - Teresa Wojtasievicz
- Department of Neurosurgery, Johns Hopkins Hospital, the Johns Hopkins University School of Medicine and Bloomberg School of Public Health, Baltimore, Maryland
| | - Brian Hwang
- Department of Neurosurgery, Johns Hopkins Hospital, the Johns Hopkins University School of Medicine and Bloomberg School of Public Health, Baltimore, Maryland
| | - Bernadette Cullen
- Department of Psychiatry, Johns Hopkins Hospital, the Johns Hopkins University School of Medicine and Bloomberg School of Public Health, Baltimore, Maryland
| | - Martijn Figee
- Nash Family Center for Advanced Circuit Therapeutics, Icahn School of Medicine, New York, New York
| | - Lauren Moran
- Division of Psychotic Disorders, McLean Hospital, Belmont, Massachusetts
| | - Fred Lenz
- Department of Neurosurgery, Johns Hopkins Hospital, the Johns Hopkins University School of Medicine and Bloomberg School of Public Health, Baltimore, Maryland
| | - Akira Sawa
- Johns Hopkins Schizophrenia Center, Johns Hopkins Hospital, the Johns Hopkins University School of Medicine and Bloomberg School of Public Health, Baltimore, Maryland; Department of Psychiatry, Johns Hopkins Hospital, the Johns Hopkins University School of Medicine and Bloomberg School of Public Health, Baltimore, Maryland; Department of Neuroscience, Johns Hopkins Hospital, the Johns Hopkins University School of Medicine and Bloomberg School of Public Health, Baltimore, Maryland; Department of Biomedical Engineering, Johns Hopkins Hospital, the Johns Hopkins University School of Medicine and Bloomberg School of Public Health, Baltimore, Maryland; Department of Mental Health, Johns Hopkins Hospital, the Johns Hopkins University School of Medicine and Bloomberg School of Public Health, Baltimore, Maryland
| | - David J Schretlen
- Department of Psychiatry, Johns Hopkins Hospital, the Johns Hopkins University School of Medicine and Bloomberg School of Public Health, Baltimore, Maryland
| | - William Anderson
- Department of Neurosurgery, Johns Hopkins Hospital, the Johns Hopkins University School of Medicine and Bloomberg School of Public Health, Baltimore, Maryland
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Hwang BY, Mampre D, Mills K, Courtney P, Kim MJ, Butala AA, Anderson WS. Non-staged bilateral Globus Pallidus Internus deep brain stimulation lead revision using intraoperative MRI: a case report and literature review. Br J Neurosurg 2020; 35:301-305. [PMID: 32648480 DOI: 10.1080/02688697.2020.1789556] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Deep brain stimulation (DBS) lead revision due to suboptimal therapy is common but there is no standardised protocol. We describe a novel technique using iMRI to perform concurrent new Globus Pallidus Internus (GPi) DBS lead implantation and old lead removal in a dystonia patient.Case-description: A 60-year-old woman with medication and neurotoxin-refractory isolated cervical dystonia underwent awake bilateral GPi DBS surgery with MER-guided lead implantation. She initially had a favourable response but later reported suboptimal benefit despite reprogramming. MRI demonstrated suboptimal lead placement and MRI-guided revision surgery under general anesthesia was planned. The goal was to place new leads superior and medial to the existing leads. Using a 1.5 T iMRI and the ClearPoint® NeuroNavigation system, new leads were placed through the existing burr holes, into the new targets with radial errors < 0.08mm bilaterally without crossing the old leads. The old leads were then removed and the new leads connected to the existing pulse generator. The patient tolerated the procedure well and had improved side-effect profile at all contacts at 1-month follow-up. CONCLUSIONS Non-staged iMRI-guided DBS revision surgery under general anesthesia is technically feasible and is an alternative strategy to a staged iMRI-guided revision surgery or an awake MER-guided revision surgery in select patients.
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Affiliation(s)
- Brian Y Hwang
- Department of Neurosurgery, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - David Mampre
- Department of Neurosurgery, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Kelly Mills
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Pamala Courtney
- Department of Radiology, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Min Jae Kim
- Department of Biomedical Engineering and Neuroscience, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Ankur A Butala
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - William S Anderson
- Department of Neurosurgery, Johns Hopkins School of Medicine, Baltimore, MD, USA
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Butala AA, Pontone GM. Absence of Evidence Versus Evidence of Absence-SAPS-PD. Am J Geriatr Psychiatry 2018; 26:1012-1013. [PMID: 30077588 DOI: 10.1016/j.jagp.2018.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 06/18/2018] [Accepted: 06/18/2018] [Indexed: 11/24/2022]
Affiliation(s)
- Ankur A Butala
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD; Department of Psychiatry, Johns Hopkins University School of Medicine, Baltimore, MD.
| | - Gregory M Pontone
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD; Department of Psychiatry, Johns Hopkins University School of Medicine, Baltimore, MD
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