Double Trouble: Association of Malignant Melanoma with Sporadic and Genetic Forms of Parkinson's Disease and Asymptomatic Carriers of Related Genes: A Brief Report

Introduction: Previous epidemiological evidence has established the co-occurrence of malignant melanoma (MM) and Parkinson's disease (PD). Shared molecular mechanisms have been proposed to be implicated in this relationship. The aim of the present study was to assess the prevalence of MM in patients with sporadic and genetic types of PD, as well as in asymptomatic carriers of PD-related genes. Methods: Data regarding past medical history and concomitant disease of 1416 patients with PD (including 20 participants with prodromal disease who phenoconverted to PD), 275 healthy controls (HCs) and 670 asymptomatic carriers of PD-related genes were obtained from the database of the Parkinson's Progression Markers Initiative (PPMI). Focus was placed on information about a medical record of MM. We also retrieved data regarding the genetic status of selected PPMI participants with a positive MM history. Results: In total, 46 patients with PD reported a positive MM history. Concerning the genetic forms of PD, nine of these PD patients (2.47%) carried a Leucine Rich Repeat Kinase 2 (LRRK2) gene mutation (mainly the G2019S), while eight (4.49%) harbored a Glucocerebrosidase (GBA) gene mutation (mainly the N370S). No alpha-synuclein (SNCA) gene mutation was identified in patients with an MM history. The remaining 29 PD patients (3.5%) were genetically undetermined. In total, 18 asymptomatic carriers of PD-related genes had a positive medical history for MM: among them, 10 carried an LRRK2 gene mutation (2.69%) and 10 a GBA gene mutation (3.51%) (2 were dual carriers). MM history was identified for seven HCs (2.5%). Conclusions: We replicated the previously reported association between genetically undetermined PD (GU-PD) and MM. A correlation of LRRK2 mutations with the development of MM could not be verified in either symptomatic PD patients or asymptomatic carriers, implicating distinct pathogenetic mechanisms as compared to GU-PD. Importantly, despite the limited literature evidence on Gaucher disease, this study highlights for the first time the relatively high prevalence of MM among asymptomatic and symptomatic PD GBA mutation carriers, with potential clinical implications.

Ambiental Factors in Parkinson's Disease Progression: A Systematic Review

Background and Objectives: So far, there is little evidence of the ambient effect on motor and non-motor symptoms of Parkinson's Disease (PD). This systematic review aimed to determine the association between ambiental factors and the progression of PD. Materials and Methods: A systematic literature search of PubMed, Cochrane, Embase, and Web of Science was conducted up to 21 December 2021 according the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Results: Eight articles were used in the analyses. Long-term exposure to fine particles (particulate matter ≤ 2.5 μm; PM_2.5) was positively associated with disease aggravation in two studies. Short-term PM_2.5 exposure was positively associated with disease aggravation in three studies. Significant associations were found between PD aggravation and NO₂, SO₂, CO, nitrate and organic matter (OM) concentrations in two studies. Associations were more pronounced, without reaching statistical significance however, in women, patients over 65 years old and cold temperatures. A 1% increase in temperature was associated with a significant 0.18% increase in Levodopa Equivalent Dose (LED). Ultraviolet light and humidity were not significantly associated with an increase in LED. There was no difference in hallucination severity with changing seasons. There was no evidence for seasonal fluctuation in Unified Parkinson's Disease Rating Scale (UPDRS) scores. Conclusions: There is a link between air pollutants and temperature for PD progression, but this has yet to be proven. More longitudinal studies are warranted to confirm these findings.

Effects of a structured dance program in Parkinson's disease. A Greek pilot study

INTRODUCTION

Dance for Parkinson's Disease® (DfPD®) is a structured dance program that has never been evaluated in Greek PD population. This study assesses for the first time the efficacy, safety and feasibility of DfPD® program in Greek PD patients.

MATERIAL AND METHODS

A total of 16 early-to-mid-stage PD patients (50% men, aged 56 ± 12) underwent a total of 16 60-min classes of adjusted to Greek music and dance culture DfPD®, twice weekly, over 8 weeks. Assessments were performed at baseline and at the end of the study period and included quality of life (PDQ-8), depressive symptoms (BDI-II), fatigue (PFS-16), cognitive functions (MoCA), balance (BBS) and body mass index (BMI). Safety (possible falls, injuries, muscle soreness or excessive fatigue) and feasibility (technical and financial parameters, willingness for participation and continuation, recruitment rates) were also assessed.

RESULTS

Statistically significant improvements were found in quality of life (29 ± 47%, p = 0,020), depressive symptoms (26 ± 52%, p = 0,046), fatigue (13 ± 20%, p = 0,021), cognitive functions (17 ± 23%, p = 0,010), balance (5 ± 4%, p = 0,003) and BMI (2 ± 2%, p = 0,010). No adverse events, high adherence (93,75%) and low attrition (12,5%) rates were reported.

CONCLUSION

A twice weekly 60-min DfPD® class for 8 weeks is a safe and feasible non-pharmacological complementary therapeutic intervention for Greek PD patients and may improve their quality of life, depressive symptoms, fatigue, cognitive functions, balance, and BMI. Further research on this intervention is warranted.

Factors associated with perceived social support of patients with multiple sclerosis

Background: Multiple sclerosis (MS) is an inflammatory chronic disease of the central nervous system (CNS) which is related with unpredictable course and increasing disability. Social support as an available interpersonal resource may help patients with MS. The purpose of the present study was to evaluate perceived social support in patients with MS as well as the associated factors. Methods: The sample of this cross-sectional study included 200 patients with MS. Data collection was performed by the completion of the Multidimensional Scale of Perceived Social Support (MSPSS) and a questionnaire which included patients' characteristics. Results: Patients reported to perceive high support from significant others and their family (median: 24.0 and 23.5, respectively) and less from their friends (median: 20). Moreover, a statistically significant association was found between social support from significant others and marital status (P = 0.010), modification of daily activities (P = 0.018), difficulties with social and family environment (P ≤ 0.001 and P ≤ 0.001, respectively), frequent urination (P = 0.015), and whether they easily forgot (P = 0.049), characterized themselves as anxious (P = 0.049), and believed in God (P = 0.002). Also, a statistically significant association was fond between social support from family and relation with health professionals (P = 0.041), difficulties with social and family environment (P = 0.003 and P ≤ 0.001, respectively), and whether they considered themselves as anxious (P = 0.050), and they believed in God (P ≤ 0.001). Furthermore, a statistically significant association was found between support from friends and modification of daily activities (P = 0.010), help in daily activities (P = 0.016), need for movement assistance (P = 0.001), difficulties with social and family environment (P ≤ 0.001 and P = 0.005, respectively), and whether they considered themselves anxious (P = 0.046). Conclusion: Factors associated with perceived social support should be evaluated when planning holistic care to patients with MS.

Medical cannabis as an alternative therapeutics for Parkinsons' disease: Systematic review

OBJECTIVES

1) to evaluate the efficacy of medical cannabinoids (MC) by appraising the quality of evidence from clinical studies 2) to explore the factors hampering the MC use in clinical practice of Parkinson's disease (PD).

METHODS

We performed a systematic review through various databases. The quality of 14 studies was assessed by Cochrane risk bias (5 randomized controlled trials- RCT) and Newcastle-Ottawa scale (9 uncontrolled studies).

RESULTS

The positive effects on motor (5 studies) and non-motor symptoms (4 studies) described in uncontrolled studies have not been confirmed by the few and small RCTs. Only one RCT found a reduction of levodopa-induced dyskinesias, another a reduction in anxiety and tremor amplitude in an anxiogenic situation, while the remaining three without effect on motor/non-motor symptoms. Physical and psychological symptoms are among the most common side effects.

CONCLUSIONS

There is insufficient evidence to reform international legislation regarding cannabis use in PD practice.

A case of Alemtuzumab-induced neutropenia in multiple sclerosis in association with the expansion of large granular lymphocytes

BACKGROUND

Alemtuzumab has been demonstrated to reduce the risks of relapse and accumulation of sustained disability in Multiple Sclerosis (MS) patients compared to β-interferon. It acts against CD52, leading primarily to lymphopenia. Recent data have shown that mild neutropenia is observed in 16% of treated MS-patients whereas severe neutropenia occurred in 0.6%.

CASE PRESENTATION

Herein, we present the case of a 34-year-old woman with relapsing-remitting MS, with a history of treatment with glatiramer acetate and natalizumab, who subsequently received Alemtuzumab (12 mg / 24 h × 5 days). 70-days after the last Alemtuzumab administration, the patient displayed neutropenia (500 neutrophils/μL) with virtual absence of B-cells (0.6% of total lymphocytes), low values of CD4-T-cells (6.6%) and predominance of CD8-T-cells (48%) and NK-cells (47%); while large granular lymphocytes (LGL) predominated in the blood-smear examination. Due to prolonged neutropenia (5-days) the patient was placed on low-dose corticosteroids leading to sustained remission.

CONCLUSION

This is the first case of a patient with relapsing-remitting MS with neutropenia two months post-Alemtuzumab, with simultaneous presence of LGL cells in the blood and a robust therapeutic response to prednisolone. We recommend testing with a complete blood count every 15 days in the first 3 months after the 1st Alemtuzumab administration and searching for large granular lymphocytes cell expansion on microscopic examination of the peripheral blood if neutropenia develops.

Nurses' knowledge about perioperative care of patients with neurological diseases

This study investigated the level of nurses' knowledge regarding the perioperative care of neurological patients. An author-developed questionnaire of 20 items was used in a sample of 94 hospital nurses serving in the neurology, surgery and anesthesiology departments and the intensive care unit. The average percentage of participants with correct answers was 49.2%. The mean value of participants' score was 9.8 ±3.4. Preexisting experience in the care of cases with multiple sclerosis and Parkinson's disease was positively related to the level of knowledge (p = 0.001 and 0.014 respectively). The ascertained level of nurses' knowledge regarding the perioperative care of neurological patients was moderate, questioning their adequacy to handle such cases. Previous experience in the care of particular diseases had significantly positive impact on knowledge, suggesting potential improvement strategies through targeted education and specialization of nurses. In conclusion, nurse's knowledge regarding perioperative care of neurological patients was insufficient, requiring appropriate improvement interventions.

Predicting caregiving status and caregivers' burden in multiple sclerosis. A short report

OBJECTIVES

Predicting caregiving status (CS) in multiple sclerosis (MS) is of both clinical and health policy-making value. The aim of this cross-sectional study was to assess the clinical predictors of CS, along with factors related to caregivers' stress.

METHODS

A sample of 342 clinically definite MS patients (67.5% females, 67.8% relapsing MS, mean age 43.1 ± 11.4 year-old, mean disease duration 147 ± 105.4 months, median Expanded Disability Status Scale -EDSS-3.0) was screened for CS. The Multiple Sclerosis Quality of Life-54 and Zarit Burden Interview were used to measure quality of patients' life and the their caregivers' burden, respectively.

RESULTS

In total, 57.9% of patients reported at least one caregiver, 97% of which were relatives or friends. Higher EDSS was associated with higher chance of reporting a caregiver. Two EDSS cut-offs were recognized; 2.0 and 4.5, the former with increased sensitivity (78.8%) and the latter with increased specificity (82.3%) to predict CS. Patients in the mild disability group (EDSS: 0-1.5) needing a caregiver had higher subjective cognitive function, implying presumably a beneficial role of care in cognition. Age and education were showed to affect CS in the moderate disability group (EDSS: 2.0-4.5). Physical and mental disability was more pronounced in patients reporting at least one caregiver in the high disability group (EDSS above 4.5). Caregivers' stress was significantly positively correlated with age, EDSS, and duration of the disease and negatively with cognitive, physical, and mental health.

DISCUSSION

In conclusion, the clinical predictors of CS are known to serve well both the researchers and the clinicians.