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Morrow CB, Hinkle JT, Seemiller J, Mills KA, Pontone GM. The Association of Antidepressant Use and Impulse Control Disorder in Parkinson's Disease. Am J Geriatr Psychiatry 2024; 32:710-720. [PMID: 38238235 PMCID: PMC11096064 DOI: 10.1016/j.jagp.2023.12.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 12/22/2023] [Accepted: 12/27/2023] [Indexed: 02/22/2024]
Abstract
OBJECTIVES To examine whether initiation of an antidepressant is associated with the development of impulse control disorder (ICD) in patients with Parkinson's disease (PD). DESIGN We performed a retrospective analysis utilizing data from the Parkinson's Progression Markers Initiative (PPMI). Two-sample Mann-Whitney tests were used for comparison of continuous variables and Pearson χ2 tests were used for categorical variables. Kaplan-Meier survival analysis and cox proportional hazards regression analysis was used to assess the hazard of ICD with antidepressant exposure. SETTING The PPMI is a multicenter observational study of early PD with 52 sites throughout North America, Europe, and Africa. PARTICIPANTS Participants in the current study were those in the PPMI PD cohort with a primary diagnosis of idiopathic PD. MEASUREMENTS The presence of ICD was captured using the Questionnaire for Impulsive-Compulsive Disorders in Parkinson's Disease (QUIP). Antidepressant use was defined based on medication logs for each participant. Depressive symptoms were captured using the Geriatric Depression Scale (GDS). RESULTS A total of 1,045 individuals were included in the final analysis. There was a significant increase in the probability of ICD in those exposed to serotonergic antidepressants compared to those not exposed (Log-rank p <0.001). Serotonergic antidepressant use was associated with a hazard ratio for ICD of 1.4 (95% CI 1.0-1.8, z-value 2.1, p = 0.04) after adjusting for dopamine agonist use, depression, bupropion use, MAOI-B use, amantadine use, LEDD, disease duration, sex, and age. CONCLUSIONS Serotonergic antidepressant use appears to be temporally associated with ICD in patients with PD.
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Affiliation(s)
- Christopher B Morrow
- Department of Psychiatry and Behavioral Sciences (CBM, JTH, GMP), Johns Hopkins University School of Medicine, Baltimore, MD.
| | - Jared T Hinkle
- Department of Psychiatry and Behavioral Sciences (CBM, JTH, GMP), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Joseph Seemiller
- Department of Neurology (JS, KAM), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Kelly A Mills
- Department of Neurology (JS, KAM), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Gregory M Pontone
- Department of Psychiatry and Behavioral Sciences (CBM, JTH, GMP), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurology (GMP), University of Florida College of Medicine, Gainesville, FL
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Seemiller J, Morrow C, Hinkle JT, Perepezko K, Kamath V, Pontone GM, Mills KA. Impact of Acute Dopamine Replacement on Cognitive Function in Parkinson's Disease. Mov Disord Clin Pract 2024; 11:534-542. [PMID: 38470011 PMCID: PMC11078494 DOI: 10.1002/mdc3.14017] [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: 11/02/2023] [Revised: 01/10/2024] [Accepted: 02/13/2024] [Indexed: 03/13/2024] Open
Abstract
BACKGROUND PD causes striatal dopaminergic denervation in a posterior/dorsal to anterior/ventral gradient, leaving motor and associative cortico-striato-pallido-thalamic loops differentially susceptible to hyperdopaminergic effects with treatment. As the choice and titration of symptomatic PD medications are guided primarily by motor symptoms, it is important to understand their cognitive implications. OBJECTIVE To investigate the effects of acute dopaminergic medication administration on executive function in Parkinson's disease (PD). METHODS Participants with idiopathic PD were administered the oral Symbol Digit Modalities Test (SDMT; n = 181) and the Stroop test (n = 172) in the off-medication and "best on" medication states. ANCOVA was used to test for differences between off-medication and on-medication scores corrected for age and years of education. RESULTS After administration of symptomatic medications, scores worsened on the SDMT (F = 11.70, P < 0.001, d = -0.13), improved on the Stroop color (F = 26.89, P < 0.001, d = 0.184), word (F = 6.25, P = 0.013, d = 0.09), and color-word (F = 13.22, P < 0.001, d = 0.16) test components, and the Stroop difference and ratio-based interference scores did not significantly change. Longer disease duration correlated with lower scores on the SDMT, Stroop color, word, and color-word scores; however, longer disease duration and higher levodopa-equivalents correlated with higher Stroop difference-based interference scores. CONCLUSIONS Symptomatic medication differentially affects performance on two cognitive tests in PD. After acute treatment, core Stroop measures improved, Stroop interference was unchanged, and SDMT performance worsened, likely reflecting complex changes in processing speed and executive function related to acute treatment. When considering motor symptom therapies in PD, an individual's cognitive demands and expectations, especially regarding executive function, should be considered.
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Affiliation(s)
- Joseph Seemiller
- Department of NeurologyJohns Hopkins School of MedicineBaltimoreMarylandUSA
| | - Christopher Morrow
- Department of Psychiatry and Behavioral SciencesJohns Hopkins School of MedicineBaltimoreMarylandUSA
| | - Jared T. Hinkle
- Department of Psychiatry and Behavioral SciencesJohns Hopkins School of MedicineBaltimoreMarylandUSA
| | - Kate Perepezko
- National Rehabilitation Research & Training Center on Family Support, University of PittsburghPittsburghPennsylvaniaUSA
| | - Vidyulata Kamath
- Department of Psychiatry and Behavioral SciencesJohns Hopkins School of MedicineBaltimoreMarylandUSA
| | - Gregory M. Pontone
- Department of Psychiatry and Behavioral SciencesJohns Hopkins School of MedicineBaltimoreMarylandUSA
- Department of NeurologyUniversity of Florida College of MedicineGainesvilleFloridaUSA
| | - Kelly A. Mills
- Department of NeurologyJohns Hopkins School of MedicineBaltimoreMarylandUSA
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Morrow CB, Hinkle JT, Seemiller J, Mills KA, Pontone GM. Examining the link between impulse control disorder and antidepressant use in Parkinson's disease. Parkinsonism Relat Disord 2023; 117:105918. [PMID: 37922636 PMCID: PMC10842227 DOI: 10.1016/j.parkreldis.2023.105918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 10/26/2023] [Accepted: 10/27/2023] [Indexed: 11/07/2023]
Abstract
INTRODUCTION Impulse control disorders (ICD) in Parkinson's disease (PD) and hypomanic episodes of bipolar disorder show overlapping symptoms, suggesting a shared neurobiology. To explore this, the following hypotheses are tested: (1) larger changes in affective symptoms from OFF to ON medication states will be associated with ICD, (2) antidepressant exposure will be associated with larger OFF to ON affective symptom changes, and (3) antidepressant exposure will be associated with ICD. METHODS 200 participants (mean age 65, 61 % male) were evaluated in "off" and "on" dopamine states. Affective symptoms were captured using the Hamilton Anxiety and Depression Rating Scales. Differences in clinical outcomes were compared using two-sample Wilcoxon rank-sum tests and Pearson χ2 tests. We performed multivariable logistic regression to assess the association of antidepressant exposure on ICD. RESULTS Participants with an ICD had higher anxiety and depressive scores in "on" and "off" states and larger changes in depressive symptoms from OFF to ON states compared to those without an ICD. Participants on antidepressants had higher anxiety scores in "on" and "off" states, higher depressive scores in the "off" state, and larger changes in anxiety symptoms from OFF to ON states than those not on an antidepressant. Antidepressant use was associated with a higher odds of an ICD (OR 2.3, CI [1.0-4.5], p-value 0.04). CONCLUSIONS Affective symptom severity in "on" and "off" dopamine states is associated with ICD. Antidepressant therapy may be associated with ICD. Future prospective studies clarifying temporal associations between antidepressant initiation and ICD emergence are needed.
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Affiliation(s)
- Christopher B Morrow
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, USA.
| | - Jared T Hinkle
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, USA
| | - Joseph Seemiller
- Department of Neurology, Johns Hopkins University School of Medicine, USA
| | - Kelly A Mills
- Department of Neurology, Johns Hopkins University School of Medicine, USA
| | - Gregory M Pontone
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, USA
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Berger SL, Seemiller J, Rosenthal LS. Synuclein Seed Amplification in the Cerebrospinal Fluid: Research and Clinical Implications. Mov Disord 2023; 38:1990-1991. [PMID: 37860997 DOI: 10.1002/mds.29619] [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: 05/24/2023] [Revised: 07/03/2023] [Accepted: 09/07/2023] [Indexed: 10/21/2023] Open
Affiliation(s)
- Stephen L Berger
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Joseph Seemiller
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Liana S Rosenthal
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
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Seemiller J, Challagundla S, Taylor T, Zand R. Intrathecal blood injection: a case report of a rare complication of an epidural blood patch. BMC Neurol 2020; 20:187. [PMID: 32404065 PMCID: PMC7222553 DOI: 10.1186/s12883-020-01763-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 05/04/2020] [Indexed: 11/10/2022] Open
Abstract
Background Intrathecal injection is a rare complication of spinal anesthesia and an underreported complication of epidural blood patches. Although there are other reported cases of intrathecal blood injection, these cases lack confirmatory imaging and others report injection of mixed blood with other agents. Case presentation We present a case report of post-laminectomy cerebrospinal fluid leak who underwent epidural blood patch placement. CT and MRI brain imaging was obtained, depicting intrathecal blood products. The patient had subsequent seizures and respiratory distress, received supportive care, and returned to baseline after several days. Conclusion The patient’s clinical course illustrates the potential complications of blood products within CSF, including seizures and respiratory distress, which improved with supportive care in this case. Importantly, to our knowledge, this is the only report that clearly depicts injection of purely blood products, without other confounding agents (such as gadolinium), into intrathecal space and with diffuse spread through the CSF as visualized on CT and MRI imaging.
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Affiliation(s)
- Joseph Seemiller
- Department of Neurology, Neuroscience Institute, Geisinger Medical Center, 100 N. Academy Ave, Danville, PA, 17822, USA.
| | - Sankeerth Challagundla
- Department of Neurology, Neuroscience Institute, Geisinger Medical Center, 100 N. Academy Ave, Danville, PA, 17822, USA
| | - Travis Taylor
- Department of Neurology, Neuroscience Institute, Geisinger Medical Center, 100 N. Academy Ave, Danville, PA, 17822, USA
| | - Ramin Zand
- Department of Neurology, Neuroscience Institute, Geisinger Medical Center, 100 N. Academy Ave, Danville, PA, 17822, USA
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Schwartz F, Tahmasian M, Maier F, Rochhausen L, Schnorrenberg KL, Samea F, Seemiller J, Zarei M, Sorg C, Drzezga A, Timmermann L, Meyer TD, van Eimeren T, Eggers C. Overlapping and distinct neural metabolic patterns related to impulsivity and hypomania in Parkinson's disease. Brain Imaging Behav 2019; 13:241-254. [PMID: 29322397 DOI: 10.1007/s11682-017-9812-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Impulsivity and hypomania are common non-motor features in Parkinson's disease (PD). The aim of this study was to find the overlapping and distinct neural correlates of these symptoms in PD. Symptoms of impulsivity and hypomania were assessed in 24 PD patients using the Barratt Impulsiveness Scale (BIS-11) and Self-Report Manic Inventory (SRMI), respectively. In addition, fluorodeoxyglucose positron emission tomography (FDG-PET) imaging for each individual was performed. We conducted two separate multiple regression analyses for BIS-11 and SRMI scores with FDG-PET data to identify the brain regions that are associated with both impulsivity and hypomania scores, as well as those exclusive to each symptom. Then, seed-based functional connectivity analyses on healthy subjects identified the areas connected to each of the exclusive regions and the overlapping region, used as seeds. We observed a positive association between BIS-11 and SRMI scores and neural metabolism only in the prefrontal areas. Conjunction analysis revealed an overlapping region in the middle frontal gyrus. Regions exclusive to impulsivity were found in the medial part of the right superior frontal gyrus and regions exclusive to hypomania were in the right superior frontal gyrus, right precentral gyrus and right paracentral lobule. Connectivity patterns of seeds exclusively related to impulsivity were different from those for hypomania in healthy brains. These results provide evidence of both overlapping and distinct regions linked with impulsivity and hypomania scores in PD. The exclusive regions for each characteristic are connected to specific intrinsic functional networks.
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Affiliation(s)
- Frank Schwartz
- Department of Neurology, University Hospital Cologne, Cologne, Germany
| | - Masoud Tahmasian
- Institute of Medical Science and Technology, Shahid Beheshti University, Tehran, Iran.
| | - Franziska Maier
- Department of Neurology, University Hospital Cologne, Cologne, Germany.,Department of Neurology, University Hospital Marburg, Marburg, Germany
| | - Luisa Rochhausen
- Department of Neurology, University Hospital Cologne, Cologne, Germany
| | | | - Fateme Samea
- Institute for Cognitive and Brain Sciences, Shahid Beheshti University, Tehran, Iran
| | | | - Mojtaba Zarei
- Institute of Medical Science and Technology, Shahid Beheshti University, Tehran, Iran
| | - Christian Sorg
- Departments of Neuroradiology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany.,TUM-Neuroimaging Center (TUM-NIC), Technische Universität München, Munich, Germany.,Department of Psychiatry, Technische Universität München, Munich, Germany
| | - Alexander Drzezga
- Department of Nuclear Medicine, University Hospital Cologne, Cologne, Germany
| | - Lars Timmermann
- Department of Neurology, University Hospital Cologne, Cologne, Germany.,Department of Neurology, University Hospital Marburg, Marburg, Germany
| | - Thomas D Meyer
- McGovern Medical School, Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center, Houston, TX, USA
| | - Thilo van Eimeren
- Department of Neurology, University Hospital Cologne, Cologne, Germany.,Department of Nuclear Medicine, University Hospital Cologne, Cologne, Germany
| | - Carsten Eggers
- Department of Neurology, University Hospital Cologne, Cologne, Germany.,Department of Neurology, University Hospital Marburg, Marburg, Germany
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Hoenig MC, Bischof GN, Seemiller J, Hammes J, Kukolja J, Onur ÖA, Jessen F, Fliessbach K, Neumaier B, Fink GR, van Eimeren T, Drzezga A. Networks of tau distribution in Alzheimer’s disease. Brain 2018; 141:568-581. [DOI: 10.1093/brain/awx353] [Citation(s) in RCA: 94] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Accepted: 11/08/2017] [Indexed: 12/13/2022] Open
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