Journal of Movement Disorders最新文献

Objective: To investigate the clinical relevance of occipital hypoperfusion in Parkinson's disease (PD) with respect to clinical phenotype and risk of dementia conversion.

Methods: We enrolled 349 patients with newly diagnosed PD and 48 healthy controls who underwent dual-phase ¹⁸F-N-(3-fluoropropyl)-2β-carboxymethoxy-3β-(4-iodophenyl) nortropane (¹⁸F-FP-CIT) positron emission tomography (PET). Patients with PD were classified into three groups based on posterior cortical perfusion patterns on early-phase ¹⁸F-FP-CIT PET images: PD with preserved posterior cortical perfusion (n = 186), PD with parieto-temporal hypoperfusion (n = 84), and PD with parieto-temporo-occipital hypoperfusion (n = 79). Baseline clinical features and dementia conversion risk were compared across PD groups.

Results: Patients with preserved posterior cortical perfusion were younger than those in the other PD groups. The parieto-temporo-occipital hypoperfusion group tended to have lower Cross-Cultural Smell Identification Test scores, a higher prevalence of rapid eye movement sleep behavior disorder, higher Unified PD Rating Scale motor scores, and more severe reductions in striatal dopamine transporter availability than the other groups. The risk of dementia conversion was lower in patients with preserved posterior cortical perfusion than in those with posterior cortical hypoperfusion. However, the risk of dementia conversion did not differ between the parieto-temporal and parieto-temporo-occipital hypoperfusion groups.

Conclusions: Additional occipital hypoperfusion was not associated with an imminent risk of dementia conversion in patients with PD with posterior cortical hypoperfusion. Nonetheless, occipital involvement may serve as an indicator of the diffuse malignant subtype of PD.

Objective: Sleep disturbances are common and debilitating non-motor symptoms (NMS) in Parkinson's disease (PD), profoundly affecting quality of life. Despite emerging evidence suggesting that monoamine oxidase B (MAO-B) and catechol-O-methyltransferase (COMT) inhibitors may alleviate NMS, their specific effects on sleep remain unclear. This network meta-analysis (NMA) aimed to compare the efficacy of these inhibitors on sleep problems in PD.

Methods: Following a systematic search of PubMed, Cochrane, and EMBASE, studies comparing MAO-B or COMT inhibitors and assessing sleep outcomes in PD were identified. An NMA was conducted using data from the seven studies that met our inclusion criteria. Outcomes included subjective sleep quality, daytime sleepiness, and objective polysomnography (PSG) parameters.

Results: No statistically significant differences were found among MAO-B and COMT inhibitors in improving subjective sleep quality or daytime sleepiness. However, in analyses of objective PSG data, safinamide was found to significantly increase REM sleep duration (mean difference, 5.70 [95% CI, 2.26, 9.14]) and decrease wake time after sleep onset (mean difference, -10.20 [-19.38, -1.02]) compared to rasagiline and placebo.

Conclusion: These findings suggest that safinamide may offer additional value for managing sleep disruptions beyond its known motor benefits in patients with PD. Given the limited number and small scale of available trials, the overall evidence should be interpreted cautiously. Nonetheless, this analysis highlights the need for further high-quality trials focused on sleep outcomes to guide personalized use of MAO-B and COMT inhibitors for sleep disturbances in PD.

Background: Globus pallidus internus deep brain stimulation (GPi-DBS) is an established treatment for dystonia, but its specific efficacy for tardive dystonia (TD) remains less documented. Objectives: To evaluate the long-term clinical outcomes of GPi-DBS and identify optimal stimulation sites in patients with medically refractory TD.

Methods: We retrospectively analyzed 26 patients with TD who underwent bilateral GPi-DBS. Clinical outcomes were assessed using the Burke-Fahn-Marsden Dystonia Rating Scale (BFMDRS). Optimal stimulation sites were identified using voxel-wise Sweetspot analysis.

Results: At an average follow-up of 42 months (range 12-84 months), the mean improvement in the BFMDRS score was 76.7%. Optimal stimulation sites were located in the posteroventral region of the GPi. Two patients experienced sustained symptom remission after DBS cessation. Complications included device-related infection (n=2), dysarthria (n=4), and gait imbalance (n=1); no severe permanent complications occurred.

Conclusion: GPi-DBS is effective and safe for medically refractory tardive dystonia, providing significant long-term symptom relief. Optimal stimulation sites were located in the posteroventral GPi, consistent with those reported for other dystonia types.

Objective: This study aimed to evaluate the feasibility of muscle ultrasonography (US) as a diagnostic tool for assessing sarcopenia in patients with Parkinson's disease (PD) to facilitate early detection and intervention to help prevent falls and enhance quality of life.

Methods: This prospective single-center study evaluated the diagnostic accuracy of US for identifying sarcopenia, using the Asian Working Group for Sarcopenia 2019 criteria as the reference. A total of 85 patients with PD, were recruited between June 2022 and August 2024, consisting of 31 individuals in the sarcopenic group and 54 in the nonsarcopenic group. We compared muscle thickness (MT), cross-sectional area (CSA), and shear wave velocity of the rectus femoris (RF), anterior tibialis (AT), and biceps brachii (BB) between the two groups. Statistical analyses included univariate analysis, correlation analysis, and binary logistic regression to develop a prediction model for sarcopenia.

Results: The sarcopenic group exhibited lower MTBB, MTAT, and CSAAT than the nonsarcopenic group (all p<0.05). MTBB, CSABB, and CSAAT were significantly correlated with the appendicular skeletal muscle mass index and functional measures (all p<0.05). The prediction model, which included age, body mass index, and MTBB as predictors, achieved an area under the curve of 0.857, with a sensitivity of 80.6% and a specificity of 79.6%.

Conclusion: US is a reliable and effective diagnostic tool for assessing sarcopenia in patients with PD, providing a practical approach for early identification of this condition.

Magnetic resonance-guided focused ultrasound (MRgFUS) is an emerging and promising technology for treating movement disorders, such as essential tremors and tremor-dominant Parkinson's disease. MRgFUS utilizes advanced ultrasound transducer emitters to condense sound waves at a precisely defined point. This technology can target various brain areas, such as the pallidothalamic tract, thalamus, and pallidum, to ameliorate some of the symptoms of Parkinson's disease and other movement disorders, such as dystonic and action-induced tremors. We review the current status of preclinical and clinical trials on the clinical use, treatment outcomes, and indications of MRgFUS.