Journal of Movement Disorders最新文献

Objective: A lack of standardized methods for evaluating postural abnormalities hinders treatment progress. The role of pelvic lateral shift (PLS) in patients with Parkinson's disease (PwP) exhibiting lateral trunk flexion (LTF) remains unclear. We hypothesized that PLS is related to LTF and investigated its characteristics and relationship with the LTF angle.

Methods: PwP attending outpatient rehabilitation (March 2018-March 2023) were assessed via still images. The PLS direction, its relationship with the LTF angle, and the LTF angle on the PLS side were analyzed.

Results: Among 158 patients, PLS was contralateral in 80 (50.6%), ipsilateral in 43 (27.2%), and absent in 35 (22.2%). In the contralateral PLS, but not in the ipsilateral PLS, the PLS angle was correlated with the LTF angle (r=0.48, p<0.001). The LTF angle was greater in the contralateral shift (8.5°±9.6°) than in the ipsilateral shift (2.8°±4.2°, p<0.001).

Conclusion: Based on the positive relationship between the LTF angle and contralateral shift angle, evaluation criteria that include PLS are needed for PwP with LTF.

Objective: To investigate shoulder function and muscle alterations in patients with Parkinson's disease (PD) and determine their associations with spinopelvic parameters and clinical status.

Methods: This prospective cohort study included 62 PD patients, divided into postural instability and gait difficulty (PIGD) (n=30) and non-PIGD (n=32) groups, as well as 35 controls. The American Shoulder and Elbow Surgeons (ASES) score, shoulder range of motion (ROM), and shoulder muscle stiffness were assessed for each group. Clinical demographics, PD severity, and shoulder-related parameters were extracted and analyzed.

Results: Compared with the control group, the PIGD group had significantly lower total and subscored ASESs (all p<0.05). Compared with the controls, both the PIGD and non-PIGD groups demonstrated reduced abduction and forward flexion (all p<0.05). Compared with the non-PIGD group and the control group, the PIGD group also presented decreased external rotation (all p<0.05). Infraspinatus muscle stiffness was greater in the PIGD group than in the control group (p=0.012). Correlation analysis revealed that shoulder condition was significantly associated with PD severity and the PIGD score, whereas muscle stiffness was linked to spinopelvic alignment and the PIGD score. Various clinical factors, including PD severity, the PIGD score, the tremor score, and spinopelvic alignment, were significantly correlated with shoulder ROM.

Conclusion: PD patients experience shoulder dysfunction in various ways, including decreased ASES scores, limited ROM, and increased shoulder muscle stiffness. Our study highlighted the impact of PD motor subtype, disease severity, and spinopelvic alignment on the development of shoulder dysfunction, offering deeper insights into the pathophysiological basis of shoulder disorders in PD.

Objective: Exercise is a critical nonpharmacological intervention for Parkinson's disease (PD); however, comparative evidence on the efficacy of different exercise modalities is limited. This study aimed to compare the effects of tai chi, strength training, yoga, and home-based exercises on motor function in patients with PD.

Methods: In this multicenter, open-label, randomized clinical trial, 99 patients with PD were allocated to one of four exercise interventions: tai chi, strength training, yoga, or home-based exercises. Each intervention consisted of 12 weeks of supervised sessions, followed by 12 weeks of independent practice. The primary outcomes included the Movement Disorder Society Unified Parkinson's Disease Rating Scale (MDS-UPDRS) Part III and timed up-and-go (TUG) test parameters. The assessed secondary outcomes included physical activity (measured via short physical performance battery and the 6-minute walking test [6MWT]), balance (measured via the Mini-BEST), and freezing of gait (measured via the New Freezing of Gait Questionnaire).

Results: Home exercise and tai chi demonstrated significant improvements in the MDS-UPDRS Part III scores over 24 weeks. The 6MWT was improved by home exercises and tai chi; additionally, the Mini-BEST test scores were enhanced by strength exercises and yoga. The total duration and forward movement of the TUG test, as well as the turning duration measured via the wearable sensor, were markedly improved in the yoga group.

Conclusion: Our results support the notion that various types of adherence to and outcomes of exercise can be observed in real-world settings, even though the effectiveness of exercise is well established. These findings highlight the importance of tailoring exercise regimens by considering individual patients in PD management.

Objective: Woodhouse-Sakati syndrome (WSS) is a rare autosomal recessive neuroendocrine disorder characterized by a variety of endocrine and neurological manifestations, including extrapyramidal symptoms and intellectual disability.

Methods: This report presents the genetic characterization of five Iranian patients with WSS, including the first Iranian patient to undergo deep brain stimulation (DBS).

Results: We highlight five Iranian patients with mutations in the DCAF17 gene presenting with variable features of WSS, with symptom onset in early adolescence. Whole exome sequencing identified four homozygous variants (c.436delC, c.982-2A>G, c.580C>T, and c.838+1G>A) within the DCAF17 gene in the probands. Patients had variable responses to common therapies, and one patient achieved significant improvement following DBS.

Conclusion: We expand the clinical and genetic heterogeneity among Iranian patients and suggest the c.436delC variant as a founder mutation in the region. We highlight the importance of considering WSS in patients with both neurological and endocrine symptoms and suggest DBS as a potential treatment option.

Objective: People with Parkinson's disease (PwPD) experience a gradual decline in bed mobility independence as the disease progresses. Identifying factors associated with nonindependence in daytime bed mobility is crucial for developing effective interventions to increase independence. We investigated factors associated with nonindependence in daytime bed mobility in PwPD.

Methods: This cross-sectional study included 109 PwPD (Hoehn and Yahr [HY] stage 2-4). Patients' bed mobility ability (turning in bed, supine-to-sitting, and sitting-to-supine) was assessed during the daytime, and they were categorized into independent and nonindependent groups. Potential factors associated with bed mobility independence, including components of the Movement Disorders Society-Unified Parkinson's Disease Rating Scale (rigidity, bradykinesia, tremor, axial symptoms), neck/trunk/hip strength, the Mini-Mental State Examination, and the Trail Making Test-A and B, were evaluated.

Results: The nonindependent group presented significantly increased axial symptoms, increased rigidity in the upper and lower limbs and neck, increased upper limb bradykinesia, and decreased trunk flexion/extension strength in all bed mobility tasks (p<0.05). Multivariate regression analyses revealed that axial symptoms, upper limb rigidity, and trunk extension strength were highly discriminative for nonindependence in turning in bed (the area under the curve [AUC]=0.84). Similarly, upper limb rigidity and axial symptoms were predictive of nonindependence in supine-to-sitting and sitting-to-supine movements (AUC=0.78, 0.92). A significant difference in axial symptoms between the HY stage 4 subgroups was observed only in the sitting-to-supine movement.

Conclusion: Our findings indicate that axial symptoms and upper limb rigidity are key factors contributing to nonindependence in daytime bed mobility tasks among PwPD. Targeting these factors in rehabilitation may help mitigate the decline in bed mobility independence in PwPD.