Movement Disorders Clinical Practice最新文献

Background: Predicting falls in patients with Parkinson's disease (PD) is challenging despite their significant frequency and consequences.

Objectives: To determine incidences of first fall, walking aid requirement, and identify risk factors of subsequent risk, including factors unrelated to PD.

Methods: Study in 415 PD patients (DIGPD prospective cohort). Cumulative incidence curves were calculated and Generalized Linear Mixed Models investigated influencing factors.

Results: Five years after diagnosis, 26.1% of patients experienced falls while only 2.1% required walking aids; after 10 years, it rose to 66.5% and 17%, respectively. Median time to first fall was 7.9 years. Risk factors of falls were cognitive decline, freezing, comorbidities such as diabetes and depression, history of falls particularly in male, or low Body Mass Index (BMIs). Walking aids risk factors were older age, freezing, lower walking speed, higher BMIs, history of walking aid.

Conclusions: Treatable comorbidities (depression, diabetes, weight regulation) should be addressed in daily care to avoid falls in PD patients.

Objective: To honor the bicentenary of Jean-Martin Charcot's birth and to consolidate the primary materials from a historical exhibit on the topic at the 2025 International Parkinson and Movement Disorder Congress, this article aims to provide an overview of Charcot's place in the context of 21st century movement disorders neurology.

Background: Charcot (1825-1893) is largely considered the Father of Clinical Neurology, having established the basic discipline of anatomo-clinical correlations in brain and spinal cord disease. His contributions to movement disorders neurology were seminal and remain as anchors of 21st century neurological study.

Methods: Original and secondary sources from international archives and collections served as the material for study and interpretation.

Results: Charcot fundamentally contributed to the clinical descriptions of Parkinson's disease, other parkinsonian syndromes, tremor conditions, tic disorders and chorea. Whereas he performed extensive neuroanatomical studies, he classified most movement disorders as névroses, conditions with undetected structural lesions yet to be defined.

Conclusions: Charcot developed a clear classification system for movement disorders that largely remains intact today. He developed a French School of Neurology of both historical and modern fame, and, in introducing the model of an academic clinical hospital research center as multidimensional integration of clinical care, research, and education, he left a legacy that remains the model of the 21st century neurological research center.

Background: The Huntington's Disease Behavioral Questionnaire (HD-BQ) captures behavioral symptoms arising from cognitive, psychiatric, and functional domains. Recognizing the high prevalence of anosognosia in HD, the HD-BQ incorporates patient- and companion-reported versions.

Objective: Examine the utility of the HD-BQ in capturing behavioral symptoms in HD.

Methods: The HD-BQ was administered to 71 manifest HD patients and their companions, plus 71 healthy controls (HC). Differences in HD-BQ scores were examined using Mann-Whitney U and Wilcoxon signed-ranks tests.

Results: HD patients reported more severe behavioral symptoms than HC (p < 0.001). Companions reported more widespread and severe symptoms than patients (Z = -3.7, p < 0.001). The largest discrepancies were observed for cognitive items-difficulty shifting thoughts or activities (p < 0.001), concentrating (p = 0.002), keeping track of commitments (p = 0.006), judgment (p = 0.004), and indecisiveness (p = 0.022).

Conclusions: The HD-BQ captures a wide range of behavioral disturbances in HD. Companions consistently reported more frequent and severe symptoms than patients, likely reflecting patients' anosognosia.

Background: Dopaminergic neuron loss in the substantia nigra, particularly the nigrosomes, characterizes Parkinson's disease (PD). Nigrosome-1 absence on MRI has emerged as a potential PD biomarker.

Objectives: Assess the diagnostic accuracy of nigrosome-1 detection for differentiating PD from essential tremor (ET) in clinical practice.

Methods: Movement disorder neurologists without nigrosome evaluation experience, randomized into receiving or not training, assessed 3 Tesla MRIs from PD and ET patients. PD was defined by absence of at least one nigrosome. Diagnostic accuracy measures and inter-rater agreement were calculated.

Results: Seventy-two MRIs were included (43 PD, 29 ET). Mean sensitivity, specificity, and accuracy were 78.2% (95% confidence interval: 71.2-85.3), 56.7% (50.0-64.0), 69.5% (65.3-73.9), without significant differences between groups. Specificity (P = 0.002) and accuracy (P = 0.029) increased with rating experience.

Conclusions: Nigrosome assessment in routine MRI by inexperienced raters showed limited diagnostic performance, yet may improve with optimized protocols and continued practice.