Movement Disorders Clinical Practice最新文献

Background: Loneliness and isolation impact health detrimentally but are understudied in Parkinson's disease (PD). Outcome measurement properties for social connection remain unexplored in PD.

Objective: To evaluate the measurement properties of six social connection outcomes in PD.

Methods: We evaluated internal consistency, structural validity, and construct validity for measures of loneliness (brief UCLA Loneliness Scale [ULS3], short and long de Jong Gierveld Loneliness Scale [dJGLS], social isolation [Cohen Social Network Index-SNI total people, SNI high contact networks], and social support brief Perceived Social Support Scale [PSS]).

Results: We administered measures to 178 PD participants (M_age = 67.9; 81.5% at Hoehn & Yahr stage 2). There was strong internal consistency, content validity across outcomes, and a 1-factor structure (PSS, ULS3) and a 2-factor structure (dJGLS) for two measures each.

Conclusions: We provide a toolbox for clinicians and researchers studying social connection in PD.

Background: Previous studies suggest that early developmental delay is a common feature of Juvenile-Onset Huntington's disease (JOHD), with highest incidence in those with very high CAG repeats (> 80). However, all reports of developmental delay in JOHD are exclusively based on retrospective review of medical charts. Comprehensive assessment of birth history metrics may provide better insight into the question of early life development in JOHD.

Objective: To explore the prevalence of prematurity, birth complications, low birth weight and developmental delay in patients with JOHD in comparison to control participants.

Methods: Parents of patients with JOHD and gene-non-expanded (GNE) control participants from Kids-HD (n = 104) and Kids-JOHD (n = 34, 24% with CAG > 80) studies completed a comprehensive birth history questionnaire. Answers focused on prematurity, birth complications, and birth weight, and along with reports of early developmental milestones, were compared between groups.

Results: There were no statistically significant differences in prematurity, birth weights, birth complications, or motor and verbal developmental milestones between JOHD patients and GNE controls (all P values > 0.1). Furthermore, stratifying JOHD patients by CAG expansion (low vs. high) also showed no significant differences (GNE vs. low or GNE vs. high).

Conclusions: These findings support the notion that JOHD does not manifest as developmental delay before motor symptom onset and highlight a new framework to understand the course and nature of the disease.

Background: Botulinum toxin is a recommended treatment for tics. There is little practical guidance on the use of this treatment.

Objectives: Our aim is to describe our experience using botulinum toxin injections for tics in adults. We provide information on tics treated, muscles injected, and dosages used to give practical guidance.

Methods: We analyzed data from the Calgary Adult Tic Registry on tic severity, the tics and muscles injected, and dosages. We assessed treatment length, reasons for discontinuation, and concurrent medications.

Results: Botulinum toxin was the most used medication for tics, received by 32 of 95 (33.7%) registry participants. Participants receiving botulinum toxin were significantly older and had significantly lower vocal tic severity and total tic severity. The most common motor tics treated were blinking, head turns, and shoulder raising. The mean length of treatment was 40.4 months.

Conclusions: Botulinum toxin is an effective and well-tolerated treatment for adults with tics.

Background: Leucencephalopathy (LE) is often detected on magnetic resonance imaging in elderly patients. These white matter lesions may interfere with lead trajectories for deep brain stimulation (DBS) in patients with Parkinson's disease (PD) and are associated with complications after DBS surgery.

Objective: This study was conducted to assess the incidence of LE in PD patients and to evaluate correlations with complications after DBS surgery.

Methods: A consecutive cohort of PD patients who underwent DBS surgery in the subthalamic nucleus (STN-DBS) was retrospectively analyzed. The presence and extent of LE were quantified using the Fazekas scale. Postoperative complications were extracted from the medical records. DBS efficacy was calculated using the side-specific motor symptom ratio (Unified Parkinson's Disease Rating Scale, Part III, postoperative stimulation ON/medication off divided by preoperative medication off) at 1-year follow-up.

Results: A total of 135 PD patients were included in the study. LE was detected in 35.6% (48/135) of the patients. In 87.7% (57/65), LE was mild, in 10.7% (7/65) moderate, and in 1.6% (1/65) severe. A higher incidence of mild to moderate LE did not correlate with postoperative hemorrhage or postoperative infection. There was no correlation of LE with stimulation efficacy (r = -0.05, P = 0.69) or with surgical index (r = -0.10, P = 0.35).

Conclusions: Neither was the presence of mild to moderate LE associated with an increased risk for surgical complications, nor did it negatively impact the long-term improvement in motor function after DBS surgery in PD patients. Therefore, mild to moderate LE should not be considered a contraindication for DBS.

Background: In Parkinson's Disease (PD), upper limb tremor during walking (TW) is observed and clinical observations suggest it may represent a variant of rest tremor. However, its neurophysiological characteristics remain unexplored.

Objectives: This study compared the neurophysiological features of TW with other PD tremors and tested whether TW arises from reduced ipsilateral arm swing.

Methods: Inertial measurement units were used to measure frequency and amplitude of tremors and arm swing during walking in 25 PD patients.

Results: TW shared a similar frequency with rest and re-emergent tremor (RET) but showed significantly greater amplitude. A positive correlation was observed between the amplitude and frequency of TW with those of rest and RET on the same side. TW distribution was unrelated to reduced arm swing during walking, suggesting TW is not due to decreased ipsilateral arm movement.

Conclusions: These findings suggest that walking may act as a provocation maneuver, triggering rest tremor.