Movement Disorders Clinical Practice最新文献

Background: Early identification of pathological α-synuclein deposition (αSynD) may improve understanding of Lewy body disorder (LBD) progression and enable timely disease-modifying treatments.

Objectives: We investigated αSynD using a seed amplification assay and assessed prodromal LBD symptoms in individuals with idiopathic olfactory dysfunction (iOD).

Methods: In this cross-sectional, case-control study, we included iOD participants and normosmic healthy controls (HC) aged 55 to 75 years without diagnoses of dementia with Lewy bodies, Parkinson's disease (PD), or other major neurological disorders. iOD was defined as hyposmia without any known causes. The primary outcome was αSynD detection in skin and olfactory mucosa. Secondary outcomes included prodromal LBD symptoms: cognitive dysfunction, rapid eye movement sleep behavior disorder (RBD), motor and nonmotor symptoms (Movement Disorders Society-Unified Parkinson's Disease Rating Scale [MDS-UPDRS] Parts I-III), and prodromal PD risk.

Results: We recruited 44 iOD participants (mean age 65) and 50 HCs (mean age 67). Eighteen iOD participants (41%) were αSynD positive in skin and/or olfactory mucosa compared to 1 HC (2%, P < 0.0001). iOD participants had higher rates of cognitive dysfunction (48% vs. 24%, P = 0.02), possible RBD (41% vs. 16%, P = 0.01), and elevated MDS-UPDRS I-III (median [interquartile range]: 15 [7-22] vs. 5.5 [3-11], P < 0.0001). Dysautonomia symptoms did not differ significantly. In the iOD group, 45% met probable/possible prodromal PD criteria versus 1 control (P < 0.0001). However, αSynD-αSynD-negative iOD participants had a nonsignificantly higher prodromal PD risk compared to αSynD-positive individuals.

Conclusions: iOD exhibits high αSynD prevalence and prodromal LBD symptoms, supporting its role as an early LBD marker and potential model for early intervention and mechanistic studies.

Background: There is limited data regarding the role of pallidothalamic tract (PTT) lesioning after failure of pallidotomy.

Objectives: To report the role of unilateral PTT lesioning in refractory generalized dystonia following bilateral pallidotomy and hemi-dystonia following unilateral pallidotomy.

Methods: A single-center retrospective case series.

Results: Five patients underwent unilateral PTT lesioning after the failure of pallidotomy to control dystonia, including status dystonicus in one case. The interval between pallidotomy and PTT lesioning ranged from 2 to 90 months. Pre-PTT surgery, BFMDRS-M scores ranged from 20 to 87, and BFMDRS-D scores ranged from 8 to 23. Immediately post-PTT surgery, improvement was observed in four patients, with objective improvements ranging between 57.5 and 93.3% in the BFMDRS-M score. Two patients developed adverse effects: one experienced a mild worsening of post-pallidotomy dysarthria, and another developed impaired hand dexterity.

Conclusions: Our initial experience suggests that unilateral PTT lesioning holds promise as an option for lesional surgery following pallidotomy, in refractory dystonia.

Background: The prevalence of Parkinson's disease (PD) is increasing markedly in Asia, highlighting the urgent need to understand the current practices and challenges in delivering comprehensive PD care in this region.

Objectives: We aimed to determine the resources and facilities for comprehensive management of PD in Asia focusing on regions (South East Asia, Middle East, Indian Subcontinent, East Asia, and Central Asia) and income levels (high-income countries-HIC, upper middle-income countries-UMIC, lower middle-income countries-LMIC).

Method: A survey-based questionnaire was deployed to the MDS affiliate societies or key neurologists in 32 countries in Asia.

Results: Thirty countries/territories participated in the survey. HICs have better availability of and accessibility to most health care professionals. Central Asia has the lowest availability of and accessibility to health care professionals. PD nurses are least available (33.3%) and least easily accessible (6.7%). Levodopa and anticholinergics are the most available (100%), accessible (100%) and affordable (100%) antiparkinsonian medications. Device-aid therapies are more available and accessible in East Asian countries/territories, compared to other regions. Accessibility to allied health professionals is poor (43%). Genetic testing is available in 18 (60%) countries/territories, mostly in HIC (P = 0.031). Community engagement and public health awareness campaigns are available in 21 (70%) countries/territories. Brain bank is available in seven (24.1%) countries/territories, mostly in HIC. Telemedicine is utilized in 21 (70%) countries/territories.

Conclusion: This is the first survey-based study to highlight regional and income-based disparities on infrastructures required for comprehensive PD care in Asia. Regional collaborations between HIC and MIC may address some of these disparities.

Background: Deep brain stimulation (DBS) is an established treatment for Parkinson's disease (PD) in appropriately selected patients. DBS may be underused in certain patient populations, especially women and racialized groups. Barriers and biases to receiving DBS that could account for underuse among these groups are not well studied in Canada.

Objective: We aim to better characterize the disparities in gender, ethnicity and other demographic factors among patients referred for and receiving DBS.

Methods: We performed a retrospective chart review and phone survey of DBS patients treated at two Canadian centers and from Canada Open Parkinson Network (C-OPN). Gender, ethnicity, marital status, native language, birth country, urban versus rural residency, level of education, household income and mode of referral were studied.

Results: Among all participants, more men than women received DBS. Most patients (81.8-94.1%) in both referral and implanted groups were White. The gender and ethnicity of this cohort do not represent Canadian demographics. Patients referred and receiving surgery had higher educational level compared with general Canadian population. Being married was positively associated with DBS referral and implantation.

Conclusion: Significant ethnic and gender disparities in receiving DBS exist. Educated White men were overrepresented. Further actions need to be taken to expand the accessibility of this important treatment to all eligible PD patients with an effort to provide equitable care to women, racialized groups and those who cannot advocate for themselves in Canada.

Background: Awareness and major external events can contribute to the number of FMD cases.

Objective: To analyze trends in new Functional Movement Disorders (FMD) consultations and the impact of the COVID-19 pandemic.

Methods: Retrospective analysis of FMD new consultations (2014-2024) at a tertiary movement disorders clinic. Trends and the COVID-19 impact were analyzed with linear and segmented regression. Patient characteristics in the pre- and post-pandemic periods were compared.

Results: Among 14,587 new consultations, 162 were FMD (79% female, mean age at onset 44.7 ± 18.3 years). FMD consultations increased slowly over time, with a marked surge after 2021. The significant rise was observed during the three years post-pandemic, followed by a return to the pre-pandemic slope. Pre and post-pandemic groups' characteristics were almost similar.

Conclusions: FMD consultations increased over time and significantly after the COVID-19 pandemic. This underscores the influence of increased awareness and external factors.