Movement Disorders Clinical Practice最新文献

Background: Chronic pain (i.e. > 3 months) is a common nonmotor symptom in patients with Parkinson's disease (PD), but the attribution to PD is critical for further treatment.

Objectives: We explored the PD Pain Classification System (PD-PCS) criteria for the diagnosis of PD-related pain and mutual influences between PD-related and PD-unrelated pain.

Methods: In this multicenter study, 120 nondemented PD patients were assessed using the PD-PCS as well as motor and nonmotor questionnaires. The PD-PCS consists of 3 steps: first, it classifies chronic pain as unrelated or related to PD according to 1 of 4 criteria (at onset or aggravated by PD, in the off phase, improvement with dopaminergic treatment, and with dyskinesia); second, it allows the classification of pain mechanisms (neuropathic, nociceptive, and nociplastic); and finally, it provides a score.

Results: Chronic pain was present in 92% of patients, with PD-related pain in 73% and non-PD-related pain in 53%. Higher PD-PCS scores were reported when PD-related pain was present. In cases of concurrent PD-related and PD-unrelated pain (35%), there was a moderate correlation between pain severity. Improvement with dopaminergic medication and pain in the off phases were the most common factors defining an association of pain with PD. These factors often occur together, whereas pain during dyskinesia occurs independently.

Conclusion: The PD-PCS criteria allow differentiation between PD-related and PD-unrelated chronic pain through 2 approaches, assessing periods of either low or high dopaminergic stimulation. PD-unrelated pain should also be taken into account, as it is more common than in the general population and as it may influence PD-related pain.

Background: Huntington's disease (HD) is an autosomal dominant neurodegenerative disorder caused by a mutation in the huntingtin gene on chromosome 4, leading to progressive cognitive decline, motor impairment, and functional disability. Although balance impairment is recognized in HD, its onset and evolution with disease stage remain poorly understood.

Objective: The aim was to track the onset and evolution of balance impairment in HD with progression of disease stage using the BTrackS Balance Plate.

Methods: Total body sway (TBS) was assessed in 123 gene-positive participants and 33 healthy controls (HC) using the BTrackS Balance Plate and laptop software. The prognostic index-derived Huntington's Disease Integrated Staging System (HD-ISS) was used to stratify these subjects into stage 0/1 (n = 51), stage 2 (n = 38), and Stage 3 (n = 34). Nonparametric receiver operating characteristic curve analysis was used to compute optimal cutoff values for TBS.

Results: Balance assessment revealed significant differences in TBS between HCs and gene-positive participants (P < 0.001). TBS varied significantly across disease stages (P < 0.001), with mean values of 9.56 cm (stage 0/1), 14.46 cm (stage 2), and 28.26 cm (Stage 3). The comparison between HCs and stage 0/1 individuals revealed strong discrimination (area under the curve [AUC] = 0.709), with a threshold of 7.72 cm achieving 74.5% sensitivity. The most robust discrimination emerged between stage 2 and Stage 3 participants (AUC = 0.71), with a threshold of 11.85 cm at 82.4% sensitivity.

Conclusions: In conclusion, this cross-sectional study demonstrates that balance impairment is an early and progressive feature of HD, detectable even before the onset of overt motor symptoms.

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.