Movement Disorders Clinical Practice最新文献

Background: Impulse control disorders (ICDs) are most often associated with dopamine agonists and pulsatile dopamine replacement therapy such as oral levodopa and subcutaneous apomorphine. Intestinal levodopa-carbidopa gel may improve ICDs through rationalization of dopaminergic agents and/or a reduction of pulsatile dopaminergic stimulation, however the impact of subcutaneous foslevodopa/foscarbidopa (CSFLI) has not been reported to date.

Cases: We describe five men aged 50-68 with advanced Parkinson's disease (PD) and pre-existing ICDs who were switched to CSFLI. Four of them were transitioned directly from subcutaneous apomorphine infusions with the hope of improving ICD symptoms. All experienced worsening or persistent ICD symptoms, predominantly hypersexuality, after switching to CSFLI with a mean time to peak ICD symptoms of 4.5 weeks (range 2-6).

Conclusions: CSFLI may exacerbate ICDs in susceptible individuals. Pre-treatment screening and close monitoring are recommended.

Background: Myoclonus-dystonia (M-D) is a monogenic movement disorder, with proposed cerebellar dysfunction. Vergence eye movement deficits, characteristics of degenerative cerebellar disease, have not been studied in M-D. Cerebellar transcranial alternating current stimulation (tACS) is considered a potential therapeutic approach.

Objectives: To assess vergence and prosaccade performance as markers of cerebellar dysfunction in M-D and to evaluate the effects of cerebellar 50 Hz tACS on these eye movements.

Methods: Vergence and prosaccade performance were examined in 14 M-D patients carrying pathogenic SGCE variants and 14 healthy controls. A subgroup (n = 7) received real and sham 50 Hz cerebellar tACS in a randomized, double-blind design.

Results: M-D patients showed prolonged latency and reduced gain of convergence compared to controls. Divergence did not differ between groups. Prosaccade peak velocity was reduced in M-D patients. 50 Hz cerebellar tACS showed no effect on eye movements.

Conclusion: Impaired convergence supports cerebellar involvement in M-D. Further studies should identify affected pathways.

Background: Assessment of disease progression in Parkinson's disease (PD) usually relies on longitudinal follow-up, which is often impractical in large real-world cohorts. Cross-sectional approaches may provide pragmatic proxies to explore relative motor deterioration using routine clinical data.

Objectives: To explore clinical and non-motor correlates of estimated relative motor progression in PD using a simple ratio-based index-MDS-UPDRS Part III (OFF medication) divided by disease duration.

Methods: In this retrospective cross-sectional study, 711 patients with idiopathic PD were classified as slow or fast progressors based on the cohort median of the MDS-UPDRS III (OFF)/disease duration ratio (7.31 points/year). Motor, non-motor, demographic, and treatment-related variables were compared between groups. Multivariable logistic regression analyses were used to identify clinical features associated with higher estimated progression.

Results: Patients with higher estimated motor burden per year showed greater non-motor symptom burden, higher residual motor load (ON/OFF ratio), and a higher prevalence of the akinetic-rigid phenotype. In multivariable analyses, non-motor symptom burden, residual motor ratio, shorter disease duration, and akinetic-rigid phenotype were independently associated with higher estimated progression. Among non-motor domains, Sleep/Fatigue and Miscellaneous symptoms showed specific associations. The models demonstrated good within-cohort explanatory performance (Nagelkerke R² = 0.42-0.47) in this cross-sectional cohort.

Conclusions: This study presents a simple ratio-based proxy to explore relative motor progression in PD. While not a validated longitudinal progression measure, it may serve as a pragmatic exploratory tool for descriptive stratification of large clinical cohorts. Longitudinal validation is required.

Background: Parkinson's disease (PD) is a neurodegenerative disorder accompanied by cognitive impairment, which increases a risk of dementia as the condition progresses. Although monoamine oxidase B (MAO-B) inhibitors, such as selegiline, rasagiline and safinamide, are used to treat motor symptoms in PD, their impacts on cognitive performance remain unclear.

Objectives: This study systematically evaluated and compared the impacts of MAO-B inhibitors on global cognitive performance and performance of individual cognitive domains in patients with PD.

Methods: Databases were searched through PubMed/Medline, Embase, and Cochrane Library from the inception to May 30, 2025. Thirteen randomized controlled trials (RCTs) evaluating cognitive outcomes in patients with PD treated with selegiline, rasagiline or safinamide were included. Standardized mean differences (SMDs) for global cognition and five cognitive sub-domains were pooled, respectively, using random-effects models. Publication bias and methodological quality were also assessed.

Results: 13 RCTs met inclusion criteria. Network meta-analysis showed that only rasagiline significantly improved global cognition compared to placebo (SMD, 0.863; 95% CI, 0.064-1.663), whereas selegiline and safinamide did not show any statistical difference when compared to placebo. None of the MAO-B inhibitors demonstrated significant effects on specific cognitive sub-domains (ie, attention, executive function, memory, language, and visuospatial abilities).

Conclusions: Rasagiline may provide global cognitive benefits in PD, but MAO-B inhibitors, including rasagiline, generally did not demonstrate significant effects on individual cognitive domains. These findings suggest limited cognitive impacts of MAO-B inhibitors beyond managing the motor symptoms. Further large-scale, long-term studies using domain-specific cognitive assessments are warranted to clarify their roles in cognitive performance in patients with PD.

Background: Anxiety progression in Parkinson's disease (PD) and its link to peripheral inflammation remain unclear.

Objective: This study aimed to determine whether lymphocyte-related inflammatory markers can predict the longitudinal progression of anxiety symptoms in patients with PD.

Methods: This study utilized a large public database to evaluate 13 inflammatory markers associated with lymphocytes. Linear regression and mixed-effects models were employed to assess associations between the inflammatory indicators and anxiety symptoms.

Results: Elevated baseline neutrophil-to-lymphocyte ratio (NLR), systemic immune-inflammation index (SII), and systemic inflammation response index (SIRI) were associated with higher levels of both state and trait anxiety (P < 0.05). An increase in the NLR is indicative of the deterioration of trait anxiety (estimate = 0.455, P = 0.030), especially in late-onset PD (LOPD) patients and males.

Conclusions: The NLR is a potential biomarker for the progression of anxiety in PD patients, indicating that neuroinflammation is related to anxiety.