Movement Disorders Clinical Practice最新文献

Background: Orthostatic tremor (OT) and orthostatic myoclonus (OM) are rare hyperkinetic disorders characterized by unsteadiness during stance. Substantial clinical overlap limits the prognostic and therapeutic value of categorical diagnostic labels.

Objectives: To assess whether a multidomain disease burden framework provides more meaningful stratification than traditional OT/OM diagnoses and to identify phenotypic subgroups.

Methods: We conducted a cross-sectional analysis of 58 patients with OT/OM who underwent multidomain assessment. A composite Disease Burden Score (DBS) was derived from five domains: symptom severity, functional limitation, comorbidity burden, medication exposure, and fall risk. Patients were classified into high- and low-burden groups. Predictors of high disease burden were evaluated using Firth logistic regression and random forest classifiers. Latent class analysis (LCA) identified subgroups, and concordance between DBS strata and latent classes was assessed. Exploratory k-means and hierarchical clustering were performed for validation.

Results: DBS stratification distinguished high- and low-burden patients with strong accuracy (AUC = 0.96). All five domains contributed to burden classification, although individual regression coefficients were imprecise. LCA identified four subgroups: low-burden, functionally impaired, comorbidity-dominant, and globally burdened. These subgroups did not align with OT/OM diagnostic categories. Concordance between LCA classes and DBS strata was weak (Cramer's V = 0.176). Demographic variables and SF-36 quality-of-life domains did not differ across latent classes.

Conclusion: Multidomain clinical data enable disease-burden stratification and reveal phenotypic heterogeneity in orthostatic movement disorders. Limited correspondence with traditional diagnoses supports a spectrum-based model. DBS and LCA offer complementary frameworks for individualized assessment, warranting validation in larger and longitudinal cohorts.

Background: Urinary tract infections (UTIs) are common complications among hospitalized patients with Parkinson's disease (PD) and are associated with delirium and prolonged hospitalization.

Objectives: To determine the prevalence of UTI, identify modifiable risk factors, and evaluate associated outcomes among hospitalized patients with PD.

Methods: We conducted a retrospective cohort study using the PINC-AI Healthcare Database including PD-related hospitalizations from 2019 to 2023. UTIs diagnosed on admission or during hospitalization were identified, and multivariable analyses were performed.

Results: Among more than 321,000 PD hospitalizations, 18.9% were associated with UTI. Emergent admission, inter-facility transfer, dementia, and indwelling urinary catheter use were independently associated with UTI, whereas male sex was protective. UTI was associated with prolonged length of stay and delirium.

Conclusions: UTIs are frequent among hospitalized patients with PD and are associated with several modifiable risk factors. These findings may inform PD-specific inpatient strategies for UTI prevention and risk stratification.

Background: Management of deep brain stimulation (DBS) in late-stage Parkinson's disease (LSPD) remains challenging, particularly when deciding whether to continue or discontinue stimulation, and evidence on risk-benefit considerations is limited.

Objectives: To identify key factors to improve decision-making in DBS management for LSPD patients.

Methods: We retrospectively analyzed demographic, clinical and stimulation parameters in LSPD patients (Hoehn and Yahr ≥4; Schwab and England ≤50) who either maintained best medical therapy (BMT) or required unscheduled device-aided therapy (DAT) implantation up to 1 year after DBS discontinuation.

Results: From 2005 to 2022, 94 patients with bilateral subthalamic nucleus DBS were reviewed and among the 31 patients who have transitioned to LSPD, 15 patients remained on BMT, while 10 required rescue DAT (6 unscheduled implantable pulse generator replacements and 4 Levodopa-Carbidopa Intestinal Gel) within 3 months after discontinuation. Significant differences were observed in years of DBS (12.4 vs. 8.5), modified Falls Efficacy Scale (12.5 vs. 21.2), and months since the last parameter adjustment (30.3 vs. 23.2), with a trend toward less ΔMDS-UPDRS III worsening after stimulation was switched off (7.6 vs. 10.9). Longer DBS duration was inversely associated with rescue DAT (OR 0.529; 95% CI, 0.284-0.986), with a cutoff of 10.5 years.

Conclusion: In selected LSPD patients, a transition from DBS to BMT alone can be attempted with long-term stability, whereas in others a more conservative approach is advisable, and stimulation should be continued. Clinical, therapeutic, and care-related factors should guide decisions when discontinuation is being considered.

Biological sex shapes the risk, presentation, and progression of Parkinson's disease (PD). Nevertheless, the pathophysiological bases remain poorly understood, and sex-specific and hormonal factors are still insufficiently explored in both research and clinical practice. In the first part of this narrative review, we synthesize the most relevant evidence on sex-specific aspects of PD, including epidemiology, genetic bases, motor and non-motor features, and disease progression. We then explore sex-specific biological underpinnings revealed by translational, neuroimaging, and neurophysiological studies. In the second part, we summarize the roles of sex hormones in PD and of reproductive life factors, from menarche to pregnancy, focusing particularly on women with PD. With this review, we aim to highlight a still underexplored dimension of PD and the importance of systematically considering sex, reproductive life, and sex hormones, from experimental research to clinical care. Recognizing and integrating these factors is essential for achieving more individualized and equitable care.

Background: Microscopic colitis (MC) typically presents with chronic, non-bloody watery diarrhea. Diagnosis requires endoscopy with colonic mucosal biopsies. The etiology is multifactorial, with several medications implicated, although only a few cases have been attributed to oral levodopa/dopa-decarboxylase inhibitor (LDDCI) therapy.

Cases: We present two people with Parkinson's disease (PD; PwP) who developed MC on LDDCI therapy. Symptoms of MC resolved following the transition from oral LDDCI therapy to continuous subcutaneous foslevodopa/foscarbidopa infusion (CSFLI).

Literature review: A review of the literature identified 21 reported cases of parkinsonism patients who developed MC during LDDCI therapy across three articles. Diarrheal symptoms improved after treatment modification, either by switching the LDDCI formulation or by discontinuing the therapy.

Conclusion: In PwP presenting with LDDCI-associated MC, CSFLI represents an effective alternative that maintains dopaminergic efficacy while bypassing the gastrointestinal tract. Early recognition and timely switching to parenteral levodopa formulations may prevent prolonged symptoms and complications of MC in PwP. Microscopic colitis, a rare adverse effect of LDDCI therapy, may resolve completely with CSFLI.

Background: Subcutaneous foslevodopa-foscarbidopa (SCFF) is a novel, non-surgical dopaminergic infusion therapy for better controlling motor fluctuations in advanced Parkinson's disease (PD). However, there are scarce real-world data on efficacy, adverse events and comparisons with other infusion strategies.

Objectives: Here, we aimed to provide real-world, observational data on treatment of advanced PD with SCFF infusion and compare and review its performance versus intestinal dopaminergic treatment strategies.

Methods: We retrospectively collected monocentric data from patients with advanced PD treated with either SCFF (n = 58) or levodopa-carbidopa(-entacapone) intestinal gel (n = 70). We extracted efficacy and adverse events in a real-world setting and systematically reviewed the available literature for comparison.

Results: One-third of patients on SCFF withdrew from treatment within 4 weeks. Though generally deemed effective by both clinician and patient, there was a significant mismatch amid clinician (89%) and patient (74%) as per global clinical impression. Correspondingly, patients commonly withdrew due to preference rather than adverse events. Similar results were found for intestinal gel treated patients (89% vs. 70%). Comparison with intestinal levodopa & literature revealed that dose adjustments and adverse events in pump-based therapies for PD are overall common, yet not systematically managed.

Conclusion: Conclusively, our data suggest real-world efficacy for SCFF in controlling motor fluctuations. However, there are significant dropout rates, side effects and patient-clinician disagreement in global efficacy estimation. Comparison with intestinal infusion and literature revealed that pump-based therapies lack structured management. We recommend the establishment of systematic guidelines for pump-based therapies in advanced PD and provide a first troubleshooting algorithm for treating clinicians.