Movement Disorders Clinical Practice最新文献

Background: Globally the prevalence of Idiopathic Parkinson's Disease (IPD) is rising. Increasing recognition is being given to the influence of environmental factors on this rise, although the precise impact of such factors remains poorly understood. We need accurate ways of measuring prevalence to understand regional and global trends.

Objectives: To use case finding methodology to measure the crude, and age adjusted, prevalence of IPD in a rural area of North West England, and to describe the difference in results with those obtained using electronic record searching alone to understand the accuracy of such methods. To compare prevalence between subgroups to build hypotheses that could guide further research.

Methods: Local Parkinson's service records from several sources were searched electronically and manually reviewed against validated diagnostic criteria. Figures were age adjusted according to the national denominator population.

Results: The age adjusted prevalence of IPD was 201/100,000 (95% CI 186-217), higher than in any other published UK study using similar case finding methods. Numbers were higher using electronic diagnostic code searching alone, which may over estimate prevalence. No significant difference was seen between rural and urban areas, relative risk 0.92 (95% CI 0.80-1.06), although there was a trend to higher prevalence in historically industrial coastal areas.

Conclusions: This study highlights some of the pitfalls in using large healthcare datasets to measure IPD prevalence. Overall, the prevalence of IPD is high in this predominantly rural area, and exhibits prevalence trends that warrant further investigation in relation to genetic and environmental factors.

Background: MDS-UPDRS Severity Levels (SLs), derived from clinician- and patient-rated scales, remain underused to evaluate response to subthalamic deep brain stimulation (STN-DBS) in patients with Parkinson's disease (PD).

Objectives: To evaluate MDS-UPDRS SL as markers of STN-DBS response.

Methods: SLs were categorized as mild, moderate, or severe using established cut-off points for Parts II, III Off, and IV. Improvement was defined as a decrease in at least one SL. Part III Off improvement was correlated to quality-of-life scales and used to predict SL improvement using ROC Curve analysis.

Results: A total of 51 patients (34.1% female, aged 58.9 ± 10.2 years, disease duration 12.3 ± 4.1 years) were evaluated 12 months after surgery. MDS-UPDRS III Off changes over 30% predicted SL improvements in MDS-UPDRS II (AUC = 0.83, p = 0.015) and IV (AUC = 0.89, p = 0.001).

Conclusion: Our findings suggest that improvement in MDS-UPDRS SL are potential markers of STN-DBS response. With an MDS-UPDRS part III improvement around 30% predicting SL improvement.

Background: Deep brain stimulation (DBS) is an established treatment for movement disorders such as Parkinson's disease (PD) and essential tremor (ET). However, the decision between unilateral, staged bilateral, or simultaneous bilateral DBS remains controversial, influenced by clinical presentation, patient preferences, and economic factors.

Objective: The aim was to compare motor score improvements, adverse events (AE), incremental benefits, and progression with unilateral to bilateral procedures and the rationale for second-side surgery.

Methods: This systematic review examined studies on patients treated with unilateral or bilateral (simultaneous or staged) DBS from 1999 to 2025, focusing on outcomes, safety, and efficacy.

Results: In PD, unilateral DBS targeting the subthalamic nucleus (STN) or globus pallidus internus (GPi) improves motor scores by up to 37%, whereas bilateral DBS yields improvements of up to 66%. Unilateral DBS provides up to 75% improvement in contralateral symptoms but only up to 28% in ipsilateral symptoms. More than half of PD patients eventually opt for second-side surgery due to worsening symptoms. In ET, unilateral ventral intermediate nucleus (VIM) DBS improves hand tremor by up to 89%, with staged bilateral procedures offering an additional 77% to 89% improvement contralaterally. Axial tremor improves by up to 60% with unilateral VIM DBS and a further 60% after bilateral surgery. Bilateral VIM DBS is linked to more AEs, such as gait disorders and dysarthria, whereas STN and GPi DBS have comparable risks. Staged surgeries are associated with longer surgical times and increased revisions and programming.

Conclusions: Individualized treatment decisions are essential, with bilateral DBS providing superior long-term outcomes for both PD and ET.

Background: Gait and balance impairment is a disabling clinical feature in people with degenerative cerebellar ataxia.

Objectives: We performed a rater-blinded, parallel 3-arm randomized controlled trial with delayed-start-design (exploratory proof-of-concept study) to assess whether, compared to control, people with mild/moderate hereditary ataxia benefit from additional video-based training with different frequencies, and how clinical characteristics interact with training success.

Methods: Digital gait/balance measures were assessed before and after a three-week video-based training program at home (Train20: 4 × 20min/week, n = 11; Train40: 2 × 40min/week, n = 11; control: standard medical care, n = 10). Group differences at baseline and changes over time were assessed using ANOVA. Linear mixed models were conducted to examine the influence of clinical variables on outcomes over time. Further exploratory analyses were performed using intraclass correlation coefficients (ICC), and paired t-tests within each group.

Results: All variables showed good to excellent test-retest reliability (ICC ≥0.69). No significant interactions between group and measurement time were found for clinical or gait/balance variables (p ≥ 0.338). However, participants with higher initial disease severity, greater impairment in activities of daily living, and better well-being showed significant improvements in feet-together stance (p = 0.04), normal (p = 0.01), and backward gait (p = 0.03). Exploratory analyses showed improvement only in Train40.

Conclusions: Although the protocol did not lead to general improvements in people with mild/moderate ataxia, irrespective of training frequency, those with higher initial disease severity, higher functional impairment, and better mental well-being showed significant benefits. Greater attention should be given to the impact of well-being to enhance motor training outcomes. Longer, less frequent sessions may offer greater potential for improvement.

Background: Impulsive-compulsive behavior disorders (ICBDs) in Parkinson's disease (PD) include impulse control disorders (ICDs) and compulsive behaviors, often linked to dopaminergic treatment and altered reward processing. Interoception, the perception of internal bodily signals, plays a key role in emotional regulation and decision-making. Neuroimaging studies suggest that alterations in interoceptive and reward-related brain circuits may underlie ICDs in PD. However, the relationship between interoception and ICDs remains underexplored.

Objective: To investigate the relationship between impulse control disorders (ICD) severity and interoceptive abilities-specifically interoceptive accuracy, insight, and self-reported interoception-in PD patients.

Methods: Fifty-one participants were assessed using the Questionnaire for Impulsive-Compulsive Disorders in Parkinson's Disease Rating Scale (QUIP-RS) alongside measures of interoceptive performance, anxiety, depression, and apathy.

Results: Higher ICD severity predicted increased interoceptive insight and sensibility. No significant link was found between ICD severity and interoceptive accuracy. Additionally, higher Levodopa Equivalent Daily Dose (LEDD) was related to lower interoceptive insight, suggesting a potential modulatory effect of dopaminergic therapy on meta-cognitive interoception.

Conclusions: These findings highlight the complex interplay between ICDs and interoception, suggesting that heightened self-reported interoception and interoceptive insight may reinforce impulsive behaviors in PD via enhanced bodily signal salience. This study contributes to understanding the characteristics of ICDs in PD, implicating reward-related circuits such as the insula and anterior cingulate cortex.