Bina Patel, Marta Camacho, Jonathan R. Evans, David P. Breen, Thomas Foltynie, Sarah L. Mason, Gemma Cummins, Ruwani Wijeyekoon, Roger A. Barker, Caroline Helen Williams‐Gray
{"title":"The rs6971 TSPO Polymorphism Does Not Influence Disease Presentation or Progression in Parkinson's Disease rs6971 TSPO Polymorphism in PD","authors":"Bina Patel, Marta Camacho, Jonathan R. Evans, David P. Breen, Thomas Foltynie, Sarah L. Mason, Gemma Cummins, Ruwani Wijeyekoon, Roger A. Barker, Caroline Helen Williams‐Gray","doi":"10.1002/mds.70105","DOIUrl":"https://doi.org/10.1002/mds.70105","url":null,"abstract":"","PeriodicalId":213,"journal":{"name":"Movement Disorders","volume":"167 1","pages":""},"PeriodicalIF":8.6,"publicationDate":"2025-11-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145427428","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Tao Xie MD, PhD, Lisa Bloom SLPD, CCC-SLP, Ellen McCracken MS, CCC-SLP
<p>We read with great interest the article by Walshe et al. entitled “Measuring what matters in Parkinson's disease research and dysphagia: the need for core outcome sets”.<span><sup>1</sup></span> We strongly agree that core outcomes are needed in clinical research in dysphagia to improve the evidence base and decision making in patients with Parkinson's disease (PD), and that choking is an important item to be included in the core outcomes, as aspiration pneumonia is the primary cause of mortality in patients with PD.<span><sup>1, 2</sup></span> While patient-reported outcome measures provide useful guidance, it is important to also note that liquids pose a much higher and earlier-presenting risk of aspiration than solid foods in patients with PD.<span><sup>3, 4</sup></span> In a randomized, double-blind, long-term study, swallowing function was assessed with and without deep brain stimulation in PD patients treated with dopaminergic medications, and the depth (severity) and frequency of penetration and aspiration for liquids versus solids were compared by Penetration-Aspiration Scale (PAS) during the videofluoroscopic swallow study.<span><sup>3</sup></span> The severity and frequency of the incidence of penetration and aspiration were found to be much greater for liquids than solids, regardless of the conditions and time to assess.<span><sup>3</sup></span> Aspiration of liquids was also found to occur earlier than that of solids even in patients with early-stage PD.<span><sup>4</sup></span> These findings suggest that liquids are more sensitive than solids for detecting early aspiration or deterioration in swallowing function. In progressive supranuclear palsy (PSP) too, dysphagia to liquids precedes that to solids,<span><sup>5</sup></span> and is a major risk factor for mortality.<span><sup>6</sup></span> In both clinical and research settings, asking a simple screening question such as “Do you cough when you drink water?” could help detect early aspiration. Emphasizing this question may alert physicians, researchers, patients, and families to dysphagia in its earliest stage, before more severe complications such as choking with solid foods or aspiration pneumonia develop. Objective or instrumental evaluations identify dysphagia with more specificity than subjective reports, suggesting that we should screen patients earlier in both research and clinical practice to facilitate earlier swallow studies. PD patients should have objective swallow function evaluated earlier given the much higher dysphagia prevalence found by objective evaluation compared with subjective report.<span><sup>2</sup></span> Earlier referrals to speech pathology for evaluation may also improve swallowing outcomes.<span><sup>7</sup></span> Including information on coughing with liquids (particularly thin liquids like water) with a probing question and subsequent swallow evaluation could also allow us to accumulate knowledge on early features of dysphagia and help achieve
{"title":"Comments on “Measuring What Matters in Parkinson's Disease Research and Dysphagia: The Need for Core Outcome Sets”","authors":"Tao Xie MD, PhD, Lisa Bloom SLPD, CCC-SLP, Ellen McCracken MS, CCC-SLP","doi":"10.1002/mds.70113","DOIUrl":"10.1002/mds.70113","url":null,"abstract":"<p>We read with great interest the article by Walshe et al. entitled “Measuring what matters in Parkinson's disease research and dysphagia: the need for core outcome sets”.<span><sup>1</sup></span> We strongly agree that core outcomes are needed in clinical research in dysphagia to improve the evidence base and decision making in patients with Parkinson's disease (PD), and that choking is an important item to be included in the core outcomes, as aspiration pneumonia is the primary cause of mortality in patients with PD.<span><sup>1, 2</sup></span> While patient-reported outcome measures provide useful guidance, it is important to also note that liquids pose a much higher and earlier-presenting risk of aspiration than solid foods in patients with PD.<span><sup>3, 4</sup></span> In a randomized, double-blind, long-term study, swallowing function was assessed with and without deep brain stimulation in PD patients treated with dopaminergic medications, and the depth (severity) and frequency of penetration and aspiration for liquids versus solids were compared by Penetration-Aspiration Scale (PAS) during the videofluoroscopic swallow study.<span><sup>3</sup></span> The severity and frequency of the incidence of penetration and aspiration were found to be much greater for liquids than solids, regardless of the conditions and time to assess.<span><sup>3</sup></span> Aspiration of liquids was also found to occur earlier than that of solids even in patients with early-stage PD.<span><sup>4</sup></span> These findings suggest that liquids are more sensitive than solids for detecting early aspiration or deterioration in swallowing function. In progressive supranuclear palsy (PSP) too, dysphagia to liquids precedes that to solids,<span><sup>5</sup></span> and is a major risk factor for mortality.<span><sup>6</sup></span> In both clinical and research settings, asking a simple screening question such as “Do you cough when you drink water?” could help detect early aspiration. Emphasizing this question may alert physicians, researchers, patients, and families to dysphagia in its earliest stage, before more severe complications such as choking with solid foods or aspiration pneumonia develop. Objective or instrumental evaluations identify dysphagia with more specificity than subjective reports, suggesting that we should screen patients earlier in both research and clinical practice to facilitate earlier swallow studies. PD patients should have objective swallow function evaluated earlier given the much higher dysphagia prevalence found by objective evaluation compared with subjective report.<span><sup>2</sup></span> Earlier referrals to speech pathology for evaluation may also improve swallowing outcomes.<span><sup>7</sup></span> Including information on coughing with liquids (particularly thin liquids like water) with a probing question and subsequent swallow evaluation could also allow us to accumulate knowledge on early features of dysphagia and help achieve ","PeriodicalId":213,"journal":{"name":"Movement Disorders","volume":"40 12","pages":"2852-2853"},"PeriodicalIF":7.6,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://movementdisorders.onlinelibrary.wiley.com/doi/epdf/10.1002/mds.70113","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145411652","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Reply to “Comments on ‘Measuring What Matters in Parkinson's Disease Research and Dysphagia: The Need for Core Outcome Sets’”","authors":"Julia Hirschwald MSc, Tobias Warnecke MD","doi":"10.1002/mds.70112","DOIUrl":"10.1002/mds.70112","url":null,"abstract":"","PeriodicalId":213,"journal":{"name":"Movement Disorders","volume":"40 12","pages":"2854-2855"},"PeriodicalIF":7.6,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145411655","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Augusto Rachão, António Silva, Luísa Prada, Joana Pona‐Ferreira, Margherita Fabbri, Filipe B. Rodrigues, Tiago A. Mestre, Miguel Coelho, Mário M. Rosa, Werner Poewe, Olivier Rascol, Francisco E.C. Cardoso, Joaquim J. Ferreira
{"title":"Advertising to Healthcare Professionals: Insights from Parkinson's Disease in the Movement Disorders Journal","authors":"Augusto Rachão, António Silva, Luísa Prada, Joana Pona‐Ferreira, Margherita Fabbri, Filipe B. Rodrigues, Tiago A. Mestre, Miguel Coelho, Mário M. Rosa, Werner Poewe, Olivier Rascol, Francisco E.C. Cardoso, Joaquim J. Ferreira","doi":"10.1002/mds.70108","DOIUrl":"https://doi.org/10.1002/mds.70108","url":null,"abstract":"","PeriodicalId":213,"journal":{"name":"Movement Disorders","volume":"28 1","pages":""},"PeriodicalIF":8.6,"publicationDate":"2025-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145397460","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Bo Wang, Haotian Wang, Yixin Kang, Sheng Wu, Nan Jin, Haoyu Wang, Zhidong Cen, Dehao Yang, Xinhui Chen, Xiaofeng Dou, Congcong Yu, Yan Zhong, Mei Tian, Hong Zhang, Wei Luo
{"title":"Comments on: “Biallelic ELOVL1 Variants Are Linked to Hypomyelinating Leukodystrophy, Movement Disorder, and Ichthyosis”","authors":"DuJiang Yang, Jiexiang Yang, GuoYou Wang","doi":"10.1002/mds.70117","DOIUrl":"10.1002/mds.70117","url":null,"abstract":"","PeriodicalId":213,"journal":{"name":"Movement Disorders","volume":"40 12","pages":"2856-2857"},"PeriodicalIF":7.6,"publicationDate":"2025-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145397461","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
<p>We read with interest the systematic review on treatment options for Parkinson's disease (PD) motor fluctuations, published as an International Parkinson and Movement Disorder Society (MDS) evidence-based medicine (EBM) review article.<span><sup>1</sup></span></p><p>We appreciate the authors' motivation to provide guidance in determining which therapeutic options are safe and efficacious to reduce patients' disease burden. The article appears intrinsically consistent, following the strict Grading of Recommendations Assessment, Development and Evaluation (GRADE)-based methodology.</p><p>Having recently evaluated the literature on the same subject while developing the German Society of Neurology Guidelines for PD,<span><sup>2, 3</sup></span> we wish to share some comments on this article.<span><sup>1</sup></span></p><p>First, rapid-release (dispersible/soluble) oral levodopa is still among the most frequently prescribed off-rescue medication. This option is not mentioned in the MDS review.<span><sup>1</sup></span> In the absence of randomized controlled trials to demonstrate superiority over other therapeutic options, there is still robust clinical experience supporting this safe and efficacious option.</p><p>Inhaled levodopa is not mentioned either in the MDS review,<span><sup>1</sup></span> although the criteria set forth by the authors appear to qualify consideration of the pivotal study demonstrating its efficacy to significantly reduce motor fluctuations.<span><sup>4</sup></span> It might have been omitted since daily off-time was not the primary readout. The drug is still approved for this indication by the US Food and Drug Administration (FDA) and the European Medicines Agency (EMA).</p><p>Likewise, the commonly used dopamine agonist piribedil is not mentioned.<span><sup>1</sup></span></p><p>Intermittent application of apomorphine, either subcutaneous or sublingual, has been declassified by “insufficient evidence” in the MDS review,<span><sup>1</sup></span> although published evidence may suggest otherwise<span><sup>5, 6</sup></span> and these treatment options are approved, reimbursed, and administered successfully in many countries.</p><p>The classification of istradefylline as “likely efficacious” is interesting, since the EMA issued a negative opinion in 2021,<span><sup>7</sup></span> refusing approval for istradefylline as an add-on treatment for motor fluctuations, considering the available evidence as inconsistent and not satisfactorily showing effectiveness to reduce ‘off’ time. A pooled analysis of eight phase IIb/III trials suggested that istradefylline reduces daily off-time by only 0.38 or 0.45 hr more than placebo at 20 or 40 mg/day, respectively.<span><sup>8</sup></span></p><p>These discrepancies between the conclusions reached in this article<span><sup>1</sup></span> and the current options approved and available to aid patients with motor fluctuations demonstrate the striking limitations of the GRADE methodology, when stri
{"title":"Treatment Options for Motor Fluctuations in Parkinson's Disease","authors":"Günter Höglinger MD, Paul Lingor MD, Matthias Höllerhage MD, Claudia Trenkwalder MD","doi":"10.1002/mds.70107","DOIUrl":"10.1002/mds.70107","url":null,"abstract":"<p>We read with interest the systematic review on treatment options for Parkinson's disease (PD) motor fluctuations, published as an International Parkinson and Movement Disorder Society (MDS) evidence-based medicine (EBM) review article.<span><sup>1</sup></span></p><p>We appreciate the authors' motivation to provide guidance in determining which therapeutic options are safe and efficacious to reduce patients' disease burden. The article appears intrinsically consistent, following the strict Grading of Recommendations Assessment, Development and Evaluation (GRADE)-based methodology.</p><p>Having recently evaluated the literature on the same subject while developing the German Society of Neurology Guidelines for PD,<span><sup>2, 3</sup></span> we wish to share some comments on this article.<span><sup>1</sup></span></p><p>First, rapid-release (dispersible/soluble) oral levodopa is still among the most frequently prescribed off-rescue medication. This option is not mentioned in the MDS review.<span><sup>1</sup></span> In the absence of randomized controlled trials to demonstrate superiority over other therapeutic options, there is still robust clinical experience supporting this safe and efficacious option.</p><p>Inhaled levodopa is not mentioned either in the MDS review,<span><sup>1</sup></span> although the criteria set forth by the authors appear to qualify consideration of the pivotal study demonstrating its efficacy to significantly reduce motor fluctuations.<span><sup>4</sup></span> It might have been omitted since daily off-time was not the primary readout. The drug is still approved for this indication by the US Food and Drug Administration (FDA) and the European Medicines Agency (EMA).</p><p>Likewise, the commonly used dopamine agonist piribedil is not mentioned.<span><sup>1</sup></span></p><p>Intermittent application of apomorphine, either subcutaneous or sublingual, has been declassified by “insufficient evidence” in the MDS review,<span><sup>1</sup></span> although published evidence may suggest otherwise<span><sup>5, 6</sup></span> and these treatment options are approved, reimbursed, and administered successfully in many countries.</p><p>The classification of istradefylline as “likely efficacious” is interesting, since the EMA issued a negative opinion in 2021,<span><sup>7</sup></span> refusing approval for istradefylline as an add-on treatment for motor fluctuations, considering the available evidence as inconsistent and not satisfactorily showing effectiveness to reduce ‘off’ time. A pooled analysis of eight phase IIb/III trials suggested that istradefylline reduces daily off-time by only 0.38 or 0.45 hr more than placebo at 20 or 40 mg/day, respectively.<span><sup>8</sup></span></p><p>These discrepancies between the conclusions reached in this article<span><sup>1</sup></span> and the current options approved and available to aid patients with motor fluctuations demonstrate the striking limitations of the GRADE methodology, when stri","PeriodicalId":213,"journal":{"name":"Movement Disorders","volume":"40 12","pages":"2848-2849"},"PeriodicalIF":7.6,"publicationDate":"2025-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://movementdisorders.onlinelibrary.wiley.com/doi/epdf/10.1002/mds.70107","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145374044","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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