Movement Disorders最新文献

Background: Pallidal neurostimulation is an effective treatment for severe isolated dystonia, but long-term data from clinical trials are lacking.

Objectives: To evaluate long-term efficacy and safety of pallidal neurostimulation in patients with isolated generalized or segmental dystonia.

Methods: Extension study of the prospective multicenter trial (n = 40; July 2002 to May 2004), all patients received effective stimulation and underwent regular follow-up. The 10-year follow-up (n = 31) included Burke-Fahn-Marsden Dystonia Rating Scale (BFMDRS) motor and disability score, Beck Depression Inventory, Beck Anxiety Inventory, and Mattis Dementia Rating Scale. Primary and secondary endpoints compared motor symptoms, disability scores, mood, and cognition changes.

Results: Thirty-one patients (12 female), aged 23-72 years, completed the 10-year study extension. Per protocol analysis showed sustained significant improvement in BFMDRS motor scores at 10 years compared with baseline, without significant change from the 6-month or 5-year follow-up. On average, motor scores decreased by 25.3 ± 5.2 points at 10 years (P < 0.0001; 56% improvement). Individual outcomes varied, with 27 responders (≥25% improvement; mean improvement 65.2 ± 21.4%) and 13 non-responders compared with baseline. Sustained improvements were seen in disability, mood, and anxiety scores. Cognition remained stable.

Conclusions: This study presents the longest prospective, multicenter follow-up of pallidal neurostimulation in generalized and segmental dystonia. Two-thirds of patients showed strong and stable long-term improvements of dystonia, confirming sustained efficacy and safety over 10 years in treatment-refractory dystonic patients. However, one-third experienced primary (3/40) or secondary (10/40) treatment failure. Diagnostic advances, including genetic testing, and technological progress in pallidal neurostimulation may help to reduce the non-responder rates in the future. © 2025 The Author(s). Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.

Background: Recent studies have suggested that retinal changes measured with optical coherence tomography are detectable in early Parkinson's disease (PD), highlighting the potential of ophthalmic biomarkers for diagnosis and monitoring.

Objective: We set out to investigate the relationship between optic disc pallor measured in fundoscopy images and both prevalent and incident PD.

Methods: We analyzed color fundus photographs from 787 UK Biobank participants: 89 with prevalent PD, 317 with incident PD, and 381 age- and sex-matched controls. Optic disc pallor in several zones was quantified using semi-automated software. We used logistic and linear regression, adjusted for relevant covariates, to test for associations between disc pallor and PD status and duration.

Results: Participants with prevalent PD had significantly paler optic discs globally (OR per standard deviation [SD] increase = 1.39 [CI: 1.08-1.81], P = 0.012) and across several zones compared to controls. Each year since PD diagnosis was associated with a 1.37 SD increase in global pallor (standardized β = 1.37 [SE = 0.61], P = 0.029), and a similar increase across several zones, however, this finding was sensitive to outliers with long disease duration. No significant associations were observed for the incident PD group.

Conclusions: Optic disc pallor is significantly associated with PD and may become more pronounced with disease duration. This suggests that optic disc pallor, measured in routinely taken color fundus photographs, may serve as a biomarker for PD-related neurodegeneration. © 2025 The Author(s). Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.