Progressive supranuclear palsy (PSP) and corticobasal degeneration (CBD) manifest with variable clinical features. We initiated a multicenter prospective registry study—the Japanese Longitudinal Biomarker Study in PSP and CBD—in November 2014 at 45 Japanese institutions to collect clinical information and biological samples to elucidate the natural courses and diagnostic biomarkers of PSP/CBD.
Methods
Initial symptoms, clinical features, and scores (Progressive Supranuclear Palsy Rating Scale [PSPRS], Barthel Index, Mini-Mental State Examination, and Frontal Assessment Battery) of patients clinically diagnosed with PSP/corticobasal syndrome (CBS) at the first registration were analyzed. PSPRS score progression in the initial 8 years and predictive factors were examined.
Results
As of October 2022, first registration had been conducted for 349 patients—57 with probable/possible Richardson’s syndrome (RS), 133 with possible CBS, 41 with overlapping CBS and PSP criteria (RS/CBS group), 20 with PSP subtypes other than RS, and 98 who did not fulfill the PSP or CBS criteria. Among the RS, CBS, and RS/CBS groups, the RS group exhibited the best scores. Initial symptoms of personality change and asymmetric onset were correlated with the total PSPRS score. The average PSPRS score increment by the second registration (n = 116 patients) was 11.8 in all three groups, and progression was correlated with cognitive dysfunction. Seventy patients died during the study period. The 5-year survival rate from onset was approximately 90 %.
Conclusion
There were fewer severe clinical features in the RS group than in the CBS group. Cognitive dysfunction may be important in predicting clinical severity and disease progression.
{"title":"Japanese longitudinal biomarker study in progressive supranuclear palsy and corticobasal degeneration: Clinical features of the first registered patients and short-term follow-up analysis","authors":"Hiroshi Takigawa , Ritsuko Hanajima , Ikuko Aiba , Takayoshi Shimohata , Takahiko Tokuda , Mitsuya Morita , Osamu Onodera , Shigeo Murayama , Kazuko Hasegawa , Aya M. Tokumaru , Hisanori Kowa , Masato Kanazawa , Tameto Naoi , Kenji Nakashima , Takeshi Ikeuchi , JALPAC study group","doi":"10.1016/j.prdoa.2024.100279","DOIUrl":"10.1016/j.prdoa.2024.100279","url":null,"abstract":"<div><h3>Introduction</h3><div>Progressive supranuclear palsy (PSP) and corticobasal degeneration (CBD) manifest with variable clinical features. We initiated a multicenter prospective registry study—the Japanese Longitudinal Biomarker Study in PSP and CBD—in November 2014 at 45 Japanese institutions to collect clinical information and biological samples to elucidate the natural courses and diagnostic biomarkers of PSP/CBD.</div></div><div><h3>Methods</h3><div>Initial symptoms, clinical features, and scores (Progressive Supranuclear Palsy Rating Scale [PSPRS], Barthel Index, Mini-Mental State Examination, and Frontal Assessment Battery) of patients clinically diagnosed with PSP/corticobasal syndrome (CBS) at the first registration were analyzed. PSPRS score progression in the initial 8 years and predictive factors were examined.</div></div><div><h3>Results</h3><div>As of October 2022, first registration had been conducted for 349 patients—57 with probable/possible Richardson’s syndrome (RS), 133 with possible CBS, 41 with overlapping CBS and PSP criteria (RS/CBS group), 20 with PSP subtypes other than RS, and 98 who did not fulfill the PSP or CBS criteria. Among the RS, CBS, and RS/CBS groups, the RS group exhibited the best scores. Initial symptoms of personality change and asymmetric onset were correlated with the total PSPRS score. The average PSPRS score increment by the second registration (n = 116 patients) was 11.8 in all three groups, and progression was correlated with cognitive dysfunction. Seventy patients died during the study period. The 5-year survival rate from onset was approximately 90 %.</div></div><div><h3>Conclusion</h3><div>There were fewer severe clinical features in the RS group than in the CBS group. Cognitive dysfunction may be important in predicting clinical severity and disease progression.</div></div>","PeriodicalId":33691,"journal":{"name":"Clinical Parkinsonism Related Disorders","volume":"11 ","pages":"Article 100279"},"PeriodicalIF":1.9,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142560754","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-01-01DOI: 10.1016/j.prdoa.2024.100239
Victor S.C. Fung , Jason Aldred , Martha P. Arroyo , Filip Bergquist , Agnita J.W. Boon , Manon Bouchard , Sarah Bray , Sara Dhanani , Maurizio F. Facheris , Nahome Fisseha , Eric Freire-Alvarez , Robert A. Hauser , Anna Jeong , Jia Jia , Pavnit Kukreja , Michael J. Soileau , Amy M. Spiegel , Saritha Talapala , Arjun Tarakad , Enrique Urrea-Mendoza , Rajesh Pahwa
Background
As Parkinson's disease (PD) advances, management is challenged by an increasingly variable and inconsistent response to oral dopaminergic therapy, requiring special considerations by the provider. Continuous 24 h/day subcutaneous infusion of foslevodopa/foscarbidopa (LDp/CDp) provides steady dopaminergic stimulation that can reduce symptom fluctuation.
Objective
Our aim is to review the initiation, optimization, and maintenance of LDp/CDp therapy, identify possible challenges, and share potential mitigations.
Methods
Review available LDp/CDp clinical trial data for practical considerations regarding the management of patients during LDp/CDp therapy initiation, optimization, and maintenance based on investigator clinical trial experience.
Results
LDp/CDp initiation, optimization, and maintenance can be done without hospitalization in the clinic setting. Continuous 24 h/day LDp/CDp infusion can offer more precise symptom control than oral medications, showing improvements in motor fluctuations during both daytime and nighttime hours. Challenges include infusion-site adverse events for which early detection and prompt management may be required, as well as systemic adverse events (eg, hallucinations) that may require adjustment of the infusion rate or other interventions. A learning curve should be anticipated with initiation of therapy, and expectation setting with patients and care partners is key to successful initiation and maintenance of therapy.
Conclusion
Continuous subcutaneous infusion of LDp/CDp represents a promising therapeutic option for individuals with PD. Individualized dose optimization during both daytime and nighttime hours, coupled with patient education, and early recognition of certain adverse events (plus their appropriate management) are required for the success of this minimally invasive and highly efficacious therapy.
{"title":"Continuous subcutaneous foslevodopa/foscarbidopa infusion for the treatment of motor fluctuations in Parkinson’s disease: Considerations for initiation and maintenance","authors":"Victor S.C. Fung , Jason Aldred , Martha P. Arroyo , Filip Bergquist , Agnita J.W. Boon , Manon Bouchard , Sarah Bray , Sara Dhanani , Maurizio F. Facheris , Nahome Fisseha , Eric Freire-Alvarez , Robert A. Hauser , Anna Jeong , Jia Jia , Pavnit Kukreja , Michael J. Soileau , Amy M. Spiegel , Saritha Talapala , Arjun Tarakad , Enrique Urrea-Mendoza , Rajesh Pahwa","doi":"10.1016/j.prdoa.2024.100239","DOIUrl":"10.1016/j.prdoa.2024.100239","url":null,"abstract":"<div><h3>Background</h3><p>As Parkinson's disease (PD) advances, management is challenged by an increasingly variable and inconsistent response to oral dopaminergic therapy, requiring special considerations by the provider. Continuous 24 h/day subcutaneous infusion of foslevodopa/foscarbidopa (LDp/CDp) provides steady dopaminergic stimulation that can reduce symptom fluctuation.</p></div><div><h3>Objective</h3><p>Our aim is to review the initiation, optimization, and maintenance of LDp/CDp therapy, identify possible challenges, and share potential mitigations.</p></div><div><h3>Methods</h3><p>Review available LDp/CDp clinical trial data for practical considerations regarding the management of patients during LDp/CDp therapy initiation, optimization, and maintenance based on investigator clinical trial experience.</p></div><div><h3>Results</h3><p>LDp/CDp initiation, optimization, and maintenance can be done without hospitalization in the clinic setting. Continuous 24 h/day LDp/CDp infusion can offer more precise symptom control than oral medications, showing improvements in motor fluctuations during both daytime and nighttime hours. Challenges include infusion-site adverse events for which early detection and prompt management may be required, as well as systemic adverse events (eg, hallucinations) that may require adjustment of the infusion rate or other interventions. A learning curve should be anticipated with initiation of therapy, and expectation setting with patients and care partners is key to successful initiation and maintenance of therapy.</p></div><div><h3>Conclusion</h3><p>Continuous subcutaneous infusion of LDp/CDp represents a promising therapeutic option for individuals with PD. Individualized dose optimization during both daytime and nighttime hours, coupled with patient education, and early recognition of certain adverse events (plus their appropriate management) are required for the success of this minimally invasive and highly efficacious therapy.</p></div>","PeriodicalId":33691,"journal":{"name":"Clinical Parkinsonism Related Disorders","volume":"10 ","pages":"Article 100239"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2590112524000082/pdfft?md5=7aba3868ba6c88b9395531d46e1ba602&pid=1-s2.0-S2590112524000082-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139821206","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-01-01DOI: 10.1016/j.prdoa.2024.100240
Marialuisa Gandolfi , Christian Geroin , Gabriele Imbalzano , Serena Camozzi , Zoe Menaspà , Michele Tinazzi , Carlo Alberto Artusi
Axial postural abnormalities (PA) are frequent, highly disabling, and drug-refractory motor complications affecting patients with Parkinson’s disease (PD) or atypical parkinsonism. Over the past few years, advances have been reached across diagnosis, assessment, and pathophysiological mechanisms of PA. Nonetheless, their management remains a challenge, and these disturbances are generally overlooked by healthcare professionals, potentially resulting in their worsening and impact on patients’ disabilities. From shared consensus-based assessment and diagnostic criteria, PA calls for interdisciplinary management based on the complexity and multifactorial pathogenesis. In this context, we conducted a systematic literature review to analyze the available pharmacological and non-pharmacological treatment options for PA in PD according to the new expert-based classification of axial PA in Parkinsonism. Different multidisciplinary approaches, including dopaminergic therapy adjustment, physiotherapy, botulinum toxin injection, and deep brain stimulation, can improve PA depending on its type and severity. An early, interdisciplinary approach is recommended in PD patients to manage PA.
轴性姿势异常（PA）是帕金森病（PD）或不典型帕金森病患者经常出现的、致残率高且药物难治的运动并发症。在过去几年中，帕金森病的诊断、评估和病理生理机制都取得了进展。然而，对这些患者的管理仍然是一项挑战，医护人员通常会忽视这些障碍，从而可能导致其恶化并影响患者的残疾。从基于共识的评估和诊断标准来看，PA 需要基于其复杂性和多因素致病机理进行跨学科管理。在此背景下，我们进行了一项系统性文献综述，根据基于专家的帕金森病轴性 PA 新分类，分析了帕金森病 PA 可用的药物和非药物治疗方案。根据PA的类型和严重程度，不同的多学科方法，包括多巴胺能治疗调整、物理治疗、肉毒毒素注射和脑深部刺激，可改善PA。建议帕金森病患者尽早采用跨学科方法来控制 PA。
{"title":"Treatment of axial postural abnormalities in parkinsonism disorders: A systematic review of pharmacological, rehabilitative and surgical interventions","authors":"Marialuisa Gandolfi , Christian Geroin , Gabriele Imbalzano , Serena Camozzi , Zoe Menaspà , Michele Tinazzi , Carlo Alberto Artusi","doi":"10.1016/j.prdoa.2024.100240","DOIUrl":"10.1016/j.prdoa.2024.100240","url":null,"abstract":"<div><p>Axial postural abnormalities (PA) are frequent, highly disabling, and drug-refractory motor complications affecting patients with Parkinson’s disease (PD) or atypical parkinsonism. Over the past few years, advances have been reached across diagnosis, assessment, and pathophysiological mechanisms of PA. Nonetheless, their management remains a challenge, and these disturbances are generally overlooked by healthcare professionals, potentially resulting in their worsening and impact on patients’ disabilities. From shared consensus-based assessment and diagnostic criteria, PA calls for interdisciplinary management based on the complexity and multifactorial pathogenesis. In this context, we conducted a systematic literature review to analyze the available pharmacological and non-pharmacological treatment options for PA in PD according to the new expert-based classification of axial PA in Parkinsonism. Different multidisciplinary approaches, including dopaminergic therapy adjustment, physiotherapy, botulinum toxin injection, and deep brain stimulation, can improve PA depending on its type and severity. An early, interdisciplinary approach is recommended in PD patients to manage PA.</p></div>","PeriodicalId":33691,"journal":{"name":"Clinical Parkinsonism Related Disorders","volume":"10 ","pages":"Article 100240"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2590112524000094/pdfft?md5=b64a9296fddf6d5c57cb97ccc5634bb0&pid=1-s2.0-S2590112524000094-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140272859","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-01-01DOI: 10.1016/j.prdoa.2024.100283
Éadaoin Flynn , Julie Regan , Julia Glinzer , Sean O’Dowd , Margaret Walshe
Introduction
One of the most prevalent types of atypical parkinsonian syndrome is progressive supranuclear palsy (PSP). PSP is associated with early onset of dysphagia which can result in malnutrition, dehydration, and aspiration pneumonia, affecting quality of life and increasing mortality rate. To date, research describing dysphagia in PSP and its impact is scant.
Methods
The objective of this scoping review is to determine the characteristics of dysphagia in PSP, differences in dysphagia presentation according to PSP subtype, principal methods used for identifying and diagnosing dysphagia and the impact dysphagia has on quality of life in individuals with PSP. This review was conducted in accordance with the JBI methodology. Six electronic databases were searched.
Results
Of the 20 studies included, the most frequently reported characteristics of dysphagia were oral preparatory and oral phase difficulties. A variety of methods were used to identify and diagnose dysphagia including instrumental assessment (65%), patient reported scales (45%) and clinical swallow evaluation (20%). The most used instrumental assessment was videofluoroscopy (46%). Limited data was available describing characteristics of dysphagia according to the subtype of PSP. The impact that dysphagia has on quality of life was assessed in only one study.
Conclusion
A range of assessment methods are used to identify and diagnose dysphagia in patients with PSP. Further research is needed to investigate if particular characteristics are associated with certain PSP subtypes. Future studies should also measure the impact that dysphagia has on quality of life in this population.
{"title":"Dysphagia in progressive supranuclear palsy: A scoping review","authors":"Éadaoin Flynn , Julie Regan , Julia Glinzer , Sean O’Dowd , Margaret Walshe","doi":"10.1016/j.prdoa.2024.100283","DOIUrl":"10.1016/j.prdoa.2024.100283","url":null,"abstract":"<div><h3>Introduction</h3><div>One of the most prevalent types of atypical parkinsonian syndrome is progressive supranuclear palsy (PSP). PSP is associated with early onset of dysphagia which can result in malnutrition, dehydration, and aspiration pneumonia, affecting quality of life and increasing mortality rate. To date, research describing dysphagia in PSP and its impact is scant.</div></div><div><h3>Methods</h3><div>The objective of this scoping review is to determine the characteristics of dysphagia in PSP, differences in dysphagia presentation according to PSP subtype, principal methods used for identifying and diagnosing dysphagia and the impact dysphagia has on quality of life in individuals with PSP. This review was conducted in accordance with the JBI methodology. Six electronic databases were searched.</div></div><div><h3>Results</h3><div>Of the 20 studies included, the most frequently reported characteristics of dysphagia were oral preparatory and oral phase difficulties. A variety of methods were used to identify and diagnose dysphagia including instrumental assessment (65%), patient reported scales (45%) and clinical swallow evaluation (20%). The most used instrumental assessment was videofluoroscopy (46%). Limited data was available describing characteristics of dysphagia according to the subtype of PSP. The impact that dysphagia has on quality of life was assessed in only one study.</div></div><div><h3>Conclusion</h3><div>A range of assessment methods are used to identify and diagnose dysphagia in patients with PSP. Further research is needed to investigate if particular characteristics are associated with certain PSP subtypes. Future studies should also measure the impact that dysphagia has on quality of life in this population.</div></div>","PeriodicalId":33691,"journal":{"name":"Clinical Parkinsonism Related Disorders","volume":"11 ","pages":"Article 100283"},"PeriodicalIF":1.9,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142745157","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-01-01DOI: 10.1016/j.prdoa.2024.100270
Thuong Huyen Thi Dang , Daniel Truong , Khang Vinh Nguyen , Uyen Le Ngoc Ha , Khang Chung Ngoc Vo , Thanh Vinh Nguyen , Hien Thi Le , Tai Ngoc Tran
Introduction
Olfactory dysfunction is one of the most common non-motor symptoms of Parkinson’s disease (PD). The association between smell identification ability and motor subtypes of PD is not uniform in previous studies. This study aimed to compare the odor identification ability among different motor subtypes of PD in Vietnamese participants.
Methods
Patients who were diagnosed with PD according to the International Parkinson’s Disease and Movement Disorder Society 2015 Diagnostic Criteria and had normal cognitive function were recruited. Participants were divided into akinetic-rigid (AR), tremor-dominant (TD), and mixed (MX) motor subgroups using the Movement Disorder Society-Unified Parkinson’s Disease Rating Scale (MDS-UPDRS) score. Olfactory identification ability was evaluated using the Vietnamese Smell Identification Test (VSIT) and the Brief Smell Identification Test (BSIT). Cognitive status was assessed using the Mini-Mental State Examination (MMSE). Age, age at PD onset, disease duration, smell identification ability, and cognitive function were compared among the three PD motor subtypes.
Results
The AR subgroup was the most common motor subtype (n = 164, 75.2 %), followed by TD (n = 39, 17.9 %), and MX (n = 15, 6.9 %) subtypes. Age, age at PD onset, sex, disease duration, and MMSE score were not significantly different between the three motor subgroups (all p > 0.05). The median (IQR) VSIT scores of AR, TD, and MX subgroups were 5.00 [4.00;7.00], 5.00 [3.50;7.00], and 5.00 [3.00;6.00], respectively. The median (IQR) BSIT scores of AR, TD, and MX subgroups were 6.00 [4.00;7.00], 5.00 [4.00;7.00], and 5.00 [4.50;7.00], respectively. The VSIT and the BSIT scores were not significantly different among the three motor subtypes (all p > 0.05).
Conclusion
Smell identification ability assessed in both the VSIT and BSIT did not differ across the three motor subtypes of PD.
{"title":"Comparing smell identification ability among different motor subtypes of Parkinson’s disease using the Vietnamese Smell Identification Test and the Brief Smell Identification Test","authors":"Thuong Huyen Thi Dang , Daniel Truong , Khang Vinh Nguyen , Uyen Le Ngoc Ha , Khang Chung Ngoc Vo , Thanh Vinh Nguyen , Hien Thi Le , Tai Ngoc Tran","doi":"10.1016/j.prdoa.2024.100270","DOIUrl":"10.1016/j.prdoa.2024.100270","url":null,"abstract":"<div><h3>Introduction</h3><p>Olfactory dysfunction is one of the most common non-motor symptoms of Parkinson’s disease (PD). The association between smell identification ability and motor subtypes of PD is not uniform in previous studies. This study aimed to compare the odor identification ability among different motor subtypes of PD in Vietnamese participants.</p></div><div><h3>Methods</h3><p>Patients who were diagnosed with PD according to the International Parkinson’s Disease and Movement Disorder Society 2015 Diagnostic Criteria and had normal cognitive function were recruited. Participants were divided into akinetic-rigid (AR), tremor-dominant (TD), and mixed (MX) motor subgroups using the Movement Disorder Society-Unified Parkinson’s Disease Rating Scale (MDS-UPDRS) score. Olfactory identification ability was evaluated using the Vietnamese Smell Identification Test (VSIT) and the Brief Smell Identification Test (BSIT). Cognitive status was assessed using the Mini-Mental State Examination (MMSE). Age, age at PD onset, disease duration, smell identification ability, and cognitive function were compared among the three PD motor subtypes.</p></div><div><h3>Results</h3><p>The AR subgroup was the most common motor subtype (n = 164, 75.2 %), followed by TD (n = 39, 17.9 %), and MX (n = 15, 6.9 %) subtypes. Age, age at PD onset, sex, disease duration, and MMSE score were not significantly different between the three motor subgroups (all p > 0.05). The median (IQR) VSIT scores of AR, TD, and MX subgroups were 5.00 [4.00;7.00], 5.00 [3.50;7.00], and 5.00 [3.00;6.00], respectively. The median (IQR) BSIT scores of AR, TD, and MX subgroups were 6.00 [4.00;7.00], 5.00 [4.00;7.00], and 5.00 [4.50;7.00], respectively. The VSIT and the BSIT scores were not significantly different among the three motor subtypes (all p > 0.05).</p></div><div><h3>Conclusion</h3><p>Smell identification ability assessed in both the VSIT and BSIT did not differ across the three motor subtypes of PD.</p></div>","PeriodicalId":33691,"journal":{"name":"Clinical Parkinsonism Related Disorders","volume":"11 ","pages":"Article 100270"},"PeriodicalIF":1.9,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2590112524000410/pdfft?md5=0e0ac9e42873dd16bdcafb91d0e2b732&pid=1-s2.0-S2590112524000410-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142239850","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-01-01DOI: 10.1016/j.prdoa.2024.100273
Ana Luísa de Almeida Marcelino , Viktor Heinz , Melanie Astalosch , Bassam Al-Fatly , Gerd-Helge Schneider , Patricia Krause , Dorothee Kübler-Weller , Andrea A. Kühn
Background
Segmented electrodes for deep brain stimulation (DBS) of the subthalamic nucleus (STN) in Parkinson’s disease (PD) enable directional current steering leading to expanded programming options.
Objective
This retrospective study covering a longitudinal period of up to 7 years compares the efficacy of segmented and non-segmented leads in motor symptom alleviation and reduction of dopaminergic medication in PD patients treated in a specialized center and assesses the long-term use of directional steering in clinical routine.
Methods
Demographic data and clinical scores before surgery and at 12-month follow-up (12MFU) as well as stimulation parameters at 12MFU and last follow-up (LFU) were assessed in all patients implanted with segmented leads between 01/2016 and 12/2019 and non-segmented leads in a corresponding time-period. Patients were classified as very good (>60 %), good (30–60 %) and poor (<30 %) responders according to DBS-induced motor improvement.
Results
Clinical data at 12MFU was available for 61/96 patients with segmented (SEG) and 42/53 with non-segmented leads (N-SEG). Mean DBS-induced motor improvement and reduction of medication at 12MFU did not differ significantly between SEG and N-SEG groups or in a subgroup analysis of steering modes. There was a lower proportion of poor responders in the SEG compared with the N-SEG group (23% vs. 31%), though not statistically significant. At LFU, the percentage of patients set at directional steering increased from 54% to 70%.
Conclusion
Efficacy in reduction of motor symptoms and medication does not differ between electrode types for STN-DBS at 12 months follow-up. The use of directional steering increases over time and may account for a lower proportion of poor responders.
{"title":"Single-center experience of utilization and clinical efficacy of segmented leads for subthalamic deep brain stimulation in Parkinson’s disease","authors":"Ana Luísa de Almeida Marcelino , Viktor Heinz , Melanie Astalosch , Bassam Al-Fatly , Gerd-Helge Schneider , Patricia Krause , Dorothee Kübler-Weller , Andrea A. Kühn","doi":"10.1016/j.prdoa.2024.100273","DOIUrl":"10.1016/j.prdoa.2024.100273","url":null,"abstract":"<div><h3>Background</h3><div>Segmented electrodes for deep brain stimulation (DBS) of the subthalamic nucleus (STN) in Parkinson’s disease (PD) enable directional current steering leading to expanded programming options.</div></div><div><h3>Objective</h3><div>This retrospective study covering a longitudinal period of up to 7 years compares the efficacy of segmented and non-segmented leads in motor symptom alleviation and reduction of dopaminergic medication in PD patients treated in a specialized center and assesses the long-term use of directional steering in clinical routine.</div></div><div><h3>Methods</h3><div>Demographic data and clinical scores before surgery and at 12-month follow-up (12MFU) as well as stimulation parameters at 12MFU and last follow-up (LFU) were assessed in all patients implanted with segmented leads between 01/2016 and 12/2019 and non-segmented leads in a corresponding time-period. Patients were classified as very good (>60 %), good (30–60 %) and poor (<30 %) responders according to DBS-induced motor improvement.</div></div><div><h3>Results</h3><div>Clinical data at 12MFU was available for 61/96 patients with segmented (SEG) and 42/53 with non-segmented leads (N-SEG). Mean DBS-induced motor improvement and reduction of medication at 12MFU did not differ significantly between SEG and N-SEG groups or in a subgroup analysis of steering modes. There was a lower proportion of poor responders in the SEG compared with the N-SEG group (23% vs. 31%), though not statistically significant. At LFU, the percentage of patients set at directional steering increased from 54% to 70%.</div></div><div><h3>Conclusion</h3><div>Efficacy in reduction of motor symptoms and medication does not differ between electrode types for STN-DBS at 12 months follow-up. The use of directional steering increases over time and may account for a lower proportion of poor responders.</div></div>","PeriodicalId":33691,"journal":{"name":"Clinical Parkinsonism Related Disorders","volume":"11 ","pages":"Article 100273"},"PeriodicalIF":1.9,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142424855","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-01-01DOI: 10.1016/j.prdoa.2024.100274
Emily Tharp, Juan D. Martinez-Lemus, Mya C. Schiess, Timothy M. Ellmore, Jessika Suescun, Mohammad Shahnawaz
{"title":"Role of alpha-synuclein seed amplification assay in Parkinson’s disease clinical trials: A case of misdiagnosis","authors":"Emily Tharp, Juan D. Martinez-Lemus, Mya C. Schiess, Timothy M. Ellmore, Jessika Suescun, Mohammad Shahnawaz","doi":"10.1016/j.prdoa.2024.100274","DOIUrl":"10.1016/j.prdoa.2024.100274","url":null,"abstract":"","PeriodicalId":33691,"journal":{"name":"Clinical Parkinsonism Related Disorders","volume":"11 ","pages":"Article 100274"},"PeriodicalIF":1.9,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142424907","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-01-01DOI: 10.1016/j.prdoa.2024.100276
Ke-Fan Li , Jun Li , A-Long Xia , Xiao-Wei Wang , Ai-Ling Wang , Ying Shi , Huai-Zhen Chen
Background
Fine motor impairment is common in Parkinson’s disease (PD), which reduces patients’ quality of life. There are few suitable targeted treatments. We conducted a clinical trial to determine whether Baduanjin Qigong exercise would increase fine motor skills in PD patients.
Methods
Sixty PD patients (Hoehn-Yahr stage 1–4) with hand fine motor impairment were randomly assigned to the Baduanjin group and the physical activity group. Baduanjin group practiced Baduanjin exercise five times weekly for 40 min (warm-up 5 min, Baduanjin 30 min, cool-down 5 min). The usual physical activity groups maintained their habit of usual physical activities. The participants underwent assessments in the “ON” medication state at baseline and 4-week follow-up time points. The Purdue Pegboard Test (PPT) was used as the primary outcome to assess manual dexterity. The secondary outcomes included the Movement Disorders Society-Unified Parkinson’s Disease Rating Scale, part III (MDS-UPDRS III), and the Parkinson’s disease questionnaire (PDQ-39).
Results
The results of PPT revealed the Baduanjin group showed statistically significant improvement in the “non-dominant hand” and “assembly” scores compared to the usual physical activity group (P < 0.05), but with no significant difference in “dominant hand” and “both hands” (P > 0.05). Additionally, the Baduanjin group showed better performance in the PDQ-39 (P < 0.05).
Conclusion
Our study concludes that a 4-week Baduanjin exercise is effective in improving fine motor function and quality of life in patients with mild and moderate PD. The results suggest a promising intervention to be implemented in community or home settings for managing fine motor impairment in PD.
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