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Hauser RA, Videnovic A, Soares-da-Silva P, Liang GS, Olson K, Jen E, Rocha JF, Klepitskaya O. OFF-times before, during, and after nighttime sleep periods in Parkinson's disease patients with motor fluctuations and the effects of opicapone: A post hoc analysis of diary data from BIPARK-1 and -2. Parkinsonism Relat Disord 2024; 123:106971. [PMID: 38631081 DOI: 10.1016/j.parkreldis.2024.106971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Revised: 04/05/2024] [Accepted: 04/07/2024] [Indexed: 04/19/2024]
Abstract
INTRODUCTION In BIPARK-1 and BIPARK-2, addition of once-daily opicapone to levodopa/carbidopa significantly reduced daily "OFF"-time relative to placebo in adults with Parkinson's disease (PD) and motor fluctuations. Diary data from these studies were pooled and analyzed post hoc to characterize "OFF"-times around nighttime sleep and to explore the effects of opicapone 50 mg. METHODS "OFF" before sleep (OBS), "OFF during the nighttime sleep period" (ODNSP), early morning "OFF" (EMO), and duration of nighttime sleep and awake periods were analyzed descriptively at baseline. Mean changes from baseline to Week 14/15 (end of double-blind treatment) were analyzed using two-sided t-tests in participants with data for both visits. RESULTS At baseline, 88.3 % (454/514) of participants reported having OBS (34.0 %), ODNSP (17.1 %), or EMO (79.6 %). Those with ODNSP had substantially shorter mean duration of uninterrupted sleep (4.4 h) than the overall pooled population (7.1 h). At Week 14/15, mean decrease from baseline in ODNSP duration was significantly greater with opicapone than with placebo (-0.9 vs. -0.4 h, P < 0.05). In participants with ODNSP at baseline, the decrease in total time spent awake during the night-time sleep period was significantly greater with opicapone than with placebo (-1.0 vs. -0.4 h, P < 0.05), as was the reduction in percent time spent awake during the night-time sleep period (-12.8 % vs. -4.5 %, P < 0.05). CONCLUSION "OFF"-times around nighttime sleep were common in BIPARK-1 and BIPARK-2. Opicapone may improve sleep by decreasing the amount of time spent awake during the night in patients with PD who have night-time sleep period "OFF" episodes.
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Affiliation(s)
- Robert A Hauser
- University of South Florida, Parkinson's Disease & Movement Disorders Center, 4001 E. Fletcher Ave, 6th Floor, Tampa, FL, 33613, USA.
| | - Aleksandar Videnovic
- Department of Neurology, Harvard Medical School, Massachusetts General Hospital, 165 Cambridge Street, Suite 650, Boston, MA, 02214, USA
| | - Patrício Soares-da-Silva
- BIAL-Portela & C(a), S.A., À Avenida da Siderurgia Nacional, 4745-457, Coronado, Portugal; University of Porto, Praça Gomes Teixeira, 4099-002, Porto, Portugal
| | - Grace S Liang
- Neurocrine Biosciences, Inc., 12780 El Camino Real, San Diego, CA, 92130, USA
| | - Kurt Olson
- Neurocrine Biosciences, Inc., 12780 El Camino Real, San Diego, CA, 92130, USA
| | - Eric Jen
- Neurocrine Biosciences, Inc., 12780 El Camino Real, San Diego, CA, 92130, USA
| | - José-Francisco Rocha
- BIAL-Portela & C(a), S.A., À Avenida da Siderurgia Nacional, 4745-457, Coronado, Portugal
| | - Olga Klepitskaya
- Neurocrine Biosciences, Inc., 12780 El Camino Real, San Diego, CA, 92130, USA
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Fay-Karmon T, Galor N, Heimler B, Zilka A, Bartsch RP, Plotnik M, Hassin-Baer S. Home-based monitoring of persons with advanced Parkinson's disease using smartwatch-smartphone technology. Sci Rep 2024; 14:9. [PMID: 38167434 PMCID: PMC10761812 DOI: 10.1038/s41598-023-48209-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Accepted: 11/23/2023] [Indexed: 01/05/2024] Open
Abstract
Movement deterioration is the hallmark of Parkinson's disease (PD), characterized by levodopa-induced motor-fluctuations (i.e., symptoms' variability related to the medication cycle) in advanced stages. However, motor symptoms are typically too sporadically and/or subjectively assessed, ultimately preventing the effective monitoring of their progression, and thus leading to suboptimal treatment/therapeutic choices. Smartwatches (SW) enable a quantitative-oriented approach to motor-symptoms evaluation, namely home-based monitoring (HBM) using an embedded inertial measurement unit. Studies validated such approach against in-clinic evaluations. In this work, we aimed at delineating personalized motor-fluctuations' profiles, thus capturing individual differences. 21 advanced PD patients with motor fluctuations were monitored for 2 weeks using a SW and a smartphone-dedicated app (Intel Pharma Analytics Platform). The SW continuously collected passive data (tremor, dyskinesia, level of activity using dedicated algorithms) and active data, i.e., time-up-and-go, finger tapping, hand tremor and hand rotation carried out daily, once in OFF and once in ON levodopa periods. We observed overall high compliance with the protocol. Furthermore, we observed striking differences among the individual patterns of symptoms' levodopa-related variations across the HBM, allowing to divide our participants among four data-driven, motor-fluctuations' profiles. This highlights the potential of HBM using SW technology for revolutionizing clinical practices.
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Affiliation(s)
- Tsviya Fay-Karmon
- Movement Disorders Institute, Department of Neurology, Sheba Medical Center, Ramat Gan, Israel
| | - Noam Galor
- Center of Advanced Technologies in Rehabilitation, Sheba Medical Center, Ramat Gan, Israel
| | - Benedetta Heimler
- Center of Advanced Technologies in Rehabilitation, Sheba Medical Center, Ramat Gan, Israel
| | - Asaf Zilka
- Movement Disorders Institute, Department of Neurology, Sheba Medical Center, Ramat Gan, Israel
| | - Ronny P Bartsch
- Department of Physics, Bar-Ilan University, Ramat Gan, Israel
| | - Meir Plotnik
- Center of Advanced Technologies in Rehabilitation, Sheba Medical Center, Ramat Gan, Israel
- Department of Physiology and Pharmacology, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
| | - Sharon Hassin-Baer
- Movement Disorders Institute, Department of Neurology, Sheba Medical Center, Ramat Gan, Israel.
- Department of Neurology and Neurosurgery, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
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Aldred J, Freire-Alvarez E, Amelin AV, Antonini A, Bergmans B, Bergquist F, Bouchard M, Budur K, Carroll C, Chaudhuri KR, Criswell SR, Danielsen EH, Gandor F, Jia J, Kimber TE, Mochizuki H, Robieson WZ, Spiegel AM, Standaert DG, Talapala S, Facheris MF, Fung VSC. Continuous Subcutaneous Foslevodopa/Foscarbidopa in Parkinson's Disease: Safety and Efficacy Results From a 12-Month, Single-Arm, Open-Label, Phase 3 Study. Neurol Ther 2023; 12:1937-1958. [PMID: 37632656 PMCID: PMC10630297 DOI: 10.1007/s40120-023-00533-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 08/07/2023] [Indexed: 08/28/2023] Open
Abstract
INTRODUCTION Foslevodopa/foscarbidopa, a soluble formulation of levodopa/carbidopa (LD/CD) prodrugs for the treatment of Parkinson's disease (PD), is administered as a 24-hour/day continuous subcutaneous infusion (CSCI) with a single infusion site. The efficacy and safety of foslevodopa/foscarbidopa versus oral immediate-release LD/CD was previously demonstrated in patients with PD in a 12-week, randomized, double-blind, phase 3 trial (NCT04380142). We report the results of a separate 52-week, open-label, phase 3 registrational trial (NCT03781167) that evaluated the safety/tolerability and efficacy of 24-hour/day foslevodopa/foscarbidopa CSCI in patients with advanced PD. METHODS Male and female patients with levodopa-responsive PD and ≥ 2.5 hours of "Off" time/day received 24-hour/day foslevodopa/foscarbidopa CSCI at individually optimized therapeutic doses (approximately 700-4250 mg of LD per 24 hours) for 52 weeks. The primary endpoint was safety/tolerability. Secondary endpoints included changes from baseline in normalized "Off" and "On" time, percentage of patients reporting morning akinesia, Movement Disorder Society Unified Parkinson's Disease Rating Scale (MDS-UPDRS), Parkinson's Disease Sleep Scale-2 (PDSS-2), 39-item Parkinson's Disease Questionnaire (PDQ-39), and EuroQol 5-dimension questionnaire (EQ-5D-5L). RESULTS Of 244 enrolled patients, 107 discontinued, and 137 completed treatment. Infusion site events were the most common adverse events (AEs). AEs were mostly nonserious (25.8% of patients reported serious AEs) and mild/moderate in severity. At week 52, "On" time without troublesome dyskinesia and "Off" time were improved from baseline (mean [standard deviation (SD)] change in normalized "On" time without troublesome dyskinesia, 3.8 [3.3] hours; normalized "Off" time, -3.5 [3.1] hours). The percentage of patients experiencing morning akinesia dropped from 77.7% at baseline to 27.8% at week 52. Sleep quality (PDSS-2) and quality of life (PDQ-39 and EQ-5D-5L) also improved. CONCLUSION Foslevodopa/foscarbidopa has the potential to provide a safe and efficacious, individualized, 24-hour/day, nonsurgical alternative for patients with PD. TRIAL REGISTRATION NUMBER ClinicalTrials.gov identifier NCT03781167.
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Affiliation(s)
- Jason Aldred
- Selkirk Neurology and Inland Northwest Research, 610 S Sherman St, Spokane, WA, 99202, USA.
| | - Eric Freire-Alvarez
- Neurology Department, University General Hospital of Elche, Carrer Almazara, 11, 03203, Elche, Spain
| | - Alexander V Amelin
- Department of Neurology and Neurosurgery, Pavlov First Saint Petersburg State Medical University, Ulitsa L'va Tolstogo, 6-8, St. Petersburg, 197022, Russia
| | - Angelo Antonini
- Parkinson and Movement Disorders Unit, Department of Neuroscience, Padua University, Via VIII Febbraio, 2, 35122, Padua, Italy
| | - Bruno Bergmans
- Department of Neurology, AZ St-Jan Brugge-Oostende AV, Ruddershove 10, 8000, Brugge, Belgium
- Department of Neurology, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - Filip Bergquist
- Department of Pharmacology, University of Gothenburg, Universitetsplatsen 1, 405 30, Gothenburg, Sweden
| | - Manon Bouchard
- Clinique Neuro-Lévis, 1190 A Rue de Courchevel #301, Lévis, QC, G6W 0M5, Canada
| | - Kumar Budur
- AbbVie Inc., 1 N. Waukegan Road, North Chicago, IL, 60064, USA
| | - Camille Carroll
- Faculty of Health, University of Plymouth, Drake Circus, Plymouth, PL4 8AA, UK
| | - K Ray Chaudhuri
- Parkinson's Foundation International Centre of Excellence, King's College Hospital, Denmark Hill, London, SE5 9RS, UK
- King's College Institute of Psychiatry, Psychology and Neuroscience, 16 De Crespigny Park, London, SE5 8AF, UK
| | - Susan R Criswell
- Department of Neurology, Washington University in St. Louis, 1 Brookings Dr, St. Louis, MO, 63130, USA
| | - Erik H Danielsen
- Department of Neurology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus, Denmark
| | - Florin Gandor
- Movement Disorders Hospital, Straße Nach Fichtenwalde 16, 14547, Beelitz-Heilstätten, Germany
- Department of Neurology, Otto-Von-Guericke University Magdeburg, Universitätspl. 2, 39106, Magdeburg, Germany
| | - Jia Jia
- AbbVie Inc., 1 N. Waukegan Road, North Chicago, IL, 60064, USA
| | - Thomas E Kimber
- Department of Neurology, Royal Adelaide Hospital, Port Road, Adelaide, SA, 5000, Australia
- Department of Medicine, University of Adelaide, 4 North Terrace, Adelaide, SA, 5000, Australia
| | - Hideki Mochizuki
- Department of Neurology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | | | - Amy M Spiegel
- AbbVie Inc., 1 N. Waukegan Road, North Chicago, IL, 60064, USA
| | - David G Standaert
- Department of Neurology, Heersink School of Medicine, University of Alabama at Birmingham, 1670 University Blvd, Birmingham, AL, 35233, USA
| | | | | | - Victor S C Fung
- Movement Disorders Unit, Westmead Hospital, Cnr Hawkesbury Road and Darcy Rd, Westmead, NSW, 2145, Australia
- Faculty of Medicine and Health, Sydney Medical School, University of Sydney, Sydney, NSW, 2006, Australia
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Löhle M, Timpka J, Bremer A, Khodakarami H, Gandor F, Horne M, Ebersbach G, Odin P, Storch A. Application of single wrist-wearable accelerometry for objective motor diary assessment in fluctuating Parkinson's disease. NPJ Digit Med 2023; 6:194. [PMID: 37848531 PMCID: PMC10582031 DOI: 10.1038/s41746-023-00937-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 09/29/2023] [Indexed: 10/19/2023] Open
Abstract
Advanced Parkinson's disease (PD) is characterized by motor fluctuations including unpredictable oscillations remarkably impairing quality of life. Effective management and development of novel therapies for these response fluctuations largely depend on clinical rating instruments such as the widely-used PD home diary, which are associated with biases and errors. Recent advancements in digital health technologies provide user-friendly wearables that can be tailored for continuous monitoring of motor fluctuations. Their criterion validity under real-world conditions using clinical examination as the gold standard remains to be determined. We prospectively examined this validity of a wearable accelerometer-based digital Parkinson's Motor Diary (adPMD) using the Parkinson's Kinetigraph (PKG®) in an alternative application by converting its continuous data into one of the three motor categories of the PD home diary (Off, On and Dyskinetic state). Sixty-three out of 91 eligible participants with fluctuating PD (46% men, average age 66) had predefined sufficient adPMD datasets (>70% of half-hour periods) from 2 consecutive days. 92% of per-protocol assessments were completed. adPMD monitoring of daily times in motor states showed moderate validity for Off and Dyskinetic state (ICC = 0.43-0.51), while inter-rating methods agreements on half-hour-level can be characterized as poor (median Cohen's κ = 0.13-0.21). Individualization of adPMD thresholds for transferring accelerometer data into diary categories improved temporal agreements up to moderate level for Dyskinetic state detection (median Cohen's κ = 0.25-0.41). Here we report that adPMD real-world-monitoring captures daily times in Off and Dyskinetic state in advanced PD with moderate validities, while temporal agreement of adPMD and clinical observer diary data is limited.
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Affiliation(s)
- Matthias Löhle
- Department of Neurology, University Medical Center Rostock, Rostock, Germany.
- German Center for Neurodegenerative Diseases (DZNE) Rostock-Greifswald, Rostock, Germany.
| | - Jonathan Timpka
- Division of Neurology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
- Department of Neurology, Skåne University Hospital, Lund, Sweden
| | - Alexander Bremer
- Department of Neurology, University Medical Center Rostock, Rostock, Germany
| | | | - Florin Gandor
- Movement Disorders Hospital, Beelitz-Heilstätten, Beelitz, Germany
- Department of Neurology, Otto-von-Guericke University, Magdeburg, Germany
| | - Malcom Horne
- Bionics Institute, Melbourne, VIC, Australia
- The Department of Medicine, The University of Melbourne, St Vincent's Hospital, Fitzroy, VIC, 3010, Australia
| | - Georg Ebersbach
- Movement Disorders Hospital, Beelitz-Heilstätten, Beelitz, Germany
| | - Per Odin
- Division of Neurology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
- Department of Neurology, Skåne University Hospital, Lund, Sweden
| | - Alexander Storch
- Department of Neurology, University Medical Center Rostock, Rostock, Germany.
- German Center for Neurodegenerative Diseases (DZNE) Rostock-Greifswald, Rostock, Germany.
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Qu Y, Zhang T, Duo Y, Chen L, Li X. Identification and quantitative assessment of motor complications in Parkinson's disease using the Parkinson's KinetiGraph™. Front Aging Neurosci 2023; 15:1142268. [PMID: 37593376 PMCID: PMC10427502 DOI: 10.3389/fnagi.2023.1142268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 07/17/2023] [Indexed: 08/19/2023] Open
Abstract
Introduction Effective management and therapies for the motor complications of Parkinson's disease (PD) require appropriate clinical evaluation. The Parkinson's KinetiGraph™ (PKG) is a wearable biosensor system that can record the motion characteristics of PD objectively and remotely. Objective The study aims to investigate the value of PKG in identifying and quantitatively assessing motor complications including motor fluctuations and dyskinesia in the Chinese PD population, as well as the correlation with the clinical scale assessments. Methods Eighty-four subjects with PD were recruited and continuously wore the PKG for 7 days. Reports with 7-day output data were provided by the manufacturer, including the fluctuation scores (FS) and dyskinesia scores (DKS). Specialists in movement disorders used the Movement Disorder Society-Unified Parkinson's Disease Rating Scale-IV (MDS-UPDRS IV), the wearing-off questionnaire 9 (WOQ-9), and the unified dyskinesia rating scale (UDysRS) for the clinical assessment of motor complications. Spearman correlation analyses were used to evaluate the correlation between the FS and DKS recorded by the PKG and the clinical scale assessment results. Receiver operating characteristic (ROC) curves were generated to analyze the sensitivity and specificity of the FS and DKS scores in the identification of PD motor complications. Results The FS was significantly positively correlated with the MDS-UPDRS IV motor fluctuation (items 4.3-4.5) scores (r = 0.645, p < 0.001). ROC curve analysis showed a maximum FS cut-off value of 7.5 to identify motor fluctuation, with a sensitivity of 74.3% and specificity of 87.8%. The DKS was significantly positively correlated with the UDysRS total score (r = 0.629, p < 0.001) and the UDysRS III score (r = 0.634, p < 0.001). ROC curve analysis showed that the maximum DKS cut-off value for the diagnosis of dyskinesia was 0.7, with a sensitivity of 83.3% and a specificity of 83.3%. Conclusion The PKG assessment of motor complications in the PD population analyzed in this study has a significant correlation with the clinical scale assessment, high sensitivity, and high specificity. Compared with clinical evaluations, PKG can objectively, quantitatively, and remotely identify and assess motor complications in PD, providing a good objective recording for managing motor complications.
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Affiliation(s)
- Yan Qu
- Department of Neurology, Affiliated Dalian Municipal Friendship Hospital of Dalian Medical University, Dalian, China
| | - Tingting Zhang
- Department of Neurology, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Yunyan Duo
- Department of Neurology, Affiliated Dalian Municipal Friendship Hospital of Dalian Medical University, Dalian, China
| | - Liling Chen
- Department of Neurology, Affiliated Dalian Municipal Friendship Hospital of Dalian Medical University, Dalian, China
| | - Xiaohong Li
- Department of Neurology, Affiliated Dalian Municipal Friendship Hospital of Dalian Medical University, Dalian, China
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Broeder S, Roussos G, De Vleeschhauwer J, D'Cruz N, de Xivry JJO, Nieuwboer A. A smartphone-based tapping task as a marker of medication response in Parkinson's disease: a proof of concept study. J Neural Transm (Vienna) 2023:10.1007/s00702-023-02659-w. [PMID: 37268772 DOI: 10.1007/s00702-023-02659-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 05/24/2023] [Indexed: 06/04/2023]
Abstract
Tapping tasks have the potential to distinguish between ON-OFF fluctuations in Parkinson's disease (PD) possibly aiding assessment of medication status in e-diaries and research. This proof of concept study aims to assess the feasibility and accuracy of a smartphone-based tapping task (developed as part of the cloudUPDRS-project) to discriminate between ON-OFF used in the home setting without supervision. 32 PD patients performed the task before their first medication intake, followed by two test sessions after 1 and 3 h. Testing was repeated for 7 days. Index finger tapping between two targets was performed as fast as possible with each hand. Self-reported ON-OFF status was also indicated. Reminders were sent for testing and medication intake. We studied task compliance, objective performance (frequency and inter-tap distance), classification accuracy and repeatability of tapping. Average compliance was 97.0% (± 3.3%), but 16 patients (50%) needed remote assistance. Self-reported ON-OFF scores and objective tapping were worse pre versus post medication intake (p < 0.0005). Repeated tests showed good to excellent test-retest reliability in ON (0.707 ≤ ICC ≤ 0.975). Although 7 days learning effects were apparent, ON-OFF differences remained. Discriminative accuracy for ON-OFF was particularly good for right-hand tapping (0.72 ≤ AUC ≤ 0.80). Medication dose was associated with ON-OFF tapping changes. Unsupervised tapping tests performed on a smartphone have the potential to classify ON-OFF fluctuations in the home setting, despite some learning and time effects. Replication of these results are needed in a wider sample of patients.
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Affiliation(s)
- Sanne Broeder
- KU Leuven, Department of Rehabilitation Sciences, Neurorehabilitation Research Group (eNRGy), Tervuursevest 101, 3001, Leuven, Belgium.
| | - George Roussos
- Department of Computer Science and Information Systems, Birkbeck College, University of London, Malet Street, London, WC1E 7HX, UK
| | - Joni De Vleeschhauwer
- KU Leuven, Department of Rehabilitation Sciences, Neurorehabilitation Research Group (eNRGy), Tervuursevest 101, 3001, Leuven, Belgium
| | - Nicholas D'Cruz
- KU Leuven, Department of Rehabilitation Sciences, Neurorehabilitation Research Group (eNRGy), Tervuursevest 101, 3001, Leuven, Belgium
| | - Jean-Jacques Orban de Xivry
- KU Leuven, Department of Kinesiology, Movement Control and Neuroplasticity Research Group, Tervuursevest 101, 3001, Leuven, Belgium
- KU Leuven, KU Leuven Brain Institute, Leuven, Belgium
| | - Alice Nieuwboer
- KU Leuven, Department of Rehabilitation Sciences, Neurorehabilitation Research Group (eNRGy), Tervuursevest 101, 3001, Leuven, Belgium
- KU Leuven, KU Leuven Brain Institute, Leuven, Belgium
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Antonini A, Reichmann H, Gentile G, Garon M, Tedesco C, Frank A, Falkenburger B, Konitsiotis S, Tsamis K, Rigas G, Kostikis N, Ntanis A, Pattichis C. Toward objective monitoring of Parkinson's disease motor symptoms using a wearable device: wearability and performance evaluation of PDMonitor ®. Front Neurol 2023; 14:1080752. [PMID: 37260606 PMCID: PMC10228366 DOI: 10.3389/fneur.2023.1080752] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 02/27/2023] [Indexed: 06/02/2023] Open
Abstract
Parkinson's disease (PD) is characterized by a variety of motor and non-motor symptoms. As disease progresses, fluctuations in the response to levodopa treatment may develop, along with emergence of freezing of gait (FoG) and levodopa induced dyskinesia (LiD). The optimal management of the motor symptoms and their complications, depends, principally, on the consistent detection of their course, leading to improved treatment decisions. During the last few years, wearable devices have started to be used in the clinical practice for monitoring patients' PD-related motor symptoms, during their daily activities. This work describes the results of 2 multi-site clinical studies (PDNST001 and PDNST002) designed to validate the performance and the wearability of a new wearable monitoring device, the PDMonitor®, in the detection of PD-related motor symptoms. For the studies, 65 patients with Parkinson's disease and 28 healthy individuals (controls) were recruited. Specifically, during the Phase I of the first study, participants used the monitoring device for 2-6 h in a clinic while neurologists assessed the exhibited parkinsonian symptoms every half hour using the Unified Parkinson's Disease Rating Scale (UPDRS) Part III, as well as the Abnormal Involuntary Movement Scale (AIMS) for dyskinesia severity assessment. The goal of Phase I was data gathering. On the other hand, during the Phase II of the first study, as well as during the second study (PDNST002), day-to-day variability was evaluated, with patients in the former and with control subjects in the latter. In both cases, the device was used for a number of days, with the subjects being unsupervised and free to perform any kind of daily activities. The monitoring device produced estimations of the severity of the majority of PD-related motor symptoms and their fluctuations. Statistical analysis demonstrated that the accuracy in the detection of symptoms and the correlation between their severity and the expert evaluations were high. As a result, the studies confirmed the effectiveness of the system as a continuous telemonitoring solution, easy to be used to facilitate decision-making for the treatment of patients with Parkinson's disease.
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Affiliation(s)
- Angelo Antonini
- Parkinson and Movement Disorders Unit, Study Center for Neurodegeneration (CESNE), Department of Neuroscience, University of Padua, Padua, Italy
| | - Heinz Reichmann
- Department of Neurology, University Hospital Carl Gustav Carus and Carl Gustav Carus Faculty of Medicine, Technische Universitat Dresden, Dresden, Germany
| | - Giovanni Gentile
- Parkinson and Movement Disorders Unit, Study Center for Neurodegeneration (CESNE), Department of Neuroscience, University of Padua, Padua, Italy
| | - Michela Garon
- Parkinson and Movement Disorders Unit, Study Center for Neurodegeneration (CESNE), Department of Neuroscience, University of Padua, Padua, Italy
| | - Chiara Tedesco
- Parkinson and Movement Disorders Unit, Study Center for Neurodegeneration (CESNE), Department of Neuroscience, University of Padua, Padua, Italy
| | - Anika Frank
- Department of Neurology, University Hospital Carl Gustav Carus and Carl Gustav Carus Faculty of Medicine, Technische Universitat Dresden, Dresden, Germany
- German Center for Neurodegenerative Diseases (DZNE), Dresden, Germany
| | - Bjoern Falkenburger
- Department of Neurology, University Hospital Carl Gustav Carus and Carl Gustav Carus Faculty of Medicine, Technische Universitat Dresden, Dresden, Germany
- German Center for Neurodegenerative Diseases (DZNE), Dresden, Germany
| | - Spyridon Konitsiotis
- Department of Neurology, University Hospital of Ioannina and Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Konstantinos Tsamis
- Department of Neurology, University Hospital of Ioannina and Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | | | | | | | - Constantinos Pattichis
- Department of Computer Science and Biomedical Engineering Research Centre, University of Cyprus, Nicosia, Cyprus
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Feasibility of a wearable inertial sensor to assess motor complications and treatment in Parkinson's disease. PLoS One 2023; 18:e0279910. [PMID: 36730238 PMCID: PMC9894418 DOI: 10.1371/journal.pone.0279910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 12/18/2022] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Wearable sensors-based systems have emerged as a potential tool to continuously monitor Parkinson's Disease (PD) motor features in free-living environments. OBJECTIVES To analyse the responsivity of wearable inertial sensor (WIS) measures (On/Off-Time, dyskinesia, freezing of gait (FoG) and gait parameters) after treatment adjustments. We also aim to study the ability of the sensor in the detection of MF, dyskinesia, FoG and the percentage of Off-Time, under ambulatory conditions of use. METHODS We conducted an observational, open-label study. PD patients wore a validated WIS (STAT-ONTM) for one week (before treatment), and one week, three months after therapeutic changes. The patients were analyzed into two groups according to whether treatment changes had been indicated or not. RESULTS Thirty-nine PD patients were included in the study (PD duration 8 ± 3.5 years). Treatment changes were made in 29 patients (85%). When comparing the two groups (treatment intervention vs no intervention), the WIS detected significant changes in the mean percentage of Off-Time (p = 0.007), the mean percentage of On-Time (p = 0.002), the number of steps (p = 0.008) and the gait fluidity (p = 0.004). The mean percentage of Off-Time among the patients who decreased their Off-Time (79% of patients) was -7.54 ± 5.26. The mean percentage of On-Time among the patients that increased their On-Time (59% of patients) was 8.9 ± 6.46. The Spearman correlation between the mean fluidity of the stride and the UPDRS-III- Factor I was 0.6 (p = <0.001). The system detected motor fluctuations (MF) in thirty-seven patients (95%), whilst dyskinesia and FoG were detected in fifteen (41%), and nine PD patients (23%), respectively. However, the kappa agreement analysis between the UPDRS-IV/clinical interview and the sensor was 0.089 for MF, 0.318 for dyskinesia and 0.481 for FoG. CONCLUSIONS It's feasible to use this sensor for monitoring PD treatment under ambulatory conditions. This system could serve as a complementary tool to assess PD motor complications and treatment adjustments, although more studies are required.
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De Pandis MF, Torti M, Rotondo R, Iodice L, Levi Della Vida M, Casali M, Vacca L, Viselli F, Servodidio V, Proietti S, Stocchi F. Therapeutic education for empowerment and engagement in patients with Parkinson's disease: A non-pharmacological, interventional, multicentric, randomized controlled trial. Front Neurol 2023; 14:1167685. [PMID: 37144003 PMCID: PMC10151770 DOI: 10.3389/fneur.2023.1167685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 03/27/2023] [Indexed: 05/06/2023] Open
Abstract
Background In 1997 the European Parkinson's Disease Associations launched the Charter for People with Parkinson's disease that stated the right of patients to be informed and trained on the disease, its course, and treatments available. To date, few data analyzed the effectiveness of education program on motor and non-motor symptoms of PD. Objective The aim of this study was to evaluate the efficacy of an education program as it was a pharmacological treatment, thus choosing as the primary endpoint the change in daily OFF hours, the most widely used outcome in pharmaceutical clinical trials on PD patients with motor fluctuations. Secondary outcomes were change in motor and non-motor symptoms, quality of life and social functioning. The long-term efficacy of the education therapy was also evaluated by analyzing data collected at 12- and 24-weeks follow-up outpatient visits. Methods One hundred and twenty advanced patients and their caregivers were assigned to the intervention or control group in a single-blind, multicentric, prospective, randomized study evaluating an education program structured in individual and group sessions over a 6-weeks period.At the end of study, the intervention group showed a significant reduction in daily OFF hours compared to control patients (-1.07 ± 0.78 vs. 0.09 ± 0.35, p < 0.0001) and a significant improvement was also reported in most secondary outcomes. Patients retained significant medication adherence and daily OFF hours reduction at 12- and 24-weeks follow-up. Conclusion The results obtained demonstrated that education programs may translate in a notable improvement in motor fluctuations and non-motor symptoms in advanced PD patients.Clinical Trial Registration:Clinicaltrials.gov, identifier NCT04378127.
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Affiliation(s)
| | | | | | - Lanfranco Iodice
- Health Management, University Hospital “Federico II”, Naples, Italy
- Italian Health Ministry c/o USMAF Campania, Naples, Italy
| | | | | | | | | | | | | | - Fabrizio Stocchi
- IRCCS San Raffaele Roma, Rome, Italy
- San Raffaele University, Rome, Italy
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10
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Gonzalez-Robles C, Weil RS, van Wamelen D, Bartlett M, Burnell M, Clarke CS, Hu MT, Huxford B, Jha A, Lambert C, Lawton M, Mills G, Noyce A, Piccini P, Pushparatnam K, Rochester L, Siu C, Williams-Gray CH, Zeissler ML, Zetterberg H, Carroll CB, Foltynie T, Schrag A. Outcome Measures for Disease-Modifying Trials in Parkinson's Disease: Consensus Paper by the EJS ACT-PD Multi-Arm Multi-Stage Trial Initiative. JOURNAL OF PARKINSON'S DISEASE 2023; 13:1011-1033. [PMID: 37545260 PMCID: PMC10578294 DOI: 10.3233/jpd-230051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/23/2023] [Indexed: 08/08/2023]
Abstract
BACKGROUND Multi-arm, multi-stage (MAMS) platform trials can accelerate the identification of disease-modifying treatments for Parkinson's disease (PD) but there is no current consensus on the optimal outcome measures (OM) for this approach. OBJECTIVE To provide an up-to-date inventory of OM for disease-modifying PD trials, and a framework for future selection of OM for such trials. METHODS As part of the Edmond J Safra Accelerating Clinical Trials in Parkinson Disease (EJS ACT-PD) initiative, an expert group with Patient and Public Involvement and Engagement (PPIE) representatives' input reviewed and evaluated available evidence on OM for potential use in trials to delay progression of PD. Each OM was ranked based on aspects such as validity, sensitivity to change, participant burden and practicality for a multi-site trial. Review of evidence and expert opinion led to the present inventory. RESULTS An extensive inventory of OM was created, divided into: general, motor and non-motor scales, diaries and fluctuation questionnaires, cognitive, disability and health-related quality of life, capability, quantitative motor, wearable and digital, combined, resource use, imaging and wet biomarkers, and milestone-based. A framework for evaluation of OM is presented to update the inventory in the future. PPIE input highlighted the need for OM which reflect their experience of disease progression and are applicable to diverse populations and disease stages. CONCLUSION We present a range of OM, classified according to a transparent framework, to aid selection of OM for disease-modifying PD trials, whilst allowing for inclusion or re-classification of relevant OM as new evidence emerges.
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Affiliation(s)
| | | | | | | | - Matthew Burnell
- Medical Research Council Clinical Trials Unit at University College London, London, UK
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11
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Soileau MJ, Aldred J, Budur K, Fisseha N, Fung VS, Jeong A, Kimber TE, Klos K, Litvan I, O'Neill D, Robieson WZ, Spindler MA, Standaert DG, Talapala S, Vaou EO, Zheng H, Facheris MF, Hauser RA. Safety and efficacy of continuous subcutaneous foslevodopa-foscarbidopa in patients with advanced Parkinson's disease: a randomised, double-blind, active-controlled, phase 3 trial. Lancet Neurol 2022; 21:1099-1109. [PMID: 36402160 DOI: 10.1016/s1474-4422(22)00400-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 08/31/2022] [Accepted: 09/15/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND Levodopa is the most effective symptomatic therapy for Parkinson's disease, but patients with advanced Parkinson's disease develop motor fluctuations with chronic oral levodopa therapy. Foslevodopa-foscarbidopa is a soluble formulation of levodopa and carbidopa prodrugs that is delivered as a 24-h/day continuous subcutaneous infusion, and we aimed to assess the safety and efficacy of this formulation in patients with advanced Parkinson's disease. METHODS A 12-week randomised, double-blind, double-dummy, active-controlled study was done at 65 academic and community study centres in the USA and Australia. Patients with levodopa-responsive advanced Parkinson's disease inadequately controlled on current therapy, including at least 2·5 h of average daily off time, were randomly assigned (1:1) to continuous subcutaneous infusion of foslevodopa-foscarbidopa plus oral placebo or to oral immediate-release levodopa-carbidopa plus continuous subcutaneous infusion of placebo solution. Randomisation was stratified by site by means of a permutated-block schedule with a block size of two. The participants, treating investigators, study site personnel, and sponsor were masked to treatment group allocation. The primary and first key secondary endpoint in the hierarchical testing strategy were change from baseline to week 12 in on time without troublesome dyskinesia and off time, respectively; both endpoints were evaluated by an intention-to-treat analysis applying a mixed model for repeated measures analysis. Safety and tolerability were assessed throughout the study. The study is completed and is listed on ClinicalTrials.gov, NCT04380142. FINDINGS Between Oct 19, 2020, and Sept 29, 2021, of 270 participants screened and 174 enrolled, 141 were randomly assigned and received continuous subcutaneous infusion of foslevodopa-foscarbidopa plus oral placebo capsules (n=74) or oral encapsulated immediate-release levodopa-carbidopa plus continuous subcutaneous infusion of placebo solution (n=67). Compared with levodopa-carbidopa, foslevodopa-foscarbidopa showed a significantly greater increase in on time without troublesome dyskinesia (model-based mean [SE] 2·72 [0·52] vs 0·97 [0·50] h; difference 1·75 h, 95% CI 0·46 to 3·05; p=0·0083) and a significantly greater reduction in off time (-2·75 [0·50] vs -0·96 [0·49] h; difference -1·79 h, -3·03 to -0·54; p=0·0054). Hierarchical testing ended after the first secondary endpoint. Adverse events were reported in 63 (85%) of 74 patients in the foslevodopa-foscarbidopa group versus 42 (63%) of 67 in the levodopa-carbidopa group, and incidences of serious adverse events were similar between the groups (six [8%] of 74 vs four [6%] of 67, respectively). The most frequent adverse events in the foslevodopa-foscarbidopa group were infusion site adverse events (erythema 20 [27%]), pain 19 [26%]), cellulitis (14 [19%]), and oedema (nine [12%]), most of which were non-serious and mild-moderate in severity. The only system organ class that had more than one serious adverse event in the foslevodopa-foscarbidopa group was infections and infestations (catheter site cellulitis [one [1%]] and infusion site cellulitis [one [1%]). Adverse events led to premature discontinuation of study drug in 16 (22%) of 74 participants in the foslevodopa-foscarbidopa group versus one (1%) of 67 participants in the oral levodopa-carbidopa group. INTERPRETATION Foslevodopa-foscarbidopa improved motor fluctuations, with benefits in both on time without troublesome dyskinesia and off time. Foslevodopa-foscarbidopa has a favourable benefit-risk profile and represents a potential non-surgical alternative for patients with advanced Parkinson's disease. FUNDING AbbVie.
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Affiliation(s)
| | - Jason Aldred
- Selkirk Neurology & Inland Northwest Research, Spokane, WA, USA
| | | | | | - Victor Sc Fung
- Movement Disorders Unit, Westmead Hospital, Westmead, Australia; Sydney Medical School, University of Sydney, Sydney NSW, Australia
| | | | - Thomas E Kimber
- Royal Adelaide Hospital, Adelaide, SA, Australia; Department of Medicine, University of Adelaide, Adelaide, SA, Australia
| | - Kevin Klos
- Movement Disorder Clinic of Oklahoma, Tulsa, OK, USA
| | - Irene Litvan
- Parkinson and Other Movement Disorders Center, University of California San Diego, La Jolla, CA, USA
| | - Daniel O'Neill
- South Western Sydney Local Health District, Liverpool, NSW, Australia
| | | | - Meredith A Spindler
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - David G Standaert
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, USA
| | | | | | | | | | - Robert A Hauser
- University of South Florida Parkinson's Disease and Movement Disorders Center of Excellence, Tampa, FL, USA
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12
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Ferreira JJ, Poewe W, Rascol O, Stocchi F, Antonini A, Moreira J, Guimarães B, Rocha JF, Soares-da-Silva P. Effect of Opicapone on Levodopa Pharmacokinetics in Patients with Fluctuating Parkinson's Disease. Mov Disord 2022; 37:2272-2283. [PMID: 36054562 DOI: 10.1002/mds.29193] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 07/19/2022] [Accepted: 07/28/2022] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Inhibiting catechol-O-methyltransferase extends the plasma half-life of levodopa, potentially allowing physicians to optimize the levodopa regimen in patients with Parkinson's disease (PD) experiencing motor fluctuations. OBJECTIVES To evaluate the effects of once-daily opicapone on levodopa plasma pharmacokinetics and motor response when added to two different levodopa dosing regimens. METHODS A total of 24 patients with PD and motor fluctuations were enrolled in an exploratory, open-label, modified cross-over trial. Participants first received levodopa/carbidopa 500/125 mg (five intakes) for 2 weeks and were then randomly assigned (1:1) to levodopa/carbidopa 400/100 mg given over either four or five daily intakes plus opicapone 50 mg for an additional 2 weeks. Levodopa 12-hour pharmacokinetics was the primary outcome (ie, excluding the effect of last/evening levodopa/carbidopa intake), with motor complications evaluated as secondary outcomes. RESULTS Over 12-hour pharmacokinetics and compared with five-intake levodopa/carbidopa 500/125 mg without opicapone, maximal levodopa concentrations were similar or nonsignificantly higher on both levodopa/carbidopa 400/100 mg regimens plus opicapone. Despite a 100 mg lower total levodopa/carbidopa daily dose, adding opicapone 50 mg at least doubled the levodopa plasma half-life and minimal concentrations, with a significant ≈30% increase in total exposure. The levodopa fluctuation index was only significantly lower for the five intakes plus opicapone regimen (difference of -71.8%; P < 0.0001). Modifications to levodopa pharmacokinetics were associated with decreased off time and increased on time. CONCLUSIONS Combining opicapone 50 mg with a 100 mg lower daily dose of levodopa provides higher levodopa bioavailability with avoidance of trough levels. Despite the lower levodopa dose, modifying the levodopa pharmacokinetic profile with opicapone was associated with decreased off time and increased on time. © 2022 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Joaquim J Ferreira
- Laboratory of Clinical Pharmacology and Therapeutics, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal.,CNS-Campus Neurológico Sénior, Torres Vedras, Portugal
| | - Werner Poewe
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Olivier Rascol
- Department of Neurosciences and Clinical Pharmacology, University of Toulouse, Toulouse, France
| | - Fabrizio Stocchi
- Department of Neurology, University San Raffaele and IRCCS (Istituto di Ricovero e Cura a Carattere Scientifico) San Raffaele Pisana, Rome, Italy
| | - Angelo Antonini
- Parkinson and Movement Disorders Unit, Study Center for Neurodegeneration, Department of Neurosciences University of Padova, Padova, Italy
| | - Joana Moreira
- BIAL-Portela & Ca S.A, Research & Development Department, Coronado, Portugal
| | - Bruno Guimarães
- BIAL-Portela & Ca S.A, Research & Development Department, Coronado, Portugal
| | | | - Patrício Soares-da-Silva
- BIAL-Portela & Ca S.A, Research & Development Department, Coronado, Portugal.,University of Porto, Pharmacology Department, Porto, Portugal.,MedInUP-Center for Drug Discovery and Innovative Medicines, University of Porto, Porto, Portugal
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13
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Bendig J, Spanz A, Leidig J, Frank A, Stahr M, Reichmann H, Loewenbrück KF, Falkenburger BH. Measuring the Usability of eHealth Solutions for Patients With Parkinson Disease: Observational Study. JMIR Form Res 2022; 6:e39954. [DOI: 10.2196/39954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Revised: 08/28/2022] [Accepted: 09/03/2022] [Indexed: 11/06/2022] Open
Abstract
Background
Parkinson disease (PD) is a neurodegenerative disorder with a variety of motor and nonmotor symptoms. Many of these symptoms can be monitored by eHealth solutions, including smartphone apps, wearable sensors, and camera systems. The usability of such systems is a key factor in long-term use, but not much is known about the predictors of successful use and preferable methods to assess usability in patients with PD.
Objective
This study tested methods to assess usability and determined prerequisites for successful use in patients with PD.
Methods
We performed comprehensive usability assessments with 18 patients with PD using a mixed methods usability battery containing the System Usability Scale, a rater-based evaluation of device-specific tasks, and qualitative interviews. Each patient performed the usability battery with 2 of 3 randomly assigned devices: a tablet app, wearable sensors, and a camera system. The usability battery was administered at the beginning and at the end of a 4-day testing period. Between usability batteries, the systems were used by the patients during 3 sessions of motor assessments (wearable sensors and camera system) and at the movement disorder ward (tablet app).
Results
In this study, the rater-based evaluation of tasks discriminated the best between the 3 eHealth solutions, whereas subjective modalities such as the System Usability Scale were not able to distinguish between the systems. Successful use was associated with different clinical characteristics for each system: eHealth literacy and cognitive function predicted successful use of the tablet app, and better motor function and lower age correlated with the independent use of the camera system. The successful use of the wearable sensors was independent of clinical characteristics. Unfortunately, patients who were not able to use the devices well provided few improvement suggestions in qualitative interviews.
Conclusions
eHealth solutions should be developed with a specific set of patients in mind and subsequently tested in this cohort. For a complete picture, usability assessments should include a rater-based evaluation of task performance, and there is a need to develop strategies to circumvent the underrepresentation of poorly performing patients in qualitative usability research.
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14
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Ramesh V, Bilal E. Detecting motor symptom fluctuations in Parkinson's disease with generative adversarial networks. NPJ Digit Med 2022; 5:138. [PMID: 36085350 PMCID: PMC9463161 DOI: 10.1038/s41746-022-00674-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 08/08/2022] [Indexed: 11/09/2022] Open
Abstract
Parkinson's disease is a neurodegenerative disorder characterized by several motor symptoms that develop gradually: tremor, bradykinesia, limb rigidity, and gait and balance problems. While there is no cure, levodopa therapy has been shown to mitigate symptoms. A patient on levodopa experiences cycles in the severity of their symptoms, characterized by an ON state-when the drug is active-and an OFF state-when symptoms worsen as the drug wears off. The longitudinal progression of the disease is monitored using episodic assessments performed by trained physicians in the clinic, such as the Unified Parkinson's Disease Rating Scale (UPDRS). Lately, there has been an effort in the field to develop continuous, objective measures of motor symptoms based on wearable sensors and other remote monitoring devices. In this work, we present an effort towards such a solution that uses a single wearable inertial sensor to automatically assess the postural instability and gait disorder (PIGD) of a Parkinson's disease patient. Sensor data was collected from two independent studies of subjects performing the UPDRS test and then used to train and validate a convolutional neural network model. Given the typical limited size of such studies we also employed the use of generative adversarial networks to improve the performance of deep-learning models that usually require larger amounts of data for training. We show that for a 2-min walk test, our method's predicted PIGD scores can be used to identify a patient's ON/OFF states better than a physician evaluated on the same criteria. This result paves the way for more reliable, continuous tracking of Parkinson's disease symptoms.
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Affiliation(s)
- Vishwajith Ramesh
- Department of Biomedical Informatics, University of California, San Diego, CA, USA.
| | - Erhan Bilal
- T.J. Watson Research Center, IBM Research, Yorktown Heights, NY, USA
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15
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Safarpour D, Brumbach BH, Arena M, Quinn J, Diamond S, Nutt JG, Pfeiffer R. Gastrointestinal Motility and Response to Levodopa in Parkinson's Disease: A Proof-of-Concept Study. Mov Disord 2022; 37:2153-2158. [PMID: 35969014 DOI: 10.1002/mds.29176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 06/24/2022] [Accepted: 07/18/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Simultaneous measurement of gastrointestinal transit time (GITT) and plasma levodopa concentration (PLC) is crucial to understanding the effect of dysfunctional motility on levodopa response in patients with Parkinson's disease (PwPD). OBJECTIVE The aim is to determine if altered segmental GITT correlates with clinical response and PLC variability in PwPD. METHODS Ten typical and 10 erratic responders ingested the SmartPill (SP) wireless motility capsule. Serial PLC and finger tapping, obtained every 30 minutes for 3 hours after SP/levodopa ingestion, evaluated the correlation between GITT, clinical response, and PLC. Glucose breath testing assessed small intestinal bacterial overgrowth (SIBO). RESULTS GITT was not significantly different in "typical" and "erratic" responders. SIBO was positive in half of the erratic and negative in most typical responders. CONCLUSION SP is a feasible technology for assessing GITT in PwPD. A larger study may be able to significantly differentiate/correlate GITT in different segments of the GI tract with response to levodopa. © 2022 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Delaram Safarpour
- Department of Neurology, Oregon Health & Science University, Portland, Oregon, USA
| | - Barbara H Brumbach
- OHSU-PSU School of Public Health, Biostatistics and Design Program, Oregon Health & Science University, Portland, Oregon, USA
| | - Monica Arena
- Department of Neurology, Oregon Health & Science University, Portland, Oregon, USA
| | - Joseph Quinn
- Department of Neurology, Oregon Health & Science University, Portland, Oregon, USA
| | - Sarah Diamond
- Department of Medicine, Oregon Health & Science University, Portland, Oregon, USA
| | - Jay G Nutt
- Department of Neurology, Oregon Health & Science University, Portland, Oregon, USA
| | - RonaldF Pfeiffer
- Department of Neurology, Oregon Health & Science University, Portland, Oregon, USA
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Timpka J, Löhle M, Bremer A, Christiansson S, Gandor F, Ebersbach G, Dahlström Ö, Iwarsson S, Nilsson MH, Storch A, Odin P. Objective Observer vs. Patient Motor State Assessments Using the PD Home Diary in Advanced Parkinson's Disease. Front Neurol 2022; 13:935664. [PMID: 35903114 PMCID: PMC9321639 DOI: 10.3389/fneur.2022.935664] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 06/14/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundThe Parkinson Disease (PD) Home Diary (HD) is a commonly used clinical outcome measure, but it has not been extensively compared to direct assessments by experienced observers.ObjectiveValidation of patient-reported HD by investigating the agreement between motor state assessments by patients and observers.MethodsThis observational study included patients with PD and motor fluctuations. Observers were physicians or research nurses. Patients completed a screening visit, one day of diary ratings at home, and then two days of ratings on-site during which patients and observers simultaneously judged the participants' motor state.ResultsObservers and 40 patients completed 1,288 pairs of half-hourly blinded motor state assessments. There were significant differences between observer and patient ratings (P < 0.001) and the temporal agreement was poor (Cohen's κ = 0.358). The agreement between patient and observer ratings was 71.1% for observed “On without dyskinesia”, 57.3% for observed “Off”, and 49.4% for observed “On with dyskinesia”. Daily times spent in the three motor states as aggregated diary data showed fair to excellent reliability with intraclass coefficient values ranging from 0.45 to 0.52 for “On” and 0.77 for “Off”.ConclusionThere were significant differences between observer and patient ratings. Patients and observers generally agreed on when the patients was in the “On” state (with or without dyskinesia). Patient ratings on the hour level seem to be influenced by other aspects of the patients' experience than the observed motor state, but assessment of daily time spent in the different motor state provides reasonable reliability.
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Affiliation(s)
- Jonathan Timpka
- Division of Neurology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
- Department of Neurology, Skåne University Hospital, Lund, Sweden
- *Correspondence: Jonathan Timpka
| | - Matthias Löhle
- Department of Neurology, University of Rostock, Rostock, Germany
- German Center for Neurodegenerative Diseases (DZNE) Rostock/Greifswald, Rostock, Germany
| | - Alexander Bremer
- Department of Neurology, University of Rostock, Rostock, Germany
- German Center for Neurodegenerative Diseases (DZNE) Rostock/Greifswald, Rostock, Germany
| | - Sofia Christiansson
- Division of Neurology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
- Department of Neurology, Skåne University Hospital, Lund, Sweden
| | - Florin Gandor
- Movement Disorders Clinic, Beelitz-Heilstätten, Germany
- Department of Neurology, Otto-von-Guericke University, Magdeburg, Germany
| | | | - Örjan Dahlström
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden
- Athletics Research Center, Linköping University, Linköping, Sweden
| | | | - Maria H. Nilsson
- Department of Health Sciences, Lund University, Lund, Sweden
- Memory Clinic, Skåne University Hospital, Malmö, Sweden
| | - Alexander Storch
- Department of Neurology, University of Rostock, Rostock, Germany
- German Center for Neurodegenerative Diseases (DZNE) Rostock/Greifswald, Rostock, Germany
| | - Per Odin
- Division of Neurology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
- Department of Neurology, Skåne University Hospital, Lund, Sweden
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Rodríguez-Martín D, Cabestany J, Pérez-López C, Pie M, Calvet J, Samà A, Capra C, Català A, Rodríguez-Molinero A. A New Paradigm in Parkinson's Disease Evaluation With Wearable Medical Devices: A Review of STAT-ON TM. Front Neurol 2022; 13:912343. [PMID: 35720090 PMCID: PMC9202426 DOI: 10.3389/fneur.2022.912343] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 04/22/2022] [Indexed: 11/13/2022] Open
Abstract
In the past decade, the use of wearable medical devices has been a great breakthrough in clinical practice, trials, and research. In the Parkinson's disease field, clinical evaluation is time limited, and healthcare professionals need to rely on retrospective data collected through patients' self-filled diaries and administered questionnaires. As this often leads to inaccurate evaluations, a more objective system for symptom monitoring in a patient's daily life is claimed. In this regard, the use of wearable medical devices is crucial. This study aims at presenting a review on STAT-ONTM, a wearable medical device Class IIa, which provides objective information on the distribution and severity of PD motor symptoms in home environments. The sensor analyzes inertial signals, with a set of validated machine learning algorithms running in real time. The device was developed for 12 years, and this review aims at gathering all the results achieved within this time frame. First, a compendium of the complete journey of STAT-ONTM since 2009 is presented, encompassing different studies and developments in funded European and Spanish national projects. Subsequently, the methodology of database construction and machine learning algorithms design and development is described. Finally, clinical validation and external studies of STAT-ONTM are presented.
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Affiliation(s)
| | - Joan Cabestany
- Technical Research Centre for Dependency Care and Autonomous Living, Universitat Politecnica de Catalunya, Barcelona, Spain
| | - Carlos Pérez-López
- Department of Investigation, Consorci Sanitari Alt Penedès - Garraf, Vilanova i la Geltrú, Spain
| | - Marti Pie
- Sense4Care S.L., Cornellà de Llobregat, Spain
| | - Joan Calvet
- Sense4Care S.L., Cornellà de Llobregat, Spain
| | - Albert Samà
- Sense4Care S.L., Cornellà de Llobregat, Spain
| | | | - Andreu Català
- Technical Research Centre for Dependency Care and Autonomous Living, Universitat Politecnica de Catalunya, Barcelona, Spain
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Validation of the PD home diary for assessment of motor fluctuations in advanced Parkinson's disease. NPJ Parkinsons Dis 2022; 8:69. [PMID: 35654835 PMCID: PMC9163037 DOI: 10.1038/s41531-022-00331-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 05/10/2022] [Indexed: 11/09/2022] Open
Abstract
The Parkinson's disease (PD) home diary is frequently used in clinical trials to measure efficacy of medical treatments for motor fluctuations in advanced PD. This prospective study in fluctuating PD patients examines the validity of the diary for quantification of motor states in comparison to direct clinical observation. 51 patients (median age: 65 years, disease duration: 11 years) completed the diary half-hourly for two consecutive days and were simultaneously rated by an experienced observer, who independently evaluated motor states half-hourly throughout daytime. Overall agreement (Cohen's kappa) between patient and observer diary entries was 59.8% (0.387). Patients documented more On without dyskinesia (52.3% vs. 38.9%, P < 0.001) and less On with dyskinesia (21.5% vs. 34.2%, P < 0.001), whereas proportions for Off intervals were not different between patient and observer diaries (26.2% vs. 27.0%, P = 0.97). Temporal agreement between diary ratings was unsatisfactory, particularly for On with dyskinesia. Taken together, our study suggests that the PD home diary only inadequately reflects actual motor states compared to direct clinical observation.
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Body-Worn Sensors for Parkinson’s disease: A qualitative approach with patients and healthcare professionals. PLoS One 2022; 17:e0265438. [PMID: 35511812 PMCID: PMC9070870 DOI: 10.1371/journal.pone.0265438] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 03/01/2022] [Indexed: 11/29/2022] Open
Abstract
Body-Worn Sensors (BWS) provide reliable objective and continuous assessment of Parkinson’s disease (PD) motor symptoms, but their implementation in clinical routine has not yet become widespread. Users’ perceptions of BWS have not been explored. This study intended to evaluate the usability, user experience (UX), patients’ perceptions of BWS, and health professionals’ (HP) opinions on BWS monitoring. A qualitative analysis was performed from semi-structured interviews conducted with 22 patients and 9 HP experts in PD. Patients completed two interviews before and after the BWS one-week experiment, and they answered two questionnaires assessing the usability and UX. Patients rated the three BWS usability with high scores (SUS median [range]: 87.5 [72.5–100]). The UX across all dimensions of their interaction with the BWS was positive. During interviews, all patients and HP expressed interest in BWS monitoring. Patients’ hopes and expectations increased the more they learned about BWS. They manifested enthusiasm to wear BWS, which they imagined could improve their PD symptoms. HP highlighted needs for logistical support in the implementation of BWS in their practice. Both patients and HP suggested possible uses of BWS monitoring in clinical practice, for treatment adjustments for example, or for research purposes. Patients and HP shared ideas about the use of BWS monitoring, although patients may be more likely to integrate BWS into their disease follow-up compared to HP in their practice. This study highlights gaps that need to be fulfilled to facilitate BWS adoption and promote their potential.
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Farzanehfar P, Woodrow H, Horne M. Sensor Measurements Can Characterize Fluctuations and Wearing Off in Parkinson’s Disease and Guide Therapy to Improve Motor, Non-motor and Quality of Life Scores. Front Aging Neurosci 2022; 14:852992. [PMID: 35401155 PMCID: PMC8984604 DOI: 10.3389/fnagi.2022.852992] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 02/25/2022] [Indexed: 12/11/2022] Open
Abstract
Objectives The aim was to examine the role of sensor measurement in identifying and managing fluctuations in bradykinesia of Parkinson’s Disease. Method Clinical scales and data from wearable sensors obtained before and after optimization of treatment from 107 participants who participated in a previous study was used. Fluctuators were identified by a levodopa response or wearing off in their sensor data and were subdivided according to whether the sensor’s bradykinesia scores were in target range, representing acceptable bradykinesia for part of the dose (Controlled Fluctuator: n = 22) or above target for the whole dose period (Uncontrolled Fluctuator; n = 28). Uncontrolled Non-fluctuators (n = 24) were cases without a levodopa response or wearing-off and sensor bradykinesia scores above target throughout the day (un-controlled). Controlled Non-fluctuators (n = 33) were below target throughout the day (controlled) and used as a reference for good control (MDS-UPDRS III = 33 ± 8.6 and PDQ39 = 28 ± 18). Results Treating Fluctuators significantly improved motor and quality of life scores. Converting fluctuators into Controlled Non-fluctuators significantly improved motor, non-motor and quality of life scores and a similar but less significant improvement was obtained by conversion to a Controlled Fluctuator. There was a significantly greater likelihood of achieving these changes when objective measurement was used to guide management. Conclusions The sensor’s classification of fluctuators bore a relation to severity of clinical scores and treatment of fluctuation improved clinical scores. The sensor measurement aided in recognizing and removing fluctuations with treatment and resulted in better clinical scores, presumably by assisting therapeutic decisions.
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Affiliation(s)
- Parisa Farzanehfar
- Parkinson’s Laboratory, Florey Institute of Neurosciences and Mental Health, Parkville, VIC, Australia
| | - Holly Woodrow
- Parkinson’s Laboratory, Florey Institute of Neurosciences and Mental Health, Parkville, VIC, Australia
| | - Malcolm Horne
- Parkinson’s Laboratory, Florey Institute of Neurosciences and Mental Health, Parkville, VIC, Australia
- Department of Clinical Neurosciences, St. Vincent’s Hospital Fitzroy, Fitzroy, VIC, Australia
- *Correspondence: Malcolm Horne,
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21
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Rascol O, Medori R, Baayen C, Such P, Meulien D. A Randomized, Double-Blind, Controlled Phase II Study of Foliglurax in Parkinson's Disease. Mov Disord 2022; 37:1088-1093. [PMID: 35218231 PMCID: PMC9303267 DOI: 10.1002/mds.28970] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 01/28/2022] [Accepted: 02/01/2022] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Agents targeting the metabotropic glutamate receptor 4 have emerged as a potentially attractive new class of drugs for the treatment of Parkinson's disease (PD). OBJECTIVE The objective of this study was to evaluate the efficacy and safety of foliglurax in reducing off time and dyskinesia in patients with PD. METHODS This was a 28-day, multicenter, randomized, placebo-controlled, double-blind clinical trial of foliglurax 10 and 30 mg as adjunct to levodopa in 157 randomly assigned patients with PD and motor complications. RESULTS Although dose-dependent decreases in daily awake off time were apparent following treatment with foliglurax, the change from baseline to day 28 in off time (primary endpoint) and dyskinesia (secondary endpoint) did not improve significantly compared with placebo for either foliglurax dose. Treatment with foliglurax was generally safe, and there were no relevant safety signals. CONCLUSIONS There was no evidence in this study that foliglurax has efficacy in improving levodopa-induced motor complications in PD. © 2022 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Olivier Rascol
- Clinical Investigation Center CIC1436, Department of Clinical Pharmacology and Neurosciences, Parkinson Expert Centre, NeuroToul Center of Excellence in Neurodegeneration (COEN) of Toulouse and NS-Park/FCRIN Network; INSERM, University of Toulouse 3, CHU of Toulouse, Toulouse, France
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22
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Hauser RA, Goud S, Formella AE. Potential utility of amantadine DR/ER in persons with Parkinson’s disease meeting 5-2-1 criteria for device aided therapy. Clin Park Relat Disord 2022; 6:100123. [PMID: 35059622 PMCID: PMC8760552 DOI: 10.1016/j.prdoa.2021.100123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 12/02/2021] [Indexed: 11/30/2022] Open
Abstract
5-2-1 criteria help identify PD patients who may benefit from device aided therapy. Amantadine-DR/ER increased ‘good’ ON time in patients meeting 5-2-1 criteria. Increased good ON time resulted from reductions in troublesome dyskinesia and OFF. Amantadine-DR/ER efficacy was maintained over 100 weeks in this advanced population.
Background The 5-2-1 criteria (≥5 levodopa doses/day, ≥2 h OFF/day, and ≥ 1-hour dyskinesia/day) propose to identify people with Parkinson’s disease (PD) who are poorly controlled on oral therapies and who may therefore benefit from device-aided therapies. Amantadine-DR/ER is the only medication FDA-approved for both dyskinesia and OFF episodes in levodopa-treated patients. In this post-hoc analysis of phase 3 clinical trials, we evaluated the efficacy and safety of amantadine-DR/ER in patients meeting 5-2-1 criteria. Methods Week-12 treatment differences (Amantadine-DR/ER − placebo) in the Unified Dyskinesia Rating Scale (UDysRS) and PD motor states (patient diaries) were evaluated in pooled, phase-3, double-blind trial participants meeting 5-2-1 criteria at baseline. This 5-2-1 cohort was followed into a 2-year open-label trial, where Movement Disorder Society - Unified Parkinson’s Disease Rate Scale (MDS-UPDRS) Part IV scores were assessed relative to double-blind baseline. Results Of 198 enrolled participants in the phase 3 trials, 65 (33%; n = 29 placebo; n = 36 amantadine-DR/ER) comprised the 5-2-1 cohort. At Week-12 endpoint, amantadine-DR/ER significantly improved UDysRS scores (treatment difference of 9.57 ± 3.15 points, p = 0.004) and ON time without troublesome dyskinesia (‘good ON’, treatment difference of 2.9 ± 0.90 h/day, p = 0.002). Improvements in good ON time resulted from significant reductions in both troublesome dyskinesia and OFF time. Treatment benefit on MDS-UPDRS-Part IV was sustained through open-label, follow-up. The most common adverse events in patients who met 5-2-1 criteria and were treated with amantadine-DR/ER included falls and peripheral edema. Conclusions Findings suggest Amantadine-DR/ER should be considered as an option for people with PD who meet 5-2-1 criteria.
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Garcia-Agundez A, Eickhoff C. Towards Objective Quantification of Hand Tremors and Bradykinesia Using Contactless Sensors: A Systematic Review. Front Aging Neurosci 2021; 13:716102. [PMID: 34759810 PMCID: PMC8572888 DOI: 10.3389/fnagi.2021.716102] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 09/27/2021] [Indexed: 11/26/2022] Open
Abstract
Assessing the progression of movement disorders such as Parkinson's Disease (PD) is key in adjusting therapeutic interventions. However, current methods are still based on subjective factors such as visual observation, resulting in significant inter-rater variability on clinical scales such as UPDRS. Recent studies show the potential of sensor-based methods to address this limitation. The goal of this systematic review is to provide an up-to-date analysis of contactless sensor-based methods to estimate hand dexterity UPDRS scores in PD patients. Two hundred and twenty-four abstracts were screened and nine articles selected for analysis. Evidence obtained in a cumulative cohort of n = 187 patients and 1, 385 samples indicates that contactless sensors, particularly the Leap Motion Controller (LMC), can be used to assess UPDRS hand motor tasks 3.4, 3.5, 3.6, 3.15, and 3.17, although accuracy varies. Early evidence shows that sensor-based methods have clinical potential and might, after refinement, complement, or serve as a support to subjective assessment procedures. Given the nature of UPDRS assessment, future studies should observe whether LMC classification error falls within inter-rater variability for clinician-measured UPDRS scores to validate its clinical utility. Conversely, variables relevant to LMC classification such as power spectral densities or movement opening and closing speeds could set the basis for the design of more objective expert systems to assess hand dexterity in PD.
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Affiliation(s)
- Augusto Garcia-Agundez
- AI Lab, Brown Center for Biomedical Informatics, Brown University, Providence, RI, United States
| | - Carsten Eickhoff
- AI Lab, Brown Center for Biomedical Informatics, Brown University, Providence, RI, United States
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Giladi N, Gurevich T, Djaldetti R, Adar L, Case R, Leibman-Barak S, Sasson N, Caraco Y. ND0612 (levodopa/carbidopa for subcutaneous infusion) in patients with Parkinson's disease and motor response fluctuations: A randomized, placebo-controlled phase 2 study. Parkinsonism Relat Disord 2021; 91:139-145. [PMID: 34619438 DOI: 10.1016/j.parkreldis.2021.09.024] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 09/21/2021] [Accepted: 09/28/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION ND0612 is a continuous, subcutaneous levodopa/carbidopa delivery system under development for patients with Parkinson's disease (PD) and motor fluctuations. METHODS This was a randomized, placebo-controlled, double-blind, 2-period study evaluating the safety and pharmacokinetics of ND0612 in PD patients on an optimized oral levodopa regimen and experiencing ≥2 h/day of OFF time. During Period-1, patients received their current standard of care (SoC) levodopa/carbidopa and were randomized (2:1) to 14 days treatment with adjunct ND0612 (daily levodopa/carbidopa dose of 270/63 mg) or placebo infusion +SoC. During Period-2, 16 patients were randomized to receive 7 days treatment with ND0612 or ND0612 plus oral entacapone. Reduction in OFF time was analyzed as an exploratory measure using a futility design with a predefined margin of 1.6 h. RESULTS ND0612 was well-tolerated; most patients experienced infusion site nodules (95% vs. 56% with placebo), which all resolved without sequelae. Patients treated with adjunct ND0612 during Period-1 avoided deep troughs in levodopa plasma levels and had a decreased fluctuation index versus placebo (1.6 ± 0.5 vs 3.1 ± 1.6 at end of Period-1, respectively). In Period-2, the coadministration of entacapone with continuous ND0612 SC infusion translated to an increase in mean levodopa AUC0-10h compared to baseline. Exploratory efficacy analysis of Period 1 showed mean ± SD OFF time reductions of -2.13 ± 2.24 [90%CI: -2.8, ∞] hours (p = 0.84 using H0 of μ0 ≤-1.6). CONCLUSION Levodopa/carbidopa infusion with ND0612 was generally well-tolerated and resulted in reduced fluctuations in plasma levodopa concentrations when given with SoC oral levodopa. ND0612 met the efficacy endpoint for the futility design.
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Affiliation(s)
- Nir Giladi
- Neurological Institute, Tel Aviv Medical Center, 6 Weizmann Street, Tel Aviv, 6423906, Israel; Sackler School of Medicine, Tel Aviv University, P.O. Box 39040, Tel Aviv, 6997801, Israel; Sagol School of Neuroscience, Tel Aviv University, P.O. Box 39040, Tel Aviv, 6997801, Israel.
| | - Tanya Gurevich
- Neurological Institute, Tel Aviv Medical Center, 6 Weizmann Street, Tel Aviv, 6423906, Israel; Sackler School of Medicine, Tel Aviv University, P.O. Box 39040, Tel Aviv, 6997801, Israel; Sagol School of Neuroscience, Tel Aviv University, P.O. Box 39040, Tel Aviv, 6997801, Israel
| | - Ruth Djaldetti
- Sackler School of Medicine, Tel Aviv University, P.O. Box 39040, Tel Aviv, 6997801, Israel; Department of Neurology, Rabin Medical Center, Zeev Jabotinsky St 39, Petah Tikva, 49100, Israel
| | - Liat Adar
- NeuroDerm Ltd, 3 Pekeris Street, Ruhrberg Science Bldg., Rabin Science Park, Rehovot, Israel
| | - Ryan Case
- NeuroDerm Ltd, 3 Pekeris Street, Ruhrberg Science Bldg., Rabin Science Park, Rehovot, Israel
| | - Shelly Leibman-Barak
- NeuroDerm Ltd, 3 Pekeris Street, Ruhrberg Science Bldg., Rabin Science Park, Rehovot, Israel
| | - Nissim Sasson
- NeuroDerm Ltd, 3 Pekeris Street, Ruhrberg Science Bldg., Rabin Science Park, Rehovot, Israel
| | - Yoseph Caraco
- Hadassah Medical Center, Kalman Ya'akov Man St, Jerusalem, 91200, Israel
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Jenner P, Rocha JF, Ferreira JJ, Rascol O, Soares-da-Silva P. Redefining the strategy for the use of COMT inhibitors in Parkinson's disease: the role of opicapone. Expert Rev Neurother 2021; 21:1019-1033. [PMID: 34525893 DOI: 10.1080/14737175.2021.1968298] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Levodopa remains the gold-standard Parkinson's disease (PD) treatment, but the inevitable development of motor complications has led to intense activity in pursuit of its optimal delivery. AREAS COVERED Peripheral inhibition of dopa-decarboxylase has long been considered an essential component of levodopa treatment at every stage of illness. In contrast, only relatively recently have catechol-O-methyltransferase (COMT) inhibitors been utilized to block the other major pathway of degradation and optimize levodopa delivery to the brain. First and second-generation COMT inhibitors were deficient because of toxicity, sub-optimal pharmacokinetics or a short duration of effect. As such, they have only been employed once 'wearing-off' has developed. However, the third-generation COMT inhibitor, opicapone has overcome these difficulties and exhibits long-lasting enzyme inhibition without the toxicity observed with previous generations of COMT inhibitors. In clinical trials and real-world PD studies opicapone improves the levodopa plasma profile and results in a significant improvement in ON time in 'fluctuating' disease, but it has not yet been included in the algorithm for early treatment. EXPERT OPINION This review argues for a shift in the positioning of COMT inhibition with opicapone in the PD algorithm and lays out a pathway for proving its effectiveness in early disease.
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Affiliation(s)
- Peter Jenner
- Institute of Pharmaceutical Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | | | - Joaquim J Ferreira
- Laboratory of Clinical Pharmacology and Therapeutics, Faculdade De Medicina, Universidade De Lisboa, Lisboa, Portugal.,CNS - Campus Neurológico, Torres Vedras, Portugal
| | - Olivier Rascol
- Clinical Investigation Center CIC1436, Departments of Clinical Pharmacology and Neurosciences, NS-Park/FCRIN Network and Toulouse NeuroToul Coen Center; Inserm, University Hospital of Toulouse, and University of Toulouse 3, Toulouse, France
| | - Patrício Soares-da-Silva
- Department of Research & Development, BIAL - Portela & Ca SA, Portugal.,Department of Pharmacology and Therapeutics, Faculty of Medicine, University Porto, Porto, Portugal
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Poewe W, Stocchi F, Arkadir D, Ebersbach G, Ellenbogen AL, Giladi N, Isaacson SH, Kieburtz K, LeWitt P, Olanow CW, Simuni T, Thomas A, Zlotogorski A, Adar L, Case R, Oren S, Fuchs Orenbach S, Rosenfeld O, Sasson N, Yardeni T, Espay AJ. Subcutaneous Levodopa Infusion for Parkinson's Disease: 1-Year Data from the Open-Label BeyoND Study. Mov Disord 2021; 36:2687-2692. [PMID: 34496081 PMCID: PMC9291977 DOI: 10.1002/mds.28758] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Revised: 06/17/2021] [Accepted: 07/26/2021] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Continuous, subcutaneous (SC) levodopa/carbidopa infusion with ND0612 is under development as a treatment for patients with Parkinson's disease (PD) and motor fluctuations. OBJECTIVE Evaluate 1-year safety data. METHODS BeyoND is an open-label study evaluating the long-term safety of two ND0612 dosing regimens. RESULTS Of the 214 enrolled patients (24-hour SC infusion: n = 90; 16-hour SC infusion: n = 124), 120 (56%) completed 12 months of treatment. Leading causes for study discontinuation were consent withdrawal (19.6%) and adverse events (17.3%). Rates of discontinuation were reduced from 49% to 29% after a protocol revision and retraining. Systemic safety was typical for PD patients treated with levodopa/carbidopa. Most patients experienced infusion site reactions, particularly nodules (30.8%) and hematoma (25.2%), which were judged mostly mild to moderate and led to discontinuation in only 10.3% of the participants. CONCLUSIONS Subcutaneous levodopa/carbidopa continuous infusion with ND0612 is generally safe, with typical infusion site reactions for SC delivery as the main adverse event. © 2021 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Werner Poewe
- Department of Neurology, Medical University Innsbruck, Innsbruck, Austria
| | - Fabrizio Stocchi
- University and Institute for Research and Medical Care IRCCS San Raffaele, Rome, Italy
| | - David Arkadir
- Department of Neurology, The Faculty of Medicine, Hadassah Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Georg Ebersbach
- Movement Disorder Clinic, Beelitz-Heilstaetten, Beelitz, Germany
| | - Aaron L Ellenbogen
- Michigan Institute for Neurological Disorders, Farmington Hills, Michigan, USA
| | - Nir Giladi
- Tel Aviv Medical Center, Sackler School of Medicine, Sagol School of Neurosciences, Neurological Institute, Tel-Aviv University, Tel Aviv, Israel
| | - Stuart H Isaacson
- Parkinson's Disease and Movement Disorders Center of Boca Raton, Boca Raton, Florida, USA
| | - Karl Kieburtz
- Departments of Neurology, Wayne State University School of Medicine and Henry Ford Hospital, Detroit, Michigan, USA
| | | | - C Warren Olanow
- Departments of Neurology, Wayne State University School of Medicine and Henry Ford Hospital, Detroit, Michigan, USA
| | - Tanya Simuni
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Astrid Thomas
- Department of Neuroscience, Imaging and Clinical Sciences and Center of Advanced Studies and Technology CAST, University Chieti Pescara, Chieti, Italy
| | - Abraham Zlotogorski
- Department of Dermatology, The Faculty of Medicine, Hadassah Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel
| | | | | | | | | | | | | | | | - Alberto J Espay
- James J. and Joan A. Gardner Center for Parkinson's Disease and Movement Disorders, University of Cincinnati, Cincinnati, Ohio, USA
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Comparison of the Parkinson's KinetiGraph to off/on levodopa response testing: Single center experience. Clin Neurol Neurosurg 2021; 209:106890. [PMID: 34455169 DOI: 10.1016/j.clineuro.2021.106890] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Revised: 07/13/2021] [Accepted: 08/08/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND AND OBJECTIVE Levodopa off/on testing is frequently performed to assess medication response in patients with Parkinson's disease (PD) as an aid in determining best medical management or potential surgical candidacy. The Parkinson's Kinetigraph (PKG) is a wearable device which generates tremor, bradykinesia (BKS) and dyskinesia (DKS) scores representing motor symptoms over a six-day period. In this study, we compared off/on testing with PKG motor scores. METHODS Patients were enrolled as part of an observational study: Assessing the Longitudinal Signs in PD, a three-year study evaluating clinical and biomarker evolution in patients with PD taking levodopa. Patients underwent off/on testing at baseline and 6-month visits. A greater than 30% improvement between off and on MDS-Unified Parkinson's Disease Rating Scale scores was considered a robust response. After each visit, patients wore the PKG for 6 days. A bradykinesia score (BKS) greater than 26 and dyskinesia score (DKS) greater than 9 were considered poorly controlled bradykinesia and dyskinesia, respectively. RESULTS The median BKS at the baseline and 6-month visits were 27.15 and 27.55, respectively, despite a robust median off/on improvement at both visits. In addition, 10/18 (66%) and 7/13 (53.8%) patients with robust off/on improvement at the baseline and 6-month visits, respectively, demonstrated a BKS > 26 or DKS > 9. CONCLUSION A robust off/on response during a clinic visit does not necessarily reflect adequately controlled motor symptoms. The PKG, by virtue of its continuous recording of motor movements, may provide additional clinically relevant data on motor symptoms which may be useful for prospective observational studies.
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Rodríguez-Molinero A, Hernández-Vara J, Miñarro A, Pérez-López C, Bayes-Rusiñol À, Martínez-Castrillo JC, Pérez-Martínez DA. Multicentre, randomised, single-blind, parallel group trial to compare the effectiveness of a Holter for Parkinson's symptoms against other clinical monitoring methods: study protocol. BMJ Open 2021; 11:e045272. [PMID: 34281918 PMCID: PMC8291311 DOI: 10.1136/bmjopen-2020-045272] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION In recent years, multiple studies have aimed to develop and validate portable technological devices capable of monitoring the motor complications of Parkinson's disease patients (Parkinson's Holter). The effectiveness of these monitoring devices for improving clinical control is not known. METHODS AND ANALYSIS This is a single-blind, cluster-randomised controlled clinical trial. Neurologists from Spanish health centres will be randomly assigned to one of three study arms (1:1:1): (a) therapeutic adjustment using information from a Parkinson's Holter that will be worn by their patients for 7 days, (b) therapeutic adjustment using information from a diary of motor fluctuations that will be completed by their patients for 7 days and (c) therapeutic adjustment using clinical information collected during consultation. It is expected that 162 consecutive patients will be included over a period of 6 months.The primary outcome is the efficiency of the Parkinson's Holter compared with traditional clinical practice in terms of Off time reduction with respect to the baseline (recorded through a diary of motor fluctuations, which will be completed by all patients). As secondary outcomes, changes in variables related to other motor complications (dyskinesia and freezing of gait), quality of life, autonomy in activities of daily living, adherence to the monitoring system and number of doctor-patient contacts will be analysed. The noninferiority of the Parkinson's Holter against the diary of motor fluctuations in terms of Off time reduction will be studied as the exploratory objective.Ethics and dissemination approval for this study has been obtained from the Hospital Universitari de Bellvitge Ethics Committee. The results of this study will inform the practical utility of the objective information provided by a Parkinson's Holter and, therefore, the convenience of adopting this technology in clinical practice and in future clinical trials. We expect public dissemination of the results in 2022. TRIAL REGISTRATION NCT04176302; https://clinicaltrials.gov/show/NCT04176302.
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Affiliation(s)
| | - Jorge Hernández-Vara
- Department of Neurology, Hospital Universitari Vall d'Hebron and Neurodegenerative Diseases Research Group, Barcelona, Spain
| | - Antonio Miñarro
- Department of Genetics, Microbiology and Statistics, Faculty of Biology, Universitat de Barcelona, Barcelona, Spain
| | - Carlos Pérez-López
- Àrea de Recerca, Consorci Sanitari de l'Alt Penedès i Garraf, Vilafranca del Pendès, Spain
| | - Àngels Bayes-Rusiñol
- Parkinson's and Movement Disorders Unit, Hospital Quirón Teknon, Barcelona, Spain
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Khodakarami H, Shokouhi N, Horne M. A method for measuring time spent in bradykinesia and dyskinesia in people with Parkinson's disease using an ambulatory monitor. J Neuroeng Rehabil 2021; 18:116. [PMID: 34271971 PMCID: PMC8283900 DOI: 10.1186/s12984-021-00905-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 06/25/2021] [Indexed: 01/07/2023] Open
Abstract
Background Fluctuations in motor function in Parkinson’s Disease (PD) are frequent and cause significant disability. Frequently device assisted therapies are required to treat them. Currently, fluctuations are self-reported through diaries and history yet frequently people with PD do not accurately identify and report fluctuations. As the management of fluctuations and the outcomes of many clinical trials depend on accurately measuring fluctuations a means of objectively measuring time spent with bradykinesia or dyskinesia would be important. The aim of this study was to present a system that uses wearable sensors to measure the percentage of time that bradykinesia or dyskinesia scores are above a target as a means for assessing levels of treatment and fluctuations in PD. Methods Data in a database of 228 people with Parkinson’s Disease and 157 control subjects, who had worn the Parkinson’s Kinetigraph ((PKG, Global Kinetics Corporation™, Australia) and scores from the Unified Parkinson’s Disease Rating Scale (UPDRS) and other clinic scales were used. The PKG’s provided score for bradykinesia and dyskinesia every two minutes and these were compared to a previously established target range representing a UPDRS III score of 35. The proportion of these scores above target over the 6 days that the PKG was worn were used to derive the percent time in bradykinesia (PTB) and percent time in dyskinesia (PTD). As well, a previously describe algorithm for estimating the amplitude of the levodopa response was used to determine whether a subject was a fluctuator or non-fluctuator. Results Using this approach, a normal range of PTB and PTD based on Control subject was developed. The level of PTB and PTD experienced by people with PD was compared with their levels of fluctuation. There was a correlation (Pearson’s ρ = 0.4) between UPDRS II scores and PTB: the correlation between Parkinson Disease Questionnaire scores and UPDRS Total scores and PTB and slightly lower. PTB and PTD fell in response to treatment for bradykinesia or dyskinesia (respectively) with greater sensitivity than clinical scales. Conclusions This approach provides an objective assessment of the severity of fluctuations in Parkinson’s Disease that could be used in in clinical trials and routine care. Supplementary Information The online version contains supplementary material available at 10.1186/s12984-021-00905-4.
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Affiliation(s)
- Hamid Khodakarami
- Global Kinetics Pty Ltd, 31 Queen St., Melbourne, Victoria, Australia
| | - Navid Shokouhi
- Global Kinetics Pty Ltd, 31 Queen St., Melbourne, Victoria, Australia
| | - Malcolm Horne
- Florey Institute of Neuroscience and Mental Health, Victoria, Australia. .,The Department of Medicine, The University of Melbourne, St Vincent's Hospital, Fitzroy, VIC, 3010, Australia. .,Department of Neurology, St Vincent's Hospital, Fitzroy, VIC, Australia.
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30
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Automated assessment of Parkinsonian finger-tapping tests through a vision-based fine-grained classification model. Neurocomputing 2021. [DOI: 10.1016/j.neucom.2021.02.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Giossi R, Carrara F, Mazzari M, Lo Re F, Senatore M, Schicchi A, Corrù F, Fittipaldo VA, Pani A, Tramacere I, Elia AE, Scaglione F. Overall Efficacy and Safety of Safinamide in Parkinson's Disease: A Systematic Review and a Meta-analysis. Clin Drug Investig 2021; 41:321-339. [PMID: 33674954 PMCID: PMC8004480 DOI: 10.1007/s40261-021-01011-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/05/2021] [Indexed: 12/05/2022]
Abstract
BACKGROUND AND OBJECTIVE: Safinamide is a novel anti-parkinsonian drug with possible anti-dyskinetic properties. Parkinson's disease (PD) is a complex disease. The objective of this systematic review and meta-analysis is to evaluate the efficacy and safety of safinamide administration compared to placebo in PD patients on multiple outcomes. METHODS PubMed, EMBASE, Cochrane CENTRAL, LILACS, and trial databases were searched up to 23 December 2020 for randomized controlled studies (RCTs) comparing safinamide to placebo, alone or as add-on therapy in PD. Data were extracted from literature and regulatory agencies. Primary outcomes were ON-time without troublesome dyskinesia, OFF-time, and Unified Parkinson's Disease Rating Scale (UPDRS) section III (UPDRS-III). Secondary outcomes included any dyskinesia rating scale (DRS), ON-time with troublesome dyskinesia, UPDRS-II, and Parkinson's Disease Questionnaire 39 (PDQ-39). In order to estimate mean difference (MD) and odds ratios with 95% confidence intervals (CI), generic inverse variance and Mantel-Haenszel methods were used for continuous and dichotomous variables, respectively. Analyses were performed grouping by PD with (PDwMF) or without (PDwoMF) motor fluctuations, safinamide dose, and concomitant dopaminergic treatment. Summary of findings with GRADE were performed. RESULTS Six studies with a total of 2792 participants were identified. In PDwMF patients, safinamide 100 mg as add-on to levodopa (L-dopa) significantly increased ON-time without troublesome dyskinesia (MD = 0.95 h; 95% CI from 0.41 to 1.49), reduced OFF-time (MD = - 1.06 h; 95% CI from - 1.60 to - 0.51), and improved UPDRS-III (MD = - 2.77; 95% CI from - 4.27 to - 1.28) with moderate quality of evidence. Similar results were observed for the 50 mg dose. However, the quality of evidence was moderate only for ON-time without troublesome dyskinesia, whereas for OFF-time and UPDRS-III was low. In PDwoMF patients taking a single dopamine agonist, safinamide 100 mg resulted in little to no clinically significant improvement in UPDRS-III (MD = - 1.84; 95% CI from - 3.19 to - 0.49), with moderate quality of evidence. Conversely, in PDwoMF patients, the 200 mg and 50 mg doses showed nonsignificant improvement in UPDRS-III, with very low and moderate quality of evidence, respectively. In PDwMF patients taking safinamide 100 mg or 50 mg, nonsignificant differences were observed for ON-time with troublesome dyskinesia and DRS, with high and low quality of evidence, respectively. In the same patients, UPDRS-II was significantly improved at the 100 mg and 50 mg dose, with high and moderate quality of evidence. In PDwoMF, UPDRS-II showed a little yet significant difference only at 100 mg, with low quality of evidence. PDQ-39 resulted significantly improved only with the 100 mg dose in PDwMF, with low quality of evidence. CONCLUSION Overall, safinamide is effective in PDwMF patients taking L-dopa both at 100 and 50 mg daily. Evidence for efficacy in early PD is limited. Further trials are needed to better evaluate the anti-dyskinetic properties of safinamide.
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Affiliation(s)
- Riccardo Giossi
- Department of Oncology and Onco-Hematology, Postgraduate School of Clinical Pharmacology and Toxicology, University of Milan, 20129, Milan, Italy.
- Neuroimmunology and Neuromuscular Diseases Unit, Fondazione I.R.C.C.S. Istituto Neurologico Carlo Besta, Milan, Italy.
| | - Federica Carrara
- Department of Oncology and Onco-Hematology, Postgraduate School of Clinical Pharmacology and Toxicology, University of Milan, 20129, Milan, Italy
| | - Martina Mazzari
- Department of Oncology and Onco-Hematology, Postgraduate School of Clinical Pharmacology and Toxicology, University of Milan, 20129, Milan, Italy
| | - Francesco Lo Re
- Department of Oncology and Onco-Hematology, Postgraduate School of Clinical Pharmacology and Toxicology, University of Milan, 20129, Milan, Italy
- Department of Pharmacy, "S. Maria della Misericordia" University Hospital Friuli Centrale, Udine, Italy
| | - Michele Senatore
- Department of Oncology and Onco-Hematology, Postgraduate School of Clinical Pharmacology and Toxicology, University of Milan, 20129, Milan, Italy
- Clinical Pharmacology Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Azzurra Schicchi
- Pavia Poison Control Centre - National Toxicology Information Centre - Clinical and Experimental Lab, Toxicology Unit - Istituti Clinici Scientifici Maugeri IRCCS, Pavia, Italy
| | - Federica Corrù
- Department of Oncology and Onco-Hematology, Postgraduate School of Clinical Pharmacology and Toxicology, University of Milan, 20129, Milan, Italy
| | | | - Arianna Pani
- Department of Oncology and Onco-Hematology, Postgraduate School of Clinical Pharmacology and Toxicology, University of Milan, 20129, Milan, Italy
| | - Irene Tramacere
- Department of Research and Clinical Development, Scientific Directorate, Fondazione I.R.C.C.S. Istituto Neurologico Carlo Besta, Milan, Italy
| | - Antonio Emanuele Elia
- Parkinson and Movement Diseases Unit, Fondazione I.R.C.C.S. Istituto Neurologico Carlo Besta, Milan, Italy
| | - Francesco Scaglione
- Department of Oncology and Onco-Hematology, Postgraduate School of Clinical Pharmacology and Toxicology, University of Milan, 20129, Milan, Italy
- Clinical Pharmacology Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
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Daneault JF, Vergara-Diaz G, Parisi F, Admati C, Alfonso C, Bertoli M, Bonizzoni E, Carvalho GF, Costante G, Fabara EE, Fixler N, Golabchi FN, Growdon J, Sapienza S, Snyder P, Shpigelman S, Sudarsky L, Daeschler M, Bataille L, Sieberts SK, Omberg L, Moore S, Bonato P. Accelerometer data collected with a minimum set of wearable sensors from subjects with Parkinson's disease. Sci Data 2021; 8:48. [PMID: 33547309 PMCID: PMC7865022 DOI: 10.1038/s41597-021-00830-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 11/24/2020] [Indexed: 12/22/2022] Open
Abstract
Parkinson's disease (PD) is a neurodegenerative disorder associated with motor and non-motor symptoms. Current treatments primarily focus on managing motor symptom severity such as tremor, bradykinesia, and rigidity. However, as the disease progresses, treatment side-effects can emerge such as on/off periods and dyskinesia. The objective of the Levodopa Response Study was to identify whether wearable sensor data can be used to objectively quantify symptom severity in individuals with PD exhibiting motor fluctuations. Thirty-one subjects with PD were recruited from 2 sites to participate in a 4-day study. Data was collected using 2 wrist-worn accelerometers and a waist-worn smartphone. During Days 1 and 4, a portion of the data was collected in the laboratory while subjects performed a battery of motor tasks as clinicians rated symptom severity. The remaining of the recordings were performed in the home and community settings. To our knowledge, this is the first dataset collected using wearable accelerometers with specific focus on individuals with PD experiencing motor fluctuations that is made available via an open data repository.
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Affiliation(s)
- Jean-Francois Daneault
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital, Boston, Massachusetts, USA
- Department of Rehabilitation and Movement Sciences, Rutgers University, Newark, New Jersey, USA
| | - Gloria Vergara-Diaz
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital, Boston, Massachusetts, USA
| | - Federico Parisi
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital, Boston, Massachusetts, USA
| | - Chen Admati
- Intel Corporation, IT Advanced Analytics, Bethlehem, Israel
| | - Christina Alfonso
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Matilde Bertoli
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital, Boston, Massachusetts, USA
| | - Edoardo Bonizzoni
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital, Boston, Massachusetts, USA
| | - Gabriela Ferreira Carvalho
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital, Boston, Massachusetts, USA
| | - Gianluca Costante
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital, Boston, Massachusetts, USA
| | - Eric Eduardo Fabara
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital, Boston, Massachusetts, USA
| | - Naama Fixler
- Intel Corporation, IT Advanced Analytics, Bethlehem, Israel
| | - Fatemah Noushin Golabchi
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital, Boston, Massachusetts, USA
| | - John Growdon
- Department of Neurology, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Stefano Sapienza
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital, Boston, Massachusetts, USA
| | - Phil Snyder
- Sage Bionetworks, Seattle, Washington, 98121, USA
| | | | - Lewis Sudarsky
- Department of Neurology, Harvard Medical School, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | | | | | | | | | - Steven Moore
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- School of Engineering and Technology, Central Queensland University, Rockhampton, Australia
| | - Paolo Bonato
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital, Boston, Massachusetts, USA.
- Wyss Institute for Biologically Inspired Engineering, Harvard University, Cambridge, Massachusetts, USA.
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Santos García D, López Ariztegui N, Cubo E, Vinagre Aragón A, García-Ramos R, Borrué C, Fernández-Pajarín G, Caballol N, Cabo I, Barrios-López JM, Hernández Vara J, Ávila Rivera MA, Gasca-Salas C, Escalante S, Manrique de Lara P, Pérez Noguera R, Álvarez Sauco M, Sierra M, Monje MHG, Sánchez Ferro A, Novo Ponte S, Alonso-Frech F, Macías-García D, Legarda I, Rojo A, Álvarez Fernández I, Buongiorno MT, Pastor P, García Ruíz P. Clinical utility of a personalized and long-term monitoring device for Parkinson's disease in a real clinical practice setting: An expert opinion survey on STAT-ON™. Neurologia 2020; 38:S0213-4853(20)30339-X. [PMID: 33358530 DOI: 10.1016/j.nrl.2020.10.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 10/01/2020] [Accepted: 10/05/2020] [Indexed: 10/22/2022] Open
Abstract
BACKGROUND STAT-ON™ is an objective tool that registers ON-OFF fluctuations making possible to know the state of the patient at every moment of the day in normal life. Our aim was to analyze the opinion of different Parkinson's disease experts about the STAT-ON™ tool after using the device in a real clinical practice setting (RCPS). METHODS STAT-ON™ was provided by the Company Sense4Care to Spanish neurologists for using it in a RCPS. Each neurologist had the device for at least three months and could use it in PD patients at his/her own discretion. In February 2020, a survey with 30 questions was sent to all participants. RESULTS Two thirds of neurologists (53.8% females; mean age 44.9±9 years old) worked in a Movement Disorders Unit, the average experience in PD was 16±6.9 years, and 40.7% of them had previously used other devices. A total of 119 evaluations were performed in 114 patients (range 2-9 by neurologist; mean 4.5±2.3). STAT-ON™ was considered "quite" to "very useful" by 74% of the neurologists with an overall opinion of 6.9±1.7 (0, worst; 10, best). STAT-ON™ was considered better than diaries by 70.3% of neurologists and a useful tool for the identification of patients with advanced PD by 81.5%. Proper identification of freezing of gait episodes and falls were frequent limitations reported. CONCLUSION STAT-ON™ could be a useful device for using in PD patients in clinical practice.
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Affiliation(s)
- D Santos García
- CHUAC, Complejo Hospitalario Universitario de A Coruña, Spain.
| | | | - E Cubo
- Complejo Asistencial Universitario de Burgos, Burgos, Spain
| | | | | | - C Borrué
- Hospital Infanta Sofía, Madrid, Spain
| | | | - N Caballol
- Consorci Sanitari Integral, Hospital Moisés Broggi, Sant Joan Despí, Barcelona, Spain
| | - I Cabo
- Complejo Hospitalario Universitario de Pontevedra (CHOP), Pontevedra, Spain
| | | | | | - M A Ávila Rivera
- Consorci Sanitari Integral, Hospital General de L'Hospitalet, L'Hospitalet de Llobregat, Barcelona, Spain
| | | | - S Escalante
- Hospital de Tortosa Verge de la Cinta (HTVC), Tortosa, Tarragona, Spain
| | | | | | | | - M Sierra
- Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - M H G Monje
- CINAC, Hospital Puerta del Sur, Madrid, Spain
| | | | | | | | | | - I Legarda
- Hospital Universitario Son Espases, Palma de Mallorca, Spain
| | - A Rojo
- Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, Spain
| | | | - M T Buongiorno
- Hospital Universitari Mutua de Terrassa, Terrassa, Barcelona, Spain
| | - P Pastor
- Hospital Universitari Mutua de Terrassa, Terrassa, Barcelona, Spain
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Höglund A, Hagell P, Broman JE, Pålhagen S, Sorjonen K, Fredrikson S, Svenningsson P. Associations Between Fluctuations in Daytime Sleepiness and Motor and Non-Motor Symptoms in Parkinson's Disease. Mov Disord Clin Pract 2020; 8:44-50. [PMID: 33426158 PMCID: PMC7780947 DOI: 10.1002/mdc3.13102] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Revised: 08/27/2020] [Accepted: 10/07/2020] [Indexed: 11/10/2022] Open
Abstract
Background Non‐motor fluctuations are a major concern in Parkinson's disease (PD), and they have been categorized into neuropsychiatric, autonomic and sensory fluctuations. However, this categorization does not include sleep and sleep‐related features, and the association between daytime sleepiness and other motor and/or non‐motor fluctuations in PD remains to be elucidated. Objective To investigate the relationship between daytime sleepiness and other non‐motor and motor fluctuations in people with PD. Methods A three‐day home diary recording daytime sleepiness, mood, anxiety, and motor symptoms was used along with the Karolinska Sleepiness Scale (KSS) and 6 days of accelerometer (Parkinson's KinetiGraph™; PKG™) registration to detect motor fluctuations among people with a DaTSCAN verified clinical PD diagnosis (32 men; mean PD duration, 8.2 years). Participants were categorized as motor fluctuators or non‐fluctuators according to the UPDRS part IV and/or the presence of motor and non‐motor fluctuations. Results Fifty‐two people with PD participated. Daytime sleepiness correlated significantly with motor symptoms, mood and anxiety among those classified as motor fluctuators (n = 28). Motor fluctuators showed stronger correlations between the individual mean level of all diary variables (daytime sleepiness, anxiety, mood and motor symptoms) when compared to the non‐fluctuators (n = 24). Stronger positive within‐individual correlations were found among fluctuators in comparison to non‐fluctuators. In general, PKG data did not correlate with diary data. Conclusion Episodes of daytime sleepiness, as reported by home diaries, were associated with other self‐reported non‐motor and motor fluctuations, but were not supported by PKG data.
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Affiliation(s)
- Arja Höglund
- Department of Clinical Neuroscience Karolinska Institutet Stockholm Sweden.,Department of Neurology Karolinska University Hospital Huddinge Stockholm Sweden
| | - Peter Hagell
- The PRO-CARE Group, Faculty of Health Sciences Kristianstad University Kristianstad Sweden
| | - Jan-Erik Broman
- Department of Neuroscience, Psychiatry Uppsala University Uppsala Sweden
| | - Sven Pålhagen
- Department of Clinical Neuroscience Karolinska Institutet Stockholm Sweden.,Department of Neurology Karolinska University Hospital Huddinge Stockholm Sweden
| | - Kimmo Sorjonen
- Department of Clinical Neuroscience Karolinska Institutet Stockholm Sweden
| | - Sten Fredrikson
- Department of Clinical Neuroscience Karolinska Institutet Stockholm Sweden.,Department of Neurology Karolinska University Hospital Huddinge Stockholm Sweden
| | - Per Svenningsson
- Department of Clinical Neuroscience Karolinska Institutet Stockholm Sweden.,Department of Neurology Karolinska University Hospital Huddinge Stockholm Sweden
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Evers LJ, Raykov YP, Krijthe JH, Silva de Lima AL, Badawy R, Claes K, Heskes TM, Little MA, Meinders MJ, Bloem BR. Real-Life Gait Performance as a Digital Biomarker for Motor Fluctuations: The Parkinson@Home Validation Study. J Med Internet Res 2020; 22:e19068. [PMID: 33034562 PMCID: PMC7584982 DOI: 10.2196/19068] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 08/10/2020] [Accepted: 08/21/2020] [Indexed: 12/16/2022] Open
Abstract
Background Wearable sensors have been used successfully to characterize bradykinetic gait in patients with Parkinson disease (PD), but most studies to date have been conducted in highly controlled laboratory environments. Objective This paper aims to assess whether sensor-based analysis of real-life gait can be used to objectively and remotely monitor motor fluctuations in PD. Methods The Parkinson@Home validation study provides a new reference data set for the development of digital biomarkers to monitor persons with PD in daily life. Specifically, a group of 25 patients with PD with motor fluctuations and 25 age-matched controls performed unscripted daily activities in and around their homes for at least one hour while being recorded on video. Patients with PD did this twice: once after overnight withdrawal of dopaminergic medication and again 1 hour after medication intake. Participants wore sensors on both wrists and ankles, on the lower back, and in the front pants pocket, capturing movement and contextual data. Gait segments of 25 seconds were extracted from accelerometer signals based on manual video annotations. The power spectral density of each segment and device was estimated using Welch’s method, from which the total power in the 0.5- to 10-Hz band, width of the dominant frequency, and cadence were derived. The ability to discriminate between before and after medication intake and between patients with PD and controls was evaluated using leave-one-subject-out nested cross-validation. Results From 18 patients with PD (11 men; median age 65 years) and 24 controls (13 men; median age 68 years), ≥10 gait segments were available. Using logistic LASSO (least absolute shrinkage and selection operator) regression, we classified whether the unscripted gait segments occurred before or after medication intake, with mean area under the receiver operator curves (AUCs) varying between 0.70 (ankle of least affected side, 95% CI 0.60-0.81) and 0.82 (ankle of most affected side, 95% CI 0.72-0.92) across sensor locations. Combining all sensor locations did not significantly improve classification (AUC 0.84, 95% CI 0.75-0.93). Of all signal properties, the total power in the 0.5- to 10-Hz band was most responsive to dopaminergic medication. Discriminating between patients with PD and controls was generally more difficult (AUC of all sensor locations combined: 0.76, 95% CI 0.62-0.90). The video recordings revealed that the positioning of the hands during real-life gait had a substantial impact on the power spectral density of both the wrist and pants pocket sensor. Conclusions We present a new video-referenced data set that includes unscripted activities in and around the participants’ homes. Using this data set, we show the feasibility of using sensor-based analysis of real-life gait to monitor motor fluctuations with a single sensor location. Future work may assess the value of contextual sensors to control for real-world confounders.
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Affiliation(s)
- Luc Jw Evers
- Center of Expertise for Parkinson and Movement Disorders, department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, Netherlands.,Institute for Computing and Information Sciences, Radboud University, Nijmegen, Netherlands
| | - Yordan P Raykov
- Department of Mathematics, School of Engineering and Applied Sciences, Aston University, Birmingham, United Kingdom
| | - Jesse H Krijthe
- Institute for Computing and Information Sciences, Radboud University, Nijmegen, Netherlands
| | - Ana Lígia Silva de Lima
- Center of Expertise for Parkinson and Movement Disorders, department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, Netherlands
| | - Reham Badawy
- School of Computer Science, University of Birmingham, Birmingham, United Kingdom
| | | | - Tom M Heskes
- Institute for Computing and Information Sciences, Radboud University, Nijmegen, Netherlands
| | - Max A Little
- School of Computer Science, University of Birmingham, Birmingham, United Kingdom
| | - Marjan J Meinders
- Scientific Center for Quality of Healthcare (IQ healthcare), Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, Netherlands
| | - Bastiaan R Bloem
- Center of Expertise for Parkinson and Movement Disorders, department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, Netherlands
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Farzanehfar P, Woodrow H, Horne M. Assessment of Wearing Off in Parkinson's disease using objective measurement. J Neurol 2020; 268:914-922. [PMID: 32935159 DOI: 10.1007/s00415-020-10222-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 09/05/2020] [Accepted: 09/08/2020] [Indexed: 01/06/2023]
Abstract
BACKGROUND Development of "Wearing Off" (WO) of motor and non-motor function in Parkinson's disease (PD) adversely affects quality of life. This suggest that identifying and treating WO is important. However, identification of WO depends on people with PD (PwP) recognising and reporting WO and there is a perception that WO may be significantly underestimated. OBJECTIVE We investigate the feasibility of identifying "Wearing Off" using objective measurement and assess the clinical benefit in rectifying it. METHOD In this study, 200 PwP were studied for evidence of WO using a continuously worn wearable system. Eighty-five patients (43%) were found to have WO and treatment was changed to mitigate the effects of WO. RESULTS Factors, such as duration of disease, high baseline MDS-UPDRS (motor component), high Percent Time in Bradykinesia (PTB), high Levodopa Equivalent Daily Dose (LEDD), frequent Levodopa doses and younger age of onset, are associated with severity of motor complications. Patients with more severe WO experienced worse motor and non-motor symptoms and lower quality of life. Quality of life significantly improved in PwP when WO was treated. CONCLUSION The findings reported in this study provide evidence that identifying and treating WO improves outcomes of PwP and that objective measurements may help clinicians to identify and treat WO.
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Affiliation(s)
- Parisa Farzanehfar
- The Florey Institute of Neuroscience and Mental Health, Parkville, Australia. .,Northern Hospital, Epping, Australia. .,The University of Melbourne, Melbourne, Australia.
| | - Holly Woodrow
- The Florey Institute of Neuroscience and Mental Health, Parkville, Australia.,The University of Melbourne, Melbourne, Australia
| | - Malcolm Horne
- The Florey Institute of Neuroscience and Mental Health, Parkville, Australia.,The University of Melbourne, Melbourne, Australia.,St Vincent's Hospital, Fitzroy, Australia
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37
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Monje MHG, Foffani G, Obeso J, Sánchez-Ferro Á. New Sensor and Wearable Technologies to Aid in the Diagnosis and Treatment Monitoring of Parkinson's Disease. Annu Rev Biomed Eng 2020; 21:111-143. [PMID: 31167102 DOI: 10.1146/annurev-bioeng-062117-121036] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Parkinson's disease (PD) is a degenerative disorder of the brain characterized by the impairment of the nigrostriatal system. This impairment leads to specific motor manifestations (i.e., bradykinesia, tremor, and rigidity) that are assessed through clinical examination, scales, and patient-reported outcomes. New sensor-based and wearable technologies are progressively revolutionizing PD care by objectively measuring these manifestations and improving PD diagnosis and treatment monitoring. However, their use is still limited in clinical practice, perhaps because of the absence of external validation and standards for their continuous use at home. In the near future, these systems will progressively complement traditional tools and revolutionize the way we diagnose and monitor patients with PD.
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Affiliation(s)
- Mariana H G Monje
- HM CINAC, Hospital Universitario HM Puerta del Sur, Universidad CEU-San Pablo, 28938 Móstoles, Madrid, Spain; , , , .,Department of Anatomy, Histology and Neuroscience, School of Medicine, Universidad Autónoma de Madrid, 28029 Madrid, Spain
| | - Guglielmo Foffani
- HM CINAC, Hospital Universitario HM Puerta del Sur, Universidad CEU-San Pablo, 28938 Móstoles, Madrid, Spain; , , , .,Hospital Nacional de Parapléjicos, Servicio de Salud de Castilla La Mancha, 45071 Toledo, Spain
| | - José Obeso
- HM CINAC, Hospital Universitario HM Puerta del Sur, Universidad CEU-San Pablo, 28938 Móstoles, Madrid, Spain; , , , .,Centro de Investigación Biomédica en Red, Enfermedades Neurodegenerativas, 28031 Madrid, Spain
| | - Álvaro Sánchez-Ferro
- HM CINAC, Hospital Universitario HM Puerta del Sur, Universidad CEU-San Pablo, 28938 Móstoles, Madrid, Spain; , , , .,Centro de Investigación Biomédica en Red, Enfermedades Neurodegenerativas, 28031 Madrid, Spain.,Research Laboratory of Electronics, Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, USA
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Hattori N, Kitabayashi H, Kanda T, Nomura T, Toyama K, Mori A. A Pooled Analysis From Phase 2b and 3 Studies in Japan of Istradefylline in Parkinson's Disease. Mov Disord 2020; 35:1481-1487. [PMID: 32501582 PMCID: PMC7496465 DOI: 10.1002/mds.28095] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Revised: 04/17/2020] [Accepted: 04/19/2020] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Characterization of patient factors associated with istradefylline efficacy may facilitate personally optimized treatment. OBJECTIVES We aimed to examine which patient factors are associated with favorable istradefylline treatment outcomes in PD patients with motor complications. METHODS We performed a pooled analysis of data from two identical phase 2b and 3 Japanese studies of istradefylline. Logistic regression models were used to assess the association of 12 patient characteristics with favorable outcomes. RESULTS Off time reduction and increased good on time with istradefylline provided a significantly favorable response in patients aged ≥65 years. Off time reduction was more favorable in patients with ≥8-hour daily off time at baseline. Improvement in UPDRS Part III was favorable in patients with UPDRS Part III baseline score ≥ 20. CONCLUSIONS Several patient factors influenced the effect of istradefylline on motor fluctuations, motor function, activities of daily living, and clinical impression. © 2020 The Authors. Movement Disorders published by Wiley Periodicals, Inc. on behalf of International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Nobutaka Hattori
- Department of Neurology, Juntendo University School of Medicine, Tokyo, Japan
| | | | - Tomoyuki Kanda
- Medical Affairs Department, Kyowa Kirin Co., Ltd., Tokyo, Japan
| | - Takanobu Nomura
- Medical Affairs Department, Kyowa Kirin Co., Ltd., Tokyo, Japan
| | - Keizo Toyama
- R&D Division, Kyowa Kirin Co., Ltd., Tokyo, Japan
| | - Akihisa Mori
- Medical Affairs Department, Kyowa Kirin Co., Ltd., Tokyo, Japan
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Rascol O. CVT-301 for Parkinson's disease: dose and effect size issues. Lancet Neurol 2020; 18:128-130. [PMID: 30663600 DOI: 10.1016/s1474-4422(18)30496-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Revised: 12/06/2018] [Accepted: 12/06/2018] [Indexed: 10/27/2022]
Affiliation(s)
- Olivier Rascol
- Centre d'Investigation Clinique, Services de Neurologie et de Pharmacologie Clinique, Réseau NS-PARK/FCRIN et Centre COEN NeuroToul, Centre Hospitalier Universitaire de Toulouse, Institut National de la Santé et de la Recherche Médicale, University of Toulouse, 31300 Toulouse, France.
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40
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Aghanavesi S, Westin J, Bergquist F, Nyholm D, Askmark H, Aquilonius SM, Constantinescu R, Medvedev A, Spira J, Ohlsson F, Thomas I, Ericsson A, Buvarp DJ, Memedi M. A multiple motion sensors index for motor state quantification in Parkinson's disease. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2020; 189:105309. [PMID: 31982667 DOI: 10.1016/j.cmpb.2019.105309] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 12/22/2019] [Accepted: 12/29/2019] [Indexed: 06/10/2023]
Abstract
AIM To construct a Treatment Response Index from Multiple Sensors (TRIMS) for quantification of motor state in patients with Parkinson's disease (PD) during a single levodopa dose. Another aim was to compare TRIMS to sensor indexes derived from individual motor tasks. METHOD Nineteen PD patients performed three motor tests including leg agility, pronation-supination movement of hands, and walking in a clinic while wearing inertial measurement unit sensors on their wrists and ankles. They performed the tests repeatedly before and after taking 150% of their individual oral levodopa-carbidopa equivalent morning dose.Three neurologists blinded to treatment status, viewed patients' videos and rated their motor symptoms, dyskinesia, overall motor state based on selected items of Unified PD Rating Scale (UPDRS) part III, Dyskinesia scale, and Treatment Response Scale (TRS). To build TRIMS, out of initially 178 extracted features from upper- and lower-limbs data, 39 features were selected by stepwise regression method and were used as input to support vector machines to be mapped to mean reference TRS scores using 10-fold cross-validation method. Test-retest reliability, responsiveness to medication, and correlation to TRS as well as other UPDRS items were evaluated for TRIMS. RESULTS The correlation of TRIMS with TRS was 0.93. TRIMS had good test-retest reliability (ICC = 0.83). Responsiveness of the TRIMS to medication was good compared to TRS indicating its power in capturing the treatment effects. TRIMS was highly correlated to dyskinesia (R = 0.85), bradykinesia (R = 0.84) and gait (R = 0.79) UPDRS items. Correlation of sensor index from the upper-limb to TRS was 0.89. CONCLUSION Using the fusion of upper- and lower-limbs sensor data to construct TRIMS provided accurate PD motor states estimation and responsive to treatment. In addition, quantification of upper-limb sensor data during walking test provided strong results.
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Affiliation(s)
| | - Jerker Westin
- Department of Computer Engineering, Dalarna University, Falun, Sweden.
| | - Filip Bergquist
- Department of Pharmacology at Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden.
| | - Dag Nyholm
- Department of Neuroscience, Neurology at Uppsala University, Uppsala, Sweden.
| | - Håkan Askmark
- Department of Neuroscience, Neurology at Uppsala University, Uppsala, Sweden.
| | | | - Radu Constantinescu
- Department of Clinical Neuroscience, University of Gothenburg, Gothenburg, Sweden.
| | - Alexander Medvedev
- Department of Information Technology, at Uppsala University, Uppsala, Sweden.
| | | | | | - Ilias Thomas
- Department of Statistics, Dalarna University, Falun, Sweden.
| | | | - Dongni Johansson Buvarp
- Department of Clinical Neuroscience and Rehabilitation, University of Gothenburg, Gothenburg, Sweden.
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Vitek JL, Jain R, Chen L, Tröster AI, Schrock LE, House PA, Giroux ML, Hebb AO, Farris SM, Whiting DM, Leichliter TA, Ostrem JL, San Luciano M, Galifianakis N, Verhagen Metman L, Sani S, Karl JA, Siddiqui MS, Tatter SB, Ul Haq I, Machado AG, Gostkowski M, Tagliati M, Mamelak AN, Okun MS, Foote KD, Moguel-Cobos G, Ponce FA, Pahwa R, Nazzaro JM, Buetefisch CM, Gross RE, Luca CC, Jagid JR, Revuelta GJ, Takacs I, Pourfar MH, Mogilner AY, Duker AP, Mandybur GT, Rosenow JM, Cooper SE, Park MC, Khandhar SM, Sedrak M, Phibbs FT, Pilitsis JG, Uitti RJ, Starr PA. Subthalamic nucleus deep brain stimulation with a multiple independent constant current-controlled device in Parkinson's disease (INTREPID): a multicentre, double-blind, randomised, sham-controlled study. Lancet Neurol 2020; 19:491-501. [PMID: 32470421 DOI: 10.1016/s1474-4422(20)30108-3] [Citation(s) in RCA: 72] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Revised: 03/04/2020] [Accepted: 03/16/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Deep brain stimulation (DBS) of the subthalamic nucleus is an established therapeutic option for managing motor symptoms of Parkinson's disease. We conducted a double-blind, sham-controlled, randomised controlled trial to assess subthalamic nucleus DBS, with a novel multiple independent contact current-controlled (MICC) device, in patients with Parkinson's disease. METHODS This trial took place at 23 implanting centres in the USA. Key inclusion criteria were age between 22 and 75 years, a diagnosis of idiopathic Parkinson's disease with over 5 years of motor symptoms, and stable use of anti-parkinsonian medications for 28 days before consent. Patients who passed screening criteria were implanted with the DBS device bilaterally in the subthalamic nucleus. Patients were randomly assigned in a 3:1 ratio to receive either active therapeutic stimulation settings (active group) or subtherapeutic stimulation settings (control group) for the 3-month blinded period. Randomisation took place with a computer-generated data capture system using a pre-generated randomisation table, stratified by site with random permuted blocks. During the 3-month blinded period, both patients and the assessors were masked to the treatment group while the unmasked programmer was responsible for programming and optimisation of device settings. The primary outcome was the difference in mean change from baseline visit to 3 months post-randomisation between the active and control groups in the mean number of waking hours per day with good symptom control and no troublesome dyskinesias, with no increase in anti-parkinsonian medications. Upon completion of the blinded phase, all patients received active treatment in the open-label period for up to 5 years. Primary and secondary outcomes were analysed by intention to treat. All patients who provided informed consent were included in the safety analysis. The open-label phase is ongoing with no new enrolment, and current findings are based on the prespecified interim analysis of the first 160 randomly assigned patients. The study is registered with ClinicalTrials.gov, NCT01839396. FINDINGS Between May 17, 2013, and Nov 30, 2017, 313 patients were enrolled across 23 sites. Of these 313 patients, 196 (63%) received the DBS implant and 191 (61%) were randomly assigned. Of the 160 patients included in the interim analysis, 121 (76%) were randomly assigned to the active group and 39 (24%) to the control group. The difference in mean change from the baseline visit (post-implant) to 3 months post-randomisation in increased ON time without troublesome dyskinesias between the active and control groups was 3·03 h (SD 4·52, 95% CI 1·3-4·7; p<0·0001). 26 serious adverse events in 20 (13%) patients occurred during the 3-month blinded period. Of these, 18 events were reported in the active group and 8 in the control group. One death was reported among the 196 patients before randomisation, which was unrelated to the procedure, device, or stimulation. INTERPRETATION This double-blind, sham-controlled, randomised controlled trial provides class I evidence of the safety and clinical efficacy of subthalamic nucleus DBS with a novel MICC device for the treatment of motor symptoms of Parkinson's disease. Future trials are needed to investigate potential benefits of producing a more defined current field using MICC technology, and its effect on clinical outcomes. FUNDING Boston Scientific.
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Affiliation(s)
- Jerrold L Vitek
- Department of Neurology, University of Minnesota School of Medicine, Minneapolis, MN, USA.
| | - Roshini Jain
- Division of Neuromodulation, Boston Scientific, Valencia, CA, USA
| | - Lilly Chen
- Division of Neuromodulation, Boston Scientific, Valencia, CA, USA
| | - Alexander I Tröster
- Department of Clinical Neuropsychology, Barrow Neurological Institute, Phoenix, AZ, USA
| | - Lauren E Schrock
- Department of Neurology, University of Minnesota School of Medicine, Minneapolis, MN, USA
| | | | - Monique L Giroux
- Movement and Neuroperformance Center of Colorado, Englewood, CO, USA; Clinical Research Neurology, Eisai, Woodcliff Lake, NJ, USA
| | - Adam O Hebb
- Department of Neurological Surgery, Kaiser Permanente, Denver, CO, USA
| | - Sierra M Farris
- Division of Neuromodulation, Boston Scientific, Valencia, CA, USA; Movement and Neuroperformance Center of Colorado, Englewood, CO, USA
| | - Donald M Whiting
- Department of Neurosurgery, Allegheny General Hospital, Pittsburgh, PA, USA
| | | | - Jill L Ostrem
- Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Marta San Luciano
- Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Nicholas Galifianakis
- Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Leo Verhagen Metman
- Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, USA
| | - Sepehr Sani
- Department of Neurological Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Jessica A Karl
- Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, USA
| | - Mustafa S Siddiqui
- Department of Neurology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Stephen B Tatter
- Department of Neurosurgery, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Ihtsham Ul Haq
- Department of Neurology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Andre G Machado
- Center for Neurological Restoration, Cleveland Clinic, Cleveland, OH, USA
| | - Michal Gostkowski
- Center for Neurological Restoration, Cleveland Clinic, Cleveland, OH, USA
| | - Michele Tagliati
- Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Adam N Mamelak
- Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Michael S Okun
- Department of Neurology, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Kelly D Foote
- Department of Neurosurgery, College of Medicine, University of Florida, Gainesville, FL, USA
| | | | - Francisco A Ponce
- Department of Neurosurgery, Barrow Neurological Institute, Phoenix, AZ, USA
| | - Rajesh Pahwa
- Department of Neurology, University of Kansas Medical Center, Kansas City, KS, USA
| | - Jules M Nazzaro
- Department of Neurosurgery, University of Kansas Medical Center, Kansas City, KS, USA
| | | | - Robert E Gross
- Department of Neurosurgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Corneliu C Luca
- Department of Neurology, University of Miami School of Medicine, Miami, FL, USA
| | - Jonathan R Jagid
- Department of Neurosurgery, University of Miami School of Medicine, Miami, FL, USA
| | - Gonzalo J Revuelta
- Department of Neurology, Medical University of South Carolina, Charleston, SC, USA
| | - Istvan Takacs
- Department of Neurosurgery, Medical University of South Carolina, Charleston, SC, USA
| | - Michael H Pourfar
- Department of Neurology, New York University Medical Center, New York City, NY, USA
| | - Alon Y Mogilner
- Department of Neurosurgery, New York University Medical Center, New York City, NY, USA
| | - Andrew P Duker
- Department of Neurology, University of Cincinnati Medical Center, Cincinnati, OH, USA
| | - George T Mandybur
- Department of Neurosurgery, University of Cincinnati Medical Center, Cincinnati, OH, USA
| | - Joshua M Rosenow
- Department of Neurosurgery, Northwestern University School of Medicine, Chicago, IL, USA
| | - Scott E Cooper
- Department of Neurology, University of Minnesota School of Medicine, Minneapolis, MN, USA
| | - Michael C Park
- Department of Neurosurgery, University of Minnesota School of Medicine, Minneapolis, MN, USA
| | - Suketu M Khandhar
- Department of Neurology, Kaiser Permanente Medical Center, Sacramento, CA, USA
| | - Mark Sedrak
- Department of Neurosurgery, Kaiser Permanente Medical Center, Redwood City, CA, USA
| | - Fenna T Phibbs
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Julie G Pilitsis
- Department of Neurosurgery, Albany Medical Center, Albany, NY, USA
| | - Ryan J Uitti
- Department of Neurology, Mayo Clinic, Jacksonville, FL, USA
| | - Philip A Starr
- Department of Neurosurgery, University of California, San Francisco, San Francisco, CA, USA
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Shawen N, O'Brien MK, Venkatesan S, Lonini L, Simuni T, Hamilton JL, Ghaffari R, Rogers JA, Jayaraman A. Role of data measurement characteristics in the accurate detection of Parkinson's disease symptoms using wearable sensors. J Neuroeng Rehabil 2020; 17:52. [PMID: 32312287 PMCID: PMC7168958 DOI: 10.1186/s12984-020-00684-4] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Accepted: 04/03/2020] [Indexed: 01/07/2023] Open
Abstract
Background Parkinson’s disease (PD) is a progressive neurological disease, with characteristic motor symptoms such as tremor and bradykinesia. There is a growing interest to continuously monitor these and other symptoms through body-worn sensor technology. However, limited battery life and memory capacity hinder the potential for continuous, long-term monitoring with these devices. There is little information available on the relative value of adding sensors, increasing sampling rate, or computing complex signal features, all of which may improve accuracy of symptom detection at the expense of computational resources. Here we build on a previous study to investigate the relationship between data measurement characteristics and accuracy when using wearable sensor data to classify tremor and bradykinesia in patients with PD. Methods Thirteen individuals with PD wore a flexible, skin-mounted sensor (collecting tri-axial accelerometer and gyroscope data) and a commercial smart watch (collecting tri-axial accelerometer data) on their predominantly affected hand. The participants performed a series of standardized motor tasks, during which a clinician scored the severity of tremor and bradykinesia in that limb. Machine learning models were trained on scored data to classify tremor and bradykinesia. Model performance was compared when using different types of sensors (accelerometer and/or gyroscope), different data sampling rates (up to 62.5 Hz), and different categories of pre-engineered features (up to 148 features). Performance was also compared between the flexible sensor and smart watch for each analysis. Results First, there was no effect of device type for classifying tremor symptoms (p > 0.34), but bradykinesia models incorporating gyroscope data performed slightly better (up to 0.05 AUROC) than other models (p = 0.01). Second, model performance decreased with sampling frequency (p < 0.001) for tremor, but not bradykinesia (p > 0.47). Finally, model performance for both symptoms was maintained after substantially reducing the feature set. Conclusions Our findings demonstrate the ability to simplify measurement characteristics from body-worn sensors while maintaining performance in PD symptom detection. Understanding the trade-off between model performance and data resolution is crucial to design efficient, accurate wearable sensing systems. This approach may improve the feasibility of long-term, continuous, and real-time monitoring of PD symptoms by reducing computational burden on wearable devices.
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Affiliation(s)
- Nicholas Shawen
- Max Nader Lab for Rehabilitation Technologies and Outcomes, Shirley Ryan AbilityLab, Chicago, IL, 60611, USA.,Feinberg School of Medicine, Northwestern University, Chicago, IL, 60611, USA
| | - Megan K O'Brien
- Max Nader Lab for Rehabilitation Technologies and Outcomes, Shirley Ryan AbilityLab, Chicago, IL, 60611, USA.,Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, IL, 60611, USA
| | - Sanjeev Venkatesan
- Max Nader Lab for Rehabilitation Technologies and Outcomes, Shirley Ryan AbilityLab, Chicago, IL, 60611, USA.,Department of Computer Science, University of Illinois at Urbana-Champagne, Urbana, IL, 61801, USA
| | - Luca Lonini
- Max Nader Lab for Rehabilitation Technologies and Outcomes, Shirley Ryan AbilityLab, Chicago, IL, 60611, USA.,Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, IL, 60611, USA
| | - Tanya Simuni
- Department of Neurology, Northwestern University, Chicago, IL, 60611, USA
| | - Jamie L Hamilton
- The Michael J. Fox Foundation for Parkinson's Research, New York, NY, 10120, USA
| | - Roozbeh Ghaffari
- Center for Bio-Integrated Electronics, Departments of Materials Science and Engineering, Biomedical Engineering, Chemistry, Mechanical Engineering, Electrical Engineering and Computer Science, Neurological Surgery, Simpson Querrey Institute for Nano/Biotechnology, McCormick School of Engineering, Feinberg School of Medicine, Northwestern University, Evanston, IL, 60208, USA
| | - John A Rogers
- Center for Bio-Integrated Electronics, Departments of Materials Science and Engineering, Biomedical Engineering, Chemistry, Mechanical Engineering, Electrical Engineering and Computer Science, Neurological Surgery, Simpson Querrey Institute for Nano/Biotechnology, McCormick School of Engineering, Feinberg School of Medicine, Northwestern University, Evanston, IL, 60208, USA
| | - Arun Jayaraman
- Max Nader Lab for Rehabilitation Technologies and Outcomes, Shirley Ryan AbilityLab, Chicago, IL, 60611, USA. .,Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, IL, 60611, USA. .,Department of Physical Therapy and Human Movement Sciences, Northwestern University, Chicago, IL, 60611, USA.
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Srinivasan R, Ben-Pazi H, Dekker M, Cubo E, Bloem B, Moukheiber E, Gonzalez-Santos J, Guttman M. Telemedicine for Hyperkinetic Movement Disorders. TREMOR AND OTHER HYPERKINETIC MOVEMENTS (NEW YORK, N.Y.) 2020; 10:tre-10-698. [PMID: 32195039 PMCID: PMC7070700 DOI: 10.7916/tohm.v0.698] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/30/2019] [Accepted: 01/17/2020] [Indexed: 01/06/2023]
Abstract
Telemedicine is the use of electronic communication technology to facilitate healthcare between distant providers and patients. In addition to synchronous video conferencing, asynchronous video transfer has been used to support care for neurology patients. There is a growing literature on using telemedicine in movement disorders, with the most common focus on Parkinson’s disease. There is accumulating evidence for videoconferencing to diagnose and treat patients with hyperkinetic movement disorders and to support providers in remote underserviced areas. Cognitive testing has been shown to be feasible remotely. Genetic counseling and other counseling-based therapeutic interventions have also successfully performed in hyperkinetic movement disorders. We use a problem-based approach to review the current evidence for the use of telemedicine in various hyperkinetic movement disorders. This Viewpoint attempts to identify possible telemedicine solutions as well as discussing unmet needs and future directions.
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Affiliation(s)
| | - Hilla Ben-Pazi
- Pediatric Neurology Department, Assuta Ashdod, Ashdod, IL
| | - Marieke Dekker
- Department of Internal Medicine, Kilimanjaro Christian Medical Centre, Moshi, TZ
| | - Esther Cubo
- Neurology Department, Hospital Universitario Burgos, Burgos, ES
| | - Bas Bloem
- Department of Neurology, Radbound Medical Center, Nijmegen, NL
| | - Emile Moukheiber
- Department of Neurology, John Hopkins University School of Medicine, Baltimore, MD, US
| | | | - Mark Guttman
- Centre for Movement Disorders, Toronto, Ontario, CA.,Department of Internal Medicine, Division of Neurology, University of Toronto, Toronto, CA
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Mahadevan N, Demanuele C, Zhang H, Volfson D, Ho B, Erb MK, Patel S. Development of digital biomarkers for resting tremor and bradykinesia using a wrist-worn wearable device. NPJ Digit Med 2020; 3:5. [PMID: 31970290 PMCID: PMC6962225 DOI: 10.1038/s41746-019-0217-7] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Accepted: 12/16/2019] [Indexed: 01/09/2023] Open
Abstract
Objective assessment of Parkinson's disease symptoms during daily life can help improve disease management and accelerate the development of new therapies. However, many current approaches require the use of multiple devices, or performance of prescribed motor activities, which makes them ill-suited for free-living conditions. Furthermore, there is a lack of open methods that have demonstrated both criterion and discriminative validity for continuous objective assessment of motor symptoms in this population. Hence, there is a need for systems that can reduce patient burden by using a minimal sensor setup while continuously capturing clinically meaningful measures of motor symptom severity under free-living conditions. We propose a method that sequentially processes epochs of raw sensor data from a single wrist-worn accelerometer by using heuristic and machine learning models in a hierarchical framework to provide continuous monitoring of tremor and bradykinesia. Results show that sensor derived continuous measures of resting tremor and bradykinesia achieve good to strong agreement with clinical assessment of symptom severity and are able to discriminate between treatment-related changes in motor states.
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Affiliation(s)
| | | | - Hao Zhang
- Pfizer, Inc., Cambridge, MA 02139 USA
| | | | - Bryan Ho
- Tufts Medical Center, Boston, MA 02111 USA
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McNaney R, Miller N, Vines J, Olivier P, Ladha K, Jackson D, Walker R. The feasibility and acceptability of using a novel wrist worn cueing device to self-manage drooling problems in people with Parkinson's disease: A pilot study. J Rehabil Assist Technol Eng 2019; 6:2055668319852529. [PMID: 31662884 PMCID: PMC6796203 DOI: 10.1177/2055668319852529] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Accepted: 04/27/2019] [Indexed: 11/24/2022] Open
Abstract
Introduction Daytime drooling is experienced by around 50% of Parkinson’s patients, who
fail to swallow saliva in sufficient volume or regularity, despite normal
production. This research explored the feasibility and acceptability of
using a cueing device, to improve drooling. Methods During a four-week intervention, 28 participants were asked to use a cueing
device for 1 h per day. During this time, the device vibrated
once-per-minute, reminding the participant to swallow their saliva. A daily
diary was used to collect self-report around swallowing severity, frequency,
and duration. This was filled out by participants for one week before, four
weeks during and for one week immediately after intervention. Diaries were
also collected for one week during a follow up, carried out four weeks after
intervention finished. Results Participants self-reported benefits in drooling severity
(p = 0.031), frequency (p ≤ 0.001), and
duration (p = 0.001) after using the device. Improvements
were maintained at follow up. Twenty-two participants explicitly reported a
positive benefit to their drooling during exit interview. All felt the
intervention and device were acceptable and usable. Conclusions Using a cueing device for one month had perceived benefit to drooling
severity, frequency and duration in patients with Parkinson’s. Participants
accepted the device and treatment protocol.
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Affiliation(s)
- Roisin McNaney
- School of Computer Science Electrical Engineering and Engineering Maths, University of Bristol, Bristol, UK
| | - Nick Miller
- Institute for Ageing, Newcastle University, Newcastle upon Tyne, UK
| | - John Vines
- NORTHLab, Northumbria University, Newcastle upon Tyne, UK
| | - Patrick Olivier
- Open Lab, School of Computing Science, Newcastle University, Newcastle upon Tyne, UK
| | - Karim Ladha
- Open Lab, School of Computing Science, Newcastle University, Newcastle upon Tyne, UK
| | - Daniel Jackson
- Open Lab, School of Computing Science, Newcastle University, Newcastle upon Tyne, UK
| | - Richard Walker
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK.,Northumbria Healthcare NHS Foundation Trust, North Tyneside General Hospital, North Shields, UK
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Pharmacodynamics, Efficacy, and Safety of IPX203 in Parkinson Disease Patients With Motor Fluctuations. Clin Neuropharmacol 2019; 42:149-156. [PMID: 31306216 PMCID: PMC6791502 DOI: 10.1097/wnf.0000000000000354] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES IPX203 is an investigational oral extended-release capsule formulation of carbidopa and levodopa. The pharmacodynamics and efficacy of IPX203 were compared with immediate-release carbidopa-levodopa (IR CD-LD) in this open-label, rater-blinded, multicenter, crossover study in patients with advanced Parkinson disease (PD). METHODS Twenty-eight patients were randomized to 2 weeks of treatment with IR CD-LD followed by IPX203 or IPX203 followed by IR CD-LD. Pharmacokinetic and motor assessments were conducted on days 1 and 15 of each treatment period. Efficacy was assessed using a 3-day PD diary. Pharmacodynamics were assessed by rater-blinded Movement Disorder Society-Unified Parkinson's Disease Rating Scale Part III and Investigator Assessment of Subject's Motor State. RESULTS After a single dose, levodopa concentrations were sustained above 50% of peak concentration for 4.6 hours with IPX203 versus 1.5 hours with IR CD-LD (P < 0.0001). Based on the PD diary, patients experienced significantly less Off time with IPX203 as a percentage of waking hours than IR CD-LD (mean 19.3% vs 33.5%, respectively; P < 0.0001), translating into 2.3 hours less Off time than IR CD-LD with most of this improvement (1.9 hours) being Good On time. There was no significant difference in the amount of On time with troublesome dyskinesia between treatments. Pharmacodynamic assessments demonstrated similar outcomes in favor of IPX203 on day 1 and a significant predose benefit on motor examination after multiple dosing. CONCLUSIONS IPX203 demonstrated a sustained effect to reduce Off time and improve Good On time in patients with PD and motor fluctuations. Both treatments were well tolerated.
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Single-Dose Pharmacokinetics and Pharmacodynamics of IPX203 in Patients With Advanced Parkinson Disease: A Comparison With Immediate-Release Carbidopa-Levodopa and With Extended-Release Carbidopa-Levodopa Capsules. Clin Neuropharmacol 2019; 42:4-8. [PMID: 30520758 PMCID: PMC7654938 DOI: 10.1097/wnf.0000000000000314] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Objective IPX203 is an investigational oral extended-release capsule formulation of carbidopa-levodopa (CD-LD). The aim of this study was to characterize the single-dose pharmacodynamics, pharmacokinetics, and safety of IPX203 in subjects with advanced Parkinson disease compared with immediate-release (IR) CD-LD and extended-release CD-LD (Rytary). Methods This was a randomized, open-label, rater-blinded, multicenter, single-dose crossover study. Blinded clinicians assessed subject's motor state and Movement Disorders Society Unified Parkinson's Disease Rating Scale (MDS-UPDRS) part III scores for up to 10 hours postdose. Duration of effect was determined using improvement thresholds in the MDS-UPDRS part III. Results Levodopa concentrations increased rapidly and similarly across all 3 treatments and were sustained for a longer duration after IPX203 dosing. All treatments exhibited a rapid onset of pharmacodynamic effect, whereas IPX203 had a significantly longer duration of effect based on MDS-UPDRS part III scores compared with IR CD-LD (P < 0.0001) and Rytary (P ≤ 0.0290). IPX203 had a 2.7-hour advantage over IR CD-LD (P < 0.0001) and a 0.9-hour advantage over Rytary in “off” time (P = 0.023) and in “good on” time (2.6 hours more than IR CD-LD, P < 0.0001; 0.9 hours more than Rytary, P = 0.0259) as measured by the Investigator Assessment of Subject's Motor State. Subjects were 77% more likely to require rescue following IR CD-LD treatment compared with IPX203 (hazard ratio, 0.23; P < 0.0001). More subjects reported treatment-emergent adverse effects during IR CD-LD (28.0%) and IPX203 (19.2%) than during Rytary (8.0%) treatment. Conclusions Compared with Rytary and IR CD-LD, IPX203 had a longer pharmacodynamic effect consistent with LD pharmacokinetics for the 3 treatments. The safety and tolerability of IPX203 were similar to those of IR CD-LD and Rytary.
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Boroojerdi B, Ghaffari R, Mahadevan N, Markowitz M, Melton K, Morey B, Otoul C, Patel S, Phillips J, Sen-Gupta E, Stumpp O, Tatla D, Terricabras D, Claes K, Wright JA, Sheth N. Clinical feasibility of a wearable, conformable sensor patch to monitor motor symptoms in Parkinson's disease. Parkinsonism Relat Disord 2019; 61:70-76. [DOI: 10.1016/j.parkreldis.2018.11.024] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Revised: 10/11/2018] [Accepted: 11/26/2018] [Indexed: 10/27/2022]
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Aghanavesi S, Bergquist F, Nyholm D, Senek M, Memedi M. Motion Sensor-Based Assessment of Parkinson's Disease Motor Symptoms During Leg Agility Tests: Results From Levodopa Challenge. IEEE J Biomed Health Inform 2019; 24:111-119. [PMID: 30763248 DOI: 10.1109/jbhi.2019.2898332] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Parkinson's disease (PD) is a degenerative, progressive disorder of the central nervous system that mainly affects motor control. The aim of this study was to develop data-driven methods and test their clinimetric properties to detect and quantify PD motor states using motion sensor data from leg agility tests. Nineteen PD patients were recruited in a levodopa single dose challenge study. PD patients performed leg agility tasks while wearing motion sensors on their lower extremities. Clinical evaluation of video recordings was performed by three movement disorder specialists who used four items from the motor section of the unified PD rating scale (UPDRS), the treatment response scale (TRS) and a dyskinesia score. Using the sensor data, spatiotemporal features were calculated and relevant features were selected by feature selection. Machine learning methods like support vector machines (SVM), decision trees, and linear regression, using ten-fold cross validation were trained to predict motor states of the patients. SVM showed the best convergence validity with correlation coefficients of 0.81 to TRS, 0.83 to UPDRS #31 (body bradykinesia and hypokinesia), 0.78 to SUMUPDRS (the sum of the UPDRS items: #26-leg agility, #27-arising from chair, and #29-gait), and 0.67 to dyskinesia. Additionally, the SVM-based scores had similar test-retest reliability in relation to clinical ratings. The SVM-based scores were less responsive to treatment effects than the clinical scores, particularly with regards to dyskinesia. In conclusion, the results from this study indicate that using motion sensors during leg agility tests may lead to valid and reliable objective measures of PD motor symptoms.
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Stocchi F, Coletti C, Bonassi S, Radicati FG, Vacca L. Early-morning OFF and levodopa dose failures in patients with Parkinson's disease attending a routine clinical appointment using Time-to-ON Questionnaire. Eur J Neurol 2019; 26:821-826. [PMID: 30585679 DOI: 10.1111/ene.13895] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Accepted: 12/17/2018] [Indexed: 12/25/2022]
Abstract
BACKGROUND AND PURPOSE In patients with Parkinson's disease (PD) with motor fluctuations, total daily OFF time is comprised of both end-of-dose time and the time taken to turn ON with medication. However, little is known about the impact of delays in ON time. METHODS This was a single-visit pilot study of fluctuating patients with PD attending a routine appointment. During a single visit, adult patients with idiopathic PD who were treated with levodopa for at least 1 year completed a questionnaire evaluating the time waiting for ON and the symptoms experienced while waiting to turn ON. Patients then completed a 5-day home time-to-ON diary, where they documented how long it took to turn ON following their first morning dose of levodopa in 5-min increments. RESULTS A total of 151 consecutive patients completed the study survey, of whom 97 (64.2%) experienced motor fluctuations. Of the patients experiencing motor fluctuations, 54 (56%) reported delays in ON time (latency >30 min) following their first morning dose of levodopa. Half (51%) reported that they had experienced delayed ON at least once in the previous week and 21% reported having delayed ON during all seven mornings of the previous week. In addition, 10% of patients reported having dose failures on four or more mornings during the previous week. The most common symptoms experienced while waiting for ON were slowness (94.8%), fatigue (87.6%), reduced dexterity (82.5%), problems in walking (66.0%) and problems with balance (59.8%). CONCLUSION Early-morning OFF problems such as delays in time to ON and dose failures are common in levodopa-treated patients with PD.
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Affiliation(s)
- F Stocchi
- University and Institute for Research and Medical Care IRCCS San Raffaele, Rome
| | - C Coletti
- University and Institute for Research and Medical Care IRCCS San Raffaele, Rome
| | - S Bonassi
- University and Institute for Research and Medical Care IRCCS San Raffaele, Rome
| | - F G Radicati
- University and Institute for Research and Medical Care IRCCS San Raffaele, Rome
| | - L Vacca
- Neurology Department, Casa di Cura Privata Policlinico (CCPP), Milan, Italy
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