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Caronni S, Del Sorbo F, Barichella M, Fothergill-Misbah N, Denne T, Laguna J, Urasa S, Dekker MCJ, Akpalu A, Sarfo FS, Cham M, Pezzoli G, Cilia R. Mucuna pruriens to treat Parkinson's disease in low-income countries: Recommendations and practical guidelines from the farmer to clinical trials. Paving the way for future use in clinical practice. Parkinsonism Relat Disord 2024:106983. [PMID: 38797572 DOI: 10.1016/j.parkreldis.2024.106983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Revised: 04/24/2024] [Accepted: 04/27/2024] [Indexed: 05/29/2024]
Abstract
Parkinson's disease (PD) is a progressive and disabling neurodegenerative disease that rapidly worsens and results in premature mortality if left untreated. Although levodopa is the gold standard treatment for PD globally, its accessibility and affordability are severely limited in low- and middle-income countries worldwide. In this scenario, Mucuna pruriens (MP), a leguminous plant growing wild in tropical regions, emerges as a potential alternative or adjunct to levodopa-based medications due to its cost-effectiveness and global natural availability. Recent studies have demonstrated that MP can significantly ameliorate motor symptoms, although tolerability may vary. The proposition that MP could play a pivotal role in providing affordable and symptomatic relief for PD in low- and middle-income countries is grounded in its promising therapeutic profile, yet caution is warranted until more comprehensive data on the long-term safety and efficacy of MP become available. This manuscript summarizes the knowledge gained about MP by the authors, focusing on how to cultivate, store, and provide it to patients in the safest and most effective way in clinical trials. We aim to increase clinical trials investigating its safety and efficacy in PD, before promoting individual use of MP on a global scale, particularly in countries where availability and affordability of levodopa-based medications is still limited.
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Affiliation(s)
- Serena Caronni
- Parkinson Institute, ASST Gaetano Pini-CTO, Milan, Italy
| | | | | | | | - Tanya Denne
- Bastyr University Research Institute, Bastyr University, Kenmore, WA, USA
| | - Janeth Laguna
- Neurology Clinic, Clinica Niño Jesus, Santa Cruz, Bolivia
| | - Sarah Urasa
- Department of Medicine and Pediatrics, Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - Marieke C J Dekker
- Department of Medicine and Pediatrics, Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - Albert Akpalu
- Department of Medicine, University of Ghana Medical School, Accra, Ghana
| | | | - Momodou Cham
- Richard Novati Catholic Hospital, Sogakope, Ghana
| | - Gianni Pezzoli
- Fondazione Grigioni per il Morbo di Parkinson, Milan, Italy
| | - Roberto Cilia
- Fondazione IRCCS Istituto Neurologico Carlo Besta, Department of Clinical Neurosciences, Parkinson and Movement Disorders Unit, Milan, Italy.
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Essam M, Hamid E, Abushady E, El-Balkimy M, Antonini A, Shalash A. Role of zonisamide in advanced Parkinson's disease: a randomized placebo-controlled study. Neurol Sci 2024; 45:1725-1734. [PMID: 38376645 PMCID: PMC10943138 DOI: 10.1007/s10072-024-07396-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Accepted: 02/07/2024] [Indexed: 02/21/2024]
Abstract
BACKGROUND Zonisamide (ZNS) has shown some efficacy in motor symptoms of PD; however, more evidence is lacking, and its effects on nonmotor symptoms (NMSs) and quality of life (QoL) remain to be investigated. This randomized double-blinded placebo-controlled crossover study investigated the effect of ZNS on motor and NMS symptoms and QoL in advanced PD. METHODS PD patients with Hoehn and Yahr stage ≥ 2 ("On" state) and at least 2 h off time daily were randomized to groups: ZNS 25 mg, ZNS 50 mg and placebo. Groups were assessed at baseline and at the 1- and 3-month follow-ups. The primary endpoint was the change in the total MDS-UPDRS III "On", while the secondary endpoint was the change in the total and parts I and IV MDS-UPDRS, Nonmotor Symptoms Scale and Parkinson's disease questionnaire-39 at the final assessment. RESULTS Sixty-nine patients were assessed for efficacy at the 1-month follow-up, and 58 patients were assessed at the 3-month follow-up. The primary endpoint showed significant improvement in the ZNS 25 mg group compared to the placebo group (p = 0.009). At the final assessment, the ZNS 25 mg group showed significant improvement of total and part VI MDS-UPDRS, bradykinesia, tremor and functional impact of fluctuations compared to placebo. There was no change in dyskinesia, NMSs, QoL or side effects except for sedation. CONCLUSION ZNS has a favourable effect on motor symptoms in patients with wearing off as adjunctive therapy with other dopaminergic drugs, with no exacerbation of dyskinesia and a limited impact on NMSs and QoL. TRIAL REGISTRATION Clinicaltrials.gov, NCT04182399, in 24/11/2019.
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Affiliation(s)
- Mohamed Essam
- Department of Neurology, Faculty of Medicine, Ain Shams University, 38 Abbassia Square, Cairo, Egypt
| | - Eman Hamid
- Department of Neurology, Faculty of Medicine, Ain Shams University, 38 Abbassia Square, Cairo, Egypt
| | - Eman Abushady
- Department of Neurology, Faculty of Medicine, Ain Shams University, 38 Abbassia Square, Cairo, Egypt
| | - Mahmoud El-Balkimy
- Department of Neurology, Faculty of Medicine, Ain Shams University, 38 Abbassia Square, Cairo, Egypt
| | - Angelo Antonini
- Parkinson and Movement Disorders Unit, Study Center for Neurodegeneration (CESNE), Department of Neuroscience, University of Padua, 35131, Padua, Italy
| | - Ali Shalash
- Department of Neurology, Faculty of Medicine, Ain Shams University, 38 Abbassia Square, Cairo, Egypt.
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Rodriguez-Porcel F, Sarva H, Joutsa J, Falup-Pecurariu C, Shukla AW, Mehanna R, Śmiłowska K, Lanza G, Filipović SR, Shalash A, Ferris M, Jankovic J, Espay AJ, Pandey S. Current opinions and practices in post-stroke movement disorders: Survey of movement disorders society members. J Neurol Sci 2024; 458:122925. [PMID: 38340409 DOI: 10.1016/j.jns.2024.122925] [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: 11/16/2023] [Revised: 02/03/2024] [Accepted: 02/06/2024] [Indexed: 02/12/2024]
Abstract
BACKGROUND Post-stroke movement disorders (PSMD) encompass a wide array of presentations, which vary in mode of onset, phenomenology, response to treatment, and natural history. There are no evidence-based guidelines on the diagnosis and treatment of PSMD. OBJECTIVES To survey current opinions and practices on the diagnosis and treatment of PSMD. METHODS A survey was developed by the PSMD Study Group, commissioned by the International Parkinson's and Movement Disorders Society (MDS). The survey, distributed to all members, yielded a total of 529 responses, 395 (74.7%) of which came from clinicians with experience with PSMD. RESULTS Parkinsonism (68%), hemiballismus/hemichorea (61%), tremor (58%), and dystonia (54%) were by far the most commonly endorsed presentation of PSMD, although this varied by region. Basal ganglia stroke (76% of responders), symptoms contralateral to stroke (75%), and a temporal relationship (59%) were considered important factors for the diagnosis of PSMD. Oral medication use depended on the phenomenology of the PSMD. Almost 50% of respondents considered deep brain stimulation and ablative surgeries as options for treatment. The lack of guidelines for the diagnosis and treatment was considered the most important gap to address. CONCLUSIONS Regionally varying opinions and practices on PSMD highlight gaps in (and mistranslation of) epidemiologic and therapeutic knowledge. Multicenter registries and prospective community-based studies are needed for the creation of evidence-based guidelines to inform the diagnosis and treatment of patients with PSMD.
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Affiliation(s)
| | - Harini Sarva
- Parkinson's Disease and Movement Disorders Institute, Department of Neurology, Weill Cornell Medicine, NY, New York, USA
| | - Juho Joutsa
- Turku Brain and Mind Center, Clinical Neurosciences, University of Turku; Turku PET Centre, Neurocenter, Turku University Hospital, Turku, Finland
| | | | - Aparna Wagle Shukla
- Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, USA
| | - Raja Mehanna
- Department of Neurology, University of Texas Health Science Center at Houston, TX, USA
| | | | - Giuseppe Lanza
- Department of Surgery and Medical-Surgical Specialties, University of Catania, Catania, Italy; Clinical Neurophysiology Research Unit, Oasi Research Institute-IRCCS, Troina, Italy
| | - Saša R Filipović
- University of Belgrade, Institute for Medical Research, Human Neuroscience Group, Belgrade, Serbia
| | - Ali Shalash
- Department of Neurology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Margaret Ferris
- Department of Neurology Stanford University, Palo Alto, CA, USA
| | - Joseph Jankovic
- Parkinson's Disease Center and Movement Disorders Clinic, Department of Neurology, Baylor College of Medicine, Houston, TX, USA
| | - Alberto J Espay
- James J. and Joan A. Gardner Family Center for Parkinson's Disease and Movement Disorders, Department of Neurology, University of Cincinnati, Cincinnati, OH, USA
| | - Sanjay Pandey
- Department of Neurology and Stroke Medicine, Amrita Hospital, Mata Amritanandamayi Marg Sector 88, Faridabad, Delhi National Capital Region, India
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4
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Tan AH, Cornejo‐Olivas M, Okubadejo N, Pal PK, Saranza G, Saffie‐Awad P, Ahmad‐Annuar A, Schumacher‐Schuh AF, Okeng'o K, Mata IF, Gatto EM, Lim S. Genetic Testing for Parkinson's Disease and Movement Disorders in Less Privileged Areas: Barriers and Opportunities. Mov Disord Clin Pract 2024; 11:14-20. [PMID: 38291851 PMCID: PMC10828609 DOI: 10.1002/mdc3.13903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 07/14/2023] [Accepted: 07/30/2023] [Indexed: 02/01/2024] Open
Affiliation(s)
- Ai Huey Tan
- Division of Neurology, Department of Medicine, Faculty of MedicineUniversity of MalayaKuala LumpurMalaysia
| | - Mario Cornejo‐Olivas
- Neurogenetics Working GroupUniversidad Científica del SurLimaPeru
- Neurogenetics Research Center, Instituto Nacional de Ciencias NeurológicasLimaPeru
| | - Njideka Okubadejo
- Department of Medicine, College of MedicineUniversity of LagosLagosNigeria
| | - Pramod Kumar Pal
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS)BengaluruIndia
| | - Gerard Saranza
- Movement Disorders Service, Section of Neurology, Department of Internal Medicine, Chong Hua Hospital and Vicente Sotto Memorial Medical CenterCebuPhilippines
| | - Paula Saffie‐Awad
- CETRAM‐Centro de Estudios de Transtornos del Movimiento, Clínica Santa MaríaSantiagoChile
| | - Azlina Ahmad‐Annuar
- Department of Biomedical Science, Faculty of MedicineUniversity of MalayaKuala LumpurMalaysia
| | - Artur F. Schumacher‐Schuh
- Departamento de FarmacologiaUniversidade Federal do Rio Grande do SulPorto AlegreBrazil
- Serviço de Neurologia, Hospital de Clínicas de Porto AlegrePorto AlegreBrazil
| | | | - Ignacio F. Mata
- Genomic Medicine Institute, Lerner Research Institute, Genomic Medicine, Cleveland Clinic FoundationClevelandOhioUSA
| | - Emilia M. Gatto
- Department of Neurology, Hospital Sanatorio de la Trinidad Mitre, Instituto de Neurociencias Buenos Aires, School of MedicineBuenos Aires UniversityBuenos AiresArgentina
| | - Shen‐Yang Lim
- Division of Neurology, Department of Medicine, Faculty of MedicineUniversity of MalayaKuala LumpurMalaysia
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Cardoso F. Difficulties of Access to Diagnostic Methods and Therapies in Movement Disorders: A Call to Action. Mov Disord Clin Pract 2024; 11:7-9. [PMID: 38291850 PMCID: PMC10828618 DOI: 10.1002/mdc3.13904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Revised: 05/21/2023] [Accepted: 05/26/2023] [Indexed: 02/01/2024] Open
Affiliation(s)
- Francisco Cardoso
- Movement Disorders Unit, Neurology Service, Internal Medicine DepartmentThe Federal University of Minas GeraisBelo HorizonteBrazil
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Cilia R, Dekker MCJ, Cubo E, Agoriwo MW. Delivery of Allied Health Therapies to People with Parkinson's Disease in Africa. JOURNAL OF PARKINSON'S DISEASE 2023:JPD230262. [PMID: 38143371 DOI: 10.3233/jpd-230262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2023]
Abstract
Allied health therapies refer to a range of healthcare professionals, including physiotherapists, occupational and speech-language therapists, who aim to optimize daily function and quality of life in conjunction with medical care. In this narrative review of literature on allied health therapies in people with Parkinson's disease (PD), we focused on the diversity in healthcare access, state of the art, current challenges in the African continent, and proposed solutions and future perspectives. Despite the increasing prevalence and awareness of PD in Africa, numerous challenges persist in its management. These include resource limitations, geographical barriers, sociocultural beliefs, and economic constraints. Nevertheless, innovative solutions, including telerehabilitation and community-based rehabilitation, offer hope. Collaborative efforts within the continent and internationally have shown potential in bridging training and resource gaps. Significant strides can be made with tailored interventions, technological advancements, and multifaceted collaborations. This review offers practical insights for healthcare professionals, policymakers, and caregivers to navigate and optimize PD care in the African context.
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Affiliation(s)
- Roberto Cilia
- Fondazione IRCCS Istituto Neurologico Carlo Besta, Department of Clinical Neurosciences, Parkinson and Movement Disorders Unit, Milan, Italy
| | - Marieke C J Dekker
- Department of Medicine and Pediatrics, Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - Esther Cubo
- Neurology Department, Hospital Universitario Burgos, Burgos, Spain
| | - Mary W Agoriwo
- Department of Physiotherapy and Rehabilitation Sciences, University of Health and Allied Sciences, Ho, Ghana
- Division of Physiotherapy, Stellenbosch University, Cape Town, South Africa
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Memon AA, Gelman K, Melott J, Billings R, Fullard M, Catiul C, Miocinovic S, Amara AW. A systematic review of health disparities research in deep brain stimulation surgery for Parkinson's disease. Front Hum Neurosci 2023; 17:1269401. [PMID: 37964803 PMCID: PMC10641459 DOI: 10.3389/fnhum.2023.1269401] [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: 07/29/2023] [Accepted: 10/05/2023] [Indexed: 11/16/2023] Open
Abstract
Background Deep brain stimulation (DBS) is the primary surgical intervention for Parkinson's disease (PD) patients with insufficient response to medication, significantly improving motor symptoms and quality of life. Despite FDA approval for over two decades, access to this therapy remains limited. This systematic review aims to evaluate the influence of gender, race/ethnicity, socioeconomic status, and age on health disparities associated with DBS for PD, providing an overview of current research in this field. Methods A systematic literature search was conducted in PubMed/MEDLINE, Embase, Web of Science and Cochrane databases from 1960 to September 12th, 2023, following Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. Studies that examine the disparities in accessing DBS among patients with PD were included, comparing different demographic factors. Findings were synthesized and presented narratively to identify and understand DBS disparities. Results After screening for relevance, 25 studies published between 1960 and 2023 were included, with 16 studies meeting full-text review criteria. While reviewing the references of the 16 articles, two additional studies were included, bringing the total number of included studies to 18. Most studies originated from the United States (44%). The identified studies were categorized as identifying disparities, understanding disparities, or reducing disparities. The majority focused on identifying disparities (72%), while fewer studies delved into understanding the underlying factors (28%). No studies evaluated strategies for reducing disparities. The findings indicate that elderly, female, and Black people, as well as those from low socioeconomic backgrounds and developing countries face greater obstacles in accessing DBS for PD. Conclusion This study highlights factors contributing to disparities in DBS utilization for PD, including race, gender, and socioeconomic status. Public health policymakers, practitioners, and clinicians should recognize these inequalities and work toward reducing disparities, particularly among vulnerable populations.
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Affiliation(s)
- Adeel A. Memon
- Department of Neurology, Rockefeller Neuroscience Institute, West Virginia University, Morgantown, WV, United States
| | - Kate Gelman
- School of Medicine, West Virginia University, Morgantown, WV, United States
| | - Joseph Melott
- School of Medicine, West Virginia University, Morgantown, WV, United States
| | - Rebecca Billings
- UAB Libraries, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Michelle Fullard
- Department of Neurology, University of Colorado, Aurora, CO, United States
| | - Corina Catiul
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, United States
| | | | - Amy W. Amara
- Department of Neurology, University of Colorado, Aurora, CO, United States
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8
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Walker R, Fothergill-Misbah N, Kariuki S, Ojo O, Cilia R, Dekker MCJ, Agabi O, Akpalu A, Amod F, Breckons M, Cham M, Del Din S, Dotchin C, Guggsa S, Kwasa J, Mushi D, Nwaokorie FO, Park T, Rochester L, Rogathi J, Sarfo FS, Shalash A, Ternent L, Urasa S, Okubadejo N. Transforming Parkinson's Care in Africa (TraPCAf): protocol for a multimethodology National Institute for Health and Care Research Global Health Research Group project. BMC Neurol 2023; 23:373. [PMID: 37858118 PMCID: PMC10585779 DOI: 10.1186/s12883-023-03414-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 09/29/2023] [Indexed: 10/21/2023] Open
Abstract
BACKGROUND Parkinson's disease (PD) is the second most common neurodegenerative disorder and, according to the Global Burden of Disease estimates in 2015, was the fastest growing neurological disorder globally with respect to associated prevalence, disability, and deaths. Information regarding the awareness, diagnosis, phenotypic characteristics, epidemiology, prevalence, risk factors, treatment, economic impact and lived experiences of people with PD from the African perspective is relatively sparse in contrast to the developed world, and much remains to be learned from, and about, the continent. METHODS Transforming Parkinson's Care in Africa (TraPCAf) is a multi-faceted, mixed-methods, multi-national research grant. The study design includes multiple sub-studies, combining observational (qualitative and quantitative) approaches for the epidemiological, clinical, risk factor and lived experience components, as appropriate, and interventional methods (clinical trial component). The aim of TraPCAf is to describe and gain a better understanding of the current situation of PD in Africa. The countries included in this National Institute for Health and Care Research (NIHR) Global Health Research Group (Egypt, Ethiopia, Ghana, Kenya, Nigeria, South Africa and Tanzania) represent diverse African geographies and genetic profiles, with differing resources, healthcare systems, health and social protection schemes, and policies. The research team is composed of experts in the field with vast experience in PD, jointly led by a UK-based and Africa-based investigator. DISCUSSION Despite the increasing prevalence of PD globally, robust data on the disease from Africa are lacking. Existing data point towards the poor awareness of PD and other neurological disorders on the continent and subsequent challenges with stigma, and limited access to affordable services and medication. This multi-site study will be the first of its kind in Africa. The data collected across the proposed sub-studies will provide novel and conclusive insights into the situation of PD. The selected country sites will allow for useful comparisons and make results relevant to other low- and middle-income countries. This grant is timely, as global recognition of PD and the public health challenge it poses builds. The work will contribute to broader initiatives, including the World Health Organization's Intersectoral global action plan on epilepsy and other neurological disorders. TRIAL REGISTRATION https://doi.org/10.1186/ISRCTN77014546 .
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Affiliation(s)
- R Walker
- Northumbria Healthcare NHS Foundation Trust, Newcastle upon Tyne, UK
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - N Fothergill-Misbah
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK.
| | - S Kariuki
- Neuroscience Unit, KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | - O Ojo
- College of Medicine, University of Lagos, Lagos, Nigeria
- Lagos University Teaching Hospital, Lagos, Nigeria
| | - R Cilia
- Parkinson and Movement Disorders Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - M C J Dekker
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - O Agabi
- College of Medicine, University of Lagos, Lagos, Nigeria
| | - A Akpalu
- University of Ghana Medical School, Korle Bu Teaching Hospital, Accra, Ghana
| | - F Amod
- University of KwaZulu-Natal, Durban, South Africa
| | - M Breckons
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - M Cham
- Richard Novati Catholic Hospital, Sogakope, Ghana
| | - S Del Din
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
- National Institute for Health and Care Research (NIHR) Newcastle Biomedical Research Centre (BRC), Newcastle University and Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - C Dotchin
- Northumbria Healthcare NHS Foundation Trust, Newcastle upon Tyne, UK
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - S Guggsa
- Addis Ababa University, Addis Ababa, Ethiopia
| | - J Kwasa
- Department of Clinical Medicine and Therapeutics, University of Nairobi, Nairobi, Kenya
| | - D Mushi
- Institute of Public Health, Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - F O Nwaokorie
- Department of Medical Laboratory Science, Faculty of Basic Medical Sciences, College of Medicine, University of Lagos, Lagos, Nigeria
| | - T Park
- Parkinson's Africa, Kingston upon Thames, UK
| | - L Rochester
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
- National Institute for Health and Care Research (NIHR) Newcastle Biomedical Research Centre (BRC), Newcastle University and Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - J Rogathi
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - F S Sarfo
- Kwame Nkrumah University of Science & Technology, Kumasi, Ghana
| | - A Shalash
- Department of Neurology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - L Ternent
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - S Urasa
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - N Okubadejo
- College of Medicine, University of Lagos, Lagos, Nigeria
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Saunders-Pullman R, Raymond D, Ortega RA, Shalash A, Gatto E, Salari M, Markgraf M, Alcalay RN, Mascalzoni D, Mencacci NE, Bonifati V, Merello M, Chung SJ, Novakovic I, Bardien S, Pal G, Hall A, Hattori N, Lynch T, Thaler A, Sue CM, Foroud T, Verbrugge J, Schulze J, Cook L, Marder K, Suchowersky O, Klein C, Simuni T. International Genetic Testing and Counseling Practices for Parkinson's Disease. Mov Disord 2023; 38:1527-1535. [PMID: 37310233 PMCID: PMC10461455 DOI: 10.1002/mds.29442] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 04/18/2023] [Accepted: 04/26/2023] [Indexed: 06/14/2023] Open
Abstract
BACKGROUND There is growing clinical and research utilization of genetic testing in Parkinson's disease (PD), including direct-to-consumer testing. OBJECTIVES The aim is to determine the international landscape of genetic testing in PD to inform future worldwide recommendations. METHODS A web-based survey assessing current practices, concerns, and barriers to genetic testing and counseling was administered to the International Parkinson and Movement Disorders Society membership. RESULTS Common hurdles across sites included cost and access to genetic testing, and counseling, as well as education on genetic counseling. Region-dependent differences in access to and availability of testing and counseling were most notable in Africa. High-income countries also demonstrated heterogeneity, with European nations more likely to have genetic testing covered through insurance than Pan-American and Asian countries. CONCLUSIONS This survey highlights not only diversity of barriers in different regions but also the shared and highly actionable needs for improved education and access to genetic counseling and testing for PD worldwide. © 2023 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Rachel Saunders-Pullman
- Department of Neurology, Mount Sinai Beth Israel, and Icahn School of Medicine, Mount Sinai, New York, New York, USA
| | - Deborah Raymond
- Department of Neurology, Mount Sinai Beth Israel, and Icahn School of Medicine, Mount Sinai, New York, New York, USA
| | - Roberto A Ortega
- Department of Neurology, Mount Sinai Beth Israel, and Icahn School of Medicine, Mount Sinai, New York, New York, USA
| | - Ali Shalash
- Department of Neurology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Emilia Gatto
- Instituto de Neurociencias Buenos Aires, Affiliated University of Buenos Aires, Argentina
| | - Mehri Salari
- Functional Neurosurgery Research Center, Shohada-e Tajrish Comprehensive Neurosurgical Center of Excellence, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Maggie Markgraf
- Department of Neurology, Mount Sinai Beth Israel, and Icahn School of Medicine, Mount Sinai, New York, New York, USA
| | - Roy N. Alcalay
- Department of Neurology, Columbia University Irving Medical Center, New York, New York, USA; and Movement Disorders Division, Neurological Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Deborah Mascalzoni
- Institute for Biomedicine, Eurac Research, Affiliated Institute of the University of Lübeck, Bolzano, Italy; and Center for Research Ethics and Bioethics, Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Niccolò E. Mencacci
- Ken and Ruth Davee Department of Neurology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA
| | - Vincenzo Bonifati
- Department of Clinical Genetics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Marcelo Merello
- Movement Disorders Section, Neuroscience Department Fleni, Buenos Aires, Argentina, and National Research Council (CONICET), Buenos Aires, Argentina, and Pontifical Catholic University of Argentina, Buenos Aires, Argentina
| | - Sun Ju Chung
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Ivana Novakovic
- Faculty of Medicine, Institute of Human Genetics, School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Soraya Bardien
- Division of Molecular Biology and Human Genetics, Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa; South African Medical Research Council/ Stellenbosch University Genomics of Brain Disorders Research Unit, Cape Town, South Africa
| | - Gian Pal
- Department of Neurology, Rutgers-Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Anne Hall
- Research Advocate, Parkinson’s Foundation, New York, NY, USA
| | - Nobutaka Hattori
- Department of Neurology, Faculty of Medicine, Juntendo University Tokyo, Japan; Research Institute of Disease of Old Age, Graduate School of Medicine, Juntendo University, Tokyo, Japan; Neurodegenerative Disorders Collaborative Laboratory, RIKEN Center for Brain Science, Saitama, Japan
| | - Timothy Lynch
- The Dublin Neurological Institute at the Mater Misericordiae University Hospital, Dublin, Ireland; and Health Affairs & School of Medicine and Medical Science, University College Dublin, Dublin, Ireland
| | - Avner Thaler
- Movement Disorders Unit, Neurological Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel; and Laboratory of Early Markers of Neurodegeneration, Neurological Institute, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Carolyn M. Sue
- Department of Neurogenetics, Kolling Institute, Royal North Shore Hospital and University of Sydney, Sydney, Australia
| | - Tatiana Foroud
- Department of Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Jennifer Verbrugge
- Department of Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Jeanine Schulze
- Department of Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Lola Cook
- Department of Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Karen Marder
- Department of Neurology, Columbia University Irving Medical Center, New York, New York, USA
| | - Oksana Suchowersky
- Departments of Medicine (Neurology), Medical Genetics and Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - Christine Klein
- Institute of Neurogenetics, University of Lübeck and University Hospital Schleswig-Holstein, Lübeck, Germany
| | - Tatyana Simuni
- Ken and Ruth Davee Department of Neurology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA
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10
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Pal G, Cook L, Schulze J, Verbrugge J, Alcalay RN, Merello M, Sue CM, Bardien S, Bonifati V, Chung SJ, Foroud T, Gatto E, Hall A, Hattori N, Lynch T, Marder K, Mascalzoni D, Novaković I, Thaler A, Raymond D, Salari M, Shalash A, Suchowersky O, Mencacci NE, Simuni T, Saunders‐Pullman R, Klein C. Genetic Testing in Parkinson's Disease. Mov Disord 2023; 38:1384-1396. [PMID: 37365908 PMCID: PMC10946878 DOI: 10.1002/mds.29500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 02/28/2023] [Accepted: 05/24/2023] [Indexed: 06/28/2023] Open
Abstract
Genetic testing for persons with Parkinson's disease is becoming increasingly common. Significant gains have been made regarding genetic testing methods, and testing is becoming more readily available in clinical, research, and direct-to-consumer settings. Although the potential utility of clinical testing is expanding, there are currently no proven gene-targeted therapies, but clinical trials are underway. Furthermore, genetic testing practices vary widely, as do knowledge and attitudes of relevant stakeholders. The specter of testing mandates financial, ethical, and physician engagement, and there is a need for guidelines to help navigate the myriad of challenges. However, to develop guidelines, gaps and controversies need to be clearly identified and analyzed. To this end, we first reviewed recent literature and subsequently identified gaps and controversies, some of which were partially addressed in the literature, but many of which are not well delineated or researched. Key gaps and controversies include: (1) Is genetic testing appropriate in symptomatic and asymptomatic individuals without medical actionability? (2) How, if at all, should testing vary based on ethnicity? (3) What are the long-term outcomes of consumer- and research-based genetic testing in presymptomatic PD? (4) What resources are needed for clinical genetic testing, and how is this impacted by models of care and cost-benefit considerations? Addressing these issues will help facilitate the development of consensus and guidelines regarding the approach and access to genetic testing and counseling. This is also needed to guide a multidisciplinary approach that accounts for cultural, geographic, and socioeconomic factors in developing testing guidelines. © 2023 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Gian Pal
- Department of NeurologyRutgers‐Robert Wood Johnson Medical SchoolNew BrunswickNew JerseyUSA
| | - Lola Cook
- Department of Medical and Molecular GeneticsIndiana University School of MedicineIndianapolisIndianaUSA
| | - Jeanine Schulze
- Department of Medical and Molecular GeneticsIndiana University School of MedicineIndianapolisIndianaUSA
| | - Jennifer Verbrugge
- Department of Medical and Molecular GeneticsIndiana University School of MedicineIndianapolisIndianaUSA
| | - Roy N. Alcalay
- Department of NeurologyColumbia University Irving Medical CenterNew YorkNew YorkUSA
- Movement Disorders Division, Neurological InstituteTel Aviv Sourasky Medical CenterTel AvivIsrael
| | - Marcelo Merello
- Neuroscience Department FleniCONICET, Catholic University of Buenos AiresBuenos AiresArgentina
| | - Carolyn M. Sue
- Department of NeurologyRoyal North Shore HospitalSt LeonardsNew South WalesAustralia
- Department of Neurogenetics, Kolling Institute, Faculty of Medicine and HealthUniversity of SydneySt LeonardsNew South WalesAustralia
| | - Soraya Bardien
- Division of Molecular Biology and Human Genetics, Department of Biomedical Sciences, Faculty of Medicine and Health SciencesStellenbosch UniversityCape TownSouth Africa
- South African Medical Research Council/Stellenbosch University Genomics of Brain Disorders Research UnitStellenbosch UniversityCape TownSouth Africa
| | - Vincenzo Bonifati
- Department of Clinical Genetics, Erasmus MCUniversity Medical Center RotterdamRotterdamthe Netherlands
| | - Sun Ju Chung
- Department of Neurology, Asan Medical CenterUniversity of Ulsan College of MedicineSeoulSouth Korea
| | - Tatiana Foroud
- Department of Medical and Molecular GeneticsIndiana University School of MedicineIndianapolisIndianaUSA
| | - Emilia Gatto
- Instituto de Neurociencias Buenos AiresAffiliated Buenos Aires UniversityBuenos AiresArgentina
| | - Anne Hall
- Parkinson's FoundationNew YorkNew YorkUSA
| | - Nobutaka Hattori
- Research Institute of Disease of Old Age, Graduate School of MedicineJuntendo UniversityTokyoJapan
- Department of NeurologyJuntendo University School of MedicineTokyoJapan
- Neurodegenerative Disorders Collaborative LaboratoryRIKEN Center for Brain ScienceSaitamaJapan
| | - Tim Lynch
- Dublin Neurological Institute at the Mater Misericordiae University HospitalDublinIreland
| | - Karen Marder
- Department of NeurologyColumbia University Irving Medical CenterNew YorkNew YorkUSA
| | - Deborah Mascalzoni
- Institute for Biomedicine, Eurac ResearchAffiliated Institute of the University of LübeckBolzanoItaly
- Center for Research Ethics and Bioethics, Department of Public Health and Caring SciencesUppsala UniversityUppsalaSweden
| | - Ivana Novaković
- Institute of Human Genetics, Faculty of MedicineUniversity of BelgradeBelgradeSerbia
| | - Avner Thaler
- Movement Disorders Unit, Neurological InstituteTel‐Aviv Medical CenterTel AvivIsrael
- Sackler School of MedicineTel‐Aviv UniversityTel AvivIsrael
- Sagol School of NeuroscienceTel‐Aviv UniversityTel AvivIsrael
- Laboratory of Early Markers of Neurodegeneration, Neurological InstituteTel‐Aviv Medical CenterTel AvivIsrael
| | - Deborah Raymond
- Department of NeurologyMount Sinai Beth Israel and Icahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
| | - Mehri Salari
- Functional Neurosurgery Research Center, Shohada‐e Tajrish Comprehensive Neurosurgical Center of ExcellenceShahid Beheshti University of Medical SciencesTehranIran
| | - Ali Shalash
- Department of Neurology, Faculty of MedicineAin Shams UniversityCairoEgypt
| | - Oksana Suchowersky
- Department of Medicine (Neurology), Medical Genetics and PediatricsUniversity of AlbertaEdmontonAlbertaCanada
| | - Niccolò E. Mencacci
- Ken and Ruth Davee Department of Neurology and Simpson Querrey Center for NeurogeneticsNorthwestern University, Feinberg School of MedicineChicagoIllinoisUSA
- Parkinson's Disease and Movement Disorders CenterNorthwestern University Feinberg School of MedicineChicagoIllinoisUSA
| | - Tanya Simuni
- Parkinson's Disease and Movement Disorders CenterNorthwestern University Feinberg School of MedicineChicagoIllinoisUSA
| | - Rachel Saunders‐Pullman
- Department of NeurologyMount Sinai Beth Israel and Icahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
| | - Christine Klein
- Institute of NeurogeneticsUniversity of Lübeck and University Hospital Schleswig‐HolsteinLübeckGermany
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11
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Jost ST, Kaldenbach MA, Antonini A, Martinez-Martin P, Timmermann L, Odin P, Katzenschlager R, Borgohain R, Fasano A, Stocchi F, Hattori N, Kukkle PL, Rodríguez-Violante M, Falup-Pecurariu C, Schade S, Petry-Schmelzer JN, Metta V, Weintraub D, Deuschl G, Espay AJ, Tan EK, Bhidayasiri R, Fung VSC, Cardoso F, Trenkwalder C, Jenner P, Ray Chaudhuri K, Dafsari HS. Levodopa Dose Equivalency in Parkinson's Disease: Updated Systematic Review and Proposals. Mov Disord 2023. [PMID: 37147135 DOI: 10.1002/mds.29410] [Citation(s) in RCA: 24] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 03/07/2023] [Accepted: 03/29/2023] [Indexed: 05/07/2023] Open
Abstract
BACKGROUND To compare drug regimens across clinical trials in Parkinson's disease (PD) conversion formulae between antiparkinsonian drugs have been developed. These are reported in relation to levodopa as the benchmark drug in PD pharmacotherapy as 'levodopa equivalent dose' (LED). Currently, the LED conversion formulae proposed in 2010 by Tomlinson et al. based on a systematic review are predominantly used. However, new drugs with established and novel mechanisms of action and novel formulations of longstanding drugs have been developed since 2010. Therefore, consensus proposals for updated LED conversion formulae are needed. OBJECTIVES To update LED conversion formulae based on a systematic review. METHODS The MEDLINE, CENTRAL, and Embase databases were searched from January 2010 to July 2021. Additionally, in a standardized process according to the GRADE grid method, consensus proposals were issued for drugs with scarce data on levodopa dose equivalency. RESULTS The systematic database search yielded 3076 articles of which 682 were eligible for inclusion in the systematic review. Based on these data and the standardized consensus process, we present proposals for LED conversion formulae for a wide range of drugs that are currently available for the pharmacotherapy of PD or are expected to be introduced soon. CONCLUSIONS The LED conversion formulae issued in this Position Paper will serve as a research tool to compare the equivalence of antiparkinsonian medication across PD study cohorts and facilitate research on the clinical efficacy of pharmacological and surgical treatments as well as other non-pharmacological interventions in PD. © 2023 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Stefanie T Jost
- Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Marie-Ann Kaldenbach
- Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Angelo Antonini
- Parkinson and Movement Disorders Unit, Department of Neurosciences (DNS), University of Padua, Padova, Italy
| | - Pablo Martinez-Martin
- Center for Networked Biomedical Research in Neurodegenerative Diseases (CIBERNED), Carlos III Institute of Health, Madrid, Spain
| | - Lars Timmermann
- Department of Neurology, University Hospital Giessen and Marburg, Marburg, Germany
| | - Per Odin
- Division of Neurology, Lund University, Lund, Sweden
- Department of Neurology, Skåne University Hospital, Lund, Sweden
| | - Regina Katzenschlager
- Department of Neurology, Karl Landsteiner Institute for Neuroimmunological and Neurodegenerative Disorders at Klinik Donaustadt, Vienna, Austria
| | - Rupam Borgohain
- Department of Neurology, Nizam's Institute of Medical Sciences, Hyderabad, India
| | - Alfonso Fasano
- Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital-University Health Network (UHN), Toronto, Ontario, Canada
- Division of Neurology, University of Toronto, Toronto, Ontario, Canada
- Krembil Research Institute, Toronto, Ontario, Canada
- Department of Parkinson's Disease & Movement Disorders Rehabilitation, Moriggia-Pelascini Hospital-Gravedona ed Uniti, Como, Italy
| | - Fabrizio Stocchi
- University and Institute for Research and Medical Care IRCCS San Raffaele, Rome, Italy
| | - Nobutaka Hattori
- Department of Neurology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Prashanth Lingappa Kukkle
- Center for Parkinson's Disease and Movement Disorders, Manipal Hospital, Bangalore, India
- Parkinson's Disease and Movement Disorders Clinic, Bangalore, India
| | - Mayela Rodríguez-Violante
- Insituto Nacional de Neurologia y Neurocirugia, Movement Disorders Clinic, Mexico City, Mexico
- Movement Disorder Clinic, National Institute of Neurology and Neurosurgery, Mexico City, Mexico
| | - Cristian Falup-Pecurariu
- Department of Neurology, Faculty of Medicine, Transilvania University of Brașov, Brașov, Romania
- Department of Neurology, County Emergency Clinic Hospital, Brașov, Romania
| | - Sebastian Schade
- Department of Clinical Neurophysiology, University Medical Center Göttingen, Göttingen, Germany
| | - Jan Niklas Petry-Schmelzer
- Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Vinod Metta
- Parkinson Foundation International Centre of Excellence, King's College Hospital, London, United Kingdom
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Daniel Weintraub
- Departments of Psychiatry and Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Parkinson's Disease Research, Education and Clinical Center (PADRECC), Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania, USA
| | - Guenther Deuschl
- Department of Neurology, University Hospital Schleswig-Holstein (UKSH), Christian-Albrechts-University Kiel, Kiel, Germany
| | - Alberto J Espay
- University of Cincinnati Gardner Neuroscience Institute, Gardner Family Center for Parkinson's Disease and Movement Disorders, Department of Neurology, University of Cincinnati, Cincinnati, Ohio, USA
| | - Eng-King Tan
- Department of Neurology, National Neuroscience Institute, Singapore General Hospital, Singapore, Singapore
- Neuroscience and Behavioral Disorders (NBD) Department, Duke-NUS Medical School, Singapore, Singapore
| | - Roongroj Bhidayasiri
- Chulalongkorn Centre of Excellence for Parkinson's Disease & Related Disorders, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
- The Academy of Science, The Royal Society of Thailand, Bangkok, Thailand
| | - Victor S C Fung
- Movement Disorder Unit, Department of Neurology, Westmead Hospital, Westmead, Australia
| | - Francisco Cardoso
- Movement Disorders Unit, Internal Medicine Department, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Claudia Trenkwalder
- Paracelsus-Elena-Klinik, Kassel, Germany
- Department of Neurosurgery, University Medical Center Göttingen, Göttingen, Germany
| | - Peter Jenner
- Institute of Pharmaceutical Sciences, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom
| | - K Ray Chaudhuri
- Department of Neurology, County Emergency Clinic Hospital, Brașov, Romania
- Department of Clinical Neurophysiology, University Medical Center Göttingen, Göttingen, Germany
- NIHR Mental Health Biomedical Research Centre and Dementia Biomedical Research Unit, South London and Maudsley NHS Foundation Trust and King's College London, London, United Kingdom
| | - Haidar S Dafsari
- Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
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12
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Painous C, Martí MJ, Graessner H, Camargo AP, El-Jaafary SI, Martínez-Ramírez D, Ojo OO, Taiwo FT, Rajan R, Cornejo-Olivas M, Ayele BA, Tibar H, Kearney M, Gatto E, Tijssen MA. Management of rare movement diseases in different world regions. Parkinsonism Relat Disord 2023; 108:105286. [PMID: 36669905 DOI: 10.1016/j.parkreldis.2023.105286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Revised: 01/08/2023] [Accepted: 01/13/2023] [Indexed: 01/15/2023]
Abstract
To evaluate the management of rare movement disorders (RMD) at the international level and identify care needs to be addressed, the Rare Movement Disorders Study Group of the International Parkinson and Movement Disorders Society (MDS) has conducted an exploratory survey. We sent an online survey to experts in Africa, Asia, Oceania and American continents following the classification of the MDS Regional Sections: Africa, Asia and Oceania (A&O), and Pan-America. We did not include Europe as the European Reference Network for Rare Neurological Diseases recently performed a similar care needs survey across European countries. We obtained responses from experts from 20 African, 26 A&O and 19 Pan-American countries. According to the respondents, only 55% of African countries had movement disorders experts, while these were present in 96% of A&O and 91% of Pan-American. Access to care for patients with RMD was stated difficult in 70% of African, 54% of A&O, and 65% of Pan-American countries. Africa was the region with greatest difficulties in accessing diagnostic tests. However, in Pan-America and A&O, large inequalities were observed between countries with quite variable access to therapeutic options such as deep brain stimulation. The survey results reflect wide variability in the management of RMD and provide evidence that a worldwide care-focused network is highly warranted. Scientific and medical organisations should raise awareness of deficits in managing RMD and care disparities among regions. The goals should be to facilitate the training of professionals, establish improvement strategies, and increase support and budgeting for these diseases.
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Affiliation(s)
- Celia Painous
- Movement Disorders Unit, Neurology Service, Hospital Clínic de Barcelona, Catalonia Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red de Enfermedades Neurodegenerativas (CIBERNED: CB06/05/0018-ISCIII), Barcelona, Spain
| | - Maria J Martí
- Movement Disorders Unit, Neurology Service, Hospital Clínic de Barcelona, Catalonia Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red de Enfermedades Neurodegenerativas (CIBERNED: CB06/05/0018-ISCIII), Barcelona, Spain
| | - Holm Graessner
- Institute for Medical Genetics and Applied Genomics, University of Tübingen, Tübingen, Germany; Centre for Rare Diseases, University Hospital Tübingen, Tübingen, Germany
| | - Andrea Paola Camargo
- Fundación universitaria ciencias de la salud, Hospital de San José, Bogotá, Colombia
| | - Shaimaa Ibrahim El-Jaafary
- Neurology Department, Cairo University, Egypt; Global Brain Health Institute.Trinity College Dublin, Ireland
| | | | - Oluwadamilola O Ojo
- Neurology Unit, Department of Medicine, College of Medicine of the University of Lagos & Lagos University Teaching Hospital, Lagos, Nigeria
| | | | - Roopa Rajan
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Mario Cornejo-Olivas
- Neurogenetics Research Center, Instituto Nacional de Ciencias Neurológicas, Lima, Peru; Carrera de Medicina, Universidad Científica del Sur, Lima, Peru
| | - Biniyam A Ayele
- Department of Neurology, College of Health Science, Addis Ababa University, Addis Ababa, Ethiopia
| | - Houyam Tibar
- Service de Neurologie B et de Neurogénétique, Hôpital des spécialités OTO-Neuro-Ophtalmologique. Ibn Sina University Hospital Mohamed 5 University, Medical School of Rabat, Rabat, Morocco
| | - Mary Kearney
- Irish College of General Practitioners and Primary Care Physician, Dublin, Ireland; ERN-RND European Patient Advocacy Group Representatives, Germany
| | - Emilia Gatto
- Department of Neurology, Sanatorio de la Trinidad Mite. Department of Parkinson's Disease and Movement Disorders, INEBA Affiliated University of Buenos Aires, Buenos Aires, Argentina
| | - Marina Aj Tijssen
- University of Groningen, University Medical Center Groningen, Department of Neurology, Groningen, the Netherlands; Expertise Center Movement Disorders Groningen, University Medical Center Groningen, Groningen, the Netherlands.
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13
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Fothergill-Misbah N. The lived experience of stigma and parkinson's disease in Kenya: a public health challenge. BMC Public Health 2023; 23:364. [PMID: 36803768 PMCID: PMC9940067 DOI: 10.1186/s12889-023-15278-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 02/15/2023] [Indexed: 02/22/2023] Open
Abstract
BACKGROUND As a disease characterised by non-motor and very visible motor symptoms, Parkinson's disease has been associated with multiple forms of stigma, while awareness about the disease globally remains low. The experience of stigma relating to Parkinson's disease from high-income nations is well-documented, while less is known about low- and middle-income countries (LMICs). Literature on stigma and disease from Africa and the Global South has described the added complexities people face resulting from structural violence, as well as perceptions about symptoms and disease associated with supernatural beliefs, which can have significant implications for access to healthcare and support. Stigma is a recognised barrier to health-seeking behaviour and a social determinant of population health. METHODS This study draws on qualitative data collected as part of a wider ethnographic study to explore the lived experience of Parkinson's disease in Kenya. Participants include 55 people diagnosed with Parkinson's and 23 caregivers. The paper draws on the Health Stigma and Discrimination Framework as a tool to understand stigma as a process. RESULTS Data from interviews identified the drivers and facilitators of stigma, including poor awareness of Parkinson's, lack of clinical capacity, supernatural beliefs, stereotypes, fear of contagion and blame. Participants reported their lived realities of stigma, and experiences of stigma practices, which had significant negative health and social outcomes, including social isolation and difficulty accessing treatment. Ultimately, stigma had a negative and corrosive effect on the health and wellbeing of patients. CONCLUSION This paper highlights the interplay of structural constraints and the negative consequences of stigma experienced by people living with Parkinson's in Kenya. The deep understanding of stigma made possible through this ethnographic research leads us to see stigma as a process, something that is embodied and enacted. Targeted and nuanced ways of tackling stigma are suggested, including educational and awareness campaigns, training, and the development of support groups. Importantly, the paper shows that awareness of, and advocacy for the recognition of, Parkinson's globally needs to improve. This recommendation is in line with the World Health Organization's Technical Brief on Parkinson disease, which responds to the growing public health challenge posed by Parkinson's.
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14
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Hamid E, Okengo K, Ayele BA, Gams Massi D, Ben Sassi S, Tibar H, El-Sadig SM, Mahoui S, Razafimahefa J, Kouame-Assouan AE, Ben-Adji D, Modeste LYT, Mohamed MH, Nsengiyumva N, Alwahchi WA, Neshuku SN, Ocampo C, Sakadi F, Caiano JB, Rodrigues Fortes A, Fall M, Ngwende GW, Hooker J, Charway-Felli A, Atadzhanov M, Carr J, Okubadejo NU, Shalash A. The Gaps and Prospects of Movement Disorders Education and Research in Africa: A Continental Survey. Mov Disord 2023; 38:178-184. [PMID: 36703239 DOI: 10.1002/mds.29313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 12/04/2022] [Accepted: 12/12/2022] [Indexed: 01/28/2023] Open
Affiliation(s)
- Eman Hamid
- Department of Neurology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | | | - Biniyam A Ayele
- Black Lion Specialized Hospital, Department of Neurology, School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia
| | - Daniel Gams Massi
- Douala General Hospital, Faculty of Health Sciences, University of Buea, Buea, Cameroon
| | - Samia Ben Sassi
- Mongi Ben Hamida National Institute of Neurology, Tunis, Tunisia
| | - Houyam Tibar
- Neurology B and Neurogenetics Department, Hôpital des Spécialités de Rabat, IBN SINA University Hospital of Rabat, Medical School of Rabat, Mohamed 5 University of Rabat, Rabat, Morocco
| | - Sarah Misbah El-Sadig
- Soba University Hospital, Khartoum, Sudan.,Faculty of Medicine, University of Khartoum, Khartoum, Sudan
| | - Soulaimane Mahoui
- Faculty of Medicine of Algaiers, Béjaia, Algeria.,Specialized Hospital of Benaknoun Algiers, Ben Aknoun, Algeria
| | - Julien Razafimahefa
- Faculté Médecine Antananarivo/Hôpital Joseph Raseta Befelatanana, Antananarivo, Madagascar
| | | | | | | | - Muhyadin Hassan Mohamed
- Department of Neurology, East Africa University Hospital and EAU Faculty of Medicine and Health Sciences, Bosaso, Somalia
| | | | | | | | | | - Foksouna Sakadi
- University Hospital Center of National Reference, N'djamena, Chad
| | | | | | | | | | | | | | | | - Jonathan Carr
- Division of Neurology, Stellenbosch University, Cape Town, South Africa
| | - Njideka U Okubadejo
- Department of Medicine, College of Medicine, University of Lagos, Idi Araba, Nigeria
| | - Ali Shalash
- Department of Neurology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
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15
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Bhidayasiri R, Kalia LV, Bloem BR. Tackling Parkinson's Disease as a Global Challenge. JOURNAL OF PARKINSON'S DISEASE 2023; 13:1277-1280. [PMID: 38143374 PMCID: PMC10741319 DOI: 10.3233/jpd-239005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/14/2023] [Indexed: 12/26/2023]
Affiliation(s)
- Roongroj Bhidayasiri
- Chulalongkorn Centre of Excellence for Parkinson’s Disease & Related Disorders, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
- The Academy of Science, The Royal Society of Thailand, Bangkok, Thailand
| | - Lorraine V. Kalia
- Division of Neurology, Department of Medicine, Tanz Centre for Research in Neurodegenerative Diseases, University of Toronto, Toronto, Canada
- Krembil Research Institute, Edmond J. Safra Program in Parkinson’s Disease and the Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, University Health Network, Toronto, Canada
| | - Bastiaan R. Bloem
- Radbound University Nijmegen Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, Center of Expertise for Parkinson & Movement Disorders, Nijmegen, The Netherlands
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16
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Schumacher-Schuh AF, Bieger A, Okunoye O, Mok KY, Lim SY, Bardien S, Ahmad-Annuar A, Santos-Lobato BL, Strelow MZ, Salama M, Rao SC, Zewde YZ, Dindayal S, Azar J, Prashanth LK, Rajan R, Noyce AJ, Okubadejo N, Rizig M, Lesage S, Mata IF. Underrepresented Populations in Parkinson's Genetics Research: Current Landscape and Future Directions. Mov Disord 2022; 37:1593-1604. [PMID: 35867623 PMCID: PMC10360137 DOI: 10.1002/mds.29126] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 04/18/2022] [Accepted: 05/30/2022] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Human genetics research lacks diversity; over 80% of genome-wide association studies have been conducted on individuals of European ancestry. In addition to limiting insights regarding disease mechanisms, disproportionate representation can create disparities preventing equitable implementation of personalized medicine. OBJECTIVE This systematic review provides an overview of research involving Parkinson's disease (PD) genetics in underrepresented populations (URP) and sets a baseline to measure the future impact of current efforts in those populations. METHODS We searched PubMed and EMBASE until October 2021 using search strings for "PD," "genetics," the main "URP," and and the countries in Latin America, Caribbean, Africa, Asia, and Oceania (excluding Australia and New Zealand). Inclusion criteria were original studies, written in English, reporting genetic results on PD from non-European populations. Two levels of independent reviewers identified and extracted information. RESULTS We observed imbalances in PD genetic studies among URPs. Asian participants from Greater China were described in the majority of the articles published (57%), but other populations were less well studied; for example, Blacks were represented in just 4.0% of the publications. Also, although idiopathic PD was more studied than monogenic forms of the disease, most studies analyzed a limited number of genetic variants. We identified just nine studies using a genome-wide approach published up to 2021, including URPs. CONCLUSION This review provides insight into the significant lack of population diversity in PD research highlighting the immediate need for better representation. The Global Parkinson's Genetics Program (GP2) and similar initiatives aim to impact research in URPs, and the early metrics presented here can be used to measure progress in the field of PD genetics in the future. © 2022 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Artur Francisco Schumacher-Schuh
- Departamento de Farmacologia, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,Serviço de Neurologia, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
| | - Andrei Bieger
- Graduate Program in Biological Sciences: Biochemistry, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Olaitan Okunoye
- Department of Clinical and Movement Neurosciences, Queen Square Institute of Neurology, University College London, United Kingdom
| | - Kin Ying Mok
- Department of Neurodegenerative Disease and UK Dementia Research Institute, University College of London, London, United Kingdom.,Division of Life Sciences, Hong Kong University of Science and Technology, Hong Kong, China
| | - Shen-Yang Lim
- Division of Neurology, Department of Medicine, and the Mah Pooi Soo & Tan Chin Nam Centre for Parkinson's & Related Disorders, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Soraya Bardien
- Division of Molecular Biology and Human Genetics, Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Azlina Ahmad-Annuar
- Department of Biomedical Science, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | | | - Matheus Zschornack Strelow
- Graduate Program in Medicine: Medical Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Mohamed Salama
- Institute of Global Health and Human Ecology, The American University in Cairo, Cairo, Egypt
| | - Shilpa C Rao
- Genomic Medicine Institute, Lerner Research Institute, Genomic Medicine, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Yared Zenebe Zewde
- Department of Neurology, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Saiesha Dindayal
- Division of Neurology, Department of Neurosciences, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Jihan Azar
- Institute of Global Health and Human Ecology, The American University in Cairo, Cairo, Egypt
| | | | - Roopa Rajan
- Department of Neurology, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Alastair J Noyce
- Preventive Neurology Unit, Centre for Prevention, Detection and Diagnosis, Wolfson Institute of Population Health, Queen Mary University of London, London, United Kingdom
| | - Njideka Okubadejo
- Department of Medicine, College of Medicine, University of Lagos, Lagos State, Nigeria
| | - Mie Rizig
- Institute of Neurology, University College of London, London, United Kingdom
| | - Suzanne Lesage
- Sorbonne Université, Institut du Cerveau-Paris Brain Institute-ICM, INSERM, CNRS, Assistance Publique Hôpitaux de Paris, Hôpital Pitié-Salpêtrière, CIC Neurosciences, Paris, France
| | - Ignacio Fernandez Mata
- Genomic Medicine Institute, Lerner Research Institute, Genomic Medicine, Cleveland Clinic Foundation, Cleveland, Ohio, USA
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Ratliff JB, Schaefer SM, Chitnis S, Cooney JW, Hess CW, Okubadejo N, Shalash A, Moro E, Sue C, Pandey S, Pal PK, Yang L. Viewpoint on Milestones for Fellowship Training in Movement Disorders. Mov Disord 2022; 37:1605-1609. [PMID: 35816077 PMCID: PMC9543200 DOI: 10.1002/mds.29146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 06/07/2022] [Accepted: 06/09/2022] [Indexed: 11/18/2022] Open
Affiliation(s)
- Jeffrey B Ratliff
- Department of Neurology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Sara M Schaefer
- Department of Neurology, Yale University, New Haven, Connecticut, USA
| | - Shilpa Chitnis
- Department of Neurology, University of Texas, Southwestern Medical Center, Dallas, Texas, USA
| | - Jeffrey W Cooney
- Department of Neurology, Duke University, Durham, North Carolina, USA
| | - Christopher W Hess
- Department of Neurology, University of Florida, Gainesville, Florida, USA
| | | | - Ali Shalash
- Department of Neurology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Elena Moro
- Grenoble Alpes University, CHU de Grenoble, Division of Neurology, Grenoble Institute of Neurosciences, Grenoble, France
| | - Carolyn Sue
- Department of Neurology, Royal North Shore Hospital and Kolling Institute, University of Sydney, Sydney, New South Wales, Australia
| | - Sanjay Pandey
- Department of Neurology, Govind Ballabh Pant Institute of Postgraduate Medical Education and Research, New Delhi, India
| | - Pramod K Pal
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
| | - Laurice Yang
- Department of Neurology, Stanford University, Palo Alto, California, USA
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18
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Goh ZHK, Cheong JLY, Marras C, Tanner CM, Kasten M, Korczyn AD, Chahine L, Lo R, Noyce AJ. Surveying Global Availability of Parkinson's Disease Treatment. JOURNAL OF PARKINSON'S DISEASE 2022; 12:1023-1034. [PMID: 35147549 DOI: 10.3233/jpd-213006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
BACKGROUND Parkinson's disease (PD) is a debilitating neurodegenerative disease with both motor and non-motor manifestations. Available treatment reduces symptoms and is critical for improving quality of life. Treatment options include drugs, device-aided therapies, and non-pharmacological therapies. Complementary and alternative therapies (CATs) are also used in some countries. OBJECTIVE To examine the availability of PD treatment by country, and differences by national income as defined by the World Bank (high income countries (HICs), upper middle income countries (UMICs), lower middle income countries (LMICs) and low income countries (LICs)). METHODS This study was conducted by surveying International Parkinson and Movement Disorders Society members about availability of PD treatment. LMICs and LICs (LMICs/LICs) were analysed together. RESULTS There were 352 valid responses from 76 countries (41.5% from HICs, 30.4% from UMICs, and 28.1% from LMICs/LICs). Levodopa was widely available across all income groups (99%). Availability of other PD drugs decreased with national income. Availability of device-aided therapies decreased with national income (100% availability in HICs, 92.5% among UMICs, and 57.6% among LMICs/LICs). A similar trend was observed for CATs (37.0% availability in HICs, 31.8% in UMICs, and 19.2% in LMIC/LICs). Physiotherapy was the most available non-pharmacological therapy (> 90% respondents). Occupational therapy and SALT were less available in LMIC/LICs (49.5% and 55.6% respectively) compared to HICs (80.1% and 84.9% respectively). CONCLUSION Our survey highlights significant discrepancies in availability of PD treatments between countries and income groups. This is concerning given the symptomatic benefit patients gain from treatment. Improving equitable access to PD treatment should be prioritised.
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Affiliation(s)
- Zhao H K Goh
- Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Julia L Y Cheong
- Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Connie Marras
- Morton and Gloria Shulman Movement Disorders Centre and the Edmond J Safra Program in Parkinson's Research, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Caroline M Tanner
- Department of Neurology, Weill Institute for Neuroscience University of California - San Francisco, and Parkinson's Disease Research Education and Clinical Center, San Francisco Veteran's Affairs Medical Center, San Francisco, CA, USA
| | - Meike Kasten
- Institute of Neurogenetics, University of Lübeck, Germany
| | | | - Lana Chahine
- Department of Neurology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Raymond Lo
- Memory and Aging Center, Department of Neurology, Buddhist Tzu Chi General Hospital, and Tzu Chi University, Hualien, Taiwan
| | - Alastair J Noyce
- Preventive Neurology Unit, Wolfson Institute of Population Health, Queen Mary University of London, UK
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The Current State of Parkinsonism in West Africa: A Systematic Review. PARKINSONS DISEASE 2021; 2021:7479423. [PMID: 34631006 PMCID: PMC8497159 DOI: 10.1155/2021/7479423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 09/06/2021] [Accepted: 09/07/2021] [Indexed: 11/18/2022]
Abstract
Parkinsonism is one of the most common neurodegenerative diseases among the elderly. Africa is experiencing an increasing burden of age-related conditions including parkinsonism. However, there is not enough data on the prevalence, symptoms, and management of the disorder in West African patients. This systematic review examines the current state of parkinsonism in West Africa by discussing its epidemiology, symptomatology, and treatment. We searched PubMed, BioMed Central, and AJOL databases from January 2000 to December 2020 for studies on parkinsonism conducted in West African countries. We included 32 studies in this review: 23 from Nigeria, 5 from Ghana, and 1 each from Benin, Mali, Niger, and Senegal. Out of the 32 reviewed studies, 11 focused on the prevalence of parkinsonism, 4 examined the genetics of Parkinson's disease (PD), and 17 described the symptomatology and therapy of parkinsonism. The prevalence of parkinsonism in West Africa ranges from 6.0% to 8.3% of neurologic admissions/consultations. The estimated crude prevalence of PD in West Africa varies from 15 to 572 per 100,000 people. Thus far, no pathogenic genetic variants have been associated with PD in the region. Levodopa is frequently used singly or in combination with other medications to manage parkinsonian symptoms, which is consistent with reports from other African regions. Most of the reviewed studies focused only on PD, limiting assessment of other forms of parkinsonism. Almost all the prevalence studies were hospital-based and monocentric, making it impossible to accurately estimate the true prevalence of parkinsonism in West Africa. Larger community-based prevalence studies are recommended to enable accurate quantification of disease burden. Future genetic investigations should consider a wider array of gene mutations associated with parkinsonism. Moreover, public health surveillance strategies should be established to monitor the epidemiology of the disorder.
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