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Rački V, Hero M, Papić E, Rožmarić G, Čizmarević NS, Chudy D, Peterlin B, Vuletić V. Applicability of clinical genetic testing for deep brain stimulation treatment in monogenic Parkinson's disease and monogenic dystonia: a multidisciplinary team perspective. Front Neurosci 2023; 17:1282267. [PMID: 38027472 PMCID: PMC10667448 DOI: 10.3389/fnins.2023.1282267] [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: 08/23/2023] [Accepted: 10/27/2023] [Indexed: 12/01/2023] Open
Abstract
In this perspective article, we highlight the possible applicability of genetic testing in Parkinson's disease and dystonia patients treated with deep brain stimulation (DBS). DBS, a neuromodulatory technique employing electrical stimulation, has historically targeted motor symptoms in advanced PD and dystonia, yet its precise mechanisms remain elusive. Genetic insights have emerged as potential determinants of DBS efficacy. Known PD genes such as GBA, SNCA, LRRK2, and PRKN are most studied, even though further studies are required to make firm conclusions. Variable outcomes depending on genotype is present in genetic dystonia, as DYT-TOR1A, NBIA/DYTPANK2, DYT-SCGE and X-linked dystonia-parkinsonism have demonstrated promising outcomes following GPi-DBS, while varying outcomes have been documented in DYT-THAP1. We present two clinical vignettes that illustrate the applicability of genetics in clinical practice, with one PD patient with compound GBA mutations and one GNAL dystonia patient. Integrating genetic testing into clinical practice is pivotal, particularly with advancements in next-generation sequencing. However, there is a clear need for further research, especially in rarer monogenic forms. Our perspective is that applying genetics in PD and dystonia is possible today, and despite challenges, it has the potential to refine patient selection and enhance treatment outcomes.
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Affiliation(s)
- Valentino Rački
- Department of Neurology, Clinical Hospital Center Rijeka, Rijeka, Croatia
- Department of Neurology, Faculty of Medicine, University of Rijeka, Rijeka, Croatia
| | - Mario Hero
- Department of Neurology, Clinical Hospital Center Rijeka, Rijeka, Croatia
- Department of Neurology, Faculty of Medicine, University of Rijeka, Rijeka, Croatia
| | - Eliša Papić
- Department of Neurology, Clinical Hospital Center Rijeka, Rijeka, Croatia
- Department of Neurology, Faculty of Medicine, University of Rijeka, Rijeka, Croatia
| | - Gloria Rožmarić
- Department of Neurology, Clinical Hospital Center Rijeka, Rijeka, Croatia
| | - Nada Starčević Čizmarević
- Department of Medical Genomics and Biology, Faculty of Medicine, University of Rijeka, Rijeka, Croatia
| | - Darko Chudy
- Department of Neurosurgery, Clinical Hospital Dubrava, Zagreb, Croatia
| | - Borut Peterlin
- Clinical Institute of Genomic Medicine, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Vladimira Vuletić
- Department of Neurology, Clinical Hospital Center Rijeka, Rijeka, Croatia
- Department of Neurology, Faculty of Medicine, University of Rijeka, Rijeka, Croatia
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Voruz P, Haegelen C, Assal F, Drapier S, Drapier D, Sauleau P, Vérin M, Péron JA. Motor Symptom Asymmetry Predicts Cognitive and Neuropsychiatric Profile Following Deep Brain Stimulation of the Subthalamic Nucleus in Parkinson's Disease: a 5-Year Longitudinal Study. Arch Clin Neuropsychol 2023; 38:904-912. [PMID: 36796803 PMCID: PMC10456213 DOI: 10.1093/arclin/acad013] [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] [Accepted: 01/12/2023] [Indexed: 02/18/2023] Open
Abstract
INTRODUCTION Risk factors (e.g., motor symptom asymmetry) for short- and long-term cognitive and neuropsychiatric symptoms following deep brain stimulation (DBS) of the subthalamic nucleus (STN) in patients with Parkinson's disease have yet to be fully identified. The objectives of the present study were to determine whether motor symptom asymmetry in Parkinson's disease is one such risk factor and to identify predictors of subnormal cognitive decline. METHODS A total of 26 patients receiving STN-DBS (13 with left-sided motor symptoms and 13 with right-sided ones) underwent follow-up neuropsychological, depression and apathy assessments over a 5-year period. Nonparametric intergroup comparisons were performed on raw scores, as well as Cox regression analyses on standardized Mattis Dementia Rating Scale scores. RESULTS Compared with patients who had predominantly left-sided symptoms, right-sided patients scored higher on both apathy (at 3 months and 36 months) and depressive symptoms (at 6 months and 12 months) and scored lower on global cognitive efficiency (at 36 months and 60 months). Survival analyses revealed that only right-sided patients had subnormal standardized dementia scores, which were negatively associated with the number of perseverations in the Wisconsin Card Scoring Test. CONCLUSION Right-sided motor symptoms are a risk factor for more severe short- and long-term cognitive and neuropsychiatric symptoms following STN-DBS, confirming literature findings on left hemispheric vulnerability.
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Affiliation(s)
- Philippe Voruz
- Clinical and Experimental Neuropsychology Laboratory, Faculty of Psychology, Geneva, Switzerland
- Neurology Department, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Claire Haegelen
- Neurosurgery Department, Pontchaillou University Hospital, Rennes, France
- MediCIS, INSERM-University of Rennes 1, Rennes, France
| | - Frédéric Assal
- Neurology Department, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Sophie Drapier
- ‘Behavior and Basal Ganglia’ Research Unit, University of Rennes 1, Rennes, France
- Neurology Department, Pontchaillou University Hospital, Rennes, France
| | - Dominique Drapier
- ‘Behavior and Basal Ganglia’ Research Unit, University of Rennes 1, Rennes, France
- Adult Psychiatry Department, Guillaume Régnier Hospital, Rennes, France
| | - Paul Sauleau
- ‘Behavior and Basal Ganglia’ Research Unit, University of Rennes 1, Rennes, France
- Physiology Department, Pontchaillou University Hospital, Rennes, France
| | - Marc Vérin
- ‘Behavior and Basal Ganglia’ Research Unit, University of Rennes 1, Rennes, France
- Neurology Department, Pontchaillou University Hospital, Rennes, France
| | - Julie A Péron
- Clinical and Experimental Neuropsychology Laboratory, Faculty of Psychology, Geneva, Switzerland
- Neurology Department, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
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Voruz P, Pierce J, Ahrweiller K, Haegelen C, Sauleau P, Drapier S, Drapier D, Vérin M, Péron J. Motor symptom asymmetry predicts non-motor outcome and quality of life following STN DBS in Parkinson's disease. Sci Rep 2022; 12:3007. [PMID: 35194127 PMCID: PMC8863787 DOI: 10.1038/s41598-022-07026-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 01/27/2022] [Indexed: 11/09/2022] Open
Abstract
Risk factors for long-term non-motor symptoms and quality of life following subthalamic nucleus deep brain stimulation (STN DBS) have not yet been fully identified. In the present study, we investigated the impact of motor symptom asymmetry in Parkinson's disease. Data were extracted for 52 patients with Parkinson's disease (half with predominantly left-sided motor symptoms and half with predominantly right-sided ones) who underwent bilateral STN and a matched healthy control group. Performances for cognitive tests, apathy and depression symptoms, as well as quality-of-life questionnaires at 12 months post-DBS were compared with a pre-DBS baseline. Results indicated a deterioration in cognitive performance post-DBS in patients with predominantly left-sided motor symptoms. Performances of patients with predominantly right-sided motor symptoms were maintained, except for a verbal executive task. These differential effects had an impact on patients' quality of life. The results highlight the existence of two distinct cognitive profiles of Parkinson's disease, depending on motor symptom asymmetry. This asymmetry is a potential risk factor for non-motor adverse effects following STN DBS.
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Affiliation(s)
- Philippe Voruz
- Clinical and Experimental Neuropsychology Laboratory, Faculty of Psychology and Educational Sciences, 40 bd du Pont d'Arve, 1205, Geneva, Switzerland.,Neuropsychology Unit, Neurology Department, University Hospitals of Geneva, Geneva, Switzerland
| | - Jordan Pierce
- Clinical and Experimental Neuropsychology Laboratory, Faculty of Psychology and Educational Sciences, 40 bd du Pont d'Arve, 1205, Geneva, Switzerland
| | - Kévin Ahrweiller
- 'Behavior and Basal Ganglia' Research Unit, University of Rennes 1-Rennes University Hospital, Rennes, France.,Neurology Department, Pontchaillou Hospital, Rennes University Hospital, Rennes, France
| | - Claire Haegelen
- Neurosurgery Department, Pontchaillou Hospital, Rennes University Hospital, Rennes, France.,MediCIS, INSERM-University of Rennes 1, Rennes, France
| | - Paul Sauleau
- 'Behavior and Basal Ganglia' Research Unit, University of Rennes 1-Rennes University Hospital, Rennes, France.,Physiology Department, Pontchaillou Hospital, Rennes University Hospital, Rennes, France
| | - Sophie Drapier
- 'Behavior and Basal Ganglia' Research Unit, University of Rennes 1-Rennes University Hospital, Rennes, France.,Neurology Department, Pontchaillou Hospital, Rennes University Hospital, Rennes, France
| | - Dominique Drapier
- 'Behavior and Basal Ganglia' Research Unit, University of Rennes 1-Rennes University Hospital, Rennes, France.,Adult Psychiatry Department, Guillaume Régnier Hospital, Rennes, France
| | - Marc Vérin
- 'Behavior and Basal Ganglia' Research Unit, University of Rennes 1-Rennes University Hospital, Rennes, France.,Neurology Department, Pontchaillou Hospital, Rennes University Hospital, Rennes, France
| | - Julie Péron
- Clinical and Experimental Neuropsychology Laboratory, Faculty of Psychology and Educational Sciences, 40 bd du Pont d'Arve, 1205, Geneva, Switzerland. .,Neuropsychology Unit, Neurology Department, University Hospitals of Geneva, Geneva, Switzerland. .,'Behavior and Basal Ganglia' Research Unit, University of Rennes 1-Rennes University Hospital, Rennes, France.
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Lin Z, Zhang C, Li D, Sun B. Preoperative Levodopa Response and Deep Brain Stimulation Effects on Motor Outcomes in Parkinson's Disease: A Systematic Review. Mov Disord Clin Pract 2021; 9:140-155. [PMID: 35146054 DOI: 10.1002/mdc3.13379] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 11/10/2021] [Accepted: 11/12/2021] [Indexed: 11/10/2022] Open
Affiliation(s)
- Zhengyu Lin
- Department of Neurosurgery, Ruijin Hospital Shanghai Jiao Tong University School of Medicine Shanghai China
- Center for Functional Neurosurgery Ruijin Hospital, Shanghai Jiao Tong University School of Medicine Shanghai China
- Institute of Clinical Neuroscience Ruijin Hospital LuWan Branch, Shanghai Jiao Tong University School of Medicine Shanghai China
| | - Chencheng Zhang
- Department of Neurosurgery, Ruijin Hospital Shanghai Jiao Tong University School of Medicine Shanghai China
- Center for Functional Neurosurgery Ruijin Hospital, Shanghai Jiao Tong University School of Medicine Shanghai China
- Institute of Clinical Neuroscience Ruijin Hospital LuWan Branch, Shanghai Jiao Tong University School of Medicine Shanghai China
- Shanghai Research Center for Brain Science and Brain‐Inspired Intelligence Shanghai China
| | - Dianyou Li
- Department of Neurosurgery, Ruijin Hospital Shanghai Jiao Tong University School of Medicine Shanghai China
- Center for Functional Neurosurgery Ruijin Hospital, Shanghai Jiao Tong University School of Medicine Shanghai China
- Institute of Clinical Neuroscience Ruijin Hospital LuWan Branch, Shanghai Jiao Tong University School of Medicine Shanghai China
| | - Bomin Sun
- Department of Neurosurgery, Ruijin Hospital Shanghai Jiao Tong University School of Medicine Shanghai China
- Center for Functional Neurosurgery Ruijin Hospital, Shanghai Jiao Tong University School of Medicine Shanghai China
- Institute of Clinical Neuroscience Ruijin Hospital LuWan Branch, Shanghai Jiao Tong University School of Medicine Shanghai China
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Luo C, Gao Y, Hu N, Wei X, Xiao Y, Wang W, Lui S, Gong Q. Distinct hippocampal subfield atrophy in Parkinson's disease regarding motor subtypes. Parkinsonism Relat Disord 2021; 93:66-70. [PMID: 34808520 DOI: 10.1016/j.parkreldis.2021.11.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 10/22/2021] [Accepted: 11/09/2021] [Indexed: 02/08/2023]
Abstract
INTRODUCTION Global hippocampal atrophy has been repeatedly reported in patients with Parkinson's disease (PD). However, there is limited literature on the differential involvement of hippocampal subfields among PD motor subtypes. This study aimed to investigate hippocampal subfield alterations in patients with PD based on their predominant symptoms. METHOD We enrolled 31 PD patients with the tremor-dominant (TD) subtype, 27 PD patients with postural instability and gait disturbance-dominant (PIGD) subtype, and 40 healthy controls (HCs). All participants underwent high-spatial-resolution T1-weighted magnetic resonance imaging. The volume of hippocampal subfields was measured using FreeSurfer software, compared across groups, and correlated with clinical features. RESULTS We found volumetric reductions in the hippocampal subfield in both patient subtypes compared to HCs, which were more pronounced in the PIGD subtype. The PIGD subtype had accelerated age-related alterations in the hippocampus compared to the TD subtype. Bilateral hippocampal volumes were positively associated with cognitive performance levels, but not with disease severity and duration in patients. CONCLUSIONS Alterations in the hippocampal subfields of patients with PD differed based on their predominant symptoms. These findings are of relevance for understanding the pathophysiology of the increased risk of cognitive impairment in PIGD.
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Affiliation(s)
- Chunyan Luo
- Huaxi MR Research Center, Department of Radiology and National Clinical Research Center for Geriatrics, West China Hospital of Sichuan University, Chengdu, Sichuan Province, China; Psychoradiology Research Unit of the Chinese Academy of Medical Sciences, West China Hospital of Sichuan University, Chengdu, China
| | - Yuan Gao
- Department of Neurosurgery, West China Hospital of Sichuan University, Chengdu, China
| | - Na Hu
- Psychoradiology Research Unit of the Chinese Academy of Medical Sciences, West China Hospital of Sichuan University, Chengdu, China
| | - Xia Wei
- Huaxi MR Research Center, Department of Radiology and National Clinical Research Center for Geriatrics, West China Hospital of Sichuan University, Chengdu, Sichuan Province, China; Psychoradiology Research Unit of the Chinese Academy of Medical Sciences, West China Hospital of Sichuan University, Chengdu, China
| | - Yuan Xiao
- Huaxi MR Research Center, Department of Radiology and National Clinical Research Center for Geriatrics, West China Hospital of Sichuan University, Chengdu, Sichuan Province, China; Psychoradiology Research Unit of the Chinese Academy of Medical Sciences, West China Hospital of Sichuan University, Chengdu, China
| | - Wei Wang
- Department of Neurosurgery, West China Hospital of Sichuan University, Chengdu, China.
| | - Su Lui
- Huaxi MR Research Center, Department of Radiology and National Clinical Research Center for Geriatrics, West China Hospital of Sichuan University, Chengdu, Sichuan Province, China; Psychoradiology Research Unit of the Chinese Academy of Medical Sciences, West China Hospital of Sichuan University, Chengdu, China.
| | - Qiyong Gong
- Huaxi MR Research Center, Department of Radiology and National Clinical Research Center for Geriatrics, West China Hospital of Sichuan University, Chengdu, Sichuan Province, China; Psychoradiology Research Unit of the Chinese Academy of Medical Sciences, West China Hospital of Sichuan University, Chengdu, China
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Brozova H, Barnaure I, Ruzicka E, Stochl J, Alterman R, Tagliati M. Short- and Long-Term Effects of DBS on Gait in Parkinson's Disease. Front Neurol 2021; 12:688760. [PMID: 34690908 PMCID: PMC8531078 DOI: 10.3389/fneur.2021.688760] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 08/11/2021] [Indexed: 12/18/2022] Open
Abstract
The aim was to compare the short and long-term effects of subthalamic nucleus (STN) deep brain stimulation (DBS) on gait dysfunction and other cardinal symptoms of Parkinson's disease (PD). Two groups of patients were studied. The first group (short-term DBS, n = 8) included patients recently implanted with STN DBS (mean time since DBS 15.8 months, mean age 58.8 years, PD duration 13 years); the second group (long-term DBS, n = 10) included patients with at least 5 years of DBS therapy (mean time since DBS 67.6 months, mean age 61.7 years, PD duration 17.1 years). Both groups were examined using the Unified Parkinson's Disease Rating Scale (UPDRS) and Gait and Balance scale (GABS) during four stimulation/medication states (ON/OFF; OFF/OFF; OFF/ON; ON/ON). Data were analyzed using repeated measures ANOVA with time since implantation (years) between groups and medication or DBS effect (ON, OFF) within groups. In the short-term DBS group, stimulation improved all UPDRS subscores similar to dopaminergic medications. In particular, average gait improvement was over 40% (p = 0.01), as measured by the UPDRS item 29 and GABS II. In the long-term DBS group, stimulation consistently improved all clinical subscores with the exception of gait and postural instability. In these patients, the effect of levodopa on gait was partially preserved. Short-term improvement of gait abnormalities appears to significantly decline after 5 years of STN DBS in PD patients, while effectiveness for other symptoms remains stable. Progressive non-dopaminergic (non-DBS responsive) mechanisms or deleterious effects of high frequency STN stimulation on gait function may play a role.
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Affiliation(s)
- Hana Brozova
- Department of Neurology and Centre of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czechia
| | - Isabelle Barnaure
- Department of Neuroradiology, Kantonsspital Aarau, Aarau, Switzerland
| | - Evzen Ruzicka
- Department of Neurology and Centre of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czechia
| | - Jan Stochl
- Department of Kinanthropology, Charles University in Prague, Prague, Czechia.,Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
| | - Ron Alterman
- Department of Neurosurgery, Beth Israel Deaconess Medical Center, Boston, MA, United States
| | - Michele Tagliati
- Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, CA, United States
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Boonstra JT, Michielse S, Temel Y, Hoogland G, Jahanshahi A. Neuroimaging Detectable Differences between Parkinson's Disease Motor Subtypes: A Systematic Review. Mov Disord Clin Pract 2021; 8:175-192. [PMID: 33553487 PMCID: PMC7853198 DOI: 10.1002/mdc3.13107] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 09/10/2020] [Accepted: 10/07/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The neuroanatomical substrates of Parkinson's disease (PD) with tremor-dominance (TD) and those with non-tremor dominance (nTD), postural instability and gait difficulty (PIGD), and akinetic-rigid (AR) are not fully differentiated. A better understanding of symptom specific pathoanatomical markers of PD subtypes may result in earlier diagnosis and more tailored treatment. Here, we aim to give an overview of the neuroimaging literature that compared PD motor subtypes. METHODS A systematic literature review on neuroimaging studies of PD subtypes was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Search terms submitted to the PubMed database included: "Parkinson's disease", "MRI" and "motor subtypes" (TD, nTD, PIGD, AR). The results are first discussed from macro to micro level of organization (i.e., (1) structural; (2) functional; and (3) molecular) and then by applied imaging methodology. FINDINGS Several neuroimaging methods including diffusion imaging and positron emission tomography (PET) distinguish specific PD motor subtypes well, although findings are mixed. Furthermore, our review demonstrates that nTD-PD patients have more severe neuroalterations compared to TD-PD patients. More specifically, nTD-PD patients have deficits within striato-thalamo-cortical (STC) circuitry and other thalamocortical projections related to cognitive and sensorimotor function, while TD-PD patients tend to have greater cerebello-thalamo-cortical (CTC) circuitry dysfunction. CONCLUSIONS Based on the literature, STC and CTC circuitry deficits seem to be the key features of PD and the subtypes. Future research should make greater use of multimodal neuroimaging and techniques that have higher sensitivity in delineating subcortical structures involved in motor diseases.
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Affiliation(s)
- Jackson Tyler Boonstra
- Department of Neurosurgery, School for Mental Health and Neuroscience (MHeNS)Maastricht University Medical CenterMaastrichtThe Netherlands
| | - Stijn Michielse
- Department of Neurosurgery, School for Mental Health and Neuroscience (MHeNS)Maastricht University Medical CenterMaastrichtThe Netherlands
| | - Yasin Temel
- Department of Neurosurgery, School for Mental Health and Neuroscience (MHeNS)Maastricht University Medical CenterMaastrichtThe Netherlands
| | - Govert Hoogland
- Department of Neurosurgery, School for Mental Health and Neuroscience (MHeNS)Maastricht University Medical CenterMaastrichtThe Netherlands
| | - Ali Jahanshahi
- Department of Neurosurgery, School for Mental Health and Neuroscience (MHeNS)Maastricht University Medical CenterMaastrichtThe Netherlands
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Marsili L, Vizcarra JA, Sturchio A, Dwivedi AK, Keeling EG, Patel D, Mishra M, Farooqi A, Merola A, Fasano A, Mata IF, Kauffman MA, Espay AJ. When does postural instability appear in monogenic parkinsonisms? An individual-patient meta-analysis. J Neurol 2020; 268:3203-3211. [PMID: 32436106 DOI: 10.1007/s00415-020-09892-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 05/03/2020] [Accepted: 05/05/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Postural instability is a disease milestone signaling advanced disease. OBJECTIVES To estimate the onset of postural instability in monogenic parkinsonisms. METHODS We systematically reviewed studies (PubMed 1996-2017) in SNCA, PRKN, PINK1, DJ-1, LRRK2, ATP13A2, FBXO7, VPS35, DNAJC6, or SYNJ1-related monogenic parkinsonisms, with documented postural instability. Genes with ≥ 15 patients were included in an individual-patient meta-analysis and compared with a retrospectively collected sporadic Parkinson's disease cohort from our center. The primary outcome measure was the progression-free survival from postural instability using Kaplan-Meier survival curves. Cox proportional hazards analyses were summarized using hazards ratio (HR). RESULTS Of 2085 eligible studies, 124 met full criteria (636 patients) for the systematic review, whereas a total of 871 subjects (270 from sporadic cohort, 601 monogenic parkinsonisms) were included in the individual-patient meta-analysis. Postural instability was reported in 80% of DJ-1, 40% of PRKN, 39% of PINK1, 34% of ATP13A2, 31% of LRRK2, and 29% of SNCA patients. Progression-free survival from postural instability at 10 years after disease onset was longest in ATP13A2 (97%) and shortest in SNCA (50%). Halfway between these two extremes were PRKN (88%), PINK1 (87%), and LRRK2 (81%), similar to sporadic Parkinson's disease (72%). Higher risk of postural instability was observed in SNCA (HR = 3.2, p = 0.007) and DJ-1 (HR = 3.96, p = 0.001) compared to sporadic Parkinson's disease. Young age at onset in PINK1 and female sex in LRRK2 were associated with a decreased risk of postural instability. CONCLUSIONS Monogenic parkinsonisms exhibit differential timelines to postural instability, informing prognostic counseling and interpretation of future genotype-specific treatment trials.
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Affiliation(s)
- Luca Marsili
- Department of Neurology, Gardner Family Center for Parkinson's Disease and Movement Disorders, University 6 of Cincinnati, Cincinnati, OH, USA
| | - Joaquin A Vizcarra
- Department of Neurology, Gardner Family Center for Parkinson's Disease and Movement Disorders, University 6 of Cincinnati, Cincinnati, OH, USA
- Department of Neurology, Emory University, Atlanta, GA, USA
| | - Andrea Sturchio
- Department of Neurology, Gardner Family Center for Parkinson's Disease and Movement Disorders, University 6 of Cincinnati, Cincinnati, OH, USA
| | - Alok K Dwivedi
- Division of Biostatistics and Epidemiology, Department of Molecular and Translational Medicine, Texas Tech University Health Sciences Center, El Paso, TX, USA
| | - Elizabeth G Keeling
- Department of Neurology, Gardner Family Center for Parkinson's Disease and Movement Disorders, University 6 of Cincinnati, Cincinnati, OH, USA
| | - Dhiren Patel
- Department of Neurology, Gardner Family Center for Parkinson's Disease and Movement Disorders, University 6 of Cincinnati, Cincinnati, OH, USA
| | - Murli Mishra
- Department of Neurology, Gardner Family Center for Parkinson's Disease and Movement Disorders, University 6 of Cincinnati, Cincinnati, OH, USA
- St. George's University School of Medicine, St. George, Grenada
| | - Ashar Farooqi
- Department of Neurology, Gardner Family Center for Parkinson's Disease and Movement Disorders, University 6 of Cincinnati, Cincinnati, OH, USA
| | - Aristide Merola
- Wexner Medical Center Department of Neurology, Ohio State University, Columbus, Ohio, USA
| | - Alfonso Fasano
- Division of Neurology, Edmond J. Safra Program in Parkinson's Disease and Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, UHN, University of Toronto, Toronto, ON, Canada
- Krembil Brain Institute, Toronto, ON, Canada
- CenteR for Advancing Neurotechnological Innovation To Application (CRANIA), Toronto, ON, Canada
| | - Ignacio F Mata
- Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Marcelo A Kauffman
- Consultorio Y Laboratorio de Neurogenética, Centro Universitario de Neurología José María Ramos Mejía, Buenos Aires, Argentina
| | - Alberto J Espay
- Department of Neurology, Gardner Family Center for Parkinson's Disease and Movement Disorders, University 6 of Cincinnati, Cincinnati, OH, USA.
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