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Gandolfi M, Artusi CA, Imbalzano G, Camozzi S, Crestani M, Lopiano L, Tinazzi M, Geroin C. Botulinum Toxin for Axial Postural Abnormalities in Parkinson's Disease: A Systematic Review. Toxins (Basel) 2024; 16:228. [PMID: 38787080 PMCID: PMC11125648 DOI: 10.3390/toxins16050228] [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: 03/29/2024] [Revised: 04/23/2024] [Accepted: 05/09/2024] [Indexed: 05/25/2024] Open
Abstract
Axial postural abnormalities (APAs), characterized by their frequency, disabling nature, and resistance to pharmacological treatments, significantly impact Parkinson's disease and atypical Parkinsonism patients. Despite advancements in diagnosing, assessing, and understanding their pathophysiology, managing these complications remains a significant challenge. Often underestimated by healthcare professionals, these disturbances can exacerbate disability. This systematic review assesses botulinum toxin treatments' effectiveness, alone and with rehabilitation, in addressing APAs in Parkinson's disease, utilizing MEDLINE (PubMed), Web of Science, and SCOPUS databases for source material. Of the 1087 records retrieved, 16 met the selection criteria. Most research has focused on botulinum toxin (BoNT) as the primary treatment for camptocormia and Pisa syndrome, utilizing mostly observational methods. Despite dose and injection site variations, a common strategy was using electromyography-guided injections, occasionally enhanced with ultrasound. Patients with Pisa syndrome notably saw consistent improvements in APAs and pain. However, studies on the combined effects of botulinum toxin and rehabilitation are limited, and antecollis is significantly under-researched. These findings recommend precise BoNT injections into hyperactive muscles in well-selected patients by skilled clinicians, avoiding compensatory muscles, and underscore the necessity of early rehabilitation. Rehabilitation is crucial in a multidisciplinary approach to managing APAs, highlighting the importance of a multidisciplinary team of experts.
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Affiliation(s)
- Marialuisa Gandolfi
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, 37134 Verona, Italy; (S.C.); (M.C.)
- Neuromotor and Cognitive Rehabilitation Research Centre (CRRNC), University of Verona, 37134 Verona, Italy
- Neurorehabilitation Unit, AOUI Verona, 37134 Verona, Italy
| | - Carlo Alberto Artusi
- Department of Neuroscience “Rita Levi Montalcini”, University of Turin, 10126 Turin, Italy; (C.A.A.); (G.I.); (L.L.)
- SC Neurology 2U, AOU Città della Salute e della Scienza, 10126 Turin, Italy
| | - Gabriele Imbalzano
- Department of Neuroscience “Rita Levi Montalcini”, University of Turin, 10126 Turin, Italy; (C.A.A.); (G.I.); (L.L.)
- SC Neurology 2U, AOU Città della Salute e della Scienza, 10126 Turin, Italy
| | - Serena Camozzi
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, 37134 Verona, Italy; (S.C.); (M.C.)
| | - Mauro Crestani
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, 37134 Verona, Italy; (S.C.); (M.C.)
| | - Leonardo Lopiano
- Department of Neuroscience “Rita Levi Montalcini”, University of Turin, 10126 Turin, Italy; (C.A.A.); (G.I.); (L.L.)
- SC Neurology 2U, AOU Città della Salute e della Scienza, 10126 Turin, Italy
| | - Michele Tinazzi
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, 37134 Verona, Italy; (S.C.); (M.C.)
| | - Christian Geroin
- Department of Surgery, Dentistry, Paediatrics and Gynecology, University of Verona, 37134 Verona, Italy;
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Hanlon CA, Lench DH, Pell G, Roth Y, Zangen A, Tendler A. Bilateral deep transcranial magnetic stimulation of motor and prefrontal cortices in Parkinson's disease: a comprehensive review. Front Hum Neurosci 2024; 17:1336027. [PMID: 38328677 PMCID: PMC10847590 DOI: 10.3389/fnhum.2023.1336027] [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: 11/09/2023] [Accepted: 12/18/2023] [Indexed: 02/09/2024] Open
Abstract
Parkinson's disease (PD) is a prevalent neurodegenerative disorder characterized by both motor and non-motor symptoms, many of which are resistant to currently available treatments. Since the discovery that non-invasive transcranial magnetic stimulation (TMS) can cause dopamine release in PD patients, there has been growing interest in the use of TMS to fill existing gaps in the treatment continuum for PD. This review evaluates the safety and efficacy of a unique multifocal, bilateral Deep TMS protocol, which has been evaluated as a tool to address motor and non-motor symptoms of PD. Six published clinical trials have delivered a two-stage TMS protocol with an H-Coil targeting both the prefrontal cortex (PFC) and motor cortex (M1) bilaterally (220 PD patients in total; 108 from two randomized, sham-controlled studies; 112 from open label or registry studies). In all studies TMS was delivered to M1 bilaterally (Stage 1) and then to the PFC bilaterally (Stage 2) with approximately 900 pulses per stage. For Stage 1 (M1), two studies delivered 10 Hz at 90% motor threshold (MT) while four studies delivered 1 Hz at 110% MT. For Stage 2 (PFC), all studies delivered 10 Hz at 100% MT. The results suggest that this two-stage Deep TMS protocol is a safe, moderately effective treatment for motor symptoms of PD, and that severely impaired patients have the highest benefits. Deep TMS also improves mood symptoms and cognitive function in these patients. Further research is needed to establish optimal dosing and the long-term durability of treatment effects.
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Affiliation(s)
- Colleen A. Hanlon
- Department of Cancer Biology, Wake Forest School of Medicine, Winston-Salem, NC, United States
- BrainsWay Ltd., Jerusalem, Israel
| | - Daniel H. Lench
- Department of Neurology, Medical University of South Carolina, Charleston, SC, United States
| | | | - Yiftach Roth
- BrainsWay Ltd., Jerusalem, Israel
- Department of Life Sciences, Ben Gurion University of the Negev, Beersheba, Israel
| | - Abraham Zangen
- Department of Life Sciences, Ben Gurion University of the Negev, Beersheba, Israel
| | - Aron Tendler
- BrainsWay Ltd., Jerusalem, Israel
- Department of Life Sciences, Ben Gurion University of the Negev, Beersheba, Israel
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Langer A, Roth D, Santer A, Flotz A, Gruber J, Wizany L, Hasenauer S, Pokan R, Dabnichki P, Treven M, Zimmel S, Schmoeger M, Willinger U, Gassner L, Maetzler W, Zach H. Climb up! Head up! Climbing improves posture in Parkinson's disease. A secondary analysis from a randomized controlled trial. Clin Rehabil 2023; 37:1492-1500. [PMID: 37157229 PMCID: PMC10492431 DOI: 10.1177/02692155231174990] [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: 05/16/2022] [Accepted: 04/14/2023] [Indexed: 05/10/2023]
Abstract
OBJECTIVE To investigate the effect of sport climbing on a biomechanical marker of axial posture in patients with Parkinson's disease, as well as its association with age, body mass index and health-related quality-of-life outcome measures. DESIGN Pre-planned secondary analysis of our randomized controlled, semi-blind trial (unblinded patients, blinded assessors) comparing sport climbing to unsupervised exercise. SETTING Single-centre study conducted at the Department of Neurology of the Medical University of Vienna, Austria. PARTICIPANTS Forty-eight Parkinson's disease patients (aged 64 ± 8 years, Hoehn & Yahr stage 2-3) were included. INTERVENTION Sport climbers (n = 24) followed a 12-week, 90 min/week supervised top-rope sport climbing course in an indoor climbing gym. The unsupervised training group (n = 24) independently followed the 'European Physiotherapy Guidelines for Parkinson's Disease' and World Health Organization recommendations for an active lifestyle for 12 weeks. MAIN MEASURES Posture was assessed with the horizontal distance of the seventh cervical vertebra to the wall at baseline and after the intervention. RESULTS Participating in the sport climbing group significantly predicted the biomechanical marker of axial posture (P = 0.044). The improvement in the biomechanical marker did not affect the quality of life, depression, fatigue, physical activity or fear of falling. Participants in the sport climbing group showed a significantly decreased horizontal distance of the seventh cervical vertebra to the wall after the intervention (-1.7 cm (95%CI [-2.6, -0.8]). In the unsupervised training group, no difference was found (-0.5 cm; 95%CI -1.3, 0.2]). CONCLUSIONS We conclude that sport climbing improves a biomechanical marker of axial posture in Parkinson's disease.
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Affiliation(s)
- Agnes Langer
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Dominik Roth
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
| | - Agnes Santer
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Anna Flotz
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Jakob Gruber
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Laurenz Wizany
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | | | - Rochus Pokan
- Department of Sport Physiology, Institute of Sports Sciences, University of Vienna, Vienna, Austria
| | - Peter Dabnichki
- School of Engineering, RMIT University, Melbourne, Victoria, Australia
| | - Marco Treven
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Sarah Zimmel
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | | | - Ulrike Willinger
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Lucia Gassner
- Department of Sport Physiology, Institute of Sports Sciences, University of Vienna, Vienna, Austria
- School of Engineering, RMIT University, Melbourne, Victoria, Australia
| | - Walter Maetzler
- Department of Neurology, University Hospital Schleswig-Holstein and Kiel University, Kiel, Germany
| | - Heidemarie Zach
- Department of Neurology, Medical University of Vienna, Vienna, Austria
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Fan W, Fong KNK, Wang SM. Effects of training involving patterned sensory enhancement on improving upper-limb movements in patients with Parkinson's disease: protocol of a randomised controlled trial. BMJ Open 2023; 13:e072416. [PMID: 37438071 DOI: 10.1136/bmjopen-2023-072416] [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] [Indexed: 07/14/2023] Open
Abstract
INTRODUCTION Bradykinesia (ie, slow movements) is one of the most prominent symptoms of Parkinson's disease (PD) and has a negative impact on quality of life. Rhythmic auditory stimulation (RAS), a widely used and promising treatment technique, has been shown to effectively improve gait speed in patients with PD. The upper-limb movements, which also suffer from bradykinesia, are essential for daily life and directly impact quality of life. The term, patterned sensory enhancement (PSE) instead of RAS, is used when movement training targets the human body except lower limbs. Up until now, scarce studies have explored effects of training involving PSE on upper-limb movements. The purpose of this study is to investigate effects of movement training involving PSE on upper-limb movement speed and function in patients with PD. METHODS AND ANALYSIS A total of 138 patients with PD will be randomly assigned into two groups: the PSE group and the no-PSE group. A 21-day upper-limb training involving PSE (for the PSE group) or without PSE (for the no-PSE group) will be provided to the patients. An assessor will administer the box and block test and the Jebsen hand function test before and after training to assess upper-limb movement speed and function. The one-way analysis of covariance will be performed. This randomised controlled trial will provide evidence supporting effectiveness of upper-limb movement training involving PSE on reducing severity of bradykinesia in patients with PD. ETHICS AND DISSEMINATION Ethical approval has been obtained from the Institutional Review Board of the Hong Kong Polytechnic University with the reference number HSEARS20221027005. Informed consent forms will be gathered from all patients before their participation. Study results will be disseminated through conferences and peer-reviewed academic journals. TRIAL REGISTRATION NUMBER NCT05637593.
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Affiliation(s)
- Wei Fan
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong, China
| | - Kenneth N K Fong
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong, China
| | - Shu-Mei Wang
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong, China
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Sheng S, Li X, Zhao S, Zheng C, Zhang F. Effects of levodopa on gut bacterial antibiotic resistance in Parkinson's disease rat. Front Aging Neurosci 2023; 15:1122712. [PMID: 36824263 PMCID: PMC9941341 DOI: 10.3389/fnagi.2023.1122712] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 01/23/2023] [Indexed: 02/10/2023] Open
Abstract
The second most prevalent neurodegenerative ailment, Parkinson's disease (PD), is characterized by both motor and non-motor symptoms. Levodopa is the backbone of treatment for PD at the moment. However, levodopa-induced side effects, such as dyskinesia, are commonly seen in PD patients. Recently, several antibiotics were found to present neuroprotective properties against neurodegenerative and neuro-inflammatory processes, which might be developed to effective therapies against PD. In this study, we aimed to identify if levodopa treatment could influence the gut bacterial antibiotic resistance in PD rat. Fecal samples were collected from healthy rats and 6-OHDA induced PD rats treated with different doses of levodopa, metagenomic sequencing data showed that levodopa resulted in gut bacteria composition change, the biomarkers of gut bacteria analyzed by LEfSe changed as well. More interestingly, compared with levodopa (5 mg/kg)-treated or no levodopa-treated PD rats, levodopa (10 mg/kg) caused a significant decrease in the abundance of tetW and vanTG genes in intestinal bacteria, which were related to tetracycline and vancomycin resistance, while the abundance of AAC6-lb-Suzhou gene increased apparently, which was related to aminoglycosides resistance, even though the total quantity of Antibiotic Resistance Gene (ARG) and Antibiotic Resistance Ontology (ARO) among all groups did not significantly differ. Consequently, our results imply that the combination of levodopa and antibiotics, such as tetracycline and vancomycin, in the treatment of PD may decrease the amount of corresponding antibiotic resistance genes in gut bacteria, which would give a theoretical basis for treating PD with levodopa combined with tetracycline and vancomycin in the future.
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Affiliation(s)
- Shuo Sheng
- Key Laboratory of Basic Pharmacology of the Ministry of Education, Joint International Research Laboratory of Ethnomedicine of the Ministry of Education and Key Laboratory of Basic Pharmacology of Guizhou Province, Zunyi Medical University, Zunyi, Guizhou, China
| | - Xianwei Li
- Key Laboratory of Basic Pharmacology of the Ministry of Education, Joint International Research Laboratory of Ethnomedicine of the Ministry of Education and Key Laboratory of Basic Pharmacology of Guizhou Province, Zunyi Medical University, Zunyi, Guizhou, China
| | - Shuo Zhao
- Electron Microscopy Room of School of Basic Medicine, Zunyi Medical University, Zunyi, Guizhou, China
| | - Changqing Zheng
- Key Laboratory of Basic Pharmacology of the Ministry of Education, Joint International Research Laboratory of Ethnomedicine of the Ministry of Education and Key Laboratory of Basic Pharmacology of Guizhou Province, Zunyi Medical University, Zunyi, Guizhou, China
| | - Feng Zhang
- Key Laboratory of Basic Pharmacology of the Ministry of Education, Joint International Research Laboratory of Ethnomedicine of the Ministry of Education and Key Laboratory of Basic Pharmacology of Guizhou Province, Zunyi Medical University, Zunyi, Guizhou, China,Laboratory Animal Center, Zunyi Medical University, Zunyi, Guizhou, China,The Collaborative Innovation Center of Tissue Damage Repair and Regeneration Medicine of Zunyi Medical University, Zunyi, Guizhou, China,*Correspondence: Feng Zhang, ✉
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Cont C, Lehto A, Stute N, Galli A, Schulte C, Deer V, Wessler M, Wojtecki L. Safety of Deep Repetitive Transcranial Magnetic Stimulation (drTMS) against Medical Refractory Symptoms in Parkinson Syndromes: First German Real-World Data with a Specific H5 Coil. Neurol Int 2022; 14:1024-1035. [PMID: 36548187 PMCID: PMC9783590 DOI: 10.3390/neurolint14040082] [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: 10/25/2022] [Revised: 12/01/2022] [Accepted: 12/07/2022] [Indexed: 12/14/2022] Open
Abstract
So far, deep repetitive transcranial magnetic stimulation (drTMS) has shown promising results as an add-on treatment for Parkinson's disease (PD) but not for non-idiopathic Parkinson Syndromes (PS). We aimed to investigate the safety and feasibility of drTMS application in patients with different Parkinson Syndromes and medical refractory symptoms. Multifaceted real-world data (n = 21) were retrospectively analyzed regarding adverse effects as well as short-term effects of the drTMS treatment on patients' self-rated symptom severity and motor, cognitive, and emotional functions. The drTMS treatment with H5 coil included a sequential 1 Hz primary motor cortex stimulation contralateral to the more-affected body side and a bilateral 10 Hz stimulation of the prefrontal cortex. Overall, drTMS could be safely administered to patients with different PSs and medical refractory symptoms, but large variation was apparent in the rate and severity ratings of the reported adverse event/adverse device effect. The treatment significantly decreased the subjective main symptom severity. This effect was more pronounced in older patients with PD. Furthermore, analysis showed an improvement in depression, but no effect could be established in terms of cognitive performance. drTMS can be safely administered to patients with PS and medical refractory symptoms and can decrease the subjective motor symptom severity and depression.
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Affiliation(s)
- Celine Cont
- Department of Neurology and Neurorehabilitation, Hospital zum Heiligen Geist, Academic Teaching Hospital of the Heinrich-Heine-University Düsseldorf, 47906 Kempen, Germany
- Institute of Clinical Neuroscience and Medical Psychology, Medical Faculty, Heinrich-Heine-University Düsseldorf, 40225 Düsseldorf, Germany
| | - Annaliis Lehto
- Department of Neurology and Neurorehabilitation, Hospital zum Heiligen Geist, Academic Teaching Hospital of the Heinrich-Heine-University Düsseldorf, 47906 Kempen, Germany
- Translational Neurodegeneration Section “Albrecht Kossel”, Department of Neurology, University Medical Center Rostock, University of Rostock, 18147 Rostock, Germany
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE) Rostock/Greifswald, 18147 Rostock, Germany
| | - Nathalie Stute
- Department of Neurology and Neurorehabilitation, Hospital zum Heiligen Geist, Academic Teaching Hospital of the Heinrich-Heine-University Düsseldorf, 47906 Kempen, Germany
| | - Anastasia Galli
- Department of Neurology and Neurorehabilitation, Hospital zum Heiligen Geist, Academic Teaching Hospital of the Heinrich-Heine-University Düsseldorf, 47906 Kempen, Germany
| | - Christina Schulte
- Department of Neurology and Neurorehabilitation, Hospital zum Heiligen Geist, Academic Teaching Hospital of the Heinrich-Heine-University Düsseldorf, 47906 Kempen, Germany
| | - Veronika Deer
- Department of Neurology and Neurorehabilitation, Hospital zum Heiligen Geist, Academic Teaching Hospital of the Heinrich-Heine-University Düsseldorf, 47906 Kempen, Germany
| | - Michaela Wessler
- Department of Neurology and Neurorehabilitation, Hospital zum Heiligen Geist, Academic Teaching Hospital of the Heinrich-Heine-University Düsseldorf, 47906 Kempen, Germany
| | - Lars Wojtecki
- Department of Neurology and Neurorehabilitation, Hospital zum Heiligen Geist, Academic Teaching Hospital of the Heinrich-Heine-University Düsseldorf, 47906 Kempen, Germany
- Institute of Clinical Neuroscience and Medical Psychology, Medical Faculty, Heinrich-Heine-University Düsseldorf, 40225 Düsseldorf, Germany
- Correspondence:
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Tosserams A, Keijsers N, Kapelle W, Kessels RPC, Weerdesteyn V, Bloem BR, Nonnekes J. Evaluation of Compensation Strategies for Gait Impairment in Patients With Parkinson Disease. Neurology 2022; 99:e2253-e2263. [PMID: 36008154 PMCID: PMC9694838 DOI: 10.1212/wnl.0000000000201159] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 07/11/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Compensation strategies are essential in Parkinson disease (PD) gait rehabilitation. However, besides external cueing, these strategies have rarely been investigated systematically. We aimed to perform the following: (1) establish the patients' perspective on the efficacy and usability of 5 different compensation strategies; (2) quantify the efficacy of these strategies on spatiotemporal gait parameters; and (3) explore associations between the effects of specific strategies and patient characteristics. METHODS We recruited persons with PD and self-reported disabling gait impairments for this laboratory-based, within-subject study. Clinimetrics included the following: questionnaires (New Freezing of Gait Questionnaire, Vividness of Movement Imagery Questionnaire, Goldsmiths Musical Sophistication Index), cognitive assessments (Attentional Network Test and Montreal Cognitive Assessment [MoCA], Brixton), and physical examinations (Movement Disorders Society Unified Parkinson's Disease Rating Scale [MDS-UPDRS III], Mini-Balance Evaluation Systems Test, tandem gait, and rapid turns test). Gait assessment consisted of six 3-minute trials of continuous walking around a 6-m walkway. Trials comprised the following: (1) baseline gait; (2) external cueing; (3) internal cueing; (4) action observation; (5) motor imagery; and (6) adopting a new walking pattern. Spatiotemporal gait parameters were acquired using 3-dimensional motion capture analysis. Strategy efficacy was determined by the change in gait variability compared with baseline gait. Associated patient characteristics were explored using regression analyses. RESULTS A total of 101 participants (50 men; median [range] age: 66 [47-91] years) were included. The effects of the different strategies varied greatly among participants. While participants with higher baseline variability showed larger improvements using compensation strategies, participants without freezing of gait, with lower MDS-UPDRS III scores, higher balance capacity, and better performance in orienting attention also showed greater improvements in gait variability. Higher MoCA scores were associated with greater efficacy of external cueing. DISCUSSION Our findings support the use of compensation strategies in gait rehabilitation for PD but highlight the importance of a personalized approach. Even patients with high gait variability are able to improve through the application of compensation strategies, but certain levels of cognitive and functional reserve seem necessary to optimally benefit from them.
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Affiliation(s)
- Anouk Tosserams
- From the Departments of Rehabilitation (A.T., N.K., W.K., V.W., J.N.), and Neurology (A.T., W.K., B.R.B.), Center of Expertise for Parkinson & Movement Disorders, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre; Department of Research (N.K., V.W.), Sint Maartenskliniek; Departments of Sensorimotor Neuroscience (N.K.), and Neuropsychology and Rehabilitation Psychology (R.P.C.K.), Donders Institute for Brain, Cognition and Behaviour, Radboud University; Department of Medical Psychology and Radboudumc Alzheimer Center (R.P.C.K.), Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen; Vincent van Gogh Institute for Psychiatry (R.P.C.K.), Venray; Klimmendaal Rehabilitation Center (R.P.C.K.), Arnhem; Tactus Addication Care (R.P.C.K.), Deventer; and Department of Rehabilitation (J.N.), Sint Maartenskliniek, Nijmegen, the Netherlands.
| | - Noël Keijsers
- From the Departments of Rehabilitation (A.T., N.K., W.K., V.W., J.N.), and Neurology (A.T., W.K., B.R.B.), Center of Expertise for Parkinson & Movement Disorders, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre; Department of Research (N.K., V.W.), Sint Maartenskliniek; Departments of Sensorimotor Neuroscience (N.K.), and Neuropsychology and Rehabilitation Psychology (R.P.C.K.), Donders Institute for Brain, Cognition and Behaviour, Radboud University; Department of Medical Psychology and Radboudumc Alzheimer Center (R.P.C.K.), Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen; Vincent van Gogh Institute for Psychiatry (R.P.C.K.), Venray; Klimmendaal Rehabilitation Center (R.P.C.K.), Arnhem; Tactus Addication Care (R.P.C.K.), Deventer; and Department of Rehabilitation (J.N.), Sint Maartenskliniek, Nijmegen, the Netherlands
| | - Willanka Kapelle
- From the Departments of Rehabilitation (A.T., N.K., W.K., V.W., J.N.), and Neurology (A.T., W.K., B.R.B.), Center of Expertise for Parkinson & Movement Disorders, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre; Department of Research (N.K., V.W.), Sint Maartenskliniek; Departments of Sensorimotor Neuroscience (N.K.), and Neuropsychology and Rehabilitation Psychology (R.P.C.K.), Donders Institute for Brain, Cognition and Behaviour, Radboud University; Department of Medical Psychology and Radboudumc Alzheimer Center (R.P.C.K.), Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen; Vincent van Gogh Institute for Psychiatry (R.P.C.K.), Venray; Klimmendaal Rehabilitation Center (R.P.C.K.), Arnhem; Tactus Addication Care (R.P.C.K.), Deventer; and Department of Rehabilitation (J.N.), Sint Maartenskliniek, Nijmegen, the Netherlands
| | - Roy P C Kessels
- From the Departments of Rehabilitation (A.T., N.K., W.K., V.W., J.N.), and Neurology (A.T., W.K., B.R.B.), Center of Expertise for Parkinson & Movement Disorders, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre; Department of Research (N.K., V.W.), Sint Maartenskliniek; Departments of Sensorimotor Neuroscience (N.K.), and Neuropsychology and Rehabilitation Psychology (R.P.C.K.), Donders Institute for Brain, Cognition and Behaviour, Radboud University; Department of Medical Psychology and Radboudumc Alzheimer Center (R.P.C.K.), Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen; Vincent van Gogh Institute for Psychiatry (R.P.C.K.), Venray; Klimmendaal Rehabilitation Center (R.P.C.K.), Arnhem; Tactus Addication Care (R.P.C.K.), Deventer; and Department of Rehabilitation (J.N.), Sint Maartenskliniek, Nijmegen, the Netherlands
| | - Vivian Weerdesteyn
- From the Departments of Rehabilitation (A.T., N.K., W.K., V.W., J.N.), and Neurology (A.T., W.K., B.R.B.), Center of Expertise for Parkinson & Movement Disorders, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre; Department of Research (N.K., V.W.), Sint Maartenskliniek; Departments of Sensorimotor Neuroscience (N.K.), and Neuropsychology and Rehabilitation Psychology (R.P.C.K.), Donders Institute for Brain, Cognition and Behaviour, Radboud University; Department of Medical Psychology and Radboudumc Alzheimer Center (R.P.C.K.), Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen; Vincent van Gogh Institute for Psychiatry (R.P.C.K.), Venray; Klimmendaal Rehabilitation Center (R.P.C.K.), Arnhem; Tactus Addication Care (R.P.C.K.), Deventer; and Department of Rehabilitation (J.N.), Sint Maartenskliniek, Nijmegen, the Netherlands
| | - Bastiaan R Bloem
- From the Departments of Rehabilitation (A.T., N.K., W.K., V.W., J.N.), and Neurology (A.T., W.K., B.R.B.), Center of Expertise for Parkinson & Movement Disorders, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre; Department of Research (N.K., V.W.), Sint Maartenskliniek; Departments of Sensorimotor Neuroscience (N.K.), and Neuropsychology and Rehabilitation Psychology (R.P.C.K.), Donders Institute for Brain, Cognition and Behaviour, Radboud University; Department of Medical Psychology and Radboudumc Alzheimer Center (R.P.C.K.), Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen; Vincent van Gogh Institute for Psychiatry (R.P.C.K.), Venray; Klimmendaal Rehabilitation Center (R.P.C.K.), Arnhem; Tactus Addication Care (R.P.C.K.), Deventer; and Department of Rehabilitation (J.N.), Sint Maartenskliniek, Nijmegen, the Netherlands
| | - Jorik Nonnekes
- From the Departments of Rehabilitation (A.T., N.K., W.K., V.W., J.N.), and Neurology (A.T., W.K., B.R.B.), Center of Expertise for Parkinson & Movement Disorders, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre; Department of Research (N.K., V.W.), Sint Maartenskliniek; Departments of Sensorimotor Neuroscience (N.K.), and Neuropsychology and Rehabilitation Psychology (R.P.C.K.), Donders Institute for Brain, Cognition and Behaviour, Radboud University; Department of Medical Psychology and Radboudumc Alzheimer Center (R.P.C.K.), Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen; Vincent van Gogh Institute for Psychiatry (R.P.C.K.), Venray; Klimmendaal Rehabilitation Center (R.P.C.K.), Arnhem; Tactus Addication Care (R.P.C.K.), Deventer; and Department of Rehabilitation (J.N.), Sint Maartenskliniek, Nijmegen, the Netherlands
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8
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Karimi F, Niu J, Gouweleeuw K, Almeida Q, Jiang N. Movement-related EEG signatures associated with freezing of gait in Parkinson's disease: an integrative analysis. Brain Commun 2021; 3:fcab277. [PMID: 34877535 PMCID: PMC8643573 DOI: 10.1093/braincomms/fcab277] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 08/20/2021] [Accepted: 09/28/2021] [Indexed: 01/09/2023] Open
Abstract
Freezing of gait is the most severe gait deficit associated with Parkinson's disease and significantly affects patients' independence and consequently their quality of life. The lack of a clear understanding of its underlying neurophysiological mechanism has resulted in limited effectiveness of the current treatment options. In this study, we investigated EEG features over (pre-)supplementary motor area and primary motor cortex during a simple cue-based ankle dorsiflexion movement. These features include movement-related cortical potentials (0.05-5 Hz) and brain oscillations (1-50 Hz). Electromyogram signal from the tibialis anterior muscle of the dominant foot was used to determine the movement onset. The EEG features before, during and following the onset of the movement were compared among three groups of participants: patients with freezing (N = 14, 11 males), patients without freezing (N = 14, 13 males) and healthy age-matched controls (N = 13, 10 males) with 15 recorded trials for each individual. Additionally, Parkinson's disease patients with freezing of gait were separated into mild (N = 7) and severe cases (N = 5), so that EEG features associated with freezing severity could be investigated. The results indicated significant differences between patients with severe freezing of gait compared to healthy controls and patients without freezing of gait. In addition, patients with mild and severe freezing represented cortical activity differences. For patients with freezing, the initial component of movement-related cortical potential is significantly lower than that of the healthy controls (P = 0.002) and is affected by the severity of freezing. Furthermore, a striking absence of beta frequency band (12-35 Hz) desynchronization was observed in patients with freezing, especially low-beta frequency band over Cz, before the movement, which was also associated with the severity of the freezing of gait. Low-beta (13-20 Hz) and high-beta (21-35 Hz) frequency band activities represented unique features for each group. Beta event-related desynchronization over Cz present in healthy controls prior to movement onset, was partially replaced by the theta band (4-8 Hz) synchrony in patients with freezing. Patients with severe freezing also represented some level of theta band synchronization over contralateral supplementary motor area. This suggests the involvement of cognitive processing over the motor cortex in controlling cue-based voluntary movement as a compensatory mechanism associated with freezing of gait. The EEG features identified in this study are indicative of important freezing of gait clinical characteristics such as severity and contribute to a better understanding of the underlying neurophysiology of the mysterious phenomenon of freezing of gait.
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Affiliation(s)
- Fatemeh Karimi
- Systems Design Engineering Department, University of Waterloo, Waterloo N2L 3G1, Canada
| | - Jiansheng Niu
- Systems Design Engineering Department, University of Waterloo, Waterloo N2L 3G1, Canada
| | - Kim Gouweleeuw
- Department of Human Media Interaction, University of Twente, 7522 NB Enschede, The Netherlands
| | - Quincy Almeida
- Department of Kinesiology and Physical Education, Wilfrid Laurier University, Waterloo N2L 3C5, Canada
| | - Ning Jiang
- Systems Design Engineering Department, University of Waterloo, Waterloo N2L 3G1, Canada
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9
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Tosserams A, Wit L, Sturkenboom IHWM, Nijkrake MJ, Bloem BR, Nonnekes J. Perception and Use of Compensation Strategies for Gait Impairment by Persons With Parkinson Disease. Neurology 2021; 97:e1404-e1412. [PMID: 34497067 PMCID: PMC8520387 DOI: 10.1212/wnl.0000000000012633] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Accepted: 07/07/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Gait impairments are common and disabling in Parkinson disease (PD). Applying compensation strategies helps to overcome these gait deficits. Clinical observations suggest that the efficacy of different compensation strategies varies depending on both individual patient characteristics and the context in which the strategies are applied. This has never been investigated systematically, hampering the ability of clinicians to provide a more personalized approach to gait rehabilitation. We had 3 aims: (1) to evaluate patients' awareness and actual use of compensation categories for gait impairments in PD, (2) to investigate the patient-rated efficacy of the various compensation strategies and whether this efficacy depends on the context in which the strategies are applied, and (3) to explore differences in the efficacy between subgroups based on sex, age, disease duration, freezing status, and ability to perform a dual task. METHODS A survey was conducted among 4,324 adults with PD and self-reported disabling gait impairments. RESULTS The main findings are as follows: (1) compensation strategies for gait impairments are commonly used by persons with PD, but their awareness of the full spectrum of available strategies is limited; (2) the patient-rated efficacy of compensation strategies is high but varies depending on the context in which they are applied; and (3) compensation strategies are useful for all types of patients with PD, but the efficacy of the different strategies varies per person. DISCUSSION The choice of compensation strategies for gait impairment in PD should be tailored to the individual patient and to the context in which the strategy needs to be applied. CLASSIFICATION OF EVIDENCE This data provides Class IV evidence that compensation strategies are an effective treatment for gait impairment in patients with PD.
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Affiliation(s)
- Anouk Tosserams
- From the Department of Neurology (A.T., B.R.B.) and Department of Rehabilitation (A.T., L.W., I.H.W.M.S., M.J.N., J.N.), Center of Expertise for Parkinson & Movement Disorders, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre; and Department of Rehabilitation (J.N.), Sint Maartenskliniek, Nijmegen, the Netherlands.
| | - Lisanne Wit
- From the Department of Neurology (A.T., B.R.B.) and Department of Rehabilitation (A.T., L.W., I.H.W.M.S., M.J.N., J.N.), Center of Expertise for Parkinson & Movement Disorders, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre; and Department of Rehabilitation (J.N.), Sint Maartenskliniek, Nijmegen, the Netherlands
| | - Ingrid H W M Sturkenboom
- From the Department of Neurology (A.T., B.R.B.) and Department of Rehabilitation (A.T., L.W., I.H.W.M.S., M.J.N., J.N.), Center of Expertise for Parkinson & Movement Disorders, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre; and Department of Rehabilitation (J.N.), Sint Maartenskliniek, Nijmegen, the Netherlands
| | - Maarten J Nijkrake
- From the Department of Neurology (A.T., B.R.B.) and Department of Rehabilitation (A.T., L.W., I.H.W.M.S., M.J.N., J.N.), Center of Expertise for Parkinson & Movement Disorders, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre; and Department of Rehabilitation (J.N.), Sint Maartenskliniek, Nijmegen, the Netherlands
| | - Bastiaan R Bloem
- From the Department of Neurology (A.T., B.R.B.) and Department of Rehabilitation (A.T., L.W., I.H.W.M.S., M.J.N., J.N.), Center of Expertise for Parkinson & Movement Disorders, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre; and Department of Rehabilitation (J.N.), Sint Maartenskliniek, Nijmegen, the Netherlands
| | - Jorik Nonnekes
- From the Department of Neurology (A.T., B.R.B.) and Department of Rehabilitation (A.T., L.W., I.H.W.M.S., M.J.N., J.N.), Center of Expertise for Parkinson & Movement Disorders, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre; and Department of Rehabilitation (J.N.), Sint Maartenskliniek, Nijmegen, the Netherlands
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10
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Jeong SH, Yoo HS, Chung SJ, Jung JH, Lee YH, Baik K, Sohn YH, Lee PH. Neuropsychiatric Burden Is a Predictor of Early Freezing and Motor Progression in Drug-Naïve Parkinson's Disease. JOURNAL OF PARKINSONS DISEASE 2021; 11:1947-1956. [PMID: 34151858 DOI: 10.3233/jpd-212660] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
BACKGROUND Neuropsychiatric symptoms (NPS) are the most common non-motor symptom in Parkinson's disease (PD). OBJECTIVE To investigate the association between the burden of NPS and motor prognosis in patients with PD. METHODS We enrolled 329 drug-naïve patients with PD, who was non-demented and followed-up≥2 years after their first visit to the clinic with baseline dopamine transporter (DAT) imaging and neuropsychiatric inventory (NPI) scores. We performed a survival analysis and a linear mixed model analysis to assess longitudinal motor outcomes according to the NPI total score. RESULTS The Kaplan-Meier analysis showed no difference in the development of levodopa-induced dyskinesia and wearing-off according to the NPI total score. However, higher burden of NPI total score was associated with earlier freezing of gait (FOG) development in the time-dependent Cox regression models after adjusting for age at symptom onset, sex, disease duration, Unified PD Rating Scale motor score, baseline Mini-Mental State Examination score, DAT activity in the posterior putamen and levodopa-equivalent daily dose (LEDD) (Hazard ratio 1.047, p = 0.002). A linear mixed model analysis revealed that patients with a higher NPI total score had a more rapid LEDD increment (NPI×time, p = 0.003). Among 52 patients with PD who eventually developed FOG during the follow-up period, there was a significant correlation between the NPI total score and time with FOG development (γ= -0.472; p = 0.001) after adjusting for confounding factors. CONCLUSION The present study demonstrated that the severity of NPS is a predictor of early freezing and motor progression in patients with PD.
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Affiliation(s)
- Seong Ho Jeong
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea.,Department of Neurology, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, South Korea
| | - Han Soo Yoo
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - Seok Jong Chung
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea.,Department of Neurology, Yongin Severance Hospital, Yonsei University Health System, Yongin, South Korea
| | - Jin Ho Jung
- Department of Neurology, Busan Paik Hospital, Inje University College of Medicine, Seoul, South Korea
| | - Yang Hyun Lee
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - Kyoungwon Baik
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - Young H Sohn
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - Phil Hyu Lee
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea.,Severance Biomedical Science Institute, Yonsei University College of Medicine, Seoul, South Korea
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11
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Park HJ, Kang J. A Computational Framework for Controlling the Self-Restorative Brain Based on the Free Energy and Degeneracy Principles. Front Comput Neurosci 2021; 15:590019. [PMID: 33935674 PMCID: PMC8079648 DOI: 10.3389/fncom.2021.590019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 03/18/2021] [Indexed: 11/13/2022] Open
Abstract
The brain is a non-linear dynamical system with a self-restoration process, which protects itself from external damage but is often a bottleneck for clinical treatment. To treat the brain to induce the desired functionality, formulation of a self-restoration process is necessary for optimal brain control. This study proposes a computational model for the brain's self-restoration process following the free-energy and degeneracy principles. Based on this model, a computational framework for brain control is established. We posited that the pre-treatment brain circuit has long been configured in response to the environmental (the other neural populations') demands on the circuit. Since the demands persist even after treatment, the treated circuit's response to the demand may gradually approximate the pre-treatment functionality. In this framework, an energy landscape of regional activities, estimated from resting-state endogenous activities by a pairwise maximum entropy model, is used to represent the pre-treatment functionality. The approximation of the pre-treatment functionality occurs via reconfiguration of interactions among neural populations within the treated circuit. To establish the current framework's construct validity, we conducted various simulations. The simulations suggested that brain control should include the self-restoration process, without which the treatment was not optimal. We also presented simulations for optimizing repetitive treatments and optimal timing of the treatment. These results suggest a plausibility of the current framework in controlling the non-linear dynamical brain with a self-restoration process.
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Affiliation(s)
- Hae-Jeong Park
- Center for Systems and Translational Brain Science, Institute of Human Complexity and Systems Science, Yonsei University, Seoul, South Korea.,Department of Nuclear Medicine, Yonsei University College of Medicine, Seoul, South Korea.,Department of Psychiatry, Yonsei University College of Medicine, Seoul, South Korea.,Brain Korea 21 Project, Graduate School of Medical Science, Yonsei University College of Medicine, Seoul, South Korea.,Department of Cognitive Science, Yonsei University, Seoul, South Korea
| | - Jiyoung Kang
- Center for Systems and Translational Brain Science, Institute of Human Complexity and Systems Science, Yonsei University, Seoul, South Korea.,Department of Nuclear Medicine, Yonsei University College of Medicine, Seoul, South Korea
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12
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Chow R, Tripp BP, Rzondzinski D, Almeida QJ. Investigating Therapies for Freezing of Gait Targeting the Cognitive, Limbic, and Sensorimotor Domains. Neurorehabil Neural Repair 2021; 35:290-299. [PMID: 33559531 PMCID: PMC7934156 DOI: 10.1177/1545968321992331] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Background Freezing of gait (FOG) is arguably the most disabling motor symptom experienced with Parkinson’s disease (PD), but treatments are extremely limited due to our poor understanding of the underlying mechanisms. Three cortical domains are postulated in recent research (ie, the cognitive, limbic, and sensorimotor domains), thus, treatments targeting these mechanisms of FOG may potentially be effective. Cognitive training, cognitive behavioral therapy (CBT, a well-known anxiety intervention), and proprioceptive training may address the cognitive, limbic, and sensorimotor domains, respectively. Objective To investigate whether these 3 treatments could improve functional outcomes of FOG. Methods In a single-blind, randomized crossover design, 15 individuals with PD and FOG were randomized into different, counterbalanced orders of receiving the interventions. Each consisted of eight 1-hour sessions, twice weekly for 4 weeks. FOG severity was assessed as the primary outcome using a novel gait paradigm that was aimed at evoking FOG when the cognitive, limbic, or sensorimotor domains were independently challenged. Results FOG severity significantly improved after the cognitive intervention, with strong trends toward improvement specifically in the baseline and cognitive-challenge assessment conditions. CBT, as the anxiety intervention, resulted in significantly worse FOG severity. In contrast, proprioceptive training significantly improved FOG severity, with consistent trends across all conditions. Conclusions The cognitive and proprioceptive treatments appeared to improve different aspects of FOG. Thus, either of these interventions could potentially be a viable treatment for FOG. However, although the results were statistically significant, they could be sensitive to the relatively small number of participants in the study. Considering the significant results together with nonsignificant trends in both FOG and gait measures, and given equal time for each intervention, proprioceptive training produced the most consistent indications of benefits in this study. (clinicaltrials.gov NCT03065127).
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Affiliation(s)
- Rebecca Chow
- Wilfrid Laurier University, Waterloo, Ontario, Canada
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13
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A computational framework for optimal control of a self-adjustive neural system with activity-dependent and homeostatic plasticity. Neuroimage 2021; 230:117805. [PMID: 33524581 DOI: 10.1016/j.neuroimage.2021.117805] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Revised: 01/20/2021] [Accepted: 01/24/2021] [Indexed: 12/13/2022] Open
Abstract
The control of the brain system has received increasing attention in the domain of brain science. Most brain control studies have been conducted to explore the brain network's graph-theoretic properties or to produce the desired state based on neural state dynamics, regarding the brain as a passively responding system. However, the self-adjusting nature of neural system after treatment has not been fully considered in the brain control. In the present study, we propose a computational framework for optimal control of the brain with a self-adjustment process in the effective connectivity after treatment. The neural system is modeled to adjust its outgoing effective connectivity as activity-dependent plasticity after treatment, followed by synaptic rescaling of incoming effective connectivity. To control this neural system to induce the desired function, the system's self-adjustment parameter is first estimated, based on which the treatment is optimized. Utilizing this framework, we conducted simulations of optimal control over a functional hippocampal circuitry, estimated using dynamic causal modeling of voltage-sensitive dye imaging from the wild type and mutant mice, responding to consecutive electrical stimuli. Simulation results for optimal control of the abnormal circuit toward a healthy circuit using a single node treatment, neural-type specific treatment as an analogy of medication, and combined treatments of medication and nodal treatment suggest the plausibility of the current framework in controlling the self-adjusting neural system within a restricted treatment setting. We believe the proposed computational framework of the self-adjustment system would help optimal control of the dynamic brain after treatment.
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14
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Leuk JSP, Low LLN, Teo WP. An Overview of Acoustic-Based Interventions to Improve Motor Symptoms in Parkinson's Disease. Front Aging Neurosci 2020; 12:243. [PMID: 32922283 PMCID: PMC7457064 DOI: 10.3389/fnagi.2020.00243] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 07/13/2020] [Indexed: 01/23/2023] Open
Abstract
Parkinson’s disease (PD) is characterized by motor and cognitive deficits that negatively impact on activities of daily living. While dopaminergic medications are used to attenuate motor symptoms, adjuvant therapies such as acoustic-based non-pharmacological interventions are used as a complement to standard drug treatments. At present, preliminary studies of acoustic-based interventions such as rhythmic-auditory stimulation (RAS) and vibroacoustic therapy (VAT) suggest two competing hypotheses: (1) RAS may recruit alternative motor networks that may bypass faulty spatiotemporal motor networks of movement in PD; or (2) the use of RAS enhances BG function through entrainment of beta oscillatory activities. In this mini review article, we discuss the mechanisms underlying the role of acoustic-based interventions and how it may serve to improve motor deficits such as gait impairments and tremors. We further provide suggestions for future work that may use a combination of RAS, VAT, and physical therapy to improve motor function in PD.
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Affiliation(s)
- Jessie Siew Pin Leuk
- Physical Education and Sports Science (PESS) Academic Group, National Institute of Education, Nanyang Technological University, Singapore, Singapore
| | - Linette Li Neng Low
- Physical Education and Sports Science (PESS) Academic Group, National Institute of Education, Nanyang Technological University, Singapore, Singapore
| | - Wei-Peng Teo
- Physical Education and Sports Science (PESS) Academic Group, National Institute of Education, Nanyang Technological University, Singapore, Singapore.,Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC, Australia
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15
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Yao MS, Zhou LC, Tan YY, Jiang H, Chen ZC, Zhu L, Luo ND, Wu QZ, Kang WY, Liu J. Gait Characteristics and Brain Activity in Parkinson's Disease with Concomitant Postural Abnormalities. Aging Dis 2020; 11:791-800. [PMID: 32765946 PMCID: PMC7390521 DOI: 10.14336/ad.2019.0929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2019] [Accepted: 09/29/2019] [Indexed: 11/02/2022] Open
Abstract
To explore the underlying pathogenic mechanism of Parkinson's disease (PD) with concomitant postural abnormalities (PDPA) through the relationship between its gait and brain function characteristics. PD patients from the neurology outpatient clinic at Ruijin Hospital were recruited and grouped according to whether postural abnormalities (including camptocormia and Pisa syndrome) were present. PD-related scale assessments, three-dimensional gait tests and brain resting-state functional magnetic imaging were performed and analyzed. The gait characteristics independently associated with PDPA were decreased pelvic obliquity angle and progressive downward movement of the center of mass during walking. PDPA features included decreased functional connectivity between the left insula and bilateral supplementary motor area, which was significantly correlated with reduced Berg Balance Scale scores. Functional connectivity between the right insula and bilateral middle frontal gyrus was decreased and significantly correlated with a decreased pelvic obliquity angle and poor performance on the Timed Up and Go test. Moreover, through diffusion tensor imaging analysis, the average fractional anisotropy value of the fibers connecting the left insula and left supplementary motor area was shown to be decreased in PDPA. There is decreased functional connectivity among the insula, supplementary motor area and middle frontal gyrus with structural abnormalities between the left insula and the left supplementary motor area; these changes in brain connectivity are probably among the causes of gait dysfunction in PDPA and provide some clues regarding the pathogenic mechanisms of PDPA.
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Affiliation(s)
- Meng-sha Yao
- Department of Neurology & Collaborative Innovation Center for Brain Science, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Li-che Zhou
- Department of Neurology & Collaborative Innovation Center for Brain Science, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Yu-yan Tan
- Department of Neurology & Collaborative Innovation Center for Brain Science, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Hong Jiang
- Department of Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Zhi-chun Chen
- Department of Neurology & Collaborative Innovation Center for Brain Science, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Lin Zhu
- Department of Neurology & Collaborative Innovation Center for Brain Science, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Ning-di Luo
- Department of Neurology & Collaborative Innovation Center for Brain Science, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Quan-zhou Wu
- State Key Laboratory of ISN, School of Computer Science and Technology, Xidian University, Xi'an, Shanxi Province, China.
| | - Wen-yan Kang
- Department of Neurology & Collaborative Innovation Center for Brain Science, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
- Department of Neurology, Ruijin Hospital North, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Jun Liu
- Department of Neurology & Collaborative Innovation Center for Brain Science, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
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16
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Hegelmaier T, Lebbing M, Duscha A, Tomaske L, Tönges L, Holm JB, Bjørn Nielsen H, Gatermann SG, Przuntek H, Haghikia A. Interventional Influence of the Intestinal Microbiome Through Dietary Intervention and Bowel Cleansing Might Improve Motor Symptoms in Parkinson's Disease. Cells 2020; 9:cells9020376. [PMID: 32041265 PMCID: PMC7072275 DOI: 10.3390/cells9020376] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2019] [Revised: 01/12/2020] [Accepted: 02/01/2020] [Indexed: 02/07/2023] Open
Abstract
The impact of the gut microbiome is being increasingly appreciated in health and in various chronic diseases, among them neurodegenerative disorders such as Parkinson’s disease (PD). In the pathogenesis of PD, the role of the gut has been previously established. In conjunction with a better understanding of the intestinal microbiome, a link to the misfolding and spread of alpha-synuclein via inflammatory processes within the gut is discussed. In a case-control study, we assessed the gut microbiome of 54 PD patients and 32 healthy controls (HC). Additionally, we tested in this proof-of-concept study whether dietary intervention alone or additional physical colon cleaning may lead to changes of the gut microbiome in PD. 16 PD patients underwent a well-controlled balanced, ovo-lacto vegetarian diet intervention including short fatty acids for 14 days. 10 of those patients received additional treatment with daily fecal enema over 8 days. Stool samples were collected before and after 14 days of intervention. In comparison to HC, we could confirm previously reported PD associated microbiome changes. The UDPRS III significantly improved and the levodopa-equivalent daily dose decreased after vegetarian diet and fecal enema in a one-year follow-up. Additionally, we observed a significant association between the gut microbiome diversity and the UPDRS III and the abundance of Ruminococcaceae. Additionally, the abundance of Clostridiaceae was significantly reduced after enema. Dietary intervention and bowel cleansing may provide an additional non-pharmacologic therapeutic option for PD patients.
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Affiliation(s)
- Tobias Hegelmaier
- Department of Neurology, Ruhr-University Bochum, St. Josef-Hospital Bochum, Bochum, 44791, Germany; (T.H.); (A.D.); (L.T.); (L.T.)
| | - Marco Lebbing
- Clinic of Neurology II, EVK Hattingen, Hattingen 45525, Germany; (M.L.); (H.P.)
| | - Alexander Duscha
- Department of Neurology, Ruhr-University Bochum, St. Josef-Hospital Bochum, Bochum, 44791, Germany; (T.H.); (A.D.); (L.T.); (L.T.)
| | - Laura Tomaske
- Department of Neurology, Ruhr-University Bochum, St. Josef-Hospital Bochum, Bochum, 44791, Germany; (T.H.); (A.D.); (L.T.); (L.T.)
| | - Lars Tönges
- Department of Neurology, Ruhr-University Bochum, St. Josef-Hospital Bochum, Bochum, 44791, Germany; (T.H.); (A.D.); (L.T.); (L.T.)
| | - Jacob Bak Holm
- Clinical Microbiomics A/S, Copenhagen 2200, Denmark; (J.B.H.); (H.B.N.)
| | | | - Sören G. Gatermann
- Department of Medical Microbiology, Ruhr-University Bochum, Bochum, 44801, Germany;
| | - Horst Przuntek
- Clinic of Neurology II, EVK Hattingen, Hattingen 45525, Germany; (M.L.); (H.P.)
| | - Aiden Haghikia
- Department of Neurology, Ruhr-University Bochum, St. Josef-Hospital Bochum, Bochum, 44791, Germany; (T.H.); (A.D.); (L.T.); (L.T.)
- Correspondence: ; Tel.: +49-234-509-2411; Fax: +49-234-509-2414
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17
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Ozanne A, Sawatzky R, Håkanson C, Alvariza A, Fürst CJ, Årestedt K, Öhlén J. Symptom relief during last week of life in neurological diseases. Brain Behav 2019; 9:e01348. [PMID: 31287226 PMCID: PMC6710202 DOI: 10.1002/brb3.1348] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Accepted: 05/18/2019] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVES The aim of this study was to investigate symptom prevalence, symptom relief, and palliative care indicators during the last week of life, comparing them for patients with motor neuron disease (MND), central nervous system tumors (CNS tumor), and other neurological diseases (OND). MATERIAL & METHODS Data were obtained from the Swedish Register for Palliative Care, which documents care during the last week of life. Logistic regression was used to compare patients with MND (n = 419), CNS tumor (n = 799), and OND (n = 1,407) as the cause of death. RESULTS The most prevalent symptoms for all neurological disease groups were pain (52.7% to 72.2%) and rattles (58.1% to 65.6%). Compared to MND and OND, patients with CNS tumors were more likely to have totally relieved pain, shortness of breath, rattles, and anxiety. They were also more likely to have their pain assessed with a validated tool; to receive symptom treatment for anxiety, nausea, rattles, and pain; to have had family members receive end-of-life discussions; to have someone present at death; and to have had their family members offered bereavement support. Both patients with CNS tumor and MND were more likely than patients with OND to receive consultation with a pain unit and to have had end-of-life discussions. CONCLUSIONS The study reveals high symptom burden and differences in palliative care between the groups during the last week of life. There is a need for person-centered care planning based on a palliative approach, focused on improving symptom assessments, relief, and end-of-life conversations.
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Affiliation(s)
- Anneli Ozanne
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Richard Sawatzky
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,School of Nursing, Trinity Western University, Langley, British Columbia, Canada.,Centre for Health Evaluation & Outcome Sciences, St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - Cecilia Håkanson
- Department of Nursing Science, Sophiahemmet University, Stockholm, Sweden
| | - Anette Alvariza
- Department of Health Care Sciences, Palliative Research Centre, Ersta Sköndal Bräcke University College, Stockholm, Sweden.,Capio Palliative Care, Dalen hospital, Stockholm, Sweden
| | - Carl Johan Fürst
- The Institute for Palliative Care, Lund University and Region Skåne, Lund, Sweden.,Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Kristofer Årestedt
- Faculty of Health and Life Sciences, Linnaeus University, Kalmar, Sweden.,The Research Section, Kalmar County Council, Kalmar, Sweden
| | - Joakim Öhlén
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Palliative Centre, Sahlgrenska University Hospital, Gothenburg, Sweden.,The University of Gothenburg Centre for Person-centred Care, Gothenburg, Sweden
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18
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Barbe AG, Ludwar L, Scharfenberg I, Hellmich M, Dano R, Barbe MT, Noack MJ. Circadian rhythms and influencing factors of xerostomia among Parkinson’s disease patients. Oral Dis 2018; 25:282-289. [DOI: 10.1111/odi.12942] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Revised: 07/01/2018] [Accepted: 07/16/2018] [Indexed: 01/09/2023]
Affiliation(s)
- Anna Greta Barbe
- Department of Operative Dentistry and Periodontology, Centre of Dental Medicine University of Cologne Köln Germany
| | - Lena Ludwar
- Department of Operative Dentistry and Periodontology, Centre of Dental Medicine University of Cologne Köln Germany
| | - Isabel Scharfenberg
- Department of Operative Dentistry and Periodontology, Centre of Dental Medicine University of Cologne Köln Germany
| | - Martin Hellmich
- Institute of Medical Statistics and Computational Biology University of Cologne Köln Germany
| | - Richard Dano
- Department of Neurology University of Cologne Köln Germany
| | | | - Michael Johannes Noack
- Department of Operative Dentistry and Periodontology, Centre of Dental Medicine University of Cologne Köln Germany
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19
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Perugini A, Ditterich J, Shaikh AG, Knowlton BJ, Basso MA. Paradoxical Decision-Making: A Framework for Understanding Cognition in Parkinson's Disease. Trends Neurosci 2018; 41:512-525. [PMID: 29747856 PMCID: PMC6124671 DOI: 10.1016/j.tins.2018.04.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Revised: 04/09/2018] [Accepted: 04/16/2018] [Indexed: 12/11/2022]
Abstract
People with Parkinson's disease (PD) show impaired decision-making when sensory and memory information must be combined. This recently identified impairment results from an inability to accumulate the proper amount of information needed to make a decision and appears to be independent of dopamine tone and reinforcement learning mechanisms. Although considerable work focuses on PD and decisions involving risk and reward, in this Opinion article we propose that the emerging findings in perceptual decision-making highlight the multisystem nature of PD, and that unraveling the neuronal circuits underlying perceptual decision-making impairment may help in understanding other cognitive impairments in people with PD. We also discuss how a decision-making framework may be extended to gain insights into mechanisms of motor impairments in PD.
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Affiliation(s)
- Alessandra Perugini
- Fuster Laboratory of Cognitive Neuroscience, Department of Psychiatry and Biobehavioral Sciences, Department of Neurobiology, Semel Institute for Neuroscience and Human Behavior, Brain Research Institute, The David Geffen School of Medicine, Los Angeles, CA 90095, USA
| | - Jochen Ditterich
- Center for Neuroscience and Department of Neurobiology, Physiology, and Behavior, University of California, Davis, CA, USA
| | - Aasef G Shaikh
- Department of Neurology, Case Western Reserve University, Cleveland, OH 44106, USA
| | - Barbara J Knowlton
- Department of Psychology, University of California Los Angeles, Los Angeles, CA, USA
| | - Michele A Basso
- Fuster Laboratory of Cognitive Neuroscience, Department of Psychiatry and Biobehavioral Sciences, Department of Neurobiology, Semel Institute for Neuroscience and Human Behavior, Brain Research Institute, The David Geffen School of Medicine, Los Angeles, CA 90095, USA.
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20
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Antonini A, Robieson WZ, Bergmann L, Yegin A, Poewe W. Age/disease duration influence on activities of daily living and quality of life after levodopa-carbidopa intestinal gel in Parkinson's disease. Neurodegener Dis Manag 2018; 8:161-170. [DOI: 10.2217/nmt-2017-0046] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: To determine if age and Parkinson's disease duration at therapy initiation influence the efficacy of levodopa-carbidopa intestinal gel (LCIG) on quality of life and activities of daily living. Patients & methods: This post hoc analysis assessed subgroups of patients stratified by baseline age, disease duration, hours/day of ‘off’ time and levodopa equivalent dose. Patients’ data were collected from the GLORIA study, a 24-month observational registry evaluating long-term effectiveness of LCIG. Results & conclusion: LCIG therapy led to sustained improvements in quality of life irrespective of patient age and disease duration at baseline. Improvements in activities of daily living were observed across all subgroups, particularly in younger patients, patients with shorter disease duration and in patients with the highest baseline levodopa equivalent dose.
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Affiliation(s)
- Angelo Antonini
- Department of Neuroscience, Padua University, Padua, 35122, Italy
| | | | | | | | - Werner Poewe
- Department of Neurology, Medical University of Innsbruck, Innsbruck, A-6060, Austria
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21
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Debû B, De Oliveira Godeiro C, Lino JC, Moro E. Managing Gait, Balance, and Posture in Parkinson's Disease. Curr Neurol Neurosci Rep 2018; 18:23. [PMID: 29623455 DOI: 10.1007/s11910-018-0828-4] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
PURPOSE OF REVIEW Postural instability and gait difficulties inexorably worsen with Parkinson's disease (PD) progression and become treatment resistant, with a severe impact on autonomy and quality of life. We review the main characteristics of balance instability, gait disabilities, and static postural alterations in advanced PD, and the available treatment strategies. RECENT FINDINGS It remains very difficult to satisfactorily alleviate gait and postural disturbances in advanced PD. Medical and surgical interventions often fail to provide satisfactory or durable alleviation of these axial symptoms, that may actually call for differential treatments. Exercise and adapted physical activity programs can contribute to improving the patients' condition. Gait, balance, and postural disabilities are often lumped together under the Postural Instability and Gait Difficulties umbrella term. This may lead to sub-optimal patients' management as data suggest that postural, balance, and gait problems might depend on distinct underlying mechanisms. We advocate for a multidisciplinary approach from the day of diagnosis.
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Affiliation(s)
- Bettina Debû
- University Grenoble Alpes, Grenoble, France.
- INSERM U1216, Grenoble, France.
| | - Clecio De Oliveira Godeiro
- INSERM U1216, Grenoble, France
- Movement Disorders Unit, Division of Neurology, CHU Grenoble Alpes, Grenoble, France
- Division of Neurology, Federal University of Rio Grande do Norte, Natal, Brazil
| | - Jarbas Correa Lino
- INSERM U1216, Grenoble, France
- Movement Disorders Unit, Division of Neurology, CHU Grenoble Alpes, Grenoble, France
- Division of Neurology, CHU Amiens, Amiens, France
| | - Elena Moro
- University Grenoble Alpes, Grenoble, France
- INSERM U1216, Grenoble, France
- Movement Disorders Unit, Division of Neurology, CHU Grenoble Alpes, Grenoble, France
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22
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Incorporating oral health into interprofessional care teams for patients with Parkinson's disease. Parkinsonism Relat Disord 2017; 43:9-14. [DOI: 10.1016/j.parkreldis.2017.07.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Revised: 07/04/2017] [Accepted: 07/15/2017] [Indexed: 02/01/2023]
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23
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Nonnekes J, Timmer MHM, de Vries NM, Rascol O, Helmich RC, Bloem BR. Unmasking levodopa resistance in Parkinson's disease. Mov Disord 2016; 31:1602-1609. [PMID: 27430479 DOI: 10.1002/mds.26712] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Revised: 05/31/2016] [Accepted: 06/01/2016] [Indexed: 12/27/2022] Open
Abstract
Some motor and nonmotor features associated with Parkinson's disease (PD) do not seem to respond well to levodopa (or other forms of dopaminergic medication) or appear to become resistant to levodopa treatment with disease progression and longer disease duration. In this narrative review, we elaborate on this issue of levodopa resistance in PD. First, we discuss the possibility of pseudoresistance, which refers to dopamine-sensitive symptoms or signs that falsely appear to be (or have become) resistant to levodopa, when in fact other mechanisms are at play, resulting in suboptimal dopaminergic efficacy. Examples include interindividual differences in pharmacodynamics and pharmacokinetics and underdosing because of dose-limiting side effects or because of levodopa phobia. Moreover, pseudoresistance can emerge as not all features of PD respond adequately to the same dosage of levodopa. Second, we address that for several motor features (eg, freezing of gait or tremor) and several nonmotor features (eg, specific cognitive functions), the response to levodopa is fairly complex, with a combination of levodopa-responsive, levodopa-resistant, and even levodopa-induced characteristics. A possible explanation relates to the mixed presence of underlying dopaminergic and nondopaminergic brain lesions. We suggest that clinicians take these possibilities into account before concluding that symptoms or signs of PD are totally levodopa resistant. © 2016 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Jorik Nonnekes
- Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Department of Rehabilitation, Nijmegen, The Netherlands
| | - Monique H M Timmer
- Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, Nijmegen, The Netherlands
| | - Nienke M de Vries
- Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, Nijmegen, The Netherlands
| | - Olivier Rascol
- Department of Clinical Pharmacology and Neurosciences, NeuroToul Center of Excellence in Neurodegeneration (COEN), University Hospital and University of Toulouse, Toulouse, France.,INSERM CIC1436, UMR1214, and NS-Park/FCRIN Clinical Research Network Toulouse, Toulouse, France
| | - Rick C Helmich
- Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, Nijmegen, The Netherlands
| | - Bastiaan R Bloem
- Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, Nijmegen, The Netherlands
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