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Sauerbier A, Herberg J, Stopic V, Loehrer PA, Ashkan K, Rizos A, Jost ST, Petry-Schmelzer JN, Gronostay A, Schneider C, Visser-Vandewalle V, Evans J, Nimsky C, Fink GR, Antonini A, Martinez-Martin P, Silverdale M, Weintraub D, Schrag A, Ray Chaudhuri K, Timmermann L, Dafsari HS. Predictors of short-term anxiety outcome in subthalamic stimulation for Parkinson's disease. NPJ Parkinsons Dis 2024; 10:114. [PMID: 38851717 PMCID: PMC11162430 DOI: 10.1038/s41531-024-00701-6] [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: 09/21/2023] [Accepted: 04/02/2024] [Indexed: 06/10/2024] Open
Abstract
The effects of subthalamic nucleus deep brain stimulation (STN-DBS) on anxiety in Parkinson's disease (PD) are understudied. We identified clinical predictors of STN-DBS effects on anxiety in this study. In this prospective, open-label, multicentre study, we assessed patients with anxiety undergoing STN-DBS for PD preoperatively and at 6-month follow-up postoperatively. We assessed the Hospital Anxiety and Depression Scale (HADS-anxiety and depression subscales), Unified PD Rating Scale-motor examination, Scales for Outcomes in PD-motor (SCOPA-M)-activities of daily living (ADL) and -motor complications, Non-Motor Symptom Scale (NMSS), PDQuestionnaire-8 (PDQ-8), and levodopa-equivalent daily dose. We tested changes at follow-up with Wilcoxon signed-rank test and corrected for multiple comparisons (Bonferroni method). We identified patients with a clinically relevant anxiety improvement of anxiety based on a designated threshold of ½ standard deviation of baseline HADS-anxiety. Moreover, we investigated predictors of HADS-anxiety changes with correlations and linear regressions. We included 50 patients with clinically relevant baseline anxiety (i.e., HADS-anxiety ≥ 8) aged 63.1 years ± 8.3 with 10.4 years ± 4.5 PD duration. HADS-anxiety improved significantly at 6-month follow-up as 80% of our cohort experienced clinically relevant anxiety improvement. In predictor analyses, worse baseline SCOPA-ADL and NMSS-urinary domain were associated with greater HADS-anxiety improvements. HADS-anxiety and PDQ-8 changes correlated moderately. Worse preoperative ADL and urinary symptoms predicted favourable postoperative anxiety outcome, which in turn was directly proportionate to greater QoL improvement. This study highlights the importance of detailed anxiety assessments alongside other non-motor and motor symptoms when advising and monitoring patients undergoing STN-DBS for PD.
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Affiliation(s)
- Anna Sauerbier
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Neurology, Cologne, Germany.
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
| | - Johanna Herberg
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Neurology, Cologne, Germany
| | - Vasilija Stopic
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Neurology, Cologne, Germany
| | - Philipp A Loehrer
- Department of Neurology, University Hospital Giessen and Marburg, Campus Marburg, Marburg, Germany
| | - Keyoumars Ashkan
- Parkinson Foundation International Centre of Excellence, King's College Hospital, London, UK
| | - Alexandra Rizos
- Parkinson Foundation International Centre of Excellence, King's College Hospital, London, UK
| | - Stefanie T Jost
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Neurology, Cologne, Germany
| | - Jan Niklas Petry-Schmelzer
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Neurology, Cologne, Germany
| | - Alexandra Gronostay
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Neurology, Cologne, Germany
| | - Christian Schneider
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Neurology, Cologne, Germany
| | - Veerle Visser-Vandewalle
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Stereotactic and Functional Neurosurgery, Cologne, Germany
| | - Julian Evans
- Department of Neurology and Neurosurgery, Salford Royal NHS Foundation Trust, Manchester Academic Health Science Centre, Greater Manchester, UK
| | - Christopher Nimsky
- Department of Neurosurgery, University Hospital Giessen and Marburg, Campus Marburg, Marburg, Germany
| | - Gereon R Fink
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Neurology, Cologne, Germany
- Cognitive Neuroscience, Institute of Neuroscience and Medicine (INM-3), Research Centre Jülich, Jülich, Germany
| | - Angelo Antonini
- Parkinson and Movement Disorders Unit, Department of Neurosciences (DNS), University of Padua, Padova, Italy
| | - Pablo Martinez-Martin
- Center for Networked Biomedical Research in Neurodegenerative Diseases (CIBERNED), Carlos III Institute of Health, Madrid, Spain
| | - Monty Silverdale
- Department of Neurology and Neurosurgery, Salford Royal NHS Foundation Trust, Manchester Academic Health Science Centre, Greater Manchester, UK
| | - Daniel Weintraub
- Departments of Psychiatry and Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, 19104-2676, USA
| | - Anette Schrag
- Department of Clinical and Movement Neurosciences, UCL Institute of Neurology, University College London, London, UK
| | - K Ray Chaudhuri
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- Parkinson Foundation International Centre of Excellence, King's College Hospital, London, UK
| | - Lars Timmermann
- Department of Neurology, University Hospital Giessen and Marburg, Campus Marburg, Marburg, Germany
| | - Haidar S Dafsari
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Neurology, Cologne, Germany.
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Haliasos N, Giakoumettis D, Gnanaratnasingham P, Low HL, Misbahuddin A, Zikos P, Sakkalis V, Cleo S, Vakis A, Bisdas S. Personalizing Deep Brain Stimulation Therapy for Parkinson's Disease With Whole-Brain MRI Radiomics and Machine Learning. Cureus 2024; 16:e59915. [PMID: 38854362 PMCID: PMC11161197 DOI: 10.7759/cureus.59915] [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] [Accepted: 05/08/2024] [Indexed: 06/11/2024] Open
Abstract
Background Deep brain stimulation (DBS) is a well-recognised treatment for advanced Parkinson's disease (PD) patients. Structural brain alterations of the white matter can correlate with disease progression and act as a biomarker for DBS therapy outcomes. This study aims to develop a machine learning-driven predictive model for DBS patient selection using whole-brain white matter radiomics and common clinical variables. Methodology A total of 120 PD patients underwent DBS of the subthalamic nucleus. Their therapy effect was assessed at the one-year follow-up with the Unified Parkinson's Disease Rating Scale-part III (UPDRSIII) motor component. Radiomics analysis of whole-brain white matter was performed with PyRadiomics. The following machine learning methods were used: logistic regression (LR), support vector machine, naïve Bayes, K-nearest neighbours, and random forest (RF) to allow prediction of clinically meaningful UPRDSIII motor response before and after. Clinical variables were also added to the model to improve accuracy. Results The RF model showed the best performance on the final whole dataset with an area under the curve (AUC) of 0.99, accuracy of 0.95, sensitivity of 0.93, and specificity of 0.97. At the same time, the LR model showed an AUC of 0.93, accuracy of 0.88, sensitivity of 0.84, and specificity of 0.91. Conclusions Machine learning models can be used in clinical decision support tools which can deliver true personalised therapy recommendations for PD patients. Clinicians and engineers should choose between best-performing, less interpretable models vs. most interpretable, lesser-performing models. Larger clinical trials would allow to build trust among clinicians and patients to widely use these AI tools in the future.
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Affiliation(s)
- Nikolaos Haliasos
- Neurosurgery, Queen's Hospital, Romford, GBR
- Centre for Neuroscience, Surgery and Trauma, Blizard Institute, Queen Mary University, London, GBR
- Health and Medical Sciences, The Alan Turing Institute for Data Science and Artificial Intelligence, London, GBR
| | | | | | | | | | | | - Vangelis Sakkalis
- Institute of Computer Science, Foundation for Research and Technology, Heraklion, GRC
| | - Spanaki Cleo
- Neurology, School of Medicine, University of Crete, Heraklion, GRC
| | - Antonios Vakis
- Neurosurgery, School of Medicine, University of Crete, Heraklion, GRC
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Kähkölä J, Katisko J, Lahtinen M. Deep Brain Stimulation of Subthalamic Nucleus Improves Quality of Life in General and Mental Health Domains in Parkinson's Disease to the Level of the General Population. Neuromodulation 2024; 27:520-527. [PMID: 37086220 DOI: 10.1016/j.neurom.2023.03.007] [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: 12/17/2022] [Revised: 02/24/2023] [Accepted: 03/16/2023] [Indexed: 04/23/2023]
Abstract
OBJECTIVES Parkinson's disease (PD) leads to significant impairment in quality of life (QoL) across various domains. Deep brain stimulation of the subthalamic nucleus (STN-DBS) is known to improve motor and nonmotor symptoms in PD. The aim was to study whether STN-DBS could improve the QoL of patients with PD to the level of the general population, and to determine factors predicting better motor outcomes. MATERIALS AND METHODS The retrospective analysis included 43 patients who underwent either primary or revision STN-DBS. Patients filled out a general QoL questionnaire (RAND 36-item health survey) before and 12 months after surgery, and scores were compared with age- and sex-adjusted national population values. In addition, motor scores were calculated using Unified Parkinson Disease Rating Scale part 3 (UPDRS 3) with the best PD medication. Levodopa equivalent daily dose (LEDD) was also collected. Changes in the QoL were compared with operation age, disease duration, and preoperative QoL. RESULTS Preoperatively, patients had significantly impaired QoL in all subsections compared with that of the general population. The mean postoperative UPDRS 3 improvement was 50.0%, and reduction in LEDD was 69.0%. Statistically significant QoL improvements were found in Physical Function, Mental Health, Social Function, Vitality, and Role Physical 12 months postoperatively compared with baseline. The mean differences compared with a healthy population were not statistically significant in General Health, Mental Health, Vitality, and Role Emotional. Furthermore, disease duration was found to be negatively correlated with improvements in UPDRS 3 score, and worse preoperative QoL positively correlated with changes in Physical Function. CONCLUSIONS Patients experienced significant QoL improvements after STN-DBS. The General Health and Mental Health of patients were postoperatively most comparable with age- and sex-adjusted population values. Moreover, earlier stimulation predicted better motor improvements, which emphasizes the importance of earlier timing of STN-DBS surgery and minimizing loss of function at a critical disease stage.
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Affiliation(s)
- Johannes Kähkölä
- Oulu Research Group of Advanced Surgical Technologies and Physics, Medical Research Center, Oulu University Hospital, University of Oulu, Oulu, Finland; Research Unit of Clinical Medicine, University of Oulu, Oulu, Finland
| | - Jani Katisko
- Oulu Research Group of Advanced Surgical Technologies and Physics, Medical Research Center, Oulu University Hospital, University of Oulu, Oulu, Finland; Neurocenter, Oulu University Hospital, University of Oulu, Oulu, Finland; Research Unit of Clinical Medicine, University of Oulu, Oulu, Finland
| | - Maija Lahtinen
- Oulu Research Group of Advanced Surgical Technologies and Physics, Medical Research Center, Oulu University Hospital, University of Oulu, Oulu, Finland; Neurocenter, Oulu University Hospital, University of Oulu, Oulu, Finland; Research Unit of Clinical Medicine, University of Oulu, Oulu, Finland.
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Semmler C, Stopic V, Jost ST, Fink GR, Weiss PH, Barbe MT. Preoperative motor deficits and depressive symptoms predict quality of life in patients with Parkinson's disease at different time points after surgery for subthalamic stimulation: a retrospective study. Neurol Res Pract 2024; 6:8. [PMID: 38326916 PMCID: PMC10851535 DOI: 10.1186/s42466-023-00303-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 12/11/2023] [Indexed: 02/09/2024] Open
Abstract
BACKGROUND While subthalamic nucleus deep brain stimulation (STN-DBS) improves the quality of life (QoL) of patients with Parkinson's disease (PD), the clinical parameters that predict this improvement remain debated. This retrospective study explored whether preoperative motor, cognitive, and affective parameters predict QoL or its components at 6 and 12 months after STN-DBS surgery. METHODS QoL was assessed with the Parkinson's Disease Questionnaire-39 (PDQ-39) before (baseline), at 6 months (N = 90) and 12 months (N = 63) after STN-DBS surgery. Changes in the PDQ-39 and its subdomains were analysed with Wilcoxon signed-rank tests. In total, seven motor, cognitive, and affective parameters recorded at baseline were used in multiple linear regressions to predict QoL and its subdomains. RESULTS QoL had improved significantly at six months post STN-DBS surgery. After 12 months, this effect remained significant but was less pronounced. At both time points, significant improvements in mobility, activities of daily living, stigma, and bodily discomfort were present. Correlation and linear regression analyses showed that preoperative QoL status and changes in QoL at 6 and 12 months after surgery were driven by preoperative dopaminergic medication, as well as motor (UPDRS-III medOFF and PIGD-subscore medOFF) and affective (HADS anxiety and depression) symptoms. In contrast, preoperative cognitive performance did not predict QoL at any time point. CONCLUSION Data show that preoperative motor and affective symptoms drive both QoL baseline status and changes in QoL after STN-DBS surgery. Thus, these clinical parameters need to be assessed appropriately to provide comprehensive presurgical advice to patients suffering from PD.
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Affiliation(s)
- Carolin Semmler
- Faculty of Medicine, University of Cologne, Cologne, Germany.
- Department of Neurology, University Hospital Cologne, Cologne, Germany.
| | - Vasilija Stopic
- Faculty of Medicine, University of Cologne, Cologne, Germany
- Department of Neurology, University Hospital Cologne, Cologne, Germany
| | - Stefanie T Jost
- Faculty of Medicine, University of Cologne, Cologne, Germany
- Department of Neurology, University Hospital Cologne, Cologne, Germany
| | - Gereon R Fink
- Faculty of Medicine, University of Cologne, Cologne, Germany
- Department of Neurology, University Hospital Cologne, Cologne, Germany
- Cognitive Neuroscience, Institute of Neuroscience and Medicine (INM-3), Forschungszentrum Jülich, Jülich, Germany
| | - Peter H Weiss
- Faculty of Medicine, University of Cologne, Cologne, Germany
- Department of Neurology, University Hospital Cologne, Cologne, Germany
- Cognitive Neuroscience, Institute of Neuroscience and Medicine (INM-3), Forschungszentrum Jülich, Jülich, Germany
| | - Michael T Barbe
- Faculty of Medicine, University of Cologne, Cologne, Germany
- Department of Neurology, University Hospital Cologne, Cologne, Germany
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Gao Y, Wang J, Wang L, Li D, Sun B, Qiu X. Preoperative Attention/Memory Problem Affects the Quality of Life of Parkinson's Disease Patients after Deep Brain Stimulation: A Cohort Study. PARKINSON'S DISEASE 2024; 2024:3651705. [PMID: 38356939 PMCID: PMC10866634 DOI: 10.1155/2024/3651705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 12/17/2023] [Accepted: 01/24/2024] [Indexed: 02/16/2024]
Abstract
Objectives The aim of this study was to investigate the impact of nonmotor symptoms (NMS) on the quality of life (QoL) outcome after subthalamic nucleus deep brain stimulation (STN-DBS) at the 1-year follow-up. Methods Ninety-three patients diagnosed with Parkinson's disease (PD), who underwent subthalamic nucleus deep brain stimulation (STN-DBS) between April 2020 and August 2021, were included in this study. Demographic information was gathered through a self-designed questionnaire. The severity of both motor and non-motor symptoms, along with the quality of life (QoL), was assessed using the Unified Parkinson's Disease Rating Scale-III (UPDRS-III), Nonmotor Symptoms Scale (NMSS), and 8-item Parkinson's Disease Questionnaire (PDQ-8), respectively. Results Significant differences were observed in the UPDRS-III score, NMSS summary index (SI), and subscores of six domains (sleep/fatigue, mood/cognition, perceptual problems/hallucinations, attention/memory, urinary, and sexual function) between the baseline and the 6- and 12-month follow-ups. The correlation analysis revealed positive correlations between the preoperative NMSS SI and subscores of seven domains (cardiovascular, sleep/fatigue, mood/cognition, perceptual problems/hallucinations, attention/memory, gastrointestinal, and urinary) and ΔPDQ-8. Moreover, the preoperative PDQ-8 SI (β = 0.869, P < 0.001) and the preoperative attention/memory subscore (β = -0.154, P = 0.026) were predictive of the postsurgery improvement in quality of life (QoL). Conclusion Deep brain stimulation (DBS) led to an improvement in the patients' nonmotor symptoms (NMS) at the 1-year follow-up, along with a correlation observed between NMS and the patients' quality of life (QoL). Notably, the severity of preoperative attention/memory problems emerged as the most significant predictor of NMS influencing the QoL outcome after STN-DBS at the 1-year follow-up.
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Affiliation(s)
- Ying Gao
- Department of Nursing, Ruijin Hospital, Shanghai Jiao Tong University, Shanghai, China
- Public Health Department, Hongqiao International Institute of Medicine, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Institute of Health Informatics, University College London, London, UK
| | - Jue Wang
- Department of Nursing, Ruijin Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Linbin Wang
- Department of Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Dianyou Li
- Department of Neurosurgery, Ruijin Hospital, 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
| | - Xian Qiu
- Department of Nursing, Ruijin Hospital, Shanghai Jiao Tong University, Shanghai, China
- Department of Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Hong J, Xie H, Chen Y, Liu D, Wang T, Xiong K, Mao Z. Effects of STN-DBS on cognition and mood in young-onset Parkinson's disease: a two-year follow-up. Front Aging Neurosci 2024; 15:1177889. [PMID: 38292047 PMCID: PMC10824910 DOI: 10.3389/fnagi.2023.1177889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 12/26/2023] [Indexed: 02/01/2024] Open
Abstract
Background The effects of subthalamic nucleus deep brain stimulation (STN-DBS) on the cognition and mood of patients with PD are still not uniformly concluded, and young-onset Parkinson's disease (YOPD) is even less explored. Objective To observe the effectiveness of STN-DBS on the cognition and mood of YOPD patients. Methods A total of 27 subjects, with a mean age at onset of 39.48 ± 6.24 and age at surgery for STN-DBS of 48.44 ± 4.85, were followed up preoperatively and for 2 years postoperatively. Using the Unified Parkinson disease rating scale (UPDRS), H&Y(Hoehn and Yahr stage), 39-Item Parkinson's Disease Questionnaire (PDQ-39), Mini-mental state examination (MMSE), Montreal Cognitive Assessment (MoCA), Hamilton depression scale (HAMD), Hamilton anxiety scale (HAMA) to assess motor, cognition, and mood. Results At the 2-year follow-up after STN-DBS, YOPD patients showed significant improvements in motor and quality of life (UPDRS III: p < 0.001, PDQ-39: p < 0.001); overall cognition was not significantly different from preoperative (MMSE: p = 0.275, MoCA: p = 0.913), although language function was significantly impaired compared to preoperative (MMSE: p = 0.004, MoCA: p = 0.009); depression and anxiety symptoms also improved significantly (HAMD: p < 0.001, HAMA: p < 0.001) and the depression score correlated significantly with motor (preoperative: r = 0.493, p = 0.009), disease duration (preoperative: r = 0.519, p = 0.006; postoperative: r = 0.406, p = 0.036) and H&Y (preoperative: r = 0.430, p = 0.025; postoperative: r = 0.387, p = 0.046); total anxiety scores were also significantly correlated with motor (preoperative: r = 0.553, p = 0.003; postoperative: r = 0.444, p = 0.020), disease duration (preoperative: r = 0.417, p = 0.031), PDQ-39 (preoperative: r = 0.464, p = 0.015) and H&Y (preoperative: r = 0.440, p = 0.022; postoperative: r = 0.526, p = 0.005). Conclusion STN-DBS is a safe and effective treatment for YOPD. The mood improved significantly, and overall cognition was not impaired, were only verbal fluency decreased but did not affect the improvement in quality of life.
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Affiliation(s)
- Jun Hong
- Department of Anatomy and Neurobiology, School of Basic Medical Science, Central South University, Changsha, China
- Department of Neurosurgery, The First Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - Huimin Xie
- Department of Neurosurgery, The First Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - Yuhua Chen
- Department of Anatomy and Neurobiology, School of Basic Medical Science, Central South University, Changsha, China
| | - Di Liu
- Department of Neurosurgery, The First Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - Tianyu Wang
- Department of Neurosurgery, The First Medical Centre, Chinese PLA General Hospital, Beijing, China
- Hebei Key Laboratory of Nerve Injury and Repair, Chengde Medical University, Chengde, China
| | - Kun Xiong
- Department of Anatomy and Neurobiology, School of Basic Medical Science, Central South University, Changsha, China
- Key Laboratory of Emergency and Trauma, Ministry of Education, College of Emergency and Trauma, Hainan Medical University, Haikou, China
- Hunan Key Laboratory of Ophthalmology, Central South University, Changsha, China
| | - Zhiqi Mao
- Department of Neurosurgery, The First Medical Centre, Chinese PLA General Hospital, Beijing, China
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Jost ST, Aloui S, Evans J, Ashkan K, Sauerbier A, Rizos A, Petry-Schmelzer JN, Gronostay A, Fink GR, Visser-Vandewalle V, Antonini A, Silverdale M, Timmermann L, Martinez-Martin P, Chaudhuri KR, Dafsari HS. Neurostimulation for Advanced Parkinson Disease and Quality of Life at 5 Years: A Nonrandomized Controlled Trial. JAMA Netw Open 2024; 7:e2352177. [PMID: 38236600 PMCID: PMC10797423 DOI: 10.1001/jamanetworkopen.2023.52177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 11/29/2023] [Indexed: 01/19/2024] Open
Abstract
Importance Deep brain stimulation of the subthalamic nucleus (STN-DBS) improves quality of life (QOL) in patients with advanced Parkinson disease (PD). However, controlled studies with more than 3 years of follow-up are lacking. Objective To investigate the long-term effects of STN-DBS on QOL compared with standard-of-care medication (MED). Design, Setting, and Participants In this prospective, observational, quasi-experimental, longitudinal nonrandomized controlled trial, 183 patients were screened for eligibility and 167 were enrolled from March 1, 2011, to May 31, 2017, at 3 European university centers. Propensity score matching for demographic and clinical characteristics was applied to 108 patients with PD (62 in the STN-DBS group and 46 in the MED group), resulting in a well-balanced, matched subcohort of 25 patients per group. Data analysis was performed from September 2022 to January 2023. Exposure Treatment for PD of STN-DBS or MED. Main Outcomes and Measures Assessments included Parkinson's Disease Questionnaire 8 (PDQ-8), Unified PD Rating Scale-motor examination, Scales for Outcomes in PD-activities of daily living (ADL) and motor complications, and levodopa-equivalent daily dose. Within-group longitudinal outcome changes, between-group differences, and correlations of change scores were analyzed. Results The study population in the analysis included 108 patients (mean [SD] age, 63.7 [8.3] years; 66 [61.1%] male). At 5-year follow-up, PDQ-8 and ADL worsened only in the MED group (PDQ-8 change, -10.9; 95% CI, -19.0 to -2.7; P = .01; ADL change: -2.0; 95% CI, -3.1 to -0.8; P = .002), whereas both outcomes remained stable in the STN-DBS group (PDQ-8 change, -4.3; 95% CI, -13.2 to 4.7; P = .34; ADL change, -0.8; 95% CI, -2.5 to 1.0; P = .38). Changes in PDQ-8 and ADL correlated moderately (rs = .40, P = .008). Furthermore, STN-DBS outcomes were favorable for motor complications (median difference in change scores between STN-DBS and MED, -2.0; 95% CI, -4.0 to -1.0; P = .003), mobility (-1.0; 95% CI, -2.0 to 0; P = .03), and levodopa-equivalent daily dose reduction (-821.4; 95% CI, -1111.9 to -530.8; P < .001). Conclusions and Relevance This study provides evidence of differences in QOL outcomes at 5-year follow-up between STN-DBS (stable) and MED (worsened), mainly driven by the favorable effect of STN-DBS on mobility (class IIb evidence). The association between changes in QOL and ADL, but not motor impairment or complications, highlights the relative importance of ADL outcomes for long-term DBS assessments. Trial Registration German ClinicalTrials Registry: DRKS00006735.
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Affiliation(s)
- Stefanie T. Jost
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Neurology, Cologne, Germany
| | - Salima Aloui
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Neurology, Cologne, Germany
| | - Julian Evans
- Department of Neurology and Neurosurgery, Salford Royal NHS Foundation Trust, Manchester, UK
| | - Keyoumars Ashkan
- Parkinson Foundation International Centre of Excellence, King’s College Hospital, London, UK
- Academic Health Science Centre, University of Manchester, Greater Manchester, UK
| | - Anna Sauerbier
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Neurology, Cologne, Germany
| | - Alexandra Rizos
- Parkinson Foundation International Centre of Excellence, King’s College Hospital, London, UK
- Academic Health Science Centre, University of Manchester, Greater Manchester, UK
| | - Jan Niklas Petry-Schmelzer
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Neurology, Cologne, Germany
| | - Alexandra Gronostay
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Neurology, Cologne, Germany
| | - Gereon R. Fink
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Neurology, Cologne, Germany
- Cognitive Neuroscience, Institute of Neuroscience and Medicine (INM-3), Research Centre Jülich, Jülich, Germany
| | - Veerle Visser-Vandewalle
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Stereotactic and Functional Neurosurgery, Cologne, Germany
| | - Angelo Antonini
- Department of Neurosciences (DNS), Padova University, Padova, Italy
| | - Monty Silverdale
- Department of Neurology and Neurosurgery, Salford Royal NHS Foundation Trust, Manchester, UK
| | - Lars Timmermann
- Department of Neurology, University Hospital Giessen and Marburg, Campus Marburg, Marburg, Germany
| | - Pablo Martinez-Martin
- Center for Networked Biomedical Research in Neurodegenerative Diseases (CIBERNED), Carlos III Institute of Health, Madrid, Spain
| | - K. Ray Chaudhuri
- Parkinson Foundation International Centre of Excellence, King’s College Hospital, London, UK
- Academic Health Science Centre, University of Manchester, Greater Manchester, UK
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
- NIHR Mental Health Biomedical Research Centre and Dementia Biomedical Research Unit, South London and Maudsley NHS Foundation Trust and King’s College London, London, UK
| | - Haidar S. Dafsari
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Neurology, Cologne, Germany
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Pal G, Corcos DM, Metman LV, Israel Z, Bergman H, Arkadir D. Cognitive Effects of Subthalamic Nucleus Deep Brain Stimulation in Parkinson's Disease with GBA1 Pathogenic Variants. Mov Disord 2023; 38:2155-2162. [PMID: 37916476 PMCID: PMC10990226 DOI: 10.1002/mds.29647] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 10/09/2023] [Accepted: 10/13/2023] [Indexed: 11/03/2023] Open
Abstract
Genetic subtyping of patients with Parkinson's disease (PD) may assist in predicting the cognitive and motor outcomes of subthalamic deep brain stimulation (STN-DBS). Practical questions were recently raised with the emergence of new data regarding suboptimal cognitive outcomes after STN-DBS in individuals with PD associated with pathogenic variants in glucocerebrosidase gene (GBA1-PD). However, a variety of gaps and controversies remain. (1) Does STN-DBS truly accelerate cognitive deterioration in GBA1-PD? If so, what is the clinical significance of this acceleration? (2) How should the overall risk-to-benefit ratio of STN-DBS in GBA1-PD be established? (3) If STN-DBS has a negative effect on cognition in GBA1-PD, how can this effect be minimized? (4) Should PD patients be genetically tested before STN-DBS? (5) How should GBA1-PD patients considering STN-DBS be counseled? We aim to summarize the currently available relevant data and detail the gaps and controversies that exist pertaining to these questions. In the absence of evidence-based data, all authors strongly agree that clinicians should not categorically deny DBS to PD patients based solely on genotype (GBA1 status). We suggest that PD patients considering DBS may be offered genetic testing for GBA1, where available and feasible, so the potential risks and benefits of STN-DBS can be properly weighed by both the patient and clinician. © 2023 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Gian Pal
- Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, United States
| | - Daniel M. Corcos
- Department of Physical Therapy and Human Movement Sciences, Northwestern University, Chicago, Illinois, United States
| | - Leo Verhagen Metman
- Parkinson’s Disease and Movement Disorders Center, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Zvi Israel
- Faculty of Medicine, The Hebrew University and Hadassah, Jerusalem, Jerusalem, Israel
- Department of Neurosurgery, Hadassah Medical Center, Jerusalem, Israel
| | - Hagai Bergman
- Faculty of Medicine, The Hebrew University and Hadassah, Jerusalem, Jerusalem, Israel
- Department of Medical Neurobiology, Institute of Medical Research Israel–Canada (IMRIC), The Hebrew University–Hadassah Medical School, Jerusalem, Israel
- The Edmond and Lily Safra Center for Brain Sciences, The Hebrew University, Jerusalem, Israel
| | - David Arkadir
- Faculty of Medicine, The Hebrew University and Hadassah, Jerusalem, Jerusalem, Israel
- Department of Neurology, Hadassah Medical Center, Jerusalem, Israel
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9
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Song YT, Liu YB, Xiang HB, Manyande A, He ZG. The Application of Deep Brain Stimulation for Parkinson's Disease on the Motor Pathway: A Bibliometric Analysis across 10 Years. Curr Med Sci 2023; 43:1247-1257. [PMID: 38153631 DOI: 10.1007/s11596-023-2811-9] [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: 08/08/2023] [Accepted: 09/27/2023] [Indexed: 12/29/2023]
Abstract
BACKGROUND AND OBJECTIVE Since its initial report by James Parkinson in 1817, Parkinson's disease (PD) has remained a central subject of research and clinical advancement. The disease is estimated to affect approximately 1% of adults aged 60 and above. Deep brain stimulation, emerging as an alternative therapy for end-stage cases, has offered a lifeline to numerous patients. This review aimed to analyze publications pertaining to the impact of deep brain stimulation on the motor pathway in patients with PD over the last decade. METHODS Data were obtained from the Web of Science Core Collection through the library of Huazhong University of Science and Technology (China). The search strategy encompassed the following keywords: "deep brain stimulation", "Parkinson's disease", "motor pathway", and "human", from January 1, 2012, to December 1, 2022. Additionally, this review visualized the findings using the Citespace software. RESULTS The results indicated that the United States, the United Kingdom, Germany, and China were the primary contributors to this research field. University College London, Capital Medical University, and Maastricht University were the top 3 research institutions in the research area. Tom Foltynie ranked first with 6 publications, and the journals of Brain and Brain Stimulation published the greatest number of relevant articles. The prevailing research focal points in this domain, as determined by keywords "burst analysis", "encompassed neuronal activity", "nucleus", "hyper direct pathway", etc. CONCLUSION: This study has provided a new perspective through bibliometric analysis of the deep brain stimulation therapy for treating patients with PD, which can shed light on future research to advance our comprehension of this particular field of study.
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Affiliation(s)
- Yong-Tang Song
- Medical Association of Hubei Province, Wuhan, 430060, China
| | - Yan-Bo Liu
- Department of Anesthesiology, Hubei Key Laboratory of Geriatric Anesthesia and Perioperative Brain Health, Wuhan Clinical Research Center for Geriatric Anesthesia, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Hong-Bing Xiang
- Department of Anesthesiology, Hubei Key Laboratory of Geriatric Anesthesia and Perioperative Brain Health, Wuhan Clinical Research Center for Geriatric Anesthesia, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Anne Manyande
- School of Human and Social Sciences, University of West London, London, 0044, UK
| | - Zhi-Gang He
- Department of Anesthesiology, Hubei Key Laboratory of Geriatric Anesthesia and Perioperative Brain Health, Wuhan Clinical Research Center for Geriatric Anesthesia, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.
- Department of Emergency Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.
- Department of Critical Care Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.
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10
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Xu W, Wang J, Li XN, Liang J, Song L, Wu Y, Liu Z, Sun B, Li WG. Neuronal and synaptic adaptations underlying the benefits of deep brain stimulation for Parkinson's disease. Transl Neurodegener 2023; 12:55. [PMID: 38037124 PMCID: PMC10688037 DOI: 10.1186/s40035-023-00390-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 11/19/2023] [Indexed: 12/02/2023] Open
Abstract
Deep brain stimulation (DBS) is a well-established and effective treatment for patients with advanced Parkinson's disease (PD), yet its underlying mechanisms remain enigmatic. Optogenetics, primarily conducted in animal models, provides a unique approach that allows cell type- and projection-specific modulation that mirrors the frequency-dependent stimulus effects of DBS. Opto-DBS research in animal models plays a pivotal role in unraveling the neuronal and synaptic adaptations that contribute to the efficacy of DBS in PD treatment. DBS-induced neuronal responses rely on a complex interplay between the distributions of presynaptic inputs, frequency-dependent synaptic depression, and the intrinsic excitability of postsynaptic neurons. This orchestration leads to conversion of firing patterns, enabling both antidromic and orthodromic modulation of neural circuits. Understanding these mechanisms is vital for decoding position- and programming-dependent effects of DBS. Furthermore, patterned stimulation is emerging as a promising strategy yielding long-lasting therapeutic benefits. Research on the neuronal and synaptic adaptations to DBS may pave the way for the development of more enduring and precise modulation patterns. Advanced technologies, such as adaptive DBS or directional electrodes, can also be integrated for circuit-specific neuromodulation. These insights hold the potential to greatly improve the effectiveness of DBS and advance PD treatment to new levels.
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Affiliation(s)
- Wenying Xu
- Department of Rehabilitation Medicine, Huashan Hospital, Institute for Translational Brain Research, State Key Laboratory of Medical Neurobiology and Ministry of Education Frontiers Center for Brain Science, Fudan University, Shanghai, 200032, China
- Department of Neurosurgery, Center for Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Jie Wang
- Department of Rehabilitation Medicine, Huashan Hospital, Institute for Translational Brain Research, State Key Laboratory of Medical Neurobiology and Ministry of Education Frontiers Center for Brain Science, Fudan University, Shanghai, 200032, China
- Department of Neurology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200092, China
| | - Xin-Ni Li
- Department of Rehabilitation Medicine, Huashan Hospital, Institute for Translational Brain Research, State Key Laboratory of Medical Neurobiology and Ministry of Education Frontiers Center for Brain Science, Fudan University, Shanghai, 200032, China
| | - Jingxue Liang
- Department of Rehabilitation Medicine, Huashan Hospital, Institute for Translational Brain Research, State Key Laboratory of Medical Neurobiology and Ministry of Education Frontiers Center for Brain Science, Fudan University, Shanghai, 200032, China
- Department of Neurology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200092, China
| | - Lu Song
- Department of Neurology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200092, China
| | - Yi Wu
- Department of Rehabilitation Medicine, Huashan Hospital, Institute for Translational Brain Research, State Key Laboratory of Medical Neurobiology and Ministry of Education Frontiers Center for Brain Science, Fudan University, Shanghai, 200032, China
| | - Zhenguo Liu
- Department of Neurology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200092, China.
| | - Bomin Sun
- Department of Neurosurgery, Center for Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China.
| | - Wei-Guang Li
- Department of Rehabilitation Medicine, Huashan Hospital, Institute for Translational Brain Research, State Key Laboratory of Medical Neurobiology and Ministry of Education Frontiers Center for Brain Science, Fudan University, Shanghai, 200032, China.
- Ministry of Education-Shanghai Key Laboratory for Children's Environmental Health, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200092, China.
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11
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Hall D. Device-aided therapies for Parkinson's disease: "All for one, one for all, that is our device". Parkinsonism Relat Disord 2023; 116:105862. [PMID: 37778884 DOI: 10.1016/j.parkreldis.2023.105862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/03/2023]
Affiliation(s)
- Deborah Hall
- Department of Neurological Sciences, Rush University Medical Center, 1725 West Harrison, Suite 755, Chicago, IL, 60612, USA.
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12
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Wolke R, Becktepe JS, Paschen S, Helmers A, Kübler‐Weller D, Youn J, Brinker D, Bergman H, Kühn AA, Fasano A, Deuschl G. The Role of Levodopa Challenge in Predicting the Outcome of Subthalamic Deep Brain Stimulation. Mov Disord Clin Pract 2023; 10:1181-1191. [PMID: 37635781 PMCID: PMC10450242 DOI: 10.1002/mdc3.13825] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 05/14/2023] [Accepted: 06/14/2023] [Indexed: 08/29/2023] Open
Abstract
Background Deep brain stimulation of the subthalamic nucleus (STN-DBS) is an effective and evidence-based treatment for idiopathic Parkinson's disease (iPD). A minority of patients does not sufficiently benefit from STN-DBS. Objective The predictive validity of the levodopa challenge for individual patients is analyzed. Methods Data from patients assessed with a preoperative Levodopa-test and a follow-up examination (mean ± standard deviation: 9.15 months ±3.39) from Kiel (n = 253), Berlin (n = 78) and Toronto (n = 98) were studied. Insufficient DBS outcome was defined as an overall UPDRS-III reduction <33% compared to UPDRS-III in med-off at baseline or alternatively if the minimal clinically important improvement of 5 points was not reached. Single UPDRS-items and sub-scores were dichotomized. Following exploratory analysis, we trained supervised regression- and classification models for outcome prediction. Results Data analysis confirmed significant correlation between the absolute UPDRS-III reduction during Levodopa challenge and after stimulation. But individual improvement was inaccurately predicted with a large range of up to 30 UPDRS III points. Further analysis identified preoperative UPDRS-III/med-off-scores and preoperative Levodopa-improvement as most influential factors. The models for UPDRS-III and sub-scores improvement achieved comparably low accuracy. Conclusions With large prediction intervals, the Levodopa challenge use for patient counseling is limited, though remains important for excluding non-responders to Levodopa. Despite these deficiencies, the current practice of patient selection is highly successful and builds not only on the Levodopa challenge. However, more specific motor tasks and further paraclinical tools for prediction need to be developed.
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Affiliation(s)
- Robin Wolke
- Department of NeurologyUKSH, Christian‐Albrechts University KielKielGermany
| | | | - Steffen Paschen
- Department of NeurologyUKSH, Christian‐Albrechts University KielKielGermany
| | - Ann‐Kristin Helmers
- Department of NeurosurgeryUKSH, Christian‐Albrechts University KielKielGermany
| | - Dorothee Kübler‐Weller
- Movement Disorder and Neuromodulation Unit, Department of NeurologyCharité–UniversitätsmedizinBerlinGermany
| | - Jinyoung Youn
- Department of Neurology, Samsung Medical CenterSchool of medicine Sungkyunkwan UniversitySeoulSouth Korea
| | - Dana Brinker
- Department of NeurologyUKSH, Christian‐Albrechts University KielKielGermany
| | - Hagai Bergman
- The Edmond andLily Safra Center for Brain Sciences (ELSC)The Hebrew UniversityJerusalemIsrael
- Department of Medical Neurobiology (Physiology), Institute of Medical Research‐Israel Canada (IMRIC), Faculty of MedicineThe Hebrew UniversityJerusalemIsrael
- Department of Neurosurgery, Hadassah Medical CenterThe Hebrew UniversityJerusalemIsrael
| | - Andrea A. Kühn
- Movement Disorder and Neuromodulation Unit, Department of NeurologyCharité–UniversitätsmedizinBerlinGermany
| | - Alfonso Fasano
- Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders ClinicToronto Western Hospital, UHNTorontoOntarioCanada
- Division of NeurologyUniversity of TorontoTorontoOntarioCanada
- Krembil Brain InstituteTorontoOntarioCanada
- Center for Advancing Neurotechnological Innovation to Application (CRANIA)TorontoOntarioCanada
| | - Günther Deuschl
- Department of NeurologyUKSH, Christian‐Albrechts University KielKielGermany
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13
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Geraedts VJ, van Vugt JPP, Marinus J, Kuiper R, Middelkoop HAM, Zutt R, van der Gaag NA, Hoffmann CFE, Dorresteijn LDA, van Hilten JJ, Contarino MF. Predicting Motor Outcome and Quality of Life After Subthalamic Deep Brain Stimulation for Parkinson's Disease: The Role of Standard Screening Measures and Wearable-Data. JOURNAL OF PARKINSON'S DISEASE 2023:JPD225101. [PMID: 37182900 DOI: 10.3233/jpd-225101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
BACKGROUND Standardized screening for subthalamic deep brain stimulation (STN DBS) in Parkinson's disease (PD) patients is crucial to determine eligibility, but its utility to predict postoperative outcomes in eligible patients is inconclusive. It is unknown whether wearable data can contribute to this aim. OBJECTIVE To evaluate the utility of universal components incorporated in the DBS screening, complemented by a wearable sensor, to predict motor outcomes and Quality of life (QoL) one year after STN DBS surgery. METHODS Consecutive patients were included in the OPTIMIST cohort study from two DBS centers. Standardized assessments included a preoperative Levodopa Challenge Test (LCT), and questionnaires on QoL and non-motor symptoms including cognition, psychiatric symptoms, impulsiveness, autonomic symptoms, and sleeping problems. Moreover, an ambulatory wearable sensor (Parkinson Kinetigraph (PKG)) was used. Postoperative assessments were similar and also included a Stimulation Challenge Test to determine DBS effects on motor function. RESULTS Eighty-three patients were included (median (interquartile range) age 63 (56-68) years, 36% female). Med-OFF (Stim-OFF) motor severity deteriorated indicating disease progression, but patients significantly improved in terms of Med-ON (Stim-ON) motor function, motor fluctuations, QoL, and most non-motor domains. Motor outcomes were not predicted by preoperative tests, including covariates of either LCT or PKG. Postoperative QoL was predicted by better preoperative QoL, lower age, and more preoperative impulsiveness scores in multivariate models. CONCLUSION Data from the DBS screening including wearable data do not predict postoperative motor outcome at one year. Post-DBS QoL appears primarily driven by non-motor symptoms, rather than by motor improvement.
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Affiliation(s)
- Victor J Geraedts
- Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
| | | | - Johan Marinus
- Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands
| | - Roy Kuiper
- Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands
- Department of Neurology, HAGA Teaching Hospital, Den Haag, the Netherlands
| | - Huub A M Middelkoop
- Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands
| | - Rodi Zutt
- Department of Neurology, HAGA Teaching Hospital, Den Haag, the Netherlands
| | - Niels A van der Gaag
- Department of Neurosurgery, HAGA Teaching Hospital, Den Haag, the Netherlands
- Department of Neurosurgery, Leiden University Medical Center, Leiden, the Netherlands
| | - Carel F E Hoffmann
- Department of Neurosurgery, HAGA Teaching Hospital, Den Haag, the Netherlands
| | | | - Jacobus J van Hilten
- Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands
| | - Maria Fiorella Contarino
- Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands
- Department of Neurology, HAGA Teaching Hospital, Den Haag, the Netherlands
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14
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Nguyen AL, Hussain MA, Pasipanodya E, Rubtsova AA, Moore RC, Jeste DV, Moore DJ. The impact of life stress, psychological resources, and proactive behaviors on quality of life among people living with HIV. Aging Ment Health 2023; 27:948-956. [PMID: 35486380 PMCID: PMC9943531 DOI: 10.1080/13607863.2022.2068126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 04/08/2022] [Indexed: 02/01/2023]
Abstract
OBJECTIVES Quality of life (QoL) is an important consideration for people living with HIV (PWH). We investigated the relationship between stress, psychological resources, and proactive behaviors, on QoL (conceptualized as life satisfaction, successful aging, and depressive symptoms) by testing the hypotheses: (1) greater life stress (stress and functional impairment) is associated with poorer QoL; (2) resources (mastery, resilience, and social support) are associated with better QoL, beyond the influence of stress; and (3) proactive behaviors (medication management and leisure activities) mediate the relationship between resources and QoL. METHODS Secondary analyses were performed (N = 128 PWH). Participants' mean age was 52.3, 83.6% were male, and 53.9 identified as white. Multivariate regressions were performed within the context of path analyses. RESULTS In series 1, greater stress was associated with poorer life satisfaction (p < 0.001), lower self-rated successful aging (p < 0.001), and greater depression (p < 0.001). Functional impairment was associated with lower successful aging (p = 0.017) and greater depression (p = 0.001). In series 2, which accounted for mastery, resilience, social support, as well as demographic covariates, mastery was associated with greater life satisfaction (p = 0.038). In series 3, stress, functional impairment, leisure activities, and ART management were added to the model and social support was associated with engagement in leisure activities (p < 0.001), which was associated with better successful aging (p = 0.006). Fit indices suggested adequate relative fit. In bootstrapped analyses of indirect effects, social support was indirectly associated with successful aging through leisure activities (p = 0.020). CONCLUSIONS QoL, as captured by self-rated successful aging, is threatened by stress but positively influenced by social support and engaging in leisure activities. Findings support a model of proactive successful aging for PWH.
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Affiliation(s)
- Annie L. Nguyen
- Department of Family Medicine, University of Southern California, Los Angeles, CA, USA
| | - Mariam A. Hussain
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
- Joint Doctoral Program in Clinical Psychology, San Diego State University and University of California San Diego, San Diego, CA, USA
| | | | - Anna A. Rubtsova
- Department of Behavioral, Social, and Health Education Sciences, Emory University, Atlanta, GA, USA
| | - Raeanne C. Moore
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
| | - Dilip V. Jeste
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
| | - David J. Moore
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
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15
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Kremer NI, van Laar T, Lange SF, Statius Muller S, la Bastide-van Gemert S, Oterdoom DM, Drost G, van Dijk JMC. STN-DBS electrode placement accuracy and motor improvement in Parkinson's disease: systematic review and individual patient meta-analysis. J Neurol Neurosurg Psychiatry 2023; 94:236-244. [PMID: 36207065 DOI: 10.1136/jnnp-2022-329192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Accepted: 09/21/2022] [Indexed: 11/05/2022]
Abstract
Deep brain stimulation (DBS) of the subthalamic nucleus (STN) is an effective neurosurgical treatment for Parkinson's disease. Surgical accuracy is a critical determinant to achieve an adequate DBS effect on motor performance. A two-millimetre surgical accuracy is commonly accepted, but scientific evidence is lacking. A systematic review and meta-analysis of study-level and individual patient data (IPD) was performed by a comprehensive search in MEDLINE, EMBASE and Cochrane Library. Primary outcome measures were (1) radial error between the implanted electrode and target; (2) DBS motor improvement on the Unified Parkinson's Disease Rating Scale part III (motor examination). On a study level, meta-regression analysis was performed. Also, publication bias was assessed. For IPD meta-analysis, a linear mixed effects model was used. Forty studies (1391 patients) were included, reporting radial errors of 0.45-1.86 mm. Errors within this range did not significantly influence the DBS effect on motor improvement. Additional IPD analysis (206 patients) revealed that a mean radial error of 1.13±0.75 mm did not significantly change the extent of DBS motor improvement. Our meta-analysis showed a huge publication bias on accuracy data in DBS. Therefore, the current literature does not provide an unequivocal upper threshold for acceptable accuracy of STN-DBS surgery. Based on the current literature, DBS-electrodes placed within a 2 mm range of the intended target do not have to be repositioned to enhance motor improvement after STN-DBS for Parkinson's disease. However, an indisputable upper cut-off value for surgical accuracy remains to be established. PROSPERO registration number is CRD42018089539.
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Affiliation(s)
- Naomi I Kremer
- Neurosurgery, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Teus van Laar
- Neurology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Stèfan F Lange
- Neurosurgery, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Sijmen Statius Muller
- Neurosurgery, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | | | - Dl Marinus Oterdoom
- Neurosurgery, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Gea Drost
- Neurosurgery, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
- Neurology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - J Marc C van Dijk
- Neurosurgery, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
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16
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Krahulik D, Blazek F, Nevrly M, Otruba P, Hrabalek L, Kanovsky P, Valosek J. Imaging Modalities Used for Frameless and Fiducial-Less Deep Brain Stimulation: A Single Centre Exploratory Study among Parkinson's Disease Cases. Diagnostics (Basel) 2022; 12:diagnostics12123132. [PMID: 36553139 PMCID: PMC9777451 DOI: 10.3390/diagnostics12123132] [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: 11/08/2022] [Revised: 12/06/2022] [Accepted: 12/10/2022] [Indexed: 12/14/2022] Open
Abstract
Deep brain stimulation (DBS) is a beneficial procedure for treating idiopathic Parkinson's disease (PD), essential tremor, and dystonia. The authors describe their set of imaging modalities used for a frameless and fiducial-less method of DBS. CT and MRI scans are obtained preoperatively, and STN parcellation is done based on diffusion tractography. During the surgery, an intraoperative cone-beam computed tomography scan is obtained and merged with the preoperatively-acquired images to place electrodes using a frameless and fiducial-less system. Accuracy is evaluated prospectively. The described sequence of imaging methods shows excellent accuracy compared to the frame-based techniques.
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Affiliation(s)
- David Krahulik
- Department of Neurosurgery, University Hospital Olomouc, 77900 Olomouc, Czech Republic
- Correspondence:
| | - Filip Blazek
- Department of Neurosurgery, University Hospital Olomouc, 77900 Olomouc, Czech Republic
| | - Martin Nevrly
- Department of Neurology, University Hospital Olomouc, 77900 Olomouc, Czech Republic
| | - Pavel Otruba
- Department of Neurology, University Hospital Olomouc, 77900 Olomouc, Czech Republic
| | - Lumir Hrabalek
- Department of Neurosurgery, University Hospital Olomouc, 77900 Olomouc, Czech Republic
| | - Petr Kanovsky
- Department of Neurology, University Hospital Olomouc, 77900 Olomouc, Czech Republic
| | - Jan Valosek
- Department of Neurosurgery, University Hospital Olomouc, 77900 Olomouc, Czech Republic
- Department of Neurology, University Hospital Olomouc, 77900 Olomouc, Czech Republic
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17
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Chen F, Meng X, Li T, Xu Z, Li S, Zhou Y, Hou X, Tan S, Mei L, Li L, Chang B, Wang W, Liu M. Predictive nomogram for deep brain stimulation-related infections. Neurosurg Focus 2022; 53:E8. [PMID: 36455280 DOI: 10.3171/2022.9.focus21558] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 09/21/2022] [Indexed: 12/04/2022]
Abstract
OBJECTIVE Infection is one of the important and frequent complications following implantable pulse generator and deep brain stimulation (DBS) electrode insertion. The goal of this study was to retrospectively evaluate and identify potential risk factors for DBS infections. METHODS From January 2015 to January 2021 in Qingdao municipal hospital (training cohort) and The First Affiliated Hospital of the University of Science and Technology of China (validation cohort), the authors enrolled patients with Parkinson disease who had undergone primary DBS placement or implantable pulse generator replacement. The cases were divided into infection or no-infection groups according to the 6-month follow-up. The authors used the logistic regression models to determine the association between the variables and DBS infection. Depending on the results of logistic regression, the authors established a nomogram. The calibration curves, receiver operating characteristic curve analysis, and decision curves were used to evaluate the reliability of the nomogram. RESULTS There were 191 cases enrolled in the no-infection group and 20 cases in the infection group in the training cohort. The univariate logistic regression showed that BMI, blood glucose, and albumin were all significant predictors of infection after DBS surgery (OR 0.832 [p = 0.009], OR 1.735 [p < 0.001], and OR 0.823 [p = 0.001], respectively). In the crude, adjust I, and adjust II models, the three variables stated above were all considered to be significant predictors of infection after DBS surgery. The calibration curves in both training and validation cohorts showed that the predicted outcome fitted well to the observed outcome (p > 0.05). The decision curves showed that the nomogram had more benefits than the "All or None" scheme. The areas under the curve were 0.93 and 0.83 in the training and validation cohorts, respectively. CONCLUSIONS The nomogram included BMI, blood glucose, and albumin, which were significant predictors of infection in patients with DBS surgery. The nomogram was reliable for clinical application.
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Affiliation(s)
- Feng Chen
- 1Department of Neurosurgery, Qingdao Municipal Hospital (Headquarters), Qingdao, Shandong Province
| | - Xiankun Meng
- 2Department of Neurosurgery, Qingdao Municipal Hospital, School of Medicine, Qingdao University, Qingdao, Shandong Province; and
| | - Tong Li
- 1Department of Neurosurgery, Qingdao Municipal Hospital (Headquarters), Qingdao, Shandong Province
| | - Zhiming Xu
- 1Department of Neurosurgery, Qingdao Municipal Hospital (Headquarters), Qingdao, Shandong Province
| | - Shengli Li
- 1Department of Neurosurgery, Qingdao Municipal Hospital (Headquarters), Qingdao, Shandong Province
| | - Yong Zhou
- 1Department of Neurosurgery, Qingdao Municipal Hospital (Headquarters), Qingdao, Shandong Province
| | - Xiaoqun Hou
- 1Department of Neurosurgery, Qingdao Municipal Hospital (Headquarters), Qingdao, Shandong Province
| | - Shougang Tan
- 1Department of Neurosurgery, Qingdao Municipal Hospital (Headquarters), Qingdao, Shandong Province
| | - Lin Mei
- 1Department of Neurosurgery, Qingdao Municipal Hospital (Headquarters), Qingdao, Shandong Province
| | - Luo Li
- 2Department of Neurosurgery, Qingdao Municipal Hospital, School of Medicine, Qingdao University, Qingdao, Shandong Province; and
| | - Bowen Chang
- 3Division of Life Sciences and Medicine, Department of Neurosurgery, The First Affiliated Hospital of the University of Science and Technology of China, Hefei, Anhui Province, People's Republic of China
| | - Weimin Wang
- 1Department of Neurosurgery, Qingdao Municipal Hospital (Headquarters), Qingdao, Shandong Province
| | - Mingxing Liu
- 1Department of Neurosurgery, Qingdao Municipal Hospital (Headquarters), Qingdao, Shandong Province
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Salles PA, Mata IF. Steering the genes into the field of deep brain stimulation. Parkinsonism Relat Disord 2022; 103:166-168. [PMID: 36109294 DOI: 10.1016/j.parkreldis.2022.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Philippe A Salles
- Centro de Trastornos Del Movimiento CETRAM, Santiago, Chile; Movement Disorders Section, Neurology Department, Clínica Alemana, Santiago, Chile; Movement Disorders Section, Neuroscience Center, Clínica Dávila, Santiago, Chile.
| | - Ignacio F Mata
- Genomic Medicine Institute, Lerner Research Institute, Cleveland Clinic, OH, USA.
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Genetic stratification of motor and QoL outcomes in Parkinson's disease in the EARLYSTIM study. Parkinsonism Relat Disord 2022; 103:169-174. [PMID: 36117018 DOI: 10.1016/j.parkreldis.2022.08.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 08/16/2022] [Accepted: 08/20/2022] [Indexed: 11/22/2022]
Abstract
PURPOSE The decision for subthalamic deep brain stimulation (STN-DBS) in Parkinson's disease (PD) relies on clinical predictors. Whether genetic variables could predict favourable or unfavourable decisions is under investigation. OBJECTIVE First, we aimed to reproduce the previous observation that SNCA rs356220 was associated with favourable STN-DBS motor response. In additional exploratory analyses, we studied if other PD risk and progression variants from the latest GWAS are associated with therapeutic outcome. Further, we evaluated the predictive value of polygenic risk scores. METHODS We comprehensively genotyped patients from the EarlyStim cohort using NeuroChip, and assessed the clinico-genetic associations with longitudinal outcome parameters. RESULTS The SNCA rs356220 variant did not predict UPDRS III outcomes. However, it was associated with quality of life improvement in secondary analyses. Several polymorphisms from previously identified GWAS hits predicted motor or quality of life outcomes in DBS patients. Polygenic risk scores did not predict any outcome parameter. CONCLUSIONS Our findings support the hypothesis that different common genetic markers are associated with favourable quality of life outcomes of STN-DBS in PD. These findings can be the basis for further validation in larger and independent cohorts.
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Chen PL, Chen YC, Tu PH, Liu TC, Chen MC, Wu HT, Yeap MC, Yeh CH, Lu CS, Chen CC. Subthalamic high-beta oscillation informs the outcome of deep brain stimulation in patients with Parkinson's disease. Front Hum Neurosci 2022; 16:958521. [PMID: 36158623 PMCID: PMC9493001 DOI: 10.3389/fnhum.2022.958521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 08/09/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundThe therapeutic effect of deep brain stimulation (DBS) of the subthalamic nucleus (STN) for Parkinson's disease (PD) is related to the modulation of pathological neural activities, particularly the synchronization in the β band (13–35 Hz). However, whether the local β activity in the STN region can directly predict the stimulation outcome remains unclear.ObjectiveWe tested the hypothesis that low-β (13–20 Hz) and/or high-β (20–35 Hz) band activities recorded from the STN region can predict DBS efficacy.MethodsLocal field potentials (LFPs) were recorded in 26 patients undergoing deep brain stimulation surgery in the subthalamic nucleus area. Recordings were made after the implantation of the DBS electrode prior to its connection to a stimulator. The maximum normalized powers in the theta (4–7 Hz), alpha (7–13 Hz), low-β (13–20 Hz), high-β (20–35 Hz), and low-γ (40–55 Hz) subbands in the postoperatively recorded LFP were correlated with the stimulation-induced improvement in contralateral tremor or bradykinesia–rigidity. The distance between the contact selected for stimulation and the contact with the maximum subband power was correlated with the stimulation efficacy. Following the identification of the potential predictors by the significant correlations, a multiple regression analysis was performed to evaluate their effect on the outcome.ResultsThe maximum high-β power was positively correlated with bradykinesia–rigidity improvement (rs = 0.549, p < 0.0001). The distance to the contact with maximum high-β power was negatively correlated with bradykinesia–rigidity improvement (rs = −0.452, p < 0.001). No significant correlation was observed with low-β power. The maximum high-β power and the distance to the contact with maximum high-β power were both significant predictors for bradykinesia–rigidity improvement in the multiple regression analysis, explaining 37.4% of the variance altogether. Tremor improvement was not significantly correlated with any frequency.ConclusionHigh-β oscillations, but not low-β oscillations, recorded from the STN region with the DBS lead can inform stimulation-induced improvement in contralateral bradykinesia–rigidity in patients with PD. High-β oscillations can help refine electrode targeting and inform contact selection for DBS therapy.
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Affiliation(s)
- Po-Lin Chen
- Division of Movement Disorders, Department of Neurology, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- Neuroscience Research Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Yi-Chieh Chen
- Division of Movement Disorders, Department of Neurology, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- Neuroscience Research Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Po-Hsun Tu
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Neurosurgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Tzu-Chi Liu
- Neuroscience Research Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- Department of Mathematics, National Taiwan University, Taipei, Taiwan
| | - Min-Chi Chen
- Department of Public Health, Biostatistics Consulting Center, College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Hau-Tieng Wu
- Department of Mathematics, Duke University, Durham, NC, United States
- Department of Statistical Science, Duke University, Durham, NC, United States
| | - Mun-Chun Yeap
- Department of Neurosurgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Chih-Hua Yeh
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Neuroradiology, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Chin-Song Lu
- Professor Lu Neurological Clinic, Taoyuan, Taiwan
| | - Chiung-Chu Chen
- Division of Movement Disorders, Department of Neurology, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- Neuroscience Research Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
- *Correspondence: Chiung-Chu Chen
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Deuschl G, Antonini A, Costa J, Śmiłowska K, Berg D, Corvol J, Fabbrini G, Ferreira J, Foltynie T, Mir P, Schrag A, Seppi K, Taba P, Ruzicka E, Selikhova M, Henschke N, Villanueva G, Moro E. European Academy of Neurology/Movement Disorder Society ‐ European Section guideline on the treatment of Parkinson's disease: I. Invasive therapies. Eur J Neurol 2022; 29:2580-2595. [DOI: 10.1111/ene.15386] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Accepted: 04/25/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Günther Deuschl
- Department of Neurology, UKSH‐Kiel Campus Christian‐Albrechts‐University Kiel Germany
| | - Angelo Antonini
- Parkinson and Movement Disorders Unit, Department of Neuroscience University of Padua Padua Italy
| | - Joao Costa
- Faculdade de Medicina da Universidade de Lisboa Lisbon Portugal
| | - Katarzyna Śmiłowska
- Department of Neurology, UKSH‐Kiel Campus Christian‐Albrechts‐University Kiel Germany
| | - Daniela Berg
- Department of Neurology, UKSH‐Kiel Campus Christian‐Albrechts‐University Kiel Germany
| | - Jean‐Christophe Corvol
- Institut du Cerveau–Paris Brain Institute Assistance Publique Hôpitaux de Paris Pitié‐Salpêtrière Hospital Department of Neurology, Centre d'Investigation Clinique Neurosciences Sorbonne Université Paris France
| | - Giovanni Fabbrini
- Department Human Neurosciences Sapienza University of Rome Rome Italy
- Neuromed Rome Italy
| | - Joaquim Ferreira
- Faculdade de Medicina Universidade de Lisboa Lisbon Portugal
- Instituto de Medicina Molecular João Lobo Antunes Lisbon Portugal
- Campus Neurológico Torres Vedras Portugal
| | - Tom Foltynie
- Department of Clinical & Movement Neurosciences Institute of Neurology London UK
| | - Pablo Mir
- Unidad de Trastornos del Movimiento Servicio de Neurología y Neurofisiología Clínica Instituto de Biomedicina de Sevilla Hospital Universitario Virgen del Rocío/Universidad de Sevilla Seville Spain
- Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas Madrid Spain
- Departamento de Medicina Facultad de Medicina Universidad de Sevilla Seville Spain
| | - Annette Schrag
- Institute of Neurology, University Clinic London London UK
| | - Klaus Seppi
- Klinik f. Neurologie Medizinische Universität Innsbruck Innsbruck Austria
| | - Pille Taba
- Department of Neurology and Neurosurgery, Institute of Clinical Medicine University of Tartu Tartu Estonia
- Tartu University Hospital Tartu Estonia
| | - Evzen Ruzicka
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine Charles University and General University Hospital in Prague Prague Czechia
| | - Marianna Selikhova
- Department of Neurology Pirogov Russian National Research Medical University Moscow Russia
| | | | | | - Elena Moro
- Division of Neurology, Grenoble, Grenoble Institute of Neurosciences Grenoble Alpes University Grenoble France
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Deuschl G, Antonini A, Costa J, Śmiłowska K, Berg D, Corvol J, Fabbrini G, Ferreira J, Foltynie T, Mir P, Schrag A, Seppi K, Taba P, Ruzicka E, Selikhova M, Henschke N, Villanueva G, Moro E. European Academy of Neurology/Movement Disorder Society‐European Section Guideline on the Treatment of Parkinson's Disease: I. Invasive Therapies. Mov Disord 2022; 37:1360-1374. [DOI: 10.1002/mds.29066] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 04/11/2022] [Accepted: 04/22/2022] [Indexed: 02/06/2023] Open
Affiliation(s)
- Günther Deuschl
- Department of Neurology, UKSH‐Kiel Campus Christian‐Albrechts‐University Kiel Germany
| | - Angelo Antonini
- Parkinson and Movement Disorders Unit, Department of Neuroscience University of Padua Padua Italy
| | - Joao Costa
- Faculdade de Medicina da Universidade de Lisboa Lisbon Portugal
| | - Katarzyna Śmiłowska
- Department of Neurology, UKSH‐Kiel Campus Christian‐Albrechts‐University Kiel Germany
| | - Daniela Berg
- Department of Neurology, UKSH‐Kiel Campus Christian‐Albrechts‐University Kiel Germany
| | - Jean‐Christophe Corvol
- Institut du Cerveau‐Paris Brain Institute, Assistance Publique Hôpitaux de Paris, Pitié‐Salpêtrière Hospital, Department of Neurology, Centre d'Investigation Clinique Neurosciences Sorbonne Université Paris France
| | - Giovanni Fabbrini
- Department Human Neurosciences Sapienza University of Rome Rome Italy
- IRCCS Neuromed Rome Italy
| | - Joaquim Ferreira
- Faculdade de Medicina Universidade de Lisboa Lisbon Portugal
- Instituto de Medicina Molecular João Lobo Antunes Lisbon Portugal
- Campus Neurológico Torres Vedras Portugal
| | - Tom Foltynie
- Department of Clinical & Movement Neurosciences Institute of Neurology London UK
| | - Pablo Mir
- Unidad de Trastornos del Movimiento Servicio de Neurología y Neurofisiología Clínica Instituto de Biomedicina de Sevilla Hospital Universitario Virgen del Rocío/Universidad de Sevilla Seville Spain
- Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas Madrid Spain
- Departamento de Medicina Facultad de Medicina Universidad de Sevilla Seville Spain
| | - Annette Schrag
- Institute of Neurology, University Clinic London London UK
| | - Klaus Seppi
- Klinik f. Neurologie Medizinische Universität Innsbruck Innsbruck Austria
| | - Pille Taba
- Department of Neurology and Neurosurgery, Institute of Clinical Medicine University of Tartu Tartu Estonia
- Tartu University Hospital Tartu Estonia
| | - Evzen Ruzicka
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine Charles University and General University Hospital in Prague Prague Czechia
| | | | | | | | - Elena Moro
- Division of Neurology, Grenoble, Grenoble Institute of Neurosciences Grenoble Alpes University Grenoble France
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Design and Application of Automated Algorithms for Diagnosis and Treatment Optimization in Neurodegenerative Diseases. Neuroinformatics 2022; 20:765-775. [PMID: 35262881 DOI: 10.1007/s12021-022-09578-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/22/2022] [Indexed: 12/31/2022]
Abstract
Neurodegenerative diseases represent a growing healthcare problem, mainly related to an aging population worldwide and thus their increasing prevalence. In particular, Alzheimer's disease (AD) and Parkinson's disease (PD) are leading neurodegenerative diseases. To aid their diagnosis and optimize treatment, we have developed a classification algorithm for AD to manipulate magnetic resonance images (MRI) stored in a large database of patients, containing 1,200 images. The algorithm can predict whether a patient is healthy, has mild cognitive impairment, or already has AD. We then applied this classification algorithm to therapeutic outcomes in PD after treatment with deep brain stimulation (DBS), to assess which stereotactic variables were the most important to consider when performing surgery in this indication. Here, we describe the stereotactic system used for DBS procedures, and compare different planning methods with the gold standard normally used (i.e., neurophysiological coordinates recorded intraoperatively). We used information collected from database of 72 DBS electrodes implanted in PD patients, and assessed the potentially most beneficial ranges of deviation within planning and neurophysiological coordinates from the operating room, to provide neurosurgeons with additional landmarks that may help to optimize outcomes: we observed that x coordinate deviation within CT scan and gold standard intra-operative neurophysiological coordinates is a robust matric to pre-assess positive therapy outcomes- "good therapy" prediction if deviation is higher than 2.5 mm. When being less than 2.5 mm, adding directly calculated variables deviation (on Y and Z axis) would lead to specific assessment of "very good therapy".
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The Deep Brain Stimulation Impairment Scale: A useful complement in assessment of well-being and functioning in DBS-patients - Results from a large multicentre survey in patients with Parkinson's disease. Parkinsonism Relat Disord 2022; 99:8-15. [PMID: 35561498 DOI: 10.1016/j.parkreldis.2022.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 04/11/2022] [Accepted: 04/16/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND Deep Brain Stimulation (DBS) has been proven to alleviate motor symptoms in Parkinson's Disease (PD). Regarding non-motor symptoms, however, inconsistencies have been reported, on whether DBS causes reductions in well-being and functioning. To assess motor and non-motor impairment in DBS-patients, the Deep Brain Stimulation Impairment Scale (DBS-IS) has been developed. Yet, the extent to which the DBS-IS detects impairment in DBS-patients and thus could serve as a useful tool that complements the PDQ-39 (gold standard) in assessment of well-being and functioning in PD-patients has not been shown. OBJECTIVES By comparing DBS and non-DBS-patients we aimed to identify DBS-specific symptoms. We thereby aimed to show in how far the DBS-IS complements the PDQ-39 in assessing well-being and functioning in PD patients under DBS. METHODS In a cross-sectional study, 186 DBS-patients were matched (for age, disease duration and sex) to 186 non-DBS-patients (N = 372) and the two groups were compared regarding well-being and functioning: Impairment was assessed via DBS-IS and overall Quality of Life (QoL) was assessed via PDQ-39. Additionally, we analyzed differences in impairment between age and disease duration clusters. RESULTS DBS-patients showed significantly higher total impairment (DBS-IS) and significantly higher impairment on the subscales Postural Instability and Gait difficulties and speaking difficulties than non-DBS-patients. Impairment increased with age and disease duration and, overall, differences in impairment rose by age. Overall QoL (PDQ-39) was non-significantly lower in DBS-patients. CONCLUSION Since there is evidence that the PDQ-39 misses some DBS-specific symptoms, the DBS-IS is recommended to complement the PDQ-39 when assessing DBS-patients.
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25
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França C, Carra RB, Diniz JM, Munhoz RP, Cury RG. Deep brain stimulation in Parkinson's disease: state of the art and future perspectives. ARQUIVOS DE NEURO-PSIQUIATRIA 2022; 80:105-115. [PMID: 35976323 PMCID: PMC9491408 DOI: 10.1590/0004-282x-anp-2022-s133] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 04/29/2022] [Indexed: 05/14/2023]
Abstract
For more than 30 years, Deep Brain Stimulation (DBS) has been a therapeutic option for Parkinson's disease (PD) treatment. However, this therapy is still underutilized mainly due to misinformation regarding risks and clinical outcomes. DBS can ameliorate several motor and non-motor symptoms, improving patients' quality of life. Furthermore, most of the improvement after DBS is long-lasting and present even in advanced PD. Adequate patient selection, precise electric leads placement, and correct DBS programming are paramount for good surgical outcomes. Nonetheless, DBS still has many limitations: axial symptoms and signs, such as speech, balance and gait, do not improve to the same extent as appendicular symptoms and can even be worsened as a direct or indirect consequence of surgery and stimulation. In addition, there are still unanswered questions regarding patient's selection, surgical planning and programming techniques, such as the role of surgicogenomics, more precise imaging-based lead placement, new brain targets, advanced programming strategies and hardware features. The net effect of these innovations should not only be to refine the beneficial effect we currently observe on selected symptoms and signs but also to improve treatment resistant facets of PD, such as axial and non-motor features. In this review, we discuss the current state of the art regarding DBS selection, implant, and programming, and explore new advances in the DBS field.
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Affiliation(s)
- Carina França
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Neurologia, Centro de Distúrbios do Movimento, São Paulo, SP, Brazil
| | - Rafael Bernhart Carra
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Neurologia, Centro de Distúrbios do Movimento, São Paulo, SP, Brazil
| | - Juliete Melo Diniz
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Neurologia, Divisão de Neurocirurgia Funcional, São Paulo, SP, Brazil
| | - Renato Puppi Munhoz
- University of Toronto, Toronto Western Hospital, Movement Disorders Centre, Toronto, ON, Canada
| | - Rubens Gisbert Cury
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Neurologia, Centro de Distúrbios do Movimento, São Paulo, SP, Brazil
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Meng D, Jin Z, Chen K, Yu X, Wang Y, Du W, Wei J, Xi J, Fang B. Quality of life predicts rehabilitation prognosis in Parkinson's disease patients: Factors influence rehabilitation prognosis: Factors influence rehabilitation prognosis. Brain Behav 2022; 12:e2579. [PMID: 35429406 PMCID: PMC9120870 DOI: 10.1002/brb3.2579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 02/14/2022] [Accepted: 03/20/2022] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Rehabilitation has been reported to improve the quality of life (QoL) of patients with Parkinson's disease (PD). Nevertheless, not all patients are satisfied with rehabilitation outcomes and could achieve a significant improvement in QoL. OBJECTIVE To detect possible predictors of QoL improvement in patients with PD after rehabilitation. METHODS A total of 86 PD patients were included and followed up for 3 months with a 39-item Parkinson's Disease Questionnaire summary index (PDQ-39 SI) as the primary endpoint. All patients received 2 weeks of multidisciplinary intensive rehabilitation treatment (MIRT). Changes in patients' QoL were assessed using the PDQ-39 at baseline and at the 3-month follow-up. The reliable change index (RCI) was adapted to determine the individual QoL outcome. The predictors of QoL outcome were detected using logistic regression analysis. RESULTS After a 3-month follow-up, PDQ-39 SI decreased significantly from 22.95 ± 9.75 to 18.73 ± 10.32 (P < 0.001). Scores for QoL improved (RCI>10.9) after rehabilitation for 18.6% of the patients, and 74.4% of patients reported an unchanged QoL (-10.9≤RCI≤10.9), while 7.0% of patients reported a worsening of QoL (RCI<-10.9). Among the baseline parameters, the PDQ-39 SI was a baseline predictor for changes in QoL in the logistic regression model (OR: 1.15, CI: 1.07-1.24, P < 0.001). CONCLUSIONS MIRT could improve QoL for some patients with PD, and PDQ-39 score at baseline is the most important predictor for QoL improvements after rehabilitation for this patients.
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Affiliation(s)
- Detao Meng
- Parkinson Medical Center, Beijing Rehabilitation Hospital, Capital Medical University, Beijing, China
| | - Zhaohui Jin
- Parkinson Medical Center, Beijing Rehabilitation Hospital, Capital Medical University, Beijing, China
| | - Keke Chen
- Beijing Rehabilitation Medical College, Capital Medical University, Beijing, China
| | - Xin Yu
- Beijing Rehabilitation Medical College, Capital Medical University, Beijing, China
| | - Yixuan Wang
- Parkinson Medical Center, Beijing Rehabilitation Hospital, Capital Medical University, Beijing, China
| | - Wenjun Du
- Parkinson Medical Center, Beijing Rehabilitation Hospital, Capital Medical University, Beijing, China
| | - Jingran Wei
- Parkinson Medical Center, Beijing Rehabilitation Hospital, Capital Medical University, Beijing, China
| | - Jianing Xi
- Parkinson Medical Center, Beijing Rehabilitation Hospital, Capital Medical University, Beijing, China
| | - Boyan Fang
- Parkinson Medical Center, Beijing Rehabilitation Hospital, Capital Medical University, Beijing, China
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27
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Caregiver Burden in Partners of Parkinsonian Patients with Deep Brain Stimulation. Brain Sci 2022; 12:brainsci12020238. [PMID: 35204001 PMCID: PMC8870343 DOI: 10.3390/brainsci12020238] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 02/06/2022] [Accepted: 02/07/2022] [Indexed: 01/12/2023] Open
Abstract
In Parkinson’s disease (PD) patients, the progressive nature of the disease and the variability of disabling motor and non-motor symptoms contribute to the growing caregiver burden of PD partners and conflicts in their relationships. Deep brain stimulation (DBS) improves PD symptoms and patients’ quality of life but necessitates an intensified therapy optimization after DBS surgery. This review illuminates caregiver burden in the context of DBS, framing both pre- and postoperative aspects. We aim to provide an overview of perioperative factors influencing caregiver burden and wish to stimulate further recognition of caregiver burden of PD patients with DBS.
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Chen Y, Zu J, Zhang W, Xu C, Cui G, Cui C, Xiao Q. Comparative Analysis of Acute Levodopa Challenge Test and the Outcomes of Deep Brain Stimulation in Parkinson's Disease. J Neurol Surg A Cent Eur Neurosurg 2021; 83:535-539. [PMID: 34897613 DOI: 10.1055/s-0041-1739226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND We study the correlation between the preoperative levodopa challenge test and the efficacy of deep brain stimulation (DBS) surgery in Parkinson's disease (PD). METHODS Fifty patients with PD who underwent DBS treatment in our hospital from October 2016 to October 2017 were enrolled in this study. Using the Unified Parkinson Disease Rating Scale-III (UPDRS-III) as an indicator, we analyzed the improvement in motor symptoms on the levodopa challenge test and by DBS surgery. We also discussed the correlation between the effects of the levodopa challenge test and DBS surgery. RESULTS There was no correlation between the results of the levodopa challenge test and DBS surgery. There was a linear correlation between muscle rigidity and bradykinesia, whereas the linear correlation between other symptoms was weak. CONCLUSION The levodopa challenge test can be used as a screening tool for patients undergoing DBS surgery, and can predict the degree of improvement in muscle rigidity and bradykinesia surgery. However, the prediction of the degree of improvement of total motor symptoms is poor.
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Affiliation(s)
- Yusheng Chen
- Department of Neurology, the Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Jie Zu
- Parkinson Disease Center, the Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Wei Zhang
- Parkinson Disease Center, the Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Chuanying Xu
- Parkinson Disease Center, the Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Guiyun Cui
- Parkinson Disease Center, the Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Chenchen Cui
- Parkinson Disease Center, the Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Qihua Xiao
- Parkinson Disease Center, the Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
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Sauerbier A, Loehrer P, Jost ST, Heil S, Petry-Schmelzer JN, Herberg J, Bachon P, Aloui S, Gronostay A, Klingelhoefer L, Baldermann JC, Huys D, Nimsky C, Barbe MT, Fink GR, Martinez-Martin P, Ray Chaudhuri K, Visser-Vandewalle V, Timmermann L, Weintraub D, Dafsari HS. Predictors of short-term impulsive and compulsive behaviour after subthalamic stimulation in Parkinson disease. J Neurol Neurosurg Psychiatry 2021; 92:1313-1318. [PMID: 34510000 PMCID: PMC8606469 DOI: 10.1136/jnnp-2021-326131] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 06/20/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND The effects of subthalamic stimulation (subthalamic nucleus-deep brain stimulation, STN-DBS) on impulsive and compulsive behaviours (ICB) in Parkinson's disease (PD) are understudied. OBJECTIVE To investigate clinical predictors of STN-DBS effects on ICB. METHODS In this prospective, open-label, multicentre study in patients with PD undergoing bilateral STN-DBS, we assessed patients preoperatively and at 6-month follow-up postoperatively. Clinical scales included the Questionnaire for Impulsive-Compulsive Disorders in PD-Rating Scale (QUIP-RS), PD Questionnaire-8, Non-Motor Symptom Scale (NMSS), Unified PD Rating Scale in addition to levodopa-equivalent daily dose total (LEDD-total) and dopamine agonists (LEDD-DA). Changes at follow-up were analysed with Wilcoxon signed-rank test and corrected for multiple comparisons (Bonferroni method). We explored predictors of QUIP-RS changes using correlations and linear regressions. Finally, we dichotomised patients into 'QUIP-RS improvement or worsening' and analysed between-group differences. RESULTS We included 55 patients aged 61.7 years±8.4 with 9.8 years±4.6 PD duration. QUIP-RS cut-offs and psychiatric assessments identified patients with preoperative ICB. In patients with ICB, QUIP-RS improved significantly. However, we observed considerable interindividual variability of clinically relevant QUIP-RS outcomes as 27.3% experienced worsening and 29.1% an improvement. In post hoc analyses, higher baseline QUIP-RS and lower baseline LEDD-DA were associated with greater QUIP-RS improvements. Additionally, the 'QUIP-RS worsening' group had more severe baseline impairment in the NMSS attention/memory domain. CONCLUSIONS Our results show favourable ICB outcomes in patients with higher preoperative ICB severity and lower preoperative DA doses, and worse outcomes in patients with more severe baseline attention/memory deficits. These findings emphasise the need for comprehensive non-motor and motor symptoms assessments in patients undergoing STN-DBS. TRIAL REGISTRATION NUMBER DRKS00006735.
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Affiliation(s)
- Anna Sauerbier
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK .,Department of Neurology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Philipp Loehrer
- Department of Neurology, University of Marburg and University Hospital Giessen and Marburg, Campus Marburg, Marburg, Germany
| | - Stefanie T Jost
- Department of Neurology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Shania Heil
- Department of Neurology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Jan N Petry-Schmelzer
- Department of Neurology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Johanna Herberg
- Department of Neurology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Pia Bachon
- Department of Neurology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Salima Aloui
- Department of Neurology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Alexandra Gronostay
- Department of Neurology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Lisa Klingelhoefer
- Deptartment of Neurology, University of Dresden and University Hospital Dresden, Dresden, Germany
| | - J Carlos Baldermann
- Department of Neurology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany.,Department of Psychiatry, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Daniel Huys
- Department of Psychiatry, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Christopher Nimsky
- Department of Neurosurgery, University of Marburg and University Hospital Giessen and Marburg, Campus Marburg, Marburg, Germany
| | - Michael T Barbe
- Department of Neurology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Gereon R Fink
- Department of Neurology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany.,Cognitive Neuroscience, Institute of Neuroscience and Medicine (INM-3), Research Center Jülich, Jülich, Germany
| | - Pablo Martinez-Martin
- Center for Networked Biomedical Research in Neurodegenerative Diseases (CIBERNED), Carlos III Institute of Health, Madrid, Spain
| | - K Ray Chaudhuri
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,Parkinson's Centre of Excellence, Department of Neurology, King's College Hospital NHS Foundation Trust, London, UK.,NIHR Mental Health Biomedical Research Centre and Dementia Biomedical Research Unit, South London and Maudsley NHS Foundation Trust and King's College London, London, UK
| | - Veerle Visser-Vandewalle
- Department of Stereotaxy and Functional Neurosurgery, University of Cologne and University Hospital Cologne, Cologne, Germany
| | - Lars Timmermann
- Department of Neurology, University of Marburg and University Hospital Giessen and Marburg, Campus Marburg, Marburg, Germany
| | - Daniel Weintraub
- Departments of Psychiatry and Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Haidar S Dafsari
- Department of Neurology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
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Besse-Pinot E, Pereira B, Durif F, Fantini ML, Durand E, Debilly B, Derost P, Moreau C, Hainque E, Rouaud T, Eusebio A, Benatru I, Drapier S, Guehl D, Rascol O, Maltête D, Lagha-Boukbiza O, Giordana C, Tir M, Thobois S, Hopes L, Hubsch C, Jarraya B, Rolland AS, Corvol JC, Devos D, Marques A. Preoperative REM Sleep Behavior Disorder and Subthalamic Nucleus Deep Brain Stimulation Outcome in Parkinson Disease 1 Year After Surgery. Neurology 2021; 97:e1994-e2006. [PMID: 34667082 DOI: 10.1212/wnl.0000000000012862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 09/20/2021] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVES To determine whether patients with Parkinson disease (PD) eligible for subthalamic nucleus deep brain stimulation (STN-DBS) with probable REM sleep behavior disorder (RBD) preoperatively could be more at risk of poorer motor, nonmotor, and quality of life outcomes 12 months after surgery compared to those without RBD. METHODS We analyzed the preoperative clinical profile of 448 patients with PD from a French multicentric prospective study (PREDISTIM) according to the presence or absence of probable RBD based on the RBD Single Question and RBD Screening Questionnaire. Among the 215 patients with PD with 12 months of follow-up after STN-DBS, we compared motor, cognitive, psycho-behavioral profile, and quality of life outcomes in patients with (pre-opRBD+) or without (pre-opRBD-) probable RBD preoperatively. RESULTS At preoperative evaluation, pre-opRBD+ patients were older (61 ± 7.2 vs 59.5 ± 7.7 years; p = 0.02), had less motor impairment (Movement Disorder Society-sponsored version of the Unified Parkinson's Disease Rating Scale [MDS-UPDRS] III "off": 38.7 ± 16.2 vs 43.4 ± 7.1; p = 0.03) but more nonmotor symptoms on daily living activities (MDS-UPDRS I: 12.6 ± 5.5 vs 10.7 ± 5.3; p < 0.001), had more psychobehavioral manifestations (Ardouin Scale of Behavior in Parkinson's Disease total: 7.7 ± 5.1 vs 5.1 ± 0.4; p = 0.003), and had worse quality of life (Parkinson's Disease Questionnaire-39: 33 ± 12 vs 29 ± 12; p = 0.03), as compared to pre-opRBD- patients. Both pre-opRBD+ and pre-opRBD- patients had significant MDS-UPDRS IV score decrease (-37% and -33%, respectively), MDS-UPDRS III "med 'off'/stim 'on'" score decrease (-52% and -54%), and dopaminergic treatment decrease (-52% and -49%) after surgery, with no between-group difference. There was no between-group difference for cognitive and global quality of life outcomes. CONCLUSIONS In patients with PD eligible for STN-DBS, the presence of probable RBD preoperatively is not associated with a different clinical outcome 1 year after neurosurgery. TRIAL REGISTRATION INFORMATION NCT02360683. CLASSIFICATION OF EVIDENCE This study provides Class II evidence that in patients with PD eligible for STN-DBS, the presence of probable RBD preoperatively is not associated with poorer outcomes 1 year post surgery.
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Affiliation(s)
- Elsa Besse-Pinot
- From the Neurology Department, Université Clermont Auvergne, EA7280 (E.B.-P., F.D., M.L.F., E.D., B.D., P.D., A.M.), and Biostatistics Department (B.P.), Clermont-Ferrand University Hospital, NS-Park/F-CRIN Network; Departments of Medical Pharmacology and Neurology and Movement Disorders, Referent Center of Parkinson's Disease, INSERM UMRS_1171, Licend, CHU of Lille (C.M.), and Department of Medical Pharmacology, University Hospital, Lille Neuroscience & Cognition, INSERM, UMR-S1172 (A.-S.R., D.D.), University of Lille, NS-Park/F-CRIN Network; Department of Neurology, Paris Brain Institute (ICM) (E.H., J.-C.C.), Institut Du Cerveau, INSERM CNRS, Assistance Publique Hôpitaux de Paris, Sorbonne Université, Hôpital Pitié-Salpêtrière, NS-Park/F-CRIN Network; Department of Neurology (T.R.), Nantes University Hospital, NS-Park/F-CRIN Network; Department of Neurology (A.E.), Assistance Publique Hôpitaux de Marseille, Timone University Hospital and Institut de Neurosciences de La Timone, NS-Park/F-CRIN Network; Department of Neurology (I.B.), University Poitiers, NS-Park/F-CRIN Network; Department of Neurology (S.D.), University Hospital of Rennes, NS-Park/F-CRIN Network; Institut des Maladies Neurodégénératives, Centre Expert Parkinson (D.G.), CHU de Bordeaux, NS-Park/F-CRIN Network; Parkinson Expert Center, Department of Clinical Pharmacology and Neuroscience (O.R.), Clinical Investigation Center CIC1436, NeuroToul COEN Center, Toulouse University Hospital, University of Toulouse 3, INSERM, NS-Park/F-CRIN Network; Department of Neurology (D.M.), Rouen University Hospital and University of Rouen; Laboratory of Neuronal and Neuroendocrine Differentiation and Communication (D.M.), INSERM U1239, NS-Park/F-CRIN Network, Mont-Saint-Aignan; Department of Neurology (O.L.-B.), Strasbourg University Hospital, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Université de Strasbourg, NS-Park/F-CRIN Network; Department of Neurology (C.G.), Centre Hospitalier Universitaire de Nice, NS-Park/F-CRIN Network; Departments of Neurology and Neurosurgery (M.T.), Expert Centre for Parkinson's Disease, EA 4559 Laboratoire de Neurosciences Fonctionnelles et Pathologie, Amiens University Hospital, Université de Picardie Jules Verne, NS-Park/F-CRIN Network, Amiens; Department of Neurology C (S.T.), Pierre Wertheimer Neurological Hospital, Hospices Civils de Lyon, University Hospital of Lyon, Université Claude Bernard Lyon 1, CNRS, Institut des Sciences Cognitives Marc Jeannerod, UMR 5229 CNRS, NS-PARK/F-CRIN Network; Department of Neurology (L.H.), University Hospital of Nancy, NS-PARK/F-CRIN Network; Department of Neurology (C.H.), Hospital Fondation Ophtalmologique Adolphe de Rothschild, NS-PARK/F-CRIN Network; and Neuroscience Pole (B.J.), Hôpital Foch, Université Paris-Saclay (UVSQ), INSERM-CEA NeuroSpin, NS-PARK/F-CRIN Network, Paris, France
| | - Bruno Pereira
- From the Neurology Department, Université Clermont Auvergne, EA7280 (E.B.-P., F.D., M.L.F., E.D., B.D., P.D., A.M.), and Biostatistics Department (B.P.), Clermont-Ferrand University Hospital, NS-Park/F-CRIN Network; Departments of Medical Pharmacology and Neurology and Movement Disorders, Referent Center of Parkinson's Disease, INSERM UMRS_1171, Licend, CHU of Lille (C.M.), and Department of Medical Pharmacology, University Hospital, Lille Neuroscience & Cognition, INSERM, UMR-S1172 (A.-S.R., D.D.), University of Lille, NS-Park/F-CRIN Network; Department of Neurology, Paris Brain Institute (ICM) (E.H., J.-C.C.), Institut Du Cerveau, INSERM CNRS, Assistance Publique Hôpitaux de Paris, Sorbonne Université, Hôpital Pitié-Salpêtrière, NS-Park/F-CRIN Network; Department of Neurology (T.R.), Nantes University Hospital, NS-Park/F-CRIN Network; Department of Neurology (A.E.), Assistance Publique Hôpitaux de Marseille, Timone University Hospital and Institut de Neurosciences de La Timone, NS-Park/F-CRIN Network; Department of Neurology (I.B.), University Poitiers, NS-Park/F-CRIN Network; Department of Neurology (S.D.), University Hospital of Rennes, NS-Park/F-CRIN Network; Institut des Maladies Neurodégénératives, Centre Expert Parkinson (D.G.), CHU de Bordeaux, NS-Park/F-CRIN Network; Parkinson Expert Center, Department of Clinical Pharmacology and Neuroscience (O.R.), Clinical Investigation Center CIC1436, NeuroToul COEN Center, Toulouse University Hospital, University of Toulouse 3, INSERM, NS-Park/F-CRIN Network; Department of Neurology (D.M.), Rouen University Hospital and University of Rouen; Laboratory of Neuronal and Neuroendocrine Differentiation and Communication (D.M.), INSERM U1239, NS-Park/F-CRIN Network, Mont-Saint-Aignan; Department of Neurology (O.L.-B.), Strasbourg University Hospital, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Université de Strasbourg, NS-Park/F-CRIN Network; Department of Neurology (C.G.), Centre Hospitalier Universitaire de Nice, NS-Park/F-CRIN Network; Departments of Neurology and Neurosurgery (M.T.), Expert Centre for Parkinson's Disease, EA 4559 Laboratoire de Neurosciences Fonctionnelles et Pathologie, Amiens University Hospital, Université de Picardie Jules Verne, NS-Park/F-CRIN Network, Amiens; Department of Neurology C (S.T.), Pierre Wertheimer Neurological Hospital, Hospices Civils de Lyon, University Hospital of Lyon, Université Claude Bernard Lyon 1, CNRS, Institut des Sciences Cognitives Marc Jeannerod, UMR 5229 CNRS, NS-PARK/F-CRIN Network; Department of Neurology (L.H.), University Hospital of Nancy, NS-PARK/F-CRIN Network; Department of Neurology (C.H.), Hospital Fondation Ophtalmologique Adolphe de Rothschild, NS-PARK/F-CRIN Network; and Neuroscience Pole (B.J.), Hôpital Foch, Université Paris-Saclay (UVSQ), INSERM-CEA NeuroSpin, NS-PARK/F-CRIN Network, Paris, France
| | - Franck Durif
- From the Neurology Department, Université Clermont Auvergne, EA7280 (E.B.-P., F.D., M.L.F., E.D., B.D., P.D., A.M.), and Biostatistics Department (B.P.), Clermont-Ferrand University Hospital, NS-Park/F-CRIN Network; Departments of Medical Pharmacology and Neurology and Movement Disorders, Referent Center of Parkinson's Disease, INSERM UMRS_1171, Licend, CHU of Lille (C.M.), and Department of Medical Pharmacology, University Hospital, Lille Neuroscience & Cognition, INSERM, UMR-S1172 (A.-S.R., D.D.), University of Lille, NS-Park/F-CRIN Network; Department of Neurology, Paris Brain Institute (ICM) (E.H., J.-C.C.), Institut Du Cerveau, INSERM CNRS, Assistance Publique Hôpitaux de Paris, Sorbonne Université, Hôpital Pitié-Salpêtrière, NS-Park/F-CRIN Network; Department of Neurology (T.R.), Nantes University Hospital, NS-Park/F-CRIN Network; Department of Neurology (A.E.), Assistance Publique Hôpitaux de Marseille, Timone University Hospital and Institut de Neurosciences de La Timone, NS-Park/F-CRIN Network; Department of Neurology (I.B.), University Poitiers, NS-Park/F-CRIN Network; Department of Neurology (S.D.), University Hospital of Rennes, NS-Park/F-CRIN Network; Institut des Maladies Neurodégénératives, Centre Expert Parkinson (D.G.), CHU de Bordeaux, NS-Park/F-CRIN Network; Parkinson Expert Center, Department of Clinical Pharmacology and Neuroscience (O.R.), Clinical Investigation Center CIC1436, NeuroToul COEN Center, Toulouse University Hospital, University of Toulouse 3, INSERM, NS-Park/F-CRIN Network; Department of Neurology (D.M.), Rouen University Hospital and University of Rouen; Laboratory of Neuronal and Neuroendocrine Differentiation and Communication (D.M.), INSERM U1239, NS-Park/F-CRIN Network, Mont-Saint-Aignan; Department of Neurology (O.L.-B.), Strasbourg University Hospital, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Université de Strasbourg, NS-Park/F-CRIN Network; Department of Neurology (C.G.), Centre Hospitalier Universitaire de Nice, NS-Park/F-CRIN Network; Departments of Neurology and Neurosurgery (M.T.), Expert Centre for Parkinson's Disease, EA 4559 Laboratoire de Neurosciences Fonctionnelles et Pathologie, Amiens University Hospital, Université de Picardie Jules Verne, NS-Park/F-CRIN Network, Amiens; Department of Neurology C (S.T.), Pierre Wertheimer Neurological Hospital, Hospices Civils de Lyon, University Hospital of Lyon, Université Claude Bernard Lyon 1, CNRS, Institut des Sciences Cognitives Marc Jeannerod, UMR 5229 CNRS, NS-PARK/F-CRIN Network; Department of Neurology (L.H.), University Hospital of Nancy, NS-PARK/F-CRIN Network; Department of Neurology (C.H.), Hospital Fondation Ophtalmologique Adolphe de Rothschild, NS-PARK/F-CRIN Network; and Neuroscience Pole (B.J.), Hôpital Foch, Université Paris-Saclay (UVSQ), INSERM-CEA NeuroSpin, NS-PARK/F-CRIN Network, Paris, France
| | - Maria Livia Fantini
- From the Neurology Department, Université Clermont Auvergne, EA7280 (E.B.-P., F.D., M.L.F., E.D., B.D., P.D., A.M.), and Biostatistics Department (B.P.), Clermont-Ferrand University Hospital, NS-Park/F-CRIN Network; Departments of Medical Pharmacology and Neurology and Movement Disorders, Referent Center of Parkinson's Disease, INSERM UMRS_1171, Licend, CHU of Lille (C.M.), and Department of Medical Pharmacology, University Hospital, Lille Neuroscience & Cognition, INSERM, UMR-S1172 (A.-S.R., D.D.), University of Lille, NS-Park/F-CRIN Network; Department of Neurology, Paris Brain Institute (ICM) (E.H., J.-C.C.), Institut Du Cerveau, INSERM CNRS, Assistance Publique Hôpitaux de Paris, Sorbonne Université, Hôpital Pitié-Salpêtrière, NS-Park/F-CRIN Network; Department of Neurology (T.R.), Nantes University Hospital, NS-Park/F-CRIN Network; Department of Neurology (A.E.), Assistance Publique Hôpitaux de Marseille, Timone University Hospital and Institut de Neurosciences de La Timone, NS-Park/F-CRIN Network; Department of Neurology (I.B.), University Poitiers, NS-Park/F-CRIN Network; Department of Neurology (S.D.), University Hospital of Rennes, NS-Park/F-CRIN Network; Institut des Maladies Neurodégénératives, Centre Expert Parkinson (D.G.), CHU de Bordeaux, NS-Park/F-CRIN Network; Parkinson Expert Center, Department of Clinical Pharmacology and Neuroscience (O.R.), Clinical Investigation Center CIC1436, NeuroToul COEN Center, Toulouse University Hospital, University of Toulouse 3, INSERM, NS-Park/F-CRIN Network; Department of Neurology (D.M.), Rouen University Hospital and University of Rouen; Laboratory of Neuronal and Neuroendocrine Differentiation and Communication (D.M.), INSERM U1239, NS-Park/F-CRIN Network, Mont-Saint-Aignan; Department of Neurology (O.L.-B.), Strasbourg University Hospital, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Université de Strasbourg, NS-Park/F-CRIN Network; Department of Neurology (C.G.), Centre Hospitalier Universitaire de Nice, NS-Park/F-CRIN Network; Departments of Neurology and Neurosurgery (M.T.), Expert Centre for Parkinson's Disease, EA 4559 Laboratoire de Neurosciences Fonctionnelles et Pathologie, Amiens University Hospital, Université de Picardie Jules Verne, NS-Park/F-CRIN Network, Amiens; Department of Neurology C (S.T.), Pierre Wertheimer Neurological Hospital, Hospices Civils de Lyon, University Hospital of Lyon, Université Claude Bernard Lyon 1, CNRS, Institut des Sciences Cognitives Marc Jeannerod, UMR 5229 CNRS, NS-PARK/F-CRIN Network; Department of Neurology (L.H.), University Hospital of Nancy, NS-PARK/F-CRIN Network; Department of Neurology (C.H.), Hospital Fondation Ophtalmologique Adolphe de Rothschild, NS-PARK/F-CRIN Network; and Neuroscience Pole (B.J.), Hôpital Foch, Université Paris-Saclay (UVSQ), INSERM-CEA NeuroSpin, NS-PARK/F-CRIN Network, Paris, France
| | - Elodie Durand
- From the Neurology Department, Université Clermont Auvergne, EA7280 (E.B.-P., F.D., M.L.F., E.D., B.D., P.D., A.M.), and Biostatistics Department (B.P.), Clermont-Ferrand University Hospital, NS-Park/F-CRIN Network; Departments of Medical Pharmacology and Neurology and Movement Disorders, Referent Center of Parkinson's Disease, INSERM UMRS_1171, Licend, CHU of Lille (C.M.), and Department of Medical Pharmacology, University Hospital, Lille Neuroscience & Cognition, INSERM, UMR-S1172 (A.-S.R., D.D.), University of Lille, NS-Park/F-CRIN Network; Department of Neurology, Paris Brain Institute (ICM) (E.H., J.-C.C.), Institut Du Cerveau, INSERM CNRS, Assistance Publique Hôpitaux de Paris, Sorbonne Université, Hôpital Pitié-Salpêtrière, NS-Park/F-CRIN Network; Department of Neurology (T.R.), Nantes University Hospital, NS-Park/F-CRIN Network; Department of Neurology (A.E.), Assistance Publique Hôpitaux de Marseille, Timone University Hospital and Institut de Neurosciences de La Timone, NS-Park/F-CRIN Network; Department of Neurology (I.B.), University Poitiers, NS-Park/F-CRIN Network; Department of Neurology (S.D.), University Hospital of Rennes, NS-Park/F-CRIN Network; Institut des Maladies Neurodégénératives, Centre Expert Parkinson (D.G.), CHU de Bordeaux, NS-Park/F-CRIN Network; Parkinson Expert Center, Department of Clinical Pharmacology and Neuroscience (O.R.), Clinical Investigation Center CIC1436, NeuroToul COEN Center, Toulouse University Hospital, University of Toulouse 3, INSERM, NS-Park/F-CRIN Network; Department of Neurology (D.M.), Rouen University Hospital and University of Rouen; Laboratory of Neuronal and Neuroendocrine Differentiation and Communication (D.M.), INSERM U1239, NS-Park/F-CRIN Network, Mont-Saint-Aignan; Department of Neurology (O.L.-B.), Strasbourg University Hospital, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Université de Strasbourg, NS-Park/F-CRIN Network; Department of Neurology (C.G.), Centre Hospitalier Universitaire de Nice, NS-Park/F-CRIN Network; Departments of Neurology and Neurosurgery (M.T.), Expert Centre for Parkinson's Disease, EA 4559 Laboratoire de Neurosciences Fonctionnelles et Pathologie, Amiens University Hospital, Université de Picardie Jules Verne, NS-Park/F-CRIN Network, Amiens; Department of Neurology C (S.T.), Pierre Wertheimer Neurological Hospital, Hospices Civils de Lyon, University Hospital of Lyon, Université Claude Bernard Lyon 1, CNRS, Institut des Sciences Cognitives Marc Jeannerod, UMR 5229 CNRS, NS-PARK/F-CRIN Network; Department of Neurology (L.H.), University Hospital of Nancy, NS-PARK/F-CRIN Network; Department of Neurology (C.H.), Hospital Fondation Ophtalmologique Adolphe de Rothschild, NS-PARK/F-CRIN Network; and Neuroscience Pole (B.J.), Hôpital Foch, Université Paris-Saclay (UVSQ), INSERM-CEA NeuroSpin, NS-PARK/F-CRIN Network, Paris, France
| | - Bérengère Debilly
- From the Neurology Department, Université Clermont Auvergne, EA7280 (E.B.-P., F.D., M.L.F., E.D., B.D., P.D., A.M.), and Biostatistics Department (B.P.), Clermont-Ferrand University Hospital, NS-Park/F-CRIN Network; Departments of Medical Pharmacology and Neurology and Movement Disorders, Referent Center of Parkinson's Disease, INSERM UMRS_1171, Licend, CHU of Lille (C.M.), and Department of Medical Pharmacology, University Hospital, Lille Neuroscience & Cognition, INSERM, UMR-S1172 (A.-S.R., D.D.), University of Lille, NS-Park/F-CRIN Network; Department of Neurology, Paris Brain Institute (ICM) (E.H., J.-C.C.), Institut Du Cerveau, INSERM CNRS, Assistance Publique Hôpitaux de Paris, Sorbonne Université, Hôpital Pitié-Salpêtrière, NS-Park/F-CRIN Network; Department of Neurology (T.R.), Nantes University Hospital, NS-Park/F-CRIN Network; Department of Neurology (A.E.), Assistance Publique Hôpitaux de Marseille, Timone University Hospital and Institut de Neurosciences de La Timone, NS-Park/F-CRIN Network; Department of Neurology (I.B.), University Poitiers, NS-Park/F-CRIN Network; Department of Neurology (S.D.), University Hospital of Rennes, NS-Park/F-CRIN Network; Institut des Maladies Neurodégénératives, Centre Expert Parkinson (D.G.), CHU de Bordeaux, NS-Park/F-CRIN Network; Parkinson Expert Center, Department of Clinical Pharmacology and Neuroscience (O.R.), Clinical Investigation Center CIC1436, NeuroToul COEN Center, Toulouse University Hospital, University of Toulouse 3, INSERM, NS-Park/F-CRIN Network; Department of Neurology (D.M.), Rouen University Hospital and University of Rouen; Laboratory of Neuronal and Neuroendocrine Differentiation and Communication (D.M.), INSERM U1239, NS-Park/F-CRIN Network, Mont-Saint-Aignan; Department of Neurology (O.L.-B.), Strasbourg University Hospital, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Université de Strasbourg, NS-Park/F-CRIN Network; Department of Neurology (C.G.), Centre Hospitalier Universitaire de Nice, NS-Park/F-CRIN Network; Departments of Neurology and Neurosurgery (M.T.), Expert Centre for Parkinson's Disease, EA 4559 Laboratoire de Neurosciences Fonctionnelles et Pathologie, Amiens University Hospital, Université de Picardie Jules Verne, NS-Park/F-CRIN Network, Amiens; Department of Neurology C (S.T.), Pierre Wertheimer Neurological Hospital, Hospices Civils de Lyon, University Hospital of Lyon, Université Claude Bernard Lyon 1, CNRS, Institut des Sciences Cognitives Marc Jeannerod, UMR 5229 CNRS, NS-PARK/F-CRIN Network; Department of Neurology (L.H.), University Hospital of Nancy, NS-PARK/F-CRIN Network; Department of Neurology (C.H.), Hospital Fondation Ophtalmologique Adolphe de Rothschild, NS-PARK/F-CRIN Network; and Neuroscience Pole (B.J.), Hôpital Foch, Université Paris-Saclay (UVSQ), INSERM-CEA NeuroSpin, NS-PARK/F-CRIN Network, Paris, France
| | - Philippe Derost
- From the Neurology Department, Université Clermont Auvergne, EA7280 (E.B.-P., F.D., M.L.F., E.D., B.D., P.D., A.M.), and Biostatistics Department (B.P.), Clermont-Ferrand University Hospital, NS-Park/F-CRIN Network; Departments of Medical Pharmacology and Neurology and Movement Disorders, Referent Center of Parkinson's Disease, INSERM UMRS_1171, Licend, CHU of Lille (C.M.), and Department of Medical Pharmacology, University Hospital, Lille Neuroscience & Cognition, INSERM, UMR-S1172 (A.-S.R., D.D.), University of Lille, NS-Park/F-CRIN Network; Department of Neurology, Paris Brain Institute (ICM) (E.H., J.-C.C.), Institut Du Cerveau, INSERM CNRS, Assistance Publique Hôpitaux de Paris, Sorbonne Université, Hôpital Pitié-Salpêtrière, NS-Park/F-CRIN Network; Department of Neurology (T.R.), Nantes University Hospital, NS-Park/F-CRIN Network; Department of Neurology (A.E.), Assistance Publique Hôpitaux de Marseille, Timone University Hospital and Institut de Neurosciences de La Timone, NS-Park/F-CRIN Network; Department of Neurology (I.B.), University Poitiers, NS-Park/F-CRIN Network; Department of Neurology (S.D.), University Hospital of Rennes, NS-Park/F-CRIN Network; Institut des Maladies Neurodégénératives, Centre Expert Parkinson (D.G.), CHU de Bordeaux, NS-Park/F-CRIN Network; Parkinson Expert Center, Department of Clinical Pharmacology and Neuroscience (O.R.), Clinical Investigation Center CIC1436, NeuroToul COEN Center, Toulouse University Hospital, University of Toulouse 3, INSERM, NS-Park/F-CRIN Network; Department of Neurology (D.M.), Rouen University Hospital and University of Rouen; Laboratory of Neuronal and Neuroendocrine Differentiation and Communication (D.M.), INSERM U1239, NS-Park/F-CRIN Network, Mont-Saint-Aignan; Department of Neurology (O.L.-B.), Strasbourg University Hospital, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Université de Strasbourg, NS-Park/F-CRIN Network; Department of Neurology (C.G.), Centre Hospitalier Universitaire de Nice, NS-Park/F-CRIN Network; Departments of Neurology and Neurosurgery (M.T.), Expert Centre for Parkinson's Disease, EA 4559 Laboratoire de Neurosciences Fonctionnelles et Pathologie, Amiens University Hospital, Université de Picardie Jules Verne, NS-Park/F-CRIN Network, Amiens; Department of Neurology C (S.T.), Pierre Wertheimer Neurological Hospital, Hospices Civils de Lyon, University Hospital of Lyon, Université Claude Bernard Lyon 1, CNRS, Institut des Sciences Cognitives Marc Jeannerod, UMR 5229 CNRS, NS-PARK/F-CRIN Network; Department of Neurology (L.H.), University Hospital of Nancy, NS-PARK/F-CRIN Network; Department of Neurology (C.H.), Hospital Fondation Ophtalmologique Adolphe de Rothschild, NS-PARK/F-CRIN Network; and Neuroscience Pole (B.J.), Hôpital Foch, Université Paris-Saclay (UVSQ), INSERM-CEA NeuroSpin, NS-PARK/F-CRIN Network, Paris, France
| | - Caroline Moreau
- From the Neurology Department, Université Clermont Auvergne, EA7280 (E.B.-P., F.D., M.L.F., E.D., B.D., P.D., A.M.), and Biostatistics Department (B.P.), Clermont-Ferrand University Hospital, NS-Park/F-CRIN Network; Departments of Medical Pharmacology and Neurology and Movement Disorders, Referent Center of Parkinson's Disease, INSERM UMRS_1171, Licend, CHU of Lille (C.M.), and Department of Medical Pharmacology, University Hospital, Lille Neuroscience & Cognition, INSERM, UMR-S1172 (A.-S.R., D.D.), University of Lille, NS-Park/F-CRIN Network; Department of Neurology, Paris Brain Institute (ICM) (E.H., J.-C.C.), Institut Du Cerveau, INSERM CNRS, Assistance Publique Hôpitaux de Paris, Sorbonne Université, Hôpital Pitié-Salpêtrière, NS-Park/F-CRIN Network; Department of Neurology (T.R.), Nantes University Hospital, NS-Park/F-CRIN Network; Department of Neurology (A.E.), Assistance Publique Hôpitaux de Marseille, Timone University Hospital and Institut de Neurosciences de La Timone, NS-Park/F-CRIN Network; Department of Neurology (I.B.), University Poitiers, NS-Park/F-CRIN Network; Department of Neurology (S.D.), University Hospital of Rennes, NS-Park/F-CRIN Network; Institut des Maladies Neurodégénératives, Centre Expert Parkinson (D.G.), CHU de Bordeaux, NS-Park/F-CRIN Network; Parkinson Expert Center, Department of Clinical Pharmacology and Neuroscience (O.R.), Clinical Investigation Center CIC1436, NeuroToul COEN Center, Toulouse University Hospital, University of Toulouse 3, INSERM, NS-Park/F-CRIN Network; Department of Neurology (D.M.), Rouen University Hospital and University of Rouen; Laboratory of Neuronal and Neuroendocrine Differentiation and Communication (D.M.), INSERM U1239, NS-Park/F-CRIN Network, Mont-Saint-Aignan; Department of Neurology (O.L.-B.), Strasbourg University Hospital, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Université de Strasbourg, NS-Park/F-CRIN Network; Department of Neurology (C.G.), Centre Hospitalier Universitaire de Nice, NS-Park/F-CRIN Network; Departments of Neurology and Neurosurgery (M.T.), Expert Centre for Parkinson's Disease, EA 4559 Laboratoire de Neurosciences Fonctionnelles et Pathologie, Amiens University Hospital, Université de Picardie Jules Verne, NS-Park/F-CRIN Network, Amiens; Department of Neurology C (S.T.), Pierre Wertheimer Neurological Hospital, Hospices Civils de Lyon, University Hospital of Lyon, Université Claude Bernard Lyon 1, CNRS, Institut des Sciences Cognitives Marc Jeannerod, UMR 5229 CNRS, NS-PARK/F-CRIN Network; Department of Neurology (L.H.), University Hospital of Nancy, NS-PARK/F-CRIN Network; Department of Neurology (C.H.), Hospital Fondation Ophtalmologique Adolphe de Rothschild, NS-PARK/F-CRIN Network; and Neuroscience Pole (B.J.), Hôpital Foch, Université Paris-Saclay (UVSQ), INSERM-CEA NeuroSpin, NS-PARK/F-CRIN Network, Paris, France
| | - Elodie Hainque
- From the Neurology Department, Université Clermont Auvergne, EA7280 (E.B.-P., F.D., M.L.F., E.D., B.D., P.D., A.M.), and Biostatistics Department (B.P.), Clermont-Ferrand University Hospital, NS-Park/F-CRIN Network; Departments of Medical Pharmacology and Neurology and Movement Disorders, Referent Center of Parkinson's Disease, INSERM UMRS_1171, Licend, CHU of Lille (C.M.), and Department of Medical Pharmacology, University Hospital, Lille Neuroscience & Cognition, INSERM, UMR-S1172 (A.-S.R., D.D.), University of Lille, NS-Park/F-CRIN Network; Department of Neurology, Paris Brain Institute (ICM) (E.H., J.-C.C.), Institut Du Cerveau, INSERM CNRS, Assistance Publique Hôpitaux de Paris, Sorbonne Université, Hôpital Pitié-Salpêtrière, NS-Park/F-CRIN Network; Department of Neurology (T.R.), Nantes University Hospital, NS-Park/F-CRIN Network; Department of Neurology (A.E.), Assistance Publique Hôpitaux de Marseille, Timone University Hospital and Institut de Neurosciences de La Timone, NS-Park/F-CRIN Network; Department of Neurology (I.B.), University Poitiers, NS-Park/F-CRIN Network; Department of Neurology (S.D.), University Hospital of Rennes, NS-Park/F-CRIN Network; Institut des Maladies Neurodégénératives, Centre Expert Parkinson (D.G.), CHU de Bordeaux, NS-Park/F-CRIN Network; Parkinson Expert Center, Department of Clinical Pharmacology and Neuroscience (O.R.), Clinical Investigation Center CIC1436, NeuroToul COEN Center, Toulouse University Hospital, University of Toulouse 3, INSERM, NS-Park/F-CRIN Network; Department of Neurology (D.M.), Rouen University Hospital and University of Rouen; Laboratory of Neuronal and Neuroendocrine Differentiation and Communication (D.M.), INSERM U1239, NS-Park/F-CRIN Network, Mont-Saint-Aignan; Department of Neurology (O.L.-B.), Strasbourg University Hospital, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Université de Strasbourg, NS-Park/F-CRIN Network; Department of Neurology (C.G.), Centre Hospitalier Universitaire de Nice, NS-Park/F-CRIN Network; Departments of Neurology and Neurosurgery (M.T.), Expert Centre for Parkinson's Disease, EA 4559 Laboratoire de Neurosciences Fonctionnelles et Pathologie, Amiens University Hospital, Université de Picardie Jules Verne, NS-Park/F-CRIN Network, Amiens; Department of Neurology C (S.T.), Pierre Wertheimer Neurological Hospital, Hospices Civils de Lyon, University Hospital of Lyon, Université Claude Bernard Lyon 1, CNRS, Institut des Sciences Cognitives Marc Jeannerod, UMR 5229 CNRS, NS-PARK/F-CRIN Network; Department of Neurology (L.H.), University Hospital of Nancy, NS-PARK/F-CRIN Network; Department of Neurology (C.H.), Hospital Fondation Ophtalmologique Adolphe de Rothschild, NS-PARK/F-CRIN Network; and Neuroscience Pole (B.J.), Hôpital Foch, Université Paris-Saclay (UVSQ), INSERM-CEA NeuroSpin, NS-PARK/F-CRIN Network, Paris, France
| | - Tiphaine Rouaud
- From the Neurology Department, Université Clermont Auvergne, EA7280 (E.B.-P., F.D., M.L.F., E.D., B.D., P.D., A.M.), and Biostatistics Department (B.P.), Clermont-Ferrand University Hospital, NS-Park/F-CRIN Network; Departments of Medical Pharmacology and Neurology and Movement Disorders, Referent Center of Parkinson's Disease, INSERM UMRS_1171, Licend, CHU of Lille (C.M.), and Department of Medical Pharmacology, University Hospital, Lille Neuroscience & Cognition, INSERM, UMR-S1172 (A.-S.R., D.D.), University of Lille, NS-Park/F-CRIN Network; Department of Neurology, Paris Brain Institute (ICM) (E.H., J.-C.C.), Institut Du Cerveau, INSERM CNRS, Assistance Publique Hôpitaux de Paris, Sorbonne Université, Hôpital Pitié-Salpêtrière, NS-Park/F-CRIN Network; Department of Neurology (T.R.), Nantes University Hospital, NS-Park/F-CRIN Network; Department of Neurology (A.E.), Assistance Publique Hôpitaux de Marseille, Timone University Hospital and Institut de Neurosciences de La Timone, NS-Park/F-CRIN Network; Department of Neurology (I.B.), University Poitiers, NS-Park/F-CRIN Network; Department of Neurology (S.D.), University Hospital of Rennes, NS-Park/F-CRIN Network; Institut des Maladies Neurodégénératives, Centre Expert Parkinson (D.G.), CHU de Bordeaux, NS-Park/F-CRIN Network; Parkinson Expert Center, Department of Clinical Pharmacology and Neuroscience (O.R.), Clinical Investigation Center CIC1436, NeuroToul COEN Center, Toulouse University Hospital, University of Toulouse 3, INSERM, NS-Park/F-CRIN Network; Department of Neurology (D.M.), Rouen University Hospital and University of Rouen; Laboratory of Neuronal and Neuroendocrine Differentiation and Communication (D.M.), INSERM U1239, NS-Park/F-CRIN Network, Mont-Saint-Aignan; Department of Neurology (O.L.-B.), Strasbourg University Hospital, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Université de Strasbourg, NS-Park/F-CRIN Network; Department of Neurology (C.G.), Centre Hospitalier Universitaire de Nice, NS-Park/F-CRIN Network; Departments of Neurology and Neurosurgery (M.T.), Expert Centre for Parkinson's Disease, EA 4559 Laboratoire de Neurosciences Fonctionnelles et Pathologie, Amiens University Hospital, Université de Picardie Jules Verne, NS-Park/F-CRIN Network, Amiens; Department of Neurology C (S.T.), Pierre Wertheimer Neurological Hospital, Hospices Civils de Lyon, University Hospital of Lyon, Université Claude Bernard Lyon 1, CNRS, Institut des Sciences Cognitives Marc Jeannerod, UMR 5229 CNRS, NS-PARK/F-CRIN Network; Department of Neurology (L.H.), University Hospital of Nancy, NS-PARK/F-CRIN Network; Department of Neurology (C.H.), Hospital Fondation Ophtalmologique Adolphe de Rothschild, NS-PARK/F-CRIN Network; and Neuroscience Pole (B.J.), Hôpital Foch, Université Paris-Saclay (UVSQ), INSERM-CEA NeuroSpin, NS-PARK/F-CRIN Network, Paris, France
| | - Alexandre Eusebio
- From the Neurology Department, Université Clermont Auvergne, EA7280 (E.B.-P., F.D., M.L.F., E.D., B.D., P.D., A.M.), and Biostatistics Department (B.P.), Clermont-Ferrand University Hospital, NS-Park/F-CRIN Network; Departments of Medical Pharmacology and Neurology and Movement Disorders, Referent Center of Parkinson's Disease, INSERM UMRS_1171, Licend, CHU of Lille (C.M.), and Department of Medical Pharmacology, University Hospital, Lille Neuroscience & Cognition, INSERM, UMR-S1172 (A.-S.R., D.D.), University of Lille, NS-Park/F-CRIN Network; Department of Neurology, Paris Brain Institute (ICM) (E.H., J.-C.C.), Institut Du Cerveau, INSERM CNRS, Assistance Publique Hôpitaux de Paris, Sorbonne Université, Hôpital Pitié-Salpêtrière, NS-Park/F-CRIN Network; Department of Neurology (T.R.), Nantes University Hospital, NS-Park/F-CRIN Network; Department of Neurology (A.E.), Assistance Publique Hôpitaux de Marseille, Timone University Hospital and Institut de Neurosciences de La Timone, NS-Park/F-CRIN Network; Department of Neurology (I.B.), University Poitiers, NS-Park/F-CRIN Network; Department of Neurology (S.D.), University Hospital of Rennes, NS-Park/F-CRIN Network; Institut des Maladies Neurodégénératives, Centre Expert Parkinson (D.G.), CHU de Bordeaux, NS-Park/F-CRIN Network; Parkinson Expert Center, Department of Clinical Pharmacology and Neuroscience (O.R.), Clinical Investigation Center CIC1436, NeuroToul COEN Center, Toulouse University Hospital, University of Toulouse 3, INSERM, NS-Park/F-CRIN Network; Department of Neurology (D.M.), Rouen University Hospital and University of Rouen; Laboratory of Neuronal and Neuroendocrine Differentiation and Communication (D.M.), INSERM U1239, NS-Park/F-CRIN Network, Mont-Saint-Aignan; Department of Neurology (O.L.-B.), Strasbourg University Hospital, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Université de Strasbourg, NS-Park/F-CRIN Network; Department of Neurology (C.G.), Centre Hospitalier Universitaire de Nice, NS-Park/F-CRIN Network; Departments of Neurology and Neurosurgery (M.T.), Expert Centre for Parkinson's Disease, EA 4559 Laboratoire de Neurosciences Fonctionnelles et Pathologie, Amiens University Hospital, Université de Picardie Jules Verne, NS-Park/F-CRIN Network, Amiens; Department of Neurology C (S.T.), Pierre Wertheimer Neurological Hospital, Hospices Civils de Lyon, University Hospital of Lyon, Université Claude Bernard Lyon 1, CNRS, Institut des Sciences Cognitives Marc Jeannerod, UMR 5229 CNRS, NS-PARK/F-CRIN Network; Department of Neurology (L.H.), University Hospital of Nancy, NS-PARK/F-CRIN Network; Department of Neurology (C.H.), Hospital Fondation Ophtalmologique Adolphe de Rothschild, NS-PARK/F-CRIN Network; and Neuroscience Pole (B.J.), Hôpital Foch, Université Paris-Saclay (UVSQ), INSERM-CEA NeuroSpin, NS-PARK/F-CRIN Network, Paris, France
| | - Isabelle Benatru
- From the Neurology Department, Université Clermont Auvergne, EA7280 (E.B.-P., F.D., M.L.F., E.D., B.D., P.D., A.M.), and Biostatistics Department (B.P.), Clermont-Ferrand University Hospital, NS-Park/F-CRIN Network; Departments of Medical Pharmacology and Neurology and Movement Disorders, Referent Center of Parkinson's Disease, INSERM UMRS_1171, Licend, CHU of Lille (C.M.), and Department of Medical Pharmacology, University Hospital, Lille Neuroscience & Cognition, INSERM, UMR-S1172 (A.-S.R., D.D.), University of Lille, NS-Park/F-CRIN Network; Department of Neurology, Paris Brain Institute (ICM) (E.H., J.-C.C.), Institut Du Cerveau, INSERM CNRS, Assistance Publique Hôpitaux de Paris, Sorbonne Université, Hôpital Pitié-Salpêtrière, NS-Park/F-CRIN Network; Department of Neurology (T.R.), Nantes University Hospital, NS-Park/F-CRIN Network; Department of Neurology (A.E.), Assistance Publique Hôpitaux de Marseille, Timone University Hospital and Institut de Neurosciences de La Timone, NS-Park/F-CRIN Network; Department of Neurology (I.B.), University Poitiers, NS-Park/F-CRIN Network; Department of Neurology (S.D.), University Hospital of Rennes, NS-Park/F-CRIN Network; Institut des Maladies Neurodégénératives, Centre Expert Parkinson (D.G.), CHU de Bordeaux, NS-Park/F-CRIN Network; Parkinson Expert Center, Department of Clinical Pharmacology and Neuroscience (O.R.), Clinical Investigation Center CIC1436, NeuroToul COEN Center, Toulouse University Hospital, University of Toulouse 3, INSERM, NS-Park/F-CRIN Network; Department of Neurology (D.M.), Rouen University Hospital and University of Rouen; Laboratory of Neuronal and Neuroendocrine Differentiation and Communication (D.M.), INSERM U1239, NS-Park/F-CRIN Network, Mont-Saint-Aignan; Department of Neurology (O.L.-B.), Strasbourg University Hospital, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Université de Strasbourg, NS-Park/F-CRIN Network; Department of Neurology (C.G.), Centre Hospitalier Universitaire de Nice, NS-Park/F-CRIN Network; Departments of Neurology and Neurosurgery (M.T.), Expert Centre for Parkinson's Disease, EA 4559 Laboratoire de Neurosciences Fonctionnelles et Pathologie, Amiens University Hospital, Université de Picardie Jules Verne, NS-Park/F-CRIN Network, Amiens; Department of Neurology C (S.T.), Pierre Wertheimer Neurological Hospital, Hospices Civils de Lyon, University Hospital of Lyon, Université Claude Bernard Lyon 1, CNRS, Institut des Sciences Cognitives Marc Jeannerod, UMR 5229 CNRS, NS-PARK/F-CRIN Network; Department of Neurology (L.H.), University Hospital of Nancy, NS-PARK/F-CRIN Network; Department of Neurology (C.H.), Hospital Fondation Ophtalmologique Adolphe de Rothschild, NS-PARK/F-CRIN Network; and Neuroscience Pole (B.J.), Hôpital Foch, Université Paris-Saclay (UVSQ), INSERM-CEA NeuroSpin, NS-PARK/F-CRIN Network, Paris, France
| | - Sophie Drapier
- From the Neurology Department, Université Clermont Auvergne, EA7280 (E.B.-P., F.D., M.L.F., E.D., B.D., P.D., A.M.), and Biostatistics Department (B.P.), Clermont-Ferrand University Hospital, NS-Park/F-CRIN Network; Departments of Medical Pharmacology and Neurology and Movement Disorders, Referent Center of Parkinson's Disease, INSERM UMRS_1171, Licend, CHU of Lille (C.M.), and Department of Medical Pharmacology, University Hospital, Lille Neuroscience & Cognition, INSERM, UMR-S1172 (A.-S.R., D.D.), University of Lille, NS-Park/F-CRIN Network; Department of Neurology, Paris Brain Institute (ICM) (E.H., J.-C.C.), Institut Du Cerveau, INSERM CNRS, Assistance Publique Hôpitaux de Paris, Sorbonne Université, Hôpital Pitié-Salpêtrière, NS-Park/F-CRIN Network; Department of Neurology (T.R.), Nantes University Hospital, NS-Park/F-CRIN Network; Department of Neurology (A.E.), Assistance Publique Hôpitaux de Marseille, Timone University Hospital and Institut de Neurosciences de La Timone, NS-Park/F-CRIN Network; Department of Neurology (I.B.), University Poitiers, NS-Park/F-CRIN Network; Department of Neurology (S.D.), University Hospital of Rennes, NS-Park/F-CRIN Network; Institut des Maladies Neurodégénératives, Centre Expert Parkinson (D.G.), CHU de Bordeaux, NS-Park/F-CRIN Network; Parkinson Expert Center, Department of Clinical Pharmacology and Neuroscience (O.R.), Clinical Investigation Center CIC1436, NeuroToul COEN Center, Toulouse University Hospital, University of Toulouse 3, INSERM, NS-Park/F-CRIN Network; Department of Neurology (D.M.), Rouen University Hospital and University of Rouen; Laboratory of Neuronal and Neuroendocrine Differentiation and Communication (D.M.), INSERM U1239, NS-Park/F-CRIN Network, Mont-Saint-Aignan; Department of Neurology (O.L.-B.), Strasbourg University Hospital, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Université de Strasbourg, NS-Park/F-CRIN Network; Department of Neurology (C.G.), Centre Hospitalier Universitaire de Nice, NS-Park/F-CRIN Network; Departments of Neurology and Neurosurgery (M.T.), Expert Centre for Parkinson's Disease, EA 4559 Laboratoire de Neurosciences Fonctionnelles et Pathologie, Amiens University Hospital, Université de Picardie Jules Verne, NS-Park/F-CRIN Network, Amiens; Department of Neurology C (S.T.), Pierre Wertheimer Neurological Hospital, Hospices Civils de Lyon, University Hospital of Lyon, Université Claude Bernard Lyon 1, CNRS, Institut des Sciences Cognitives Marc Jeannerod, UMR 5229 CNRS, NS-PARK/F-CRIN Network; Department of Neurology (L.H.), University Hospital of Nancy, NS-PARK/F-CRIN Network; Department of Neurology (C.H.), Hospital Fondation Ophtalmologique Adolphe de Rothschild, NS-PARK/F-CRIN Network; and Neuroscience Pole (B.J.), Hôpital Foch, Université Paris-Saclay (UVSQ), INSERM-CEA NeuroSpin, NS-PARK/F-CRIN Network, Paris, France
| | - Dominique Guehl
- From the Neurology Department, Université Clermont Auvergne, EA7280 (E.B.-P., F.D., M.L.F., E.D., B.D., P.D., A.M.), and Biostatistics Department (B.P.), Clermont-Ferrand University Hospital, NS-Park/F-CRIN Network; Departments of Medical Pharmacology and Neurology and Movement Disorders, Referent Center of Parkinson's Disease, INSERM UMRS_1171, Licend, CHU of Lille (C.M.), and Department of Medical Pharmacology, University Hospital, Lille Neuroscience & Cognition, INSERM, UMR-S1172 (A.-S.R., D.D.), University of Lille, NS-Park/F-CRIN Network; Department of Neurology, Paris Brain Institute (ICM) (E.H., J.-C.C.), Institut Du Cerveau, INSERM CNRS, Assistance Publique Hôpitaux de Paris, Sorbonne Université, Hôpital Pitié-Salpêtrière, NS-Park/F-CRIN Network; Department of Neurology (T.R.), Nantes University Hospital, NS-Park/F-CRIN Network; Department of Neurology (A.E.), Assistance Publique Hôpitaux de Marseille, Timone University Hospital and Institut de Neurosciences de La Timone, NS-Park/F-CRIN Network; Department of Neurology (I.B.), University Poitiers, NS-Park/F-CRIN Network; Department of Neurology (S.D.), University Hospital of Rennes, NS-Park/F-CRIN Network; Institut des Maladies Neurodégénératives, Centre Expert Parkinson (D.G.), CHU de Bordeaux, NS-Park/F-CRIN Network; Parkinson Expert Center, Department of Clinical Pharmacology and Neuroscience (O.R.), Clinical Investigation Center CIC1436, NeuroToul COEN Center, Toulouse University Hospital, University of Toulouse 3, INSERM, NS-Park/F-CRIN Network; Department of Neurology (D.M.), Rouen University Hospital and University of Rouen; Laboratory of Neuronal and Neuroendocrine Differentiation and Communication (D.M.), INSERM U1239, NS-Park/F-CRIN Network, Mont-Saint-Aignan; Department of Neurology (O.L.-B.), Strasbourg University Hospital, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Université de Strasbourg, NS-Park/F-CRIN Network; Department of Neurology (C.G.), Centre Hospitalier Universitaire de Nice, NS-Park/F-CRIN Network; Departments of Neurology and Neurosurgery (M.T.), Expert Centre for Parkinson's Disease, EA 4559 Laboratoire de Neurosciences Fonctionnelles et Pathologie, Amiens University Hospital, Université de Picardie Jules Verne, NS-Park/F-CRIN Network, Amiens; Department of Neurology C (S.T.), Pierre Wertheimer Neurological Hospital, Hospices Civils de Lyon, University Hospital of Lyon, Université Claude Bernard Lyon 1, CNRS, Institut des Sciences Cognitives Marc Jeannerod, UMR 5229 CNRS, NS-PARK/F-CRIN Network; Department of Neurology (L.H.), University Hospital of Nancy, NS-PARK/F-CRIN Network; Department of Neurology (C.H.), Hospital Fondation Ophtalmologique Adolphe de Rothschild, NS-PARK/F-CRIN Network; and Neuroscience Pole (B.J.), Hôpital Foch, Université Paris-Saclay (UVSQ), INSERM-CEA NeuroSpin, NS-PARK/F-CRIN Network, Paris, France
| | - Olivier Rascol
- From the Neurology Department, Université Clermont Auvergne, EA7280 (E.B.-P., F.D., M.L.F., E.D., B.D., P.D., A.M.), and Biostatistics Department (B.P.), Clermont-Ferrand University Hospital, NS-Park/F-CRIN Network; Departments of Medical Pharmacology and Neurology and Movement Disorders, Referent Center of Parkinson's Disease, INSERM UMRS_1171, Licend, CHU of Lille (C.M.), and Department of Medical Pharmacology, University Hospital, Lille Neuroscience & Cognition, INSERM, UMR-S1172 (A.-S.R., D.D.), University of Lille, NS-Park/F-CRIN Network; Department of Neurology, Paris Brain Institute (ICM) (E.H., J.-C.C.), Institut Du Cerveau, INSERM CNRS, Assistance Publique Hôpitaux de Paris, Sorbonne Université, Hôpital Pitié-Salpêtrière, NS-Park/F-CRIN Network; Department of Neurology (T.R.), Nantes University Hospital, NS-Park/F-CRIN Network; Department of Neurology (A.E.), Assistance Publique Hôpitaux de Marseille, Timone University Hospital and Institut de Neurosciences de La Timone, NS-Park/F-CRIN Network; Department of Neurology (I.B.), University Poitiers, NS-Park/F-CRIN Network; Department of Neurology (S.D.), University Hospital of Rennes, NS-Park/F-CRIN Network; Institut des Maladies Neurodégénératives, Centre Expert Parkinson (D.G.), CHU de Bordeaux, NS-Park/F-CRIN Network; Parkinson Expert Center, Department of Clinical Pharmacology and Neuroscience (O.R.), Clinical Investigation Center CIC1436, NeuroToul COEN Center, Toulouse University Hospital, University of Toulouse 3, INSERM, NS-Park/F-CRIN Network; Department of Neurology (D.M.), Rouen University Hospital and University of Rouen; Laboratory of Neuronal and Neuroendocrine Differentiation and Communication (D.M.), INSERM U1239, NS-Park/F-CRIN Network, Mont-Saint-Aignan; Department of Neurology (O.L.-B.), Strasbourg University Hospital, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Université de Strasbourg, NS-Park/F-CRIN Network; Department of Neurology (C.G.), Centre Hospitalier Universitaire de Nice, NS-Park/F-CRIN Network; Departments of Neurology and Neurosurgery (M.T.), Expert Centre for Parkinson's Disease, EA 4559 Laboratoire de Neurosciences Fonctionnelles et Pathologie, Amiens University Hospital, Université de Picardie Jules Verne, NS-Park/F-CRIN Network, Amiens; Department of Neurology C (S.T.), Pierre Wertheimer Neurological Hospital, Hospices Civils de Lyon, University Hospital of Lyon, Université Claude Bernard Lyon 1, CNRS, Institut des Sciences Cognitives Marc Jeannerod, UMR 5229 CNRS, NS-PARK/F-CRIN Network; Department of Neurology (L.H.), University Hospital of Nancy, NS-PARK/F-CRIN Network; Department of Neurology (C.H.), Hospital Fondation Ophtalmologique Adolphe de Rothschild, NS-PARK/F-CRIN Network; and Neuroscience Pole (B.J.), Hôpital Foch, Université Paris-Saclay (UVSQ), INSERM-CEA NeuroSpin, NS-PARK/F-CRIN Network, Paris, France
| | - David Maltête
- From the Neurology Department, Université Clermont Auvergne, EA7280 (E.B.-P., F.D., M.L.F., E.D., B.D., P.D., A.M.), and Biostatistics Department (B.P.), Clermont-Ferrand University Hospital, NS-Park/F-CRIN Network; Departments of Medical Pharmacology and Neurology and Movement Disorders, Referent Center of Parkinson's Disease, INSERM UMRS_1171, Licend, CHU of Lille (C.M.), and Department of Medical Pharmacology, University Hospital, Lille Neuroscience & Cognition, INSERM, UMR-S1172 (A.-S.R., D.D.), University of Lille, NS-Park/F-CRIN Network; Department of Neurology, Paris Brain Institute (ICM) (E.H., J.-C.C.), Institut Du Cerveau, INSERM CNRS, Assistance Publique Hôpitaux de Paris, Sorbonne Université, Hôpital Pitié-Salpêtrière, NS-Park/F-CRIN Network; Department of Neurology (T.R.), Nantes University Hospital, NS-Park/F-CRIN Network; Department of Neurology (A.E.), Assistance Publique Hôpitaux de Marseille, Timone University Hospital and Institut de Neurosciences de La Timone, NS-Park/F-CRIN Network; Department of Neurology (I.B.), University Poitiers, NS-Park/F-CRIN Network; Department of Neurology (S.D.), University Hospital of Rennes, NS-Park/F-CRIN Network; Institut des Maladies Neurodégénératives, Centre Expert Parkinson (D.G.), CHU de Bordeaux, NS-Park/F-CRIN Network; Parkinson Expert Center, Department of Clinical Pharmacology and Neuroscience (O.R.), Clinical Investigation Center CIC1436, NeuroToul COEN Center, Toulouse University Hospital, University of Toulouse 3, INSERM, NS-Park/F-CRIN Network; Department of Neurology (D.M.), Rouen University Hospital and University of Rouen; Laboratory of Neuronal and Neuroendocrine Differentiation and Communication (D.M.), INSERM U1239, NS-Park/F-CRIN Network, Mont-Saint-Aignan; Department of Neurology (O.L.-B.), Strasbourg University Hospital, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Université de Strasbourg, NS-Park/F-CRIN Network; Department of Neurology (C.G.), Centre Hospitalier Universitaire de Nice, NS-Park/F-CRIN Network; Departments of Neurology and Neurosurgery (M.T.), Expert Centre for Parkinson's Disease, EA 4559 Laboratoire de Neurosciences Fonctionnelles et Pathologie, Amiens University Hospital, Université de Picardie Jules Verne, NS-Park/F-CRIN Network, Amiens; Department of Neurology C (S.T.), Pierre Wertheimer Neurological Hospital, Hospices Civils de Lyon, University Hospital of Lyon, Université Claude Bernard Lyon 1, CNRS, Institut des Sciences Cognitives Marc Jeannerod, UMR 5229 CNRS, NS-PARK/F-CRIN Network; Department of Neurology (L.H.), University Hospital of Nancy, NS-PARK/F-CRIN Network; Department of Neurology (C.H.), Hospital Fondation Ophtalmologique Adolphe de Rothschild, NS-PARK/F-CRIN Network; and Neuroscience Pole (B.J.), Hôpital Foch, Université Paris-Saclay (UVSQ), INSERM-CEA NeuroSpin, NS-PARK/F-CRIN Network, Paris, France
| | - Ouhaïd Lagha-Boukbiza
- From the Neurology Department, Université Clermont Auvergne, EA7280 (E.B.-P., F.D., M.L.F., E.D., B.D., P.D., A.M.), and Biostatistics Department (B.P.), Clermont-Ferrand University Hospital, NS-Park/F-CRIN Network; Departments of Medical Pharmacology and Neurology and Movement Disorders, Referent Center of Parkinson's Disease, INSERM UMRS_1171, Licend, CHU of Lille (C.M.), and Department of Medical Pharmacology, University Hospital, Lille Neuroscience & Cognition, INSERM, UMR-S1172 (A.-S.R., D.D.), University of Lille, NS-Park/F-CRIN Network; Department of Neurology, Paris Brain Institute (ICM) (E.H., J.-C.C.), Institut Du Cerveau, INSERM CNRS, Assistance Publique Hôpitaux de Paris, Sorbonne Université, Hôpital Pitié-Salpêtrière, NS-Park/F-CRIN Network; Department of Neurology (T.R.), Nantes University Hospital, NS-Park/F-CRIN Network; Department of Neurology (A.E.), Assistance Publique Hôpitaux de Marseille, Timone University Hospital and Institut de Neurosciences de La Timone, NS-Park/F-CRIN Network; Department of Neurology (I.B.), University Poitiers, NS-Park/F-CRIN Network; Department of Neurology (S.D.), University Hospital of Rennes, NS-Park/F-CRIN Network; Institut des Maladies Neurodégénératives, Centre Expert Parkinson (D.G.), CHU de Bordeaux, NS-Park/F-CRIN Network; Parkinson Expert Center, Department of Clinical Pharmacology and Neuroscience (O.R.), Clinical Investigation Center CIC1436, NeuroToul COEN Center, Toulouse University Hospital, University of Toulouse 3, INSERM, NS-Park/F-CRIN Network; Department of Neurology (D.M.), Rouen University Hospital and University of Rouen; Laboratory of Neuronal and Neuroendocrine Differentiation and Communication (D.M.), INSERM U1239, NS-Park/F-CRIN Network, Mont-Saint-Aignan; Department of Neurology (O.L.-B.), Strasbourg University Hospital, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Université de Strasbourg, NS-Park/F-CRIN Network; Department of Neurology (C.G.), Centre Hospitalier Universitaire de Nice, NS-Park/F-CRIN Network; Departments of Neurology and Neurosurgery (M.T.), Expert Centre for Parkinson's Disease, EA 4559 Laboratoire de Neurosciences Fonctionnelles et Pathologie, Amiens University Hospital, Université de Picardie Jules Verne, NS-Park/F-CRIN Network, Amiens; Department of Neurology C (S.T.), Pierre Wertheimer Neurological Hospital, Hospices Civils de Lyon, University Hospital of Lyon, Université Claude Bernard Lyon 1, CNRS, Institut des Sciences Cognitives Marc Jeannerod, UMR 5229 CNRS, NS-PARK/F-CRIN Network; Department of Neurology (L.H.), University Hospital of Nancy, NS-PARK/F-CRIN Network; Department of Neurology (C.H.), Hospital Fondation Ophtalmologique Adolphe de Rothschild, NS-PARK/F-CRIN Network; and Neuroscience Pole (B.J.), Hôpital Foch, Université Paris-Saclay (UVSQ), INSERM-CEA NeuroSpin, NS-PARK/F-CRIN Network, Paris, France
| | - Caroline Giordana
- From the Neurology Department, Université Clermont Auvergne, EA7280 (E.B.-P., F.D., M.L.F., E.D., B.D., P.D., A.M.), and Biostatistics Department (B.P.), Clermont-Ferrand University Hospital, NS-Park/F-CRIN Network; Departments of Medical Pharmacology and Neurology and Movement Disorders, Referent Center of Parkinson's Disease, INSERM UMRS_1171, Licend, CHU of Lille (C.M.), and Department of Medical Pharmacology, University Hospital, Lille Neuroscience & Cognition, INSERM, UMR-S1172 (A.-S.R., D.D.), University of Lille, NS-Park/F-CRIN Network; Department of Neurology, Paris Brain Institute (ICM) (E.H., J.-C.C.), Institut Du Cerveau, INSERM CNRS, Assistance Publique Hôpitaux de Paris, Sorbonne Université, Hôpital Pitié-Salpêtrière, NS-Park/F-CRIN Network; Department of Neurology (T.R.), Nantes University Hospital, NS-Park/F-CRIN Network; Department of Neurology (A.E.), Assistance Publique Hôpitaux de Marseille, Timone University Hospital and Institut de Neurosciences de La Timone, NS-Park/F-CRIN Network; Department of Neurology (I.B.), University Poitiers, NS-Park/F-CRIN Network; Department of Neurology (S.D.), University Hospital of Rennes, NS-Park/F-CRIN Network; Institut des Maladies Neurodégénératives, Centre Expert Parkinson (D.G.), CHU de Bordeaux, NS-Park/F-CRIN Network; Parkinson Expert Center, Department of Clinical Pharmacology and Neuroscience (O.R.), Clinical Investigation Center CIC1436, NeuroToul COEN Center, Toulouse University Hospital, University of Toulouse 3, INSERM, NS-Park/F-CRIN Network; Department of Neurology (D.M.), Rouen University Hospital and University of Rouen; Laboratory of Neuronal and Neuroendocrine Differentiation and Communication (D.M.), INSERM U1239, NS-Park/F-CRIN Network, Mont-Saint-Aignan; Department of Neurology (O.L.-B.), Strasbourg University Hospital, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Université de Strasbourg, NS-Park/F-CRIN Network; Department of Neurology (C.G.), Centre Hospitalier Universitaire de Nice, NS-Park/F-CRIN Network; Departments of Neurology and Neurosurgery (M.T.), Expert Centre for Parkinson's Disease, EA 4559 Laboratoire de Neurosciences Fonctionnelles et Pathologie, Amiens University Hospital, Université de Picardie Jules Verne, NS-Park/F-CRIN Network, Amiens; Department of Neurology C (S.T.), Pierre Wertheimer Neurological Hospital, Hospices Civils de Lyon, University Hospital of Lyon, Université Claude Bernard Lyon 1, CNRS, Institut des Sciences Cognitives Marc Jeannerod, UMR 5229 CNRS, NS-PARK/F-CRIN Network; Department of Neurology (L.H.), University Hospital of Nancy, NS-PARK/F-CRIN Network; Department of Neurology (C.H.), Hospital Fondation Ophtalmologique Adolphe de Rothschild, NS-PARK/F-CRIN Network; and Neuroscience Pole (B.J.), Hôpital Foch, Université Paris-Saclay (UVSQ), INSERM-CEA NeuroSpin, NS-PARK/F-CRIN Network, Paris, France
| | - Melissa Tir
- From the Neurology Department, Université Clermont Auvergne, EA7280 (E.B.-P., F.D., M.L.F., E.D., B.D., P.D., A.M.), and Biostatistics Department (B.P.), Clermont-Ferrand University Hospital, NS-Park/F-CRIN Network; Departments of Medical Pharmacology and Neurology and Movement Disorders, Referent Center of Parkinson's Disease, INSERM UMRS_1171, Licend, CHU of Lille (C.M.), and Department of Medical Pharmacology, University Hospital, Lille Neuroscience & Cognition, INSERM, UMR-S1172 (A.-S.R., D.D.), University of Lille, NS-Park/F-CRIN Network; Department of Neurology, Paris Brain Institute (ICM) (E.H., J.-C.C.), Institut Du Cerveau, INSERM CNRS, Assistance Publique Hôpitaux de Paris, Sorbonne Université, Hôpital Pitié-Salpêtrière, NS-Park/F-CRIN Network; Department of Neurology (T.R.), Nantes University Hospital, NS-Park/F-CRIN Network; Department of Neurology (A.E.), Assistance Publique Hôpitaux de Marseille, Timone University Hospital and Institut de Neurosciences de La Timone, NS-Park/F-CRIN Network; Department of Neurology (I.B.), University Poitiers, NS-Park/F-CRIN Network; Department of Neurology (S.D.), University Hospital of Rennes, NS-Park/F-CRIN Network; Institut des Maladies Neurodégénératives, Centre Expert Parkinson (D.G.), CHU de Bordeaux, NS-Park/F-CRIN Network; Parkinson Expert Center, Department of Clinical Pharmacology and Neuroscience (O.R.), Clinical Investigation Center CIC1436, NeuroToul COEN Center, Toulouse University Hospital, University of Toulouse 3, INSERM, NS-Park/F-CRIN Network; Department of Neurology (D.M.), Rouen University Hospital and University of Rouen; Laboratory of Neuronal and Neuroendocrine Differentiation and Communication (D.M.), INSERM U1239, NS-Park/F-CRIN Network, Mont-Saint-Aignan; Department of Neurology (O.L.-B.), Strasbourg University Hospital, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Université de Strasbourg, NS-Park/F-CRIN Network; Department of Neurology (C.G.), Centre Hospitalier Universitaire de Nice, NS-Park/F-CRIN Network; Departments of Neurology and Neurosurgery (M.T.), Expert Centre for Parkinson's Disease, EA 4559 Laboratoire de Neurosciences Fonctionnelles et Pathologie, Amiens University Hospital, Université de Picardie Jules Verne, NS-Park/F-CRIN Network, Amiens; Department of Neurology C (S.T.), Pierre Wertheimer Neurological Hospital, Hospices Civils de Lyon, University Hospital of Lyon, Université Claude Bernard Lyon 1, CNRS, Institut des Sciences Cognitives Marc Jeannerod, UMR 5229 CNRS, NS-PARK/F-CRIN Network; Department of Neurology (L.H.), University Hospital of Nancy, NS-PARK/F-CRIN Network; Department of Neurology (C.H.), Hospital Fondation Ophtalmologique Adolphe de Rothschild, NS-PARK/F-CRIN Network; and Neuroscience Pole (B.J.), Hôpital Foch, Université Paris-Saclay (UVSQ), INSERM-CEA NeuroSpin, NS-PARK/F-CRIN Network, Paris, France
| | - Stéphane Thobois
- From the Neurology Department, Université Clermont Auvergne, EA7280 (E.B.-P., F.D., M.L.F., E.D., B.D., P.D., A.M.), and Biostatistics Department (B.P.), Clermont-Ferrand University Hospital, NS-Park/F-CRIN Network; Departments of Medical Pharmacology and Neurology and Movement Disorders, Referent Center of Parkinson's Disease, INSERM UMRS_1171, Licend, CHU of Lille (C.M.), and Department of Medical Pharmacology, University Hospital, Lille Neuroscience & Cognition, INSERM, UMR-S1172 (A.-S.R., D.D.), University of Lille, NS-Park/F-CRIN Network; Department of Neurology, Paris Brain Institute (ICM) (E.H., J.-C.C.), Institut Du Cerveau, INSERM CNRS, Assistance Publique Hôpitaux de Paris, Sorbonne Université, Hôpital Pitié-Salpêtrière, NS-Park/F-CRIN Network; Department of Neurology (T.R.), Nantes University Hospital, NS-Park/F-CRIN Network; Department of Neurology (A.E.), Assistance Publique Hôpitaux de Marseille, Timone University Hospital and Institut de Neurosciences de La Timone, NS-Park/F-CRIN Network; Department of Neurology (I.B.), University Poitiers, NS-Park/F-CRIN Network; Department of Neurology (S.D.), University Hospital of Rennes, NS-Park/F-CRIN Network; Institut des Maladies Neurodégénératives, Centre Expert Parkinson (D.G.), CHU de Bordeaux, NS-Park/F-CRIN Network; Parkinson Expert Center, Department of Clinical Pharmacology and Neuroscience (O.R.), Clinical Investigation Center CIC1436, NeuroToul COEN Center, Toulouse University Hospital, University of Toulouse 3, INSERM, NS-Park/F-CRIN Network; Department of Neurology (D.M.), Rouen University Hospital and University of Rouen; Laboratory of Neuronal and Neuroendocrine Differentiation and Communication (D.M.), INSERM U1239, NS-Park/F-CRIN Network, Mont-Saint-Aignan; Department of Neurology (O.L.-B.), Strasbourg University Hospital, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Université de Strasbourg, NS-Park/F-CRIN Network; Department of Neurology (C.G.), Centre Hospitalier Universitaire de Nice, NS-Park/F-CRIN Network; Departments of Neurology and Neurosurgery (M.T.), Expert Centre for Parkinson's Disease, EA 4559 Laboratoire de Neurosciences Fonctionnelles et Pathologie, Amiens University Hospital, Université de Picardie Jules Verne, NS-Park/F-CRIN Network, Amiens; Department of Neurology C (S.T.), Pierre Wertheimer Neurological Hospital, Hospices Civils de Lyon, University Hospital of Lyon, Université Claude Bernard Lyon 1, CNRS, Institut des Sciences Cognitives Marc Jeannerod, UMR 5229 CNRS, NS-PARK/F-CRIN Network; Department of Neurology (L.H.), University Hospital of Nancy, NS-PARK/F-CRIN Network; Department of Neurology (C.H.), Hospital Fondation Ophtalmologique Adolphe de Rothschild, NS-PARK/F-CRIN Network; and Neuroscience Pole (B.J.), Hôpital Foch, Université Paris-Saclay (UVSQ), INSERM-CEA NeuroSpin, NS-PARK/F-CRIN Network, Paris, France
| | - Lucie Hopes
- From the Neurology Department, Université Clermont Auvergne, EA7280 (E.B.-P., F.D., M.L.F., E.D., B.D., P.D., A.M.), and Biostatistics Department (B.P.), Clermont-Ferrand University Hospital, NS-Park/F-CRIN Network; Departments of Medical Pharmacology and Neurology and Movement Disorders, Referent Center of Parkinson's Disease, INSERM UMRS_1171, Licend, CHU of Lille (C.M.), and Department of Medical Pharmacology, University Hospital, Lille Neuroscience & Cognition, INSERM, UMR-S1172 (A.-S.R., D.D.), University of Lille, NS-Park/F-CRIN Network; Department of Neurology, Paris Brain Institute (ICM) (E.H., J.-C.C.), Institut Du Cerveau, INSERM CNRS, Assistance Publique Hôpitaux de Paris, Sorbonne Université, Hôpital Pitié-Salpêtrière, NS-Park/F-CRIN Network; Department of Neurology (T.R.), Nantes University Hospital, NS-Park/F-CRIN Network; Department of Neurology (A.E.), Assistance Publique Hôpitaux de Marseille, Timone University Hospital and Institut de Neurosciences de La Timone, NS-Park/F-CRIN Network; Department of Neurology (I.B.), University Poitiers, NS-Park/F-CRIN Network; Department of Neurology (S.D.), University Hospital of Rennes, NS-Park/F-CRIN Network; Institut des Maladies Neurodégénératives, Centre Expert Parkinson (D.G.), CHU de Bordeaux, NS-Park/F-CRIN Network; Parkinson Expert Center, Department of Clinical Pharmacology and Neuroscience (O.R.), Clinical Investigation Center CIC1436, NeuroToul COEN Center, Toulouse University Hospital, University of Toulouse 3, INSERM, NS-Park/F-CRIN Network; Department of Neurology (D.M.), Rouen University Hospital and University of Rouen; Laboratory of Neuronal and Neuroendocrine Differentiation and Communication (D.M.), INSERM U1239, NS-Park/F-CRIN Network, Mont-Saint-Aignan; Department of Neurology (O.L.-B.), Strasbourg University Hospital, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Université de Strasbourg, NS-Park/F-CRIN Network; Department of Neurology (C.G.), Centre Hospitalier Universitaire de Nice, NS-Park/F-CRIN Network; Departments of Neurology and Neurosurgery (M.T.), Expert Centre for Parkinson's Disease, EA 4559 Laboratoire de Neurosciences Fonctionnelles et Pathologie, Amiens University Hospital, Université de Picardie Jules Verne, NS-Park/F-CRIN Network, Amiens; Department of Neurology C (S.T.), Pierre Wertheimer Neurological Hospital, Hospices Civils de Lyon, University Hospital of Lyon, Université Claude Bernard Lyon 1, CNRS, Institut des Sciences Cognitives Marc Jeannerod, UMR 5229 CNRS, NS-PARK/F-CRIN Network; Department of Neurology (L.H.), University Hospital of Nancy, NS-PARK/F-CRIN Network; Department of Neurology (C.H.), Hospital Fondation Ophtalmologique Adolphe de Rothschild, NS-PARK/F-CRIN Network; and Neuroscience Pole (B.J.), Hôpital Foch, Université Paris-Saclay (UVSQ), INSERM-CEA NeuroSpin, NS-PARK/F-CRIN Network, Paris, France
| | - Cécile Hubsch
- From the Neurology Department, Université Clermont Auvergne, EA7280 (E.B.-P., F.D., M.L.F., E.D., B.D., P.D., A.M.), and Biostatistics Department (B.P.), Clermont-Ferrand University Hospital, NS-Park/F-CRIN Network; Departments of Medical Pharmacology and Neurology and Movement Disorders, Referent Center of Parkinson's Disease, INSERM UMRS_1171, Licend, CHU of Lille (C.M.), and Department of Medical Pharmacology, University Hospital, Lille Neuroscience & Cognition, INSERM, UMR-S1172 (A.-S.R., D.D.), University of Lille, NS-Park/F-CRIN Network; Department of Neurology, Paris Brain Institute (ICM) (E.H., J.-C.C.), Institut Du Cerveau, INSERM CNRS, Assistance Publique Hôpitaux de Paris, Sorbonne Université, Hôpital Pitié-Salpêtrière, NS-Park/F-CRIN Network; Department of Neurology (T.R.), Nantes University Hospital, NS-Park/F-CRIN Network; Department of Neurology (A.E.), Assistance Publique Hôpitaux de Marseille, Timone University Hospital and Institut de Neurosciences de La Timone, NS-Park/F-CRIN Network; Department of Neurology (I.B.), University Poitiers, NS-Park/F-CRIN Network; Department of Neurology (S.D.), University Hospital of Rennes, NS-Park/F-CRIN Network; Institut des Maladies Neurodégénératives, Centre Expert Parkinson (D.G.), CHU de Bordeaux, NS-Park/F-CRIN Network; Parkinson Expert Center, Department of Clinical Pharmacology and Neuroscience (O.R.), Clinical Investigation Center CIC1436, NeuroToul COEN Center, Toulouse University Hospital, University of Toulouse 3, INSERM, NS-Park/F-CRIN Network; Department of Neurology (D.M.), Rouen University Hospital and University of Rouen; Laboratory of Neuronal and Neuroendocrine Differentiation and Communication (D.M.), INSERM U1239, NS-Park/F-CRIN Network, Mont-Saint-Aignan; Department of Neurology (O.L.-B.), Strasbourg University Hospital, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Université de Strasbourg, NS-Park/F-CRIN Network; Department of Neurology (C.G.), Centre Hospitalier Universitaire de Nice, NS-Park/F-CRIN Network; Departments of Neurology and Neurosurgery (M.T.), Expert Centre for Parkinson's Disease, EA 4559 Laboratoire de Neurosciences Fonctionnelles et Pathologie, Amiens University Hospital, Université de Picardie Jules Verne, NS-Park/F-CRIN Network, Amiens; Department of Neurology C (S.T.), Pierre Wertheimer Neurological Hospital, Hospices Civils de Lyon, University Hospital of Lyon, Université Claude Bernard Lyon 1, CNRS, Institut des Sciences Cognitives Marc Jeannerod, UMR 5229 CNRS, NS-PARK/F-CRIN Network; Department of Neurology (L.H.), University Hospital of Nancy, NS-PARK/F-CRIN Network; Department of Neurology (C.H.), Hospital Fondation Ophtalmologique Adolphe de Rothschild, NS-PARK/F-CRIN Network; and Neuroscience Pole (B.J.), Hôpital Foch, Université Paris-Saclay (UVSQ), INSERM-CEA NeuroSpin, NS-PARK/F-CRIN Network, Paris, France
| | - Béchir Jarraya
- From the Neurology Department, Université Clermont Auvergne, EA7280 (E.B.-P., F.D., M.L.F., E.D., B.D., P.D., A.M.), and Biostatistics Department (B.P.), Clermont-Ferrand University Hospital, NS-Park/F-CRIN Network; Departments of Medical Pharmacology and Neurology and Movement Disorders, Referent Center of Parkinson's Disease, INSERM UMRS_1171, Licend, CHU of Lille (C.M.), and Department of Medical Pharmacology, University Hospital, Lille Neuroscience & Cognition, INSERM, UMR-S1172 (A.-S.R., D.D.), University of Lille, NS-Park/F-CRIN Network; Department of Neurology, Paris Brain Institute (ICM) (E.H., J.-C.C.), Institut Du Cerveau, INSERM CNRS, Assistance Publique Hôpitaux de Paris, Sorbonne Université, Hôpital Pitié-Salpêtrière, NS-Park/F-CRIN Network; Department of Neurology (T.R.), Nantes University Hospital, NS-Park/F-CRIN Network; Department of Neurology (A.E.), Assistance Publique Hôpitaux de Marseille, Timone University Hospital and Institut de Neurosciences de La Timone, NS-Park/F-CRIN Network; Department of Neurology (I.B.), University Poitiers, NS-Park/F-CRIN Network; Department of Neurology (S.D.), University Hospital of Rennes, NS-Park/F-CRIN Network; Institut des Maladies Neurodégénératives, Centre Expert Parkinson (D.G.), CHU de Bordeaux, NS-Park/F-CRIN Network; Parkinson Expert Center, Department of Clinical Pharmacology and Neuroscience (O.R.), Clinical Investigation Center CIC1436, NeuroToul COEN Center, Toulouse University Hospital, University of Toulouse 3, INSERM, NS-Park/F-CRIN Network; Department of Neurology (D.M.), Rouen University Hospital and University of Rouen; Laboratory of Neuronal and Neuroendocrine Differentiation and Communication (D.M.), INSERM U1239, NS-Park/F-CRIN Network, Mont-Saint-Aignan; Department of Neurology (O.L.-B.), Strasbourg University Hospital, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Université de Strasbourg, NS-Park/F-CRIN Network; Department of Neurology (C.G.), Centre Hospitalier Universitaire de Nice, NS-Park/F-CRIN Network; Departments of Neurology and Neurosurgery (M.T.), Expert Centre for Parkinson's Disease, EA 4559 Laboratoire de Neurosciences Fonctionnelles et Pathologie, Amiens University Hospital, Université de Picardie Jules Verne, NS-Park/F-CRIN Network, Amiens; Department of Neurology C (S.T.), Pierre Wertheimer Neurological Hospital, Hospices Civils de Lyon, University Hospital of Lyon, Université Claude Bernard Lyon 1, CNRS, Institut des Sciences Cognitives Marc Jeannerod, UMR 5229 CNRS, NS-PARK/F-CRIN Network; Department of Neurology (L.H.), University Hospital of Nancy, NS-PARK/F-CRIN Network; Department of Neurology (C.H.), Hospital Fondation Ophtalmologique Adolphe de Rothschild, NS-PARK/F-CRIN Network; and Neuroscience Pole (B.J.), Hôpital Foch, Université Paris-Saclay (UVSQ), INSERM-CEA NeuroSpin, NS-PARK/F-CRIN Network, Paris, France
| | - Anne-Sophie Rolland
- From the Neurology Department, Université Clermont Auvergne, EA7280 (E.B.-P., F.D., M.L.F., E.D., B.D., P.D., A.M.), and Biostatistics Department (B.P.), Clermont-Ferrand University Hospital, NS-Park/F-CRIN Network; Departments of Medical Pharmacology and Neurology and Movement Disorders, Referent Center of Parkinson's Disease, INSERM UMRS_1171, Licend, CHU of Lille (C.M.), and Department of Medical Pharmacology, University Hospital, Lille Neuroscience & Cognition, INSERM, UMR-S1172 (A.-S.R., D.D.), University of Lille, NS-Park/F-CRIN Network; Department of Neurology, Paris Brain Institute (ICM) (E.H., J.-C.C.), Institut Du Cerveau, INSERM CNRS, Assistance Publique Hôpitaux de Paris, Sorbonne Université, Hôpital Pitié-Salpêtrière, NS-Park/F-CRIN Network; Department of Neurology (T.R.), Nantes University Hospital, NS-Park/F-CRIN Network; Department of Neurology (A.E.), Assistance Publique Hôpitaux de Marseille, Timone University Hospital and Institut de Neurosciences de La Timone, NS-Park/F-CRIN Network; Department of Neurology (I.B.), University Poitiers, NS-Park/F-CRIN Network; Department of Neurology (S.D.), University Hospital of Rennes, NS-Park/F-CRIN Network; Institut des Maladies Neurodégénératives, Centre Expert Parkinson (D.G.), CHU de Bordeaux, NS-Park/F-CRIN Network; Parkinson Expert Center, Department of Clinical Pharmacology and Neuroscience (O.R.), Clinical Investigation Center CIC1436, NeuroToul COEN Center, Toulouse University Hospital, University of Toulouse 3, INSERM, NS-Park/F-CRIN Network; Department of Neurology (D.M.), Rouen University Hospital and University of Rouen; Laboratory of Neuronal and Neuroendocrine Differentiation and Communication (D.M.), INSERM U1239, NS-Park/F-CRIN Network, Mont-Saint-Aignan; Department of Neurology (O.L.-B.), Strasbourg University Hospital, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Université de Strasbourg, NS-Park/F-CRIN Network; Department of Neurology (C.G.), Centre Hospitalier Universitaire de Nice, NS-Park/F-CRIN Network; Departments of Neurology and Neurosurgery (M.T.), Expert Centre for Parkinson's Disease, EA 4559 Laboratoire de Neurosciences Fonctionnelles et Pathologie, Amiens University Hospital, Université de Picardie Jules Verne, NS-Park/F-CRIN Network, Amiens; Department of Neurology C (S.T.), Pierre Wertheimer Neurological Hospital, Hospices Civils de Lyon, University Hospital of Lyon, Université Claude Bernard Lyon 1, CNRS, Institut des Sciences Cognitives Marc Jeannerod, UMR 5229 CNRS, NS-PARK/F-CRIN Network; Department of Neurology (L.H.), University Hospital of Nancy, NS-PARK/F-CRIN Network; Department of Neurology (C.H.), Hospital Fondation Ophtalmologique Adolphe de Rothschild, NS-PARK/F-CRIN Network; and Neuroscience Pole (B.J.), Hôpital Foch, Université Paris-Saclay (UVSQ), INSERM-CEA NeuroSpin, NS-PARK/F-CRIN Network, Paris, France
| | - Jean-Christophe Corvol
- From the Neurology Department, Université Clermont Auvergne, EA7280 (E.B.-P., F.D., M.L.F., E.D., B.D., P.D., A.M.), and Biostatistics Department (B.P.), Clermont-Ferrand University Hospital, NS-Park/F-CRIN Network; Departments of Medical Pharmacology and Neurology and Movement Disorders, Referent Center of Parkinson's Disease, INSERM UMRS_1171, Licend, CHU of Lille (C.M.), and Department of Medical Pharmacology, University Hospital, Lille Neuroscience & Cognition, INSERM, UMR-S1172 (A.-S.R., D.D.), University of Lille, NS-Park/F-CRIN Network; Department of Neurology, Paris Brain Institute (ICM) (E.H., J.-C.C.), Institut Du Cerveau, INSERM CNRS, Assistance Publique Hôpitaux de Paris, Sorbonne Université, Hôpital Pitié-Salpêtrière, NS-Park/F-CRIN Network; Department of Neurology (T.R.), Nantes University Hospital, NS-Park/F-CRIN Network; Department of Neurology (A.E.), Assistance Publique Hôpitaux de Marseille, Timone University Hospital and Institut de Neurosciences de La Timone, NS-Park/F-CRIN Network; Department of Neurology (I.B.), University Poitiers, NS-Park/F-CRIN Network; Department of Neurology (S.D.), University Hospital of Rennes, NS-Park/F-CRIN Network; Institut des Maladies Neurodégénératives, Centre Expert Parkinson (D.G.), CHU de Bordeaux, NS-Park/F-CRIN Network; Parkinson Expert Center, Department of Clinical Pharmacology and Neuroscience (O.R.), Clinical Investigation Center CIC1436, NeuroToul COEN Center, Toulouse University Hospital, University of Toulouse 3, INSERM, NS-Park/F-CRIN Network; Department of Neurology (D.M.), Rouen University Hospital and University of Rouen; Laboratory of Neuronal and Neuroendocrine Differentiation and Communication (D.M.), INSERM U1239, NS-Park/F-CRIN Network, Mont-Saint-Aignan; Department of Neurology (O.L.-B.), Strasbourg University Hospital, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Université de Strasbourg, NS-Park/F-CRIN Network; Department of Neurology (C.G.), Centre Hospitalier Universitaire de Nice, NS-Park/F-CRIN Network; Departments of Neurology and Neurosurgery (M.T.), Expert Centre for Parkinson's Disease, EA 4559 Laboratoire de Neurosciences Fonctionnelles et Pathologie, Amiens University Hospital, Université de Picardie Jules Verne, NS-Park/F-CRIN Network, Amiens; Department of Neurology C (S.T.), Pierre Wertheimer Neurological Hospital, Hospices Civils de Lyon, University Hospital of Lyon, Université Claude Bernard Lyon 1, CNRS, Institut des Sciences Cognitives Marc Jeannerod, UMR 5229 CNRS, NS-PARK/F-CRIN Network; Department of Neurology (L.H.), University Hospital of Nancy, NS-PARK/F-CRIN Network; Department of Neurology (C.H.), Hospital Fondation Ophtalmologique Adolphe de Rothschild, NS-PARK/F-CRIN Network; and Neuroscience Pole (B.J.), Hôpital Foch, Université Paris-Saclay (UVSQ), INSERM-CEA NeuroSpin, NS-PARK/F-CRIN Network, Paris, France
| | - David Devos
- From the Neurology Department, Université Clermont Auvergne, EA7280 (E.B.-P., F.D., M.L.F., E.D., B.D., P.D., A.M.), and Biostatistics Department (B.P.), Clermont-Ferrand University Hospital, NS-Park/F-CRIN Network; Departments of Medical Pharmacology and Neurology and Movement Disorders, Referent Center of Parkinson's Disease, INSERM UMRS_1171, Licend, CHU of Lille (C.M.), and Department of Medical Pharmacology, University Hospital, Lille Neuroscience & Cognition, INSERM, UMR-S1172 (A.-S.R., D.D.), University of Lille, NS-Park/F-CRIN Network; Department of Neurology, Paris Brain Institute (ICM) (E.H., J.-C.C.), Institut Du Cerveau, INSERM CNRS, Assistance Publique Hôpitaux de Paris, Sorbonne Université, Hôpital Pitié-Salpêtrière, NS-Park/F-CRIN Network; Department of Neurology (T.R.), Nantes University Hospital, NS-Park/F-CRIN Network; Department of Neurology (A.E.), Assistance Publique Hôpitaux de Marseille, Timone University Hospital and Institut de Neurosciences de La Timone, NS-Park/F-CRIN Network; Department of Neurology (I.B.), University Poitiers, NS-Park/F-CRIN Network; Department of Neurology (S.D.), University Hospital of Rennes, NS-Park/F-CRIN Network; Institut des Maladies Neurodégénératives, Centre Expert Parkinson (D.G.), CHU de Bordeaux, NS-Park/F-CRIN Network; Parkinson Expert Center, Department of Clinical Pharmacology and Neuroscience (O.R.), Clinical Investigation Center CIC1436, NeuroToul COEN Center, Toulouse University Hospital, University of Toulouse 3, INSERM, NS-Park/F-CRIN Network; Department of Neurology (D.M.), Rouen University Hospital and University of Rouen; Laboratory of Neuronal and Neuroendocrine Differentiation and Communication (D.M.), INSERM U1239, NS-Park/F-CRIN Network, Mont-Saint-Aignan; Department of Neurology (O.L.-B.), Strasbourg University Hospital, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Université de Strasbourg, NS-Park/F-CRIN Network; Department of Neurology (C.G.), Centre Hospitalier Universitaire de Nice, NS-Park/F-CRIN Network; Departments of Neurology and Neurosurgery (M.T.), Expert Centre for Parkinson's Disease, EA 4559 Laboratoire de Neurosciences Fonctionnelles et Pathologie, Amiens University Hospital, Université de Picardie Jules Verne, NS-Park/F-CRIN Network, Amiens; Department of Neurology C (S.T.), Pierre Wertheimer Neurological Hospital, Hospices Civils de Lyon, University Hospital of Lyon, Université Claude Bernard Lyon 1, CNRS, Institut des Sciences Cognitives Marc Jeannerod, UMR 5229 CNRS, NS-PARK/F-CRIN Network; Department of Neurology (L.H.), University Hospital of Nancy, NS-PARK/F-CRIN Network; Department of Neurology (C.H.), Hospital Fondation Ophtalmologique Adolphe de Rothschild, NS-PARK/F-CRIN Network; and Neuroscience Pole (B.J.), Hôpital Foch, Université Paris-Saclay (UVSQ), INSERM-CEA NeuroSpin, NS-PARK/F-CRIN Network, Paris, France
| | - Ana Marques
- From the Neurology Department, Université Clermont Auvergne, EA7280 (E.B.-P., F.D., M.L.F., E.D., B.D., P.D., A.M.), and Biostatistics Department (B.P.), Clermont-Ferrand University Hospital, NS-Park/F-CRIN Network; Departments of Medical Pharmacology and Neurology and Movement Disorders, Referent Center of Parkinson's Disease, INSERM UMRS_1171, Licend, CHU of Lille (C.M.), and Department of Medical Pharmacology, University Hospital, Lille Neuroscience & Cognition, INSERM, UMR-S1172 (A.-S.R., D.D.), University of Lille, NS-Park/F-CRIN Network; Department of Neurology, Paris Brain Institute (ICM) (E.H., J.-C.C.), Institut Du Cerveau, INSERM CNRS, Assistance Publique Hôpitaux de Paris, Sorbonne Université, Hôpital Pitié-Salpêtrière, NS-Park/F-CRIN Network; Department of Neurology (T.R.), Nantes University Hospital, NS-Park/F-CRIN Network; Department of Neurology (A.E.), Assistance Publique Hôpitaux de Marseille, Timone University Hospital and Institut de Neurosciences de La Timone, NS-Park/F-CRIN Network; Department of Neurology (I.B.), University Poitiers, NS-Park/F-CRIN Network; Department of Neurology (S.D.), University Hospital of Rennes, NS-Park/F-CRIN Network; Institut des Maladies Neurodégénératives, Centre Expert Parkinson (D.G.), CHU de Bordeaux, NS-Park/F-CRIN Network; Parkinson Expert Center, Department of Clinical Pharmacology and Neuroscience (O.R.), Clinical Investigation Center CIC1436, NeuroToul COEN Center, Toulouse University Hospital, University of Toulouse 3, INSERM, NS-Park/F-CRIN Network; Department of Neurology (D.M.), Rouen University Hospital and University of Rouen; Laboratory of Neuronal and Neuroendocrine Differentiation and Communication (D.M.), INSERM U1239, NS-Park/F-CRIN Network, Mont-Saint-Aignan; Department of Neurology (O.L.-B.), Strasbourg University Hospital, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Université de Strasbourg, NS-Park/F-CRIN Network; Department of Neurology (C.G.), Centre Hospitalier Universitaire de Nice, NS-Park/F-CRIN Network; Departments of Neurology and Neurosurgery (M.T.), Expert Centre for Parkinson's Disease, EA 4559 Laboratoire de Neurosciences Fonctionnelles et Pathologie, Amiens University Hospital, Université de Picardie Jules Verne, NS-Park/F-CRIN Network, Amiens; Department of Neurology C (S.T.), Pierre Wertheimer Neurological Hospital, Hospices Civils de Lyon, University Hospital of Lyon, Université Claude Bernard Lyon 1, CNRS, Institut des Sciences Cognitives Marc Jeannerod, UMR 5229 CNRS, NS-PARK/F-CRIN Network; Department of Neurology (L.H.), University Hospital of Nancy, NS-PARK/F-CRIN Network; Department of Neurology (C.H.), Hospital Fondation Ophtalmologique Adolphe de Rothschild, NS-PARK/F-CRIN Network; and Neuroscience Pole (B.J.), Hôpital Foch, Université Paris-Saclay (UVSQ), INSERM-CEA NeuroSpin, NS-PARK/F-CRIN Network, Paris, France.
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Levodopa Challenge Test Predicts STN-DBS Outcomes in Various Parkinson's Disease Motor Subtypes: A More Accurate Judgment. Neural Plast 2021; 2021:4762027. [PMID: 34721568 PMCID: PMC8553443 DOI: 10.1155/2021/4762027] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 08/01/2021] [Accepted: 08/16/2021] [Indexed: 12/03/2022] Open
Abstract
Background The relationship between the levodopa challenge test (LDCT) and postoperative subthalamic nucleus-deep brain stimulation (STN-DBS) benefits is controversial in patients with Parkinson's disease (PD). We aim to evaluate the value of total levodopa response (TLR) and symptom levodopa response (SLR) in predicting postoperative improvement in different PD motor subtypes. Methods Studies were split into a training set (147 patients) and a validation set (304 patients). We retrospectively collected data from 147 patients who received the Unified Parkinson's Disease Rating Scale- (UPDRS-) III and the Parkinson's Disease Questionnaire- (PDQ-) 39 evaluation. Patients were classified into tremor-dominant (TD), akinetic-rigid-dominant (AR), and mixed (MX) groups. Clinically important difference (CID) was employed to dichotomize DBS effects. For patients in each subtype group from the training set, we used the correlation and receiver operator characteristic (ROC) curve analyses to explore the strength of their relations. Areas under the curve (AUCs) were calculated and compared through the DeLong test. Results developed from the training set were applied into the validation set to predict postoperative improvement in different PD motor subtypes. Results In the validation cohort, TLR significantly correlated with postoperative motor (p < 0.001) and quality of life (QOL) (p < 0.001) improvement in the MX group. The AUC between TLR and UPDRS-III (TU) is 0.800. The AUC between TLR and PDQ-39 (TP) is 0.770. An associated criterion in both TU and TP is around 50%. In the AR group, strong correlation was only found in SLR and PDQ-39 (SP) (p < 0.001). And the AUC of SP is significantly larger than that in TLR and PDQ-39 (TP) (p = 0.034). An associated criterion in SP is around 37%. No significant correlation was found in the TD group. Conclusions We provide a more accurate judgment for LDCT. TLR strongly correlated with postoperative UPDRS-III and PDQ-39 improvement in MX patients. A TLR > 50% may indicate a higher possibility of clinically meaningful benefits from STN-DBS comparing to medication only. SLR can well predict QOL improvement in AR patients. Similarly, a SLR > 37% may indicate a higher possibility of clinically significant benefits from STN-DBS. LDCT provides limited information for TD patients.
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Outram S, Muñoz KA, Kostick-Quenet K, Sanchez CE, Kalwani L, Lavingia R, Torgerson L, Sierra-Mercado D, Robinson JO, Pereira S, Koenig BA, Starr PA, Gunduz A, Foote KD, Okun MS, Goodman WK, McGuire AL, Zuk P, Lázaro-Muñoz G. Patient, Caregiver, and Decliner Perspectives on Whether to Enroll in Adaptive Deep Brain Stimulation Research. Front Neurosci 2021; 15:734182. [PMID: 34690676 PMCID: PMC8529029 DOI: 10.3389/fnins.2021.734182] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 08/16/2021] [Indexed: 11/13/2022] Open
Abstract
This research study provides patient and caregiver perspectives as to whether or not to undergo adaptive deep brain stimulation (aDBS) research. A total of 51 interviews were conducted in a multi-site study including patients undergoing aDBS and their respective caregivers along with persons declining aDBS. Reasons highlighted for undergoing aDBS included hopes for symptom alleviation, declining quality of life, desirability of being in research, and altruism. The primary reasons for not undergoing aDBS issues were practical rather than specific to aDBS technology, although some persons highlighted a desire to not be the first to trial the new technology. These themes are discussed in the context of "push" factors wherein any form of surgical intervention is preferable to none and "pull" factors wherein opportunities to contribute to science combine with hopes and/or expectations for the alleviation of symptoms. We highlight the significance of study design in decision making. aDBS is an innovative technology and not a completely new technology. Many participants expressed value in being part of research as an important consideration. We suggest that there are important implications when comparing patient perspectives vs. theoretical perspectives on the choice for or against aDBS. Additionally, it will be important how we communicate with patients especially in reference to the complexity of study design. Ultimately, this study reveals that there are benefits and potential risks when choosing a research study that involves implantation of a medical device.
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Affiliation(s)
- Simon Outram
- Program in Bioethics, University of California, San Francisco, San Francisco, CA, United States
| | - Katrina A Muñoz
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, TX, United States
| | - Kristin Kostick-Quenet
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, TX, United States
| | - Clarissa E Sanchez
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, TX, United States
| | - Lavina Kalwani
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, TX, United States
| | | | - Laura Torgerson
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, TX, United States
| | - Demetrio Sierra-Mercado
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, TX, United States.,Department of Anatomy and Neurobiology, School of Medicine, University of Puerto Rico, San Juan, Puerto Rico
| | - Jill O Robinson
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, TX, United States
| | - Stacey Pereira
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, TX, United States
| | - Barbara A Koenig
- Program in Bioethics, University of California, San Francisco, San Francisco, CA, United States
| | - Philip A Starr
- Department of Neurosurgery, University of California, San Francisco, San Francisco, CA, United States
| | - Aysegul Gunduz
- Fixel Institute for Neurological Diseases, Program for Movement Disorders and Neurorestoration, Department of Neurology, University of Florida, Gainesville, FL, United States.,Department of Biomedical Engineering, University of Florida, Gainesville, FL, United States
| | - Kelly D Foote
- Fixel Institute for Neurological Diseases, Program for Movement Disorders and Neurorestoration, Department of Neurology, University of Florida, Gainesville, FL, United States
| | - Michael S Okun
- Fixel Institute for Neurological Diseases, Program for Movement Disorders and Neurorestoration, Department of Neurology, University of Florida, Gainesville, FL, United States
| | - Wayne K Goodman
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, United States
| | - Amy L McGuire
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, TX, United States
| | - Peter Zuk
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, TX, United States
| | - Gabriel Lázaro-Muñoz
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, TX, United States
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Sauerbier A, Bachon P, Ambrosio L, Loehrer PA, Rizos A, Jost ST, Gronostay A, Konitsioti A, Barbe MT, Fink GR, Ashkan K, Nimsky C, Visser-Vandewalle V, Chaudhuri KR, Timmermann L, Martinez-Martin P, Dafsari HS. The New Satisfaction with Life and Treatment Scale (SLTS-7) in Patients with Parkinson's Disease. JOURNAL OF PARKINSONS DISEASE 2021; 12:453-464. [PMID: 34719509 DOI: 10.3233/jpd-212823] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND The satisfaction with life and, in particular, with treatment in Parkinson's disease (PD) is understudied. OBJECTIVE To explore a new 7-item rating tool assessing satisfaction with life and treatment (SLTS-7) in PD. METHODS In this cross-sectional, multi-center study, including patients screened for advanced therapies, psychometric characteristics of the SLTS-7 were analyzed. An exploratory factor analysis identified the underlying factorial structure of the SLTS-7. RESULTS 117 patients were included, and the data quality of the SLTS-7 was excellent (computable data 100%), and acceptability measures satisfied standard criteria. Besides the global assessment (item 1), the exploratory factor analysis produced item 2 (physical satisfaction) as an independent item and two factors among the remaining items: items 3-5 (psycho-social satisfaction), and items 6 and 7 (treatment satisfaction). Cronbach's alpha was 0.89, indicative of high internal consistency. The SLTS-7 total score correlated moderately with motor symptoms and weakly with non-motor symptoms total scores. SLTS-7 showed the highest correlations with the European Quality of Life with 5 items (EQ-5D) visual analog scale (0.43-0.58, p < 0.01), indicating a moderate convergent validity. The SLTS-7 significantly increased with higher non-motor symptoms burden levels (p = 0.002). CONCLUSION Life satisfaction in PD covers three specific aspects, namely physical, psycho-social, and treatment satisfaction. The new SLTS-7 is a valid, reliable, and easy-to-use tool to assess satisfaction with life and treatment in patients with PD screened for advanced therapies. Longitudinal studies analyzing the effect of advanced PD treatment on life and treatment satisfaction are warranted.
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Affiliation(s)
- Anna Sauerbier
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Neurology, Cologne, Germany.,Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Pia Bachon
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Neurology, Cologne, Germany
| | - Leire Ambrosio
- NIHR Applied Research Collaboration Wessex, School of Health Sciences, University of Southampton, United Kingdom
| | - Philipp A Loehrer
- Department of Neurology, University Hospital Giessen and Marburg, Campus Marburg, Marburg, Germany
| | - Alexandra Rizos
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom.,Parkinson Foundation International Centre of Excellence, King's College Hospital, London, United Kingdom
| | - Stefanie T Jost
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Neurology, Cologne, Germany
| | - Alexandra Gronostay
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Neurology, Cologne, Germany
| | - Agni Konitsioti
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Neurology, Cologne, Germany
| | - Michael T Barbe
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Neurology, Cologne, Germany
| | - Gereon R Fink
- Cognitive Neuroscience, Institute of Neuroscience and Medicine (INM-3), Research Centre Jülich, Jülich, Germany
| | - Keyoumars Ashkan
- Parkinson Foundation International Centre of Excellence, King's College Hospital, London, United Kingdom
| | | | - Veerle Visser-Vandewalle
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Stereotactic and Functional Neurosurgery, Cologne, Germany
| | - K Ray Chaudhuri
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom.,Parkinson Foundation International Centre of Excellence, King's College Hospital, London, United Kingdom.,NIHR Mental Health Biomedical Research Centre and Dementia Biomedical Research Unit, South London and Maudsley NHS Foundation Trust and King's College London
| | - Lars Timmermann
- Department of Neurology, University Hospital Giessen and Marburg, Campus Marburg, Marburg, Germany
| | - Pablo Martinez-Martin
- Center for Networked Biomedical Research in Neurodegenerative Diseases (CIBERNED), Carlos III Institute of Health, Madrid, Spain
| | - Haidar S Dafsari
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Neurology, Cologne, Germany
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Alanazi FI, Al-Ozzi TM, Kalia SK, Hodaie M, Lozano AM, Cohn M, Hutchison WD. Neurophysiological responses of globus pallidus internus during the auditory oddball task in Parkinson's disease. Neurobiol Dis 2021; 159:105490. [PMID: 34461266 DOI: 10.1016/j.nbd.2021.105490] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 08/21/2021] [Accepted: 08/25/2021] [Indexed: 11/28/2022] Open
Abstract
Parkinson's disease can be associated with significant cognitive impairment that may lead to dementia. Deep brain stimulation (DBS) of the subthalamic nucleus is an effective therapy for motor symptoms but is associated with cognitive decline. DBS of globus pallidus internus (GPi) poses less risk of cognitive decline so may be the preferred target. A research priority is to identify biomarkers of cognitive decline in this population, but efforts are hampered by a lack of understanding of the role of the different basal ganglia nuclei, such as the globus pallidus, in cognitive processing. During deep brain stimulation (DBS) surgery, we monitored single units, beta oscillatory LFP activity as well as event related potentials (ERPs) from the globus pallidus internus (GPi) of 16 Parkinson's disease patients, while they performed an auditory attention task. We used an auditory oddball task, during which one standard tone is presented at regular intervals and a second deviant tone is presented with a low probability that the subject is requested to count and report at the end of the task. All forms of neuronal activity studied were selective modulated by the attended tones. Of 62 neurons studied, the majority (51 or 82%) responded selectively to the deviant tone. Beta oscillatory activity showed an overall desynchronization during both types of attended tones interspersed by bursts of beta activity giving rise to peaks at a latency of around 200 ms after tone onset. cognitive ERPs recorded in GPi were selective to the attended tone and the right-side cERP was larger than the left side. The averages of trials showing a difference in beta oscillatory activity between deviant and standard also had a significant difference in cERP amplitude. In one block of trials, the random occurrence of 3 deviant tones in short succession silenced the activity of the GPi neuron being recorded. Trial blocks where a clear difference in LFP beta was seen were twice as likely to yield a correct tone count (25 vs 11). The data demonstrate strong modulation of GPi neuronal activity during the auditory oddball task. Overall, this study demonstrates an involvement of GPi in processing of non-motor cognitive tasks such as working memory and attention, and suggests that direct effects of DBS in non-motor GPi may contribute to cognitive changes observed post-operatively.
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Affiliation(s)
- Frhan I Alanazi
- Department of Physiology, University of Toronto, Canada; Krembil Research Institute, Toronto, Canada
| | - Tameem M Al-Ozzi
- Department of Physiology, University of Toronto, Canada; Krembil Research Institute, Toronto, Canada
| | - Suneil K Kalia
- Department of Surgery, University of Toronto, Canada; Division of Neurosurgery, Toronto Western Hospital - University Health Network, Canada; Krembil Research Institute, Toronto, Canada
| | - Mojgan Hodaie
- Department of Surgery, University of Toronto, Canada; Division of Neurosurgery, Toronto Western Hospital - University Health Network, Canada; Krembil Research Institute, Toronto, Canada
| | - Andres M Lozano
- Department of Surgery, University of Toronto, Canada; Division of Neurosurgery, Toronto Western Hospital - University Health Network, Canada; Krembil Research Institute, Toronto, Canada
| | - Melanie Cohn
- Krembil Research Institute, Toronto, Canada; Department of Psychology, University of Toronto, Canada
| | - William D Hutchison
- Department of Physiology, University of Toronto, Canada; Department of Surgery, University of Toronto, Canada; Division of Neurosurgery, Toronto Western Hospital - University Health Network, Canada; Krembil Research Institute, Toronto, Canada.
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Personalised Advanced Therapies in Parkinson's Disease: The Role of Non-Motor Symptoms Profile. J Pers Med 2021; 11:jpm11080773. [PMID: 34442417 PMCID: PMC8400869 DOI: 10.3390/jpm11080773] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 07/25/2021] [Accepted: 07/26/2021] [Indexed: 12/22/2022] Open
Abstract
Device-aided therapies, including levodopa-carbidopa intestinal gel infusion, apomorphine subcutaneous infusion, and deep brain stimulation, are available in many countries for the management of the advanced stage of Parkinson’s disease (PD). Currently, selection of device-aided therapies is mainly focused on patients’ motor profile while non-motor symptoms play a role limited to being regarded as possible exclusion criteria in the decision-making process for the delivery and sustenance of a successful treatment. Differential beneficial effects on specific non-motor symptoms of the currently available device-aided therapies for PD are emerging and these could hold relevant clinical implications. In this viewpoint, we suggest that specific non-motor symptoms could be used as an additional anchor to motor symptoms and not merely as exclusion criteria to deliver bespoke and patient-specific personalised therapy for advanced PD.
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Schedlich-Teufer C, Jost ST, Krack P, Witt K, Weintraub D, Baldermann JC, Sommerauer M, Amstutz D, van Eimeren T, Dafsari HS, Kalbe E, Visser-Vandewalle V, Fink GR, Kessler J, Barbe MT. Assessment of Affective-Behavioral States in Parkinson's Disease Patients: Towards a New Screening Tool. JOURNAL OF PARKINSONS DISEASE 2021; 11:1417-1430. [PMID: 33967055 DOI: 10.3233/jpd-202375] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Assessment of affective-behavioral states in patients with Parkinson's disease (PD) undergoing deep brain stimulation (DBS) is essential. OBJECTIVE To analyze well-established questionnaires as a pilot-study with the long term aim to develop a screening tool evaluating affective-behavioral dysfunction, including depression, anxiety, apathy, mania, and impulse control disorders, in PD patients screened for DBS. METHODS Two hundred ninety-seven inpatients with PD underwent standardized neuropsychiatric testing including German versions of Beck Depression Inventory-II, Hospital Anxiety and Depression Scale, Apathy Evaluation Scale, Self-Report Manic Inventory, and Questionnaire for Impulsive-Compulsive Disorders in PD-Rating Scale, to assess appropriateness for DBS. Statistical item reduction was based on exploratory factor analysis, Cronbach's alpha, item-total correlations, item difficulty, and inter-item correlations. Confirmatory factor analysis was conducted to assess factorial validity. An expert rating was performed to identify clinically relevant items in the context of PD and DBS, to maintain content validity. We compared the shortened subscales with the original questionnaires using correlations. To determine cutoff points, receiver operating characteristics analysis was performed. RESULTS The items of the initial questionnaires were reduced from 129 to 38 items. Results of confirmatory factor analyses supported the validity of the shortened pool. It demonstrated high internal consistency (Cronbach's alpha = 0.72-0.83 across subscales), and the individual subscales were correlated with the corresponding original scales (rs = 0.84-0.95). Sensitivities and specificities exceeded 0.7. CONCLUSION The shortened item pool, including 38 items, provides a good basis for the development of a screening tool, capturing affective-behavioral symptoms in PD patients before DBS implantation. Confirmation of the validity of such a screening tool in an independent sample of PD patients is warranted.
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Affiliation(s)
- Charlotte Schedlich-Teufer
- Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Stefanie Theresa Jost
- Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Paul Krack
- Department of Neurology, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Karsten Witt
- Department of Neurology, School of Medicine and Health Sciences, University of Oldenburg, Oldenburg, Germany.,Research Center Neurosensory Science, University of Oldenburg, Oldenburg, Germany
| | - Daniel Weintraub
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.,Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.,Parkinson's Disease Research, Education and Clinical Center, Philadelphia Veterans Affairs Medical Center, Philadelphia, PA, USA
| | - Juan Carlos Baldermann
- Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.,Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Michael Sommerauer
- Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Deborah Amstutz
- Department of Neurology, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Thilo van Eimeren
- Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.,Department of Nuclear Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.,German Center for Neurodegenerative Diseases (DZNE), Bonn-Cologne, Germany
| | - Haidar Salimi Dafsari
- Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Elke Kalbe
- Department of Medical Psychology, Neuropsychology and Gender Studies & Center for Neuropsychological Diagnostics and Intervention (CeNDI), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Veerle Visser-Vandewalle
- Department of Stereotactic and Functional Neurosurgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Gereon Rudolf Fink
- Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.,Cognitive Neuroscience, Institute of Neuroscience and Medicine (INM-3), Research Center Jülich, Jülich, Germany
| | - Josef Kessler
- Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Michael Thomas Barbe
- Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
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Weiss D, Volkmann J, Fasano A, Kühn A, Krack P, Deuschl G. Changing Gears - DBS For Dopaminergic Desensitization in Parkinson's Disease? Ann Neurol 2021; 90:699-710. [PMID: 34235776 DOI: 10.1002/ana.26164] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 07/06/2021] [Accepted: 07/06/2021] [Indexed: 12/19/2022]
Abstract
In Parkinson's disease, both motor and neuropsychiatric complications unfold as a consequence of both incremental striatal dopaminergic denervation and intensifying long-term dopaminergic treatment. Together, this leads to 'dopaminergic sensitization' steadily increasing motor and behavioral responses to dopaminergic medication that result in the detrimental sequalae of long-term dopaminergic treatment. We review the clinical presentations of 'dopaminergic sensitization', including rebound off and dyskinesia in the motor domain, and neuropsychiatric fluctuations and behavioral addictions with impulse control disorders and dopamine dysregulation syndrome in the neuropsychiatric domain. We summarize state-of-the-art deep brain stimulation, and show that STN-DBS allows dopaminergic medication to be tapered, thus supporting dopaminergic desensitization. In this framework, we develop our integrated debatable viewpoint of "changing gears", that is we suggest rethinking earlier use of subthalamic nucleus deep brain stimulation, when the first clinical signs of dopaminergic motor or neuropsychiatric complications emerge over the steadily progressive disease course. In this sense, subthalamic deep brain stimulation may help reduce longitudinal motor and neuropsychiatric symptom expression - importantly, not by neuroprotection but by supporting dopaminergic desensitization through postoperative medication reduction. Therefore, we suggest considering STN-DBS early enough before patients encounter potentially irreversible psychosocial consequences of dopaminergic complications, but importantly not before a patient shows first clinical signs of dopaminergic complications. We propose to consider neuropsychiatric dopaminergic complications as a new inclusion criterion in addition to established motor criteria, but this concept will require validation in future clinical trials. ANN NEUROL 2021.
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Affiliation(s)
- Daniel Weiss
- Centre for Neurology, Department for Neurodegenerative Diseases, and Hertie-Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
| | - Jens Volkmann
- Department of Neurology, University Hospital and Julius-Maximilian-University, Würzburg, Germany
| | - Alfonso Fasano
- Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, UHN, Toronto, ON, Canada.,Division of Neurology, University of Toronto, Toronto, ON, Canada.,Krembil Brain Institute, Toronto, ON, Canada.,Center for Advancing Neurotechnological Innovation to Application (CRANIA), Toronto, ON, Canada
| | - Andrea Kühn
- Department of Neurology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Paul Krack
- Department of Neurology, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Günther Deuschl
- Department of Neurology, University Hospital Schleswig Holstein (UKSH), Christian-Albrechts-University Kiel, Kiel, Germany
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Jost ST, Visser-Vandewalle V, Rizos A, Loehrer PA, Silverdale M, Evans J, Samuel M, Petry-Schmelzer JN, Sauerbier A, Gronostay A, Barbe MT, Fink GR, Ashkan K, Antonini A, Martinez-Martin P, Chaudhuri KR, Timmermann L, Dafsari HS. Non-motor predictors of 36-month quality of life after subthalamic stimulation in Parkinson disease. NPJ PARKINSONS DISEASE 2021; 7:48. [PMID: 34103534 PMCID: PMC8187358 DOI: 10.1038/s41531-021-00174-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 02/19/2021] [Indexed: 12/13/2022]
Abstract
To identify predictors of 36-month follow-up quality of life (QoL) outcome after bilateral subthalamic nucleus deep brain stimulation (STN-DBS) in Parkinson’s disease (PD). In this ongoing, prospective, multicenter international study (Cologne, Manchester, London) including 73 patients undergoing STN-DBS, we assessed the following scales preoperatively and at 6-month and 36-month follow-up: PD Questionnaire-8 (PDQ-8), NMSScale (NMSS), Scales for Outcomes in PD (SCOPA)-motor examination, -activities of daily living, and -complications, and levodopa equivalent daily dose (LEDD). We analyzed factors associated with QoL improvement at 36-month follow-up based on (1) correlations between baseline test scores and QoL improvement, (2) step-wise linear regressions with baseline test scores as independent and QoL improvement as dependent variables, (3) logistic regressions and receiver operating characteristic curves using a dichotomized variable “QoL responders”/“non-responders”. At both follow-ups, NMSS total score, SCOPA-motor examination, and -complications improved and LEDD was reduced significantly. PDQ-8 improved at 6-month follow-up with subsequent decrements in gains at 36-month follow-up when 61.6% of patients were categorized as “QoL non-responders”. Correlations, linear, and logistic regression analyses found greater PDQ-8 improvements in patients with younger age, worse PDQ-8, and worse specific NMS at baseline, such as ‘difficulties experiencing pleasure’ and ‘problems sustaining concentration’. Baseline SCOPA scores were not associated with PDQ-8 changes. Our results provide evidence that 36-month QoL changes depend on baseline neuropsychological and neuropsychiatric non-motor symptoms burden. These findings highlight the need for an assessment of a wide range of non-motor and motor symptoms when advising and selecting individuals for DBS therapy.
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Affiliation(s)
- Stefanie T Jost
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Neurology, Cologne, Germany.
| | - Veerle Visser-Vandewalle
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Stereotaxy and Functional Neurosurgery, Cologne, Germany
| | - Alexandra Rizos
- Parkinson Foundation International Centre of Excellence, King's College Hospital, London, UK
| | - Philipp A Loehrer
- Department of Neurology, University Hospital Giessen and Marburg, Campus Marburg, Marburg, Germany
| | - Monty Silverdale
- Department of Neurology and Neurosurgery, Salford Royal NHS Foundation Trust, Manchester Academic Health Science Centre, University of Manchester, Greater Manchester, UK
| | - Julian Evans
- Department of Neurology and Neurosurgery, Salford Royal NHS Foundation Trust, Manchester Academic Health Science Centre, University of Manchester, Greater Manchester, UK
| | - Michael Samuel
- Parkinson Foundation International Centre of Excellence, King's College Hospital, London, UK
| | - Jan Niklas Petry-Schmelzer
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Neurology, Cologne, Germany
| | - Anna Sauerbier
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Neurology, Cologne, Germany.,Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Alexandra Gronostay
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Neurology, Cologne, Germany
| | - Michael T Barbe
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Neurology, Cologne, Germany
| | - Gereon R Fink
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Neurology, Cologne, Germany.,Cognitive Neuroscience, Institute of Neuroscience and Medicine (INM-3), Research Centre Jülich, Jülich, Germany
| | - Keyoumars Ashkan
- Parkinson Foundation International Centre of Excellence, King's College Hospital, London, UK
| | - Angelo Antonini
- Department of Neurosciences (DNS), Padova University, Padova, Italy
| | - Pablo Martinez-Martin
- Center for Networked Biomedical Research in Neurodegenerative Diseases (CIBERNED), Carlos III Institute of Health, Madrid, Spain
| | - K Ray Chaudhuri
- Parkinson Foundation International Centre of Excellence, King's College Hospital, London, UK.,Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Lars Timmermann
- Department of Neurology, University Hospital Giessen and Marburg, Campus Marburg, Marburg, Germany
| | - Haidar S Dafsari
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Neurology, Cologne, Germany.
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Nijhuis FAP, Esselink R, de Bie RMA, Groenewoud H, Bloem BR, Post B, Meinders MJ. Translating Evidence to Advanced Parkinson's Disease Patients: A Systematic Review and Meta-Analysis. Mov Disord 2021; 36:1293-1307. [PMID: 33797786 PMCID: PMC8252410 DOI: 10.1002/mds.28599] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 02/02/2021] [Accepted: 03/01/2021] [Indexed: 12/19/2022] Open
Abstract
In the advanced stages of Parkinson's disease (PD), patients frequently experience disabling motor complications. Treatment options include deep brain stimulation (DBS), levodopa‐carbidopa intestinal gel (LCIG), and continuous subcutaneous apomorphine infusion (CSAI). Choosing among these treatments is influenced by scientific evidence, clinical expertise, and patient preferences. To foster patient engagement in decision‐making among the options, scientific evidence should be adjusted to their information needs. We conducted a systematic review from the patient perspective. First, patients selected outcomes for a treatment choice: quality of life, activities of daily living, ON and OFF time, and adverse events. Second, we conducted a systematic review and meta‐analysis for each treatment versus best medical treatment using Grading of Recommendations, Assessment, Development, and Evaluation (GRADE). Finally, the evidence was transformed into comprehensible and comparable information. We converted the meta‐analysis results into the number of patients (per 100) who benefit clinically from an advanced treatment per outcome, based on the minimal clinically important difference and the cumulative distribution function. Although this approach allows for a comparison of outcomes across the three device‐aided therapies, they have never been compared directly. The interpretation is hindered by the relatively short follow‐up time in the included studies, usually less than 12 months. These limitations should be clarified to patients during the decision‐making process. This review can help patients integrate the evidence with their own preferences, and with their clinician's expertise, to reach an informed decision. © 2021 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society
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Affiliation(s)
- Frouke A P Nijhuis
- Department of Neurology, Canisius Wilhelmina Hospital, Nijmegen, the Netherlands.,Department of Neurology, Radboud University Medical Center, Donders Institute for Brain, Cognition and Behavior, Nijmegen, the Netherlands
| | - Rianne Esselink
- Department of Neurology, Radboud University Medical Center, Donders Institute for Brain, Cognition and Behavior, Nijmegen, the Netherlands
| | - Rob M A de Bie
- Department of Neurology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam Neuroscience, Amsterdam, the Netherlands
| | - Hans Groenewoud
- Department for Health Evidence, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Bastiaan R Bloem
- Department of Neurology, Radboud University Medical Center, Donders Institute for Brain, Cognition and Behavior, Nijmegen, the Netherlands
| | - Bart Post
- Department of Neurology, Radboud University Medical Center, Donders Institute for Brain, Cognition and Behavior, Nijmegen, the Netherlands
| | - Marjan J Meinders
- Department of Neurology, Radboud University Medical Center, Donders Institute for Brain, Cognition and Behavior, Nijmegen, the Netherlands
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Artusi CA, Romagnolo A, Imbalzano G, Montanaro E, Zibetti M, Rizzone MG, Lopiano L. Deep brain stimulation outcomes in the malignant end of Parkinson's disease spectrum. Parkinsonism Relat Disord 2021; 86:5-9. [PMID: 33812276 DOI: 10.1016/j.parkreldis.2021.03.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 03/17/2021] [Accepted: 03/19/2021] [Indexed: 11/15/2022]
Abstract
BACKGROUND Heterogeneity of Parkinson's Disease (PD) phenotype may influence deep brain stimulation (DBS) outcome. However, DBS response in the malignant end of the PD spectrum has been poorly investigated. OBJECTIVE To evaluate and compare DBS outcomes in malignant and benign PD patients, defined according to motor and non-motor symptom presentation at the presurgical selection. METHODS We categorized a cohort of 154 parkinsonian patients fulfilling criteria for subthalamic nucleus (STN)-DBS into malignant, benign, and intermediate subtypes, according to a recently validated clinical PD classification. DBS efficacy on daily living independence (Schwab and England -S&E-score ≥70%), motor symptoms, and motor fluctuations (Unified Parkinson's Disease Rating Scale -UPDRS- part-III and -IV, and Ambulatory Capacity Measure) were compared between malignant and benign patients, using corrected binary logistic regressions and repeated measure general linear model. RESULTS One year after surgery, the probability of losing daily life independence was 16-fold higher in malignant patients, even after adjusting for age at PD onset, PD duration, and percentage of motor improvement after STN-DBS (OR: 16.233; p: 0.035). Conversely, malignant and benign patients showed a similar extent of improvement after STN-DBS (p > 0.05) in motor symptoms, motor fluctuations, and ambulatory capacity, both in medication-ON and medication-OFF conditions. CONCLUSION DBS candidates in the malignant end of the PD spectrum may profit from a similar improvement of motor symptoms and fluctuations after STN-DBS when compared to benign PD. However, patients of the malignant group have a lower probability of maintaining independence in daily life early after surgery.
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Affiliation(s)
- Carlo Alberto Artusi
- Department of Neuroscience "Rita Levi Montalcini", University of Torino, Torino, Italy; Neurology 2 Unit, A.O.U. Città Della Salute e Della Scienza di Torino, Corso Bramante 88, 10124, Torino, Italy.
| | - Alberto Romagnolo
- Department of Neuroscience "Rita Levi Montalcini", University of Torino, Torino, Italy; Neurology 2 Unit, A.O.U. Città Della Salute e Della Scienza di Torino, Corso Bramante 88, 10124, Torino, Italy
| | - Gabriele Imbalzano
- Department of Neuroscience "Rita Levi Montalcini", University of Torino, Torino, Italy; Neurology 2 Unit, A.O.U. Città Della Salute e Della Scienza di Torino, Corso Bramante 88, 10124, Torino, Italy
| | - Elisa Montanaro
- Department of Neuroscience "Rita Levi Montalcini", University of Torino, Torino, Italy; Neurology 2 Unit, A.O.U. Città Della Salute e Della Scienza di Torino, Corso Bramante 88, 10124, Torino, Italy
| | - Maurizio Zibetti
- Department of Neuroscience "Rita Levi Montalcini", University of Torino, Torino, Italy; Neurology 2 Unit, A.O.U. Città Della Salute e Della Scienza di Torino, Corso Bramante 88, 10124, Torino, Italy
| | - Mario Giorgio Rizzone
- Department of Neuroscience "Rita Levi Montalcini", University of Torino, Torino, Italy; Neurology 2 Unit, A.O.U. Città Della Salute e Della Scienza di Torino, Corso Bramante 88, 10124, Torino, Italy
| | - Leonardo Lopiano
- Department of Neuroscience "Rita Levi Montalcini", University of Torino, Torino, Italy; Neurology 2 Unit, A.O.U. Città Della Salute e Della Scienza di Torino, Corso Bramante 88, 10124, Torino, Italy
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John KD, Wylie SA, Dawant BM, Rodriguez WJ, Phibbs FT, Bradley EB, Neimat JS, van Wouwe NC. Deep brain stimulation effects on verbal fluency dissociated by target and active contact location. Ann Clin Transl Neurol 2021; 8:613-622. [PMID: 33596331 PMCID: PMC7951101 DOI: 10.1002/acn3.51304] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 12/17/2020] [Accepted: 12/23/2020] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Deep brain stimulation (DBS) improves motor symptoms in Parkinson's disease (PD), but it can also disrupt verbal fluency with significant costs to quality of life. The current study investigated how variability of bilateral active electrode coordinates along the superior/inferior, anterior/posterior, and lateral/medial axes in the subthalamic nucleus (STN) or the globus pallidus interna (GPi) contribute to changes in verbal fluency. We predicted that electrode location in the left hemisphere would be linked to changes in fluency, especially in the STN. METHODS Forty PD participants treated with bilateral DBS targeting STN (n = 23) or GPi (n = 17) completed verbal fluency testing in their optimally treated state before and after DBS therapy. Normalized atlas coordinates from left and right active electrode positions along superior/inferior, anterior/posterior, and lateral/medial axes were used to predict changes in fluency postoperatively, separately for patients with STN and GPi targets. RESULTS Consistent with prior studies, fluency significantly declined pre- to postsurgery (in both DBS targets). In STN-DBS patients, electrode position along the inferior to superior axis in the left STN was a significant predictor of fluency changes; relatively more superior left active electrode was associated with the largest fluency declines in STN. Electrode coordinates in right STN or GPi (left or right) did not predict fluency changes. INTERPRETATION We discuss these findings in light of putative mechanisms and potential clinical impact.
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Affiliation(s)
- Kevin D. John
- Department of Neurological SurgeryUniversity of LouisvilleLouisvilleKYUSA
| | - Scott A. Wylie
- Department of Neurological SurgeryUniversity of LouisvilleLouisvilleKYUSA
| | - Benoit M. Dawant
- Department of Electrical Engineering and Computer ScienceVanderbilt UniversityNashvilleTNUSA
| | - William J. Rodriguez
- Department of Electrical Engineering and Computer ScienceVanderbilt UniversityNashvilleTNUSA
| | - Fenna T. Phibbs
- Department of NeurologyVanderbilt University Medical CenterNashvilleTNUSA
| | - Elise B. Bradley
- Department of NeurologyVanderbilt University Medical CenterNashvilleTNUSA
| | - Joseph S. Neimat
- Department of Neurological SurgeryUniversity of LouisvilleLouisvilleKYUSA
| | - Nelleke C. van Wouwe
- Department of Neurological SurgeryUniversity of LouisvilleLouisvilleKYUSA
- Department of NeurologyVanderbilt University Medical CenterNashvilleTNUSA
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Cabrera LY, Mitchell SD, Bender A, Tvedten E, Sidiropoulos C, Sarva H. Attitudes toward use and timing of deep brain stimulation: a patient's with DBS perspective. Clin Neurol Neurosurg 2021; 203:106553. [PMID: 33610086 DOI: 10.1016/j.clineuro.2021.106553] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 01/16/2021] [Accepted: 02/06/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To guide responsive policy and better understand factors that might shape patients' decisions to have DBS earlier, we explore perspectives and attitudes toward earlier deep brain stimulation (DBS) of Parkinson disease (PD) patients with DBS. INTRODUCTION Before the US Food and Drug Administration released its change of indication for the use of DBS for PD, several groups had performed DBS earlier in disease course. METHODS We designed an online survey comprising Likert-type, multiple choice, and rank-order questions and distributed it to PD patients. We analyzed patient considerations for having chosen DBS and for choosing or rejecting to have DBS earlier, as well as factors potentially shaping perspectives around DBS and its timing. Data was analyzed using descriptive and inferential statistics. RESULTS Among the 160 participants in the sample, the most important consideration for choosing DBS was the possibility of better symptomatic control compared to medication alone. The most important consideration for delaying DBS was possible ineffectiveness. 41.3 % (n = 66) of respondents supported earlier DBS use, 38.8 % (n = 62) did not, and the remainder (n = 30) were uncertain. Patients who supported earlier DBS use cited the possibility of better symptomatic control than with medication alone, while those who did not support earlier use felt that medication options should be exhausted first. CONCLUSION Our results suggest that there are multiple factors shaping patient perceptions around earlier DBS implantation. Future work should compare perceptions before and after DBS implantation, as well as pair perceptions with clinical outcomes.
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Affiliation(s)
- Laura Y Cabrera
- Center for Ethics and Humanities in the Life Sciences, Michigan State University, East Lansing, MI, USA.
| | - Steven D Mitchell
- Department of Neurology, Michigan State University, East Lansing, MI, USA
| | - Andrew Bender
- Department of Epidemiology, Michigan State University, East Lansing, MI, USA
| | - Erika Tvedten
- College of Osteopathic Medicine, Michigan State University, East Lansing, MI, USA
| | | | - Harini Sarva
- Department of Neurology, Weill Cornell Medicine, New York, NY, USA
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Krause KJ, Phibbs F, Davis T, Fabbri D. Predicting Motor Responsiveness to Deep Brain Stimulation with Machine Learning. AMIA ... ANNUAL SYMPOSIUM PROCEEDINGS. AMIA SYMPOSIUM 2021; 2021:651-659. [PMID: 35308984 PMCID: PMC8861668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/13/2023]
Abstract
Deep brain stimulation is a complex movement disorder intervention that requires highly invasive brain surgery. Clinicians struggle to predict how patients will respond to this treatment. To address this problem, we are working toward developing a clinical tool to help neurologists predict deep brain stimulation response. We analyzed a cohort of 105 Parkinson's patients who underwent deep brain stimulation at Vanderbilt University Medical Center. We developed binary and multicategory models for predicting likelihood of motor symptom reduction after undergoing deep brain stimulation. We compared the performances of our best models to predictions made by neurologist experts in movement disorders. The strongest binary classification model achieved a 10-fold cross validation AUC of 0.90, outperforming the best neurologist predictions (0.56). These results are promising for future clinical applications, though more work is necessary to validate these findings in a larger cohort and taking into consideration broader quality of life outcome measures.
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Affiliation(s)
- Kevin J Krause
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
| | - Fenna Phibbs
- Department of Neurology, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
| | - Thomas Davis
- Department of Neurology, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
| | - Daniel Fabbri
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
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Deep Brain Stimulation Selection Criteria for Parkinson's Disease: Time to Go beyond CAPSIT-PD. J Clin Med 2020; 9:jcm9123931. [PMID: 33291579 PMCID: PMC7761824 DOI: 10.3390/jcm9123931] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Revised: 11/24/2020] [Accepted: 12/02/2020] [Indexed: 12/13/2022] Open
Abstract
Despite being introduced in clinical practice more than 20 years ago, selection criteria for deep brain stimulation (DBS) in Parkinson's disease (PD) rely on a document published in 1999 called 'Core Assessment Program for Surgical Interventional Therapies in Parkinson's Disease'. These criteria are useful in supporting the selection of candidates. However, they are both restrictive and out-of-date, because the knowledge on PD progression and phenotyping has massively evolved. Advances in understanding the heterogeneity of PD presentation, courses, phenotypes, and genotypes, render a better identification of good DBS outcome predictors a research priority. Additionally, DBS invasiveness, cost, and the possibility of serious adverse events make it mandatory to predict as accurately as possible the clinical outcome when informing the patients about their suitability for surgery. In this viewpoint, we analyzed the pre-surgical assessment according to the following topics: early versus delayed DBS; the evolution of the levodopa challenge test; and the relevance of axial symptoms; patient-centered outcome measures; non-motor symptoms; and genetics. Based on the literature, we encourage rethinking of the selection process for DBS in PD, which should move toward a broad clinical and instrumental assessment of non-motor symptoms, quantitative measurement of gait, posture, and balance, and in-depth genotypic and phenotypic characterization.
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Habets JG, Janssen ML, Duits AA, Sijben LC, Mulders AE, De Greef B, Temel Y, Kuijf ML, Kubben PL, Herff C. Machine learning prediction of motor response after deep brain stimulation in Parkinson's disease-proof of principle in a retrospective cohort. PeerJ 2020; 8:e10317. [PMID: 33240642 PMCID: PMC7680051 DOI: 10.7717/peerj.10317] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 10/16/2020] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION Despite careful patient selection for subthalamic nucleus deep brain stimulation (STN DBS), some Parkinson's disease patients show limited improvement of motor disability. Innovative predictive analysing methods hold potential to develop a tool for clinicians that reliably predicts individual postoperative motor response, by only regarding clinical preoperative variables. The main aim of preoperative prediction would be to improve preoperative patient counselling, expectation management, and postoperative patient satisfaction. METHODS We developed a machine learning logistic regression prediction model which generates probabilities for experiencing weak motor response one year after surgery. The model analyses preoperative variables and is trained on 89 patients using a five-fold cross-validation. Imaging and neurophysiology data are left out intentionally to ensure usability in the preoperative clinical practice. Weak responders (n = 30) were defined as patients who fail to show clinically relevant improvement on Unified Parkinson Disease Rating Scale II, III or IV. RESULTS The model predicts weak responders with an average area under the curve of the receiver operating characteristic of 0.79 (standard deviation: 0.08), a true positive rate of 0.80 and a false positive rate of 0.24, and a diagnostic accuracy of 78%. The reported influences of individual preoperative variables are useful for clinical interpretation of the model, but cannot been interpreted separately regardless of the other variables in the model. CONCLUSION The model's diagnostic accuracy confirms the utility of machine learning based motor response prediction based on clinical preoperative variables. After reproduction and validation in a larger and prospective cohort, this prediction model holds potential to support clinicians during preoperative patient counseling.
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Affiliation(s)
- Jeroen G.V. Habets
- Department of Neurosurgery, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Marcus L.F. Janssen
- Department of Neurosurgery, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
- Department of Clinical Neurophysiology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Annelien A. Duits
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Laura C.J. Sijben
- Department of Neurology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Anne E.P. Mulders
- Department of Neurosurgery, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Bianca De Greef
- Department of Neurology, Maastricht University Medical Center, Maastricht, The Netherlands
- Department of Clinical Epidemiology and Medical Technology Assessment (KEMTA), Maastricht University Medical Center, Maastricht, The Netherlands
| | - Yasin Temel
- Department of Neurosurgery, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
- Department of Neurosurgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Mark L. Kuijf
- Department of Neurology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Pieter L. Kubben
- Department of Neurosurgery, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
- Department of Neurosurgery, Maastricht University Medical Center, Maastricht, The Netherlands
- Department of Neurosurgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Christian Herff
- Department of Neurosurgery, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
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Marsili L, Bologna M, Miyasaki JM, Colosimo C. Parkinson's disease advanced therapies - A systematic review: More unanswered questions than guidance. Parkinsonism Relat Disord 2020; 83:132-139. [PMID: 33158747 DOI: 10.1016/j.parkreldis.2020.10.042] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Revised: 10/28/2020] [Accepted: 10/29/2020] [Indexed: 11/16/2022]
Abstract
In advanced Parkinson's disease (PD), therapeutic interventions include device-aided therapies such as continuous subcutaneous apomorphine infusion (CSAI), levodopa-carbidopa intestinal gel (LCIG) infusion, and deep brain stimulation (DBS). We reappraised the evidence guiding the decision of appropriate device-aided therapies in advanced PD, and systematically reviewed the literature (including ongoing clinical trials) comparing CSAI, LCIG, DBS in terms of efficacy and cost-effectiveness, with particular consideration to possible conflicts of interests. Of 14,980 documents screened, sixteen were included (4 and 13 studies examining efficacy and cost-effectiveness, respectively). LCIG and DBS showed higher efficacy compared to best medical therapy (BMT). DBS was more expensive than BMT and LCIG. Lifetime costs of CSAI were lower of those of DBS, and DBS lifetime costs were lower than those of LCIG. The majority of studies (11 out of 16) showed direct or indirect sponsorship from pharmaceutical or device companies. Only one ongoing clinical trial comparing LCIG with DBS was found. Device-aided therapies address unmet needs in advanced PD. LCIG and DBS are superior to BMT in head-to-head studies; however, initial and lifetime costs should be considered when choosing those therapies. Guidelines to assist clinicians and patients to choose device-aided therapies, free from conflict of interests, are required.
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Affiliation(s)
- Luca Marsili
- Gardner Family Center for Parkinson's Disease and Movement Disorders, Department of Neurology, University of Cincinnati, Cincinnati, OH, USA.
| | - Matteo Bologna
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy; IRCCS Neuromed, Pozzilli, IS, Italy
| | - Janis M Miyasaki
- Department of Medicine, Division of Neurology, Parkinson and Movement Disorders Program and the Complex Neurologic Symptoms Clinic, Kaye Edmonton Clinic, University of Alberta, Edmonton, AL, Canada
| | - Carlo Colosimo
- Department of Neurology, Santa Maria University Hospital, Terni, Italy
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Interpretation of health-related quality of life outcomes in Parkinson's disease from the EARLYSTIM Study. PLoS One 2020; 15:e0237498. [PMID: 32822437 PMCID: PMC7442251 DOI: 10.1371/journal.pone.0237498] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Accepted: 07/27/2020] [Indexed: 11/23/2022] Open
Abstract
The EARLYSTIM Study compared deep brain stimulation (DBS) with best medical treatment (BMT) over 2-years, showing a between-group difference of 8.0 from baseline in favor of DBS in health-related quality of life (HRQoL), measured with the PDQ-39 SI (summary index). This study obtained complementary information about the importance of the change in HRQoL as measured by the PDQ-39, using anchor-based (Patient Global Impression of Change, PGIC) and distribution-based techniques (magnitude of change, effect size, thresholds, distribution of benefit) applied to the EARLYSTIM study data. Anchor-based techniques showed a difference follow-up–baseline for patients who reported “minimal improvement” of -5.8 [-9.9, -1.6] (mean [95%CI]) in the DBS group vs -2.9 [-9.0, 3.1] in the BMT group. As the vast majority (80.8%) of DBS patients reported “much or very much improvement”, this difference was explored for the latter group and amounted to -8.7 for the DBS group and -6.5 in the BMT group. Distribution-based techniques that analyzed the relative change and treatment effect size showed a moderate benefit of the DBS on the HRQoL, whereas a slight worsening was observed in the BMT group. The change in the DBS group (-7.8) was higher than the MIC (Minimally Important Change) estimated value (-5.8 by the anchor; -6.3 by triangulation of thresholds), but not in the BMT (0.2 vs. -3.0 to -5.4, respectively). Almost 90% of the patients in the DBS group declared some improvement (58.3% and 56.7% beyond the estimated MIC), which was significantly different from the BMT group whose proportions were 32.0% and 30.3%, respectively. The number needed to treat to improve ≥1 MIC by DBS vs BMT was 3.8. Change in depression, disability and pain influenced the improvement of the DBS group. DBS improved HRQoL in a high proportion of patients to a significant and moderate degree, at 2 years follow-up.
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Cernera S, Eisinger RS, Wong JK, Ho KWD, Lopes JL, To K, Carbunaru S, Ramirez-Zamora A, Almeida L, Foote KD, Okun MS, Gunduz A. Long-term Parkinson's disease quality of life after staged DBS: STN vs GPi and first vs second lead. NPJ PARKINSONS DISEASE 2020; 6:13. [PMID: 32656315 PMCID: PMC7338364 DOI: 10.1038/s41531-020-0115-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/23/2019] [Accepted: 06/04/2020] [Indexed: 12/11/2022]
Abstract
Deep brain stimulation (DBS) for Parkinson’s disease (PD) improves quality of life (QoL), but longitudinal follow-up data are scarce. We sought to quantify long-term benefits of subthalamic nucleus (STN) vs globus pallidus internus (GPi), and unilateral vs staged bilateral PD-DBS on postoperative QoL. This is a retrospective, longitudinal, non-randomized study using the PD QoL questionnaire (PDQ)-39 in patients with STN- or GPi-DBS, and with unilateral (N = 191) or staged bilateral (an additional contralateral lead implant) surgery (N = 127 and 156 for the first and second lead, respectively). Changes in PDQ-39 summary index (PDQ-39SI) and subscores throughout 60 months of follow-up were used as the primary analysis. We applied mixed models that included levodopa and covariates that differed at baseline across groups. For unilateral implantation, we observed an initial improvement in PDQ-39SI of 15.55 ± 3.29% (µ ± SE) across both brain targets at 4 months postoperatively. Unilateral STN patients demonstrated greater improvement in PDQ-39SI than GPi patients at 4 and 18 months postoperatively. Analysis of patients with staged bilateral leads revealed an initial 25.34 ± 2.74% (µ ± SE) improvement in PDQ-39SI at 4 months after the first lead with further improvement until 18 months, with no difference across targets. Scores did not improve after the second lead with gradual worsening starting at 18 months postoperatively. STN-DBS provided greater short-term QoL improvement than GPi-DBS for unilateral surgery. For staged bilateral DBS, overall QoL improvement was explained primarily by the first lead. Decision-making for patients considering DBS should include a discussion surrounding the potential risks and benefits from a second DBS lead.
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Affiliation(s)
- Stephanie Cernera
- J. Crayton Pruitt Department of Biomedical Engineering, Gainesville, FL USA
| | - Robert S Eisinger
- Department of Neuroscience, Norman Fixel Institute for Neurological Diseases, Gainesville, FL USA
| | - Joshua K Wong
- Department of Neurology, Norman Fixel Institute for Neurological Diseases, Gainesville, FL USA
| | - Kwo Wei David Ho
- Department of Neurology, Norman Fixel Institute for Neurological Diseases, Gainesville, FL USA
| | - Janine Lobo Lopes
- Department of Neurology, Norman Fixel Institute for Neurological Diseases, Gainesville, FL USA
| | - Kevin To
- Department of Neuroscience, Norman Fixel Institute for Neurological Diseases, Gainesville, FL USA
| | - Samuel Carbunaru
- Department of Neuroscience, Norman Fixel Institute for Neurological Diseases, Gainesville, FL USA
| | - Adolfo Ramirez-Zamora
- Department of Neurology, Norman Fixel Institute for Neurological Diseases, Gainesville, FL USA
| | - Leonardo Almeida
- Department of Neurosurgery, Norman Fixel Institute for Neurological Diseases, Gainesville, FL USA
| | - Kelly D Foote
- Department of Neurosurgery, Norman Fixel Institute for Neurological Diseases, Gainesville, FL USA
| | - Michael S Okun
- Department of Neuroscience, Norman Fixel Institute for Neurological Diseases, Gainesville, FL USA.,Department of Neurology, Norman Fixel Institute for Neurological Diseases, Gainesville, FL USA.,Department of Neurosurgery, Norman Fixel Institute for Neurological Diseases, Gainesville, FL USA
| | - Aysegul Gunduz
- J. Crayton Pruitt Department of Biomedical Engineering, Gainesville, FL USA.,Department of Neuroscience, Norman Fixel Institute for Neurological Diseases, Gainesville, FL USA.,Department of Neurology, Norman Fixel Institute for Neurological Diseases, Gainesville, FL USA
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Petry-Schmelzer JN, Krause M, Dembek TA, Horn A, Evans J, Ashkan K, Rizos A, Silverdale M, Schumacher W, Sack C, Loehrer PA, Fink GR, Fonoff ET, Martinez-Martin P, Antonini A, Barbe MT, Visser-Vandewalle V, Ray-Chaudhuri K, Timmermann L, Dafsari HS. Non-motor outcomes depend on location of neurostimulation in Parkinson's disease. Brain 2020; 142:3592-3604. [PMID: 31553039 DOI: 10.1093/brain/awz285] [Citation(s) in RCA: 85] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 06/11/2019] [Accepted: 07/15/2019] [Indexed: 01/29/2023] Open
Abstract
Deep brain stimulation of the subthalamic nucleus is an effective and established therapy for patients with advanced Parkinson's disease improving quality of life, motor symptoms and non-motor symptoms. However, there is a considerable degree of interindividual variability for these outcomes, likely due to variability in electrode placement and stimulation settings. Here, we present probabilistic mapping data from a prospective, open-label, multicentre, international study to investigate the influence of the location of subthalamic nucleus deep brain stimulation on non-motor symptoms in patients with Parkinson's disease. A total of 91 Parkinson's disease patients undergoing bilateral deep brain stimulation of the subthalamic nucleus were included, and we investigated NMSScale, NMSQuestionnaire, Scales for Outcomes in Parkinson's disease-motor examination, -activities of daily living, and -motor complications, and Parkinson's disease Questionnaire-8 preoperatively and at 6-month follow-up after surgery. Leads were localized in standard space using the Lead-DBS toolbox and individual volumes of tissue activated were calculated based on clinical stimulation settings. Probabilistic stimulation maps and non-parametric permutation statistics were applied to identify voxels with significant above or below average improvement for each scale and analysed using the DISTAL atlas. All outcomes improved significantly at follow-up. Significant spatial distribution patterns of neurostimulation were observed for NMSScale total score and its mood/apathy and attention/memory domains. For both domains, voxels associated with below average improvement were mainly located dorsal to the subthalamic nucleus. In contrast, above average improvement for mood/apathy was observed in the ventral border region of the subthalamic nucleus and in its sensorimotor subregion and for attention/memory in the associative subregion. A trend was observed for NMSScale sleep domain showing voxels with above average improvement located ventral to the subthalamic nucleus. Our study provides evidence that the interindividual variability of mood/apathy, attention/memory, and sleep outcomes after subthalamic nucleus deep brain stimulation depends on the location of neurostimulation. This study highlights the importance of holistic assessments of motor and non-motor aspects of Parkinson's disease to tailor surgical targeting and stimulation parameter settings to patients' personal profiles.
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Affiliation(s)
- Jan Niklas Petry-Schmelzer
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Neurology, Cologne, Germany
| | - Max Krause
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Neurology, Cologne, Germany
| | - Till A Dembek
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Neurology, Cologne, Germany
| | - Andreas Horn
- Department of Neurology, Charité - University Medicine Berlin, Berlin, Germany
| | - Julian Evans
- Department of Neurology and Neurosurgery, Salford Royal Foundation Thrust, Greater Manchester, UK
| | - Keyoumars Ashkan
- National Parkinson Foundation Centre of Excellence, King's College Hospital, London, UK
| | - Alexandra Rizos
- National Parkinson Foundation Centre of Excellence, King's College Hospital, London, UK
| | - Monty Silverdale
- Department of Neurology and Neurosurgery, Salford Royal Foundation Thrust, Greater Manchester, UK
| | - Wibke Schumacher
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Neurology, Cologne, Germany
| | - Carolin Sack
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Neurology, Cologne, Germany
| | - Philipp A Loehrer
- Department of Neurology, University Hospital Giessen and Marburg, Campus Marburg, Marburg, Germany
| | - Gereon R Fink
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Neurology, Cologne, Germany.,Cognitive Neuroscience, Institute of Neuroscience and Medicine (INM-3), Research Center Jülich, Jülich, Germany
| | - Erich T Fonoff
- Division of Functional Neurosurgery of Institute of Psychiatry, Department of Neurology, University of São Paulo Medical School, São Paulo, Brazil
| | - Pablo Martinez-Martin
- National Center of Epidemiology and CIBERNED, Carlos III Institute of Health, Madrid, Spain
| | - Angelo Antonini
- Department of Neuroscience, University of Padua, Padua, Italy
| | - Michael T Barbe
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Neurology, Cologne, Germany
| | - Veerle Visser-Vandewalle
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Stereotaxy and Functional Neurosurgery, Cologne, Germany
| | - K Ray-Chaudhuri
- National Parkinson Foundation Centre of Excellence, King's College Hospital, London, UK.,The Maurice Wohl Clinical Neuroscience Institute, King's College London, London, UK
| | - Lars Timmermann
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Neurology, Cologne, Germany.,Department of Neurology, University Hospital Giessen and Marburg, Campus Marburg, Marburg, Germany
| | - Haidar S Dafsari
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Neurology, Cologne, Germany.,National Parkinson Foundation Centre of Excellence, King's College Hospital, London, UK
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Health-Related Quality of Life Outcomes from Botulinum Toxin Treatment in Spasticity. Toxins (Basel) 2020; 12:toxins12050292. [PMID: 32375388 PMCID: PMC7291043 DOI: 10.3390/toxins12050292] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 04/23/2020] [Accepted: 05/02/2020] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE The effects of botulinum toxin injections (BoNT) on health-related quality of life along the complex spectrum of spasticity needs further characterization to guide practitioners in a real-life therapeutic environment. METHODS In this study, we analyzed 50 consecutive and unselected patients with spasticity before and four weeks after re-injection of botulinum toxin. Health-related quality of life in terms of the EuroQol (EQ) as well as further motor and non-motor characteristics were assessed. RESULTS BoNT improved the EQ visual analog scale (EQ VAS). In addition, state of health and pain maxima improved. The EQ VAS improvement correlated with pre-injection characteristics of the EQ VAS and life satisfaction in the "movement disorders" domain. CONCLUSION EQ VAS is sensitive for monitoring HR-QoL outcomes in an unselected real life observational cohort. This study may inform future studies intended to validate prediction variables that could inform on HR-QoL effects of BoNT treatment in spasticity.
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