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Riboldi GM, Frucht SJ. Is essential tremor a family of diseases or a syndrome? A family of diseases. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2022; 163:7-29. [PMID: 35750371 DOI: 10.1016/bs.irn.2022.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
It is now well-established that essential tremor (ET) can manifest with different clinical presentations and progressions (i.e., upper limb tremor, head tremor, voice tremor, lower limb tremor, task- or position-specific tremor, or a combination of those). Common traits and overlaps are identifiable across these different subtypes of ET, including a slow rate of progression, a response to alcohol and a positive family history. At the same time, each of these manifestations are associated with specific demographic, clinical and treatment-response characteristics suggesting a family of diseases rather than a spectrum of a syndrome. Here we summarize the most important clinical, demographic, neuropathological and imagingfeatures of ET and of its subtypes to support ET as a family of identifiable conditions. This classification has relevance for counseling of patients with regard to disease progression and treatment response, as well as for the design of therapeutic clinical trials.
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Affiliation(s)
- Giulietta M Riboldi
- The Marlene and Paolo Fresco Institute for Parkinson's and Movement Disorders, New York University Langone Health, New York, NY, United States
| | - Steven J Frucht
- The Marlene and Paolo Fresco Institute for Parkinson's and Movement Disorders, New York University Langone Health, New York, NY, United States.
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Xu H, Zou P, He ZY, Wang WB, Xu HJ. Iodine-Promoted Cyclization of Alkylidene Barbiturates in Water: Facile Synthesis of Dihydrofuryl Spirobarbiturates. HETEROCYCLES 2022. [DOI: 10.3987/com-21-14616] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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3
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Lee A, Sarva H. Approach to Tremor Disorders. Semin Neurol 2021; 41:731-743. [PMID: 34826875 DOI: 10.1055/s-0041-1726356] [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
Tremor disorders are diverse and complex. Historical clues and examination features play a major role in diagnosing these disorders, but diagnosis can be challenging due to phenotypic overlap. Ancillary testing, such as neuroimaging or laboratory testing, is driven by the history and examination, and should be performed particularly when there are other neurological or systemic manifestations. The pathophysiology of tremor is not entirely understood, but likely involves multiple networks along with the cerebello-thalamo-cortical pathways. Treatment options include medications, botulinum toxin, surgery, and nonpharmacologic interventions utilizing physical and occupational therapies and assistive devices. Further work is needed in developing accurate diagnostic tests and better treatment options for tremor disorders.
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Affiliation(s)
- Andrea Lee
- Parkinson's Disease and Movement Disorders Institute, Division of Neurodegenerative Diseases, Department of Neurology, Weill Cornell Medicine, New York, New York
| | - Harini Sarva
- Parkinson's Disease and Movement Disorders Institute, Division of Neurodegenerative Diseases, Department of Neurology, Weill Cornell Medicine, New York, New York
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Direct four-component assembling of arylaldehydes, dimethylbarbituric acid, 4-hydroxycoumarine, and cyclic amines into complex scaffolds with three different heterocyclic rings. MONATSHEFTE FUR CHEMIE 2021. [DOI: 10.1007/s00706-021-02849-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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5
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Xu H, Huang RL, Shu Z, Hong R, Zhang Z. Chemoselective synthesis of 5,4'-imidazolinyl spirobarbiturates via NBS-promoted cyclization of unsaturated barbiturates and amidines. Org Biomol Chem 2021; 19:4978-4985. [PMID: 34008679 DOI: 10.1039/d1ob00508a] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
A selective cyclization of unsaturated barbiturates and amidines promoted by N-bromosuccinimide has been successfully developed to afford a vast variety of 5,4'-imidazolinyl spirobarbiturates in moderate to good yields. The present protocol features broad substrate scope, facile work-up procedure and mild reaction conditions, providing a novel strategy for the highly selective and efficient construction of structurally diverse spiroimidazolines.
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Affiliation(s)
- Hui Xu
- Anhui Province Key Laboratory of Functional Coordinated Complexes for Materials Chemistry Application, and School of Chemical and Environmental Engineering, Anhui Polytechnic University, Wuhu 241000, P. R. China.
| | - Rong-Lu Huang
- Anhui Province Key Laboratory of Functional Coordinated Complexes for Materials Chemistry Application, and School of Chemical and Environmental Engineering, Anhui Polytechnic University, Wuhu 241000, P. R. China.
| | - Zhu Shu
- Anhui Province Key Laboratory of Functional Coordinated Complexes for Materials Chemistry Application, and School of Chemical and Environmental Engineering, Anhui Polytechnic University, Wuhu 241000, P. R. China.
| | - Ran Hong
- Anhui Province Key Laboratory of Functional Coordinated Complexes for Materials Chemistry Application, and School of Chemical and Environmental Engineering, Anhui Polytechnic University, Wuhu 241000, P. R. China.
| | - Ze Zhang
- Anhui Province Key Laboratory of Functional Coordinated Complexes for Materials Chemistry Application, and School of Chemical and Environmental Engineering, Anhui Polytechnic University, Wuhu 241000, P. R. China.
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Facile catalyst-free synthesis of perfluoroalkylated cis-spiropyrimidine-5,1′-quinolizines and pyrano[2,3-d]pyrimidines. J Fluor Chem 2019. [DOI: 10.1016/j.jfluchem.2019.109411] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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7
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Yi A, Zahedi A, Wang Y, Tan UX, Zhang D. A Novel Exoskeleton System Based on Magnetorheological Fluid for Tremor Suppression of Wrist Joints. IEEE Int Conf Rehabil Robot 2019; 2019:1115-1120. [PMID: 31374779 DOI: 10.1109/icorr.2019.8779363] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Pathological tremor is caused by a variety of neurological diseases. Although it is not life-threatening, it brings great inconvenience to patients. Traditional treatments including medication, rehabilitation programs and deep brain stimulation (DBS) have shown limited effectiveness along with risks and side effects. In order to overcome the limitations of these treatments, a new method, wearable exoskeleton technology, is introduced that aims to provide a new solution for tremor management. Based on this method, a wrist tremor suppression exoskeleton (WTSE) is developed in this research. A magnetorheological (MR) fluid damper is designed for controllable damping force and an embedded acquisition platform is used to acquire real-time tremor information. The total weight of the WTSE is 262.13 g and the maximum sustained damping force reaches 8 N. The prototype is wearable and the damping force is real-time adjustable. According to preliminary results, the signal acquisition system can obtain reliable data and the WTSE can reduce the amplitude of acceleration and angular velocity of simulated tremor by 60.39% and 55.07%, respectively.
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ALLEN BRENDONC, CHARLES STEVENK. EFFECT OF GYROSCOPE PARAMETERS ON GYROSCOPIC TREMOR SUPPRESSION IN A SINGLE DEGREE OF FREEDOM. J MECH MED BIOL 2019. [DOI: 10.1142/s0219519419500246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Although tremor is one of the most common movement disorders, there are few effective tremor-suppressing options available to patients. Gyrostabilization is a potential option, but we do not currently know how to optimize gyrostabilization for tremor suppression. To address this gap, we present a systematic investigation of how gyrostabilizer parameters affect tremor suppression in a single degree of freedom (DOF). A simple model with a single DOF at the wrist and a gyroscope mounted on the back of the hand was used to focus on the most basic effects. We simulated the frequency response of the system (hand + gyroscope) to a tremorogenic input torque at the wrist. Varying system parameters one at a time, we determined the effect of individual parameters on the system’s frequency response. To minimize the bandwidth without adding significant inertia, the inertia and spin speed of the flywheel should be as high as design constraints allow, whereas the distance from the wrist joint axis to the gyroscope and the precession stiffness and damping should be kept as low as possible. The results demonstrate the potential of gyroscopic tremor suppression and can serve as foundation for further investigations of gyroscopic tremor suppression in the upper limb.
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Affiliation(s)
- BRENDON C. ALLEN
- Mechanical Engineering, Brigham Young University, 350 EB, Provo, UT 84602, USA
| | - STEVEN K. CHARLES
- Mechanical Engineering and Neuroscience, Brigham Young University, 350 EB, Provo, UT 84602, USA
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Yan X, Shao P, Song X, Zhang C, Lu C, Liu S, Li Y. Chemoselective syntheses of spirodihydrofuryl and spirocyclopropyl barbiturates via cascade reactions of barbiturate-based olefins and acetylacetone. Org Biomol Chem 2019; 17:2684-2690. [PMID: 30768085 DOI: 10.1039/c9ob00004f] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
The Michael addition initiated ring closure reaction of barbiturate-based olefins and acetylacetone with NBS has been explored. The efficient and chemoselective approach for the synthesis of barbiturate-fused spirocycles was established. Spirodihydrofuryl barbiturates and spirocyclopropyl barbiturates were synthesized selectively via cascade reactions under different basic conditions in moderate to excellent yields. The structure of 2-(4-chlorophenyl)-1,1-diacetyl-5,7-dimethyl-5,7-diazaspiro[2,5]octane-4,6,8-trione was confirmed by single crystal X-ray diffraction analysis.
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Affiliation(s)
- Xuebin Yan
- College of Chemistry and Molecular Engineering, Zhengzhou University, Zhengzhou 450001, P. R. China.
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10
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First diastereoselective synthesis of perfluoroalkylated cis-spiropyrido[2,1-a]isoquinoline-1,5’-pyrimidines. J Fluor Chem 2018. [DOI: 10.1016/j.jfluchem.2018.09.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Schreglmann SR, Krauss JK, Chang JW, Bhatia KP, Kägi G. Functional lesional neurosurgery for tremor: a systematic review and meta-analysis. J Neurol Neurosurg Psychiatry 2018; 89:717-726. [PMID: 29326290 DOI: 10.1136/jnnp-2017-316302] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Revised: 09/20/2017] [Accepted: 11/20/2017] [Indexed: 11/03/2022]
Abstract
BACKGROUND This work evaluates the consistency, effect size and incidence of persistent side effects of lesional neurosurgical interventions in the treatment of tremor due to Parkinson's disease (PD), essential tremor (ET), multiple sclerosis (MS) and midbrain lesions. METHODS Systematic review and meta-analysis according to PRISMA-P guidelines. Random effects meta-analysis of standardised mean difference based on a peer-reviewed protocol (PROSPERO no. CRD42016048049). RESULTS From 1249 abstracts screened, 86 peer-reviewed studies reporting 102 cohorts homogeneous for tremor aetiology, surgical target and technique were included.Effect on PD tremor was better when targeted at the ventral intermediate nucleus (V.im.) by radiofrequency ablation (RF) (Hedge's g: -4.15;) over V.im. by Gamma Knife (GK) (-2.2), subthalamic nucleus (STN) by RF (-1.12) and globus pallidus internus (GPi) by RF (-0.89). For ET MRI-guided focused ultrasound (MRIgFUS) ablation of the cerebellothalamic tract (CTT) (-2.35) and V.im. (-2.08) showed similar mean tremor reductions to V.im. ablation by RF (-2.42) or GK (-2.13). In MS V.im. ablation by GK (-1.96) and RF (-1.63) were similarly effective.Mean rates of persistent side effects after unilateral lesions in PD were 12.8% (RF V.im.), 13.6% (RF STN), 9.2% (RF GPi), 0.7% (GK V.im.) and 7.0% (MRIgFUS V.im.). For ET, rates were 9.3% (RF V.im.), 1.8% (GK V.im.), 18.7% (MRIgFUS V.im.) and 0.0% (MRIgFUS CTT), for MS 37.7% (RF V.im.) and for rubral tremor 30.3% (RF V.im.). CONCLUSION This meta-analysis quantifies safety, consistency and efficacy of lesional neurosurgical interventions for tremor by target, technique and aetiology.
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Affiliation(s)
- Sebastian R Schreglmann
- Department of Neurology, Kantonsspital St. Gallen, St. Gallen, Switzerland.,Sobell Department of Motor Neuroscience and Movement Disorders, Institute of Neurology, London, UK
| | - Joachim K Krauss
- Department of Neurosurgery, Medizinische Hochschule Hannover, Hannover, Germany
| | - Jin Woo Chang
- Department of Neurosurgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Kailash P Bhatia
- Sobell Department of Motor Neuroscience and Movement Disorders, Institute of Neurology, London, UK
| | - Georg Kägi
- Department of Neurology, Kantonsspital St. Gallen, St. Gallen, Switzerland
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Schreglmann SR, Krauss JK, Chang JW, Martin E, Werner B, Bauer R, Hägele-Link S, Bhatia KP, Kägi G. Functional lesional neurosurgery for tremor: back to the future? J Neurol Neurosurg Psychiatry 2018; 89:727-735. [PMID: 29269505 DOI: 10.1136/jnnp-2017-316301] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Revised: 09/18/2017] [Accepted: 11/20/2017] [Indexed: 11/03/2022]
Abstract
For nearly a century, functional neurosurgery has been applied in the treatment of tremor. While deep brain stimulation has been in the focus of academic interest in recent years, the establishment of incisionless technology, such as MRI-guided high-intensity focused ultrasound, has again stirred interest in lesional approaches.In this article, we will discuss the historical development of surgical technique and targets, as well as the technological state-of-the-art of conventional and incisionless interventions for tremor due to Parkinson's disease, essential and dystonic tremor and tremor related to multiple sclerosis (MS) and midbrain lesions. We will also summarise technique-inherent advantages of each technology and compare their lesion characteristics. From this, we identify gaps in the current literature and derive future directions for functional lesional neurosurgery, in particularly potential trial designs, alternative targets and the unsolved problem of bilateral lesional treatment. The results of a systematic review and meta-analysis of the consistency, efficacy and side effect rate of lesional treatments for tremor are presented separately alongside this article.
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Affiliation(s)
- Sebastian R Schreglmann
- Department of Neurology, Kantonsspital St. Gallen, St. Gallen, Switzerland.,Sobell Department of Motor Neuroscience and Movement Disorders, Institute of Neurology, UCL, London, UK
| | - Joachim K Krauss
- Department of Neurosurgery, Medizinische Hochschule Hannover, Hannover, Germany
| | - Jin Woo Chang
- Department of Neurosurgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Ernst Martin
- Center for Focused Ultrasound, University of Zurich, Children's Hospital Zurich, Zurich, Switzerland
| | - Beat Werner
- Center for Focused Ultrasound, University of Zurich, Children's Hospital Zurich, Zurich, Switzerland
| | - Ronald Bauer
- Department of Neurosurgery, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Stefan Hägele-Link
- Department of Neurology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Kailash P Bhatia
- Sobell Department of Motor Neuroscience and Movement Disorders, Institute of Neurology, UCL, London, UK
| | - Georg Kägi
- Department of Neurology, Kantonsspital St. Gallen, St. Gallen, Switzerland
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Clinical response to Vim's thalamic stereotactic radiosurgery for essential tremor is associated with distinctive functional connectivity patterns. Acta Neurochir (Wien) 2018; 160:611-624. [PMID: 29335882 DOI: 10.1007/s00701-017-3456-x] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Accepted: 12/26/2017] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Essential tremor (ET) is the most common movement disorder. Drug-resistant ET can benefit from standard surgical stereotactic procedures (deep brain stimulation, thalamotomy) or minimally invasive high-intensity focused ultrasound (HIFU) or stereotactic radiosurgical thalamotomy (SRS-T). Resting-state fMRI (rs-fMRI) is a non-invasive imaging method acquired in absence of a task. We examined whether rs-fMRI correlates with tremor score on the treated hand (TSTH) improvement 1 year after SRS-T. METHODS We included 17 consecutive patients treated with left unilateral SRS-T in Marseille, France. Tremor score evaluation and rs-fMRI were acquired at baseline and 1 year after SRS-T. Resting-state data (34 scans) were analyzed without a priori hypothesis, in Lausanne, Switzerland. Based on degree of improvement in TSTH, to consider SRS-T at least as effective as medication, we separated two groups: 1, ≤ 50% (n = 6, 35.3%); 2, > 50% (n = 11, 64.7%). They did not differ statistically by age (p = 0.86), duration of symptoms (p = 0.41), or lesion volume at 1 year (p = 0.06). RESULTS We report TSTH improvement correlated with interconnectivity strength between salience network with the left claustrum and putamen, as well as between bilateral motor cortices, frontal eye fields and left cerebellum lobule VI with right visual association area (the former also with lesion volume). Longitudinal changes showed additional associations in interconnectivity strength between right dorsal attention network with ventro-lateral prefrontal cortex and a reminiscent salience network with fusiform gyrus. CONCLUSIONS Brain connectivity measured by resting-state fMRI relates to clinical response after SRS-T. Relevant networks are visual, motor, and attention. Interconnectivity between visual and motor areas is a novel finding, revealing implication in movement sensory guidance.
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Zhu Y, Wang Z, Zhang J, Yu J, Yan L, Li Y, Chen L, Yan X. An Organocatalytic Synthesis of Chiral Pyrano[2,3-d
]pyrimidines through [3+3] Annulation of 1,3-Dimethyl-barbituric Acid with 2-(1-Alkynyl)-2-alken-1-ones. European J Org Chem 2018. [DOI: 10.1002/ejoc.201701581] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- Yali Zhu
- School of Chemical Engineering and Technology; Tianjin University; Tianjin P. R. China
- Collaborative Innovation Center of Chemical Science and Engineering (Tianjin); Tianjin P. R. China
| | - Zhonghe Wang
- School of Chemical Engineering and Technology; Tianjin University; Tianjin P. R. China
- Collaborative Innovation Center of Chemical Science and Engineering (Tianjin); Tianjin P. R. China
| | - Jing Zhang
- School of Chemical Engineering and Technology; Tianjin University; Tianjin P. R. China
- Collaborative Innovation Center of Chemical Science and Engineering (Tianjin); Tianjin P. R. China
| | - Jia Yu
- School of Chemical Engineering and Technology; Tianjin University; Tianjin P. R. China
- Collaborative Innovation Center of Chemical Science and Engineering (Tianjin); Tianjin P. R. China
| | - Lijuan Yan
- School of Chemical Engineering and Technology; Tianjin University; Tianjin P. R. China
- Collaborative Innovation Center of Chemical Science and Engineering (Tianjin); Tianjin P. R. China
| | - Yang Li
- School of Chemical Engineering and Technology; Tianjin University; Tianjin P. R. China
- Collaborative Innovation Center of Chemical Science and Engineering (Tianjin); Tianjin P. R. China
- Tianjin Engineering Research Center of Functional Fine Chemicals; 300350 Tianjin P. R. China
| | - Ligong Chen
- School of Chemical Engineering and Technology; Tianjin University; Tianjin P. R. China
- Collaborative Innovation Center of Chemical Science and Engineering (Tianjin); Tianjin P. R. China
- Tianjin Engineering Research Center of Functional Fine Chemicals; 300350 Tianjin P. R. China
| | - Xilong Yan
- School of Chemical Engineering and Technology; Tianjin University; Tianjin P. R. China
- Collaborative Innovation Center of Chemical Science and Engineering (Tianjin); Tianjin P. R. China
- Tianjin Engineering Research Center of Functional Fine Chemicals; 300350 Tianjin P. R. China
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Botulinum Toxin Type A Injections as Monotherapy for Upper Limb Essential Tremor Using Kinematics. Can J Neurol Sci 2017; 45:11-22. [DOI: 10.1017/cjn.2017.260] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
AbstractBackground:There is a significant need for a targeted therapy for essential tremor (ET), as medications have not been developed specifically for ET, and the ones prescribed are often not well-tolerated, so that many patients remain untreated. Recent work has shown that, unlike previous experience, kinematically guided individualized botulinum toxin type A (BoNT-A) injections provide benefit along with minimal weakness. Ours is the first long-term (96-week) safety and efficacy study of BoNT-A as monotherapy for ET using kinematically driven injection parameters.Methods:Ten ET patients were administered six serial BoNT-A treatments every 16 weeks and were assessed at 6 weeks following treatment. During each study visit, the Fahn–Tolosa–Marin (FTM) scale, the Unified Parkinson’s Disease Rating Scale, and the Quality of Life for Essential Tremor Questionnaire (QUEST) were administered along with kinematic assessment of the treated limb. Participants performed scripted tasks with motion sensors placed over each arm joint. Dosing patterns were determined using the movement disorder neurologist’s interpretation of muscles contributing to the kinematically analyzed upper limb tremor biomechanics.Results:There was a 33.8% (p<0.05) functional improvement (FTM part C) and a 39.8% (p<0.0005) improvement in QUEST score at week 96 compared to pretreatment scores at week 0. Although there was a 44.6% (p<0.0005) non-dose-dependent reduction in maximal grip strength, only 2 participants complained of mild weakness. Following the fourth serial treatment, mean action tremor score was reduced by 62.9% (p=0.001) in the treated and by 44.4% (p=0.03) in the untreated arm at week 96 compared to week 48.Conclusions:Individualized BoNT-A dosing patterns to each individual’s tremor biomechanics provided an effective monotherapy for ET as function improved without functionally limiting muscle weakness.
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Assessing the clinical outcome of Vim radiosurgery with voxel-based morphometry: visual areas are linked with tremor arrest! Acta Neurochir (Wien) 2017; 159:2139-2144. [PMID: 28942466 DOI: 10.1007/s00701-017-3317-7] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Accepted: 08/28/2017] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Radiosurgery (RS) is an alternative to open standard stereotactic procedures (deep-brain stimulation or radiofrequency thalamotomy) for drug-resistant essential tremor (ET), aiming at the same target (ventro-intermediate nucleus, Vim). We investigated the Vim RS outcome using voxel-based morphometry by evaluating the interaction between clinical response and time. METHODS Thirty-eight patients with right-sided ET benefited from left unilateral Vim RS. Targeting was performed using 130 Gy and a single 4-mm collimator. Neurological and neuroimaging assessment was completed at baseline and 1 year. Clinical responders were considered those with at least 50% improvement in tremor score on the treated hand (TSTH). RESULTS Interaction between clinical response and time showed the left temporal pole and occipital cortex (Brodmann area 19, including V4, V5 and the parahippocampal place area) as statistically significant. A decrease in gray matter density (GMD) 1 year after Vim RS correlated with higher TSTH improvement (Spearman = 0.01) for both anatomical areas. Higher baseline GMD within the left temporal pole correlated with better TSTH improvement (Spearman = 0.004). CONCLUSIONS Statistically significant structural changes in the relationship to clinical response after Vim RS are present in remote areas, advocating a distant neurobiological effect. The former regions are mainly involved in locomotor monitoring toward the local and distant environment, suggesting the recruiting requirement in targeting of the specific visuomotor networks.
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“On-water” catalyst-free, one-pot synthesis of quaternary centered and spiro-tetrahydrothiophene-barbiturate hybrids. Tetrahedron Lett 2017. [DOI: 10.1016/j.tetlet.2017.06.029] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Schreglmann SR, Krauss JK, Chang JW, Bhatia KP, Kägi G. Functional lesional neurosurgery for tremor-a protocol for a systematic review and meta-analysis. BMJ Open 2017; 7:e015409. [PMID: 28487460 PMCID: PMC5623440 DOI: 10.1136/bmjopen-2016-015409] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
INTRODUCTION The recent introduction of incision-less lesional neurosurgery using Gamma Knife and MRI-guided focused ultrasound has revived interest in lesional treatment options for tremor disorders. Preliminary literature researches reveal that the consistency of treatment effects after lesional neurosurgery for tremor has not formally been assessed yet. Similarly, the efficacy of different targets for lesional treatment and incidence of persistent side effects of lesional neurosurgical interventions has not been comprehensively assessed. This work therefore aims to describe a suitable process how to review the existing literature on efficacy and persistent side effects of lesional neurosurgical treatment for tremor due to Parkinson's disease, essential tremor, multiple sclerosis and midbrain/rubral tremor. METHODS AND ANALYSIS We will search electronic databases (Medline, Cochrane) and reference lists of included articles for studies reporting lesional interventions for tremor in cohorts homogeneous for tremor aetiology and intervention (technique and target). We will include cohorts with a minimum number of five subjects and follow-up of 2 months. One investigator will perform the initial literature search and two investigators then independently decide which references to include for final efficacy and safety analysis. After settling of disagreement, data will be extracted from articles using a standardised template. We will perform a random-effect meta-analysis calculating standardised mean differences (Hedge's g) for comparison in Forest plots and subgroup analysis after assessment of heterogeneity using I2 statistics. ETHICS AND DISSEMINATION This study will summarise the available evidence on the efficacy of lesional interventions for the most frequent tremor disorders, as well as for the incidence rate of persisting side effects after unilateral lesional treatment. This data will be useful to guide future work on incision-less lesional interventions for tremor. SYSTEMATIC REVIEW REGISTRATION This study has been registered with the PROSPERO database (no. CRD42016048049).
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Affiliation(s)
| | - Joachim K Krauss
- Department of Neurosurgery, Medizinische Hochschule Hannover, Hannover, Germany
| | - Jin Woo Chang
- Department of Neurosurgery, Yonsei University College of Medicine, Seodaemun-gu, Seoul, South Korea
| | - Kailash P Bhatia
- Department of Motor Neuroscience and Movement Disorders, Institute of Neurology, London, UK
| | - Georg Kägi
- Department of Neurology, Kantonsspital St. Gallen, St. Gallen, Switzerland
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Dideriksen JL, Laine CM, Dosen S, Muceli S, Rocon E, Pons JL, Benito-Leon J, Farina D. Electrical Stimulation of Afferent Pathways for the Suppression of Pathological Tremor. Front Neurosci 2017; 11:178. [PMID: 28420958 PMCID: PMC5378793 DOI: 10.3389/fnins.2017.00178] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Accepted: 03/20/2017] [Indexed: 11/13/2022] Open
Abstract
Pathological tremors are involuntary oscillatory movements which cannot be fully attenuated using conventional treatments. For this reason, several studies have investigated the use of neuromuscular electrical stimulation for tremor suppression. In a recent study, however, we found that electrical stimulation below the motor threshold also suppressed tremor, indicating involvement of afferent pathways. In this study, we further explored this possibility by systematically investigating how tremor suppression by afferent stimulation depends on the stimulation settings. In this way, we aimed at identifying the optimal stimulation strategy, as well as to elucidate the underlying physiological mechanisms of tremor suppression. Stimulation strategies varying the stimulation intensity and pulse timing were tested in nine tremor patients using either intramuscular or surface stimulation. Significant tremor suppression was observed in six patients (tremor suppression > 75% was observed in three patients) and the average optimal suppression level observed across all subjects was 52%. The efficiency for each stimulation setting, however, varied substantially across patients and it was not possible to identify a single set of stimulation parameters that yielded positive results in all patients. For example, tremor suppression was achieved both with stimulation delivered in an out-of-phase pattern with respect to the tremor, and with random timing of the stimulation. Overall, these results indicate that low-current stimulation of afferent fibers is a promising approach for tremor suppression, but that further research is required to identify how the effect can be maximized in the individual patient.
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Affiliation(s)
- Jakob L Dideriksen
- SMI, Department of Health Science and Technology, Aalborg UniversityAalborg, Denmark
| | - Christopher M Laine
- Brain-Body Dynamics Lab, University of Southern CaliforniaLos Angeles, CA, USA
| | - Strahinja Dosen
- Institute of Neurorehabilitation Systems, University Medical Center GöttingenGöttingen, Germany.,Clinic for Trauma Surgery, Orthopedics and Plastic Surgery, University Medical Center GöttingenGöttingen, Germany
| | - Silvia Muceli
- Institute of Neurorehabilitation Systems, University Medical Center GöttingenGöttingen, Germany.,Clinic for Trauma Surgery, Orthopedics and Plastic Surgery, University Medical Center GöttingenGöttingen, Germany
| | - Eduardo Rocon
- Center for Automation and Robotics, Consejo Superior de Investigaciones CientíficasArganda del Rey, Spain
| | - José L Pons
- Neural Rehabilitation Group, Instituto Cajal, Consejo Superior de Investigaciones CientíficasMadrid, Spain
| | | | - Dario Farina
- Department of Bioengineering, Imperial College LondonLondon, UK
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20
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Synthesis, Crystal Structure and DFT Studies of 1,3-Dimethyl-5-propionylpyrimidine-2,4,6(1H,3H,5H)-trione. CRYSTALS 2017. [DOI: 10.3390/cryst7010031] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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21
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Synthesis, Characterization, and Tautomerism of 1,3-Dimethyl Pyrimidine-2,4,6-Trione s-Triazinyl Hydrazine/Hydrazone Derivatives. J CHEM-NY 2017. [DOI: 10.1155/2017/5702962] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
1,3,5-Triazines and pyrimidine-2,4,6-triones belong to that class of compounds which are well known in literature for possessing wide range of biological activities. Here, we report a new family of compounds that encompasses these two structures. The union of both heterocycles was carried out through a hydrazone moiety incorporated into an acetyl group at the position 5 of 1,3-dimethyl pyrimidine derivative. The synthetic strategy adopted allowed the preparation of the target compounds with excellent yields and good purities. The synthesized compounds were well characterized by NMR (1H and 13C), HRMS, and elemental analysis. Furthermore, the tautomerism of enhydrazine versus hydrazone has also been studied.
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22
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Gao X, Li Z, Yang W, Liu Y, Chen W, Zhang C, Zheng L, Guo H. Phosphine-catalyzed [3 + 2] and [4 + 2] annulation reactions of ynones with barbiturate-derived alkenes. Org Biomol Chem 2017; 15:5298-5307. [DOI: 10.1039/c7ob01034f] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
The phosphine-catalyzed [3 + 2] annulation reaction of ynones and barbiturate-derived alkenes has been developed with the assistance of a weak acid, giving functionalized spirobarbiturate-cyclopentanones.
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Affiliation(s)
- Xing Gao
- Department of Applied Chemistry
- China Agricultural University
- Beijing 100193
- China
| | - Zhen Li
- Department of Applied Chemistry
- China Agricultural University
- Beijing 100193
- China
| | - Wenjun Yang
- Department of Applied Chemistry
- China Agricultural University
- Beijing 100193
- China
| | - Yang Liu
- Department of Applied Chemistry
- China Agricultural University
- Beijing 100193
- China
| | - Wufeng Chen
- Department of Applied Chemistry
- China Agricultural University
- Beijing 100193
- China
| | - Cheng Zhang
- Department of Applied Chemistry
- China Agricultural University
- Beijing 100193
- China
| | - Lufei Zheng
- Institute of Quality Standards & Testing Technology for Agro-Products
- Chinese Academy of Agricultural Sciences
- Beijing 100081
- China
| | - Hongchao Guo
- Department of Applied Chemistry
- China Agricultural University
- Beijing 100193
- China
- Key Laboratory of Green Pesticide and Agricultural Bioengineering
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Abstract
Functional neurosurgery has undergone rapid growth over the last few years fueled by advances in imaging technology and novel treatment modalities. These advances have led to new surgical treatments using minimally invasive and precise techniques for conditions such as Parkinson's disease, essential tremor, epilepsy, and psychiatric disorders. Understanding the goals and technological issues of these procedures is imperative for the anesthesiologist to ensure safe management of patients presenting for functional neurosurgical procedures. In this review, we discuss the advances in neurosurgical techniques for deep brain stimulation, focused ultrasound and minimally invasive laser-based treatment of refractory epilepsy and provide a guideline for anesthesiologists caring for patients undergoing these procedures.
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24
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Liu Y, Yang W, Wu Y, Mao B, Gao X, Liu H, Sun Z, Xiao Y, Guo H. Asymmetric Construction of Highly Functionalized Spirobarbiturate-Cyclopentenes through Chiral Phosphine-Catalyzed [3+2] Annulation of Morita-Baylis-Hillman Carbonates with Barbiturate-Derived Alkenes. Adv Synth Catal 2016. [DOI: 10.1002/adsc.201600450] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Yang Liu
- Department of Applied Chemistry; China Agricultural University; 2 West Yuanmingyuan Road Beijing 100193 People's Republic of China
| | - Wenjun Yang
- Department of Applied Chemistry; China Agricultural University; 2 West Yuanmingyuan Road Beijing 100193 People's Republic of China
| | - Yang Wu
- Department of Applied Chemistry; China Agricultural University; 2 West Yuanmingyuan Road Beijing 100193 People's Republic of China
| | - Biming Mao
- Department of Applied Chemistry; China Agricultural University; 2 West Yuanmingyuan Road Beijing 100193 People's Republic of China
| | - Xing Gao
- Department of Applied Chemistry; China Agricultural University; 2 West Yuanmingyuan Road Beijing 100193 People's Republic of China
| | - Honglei Liu
- Department of Applied Chemistry; China Agricultural University; 2 West Yuanmingyuan Road Beijing 100193 People's Republic of China
| | - Zhanhu Sun
- Department of Applied Chemistry; China Agricultural University; 2 West Yuanmingyuan Road Beijing 100193 People's Republic of China
| | - Yumei Xiao
- Department of Applied Chemistry; China Agricultural University; 2 West Yuanmingyuan Road Beijing 100193 People's Republic of China
| | - Hongchao Guo
- Department of Applied Chemistry; China Agricultural University; 2 West Yuanmingyuan Road Beijing 100193 People's Republic of China
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25
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Liu H, Liu Y, Yuan C, Wang GP, Zhu SF, Wu Y, Wang B, Sun Z, Xiao Y, Zhou QL, Guo H. Enantioselective Synthesis of Spirobarbiturate-Cyclohexenes through Phosphine-Catalyzed Asymmetric [4 + 2] Annulation of Barbiturate-Derived Alkenes with Allenoates. Org Lett 2016; 18:1302-5. [DOI: 10.1021/acs.orglett.6b00239] [Citation(s) in RCA: 83] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Affiliation(s)
- Honglei Liu
- Department
of Applied Chemistry, China Agricultural University, Beijing 100193, P. R. China
| | - Yang Liu
- Department
of Applied Chemistry, China Agricultural University, Beijing 100193, P. R. China
| | - Chunhao Yuan
- Department
of Applied Chemistry, China Agricultural University, Beijing 100193, P. R. China
| | - Guo-Peng Wang
- State
Key Laboratory and Institute of Elemento-Organic Chemistry, Collaborative
Innovation Center of Chemical Science and Engineering (Tianjin), Nankai University, Tianjin 300071, China
| | - Shou-Fei Zhu
- State
Key Laboratory and Institute of Elemento-Organic Chemistry, Collaborative
Innovation Center of Chemical Science and Engineering (Tianjin), Nankai University, Tianjin 300071, China
| | - Yang Wu
- Department
of Applied Chemistry, China Agricultural University, Beijing 100193, P. R. China
| | - Bo Wang
- Department
of Applied Chemistry, China Agricultural University, Beijing 100193, P. R. China
| | - Zhanhu Sun
- Department
of Applied Chemistry, China Agricultural University, Beijing 100193, P. R. China
| | - Yumei Xiao
- Department
of Applied Chemistry, China Agricultural University, Beijing 100193, P. R. China
| | - Qi-Lin Zhou
- State
Key Laboratory and Institute of Elemento-Organic Chemistry, Collaborative
Innovation Center of Chemical Science and Engineering (Tianjin), Nankai University, Tianjin 300071, China
| | - Hongchao Guo
- Department
of Applied Chemistry, China Agricultural University, Beijing 100193, P. R. China
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De Crescentini L, Attanasi OA, Campisi LA, Favi G, Lillini S, Ursini F, Mantellini F. Double Michael addition/aza-cyclization: a valuable sequence for the construction of symmetrical and unsymmetrical spirobarbiturate-pyridines. Tetrahedron 2015. [DOI: 10.1016/j.tet.2015.04.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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28
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Elinson MN, Nasybullin RF, Sokolova OO, Zaimovskaya TA, Egorov MP. Non-catalytic multicomponent rapid and efficient approach to 10-(2,4,6-trioxohexahydropyrimidin-5-yl)-3,3-dimethyl-2,3,4,9-tetrahydro-1H-xanthen-1-ones from salicylaldehydes, dimedone, and barbituric acids. MONATSHEFTE FUR CHEMIE 2015. [DOI: 10.1007/s00706-015-1512-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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29
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Barakat A, Al-Najjar HJ, Al-Majid AM, Soliman SM, Mabkhot YN, Ghabbour HA, Fun HK. Synthesis and molecular characterization of 5,5′-((2,4-dichlorophenyl)methylene)bis(1,3-dimethylpyrimidine-2,4,6(1H,3H,5H)-trione). J Mol Struct 2015. [DOI: 10.1016/j.molstruc.2014.12.030] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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30
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Dosen S, Muceli S, Dideriksen JL, Romero JP, Rocon E, Pons J, Farina D. Online tremor suppression using electromyography and low-level electrical stimulation. IEEE Trans Neural Syst Rehabil Eng 2014; 23:385-95. [PMID: 25051555 DOI: 10.1109/tnsre.2014.2328296] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Tremor is one of the most prevalent movement disorders. There is a large proportion of patients (around 25%) in whom current treatments do not attain a significant tremor reduction. This paper proposes a tremor suppression strategy that detects tremor from the electromyographic signals of the muscles from which tremor originates and counteracts it by delivering electrical stimulation to the antagonist muscles in an out of phase manner. The detection was based on the iterative Hilbert transform and stimulation was delivered above the motor threshold (motor stimulation) and below the motor threshold (sensory stimulation). The system was tested on six patients with predominant wrist flexion/extension tremor (four with Parkinson disease and two with Essential tremor) and led to an average tremor reduction in the range of 46%-81% and 35%-48% across five patients when using the motor and sensory stimulation, respectively. In one patient, the system did not attenuate tremor. These results demonstrate that tremor attenuation might be achieved by delivering electrical stimulation below the motor threshold, preventing muscle fatigue and discomfort for the patients, which sets the basis for the development of an alternative treatment for tremor.
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31
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Closed-loop brain-machine-body interfaces for noninvasive rehabilitation of movement disorders. Ann Biomed Eng 2014; 42:1573-93. [PMID: 24833254 DOI: 10.1007/s10439-014-1032-6] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2013] [Accepted: 05/07/2014] [Indexed: 12/17/2022]
Abstract
Traditional approaches for neurological rehabilitation of patients affected with movement disorders, such as Parkinson's disease (PD), dystonia, and essential tremor (ET) consist mainly of oral medication, physical therapy, and botulinum toxin injections. Recently, the more invasive method of deep brain stimulation (DBS) showed significant improvement of the physical symptoms associated with these disorders. In the past several years, the adoption of feedback control theory helped DBS protocols to take into account the progressive and dynamic nature of these neurological movement disorders that had largely been ignored so far. As a result, a more efficient and effective management of PD cardinal symptoms has emerged. In this paper, we review closed-loop systems for rehabilitation of movement disorders, focusing on PD, for which several invasive and noninvasive methods have been developed during the last decade, reducing the complications and side effects associated with traditional rehabilitation approaches and paving the way for tailored individual therapeutics. We then present a novel, transformative, noninvasive closed-loop framework based on force neurofeedback and discuss several future developments of closed-loop systems that might bring us closer to individualized solutions for neurological rehabilitation of movement disorders.
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32
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De Giorgi V, Gandini S, Grazzini M, Benemei S, Marchionni N, Geppetti P. Effect of β-blockers and other antihypertensive drugs on the risk of melanoma recurrence and death. Mayo Clin Proc 2013; 88:1196-203. [PMID: 24182700 DOI: 10.1016/j.mayocp.2013.09.001] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2013] [Revised: 07/14/2013] [Accepted: 09/05/2013] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To verify preliminary studies on patients with melanoma exposed to β-blockers that suggested a reduced risk of disease recurrence and death. PATIENTS AND METHODS Data were obtained from all consecutive patients diagnosed as having melanoma between January 1, 1993, and December 31, 2009, at the Department of Dermatology of the University of Florence, Azienda Sanitaria di Firenze. Participants were excluded if at baseline they reported a previous diagnosis of cutaneous malignant melanoma or another malignant disease. We also excluded participants with evidence of visceral, lymph nodal, and in-transit metastasis at the time of the diagnosis. RESULTS Of 741 consecutive patients with melanoma, 79 (11%) were prescribed β-blockers (for hypertension in most cases) for 1 or more years (treated) and 662 (89%) were not (untreated). The multivariate Cox model indicated that the treated group had improved overall survival after a median follow-up of 4 years (P=.005). For each year of β-blocker use, the risk of death was reduced by 38%. The presence of hypertension, the use of antihypertensive agents for 1 or more years, or the use of other commonly used medicines were not associated with a better outcome for patients with melanoma. CONCLUSION The results confirm and strengthen previous findings that β-blocker use is associated with a reduced risk of melanoma recurrence and death. The results also indicate the strong need for a randomized clinical trial to conclusively assess whether β-blockers afford protection against melanoma recurrence and death.
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Flavel SC, Koch JD, White JM, Todd G. Illicit stimulant use in humans is associated with a long-term increase in tremor. PLoS One 2012; 7:e52025. [PMID: 23272201 PMCID: PMC3525545 DOI: 10.1371/journal.pone.0052025] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2012] [Accepted: 11/12/2012] [Indexed: 11/18/2022] Open
Abstract
Use of illicit stimulants such as methamphetamine, cocaine, and ecstasy is a significant health problem. The United Nations Office on Drugs and Crime estimates that 14-57 million people use stimulants each year. Chronic use of illicit stimulants can cause neurotoxicity in animals and humans but the long-term functional consequences are not well understood. Stimulant users self-report problems with tremor whilst abstinent. Thus, the aim of the current study was to investigate the long-term effect of stimulant use on human tremor during rest and movement. We hypothesized that individuals with a history of stimulant use would exhibit abnormally large tremor during rest and movement. Tremor was assessed in abstinent ecstasy users (n = 9; 22 ± 3 yrs) and abstinent users of amphetamine-like drugs (n = 7; 33 ± 9 yrs) and in two control groups: non-drug users (n = 23; 27 ± 8 yrs) and cannabis users (n = 12; 24 ± 7 yrs). Tremor was measured with an accelerometer attached to the index finger at rest (30 s) and during flexion and extension of the index finger (30 s). Acceleration traces were analyzed with fast-Fourier transform. During movement, tremor amplitude was significantly greater in ecstasy users than in non-drug users (frequency range 3.9-13.3 Hz; P<0.05), but was unaffected in cannabis users or users of amphetamine-like drugs. The peak frequency of tremor did not significantly differ between groups nor did resting tremor. In conclusion, abstinent ecstasy users exhibit an abnormally large tremor during movement. Further work is required to determine if the abnormality translates to increased risk of movement disorders in this population.
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Affiliation(s)
- Stanley C. Flavel
- School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, South Australia, Australia
| | - Jenna D. Koch
- School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, South Australia, Australia
| | - Jason M. White
- School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, South Australia, Australia
- Sansom Institute, University of South Australia, Adelaide, South Australia, Australia
| | - Gabrielle Todd
- School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, South Australia, Australia
- Sansom Institute, University of South Australia, Adelaide, South Australia, Australia
- * E-mail:
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What's the role of topiramate in the management of patients with hyperkinetic movement disorders? Pharmacol Rep 2012; 64:24-30. [PMID: 22580517 DOI: 10.1016/s1734-1140(12)70727-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2011] [Revised: 09/05/2011] [Indexed: 11/22/2022]
Abstract
Topiramate (TPM) is an O-alkyl sulfamate derivative of the naturally occurring monosaccharide D-fructose with an epileptic activity. However, it has been suggested that, in addition to its use in epilepsy, TPM could also be used in the treatment of neurological disorders, psychiatric conditions and hyperkinetic movement disorders. The clinical applications of TPM in hyperkinetic movement disorders is consistent with the multiple pharmacodynamic mechanisms e.g., the modulation of both γ-aminobutyric acidergic or glutamatergic neurotransmission and the modulation of voltage-gated ion channels or intracellular signalling pathways. The purpose of the present review is to describe the mechanisms of action of TPM and its clinical efficacy in patients with hyperkinetic movement disorders.
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Bentué-Ferrer D, Verdier MC, Tribut O. Suivi thérapeutique pharmacologique de la primidone et du phénobarbital. Therapie 2012; 67:381-90. [DOI: 10.2515/therapie/2012036] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2011] [Accepted: 04/17/2012] [Indexed: 11/20/2022]
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Resnick AS, Okun MS, Malapira T, Smith D, Vale FL, Sullivan K, Miller A, Jahan I, Zesiewicz T. Sustained Medication Reduction Following Unilateral VIM Thalamic Stimulation for Essential Tremor. Tremor Other Hyperkinet Mov (N Y) 2012; 2:tre-02-38-193-1. [PMID: 23440408 PMCID: PMC3569968 DOI: 10.7916/d8zg6qz2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2011] [Accepted: 07/26/2011] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Deep brain stimulation (DBS) is an increasingly utilized therapeutic modality for the management of medication refractory essential tremor (ET). The aim of this study was to determine whether DBS allowed for anti-tremor medication reduction within the year after the procedure was performed. METHODS We conducted a retrospective chart review and telephone interviews on 34 consecutive patients who had been diagnosed with ET, and who had undergone unilateral DBS surgery. RESULTS Of the 34 patients in our cohort, 31 patients (91%) completely stopped all anti-tremor medications either before surgery (21 patients, 62%) or in the year following DBS surgery (10 patients, 29%). Patients who discontinued tremor medications before DBS surgery did so because their tremors either became refractory to anti-tremor medication, or they developed adverse events to tremor medications. Patients who stopped tremor medications after DBS surgery did so due to sufficient tremor control. Only three patients (9%) who were taking tremor medications at the time of surgery continued the use of a beta-blocker post-operatively for the purpose of hypertension management in all cases. DISCUSSION The data from this study indicate that medication cessation is common following unilateral DBS for ET.
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Affiliation(s)
- Andrew S. Resnick
- Department of Neurology, University of South Florida College of Medicine, Parkinson's Disease and Movement Disorders Center, Tampa, Florida, United States of America,UF Center for Movement Disorders and Neurorestoration, Gainesville, Florida, United States of America
| | - Michael S. Okun
- UF Center for Movement Disorders and Neurorestoration, Gainesville, Florida, United States of America
| | - Teresita Malapira
- UF Center for Movement Disorders and Neurorestoration, Gainesville, Florida, United States of America
| | - Donald Smith
- Department of Neurosurgery and Brain Repair, University of South Florida College of Medicine, Parkinson's Disease and Movement Disorders Center, Tampa, Florida, United States of America
| | - Fernando L. Vale
- Department of Neurosurgery and Brain Repair, University of South Florida College of Medicine, Parkinson's Disease and Movement Disorders Center, Tampa, Florida, United States of America
| | - Kelly Sullivan
- Department of Neurology, University of South Florida College of Medicine, Parkinson's Disease and Movement Disorders Center, Tampa, Florida, United States of America
| | - Amber Miller
- Department of Neurology, University of South Florida College of Medicine, Parkinson's Disease and Movement Disorders Center, Tampa, Florida, United States of America
| | - Israt Jahan
- Department of Neurology, University of South Florida College of Medicine, Parkinson's Disease and Movement Disorders Center, Tampa, Florida, United States of America
| | - Theresa Zesiewicz
- Department of Neurology, University of South Florida College of Medicine, Parkinson's Disease and Movement Disorders Center, Tampa, Florida, United States of America,*To whom correspondence should be addressed. E-mail:
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Louis ED. Treatment of Essential Tremor: Are there Issues We are Overlooking? Front Neurol 2012; 2:91. [PMID: 22275907 PMCID: PMC3257846 DOI: 10.3389/fneur.2011.00091] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2011] [Accepted: 12/28/2011] [Indexed: 12/19/2022] Open
Abstract
Background: Essential tremor (ET) is one of the most common neurological diseases. Although a large number of medications have been tested, there are only two first-line medications, primidone and propranolol, which is a situation that has not changed in approximately 30 years. Several recent reviews have summarized the current pharmacotherapeutic options for ET and the approach to the management of ET patients. Yet there remain a number of important issues, both scientific and clinical, that have not been broached in the literature and that have therapeutic implications. Objectives: To introduce several clinical and scientific issues that have not formally entered the published literature on the treatment of ET. Methods: In September 2011, materials for this article were gathered during a literature search of PubMed using the following terms: ET, clinical, clinical trial, treatment, medications, therapeutics. English-language articles were selected for further review. Results: The paper focuses on several topics that have received scant or no discussion in the published literature on ET therapeutics. These topics are as follows: the nature of the underlying disease pathophysiology, the presence of pathological heterogeneity, the complexity of cellular and neurochemical changes which may be underlying this disorder, the presence of clinical heterogeneity, the selection of treatment endpoints, the effects of diagnostic uncertainty, the presence of cognitive and psychiatric features in ET, the identification of possible modifiable risk factors, and the absence of any neuroprotective therapies. Conclusion: The author has identified several topics that have received scant or no discussion in the published literature on ET therapeutics. Further discussion of the issues raised here may lead to improvements in clinical trial methodologies as well as facilitate the development of fresh approaches to pharmacotherapy.
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Affiliation(s)
- Elan D Louis
- Gertrude H. Sergievsky Center, College of Physicians and Surgeons, Columbia University New York, NY, USA
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Vereshchagin AN, Elinson MN, Dorofeeva EO, Zaimovskaya TA, Stepanov NO, Gorbunov SV, Belyakov PA, Nikishin GI. Electrocatalytic and chemical assembling of N,N′-dialkylbarbituric acids and aldehydes: efficient cascade approach to the spiro-[furo[2,3-d]pyrimidine-6,5′-pyrimidine]-2,2′,4,4′,6′-(1′H,3H,3′H)-pentone framework. Tetrahedron 2012. [DOI: 10.1016/j.tet.2011.11.057] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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39
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Meidahl Petersen K, Jimenez-Solem E, Andersen JT, Petersen M, Brødbæk K, Køber L, Torp-Pedersen C, Poulsen HE. β-Blocker treatment during pregnancy and adverse pregnancy outcomes: a nationwide population-based cohort study. BMJ Open 2012; 2:bmjopen-2012-001185. [PMID: 22815467 PMCID: PMC3401834 DOI: 10.1136/bmjopen-2012-001185] [Citation(s) in RCA: 89] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To investigate the association between exposure to β-blockers during pregnancy and the risk of being born small for gestational age (SGA), preterm birth and perinatal mortality in a nationwide cohort. DESIGN A population-based retrospective cohort study, using the Danish Fertility Database. The authors identified all pregnant women redeeming a prescription for β-blockers using the National Prescription Registry. Multivariate logistic regression models were used to assess the association between exposure and our outcomes. SETTING Register-based survey. PARTICIPANTS 911'685 births between 1995 and 2008 obtained from the Danish Fertility Database. OUTCOME MEASURES Being born SGA was defined as having a birth weight below the 10th percentile for the corresponding gestational week. Preterm birth was defined as birth before the 37th gestational week. Perinatal mortality was defined as either death occurring within the first 28 days of life or stillbirth. Before 2004, fetal deaths were recorded as stillbirths if they occurred after 28 weeks of gestation, but since then stillbirth is recorded for deaths after 22 gestational weeks. RESULTS The authors identified 2459 pregnancies exposed to β-blockers. β-Blocker exposure during pregnancy was found to be associated with increased risk of SGA (adjusted OR 1.97, 95% CI 1.75 to 2.23), preterm birth (adjusted OR 2.26, 95% CI 2.03 to 2.52) and perinatal mortality (adjusted OR 1.89, 95% CI 1.25 to 2.84). Analyses were adjusted for socioeconomic and maternal variables. The authors found similar risk profiles for pregnancies exposed to labetalol and for pregnancies exposed to other β-blockers. CONCLUSIONS The authors found that exposure to β-blockers during pregnancy was associated with being born SGA, preterm birth and perinatal mortality. Our findings show that labetalol is not safer than other β-blockers during pregnancy.
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Affiliation(s)
- Kasper Meidahl Petersen
- Department of Clinical Pharmacology, Q, Rigshospitalet, University Hospital Copenhagen, Copenhagen, Denmark
| | - Espen Jimenez-Solem
- Department of Clinical Pharmacology, Q, Rigshospitalet, University Hospital Copenhagen, Copenhagen, Denmark
| | - Jon Traerup Andersen
- Department of Clinical Pharmacology, Q, Rigshospitalet, University Hospital Copenhagen, Copenhagen, Denmark
| | - Morten Petersen
- Department of Clinical Pharmacology, Q, Rigshospitalet, University Hospital Copenhagen, Copenhagen, Denmark
| | - Kasper Brødbæk
- Department of Clinical Pharmacology, Q, Rigshospitalet, University Hospital Copenhagen, Copenhagen, Denmark
| | - Lars Køber
- Department of Cardiology, Rigshospitalet, University Hospital Copenhagen, Copenhagen, Denmark
| | | | - Henrik Enghusen Poulsen
- Department of Clinical Pharmacology, Q, Rigshospitalet, University Hospital Copenhagen, Copenhagen, Denmark
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Rees K, Stowe R, Patel S, Ives N, Breen K, Ben-Shlomo Y, Clarke CE. Anti-hypertensive drugs as disease-modifying agents for Parkinson's disease: evidence from observational studies and clinical trials. Cochrane Database Syst Rev 2011:CD008535. [PMID: 22071852 DOI: 10.1002/14651858.cd008535.pub2] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Current treatment for Parkinson's disease (PD) is focused on relieving symptoms, at present there is nothing that is widely accepted to halt or slow disease progression. Potential neuroprotective or disease modifying agents have been identified from preclinical studies. One such group of compounds are anti-hypertensive drugs. OBJECTIVES 1) Do anti-hypertensive drugs prevent the onset of PD? (primary prevention)2) Are anti-hypertensive drugs disease modifying agents in PD, do they slow the progression of disease once PD is established? (secondary prevention)3) What are the adverse effects of taking anti-hypertensive drugs for patients with PD? SEARCH METHODS Electronic databases including trial registers were searched, complemented with handsearching of conference proceedings and searching the citations of key articles (updated May 2011). Authors were contacted, to provide additional information, where necessary. SELECTION CRITERIA For the primary prevention review, primary prevention trials and observational studies (cohort and case control studies) were sought. Participants were free of PD when exposure to anti-hypertensive drugs was assessed. For the secondary prevention review, clinical trials in patients with well defined PD were sought. Two people independently selected studies for inclusion using predetermined criteria. DATA COLLECTION AND ANALYSIS Data were abstracted from the source papers and methodological quality was assessed independently by two review authors. Results for both reviews were dealt with descriptively. MAIN RESULTS Two cohort studies and four case control studies met the inclusion criteria for the primary prevention review. The two cohort studies found no effect of exposure to calcium channel blockers on the risk of developing PD. Three case control studies looked at the effects of exposure to calcium channel blockers and beta blockers on the risk of developing PD but the assessment periods of exposure were markedly different prior to PD onset, and different subclasses of drugs were examined, so results were not comparable. A protective effect of centrally acting calcium channel blockers was found in one study.Two trials and one ongoing trial met the inclusion criteria for the secondary prevention review. Each completed trial examined a different class of anti-hypertensive drug. The ongoing trial is examining the effects of the calcium channel blocker isradipine on motor symptoms and disease progression. It follows an earlier tolerability study. The results are due in the year 2012.Adverse effects were noted in all included trials and included intolerability to the drugs and worsening PD symptoms. AUTHORS' CONCLUSIONS There is currently a lack of evidence for the use of antihypertensive drugs for either the primary or secondary prevention of PD. More observational studies are required to identify potential drugs to go forward for safety and tolerability studies in people with early PD. The results of the ongoing trial will help inform further research.
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Affiliation(s)
- Karen Rees
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK.
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Cognitive effects of carisbamate in randomized, placebo-controlled, healthy-volunteer, multidose studies. Epilepsy Behav 2011; 22:324-30. [PMID: 21849260 DOI: 10.1016/j.yebeh.2011.07.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2011] [Revised: 07/07/2011] [Accepted: 07/08/2011] [Indexed: 11/24/2022]
Abstract
Adverse cognitive effects are an important concern for drugs that influence the central nervous system. Carisbamate is a novel drug in development for treatment of seizures and neuropathic pain. Information on its cognitive effects is limited. Three controlled, multiple-dose, crossover studies with treatment durations of 5-9 days were designed to examine the cognitive effects of carisbamate on healthy volunteers. In one study, apparent dose-dependent effects on response, vigilance, and recognition speed were observed (1000 mg and 1500 mg/day). Carisbamate did not differ from placebo for most variables in the other two studies, but increased reaction time and reduced Sternberg memory were seen at higher dosages. Carisbamate did not produce clinically significant adverse effects on cognitive performance at doses <1000 mg/day. Effects were mild to modest at the higher doses tested.
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Abstract
Tremor is the most common movement disorder presenting to an outpatient neurology practice and is defined as a rhythmical, involuntary oscillatory movement of a body part. The authors review the clinical examination, classification, and diagnosis of tremor. The pathophysiology of the more common forms of tremor is outlined, and treatment options are discussed. Essential tremor is characterized primarily by postural and action tremors, may be a neurodegenerative disorder with pathologic changes in the cerebellum, and can be treated with a wide range of pharmacologic and nonpharmacologic methods. Tremor at rest is typical for Parkinson's disease, but may arise independently of a dopaminergic deficit. Enhanced physiologic tremor, intention tremor, and dystonic tremor are discussed. Further differential diagnoses described in this review include drug- or toxin-induced tremor, neuropathic tremor, psychogenic tremor, orthostatic tremor, palatal tremor, tremor in Wilson's disease, and tremor secondary to cerebral lesions, such as Holmes' tremor (midbrain tremor). An individualized approach to treatment of tremor patients is important, taking into account the degree of disability, including social embarrassment, which the tremor causes in the patient's life.
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Elinson MN, Vereshchagin AN, Stepanov NO, Belyakov PA, Nikishin GI. Cascade assembly of N,N′-dialkylbarbituric acids and aldehydes: a simple and efficient one-pot approach to the substituted 1,5-dihydro-2H,2′H-spiro(furo[2,3-d]pyrimidine-6,5′-pyrimidine)-2,2′,4,4′,6′(1′H,3H,3′H)-pentone framework. Tetrahedron Lett 2010. [DOI: 10.1016/j.tetlet.2010.10.041] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Siniscalchi A, Gallelli L, De Sarro G. Use of antiepileptic drugs for hyperkinetic movement disorders. Curr Neuropharmacol 2010; 8:359-66. [PMID: 21629443 PMCID: PMC3080592 DOI: 10.2174/157015910793358187] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2010] [Revised: 04/23/2010] [Accepted: 04/30/2010] [Indexed: 11/23/2022] Open
Abstract
Many studies investigated the use of antiepileptic drugs (AEDs) in several neurological diseases other than epilepsy. These neurological disorders, usually, involve neuronal excitability through the modulating of ion channels, receptors and intracellular signaling pathways, and are the targets of the AEDs. This article provides a review of the clinical efficacy of both conventional and newer AEDs in hyperkinetic movement disorders. Some of these indications for AEDs have been established, while others are under investigation. The modulation of GABAergic transmission may explain the neuronal hyper-excitability that underlies some forms of hyperkinetic movement disorders. So, AEDs able to increase GABAergic neurotransmission may play a role in hyperkinetic movement disorders treatment. Therefore, AEDs could represent a useful therapeutic option in the management of hyperkinetic movement disorders where the available treatments are ineffective.
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Affiliation(s)
- A Siniscalchi
- Department of Neuroscience, Neurology Division, Annunziata Hospital, Cosenza, Italy
| | - L Gallelli
- Pharmacology, Department of Experimental and Clinical Medicine, Faculty of Medicine, University Magna Graecia of Catanzaro, Clinical Pharmacology Unit, Mater Domini University Hospital, Catanzaro, Italy
| | - G De Sarro
- Pharmacology, Department of Experimental and Clinical Medicine, Faculty of Medicine, University Magna Graecia of Catanzaro, Clinical Pharmacology Unit, Mater Domini University Hospital, Catanzaro, Italy
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&NA;. Essential tremor in children is generally mild, but some patients may require pharmacological treatment. DRUGS & THERAPY PERSPECTIVES 2010. [DOI: 10.2165/11205170-000000000-00000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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Ritz B, Rhodes SL, Qian L, Schernhammer E, Olsen JH, Friis S. L-type calcium channel blockers and Parkinson disease in Denmark. Ann Neurol 2010; 67:600-6. [PMID: 20437557 PMCID: PMC2917467 DOI: 10.1002/ana.21937] [Citation(s) in RCA: 136] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
OBJECTIVE This study was undertaken to investigate L-type calcium channel blockers of the dihydropyridine class for association with Parkinson disease (PD), because some of these drugs traverse the blood-brain barrier, are potentially neuroprotective, and have previously been evaluated for impact on PD risk. METHODS We identified 1,931 patients with a first-time diagnosis for PD between 2001 and 2006 as reported in the Danish national hospital/outpatient database and density matched them by birth year and sex to 9,651 controls from the population register. The index date for cases and their corresponding controls was advanced to the date of first recorded prescription for anti-Parkinson drugs, if prior to first PD diagnosis in the hospital records. Prescriptions were determined from the national pharmacy database. In our primary analyses, we excluded all calcium channel blocker prescriptions 2 years before index date/PD diagnosis. RESULTS Employing logistic regression analysis adjusting for age, sex, diagnosis of chronic pulmonary obstructive disorder, and Charlson comorbidity score, we found that subjects prescribed dihydropyridines (excludes amlodipine) between 1995 and 2 years prior to the index date were less likely to develop PD (odds ratio, 0.73; 95% confidence interval, 0.54-0.97); this 27% risk reduction did not differ with length or intensity of use. Risk estimates were close to null for the peripherally acting drug amlodipine and for other antihypertensive medications. INTERPRETATION Our data suggest a potential neuroprotective role for centrally acting L-type calcium channel blockers of the dihydropyridine class in PD that should be further investigated in studies that can distinguish between types of L-type channel blockers.
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Affiliation(s)
- Beate Ritz
- Department of Epidemiology, University of California at Los Angeles School of Public Health, Los Angeles, CA, USA.
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Elble RJ, Biondi DM, Ascher S, Wiegand F, Hulihan J. Carisbamate in essential tremor: Brief report of a proof of concept study. Mov Disord 2010; 25:634-8. [DOI: 10.1002/mds.22872] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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Pharmacological characterization of harmaline-induced tremor activity in mice. Eur J Pharmacol 2009; 616:73-80. [DOI: 10.1016/j.ejphar.2009.05.031] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2009] [Revised: 05/12/2009] [Accepted: 05/19/2009] [Indexed: 01/06/2023]
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