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Zhong C, Guo N, Hu C, Ni R, Zhang X, Meng Z, Liu T, Ding S, Ding W, Zhao Y, Cao L, Zheng Y. Efficacy of Wearable low-intensity pulsed Ultrasound treatment in the Movement disorder in Parkinson's disease (the SWUMP trial): protocol for a single-site, double-blind, randomized controlled trial. Trials 2024; 25:275. [PMID: 38650028 PMCID: PMC11036625 DOI: 10.1186/s13063-024-08092-y] [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: 12/12/2023] [Accepted: 04/03/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND Parkinson's disease (PD) is a progressive, neurodegenerative illness marked by the loss of dopaminergic neurons, causing motor symptoms. Oral levodopa replacement therapy remains the gold standard in the treatment of PD. It is, nevertheless, a symptomatic treatment. There is currently no effective treatment for PD. Therefore, new therapies for PD are highly desirable. Low-intensity pulsed ultrasound (LIPUS) has been shown to improve behavioral functions in PD animal models. It is a new type of neuromodulation approach that combines noninvasiveness with high spatial precision. The purpose of this study is to establish a new clinical protocol for LIPUS in the treatment of movement disorders in patients with PD. METHODS This protocol is a single-site, prospective, double-blind, randomized controlled trial (RCT). Forty-eight participants with clinically confirmed PD will be randomly allocated to one of two groups: LIPUS group or sham group. All of the participants continue to use pharmacological therapy as a fundamental treatment. The primary outcome is the difference between groups from baseline to 4 months in the change in the Unified Parkinson's Disease Rating Scale (UPDRS) motor score (part III). The secondary outcomes include the rating scales such as the Mini-Mental State Examination (MMSE), and other three rating scales, and medical examinations including high-density electroencephalography (hdEEG) and functional magnetic resonance imaging (fMRI). The primary safety outcome will be assessed at 4 months, and adverse events will be recorded. DISCUSSION This study represents the clinical investigation into the efficacy of therapeutic LIPUS in the treatment of PD for the first time. If LIPUS is determined to be effective, it could offer a practical and innovative means of expanding the accessibility of ultrasound therapy by using a wearable LIPUS device within a home setting. TRIAL REGISTRATION Chinese Clinical Trial Registry ChiCTR2100052093. Registered on 17 October 2021.
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Affiliation(s)
- Chuanyu Zhong
- Department of Ultrasound in Medicine, Shanghai Jiao Tong University of Medicine Affiliated Sixth People's Hospital, Shanghai, 200233, People's Republic of China
| | - Ning Guo
- Department of Ultrasound in Medicine, Shanghai Jiao Tong University of Medicine Affiliated Sixth People's Hospital, Shanghai, 200233, People's Republic of China
| | - Canfang Hu
- Department of Neurology, Shanghai Jiao Tong University of Medicine Affiliated Sixth People's Hospital, Shanghai, 200233, People's Republic of China
- Department of Neurology Medical, Jinshan Branch of Shanghai Sixth People's Hospital, Shanghai, 201599, People's Republic of China
| | - Ruilong Ni
- Department of Neurology, Shanghai Jiao Tong University of Medicine Affiliated Sixth People's Hospital, Shanghai, 200233, People's Republic of China
| | - Xiaojie Zhang
- Department of Neurology, Shanghai Jiao Tong University of Medicine Affiliated Sixth People's Hospital, Shanghai, 200233, People's Republic of China
| | - Zheying Meng
- Department of Ultrasound in Medicine, Shanghai Jiao Tong University of Medicine Affiliated Sixth People's Hospital, Shanghai, 200233, People's Republic of China
| | - Taotao Liu
- Department of Neurology, Shanghai Jiao Tong University of Medicine Affiliated Sixth People's Hospital, Shanghai, 200233, People's Republic of China
| | - Siqi Ding
- Department of Neurology, Shanghai Jiao Tong University of Medicine Affiliated Sixth People's Hospital, Shanghai, 200233, People's Republic of China
| | - Wanhai Ding
- Department of Neurosurgery, Shanghai Jiao Tong University of Medicine Affiliated Sixth People's Hospital, Shanghai, 200233, People's Republic of China
| | - Yuwu Zhao
- Department of Neurology, Shanghai Jiao Tong University of Medicine Affiliated Sixth People's Hospital, Shanghai, 200233, People's Republic of China.
| | - Li Cao
- Department of Neurology, Shanghai Jiao Tong University of Medicine Affiliated Sixth People's Hospital, Shanghai, 200233, People's Republic of China.
| | - Yuanyi Zheng
- Department of Ultrasound in Medicine, Shanghai Jiao Tong University of Medicine Affiliated Sixth People's Hospital, Shanghai, 200233, People's Republic of China.
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Zhang Y, Zhang YC, Sheng YJ, Chen XF, Wang CS, Ma Q, Chen HB, Yu LF, Mao CJ, Xiong KP, Luo WF, Liu CF. Sonographic Alteration of Basal Ganglia in Different Forms of Primary Focal Dystonia: A Cross-sectional Study. Chin Med J (Engl) 2016; 129:942-5. [PMID: 27064039 PMCID: PMC4831529 DOI: 10.4103/0366-6999.179792] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background: Few studies have addressed whether abnormalities in the lenticular nucleus (LN) are characteristic transcranial sonography (TCS) echo features in patients with primary dystonia. This study aimed to explore alterations in the basal ganglia in different forms of primary focal dystonia. Methods: cross-sectional observational study was performed between December 2013 and December 2014 in 80 patients with different forms of primary focal dystonia and 55 neurologically normal control subjects. TCS was performed in patients and control subjects. Multiple comparisons of multiple rates were used to compare LN hyperechogenicity ratios between control and patient groups. Results: Thirteen individuals were excluded due to poor temporal bone windows, and two subjects were excluded due to disagreement in evaluation by sonologists. Totally, 70 patients (cervical dystonia, n = 30; blepharospasm, n = 30; oromandibular dystonia, n = 10) and 50 normal controls were included in the final analysis. LN hyperechogenicity was observed in 51% (36/70) of patients with primary focal dystonia, compared with 12% (6/50) of controls (P < 0.001). Substantia nigra hyperechogenicity did not differ between the two groups. LN hyperechogenicity was observed in 73% (22/30) of patients with cervical dystonia, a greater prevalence than in patients with blepharospasm (33%, 10/30, P = 0.002) and oromandibular dystonia (40%, 4/10, P = 0.126). LN hyperechogenicity was more frequently observed in patients with cervical dystonia compared with controls (73% vs. 12%, P < 0.001); however, no significant difference was detected in patients with blepharospasm (33% vs. 12%, P = 0.021) or oromandibular dystonia (40% vs. 12%, P = 0.088). Conclusions: LN hyperechogenicity is more frequently observed in patients with primary focal dystonia than in controls. It does not appear to be a characteristic TCS echo feature in patients with blepharospasm or oromandibular dystonia.
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Affiliation(s)
| | - Ying-Chun Zhang
- Department of Ultrasound, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215004, China
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Pilotto A, Yilmaz R, Berg D. Developments in the role of transcranial sonography for the differential diagnosis of parkinsonism. Curr Neurol Neurosci Rep 2016; 15:43. [PMID: 26008814 DOI: 10.1007/s11910-015-0566-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
In the last two decades transcranial sonography (TCS) has developed as a valuable, supplementary tool in the diagnosis and differential diagnosis of movement disorders. In this review, we highlight recent evidence supporting TCS as a reliable method in the differential diagnosis of parkinsonism, combining substantia nigra (SN), basal ganglia and ventricular system findings. Moreover, several studies support SN hyperechogenicity as one of most important risk factors for Parkinson's disease (PD). The advantages of TCS include short investigation time, low cost and lack of radiation. Principal limitations are still the dependency on the bone window and operator experience. New automated algorithms may reduce the role of investigator skill in the assessment and interpretation, increasing TCS diagnostic reliability. Based on the convincing evidence available, the EFNS accredited the method of TCS a level A recommendation for supporting the diagnosis of PD and its differential diagnosis from secondary and atypical parkinsonism. An increasing number of training programmes is extending the use of this technique in clinical practice.
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Affiliation(s)
- Andrea Pilotto
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
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Toomsoo T, Liepelt-Scarfone I, Kerner R, Kadastik-Eerme L, Asser T, Rubanovits I, Berg D, Taba P. Substantia Nigra Hyperechogenicity: Validation of Transcranial Sonography for Parkinson Disease Diagnosis in a Large Estonian Cohort. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2016; 35:17-23. [PMID: 26589647 DOI: 10.7863/ultra.14.12069] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/30/2014] [Accepted: 04/07/2015] [Indexed: 06/05/2023]
Abstract
OBJECTIVES Substantia nigra hyperechogenicity is a promising biomarker for Parkinson disease (PD). Substantia nigra hyperechogenicity has previously been established as a useful diagnostic criterion in several European and Asian patient cohorts. However, diagnostic cutoff values for substantia nigra hyperechogenicity remain unknown for most patient populations. This study validated the diagnostic accuracy of substantia nigra hyperechogenicity in a large cohort of patients with PD in Estonia. METHODS The study included 300 patients with PD from Estonia, representing 10% of the national PD patient population, and 200 healthy control participants. To define the optimal cutoff value in the PD cohort, data from a single assessment versus repetitive assessments by transcranial sonography were compared. With the use of 3 repetitive assessments, the diagnostic accuracy of the data was measured. In addition, calculations for percentile values were used to define substantia nigra hyperechogenicity among controls. RESULTS Our data showed that the multiassessment approach yielded higher diagnostic accuracy than a single assessment (P = .021). The highest diagnostic accuracy was achieved by using the measurement mean to define substantia nigra hyperechogenicity, which was 0.23 cm(2) (sensitivity, 88.7%; specificity, 92.2%), whereas single measurements detected PD with higher sensitivity (sensitivity, 93.2%; specificity, 85.1%). No significant difference was found between mean and median measurements (P= .18). CONCLUSIONS This study indicates the diagnostic merit of transcranial sonography in PD diagnosis in an additional population and demonstrates that transcranial sonography of the substantia nigra is a relevant and useful diagnostic tool for patients with PD.
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Affiliation(s)
- Toomas Toomsoo
- Center of Neurology, East Tallinn Central Hospital, Tallinn, Estonia (T.T., I.R.); Department of Neurodegeneration, Center of Neurology, Hertie Institute of Clinical Brain Research and German Center of Neurodegenerative Diseases, University of Tübingen, Tübingen, Germany (I.L.-S., D.B.); Statistics Estonia, Tallinn, Estonia (R.K.); and Department of Neurology and Neurosurgery, University of Tartu, Tartu, Estonia (L.K.-E., T.A., P.T.)
| | - Inga Liepelt-Scarfone
- Center of Neurology, East Tallinn Central Hospital, Tallinn, Estonia (T.T., I.R.); Department of Neurodegeneration, Center of Neurology, Hertie Institute of Clinical Brain Research and German Center of Neurodegenerative Diseases, University of Tübingen, Tübingen, Germany (I.L.-S., D.B.); Statistics Estonia, Tallinn, Estonia (R.K.); and Department of Neurology and Neurosurgery, University of Tartu, Tartu, Estonia (L.K.-E., T.A., P.T.)
| | - Riina Kerner
- Center of Neurology, East Tallinn Central Hospital, Tallinn, Estonia (T.T., I.R.); Department of Neurodegeneration, Center of Neurology, Hertie Institute of Clinical Brain Research and German Center of Neurodegenerative Diseases, University of Tübingen, Tübingen, Germany (I.L.-S., D.B.); Statistics Estonia, Tallinn, Estonia (R.K.); and Department of Neurology and Neurosurgery, University of Tartu, Tartu, Estonia (L.K.-E., T.A., P.T.)
| | - Liis Kadastik-Eerme
- Center of Neurology, East Tallinn Central Hospital, Tallinn, Estonia (T.T., I.R.); Department of Neurodegeneration, Center of Neurology, Hertie Institute of Clinical Brain Research and German Center of Neurodegenerative Diseases, University of Tübingen, Tübingen, Germany (I.L.-S., D.B.); Statistics Estonia, Tallinn, Estonia (R.K.); and Department of Neurology and Neurosurgery, University of Tartu, Tartu, Estonia (L.K.-E., T.A., P.T.)
| | - Toomas Asser
- Center of Neurology, East Tallinn Central Hospital, Tallinn, Estonia (T.T., I.R.); Department of Neurodegeneration, Center of Neurology, Hertie Institute of Clinical Brain Research and German Center of Neurodegenerative Diseases, University of Tübingen, Tübingen, Germany (I.L.-S., D.B.); Statistics Estonia, Tallinn, Estonia (R.K.); and Department of Neurology and Neurosurgery, University of Tartu, Tartu, Estonia (L.K.-E., T.A., P.T.).
| | - Inna Rubanovits
- Center of Neurology, East Tallinn Central Hospital, Tallinn, Estonia (T.T., I.R.); Department of Neurodegeneration, Center of Neurology, Hertie Institute of Clinical Brain Research and German Center of Neurodegenerative Diseases, University of Tübingen, Tübingen, Germany (I.L.-S., D.B.); Statistics Estonia, Tallinn, Estonia (R.K.); and Department of Neurology and Neurosurgery, University of Tartu, Tartu, Estonia (L.K.-E., T.A., P.T.)
| | - Daniela Berg
- Center of Neurology, East Tallinn Central Hospital, Tallinn, Estonia (T.T., I.R.); Department of Neurodegeneration, Center of Neurology, Hertie Institute of Clinical Brain Research and German Center of Neurodegenerative Diseases, University of Tübingen, Tübingen, Germany (I.L.-S., D.B.); Statistics Estonia, Tallinn, Estonia (R.K.); and Department of Neurology and Neurosurgery, University of Tartu, Tartu, Estonia (L.K.-E., T.A., P.T.)
| | - Pille Taba
- Center of Neurology, East Tallinn Central Hospital, Tallinn, Estonia (T.T., I.R.); Department of Neurodegeneration, Center of Neurology, Hertie Institute of Clinical Brain Research and German Center of Neurodegenerative Diseases, University of Tübingen, Tübingen, Germany (I.L.-S., D.B.); Statistics Estonia, Tallinn, Estonia (R.K.); and Department of Neurology and Neurosurgery, University of Tartu, Tartu, Estonia (L.K.-E., T.A., P.T.)
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Mahlknecht P, Poewe W. Defining premotor Parkinson’s disease: a window of opportunity for neuroprotection? Neurodegener Dis Manag 2013. [DOI: 10.2217/nmt.12.74] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
SUMMARY The diagnosis of Parkinson’s disease (PD) is based on clinical grounds alone and requires the presence of bradykinesia and at least one further motor symptom out of tremor, rigidity or postural instability. Nevertheless, a variety of non-motor symptoms are an integral part of the clinical spectrum of the disease and may even be present before the first appearance of classical motor signs. The ultimate goal of any neuroprotective therapy will be to delay or prevent the onset of clinical disease. The current challenge is, therefore, to identify markers that would allow earlier diagnosis during the premotor stages of PD. The present review discusses potential markers of premotor PD including non-motor symptoms, neuroimaging, genetic susceptibility factors and molecular biomarkers. With the aid of such biomarkers, PD risk cohorts may eventually become sufficiently well defined to allow for ‘neuroprevention’ trials using rates of conversion to motor PD as a primary end point.
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Affiliation(s)
- Philipp Mahlknecht
- Department of Neurology, University of Innsbruck, A-6020 Innsbruck, Anichstraße 35, Austria
| | - Werner Poewe
- Department of Neurology, University of Innsbruck, A-6020 Innsbruck, Anichstraße 35, Austria
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Kresojević N, Mijajlović M, Perić S, Pavlović A, Svetel M, Janković M, Dobričić V, Novaković I, Lakočević MB, Klein C, Kostić VS. Transcranial sonography in patients with Parkinson's disease with glucocerebrosidase mutations. Parkinsonism Relat Disord 2013; 19:431-5. [PMID: 23332636 DOI: 10.1016/j.parkreldis.2012.12.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2012] [Revised: 11/22/2012] [Accepted: 12/13/2012] [Indexed: 12/25/2022]
Abstract
OBJECTIVES The aim of this study was to search for possible differences in the findings of transcranial sonography (TCS) between groups of patients with glucocerebrosidase (GBA)-associated Parkinson's disease (PD) (4 patients with Gaucher disease type 1 and parkinsonism [GD+PD+] and 18 PD patients with heterozygous GBA mutations; [GBA+PD+]) and groups of 12 patients with Gaucher disease type 1 and no signs of parkinsonism (GD+PD-), 9 asymptomatic carriers of heterozygous GBA mutations (GBA+PD-), 32 sporadic PD patients (sPD), and 43 healthy controls. RESULTS In all groups of patients, except asymptomatic carriers of heterozygous GBA mutations (mean ± SD: 0.16 ± 0.03 cm(2)), the maximal areas of substantia nigra hyperechogenicity (aSN-max) was higher (GD+PD+: 0.28 ± 0.15 cm(2); GD+PD-: 0.18 ± 0.06 cm(2); GBA+PD+: 0.27 ± 0.06 cm(2); sPD: 0.28 ± 0.10 cm(2)) when compared to controls (0.12 ± 0.08 cm(2)) (p = 0.001). In GBA-associated PD (GD+PD+ and GBA+PD+) and sPD, aSNmax values were very similar. Moderate or marked SN hyperechogenicity was present in 87.5% of sPD patients and in 83% of PD patients with heterozygous GBA mutations, but in only 11.6% of controls, and in 22.2% and 33.3% of patients from GBA+PD- and GD+PD- groups, respectively (p < 0.001). The prevalence of interrupted or missing echogenicity of the brainstem raphe differed between the groups (p = 0.046), while no difference was observed in the diameter of the third ventricle. CONCLUSIONS TCS findings in GBA-associated PD were consistent to those of patients with sporadic PD.
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Affiliation(s)
- Nikola Kresojević
- Clinic for Neurology CCS, School of Medicine, University of Belgrade, Serbia
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