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Abreu-Silveira C, Reis F, Barbosa ER, Silveira-Moriyama L. Pac-Man Ghost Sign In Bilateral Hypertrophic Olivary Degeneration. Can J Neurol Sci 2024; 51:280-281. [PMID: 37203792 DOI: 10.1017/cjn.2023.56] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Affiliation(s)
- Camila Abreu-Silveira
- Department of Neurology, Universidade Estadual de Campinas (Unicamp), Campinas, Brazil
| | - Fabiano Reis
- Department of Anesthesiology, Oncology and Radiology, Universidade Estadual de Campinas (Unicamp), Campinas, Brazil
| | - Egberto R Barbosa
- Department of Neurology, University of São Paulo School of Medicine, São Paulo, Brazil
| | - Laura Silveira-Moriyama
- Department of Neurology, Universidade Estadual de Campinas (Unicamp), Campinas, Brazil
- Education Unit, University College London, Institute of Neurology, London, United Kingdom
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Bovolenta TM, Schumacher-Schuh AF, Santos-Lobato BLD, Godeiro Júnior CDO, Silva DJD, Nicaretta D, Barbosa ER, Cardoso FEC, Della Coletta MV, Braga Neto P, Cury RG, Tumas V, Felicio AC. Average annual cost of Parkinson's disease in a Brazilian multiethnic population. Parkinsonism Relat Disord 2023; 117:105897. [PMID: 37931350 DOI: 10.1016/j.parkreldis.2023.105897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 10/10/2023] [Accepted: 10/13/2023] [Indexed: 11/08/2023]
Abstract
INTRODUCTION With the current demographic transition, it is estimated that by 2050 Brazil will have a population of 90 million people aged 60 years or more, and in parallel Parkinson's disease (PD) will bring a considerable economic burden to our society. Brazil is considered multiracial due to its colonization, generating important social and regional inequalities. Knowing the costs of the PD may aid to improve local public policies. However, in Brazil, no estimates of these values have been made so far. OBJECTIVES To evaluate direct, indirect, and out-of-pocket costs in Brazilian people with PD (PwP). METHODS Categorical and numerical data were collected through a customized and standardized cost-related-questionnaire from 1055 PwP nationwide, from 10 tertiary movement disorders centers across all Brazilian regions. RESULTS The estimated average annual cost of PwP was US$ 4020.48. Direct and indirect costs accounted for 63% and 36% of the total, respectively, and out-of-pocket costs were 49%. There were no evidence of differences in the total cost of PD across the regions of the country; however, differences were reported between the stages of the Hoehn and Yahr scale (H&Y). CONCLUSION This data suggests a considerable burden of PD for Brazilian society in general, not only for the public health system, but mainly for those with PD.
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Affiliation(s)
| | | | | | | | - Delson José da Silva
- Neuroscience Core, Hospital Clinics, Federal University of Goiás, Brazil Integrated Neurosciences Institute, Goiás, Brazil.
| | - Denise Nicaretta
- School of Medicine and Surgery - UNIRIO HUGG/EBSERH Rio de Janeiro, Brazil.
| | - Egberto R Barbosa
- Movement Disorders Clinic, Department of Neurology, School of Medicine of the University of São Paulo, São Paulo, SP, Brazil.
| | - Francisco E C Cardoso
- Movement Disorders Unit Hospital das Clínicas, Federal University of Minas Gerais, Belo Horizonte, Brazil.
| | | | - Pedro Braga Neto
- Department of Clinical Medicine, Neurology Section, Federal University of Ceará, Ceará, Brazil.
| | - Rubens G Cury
- Movement Disorders Center, Department of Neurology, School of Medicine, University of São Paulo, São Paulo, Brazil.
| | - Vitor Tumas
- Department of Neuroscience and Sciences of Behavior, Division of Neurology, Faculty of Medicine of Ribeirão Preto, University of São Paulo, São Paulo, Brazil.
| | - Andre C Felicio
- Department of Neurology and Brain Institute, Hospital Israelita Albert Einstein, São Paulo, Brazil.
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Capato TTC, Rodrigues R, Cury RG, Teixeira MJ, Barbosa ER. Clinical assessment of upper limb impairments and functional capacity in Parkinson's disease: a systematic review. Arq Neuropsiquiatr 2023; 81:1008-1015. [PMID: 37899049 PMCID: PMC10689111 DOI: 10.1055/s-0043-1772769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 07/19/2023] [Indexed: 10/31/2023]
Abstract
BACKGROUND Parkinson's disease (PD) may progressively reduce the upper limb's functionality. Currently, there is no standardized upper limb functional capacity assessment in PD in the rehabilitation field. OBJECTIVE To identify specific outcome measurements to assess upper limbs in PD and access functional capacity. METHODS We systematically reviewed and analyzed the literature in English published from August/2012 to August/2022 according to PRISMA. The following keywords were used in our search: "upper limbs" OR "upper extremity" and "Parkinson's disease." Two researchers searched independently, including studies accordingly to our inclusion and exclusion criteria. Registered at PROSPERO CRD42021254486. RESULTS We found 797 studies, and 50 were included in this review (n = 2.239 participants in H&Y stage 1-4). The most common upper limbs outcome measures found in the studies were: (i) UPDRS-III and MDS-UPDRS to assess the severity and progression of PD motor symptoms (tremor, bradykinesia, and rigidity) (ii) Nine Hole Peg Test and Purdue Pegboard Test to assess manual dexterity; (iii) Spiral test and Funnel test to provoke and assess freezing of upper limbs; (iv) Technology assessment such as wearables sensors, apps, and other device were also found. CONCLUSION We found evidence to support upper limb impairments assessments in PD. However, there is still a large shortage of specific tests to assess the functional capacity of the upper limbs. The upper limbs' functional capacity is insufficiently investigated during the clinical and rehabilitation examination due to a lack of specific outcome measures to assess functionality.
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Affiliation(s)
- Tamine T. C. Capato
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Neurologia, Centro de Distúrbios do Movimento, São Paulo SP, Brazil.
- Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behavior, Department of Neurology, Nijmegen, The Netherlands.
| | - Rúbia Rodrigues
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Neurologia, Centro de Distúrbios do Movimento, São Paulo SP, Brazil.
| | - Rubens G. Cury
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Neurologia, Centro de Distúrbios do Movimento, São Paulo SP, Brazil.
| | | | - Egberto R. Barbosa
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Neurologia, Centro de Distúrbios do Movimento, São Paulo SP, Brazil.
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Jansen JAF, Capato TTC, Darweesh SKL, Barbosa ER, Donders R, Bloem BR, Nonnekes J. Exploring the levodopa-paradox of freezing of gait in dopaminergic medication-naïve Parkinson's disease populations. NPJ Parkinsons Dis 2023; 9:130. [PMID: 37689706 PMCID: PMC10492797 DOI: 10.1038/s41531-023-00575-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 08/25/2023] [Indexed: 09/11/2023] Open
Abstract
The relationship between dopaminergic treatment and freezing of gait (FOG) in Parkinson's disease (PD) is complex: levodopa is the most effective symptomatic treatment for FOG, but long-term pulsatile levodopa treatment has also been linked to an increase in the occurrence of FOG. This concept, however, continues to be debated. Here, we compared the occurrence of FOG between a levodopa-naive PD cohort and a levodopa-treated cohort. Forty-nine treatment-naive patients and 150 levodopa-treated patients were included. The time since first motor symptoms was at least 5 years. Disease severity was assessed using the MDS-UPDRS part III. Occurrence of FOG was assessed subjectively (new freezing-of-gait-questionnaire) and objectively (rapid turns test and Timed Up-and-Go test). The presence of FOG was compared between the levodopa-treated and levodopa-naive groups using a chi-square test of homogeneity. We also performed a binomial Firth logistic regression with disease duration, disease severity, country of inclusion, location of measurement, and executive function as covariates. Subjective FOG was more common in the levodopa-treated cohort (n = 41, 27%) compared to the levodopa-naive cohort (n = 2, 4%, p < 0.001). The association between FOG and levodopa treatment remained after adjustment for covariates (OR = 6.04, 95%Cl [1.60, 33.44], p = 0.006). Objectively verified FOG was more common in the levodopa-treated cohort (n = 21, 14%) compared to the levodopa-naive cohort (n = 1, 2%, p = 0.02). We found an association between long-term pulsatile levodopa treatment and an increased occurrence of FOG. Future studies should further explore the role of nonphysiological stimulation of dopamine receptors in generating FOG, as a basis for possible prevention studies.
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Affiliation(s)
- Jamie A F Jansen
- Radboud University Medical Center, Donders Institute for Brain, Cognition and Behavior, Department of Rehabilitation, Center of Expertise for Parkinson & Movement Disorders, Nijmegen, The Netherlands
| | - Tamine T C Capato
- University of São Paulo, Department of Neurology, Movement Disorders Center, São Paulo, Brazil
- Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, Centre of Expertise for Parkinson & Movement Disorders, Nijmegen, The Netherlands
| | - Sirwan K L Darweesh
- Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, Centre of Expertise for Parkinson & Movement Disorders, Nijmegen, The Netherlands
| | - Egberto R Barbosa
- University of São Paulo, Department of Neurology, Movement Disorders Center, São Paulo, Brazil
| | - Rogier Donders
- Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | - Bastiaan R Bloem
- Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, Centre of Expertise for Parkinson & Movement Disorders, Nijmegen, The Netherlands
| | - Jorik Nonnekes
- Radboud University Medical Center, Donders Institute for Brain, Cognition and Behavior, Department of Rehabilitation, Center of Expertise for Parkinson & Movement Disorders, Nijmegen, The Netherlands.
- Department of Rehabilitation, Sint Maartenskliniek, Ubbergen, The Netherlands.
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Abreu‐Silveira C, Barbosa ER, Silveira‐Moriyama L. Comment on: A Case to Tear One's Hair Out: Trichotillomania in Wilson's Disease. Mov Disord Clin Pract 2023; 10:156-157. [PMID: 36704073 PMCID: PMC9847271 DOI: 10.1002/mdc3.13611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 10/17/2022] [Indexed: 11/06/2022] Open
Affiliation(s)
| | - Egberto R. Barbosa
- Department of NeurologyUniversity of São Paulo School of MedicineSão PauloBrazil
| | - Laura Silveira‐Moriyama
- Department of NeurologyUniversity of Campinas (Unicamp)CampinasBrazil
- Education UnitUniversity College London Institute of Neurology, University College LondonLondonUK
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Capato TTC, Cury RG, Tornai J, Fonoff ET, Guimarães R, Jacobsen MT, Haddad MS, Barbosa ER. Use of Objective Outcomes Measures to Verify the Effects of ICF-Based Gait Treatment in Huntington's Disease Patient on Globus Pallidus Deep Brain Stimulation: A Case Report. Front Rehabilit Sci 2022; 3:849333. [PMID: 36189041 PMCID: PMC9397791 DOI: 10.3389/fresc.2022.849333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 03/23/2022] [Indexed: 11/13/2022]
Abstract
In advanced stages of in Huntington's disease (HD) gait impairments and severe chorea are usually medication-refractory. The long-term effects on gait in HD of physiotherapy ICF-based management post- globus pallidus deep brain stimulation (GPi DBS) are not well-established. Physiotherapy has been recognized as an essential element in HD treatment. Here, we present a case report of a 56-year-old woman with HD on the advanced stage and severe chorea medication-refractory after GPi-DBS. We performed multidisciplinary motor assessments ICF-based to identify the disability at clinical and home-setting, including environmental and personal factors before and after GPi-DBS surgery and at 11-time points follow-up. The surgery was very successful and directly post GPi-DBS, there were a significant improvement in chorea and a substantial decrease in medication dose. A framework ICF- based physiotherapy protocol with external cues was developed to improve gait was delivered post-surgery and was continued three times/week during 18-months. Physiotherapy sessions consisted of a personalized protocol of exercises with functional movements, balance, and gait training with external cues. Improvements in gait were observed in 3-months post-intervention and were more expressive in 6-months follow-up. Our patient improved substantially HD motor symptoms and her quality of life after GPi-DBS intervention and a physiotherapy program ICF-based. The objective outcomes measures used to assess gait have served as endpoints to assessing the patient's motor profile during the pre-operative period. Assessments were helpful to verify the efficacy of the multidisciplinary intervention in long-term.ConclusionPeriodically assessing function and disability using outcome improvements may support clinicians' decisions about DBS, medication adjustments and guide physiotherapists to personalize the ICF-based intervention.
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Affiliation(s)
- Tamine T. C. Capato
- Department of Neurology, Movement Disorders Center, University of São Paulo, São Paulo, Brazil
- Radboud University Medical Centre, Nijmegen, Netherlands
- Donders Institute for Brain, Cognition and Behaviour, Nijmegen, Netherlands
- Department of Neurology, Nijmegen, Netherlands
- Centre of Expertise for Parkinson & Movement Disorders, Nijmegen, Netherlands
- *Correspondence: Tamine T. C. Capato
| | - Rubens G. Cury
- Department of Neurology, Movement Disorders Center, University of São Paulo, São Paulo, Brazil
| | - Juliana Tornai
- PHYSICAL Parkinson's Disease and Movement Disorders Rehabilitation Center, São Paulo, Brazil
| | - Erich T. Fonoff
- Department of Neurology, Movement Disorders Center, University of São Paulo, São Paulo, Brazil
| | - Renata Guimarães
- PHYSICAL Parkinson's Disease and Movement Disorders Rehabilitation Center, São Paulo, Brazil
| | - Manoel T. Jacobsen
- Neurosurgery Division, Department of Neurology, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Mônica S. Haddad
- Radboud University Medical Centre, Nijmegen, Netherlands
- Donders Institute for Brain, Cognition and Behaviour, Nijmegen, Netherlands
- Department of Neurology, Nijmegen, Netherlands
- Centre of Expertise for Parkinson & Movement Disorders, Nijmegen, Netherlands
| | - Egberto R. Barbosa
- Radboud University Medical Centre, Nijmegen, Netherlands
- Donders Institute for Brain, Cognition and Behaviour, Nijmegen, Netherlands
- Department of Neurology, Nijmegen, Netherlands
- Centre of Expertise for Parkinson & Movement Disorders, Nijmegen, Netherlands
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Capato TTC, de Vries NM, IntHout J, Barbosa ER, Nonnekes J, Bloem BR. Multimodal Balance Training Supported by Rhythmical Auditory Stimuli in Parkinson's Disease: A Randomized Clinical Trial. J Parkinsons Dis 2021; 10:333-346. [PMID: 31884492 PMCID: PMC7029328 DOI: 10.3233/jpd-191752] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
Background: Balance impairment in Parkinson’s disease (PD) improves only partially with dopaminergic medication. Therefore, non-pharmacological interventions such as physiotherapy are important elements in clinical management. External cues are often applied to improve gait, but their effects on balance control are unclear. Objective/Methods: We performed a prospective, single-blind, randomized clinical trial to study the effectiveness of balance training with and without rhythmical auditory cues. We screened 201 volunteers by telephone; 154 were assigned randomly into three groups: (1) multimodal balance training supported by rhythmical auditory stimuli (n = 56) (RAS-supported multimodal balance training); (2) regular multimodal balance training without rhythmical auditory stimuli (n = 50); and (3) control intervention involving a general education program (n = 48). Training was performed for 5 weeks, two times/week. Linear mixed models were used for all outcomes. Primary outcome was the Mini-BESTest (MBEST) score immediately after the training period. Assessments were performed by a single, blinded assessor at baseline, immediately post intervention, and after one and 6-months follow-up. Results: Immediately post intervention, RAS-supported multimodal balance training was more effective than regular multimodal balance training on MBEST (difference 3.5 (95% Confidence Interval (CI) 2.2; 4.8)), p < 0.001). Patients allocated to both active interventions improved compared to controls (MBEST estimated mean difference versus controls 6.6 (CI 5.2; 8.0), p < 0.001 for RAS-supported multimodal balance training; and 3.0 (CI 2.7; 5.3), p < 0.001 for regular multimodal balance training). Improvements were retained at one-month follow-up for both active interventions, but only the RAS-supported multimodal balance training group maintained its improvement at 6 months. Conclusion: Both RAS-supported multimodal balance training and regular multimodal balance training improve balance, but RAS-supported multimodal balance training–adding rhythmical auditory cues to regular multimodal balance training–has greater and more sustained effects.
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Affiliation(s)
- Tamine T C Capato
- Department of Neurology, Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Centre of Expertise for Parkinson & Movement Disorders, Nijmegen, The Netherlands.,Department of Neurology, University of São Paulo, Movement Disorder Center, São Paulo, Brazil
| | - Nienke M de Vries
- Department of Neurology, Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Centre of Expertise for Parkinson & Movement Disorders, Nijmegen, The Netherlands
| | - Joanna IntHout
- Department for Health Evidence, Radboud University Medial Centre, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | - Egberto R Barbosa
- Department of Neurology, University of São Paulo, Movement Disorder Center, São Paulo, Brazil
| | - Jorik Nonnekes
- Department of Rehabilitation, Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands
| | - Bastiaan R Bloem
- Department of Neurology, Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Centre of Expertise for Parkinson & Movement Disorders, Nijmegen, The Netherlands
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Mylius V, Perez Lloret S, Cury RG, Teixeira MJ, Barbosa VR, Barbosa ER, Moreira LI, Listik C, Fernandes AM, de Lacerda Veiga D, Barbour J, Hollenstein N, Oechsner M, Walch J, Brugger F, Hägele-Link S, Beer S, Rizos A, Chaudhuri KR, Bouhassira D, Lefaucheur JP, Timmermann L, Gonzenbach R, Kägi G, Möller JC, Ciampi de Andrade D. The Parkinson disease pain classification system: results from an international mechanism-based classification approach. Pain 2021; 162:1201-1210. [PMID: 33044395 PMCID: PMC7977616 DOI: 10.1097/j.pain.0000000000002107] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 09/20/2020] [Accepted: 10/05/2020] [Indexed: 12/11/2022]
Abstract
ABSTRACT Pain is a common nonmotor symptom in patients with Parkinson disease (PD) but the correct diagnosis of the respective cause remains difficult because suitable tools are lacking, so far. We developed a framework to differentiate PD- from non-PD-related pain and classify PD-related pain into 3 groups based on validated mechanistic pain descriptors (nociceptive, neuropathic, or nociplastic), which encompass all the previously described PD pain types. Severity of PD-related pain syndromes was scored by ratings of intensity, frequency, and interference with daily living activities. The PD-Pain Classification System (PD-PCS) was compared with classic pain measures (ie, brief pain inventory and McGill pain questionnaire [MPQ], PDQ-8 quality of life score, MDS-UPDRS scores, and nonmotor symptoms). 159 nondemented PD patients (disease duration 10.2 ± 7.6 years) and 37 healthy controls were recruited in 4 centers. PD-related pain was present in 122 patients (77%), with 24 (15%) suffering one or more syndromes at the same time. PD-related nociceptive, neuropathic, or nociplastic pain was diagnosed in 87 (55%), 25 (16%), or 35 (22%), respectively. Pain unrelated to PD was present in 35 (22%) patients. Overall, PD-PCS severity score significantly correlated with pain's Brief Pain Inventory and MPQ ratings, presence of dyskinesia and motor fluctuations, PDQ-8 scores, depression, and anxiety measures. Moderate intrarater and interrater reliability was observed. The PD-PCS is a valid and reliable tool for differentiating PD-related pain from PD-unrelated pain. It detects and scores mechanistic pain subtypes in a pragmatic and treatment-oriented approach, unifying previous classifications of PD-pain.
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Affiliation(s)
- Veit Mylius
- Department of Neurology, Center for Neurorehabilitation, Valens, Switzerland
- Department of Neurology, Kantonsspital St, Gallen, Switzerland
- Department of Neurology, Philipps University, Marburg, Germany
| | - Santiago Perez Lloret
- Biomedical Research Center (CAECIHS-UAI), National Research Council (CONICET), and Faculty of Medicine, Pontifical Catholic University of Argentina, Buenos Aires, Argentina
| | - Rubens G. Cury
- Pain Center, LIM-62, Departamento de Neurologia da Faculdade de Medicina da Universidade de Sao Paulo, Hospital das Clínicas, Sao Paulo, Brazil
| | - Manoel J. Teixeira
- Pain Center, LIM-62, Departamento de Neurologia da Faculdade de Medicina da Universidade de Sao Paulo, Hospital das Clínicas, Sao Paulo, Brazil
| | - Victor R. Barbosa
- Pain Center, LIM-62, Departamento de Neurologia da Faculdade de Medicina da Universidade de Sao Paulo, Hospital das Clínicas, Sao Paulo, Brazil
| | - Egberto R. Barbosa
- Pain Center, LIM-62, Departamento de Neurologia da Faculdade de Medicina da Universidade de Sao Paulo, Hospital das Clínicas, Sao Paulo, Brazil
| | - Larissa I. Moreira
- Pain Center, LIM-62, Departamento de Neurologia da Faculdade de Medicina da Universidade de Sao Paulo, Hospital das Clínicas, Sao Paulo, Brazil
| | - Clarice Listik
- Pain Center, LIM-62, Departamento de Neurologia da Faculdade de Medicina da Universidade de Sao Paulo, Hospital das Clínicas, Sao Paulo, Brazil
| | - Ana M. Fernandes
- Pain Center, LIM-62, Departamento de Neurologia da Faculdade de Medicina da Universidade de Sao Paulo, Hospital das Clínicas, Sao Paulo, Brazil
| | - Diogo de Lacerda Veiga
- Pain Center, LIM-62, Departamento de Neurologia da Faculdade de Medicina da Universidade de Sao Paulo, Hospital das Clínicas, Sao Paulo, Brazil
| | - Julio Barbour
- Pain Center, LIM-62, Departamento de Neurologia da Faculdade de Medicina da Universidade de Sao Paulo, Hospital das Clínicas, Sao Paulo, Brazil
| | | | - Matthias Oechsner
- Parkinson Center, Center for Neurological Rehabilitation, Zihlschlacht, Switzerland
| | - Julia Walch
- Department of Neurology, Kantonsspital St, Gallen, Switzerland
| | - Florian Brugger
- Department of Neurology, Kantonsspital St, Gallen, Switzerland
| | | | - Serafin Beer
- Department of Neurology, Center for Neurorehabilitation, Valens, Switzerland
| | - Alexandra Rizos
- King's College Hospital, Parkinson Foundation Centre of Excellence, London, United Kingdom
| | - Kallol Ray Chaudhuri
- King's College Hospital, Parkinson Foundation Centre of Excellence, London, United Kingdom
- King's College London, Department Basic and Clinical Neuroscience, London, United Kingdom
- The Maurice Wohl Clinical Neuroscience Institute, London, United Kingdom
| | - Didier Bouhassira
- INSERM U-987, Centre d'Evaluation et de Traitement de la Douleur, Hôpital Ambroise Paré, Assistance Publique—Hôpitaux de Paris, Boulogne-Billancourt and Université Versailles-Saint-Quentin, France
| | - Jean-Pascal Lefaucheur
- EA 4391, Unité de Neurophysiologie Clinique, Hôpital Henri Mondor, Assistance Publique—Hôpitaux de Paris, Faculté de Médecine de Créteil, Université Paris-Est-Créteil, France
| | - Lars Timmermann
- Department of Neurology, Philipps University, Marburg, Germany
| | - Roman Gonzenbach
- Department of Neurology, Center for Neurorehabilitation, Valens, Switzerland
| | - Georg Kägi
- Department of Neurology, Kantonsspital St, Gallen, Switzerland
| | - Jens Carsten Möller
- Department of Neurology, Philipps University, Marburg, Germany
- Parkinson Center, Center for Neurological Rehabilitation, Zihlschlacht, Switzerland
| | - Daniel Ciampi de Andrade
- Pain Center, LIM-62, Departamento de Neurologia da Faculdade de Medicina da Universidade de Sao Paulo, Hospital das Clínicas, Sao Paulo, Brazil
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Cury RG, Carra RB, Capato TTC, Teixeira MJ, Barbosa ER. Spinal Cord Stimulation for Parkinson's Disease: Dynamic Habituation as a Mechanism of Failure? Mov Disord 2020; 35:1882-1883. [PMID: 33068473 DOI: 10.1002/mds.28271] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 05/18/2020] [Indexed: 11/11/2022] Open
Affiliation(s)
- Rubens G Cury
- Movement Disorders Center, Department of Neurology, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Rafael B Carra
- Movement Disorders Center, Department of Neurology, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Tamine T C Capato
- Movement Disorders Center, Department of Neurology, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Manoel J Teixeira
- Functional Neurosurgery, Department of Neurology, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Egberto R Barbosa
- Movement Disorders Center, Department of Neurology, School of Medicine, University of São Paulo, São Paulo, Brazil
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Vieira-Yano B, Martini DN, Horak FB, de Lima-Pardini A, Almeida F, Santana VP, Lima D, Batista AX, Marquesini R, Lira J, Barbosa ER, Corcos DM, Ugrinowitsch C, Silva-Batista C. The Adapted Resistance Training with Instability Randomized Controlled Trial for Gait Automaticity. Mov Disord 2020; 36:152-163. [PMID: 32955752 DOI: 10.1002/mds.28298] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 08/06/2020] [Accepted: 08/26/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Deficits in the cerebellar locomotor region (CLR) have been associated with loss of gait automaticity in individuals with freezing of gait in Parkinson's disease (freezers); however, exercise interventions that restore gait automaticity in freezers are lacking. We evaluated the effects of the adapted resistance training with instability ([ARTI] complex exercises) compared with traditional motor rehabilitation (without complex exercises) on gait automaticity and attentional set-shifting. We also verified associations between gait automaticity change and CLR activation change previously published. METHODS Freezers were randomized either to the experimental group (ARTI, n = 17) or to the active control group (traditional motor rehabilitation, n = 15). Both training groups performed exercises 3 times a week for 12 weeks. Gait automaticity (dual-task and dual-task cost [DTC] on gait speed and stride length), single-task gait speed and stride length, attentional set-shifting (time between Trail Making Test parts B and A), and CLR activation during a functional magnetic resonance imaging protocol of simulated step initiation task were evaluated before and after interventions. RESULTS Both training groups improved gait parameters in single task (P < 0.05), but ARTI was more effective than traditional motor rehabilitation in improving DTC on gait speed, DTC on stride length, dual-task stride length, and CLR activation (P < 0.05). Changes in CLR activation were associated with changes in DTC on stride length (r = 0.68, P = 0.002) following ARTI. Only ARTI improved attentional set-shifting at posttraining (P < 0.05). CONCLUSIONS ARTI restores gait automaticity and improves attentional set-shifting in freezers attributed to the usage of exercises with high motor complexity. © 2020 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Bianca Vieira-Yano
- Exercise Neuroscience Research Group, University of Sao Paulo, Sao Paulo, Brazil.,School of Arts, Sciences and Humanities, University of São Paulo, Sao Paulo, Brazil
| | - Douglas N Martini
- Department of Neurology, Oregon Health and Science University, Portland, Oregon, USA
| | - Fay B Horak
- Department of Neurology, Oregon Health and Science University, Portland, Oregon, USA
| | | | - Filipe Almeida
- Exercise Neuroscience Research Group, University of Sao Paulo, Sao Paulo, Brazil
| | - Vagner P Santana
- Exercise Neuroscience Research Group, University of Sao Paulo, Sao Paulo, Brazil
| | - Daniel Lima
- Exercise Neuroscience Research Group, University of Sao Paulo, Sao Paulo, Brazil
| | - Alana X Batista
- Department of Radiology, University of São Paulo, São Paulo, Brazil
| | - Raquel Marquesini
- Laboratory of Neuromuscular Adaptations to Strength Training, School of Physical Education and Sport, University of São Paulo, São Paulo, Brazil
| | - Jumes Lira
- Exercise Neuroscience Research Group, University of Sao Paulo, Sao Paulo, Brazil.,Laboratory of Neuromuscular Adaptations to Strength Training, School of Physical Education and Sport, University of São Paulo, São Paulo, Brazil
| | - Egberto R Barbosa
- Movement Disorders Clinic, Department of Neurology, School of Medicine of the University of São Paulo, São Paulo, Brazil
| | - Daniel M Corcos
- Department of Physical Therapy and Human Movement Sciences, Northwestern University, Chicago, Illinois, USA
| | - Carlos Ugrinowitsch
- Laboratory of Neuromuscular Adaptations to Strength Training, School of Physical Education and Sport, University of São Paulo, São Paulo, Brazil
| | - Carla Silva-Batista
- Exercise Neuroscience Research Group, University of Sao Paulo, Sao Paulo, Brazil.,School of Arts, Sciences and Humanities, University of São Paulo, Sao Paulo, Brazil.,Laboratory of Neuromuscular Adaptations to Strength Training, School of Physical Education and Sport, University of São Paulo, São Paulo, Brazil
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11
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França C, de Andrade DC, Silva V, Galhardoni R, Barbosa ER, Teixeira MJ, Cury RG. Effects of cerebellar transcranial magnetic stimulation on ataxias: A randomized trial. Parkinsonism Relat Disord 2020; 80:1-6. [PMID: 32920321 DOI: 10.1016/j.parkreldis.2020.09.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 09/01/2020] [Accepted: 09/03/2020] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Cerebellar ataxia remains a neurological symptom orphan of treatment interventions, despite being prevalent and incapacitating. We aimed to study, in a double-blind design, whether cerebellar modulation could improve ataxia. METHODS We included patients with diagnosis of spinocerebellar ataxia type 3, multiple systems atrophy cerebellar type, or post-lesion ataxia. Patients received five sessions each of sham and active cerebellar 1 Hz deep repetitive transcranial magnetic stimulation in randomized order. Our primary outcome was the decrease in the Scale for the Assessment and Rating of Ataxia when comparing phases (active x sham). Secondary outcomes measures included the International Cooperative Ataxia Rating Scale, and other motor, cognitive, and quality of life scales. This study was registered at clinicaltrials.gov (protocol NCT03213106). RESULTS Twenty-four patients aged 29-74 years were included in our trial. After active stimulation, the Scale for the Assessment and Rating of Ataxia score was significantly lower than the score after sham stimulation [median (interquartile range) of 10.2 (6.2, 16.2) versus 12.8 (9.6, 17.8); p = 0.002]. The International Cooperative Ataxia Rating Scale score also improved after active stimulation versus sham [median (interquartile range) of 29.0 (21.0, 43.5) versus 32.8 (22.0, 47.0); p = 0.005]. Other secondary outcomes were not significantly modified by stimulation. No patient presented severe side effects, and nine presented mild and self-limited symptoms. CONCLUSIONS Our protocol was safe and well-tolerated. These findings suggest that cerebellar modulation may improve ataxic symptom and provide reassurance about safety for clinical practice.
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Affiliation(s)
- Carina França
- Movement Disorders Center, LIM 62, Department of Neurology, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Daniel C de Andrade
- Service of Interdisciplinary Neuromodulation (SIN), Laboratory of Neurosciences (LIM-27), Department and Institute of Psychiatry, University of São Paulo, São Paulo, Brazil
| | - Valquíria Silva
- Service of Interdisciplinary Neuromodulation (SIN), Laboratory of Neurosciences (LIM-27), Department and Institute of Psychiatry, University of São Paulo, São Paulo, Brazil
| | - Ricardo Galhardoni
- Service of Interdisciplinary Neuromodulation (SIN), Laboratory of Neurosciences (LIM-27), Department and Institute of Psychiatry, University of São Paulo, São Paulo, Brazil
| | - Egberto R Barbosa
- Movement Disorders Center, LIM 62, Department of Neurology, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Manoel J Teixeira
- Service of Interdisciplinary Neuromodulation (SIN), Laboratory of Neurosciences (LIM-27), Department and Institute of Psychiatry, University of São Paulo, São Paulo, Brazil; Functional Neurosurgery Division, Department of Neurology, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Rubens G Cury
- Movement Disorders Center, LIM 62, Department of Neurology, School of Medicine, University of São Paulo, São Paulo, Brazil; Service of Interdisciplinary Neuromodulation (SIN), Laboratory of Neurosciences (LIM-27), Department and Institute of Psychiatry, University of São Paulo, São Paulo, Brazil.
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12
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Capato TTC, de Vries NM, IntHout J, Ramjith J, Barbosa ER, Nonnekes J, Bloem BR. Multimodal Balance Training Supported by Rhythmic Auditory Stimuli in Parkinson Disease: Effects in Freezers and Nonfreezers. Phys Ther 2020; 100:2023-2034. [PMID: 32737973 PMCID: PMC7596891 DOI: 10.1093/ptj/pzaa146] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 02/04/2020] [Accepted: 07/05/2020] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To fulfill the potential of nonpharmacological interventions for people with Parkinson disease (PD), individually tailored treatment is needed. Multimodal balance training supported by rhythmic auditory stimuli (RAS) can improve balance and gait in people with PD. The purpose of this study was to determine whether both freezers and nonfreezers benefit. METHODS A secondary analysis was conducted on a large randomized controlled trial that included 154 patients with PD (Hoehn & Yahr Stages 1-3 while ON-medication) who were assigned randomly to 3 groups: (1) multimodal balance training with RAS delivered by a metronome (RAS-supported multimodal balance training); (2) regular multimodal balance training without rhythmic auditory cues; and (3) a control intervention (involving an educational program). Training was performed for 5 weeks, twice per week. The primary outcome was the Mini-BESTest score directly after the training period. Assessments were performed by a single, masked assessor at baseline, directly postintervention, and after 1-month and 6-month follow-up. Outcomes were analyzed in 1 analysis, and the results were presented separately for freezers and nonfreezers with a linear mixed model, adjusted for baseline Mini-BESTest scores, Unified Parkinson's Disease Rating Scale scores, and levodopa equivalent dose. RESULTS In both freezers and nonfreezers, both RAS-supported multimodal training and regular training significantly improved the Mini-BESTest scores compared with baseline scores and with the control group scores. The improvement was larger for RAS-supported training compared with regular training, for both freezers and nonfreezers. Only the RAS-supported training group retained the improvements compared with baseline measurements at 6-month follow-up, and this was true for both freezers and nonfreezers. CONCLUSIONS RAS-supported multimodal training is effective in improving balance performance in both freezers and nonfreezers. IMPACT Until this study, it was unknown whether both freezers and nonfreezers could benefit from multimodal balance training. With this information, clinicians who work with people with PD will be better able to apply personalized gait rehabilitation. LAY SUMMARY Adding rhythmic auditory stimuli (RAS) to balance training is beneficial for both freezers and nonfreezers, at least in persons with mild to moderate disease stages. This RAS-supported multimodal training has good potential for a wider clinical implementation with good long-term effects.
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Affiliation(s)
| | - Nienke M de Vries
- Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, and Center of Expertise for Parkinson & Movement Disorders, Radboud University Medical Center
| | - Joanna IntHout
- Department for Health Evidence, Radboud Institute for Health Sciences, Radboud University Medical Center
| | - Jordache Ramjith
- Department for Health Evidence, Radboud Institute for Health Sciences, Radboud University Medical Center
| | - Egberto R Barbosa
- Movement Disorders Clinic, Department of Neurology, University of São Paulo
| | - Jorik Nonnekes
- Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, and Center of Expertise for Parkinson & Movement Disorders, Radboud University Medical Center; and Department of Rehabilitation, Sint Maartenskliniek, Nijmegen, the Netherlands
| | - Bastiaan R Bloem
- Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, and Center of Expertise for Parkinson & Movement Disorders, Radboud University Medical Center
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Cury RG, Carra R, Reis J, Barbosa ER. Optimizing Noninvasive Stimulation to Treat Gait Problems in Parkinson Disease. Arch Phys Med Rehabil 2020; 101:1097-1098. [PMID: 32044041 DOI: 10.1016/j.apmr.2019.10.198] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 10/02/2019] [Indexed: 10/25/2022]
Affiliation(s)
| | - Rafael Carra
- Movement Disorders Unit, University of São Paulo, São Paulo, Brazil
| | - Janaína Reis
- Movement Disorders Unit, University of São Paulo, São Paulo, Brazil
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14
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Capato TTC, Nonnekes J, Barbosa ER, Bloem BR. Internal and external compensation strategies to alleviate upper limb freezing in Parkinson's disease. Parkinsonism Relat Disord 2019; 64:335-336. [PMID: 30910504 DOI: 10.1016/j.parkreldis.2019.03.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Revised: 03/11/2019] [Accepted: 03/12/2019] [Indexed: 10/27/2022]
Affiliation(s)
- Tamine T C Capato
- Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, Nijmegen, the Netherlands; University of São Paulo, Department of Neurology, Movement Disorders Clinic, HC FMUSP, São Paulo, Brazil.
| | - Jorik Nonnekes
- Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Department of Rehabilitation, Nijmegen, the Netherlands
| | - Egberto R Barbosa
- University of São Paulo, Department of Neurology, Movement Disorders Clinic, HC FMUSP, São Paulo, Brazil
| | - Bastiaan R Bloem
- Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, Nijmegen, the Netherlands
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Tribl GG, Trindade MC, Bittencourt T, Lorenzi-Filho G, Cardoso Alves R, Ciampi de Andrade D, Fonoff ET, Bor-Seng-Shu E, Machado AA, Schenck CH, Teixeira MJ, Barbosa ER. Wilson's disease with and without rapid eye movement sleep behavior disorder compared to healthy matched controls. Sleep Med 2015; 17:179-85. [PMID: 26763676 DOI: 10.1016/j.sleep.2015.09.003] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Revised: 08/05/2015] [Accepted: 09/01/2015] [Indexed: 01/07/2023]
Abstract
OBJECTIVE Quantitative data are reported on rapid eye movement (REM) sleep behavior disorder (RBD) in a cohort of predominantly neurological Wilson's disease (WD). METHODS A total of 41 patients with WD and 41 healthy, age- and gender-matched controls were studied by conducting face-to-face interviews, neurological and clinical examinations, laboratory tests, and WD- and RBD-specific scales. Video-polysomnography and quantification of REM sleep without atonia (RWA) were conducted in 35 patients and 41 controls. RESULTS Patients with WD showed significantly worse sleep quality, less sleep efficiency, increased wakefulness after sleep onset, and more arousals compared to healthy controls. Five patients with WD (four women) fulfilled the diagnostic criteria for RBD with significantly higher values in RWA, RBD Questionnaire-Hong Kong, and RBD Screening Questionnaire compared to patients with WD without RBD. In three patients with WD, RBD had manifested before any other symptom that could be attributed to WD. Percentage of RWA was significantly lower in WD without RBD than in WD with RBD, but still significantly increased compared to controls. CONCLUSIONS RBD can be comorbid with WD. RWA is commonly present in WD, both in the presence or absence of clinical RBD. A causal connection is possible, though retrospective determination of RBD onset and the low number of patients do not allow a definitive conclusion at this point. However, screening for WD in idiopathic RBD is available at low cost and is recommended. Early-stage copper chelation therapy provides a highly effective treatment to prevent further WD manifestations and might also control the comorbid RBD.
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Affiliation(s)
- Gotthard G Tribl
- Division of Neurology and Neurosurgery, Hospital das Clinicas, University of Sao Paulo School of Medicine, Av. Dr. Eneas de Carvalho Aguiar, 255, 5° andar, sala 5084, Pinheiros, 05403-900 Sao Paulo, Brazil; Sleep Laboratory, Pulmonary Division, InCor, University of Sao Paulo School of Medicine, Av. Dr. Eneas de Carvalho Aguiar, 44, Cerqueira Cesar, 05403-000 Sao Paulo, Brazil.
| | - Mateus C Trindade
- Division of Neurology and Neurosurgery, Hospital das Clinicas, University of Sao Paulo School of Medicine, Av. Dr. Eneas de Carvalho Aguiar, 255, 5° andar, sala 5084, Pinheiros, 05403-900 Sao Paulo, Brazil
| | - Thais Bittencourt
- Sleep Laboratory, Pulmonary Division, InCor, University of Sao Paulo School of Medicine, Av. Dr. Eneas de Carvalho Aguiar, 44, Cerqueira Cesar, 05403-000 Sao Paulo, Brazil
| | - Geraldo Lorenzi-Filho
- Sleep Laboratory, Pulmonary Division, InCor, University of Sao Paulo School of Medicine, Av. Dr. Eneas de Carvalho Aguiar, 44, Cerqueira Cesar, 05403-000 Sao Paulo, Brazil
| | - Rosana Cardoso Alves
- Division of Neurology and Neurosurgery, Hospital das Clinicas, University of Sao Paulo School of Medicine, Av. Dr. Eneas de Carvalho Aguiar, 255, 5° andar, sala 5084, Pinheiros, 05403-900 Sao Paulo, Brazil
| | - Daniel Ciampi de Andrade
- Division of Neurology and Neurosurgery, Hospital das Clinicas, University of Sao Paulo School of Medicine, Av. Dr. Eneas de Carvalho Aguiar, 255, 5° andar, sala 5084, Pinheiros, 05403-900 Sao Paulo, Brazil
| | - Erich T Fonoff
- Division of Neurology and Neurosurgery, Hospital das Clinicas, University of Sao Paulo School of Medicine, Av. Dr. Eneas de Carvalho Aguiar, 255, 5° andar, sala 5084, Pinheiros, 05403-900 Sao Paulo, Brazil
| | - Edson Bor-Seng-Shu
- Division of Neurology and Neurosurgery, Hospital das Clinicas, University of Sao Paulo School of Medicine, Av. Dr. Eneas de Carvalho Aguiar, 255, 5° andar, sala 5084, Pinheiros, 05403-900 Sao Paulo, Brazil
| | - Alexandre A Machado
- Division of Neurology and Neurosurgery, Hospital das Clinicas, University of Sao Paulo School of Medicine, Av. Dr. Eneas de Carvalho Aguiar, 255, 5° andar, sala 5084, Pinheiros, 05403-900 Sao Paulo, Brazil
| | - Carlos H Schenck
- Department of Psychiatry, Minnesota Regional Sleep Disorders Center, Hennepin County Medical Center and University of Minnesota Medical School, 701 Park Ave., Minneapolis, MN 55415, USA
| | - Manoel J Teixeira
- Division of Neurology and Neurosurgery, Hospital das Clinicas, University of Sao Paulo School of Medicine, Av. Dr. Eneas de Carvalho Aguiar, 255, 5° andar, sala 5084, Pinheiros, 05403-900 Sao Paulo, Brazil
| | - Egberto R Barbosa
- Division of Neurology and Neurosurgery, Hospital das Clinicas, University of Sao Paulo School of Medicine, Av. Dr. Eneas de Carvalho Aguiar, 255, 5° andar, sala 5084, Pinheiros, 05403-900 Sao Paulo, Brazil
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Menéndez DFS, Cury RG, Barbosa ER, Teixeira MJ, Fonoff ET. Hypertrophic olivary degeneration and holmes' tremor secondary to bleeding of cavernous malformation in the midbrain. Tremor Other Hyperkinet Mov (N Y) 2014; 4:264. [PMID: 25332842 PMCID: PMC4198399 DOI: 10.7916/d8pg1pxt] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/11/2014] [Accepted: 08/18/2014] [Indexed: 12/04/2022]
Abstract
Background Hypertrophic olivary degeneration (HOD) is a rare phenomenon, probably related to transsynaptic degeneration of the inferior olivary nucleus. It usually occurs as a response to primary injury of dento-rubro-olivary pathways. Case report A young man developed Holmes' tremor 7 months after a cavernous malformation bleed in the midbrain. Typical findings of HOD were observed in the magnetic resonance images: bilateral and asymmetric hypertrophy of the olivary nucleus with slight hypersignal in T2-weighted images. Because of the striking disability related to drug-resistant tremor, the patient underwent stereotactic thalamotomy (nucleus ventralis intermedius of the thalamus/zona incerta) with pronounced functional improvement over time. Discussion Disruption of circuits in the Guillain–Mollaret triangle classically results in palatal myoclonus, however midbrain (Holmes') tremor can also occur, as we now describe.
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Affiliation(s)
- Djalma F S Menéndez
- Division of Functional Neurosurgery of the Institute of Psychiatry of the Hospital das Clinicas of the University of São Paulo
| | - Rubens G Cury
- Abnormal Movements Unit of the Hospital das Clinicas of the University of São Paulo
| | - Egberto R Barbosa
- Abnormal Movements Unit of the Hospital das Clinicas of the University of São Paulo
| | - Manoel J Teixeira
- Discipline of Neurosurgery of the São Paulo University Medical School
| | - Erich T Fonoff
- Discipline of Neurosurgery of the São Paulo University Medical School
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Cury RG, Galhardoni R, Fonoff ET, Dos Santos Ghilardi MG, Fonoff F, Arnaut D, Myczkowski ML, Marcolin MA, Bor-Seng-Shu E, Barbosa ER, Teixeira MJ, Ciampi de Andrade D. Effects of deep brain stimulation on pain and other nonmotor symptoms in Parkinson disease. Neurology 2014; 83:1403-9. [PMID: 25217059 DOI: 10.1212/wnl.0000000000000887] [Citation(s) in RCA: 81] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To prospectively evaluate the effect of subthalamic nucleus deep brain stimulation (STN-DBS) on the different characteristics of pain and other nonmotor symptoms (NMS) in patients with Parkinson disease (PD). METHODS Forty-four patients with PD and refractory motor symptoms were screened for STN-DBS. Patients were evaluated before and 1 year after surgery. The primary outcome was change in pain prevalence after surgery. Secondary outcome measures were changes in motor function (Unified Parkinson's Disease Rating Scale), characteristics of pain and other NMS using specific scales and questionnaires, and quality of life. RESULTS Forty-one patients completed the study. The prevalence of pain changed from 70% to 21% after surgery (p < 0.001). There were also significant improvements in pain intensity, NMS, and quality of life after STN-DBS (p < 0.05). Dystonic and musculoskeletal pain responded well to DBS, while central pain and neuropathic pain were not influenced by surgery. There was a strong correlation between the change in pain intensity and the improvement in quality of life (r = 0.708, p < 0.005). No correlation was found between pain improvement and preoperative response to levodopa or motor improvement during stimulation (r = 0.247, p = 0.197 and r = 0.249, p = 0.193, respectively) or with changes in other NMS. CONCLUSIONS STN-DBS decreased pain after surgery, but had different effects in different types of PD-related pain. Motor and nonmotor symptom improvements after STN-DBS did not correlate with pain relief. CLASSIFICATION OF EVIDENCE This study provides Class IV evidence that in patients with idiopathic PD with refractory motor fluctuations, STN-DBS decreases the prevalence of pain and improves quality of life.
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Affiliation(s)
- Rubens G Cury
- From the Pain Center, Department of Neurology, School of Medicine (R.G.C., R.G., E.T.F., M.J.T., D.C.d.A.), Transcranial Magnetic Stimulation Laboratory, Psychiatry Institute (E.T.F., D.A., M.L.M., M.A.M., M.J.T.), Movement Disorders Center, Department of Neurology, School of Medicine (R.G.C., E.R.B., M.J.T.), and Neurosurgery Division, Department of Neurology, School of Medicine (E.T.F., M.G.d.S.G., F.F., E.B.-S.-S., M.J.T.), University of São Paulo; and Pain Center (R.G.C., M.J.T.), Instituto do Câncer do Estado de São Paulo, Brazil
| | - Ricardo Galhardoni
- From the Pain Center, Department of Neurology, School of Medicine (R.G.C., R.G., E.T.F., M.J.T., D.C.d.A.), Transcranial Magnetic Stimulation Laboratory, Psychiatry Institute (E.T.F., D.A., M.L.M., M.A.M., M.J.T.), Movement Disorders Center, Department of Neurology, School of Medicine (R.G.C., E.R.B., M.J.T.), and Neurosurgery Division, Department of Neurology, School of Medicine (E.T.F., M.G.d.S.G., F.F., E.B.-S.-S., M.J.T.), University of São Paulo; and Pain Center (R.G.C., M.J.T.), Instituto do Câncer do Estado de São Paulo, Brazil
| | - Erich T Fonoff
- From the Pain Center, Department of Neurology, School of Medicine (R.G.C., R.G., E.T.F., M.J.T., D.C.d.A.), Transcranial Magnetic Stimulation Laboratory, Psychiatry Institute (E.T.F., D.A., M.L.M., M.A.M., M.J.T.), Movement Disorders Center, Department of Neurology, School of Medicine (R.G.C., E.R.B., M.J.T.), and Neurosurgery Division, Department of Neurology, School of Medicine (E.T.F., M.G.d.S.G., F.F., E.B.-S.-S., M.J.T.), University of São Paulo; and Pain Center (R.G.C., M.J.T.), Instituto do Câncer do Estado de São Paulo, Brazil
| | - Maria G Dos Santos Ghilardi
- From the Pain Center, Department of Neurology, School of Medicine (R.G.C., R.G., E.T.F., M.J.T., D.C.d.A.), Transcranial Magnetic Stimulation Laboratory, Psychiatry Institute (E.T.F., D.A., M.L.M., M.A.M., M.J.T.), Movement Disorders Center, Department of Neurology, School of Medicine (R.G.C., E.R.B., M.J.T.), and Neurosurgery Division, Department of Neurology, School of Medicine (E.T.F., M.G.d.S.G., F.F., E.B.-S.-S., M.J.T.), University of São Paulo; and Pain Center (R.G.C., M.J.T.), Instituto do Câncer do Estado de São Paulo, Brazil
| | - Fernanda Fonoff
- From the Pain Center, Department of Neurology, School of Medicine (R.G.C., R.G., E.T.F., M.J.T., D.C.d.A.), Transcranial Magnetic Stimulation Laboratory, Psychiatry Institute (E.T.F., D.A., M.L.M., M.A.M., M.J.T.), Movement Disorders Center, Department of Neurology, School of Medicine (R.G.C., E.R.B., M.J.T.), and Neurosurgery Division, Department of Neurology, School of Medicine (E.T.F., M.G.d.S.G., F.F., E.B.-S.-S., M.J.T.), University of São Paulo; and Pain Center (R.G.C., M.J.T.), Instituto do Câncer do Estado de São Paulo, Brazil
| | - Debora Arnaut
- From the Pain Center, Department of Neurology, School of Medicine (R.G.C., R.G., E.T.F., M.J.T., D.C.d.A.), Transcranial Magnetic Stimulation Laboratory, Psychiatry Institute (E.T.F., D.A., M.L.M., M.A.M., M.J.T.), Movement Disorders Center, Department of Neurology, School of Medicine (R.G.C., E.R.B., M.J.T.), and Neurosurgery Division, Department of Neurology, School of Medicine (E.T.F., M.G.d.S.G., F.F., E.B.-S.-S., M.J.T.), University of São Paulo; and Pain Center (R.G.C., M.J.T.), Instituto do Câncer do Estado de São Paulo, Brazil
| | - Martin L Myczkowski
- From the Pain Center, Department of Neurology, School of Medicine (R.G.C., R.G., E.T.F., M.J.T., D.C.d.A.), Transcranial Magnetic Stimulation Laboratory, Psychiatry Institute (E.T.F., D.A., M.L.M., M.A.M., M.J.T.), Movement Disorders Center, Department of Neurology, School of Medicine (R.G.C., E.R.B., M.J.T.), and Neurosurgery Division, Department of Neurology, School of Medicine (E.T.F., M.G.d.S.G., F.F., E.B.-S.-S., M.J.T.), University of São Paulo; and Pain Center (R.G.C., M.J.T.), Instituto do Câncer do Estado de São Paulo, Brazil
| | - Marco A Marcolin
- From the Pain Center, Department of Neurology, School of Medicine (R.G.C., R.G., E.T.F., M.J.T., D.C.d.A.), Transcranial Magnetic Stimulation Laboratory, Psychiatry Institute (E.T.F., D.A., M.L.M., M.A.M., M.J.T.), Movement Disorders Center, Department of Neurology, School of Medicine (R.G.C., E.R.B., M.J.T.), and Neurosurgery Division, Department of Neurology, School of Medicine (E.T.F., M.G.d.S.G., F.F., E.B.-S.-S., M.J.T.), University of São Paulo; and Pain Center (R.G.C., M.J.T.), Instituto do Câncer do Estado de São Paulo, Brazil
| | - Edson Bor-Seng-Shu
- From the Pain Center, Department of Neurology, School of Medicine (R.G.C., R.G., E.T.F., M.J.T., D.C.d.A.), Transcranial Magnetic Stimulation Laboratory, Psychiatry Institute (E.T.F., D.A., M.L.M., M.A.M., M.J.T.), Movement Disorders Center, Department of Neurology, School of Medicine (R.G.C., E.R.B., M.J.T.), and Neurosurgery Division, Department of Neurology, School of Medicine (E.T.F., M.G.d.S.G., F.F., E.B.-S.-S., M.J.T.), University of São Paulo; and Pain Center (R.G.C., M.J.T.), Instituto do Câncer do Estado de São Paulo, Brazil
| | - Egberto R Barbosa
- From the Pain Center, Department of Neurology, School of Medicine (R.G.C., R.G., E.T.F., M.J.T., D.C.d.A.), Transcranial Magnetic Stimulation Laboratory, Psychiatry Institute (E.T.F., D.A., M.L.M., M.A.M., M.J.T.), Movement Disorders Center, Department of Neurology, School of Medicine (R.G.C., E.R.B., M.J.T.), and Neurosurgery Division, Department of Neurology, School of Medicine (E.T.F., M.G.d.S.G., F.F., E.B.-S.-S., M.J.T.), University of São Paulo; and Pain Center (R.G.C., M.J.T.), Instituto do Câncer do Estado de São Paulo, Brazil
| | - Manoel J Teixeira
- From the Pain Center, Department of Neurology, School of Medicine (R.G.C., R.G., E.T.F., M.J.T., D.C.d.A.), Transcranial Magnetic Stimulation Laboratory, Psychiatry Institute (E.T.F., D.A., M.L.M., M.A.M., M.J.T.), Movement Disorders Center, Department of Neurology, School of Medicine (R.G.C., E.R.B., M.J.T.), and Neurosurgery Division, Department of Neurology, School of Medicine (E.T.F., M.G.d.S.G., F.F., E.B.-S.-S., M.J.T.), University of São Paulo; and Pain Center (R.G.C., M.J.T.), Instituto do Câncer do Estado de São Paulo, Brazil
| | - Daniel Ciampi de Andrade
- From the Pain Center, Department of Neurology, School of Medicine (R.G.C., R.G., E.T.F., M.J.T., D.C.d.A.), Transcranial Magnetic Stimulation Laboratory, Psychiatry Institute (E.T.F., D.A., M.L.M., M.A.M., M.J.T.), Movement Disorders Center, Department of Neurology, School of Medicine (R.G.C., E.R.B., M.J.T.), and Neurosurgery Division, Department of Neurology, School of Medicine (E.T.F., M.G.d.S.G., F.F., E.B.-S.-S., M.J.T.), University of São Paulo; and Pain Center (R.G.C., M.J.T.), Instituto do Câncer do Estado de São Paulo, Brazil.
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Tribl GG, Bor-Seng-Shu E, Trindade MC, Lucato LT, Teixeira MJ, Barbosa ER. Wilson?s disease presenting as rapid eye movement sleep behavior disorder: a possible window to early treatment. Arq Neuro-Psiquiatr 2014; 72:653-8. [DOI: 10.1590/0004-282x20140118] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/13/2014] [Accepted: 07/16/2014] [Indexed: 11/22/2022]
Abstract
Objective To describe characteristics of REM sleep behavior disorder in Wilson’s disease. Method Questionnaire-based interviews (patients and relatives), neurological examinations, two-week prospective dream-diary, video-polysomnography, transcranial sonography, MRI. Results Four Wilson’s disease cases with REM sleep behavior disorder were described; three had REM sleep behavior disorder as initial symptom. All showed mesencephalic tegmental/tectal sonographic hyperechogenicities and two presented ponto-mesencephalic tegmental MRI hyperintensities. Conclusion This first description of REM sleep behavior disorder in Wilson’s disease in literature documents REM sleep behavior disorder as a possible presenting symptom of Wilson’s disease and adds further evidence to the parallelism of Parkinson’s disease and Wilson’s disease in phenotype and brainstem topography, which ought to be further studied. REM sleep behavior disorder has prognostic relevance for neurodegeneration in α-synucleinopathies. In Wilson’s disease, usefulness of early diagnosis and treatment are already well established. REM sleep behavior disorder in Wilson’s disease offers a possible theoretical model for potential early treatment in this extrapyramidal and brainstem paradigm syndrome, previewing the possibility of neuroprotective treatment for REM sleep behavior disorder in “pre-clinical” Parkinson’s disease.
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da Silva-Júnior FP, do Prado GF, Barbosa ER, Tufik S, Togeiro SM. Sleep disordered breathing in Parkinson's disease: A critical appraisal. Sleep Med Rev 2014; 18:173-8. [DOI: 10.1016/j.smrv.2013.04.005] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2012] [Revised: 03/17/2013] [Accepted: 04/24/2013] [Indexed: 10/26/2022]
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Gomes CM, Sammour ZM, Bessa Junior JD, Barbosa ER, Lopes RI, Sallem FS, Trigo-Rocha FE, Bruschini H, Nitti VW, Srougi M. Neurological status predicts response to alpha-blockers in men with voiding dysfunction and Parkinson's disease. Clinics (Sao Paulo) 2014; 69:817-22. [PMID: 25627993 PMCID: PMC4286669 DOI: 10.6061/clinics/2014(12)05] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2014] [Accepted: 09/12/2014] [Indexed: 01/26/2023] Open
Abstract
OBJECTIVES To evaluate predictors of the response to doxazosin, a selective alpha-adrenoceptor antagonist, when used for the treatment of lower urinary tract symptoms in men with Parkinson's disease. METHODS In a prospective study, 33 consecutive men (mean age 59.2 ± 7.0 years) with Parkinson's disease and lower urinary tract symptoms were evaluated. Neurological dysfunction was assessed with the Unified Parkinson's Disease Rating Scale. Urological assessment was performed at baseline and after 12 weeks of treatment with 4 mg/day of extended-release doxazosin, including symptom evaluation with the International Continence Society male short-form questionnaire, an assessment of the impact of lower urinary tract symptoms on quality of life and urodynamics. Clinical and urodynamic predictors of response were specifically evaluated. RESULTS Compared with the score at baseline, the total International Continence Society male short-form score was reduced after doxazosin administration, from 17.4 ± 7.5 to 11.1 ± 6.9 (p<0.001). The impact of lower urinary tract symptoms on quality of life was also significantly reduced, from 1.8 ± 1.1 to 1.0 ± 1.0 (p<0.001) and the maximum urinary flow varied from 9.3 ± 4.4 to 11.2 ± 4.6 ml/s (p=0.025). The severity of neurological impairment was the only predictor of the clinical response. Additionally, patients with a Unified Parkinson's Disease Rating Scale score lower than 70 had a significantly higher chance of clinical improvement with doxazosin treatment than those with higher Unified Parkinson's Disease Rating Scale scores did (RR=3.10, 95% CI=[1.15 to 5.37], p=0.011). CONCLUSIONS Doxazosin resulted in the improvement of lower urinary tract symptoms and the maximum flow rate and was well tolerated in men with Parkinson's disease. The response to treatment is dependent on the severity of neurological disability.
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Affiliation(s)
- Cristiano M Gomes
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Division of Urology, São Paulo, SP, Brazil
| | - Zein M Sammour
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Division of Urology, São Paulo, SP, Brazil
| | - Jose de Bessa Junior
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Division of Urology, São Paulo, SP, Brazil
| | - Egberto R Barbosa
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Department of Neurology, São Paulo, SP, Brazil
| | - Roberto I Lopes
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Division of Urology, São Paulo, SP, Brazil
| | - Flávio S Sallem
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Department of Neurology, São Paulo, SP, Brazil
| | - Flavio E Trigo-Rocha
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Division of Urology, São Paulo, SP, Brazil
| | - Homero Bruschini
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Division of Urology, São Paulo, SP, Brazil
| | - Victor W Nitti
- New York University, Department of Urology, New York, USA
| | - Miguel Srougi
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Division of Urology, São Paulo, SP, Brazil
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Quadri M, Fang M, Picillo M, Olgiati S, Breedveld GJ, Graafland J, Wu B, Xu F, Erro R, Amboni M, Pappatà S, Quarantelli M, Annesi G, Quattrone A, Chien HF, Barbosa ER, Oostra BA, Barone P, Wang J, Bonifati V. Mutation in theSYNJ1Gene Associated with Autosomal Recessive, Early-Onset Parkinsonism. Hum Mutat 2013; 34:1208-15. [DOI: 10.1002/humu.22373] [Citation(s) in RCA: 230] [Impact Index Per Article: 20.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2013] [Accepted: 06/19/2013] [Indexed: 11/10/2022]
Affiliation(s)
- Marialuisa Quadri
- Department of Clinical Genetics; Erasmus MC; Rotterdam The Netherlands
| | | | - Marina Picillo
- Department of Neurological Sciences; University of Naples “Federico II”; Naples Italy
| | - Simone Olgiati
- Department of Clinical Genetics; Erasmus MC; Rotterdam The Netherlands
| | | | - Josja Graafland
- Department of Clinical Genetics; Erasmus MC; Rotterdam The Netherlands
| | - Bin Wu
- BGI-Shenzhen; Shenzhen China
| | | | - Roberto Erro
- Department of Neurological Sciences; University of Naples “Federico II”; Naples Italy
| | - Marianna Amboni
- IDC Hermitage-Capodimonte Institute; Naples Italy
- Department of Medicine and Surgery; CEMAND, University of Salerno; Salerno Italy
| | - Sabina Pappatà
- Biostructure and Bioimaging Institute; National Research Council; Naples Italy
| | - Mario Quarantelli
- Biostructure and Bioimaging Institute; National Research Council; Naples Italy
| | - Grazia Annesi
- Institute of Neurological Science; National Research Council; Cosenza Italy
| | - Aldo Quattrone
- Institute of Neurology; University Magna Graecia; Catanzaro Italy
| | - Hsin F. Chien
- Department of Neurology; University of São Paulo; São Paulo Brazil
| | | | - Ben A. Oostra
- Department of Clinical Genetics; Erasmus MC; Rotterdam The Netherlands
| | - Paolo Barone
- Department of Medicine and Surgery; CEMAND, University of Salerno; Salerno Italy
| | - Jun Wang
- BGI-Shenzhen; Shenzhen China
- Department of Biology; University of Copenhagen; Copenhagen Denmark
- King Abdulaziz University; Jeddah Saudi Arabia
- The Novo Nordisk Foundation Center for Basic Metabolic Research; University of Copenhagen; Copenhagen Denmark
| | - Vincenzo Bonifati
- Department of Clinical Genetics; Erasmus MC; Rotterdam The Netherlands
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Moscovich M, Munhoz RP, Teive HA, Raskin S, Carvalho MJ, Barbosa ER, Ranvaud R, Liu J, McFarland K, Ashizawa T, Lees AJ, Silveira-Moriyama L. Olfactory impairment in familial ataxias. J Neurol Neurosurg Psychiatry 2012; 83:970-4. [PMID: 22791905 PMCID: PMC3521149 DOI: 10.1136/jnnp-2012-302770] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
The main clinical manifestations of the spinocerebellar ataxias (SCAs) result from the involvement of the cerebellum and its connections. Cerebellar activity has been consistently observed in functional imaging studies of olfaction, but the anatomical pathways responsible for this connection have not yet been elucidated. Previous studies have demonstrated olfactory deficit in SCA2, Friedreich's ataxia and in small groups of ataxia of diverse aetiology. The authors used a validated version of the 16-item smell identification test from Sniffin' Sticks (SS-16) was used to evaluate 37 patients with genetically determined autosomal dominant ataxia, and 31 with familial ataxia of unknown genetic basis. This data was also compared with results in 106 Parkinson's disease patients and 218 healthy controls. The SS-16 score was significantly lower in ataxia than in the control group (p<0.001, 95% CI for β=0.55 to 1.90) and significantly higher in ataxia than in Parkinson's disease (p<0.001, 95% CI for β=-4.58 to -3.00) when adjusted for age (p=0.001, 95% CI for β=-0.05 to -0.01), gender (p=0.19) and history of tobacco use (p=0.41). When adjusted for general cognitive function, no significant difference was found between the ataxia and control groups. This study confirms previous findings of mild hyposmia in ataxia, and further suggests this may be due to general cognitive deficits rather than specific olfactory problems.
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Affiliation(s)
- Mariana Moscovich
- Department of Neurology, Hospital de Clínicas, Federal University of Paraná, Curitiba-PR, Brazil
- Department of Neurology, University of Florida, Center for Movement Disorders & Neurorestoration, McKnight Brain Institute, Gainesville, FL, USA
- Department of Neurology, Pontifical Catholic University of Parana, Curitiba, Parana, Brazil
| | - Renato Puppi Munhoz
- Department of Neurology, Hospital de Clínicas, Federal University of Paraná, Curitiba-PR, Brazil
- Department of Neurology, Pontifical Catholic University of Parana, Curitiba, Parana, Brazil
| | - Helio A Teive
- Department of Neurology, Hospital de Clínicas, Federal University of Paraná, Curitiba-PR, Brazil
| | - Salmo Raskin
- Department of Neurology, Hospital de Clínicas, Federal University of Paraná, Curitiba-PR, Brazil
- Core for Advanced Molecular Investigation, Graduate Program in Health Sciences, Center for Biological and Health Sciences, Pontifical Catholic University of Paraná Curitiba, Parana, Brazil
| | - Margaret J Carvalho
- Department of Neurology, University of Sao Paulo School of Medicine, Sao Paulo, Brazil
| | - Egberto R Barbosa
- Department of Neurology, University of Sao Paulo School of Medicine, Sao Paulo, Brazil
| | - Ronald Ranvaud
- Department of Neurology, University of Sao Paulo School of Medicine, Sao Paulo, Brazil
- Department of Physiology and Biophysics, Institute of Biomedical Sciences, University of Sao Paulo, Brazil
| | - Jilin Liu
- Department of Neurology, University of Florida, Center for Movement Disorders & Neurorestoration, McKnight Brain Institute, Gainesville, FL, USA
| | - Karen McFarland
- Department of Neurology, University of Florida, Center for Movement Disorders & Neurorestoration, McKnight Brain Institute, Gainesville, FL, USA
| | - Tetsuo Ashizawa
- Department of Neurology, University of Florida, Center for Movement Disorders & Neurorestoration, McKnight Brain Institute, Gainesville, FL, USA
| | - Andrew J Lees
- Reta Lila Weston Institute of Neurological Studies, UCL Institute of Neurology, London, UK
| | - Laura Silveira-Moriyama
- Reta Lila Weston Institute of Neurological Studies, UCL Institute of Neurology, London, UK
- Department of Neurology, University of Campinas, UNICAMP, Brazil
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da Silva-Júnior FP, Machado AAC, Lucato LT, Cançado ELR, Barbosa ER. Copper deficiency myeloneuropathy in a patient with Wilson disease. Neurology 2011; 76:1673-4. [PMID: 21555737 DOI: 10.1212/wnl.0b013e318219fac8] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Silveira-Moriyama L, Azevedo AMS, Ranvaud R, Barbosa ER, Doty RL, Lees AJ. Applying a new version of the Brazilian-Portuguese UPSIT smell test in Brazil. Arq Neuropsiquiatr 2011; 68:700-5. [PMID: 21049178 DOI: 10.1590/s0004-282x2010000500005] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2009] [Accepted: 03/11/2010] [Indexed: 11/22/2022]
Abstract
Standardized olfactory tests are now available to quantitatively assess disorders of olfaction. A Brazilian-Portuguese version of the University of Pennsylvania Smell Identification Test (UPSIT) is currently being developed specifically for the Brazilian population. The most recent Brazilian-Portuguese version of the UPSIT (UPSIT-Br2) was administered to 88 Brazilian subjects who had no history of neurological or otorhinolaryngological disease. UPSIT-Br2 scores decreased with age, were lower in men than in women, and were lower in subjects with lower income. The degree to which the poorer performance of subjects with lower socio-economic status reflects lack of familiarity with test items is not known. Although this version of the UPSIT provides a sensitive and useful test of smell function for the Brazilian population, a revision of some test items is needed to achieve comparable norms to those found using the North American UPSIT in the United States.
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Affiliation(s)
- Laura Silveira-Moriyama
- Reta Lila Weston Institute of Neurological Studies Queen Square Brain Bank for Neurological Diseases, UCL Institute of Neurology, London, UK
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Capelli LP, Gonçalves MRR, Leite CC, Barbosa ER, Nitrini R, Vianna-Morgante AM. The fragile x-associated tremor and ataxia syndrome (FXTAS). Arq Neuro-Psiquiatr 2010; 68:791-8. [DOI: 10.1590/s0004-282x2010000500023] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2010] [Accepted: 04/06/2010] [Indexed: 01/11/2023]
Abstract
FXTAS (Fragile X-associated tremor and ataxia syndrome) is a late- onset neurodegenerative disorder affecting mainly men, over 50 years of age, who are carriers of the FMR1 gene premutation. The full mutation of this gene causes the fragile X syndrome (FXS), the most common cause of inherited mental retardation. Individuals affected by FXTAS generally present intention tremor and gait ataxia that might be associated to specific radiological and/or neuropathological signs. Other features commonly observed are parkinsonism, cognitive decline, peripheral neuropathy and autonomic dysfunction. Nearly a decade after its clinical characterization, FXTAS is poorly recognized in Brazil. Here we present a review of the current knowledge on the clinical, genetic and diagnostic aspects of the disease.
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Silveira-Moriyama L, Munhoz RP, de J. Carvalho M, Raskin S, Rogaeva E, de C. Aguiar P, Bressan RA, Felicio AC, Barsottini OG, Andrade LAF, Chien HF, Bonifati V, Barbosa ER, Teive HA, Lees AJ. Olfactory heterogeneity in LRRK2
related Parkinsonism. Mov Disord 2010; 25:2879-83. [DOI: 10.1002/mds.23325] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
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Di Fonzo A, Fabrizio E, Thomas A, Fincati E, Marconi R, Tinazzi M, Breedveld GJ, Simons EJ, Chien HF, Ferreira JJ, Horstink MW, Abbruzzese G, Borroni B, Cossu G, Libera AD, Fabbrini G, Guidi M, De Mari M, Lopiano L, Martignoni E, Marini P, Onofrj M, Padovani A, Stocchi F, Toni V, Sampaio C, Barbosa ER, Meco G, Oostra BA, Bonifati V. GIGYF2 mutations are not a frequent cause of familial Parkinson's disease. Parkinsonism Relat Disord 2009; 15:703-5. [DOI: 10.1016/j.parkreldis.2009.05.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2009] [Accepted: 05/01/2009] [Indexed: 11/29/2022]
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Sidransky E, Nalls MA, Aasly JO, Aharon-Peretz J, Annesi G, Barbosa ER, Bar-Shira A, Berg D, Bras J, Brice A, Chen CM, Clark LN, Condroyer C, De Marco EV, Dürr A, Eblan MJ, Fahn S, Farrer MJ, Fung HC, Gan-Or Z, Gasser T, Gershoni-Baruch R, Giladi N, Griffith A, Gurevich T, Januario C, Kropp P, Lang AE, Lee-Chen GJ, Lesage S, Marder K, Mata IF, Mirelman A, Mitsui J, Mizuta I, Nicoletti G, Oliveira C, Ottman R, Orr-Urtreger A, Pereira LV, Quattrone A, Rogaeva E, Rolfs A, Rosenbaum H, Rozenberg R, Samii A, Samaddar T, Schulte C, Sharma M, Singleton A, Spitz M, Tan EK, Tayebi N, Toda T, Troiano AR, Tsuji S, Wittstock M, Wolfsberg TG, Wu YR, Zabetian CP, Zhao Y, Ziegler SG. Multicenter analysis of glucocerebrosidase mutations in Parkinson's disease. N Engl J Med 2009; 361:1651-61. [PMID: 19846850 PMCID: PMC2856322 DOI: 10.1056/nejmoa0901281] [Citation(s) in RCA: 1464] [Impact Index Per Article: 97.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Recent studies indicate an increased frequency of mutations in the gene encoding glucocerebrosidase (GBA), a deficiency of which causes Gaucher's disease, among patients with Parkinson's disease. We aimed to ascertain the frequency of GBA mutations in an ethnically diverse group of patients with Parkinson's disease. METHODS Sixteen centers participated in our international, collaborative study: five from the Americas, six from Europe, two from Israel, and three from Asia. Each center genotyped a standard DNA panel to permit comparison of the genotyping results across centers. Genotypes and phenotypic data from a total of 5691 patients with Parkinson's disease (780 Ashkenazi Jews) and 4898 controls (387 Ashkenazi Jews) were analyzed, with multivariate logistic-regression models and the Mantel-Haenszel procedure used to estimate odds ratios across centers. RESULTS All 16 centers could detect two GBA mutations, L444P and N370S. Among Ashkenazi Jewish subjects, either mutation was found in 15% of patients and 3% of controls, and among non-Ashkenazi Jewish subjects, either mutation was found in 3% of patients and less than 1% of controls. GBA was fully sequenced for 1883 non-Ashkenazi Jewish patients, and mutations were identified in 7%, showing that limited mutation screening can miss half the mutant alleles. The odds ratio for any GBA mutation in patients versus controls was 5.43 across centers. As compared with patients who did not carry a GBA mutation, those with a GBA mutation presented earlier with the disease, were more likely to have affected relatives, and were more likely to have atypical clinical manifestations. CONCLUSIONS Data collected from 16 centers demonstrate that there is a strong association between GBA mutations and Parkinson's disease.
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Affiliation(s)
- E Sidransky
- Section on Molecular Neurogenetics, Medical Genetics Branch, NHGRI, National Institutes of Health, Bethesda, MD 20892-3708, USA.
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Silveira-Moriyama L, Petrie A, Williams DR, Evans A, Katzenschlager R, Barbosa ER, Lees AJ. The use of a color coded probability scale to interpret smell tests in suspected parkinsonism. Mov Disord 2009; 24:1144-53. [PMID: 19370732 DOI: 10.1002/mds.22494] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Smell identification tests (SITs) have been suggested as useful in the differential diagnosis of Parkinson's disease (PD). We have applied the 40 item University of Pennsylvania SIT (UPSIT-40) and/or the 16 item SIT from Sniffin Sticks (SS-16) to 193 nondemented PD patients and 157 controls and used logistic regression analysis to associate the SIT result with the probability of an individual patient having PD ("PD probability"). Reliability measures (95% CI) using the clinical diagnosis as a gold standard and a dichotomized result of the smell test into high (50% or more) or low (<50%) "PD probability" were: sensitivity 85.0% (78.8-89.7%), specificity 84.6% (77.3-89.9%) for the UPSIT-40; sensitivity 90.4% (83.5-94.7%), specificity 85.5% (76.2-91.7%) for the SS-16. Based on these findings we have created color coded visual tools (PD probability rulers) and applied them to 39 clinically uncertain parkinsonian syndromes (CUPS) patients who had been investigated with dopamine transporter SPECT scanning using [123-I]-FP-CIT SPECT (DaTSCAN) for suspected Parkinson's disease. In 32 of 36 CUPS cases (88.9%, kappa = 0.72) the probability ruler predicted the result of the DaTSCAN. We suggest smell tests could be used routinely in challenging cases where there is diagnostic uncertainty and help inform decision making relating to the need for neuro imaging.
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Affiliation(s)
- Laura Silveira-Moriyama
- Reta Lila Weston Institute of Neurological Studies, UCL Institute of Neurology, London, United Kingdom
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Sammour ZM, Gomes CM, Barbosa ER, Lopes RI, Sallem FS, Trigo-Rocha FE, Bruschini H, Srougi M. Voiding dysfunction in patients with Parkinson's disease: Impact of neurological impairment and clinical parameters. Neurourol Urodyn 2009; 28:510-5. [DOI: 10.1002/nau.20681] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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Cardoso EF, Fregni F, Maia FM, Melo LM, Sato JR, Cruz ACM, Bianchi ET, Barbosa ER, Amaro E. fMRI changes in the visual cortex of patients with Parkinson's Disease. Neuroimage 2009. [DOI: 10.1016/s1053-8119(09)71065-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Santos VM, Barbosa ER, Lima SHM, Porto AS. Abdominal cocoon associated with endometriosis. Singapore Med J 2007; 48:e240-2. [PMID: 17728949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
Abdominal cocoon is a rare cause of intestinal obstruction in adults. Diagnosis is usually established at laparotomy in patients with recurrent attacks of non-strangulating small bowel obstruction. A 40-year-old infertile Brazilian woman with intestinal obstruction and massive haemoserous ascites, due to coexistent ovarian endometriosis and abdominal cocoon, is reported. Abdominal pain, nausea, vomiting and a palpable mass, in addition to imaging of small bowel obstruction and thickened peritoneum, raised diagnostic suspicion. Higher awareness allows for early diagnoses and yields better results during management.
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Affiliation(s)
- V M Santos
- Department of Internal Medicine, Catholic University Medical Course, Armed Forces Hospital, Estrada do Contorno do Bosque s/n, Brasilia DF, Brazil.
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Capelli LP, Gonçalves MRR, Kok F, Leite CC, Nitrini R, Barbosa ER, Vianna-Morgante AM. Fragile X-associated tremor/ataxia syndrome: intrafamilial variability and the size of the FMR1 premutation CGG repeat. Mov Disord 2007; 22:866-70. [PMID: 17290448 DOI: 10.1002/mds.21347] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Fragile X-associated tremor/ataxia syndrome (FXTAS) is a neurological progressive disorder associated with the FMR1 gene premutation. We report on variable presentation of findings associated with FXTAS in 3 brothers aged 68, 74, and 73 years, carrying premutation alleles of (CGG)(123,) (CGG)(109), and (CGG)(91) triplets, respectively. Based on previously proposed diagnostic criteria for the syndrome, clinical and radiological data allowed establishing a "definite" diagnosis of FXTAS in the two carriers of the longest (CGG)(n). The carrier of the (CGG)(91) allele, although presenting a major radiological sign of the syndrome (symmetrical white-matter lesions in the middle cerebellar peduncles), did not have any significant neurological manifestation at 73 years of age.
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Affiliation(s)
- Leonardo P Capelli
- Department of Genetics and Evolutionary Biology, Institute of Biosciences, University of São Paulo, São Paulo, Brazil
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Gonçalves MRR, Capelli LP, Nitrini R, Barbosa ER, Porto CS, Lucato LT, Vianna-Morgante AM. Atypical clinical course of FXTAS: rapidly progressive dementia as the major symptom. Neurology 2007; 68:1864-6. [PMID: 17515552 DOI: 10.1212/01.wnl.0000262058.68100.ea] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- M R R Gonçalves
- Department of Neurology, School of Medicine, University of São Paulo, Brazil
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Di Fonzo A, Chien HF, Socal M, Giraudo S, Tassorelli C, Iliceto G, Fabbrini G, Marconi R, Fincati E, Abbruzzese G, Marini P, Squitieri F, Horstink MW, Montagna P, Libera AD, Stocchi F, Goldwurm S, Ferreira JJ, Meco G, Martignoni E, Lopiano L, Jardim LB, Oostra BA, Barbosa ER, Bonifati V. ATP13A2 missense mutations in juvenile parkinsonism and young onset Parkinson disease. Neurology 2007; 68:1557-62. [PMID: 17485642 DOI: 10.1212/01.wnl.0000260963.08711.08] [Citation(s) in RCA: 235] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To assess the prevalence, nature, and associated phenotypes of ATP13A2 gene mutations among patients with juvenile parkinsonism (onset <21 years) or young onset (between 21 and 40 years) Parkinson disease (YOPD). METHODS We studied 46 patients, mostly from Italy or Brazil, including 11 with juvenile parkinsonism and 35 with YOPD. Thirty-three cases were sporadic and 13 had positive family history compatible with autosomal recessive inheritance. Forty-two had only parkinsonian signs, while four (all juvenile-onset) had multisystemic involvement. The whole ATP13A2 coding region (29 exons) and exon-intron boundaries were sequenced from genomic DNA. RESULTS A novel homozygous missense mutation (Gly504Arg) was identified in one sporadic case from Brazil with juvenile parkinsonism. This patient had symptoms onset at age 12, levodopa-responsive severe akinetic-rigid parkinsonism, levodopa-induced motor fluctuations and dyskinesias, severe visual hallucinations, and supranuclear vertical gaze paresis, but no pyramidal deficit nor dementia. Brain CT scan showed moderate diffuse atrophy. Furthermore, two Italian cases with YOPD without atypical features carried a novel missense mutation (Thr12Met, Gly533Arg) in single heterozygous state. CONCLUSIONS We confirm that ATP13A2 homozygous mutations are associated with human parkinsonism, and expand the associated genotypic and clinical spectrum, by describing a homozygous missense mutation in this gene in a patient with a phenotype milder than that initially associated with ATP13A2 mutations (Kufor-Rakeb syndrome). Our data also suggest that ATP13A2 single heterozygous mutations might be etiologically relevant for patients with YOPD and further studies of this gene in Parkinson disease are warranted.
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Affiliation(s)
- A Di Fonzo
- Department of Clinical Genetics, Erasmus MC, Rotterdam, The Netherlands.
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Fregni F, Boggio PS, Santos MC, Lima M, Vieira AL, Rigonatti SP, Silva MTA, Barbosa ER, Nitsche MA, Pascual-Leone A. Noninvasive cortical stimulation with transcranial direct current stimulation in Parkinson's disease. Mov Disord 2007; 21:1693-702. [PMID: 16817194 DOI: 10.1002/mds.21012] [Citation(s) in RCA: 298] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Electrical stimulation of deep brain structures, such as globus pallidus and subthalamic nucleus, is widely accepted as a therapeutic tool for patients with Parkinson's disease (PD). Cortical stimulation either with epidural implanted electrodes or repetitive transcranial magnetic stimulation can be associated with motor function enhancement in PD. We aimed to study the effects of another noninvasive technique of cortical brain stimulation, transcranial direct current stimulation (tDCS), on motor function and motor-evoked potential (MEP) characteristics of PD patients. We tested tDCS using different electrode montages [anodal stimulation of primary motor cortex (M1), cathodal stimulation of M1, anodal stimulation of dorsolateral prefrontal cortex (DLPFC), and sham-stimulation] and evaluated the effects on motor function--as indexed by Unified Parkinson's Disease Rating Scale (UPDRS), simple reaction time (sRT) and Purdue Pegboard test--and on corticospinal motor excitability (MEP characteristics). All experiments were performed in a double-blinded manner. Anodal stimulation of M1 was associated with a significant improvement of motor function compared to sham-stimulation in the UPDRS (P < 0.001) and sRT (P = 0.019). This effect was not observed for cathodal stimulation of M1 or anodal stimulation of DLPFC. Furthermore, whereas anodal stimulation of M1 significantly increased MEP amplitude and area, cathodal stimulation of M1 significantly decreased them. There was a trend toward a significant correlation between motor function improvement after M1 anodal-tDCS and MEP area increase. These results confirm and extend the notion that cortical brain stimulation might improve motor function in patients with PD.
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Affiliation(s)
- Felipe Fregni
- Harvard Center for Non-Invasive Brain Stimulation, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts 02215, USA.
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Arantes PR, Cardoso EF, Barreiros MA, Teixeira MJ, Gonçalves MR, Barbosa ER, Sukwinder SS, Leite CC, Amaro E. Performing functional magnetic resonance imaging in patients with Parkinson's disease treated with deep brain stimulation. Mov Disord 2007; 21:1154-62. [PMID: 16671094 DOI: 10.1002/mds.20912] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Deep brain stimulation (DBS) is a relatively novel treatment in advanced Parkinson's disease (PD). Functional magnetic resonance imaging (fMRI) is a useful technique for examining the effects of DBS both within the basal ganglia and its cortical connectivity. There are technical difficulties in imaging patients with PD, and the DBS itself can generate image artifacts. We describe aspects related to optimizing the fMRI acquisition parameters in patients with DBS and the results of sensorimotor activation tasks performed by four PD patients during hand, foot, and tongue movements, both before and after DBS implant. Provided that all safety conditions are followed, it is possible to perform fMRI in patients with PD and DBS. The standard DBS surgical procedure has to be slightly modified in order to reduce image artifacts. The event-related design provided increased power to detect sensorimotor cortex and basal ganglia activation.
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Affiliation(s)
- Paula R Arantes
- Department of Radiology, University of São Paulo Medical School, São Paulo, Brazil
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38
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Fregni F, Boggio PS, Bermpohl F, Maia F, Rigonatti SP, Barbosa ER, Pascual-Leone A. Immediate placebo effect in Parkinson's disease--is the subjective relief accompanied by objective improvement? Eur Neurol 2006; 56:222-9. [PMID: 17057382 DOI: 10.1159/000096490] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2006] [Accepted: 07/05/2006] [Indexed: 11/19/2022]
Abstract
BACKGROUND A recent well-conducted meta-analysis showed that placebo effect is associated with a possible small benefit for subjective outcomes, but has no significant effects on objective outcomes. OBJECTIVE Herein, we aimed to investigate the immediate effects of two different types of placebo [placebo pill and sham transcranial magnetic stimulation (TMS)] in Parkinson's disease (PD) patients and compared them to the standard treatment (levodopa) in a proper randomized, double-blind, crossover clinical trial. METHODS PD patients received three different interventions on different days: levodopa, placebo pill, and sham TMS. The motor function was assessed using simple and choice reaction time, Unified Parkinson's Disease Rating Scale (UPDRS), finger tapping, Purdue Pegboard test, time to button up, walking time and supination-pronation. The subjective motor function was measured by a visual analogue scale (VAS). RESULTS The results showed that there was a significant motor function in the motor function only after the treatment with levodopa, but not after treatment with placebo pills or sham TMS. However, patients reported a similar subjective improvement in motor function indexed by VAS following these three treatments. CONCLUSION These results suggest that placebo interventions in PD may have an immediate subjective sensation of improvement but result in no significant objective motor changes compared with levodopa treatment. Although physiological changes are possible after a placebo intervention, our findings suggest that the acute placebo effect in PD may be the result of the subjective change in the motor rating only.
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Affiliation(s)
- Felipe Fregni
- Harvard Center for Noninvasive Brain Stimulation, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass, USA.
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Fregni F, Ono CR, Santos CM, Bermpohl F, Buchpiguel C, Barbosa ER, Marcolin MA, Pascual-Leone A, Valente KD. Effects of antidepressant treatment with rTMS and fluoxetine on brain perfusion in PD. Neurology 2006; 66:1629-37. [PMID: 16769932 DOI: 10.1212/01.wnl.0000218194.12054.60] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Although depression is highly prevalent in Parkinson disease (PD), little is known about the neural correlates associated with depression and antidepressant treatment in PD. OBJECTIVE To examine the effects of fluoxetine and repetitive transcranial magnetic stimulation (rTMS) on regional cerebral blood flow (rCBF) using SPECT in patients with PD and depression. METHODS Twenty-six patients were enrolled into two groups: One received active rTMS and placebo medication and the other sham rTMS and fluoxetine 20 mg/day. Brain SPECT was performed at baseline and after 2 and 8 weeks. Changes in rCBF were compared across timepoints and correlated with clinical scores. In addition, baseline rCBF of these patients was compared with that of 29 healthy, age-matched subjects. RESULTS At baseline, patients with PD and depression showed significantly lower rCBF in the left prefrontal cortex, posterior cingulate gyrus, left insula, and right parietal cortex when compared with healthy controls. Both treatments induced significant clinical improvement and increases in rCBF in the posterior cingulate gyrus and decreases in rCBF in the right medial frontal gyrus. These changes were significantly correlated to the clinical outcome. Furthermore, the comparison between these two treatments revealed that whereas rTMS treatment was associated with an increased perfusion in the right and left prefrontal cortex, fluoxetine treatment was associated with a relative rCBF increase in the occipital lobe. CONCLUSION Depression in patients with Parkinson disease is correlated with a dysfunction of the frontal-limbic network that can be modulated by two different antidepressant therapies.
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Affiliation(s)
- F Fregni
- Harvard Center for Noninvasive Brain Stimulation, Department of Neurology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA 02215, USA.
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Dias AE, Barbosa ER, Coracini K, Maia F, Marcolin MA, Fregni F. Effects of repetitive transcranial magnetic stimulation on voice and speech in Parkinson's disease. Acta Neurol Scand 2006; 113:92-9. [PMID: 16411969 DOI: 10.1111/j.1600-0404.2005.00558.x] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To investigate the effects of repetitive transcranial magnetic stimulation (rTMS) on vocal function in Parkinson's disease (PD). MATERIAL AND METHODS Two different sets of rTMS parameters were investigated on 30 patients with PD: active or sham 15 Hz rTMS of the left dorsolateral prefrontal cortex (LDLPFC) (110% of motor threshold (MT), 3000 pulses per session) and active 5 Hz rTMS of the primary motor cortex (M1)-mouth area (90% MT, 2250 pulses per session). A blind rater evaluated speech characteristics (acoustic and perceptual analysis of voice) and voice-related quality of life (V-RQOL). RESULTS rTMS of LDLPFC resulted in mood amelioration and subjective improvement of the V-RQOL only (71.9% improvement, P < 0.001), but not in objective measures such as fundamental frequency (P = 0.86) and voice intensity (P = 0.99). On the other hand, rTMS of M1-mouth induced a significant improvement of the fundamental frequency (12.9% for men and 7.6% for women, P < 0.0001) and voice intensity (20.6%, P < 0.0001). CONCLUSIONS Our findings provide initial evidence that rTMS of the primary motor cortex might yield a beneficial effect on vocal function in PD.
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Affiliation(s)
- A E Dias
- Department of Neurology and Psychiatry, University of Sao Paulo, Sao Paulo, Brazil
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Boggio PS, Fregni F, Bermpohl F, Mansur CG, Rosa M, Rumi DO, Barbosa ER, Odebrecht Rosa M, Pascual-Leone A, Rigonatti SP, Marcolin MA, Araujo Silva MT. Effect of repetitive TMS and fluoxetine on cognitive function in patients with Parkinson's disease and concurrent depression. Mov Disord 2005; 20:1178-84. [PMID: 15895421 DOI: 10.1002/mds.20508] [Citation(s) in RCA: 160] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Previous studies show that cognitive functions are more impaired in patients with Parkinson's disease (PD) and depression than in nondepressed PD patients. We compared the cognitive effects of two types of antidepressant treatments in PD patients: fluoxetine (20 mg/day) versus repetitive transcranial magnetic stimulation (rTMS, 15 Hz, 110% above motor threshold, 10 daily sessions) of the left dorsolateral prefrontal cortex. Twenty-five patients with PD and depression were randomly assigned either to Group 1 (active rTMS and placebo medication) or to Group 2 (sham rTMS and fluoxetine). A neuropsychological battery was assessed by a rater blind to treatment arm at baseline and 2 and 8 weeks after treatment. Patients in both groups had a significant improvement of Stroop (colored words and interference card) and Hooper and Wisconsin (perseverative errors) test performances after both treatments. Furthermore, there were no adverse effects after either rTMS or fluoxetine in any neuropsychological test of the cognitive test battery. The results show that rTMS could improve some aspects of cognition in PD patients similar to that of fluoxetine. The mechanisms for this cognitive improvement are unclear, but it is in the context of mood improvement.
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Affiliation(s)
- Paulo S Boggio
- Department of Experimental Psychology, Institute of Psychology, University of Sao Paulo, Sao Paulo, SP, Brazil
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Chien HF, Rohé CF, Costa MDL, Breedveld GJ, Oostra BA, Barbosa ER, Bonifati V. Early-onset Parkinson's disease caused by a novel parkin mutation in a genetic isolate from north-eastern Brazil. Neurogenetics 2005; 7:13-9. [PMID: 16328510 DOI: 10.1007/s10048-005-0017-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2005] [Accepted: 08/30/2005] [Indexed: 10/25/2022]
Abstract
We describe clinical and molecular findings in a genetic isolate from north-eastern Brazil with early-onset Parkinson's disease (PD) and a novel mutation in the parkin gene. Genealogical studies could connect 255 individuals, of whom 15 had PD. Geographic isolation and multiple consanguineous marriages initially suggested an autosomal recessive inheritance for PD in these patients. The available individuals were personally examined, and DNA was obtained from 26 members: ten early-onset PD patients, one case with likely neuroleptic-induced parkinsonism and 15 unaffected relatives. The average age at onset of PD symptoms was 30.8 years (range 12-46). Haplotype analysis revealed homozygosity in the PD patients for markers across the PARK2 locus. Genomic sequencing identified a novel homozygous splice-site parkin mutation (IVS1 + 1G/T), which completely co-segregated with the early-onset PD phenotype. cDNA analysis confirmed the total loss of parkin transcript in homozygous mutation carriers, delineating this as a loss-of-function mutation. The case with neuroleptic-induced parkinsonism and 13 of 15 healthy relatives were heterozygous carriers of the mutation. The absence of PD in heterozygous carriers indicates a genuinely recessive nature of this mutation, suggesting that parkin haploinsufficiency is not a relevant risk factor for early- or late-onset PD. However, parkin haploinsufficiency could facilitate the emergence of neuroleptic-induced parkinsonism. The cluster reported here, which to our knowledge is the largest described to date with early-onset PD and parkin mutations, also offers a unique opportunity for the search of modifiers of the parkin-related disease.
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Affiliation(s)
- Hsin F Chien
- Department of Neurology, University of São Paulo School of Medicine, São Paulo, Brazil
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Heise CO, Gonçalves LR, Barbosa ER, Gherpelli JLD. Botulinum toxin for treatment of cocontractions related to obstetrical brachial plexopathy. Arq Neuro-Psiquiatr 2005; 63:588-91. [PMID: 16172705 DOI: 10.1590/s0004-282x2005000400006] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Botulinum toxin type A was recently introduced for treatment of biceps - triceps muscle cocontraction, which compromises elbow function in children with obstetrical brachial plexopathy. This is our preliminary experience with this new approach. Eight children were treated with 2 - 3 U/kg of botulinum toxin injected in the triceps (4 patients) and biceps (4 patients) muscle, divided in 2 or 3 sites. All patients submitted to triceps injections showed a long-lasting improvement of active elbow flexion and none required new injections, after a follow-up of 3 to 18 months. Three of the patients submitted to biceps injections showed some improvement of elbow extension, but none developed anti-gravitational strength for elbow extension and the effect lasted only three to five months. One patient showed no response to triceps injections. Our data suggest that botulinum toxin can be useful in some children that have persistent disability secondary to obstetrical brachial plexopathy.
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Affiliation(s)
- Carlos O Heise
- Department of Neurology, University of São Paulo Medical School, São Paulo, SP, Brazil.
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Abstract
To evaluate the long-term effect of botulinum toxin type A (BTX) in the treatment of blepharospasm, a retrospective analysis was conducted from the patients seen at the Movement Disorders Clinic of the Department of Neurology, Hospital das Clínicas, University of São Paulo School of Medicine from 1993 to 2003. A total of 379 treatments with BTX were administered to 30 patients with blepharospasm. Sixty six per cent of the subjects had used oral medication for dystonia and only 15% of them reported satisfactory response to this treatment. Ninety three per cent of the patients showed significant improvement after the first BTX injection. There was no decrement in response when compared the first and the last injection recorded. Adverse effects, mostly minor, developed at least once in 53% of patients. Six patients (20%) discontinued the treatment but there was no case of secondary resistance.
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Affiliation(s)
- Laura Silveira-Moriyama
- Movement Disorders Clinic of the Department of Neurology, Hospital das Clínicas, University of São Paulo School of Medicine, São Paulo SP, Brazil (HC- FMUSP)
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46
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Lucato LT, Otaduy MCG, Barbosa ER, Machado AAC, McKinney A, Bacheschi LA, Scaff M, Cerri GG, Leite CC. Proton MR spectroscopy in Wilson disease: analysis of 36 cases. AJNR Am J Neuroradiol 2005; 26:1066-71. [PMID: 15891161 PMCID: PMC8158586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
BACKGROUND AND PURPOSE Wilson disease (WD) is rare but one of the few metabolic disorders that can possibly benefit from effective available treatments. The literature regarding proton MR spectroscopy (MRS) in WD is scarce and controversial. The purpose of this study was to determine the brain metabolic changes due to WD by using MRS. To our knowledge, this is the first time that MRS was performed in such a large sample of patients with WD. METHODS Thirty-six patients with WD and 37 healthy volunteers were examined with MRS in the parieto-occipital cortex, frontal white matter, and basal ganglia (BG). Ratios of the following metabolites were calculated in relation to creatine (Cr): N-acetylaspartate (NAA), choline (Cho), myo-inositol (mI), and glutamine/glutamate (Glx). The mean peak line width was measured on each spectrum. RESULTS Compared with control subjects, patients with WD had significantly decreased NAA/Cr ratios in the three studied areas (P < .005) and an increased mI/Cr ratio in the BG (P < .001). Cho/Cr and Glx/Cr did not differ between the groups. The mean peak line in the BG was wider in patients than in control subjects. CONCLUSION WD is unequivocally associated with MRS changes that could possibly be assigned to neuronal loss (in the three studied areas), to gliosis, and to iron and/or copper deposition in the BG.
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Affiliation(s)
- Leandro T Lucato
- Department of Radiology, the Clinics Hospital of the University of Sao Paulo, School of Medicine, Brazil
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Ferraz HB, Quagliato EAB, Rieder CRM, Silva DJ, Teive HAG, Barbosa ER, Cardoso F, Limongi JCP, Bezerra JMF, Andrade LAF, Allam N, Prado RCP, Tomas V. Comments on the paper "High doses of riboflavin and the elimination of dietary red meat promote the recovery of some motor functions in Parkinson's disease patients. C.G. Coimbra and V.B.C. Junqueira. Brazilian Journal of Medical and Biological Research, 36: 1409-1417, 2003". Braz J Med Biol Res 2004; 37:1297-9; discussion 1299-302. [PMID: 15334194 DOI: 10.1590/s0100-879x2004000900002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- H B Ferraz
- Setor de Distúrbios do Movimento, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brasil
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Abstract
Chediak-Higashi syndrome (CHS), typically presents with partial albinism and severe hematological abnormalities. About 10% of the patients have a mild adult form associated with various neurological manifestations. We describe the case of a 24-year-old woman with parkinsonism that responded well to antiparkinsonian drugs.
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Fregni F, Santos CM, Myczkowski ML, Rigolino R, Gallucci-Neto J, Barbosa ER, Valente KD, Pascual-Leone A, Marcolin MA. Repetitive transcranial magnetic stimulation is as effective as fluoxetine in the treatment of depression in patients with Parkinson's disease. J Neurol Neurosurg Psychiatry 2004; 75:1171-4. [PMID: 15258224 PMCID: PMC1739189 DOI: 10.1136/jnnp.2003.027060] [Citation(s) in RCA: 165] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To study the efficacy of 15 Hz repetitive transcranial magnetic stimulation (rTMS) in treating depression in patients with Parkinson's disease. METHODS 42 patients were enrolled into two groups: group 1, active rTMS (15 Hz rTMS for 10 days) and placebo drug treatment; group 2, sham rTMS and fluoxetine 20 mg/day. A specially designed sham coil was used for sham stimulation. The unified Parkinson's disease rating scale (UPDRS), activities of daily living (ADL), Hamilton rating scale for depression (HRSD), Beck depression inventory (BDI), and mini-mental state examination (MMSE) were assessed by a rater blinded to treatment arm. RESULTS HRSD and BDI were improved to the same extent in both groups after two weeks of treatment (38% and 32% for group 1, 41% and 33% for group 2, respectively). At week 8 there was a tendency for worse motor UPDRS scores in group 2 (NS). ADL showed improvement at week 8 only in group 1. MMSE improved in both groups after treatment, but faster in group 1 than in group 2. There were fewer adverse effects in group 1 than in group 2. CONCLUSIONS rTMS has the same antidepressant efficacy as fluoxetine and may have the additional advantage of some motor improvement and earlier cognitive improvement, with fewer adverse effects.
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Affiliation(s)
- F Fregni
- Department of Neurology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts 02215, USA.
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Deguti MM, Genschel J, Cancado ELR, Barbosa ER, Bochow B, Mucenic M, Porta G, Lochs H, Carrilho FJ, Schmidt HHJ. Wilson disease: novel mutations in the ATP7B gene and clinical correlation in Brazilian patients. Hum Mutat 2004; 23:398. [PMID: 15024742 DOI: 10.1002/humu.9227] [Citation(s) in RCA: 78] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Wilson disease (WD) is a rare inherited autosomal recessive disorder caused by a defect in a metal transporting P-type ATPase, resulting in copper overload in various tissues and cells. The aim was to assess both the phenotype in Brazilian WD patients and the corresponding ATP7B genotype. Sixty subjects belonging to 46 pedigrees diagnosed as WD were included in this study. Direct sequencing of all 21 exons within ATP7B and their flanking introns was performed. Demographic, clinical, laboratory and histopathological data at the time of diagnosis were obtained. We identified twenty-five mutations, twelve of them reported for the first time. The c.3402delC mutation had the highest allelic frequency (30.8%), followed by the c.2123T>C (p.L708P) (16.7%). Exons 8 and 15 were the site of 62.5% of the mutations. The common European mutation c.3207C>A (p.H1069Q) was not present at all. Phenotype varied greatly among individuals with the same ATP7B genotype. Our data confirm the heterogeneity of ATP7B genotype in Brazilian WD patients. The mutational spectrum is compatible with the Brazilian history of Mediterranean immigration; however, new mutations, and different frequencies and phenotype associated with the previously known mutations characterize this population. Exons 8 and 15 should be preferentially screened in WD cases from Brazil. Phenotype variation among subjects with the same ATP7B genotype suggests that modifying factors play an additional role in the pathogenesis of WD.
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Affiliation(s)
- Marta M Deguti
- Department of Gastroenterology, Sao Paulo University School of Medicine, Sao Paulo, Brazil
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