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Espay AJ, Stocchi F, Pahwa R, Albanese A, Ellenbogen A, Ferreira JJ, Giladi N, Gurevich T, Hassin-Baer S, Hernandez-Vara J, Isaacson SH, Kieburtz K, LeWitt PA, Lopez-Manzanares L, Olanow CW, Poewe W, Sarva H, Yardeni T, Adar L, Salin L, Lopes N, Sasson N, Case R, Rascol O. Safety and efficacy of continuous subcutaneous levodopa-carbidopa infusion (ND0612) for Parkinson's disease with motor fluctuations (BouNDless): a phase 3, randomised, double-blind, double-dummy, multicentre trial. Lancet Neurol 2024; 23:465-476. [PMID: 38499015 DOI: 10.1016/s1474-4422(24)00052-8] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 01/18/2024] [Accepted: 01/30/2024] [Indexed: 03/20/2024]
Abstract
BACKGROUND Conventional oral levodopa therapy for the treatment of Parkinson's disease can be associated with variations in plasma concentrations. Levodopa infusion strategies might provide more consistent drug delivery and fewer motor fluctuations. We aimed to assess the safety and efficacy of a continuous 24 h/day subcutaneous infusion of ND0612 (a levodopa-carbidopa solution) compared with oral immediate-release levodopa-carbidopa for the treatment of motor fluctuations in people with Parkinson's disease. METHODS We conducted a phase 3, randomised, double-blind, double-dummy, active-controlled, multicentre trial at 117 academic and community neurology sites in 16 countries, including in Europe, Israel, and the USA. Eligible participants were men and women aged 30 years or older with a diagnosis of Parkinson's disease (Hoehn and Yahr stage ≤3 in the on state) who experienced at least 2·5 h/day of off time. Participants underwent an open-label run-in phase (<12 weeks), during which time optimal regimens were established for both oral immediate-release levodopa-carbidopa and for 24 h/day subcutaneous ND0612 infusion (levodopa-carbidopa 60·0/7·5 mg/mL), with supplemental oral levodopa-carbidopa if needed. Participants were then randomly assigned (1:1) to 12 weeks of double-blind treatment with their optimised regimen of either subcutaneous ND0612 or oral levodopa-carbidopa, with matching oral or subcutaneous placebo given as required to maintain blinding. Randomisation was done via an interactive web response system, stratified by region, using a permuted block schedule. Participants, study partners, treating investigators, study site personnel, and the sponsor were masked to treatment group allocation. The primary efficacy endpoint was the change from baseline (ie, time of randomisation, when all patients were receiving an optimised open-label ND0612 regimen) to end of the double-blind phase in total daily on time without troublesome dyskinesia, analysed by intention to treat. This trial is registered with ClinicalTrials.gov, NCT04006210, and is complete. FINDINGS Between Sept 30, 2019, and April 8, 2022, 381 participants were enrolled, of whom 259 (68%) were randomly assigned, 128 (49%) to subcutaneous ND0612 and 131 (51%) to oral levodopa-carbidopa. 243 (94%) participants completed the study. Treatment with subcutaneous ND0612 provided an additional 1·72 h (95% CI 1·08 to 2·36) of on time without troublesome dyskinesia compared with oral levodopa-carbidopa (change from baseline of -0·48 h [-0·94 to -0·02] with subcutaneous ND0612 vs -2·20 h [-2·65 to -1·74] with oral levodopa-carbidopa; p<0·0001). Significant treatment differences favouring subcutaneous ND0612 were also found in the first four of nine prespecified hierarchical outcomes of daily off time (-1·40 h [95% CI -1·99 to -0·80]), Movement Disorders Society-Unified Parkinson's Disease Rating Scale part II scores (-3·05 [-4·28 to -1·81]), Patients Global Impression of Change (odds ratio [OR] 5·31 [2·67 to 10·58]), and Clinical Global Impression of Improvement (OR 7·23 [3·57 to 14·64]). Hierarchical testing ended after the fourth secondary endpoint. Adverse events were reported by 287 (89%) of 322 participants during open-label ND0612 optimisation, and by 103 (80%) of 128 in the ND0612 group and 97 (74%) of 131 in the oral levodopa-carbidopa group during the double-blind phase. The most common adverse events were infusion-site reactions (266 [83%] participants during open-label ND0612, and 73 [57%] in the ND0612 group vs 56 [43%] in the oral levodopa-carbidopa group during the double-blind phase), most of which were mild. Serious adverse events in four participants in the ND0612 group were related to study treatment (infusion-site cellulitis [n=2], infusion-site abscess and infusion-site ulcer [n=1]; and paraesthesia and peripheral sensorimotor neuropathy [n=1]). One participant in the ND0612 group died during the double-blind phase, but the death was not related to study treatment (fall leading to traumatic brain injury). INTERPRETATION Results of this phase 3 study showed that subcutaneous ND0612 used in combination with oral immediate-release levodopa-carbidopa increased on time without troublesome dyskinesia and reduced off time, with a favourable benefit-risk profile. ND0612 might offer a safe and efficacious subcutaneous levodopa infusion approach to managing motor fluctuations in people with Parkinson's disease. The ongoing open-label extension phase will provide further information on the long-term efficacy and safety of treatment. FUNDING NeuroDerm.
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Affiliation(s)
- Alberto J Espay
- James J and Joan A Gardner Center for Parkinson's Disease and Movement Disorders, University of Cincinnati, Cincinnati, OH, USA.
| | - Fabrizio Stocchi
- Department of Neurology, University San Raffaele Roma and Institute for Research and Medical Care IRCCS San Raffaele, Rome, Italy
| | - Rajesh Pahwa
- Department of Neurology, University of Kansas Medical Center, Kansas City, KS, USA
| | - Alberto Albanese
- Department of Neurology, IRCCS Humanitas Research Hospital, Rozzano, Italy
| | - Aaron Ellenbogen
- Michigan Institute for Neurological Disorders, Farmington Hills, MI, USA
| | - Joaquim J Ferreira
- Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal; Campus Neurológico Sénior, Torres Vedras, Portugal
| | - Nir Giladi
- Brain Institute, Tel Aviv Medical Center, Faculty of Medicine, Sagol School of Neurosciences, Tel Aviv University, Tel Aviv, Israel
| | - Tanya Gurevich
- Movement Disorders Unit, Neurological Institute, Tel Aviv Medical Center, Faculty of Medicine, Sagol School of Neurosciences, Tel Aviv University, Tel Aviv, Israel
| | - Sharon Hassin-Baer
- Movement Disorders Institute, Department of Neurology, Sheba Medical Center, Tel Hashomer, Israel; Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Jorge Hernandez-Vara
- Neurology Department and Neurodegenerative Disorders Research Group, Vall D'Hebron Hospital, Barcelona, Spain; Hospital Universitari Vall D'Hebron, Barcelona, Spain
| | - Stuart H Isaacson
- Parkinson's Disease and Movement Disorders Center of Boca Raton, Boca Raton, FL, USA
| | | | - Peter A LeWitt
- Department of Neurology, Wayne State University School of Medicine, Detroit, MI, USA; Department of Neurology, Henry Ford Hospital, Detroit, MI, USA
| | | | - C Warren Olanow
- Clintrex Research Corp, Sarasota, FL, USA; Department of Neurology, Mount Sinai School of Medicine, New York, NY, USA
| | - Werner Poewe
- Department of Neurology, Medical University Innsbruck, Innsbruck, Austria
| | | | | | | | | | | | | | | | - Olivier Rascol
- University of Toulouse 3, University Hospital of Toulouse, INSERM, Clinical Investigation Center CIC1436, Department of Neurosciences and Department of Clinical Pharmacology, Toulouse, France; NS-Park/FCRIN Network, Toulouse, France.
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Sehgal RR, Sarva H, Safdieh JE, Robbins MS. Pearls and pitfalls in letters of recommendation for neurology residency applications. J Neurol Sci 2024; 459:122951. [PMID: 38461761 DOI: 10.1016/j.jns.2024.122951] [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] [Subscribe] [Scholar Register] [Received: 12/24/2023] [Revised: 02/28/2024] [Accepted: 03/04/2024] [Indexed: 03/12/2024]
Abstract
Letters of recommendation are a cornerstone of residency applications. Variability and bias in letters exists across specialties, neurology being no exception. Studies done in other specialty fields assessing nuanced language uncovered key attention points for improvement and mitigation of bias, lessons from which should be applied in the field of neurology. We review common pearls and pitfalls in the letter solicitation, writing and reading process, with suggested best-practices for residency applicants, letter writers, and program faculty reviewers. We advocate for the thoughtful selection of writers, emphasis on highlighting professional skills, and attention to implicit bias. This discussion focuses on recommendations for US advanced or categorical neurology programs, but elements of this guidance may apply more broadly to fellowship and faculty promotion letters as well.
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Affiliation(s)
- Ryka R Sehgal
- Department of Neurology, University of California - San Francisco, 505 Parnassus Avenue, M798, Box 0114, San Francisco, CA, USA 94143.
| | - Harini Sarva
- Department of Neurology, Weill Cornell Medicine/NewYork-Presbyterian Hospital, 520 E 70(th) St, Suite 607, New York City, NY, USA 10021.
| | - Joseph E Safdieh
- Department of Neurology, Weill Cornell Medicine/NewYork-Presbyterian Hospital, 520 E 70(th) St, Suite 607, New York City, NY, USA 10021.
| | - Matthew S Robbins
- Department of Neurology, Weill Cornell Medicine/NewYork-Presbyterian Hospital, 520 E 70(th) St, Suite 607, New York City, NY, USA 10021.
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Sarva H, Rodriguez-Porcel F, Rivera F, Gonzalez CD, Barkan S, Tripathi S, Gatto E, Ruiz PG. The role of genetics in the treatment of dystonia with deep brain stimulation: Systematic review and Meta-analysis. J Neurol Sci 2024; 459:122970. [PMID: 38520940 DOI: 10.1016/j.jns.2024.122970] [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] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Revised: 03/15/2024] [Accepted: 03/17/2024] [Indexed: 03/25/2024]
Abstract
BACKGROUND Dystonia is a movement disorder characterized by sustained or intermittent muscle contractions that lead to involuntary postures or repetitive movements. Genetic mutations are being increasingly recognized as a cause of dystonia. Deep brain stimulation (DBS) is one of the limited treatment options available. However, there are varying reports on its efficacy in genetic dystonias. This systematic review of the characteristics of genetic dystonias treated with DBS and their outcomes aims to aid in the evaluation of eligibility for such treatment. METHODS We performed a PUBMED search of all papers related to genetic dystonias and DBS up until April 2022. In addition to performing a systematic review, we also performed a meta-analysis to assess the role of the mutation on DBS response. We included cases that had a confirmed genetic mutation and DBS along with pre-and post-operative BFMDRS. RESULTS Ninety-one reports met our inclusion criteria and from them, 235 cases were analyzed. Based on our analysis DYT-TOR1A dystonia had the best evidence for DBS response and Rapid-Onset Dystonia Parkinsonism was among the least responsive to DBS. CONCLUSION While our report supports the role of genetics in DBS selection and response, it is limited by the rarity of the individual genetic conditions, the reliance on case reports and case series, and the limited ability to obtain genetic testing on a large scale in real-time as opposed to retrospectively as in many cases.
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Affiliation(s)
- Harini Sarva
- Parkinson's Disease and Movement Disorders Institute, Weill Cornell Medicine, 428 E72nd Street, Suite 400, NY, NY 10021, USA.
| | | | - Francisco Rivera
- CEMIC University Institute, School of Medicine, Department of Pharmacology, Buenos Aires, Argentina
| | - Claudio Daniel Gonzalez
- CEMIC University Institute, School of Medicine, Department of Pharmacology, Buenos Aires, Argentina
| | - Samantha Barkan
- Parkinson's Disease and Movement Disorders Institute, Weill Cornell Medicine, 428 E72nd Street, Suite 400, NY, NY 10021, USA
| | - Susmit Tripathi
- Parkinson's Disease and Movement Disorders Institute, Weill Cornell Medicine, 428 E72nd Street, Suite 400, NY, NY 10021, USA
| | - Emilia Gatto
- Instituto de Neurociencias Buenos Aires, INEBA, Facultad de Medicina, Universidad de Buenos Aires, Argentina
| | - Pedro Garcia Ruiz
- Movement Disorders Unit, Department of Neurology, Fundacion Jimenez Diaz, Universidad Autónoma de Madrid, Madrid, Spain
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Rodriguez-Porcel F, Sarva H, Joutsa J, Falup-Pecurariu C, Shukla AW, Mehanna R, Śmiłowska K, Lanza G, Filipović SR, Shalash A, Ferris M, Jankovic J, Espay AJ, Pandey S. Current opinions and practices in post-stroke movement disorders: Survey of movement disorders society members. J Neurol Sci 2024; 458:122925. [PMID: 38340409 DOI: 10.1016/j.jns.2024.122925] [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] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 02/03/2024] [Accepted: 02/06/2024] [Indexed: 02/12/2024]
Abstract
BACKGROUND Post-stroke movement disorders (PSMD) encompass a wide array of presentations, which vary in mode of onset, phenomenology, response to treatment, and natural history. There are no evidence-based guidelines on the diagnosis and treatment of PSMD. OBJECTIVES To survey current opinions and practices on the diagnosis and treatment of PSMD. METHODS A survey was developed by the PSMD Study Group, commissioned by the International Parkinson's and Movement Disorders Society (MDS). The survey, distributed to all members, yielded a total of 529 responses, 395 (74.7%) of which came from clinicians with experience with PSMD. RESULTS Parkinsonism (68%), hemiballismus/hemichorea (61%), tremor (58%), and dystonia (54%) were by far the most commonly endorsed presentation of PSMD, although this varied by region. Basal ganglia stroke (76% of responders), symptoms contralateral to stroke (75%), and a temporal relationship (59%) were considered important factors for the diagnosis of PSMD. Oral medication use depended on the phenomenology of the PSMD. Almost 50% of respondents considered deep brain stimulation and ablative surgeries as options for treatment. The lack of guidelines for the diagnosis and treatment was considered the most important gap to address. CONCLUSIONS Regionally varying opinions and practices on PSMD highlight gaps in (and mistranslation of) epidemiologic and therapeutic knowledge. Multicenter registries and prospective community-based studies are needed for the creation of evidence-based guidelines to inform the diagnosis and treatment of patients with PSMD.
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Affiliation(s)
| | - Harini Sarva
- Parkinson's Disease and Movement Disorders Institute, Department of Neurology, Weill Cornell Medicine, NY, New York, USA
| | - Juho Joutsa
- Turku Brain and Mind Center, Clinical Neurosciences, University of Turku; Turku PET Centre, Neurocenter, Turku University Hospital, Turku, Finland
| | | | - Aparna Wagle Shukla
- Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, USA
| | - Raja Mehanna
- Department of Neurology, University of Texas Health Science Center at Houston, TX, USA
| | | | - Giuseppe Lanza
- Department of Surgery and Medical-Surgical Specialties, University of Catania, Catania, Italy; Clinical Neurophysiology Research Unit, Oasi Research Institute-IRCCS, Troina, Italy
| | - Saša R Filipović
- University of Belgrade, Institute for Medical Research, Human Neuroscience Group, Belgrade, Serbia
| | - Ali Shalash
- Department of Neurology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Margaret Ferris
- Department of Neurology Stanford University, Palo Alto, CA, USA
| | - Joseph Jankovic
- Parkinson's Disease Center and Movement Disorders Clinic, Department of Neurology, Baylor College of Medicine, Houston, TX, USA
| | - Alberto J Espay
- James J. and Joan A. Gardner Family Center for Parkinson's Disease and Movement Disorders, Department of Neurology, University of Cincinnati, Cincinnati, OH, USA
| | - Sanjay Pandey
- Department of Neurology and Stroke Medicine, Amrita Hospital, Mata Amritanandamayi Marg Sector 88, Faridabad, Delhi National Capital Region, India
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Zolin A, Zhang C, Ooi H, Sarva H, Kamel H, Parikh NS. Association of liver fibrosis with cognitive decline in Parkinson's disease. J Clin Neurosci 2024; 119:10-16. [PMID: 37976909 DOI: 10.1016/j.jocn.2023.11.019] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 10/23/2023] [Accepted: 11/10/2023] [Indexed: 11/19/2023]
Abstract
BACKGROUND Cognitive decline is a common but variable non-motor manifestation of Parkinson's disease. Chronic liver disease contributes to dementia, but its impact on cognitive performance in Parkinson's disease is unknown. We assessed the effect of liver fibrosis on cognition in Parkinson's disease. METHODS We conducted a retrospective cohort study using data from the Parkinson's Progression Markers Initiative. Our exposure was liver fibrosis at baseline, based on the validated Fibrosis-4 score. Our primary outcome was the Montreal Cognitive Assessment, and additional outcome measures were the Symbol Digit Modalities Test, the Benton Judgement of Line Orientation, the Letter-Number Sequencing Test, and the Modified Semantic Fluency Test. We used linear regression models to assess the relationship between liver fibrosis and scores on cognitive assessments at baseline and linear mixed models to evaluate the association between baseline Fibrosis-4 score with changes in each cognitive test over five years. Models were adjusted for demographics, comorbidities, and alcohol use. RESULTS We included 409 participants (mean age 61, 40 % women). There was no significant association between liver fibrosis and baseline performance on any of the cognitive assessments in adjusted models. However, over the subsequent five year period, liver fibrosis was associated with more rapid decline in scores on the Montreal Cognitive Assessment (interaction coefficient, -0.07; 95 % CI, -0.12, -0.02), the Symbol Digit Modalities Test, the Benton Judgement of Line Orientation, and the Modified Semantic Fluency Test. CONCLUSION In people with Parkinson's disease, the presence of comorbid liver fibrosis was associated with more rapid decline across multiple cognitive domains.
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Affiliation(s)
- Aryeh Zolin
- Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute and Department of Neurology, Weill Cornell Medicine, New York, NY, USA
| | - Cenai Zhang
- Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute and Department of Neurology, Weill Cornell Medicine, New York, NY, USA
| | - Hwai Ooi
- Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute and Department of Neurology, Weill Cornell Medicine, New York, NY, USA; Parkinson's Disease and Movement Disorders Institute, Department of Neurology, Weill Cornell Medicine, New York, NY, USA
| | - Harini Sarva
- Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute and Department of Neurology, Weill Cornell Medicine, New York, NY, USA; Parkinson's Disease and Movement Disorders Institute, Department of Neurology, Weill Cornell Medicine, New York, NY, USA
| | - Hooman Kamel
- Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute and Department of Neurology, Weill Cornell Medicine, New York, NY, USA
| | - Neal S Parikh
- Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute and Department of Neurology, Weill Cornell Medicine, New York, NY, USA.
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Barone DA, Sarva H, Hellmers N, Wang F, Wu Z, Krieger AC, Henchcliffe C. Neurologic and psychiatric features of impending neurodegeneration in iRBD. Clin Park Relat Disord 2023; 9:100216. [PMID: 37680305 PMCID: PMC10480303 DOI: 10.1016/j.prdoa.2023.100216] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 08/04/2023] [Accepted: 08/23/2023] [Indexed: 09/09/2023] Open
Abstract
Introduction Idiopathic rapid eye movement (REM) sleep behavior disorder (iRBD) is linked to Parkinson's disease and other alpha-synucleinopathies, but various subsets of iRBD may not carry equal risk (i.e., those with depression are at higher risk than those without). Here, we prospectively focus on neurologic and psychiatric aspects of subjects with iRBD, in an attempt to determine what factors are prominent in those who undergo phenoconversion as opposed to those who do not. Methods We analyzed data from the "REM Sleep Behavior Disorder Associations with Parkinson's Disease Study (RAPiDS)" cohort both at baseline and then at follow-up evaluations (1 to 3 years later) utilizing several neurologic batteries, including the Movement Disorder Society's Unified Parkinson's Disease Rating Scale (MDS-UPDRS), the Montreal Cognitive Assessment (MoCA), the Questionnaire for Impulsive-Compulsive Disorders in Parkinson's Disease (QUIP), the 10-M Walk Test (10MWT), and the Epworth Sleepiness Scale. Determination of phenoconversion was ascertained from physical examination and medical chart review from the initial evaluation onward. Results Of those who completed both evaluations, there were 33 subjects with iRBD, with an average age of 63.1 ± 12.8 years, with 9 women and 24 men. Of these, 8 (24%) iRBD subjects developed neurodegenerative illness, and demonstrated multiple areas of neurologic and psychiatric signs and symptoms, such as speech and movement problems as well as anxiety and depression. Conclusions Our data adds to the literature regarding risk of phenoconversion in those with iRBD. Further study will be needed, but it is clear that not all subjects with iRBD present the same risk for neurodegeneration.
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Affiliation(s)
| | - Harini Sarva
- Department of Neurology, Weill Cornell Medicine, United States
| | | | - Fei Wang
- Department of Population Health Sciences, Weill Cornell Medicine, United States
| | - Zhenxing Wu
- Department of Population Health Sciences, Weill Cornell Medicine, United States
| | - Ana C. Krieger
- Department of Neurology, Weill Cornell Medicine, United States
| | - Claire Henchcliffe
- Department of Neurology, University of California, Irvine, School of Medicine, United States
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Martindale JM, Sarva H, Martino D, Gilbert DL, Ganos C, Pringsheim T, Black K, Malaty IA. Study protocol: A cross-sectional survey of clinicians to identify barriers to clinical practice guideline implementation in the assessment and treatment of persistent tic disorders. PLoS One 2023; 18:e0288408. [PMID: 37467237 DOI: 10.1371/journal.pone.0288408] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 06/26/2023] [Indexed: 07/21/2023] Open
Abstract
INTRODUCTION Eight members of the International Parkinson's Disease and Movement Disorders Society Tic and Tourette Syndrome Study Group formed a subcommittee to discuss further barriers to practice guideline implementation. Based on expert opinion and literature review, the consensus was that practice variations continue to be quite broad and that many barriers in different clinical settings might negatively influence the adoption of the American Academy of Neurology and the European Society for the Study of Tourette Syndrome published guidelines. OBJECTIVES 1) To identify how clinical practices diverge from the existing American Academy of Neurology and European Society for the Study of Tourette Syndrome guidelines, and 2) to identify categories of barriers leading to these clinical care gaps. METHODS AND ANALYSIS This article presents the methodology of a planned cross-sectional survey amongst healthcare professionals routinely involved in the clinical care of patients with persistent tic disorders, aimed at 1) identifying how practices diverge from the published guidelines; and 2) identifying categories of barriers leading to these clinical care gaps. Purposeful sampling methods are used to identify and recruit critical persistent tic disorders stakeholders. The analysis will use descriptive statistics.
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Affiliation(s)
- Jaclyn M Martindale
- Department of Neurology, Atrium Health Wake Forest Baptist, Wake Forest University School of Medicine, Winston-Salem, NC, United States of America
| | - Harini Sarva
- Department of Neurology, Division of Neurodegenerative Diseases Weill Cornell Medicine, Parkinson's Disease and Movement Disorders Institute, New York, NY, United States of America
| | - Davide Martino
- Department of Clinical Neurosciences, University of Calgary and Hotchkiss Brain Institute, Cumming School of Medicine, Calgary, Alberta, Canada
| | - Donald L Gilbert
- Department of Pediatrics, Division of Neurology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, United States of America
| | - Christos Ganos
- Department of Neurology, Charité University Medicine Berlin, Berlin, Germany
| | - Tamara Pringsheim
- Department of Clinical Neurosciences, Psychiatry, Pediatrics and Community Health Sciences University of Calgary, Calgary, Alberta, Canada
| | - Kevin Black
- Departments of Psychiatry, Neurology, Radiology, and Neuroscience, Washington University School of Medicine, St. Louis, MO, United States of America
| | - Irene A Malaty
- Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida College of Medicine, Gainesville, FL, United States of America
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Zolin A, Broner SW, Yoo A, Guan I, Lakhani S, Trabilsy M, Klebanoff L, Vo M, Sarva H. Dystonia phenomenology and treatment response in migraine. Headache 2023; 63:255-263. [PMID: 36794299 DOI: 10.1111/head.14467] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 09/12/2022] [Accepted: 09/12/2022] [Indexed: 02/17/2023]
Abstract
OBJECTIVE To describe the phenomenology of cervical dystonia (CD) in patients with migraine and the effect of its treatment on migraine frequency. BACKGROUND Preliminary studies demonstrate that treatment of CD with botulinum toxin in those with migraine can improve both conditions. However, the phenomenology of CD in the setting of migraine has not been formally described. METHODS We conducted a single-center, descriptive, retrospective case series of patients with a verified diagnosis of migraine who were referred to our movement disorder center for evaluation of co-existing, untreated CD. Patient demographics, characteristics of migraine and CD, and effects of cervical onabotulinumtoxinA (BoTNA) injections were recorded and analyzed. RESULTS We identified 58 patients with comorbid CD and migraine. The majority were female (51/58 [88%]) and migraine preceded CD in 72% (38/53) of patients by a mean (range) of 16.0 (0-36) years. Nearly all the patients had laterocollis (57/58) and 60% (35/58) had concurrent torticollis. Migraine was found to be both ipsilateral and contralateral to the dystonia in a comparable proportion of patients (11/52 [21%] vs. 15/52 [28%]). There was no significant relationship between migraine frequency and dystonia severity. Treatment of CD with BoTNA reduced migraine frequency in most patients (15/26 [58%] at 3 months and 10/16 [63%] at 12 months). CONCLUSIONS In our cohort, migraine often preceded dystonia symptoms and laterocollis was the most described dystonia phenotype. The lateralization and severity/frequency of these two disorders were unrelated, but dystonic movements were a common migraine trigger. We corroborated previous reports that cervical BoTNA injections reduced migraine frequency. Providers treating patients with migraine and neck pain who are not fully responding to typical therapies should screen for possible CD as a confounding factor, which when treated can reduce migraine frequency.
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Affiliation(s)
- Aryeh Zolin
- Department of Neurology, Weill Cornell Medical College, New York, New York, USA.,Neurology Residency Program, Department of Neurology, New York Presbyterian Hospital, New York, New York, USA
| | - Susan W Broner
- Weill Cornell Medicine Headache Program, Department of Neurology, Weill Cornell Medical College, New York, New York, USA
| | - Andrea Yoo
- Neurology Residency Program, Department of Neurology, New York Presbyterian Hospital, New York, New York, USA
| | - Ivan Guan
- Department of Neurology, Weill Cornell Medical College, New York, New York, USA
| | - Shenela Lakhani
- Department of Neurology, Weill Cornell Medical College, New York, New York, USA.,Center for Neurogenetics, Feil Family Brain and Mind Research Institute, Weill Cornell Medical College, New York, New York, USA
| | - Maissa Trabilsy
- Department of Neurology, Weill Cornell Medical College, New York, New York, USA
| | - Louise Klebanoff
- Department of Neurology, Weill Cornell Medical College, New York, New York, USA
| | - Mary Vo
- Department of Neurology, Weill Cornell Medical College, New York, New York, USA
| | - Harini Sarva
- Parkinson's Disease & Movement Disorders Institute, Department of Neurology, Weill Cornell Medical College, New York, New York, USA
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Lim MM, Sarva H, Hiller A, Feitell S, Oates P, Barone D, Walker RH. Sleep disorders in McLeod syndrome: A case series. Parkinsonism Relat Disord 2022; 102:86-88. [PMID: 35977449 DOI: 10.1016/j.parkreldis.2022.07.013] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Revised: 07/12/2022] [Accepted: 07/17/2022] [Indexed: 10/15/2022]
Affiliation(s)
- Miranda M Lim
- VA Portland Health Care System, Portland, OR, USA; Oregon Health & Science University, Department of Neurology, Portland, OR, USA; Oregon Health & Science University, Department of Behavioral Neuroscience, Portland, OR, USA; Oregon Health & Science University, Oregon Institute of Occupational Health Sciences, Portland, OR, USA; VA Portland Health Care System, National Center for Rehabilitative Auditory Research, Portland, OR, USA
| | - Harini Sarva
- Parkinson's Disease and Movement Disorders Institute, Department of Neurology, Weill Cornell Medicine, New York, NY, USA
| | - Amie Hiller
- Oregon Health & Science University, Department of Neurology, Portland, OR, USA; Parkinson's Disease Research, Education, and Clinical Center, VA Portland Health Care System, Portland, OR, USA
| | - Scott Feitell
- Sands-Constellation Heart Institute, Rochester Regional Health, Rochester, NY, USA
| | - Patricia Oates
- Sands-Constellation Heart Institute, Rochester Regional Health, Rochester, NY, USA
| | - Daniel Barone
- Division of Sleep Medicine, Department of Neurology, Weill Cornell Medicine, New York, NY, USA
| | - Ruth H Walker
- Department of Neurology, James J. Peters Veterans Affairs Medical Center, Bronx, NY, USA; Department of Neurology, Mount Sinai School of Medicine, New York, NY, USA.
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Tripathi S, Malhotra A, Qazi M, Chou J, Wang F, Barkan S, Hellmers N, Henchcliffe C, Sarva H. Clinical Review of Smartphone Applications in Parkinson's Disease. Neurologist 2022; 27:183-193. [PMID: 35051970 DOI: 10.1097/nrl.0000000000000413] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Parkinson's disease (PD) is the second leading neurodegenerative disease worldwide. Important advances in monitoring and treatment have been made in recent years. This article reviews literature on utility of smartphone applications in monitoring PD symptoms that may ultimately facilitate improved patient care, and on movement modulation as a potential therapeutic. REVIEW SUMMARY Novel mobile phone applications can provide one-time and/or continuous data to monitor PD motor symptoms in person or remotely, that may support precise therapeutic adjustments and management decisions. Apps have also been developed for medication management and treatment. CONCLUSIONS Smartphone applications provide a wide array of platforms allowing for meaningful short-term and long-term data collection and are also being tested for intervention. However, the variability of the applications and the need to translate complicated sensor data may hinder immediate clinical applicability. Future studies should involve stake-holders early in the design process to promote usability and streamline the interface between patients, clinicians, and PD apps.
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Affiliation(s)
- Susmit Tripathi
- Department of Neurology, New York-Presbyterian Hospital/Weill Cornell Medical Center
- Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Ashwin Malhotra
- Department of Neurology, New York-Presbyterian Hospital/Weill Cornell Medical Center
- Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Murtaza Qazi
- Weill Cornell Medicine Qatar, Education City, Qatar
| | - Jingyuan Chou
- Department of Neurology, New York-Presbyterian Hospital/Weill Cornell Medical Center
| | - Fei Wang
- Department of Neurology, New York-Presbyterian Hospital/Weill Cornell Medical Center
| | - Samantha Barkan
- Department of Neurology, New York-Presbyterian Hospital/Weill Cornell Medical Center
| | - Natalie Hellmers
- Department of Neurology, New York-Presbyterian Hospital/Weill Cornell Medical Center
| | - Claire Henchcliffe
- Department of Neurology, New York-Presbyterian Hospital/Weill Cornell Medical Center
- Department of Neurology, University of California, Irvine, Irvine, CA
| | - Harini Sarva
- Department of Neurology, New York-Presbyterian Hospital/Weill Cornell Medical Center
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Alfonso D, Cabrera LY, Sidiropoulos C, Wang F, Sarva H. How Parkinson's patients in the USA perceive deep brain stimulation in the 21st century: Results of a nationwide survey. J Clin Neurosci 2021; 95:20-26. [PMID: 34929646 DOI: 10.1016/j.jocn.2021.11.017] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 10/20/2021] [Accepted: 11/21/2021] [Indexed: 10/19/2022]
Abstract
Research on attitudes regarding the use and timing of deep brain stimulation (DBS) has been mostly qualitative to this date. In this study, we aim to examine attitudes and perceptions about the use and timing of DBS in patients with Parkinson's disease (PD) who have not had DBS. We designed an online survey comprising Likert-type, multiple choice, and rank-order questions and distributed it to PD patients. We recruited participants via flyers, the Michael J. Fox Foundation Trial Finder, and the Parkinson Alliance website. We analyzed considerations for choosing or rejecting DBS and when participants would consider such a decision to be premature. Data were analyzed using descriptive and inferential statistics, including a multinomial logistic regression model. Among the 285 participants who reported not having undergone DBS, the most frequent concerns were related to the efficacy of DBS and not having exhausted medication alternatives. DBS was viewed as less convenient, effective, and safe when PD symptoms were still manageable by medication. Our regression model suggests that having fewer concerns over technical problems was a positive predictor of preferring early DBS, while concerns over DBS interfering with friendships and relationships was a negative predictor. Our results suggest that patients with PD who have not undergone DBS have a wide variety of attitudes regarding DBS and its timing. Given the increasing number of therapeutic options for PD, future work should compare perceptions and preferences regarding different PD treatment modalities to provide the best counseling for patients regarding their therapeutic options.
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Affiliation(s)
- Daniel Alfonso
- Weill Cornell Medical College, Weill Cornell Medicine, 1300 York Ave, New York, NY 10065, USA.
| | - Laura Y Cabrera
- Center for Neural Engineering, Department of Engineering Science and Mechanics, Pennsylvania State University, W-316 Millennium Science Complex, University Park, PA 16802, USA.
| | - Christos Sidiropoulos
- Department of Neurology and Ophthalmology, Michigan State University, 804 Service Road, East Lansing, MI 48824, USA.
| | - Fei Wang
- Population Health Sciences, Weill Cornell Medicine, 1300 York Ave, New York, NY 10065, USA.
| | - Harini Sarva
- Parkinson's Disease and Movement Disorders Institute, Department of Neurology, Weill Cornell Medicine, 428 E 72(nd) St Suite 400, New York, NY 10021, USA.
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Cabrera LY, Young Han C, Ostendorf T, Jimenez-Shahed J, Sarva H. Neurologists' Attitudes Toward Use and Timing of Deep Brain Stimulation. Neurol Clin Pract 2021; 11:506-516. [PMID: 34992957 PMCID: PMC8723941 DOI: 10.1212/cpj.0000000000001098] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 03/19/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVE We sought to explore current perspectives and attitudes of general neurologists and movement disorder specialists toward deep brain stimulation (DBS) for Parkinson disease (PD), focusing on perspectives on its earlier use in the clinical course of the disease. METHODS We designed a 30-question online survey comprised of Likert-type, multiple choice, and rank-order questions, which was distributed to 932 neurologist members of the American Academy of Neurology. We analyzed clinicians' sociodemographic information, treatment patterns used for patients with PD, reasons for and against patient referral for DBS, and general attitudes toward DBS. Data were analyzed using descriptive and inferential statistics. RESULTS We received 164/930 completed surveys (completion rate of 18%). Overall, most respondents agreed that DBS was more useful after the appearance of motor complications and that DBS utilization offered better management of PD than medication alone. However, respondents were divided on issues like minimum duration of disease needed to consider DBS as a treatment option and timing of DBS referral relative to disease progression. Specifically, differences between movement disorder specialists and general neurologists were seen in medication management of symptoms and dyskinesia. CONCLUSIONS There remains a lack of consensus on several aspects of DBS, including medical management before offering DBS and the appropriate timing of its consideration for patients. Given the effect of such lack of consensus on patients' outcomes and recent evidence on positive DBS results, it is essential to update DBS professional guidelines with a focus on medical management and the timely use of DBS.
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Affiliation(s)
- Laura Yenisa Cabrera
- Center for Ethics and Humanities in the Life Sciences (LYC), Department of Translational Neuroscience, Michigan State University, East Lansing, current affiliation: Center for Neural Engineering, Department of Engineering Science and Mechanics, Rock Ethics Institutes, Pennsylvania State University; Weill Cornell Medicine (CYH), New York; American Academy of Neurology (TO), Minneapolis, MN; Bonnie and Tom Strauss Movement Disorders Center (JJ-S), Icahn School of Medicine at Mount Sinai, New York; and Parkinson's Disease and Movement Disorders Institute (HS), Department of Neurology, Weill Cornell Medicine, New York
| | - Catherine Young Han
- Center for Ethics and Humanities in the Life Sciences (LYC), Department of Translational Neuroscience, Michigan State University, East Lansing, current affiliation: Center for Neural Engineering, Department of Engineering Science and Mechanics, Rock Ethics Institutes, Pennsylvania State University; Weill Cornell Medicine (CYH), New York; American Academy of Neurology (TO), Minneapolis, MN; Bonnie and Tom Strauss Movement Disorders Center (JJ-S), Icahn School of Medicine at Mount Sinai, New York; and Parkinson's Disease and Movement Disorders Institute (HS), Department of Neurology, Weill Cornell Medicine, New York
| | - Tasha Ostendorf
- Center for Ethics and Humanities in the Life Sciences (LYC), Department of Translational Neuroscience, Michigan State University, East Lansing, current affiliation: Center for Neural Engineering, Department of Engineering Science and Mechanics, Rock Ethics Institutes, Pennsylvania State University; Weill Cornell Medicine (CYH), New York; American Academy of Neurology (TO), Minneapolis, MN; Bonnie and Tom Strauss Movement Disorders Center (JJ-S), Icahn School of Medicine at Mount Sinai, New York; and Parkinson's Disease and Movement Disorders Institute (HS), Department of Neurology, Weill Cornell Medicine, New York
| | - Joohi Jimenez-Shahed
- Center for Ethics and Humanities in the Life Sciences (LYC), Department of Translational Neuroscience, Michigan State University, East Lansing, current affiliation: Center for Neural Engineering, Department of Engineering Science and Mechanics, Rock Ethics Institutes, Pennsylvania State University; Weill Cornell Medicine (CYH), New York; American Academy of Neurology (TO), Minneapolis, MN; Bonnie and Tom Strauss Movement Disorders Center (JJ-S), Icahn School of Medicine at Mount Sinai, New York; and Parkinson's Disease and Movement Disorders Institute (HS), Department of Neurology, Weill Cornell Medicine, New York
| | - Harini Sarva
- Center for Ethics and Humanities in the Life Sciences (LYC), Department of Translational Neuroscience, Michigan State University, East Lansing, current affiliation: Center for Neural Engineering, Department of Engineering Science and Mechanics, Rock Ethics Institutes, Pennsylvania State University; Weill Cornell Medicine (CYH), New York; American Academy of Neurology (TO), Minneapolis, MN; Bonnie and Tom Strauss Movement Disorders Center (JJ-S), Icahn School of Medicine at Mount Sinai, New York; and Parkinson's Disease and Movement Disorders Institute (HS), Department of Neurology, Weill Cornell Medicine, New York
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13
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Lee A, Sarva H. Approach to Tremor Disorders. Semin Neurol 2021; 41:731-743. [PMID: 34826875 DOI: 10.1055/s-0041-1726356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Tremor disorders are diverse and complex. Historical clues and examination features play a major role in diagnosing these disorders, but diagnosis can be challenging due to phenotypic overlap. Ancillary testing, such as neuroimaging or laboratory testing, is driven by the history and examination, and should be performed particularly when there are other neurological or systemic manifestations. The pathophysiology of tremor is not entirely understood, but likely involves multiple networks along with the cerebello-thalamo-cortical pathways. Treatment options include medications, botulinum toxin, surgery, and nonpharmacologic interventions utilizing physical and occupational therapies and assistive devices. Further work is needed in developing accurate diagnostic tests and better treatment options for tremor disorders.
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Affiliation(s)
- Andrea Lee
- Parkinson's Disease and Movement Disorders Institute, Division of Neurodegenerative Diseases, Department of Neurology, Weill Cornell Medicine, New York, New York
| | - Harini Sarva
- Parkinson's Disease and Movement Disorders Institute, Division of Neurodegenerative Diseases, Department of Neurology, Weill Cornell Medicine, New York, New York
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14
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Siddiqui MS, Jimenez-Shahed J, Mari Z, Walter BL, De Jesus S, Panov F, Schwalb JM, York MK, Sarva H, Bertoni JM, Patel N, Zhang L, McInerney J, Rosenow JM. North American survey on impact of the COVID-19 pandemic shutdown on DBS care. Parkinsonism Relat Disord 2021; 92:41-45. [PMID: 34688029 PMCID: PMC8522505 DOI: 10.1016/j.parkreldis.2021.10.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 09/14/2021] [Accepted: 10/10/2021] [Indexed: 12/25/2022]
Abstract
Background The initial COVID-19 pandemic shutdown led to the canceling of elective surgeries throughout most of the USA and Canada. Objective This survey was carried out on behalf of the Parkinson Study Group (PSG) to understand the impact of the shutdown on deep brain stimulation (DBS) practices in North America. Methods A survey was distributed through RedCap® to the members of the PSG Functional Neurosurgical Working Group. Only one member from each site was asked to respond to the survey. Responses were collected from May 15 to June 6, 2020. Results Twenty-three sites participated; 19 (83%) sites were from the USA and 4 (17%) from Canada. Twenty-one sites were academic medical centers. COVID-19 associated DBS restrictions were in place from 4 to 16 weeks. One-third of sites halted preoperative evaluations, while two-thirds of the sites offered limited preoperative evaluations. Institutional policy was the main contributor for the reported practice changes, with 87% of the sites additionally reporting patient-driven surgical delays secondary to pandemic concerns. Pre-post DBS associated management changes affected preoperative assessments 96%; electrode placement 87%; new implantable pulse generator (IPG) placement 83%; IPG replacement 65%; immediate postoperative DBS programming 74%; and routine DBS programming 91%. Conclusion The COVID-19 pandemic related shutdown resulted in DBS practice changes in almost all North American sites who responded to this large survey. Information learned could inform development of future contingency plans to reduce patient delays in care under similar circumstances.
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Affiliation(s)
- Mustafa S Siddiqui
- Department of Neurology, Wake Forest School of Medicine, 1 Medical Center, Boulevard, Winston-Salem, NC, 27157, USA.
| | - Joohi Jimenez-Shahed
- Icahn School of Medicine at Mount Sinai, 1000 10th Ave., Suite 10c, New York, NY, 10019, USA.
| | - Zoltan Mari
- Cleveland Clinic Lou Ruvo Center for Brain Health, 888 W Bonneville Ave, Las Vegas, NV, 89117, USA.
| | | | - Sol De Jesus
- Pennsylvania State University - Milton S. Hershey Medical Center, 30 Hope Drive, Suite 2800 P.O. Box 859, Mail Code EC037, Hershey, PA, 17033, USA.
| | - Fedor Panov
- Mount Sinai Medical Center, 1000 10th Ave, Suite 10C, Brooklyn, NY, 11217, USA.
| | - Jason M Schwalb
- Henry Ford Medical Group, 6777 West Maple Road, West Bloomfield, MI, 48322, USA.
| | - Michele K York
- Baylor College of Medicine, 7200 Cambridge St, 9th Floor, Houston, TX, 77030, USA.
| | - Harini Sarva
- Weill Cornell Medicine, 428 E 72nd Street, STE 400, NY, NY, 10021, USA.
| | - John M Bertoni
- University of Nebraska Medical Center, 988440 Nebraska Medical Center, Omaha, NE, 68198, USA.
| | - Neepa Patel
- Rush University Medical Center, 1725 West Harrison St. Suite 755, Chicago, IL, 60612, USA.
| | - Lin Zhang
- UCDavis, 4860 Y Street, ACC Building, Suite 3700, Sacramento, CA, 95817, USA.
| | - James McInerney
- Penn State Health, Milton S. Hershey Medical Center, Department of Neurosurgery, 30 Hope Drive, EC110, Hershey, PA, 17033, USA.
| | - Joshua M Rosenow
- Northwestern University Feinberg School of Medicine Department of Neurosurgery, 676 N St. Clair St, Suite 2210, Chicago, IL, USA.
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15
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Testini P, Sarva H, Schwalb J, Barkan S, Cabrera LY. Neurosurgeons perspective on the shift towards earlier use of deep brain stimulation for Parkinson disease. Interdisciplinary Neurosurgery 2021. [DOI: 10.1016/j.inat.2021.101224] [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: 11/26/2022] Open
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16
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Chou KL, Martello J, Atem J, Elrod M, Foster ER, Freshwater K, Gunzler SA, Kim H, Mahajan A, Sarva H, Stebbins GT, Lee E, Yang L. Quality Improvement in Neurology: 2020 Parkinson Disease Quality Measurement Set Update. Neurology 2021; 97:239-245. [PMID: 34341076 DOI: 10.1212/wnl.0000000000012198] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 04/07/2021] [Indexed: 12/13/2022] Open
Affiliation(s)
- Kelvin L Chou
- From the University of Michigan Medical School (K.L.C.), Ann Arbor; Christiana Care (J.M.), Wilmington, DE; UT Southwestern Medical Center (J.A.), Dallas, TX; MaxMD (M.E.), Fort Lee, NJ; Washington University School of Medicine (E.R.F.), St. Louis, MO; Bronson Neuroscience Center (K.F.), Kalamazoo, MI; University Hospitals Cleveland Medical Center and Case Western Reserve University (S.A.G.), OH; Veterans Affairs Puget Sound Health Care System (H.K.), Seattle, WA; Rush University Medical Center (A.M.), Chicago, IL; Weill Cornell Medicine (H.S.), New York, NY; Rush University (G.T.S.), Chicago, IL; American Academy of Neurology (E.L.), Minneapolis, MN; and Stanford Health Care (L.Y.), Palo Alto, CA
| | - Justin Martello
- From the University of Michigan Medical School (K.L.C.), Ann Arbor; Christiana Care (J.M.), Wilmington, DE; UT Southwestern Medical Center (J.A.), Dallas, TX; MaxMD (M.E.), Fort Lee, NJ; Washington University School of Medicine (E.R.F.), St. Louis, MO; Bronson Neuroscience Center (K.F.), Kalamazoo, MI; University Hospitals Cleveland Medical Center and Case Western Reserve University (S.A.G.), OH; Veterans Affairs Puget Sound Health Care System (H.K.), Seattle, WA; Rush University Medical Center (A.M.), Chicago, IL; Weill Cornell Medicine (H.S.), New York, NY; Rush University (G.T.S.), Chicago, IL; American Academy of Neurology (E.L.), Minneapolis, MN; and Stanford Health Care (L.Y.), Palo Alto, CA
| | - Juliana Atem
- From the University of Michigan Medical School (K.L.C.), Ann Arbor; Christiana Care (J.M.), Wilmington, DE; UT Southwestern Medical Center (J.A.), Dallas, TX; MaxMD (M.E.), Fort Lee, NJ; Washington University School of Medicine (E.R.F.), St. Louis, MO; Bronson Neuroscience Center (K.F.), Kalamazoo, MI; University Hospitals Cleveland Medical Center and Case Western Reserve University (S.A.G.), OH; Veterans Affairs Puget Sound Health Care System (H.K.), Seattle, WA; Rush University Medical Center (A.M.), Chicago, IL; Weill Cornell Medicine (H.S.), New York, NY; Rush University (G.T.S.), Chicago, IL; American Academy of Neurology (E.L.), Minneapolis, MN; and Stanford Health Care (L.Y.), Palo Alto, CA
| | - Matt Elrod
- From the University of Michigan Medical School (K.L.C.), Ann Arbor; Christiana Care (J.M.), Wilmington, DE; UT Southwestern Medical Center (J.A.), Dallas, TX; MaxMD (M.E.), Fort Lee, NJ; Washington University School of Medicine (E.R.F.), St. Louis, MO; Bronson Neuroscience Center (K.F.), Kalamazoo, MI; University Hospitals Cleveland Medical Center and Case Western Reserve University (S.A.G.), OH; Veterans Affairs Puget Sound Health Care System (H.K.), Seattle, WA; Rush University Medical Center (A.M.), Chicago, IL; Weill Cornell Medicine (H.S.), New York, NY; Rush University (G.T.S.), Chicago, IL; American Academy of Neurology (E.L.), Minneapolis, MN; and Stanford Health Care (L.Y.), Palo Alto, CA
| | - Erin R Foster
- From the University of Michigan Medical School (K.L.C.), Ann Arbor; Christiana Care (J.M.), Wilmington, DE; UT Southwestern Medical Center (J.A.), Dallas, TX; MaxMD (M.E.), Fort Lee, NJ; Washington University School of Medicine (E.R.F.), St. Louis, MO; Bronson Neuroscience Center (K.F.), Kalamazoo, MI; University Hospitals Cleveland Medical Center and Case Western Reserve University (S.A.G.), OH; Veterans Affairs Puget Sound Health Care System (H.K.), Seattle, WA; Rush University Medical Center (A.M.), Chicago, IL; Weill Cornell Medicine (H.S.), New York, NY; Rush University (G.T.S.), Chicago, IL; American Academy of Neurology (E.L.), Minneapolis, MN; and Stanford Health Care (L.Y.), Palo Alto, CA
| | - Karen Freshwater
- From the University of Michigan Medical School (K.L.C.), Ann Arbor; Christiana Care (J.M.), Wilmington, DE; UT Southwestern Medical Center (J.A.), Dallas, TX; MaxMD (M.E.), Fort Lee, NJ; Washington University School of Medicine (E.R.F.), St. Louis, MO; Bronson Neuroscience Center (K.F.), Kalamazoo, MI; University Hospitals Cleveland Medical Center and Case Western Reserve University (S.A.G.), OH; Veterans Affairs Puget Sound Health Care System (H.K.), Seattle, WA; Rush University Medical Center (A.M.), Chicago, IL; Weill Cornell Medicine (H.S.), New York, NY; Rush University (G.T.S.), Chicago, IL; American Academy of Neurology (E.L.), Minneapolis, MN; and Stanford Health Care (L.Y.), Palo Alto, CA
| | - Steven A Gunzler
- From the University of Michigan Medical School (K.L.C.), Ann Arbor; Christiana Care (J.M.), Wilmington, DE; UT Southwestern Medical Center (J.A.), Dallas, TX; MaxMD (M.E.), Fort Lee, NJ; Washington University School of Medicine (E.R.F.), St. Louis, MO; Bronson Neuroscience Center (K.F.), Kalamazoo, MI; University Hospitals Cleveland Medical Center and Case Western Reserve University (S.A.G.), OH; Veterans Affairs Puget Sound Health Care System (H.K.), Seattle, WA; Rush University Medical Center (A.M.), Chicago, IL; Weill Cornell Medicine (H.S.), New York, NY; Rush University (G.T.S.), Chicago, IL; American Academy of Neurology (E.L.), Minneapolis, MN; and Stanford Health Care (L.Y.), Palo Alto, CA
| | - Hojoong Kim
- From the University of Michigan Medical School (K.L.C.), Ann Arbor; Christiana Care (J.M.), Wilmington, DE; UT Southwestern Medical Center (J.A.), Dallas, TX; MaxMD (M.E.), Fort Lee, NJ; Washington University School of Medicine (E.R.F.), St. Louis, MO; Bronson Neuroscience Center (K.F.), Kalamazoo, MI; University Hospitals Cleveland Medical Center and Case Western Reserve University (S.A.G.), OH; Veterans Affairs Puget Sound Health Care System (H.K.), Seattle, WA; Rush University Medical Center (A.M.), Chicago, IL; Weill Cornell Medicine (H.S.), New York, NY; Rush University (G.T.S.), Chicago, IL; American Academy of Neurology (E.L.), Minneapolis, MN; and Stanford Health Care (L.Y.), Palo Alto, CA
| | - Abhimanyu Mahajan
- From the University of Michigan Medical School (K.L.C.), Ann Arbor; Christiana Care (J.M.), Wilmington, DE; UT Southwestern Medical Center (J.A.), Dallas, TX; MaxMD (M.E.), Fort Lee, NJ; Washington University School of Medicine (E.R.F.), St. Louis, MO; Bronson Neuroscience Center (K.F.), Kalamazoo, MI; University Hospitals Cleveland Medical Center and Case Western Reserve University (S.A.G.), OH; Veterans Affairs Puget Sound Health Care System (H.K.), Seattle, WA; Rush University Medical Center (A.M.), Chicago, IL; Weill Cornell Medicine (H.S.), New York, NY; Rush University (G.T.S.), Chicago, IL; American Academy of Neurology (E.L.), Minneapolis, MN; and Stanford Health Care (L.Y.), Palo Alto, CA
| | - Harini Sarva
- From the University of Michigan Medical School (K.L.C.), Ann Arbor; Christiana Care (J.M.), Wilmington, DE; UT Southwestern Medical Center (J.A.), Dallas, TX; MaxMD (M.E.), Fort Lee, NJ; Washington University School of Medicine (E.R.F.), St. Louis, MO; Bronson Neuroscience Center (K.F.), Kalamazoo, MI; University Hospitals Cleveland Medical Center and Case Western Reserve University (S.A.G.), OH; Veterans Affairs Puget Sound Health Care System (H.K.), Seattle, WA; Rush University Medical Center (A.M.), Chicago, IL; Weill Cornell Medicine (H.S.), New York, NY; Rush University (G.T.S.), Chicago, IL; American Academy of Neurology (E.L.), Minneapolis, MN; and Stanford Health Care (L.Y.), Palo Alto, CA
| | - Glenn T Stebbins
- From the University of Michigan Medical School (K.L.C.), Ann Arbor; Christiana Care (J.M.), Wilmington, DE; UT Southwestern Medical Center (J.A.), Dallas, TX; MaxMD (M.E.), Fort Lee, NJ; Washington University School of Medicine (E.R.F.), St. Louis, MO; Bronson Neuroscience Center (K.F.), Kalamazoo, MI; University Hospitals Cleveland Medical Center and Case Western Reserve University (S.A.G.), OH; Veterans Affairs Puget Sound Health Care System (H.K.), Seattle, WA; Rush University Medical Center (A.M.), Chicago, IL; Weill Cornell Medicine (H.S.), New York, NY; Rush University (G.T.S.), Chicago, IL; American Academy of Neurology (E.L.), Minneapolis, MN; and Stanford Health Care (L.Y.), Palo Alto, CA
| | - Erin Lee
- From the University of Michigan Medical School (K.L.C.), Ann Arbor; Christiana Care (J.M.), Wilmington, DE; UT Southwestern Medical Center (J.A.), Dallas, TX; MaxMD (M.E.), Fort Lee, NJ; Washington University School of Medicine (E.R.F.), St. Louis, MO; Bronson Neuroscience Center (K.F.), Kalamazoo, MI; University Hospitals Cleveland Medical Center and Case Western Reserve University (S.A.G.), OH; Veterans Affairs Puget Sound Health Care System (H.K.), Seattle, WA; Rush University Medical Center (A.M.), Chicago, IL; Weill Cornell Medicine (H.S.), New York, NY; Rush University (G.T.S.), Chicago, IL; American Academy of Neurology (E.L.), Minneapolis, MN; and Stanford Health Care (L.Y.), Palo Alto, CA.
| | - Laurice Yang
- From the University of Michigan Medical School (K.L.C.), Ann Arbor; Christiana Care (J.M.), Wilmington, DE; UT Southwestern Medical Center (J.A.), Dallas, TX; MaxMD (M.E.), Fort Lee, NJ; Washington University School of Medicine (E.R.F.), St. Louis, MO; Bronson Neuroscience Center (K.F.), Kalamazoo, MI; University Hospitals Cleveland Medical Center and Case Western Reserve University (S.A.G.), OH; Veterans Affairs Puget Sound Health Care System (H.K.), Seattle, WA; Rush University Medical Center (A.M.), Chicago, IL; Weill Cornell Medicine (H.S.), New York, NY; Rush University (G.T.S.), Chicago, IL; American Academy of Neurology (E.L.), Minneapolis, MN; and Stanford Health Care (L.Y.), Palo Alto, CA
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Nwabuobi L, Zhang C, Henchcliffe C, Shah H, Sarva H, Lee A, Kamel H. Characteristics and Outcomes of Parkinson's Disease Individuals Hospitalized with COVID-19 in a New York City Hospital System. Mov Disord Clin Pract 2021; 8:1100-1106. [PMID: 34541022 PMCID: PMC8441912 DOI: 10.1002/mdc3.13309] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 06/01/2021] [Accepted: 07/03/2021] [Indexed: 01/15/2023] Open
Abstract
Background The coronavirus disease 2019 (COVID‐19) pandemic has caused worse health outcomes among elderly populations with specific pre‐existing medical conditions and chronic illnesses. There are limited data on health outcomes of hospitalized Parkinson's disease (PD) individuals infected with COVID‐19. Objectives To determine clinical characteristics and outcomes in hospitalized PD individuals infected with COVID‐19. Methods Individuals admitted to NewYork‐Presbyterian with a diagnosis of PD were retrospectively identified using an electronic medical record system. Clinical characteristics and mortality were abstracted. Results Twenty‐five individuals with PD, mostly male (76%) with a median age of 82 years (IQR 73–88 years), were hospitalized for COVID‐19 infection. A total of 80% of individuals had mid‐stage to advanced PD (Hoehn and Yahr 3–5) and 80% were on symptomatic pharmacologic therapy, most commonly levodopa (72%). The most common comorbidities were hypertension (72%) and mild cognitive impairment or dementia (48%). A total of 44% and 12% of individuals presented with altered mental status and falls, respectively. Mortality rate was 32% compared to 26% for age‐matched controls (P = 0.743). Individuals who died were more likely to have encephalopathy during their admission (88% vs. 35%; P < 0.03). Conclusion PD individuals who require hospitalization for COVID‐19 infection are likely to be elderly, have mid‐stage to advanced disease, and be on pharmacologic therapy. Hypertension and cognitive impairment are common comorbidities in these individuals and encephalopathy during hospitalization is associated with risk of death. Altered mental status and falls are clinical presentations of COVID‐19 infection in PD that clinicians should be aware of. A diagnosis of PD is not a risk factor for COVID‐19 mortality.
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Affiliation(s)
- Lynda Nwabuobi
- Division of Neurodegenerative Diseases, Parkinson's Disease and Movement Disorders Institute, Department of Neurology Weill Cornell Medicine New York New York USA
| | - Cenai Zhang
- Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute and Department of Neurology Weill Cornell Medicine New York New York USA
| | | | - Hiral Shah
- Department of Neurology Columbia University Irving Medical Center New York New York USA
| | - Harini Sarva
- Division of Neurodegenerative Diseases, Parkinson's Disease and Movement Disorders Institute, Department of Neurology Weill Cornell Medicine New York New York USA
| | - Andrea Lee
- Division of Neurodegenerative Diseases, Parkinson's Disease and Movement Disorders Institute, Department of Neurology Weill Cornell Medicine New York New York USA
| | - Hooman Kamel
- Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute and Department of Neurology Weill Cornell Medicine New York New York USA
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Hellmers N, Barkan S, Auerbach G, Hanineva A, Popa P, Sarva H, Henchcliffe C. Tablet-based patient educational interventions in care and management of complex movement disorders. Disabil Rehabil Assist Technol 2021:1-8. [PMID: 33784918 DOI: 10.1080/17483107.2021.1900934] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Patient education is an essential part of management of complex, disabling neurological disorders. Mobile web-based educational materials provide a novel and potentially valuable means to communicate clinical information that can aid in both medical management and rehabilitation. AIMS We, therefore, evaluated an educational tablet-based intervention in three patient cohorts regarding the following topics: Parkinson's disease (PD) medications, dystonia and botulinum toxin treatment. METHODS A total of 50 subjects with PD, 32 with dystonia and 61 receiving botulinum toxin treatment for movement disorders or sialorrhoea were enrolled. Participants in each cohort completed a specific educational module at the time of their regularly scheduled clinic visit, comprising slides, in addition to pre- and post-module quizzes and a satisfaction survey. Additionally, participants in the dystonia and botulinum toxin modules were given a follow-up test at their 3- or 6-month clinical treatment visit. RESULTS There were 143 participants with 50 completing the PD module, 32 completing the dystonia module and 61 completing the botulinum toxin module. All three groups demonstrated significant improvement in knowledge of module content between their pre- and post-module test scores (PD: p=.0001, dystonia: p<.0001 and botulinum toxin: p=.008), and those who took the dystonia module maintained significant improvement at either a 3- or 6-month follow up compared to pre-module (p <.0001). CONCLUSIONS Tablet-based teaching modules are an effective means of communicating key concepts to patients. This study supports their use for improving patient understanding that can support lifelong approaches to managing disabling, neurological conditions.Implication for RehabilitationTablet-based modules are relatively easy to use for enhancing education during clinic visits and can possibly help reduce and maintain disability with chronic conditions like Parkinson's disease and dystonia.Improvements in post-test scores suggested that patient participants were able to retain information from the tablets about their complex and challenging conditions and treatments.Adding patients who are fluent in another language would have made this study more generalizable and future studies exploring educational interventions are warranted to help better tailor interventions to patients with chronic neurologic illnesses to help understand the complex aspects of their medical and rehabilitation therapy.The effect of cognitive changes in neurological conditions and understanding of educational information needs to be further tested.This positive result is especially meaningful during the COVID-19 pandemic when in-person access to both medical and rehabilitative care has been curtailed.
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Affiliation(s)
- Natalie Hellmers
- Department of Neurology, Weill Cornell Medicine, Parkinson's Disease and Movement Disorders Institute, New York, NY, USA
| | - Samantha Barkan
- Department of Neurology, Weill Cornell Medicine, Parkinson's Disease and Movement Disorders Institute, New York, NY, USA
| | - Gabrielle Auerbach
- Department of Neurology, Weill Cornell Medicine, Parkinson's Disease and Movement Disorders Institute, New York, NY, USA
| | - Aneliya Hanineva
- Department of Neurology, Weill Cornell Medicine, Parkinson's Disease and Movement Disorders Institute, New York, NY, USA
| | - Paul Popa
- Department of Neurology, Weill Cornell Medicine, Parkinson's Disease and Movement Disorders Institute, New York, NY, USA
| | - Harini Sarva
- Department of Neurology, Weill Cornell Medicine, Parkinson's Disease and Movement Disorders Institute, New York, NY, USA
| | - Claire Henchcliffe
- Department of Neurology, Weill Cornell Medicine, Parkinson's Disease and Movement Disorders Institute, New York, NY, USA
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Sarva H, Patino GA, Rashid M, Owens JWM, Robbins MS, Sandrone S. The status of neurology fellowships in the United States: clinical needs, educational barriers, and future outlooks. BMC Med Educ 2021; 21:108. [PMID: 33596875 PMCID: PMC7891131 DOI: 10.1186/s12909-021-02536-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 02/04/2021] [Indexed: 06/12/2023]
Abstract
The need for subspecialty-trained neurologists is growing in parallel with increasing disease burden. However, despite the immense burden of neurological diseases, like headache and neurodegenerative disorders, recruitment into these subspecialties remains insufficient in the United States. In this manuscript, a group of educators from the American Academy of Neurology's A.B. Baker Section on Neurological Education sought to review and discuss the current landscape of neurology fellowships in the United States, the factors driving fellowship recruitment and the educational barriers. Moreover, suggestions to potentially improve recruitment for under-selected fellowships, which can contribute towards an alignment between neurological education and neurological needs, and future educational scenarios are discussed.
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Affiliation(s)
- Harini Sarva
- A.B. Baker Section on Neurological Education, American Academy of Neurology, Minneapolis, USA.
- Weill Cornell Medicine, New York, NY, USA.
| | - Gustavo A Patino
- A.B. Baker Section on Neurological Education, American Academy of Neurology, Minneapolis, USA
- Oakland University William Beaumont School of Medicine, Rochester, MI, USA
| | - Mehmood Rashid
- A.B. Baker Section on Neurological Education, American Academy of Neurology, Minneapolis, USA
- The University of Toledo, Toledo, OH, USA
| | - James W M Owens
- A.B. Baker Section on Neurological Education, American Academy of Neurology, Minneapolis, USA.
- University of Washington, Seattle, Washington, USA.
| | - Matthew S Robbins
- A.B. Baker Section on Neurological Education, American Academy of Neurology, Minneapolis, USA
- Weill Cornell Medicine, New York, NY, USA
| | - Stefano Sandrone
- A.B. Baker Section on Neurological Education, American Academy of Neurology, Minneapolis, USA
- Imperial College London, London, UK
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20
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Cabrera LY, Mitchell SD, Bender A, Tvedten E, Sidiropoulos C, Sarva H. Attitudes toward use and timing of deep brain stimulation: a patient's with DBS perspective. Clin Neurol Neurosurg 2021; 203:106553. [PMID: 33610086 DOI: 10.1016/j.clineuro.2021.106553] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 01/16/2021] [Accepted: 02/06/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To guide responsive policy and better understand factors that might shape patients' decisions to have DBS earlier, we explore perspectives and attitudes toward earlier deep brain stimulation (DBS) of Parkinson disease (PD) patients with DBS. INTRODUCTION Before the US Food and Drug Administration released its change of indication for the use of DBS for PD, several groups had performed DBS earlier in disease course. METHODS We designed an online survey comprising Likert-type, multiple choice, and rank-order questions and distributed it to PD patients. We analyzed patient considerations for having chosen DBS and for choosing or rejecting to have DBS earlier, as well as factors potentially shaping perspectives around DBS and its timing. Data was analyzed using descriptive and inferential statistics. RESULTS Among the 160 participants in the sample, the most important consideration for choosing DBS was the possibility of better symptomatic control compared to medication alone. The most important consideration for delaying DBS was possible ineffectiveness. 41.3 % (n = 66) of respondents supported earlier DBS use, 38.8 % (n = 62) did not, and the remainder (n = 30) were uncertain. Patients who supported earlier DBS use cited the possibility of better symptomatic control than with medication alone, while those who did not support earlier use felt that medication options should be exhausted first. CONCLUSION Our results suggest that there are multiple factors shaping patient perceptions around earlier DBS implantation. Future work should compare perceptions before and after DBS implantation, as well as pair perceptions with clinical outcomes.
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Affiliation(s)
- Laura Y Cabrera
- Center for Ethics and Humanities in the Life Sciences, Michigan State University, East Lansing, MI, USA.
| | - Steven D Mitchell
- Department of Neurology, Michigan State University, East Lansing, MI, USA
| | - Andrew Bender
- Department of Epidemiology, Michigan State University, East Lansing, MI, USA
| | - Erika Tvedten
- College of Osteopathic Medicine, Michigan State University, East Lansing, MI, USA
| | | | - Harini Sarva
- Department of Neurology, Weill Cornell Medicine, New York, NY, USA
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21
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Lee A, Hellmers N, Vo M, Wang F, Popa P, Barkan S, Patel D, Campbell C, Henchcliffe C, Sarva H. Can google glass™ technology improve freezing of gait in parkinsonism? A pilot study. Disabil Rehabil Assist Technol 2020; 18:327-332. [PMID: 33216658 DOI: 10.1080/17483107.2020.1849433] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PURPOSE Freezing of gait (FOG) is a disabling phenomenon defined by the periodic absence or reduction of forward progression of the feet despite the intention to walk. We sought to understand whether Google Glass (GG), a lightweight wearable device that provides simultaneous visual-auditory cues, might improve FOG in parkinsonism. METHODS Patients with parkinsonism and FOG utilized GG custom-made auditory-visual cue applications: "Walk With Me" and "Unfreeze Me" in a single session intervention. We recorded ambulation time with and without GG under multiple conditions including 25 feet straight walk, dual task of performing serial 7's while straight walking, 180 degree turn after walking 25 feet, and walking through a doorway. FOG and patient experience questionnaires were administered. RESULTS Using the GG "Walk With Me" program, improvements were noted in the following: average 25 feet straight walk by 0.32 s (SD 2.12); average dual task of serial 7's and 25 feet straight walk by 1.79 s (SD 2.91); and average walk through doorway by 0.59 s (SD 0.81). Average 180 degree turn after 25 feet walk worsened by 1.89 s (SD 10.66). Using the "Unfreeze Me" program, only the average dual task of serial 7's and 25 feet straight walk improved (better by 0.82 s (SD 3.08 sec). All other tasks had worse performance in terms of speed of completion. CONCLUSION This feasibility study provides preliminary data suggesting that some walking tasks may improve with GG, which uses various musical dance programs to provide visual and auditory cueing for patients with FOG.IMPLICATIONS FOR REHABILITATIONFreezing of gait in parkinsonian syndromes is a disabling motor block described by patients as having their feet stuck to the floor leading to difficulty in initiation of gait and increased risk for falls.Wearable assistive devices such as Google Glass™ use visual and auditory cueing that may improve gait pattern in patients with freezing of gait.Augmented reality programs using wearable assistive devices are a home-based therapy, with the potential for reinforcing physical therapy techniques; this is especially meaningful during the COVID-19 pandemic when access to both medical and rehabilitative care has been curtailed.
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Affiliation(s)
- Andrea Lee
- Weill Cornell Medical College, New York, NY, USA
| | | | - Mary Vo
- Weill Cornell Medical College, New York, NY, USA
| | - Fei Wang
- Weill Cornell Medical College, New York, NY, USA
| | - Paul Popa
- Weill Cornell Medical College, New York, NY, USA
| | | | - Dylon Patel
- Weill Cornell Medical College, New York, NY, USA
| | | | | | - Harini Sarva
- Weill Cornell Medical College, New York, NY, USA
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23
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Rahman A, Schelbaum E, Hoffman K, Diaz I, Hristov H, Andrews R, Jett S, Jackson H, Lee A, Sarva H, Pahlajani S, Matthews D, Dyke J, de Leon MJ, Isaacson RS, Brinton RD, Mosconi L. Sex-driven modifiers of Alzheimer risk: A multimodality brain imaging study. Neurology 2020; 95:e166-e178. [PMID: 32580974 DOI: 10.1212/wnl.0000000000009781] [Citation(s) in RCA: 75] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Accepted: 12/17/2019] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE To investigate sex differences in late-onset Alzheimer disease (AD) risks by means of multimodality brain biomarkers (β-amyloid load via 11C-Pittsburgh compound B [PiB] PET, neurodegeneration via 18F-fluorodeoxyglucose [FDG] PET and structural MRI). METHODS We examined 121 cognitively normal participants (85 women and 36 men) 40 to 65 years of age with clinical, laboratory, neuropsychological, lifestyle, MRI, FDG- and PiB-PET examinations. Several clinical (e.g., age, education, APOE status, family history), medical (e.g., depression, diabetes mellitus, hyperlipidemia), hormonal (e.g., thyroid disease, menopause), and lifestyle AD risk factors (e.g., smoking, diet, exercise, intellectual activity) were assessed. Statistical parametric mapping and least absolute shrinkage and selection operator regressions were used to compare AD biomarkers between men and women and to identify the risk factors associated with sex-related differences. RESULTS Groups were comparable on clinical and cognitive measures. After adjustment for each modality-specific confounders, the female group showed higher PiB β-amyloid deposition, lower FDG glucose metabolism, and lower MRI gray and white matter volumes compared to the male group (p < 0.05, family-wise error corrected for multiple comparisons). The male group did not show biomarker abnormalities compared to the female group. Results were independent of age and remained significant with the use of age-matched groups. Second to female sex, menopausal status was the predictor most consistently and strongly associated with the observed brain biomarker differences, followed by hormone therapy, hysterectomy status, and thyroid disease. CONCLUSION Hormonal risk factors, in particular menopause, predict AD endophenotype in middle-aged women. These findings suggest that the window of opportunity for AD preventive interventions in women is early in the endocrine aging process.
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Affiliation(s)
- Aneela Rahman
- From the Departments of Neurology (A.R., E.S., I.D., H.H., S.J., H.J., A.L., H.S., S.P., R.S.I., L.M.) and Radiology (J.D., M.J.d.L., L.M.), Weill Cornell Medical College; Division of Biostatistics and Epidemiology (K.H., I.D.), Department of Healthcare Policy and Research, Weill Cornell Medicine, New York, NY; ADM Diagnostics (R.A., D.M.), Chicago, IL; and Departments of Pharmacology and Neurology (R.D.B.), College of Medicine, University of Arizona, Tucson
| | - Eva Schelbaum
- From the Departments of Neurology (A.R., E.S., I.D., H.H., S.J., H.J., A.L., H.S., S.P., R.S.I., L.M.) and Radiology (J.D., M.J.d.L., L.M.), Weill Cornell Medical College; Division of Biostatistics and Epidemiology (K.H., I.D.), Department of Healthcare Policy and Research, Weill Cornell Medicine, New York, NY; ADM Diagnostics (R.A., D.M.), Chicago, IL; and Departments of Pharmacology and Neurology (R.D.B.), College of Medicine, University of Arizona, Tucson
| | - Katherine Hoffman
- From the Departments of Neurology (A.R., E.S., I.D., H.H., S.J., H.J., A.L., H.S., S.P., R.S.I., L.M.) and Radiology (J.D., M.J.d.L., L.M.), Weill Cornell Medical College; Division of Biostatistics and Epidemiology (K.H., I.D.), Department of Healthcare Policy and Research, Weill Cornell Medicine, New York, NY; ADM Diagnostics (R.A., D.M.), Chicago, IL; and Departments of Pharmacology and Neurology (R.D.B.), College of Medicine, University of Arizona, Tucson
| | - Ivan Diaz
- From the Departments of Neurology (A.R., E.S., I.D., H.H., S.J., H.J., A.L., H.S., S.P., R.S.I., L.M.) and Radiology (J.D., M.J.d.L., L.M.), Weill Cornell Medical College; Division of Biostatistics and Epidemiology (K.H., I.D.), Department of Healthcare Policy and Research, Weill Cornell Medicine, New York, NY; ADM Diagnostics (R.A., D.M.), Chicago, IL; and Departments of Pharmacology and Neurology (R.D.B.), College of Medicine, University of Arizona, Tucson
| | - Hollie Hristov
- From the Departments of Neurology (A.R., E.S., I.D., H.H., S.J., H.J., A.L., H.S., S.P., R.S.I., L.M.) and Radiology (J.D., M.J.d.L., L.M.), Weill Cornell Medical College; Division of Biostatistics and Epidemiology (K.H., I.D.), Department of Healthcare Policy and Research, Weill Cornell Medicine, New York, NY; ADM Diagnostics (R.A., D.M.), Chicago, IL; and Departments of Pharmacology and Neurology (R.D.B.), College of Medicine, University of Arizona, Tucson
| | - Randolph Andrews
- From the Departments of Neurology (A.R., E.S., I.D., H.H., S.J., H.J., A.L., H.S., S.P., R.S.I., L.M.) and Radiology (J.D., M.J.d.L., L.M.), Weill Cornell Medical College; Division of Biostatistics and Epidemiology (K.H., I.D.), Department of Healthcare Policy and Research, Weill Cornell Medicine, New York, NY; ADM Diagnostics (R.A., D.M.), Chicago, IL; and Departments of Pharmacology and Neurology (R.D.B.), College of Medicine, University of Arizona, Tucson
| | - Steven Jett
- From the Departments of Neurology (A.R., E.S., I.D., H.H., S.J., H.J., A.L., H.S., S.P., R.S.I., L.M.) and Radiology (J.D., M.J.d.L., L.M.), Weill Cornell Medical College; Division of Biostatistics and Epidemiology (K.H., I.D.), Department of Healthcare Policy and Research, Weill Cornell Medicine, New York, NY; ADM Diagnostics (R.A., D.M.), Chicago, IL; and Departments of Pharmacology and Neurology (R.D.B.), College of Medicine, University of Arizona, Tucson
| | - Hande Jackson
- From the Departments of Neurology (A.R., E.S., I.D., H.H., S.J., H.J., A.L., H.S., S.P., R.S.I., L.M.) and Radiology (J.D., M.J.d.L., L.M.), Weill Cornell Medical College; Division of Biostatistics and Epidemiology (K.H., I.D.), Department of Healthcare Policy and Research, Weill Cornell Medicine, New York, NY; ADM Diagnostics (R.A., D.M.), Chicago, IL; and Departments of Pharmacology and Neurology (R.D.B.), College of Medicine, University of Arizona, Tucson
| | - Andrea Lee
- From the Departments of Neurology (A.R., E.S., I.D., H.H., S.J., H.J., A.L., H.S., S.P., R.S.I., L.M.) and Radiology (J.D., M.J.d.L., L.M.), Weill Cornell Medical College; Division of Biostatistics and Epidemiology (K.H., I.D.), Department of Healthcare Policy and Research, Weill Cornell Medicine, New York, NY; ADM Diagnostics (R.A., D.M.), Chicago, IL; and Departments of Pharmacology and Neurology (R.D.B.), College of Medicine, University of Arizona, Tucson
| | - Harini Sarva
- From the Departments of Neurology (A.R., E.S., I.D., H.H., S.J., H.J., A.L., H.S., S.P., R.S.I., L.M.) and Radiology (J.D., M.J.d.L., L.M.), Weill Cornell Medical College; Division of Biostatistics and Epidemiology (K.H., I.D.), Department of Healthcare Policy and Research, Weill Cornell Medicine, New York, NY; ADM Diagnostics (R.A., D.M.), Chicago, IL; and Departments of Pharmacology and Neurology (R.D.B.), College of Medicine, University of Arizona, Tucson
| | - Silky Pahlajani
- From the Departments of Neurology (A.R., E.S., I.D., H.H., S.J., H.J., A.L., H.S., S.P., R.S.I., L.M.) and Radiology (J.D., M.J.d.L., L.M.), Weill Cornell Medical College; Division of Biostatistics and Epidemiology (K.H., I.D.), Department of Healthcare Policy and Research, Weill Cornell Medicine, New York, NY; ADM Diagnostics (R.A., D.M.), Chicago, IL; and Departments of Pharmacology and Neurology (R.D.B.), College of Medicine, University of Arizona, Tucson
| | - Dawn Matthews
- From the Departments of Neurology (A.R., E.S., I.D., H.H., S.J., H.J., A.L., H.S., S.P., R.S.I., L.M.) and Radiology (J.D., M.J.d.L., L.M.), Weill Cornell Medical College; Division of Biostatistics and Epidemiology (K.H., I.D.), Department of Healthcare Policy and Research, Weill Cornell Medicine, New York, NY; ADM Diagnostics (R.A., D.M.), Chicago, IL; and Departments of Pharmacology and Neurology (R.D.B.), College of Medicine, University of Arizona, Tucson
| | - Jonathan Dyke
- From the Departments of Neurology (A.R., E.S., I.D., H.H., S.J., H.J., A.L., H.S., S.P., R.S.I., L.M.) and Radiology (J.D., M.J.d.L., L.M.), Weill Cornell Medical College; Division of Biostatistics and Epidemiology (K.H., I.D.), Department of Healthcare Policy and Research, Weill Cornell Medicine, New York, NY; ADM Diagnostics (R.A., D.M.), Chicago, IL; and Departments of Pharmacology and Neurology (R.D.B.), College of Medicine, University of Arizona, Tucson
| | - Mony J de Leon
- From the Departments of Neurology (A.R., E.S., I.D., H.H., S.J., H.J., A.L., H.S., S.P., R.S.I., L.M.) and Radiology (J.D., M.J.d.L., L.M.), Weill Cornell Medical College; Division of Biostatistics and Epidemiology (K.H., I.D.), Department of Healthcare Policy and Research, Weill Cornell Medicine, New York, NY; ADM Diagnostics (R.A., D.M.), Chicago, IL; and Departments of Pharmacology and Neurology (R.D.B.), College of Medicine, University of Arizona, Tucson
| | - Richard S Isaacson
- From the Departments of Neurology (A.R., E.S., I.D., H.H., S.J., H.J., A.L., H.S., S.P., R.S.I., L.M.) and Radiology (J.D., M.J.d.L., L.M.), Weill Cornell Medical College; Division of Biostatistics and Epidemiology (K.H., I.D.), Department of Healthcare Policy and Research, Weill Cornell Medicine, New York, NY; ADM Diagnostics (R.A., D.M.), Chicago, IL; and Departments of Pharmacology and Neurology (R.D.B.), College of Medicine, University of Arizona, Tucson
| | - Roberta D Brinton
- From the Departments of Neurology (A.R., E.S., I.D., H.H., S.J., H.J., A.L., H.S., S.P., R.S.I., L.M.) and Radiology (J.D., M.J.d.L., L.M.), Weill Cornell Medical College; Division of Biostatistics and Epidemiology (K.H., I.D.), Department of Healthcare Policy and Research, Weill Cornell Medicine, New York, NY; ADM Diagnostics (R.A., D.M.), Chicago, IL; and Departments of Pharmacology and Neurology (R.D.B.), College of Medicine, University of Arizona, Tucson
| | - Lisa Mosconi
- From the Departments of Neurology (A.R., E.S., I.D., H.H., S.J., H.J., A.L., H.S., S.P., R.S.I., L.M.) and Radiology (J.D., M.J.d.L., L.M.), Weill Cornell Medical College; Division of Biostatistics and Epidemiology (K.H., I.D.), Department of Healthcare Policy and Research, Weill Cornell Medicine, New York, NY; ADM Diagnostics (R.A., D.M.), Chicago, IL; and Departments of Pharmacology and Neurology (R.D.B.), College of Medicine, University of Arizona, Tucson.
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Abstract
There is escalating interest in cell-based therapies to restore lost dopamine inputs in Parkinson's disease. This is based upon the rationale that implanting dopamine progenitors into the striatum can potentially improve dopamine-responsive motor symptoms. A rich body of data describing clinical trials of previous cell transplantation exists. These have included multiple cell sources for transplantation including allogeneic (human embryonic mesencephalic tissue, retinal pigment epithelial cells) and autologous (carotid body, adrenal medullary tissue) cells, as well as xenotransplantation. However, there are multiple limitations related to these cell sources, including availability of adequate numbers of cells for transplant, heterogeneity within cells transplanted, imprecisely defined mechanisms of action, and poor cell survival after transplantation in some cases. Nonetheless, evidence has accrued from a subset of trials to support the rationale for such a regenerative approach. Recent rapid advances in stem cell technology may now overcome these prior limitations. For example, dopamine neuron precursor cells for transplant can be generated from induced pluripotent cells and human embryonic stem cells. The benefits of these innovative approaches include: the possibility of scalability; a high degree of quality control; and improved understanding of mechanisms of action with rigorous preclinical testing. In this review, we focus on the potential for cell-based therapies in Parkinson's disease to restore the function of dopaminergic neurons, we critically review previous attempts to harness such strategies, we discuss potential benefits and predicted limitations, and we address how previous roadblocks may be overcome to bring a cell-based approach to the clinic.
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Affiliation(s)
- Claire Henchcliffe
- Department of Neurology, Weill Medical College of Cornell University, 428 East 72nd Street, Suite 400, New York, NY, 10021, USA.
| | - Harini Sarva
- Department of Neurology, Weill Medical College of Cornell University, 428 East 72nd Street, Suite 400, New York, NY, 10021, USA
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Sandrone S, Berthaud JV, Carlson C, Cios J, Dixit N, Farheen A, Kraker J, Owens JWM, Patino G, Sarva H, Weber D, Schneider LD. Education Research: Flipped classroom in neurology: Principles, practices, and perspectives. Neurology 2020; 93:e106-e111. [PMID: 31262995 DOI: 10.1212/wnl.0000000000007730] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [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
How to most effectively deliver a large amount of information in an engaging environment that encourages critical thinking is a question that has long plagued educators. With ever-increasing demands on both resident and faculty time, from shrinking duty hours to increased patient complexity, combined with the exponential growth of medical knowledge and unequal access to the spectrum of neurologic subspecialties around the country, this question has become especially pertinent to neurology residency training. A team of educators from the American Academy of Neurology's A.B. Baker Section on Neurological Education sought to review the current evidence regarding the implementation of the flipped classroom format. This educational model has only recently been applied to health care education along the training continuum, and a small collection of articles has, so far, used disparate methods of curricular implementation and assessment. While the feedback from learners is generally positive, a number of obstacles to implementation exist, most notably learner time commitments. These are presented with discussion of potential solutions along with suggestions for future studies.
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Affiliation(s)
- Stefano Sandrone
- From the A.B. Baker Section on Neurological Education (S.S., J.V.B., C.C., J.C., N.D., A.F., J.K., J.W.M.O., G.P., H.S., D.W., L.D.S.), American Academy of Neurology, Minneapolis, MN; Imperial College London (S.S.), UK; University of Michigan (J.V.B.), Ann Arbor; Medical College of Wisconsin (C.C.), Milwaukee; Ohio State University (J.C.), Columbus; Weill Cornell Medicine (N.D., H.S.), New York, NY; Lebanon VA Medical Center (A.F.), PA; Tulane University School of Medicine (J.K.), New Orleans, LA; University of Washington (J.W.M.O.), Seattle; Oakland University William Beaumont School of Medicine (G.P.), Auburn Hills, MI; St. Louis University (D.W.), MO; and Stanford University (L.D.S.), CA.
| | - Jimmy V Berthaud
- From the A.B. Baker Section on Neurological Education (S.S., J.V.B., C.C., J.C., N.D., A.F., J.K., J.W.M.O., G.P., H.S., D.W., L.D.S.), American Academy of Neurology, Minneapolis, MN; Imperial College London (S.S.), UK; University of Michigan (J.V.B.), Ann Arbor; Medical College of Wisconsin (C.C.), Milwaukee; Ohio State University (J.C.), Columbus; Weill Cornell Medicine (N.D., H.S.), New York, NY; Lebanon VA Medical Center (A.F.), PA; Tulane University School of Medicine (J.K.), New Orleans, LA; University of Washington (J.W.M.O.), Seattle; Oakland University William Beaumont School of Medicine (G.P.), Auburn Hills, MI; St. Louis University (D.W.), MO; and Stanford University (L.D.S.), CA
| | - Chad Carlson
- From the A.B. Baker Section on Neurological Education (S.S., J.V.B., C.C., J.C., N.D., A.F., J.K., J.W.M.O., G.P., H.S., D.W., L.D.S.), American Academy of Neurology, Minneapolis, MN; Imperial College London (S.S.), UK; University of Michigan (J.V.B.), Ann Arbor; Medical College of Wisconsin (C.C.), Milwaukee; Ohio State University (J.C.), Columbus; Weill Cornell Medicine (N.D., H.S.), New York, NY; Lebanon VA Medical Center (A.F.), PA; Tulane University School of Medicine (J.K.), New Orleans, LA; University of Washington (J.W.M.O.), Seattle; Oakland University William Beaumont School of Medicine (G.P.), Auburn Hills, MI; St. Louis University (D.W.), MO; and Stanford University (L.D.S.), CA
| | - Jacquelyne Cios
- From the A.B. Baker Section on Neurological Education (S.S., J.V.B., C.C., J.C., N.D., A.F., J.K., J.W.M.O., G.P., H.S., D.W., L.D.S.), American Academy of Neurology, Minneapolis, MN; Imperial College London (S.S.), UK; University of Michigan (J.V.B.), Ann Arbor; Medical College of Wisconsin (C.C.), Milwaukee; Ohio State University (J.C.), Columbus; Weill Cornell Medicine (N.D., H.S.), New York, NY; Lebanon VA Medical Center (A.F.), PA; Tulane University School of Medicine (J.K.), New Orleans, LA; University of Washington (J.W.M.O.), Seattle; Oakland University William Beaumont School of Medicine (G.P.), Auburn Hills, MI; St. Louis University (D.W.), MO; and Stanford University (L.D.S.), CA
| | - Neel Dixit
- From the A.B. Baker Section on Neurological Education (S.S., J.V.B., C.C., J.C., N.D., A.F., J.K., J.W.M.O., G.P., H.S., D.W., L.D.S.), American Academy of Neurology, Minneapolis, MN; Imperial College London (S.S.), UK; University of Michigan (J.V.B.), Ann Arbor; Medical College of Wisconsin (C.C.), Milwaukee; Ohio State University (J.C.), Columbus; Weill Cornell Medicine (N.D., H.S.), New York, NY; Lebanon VA Medical Center (A.F.), PA; Tulane University School of Medicine (J.K.), New Orleans, LA; University of Washington (J.W.M.O.), Seattle; Oakland University William Beaumont School of Medicine (G.P.), Auburn Hills, MI; St. Louis University (D.W.), MO; and Stanford University (L.D.S.), CA
| | - Amtul Farheen
- From the A.B. Baker Section on Neurological Education (S.S., J.V.B., C.C., J.C., N.D., A.F., J.K., J.W.M.O., G.P., H.S., D.W., L.D.S.), American Academy of Neurology, Minneapolis, MN; Imperial College London (S.S.), UK; University of Michigan (J.V.B.), Ann Arbor; Medical College of Wisconsin (C.C.), Milwaukee; Ohio State University (J.C.), Columbus; Weill Cornell Medicine (N.D., H.S.), New York, NY; Lebanon VA Medical Center (A.F.), PA; Tulane University School of Medicine (J.K.), New Orleans, LA; University of Washington (J.W.M.O.), Seattle; Oakland University William Beaumont School of Medicine (G.P.), Auburn Hills, MI; St. Louis University (D.W.), MO; and Stanford University (L.D.S.), CA
| | - Jessica Kraker
- From the A.B. Baker Section on Neurological Education (S.S., J.V.B., C.C., J.C., N.D., A.F., J.K., J.W.M.O., G.P., H.S., D.W., L.D.S.), American Academy of Neurology, Minneapolis, MN; Imperial College London (S.S.), UK; University of Michigan (J.V.B.), Ann Arbor; Medical College of Wisconsin (C.C.), Milwaukee; Ohio State University (J.C.), Columbus; Weill Cornell Medicine (N.D., H.S.), New York, NY; Lebanon VA Medical Center (A.F.), PA; Tulane University School of Medicine (J.K.), New Orleans, LA; University of Washington (J.W.M.O.), Seattle; Oakland University William Beaumont School of Medicine (G.P.), Auburn Hills, MI; St. Louis University (D.W.), MO; and Stanford University (L.D.S.), CA
| | - James W M Owens
- From the A.B. Baker Section on Neurological Education (S.S., J.V.B., C.C., J.C., N.D., A.F., J.K., J.W.M.O., G.P., H.S., D.W., L.D.S.), American Academy of Neurology, Minneapolis, MN; Imperial College London (S.S.), UK; University of Michigan (J.V.B.), Ann Arbor; Medical College of Wisconsin (C.C.), Milwaukee; Ohio State University (J.C.), Columbus; Weill Cornell Medicine (N.D., H.S.), New York, NY; Lebanon VA Medical Center (A.F.), PA; Tulane University School of Medicine (J.K.), New Orleans, LA; University of Washington (J.W.M.O.), Seattle; Oakland University William Beaumont School of Medicine (G.P.), Auburn Hills, MI; St. Louis University (D.W.), MO; and Stanford University (L.D.S.), CA
| | - Gustavo Patino
- From the A.B. Baker Section on Neurological Education (S.S., J.V.B., C.C., J.C., N.D., A.F., J.K., J.W.M.O., G.P., H.S., D.W., L.D.S.), American Academy of Neurology, Minneapolis, MN; Imperial College London (S.S.), UK; University of Michigan (J.V.B.), Ann Arbor; Medical College of Wisconsin (C.C.), Milwaukee; Ohio State University (J.C.), Columbus; Weill Cornell Medicine (N.D., H.S.), New York, NY; Lebanon VA Medical Center (A.F.), PA; Tulane University School of Medicine (J.K.), New Orleans, LA; University of Washington (J.W.M.O.), Seattle; Oakland University William Beaumont School of Medicine (G.P.), Auburn Hills, MI; St. Louis University (D.W.), MO; and Stanford University (L.D.S.), CA
| | - Harini Sarva
- From the A.B. Baker Section on Neurological Education (S.S., J.V.B., C.C., J.C., N.D., A.F., J.K., J.W.M.O., G.P., H.S., D.W., L.D.S.), American Academy of Neurology, Minneapolis, MN; Imperial College London (S.S.), UK; University of Michigan (J.V.B.), Ann Arbor; Medical College of Wisconsin (C.C.), Milwaukee; Ohio State University (J.C.), Columbus; Weill Cornell Medicine (N.D., H.S.), New York, NY; Lebanon VA Medical Center (A.F.), PA; Tulane University School of Medicine (J.K.), New Orleans, LA; University of Washington (J.W.M.O.), Seattle; Oakland University William Beaumont School of Medicine (G.P.), Auburn Hills, MI; St. Louis University (D.W.), MO; and Stanford University (L.D.S.), CA
| | - Daniel Weber
- From the A.B. Baker Section on Neurological Education (S.S., J.V.B., C.C., J.C., N.D., A.F., J.K., J.W.M.O., G.P., H.S., D.W., L.D.S.), American Academy of Neurology, Minneapolis, MN; Imperial College London (S.S.), UK; University of Michigan (J.V.B.), Ann Arbor; Medical College of Wisconsin (C.C.), Milwaukee; Ohio State University (J.C.), Columbus; Weill Cornell Medicine (N.D., H.S.), New York, NY; Lebanon VA Medical Center (A.F.), PA; Tulane University School of Medicine (J.K.), New Orleans, LA; University of Washington (J.W.M.O.), Seattle; Oakland University William Beaumont School of Medicine (G.P.), Auburn Hills, MI; St. Louis University (D.W.), MO; and Stanford University (L.D.S.), CA
| | - Logan D Schneider
- From the A.B. Baker Section on Neurological Education (S.S., J.V.B., C.C., J.C., N.D., A.F., J.K., J.W.M.O., G.P., H.S., D.W., L.D.S.), American Academy of Neurology, Minneapolis, MN; Imperial College London (S.S.), UK; University of Michigan (J.V.B.), Ann Arbor; Medical College of Wisconsin (C.C.), Milwaukee; Ohio State University (J.C.), Columbus; Weill Cornell Medicine (N.D., H.S.), New York, NY; Lebanon VA Medical Center (A.F.), PA; Tulane University School of Medicine (J.K.), New Orleans, LA; University of Washington (J.W.M.O.), Seattle; Oakland University William Beaumont School of Medicine (G.P.), Auburn Hills, MI; St. Louis University (D.W.), MO; and Stanford University (L.D.S.), CA
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Sandrone S, Berthaud JV, Carlson C, Cios J, Dixit N, Farheen A, Kraker J, Owens JWM, Patino G, Sarva H, Weber D, Schneider LD. Active Learning in Psychiatry Education: Current Practices and Future Perspectives. Front Psychiatry 2020; 11:211. [PMID: 32390876 PMCID: PMC7190786 DOI: 10.3389/fpsyt.2020.00211] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2019] [Accepted: 03/03/2020] [Indexed: 01/21/2023] Open
Abstract
Over the past few decades, medical education has seen increased interest in the use of active learning formats to engage learners and promote knowledge application over knowledge acquisition. The field of psychiatry, in particular, has pioneered a host of novel active learning paradigms. These have contributed to our understanding of the role of andragogy along the continuum of medical education, from undergraduate to continuing medical education. In an effort to frame the successes and failures of various attempts at integrating active learning into healthcare curricula, a group of educators from the A. B. Baker Section on Neurological Education from the American Academy of Neurology reviewed the state of the field in its partner field of medical neuroscience. Herein we provide a narrative review of the literature, outlining the basis for implementing active learning, the novel formats that have been used, and the lessons learned from qualitative and quantitative analysis of the research that has been done to date. While preparation time seems to present the greatest obstacle to acceptance from learners and educators, there is generally positive reception to the new educational formats. Additionally, most assessments of trainee performance have suggested non-inferiority (if not superiority). However, occasional mixed findings point to a need for better assessments of the type of learning that these new formats engender: knowledge application rather than acquisition. Moreover, this field is relatively nascent and, in order to ascertain how best to integrate active learning into psychiatry education, a framework for quantitative outcome assessments is needed going forward.
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Affiliation(s)
- Stefano Sandrone
- A.B. Baker Section on Neurological Education, American Academy of Neurology, Minneapolis, MN, United States.,Department of Brain Sciences, Imperial College London, London, United Kingdom
| | - Jimmy V Berthaud
- A.B. Baker Section on Neurological Education, American Academy of Neurology, Minneapolis, MN, United States.,Department of Neurology, University of Michigan, Ann Arbor, MI, United States
| | - Chad Carlson
- A.B. Baker Section on Neurological Education, American Academy of Neurology, Minneapolis, MN, United States.,Department of Neurology, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Jacquelyne Cios
- A.B. Baker Section on Neurological Education, American Academy of Neurology, Minneapolis, MN, United States.,Department of Neurology, Ohio State University, Columbus, OH, United States
| | - Neel Dixit
- A.B. Baker Section on Neurological Education, American Academy of Neurology, Minneapolis, MN, United States.,Department of Neurology, Weill Cornell Medicine, New York, NY, United States
| | - Amtul Farheen
- A.B. Baker Section on Neurological Education, American Academy of Neurology, Minneapolis, MN, United States.,Department of Neurology, Lebanon VA Medical Center, Lebanon, PA, United States
| | - Jessica Kraker
- A.B. Baker Section on Neurological Education, American Academy of Neurology, Minneapolis, MN, United States.,Department of Neurology, Tulane University School of Medicine, New Orleans, LA, United States
| | - James W M Owens
- A.B. Baker Section on Neurological Education, American Academy of Neurology, Minneapolis, MN, United States.,Department of Neurology, Division of Pediatric Neurology, University of Washington, Washington, Seattle, WA, United States
| | - Gustavo Patino
- A.B. Baker Section on Neurological Education, American Academy of Neurology, Minneapolis, MN, United States.,Department of Biomedical Sciences, Division of Neuroscience, Oakland University William Beaumont School of Medicine, Auburn Hills, MI, United States
| | - Harini Sarva
- A.B. Baker Section on Neurological Education, American Academy of Neurology, Minneapolis, MN, United States.,Department of Neurology, Weill Cornell Medicine, New York, NY, United States
| | - Daniel Weber
- A.B. Baker Section on Neurological Education, American Academy of Neurology, Minneapolis, MN, United States.,Department of Neurology, St. Louis University, St. Louis, MO, United States
| | - Logan D Schneider
- A.B. Baker Section on Neurological Education, American Academy of Neurology, Minneapolis, MN, United States.,Stanford/VA Alzheimer's Center, Palo Alto VA Health Care System, Livermore, CA, United States.,Sierra Pacific Mental Illness Research Education and Clinical Centers, VA Palo Alto Health Care System, Livermore, CA, United States
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Barone DA, Wang F, Ravdin L, Vo M, Lee A, Sarva H, Hellmers N, Krieger AC, Henchcliffe C. Comorbid neuropsychiatric and autonomic features in REM sleep behavior disorder. Clin Park Relat Disord 2020; 3:100044. [PMID: 34316629 PMCID: PMC8298794 DOI: 10.1016/j.prdoa.2020.100044] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Revised: 12/27/2019] [Accepted: 01/26/2020] [Indexed: 11/28/2022] Open
Abstract
Objective Our aim is to define the extent of comorbidities in order to improve clinical care of patients with idiopathic rapid eye movement sleep behavior disorder (iRBD) utilizing the REM Sleep Behavior Disorder Associations with Parkinson's Disease Study (RAPiDS) cohort. Methods Consecutive adult study participants with iRBD confirmed on polysomnogram (PSG) were prospectively recruited from the Weill Cornell Center for Sleep Medicine. Evaluations comprised multiple facets of sleep, neurological, autonomic, and psychiatric function. Results Participants evaluated included 30 individuals with iRBD, with mean 1.5 ± 2.3 years from PSG to neuropsychiatric evaluation. Mean age was 59.5 ± 16.0 years at time of PSG, and 6/30 were women. Urinary difficulties were reported in 14/30 (47%): slight 7 (23%), mild 4 (13%), moderate 2 (7%), and severe 1 (3.0%). Ten out of 29 (34%) had abnormal Montreal Cognitive Assessment (MoCA) scores and the mean was 26.5 ± 3.2. The distribution of MoCA scores was significantly associated with urinary problems insofar as the more severe urinary problems were, the lower the MoCA scores (p = 0.04). Conclusions In this RAPiDS cohort, we detected an unexpectedly high occurrence of non-motor dysfunction. Our results point to the need for screening patients with iRBD for complaints that are actionable, for example those affecting mood, cognition, urinary function, and bowel function. We propose the term RBD+ to be used to identify such individuals. For the quality of life in patients diagnosed with RBD, a closer look by the clinician should be enacted, with appropriate referrals and workup. Comorbidities in idiopathic rapid eye movement sleep behavior disorder (iRBD) is further defined. REM Sleep Behavior Disorder Associations with Parkinson's Disease Study (RAPiDS) cohort There was a high occurrence of non-motor dysfunction in this cohort. The need for screening patients with iRBD for complaints that are actionable was demonstrated. We proposed the term “RBD+” to be used to identify such individuals.
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Affiliation(s)
- Daniel A. Barone
- Corresponding author at: Weill Cornell Medical College, Center for Sleep Medicine, 425 East 61st 5th Floor, New York, NY 10065, United States of America.
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Sandrone S, Berthaud JV, Carlson C, Cios J, Dixit N, Farheen A, Kraker J, Owens JWM, Patino G, Sarva H, Weber D, Schneider LD. Strategic Considerations for Applying the Flipped Classroom to Neurology Education. Ann Neurol 2019; 87:4-9. [PMID: 31581320 DOI: 10.1002/ana.25609] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 09/24/2019] [Accepted: 09/24/2019] [Indexed: 01/12/2023]
Abstract
Nowadays, the "flipped classroom" approach is taking the center stage within medical education. However, very few reports on the implementation of the flipped classroom in neurology have been published to date, and this educational model still represents a challenge for students and educators alike. In this article, neurology educators from the American Academy of Neurology's A. B. Baker Section on Neurological Education analyze reports of flipped classroom in other medical/surgical subspecialties, review the current implementation in neurology, and discuss future strategies to flip the neurology curriculum through contextualization of the benefits and the consequences. ANN NEUROL 2020;87:4-9.
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Affiliation(s)
- Stefano Sandrone
- A. B. Baker Section on Neurological Education, American Academy of Neurology, Minneapolis, MN.,Department of Brain Sciences, Imperial College London, London, United Kingdom
| | - Jimmy V Berthaud
- A. B. Baker Section on Neurological Education, American Academy of Neurology, Minneapolis, MN.,Department of Neurology, University of Michigan, Ann Arbor, MI
| | - Chad Carlson
- A. B. Baker Section on Neurological Education, American Academy of Neurology, Minneapolis, MN.,Department of Neurology, Medical College of Wisconsin, Milwaukee, WI
| | - Jacquelyne Cios
- A. B. Baker Section on Neurological Education, American Academy of Neurology, Minneapolis, MN.,Department of Neurology, Ohio State University, Columbus, OH
| | - Neel Dixit
- A. B. Baker Section on Neurological Education, American Academy of Neurology, Minneapolis, MN.,Department of Neurology, Weill Cornell Medicine, New York, NY
| | - Amtul Farheen
- A. B. Baker Section on Neurological Education, American Academy of Neurology, Minneapolis, MN.,Neurology Service, Lebanon VA Medical Center, Lebanon, PA
| | - Jessica Kraker
- A. B. Baker Section on Neurological Education, American Academy of Neurology, Minneapolis, MN.,Department of Neurology, Tulane University School of Medicine, New Orleans, LA
| | - James W M Owens
- A. B. Baker Section on Neurological Education, American Academy of Neurology, Minneapolis, MN.,Department of Neurology, University of Washington, Seattle, WA
| | - Gustavo Patino
- A. B. Baker Section on Neurological Education, American Academy of Neurology, Minneapolis, MN.,Department of Foundational Medical Studies, Oakland University William Beaumont School of Medicine, Rochester, MI
| | - Harini Sarva
- A. B. Baker Section on Neurological Education, American Academy of Neurology, Minneapolis, MN.,Department of Neurology, Weill Cornell Medicine, New York, NY
| | - Daniel Weber
- A. B. Baker Section on Neurological Education, American Academy of Neurology, Minneapolis, MN.,Department of Neurology, St Louis University, St Louis, MO
| | - Logan D Schneider
- A. B. Baker Section on Neurological Education, American Academy of Neurology, Minneapolis, MN.,Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA.,Sierra Pacific Mental Illness Research Education and Clinical Centers, VA Palo Alto Health Care System, Palo Alto, CA
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Weber D, Sarva H, Weaver J, Wang F, Chou J, Cornes S, Nickels K, Safdieh JE, Poncelet A, Stern BJ. Current state of educational compensation in academic neurology. Neurology 2019; 93:30-34. [DOI: 10.1212/wnl.0000000000007664] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Accepted: 03/12/2019] [Indexed: 11/15/2022] Open
Abstract
In the current medical climate, medical education is at risk of being de-emphasized, leading to less financial support and compensation for faculty. A rise in compensation plans that reward clinical or research productivity fails to incentivize and threatens to erode the educational missions of our academic institutions. Aligning compensation with the all-encompassing mission of academic centers can lead to increased faculty well-being, clinical productivity, and scholarship. An anonymous survey developed by members of the A.B. Baker Section on Neurologic Education was sent to the 133 chairs of neurology to assess the type of compensation faculty receive for teaching efforts. Seventy responses were received, with 59 being from chairs. Key results include the following: 36% of departments offered direct compensation; 36% did not; residency program directors received the most salary support at 36.5% full-time equivalent; and administrative roles had greatest weight in determining academic compensation. We believe a more effective, transparent system of recording and rewarding faculty for their educational efforts would encourage faculty to teach, streamline promotions for clinical educators, and strengthen undergraduate and graduate education in neurology.
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Sandrone S, Berthaud JV, Chuquilin M, Cios J, Ghosh P, Gottlieb-Smith RJ, Kushlaf H, Mantri S, Masangkay N, Menkes DL, Nevel KS, Sarva H, Schneider LD. Neurologic and neuroscience education. Neurology 2018; 92:174-179. [DOI: 10.1212/wnl.0000000000006716] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Accepted: 09/21/2018] [Indexed: 01/06/2023] Open
Abstract
Neurologic disorders are among the most frequent causes of morbidity and mortality in the United States. Moreover, the current shortfall of neurologists is expected to worsen over the coming decade. As a consequence, many patients with neurologic disorders will be treated by physicians and primary care providers without formal neurologic training. Furthermore, a pervasive and well-described fear of neurology, termed neurophobia, has been identified in medical student cohorts, residents, and among general practitioners. In this article, members of the American Academy of Neurology A.B. Baker Section on Neurological Education review current guidelines regarding neurologic and neuroscience education, contextualize the genesis and the negative consequences of neurophobia, and provide strategies to mitigate it for purposes of mentoring future generations of health care providers.
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Sarva H, Trosch R, Kiss ZHT, Furtado S, Luciano MS, Glickman A, Raymond D, Ozelius LJ, Bressman SB, Saunders-Pullman R. Deep Brain Stimulation in Isolated Dystonia With a GNAL Mutation. Mov Disord 2018; 34:301-303. [PMID: 30536916 DOI: 10.1002/mds.27585] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Revised: 10/16/2018] [Accepted: 11/15/2018] [Indexed: 11/10/2022] Open
Affiliation(s)
- Harini Sarva
- Department of Neurology, Mount Sinai Beth Israel Medical Center, New York, New York, USA
| | - Richard Trosch
- Department of Neurology, Oakland University - William Beaumont School of Medicine, Southfield, Michigan, USA
| | - Zelma H T Kiss
- Hotchkiss Brain Institute and Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
| | - Sarah Furtado
- Hotchkiss Brain Institute and Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
| | - Marta San Luciano
- Movement Disorder and Neuromodulation Center, Department of Neurology, UCSF Medical Center, San Francisco, California, USA
| | - Amanda Glickman
- Department of Neurology, Mount Sinai Beth Israel Medical Center, New York, New York, USA
| | - Deborah Raymond
- Department of Neurology, Mount Sinai Beth Israel Medical Center, New York, New York, USA
| | - Laurie J Ozelius
- Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Charlestown, Massachusetts, USA
| | - Susan B Bressman
- Department of Neurology, Mount Sinai Beth Israel Medical Center, New York, New York, USA
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Chazen JL, Sarva H, Stieg PE, Min RJ, Ballon DJ, Pryor KO, Riegelhaupt PM, Kaplitt MG. Clinical improvement associated with targeted interruption of the cerebellothalamic tract following MR-guided focused ultrasound for essential tremor. J Neurosurg 2018; 129:315-323. [DOI: 10.3171/2017.4.jns162803] [Citation(s) in RCA: 70] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVEThe objective of this study was to evaluate the utility of diffusion tensor imaging (DTI) tractography–based targeting of the dentatorubrothalamic tract (DRT) for magnetic resonance–guided focused ultrasound (MRgFUS) thalamotomy in patients with essential tremor (ET) and correlate postprocedural tract disruption with clinical outcomes.METHODSFour patients received preprocedural and immediate postprocedural DTI in addition to traditional anatomical MRI sequences for MRgFUS thalamotomy. Optimal ablation sites were selected based on the patient-specific location of the DRT as demonstrated by DTI (direct targeting) and correlated with traditional atlas-based measurements for thalamic ventral intermediate nucleus (Vim) lesioning (indirect targeting). Fiber tracts were displayed three-dimensionally during the procedure and used in conjunction with clinical signs of tremor control for fine correction of the ablation site. Immediately following the conclusion of the procedure, the MRgFUS head frame was removed and patients were placed in a 32-channel MRI head coil for follow-up DTI and anatomical MRI sequences.RESULTSAll patients had excellent postoperative tremor control and successful pre- and postprocedural DTI fiber tracking of the corticospinal tract, medial lemniscus, and DRT. Immediate postprocedure DTI failed to track the DRT ipsilateral to the lesion site with a preserved contralateral DRT, coincident with substantial resolution of contralateral tremor.CONCLUSIONSDTI can reliably identify the optimal ablation target and demonstrates tract disruption on immediate postprocedural imaging. A clinical improvement of ET was observed immediately following the procedure, correlating with DRT disruption and suggesting that interruption of the DRT is a consequence of clinically successful MRgFUS thalamotomy. These findings may have utility for both MRgFUS procedure planning in surgically naive patients and retreatment of patients who have previously undergone unsuccessful thalamic Vim lesioning.
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Affiliation(s)
| | | | | | | | | | - Kane O. Pryor
- 4Anesthesia, Weill Cornell Medicine, NewYork-Presbyterian Hospital, New York, New York
| | - Paul M. Riegelhaupt
- 4Anesthesia, Weill Cornell Medicine, NewYork-Presbyterian Hospital, New York, New York
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Abstract
INTRODUCTION Valbenazine is a selective VMAT2 inhibitor that the FDA approved in April 2017 for the specific treatment of tardive dyskinesia (TD), a movement disorder commonly caused by dopamine blocking agents. Valbenazine acts to decrease dopamine release, reducing excessive movement found in TD. Areas covered: This drug profile reviews the development of valbenazine and the clinical trials that led to its approval as the first treatment specific to TD. The literature search was performed with the PubMed online database. Expert commentary: Two clinical trials assessing the efficacy of valbenazine have shown the reduction of antipsychotic-induced involuntary movement. No life threatening adverse effects were found. Data from a 42-week extension study demonstrated sustained response.
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Affiliation(s)
- Harini Sarva
- a Parkinson's Disease and Movement Disorders Institute , Weill Cornell Medicine/New York Presbyterian Hospital , New York , NY , USA
| | - Claire Henchcliffe
- a Parkinson's Disease and Movement Disorders Institute , Weill Cornell Medicine/New York Presbyterian Hospital , New York , NY , USA
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Noch E, Henchcliffe C, Hellmers N, Chu ML, Pappas J, Moran E, Alcaraz W, Sarva H. Kufor-Rakeb Syndrome Due to a Novel ATP13A2 Mutation in 2 Chinese-American Brothers. Mov Disord Clin Pract 2017; 5:92-95. [PMID: 30746398 DOI: 10.1002/mdc3.12567] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Revised: 10/13/2017] [Accepted: 10/23/2017] [Indexed: 12/19/2022] Open
Affiliation(s)
- Evan Noch
- Department of Neurology Weill Cornell Medicine New York-Presbyterian Hospital New York New York USA
| | - Claire Henchcliffe
- Department of Neurology Weill Cornell Medicine New York-Presbyterian Hospital New York New York USA
| | - Natalie Hellmers
- Department of Neurology Weill Cornell Medicine New York-Presbyterian Hospital New York New York USA
| | - Mary Lynn Chu
- Department of Neurology New York University Langone Medical Center New York New York USA
| | - John Pappas
- Department of Pediatrics New York University Langone Medical Center New York New York USA
| | - Ellen Moran
- Center for Children New York University Hospital for Joint Diseases New York New York USA
| | | | - Harini Sarva
- Department of Neurology Weill Cornell Medicine New York-Presbyterian Hospital New York New York USA
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Estes C, Sadoughi B, Coleman R, Sarva H, Mauer E, Sulica L. A prospective crossover trial of botulinum toxin chemodenervation versus injection augmentation for essential voice tremor. Laryngoscope 2017; 128:437-446. [DOI: 10.1002/lary.26911] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/18/2017] [Indexed: 11/11/2022]
Affiliation(s)
- Christine Estes
- Sean Parker Institute for the Voice, Department of Otolaryngology-Head and Neck Surgery, Weill Cornell Medical College; New York New York U.S.A
| | - Babak Sadoughi
- Sean Parker Institute for the Voice, Department of Otolaryngology-Head and Neck Surgery, Weill Cornell Medical College; New York New York U.S.A
| | - Rachel Coleman
- Sean Parker Institute for the Voice, Department of Otolaryngology-Head and Neck Surgery, Weill Cornell Medical College; New York New York U.S.A
| | - Harini Sarva
- Department of Neurology, Weill Cornell Medical College; New York New York U.S.A
| | - Elizabeth Mauer
- Department of Biostatistics and Epidemiology; Weill Cornell Medical College; New York New York U.S.A
| | - Lucian Sulica
- Sean Parker Institute for the Voice, Department of Otolaryngology-Head and Neck Surgery, Weill Cornell Medical College; New York New York U.S.A
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Sarva H, Miravite J, Swan MC, Deik A, Raymond D, Severt WL, Kopell BH. A Case of Myoclonus-Dystonia Responding to Low-frequency Pallidal Stimulation. Tremor Other Hyperkinet Mov (N Y) 2017; 7:460. [PMID: 28503362 PMCID: PMC5425800 DOI: 10.7916/d82z1bs4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2017] [Accepted: 04/17/2017] [Indexed: 06/07/2023] Open
Abstract
BACKGROUND High-frequency pallidal stimulation has been shown to improve various types of dystonia, including myoclonus-dystonia. CASE REPORT We report a case of epsilon sarcoglycan mutation-negative myoclonus-dystonia with response to low-frequency bilateral pallidal stimulation. DISCUSSION Low-frequency pallidal stimulation provides an effective means of treating various dystonias, regardless of genetic status, as in our case, as it provides increased programming options with fewer adverse effects.
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Affiliation(s)
- Harini Sarva
- Parkinson’s Disease and Movement Disorders Institute, Department of Neurology, Weill Cornell Medicine, New York, NY, USA
| | - Joan Miravite
- Department of Neurology, Division of Movement Disorders, Icahn School of Medicine at Mount Sinai, Mount Sinai Beth Israel Medical Center, New York, NY, USA
| | - Matthew C. Swan
- Department of Neurology, Division of Movement Disorders, Icahn School of Medicine at Mount Sinai, Mount Sinai Beth Israel Medical Center, New York, NY, USA
| | - Andres Deik
- Parkinson Disease and Movement Disorders Center, Department of Neurology, University of Pennsylvania, Philadelphia, PA, USA
| | - Deborah Raymond
- Department of Neurology, Division of Movement Disorders, Icahn School of Medicine at Mount Sinai, Mount Sinai Beth Israel Medical Center, New York, NY, USA
| | - William Lawrence Severt
- Department of Neurology, Division of Movement Disorders, Icahn School of Medicine at Mount Sinai, Mount Sinai Beth Israel Medical Center, New York, NY, USA
| | - Brian H. Kopell
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, Mount Sinai Medical Center, New York, NY, USA
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Abstract
Parkinson's disease (PD) is a progressive neurodegenerative disorder with both motor and nonmotor symptoms (NMS), leading to significant morbidity and caregiver burden. Psychosis is common but is under recognized by physicians. When present, it increases the patient's risk of hospitalization and nursing home placement and caregiver burden. Although the atypical antipsychotic agent, clozapine, has been considered the gold standard treatment, severe agranulocytosis in 0.38% of patients and more commonly milder leukopenia, resulting in frequent blood testing, limit its use. Pimavanserin, a 5HT2A receptor inverse agonist, has been shown to reduce psychosis in PD without worsening motor symptoms. It is therefore a welcome therapeutic option for this devastating NMS.
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Affiliation(s)
- Harini Sarva
- Division of Neurology, Maimonides Medical Center, 883 65 Street, Brooklyn, NY 11220, USA
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Swan M, Doan N, Ortega RA, Barrett M, Nichols W, Ozelius L, Soto-Valencia J, Boschung S, Deik A, Sarva H, Cabassa J, Johannes B, Raymond D, Marder K, Giladi N, Miravite J, Severt W, Sachdev R, Shanker V, Bressman S, Saunders-Pullman R. Neuropsychiatric characteristics of GBA-associated Parkinson disease. J Neurol Sci 2016; 370:63-69. [PMID: 27772789 DOI: 10.1016/j.jns.2016.08.059] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [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: 05/02/2016] [Revised: 08/22/2016] [Accepted: 08/29/2016] [Indexed: 12/29/2022]
Abstract
Mutations in GBA1 are a well-established risk factor for Parkinson disease (PD). GBA-associated PD (GBA-PD) may have a higher burden of nonmotor symptoms than idiopathic PD (IPD). We sought to characterize the relationship between GBA-PD and neuropsychiatric symptoms. Subjects were screened for common GBA1 mutations. GBA-PD (n=31) and non-carrier (IPD; n=55) scores were compared on the Unified Parkinson Disease Rating Scale (UPDRS), Montreal Cognitive Assessment (MoCA), Beck Depression Inventory (BDI), and the State-Trait Anxiety Index (STAI). In univariate comparisons, GBA-PD had a greater prevalence of depression (33.3%) versus IPD (13.2%) (p<0.05). In regression models controlling for age, sex, disease duration, motor disability, and MoCA score, GBA-PD had an increased odds of depression (OR 3.66, 95% CI 1.13-11.8) (p=0.03). Post-hoc analysis stratified by sex showed that, among men, GBA-PD had a higher burden of trait anxiety and depression than IPD; this finding was sustained in multivariate models. Among women, GBA-PD did not confer greater psychiatric morbidity than IPD. These results suggest that GBA1 mutations confer greater risk of neuropsychiatric morbidity in PD, and that sex may affect this association.
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Affiliation(s)
- Matthew Swan
- Department of Neurology, Mount Sinai Beth Israel, and Department of Neurology, Icahn School of Medicine, Mount Sinai, New York, NY, USA; Department of Neurology, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY, USA.
| | - Nancy Doan
- Department of Neurology, Mount Sinai Beth Israel, and Department of Neurology, Icahn School of Medicine, Mount Sinai, New York, NY, USA
| | - Robert A Ortega
- Department of Neurology, Mount Sinai Beth Israel, and Department of Neurology, Icahn School of Medicine, Mount Sinai, New York, NY, USA
| | - Matthew Barrett
- Department of Neurology, University of Virginia Health System, Charlottesville, VA, USA.
| | - William Nichols
- Division of Human Genetics, Cincinnati Children's Hospital Medical Center, and Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
| | - Laurie Ozelius
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA.
| | - Jeannie Soto-Valencia
- Department of Neurology, Mount Sinai Beth Israel, and Department of Neurology, Icahn School of Medicine, Mount Sinai, New York, NY, USA
| | - Sarah Boschung
- Department of Neurology, Mount Sinai Beth Israel, and Department of Neurology, Icahn School of Medicine, Mount Sinai, New York, NY, USA
| | - Andres Deik
- Department of Neurology, Mount Sinai Beth Israel, and Department of Neurology, Icahn School of Medicine, Mount Sinai, New York, NY, USA.
| | - Harini Sarva
- Department of Neurology, Mount Sinai Beth Israel, and Department of Neurology, Icahn School of Medicine, Mount Sinai, New York, NY, USA.
| | - Jose Cabassa
- Department of Neurology, Mount Sinai Beth Israel, and Department of Neurology, Icahn School of Medicine, Mount Sinai, New York, NY, USA.
| | - Brooke Johannes
- Department of Neurology, Mount Sinai Beth Israel, and Department of Neurology, Icahn School of Medicine, Mount Sinai, New York, NY, USA
| | - Deborah Raymond
- Department of Neurology, Mount Sinai Beth Israel, and Department of Neurology, Icahn School of Medicine, Mount Sinai, New York, NY, USA
| | - Karen Marder
- Department of Neurology and Psychiatry, Taub Institute, and Sergievsky Center, Columbia University, College of Physicians and Surgeons, New York, NY, USA.
| | - Nir Giladi
- Movement Disorders Unit, Neurological Institute, Tel Aviv Medical Center, Sackler School of Medicine, Sagol School of Neuroscience, Tel-Aviv University, Tel Aviv, Israel.
| | - Joan Miravite
- Department of Neurology, Mount Sinai Beth Israel, and Department of Neurology, Icahn School of Medicine, Mount Sinai, New York, NY, USA
| | - William Severt
- Department of Neurology, Mount Sinai Beth Israel, and Department of Neurology, Icahn School of Medicine, Mount Sinai, New York, NY, USA
| | - Rivka Sachdev
- Department of Neurology, Mount Sinai Beth Israel, and Department of Neurology, Icahn School of Medicine, Mount Sinai, New York, NY, USA
| | - Vicki Shanker
- Department of Neurology, Mount Sinai Beth Israel, and Department of Neurology, Icahn School of Medicine, Mount Sinai, New York, NY, USA
| | - Susan Bressman
- Department of Neurology, Mount Sinai Beth Israel, and Department of Neurology, Icahn School of Medicine, Mount Sinai, New York, NY, USA
| | - Rachel Saunders-Pullman
- Department of Neurology, Mount Sinai Beth Israel, and Department of Neurology, Icahn School of Medicine, Mount Sinai, New York, NY, USA.
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Sarva H, Deik A, Ullah A, Severt WL. Clinical Spectrum of Stiff Person Syndrome: A Review of Recent Reports. Tremor Other Hyperkinet Mov (N Y) 2016; 6:340. [PMID: 26989571 PMCID: PMC4790195 DOI: 10.7916/d85m65gd] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/25/2015] [Accepted: 12/22/2015] [Indexed: 12/11/2022]
Abstract
Background “Classic” stiff person syndrome (SPS) features stiffness, anti-glutamic acid decarboxylase (anti-GAD) antibodies, and other findings. Anti-GAD antibodies are also detected in some neurological syndromes (such as ataxia) in which stiffness is inconsistently present. Patients with otherwise “classic” SPS may either lack anti-GAD antibodies or be seropositive for others. Hence, SPS cases appear to fall within a clinical spectrum that includes conditions such as progressive encephalomyelitis with rigidity and myoclonus (PERM), which exhibits brainstem and autonomic features. We have compiled herein SPS-spectrum cases reported since 2010, and have segregated them on the basis of likely disease mechanism (autoimmune, paraneoplastic, or cryptogenic) for analysis. Methods The phrases “stiff person syndrome”, “PERM”, “anti-GAD antibody syndrome”, and “glycine receptor antibody neurological disorders” were searched for in PubMed in January 2015. The results were narrowed to 72 citations after excluding non-English and duplicate reports. Clinical descriptions, laboratory data, management, and outcomes were categorized, tabulated, and analyzed. Results Sixty-nine autoimmune, 19 paraneoplastic, and 13 cryptogenic SPS-spectrum cases were identified. SPS was the predominant diagnosis among the groups. Roughly two-thirds of autoimmune and paraneoplastic cases were female. Anti-GAD antibodies were most frequently identified, followed by anti-amphiphysin among paraneoplastic cases and by anti-glycine receptor antibodies among autoimmune cases. Benzodiazepines were the most commonly used medications. Prognosis seemed best for cryptogenic cases; malignancy worsened that of paraneoplastic cases. Discussion Grouping SPS-spectrum cases by pathophysiology provided insights into work-up, treatment, and prognosis. Ample phenotypic and serologic variations are present within the categories. Ruling out malignancy and autoimmunity is appropriate for suspected SPS-spectrum cases.
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Affiliation(s)
- Harini Sarva
- Department of Neurology, Maimonides Medical Center, Brooklyn, NY, USA
| | - Andres Deik
- Parkinson Disease and Movement Disorders Center, Department of Neurology, University of Pennsylvania, PA, USA
| | - Aman Ullah
- Department of Neurology, Maimonides Medical Center, Brooklyn, NY, USA
| | - William L Severt
- Department of Neurology, Division of Movement Disorders, Icahn School of Medicine at Mount Sinai, Mount Sinai Beth Israel Medical Center, New York, NY, USA
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Sarva H, Severt WL, Jacoby N, Pullman SL, Saunders-Pullman R. Secondary orthostatic tremor in the setting of cerebellar degeneration. J Clin Neurosci 2016; 27:173-5. [PMID: 26765757 DOI: 10.1016/j.jocn.2015.10.027] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [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: 08/25/2014] [Revised: 07/10/2015] [Accepted: 10/17/2015] [Indexed: 11/27/2022]
Abstract
Orthostatic tremor (OT) and cerebellar ataxia are uncommon and difficult to treat. We present two patients with OT and cerebellar degeneration, one of whom had spinocerebellar ataxia type 2 and a good treatment response.
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Affiliation(s)
- Harini Sarva
- Department of Neurology, Division of Movement Disorders, Mount Sinai Beth Israel, 10 Union Square East, New York, NY 10003, USA.
| | - William Lawrence Severt
- Department of Neurology, Division of Movement Disorders, Mount Sinai Beth Israel, 10 Union Square East, New York, NY 10003, USA
| | - Nuri Jacoby
- Department of Neurology, Maimonides Medical Center, Brooklyn, NY, USA
| | - Seth L Pullman
- The Neurological Institute, Columbia University Medical Center, New York, NY, USA
| | - Rachel Saunders-Pullman
- Department of Neurology, Division of Movement Disorders, Mount Sinai Beth Israel, 10 Union Square East, New York, NY 10003, USA; Department of Neurology, Icahn School of Medicine, Mount Sinai Medical Center, New York, NY, USA
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Khasani S, Gill S, Semenova L, Sarva H. Predominant Jaw Myoclonus from Cefepime Toxicity: A Case Report and a Review of the Literature. J Mov Disord 2015; 8:144-6. [PMID: 26413243 PMCID: PMC4572666 DOI: 10.14802/jmd.15017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2015] [Revised: 08/21/2015] [Accepted: 08/21/2015] [Indexed: 11/24/2022] Open
Affiliation(s)
- Sina Khasani
- Division of Neurology, Maimonides Medical Center, Brooklyn, New York, USA
| | - Sonia Gill
- St. George's University School of Medicine, Grenada
| | - Liliya Semenova
- Institute of Technology College of Osteopathic Medicine, Old Westbury, New York, USA
| | - Harini Sarva
- Division of Neurology, Maimonides Medical Center, Brooklyn, New York, USA
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Sarva H, Deik A, Swan MC, Severt WL. Freezing of gait after a hemorrhagic stroke can respond to venlafaxine and rivastigmine. Neurol Clin Pract 2015; 5:267-269. [DOI: 10.1212/cpj.0000000000000123] [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: 11/15/2022]
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Miravite J, Deik A, Swan M, Sarva H, Kopell BH, Severt WL. Parkinsonism and dystonia in Lubag disease respond well to high pulse width/low-frequency globus pallidus interna DBS. Neurol Clin Pract 2015; 5:480-483. [PMID: 29595821 DOI: 10.1212/cpj.0000000000000130] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [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]
Affiliation(s)
- Joan Miravite
- Department of Neurology (JM, WLS), Mount Sinai Beth Israel, New York, NY; Department of Neurology (AD), University of Pennsylvania Parkinson's Disease and Movement Disorders Center, Philadelphia, PA; Saul R. Korey Department of Neurology (MS), Albert Einstein College of Medicine, Bronx, NY; Department of Neurology (HS), Maimonides Medical Center, Brooklyn, NY; and Departments of Neurosurgery, Neurology, Psychiatry, and Neuroscience (BHK), Mount Sinai Medical Center, New York, NY
| | - Andres Deik
- Department of Neurology (JM, WLS), Mount Sinai Beth Israel, New York, NY; Department of Neurology (AD), University of Pennsylvania Parkinson's Disease and Movement Disorders Center, Philadelphia, PA; Saul R. Korey Department of Neurology (MS), Albert Einstein College of Medicine, Bronx, NY; Department of Neurology (HS), Maimonides Medical Center, Brooklyn, NY; and Departments of Neurosurgery, Neurology, Psychiatry, and Neuroscience (BHK), Mount Sinai Medical Center, New York, NY
| | - Matthew Swan
- Department of Neurology (JM, WLS), Mount Sinai Beth Israel, New York, NY; Department of Neurology (AD), University of Pennsylvania Parkinson's Disease and Movement Disorders Center, Philadelphia, PA; Saul R. Korey Department of Neurology (MS), Albert Einstein College of Medicine, Bronx, NY; Department of Neurology (HS), Maimonides Medical Center, Brooklyn, NY; and Departments of Neurosurgery, Neurology, Psychiatry, and Neuroscience (BHK), Mount Sinai Medical Center, New York, NY
| | - Harini Sarva
- Department of Neurology (JM, WLS), Mount Sinai Beth Israel, New York, NY; Department of Neurology (AD), University of Pennsylvania Parkinson's Disease and Movement Disorders Center, Philadelphia, PA; Saul R. Korey Department of Neurology (MS), Albert Einstein College of Medicine, Bronx, NY; Department of Neurology (HS), Maimonides Medical Center, Brooklyn, NY; and Departments of Neurosurgery, Neurology, Psychiatry, and Neuroscience (BHK), Mount Sinai Medical Center, New York, NY
| | - Brian Harris Kopell
- Department of Neurology (JM, WLS), Mount Sinai Beth Israel, New York, NY; Department of Neurology (AD), University of Pennsylvania Parkinson's Disease and Movement Disorders Center, Philadelphia, PA; Saul R. Korey Department of Neurology (MS), Albert Einstein College of Medicine, Bronx, NY; Department of Neurology (HS), Maimonides Medical Center, Brooklyn, NY; and Departments of Neurosurgery, Neurology, Psychiatry, and Neuroscience (BHK), Mount Sinai Medical Center, New York, NY
| | - William Lawrence Severt
- Department of Neurology (JM, WLS), Mount Sinai Beth Israel, New York, NY; Department of Neurology (AD), University of Pennsylvania Parkinson's Disease and Movement Disorders Center, Philadelphia, PA; Saul R. Korey Department of Neurology (MS), Albert Einstein College of Medicine, Bronx, NY; Department of Neurology (HS), Maimonides Medical Center, Brooklyn, NY; and Departments of Neurosurgery, Neurology, Psychiatry, and Neuroscience (BHK), Mount Sinai Medical Center, New York, NY
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Sarva H, Deik A, Severt WL. Pathophysiology and treatment of alien hand syndrome. Tremor Other Hyperkinet Mov (N Y) 2014; 4:241. [PMID: 25506043 PMCID: PMC4261226 DOI: 10.7916/d8vx0f48] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/09/2014] [Accepted: 10/21/2014] [Indexed: 12/01/2022]
Abstract
Background Alien hand syndrome (AHS) is a disorder of involuntary, yet purposeful,
hand movements that may be accompanied by agnosia, aphasia, weakness, or sensory
loss. We herein review the most reported cases, current understanding of the
pathophysiology, and treatments. Methods We performed a PubMed search in July of 2014 using the phrases “alien hand
syndrome,” “alien hand syndrome pathophysiology,” “alien
hand syndrome treatment,” and “anarchic hand syndrome.” The
search yielded 141 papers (reviews, case reports, case series, and clinical
studies), of which we reviewed 109. Non-English reports without
English abstracts were excluded. Results Accumulating evidence indicates that there are three AHS variants: frontal,
callosal, and posterior. Patients may demonstrate symptoms of multiple types;
there is a lack of correlation between phenomenology and neuroimaging findings.
Most pathologic and functional imaging studies suggest network disruption causing
loss of inhibition as the likely cause. Successful interventions include botulinum
toxin injections, clonazepam, visuospatial coaching techniques, distracting the
affected hand, and cognitive behavioral therapy. Discussion The available literature suggests that overlap between AHS subtypes is common. The
evidence for effective treatments remains anecdotal, and, given the rarity of AHS,
the possibility of performing randomized, placebo-controlled trials seems
unlikely. As with many other interventions for movement disorders, identifying the
specific functional impairments caused by AHS may provide the best guidance
towards individualized supportive care.
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Affiliation(s)
- Harini Sarva
- Department of Neurology, Maimonides Medical Center, New York, NY, USA
| | - Andres Deik
- Parkinson Disease and Movement Disorders Center, Department of Neurology, University of Pennsylvania, Philadelphia, PA, USA
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Sarva H, Shanker VL. Treatment Options in Degenerative Cerebellar Ataxia: A Systematic Review. Mov Disord Clin Pract 2014; 1:291-298. [PMID: 30363941 DOI: 10.1002/mdc3.12057] [Citation(s) in RCA: 28] [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] [Subscribe] [Scholar Register] [Received: 03/20/2014] [Revised: 05/06/2014] [Accepted: 05/16/2014] [Indexed: 12/12/2022] Open
Abstract
The etiology of cerebellar ataxia (CA) is heterogeneous and includes easily identified and often reversible causes (i.e., drug toxicity and vitamin B12 deficiency) as well as irreversible degenerative conditions. It is the latter that poses a significant therapeutic challenge for practitioners treating this population of patients. To date, there are no U.S. Food and Drug Administration-approved medications for the treatment of CA. The literature, consisting mostly of case reports, case series, and small clinical trials, is sparse and scattered. These studies are difficult to translate clinically because they often describe diverse study populations with various identified and unidentified genetic etiologies. In addition, the reported treatment duration is often brief, and it is uncertain whether any of these options provide substantially lasting benefits. In this article, we review published reports and studies to aid the practitioner counseling patients with degenerative ataxias.
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Affiliation(s)
- Harini Sarva
- Division of Movement Disorders Department of Neurology Icahn School of Medicine at Mount Sinai Mount Sinai Beth Israel Medical Center New York New York USA
| | - Vicki Lynn Shanker
- Division of Movement Disorders Department of Neurology Icahn School of Medicine at Mount Sinai Mount Sinai Beth Israel Medical Center New York New York USA
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Alcalay RN, Mirelman A, Saunders-Pullman R, Tang MX, Mejia Santana H, Raymond D, Roos E, Orbe-Reilly M, Gurevich T, Bar Shira A, Gana Weisz M, Yasinovsky K, Zalis M, Thaler A, Deik A, Barrett MJ, Cabassa J, Groves M, Hunt AL, Lubarr N, San Luciano M, Miravite J, Palmese C, Sachdev R, Sarva H, Severt L, Shanker V, Swan MC, Soto-Valencia J, Johannes B, Ortega R, Fahn S, Cote L, Waters C, Mazzoni P, Ford B, Louis E, Levy O, Rosado L, Ruiz D, Dorovski T, Pauciulo M, Nichols W, Orr-Urtreger A, Ozelius L, Clark L, Giladi N, Bressman S, Marder KS. Parkinson disease phenotype in Ashkenazi Jews with and without LRRK2 G2019S mutations. Mov Disord 2013; 28:1966-71. [PMID: 24243757 DOI: 10.1002/mds.25647] [Citation(s) in RCA: 111] [Impact Index Per Article: 10.1] [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: 05/10/2013] [Revised: 07/11/2013] [Accepted: 07/28/2013] [Indexed: 12/12/2022] Open
Abstract
The phenotype of Parkinson's disease (PD) in patients with and without leucine-rich repeat kinase 2 (LRRK2) G2019S mutations reportedly is similar; however, large, uniformly evaluated series are lacking. The objective of this study was to characterize the clinical phenotype of Ashkenazi Jewish (AJ) PD carriers of the LRRK2 G2019S mutation. We studied 553 AJ PD patients, including 65 patients who were previously reported, from three sites (two in New York and one in Tel-Aviv). Glucocerebrosidase (GBA) mutation carriers were excluded. Evaluations included the Montreal Cognitive Assessment (MoCA), the Unified Parkinson's Disease Rating Scale (UPDRS), the Geriatric Depression Scale (GDS) and the Non-Motor Symptoms (NMS) questionnaire. Regression models were constructed to test the association between clinical and demographic features and LRRK2 status (outcome) in 488 newly recruited participants. LRRK2 G2019S carriers (n = 97) and non-carriers (n = 391) were similar in age and age at onset of PD. Carriers had longer disease duration (8.6 years vs. 6.1 years; P < 0.001), were more likely to be women (51.5% vs. 37.9%; P = 0.015), and more often reported first symptoms in the lower extremities (40.0% vs. 19.2%; P < 0.001). In logistic models that were adjusted for age, disease duration, sex, education, and site, carriers were more likely to have lower extremity onset (P < 0.001), postural instability and gait difficulty (PIGD) (P = 0.043), and a persistent levodopa response for >5 years (P = 0.042). Performance on the UPDRS, MoCA, GDS, and NMS did not differ by mutation status. PD in AJ LRRK2 G2019S mutation carriers is similar to idiopathic PD but is characterized by more frequent lower extremity involvement at onset and PIGD without the associated cognitive impairment.
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Affiliation(s)
- Roy N Alcalay
- Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, New York, USA; Taub Institute for Research on Alzheimer's Disease and the Aging Brain, College of Physicians and Surgeons, Columbia University, New York, New York, USA
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Affiliation(s)
| | | | | | - George Vas
- SUNY Downstate Medical Center, Brooklyn, NY
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Panichpisal K, Omoregie E, Rodriguez A, Sarva H, Law S, Rojas-Soto D, Dardis C, Ramirez-Abreu D, Nguyen C, Sareen A, Kotseva M, Cherian S, Moradiya Y, Antezana A, Bulic S, Jadoo C, Personna-Policard J, Vulkanov V, Emami A, Arya K, Jirasakuldej S, Kozlova O, McIntyre S, Thomas L, Rosenbaum D, Levine S, Baird A. Stroke Risk Factors and Ischemic Subtypes in a Multiethnic Population in Central and East Brooklyn (P07.050). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.p07.050] [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: 11/15/2022] Open
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