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Kulisevsky J, Esquivel A, Freire-Álvarez E, Gómez-Esteban JC, Legarda-Ramírez I, Avilés A, Mata-Álvarez-Santullano M. SYNAPSES. A European observational study to evaluate the safety and the effectiveness of safinamide in routine clinical practice: post-hoc analysis of the Spanish study population. Rev Neurol 2023; 77:1-12. [PMID: 37752685 DOI: 10.33588/rn.77s02.2023217] [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: 09/28/2023]
Abstract
INTRODUCTION Parkinson's Disease (PD) is a progressive age-related neurodegenerative condition requiring new therapeutic alternatives. Safinamide, a novel levodopa add-on therapy, positively affects disease fluctuations by modulating both dopaminergic and glutamatergic systems. To further investigate the use of safinamide in European routine clinical practice, the present post-hoc analysis aimed to understand safinamide's safety profile within the Spanish study population. PATIENTS AND METHODS Five hundred eleven Spanish patients with PD were evaluated at baseline, four (±1), eight (±1), and 12 (±1) months after initiating safinamide treatment. Unified Parkinson's Disease Rating Scale (UPDRS) total score and UPDRS part III score during on time were used to measure the overall severity of PD and motor complications, respectively, while the severity of adverse events was evaluated following the investigators' criteria. RESULTS Safinamide showed a favourable safety profile within the Spanish study population, although prescription to patients with psychiatric conditions and off-label use were more frequent than in the European study population. In Spain, clinically meaningful improvements were observed in UPDRS scores when safinamide was used as the only add-on therapy to levodopa (57.4% and 53.7% of patients) and when switching from rasagiline (55.1% of patients). Motor complications were reduced from 83.2% to 63.3% after the study period. Increased safety concerns were undetected in any patient subgroup, although patients with cognitive impairment showed a slightly higher frequency of adverse events. CONCLUSIONS This subanalysis further supports safinamide use as a safe and efficacious option for the management of motor fluctuations in different subgroups of levodopa-treated patients. However, safinamide should be used with caution in patients with cognitive impairment.
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Affiliation(s)
- J Kulisevsky
- Hospital de la Santa Creu i Sant Pau, 08025 Barcelona, España
- CIBERNED. Centro de Investigación Biomédica en Red Enfermedades Neurodegenerativas, Madrid, España
| | - A Esquivel
- Hospital Universitario Infanta Leonor, Madrid, España
| | - E Freire-Álvarez
- Hospital IMED, Elche, España
- Hospital General Universitario, Elche, España
| | | | | | - A Avilés
- Zambon S.A.U. España, Santa Perpètua de Mogoda, España
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Kulisevsky J. Pharmacological management of Parkinson's disease motor symptoms: update and recommendations from an expert. Rev Neurol 2022; 75:S1-S10. [PMID: 36342310 DOI: 10.33588/rn.75s04.2022217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
INTRODUCTION Parkinson's disease (PD) is a neurodegenerative multisystemic disorder that affects approximately 1% of the population over 55 years old, with the mean age of onset at 60 years old, and the prevalence of the disease constantly growing. DEVELOPMENT PD is a progressive disease characterized by motor and non-motor symptoms that compromise patients' daily activities. It has a variable profile of onset and clinical evolution. Although currently available treatments have failed to clinically demonstrate neuroprotective properties, most motor symptoms are acceptably managed with dopaminergic medication. More than 50 years after launching levodopa, it remains the most effective treatment of motor symptoms in PD, able to provide sustained benefit throughout the entire course of the disease. Nevertheless, after two to three years of treatment, certain fluctuations start to appear in motor and non-motor responses to different doses of levodopa. Early identification and treatment of these fluctuations have a strong positive impact on the quality of life of the patient. Frequently accompanied by involuntary movements, proper control of fluctuations requires periodical adjustments of the medication and expert supplementation with dopaminergic and non-dopaminergic adjuvants. CONCLUSIONS The main purpose of this work is to offer a practical, updated guideline for neurologists regarding the use of dopaminergic agents from the initial stages of PD. Special emphasis is placed on the critical period after the end of the 'honeymoon' phase when variations in the symptomatology presented by each patient appear, forcing re-adjustment of the medication to fit their individual needs.
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Affiliation(s)
- J Kulisevsky
- Hospital de la Santa Creu i Sant Pau, 08025 Barcelona, España.,CIBERNED. Centro de Investigación Biomédica en Red Enfermedades Neurodegenerativas, Madrid, España
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Santos-García D, Castro ES, de Deus Fonticoba T, Panceiras MJF, Enriquez JGM, González JMP, Bartolomé CC, Planellas LL, Caldentey JG, Caballol N, Legarda I, López IC, Manzanares LL, Rivera MAÁ, Catalán MJ, Nogueira V, Borrué C, Sauco MÁ, Vela L, Cubo E, Castrillo JCM, Alonso PS, Losada MGA, Ariztegui NL, Gastón MI, Kulisevsky J, Pagonabarraga J, Seijo M, Martínez JR, Valero C, Kurtis M, Ardura JG, Prieto C, Mir P, Martinez-Martin P. Sleep Problems Are Related to a Worse Quality of Life and a Greater Non-Motor Symptoms Burden in Parkinson's Disease. J Geriatr Psychiatry Neurol 2021; 34:642-658. [PMID: 33043810 DOI: 10.1177/0891988720964250] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
INTRODUCTION The aim of the present study was to examine the frequency of self-reported sleep problems and their associated factors in a large cohort of PD patients. METHODS PD patients and controls, recruited from 35 centers of Spain from the COPPADIS cohort were included in this cross-sectional study. Sleep problems were assessed by the Spanish version of the Parkinson's disease Sleep Scale version 1 (PDSS-1). An overall score below 82 or a score below 5 on at least 1 item was defined as sleep problems. RESULTS The frequency of sleep problems was nearly double in PD patients compared to controls: 65.8% (448/681) vs 33.5% (65/206) (p < 0.0001). Mean total PDSS score was lower in PD patients than controls: 114.9 ± 28.8 vs 132.8 ± 16.3 (p < 0.0001). Quality of life (QoL) was worse in PD patients with sleep problems compared to those without: PDQ-39SI, 19.3 ± 14 vs 13 ± 11.6 (p < 0.0001); EUROHIS-QoL8, 3.7 ± 0.5 vs 3.9 ± 0.5 (p < 0.0001). Non-motor symptoms burden (NMSS; OR = 1.029; 95%CI 1.015-1.043; p < 0.0001) and impulse control behaviors (QUIP-RS; OR = 1.054; 95%CI 1.009-1.101; p = 0.018) were associated with sleep problems after adjustment for age, gender, disease duration, daily equivalent levodopa dose, H&Y, UPDRS-III, UPDRS-IV, PD-CRS, BDI-II, NPI, VAS-Pain, VAFS, FOGQ, and total number of non-antiparkinsonian treatments. CONCLUSION Sleep problems were frequent in PD patients and were related to both a worse QoL and a greater non-motor symptoms burden in PD. These findings call for increased awareness of sleep problems in PD patients.
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Affiliation(s)
| | - E Suárez Castro
- Hospital Arquitecto Marcide y Hospital Naval, Complejo Hospitalario Universitario de Ferrol (CHUF), Ferrol, A Coruña, Spain
| | - T de Deus Fonticoba
- Hospital Arquitecto Marcide y Hospital Naval, Complejo Hospitalario Universitario de Ferrol (CHUF), Ferrol, A Coruña, Spain
| | | | | | - J M Paz González
- CHUAC, Complejo Hospitalario Universitario de A Coruña, A Coruña, Spain
| | - C Cores Bartolomé
- CHUAC, Complejo Hospitalario Universitario de A Coruña, A Coruña, Spain
| | | | | | - N Caballol
- Consorci Sanitari Integral, Hospital Moisés Broggi, Sant Joan Despí, Barcelona, Spain
| | - I Legarda
- Hospital Universitario Son Espases, Palma de Mallorca, Spain
| | - I Cabo López
- Complejo Hospitalario Universitario de Pontevedra (CHOP), Pontevedra, Spain
| | | | - M A Ávila Rivera
- Consorci Sanitari Integral, Hospital General de L´Hospitalet, L´Hospitalet de Llobregat, Barcelona, Spain
| | - M J Catalán
- Hospital Universitario Clínico San Carlos, Madrid, Spain
| | - V Nogueira
- Hospital Da Costa de Burela, Lugo, Spain
| | - C Borrué
- Hospital Infanta Sofía, Madrid, Spain
| | | | - L Vela
- Fundación Hospital de Alcorcón, Madrid, Spain
| | - E Cubo
- Complejo Asistencial Universitario de Burgos, Burgos, Spain
| | | | | | - M G Alonso Losada
- Hospital Álvaro Cunqueiro, Complejo Hospitalario Universitario de Vigo (CHUVI), Vigo, Spain
| | | | - M I Gastón
- Complejo Hospitalario de Navarra, Pamplona, Spain
| | | | | | - M Seijo
- Complejo Hospitalario Universitario de Pontevedra (CHOP), Pontevedra, Spain
| | | | - C Valero
- Hospital Arnau de Vilanova, Valencia, Spain
| | - M Kurtis
- Hospital Ruber Internacional, Madrid, Spain
| | | | - C Prieto
- Hospital Rey Juan Carlos, Madrid, Spain
| | - P Mir
- Unidad de Trastornos del Movimiento, Servicio de Neurología y Neurofisiología Clínica, Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Seville, Spain.,Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain
| | - P Martinez-Martin
- Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain
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Santos-García D, de Deus Fonticoba T, Cores Bartolomé C, Suárez Castro E, Jesús S, Mir P, Pascual-Sedano B, Pagonabarraga J, Kulisevsky J, Hernández-Vara J, Planellas LL, Cabo-López I, Seijo-Martínez M, Legarda I, Carrillo Padilla F, Caballol N, Cubo E, Nogueira V, Alonso Losada MG, López Ariztegui N, González Aramburu I, García Caldentey J, Borrue C, Valero C, Sánchez Alonso P. Depression is Associated with Impulse-compulsive Behaviors in Parkinson's disease. J Affect Disord 2021; 280:77-89. [PMID: 33242731 DOI: 10.1016/j.jad.2020.11.075] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Revised: 09/26/2020] [Accepted: 11/08/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Depression and impulse control disorders (ICDs) are both common in Parkinson's disease (PD) patients and their coexistence is frequent. Our aim was to determine the relationship between depression and impulsive-compulsive behaviors (ICBs) in a large cohort of PD patients. METHODS PD patients recruited from 35 centers of Spain from the COPPADIS cohort from January 2016 to November 2017 were included in the study. The QUIP-RS (Questionnaire for Impulsive-Compulsive Disorders in Parkinson's Disease-Rating Scale) was used for screening ICDs (cutoff points: gambling ≥6, buying ≥8, sex≥8, eating≥7) and compulsive behaviors (CBs) (cutoff points: hobbyism-punding ≥7). Mood was assessed with the BDI-II (Beck Depression Inventory - II) and major, minor, and subthreshold depression were defined. RESULTS Depression was more frequent in PD patients with ICBs than in those without: 66.3% (69/104) vs 47.5% (242/509); p<0.0001. Major depression was more frequent in this group as well: 22.1% [23/104] vs 14.5% [74/509]; p=0.041. Considering types of ICBs individually, depression was more frequent in patients with pathological gambling (88.9% [8/9] vs 50.2% [303/603]; p=0.021), compulsive eating behavior (65.9% [27/41] vs 49.7% [284/572]; p=0.032), and hobbyism-punding (69% [29/42] vs 49.4% [282/571]; p=0.010) than in those without, respectively. The presence of ICBs was also associated with depression (OR=1.831; 95%CI 1.048-3.201; p=0.034) after adjusting for age, sex, civil status, disease duration, equivalent daily levodopa dose, antidepressant treatment, Hoehn&Yahr stage, non-motor symptoms burden, autonomy for activities of daily living, and global perception of QoL. LIMITATIONS Cross-sectional design. CONCLUSIONS Depression is associated with ICBs in PD. Specifically, with pathological gambling, compulsive eating behavior, and hobbyism-punding.
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Affiliation(s)
- D Santos-García
- Complejo Hospitalario Universitario de A Coruña (CHUAC), A Coruña, Spain.
| | - T de Deus Fonticoba
- Hospital Arquitecto Marcide y Hospital Naval, Complejo Hospitalario Universitario de Ferrol (CHUF), Ferrol, A Coruña, Spain
| | - C Cores Bartolomé
- Complejo Hospitalario Universitario de A Coruña (CHUAC), A Coruña, Spain
| | - E Suárez Castro
- Hospital Arquitecto Marcide y Hospital Naval, Complejo Hospitalario Universitario de Ferrol (CHUF), Ferrol, A Coruña, Spain
| | - S Jesús
- Hospital Universitario Virgen del Rocío, Sevilla, Spain; Centro de Investigación en Red-Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain
| | - P Mir
- Hospital Universitario Virgen del Rocío, Sevilla, Spain; Centro de Investigación en Red-Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain
| | - B Pascual-Sedano
- Centro de Investigación en Red-Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain; Hospital de la Santa Creu i Sant Pau, Barcelona; Faculty of Health Sciences, Universitat Oberta de Catalunya (UOC), Barcelona, Spain
| | - J Pagonabarraga
- Centro de Investigación en Red-Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain; Hospital de la Santa Creu i Sant Pau, Barcelona
| | - J Kulisevsky
- Centro de Investigación en Red-Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain; Hospital de la Santa Creu i Sant Pau, Barcelona; Faculty of Health Sciences, Universitat Oberta de Catalunya (UOC), Barcelona, Spain
| | - J Hernández-Vara
- Hospital Universitario Vall d'Hebron and Neurodegenerative Diseases Research Group, Vall D Hebron Research Institute (VHIR), Barcelona, Spain
| | | | - I Cabo-López
- Complejo Hospitalario Universitario de Pontevedra (CHOP), Pontevedra, Spain
| | - M Seijo-Martínez
- Complejo Hospitalario Universitario de Pontevedra (CHOP), Pontevedra, Spain
| | - I Legarda
- Hospital Universitario Son Espases, Palma de Mallorca, Spain
| | - F Carrillo Padilla
- Hospital Universitario de Canarias, San Cristóbal de la Laguna, Santa Cruz de Tenerife, Spain
| | - N Caballol
- Consorci Sanitari Integral, Hospital Moisés Broggi, Sant Joan Despí, Barcelona, Spain
| | - E Cubo
- Complejo Asistencial Universitario de Burgos, Burgos, Spain
| | - V Nogueira
- Hospital Da Costa de Burela, Lugo, Spain
| | - M G Alonso Losada
- Hospital Álvaro Cunqueiro, Complejo Hospitalario Universitario de Vigo (CHUVI), Vigo, Spain
| | | | - I González Aramburu
- Centro de Investigación en Red-Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain; Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | | | - C Borrue
- Hospital Infanta Sofía, Madrid, Spain
| | - C Valero
- Hospital Arnau de Vilanova, Valencia, Spain
| | - P Sánchez Alonso
- Centro de Investigación en Red-Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain; Hospital Universitario Puerta de Hierro, Madrid, Spain
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Bejr-Kasem H, Sampedro F, Marín-Lahoz J, Martínez-Horta S, Pagonabarraga J, Kulisevsky J. Minor hallucinations reflect early gray matter loss and predict subjective cognitive decline in Parkinson's disease. Eur J Neurol 2020; 28:438-447. [PMID: 33032389 DOI: 10.1111/ene.14576] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [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: 06/07/2020] [Accepted: 10/02/2020] [Indexed: 12/25/2022]
Abstract
BACKGROUND AND PURPOSE Well-structured hallucinations in Parkinson's disease (PD) are associated with poor prognosis and dementia. However, the predictive value of minor psychotic phenomena in cognitive deterioration is not well known. Cross-sectional studies have shown that PD patients with minor hallucinations have more severe cortical atrophy than non-hallucinators, but baseline and longitudinal studies addressing the evolution of these brain differences are lacking. The impact of developing minor hallucinations on cognitive impairment and cortical atrophy progression in early PD was explored. METHODS One hundred and thirty-one de novo PD patients from the Parkinson's Progression Marker Initiative for whom brain magnetic resonance imaging scans were available were included. Cognitive outcome at 5 years was compared between patients with and without minor hallucinations during follow-up. Additionally, using gray matter volume (GMV) voxel-based morphometry, cross-sectional (at baseline) and longitudinal (1- and 2-year GMV loss) structural brain differences between groups were studied. RESULTS During follow-up, 35.1% of patients developed minor hallucinations. At 5 years, these patients showed an increased prevalence of subjective cognitive decline compared to non-hallucinators (44.1% vs. 13.9%; p < 0.001), but not formal cognitive impairment. Additionally, compared to non-hallucinators, they exhibited reduced GMV at baseline in visuoperceptive areas and increased GMV loss in left temporal areas (p < 0.05 corrected). CONCLUSIONS Minor hallucinations seem to be an early clinical marker of increased neurodegeneration and are associated with mid-term subjective cognitive decline. Longer follow-up analyses would be needed to further define if these findings could reflect a higher risk of future cognitive deterioration.
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Affiliation(s)
- H Bejr-Kasem
- Movement Disorders Unit, Neurology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.,Universitat Autònoma de Barcelona (U.A.B.), Department of Medicine, Barcelona, Spain.,Institut d´Investigacions Biomèdiques- Sant Pau (IIB-Sant Pau), Barcelona, Spain.,Centro de Investigación en Red-Enfermedades Neurodegenerativas (CIBERNED), Barcelona, Spain
| | - F Sampedro
- Movement Disorders Unit, Neurology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.,Universitat Autònoma de Barcelona (U.A.B.), Department of Medicine, Barcelona, Spain.,Institut d´Investigacions Biomèdiques- Sant Pau (IIB-Sant Pau), Barcelona, Spain.,Centro de Investigación en Red-Enfermedades Neurodegenerativas (CIBERNED), Barcelona, Spain
| | - J Marín-Lahoz
- Movement Disorders Unit, Neurology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.,Universitat Autònoma de Barcelona (U.A.B.), Department of Medicine, Barcelona, Spain.,Institut d´Investigacions Biomèdiques- Sant Pau (IIB-Sant Pau), Barcelona, Spain.,Centro de Investigación en Red-Enfermedades Neurodegenerativas (CIBERNED), Barcelona, Spain
| | - S Martínez-Horta
- Movement Disorders Unit, Neurology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.,Universitat Autònoma de Barcelona (U.A.B.), Department of Medicine, Barcelona, Spain.,Institut d´Investigacions Biomèdiques- Sant Pau (IIB-Sant Pau), Barcelona, Spain.,Centro de Investigación en Red-Enfermedades Neurodegenerativas (CIBERNED), Barcelona, Spain
| | - J Pagonabarraga
- Movement Disorders Unit, Neurology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.,Universitat Autònoma de Barcelona (U.A.B.), Department of Medicine, Barcelona, Spain.,Institut d´Investigacions Biomèdiques- Sant Pau (IIB-Sant Pau), Barcelona, Spain.,Centro de Investigación en Red-Enfermedades Neurodegenerativas (CIBERNED), Barcelona, Spain
| | - J Kulisevsky
- Movement Disorders Unit, Neurology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.,Universitat Autònoma de Barcelona (U.A.B.), Department of Medicine, Barcelona, Spain.,Institut d´Investigacions Biomèdiques- Sant Pau (IIB-Sant Pau), Barcelona, Spain.,Centro de Investigación en Red-Enfermedades Neurodegenerativas (CIBERNED), Barcelona, Spain
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Jesús S, Labrador-Espinosa MA, Adarmes AD, Méndel-Del Barrio C, Martínez-Castrillo JC, Alonso-Cánovas A, Sánchez Alonso P, Novo-Ponte S, Alonso-Losada MG, López Ariztegui N, Segundo Rodríguez JC, Morales MI, Gastón I, Lacruz Bescos F, Clavero Ibarra P, Kulisevsky J, Pagonabarraga J, Pascual-Sedano B, Martínez-Martín P, Santos-García D, Mir P. Non-motor symptom burden in patients with Parkinson's disease with impulse control disorders and compulsive behaviours: results from the COPPADIS cohort. Sci Rep 2020; 10:16893. [PMID: 33037247 PMCID: PMC7547680 DOI: 10.1038/s41598-020-73756-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 01/07/2020] [Accepted: 08/14/2020] [Indexed: 12/19/2022] Open
Abstract
The study was aimed at analysing the frequency of impulse control disorders (ICDs) and compulsive behaviours (CBs) in patients with Parkinson's disease (PD) and in control subjects (CS) as well as the relationship between ICDs/CBs and motor, nonmotor features and dopaminergic treatment in PD patients. Data came from COPPADIS-2015, an observational, descriptive, nationwide (Spain) study. We used the validated Questionnaire for Impulsive-Compulsive Disorders in Parkinson's Disease-Rating Scale (QUIP-RS) for ICD/CB screening. The association between demographic data and ICDs/CBs was analyzed in both groups. In PD, this relationship was evaluated using clinical features and treatment-related data. As result, 613 PD patients (mean age 62.47 ± 9.09 years, 59.87% men) and 179 CS (mean age 60.84 ± 8.33 years, 47.48% men) were included. ICDs and CBs were more frequent in PD (ICDs 12.7% vs. 1.6%, p < 0.001; CBs 7.18% vs. 1.67%, p = 0.01). PD patients had more frequent previous ICDs history, premorbid impulsive personality and antidepressant treatment (p < 0.05) compared with CS. In PD, patients with ICDs/CBs presented younger age at disease onset, more frequent history of previous ICDs and premorbid personality (p < 0.05), as well as higher comorbidity with nonmotor symptoms, including depression and poor quality of life. Treatment with dopamine agonists increased the risk of ICDs/CBs, being dose dependent (p < 0.05). As conclusions, ICDs and CBs were more frequent in patients with PD than in CS. More nonmotor symptoms were present in patients with PD who had ICDs/CBs compared with those without. Dopamine agonists have a prominent effect on ICDs/CBs, which could be influenced by dose.
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Affiliation(s)
- S Jesús
- Unidad de Trastornos del Movimiento, Servicio de Neurología Y Neurofisiología Clínica, Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Av. Manuel Siurot s/n. 41013, Seville, Spain.,Centro de Investigación Biomédica en Red Sobre Enfermedades Neurodegenerativas (CIBERNED), Barcelona, Spain
| | - M A Labrador-Espinosa
- Unidad de Trastornos del Movimiento, Servicio de Neurología Y Neurofisiología Clínica, Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Av. Manuel Siurot s/n. 41013, Seville, Spain.,Centro de Investigación Biomédica en Red Sobre Enfermedades Neurodegenerativas (CIBERNED), Barcelona, Spain
| | - A D Adarmes
- Unidad de Trastornos del Movimiento, Servicio de Neurología Y Neurofisiología Clínica, Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Av. Manuel Siurot s/n. 41013, Seville, Spain.,Centro de Investigación Biomédica en Red Sobre Enfermedades Neurodegenerativas (CIBERNED), Barcelona, Spain
| | - C Méndel-Del Barrio
- Unidad de Trastornos del Movimiento, Servicio de Neurología Y Neurofisiología Clínica, Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Av. Manuel Siurot s/n. 41013, Seville, Spain.,Centro de Investigación Biomédica en Red Sobre Enfermedades Neurodegenerativas (CIBERNED), Barcelona, Spain
| | | | | | | | - S Novo-Ponte
- Hospital Universitario Puerta del Hierro, Madrid, Spain
| | - M G Alonso-Losada
- Hospital Meixoeiro, Complejo Hospitalario Universitario de Vigo, Vigo, Spain
| | | | | | - M I Morales
- Complejo Hospitalario de Toledo, Toledo, Spain
| | - I Gastón
- Complejo Hospitalario de Navarra, Pamplona, Navarra, Spain
| | | | | | - J Kulisevsky
- Centro de Investigación Biomédica en Red Sobre Enfermedades Neurodegenerativas (CIBERNED), Barcelona, Spain.,Unidad de Trastornos del Movimiento, Servicio de Neurología, Hospital de La Santa Creu I Sant Pau, Barcelona, Spain
| | - J Pagonabarraga
- Centro de Investigación Biomédica en Red Sobre Enfermedades Neurodegenerativas (CIBERNED), Barcelona, Spain.,Unidad de Trastornos del Movimiento, Servicio de Neurología, Hospital de La Santa Creu I Sant Pau, Barcelona, Spain
| | - B Pascual-Sedano
- Centro de Investigación Biomédica en Red Sobre Enfermedades Neurodegenerativas (CIBERNED), Barcelona, Spain.,Unidad de Trastornos del Movimiento, Servicio de Neurología, Hospital de La Santa Creu I Sant Pau, Barcelona, Spain.,Faculty of Health Sciences, Universitat Oberta de Catalunya (UOC), Barcelona, Spain
| | - P Martínez-Martín
- Centro de Investigación Biomédica en Red Sobre Enfermedades Neurodegenerativas (CIBERNED), Barcelona, Spain.,Centro Nacional de Epidemiología, Instituto de Salud Carlos III, Madrid, Spain
| | - D Santos-García
- Complejo Hospitalario Universitario de A Coruña (CHUAC), A Coruña, Spain
| | - P Mir
- Unidad de Trastornos del Movimiento, Servicio de Neurología Y Neurofisiología Clínica, Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Av. Manuel Siurot s/n. 41013, Seville, Spain. .,Centro de Investigación Biomédica en Red Sobre Enfermedades Neurodegenerativas (CIBERNED), Barcelona, Spain.
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Marín-Lahoz J, Martínez-Horta S, Sampedro F, Pagonabarraga J, Horta-Barba A, Bejr-Kasem H, Botí MÁ, Fernández-Bobadilla R, Pascual-Sedano B, Pérez-Pérez J, Aracil-Bolaños I, Gironell A, Gómez-Ansón B, Kulisevsky J. Measuring impulsivity in Parkinson's disease: a correlational and structural neuroimaging study using different tests. Eur J Neurol 2020; 27:1478-1486. [PMID: 32250513 DOI: 10.1111/ene.14235] [Citation(s) in RCA: 4] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Accepted: 03/12/2020] [Indexed: 12/21/2022]
Abstract
BACKGROUND AND PURPOSE Impulsivity is an aspect of personality and a major component of multiple neuropsychiatric conditions. In Parkinson's disease, it has been associated with the expression of impulse control disorders, a highly prevalent non-motor complication. Even though multiple tests of impulsivity have been used in this context, the impact of test choice has not been addressed. The aim was to evaluate whether different impulsivity measures in Parkinson's disease share substantial inter-scale and anatomical correlations or rather mirror different underlying phenomena. METHODS In a consecutive sample of 89 Parkinson's disease patients without impulse control disorders, four common tests were evaluated assessing different aspects of impulsivity: impulsiveness trait, decisions under implicit risk with and without losses, and delay discounting. Correlations among test scores were analysed and each score was used as a regressor in a set of grey matter volume (GMV) voxel-based morphometry analyses to explore their brain structural correlates. RESULTS No significant correlations were found between the different impulsivity tests. Furthermore, their structural brain correlates were divergent. Impulsiveness trait appeared to be associated with lower GMV in dorsal-lateral prefrontal cortices, implicit risk (with losses) with higher GMV in the left nucleus accumbens and lower left insular GMV, implicit risk (without losses) with higher GMV in the left lingual gyrus and lower GMV in the gyri recti and delay discounting with higher GMV in the left nucleus accumbens. CONCLUSIONS In Parkinson's disease, different impulsivity measures reflect very dissimilar behavioural and brain structural correlates. Our results suggest that parkinsonian impulsivity is not a unitary phenomenon but rather a heterogeneous entity.
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Affiliation(s)
- J Marín-Lahoz
- Movement Disorders Unit, Neurology Department, Sant Pau Hospital, Barcelona, Spain.,Institut d´Investigacions Biomèdiques-Sant Pau (IIB-Sant Pau), Barcelona, Spain.,Universitat Autònoma de Barcelona (U.A.B.), Barcelona, Spain.,Centro de Investigación en Red-Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain
| | - S Martínez-Horta
- Movement Disorders Unit, Neurology Department, Sant Pau Hospital, Barcelona, Spain.,Institut d´Investigacions Biomèdiques-Sant Pau (IIB-Sant Pau), Barcelona, Spain.,Centro de Investigación en Red-Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain
| | - F Sampedro
- Movement Disorders Unit, Neurology Department, Sant Pau Hospital, Barcelona, Spain.,Institut d´Investigacions Biomèdiques-Sant Pau (IIB-Sant Pau), Barcelona, Spain.,Centro de Investigación en Red-Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain
| | - J Pagonabarraga
- Movement Disorders Unit, Neurology Department, Sant Pau Hospital, Barcelona, Spain.,Institut d´Investigacions Biomèdiques-Sant Pau (IIB-Sant Pau), Barcelona, Spain.,Universitat Autònoma de Barcelona (U.A.B.), Barcelona, Spain.,Centro de Investigación en Red-Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain
| | - A Horta-Barba
- Movement Disorders Unit, Neurology Department, Sant Pau Hospital, Barcelona, Spain.,Institut d´Investigacions Biomèdiques-Sant Pau (IIB-Sant Pau), Barcelona, Spain.,Centro de Investigación en Red-Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain
| | - H Bejr-Kasem
- Movement Disorders Unit, Neurology Department, Sant Pau Hospital, Barcelona, Spain.,Institut d´Investigacions Biomèdiques-Sant Pau (IIB-Sant Pau), Barcelona, Spain.,Universitat Autònoma de Barcelona (U.A.B.), Barcelona, Spain.,Centro de Investigación en Red-Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain.,Universitat Oberta de Catalunya, Barcelona, Spain
| | - M Á Botí
- Universitat Oberta de Catalunya, Barcelona, Spain.,Asociació Catalana per al Parkinson, Barcelona, Spain
| | | | - B Pascual-Sedano
- Movement Disorders Unit, Neurology Department, Sant Pau Hospital, Barcelona, Spain.,Institut d´Investigacions Biomèdiques-Sant Pau (IIB-Sant Pau), Barcelona, Spain.,Centro de Investigación en Red-Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain.,Universitat Oberta de Catalunya, Barcelona, Spain
| | - J Pérez-Pérez
- Movement Disorders Unit, Neurology Department, Sant Pau Hospital, Barcelona, Spain.,Institut d´Investigacions Biomèdiques-Sant Pau (IIB-Sant Pau), Barcelona, Spain.,Centro de Investigación en Red-Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain
| | - I Aracil-Bolaños
- Movement Disorders Unit, Neurology Department, Sant Pau Hospital, Barcelona, Spain.,Institut d´Investigacions Biomèdiques-Sant Pau (IIB-Sant Pau), Barcelona, Spain.,Centro de Investigación en Red-Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain
| | - A Gironell
- Movement Disorders Unit, Neurology Department, Sant Pau Hospital, Barcelona, Spain.,Institut d´Investigacions Biomèdiques-Sant Pau (IIB-Sant Pau), Barcelona, Spain.,Centro de Investigación en Red-Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain
| | - B Gómez-Ansón
- Institut d´Investigacions Biomèdiques-Sant Pau (IIB-Sant Pau), Barcelona, Spain.,Universitat Autònoma de Barcelona (U.A.B.), Barcelona, Spain.,Neuroradiology Unit, Radiology Department, Sant Pau Hospital, Barcelona, Spain
| | - J Kulisevsky
- Movement Disorders Unit, Neurology Department, Sant Pau Hospital, Barcelona, Spain.,Institut d´Investigacions Biomèdiques-Sant Pau (IIB-Sant Pau), Barcelona, Spain.,Universitat Autònoma de Barcelona (U.A.B.), Barcelona, Spain.,Centro de Investigación en Red-Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain
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8
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Sampedro F, Martínez-Horta S, Perez-Perez J, Horta-Barba A, Martin-Lahoz J, Alonso-Solís A, Corripio I, Gomez-Anson B, Kulisevsky J. Widespread Increased Diffusivity Reveals Early Cortical Degeneration in Huntington Disease. AJNR Am J Neuroradiol 2019; 40:1464-1468. [PMID: 31467235 DOI: 10.3174/ajnr.a6168] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Accepted: 07/07/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND PURPOSE Huntington disease is a devastating genetic neurodegenerative disorder for which no effective treatment is yet available. Although progressive striatal atrophy is its pathologic hallmark, concomitant cortical deterioration is assumed to occur, but it is poorly characterized. Our objective was to study the loss of cortical integrity and its association with clinical indicators throughout the course of the disease. MATERIALS AND METHODS Using a cohort of 39 patients with Huntington disease and 25 controls with available MR imaging (T1WI and DTI), we compared cortical atrophy and intracortical diffusivity across disease stages. Intracortical diffusivity is a DTI-derived metric that has recently been suggested to detect incipient neuronal death because water can diffuse more freely in cortical regions with reduced neural density. RESULTS We observed progressive thinning and increasing diffusivity within the cerebral cortex of patients with Huntington disease (P < .05, corrected for multiple comparisons). Most important, in the absence of pronounced atrophy, widespread increased diffusivity was already present in individuals with premanifest Huntington disease, correlating, in turn, with clinical and disease-specific progression markers. CONCLUSIONS Intracortical diffusivity may be more sensitive than cortical thinning for tracking early neurodegeneration in Huntington disease. Moreover, our findings provide further evidence of an early cortical compromise in Huntington disease, which contributes to our understanding of its clinical phenotype and could have important therapeutic implications.
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Affiliation(s)
- F Sampedro
- From the Movement Disorders Unit (F.S., S.M.-H., J.P.-P., A.H.-B., J.M.-L., J.K.), Neurology Department.,Biomedical Research Institute (F.S., S.M.-H., J.P.-P., A.H.-B., J.M.-L., A.A.-S., I.C., J.K.), Barcelona, Spain.,Centro de Investigación en Red-Enfermedades Neurodegenerativas (F.S., S.M.-H., J.P.-P., A.H.-B., J.M.-L., J.K.), Madrid, Spain
| | - S Martínez-Horta
- From the Movement Disorders Unit (F.S., S.M.-H., J.P.-P., A.H.-B., J.M.-L., J.K.), Neurology Department.,Biomedical Research Institute (F.S., S.M.-H., J.P.-P., A.H.-B., J.M.-L., A.A.-S., I.C., J.K.), Barcelona, Spain.,Centro de Investigación en Red-Enfermedades Neurodegenerativas (F.S., S.M.-H., J.P.-P., A.H.-B., J.M.-L., J.K.), Madrid, Spain.,Universitat Autónoma de Barcelona (S.M.-H., J.P.-P., J.M.-L., B.G.-A., J.K.), Barcelona, Spain
| | - J Perez-Perez
- From the Movement Disorders Unit (F.S., S.M.-H., J.P.-P., A.H.-B., J.M.-L., J.K.), Neurology Department.,Biomedical Research Institute (F.S., S.M.-H., J.P.-P., A.H.-B., J.M.-L., A.A.-S., I.C., J.K.), Barcelona, Spain.,Centro de Investigación en Red-Enfermedades Neurodegenerativas (F.S., S.M.-H., J.P.-P., A.H.-B., J.M.-L., J.K.), Madrid, Spain.,Universitat Autónoma de Barcelona (S.M.-H., J.P.-P., J.M.-L., B.G.-A., J.K.), Barcelona, Spain
| | - A Horta-Barba
- From the Movement Disorders Unit (F.S., S.M.-H., J.P.-P., A.H.-B., J.M.-L., J.K.), Neurology Department.,Biomedical Research Institute (F.S., S.M.-H., J.P.-P., A.H.-B., J.M.-L., A.A.-S., I.C., J.K.), Barcelona, Spain.,Centro de Investigación en Red-Enfermedades Neurodegenerativas (F.S., S.M.-H., J.P.-P., A.H.-B., J.M.-L., J.K.), Madrid, Spain
| | - J Martin-Lahoz
- From the Movement Disorders Unit (F.S., S.M.-H., J.P.-P., A.H.-B., J.M.-L., J.K.), Neurology Department.,Biomedical Research Institute (F.S., S.M.-H., J.P.-P., A.H.-B., J.M.-L., A.A.-S., I.C., J.K.), Barcelona, Spain.,Centro de Investigación en Red-Enfermedades Neurodegenerativas (F.S., S.M.-H., J.P.-P., A.H.-B., J.M.-L., J.K.), Madrid, Spain.,Universitat Autónoma de Barcelona (S.M.-H., J.P.-P., J.M.-L., B.G.-A., J.K.), Barcelona, Spain
| | - A Alonso-Solís
- Biomedical Research Institute (F.S., S.M.-H., J.P.-P., A.H.-B., J.M.-L., A.A.-S., I.C., J.K.), Barcelona, Spain
| | - I Corripio
- Psychiatry Department (I.C.), Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.,Biomedical Research Institute (F.S., S.M.-H., J.P.-P., A.H.-B., J.M.-L., A.A.-S., I.C., J.K.), Barcelona, Spain.,Centro de Investigación Biomédica en Red-Salud Mental (I.C.), Madrid, Spain
| | - B Gomez-Anson
- Neuroradiology, Radiology Department (B.G.-A.).,European Huntington's Disease Network (S.M.-H., J.P.-P., A.H.-B., J.K.), Ulm, Germany
| | - J Kulisevsky
- From the Movement Disorders Unit (F.S., S.M.-H., J.P.-P., A.H.-B., J.M.-L., J.K.), Neurology Department .,Biomedical Research Institute (F.S., S.M.-H., J.P.-P., A.H.-B., J.M.-L., A.A.-S., I.C., J.K.), Barcelona, Spain.,Centro de Investigación en Red-Enfermedades Neurodegenerativas (F.S., S.M.-H., J.P.-P., A.H.-B., J.M.-L., J.K.), Madrid, Spain.,European Huntington's Disease Network (S.M.-H., J.P.-P., A.H.-B., J.K.), Ulm, Germany
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Santos García D, Jesús S, Aguilar M, Planellas LL, García Caldentey J, Caballol N, Legarda I, Hernández Vara J, Cabo I, López Manzanares L, González Aramburu I, Ávila Rivera MA, Catalán MJ, López Díaz L, Puente V, García Moreno JM, Borrué C, Solano Vila B, Álvarez Sauco M, Vela L, Escalante S, Cubo E, Carrillo Padilla F, Martínez Castrillo JC, Sánchez Alonso P, Alonso Losada MG, López Ariztegui N, Gastón I, Kulisevsky J, Menéndez González M, Seijo M, Rúiz Martínez J, Valero C, Kurtis M, Fábregues‐Boixar O, González Ardura J, Prieto Jurczynska C, Martinez‐Martin P, Mir P, Adarmes Astrid D, Almeria M, Alonso Cánovas A, Alonso Frech F, Aneiros Díaz A, Arnáiz S, Arribas S, Ascunce Vidondo A, Bernardo Lambrich N, Bejr‐Kasem H, Blázquez Estrada M, Botí M, Cabello González C, Cámara Lorenzo A, Carrillo F, Casas E, Clavero P, Cortina Fernández A, Cots Foraster A, Crespo Cuevas A, de Deus Fonticoba T, Díez‐Fairen M, Erro E, Estelrich Peyret E, Fernández Guillán N, Gámez P, Gallego M, García Campos C, Gómez Garre MP, González Aloy J, González García B, González Palmás MJ, González Toledo GR, Golpe Díaz A, Grau Solá M, Guardia G, Horta‐Barba A, Infante J, Labandeira C, Labrador MA, Lacruz F, Lage Castro M, López Seoane B, Macías Y, Mata M, Martí Andres G, Martí MJ, McAfee D, Meitín MT, Méndez del Barrio C, Miranda Santiago J, Morales Casado MI, Moreno Diéguez A, Nogueira V, Novo Amado A, Novo Ponte S, Ordás C, Pagonabarraga J, Pareés I, Pascual‐Sedano B, Pastor P, Pérez Fuertes A, Pérez Noguera R, Prats MA, Pueyo Morlans M, Redondo Rafales N, Rodríguez Méndez L, Rodríguez Pérez AB, Roldán F, Ruíz De Arcos M, Sánchez‐Carpintero M, Sánchez Díez G, Sánchez Rodríguez A, Santacruz P, Segundo Rodríguez JC, Serarols A, Sierra Peña M, Suárez Castro E, Tartari JP, Vargas L, Vázquez Gómez R, Villanueva C, Vives B, Villar MD. COPPADIS
‐2015 (
CO
hort of Patients with PArkinson's
DI
sease in Spain, 2015): an ongoing global Parkinson's disease project about disease progression with more than 1000 subjects included. Results from the baseline evaluation. Eur J Neurol 2019; 26:1399-1407. [DOI: 10.1111/ene.14008] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Accepted: 05/23/2019] [Indexed: 01/03/2023]
Affiliation(s)
- D. Santos García
- CHUAC, Complejo Hospitalario Universitario de A Coruña A CoruñaSpain
| | - S. Jesús
- Hospital Universitario Virgen del Rocío SevillaSpain
| | - M. Aguilar
- Hospital Universitari Mutua de Terrassa Terrassa Barcelona Spain
| | | | | | - N. Caballol
- Consorci Sanitari Integral Hospital Moisés Broggi Sant Joan Despí Barcelona Spain
| | - I. Legarda
- Hospital Universitario Son Espases Palma de MallorcaSpain
| | | | - I. Cabo
- Complejo Hospitalario Universitario de Pontevedra (CHOP) PontevedraSpain
| | | | | | - M. A. Ávila Rivera
- Consorci Sanitari Integral Hospital General de L'Hospitalet, L'Hospitalet de Llobregat Barcelona Spain
| | - M. J. Catalán
- Hospital Universitario Clínico San Carlos Madrid Spain
| | - L. López Díaz
- Complejo Hospitalario Universitario de Orense (CHUO) Orense Spain
| | | | | | | | - B. Solano Vila
- Institut d'Assistència Sanitària (IAS) – Institut Català de la Salut Girona Spain
| | | | - L. Vela
- Fundación Hospital de Alcorcón MadridSpain
| | - S. Escalante
- Hospital de Tortosa Verge de la Cinta (HTVC) Tortosa Tarragona Spain
| | - E. Cubo
- Complejo Asistencial Universitario de Burgos Burgos Spain
| | - F. Carrillo Padilla
- Hospital Universitario de Canarias San Cristóbal de la LagunaSanta Cruz de Tenerife Spain
| | | | | | - M. G. Alonso Losada
- Hospital Álvaro Cunqueiro Complejo Hospitalario Universitario de Vigo (CHUVI) Vigo Spain
| | | | - I. Gastón
- Complejo Hospitalario de Navarra Pamplona Spain
| | | | | | - M. Seijo
- Complejo Hospitalario Universitario de Pontevedra (CHOP) PontevedraSpain
| | | | - C. Valero
- Hospital Arnau de Vilanova Valencia Spain
| | - M. Kurtis
- Hospital Ruber Internacional Madrid Spain
| | | | | | | | - P. Martinez‐Martin
- Centro Nacional de Epidemiología y CIBERNED Instituto de Salud Carlos III Madrid Spain
| | - P. Mir
- Hospital Universitario Virgen del Rocío SevillaSpain
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Toledo M, Carnero-Pardo C, Carreno-Martinez M, Escudero-Torrella J, Gaig C, Garcia-Ribas G, Gil-Nagel A, Grandas FJ, Kulisevsky J, Lainez-Andres JM, Pareja JA, Porta-Etessam J, Poza-Aldea JJ, Rodriguez-Oroz MC, Serratosa JM, Villanueva V. [«Apuntes en Neurologia» (Notes in Neurology): a synthesis of the evidence on common paroxysmal neurological disorders and on neurodegenerative disorders]. Rev Neurol 2018; 67:S1-S21. [PMID: 30484273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
«Apuntes en Neurologia» is an initiative in which prominent national and international leaders, with broad academic recognition, came together to synthesise the most outstanding clinical aspects within their area of interest and to discuss the latest developments in a more accessible language. Understanding the factors that affect the onset and progression of any neurological disease through a review is important to be able to develop strategies to reduce the burden of these diseases. Moreover, knowledge of the clinical aspects is essential to solve the problems of daily clinical practice. The data collected here reflect the weight of evidence and some of them anticipate a promising future in the treatment of these diseases. This first edition focuses on common paroxysmal neurological disorders such as migraine, epilepsy and sleep disorders, as well as neurodegenerative disorders such as Parkinson's disease and cognitive impairment. These are clearly different pathologies, although some of them such as migraine and epilepsy, may share clinical symptoms. Sleep disorders, however, are important manifestations of neurodegenerative diseases that are sometimes clinically apparent long before the onset of other neurological symptoms. After recalling pathophysiology and diagnosis, the current review focuses on bringing together the main advances in five of the major neurological diseases.
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Affiliation(s)
- M Toledo
- Hospitals Vall d'Hebron, 08035 Barcelona, Espana
| | - C Carnero-Pardo
- Hospital Universitario Virgen de las Nieves, 18013 Granada, Espana
| | | | | | - C Gaig
- Hospital Clinic de Barcelona, 08036 Barcelona, Espana
| | - G Garcia-Ribas
- Hospital Universitario Ramon y Cajal, 28034 Madrid, Espana
| | - A Gil-Nagel
- Hospital Ruber Internacional, 28034 Madrid, Espana
| | - F J Grandas
- Hospital General Universitario Gregorio Maranon, Madrid, Espana
| | - J Kulisevsky
- Hospital de la Santa Creu i Sant Pau, 08025 Barcelona, Espana
| | | | - J A Pareja
- Hospital Universitario Fundacion Alcorcon, 28922 Alcorcon, Espana
| | | | | | - M C Rodriguez-Oroz
- Clinica Universidad de Navarra, Pamplona, Espana
- CIBERNED. Centro de Investigacion Biomedica en Red Enfermedades Neurodegenerativas, Madrid, Espana
- Ikerbasque, Fundacion Vasca para la Ciencia, Bilbao, Espana
- Centro Vasco de Cognicion, Cerebro y Lenguaje, San Sebastian, Espana
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11
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Gardoni F, Morari M, Kulisevsky J, Brugnoli A, Novello S, Pisanò CA, Caccia C, Mellone M, Melloni E, Padoani G, Sosti V, Vailati S, Keywood C. Safinamide Modulates Striatal Glutamatergic Signaling in a Rat Model of Levodopa-Induced Dyskinesia. J Pharmacol Exp Ther 2018; 367:442-451. [DOI: 10.1124/jpet.118.251645] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2018] [Accepted: 09/17/2018] [Indexed: 11/22/2022] Open
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12
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Bellosta Diago E, Pérez-Pérez J, Santos Lasaosa S, Viloria Alebesque A, Martínez-Horta S, Kulisevsky J, López Del Val J. Neurocardiovascular pathology in pre-manifest and early-stage Huntington's disease. Eur J Neurol 2018. [PMID: 29537687 DOI: 10.1111/ene.13630] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [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: 12/14/2022]
Abstract
BACKGROUND AND PURPOSE Cardiovascular events are a major cause of early death in the Huntington's disease (HD) population. Dysautonomia as well as deterioration of circadian rhythms can be detected early in the disease progression and can have profound effects on cardiac health. The aim of the present study was to determine if patients with HD and pre-manifest mutation carriers present a higher risk of cardiovascular disease than non-mutation-carrying controls. METHODS This was a prospective, cross-sectional, multicentre study of 38 HD mutation carriers (23 pre-manifest and 15 early-stage patients) compared with 38 age- and gender-matched healthy controls. Clinical and epidemiological variables, including the main haematological vascular risk factors, were recorded. Ambulatory blood-pressure monitoring and carotid intima-media thickness (CIMT) measurement were performed to assess autonomic function and as target-organ damage markers. RESULTS Most (63.2%) patients with HD (86.7% and 47.8%, respectively, of the early-stage and pre-manifest patients) were non-dippers compared with 23.7% of controls (P = 0.001). CIMT values were in the 75th percentile in 46.7% and 43.5%, respectively, of the early-stage and pre-manifest patients, whereas none of the controls presented pathological values (P = 0.001 and P = 0.006, respectively). Nocturnal non-dipping was significantly associated with CIMT values in patients (P = 0.002) but not in controls. CONCLUSIONS These results suggest that higher cardiovascular risks and target-organ damage are present even in pre-manifest patients. Although larger studies are needed to confirm these findings, clinicians should consider these results in the cardiovascular management of patients with HD.
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Affiliation(s)
- E Bellosta Diago
- Neurology Department, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain.,Resarch Group of Movement Disorders and Headache (GIIS070), Instituto de Investigación Sanitaria de Aragón (IIS-Aragón), Zaragoza, Spain
| | - J Pérez-Pérez
- Neurology Department, Movement Disorders Unit, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.,Biomedical Research Institute Sant Pau (IIB-Sant Pau), Barcelona, Spain.,Centro Investigación Biomedica en Red-Enfermedades Neurodegenerativas (CIBERNED), Barcelona, Spain
| | - S Santos Lasaosa
- Neurology Department, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain.,Resarch Group of Movement Disorders and Headache (GIIS070), Instituto de Investigación Sanitaria de Aragón (IIS-Aragón), Zaragoza, Spain
| | - A Viloria Alebesque
- Neurology Department, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain.,Resarch Group of Movement Disorders and Headache (GIIS070), Instituto de Investigación Sanitaria de Aragón (IIS-Aragón), Zaragoza, Spain
| | - S Martínez-Horta
- Neurology Department, Movement Disorders Unit, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.,Biomedical Research Institute Sant Pau (IIB-Sant Pau), Barcelona, Spain.,Centro Investigación Biomedica en Red-Enfermedades Neurodegenerativas (CIBERNED), Barcelona, Spain
| | - J Kulisevsky
- Neurology Department, Movement Disorders Unit, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.,Biomedical Research Institute Sant Pau (IIB-Sant Pau), Barcelona, Spain.,Centro Investigación Biomedica en Red-Enfermedades Neurodegenerativas (CIBERNED), Barcelona, Spain
| | - J López Del Val
- Neurology Department, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain.,Resarch Group of Movement Disorders and Headache (GIIS070), Instituto de Investigación Sanitaria de Aragón (IIS-Aragón), Zaragoza, Spain
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13
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Pagonabarraga J, Kulisevsky J. [Safinamide from daily clinical practice: first clinical steps]. Rev Neurol 2017; 65:433-438. [PMID: 29130466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
INTRODUCTION The management of motor complications in Parkinson's disease (PD) is still limited. Safinamide, a new drug that has MAO-B inhibition and antiglutamatergic effects through inhibition of sodium channels, has shown efficacy for the treatment of fluctuations at doses of 50-100 mg/day. PATIENTS AND METHODS From daily clinical practice, we describe the efficacy and tolerability of safinamide at three months in PD patients with motor complications. Efficacy was assessed by the Clinical Global Impression of Change scale and change in 'off' time during the daytime. All reported adverse events were recorded. RESULTS Fifty patients were recruited. 57.4% reported to be much better or moderately better at three months, improving both motor and non-motor fluctuations. Significant decrease of 0.9 ± 0.6 h/day was achieved at three months. In 13 patients (27.6%), levodopa equivalent daily dose was reduced in 132 mg/day. In patients with dyskinesias, safinamide 100 mg/day was better for controlling fluctuations and dyskinesias. 19% of patients had mild adverse events. Seven patients stopped treatment after development of confusional syndrome. CONCLUSIONS The dopaminergic and non-dopaminergic action of safinamide exerts a good control of motor fluctuations. In patients with fluctuations and dyskinesias the dose of 100 mg/day of safinamide is preferred. Tolerability was good, except for patients older than 75 years or in advanced stages of the disease.
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Affiliation(s)
- J Pagonabarraga
- Hospital de la Santa Creu i Sant Pau, 08025 Barcelona, Espana
| | - J Kulisevsky
- Hospital de la Santa Creu i Sant Pau, 08025 Barcelona, Espana
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Gardoni F, Morari M, Kulisevsky J, Brugnoli A, Caccia C, Mellone M, Melloni E, Padoani G, Sosti M, Vailati S, Keywood C. Safinamide modulates levodopa induced striatal glutamatergic overactivity in a rat model of Parkinson's disease. J Neurol Sci 2017. [DOI: 10.1016/j.jns.2017.08.1027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Matias-Guiu J, Fernández de Bobadilla R, Escudero G, Pérez-Pérez J, Cortés A, Morenas-Rodríguez E, Valles-Salgado M, Moreno-Ramos T, Kulisevsky J, Matías-Guiu J. Validación de la versión española del test Addenbrooke's Cognitive Examination III para el diagnóstico de demencia. Neurologia 2015; 30:545-51. [DOI: 10.1016/j.nrl.2014.05.004] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2014] [Revised: 05/09/2014] [Accepted: 05/18/2014] [Indexed: 12/22/2022] Open
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Matias-Guiu J, Fernández de Bobadilla R, Escudero G, Pérez-Pérez J, Cortés A, Morenas-Rodríguez E, Valles-Salgado M, Moreno-Ramos T, Kulisevsky J, Matías-Guiu J. Validation of the Spanish version of Addenbrooke's Cognitive Examination III for diagnosing dementia. Neurología (English Edition) 2015. [DOI: 10.1016/j.nrleng.2014.05.001] [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: 10/22/2022] Open
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Marin-Lahoz J, Pagonabarraga J, Fernandez-de-Bobadilla R, Pascual-Sedano B, Perez-Perez J, Gironell A, Kulisevsky J. Impulsivity, but not dopamine agonists, explains severity of impulse control disorders in PD. J Neurol Sci 2015. [DOI: 10.1016/j.jns.2015.08.209] [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: 10/22/2022]
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Perez-Perez J, Martinez-Horta S, Carceller M, Pagonabarraga J, de Bobadilla R, Campolongo A, Kulisevsky J. H15 Prevalence And Phenomenology Of Psychotic Symptoms In Huntington's Disease. Journal of Neurology, Neurosurgery & Psychiatry 2014. [DOI: 10.1136/jnnp-2014-309032.160] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Martinez-Horta S, Perez-Perez J, Carceller M, de Bobadilla R, Pagonabarraga J, Campolongo A, Pascual-Sedano B, Kulisevsky J. H05 Prevalence And Correlates Of Neuropsychiatric Symptoms In Pre-manifested And Early Stage Huntington's Disease. Journal of Neurology, Neurosurgery & Psychiatry 2014. [DOI: 10.1136/jnnp-2014-309032.150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Perez-Perez J, Martinez-Horta S, Pagonabarraga J, Carceller M, Kulisevsky J. N06 Rasagiline For The Treatment Of Parkinsonism In Huntington's Disease. Journal of Neurology, Neurosurgery & Psychiatry 2014. [DOI: 10.1136/jnnp-2014-309032.298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Rodriguez-Dechicha N, Vaquer I, Camara E, Garcia-Gorro C, Calopa M, Garau-Rolandi M, Garcia A, Martinez S, Perez J, Kulisevsky J, Munoz E, Santa-Cruz P, Ruiz J, Mareca C, Caballol N, Subira S, de Diego-Balaguer R. H03 Awareness Of Dysexecutive Function In Huntington Disease. Journal of Neurology, Neurosurgery & Psychiatry 2014. [DOI: 10.1136/jnnp-2014-309032.148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Sosti M, Martinez-Horta S, Perez Perez J, Arenas F, Kulisevsky J. C08 Set-shifting Deficits In The Pre-symptomatic Bachd Transgenic Rat Model Of Huntington's Disease. J Neurol Psychiatry 2014. [DOI: 10.1136/jnnp-2014-309032.81] [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: 11/04/2022]
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Garcia-Gorro C, Vila A, Rodriguez-Dechicha N, Martinez-Horta S, Vaquer I, Calopa M, Perez-Perez J, Munoz E, Santacruz P, Ruiz J, Mareca C, Caballol N, Kulisevsky J, Subira S, Camara E, de Diego-Balaguer R. E26 Abnormal Functional Connectivity in Huntington's Disease During a Sequential Motor Task. Journal of Neurology, Neurosurgery & Psychiatry 2014. [DOI: 10.1136/jnnp-2014-309032.129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Martinez-Horta S, Perez-Perez J, Sampedro-Santalo F, Pagonabarraga J, Carceller M, de Bobadilla R, Fernandez A, Lopez-Mora D, Camacho V, Gomez-Anson B, Kulisevsky J. E30 Brain Metabolic Correlates Of Apathy And Depression In Pre-manifested Huntington's Disease: A 18-fgd Pet Study. Journal of Neurology, Neurosurgery & Psychiatry 2014. [DOI: 10.1136/jnnp-2014-309032.133] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Yagüe S, Aceituno A, Belvis R, Mayolas N, Sanuy B, Torres T, Kulisevsky J. Sphincter dysfunction in a case of cauda equina disorder: An atypical variant of autoimmune lumbosacral polyradiculoneuropathy. J Neurol Sci 2013. [DOI: 10.1016/j.jns.2013.07.1690] [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: 10/26/2022]
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Kulisevsky J, Luquin MR, Arbelo JM, Burguera JA, Carrillo F, Castro A, Chacón J, García-Ruiz PJ, Lezcano E, Mir P, Martinez-Castrillo JC, Martínez-Torres I, Puente V, Sesar A, Valldeoriola-Serra F, Yañez R. [Advanced Parkinson's disease: clinical characteristics and treatment (part 1)]. Neurologia 2013; 28:503-21. [PMID: 23856182 DOI: 10.1016/j.nrl.2013.05.001] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [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: 03/15/2013] [Revised: 04/16/2013] [Accepted: 05/02/2013] [Indexed: 01/19/2023] Open
Abstract
INTRODUCTION A large percentage of patients with Parkinson's disease (PD) develop motor fluctuations, dyskinesias, and severe non-motor symptoms within 3 to 5 years of starting dopaminergic therapy, and these motor complications are refractory to treatment. Several authors refer to this stage of the disease as advanced Parkinson's disease. OBJECTIVE To define the clinical manifestations of advanced PD and the risk factors for reaching this stage of the disease. DEVELOPMENT This consensus document has been prepared by using an exhaustive literature search and by discussion of the contents by an expert group on movement disorders of the Sociedad Española de Neurología (Spanish Neurology Society), coordinated by two of the authors (JK and MRL). CONCLUSIONS Severe motor fluctuations and dyskinesias, axial motor symptoms resistant to levodopa, and cognitive decline are the main signs in the clinical phenotype of advanced PD.
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Affiliation(s)
- J Kulisevsky
- Servicio de Neurología, Hospital Sant Pau, IIB Sant Pau, CIBERNED, Universitat Autònoma de Barcelona, Barcelona, España.
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Berardelli A, Wenning GK, Antonini A, Berg D, Bloem BR, Bonifati V, Brooks D, Burn DJ, Colosimo C, Fanciulli A, Ferreira J, Gasser T, Grandas F, Kanovsky P, Kostic V, Kulisevsky J, Oertel W, Poewe W, Reese JP, Relja M, Ruzicka E, Schrag A, Seppi K, Taba P, Vidailhet M. EFNS/MDS-ES/ENS [corrected] recommendations for the diagnosis of Parkinson's disease. Eur J Neurol 2013; 20:16-34. [PMID: 23279440 DOI: 10.1111/ene.12022] [Citation(s) in RCA: 323] [Impact Index Per Article: 29.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2012] [Accepted: 09/18/2012] [Indexed: 01/24/2023]
Abstract
BACKGROUND A Task Force was convened by the EFNS/MDS-ES Scientist Panel on Parkinson's disease (PD) and other movement disorders to systemically review relevant publications on the diagnosis of PD. METHODS Following the EFNS instruction for the preparation of neurological diagnostic guidelines, recommendation levels have been generated for diagnostic criteria and investigations. RESULTS For the clinical diagnosis, we recommend the use of the Queen Square Brain Bank criteria (Level B). Genetic testing for specific mutations is recommended on an individual basis (Level B), taking into account specific features (i.e. family history and age of onset). We recommend olfactory testing to differentiate PD from other parkinsonian disorders including recessive forms (Level A). Screening for pre-motor PD with olfactory testing requires additional tests due to limited specificity. Drug challenge tests are not recommended for the diagnosis in de novo parkinsonian patients. There is an insufficient evidence to support their role in the differential diagnosis between PD and other parkinsonian syndromes. We recommend an assessment of cognition and a screening for REM sleep behaviour disorder, psychotic manifestations and severe depression in the initial evaluation of suspected PD cases (Level A). Transcranial sonography is recommended for the differentiation of PD from atypical and secondary parkinsonian disorders (Level A), for the early diagnosis of PD and in the detection of subjects at risk for PD (Level A), although the technique is so far not universally used and requires some expertise. Because specificity of TCS for the development of PD is limited, TCS should be used in conjunction with other screening tests. Conventional magnetic resonance imaging and diffusion-weighted imaging at 1.5 T are recommended as neuroimaging tools that can support a diagnosis of multiple system atrophy (MSA) or progressive supranuclear palsy versus PD on the basis of regional atrophy and signal change as well as diffusivity patterns (Level A). DaTscan SPECT is registered in Europe and the United States for the differential diagnosis between degenerative parkinsonisms and essential tremor (Level A). More specifically, DaTscan is indicated in the presence of significant diagnostic uncertainty such as parkinsonism associated with neuroleptic exposure and atypical tremor manifestations such as isolated unilateral postural tremor. Studies of [(123) I]MIBG/SPECT cardiac uptake may be used to identify patients with PD versus controls and MSA patients (Level A). All other SPECT imaging studies do not fulfil registration standards and cannot be recommended for routine clinical use. At the moment, no conclusion can be drawn as to diagnostic efficacy of autonomic function tests, neurophysiological tests and positron emission tomography imaging in PD. CONCLUSIONS The diagnosis of PD is still largely based on the correct identification of its clinical features. Selected investigations (genetic, olfactory, and neuroimaging studies) have an ancillary role in confirming the diagnosis, and some of them could be possibly used in the near future to identify subjects in a pre-symptomatic phase of the disease.
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Affiliation(s)
- A Berardelli
- Dipartimento di Neurologia e Psichiatria and IRCCS NEUROMED Institute, Sapienza, Università di Roma, Rome, Italy.
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Martínez-Horta S, Kulisevsky J. J01 Cognitive alterations in Huntington's disease. J Neurol Psychiatry 2012. [DOI: 10.1136/jnnp-2012-303524.111] [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: 11/04/2022]
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Kulisevsky J, Fernandez de Bobadilla R, Pagonabarraga J, Martinez-Horta S, Garcia-Sanchez C, Pascual-Sedano B, Campolongo A, Villa C, Ribosa R, Gironell A. The Parkinson Disease Cognitive Functional Rating Scale (PD-CFRS): A Brief and Specific Instrument To Rate the Impact of PD Cognitive Symptoms on Daily Function (P06.054). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.p06.054] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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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Santos M, Pagonabarraga J, Kulisevsky J. 1.253 HYPERHOMOCYSTEINEMIA AS A POSSIBLE CAUSE OF HEMICHOREA-HEMIBALLISMUS-SYNDROME. Parkinsonism Relat Disord 2012. [DOI: 10.1016/s1353-8020(11)70311-x] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Pagonabarraga J, Martinez-Horta S, Fernández-Bobadilla R, Villa C, Ribosa R, Pascual-Sedano B, Kulisevsky J. 1.090 HALLUCINATIONS IN DRUG-NAÍVE, NEWLY-DIAGNOSED PARKINSON'S DISEASE. Parkinsonism Relat Disord 2012. [DOI: 10.1016/s1353-8020(11)70204-8] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Perez J, Pagonabarraga J, Sierra S, Pascual-Sedano B, Gironell A, Kulisevsky J. 2.264 NEUROPSYCHIATRIC PROFILE OF PATIENTS ON TREATMENT WITH PRAMIPEXOLE, ROPINIROLE OR LEVODOPA IN MONOTHERAPY: HEAD-TO-HEAD COMPARISON. Parkinsonism Relat Disord 2012. [DOI: 10.1016/s1353-8020(11)70588-0] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Kulisevsky J, Pagonabarraga J, Llebaria G, Hernández B, Arranz J. Evaluación de la satisfacción médico/paciente con el uso del “Parkinson's Disease Dementia-Short-Screen” (PDD-SS): un test de cribado para la demencia en la enfermedad de Parkinson (estudio DIFUSION). Neurologia 2011; 26:461-7. [DOI: 10.1016/j.nrl.2011.03.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2011] [Accepted: 03/12/2011] [Indexed: 10/17/2022] Open
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Rodriguez-Revenga L, Pagonabarraga J, Gómez-Anson B, López-Mourelo O, Madrigal I, Xunclà M, Kulisevsky J, Milà M. Motor and mental dysfunction in mother-daughter transmitted FXTAS. Neurology 2010; 75:1370-6. [PMID: 20938029 DOI: 10.1212/wnl.0b013e3181f73660] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [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
OBJECTIVES Fragile X-associated tremor/ataxia syndrome (FXTAS) is a late-onset neuropsychiatric degenerative disorder that occurs predominantly in male FMR1 premutation carriers. Recently, a broader FXTAS spectrum that, besides the core features of tremor and gait ataxia, also includes neuropsychiatric symptoms and neuropathy as further clinically relevant symptoms has been described among females. Herein 2 fragile X syndrome families with a mother-daughter FXTAS transmission are described in detail in order to shed more light on the female FXTAS phenotype. METHODS Molecular characterization included CGG repeat length, X-chromosome inactivation pattern determination, as well as FMR1 mRNA and FMRP levels quantification. Neuroradiologic examination was performed by 3-T MRI. Neuropsychological assessment included global cognitive, attention, and executive prefrontal functions, verbal fluencies, verbal memory, and visuospatial perception. RESULTS Molecular, neurologic, neuropsychiatric, psychological, cognitive, and neuroradiologic features description of 2 fragile X syndrome families with a mother-daughter FXTAS transmission in which dementia is present in both mothers. CONCLUSIONS Although it is not yet clear to what extent FXTAS shortens lifespan, our findings show that FXTAS progresses from mild tremor and/or ataxia to disabling motor and cognitive impairment, compromising the patients' quality of life. Furthermore, our results show that FXTAS in women can also develop as a multisystem neurodegenerative disorder with central and peripheral nervous system involvement, and both motor and mental disturbances.
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Aarsland D, Bronnick K, Williams-Gray C, Weintraub D, Marder K, Kulisevsky J, Burn D, Barone P, Pagonabarraga J, Allcock L, Santangelo G, Foltynie T, Janvin C, Larsen JP, Barker RA, Emre M. Mild cognitive impairment in Parkinson disease: a multicenter pooled analysis. Neurology 2010; 75:1062-9. [PMID: 20855849 DOI: 10.1212/wnl.0b013e3181f39d0e] [Citation(s) in RCA: 514] [Impact Index Per Article: 36.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND In studies of mild cognitive impairment (MCI) in Parkinson disease (PD), patients without dementia have reported variable prevalences and profiles of MCI, likely to be due to methodologic differences between the studies. OBJECTIVE The objective of this study was to determine frequency and the profile of MCI in a large, multicenter cohort of well-defined patients with PD using a standardized analytic method and a common definition of MCI. METHODS A total of 1,346 patients with PD from 8 different cohorts were included. Standardized analysis of verbal memory, visuospatial, and attentional/executive abilities was performed. Subjects were classified as having MCI if their age- and education-corrected z score on one or more cognitive domains was at least 1.5 standard deviations below the mean of either control subjects or normative data. RESULTS A total of 25.8% of subjects (95% confidence interval [CI] 23.5-28.2) were classified as having MCI. Memory impairment was most common (13.3%; 11.6-15.3), followed by visuospatial (11.0%; 9.4-13.0) and attention/executive ability impairment (10.1%; 8.6-11.9). Regarding cognitive profiles, 11.3% (9.7-13.1) were classified as nonamnestic single-domain MCI, 8.9% (7.0-9.9) as amnestic single-domain, 4.8% (3.8-6.1) as amnestic multiple-domain, and 1.3% (0.9-2.1) as nonamnestic multiple-domain MCI. Having MCI was associated with older age at assessment and at disease onset, male gender, depression, more severe motor symptoms, and advanced disease stage. CONCLUSIONS MCI is common in patients with PD without dementia, affecting a range of cognitive domains, including memory, visual-spatial, and attention/executive abilities. Future studies of patients with PD with MCI need to determine risk factors for ongoing cognitive decline and assess interventions at a predementia stage.
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Affiliation(s)
- D Aarsland
- Stavanger University Hospital, Psychiatric Division, PO Box 8100, 4068 Stavanger, Norway.
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Valldeoriola F, Regidor I, Mínguez-Castellanos A, Lezcano E, García-Ruiz P, Rojo A, Salvador A, Castro A, Grandas F, Kulisevsky J, Martí MJ, Martínez-Martín P, Relova L, Rumià J, Cámara A, Burguera JA, Linazasoro G, de Val JL, Obeso J, Rodríguez-Oroz MC, Tolosa E. Efficacy and safety of pallidal stimulation in primary dystonia: results of the Spanish multicentric study. J Neurol Neurosurg Psychiatry 2010; 81:65-9. [PMID: 19744963 DOI: 10.1136/jnnp.2009.174342] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND Dystonia is a complex clinical syndrome originated by a wide range of aetiologies. The diagnosis of dystonia is made after the evaluation of aetiological, phenomenological and genetic factors. Medications, except in patients with dopa-responsive dystonia, are of limited efficacy. Botulinum toxin injections are not applicable to patients with generalised dystonia, since many muscular groups contribute to disability. Clinical studies in children and adults with primary generalised dystonia (PGD) have reported beneficial effects of bilateral GPi deep brain stimulation (DBS) in both motor symptoms and disability produced by dystonia as well as a favourable impact of DBS in the health-related quality of life (HRQoL). Some clinical aspects of GPi stimulation in primary dystonia still remain controversial such as the influence of disease duration or age at onset in determining the postoperative clinical outcome. RESULTS The authors report the results of a multicentric study designed to assess the tolerability and clinical effects of bilateral pallidal DBS on motor impairment, functional disability, quality of life, pain and mood in patients with medically refractory primary generalised or segmental dystonia.
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Affiliation(s)
- F Valldeoriola
- Hospital Clínic, University of Barcelona, Barcelona, Spain.
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Kulisevsky J. O.104 Cognitive dysfunction/dementia. Parkinsonism Relat Disord 2009. [DOI: 10.1016/s1353-8020(09)70119-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Pérez V, Marin C, Rubio A, Aguilar E, Barbanoj M, Kulisevsky J. Effect of the additional noradrenergic neurodegeneration to 6-OHDA-lesioned rats in levodopa-induced dyskinesias and in cognitive disturbances. J Neural Transm (Vienna) 2009; 116:1257-66. [PMID: 19710996 DOI: 10.1007/s00702-009-0291-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2009] [Accepted: 07/31/2009] [Indexed: 10/20/2022]
Abstract
Parkinson's disease is a motor and cognitive disorder characterised by a progressive loss of the substantia nigra pars compacta (SNc) dopaminergic neurons as well as of the locus coeruleus (LC) noradrenergic neurons. It has been suggested that LC neurodegeneration might influence levodopa-induced motor disturbances and cognitive performance. We investigated the influence of dopaminergic and noradrenergic lesions on levodopa-induced dyskinesias and on working memory in rats. Two groups of animals were used: (1) rats with a dopaminergic lesion induced by a unilateral administration of the neurotoxin 6-hydroxydopamine (6-OHDA), and (2) rats with a combined lesion of the dopaminergic and noradrenergic systems induced by 6-OHDA and N-(2-chloroethyl)-N-ethyl-2-bromobenzylamine (DSP-4), respectively. Dyskinesias were evaluated on days 1, 8, 15 and 22 of chronic levodopa treatment (6 mg/kg, twice at day, i.p.). Working memory was evaluated by a radial-arm maze (1) before lesions, (2) before levodopa administration and (3) after 22 days of levodopa treatment. Total, axial, limb and orofacial dyskinesias not differed significantly between both groups. Working memory tasks worsened in both lesioned groups reaching significance in terms of time of performance (P < 0.05). The number of repeated entries in the same arm (errors) was only significant in the double-lesioned group (P < 0.05). This behaviour was not different from the one observed after chronic levodopa treatment. These results suggest that levodopa-induced dyskinesias in the 6-OHDA-lesioned rats were not affected by the additional noradrenergic lesion, whereas this last condition was sufficient to worse the cognitive performance deficit produced by the dopaminergic lesion.
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Affiliation(s)
- V Pérez
- Laboratori de Neuropsicofarmacología, Institut de Recerca de l'Hospital de la Sta Creu i de Sant Pau, Avgda. St. Antoni M feminine Claret, 167, 08025, Barcelona, Spain
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Kulisevsky J, Pagonabarraga J, Pascual-Sedano B, Gironell A, García-Sánchez C, Martínez-Corral M. Motor changes during sertraline treatment in depressed patients with Parkinson's disease*. Eur J Neurol 2008; 15:953-9. [PMID: 18637826 DOI: 10.1111/j.1468-1331.2008.02218.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND Pharmacological interventions to treat depressive symptoms associated with Parkinson's disease (PD) are limited. Whether selective serotonine re-uptake inhibitors increase parkinsonism or have clinically significant interactions with antiparkinsonian drugs is unresolved. PURPOSE We used a naturalistic approach to prospectively investigate the long-term effects on motor status of adding sertraline in a large sample of community-dwelling PD patients with depressive symptoms. METHODS Main outcome measure was the motor part of the Unified PD Rating Scale (UPDRS) at baseline and at 1-, 3-, and 6-month follow-up. Secondary measures were the change in antiparkinsonian drugs expressed as total levodopa equivalent dose and the scores of the Hospital Anxiety and Depression Scale (HADS). Of the 374 patients included, 310 (82%) completed the study. RESULTS Treatment with sertraline (mean dose 66.0 +/- 29.8 mg) resulted in improvement in all UPDRS domains along with a significant decrease of the HADS scores. A modest but significant increase of the total dose of levodopa, without significant change of total levodopa equivalent dose, was observed. Almost 8% of patients discontinued medication for adverse events, mainly related to the gastrointestinal system. CONCLUSIONS Although worsening of tremor was observed in some patients, active management of depression with sertraline appears to have a positive impact on parkinsonism.
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Affiliation(s)
- J Kulisevsky
- Movement Disorders Unit, Neurology Department, Sant Pau Hospital, Autonomous University of Barcelona, Barcelona, Spain.
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Abstract
The addition of entacapone to levodopa-carbidopa (LC) or the switch from LC to a tablet containing levodopa-carbidopa-entacapone (LCE) improves the wearing-off phenomenon, increases the 'on' time and decreases the 'off' time, but the appearance or exacerbation of dyskinesias is the more frequent side-effect. Thus, a reduction of the total levodopa dosage would be recommended. However, this could result in a lack of efficacy against the wearing-off. We report on the results of a clinical trial conducted to determine the best way in terms of efficacy, tolerability and safety of switching from LC to LCE in patients with Parkinson's disease (PD) and end of dose wearing-off. 39 patients with PD and wearing-off without or with mild dyskinesias were randomly assigned to either a group receiving the same LC dosage or to a group in which the total LC amount was reduced by 15-25%. Four weeks after the change, both groups showed an increase in daily 'on' time and a reduction in the daily time spent in 'off'. Two patients in each group experienced an increase in basal dyskinesias. No differences in clinical assessment between groups were found. Tolerance was excellent. This study suggests that switching from LC to LCE in patients with mild-to-moderate wearing-off can be done safely with or without reducing the total LD amount, but in the clinical setting it would be more practical to keep the dosage of LC unchanged unless severe dyskinesias are present.
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Affiliation(s)
- G Linazasoro
- Centro Investigación Parkinson, Policlínica Gipuzkoa, San Sebastián, Spain.
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Martínez-Corral M, Kulisevsky J. [Pramipexole and Parkinson's disease, an update]. Rev Neurol 2008; 46:49-52. [PMID: 18214827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Pramipexole is a non-ergotic D2/D3 dopaminergic agonist that can be used to treat the symptoms of Parkinson's disease safely and effectively both as monotherapy in the early stages and in the advanced phases in association with levodopa, which improves the motor fluctuations and dyskinesias. Furthermore, in laboratory studies pramipexole has proved to exert neuroprotector effects and its use in clinical practice from the early stages of the disease has been related to a delay in the appearance of motor complications (fluctuations and dyskinesias). It has recently been shown that it is especially valuable in the treatment of tremors and is also effective in improving certain non-motor symptoms such as depression. Pramipexole is free of the severe side effects (fibrosis and valve disease) linked with ergotic dopaminergic agonists and causes fewer digestive and dysautonomic alterations. Other undesirable side effects of treatment with non-ergotic agonists, such as hallucinations, the appearance of oedemas and drowsiness, can be minimised by carefully selecting the patients. Further studies need to be conducted to help define the long-term effects of dopaminergic agonists on the progress of the disease and also to show the differences between non-ergotic agonists in clinical practice.
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Affiliation(s)
- M Martínez-Corral
- Unidad de Trastornos del Movimiento, Servicio de Neurología, Hospital de la Santa Creu i Sant Pau, Barcelona
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Estorch M, Camacho V, Fuertes J, Rodríguez-Revuelto A, Hernández MA, Flotats A, Kulisevsky J, Carrió I. Demencia con cuerpos de Lewy y enfermedad de Alzheimer: diagnóstico diferencial mediante estudio de la inervación simpática cardíaca con MIBG. ACTA ACUST UNITED AC 2006; 25:229-35. [PMID: 16827985 DOI: 10.1157/13090655] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [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: 11/21/2022]
Abstract
UNLABELLED Dementia with Lewy bodies (DLB) is the second most common cause of degenerative dementia after Alzheimer's disease (AD). At present, pre-mortem diagnosis of DLB can only be made clinically using the International Consensus Criteria. However, an accurate differential diagnosis between these diseases could improve the therapeutic handling of patients with DLB, due to their supersensitivity to neuroleptic treatment and the difficult treatment of their psychotic symptoms. OBJECTIVE To assess the utility of cardiac MIBG imaging as diagnostic study for DLB, to help in the differential diagnosis with AD. MATERIAL AND METHODS Cardiac MIBG imaging was performed in 11 patients with clinical criteria of probable DLB (7 males, mean age 77 years [range 62-89 years], mean MMSE 17 [range 11-28], and in 9 patients with clinical criteria of probable AD (3 males, mean age 79 years [range 61-87 years], mean MMSE 17 [range 4-25]). Planar anterior images of the thorax were acquired at 15 minutes. (early study) and 4 hours (late study) after tracer injection. Myocardial MIBG activity was quantified by means of a heart-to-mediastinum ratio (HMR). A HMR > 1.8 was considered normal. RESULTS Respect AD patients, patients with DLB showed decreased HMR in the early study (1.34 +/- 0.27 [range 1.03-1.98] vs. 1.84 +/- 0.22 [range 1.53-2.15], p<0.001) and in the late study (1.22 +/- 0.23 [range 0.95-1.75] vs. 1.73 +/- 0.08 [range 1.59-1.89], p<0.0001). CONCLUSIONS Cardiac MIBG imaging could be a useful tool for differential diagnosis between DLB and AD.
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Affiliation(s)
- M Estorch
- Servicio de Medicina Nuclear, Hospital de la Santa Creu i Sant Pau, Universidad Autónoma de Barcelona, Barcelona, España.
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Kulisevsky J. IV.5 The role of the dopaminergic system in dementia associated with Parkinson's Disease. Parkinsonism Relat Disord 2006. [DOI: 10.1016/s1353-8020(07)70041-x] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Kulisevsky J. II.4 The role of dopamine in Parkinson's Disease-related cognitive dysfunction. Parkinsonism Relat Disord 2006. [DOI: 10.1016/s1353-8020(07)70021-4] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Abstract
The aim of the present study was to determine the effects of high frequency repetitive transcranial magnetic stimulation (rTMS) over different neuroanatomical areas [left and right doroslateral prefrontal cortex (DLPFC) and right cerebellar hemisphere] on time production task. The study was performed in 16 healthy right-handed men with a cross-over, within subject repeated measures design. There were four rTMS conditions: baseline without stimulation, high frequency rTMS over right, left DLPFC and over right cerebellum. The volunteers were asked to produce a 3-min interval by internal counting. The rTMS was applied during the task. No significantly differences were observed in absolute error scores in time estimation task with any rTMS condition. This preliminary study does not support the role of the prefrontal lobe in time production processes.
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Affiliation(s)
- A Gironell
- Cognitive and Movement Disorders Section, Department of Neurology, Hospital de la Santa Creu i Sant Pau, Autonomous University of Barcelona, Catalonia, Spain.
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Rodriguez-Oroz MC, Obeso JA, Lang AE, Houeto JL, Pollak P, Rehncrona S, Kulisevsky J, Albanese A, Volkmann J, Hariz MI, Quinn NP, Speelman JD, Guridi J, Zamarbide I, Gironell A, Molet J, Pascual-Sedano B, Pidoux B, Bonnet AM, Agid Y, Xie J, Benabid AL, Lozano AM, Saint-Cyr J, Romito L, Contarino MF, Scerrati M, Fraix V, Van Blercom N. Bilateral deep brain stimulation in Parkinson's disease: a multicentre study with 4 years follow-up. ACTA ACUST UNITED AC 2005; 128:2240-9. [PMID: 15975946 DOI: 10.1093/brain/awh571] [Citation(s) in RCA: 669] [Impact Index Per Article: 35.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Deep brain stimulation (DBS) is associated with significant improvement of motor complications in patients with severe Parkinson's disease after some 6-12 months of treatment. Long-term results in a large number of patients have been reported only from a single study centre. We report 69 Parkinson's disease patients treated with bilateral DBS of the subthalamic nucleus (STN, n = 49) or globus pallidus internus (GPi, n = 20) included in a multicentre study. Patients were assessed preoperatively and at 1 year and 3-4 years after surgery. The primary outcome measure was the change in the 'off' medication score of the Unified Parkinson's Disease Rating Scale motor part (UPDRS-III) at 3-4 years. Stimulation of the STN or GPi induced a significant improvement (50 and 39%; P < 0.0001) of the 'off' medication UPDRS-III score at 3-4 years with respect to baseline. Stimulation improved cardinal features and activities of daily living (ADL) (P < 0.0001 and P < 0.02 for STN and GPi, respectively) and prolonged the 'on' time spent with good mobility without dyskinesias (P < 0.00001). Daily dosage of levodopa was significantly reduced (35%) in the STN-treated group only (P < 0.001). Comparison of the improvement induced by stimulation at 1 year with 3-4 years showed a significant worsening in the 'on' medication motor states of the UPDRS-III, ADL and gait in both STN and GPi groups, and speech and postural stability in the STN-treated group. Adverse events (AEs) included cognitive decline, speech difficulty, instability, gait disorders and depression. These were more common in patients treated with DBS of the STN. No patient abandoned treatment as a result of these side effects. This experience, which represents the first multicentre study assessing the long-term efficacy of either STN or GPi stimulation, shows a significant and substantial clinically important therapeutic benefit for at least 3-4 years in a large cohort of patients with severe Parkinson's disease.
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Affiliation(s)
- M C Rodriguez-Oroz
- Department of Neurology and Neurosurgery, Clinica Universitaria and Medical School, University of Navarra and CIMA, Pamplona, Spain
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García-Sánchez C, Estévez-González A, Boltes A, Otermín P, López-Góngora M, Gironell A, Kulisevsky J. [Cognitive and functional decline in the stage previous to the diagnosis of Alzheimers disease]. Neurologia 2003; 18:716-22. [PMID: 14648347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/27/2023] Open
Abstract
INTRODUCTION The decline in the phase prior to diagnosis of Alzheimers disease (AD) is not well known, although this knowledge is necessary to evaluate the efficiency of new drugs that can influence in disease course prior to diagnosis. OBJECTIVE To contribute to better knowledge of the decline prior to diagnosis, we have investigated the cognitive and functional deterioration for 2-3 years before the probable AD diagnosis was established. PATIENTS AND METHODS We compared results obtained by 17 control subjects and 27 patients at the time of diagnosis of a probable AD with results obtained 2-3 years before (interval of 27.7 4 months). We compared memory functions (logical, recognition, learning and autobiographical memory), naming, visual and visuospatial gnosis, visuoconstructive praxis, verbal fluency and the Mini-Mental State Examination (MMSE), Informant Questionnaire and Blessed's Scale scores. RESULTS Performance of control subjects did not change. AD patients showed a significant decline in scores, except for verbal fluency. In order of importance, cognitive decline was more marked in scores of learning memory, visuospatial gnosis, autobiographical memory and visuoconstructive praxis. CONCLUSIONS Decline prior to diagnosis of AD is characterized by an important learning memory impairment. Deterioration of visuospatial gnosis and visuoconstructive praxis is greater than deterioration of MMSE and Informant Questionnaire scores.
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Affiliation(s)
- C García-Sánchez
- Servicio de Neurología, Hospital de la Santa Creu i Sant Pau Universidad Autónoma de Barcelona, Spain.
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Gutiérrez L, Dávalos A, Pedraza S, García Sánchez C, Kulisevsky J. [Neuropsychological and behavioural impairments resulting from bilateral thalamic infarct]. Neurologia 2003; 18:404-8. [PMID: 14505251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/27/2023] Open
Abstract
The neuropsychological characteristics of a patient with a bilateral thalamic infarct in the posterior communicating artery territory due to basilar artery thrombosis are described. MRI examination showed bilateral thalamic acute ischemic lesions in the zone anterior to the tuberothalamic branches. In the cognitive exploration, the patient showed verbal and visual memory disorders, impairment of the executive functions including inability to generate and make decisions and behavioural disorders including lack of inhibition, euphoria, and occasional aggressiveness. Two months later the patient had improved in the neuropsychological test scores but still suffered from severe recent memory loss, and certain behavioural disorders including lack of inhibition and euphoria. Other cases on thalamic infarcts with cognitive and behavioural impairments due to disconnection of the front subcortical pathways have been described in the literature.
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Affiliation(s)
- L Gutiérrez
- Servicio de Neurología, Hospital Universitario Doctor Josep Trueta, Girona.
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Barbanoj MJ, Valle M, Kulisevsky J, Pérez V, Gambús P. Uses of pharmaco-EEG and pharmacokinetic-pharmacodynamic modeling in the clinical scenario. Methods Find Exp Clin Pharmacol 2003; 24 Suppl D:139-44. [PMID: 12575481] [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] [Subscribe] [Scholar Register] [Indexed: 02/28/2023]
Abstract
In order to place pharmaco-EEG within the clinical context, the distinction between biomarkers, surrogate endpoints, clinical endpoints and clinical outcomes is introduced. State-of-the-art applications of pharmaco-EEG, together with pharmacokinetic-pharmacodynamic modeling in everyday clinical practice in anesthesiology (semilinear canonical correlation), psychiatry (discrimination between responders and nonresponders to pharmacological treatment using the test dose), neurology (antiepileptic field) and neurophysiology (first-order Markov model of sleep stage transitions) are discussed. The combination of both procedures, although successfully used during some drug development programs (opioids or benzodiazepines), is not widely applied in the clinical scenario where the central nervous system (CNS) is concerned. Much work is still need to develop fully the potentials that pharmaco-EEG together with pharmacokinetic-pharmacodynamic modeling could bring to therapeutics in neuroscience.
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Affiliation(s)
- M J Barbanoj
- Centre d'Investigació de Medicaments, Institut de Recerca, Servei de Faramacologia Clínica, HSCSP, Departament de Farmacologia i Terapèutica UAB, Barcelona, Spain
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Gironell A, Crusat M, Rigau E, García-Nonell C, Velo E, García-Sánchez C, Kulisevsky J. [Validation of the translation to Catalan and Spanish of cognitive evoked potential N400]. Neurologia 2003; 18:310-7. [PMID: 12838450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/03/2023] Open
Abstract
INTRODUCTION The cognitive evoked potential N400 permits an objective assessment of the verbal semantic processing. It has been suspected to be clinically useful in cognitive abnormalities and a correlation with attentional and memory functions has been found. The present study tries to validate the translation and adaptation of the English paradigm to the Catalan and Spanish languages. METHOD The study was performed on 16 healthy volunteers with Catalan native language and 16 volunteers with Spanish native language. Three blocks of 50 sentences (4-9 words) were administered using headphones. The last word of 50 % of the sentences was incongruent. The beginning of this word was the trigger for the EEG average. EEG leads used were: Fz, Cz, Pz, C3, C4, T3, T4 with biauricular reference. The measures were amplitude and latency of the potential obtained after the subtraction of the EEG average of congruent and incongruent sentences. A t-test for one sample (the original potential) was applied. RESULTS Amplitude and latency of the potential obtained by the Catalan and Spanish languages were not result statistically different from the original potential. The major amplitude was obtained in Cz. Mean amplitudes: Catalan language: 5.3 2.3 V (95 % CI for the difference: 0.39 2.12 V); Spanish language: 5.2 2.3 V (95 % CI for the difference: 0.43 2.32 V). CONCLUSIONS The Catalan and Spanish version of the N400 evoked potential offer the possibility to use an objective instrument for the study of language in neuroscience.
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Affiliation(s)
- A Gironell
- Servicio de Neurología, Hospital de Sant Pau, Universidad Autónoma de Barcelona, Spain.
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