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Piat C, Mullan AF, Stang CD, Hajeb M, Camerucci E, Turcano P, Martin PR, Bower JH, Savica R. Risk of hospitalization in synucleinopathies and impact of psychosis. Front Aging Neurosci 2023; 15:1274821. [PMID: 37810618 PMCID: PMC10557428 DOI: 10.3389/fnagi.2023.1274821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 09/04/2023] [Indexed: 10/10/2023] Open
Abstract
Background Few studies have investigated the risk of hospitalization among patients with synucleinopathies (Parkinson disease, Dementia with Lewy Bodies, Parkinson disease dementia, Multiple System Atrophy) with associated psychosis and the impact of antipsychotic treatments on hospital admissions and duration of the stay. Objective To determine the risk of hospitalization among patients with synucleinopathies and in patients with associated psychosis. To evaluate the impact of antipsychotic treatments on hospital admission of patients with synucleinopathies and psychosis in an incident cohort study in Olmsted County, Minnesota (MN). Methods We used the Rochester Epidemiology Project (REP) to define an incident cohort of patients with clinically diagnosed synucleinopathies (1991-2010) in Olmsted County, MN. A movement disorder specialist reviewed all medical records to confirm the clinical diagnosis of synucleinopathies using the NINDS/NIMH unified diagnostic criteria. Results We included 416 incident cases of clinically diagnosed synucleinopathies from 2,669 hospitalizations. 409 patients (98.3%) were admitted to the hospital at least once for any cause after the onset of parkinsonism. The median number of hospitalizations for a single patient was 5. In total, 195 (46.9%) patients met the criteria for psychosis: patients with psychosis had a 49% (HR = 1.49, p < 0.01) increased risk of hospitalization compared to patients without psychosis. Among patients with psychosis, 76 (39%) received antipsychotic medication. Treatment with antipsychotic medications did not affect the risk of hospitalization (HR = 0.93, p = 0.65). The median length of hospitalization among the entire cohort was 1 (IQR 0-4) day. There was no difference between hospitalization length for patients with no psychosis and patients with active psychosis (RR = 1.08, p = 0.43) or patients with resolved psychosis (RR = 0.79, p = 0.24). Conclusion Psychosis increases the risk of hospitalization in patients with clinically defined synucleinopathies; however, it does not affect the length of hospital stays in our cohort. Antipsychotic treatment does not affect the risk of hospitalization in our study.
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Affiliation(s)
- Capucine Piat
- Mayo Clinic Department of Neurology, Rochester, MN, United States
| | - Aidan F. Mullan
- Mayo Clinic Department of Health Sciences Research, Rochester, MN, United States
| | - Cole D. Stang
- Mayo Clinic Department of Neurology, Rochester, MN, United States
| | - Mania Hajeb
- Mayo Clinic Department of Neurology, Rochester, MN, United States
| | - Emanuele Camerucci
- Department of Neurology, Kansas University Medical Center, Kansas City, KS, United States
| | | | - Peter R. Martin
- Mayo Clinic Department of Health Sciences Research, Rochester, MN, United States
| | - James H. Bower
- Mayo Clinic Department of Neurology, Rochester, MN, United States
| | - Rodolfo Savica
- Mayo Clinic Department of Neurology, Rochester, MN, United States
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Chia NH, McKeon A, Dalakas MC, Flanagan EP, Bower JH, Klassen BT, Dubey D, Zalewski NL, Duffy D, Pittock SJ, Zekeridou A. Stiff person spectrum disorder diagnosis, misdiagnosis, and suggested diagnostic criteria. Ann Clin Transl Neurol 2023. [PMID: 37212351 DOI: 10.1002/acn3.51791] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 05/02/2023] [Indexed: 05/23/2023] Open
Abstract
BACKGROUND Stiff person spectrum disorder (SPSD) is heterogeneous, and accurate diagnosis can be challenging. METHODS Patients referred for diagnosis/suspicion of SPSD at the Mayo Autoimmune Neurology Clinic from July 01, 2016, to June 30, 2021, were retrospectively identified. SPSD diagnosis was defined as clinical SPSD manifestations confirmed by an autoimmune neurologist and seropositivity for high-titer GAD65-IgG (>20.0 nmol/L), glycine-receptor-IgG or amphiphysin-IgG, and/or confirmatory electrodiagnostic studies (essential if seronegative). Clinical presentation, examination, and ancillary testing were compared to differentiate SPSD from non-SPSD. RESULTS Of 173 cases, 48 (28%) were diagnosed with SPSD and 125 (72%) with non-SPSD. Most SPSD were seropositive (41/48: GAD65-IgG 28/41, glycine-receptor-IgG 12/41, amphiphysin-IgG 2/41). Pain syndromes or functional neurologic disorder were the most common non-SPSD diagnoses (81/125, 65%). SPSD patients more commonly reported exaggerated startle (81% vs. 56%, p = 0.02), unexplained falls (76% vs. 46%, p = 0.001), and other associated autoimmunity (50% vs. 27%, p = 0.005). SPSD more often had hypertonia (60% vs. 24%, p < 0.001), hyperreflexia (71% vs. 43%, p = 0.001), and lumbar hyperlordosis (67% vs. 9%, p < 0.001) and less likely functional neurologic signs (6% vs. 33%, p = 0.001). SPSD patients more frequently had electrodiagnostic abnormalities (74% vs. 17%, p < 0.001), and at least moderate symptomatic improvement with benzodiazepines (51% vs. 16%, p < 0.001) or immunotherapy (45% vs. 13% p < 0.001). Only 4/78 non-SPSD patients who received immunotherapy had alternative neurologic autoimmunity. INTERPRETATION Misdiagnosis was threefold more common than confirmed SPSD. Functional or non-neurologic disorders accounted for most misdiagnoses. Clinical and ancillary testing factors can reduce misdiagnosis and exposure to unnecessary treatments. SPSD diagnostic criteria are suggested.
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Affiliation(s)
- Nicholas H Chia
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - Andrew McKeon
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
- Center of MS and Autoimmune Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - Marinos C Dalakas
- Department of Neurology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
- Neuroimmunology Unit, National and Kapodistrian University of Athens, Athens, Greece
| | - Eoin P Flanagan
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
- Center of MS and Autoimmune Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - James H Bower
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - Bryan T Klassen
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - Divyanshu Dubey
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
- Center of MS and Autoimmune Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - Nicholas L Zalewski
- Center of MS and Autoimmune Neurology, Mayo Clinic, Rochester, Minnesota, USA
- Department of Neurology, Mayo Clinic, Scottsdale, Arizona, USA
| | - Dustin Duffy
- Center of MS and Autoimmune Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - Sean J Pittock
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
- Center of MS and Autoimmune Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - Anastasia Zekeridou
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
- Center of MS and Autoimmune Neurology, Mayo Clinic, Rochester, Minnesota, USA
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Bailey ES, Hooshmand SJ, Badihian N, Sandroni P, Benarroch EE, Bower JH, Low PA, Singer W, Coon EA. Sex and Gender Influence Urinary Symptoms and Management in Multiple System Atrophy. J Mov Disord 2023; 16:196-201. [PMID: 37258281 DOI: 10.14802/jmd.23016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 03/24/2023] [Indexed: 06/02/2023] Open
Abstract
OBJECTIVE Multiple system atrophy (MSA) is characterized by urinary dysfunction, yet the influence of sex and gender on urinary symptoms and treatment is unclear. We sought to characterize sex and gender differences in the symptomatology, evaluation, and management of urinary dysfunction in patients with MSA. METHODS Patients with MSA evaluated at our institution were reviewed and stratified by sex. RESULTS While the prevalence of urinary symptoms was similar in male and female patients, incontinence was more common in females. Despite this, males and females underwent postvoid residual (PVR) measurement at similar rates. While catheterization rates were similar when PVR was measured, males were more than twice as likely to be catheterized than females in the absence of PVR measurement. CONCLUSION Urinary symptoms are common in MSA, but their presentation differs between males and females. The difference in catheterization rates may be driven by a gender disparity in referrals for PVR, which can guide treatment.
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Affiliation(s)
| | | | - Negin Badihian
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | - Paola Sandroni
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | | | - James H Bower
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | - Phillip A Low
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
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Camerucci E, Mullan AF, Bower JH, Bharucha AE, Turcano P, Stang CD, Benarroch EE, Boeve BF, Ahlskog JE, Savica R. Lifelong constipation in Parkinson's disease and other clinically defined alpha-synucleinopathies: A population-based study in Southeast Minnesota. Parkinsonism Relat Disord 2023; 107:105244. [PMID: 36630736 PMCID: PMC10262204 DOI: 10.1016/j.parkreldis.2022.105244] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Epidemiological studies show correlations between constipation and development of Parkinson's disease (PD); however, few studies have explored the association between constipation and dementia with Lewy bodies (DLB), Parkinson's disease dementia (PDD), and multiple system atrophy (MSA). We sought to explore the lifelong association of constipation and PD, DLB, PDD, and MSA (α-Synucleinopathies), compared to age- and sex-matched controls. METHODS Using the Rochester Epidemiology Project (REP), we established an incident cohort of clinically defined α-synucleinopathies. A movement-disorder specialist reviewed all medical charts to establish clinical diagnoses. RESULTS We identified 453 incident cases of clinically diagnosed α-synucleinopathies and an identical number of age- and sex-matched controls in Olmsted County (MN), 1991-2010. There were 303 cases of PD; 80, DLB; 54, PDD; and 16, MSA. Approximately 50% of α-synucleinopathies of all types reported constipation, compared to 27% in controls. The earliest pre-motor onset constipation was in DLB (median, 3.76 years prior to α-synucleinopathies motor-symptom onset); latest onset post-motor constipation was in PD (median, 5.15 years after motor-symptom onset). PD also had the highest longstanding constipation rate (18.2%). All α-synucleinopathies had higher odds of constipation compared to controls, except for MSA (p = 0.09), likely due to a limited sample size. CONCLUSION PD, DLB, and PDD had higher odds of constipation compared to controls; PD had the most widespread onset of lifelong constipation, both longstanding and pre- or post-motor onset symptoms. Our results indicate that constipation rates do not differ among α-synucleinopathies but do differ in terms of temporal onset compared to disease onset.
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Affiliation(s)
- Emanuele Camerucci
- Department of Neurology, Mayo Clinic, Rochester, MN, USA; Department of Neurology, University of Kansas Medical Center (KUMC), Kansas City, MO, USA
| | - Aidan F Mullan
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | - James H Bower
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | - Adil E Bharucha
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
| | | | - Cole D Stang
- Department of Neurology, Mayo Clinic, Rochester, MN, USA; University of Minnesota Medical School, Duluth, MN, USA
| | | | | | - J Eric Ahlskog
- Department of Neurology, Mayo Clinic, Rochester, MN, USA.
| | - Rodolfo Savica
- Department of Neurology, Mayo Clinic, Rochester, MN, USA; Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
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Stang CD, Mullan AF, Camerucci E, Hajeb M, Turcano P, Martin P, Mielke MM, Josephs KA, Splett M, Abler V, Boeve BF, Bower JH, Savica R. Incidence, Prevalence, and Mortality of Psychosis Associated with Parkinson's Disease (1991-2010). J Parkinsons Dis 2022; 12:1319-1327. [PMID: 35213389 PMCID: PMC9336204 DOI: 10.3233/jpd-213035] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND Parkinson's disease (PD)-associated psychosis is a well-known non-motor complication, occurring years after diagnosis of PD. Incidence data vary across different studies highlighting a need for long-term observation and clinical definition. OBJECTIVE To determine the incidence of psychosis in patients with PD and to investigate their survival in an incident cohort study from 1991-2010 in Olmsted County, MN. METHODS We used the Rochester Epidemiology Project to define an incident-cohort study of parkinsonism (1991-2010) in Olmsted County, MN. A movement-disorder specialist reviewed the electronic medical records and applied diagnosis criteria to PD. Psychosis was diagnosed using of NINDS/NIMH unified criteria. RESULTS We identified 669 cases of parkinsonism; 297 patients were clinically diagnosed with PD. 114/297 (38.4%) patients had evidence of psychosis (60% male); the median onset age of psychosis was 79.4 years. The incidence of Parkinson's disease psychosis (PDP) was 4.28/100 person-years. PDP patients had a 71% increased risk of death compared to PD patients. In PD patients without psychosis, men had 73.4% increased risk of death compared to women, whereas no significant sex difference was observed among PDP men vs. women. Of 114 patients diagnosed with psychosis, 59 were treated with antipsychotics. There was no significant difference in survival between treated and untreated patients. CONCLUSION PDP increased the odds of death compared to PD patients. Men with PD without psychosis had greater odds of death compared to women; however, in PD with psychosis the odds of death were comparable among sexes. Lastly, treatment with anti-psychotics did not significantly affect survival.
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Affiliation(s)
- Cole D. Stang
- Mayo Clinic Department of Neurology, Rochester, Minnesota, USA
| | - Aidan F. Mullan
- Mayo Clinic Department of Health Sciences Research, Rochester, Minnesota, USA
| | | | - Mania Hajeb
- Mayo Clinic Department of Neurology, Rochester, Minnesota, USA
| | | | - Peter Martin
- Mayo Clinic Department of Health Sciences Research, Rochester, Minnesota, USA
| | - Michelle M. Mielke
- Mayo Clinic Department of Health Sciences Research, Rochester, Minnesota, USA
| | | | | | - Victor Abler
- ACADIA Pharmaceuticals Inc., San Diego, California, USA
| | | | - James H. Bower
- Mayo Clinic Department of Neurology, Rochester, Minnesota, USA
| | - Rodolfo Savica
- Mayo Clinic Department of Neurology, Rochester, Minnesota, USA,Mayo Clinic Department of Health Sciences Research, Rochester, Minnesota, USA,Corresponding Author: Rodolfo Savica, MD, PhD, Department of Neurology, Mayo Clinic, 200 First Street, SW, Rochester, MN 55905, (507) 284-2120/
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Camerucci E, Stang CD, Turcano P, Tipton PW, Bower JH, Hassan A, Klassen BT, Savica R. Deep Brain Stimulation and Treatment Outcomes of Young- and Late-Onset (≤55 Years) Parkinson's Disease: A Population-Based Study. Front Neurol 2021; 12:784398. [PMID: 34956065 PMCID: PMC8702827 DOI: 10.3389/fneur.2021.784398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 11/22/2021] [Indexed: 11/13/2022] Open
Abstract
Background: No studies have reported the rate of motor complications (MC) and response to medical and surgical treatment in a population-based cohort of young-onset Parkinson's Disease (YOPD) patients and a cohort of sex-matched late-onset Parkinson's Disease (LOPD). Objective: To assess the outcomes of dopaminergic treatment in YOPD and LOPD, explore treatment-induced MC, medical adjustment, and rate of deep brain stimulation (DBS). Methods: We used the expanded Rochester Epidemiology Project (eREP) to investigate a population-based cohort of YOPD between 2010 and 2015 in 7 counties in Minnesota. Cases with onset ≤55 years of age were included as YOPD. An additional sex-matched cohort of LOPD (onset at ≥56 years of age) was included for comparison. All medical records were reviewed to confirm the diagnoses. Results: In the seven counties 2010–15, there were 28 YOPD patients, which were matched with a LOPD cohort. Sixteen (57%) YOPD had MC, as compared to 9 (32%) LOPD. In YOPD, 9 had motor fluctuations (MF) and Levodopa-induced dyskinesia (LID) together, whereas 3 had LID only and 4 MF only. In LOPD, 3 had MF and LID, 3 MF only, and 3 LID only. Following medical treatment for MC, 6/16 YOPD (38%) and 3/9 (33%) LOPD had symptoms resolution. In YOPD, 11/16 (69%) were considered for DBS implantation, in LOPD they were 2/9 (22%), but only 7 (6 YOPD and 1 LOPD) underwent the procedure. YOPD had significantly higher rates in both DBS candidacy and DBS surgery (respectively, p = 0.03 and p = 0.04). Among DBS-YOPD, 5/6 (83%) had positive motor response to the surgery; the LOPD case had a poor response. We report the population-based incidence of both YOPD with motor complications and YOPD undergoing DBS, which were 1.17 and 0.44 cases per 100,000 person-years, respectively. Conclusion: Fifty-seven percent of our YOPD patients and 32% of the LOPD had motor complications. Roughly half of both YOPD and LOPD were treatment resistant. YOPD had higher rates of DBS candidacy and surgery. Six YOPD and 1 LOPD underwent DBS implantation and most of them had a positive motor response after the surgery.
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Affiliation(s)
| | - Cole D Stang
- Department of Neurology, Mayo Clinic, Rochester, MN, United States
| | - Pierpaolo Turcano
- Department of Neurology, Mayo Clinic, Jacksonville, FL, United States
| | - Philip W Tipton
- Department of Neurology, Mayo Clinic, Rochester, MN, United States
| | - James H Bower
- Department of Neurology, Mayo Clinic, Rochester, MN, United States
| | - Anhar Hassan
- Department of Neurology, Mayo Clinic, Rochester, MN, United States
| | - Bryan T Klassen
- Department of Neurology, Mayo Clinic, Rochester, MN, United States
| | - Rodolfo Savica
- Department of Neurology, Mayo Clinic, Rochester, MN, United States
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Ayele BA, Zewde YZ, Tafesse A, Sultan A, Friedman JH, Bower JH. Non-Motor Symptoms and Associated Factors in Parkinson's Disease Patients in Addis Ababa, Ethiopia: A Multicenter Cross-Sectional Study. Ethiop J Health Sci 2021; 31:837-846. [PMID: 34703184 PMCID: PMC8512934 DOI: 10.4314/ejhs.v31i4.19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 02/21/2021] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Non-motor symptoms (NMSs) of Parkinson's disease (PD) were often overlooked and less studied. Little is known about NMSs in Ethiopia. The aim of the study was to determine the prevalence of NMSs and associated factors. METHODS A multi-center cross-sectional observational study was conducted. NMS questionnaire was used to screen for the NMSs. Both descriptive and analytical statistics were used to analyze the data. RESULTS Total of 123 PD patients with median of 4 years were investigated. The mean age of PD patients was 62.9 years. The mean age of PD onset was 58.3 years. In 23.6% the age of onset was below age 50. Males accounted 72.4%. Majority of the patients were on Levodopa alone and 31.7% were on levodopa plus trihexyphenidyl. Longer duration of illness was associated with frequent occurrence of NMSs. Constipation was the commonest NMS (78%), followed by urinary urgency (67.5%) and nocturia (63.4%). An unexplained pain was reported by 45.5 %, cognitive impairment (45.5%), and sleep disturbance was reported by 45.5% of the study participants. Neurophysciatric symptoms were reported by small proportion of the patients. Lower monthly earning was associated with swallowing problem, unexplained weight change, and lighheadness. CONCLUSION The prevalence of NMS was high among PD patients in Ethiopia. Constipation was the commonest NMS. Longer duration of illness was associated with frequent occurrence of NMSs. Lower monthly earning was associated with swallowing problem, unexplained weight change, and lighheadness.
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Affiliation(s)
- Biniyam A Ayele
- Department of Neurology, College of Health Sciences, Addis Ababa University, Ethiopia
| | - Yared Zenebe Zewde
- Department of Neurology, College of Health Sciences, Addis Ababa University, Ethiopia
| | - Abenet Tafesse
- Department of Neurology, College of Health Sciences, Addis Ababa University, Ethiopia
| | - Amir Sultan
- Gastroenterology and Hepatology Division, Department of Internal Medicine, College of Health Sciences, Addis Ababa University
| | - Joseph H Friedman
- Stanley Aronson Chair in Neurodegenerative Disorders, Director of Movement Disorders Program, Butler Hospital, Department of Neurology, Alpert Medical School of Brown University, Providence, RI, USA
| | - James H Bower
- Chair of Division of Movement Disorders, Department of Neurology, Mayo clinic, Rochester, Minnesota, USA
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Klassen BT, Caviness JN, Bower JH. Electrophysiology Testing of Movement Disorders. Clin Neurophysiol 2021. [DOI: 10.1093/med/9780190067854.003.0049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/12/2023]
Abstract
AbstractThe gold standard for diagnosis of most movement disorders remains a careful neurologic examination; however, neurophysiologic evaluation can often complement the clinical examination. Rather than focus on specific electromyographic (EMG) spike morphologies, as is done in neuromuscular EMG, movement disorder neurophysiology studies focus on the pattern of discharges over time and in relation to patterns in other muscles. Thus, surface EMG polygraphy is the main method used, at times in conjunction with simultaneous EEG. Tremor, dystonia, and myoclonus can all be evaluated in this manner. Evoked responses are also useful, particularly to evaluate some types of myoclonus and startle disorders. In order to fully integrate movement neurophysiology into the comprehensive care of patients with movement disorders, a good understanding of both the neurophysiologic techniques and the underlying disease states is necessary; this chapter provides an overview of both.
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Stang CD, Turcano P, Mielke MM, Josephs KA, Bower JH, Ahlskog JE, Boeve BF, Martin PR, Upadhyaya SG, Savica R. Incidence and Trends of Progressive Supranuclear Palsy and Corticobasal Syndrome: A Population-Based Study. J Parkinsons Dis 2021; 10:179-184. [PMID: 31594251 DOI: 10.3233/jpd-191744] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Few studies have investigated the incidence of PSP and CBS in the population. OBJECTIVE To examine the incidence of and trends in progressive supranuclear palsy (PSP) and corticobasal syndrome (CBS) in a population-based cohort of residents of Olmsted County, MN. METHODS We used the 1991-2005 population-based, Olmsted County Parkinsonism-cohort study, defined via the Rochester Epidemiology Project. A movement-disorder specialist reviewed medical records, to confirm PSP and CBS diagnoses. RESULTS We identified 21 patients with these diagnoses 1991-2005 : 18 (85.7%), PSP; 3 (14.3%), CBS. The median diagnosis age was 78 (range: 66-88). 13/21 (62.0%) were male. MRI was performed pre-diagnosis in 11 patients (8 PSP and 3 CBD); 10 showed atrophy consistent with clinical diagnoses. We observed concordance between clinical and pathological diagnoses in two PSP patients who underwent autopsy. Combined incidence for PSP and CBS in Olmsted County was 3.1 per 100,000 person-years (2.6 per 100,000 person-years, PSP; 0.4 per 100,000 person-years, CBS). Incidence was higher in men (4.5, 95% CI, 2.0-7.0) than women (1.8, 95% CI, 0.5-2.9). A combined, significant trend of increasing incidence was observed between 1991 and 2005 (B=0.69, 95% CI 0.42, 0.96, p<0.001). Median time from symptom onset to death among both groups was 6 years (range PSP, 1-10 years; range CBS, 3-8 years). CONCLUSIONS The combined incidence for PSP and CBS was 3.1 per 100,000 person-years, higher in men than women. We observed a significant increase in both PSP and CBS, likely due to advancing imaging technology and improved diagnostic ability among physicians.
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Affiliation(s)
- Cole D Stang
- Mayo Clinic Department of Neurology, Rochester, MN, USA
| | | | - Michelle M Mielke
- Mayo Clinic Department of Health Sciences Research, Rochester, MN, USA
| | | | - James H Bower
- Mayo Clinic Department of Neurology, Rochester, MN, USA
| | | | | | - Peter R Martin
- Mayo Clinic Department of Health Sciences Research, Rochester, MN, USA
| | | | - Rodolfo Savica
- Mayo Clinic Department of Neurology, Rochester, MN, USA.,Mayo Clinic Department of Health Sciences Research, Rochester, MN, USA
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Camerucci E, Stang CD, Hajeb M, Turcano P, Mullan AF, Martin P, Ross OA, Bower JH, Mielke MM, Savica R. Early-Onset Parkinsonism and Early-Onset Parkinson's Disease: A Population-Based Study (2010-2015). J Parkinsons Dis 2021; 11:1197-1207. [PMID: 33720851 PMCID: PMC8355040 DOI: 10.3233/jpd-202464] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
BACKGROUND Early-onset Parkinson's disease (EOPD), occurring between ages 40 and 55, carries social, societal, and personal consequences and may progress, with fewer comorbidities than typical, later-onset disease. OBJECTIVE To examine the incidence and survival of EOPD and other Parkinsonism occurring before age 55 in the population-based cohort of residents in seven Minnesota counties. METHODS A movement-disorder specialist reviewed all the medical records in a 2010-2015 Parkinsonism-incident cohort to confirm diagnosis and subtypes. RESULTS We identified 27 patients diagnosed at ≤ 50 years with incident Parkinsonism 2010-15:11 (41%) cases of EOPD, 13 (48%) drug-induced Parkinsonism, and 3 (11%) other Parkinsonism; we also identified 69 incident cases of Parkinsonism ≤ 55 years, of which 28 (41%) were EOPD, 28 (41%) DIP, and 13 (19%) other Parkinsonism. Overall incidence for Parkinsonism ≤ 50 years was 1.98/100,000 person-years, and for EOPD was 0.81/100,000 person-years. In patients ≤ 55 years, Parkinsonism incidence was 5.05/100,000 person-years: in EOPD, 2.05/100,000 person-years. Levodopa-induced dyskinesia was present in 45%of EOPD (both ≤ 50 years and ≤ 55 years). Onset of cardinal motor symptoms was proximate to the diagnosis of EOPD, except for impaired postural reflexes, which occurred later in the course of EOPD. Among the 69 Parkinsonism cases ≤ 55 years, 9 (13%; all male) were deceased (only 1 case of EOPD). Men had a higher mortality risk compared to women (p = 0.049). CONCLUSION The incidence of EOPD ≤ 50 years was 0.81/100,000 person-years (1.98 in Parkinsonism all type); prior to ≤ 55 years was 2.05/100,000 person-years (5.05 in Parkinsonism all type) with higher incidence in men than women. Men with Parkinsonism, all type, had higher mortality compared to women.
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Affiliation(s)
| | - Cole D. Stang
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - Mania Hajeb
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Aidan F. Mullan
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA
| | - Peter Martin
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA
| | - Owen A. Ross
- Department of Neurology, Mayo Clinic, Jacksonville, Florida, USA
- Department of Clinical Genomics, Mayo Clinic, Jacksonville, Florida, USA
| | - James H. Bower
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - Michelle M. Mielke
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA
| | - Rodolfo Savica
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
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11
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Stang CD, Mullan AF, Hajeb M, Camerucci E, Turcano P, Martin P, Mielke MM, Josephs KA, Bower JH, St Louis EK, Boeve BF, Savica R. Timeline of Rapid Eye Movement Sleep Behavior Disorder in Overt Alpha-Synucleinopathies. Ann Neurol 2020; 89:293-303. [PMID: 33155696 DOI: 10.1002/ana.25952] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 11/03/2020] [Accepted: 11/04/2020] [Indexed: 12/15/2022]
Abstract
OBJECTIVE The aim was to analyze the timeline, prevalence, and survival of rapid eye movement (REM) sleep behavior disorder (RBD) in patients who developed alpha-synucleinopathies (Parkinson disease, dementia with Lewy bodies, and Parkinson disease dementia) compared with age- and sex-matched controls in a population-based incident-cohort study. METHODS We used a population-based, 1991 to 2010 incident-cohort study of alpha-synucleinopathies. A movement-disorder specialist reviewed medical records to confirm diagnoses. RBD was diagnosed by reported dream-enactment symptoms or polysomnography. Probable RBD and polysomnographically confirmed RBD were analyzed separately and combined. RESULTS Among the 444 incident cases of alpha-synucleinopathy, 86 were clinically diagnosed with RBD (19.8%), including 30 (35%) by polysomnography and 56 (65%) as probable. The prevalence of idiopathic RBD at alpha-synucleinopathy diagnosis was 3.4%, increasing to 23.8% after 15 years. Cumulative lifetime incidence was 53 times greater in alpha-synucleinopathy patients than in controls (odds ratio [OR] = 53.1, 95% confidence interval [CI]: 13.0-217.2, p < 0.0001), higher in dementia with Lewy bodies than in Parkinson disease (OR = 2.57, 95% CI: 1.50-4.40, p = 0.0004), and higher in men than in women with Parkinson disease, dementia with Lewy bodies, or Parkinson disease dementia (OR = 3.70, 95% CI: 2.07-6.62, p < 0.0001), but did not increase mortality risk. INTERPRETATION Our cohort had RBD incidence of 3.4%. Overall RBD increased to 23.8% after 15 years, with an overall incidence of 2.5 cases per 100 person-years. With 53 times greater lifetime incidence in alpha-synucleinopathy patients than in controls, RBD was more likely to develop in dementia with Lewy bodies than in Parkinson disease or Parkinson disease dementia, and in men than in women, but did not increase mortality risk within our cohort. ANN NEUROL 2021;89:293-303.
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Affiliation(s)
- Cole D Stang
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | - Aidan F Mullan
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Mania Hajeb
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | | | | | - Peter Martin
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Michelle M Mielke
- Department of Neurology, Mayo Clinic, Rochester, MN, USA.,Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | | | - James H Bower
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | - Erik K St Louis
- Department of Neurology, Mayo Clinic, Rochester, MN, USA.,Division of Pulmonary and Critical Care Medicine, Mayo Center for Sleep Medicine, Rochester, MN, USA.,Mayo Clinic Health System, Skemp Franciscan Health, La Crosse, WI, USA
| | - Bradley F Boeve
- Department of Neurology, Mayo Clinic, Rochester, MN, USA.,Division of Pulmonary and Critical Care Medicine, Mayo Center for Sleep Medicine, Rochester, MN, USA
| | - Rodolfo Savica
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
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12
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Budhram A, Simpson HD, Bower JH, Hassan A, Conway BL, Flanagan EP. Holmes Tremor With Perirolandic Demyelinating Lesions: A Distinct Clinicoradiographic Syndrome. Neurology 2020; 96:231-232. [PMID: 33219140 DOI: 10.1212/wnl.0000000000011235] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 10/14/2020] [Indexed: 11/15/2022] Open
Affiliation(s)
- Adrian Budhram
- From the Departments of Neurology (A.B., H.D.S., J.H.B., A.H., B.L.C., E.P.F.) and Laboratory Medicine and Pathology (E.P.F.), Mayo Clinic, Rochester, MN; and Department of Clinical Neurological Sciences (A.B.), London Health Sciences Centre, Western University, Canada
| | - Hugh D Simpson
- From the Departments of Neurology (A.B., H.D.S., J.H.B., A.H., B.L.C., E.P.F.) and Laboratory Medicine and Pathology (E.P.F.), Mayo Clinic, Rochester, MN; and Department of Clinical Neurological Sciences (A.B.), London Health Sciences Centre, Western University, Canada
| | - James H Bower
- From the Departments of Neurology (A.B., H.D.S., J.H.B., A.H., B.L.C., E.P.F.) and Laboratory Medicine and Pathology (E.P.F.), Mayo Clinic, Rochester, MN; and Department of Clinical Neurological Sciences (A.B.), London Health Sciences Centre, Western University, Canada
| | - Anhar Hassan
- From the Departments of Neurology (A.B., H.D.S., J.H.B., A.H., B.L.C., E.P.F.) and Laboratory Medicine and Pathology (E.P.F.), Mayo Clinic, Rochester, MN; and Department of Clinical Neurological Sciences (A.B.), London Health Sciences Centre, Western University, Canada
| | - Brittani L Conway
- From the Departments of Neurology (A.B., H.D.S., J.H.B., A.H., B.L.C., E.P.F.) and Laboratory Medicine and Pathology (E.P.F.), Mayo Clinic, Rochester, MN; and Department of Clinical Neurological Sciences (A.B.), London Health Sciences Centre, Western University, Canada
| | - Eoin P Flanagan
- From the Departments of Neurology (A.B., H.D.S., J.H.B., A.H., B.L.C., E.P.F.) and Laboratory Medicine and Pathology (E.P.F.), Mayo Clinic, Rochester, MN; and Department of Clinical Neurological Sciences (A.B.), London Health Sciences Centre, Western University, Canada.
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13
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Peterson BJ, Rocca WA, Bower JH, Savica R, Mielke MM. Identifying incident Parkinson's disease using administrative diagnostic codes: a validation study. Clin Park Relat Disord 2020; 3:100061. [PMID: 34164614 PMCID: PMC8218579 DOI: 10.1016/j.prdoa.2020.100061] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 05/20/2020] [Accepted: 06/02/2020] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Administrative databases that capture diagnostic codes are increasingly being used worldwide for research because they can save time and reduce costs. However, assessing validity is necessary before defining diseases using only diagnostic codes in research applications. OBJECTIVE Our objective was to assess the validity of using diagnostic codes to identify incident Parkinson's disease (PD) cases in Olmsted County, Minnesota using an established standard for comparison (1976-2005). METHODS Cases were identified solely using computer programs applied to administrative diagnostic code indexes from the Rochester Epidemiology Project (REP). Two codes >30 days apart or one code on the death certificate constituted PD. The standard was a clinical diagnosis by movement disorders specialists based on medical record review. Validity was assessed using positive predictive value (PPV) and sensitivity. Numbers of incident cases and incidence rates were compared between the two ascertainment methods by sex. RESULTS The codes only method over-counted the number of incident PD cases by 73% (804 versus 464), and this over-counting generally increased with calendar year. Sensitivity was 80% (95% CI [76%, 84%]) and PPV was 46% (95% CI [34%, 50%]). Disease status misclassification accounted for two-thirds of falsely identified cases, where individuals were found to not have PD (43%) or even parkinsonism (23%) after medical record review. The codes only method also over-estimated the incidence rate time trend for men and women by approximately two-fold. CONCLUSION In our context, using administrative diagnostic codes only to identify incident PD cases is not recommended unless more accurate algorithms are developed.
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Affiliation(s)
- Brett J. Peterson
- Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Walter A. Rocca
- Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | - James H. Bower
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | - Rodolfo Savica
- Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | - Michelle M. Mielke
- Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
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14
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McCarter SJ, Coon EA, Savica R, St Louis EK, Bower JH, Benarroch EE, Sandroni P, Low P, Singer W. Lower Vitamin B12 Level at Multiple System Atrophy Diagnosis Is Associated With Shorter Survival. Mov Disord 2020; 35:1462-1466. [PMID: 32320519 DOI: 10.1002/mds.28070] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 03/30/2020] [Accepted: 03/31/2020] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Multiple system atrophy (MSA) is a neurodegenerative disorder from α-synuclein aggregation. in vitro studies suggest vitamin B12 may interrupt α-synuclein-mediated neurodegeneration. The objective of this study was to determine whether serum vitamin B12 level at MSA diagnosis is associated with survival. METHODS One hundred eighty-two MSA patients evaluated at Mayo Clinic with vitamin B12 testing were studied. We determined the risk of death in relationship to serum vitamin B12 levels at MSA diagnosis, adjusting for predictors of poor survival. RESULTS Predictors of shorter survival included vitamin B12 < 367 ng/L (HR, 1.8; 95% CI, 1.3-2.7), falls within 3 years of MSA diagnosis (HR, 1.6; 95% CI, 1.1-2.3), bladder symptoms (HR, 1.6; 95% CI, 1.0-2.6), urinary catheter requirement (HR, 1.7; 95% CI, 1.0-2.8), male sex (HR, 1.4; 95% CI, 1.0-2.0), and MSA-P subtype (HR, 1.5; 95% CI, 1.0-2.0). CONCLUSIONS Low vitamin B12 levels are associated with shorter survival in MSA. Additional studies to explore this observation and assess the potential role of vitamin B12 as a modifiable survival factor are needed. © 2020 International Parkinson and Movement Disorder Society.
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Affiliation(s)
| | | | - Rodolfo Savica
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - Erik K St Louis
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - James H Bower
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Paola Sandroni
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - Phillip Low
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - Wolfgang Singer
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
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15
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Turcano P, Stang CD, Bower JH, Ahlskog JE, Boeve BF, Mielke MM, Savica R. Levodopa-induced dyskinesia in dementia with Lewy bodies and Parkinson disease with dementia. Neurol Clin Pract 2020; 10:156-161. [PMID: 32309034 DOI: 10.1212/cpj.0000000000000703] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Accepted: 06/03/2019] [Indexed: 12/25/2022]
Abstract
Objective To investigate the frequency of levodopa-induced dyskinesia in dementia with Lewy bodies (DLBs) and Parkinson disease with dementia (PDD) and compare these frequencies with patients with incident Parkinson disease (PD) through a population-based cohort study. Methods We identified all patients with DLB, PDD, and PD without dementia in a 1991-2010 population-based parkinsonism-incident cohort, in Olmsted County, Minnesota. We abstracted information about levodopa-induced dyskinesia. We compared patients with DLB and PDD with dyskinesia with patients with PD from the same cohort. Results Levodopa use and dyskinesia data were available for 141/143 (98.6%) patients with a diagnosis of either DLB or PDD; 87 (61.7%), treated with levodopa. Dyskinesia was documented in 12.6% (8 DLB and 3 PDD) of levodopa-treated patients. Among these patients, median parkinsonism diagnosis age was 74 years (range: 64-80 years); 63.6%, male. The median interval from levodopa initiation to dyskinesia onset was 2 years (range: 3 months-4 years); the median daily levodopa dosage was 600 mg (range: 50-1,600 mg). Dyskinesia severity led to levodopa adjustments in 5 patients, and all improved. Patients with dyskinesia were diagnosed with parkinsonism at a significantly younger age compared with patients without dyskinesia (p < 0.001). Levodopa dosage was unrelated to increased risk of dyskinesias among DLB and PDD. In contrast, 30.1% of levodopa-treated patients with PD developed dyskinesia. In age-, sex-, and levodopa dosage-adjusted models, Patients with DLB and PDD each had lower odds of developing dyskinesia than patients with PD (odds ratio = 0.42, 95% CI 0.21-0.88; p = 0.02). Conclusions The dyskinesia risk for levodopa-treated patients with DLB or PDD was substantially less than for levodopa-treated patients with PD.
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Affiliation(s)
- Pierpaolo Turcano
- Department of Neurology (PT, CDS, JHB, JEA, BFB, RS) and Department of Health Sciences Research (MMM, RS), Mayo Clinic, Rochester, MN
| | - Cole D Stang
- Department of Neurology (PT, CDS, JHB, JEA, BFB, RS) and Department of Health Sciences Research (MMM, RS), Mayo Clinic, Rochester, MN
| | - James H Bower
- Department of Neurology (PT, CDS, JHB, JEA, BFB, RS) and Department of Health Sciences Research (MMM, RS), Mayo Clinic, Rochester, MN
| | - J Eric Ahlskog
- Department of Neurology (PT, CDS, JHB, JEA, BFB, RS) and Department of Health Sciences Research (MMM, RS), Mayo Clinic, Rochester, MN
| | - Bradley F Boeve
- Department of Neurology (PT, CDS, JHB, JEA, BFB, RS) and Department of Health Sciences Research (MMM, RS), Mayo Clinic, Rochester, MN
| | - Michelle M Mielke
- Department of Neurology (PT, CDS, JHB, JEA, BFB, RS) and Department of Health Sciences Research (MMM, RS), Mayo Clinic, Rochester, MN
| | - Rodolfo Savica
- Department of Neurology (PT, CDS, JHB, JEA, BFB, RS) and Department of Health Sciences Research (MMM, RS), Mayo Clinic, Rochester, MN
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16
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McCarter SJ, Stang C, Turcano P, Mielke MM, Ali F, Bower JH, Savica R. Higher vitamin B12 level at Parkinson's disease diagnosis is associated with lower risk of future dementia. Parkinsonism Relat Disord 2020; 73:19-22. [PMID: 32203914 DOI: 10.1016/j.parkreldis.2020.03.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 03/10/2020] [Accepted: 03/14/2020] [Indexed: 12/21/2022]
Abstract
INTRODUCTION To determine whether vitamin B12 level at Parkinson's disease (PD) diagnosis predicts time to develop dementia. METHODS We utilized a population-based cohort of Parkinsonism patients to examine the relationship between serum vitamin B12 at the time of PD diagnosis and dementia risk. Receiver operating curves were calculated for vitamin B12 cutoffs maximizing sensitivity and specificity for determining who developed dementia. Time from Parkinsonism diagnosis to dementia, death, or censoring was calculated utilizing Kaplan-Meier analysis and Cox-proportional hazard models. RESULTS PD patients who did not develop dementia had higher baseline levels of vitamin B12 at PD diagnosis (648.5 ng/L vs 452 ng/L, p < 0.05) than those who developed dementia. Dementia risk was significantly lower in the 3rd tertile compared with 2nd tertile and trended towards significance compared to the 1st tertile. Each 100 unit increase in vitamin B12 level had a hazard ratio of 0.31 (95% CI 0.44-0.95) for future dementia (p < 0.05). Vitamin B12 cutoff of <587 ng/L was 87% sensitive and 70% specific (AUC 0.79, 95% CI 0.60-0.98) distinguishing patients with dementia. PD patients with vitamin B12 levels <587 ng/L were 5.4 times more likely to develop dementia, with 50% having dementia within 5 years of PD diagnosis compared with 11% in those with a vitamin B12 level of ≥587 ng/L (p < 0.05). CONCLUSION Higher levels of serum vitamin B12 at PD diagnosis correlate with lower risk of future dementia. The role of vitamin B12 in the development of dementia among PD patients deserves further evaluation.
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Affiliation(s)
- Stuart J McCarter
- Mayo Clinic Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | - Cole Stang
- Mayo Clinic Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | - Pierpaolo Turcano
- Mayo Clinic Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | - Michelle M Mielke
- Mayo Clinic Department of Neurology, Mayo Clinic, Rochester, MN, USA; Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Farwa Ali
- Mayo Clinic Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | - James H Bower
- Mayo Clinic Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | - Rodolfo Savica
- Mayo Clinic Department of Neurology, Mayo Clinic, Rochester, MN, USA; Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA.
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17
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Hasan S, Mielke MM, Turcano P, Ahlskog JE, Bower JH, Savica R. Traumatic brain injury preceding clinically diagnosed α-synucleinopathies: A case-control study. Neurology 2020; 94:e764-e773. [PMID: 31992680 PMCID: PMC7136055 DOI: 10.1212/wnl.0000000000008995] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Accepted: 09/01/2019] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE To determine the association between traumatic brain injury (TBI) and any clinically diagnosed α-synucleinopathy including Parkinson disease (PD), dementia with Lewy bodies (DLB), PD dementia (PDD), and multiple system atrophy (MSA). METHODS Using the medical records-linkage system of the Rochester Epidemiology Project, we identified incident cases of α-synucleinopathies in Olmsted County, Minnesota, from 1991 to 2010, matching by age (±1 year) at symptom onset and sex to controls. We reviewed records of cases and controls to detect TBI prior to clinical-motor onset of any α-synucleinopathies. We based severity (possible, probable, and definite) upon the Mayo Classification System for TBI Severity. Using conditional-logistic regression, we calculated the odds ratio (OR) of all α-synucleinopathies and type, adjusting for coffee intake and smoking. RESULTS TBI frequency was lower among cases (7.0%) than controls (8.2%). No association was found between TBI and all α-synucleinopathies in multivariable analyses (OR 0.90, 95% confidence interval [CI] 0.54-1.52). No association presented when examining the number of TBIs, TBI severity, time between TBI exposure and index date, age at index date, or sex. When stratifying by each individual α-synucleinopathy, we did not identify any associations between TBI and PD, DLB, or PDD. Among the MSA group, 1 (6.4%) and 0 controls experienced a TBI (OR could not be estimated). CONCLUSIONS In this nested case-control population-based analysis, TBI was not associated with subsequent α-synucleinopathies in general or any individual α-synucleinopathy. This did not change based on the temporality or the severity of the TBI. Our findings may be limited by the study power.
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Affiliation(s)
- Shemonti Hasan
- From the Alix School of Medicine (S.H.), Department of Health Sciences Research (M.M.M., R.S.), and Department of Neurology (P.T., J.E.A., J.H.B., R.S.), Mayo Clinic, Rochester, MN
| | - Michelle M Mielke
- From the Alix School of Medicine (S.H.), Department of Health Sciences Research (M.M.M., R.S.), and Department of Neurology (P.T., J.E.A., J.H.B., R.S.), Mayo Clinic, Rochester, MN
| | - Pierpaolo Turcano
- From the Alix School of Medicine (S.H.), Department of Health Sciences Research (M.M.M., R.S.), and Department of Neurology (P.T., J.E.A., J.H.B., R.S.), Mayo Clinic, Rochester, MN
| | - J Eric Ahlskog
- From the Alix School of Medicine (S.H.), Department of Health Sciences Research (M.M.M., R.S.), and Department of Neurology (P.T., J.E.A., J.H.B., R.S.), Mayo Clinic, Rochester, MN
| | - James H Bower
- From the Alix School of Medicine (S.H.), Department of Health Sciences Research (M.M.M., R.S.), and Department of Neurology (P.T., J.E.A., J.H.B., R.S.), Mayo Clinic, Rochester, MN
| | - Rodolfo Savica
- From the Alix School of Medicine (S.H.), Department of Health Sciences Research (M.M.M., R.S.), and Department of Neurology (P.T., J.E.A., J.H.B., R.S.), Mayo Clinic, Rochester, MN.
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18
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Savica R, Turcano P, Bower JH, Ahlskog JE, Mielke MM. Survival and Progression in Synucleinopathy Phenotypes With Parkinsonism: A Population-Based Study. Mayo Clin Proc 2019; 94:1825-1831. [PMID: 31405749 PMCID: PMC7073008 DOI: 10.1016/j.mayocp.2019.04.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Revised: 03/20/2019] [Accepted: 04/01/2019] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To compare survival by the presenting parkinsonism symptoms at diagnosis among patients with incident clinically diagnosed synucleinopathies. PATIENTS AND METHODS Using the Rochester Epidemiology Project medical records-linkage system, we identified all persons residing in Olmsted County, Minnesota, who received a diagnostic code of parkinsonism from January 1, 1991, through December 31, 2010. A movement disorder specialist reviewed the complete medical records of each individual to confirm the presence of parkinsonism, determine the type of synucleinopathy, and identify the onset dates of each cardinal symptom (tremor at rest, bradykinesia, rigidity, and impaired postural reflexes). We determined the median time from age at diagnosis to death or censoring (June 30, 2015) for each presenting symptom and the age- and sex-adjusted risk of death. RESULTS From 1991 through 2010, a total of 433 individuals had a synucleinopathy diagnosed (301 [69.5%], Parkinson disease; 68 [15.7%], dementia with Lewy bodies; 52 [12.0%], Parkinson disease dementia; and 12 [2.8%], multiple systems atrophy with parkinsonism). Overall, the risk of death in the tremor-predominant group was less than that in the bradykinesia/rigidity-only group (hazard ratio [HR], 0.59; 95% CI, 0.40-0.87; P=.007). Similarly, risk of death in the bradykinesia/rigidity-only group was significantly greater than in the tremor-predominant group (HR, 1.75; 95% CI, 1.23-2.51; P=.002) and compared with tremor before bradykinesia (HR, 1.75; 95% CI, 1.24-2.47; P=.001). CONCLUSION Patients with tremor as a presenting symptom have longer survival. In contrast, the presence of bradykinesia/rigidity as a presenting symptom correlates with reduced survival across all types of synucleinopathies.
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Affiliation(s)
- Rodolfo Savica
- Department of Neurology, Mayo Clinic, Rochester, MN; Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic, Rochester, MN.
| | | | | | | | - Michelle M Mielke
- Department of Neurology, Mayo Clinic, Rochester, MN; Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic, Rochester, MN
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Melka D, Tafesse A, Bower JH, Assefa D. Prevalence of sleep disorders in Parkinson's disease patients in two neurology referral hospitals in Ethiopia. BMC Neurol 2019; 19:205. [PMID: 31438888 PMCID: PMC6706909 DOI: 10.1186/s12883-019-1431-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Accepted: 07/23/2019] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Non motor symptoms (NMS) of Parkinson's disease (PD) are common and can be more disabling than motor symptoms. Sleep disorders can be seen in up to 98% of patients with Parkinson disease. Poor sleep quality has been associated with poverty and race, and yet there has been no prior report on sleep disorders in those with PD living in sub Saharan Africa. We wished to document the prevalence of sleep disorders in PD patients in Ethiopia. METHODS We conducted a cross-sectional point prevalence study from July 1 to October 30, 2015 of all patients attending the neurology outpatient department in Tikur Anbessa and Zewuditu Memorial Hospitals, Addis Ababa, Ethiopia. Demographic data, clinical history and physical examination findings were collected from participants using a structured questionnaire. We used the Parkinson's disease sleep scale version two (PDSS-2) and Epworth Sleepiness Scale (ESS) to assess the sleep symptoms. RESULTS Of the 155 patients surveyed, all patients reported some sleep problem. Over 43.9% of patients had a PDSS score > 18. The median score of ESS was 9 (IQR = 5-12), with 77/155 (49.7%) of the patients having possible or definite excessive daytime somnolence. A high EDSS score significantly associated with a Hoehn & Yahr score > 4 (p = 0.02). CONCLUSIONS In Ethiopian PD patients, the prevalence of those with severe sleep disorders is the highest reported to date. The prevalence of possible/definite EDS is amongst the highest in the world. Further investigation into whether poverty or race explains this finding is needed.
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Affiliation(s)
- Dereje Melka
- Department of Neurology, Addis Ababa University School of Medicine, P.O.Box 1176, Addis Ababa, Ethiopia
| | - Abenet Tafesse
- Department of Neurology, Addis Ababa University School of Medicine, P.O.Box 1176, Addis Ababa, Ethiopia
| | - James H. Bower
- Department of Neurology, Mayo Clinic School of Medicine, 200 First St SW, Rochester, MN USA
| | - Demeke Assefa
- Department of Health Service Management and Reproductive Health, School of Public Health College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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20
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Jackson L, Coon EA, Ahlskog JE, Bower JH, Sandroni P, Benarroch EE, Mandrekar JN, Low PA, Singer W. Earlier age of onset in multiple system atrophy with smoking and heavy alcohol use. Parkinsonism Relat Disord 2019; 66:212-215. [PMID: 31327626 DOI: 10.1016/j.parkreldis.2019.07.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 06/25/2019] [Accepted: 07/13/2019] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To determine whether smoking or alcohol use impacts the age of onset and disease duration in multiple system atrophy (MSA). METHODS All patients diagnosed with MSA at Mayo Clinic, Rochester between 1998 and 2012 completed standardized questionnaires surveying smoking and alcohol use at the time of presentation. RESULTS Of 551 patients with smoking and alcohol use data, 281 were past or present smokers with age of onset of 60.76 years compared to 62.97 years in controls (p = 0.0144). Age of onset in the 87 heavy alcohol users was 56.87 years compared to 62.97 years in controls (p = 0.0133). There was no difference in disease duration for smokers (p = 0.2758) or heavy alcohol users (p = 0.4820) compared to controls. CONCLUSION Our findings show that smoking history and/or heavy alcohol use is associated with younger age of onset in MSA but do not influence survival.
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Affiliation(s)
- Lauren Jackson
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | | | - J Eric Ahlskog
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | - James H Bower
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | - Paola Sandroni
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | | | - Jay N Mandrekar
- Department of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA
| | - Phillip A Low
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
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21
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Singer W, Dietz AB, Zeller AD, Gehrking TL, Schmelzer JD, Schmeichel AM, Gehrking JA, Suarez MD, Sletten DM, Minota Pacheco KV, Coon EA, Sandroni P, Benarroch EE, Fealey RD, Matsumoto JY, Bower JH, Hassan A, McKeon A, Windebank AJ, Mandrekar JN, Low PA. Intrathecal administration of autologous mesenchymal stem cells in multiple system atrophy. Neurology 2019; 93:e77-e87. [PMID: 31152011 PMCID: PMC6659003 DOI: 10.1212/wnl.0000000000007720] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Accepted: 02/14/2019] [Indexed: 01/28/2023] Open
Abstract
OBJECTIVE This phase I/II study sought to explore intrathecal administration of mesenchymal stem cells (MSCs) as therapeutic approach to multiple system atrophy (MSA). METHODS Utilizing a dose-escalation design, we delivered between 10 and 200 million adipose-derived autologous MSCs intrathecally to patients with early MSA. Patients were closely followed with clinical, laboratory, and imaging surveillance. Primary endpoints were frequency and type of adverse events; key secondary endpoint was the rate of disease progression assessed by the Unified MSA Rating Scale (UMSARS). RESULTS Twenty-four patients received treatment. There were no attributable serious adverse events, and injections were generally well-tolerated. At the highest dose tier, 3 of 4 patients developed low back/posterior leg pain, associated with thickening/enhancement of lumbar nerve roots. Although there were no associated neurologic deficits, we decided that dose-limiting toxicity was reached. A total of 6 of 12 patients in the medium dose tier developed similar, but milder and transient discomfort. Rate of progression (UMSARS total) was markedly lower compared to a matched historical control group (0.40 ± 0.59 vs 1.44 ± 1.42 points/month, p = 0.004) with an apparent dose-dependent effect. CONCLUSIONS Intrathecal MSC administration in MSA is safe and well-tolerated but can be associated with a painful implantation response at high doses. Compelling dose-dependent efficacy signals are the basis for a planned placebo-controlled trial. CLASSIFICATION OF EVIDENCE This phase I/II study provides Class IV evidence that for patients with early MSA, intrathecal MSC administration is safe, may result in a painful implantation response at high doses, and is associated with dose-dependent efficacy signals.
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Affiliation(s)
- Wolfgang Singer
- From the Departments of Neurology (W.S., A.D.Z., T.L.G., J.D.S., A.M.S., J.A.G., M.D.S., D.M.S., K.V.M.P., E.A.C., P.S., E.E.B., R.D.F., J.Y.M., J.H.B., A.H., A.M., A.J.W., P.A.L.), Laboratory Medicine and Pathology (A.B.D.), and Biomedical Statistics and Informatics (J.N.M.), Mayo Clinic, Rochester, MN.
| | - Allan B Dietz
- From the Departments of Neurology (W.S., A.D.Z., T.L.G., J.D.S., A.M.S., J.A.G., M.D.S., D.M.S., K.V.M.P., E.A.C., P.S., E.E.B., R.D.F., J.Y.M., J.H.B., A.H., A.M., A.J.W., P.A.L.), Laboratory Medicine and Pathology (A.B.D.), and Biomedical Statistics and Informatics (J.N.M.), Mayo Clinic, Rochester, MN
| | - Anita D Zeller
- From the Departments of Neurology (W.S., A.D.Z., T.L.G., J.D.S., A.M.S., J.A.G., M.D.S., D.M.S., K.V.M.P., E.A.C., P.S., E.E.B., R.D.F., J.Y.M., J.H.B., A.H., A.M., A.J.W., P.A.L.), Laboratory Medicine and Pathology (A.B.D.), and Biomedical Statistics and Informatics (J.N.M.), Mayo Clinic, Rochester, MN
| | - Tonette L Gehrking
- From the Departments of Neurology (W.S., A.D.Z., T.L.G., J.D.S., A.M.S., J.A.G., M.D.S., D.M.S., K.V.M.P., E.A.C., P.S., E.E.B., R.D.F., J.Y.M., J.H.B., A.H., A.M., A.J.W., P.A.L.), Laboratory Medicine and Pathology (A.B.D.), and Biomedical Statistics and Informatics (J.N.M.), Mayo Clinic, Rochester, MN
| | - James D Schmelzer
- From the Departments of Neurology (W.S., A.D.Z., T.L.G., J.D.S., A.M.S., J.A.G., M.D.S., D.M.S., K.V.M.P., E.A.C., P.S., E.E.B., R.D.F., J.Y.M., J.H.B., A.H., A.M., A.J.W., P.A.L.), Laboratory Medicine and Pathology (A.B.D.), and Biomedical Statistics and Informatics (J.N.M.), Mayo Clinic, Rochester, MN
| | - Ann M Schmeichel
- From the Departments of Neurology (W.S., A.D.Z., T.L.G., J.D.S., A.M.S., J.A.G., M.D.S., D.M.S., K.V.M.P., E.A.C., P.S., E.E.B., R.D.F., J.Y.M., J.H.B., A.H., A.M., A.J.W., P.A.L.), Laboratory Medicine and Pathology (A.B.D.), and Biomedical Statistics and Informatics (J.N.M.), Mayo Clinic, Rochester, MN
| | - Jade A Gehrking
- From the Departments of Neurology (W.S., A.D.Z., T.L.G., J.D.S., A.M.S., J.A.G., M.D.S., D.M.S., K.V.M.P., E.A.C., P.S., E.E.B., R.D.F., J.Y.M., J.H.B., A.H., A.M., A.J.W., P.A.L.), Laboratory Medicine and Pathology (A.B.D.), and Biomedical Statistics and Informatics (J.N.M.), Mayo Clinic, Rochester, MN
| | - Mariana D Suarez
- From the Departments of Neurology (W.S., A.D.Z., T.L.G., J.D.S., A.M.S., J.A.G., M.D.S., D.M.S., K.V.M.P., E.A.C., P.S., E.E.B., R.D.F., J.Y.M., J.H.B., A.H., A.M., A.J.W., P.A.L.), Laboratory Medicine and Pathology (A.B.D.), and Biomedical Statistics and Informatics (J.N.M.), Mayo Clinic, Rochester, MN
| | - David M Sletten
- From the Departments of Neurology (W.S., A.D.Z., T.L.G., J.D.S., A.M.S., J.A.G., M.D.S., D.M.S., K.V.M.P., E.A.C., P.S., E.E.B., R.D.F., J.Y.M., J.H.B., A.H., A.M., A.J.W., P.A.L.), Laboratory Medicine and Pathology (A.B.D.), and Biomedical Statistics and Informatics (J.N.M.), Mayo Clinic, Rochester, MN
| | - Karla V Minota Pacheco
- From the Departments of Neurology (W.S., A.D.Z., T.L.G., J.D.S., A.M.S., J.A.G., M.D.S., D.M.S., K.V.M.P., E.A.C., P.S., E.E.B., R.D.F., J.Y.M., J.H.B., A.H., A.M., A.J.W., P.A.L.), Laboratory Medicine and Pathology (A.B.D.), and Biomedical Statistics and Informatics (J.N.M.), Mayo Clinic, Rochester, MN
| | - Elizabeth A Coon
- From the Departments of Neurology (W.S., A.D.Z., T.L.G., J.D.S., A.M.S., J.A.G., M.D.S., D.M.S., K.V.M.P., E.A.C., P.S., E.E.B., R.D.F., J.Y.M., J.H.B., A.H., A.M., A.J.W., P.A.L.), Laboratory Medicine and Pathology (A.B.D.), and Biomedical Statistics and Informatics (J.N.M.), Mayo Clinic, Rochester, MN
| | - Paola Sandroni
- From the Departments of Neurology (W.S., A.D.Z., T.L.G., J.D.S., A.M.S., J.A.G., M.D.S., D.M.S., K.V.M.P., E.A.C., P.S., E.E.B., R.D.F., J.Y.M., J.H.B., A.H., A.M., A.J.W., P.A.L.), Laboratory Medicine and Pathology (A.B.D.), and Biomedical Statistics and Informatics (J.N.M.), Mayo Clinic, Rochester, MN
| | - Eduardo E Benarroch
- From the Departments of Neurology (W.S., A.D.Z., T.L.G., J.D.S., A.M.S., J.A.G., M.D.S., D.M.S., K.V.M.P., E.A.C., P.S., E.E.B., R.D.F., J.Y.M., J.H.B., A.H., A.M., A.J.W., P.A.L.), Laboratory Medicine and Pathology (A.B.D.), and Biomedical Statistics and Informatics (J.N.M.), Mayo Clinic, Rochester, MN
| | - Robert D Fealey
- From the Departments of Neurology (W.S., A.D.Z., T.L.G., J.D.S., A.M.S., J.A.G., M.D.S., D.M.S., K.V.M.P., E.A.C., P.S., E.E.B., R.D.F., J.Y.M., J.H.B., A.H., A.M., A.J.W., P.A.L.), Laboratory Medicine and Pathology (A.B.D.), and Biomedical Statistics and Informatics (J.N.M.), Mayo Clinic, Rochester, MN
| | - Joseph Y Matsumoto
- From the Departments of Neurology (W.S., A.D.Z., T.L.G., J.D.S., A.M.S., J.A.G., M.D.S., D.M.S., K.V.M.P., E.A.C., P.S., E.E.B., R.D.F., J.Y.M., J.H.B., A.H., A.M., A.J.W., P.A.L.), Laboratory Medicine and Pathology (A.B.D.), and Biomedical Statistics and Informatics (J.N.M.), Mayo Clinic, Rochester, MN
| | - James H Bower
- From the Departments of Neurology (W.S., A.D.Z., T.L.G., J.D.S., A.M.S., J.A.G., M.D.S., D.M.S., K.V.M.P., E.A.C., P.S., E.E.B., R.D.F., J.Y.M., J.H.B., A.H., A.M., A.J.W., P.A.L.), Laboratory Medicine and Pathology (A.B.D.), and Biomedical Statistics and Informatics (J.N.M.), Mayo Clinic, Rochester, MN
| | - Anhar Hassan
- From the Departments of Neurology (W.S., A.D.Z., T.L.G., J.D.S., A.M.S., J.A.G., M.D.S., D.M.S., K.V.M.P., E.A.C., P.S., E.E.B., R.D.F., J.Y.M., J.H.B., A.H., A.M., A.J.W., P.A.L.), Laboratory Medicine and Pathology (A.B.D.), and Biomedical Statistics and Informatics (J.N.M.), Mayo Clinic, Rochester, MN
| | - Andrew McKeon
- From the Departments of Neurology (W.S., A.D.Z., T.L.G., J.D.S., A.M.S., J.A.G., M.D.S., D.M.S., K.V.M.P., E.A.C., P.S., E.E.B., R.D.F., J.Y.M., J.H.B., A.H., A.M., A.J.W., P.A.L.), Laboratory Medicine and Pathology (A.B.D.), and Biomedical Statistics and Informatics (J.N.M.), Mayo Clinic, Rochester, MN
| | - Anthony J Windebank
- From the Departments of Neurology (W.S., A.D.Z., T.L.G., J.D.S., A.M.S., J.A.G., M.D.S., D.M.S., K.V.M.P., E.A.C., P.S., E.E.B., R.D.F., J.Y.M., J.H.B., A.H., A.M., A.J.W., P.A.L.), Laboratory Medicine and Pathology (A.B.D.), and Biomedical Statistics and Informatics (J.N.M.), Mayo Clinic, Rochester, MN
| | - Jay N Mandrekar
- From the Departments of Neurology (W.S., A.D.Z., T.L.G., J.D.S., A.M.S., J.A.G., M.D.S., D.M.S., K.V.M.P., E.A.C., P.S., E.E.B., R.D.F., J.Y.M., J.H.B., A.H., A.M., A.J.W., P.A.L.), Laboratory Medicine and Pathology (A.B.D.), and Biomedical Statistics and Informatics (J.N.M.), Mayo Clinic, Rochester, MN
| | - Phillip A Low
- From the Departments of Neurology (W.S., A.D.Z., T.L.G., J.D.S., A.M.S., J.A.G., M.D.S., D.M.S., K.V.M.P., E.A.C., P.S., E.E.B., R.D.F., J.Y.M., J.H.B., A.H., A.M., A.J.W., P.A.L.), Laboratory Medicine and Pathology (A.B.D.), and Biomedical Statistics and Informatics (J.N.M.), Mayo Clinic, Rochester, MN
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Ali F, Martin PR, Botha H, Ahlskog JE, Bower JH, Masumoto JY, Maraganore D, Hassan A, Eggers S, Boeve BF, Knopman DS, Drubach D, Petersen RC, Dunkley ED, van Gerpen J, Uitti R, Whitwell JL, Dickson DW, Josephs KA. Sensitivity and Specificity of Diagnostic Criteria for Progressive Supranuclear Palsy. Mov Disord 2019; 34:1144-1153. [PMID: 30726566 DOI: 10.1002/mds.27619] [Citation(s) in RCA: 89] [Impact Index Per Article: 17.8] [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: 10/28/2018] [Revised: 12/08/2018] [Accepted: 12/23/2018] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND In 2017, the International Parkinson and Movement Disorder Society put forward new clinical criteria for the diagnosis of PSP, recognizing diverse PSP phenotypes. In this study, we compared the sensitivity and specificity of the new criteria with the National Institutes of Neurological Disease and Society for Progressive Supranuclear Palsy criteria at different times. METHODS Patients with clinical parkinsonism, clinical and/or neuropathological diagnosis of PSP, were identified from the Society for Progressive Supranuclear Palsy brain bank. All patients had neuropathologic diagnoses and detailed clinical examination performed by a neurologist at 1 of the 3 Mayo Clinic sites, in Florida, Arizona, and Minnesota. Clinical symptoms and signs were abstracted retrospectively in a blinded fashion and used to determine whether patients met either diagnostic criterion. Patients were divided into early and late disease stage groups using a 3-year cutoff. RESULTS A total of 129 patients were included, of whom 66 had PSP pathology (51%). The remainder had other neurodegenerative diseases. The overall sensitivity of the International Parkinson and Movement Disorder Society criteria was 87.9%, compared with 45.5% for the National Institutes of Neurological Disease and Society for Progressive Supranuclear Palsy criteria, whereas the specificity of the International Parkinson and Movement Disorder Society probable PSP criteria was 85.7%, compared with 90.5% for the National Institutes of Neurological Disease and Society for Progressive Supranuclear Palsy. Individual patients were noted to have features of multiple PSP phenotypes. CONCLUSION The International Parkinson and Movement Disorder Society criteria recognize several phenotypes of progressive supranuclear palsy and hence have higher sensitivity than the previous criteria. © 2019 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Farwa Ali
- Department of Neurology, Mayo Clinic Rochester, Rochester, Minnesota, USA
| | - Peter R Martin
- Department of Biostatistics, Mayo Clinic Rochester, Rochester, Minnesota, USA
| | - Hugo Botha
- Department of Neurology, Mayo Clinic Rochester, Rochester, Minnesota, USA
| | - J Eric Ahlskog
- Department of Neurology, Mayo Clinic Rochester, Rochester, Minnesota, USA
| | - James H Bower
- Department of Neurology, Mayo Clinic Rochester, Rochester, Minnesota, USA
| | | | | | - Anhar Hassan
- Department of Neurology, Mayo Clinic Rochester, Rochester, Minnesota, USA
| | - Scott Eggers
- Department of Neurology, Mayo Clinic Rochester, Rochester, Minnesota, USA
| | - Bradley F Boeve
- Department of Neurology, Mayo Clinic Rochester, Rochester, Minnesota, USA
| | - David S Knopman
- Department of Neurology, Mayo Clinic Rochester, Rochester, Minnesota, USA
| | - Daniel Drubach
- Department of Neurology, Mayo Clinic Rochester, Rochester, Minnesota, USA
| | - Ronald C Petersen
- Department of Neurology, Mayo Clinic Rochester, Rochester, Minnesota, USA
| | | | - Jay van Gerpen
- Department of Neurology, Mayo Clinic Arizona, Phoenix, Arizona, USA
| | - Ryan Uitti
- Department of Neurology, Mayo Clinic Florida, Jacksonville, Florida, USA
| | | | - Dennis W Dickson
- Department of Neuroscience, Mayo Clinic Florida, Jacksonville, Florida, USA
| | - Keith A Josephs
- Department of Neurology, Mayo Clinic Rochester, Rochester, Minnesota, USA
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Turcano P, Mielke MM, Bower JH, Parisi JE, Cutsforth-Gregory JK, Ahlskog JE, Savica R. Levodopa-induced dyskinesia in Parkinson disease: A population-based cohort study. Neurology 2018; 91:e2238-e2243. [PMID: 30404780 DOI: 10.1212/wnl.0000000000006643] [Citation(s) in RCA: 64] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Accepted: 08/29/2018] [Indexed: 01/14/2023] Open
Abstract
OBJECTIVE To assess dyskinesia frequency in a population-based cohort of patients with Parkinson disease (PD). Dyskinesia complicates levodopa treatment and affects quality of life. METHODS Utilizing the 1991-2010 population-based, parkinsonism-incident cohort of Olmsted County, MN (n = 669), accessed via the Rochester Epidemiology Project, we identified patients with PD and abstracted levodopa-related dyskinesia information. RESULTS Of 309 patients with PD (46.2% with parkinsonisms), 279 (90.3%) received levodopa. Most (230/279; 82.4%) had been treated by a Mayo Clinic neurologist. Median age of the 309 patients with PD at the time of diagnosis was 74.1 years (range 33.1-97.8 years). Median-age levodopa initiation in this cohort was 75 years (range 37-98 years), and median-duration levodopa treatment was 6 years (range 2 months to 19.8 years). Dyskinesia was documented in 84 of 279 patients (30.1%). Median time from levodopa initiation to dyskinesia onset was 4 years (range 2 months to 20 years); those with dyskinesia (65.5%; 55/84) developed it within 5 years of levodopa initiation (9 within the first year). Dyskinesia was mild in 57/84 (67.9%), moderate in 16/84 (19.1%), and severe in 9/84 (10.7%); severity was not reported in 2 cases. Dyskinesia severity led to levodopa adjustments or amantadine initiation in 60.7% (51/84 of those with dyskinesia), with improvement in 23/51 (45.1%). Thirteen patients with dyskinesia underwent deep brain stimulation, reporting marked improvement. Postmortem examination confirmed Lewy body disease in 7 autopsied cases. CONCLUSIONS Levodopa-induced dyskinesia affected 30% of the patients with PD in our cohort. Mayo neurologists favoring levodopa dosage optimization treated most patients. Dyskinesia was severe in 3.2% of all levodopa-treated patients with PD (10.7% of all patients with dyskinesia) with marked improvement among those treated with deep brain stimulation.
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Affiliation(s)
- Pierpaolo Turcano
- From the Departments of Neurology (P.T., M.M.M., J.H.B., J.K.C.-G., J.E.A., R.S.), Health Science Research (M.M.M.), and Laboratory Medicine and Pathology (J.E.P.), Mayo Clinic, Rochester, MN
| | - Michelle M Mielke
- From the Departments of Neurology (P.T., M.M.M., J.H.B., J.K.C.-G., J.E.A., R.S.), Health Science Research (M.M.M.), and Laboratory Medicine and Pathology (J.E.P.), Mayo Clinic, Rochester, MN
| | - James H Bower
- From the Departments of Neurology (P.T., M.M.M., J.H.B., J.K.C.-G., J.E.A., R.S.), Health Science Research (M.M.M.), and Laboratory Medicine and Pathology (J.E.P.), Mayo Clinic, Rochester, MN
| | - Joseph E Parisi
- From the Departments of Neurology (P.T., M.M.M., J.H.B., J.K.C.-G., J.E.A., R.S.), Health Science Research (M.M.M.), and Laboratory Medicine and Pathology (J.E.P.), Mayo Clinic, Rochester, MN
| | - Jeremy K Cutsforth-Gregory
- From the Departments of Neurology (P.T., M.M.M., J.H.B., J.K.C.-G., J.E.A., R.S.), Health Science Research (M.M.M.), and Laboratory Medicine and Pathology (J.E.P.), Mayo Clinic, Rochester, MN
| | - J Eric Ahlskog
- From the Departments of Neurology (P.T., M.M.M., J.H.B., J.K.C.-G., J.E.A., R.S.), Health Science Research (M.M.M.), and Laboratory Medicine and Pathology (J.E.P.), Mayo Clinic, Rochester, MN
| | - Rodolfo Savica
- From the Departments of Neurology (P.T., M.M.M., J.H.B., J.K.C.-G., J.E.A., R.S.), Health Science Research (M.M.M.), and Laboratory Medicine and Pathology (J.E.P.), Mayo Clinic, Rochester, MN.
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Hirsi JO, Yifru YM, Metaferia GZ, Bower JH. Prevalence of pain in patients with Parkinson's disease in Addis Ababa, Ethiopia. Parkinsonism Relat Disord 2018; 61:214-218. [PMID: 30340911 DOI: 10.1016/j.parkreldis.2018.09.030] [Citation(s) in RCA: 6] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Revised: 08/26/2018] [Accepted: 09/27/2018] [Indexed: 10/28/2022]
Abstract
INTRODUCTION Pain is a common non-motor feature encountered by patients with Parkinson's disease. Recognition and accurate characterization of pain is crucial for the optimal treatment of Parkinson's disease patients. Pain has been associated with poverty and ethnicity. We determined the prevalence of pain in Parkinson's disease patients in Ethiopia. METHOD We conducted a cross-sectional study for a six month period from April 01, 2017-September 30, 2017 with patients with Parkinson's disease who were attending two neurology referral clinics in Addis Ababa, Ethiopia to assess for the prevalence and the characterization of pain. RESULTS We surveyed 103 patients with Parkinson's disease. Of these, 87/103 (84%) had symptoms of pain. Only 16/87 (18.4%) received pain medications, and no one was referred for physiotherapy. CONCLUSION In Ethiopia, the prevalence of pain in Parkinson's disease patients is amongst the highest in the world, under recognized and undertreated.
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Affiliation(s)
- Jama Osman Hirsi
- Department of Neurology, Addis Ababa University School of Medicine, Addis Ababa, Ethiopia.
| | - Yared Mamushet Yifru
- Department of Neurology, Addis Ababa University School of Medicine, Addis Ababa, Ethiopia.
| | - Guta Zenebe Metaferia
- Department of Neurology, Addis Ababa University School of Medicine, Addis Ababa, Ethiopia.
| | - James H Bower
- Department of Neurology, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA.
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Marras C, Beck JC, Bower JH, Roberts E, Ritz B, Ross GW, Abbott RD, Savica R, Van Den Eeden SK, Willis AW, Tanner CM. Prevalence of Parkinson's disease across North America. NPJ Parkinsons Dis 2018; 4:21. [PMID: 30003140 PMCID: PMC6039505 DOI: 10.1038/s41531-018-0058-0] [Citation(s) in RCA: 474] [Impact Index Per Article: 79.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/21/2018] [Revised: 05/20/2018] [Accepted: 05/23/2018] [Indexed: 01/19/2023]
Abstract
Estimates of the prevalence of Parkinson's disease in North America have varied widely and many estimates are based on small numbers of cases and from small regional subpopulations. We sought to estimate the prevalence of Parkinson's disease in North America by combining data from a multi-study sampling strategy in diverse geographic regions and/or data sources. Five separate cohort studies in California (2), Minnesota (1), Hawaii USA (1), and Ontario, Canada (1) estimated the prevalence of PD from health-care records (3), active ascertainment through facilities, large group, and neurology practices (1), and longitudinal follow-up of a population cohort (1). US Medicare program data provided complementary estimates for the corresponding regions. Using our age- and sex-specific meta-estimates from California, Minnesota, and Ontario and the US population structure from 2010, we estimate the overall prevalence of PD among those aged ≥45 years to be 572 per 100,000 (95% confidence interval 537-614) that there were 680,000 individuals in the US aged ≥45 years with PD in 2010 and that that number will rise to approximately 930,000 in 2020 and 1,238,000 in 2030 based on the US Census Bureau population projections. Regional variations in prevalence were also observed in both the project results and the Medicare-based calculations with which they were compared. The estimates generated by the Hawaiian study were lower across age categories. These estimates can guide health-care planning but should be considered minimum estimates. Some heterogeneity exists that remains to be understood.
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Affiliation(s)
- C Marras
- 1The Morton and Gloria Shulman Movement Disorders Centre and the Edmond J Safra Program in Parkinson's Research, Toronto Western Hospital, University of Toronto, Toronto, ON Canada
| | - J C Beck
- The Parkinson's Foundation, New York, NY USA.,3New York University, New York, NY USA
| | - J H Bower
- 4Department of Neurology, School of Medicine, Mayo Clinic, Rochester, MN USA
| | - E Roberts
- 5Public Health Institute, Oakland, CA USA
| | - B Ritz
- 6Department of Epidemiology, UCLA Fielding School of Public Health and UCLA Geffen School of Medicine, Los Angeles, CA USA.,7Department of Environmental Health, UCLA Fielding School of Public Health and UCLA Geffen School of Medicine, Los Angeles, CA USA.,8Department of Neurology, UCLA Fielding School of Public Health and UCLA Geffen School of Medicine, Los Angeles, CA USA
| | - G W Ross
- 9Veterans Affairs Pacific Islands Health Care System, Honolulu, HI USA
| | - R D Abbott
- 10Center for Epidemiologic Research in Asia, Shiga University of Medical Science, Otsu, Japan
| | - R Savica
- 4Department of Neurology, School of Medicine, Mayo Clinic, Rochester, MN USA
| | - S K Van Den Eeden
- 11Division of Research, Kaiser Permanente Northern California, Oakland, CA USA
| | - A W Willis
- 12Department of Neurology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA USA.,13Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA USA
| | - C M Tanner
- 14Department of Neurology, University of California - San Francisco & PD Research Education and Clinical Center, San Francisco Veterans Affairs Health Care System, San Francisco, CA USA
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Hinson SR, Lopez-Chiriboga AS, Bower JH, Matsumoto JY, Hassan A, Basal E, Lennon VA, Pittock SJ, McKeon A. Glycine receptor modulating antibody predicting treatable stiff-person spectrum disorders. Neurol Neuroimmunol Neuroinflamm 2018; 5:e438. [PMID: 29464188 PMCID: PMC5813079 DOI: 10.1212/nxi.0000000000000438] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Accepted: 12/05/2017] [Indexed: 12/16/2022]
Abstract
Background Glycine receptor alpha-1 subunit (GlyRα1)-immunoglobulin G (IgG) is diagnostic of stiff-person syndrome (SPS) spectrum but has been reported detectable in other neurologic diseases for which significance is less certain. Methods To assess GlyRα1-IgGs as biomarkers of SPS spectrum among patients and controls, specimens were tested using cell-based assays (binding [4°C] and modulating [antigen endocytosing, 37°C]). Medical records of seropositive patients were reviewed. Results GlyRα1-IgG (binding antibody) was detected in 21 of 247 patients with suspected SPS spectrum (8.5%) and in 8 of 190 healthy subject sera (4%) but not CSF. Among 21 seropositive patients, 20 had confirmed SPS spectrum clinically, but 1 was later determined to have a functional neurologic disorder. Sera from 9 patients with SPS spectrum , but not 7 controls, nor the functional patient, caused GlyRα1 modulation (100% specificity). SPS spectrum phenotypes included progressive encephalomyelitis with rigidity and myoclonus (PERM) (8), classic SPS (5), stiff limb (5), stiff trunk (1), and isolated exaggerated startle (hyperekplexia, 1). Neuropsychiatric symptoms present in 12 patients (60%) were anxiety (11), depression (6), and delirium (3). Anxiety was particularly severe in 3 patients with PERM. Objective improvements in SPS neurologic symptoms were recorded in 16 of 18 patients who received first-line immunotherapy (89%, 9/10 treated with corticosteroids, 8/10 treated with IVIg, 3/4 treated with plasma exchange, and 1 treated with rituximab). Treatment-sparing maintenance strategies were successful in 4 of 7 patients (rituximab [2/3], azathioprine [1/1], and mycophenolate [1/3]). Conclusions GlyRα1-modulating antibody improves diagnostic specificity for immunologically treatable SPS spectrum disorders. Classification of evidence This study provides Class IV evidence that GlyRα1-modulating antibody accurately identifies patients with treatable SPS spectrum disorders.
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Affiliation(s)
- Shannon R Hinson
- Department of Laboratory Medicine and Pathology (S.R.H., E.B., V.A.L., S.J.P., A.M.), Department of Neurology (A.S.L.-C., J.H.B., J.Y.M., A.H., V.A.L., S.J.P., A.M.), and Department of Immunology (V.A.L.), Mayo Clinic, Rochester, MN
| | - A Sebastian Lopez-Chiriboga
- Department of Laboratory Medicine and Pathology (S.R.H., E.B., V.A.L., S.J.P., A.M.), Department of Neurology (A.S.L.-C., J.H.B., J.Y.M., A.H., V.A.L., S.J.P., A.M.), and Department of Immunology (V.A.L.), Mayo Clinic, Rochester, MN
| | - James H Bower
- Department of Laboratory Medicine and Pathology (S.R.H., E.B., V.A.L., S.J.P., A.M.), Department of Neurology (A.S.L.-C., J.H.B., J.Y.M., A.H., V.A.L., S.J.P., A.M.), and Department of Immunology (V.A.L.), Mayo Clinic, Rochester, MN
| | - Joseph Y Matsumoto
- Department of Laboratory Medicine and Pathology (S.R.H., E.B., V.A.L., S.J.P., A.M.), Department of Neurology (A.S.L.-C., J.H.B., J.Y.M., A.H., V.A.L., S.J.P., A.M.), and Department of Immunology (V.A.L.), Mayo Clinic, Rochester, MN
| | - Anhar Hassan
- Department of Laboratory Medicine and Pathology (S.R.H., E.B., V.A.L., S.J.P., A.M.), Department of Neurology (A.S.L.-C., J.H.B., J.Y.M., A.H., V.A.L., S.J.P., A.M.), and Department of Immunology (V.A.L.), Mayo Clinic, Rochester, MN
| | - Eati Basal
- Department of Laboratory Medicine and Pathology (S.R.H., E.B., V.A.L., S.J.P., A.M.), Department of Neurology (A.S.L.-C., J.H.B., J.Y.M., A.H., V.A.L., S.J.P., A.M.), and Department of Immunology (V.A.L.), Mayo Clinic, Rochester, MN
| | - Vanda A Lennon
- Department of Laboratory Medicine and Pathology (S.R.H., E.B., V.A.L., S.J.P., A.M.), Department of Neurology (A.S.L.-C., J.H.B., J.Y.M., A.H., V.A.L., S.J.P., A.M.), and Department of Immunology (V.A.L.), Mayo Clinic, Rochester, MN
| | - Sean J Pittock
- Department of Laboratory Medicine and Pathology (S.R.H., E.B., V.A.L., S.J.P., A.M.), Department of Neurology (A.S.L.-C., J.H.B., J.Y.M., A.H., V.A.L., S.J.P., A.M.), and Department of Immunology (V.A.L.), Mayo Clinic, Rochester, MN
| | - Andrew McKeon
- Department of Laboratory Medicine and Pathology (S.R.H., E.B., V.A.L., S.J.P., A.M.), Department of Neurology (A.S.L.-C., J.H.B., J.Y.M., A.H., V.A.L., S.J.P., A.M.), and Department of Immunology (V.A.L.), Mayo Clinic, Rochester, MN
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Savica R, Grossardt BR, Rocca WA, Bower JH. Parkinson disease with and without Dementia: A prevalence study and future projections. Mov Disord 2018; 33:537-543. [PMID: 29356127 DOI: 10.1002/mds.27277] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Revised: 11/08/2017] [Accepted: 11/27/2017] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Limited population-based information is available on the co-occurrence of dementia and PD. However, projecting the prevalence of PD with and without dementia during the next 50 years is crucial for planning public-health and patient-care initiatives. OBJECTIVES The objective of this study was to project the prevalence of PD with and without dementia in the United States by 2060. METHODS We used the Rochester Epidemiology Project medical records-linkage system to identify all persons with PD with or without dementia residing in Olmsted County, Minnesota, on January 1, 2006. A movement disorders specialist reviewed the complete medical records of each person to confirm the presence of PD. We calculated the age- and sex-specific prevalence of PD with and without dementia and projected U.S. prevalence through 2060. RESULTS We identified 296 persons with PD with and without dementia on the prevalence date (187 men, 109 women); the overall prevalence increased with age from 0.01% (30-39 years) to 2.83% (≥90 years). The prevalence of PD without dementia increased with age from 0.01% (30-39 years) to 1.25% (≥90 years). The prevalence of PD with dementia increased with age from 0.10% (60-69 years) to 1.59% (≥90 years). The prevalence was higher in men than in women for all subtypes and all age groups. We project by 2060 an approximate doubling of the number of persons with PD without dementia and a tripling of the number of persons with PD with dementia in the United States. CONCLUSIONS The prevalence of PD with and without dementia increases with age and is higher in men than women. We project that the number of persons with PD in the United States will increase substantially by 2060. © 2018 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Rodolfo Savica
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA.,Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA
| | - Brandon R Grossardt
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA
| | - Walter A Rocca
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA.,Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA
| | - James H Bower
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
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Bower JH, Grossardt BR, Rocca WA, Savica R. Prevalence of and indications for antipsychotic use in Parkinson's disease. Mov Disord 2017; 33:325-328. [PMID: 29278275 DOI: 10.1002/mds.27256] [Citation(s) in RCA: 7] [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: 07/11/2017] [Revised: 11/01/2017] [Accepted: 11/05/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The prevalence of patients with PD taking antipsychotics is unknown. OBJECTIVE To measure the prevalence of patients with PD taking antipsychotics. METHODS We used the medical records-linkage system of the Rochester Epidemiology Project to study the use of antipsychotic medication in all persons with Parkinson disease in Olmsted County, Minnesota on 1 January 2006. RESULTS There were 296 patients with PD in Olmsted County on 1 January 2006. The overall prevalence of antipsychotic use was 9.8% (29 of 296); 95.5% (28 of 29) of the patients had dementia when initiating antipsychotics. The most frequent indication (71.4%; 20 of 28) was psychosis or behavior threatening to the patient or others. CONCLUSIONS The prevalence of antipsychotic use in patients with PD is lower than expected from previously reported cumulative incidences. Dementia is highly prevalent in those starting antipsychotics. Most of the patients on antipsychotics had a reasonable risk-benefit ratio for taking them. © 2017 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- James H Bower
- Department of Neurology, College of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Brandon R Grossardt
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, College of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Walter A Rocca
- Department of Neurology, College of Medicine, Mayo Clinic, Rochester, Minnesota, USA.,Division of Epidemiology, Department of Health Sciences Research, College of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Rodolfo Savica
- Department of Neurology, College of Medicine, Mayo Clinic, Rochester, Minnesota, USA.,Division of Epidemiology, Department of Health Sciences Research, College of Medicine, Mayo Clinic, Rochester, Minnesota, USA
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Mittal SO, Mack K, Bower JH. Fragile X-associated Tremor/Ataxia Syndrome in an Adolescent Female. Mov Disord Clin Pract 2017; 4:778-780. [DOI: 10.1002/mdc3.12513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Revised: 05/03/2017] [Accepted: 05/18/2017] [Indexed: 11/08/2022] Open
Affiliation(s)
| | - Kenneth Mack
- Department of Pediatric Neurology; Mayo Clinic; Rochester Minnesota
| | - James H. Bower
- Department of Neurology; Mayo Clinic; Rochester Minnesota
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Turcano P, Mielke MM, Josephs KA, Bower JH, Parisi JE, Boeve BF, Savica R. Clinicopathologic discrepancies in a population-based incidence study of parkinsonism in olmsted county: 1991-2010. Mov Disord 2017; 32:1439-1446. [PMID: 28843020 DOI: 10.1002/mds.27125] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Revised: 06/21/2017] [Accepted: 06/26/2017] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE The purpose of this study was to examine the discrepancies between the clinical diagnosis of parkinsonism and neuropathological findings in a population-based cohort with parkinsonian disorders. BACKGROUND The specific clinical diagnosis of parkinsonism is challenging, and definite confirmation requires neuropathological evaluation. Currently, autopsies are seldom performed, and most brain autopsies represent atypical or diagnostically unresolved cases. METHODS We used a defined population-based incidence cohort with clinical parkinsonism (n = 669) from the Rochester Epidemiology Project in Olmsted County, Minnesota, 1991-2010. We reviewed reports of all patients who underwent neuropathologic examination at autopsy (n = 60; 9%) and applied consensus pathologic guidelines for neurodegenerative disease diagnosis. RESULTS Among the 60 patients examined pathologically, the median time from the last recorded clinical diagnosis to death was 7 years (range from 2 to 17 years). Clinical-pathological concordance was found in 52 cases (86.7%), whereas 8 (13.3%) had a clinical-pathological discrepancy. Four patients with a clinical diagnosis of idiopathic Parkinson's disease had no pathological evidence of Lewy bodies or α-synucleinopathy; of these, pathological diagnoses were Alzheimer's disease (2 cases), progressive supranuclear palsy (1 case), and vascular parkinsonism (1 case). Two patients with clinical diagnoses of "dementia with Lewy bodies" and one patient with an "unspecified parkinsonism" had a pathological diagnosis of Alzheimer's disease without concomitant α-synuclein lesions. One patient with clinically diagnosed "progressive supranuclear palsy" had indeterminate pathological findings without α-synuclein or Aβ- or tau-immunoreactive lesions at autopsy. CONCLUSIONS Overall, the clinical diagnoses of parkinsonian subtypes had good concordance with pathological confirmation (86.7%). However, clinical-pathological discrepancies were documented in 13.3%. © 2017 International Parkinson and Movement Disorder Society.
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Affiliation(s)
| | - Michelle M Mielke
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA.,Department of Neurology and Health Science Research, Mayo Clinic, Rochester, Minnesota, USA
| | - Keith A Josephs
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - James H Bower
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - Joseph E Parisi
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA.,Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Bradley F Boeve
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - Rodolfo Savica
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA.,Department of Neurology and Health Science Research, Mayo Clinic, Rochester, Minnesota, USA
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Savica R, Grossardt BR, Bower JH, Ahlskog JE, Boeve BF, Graff-Radford J, Rocca WA, Mielke MM. Survival and Causes of Death Among People With Clinically Diagnosed Synucleinopathies With Parkinsonism: A Population-Based Study. JAMA Neurol 2017; 74:839-846. [PMID: 28505261 DOI: 10.1001/jamaneurol.2017.0603] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Importance To our knowledge, a comprehensive study of the survival and causes of death of persons with synucleinopathies compared with the general population has not been conducted. Understanding the long-term outcomes of these conditions may inform patients and caregivers of the expected disease duration and may help with care planning. Objective To compare survival rates and causes of death among patients with incident, clinically diagnosed synucleinopathies and age- and sex-matched referent participants. Design, Setting, and Participants This population-based study used the Rochester Epidemiology Project medical records-linkage system to identify all residents in Olmsted County, Minnesota, who received a diagnostic code of parkinsonism from 1991 through 2010. A movement-disorders specialist reviewed the medical records of each individual to confirm the presence of parkinsonism and determine the type of synucleinopathy. For each confirmed patient, an age- and sex-matched Olmsted County resident without parkinsonism was also identified. Main Outcomes and Measures We determined the age- and sex-adjusted risk of death for each type of synucleinopathy, the median time from diagnosis to death, and the causes of death. Results Of the 461 patients with synucleinopathies, 279 (60.5%) were men, and of the 452 referent participants, 272 (60.2%) were men. From 1991 through 2010, 461 individuals received a diagnosis of a synucleinopathy (309 [67%] of Parkinson disease, 81 [17.6%] of dementia with Lewy bodies, 55 [11.9%] of Parkinson disease dementia, and 16 [3.5%] of multiple system atrophy with parkinsonism). During follow-up, 68.6% (n = 316) of the patients with synucleinopathies and 48.7% (n = 220) of the referent participants died. Patients with any synucleinopathy died a median of 2 years earlier than referent participants. Patients with multiple system atrophy with parkinsonism (hazard ratio, 10.51; 95% CI, 2.92-37.82) had the highest risk of death compared with referent participants, followed by those with dementia with Lewy bodies (hazard ratio, 3.94; 95% CI, 2.61-5.94), Parkinson disease with dementia (hazard ratio, 3.86; 95% CI, 2.36-6.30), and Parkinson disease (hazard ratio, 1.75; 95% CI, 1.39-2.21). Neurodegenerative disease was the most frequent cause of death listed on the death certificate for patients, and cardiovascular disease was the most frequent cause of death among referent participants. Conclusions and Relevance Individuals with multiple system atrophy with parkinsonism, dementia with Lewy bodies, and Parkinson disease dementia have increased mortality compared with the general population. The mortality among persons with Parkinson disease is only moderately increased compared with the general population.
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Affiliation(s)
- Rodolfo Savica
- Department of Neurology, Mayo Clinic, Rochester, Minnesota2Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
| | - Brandon R Grossardt
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
| | - James H Bower
- Department of Neurology, Mayo Clinic, Rochester, Minnesota
| | - J Eric Ahlskog
- Department of Neurology, Mayo Clinic, Rochester, Minnesota
| | | | | | - Walter A Rocca
- Department of Neurology, Mayo Clinic, Rochester, Minnesota2Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
| | - Michelle M Mielke
- Department of Neurology, Mayo Clinic, Rochester, Minnesota2Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
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Abstract
IMPORTANCE Changes over time in the incidence of parkinsonism and Parkinson disease (PD) remain uncertain. OBJECTIVE To investigate secular trends (period effects) and birth cohort trends in the incidence of parkinsonism and PD over 30 years in a geographically defined American population. DESIGN, SETTING, AND PARTICIPANTS We used the medical records-linkage system of the Rochester Epidemiology Project to identify incidence cases of PD and other types of parkinsonism in Olmsted County, Minnesota, from 1976 to 2005. All cases were classified by a movement disorder specialist using defined criteria through the review of the complete medical records within the system. The analyses for this study were conducted between May 2015 and January 2016. MAIN OUTCOMES AND MEASURES Incidence rates of parkinsonism and PD over 30 years. We tested for secular trends (period effects) using negative binomial regression models and for birth cohort effects using age-period-cohort models. RESULTS Of 906 patients with parkinsonism, 501 were men, and the median age at onset was 74 years (interquartile range, 66-81 years). Of the 464 patients with PD, 275 were men, and the median age at onset was 73 years (interquartile range, 64-80 years). The overall incidence rates increased significantly over 30 years in men for both parkinsonism (relative risk [RR], 1.17 per decade; 95% CI, 1.03-1.33) and PD (RR, 1.24 per decade; 95% CI, 1.08-1.43). These trends were driven primarily by the older age groups. In particular, for men 70 years or older, incidence rates increased for both parkinsonism (RR, 1.24 per decade; 95% CI, 1.07-1.44) and PD (RR, 1.35 per decade; 95% CI, 1.10-1.65). The secular trends were not significant for women overall or in age strata. We observed an increased risk for both men and women born in the 1920 cohort (1915-1924). However, this birth cohort effect was significant only for PD and only in men. CONCLUSIONS AND REVELANCE Our study suggests that the incidence of parkinsonism and PD may have increased between 1976 and 2005, particularly in men 70 years and older. These trends may be associated with the dramatic changes in smoking behavior that took place in the second half of the 20th century or with other lifestyle or environmental changes. However, the trends could be spurious and need to be confirmed in other populations.
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Affiliation(s)
- Rodolfo Savica
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota2Department of Neurology, Mayo Clinic, Rochester, Minnesota
| | | | - James H Bower
- Department of Neurology, Mayo Clinic, Rochester, Minnesota
| | - J Eric Ahlskog
- Department of Neurology, Mayo Clinic, Rochester, Minnesota
| | - Walter A Rocca
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota2Department of Neurology, Mayo Clinic, Rochester, Minnesota
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Savica R, Grossardt BR, Bower JH, Ahlskog JE, Mielke MM, Rocca WA. Incidence and time trends of drug-induced parkinsonism: A 30-year population-based study. Mov Disord 2016; 32:227-234. [PMID: 27779780 PMCID: PMC5318251 DOI: 10.1002/mds.26839] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Revised: 09/07/2016] [Accepted: 09/19/2016] [Indexed: 12/22/2022] Open
Abstract
Background Epidemiological studies of drug‐induced parkinsonism remain limited. Objectives To investigate the incidence and time trends of drug‐induced parkinsonism over 30 years in a geographically defined American population. Methods We used the medical records‐linkage system of the Rochester Epidemiology Project to identify all persons in Olmsted County, Minnesota, who received a screening diagnostic code for parkinsonism from 1976 through 2005. A movement disorders specialist reviewed the complete medical records of each person to confirm the presence of drug‐induced parkinsonism associated with dopamine‐blocking or dopamine‐depleting medications. Results Among 906 incident cases of parkinsonism from 1976 to 2005, 108 persons had drug‐induced parkinsonism (11.9%). The average annual incidence rate of drug‐induced parkinsonism was 3.3 per 100,000 person‐years, was higher in women, and increased with older age. Drug‐induced parkinsonism was the fifth‐most common type of parkinsonism overall; however, it was the most common type among persons younger than age 40 years. Typical antipsychotic drugs were the most common class of drugs associated with parkinsonism, whereas atypical antipsychotic drugs were rarely involved. The incidence rate of drug‐induced parkinsonism decreased 32.0% per decade (relative risk = 0.68; 95% confidence interval: 0.49–0.94) and 68.6% over the 30 years of the study. The decrease was similar in men (65.2%) and women (69.4%); however, the trend was significant only in women. Conclusions The incidence of drug‐induced parkinsonism increased with older age and was higher in women at all ages. Typical antipsychotic drugs were the most common cause. The incidence of drug‐induced parkinsonism decreased over the 30 years of the study because of changes in drug use. © 2016 The Authors. Movement Disorders published by Wiley Periodicals, Inc. on behalf of International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Rodolfo Savica
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA.,Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA
| | - Brandon R Grossardt
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - James H Bower
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - J Eric Ahlskog
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - Michelle M Mielke
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA.,Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA
| | - Walter A Rocca
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA.,Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA
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Benito-León J, Domingo-Santos A, Hassan A, Ahlskog JE, Matsumoto JY, Bower JH. Orthostatic tremor: Clinical, electrophysiologic, and treatment findings in 184 patients. Neurology 2016; 87:341. [PMID: 27432180 DOI: 10.1212/wnl.0000000000002907] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Cutsforth-Gregory JK, Ahlskog JE, McKeon A, Burnett MS, Matsumoto JY, Hassan A, Bower JH. Repetitive exercise dystonia: A difficult to treat hazard of runner and non-runner athletes. Parkinsonism Relat Disord 2016; 27:74-80. [PMID: 27017145 DOI: 10.1016/j.parkreldis.2016.03.013] [Citation(s) in RCA: 16] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Revised: 02/29/2016] [Accepted: 03/17/2016] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Runner's dystonia has previously been described in small series or case reports as a lower limb, task-specific dystonia. We have occasionally encountered this disorder and recognized the same phenomenon in non-runners regularly engaging in lower limb exercise. We wished to characterize the syndrome further, including outcomes, treatment, and the diagnostic usefulness of electrophysiology. METHODS We conducted a retrospective review and follow-up survey of adults seen at Mayo Clinic (1996-2015) with task-specific dystonia arising after prolonged repetitive lower limb exercise. The findings were compared to all 21 previously reported cases of runner's dystonia. RESULTS We identified 20 patients with this condition, 13 runners and seven non-runner athletes. Median age at dystonia onset was in mid-adulthood. Correct diagnosis was delayed by a median of 3.5 years in runners and 1.6 years in non-runners, by which time more than one-third of patients had undergone unsuccessful invasive procedures. Most patients had dystonia onset in the distal lower limb. Dystonia was task-specific with exercise at onset but progressed to affect walking in most. Sensory tricks were reported in some. Surface EMG was consistent with task-specific dystonia in nine patients. Botulinum toxin, levodopa, clonazepam, trihexyphenidyl, and physical therapy provided modest benefit to some, but all patients remained substantially symptomatic at last follow up. CONCLUSIONS Repetitive exercise dystonia is task-specific, confined to the lower limb and occasionally trunk musculature. It tends to be treatment-refractory and limits ability to exercise. Diagnosis is typically delayed, and unnecessary surgical procedures are common. Surface EMG may aid the diagnosis.
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Affiliation(s)
| | - J Eric Ahlskog
- Department of Neurology, Mayo Clinic, Rochester, MN, USA.
| | - Andrew McKeon
- Department of Neurology, Mayo Clinic, Rochester, MN, USA; Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA.
| | | | | | - Anhar Hassan
- Department of Neurology, Mayo Clinic, Rochester, MN, USA.
| | - James H Bower
- Department of Neurology, Mayo Clinic, Rochester, MN, USA.
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Caviness JN, van Gerpen JA, Klassen BT, Bower JH, Matsumoto JY. Electrophysiology Testing of Movement Disorders. Clin Neurophysiol 2016. [DOI: 10.1093/med/9780190259631.003.0043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
A battery of tools is used to provide neurophysiological characteristics of movement disorders, including EMG, EEG, EEG-EMG with back-averaging, evoked potentials, and long-latency EMG reflexes. Surface EMG forms the foundation of movement neurophysiology and can clarify muscle discharge timing and spatial relationships, as well as frequency information. This is useful for distinguishing tremor types, tremor versus myoclonus, and which muscles are involved in dystonia. Common modalities that are simultaneously recorded with EMG are EEG and motion detectors. Combined EMG with EEG recordings during myoclonus is useful for myoclonus classification and source localization. Evoked potentials and long-latency reflexes can assist with defining the myoclonus pathophysiology. These tests can distinguish between myoclonus of cortical versus subcortical origin, which affects treatment strategy decisions. EMG is useful for muscle localization for botulinum toxin injection. Chorea, tics, and psychogenic movement disorders mostly show nonspecific EMG patterns, limiting the usefulness of the technique in these situations.
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Hassan A, Ahlskog JE, Matsumoto JY, Milber JM, Bower JH, Wilkinson JR. Orthostatic tremor: Clinical, electrophysiologic, and treatment findings in 184 patients. Neurology 2016; 86:458-64. [PMID: 26747880 DOI: 10.1212/wnl.0000000000002328] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Accepted: 10/07/2015] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To evaluate the clinical, electrophysiologic, and treatment outcome features of orthostatic tremor (OT) in a large case series. METHODS We performed medical record review of 184 patients who met clinical and electrodiagnostic criteria for OT from 1976 to 2013 at the Mayo Clinic. Demographic, clinical, electrophysiologic, and treatment data were extracted. RESULTS The majority of OT cases were female (63.6%) and mean age at onset was 59.3 years (range 13-85 years). Diagnosis was delayed by a mean of 7.2 years (range 0-44 years). The average tremor frequency was 15.7 Hz (range 12.5-20 Hz), and transmitted to the arms on weight-bearing (95.5%). Patients reported a spectrum of progressive orthostatic leg symptoms, relieved by sitting or leaning. Falls were reported in 24.1%. Coexistent neurologic disorders included essential tremor (22.8%), other tremor (4.9%), and parkinsonism (8.7%). Family history of OT was noted in 4.9%. Of 46 medications trialed, 24 failed to provide any benefit. Benzodiazepines provided at least mild benefit in 55.9%, and moderate to marked benefit in 31.5%; β-blockers (31.0%) and anticonvulsants (25.0%) provided mild benefit, and the remainder were largely ineffective. Medication benefit waned over time. Deep brain stimulation (DBS) was effective in 2 cases. CONCLUSION OT predominantly affects female seniors, and the diagnosis should be considered with any orthostatic-induced leg symptoms, and confirmed by surface EMG. Benzodiazepines are the most efficacious treatment, followed by β-blockers and anticonvulsants. DBS should be further explored for treatment.
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Affiliation(s)
- Anhar Hassan
- From the Department of Neurology (A.H., J.E.A., J.Y.M., J.H.B.), Mayo Clinic, Rochester, MN; SUNY Downstate College of Medicine (J.M.M.), Brooklyn, NY; University of Pennsylvania (J.R.W.), Philadelphia; and Parkinson's Disease Research, Education and Clinical Center (PADRECC) (J.R.W.), Philadelphia VA Medical Center, PA.
| | - J Eric Ahlskog
- From the Department of Neurology (A.H., J.E.A., J.Y.M., J.H.B.), Mayo Clinic, Rochester, MN; SUNY Downstate College of Medicine (J.M.M.), Brooklyn, NY; University of Pennsylvania (J.R.W.), Philadelphia; and Parkinson's Disease Research, Education and Clinical Center (PADRECC) (J.R.W.), Philadelphia VA Medical Center, PA
| | - Joseph Y Matsumoto
- From the Department of Neurology (A.H., J.E.A., J.Y.M., J.H.B.), Mayo Clinic, Rochester, MN; SUNY Downstate College of Medicine (J.M.M.), Brooklyn, NY; University of Pennsylvania (J.R.W.), Philadelphia; and Parkinson's Disease Research, Education and Clinical Center (PADRECC) (J.R.W.), Philadelphia VA Medical Center, PA
| | - Joshua M Milber
- From the Department of Neurology (A.H., J.E.A., J.Y.M., J.H.B.), Mayo Clinic, Rochester, MN; SUNY Downstate College of Medicine (J.M.M.), Brooklyn, NY; University of Pennsylvania (J.R.W.), Philadelphia; and Parkinson's Disease Research, Education and Clinical Center (PADRECC) (J.R.W.), Philadelphia VA Medical Center, PA
| | - James H Bower
- From the Department of Neurology (A.H., J.E.A., J.Y.M., J.H.B.), Mayo Clinic, Rochester, MN; SUNY Downstate College of Medicine (J.M.M.), Brooklyn, NY; University of Pennsylvania (J.R.W.), Philadelphia; and Parkinson's Disease Research, Education and Clinical Center (PADRECC) (J.R.W.), Philadelphia VA Medical Center, PA
| | - Jayne R Wilkinson
- From the Department of Neurology (A.H., J.E.A., J.Y.M., J.H.B.), Mayo Clinic, Rochester, MN; SUNY Downstate College of Medicine (J.M.M.), Brooklyn, NY; University of Pennsylvania (J.R.W.), Philadelphia; and Parkinson's Disease Research, Education and Clinical Center (PADRECC) (J.R.W.), Philadelphia VA Medical Center, PA
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Coon EA, Sletten DM, Suarez MD, Mandrekar JN, Ahlskog JE, Bower JH, Matsumoto JY, Silber MH, Benarroch EE, Fealey RD, Sandroni P, Low PA, Singer W. Clinical features and autonomic testing predict survival in multiple system atrophy. Brain 2015; 138:3623-31. [PMID: 26369944 DOI: 10.1093/brain/awv274] [Citation(s) in RCA: 94] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Accepted: 07/26/2015] [Indexed: 11/12/2022] Open
Abstract
Multiple system atrophy is characterized by autonomic failure along with motor symptoms of parkinsonism and/or cerebellar ataxia. There are differing reports on the influence of certain clinical features, including motor subtype (multiple system atrophy-parkinsonism versus multiple system atrophy-cerebellar ataxia), age of onset, gender, and early autonomic symptoms, on the survival in patients with multiple system atrophy. We sought to evaluate overall survival and predictors of survival in a large cohort of patients with multiple system atrophy seen at a single referral centre where objective autonomic testing is routinely performed for this indication. All cases of multiple system atrophy evaluated at Mayo Clinic, Rochester and assessed with an autonomic reflex screen between January 1998 and December 2012 were retrospectively reviewed. A total of 685 patients were identified; 594 met criteria for probable multiple system atrophy, and 91 for possible multiple system atrophy. Multiple system atrophy-parkinsonism was the predominant subtype in 430 patients (63%). Average age of onset was earlier in multiple system atrophy-cerebellar ataxia (58.4 years) compared to multiple system atrophy-parkinsonism (62.3 years; P < 0.001). Median disease duration from symptom onset to death was 7.51 years (95% confidence interval 7.18-7.78) while time from diagnosis to death was 3.33 years (95% confidence interval 2.92-3.59). There was no difference in survival between motor subtypes of multiple system atrophy (P = 0.232). An initial motor symptom was most common (61%) followed by autonomic onset (28%) and combined motor and autonomic symptoms (11%). The initial onset of either motor or autonomic symptoms did not influence length of survival. However, a number of clinical and autonomic laboratory features predicted unfavourable survival in a univariate analysis. A multivariate model retained the following unfavourable predictors of survival: (i) falls within 3 years of onset (hazard ratio 2.31, P < 0.0001); (ii) bladder symptoms (hazard ratio 1.96, P < 0.0001); (iii) urinary catheterization within 3 years of symptom onset (hazard ratio 1.67, P < 0.003); (iv) orthostatic intolerance within 1 year of symptom onset (hazard ratio 1.28, P < 0.014); (v) older age of onset (hazard ratio 1.02, P = 0.001); and (vi) degree of autonomic failure as measured by a validated composite autonomic severity score (hazard ratio 1.07, P < 0.0023). We conclude that carefully selected clinical features can be used to predict survival in patients with multiple system atrophy. Autonomic testing adds an additional, independent predictor of survival, demonstrating its value not only in the diagnosis of multiple system atrophy but also as prognostic marker.
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Affiliation(s)
| | | | | | - Jay N Mandrekar
- 2 Department of Clinical Statistics, Mayo Clinic, Rochester, MN, USA
| | - J Eric Ahlskog
- 1 Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | - James H Bower
- 1 Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | | | | | | | | | - Paola Sandroni
- 1 Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | - Phillip A Low
- 1 Department of Neurology, Mayo Clinic, Rochester, MN, USA
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Cutsforth-Gregory JK, Bower JH. Athlete's Dystonia. An Occupational Hazard of Athletes. Minn Med 2015; 98:42-43. [PMID: 26267919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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Bower JH, Diop AG, Gouider R, Schmutzhard E. Addressing neurologic needs in sub-Saharan Africa: An opportunity for multisociety cooperation. Neurology 2014; 83:1207-9. [PMID: 25253876 DOI: 10.1212/wnl.0000000000000810] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- James H Bower
- From the Department of Neurology (J.H.B.), Mayo Clinic, Rochester, MN; Clinique Neurologique (A.G.D.), CHU de Fann, Dakar, Sénégal; Service de Neurologie (R.G.), Hôpital Razi, Manouba, Tunis; and the Department of Neurology (E.S.), NICU, Medical University, Innsbruck, Austria.
| | - Amadou Gallo Diop
- From the Department of Neurology (J.H.B.), Mayo Clinic, Rochester, MN; Clinique Neurologique (A.G.D.), CHU de Fann, Dakar, Sénégal; Service de Neurologie (R.G.), Hôpital Razi, Manouba, Tunis; and the Department of Neurology (E.S.), NICU, Medical University, Innsbruck, Austria
| | - Riadh Gouider
- From the Department of Neurology (J.H.B.), Mayo Clinic, Rochester, MN; Clinique Neurologique (A.G.D.), CHU de Fann, Dakar, Sénégal; Service de Neurologie (R.G.), Hôpital Razi, Manouba, Tunis; and the Department of Neurology (E.S.), NICU, Medical University, Innsbruck, Austria
| | - Erich Schmutzhard
- From the Department of Neurology (J.H.B.), Mayo Clinic, Rochester, MN; Clinique Neurologique (A.G.D.), CHU de Fann, Dakar, Sénégal; Service de Neurologie (R.G.), Hôpital Razi, Manouba, Tunis; and the Department of Neurology (E.S.), NICU, Medical University, Innsbruck, Austria
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Figueroa JJ, Singer W, Parsaik A, Benarroch EE, Ahlskog JE, Fealey RD, Parisi JE, Sandroni P, Mandrekar J, Iodice V, Low PA, Bower JH. Multiple system atrophy: prognostic indicators of survival. Mov Disord 2014; 29:1151-7. [PMID: 24909319 DOI: 10.1002/mds.25927] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2014] [Revised: 04/24/2014] [Accepted: 05/04/2014] [Indexed: 12/19/2022] Open
Abstract
Neurological and autonomic presentation in multiple system atrophy (MSA) may predict early mortality. Quantification of early autonomic failure as a mortality predictor is lacking. Early neurological and autonomic clinical features were retrospectively reviewed in 49 MSA cases (median age at onset, 56.1 years; 16 women) confirmed by autopsy at Mayo Clinic. When available, the 10-point composite autonomic severity score derived from the autonomic reflex screen provided quantification of the degree of autonomic failure and thermoregulatory sweat test quantitated body surface anhidrosis. Symptoms at onset were autonomic in 50%, parkinsonian in 30%, and cerebellar in 20% of cases. Survival (median [95% confidence interval]) was 8.6 [6.7-10.2] years. Survival was shorter in patients with early laboratory evidence of generalized (composite autonomic severity score ≥ 6) autonomic failure (7.0 [3.9-9.8] vs. 9.8 [4.6-13.8] years; P = 0.036), and early requirement of bladder catheterization (7.3 [3.1-10.2] vs. 13.7 [8.5-14.9] years; P = 0.003) compared with those without these clinical features. On Cox proportional analysis, prognostic indicators of shorter survival were older age at onset (hazard ratio [95% confidence interval], 1.04 [1.01-1.08]; P = 0.03), early requirement of bladder catheterization (7.9 [1.88-38.63]; P = 0.004), and early generalized (composite autonomic severity score ≥ 6) autonomic failure (2.8 [1.01-9.26]; P = 0.047). Gender, phenotype, and early development of gait instability, aid-requiring ambulation, orthostatic symptoms, neurogenic bladder, or significant anhidrosis (thermoregulatory sweat test ≥ 40%) were not indicators of shorter survival. Our data suggest that early development of severe generalized autonomic failure more than triples the risk of shorter survival in patients with MSA.
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Affiliation(s)
- Juan J Figueroa
- Department of Neurology, Medical College of Wisconsin, Milwaukee, WI
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O'Gorman CM, Bower JH, Matsumoto JY, Kantarci OH, Kumar N. When Drinking Makes the Tremor Worse: A Task-Specific Orolingual Tremor. Mov Disord Clin Pract 2014; 1:237-239. [PMID: 30363876 DOI: 10.1002/mdc3.12041] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2014] [Revised: 04/17/2014] [Accepted: 04/18/2014] [Indexed: 11/07/2022] Open
Affiliation(s)
| | - James H Bower
- Department of Neurology Mayo Clinic Rochester Minnesota USA
| | | | | | - Neeraj Kumar
- Department of Neurology Mayo Clinic Rochester Minnesota USA
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Meta J, Nasuwa F, Mwendo E, Reyburn H, Bower JH. Improving the consent process for neuroepidemiologic research in resource-poor settings. Neurology 2014; 82:895-7. [PMID: 24616193 DOI: 10.1212/wnl.0000000000000184] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Judith Meta
- From the Joint Malaria Programme (J.M., F.N., H.R.), London School of Hygiene and Tropical Medicine; Kilimanjaro Christian Medical University College (E.M.), Moshi, Tanzania; and the Department of Neurology (J.H.B.), Mayo Clinic, Rochester, MN
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Abstract
IMPORTANCE Epidemiologic data on dementia with Lewy bodies (DLB) and Parkinson disease dementia (PDD) remain limited in the United States and worldwide. These data are essential to guide research and clinical or public health interventions. OBJECTIVE To investigate the incidence of DLB among residents of Olmsted County, Minnesota, and compare it with the incidence of PDD. DESIGN The medical records linkage system of the Rochester Epidemiology Project was used to identify all persons who developed parkinsonism and, in particular, DLB or PDD from 1991 through 2005 (15 years). A movement disorders specialist reviewed the complete medical records of each suspected patient to confirm the diagnosis. SETTING Olmsted County, Minnesota, from 1991 through 2005 (15 years). PARTICIPANTS All the residents of Olmsted County, Minnesota, who gave authorization for medical record research. MAIN OUTCOMES AND MEASURES Incidence of DLB and PDD. RESULTS Among 542 incident cases of parkinsonism, 64 had DLB and 46 had PDD. The incidence rate of DLB was 3.5 per 100,000 person-years overall, and it increased steeply with age. The incidence of PDD was 2.5 overall and also increased steeply with age. The incidence rate of DLB and PDD combined was 5.9. Patients with DLB were younger at onset of symptoms than patients with PDD and had more hallucinations and cognitive fluctuations. Men had a higher incidence of DLB than women across the age spectrum. The pathology was consistent with the clinical diagnosis in 24 of 31 patients (77.4%) who underwent autopsy. CONCLUSIONS AND RELEVANCE The overall incidence rate of DLB is lower than the rate of Parkinson disease. The incidence of DLB increases steeply with age and is markedly higher in men. This men to women difference may suggest different etiologic mechanisms. Our findings may guide health care planning and prompt new studies.
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Affiliation(s)
- Rodolfo Savica
- Department of Neurology, College of Medicine, Mayo Clinic, Rochester, Minnesota2Division of Epidemiology, Department of Health Sciences Research, College of Medicine, Mayo Clinic, Rochester, Minnesota
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Abstract
IMPORTANCE The frequency and distribution of synucleinopathies and tauopathies manifesting with parkinsonism in the general population are poorly understood, thus affecting health care planning and research. OBJECTIVE To investigate the incidence and distribution of specific types of parkinsonism and related proteinopathies. DESIGN We used the medical records-linkage system of the Rochester Epidemiology Project to identify all subjects who received a screening diagnostic code related to parkinsonism in Olmsted County, Minnesota, from January 1, 1991, through December 31, 2005 (15 years). A movement disorders specialist reviewed the complete medical records of each subject who screened positive to determine the type of parkinsonism and the presumed proteinopathy using specified criteria. SETTING Geographically defined population. PARTICIPANTS All residents of Olmsted County who provided authorization to use their data for medical records research (population-based sample). MAIN OUTCOME AND MEASURES Incidence of parkinsonism and specific proteinopathies. RESULTS Among 542 incident cases of parkinsonism, 409 (75.5%) were classified as proteinopathies. Of the 389 patients with presumed synucleinopathies (71.8%), 264 had Parkinson disease (48.7% of all cases). The incidence rate of synucleinopathies was 21.0 per 100 000 person-years overall and increased steeply with age. The incidence rate of tauopathies was 1.1 overall (20 cases), and the most common tauopathy was progressive supranuclear palsy (16 cases). Thirty-six subjects had drug-induced parkinsonism (6.6%), 11 had vascular parkinsonism (2.0%), 1 had amyotrophic lateral sclerosis in parkinsonism (0.2%), 1 had parkinsonism secondary to surgery (0.2%), and 84 remained unspecified (15.5%). Men had a higher incidence than women for most types of parkinsonism. Findings at brain autopsy confirmed the clinical diagnosis in 53 of 65 patients who underwent autopsy (81.5%). CONCLUSIONS AND RELEVANCE The incidence of proteinopathies related to parkinsonism increases steeply with age and is consistently higher in men than women. Clinically diagnosed synucleinopathies are much more common than tauopathies. Findings at autopsy confirm the clinical diagnosis of presumed proteinopathy. Our findings may guide health care planning and prompt new research directions.
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Affiliation(s)
- Rodolfo Savica
- Division of Epidemiology, Department of Health Science Research, College of Medicine, Mayo Clinic, Rochester, Minnesota 55905, USA
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Savica R, Grossardt BR, Bower JH, Ahlskog JE, Rocca WA. Risk factors for Parkinson's disease may differ in men and women: an exploratory study. Horm Behav 2013; 63:308-14. [PMID: 22687345 PMCID: PMC3477259 DOI: 10.1016/j.yhbeh.2012.05.013] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2012] [Revised: 04/13/2012] [Accepted: 05/31/2012] [Indexed: 11/24/2022]
Abstract
Although several environmental and genetic risk or protective factors have been associated with Parkinson's disease (PD), their interactions overall and in men and women separately remain unknown. We used the medical records-linkage system of the Rochester Epidemiology Project to identify 196 subjects who developed PD in Olmsted County, MN, from 1976 through 1995. Each incident case was matched by age (±1 year) and sex to a general population control. We considered the following 12 risk or protective factors: personal history of head trauma, pesticide use, immunologic diseases, anemia, hysterectomy (in women only), cigarette smoking, coffee consumption, and education; and family history of parkinsonism, essential tremor, dementia, or psychiatric disorders. We used recursive partitioning analyses to explore interactions overall and in men and women separately and used logistic regression analyses to test for interactions. In the overall group, we observed the independent effects of anemia, lack of coffee consumption (never vs. ever), and head trauma; however, the findings were different in men and women. In men, we observed the independent effects of lack of coffee consumption (never vs. ever), head trauma, and pesticide use, and a suggestive synergistic interaction between immunologic diseases and family history of dementia. By contrast, in women, anemia was the most important factor and we observed a suggestive synergistic interaction between anemia and higher education. Risk factors for PD and their interactions may differ in men and women.
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Affiliation(s)
- Rodolfo Savica
- Division of Epidemiology, Department of Health Sciences Research, College of Medicine, Mayo Clinic, Rochester, MN, USA.
- Department of Neurology, Department of Health Sciences Research, College of Medicine, Mayo Clinic, Rochester, MN, USA.
| | - Brandon R. Grossardt
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, College of Medicine, Mayo Clinic, Rochester, MN, USA.
| | - James H. Bower
- Department of Neurology, Department of Health Sciences Research, College of Medicine, Mayo Clinic, Rochester, MN, USA.
| | - J. Eric Ahlskog
- Department of Neurology, Department of Health Sciences Research, College of Medicine, Mayo Clinic, Rochester, MN, USA.
| | - Walter A. Rocca
- Division of Epidemiology, Department of Health Sciences Research, College of Medicine, Mayo Clinic, Rochester, MN, USA.
- Department of Neurology, Department of Health Sciences Research, College of Medicine, Mayo Clinic, Rochester, MN, USA.
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Bower JH, Mwendo E, Walker R, Maro V, Enquosellasie F, Ali S. Validity of a screening instrument for neurologic disability in resource-poor African communities. J Neurol Sci 2012; 320:52-5. [PMID: 22795389 DOI: 10.1016/j.jns.2012.06.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2011] [Revised: 05/28/2012] [Accepted: 06/23/2012] [Indexed: 12/19/2022]
Abstract
BACKGROUND There have been no recent population-based studies on all-cause adult neurological morbidity in sub-Saharan Africa. We have developed a screening survey to improve the feasibility in performing these studies. METHODS Our screening instrument contains both history questions and examination items. We pilot tested this instrument in the Hai District, Tanzania, and Butajira, Ethiopia using trained individuals from the local communities. To measure sensitivity, we applied the instrument blindly to 25 previously-identified subjects with Parkinson's disease, stroke or epilepsy. To measure specificity, we examined 42 randomly selected previously screened subjects. We also compared the validity of the entire instrument to the history-only section. RESULTS There were 669 adult subjects screened in both communities (150 screen-positives, and 519 screen-negatives). The sensitivity of the instrument was 100% (95% CI 84.2-100%) and the specificity was 82.4% (95% CI 66.1-92.0%). However, when restricting the instrument to the history-only section, the sensitivity remained unchanged, but the specificity became 91.2% (95% CI 76.3-97.7%; p=0.48). CONCLUSIONS We have created a valid tool to screen adults for neurologic morbidity in resource-poor communities. The use of the history-only section of the tool is adequate as a screen and will improve feasibility.
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Affiliation(s)
- James H Bower
- Mayo Clinic, Department of Neurology, Rochester, MN, USA.
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Iodice V, Lipp A, Ahlskog JE, Sandroni P, Fealey RD, Parisi JE, Matsumoto JY, Benarroch EE, Kimpinski K, Singer W, Gehrking TL, Gehrking JA, Sletten DM, Schmeichel AM, Bower JH, Gilman S, Figueroa J, Low PA. Autopsy confirmed multiple system atrophy cases: Mayo experience and role of autonomic function tests. J Neurol Neurosurg Psychiatry 2012; 83:453-9. [PMID: 22228725 PMCID: PMC3454474 DOI: 10.1136/jnnp-2011-301068] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND Multiple system atrophy (MSA) is a sporadic progressive neurodegenerative disorder characterised by autonomic failure, manifested as orthostatic hypotension or urogenital dysfunction, with combinations of parkinsonism that is poorly responsive to levodopa, cerebellar ataxia and corticospinal dysfunction. Published autopsy confirmed cases have provided reasonable neurological characterisation but have lacked adequate autonomic function testing. OBJECTIVES To retrospectively evaluate if the autonomic characterisation of MSA is accurate in autopsy confirmed MSA and if consensus criteria are validated by autopsy confirmation. METHODS 29 autopsy confirmed cases of MSA evaluated at the Mayo Clinic who had undergone formalised autonomic testing, including adrenergic, sudomotor and cardiovagal functions and Thermoregulatory Sweat Test (TST), from which the Composite Autonomic Severity Score (CASS) was derived, were included in the study. PATIENT CHARACTERISTICS 17 men, 12 women; age of onset 57±8.1 years; disease duration to death 6.5±3.3 years; first symptom autonomic in 18, parkinsonism in seven and cerebellar in two. Clinical phenotype at first visit was MSA-P (predominant parkinsonism) in 18, MSA-C (predominant cerebellar involvement) in eight, pure autonomic failure in two and Parkinson's disease in one. Clinical diagnosis at last visit was MSA for 28 cases. Autonomic failure was severe: CASS was 7.2±2.3 (maximum 10). TST% was 65.6±33.9% and exceeded 30% in 82% of patients. The most common pattern was global anhidrosis. Norepinephrine was normal supine (203.6±112.7) but orthostatic increment of 33.5±23.2% was reduced. Four clinical features (rapid progression, early postural instability, poor levodopa responsiveness and symmetric involvement) were common. CONCLUSION The pattern of severe and progressive generalised autonomic failure with severe adrenergic and sudomotor failure combined with the clinical phenotype is highly predictive of MSA.
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Affiliation(s)
- Valeria Iodice
- Neurovascular and Autonomic Medicine Unit, Imperial College London, UK
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Savica R, Grossardt BR, Bower JH, Klassen BT, Matsumoto JY. Clinical failure of botulinum toxin A in movement disorders. Parkinsonism Relat Disord 2011; 18:73-5. [PMID: 21880538 DOI: 10.1016/j.parkreldis.2011.07.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2011] [Revised: 07/21/2011] [Accepted: 07/31/2011] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Botulinum toxin (BTX) injections have been used extensively in medicine; however, little is known about the factors predicting the loss of effectiveness of botulin toxin. METHODS Using a clinical database, we identified 401 subjects who had been treated for movement disorders from 1998 through 2010 with onabotulinumtoxin A (BTX A) or who switched from BTX A to rimabotulinumtoxin B (BTX B). We compared patients who switched from type A to type B with patients using type A only with regard to number of visits, total number of injections, number of initial and final sites, number of initial units used, and duration of treatments. RESULTS We observed that patients who switched from BTX A to B had a significantly higher number of initial injection sites than patients with BTX A only (BTX A to B median = 8.5; BTX A median = 6; p for difference = 0.006), had a higher number of final sites (BTX A to B median = 9 BTX A median = 7; p = 0.01), and were also more likely to have multiple reasons for injection (BTX A to B = 25.0%; botulin toxin A = 5.3%; p = 0.01). We did not find significant differences between groups based on the other variables. CONCLUSIONS Our findings suggest that higher number of sites rather than higher number of units or years of treatment are associated with the loss of effectiveness to BTX A. It is possible that the loss of effectiveness to the BTX is more strongly elicited when the injections are widely diffuse.
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Affiliation(s)
- Rodolfo Savica
- Department of Neurology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
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