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Salinas M, Yazdani U, Oblack A, McDaniels B, Ahmed N, Haque B, Pouratian N, Chitnis S. Know DBS: patient perceptions and knowledge of deep brain stimulation in Parkinson's disease. Ther Adv Neurol Disord 2024; 17:17562864241233038. [PMID: 38455848 PMCID: PMC10919129 DOI: 10.1177/17562864241233038] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 01/29/2024] [Indexed: 03/09/2024] Open
Abstract
Introduction Deep brain stimulation (DBS) is an established therapy for Parkinson's disease (PD) that can significantly improve motor symptoms and quality of life. Despite its effectiveness, little is known about patient perceptions of DBS. Objectives To evaluate patient perceptions of DBS for PD, focusing on understanding, satisfaction, and factors influencing their outlook. This study aims to enhance patient education and counseling by identifying key determinants of patient perceptions. Design A patient survey. Methods We surveyed 77 PD patients who had undergone DBS at multiple centers using a comprehensive questionnaire. The questionnaire included questions on demographic information, disease history, and detailed understanding about the indications for DBS, side effects, outlook, and other common misconceptions. We summarize data using measures of central tendency and dispersion appropriate to the data type (categorical, continuous, proportional) and model relationships among variables using fractional and linear regression methods. Results Participants had a median age of 66 years, were predominantly male (66%), Caucasian (90%), well-educated (79% with at least college degrees), and had a disease duration of greater than 5 years (97%). They conveyed good understanding of the signs and symptoms addressed by DBS across the motor and non-motor domains and associated side effects. Regression analysis identified age, disease duration, and education level as key determinants of patient understanding and outlook of DBS. Conclusion Our study provides a detailed understanding of patient perceptions of DBS for PD, including the benefits, challenges, and misconceptions. Our findings underscore the importance of identifying the causes of disparities in patient knowledge and perceptions regarding DBS to tailor patient counseling and ensure optimal treatment outcomes.
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Affiliation(s)
- Meagen Salinas
- Department of Neurology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390, USA
- Neurology Section, VA North Texas Health Care System, Dallas, TX, USA
| | - Umar Yazdani
- Department of Neurology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Austin Oblack
- Department of Neurology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Bradley McDaniels
- Department of Rehabilitation and Health Services, University of North Texas, Denton, TX, USA
| | - Nida Ahmed
- Department of Neurology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Bilal Haque
- Department of Neurology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Nader Pouratian
- Department of Neurosurgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Shilpa Chitnis
- Department of Neurology, University of Texas Southwestern Medical Center, Dallas, TX, USA
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Dewey C, Feltrin F, Shah B, Pinho M, DeBevits J, Achilleos M, McCreary M, Lynch S, Chitnis S, Dewey R. Structural MRI Ratios Fail to Distinguish Progressive Supranuclear Palsy From Parkinson Disease in Individual Patients. Neurol Clin Pract 2023; 13:e200157. [PMID: 37124461 PMCID: PMC10139740 DOI: 10.1212/cpj.0000000000200157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 02/24/2023] [Indexed: 05/02/2023]
Abstract
Background and Objectives Parkinson disease (PD) and progressive supranuclear palsy (PSP) are often difficult to differentiate in the clinic. The MR parkinsonism index (MRPI) has been recommended to assist in making this distinction. We aimed to assess the usefulness of this tool in our real-world practice of movement disorders. Methods We prospectively obtained MRI scans on consecutive patients with movement disorders with a clinical indication for imaging and obtained measures of MRI regions of interest (ROIs) from our neuroradiologists. The authors reviewed all MRI scans and corrected any errors in the original ROI drawings for this analysis. We retrospectively assigned diagnoses using established consensus criteria from progress notes stored in our electronic medical record. We analyzed the data using multinomial logistic regression models and receiver operating curve analysis to determine the predictive accuracy of the MRI ratios. Results MRI measures and consensus diagnoses were available on 130 patients with PD, 54 with PSP, and 77 diagnosed as other. The out-of-sample prediction error rate of our 5 regression models ranged from 45% to 59%. The average sensitivity and specificity of the 5 models in the testing sample were 53% and 80%, respectively. The positive predictive value of an MRPI ≥13.55 (the published cutoff) in our patients was 79%. Discussion These results indicate that MRI measures of brain structures were not effective at predicting diagnosis in individual patients. We conclude that the search for a biomarker that can differentiate PSP from PD must continue.
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Affiliation(s)
- Chadrick Dewey
- Department of Neurology (CD, SL, SC, RD), Department of Radiology (FF, BS, MP, JD, MA), Division of Neuroradiology, and Perot Foundation Neuroscience Translational Research Center (MM), O'Donnell Brain Institute, University of Texas Southwestern Medical Center
| | - Fabricio Feltrin
- Department of Neurology (CD, SL, SC, RD), Department of Radiology (FF, BS, MP, JD, MA), Division of Neuroradiology, and Perot Foundation Neuroscience Translational Research Center (MM), O'Donnell Brain Institute, University of Texas Southwestern Medical Center
| | - Bhavya Shah
- Department of Neurology (CD, SL, SC, RD), Department of Radiology (FF, BS, MP, JD, MA), Division of Neuroradiology, and Perot Foundation Neuroscience Translational Research Center (MM), O'Donnell Brain Institute, University of Texas Southwestern Medical Center
| | - Marco Pinho
- Department of Neurology (CD, SL, SC, RD), Department of Radiology (FF, BS, MP, JD, MA), Division of Neuroradiology, and Perot Foundation Neuroscience Translational Research Center (MM), O'Donnell Brain Institute, University of Texas Southwestern Medical Center
| | - John DeBevits
- Department of Neurology (CD, SL, SC, RD), Department of Radiology (FF, BS, MP, JD, MA), Division of Neuroradiology, and Perot Foundation Neuroscience Translational Research Center (MM), O'Donnell Brain Institute, University of Texas Southwestern Medical Center
| | - Michael Achilleos
- Department of Neurology (CD, SL, SC, RD), Department of Radiology (FF, BS, MP, JD, MA), Division of Neuroradiology, and Perot Foundation Neuroscience Translational Research Center (MM), O'Donnell Brain Institute, University of Texas Southwestern Medical Center
| | - Morgan McCreary
- Department of Neurology (CD, SL, SC, RD), Department of Radiology (FF, BS, MP, JD, MA), Division of Neuroradiology, and Perot Foundation Neuroscience Translational Research Center (MM), O'Donnell Brain Institute, University of Texas Southwestern Medical Center
| | - Sloan Lynch
- Department of Neurology (CD, SL, SC, RD), Department of Radiology (FF, BS, MP, JD, MA), Division of Neuroradiology, and Perot Foundation Neuroscience Translational Research Center (MM), O'Donnell Brain Institute, University of Texas Southwestern Medical Center
| | - Shilpa Chitnis
- Department of Neurology (CD, SL, SC, RD), Department of Radiology (FF, BS, MP, JD, MA), Division of Neuroradiology, and Perot Foundation Neuroscience Translational Research Center (MM), O'Donnell Brain Institute, University of Texas Southwestern Medical Center
| | - Richard Dewey
- Department of Neurology (CD, SL, SC, RD), Department of Radiology (FF, BS, MP, JD, MA), Division of Neuroradiology, and Perot Foundation Neuroscience Translational Research Center (MM), O'Donnell Brain Institute, University of Texas Southwestern Medical Center
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McDaniels B, Subramanian I, Kurian S, Chitnis S. Early-onset Parkinson's disease: An assessment of unmet psychosocial needs. Parkinsonism Relat Disord 2023; 110:105395. [PMID: 37037068 DOI: 10.1016/j.parkreldis.2023.105395] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 03/29/2023] [Accepted: 04/02/2023] [Indexed: 04/09/2023]
Abstract
BACKGROUND Early onset Parkinson's disease (EOPD) affects people in the prime of their lives, typically between 21 and 50 years of age, which results in a variety of challenges that are unique compared to those diagnosed later in life. A better understanding of the unmet needs of this population is critical to delivering bespoke care and improving their quality of life. OBJECTIVES To assess the unmet needs of people with early onset Parkinson's disease. METHODS A cross-sectional sample of 198 adults with self-identified early onset Parkinson's disease completed surveys to ascertain the most common unmet needs of this population. Simple descriptive statistics including frequencies, means, and standard deviations were used to quantify the most common unmet needs and were compared between men, women, and Hispanic/Latino with significance determined by chi-square tests. RESULTS Overall, the top five unmet needs were (1) need for "a community more like me" (65.2%), (2) more PD information (48%), (3) information about how their PD will progress (47%), (4) help with mental health issues (34.8%), and (5) help with employment issues (33.8%). The top unmet need for men was help with employment issues (50.8%), for women, "a community more like me" (72.3%), and for Hispanic/Latinos, more PD information (47%). CONCLUSION Although the number of people living with EOPD is considerably smaller than those with conventional age at onset, the potential impact to quality of life in this population remains tremendous. We propose a framework to start to address these needs.
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Dewey DC, Chitnis S, McCreary MC, Gerald A, Dewey CH, Pantelyat A, Dawson TM, Rosenthal LS, Dewey RB. APDM gait and balance measures fail to predict symptom progression rate in Parkinson's disease. Front Neurol 2022; 13:1041014. [PMID: 36438964 PMCID: PMC9681812 DOI: 10.3389/fneur.2022.1041014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Accepted: 10/17/2022] [Indexed: 11/10/2022] Open
Abstract
Parkinson's disease (PD) results in progressively worsening gait and balance dysfunction that can be measured using computerized devices. We utilized the longitudinal database of the Parkinson's Disease Biomarker Program to determine if baseline gait and balance measures predict future rates of symptom progression. We included 230, 222, 164, and 177 PD subjects with 6, 12, 18, and 24 months of follow-up, respectively, and we defined progression as worsening of the following clinical parameters: MDS-UPDRS total score, Montreal Cognitive Assessment, PDQ-39 mobility subscale, levodopa equivalent daily dose, Schwab and England score, and global composite outcome. We developed ridge regression models to independently estimate how each gait or balance measure, or combination of measures, predicted progression. The accuracy of each ridge regression model was calculated by cross-validation in which 90% of the data were used to estimate the ridge regression model which was then tested on the 10% of data left out. While the models modestly predicted change in outcomes at the 6-month follow-up visit (accuracy in the range of 66–71%) there was no change in the outcome variables during this short follow-up (median change in MDS-UPDRS total score = 0 and change in LEDD = 0). At follow-up periods of 12, 18, and 24 months, the models failed to predict change (accuracy in the held-out sets ranged from 42 to 60%). We conclude that this set of computerized gait and balance measures performed at baseline is unlikely to help predict future disease progression in PD. Research scientists must continue to search for progression predictors to enhance the performance of disease modifying clinical trials.
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Affiliation(s)
- D. Campbell Dewey
- Department of Neurology, UT Southwestern Medical Center, O'Donnell Brain Institute, Dallas, TX, United States
| | - Shilpa Chitnis
- Department of Neurology, UT Southwestern Medical Center, O'Donnell Brain Institute, Dallas, TX, United States
| | - Morgan C. McCreary
- Perot Foundation Neuroscience Translational Research Center, UT Southwestern Medical Center, O'Donnell Brain Institute, Dallas, TX, United States
| | - Ashley Gerald
- Department of Neurology, UT Southwestern Medical Center, O'Donnell Brain Institute, Dallas, TX, United States
| | - Chadrick H. Dewey
- Department of Neurology, UT Southwestern Medical Center, O'Donnell Brain Institute, Dallas, TX, United States
| | - Alexander Pantelyat
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Ted M. Dawson
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Liana S. Rosenthal
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Richard B. Dewey
- Department of Neurology, UT Southwestern Medical Center, O'Donnell Brain Institute, Dallas, TX, United States
- *Correspondence: Richard B. Dewey Jr.
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Ratliff JB, Schaefer SM, Chitnis S, Cooney JW, Hess CW, Okubadejo N, Shalash A, Moro E, Sue C, Pandey S, Pal PK, Yang L. Viewpoint on Milestones for Fellowship Training in Movement Disorders. Mov Disord 2022; 37:1605-1609. [PMID: 35816077 PMCID: PMC9543200 DOI: 10.1002/mds.29146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 06/07/2022] [Accepted: 06/09/2022] [Indexed: 11/18/2022] Open
Affiliation(s)
- Jeffrey B Ratliff
- Department of Neurology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Sara M Schaefer
- Department of Neurology, Yale University, New Haven, Connecticut, USA
| | - Shilpa Chitnis
- Department of Neurology, University of Texas, Southwestern Medical Center, Dallas, Texas, USA
| | - Jeffrey W Cooney
- Department of Neurology, Duke University, Durham, North Carolina, USA
| | - Christopher W Hess
- Department of Neurology, University of Florida, Gainesville, Florida, USA
| | | | - Ali Shalash
- Department of Neurology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Elena Moro
- Grenoble Alpes University, CHU de Grenoble, Division of Neurology, Grenoble Institute of Neurosciences, Grenoble, France
| | - Carolyn Sue
- Department of Neurology, Royal North Shore Hospital and Kolling Institute, University of Sydney, Sydney, New South Wales, Australia
| | - Sanjay Pandey
- Department of Neurology, Govind Ballabh Pant Institute of Postgraduate Medical Education and Research, New Delhi, India
| | - Pramod K Pal
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
| | - Laurice Yang
- Department of Neurology, Stanford University, Palo Alto, California, USA
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Behrman A, Cody J, Chitnis S, Elandary S. Dysarthria treatment for Parkinson's disease: one-year follow-up of SPEAK OUT! ® with the LOUD Crowd ®. LOGOP PHONIATR VOCO 2021; 47:271-278. [PMID: 34338571 DOI: 10.1080/14015439.2021.1958001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION SPEAK OUT! with The LOUD Crowd is a standardized speech therapy program typically consisting of 12 one-on-one treatments and ongoing weekly group maintenance sessions for patients with dysarthria due to Parkinson's disease (PD). It is based upon the hypothesis that increased attention to speech, which is a goal-directed motor activity, may compensate for the impairment in automatic sequential motor behaviors often demonstrated in patients with PD. We present results on the 1-year response to treatment. METHODS Forty individuals with idiopathic PD received SPEAK OUT! delivered in 12 one-on-one 40-min treatment sessions 3 times per week for four consecutive weeks in addition to ongoing group maintenance sessions called The LOUD Crowd. Evaluations occurred 3 times at baseline, within one and six weeks after completion of the SPEAK OUT! sessions (N = 40) and 1-year later (N = 35). Assessments included mean speech intensity and intonation from reading and monolog, the voice quality acoustic measure called cepstral peak prominence (CPP), and scores on the voice-related quality of life questionnaire. RESULTS The significant improvements achieved in all outcome measures from baseline to completion of SPEAK OUT! were maintained 1-year later. Participation throughout the year in regular group maintenance sessions (The LOUD Crowd) was positively correlated with level of improvement at 1 year for all measures except patient perception of voice. CONCLUSIONS These long-term data contribute evidence of the effectiveness of this speech therapy program for improving communication for individuals with PD and emphasize the importance of regular and ongoing group sessions to sustain therapeutic gains.
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Affiliation(s)
- Alison Behrman
- Department of Speech-Language-Hearing Sciences, Lehman College
- City University of New York, Bronx, NY, USA
| | | | - Shilpa Chitnis
- Parkinson Voice Project, Richardson, TX, USA.,Department of Neurology, University of Texas Southwestern Medical Center, Dallas, TX, USA
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Mahajan A, El-Nazer R, Chitnis S. An Online Education Method for Movement Disorders During COVID-19: Opportunity and Experience. Mov Disord 2021; 36:1475-1480. [PMID: 33938588 PMCID: PMC8242782 DOI: 10.1002/mds.28648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 04/04/2021] [Accepted: 04/29/2021] [Indexed: 11/10/2022] Open
Affiliation(s)
- Abhimanyu Mahajan
- Department of Neurology, Rush Parkinson's Disease and Movement Disorders Program, Chicago, Illinois, USA
| | - Rasheda El-Nazer
- Department of Neurology, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Shilpa Chitnis
- Department of Neurology, UT Southwestern Medical Center, Dallas, Texas, USA
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Ali U, Pavey W, Hickey J, Chitnis S, Ludewick H, Abbot S, Gupta A, Ho K. R43 Using Shear Wave Elastography to Characterise Ischaemic Contracture in Rodent Hearts. Heart Lung Circ 2021. [DOI: 10.1016/j.hlc.2021.03.201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Tamás G, Fabbri M, Falup-Pecurariu C, Teodoro T, Kurtis MM, Aliyev R, Bonello M, Brozova H, Coelho MS, Contarino MF, Corvol JC, Dietrichs E, Ben Djebara M, Elmgreen SB, Groppa S, Kadastik-Eerme L, Khatiashvili I, Kostić V, Krismer F, Hassan Mansour A, Odin P, Gavriliuc O, Olszewska DA, Relja M, Scheperjans F, Skorvanek M, Smilowska K, Taba P, Tavadyan Z, Valante R, Vujovic B, Waldvogel D, Yalcin-Cakmakli G, Chitnis S, Ferreira JJ. Lack of Accredited Clinical Training in Movement Disorders in Europe, Egypt, and Tunisia. J Parkinsons Dis 2020; 10:1833-1843. [PMID: 32651331 DOI: 10.3233/jpd-202000] [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] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Little information is available on the official postgraduate and subspecialty training programs in movement disorders (MD) in Europe and North Africa. OBJECTIVE To survey the accessible MD clinical training in these regions. METHODS We designed a survey on clinical training in MD in different medical fields, at postgraduate and specialized levels. We assessed the characteristics of the participants and the facilities for MD care in their respective countries. We examined whether there are structured, or even accredited postgraduate, or subspecialty MD training programs in neurology, neurosurgery, internal medicine, geriatrics, neuroradiology, neuropediatrics, and general practice. Participants also shared their suggestions and needs. RESULTS The survey was completed in 31/49 countries. Structured postgraduate MD programs in neurology exist in 20 countries; structured neurology subspecialty training exists in 14 countries and is being developed in two additional countries. Certified neurology subspecialty training was reported to exist in 7 countries. Recommended reading lists, printed books, and other materials are the most popular educational tools, while courses, lectures, webinars, and case presentations are the most popular learning formats. Mandatory activities and skills to be certified were not defined in 15/31 countries. Most participants expressed their need for a mandatory postgraduate MD program and for certified MD sub-specialization programs in neurology. CONCLUSION Certified postgraduate and subspecialty training exists only in a minority of European countries and was not found in the surveyed Egypt and Tunisia. MD training should be improved in many countries.
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Affiliation(s)
- Gertrúd Tamás
- Department of Neurology, Semmelweis University, Budapest, Hungary
| | - Margherita Fabbri
- Department of Neuroscience "Rita Levi Montalcini", University of Turin, Italy.,Instituto de Medicina Molecular, Lisbon, Portugal.,Laboratory of Clinical Pharmacology and Therapeutics, Faculdade de Medicina, Universidade de Lisboa, Portugal
| | | | - Tiago Teodoro
- Instituto de Medicina Molecular, Lisbon, Portugal.,Neurosciences Research Centre, Molecular and Clinical Sciences Research Institute, St George's, University of London, London, UK.,Ashford and St Peter's Hospital NHS Trust, Chertsey, Surrey, UK
| | - Mónica M Kurtis
- Movement Disorders Unit, Neurology Department, Hospital Ruber Internacional, Madrid, Spain
| | - Rahim Aliyev
- Department of Neurology and Clinical Neurophysiology, Azerbaijan State Advanced Training Institute for Doctors named after A. Aliyev, Baku, Republic of Azerbaijan
| | - Michael Bonello
- Department of Neurology, The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Hana Brozova
- Department of Neurology and Center of Clinical Neuroscience, Charles University, First Faculty of Medicine, Prague, Czech Republic
| | - Miguel Soares Coelho
- Instituto de Medicina Molecular, Lisbon, Portugal.,Laboratory of Clinical Pharmacology and Therapeutics, Faculdade de Medicina, Universidade de Lisboa, Portugal.,Department of Neurosciences, Neurology Service, Hospital Santa Maria, Lisbon, Portugal
| | - Maria Fiorella Contarino
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands.,Department of Neurology, Haga Teaching Hospital, The Hague, The Netherlands
| | - Jean-Christophe Corvol
- Department of Neurology, Sorbonne Université, Assistance Publique Hôpitaux de Paris, Inserm, CNRS, Hôpital Pitié-Salpêtrière, Institut du Cerveau et de la Moelle, Paris, France
| | - Espen Dietrichs
- Department of Neurology, Oslo University Hospital and University of Oslo, Oslo, Norway
| | - Mouna Ben Djebara
- Department of Neurology, Razi Hospital, Faculté de Médecine de Tunis, University Tunis-El Manar, Tunisia
| | | | - Sergiu Groppa
- Department of Neurology, Movement Disorders, Imaging and Neurostimulation, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Liis Kadastik-Eerme
- Department of Neurology and Neurosurgery, University of Tartu, Tartu, Estonia.,Department of Neurology, Tartu University Hospital, Tartu, Estonia
| | - Irine Khatiashvili
- Department of Clinical Neurology, Tbilisi State Medical University, Tbilisi, Georgia
| | - Vladimir Kostić
- Department of Neurology CCS, University of Belgrade, Belgrade, Serbia
| | - Florian Krismer
- Department of Neurology, Medical University Innsbruck, Innsbruck, Austria
| | - Alia Hassan Mansour
- Department of Neurology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Per Odin
- Department of Clinical Sciences, Division of Neurology, Lund University, Lund, Sweden
| | - Olga Gavriliuc
- Department of Neurology, State University of Medicine and Pharmacy Nicolae Testemitanu, Chisinau, Republic of Moldova
| | - Diana Angelika Olszewska
- Department of Neurology, Dublin Neurological Institute at the Mater Misericordiae University Hospital, Dublin, Ireland
| | - Maja Relja
- Croatian Academy of Medical Sciences and School of Medicine, Zagreb University, Zagreb, Croatia
| | - Filip Scheperjans
- Department of Neurology, Helsinki University Hospital, and Department of Neurological Sciences (Neurology), University of Helsinki, Helsinki, Finland
| | - Matej Skorvanek
- Department of Neurology, Faculty of Medicine, P. J. Safarik University, Kosice, Slovak Republic.,Department of Neurology, University Hospital L. Pasteur, Kosice, Slovak Republic
| | | | - Pille Taba
- Department of Neurology and Neurosurgery, University of Tartu, Tartu, Estonia.,Department of Neurology, Tartu University Hospital, Tartu, Estonia
| | - Zaruhi Tavadyan
- Department of Neurology and Neurosurgery, National Institute of Health, Yerevan, Armenia.,"Somnus" Sleep and Movement Disorders Clinic, Yerevan, Armenia
| | - Ramona Valante
- Department of Neurology, Pauls Stradiņš Clinical University Hospital, Riga, Latvia
| | - Balsa Vujovic
- Department of Neurology, Clinical Center of Montenegro, Podgorica, Montenegro
| | - Daniel Waldvogel
- Department of Neurology, University Hospital Zurich, Zurich, Switzerland
| | | | - Shilpa Chitnis
- Department of Neurology and Neurotherapeutics, Southwestern Medical Center, University of Texas, Dallas, Texas, US
| | - Joaquim J Ferreira
- Instituto de Medicina Molecular, Lisbon, Portugal.,Laboratory of Clinical Pharmacology and Therapeutics, Faculdade de Medicina, Universidade de Lisboa, Portugal.,CNS - Campus Neurológico Sénior, Torres Vedras, Portugal
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Behrman A, Cody J, Elandary S, Flom P, Chitnis S. The Effect of SPEAK OUT! and The LOUD Crowd on Dysarthria Due to Parkinson's Disease. Am J Speech Lang Pathol 2020; 29:1448-1465. [PMID: 32421347 PMCID: PMC7893519 DOI: 10.1044/2020_ajslp-19-00024] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 12/09/2019] [Accepted: 02/12/2020] [Indexed: 05/31/2023]
Abstract
Purpose SPEAK OUT! and The LOUD Crowd is a standardized speech therapy program of 12 individual treatments combined with ongoing weekly group sessions for individuals with dysarthria due to Parkinson's disease (PD). The premise of this program is that individuals with PD must rely on goal-directed basal ganglia-cortical circuits to compensate for deficits in habitual, automatic control. The purpose of this study was to assess the outcome of this therapy program. Method Forty individuals with idiopathic PD received SPEAK OUT! in 12 individual 40-min sessions 3 times per week for 4 consecutive weeks and also participated in The LOUD Crowd. Assessments were conducted 3 times at baseline and then within 1 and 6 weeks after completion of the individual SPEAK OUT! sessions. Twenty-five adults without communication disorders were assessed on the same schedule. Acoustic outcome measures were mean intensity from reading and monologue, the prosody measures of standard deviation of intensity and frequency from reading and monologue, and the voice quality measure of cepstral peak prominence from reading. Patient perception of voice was also assessed with the Voice-Related Quality of Life. Results Posttherapy, mean intensity was greater and variation of frequency was larger in reading and monologue, while variation in intensity was larger in monologue but unchanged in reading. Cepstral peak prominence and Voice-Related Quality of Life scores were significantly higher (improved) after therapy. Conclusion These data contribute to evidence of the effectiveness of this program for hypokinetic dysarthria secondary to idiopathic PD and thus inform clinical practice in the selection among treatment options.
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Affiliation(s)
| | | | | | - Peter Flom
- Research Foundation, City University of New York, NY
- Peter Flom Consulting, New York, NY
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Shah BR, Lehman VT, Kaufmann TJ, Blezek D, Waugh J, Imphean D, Yu FF, Patel TR, Chitnis S, Dewey RB, Maldjian JA, Chopra R. Advanced MRI techniques for transcranial high intensity focused ultrasound targeting. Brain 2020; 143:2664-2672. [DOI: 10.1093/brain/awaa107] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2019] [Revised: 02/07/2020] [Accepted: 02/20/2020] [Indexed: 11/14/2022] Open
Abstract
Abstract
Magnetic resonance guided high intensity focused ultrasound is a novel, non-invasive, image-guided procedure that is able to ablate intracranial tissue with submillimetre precision. It is currently FDA approved for essential tremor and tremor dominant Parkinson’s disease. The aim of this update is to review the limitations of current landmark-based targeting techniques of the ventral intermediate nucleus and demonstrate the role of emerging imaging techniques that are relevant for both magnetic resonance guided high intensity focused ultrasound and deep brain stimulation. A significant limitation of standard MRI sequences is that the ventral intermediate nucleus, dentatorubrothalamic tract, and other deep brain nuclei cannot be clearly identified. This paper provides original, annotated images demarcating the ventral intermediate nucleus, dentatorubrothalamic tract, and other deep brain nuclei on advanced MRI sequences such as fast grey matter acquisition T1 inversion recovery, quantitative susceptibility mapping, susceptibility weighted imaging, and diffusion tensor imaging tractography. Additionally, the paper reviews clinical efficacy of targeting with these novel MRI techniques when compared to current established landmark-based targeting techniques. The paper has widespread applicability to both deep brain stimulation and magnetic resonance guided high intensity focused ultrasound.
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Affiliation(s)
- Bhavya R Shah
- Department of Radiology, University of Texas Southwestern, Dallas, TX 75390, USA
- Department of Neurosurgery, University of Texas Southwestern, Dallas, TX 75390, USA
- O’Donnell Brain Institute, University of Texas Southwestern, Dallas, TX 75390, USA
- Advanced Imaging Research Center, University of Texas Southwestern, Dallas, TX 75390, USA
| | - Vance T Lehman
- Department of Radiology, The Mayo Clinic, Rochester, MN 55905, USA
| | | | - Daniel Blezek
- Department of Radiology, The Mayo Clinic, Rochester, MN 55905, USA
| | - Jeff Waugh
- O’Donnell Brain Institute, University of Texas Southwestern, Dallas, TX 75390, USA
- Department of Pediatrics, University of Texas Southwestern, Dallas, TX 75390, USA
- Department of Neurology, University of Texas Southwestern, Dallas, TX 75390, USA
| | - Darren Imphean
- University of Texas Southwestern Medical School, Dallas, TX 75390, USA
| | - Frank F Yu
- Department of Radiology, University of Texas Southwestern, Dallas, TX 75390, USA
- O’Donnell Brain Institute, University of Texas Southwestern, Dallas, TX 75390, USA
- Advanced Imaging Research Center, University of Texas Southwestern, Dallas, TX 75390, USA
| | - Toral R Patel
- Department of Neurosurgery, University of Texas Southwestern, Dallas, TX 75390, USA
- O’Donnell Brain Institute, University of Texas Southwestern, Dallas, TX 75390, USA
| | - Shilpa Chitnis
- O’Donnell Brain Institute, University of Texas Southwestern, Dallas, TX 75390, USA
- Department of Neurology, University of Texas Southwestern, Dallas, TX 75390, USA
| | - Richard B Dewey
- O’Donnell Brain Institute, University of Texas Southwestern, Dallas, TX 75390, USA
- Department of Neurology, University of Texas Southwestern, Dallas, TX 75390, USA
| | - Joseph A Maldjian
- Department of Radiology, University of Texas Southwestern, Dallas, TX 75390, USA
- O’Donnell Brain Institute, University of Texas Southwestern, Dallas, TX 75390, USA
- Advanced Imaging Research Center, University of Texas Southwestern, Dallas, TX 75390, USA
| | - Rajiv Chopra
- Department of Radiology, University of Texas Southwestern, Dallas, TX 75390, USA
- Advanced Imaging Research Center, University of Texas Southwestern, Dallas, TX 75390, USA
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Salinas MR, Chambers EJ, Ho T, Khemani P, Olson DM, Stutzman S, Chitnis S. Patient perceptions and knowledge of Parkinson's disease and treatment (KnowPD). Clin Park Relat Disord 2020; 3:100038. [PMID: 34316624 PMCID: PMC8298769 DOI: 10.1016/j.prdoa.2020.100038] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2019] [Revised: 09/28/2019] [Accepted: 11/25/2019] [Indexed: 12/02/2022] Open
Abstract
Background As the 2nd most common neurodegenerative disorder, Parkinson's disease (PD) affects over 1 million Americans. Treatment is complex and may include pharmacotherapy, rehabilitative measures, and surgical intervention. A comprehensive understanding of the patient's perceptions about PD is a vital step towards improving health literacy and clinical outcomes. Methods KnowPD is a web-based survey with Likert responses for a cross-sectional, nonrandomized study to assess patients' knowledge of PD symptoms, medications, deep brain stimulation (DBS), rehabilitation, and other factors relevant to disease management. Results Of the 98 subjects surveyed, 90% agreed they had sufficient knowledge of PD. However, in this cohort, 82% incorrectly believed levodopa stops working as the disease progresses, 77% erroneously thought DBS improves balance and reduces falls, and, <50% could answer specific questions regarding the dosing of levodopa despite over 75% reporting managing their own medications. A majority of patients (84%) believed it was possible to live well with PD, correlating with their self-reported knowledge of the disease. Finally, patients selected electronic video (13.7%) and reading (20.0%) material, yearly symposia (20.0%), and lunch lectures (28.4%) as their preferred method of information delivery. Conclusion Misconceptions are prevalent among PD patients, and these appear to be unrelated to gender, provider type, or education level. Identification and characterization of this knowledge gap is vital towards allocating patient education resources, and the findings described herein will form the basis for effective educational interventions.
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Pavey W, Hickey J, Chitnis S, Ali U, Gupta A, Abbott S, Ludewick H. Using Shear Wave Elastography to Characterise Ischaemic Contracture in Rodent Hearts. Heart Lung Circ 2019. [DOI: 10.1016/j.hlc.2019.06.149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Sharma VD, Sengupta S, Chitnis S, Amara AW. Deep Brain Stimulation and Sleep-Wake Disturbances in Parkinson Disease: A Review. Front Neurol 2018; 9:697. [PMID: 30210429 PMCID: PMC6119706 DOI: 10.3389/fneur.2018.00697] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [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: 03/15/2018] [Accepted: 08/02/2018] [Indexed: 12/02/2022] Open
Abstract
Sleep-wake disturbances are common non-motor manifestations in Parkinson Disease (PD). Complex pathophysiological changes secondary to neurodegeneration in combination with motor symptoms and dopaminergic medications contribute to development of sleep-wake disturbances. The management of sleep complaints in PD is important as this symptom can affect daily activities and impair quality of life. Deep brain stimulation (DBS) is an effective adjunctive therapy for management of motor symptoms in PD. However, its effect on non-motor symptoms including sleep-wake disturbances is not widely understood. In this article, we reviewed studies assessing the effect of DBS at various therapeutic targets on sleep-wake disturbances. Of the studies examining the role of DBS in sleep-wake disturbances, the effect of subthalamic nucleus stimulation is most widely studied and has shown improvement in sleep quality, sleep efficiency, and sleep duration. Although, studies investigating changes in sleep with stimulation of thalamus, globus pallidus interna, and pedunculopontine nucleus are limited, they support the potential for modulation of sleep-wake centers with DBS at these sites. The mechanism by which DBS at different anatomical targets affects sleep-wake disturbances in PD is unclear and may involves multiple factors, including improved motor symptoms, medication adjustment, and direct modulation of sleep-wake centers.
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Affiliation(s)
- Vibhash D Sharma
- Department of Neurology, University of Kansas Medical Center, Kansas City, KS, United States
| | - Samarpita Sengupta
- Department of Neurology, University of Southwestern Medical Center, Dallas, TX, United States
| | - Shilpa Chitnis
- Department of Neurology, University of Southwestern Medical Center, Dallas, TX, United States
| | - Amy W Amara
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, United States
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Sharma VD, Bona AR, Mantovani A, Miocinovic S, Khemani P, Goldberg MP, Foote KD, Whitworth LA, Chitnis S, Okun MS. Cystic Lesions as a Rare Complication of Deep Brain Stimulation. Mov Disord Clin Pract 2015; 3:87-90. [PMID: 30363583 DOI: 10.1002/mdc3.12230] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2015] [Revised: 06/10/2015] [Accepted: 07/05/2015] [Indexed: 11/12/2022] Open
Abstract
DBS is a typically well-tolerated operation for treatment of Parkinson's disease, dystonia, and essential tremor (ET). Complications related to the surgical procedure and implanted hardware may occur. More commonly reported complications include hemorrhage, seizure, confusion, and infection. In this article, we report on a rare, but important, complication of DBS surgery, a brain cyst formation at the tip of the implanted ventralis intermedius nucleus (VIM) DBS lead in 2 patients who underwent the procedure at 2 different centers. The indication for surgery was debilitating ET, and in both cases, there was development of a delayed-onset neurological deficit associated with an internal capsule/thalamic cystic lesion formation located at the tip of the DBS lead. Case 1 presented within a few months post-DBS, whereas case 2 had a 10-mo delay to onset of symptoms. No clinical and radiological signs of infection were observed and both DBS systems were explanted with uneventful recovery.
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Affiliation(s)
- Vibhash D Sharma
- Department of Neurology Emory University School of Medicine Atlanta Georgia USA
| | - Alberto R Bona
- Center for Movement Disorders and Neurorestoration University of Florida Gainesville Florida USA
| | - Alessandra Mantovani
- Center for Movement Disorders and Neurorestoration University of Florida Gainesville Florida USA
| | | | - Pravin Khemani
- Department of Neurology and Neurotherapeuthics UT Southwestern Medical Center Dallas Texas USA
| | - Mark P Goldberg
- Department of Neurology and Neurotherapeuthics UT Southwestern Medical Center Dallas Texas USA
| | - Kelly D Foote
- Center for Movement Disorders and Neurorestoration University of Florida Gainesville Florida USA
| | - Louis A Whitworth
- Department of Neurology and Neurotherapeuthics UT Southwestern Medical Center Dallas Texas USA
| | - Shilpa Chitnis
- Department of Neurology and Neurotherapeuthics UT Southwestern Medical Center Dallas Texas USA
| | - Michael S Okun
- Center for Movement Disorders and Neurorestoration University of Florida Gainesville Florida USA
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Miocinovic S, Khemani P, Whiddon R, Zeilman P, Martinez-Ramirez D, Okun MS, Chitnis S. Outcomes, management, and potential mechanisms of interleaving deep brain stimulation settings. Parkinsonism Relat Disord 2014; 20:1434-7. [DOI: 10.1016/j.parkreldis.2014.10.011] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2014] [Revised: 09/12/2014] [Accepted: 10/11/2014] [Indexed: 11/25/2022]
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Dewey DC, Miocinovic S, Bernstein I, Khemani P, Dewey RB, Querry R, Chitnis S, Dewey RB. Automated gait and balance parameters diagnose and correlate with severity in Parkinson disease. J Neurol Sci 2014; 345:131-8. [PMID: 25082782 DOI: 10.1016/j.jns.2014.07.026] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2014] [Revised: 07/08/2014] [Accepted: 07/11/2014] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To assess the suitability of instrumented gait and balance measures for diagnosis and estimation of disease severity in PD. METHODS Each subject performed iTUG (instrumented Timed-Up-and-Go) and iSway (instrumented Sway) using the APDM(®) Mobility Lab. MDS-UPDRS parts II and III, a postural instability and gait disorder (PIGD) score, the mobility subscale of the PDQ-39, and Hoehn & Yahr stage were measured in the PD cohort. Two sets of gait and balance variables were defined by high correlation with diagnosis or disease severity and were evaluated using multiple linear and logistic regressions, ROC analyses, and t-tests. RESULTS 135 PD subjects and 66 age-matched controls were evaluated in this prospective cohort study. We found that both iTUG and iSway variables differentiated PD subjects from controls (area under the ROC curve was 0.82 and 0.75 respectively) and correlated with all PD severity measures (R(2) ranging from 0.18 to 0.61). Objective exam-based scores correlated more strongly with iTUG than iSway. The chosen set of iTUG variables was abnormal in very mild disease. Age and gender influenced gait and balance parameters and were therefore controlled in all analyses. INTERPRETATION Our study identified sets of iTUG and iSway variables which correlate with PD severity measures and differentiate PD subjects from controls. These gait and balance measures could potentially serve as markers of PD progression and are under evaluation for this purpose in the ongoing NIH Parkinson Disease Biomarker Program.
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Affiliation(s)
- D Campbell Dewey
- Department of Neurology, University of Texas Southwestern Medical Center, United States
| | - Svjetlana Miocinovic
- Department of Neurology, University of Texas Southwestern Medical Center, United States
| | - Ira Bernstein
- Department of Clinical Sciences, University of Texas Southwestern Medical Center, United States
| | - Pravin Khemani
- Department of Neurology, University of Texas Southwestern Medical Center, United States
| | - Richard B Dewey
- Department of Neurology, University of Texas Southwestern Medical Center, United States
| | - Ross Querry
- Department of Physical Therapy, University of Texas Southwestern Medical Center, United States
| | - Shilpa Chitnis
- Department of Neurology, University of Texas Southwestern Medical Center, United States
| | - Richard B Dewey
- Department of Neurology, University of Texas Southwestern Medical Center, United States.
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Nandedkar TD, Sagvekar P, Thakur B, Navlakhe R, Chitnis S, Mahale SD, D'Souza S, Patel KD, Vavia PR. Polymeric nanoparticle formulation of octapeptide (NP-OP): in vitro release and in vivo effect in common marmosets, Callithrix jacchus Linn. Indian J Exp Biol 2013; 51:1055-1062. [PMID: 24579370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Octapeptide (OP)/FSH-Receptor Binding Inhibitor-8 (FRBI-8), is a synthetic peptide corresponding to N-terminal sequence of purified fraction of Follicle Stimulating Hormone Binding-Inhibitor (FSHBI), isolated earlier from human ovarian follicular-fluid. In order to avoid the repeated drug-administration, OP-loaded, polymeric polylactide (PLA) nanoparticle formulation (NP-OP), was developed using multiple-emulsion technique. This yielded an average particle size of 120 nm with 70% encapsulation-efficiency. In vitro release profile of NP-OP showed sustained release of OP for 21 days. In vivo anti-fertility studies were conducted in marmosets. Results indicated that control animals conceived in the same cycle while two of three treated animals failed to conceive in treatment cycle. The in vivo studies thus corroborate with in vitro release of OP, demonstrating its anti-fertility activity in 66% of animals.
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Affiliation(s)
- T D Nandedkar
- National Institute for Research in Reproductive Health (ICMR), Parel, Mumbai 400 012, India.
| | - P Sagvekar
- National Institute for Research in Reproductive Health (ICMR), Parel, Mumbai 400 012, India
| | - B Thakur
- National Institute for Research in Reproductive Health (ICMR), Parel, Mumbai 400 012, India
| | - R Navlakhe
- National Institute for Research in Reproductive Health (ICMR), Parel, Mumbai 400 012, India
| | - S Chitnis
- National Institute for Research in Reproductive Health (ICMR), Parel, Mumbai 400 012, India
| | - S D Mahale
- National Institute for Research in Reproductive Health (ICMR), Parel, Mumbai 400 012, India
| | - S D'Souza
- National Institute for Research in Reproductive Health (ICMR), Parel, Mumbai 400 012, India
| | - K D Patel
- Institute of Chemical Technology, Matunga, Mumbai 400 019, India
| | - P R Vavia
- Institute of Chemical Technology, Matunga, Mumbai 400 019, India
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Abstract
Deep brain stimulation (DBS) is an effective surgical treatment for medication-refractory hypokinetic and hyperkinetic movement disorders, and it is being explored for a variety of other neurological and psychiatric diseases. Deep brain stimulation has been Food and Drug Administration-approved for essential tremor and Parkinson disease and has a humanitarian device exemption for dystonia and obsessive-compulsive disorder. Neurostimulation is the fruit of decades of both technical and scientific advances in the field of basic neuroscience and functional neurosurgery. Despite the clinical success of DBS, the therapeutic mechanism of DBS remains under debate. Our objective is to provide a comprehensive review of DBS focusing on movement disorders, including the historical evolution of the technique, applications and outcomes with an overview of the most pertinent literature, current views on mechanisms of stimulation, and description of hardware and programming techniques. We conclude with a discussion of future developments in neurostimulation.
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Affiliation(s)
- Svjetlana Miocinovic
- Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center, Dallas, TX, USA
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Chitnis S, Jaffery M, Dewey RB. Outcomes From Switching From Rotigotine Patch to Alternate Therapies in Parkinson's Disease. Int J Neurosci 2012; 122:22-5. [DOI: 10.3109/00207454.2011.617016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Tossberg JT, Crooke PS, Henderson MA, Sriram S, Mrelashvili D, Chitnis S, Polman C, Vosslamber S, Verweij CL, Olsen NJ, Aune TM. Gene-expression signatures: biomarkers toward diagnosing multiple sclerosis. Genes Immun 2011; 13:146-54. [PMID: 21938015 PMCID: PMC3291793 DOI: 10.1038/gene.2011.66] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Identification of biomarkers contributing to disease diagnosis, classification or prognosis could be of considerable utility. For example, primary methods to diagnose multiple sclerosis (MS) include magnetic resonance imaging and detection of immunological abnormalities in cerebrospinal fluid. We determined whether gene-expression differences in blood discriminated MS subjects from comparator groups, and identified panels of ratios that performed with varying degrees of accuracy depending upon complexity of comparator groups. High levels of overall accuracy were achieved by comparing MS with homogeneous comparator groups. Overall accuracy was compromised when MS was compared with a heterogeneous comparator group. Results, validated in independent cohorts, indicate that gene-expression differences in blood accurately exclude or include a diagnosis of MS and suggest that these approaches may provide clinically useful prediction of MS.
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Affiliation(s)
- J T Tossberg
- Research Department, ArthroChip, LLC, Franklin, TN, USA
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Affiliation(s)
- Hamid Sadeghian
- Department of Neurology, Virginia Commonwealth University, PO Box 980599, Richmond, VA 23298-0599, USA.
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Chitnis S, Chitnis V, Chitnis D. Emergence of multidrugresistant gram negative bacilli and enterococci from rectal swabs of newborn and their mothers from Central India. Int J Infect Dis 2010. [DOI: 10.1016/j.ijid.2010.02.1577] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Abstract
Parkinson's disease has now evolved beyond what was considered to be a traditional motor disorder. It is being increasingly recognized that non-motor symptoms such as cognitive impairment, frank dementia, psychosis, depression, autonomic dysfunction and sleep disturbances are just as integral to the disease spectrum. The cholinergic system has been proposed to play a pivotal role in cognitive dysfunction. Based on interpretation of clinical studies in patients with Alzheimer's, cholinesterase inhibitors have also been studied for dementia associated with Parkinson's disease. Most of these include large and small placebo-controlled studies and several pilot studies have indicated that cholinesterase inhibitors have a favorable effect on cognition, psychiatric symptoms and global function in Parkinson's disease dementia. A large randomized placebo-controlled clinical trial showed that rivastigmine had moderate improvement in dementia associated with Parkinson's disease. The magnitude of effects in terms of scores for the cognitive subscale of the Alzheimer's disease assessment scale and Alzheimer's disease cooperative study-clinicians global impression of change were similar to those observed among patients with Alzheimer's disease who were treated with cholinesterase inhibitors. A transdermal patch which gradually releases rivastigmine over the application period is now available for use in mild to moderate dementia associated with Parkinson's disease and Alzheimer's disease.
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Affiliation(s)
- Shilpa Chitnis
- UT Southwestern Medical Center-Neurology, 5323 Harry Hines Blvd, Dallas, Texas 75390-9036, USA.
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Chitnis S. Optimizing therapeutic effects in patients with comorbidities: drug-resistant tremor, autonomic dysfunction, psychiatric disorders, and cognitive impairment. Neurol Clin 2008; 26:S29-44, v-vi. [PMID: 18774441 DOI: 10.1016/j.ncl.2008.05.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Parkinsonism is a syndrome characterized by a combination of cardinal features including resting tremor, bradykinesia, rigidity, and loss of postural reflexes. The most common presentation of parkinsonism is the idiopathic variety first described by James Parkinson in 1817 now known as Parkinson's disease (PD). This article focuses on identifying the different subtypes of PD, with the recognition that treatment approaches may differ depending on the initial presenting feature. It also addresses issues related to the recognition and treatment of nonmotor comorbidities of PD, such as autonomic dysfunction and neuropsychiatric problems including depression and dementia.
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Affiliation(s)
- Shilpa Chitnis
- Clinical Center for Movement Disorders, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390-9036, USA.
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Abstract
Restless legs syndrome (RLS) is a chronic neurological disorder associated with sleep disturbance. Ropinirole, a non-ergot dopamine agonist, has been widely studied for the treatment of moderate-to-severe primary RLS in a comprehensive clinical development program. In these studies, ropinirole was effective in significantly improving the symptoms of RLS, compared with placebo, in patients with moderate-to-severe primary RLS. These improvements are supported by data from individual studies, as well as by pooled analyses. Significant improvements in RLS symptoms were observed within 2 nights of treatment. Ropinirole also produced significant benefits on objective measures of RLS motor symptoms, such as periodic leg movements; and on subjective measures of sleep, ropinirole was generally well tolerated. A newly developed extended-release formulation of ropinirole may benefit patients who warrant an extended duration of therapy.
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Affiliation(s)
- Shilpa Chitnis
- Neurology, UT Southwestern Medical Center, 5323 Harry Hines Blvd, J3.134 E, Dallas, Texas 75390-9036, USA.
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Chitnis DS, Chitnis S, Chitnis V, Nanda H. Preservation of <i> Vibrio cholerae</i> by suspension in normal saline. Indian J Med Microbiol 2008; 26:198-9. [DOI: 10.4103/0255-0857.40546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Chitnis DS, Katara G, Hemvani N, Chitnis S, Chitnis V. Surface disinfection by exposure to germicidal UV light. Indian J Med Microbiol 2008; 26:241-2. [DOI: 10.4103/0255-0857.42034] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Chitnis S, Chitnis V, Chitnis DS. In vitro synergistic activity of colistin with aminoglycosides, beta-lactams and rifampin against multidrug-resistant gram-negative bacteria. J Chemother 2007; 19:226-9. [PMID: 17434834 DOI: 10.1179/joc.2007.19.2.226] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Affiliation(s)
- S Chitnis
- Department of Microbiology, Choitram Hospital and Research Centre, Indore, India.
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Chitnis S, Chitnis V, Hemvani N, Chitnis DS. In vitro Susceptibility to Meropenem and Other Antimicrobial Agents among Gram-Negative Bacilli Isolated from Hospitalized Patients in Central India. Chemotherapy 2005; 52:43-5. [PMID: 16340199 DOI: 10.1159/000090243] [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] [Subscribe] [Scholar Register] [Received: 02/12/2004] [Accepted: 06/20/2005] [Indexed: 11/19/2022]
Abstract
BACKGROUND Growing multiple drug resistance among gram-negative bacilli among hospitalized patients is a serious therapeutic problem, and the aim of the study was to assess the situation in our hospital. METHODS Antimicrobial susceptibility testing with the disk method was carried out on 1,533 isolates of gram-negative bacilli from urine, pus, body fluid and blood from hospitalized patients. RESULTS Seventeen percent of isolates were susceptible only to meropenem and either to piperacillin + tazobactam, to cefoperazone + sulbactam or to both. Eleven percent of isolates were susceptible only to meropenem and 6% were resistant to all antimicrobial agents including meropenem. CONCLUSION Growing multiple drug resistance among gram-negative bacilli in hospital practice demands a rigid antibiotic policy and strict infection control measures.
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Affiliation(s)
- S Chitnis
- Department of Microbiology and Immunology, Choithram Hospital and Research Centre, Indore, India.
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Chitnis V, Chitnis S, Vaidya K, Ravikant S, Patil S, Chitnis DS. Bacterial population changes in hospital effluent treatment plant in central India. Water Res 2004; 38:441-7. [PMID: 14675656 DOI: 10.1016/j.watres.2003.09.038] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
Hospital effluent with its high content of multidrug resistant (MDR) enterobacteria and the presence of enteric pathogens could pose a grave problem for the community. It was planned at our tertiary care hospital in central India to study the population changes at various steps of effluent treatment plant (ETP) like collection, aeration, clarification, liquid sludge, dried sludge, high-pressure filter and treated wastewater. The study included viable bacterial counts, coliform counts, staphylococcal, enterococcal, Pseudomonas and multiple drug resistant (MDR) gram negative bacterial counts in the different stages of ETP. In order to study the distribution of bacteria as free floating in liquid and adherent to suspended particles, enumeration of the bacteria in the filterate and the sediment was also carried out. The effluent input showed 55% of the 8.6 x 10(6)/ml bacteria as coliforms and E. coli which was a typical of fecal flora. The prevalence of MDR coliforms was 0.26%. The substantial reduction (> 3log) was seen for the effluent coming from the clarifier. The bulk of the bacteria in the hospital effluent remains firmly adhered to solid particles; aeration and clarification removes bulk of the bacteria by physical processes like flocculation. The treated liquid effluent still contains sizeable loads of MDR bacteria and inactivation by procedure such as chlorination is required. The bacteria get concentrated in sludge and a greater concentration of chlorine is required for decontamination.
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Affiliation(s)
- V Chitnis
- Department of Microbiology and Immunology, Choithram Hospital and Research Centre, Indore 452001, India.
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Abstract
Poor developing countries cannot afford expensive technologies such as incineration for management of infectious biomedical waste. We assessed solar heating as an alternative technology. We immersed simulated infectious waste with added challenge bacteria in water in a box-type solar cooker, which was left in the sun for 6 h. In 24 sets of observations, the amount of viable bacteria was reduced by about 7 log. We also tested infectious medical waste with a heavy load of bacteria (10(8)-10(9)/g) from our hospital's burn unit for solar heat disinfection in 20 experiments. Our results showed a similar 7 log reduction in the amount of viable bacteria. Solar heating thus seems to be a cheap method to disinfect infectious medical waste in less economically developed countries.
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Affiliation(s)
- V Chitnis
- Department of Microbiology, Choithram Hospital and Research Centre, Indore, India.
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Chitnis V, Chitnis S, Patil S, Chitnis D. TREATMENT OF DISCARDED BLOOD UNITS: DISINFECTION WITH HYPOCHLORITE / FORMALIN VERSUS STEAM STERILIZATION. Indian J Med Microbiol 2003. [DOI: 10.1016/s0255-0857(21)03011-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Chitnis V, Chitnis S, Patil S, Chitnis D. Treatment of discarded blood units: disinfection with hypochlorite / formalin versus steam sterilization. Indian J Med Microbiol 2003; 21:265-7. [PMID: 17643040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
Blood bank regulations and bio medical waste rules of India advocate disinfection of contaminated blood units. Incineration is not recommended due to poly-vinyl chloride (PVC) content of blood bags. This study was designed to evaluate the efficacy of chemical disinfection of blood units deliberately contaminated with Staphylococcus aureus and E. coli with 1 and 6 % hypochlorite, 10% formalin and 33% formaldehyde and autoclaving of blood units contaminated with the above mentioned vegetative forms and B. stearothermophilus spores. Only 33 % formaldehyde could bring about 5 log reduction of bacteria but it is highly irritating and toxic. Autoclaving at 15 lbs pressure for 2 hours uniformly inactivated the vegetative forms and B. stearothermophilus spores. Thus, autoclaving of PVC blood bags is a safer and reliable method compared to chemical disinfection.
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Affiliation(s)
- V Chitnis
- Department of Microbiology, Choithram Hospital and Research Centre, Indore - 452 001, India
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Chitnis V, Chitnis DS, Patil S, Chitnis S. Hypochlorite (1%) is inefficient in decontaminating blood containing hypodermic needles. Indian J Med Microbiol 2002; 20:215-8. [PMID: 17657074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
Infectious biomedical waste and sharps have a potential hazard of transmission of pathogens. Among sharps, used needles form a major share and disinfection by 1 % hypochlorite is recommended in biomedical waste management rules of India. The aim of the present study was to evaluate the efficacy of hypochlorite for the decontamination of needles. Needles (16 g) filled with suspensions of standard strains and clinical isolates of gram positive and gram negative bacteria in plain normal saline and in human blood containing anticoagulant, were exposed to 1% hypochlorite and the surviving bacteria were subjected to viable counts. The observations indicated that 85 - 90 % of the needles filled with bacterial suspensions in saline are disinfected to a level of > 5 log bacterial reduction (standard disinfection) on exposure to hypochlorite but only 15 to 30% needles contaminated with the challenge bacteria suspended in blood showed > 5 log reduction in viable counts. Thus, hypochlorite treatment is inadequate for disinfecting needles contaminated with pathogenic bacteria in presence of blood and should not be recommended as an option for disinfection of the needles.
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Affiliation(s)
- V Chitnis
- Department of Microbiology, Choithram Hospital & Research Centre, Indore - 452009, M.P, India
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Chitnis S, Mondal D, Agrawal KC. Zidovudine (AZT) treatment suppresses granulocyte-monocyte colony stimulating factor receptor type alpha (GM-CSFR alpha) gene expression in murine bone marrow cells. Life Sci 2002; 71:967-78. [PMID: 12084393 DOI: 10.1016/s0024-3205(02)01790-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
In vitro exposure of murine bone marrow cells to increasing concentrations of zidovudine (AZT, 0.1-50 microM) had a concentration dependent suppressive effect on the growth of granulocyte-monocyte colony forming unit (CFU-GM) derived colonies. In our previous published study, the mechanism of AZT-induced suppression of erythroid colony forming unit (CFU-E) derived colonies was linked to a decrease in erythropoitin receptor (Epo-R) gene expression. In this study, we have observed that AZT exposure also induced a concentration dependent suppressive effect (35-90%) on GM-CSF receptor type alpha (GM-CSFR alpha) gene expression. The suppression of GM-CSFR alpha mRNA expression was specific, since AZT caused a much lower decrease (15-22%) on the IL-3 receptor type alpha (IL-3R alpha) message level, and had an insignificant effect on glyceraldehyde 3-phosphate dehydrogenase (GAPDH) and c-myc message levels. Erythropoietin (Epo) therapy has been used for reversal of AZT induced erythroid toxicity. Exposure to increasing concentrations (10-500 U/ml) of GM-CSF was unable to override the suppressive effect of AZT on CFU-GM derived colonies, however, treatment in combination with IL-3 (10-250 U/ml) ameliorated the suppressive effects of AZT on CFU-GM and on GM-CSFR alpha and IL-3R alpha gene expression. These findings suggest a mechanism via which AZT may suppress granulocyte-monocyte specific differentiation in murine bone marrow cells. These data also suggest that a combination of GM-CSF and IL-3 may be a superior therapeutic intervention for AZT-induced neutropenia.
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Affiliation(s)
- Shilpa Chitnis
- Department of Pharmacology, Tulane University Health Sciences Center, New Orleans, LA 70112-2699, USA
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Baugh JA, Chitnis S, Donnelly SC, Monteiro J, Lin X, Plant BJ, Wolfe F, Gregersen PK, Bucala R. A functional promoter polymorphism in the macrophage migration inhibitory factor (MIF) gene associated with disease severity in rheumatoid arthritis. Genes Immun 2002; 3:170-6. [PMID: 12070782 DOI: 10.1038/sj.gene.6363867] [Citation(s) in RCA: 273] [Impact Index Per Article: 12.4] [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: 01/02/2002] [Revised: 02/06/2002] [Accepted: 02/06/2002] [Indexed: 11/08/2022]
Abstract
The macrophage migration inhibitory factor (MIF) is a potent pro-inflammatory cytokine and regulates the anti-inflammator effects of glucocorticoids. An important role for MIF within the cytokine cascade is to act in concert with endogenous glucocorticoids to control the set-point and magnitude of the inflammatory response. Elevated expression of MIF in the circulation and in the synovial joint has been documented in rheumatoid arthritis. MIF also has been linked to the development of joint damage and disease pathology in experimental animal models. We describe herein a novel CATT-tetranucleotide repeat polymorphism at position -794 of the human Mif gene and show that it functionally affects the activity of the MIF promoter in gene reporter assays. We describe four genotypes which comprise 5, 6, 7, or 8-CATT repeat units and show that the 5-CATT allele has the lowest level of basal and stimulated MIF promoter activity in vitro. The presence of the low expressing, 5-CATT repeat allele correlated with low disease severity in a cohort of rheumatoid arthritis patients.
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Affiliation(s)
- J A Baugh
- Laboratory of Medical Biochemistry, The Picower Institute for Medical Research, 350 Community Drive, Manhasset, NY 11030, USA
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Hofmann MA, Drury S, Hudson BI, Gleason MR, Qu W, Lu Y, Lalla E, Chitnis S, Monteiro J, Stickland MH, Bucciarelli LG, Moser B, Moxley G, Itescu S, Grant PJ, Gregersen PK, Stern DM, Schmidt AM. RAGE and arthritis: the G82S polymorphism amplifies the inflammatory response. Genes Immun 2002; 3:123-35. [PMID: 12070776 DOI: 10.1038/sj.gene.6363861] [Citation(s) in RCA: 284] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2002] [Revised: 01/27/2002] [Accepted: 01/28/2002] [Indexed: 12/13/2022]
Abstract
The receptor for advanced glycation end products (RAGE) and its proinflammatory S100/calgranulin ligands are enriched in joints of subjects with rheumatoid arthritis (RA) and amplify the immune/inflammatory response. In a model of inflammatory arthritis, blockade of RAGE in mice immunized and challenged with bovine type II collagen suppressed clinical and histologic evidence of arthritis, in parallel with diminished levels of TNF-alpha, IL-6, and matrix metalloproteinases (MMP) 3, 9 and 13 in affected tissues. Allelic variation within key domains of RAGE may influence these proinflammatory mechanisms, thereby predisposing individuals to heightened inflammatory responses. A polymorphism of the RAGE gene within the ligand-binding domain of the receptor has been identified, consisting of a glycine to serine change at position 82. Cells bearing the RAGE 82S allele displayed enhanced binding and cytokine/MMP generation following ligation by a prototypic S100/calgranulin compared with cells expressing the RAGE 82G allele. In human subjects, a case-control study demonstrated an increased prevalence of the 82S allele in patients with RA compared with control subjects. These data suggest that RAGE 82S upregulates the inflammatory response upon engagement of S100/calgranulins, and, thereby, may contribute to enhanced proinflammatory mechanisms in immune/inflammatory diseases.
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Affiliation(s)
- M A Hofmann
- College of Physicians and Surgeons, Columbia University, New York, NY 10032, USA
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Chitnis S, Derom C, Vlietinck R, Derom R, Monteiro J, Gregersen PK. X chromosome-inactivation patterns confirm the late timing of monoamniotic-MZ twinning. Am J Hum Genet 1999; 65:570-1. [PMID: 10417301 PMCID: PMC1377957 DOI: 10.1086/302502] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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Sand PL, Taylor N, Rawlings M, Chitnis S. Performance of children with spina bifida manifesta on the Frostig Developmental Test of Visual Perception. Percept Mot Skills 1973; 37:539-46. [PMID: 4583731 DOI: 10.2466/pms.1973.37.2.539] [Citation(s) in RCA: 27] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Children with spina bifida manifesta have been described as having a higher than average probability of visual-perceptual impairment. However, documentation with standardized test instruments of visual-perceptual functioning observed for this group has been meagre. In the present study, approximately 60% of Ss examined failed to show age-appropriate performance on the Frostig Developmental Test of Visual Perception. Performance on the Frostig test was analyzed for these Ss in relation to level of spinal cord lesion, presence or absence of hydrocephalus, age, IQ. Possible causal bases for visual-perceptual impairment in these children and implication for training are discussed.
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