1
|
Frank S, Anderson KE, Fernandez HH, Hauser RA, Claassen DO, Stamler D, Factor SA, Jimenez-Shahed J, Barkay H, Wilhelm A, Alexander JK, Chaijale N, Barash S, Savola JM, Gordon MF, Chen M. Safety of Deutetrabenazine for the Treatment of Tardive Dyskinesia and Chorea Associated with Huntington Disease. Neurol Ther 2024:10.1007/s40120-024-00600-1. [PMID: 38557959 DOI: 10.1007/s40120-024-00600-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 03/04/2024] [Indexed: 04/04/2024] Open
Abstract
INTRODUCTION Deutetrabenazine is a vesicular monoamine transporter 2 inhibitor used to treat tardive dyskinesia (TD) and chorea associated with Huntington disease (HD). To enhance detection of safety signals across individual trials, integrated safety analyses of deutetrabenazine in TD and HD chorea were conducted. METHODS For TD, safety data were integrated from two 12-week pivotal studies (ARM-TD and AIM-TD) and through week 15 of the open-label extension (OLE) study (RIM-TD). Data were analyzed by deutetrabenazine treatment group and placebo. For HD, safety data were integrated from the 12-week pivotal study (First-HD) and through week 15 of the OLE study (ARC-HD) for patients previously receiving placebo. Integrated deutetrabenazine data were compared with placebo from the pivotal study. RESULTS For TD, deutetrabenazine (n = 384) was generally well tolerated compared with placebo (n = 130). Adverse event (AE) incidence was numerically higher in the response-driven deutetrabenazine vs the fixed-dose deutetrabenazine and placebo groups, respectively (any AE, 59.5% vs 44.4-50.0% and 53.8%; treatment-related AE, 38.1% vs 18.1-25.0% and 30.8%). Serious AEs were reported for 2.8-8.3% of patients in the deutetrabenazine groups and 6.9% in the placebo group. Common AEs (≥ 4%) included headache, somnolence, nausea, anxiety, fatigue, dry mouth, and diarrhea. AE incidence was higher during the titration vs maintenance periods. For HD, AE incidence was numerically higher with deutetrabenazine (n = 84) vs placebo (n = 45; any AE, 64.3% vs 60.0%; treatment-related AE, 38.1% vs 26.7%); serious AEs were reported for similar proportions for the deutetrabenazine and placebo groups, 2.4% and 2.2%, respectively. Common AEs (≥ 4%) included irritability, fall, depression, dry mouth, and fatigue. CONCLUSIONS Data from an integrated analysis of studies in TD and an integrated analysis of studies of chorea in HD showed that deutetrabenazine has a favorable safety profile and is well tolerated across indications. TRIAL REGISTRATION ClinicalTrials.gov identifiers, NCT02291861, NCT02195700, NCT01795859, NCT02198794, NCT01897896.
Collapse
Affiliation(s)
- Samuel Frank
- Beth Israel Deaconess Medical Center/Harvard Medical School, 330 Brookline Ave., Kirstein 228, Boston, MA, 02215, USA.
| | | | | | - Robert A Hauser
- University of South Florida Parkinson's Disease and Movement Disorders Center, Tampa, FL, USA
| | | | - David Stamler
- Teva Branded Pharmaceutical Products R&D, Inc., La Jolla, CA, USA
| | | | | | - Hadas Barkay
- Teva Pharmaceutical Industries Ltd., Netanya, Israel
| | - Amanda Wilhelm
- Teva Branded Pharmaceutical Products R&D, Inc., West Chester, PA, USA
| | | | - Nayla Chaijale
- Teva Branded Pharmaceutical Products R&D, Inc., West Chester, PA, USA
| | - Steve Barash
- Teva Branded Pharmaceutical Products R&D, Inc., West Chester, PA, USA
| | | | | | - Maria Chen
- Teva Branded Pharmaceutical Products R&D, Inc., West Chester, PA, USA
| |
Collapse
|
2
|
Tripathi R, McKay JL, Factor SA, Esper CD, Bernhard D, Testini P, Miocinovic S. Impact of deep brain stimulation on gait in Parkinson disease: A kinematic study. Gait Posture 2024; 108:151-156. [PMID: 38070393 DOI: 10.1016/j.gaitpost.2023.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 11/06/2023] [Accepted: 12/05/2023] [Indexed: 02/02/2024]
Abstract
BACKGROUND The effect of Deep Brain Stimulation (DBS) on gait in Parkinson's Disease (PD) is poorly understood. Kinematic studies utilizing quantitative gait outcomes such as speed, cadence, and stride length have shown mixed results and were done mostly before and after acute DBS discontinuation. OBJECTIVE To examine longitudinal changes in kinematic gait outcomes before and after DBS surgery. METHOD We retrospectively assessed changes in quantitative gait outcomes via motion capture in 22 PD patients before and after subthalamic (STN) or globus pallidus internus (GPi) DBS, in on medication state. Associations between gait outcomes and clinical variables were also assessed. RESULT Gait speed reduced from 110.7 ± 21.3 cm/s before surgery to 93.6 ± 24.9 after surgery (7.7 ± 2.9 months post-surgery, duration between assessments was 15.0 ± 3.8 months). Cadence, step length, stride length, and single support time reduced, while total support time, and initial double support time increased. Despite this, there was overall improvement in the Movement Disorder Society-Unified Parkinson Disease Rating Scale-Part III score "on medication/on stimulation" score (from 19.8 ± 10.7-13.9 ± 8.6). Change of gait speed was not related to changes in levodopa dosage, disease duration, unilateral vs bilateral stimulation, or target nucleus. CONCLUSION Quantitative gait outcomes in on medication state worsened after chronic DBS therapy despite improvement in other clinical outcomes. Whether these changes reflect the effects of DBS as opposed to ongoing disease progression is unknown.
Collapse
Affiliation(s)
- Richa Tripathi
- Jean & Paul Amos PD & Movement Disorders Program, Department of Neurology, Emory University School of Medicine, United States.
| | - J Lucas McKay
- Jean & Paul Amos PD & Movement Disorders Program, Department of Neurology, Emory University School of Medicine, United States; Department of Biomedical Informatics, Emory University School of Medicine, United States; Wallace H. Coulter Department of Biomedical Engineering, Emory University and Georgia Tech, United States
| | - Stewart A Factor
- Jean & Paul Amos PD & Movement Disorders Program, Department of Neurology, Emory University School of Medicine, United States
| | - Christine D Esper
- Jean & Paul Amos PD & Movement Disorders Program, Department of Neurology, Emory University School of Medicine, United States
| | - Douglas Bernhard
- Jean & Paul Amos PD & Movement Disorders Program, Department of Neurology, Emory University School of Medicine, United States
| | - Paola Testini
- Jean & Paul Amos PD & Movement Disorders Program, Department of Neurology, Emory University School of Medicine, United States
| | - Svjetlana Miocinovic
- Jean & Paul Amos PD & Movement Disorders Program, Department of Neurology, Emory University School of Medicine, United States; Wallace H. Coulter Department of Biomedical Engineering, Emory University and Georgia Tech, United States
| |
Collapse
|
3
|
Gong NJ, Clifford GD, Esper CD, Factor SA, McKay JL, Kwon H. Classifying Tremor Dominant and Postural Instability and Gait Difficulty Subtypes of Parkinson's Disease from Full-Body Kinematics. Sensors (Basel) 2023; 23:8330. [PMID: 37837160 PMCID: PMC10575216 DOI: 10.3390/s23198330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 10/03/2023] [Accepted: 10/07/2023] [Indexed: 10/15/2023]
Abstract
Characterizing motor subtypes of Parkinson's disease (PD) is an important aspect of clinical care that is useful for prognosis and medical management. Although all PD cases involve the loss of dopaminergic neurons in the brain, individual cases may present with different combinations of motor signs, which may indicate differences in underlying pathology and potential response to treatment. However, the conventional method for distinguishing PD motor subtypes involves resource-intensive physical examination by a movement disorders specialist. Moreover, the standardized rating scales for PD rely on subjective observation, which requires specialized training and unavoidable inter-rater variability. In this work, we propose a system that uses machine learning models to automatically and objectively identify some PD motor subtypes, specifically Tremor-Dominant (TD) and Postural Instability and Gait Difficulty (PIGD), from 3D kinematic data recorded during walking tasks for patients with PD (MDS-UPDRS-III Score, 34.7 ± 10.5, average disease duration 7.5 ± 4.5 years). This study demonstrates a machine learning model utilizing kinematic data that identifies PD motor subtypes with a 79.6% F1 score (N = 55 patients with parkinsonism). This significantly outperformed a comparison model using classification based on gait features (19.8% F1 score). Variants of our model trained to individual patients achieved a 95.4% F1 score. This analysis revealed that both temporal, spectral, and statistical features from lower body movements are helpful in distinguishing motor subtypes. Automatically assessing PD motor subtypes simply from walking may reduce the time and resources required from specialists, thereby improving patient care for PD treatments. Furthermore, this system can provide objective assessments to track the changes in PD motor subtypes over time to implement and modify appropriate treatment plans for individual patients as needed.
Collapse
Affiliation(s)
- N. Jabin Gong
- School of Computer Science, College of Computing, Georgia Institute of Technology, Atlanta, GA 30332, USA;
| | - Gari D. Clifford
- Department of Biomedical Informatics, School of Medicine, Emory University, Atlanta, GA 30322, USA (J.L.M.)
- Department of Biomedical Engineering, Emory University and Georgia Institute of Technology, Atlanta, GA 30322, USA
| | - Christine D. Esper
- Jean and Paul Amos Parkinson’s Disease and Movement Disorders Program, Department of Neurology, School of Medicine, Emory University, Atlanta, GA 30322, USA; (C.D.E.); (S.A.F.)
| | - Stewart A. Factor
- Jean and Paul Amos Parkinson’s Disease and Movement Disorders Program, Department of Neurology, School of Medicine, Emory University, Atlanta, GA 30322, USA; (C.D.E.); (S.A.F.)
| | - J. Lucas McKay
- Department of Biomedical Informatics, School of Medicine, Emory University, Atlanta, GA 30322, USA (J.L.M.)
| | - Hyeokhyen Kwon
- Department of Biomedical Informatics, School of Medicine, Emory University, Atlanta, GA 30322, USA (J.L.M.)
| |
Collapse
|
4
|
Block CK, Patel M, Risk BB, Staikova E, Loring D, Esper CD, Scorr L, Higginbotham L, Aia P, De Long MR, Wichmann T, Factor SA, Au Yong N, Willie JT, Boulis NM, Gross RE, Buetefisch C, Miocinovic S. Reply: Deep Brain Stimulation Outcomes in Parkinson's Disease Patients with Cognitive Impairment: Implications and Considerations. Mov Disord Clin Pract 2023; 10:1235-1236. [PMID: 37635771 PMCID: PMC10450235 DOI: 10.1002/mdc3.13818] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 06/14/2023] [Indexed: 08/29/2023] Open
Affiliation(s)
- Cady K. Block
- Department of NeurologyEmory University School of MedicineAtlantaGeorgiaUSA
| | - Margi Patel
- Department of NeurologyTexas A&M University, Baylor University Medical CenterDallasTexasUSA
| | - Benjamin B. Risk
- Department of Biostatistics and BioinformaticsEmory University Rollins School of Public HealthAtlantaGeorgiaUSA
- Emory Udall Center of Excellence in Parkinson's Disease ResearchEmory National Primate Research CenterAtlantaGeorgiaUSA
| | - Ekaterina Staikova
- Department of NeurologyEmory University School of MedicineAtlantaGeorgiaUSA
| | - David Loring
- Department of NeurologyEmory University School of MedicineAtlantaGeorgiaUSA
| | - Christine D. Esper
- Department of NeurologyEmory University School of MedicineAtlantaGeorgiaUSA
| | - Laura Scorr
- Department of NeurologyEmory University School of MedicineAtlantaGeorgiaUSA
| | - Lenora Higginbotham
- Department of NeurologyEmory University School of MedicineAtlantaGeorgiaUSA
- Emory Udall Center of Excellence in Parkinson's Disease ResearchEmory National Primate Research CenterAtlantaGeorgiaUSA
| | - Pratibha Aia
- Department of NeurologyEmory University School of MedicineAtlantaGeorgiaUSA
| | - Mahlon R. De Long
- Department of NeurologyEmory University School of MedicineAtlantaGeorgiaUSA
| | - Thomas Wichmann
- Department of NeurologyEmory University School of MedicineAtlantaGeorgiaUSA
- Emory Udall Center of Excellence in Parkinson's Disease ResearchEmory National Primate Research CenterAtlantaGeorgiaUSA
| | - Stewart A. Factor
- Department of NeurologyEmory University School of MedicineAtlantaGeorgiaUSA
- Emory Udall Center of Excellence in Parkinson's Disease ResearchEmory National Primate Research CenterAtlantaGeorgiaUSA
| | - Nicholas Au Yong
- Department of NeurosurgeryEmory University School of MedicineAtlantaGeorgiaUSA
| | - Jon T. Willie
- Department of Neurosurgery, Neurology, and PsychiatryWashington University School of MedicineSt LouisMissouriUSA
| | - Nicholas M. Boulis
- Department of NeurosurgeryEmory University School of MedicineAtlantaGeorgiaUSA
| | - Robert E. Gross
- Department of NeurosurgeryEmory University School of MedicineAtlantaGeorgiaUSA
| | - Cathrin Buetefisch
- Department of Neurology, Rehabilitation Medicine, and RadiologyEmory University School of MedicineAtlantaGeorgiaUSA
| | - Svjetlana Miocinovic
- Department of NeurologyEmory University School of MedicineAtlantaGeorgiaUSA
- Emory Udall Center of Excellence in Parkinson's Disease ResearchEmory National Primate Research CenterAtlantaGeorgiaUSA
| |
Collapse
|
5
|
Huddleston DE, Chen X, Hwang K, Langley J, Tripathi R, Tucker K, McKay JL, Hu X, Factor SA. Neuromelanin-sensitive MRI correlates of cognitive and motor function in Parkinson's disease with freezing of gait. medRxiv 2023:2023.07.04.23292227. [PMID: 37461735 PMCID: PMC10350131 DOI: 10.1101/2023.07.04.23292227] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 07/25/2023]
Abstract
Substantia nigra pars compacta (SNc) and locus coeruleus (LC) are neuromelanin-rich nuclei implicated in diverse cognitive and motor processes in normal brain function and disease. However, their roles in aging and neurodegenerative disease mechanisms have remained unclear due to a lack of tools to study them in vivo. Preclinical and post-mortem human investigations indicate that the relationship between tissue neuromelanin content and neurodegeneration is complex. Neuromelanin exhibits both neuroprotective and cytotoxic characteristics, and tissue neuromelanin content varies across the lifespan, exhibiting an inverted U-shaped relationship with age. Neuromelanin-sensitive MRI (NM-MRI) is an emerging modality that allows measurement of neuromelanin-associated contrast in SNc and LC in humans. NM-MRI robustly detects disease effects in these structures in neurodegenerative and psychiatric conditions, including Parkinson's disease (PD). Previous NM-MRI studies of PD have largely focused on detecting disease group effects, but few studies have reported NM-MRI correlations with phenotype. Because neuromelanin dynamics are complex, we hypothesize that they are best interpreted in the context of both disease stage and aging, with neuromelanin loss correlating with symptoms most clearly in advanced stages where neuromelanin loss and neurodegeneration are coupled. We tested this hypothesis using NM-MRI to measure SNc and LC volumes in healthy older adult control individuals and in PD patients with and without freezing of gait (FOG), a severe and disabling PD symptom. We assessed for group differences and correlations between NM-MRI measures and aging, cognition and motor deficits. SNc volume was significantly decreased in PD with FOG compared to controls. SNc volume correlated significantly with motor symptoms and cognitive measures in PD with FOG, but not in PD without FOG. SNc volume correlated significantly with aging in PD. When PD patients were stratified by disease duration, SNc volume correlated with aging, cognition, and motor deficits only in PD with disease duration >5 years. We conclude that in severe or advanced PD, identified by either FOG or disease duration >5 years, the observed correlations between SNc volume and aging, cognition, and motor function may reflect the coupling of neuromelanin loss with neurodegeneration and the associated emergence of a linear relationship between NM-MRI measures and phenotype.
Collapse
Affiliation(s)
- Daniel E. Huddleston
- Jean and Paul Amos Parkinson’s Disease and Movement Disorder Program, Department of Neurology, Emory University, Atlanta, GA, USA
| | - Xiangchuan Chen
- Jean and Paul Amos Parkinson’s Disease and Movement Disorder Program, Department of Neurology, Emory University, Atlanta, GA, USA
| | - Kristy Hwang
- Department of Neurology, University of California, San Diego
| | - Jason Langley
- Center for Advanced Neuroimaging, University of California Riverside, Riverside, CA, USA
| | - Richa Tripathi
- Jean and Paul Amos Parkinson’s Disease and Movement Disorder Program, Department of Neurology, Emory University, Atlanta, GA, USA
| | - Kelsey Tucker
- Jean and Paul Amos Parkinson’s Disease and Movement Disorder Program, Department of Neurology, Emory University, Atlanta, GA, USA
| | - J. Lucas McKay
- Jean and Paul Amos Parkinson’s Disease and Movement Disorder Program, Department of Neurology, Emory University, Atlanta, GA, USA
- Department of Biomedical Informatics, Emory University, Atlanta, GA, USA
| | - Xiaoping Hu
- Center for Advanced Neuroimaging, University of California Riverside, Riverside, CA, USA
- Department of Bioengineering, University of California Riverside, Riverside, CA, USA
| | - Stewart A. Factor
- Jean and Paul Amos Parkinson’s Disease and Movement Disorder Program, Department of Neurology, Emory University, Atlanta, GA, USA
| |
Collapse
|
6
|
Martino D, Karnik V, Bhidayasiri R, Hall DA, Hauser RA, Macerollo A, Pringsheim TM, Truong D, Factor SA, Skorvanek M, Schrag A. Scales for Antipsychotic-Associated Movement Disorders: Systematic Review, Critique, and Recommendations. Mov Disord 2023; 38:1008-1026. [PMID: 37081740 DOI: 10.1002/mds.29392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 02/13/2023] [Accepted: 03/13/2023] [Indexed: 04/22/2023] Open
Abstract
BACKGROUND Antipsychotic-associated movement disorders remain common and disabling. Their screening and assessment are challenging due to clinical heterogeneity and different use of nomenclature between psychiatrists and neurologists. OBJECTIVE An International Parkinson and Movement Disorder Society subcommittee aimed to rate psychometric quality of severity and screening instruments for antipsychotic-associated movement disorders. METHODS Following the methodology adopted by previous International Parkinson and Movement Disorders Society subcommittee papers, instruments for antipsychotic-associated movement disorders were reviewed, applying a classification as "recommended," "recommended with caveats," "suggested," or "listed." RESULTS Our review identified 23 instruments. The highest grade of recommendation reached is "recommended with caveats," assigned to seven severity rating instruments (Extrapyramidal Symptoms Rating Scale, Barnes Akathisia Rating Scale, Abnormal Involuntary Movements Scale, Drug-Induced Extra-Pyramidal Symptoms Scale, Maryland Psychiatric Research Centre involuntary movements scale, Simpson Angus Scale, and Matson Evaluation of Drug Side effects). Only three of these seven (Drug-Induced Extra-Pyramidal Symptoms Scale, Maryland Psychiatric Research Centre, Matson Evaluation of Drug Side effects) were also screening instruments. Their main caveats are insufficient demonstration of psychometric properties (internal consistency, skewing, responsiveness to change) and long duration of administration. Eight "suggested" instruments did not meet requirements for the "recommended" grade also because of insufficient psychometric validation. Other limitations shared by several instruments are lack of comprehensiveness in assessing the spectrum of antipsychotic-associated movement disorders and ambiguous nomenclature. CONCLUSIONS The high number of instruments "recommended with caveats" does not support the need for developing new instruments for antipsychotic-associated movement disorders. However, addressing the caveats with new psychometric studies and revising existing instruments to improve the clarity of their nomenclature are recommended next steps. © 2023 International Parkinson and Movement Disorder Society.
Collapse
Affiliation(s)
- Davide Martino
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
- Alberta Children's Research Institute, University of Calgary, Calgary, Alberta, Canada
| | - Vikram Karnik
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Roongroj Bhidayasiri
- Chulalongkorn Centre of Excellence for Parkinson's Disease & Related Disorders, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
- The Academy of Science, The Royal Society of Thailand, Bangkok, Thailand
| | - Deborah A Hall
- Division of Movement Disorders, Department of Neurological Sciences, Rush University Medical Center, Chicago, Illinois, USA
| | - Robert A Hauser
- Parkinson's Disease and Movement Disorders Center, Parkinson Foundation Center of Excellence, Department of Neurology, University of South Florida, Tampa, Florida, USA
| | - Antonella Macerollo
- The Walton Centre NHS Foundation Trust for Neurology and Neurosurgery, Liverpool, United Kingdom
- Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, United Kingdom
| | - Tamara M Pringsheim
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
- Department of Clinical Neurosciences, Psychiatry, Pediatrics and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
- Mathison Centre for Mental Health Research and Education, Calgary, Alberta, Canada
| | - Daniel Truong
- The Parkinson's and Movement Disorder Institute, Orange Coast Memorial Medical Center, Fountain Valley, California, USA
| | - Stewart A Factor
- Jean and Paul Amos Parkinson's Disease and Movement Disorder Program, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Matej Skorvanek
- Department of Neurology, P.J. Safarik University, Kosice, Slovak Republic
- Department of Neurology, University Hospital of L. Pasteur, Kosice, Slovak Republic
| | - Anette Schrag
- Department of Clinical Neurosciences, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
| |
Collapse
|
7
|
Agharazi H, Hardin EC, Flannery K, Beylergil SB, Noecker A, Kilbane C, Factor SA, McIntyre C, Shaikh AG. Physiological measures and anatomical correlates of subthalamic deep brain stimulation effect on gait in Parkinson's disease. J Neurol Sci 2023; 449:120647. [PMID: 37100017 DOI: 10.1016/j.jns.2023.120647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Revised: 03/25/2023] [Accepted: 04/08/2023] [Indexed: 04/28/2023]
Abstract
We examined whether conflicting visual and non-visual information leads to gait abnormalities and how the subthalamic deep brain stimulation (STN DBS) influences gait dysfunction in Parkinson's disease (PD). We used a motion capture system to measure the kinematics of the lower limbs during treadmill walking in immersive virtual reality. The visual information provided in the virtual reality paradigm was modulated to create a mismatch between the optic-flow velocity of the visual scene and the walking speed on the treadmill. In each mismatched condition, we calculated the step duration, step length, step phase, step height, and asymmetries. The key finding of our study was that mismatch between treadmill walking speed and the optic-flow velocity did not consistently alter gait parameters in PD. We also found that STN DBS improved the PD gait pattern by changing the stride length and step height. The effects on phase and left/right asymmetry were not statistically significant. The DBS parameters and location also determined its effects on gait. Statistical effects on stride length and step height were noted when the DBS volume of activated tissue (VTA) was in the dorsal aspect of the subthalamus. The statistically significant effects of STN DBS was present when VTA significantly overlapped with MR tractogrphically measured motor and pre-motor hyperdirect pathways. In summary, our results provide novel insight into ways for controlling walking behavior in PD using STN DBS.
Collapse
Affiliation(s)
- Hanieh Agharazi
- Louis Stokes Cleveland VA Medical Center, Cleveland, OH, United States of America
| | - Elizabeth C Hardin
- Louis Stokes Cleveland VA Medical Center, Cleveland, OH, United States of America; Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, United States of America
| | - Katherine Flannery
- Louis Stokes Cleveland VA Medical Center, Cleveland, OH, United States of America
| | | | - Angela Noecker
- Department of Biomedical Engineering, Duke University, Durham, NC, United States of America
| | - Camilla Kilbane
- Neurological Institute, University Hospitals, Cleveland, OH, United States of America; Department of Neurology, Case Western Reserve University, Cleveland, OH, United States of America
| | - Stewart A Factor
- Jean and Paul Amos Parkinson's Disease and Movement Disorder Program, Department of Neurology, Emory University, Atlanta, GA, United States of America
| | - Cameron McIntyre
- Department of Biomedical Engineering, Duke University, Durham, NC, United States of America
| | - Aasef G Shaikh
- Louis Stokes Cleveland VA Medical Center, Cleveland, OH, United States of America; Neurological Institute, University Hospitals, Cleveland, OH, United States of America; Department of Neurology, Case Western Reserve University, Cleveland, OH, United States of America; Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, United States of America.
| |
Collapse
|
8
|
McKay JL, Nye J, Goldstein FC, Sommerfeld B, Smith Y, Weinshenker D, Factor SA. Levodopa responsive freezing of gait is associated with reduced norepinephrine transporter binding in Parkinson's disease. Neurobiol Dis 2023; 179:106048. [PMID: 36813207 DOI: 10.1016/j.nbd.2023.106048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 02/15/2023] [Accepted: 02/16/2023] [Indexed: 02/23/2023] Open
Abstract
BACKGROUND Freezing of gait (FOG) is a major cause of falling in Parkinson's disease (PD) and can be responsive or unresponsive to levodopa. Pathophysiology is poorly understood. OBJECTIVE To examine the link between noradrenergic systems, the development of FOG in PD and its responsiveness to levodopa. METHODS We examined norepinephrine transporter (NET) binding via brain positron emission tomography (PET) to evaluate changes in NET density associated with FOG using the high affinity selective NET antagonist radioligand [11C]MeNER (2S,3S)(2-[α-(2-methoxyphenoxy)benzyl]morpholine) in 52 parkinsonian patients. We used a rigorous levodopa challenge paradigm to characterize PD patients as non-freezing (NO-FOG, N = 16), levodopa responsive freezing (OFF-FOG, N = 10), and levodopa-unresponsive freezing (ONOFF-FOG, N = 21), and also included a non-PD FOG group, primary progressive freezing of gait (PP-FOG, N = 5). RESULTS Linear mixed models identified significant reductions in whole brain NET binding in the OFF-FOG group compared to the NO-FOG group (-16.8%, P = 0.021) and regionally in the frontal lobe, left and right thalamus, temporal lobe, and locus coeruleus, with the strongest effect in right thalamus (P = 0.038). Additional regions examined in a post hoc secondary analysis including the left and right amygdalae confirmed the contrast between OFF-FOG and NO-FOG (P = 0.003). A linear regression analysis identified an association between reduced NET binding in the right thalamus and more severe New FOG Questionnaire (N-FOG-Q) score only in the OFF-FOG group (P = 0.022). CONCLUSION This is the first study to examine brain noradrenergic innervation using NET-PET in PD patients with and without FOG. Based on the normal regional distribution of noradrenergic innervation and pathological studies in the thalamus of PD patients, the implications of our findings suggest that noradrenergic limbic pathways may play a key role in OFF-FOG in PD. This finding could have implications for clinical subtyping of FOG as well as development of therapies.
Collapse
Affiliation(s)
- J Lucas McKay
- Jean & Paul Amos Parkinson's Disease & Movement Disorders Program, Department of Neurology, Emory University, Atlanta, GA 30329, USA; Department of Biomedical Informatics, Emory University, Atlanta, GA 30322, USA; Wallace H. Coulter Department of Biomedical Engineering, Georgia Tech and Emory University, Atlanta, GA 30332, USA
| | - Jonathan Nye
- Department of Radiology and Imaging Sciences, Emory University, Atlanta, GA 30322, USA
| | - Felicia C Goldstein
- Neuropsychology Program, Department of Neurology, Emory University, Atlanta, GA 30329, USA
| | - Barbara Sommerfeld
- Jean & Paul Amos Parkinson's Disease & Movement Disorders Program, Department of Neurology, Emory University, Atlanta, GA 30329, USA
| | - Yoland Smith
- Jean & Paul Amos Parkinson's Disease & Movement Disorders Program, Department of Neurology, Emory University, Atlanta, GA 30329, USA; Emory National Primate Center, Emory University, Atlanta, GA 30329, USA
| | - David Weinshenker
- Department of Human Genetics, Emory University, Atlanta, GA 30322, USA
| | - Stewart A Factor
- Jean & Paul Amos Parkinson's Disease & Movement Disorders Program, Department of Neurology, Emory University, Atlanta, GA 30329, USA.
| |
Collapse
|
9
|
Block CK, Patel M, Risk BB, Staikova E, Loring D, Esper CD, Scorr L, Higginbotham L, Aia P, DeLong MR, Wichmann T, Factor SA, Au Yong N, Willie JT, Boulis NM, Gross RE, Buetefisch C, Miocinovic S. Patients with Cognitive Impairment in Parkinson's Disease Benefit from Deep Brain Stimulation: A Case-Control Study. Mov Disord Clin Pract 2023; 10:382-391. [PMID: 36949802 PMCID: PMC10026300 DOI: 10.1002/mdc3.13660] [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: 09/30/2022] [Revised: 11/23/2022] [Accepted: 12/17/2022] [Indexed: 01/18/2023] Open
Abstract
Background Deep brain stimulation (DBS) for Parkinson's disease (PD) is generally contraindicated in persons with dementia but it is frequently performed in people with mild cognitive impairment or normal cognition, and current clinical guidelines are primarily based on these cohorts. Objectives To determine if moderately cognitive impaired individuals including those with mild dementia could meaningfully benefit from DBS in terms of motor and non-motor outcomes. Methods In this retrospective case-control study, we identified a cohort of 40 patients with PD who exhibited moderate (two or more standard deviations below normative scores) cognitive impairment (CI) during presurgical workup and compared their 1-year clinical outcomes to a cohort of 40 matched patients with normal cognition (NC). The surgery targeted subthalamus, pallidus or motor thalamus, in a unilateral, bilateral or staged approach. Results At preoperative baseline, the CI cohort had higher Unified Parkinson's Disease Rating Scale (UPDRS) subscores, but similar levodopa responsiveness compared to the NC cohort. The NC and CI cohorts demonstrated comparable degrees of postoperative improvement in the OFF-medication motor scores, motor fluctuations, and medication reduction. There was no difference in adverse event rates between the two cohorts. Outcomes in the CI cohort did not depend on the target, surgical staging, or impaired cognitive domain. Conclusions Moderately cognitively impaired patients with PD can experience meaningful motor benefit and medication reduction with DBS.
Collapse
Affiliation(s)
- Cady K. Block
- Department of NeurologyEmory University School of MedicineAtlantaGeorgiaUSA
| | - Margi Patel
- Department of NeurologyTexas A&M University, Baylor University Medical CenterDallasTexasUSA
| | - Benjamin B. Risk
- Department of Biostatistics and BioinformaticsEmory University Rollins School of Public HealthAtlantaGeorgiaUSA
- Emory Udall Center of Excellence in Parkinson's Disease ResearchEmory National Primate Research CenterAtlantaGeorgiaUSA
| | - Ekaterina Staikova
- Department of NeurologyEmory University School of MedicineAtlantaGeorgiaUSA
| | - David Loring
- Department of NeurologyEmory University School of MedicineAtlantaGeorgiaUSA
| | - Christine D. Esper
- Department of NeurologyEmory University School of MedicineAtlantaGeorgiaUSA
| | - Laura Scorr
- Department of NeurologyEmory University School of MedicineAtlantaGeorgiaUSA
| | - Lenora Higginbotham
- Department of NeurologyEmory University School of MedicineAtlantaGeorgiaUSA
- Emory Udall Center of Excellence in Parkinson's Disease ResearchEmory National Primate Research CenterAtlantaGeorgiaUSA
| | - Pratibha Aia
- Department of NeurologyEmory University School of MedicineAtlantaGeorgiaUSA
| | - Mahlon R. DeLong
- Department of NeurologyEmory University School of MedicineAtlantaGeorgiaUSA
| | - Thomas Wichmann
- Department of NeurologyEmory University School of MedicineAtlantaGeorgiaUSA
- Emory Udall Center of Excellence in Parkinson's Disease ResearchEmory National Primate Research CenterAtlantaGeorgiaUSA
| | - Stewart A. Factor
- Department of NeurologyEmory University School of MedicineAtlantaGeorgiaUSA
- Emory Udall Center of Excellence in Parkinson's Disease ResearchEmory National Primate Research CenterAtlantaGeorgiaUSA
| | - Nicholas Au Yong
- Department of NeurosurgeryEmory University School of MedicineAtlantaGeorgiaUSA
| | - Jon T. Willie
- Department of Neurosurgery, Neurology and PsychiatryWashington University School of MedicineSt LouisMissouriUSA
| | - Nicholas M. Boulis
- Emory Udall Center of Excellence in Parkinson's Disease ResearchEmory National Primate Research CenterAtlantaGeorgiaUSA
| | - Robert E. Gross
- Department of NeurosurgeryEmory University School of MedicineAtlantaGeorgiaUSA
| | - Cathrin Buetefisch
- Department of Neurology, Rehabilitation Medicine and RadiologyEmory University School of MedicineAtlantaGeorgiaUSA
| | - Svjetlana Miocinovic
- Department of NeurologyEmory University School of MedicineAtlantaGeorgiaUSA
- Emory Udall Center of Excellence in Parkinson's Disease ResearchEmory National Primate Research CenterAtlantaGeorgiaUSA
| |
Collapse
|
10
|
Kwon H, Clifford GD, Genias I, Bernhard D, Esper CD, Factor SA, McKay JL. An Explainable Spatial-Temporal Graphical Convolutional Network to Score Freezing of Gait in Parkinsonian Patients. Sensors (Basel) 2023; 23:1766. [PMID: 36850363 PMCID: PMC9968199 DOI: 10.3390/s23041766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 01/27/2023] [Accepted: 02/01/2023] [Indexed: 06/18/2023]
Abstract
Freezing of gait (FOG) is a poorly understood heterogeneous gait disorder seen in patients with parkinsonism which contributes to significant morbidity and social isolation. FOG is currently measured with scales that are typically performed by movement disorders specialists (i.e., MDS-UPDRS), or through patient completed questionnaires (N-FOG-Q) both of which are inadequate in addressing the heterogeneous nature of the disorder and are unsuitable for use in clinical trials The purpose of this study was to devise a method to measure FOG objectively, hence improving our ability to identify it and accurately evaluate new therapies. A major innovation of our study is that it is the first study of its kind that uses the largest sample size (>30 h, N = 57) in order to apply explainable, multi-task deep learning models for quantifying FOG over the course of the medication cycle and at varying levels of parkinsonism severity. We trained interpretable deep learning models with multi-task learning to simultaneously score FOG (cross-validated F1 score 97.6%), identify medication state (OFF vs. ON levodopa; cross-validated F1 score 96.8%), and measure total PD severity (MDS-UPDRS-III score prediction error ≤ 2.7 points) using kinematic data of a well-characterized sample of N = 57 patients during levodopa challenge tests. The proposed model was able to explain how kinematic movements are associated with each FOG severity level that were highly consistent with the features, in which movement disorders specialists are trained to identify as characteristics of freezing. Overall, we demonstrate that deep learning models' capability to capture complex movement patterns in kinematic data can automatically and objectively score FOG with high accuracy. These models have the potential to discover novel kinematic biomarkers for FOG that can be used for hypothesis generation and potentially as clinical trial outcome measures.
Collapse
Affiliation(s)
- Hyeokhyen Kwon
- Department of Biomedical Informatics, School of Medicine, Emory University, Atlanta, GA 30322, USA
| | - Gari D. Clifford
- Department of Biomedical Informatics, School of Medicine, Emory University, Atlanta, GA 30322, USA
| | - Imari Genias
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA
| | - Doug Bernhard
- Jean and Paul Amos Parkinson’s Disease and Movement Disorders Program, Department of Neurology, School of Medicine, Emory University, Atlanta, GA 30322, USA
| | - Christine D. Esper
- Jean and Paul Amos Parkinson’s Disease and Movement Disorders Program, Department of Neurology, School of Medicine, Emory University, Atlanta, GA 30322, USA
| | - Stewart A. Factor
- Jean and Paul Amos Parkinson’s Disease and Movement Disorders Program, Department of Neurology, School of Medicine, Emory University, Atlanta, GA 30322, USA
| | - J. Lucas McKay
- Department of Biomedical Informatics, School of Medicine, Emory University, Atlanta, GA 30322, USA
- Jean and Paul Amos Parkinson’s Disease and Movement Disorders Program, Department of Neurology, School of Medicine, Emory University, Atlanta, GA 30322, USA
| |
Collapse
|
11
|
Kwon H, Clifford GD, Genias I, Bernhard D, Esper CD, Factor SA, McKay JL. An explainable spatial-temporal graphical convolutional network to score freezing of gait in parkinsonian patients. medRxiv 2023:2023.01.13.23284535. [PMID: 36711809 PMCID: PMC9882551 DOI: 10.1101/2023.01.13.23284535] [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] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Freezing of gait (FOG) is a poorly understood heterogeneous gait disorder seen in patients with parkinsonism which contributes to significant morbidity and social isolation. FOG is currently measured with scales that are typically performed by movement disorders specialists (ie. MDS-UPDRS), or through patient completed questionnaires (N-FOG-Q) both of which are inadequate in addressing the heterogeneous nature of the disorder and are unsuitable for use in clinical trials The purpose of this study was to devise a method to measure FOG objectively, hence improving our ability to identify it and accurately evaluate new therapies. We trained interpretable deep learning models with multi-task learning to simultaneously score FOG (cross-validated F1 score 97.6%), identify medication state (OFF vs. ON levodopa; cross-validated F1 score 96.8%), and measure total PD severity (MDS-UPDRS-III score prediction error ≤ 2.7 points) using kinematic data of a well-characterized sample of N=57 patients during levodopa challenge tests. The proposed model was able to identify kinematic features associated with each FOG severity level that were highly consistent with the features that movement disorders specialists are trained to identify as characteristic of freezing. In this work, we demonstrate that deep learning models' capability to capture complex movement patterns in kinematic data can automatically and objectively score FOG with high accuracy. These models have the potential to discover novel kinematic biomarkers for FOG that can be used for hypothesis generation and potentially as clinical trial outcome measures.
Collapse
Affiliation(s)
- Hyeokhyen Kwon
- Department of Biomedical Informatics, School of Medicine, Emory University, Atlanta, GA, USA
| | - Gari D. Clifford
- Department of Biomedical Informatics, School of Medicine, Emory University, Atlanta, GA, USA
| | - Imari Genias
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Doug Bernhard
- Jean and Paul Amos Parkinson’s disease and Movement Disorders Program, Department of Neurology, School of Medicine, Emory University, Atlanta, GA, USA
| | - Christine D. Esper
- Jean and Paul Amos Parkinson’s disease and Movement Disorders Program, Department of Neurology, School of Medicine, Emory University, Atlanta, GA, USA
| | - Stewart A. Factor
- Jean and Paul Amos Parkinson’s disease and Movement Disorders Program, Department of Neurology, School of Medicine, Emory University, Atlanta, GA, USA
| | - J. Lucas McKay
- Department of Biomedical Informatics, School of Medicine, Emory University, Atlanta, GA, USA
- Jean and Paul Amos Parkinson’s disease and Movement Disorders Program, Department of Neurology, School of Medicine, Emory University, Atlanta, GA, USA
| |
Collapse
|
12
|
Virmani T, Landes RD, Pillai L, Glover A, Larson-Prior L, Prior F, Factor SA. Gait Declines Differentially in, and Improves Prediction of, People with Parkinson's Disease Converting to a Freezing of Gait Phenotype. J Parkinsons Dis 2023; 13:961-973. [PMID: 37522218 PMCID: PMC10578275 DOI: 10.3233/jpd-230020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/03/2023] [Indexed: 08/01/2023]
Abstract
BACKGROUND Freezing of gait (FOG) is a debilitating, variably expressed motor symptom in people with Parkinson's disease (PwPD) with limited treatments. OBJECTIVE To determine if the rate of progression in spatiotemporal gait parameters in people converting from a noFOG to a FOG phenotype (FOGConv) was faster than non-convertors, and determine if gait parameters can help predict this conversion. METHODS PwPD were objectively monitored longitudinally, approximately every 6 months. Non-motor assessments were performed at the initial visit. Steady-state gait in the levodopa ON-state was collected using a gait mat (Protokinetics) at each visit. The rate of progression in 8 spatiotemporal gait parameters was calculated. FOG convertors (FOGConv) were classified if they did not have FOG at initial visit and developed FOG at a subsequent visit. RESULTS Thirty freezers (FOG) and 30 non-freezers were monitored an average of 3.5 years, with 10 non-freezers developing FOG (FOGConv). FOGConv and FOG had faster decline in mean stride-length, swing-phase-percent, and increase in mean total-double-support percent, coefficient of variability (CV) foot-strike-length and CV swing-phase-percent than the remaining non-freezers (noFOG). On univariate modeling, progression rates of mean stride-length, stride-velocity, swing-phase-percent, total-double-support-percent and of CV swing-phase-percent had high discriminative power (AUC > 0.83) for classification of the FOGConv and noFOG groups. CONCLUSION FOGConv had a faster temporal decline in objectively quantified gait than noFOG, and progression rates of spatiotemporal gait parameters were more predictive of FOG phenotype conversion than initial (static) parameters Objectively monitoring gait in disease prediction models may help define FOG prone groups for testing putative treatments.
Collapse
Affiliation(s)
- Tuhin Virmani
- Department of Neurology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
- Department of Biomedical Informatics, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Reid D. Landes
- Department of Biostatistics, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Lakshmi Pillai
- Department of Neurology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Aliyah Glover
- Department of Neurology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Linda Larson-Prior
- Department of Neurology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
- Department of Biomedical Informatics, University of Arkansas for Medical Sciences, Little Rock, AR, USA
- Department of Neurobiology and Developmental Sciences, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Fred Prior
- Department of Biomedical Informatics, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Stewart A. Factor
- Jean and Paul Amos Parkinson’s Disease and Movement Disorder Program, Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA
| |
Collapse
|
13
|
Bohnen NI, Costa RM, Dauer WT, Factor SA, Giladi N, Hallett M, Lewis SJG, Nieuwboer A, Nutt JG, Takakusaki K, Kang UJ, Przedborski S, Papa SM. Reply to: "Letter on Discussion of Gait Research". Mov Disord 2022; 37:1328. [PMID: 35707827 DOI: 10.1002/mds.29049] [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: 04/14/2022] [Accepted: 04/18/2022] [Indexed: 11/08/2022] Open
Affiliation(s)
- Nicolaas I Bohnen
- Department of Radiology and Neurology, University of Michigan, Ann Arbor, Michigan, USA
| | - Rui M Costa
- Champalimaud Center for the Unknown, Lisbon, Portugal
| | - William T Dauer
- O'Donnell Brain Institute, UT Southwestern Medical, Dallas, Texas, USA
| | - Stewart A Factor
- Department of Neurology, Wesley Woods Health Center, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Nir Giladi
- Department of Neurology, Tel-Aviv Sourasky Medical Center, Sackler School of Medicine, Tel-Aviv University, Movement Disorders Unit, Tel-Aviv, Israel
| | - Mark Hallett
- Human Motor Control Section, NINDS, Bethesda, Maryland, USA
| | - Simon J G Lewis
- University of Sydney, SOMS, University of Sydney, Mallett Street Campus, Camperdown, New South Wales, Australia
| | - Alice Nieuwboer
- Faculty of Kinesiology and Rehabilitation Sciences, Rehabilitation Sciences, University of Leuven, Leuven, Belgium
| | - John G Nutt
- Department of Neurology, Oregon Health and Science University, Portland, Oregon, USA
| | - Kaoru Takakusaki
- Department of Precision Engineering, Research Center for Brain Function and Medical Engineering, Asahikawa Medical University, The University of Tokyo, Asahikawa, Japan
| | - Un Jung Kang
- Department of Neurology, NYU Langone Health, New York, New York, USA
| | - Serge Przedborski
- Center for Neurobiology and Behavior, Columbia University, New York, New York, USA
| | - Stella M Papa
- Department of Neurology, Emory University, Atlanta, Georgia, USA
| |
Collapse
|
14
|
Hauser RA, Barkay H, Fernandez HH, Factor SA, Jimenez-Shahed J, Gross N, Marinelli L, Wilhelm A, Alexander J, Gordon MF, Savola JM, Anderson KE. Long-Term Deutetrabenazine Treatment for Tardive Dyskinesia Is Associated With Sustained Benefits and Safety: A 3-Year, Open-Label Extension Study. Front Neurol 2022; 13:773999. [PMID: 35280262 PMCID: PMC8906841 DOI: 10.3389/fneur.2022.773999] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 01/04/2022] [Indexed: 11/25/2022] Open
Abstract
Background Deutetrabenazine is a vesicular monoamine transporter 2 inhibitor approved for the treatment of tardive dyskinesia (TD) in adults. In two 12-week pivotal studies, deutetrabenazine demonstrated statistically significant improvements in Abnormal Involuntary Movement Scale (AIMS) scores, with favorable safety/tolerability in TD patients. This study reports long-term efficacy and safety of deutetrabenazine in a 3-year, single-arm, open-label extension (OLE) study. Methods Patients who completed the pivotal studies could enroll in this single-arm OLE study, titrating up to 48 mg/day based on dyskinesia control and tolerability. Efficacy was assessed based on change from baseline in total motor AIMS score, Clinical Global Impression of Change (CGIC) and Patient Global Impression of Change (PGIC), and quality of life (QOL) assessments. Safety evaluation included adverse event (AE) incidence, reported using exposure-adjusted incidence rates, and safety scales. Results 343 patients enrolled in the study (6 patients were excluded). At Week 145 (mean dose: 39.4 ± 0.83 mg/day), mean ± SE change from baseline in total motor AIMS score was −6.6 ± 0.37 and 67% of patients achieved ≥50% improvement in total motor AIMS score. Based on CGIC and PGIC, 73% and 63% of patients achieved treatment success, respectively. QOL improvements were also observed. Deutetrabenazine was generally well tolerated, with low rates of mild-to-moderate AEs and no new safety signals; most safety scales remained unchanged over time. Conclusions Long-term deutetrabenazine treatment was associated with sustained improvement in AIMS scores, indicative of clinically meaningful long-term benefit, and was generally well tolerated. Results suggest deutetrabenazine may provide increasing benefit over time without increases in dose.
Collapse
Affiliation(s)
- Robert A Hauser
- University of South Florida Parkinson's Disease and Movement Disorders Center, Tampa, FL, United States
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
15
|
Lewis SJG, Factor SA, Giladi N, Hallett M, Nieuwboer A, Nutt JG, Przedborski S, Papa SM. Addressing the Challenges of Clinical Research for Freezing of Gait in Parkinson's Disease. Mov Disord 2022; 37:264-267. [PMID: 34939228 PMCID: PMC8840955 DOI: 10.1002/mds.28837] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 09/27/2021] [Accepted: 09/28/2021] [Indexed: 02/03/2023] Open
Affiliation(s)
- Simon J. G. Lewis
- ForeFront Parkinson’s Disease Research Clinic, Brain and Mind Centre, School of Medical Sciences, University of Sydney, NSW, Australia.,Correspondence: Dr. Lewis, Brain and Mind Centre, School of Medical Sciences, University of Sydney, Camperdown, NSW 2050, Australia; or Dr. Papa, Yerkes National Primate Research Center, Emory University, Atlanta, GA 30329, USA;
| | - Stewart A. Factor
- Jean and Paul Amos Parkinson’s disease and Movement Disorders Program, Emory University School of Medicine, Atlanta, GA USA
| | - Nir Giladi
- Movement Disorders Unit, Department of Neurology, Tel-Aviv Sourasky Medical Center, Sackler School of Medicine and Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
| | - Mark Hallett
- Human Motor Control Section, National Institute of Neurological Disorders and Stroke, NIH, Bethesda, MD, USA
| | | | - John G. Nutt
- Movement Disorder Section, Department of Neurology, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97034. USA
| | - Serge Przedborski
- Departments of Pathology & Cell Biology, Neurology, and Neuroscience, Columbia University, New York, NY, USA
| | - Stella M. Papa
- Department of Neurology, School of Medicine, and Yerkes National Primate Research Center, Emory University, Atlanta, GA, USA.,Correspondence: Dr. Lewis, Brain and Mind Centre, School of Medical Sciences, University of Sydney, Camperdown, NSW 2050, Australia; or Dr. Papa, Yerkes National Primate Research Center, Emory University, Atlanta, GA 30329, USA;
| | | |
Collapse
|
16
|
Bliwise DL, Karroum EG, Greer SA, Factor SA, Trotti LM. Restless Legs Symptoms and Periodic Leg Movements in Sleep Among Patients with Parkinson's Disease. J Parkinsons Dis 2022; 12:1339-1344. [PMID: 35311713 PMCID: PMC9156558 DOI: 10.3233/jpd-213100] [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] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND The association between restless legs syndrome (RLS) and Parkinson's disease (PD) remains controversial, with epidemiologic and descriptive evidence suggesting some potential overlap while mechanistic/genetic studies suggesting relative independence of the conditions. OBJECTIVE To examine a known, objectively measured endophenotype for RLS, periodic leg movements (PLMS) in sleep, in patients with PD and relate that objective finding to restless legs symptoms. METHODS We performed polysomnography for one (n = 8) or two (n = 67) consecutive nights in 75 PD patients and examined the association of PLMS with restless legs symptoms. RESULTS We found no association between restless legs symptoms and PLMS in PD. Prevalence of both was similar to data reported previously in other PD samples. CONCLUSION We interpret these results as suggesting that restless legs symptoms in PD patients may represent a different phenomenon and pathophysiology than RLS in the non-PD population.
Collapse
Affiliation(s)
- Donald L. Bliwise
- Department of Neurology, Emory University School of Medicine, Atlanta, Georgia
| | - Elias G. Karroum
- Department of Neurology, George Washington University School of Medicine, Washington, D.C
| | - Sophia A. Greer
- School of Medicine, University of Missouri, Columbia, Missouri
| | - Stewart A. Factor
- Department of Neurology, Emory University School of Medicine, Atlanta, Georgia
| | - Lynn Marie Trotti
- Department of Neurology, Emory University School of Medicine, Atlanta, Georgia
| |
Collapse
|
17
|
Vu JP, Cisneros E, Zhao J, Lee HY, Jankovic J, Factor SA, Goetz CG, Barbano RL, Perlmutter JS, Jinnah HA, Richardson SP, Stebbins GT, Elble RJ, Comella CL, Peterson DA. From null to midline: changes in head posture do not predictably change head tremor in cervical dystonia. Dystonia 2022; 1:10684. [PMID: 37101941 PMCID: PMC10128866 DOI: 10.3389/dyst.2022.10684] [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] [Subscribe] [Scholar Register] [Indexed: 04/28/2023]
Abstract
Introduction A common view is that head tremor (HT) in cervical dystonia (CD) decreases when the head assumes an unopposed dystonic posture and increases when the head is held at midline. However, this has not been examined with objective measures in a large, multicenter cohort. Methods For 80 participants with CD and HT, we analyzed videos from examination segments in which participants were instructed to 1) let their head drift to its most comfortable position (null point) and then 2) hold their head straight at midline. We used our previously developed Computational Motor Objective Rater (CMOR) to quantify changes in severity, amplitude, and frequency between the two postures. Results Although up to 9% of participants had exacerbated HT in midline, across the whole cohort, paired t-tests reveal no significant changes in overall severity (t = -0.23, p = 0.81), amplitude (t = -0.80, p = 0.43), and frequency (t = 1.48, p = 0.14) between the two postures. Conclusions When instructed to first let their head drift to its null point and then to hold their head straight at midline, most patient's changes in HT were below the thresholds one would expect from the sensitivity of clinical rating scales. Counter to common clinical impression, CMOR objectively showed that HT does not consistently increase at midline posture in comparison to the null posture.
Collapse
Affiliation(s)
- Jeanne P. Vu
- Computational Neurology Center, Institute for Neural Computation, University of California, San Diego, La Jolla, CA, USA
| | - Elizabeth Cisneros
- Computational Neurology Center, Institute for Neural Computation, University of California, San Diego, La Jolla, CA, USA
| | - Jerry Zhao
- Computational Neurology Center, Institute for Neural Computation, University of California, San Diego, La Jolla, CA, USA
| | - Ha Yeon Lee
- Computational Neurology Center, Institute for Neural Computation, University of California, San Diego, La Jolla, CA, USA
| | - Joseph Jankovic
- Parkinson’s Disease Center and Movement Disorders Clinic, Department of Neurology, Baylor College of Medicine, Houston, TX, USA
| | - Stewart A. Factor
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA
| | - Christopher G. Goetz
- Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, USA
| | | | - Joel S. Perlmutter
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA
- Departments of Radiology, Neuroscience, Physical Therapy, and Occupational Therapy, Washington University School of Medicine, St. Louis, MO, USA
| | - Hyder A. Jinnah
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA
- Departments of Human Genetics and Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
| | - Sarah Pirio Richardson
- Department of Neurology, University of New Mexico Health Sciences Center, Albuquerque, NM, USA
- Neurology Service, New Mexico Veterans Affairs Health Care System, Albuquerque, NM, USA
| | - Glenn T. Stebbins
- Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, USA
| | - Rodger J. Elble
- Department of Neurology, Southern Illinois University School of Medicine, Springfield, IL, USA
| | - Cynthia L. Comella
- Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, USA
| | - David A. Peterson
- Computational Neurology Center, Institute for Neural Computation, University of California, San Diego, La Jolla, CA, USA
- Computational Neurobiology Laboratory, Salk Institute for Biological Studies, La Jolla, CA, USA
- Name, address, telephone and email address of the corresponding author: David Peterson, CNL-S, Salk Institute for Biological Studies, 10010 N. Torrey Pines Rd, La Jolla, CA 92037, 858-334-3110, Fax number: N/A,
| |
Collapse
|
18
|
Ticku H, Fotedar N, Juncos J, Factor SA, Shaikh AG. Pseudonystagmus in progressive supranuclear palsy. J Neurol Sci 2022; 434:120157. [DOI: 10.1016/j.jns.2022.120157] [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] [Received: 08/16/2021] [Revised: 08/30/2021] [Accepted: 01/13/2022] [Indexed: 10/19/2022]
|
19
|
Bohnen NI, Costa RM, Dauer WT, Factor SA, Giladi N, Hallett M, Lewis SJ, Nieuwboer A, Nutt JG, Takakusaki K, Kang UJ, Przedborski S, Papa SM. Discussion of Research Priorities for Gait Disorders in Parkinson's Disease. Mov Disord 2021; 37:253-263. [PMID: 34939221 PMCID: PMC10122497 DOI: 10.1002/mds.28883] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 10/08/2021] [Accepted: 11/10/2021] [Indexed: 12/18/2022] Open
Abstract
Gait and balance abnormalities develop commonly in Parkinson's disease and are among the motor symptoms most disabling and refractory to dopaminergic or other treatments, including deep brain stimulation. Efforts to develop effective therapies are challenged by limited understanding of these complex disorders. There is a major need for novel and appropriately targeted research to expedite progress in this area. The Scientific Issues Committee of the International Parkinson and Movement Disorder Society has charged a panel of experts in the field to consider the current knowledge gaps and determine the research routes with highest potential to generate groundbreaking data. © 2021 International Parkinson and Movement Disorder Society.
Collapse
Affiliation(s)
- Nicolaas I. Bohnen
- Departments of Radiology and Neurology University of Michigan and VA Ann Arbor Healthcare System Ann Arbor Michigan USA
| | - Rui M. Costa
- Departments of Neuroscience and Neurology, Zuckerman Mind Brain Behavior Institute Columbia University New York New York USA
| | - William T. Dauer
- Departments of Neurology and Neuroscience The Peter O'Donnell Jr. Brain Institute, UT Southwestern Dallas Texas USA
| | - Stewart A. Factor
- Jean and Paul Amos Parkinson's Disease and Movement Disorders Program Emory University School of Medicine Atlanta Georgia USA
| | - Nir Giladi
- Movement Disorders Unit, Department of Neurology, Tel‐Aviv Sourasky Medical Center, Sackler School of Medicine and Sagol School of Neuroscience Tel Aviv University Tel Aviv Israel
| | - Mark Hallett
- Human Motor Control Section National Institute of Neurological Disorders and Stroke, National Institutes of Health Bethesda Maryland USA
| | - Simon J.G. Lewis
- ForeFront Parkinson's Disease Research Clinic, Brain and Mind Centre, School of Medical Sciences University of Sydney Sydney New South Wales Australia
| | - Alice Nieuwboer
- Department of Rehabilitation Sciences KU Leuven Leuven Belgium
| | - John G. Nutt
- Movement Disorder Section, Department of Neurology Oregon Health & Science University Portland Oregon USA
| | - Kaoru Takakusaki
- Department of Physiology, Section of Neuroscience Asahikawa Medical University Asahikawa Japan
| | - Un Jung Kang
- Departments of Neurology, Neuroscience, and Physiology Neuroscience Institute, The Marlene and Paolo Fresco Institute for Parkinson's and Movement Disorders, The Parekh Center for Interdisciplinary Neurology, New York University Grossman School of Medicine New York New York USA
| | - Serge Przedborski
- Departments of Pathology and Cell Biology, Neurology, and Neuroscience Columbia University New York New York USA
| | - Stella M. Papa
- Department of Neurology, School of Medicine, and Yerkes National Primate Research Center Emory University Atlanta Georgia USA
| | | |
Collapse
|
20
|
Scorr LM, Factor SA, Parra SP, Kaye R, Paniello RC, Norris SA, Perlmutter JS, Bäumer T, Usnich T, Berman BD, Mailly M, Roze E, Vidailhet M, Jankovic J, LeDoux MS, Barbano R, Chang FCF, Fung VSC, Pirio Richardson S, Blitzer A, Jinnah HA. Oromandibular Dystonia: A Clinical Examination of 2,020 Cases. Front Neurol 2021; 12:700714. [PMID: 34603182 PMCID: PMC8481678 DOI: 10.3389/fneur.2021.700714] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 08/12/2021] [Indexed: 12/31/2022] Open
Abstract
Objective: The goal of this study is to better characterize the phenotypic heterogeneity of oromandibular dystonia (OMD) for the purpose of facilitating early diagnosis. Methods: First, we provide a comprehensive summary of the literature encompassing 1,121 cases. Next, we describe the clinical features of 727 OMD subjects enrolled by the Dystonia Coalition (DC), an international multicenter cohort. Finally, we summarize clinical features and treatment outcomes from cross-sectional analysis of 172 OMD subjects from two expert centers. Results: In all cohorts, typical age at onset was in the 50s and 70% of cases were female. The Dystonia Coalition cohort revealed perioral musculature was involved most commonly (85%), followed by jaw (61%) and tongue (17%). OMD more commonly appeared as part of a segmental dystonia (43%), and less commonly focal (39%) or generalized (10%). OMD was found to be associated with impaired quality of life, independent of disease severity. On average, social anxiety (LSA score: 33 ± 28) was more common than depression (BDI II score: 9.7 ± 7.8). In the expert center cohorts, botulinum toxin injections improved symptom severity by more than 50% in ~80% of subjects, regardless of etiology. Conclusions: This comprehensive description of OMD cases has revealed novel insights into the most common OMD phenotypes, pattern of dystonia distribution, associated psychiatric disturbances, and effect on QoL. We hope these findings will improve clinical recognition to aid in timely diagnosis and inform treatment strategies.
Collapse
Affiliation(s)
- Laura M. Scorr
- Department of Neurology, Emory University, Atlanta, GA, United States
| | - Stewart A. Factor
- Department of Neurology, Emory University, Atlanta, GA, United States
| | | | - Rachel Kaye
- Department of Otolaryngology, Rutgers University, Newark, NJ, United States
| | - Randal C. Paniello
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, United States
| | - Scott A. Norris
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, United States
| | - Joel S. Perlmutter
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, United States
| | - Tobias Bäumer
- Department of Neurology, Institute of Systems Motor Science, Universität of Lübeck, Lübeck, Germany
| | - Tatiana Usnich
- Department of Neurology, Institute of Systems Motor Science, Universität of Lübeck, Lübeck, Germany
| | - Brian D. Berman
- Department of Neurology, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Marie Mailly
- Department of ENT and Head and Neck Surgery, Fondation Adolphe de Rothschild, Paris, France
| | - Emmanuel Roze
- Department of Neurology, Hôpital de la Pitié Salpétrière, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Marie Vidailhet
- Department of Neurology, Hôpital de la Pitié Salpétrière, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Joseph Jankovic
- Baylor St. Luke's Medical Center, Houston, TX, United States
| | - Mark S. LeDoux
- Veracity Neuroscience LLC, Memphis, TN, United States
- Department of Neurology, University of Memphis, Memphis, TN, United States
| | - Richard Barbano
- Department of Neurology, University of Rochester, Rochester, NY, United States
| | - Florence C. F. Chang
- Department of Neurology, Westmead Hospital and Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Victor S. C. Fung
- Department of Neurology, Westmead Hospital and Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Sarah Pirio Richardson
- Department of Neurology, University of New Mexico Health Sciences Center, Albuquerque, NM, United States
| | - Andrew Blitzer
- Head and Neck Surgical Group, New York, NY, United States
| | - H. A. Jinnah
- Department of Neurology, Emory University, Atlanta, GA, United States
| |
Collapse
|
21
|
Wallen ZD, Stone WJ, Factor SA, Molho E, Zabetian CP, Standaert DG, Payami H. Exploring human-genome gut-microbiome interaction in Parkinson's disease. NPJ Parkinsons Dis 2021; 7:74. [PMID: 34408160 PMCID: PMC8373869 DOI: 10.1038/s41531-021-00218-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 07/23/2021] [Indexed: 12/16/2022]
Abstract
The causes of complex diseases remain an enigma despite decades of epidemiologic research on environmental risks and genome-wide studies that have uncovered tens or hundreds of susceptibility loci for each disease. We hypothesize that the microbiome is the missing link. Genetic studies have shown that overexpression of alpha-synuclein, a key pathological protein in Parkinson’s disease (PD), can cause familial PD and variants at alpha-synuclein locus confer risk of idiopathic PD. Recently, dysbiosis of gut microbiome in PD was identified: altered abundances of three microbial clusters were found, one of which was composed of opportunistic pathogens. Using two large datasets, we found evidence that the overabundance of opportunistic pathogens in PD gut is influenced by the host genotype at the alpha-synuclein locus, and that the variants responsible modulate alpha-synuclein expression. Results put forth testable hypotheses on the role of gut microbiome in the pathogenesis of PD, the incomplete penetrance of PD susceptibility genes, and potential triggers of pathology in the gut.
Collapse
Affiliation(s)
- Zachary D Wallen
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - William J Stone
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Stewart A Factor
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA
| | - Eric Molho
- Department of Neurology, Albany Medical College, Albany, NY, USA
| | - Cyrus P Zabetian
- VA Puget Sound Health Care System and Department of Neurology, University of Washington, Seattle, WA, USA
| | - David G Standaert
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Haydeh Payami
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, USA.
| |
Collapse
|
22
|
Wadon ME, Bailey GA, Yilmaz Z, Hubbard E, AlSaeed M, Robinson A, McLauchlan D, Barbano RL, Marsh L, Factor SA, Fox SH, Adler CH, Rodriguez RL, Comella CL, Reich SG, Severt WL, Goetz CG, Perlmutter JS, Jinnah HA, Harding KE, Sandor C, Peall KJ. Non-motor phenotypic subgroups in adult-onset idiopathic, isolated, focal cervical dystonia. Brain Behav 2021; 11:e2292. [PMID: 34291595 PMCID: PMC8413761 DOI: 10.1002/brb3.2292] [Citation(s) in RCA: 9] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 06/15/2021] [Accepted: 07/04/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Non-motor symptoms are well established phenotypic components of adult-onset idiopathic, isolated, focal cervical dystonia (AOIFCD). However, improved understanding of their clinical heterogeneity is needed to better target therapeutic intervention. Here, we examine non-motor phenotypic features to identify possible AOIFCD subgroups. METHODS Participants diagnosed with AOIFCD were recruited via specialist neurology clinics (dystonia wales: n = 114, dystonia coalition: n = 183). Non-motor assessment included psychiatric symptoms, pain, sleep disturbance, and quality of life, assessed using self-completed questionnaires or face-to-face assessment. Both cohorts were analyzed independently using Cluster, and Bayesian multiple mixed model phenotype analyses to investigate the relationship between non-motor symptoms and determine evidence of phenotypic subgroups. RESULTS Independent cluster analysis of the two cohorts suggests two predominant phenotypic subgroups, one consisting of approximately a third of participants in both cohorts, experiencing increased levels of depression, anxiety, sleep impairment, and pain catastrophizing, as well as, decreased quality of life. The Bayesian approach reinforced this with the primary axis, which explained the majority of the variance, in each cohort being associated with psychiatric symptomology, and also sleep impairment and pain catastrophizing in the Dystonia Wales cohort. CONCLUSIONS Non-motor symptoms accompanying AOIFCD parse into two predominant phenotypic sub-groups, with differences in psychiatric symptoms, pain catastrophizing, sleep quality, and quality of life. Improved understanding of these symptom groups will enable better targeted pathophysiological investigation and future therapeutic intervention.
Collapse
Affiliation(s)
- Megan E Wadon
- Neuroscience and Mental Health Research Institute, Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, Maindy Road, Cardiff, CF24 4HQ, UK
| | - Grace A Bailey
- Neuroscience and Mental Health Research Institute, Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, Maindy Road, Cardiff, CF24 4HQ, UK
| | - Zehra Yilmaz
- Neuroscience and Mental Health Research Institute, Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, Maindy Road, Cardiff, CF24 4HQ, UK.,Institute of Neurology, University College London, Queen Square, London, WC1N 3BG, UK
| | - Emily Hubbard
- School of Medicine, Cardiff University, Heath Park Campus, Cardiff, CF14 4YS, UK
| | - Meshari AlSaeed
- School of Medicine, Cardiff University, Heath Park Campus, Cardiff, CF14 4YS, UK.,Division of Neurology, University of British Columbia, Wesbrook Mall, Vancouver, British Columbia, V6T 2B5, Canada
| | - Amy Robinson
- School of Medicine, Cardiff University, Heath Park Campus, Cardiff, CF14 4YS, UK
| | - Duncan McLauchlan
- Neuroscience and Mental Health Research Institute, Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, Maindy Road, Cardiff, CF24 4HQ, UK
| | - Richard L Barbano
- Department of Neurology, University of Rochester, Elmwood Avenue, Rochester, New York, NY 14642, USA
| | - Laura Marsh
- Menninger Department of Psychiatry, Baylor College of Medicine, Butler Boulevard, Houston, Texas, 77030, USA
| | - Stewart A Factor
- Departments of Neurology & Human Genetics, Emory University, Woodruff Circle, Atlanta, Georgia, 30322, USA
| | - Susan H Fox
- Edmond J Safra Program in Parkinson Disease, Movement Disorder Clinic, Toronto Western Hospital, Bathurst Street, Toronto, Ontario, M5T 2S8, Canada.,Department of Medicine, University of Toronto, Queen's Park Crescent West, Toronto, Ontario, M5S 3H2, Canada
| | - Charles H Adler
- The Parkinson's Disease and Movement Disorders Center, Mayo Clinic, Department of Neurology, East Shea Boulevard, Scottsdale, Arizona, 85259, USA
| | - Ramon L Rodriguez
- Department of Neurology, University of Florida, Newell Drive, Gainesville, Florida, 32611, USA
| | - Cynthia L Comella
- Department of Neurological Sciences, Rush University Medical Center, West Harrison Street, Chicago, Illinois, 60612, USA
| | - Stephen G Reich
- Department of Neurology, University of Maryland School of Medicine, south Paca Street, Baltimore, Maryland, 21201, USA
| | - William L Severt
- Beth Israel Medical Center, First Avenue, New York, New York, 10003, USA
| | - Christopher G Goetz
- Department of Neurological Sciences, Rush University Medical Center, West Harrison Street, Chicago, Illinois, 60612, USA
| | - Joel S Perlmutter
- Neurology, Radiology, Neuroscience, Physical Therapy and Occupational Therapy, Washington University School of Medicine, South Euclid Avenue, St. Louis, Missouri, 63110, USA
| | - Hyder A Jinnah
- Departments of Neurology & Human Genetics, Emory University, Woodruff Circle, Atlanta, Georgia, 30322, USA
| | - Katharine E Harding
- Department of Neurology, Aneurin Bevan University Health Board, Corporation Road, Newport, NP19 0BH, UK
| | - Cynthia Sandor
- UK Dementia Research Institute, Cardiff University, Maindy Road, Cardiff, CF24 4HQ, UK
| | - Kathryn J Peall
- Neuroscience and Mental Health Research Institute, Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, Maindy Road, Cardiff, CF24 4HQ, UK
| |
Collapse
|
23
|
Sun YV, Li C, Hui Q, Huang Y, Barbano R, Rodriguez R, Malaty IA, Reich S, Bambarger K, Holmes K, Jankovic J, Patel NJ, Roze E, Vidailhet M, Berman BD, LeDoux MS, Espay AJ, Agarwal P, Pirio-Richardson S, Frank SA, Ondo WG, Saunders-Pullman R, Chouinard S, Natividad S, Berardelli A, Pantelyat AY, Brashear A, Fox SH, Kasten M, Krämer UM, Neis M, Bäumer T, Loens S, Borsche M, Zittel S, Maurer A, Gelderblom M, Volkmann J, Odorfer T, Kühn AA, Borngräber F, König IR, Cruchaga C, Cotton AC, Kilic-Berkmen G, Freeman A, Factor SA, Scorr L, Bremner JD, Vaccarino V, Quyyumi AA, Klein C, Perlmutter JS, Lohmann K, Jinnah HA. A Multi-center Genome-wide Association Study of Cervical Dystonia. Mov Disord 2021; 36:2795-2801. [PMID: 34320236 PMCID: PMC8688173 DOI: 10.1002/mds.28732] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 06/24/2021] [Accepted: 07/12/2021] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Several monogenic causes for isolated dystonia have been identified, but they collectively account for only a small proportion of cases. Two genome-wide association studies have reported a few potential dystonia risk loci; but conclusions have been limited by small sample sizes, partial coverage of genetic variants, or poor reproducibility. OBJECTIVE To identify robust genetic variants and loci in a large multicenter cervical dystonia cohort using a genome-wide approach. METHODS We performed a genome-wide association study using cervical dystonia samples from the Dystonia Coalition. Logistic and linear regressions, including age, sex, and population structure as covariates, were employed to assess variant- and gene-based genetic associations with disease status and age at onset. We also performed a replication study for an identified genome-wide significant signal. RESULTS After quality control, 919 cervical dystonia patients compared with 1491 controls of European ancestry were included in the analyses. We identified one genome-wide significant variant (rs2219975, chromosome 3, upstream of COL8A1, P-value 3.04 × 10-8 ). The association was not replicated in a newly genotyped sample of 473 cervical dystonia cases and 481 controls. Gene-based analysis identified DENND1A to be significantly associated with cervical dystonia (P-value 1.23 × 10-6 ). One low-frequency variant was associated with lower age-at-onset (16.4 ± 2.9 years, P-value = 3.07 × 10-8 , minor allele frequency = 0.01), located within the GABBR2 gene on chromosome 9 (rs147331823). CONCLUSION The genetic underpinnings of cervical dystonia are complex and likely consist of multiple distinct variants of small effect sizes. Larger sample sizes may be needed to provide sufficient statistical power to address the presumably multi-genic etiology of cervical dystonia. © 2021 International Parkinson and Movement Disorder Society.
Collapse
Affiliation(s)
- Yan V Sun
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, Georgia, USA.,Department of Biomedical Informatics, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Chengchen Li
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, Georgia, USA
| | - Qin Hui
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, Georgia, USA
| | - Yunfeng Huang
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, Georgia, USA
| | - Richard Barbano
- Movement Disorders Division, University of Rochester, Rochester, New York, USA
| | | | - Irene A Malaty
- Department of Neurology, Fixel Institute for Neurological Diseases, University of Florida, Gainesville, Florida, USA
| | - Stephen Reich
- Department of Neurology, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Kimberly Bambarger
- Department of Neurology, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Katie Holmes
- Department of Neurology, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Joseph Jankovic
- Parkinson's Disease Center and Movement Disorders Clinic, Department of Neurology, Baylor College of Medicine, Houston, Texas, USA
| | - Neepa J Patel
- Department of Neurology, Henry Ford Health System, Henry Ford Hospital, Detroit, Michigan, USA
| | - Emmanuel Roze
- Sorbonne Université, Inserm U1127, CNRS UMR 7225, Institut du Cerveau et de la Moelle; Assistance Publique - Hôpitaux de Paris, Hôpital Salpêtrière, Département de Neurologie, Paris, France
| | - Marie Vidailhet
- Sorbonne Université, Inserm U1127, CNRS UMR 7225, Institut du Cerveau et de la Moelle; Assistance Publique - Hôpitaux de Paris, Hôpital Salpêtrière, Département de Neurologie, Paris, France
| | - Brian D Berman
- Department of Neurology, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Mark S LeDoux
- Department of Psychology, University of Memphis, Memphis, Tennessee, USA
| | - Alberto J Espay
- James J and Joan A Gardner Center for Parkinson's Disease and Movement Disorders, University of Cincinnati Academic Health Center, Cincinnati, Ohio, USA
| | - Pinky Agarwal
- Booth Gardner Parkinson's Care Center, Evergreen Health, Kirkland, Washington, USA
| | | | - Samuel A Frank
- Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - William G Ondo
- Department of Neurology, Methodist Neurological Institute, Weill Cornell Medical School, Houston, Texas, USA
| | - Rachel Saunders-Pullman
- Icahn School of Medicine at Mount Sinai, Movement Disorders, Department of Neurology, Mount Sinai Beth Israel, New York, New York, USA
| | - Sylvain Chouinard
- Unité des troubles du mouvement André-Barbeau, Centre Hospitalier de l'Université de Montréal, Montreal, Canada
| | - Stover Natividad
- Department of Neurology, The University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Alfredo Berardelli
- Department of Neurology and Psychiatry, Sapienza University of Rome and IRCCS Neuromed, Rome, Italy
| | - Alexander Y Pantelyat
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Allison Brashear
- Neurology, University of California, Davis, Sacramento, California, USA
| | - Susan H Fox
- University of Toronto, Edmond J Safra Program in Parkinson Disease; Movement Disorder Clinic, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Meike Kasten
- Institute of Neurogenetics, University of Lübeck, Lübeck, Germany.,Department of Psychiatry and Psychotherapy, University of Lübeck, Lübeck, Germany
| | - Ulrike M Krämer
- Department of Neurology, University of Lübeck, Lübeck, Germany
| | - Miriam Neis
- Department of Neurology, University of Lübeck, Lübeck, Germany.,Institute for Health Sciences, Department of Midwifery Science, University of Lübeck, Lübeck, Germany
| | - Tobias Bäumer
- Institute of Neurogenetics, University of Lübeck, Lübeck, Germany.,Institute of Systemic Motor Research, University of Lübeck, Lübeck, Germany
| | - Sebastian Loens
- Institute of Neurogenetics, University of Lübeck, Lübeck, Germany.,Institute of Systemic Motor Research, University of Lübeck, Lübeck, Germany
| | - Max Borsche
- Institute of Neurogenetics, University of Lübeck, Lübeck, Germany.,Department of Neurology, University of Lübeck, Lübeck, Germany
| | - Simone Zittel
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Antonia Maurer
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Mathias Gelderblom
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jens Volkmann
- Department of Neurology, University Hospital Würzburg, Würzburg, Germany
| | - Thorsten Odorfer
- Department of Neurology, University Hospital Würzburg, Würzburg, Germany
| | - Andrea A Kühn
- Department of Neurology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | | | - Inke R König
- Institute of Medical Biometry and Statistics, University of Lübeck, Lübeck, Germany
| | - Carlos Cruchaga
- Department of Psychiatry, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Adam C Cotton
- Department of Neurology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Gamze Kilic-Berkmen
- Department of Neurology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Alan Freeman
- Department of Neurology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Stewart A Factor
- Department of Neurology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Laura Scorr
- Department of Neurology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - J Douglas Bremner
- Atlanta VA Medical Center, Decatur, Georgia, USA.,Departments of Psychiatry & Behavioral Sciences and Radiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Viola Vaccarino
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, Georgia, USA
| | - Arshed A Quyyumi
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Christine Klein
- Institute of Neurogenetics, University of Lübeck, Lübeck, Germany
| | - Joel S Perlmutter
- Department of Neurology, Radiology, Neuroscience, Physical Therapy and Occupational Therapy, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Katja Lohmann
- Institute of Neurogenetics, University of Lübeck, Lübeck, Germany
| | - Hyder A Jinnah
- Department of Neurology, Emory University School of Medicine, Atlanta, Georgia, USA.,Department of Human Genetics, Emory University School of Medicine, Atlanta, Georgia, USA
| |
Collapse
|
24
|
Cudkowicz M, Chase MK, Coffey CS, Ecklund DJ, Thornell BJ, Lungu C, Mahoney K, Gutmann L, Shefner JM, Staley KJ, Bosch M, Foster E, Long JD, Bayman EO, Torner J, Yankey J, Peters R, Huff T, Conwit RA, Shinnar S, Patch D, Darras BT, Ellis A, Packer RJ, Marder KS, Chiriboga CA, Henchcliffe C, Moran JA, Nikolov B, Factor SA, Seeley C, Greenberg SM, Amato AA, DeGregorio S, Simuni T, Ward T, Kissel JT, Kolb SJ, Bartlett A, Quinn JF, Keith K, Levine SR, Gilles N, Coyle PK, Lamb J, Wolfe GI, Crumlish A, Mejico L, Iqbal MM, Bowen JD, Tongco C, Nabors LB, Bashir K, Benge M, McDonald CM, Henricson EK, Oskarsson B, Dobkin BH, Canamar C, Glauser TA, Woo D, Molloy A, Clark P, Vollmer TL, Stein AJ, Barohn RJ, Dimachkie MM, Le Pichon JB, Benatar MG, Steele J, Wechsler L, Clemens PR, Amity C, Holloway RG, Annis C, Goldberg MP, Andersen M, Iannaccone ST, Smith AG, Singleton JR, Doudova M, Haley EC, Quigg MS, Lowenhaupt S, Malow BA, Adkins K, Clifford DB, Teshome MA, Connolly N. Seven-Year Experience From the National Institute of Neurological Disorders and Stroke-Supported Network for Excellence in Neuroscience Clinical Trials. JAMA Neurol 2021; 77:755-763. [PMID: 32202612 DOI: 10.1001/jamaneurol.2020.0367] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Importance One major advantage of developing large, federally funded networks for clinical research in neurology is the ability to have a trial-ready network that can efficiently conduct scientifically rigorous projects to improve the health of people with neurologic disorders. Observations National Institute of Neurological Disorders and Stroke Network for Excellence in Neuroscience Clinical Trials (NeuroNEXT) was established in 2011 and renewed in 2018 with the goal of being an efficient network to test between 5 and 7 promising new agents in phase II clinical trials. A clinical coordinating center, data coordinating center, and 25 sites were competitively chosen. Common infrastructure was developed to accelerate timelines for clinical trials, including central institutional review board (a first for the National Institute of Neurological Disorders and Stroke), master clinical trial agreements, the use of common data elements, and experienced research sites and coordination centers. During the first 7 years, the network exceeded the goal of conducting 5 to 7 studies, with 9 funded. High interest was evident by receipt of 148 initial applications for potential studies in various neurologic disorders. Across the first 8 studies (the ninth study was funded at end of initial funding period), the central institutional review board approved the initial protocol in a mean (SD) of 59 (21) days, and additional sites were added a mean (SD) of 22 (18) days after submission. The median time from central institutional review board approval to first site activation was 47.5 days (mean, 102.1; range, 1-282) and from first site activation to first participant consent was 27 days (mean, 37.5; range, 0-96). The median time for database readiness was 3.5 months (mean, 4.0; range, 0-8) from funding receipt. In the 4 completed studies, enrollment met or exceeded expectations with 96% overall data accuracy across all sites. Nine peer-reviewed manuscripts were published, and 22 oral presentations or posters and 9 invited presentations were given at regional, national, and international meetings. Conclusions and Relevance NeuroNEXT initiated 8 studies, successfully enrolled participants at or ahead of schedule, collected high-quality data, published primary results in high-impact journals, and provided mentorship, expert statistical, and trial management support to several new investigators. Partnerships were successfully created between government, academia, industry, foundations, and patient advocacy groups. Clinical trial consortia can efficiently and successfully address a range of important neurologic research and therapeutic questions.
Collapse
Affiliation(s)
| | | | | | | | | | - Codrin Lungu
- Division of Clinical Research, National Institute of Neurological Disorders and Stroke, NIH, Bethesda, Maryland
| | | | | | - Jeremy M Shefner
- Barrow Neurological Institute, University of Arizona College of Medicine, Tucson
| | | | | | | | | | | | | | | | | | | | - Robin A Conwit
- Division of Clinical Research, National Institute of Neurological Disorders and Stroke, NIH, Bethesda, Maryland
| | | | - Shlomo Shinnar
- Montefiore Medical Center: Einstein Campus, Bronx, New York
| | - Donna Patch
- Montefiore Medical Center: Einstein Campus, Bronx, New York
| | | | - Audrey Ellis
- Boston Children's Hospital, Boston, Massachusetts
| | | | - Karen S Marder
- Columbia University Irving Medical Center, New York, New York.,Weill Cornell Medical, New York, New York
| | - Claudia A Chiriboga
- Columbia University Irving Medical Center, New York, New York.,Weill Cornell Medical, New York, New York
| | - Claire Henchcliffe
- Columbia University Irving Medical Center, New York, New York.,Weill Cornell Medical, New York, New York
| | - Joyce Ann Moran
- Columbia University Irving Medical Center, New York, New York.,Weill Cornell Medical, New York, New York
| | - Blagovest Nikolov
- Columbia University Irving Medical Center, New York, New York.,Weill Cornell Medical, New York, New York
| | | | - Carole Seeley
- Emory University School of Medicine, Atlanta, Georgia
| | - Steven M Greenberg
- Massachusetts General Hospital, Boston.,Brigham and Women's Hospital, Boston, Massachusetts
| | - Anthony A Amato
- Massachusetts General Hospital, Boston.,Brigham and Women's Hospital, Boston, Massachusetts
| | - Sara DeGregorio
- Massachusetts General Hospital, Boston.,Brigham and Women's Hospital, Boston, Massachusetts
| | - Tanya Simuni
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Tina Ward
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - John T Kissel
- Ohio State University Wexner Medical Center, Columbus
| | | | - Amy Bartlett
- Ohio State University Wexner Medical Center, Columbus
| | | | | | | | | | - Patricia K Coyle
- Stony Brook University, State University of New York, Stony Brook
| | - Jessica Lamb
- Stony Brook University, State University of New York, Stony Brook
| | - Gil I Wolfe
- University at Buffalo, State University of New York, Buffalo
| | | | - Luis Mejico
- SUNY Upstate Medical University, Syracuse, New York
| | | | | | | | | | | | | | | | | | | | | | | | - Tracy A Glauser
- Cincinnati Children's Hospital, University of Cincinnati, Cincinnati, Ohio
| | - Daniel Woo
- Cincinnati Children's Hospital, University of Cincinnati, Cincinnati, Ohio
| | - Angela Molloy
- Cincinnati Children's Hospital, University of Cincinnati, Cincinnati, Ohio
| | - Peggy Clark
- Cincinnati Children's Hospital, University of Cincinnati, Cincinnati, Ohio
| | | | | | - Richard J Barohn
- Children's Mercy Hospital, University of Kansas, Kansas City, Missouri
| | - Mazen M Dimachkie
- Children's Mercy Hospital, University of Kansas, Kansas City, Missouri
| | | | - Michael G Benatar
- University of Miami Miller School of Medicine, Coral Gables, Florida
| | - Julie Steele
- University of Miami Miller School of Medicine, Coral Gables, Florida
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
25
|
Liu C, Scorr L, Kilic-Berkmen G, Cotton A, Factor SA, Freeman A, Tran V, Liu K, Uppal K, Jones D, Jinnah HA, Sun YV. A metabolomic study of cervical dystonia. Parkinsonism Relat Disord 2021; 82:98-103. [PMID: 33271463 PMCID: PMC7856090 DOI: 10.1016/j.parkreldis.2020.11.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 10/26/2020] [Accepted: 11/21/2020] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Cervical dystonia is the most common of the adult-onset focal dystonias. Most cases are idiopathic. The current view is that cervical dystonia may be caused by some combination of genetic and environmental factors. Genetic contributions have been studied extensively, but there are few studies of other factors. We conducted an exploratory metabolomics analysis of cervical dystonia to identify potentially abnormal metabolites or altered biological pathways. METHODS Plasma samples from 100 cases with idiopathic cervical dystonia and 100 controls were compared using liquid chromatography coupled with mass spectrometry-based metabolomics. RESULTS A total of 7346 metabolic features remained after quality control, and up to 289 demonstrated significant differences between cases and controls, depending on statistical criteria chosen. Pathway analysis revealed 9 biological processes to be significantly associated at p < 0.05, 5 pathways were related to carbohydrate metabolism, 3 pathways were related to lipid metabolism. CONCLUSION This is the first large scale metabolomics study for any type of dystonia. The results may provide potential novel insights into the biology of cervical dystonia.
Collapse
Affiliation(s)
- Chang Liu
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA, USA.
| | - Laura Scorr
- Jean and Paul Amos Parkinson's Disease and Movement Disorder Clinic Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA.
| | - Gamze Kilic-Berkmen
- Jean and Paul Amos Parkinson's Disease and Movement Disorder Clinic Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA.
| | - Adam Cotton
- Jean and Paul Amos Parkinson's Disease and Movement Disorder Clinic Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA.
| | - Stewart A Factor
- Jean and Paul Amos Parkinson's Disease and Movement Disorder Clinic Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA.
| | - Alan Freeman
- Jean and Paul Amos Parkinson's Disease and Movement Disorder Clinic Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA.
| | - ViLinh Tran
- Clinical Biomarkers Laboratory, Department of Pulmonary, Allergy, Critical Care and Sleep Medicine, Emory University School of Medicine, Atlanta, GA, USA.
| | - Ken Liu
- Clinical Biomarkers Laboratory, Department of Pulmonary, Allergy, Critical Care and Sleep Medicine, Emory University School of Medicine, Atlanta, GA, USA.
| | - Karan Uppal
- Department of Pulmonary, Allergy, Critical Care and Sleep Medicine, Emory University School of Medicine, Atlanta, GA, USA.
| | - Dean Jones
- Department of Pulmonary, Allergy, Critical Care and Sleep Medicine, Emory University School of Medicine, Atlanta, GA, USA.
| | - H A Jinnah
- Jean and Paul Amos Parkinson's Disease and Movement Disorder Clinic Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA; Department of Human Genetics, Emory University School of Medicine, Atlanta, GA, USA.
| | - Yan V Sun
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA, USA; Department of Biomedical Informatics, Emory University School of Medicine, Atlanta, GA, USA.
| |
Collapse
|
26
|
Martino G, McKay JL, Factor SA, Ting LH. Neuromechanical Assessment of Activated vs. Resting Leg Rigidity Using the Pendulum Test Is Associated With a Fall History in People With Parkinson's Disease. Front Hum Neurosci 2020; 14:602595. [PMID: 33362496 PMCID: PMC7756105 DOI: 10.3389/fnhum.2020.602595] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 11/16/2020] [Indexed: 11/13/2022] Open
Abstract
Leg rigidity is associated with frequent falls in people with Parkinson’s disease (PD), suggesting a potential role in functional balance and gait impairments. Changes in the neural state due to secondary tasks, e.g., activation maneuvers, can exacerbate (or “activate”) rigidity, possibly increasing the risk of falls. However, the subjective interpretation and coarse classification of the standard clinical rigidity scale has prohibited the systematic, objective assessment of resting and activated leg rigidity. The pendulum test is an objective diagnostic method that we hypothesized would be sensitive enough to characterize resting and activated leg rigidity. We recorded kinematic data and electromyographic signals from rectus femoris and biceps femoris during the pendulum test in 15 individuals with PD, spanning a range of leg rigidity severity. From the recorded data of leg swing kinematics, we measured biomechanical outcomes including first swing excursion, first extension peak, number and duration of the oscillations, resting angle, relaxation index, maximum and minimum angular velocity. We examined associations between biomechanical outcomes and clinical leg rigidity score. We evaluated the effect of increasing rigidity through activation maneuvers on biomechanical outcomes. Finally, we assessed whether either biomechanical outcomes or changes in outcomes with activation were associated with a fall history. Our results suggest that the biomechanical assessment of the pendulum test can objectively quantify parkinsonian leg rigidity. We found that the presence of high rigidity during clinical exam significantly impacted biomechanical outcomes, i.e., first extension peak, number of oscillations, relaxation index, and maximum angular velocity. No differences in the effect of activation maneuvers between groups with clinically assessed low rigidity were observed, suggesting that activated rigidity may be independent of resting rigidity and should be scored as independent variables. Moreover, we found that fall history was more common among people whose rigidity was increased with a secondary task, as measured by biomechanical outcomes. We conclude that different mechanisms contributing to resting and activated rigidity may play an important yet unexplored functional role in balance impairments. The pendulum test may contribute to a better understanding of fundamental mechanisms underlying motor symptoms in PD, evaluating the efficacy of treatments, and predicting the risk of falls.
Collapse
Affiliation(s)
- Giovanni Martino
- W.H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology, Emory University, Atlanta, GA, United States
| | - J Lucas McKay
- W.H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology, Emory University, Atlanta, GA, United States.,Department of Biomedical Informatics, Emory University, Atlanta, GA, United States.,Jean and Paul Amos PD and Movement Disorders Program, Department of Neurology, Emory University, Atlanta, GA, United States
| | - Stewart A Factor
- Jean and Paul Amos PD and Movement Disorders Program, Department of Neurology, Emory University, Atlanta, GA, United States
| | - Lena H Ting
- W.H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology, Emory University, Atlanta, GA, United States.,Department of Rehabilitation Medicine, Division of Physical Therapy, Emory University, Atlanta, GA, United States
| |
Collapse
|
27
|
Abstract
Functional neurological disorder (FND) is a complex neuropsychiatric syndrome with many phenotypes that are commonly encountered in clinical practice. Despite the heterogeneity of FND, the rate of misidentification is consistently low. For the more common motor subtypes, there are clear positive clinical, electrophysiological, and rarely imaging criteria that can establish the diagnosis in the traditional sense. For nonmotor subtypes, the characterization may be less clear. Here, we argue that the current diagnostic criteria are not reflective of the current shared neuropsychiatric understanding of FND, and, as a result, provide an incomplete picture of the diagnosis. We propose a three-step diagnostic triad for FND, in which the traditional neurological diagnosis is only the first element. Other steps include psychiatric/psychological formulation, integration, and follow-up. We advocate that this diagnostic approach should be the shared responsibility of neurology and mental health professionals. Finally, a research agenda is proposed to address the missing factors in the field.
Collapse
Affiliation(s)
- Sarah C Lidstone
- Edmond J. Safra Program in Parkinson's Disease and the Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital and the University of Toronto, Toronto, Ontario, Canada
| | - Walid Nassif
- Department of Psychiatry, Emory University, and the Veterans Affairs Medical Center, Atlanta, Georgia, USA
| | - Jorge Juncos
- Department of Neurology, Jean and Paul Amos Parkinson's Disease and Movement Disorders Program, Emory University, Atlanta, Georgia, USA
| | - Stewart A Factor
- Department of Neurology, Jean and Paul Amos Parkinson's Disease and Movement Disorders Program, Emory University, Atlanta, Georgia, USA
| | - Anthony E Lang
- Edmond J. Safra Program in Parkinson's Disease and the Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital and the University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
28
|
Cisneros E, Stebbins GT, Chen Q, Vu JP, Benadof CN, Zhang Z, Barbano RL, Fox SH, Goetz CG, Jankovic J, Jinnah HA, Perlmutter JS, Adler CH, Factor SA, Reich SG, Rodriguez R, Severt LL, Stover NP, Berman BD, Comella CL, Peterson DA. It's tricky: Rating alleviating maneuvers in cervical dystonia. J Neurol Sci 2020; 419:117205. [PMID: 33160248 DOI: 10.1016/j.jns.2020.117205] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 10/12/2020] [Accepted: 10/20/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVES To investigate hypothesized sources of error when quantifying the effect of the sensory trick in cervical dystonia (CD) with the Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS-2), test strategies to mitigate them, and provide guidance for future research on the sensory trick. METHODS Previous analyses suggested the sensory trick (or "alleviating maneuver", AM) item be removed from the TWSTRS-2 because of its poor clinimetric properties. We hypothesized three sources of clinimetric weakness for rating the AM: 1) whether patients were given sufficient time to demonstrate their AM; 2) whether patients' CD was sufficiently severe for detecting AM efficacy; and 3) whether raters were inadvertently rating the item in reverse of scale instructions. We tested these hypotheses with video recordings and TWSTRS-2 ratings by one "site rater" and a panel of five "video raters" for each of 185 Dystonia Coalition patients with isolated CD. RESULTS Of 185 patients, 23 (12%) were not permitted sufficient testing time to exhibit an AM, 23 (12%) had baseline CD too mild to allow confident rating of AM effect, and 1 site- and 1 video-rater each rated the AM item with a reverse scoring convention. When these confounds were eliminated in step-wise fashion, the item's clinimetric properties improved. CONCLUSIONS The AM's efficacy can contribute to measuring CD motor severity by addressing identified sources of error during its assessment and rating. Given the AM's sensitive diagnostic and potential pathophysiologic significance, we also provide guidance on modifications to how AMs can be assessed in future CD research.
Collapse
Affiliation(s)
- Elizabeth Cisneros
- Institute for Neural Computation, University of California, San Diego, 9500 Gilman Dr, La Jolla, CA 92093, United States of America.
| | - Glenn T Stebbins
- Department of Neurological Sciences, Rush University Medical Center, 1620 W Harrison St, Chicago, IL 60612, United States of America.
| | - Qiyu Chen
- Institute for Neural Computation, University of California, San Diego, 9500 Gilman Dr, La Jolla, CA 92093, United States of America.
| | - Jeanne P Vu
- Institute for Neural Computation, University of California, San Diego, 9500 Gilman Dr, La Jolla, CA 92093, United States of America
| | - Casey N Benadof
- Institute for Neural Computation, University of California, San Diego, 9500 Gilman Dr, La Jolla, CA 92093, United States of America
| | - Zheng Zhang
- Institute for Neural Computation, University of California, San Diego, 9500 Gilman Dr, La Jolla, CA 92093, United States of America
| | - Richard L Barbano
- Department of Neurology, University of Rochester, 500 Joseph C. Wilson Blvd, Rochester, NY 14627, United States of America.
| | - Susan H Fox
- Movement Disorder Clinic, Toronto Western Hospital, 399 Bathurst Street, Toronto, ON M5T 2S8, Canada; Medical Sciences Building, 1 King's College Cir, Toronto, ON M5S 1A8, Canada.
| | - Christopher G Goetz
- Department of Neurological Sciences, Rush University Medical Center, 1620 W Harrison St, Chicago, IL 60612, United States of America.
| | - Joseph Jankovic
- Department of Neurology, Baylor College of Medicine, 1 Baylor Plaza, Houston, TX 77030, United States of America.
| | - Hyder A Jinnah
- Departments of Neurology and Human Genetics, Emory University, 1365 Clifton Rd building b suite 2200, Atlanta, GA 30322, United States of America.
| | - Joel S Perlmutter
- Department of Neurology, Washington University School of Medicine, 660 S Euclid Ave, St. Louis, MO 63110, United States of America; Departments of Radiology, Neuroscience, Physical Therapy, and Occupational Therapy, Washington University School of Medicine, 660 S Euclid Ave, St. Louis, MO 63110, United States of America.
| | - Charles H Adler
- Department of Neurology, Mayo Clinic College of Medicine, 200 1st St SW, Rochester, MN 55905, United States of America.
| | - Stewart A Factor
- Department of Neurology, Emory University School of Medicine, 201 Dowman Dr, Atlanta, GA 30322, United States of America.
| | - Stephen G Reich
- Department of Neurology, University of Maryland Medical Centre, 22 S Greene St, Baltimore, MD 21201, United States of America.
| | - Ramon Rodriguez
- UF Department of Neurology, 1149 Newell Dr, Gainesville, FL 32611, United States of America.
| | - Lawrence L Severt
- Department of Neurology, Beth Israel Medical Center, 529 W 42nd St # 6K, New York, NY 10036, United States of America
| | - Natividad P Stover
- Department of Neurology, The University of Alabama, Tuscaloosa, AL 35487, United States of America.
| | - Brian D Berman
- Department of Neurology, Virginia Commonwealth University, 1101 East Marshall Street, PO Box 980599, Richmond, VA 23298-0599, United States of America.
| | - Cynthia L Comella
- Department of Neurological Sciences, Rush University Medical Center, 1620 W Harrison St, Chicago, IL 60612, United States of America.
| | - David A Peterson
- Institute for Neural Computation, University of California, San Diego, 9500 Gilman Dr, La Jolla, CA 92093, United States of America; CNL-S, Salk Institute for Biological Studies, 10010 N Torrey Pines Rd, La Jolla, CA 92037, United States of America.
| |
Collapse
|
29
|
Richardson RM, Bankiewicz KS, Christine CW, Van Laar AD, Gross RE, Lonser R, Factor SA, Kostyk SK, Kells AP, Ravina B, Larson PS. Data-driven evolution of neurosurgical gene therapy delivery in Parkinson's disease. J Neurol Neurosurg Psychiatry 2020; 91:1210-1218. [PMID: 32732384 PMCID: PMC7569395 DOI: 10.1136/jnnp-2020-322904] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 04/28/2020] [Accepted: 06/11/2020] [Indexed: 12/11/2022]
Abstract
Loss of nigrostriatal dopaminergic projection neurons is a key pathology in Parkinson's disease, leading to abnormal function of basal ganglia motor circuits and the accompanying characteristic motor features. A number of intraparenchymally delivered gene therapies designed to modify underlying disease and/or improve clinical symptoms have shown promise in preclinical studies and subsequently were evaluated in clinical trials. Here we review the challenges with surgical delivery of gene therapy vectors that limited therapeutic outcomes in these trials, particularly the lack of real-time monitoring of vector administration. These challenges have recently been addressed during the evolution of novel techniques for vector delivery that include the use of intraoperative MRI. The preclinical development of these techniques are described in relation to recent clinical translation in an adeno-associated virus serotype 2-mediated human aromatic L-amino acid decarboxylase gene therapy development programme. This new paradigm allows visualisation of the accuracy and adequacy of viral vector delivery within target structures, enabling intertrial modifications in surgical approaches, cannula design, vector volumes and dosing. The rapid, data-driven evolution of these procedures is unique and has led to improved vector delivery.
Collapse
Affiliation(s)
- R Mark Richardson
- Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts, USA .,Harvard Medical School, Boston, Massachusetts, USA
| | - Krystof S Bankiewicz
- Department of Neurological Surgery, University of California San Francisco, San Francisco, California, USA.,Department of Neurological Surgery, Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Chadwick W Christine
- Department of Neurology, University of California San Francisco, San Francisco, California, USA
| | - Amber D Van Laar
- Department of Neurology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.,Brain Neurotherapy Bio, Inc, Columbus, Ohio, USA
| | - Robert E Gross
- Department of Neurosurgery, Emory University, Atlanta, Georgia, USA.,Department of Neurology, Emory University, Atlanta, Georgia, USA
| | - Russell Lonser
- Department of Neurological Surgery, Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Stewart A Factor
- Department of Neurology, Emory University, Atlanta, Georgia, USA
| | - Sandra K Kostyk
- Departments of Neuroscience and Neurology, Ohio State University College of Medicine, Columbus, Ohio, USA
| | | | - Bernard Ravina
- Praxis Precision Medicines, Inc, Cambridge, Massachusetts, USA
| | - Paul S Larson
- Department of Neurological Surgery, University of California San Francisco, San Francisco, California, USA
| |
Collapse
|
30
|
Higginbotham L, Ping L, Dammer EB, Duong DM, Zhou M, Gearing M, Hurst C, Glass JD, Factor SA, Johnson ECB, Hajjar I, Lah JJ, Levey AI, Seyfried NT. Integrated proteomics reveals brain-based cerebrospinal fluid biomarkers in asymptomatic and symptomatic Alzheimer's disease. Sci Adv 2020; 6:eaaz9360. [PMID: 33087358 PMCID: PMC7577712 DOI: 10.1126/sciadv.aaz9360] [Citation(s) in RCA: 153] [Impact Index Per Article: 38.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Accepted: 09/03/2020] [Indexed: 05/02/2023]
Abstract
Alzheimer's disease (AD) lacks protein biomarkers reflective of its diverse underlying pathophysiology, hindering diagnostic and therapeutic advancements. Here, we used integrative proteomics to identify cerebrospinal fluid (CSF) biomarkers representing a wide spectrum of AD pathophysiology. Multiplex mass spectrometry identified ~3500 and ~12,000 proteins in AD CSF and brain, respectively. Network analysis of the brain proteome resolved 44 biologically diverse modules, 15 of which overlapped with the CSF proteome. CSF AD markers in these overlapping modules were collapsed into five protein panels representing distinct pathophysiological processes. Synaptic and metabolic panels were decreased in AD brain but increased in CSF, while glial-enriched myelination and immunity panels were increased in brain and CSF. The consistency and disease specificity of panel changes were confirmed in >500 additional CSF samples. These panels also identified biological subpopulations within asymptomatic AD. Overall, these results are a promising step toward a network-based biomarker tool for AD clinical applications.
Collapse
Affiliation(s)
- Lenora Higginbotham
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA
- Center for Neurodegenerative Disease, Emory University School of Medicine, Atlanta, GA, USA
- Goizueta Alzheimer's Disease Research Center, Emory University, Atlanta, GA, USA
| | - Lingyan Ping
- Center for Neurodegenerative Disease, Emory University School of Medicine, Atlanta, GA, USA
- Goizueta Alzheimer's Disease Research Center, Emory University, Atlanta, GA, USA
- Department of Biochemistry, Emory University School of Medicine, Atlanta, GA, USA
| | - Eric B Dammer
- Center for Neurodegenerative Disease, Emory University School of Medicine, Atlanta, GA, USA
- Goizueta Alzheimer's Disease Research Center, Emory University, Atlanta, GA, USA
- Department of Biochemistry, Emory University School of Medicine, Atlanta, GA, USA
| | - Duc M Duong
- Center for Neurodegenerative Disease, Emory University School of Medicine, Atlanta, GA, USA
- Goizueta Alzheimer's Disease Research Center, Emory University, Atlanta, GA, USA
- Department of Biochemistry, Emory University School of Medicine, Atlanta, GA, USA
| | - Maotian Zhou
- Center for Neurodegenerative Disease, Emory University School of Medicine, Atlanta, GA, USA
- Goizueta Alzheimer's Disease Research Center, Emory University, Atlanta, GA, USA
- Department of Biochemistry, Emory University School of Medicine, Atlanta, GA, USA
| | - Marla Gearing
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA
- Goizueta Alzheimer's Disease Research Center, Emory University, Atlanta, GA, USA
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Cheyenne Hurst
- Center for Neurodegenerative Disease, Emory University School of Medicine, Atlanta, GA, USA
| | - Jonathan D Glass
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA
- Center for Neurodegenerative Disease, Emory University School of Medicine, Atlanta, GA, USA
- Goizueta Alzheimer's Disease Research Center, Emory University, Atlanta, GA, USA
| | - Stewart A Factor
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA
| | - Erik C B Johnson
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA
- Center for Neurodegenerative Disease, Emory University School of Medicine, Atlanta, GA, USA
- Goizueta Alzheimer's Disease Research Center, Emory University, Atlanta, GA, USA
| | - Ihab Hajjar
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA
- Goizueta Alzheimer's Disease Research Center, Emory University, Atlanta, GA, USA
| | - James J Lah
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA
- Center for Neurodegenerative Disease, Emory University School of Medicine, Atlanta, GA, USA
- Goizueta Alzheimer's Disease Research Center, Emory University, Atlanta, GA, USA
| | - Allan I Levey
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA.
- Center for Neurodegenerative Disease, Emory University School of Medicine, Atlanta, GA, USA
- Goizueta Alzheimer's Disease Research Center, Emory University, Atlanta, GA, USA
| | - Nicholas T Seyfried
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA.
- Center for Neurodegenerative Disease, Emory University School of Medicine, Atlanta, GA, USA
- Goizueta Alzheimer's Disease Research Center, Emory University, Atlanta, GA, USA
- Department of Biochemistry, Emory University School of Medicine, Atlanta, GA, USA
| |
Collapse
|
31
|
Abstract
Tardive syndrome (TS) is an iatrogenic, often persistent movement disorder caused by drugs that block dopamine receptors. It has a broad phenotype including movement (orobuccolingual stereotypy, dystonia, tics, and others) and nonmotor features (akathisia and pain). TS has garnered increased attention of late because of the Food and Drug Administration approval of the first therapeutic agents developed specifically for this purpose. This paper will begin with a discussion on pathogenesis, clinical features, and epidemiology. However, the main focus will be treatment options currently available for TS including a suggested algorithm based on current evidence. Recently, there have been significant advances in TS therapy, particularly with the development of 2 new vesicular monoamine transporter type 2 inhibitors for TS and with new data on the efficacy of deep brain stimulation. The discussion will start with switching antipsychotics and the use of clozapine monotherapy which, despite the lack of higher-level evidence, should be considered for the treatment of psychosis and TS. Anti-dyskinetic drugs are separated into 3 tiers: 1) vesicular monoamine transporter type 2 inhibitors, which have level A evidence, are approved for use in TS and are recommended first-choice agents; 2) drugs with lower level of evidence for efficacy including clonazepam, Ginkgo biloba, and amantadine; and 3) drugs that have the potential to be beneficial, but currently have insufficient evidence including levetiracetam, piracetam, vitamin B6, melatonin, baclofen, propranolol, zolpidem, and zonisamide. Finally, the roles of botulinum toxin and surgical therapy will be examined. Current therapies, though improved, are symptomatic. Next steps should focus on the prevention and reversal of the pathogenic process.
Collapse
Affiliation(s)
- Stewart A Factor
- Jean and Paul Amos Parkinson's Disease and Movement Disorder Program, Emory University School of Medicine, 12 Executive Park Drive Northeast, Atlanta, Georgia, 30329, USA.
| |
Collapse
|
32
|
Langley J, Huddleston DE, Crosson B, Song DD, Factor SA, Hu X. Multimodal assessment of nigrosomal degeneration in Parkinson's disease. Parkinsonism Relat Disord 2020; 80:102-107. [PMID: 32979784 DOI: 10.1016/j.parkreldis.2020.09.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 08/31/2020] [Accepted: 09/14/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Approximately forty percent of all dopaminergic neurons in SNpc are located in five dense neuronal clusters, named nigrosomes. T2- or T2*-weighted images are used to delineate the largest nigrosome, named nigrosome-1. In these images, nigrosome-1 is a hyperintense region in the caudal and dorsal portion of the T2- or T2*-weighted substantia nigra. In PD, nigrosome-1 experiences iron accumulation, which leads to a reduction in T2-weighted hyperintensity. Here, we examine neuromelanin-depletion and iron deposition in regions of interest (ROIs) derived from quantitative-voxel based morphometry (qVBM) on neuromelanin-sensitive images and compare the ROIs with nigrosome-1 identified in T2*-weighted images. METHODS Neuromelanin-sensitive and multi-echo gradient echo imaging data were obtained. R2* was calculated from multi-echo gradient echo imaging data. qVBM analysis was performed on neuromelanin-sensitive images and restricted to SNpc. Mean neuromelanin-sensitive contrast and R2* was measured from the resulting qVBM clusters. Nigrosome-1 was segmented in T2*-weighted images of control subjects and its location was compared to the spatial location of the qVBM clusters. RESULTS Two bilateral clusters emerged from the qVBM analysis. These clusters showed reduced neuromelanin-sensitive contrast and increased mean R2* in PD as compared to controls. Cluster-1 from the qVBM analysis was in a similar spatial location as nigrosome-1, as seen in T2*-weighted images. CONCLUSION qVBM cluster-1 shows reduced neuromelanin-sensitive contrast and is in a similar spatial position as nigrosome-1. This region likely corresponds to nigrosome-1 while the second cluster may correspond to nigrosome-2.
Collapse
Affiliation(s)
- Jason Langley
- Center for Advanced Neuroimaging, University of California, Riverside, Riverside, CA, USA
| | | | - Bruce Crosson
- Department of Neurology, Emory University, Atlanta, GA, USA; Department of Veterans Affairs Center for Visual and Neurocognitive Rehabilitation, Atlanta Veterans Affairs Medical Center, Decatur, GA, USA; Department of Psychology, Georgia State University, Atlanta, GA, USA
| | - David D Song
- Department of Neurosciences, University of California, Riverside, Riverside, CA, USA
| | | | - Xiaoping Hu
- Center for Advanced Neuroimaging, University of California, Riverside, Riverside, CA, USA; Department of Bioengineering, University of California, Riverside, Riverside, CA, USA.
| |
Collapse
|
33
|
Weiss D, Schoellmann A, Fox MD, Bohnen NI, Factor SA, Nieuwboer A, Hallett M, Lewis SJG. Freezing of gait: understanding the complexity of an enigmatic phenomenon. Brain 2020; 143:14-30. [PMID: 31647540 DOI: 10.1093/brain/awz314] [Citation(s) in RCA: 86] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 08/07/2019] [Accepted: 08/16/2019] [Indexed: 12/15/2022] Open
Abstract
Diverse but complementary methodologies are required to uncover the complex determinants and pathophysiology of freezing of gait. To develop future therapeutic avenues, we need a deeper understanding of the disseminated functional-anatomic network and its temporally associated dynamic processes. In this targeted review, we will summarize the latest advances across multiple methodological domains including clinical phenomenology, neurogenetics, multimodal neuroimaging, neurophysiology, and neuromodulation. We found that (i) locomotor network vulnerability is established by structural damage, e.g. from neurodegeneration possibly as result from genetic variability, or to variable degree from brain lesions. This leads to an enhanced network susceptibility, where (ii) modulators can both increase or decrease the threshold to express freezing of gait. Consequent to a threshold decrease, (iii) neuronal integration failure of a multilevel brain network will occur and affect one or numerous nodes and projections of the multilevel network. Finally, (iv) an ultimate pathway might encounter failure of effective motor output and give rise to freezing of gait as clinical endpoint. In conclusion, we derive key questions from this review that challenge this pathophysiological view. We suggest that future research on these questions should lead to improved pathophysiological insight and enhanced therapeutic strategies.
Collapse
Affiliation(s)
- Daniel Weiss
- Centre for Neurology, Department for Neurodegenerative Diseases, and Hertie-Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
| | - Anna Schoellmann
- Centre for Neurology, Department for Neurodegenerative Diseases, and Hertie-Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
| | - Michael D Fox
- Berenson-Allen Center, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical Center, Boston, MA, USA.,Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.,Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA
| | - Nicolaas I Bohnen
- Departments of Radiology and Neurology, University of Michigan, Ann Arbor, MI, USA; Veterans Administration Ann Arbor Healthcare System, Ann Arbor, MI, USA; Morris K. Udall Center of Excellence for Parkinson's Disease Research, University of Michigan, Ann Arbor, MI, USA
| | - Stewart A Factor
- Department of Neurology, Emory School of Medicine, Atlanta, GA, USA
| | - Alice Nieuwboer
- Neuromotor Rehabilitation Research Group, Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | - Mark Hallett
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - Simon J G Lewis
- Parkinson's Disease Research Clinic, Brain and Mind Centre, University of Sydney, Australia
| |
Collapse
|
34
|
Perez Parra S, McKay JL, Factor SA. Diphasic Worsening of Freezing of Gait in Parkinson's Disease. Mov Disord Clin Pract 2020; 7:325-328. [PMID: 32258233 DOI: 10.1002/mdc3.12918] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Revised: 02/07/2020] [Accepted: 02/15/2020] [Indexed: 01/17/2023] Open
Abstract
Background The relationship between freezing of gait (FOG) and levodopa response is complex. Some patients respond, some have no response and in some patients levodopa causes FOG. We present 2 cases demonstrating a diphasic worsening of FOG after levodopa dosing. Cases Two PD patients with FOG were examined during the practically defined off state, the transition from off to on (15 and 22 minutes postdose), and in the full on state (45 and 60 minutes postdose). FOG was measured using Movement Disorder Society-Unified Parkinson's Disease Rating Scale part III, item 11: freezing of gait. Both patients experienced worsening of FOG during the transition followed by improvement during the on state. Case 1 had serum levodopa levels measured. Videos are provided. Conclusions To our knowledge, this diphasic pattern of worsening of FOG has not been previously reported. The cause of this phenomenon is unknown but may relate to an inhibitory action of subthreshold levels of levodopa.
Collapse
Affiliation(s)
- Sahyli Perez Parra
- Jean & Paul Amos PD & Movement Disorders Program Department of Neurology Emory University Atlanta Georgia USA
| | - J Lucas McKay
- Wallace H. Coulter Department of Biomedical Engineering Georgia Tech and Emory University Atlanta Georgia USA
| | - Stewart A Factor
- Jean & Paul Amos PD & Movement Disorders Program Department of Neurology Emory University Atlanta Georgia USA
| |
Collapse
|
35
|
Bezchlibnyk YB, Sharma VD, Naik KB, Isbaine F, Gale JT, Cheng J, Triche SD, Miocinovic S, Buetefisch CM, Willie JT, Boulis NM, Factor SA, Wichmann T, DeLong MR, Gross RE. Clinical outcomes of globus pallidus deep brain stimulation for Parkinson disease: a comparison of intraoperative MRI- and MER-guided lead placement. J Neurosurg 2020; 134:1072-1082. [PMID: 32114534 DOI: 10.3171/2019.12.jns192010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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: 07/24/2019] [Accepted: 12/30/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Deep brain stimulation (DBS) lead placement is increasingly performed with the patient under general anesthesia by surgeons using intraoperative MRI (iMRI) guidance without microelectrode recording (MER) or macrostimulation. The authors assessed the accuracy of lead placement, safety, and motor outcomes in patients with Parkinson disease (PD) undergoing DBS lead placement into the globus pallidus internus (GPi) using iMRI or MER guidance. METHODS The authors identified all patients with PD who underwent either MER- or iMRI-guided GPi-DBS lead placement at Emory University between July 2007 and August 2016. Lead placement accuracy and adverse events were determined for all patients. Clinical outcomes were assessed using the Unified Parkinson's Disease Rating Scale (UPDRS) part III motor scores for patients completing 12 months of follow-up. The authors also assessed the levodopa-equivalent daily dose (LEDD) and stimulation parameters. RESULTS Seventy-seven patients were identified (MER, n = 28; iMRI, n = 49), in whom 131 leads were placed. The stereotactic accuracy of the surgical procedure with respect to the planned lead location was 1.94 ± 0.21 mm (mean ± SEM) (95% CI 1.54-2.34) with frame-based MER and 0.84 ± 0.007 mm (95% CI 0.69-0.98) with iMRI. The rate of serious complications was similar, at 6.9% for MER-guided DBS lead placement and 9.4% for iMRI-guided DBS lead placement (RR 0.71 [95% CI 0.13%-3.9%]; p = 0.695). Fifty-seven patients were included in clinical outcome analyses (MER, n = 16; iMRI, n = 41). Both groups had similar characteristics at baseline, although patients undergoing MER-guided DBS had a lower response on their baseline levodopa challenge (44.8% ± 5.4% [95% CI 33.2%-56.4%] vs 61.6% ± 2.1% [95% CI 57.4%-65.8%]; t = 3.558, p = 0.001). Greater improvement was seen following iMRI-guided lead placement (43.2% ± 3.5% [95% CI 36.2%-50.3%]) versus MER-guided lead placement (25.5% ± 6.7% [95% CI 11.1%-39.8%]; F = 5.835, p = 0.019). When UPDRS III motor scores were assessed only in the contralateral hemibody (per-lead analyses), the improvements remained significantly different (37.1% ± 7.2% [95% CI 22.2%-51.9%] and 50.0% ± 3.5% [95% CI 43.1%-56.9%] for MER- and iMRI-guided DBS lead placement, respectively). Both groups exhibited similar reductions in LEDDs (21.2% and 20.9%, respectively; F = 0.221, p = 0.640). The locations of all active contacts and the 2D radial distance from these to consensus coordinates for GPi-DBS lead placement (x, ±20; y, +2; and z, -4) did not differ statistically by type of surgery. CONCLUSIONS iMRI-guided GPi-DBS lead placement in PD patients was associated with significant improvement in clinical outcomes, comparable to those observed following MER-guided DBS lead placement. Furthermore, iMRI-guided DBS implantation produced a similar safety profile to that of the MER-guided procedure. As such, iMRI guidance is an alternative to MER guidance for patients undergoing GPi-DBS implantation for PD.
Collapse
Affiliation(s)
- Yarema B Bezchlibnyk
- 1Department of Neurosurgery and Brain Repair, Morsani School of Medicine, University of South Florida, Tampa, Florida.,2Department of Neurosurgery, Emory University School of Medicine, Atlanta, Georgia
| | - Vibhash D Sharma
- 3Department of Neurology, University of Kansas Medical Center, Kansas City, Kansas.,4Department of Neurology, Emory University School of Medicine
| | - Kushal B Naik
- 5Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, and
| | - Faical Isbaine
- 2Department of Neurosurgery, Emory University School of Medicine, Atlanta, Georgia
| | - John T Gale
- 2Department of Neurosurgery, Emory University School of Medicine, Atlanta, Georgia
| | - Jennifer Cheng
- 2Department of Neurosurgery, Emory University School of Medicine, Atlanta, Georgia.,6Department of Neurosurgery, University of Kansas Medical Center, Kansas City, Kansas
| | | | | | | | - Jon T Willie
- 2Department of Neurosurgery, Emory University School of Medicine, Atlanta, Georgia.,4Department of Neurology, Emory University School of Medicine
| | - Nicholas M Boulis
- 2Department of Neurosurgery, Emory University School of Medicine, Atlanta, Georgia
| | | | - Thomas Wichmann
- 4Department of Neurology, Emory University School of Medicine
| | - Mahlon R DeLong
- 4Department of Neurology, Emory University School of Medicine
| | - Robert E Gross
- 2Department of Neurosurgery, Emory University School of Medicine, Atlanta, Georgia.,4Department of Neurology, Emory University School of Medicine
| |
Collapse
|
36
|
Wallace DM, Wohlgemuth WK, Trotti LM, Amara AW, Malaty IA, Factor SA, Nallu S, Wittine L, Hauser RA. Practical Evaluation and Management of Insomnia in Parkinson's Disease: A Review. Mov Disord Clin Pract 2020; 7:250-266. [PMID: 32258222 PMCID: PMC7111581 DOI: 10.1002/mdc3.12899] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2019] [Revised: 12/10/2019] [Accepted: 01/03/2020] [Indexed: 12/12/2022] Open
Abstract
Background Insomnia is one of the most common nonmotor features of Parkinson's disease (PD). However, there are few practical guidelines for providers on how to best evaluate and treat this problem. Methods and Findings This review was developed to provide clinicians with a pragmatic approach to assessing and managing insomnia in PD. Recommendations were based on literature review and expert opinion. We addressed the following topics in this review: prevalence of insomnia in PD, sleep-wake mechanisms, theoretical models of insomnia, risk factors, assessment, pharmacologic and nonpharmacologic treatments. Insomnia treatment choices may be guided by PD severity, comorbidities, and patient preference. However, there is limited evidence supporting pharmacotherapy and nonpharmacologic treatments of insomnia in PD. Conclusions We provide a pragmatic algorithm for evaluating and treating insomnia in PD based on the literature and our clinical experience. We propose personalized insomnia treatment approaches based on age and other issues. Gaps in the existing literature and future directions in the treatment of insomnia in PD are also highlighted.
Collapse
Affiliation(s)
- Douglas M Wallace
- Department of Neurology, Sleep Medicine Division University of Miami Miller School of Medicine Miami FL USA.,Neurology Service Bruce W. Carter Department of Veterans Affairs Medical Center Miami FL USA
| | - William K Wohlgemuth
- Neurology Service Bruce W. Carter Department of Veterans Affairs Medical Center Miami FL USA.,Psychology Service Bruce W. Carter Department of Veterans Affairs Medical Center Miami FL USA
| | - Lynn Marie Trotti
- Department of Neurology and Emory Sleep Center Emory University School of Medicine Atlanta GA USA
| | - Amy W Amara
- Department of Neurology University of Alabama at Birmingham School of Medicine Birmingham AL USA
| | - Irene A Malaty
- Department of Neurology, Fixel Institute University of Florida Gainesville FL USA
| | - Stewart A Factor
- Jean and Paul Amos Parkinson's Disease and Movement Disorders Center Emory University School of Medicine Atlanta GA USA
| | - Sagarika Nallu
- Department of Pediatrics, Morsani College of Medicine University of South Florida Tampa FL USA
| | - Lara Wittine
- Department of Medicine, Morsani College of Medicine University of South Florida Tampa FL USA
| | - Robert A Hauser
- Department of Neurology, Morsani College of Medicine University of South Florida Tampa FL USA
| |
Collapse
|
37
|
Bong SM, McKay JL, Factor SA, Ting LH. Perception of whole-body motion during balance perturbations is impaired in Parkinson's disease and is associated with balance impairment. Gait Posture 2020; 76:44-50. [PMID: 31731133 PMCID: PMC7015810 DOI: 10.1016/j.gaitpost.2019.10.029] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2019] [Revised: 09/09/2019] [Accepted: 10/22/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND In addition to motor deficits, Parkinson's disease (PD) may cause perceptual impairments. The role of perceptual impairments in sensorimotor function is unclear, and has typically been studied in single-joint motions. RESEARCH QUESTION We hypothesized that perception of whole-body motion is impaired in PD and contributes to balance impairments. We tested (1) whether directional acuity to whole body perturbations during standing was worse in people with PD compared to neurotypical older adults (NOA), and (2) whether balance ability, as assessed by the MiniBESTest, was associated with poor directional acuity in either group. METHODS Participants were exposed to pairs of support-surface translation perturbations in a two-alternative forced choice testing paradigm developed previously in a young healthy population. The first perturbation of each pair that was to be judged by participants was directly backward, and the second perturbation deviated from the left or right from the backward direction by 1°-44°. Participants reported whether the perturbations in each pair were in the "same" or "different" direction. Judgements from 24 to 67 perturbation pairs were used to calculate directional acuity thresholds corresponding to "just-noticeable differences" in perturbation direction. Linear mixed models determined associations between directional thresholds and clinical variables including MDS-UPDRS-III score, age, and MiniBESTest score. RESULTS 20 PD (64 ± 7 y, 12 male, ≥12 h since last intake of antiparkinsonian medications) and 12 NOA (64 ± 8, 6 male) were assessed. Directional thresholds were higher (worse) among PD participants (17.6 ± 5.9° vs. 12.8 ± 3.3°, P < 0.01). Linear mixed models further showed that higher thresholds were associated with MDS-UPDRS-III score (P < 0.01), and were associated with poorer balance ability among PD participants (P < 0.01), but not among NOA participants (P = 0.40). SIGNIFICANCE Perception of whole-body motion is impaired in PD and may contribute to impaired balance and falls.
Collapse
Affiliation(s)
- Sistania M. Bong
- Wallace H. Coulter Department of Biomedical Engineering,
Emory University and Georgia Tech, Atlanta, Georgia, USA
| | - J. Lucas McKay
- Wallace H. Coulter Department of Biomedical Engineering,
Emory University and Georgia Tech, Atlanta, Georgia, USA
| | - Stewart A. Factor
- Jean & Paul Amos PD & Movement Disorders Program,
Department of Neurology, Emory University School of Medicine, Atlanta, Georgia,
USA
| | - Lena H. Ting
- Wallace H. Coulter Department of Biomedical Engineering,
Emory University and Georgia Tech, Atlanta, Georgia, USA.,Division of Physical Therapy, Department of Rehabilitation
Medicine, Emory University School of Medicine, Atlanta, Georgia, USA,Corresponding author Lena H. Ting PhD, Wallace H.
Coulter Department of Biomedical Engineering, Emory University and the Georgia
Institute of Technology, 1760 Haygood Drive, Suite W200, Atlanta, Georgia,
30322, USA,
| |
Collapse
|
38
|
Olanow CW, Factor SA, Espay AJ, Hauser RA, Shill HA, Isaacson S, Pahwa R, Leinonen M, Bhargava P, Sciarappa K, Navia B, Blum D, xx X. Apomorphine sublingual film for off episodes in Parkinson's disease: a randomised, double-blind, placebo-controlled phase 3 study. Lancet Neurol 2020; 19:135-144. [DOI: 10.1016/s1474-4422(19)30396-5] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 09/19/2019] [Accepted: 09/23/2019] [Indexed: 01/05/2023]
|
39
|
Fernandez HH, Stamler D, Davis MD, Factor SA, Hauser RA, Jimenez-Shahed J, Ondo WG, Jarskog LF, Woods SW, Bega D, LeDoux MS, Shprecher DR, Anderson KE. Long-term safety and efficacy of deutetrabenazine for the treatment of tardive dyskinesia. J Neurol Neurosurg Psychiatry 2019; 90:1317-1323. [PMID: 31296586 PMCID: PMC6902058 DOI: 10.1136/jnnp-2018-319918] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 05/21/2019] [Accepted: 06/18/2019] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To evaluate the long-term safety and efficacy of deutetrabenazine in patients with tardive dyskinesia (TD). METHOD Patients with TD who completed the 12 week, phase 3, placebo-controlled trials were eligible to enter this open-label, single-arm study. The open-label study consisted of a 6 week dose-escalation phase and a long-term maintenance phase (clinic visits at Weeks 4, 6 and 15, and every 13 weeks until Week 106). Patients began deutetrabenazine at 12 mg/day, titrating up to a dose that was tolerable and provided adequate dyskinesia control, based on investigator judgement, with a maximum allowed dose of 48 mg/day (36 mg/day for patients taking strong cytochrome P450 2D6 (CYP2D6) inhibitors). Safety measures included incidence of adverse events (AEs) and scales used to monitor parkinsonism, akathisia/restlessness, anxiety, depression, suicidality and somnolence/sedation. Efficacy endpoints included the change in Abnormal Involuntary Movement Scale (AIMS) score (items 1 to 7) from baseline and the proportion of patients rated as 'Much Improved' or 'Very Much Improved' on the Clinical Global Impression of Change. RESULTS A total of 343 patients enrolled in the extension study, and there were 331 patient-years of exposure in this analysis. The exposure-adjusted incidence rates of AEs with long-term treatment were comparable to or lower than those observed in the phase 3 trials. The mean (SE) change in AIMS score was -4.9 (0.4) at Week 54 (n = 146), - 6.3 (0.7) at Week 80 (n = 66) and -5.1 (2.0) at Week 106 (n = 8). CONCLUSIONS Overall, long-term treatment with deutetrabenazine was efficacious, safe, and well tolerated in patients with TD. TRIAL REGISTRATION NUMBER NCT02198794.
Collapse
Affiliation(s)
- Hubert H Fernandez
- Center for Neurological Restoration, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - David Stamler
- Former employee of Teva Pharmaceuticals, La Jolla, California, USA
| | - Mat D Davis
- Teva Pharmaceuticals, Frazer, Pennsylvania, USA
| | - Stewart A Factor
- Jean and Paul Amos Parkinson's Disease and Movement Disorder Program, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Robert A Hauser
- University of South Florida Parkinson's Disease and Movement Disorders Center, Tampa, Florida, USA
| | | | - William G Ondo
- Methodist Neurological Institute, Houston, Texas, USA.,Weill Cornell Medical College, New York, New York, USA
| | - L Fredrik Jarskog
- University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, USA
| | - Scott W Woods
- Yale University School of Medicine, New Haven, Connecticut, USA
| | - Danny Bega
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Mark S LeDoux
- University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - David R Shprecher
- University of Utah, Salt Lake City, Utah, USA.,Banner Sun Health Research Institute, Sun City, Arizona, USA
| | | |
Collapse
|
40
|
Sharma VD, Bezchlibnyk YB, Isbaine F, Naik KB, Cheng J, Gale JT, Miocinovic S, Buetefisch C, Factor SA, Willie JT, Boulis NM, Wichmann T, DeLong MR, Gross RE. Clinical outcomes of pallidal deep brain stimulation for dystonia implanted using intraoperative MRI. J Neurosurg 2019; 133:1-13. [PMID: 31604331 DOI: 10.3171/2019.6.jns19548] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [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: 03/02/2019] [Accepted: 06/27/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Lead placement for deep brain stimulation (DBS) using intraoperative MRI (iMRI) relies solely on real-time intraoperative neuroimaging to guide electrode placement, without microelectrode recording (MER) or electrical stimulation. There is limited information, however, on outcomes after iMRI-guided DBS for dystonia. The authors evaluated clinical outcomes and targeting accuracy in patients with dystonia who underwent lead placement using an iMRI targeting platform. METHODS Patients with dystonia undergoing iMRI-guided lead placement in the globus pallidus pars internus (GPi) were identified. Patients with a prior ablative or MER-guided procedure were excluded from clinical outcomes analysis. Burke-Fahn-Marsden Dystonia Rating Scale (BFMDRS) scores and Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS) scores were assessed preoperatively and at 6 and 12 months postoperatively. Other measures analyzed include lead accuracy, complications/adverse events, and stimulation parameters. RESULTS A total of 60 leads were implanted in 30 patients. Stereotactic lead accuracy in the axial plane was 0.93 ± 0.12 mm from the intended target. Nineteen patients (idiopathic focal, n = 7; idiopathic segmental, n = 5; DYT1, n = 1; tardive, n = 2; other secondary, n = 4) were included in clinical outcomes analysis. The mean improvement in BFMDRS score was 51.9% ± 9.7% at 6 months and 63.4% ± 8.0% at 1 year. TWSTRS scores in patients with predominant cervical dystonia (n = 13) improved by 53.3% ± 10.5% at 6 months and 67.6% ± 9.0% at 1 year. Serious complications occurred in 6 patients (20%), involving 8 of 60 implanted leads (13.3%). The rate of serious complications across all patients undergoing iMRI-guided DBS at the authors' institution was further reviewed, including an additional 53 patients undergoing GPi-DBS for Parkinson disease. In this expanded cohort, serious complications occurred in 11 patients (13.3%) involving 15 leads (10.1%). CONCLUSIONS Intraoperative MRI-guided lead placement in patients with dystonia showed improvement in clinical outcomes comparable to previously reported results using awake MER-guided lead placement. The accuracy of lead placement was high, and the procedure was well tolerated in the majority of patients. However, a number of patients experienced serious adverse events that were attributable to the introduction of a novel technique into a busy neurosurgical practice, and which led to the revision of protocols, product inserts, and on-site training.
Collapse
Affiliation(s)
| | - Yarema B Bezchlibnyk
- 3Neurosurgery, Emory University School of Medicine, Atlanta, Georgia
- 4Department of Neurosurgery and Brain Repair, University of South Florida, Tampa, Florida; and
| | - Faical Isbaine
- 3Neurosurgery, Emory University School of Medicine, Atlanta, Georgia
| | - Kushal B Naik
- 6Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Jennifer Cheng
- 3Neurosurgery, Emory University School of Medicine, Atlanta, Georgia
- 5Neurosurgery, University of Kansas Medical Center, Kansas City, Kansas
| | - John T Gale
- 3Neurosurgery, Emory University School of Medicine, Atlanta, Georgia
| | | | | | | | - Jon T Willie
- Departments of1Neurology and
- 3Neurosurgery, Emory University School of Medicine, Atlanta, Georgia
| | - Nicholas M Boulis
- 3Neurosurgery, Emory University School of Medicine, Atlanta, Georgia
| | | | | | - Robert E Gross
- Departments of1Neurology and
- 3Neurosurgery, Emory University School of Medicine, Atlanta, Georgia
| |
Collapse
|
41
|
Tripathi R, Reich SG, Scorr L, Guardiani E, Factor SA. Lurasidone-Induced Tardive Syndrome. Mov Disord Clin Pract 2019; 6:601-604. [PMID: 31538095 DOI: 10.1002/mdc3.12812] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 06/20/2019] [Accepted: 06/24/2019] [Indexed: 11/06/2022] Open
Abstract
Introduction Tardive syndrome (TS) is an often irreversible movement disorder caused by dopamine receptor-blocking agents (DRBAs). Although TS are well recognized to occur with typical antipsychotics, less well appreciated is that atypical antipsychotics also carry a risk of TS. Methods Case series. Results We describe 4 patients who developed tardive dystonia, tardive akathisia, and drug-induced parkinsonism with the use of the atypical antipsychotic, lurasidone, which was U.S. Food and Drug Administration approved in 2013 for use in bipolar disorder and schizophrenia. Conclusion Movement disorders are reported as a rare side effect of lurasidone, and, as such, prescribers may perceive a false sense of security regarding this potential complication. Our cases indicate that this relatively new atypical antipsychotic may cause irreversible disabling TS as well as parkinsonism. Caution must be taken when prescribing lurasidone.
Collapse
Affiliation(s)
- Richa Tripathi
- Department of Neurology Emory University School of Medicine Atlanta Georgia USA
| | - Stephen G Reich
- Department of Neurology University of Maryland School of Medicine Baltimore Maryland USA
| | - Laura Scorr
- Department of Neurology Emory University School of Medicine Atlanta Georgia USA
| | - Elizabeth Guardiani
- Department of Otorhinolaryngology-Head & Neck Surgery University of Maryland School of Medicine Baltimore Maryland USA
| | - Stewart A Factor
- Department of Neurology Emory University School of Medicine Atlanta Georgia USA
| |
Collapse
|
42
|
Factor SA, Burkhard PR, Caroff S, Friedman JH, Marras C, Tinazzi M, Comella CL. Recent developments in drug-induced movement disorders: a mixed picture. Lancet Neurol 2019; 18:880-890. [PMID: 31279747 DOI: 10.1016/s1474-4422(19)30152-8] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2018] [Revised: 03/17/2019] [Accepted: 03/19/2019] [Indexed: 01/14/2023]
Abstract
A large and ever-growing number of medications can induce various movement disorders. Drug-induced movement disorders are disabling but are often under-recognised and inappropriately managed. In particular, second generation antipsychotics, like first generation agents, are associated with potentially debilitating side-effects, most notably tardive syndromes and parkinsonism, as well as potentially fatal acute syndromes. Appropriate, evidence-based management is essential as these drugs are being prescribed to a growing population vulnerable to these side-effects, including children and elderly people. Prevention of the development of drug-induced movement disorders is an important consideration when prescribing medications that can induce movement disorders. Recent developments in diagnosis, such as the use of dopamine transporter imaging for drug-induced parkinsonism, and treatment, with the approval of valbenazine and deutetrabenazine, the first drugs indicated for tardive syndromes, have improved outcomes for many patients with drug-induced movement disorders. Future research should focus on development of safer antipsychotics and specific therapies for the different tardive syndromes and the treatment of drug-induced parkinsonism.
Collapse
Affiliation(s)
- Stewart A Factor
- Jean and Paul Amos Parkinson's Disease and Movement Disorders Program, Emory University School of Medicine, Atlanta, GA, USA.
| | - Pierre R Burkhard
- Department of Neurology, Faculty of Medicine, Geneva University Hospitals, University of Geneva, Geneva, Switzerland
| | - Stanley Caroff
- Corporal Michael J Crescenz VA Medical Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Joseph H Friedman
- Butler Hospital, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Connie Marras
- Edmond J Safra Program in Parkinson's Research, University of Toronto, Toronto Western Hospital, Toronto, ON, Canada
| | - Michele Tinazzi
- Department of Neuroscience, Biomedicine, and Movement, University of Verona, Verona, Italy
| | - Cynthia L Comella
- Department of Neurological Sciences, Rush Medical College, Chicago, IL, USA
| |
Collapse
|
43
|
McKay JL, Hackney ME, Factor SA, Ting LH. Lower Limb Rigidity Is Associated with Frequent Falls in Parkinson's Disease. Mov Disord Clin Pract 2019; 6:446-451. [PMID: 31392245 DOI: 10.1002/mdc3.12784] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [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: 01/18/2019] [Revised: 05/03/2019] [Accepted: 05/12/2019] [Indexed: 01/23/2023] Open
Abstract
Background and Objective The role of muscle rigidity as an etiological factor of falls in Parkinson's disease (PD) is poorly understood. Our objective was to determine whether lower leg rigidity was differentially associated with frequent falls in PD compared to upper limb, neck, and total rigidity measures. Methods We examined the associations between Unified Parkinson's Disease Rating Scale-Part III (motor) rigidity subscores and the history of monthly or more frequent falls in 216 individuals with PD (age, 66 ± 10 years; 36% female; disease duration, 7 ± 5 years) with logistic regression. Results A total of 35 individuals were frequent fallers. Significant associations were identified between lower limb rigidity and frequent falls (P = 0.01) after controlling for age, sex, PD duration, total Unified Parkinson's Disease Rating Scale- Part III score, and presence of freezing of gait. No significant associations (P ≥ 0.14) were identified for total, arm, or neck rigidity. Conclusion Lower limb rigidity is related to frequent falls in people with PD. Further investigation may be warranted into how parkinsonian rigidity could cause falls.
Collapse
Affiliation(s)
- J Lucas McKay
- The Wallace H. Coulter Department of Biomedical Engineering at Emory University and Georgia Tech Atlanta Georgia USA
| | - Madeleine E Hackney
- Department of Medicine, Division of General Medicine and Geriatrics Emory University School of Medicine Atlanta Georgia USA.,Rehabilitation R&D Center Atlanta Veterans Affairs Medical Center Atlanta Georgia USA
| | - Stewart A Factor
- Department of Neurology Emory University School of Medicine Atlanta Georgia USA
| | - Lena H Ting
- The Wallace H. Coulter Department of Biomedical Engineering at Emory University and Georgia Tech Atlanta Georgia USA.,Department of Rehabilitation Medicine, Division of Physical Therapy Emory University School of Medicine Atlanta Georgia USA
| |
Collapse
|
44
|
Factor SA, Remington G, Comella CL, Correll CU, Burke J, Jimenez R, Liang GS, O'Brien CF. The Effects of Valbenazine in Participants with Tardive Dyskinesia: Results of the 1-Year KINECT 3 Extension Study. J Clin Psychiatry 2019; 78:1344-1350. [PMID: 29141124 DOI: 10.4088/jcp.17m11777] [Citation(s) in RCA: 58] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Accepted: 10/11/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Valbenazine, a highly selective vesicular monoamine transporter 2 inhibitor, is approved for the treatment of tardive dyskinesia. This is the first report of long-term effects in adults with tardive dyskinesia. METHODS Participants with a DSM-IV diagnosis of schizophrenia, schizoaffective disorder, or a mood disorder who completed the 6-week, double-blind, placebo-controlled period of KINECT 3 were eligible to enter the 42-week valbenazine extension (VE) period and subsequent 4-week washout period. The extension phase was conducted from December 16, 2014, to August 3, 2016. Participants who received placebo and entered the VE period were re-randomized 1:1 to valbenazine 80 or 40 mg while others continued valbenazine at the KINECT 3 dose. Safety assessments included treatment-emergent adverse events (TEAEs) and scales for suicidal ideation/behavior, treatment-emergent akathisia or parkinsonism, and psychiatric symptoms. Efficacy assessments included the Abnormal Involuntary Movement Scale (AIMS) and Clinical Global Impression of Change-Tardive Dyskinesia (CGI-TD). RESULTS 198 participants entered the VE period, 124 (62.6%) completed treatment (week 48), and 121 (61.1%) completed the follow-up visit after washout (week 52). During the VE period, 69.2% of participants had ≥ 1 TEAE, 14.6% had a serious TEAE, and 15.7% discontinued due to a TEAE. During washout, 13.1% of participants experienced a TEAE. No apparent risk for suicidal ideation or behavior was found. Long-term valbenazine treatment did not appear to induce or worsen akathisia or parkinsonism. Participants generally remained psychiatrically stable during the study. AIMS and CGI-TD measures indicated sustained tardive dyskinesia improvement, with scores returning toward baseline after 4 weeks of valbenazine washout. CONCLUSIONS The long-term safety and tolerability of valbenazine were generally favorable, and maintenance of treatment effect was apparent with both doses during this long-term study. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT02274558.
Collapse
Affiliation(s)
- Stewart A Factor
- Emory University School of Medicine, Department of Neurology, 12 Executive Park Dr NE, Room 284, Atlanta, GA 30329. .,Department of Neurology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Gary Remington
- Schizophrenia Division, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Cynthia L Comella
- Department of Neurological Sciences, Rush University Medical Center, Chicago, Illinois, USA
| | - Christoph U Correll
- Department of Psychiatry and Molecular Medicine, Hofstra Northwell School of Medicine, New York, New York, USA
| | - Joshua Burke
- Neurocrine Biosciences, Inc, San Diego, California, USA
| | | | - Grace S Liang
- Neurocrine Biosciences, Inc, San Diego, California, USA
| | | |
Collapse
|
45
|
Espay AJ, Guskey MT, Norton JC, Coate B, Vizcarra JA, Ballard C, Factor SA, Friedman JH, Lang AE, Larsen NJ, Andersson C, Fredericks D, Weintraub D. Pimavanserin for Parkinson's Disease psychosis: Effects stratified by baseline cognition and use of cognitive-enhancing medications. Mov Disord 2018; 33:1769-1776. [PMID: 30387904 PMCID: PMC6261678 DOI: 10.1002/mds.27488] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Revised: 07/19/2018] [Accepted: 08/05/2018] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND PD psychosis is often associated with cognitive impairment, including dementia, and involves dopaminergic, serotonergic, and cholinergic mechanisms. OBJECTIVE To evaluate the differential effect of the antipsychotic pimavanserin, a selective serotonin 2A receptor inverse agonist, in PD psychosis patients with versus without cognitive impairment and in those receiving versus not receiving cognitive-enhancing medications. METHODS Data from the pivotal randomized clinical trial of pimavanserin for PD psychosis were stratified by (1) screening MMSE score as cognitively impaired (21-24) versus unimpaired (≥25) and (2) concomitant use versus nonuse of cognitive-enhancing medications. The primary outcome measure was change in the PD-adapted Scale for the Assessment of Positive Symptoms. RESULTS Mean (pimavanserin vs. placebo) change from baseline was larger in the cognitively impaired (n = 50; -6.62 vs. -0.91; P = 0.002) versus the cognitively unimpaired (n = 135; -5.50 vs. -3.23; p = 0.046) group. The comparable change was -6.04 versus -2.18 (P = 0.012) and -5.66 versus -3.15 (P = 0.041) in patients treated (n = 69) and not treated (n = 116) with concomitant cognitive-enhancing medication. Pimavanserin was similarly tolerated across all cognitive groups with no additional safety concerns identified. Overall adverse event rates were comparable across the concomitant cognitive-enhancing medication groups; however, rates of serious adverse events and discontinuations attributed to adverse events were increased in patients taking cholinesterase inhibitors. CONCLUSIONS The antipsychotic effect of pimavanserin is robust in PD patients with cognitive impairment and may be enhanced by concomitant cognitive-enhancing medication use. Future prospective studies are needed to confirm these preliminary findings. © 2018 The Authors. Movement Disorders published by Wiley Periodicals, Inc. on behalf of International Parkinson and Movement Disorder Society.
Collapse
Affiliation(s)
- Alberto J. Espay
- Gardner Family Center for Parkinson's Disease and Movement Disorders, Department of NeurologyUniversity of CincinnatiCincinnatiOhioUSA
| | | | | | - Bruce Coate
- ACADIA Pharmaceuticals Inc.San DiegoCaliforniaUSA
| | - Joaquin A. Vizcarra
- Gardner Family Center for Parkinson's Disease and Movement Disorders, Department of NeurologyUniversity of CincinnatiCincinnatiOhioUSA
| | - Clive Ballard
- University of Exeter Medical SchoolExeterUnited Kingdom
| | - Stewart A. Factor
- Jean and Paul Amos Parkinson's Disease and Movement Disorder Program, Department of NeurologyEmory University School of MedicineAtlantaGeorgiaUSA
| | - Joseph H. Friedman
- Department of NeurologyWarren Alpert Medical School of Brown UniversityProvidenceRhode IslandUSA
- Movement Disorders Program, Butler HospitalProvidenceRhode IslandUSA
| | - Anthony E. Lang
- Edmond J. Safra Program in Parkinson's Disease and the Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western HospitalUniversity of TorontoTorontoOntarioCanada
| | | | | | | | - Daniel Weintraub
- Departments of Psychiatry and NeurologyPerelman School of Medicine at the University of PennsylvaniaPhiladelphiaPennsylvaniaUSA
- Parkinson's Disease and Mental Illness Research, Education and Clinical Centers (PADRECC and MIRECC), Department of Veterans AffairsPhiladelphia VA Medical CenterPhiladelphiaPennsylvaniaUSA
| |
Collapse
|
46
|
Wallen ZD, Chen H, Hill-Burns EM, Factor SA, Zabetian CP, Payami H. Plasticity-related gene 3 ( LPPR1) and age at diagnosis of Parkinson disease. Neurol Genet 2018; 4:e271. [PMID: 30338293 PMCID: PMC6186025 DOI: 10.1212/nxg.0000000000000271] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Accepted: 06/11/2018] [Indexed: 12/22/2022]
Abstract
Objective To identify modifiers of age at diagnosis of Parkinson disease (PD). Methods Genome-wide association study (GWAS) included 1,950 individuals with PD from the NeuroGenetics Research Consortium (NGRC) study. Replication was conducted in the Parkinson's, Genes and Environment study, including 209 prevalent (PAGEP) and 517 incident (PAGEI) PD cases. Cox regression was used to test association with age at diagnosis. Individuals without neurologic disease were used to rule out confounding. Gene-level analysis and functional annotation were conducted using Functional Mapping and Annotation of GWAS platform (FUMA). Results The GWAS revealed 2 linked but seemingly independent association signals that mapped to LPPR1 on chromosome 9. LPPR1 was significant in gene-based analysis (p = 1E-8). The top signal (rs17763929, hazard ratio [HR] = 1.88, p = 5E-8) replicated in PAGEP (HR = 1.87, p = 0.01) but not in PAGEI. The second signal (rs73656147) was robust with no evidence of heterogeneity (HR = 1.95, p = 3E-6 in NGRC; HR = 2.14, p = 1E-3 in PAGEP + PAGEI, and HR = 2.00, p = 9E-9 in meta-analysis of NGRC + PAGEP + PAGEI). The associations were with age at diagnosis, not confounded by age in patients or in the general population. The PD-associated regions included variants with Combined Annotation Dependent Depletion (CADD) scores = 10–19 (top 1%–10% most deleterious mutations in the genome), a missense with predicted destabilizing effect on LPPR1, an expression quantitative trait locus (eQTL) for GRIN3A (false discovery rate [FDR] = 4E-4), and variants that overlap with enhancers in LPPR1 and interact with promoters of LPPR1 and 9 other brain-expressed genes (Hi-C FDR < 1E-6). Conclusions Through association with age at diagnosis, we uncovered LPPR1 as a modifier gene for PD. LPPR1 expression promotes neuronal regeneration after injury in animal models. Present data provide a strong foundation for mechanistic studies to test LPPR1 as a driver of response to damage and a therapeutic target for enhancing neuroregeneration and slowing disease progression.
Collapse
Affiliation(s)
- Zachary D Wallen
- Department of Neurology (Z.D.W., E.M.H.-B., H.P.), University of Alabama at Birmingham, Birmingham, AL; Department of Epidemiology and Biostatistics (H.C.), Michigan State University, East Lansing, MI; Department of Neurology (S.A.F.), Jean & Paul Amos Parkinson's Disease and Movement Disorder Program, Emory University School of Medicine, Atlanta, GA; VA Puget Sound Health Care System and Department of Neurology (C.P.Z.), University of Washington, Seattle, WA; and Center for Genomic Medicine (H.P.), HudsonAlpha Institute for Biotechnology, Huntsville, AL
| | - Honglei Chen
- Department of Neurology (Z.D.W., E.M.H.-B., H.P.), University of Alabama at Birmingham, Birmingham, AL; Department of Epidemiology and Biostatistics (H.C.), Michigan State University, East Lansing, MI; Department of Neurology (S.A.F.), Jean & Paul Amos Parkinson's Disease and Movement Disorder Program, Emory University School of Medicine, Atlanta, GA; VA Puget Sound Health Care System and Department of Neurology (C.P.Z.), University of Washington, Seattle, WA; and Center for Genomic Medicine (H.P.), HudsonAlpha Institute for Biotechnology, Huntsville, AL
| | - Erin M Hill-Burns
- Department of Neurology (Z.D.W., E.M.H.-B., H.P.), University of Alabama at Birmingham, Birmingham, AL; Department of Epidemiology and Biostatistics (H.C.), Michigan State University, East Lansing, MI; Department of Neurology (S.A.F.), Jean & Paul Amos Parkinson's Disease and Movement Disorder Program, Emory University School of Medicine, Atlanta, GA; VA Puget Sound Health Care System and Department of Neurology (C.P.Z.), University of Washington, Seattle, WA; and Center for Genomic Medicine (H.P.), HudsonAlpha Institute for Biotechnology, Huntsville, AL
| | - Stewart A Factor
- Department of Neurology (Z.D.W., E.M.H.-B., H.P.), University of Alabama at Birmingham, Birmingham, AL; Department of Epidemiology and Biostatistics (H.C.), Michigan State University, East Lansing, MI; Department of Neurology (S.A.F.), Jean & Paul Amos Parkinson's Disease and Movement Disorder Program, Emory University School of Medicine, Atlanta, GA; VA Puget Sound Health Care System and Department of Neurology (C.P.Z.), University of Washington, Seattle, WA; and Center for Genomic Medicine (H.P.), HudsonAlpha Institute for Biotechnology, Huntsville, AL
| | - Cyrus P Zabetian
- Department of Neurology (Z.D.W., E.M.H.-B., H.P.), University of Alabama at Birmingham, Birmingham, AL; Department of Epidemiology and Biostatistics (H.C.), Michigan State University, East Lansing, MI; Department of Neurology (S.A.F.), Jean & Paul Amos Parkinson's Disease and Movement Disorder Program, Emory University School of Medicine, Atlanta, GA; VA Puget Sound Health Care System and Department of Neurology (C.P.Z.), University of Washington, Seattle, WA; and Center for Genomic Medicine (H.P.), HudsonAlpha Institute for Biotechnology, Huntsville, AL
| | - Haydeh Payami
- Department of Neurology (Z.D.W., E.M.H.-B., H.P.), University of Alabama at Birmingham, Birmingham, AL; Department of Epidemiology and Biostatistics (H.C.), Michigan State University, East Lansing, MI; Department of Neurology (S.A.F.), Jean & Paul Amos Parkinson's Disease and Movement Disorder Program, Emory University School of Medicine, Atlanta, GA; VA Puget Sound Health Care System and Department of Neurology (C.P.Z.), University of Washington, Seattle, WA; and Center for Genomic Medicine (H.P.), HudsonAlpha Institute for Biotechnology, Huntsville, AL
| |
Collapse
|
47
|
Factor SA. Camptocormia: a consensus for grading on a curve. Parkinsonism Relat Disord 2018; 52:6. [DOI: 10.1016/j.parkreldis.2018.06.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
|
48
|
Scorr LM, Silver MR, Hanfelt J, Sperin E, Freeman A, Jinnah HA, Factor SA. Pilot Single-Blind Trial of AbobotulinumtoxinA in Oromandibular Dystonia. Neurotherapeutics 2018; 15:452-458. [PMID: 29542022 PMCID: PMC5935649 DOI: 10.1007/s13311-018-0620-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Oromandibular dystonia (OMD) causes involuntary movements of masticatory and lingual muscles impairing eating, speaking, and swallowing. Treatment options are limited. The objective of this study was to determine the safety and efficacy of abobotulinumtoxinA (aboBoNTA) in OMD. A dose-finding study (phase 1) followed by a single session, prospective, single-blind trial (phase 2) was carried out. OMD subjects were evaluated at baseline, 6 and 12 weeks. Muscles injected were tailored to individual symptoms using EMG guidance, but the aboBoNTA dose for each muscle was pre-specified based on phase 1 results. Evaluations were Global Dystonia Rating Scale (GDS), Unified Dystonia Rating Scale (UDRS), Clinical Global Impression (CGI) improvement and severity, and quality of life (OMDQ-25). Adverse events were monitored. The lowest dosage in phase 1 resulted in adverse effects in two of three patients and thus was used in phase 2. In phase 2, adverse effects were observed in 50% of subjects including dysphagia, voice change, and soft palate weakness. Most were mild. Significant improvement was seen in quality of life (OMDQ-25), speech (BFMq21), and change in GDS, UDRS, CGI severity assessed by the unblinded investigator, but not in blinded video ratings. We conclude that aboBoNTA therapy in this study was associated with improved quality of life and was generally well tolerated in OMD, but occurrence of dysphagia dictated the importance of using low genioglossus dosing. Face to face assessment appears to be more sensitive than video assessment for change in OMD severity. Consideration of the disability in OMD places constraints on traditional placebo-control trial design. Development of novel trial designs is warranted.
Collapse
Affiliation(s)
- Laura M Scorr
- Department of Neurology, Emory University, Atlanta, GA, USA
| | | | - John Hanfelt
- Department of Biostatistics and Bioinformatics, Emory University, Atlanta, GA, USA
| | - Elaine Sperin
- Department of Neurology, Emory University, Atlanta, GA, USA
| | - Alan Freeman
- Department of Neurology, Emory University, Atlanta, GA, USA
| | - H A Jinnah
- Department of Neurology, Emory University, Atlanta, GA, USA
| | | |
Collapse
|
49
|
Houser MC, Chang J, Factor SA, Molho ES, Zabetian CP, Hill-Burns EM, Payami H, Hertzberg VS, Tansey MG. Stool Immune Profiles Evince Gastrointestinal Inflammation in Parkinson's Disease. Mov Disord 2018; 33:793-804. [PMID: 29572994 DOI: 10.1002/mds.27326] [Citation(s) in RCA: 109] [Impact Index Per Article: 18.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2017] [Revised: 12/17/2017] [Accepted: 01/11/2018] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Gastrointestinal symptoms are common in Parkinson's disease and frequently precede the development of motor impairments. Intestinal inflammation has been proposed as a driver of disease pathology, and evaluation of inflammatory mediators in stool could possibly identify valuable early-stage biomarkers. We measured immune- and angiogenesis-related proteins in human stool to examine inflammatory profiles associated with Parkinson's disease. METHODS Stool samples and subjects' self-reported metadata were obtained from 156 individuals with Parkinson's disease and 110 without, including spouse and nonhousehold controls. Metadata were probed for disease-associated differences, and levels of 37 immune and angiogenesis factors in stool homogenates were measured by multiplexed immunoassay and compared across experimental groups. RESULTS Parkinson's disease patients reported greater incidence of intestinal disease and digestive problems than controls. Direct comparison of levels of stool analytes in patients and controls revealed elevated vascular endothelial growth factor receptor 1, interleukin-1α, and CXCL8 in patients' stool. Paired comparison of patients and spouses suggested higher levels of multiple factors in patients, but this was complicated by sex differences. Sex, body mass index, a history of smoking, and use of probiotics were found to strongly influence levels of stool analytes. Multivariate analysis accounting for these and other potential confounders confirmed elevated levels of interleukin-1α and CXCL8 and also revealed increased interleukin-1β and C-reactive protein in stool in Parkinson's disease. These differences were not dependent on subject age or disease duration. CONCLUSIONS Levels of stool immune factors indicate that intestinal inflammation is present in patients with Parkinson's disease. © 2018 International Parkinson and Movement Disorder Society.
Collapse
Affiliation(s)
- Madelyn C Houser
- Department of Physiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Jianjun Chang
- Department of Physiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Stewart A Factor
- Department of Neurology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Eric S Molho
- Department of Neurology, Albany Medical College, Albany, New York, USA
| | - Cyrus P Zabetian
- Veterans Affairs Puget Sound Health Care System and Department of Neurology, University of Washington School of Medicine, Seattle, Washington, USA
| | - Erin M Hill-Burns
- Department of Neurology, University of Alabama at Birmingham, Birminham, Alabama, USA
| | - Haydeh Payami
- Department of Neurology, University of Alabama at Birmingham, Birminham, Alabama, USA
- HudsonAlpha Institute for Biotechnology, Huntsville, Alabama
| | - Vicki S Hertzberg
- Center for Nursing Data Science, Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA
| | - Malú G Tansey
- Department of Physiology, Emory University School of Medicine, Atlanta, Georgia, USA
| |
Collapse
|
50
|
Shaikh AG, Factor SA, Juncos JL. Saccades in progressive supranuclear palsy - maladapted, irregular, curved, and slow. Mov Disord Clin Pract 2017; 4:671-681. [PMID: 29333474 PMCID: PMC5764187 DOI: 10.1002/mdc3.12491] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [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: 12/21/2016] [Revised: 02/02/2017] [Accepted: 02/07/2017] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Slowed and curved rapid eye movements, saccades, are the well-known features of progressive supranuclear palsy (PSP). We hypothesized that the saccades in PSP are not only slow and curved, but they are also irregular and have timing deficits. METHODS We tested this hypothesis in 12 patients with PSP by measuring vertical and horizontal visually guided saccades using a limbus tracker. RESULTS Both, horizontal and vertical saccades were slow and had irregular trajectory and velocity profiles, but deficits were much more robust in vertical saccades. The irregularity in the saccade velocity was due to premature interruptions that either completely stopped the eyes, or moved the eyes at much slower velocity along or in the opposite direction of the ongoing saccade. The direction of the eyes' trajectory was often changed after the interruption. We simulated a conductance based single-compartment model of the burst neurons embedded in local feedback circuit for saccade generation. This model mimicked anatomical and physiological realism, while allowing the liberty to selectively change the activation of individual burst neurons or the pause neurons. The PSP saccades were comparable to the simulations during reduced activity of the inhibitory and excitatory burst neurons. CONCLUSION PSP saccades are due to the paucity in burst generation at the excitatory and imprecise timing signal from the inhibitory burst neurons. Premature discharge of the inhibitory burst neuron further leads to breaks in the saccade trajectory, and maladaptive superior colliculus activity leading to aberrant saccades changing the intended trajectory of the ongoing saccade.
Collapse
Affiliation(s)
- Aasef G. Shaikh
- Department of NeurologyCase Western Reserve UniversityClevelandOhio
- Daroff‐Dell'Osso Ocular Motility Laboratory and Neurology ServiceLouis Stokes Cleveland Veterans Affairs Medical CenterClevelandOhio
| | - Stewart A. Factor
- Department of NeurologyMovement Disorders ProgramEmory UniversityAtlantaGeorgia
| | - Jorge L. Juncos
- Department of NeurologyMovement Disorders ProgramEmory UniversityAtlantaGeorgia
| |
Collapse
|