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Gautam D, Venkatraman V, Horns J, Yang LZ, Lee HJ, Kassavetis P, Alshaikh J, Moretti P, Shofty B, Rahimpour S. Demographics of focused ultrasound thalamotomy for essential tremor and trends in deep brain stimulation surgery after its introduction in the USA. BMJ Neurol Open 2024; 6:e000582. [PMID: 38618151 PMCID: PMC11015248 DOI: 10.1136/bmjno-2023-000582] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 01/31/2024] [Indexed: 04/16/2024] Open
Abstract
Background Essential tremor (ET) is a movement disorder that affects 4%-5% of adults >65 years. For patients with medically refractory ET, neurosurgical interventions such as deep brain stimulation (DBS) and unilateral MR-guided focused ultrasound thalamotomy (MRgFUS) are available. In this retrospective cohort study, we examined the demographics of patients with ET who have received MRgFUS and evaluated trends in DBS usage in the USA after the introduction of MRgFUS in 2016. Methods We used multiple databases to examine the demographics of patients who received DBS and MRgFUS, and trends in DBS. To assess the demographics, we queried the TriNetX database from 2003 to 2022 to identify patients diagnosed with ET and stratify them by DBS or MRgFUS treatment by using Current Procedural Terminology codes. Patient demographics were reported as frequencies and percentages. To examine the trends in DBS for ET, the yearly frequency of DBS procedures done for ET between 2012 and 2019 was extracted from the National Inpatient Sample (NIS) database, and breakpoint analysis was performed. Additionally, the yearly frequency of MRgFUS procedures for ET was obtained from Insightec Exlabate. Results Most of the patients (88.69%) in the cohort extracted from TriNetX database self-identified as white, followed by black or African American (2.40%) and Asian (0.52%). A higher percentage of black patients received MRgFUS treatment than DBS (4.10% vs 1.88%). According to the NIS database, from 2012 to 2020, 13 525 patients received DBS for ET. Conclusion This study provides an overview of the characteristics of patients who undergo DBS or MRgFUS. We found notable differences in sex and race among patients who underwent each treatment type. Additionally, until at least the beginning of 2020, the number of DBS procedures for ET was not negatively affected after the introduction of MRgFUS.
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Affiliation(s)
- Diwas Gautam
- University of Utah Health, Salt Lake City, Utah, USA
| | | | - Joshua Horns
- Department of Surgery, Surgical Population Analysis Core, University of Utah Health, Salt Lake City, Utah, USA
| | - Lexie Zidanyue Yang
- Department of Biostatistics, Duke University School of Medicine, Durham, North Carolina, USA
| | - Hui-Jie Lee
- Department of Biostatistics, Duke University School of Medicine, Durham, North Carolina, USA
| | | | - Jumana Alshaikh
- Department of Neurology, University of Utah Health, Salt Lake City, Utah, USA
| | - Paolo Moretti
- Department of Neurology, University of Utah Health, Salt Lake City, Utah, USA
| | - Ben Shofty
- Department of Neurosurgery, University of Utah Health, Salt Lake City, Utah, USA
| | - Shervin Rahimpour
- Department of Neurosurgery, University of Utah Health, Salt Lake City, Utah, USA
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Earl T, Jridi A, Thulin PC, Zorn M, McKee KE, Mitrovich K, Moretti P, Alshaikh J, Kassavetis P, Cortez MM, Lamotte G. Effect of levodopa on postural blood pressure changes in Parkinson disease: a randomized crossover study. Clin Auton Res 2024; 34:117-124. [PMID: 38429568 DOI: 10.1007/s10286-024-01024-5] [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: 10/07/2023] [Accepted: 02/06/2024] [Indexed: 03/03/2024]
Abstract
PURPOSE We investigated the effect of levodopa on postural blood pressure changes in individuals with Parkinson disease (PD) with (PD+OH) and without neurogenic OH (PD-OH). METHODS We performed a prospective randomized crossover study with autonomic testing performed ON and OFF levodopa. The primary outcome was the change in systolic blood pressure (SBP) from supine to 70° tilt at 3 min (ΔSBP-3'). Secondary outcomes included indices of baroreflex function and blood pressure and heart rate during tilt. RESULTS We enrolled 40 individuals with PD (21 PD+OH, 19 PD-OH), mean age (SD) 73.2 years (7.9), 13 women (32.5%)). There was no difference in age, sex, disease duration, and severity between PD+OH and PD-OH. Mean difference in ΔSBP-3' ON versus OFF levodopa in the whole study population was - 3.20 mmHg [- 7.36 to 0.96] (p = 0.14). Mean difference in ΔSBP-3' was - 2.14 mmHg [- 7.55 to 3.28] (p = 0.45) in PD+OH and - 5.14 mmHg [- 11.63 to 1.35] (p = 0.14) in PD-OH. Mean difference in ΔSBP ON versus OFF levodopa was greater at 7 and 10 min (- 7.52 mmHg [- 11.89 to - 3.15], p = 0.002, and - 7.82 mmHg [- 14.02 to - 1.67], p = 0.02 respectively). Levodopa was associated with lower absolute values of blood pressure in both PD+OH and PD-OH and cardiovascular noradrenergic baroreflex impairment. CONCLUSION Levodopa decreases blood pressure in both PD with and without autonomic failure, but it does not cause a greater fall in blood pressure from supine to standing at 3 min. Levodopa-induced baroreflex sympathetic noradrenergic impairment may contribute to lower blood pressure. Lower standing blood pressure with levodopa may increase the risks of fall and syncope.
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Affiliation(s)
- Timi Earl
- Department of Neurology, University of Utah, Salt Lake City, UT, USA
| | - Amani Jridi
- Utah Clinical & Translational Science Institute, University of Utah, Salt Lake City, UT, USA
| | - Perla C Thulin
- Department of Neurology, University of Utah, Salt Lake City, UT, USA
| | - Meghan Zorn
- Department of Neurology, University of Utah, Salt Lake City, UT, USA
| | - Kathleen E McKee
- Neurosciences Clinical Program, Intermountain Health, Murray, UT, USA
| | - Kristin Mitrovich
- Neurosciences Clinical Program, Intermountain Health, Murray, UT, USA
| | - Paolo Moretti
- Department of Neurology, University of Utah, Salt Lake City, UT, USA
- George E. Wahlen VA Medical Center, Salt Lake City, UT, USA
| | - Jumana Alshaikh
- Department of Neurology, University of Utah, Salt Lake City, UT, USA
| | | | - Melissa M Cortez
- Department of Neurology, University of Utah, Salt Lake City, UT, USA
| | - Guillaume Lamotte
- Department of Neurology, University of Utah, Salt Lake City, UT, USA.
- George E. Wahlen VA Medical Center, Salt Lake City, UT, USA.
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Vehar JV, Rahimpour S, Moretti P, Kassavetis P, Alshaikh J, Rolston J, Duff K. Recognition subtests of the Repeatable Battery for the Assessment of Neuropsychological Status: evidence for a cortical vs. subcortical distinction. J Clin Exp Neuropsychol 2023; 45:786-797. [PMID: 37728425 PMCID: PMC10922284 DOI: 10.1080/13803395.2023.2259044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 09/10/2023] [Indexed: 09/21/2023]
Abstract
INTRODUCTION Within clinical neuropsychology, a classic diagnostic distinction is made between cortical and subcortical disorders, especially based on their memory profiles. Typically, this is based on the comparison of recall and recognition trials, where individuals with cortical conditions do not tend to benefit (i.e., score well) on recognition trials and individuals with subcortical conditions do. Although the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) is a widely used brief cognitive battery, there is a lack of evidence to support this measure's utility in distinguishing between the memory profiles of these conditions. METHOD Thirty-six mild Alzheimer's disease (AD), 55 Parkinson's disease (PD), and 105 essential tremor (ET) participants (N = 196) were administered the RBANS with additional Story and Figure Recognition subtests. Group differences on recall and recognition scores (Total Correct, Hits or True Positives, False Positive Errors, and discriminability index) were examined across the three groups, while controlling for the influence of age and gender. RESULTS As expected, individuals with AD had poorer recognition scores compared to the other clinical groups across tasks (all p-values < .05), while the ET sample largely performed comparably to the PD sample. With the exception of comparable Figure Recognition and Recall in the PD sample, all groups exhibited significantly greater recognition Hit performance compared to Recall (all p-values < .05). CONCLUSIONS The group differences in performance across RBANS recognition subtests suggest support for traditional "cortical" and "subcortical" profiles. However, all groups, including the mild AD sample, demonstrated a benefit from recognition cues compared to free recall. Overall, these findings support the inclusion of the newly developed Story and Figure Recognition subtests in future clinical practice and research endeavors.
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Affiliation(s)
- Julia V Vehar
- Department of Psychology, University of Utah, Salt Lake City, Utah, USA
| | - Shervin Rahimpour
- Department of Neurosurgery, University of Utah, Salt Lake City, Utah, USA
| | - Paolo Moretti
- Department of Neurology, University of Utah, Salt Lake City, Utah, USA
- Department of Neurology George E. Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, Utah, USA
| | | | - Jumana Alshaikh
- Department of Neurology, University of Utah, Salt Lake City, Utah, USA
| | - John Rolston
- Department of Neurosurgery, Brigham & Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Kevin Duff
- Department of Neurology, University of Utah, Salt Lake City, Utah, USA
- Department of Neurology, Oregon Health & Science University, Portland, Oregon, USA
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Suarez-Cedeno G, Pantelyat A, Mils K, Murthy M, Alshaikh J, Rosenthal L, Bang J, Moukheiber E. Movement Disorders Virtual Fellowship Training in Times of Coronavirus Disease 2019: A Single-Center Experience. Telemed J E Health 2021; 27:1160-1165. [PMID: 33512273 DOI: 10.1089/tmj.2020.0419] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Objective: To describe the impact a global pandemic has had on a teaching movement disorders program, as well as its subsequent transition to telemedicine. Methods: In the midst of the coronavirus disease 2019 (COVID-19) pandemic, we transitioned our movement disorders fellowship program virtually over the course of a few days. Here we describe the parameters used for the telemedicine fellow supervised clinic visit over the course of 2 months. Fellow's input was obtained from a brief survey at the end of the experience. Faculty's experience was collected upon independent faculty discussions. We also summarize the challenges and advantages of this teaching experience and its downsides. Results: A total of 130 patients (102 follow-up and 28 new patients) were seen over 22 clinic days with any of our 3 fellows being supervised by 1 of the 6 attending physicians. The main challenges were related to technical difficulties and lack of portions of the examination such as tone, reflexes, and sensory testing. The main advantages were related to increased patient access and a decrease in scheduling barriers. The overall satisfaction with the experience of the fellows was positive (69%). Conclusions: This sample shows the feasibility (despite lack of prior experience) of virtual clinical supervision of movement disorders fellows for follow-up and new complex patient encounters. This novel method for movement disorders training has implications for training locally, nationally, and internationally. Limitations and possible future directions such as the inclusion of nonsynchronous recordings and devices for tone and balance testing are also discussed.
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Affiliation(s)
- Gerson Suarez-Cedeno
- Department of Neurology, Johns Hopkins University, Baltimore, Maryland, USA.,Department of Neurology, University of New Mexico, Albuquerque, New Mexico, USA
| | | | - Kelly Mils
- Department of Neurology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Maitreiyi Murthy
- Department of Neurology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Jumana Alshaikh
- Department of Neurology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Liana Rosenthal
- Department of Neurology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Jee Bang
- Department of Neurology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Emile Moukheiber
- Department of Neurology, Johns Hopkins University, Baltimore, Maryland, USA
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Kaminski HJ, Himuro K, Alshaikh J, Gong B, Cheng G, Kusner LL. Differential RNA Expression Profile of Skeletal Muscle Induced by Experimental Autoimmune Myasthenia Gravis in Rats. Front Physiol 2016; 7:524. [PMID: 27891095 PMCID: PMC5102901 DOI: 10.3389/fphys.2016.00524] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [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: 09/14/2016] [Accepted: 10/24/2016] [Indexed: 01/14/2023] Open
Abstract
The differential susceptibility of skeletal muscle by myasthenia gravis (MG) is not well understood. We utilized RNA expression profiling of extraocular muscle (EOM), diaphragm (DIA), and extensor digitorum (EDL) of rats with experimental autoimmune MG (EAMG) to evaluate the hypothesis that muscles respond differentially to injury produced by EAMG. EAMG was induced in female Lewis rats by immunization with acetylcholine receptor purified from the electric organ of the Torpedo. Six weeks later after rats had developed weakness and serum antibodies directed against the AChR, animals underwent euthanasia and RNA profiling performed on DIA, EDL, and EOM. Profiling results were validated by qPCR. Across the three muscles between the experiment and control groups, 359 probes (1.16%) with greater than 2-fold changes in expression in 7 of 9 series pairwise comparisons from 31,090 probes were identified with approximately two-thirds being increased. The three muscles shared 16 genes with increased expression and 6 reduced expression. Functional annotation demonstrated that these common expression changes fell predominantly into categories of metabolism, stress response, and signaling. Evaluation of specific gene function indicated that EAMG led to a change to oxidative metabolism. Genes related to muscle regeneration and suppression of immune response were activated. Evidence of a differential immune response among muscles was not evident. Each muscle had a distinct RNA profile but with commonality in gene categories expressed that are focused on muscle repair, moderation of inflammation, and oxidative metabolism.
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Affiliation(s)
- Henry J Kaminski
- Department of Neurology, George Washington University Washington, DC, USA
| | - Keiichi Himuro
- Department of Neurology, Graduate School of Medicine, Chiba University Chiba, Japan
| | - Jumana Alshaikh
- Department of Neurology, George Washington University Washington, DC, USA
| | - Bendi Gong
- Department of Pediatrics, Washington University St. Louis, MO, USA
| | - Georgiana Cheng
- Department of Pathobiology, Cleveland Clinic Cleveland, OH, USA
| | - Linda L Kusner
- Pharmacology and Physiology, George Washington University Washington, DC, USA
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