Movement Disorders Outpatient Clinic Research Articles

Clinical Evaluation of Parkinson's Disease Patients Admitted to the Movement Disorders Outpatient Clinic of Istanbul Taksim Training and Research Hospital, Turkey, 2023

Clinical Evaluation of Parkinson's Disease Patients Admitted to the Movement Disorders Outpatient Clinic of Istanbul Taksim Training and Research Hospital, Turkey, 2023

Erken Başlangıçlı Parkinson Hastalığı ve Genetik Sonuçları

Genetic and environmental factors play an important role in the development and progression of Parkinson’s Disease(PD). In this study, it was aimed to evaluate the genetic test results and clinical findings of early-onset Parkinson's Disease (EOPD) followed up in the movement disorders outpatient clinic of our hospital by comparing them with the literature. Patients who were followed up with the diagnosis of EOPD in the Movement Disorders Outpatient Clinic of Neurology Department, Marmara University Faculty of Medicine and whose genetic tests were performed; demographic characteristics, clinical findings and genetic test results were analyzed retrospectively. Forty-three EOPD patients (13 females, 30 males) who were genetically tested were enrolled in the study. The mean age was 52.3 (range; 31-64 years), and the mean age of disease onset was 42.8 (range; 25-49 years). Seven different mutations for PARK-2 and PINK-1 were detected in 93% of the patients for whom genetic testing was requested. Genetic mutation was not detected in 7% of the patients. While 57.5% of the patients with a positive genetic test had prodromal symptoms such as hyposmia, constipation and Rapid Eye Movement(REM) Sleep Behaviour Disorder (RBD), none of the patients with a negative genetic test had prodromal symptoms. It has been shown that some of the benign allelic mutations detected in EOPD patients may be genetic risk factors for EOPD. In our study, we wanted to draw attention to the need for multicenter studies with larger numbers of patients and healthy controls to determine the relationship between benign allelic mutations and EOPD.

New-Onset Focal Task Specific Oromandibular Dystonia in Association with Quran Recitation: A Case Series.

Focal task-specific dystonia is a form of isolated focal dystonia that occurs during the performance of a specific skilled motor task. The occurrence of oromandibular dystonia (OMD) specifically in association with the recitation of Quranic verses have been rarely reported in the literature, in non-native Arabic-speaking patients. This case series describe a rare type of focal task-specific dystonia that occurs exclusively by reciting Quran in native Arabic-speaking patients, which has never been reported, to the best of our knowledge. In this case series, we identified five patients with new-onset OMD that was exclusively induced by reciting Quran. Cases were evaluated in our Movement Disorders outpatient clinic at Ibn Sina hospital; the main tertiary neurology center in Kuwait, between 2015 and 2023. Five cases (3 males, 2 females) were identified in this study. Mean age of onset of the symptoms was 52.3 ± 4.1 years, while the median duration of the symptoms prior to diagnosis was 3 years. All patients were native Arab-speaking, with no previous history of other types of dystonia. No identifiable risk factors could be obtained including exposure to dopamine blocking agents or antipsychotics, or history of oral or dental surgery. Patients underwent a full clinical, laboratory, and radiological evaluation. All patients had OMD dystonia in varying forms and severity, while two patients had additional spasmodic dysphonia/ blepharospasm on progressive recitation. Most patients had minimal improvement with combination of oral medications and speech therapy. Four patients received botulinum toxin injections with better results. The mental and physical stress in attempting to recite the Quranic verses could have contributed to the development of OMD. Moreover, the increased demand on the muscles of the jaw, lips, and tongue during recitation can trigger the dystonic symptoms. OMD exclusively during Quran recitation is a rare phenomenon, and expands the spectrum of task-specific focal dystonia described in the literature. It was found to be distressing to the patients and a challenge to treat. Prompt recognition could minimize unnecessary testing and procedures, and facilitate earlier treatment.

Oromandibular Dystonia: Clinical and Demographic Data from Eight-Two Patients.

This study aimed to determine the demographic and clinical characteristics of patients with oromandibular dystonia (OMD). Dystonia is a movement disorder characterized by sustained involuntary muscle contractions that often cause abnormal postures. OMD is a rare focal dystonia that affects the tongue, jaw, and mouth. OMD, which is a rare public health problem, is often recognized as psychogenic and there are delays in its diagnosis and treatment. Patients with OMD, both isolated and combined, followed at our Movement Disorders Outpatient Clinic between 2004 and 2021 were enrolled in this study. Age, sex, age at onset, and disease duration were recorded. The type of OMD, affected muscles, etiologies of accompanying neurological disorders, and treatment were noted. A total of 82 patients (44 women, 38 men) were included in this study. Among these, 39 patients had isolated OMD, and 43 patients had either segmental or generalized dystonia. Seven patients reported a family history of dystonia. Only nine patients reported a sensory trick. The average disease duration was 6.01 ± 3.73 (range, 1-29) years, and the average age at onset was 43.34 ± 18.24 (range, 1-78) years. The disease etiology was unknown (idiopathic) in most patients. Fifteen patients reported task-specific dystonia. The most common type of dystonia was jaw-opening dystonia. OMD is focal dystonia that significantly affects the quality of life. This study adds more data to the literature by defining the clinical features of this rare disorder and draws attention to this neglected type of dystonia.

Educational disparities in Brazil may interfere with the cognitive performance of Parkinson's disease patients.

To evaluate the influence of clinical and demographic characteristics, specifically the education level, on the MMSE score in PD patients of a northeast Brazilian sample. We performed a cross-sectional study of 198 PD patients at a Movement Disorders outpatient clinic in Fortaleza, CE, Brazil. Participants were assessed by detailed clinical history, modified Hoehn and Yahr staging (HY), geriatric depression scale (GDS) and MMSE. We found that 68% of patients had MMSE scores below the Brazilian thresholds, which were based in Brucki et al. study (2003). There was a statistically significant difference in the bivariate analysis between educational level and cut-off classification for MMSE. More years of formal schooling were associated with more patients scoring below threshold. We found that 75%, 68.8%, and 79.7% of individuals with more than 11, 9 to 11, and 4 to 8 years of formal schooling, respectively, were below the suggested Brazilian Brucki's threshold. GDS and age were negatively correlated with total MMSE and all its domains. There was no correlation between disease duration and MMSE. Subjects with hallucinations had lower scores. Most of the sample had lower performance according to Brazilian thresholds, but there was no control group and no neuropsychological test in this study. Further studies in northeast Brazil are needed to review MMSE cut-off values.

Ataxia in a Movement Disorders Outpatient Clinic: a Single-Center Experience in Turkey.

The etiology may not be determined in patients with ataxia despite detailed evaluations. The aim of this study was to investigate the clinical and laboratory characteristics of a large cohort of patients with adult-onset ataxia of different etiologies, particularly, undetermined etiologies despite extensive clinical, genetic, laboratory, electrophysiological, and imaging investigations. The medical records of all patients diagnosed with ataxia of subacute-chronic onset between January 2011 and March 2021 were reviewed retrospectively. The records of patients with symptom onset after 16 years of age were included in the study. In all patients, clinical and demographic findings were noted. Etiologies were classified as acquired, hereditary, degenerative (multiple system atrophy-cerebellar, MSA-C), functional, and undetermined. During the study period, we determined 74 patients with ataxia and 59 (35 males) patients met the study criteria. The age range was 22-87 years. The etiologies were hereditary (n = 19), acquired (n = 14), MSA-C (n = 9), functional (n = 2), and undetermined (n = 15). The patients with hereditary etiologies and undetermined causes were significantly younger at admission and at symptom onset (p = 0.001 and p = 0.000). There was a significant delay until diagnosis in patients with hereditary etiologies compared to other etiologies. In acquired etiologies, axial findings (71.4%) were more prominent whereas extremity and axial findings were more common in patients with hereditary etiologies (83.3%, p = 0.030). There were systemic and radiological indicators such as hearing loss, juvenile cataract, or dentate hyperintensity in certain disorders. Hereditary etiologies are as common as acquired or degenerative etiologies in adults. However, they have an earlier onset and delayed diagnosis. Therefore, we should recognize the extracerebellar neurological, systemic, and neuroimaging findings.

Falls in Parkinson's disease: the impact of disease progression, treatment, and motor complications.

ABSTRACT.The prevalence of Parkinson's disease (PD) tends to increase worldwide in the coming decades. Thus, the incidence of falls is likely to increase, with a relevant burden on the health care system.Objective:The objective of this study was to evaluate clinical factors and drug use associated with falls in PD patients.Methods:We conducted a cross-sectional study at the Movement Disorders outpatient clinic of a tertiary hospital in Northeast Brazil. We performed structured interviews to collect sociodemographic and clinical data. Functional capacity was assessed using the Schwab and England Activities of Daily Living Scale and the modified Hoehn and Yahr Staging Scale. We divided the study sample into non-fallers (no falls) and fallers (≥1 fall), and non-recurrent (≤1 fall) and recurrent fallers (>1 fall).Results:The study population comprised 327 PD patients (48% women), with a mean age of 70 years. The mean disease duration was 9.9±6.9 years. The most prevalent comorbidities were depression (47.2%), hypertension (44.0%), and type 2 diabetes mellitus (21.5%). The logistic regression analysis revealed that hallucinations, amantadine, and catechol-O-methyltransferase inhibitors (entacapone) were independently associated with falls in PD patients. Also, hallucinations, dyskinesia, and the use of amantadine were independently associated with recurrent falls.Conclusions:Health care providers play an essential role in fall prevention in PD patients, particularly by identifying older adults experiencing dyskinesia and visual hallucinations. Prospective studies should investigate the use of amantadine as a risk factor for falls in PD patients.

Prevalence of syphilis reactivity in patients with stroke, cognitive impairment and extrapyramidal syndromes: a retrospective study.

In the last two decades, there has been a resurgence of syphilis worldwide. However, epidemiological data on neurosyphilis are inconsistent for the lack of reporting data and diagnostic gold standard tests. The aim of the present study was to estimate the prevalence of syphilis reactivity in a cohort of patients with neurological diseases of our hospital. We retrospectively analyzed the medical records of the patients hospitalized at the Stroke Unit of the Neurology Clinic and those suffering from cognitive impairment hospitalized at the acute ward of the Geriatrics Clinic between January 2017 and December 2019. Also the patients who attended the Movement disorder outpatient clinic during the same study period were examined. To detect syphilis reactivity a qualitative specific treponemal test on patient’s serum was performed: the Treponema pallidum haemagglutination assay (TPHA). A total of 652 patients were admitted and 315 of them (52%) were submitted to a routine screening for syphilis: 307 (97%) were negative while 8 (3%) had a positive syphilis serology. The TPHA-positive patients (4 males, 4 females) were 2 patients with stroke, 5 with cognitive impairment and 1 with Parkinsonism with a mean age of 83 years, suffering from multiple comorbidities. Although the patients we have retrospectively studied have not undergone lumbar puncture to confirm the diagnosis of neurosyphilis, the not negligible syphilis reactivity rate found in our series suggests that serological screening for syphilis should be reviewed as a routine screening test in neurology and geriatrics departments, especially if the clinical presentation of the neurological diseases is atypical.

Parkinson's Disease Profile – A 17-Year Patient Analysis

Objective: Idiopathic Parkinson's disease (IPD) is a progressive degenerative disease, which increases over the age of 65 years and causes disability in advanced stages. The main pathology is the degeneration of the basal ganglia, especially the substantia nigra. In the clinic, motor and non-motor findings (NMF) are seen, and treatment approach is symptomatic. Factors that increase the risk in Parkinson's disease are male gender, old age, white race, environmental conditions, trauma, vascular diseases, family history, and genetic mutations. In this study, idiopathic Parkinson's patients who came to our movement disorders outpatient clinic in the last 17 years were evaluated retrospectively. We aimed to determine the IPD profile in our region through demographic and clinical findings and treatments used and compare the results with the literature. Methods: We evaluated 1150 patients admitted to the neurology department of movement disorders outpatient clinic due to parkinsonism. Five hundred seventy-eight patients with IPD were included in the study. Demographic data such as age, sex, place of birth, place of residence (rural/urban), comorbidities, family history, and habits were recorded. Results: A total of 63.5% of the patients were male. The mean age of the patients was 68.51(SD ± 10.35) years old for males and 68.37(SD ± 11.22) years old for females, 62.61(SD ± 11.31) for males and 62.55(SD ± 12.46) for females. 66.4% of the patients had the first clinical finding as tremor, while 55.4% had the tremor as the leading complaint. It was seen that 57% of the patients had NMF. It was observed that 52.8% of the patients did not have dementia. As the clinical stage progressed, it was determined that there was a significant increase in dementia rate. Hypertension (HT) (M/F%:35,2/47,2 p=0.01) and thyroid diseases (M/F%:2.3/10.3 p=0,00) were more frequent in female patients than in male patients. Impulsive-compulsive behaviors (ICBs) which are treatment-related problems were more common in males than in females (M/F%:17.8/8.5 p=0,00). Conclusion: The results were found to be similar to the literature. In this study, we have noticed the neglected, incomplete, or inadequately questioned parameters in routine-intensive outpatient conditions. Taking these results into consideration, we had the opportunity to correct our shortcomings in our future studies.

Screening for depression in movement disorders clinic.

Depression is the most common, though often under-recognised, neuropsychiatric disturbance in movement disorders (MD). This study aimed to establish whether a briefer screening measure such as a visual analogue screening measure (Emotions Thermometer) or Neurological Disorders Depression Inventory for Epilepsy (NDDI-E) could be a potentially suitable screening tool for depression in MD patients. Patients attending a regional MD outpatient clinic completed the Emotional Thermometer 7-item tool (ET7), the Hospital Anxiety and Depression Scale (HADS) and the Neurological Disorders Depression Inventory for Epilepsy (NDDIE). We used the Major Depression Inventory which provided the diagnosis of depression based on ICD-10 and DSM-IV as our diagnostic gold standard to compare the performance of ET7 and its individual sub-scales, its briefer version ET4, HADS, and NDDIE. Sensitivity, specificity, positive predictive value, negative predictive value and receiver operating characteristic curves were calculated to compare the performance of the screening tools. In total, 188 patients were included in the analysis. The most accurate tools as determined by Receiver Operating Characteristics curve were HADS-D for ICD-10 depressive episode and DepT for DSM-IV major depression. ET4 performed well as a 'rule-out' screening tool for both DSM-IV and ICD-10 depression. ET4 performance was comparable to HADS without the need for clinician scoring. The briefer ET4 performed almost as well as ET7. Emotions Thermometer and NDDI-E are quick and reliable screening tools for depression in the MD population and are comparable to HADS. We suggest routine use of visual analogue ET4 as it is briefer, requires less time to complete and does not require scoring from the clinicians. It has the potential to be widely implemented across busy neurology clinics to assist in depression screening.

Bone mineral density and serum vitamin D status in Parkinson's disease: Are the stage and clinical features of the disease important?

Although it is well known that patients with Parkinson's disease (PD) have low bone mineral density (BMD) and serum vitamin D level, there are no studies evaluating their relationship with the stage and clinical features of the PD. The purpose of this study was to evaluate the relationship between BMD and serum vitamin D level and stage or clinical features of the PD. One hundred twenty-four patients with PD recruited from Movement Disorders Outpatient Clinic and age- and sex-matched 116 healthy controls were included in the study. BMD and serum vitamin D level of all participants were measured. After patients had been divided into four groups according to Hoehn and Yahr (H and Y) staging, a total of 5 groups with controls, BMD (lumbar and femoral) and serum vitamin D level were compared between groups. The relationship between the clinical features of the PD [disease duration, medication history, Unified Parkinson's Disease Rating Scale (UPDRS) part II and III, and subscores of UPDRS part III] and BMD or vitamin D was investigated. Lumbar and femoral BMD values and serum vitamin D level were significantly lower in patients with PD compared to controls. Low BMD and low serum vitamin D level were identified in the early stages of the disease (H and Y stage 1 and 1.5) and were marked by the progress of the stage of the disease. There was a negative relationship between the clinical features of the PD and both BMD and serum vitamin D level. All patients with PD should be screened for developing osteoporosis and for sufficient vitamin D level in the early stages of the disease. Preventive methods for bone quality should be taken into consideration at the onset of PD.

Serum Levels of Melatonin and Sleep Evaluation Scales in the Diagnosis of Sleep Disorders in Patients with Idiopathic Parkinson's Disease.

Sleep disturbances, such as difficulty in initiation of sleep, decrease in total sleep duration and efficacy, frequent awakenings, and increased daytime sleepiness are among the most common non-motor symptoms in patients with idiopathic Parkinson's disease (PD). However, patients usually do not consider these symptoms as important as their motor symptoms, and do not complain. We aimed to investigate PD patients for subtle sleep disturbances using sleep evaluation scales, and to evaluate the relationship between these tests and the serum levels of melatonin during night-sleep. A total of 40 PD patients (19, female), older than 50 years, registered in our "Movement Disorders Out-patient Clinic", and 40 healthy, age and sex-matched control subjects (20, female) were included in the study. All subjects were assessed using Pittsburg Sleep Quality Index (PSQI) and Epworth Sleepiness Scale (ESS). Serum melatonin levels during night-sleep were measured in blood samples taken at 00:00 and 05:00 hours in every subject. Both groups were compared for demographical data, sleep evaluation scales and serum levels of melatonin. Patients with PD had significantly higher scores in PSQI and ESS than the healthy controls (p<0.001). Although the serum melatonin levels at two different time points during night sleep were lower in PD patients than the controls, these differences did not reach statistical significance (p=0.104 at 00:00 am, p=0.528 at 05:00 am). There was no significant correlation between the PSQI scores and serum melatonin levels in patient group (p>0.05). However, there was a significant but weak correlation (r=-0.353, p=0.025) between ESS scores and the serum melatonin levels measured at 05:00 hours in patients, but not between the melatonin levels measured at 00:00 hours. Sleep evaluation questionnaires such as, PSQI and ESS, can provide useful information in PD patients with mild sleep disturbances. However, serum melatonin levels alone were not helpful in diagnosing the sleep disorders.

Microstructural white matter alterations in patients with drug induced parkinsonism.

Drug-induced parkinsonism (DIP) is the second most common etiology of parkinsonism. And yet, there is little information on structural imaging in DIP to elucidate the accurate underlying pathomechanisms. To investigate microstructural white matter (WM) in patients with DIP using diffusion tensor image and to determine its relationship to severity of parkinsonian motor symptoms and cognitive function. A total of 42 patients with DIP, 65 with Parkinson's disease, and 33 control subjects were recruited from a movement disorders outpatient clinic. We performed comparative analysis of fractional anisotropy (FA) and mean diffusivity (MD) values among groups using tract-based spatial statistics. Correlation analysis between WM integrity and parkinsonian motor symptoms and cognitive performance was also performed in DIP patients using voxel-wise statistical analysis. DIP patients had significantly lower FA and higher MD values over widespread WM areas than control subjects. The patients with DIP had poor cognitive performance relative to control subjects, which correlated well with WM properties. Additionally, the parkinsonian motor symptoms were negatively correlated with FA values. In contrast, exposure time to the offending drugs prior to the development of parkinsonism or duration of parkinsonism showed no significant association with FA or MD values. The present study demonstrates that disruption of the WM microstructure is extensive in patients with DIP, and it is correlated with clinical parameters of parkinsonism and cognitive performance. This suggests that DIP may be reflective of underlying abnormality of microstructural WM. Hum Brain Mapp 38:6043-6052, 2017. © 2017 Wiley Periodicals, Inc.

Adverse drug reaction to antiparkinson agents in Idiopathic Parkinson Disease: a prospective observational study in a Movement Disorder outpatient clinic

Background: Parkinson disease (PD) generally requires therapy for prolonged periods often with multiple drugs; drug-related adverse effects often add to the existing morbidity. Although, such ADRs are common, comprehensive information about their incidence, severity, and ultimate health effects are not available. The objective of the study was to analyze the pattern of occurrence of Adverse Drug Reactions (ADRs) in patients receiving anti-parkinson agents (APA) in a tertiary care hospital. We also aimed to assess the causality, severity and preventability of these ADRs.Methods: This prospective, observational study with 6 month follow up was conducted among consecutive PD patients receiving anti parkinson agents attending the Movement disorder clinic of Neurology department between April 1st 2011 and September 30th 2012. Tools used were ADR Reporting form of National Pharmacovigilance centre, WHO causality scale, Hartwig and Siegel scale to assess severity and Schumock and Thornton scale to assess preventability of ADRs. Descriptive statistics was used and the values were expressed in numbers and percentages.Results: ADRs were experienced in 87 patients (82.1%) out of 106 patients and most of these patients were on combination therapy (66%). No gender difference in distribution of ADRs was observed. The most common reactions were sedation, dizziness, dry mouth and fatigue. The drug usage was in the order of pramipexole (58.4%), levodopa+carbidopa (55.7%), trihexyphenidyl (28.3%), entacapone (5.7%) and amantadine (7.5%). Majority of the ADRs were mild level 1 (71.1%). ADR was maximum with entacapone. Majority of ADRs belonged to the causality possible ADR category. All the ADRs came under the definitely or probably preventable category.Conclusions: ADRs with antiparkinsonian drugs is common but mild and preventable.

Treatment of hemifacial spasm with botulinum toxin type a: effective, long lasting and well tolerated.

To evaluate the long-term effect of botulinum toxin type A (BTX-A) in the treatment of HFS. A retrospective analysis of patients treated at the Movement Disorders Outpatient Clinic in the Neurology Service, Hospital de Clínicas, Federal University of Paraná, Curitiba, from 2009 to 2013 was carried out. A total of 550 BTX-A injections were administered to 100 HFS patients. Mean duration of improvement following each injection session was 3.1 months, mean latency to detection of improvement was 7.1 days and mean success rate was 94.7%. Patients were evaluated at an interval of 5.8 months after each application. Adverse effects, which were mostly minor, were observed in 37% of the patients at least once during follow-up. The most frequent was ptosis (35.1%). Treatment of HFS with BTX-A was effective, sustainable and safe and had minimal, well-tolerated side effects.

Can recurrent falls be predicted in parkinson’s disease?

Objective: To investigate the prevalence of recurrent falls in patients who are being followed up in Movement Disorder Outpatient Clinic, demographic and clinical characteristics of patients with recurrent falls, and relative accuracy of balance assessment for prediction of falls prospectively within 1 year. Materials and Methods: The patients who were admitted to Movement Disorder Outpatient Clinic due to idiopathic Parkinson’s disease were consecutively included in the study. Demographic data and disease characteristics of the patients were recorded. Berg Balance Scale, Functional Reach Test, Five Times Sit-To-Stand Test and Timed Up and Go Test were used for assessment of balance. Subsequently, the patients and/or their relatives were asked to fill out fall diaries for 1 year. Results: At the end of one year, at least one fall was detected in 47 (46.1%) and recurrent falls were detected in 35 (34.3%) out of 102 patients. The patients who had recurrent falls had a longer duration of disease, were using higher doses of levodopa and had higher disease severity according to Hoehn &Yahr staging and Unified Parkinson’s Disease Rating Scale. These patients obtained lower scores in Functional Reach Test, Five Times Sit-To-Stand Test, Timed Up and Go Test and Berg Balance Scale. According to Receiver Operating Characteristic analysis, Functional Reach Test had maximum specificity and sensitivity for prediction of falls followed by Berg Balance Scale, Timed Up and Go Test and Five Times Sit-To-Stand Test. Conclusion: Recurrent falls have been found in approximately one-third of the patients with Parkinson’s disease. Disease progression had a negative effect on falls. While the Functional Reach Test is the most appropriate test for prediction of fall risk, Berg Balance Scale, Timed Up and Go Test and Five Times Sit-To-Stand Test were also shown to be useful. Prediction of fall risk may positively influence quality of life through preventing complications.

Lack of Association between Impulse Control Disorders and REM Sleep Behavior Disorder in Patients with Parkinson’s Disease

Purpose: Rapid eye movement sleep behavior disorder (RBD) and impulse control disorders (ICDs) are common in subjects with Parkinson’s disease. The association between these two conditions has been contradictory. The aim of this study is to analyze the association between these two non-motor symptoms. Methods: Consecutive subjects with Parkinson’s disease attending the Movement Disorders Outpatient Clinic were included. The presence of ICDs was assessed using the Questionnaire for Impulse Control Disorders Rating Scale. RBD was diagnosed by an overnight, single night polysomnography. Results: Fifty-five consecutive subjects with Parkinson’s disease were included. The prevalence of ICDs and related behaviors was 23.6% (ICD in 14.5% and related behaviors in 9.1%). RBD was diagnosed in 47.2% of the patients. No differences were found in the frequency of ICDs and related behaviors when comparing subjects with and without RBD (23% versus 24.1%, p = 0.926, respectively). Conclusion: No association between the presence of RBD and the frequency of ICDs in subjects with Parkinson’s disease was found.

P136. Relation of EEG frequency and apathy in patients with Parkinson’s disease (PD)

Objective To examine the hypothesis that apathy in patients with PD is related to frontal and temporal changes in EEG frequencies. We expected apathy to correlate with slowing of general EEG background activity, with decrease of alpha power and with increase of theta power in frontal and temporal regions of the brain. Methods 37 non-demented patients with idiopathic PD were recruited from the Movement Disorder Outpatient Clinic Basel (age: Median 69y; from 50y to 84y; 14 females). The Apathy Evaluation Scale (AES) (Marin, 1991) in informant version (AES-I) were completed by relatives of the patients.256-channel EEGs with quantitative semi-automatic analyses were used to detect alpha total-frequencies alpha 1-, alpha 2- and theta-in frontal and temporal regions. In addition, slowing of EEG was measured with Median Peak frequency. For statistics, a general linear model with backward elimination procedure was conducted. We controlled for confounding factors: age, gender, education, severity of motor symptoms, levodopa equivalent dose, depression and cognition. Results In this sample, the patients were only slightly affected by apathy ( Median =24; from 18 to 39; cut off value: 38). The resulting model was significant ( R 2 = 0.39 ; p b =−3.74; p =0.08). Relevant variables in the resulting model were alpha total, temporal right ( b =76.493; p b =−58.37; p b =−13.07; p r =−0.40), whereas in females there was no correlation between alpha total and the number of apathy symptoms ( r =0.04). Conclusions Slowing of EEG is correlated with apathy in patients with PD. This correlation is significant even in PD patients with little or no depression. This fact helps to separate the two neuropsychiatric entities. In accordance with our hypothesis, beginning apathy in PD might be related to an alpha 1 decrease the frontal left part of the brain. In contrast, alpha total of the right hemisphere positively correlates with apathy. In addition, however, the results in male gender are consistent with our expectation, but have to be replicated in a larger sample of PD patients with more severe apathy.

Effects of Repeated Botulinum Toxin Treatment for Sialorrhea in Patients with Parkinson's Disease.

To evaluate the efficacy and adverse effects of repeated onabotulinumtoxinA (BoNT-A) treatment in patients suffering from Parkinson's disease (PD) with sialorrhea. A retrospective analysis of 16 patients with sialorrhea treated with BoNT-A at our movement disorders outpatient clinic was conducted from February 2009 to September 2013. A patient with adult cerebral palsy and a patient with PD who received only a single application were excluded. BoNT-A was injected into the parotid glands without ultrasound guidance. Pre-treatment sialorrhea severity was quantified according to the Drooling Frequency and Severity Scale (DFSS). The efficacy was evaluated four weeks after BoNT-A injections using DFSS and according to the subjective assessment of the patients and/or caregivers. The mean age of the patients was 70.00±9.82 years and the mean follow-up duration was 18.78±10.37 months. Totally, 37 applications were performed. The mean BoNT-A total dose was 34.35±6.41 units. The mean scores of DFSS before and after injections were 7.00±1.03 and 3.21±0.89, respectively (p<0.001). Efficacy was 100%, and the mean experienced sialorrhea improvement was 71.78±12.95%. We found a significant difference between the first and last application in the mean duration of efficacy (17.28±9.21 weeks and 18.03±9.02 weeks, respectively, p=0.001). We did not observe side effects in this study group. Repeated injections of BoNT-A are safe and effective in treating sialorrhea in patients with PD. Based on our results, it seems that there is a maintenance of efficacy after a three-year period and an increase in the mean duration of efficacy with the number of injections. Further prospective clinical studies with larger number of patients and more longer duration of follow-up are needed to confirm our results.

Effects of cannabidiol in the treatment of patients with Parkinson's disease: an exploratory double-blind trial.

Parkinson's disease (PD) has a progressive course and is characterized by the degeneration of dopaminergic neurons. Although no neuroprotective treatments for PD have been found to date, the endocannabinoid system has emerged as a promising target. From a sample of 119 patients consecutively evaluated in a specialized movement disorders outpatient clinic, we selected 21 PD patients without dementia or comorbid psychiatric conditions. Participants were assigned to three groups of seven subjects each who were treated with placebo, cannabidiol (CBD) 75 mg/day or CBD 300 mg/day. One week before the trial and in the last week of treatment participants were assessed in respect to (i) motor and general symptoms score (UPDRS); (ii) well-being and quality of life (PDQ-39); and (iii) possible neuroprotective effects (BDNF and H(1)-MRS). We found no statistically significant differences in UPDRS scores, plasma BDNF levels or H(1)-MRS measures. However, the groups treated with placebo and CBD 300 mg/day had significantly different mean total scores in the PDQ-39 (p = 0.05). Our findings point to a possible effect of CBD in improving quality of life measures in PD patients with no psychiatric comorbidities; however, studies with larger samples and specific objectives are required before definitive conclusions can be drawn.