Movement Disorders Research Research Articles

Advancing Parkinson's Disease Research in Canada: The Canadian Open Parkinson Network (C-OPN) Cohort.

Enhancing the interactions between study participants, clinicians, and investigators is imperative for advancing Parkinson's disease (PD) research. The Canadian Open Parkinson Network (C-OPN) stands as a nationwide endeavor, connecting the PD community with ten accredited universities and movement disorders research centers spanning, at the time of this analysis, British Columbia, Alberta, Ontario, and Quebec. Our aim is to showcase C-OPN as a paradigm for bolstering national collaboration to accelerate PD research and to provide an initial overview of already collected data sets. The C-OPN database comprises de-identified data concerning demographics, symptoms and signs, treatment approaches, and standardized assessments. Additionally, it collects venous blood-derived biomaterials, such as for analyses of DNA, peripheral blood mononuclear cells (PBMC), and serum. Accessible to researchers, C-OPN resources are available through web-based data management systems for multi-center studies, including REDCap. As of November 2023, the C-OPN had enrolled 1,505 PD participants. The male-to-female ratio was 1.77:1, with 83% (n = 1098) residing in urban areas and 82% (n = 1084) having pursued post-secondary education. The average age at diagnosis was 60.2±10.3 years. Herein, our analysis of the C-OPN PD cohort encompasses environmental factors, motor and non-motor symptoms, disease management, and regional differences among provinces. As of April 2024, 32 research projects have utilized C-OPN resources. C-OPN represents a national platform promoting multidisciplinary and multisite research that focuses on PD to promote innovation, exploration of care models, and collaboration among Canadian scientists.

White Matter Microstructural Changes Using Ultra-Strong Diffusion Gradient MRI in Adult-Onset Idiopathic Focal Cervical Dystonia.

Adult-onset idiopathic focal cervical dystonia (AOIFCD) involves abnormal posturing of the cervical musculature and, in some individuals, an associated head tremor. Existing neuroimaging studies have implicated key motor networks. However, measures used to date lack specificity toward underlying pathophysiologic differences. We aim to assess white matter motor pathways for localized, microstructural differences, which may aid in understanding underlying mechanisms. Individuals diagnosed with AOIFCD and an age- and sex-matched control group were prospectively recruited through the Welsh Movement Disorders Research Network. All participants underwent in-depth clinical phenotyping and MRI (structural and diffusion sequences) using ultra-strong diffusion gradients. Tractography (whole-tract median values) and tractometry (along tract profiling) were performed for key white matter motor pathways assessing diffusion kurtosis imaging (DKI), neurite orientation dispersion and density imaging (NODDI), and standard model parameters. Groups were compared using linear model analysis with Bonferroni multiple comparison correction. Fifty participants with AOIFCD and 30 healthy control participants were recruited, with 46 with AOIFCD and 30 healthy controls included for analysis (33 without head tremor, 13 with head tremor). Significant differences were observed in the anterior thalamic radiations (lower mid-tract fractional anisotropy [estimate = -0.046, p = 3.07 × 10-3], radial kurtosis [estimate = -0.165, p = 1.42 × 10-4], f-intra-axonal signal fraction [estimate = -0.044, p = 2.78 × 10-3], p2 orientation coherence [estimate = -0.043, p = 1.64 × 10-3], higher Orientation Dispersion Index [ODI, estimate = 0.023, p = 2.22 × 10-3]) and thalamopremotor tracts (higher mid-tract mean kurtosis [estimate = 0.064, p = 7.56 × 10-4], lower Neurite Density Index [estimate = 0.062, p = 2.1 × 10-3], higher distal tract ODI [estimate = 0.062, p = 3.1 × 10-3], lower f [estimate = -0.1, p = 2.3 × 10-3], and striatopremotor tracts [proximal lower f: estimate = -0.075, p = 1.06 × 10-3]). These measures correlated with clinical measures: dystonia duration (right thalamopremotor distal ODI: r = -0.9, p = 1.29 × 10-14), psychiatric symptoms (obsessive compulsive symptoms: left anterior thalamic radiation p2 r = 0.92, p = 2.797 × 10-11), sleep quality (Sleep Disorders Questionnaire Score: left anterior thalamic radiation ODI: r = -0.84, p = 4.84 × 10-11), pain (left anterior thalamic radiation ODI: r = -0.89, p = 1.4 × 10-13), and cognitive functioning (paired associated learning task p2, r = 0.94, p = 6.68 × 10-20). Overall, localized microstructural differences were identified within tracts linking the prefrontal and premotor cortices with thalamic and basal ganglia regions, suggesting pathophysiologic processes involve microstructural aberrances of motor system modulatory pathways, particularly involving intra-axonal and fiber orientation dispersion measures.

The Role of Non-Invasive Brain Modulation in Identifying Disease Biomarkers for Diagnostic and Therapeutic Purposes in Parkinsonism.

Over the past three decades, substantial advancements have occurred in non-invasive brain stimulation (NIBS). These developments encompass various non-invasive techniques aimed at modulating brain function. Among the most widely utilized methods today are transcranial magnetic stimulation (TMS) and transcranial electrical stimulation (TES), which include direct- or alternating-current transcranial stimulation (tDCS/tACS). In addition to these established techniques, newer modalities have emerged, broadening the scope of non-invasive neuromodulation approaches available for research and clinical applications in movement disorders, particularly for Parkinson's disease (PD) and, to a lesser extent, atypical Parkinsonism (AP). All NIBS techniques offer the opportunity to explore a wide range of neurophysiological mechanisms and exert influence over distinct brain regions implicated in the pathophysiology of Parkinsonism. This paper's first aim is to provide a brief overview of the historical background and underlying physiological principles of primary NIBS techniques, focusing on their translational relevance. It aims to shed light on the potential identification of biomarkers for diagnostic and therapeutic purposes, by summarising available experimental data on individuals with Parkinsonism. To date, despite promising findings indicating the potential utility of NIBS techniques in Parkinsonism, their integration into clinical routine for diagnostic or therapeutic protocols remains a subject of ongoing investigation and scientific debate. In this context, this paper addresses current unsolved issues and methodological challenges concerning the use of NIBS, focusing on the importance of future research endeavours for maximizing the efficacy and relevance of NIBS strategies for individuals with Parkinsonism.

Bridging the gap between statistical significance and clinical relevance: A systematic review of minimum clinically important difference (MCID) thresholds of scales reported in movement disorders research

BackgroundMinimum clinically important difference (MCID) is the smallest change in an outcome measure that is considered clinically meaningful. Using validated MCID thresholds for outcomes powers trials adequately to detect meaningful treatment effects, aids in their interpretation and guides development of new outcome measures. ObjectivesTo provide a comprehensive summary of MCID thresholds of various symptom severity scales reported in movement disorder. MethodsWe conducted systematic review of the literature and included studies of one or more movement disorders, and reporting MCID scales. Results2763 reports were screened. Final review included 32 studies. Risk of bias (RoB) assessment showed most studies were of good quality. Most commonly evaluated scale was Unified Parkinson's Disease Rating Scale (UPDRS) (11 out of 32). Four studies assessing MDS-UPDRS had assessed its different sub-parts, reporting a change of 2.64,3.05,3.25 and 0.9 points to detect clinically meaningful improvement and 2.45,2.51,4.63 and 0.8 points to detect clinically meaningful worsening, for the Part I, II, III and IV, respectively. For Parts II + III, I + II + III and I + II + III + IV, MCID thresholds reported for clinically meaningful improvement were 5.73, 4.9, 6.7 and 7.1 points respectively; while those for clinically meaningful worsening were 4.7, 4.2, 5.2 and 6.3 points, respectively. MCID thresholds reported for other scales included Abnormal Involuntary Movement Scale (AIMS), Toronto Western Spasmodic Torticollis Rating Scale (TWSRS), and Burke-Fahn-Marsden Dystonia Scale (BFMD). ConclusionThis review summarizes all the MCID thresholds currently reported in Movement disorders research and provides a comprehensive resource for future trials, highlighting the need for standardized and validated MCID scales in movement disorder research.

Rethinking Movement Disorders.

At present, clinical practice and research in movement disorders (MDs) focus on the "normalization" of altered movements. In this review, rather than concentrating on problems and burdens people with MDs undoubtedly have, we highlight their hidden potentials. Starting with current definitions of Parkinson's disease (PD), dystonia, chorea, and tics, we outline that solely conceiving these phenomena as signs of dysfunction falls short of their complex nature comprising both problems and potentials. Such potentials can be traced and understood in light of well-established cognitive neuroscience frameworks, particularly ideomotor principles, and their influential modern derivatives. Using these frameworks, the wealth of data on altered perception-action integration in the different MDs can be explained and systematized using the mechanism-oriented concept of perception-action binding. According to this concept, MDs can be understood as phenomena requiring and fostering flexible modifications of perception-action associations. Consequently, although conceived as being caught in a (trough) state of deficits, given their high flexibility, people with MDs also have high potential to switch to (adaptive) peak activity that can be conceptualized as hidden potentials. Currently, clinical practice and research in MDs are concerned with deficits and thus the "deep and wide troughs," whereas "scattered narrow peaks" reflecting hidden potentials are neglected. To better delineate and utilize the latter to alleviate the burden of affected people, and destigmatize their conditions, we suggest some measures, including computational modeling combined with neurophysiological methods and tailored treatment. © 2024 International Parkinson and Movement Disorder Society.

Machine Learning in the Parkinson’s disease smartwatch (PADS) dataset

The utilisation of smart devices, such as smartwatches and smartphones, in the field of movement disorders research has gained significant attention. However, the absence of a comprehensive dataset with movement data and clinical annotations, encompassing a wide range of movement disorders including Parkinson’s disease (PD) and its differential diagnoses (DD), presents a significant gap. The availability of such a dataset is crucial for the development of reliable machine learning (ML) models on smart devices, enabling the detection of diseases and monitoring of treatment efficacy in a home-based setting. We conducted a three-year cross-sectional study at a large tertiary care hospital. A multi-modal smartphone app integrated electronic questionnaires and smartwatch measures during an interactive assessment designed by neurologists to provoke subtle changes in movement pathologies. We captured over 5000 clinical assessment steps from 504 participants, including PD, DD, and healthy controls (HC). After age-matching, an integrative ML approach combining classical signal processing and advanced deep learning techniques was implemented and cross-validated. The models achieved an average balanced accuracy of 91.16% in the classification PD vs. HC, while PD vs. DD scored 72.42%. The numbers suggest promising performance while distinguishing similar disorders remains challenging. The extensive annotations, including details on demographics, medical history, symptoms, and movement steps, provide a comprehensive database to ML techniques and encourage further investigations into phenotypical biomarkers related to movement disorders.

Important advances in movement disorders research in 2023

Important advances in movement disorders research in 2023

The Gaps and Prospects of Movement Disorders Education and Research in Africa: A Continental Survey.

The data that support the findings of this study are available from the corresponding author upon reasonable request. Appendix S1. Supplementary tables Appendix S2. Education Research Africa Survey Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.

Research in movement disorders in 2022: a new era of biomarker and treatment development

The task of identifying the crucial advances in Parkinson's disease and other movement disorders in 2022, among the more than 14 000 articles published in this field, is as daunting as it is exciting. Informed by a systematic literature review, recommendations from key opinion leaders, and our own personal appraisal, we have selected ten finalists.

Moving Forward from the COVID-19 Pandemic: Needed Changes in Movement Disorders Care and Research.

Purpose of ReviewThe COVID-19 pandemic has dramatically affected the health and well-being of individuals with movement disorders. This manuscript reviews these effects, discusses pandemic-related changes in clinical care and research, and suggests improvements to care and research models.Recent FindingsDuring the on-going COVID-19 pandemic, individuals with movement disorders have experienced worsening of symptoms, likely due to decreased access to care, loss of social connection, and decreased physical activity. Through telemedicine, care has moved out of the clinic and into the home. Clinical research has also been significantly disrupted, and there has been a shift to decentralized approaches. The pandemic has highlighted disparities in access to care and representation in research.SummaryWe must now translate these experiences into better care and research models with a focus on equitable integration of telemedicine, better support of patients and caregivers, the development of meaningful digital endpoints, and optimization of decentralized research designs.

Movement disorders research in 2021: cracking the paradigm

The approval in 2021 of a disease-modifying treatment for Alzheimer's disease should have been hailed as the most important advance in neurology of the century, validating the wider anti-protein approach to the full spectrum of neurodegenerative disorders. Yet, the light shone by a lenient US Food and Drug Administration revealed that, although the drug lowered amyloid concentrations, it did not improve recipients’ cognitive function. This biomarker–clinical discrepancy is a paradox in the so-called toxic proteinopathy paradigm. Neurologists have conceived amyloid and tau aggregation to be pathogenic in Alzheimer's disease, synuclein in Parkinson's disease, and tau in progressive supranuclear palsy. Thus, the reasoning followed that clearing protein aggregates is likely to be beneficial.

P.041 First Degree Movement Disorders Cases and Research

Background: While researchers pursue the etiology, pathophysiology and treatment of movement disorders, presently there is no biological marker for the two most common disorders – essential tremor (ET), and Parkinson’s disease and variants (Parkinson syndrome, or PS). The diagnosis of each remains clinical, but definitive diagnosis is made on brain pathology. Population epidemiological studies are hampered by a lack of diagnostic precision. Twins with the same disorder are scarce, and the next best option is studies of well-documented first-degree family members. Methods: Patients were seen at the Saskatchewan Movement Disorders Program (SMDP). All autopsied cases with known clinicopathological diagnosis of a movement disorder between 1970 and 2019 were reviewed. Only those with a first-degree family member – parent, child, and/or sibling - with a movement disorder were included. Results: 671 cases with movement disorders seen at SMDP have been autopsied. 29 cases including probands were found and thirteen first-degree families were identified; eight families were multiple (2 or more) siblings and five families included one parent/one child. In seven families, the diagnosis was concordant. Conclusions: Movement disorders in first degree relatives with autopsied verified diagnosis are dissimilar in nearly half the cases. Such small intensively studied groups offer unique research opportunities.

"Real-Life" Remote Dystonia Assessment: Feasibility, Accuracy, and Practice Implications.

"Real-Life" Remote Dystonia Assessment: Feasibility, Accuracy, and Practice Implications.

Expanding sexual and gender minority research in movement disorders: More than awareness and acceptance

Culturally competent and inclusive care is slowly becoming the standard throughout healthcare institutions. Awareness, acceptance, and inclusion of the sexual and gender minority (SGM) groups in medicine and neurology are progressing. Research in SGM health, although increasing, remains remarkably scant in parkinsonism and other movement disorders, a community whose patient population is on the rise. Most SGM health research in movement disorders only focuses on the symptoms associated with infection by the human immunodeficiency virus and the acquired immunodeficiency syndrome. Multiple clinical and epidemiological research questions remain unaddressed when considering the intersection of movement disorders and SGM health. In this article, we highlight gaps in the care of SGM individuals with movement disorders. First, the prevalence and phenomenology of movement disorders could be different, considering the different rates of risk factors and the use of gender-affirming hormones. Also, the effect of creating a safe environment in healthcare institutions to disclose sexual orientation and gender identity on seeking care, access to resources, and quality of services remains unknown. Moreover, many individuals with movement disorders would require services from multidisciplinary teams or long-term care facilities, which might not consider the needs of SGM patients in their models of care. Last, the effect of social isolation and self-perception (or misperceptions) in the SGM populations on the non-motor and motor symptoms of movement disorders and the treatment plans is not understood.

Analysis of Parkinson‘s disease movement disorder by M E R with S T N – Deep Brain Stimulations

Brain`s neuro protection is clearly the new frontier in movement disorder research and therapy. The long-term clinical studies have so far failed to prove that high-frequency stimulation has been able to slow down the evolution of the disease. So called e a r l y s t i m clinical p r o t o c o l s have only proven that it was safe to induce or stimuli sub thalamic nucleus S T N much earlier than it was so far accepted. At the experimental level, M P T P - treated monkeys, high-frequency stimuli of the S T N could protect neurons in the sub stantia nigra. To test this scientific rationale/hypothesis in humans, one would need to perform S T N induced stimuli at the very beginning of the disease, which is not easily ethically sustainable given the surgical risk, even if low, in patients who are still minimally impaired by the disease. There have been so many advancements in computing capabilities; big data management; miniaturization of electronics, devices and batteries; and new sources of energy compatible with implantation of biological devices and fuel cells. More recently, there has been an explosion of biological imaging at the nano level as well as whole-brain imaging. It is impossible to generate a reasonable picture of future technological development without being sure to be wrong. The consequence of that is that when building projects and setting new protocols as well as imagining new tools and devices, we should be confident that what has not yet been developed will eventually be created. In this article we the author explained the present past and future Parkinson`s disease prediction.

Digital Technology in Movement Disorders: Updates, Applications, and Challenges.

Purpose of ReviewDigital technology affords the opportunity to provide objective, frequent, and sensitive assessment of disease outside of the clinic environment. This article reviews recent literature on the application of digital technology in movement disorders, with a focus on Parkinson’s disease (PD) and Huntington’s disease.Recent FindingsRecent research has demonstrated the ability for digital technology to discriminate between individuals with and without PD, identify those at high risk for PD, quantify specific motor features, predict clinical events in PD, inform clinical management, and generate novel insights.SummaryDigital technology has enormous potential to transform clinical research and care in movement disorders. However, more work is needed to better validate existing digital measures, including in new populations, and to develop new more holistic digital measures that move beyond motor features.

Essential tremor quantification based on the combined use of a smartphone and a smartwatch: The NetMD study

BackgroundThe use of wearable technology is an emerging field of research in movement disorders. This paper introduces a clinical study to evaluate the feasibility, clinical correlation and reliability of using a system based in smartwatches to quantify tremor in essential tremor (ET) patients and check its acceptance as clinical monitoring tool. New methodThe system is based on a commercial smartwatch and an Android smartphone. An investigational Android application controls the process of recording raw data from the smartwatch three-dimensional gyroscopes. Thirty-four ET patients were consecutively enrolled in the experiments and assessed along one year. Arm tremor was videofilmed and scored using the Fahn-Tolosa-Marin Tremor Rating Scale (FTM-TRS). Tremor intensity was quantified with the root mean square of angular velocity measured in the patients’ wrists. ResultsEighty-two assessments with smartwatches were performed. Spearman’s correlation coefficients (ρ) between clinical tremor (FTM-TRS) scores and smartwatch measures for tremor intensity were 0.590 at rest; ρ = 0.738 in steady posture; ρ = 0.189 in finger-to-nose maneuvers; and ρ = 0.652 in pouring water task. Smartwatch reliability was checked by intraclass realiability coefficients: 0.85, 0.95, 0.91, 0.95 respectively. Most of patients showed good acceptance of the system. Comparison with existing method(s)This commodity hardware contributes to quantify tremor objectively in a consulting-room by customized Android smart devices as clinical monitoring tool. ConclusionsThe NetMD system for tremor analysis is feasible, well-correlated with clinical scores, reliable and well-accepted by patients to tremor follow-up. Therefore, it could be an option to objectively quantify tremor in ET patients during their regular follow-up.

Psychogenic movement disorders

Psychogenic (or functional) movement disorders are movement disorders of presumed psychiatric etiology. We think of the symptoms, in Freudian terms, as arising from a conversion of the psychiatric symptoms into somatic ones. The psychiatric factors are likely important, and dealing with them can be a route to improvement, but understanding the patient may require a full biopsychosocial model of disease. Patients often have psychiatric co-morbidities, such as anxiety and depression, early life and contemporaneous stress. Women are affected more than men, and patients are seen at all ages. Some patients have factitious disorder or malingering, but these patients are rare, and we cannot easily separate them from the large majority with somatization. In terms of quality of life, patients with a functional movement disorder are worse than those with Parkinson’s disease. Common manifestations are tremor, myoclonus, dystonia, and gait disorders. There are clinical clues that can help make the diagnosis, and there are clinical neurophysiological studies that are particularly helpful for tremor and myoclonus. Neuroimaging research in psychogenic movement disorders has begun to shed some light on the underlying biology, and there is some evidence for abnormal function of the amygdala which might be able to trigger involuntary movements. Only neurologists can make the diagnosis of these patients. Psychiatrists are not trained to do this, but must help with patient management. Treatment has been problematic and needs to be multidisciplinary, including pharmacotherapy, psychotherapy, social work, and physical therapy.

2 Movement disorders – the parkinson’s névrose

Born on Merseyside, Andrew Lees qualified in medicine at the Royal London Hospital Medical College in 1970. His neurological training was at University College London Hospitals and the National Hospital for Neurology and Neurosurgery, Queen Square. He also spent time at L’Hopital Salpetriere, Paris. At the age of thirty-two he was appointed to the consultant staff at the National Hospitals, The Middlesex, and Whittington Hospitals and in 1987 was elected a Fellow of the Royal College of Physicians. He was later appointed Professor of Neurology at the National Hospital for Neurology and Neurosurgery, Queen Square and was Director of the Reta Lila Weston Institute for Neurological Studies (1998–2012). He was Clinical Director of the Queen Square Brain Bank for Neurological Disorders (1985–2012) and Director of the Sara Koe PSP Research Centre (2002–2012). He is a Visiting Professor at the University of Liverpool and has close collaborations with a number of Brazilian universities. For his contributions to Brazilian neurology he was elected an overseas member of the Academia Nacional de Medicina and the Academia Brasileira de Neurologica. He was elected as a Council member of the Academy of Medical Sciences 2012- 2015. Appointed as an Expert Adviser for the UK Government National Institute for Health and Care Excellence Centre for Guidelines (2006–2019). Andrew has achieved international recognition for his work on Parkinson’s disease and abnormal movement disorders. He is an original member of the Highly Cited Researchers ISI Database. Founder member of the international Movement Disorder Society, he was elected President (2004–2006) and co-edited the Movement Disorders Journal between 1995 and 2003. In 2006, he was awarded the Movement Disorders Research Award by the American Academy of Neurology. In recent years, he has delivered the Gowers Memorial Lecture at the National Hospital, The Inaugural Lord Brain Memorial Lecture at Barts and the Royal London Hospitals and David Marsden Memorial Lecture at the European Federation of Neurological Societies. He was the recipient of Stanley Fahn Lectureship Award, MDS Dublin 2012, and has been awarded the German Society of Neurology’s 2012 Dingebauer Prize for outstanding scientific attainment in the field of Parkinson’s disease and Neurodegenerative Disorders. In 2014, Andrew received the prestigious Jay Van Andel award for outstanding research in Parkinson’s disease. Based in Grand Rapids Michigan, the Van Andel Institute is an independent research organisation dedicated to preserving, enhancing and expanding the frontiers of medical science. In 2015, he became the recipient of the Association of British Neurologists Medal, awarded annually in recognition of outstanding contributions by British and Irish neurologists to the science and practice of neurology. Jean-Martin described ‘maladie de Parkinson’ as a nevrose, a term introduced into France by Pinel and used to describe any nervous disorder without demonstrable organic pathology. In 1917 Tretiakoff working at L’Hopital Salpetriere demonstrated that a severe loss of pigmented nerve cells in the pars compacta of the substantia nigra was invariably present giving it a ‘solidity’ denied to many other movement disorders such as dystonia and chorea and brought the disease firmly into the fold of neurology. From the earliest clinical descriptions, it has been recognised that anxiety and depression can have a profound effect on the expression and severity of the motor symptoms of Parkinson’s diseasse and that the kinesics of chronic anxiety and psychomotor retardation bear a superficial similarity to the movement disorder that characterises Parkinson’s disease. Slowness of willed movement an invariable feature of Parkinson’s disease can be seen in depression and also in a rare form of obsessional compulsive disorder. The intimate links between motion and emotion in basal ganglia disorders and the notion of Parkinson’s disease as a neuropsychiatric disorder are now widely acknowledged but the idea that severe emotional stress could cause neurodegeneration is more controversial. In a paper published in 2014 Djamshidian and I hypothesised that chronic stress might cause Parkinson’s disease in susceptible individuals and that many of the symptoms reported in the pre-diagnostic phase of the illness are identical to those seen in functional somatic syndromes (Djamshidian A, et al. J Neurol Neurosurg Psychiatry 2014;85:879–882). The clinical clues that stress might be a neglected risk factor for Parkinson’s disease will be discussed in the hope of stimulating further research.

10 Impulse control disorders in parkinson’s disease

The Voon research group focuses on mechanisms underlying impulsivity and compulsivity with specific application to addictions. She obtained her medical degree and psychiatry residency training from the University of British Columbia and University of Toronto in Canada. She completed a movement disorders research fellowship at the National Institutes of Neurological Disorders and Stroke and concurrently a PhD in neuroscience from the University College London and recently completed a Wellcome Trust Intermediate Fellowship at the University of Cambridge. Her PhD focused on the dopamine-agonist related impulse control disorders (e.g. pathological gambling, binge eating, compulsive sexual behaviours and shopping). She has published over 120 manuscripts and book chapters including in high impact journals. She is a Fellow of the American Neuropsychiatric Association and chairs their Committee for Research and is on the Board of Directors for the British Neuropsychiatric Association. Chronic treatment with dopaminergic medications in Parkinson’s disease can be associated with a range of unexpected behaviours including impulse control disorders or behavioural addictions. These behaviours are common, occurring in 14% on treatment, and include pathological gambling, eating, sexual and shopping behaviours. This talk will provide an overview of emerging evidence within the last 5 years highlighting the role of dopaminergic medication interacting with the neurobiology of Parkinson’s disease and individual susceptibility. Associated factors from large epidemiological studies suggest overlaps with factors known to be associated with disorders of addiction. A critical role for stimulus-driven phasic dopaminergic activity is highlighted from animal and human studies that may underlie observations of reactivity to salient rewarding cues and novelty. Cognitive impairments focus on this balance between reward and loss and decisional impulsivity. Emerging studies from parkinsonian rodent models emphasise the facilitatory role of the parkinsonian lesion. New treatment studies highlight approaches beyond medication adjustment. Mechanisms underlying these disorders can provide critical insight into other behavioural symptoms associated with Parkinson’s disease and disorders of addictions. References . Voon V, Napier C, Frank MJ, et al. Impulse control disorders and levodopa-induced dyskinesias in Parkinson’s disease: an update. Lancet Neurology2017. . Labroots Neuroscience webinar:https://www.youtube.com/watch?v=eqOIlscDfYI