Parkinson’s Disease The latest articles from Hindawi © 2018 , Hindawi Limited . All rights reserved. Impact of Mézières Rehabilitative Method in Patients with Parkinson’s Disease: A Randomized Controlled Trial Sun, 03 Dec 2017 00:00:00 +0000 The aim of this study was to assess the efficacy of Mézières method in improving trunk flexibility of the back muscles and balance in patients with Parkinson’s disease (PD). Materials and Methods. Thirty-six patients were randomized into 2 groups: the Mézières treatment group and the control group (home exercise group). The primary outcome was the improvement in balance per the Berg Balance Scale (BBS) and the trunk flexibility of the back for the anterior flexion trunk test. Also, we evaluated pain, gait balance for the Functional Gait Assessment (FGA), disease-related disability for the Modified Parkinson’s Activity Scale and the Unified Parkinson’s Disease Rating Scale (UPDRS), the quality of life, and the functional exercise capacity. All the measures were evaluated at baseline (), at the end of the rehabilitative program (), and at the 12-week follow-up (). Results. In the Mézières group, the BBS () and trunk flexion test () improved significantly at and remained the same at . Between groups, significant changes were reported in FGA () and UPDRS Total () at and in FGA () at . Conclusion. The Mézières approach is efficacious in improving the flexibility of the trunk and balance in PD patients. Teresa Paolucci, Federico Zangrando, Giulia Piccinini, Laura Deidda, Rossella Basile, Enrico Bruno, Emigen Buzi, Alice Mannocci, Franca Tirinelli, Shalom Haggiag, Ludovico Lispi, Ciro Villani, and Vincenzo M. Saraceni Copyright © 2017 Teresa Paolucci et al. All rights reserved. Phosphorylated α-Synuclein-Copper Complex Formation in the Pathogenesis of Parkinson’s Disease Thu, 23 Nov 2017 00:00:00 +0000 Parkinson’s disease is the second most important neurodegenerative disorder worldwide. It is characterized by the presence of Lewy bodies, which are mainly composed of α-synuclein and ubiquitin-bound proteins. Both the ubiquitin proteasome system (UPS) and autophagy-lysosomal pathway (ALS) are altered in Parkinson’s disease, leading to aggregation of proteins, particularly α-synuclein. Interestingly, it has been observed that copper promotes the protein aggregation process. Additionally, phosphorylation of -synuclein along with copper also affects the protein aggregation process. The interrelation among α-synuclein phosphorylation and its capability to interact with copper, with the subsequent disruption of the protein degradation systems in the neurodegenerative process of Parkinson’s disease, will be analyzed in detail in this review. Juan Antonio Castillo-Gonzalez, Maria De Jesus Loera-Arias, Odila Saucedo-Cardenas, Roberto Montes-de-Oca-Luna, Aracely Garcia-Garcia, and Humberto Rodriguez-Rocha Copyright © 2017 Juan Antonio Castillo-Gonzalez et al. All rights reserved. Theatre Is a Valid Add-On Therapeutic Intervention for Emotional Rehabilitation of Parkinson’s Disease Patients Wed, 22 Nov 2017 08:07:44 +0000 Conventional medical treatments of Parkinson’s disease (PD) are effective on motor disturbances but may have little impact on nonmotor symptoms, especially psychiatric ones. Thus, even when motor symptomatology improves, patients might experience deterioration in their quality of life. We have shown that 3 years of active theatre is a valid complementary intervention for PD as it significantly improves the well-being of patients in comparison to patients undergoing conventional physiotherapy. Our aim was to replicate these findings while improving the efficacy of the treatment. We ran a single-blinded pilot study lasting 15 months on 24 subjects with moderate idiopathic PD. 12 were assigned to a theatre program in which patients underwent “emotional” training. The other 12 underwent group physiotherapy. Patients were evaluated at the beginning and at the end of their treatments, using a battery of eight clinical and five neuropsychological scales. We found that the emotional theatre training improved the emotional well-being of patients, whereas physiotherapy did not. Interestingly, neither of the groups showed improvements in either motor symptoms or cognitive abilities tested by the neuropsychological battery. We confirmed that theatre therapy might be helpful in improving emotional well-being in PD. Giovanni Mirabella, Paolo De Vita, Michele Fragola, Silvia Rampelli, Francesco Lena, Fulvia Dilettuso, Marta Iacopini, Raffaella d’Avella, Maria Concetta Borgese, Silvia Mazzotta, Deborah Lanni, Marco Grano, Sara Lubrani, and Nicola Modugno Copyright © 2017 Giovanni Mirabella et al. All rights reserved. Cognitive Impact of Deep Brain Stimulation on Parkinson’s Disease Patients Wed, 22 Nov 2017 06:45:14 +0000 Subthalamic nucleus (STN) or globus pallidus interna (GPi) deep brain stimulation (DBS) is considered a robust therapeutic tool in the treatment of Parkinson’s disease (PD) patients, although it has been reported to potentially cause cognitive decline in some cases. We here provide an in-depth and critical review of the current literature regarding cognition after DBS in PD, summarizing the available data on the impact of STN and GPi DBS as monotherapies and also comparative data across these two therapies on 7 cognitive domains. We provide evidence that, in appropriately screened PD patients, worsening of one or more cognitive functions is rare and subtle after DBS, without negative impact on quality of life, and that there is very little data supporting that STN DBS has a worse cognitive outcome than GPi DBS. Raja Mehanna, Jawad A. Bajwa, Hubert Fernandez, and Aparna Ashutosh Wagle Shukla Copyright © 2017 Raja Mehanna et al. All rights reserved. Should Skin Biopsies Be Performed in Patients Suspected of Having Parkinson’s Disease? Mon, 30 Oct 2017 00:00:00 +0000 In patients with Parkinson’s disease (PD), the molecularly misfolded form of α-synuclein was recently identified in cutaneous autonomic nerve fibers which displayed increased accumulation even in early disease stages. However, the underlying mechanisms of synucleinopathic nerve damage and its implication for brain pathology in later life remain to be elucidated. To date, specific diagnostic tools to evaluate small fiber pathology and to discriminate neurodegenerative proteinopathies are rare. Recently, research has indicated that deposition of α-synuclein in cutaneous nerve fibers quantified via immunohistochemistry in superficial skin biopsies might be a valid marker of PD which could facilitate early diagnosis and monitoring of disease progression. However, lack of standardization of techniques to quantify neural α-synuclein deposition limits their utility in clinical practice. Additional challenges include the identification of potential distinct morphological patterns of intraneural α-synuclein deposition among synucleinopathies to facilitate diagnostic discrimination and determining the degree to which structural damage relates to dysfunction of nerve fibers targeted by α-synuclein. Answering these questions might improve our understanding of the pathophysiological role of small fiber neuropathy in Parkinson’s disease, help identify new treatment targets, and facilitate assessment of response to neuroprotective treatment. Timo Siepmann, Ana Isabel Penzlin, Ben Min-Woo Illigens, and Heinz Reichmann Copyright © 2017 Timo Siepmann et al. All rights reserved. Antidyskinetic Treatment with MTEP Affects Multiple Molecular Pathways in the Parkinsonian Striatum Mon, 30 Oct 2017 00:00:00 +0000 Parkinson’s disease is characterized by dopaminergic neuron loss and dopamine (DA) depletion in the striatum. Standard treatment is still focused on the restoration of dopamine with exogenous L-Dopa, which however causes L-Dopa-induced dyskinesia (LID). Several studies have shown that antagonism of the metabotropic glutamate receptor 5 alleviates LID, but the underlying mechanisms have remained unclear. We set out to determine where this alleviation may depend on restoring the equilibrium between the two main striatofugal pathways. For this purpose, we examined molecular markers of direct and indirect pathway involvement (prodynorphin and proenkephalin, resp.) in a rat model of LID treated with the mGluR5 antagonist MTEP. Our results show that MTEP cotreatment significantly attenuates the upregulation of prodynorphin mRNA induced by L-Dopa while also decreasing the expression levels of proenkephalin mRNA. We also examined markers of the mGluR5-related PKC/MEK/ERK1/2 signaling pathway, finding that both the expression of PKC epsilon and the phosphorylation of MEK and ERK1/2 had decreased significantly in the MTEP-treated group. Taken together, our results show that pharmacological antagonism of mGluR5 normalizes several abnormal molecular responses in the striatum in this experimental model of LID. Jing-ya Lin, Zhen-guo Liu, Cheng-long Xie, Lu Song, and Ai-juan Yan Copyright © 2017 Jing-ya Lin et al. All rights reserved. Genetic Analysis of LRRK2 R1628P in Parkinson’s Disease in Asian Populations Wed, 25 Oct 2017 06:33:32 +0000 Although the etiology of Parkinson’s disease (PD) remains unclear, there is increasing evidence of genetic factors contributing to the onset of PD. Various mutations and risk variants of the gene LRRK2 have been reported, but the association between LRRK2 R1628P and PD is still inconsistent. Thus, we conducted a meta-analysis to determine the potential relationship between R1628P and PD. Our study sample was an aggregate of 17 publications, which in total consisted of 9,275 PD patients and 8,114 controls. All of these articles are of high quality according to NOS, and there was no obvious reporting bias or heterogeneity. In a general Asian population, the pooled OR of the risk genotype contrasts was 1.83 (95% CI: 1.57, 2.13). When stratified by ethnicity, the pooled ORs were 1.84 (95% CI: 1.56, 2.18) in a Chinese population and 1.79 (95% CI: 1.27, 2.52) in a non-Chinese population. Our study suggests that LRRK2 R1628P appears to be a risk factor for PD in Asian populations, both Chinese and non-Chinese. Yuan Zhang, Qiying Sun, Minhan Yi, Xun Zhou, Jifeng Guo, Qian Xu, Beisha Tang, and Xinxiang Yan Copyright © 2017 Yuan Zhang et al. All rights reserved. The Single Nucleotide Polymorphism rs1014290 of the SLC2A9 Gene Is Associated with Uric Acid Metabolism in Parkinson’s Disease Wed, 11 Oct 2017 07:55:40 +0000 Individuals with Parkinson’s disease (PD) have lower uric acid levels than those without PD, and the CC genotype and C minor allele of a single nucleotide polymorphism (SNP), rs1014290 of SLC2A9, are associated with lower uric acid levels. We investigated the association of rs1014290 with uric acid metabolism in a cohort of PD cases (220) and controls (110) in a Han Chinese population. Uric acid levels were determined and rs1014290 was assayed using a mutation-sensitive on/off switch technology. PD uric acid levels (291.65 ± 76.29 μmol/L) were significantly lower than the controls (325.73 ± 74.23 μmol/L, , -test). Individuals with rs1014290 TT and CT genotypes had higher uric acid levels, and those with the CC genotype had the lowest uric acid levels among both control and PD cases. The CC genotype and the C minor allele were statistically more frequent in the PD group compared to the control group. Those with the CC genotype had a statistically significant higher risk of PD than those with the TT or TC genotype (odds ratio [OR] = 2.249, 95% confidence interval [CI]: 1.129–4.480, and ). Thus, SLC2A9 rs1014290 is related to lower uric acid levels in PD patients and can be a risk factor for PD in the Han population. Jiangfang Miao, Jing Liu, Li Xiao, Jiedi Zheng, Chunfeng Liu, Zufu Zhu, Kai Li, and Weifeng Luo Copyright © 2017 Jiangfang Miao et al. All rights reserved. Depression in Parkinson’s Disease: The Contribution from Animal Studies Wed, 11 Oct 2017 00:00:00 +0000 Besides being better known for causing motor impairments, Parkinson’s disease (PD) can also cause many nonmotor symptoms, like depression and anxiety, which can cause significant loss of life quality and may not respond to regular drugs treatment. In this review, we discuss the depression in PD, based on data from studies in humans and rodents. Depression frequency seems higher in PD patients than in general population, despite high variation in data due to diagnosis disparities. Development of depression in PD seems more likely to be caused by the nigrostriatal pathway degeneration than as a consequence of the awareness of disease prognostic, and it seems to be related to dopaminergic, noradrenergic, and serotoninergic synapses deficits. The dopaminergic role could be more significant, since it can modulate the release of the others, and its depletion is progressive, due to the degenerative feature of PD. Highly regarded in major depression, serotonin can be depleted in rats after nigrostriatal damage, but data from human patients are more conflicting. Animal studies can help in understanding the neurobiological mechanisms of depression in PD and the pursuit for more effective drugs for its treatment, but they lack the complexity of the disease progression, especially the nondopaminergic degeneration. Jéssica Lopes Fontoura, Camila Baptista, Flávia de Brito Pedroso, José Augusto Pochapski, Edmar Miyoshi, and Marcelo Machado Ferro Copyright © 2017 Jéssica Lopes Fontoura et al. All rights reserved. Technology-Assisted Rehabilitation of Writing Skills in Parkinson’s Disease: Visual Cueing versus Intelligent Feedback Sun, 08 Oct 2017 00:00:00 +0000 Recent research showed that visual cueing can have both beneficial and detrimental effects on handwriting of patients with Parkinson’s disease (PD) and healthy controls depending on the circumstances. Hence, using other sensory modalities to deliver cueing or feedback may be a valuable alternative. Therefore, the current study compared the effects of short-term training with either continuous visual cues or intermittent intelligent verbal feedback. Ten PD patients and nine healthy controls were randomly assigned to one of these training modes. To assess transfer of learning, writing performance was assessed in the absence of cueing and feedback on both trained and untrained writing sequences. The feedback pen and a touch-sensitive writing tablet were used for testing. Both training types resulted in improved writing amplitudes for the trained and untrained sequences. In conclusion, these results suggest that the feedback pen is a valuable tool to implement writing training in a tailor-made fashion for people with PD. Future studies should include larger sample sizes and different subgroups of PD for long-term training with the feedback pen. Evelien Nackaerts, Alice Nieuwboer, and Elisabetta Farella Copyright © 2017 Evelien Nackaerts et al. All rights reserved. The Importance of Connection to Others in QoL in MSA and PSP Thu, 28 Sep 2017 08:28:43 +0000 Multiple System Atrophy (MSA) and Progressive Supranuclear Palsy (PSP) are atypical Parkinsonian disorders with extended morbidity and reduced lifespan, known to have marked and early impact upon quality of life (QoL). This study aimed to address the lack of studies in the literature regarding personal perspectives on QoL in MSA and PSP in both patients and carers. Participants took part in qualitative, in-depth interviews in the North East of England, exploring what impacts their QoL and their experiences of living with these complex conditions. Connection to others was found to be a prevailing theme, encompassing difficulty communicating, social isolation, impact on personal relationships, and stigma. This work is helpful in that it emphasises the personal experiences of these patients and carers, which can provide insights into important areas for clinical service planning and best clinical management of individual patients as well as considerations for future research into QoL in these rare disorders. Louise Wiblin, Rory Durcan, Mark Lee, and Katie Brittain Copyright © 2017 Louise Wiblin et al. All rights reserved. The Outcomes of Total Hip Replacement in Patients with Parkinson’s Disease: Comparison of the Elective and Hip Fracture Groups Wed, 27 Sep 2017 00:00:00 +0000 Introduction. The aim of the study was to compare the clinical outcomes following elective and traumatic total hip arthroplasty in Parkinson’s disease patients. Materials and Methods. Ten patients with osteoarthritis comprise the elective group (mean age at operation 74 years; mean follow-up 82 months). Thirteen patients with femoral fracture comprise the hip fracture group (mean age 76 years; mean follow-up 54 months). All patients were followed up at 6 and 36 months postoperatively and at the time of the latest follow-up. Results. Despite the significant improvement in Merle d’Aubigné-Postel and pain scores, disability related to Parkinson’s disease increased during the follow-up. Whereas more than 1/3 of hip fracture patients and all elective patients walked independently at 36 months after total hip arthroplasty, 43% of living patients from both groups were able to walk independently at the time of the latest follow-up. The medical complications were seen mainly in patients with hip fracture. Conclusions. Excellent pain relief with preserved walking ability without support of another person and acceptable complication profile was observed in Parkinson’s disease patients at 36 months after elective total hip arthroplasty. This procedure may be indicated in Parkinson’s disease patients after careful and individualized planning. Pavel Šponer, Tomáš Kučera, Michal Grinac, Aleš Bezrouk, and Daniel Waciakowski Copyright © 2017 Pavel Šponer et al. All rights reserved. Psychometric Evaluation of the Parkinson’s Disease Activities of Daily Living Scale Mon, 25 Sep 2017 09:31:13 +0000 Objective. To evaluate a set of psychometric properties (i.e., data completeness, targeting, and external construct validity) of the Parkinson’s disease Activities of Daily Living Scale (PADLS) in people with Parkinson’s disease (PD). Specific attention was paid to the association between PADLS and PD severity, according to the Hoehn & Yahr (H&Y) staging. Methods. The sample included 251 persons with PD (mean age 70 [SD 9] years). Data collection comprised a self-administered postal survey, structured interviews, and clinical assessments at home visits. Results. Data completeness was 99.6% and the mean PADLS score was 2.1. Floor and ceiling effects were 22% and 2%, respectively. PADLS scores were more strongly associated () with perceived functional independence, ADL dependency, walking difficulties, and self-rated PD severity than with variables such as PD duration and cognitive function (). PADLS scores differed across H&Y stages (Kruskal-Wallis test, ). Those in H&Y stages IV-V had more ADL disability than those in stage III (Mann–Whitney test, ), whereas there were no significant differences between the other stages. Conclusion. PADLS revealed excellent data completeness, acceptable targeting, and external construct validity. It seems to be well suited as a rough estimate of ADL disability in people with PD. Stina B. Jonasson, Peter Hagell, Gun-Marie Hariz, Susanne Iwarsson, and Maria H. Nilsson Copyright © 2017 Stina B. Jonasson et al. All rights reserved. DBS Programming: An Evolving Approach for Patients with Parkinson’s Disease Sun, 24 Sep 2017 00:00:00 +0000 Deep brain stimulation (DBS) surgery is a well-established therapy for control of motor symptoms in Parkinson’s disease. Despite an appropriate targeting and an accurate placement of DBS lead, a thorough and efficient programming is critical for a successful clinical outcome. DBS programming is a time consuming and laborious manual process. The current approach involves use of general guidelines involving determination of the lead type, electrode configuration, impedance check, and battery check. However there are no validated and well-established programming protocols. In this review, we will discuss the current practice and the recent advances in DBS programming including the use of interleaving, fractionated current, directional steering of current, and the use of novel DBS pulses. These technological improvements are focused on achieving a more efficient control of clinical symptoms with the least possible side effects. Other promising advances include the introduction of computer guided programming which will likely impact the efficiency of programming for the clinicians and the possibility of remote Internet based programming which will improve access to DBS care for the patients. Aparna Wagle Shukla, Pam Zeilman, Hubert Fernandez, Jawad A. Bajwa, and Raja Mehanna Copyright © 2017 Aparna Wagle Shukla et al. All rights reserved. Can a Smartphone Diagnose Parkinson Disease? A Deep Neural Network Method and Telediagnosis System Implementation Mon, 18 Sep 2017 00:00:00 +0000 Parkinson’s disease (PD) is primarily diagnosed by clinical examinations, such as walking test, handwriting test, and MRI diagnostic. In this paper, we propose a machine learning based PD telediagnosis method for smartphone. Classification of PD using speech records is a challenging task owing to the fact that the classification accuracy is still lower than doctor-level. Here we demonstrate automatic classification of PD using time frequency features, stacked autoencoders (SAE), and nearest neighbor (KNN) classifier. KNN classifier can produce promising classification results from useful representations which were learned by SAE. Empirical results show that the proposed method achieves better performance with all tested cases across classification tasks, demonstrating machine learning capable of classifying PD with a level of competence comparable to doctor. It concludes that a smartphone can therefore potentially provide low-cost PD diagnostic care. This paper also gives an implementation on browser/server system and reports the running time cost. Both advantages and disadvantages of the proposed telediagnosis system are discussed. Y. N. Zhang Copyright © 2017 Y. N. Zhang. All rights reserved. Management of Psychosis in Parkinson’s Disease: Emphasizing Clinical Subtypes and Pathophysiological Mechanisms of the Condition Tue, 12 Sep 2017 09:18:11 +0000 Investigation into neuropsychiatric symptoms in Parkinson’s disease (PD) is sparse and current drug development is mainly focused on the motor aspect of PD. The tight association of psychosis with an impaired quality of life in PD, together with an important underreporting of this comorbid condition, contributes to its actual insufficient assessment and management. Furthermore, the withdrawal from access to readily available treatment interventions is unacceptable and has an impact on PD prognosis. Despite its impact, to date no standardized guidelines to the adequate management of PD psychosis are available and they are therefore highly needed. Readily available knowledge on distinct clinical features as well as early biomarkers of psychosis in PD justifies the potential for its timely diagnosis and for early intervention strategies. Also, its specific characterisation opens up the possibility of further understanding the underlying pathophysiological mechanisms giving rise to more targeted therapeutic developments in the nearer future. A literature review on the most recent knowledge with special focus on specific clinical subtypes and pathophysiological mechanisms will not only contribute to an up to date practical approach of this condition for the health care providers, but furthermore open up new ideas for research in the near future. Raquel N. Taddei, Seyda Cankaya, Sandeep Dhaliwal, and K. Ray Chaudhuri Copyright © 2017 Raquel N. Taddei et al. All rights reserved. Chaperone-Based Therapies for Disease Modification in Parkinson’s Disease Mon, 21 Aug 2017 00:00:00 +0000 Parkinson’s disease (PD) is the second most common neurodegenerative disorder and is characterized by the presence of pathological intracellular aggregates primarily composed of misfolded α-synuclein. This pathology implicates the molecular machinery responsible for maintaining protein homeostasis (proteostasis), including molecular chaperones, in the pathobiology of the disease. There is mounting evidence from preclinical and clinical studies that various molecular chaperones are downregulated, sequestered, depleted, or dysfunctional in PD. Current therapeutic interventions for PD are inadequate as they fail to modify disease progression by ameliorating the underlying pathology. Modulating the activity of molecular chaperones, cochaperones, and their associated pathways offers a new approach for disease modifying intervention. This review will summarize the potential of chaperone-based therapies that aim to enhance the neuroprotective activity of molecular chaperones or utilize small molecule chaperones to promote proteostasis. Erik L. Friesen, Mitch L. De Snoo, Luckshi Rajendran, Lorraine V. Kalia, and Suneil K. Kalia Copyright © 2017 Erik L. Friesen et al. All rights reserved. Earlier Intervention with Deep Brain Stimulation for Parkinson’s Disease Wed, 16 Aug 2017 07:01:52 +0000 Neuromodulation of subcortical areas of the brain as therapy to reduce Parkinsonian motor symptoms was developed in the mid-twentieth century and went through many technical and scientific advances that established specific targets and stimulation parameters. Deep Brain Stimulation (DBS) was approved by the FDA in 2002 as neuromodulation therapy for advanced Parkinson’s disease, prompting several randomized controlled trials that confirmed its safety and effectiveness. The implantation of tens of thousands of patients in North America and Europe ignited research into its potential role in early disease stages and the therapeutic benefit of DBS compared to best medical therapy. In 2013 the EARLY-STIM trial provided Class I evidence for the use of DBS earlier in Parkinson’s disease. This finding led to the most recent FDA approval in patients with at least 4 years of disease duration and 4 months of motor complications as an adjunct therapy for patients not adequately controlled with medications. This following review highlights the historical development and advances made overtime in DBS implantation, the current application, and the challenges that come with it. Gerson Suarez-Cedeno, Jessika Suescun, and Mya C. Schiess Copyright © 2017 Gerson Suarez-Cedeno et al. All rights reserved. Programming for Stimulation-Induced Transient Nonmotor Psychiatric Symptoms after Bilateral Subthalamic Nucleus Deep Brain Stimulation for Parkinson’s Disease Tue, 15 Aug 2017 00:00:00 +0000 Background. Stimulation-induced transient nonmotor psychiatric symptoms (STPSs) are side effects following bilateral subthalamic nucleus deep brain stimulation (STN-DBS) in Parkinson’s disease (PD) patients. We designed algorithms which (1) determine the electrode contacts that induce STPSs and (2) provide a programming protocol to eliminate STPS and maintain the optimal motor functions. Our objective is to test the effectiveness of these algorithms. Materials and Methods. 454 PD patients who underwent programming sessions after STN-DBS implantations were retrospectively analyzed. Only STPS patients were enrolled. In these patients, the contacts inducing STPS were found and the programming protocol algorithms used. Results. Eleven patients were diagnosed with STPS. Of these patients, two had four episodes of crying, and two had four episodes of mirthful laughter. In one patient, two episodes of abnormal sense of spatial orientation were observed. Hallucination episodes were observed twice in one patient, while five patients recorded eight episodes of hypomania. There were no statistical differences between the UPDRS-III under the final stimulation parameter (without STPS) and previous optimum UPDRS-III under the STPSs (). Conclusion. The flow diagram used for determining electrode contacts that induce STPS and the programming protocol employed in the treatment of these symptoms are effective. Xi Wu, Yiqing Qiu, Keith Simfukwe, Jiali Wang, Jianchun Chen, and Xiaowu Hu Copyright © 2017 Xi Wu et al. All rights reserved. Differential Diagnosis of Parkinson Disease, Essential Tremor, and Enhanced Physiological Tremor with the Tremor Analysis of EMG Mon, 14 Aug 2017 00:00:00 +0000 We investigate the differential diagnostic value of tremor analysis of EMG on Parkinson’s disease (PD), essential tremor (ET), and enhanced physiological tremor (EPT). Clinical data from 25 patients with PD, 20 patients with ET, and 20 patients with EPT were collected. The tremor frequency and muscle contraction pattern of the resting, posture, and 500 g and 1000 g overload were recorded. The frequency of PD tremor was 4–6 Hz, and the frequency of ET was also in this range; the frequency of EPT is 6–12 hz having some overlap with PD. The muscle contraction patterns of the ET and EPT group were mainly synchronous contraction, and the muscle contraction mode of the PD group was mainly alternating contraction. Having tremor latency from rest to postural position and having changes in tremor amplitude after mental concentration in PD might distinguish ET. Tremor analysis of EMG was able to distinguish PD from ET and EPT by varying the tremor frequency and muscle contraction pattern. It can also differentiate between PD and ET by the latency and concentration effect and ET and EPT by weight load effect. Jie Zhang, Yan Xing, Xiuli Ma, and Liqun Feng Copyright © 2017 Jie Zhang et al. All rights reserved. Predictors of Functional and Quality of Life Outcomes following Deep Brain Stimulation Surgery in Parkinson’s Disease Patients: Disease, Patient, and Surgical Factors Wed, 09 Aug 2017 07:47:25 +0000 Objective. The primary objective was to evaluate predictors of quality of life (QOL) and functional outcomes following deep brain stimulation (DBS) in Parkinson’s disease (PD) patients. The secondary objective was to identify predictors of global improvement. Methods. PD patients who underwent DBS at our Center from 2006 to 2011 were evaluated by chart review and email/phone survey. Postoperative UPDRS II and EQ-5D were analyzed using simple linear regression adjusting for preoperative score. For global outcomes, we utilized the Patient Global Impression of Change Scale (PGIS) and the Clinician Global Impression of Change Scale (CGIS). Results. There were 130 patients in the dataset. Preoperative and postoperative UPDRS II and EQ-5D were available for 45 patients, PGIS for 67 patients, and CGIS for 116 patients. Patients with falls/postural instability had 6-month functional scores and 1-year QOL scores that were significantly worse than patients without falls/postural instability. For every 1-point increase in preoperative UPDRS III and for every 1-unit increase in body mass index (BMI), the 6-month functional scores significantly worsened. Patients with tremors, without dyskinesia, and without gait-freezing were more likely to have “much” or “very much” improved CGIS. Conclusions. Presence of postural instability, high BMI, and worse baseline motor scores were the greatest predictors of poorer functional and QOL outcomes after DBS. Hesham Abboud, Gencer Genc, Nicolas R. Thompson, Srivadee Oravivattanakul, Faisal Alsallom, Dennys Reyes, Kathy Wilson, Russell Cerejo, Xin Xin Yu, Darlene Floden, Anwar Ahmed, Michal Gostkowski, Ayman Ezzeldin, Hazem Marouf, Ossama Y. Mansour, Andre Machado, and Hubert H. Fernandez Copyright © 2017 Hesham Abboud et al. All rights reserved. Bridging the Gaps in Patient Education for DBS Surgery in Parkinson’s Disease Mon, 07 Aug 2017 09:59:53 +0000 Introduction. Improvements in quality of life, tremor, and other motor features have been recognized as superior in patients with advanced Parkinson’s disease (PD) treated with deep brain stimulation (DBS) surgery versus best medical therapy. We studied a group of patients with PD after undergoing DBS surgery in regard to expectations and satisfaction with DBS outcomes to determine gaps in patient education. Methods. This study was a retrospective, single academic center chart review and outcome questionnaire sent to patients with PD who had undergone DBS surgery between 2007 and 2014. Results. All patients surveyed indicated that benefit from DBS surgery met their overall expectations at least partially, but only 46.4% (SE: 9.6%) were in complete agreement. 3.6% (SE: 3.6%) of participants strongly disagreed that preoperative education prepared them adequately for the procedure and 17.9% (SE: 7.4%) only somewhat agreed. Conclusions. Our findings demonstrate that patients’ expectations of DBS surgery in PD were at least partially met. However, there was a considerable percentage of patients who did not feel adequately prepared for the procedure. A structured, multidisciplinary team approach in educating PD patients throughout the different stages of DBS surgery may be helpful in optimizing patients’ experience and satisfaction with surgery outcomes. Colleen D. Knoop, Robert Kadish, Kathy Hager, Michael C. Park, Paul D. Loprinzi, and Kathrin LaFaver Copyright © 2017 Colleen D. Knoop et al. All rights reserved. Dynamic Changes in the Nigrostriatal Pathway in the MPTP Mouse Model of Parkinson’s Disease Mon, 31 Jul 2017 00:00:00 +0000 The characteristic brain pathology and motor and nonmotor symptoms of Parkinson’s disease (PD) are well established. However, the details regarding the causes of the disease and its course are much less clear. Animal models have significantly enriched our current understanding of the progression of this disease. Among various neurotoxin-based models of PD, 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP) mouse model is the most commonly studied model. Here, we provide an overview of the dynamic changes in the nigrostriatal pathway in the MPTP mouse model of PD. Pathophysiological events, such as reductions in the striatal dopamine (DA) concentrations and levels of the tyrosine hydroxylase (TH) protein, depletion of TH-positive nerve fibers, a decrease in the number of TH-positive neurons in the substantia nigra pars compacta (SNpc), and glial activation, are addressed. This article will assist with the development of interventions or therapeutic strategies for PD. Dongping Huang, Jing Xu, Jinghui Wang, Jiabin Tong, Xiaochen Bai, Heng Li, Zishan Wang, Yulu Huang, Yufei Wu, Mei Yu, and Fang Huang Copyright © 2017 Dongping Huang et al. All rights reserved. Dual-Task Performance in GBA Parkinson’s Disease Thu, 27 Jul 2017 07:04:21 +0000 Introduction. Parkinson’s disease patients carrying a heterozygous mutation in the gene glucocerebrosidase (GBA-PD) show faster motor and cognitive decline than idiopathic Parkinson’s disease (iPD) patients, but the mechanisms behind this observation are not well understood. Successful dual tasking (DT) requires a smooth integration of motor and nonmotor operations. This study compared the DT performances between GBA-PD and iPD patients. Methods. Eleven GBA-PD patients (p.N370S, p.L444P) and eleven matched iPD patients were included. Clinical characterization included a motor score (Unified PD Rating Scale-III, UPDRS-III) and nonmotor scores (Montreal Cognitive Assessment, MoCA, and Beck’s Depression Inventory). Quantitative gait analysis during the single-task (ST) and DT assessments was performed using a wearable sensor unit. These parameters corrected for UPDRS and MoCA were then compared between the groups. Results. Under the DT condition “walking while checking boxes,” GBA-PD patients showed slower gait and box-checking speeds than iPD patients. GBA-PD and iPD patients did not show significant differences regarding dual-task costs. Conclusion. This pilot study suggests that DT performance with a secondary motor task is worse in GBA-PD than in iPD patients. This finding may be associated with the known enhanced motor and cognitive deficits in GBA-PD compared to iPD and should motivate further studies. Karin Srulijes, Kathrin Brockmann, Senait Ogbamicael, Markus A. Hobert, Ann-Kathrin Hauser, Claudia Schulte, Jasmin Fritzen, Michael Schwenk, Thomas Gasser, Daniela Berg, and Walter Maetzler Copyright © 2017 Karin Srulijes et al. All rights reserved. The Effects of Group-Based versus Individual-Based Tai Chi Training on Nonmotor Symptoms in Patients with Mild to Moderate Parkinson’s Disease: A Randomized Controlled Pilot Trial Mon, 24 Jul 2017 00:00:00 +0000 Objective. To compare the effects of group-based and individual-based Tai Chi training on nonmotor symptoms in patients with mild to moderate Parkinson’s disease. Design. Randomized controlled pilot study. Methods. 36 community-dwelling patients with Parkinson’s disease (PD) were randomly assigned to either group-based training group () or individual-based group (). Both groups received same content of Tai Chi training 3 times a week for 13 weeks. Participants were also asked to perform home exercises daily. The Non-Motor Symptoms Scale was used to assess global nonmotor symptoms change. Sleep quality, depression, and cognition were evaluated by Parkinson’s Disease Sleep Scale, Hamilton Depression Scale, and Beijing version-Montreal Cognitive Assessment, respectively. Home exercise compliance was recorded. Results. There was no significant difference between two groups at baseline. After 13 weeks, there were no statistical significance between two groups. However, the within-group effect was different. Participants in group-based and individual-based groups showed a significant improvement on global nonmotor symptoms (, ) and sleep (, ). But only group-based training patients presented a significant improvement in cognitive impairment compared with baseline (, ). For depression, no group gained a significant improvement(, ). Group-based participants had a higher home-exercise compliance rate (HeCR) than individual-based participants did (), and HeCR showed a moderate correlation with MoCA-BJ and NMSS scores changes in this study. Conclusion. Group-based Tai Chi training is considered to be a more effective and a more labor-saving method in the clinical settings, and patients tend to have a higher compliance rate in their home exercise program. This study is registered with ChiCTR-IPR-17010388. Jing Hui Yang, Ya Qun Wang, Sai Qing Ye, You Gen Cheng, Yu Chen, and Xiao Zhen Feng Copyright © 2017 Jing Hui Yang et al. All rights reserved. Evolution of Orofacial Symptoms and Disease Progression in Idiopathic Parkinson’s Disease: Longitudinal Data from the Jönköping Parkinson Registry Sun, 16 Jul 2017 09:21:52 +0000 Background. Orofacial symptoms are common in Parkinson’s disease (PD) both as initial manifestations and late markers of disease complications. We aimed to investigate the evolution of orofacial manifestations and their prognostic value throughout PD progression. Methods. Data was obtained from “Jönköping Parkinson Registry” database on routine care visits of 314 people with idiopathic PD in southern Sweden. Information on baseline symptomatology, orofacial features, UPDRS, and medications was recorded at baseline and during each follow-up visit within an average of 4.2 (range: 1–12) years. Results. Hypomimia, affected speech, drooling, and impaired swallowing were present in 37.3%/91.6%, 14.1%/65.5%, 11.7%/55.3%, and 10.2%/34.5% at baseline/follow-up, respectively. Male sex [OR = 2.4 (95% CI: 1.0–5.9)], UPDRS motor scores [OR = 1.2 (95% CI: 1.1–1.3)], dominant rigidity [OR = 5.2 (95% CI: 1.4–19.1)], and autonomic disturbance [OR = 3.4 (95% CI: 1.1–10.9)] were risk factors for drooling. Individuals with more severe orofacial burden at baseline had shorter median time to develop UPDRS-Part III > 28 [3rd tertile = 4.7 yr, 2nd tertile = 6.2 yr, and 1st tertile = 7.8 yr; p = 0.014]. Conclusions. Majority of people with PD manifest orofacial manifestations at either early or late stages of the disease. PD severity, symmetry of motor disturbances, and autonomic disorders correlate with orofacial symptoms. Individuals with more severe orofacial burden at baseline progressed faster to more advanced stages. Seyed-Mohammad Fereshtehnejad, Örjan Skogar, and Johan Lökk Copyright © 2017 Seyed-Mohammad Fereshtehnejad et al. All rights reserved. Genetic Variants in SNCA and the Risk of Sporadic Parkinson’s Disease and Clinical Outcomes: A Review Tue, 11 Jul 2017 07:12:20 +0000 There is increasing evidence of the contribution of genetic susceptibility to the etiology of Parkinson’s disease (PD). Genetic variations in the SNCA gene are well established by linkage and genome-wide association studies. Positive associations of single nucleotide polymorphisms (SNPs) in SNCA and increased risk for PD were found. However, the role of SNCA variants in individual traits or phenotypes of PD is unknown. Here, we reviewed the current literature and identified 57 studies, performed in fourteen different countries, that investigated SNCA variants and susceptibility to PD. We discussed the findings based on environmental factors, history of PD, clinical outcomes, and ethnicity. In conclusion, SNPs within the SNCA gene can modify the susceptibility to PD, leading to increased or decreased risk. The risk associations of some SNPs varied among samples. Of notice, no studies in South American or African populations were found. There is little information about the effects of these variants on particular clinical aspects of PD, such as motor and nonmotor symptoms. Similarly, evidence of possible interactions between SNCA SNPs and environmental factors or disease progression is scarce. There is a need to expand the clinical applicability of these data as well as to investigate the role of SNCA SNPs in populations with different ethnic backgrounds. Clarissa Loureiro das Chagas Campêlo and Regina Helena Silva Copyright © 2017 Clarissa Loureiro das Chagas Campêlo and Regina Helena Silva. All rights reserved. Deep Brain Stimulation in Parkinson’s Disease: New and Emerging Targets for Refractory Motor and Nonmotor Symptoms Thu, 06 Jul 2017 07:05:45 +0000 Parkinson’s disease (PD) is a progressive neurodegenerative condition characterized by bradykinesia, tremor, rigidity, and postural instability (PI), in addition to numerous nonmotor manifestations. Many pharmacological therapies now exist to successfully treat PD motor symptoms; however, as the disease progresses, it often becomes challenging to treat with medications alone. Deep brain stimulation (DBS) has become a crucial player in PD treatment, particularly for patients who have disabling motor complications from medical treatment. Well-established DBS targets include the subthalamic nucleus (STN), the globus pallidus pars interna (GPi), and to a lesser degree the ventral intermediate nucleus (VIM) of the thalamus. Studies of alternative DBS targets for PD are ongoing, the majority of which have shown some clinical benefit; however, more carefully designed and controlled studies are needed. In the present review, we discuss the role of these new and emerging DBS targets in treating refractory axial motor symptoms and other motor and nonmotor symptoms (NMS). Dustin Anderson, Grayson Beecher, and Fang Ba Copyright © 2017 Dustin Anderson et al. All rights reserved. Deep Brain Stimulation of Hemiparkinsonian Rats with Unipolar and Bipolar Electrodes for up to 6 Weeks: Behavioral Testing of Freely Moving Animals Mon, 03 Jul 2017 08:36:26 +0000 Although the clinical use of deep brain stimulation (DBS) is increasing, its basic mechanisms of action are still poorly understood. Platinum/iridium electrodes were inserted into the subthalamic nucleus of rats with unilateral 6-OHDA-induced lesions of the medial forebrain bundle. Six behavioral parameters were compared with respect to their potential to detect DBS effects. Locomotor function was quantified by (i) apomorphine-induced rotation, (ii) initiation time, (iii) the number of adjusting steps in the stepping test, and (iv) the total migration distance in the open field test. Sensorimotor neglect and anxiety were quantified by (v) the retrieval bias in the corridor test and (vi) the ratio of migration distance in the center versus in the periphery in the open field test, respectively. In our setup, unipolar stimulation was found to be more efficient than bipolar stimulation for achieving beneficial long-term DBS effects. Performance in the apomorphine-induced rotation test showed no improvement after 6 weeks. DBS reduced the initiation time of the contralateral paw in the stepping test after 3 weeks of DBS followed by 3 weeks without DBS. Similarly, sensorimotor neglect was improved. The latter two parameters were found to be most appropriate for judging therapeutic DBS effects. Kathrin Badstuebner, Ulrike Gimsa, Immo Weber, Armin Tuchscherer, and Jan Gimsa Copyright © 2017 Kathrin Badstuebner et al. All rights reserved. Comparison of Globus Pallidus Interna and Subthalamic Nucleus in Deep Brain Stimulation for Parkinson Disease: An Institutional Experience and Review Mon, 19 Jun 2017 06:10:10 +0000 Deep Brain Stimulation (DBS) has revolutionized the lives of patients of Parkinson disease, offering therapeutic options to those not benefiting entirely from medications alone. With its proven track record of outperforming the best medical management, the goal is to unlock the full potential of this therapy. Currently, the Globus Pallidus Interna (GPi) and Subthalamic Nucleus (STN) are both viable targets for DBS, and the choice of site should focus on the constellation of symptoms, both motor and nonmotor, which are key determinants to quality of life. Our article sheds light on the specific advantages and drawbacks of the two sites, highlighting the need for matching the inherent properties of a target with specific desired effects in patients. UT Southwestern Medical Center has a robust and constantly evolving DBS program and the narrative from our center provides invaluable insight into the practical realities of DBS. The ultimate decision in selecting a DBS target is complex, ideally made by a multidisciplinary team, tailored towards each patient’s profile and their expectations, by drawing upon scientific evidence coupled with experience. Ongoing research is expanding our knowledge base, which should be dynamically incorporated into an institute’s DBS paradigm to ensure that patients receive the optimal therapy. Shazia Mirza, Umar Yazdani, Richard Dewey III, Neepa Patel, Richard B. Dewey Jr., Svjetlana Miocinovic, and Shilpa Chitnis Copyright © 2017 Shazia Mirza et al. All rights reserved.