Rebecca Petty, Veena Agarwal, Jennifer Allison, Sandra Bartolomeu-Pires, Michèle Bartlett, Timothy Boey, Rebecca Croucher, Helen Collins, Sally Collins, Emma Davies, Joy Duffen, Romy Ellis-Doyle, Cristina Gonzalez-Robles, Jemma Inches, Georgia Mills, Sheila Wonnacott, Thomas Foltynie, Victoria Allgar, Tom Thompson, Camille B Carroll, Stephen Mullin, Marie Louise-Zeissler
{"title":"Improving recruitment and retention of people with Parkinson's disease to clinical studies: A scoping review.","authors":"Rebecca Petty, Veena Agarwal, Jennifer Allison, Sandra Bartolomeu-Pires, Michèle Bartlett, Timothy Boey, Rebecca Croucher, Helen Collins, Sally Collins, Emma Davies, Joy Duffen, Romy Ellis-Doyle, Cristina Gonzalez-Robles, Jemma Inches, Georgia Mills, Sheila Wonnacott, Thomas Foltynie, Victoria Allgar, Tom Thompson, Camille B Carroll, Stephen Mullin, Marie Louise-Zeissler","doi":"10.1177/1877718X241291986","DOIUrl":"10.1177/1877718X241291986","url":null,"abstract":"<p><p>BackgroundTimely recruitment and effective retention of participants are challenging for clinical Parkinson's disease (PD) research studies. Not achieving this can affect delivery costs and bias results.ObjectiveTo identify successful recruitment and retention methodologies for clinical research studies in PD.MethodsWe conducted a systematic scoping review using a Population, Intervention, Comparator, Outcome and Study design (PICOS) framework to search and screen literature within five databases for published quantitative and mixed methods studies evaluating recruitment and retention strategies of interventional and observational trials in PD.ResultsSearches identified 4608 records, of which six papers covering eight studies were included in the review following screening for eligibility. No papers on retention strategies were found that met eligibility criteria. Effective strategies for rapid recruitment included research registries and trial finders (n = 3), digital marketing campaigns (n = 3), site recruitment support (n = 1) and multiple referral sources (n = 1). Recruitment diversity was increased by online campaigns, mandatory 10% minority targets set by funders and supplemental site funding.ConclusionsThis scoping review has identified methods that can be used to increase the rate and diversity of recruitment to PD clinical studies. Retention methodologies are under-researched.</p>","PeriodicalId":16660,"journal":{"name":"Journal of Parkinson's disease","volume":" ","pages":"6-18"},"PeriodicalIF":4.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143458434","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Yuke Zhong, Huahua Su, Ying Liu, Hang Liu, Guohui Liu, Zhihui Liu, Jiahao Wei, Junyi Wang, Yuchen She, Changhong Tan, Lijuan Mo, Lin Han, Fen Deng, Xi Liu, Lifen Chen
{"title":"Association of motor subtype and tremor type with Parkinson's disease progression: An exploratory longitudinal analysis.","authors":"Yuke Zhong, Huahua Su, Ying Liu, Hang Liu, Guohui Liu, Zhihui Liu, Jiahao Wei, Junyi Wang, Yuchen She, Changhong Tan, Lijuan Mo, Lin Han, Fen Deng, Xi Liu, Lifen Chen","doi":"10.1177/1877718X241305715","DOIUrl":"10.1177/1877718X241305715","url":null,"abstract":"<p><p>BackgroundParkinson's disease (PD) is a neurodegenerative disorder with heterogenous symptoms and progression rates. Some studies have classifying PD into tremor-dominant and non-tremor-dominant PD (TD-PD and Non-TD-PD), finding that TD-PD tend to have a better prognosis, slower disease progression, and lower pathological burden compared to Non-TD-PD. However, this classification does not consider the specific types of tremors, even though recent studies have shown that different types of tremors in PD might have distinct underlying mechanism.ObjectiveData from 517 de novo drug-naïve PD patients was analyzed.MethodsSurvival analysis was carried out including motor subtypes, rest tremor presence, kinetic tremor presence, postural tremor presence, as well as the instability of tremor presence or motor subtypes as predictors. Occurrence of 6 outcomes, including motor and non-motor milestones at follow-up, were used as the time-to-event.ResultsBoth TD-PD subtype and rest tremor presence was associated with slower PD progression, while kinetic tremor presence and postural tremor presence, especially kinetic tremor presence, was associated with a faster one.ConclusionsOur study suggests different types of tremors are associated with distinct PD prognoses, indicating potential differences in underlying mechanisms. Further investigation is warranted to elucidate the specific mechanisms underlying different types of tremors in PD and to explain their relationship to disease prognosis.</p>","PeriodicalId":16660,"journal":{"name":"Journal of Parkinson's disease","volume":" ","pages":"111-121"},"PeriodicalIF":4.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143458408","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Chu Hua Chang, Elaine Guo Yan Chew, Michelle Mulan Lian, Moses Tandiono, Zheng Li, Sun Ju Chung, Louis Cs Tan, Wing-Lok Au, Kumar M Prakash, Azlina Ahmad-Annuar, Ai Huey Tan, Vincent Mok, Anne Yy Chan, Juei-Jueng Lin, Beom S Jeon, Chiea Chuen Khor, Shen-Yang Lim, Eng-King Tan, Jia Nee Foo
{"title":"Rare <i>SV2C</i> coding variants in Parkinson's disease risk.","authors":"Chu Hua Chang, Elaine Guo Yan Chew, Michelle Mulan Lian, Moses Tandiono, Zheng Li, Sun Ju Chung, Louis Cs Tan, Wing-Lok Au, Kumar M Prakash, Azlina Ahmad-Annuar, Ai Huey Tan, Vincent Mok, Anne Yy Chan, Juei-Jueng Lin, Beom S Jeon, Chiea Chuen Khor, Shen-Yang Lim, Eng-King Tan, Jia Nee Foo","doi":"10.1177/1877718X241300298","DOIUrl":"10.1177/1877718X241300298","url":null,"abstract":"<p><p>Genome-wide association studies have identified <i>SV2C</i> as a Parkinson's disease (PD) risk locus, with a common missense variant p.Asp543Asn in the synaptic vesicle glycoprotein 2C (SV2C) protein significantly associated with PD. We examined if other rare <i>SV2C</i> variants also influence PD risk. We analyzed sequencing data of 9810 East Asian individuals comprising 4298 patients and 5512 controls and identified 55 rare nonsynonymous variants. There was no significant association of rare nonsynonymous or loss-of-function variants with PD. Our findings show that besides p.Asp543Asn, other rare coding variants in <i>SV2C</i> do not play a major role in PD susceptibility in East Asia.</p>","PeriodicalId":16660,"journal":{"name":"Journal of Parkinson's disease","volume":" ","pages":"66-71"},"PeriodicalIF":4.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143458381","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Martina Mancini, Jeffrey M Hausdorff, Elisa Pelosin, Paolo Bonato, Richard Camicioli, Terry D Ellis, Jochen Klucken, Larry Gifford, Alfonso Fasano, Alice Nieuwboer, Catherine Kopil, Katharina Klapper, Leslie Kirsch, David T Dexter, Rosie Fuest, Vicki Miller, Angelica Asis, Martijn Ltm Müller, Diane Stephenson, Anat Mirelman
{"title":"A framework to standardize gait study protocols in Parkinson's disease.","authors":"Martina Mancini, Jeffrey M Hausdorff, Elisa Pelosin, Paolo Bonato, Richard Camicioli, Terry D Ellis, Jochen Klucken, Larry Gifford, Alfonso Fasano, Alice Nieuwboer, Catherine Kopil, Katharina Klapper, Leslie Kirsch, David T Dexter, Rosie Fuest, Vicki Miller, Angelica Asis, Martijn Ltm Müller, Diane Stephenson, Anat Mirelman","doi":"10.1177/1877718X241305626","DOIUrl":"10.1177/1877718X241305626","url":null,"abstract":"<p><p>BackgroundResearch over the past twenty years has shown that gait outcomes have a high sensitivity for diagnosing Parkinson's disease (PD), for detecting the effects of interventions, and for monitoring disease progression, even in early disease. However, the lack of standardization in protocols and reported gait measures is impeding data aggregation across study sites and contributes to heterogeneity in the results, thus limiting the adoption of gait outcomes in clinical trials.ObjectiveTo provide recommendations for a minimum set of gait measures to be adopted in projects evaluating people with PD to enhance standardization across the field.MethodsThe Gait Advisors Leading Outcomes for Parkinson's (GALOP) committee is an advisory committee for the MJFF. Based on a five-step approach, GALOP generated recommendations for standardizing protocols that assess quantitative gait measures, following expert consensus on best practices.ResultsBuilt on the literature and consensus amongst experts, we recommend a minimum set of meta-data to accompany gait protocols and a minimum gait assessment protocol to be performed at a comfortable speed. Suggestions on challenging testing are provided.ConclusionsTo support and empower the scientific community, we have generated recommendations to collect and share gait data gathered from people with PD using an open data repository. Standardizing gait protocols and outcomes in PD has the potential of accelerating research and clinical trials, harmonizing protocols across study sites, fostering collaborations, and in the long run, improving patient care and quality of life.</p>","PeriodicalId":16660,"journal":{"name":"Journal of Parkinson's disease","volume":" ","pages":"129-139"},"PeriodicalIF":4.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143501908","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Rethinking 'rare' <i>PINK1</i> Parkinson's disease: A meta-analysis of geographical prevalence, phenotypic diversity, and α-synuclein pathology.","authors":"Eden Paige Yin, Birger Victor Dieriks","doi":"10.1177/1877718X241304814","DOIUrl":"10.1177/1877718X241304814","url":null,"abstract":"<p><p>PTEN-induced kinase 1 (<i>PINK1</i>)-related Parkinson's disease (PD) is traditionally considered a rare autosomal recessive form of early-onset PD (EOPD), lacking classical Lewy body pathology. However, this characterization underestimates and oversimplifies <i>PINK1</i>-PD, largely due to a lack of extensive studies in diverse ethnic populations. This review and meta-analysis explores considerable variations in <i>PINK1</i> variant rates and the wide heterogeneity influenced by patient- and variant-specific factors, delineating a more precise disease profile. Our findings reveal that <i>PINK1</i>-PD is more common than previously thought, with geographic 'hotspots' where up to 9% of EOPD cases are linked to <i>PINK1</i> variants, including the pathogenic p.Leu347Pro variant affecting 1 in 1300 West Polynesians. Homozygous <i>PINK1</i>-PD typically manifests around age 35, predominantly affecting the lower limbs, with an excellent response to levodopa. Heterozygous <i>PINK1</i>-PD presents an 'intermediate' phenotype, with a later onset age (around 43 years) than homozygous <i>PINK1</i>-PD but earlier than idiopathic PD (typically after age 65). The severity of the phenotype is influenced by variant zygosity and pathogenicity, interacting with genetic and environmental factors to push some individuals beyond the disease threshold. Notably, females with <i>PINK1</i>-PD have earlier onset age than males, particularly in homozygous cases and when variants occur in the first half of <i>PINK1</i>'s kinase domain. Contrary to traditional views, α-synuclein pathology is present in 87.5% of <i>PINK1</i>-PD postmortem cases across ages and variants. We challenge conventional views on <i>PINK1</i>-PD, highlighting distinct phenotypes influenced by zygosity, sex, and a role for α-synuclein pathology, urging for increased recognition and research of this not-so-rare disease.</p>","PeriodicalId":16660,"journal":{"name":"Journal of Parkinson's disease","volume":" ","pages":"41-65"},"PeriodicalIF":4.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143458410","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Joaquim J Ferreira, Miguel F Gago, Raquel Costa, Miguel M Fonseca, Joana Almeida, José Francisco Rocha, Joerg Holenz, Claudia Trenkwalder
{"title":"Opicapone for Parkinson's disease-related sleep disturbances: The OASIS clinical trial.","authors":"Joaquim J Ferreira, Miguel F Gago, Raquel Costa, Miguel M Fonseca, Joana Almeida, José Francisco Rocha, Joerg Holenz, Claudia Trenkwalder","doi":"10.1177/1877718X241306711","DOIUrl":"10.1177/1877718X241306711","url":null,"abstract":"<p><p>BackgroundWhile sleep disturbances are among the most frequent non-motor symptoms of Parkinson's disease (PD), there is a lack of evidence to support its treatment.ObjectiveTo evaluate the efficacy of opicapone 50 mg in treating sleep disturbances in patients with PD and end-of-dose motor fluctuations.MethodsOASIS was an exploratory, open-label, single-arm clinical trial in PD patients with end-of-dose motor fluctuations and associated sleep disturbances. The primary endpoint was change from baseline to week 6 in Parkinson's Disease Sleep Scale 2 (PDSS-2). Secondary endpoints included functional motor and non-motor assessments (Movement Disorder Society [MDS]-Unified Parkinson's Disease Rating Scale [UPDRS], MDS-Non-motor Scale [NMS], 8-item PD Questionnaire [PDQ-8], 16-item PD Fatigue Scale [PFS-16], ON/OFF home diary), Clinical and Patient Global Impression of Change (CGI-C; PGI-C) and adverse events.ResultsAt week 6, there was a significant reduction of -7.9 points (95%CI -13.6, -2.2; <i>p</i> = 0.0099) in PDSS-2 total score, with a significant mean change of -4.7 in the PDSS-2 domain of disturbed sleep (95%CI: -7.2, -2.3; <i>p</i> = 0.0009). Significant reductions were also observed in PFS-16 (-9.6; <i>p</i> = 0.0211), MDS-NMS total score (-28.9; <i>p</i> = 0.0015), MDS-UPDRS-III (-6.3; <i>p</i> = 0.0253), MDS-UPDRS-IV (-1.2; <i>p</i> = 0.0044) and PDQ-8 (-14.2; <i>p</i> = 0.0051). Absolute OFF-time was reduced (-142.1 min). Most patients (93.3%) and most clinicians (80.0%) reported improvements on PGI-C and CGI-C, respectively. Opicapone was well tolerated.ConclusionsAdding opicapone 50 mg to levodopa/DDCI therapy in patients with PD and motor fluctuations and sleep disturbances improved both sleep disturbances and OFF time in these patients.</p>","PeriodicalId":16660,"journal":{"name":"Journal of Parkinson's disease","volume":" ","pages":"87-96"},"PeriodicalIF":4.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143458493","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
M Encarna Micó-Amigo, Idsart Kingma, Sebastian Heinzel, Susanne Solbrig, Markus A Hobert, Morad Elshehabi, Kathrin Brockmann, Florian G Metzger, Rob C van Lummel, Daniela Berg, Walter Maetzler, Jaap H van Dieën
{"title":"Predictive potential of circular walking in prodromal Parkinson's disease.","authors":"M Encarna Micó-Amigo, Idsart Kingma, Sebastian Heinzel, Susanne Solbrig, Markus A Hobert, Morad Elshehabi, Kathrin Brockmann, Florian G Metzger, Rob C van Lummel, Daniela Berg, Walter Maetzler, Jaap H van Dieën","doi":"10.1177/1877718X241306141","DOIUrl":"10.1177/1877718X241306141","url":null,"abstract":"<p><p>BackgroundDevelopment of objective, reliable and easy-to-use methods to detect the onset of motor changes in Parkinson's disease (PD) is required to identify the temporal window in which neuromodulatory therapies could be implemented. Turning impairments are present at early stages of PD. However, it is unclear, to date, whether circular walking is also altered in prodromal PD.ObjectiveExplore the predictive potential of circular walking in prodromal PD.MethodsWe included 102 subjects from a nine-year prospective cohort study (with 712 participants) in the current nested case-control analysis: 16 diagnosed with PD during follow-up (incident PD) and 96 healthy controls, matched in gender, age, and education with a 1:6 ratio. Forty-one gait features were extracted from baseline assessments with accelerometers under single and dual-tasking conditions. A Cox proportional hazards regression analysis was used to test the temporal association of non-correlated gait features to the probability of being diagnosed with PD.ResultsWe identified associations between time from baseline measurement to PD diagnosis for eleven gait features, mostly based on harmonic ratios, step and stride variability, and index of harmonicity, partially in combination with gait speed. Most significant associations indicated that low gait symmetry and low rhythmicity were associated with larger hazard of being diagnosed with PD. Area under the curve ranged 0.63-0.69.ConclusionsDespite low sensitivity and specificity, the findings potentially reflect prodromal motor impairments of PD manifested during circular walking, assessed quantitatively with a low-cost and wearable instrument. This will contribute to the characterization of pre-diagnostic PD motor symptoms.</p>","PeriodicalId":16660,"journal":{"name":"Journal of Parkinson's disease","volume":" ","pages":"140-153"},"PeriodicalIF":4.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143458502","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Anne Fink, Maria Angeliki S Pavlou, Kirsten Roomp, Jochen G Schneider
{"title":"Declining trends in the incidence of Parkinson's disease: A cohort study in Germany.","authors":"Anne Fink, Maria Angeliki S Pavlou, Kirsten Roomp, Jochen G Schneider","doi":"10.1177/1877718X241306132","DOIUrl":"10.1177/1877718X241306132","url":null,"abstract":"<p><p>BackgroundEpidemiologic evidence from different countries shows both increasing and decreasing incidence rates of Parkinson's disease over time without clear trends.ObjectiveWe aimed to investigate age-specific incidence rates of Parkinson's disease and possible explanations for the observed trends in Germany over a 10-year period.MethodsTwo different random samples of subjects aged ≥50 years included in 2004-2009 and 2014-2019, each consisting of 250,000 individuals, were drawn from Germany's largest health care insurance company followed up for new Parkinson's disease cases. We compared the age-specific incidence rates of Parkinson's disease for both cohorts and performed Cox regression models to calculate the hazard ratios (HR) of PD in the second period compared with the first period, adjusted for age, sex, and risk factors for Parkinson's disease.ResultsFor most age groups in men and in women, we found lower age-specific Parkinson's disease incidence rates in the second period. Cox regression analysis showed an overall 18% risk reduction in Parkinson's disease incidence (HR = 0.82, 95% confidence interval [0.76-0.89]). Mean age at diagnosis increased in men (+1.9 years) and women (+0.8 years). After adjustment for risk factors, the HR was 0.78 [0.72-0.85]. Sensitivity analysis considering the competing event of death showed an HR of 0.79 [0.73-0.86]), demonstrating the independence of time trends from changes in death rates.ConclusionsOur data show that the risk of Parkinson's disease has decreased over time and that this decrease is independent of factors such as changes in death rates, age structure, sex, and specific risk factors.</p>","PeriodicalId":16660,"journal":{"name":"Journal of Parkinson's disease","volume":" ","pages":"182-188"},"PeriodicalIF":4.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143458412","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Christopher P Hurt, Daniel J Kuhman, Alyson Moll, Barton L Guthrie, Joseph W Olson, Arie Nakhmani, Melissa Wade, Sarah A Brinkerhoff, Marshall T Holland, Harrison C Walker
{"title":"Pointing in the right direction: Greater motor improvements with directional versus circular subthalamic nucleus deep brain stimulation for Parkinson's disease.","authors":"Christopher P Hurt, Daniel J Kuhman, Alyson Moll, Barton L Guthrie, Joseph W Olson, Arie Nakhmani, Melissa Wade, Sarah A Brinkerhoff, Marshall T Holland, Harrison C Walker","doi":"10.1177/1877718X241301071","DOIUrl":"10.1177/1877718X241301071","url":null,"abstract":"<p><p>BackgroundDirectional deep brain stimulation (DBS) provides more precise control of current spread than conventional ring-shaped electrodes. Whether this enhanced flexibility improves motor function is unclear.ObjectiveHere we examine whether directional and circular stimulation differentially impact motor performance in patients with Parkinson's disease.MethodsMotor behaviors were assessed in 31 patients who underwent unilateral subthalamic nucleus brain stimulation surgery (SUNDIAL, NCT03353688). Eight configurations, including 6 directional contacts and their corresponding rings), were evaluated during device activation. Objective measures of motor performance related to limb dexterity, gait, and overall mobility were evaluated in a double-blind fashion in the \"off\" medication state versus preoperative baseline, with stimulus amplitude at the center of the therapeutic window.ResultsSignificant changes in performance were observed across each of five motor tasks between the best and worst directional contacts on a given DBS row (p < 0.001 each task). Certain stimulation directions led to functional declines versus baseline, whereas the best direction yields greater improvement than ring stimulation (p = 0.005, p = 0.001, p = 0.007, p < 0.001, respectively, across tasks). Directional DBS improves therapeutic window and side effect thresholds versus ring stimulation (0.40 ± 0.94 and 0.35 ± 0.51 mA, p < 0.001, respectively), but these variables correlated only modestly with motor performance at a given stimulation site.ConclusionsOptimized directional subthalamic nucleus DBS yields better group-level motor performance than ring stimulation, in addition to its known advantages related to tolerability. Prospective studies should evaluate whether these improvements persist over longer time intervals.</p>","PeriodicalId":16660,"journal":{"name":"Journal of Parkinson's disease","volume":" ","pages":"202-213"},"PeriodicalIF":4.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143458436","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Alfand Marl F Dy Closas, Ai Huey Tan, Yi Wen Tay, Jia Wei Hor, Tzi Shin Toh, Jia Lun Lim, Choey Yee Lew, Chun Yoong Cham, Carolyn Chue Wai Yim, Kok Yoon Chee, Chong Guan Ng, Lei Cheng Lit, Anis Nadhirah Khairul Anuar, Lara M Lange, Zih-Hua Fang, Sara Bandres Ciga, Katja Lohmann, Christine Klein, Azlina Ahmad-Annuar, Kalai Arasu Muthusamy, Shen-Yang Lim
{"title":"New insights from a Malaysian real-world deep brain stimulation cohort.","authors":"Alfand Marl F Dy Closas, Ai Huey Tan, Yi Wen Tay, Jia Wei Hor, Tzi Shin Toh, Jia Lun Lim, Choey Yee Lew, Chun Yoong Cham, Carolyn Chue Wai Yim, Kok Yoon Chee, Chong Guan Ng, Lei Cheng Lit, Anis Nadhirah Khairul Anuar, Lara M Lange, Zih-Hua Fang, Sara Bandres Ciga, Katja Lohmann, Christine Klein, Azlina Ahmad-Annuar, Kalai Arasu Muthusamy, Shen-Yang Lim","doi":"10.1177/1877718X241297715","DOIUrl":"10.1177/1877718X241297715","url":null,"abstract":"<p><p>BackgroundThe availability of deep brain stimulation (DBS), a highly efficacious treatment for several movement disorders, remains low in developing countries, with scarce data available on utilization and outcomes.ObjectiveWe characterized the DBS cohort and outcomes at a Malaysian quaternary medical center.MethodsA retrospective chart review was done on DBS-related surgery at the University of Malaya, including clinico-demographic, genetics, and outcomes data focusing on post-operative medication reduction and complications.Results149 Parkinson's disease (PD) patients underwent DBS targeting the subthalamic nucleus. Six had globus pallidus internus DBS (primarily for dystonia). Only 16.1% of patients were government-funded. Of the 133 PD patients operated in the past decade (2013-2022), 25 (18.8%) had disease duration <5 years. At 6-12 months post-DBS, median levodopa-equivalent daily dose (LEDD) reduction was 440.5 [418.9] mg/day, corresponding to a reduction of ≥50% and ≥30% in 42.2% and 69.8% of patients, respectively. LEDD reductions were larger in the early-onset and short-duration subgroups. Three patients (1.9% of 155) had symptomatic intracranial hemorrhage, resulting in stroke in two. Pathogenic monogenic or <i>GBA1</i> variants were detected in 12/76 (16%) of patients tested, mostly comprising the \"severe\" <i>GBA1</i> variant p.L483P (12%).ConclusionsThis is the largest report on DBS from Southeast Asia. The procedures were effective, and complication rates on par with international norms. Our study found a high frequency of <i>GBA1</i>-PD; and included a substantial number of patients with short-duration PD, who had good outcomes. It also highlights regional inequities in access to device-aided therapy.</p>","PeriodicalId":16660,"journal":{"name":"Journal of Parkinson's disease","volume":" ","pages":"189-201"},"PeriodicalIF":4.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143458334","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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