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1.
The Lancet Neurology ; 22(1):17-19, 2023.
Article in English | ProQuest Central | ID: covidwho-2159970

ABSTRACT

Over 1 year, the PASADENA trial tested treatment with two different doses of prasinezumab, a humanised monoclonal antibody targeting aggregated α-synuclein, and compared them with placebo in 316 participants.1 Antibody treatment did not affect clinical scores (primary outcome: sum of the Movement Disorder Society's Unified Parkinson's Disease Rating Scale [MDS-UPDRS] parts I-III) or dopamine transporter activity (as a secondary outcome measure of disease progression). Another novel marker based on a kinase assay, combined with a cellular assay of downstream substrate phosphorylation, identified 23 out of 100 LRRK2 variants as robustly stimulating kinase activity, thereby enabling the classification of variants previously considered of unknown significance as pathogenic or benign.4 This high-throughput marker of pathogenicity has direct translational implications for counselling and for stratification of participants in the imminent leucine-rich-repeat kinase inhibitor trials. A digital approach was suggested by the PASADENA study, in which a newly developed, exploratory digital outcome (combined home-based signals from a smartwatch and smartphone, which were used by all study participants) showed less decline for both active treatment arms (ie, two different doses of prasinezumab) compared with placebo.1 However, pending validation, this result is only hypothesis generating.

2.
Revue Francophone d'Orthoptie ; 2022.
Article in English, French | EMBASE | ID: covidwho-2132255

ABSTRACT

A 65-year-old man, victim of COVID in March 2020, escaped with severe functional sequelae, notably oculomotor and vestibular. The etiology remains difficult. The diagnostic approach is complicated by the context. Copyright © 2022 Elsevier Masson SAS

3.
Seizure ; 104: 12-14, 2022 Nov 22.
Article in English | MEDLINE | ID: covidwho-2122800

ABSTRACT

INTRODUCTION: At the beginning of the coronavirus virus (COVID-19) pandemic, the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV2) was thought to cause mainly respiratory symptoms, largely sparing the brain and the rest of the nervous system. However, as the knowledge about COVID-19 infection progresses and the number of COVID19-related neurological manifestations reports increases, neurotropism and neuroinvasion were finally recognized as major features of the SARS-CoV-2. Neurological manifestations involving the central nervous system are sparse, ranging from headaches, drowsiness, and neurovascular attacks to seizures and encephalitis [1]. Thus far, several cases of non-epileptic myoclonus were reported in critical patients [2,3]. Here, we report the first case of myoclonus status as the inaugural and sole symptom of COVID-19 in a conscious patient. OBSERVATION: A 60-year-old man with unknown family history and no medical issues other than smoking one cigarette packet a day over the span of 25 years. The patient presented with 5 days of abnormal movements in bilateral arms following the COVID vaccination. They were described as brief, involuntary jerking, like in sleep starts, in the proximal part of their upper members, and his face with a regular tremor in his arms exacerbated by movements and emotion. His movement disorder worsened the second day, and he developed an abnormal gait with slurred speech, concomitantly with diarrhea. Seven days following the symptoms onset, the patient was alert. His neurological exam revealed multifocal myoclonic jerks affecting four limbs predominantly proximal, the face, and the trunk (video 1). The myoclonic jerks were sensitive to tactile and auditory stimuli, without enhanced startle response or hyperekplexia. His gait was unsteady due to severe myoclonus, without cerebellar ataxia (video 2) and he had mild dysarthria. No dysmetria at the finger-to-nose and heel-to-shin tests were found. Examination of eye movements revealed paralysis of Down-Gaze and no opsoclonus was detected. Physical exam was unremarkable, including lack of fever and meningitis signs. The electroencephalogram (EEG) did not show any abnormalities concomitant with myoclonic jerks (Fig.1). The cerebral Magnetic Resonance Imaging (MRI) was normal (Fig. 2). An extensive biological work-up including a complete blood count, a comprehensive metabolic panel, an arterial blood gas analysis, a urine drug screen, a thyroid function test, a vitamin B12, folate, and ammonia level, and HIV and syphilis serologies were inconclusive. Testing for autoimmune and paraneoplastic antineuronal antibodies including anti-NMDA-R was negative. The cerebrospinal fluid (CSF) study was unremarkable (0.3 g/l of proteinorachia, 1 white blood cell). Polymerase chain reaction (PCR) for herpes simplex virus, varicella-zoster virus, and SARS-CoV-2 in CSF was negative. However, the patient tested positive for COVID-19 through PCR for viral RNA from the nasopharyngeal swab. After the administration of 12mg/day of Dexamethasone for 3 days, along with clonazepam and levetiracetam, the patient's symptoms started improving on day 3 and he displayed a very slow but progressive recovery. DISCUSSION: Our patient presented with acute isolated multifocal myoclonus status without cognitive impairment. These movements were prominent, spontaneous, worsened by action, and sensitive to touch and sound. The anatomical source of this myoclonus could be cortical or subcortical despite the absence of evident EEG discharges. Several diseases can cause acute myoclonus such as severe hypoxia, metabolic disturbances, and paraneoplastic syndromes. these diagnoses were ruled out in our patient. Post-vaccinal origin was also suggested, but its accountability was not proven. Thus, the two hypothetic etiologies raised were either para-infectious or infectious mechanisms in relation to SARS-Cov 2 infection. HIV, VZV, HSV, and syphilis infections were eliminated and the patient tested positive for SARS-Cov2 infection. In the literature, COVID-19-related myoclonus was reported as a complication of an already-known SARS-CoV-2 infection in about 50 patients so far. It generally occurs between 6 days and 26 days following the SARS-CoV-2 infection [2-5], and affects critical illness patients with cognitive decline, mainly from the intensive care unit [3,4]. Yet, our patient did not display any symptoms of COVID-19 infection before the occurrence of these abnormal movements. Furthermore, he had a relatively good general condition and no cognitive impairment. Several pathophysiological mechanisms were suggested regarding the COVID-19-related myoclonus. Either central nervous invasion by SARS-Cov 2 after transneuronal spread and/or auto-immune cross-reactivity reaction, are likely incriminated in the pathophysiology of most of the cases [6]. We believe that there is an inflammatory process involved with increased levels of proinflammatory cytokines and systemic inflammation, including cytokine storm or cytokine release syndrome targeting the brain and more specifically the cortex and basal ganglia [6]. Data collection in clinical registries is needed to increase our knowledge of the prevalence of neurological symptoms in patients with COVID-19 and will hopefully clarify the causal relationship between SARS-CoV-2 infection and post-COVID-19 myoclonic syndrome.

4.
12th International Conference on CYBER Technology in Automation, Control, and Intelligent Systems, CYBER 2022 ; : 474-479, 2022.
Article in English | Scopus | ID: covidwho-2120884

ABSTRACT

Parkinson's disease(PD) is a progressive neu-rodegenerative disease defined by clinical syndrome including bradykinesia, tremor and postural instability. The PD-related disability and impairment are usually monitored by clinicals using the MDS-UPDRS scale. However, due to COVID-19, it became much harder for the patients to reach hospitals and obtain necessary assessment and treatment. Nowadays, 2D videos are easily accessible and can be a promising so-lution for on-site and remote diagnosis of movement disorder. Inspired by the frequency-based video processing mechanism of human visual system, we propose a video-based SlowFast GCN network to quantify the gait disorder. The model consists of two parts: the fast pathway and the slow pathway. The former detects characteristics such as tremor and bilateral asymmetry, while the latter extracts characteristics such as bradykinesia and freezing of gait. Furthermore, in order to investigate the influence of age on the model performance, an aged control group and a young control group were set up for verification. The proposed model was evaluated on a video dataset collected from 68 participants. We achieved a balanced accuracy of 87.5% and precision of 87.9%, which outperformed existing competing methods. When replacing the young healthy controls with the same number of older controls, the balanced accuracy and precision were decreased by 10.4% and 9.7%, which indicates that age has a significant effect on the model perfomance. © 2022 IEEE.

5.
BMJ Evid Based Med ; 2022 Nov 11.
Article in English | MEDLINE | ID: covidwho-2119280

ABSTRACT

OBJECTIVES: To identify all outcomes, their definitions, outcome measurement instruments (OMIs), timepoints and frequency of measurement applied in clinical trials in oropharyngeal dysphagia (OD) interventions in Parkinson's disease (PD). This scoping review is the first stage of a larger project establishing a core outcome set for dysphagia interventions in Parkinson's disease (COS-DIP). DESIGN: Scoping review. METHODS: Six electronic databases and one trial registry were searched without language restrictions until March 2022. Bibliography lists of included studies were also reviewed. Study screening and data extraction were conducted independently by two reviewers using Covidence. The scoping review protocol is registered and published (http://hdl.handle.net/2262/97652). RESULTS: 19 studies with 134 outcomes were included. Trial outcomes were mapped to a recommended taxonomy for COSs and merged. 39 outcomes were identified. The most frequently measured were general swallowing-related outcomes, global quality-of-life outcomes and swallowing-related perceived health status outcomes. The applied outcomes, their definitions, OMIs, timepoints and frequency of measurement showed a high variability across all studies. CONCLUSIONS: The high variability of outcomes emphasises the need for an agreed standardised COS. This will inform clinical trial design in OD in PD, increase the quality of OD trials in PD and facilitate synthesising and comparing study results to reach conclusion on the safety and effectiveness of OD interventions in PD. It will not prevent or restrict researchers from examining other outcomes. TRIAL REGISTRATION NUMBER: The COS-DIP study, including the scoping review, was registered prospectively with the Core Outcome Measures in Effectiveness Trials Database on 24 September 2021 (www.comet-initiative.org, registration number: 1942).

6.
Neurol India ; 70(5): 2003-2008, 2022.
Article in English | MEDLINE | ID: covidwho-2117325

ABSTRACT

Background: Telemedicine (TM) consultations have shown to be feasible for the management of neurological conditions including movement disorders. In contrast, satisfaction with such consultations have been less studied. Objective: To assess the satisfaction of persons with a movement disorder with a TM consultation in comparison to previous experiences in face-to-face visits. Subjects and Methods: A cross-sectional multicenter study was carried out. Persons with a diagnosis of a movement disorder underwent a TM consultation. After the consultation concluded, a satisfaction survey was sent for the subject to fill out anonymously. The survey included ease of use-related items, setup-related items, and quality-of-service-related items. Results: A total of 175 survey responses were received (response rate of 71.4%), all of which were included for analysis. A total of 102 subjects considered that the TM consultation involved much less time in comparison to their previous experience with face-to-face visits. Overall, 96% reported to be satisfied with the consultation. In addition, 92% were satisfied or very satisfied with the neurologist ability to communicate recommendations. Furthermore, 93.7% indicated that the consultation was valuable, and 90.9% considered that they would recommend teleconsultation to another patient. Conclusion: Patients with a diagnosis of a movement disorder consider TM as a convenient and potential tool for health services with a high level of satisfaction.


Subject(s)
COVID-19 , Essential Tremor , Parkinsonian Disorders , Remote Consultation , Telemedicine , Humans , Pandemics , Personal Satisfaction , Cross-Sectional Studies , Essential Tremor/diagnosis , Essential Tremor/therapy , Follow-Up Studies , Patient Satisfaction , Parkinsonian Disorders/diagnosis , Parkinsonian Disorders/therapy
7.
Eur J Neurol ; 2022 Nov 11.
Article in English | MEDLINE | ID: covidwho-2116808

ABSTRACT

INTRODUCTION: There have been over 500 million confirmed cases of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), also known as coronavirus disease 2019 (COVID-19), across the globe. To date, a broad spectrum of neurological manifestations following acute infections as well as COVID-19 vaccines have been reported. This study aims to describe the spectrum of neurological manifestations seen in the 'COVID-19 clinic' established in a tertiary Movement Disorders clinic. METHODS: In this consecutive case-series study over the period March 2020-January 2022, clinical information regarding demographic data, clinical history and examination findings, investigation results and video recordings of outpatients with motor manifestations associated with COVID-19 infection or vaccination were reviewed. RESULTS: Twenty-one adult patients were reviewed in this ad-hoc clinic at Toronto Western Hospital. The majority of the patients were female (76%) and the average age was 50.7±17.2 years (range: 21-80 years). Nine patients (43%) presented with motor manifestations following COVID-19 infection. Twelve patients (57%) developed neurological symptoms following at least one dose of the mRNA or viral vector-based COVID-19 vaccine. The most common manifestation observed was a functional movement disorder (43%). The vaccine group demonstrated a higher number of functional disorders compared to the infection group (58% vs 22%, p=0.08). DISCUSSION: Functional motor manifestations can be associated with COVID-19 and are likely to be under reported. In view of the co-existence of functional symptoms, movement disorders and mental health conditions observed in this study, we would advocate the use of dedicated COVID-19 Neurology clinics with full access to an experienced multidisciplinary team.

8.
Covid-19 and Parkinsonism, Vol. 165 ; : 1-16, 2022.
Article in English | Web of Science | ID: covidwho-2102064

ABSTRACT

There are several known causes of secondary parkinsonism, the most common being head trauma, stroke, medications, or infections. A growing body of evidence suggests that viral agents may trigger parkinsonian symptoms, but the exact pathological mechanisms are still unknown. In some cases, lesions or inflammatory processes in the basal ganglia or substantia nigra have been found to cause reversible or permanent impairment of the dopaminergic pathway, leading to the occurrence of extrapyramidal symptoms. This chapter reviews current data regarding the viral agents commonly associated with parkinsonism, such as Epstein Barr virus (EBV), hepatitis viruses, human immunodeficiency virus (HIV), herpes viruses, influenza virus, coxsackie virus, and Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2). We present possible risk factors, proposed pathophysiology mechanisms, published case reports, common associations, and prognosis in order to offer a concise overview of the viral spectrum involved in parkinsonism.

9.
Annals of Neurology ; 92:S40-S41, 2022.
Article in English | Web of Science | ID: covidwho-2081742
10.
Drug Safety ; 45(10):1157-1158, 2022.
Article in English | ProQuest Central | ID: covidwho-2044975

ABSTRACT

Introduction: Gastrointestinal stromal tumors (GISTs), soft tissue sarcomas of the digestive tract, are associated with oncogenic mutations that led to the approval of tyrosine kinase inhibitors (TKIs) [1-2]. Considering the increased use of TKIs in clinical practice, it may be useful to identify unexpected adverse drug reactions (ADRs). Objective: The aim of this study was to describe better ADRs and to identify unexpected potential safety signals through the analysis of individual case safety reports (ICSRs) among TKIs approved for GIST collected into the European Spontaneous Reporting System (SRS) database. Methods: All ICSRs recorded starting from the drug approval up to 31 December 2021 with one of the following TKIs reported as suspected drug were included: imatinib (IM), sunitinib (SU), avapritinib (AVA), regorafenib (REG), and ripretinib (RIP). A descriptive analysis was conducted to assess all demographic characteristics. Moreover, a disproportionality analysis was performed using the Reporting Odds Ratio (ROR) with the corresponding 95% Confidence Interval (CI) to evaluate the frequency of ADRs for each TKI compared to all other TKIs. Results The number of analyzed ICSRs was 8,512 (Figure 1 Flowchart of ICSRs selection process): the 57.9% were related to IM, followed by SU (24.2%), AVA (13.1%), REG (2.7%), and RIP (2.1%). ICSRs were mainly serious (87.5%), related to males (51.7%), and to adults (44.7%);moreover, the 25.5% were fatal. The disproportionality analysis showed a higher reporting frequency of some unexpected ADRs for each TKI: gait disturbance (ROR 2.86;95% CI 1.90-4.29), hyperhidrosis (2.57;1.06-6.20), and hyperammonemia (3.92;1.05-14.60) for SU;cerebrovascular accident (6.23;2.18-17.84), hemoglobin decreased (2.23;1.08-4.61), and internal haemorrhage (14.44;3.94-52.92) for RIP;gastrointestinal ulcer (10.88;2.98-39.81) for REG;hepatic and lung cancer for IM (12.79;8.04-20.37 and 7.71;3.33-17.84, respectively);hallucination (24.33;9.02-65.68), mood swings (8.02;2.44-26.33), and stress (6.68;1.93-23.11), nephrolithiasis (6.69;2.15-20.77), pollakiuria (3.08;1.17-8.13), and dialysis (6.68;1.67-26.73), sinusitis (3.34;1.14-9.78), cellulitis (4.17;1.36-12.78), and COVID-19 (7.25;3.40-15.45), chills (2.36;1.22-4.58), limb fracture (3.53;1.63-7.60), hernia (9.23;3.71-23.00), diabetes mellitus (5.02;2.11-11.95), hyposideraemia (5.02;2.11-11.95), tinnitus (3.64;1.34-9.87), parosmia (5.00;1.12-22.38), Raynaud's phenomenon (5.00;1.12-22.38), and thyroid function test abnormal (8.90;1.99-39.83) for AVA. Conclusion: This study is largely consistent with results from literature but some unexpected ADRs were shown. Further studies are necessary to increase the awareness about the safety profiles of new TKIs approved for GISTs.

11.
Front Pediatr ; 10: 863919, 2022.
Article in English | MEDLINE | ID: covidwho-1963502

ABSTRACT

Background: There has been a rise in explosive onset of tic-like behaviors during the COVID-19 pandemic. Historically, this is an uncommon phenomenology of functional movement disorders across all ages. Both the psychological burden of the pandemic and social media usage have been implicated in the rise of these tic-like behaviors. Methods: This paper provides a narrative review of the literature on chronic tic disorders, functional tics, and mass functional illness with particular focus on the key distinguishing features, role of social media, and the role of COVID-19. Results: The COVID-19 pandemic has profoundly affected the mental health of many individuals, including children, adolescents, and their caregivers. Implementation of lockdowns, lifestyle disruptions, school closures, and social distancing have driven a surge in social media and digital technology use. The combination of predisposing factors, the psychological burden of the COVID-19 pandemic, and social media are implicated in the rise and spread of tic-like behaviors; which may represent a modern-day form of mass functional illness. While many of the features overlap with functional tics, there are emerging distinctive features that are important to recognize. A more encompassing term, Functional Tic-Like Behaviors, is used to better reflect multiple contributing factors. Conclusion: Knowledge of these differences is essential to mitigate downstream health effects and poor outcomes.

12.
Movement Disorders ; 37(7), 2022.
Article in English | ProQuest Central | ID: covidwho-1941236

ABSTRACT

July Infographic : COVID‐19 Infection Enhances Susceptibility to Oxidative Stress–Induced Parkinsonism

13.
Frontiers in Integrative Neuroscience ; 2022.
Article in English | ProQuest Central | ID: covidwho-1933732

ABSTRACT

As the COVID-19 pandemic continues to unfold, numerous neurological symptoms emerge. The literature reports more and more manifestations of SARS-CoV-2 related to headache, dizziness, impaired consciousness, cognitive impairment, and motor disorders. Moreover, the infection of SARS-CoV-2 may have a durable neurological impact. ACE2/TMPRSS2 are the main entry point into cells for some strains of coronaviruses including SARS-CoV-2, which uses it to target the central nervous system. The aim of this study is to characterise the scope of the potential complex impact of a SARS-CoV-2 infection in the brain. It concerns different scales: the topographic, cognitive, sensorimotor, and genetic one. We investigated which cognitive and sensorimotor functions are associated with the brain regions where ACE2/TMPRSS2 are overexpressed, hypothesizing that they might be particularly affected by the infection. Furthermore, overexpressed genes in these regions are likely to be impacted by COVID-19. This general understanding is crucial to establish the potential neurological manifestations of the infection. Data on mRNA expression levels of genes were provided by the Allen Institute for Brain Science, and the localisation of brain functions by the LinkRbrain platform. The latter was also used to analyse the spatial overlap between ACE2/TMPRSS2 overexpression, and either function-specific brain activations, or regional overexpression of other genes. The characterisation of these over-expressed genes was based on the GeneCards platform and the gene GSE152075 from the Gene Expression Omnibus database. We analysed the cognitive and sensorimotor functions whose role might be impaired, of which 88 have been categorized into seven groups: memory and recollection, motor function, pain, lucidity, emotion, sensory and reward. Furthermore, we categorized the genes showing a significant increase in concentration of their mRNAs in the same regions where ACE2/TMPRSS2 mRNA levels are the highest. 11 groups emerged from a bibliographical research: neurodegenerative disease, immunity, inflammation, olfactory receptor, cancer/apoptosis, executive function, senses, ischemia, motor function, myelination, and dependence. The results of this exploration could be in relation with the neurological symptoms of COVID-19. Furthermore, some genes from peripheral blood are already considered as biomarker of COVID-19. This method could generate new hypotheses to explore the neurological manifestations of COVID-19.

14.
Frontiers in Aging Neuroscience ; 2022.
Article in English | ProQuest Central | ID: covidwho-1933725

ABSTRACT

Background: Freezing of gait (FOG) is a common clinical manifestation of Parkinson’s disease (PD), mostly occurring in the intermediate and advanced stages. FOG is likely to cause patients to fall, resulting in fractures, disabilities and even death. Currently, the pathogenesis of FOG is unclear, and FOG detection and screening methods have various defects, including subjectivity, inconvenience, and high cost. Due to limited public healthcare and transportation resources during the COVID-19 pandemic, there are greater inconveniences for PD patients who need diagnosis and treatment. Objective: A method was established to automatically recognize FOG in PD patients through videos taken by mobile phone, which is time-saving, labor-saving, and low-cost for daily use, which may overcome the above defects. In the future, PD patients can undergo FOG assessment at any time in the home rather than in the hospital. Methods: In this study, motion features were extracted from timed up and go (TUG) test and the narrow TUG (Narrow) test videos of 50 FOG-PD subjects through a machine learning method;then a motion recognition model to distinguish between walking and turning stages and a model to recognize FOG in these stages were constructed using the XGBoost algorithm. Finally, we combined these three models to form a multi-stage FOG recognition model. Results: We adopted the leave-one-subject-out (LOSO) method to evaluate model performance, and the multi-stage FOG recognition model achieved a sensitivity of 87.5% sensitivity and a specificity of 79.82%. Conclusion: A method to realize remote PD patient FOG recognition based on mobile phone video is presented in this paper. This method is convenient with high recognition accuracy and can be used to rapidly evaluate FOG in the home environment and remotely manage FOG-PD, or screen patients in large-scale communities. Keywords: Parkinson’s disease, Freezing of gait, XGBoost, Machine vision, Machine learning

15.
Bipolar Disorders ; 24(S1):35-65, 2022.
Article in English | Academic Search Complete | ID: covidwho-1922839

ABSTRACT

B Method: b A semi-structured interview consisting of 20 open-ended questions was administered to 12 patients diagnosed with bipolar disorder (BD), to their caregivers and to 12 psychiatrists who were involved in the treatment of BD patients. During olanzapine treatment (mean duration, weeks [SZ = 24.7;BD-I = 25.9]), average change in weight was highest for underweight/normal weight patients (SZ = 5.9%;BD-I = 6.5%), followed by overweight (SZ = 3.7%;BD-I = 4.9%) and obese patients (SZ = 2.5%;BD-I = 3.2%). P30Fibromyalgia in patients with bipolar disorder- a cohort analysis Daniel Vasile SP 1,* sp , Octavian Vasiliu SP 2 sp SP I 1 i sp I University of Medicine and Pharmacy Carol Davila;i SP I 2 i sp I University Emergency Central Military Hospital Dr. Carol Davila i B Introduction: b A high prevalence of bipolar disorder (BD) was reported in patients with fibromyalgia, and the potential risk of treating these individuals with antidepressants has been underlined in the literature [1,2]. Deniz Ceylan SP 1,* sp , Nese Yorguner SP 2 sp , Devran Tan SP 3 sp , Kürsat Altinbas SP 4 sp , Sibel Çakir SP 5 sp SP I 1 i sp I Koç University;i SP I 2 i sp I Marmara University;i SP I 3 i sp I Nisantasi University;i SP I 4 i sp I Selçuk University;i SP I 5 i sp I Bahçesehir University i B Introduction: b Beyond a significant psychological burden in lives of patients with bipolar disorders, the COVID-19 outbreak created a significant obstacle in accessibility to mental health services, which raised a need for a country-wide network of healthcare providers for bipolar disorders in Turkey. [Extracted from the article] Copyright of Bipolar Disorders is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

16.
Bmj ; 377, 2022.
Article in English | ProQuest Central | ID: covidwho-1909710

ABSTRACT

Statins and parkinsonism Repeated assessments of 2800 community dwelling older adults suggest that statin users have a reduced risk of developing parkinsonian signs and symptoms. Exercise following a cardiovascular event Physical activity is well known to promote cardiovascular health. Consider the patient’s life expectancy before initiating intensive treatment of blood pressure (JAMA Intern Med doi:10.1001/jamainternmed.2022.1657).

17.
Age and Ageing ; 51, 2022.
Article in English | ProQuest Central | ID: covidwho-1901091

ABSTRACT

Introduction We have 262 patients under the care of older persons movement disorders service in East Suffolk, whom due to a combination of retirement and COVID pandemic hadn’t seen a consultant for their follow up in up to 18 months. There are the facilities to see patients closer to their homes with satellite outpatient clinics in Eye, Stowmarket, Felixstowe and Aldeburgh, and via telephone and video consultation. We found that 137 of these patients live in rural areas closer to these satellite clinics. An opportunity was sensed to tailor the future service to the preferences of our patients, with the aim of improving experience and satisfaction. Method We sent a postal survey to these 137 patients asking them about the importance of having one responsible consultant, the type and location of their appointment. Results We sent a postal survey to these 137 patients, we received 81 Reponses. 91% of respondents ranked it either important, quite important or very important that they see the same consultant. It was the 1st preference to be seen at a local healthcare facility with 71% of patients choosing this as their first choice versus 22% for Ipswich hospital. 7% had a 1st preference of telephone appointment. 0 patients had a 1st choice preference of video conference it was the least favourable preference for 52% of respondents. Conclusion Our cohort of patients place a high value on continuity of care and would prefer to be seen at a community clinic that is closer to home. These preferences have been discussed with PDUK and CCG and have informed how we deliver our service as of August 2021 with all patients having a locality based clinic and named consultant. Our results are at odds with the ethos of NHSX [1] and the drive to see patients virtually.

18.
Neurol Sci ; 43(9): 5165-5168, 2022 Sep.
Article in English | MEDLINE | ID: covidwho-1877850

ABSTRACT

BACKGROUND: Several neurological complications have been reported following SARS-Cov-2 vaccination, without a clear causal relationship ever being verified, including some cases of worsening of Parkinson's disease (PD) symptoms and new onset of movement disorders in non-parkinsonian patients. METHODS: We describe two new cases of PD patients treated with device-aided therapy who developed worsening of parkinsonian symptoms after receiving the third vaccine dose (booster). We also conducted a short review of the cases reported in literature of PD symptoms worsening and new onset of movement disorders in non-parkinsonian patients after SARS-Cov-2 vaccination. RESULTS: The first patient, a 46-year-old man implanted with bilateral Subthalamic Deep Brain Stimulation, experienced temporary motor and non-motor symptoms worsening after mRNA-1273 booster, improved after stimulation settings modification. The second patient, a 55-year-old man implanted with percutaneous endoscopic transgastric jejunostomy (PEG-J) for levodopa-carbidopa intestinal gel (LCIG) infusion experienced severe temporary worsening of dyskinesia and managed through temporary LCIG dose reduction. Other seven cases of vaccine-related movement disorder are currently reported in literature, four describing PD symptoms worsening and three the onset of new movement disorders in otherwise healthy people. CONCLUSION: Both our patients and the cases described so far completely recovered after few days with parkinsonian therapy modification, symptomatic treatment, or even spontaneously, underlining the transient and benign nature of side effects from vaccine. Patients should be reassured about these complications, manageable through a prompt evaluation by the reference neurologist.


Subject(s)
COVID-19 Vaccines , COVID-19 , Movement Disorders , Parkinson Disease , Vaccination , COVID-19/prevention & control , COVID-19 Vaccines/adverse effects , Carbidopa/therapeutic use , Deep Brain Stimulation , Drug Combinations , Humans , Immunization, Secondary/adverse effects , Levodopa/therapeutic use , Male , Middle Aged , Movement Disorders/etiology , Movement Disorders/therapy , Parkinson Disease/etiology , Parkinson Disease/therapy , Treatment Outcome , Vaccination/adverse effects
19.
Brain Sciences ; 12(5):513, 2022.
Article in English | ProQuest Central | ID: covidwho-1870891

ABSTRACT

Background. Loss of olfaction is a well-established early feature of Parkinson’s disease (PD). Although olfactory dysfunction has been widely described as a prodromal feature of PD in the literature, whether it can be considered a biomarker of PD progression is still a matter of debate. Objective. The aim of this work is to define the possible relationship between the progression of olfactory dysfunction and other putative clinical hallmarks of PD over time, through a systematic review of the current literature. Methods. We conducted a systematic review of the literature on PubMed from inception to March 2022. We included only longitudinal studies conducted on patients with diagnosis of idiopathic PD who underwent olfactory function testing at baseline and repeated it at least once during follow-up. Results. Among 5740 records identified through database searching, nine longitudinal studies met full criteria and underwent data extraction. Conclusions. Olfaction seemed to decrease over time, albeit with a degree of fluctuation. Moreover, smell detection ability seems to deteriorate more rapidly in the early phase of disease, indicating a possible association with disease progression. More studies are needed to better understand the role of olfaction as a biomarker of PD progression over time.

20.
Biomedicines ; 10(6)2022 May 26.
Article in English | MEDLINE | ID: covidwho-1869466

ABSTRACT

Glucose transporter type 1 (Glut1) is the main transporter involved in the cellular uptake of glucose into many tissues, and is highly expressed in the brain and in erythrocytes. Glut1 deficiency syndrome is caused mainly by mutations of the SLC2A1 gene, impairing passive glucose transport across the blood-brain barrier. All age groups, from infants to adults, may be affected, with age-specific symptoms. In its classic form, the syndrome presents as an early-onset drug-resistant metabolic epileptic encephalopathy with a complex movement disorder and developmental delay. In later-onset forms, complex motor disorder predominates, with dystonia, ataxia, chorea or spasticity, often triggered by fasting. Diagnosis is confirmed by hypoglycorrhachia (below 45 mg/dL) with normal blood glucose, 18F-fluorodeoxyglucose positron emission tomography, and genetic analysis showing pathogenic SLC2A1 variants. There are also ongoing positive studies on erythrocytes' Glut1 surface expression using flow cytometry. The standard treatment still consists of ketogenic therapies supplying ketones as alternative brain fuel. Anaplerotic substances may provide alternative energy sources. Understanding the complex interactions of Glut1 with other tissues, its signaling function for brain angiogenesis and gliosis, and the complex regulation of glucose transportation, including compensatory mechanisms in different tissues, will hopefully advance therapy. Ongoing research for future interventions is focusing on small molecules to restore Glut1, metabolic stimulation, and SLC2A1 transfer strategies. Newborn screening, early identification and treatment could minimize the neurodevelopmental disease consequences. Furthermore, understanding Glut1 relative deficiency or inhibition in inflammation, neurodegenerative disorders, and viral infections including COVID-19 and other settings could provide clues for future therapeutic approaches.

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