Clinical utility of a personalized and long-term monitoring device for Parkinson's disease in a real clinical practice setting: An expert opinion survey on STAT-ON™.

BACKGROUND: STAT-ON™ is an objective tool that registers ON-OFF fluctuations making possible to know the state of the patient at every moment of the day in normal life. Our aim was to analyze the opinion of different Parkinson's disease experts about the STAT-ON™ tool after using the device in a real clinical practice setting (RCPS). METHODS: STAT-ON™ was provided by the Company Sense4Care to Spanish neurologists for using it in a RCPS. Each neurologist had the device for at least three months and could use it in PD patients at his/her own discretion. In February 2020, a survey with 30 questions was sent to all participants. RESULTS: Two thirds of neurologists (53.8% females; mean age 44.9±9 years old) worked in a Movement Disorders Unit, the average experience in PD was 16±6.9 years, and 40.7% of them had previously used other devices. A total of 119 evaluations were performed in 114 patients (range 2-9 by neurologist; mean 4.5±2.3). STAT-ON™ was considered "quite" to "very useful" by 74% of the neurologists with an overall opinion of 6.9±1.7 (0, worst; 10, best). STAT-ON™ was considered better than diaries by 70.3% of neurologists and a useful tool for the identification of patients with advanced PD by 81.5%. Proper identification of freezing of gait episodes and falls were frequent limitations reported. CONCLUSION: STAT-ON™ could be a useful device for using in PD patients in clinical practice.

Clinical utility of a personalized and long-term monitoring device for Parkinson's disease in a real clinical practice setting: An expert opinion survey on STAT-ON™.

BACKGROUND: STAT-ON™ is an objective tool that registers ON-OFF fluctuations making possible to know the state of the patient at every moment of the day in normal life. Our aim was to analyze the opinion of different Parkinson's disease experts about the STAT-ON™ tool after using the device in a real clinical practice setting (RCPS). METHODS: STAT-ON™ was provided by the Company Sense4Care to Spanish neurologists for using it in a RCPS. Each neurologist had the device for at least three months and could use it in PD patients at his/her own discretion. In February 2020, a survey with 30 questions was sent to all participants. RESULTS: Two thirds of neurologists (53.8% females; mean age 44.9±9 years old) worked in a Movement Disorders Unit, the average experience in PD was 16±6.9 years, and 40.7% of them had previously used other devices. A total of 119 evaluations were performed in 114 patients (range 2-9 by neurologist; mean 4.5±2.3). STAT-ON™ was considered "quite" to "very useful" by 74% of the neurologists with an overall opinion of 6.9±1.7 (0, worst; 10, best). STAT-ON™ was considered better than diaries by 70.3% of neurologists and a useful tool for the identification of patients with advanced PD by 81.5%. Proper identification of freezing of gait episodes and falls were frequent limitations reported. CONCLUSION: STAT-ON™ could be a useful device for using in PD patients in clinical practice.

Cognitive and psychiatric symptoms in genetically determined Parkinson's disease: a systematic review.

The aim was to review the existing reports on cognitive and behavioural symptoms in monogenic forms of Parkinson's disease (PD) and to identify recurring patterns of clinical manifestations in those with specific mutations. A systematic literature search was conducted to retrieve observational studies of monogenic PD. Data pertaining to cognitive and psychiatric manifestations were extracted using standardized templates. The PRISMA guidelines were followed. Of the 1889 citations retrieved, 95 studies on PD-related gene mutations were included: 35 in SNCA, 35 in LRRK2, four in VPS35, 10 in Parkin, three in DJ1 and eight in PINK1. Nineteen studies (20%) provided adequate data from comprehensive cognitive assessment and 31 studies (32.6%) outlined psychiatric manifestations through the use of neuropsychiatric scales. Cognitive impairment was reported in all monogenic PD forms with variable rates (58.8% PINK1, 53.9% SNCA, 50% DJ1, 29.2% VPS35, 15.7% LRRK2 and 7.4% Parkin). In this regard, executive functions and attention were the domains most affected. With respect to psychiatric symptoms, depression was the most frequent symptom, occurring in 37.5% of PINK1 cases and 41.7% of VPS35 and LRRK2 cases. Co-occurrence of cognitive decline with visual hallucinations was evidenced. Widespread accumulation of Lewy bodies, distinctive of SNCA, PINK1 and DJ1 mutations, results in higher rates of cognitive impairment. Similarly, a higher degree of visual hallucinations is observed in SNCA mutations, probably owing to the more widespread accumulation. The lower rates of α-synuclein pathology in LRRK2 and Parkin may underpin the more benign disease course in these patients.

Neurologic diagnostic criteria for functional neurologic disorders.

The diagnosis of functional neurologic disorders can be challenging. In this chapter we review the diagnostic criteria and rating scales reported for functional/psychogenic sensorimotor disturbances, psychogenic nonepileptic seizures (PNES) and functional movement disorders (FMD). A recently published scale for sensorimotor signs has some limitations, but may help in the diagnosis, and four motor and two sensory signs have been reported as highly reliable. There is good evidence using eight specific signs for the differentiation of PNES from seizures. Recently, diagnostic criteria were developed for PNES; their sensitivity and specificity need to be evaluated. The definitive diagnosis of PNES can be made by recording typical positive features during the spells, and in a low proportion of cases, where the distinction with an organic etiology cannot easily be done, a normal electroencephalogram suggests the diagnosis. FMD diagnosis relies on diagnostic criteria, which have been refined over time and may be supplemented by laboratory tests in some phenotypes. Rating scales for PNES and FMD could be useful for severity measures, but several limitations remain to be addressed.

The high prevalence of impulse control behaviors in patients with early-onset Parkinson's disease: A cross-sectional multicenter study.

INTRODUCTION: In Parkinson's disease patients, impulse control disorders (ICDs) have been associated with younger age and early disease onset, yet the prevalence of ICDs in early-onset Parkinson's disease (EOPD) patients has yet to be studied. Thus, we set out to compare the prevalence of impulse control behaviors (ICBs) in a cohort of EOPD patients with that in age and gender matched healthy controls (HCs), as well as to analyze the association of these symptoms with the use of dopaminergic drugs and other clinical or demographic factors. METHODS: A cross-sectional, multicenter study was carried out on patients recruited from outpatient Movement Disorder Clinics, assessing ICBs using the short form of the Questionnaire for Impulsive-Compulsive Disorders in Parkinson's Disease (QUIP). In addition, depression and quality of life (QoL) were measured, along with other demographic and clinical variables. RESULTS: Of the 87 EOPD patients, 49 (58.3%) displayed an ICB, as did 28 of the 87 HCs (32.9%; p=0.001). Most of the EOPD patients that displayed an ICB (91.8%) were medicated with a dopamine agonist (DA) and accordingly, DA treatment was associated with a 7-fold increased risk of developing an ICB. Patients with ICBs had a higher depression score and a worse QoL. CONCLUSIONS: ICBs are much more prevalent in EOPD patients than in HCs and they are associated with DA intake, depression and a worse QoL.

[Video-EEG monitoring and simultaneous ECG for the differential diagnosis of transient consciousness disorders. A case report]. / Monitorización con vídeo-EEG y ECG simultáneo para el diagnóstico diferencial de trastornos de conciencia transitorios. A propósito de un caso.

We present the case of a 36 year-old woman, with history of transient consciousness disorders with vegetative state, interpreted as epileptic crises and treated with valproate for two years. After nine asymptomatic years, they reappeared associated with migraine, vomiting and some generalized convulsions. Electroencephalogram and cerebral magnetic resonance turned out normal, and treatment with zonisamide was started, without beneficial results. Later cardiological studies objectified a blockage of the left branch that coincided with dizziness. The study was completed with Video-EGG monitoring, where there was an episode that showed temporary right epileptiform activity, with a diagnosis established of focal epilepsy of unknown cause. At present, she remains asymptomatic with oxycarbazepine.

Monitorización con vídeo-EEG y ECG simultáneo para el diagnóstico diferencial de trastornos de conciencia transitorios. A propósito de un caso / Video-EEG monitoring and simultaneous ECG for the differential diagnosis of transient consciousness disorders. A case report

Se presenta el caso de una mujer de 36 años, con antecedentes de trastornos de conciencia transitorios con cortejo vegetativo en la adolescencia, interpretados como crisis epilépticas y tratados con ácido valproico durante dos años. Tras permanecer nueve años asintomática, reaparecieron asociados a migraña, vómitos y alguna convulsión generalizada. El electroencefalograma y la resonancia magnética cerebral resultaron normales e inició tratamiento con zonisamida, sin beneficio. Estudios cardiológicos posteriores objetivaron bloqueo de rama izquierda, que coincidía con mareo. Se completó el estudio mediante monitorización con vídeo-EEG, donde tuvo un episodio que evidenció actividad epileptiforme temporal derecha, estableciéndose el diagnóstico de epilepsia focal de causa desconocida. Actualmente, permanece asintomática con oxcarbacepina. La anamnesis es fundamental para diferenciar trastornos de conciencia transitorios, especialmente síncopes y crisis epilépticas, pero no siempre es suficiente. La monitorización con vídeo-EEG y registro simultáneo de electrocardiograma resulta muy útil para distinguirlos(AU)

We present the case of a 36 year-old woman, with history of transient consciousness disorders with vegetative state, interpreted as epileptic seizures and treated with valproic acid for two years. After nine asymptomatic years, they reappeared associated with migraine, vomiting and some generalized convulsions. Electroencephalogram and cerebral magnetic resonance turned out normal, and treatment with zonisamide was started, without beneficial results. Later cardiological studies objectified a blockage of the left branch that coincided with dizziness. The study was completed with Video-EEG monitoring, where there was an episode that showed right temporal epileptiform activity, with a diagnosis established of focal epilepsy of unknown etiology. At present, she remains asymptomatic with oxycarbazepine(AU)

Insuficiencia venosa cerebroespinal crónica y esclerosis múltiple: revisión y actualización del tema / Chronic cerebrospinal venous insufficiency and multiple sclerosis: a review and update of the subject

La etiología de la esclerosis múltiple se desconoce en el momento actual, aunque se acepta el origen inflamatorio autoinmune como el más probable. En la historia de esta enfermedad se propuso una fisiopatología vascular, la cual ha resurgido recientemente a partir de los trabajos de Paolo Zamboni y se ha denominado ‘insuficiencia venosa cerebroespinal crónica’. Siguiendo esta hipótesis, Zamboni plantea un tratamiento curativo para la esclerosis múltiple mediante tratamiento endovascular de la vena yugular interna y la vena ácigos. Sin embargo, varios equipos han intentado replicar sus resultados sin conseguirlo. En esta revisión describimos cronológica y objetivamente los estudios tanto de Zamboni como de los intentos posteriores de réplica. Nuestra principal conclusión es que con los resultados disponibles hasta la actualidad debemos ser cautos y no recomendar por el momento este tratamiento a nuestros pacientes de una forma sistemática (AU)

The aetiology of multiple sclerosis remains unknown at the present time, although the most likely explanation is that it has an autoimmune inflammatory origin. During the history of this disease a vascular pathophysiology was once proposed, and it has recently re-emerged as a result of the work by Paolo Zamboni with the name of ‘chronic cerebrospinal venous insufficiency’. Following this hypothesis, Zamboni puts forward a curative treatment for multiple sclerosis by means of endovascular treatment of the internal jugular vein and the azygos vein. However, several teams have attempted to replicate his findings without success. In this review, we offer a chronological description of the studies carried out by Zamboni and the later attempts to replicate his work. Our main conclusion is that, given the results we currently have available, we should be cautious and, for the time being, it would be advisable not to recommend the systematic use of this treatment for our patients (AU)

[The use of SWI-MRI to differentiate between seizures and transient ischemic attacks in a patient with cerebral amyloid angiopathy]. / Utilidad de las secuencias potenciadas en susceptibilidad paramagnética (SWI) para diferenciar crisis somestésicas de accidentes isquémicos transitori.

BACKGROUND: Cerebral amyloid angiopathy (CAA) is characterized by the deposit of ß-amyloid on the walls of small and medium-sized arteries of the cerebral cortex and leptomeninges causing cerebral bleeding. Clinical presentations may include transient neurological events for which differential diagnosis can be difficult. CASE REPORT: We report a subject with a medical history of a recent stroke who presented somesthetic seizures mimicking transient ischemic attacks owing to CAA microbleeding. Antiplatelet treatment was reduced and after lamotrigine was commenced the episodes disappeared. Susceptibility-weighted magnetic resonance imaging was very helpful for diagnosis (SWI-MRI). CONCLUSIONS: CAA microbleeding can be manifested in the form of seizures mimicking focal transient sensitive neurological deficits that can be erroneously attributed to cerebral ischemia. The present case report suggests that, despite the presence of a past medical history of strokes, neurologists should consider CAA microbleeding as a possible cause of pseudo-transient ischemic attacks. High-resolution neuroimaging including SWI-MRI imaging can be helpful in identifying cortical microbleedings. In this way, the start or increase of antiplatelet treatment can be avoided, and the risk of potentially fatal complications minimized.

Utilidad de las secuencias potenciadas en susceptibilidad paramagnética (SWI) para diferenciar crisis somestésicas de accidentes isquémicos transitorios en un paciente con angiopatía amiloide cerebral / The use of SWI-MRI to differentiate between seizures and transient ischemic attacks in a patient with cerebral amyloid angiopathy

Introducción. La angiopatía amiloide cerebral (AAC) secaracteriza por el depósito de β-amiloide en la pared delas arterias de pequeño y mediano calibre de la cortezacerebral y leptomeninges. La sintomatología puede incluireventos transitorios de diverso origen, pudiendoser difícil el diagnóstico diferencial en el momento agudo.Caso clínico. Varón con antecedente de ictus isquémico,que presentó crisis somestésicas secundarias a microsangradocerebral por AAC que simulaban ataques isquémicostransitorios. Se redujo la medicación antiagregante yposteriormente se inició tratamiento antiepiléptico desapareciendolos episodios. Las secuencias de susceptibilidadparamagnética en Resonancia Magnética cerebralfueron de gran utilidad para el diagnóstico (SWI-RM).Conclusiones. Los microsangrados de la AAC puedenmanifestarse en forma de crisis, simulando déficits focalessensitivos transitorios que pueden ser atribuidoserróneamente a isquemia cerebral. Este caso sugiereque, incluso si existe historia de accidentes cerebrovascularesisquémicos, deberían considerarse microsangradospor AAC como causa posible de pseudoaccidentesisquémicos transitorios. Las secuencias SWI-RMpueden ser útiles para identificarlos. De este modopuede prevenirse el inicio o escalada del tratamientoantiagregante o anticoagulante, evitando complicacionespotencialmente devastadoras (AU)

Background. Cerebral amyloid angiopathy (CAA) ischaracterized by the deposit of β-amyloid on the wallsof small and medium-sized arteries of the cerebral cortexand leptomeninges causing cerebral bleeding. Clinicalpresentations may include transient neurologicalevents for which differential diagnosis can be difficult.Case report. We report a subject with a medical historyof recent stroke who presented somesthetic seizuresmimicking transient ischemic attacks owing to CAAmicrobleeding. Antiplatelet treatment was reduced andafter lamotrigine was commenced the episodes disappeared.Susceptibility-weighted magnetic resonanceimaging was very helpful for diagnosis (SWI-MRI).Conclusions. CAA microbleeding can be manifested inthe form of seizures mimicking focal transient sensitiveneurological deficits that can be erroneously attributedto cerebral ischemia. The present case report suggeststhat, despite the presence of a past medical history ofstrokes, neurologists should consider CAA microbleedingas a possible cause of pseudo-transient ischemicattacks. High-resolution neuroimaging including SWIMRIimaging can be helpful in identifying cortical microbleedings.In this way, the start or increase of antiplatelettreatment can be avoided, and the risk of potentiallyfatal complications minimized (AU)