Reliability and validity of three portable devices for quantifying spatiotemporal parameters in runners of different athletic abilities during treadmill running.

This study aimed to evaluate the validity and reliability of a wearable device and a phone application for measuring spatiotemporal parameters and their relationship with running economy (RE) by comparing them with photocell data in runners of different abilities. Twenty-three male runners were divided into well-trained and recreational groups and performed a 4-min running bout at 17 and 13 km·h-1 respectively. During the bout, were measured the spatiotemporal parameters with three devices (Stryd, Runmatic, and Optojump) and RE with a gas analyser. Pearson correlation showed perfect relationships for stride frequency (SF) and stride length (SL) between the devices, and moderate for flight time (FT) and contact time (CT). There were no correlations between the spatiotemporal parameters and RE measurements. Coefficient of variation was ~ 5% in all devices for CT, SF, and SL, and higher for FT (15-24%). CT was underestimated (15-16% with Runmatic and Stryd, respectively) and FT was overestimated (36-40%) compared to Optojump. Bland-Altman plots revealed that Runmatic could be a more accurate system than Stryd. In conclusion, both devices were valid tools for measuring spatiotemporal parameters during running at RE speed. Runmatic was more valid and reliable in comparison with Stryd. In addition, at lower running speeds the devices showed less reliability.

Dopamine agonist therapy in Parkinson's disease: Spanish expert consensus on its use in different clinical situations.

BACKGROUND: Different types of therapies were proven effective for the medical management of motor and non-motor symptoms in Parkinson's disease (PD). We aimed to gain consensus on the dopamine agonist (DA) therapy use in different clinical scenarios of Parkinson's disease (PD) patients. METHODS: This consensus study was based on the nominal group technique. Initially, a consensus group comprising 12 expert neurologists in the PD field identified the topics to be addressed and elaborated different evidence-based preliminary statements. Next, a panel of 48 Spanish neurologists expressed their opinion on an internet-based systematic voting program. Finally, initial ideas were reviewed and rewritten according to panel contribution and were ranked by the consensus group using a Likert-type scale. The analysis of data was carried out by using a combination of both qualitative and quantitative methods. The consensus was achieved if the statement reached ≥ 3.5 points in the voting process. RESULTS: The consensus group produced 76 real-world recommendations. The topics addressed included 12 statements related to DA therapy in early PD, 20 statements concerning DA treatment strategy in patients with motor complications, 11 statements associated with DA drugs and their side effects, and 33 statements regarding DA therapy in specific clinical scenarios. The consensus group did not reach a consensus on 15 statements. CONCLUSION: The findings from this consensus method represent an exploratory step to help clinicians and patients in the appropriate use of DA in different stages and clinical situations of PD.

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 / Utilidad clínica del dispositivo para la monitorización personalizada de la enfermedad de Parkinson, STAT-ON, en condiciones de práctica clínica diaria: resultados de una encuesta de opinión de neurólogos expertos

Background: STAT-ON TM is an objective tool that registers ON-OFF fluctuations making possibleto know the state of the patient at every moment of the day in normal life. Our aim was toanalyze the opinion of different Parkinson’s disease experts about the STAT-ON TM tool afterusing the device in a real clinical practice setting (RCPS). Methods: STAT-ON TM was provided by the Company Sense4Care to Spanish neurologists for usingit in a RCPS. Each neurologist had the device for at least three months and could use it in PDpatients at his/her own discretion. In February 2020, a survey with 30 questions was sent to allparticipants. Results: Two thirds of neurologists (53.8% females; mean age 44.9 ± 9 years old) worked ina Movement Disorders Unit, the average experience in PD was 16 ± 6.9 years, and 40.7% ofthem had previously used other devices. A total of 119 evaluations were performed in 114patients (range 2—9 by neurologist; mean 4.5 ± 2.3). STAT-ON TM 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 TM was considered better than diaries by 70.3% of neurologists and a useful toolfor the identification of patients with advanced PD by 81.5%. Proper identification of freezingof gait episodes and falls were frequent limitations reported. Conclusion: STAT-ON TM could be a useful device for using in PD patients in clinical practice.(AU)

Introducción: STAT-ON es un dispositivo que registra las fluctuaciones on-off que permiteconocer el estado del paciente con enfermedad de Parkinson (EP) en cada momento del día.Nuestro objetivo fue analizar la opinión de diferentes expertos en EP sobre STAT-ON, después de usar el dispositivo en un entorno de práctica clínica real (PCR). Métodos: STAT-ON fue proporcionado por la compa ̃nía Sense4Care a neurólogos espa ̃noles para usarlo en PCR. Cada neurólogo dispuso del dispositivo durante al menos tres meses y podíausarlo en pacientes con EP, según su criterio. En febrero de 2020, se envió una encuesta con 30 preguntas a todos los participantes. Resultados: Dos tercios de los neurólogos (53,8% mujeres; edad promedio 44,9 ± 9 a ̃nos) trabajaban en una Unidad de Trastornos del Movimiento, con una experiencia en EP de 16 ± 6,9 a ̃nos, habiendo el 40,7% usado otros dispositivos previamente. Se realizaron un total de 119evaluaciones en 114 pacientes (rango dos a nueve por neurólogo; media 4,5 ± 2,3). STAT-ONfue considerado «bastante» a «muy útil» por el 74% de los neurólogos, con una opinión generalde 6,9 ± 1,7 (0, peor; 10, mejor). STAT-ON fue considerado mejor que los diarios por el 70,3% de los neurólogos y una herramienta útil para la identificación de pacientes con EP avanzadapor un 81,5%. La identificación adecuada de los episodios de congelación de la marcha y lascaídas fueron las limitaciones más reportadas.Conclusiones: STAT-ON podría ser un dispositivo útil para usar en la PCR.(AU)

Palliative care management in patients with Parkinson's disease and other movement disorders in Spain. National survey of neurologists.

INTRODUCTION: Palliative care in neurodegenerative diseases is useful but underused. The objective of this study is to know how palliative care (PC) is applied in Spain in order to identify limitations and unmet needs. MATERIALS AND METHODS: It is a descriptive, observational, cross-sectional study, anonymous survey type of 20 questions, directed and answered by neurologists dedicated to movement disorders (MD) in Spain. RESULTS: 58 responses were obtained from neurologists from 15 autonomous communities. 69% answered that they did not have a specialised MD nursing facility but did have a PC team in their centre (81%). No specific protocol for PC in MD was identified. All except one neurologist stated that they lacked sufficient training in PC, the main training need being the "advance directives explanation". Only 1 in 4 neurologists answered routinely explaining advance healthcare planning to their patients, recognising up to 84.5% of neurologists not knowing how to assess the patient's competence. 60.3% of those surveyed answered that between 10% and 30% of their patients would be candidates for PC, although 1 in 3 said they were not clear when to refer the patient to PC. 100% of neurologists affirmed the priority need to implement PC protocols in MD. CONCLUSIONS: Our study shows a formative deficit in PC in this area and in the care of the patient with movement disorders and their environment, and should serve as a starting point to develop consensual care protocols.

[Current status of immersive virtual reality as a tool for physical and functional rehabilitation in patients with Parkinson´s disease: systematic review]. / Estado actual de la realidad virtual inmersiva como herramienta de rehabilitación física y funcional en pacientes con enfermedad de Parkinson: revisión sistemática.

INTRODUCTION: Parkinson's disease (PD) is a complex neurodegenerative process that usually appears from the 6th decade of life and is characterized by the appearance of motor and non-motor symptoms that progress, generating functional disability and negatively impacting in quality of life. Recently, Immersive Virtual Reality (IVR) has great positive impact on health domains: as a support in psychotherapy or as a treatment of cognitive-behavioral pathologies in neurological patients. OBJECTIVE: To analyze the current published evidence in the fields of physical and functional PD rehabilitation in fully immersive environments. MATERIALS AND METHODS: A literature review, covering publications registered until December 2020 in Cinahl, Scopus, Web of Science, Sport-Discus, Dialnet and Pubmed (including Medline) was carried out. The descriptors used for the search were the terms: Parkinson disease, Virtual Reality and Exercise therapy. 140 publications were identified that addressed IVR with physical rehabilitation proposes in PD. Of these, 7 contribute useful information for pooled analysis. RESULTS: The results support the application of IVR to improve physical and functional capacities in the population with PD. Its feasibility, usability and safety suggest potential benefits in the treatment of the prevalent symptoms of the parkinsonian patient. CONCLUSIONS: Research of high methodological quality is lacking, reflecting and early stage of preclinical development. Randomized control studies with larger sample size and IVR protocols that confirm the results, while analyzing their impact on the physical and functional variables related to PD are needed.

TITLE: Estado actual de la realidad virtual inmersiva como herramienta de rehabilitación física y funcional en pacientes con enfermedad de Parkinson: revisión sistemática.Introducción. La enfermedad de Parkinson (EP) es un proceso neurodegenerativo que se caracteriza por la aparición de síntomas motores y no motores que progresan, generando discapacidad funcional e impactando negativamente en la calidad de vida del paciente. Recientemente, la realidad virtual inmersiva ha adquirido gran relevancia como apoyo al tratamiento de patologías cognitivo-conductuales del paciente neurológico. Objetivo. Analizar la evidencia actual publicada en el campo de la rehabilitación física y funcional de la EP en entornos completamente inmersivos. Materiales y métodos. Se realizó una revisión bibliográfica de publicaciones registradas en las bases de datos Medline, Cinahl, PubMed, Scopus, Web of Science, Sport-Discus y Dialnet hasta diciembre de 2020. Los descriptores utilizados para la búsqueda fueron: Parkinson disease, Virtual Reality y Exercise therapy. Tras la aplicación de los criterios de selección, del total de 140 artículos identificados, se seleccionaron siete. Resultados. Describen una experiencia segura, positiva y factible, aunque obtenidos, en su mayoría, tras la aplicación de una única sesión. Los resultados hallados en las variables vinculadas a las capacidades funcionales que se deben mejorar en la EP apoyan potenciales beneficios en el tratamiento de la sintomatología prevalente del paciente parkinsoniano. Conclusiones. Los pocos estudios existentes muestran resultados preliminares, por lo que se hacen necesarias más investigaciones de mayor calidad metodológica, mayor tamaño muestral, con un proceso de control aleatorizado y protocolos que confirmen los resultados, al tiempo que analicen su impacto en las variables físicas y funcionales vinculadas a la patología parkinsoniana.

Estado actual de la realidad virtual inmersiva como herramienta de rehabilitación física y funcional en pacientes con enfermedad de Parkinson: revisión sistemática / Current status of immersive virtual reality as a tool for physical and functional rehabilitation in patients with Parkinson´s disease: systematic review

Introducción: La enfermedad de Parkinson (EP) es un proceso neurodegenerativo que se caracteriza por la aparición de síntomas motores y no motores que progresan, generando discapacidad funcional e impactando negativamente en la calidad de vida del paciente. Recientemente, la realidad virtual inmersiva ha adquirido gran relevancia como apoyo al tratamiento de patologías cognitivo-conductuales del paciente neurológico. Objetivo: Analizar la evidencia actual publicada en el campo de la rehabilitación física y funcional de la EP en entornos completamente inmersivos. Materiales y métodos: Se realizó una revisión bibliográfica de publicaciones registradas en las bases de datos Medline, Cinahl, PubMed, Scopus, Web of Science, Sport-Discus y Dialnet hasta diciembre de 2020. Los descriptores utilizados para la búsqueda fueron: Parkinson disease, Virtual Reality y Exercise therapy. Tras la aplicación de los criterios de selección, del total de 140 artículos identificados, se seleccionaron siete.Resultados: Describen una experiencia segura, positiva y factible, aunque obtenidos, en su mayoría, tras la aplicación de una única sesión. Los resultados hallados en las variables vinculadas a las capacidades funcionales que se deben mejorar en la EP apoyan potenciales beneficios en el tratamiento de la sintomatología prevalente del paciente parkinsoniano. Conclusiones: Los pocos estudios existentes muestran resultados preliminares, por lo que se hacen necesarias más investigaciones de mayor calidad metodológica, mayor tamaño muestral, con un proceso de control aleatorizado y protocolos que confirmen los resultados, al tiempo que analicen su impacto en las variables físicas y funcionales vinculadas a la patología parkinsoniana.(AU)

Introduction: Parkinson’s disease (PD) is a complex neurodegenerative process that usually appears from the 6th decade of life and is characterized by the appearance of motor and non-motor symptoms that progress, generating functional disability and negatively impacting in quality of life. Recently, Immersive Virtual Reality (IVR) has great positive impact on health domains: as a support in psychotherapy or as a treatment of cognitive-behavioral pathologies in neurological patients. Objective: To analyze the current published evidence in the fields of physical and functional PD rehabilitation in fully immersive environments. Materials and methods: A literature review, covering publications registered until December 2020 in Cinahl, Scopus, Web of Science, Sport-Discus, Dialnet and Pubmed (including Medline) was carried out. The descriptors used for the search were the terms: Parkinson disease, Virtual Reality and Exercise therapy. 140 publications were identified that addressed IVR with physical rehabilitation proposes in PD. Of these, 7 contribute useful information for pooled analysis. Results: The results support the application of IVR to improve physical and functional capacities in the population with PD. Its feasibility, usability and safety suggest potential benefits in the treatment of the prevalent symptoms of the parkinsonian patient. Conclusions: Research of high methodological quality is lacking, reflecting and early stage of preclinical development. Randomized control studies with larger sample size and IVR protocols that confirm the results, while analyzing their impact on the physical and functional variables related to PD are needed.(AU)

Staging Parkinson's Disease Combining Motor and Nonmotor Symptoms Correlates with Disability and Quality of Life.

INTRODUCTION: In a degenerative disorder such as Parkinson's disease (PD), it is important to establish clinical stages that allow to know the course of the disease. Our aim was to analyze whether a scale combining Hoehn and Yahr's motor stage (H&Y) and the nonmotor symptoms burden (NMSB) (assessed by the nonmotor symptoms scale (NMSS)) provides information about the disability and the patient's quality of life (QoL) with regard to a defined clinical stage. MATERIALS AND METHODS: Cross-sectional study in which 603 PD patients from the COPPADIS cohort were classified according to H&Y (1, stage I; 2, stage II; 3, stage III; 4, stage IV/V) and NMSB (A: NMSS = 0-20; B: NMSS = 21-40; C: NMSS = 41-70; D: NMSS ≥ 71) in 16 stages (HY.NMSB, from 1A to 4D). QoL was assessed with the PDQ-39SI, PQ-10, and EUROHIS-QOL8 and disability with the Schwab&England ADL (Activities of Daily Living) scale. RESULTS: A worse QoL and greater disability were observed at a higher stage of H&Y and NMSB (p < 0.0001). Combining both (HY.NMSB), patients in stages 1C and 1D and 2C and 2D had significantly worse QoL and/or less autonomy for ADL than those in stages 2A and 2B and 3A and 3B, respectively (p < 0.005; e.g., PDQ-39SI in 1D [n = 15] vs 2A [n = 101]: 28.6 ± 17.1 vs 7.9 ± 5.8; p < 0.0001). CONCLUSION: The HY.NMSB scale is simple and reflects the degree of patient involvement more accurately than the H&Y. Patients with a lower H&Y stage may be more affected if they have a greater NMS burden.

Uso de la infusión intestinal continua de levodopa-carbidopa en pacientes con enfermedad de Parkinson avanzada en España. Subanálisis por comunidades autónomas / Continuous intestinal infusion of levodopa-carbidopa in patients with advanced Parkinson's disease in Spain: Subanalysis by autonomous community

OBJETIVOS: Comparar las características de los pacientes con enfermedad de Parkinson avanzada en tratamiento con infusión intestinal continua de levodopa-carbidopa (IICLC) y los datos de efectividad y seguridad de IICLC entre diferentes comunidades autónomas (CC. AA.). MÉTODOS: Estudio longitudinal observacional y retrospectivo. Se incluyeron 177 pacientes de 11 CC. AA. que iniciaron tratamiento con IICLC entre enero de 2006 y diciembre de 2011. Se compararon las características clínicas y demográficas, las variables de efectividad (cambios en el tiempo OFF, ON con y sin discinesias discapacitantes, cambios en la escala de Hoehn y Yahr y puntuación de la Unified Parkinson's Disease Rating Scale, síntomas no motores e Impresión Clínica Global) y seguridad (acontecimientos adversos), y la tasa de suspensión de IICLC. RESULTADOS: Se hallaron diferencias significativas entre las CC. AA. en diversas variables basales: duración de la enfermedad hasta el inicio de IICLC, tiempo OFF (34,9-59,7%) y ON (con o sin discinesias; 2,6-48,0%), Hoehn y Yahr en ON, Unified Parkinson's Disease Rating Scale-III en ON y OFF, presencia de ≥ 4 síntomas motores y dosis de IICLC. En el seguimiento (> 24 meses en 9 de 11 CC. AA.) hubo diferencias significativas en el porcentaje de tiempo OFF, tiempo ON sin discinesias discapacitantes, frecuencia de acontecimientos adversos e Impresión Clínica Global. La tasa de suspensión fue de entre 20-40% en todas las CC. AA., excepto en 2 (78 y 80%). CONCLUSIONES: Este estudio muestra una amplia variabilidad en la selección de los pacientes y en la efectividad y seguridad de IICLC entre las diferentes CC. AA. Podrían influir las características basales de los pacientes, la disponibilidad de un equipo multidisciplinar y la experiencia clínica

OBJECTIVES: To compare the characteristics of patients undergoing treatment with continuous intestinal infusion of levodopa-carbidopa (CIILC) for advanced Parkinson's disease and the data on the effectiveness and safety of CIILC in the different autonomous communities (AC) of Spain. METHODS: A retrospective, longitudinal, observational study was carried out into 177 patients from 11 CAs who underwent CIILC between January 2006 and December 2011. We analysed data on patients' clinical and demographic characteristics, variables related to effectiveness (changes in off time/on time with or without disabling dyskinesia; changes in Hoehn and Yahr scale and Unified Parkinson's Disease Rating Scale scores; non-motor symptoms; and Clinical Global Impression scale scores) and safety (adverse events), and the rate of CIILC discontinuation. RESULTS: Significant differences were observed between CAs for several baseline variables: duration of disease progression prior to CIILC onset, off time (34.9-59.7%) and on time (2.6-48.0%; with or without disabling dyskinesia), Hoehn and Yahr score during on time, Unified Parkinson's Disease Rating Scale-III score during both on and off time, presence of ≥ 4 motor symptoms, and CIILC dose. Significant differences were observed during follow-up (> 24 months in 9 of the 11 CAs studied) for the percentage of off time and on time without disabling dyskinesia, adverse events frequency, and Clinical Global Impression scores. The rate of CIILC discontinuation was between 20-40% in 9 CAs (78 and 80% in remaining 2 CAs). CONCLUSIONS: This study reveals a marked variability between CAs in terms of patient selection and CIILC safety and effectiveness. These results may have been influenced by patients' baseline characteristics, the availability of multidisciplinary teams, and clinical experience

Manejo de la enfermedad de Parkinson y otros trastornos del movimiento en mujeres en edad fértil: Parte 1 / Management of Parkinson's disease and other movement disorders in woman of childbearing age: Part 1

INTRODUCCIÓN: El manejo de la enfermedad de Parkinson en la mujer en edad fértil nos plantea como principal reto el manejo de la enfermedad y los fármacos durante el embarazo y lactancia. El aumento de la edad gestacional de la mujer hace más probable que la incidencia de embarazos pueda incrementarse. OBJETIVO: Definir las características clínicas y los factores que condicionan la vida de la mujer en edad fértil con enfermedad de Parkinson y definir una guía de actuación y manejo del embarazo en estas pacientes. RESULTADOS: Este documento de consenso se ha realizado mediante una búsqueda bibliográfica exhaustiva y discusión de los contenidos realizados por un grupo de expertos en trastornos del movimiento de la Sociedad Española de Neurología. CONCLUSIONES: La enfermedad de Parkinson afecta a todos los aspectos relacionados con la salud sexual y reproductiva de la mujer en edad fértil. Se debe planificar el embarazo en las mujeres con enfermedad de Parkinson para minimizar los riesgos teratogénicos sobre el feto. Se recomienda un abordaje multidisciplinar de estas pacientes para tener en cuenta todos los aspectos implicados

INTRODUCTION: The main challenge of Parkinson's disease in women of childbearing age is managing symptoms and drugs during pregnancy and breastfeeding. The increase in the age at which women are having children makes it likely that these pregnancies will become more common in future. OBJECTIVES: This study aims to define the clinical characteristics of women of childbearing age with Parkinson's disease and the factors affecting their lives, and to establish a series of guidelines for managing pregnancy in these patients. RESULTS: This consensus document was developed through an exhaustive literature search and a discussion of the available evidence by a group of movement disorder experts from the Spanish Society of Neurology. CONCLUSIONS: Parkinson's disease affects all aspects of sexual and reproductive health in women of childbearing age. Pregnancy should be well planned to minimise teratogenic risk. A multidisciplinary approach should be adopted in the management of these patients in order to take all relevant considerations into account

Manejo de la enfermedad de Parkinson y otros trastornos del movimiento en mujeres en edad fértil: parte 2 / Management of Parkinson's disease and other movement disorders in women of childbearing age: Part 2

INTRODUCCIÓN: Muchas enfermedades que cursan con trastornos del movimiento hipercinético comienzan o afectan a mujeres en edad fértil. Es importante conocer los riesgos que tienen las mujeres con estas enfermedades durante el embarazo, así como los posibles efectos de los tratamientos sobre el feto. OBJETIVOS: Definir las características clínicas y los factores que condicionan la vida de la mujer en edad fértil con distonía, corea, síndrome de Tourette, temblor y síndrome de piernas inquietas. Definir una guía de actuación y manejo del embarazo y lactancia en las pacientes con esta enfermedad. DESARROLLO: Este documento de consenso se ha realizado mediante una búsqueda bibliográfica exhaustiva y discusión de los contenidos llevadas a cabo por un Grupo de Expertos en Trastornos del Movimiento de la Sociedad Española de Neurología (SEN). CONCLUSIONES: En todas las mujeres que padecen o comienzan con trastornos del movimiento hipercinéticos se debe valorar el riesgo-beneficio de los tratamientos, reducir al máximo la dosis eficaz o administrarlo de forma puntual en los casos en que sea posible. En aquellas enfermedades de causa hereditaria es importante un consejo genético para las familias. Es importante reconocer los trastornos del movimiento desencadenados durante el embarazo como determinadas coreas y síndrome de piernas inquietas

INTRODUCTION: Many diseases associated with hyperkinetic movement disorders manifest in women of childbearing age. It is important to understand the risks of these diseases during pregnancy, and the potential risks of treatment for the fetus. OBJECTIVES: This study aims to define the clinical characteristics and the factors affecting the lives of women of childbearing age with dystonia, chorea, Tourette syndrome, tremor, and restless legs syndrome, and to establish guidelines for management of pregnancy and breastfeeding in these patients. RESULTS: This consensus document was developed through an exhaustive literature search and a discussion of the content by a group of movement disorder experts from the Spanish Society of Neurology. CONCLUSIONS: We must evaluate the risks and benefits of treatment in all women with hyperkinetic movement disorders, whether pre-existing or with onset during pregnancy, and aim to reduce effective doses as much as possible or to administer drugs only when necessary. In hereditary diseases, families should be offered genetic counselling. It is important to recognise movement disorders triggered during pregnancy, such as certain types of chorea and restless legs syndrome

Continuous intestinal infusion of levodopa-carbidopa in patients with advanced Parkinson's disease in Spain: Subanalysis by autonomous community. / Uso de la infusión intestinal continua de levodopa-carbidopa en pacientes con enfermedad de Parkinson avanzada en España. Subanálisis por comunidades autónomas.

OBJECTIVES: To compare the characteristics of patients undergoing treatment with continuous intestinal infusion of levodopa-carbidopa (CIILC) for advanced Parkinson's disease and the data on the effectiveness and safety of CIILC in the different autonomous communities (AC) of Spain. METHODS: A retrospective, longitudinal, observational study was carried out into 177 patients from 11 CAs who underwent CIILC between January 2006 and December 2011. We analysed data on patients' clinical and demographic characteristics, variables related to effectiveness (changes in off time/on time with or without disabling dyskinesia; changes in Hoehn and Yahr scale and Unified Parkinson's Disease Rating Scale scores; non-motor symptoms; and Clinical Global Impression scale scores) and safety (adverse events), and the rate of CIILC discontinuation. RESULTS: Significant differences were observed between CAs for several baseline variables: duration of disease progression prior to CIILC onset, off time (34.9-59.7%) and on time (2.6-48.0%; with or without disabling dyskinesia), Hoehn and Yahr score during on time, Unified Parkinson's Disease Rating Scale-III score during both on and off time, presence of≥ 4 motor symptoms, and CIILC dose. Significant differences were observed during follow-up (> 24 months in 9 of the 11 CAs studied) for the percentage of off time and on time without disabling dyskinesia, adverse events frequency, and Clinical Global Impression scores. The rate of CIILC discontinuation was between 20-40% in 9 CAs (78 and 80% in remaining 2 CAs). CONCLUSIONS: This study reveals a marked variability between CAs in terms of patient selection and CIILC safety and effectiveness. These results may have been influenced by patients' baseline characteristics, the availability of multidisciplinary teams, and clinical experience.

Management of Parkinson's disease and other movement disorders in woman of childbearing age: Part 1. / Manejo de la enfermedad de Parkinson y otros trastornos del movimiento en mujeres en edad fértil: Parte 1.

INTRODUCTION: The main challenge of Parkinson's disease in women of childbearing age is managing symptoms and drugs during pregnancy and breastfeeding. The increase in the age at which women are having children makes it likely that these pregnancies will become more common in future. OBJECTIVES: This study aims to define the clinical characteristics of women of childbearing age with Parkinson's disease and the factors affecting their lives, and to establish a series of guidelines for managing pregnancy in these patients. RESULTS: This consensus document was developed through an exhaustive literature search and a discussion of the available evidence by a group of movement disorder experts from the Spanish Society of Neurology. CONCLUSIONS: Parkinson's disease affects all aspects of sexual and reproductive health in women of childbearing age. Pregnancy should be well planned to minimise teratogenic risk. A multidisciplinary approach should be adopted in the management of these patients in order to take all relevant considerations into account.

Management of Parkinson's disease and other movement disorders in women of childbearing age: Part 2. / Manejo de la enfermedad de Parkinson y otros trastornos del movimiento en mujeres en edad fértil: parte 2.

INTRODUCTION: Many diseases associated with hyperkinetic movement disorders manifest in women of childbearing age. It is important to understand the risks of these diseases during pregnancy, and the potential risks of treatment for the fetus. OBJECTIVES: This study aims to define the clinical characteristics and the factors affecting the lives of women of childbearing age with dystonia, chorea, Tourette syndrome, tremor, and restless legs syndrome, and to establish guidelines for management of pregnancy and breastfeeding in these patients. RESULTS: This consensus document was developed through an exhaustive literature search and a discussion of the content by a group of movement disorder experts from the Spanish Society of Neurology. CONCLUSIONS: We must evaluate the risks and benefits of treatment in all women with hyperkinetic movement disorders, whether pre-existing or with onset during pregnancy, and aim to reduce effective doses as much as possible or to administer drugs only when necessary. In hereditary diseases, families should be offered genetic counselling. It is important to recognise movement disorders triggered during pregnancy, such as certain types of chorea and restless legs syndrome.

Depression is Associated with Impulse-compulsive Behaviors in Parkinson's disease.

BACKGROUND: Depression and impulse control disorders (ICDs) are both common in Parkinson's disease (PD) patients and their coexistence is frequent. Our aim was to determine the relationship between depression and impulsive-compulsive behaviors (ICBs) in a large cohort of PD patients. METHODS: PD patients recruited from 35 centers of Spain from the COPPADIS cohort from January 2016 to November 2017 were included in the study. The QUIP-RS (Questionnaire for Impulsive-Compulsive Disorders in Parkinson's Disease-Rating Scale) was used for screening ICDs (cutoff points: gambling ≥6, buying ≥8, sex≥8, eating≥7) and compulsive behaviors (CBs) (cutoff points: hobbyism-punding ≥7). Mood was assessed with the BDI-II (Beck Depression Inventory - II) and major, minor, and subthreshold depression were defined. RESULTS: Depression was more frequent in PD patients with ICBs than in those without: 66.3% (69/104) vs 47.5% (242/509); p<0.0001. Major depression was more frequent in this group as well: 22.1% [23/104] vs 14.5% [74/509]; p=0.041. Considering types of ICBs individually, depression was more frequent in patients with pathological gambling (88.9% [8/9] vs 50.2% [303/603]; p=0.021), compulsive eating behavior (65.9% [27/41] vs 49.7% [284/572]; p=0.032), and hobbyism-punding (69% [29/42] vs 49.4% [282/571]; p=0.010) than in those without, respectively. The presence of ICBs was also associated with depression (OR=1.831; 95%CI 1.048-3.201; p=0.034) after adjusting for age, sex, civil status, disease duration, equivalent daily levodopa dose, antidepressant treatment, Hoehn&Yahr stage, non-motor symptoms burden, autonomy for activities of daily living, and global perception of QoL. LIMITATIONS: Cross-sectional design. CONCLUSIONS: Depression is associated with ICBs in PD. Specifically, with pathological gambling, compulsive eating behavior, and hobbyism-punding.

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.