OnabotulinumtoxinA and cognitive behavioral therapy in functional dystonia: A pilot randomized clinical trial.

INTRODUCTION: Functional dystonia (FD) is a disabling movement disorder with limited therapeutic options. We aimed to examine the efficacy and safety of chemodenervation with OnabotulinumtoxinA (BoNT) versus placebo prior to cognitive behavioral therapy (CBT) in FD patients. METHODS: FD patients with a Psychogenic Movement Disorders Rating Scale (PMDRS) score ≥ 10 and persistent dystonic posturing for ≥ 1 year were randomized to BoNT or placebo injections prior to 12 weekly individualized 1-h CBT sessions. Clinical assessments included PMDRS, Hamilton Depression Scale (HAM-D), Hamilton Anxiety Scale (HAM-A), Katz index of independence in activities of daily living (ADL), and Lawton instrumental ADL (iADL). The efficacy endpoints were the change in clinical assessments at 12 weeks from baseline between and within groups. RESULTS: Of 18 screened patients, 14 were randomized, and 10 completed the study. All patients showed reductions in PMDRS irrespective of treatment group at the end of the follow-up period. There was no difference in clinical assessments between groups at 12 weeks. Change from baseline in PMDRS score was significantly improved only in the CBT group with prior administration of placebo (mean change -9.0, 95% CI -16.5, -1.5; p = 0.02). CONCLUSIONS: CBT yielded robust improvement in FD patients but was unaffected by prior administration of BoNT. These pilot data do not eliminate the potential for examining future BoNT benefit in FD patients with selected topographical involvement, such as face or neck.

App-Based Bradykinesia Tasks for Clinic and Home Assessment in Parkinson's Disease: Reliability and Responsiveness.

BACKGROUND: Clinical rating of bradykinesia in Parkinson disease (PD) is challenging as it must combine several movement features into a single score. Additionally, in-clinic assessment cannot capture fluctuations throughout the day. OBJECTIVE: To evaluate the reliability and responsiveness of a motion sensor-based tablet app for objective bradykinesia assessment in clinic and at home as compared to clinical ratings. METHODS: Thirty-two PD patients treated with subthalamic deep brain stimulation (DBS) were outfitted with a motion sensor on the index finger of the more affected hand to perform two repetitions of finger-tapping, hand opening-closing, and arm pronation-supination tasks with DBS on and 10, 20, and 30 minutes after turning DBS off. Tasks were videotaped for blinded clinician rating using the Modified Bradykinesia Rating Scale (MBRS). Participants were then sent home with an app-based system to perform two repetitions of the same tasks six times per day spaced two hours apart, three days per week, for two weeks. Intraclass correlation (ICC) and minimal detectable change (MDC) were calculated. RESULTS: As the effects of DBS wore off, motion sensors detected worsening of amplitude sooner than did clinician-rated MBRS for all three tasks. ICCs were significantly higher and MDCs were significantly lower for motion sensors in the clinic and at home than for clinician ratings (p < 0.01). CONCLUSIONS: The tablet-based app demonstrated higher reliability and responsiveness in capturing bradykinesia-related tasks in the clinic and at home than did clinician ratings. This tool may enhance the assessment of novel therapies.