The Impact of the COVID-19 Lockdown on the Quality of Life in Chronic Neurological Diseases: The Results of a COVQoL-CND Study.

BACKGROUND: Coronavirus disease 2019 (COVID-19) pandemic and lockdown period may induce an impairment in quality of life (QoL), disruption in treatment (DIT), and posttraumatic stress disorder (PTSD) in chronic neurological diseases (CNDs). To reach this information, a multicenter, cross-sectional study (COVQoL-CND) was planned. Parkinson's disease (PD), headache (HA), multiple sclerosis (MS), epilepsy (EP), polyneuropathy (PNP), and cerebrovascular disease (CVD) were selected as the CND. METHODS: The COVQoL-CND study includes demographic data, the World Health Organization Quality of Life short form (WHOQOL-BREF), and Impact of Event Scale-Revised (IES-R) forms. RESULTS: The mean age of a total of 577 patients was 49 ± 17 (19-87 years), and the ratio of female/male was 352/225. The mean age of patients with PD, HA, MS, EP, PNP, and CVD were 65 ± 11, 39 ± 12, 38 ± 10, 47 ± 17, 61 ± 12, and 60 ± 15 years, respectively. The IES-R scores were found to be higher in the younger group, those with comorbid disease, contacted with CO-VID-19 patients, or diagnosed with COVID-19. In the group with a high IES-R score, the rate of DIT was found to be high. IES-R scores were negatively correlated with QoL. IES-R total scores were found highest in the CVD group and lowest in the PD group. The ratio of DIT was found highest in the PNP group and the lowest in the EP group. Contact with CO-VID-19 patients was high in the EP and HA group. CONCLUSIONS: The results of the COVQoL-CND study showed that lockdown causes posttraumatic stress and deterioration in the QoL in CND.

Dopamine transporter SPECT imaging in Parkinson's disease and parkinsonian disorders

The dopamine transporter (DAT) imaging provides an objective tool for the assessment of dopaminergic function of presynaptic terminals which is valuable for the differential diagnosis of parkinsonian disorders related to a striatal dopaminergic deficiency from movement disorders not related a striatal dopaminergic deficiency. DAT imaging with single-photon emission computed tomography (SPECT) can be used to confirm or exclude a diagnosis of dopamine deficient parkinsonism in cases where the diagnosis is unclear. It can also detect the dopaminergic dysfunction in presymptomatic subjects at risk for Parkinson's disease (PD) since the reduced radiotracer binding to DATs in striatum is already present in the prodromal stage of PD. This review covers the rationale of using DAT SPECT imaging in the diagnosis of PD and other parkinsonian disorders, specifically focusing on the practical aspects of imaging and routine clinical indications.

Multicenter study of levodopa carbidopa intestinal gel in Parkinson's disease: the Turkish experience

Background/aim: Our purpose was to determine the efficacy of levodopa carbidopa intestinal gel (LCIG) in a series of Turkish patients with Parkinson's disease (PD). Materials and methods: We had telephone calls with 54 patients from 11 neurology centers who were on LCIG treatment, and 44 patients or their caregivers were included in an eight-item survey between September 2015 and June 2016. The reliability and validity of the survey were evaluated with intraclass correlation coefficients for every question separately. Results: Average age of the patients were 63.48 and the duration of PD was 12.79 years. Average LCIG treatment period was 15.63 months. Percentages of the patients who reported they were 'better' after LCIG treatment were as follows: 80% for time spent off, 55% for dyskinesia, 65% for tremor, 85% for gait disorder, 50% for pain, 50% for sleep disorders, 42.5% for depression, 32.5% for incontinence, and 70% for activities of daily living. Cronbach's alpha was 0.795 and the intraclass correlation coefficient was reliable for the items. Conclusion: As detected by a survey performed by telephone calls with good interrater reliability, patients with PD improve with LCIG treatment in many aspects of the disease.

Effects of different percentages of body weight-supported treadmill training in Parkinson's disease: a double-blind randomized controlled trial

Background/aim: Body weight-supported treadmill training (BWSTT) might have greater effects than conventional treadmill training (TT) in neurological diseases such as Parkinson's disease (PD). The aim of this study was to evaluate the effects of different percentages of BWSTT on gait, balance, quality of life, and fatigue in PD. Materials and methods: Thirty-five patients with moderate to advanced PD were randomized into three BWSTT groups according to the supported percentage of body weight: 0% BWSTT (control group; unsupported TT), 10% BWSTT, or 20% BWSTT. Five patients were excluded due to early discharge and 30 patients completed BWSTT sessions lasting 30 min, 5 days a week, for 6 weeks during their inpatient rehabilitation stay. The primary outcome was 6-min walk distance (6MWD). Secondary outcomes were Unified Parkinson's Disease Rating Scale (UPDRS), Berg Balance Scale (BBS), Nottingham Health Profile (NHP), Fatigue Impact Scale, and Fatigue Severity Scale scores. Measurements were performed before and after the training. Results: The unsupported TT group demonstrated no significant improvement in the outcome measures after a 6-week training except for BBS and NHP emotional subscores. Moreover, the NHP pain subscore increased in the unsupported TT group after training. The 10% and 20% supported BWSTT groups demonstrated significant improvements in 6MWD (P = 0.004 and P < 0.001, respectively), UPDRS - motor score (P = 0.012 and P = 0.005, respectively), NHP pain subscore (P = 0.003 and P = 0.002, respectively), and fatigue (P = 0.005 for both) after training. The 20% BWSTT provided the highest improvement in balance among the three groups (P < 0.001) and greater relief of fatigue than 10% BWSTT (P = 0.002). Conclusion: Six weeks of BWSTT improved walking distance and balance ability, relieved fatigue, and additionally reduced pain in patients with moderate to advanced PD.

The coin rotation test: a reliable and valid test in people with Parkinson's disease.

PURPOSE: To investigate: (1) the interrater, and test-retest reliability of the coin rotation test (CRT) in people with Parkinson's Disease (PwPD); (2) the minimum detectable change in the CRT; (3) the concurrent and known-groups validity of the CRT; and (4) the cut-off times that best discriminate PwPD from healthy people and functionally dependent PwPD from functionally independent PwPD. METHOD: Forty-eight PwPD and 33 healthy people were included. The CRT was administered with the nine-hole peg test, Movement Disorders Society Sponsored Unified Parkinson's Disease Rating Scale, Hoehn and Yahr Scale, Parkinson's Disease Questionnaire-8, and Schwab and England Scale. RESULTS: The CRT had excellent interrater and test-retest reliability. Minimal detectable changes were 5.96 and 8.23 s for the dominant and non-dominant hand, respectively. The CRT correlated with other outcome measures. Significant differences in the CRT times were found between PwPD and healthy people, and between functionally dependent PwPD and functionally independent PwPD. The cut-off times of 12.66 s on the dominant hand and 15.76 s on the non-dominant best discriminated PwPD from healthy people, while 22.99 s on the dominant hand and 23.48 s on the non-dominant best discriminated functionally dependent PwPD from functionally independent PwPD. CONCLUSIONS: The CRT is a reliable, and clinically available tool for assessing manual dexterity in PwPD.Implications for rehabilitationThe coin rotation test is a reliable, valid, and clinically available tool for assessing manual dexterity in Parkinson's Disease.The minimal detectable changes of the coin rotation test are 5.96 s for dominant hand and 8.23 s for the non-dominant hand, which may useful for clinicians and researchers to detect in any true change in manual dexterity after any intervention.The coin rotation test correlated with Parkinson's Disease-specific measurement tools.The coin rotation test times may detect impaired manual dexterity between people with Parkinson's Disease and healthy people, and between functionally dependent and functionally independent in Parkinson's Disease population.

Autonomic nervous system dysfunction and serum levels of neurotoxic and neurotrophic cytokines in patients with cobalamin deficiency.

OBJECTIVE: The imbalance between neurotoxic cytokine tumor necrosis factor-α (TNF-α) and neurotrophic cytokines epidermal growth factor (EGF) and interleukin-6 (IL-6) plays a role in the pathogenesis of cobalamin (Cbl) deficiency-induced neuropathy. The aim of this study was to evaluate autonomic nervous system dysfunction and to look for any relationship between autonomic nervous system disturbances and serum cytokine levels (TNF-α, EGF, IL-6) in patients with Cbl deficiency. METHODS: Serum levels of TNF-α, EGF and IL-6 were studied in patients with Cbl deficiency (n=41) and a healthy control group (n=17) and after 3 months in patients who underwent Cbl replacement therapy (n=22). All patients with Cbl deficiency underwent electrophysiological studies (EPS) for the diagnosis of neuropathy. Statistical analysis was performed using SPSS for Windows 11.5 software. RESULTS: With EPS, 29 of 41 Cbl-deficient patients (70.73%) demonstrated neurological dysfunction [3 (7.32%), 19 (46.34%) and 7 (17.07%) patients with sensorimotor peripheral neuropathy, parasympathetic, and sympathetic autonomic dysfunction, respectively]. Although there was no significant difference in serum levels of EGF and IL-6 between patients with versus without autonomic dysfunction, levels were significantly lower in Cbl- deficient patients than healthy controls. CONCLUSION: Presence of autonomic dysfunction seems to be a frequent neurological finding in patients with Cbl deficiency. However, we could not find any relationship between serum cytokine levels and autonomic dysfunction by EPS.

Contribution of functional dopamine D2 and D3 receptor variants to motor and non-motor symptoms of early onset Parkinson's disease.

In the present study, we focused on investigating the contribution of functional dopamine D2 and D3 receptor variants to motor and/or non-motor symptoms of early onset Parkinson's disease (EOPD). Three functional single nucleotide polymorphisms (SNPs), DRD3 rs6280, DRD2 rs2283265 and DRD2 rs1076560, were genotyped in 128 Turkish EOPD patients and then, statistical analysis was conducted for the potential impacts of SNPs on clinical parameters. All three SNPs were found to be statistically significant in terms of PD-related pain: DRD3 [rs6280; risk allele "T" for pain; p = 0.031; odds ratio (OR)=4.25], DRD2 [rs2283265; risk allele "A" for pain; p = 0.001; OR=8.47] and, DRD2 [rs1076560; risk allele "A" for pain; p = 0.022; OR=4.58]. Additionally, bilateral disease [p = 0.011; OR=5.10] and gender [risk group "female"; p = 0.003; OR=8.53] were also identified as significant univariate risk factors for PD-related pain. Based on logistic regression analysis conducted with the significant univariate risk factors, this the first report to clarify that a female patient with bilateral PD and DRD2 rs2283265 polymorphism has a significant risk for PD-related pain. Our findings might contribute to improve life quality by offering treatment options for pain in PD patients with these clinical and genetic features.

Epigenetic approach to early-onset Parkinson's disease: low methylation status of SNCA and PARK2 promoter regions.

Background and aim The effect of epigenetic modifications in the genes related to Parkinson's disease (PD) is still unclear. In the present study, we investigated methylation status of SNCA and PARK2 genes in patients with early-onset Parkinson's disease (EOPD). Materials and methods The promoter region methylation status of SNCA and PARK2 genes was evaluated by methylation specific-PCR (MSP) in 91 patients with EOPD and 52 healthy individuals. Results The methylation of SNCA and PARK2 promoter regions were significantly lower in EOPD patients compared to the control group (P = 0.013 and P = 0.03, respectively). We also found that the methylation status of the SNCA might be associated with positive family history of PD (P = 0.042). Conclusion Although it should be supported by further analysis, based on the results of the present study, the methylation status of SNCA and PARK2 genes might contribute to EOPD pathogenesis.

Accessory nerve function in lateral selective neck dissection with undissected level IIb.

BACKGROUND: To investigate the accessory nerve function in lateral selective neck dissections (LSND) performed in laryngeal squamous cell carcinoma patients without dissection of level IIB. METHODS: Fifteen LSND were performed in 11 N0 laryngeal carcinoma patients with preservation of level IIB. Distal latencies, compound muscle action potentials (CMAP), and electromyography findings were investigated before surgery, during the 3rd postoperative week, and 3 months thereafter to compare the effects of the procedure on the accessory nerve. RESULTS: Distal latencies and CMAP values were significantly lower in the early and late postoperative periods when compared with preoperative values. In 8 patients, there was no motor unit potential (MUP) in the early postoperative period. However, in the late postoperative period, there was no MUP loss. CONCLUSIONS: Only temporary functional deterioration of the accessory nerve was seen in patients in whom LSND was performed with undissected level IIB.