A partial loss of effectiveness of deep brain stimulation of the ventral intermediate nucleus of the thalamus (VIM) has been reported in some patients with essential tremor (ET), possibly due to ...habituation to permanent stimulation. This study focused on the evolution of VIM local-field potentials (LFPs) data over time to assess the long-term feasibility of closed-loop therapy based on thalamic activity. We performed recordings of thalamic LFPs in 10 patients with severe ET using the ACTIVA™ PC + S (Medtronic plc.) allowing both recordings and stimulation in the same region. Particular attention was paid to describing the evolution of LFPs over time from 3 to 24 months after surgery when the stimulation was Off. We demonstrated a significant decrease in high-beta LFPs amplitude during movements inducing tremor in comparison to the rest condition 3 months after surgery (1.91 ± 0.89 at rest vs. 1.27 ± 1.37 µV
/Hz during posture/action for N = 8/10 patients; p = 0.010), 12 months after surgery (2.92 ± 1.75 at rest vs. 2.12 ± 1.78 µV
/Hz during posture/action for N = 7/10 patients; p = 0.014) and 24 months after surgery (2.32 ± 0.35 at rest vs 0.75 ± 0.78 µV
/Hz during posture/action for 4/6 patients; p = 0.017). Among the patients who exhibited a significant decrease of high-beta LFP amplitude when stimulation was Off, this phenomenon was observed at least twice during the follow-up. Although the extent of this decrease in high-beta LFPs amplitude during movements inducing tremor may vary over time, this thalamic biomarker of movement could potentially be usable for closed-loop therapy in the long term.
Background: Non-pharmacological complementary interventions, particularly mind-body practices, are of growing importance in the management of Parkinson’s disease (PD). Among these, mindfulness ...meditation seems particularly effective, especially on anxiety and depression symptoms. However, current knowledge on mindfulness standardized programs in PD is still limited, particularly in France. Aiming at improving this knowledge we designed the M-PARK study in two phases. Phase 1 consisted in a French national survey to explore expectations, needs and initiatives for mindfulness meditation for PD patients. Phase 2 was a clinical trial with objectives to assess feasibility, acceptability and effects of a mindfulness (MBSR) program proposed to PD patients.
Methods: In phase 1, online questionnaires were addressed to members of a French PD patient’s association (France Parkinson) and French MBSR qualified instructors. In Phase 2, a clinical trial involving 30 PD patients consisted of a standard MBSR program with two additional evaluation visits one month before and after the program. Data collection included a global clinical evaluation, assessment of depression and anxiety symptoms, sleep, pain and quality of life and a face-to-face interview for qualitative assessment of the acceptability and lived experience during the program. Three MBSR programs were proposed to three groups of ten patients: two were online due to the pandemic situation, one proposed to patients with no or minor fluctuations (Group 1) and one for patients with slight to moderate fluctuations (Group 2), and the last one face-to-face for patients with no or minor fluctuations (Group 3).
Results: French survey: 209 responses were collected for the questionnaire sent to the members of the association France Parkinson; and 68 for the questionnaire sent to the instructors. Two-thirds of patients surveyed had heard of mindfulness meditation (66%), but were unaware of what this approach really consisted and how it could really help them. Few instructors (29%) had had to deal with patients with PD in their current practice. Yet 90% of patients surveyed indicated they were in favor of introducing this type of approach into their care.
Clinical trial: the results indicated that the program is feasible and acceptable both online and face-to-face for patients with PD. Among the 30 patients enrolled, 25 completed the program. No unwanted effects related to mindfulness meditation practice were observed. The results showed a statistically significant reduction in anxiety symptoms, depressive symptoms, and improvement in quality of life. Furthermore, no statistically significant change was measured for pain or sleep quality. There was no striking difference in results observed between the patient groups. For the qualitative analysis, major themes highlighted were in relation with: i) the lived experience during program; ii) changes in the daily life; and iii) disease-related changes. A large majority of patients who completed the program (24/25) described their participation as positive or very positive. They reported better management of stress and emotions, as well as greater autonomy in implementing new behavioral strategies, particularly in terms of self-care, acceptance, and de-identification from the disease.
Conclusion. Despite high expectations, PD patients are poorly informed about available mindfulness programs. This study however shows that these programs, whether offered online or face-to-face, are particularly beneficial, especially for anxiety and depressive symptoms, at least in mild-to-moderate stages of the disease.
Aging is characterized by cognitive changes such as a potential inhibition deficit. However, growing evidence shows that positive valence stimuli enhance performances in older adults to a greater ...degree than in younger adults. The aim of the present study was to investigate the effect of the emotional valence of words on lexical activation and inhibition in aging by using a new Emotional Hayling Task.
Thirty-eight younger adults (mean age = 20.11 years) and 38 older adults (mean age = 66.47 years) performed a computerized Emotional Hayling task. Participants had to choose the correct (initiation part) or incorrect (inhibition part) final words of highly predictable incomplete sentences. Final words had a negative or positive emotional valence and were paired for reaction time comparison with neutral words.
Response times were faster in younger adults than in older adults in both the initiation and the inhibition parts. In addition, response times indicated that older adults initiated more slowly negative than neutral words while no differences emerged in inhibition. No differences were obtained between negative and neutral words in younger adults. Response times showed faster initiation and inhibition for positive than for neutral words in both age groups.
These data are consistent with previous findings suggesting a disengagement from the processing of negative versus neutral words in older adults when compared with younger adults. A possible explanation is that activation of negative words in the mental lexicon is weaker in older than in younger adults. Conversely, the positive valence of words seems to enhance both activation and inhibition processes in both young and older adults. These findings suggest that positive stimuli can improve performance.
In this one‐year prospective study, Parkinson's disease (PD) patients with or without mania following STN‐DBS were compared to investigate risk and etiological factors, clinical management and ...consequences. Eighteen (16.2%) out of 111 consecutive PD patients developed mania, of whom 17 were males. No preoperative risk factor was identified. Postoperative mania was related to ventral limbic subthalamic stimulation in 15 (83%) patients, and resolved as stimulation was relocated to the sensorimotor STN, besides discontinuation or reduction of dopamine agonists and use of low‐dose clozapine in 12 patients, while motor and nonmotor outcomes were similar. These findings underpin the prominent role of limbic subthalamic stimulation in postoperative mania. ANN NEUROL 2022;92:411–417
Abstract Introduction Dementia is an exclusion criterion in current consensus diagnostic criteria, while growing evidence suggests the occurrence of cognitive dysfunction and even dementia in ...multiple system atrophy (MSA) patients. The main goal of this study was to determine if Movement Disorder Society (MDS) Parkinson's disease dementia (PDD) LEVEL-1 criteria are useful in screening for dementia in MSA patients compared to full cognitive testing (LEVEL-2 criteria). Methods In this retrospective study, MDS diagnostic criteria for PDD were applied in 111 MSA patients from three centres. LEVEL-1 evaluation (short screening test) was compared to LEVEL-2 examination (extensive neuropsychological gold standard assessment). Sensitivity, specificity, positive and negative predictive values were calculated for LEVEL-1 compared to LEVEL-2. Two Mini Mental State Examination (MMSE) cut-off scores were evaluated (<26 according to MDS procedures for the diagnosis of PDD and <27 which has proven more sensitive in a recent study proposing a short procedure for PDD screening). Results According to these criteria, 11.7% of MSA patients were demented on LEVEL-2 examination. LEVEL-1 examination showed strong specificity (96.9%) and negative predictive value (94.1%), while sensitivity (53.8%) and positive predictive (70%) value were moderate compared to LEVEL-2 evaluation. Sensitivity increased to 84.6% when using a MMSE threshold <27 for LEVEL-1. Executive dysfunction was the main prevalent finding (52% of all patients), while impairment of memory (15%), language (14%) and visuospatial functions was less frequent (13%). Conclusion Our findings suggest that the MDS PDD short screening test may be useful for the diagnosis of MSA dementia.
To determine whether patients with Parkinson disease (PD) eligible for subthalamic nucleus deep brain stimulation (STN-DBS) with probable REM sleep behavior disorder (RBD) preoperatively could be ...more at risk of poorer motor, nonmotor, and quality of life outcomes 12 months after surgery compared to those without RBD.
We analyzed the preoperative clinical profile of 448 patients with PD from a French multicentric prospective study (PREDISTIM) according to the presence or absence of probable RBD based on the RBD Single Question and RBD Screening Questionnaire. Among the 215 patients with PD with 12 months of follow-up after STN-DBS, we compared motor, cognitive, psycho-behavioral profile, and quality of life outcomes in patients with (pre-opRBD+) or without (pre-opRBD-) probable RBD preoperatively.
At preoperative evaluation, pre-opRBD+ patients were older (61 ± 7.2 vs 59.5 ± 7.7 years;
= 0.02), had less motor impairment (Movement Disorder Society-sponsored version of the Unified Parkinson's Disease Rating Scale MDS-UPDRS III "off": 38.7 ± 16.2 vs 43.4 ± 7.1;
= 0.03) but more nonmotor symptoms on daily living activities (MDS-UPDRS I: 12.6 ± 5.5 vs 10.7 ± 5.3;
< 0.001), had more psychobehavioral manifestations (Ardouin Scale of Behavior in Parkinson's Disease total: 7.7 ± 5.1 vs 5.1 ± 0.4;
= 0.003), and had worse quality of life (Parkinson's Disease Questionnaire-39: 33 ± 12 vs 29 ± 12;
= 0.03), as compared to pre-opRBD- patients. Both pre-opRBD+ and pre-opRBD- patients had significant MDS-UPDRS IV score decrease (-37% and -33%, respectively), MDS-UPDRS III "med 'off'/stim 'on'" score decrease (-52% and -54%), and dopaminergic treatment decrease (-52% and -49%) after surgery, with no between-group difference. There was no between-group difference for cognitive and global quality of life outcomes.
In patients with PD eligible for STN-DBS, the presence of probable RBD preoperatively is not associated with a different clinical outcome 1 year after neurosurgery.
NCT02360683.
This study provides Class II evidence that in patients with PD eligible for STN-DBS, the presence of probable RBD preoperatively is not associated with poorer outcomes 1 year post surgery.
Studies assessing personality dimensions by the "Temperament and Character Inventory" (TCI) have previously found an association between Parkinson's disease (PD) and lower Novelty Seeking and higher ...Harm Avoidance scores. Here, we aimed to describe personality dimensions of PD patients with motor fluctuations and compare them to a normative population and other PD populations.
All PD patients awaiting Deep Brain Stimulation (DBS) answered the TCI before neurosurgery. Their results were compared to those of historical cohorts (a French normative population, a de novo PD population, and a PD population with motor fluctuations).
Most personality dimensions of our 333 included PD patients with motor fluctuations who are candidates for DBS were different from those of the normative population and some were also different from those of the De Novo PD population, whereas they were similar to those of another population of PD patients with motor fluctuations.
During the course of PD, personality dimensions can change in parallel with the development of motor fluctuations, either due to the evolution of the disease and/or dopaminergic treatments.
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