International Parkinson And Movement Disorders Society Congress
Danielle Kipnis, MA, of Columbia University, discussed the practice of yoga for people with functional neurological disorders from her research and recommendations for future studies in the field.
A study presented at the MDS Congress 2022 found an association between migraine and the incidence of Parkinson disease in the middle-aged and older population.
Results from a pooled analysis extend and support the safety and the tolerability of the use of incobotulinumtoxinA for the treatment of adults with neurological disorders.
One of the identified loci related to clinical progression in Parkinson disease expresses ADORA2A in the cerebellum, which encodes the adenosine A2A receptor, a promising target for therapeutics in PD.
The Parkinson disease agent showed a safe and tolerable profile, with significantly greater improvements in MDS-UPDRS-III scores and OFF time per day.
Challenges In Differentiating The Ipmds Psp
While the IPMDS-PSP criteria are quite useful in differentiating PSP from other disorders, as stated above, they may not be sufficiently specific to differentiate the two common phenotypes: PSP-RS from PSP-P. To explore this further, we evaluated the new IPMDS PSP-RS and PSP-P criteria in a large sample of PSP patients participating in the ENGENE study . This study consisted of 350 PSP patients of which 259 met the probable and 76 the possible
Mds Diagnostic Criteria For Msa
The MDS criteria for the diagnosis of MSA define four levels of diagnostic certainty: neuropathologically established MSA, clinically established MSA, clinically probable MSA, and possible prodromal MSA. Neuropathologically established MSA replaces the category of definite MSA of the second consensus criteria, but the anchors remain unchanged. The diagnostic level of clinically established MSA is defined to respond to the need for diagnostic certainty at the clinical and patient level ensuring maximum specificity with acceptable sensitivity . The category of clinically probable MSA is designed to balance sensitivity and specificity . These categories are derived from the two clinical diagnostic levels of the second consensus criteria. A distinction between MSA-parkinsonian type and MSA-cerebellar type depending on the predominant motor phenotype is kept. The MDS MSA criteria introduce a new research category of possible prodromal MSA with very low specificity that is expected to continue to be refined with emerging data, particularly from prospective and biomarker studies . All three clinical diagnostic categories need validation in future studies. Operationalized definitions of all features in the MDS MSA criteria are presented in the Lexicon .
|Division into clinically established MSA-P or MSA-C according to predominant motor syndrome|
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Exclusion Features For Clinically Established And Clinically Probable Msa Diagnosis
Some of the exclusion features such as persistent levodopa responsiveness,, hyposmia, cognitive impairment, and hallucinations may occasionally manifest in MSA, but are outlined as features excluding MSA diagnosis to secure the diagnostic specificity. Structural brain MRI should be performed in all patients to exclude findings suggestive of an alternative diagnosis. Alternative conditions known to produce autonomic failure, ataxia, or parkinsonism and plausibly connected to the patient symptoms need to be excluded for all MSA diagnostic categories. Genetic screening for the common spinocerebellar ataxia , FRDA, FXTAS, and CANVAS should be considered especially in patients with cerebellar features.
Parkinsons Disease And Post
This study reported a case series of 27 people with PD who contracted COVID-19 and followed them for long-term sequelae, defined as symptoms present for more than 12 weeks after COVID-19 infection. About 85% of people with PD and COVID-19 had long-term effects. About half reported worsening of motor function and increased levodopa daily requirements. Forty percent reported fatigue and about 20% reported cognitive disturbances and sleep disturbances. Severity of the original COVID infection did not correlate with the development of long-term symptoms.
Takeaway: Long-term symptoms after COVID are common among people with PD.
APDA resources: APDA has been closely monitoring COVID-19 information as it relates to people with PD since the start of the pandemic. You can read general information about COVID-19 and PD, a COVID-19 and PD Q+A, a discussion of a post-COVID world with PD, and a summary of the research that relates to COVID-19 and PD.
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Development Of The Preliminary Version Of The Mdsnms
The preliminary version of the MDSNMS was drafted and refined by PD clinical researchers with expertise in nonmotor symptoms and scale development in a series of inperson meetings, video conferences, and by email . It was composed of 63 items in 15 domains: Depression , Anxiety , Apathy , Psychosis , Impulse control and related disorders , Other neuropsychiatric symptoms , Cognition , Orthostasis , Urinary , Sexual , Gastrointestinal , Thermoregulatory , Sleep and wakefulness , Pain , and Others . Items were selected from the NMSS and other scales relating to NMS, review of the literature, and expert consensus. Items were phrased as questions on the presence of the symptoms and designed for administration by healthcare professionals .
Each item was scored twice based on five options, for frequency and severity . Specific explanations for each of these anchors were provided. Item score was calculated by multiplying frequency x severity, total domain scores were calculated by the sum of their respective item scores, and a total instrument score generated by summing the domain scores represented total NMS burden. The MDSNMS total score ranges, in theory, from zero to 1,008 however, reaching the maximum score is very unlikely, given the low possibility of simultaneously reaching the maximum frequency and severity scores on all instrument items. This is similar to findings using the NMSS.26
Seeing A Movement Disorder Specialist
A movement disorder specialist will work closely with your neurologist or current doctor to plan your care and follow-up. A movement disorder specialist also is likely to have relationships with other specialists and allied care professionals who have experience with PD, including physical, occupational and speech therapists. A team of professionals can help provide more holistic care and address your specific needs.
Even if youve been treated for Parkinsons for some time, you may want to consult a movement disorder specialist to:
- review your current medications and recommend adjustments if needed
- assemble a team of health care professionals who will work together to determine the most appropriate treatment for your changing condition
Hear what our community suggests for preparing for an MDS appointment.
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Neurofilament Light Chain In Csf And Plasma
Neurofilament light chain level in CSF > 1400âpg/mL detected by enzyme-linked immunosorbent assay yielded 97% sensitivity and 90% specificity to distinguish MSA from LBD. Moverover, CSF NfL correlates with plasma NfL concentrations., In patients who progressed from isolated autonomic failure to MSA, CSF NfL level was increased already at the stage of isolated autonomic failure, in contrast to the patients who did not phenoconvert.
Measuring Synaptic Density In Parkinson’s Disease With Sv2a Pet Imaging
Synaptic changes play a critical role in the pathogenesis and progression of PD. This study investigates the changes in synaptic density in individuals with PD by using positron emission tomography imaging with 11C-UCB-J, a recently developed PET radiotracer that binds to the synaptic vesicle glycoprotein, 2A.
- Diseases of the Digestive System – Liver, Diseases of the Nervous System, Diseases of the EyeWilson Disease RegistryPrincipal Investigator: Michael Schilsky
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Highlights From The Movement Disorders Society Virtual Congress 2020
Every year the International Parkinson and Movement Disorder Society holds a conference and every year APDA is there, learning about the newest research and sharing our resources with the wider PD community. The MDS Congress is the preeminent gathering of medical professionals from around the world who are dedicated to Parkinsons disease and other movement disorders. So much fascinating information is shared at the Congress that each year we report back to our readers about what we have learned. You can read our recaps from 2018 and 2019 to learn more.
This year the world has been turned upside down due to the COVID-19 pandemic, and an international conference that typically brings together thousands of people from dozens of countries around the world, was not possible. And much like many other in-person gatherings, this one went virtual. It was a great accomplishment to conduct such a massive meeting on a virtual platform, and it was very exciting to be a participant in that inaugural event.
The event consisted of scientific talks as well as abstracts, or brief reports of new research.
Remote Art Therapy Is Feasible And May Benefit Individuals With Parkinsons Disease
The first study investigated the safety and efficacy of an online dance class for people with PD. A group of 13 people with PD took an online 16-week dance class together, twice a week over two months. They were followed for adherence to the classes and whether any falls or safety issues occurred. They were also assessed before and after the 16-week session, using scales for anxiety, depression, balance, and functional mobility. The study concluded that online PD dance classes were safe, and adherence was very high. Functional mobility improved over the course of the study.
The second study investigated the feasibility of remote art therapy for people with PD. In the setting of the COVID-19 pandemic, a virtual extension of an art therapy clinical trial was developed. Thirteen participants attended ten weekly sessions led by art therapists. Baseline and follow-up psychosocial assessments were performed, along with data on adherence, retention, and safety. Adherence and safety data were excellent and a trend towards improved quality of life scores was noted despite the COVID-19 restrictions at the time.
Takeaway: Online dance and art therapy classes may be a way of engaging in creative activities in a safe and effective manner for people with PD in the absence of in-person classes.
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Getting To A Movement Disorder Specialist
If you live in a rural area or have difficulty traveling, it may be challenging to find or visit a movement disorder specialist. One option might be to travel to see a movement disorder specialist once or twice a year and follow up with a local general neurologist or primary care doctor more frequently. Any time spent with a specialist may be helpful.
Technology, too, may help. Some hospitals and services can connect you with a Parkinson’s specialist without you having to leave your home. Parkinson’s Disease Care New York, for example, offers people in the state of New York video calls through a computer, tablet or smartphone with a movement disorder specialist, a neurologist or a Parkinson’s-trained nurse at no cost. Ask your doctor or support group about telemedicine opportunities.
Be Part of the Answer
You have the power to impact your future and the future of millions living with Parkinson’s disease. Explore clinical research participation today.
Gut Microbiota And Nutritional Profiles Of Parkinsons Disease Patients
This study looked at the association between gut microbiome, clinical features of PD, and nutritional profiles of people with PD. Based on validated nutritional surveys, people with PD tended to consume higher amounts of carbohydrates and increased total sugars as compared to healthy controls. Microbiome profiles were also different between PD and control patients, with people with PD showing an over-representation of bacteria in the Lactobacillaceae and Enterobacteriaceae families and under-representation of bacteria in the Pasteurellaceae family, validating trends identified in prior studies. Whether the difference in dietary profile is a cause of the difference in microbiome profile cannot be determined from this study.
Takeaway: The PD microbiome may be used in the future as a biomarker for disease. Manipulating the microbiome, possibly with dietary changes, may be a method to manage PD.
APDA resources: Learn more about the intersection between the microbiome and PD on our blog. You can also explore the fascinating research APDA has sponsored into the microbiome and PD, such as studies on the oral microbiome in Parkinsons disease and microbial-brain interactions in Parkinsons disease neurodegeneration.
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Lack Of Diversity In Parkinsons Disease Genetic Research: Current Landscape And Future Directions
This first research paper presents the infrastructure of the Global Parkinsons Genetics Program or GP2, an international collaboration aimed at understanding the genetic and clinical characteristics of people with PD, by studying data from 150,000 people with PD from 80 locations worldwide. As this data is collected, it will be made available to researchers for analysis.
In the second paper, GP2 investigated the lack of diversity in current PD genetic research. A literature search identified all the current medical papers that examined genetic data in non-European populations. Of these papers, most focused on Chinese populations. Other groups including South and East Asian , North African, Middle Eastern, Latin American, and Black populations worldwide were under-represented. GP2 is set to change this equation by recruiting cohorts worldwide.
Takeaway: There is worldwide focus on understanding the genetics of Parkinsons and including genetic populations from around the globe in this effort.
APDA resources: APDA is committed to funding the genetics of diverse PD populations. You can read more about the research that we fund, including a study on Parkinsons disease in the Mexican population and in this interview with Dr. Karen Nuytemans.
Parkinsons Foundation Presents Six Studies At Mds International Congress 2022
MIAMI & NEW YORK The Parkinsons Foundation will present six scientific posters highlighting research, care and education at the 2022 International Congress of Parkinsons Disease and Movement Disorders® hosted by the International Parkinson and Movement Disorders Society. Taking place through Sept. 18, the event brings together thousands of movement disorder specialists including the top neurologists and Parkinsons disease researchers to share ideas that can evolve the field. Selected as a Poster Tour distinction, the Foundations PD GENEration genetic registry study will be featured several times, including an invited plenary presentation by Principal Investigator, Roy Alcalay, MD, MS.
The recognition of PD GENEration at an international forum speaks to the impact that this study has already made in the field and represents our commitment to delivering improvements to Parkinsons disease care and research, said Associate Vice President of Clinical Research Anna Naito, PhD, of the Parkinsons Foundation. We are confident that PD GENErations contributions to the global research community will bring us closer to scientific breakthroughs. Through PD GENEration, we have developed international collaborations with fieldwide experts, allowing us to accelerate the research and treatment field forward globally.
Parkinsons Foundation poster presentations will include:
Gene and Variant Curation of Parkinsons Disease Genes by an Authoritative Expert Panel
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Finding The Right Movement Disorder Specialist
Having the right partnership with your doctor can make a difference, not just in managing your Parkinsons symptoms but also in how supported you feel overall. Its important for you to feel confident in that relationship and to have access to a treatment team that meets your needs.
Finding a good movement disorder specialist is a lot like hunting for a good dentist or a good mechanic: You need to ask around. Your primary care doctor or neurologist may be a good place to start. Or ask people in your support group, if you attend one, whom they see. You can also try contacting one of the national Parkinson’s organizations.
In choosing a doctor, consider how much the doctor knows and how well the doctor listens. Remember, no two cases of Parkinson’s disease are alike. Having a doctor who understands this, and who listens to you, is crucial.
With any Parkinson’s doctor, you are a partner in your care. Educate yourself about PD. Parkinson’s is different for everyone, and you can’t get the best care unless you’re specific about what you are experiencing. It’s okay to ask why particular treatments or therapies are being recommended , and it’s okay to get another opinion.
The MDS Movement Disorders Specialist Finder can help you locate a doctor in your area.
Supportive Biomarkers For Msa Diagnosis
A list of research biomarkers for MSA diagnosis consists of supportive investigational tools that provide laboratory findings suggestive of MSA, but are not required for the MSA diagnosis . They are not formally included in the MDS MSA criteria due to their limited availability , suboptimal diagnostic accuracy, or lack of diagnostic validation . Evidence proving the value of supportive biomarkers in possible prodromal MSA is limited. However, if available, to provide more evidence for future studies, research biomarkers should be applied to all MSA diagnostic categories. The Task Force recognizes that the list of supportive biomarkers will likely grow when more data become available and that criteria refinement will be needed. Task Force will plan the systematic identification of emerging or consolidating diagnostic biomarkers to promptly advise the update of the MSA criteria. For example, laryngeal motion abnormalities were detected in 93% of patients with MSA compared to 1.8% of patients with PD using flexible fiberoptic video rhinolaryngoscopy evaluation of a swallowing task. The so-called horizon scanning methodology, a tool adopted globally to identify, assess, and prioritize innovations at an early stage of their development, is proposed to achieve this goal.
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Comparison Of Gastrointestinal Transit Times In Typical And Erratic Levodopa
In this study, people with PD who had a typical response to Levodopa were compared with those who had an erratic response . Results showed that:
- Erratic responders demonstrated an erratic pattern in serum levodopa levels over time as compared to typical responders.
- 50% of erratic responders showed the presence of small intestinal bacterial overgrowth , a rate much higher than seen in typical responders.
- Erratic and typical responders were investigated with SmartPill, a wireless, ingestible capsule that travels through the GI tract and can measure transit time through the gut. Both groups showed variability in transit time in different segments of the GI tract, with more variability in the erratic responders.
Takeaway: Variable gut transit times and SIBO may play a role in why some people have erratic and variable responses to Levodopa doses.
APDA resources: There are many APDA resources that can help you learn more about the gut, GI symptoms, and PD. Or, you can review our presentation on motor fluctuations and the influence of the GI tract on motor fluctuations.