Lower extremity dystonia (LED) is a frequent complication of Parkinson disease (PD). Treatment with botulinum neurotoxinA (BoNTA) over 8 years was retrospectively reviewed. Cases 14 patients with LED received an average of 3.86 injections (1–8). Mean interval was 40 weeks (median of 25). Average dose was 182 units. Injections were well-tolerated. Using a 6 point scale, there was an average of 3.37 point improvement in disability after each session, with average duration of 28.56 weeks (median 11 weeks). After mean follow-up of 101 weeks, disabling dystonia was not present in 11 of 14 patients. Botulinum toxin is safe and effective in PD related LED. Good response to the first two injection sessions was significantly associated with greater likelihood of long-term response. Assertive BoNTA dosing may lead to sustained remission of symptoms. As natural history of LED in PD has not been reported, prospective placebo-controlled studies are needed.
Atypical antipsychotics are increasingly being used to manage depression in older adults where these symptoms can often be refractory to first-line treatment with selective serotonin reuptake inhibitors (SSRIs) or serotonin norepinephrine reuptake inhibitors (SNRIs). Unfortunately, atypical antipsychotics can be associated with the development of extrapyramidal symptoms (EPS), with drug-induced parkinsonism (DIP) being the most common movement disorder induced by this class of medication. The management of treatment-resistant depression in older adults is of particular concern as depression is a common feature of idiopathic Parkinson's disease (IPD) and can manifest prior to the development of motor symptoms. Herein, we discuss the use of atypical antipsychotics for the management of depression in older adults including the risk of DIP and propose that antipsychotics may potentially unmask IPD.
Introduction: Lewy body dementia (LBD) is common, yet under-recognized and under-researched. To plan studies with the highest impact, engagement of the community personally affected by these conditions is essential. Methods: A web-based survey of people living with LBD and current and former caregivers of people with LBD queried research priorities through forced ranking and exploration of burden of LBD symptoms. Specific caregiving needs in LBD and perceptions of research participation were also investigated. Results: Between April 7, 2021 and July 1, 2021, 984 responses were recorded. Top research priorities included disease-modifying therapies and improved disease detection and staging. People with LBD were interested in pathophysiology and more bothered by motor symptoms; caregivers were interested in risk factors and symptomatic therapies and more bothered by neuropsychiatric symptoms. Few available LBD treatments and resources were rated as helpful, and many valuable services were never received. Previous participation in LBD research was infrequent, but interest was high. Discussion: People with LBD and caregivers highlighted the need for research across all aspects of LBD, from pathophysiology and disease modification to prognosis, education, symptomatic treatments, and caregiver support. Funders should increase support for all aspects of LBD research to target the many needs identified by individuals and families living with LBD.
To determine how often orthostatic hypotension (OH) occurred in the early stages of Parkinson's disease (Hoehn and Yahr stages 1 and 2) and to describe accompanying clinical features.
Objective To determine the effect of a Best Practice Advisory (BPA) on the ordering and administration of contraindicated dopamine blocking agents (DBA) to hospitalized patients with Parkinson’s disease (PD) and related disorders. Background Patients with PD are more likely to require hospitalization and are at increased risk of complications. Administration of contraindicated DBA contributes to worsened outcomes in this patient population. Electronic medical record (EMR) warnings (also referred to as BPA) have been proposed as a way to prevent the administration of contraindicated medications. Methods A BPA was launched in January 2020 within the University of Rochester EMR system, which alerts the provider when a contraindicated DBA is ordered in hospitalized patients with PD and related disorders. Patients with PD and related disorders hospitalized at two hospitals affiliated to the University of Rochester during a time period before ( t1 : 1/1/2019–1/1/2020) and after ( t2 : 1/8/2020–1/8/2021) the implementation of the BPA were included in this study. Epic SliderDicer was used to collect the data from the University of Rochester EMR. The number of patients who had contraindicated DBA orders and administrations in both time periods, and the number of patients who had the BPA triggered during t2 were obtained. We compared the results before and after the implementation of the BPA. Results 306 patients with PD and related disorders were hospitalized during t1 and 273 during t2 . There was significantly less percentage of patients who had contraindicated DBA orders (41.5% in t1 vs. 17.6% in t2 ) and patients who had contraindicated DBA administrations (16% in t1 vs. 8.8% in t2 ) during t2 ( p < 0.05 for both comparisons). There was no significant difference between the percentage of patients who had contraindicated DBA orders in t1 and patients with attempted orders (BPA triggered) in t2 ( p = 0.27). Conclusion The results of this study increase the evidence of the potential benefit of EMR warnings for the optimization of inpatient medication management in patients with PD and related disorders. In particular, our results suggest that EMR warnings help reduce the administration of contraindicated medications, which is a known contributing factor for hospital complications in this patient population.
Melissa J. Armstrong: Melissa J. Armstrong receives grant support from ARHQ (K08HS24159), NIA (P30AG047266), the Florida Department of Health (grant 20A08), and as PI of a Lewy Body Dementia Association Research Center of Excellence site. She receives compensation from the American Academy of Neurology for work as an evidence-based medicine methodology consultant. She is on the level of evidence editorial board for Neurology® and related publications (uncompensated) and receives publishing royalties for Parkinson's Disease: Improving Patient Care (Oxford University Press, 2014). Jennifer L. Sullivan: Dr. Sullivan reports no disclosures. Katherine Amodeo: Dr. Amodeo was supported by the Michael J Fox Edmund J. Safra Fellowship in Movement Disorders from July 2107–July 2019. Katherine Amodeo is an Investigator and/or medical monitor for clinical trials supported by Genentech Roche Ltd, EIP Pharma Inc, Michael J Fox foundation for PD research, NINDS, and Acadia Pharmaceuticals Inc, and Biogene. Angela Lunde: Angela Lunde reports no disclosures. Debby W. Tsuang: Debby W. Tsuang receives grant support from the NIA (P50 AG005136, R01 AG041797, U01 AG032984, R21 AG064271 & R56 AG059739), NINDS (R03 NS103950 & U01 NS100610), NIEHS (R01ES026187). Dr. Tsuang serves on the Scientific Advisory Council, LBD Association (uncompensated). Mark A. Reger: Mark A. Reger reports no disclosures. Yeates Conwell: Yeates Conwell receives grant support from NIMH (T32 MH20061, RF1MH117528), NIA (R01 AG054457, RF1AG063811, P30AG064103), and Zhejiang University. Aaron Ritter: Aaron Ritter receives grant support from the NIGMS (P20GM109025) and the NIA (R01AG052510, R01AG059008, R01AG063689). Aaron Ritter is an investigator for clinical trials supported by Biogen, Genetech, EIP Pharma Inc, Novartis, and Eisai. Jee Bang: Jee Bang reports no disclosures. Chiadi U. Onyike: Dr. Onyike has received support from NIA, NINDS, CIHR, Biogen, Nancy H. Hall Fund for Geriatric Psychiatry and Jane Tanger Black Fund for Young-onset Dementia Research. Zoltan Mari: Zoltan Mari receives research support from Abbvie, NIH, Michael J Fox Foundation, and Eli Lily. He serves as an associate editor for Parkinsonism and Related Disorders. He serves on scientific advisory boards for GB Sciences, Neunos, SensoryCloud, NeuroReserve, and nQ Medical. He has served as a consultant and/or speaker for Biogen, Neurocrine, Kyowa Kirin, US World Meds, Amneal, Abbvie, Global Kinetics Corporation, and Acadia. He holds shares in nQ Medical, NeuroReserve, SensoryCloud, and D&D Pharma. Pamela Corsentino: Pamela Corsentino is an employee of the Lewy Body Dementia Association. Angela Taylor: Angela Taylor is an employee of the Lewy Body Dementia Association. Data sharing not applicable to this article as no datasets were generated or analyzed during the current study.
